Meditation for bipolar disorder

Mindfulness requires focusing on the present moment without harsh judgments or hasty reactions. She teaches to observe oneself: people who practice it are able to describe their state of mind in words.

At the center of this process, it seems to me, lies a form of attunement to internal processes, which allows a person to become his own best friend. And just as our attunement to children forms a healthy and strong attachment in them, our attunement to ourselves lays the foundation for the stability and flexibility of consciousness.

The act of attunement—internal in case of mindfulness and external in creating attachment—ensures healthy fiber growth in the medial prefrontal cortex.

Realizing this fact, I soon read that the area of ​​the medial prefrontal cortex is indeed thicker in mindful meditation practitioners.

The following hypothesis prompted me to suggest this technique to Jonathan: the practice would help him increase and strengthen the parts of the brain that regulate mood, stabilize his consciousness and allow him to achieve emotional balance and stability .

I didn't think he had an insecure attachment as a child, but rather that mindfulness directly stimulates the growth of a cluster of neurons called resonance channels, which include the medial prefrontal cortex.

They give us the ability to tune in to other people and regulate our own behavior. This is where the connection between attunement and regulation comes into play: internal and interpersonal forms of attunement lead to the growth of regulatory channels in the brain. When we reach a state of alignment—internal or interpersonal—we become more balanced.

Adolescent brain and prefrontal cortex

Jonathan wanted to get rid of his unpleasant symptoms as soon as possible. Adolescence is not easy without them: it is accompanied by changes in the body, a nascent and sometimes overwhelming sense of sexuality, changes in self-identification and relationships, high demands at school, uncertainty about the future and stress in the family that comes with an understanding of inevitable independence.

The teenage brain is in constant motion. The prefrontal regions, including the medial regions, do not fully mature until age twenty-five or later.

The brain is affected not only by the most powerful hormonal changes, but also by genetically programmed neural thinning - the removal of neural connections, which helps to “polish” various channels: to keep the used ones and get rid of the unnecessary ones in order to make the brain more adapted to solving current problems and efficient.

The normal process of brain restructuring is enhanced under stress, which reveals existing or provokes new problems. Because of this, the functions of the medial prefrontal cortex - from the modulation of fear to empathy and ideas of moral norms - begin to work unpredictably, and the regulation of one's own emotions is problematic for any teenager.

However, in Jonathan's case, mood dysregulation was outside the average for puberty. Most teenagers do not reach suicidal thoughts. Because of the painful episodes, Jonathan developed self-doubt. He believed that now he could not rely on a constantly failing consciousness. In my understanding, he needed to become his own best friend. If Jonathan could be helped to grow integrative fibers in the medial prefrontal cortex, it would be easier for him to reach the state of FACES flow. The integration of awareness would stabilize him.

I explained all this to Jonathan and reminded him that regular exercise, proper nutrition, and adequate sleep provide the basis for neuroplasticity. It is surprising how often the basic principles of a healthy brain are ignored.

Exercise as a treatment is greatly underestimated: aerobic exercise not only releases endorphins that positively affect mood, but also increases the number of connections between neurons. Regular and balanced nutrition reduces mood swings. And sleep is a universal remedy. With the latter, Jonathan had problems, so a systematic approach was needed.

Sleep Hygiene involves a soothing ritual before going to bed. For an hour or two, you should turn off all digital devices, do quiet activities: take a bath, listen to soothing music, read a book, and minimize the use of caffeine and other stimulants as the evening approaches. All this relaxes both the body and the mind.

With these basic rules of healthy living in place, Jonathan and I moved on to specific techniques for integration.

We have started classes aimed at training mindfulness skills. The idea was that these techniques create a temporary state of brain activation each time we repeat them. With regular repetition, short-term conditions become long-term and permanent. Thus, through practice, mindfulness becomes a character trait.

Here is a simple diagram I drew for Jonathan to give him a visual representation of the attention span. I called it the wheel of awareness.

Wheel of awareness

Imagine a bicycle wheel with an axle in the center and spokes radiating from it to the rim.

• The rim is everything we can pay attention to: thoughts and feelings, perceptions of the world around us, or sensations in the body.
• Axis is the inner space of consciousness from which awareness emanates.
• Spokes indicate the direction of attention to a specific part of the rim.

