Mindfulness for bipolar disorder: simpler than you think

I’ve been meaning to write this article for a long time. This is partly because I’ve been wanting to get round to sharing my experiences of mindfulness as a tool for bipolar self-management. It’s also because I quite regularly see people with mental health conditions tweeting about “mindfulness” techniques they have been taught, and what they describe bears no resemblance to mindfulness as I understand it or to how it is presented by key writers on the subject. I’d like to encourage people who have been put off mindfulness to think again, because I believe that it is much simpler, whilst being much more beneficial, than many people with mental health conditions have been led to believe.

I’ll start by saying that I’m not a meditation teacher. I probably won’t ever be, because my condition makes it hard for me to put in the number of meditation retreats that most teacher training courses require. But 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.

What is mindfulness?

Mindfulness techniques are drawn from Buddhist insight meditation, but are usually taught in completely secular way so that they can be learned and practised by people of any faith or none. At the heart of mindfulness is one very simple idea: that of waking up and paying attention. Stepping out of our normal internal dialogue and just noticing whatever is going on, whether inside ourselves, or all around us.

It’s easy to get so caught up in our own thoughts and worries that we don’t give much attention to anything else. For example, I often used to find that I had walked to work with very little memory of completing the half hour journey. Locked into anxieties about the day ahead, I’d missed noticing the patterns of the clouds in the sky, the flowers in people’s gardens, the smell of cut grass, the way my body felt just to be walking outside. By the time I arrived at the office I couldn’t even tell you what I’d been thinking, because I had just been running through the same old thought patterns without even noticing what I was doing.

Mindfulness techniques help us to become more switched on to what we are actually thinking/feeling/experiencing by really tuning in or “listening” to:

–       the content of our thoughts

–       what we are really feeling

–       things that are happening around us (sounds, temperature, smells)

–       how our body feels, and how our thoughts and feelings influence that.

And that’s really all we are doing. Noticing. And that’s something quite radical in our task-oriented society. There is no goal. We have no aims. We’re not setting out to be or feel a certain way. Whatever we notice, that’s it. That’s how you practice mindfulness. This means you can’t be a “bad meditator” or do somehow do mindfulness “wrong”. There is no scope for self-blame.

We might find that we notice something uncomfortable or even painful going on inside our bodies or minds. Maybe we observe that we’re having the same scary thoughts about money over and over, or that sitting still makes our shoulders hurt. When we feel pain or discomfort, we’re conditioned to try and get rid of it as soon as possible – to wriggle our shoulders to take the pain away, or think about something soothing the moment we feel scared. But in mindfulness, we’re in the business of just listening, just observing, and accepting what we find. So there’s no need to immediately act to get rid of discomfort, unless it’s really unbearable (on which more below) – we can just notice what it’s like and how we react to it.

Some people like to tune in by engaging in a formal mindfulness meditation practice. This usually involves sitting on the floor, or on a chair or stool, with eyes closed. Many people use their breathing as a kind of anchor for their mind, starting off by watching – not changing, not labelling as good/bad or right/wrong, just watching – the way their breath comes in and goes out again, wherever they feel it most strongly, whether that’s the nose, throat, chest or abdomen. Not everyone is comfortable with formal meditation – it can make some people feel too vulnerable to sit with their eyes closed. But there are infinite ways to be mindful. You can be mindful eating your lunch, paying close attention to how it smells, looks, tastes, how it feels against the tongue, thinking as you eat about who produced it and transported it and packaged it. That’s a very different experience to shovelling lunch down so fast you barely taste, it in order to get back to your desk. You can be mindful as you knit or sew, trying to pay attention to how it feels to use the needles in rhythm and have the wool or thread move through your fingers. You can be mindful as you swim, noticing how your muscles feel as they pull you through the water, how it feels to have the cold air on your wet skin, the noises in the pool as children have their swimming lessons. Whatever you are doing, just the act of noticing what’s going on, noticing how you really feel, can make it a mindful experience.

However you choose to try and practice mindfulness, you are bound to find that even with the best of intentions, your mind wanders. Minds are very busy things, reluctant to keep still and always jumping about from place to place (hence often referred to in meditation circles as “monkey mind”). That’s just the way they are, even among people who are mentally well. So when you try to be mindful and your mind slides off elsewhere, that’s inevitable. It’s not bad, it’s not wrong, it’s not proof that you are terrible at mindfulness or an awful person. No self-blame. A wandering mind is normal. And when it happens, you just start again, back with your first intention to take a bit of time out from being caught up in your thoughts. Then you carry on walking mindfully through the autumn leaves, or listening to a guided meditation, or sitting in silence on the floor watching your breathing.  And the next time your mind wanders, you just tell it again, “No, we’re doing this right now; we’re just watching the breath.” Be kind to your mind when you pull it back; it’s just a reminder. It’s not a telling off.

The great thing about mindfulness is that no matter what mistakes we have made, no matter how many times we recognise our mind has wandered, of that we have made bad choices for our mental health, it gives us infinite chances to wipe the slate clean and begin again. Every single time we gently remind ourselves that no, we’re not going to caught up in our own internal dialogue and we are going to just pay attention, we come back to this “beginner’s mind”.

Mindfulness and bipolar moods

I’ve said that it’s not necessary to do a formal “sitting practice” to be mindful, and in general that’s true. 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:

HIGH

Thoughts

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 project.”

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.”

Physical feelings

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

LOW

Thoughts

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.”

Physical feelings

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

I am already in a full on depressed or manic state, I will already know it, and will probably already have sought help 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. There’s no rulebook out there that says I “must” sit for 10 minutes, or 20, or 30. 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”)? At 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.

I think of it as being a bit like the Waitrose green token scheme. For those outside the UK, Waitrose is a (rather expensive) supermarket which gives each shopper a green plastic token at the point of payment. On the way out, the customer has pass by a container with three clear plastic compartments with slots in the top. Each compartment represents a local good cause, and shoppers “vote” with their token for how a £1000 donation from the store should be shared among the three nominated causes.

 

Being given three ways to vote makes me really stop and think about what I am doing, which worthy cause I am voting for, and why. Mindful decision-making has a similar quality. Each day I have a range of choices (or tokens, if you like) 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

 

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