Dramatic shifts in mood and energy can create havoc in the lives of those with bipolar disorder. It can be tough to hold down a job, manage everyday responsibilities, manage symptoms and maintain relationships, even if you’re taking medications or involved in therapy.
That’s what prompted William Marchand, MD, to explore the value of mindfulness for those with bipolar disorder. In his book, Mindfulness for Bipolar Disorder, he explains that mindfulness is about developing the ability to maintain awareness of the present moment, seeing thoughts as they come and go. “Emotions are like disobedient children; they tend to do the opposite of what you want. If you try to push symptoms of depression away, they will almost always push back. But if you let them be, they will diminish.”
He says, in combination with medications and/or therapy – depending on what an individual needs – mindfulness can have a significant impact on improving quality of life.
Marchand is a psychiatrist and clinical associate professor of psychiatry at the University of Utah, in Salt Lake City. Here are some of his thoughts, from a recent interview:
Why might people with bipolar disorder be interested in learning mindfulness?
Bipolar disorder is very, very difficult to treat, so most people with the disorder who receive conventional psychotherapy and medication don’t receive full remission. Mindfulness is one more tool in the tool box, to be used in combination with their other treatments. It doesn’t replace their conventional treatment, but it can reduce the suffering.
Can mindfulness reduce or eliminate the need for medication, or should it be used concurrently with drug therapy?
For those with bipolar disorder, medication should be taken as well. For those with major depression, there have been studies that show mindfulness may be helpful in preventing relapses. Mindfulness helps people appreciate their lives more fully, feel joy more fully, and take care of themselves more fully.
You say mindfulness reduces the “vicious cycles” or “autopilot thinking cycles” of bipolar disorder. What does that mean?
It’s important to recognize the autopilot thinking cycles we all have. Autopilot thinking is when thoughts, emotions and behaviors occur automatically without our making a conscious choice to think, feel, or act a certain way. It is the opposite of mindfulness. These are thinking ruts we automatically fall into. Without practicing mindfulness, we just get carried away in those thinking patterns. We also need to recognize that a lot of our thoughts are irrational and many of our thinking patterns don’t actually lead to solutions. Once we start taking our brain a little less seriously, we can step back from it a bit.
At what age do these thoughts start?
Probably around the time we start having conscious awareness of our thoughts. In childhood, our brain is remodeling and a lot of our irrational thinking ruts begin at that time. Our minds just always run. I certainly have repetitive thinking patterns.
You explain that autopilot thinking patterns and symptoms of depression almost always end up in a vicious cycle, with each making the other worse. What is it about bipolar disorder that makes this more of an issue?
I think for all of us, whether we have any psychological illness or not, our automatic thinking patterns usually make things worse. I hit my thumb with a hammer and I tell myself I’m an idiot. With bipolar disorders, these thoughts are part of what makes a depression persist. Most of the time, those thinking patterns are repeated. It’s not bipolar disorder that makes the thinking patterns worse; it’s the other way around.
How does mindfulness help us manage impulsiveness and other feelings?
We all experience desire and some degree of impulsiveness. We see a box of candy and want to take a piece, or two, or three. We tend to automatically respond to that desire without thinking about it very much. With mindfulness, we’re less likely to act impulsively. We also learn we don’t have to do anything about the feeling, whether it is anxiety, sadness or frustration. We can just let the feeling pass.
What other psychological challenges might mindfulness be useful for?
These mindfulness interventions originated with stress reduction for people with chronic illness. Mindfulness is good for everyone. When I teach mindfulness for those with bipolar and other disorders, I teach it just as I would for anyone who doesn’t have a disorder.
You talk about thinking ruts. What are they?
The most common kinds of thinking ruts involve how we see ourselves, and those typically involve all the things by which we judge ourselves: how we look, how intelligent we are, how successful we are, or just about anything in our lives that tends to be judgmental or critical of ourselves or others. A very common example is that if I make a mistake at work, then I start doubting my own competence, thinking I’m never going to be successful. The brain is never satisfied, no matter how well we’re doing, it feels like it’s not enough. Our brain is a judgmental brain; it’s a lot of the reason humans have become so successful. We’re driven to do things differently or better. Our tendency is not to feel satisfied.
Mindfulness is also effective with obsessive compulsive disorder (OCD), whether a person has obsessional thoughts or is driven toward compulsive behaviors. It helps a person get some distance from those tendencies, so they can recognize that the thought or drive to do something will pass away.
Is learning mindfulness difficult?
Yes. It really takes practice and commitment. Because of that, it’s easy for people to get discouraged. Reading my book or taking an in-person class is helpful. You can’t just will yourself to meditate. You have to keep pulling yourself back [from your thoughts]. Don’t get discouraged; everybody struggles with it. The challenge varies with what’s going on in your life, your mood, fatigue, or there may be no identifiable reason at all.
Why is learning to be present with our emotions so challenging for everyone, with or without a mental health issue?
It’s the natural tendency of our mind to avoid pain. It’s a built-in evolutionary mechanism, like what happens when we touch our finger to a hot stove. If we feel emotional pain, our auto-pilot brain tries to get rid of it, and that doesn’t work, which perpetuates the pain. We’re not allowing ourselves to experience the pain in order to heal. If we allow the pain to be present, it will pass on.
Do the drugs given to those with bi-polar disorder interfere with the process of being present with pain and feelings?
They may interfere with being present, but I don’t see that a lot. Most people still experience symptoms. The problem usually isn’t that people aren’t having any symptoms. It’s been a longstanding debate whether treating the symptoms prevents people from doing the psychological work they need to do. As a profession, we probably over treat with medication and under treat with meditation.
Is mindfulness a passive state?
It isn’t passive at all. Mindful awareness helps us see much more clearly what the best action is and move out of our own limited perspective.