Currently Funded Research

Mindfulness Treatment As A Prevention Strategy For Youth With Bipolar Disorder

Between 50%–66% of adults with bipolar disorder report onset of their illness prior to age 18, and as many as 33% before age 13. Early forms of the disorder can be detected as much as 10 years prior to the time when BD is first diagnosed. It often presents in childhood or early adolescence as significant moodiness, suicidal thinking, irritable outbursts and aggression, with sudden periods of academic deterioration. There is substantial agreement in our field that early-onset forms of BD have a significant impact on quality of life among teens. BD is one of the leading causes of suicide in teens, and it puts youth at risk for school dropout, alcohol and drug abuse, early pregnancy, and excessive medical and mental health care costs.

Without early intervention, the social, intellectual, and emotional development of kids with BD will be seriously compromised. Delaying treatment in childhood is associated with more depressive symptoms, higher suicide rates, more substance abuse, and poorer functioning in adulthood. On the hopeful side, well-timed interventions in a developing population may allow for the normative acquisition of skills such as personal autonomy, academics, and peer relationships before the more debilitating syndrome begins. Unfortunately, bipolar youth are currently treated with a wide variety of medications and therapies, with little evidence-based practice.

Psychosocial interventions during adolescence that improve emotional health and stability could have a dramatically favorable impact on individual suffering for the teen and caregiving burden on family members.

We propose a two-year study on the development of mindfulness therapy for patients in the earliest stages of bipolar disorder. We would like to modify the MBCT treatment to make it acceptable and helpful to adolescent patients (age 13 to 19) who have often experienced only 1-2 prior episodes of mania or depression, or may not have even had a full manic episode yet but are struggling with significant periods of depression and mood instability.

The plan is to offer the 8-week MBCT groups (with language and skill training activities adjusted for teens) to 30 bipolar youth (5 groups of 6 patients each) and examine their symptom trajectory over a 12-month period. We will construct the study such that groups are staggered every 3 months, so that we can compare 6 patients in each group to 6 patients who are on a randomly assigned waitlist for 6 months (also called a “wait-list controlled design”). This study design allows all study participants to eventually participate in the groups, but the timing of their participation is either immediate or delayed by six months.

We will examine the effects of these groups on mood symptoms (depression and mania) and family, social, and academic functioning (family relationships, grades, peer functioning) over 12 study months. We expect that the youth who receive immediate treatment with MBCT groups will have better symptom and functioning trajectories over 6 months than those whose MBCT treatment is delayed . We also expect that youth will do better during and following the MBCT groups than they did during their 6-month waiting period before the groups.

Mindfulness-Based Cognitive Therapy for Adolescents

The treatment adaptation will be called MBCT for Adolescents (MBCT-A) and will be a synthesis of developmentally-appropriate components adapted from MBCT and MBCT for Children (MBCT-C; Semple & Lee, 2011). MBCT-A will retain the theoretical foundation and primary aims of the adult and child programs, but will be presented in a format that is suitable and acceptable to teens in the 13-19 age bracket. Some components will be:

  • 8 sessions lasting 90 minutes each.
  • An individual assessment and orientation session (one hour) for each participant and his or her parent(s).
  • A two-hour group orientation session for parents that includes guided experiences with several mindfulness practices.
  • Less emphasis on written home practices than in MBCT for adults.
  • Greater emphasis on proactively integrating mindfulness into “real-time” everyday situations.
  • Greater focus on skills training activities to manage strong emotions that may precede unskillful reactive or impulsive behaviors.
  • More in-session opportunities to practice mindful awareness in peer interactions.
  • Language, teaching stories, and examples that are developmentally and personally relevant to adolescents.

Adolescents with BD will be recruited from two sources:

  1. New or existing patients in the Child and Adolescent Mood Disorders Clinic at UCLA, which Dr. Miklowitz directs. The CHAMP clinic evaluates 2 to 3 patients per week, about 30% of whom meet criteria for bipolar disorder. Thus, we should have ample referrals to recruit 30 patients over 2 years;
  2. We will advertise the study and the clinic resources through the new Danny Alberts Foundation website (currently under construction), and will supplement the study advertising with videotaped examples of mindfulness sessions.

MBCT Session by Session Overview

The focus of sessions 1 through 4 is essentially learning to bring greater awareness to the present moment, on purpose and nonjudgmentally. By returning attention to thoughts, feelings and body sensations, participants become aware of how little attention is usually given to daily life. They learn to become aware of how quickly the mind shifts from one topic to another, often wandering into unhelpful past- or future-oriented ruminations.

Second, having noticed that the mind is wandering, they learn to bring their attention back to a single focus. This is taught with simple practices that repeatedly return awareness to the breath, body sensations, or body movements. Participants are taught to identify and differentiate thoughts from emotions. Third, the participant learns how to become aware of how the mind-wandering can exacerbate negative thoughts and feelings. He or she can then use this enhanced awareness to be vigilant for mood shifts, and respond by handling them (at the time) or dealing with them later.

Appropriate responding is the focus of sessions 5 through 8. Whenever a negative thought or feeling arises, the MBCT training emphasizes simply allowing it to be there, before taking steps to respond skillfully by using specific strategies. Participants learn to become fully aware of the thought or feeling, and then, having acknowledged it, shift attention to their breathing for a minute, and then expand attention to the body as a whole. Taking this “breathing space” may alone be sufficient to handle a difficult mood state by reducing the intensity or duration of the unpleasant thought or feeling. In any event, creating this breathing space is seen as the essential first step in dealing more skillfully with potential mood relapse. The participant may choose to deal with the thought or feeling directly (then, or later), by experiencing it as simply a thought or feeling, or they may choose to note how the thought affects the body. Alternatively, they may choose to deal with difficulty by choosing a proactive behavior that can increase pleasure, de-escalate a challenging situation, or initiate actions that bolster their sense of self-efficacy. These skills are taught in the second half of the program.