Awareness is focused on the axis of the wheel, and we focus on various objects - points on the rim. The axis serves as a metaphor for the prefrontal cortex.

To understand how this works, let's move on to the first exercise I suggested to Jonathan.

Mindful Attention Exercise: Concentration on Breathing

Several of my patients reported that after these exercises they became less anxious, they had a deeper sense of clarity, security and well-being. I was hoping Jonathan would have the same reaction.

Fortunately, he responded well to this session and did mindful meditation daily, at first for five to ten minutes at a time. When he was distracted, he would simply capture the moment and carefully direct his attention back to his breath.

Mindfulness Training and Consciousness Stabilization

Jonathan was in the school film club, and somehow he needed to make short documentaries about different parts of the city. He showed me one of his films, and I was struck by how cleverly he used the angle of the camera to convey the mood and texture of the city where we were both born and raised.

His eyes sparkled with pride when he noticed how much I liked his work. Then I told Jonathan about the camera lens and tripod metaphor.

The lens of the camera is our ability to perceive our own consciousness. Without a tripod, consciousness trembles all the time, like amateur videos shot with a handheld camera.

Jonathan instantly understood the point of the comparison: the blurry footage was similar to the feeling of being lost that his mood swings caused him. He also liked the image of the ocean from the previous exercise. He identified himself with a cork floating on a troubled sea. Regardless of which metaphor is closer to you - the wheel, the lens or the sea - they have the same meaning . Deep within us, there is a point of observation, objectivity, and openness. It is the receptive center of our consciousness, the serene depth of the inner sea. From there, Jonathan saw how reflective awareness changes the way the brain works and its structure.

Let's look at this process using the three pillars of awareness: observation, objectivity and openness .

Mindfulness Tripod Three Legs

Observant

If I may say so, then first of all Jonathan needed to become aware of his awareness and observe the concentration of attention. When he began to focus on his breathing, he found himself constantly distracted and lost in thoughts, feelings, and memories. However, this did not mean that he was meditating incorrectly.

The meaning of the exercise is to notice moments of distraction and again focus on the object. It is like strengthening muscles: as we bend and unbend the arm, tensing and relaxing the biceps, we concentrate attention, and when it is dispersed, we return it again. This practice emphasized Jonathan's goal - in this case - concentration on the breath. Holding on to a goal is the foundation of all mindfulness practices, whether we choose to focus on posture and movement, breathing, a candle flame, or any other object. Gradually, Jonathan managed to develop the skill of conscious attention - to set a goal and stick to it.

As an add-on, Jonathan agreed to keep a diary of daily activities, noting mood swings, meditations done or not done, and aerobic exercise. This was another opportunity to develop the ability to observe internal and external impressions and think about the mechanisms of the work of consciousness.

As Jonathan began his notes, we quickly discovered that he lacked confidence in the capabilities of his mind.

Almost everyone who tries meditation finds that thoughts and feelings constantly interrupt attempts to concentrate, even after several years of practice. At such moments, Jonathan was overcome with strong irritation, and he wrote that he was losing control. He showed me excerpts from his diary, where self-abasement bordered on unwillingness to live on. But there were also gaps of something new: “My father asked me not to put the music so loudly, and I exploded. He's always picking on! But today I was able to follow the outburst of anger as if from an observation tower: I saw the smoke coming, it made me feel bad, but I couldn’t stop.” According to him, the next day he calmed down, but still felt that consciousness had “betrayed” him again.

The distance that allows you to observe your own mental activity is an important first step towards the regulation and stabilization of consciousness. Jonathan began to realize that he could ride out such a storm in the prefrontal cortex without being swayed by brainwaves from other parts of the brain. It was a good start.

Objectivity

If you are relatively new to the training of conscious attention, it will be useful for you to compare it with mastering a musical instrument. At first, you concentrate on certain elements: the strings, the keys, or the mouthpiece. Then you work on basic skills: play scales or chords, consistently focusing on each note. Purposeful and regular practice allows you to develop a new ability. It actually strengthens the areas of the brain required for a new activity.

Mindfulness training also helps to develop the ability to set a goal and go towards it, only consciousness acts as a musical instrument. This is developed through observation and contributes to the stabilization and retention of attention. The next step is to learn to distinguish the quality of awareness from the object of attention.

