1st Edition

Mindfulness-Based Cognitive Therapy for Bipolar Disorder

    Grounded in current knowledge about bipolar disorder and its treatment, this book presents an empirically supported therapy program with step-by-step guidelines for implementation. Mindfulness-based cognitive therapy (MBCT) for bipolar disorder is specifically designed for clients who have experienced many mood episodes and who struggle with chronic, pervasive depressive and residual manic symptoms. The authors provide everything needed to conduct the 12 weekly group sessions, which are supplemented by regular individual sessions. Reproducible tools include 29 client handouts and an Instructor Checklist. Purchasers get access to a companion website featuring downloadable audio recordings of the guided mindfulness practices (meditations and mindful movement), plus the reproducible materials, ready to download and print in a convenient 8 1/2 x 11 size. A separate website for use by clients features the audio recordings only.

    I. An Introduction to MBCT for Bipolar Disorder
    1. Bipolar Disorder and Mindfulness
    2. An Overview of MBCT for Bipolar Disorder
    3. Assessment and Orientation for Prospective Participants
    4. Individual Sessions
    II. The Group Sessions
    Session 1. Welcome in the Moment
    Session 2. Welcome Back to the Present
    Session 3. The End of the Honeymoon
    Session 4. Aversion and Attachment
    Session 5. Depression and Acceptance
    Session 6. Mania
    Session 7. Anger
    Session 8. Anxiety
    Session 9. Open Awareness and Loving-Kindness
    Session 10. Loving-Kindness I
    Session 11. Loving-Kindness II
    Session 12. Mindfulness Never Ends
    III. Reproducible Handouts
    Handout 1. Misconceptions about Mindfulness
    Handout 2. MBCT for Bipolar Disorder: The Roadmap
    Handout 3. Mindfulness Discussion Questions
    Handout 4. Yoga Exercise
    Handout 5. Mood Diary
    Handout 6. Planning Your Mindfulness Practice
    Handout 7. Homework Sheet
    Handout 8. Worksheet for Warning Signs and Action Plans
    Handout 9. Worksheet for Trigger Situations
    Handout 10. The Autopilot
    Handout 11. Exercise 1 for Session 5
    Handout 12. Automatic Negative Thoughts
    Handout 13. Cognitive Biases in Depression
    Handout 14. Exercise 2 for Session 5
    Handout 15. What Can I Do When I Start Feeling Down or Depressed?
    Handout 16. List of Troubling Thoughts and Feelings
    Handout 17. Why Prevent Mania with Mindfulness?
    Handout 18. Thoughts, Feelings, and Behaviors Associated with Hypomania/Mania
    Handout 19. Cognitive Biases in Hypomania/Mania
    Handout 20. What Should I Do When I Notice Warning Signs of Mania?
    Handout 21. Automatic Anger Thoughts
    Handout 22. Anger-Related Cognitive Biases
    Handout 23. Exercise for Session 7
    Handout 24. Anger Discussion Questions
    Handout 25. What Can I Do When I Feel Frustrated, Angry, or Irritable?
    Handout 26. Automatic Catastrophic Thoughts
    Handout 27. What Can I Do When I Feel Anxious?
    Handout 28. Self-Soothing Activities
    Handout 29. Mindfulness Never Ends

    List of Audio Tracks
    1. Yoga-Body Scan (23:13)
    2. Introduction to the Breathing Space (2:01)
    3. Body Scan (17:46)
    4. Mindfulness of the Breath (8:15)
    5. 3-Minute Breathing Space (3:23)
    6. Mindfulness of the Breath and Body (9:48)
    7. Mindful Sitting with Sounds and Thoughts (9:37)
    8. 3-Minute Breathing Space with Acceptance (3:55)
    9. Emotion-Focused Meditation (10:15)
    10. Open Awareness Meditation (10:29)
    11. Loving-Kindness Meditation (12:48)


    Thilo Deckersbach, PhD, is Associate Professor of Psychology at Harvard Medical School. He serves as Director of Psychology in the Bipolar Clinic and Research Program and Director of Research in the Division of Neurotherapeutics at the Massachusetts General Hospital in Boston. 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 disorder; 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 a Research Fellow at the Institute for Medical Psychology at Charité in Berlin, Germany. She was previously a Research Fellow 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 Organization), and has been a dedicated yoga and meditation practitioner since 1997. Dr. Hölzel is a recipient of the Marie Curie International Outgoing Fellowship within the 7th European Community Framework Program, and the Positive Neuroscience award from the John Templeton Foundation, among other honors. Her magnetic resonance imaging research focuses on the effects of mindfulness practice on the functional neuroanatomy of emotion regulation as well as on structural changes in the brain.

