Mindfulness Based Cognitive Therapy Improves Frontal Control in Bipolar Disorder

A Pilot EEG Study

Fleur M Howells; Victoria L Ives-Deliperi; Neil R Horn; Dan J Stein


BMC Psychiatry. 2012;12(15) 

In This Article

Abstract and Introduction

Although significant advances have been made in understanding the psychobiology of bipolar disorder, the specific deficit underlying its symptoms remains unclear. One important possibility is that attentional dysfunction is a key intermediate phenotype for understanding the pathogenesis of bipolar disorder (BD).[1–3] Thus, attentional dysfunction in BD is a consistent finding in the literature.[1,3–6] Electroencephalographic (EEG) studies have made a particular contribution to this work, reporting asymmetrical activity (at rest) and activation (during task) in bipolar disorder; however these asymmetrical differences are dependent on mood state.[4,7,8] In euthymic BD asymmetry can be seen during high task difficulty and is opposite to that which occurs in controls i.e. completion of difficult anagrams increased left frontal alpha activation while control participants showed decreased alpha activation.[9] Similarly EEG Event-related potential (ERP) studies report a myriad of deficits during attentional tasks during polar mood states, such as reduced P300 amplitude and latency.[10,11] However when euthymic, attentional task P300 amplitude and latency are similar to controls.[10] An earlier ERP auditory attentional component such as the P50, related to auditory sensory gating, is diminished in schizophrenia and has also been reported in bipolar disorder if they present with a florid history of psychosis.[12] At present it still remains unclear which attentional components are involved euthymic BD during attentional processes.

Attentional dysfunction in BD is suggested to result from interfering neural processing that is not related to the task at hand, this superfluous or interfering information processing has been suggested to result from over activity of emotional brain areas[2] and 'weak' regulation of approach systems.[13] To overcome the over activity of emotional brain areas individuals with BD show increased activity of attention related brain areas.[2] This suggests that if we are able to reduce interfering neural processing and/or improve regulation of approach systems we would improve attentional processing in BD. Mindfulness based cognitive therapy (MBCT) combines meditative practices and aspects of cognitive therapy, which is based on the mindfulness-based stress reduction program.[14] The aim of meditative practices is to "reduce or eliminate irrelevant thought processes through training of internalized attention."[15] The aim of mindfulness mediation is to "facilitate adaptive coping with life stressors and enhance emotional well-being,"[16] for a recent review see.[17] The aim of MBCT is to incorporate the above and include cognitive behavioral therapy to "teach skills that will enable a greater awareness of thoughts, without judgment, and viewing negative (positive and neutral) thoughts as passing mental events rather than as facts."[18] While some research in major depression has focused on EEG variables relevant to mindfulness,[19–21] limited research has been conducted in BD with these forms of therapy, and no EEG studies have been conducted to our knowledge.[18,22]

The aims of the present study were therefore to (1) determine brain activity and activation differences between euthymic BD and controls, at rest (EEG band frequency analysis) and during an attentional task, a continuous performance task (EEG ERP wave component analysis). (2) To determine the effects of MBCT on brain activity and activation differences in euthymic BD, at rest (EEG band frequency analysis) and during an attentional task, a continuous performance task (EEG ERP wave component analysis).


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