Jonathan and I started this stage by "scanning" the body. He needed to lie on the floor and concentrate on the part of the body that I called. We moved in succession from toes to nose, stopping periodically to allow him to notice specific sensations. When Jonathan was distracted, he needed to notice what was distracting him, let it go and focus again, just like he did with his breathing. Immersion in bodily sensations directed his attention to a new spot on the rim of the wheel of awareness. He found areas of tension or relaxation and noticed what he was distracted by, moving inside the sector of the wheel where the sixth sense is located.

Then I taught Jonathan motion meditation: he took twenty slow steps around the room, concentrating on the feet or lower legs, and using a similar approach. When Jonathan realized he was distracted, he simply brought his attention back. This set the stage for objectivity. The object of concentration changed with each practice, but the feeling of awareness remained the same.

Here is one of Jonathan's diary entries of that time: “I realized an amazing thing - I directly feel this change - I have thoughts and feelings, sometimes strong and bad. I used to think that this was all of me, but now I understand that these are just impressions that do not define me. Another note described how Jonathan once got angry with his brother. “I was just beside myself with anger. But then I forced myself to go outside. Walking in the yard, I practically felt this border in my head: one part of the consciousness saw and understood everything, and the other was under the heel of the senses. It was very strange. I watched the breath, but I'm not sure it's not useless. Later, I seem to have calmed down. I felt like I stopped taking my own feelings too seriously.”

For homework, Jonathan alternated between breathing, body scanning, and moving meditation. But at some point, his irritation returned in a new form. He said that sometimes he gets a severe "headache", a kind of "voice" telling him what he should feel and do and that he is not meditating correctly and generally good for nothing.

I reminded Jonathan that these judgments are just the activity of his mind, and convinced him that he was not alone: ​​many people have an inner judging and critical voice. But for the next step, Jonathan needed to stop slavishly obeying this voice. It seemed to me that he was ready for such a challenge.

Openness

Observation allowed Jonathan to focus on the nature of intention and attention, which are the driving forces of mental activity. Objectivity taught him to distinguish awareness from brain activity. But now the storm activity has manifested itself in the form of expectations and “I have to” statements that inevitably imprison us. And attempts to force yourself to change feelings do not lead to anything. Open awareness means that we accept them but do not give in to them.

Don't you think it's strange that Jonathan came to me wanting to be different, and I'm teaching him to accept himself as he is? There is one difference: our desire to overcome experience creates internal tension, and in doing so, we make ourselves suffer. But instead of breaking into the inner world and saying, “No, don't do it!”, we are able to accept reality and see what happens. Oddly enough, every time people realize that this helps them change. It is better to approach the inner world with openness and readiness to accept it, and not with prejudice. Imagine the following situation: one of your friends began to talk about his problems. Surely you would listen to him, ask him to tell everything that is on his mind, and in addition to sincere interest, you would offer to lend a shoulder. This is what openness means – being attuned to the current situation, being kind to yourself and supporting yourself while remaining receptive and refraining from hasty reactions and judgments.

Except Jonathan hasn't learned to be kind to himself yet. For example, he would concentrate on his breathing, get distracted, and immediately begin to think that he was meditating incorrectly. I urged Jonathan to treat harsh self-criticism as just another mental activity and suggested calling it evaluation and switching back to breathing. Jonathan liked the definition of "doubt" better.

Instead of succumbing to endless "shoulds", through openness we gradually learn to accept ourselves and our experiences. But first of all, it is necessary to understand when exactly we ourselves act as our own jailers.

Consciousness stabilized

Jonathan began to notice some changes in himself. When it was not easy for him, he went to run or ride a bicycle in order to find some way out of the condition that gripped him. Physical activity helped him calm his body, restore awareness, and restore balance. A few weeks into our work, Jonathan described a new experience for him. He began to feel raging thoughts and strong emotional outbursts with greater clarity: he managed not to give in to them. His parents were surprised and pleased that he seemed to have found a way to calm these storms.