    Lori Eisner, PhD is Assistant in Psychology at the Massachusetts General Hospital’s Bipolar Clinic and Research Program and an instructor at Harvard Medical School. Her work has been funded by the Harvard Medical School Kaplan Fellowship and the Clinical Research and Training Program. 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 regulation 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. She has been an avid yoga practitioner since 2003.

    Sara W. Lazar, PhD, is Associate Researcher in the Psychiatry Department at Massachusetts General Hospital and Assistant Professor in Psychology at Harvard Medical School. She is a board member of the Institute for Meditation and Psychotherapy. The focus of Dr. Lazar's research--which has been covered by numerous news outlets--is to elucidate the neural mechanisms underlying the beneficial effects of yoga and meditation, both in clinical settings and in healthy individuals. She has been practicing yoga and mindfulness meditation since 1994.

    Andrew A. Nierenberg, MD, is Professor of Psychiatry at Harvard Medical School, Director of the Bipolar Clinic and Research Program, and Associate Director of the Depression Clinical and Research Program at the Massachusetts General Hospital. He has been listed among the Best Doctors in North America for the treatment of mood and anxiety disorders since 1994, 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 Neuropsychopharmacology. 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.

    "Few diagnoses tax sufferers and stymie therapists as greatly as bipolar disorder. Designed around a vital core of mindfulness practices for addressing mood lability, reactivity, and blunting, this innovative treatment meaningfully expands our understanding of comprehensive care for this challenging clinical condition."--Zindel Segal, PhD, Distinguished Professor of Psychology in Mood Disorders, University of Toronto–Scarborough, Canada

    "Written in a clear and practical fashion by a highly respected team of experts, this outstanding book provides innovative mindfulness tools for the treatment of bipolar disorder. Clinicians will learn how to expand their repertoire of therapeutic skills to more effectively treat this challenging disorder. Numerous patient worksheets and handouts are included and session content is described in careful detail. I wholeheartedly recommend this excellent book."--Noreen A. Reilly-Harrington, PhD, Department of Psychiatry, Harvard Medical School, Bipolar Clinic and Research Program, Massachusetts General Hospital

    "Finally, a book that addresses the application of mindfulness strategies to bipolar disorder. The authors have used their considerable clinical and research expertise to adapt MBCT to the management of fluctuating mood states. The reader will come away with confidence that mindfulness practice is a critical component of the self-management of bipolar disorder. Well worth the read."--David J. Miklowitz, PhD, Department of Psychiatry, UCLA School of Medicine, Semel Institute for Neuroscience and Human Behavior, and Senior Clinical Researcher at the University of Oxford, United Kingdom

    "Mindfulness has been shown to produce numerous benefits as an adjunct to treatment for many medical and psychiatric disorders. At the same time, multiple studies have demonstrated the importance of behavioral treatments for patients with bipolar disorder. This useful and timely book provides what clinicians want from a manual: it describes how and why to conduct the treatment, as well as how to modify it as needed for specific clinical circumstances. This book is sure to help many clinicians treat patients with bipolar disorder."--Roger D. Weiss, MD, Department of Psychiatry, Harvard Medical School; Chief, Division of Alcohol and Drug Abuse, McLean Hospital
    -This very useful book is a valuable resource for therapists and trainees who work with patients who have bipolar disorder. It contains everything needed to implement this therapeutic approach, and it is written in a style that is easily understood. This therapeutic intervention is a refreshing addition to the medications that are the usual primary approach for treating bipolar disorder. It is highly recommended.--Journal of Clinical Psychiatry, 9/1/2015ƒƒ[A] thoughtfully written, clinically rich, and comprehensive treatment guide….A welcome addition to efforts to develop novel strategies to improve care for people with bipolar disorder. The book includes detailed information about the nature of bipolar disorder, and the authors are credited for emphasizing the importance of viewing mindfulness-based cognitive therapy within a broader context of care, including pharmacological management….A compelling guide for future study.--American Journal of Psychiatry, 7/1/2015ƒƒThis is the first book to describe how to provide MBCT for patients with bipolar disorder, and it will be a landmark. The authors focus on coping tools to manage depression, mania, anxiety, and anger. They slowly introduce and build on mindfulness skills, reinforce the relevance of daily practice, and provide guidance on how to help participants overcome obstacles to practice. This book will provide a basis for future research and practice involving MBCT for bipolar disorder….This manual is recommended for psychiatrists, psychologists, psychiatry residents, psychology students, social workers, and counselors.--Journal of Psychiatric Practice, 11/1/2015