The latest Everyday Mindfulness blog is a long but fascinating insight into the use of mindfulness as a tool for living with bipolar disorder. Take time to read it and see the valuable tools that mindfulness gives us to help with any of the tough things that life throws at us. I use mindfulness as a tool for living with the stresses and anxieties that MS throws at me, but mindfulness can be effective in dealing with anything; I am certain of this. I am particularly struck by the way that Charlotte uses mindfulness to know her own mind. I do the same. I can see when my mind is wanting to wander down those dark alleys that MS wants to take you down. At these times I need to practice and bring myself more to the present, where everything is generally OK.
Mindfulness for Bipolar by Charlotte
This article is presented in a shorted form which assumes the reader is familiar with mindfulness and the basics of meditation. For the full version of the post, click here.
I have been a fan of mindfulness ever since I undertook an 8-week Mindfulness-Based Cognitive Therapy (MBCT) course around five years ago. What I learned there felt like a genuine game-changer, so I have been practising mindfulness on and off ever since. MBCT has a good record of preventing relapse in people with recurrent depressive disorder, and that’s why I first signed up for the course. In the last year, however, I’ve really come to appreciate the additional value of mindfulness for self-management of bipolar.
In general, it’s not always necessary to do a formal “sitting practice” to be mindful. Anything that helps you wake up and pay attention to how to are in the world can be mindfulness practice – you can mindful moving, walking, eating, crafting. My strong feeling, however, is that for bipolars, sitting down and being still and quiet, even if only for five minutes a day, is very valuable. One of the key self-management skills for bipolar is learning to recognise changes in mood state. Unless we can notice when we are becoming low or high, it’s very difficult to implement any steps to try to keep us on a more even keel. Most psychiatrists and psychologists are therefore keen on their patients using bipolar mood scales. Some people find rating their depressive or (hypo)manic symptoms against a numeric scale helpful. I’ve tried quite a few, paper-based, online and as smartphone apps, but I struggle with using other people’s tools. While of course there is a common set of symptoms among people with a diagnosis of bipolar, not everyone will experience all of them. My bipolar is not the same as your bipolar. In any given tool, I tend to find questions which just don’t feel relevant to me, while other thoughts/feelings/behaviours that I know to be risky or significant just don’t get a look in. Also, quick daily or weekly “snapshots” of feelings don’t always give me the time to answer the question properly – there is too much temptation to say I’m “fine”, rather than giving the question proper consideration.
But when I sit on the floor, in silence, eyes closed, I am immediately confronted with what I am really thinking and how my body is really feeling. In simply being still and quiet, perhaps trying to turn my attention to the breath going in, coming out, I create a blank space in which I can watch my thoughts and feelings as they dance. And because I am simply watching them and not living them, I can notice, really notice, and pay attention to them. And once I’ve become fully aware of what I am thinking and what I am feeling, I can begin to categorise those internal cues to see where my mood might be heading. I’ll give you some examples:
Thoughts and emotions
Grandiosity: “I know they say there’s no right or wrong way to meditate, but I am simply better at it than the rest of this class.”
Task-driven: “What am I doing sitting here? I need to get up and get on with my
Impatience: “This ten minutes’ sitting practice is taking forever!”
Ideas of reference: “That bird I can hear is singing a special message, telling me that everything is OK.”
Pressure of thought: “Oh and I could blog about this! And this, and this! I must write all of these down.”
Paranoia: “I can’t sit here with my eyes closed makes me vulnerable to attack from malign forces.”
Projecting forward: “I want to get on with cooking the dinner.”
Increased difficulty in sitting still
Urge to tap/bounce/wriggle
Sense of physical impatience – body starting to get up before I’ve even thought about moving
Internal “itchiness” and agitation
Thoughts and emotions
Pessimism and hopelessness: “I don’t even know why I’m bothering to meditate, nothing can help me anyway.”
Increased self-blame: “If I’d meditated more when I was well, then I wouldn’t have relapsed.”
Thoughts of death/suicide: “Sitting with my eyes close feels like I’m not really here. I wish it was like this forever.”