Here is what Jonathan wrote one night in his diary: “This afternoon I had a fight with my mother. I came home from school late and she just lashed out at me and she was so angry. I went to my room. I wanted to kill myself. I sat on the bed and wondered what the point was. Then a feeling of absolute helplessness swam through my head, as if it were a raft, a boat, or a piece of wood. But if earlier I was always in a boat and sailed away, this time I was somewhere else. I saw that the raft was just a feeling of not being able to do anything to get out. But by letting the boat just be in my head without getting into it, I didn't feel so guilty about it. And then she vanished." Jonathan and I discussed how the "boat" made him understand that he shouldn't be floating aimlessly on the waves of desperation. He realized that he was able to prevent the "attack" of feelings. Jonathan was also convinced that the observation of the inner world and the willingness to accept him was taken out of a depressed state. Considering thoughts from afar, he did not succumb to them. In many ways, Jonathan's experience confirmed the results of research, according to which people who were trained in mindfulness meditation showed a change in the brain towards a state of approach. This allows you to go towards problem situations, rather than avoid them. This is how emotional stability is formed.

Jonathan later wrote: “I know it sounds stupid, but my outlook on life has changed. What used to seem like a personification of my personality turned out to be just a part of what was happening. And strong feelings are just experiences that don't define me."

I was very moved by his discoveries and marveled at Jonathan's ability to express such profound thoughts. Now we needed to hone this newfound ability in order to re-route the energy and information flows and prevent strong emotional overflows. Having learned to use the skills of self-observation, Jonathan was ready to learn the techniques that would allow him to do something. I showed him the basic ways to relax. I suggested that he choose a quiet place, imaginary or real, to represent him at critical moments. We combined this method with the grounding sensation that Jonathan achieved by simply watching his body or breathing. Over time, Jonathan learned to prevent impending emotional outbursts by noticing changes in his body: palpitations, abdominal discomfort, tense fists - and this alone helped to smooth out their intensity. Jonathan experienced for himself how mindful attention contributes to mental balance.

In his diary he wrote: “By observing my feelings, I can change what they do to me. Previously, they had explosive power and lasted for hours. Now, after a few minutes, I see them thrashing around, and when I decide not to take them to heart, they just dissolve. It's pretty weird, but for the first time in my life, I'm starting to believe in myself."

For these changes, it was necessary to accept the situation and let it go until the consciousness calmed down. It's a hard road. Emotional storms were a huge problem in Jonathan's life, but they motivated him to create a safe haven within his mind.

What transformations did Jonathan have? We don't have CT scans to be sure, but it seems to me that from a neurological standpoint, Jonathan has built up integrative fibers in the medial prefrontal cortex. He accomplished this over several months of intensive work, with two sessions a week and almost daily aerobic exercise and mindfulness practice. A new way for him to focus attention and integrate consciousness became possible due to the expansion of the medial prefrontal cortex and the buildup of GABA-inhibiting fibers, which calmed the storms raging in the subcortical regions. This kept his irritable limbic amygdala quiet, so the GABA gel didn't involve his brainstem in the maddening fight-run-freeze process. Also, most likely, Jonathan began to use his left hemisphere more and be in a state of approach. Jonathan has learned to coordinate and balance his brain activity in new and more adaptive ways. Now he could "sit out" the storm without succumbing to overwhelming manifestations of consciousness. The mental training not only eased the symptoms of mood swings, but also made Jonathan emotionally stable: “I feel very clear. I'm practically a different person. Now I'm probably stronger. "

Within six months of our working together, Jonathan's symptoms had virtually disappeared. He behaved more at ease and carefree. I would say that he was comfortable in his body. “I just don’t take all these feelings and thoughts too close to my heart, and they don’t evoke such strong emotions in me anymore!” he said. We continued to strengthen his new skills. During our last meeting, after a year of therapy, Jonathan stood up to shake my hand, and I saw again the sparkle in his eyes that had so often been hidden by a mask of anxiety and fear. Now his gaze was straight, his face relaxed, and his handshake confident. He has grown seven or eight centimeters since we first met, which seemed like an eternity ago.

After graduating from high school, Jonathan went to college in another city. Many years have passed, and recently I happened to meet his parents in a shop next door. They told me that he was doing great and the mood swings weren't coming back. He studies cinema and psychology.

Daniel Siegel. Mindsight: The New Science of Personal Transformation

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At different poles: what you should know about bipolar disorder and why people with such a diagnosis and their loved ones should not lose hope How to keep from overprotection or vice versa from a too detached position? What is better - to support as much as possible or to give a person space and time to try to cope with this on his own, so that later it would be easier for him?