Improve Bipolar Disorders in Low and Middle Income Countries with Mindfulness

Improve Bipolar Disorders in Low and Middle Income Countries with Mindfulness


By John M. de Castro, Ph.D.


Mindfulness-based cognitive therapy appears to have lasting benefits for people with bipolar disorder, , , incorporating mindfulness practices and mindful breathing into daily life on a regular basis was associated with better prevention of depressive relapse.” – Mahesh Agrawal


Bipolar Disorder, also known as Manic Depressive Disorder, is a mood disorder characterized by alternating states of extreme depression, relative normalcy, and extreme euphoria (mania). The symptoms of depression and mania are so severe that the individual is debilitated and unable to conduct their normal daily lives. The depression is so severe that suicide occurs in about 1% of cases of Bipolar Disorder. There are great individual differences in Bipolar Disorder. The extreme mood swings can last for a few days to months and can occur only once or reoccur frequently.


Bipolar Disorder affects about 1% of the population throughout the world at any time. But about 3% to 10% of the population may experience it sometime during their lives. It is usually treated with drugs. But these medications are not always effective and can have difficult side effects. Hence, there is a great need for alternative treatments. Mindfulness practices and treatments have been shown to be effective for major mental disorders, including depression and anxiety disorders and to improve the regulation of emotionsMindfulness-Based Cognitive Therapy (MBCT) was specifically developed for the treatment of depression and has been shown to be very effective.


There are a number of alternative treatments including mindfulness that have been shown to be effective for bipolar disorder in developed affluent countries. But bipolar disorder knows no borders. Countries with less affluent citizens are just as likely to suffer from bipolar disorder but may react differently to these treatments. Hence, there is a need to assesses the effectiveness of these alternative treatments on bipolar disorder in middle and low income countries.


In today’s Research News article “Psychological interventions for bipolar disorder in low- and middle-income countries: systematic review.” (See summary below or view the full text of the study at: ), Demissie and colleagues review and summarize the published research literature on the effectiveness of alternative treatments for bipolar disorder in countries with middle to low general income levels. They examined randomized controlled research studies that employed “any psychological intervention delivered either face to face (individual or group format) or online.” These included psychoeducation, family therapy, Cognitive Behavioral Therapy (CBT), or Mindfulness-Based Cognitive Therapy (MBCT).


They identified 18 studies 15 of which included psychoeducation, 2 CBT and 1 MBCT. They report that psychoeducation was effective in preventing relapse and improving treatment adherence while CBT was effective in prolonging the period of remission. All three intervention types were effective in reducing psychiatric symptoms and MBCT was also effective in promoting emotion regulation and mindfulness.


These studies suggest that alternative treatments are effective in treating bipolar disorder in middle and low income countries as they are in affluent countries. Psychoeducation appears well studied and effective. There were, however, only 2 studies with CBT and only 1 with MBCT. They suggest efficacy. But much more research is needed particularly comparing the different adjunctive treatments to determine which produce the greatest improvements alone or in combination with drugs.


So, improve bipolar disorders in low and middle income countries with psychoeducation, cognitive therapy, or mindfulness.


Even though it’s not a cure for bipolar disorder, meditation can help you relax and reduce stress. It can also help you disengage from stressful or anxious thoughts, and better control your mood.” – Anthony Watt


CMCS – Center for Mindfulness and Contemplative Studies


This and other Contemplative Studies posts are also available on Google+ and on Twitter @MindfulResearch


Study Summary


Demissie, M., Hanlon, C., Birhane, R., Ng, L., Medhin, G., & Fekadu, A. (2018). Psychological interventions for bipolar disorder in low- and middle-income countries: systematic review. BJPsych open, 4(5), 375-384. doi:10.1192/bjo.2018.46




Adjunctive psychological interventions for bipolar disorder have demonstrated better efficacy in preventing or delaying relapse and improving outcomes compared with pharmacotherapy alone.


To evaluate the efficacy of psychological interventions for bipolar disorder in low- and middle-income countries.


A systematic review was conducted using PubMed, PsycINFO, Medline, EMBASE, Cochrane database for systematic review, Cochrane central register of controlled trials, Latin America and Caribbean Center on Health Science Literature and African Journals Online databases with no restriction of language or year of publication. Methodological heterogeneity of studies precluded meta-analysis.


A total of 18 adjunctive studies were identified: psychoeducation (n = 14), family intervention (n = 1), group cognitive–behavioural therapy (CBT) (n = 2) and group mindfulness-based cognitive therapy (MBCT) (n = 1). In total, 16 of the 18 studies were from upper-middle-income countries and none from low-income countries. All used mental health specialists or experienced therapists to deliver the intervention. Most of the studies have moderately high risk of bias. Psychoeducation improved treatment adherence, knowledge of and attitudes towards bipolar disorder and quality of life, and led to decreased relapse rates and hospital admissions. Family psychoeducation prevented relapse, decreased hospital admissions and improved medication adherence. CBT reduced both depressive and manic symptoms. MBCT reduced emotional dysregulation.


Adjunctive psychological interventions alongside pharmacotherapy appear to improve the clinical outcome and quality of life of people with bipolar disorder in middle-income countries. Further studies are required to investigate contextual adaptation and the role of non-specialists in the provision of psychological interventions to ensure scalability and the efficacy of these interventions in low-income country settings.


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