Thoughts of being alone/abandoned: “No-one cares about me, I’m all alone in the world.”
Thoughts of being a burden: “It’s too much for my family to look after me, they’d be better off without me.”
Feeling physically heavy
Finding it hard to maintain an upright posture on floor or chair
A sense of being crushed from within
Feeling that I am too tired to meditate
If I am already in a full on depressed or manic state, I will already know it, and will probably already have sought help. But mindfulness helps me see which way the wind is blowing when I am in those early stages of mood change – and that’s the point at which it’s not too late, when I can intervene myself and successfully utilise self-help techniques. In the quiet of a sitting practice I can notice, and perhaps admit for the first time, that there is a pattern of hopelessness to my thoughts that I’d been trying to ignore. Or I might have been telling myself that I am only slightly hypomanic, only to find that when I sit quietly, my mind is working far faster than I had realised.
It’s important to remember that being mindful is not going to make you feel or think anything. It’s simply that stopping and tuning in allows you to take note of feelings and thoughts that were already there, but you perhaps hadn’t noticed. I’ve already said that anyone can experience painful thoughts or sensations in sitting practice. But for those of us with serious mental health problems, being still and silent can sometimes lead to us noticing things that are very painful, or perhaps frightening (for example, at one time I had hallucinations of horrific self-harm when sitting with my eyes shut). If I’m feeling overwhelmed, I just stop the practice. Sometimes I’ll take a break from sitting practice all together, and do some mindful walking or yoga instead for the next few days or weeks. Really paying attention to scary sensations and ideas is hard work. If it feels safe enough, however, I’ll stay put and see what I can notice about them. What relationship is there between the strong emotions and how my body feels? Can I get some distance by mentally labelling my thoughts, rather than living them (for example, “Uh-huh, I notice I’m experiencing suicidal thoughts right now” rather than, “Oh my God, I’m suicidal again, and I can’t stand it”)? As the MBCT courses teaches, “thoughts are not facts.” It’s often helpful to get a sense of distance between my thoughts, and me, to remind myself that my thoughts aren’t reality – they are just something my mind is doing at the moment.
Mindfulness isn’t magic. It’s not a tool to make you feel better. It’s won’t fix you. But it might empower you by giving a better, more accurate, idea of your internal mood landscape. What, if anything, you choose to with that knowledge is entirely up to you. I have completed a Wellness and Recovery Action Plan (WRAP), with a list of self-help measures to use when I know I am becoming low or high. I also use mindfulness to help me decide whether to implement the strategies in my plan. I know perfectly well that there I things I can do which are bad for my mental health (staying up all night, drinking caffeine, listening to the same songs over and over again, rushing from activity to activity). There are also things I can do which I know promote mental health (going for a walk, meditating, yoga, slowing things down, etc). Sometimes I still do things that are unhelpful, but at least if I am mindful of my choices, I know what I am choosing to do, rather than acting without thinking. And being conscious and aware allows me to look out for any ill-effects, or maybe do an extra thing from the good list to balance things out.
Each day I have a range of choices that I can choose to “spend” as I wish. I might still choose to squander some tokens on less helpful activities. But at least I am thinking about the choice, and giving myself the opportunity to consider whether it’s what I want to do. Do I really want that can of Coke? Well, yeah, I do. I know it’s bad for me, but I enjoy it enough to be worth it. And because I’ve given the matter thought, I’ll make sure that if I’m going to do it, I’ll do it earlier in the day, so it doesn’t affect my sleep pattern.
So there you have it – my personal observations on mindfulness and its value for bipolar. I’m sure there are many things I’ve left out or haven’t explained properly, so here are a few useful resources.
http://www.mbct.co.uk An introduction to MBCT by its developers (with scope for downloading the guided meditations that form part of the 8 weeks course or purchasing them as a CD)
http://www.mindfulness-meditation-now.com/ 8 week MBCT courses in London
http://www.youtube.com/watch?v=-8sCX2emO8c Short video by Prof Mark Williams on mindfulness meditation for relapse prevention in people with depression