Category: Bipolar Disorders
Aims: Mindfulness-based cognitive therapy (MBCT) is an evidence-based treatment for bipolar disorder, but requires people to change how they think. Cognitive flexibility refers to people’s ability to replace maladaptive ways of thinking with more adaptive thinking styles. Cognitive flexibility is decreased in people with bipolar disorder and could limit how well they could use MBCT. Thus, we examined whether cognitive flexibility was related to bipolar individuals’ ability to practice mindfulness.
Methods: Participants (N=30) were recruited from a specialty bipolar clinic. They completed a demographic survey, the Cognitive Flexibility Index (CFI), and Cognitive and Affective Mindfulness Scale-Revised (CAMS-R). The CFI measures cognitive flexibility and is comprised of two subscales. The control subscale assesses one’s level of perceived control over difficult situations, as well as their ability to overcome these challenging situations. The alternatives subscale assesses the ability to generate different explanations and solutions to life events. The CAMS-R assesses one’s ability to experience and describe emotions non-judgmentally as well as notice and accept thoughts and feelings. We conducted regression analyses to explore the relationship between cognitive flexibility and mindfulness. We expected that greater cognitive flexibility would predict increased mindfulness use and that scores on the control and alternative subscales would independently predict mindfulness use.
Results: We found that decreased cognitive flexibility predicted lower self-efficacy in using mindfulness skills (r=0.37; p=0.05). We also found that bipolar individuals who perceived that they had less control over their ability to manage difficult experiences also felt that they were less able to tolerate negative emotions and were less likely to use mindfulness skills (r=0.41; p=0.03). Unexpectedly, we found that there was no association between mindfulness and the alternatives subscale (r=0.26; p=0.17).
Conclusion: These findings suggest that individuals with bipolar disorder who had decreased cognitive flexibility were less able to tolerate difficult emotions as well as less able to utilize mindfulness skills. These data also suggest that bipolar individuals who reported a lack of perceived control were less likely to utilize mindfulness skills. These findings suggest that cognitive flexibility may mediate the use of mindfulness skills in bipolar disorder. These data are preliminary given that we assessed participants with self-report and we included a small sample. Future research is warranted to further explore how cognitive flexibility impacts people’s ability to use mindfulness in bipolar disorder.
Weilynn Chang– Clinical Research Coordinator, Massachusetts General Hospital, Brookline
Cara Herbitter– Doctoral Student, University of Massachusetts Boston
Andrew Nierenberg– Professor of Psychiatry, Massachusetts General Hospital, Harvard Medical School
Thilo Deckersbach– Massachusetts General Hospital, Harvard Medical School
Louisa Sylvia– Assistant Professor, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
Professor of Psychiatry
Massachusetts General Hospital, Harvard Medical School