Transcript of Interview with Dr. Randye Semple

Interview conducted by Dr. David Miklowitz 7-23-2012

Dr. Miklowitz (DM):
I’m Dr. David Miklowitz, the Director of the Child and Adolescent Mood Disorders Program at UCLA. We’ve been very fortunate to be funded by the Danny Alberts Foundation and the Attias Family Foundation for a study of mindfulness-based cognitive therapy (MBCT) for perinatal women with mood disorders. This is Dr. Randye Semple, who has been running the MBCT groups. I’m very impressed with the work you’ve done. Can you tell us how you see this work being applied to adolescents?

Dr. Semple (RS):
One of the big concerns with adolescents is impulsive behaviors. In mindfulness practice we bring our minds into the present moment, so that we can see what choices might be available in the present moment. By taking a moment to stop and check in to see what’s actually going on, we can teach adolescents to make better behavioral choices. If adolescents can learn to take the time to consider what their choices are, they may learn to make better decisions and not act so impulsively.

DM: As you know I’m very excited about this project. I do have a concern that these adolescents are coming in and playing with their cellphones and can’t wait to get back to their World of WarCraft games or whatever else. Are they going to be able to sit for an hour and meditate?

RS: Probably not. When I work with children we do mindfulness practices three to five minutes at a time, but we do them over and over again creating lots of repetition. The adults work with up to 45 to 60-minute practices. I think that the adolescents will fall somewhere in the middle. We’ll start with shorter practices and gradually build up to perhaps 20 or 30 minutes.

DM: What about kids who are suicidal? How might MBCT help?

RS:One of the main lessons of the MBCT program is that thoughts are just thoughts. They’re not facts and they’re not reality. By tuning into their own thoughts they see that essentially they are just in the mind and not in reality. Their thoughts are mental events, not facts. This allows the individual to take the opportunity to actually make the conscious choice of whether or not to put their whole body into the story line.
Often times the suicidal thoughts are going to be very much in a story line that can be separate from what the actual reality is. By being able to step out of that story line
and see that the [suicidal] thoughts are just thoughts we can reduce their emotional impact.

DM: As you know, one of the things we try to do in the CHAMP clinic is to involve families whenever we can in psychoeducation and skills training. Is there a way to involve the family in MBCT or some version of MBCT?

RS: Particularly in working with children and adolescents, involving families is not just an option, it’s essential. I think keeping adults and adolescents separate for groups might be more effective, but certainly for parents having their own experience with mindfulness and having the opportunity to practice with their own children at home can increase the resiliency of the program, no mistake.

DM: As you know adolescents with bipolar disorder come in all sizes and shapes. You have a 13-year-old who is withdrawn and irritable and doesn’t want to socialize; you have a 17-year-old that’s hypersexual, or a 15-year-old who is doing drugs. They have some elements in common, like swinging from highs to lows, but what is your thinking about how we would construct the groups? Would you put all those kids in the same group, or would you figure out groups that are age-related or symptom-related?

RS: We primarily work in mindfulness groups with whatever is relevant and present in the participants’ own lives. What is relevant and present in the life of a 13-year-old will be something quite different than what is relevant and present for an 18-year-old. So we would want to put 13 and 14 year-olds in one group, or maybe 13-14-15 and 16-17-18 in separate groups. Having an age commonality even if their current emotional states aren't the same will provide some cohesiveness within the group.

DM: You mentioned medications. My inclination would be to keep a kid on medications while they’re in this program. Would your inclination be any different?

RS: No, I totally agree. MBCT for adolescents is still at the early research stages. We have quite a bit of research support for mindfulness for treating depression in adults being as effective as antidepressant medications. Our work with children and adolescents is just beginning. Keeping kids and adolescents on their medications can be a challenge on its own, and possibly the MBCT program for adolescents could actually increase the compliance rates for medication and help them make healthier choices.

DM: Thank you.