Poverty

Improve Bipolar Disorders in Low and Middle Income Countries with Mindfulness

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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 emotions. Mindfulness-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: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6127962/ ), 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+ https://plus.google.com/106784388191201299496/posts 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

 

Abstract

Background

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

Aims

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

Method

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.

Results

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.

Conclusions

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.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6127962/

 

Improve Mental Health in Disadvantaged Populations with Mindfulness

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Improve Mental Health in Disadvantaged Populations with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Mindfulness training could be integrated into educational settings on a city, state, or national level, thus promoting health and mental health. Integrating mindfulness-based practices into educational settings could offer the potential to promote a more positive path for our children, something that would be particularly beneficial for disadvantaged urban youth like the kids in our studies.” –  Tamar Mendelson

 

Disadvantaged populations have a disproportionate share of mental health issues. Indeed, the lower the socioeconomic status of an individual the greater the likelihood of a mental disorder. It is estimated that major mental illnesses are almost 3 times more likely in the disadvantaged, including almost double the incidence of depression, triple the incidence of anxiety disorders, alcohol abuse, and eating disorders. These higher incidences of mental health issues occur, in part, due to mental health problems leading to unemployment and poverty, but also to the stresses of life in poverty.

 

The disadvantaged are much more likely to be uninsured, not have mental health services available, and less likely to seek treatment. In addition, when they are treated it is almost exclusively with drugs. These often do not work, have adverse effects, or are not taken as prescribed and are thus ineffective. Most psychotherapies were developed to treat disorders in affluent populations and are not affordable or sensitive to the unique situations and education levels of the disadvantaged. So, very few disadvantaged people with mental health problems are treated with psychotherapies.

 

Hence, there is a great need for alternative treatments for the mentally ill disadvantaged. One increasingly popular alternative is mind-body practices. These include meditation, tai chi, qigong, yoga, guided imagery, etc. In today’s Research News article “Mind–Body Approaches to Treating Mental Health Symptoms Among Disadvantaged Populations: A Comprehensive Review.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4761814/

Burnett-Zeigler and colleagues review the published research literature on the effectiveness of mind-body practices for the treatment of mental health issues in disadvantaged populations.

 

They found that in general mind-body techniques are feasible, acceptable, and efficacious with disadvantaged populations. The published research reports than Mindfulness Based Stress Reduction (MBSR) programs produced significant improvements in disadvantaged populations in general health, social functioning, vitality, physical and emotional role functioning, stress, mindfulness, anxiety, self-compassion, life satisfaction, depression, relationships, awareness, self-acceptance, and self-empowerment, nonreactivity, improved self-care, and decreased distress. The research also reports that yoga practice results in significant improvements in distressed mood, depression, emotional well-being, body weight, depression, and disease-specific quality of life. Other mind-body techniques were also reported to have similar benefits.

 

Hence the published research studies are fairly uniform in finding that mind-body practices can be successfully implemented with disadvantaged populations and produce significant mental health benefits. Although much more research is needed, these are exciting findings. Mind-body techniques show tremendous promise for the mental health needs of the disadvantaged. They can be implemented cost-effectively and many of these practices can be employed at home on convenient schedules. Hence mind-body practices, if implemented broadly, may be major contributors to improved mental health in disadvantaged populations. This, in turn, may lead to better employment possibilities and a route out of poverty.

 

So, improve mental health in disadvantaged populations with mindfulness.

 

“Research and experience have shown that meditation-based or contemplative practices have proven to be beneficial with populations that are considered at risk, marginalized, or oppressed and with those who are incarcerated.” – Sadye Logan

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

Burnett-Zeigler, I., Schuette, S., Victorson, D., & Wisner, K. L. (2016). Mind–Body Approaches to Treating Mental Health Symptoms Among Disadvantaged Populations: A Comprehensive Review. Journal of Alternative and Complementary Medicine, 22(2), 115–124. http://doi.org/10.1089/acm.2015.0038

 

Abstract

Mind–body approaches are commonly used to treat a variety of chronic health conditions, including depression and anxiety. A substantial proportion of individuals with depression and anxiety disorders do not receive conventional treatment; disadvantaged individuals are especially unlikely to receive treatment. Mind–body approaches offer a potentially more accessible and acceptable alternative to conventional mental health treatment for disadvantaged individuals, who may not otherwise receive mental health treatment. This review examines evidence for the efficacy of mind–body interventions for mental health symptoms among disadvantaged populations. While rates of utilization were relatively lower for racial/ethnic minorities, evidence suggests that significant proportions of racial/ethnic minorities are using complementary health approaches as health treatments, especially prayer/healers and natural or herbal remedies. This review of studies on the efficacy of mind–body interventions among disadvantaged populations found evidence for the efficacy of mind–body approaches for several mental and physical health symptoms, functioning, self-care, and overall quality of life.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4761814/