Mindfulness-Based Cognitive Therapy for Bipolar Disorder

354 Pages·2014·7.116 MB·English

by  Thilo Deckersbach PhD, Britta Hölzel PhD, Lori Eisner PhD, PhD Sara W. Lazar, Andrew A. Nierenberg MD

ebook
THE GUILFORD PRESS
Mindfulness-Based Cognitive therapy
for Bipolar disorder

Mindfulness-Based
Cognitive Therapy
for Bipolar Disorder
Thilo Deckersbach
Britta Hölzel
Lori Eisner
Sara W. Lazar
Andrew A. Nierenberg
THE GUILFORD PRESS
New York London
© 2014 The Guilford Press
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These materials are intended for use only by qualified mental health professionals.

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ISBN 978-1-4625-1406-9

Illustrations by Steve A. McKinley, based on the work of Alexandra Rodman.
About the Authors
Thilo Deckersbach, PhD, is Associate Professor of Psychology at Har-
vard Medical School. He serves as Director of Psychology in the Bipolar
Clinic and Research Program and as Director of Research in the Division
of Neurotherapeutics at the Massachusetts General Hospital in Boston.
Dr. Deckersbach’s research has been supported by the National Institute
of Mental Health, NARSAD, the Tourette Syndrome Association, the
International OCD Foundation, and the Depressive and Bipolar Alterna-
tive Treatment Foundation. He has published over 95 peer- reviewed papers
and book chapters. His clinical research concentrates on the development
of cognitive- behavioral and mindfulness- based treatments for bipolar dis-
order; his functional neuroimaging research focuses on the interaction of
cognitive and emotional processes in bipolar disorder. Dr. Deckersbach has
been a dedicated meditation practitioner since 2008.
Britta Hölzel, PhD, is Research Fellow at the Institute for Medical Psy-
chology at Charité in Berlin, Germany. She was previously Research Fel-
low in the Psychiatric Neuroscience Division at the Massachusetts General
Hospital and Harvard Medical School. Dr. Hölzel is a mindfulness- based
stress reduction instructor and a certified yoga teacher (Sivananda Organi-
zation), and has been a dedicated yoga and meditation practitioner since
1997. Dr. Hölzel’s work has been supported by a Marie Curie International
Outgoing Fellowship within the 7th European Community Framework
Program, a Positive Neuroscience Award from the John Templeton Founda-
tion, Varela grants from the Mind and Life Institute, and the Kusala Foun-
dation. Her magnetic resonance imaging research focuses on the effects of
mindfulness practice on the functional neuroanatomy of emotion regula-
tion as well as on structural changes in the brain.
v
vi About the Authors
Lori Eisner, PhD, is Assistant in Psychology at the Massachusetts General
Hospital’s Bipolar Clinic and Research Program and Instructor at Har-
vard Medical School. Her work has been funded by the Harvard Medical
School Kaplan Fellowship and the Clinical Research and Training Pro-
gram. Her research has focused on the development and implementation of
treatments to improve emotion regulation in people with bipolar disorder.
She has examined the feasibility of a group treatment for emotion regula-
tion that teaches mindfulness, emotion regulation, and distress tolerance
skills adapted from dialectical behavior therapy. Dr. Eisner has coauthored
four book chapters and has published in numerous peer- reviewed journals,
including Behavior Therapy, Clinical Psychology: Science and Practice,
Journal of Psychiatric Practice, and the Journal of Abnormal Psychology.
She has been an avid yoga practitioner since 2003.
Sara W. Lazar, PhD, is Associate Researcher in the Psychiatry Department
at the Massachusetts General Hospital and Assistant Professor in Psychol-
ogy at Harvard Medical School. She is a board member of the Institute for
Meditation and Psychotherapy and a contributing author to the book Mind-
fulness and Psychotherapy. The focus of Dr. Lazar’s research is the eluci-
dation of the neural mechanisms underlying the beneficial effects of yoga
and meditation, both in clinical settings and in healthy individuals. Her
research has been covered by numerous news outlets, including The New
York Times, USA Today, Time, CNN, National Public Radio, WebMD,
and The Huffington Post. She has been practicing yoga and mindfulness
meditation since 1994.
Andrew A. Nierenberg, MD, is Professor of Psychiatry at Harvard Medical
School. He serves as Director of the Bipolar Clinic and Research Program
and as Associate Director of the Depression Clinical and Research Pro-
gram at the Massachusetts General Hospital. He has been listed among
the Best Doctors in North America for the treatment of mood and anxi-
ety disorders since 1994, has received the National Depression and Manic
Depressive Association Gerald L. Klerman Young Investigator Award, and
was elected as a member of the American College of Neuropsychophar-
macology. Dr. Nierenberg’s research focuses on comparative effectiveness
of existing treatments and the development of new treatments for mood
disorders. He has published over 350 papers and 30 chapters and reviews
and is a member of the editorial boards of over 15 journals.
Preface
This book describes the development and implementation of mindfulness-
based cognitive therapy (MBCT) for individuals with bipolar disorder. It
consists of 12 120-minute group treatment sessions conducted weekly over
3 months with concurrent individual therapy sessions, held every other
week. It is grounded in MBCT for depression, developed by Zindel Segal
and colleagues, as well as established cognitive- behavioral approaches for
bipolar disorder and dialectical behavior therapy. The idea for this treat-
ment originated at a time when the initial excitement about psychosocial
treatments for bipolar disorder had begun to wane. Cognitive- behavioral
therapy, for example, initially seemed to help prevent relapse in individuals
with bipolar disorder above and beyond other types of therapy, but as it
now stands, its utility in this regard is somewhat limited. Likewise, intensive
psychotherapy for acute depression appears to add value only for patients
who are in the earlier stages of bipolar disorder but not for those who are
chronic. Therefore, we felt that additional therapeutic avenues for individu-
als with bipolar disorder were needed. MBCT for recurrent depression had
moved beyond the stage of initial research, and its efficacy had become
more established. Therefore, we thought MBCT might be a valuable option
for patients with bipolar disorder, in particular for those with a multitude
of mood episodes, co- occurring psychiatric problems, and cognitive dif-
ficulties. Because individuals with bipolar disorder face unique challenges,
we modified MBCT for depression and supplemented it with treatment ele-
ments we felt would be beneficial for individuals with bipolar disorder.
Specifically, we shortened the duration of meditations and yoga/movement
exercises, added mood monitoring and mindfulness for preventing mania
vii
viii Preface
relapse, and included exercises in transferring mindfulness into daily life.
The absence of depression (or depression symptoms) does not automatically
translate into the presence of well-being for individuals with bipolar dis-
order. Therefore, we included self- compassion and loving- kindness in this
treatment. Similar to dialectical behavior therapy, our treatment combines
group sessions with individual therapy sessions. This serves to personal-
ize MBCT treatment, helps patients who miss group sessions to stay up to
speed, and provides additional support in crisis situations. The result of
our efforts is the MBCT treatment for individuals with bipolar disorder
described in Part II of this book.
For this manual, we have created audio recordings of the mindfulness
practice exercises in the book, which can be streamed directly from the
web or downloaded in MP3 format. Most participants find it helpful to use
these audio recordings in their home practice. The audio tracks are avail-
able in two different locations: (1) on the instructor website, together with
the reproducible handouts (www.guilford.com/deckersbach-groupleaders),
and (2) on a website developed specifically for course participants (www.
guilford.com/deckersbach-audio). You can direct your course participants
to www.guilford.com/deckersbach-audio to access the recordings on their
own. Alternately, you may wish to download the audio tracks yourself and
burn them onto CDs or copy them to USB flash drives to distribute to par-
ticipants at the first session.
Numerous individuals besides the authors have contributed to this
book. We acknowledge their contributions with deep gratitude. We would
like to thank Zindel Segal for his encouragement and ongoing thought-
ful advice about our efforts to modify MBCT for individuals with bipolar
disorder. Guidance on how to implement mindfulness for individuals with
bipolar disorder also came from instructors at the Center for Mindfulness
in Medicine, Health Care, and Society at the University of Massachusetts
Medical School, as well as from other meditation teachers, among them
Zayda Vallejo, Carole Legro, and Ruth Nelson. In this book you will meet
patients who participated in the MBCT program at the Bipolar Clinic and
Research Program at the Massachusetts General Hospital. We would like
to thank them for letting us learn about their experiences, hopes, successes,
and struggles as we joined them on their journey through this program,
bringing mindfulness to their often chaotic inner lives. We have learned as
much from them as we hope they learned from working with us. The people
described in this book are real patients, but in order to protect their privacy
we changed their identities, stories, and experiences so that they cannot be
recognized.
Every book goes through multiple stages of writing and editing. Spe-
cial thanks to Barbara Watkins and Jim Nageotte of The Guilford Press