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Purpose: Children of parents with bipolar disorder are at an increased risk of developing mood disorders compared to children without bipolar parents. Early signs of bipolar disorder include symptoms of anxiety, depression, and inattention. Pharmacological interventions for treating these symptoms are often poorly tolerated and may accelerate the onset of manic symptoms. Mindfulness-Based Cognitive Therapy-Child (MBCT-C), an evidence-based manualized 12-week group intervention, has been shown to effectively treat mood and anxiety disorders in children/adolescents. However, there has been no examination of MBCT-C for youth at high risk for bipolar disorder. We examined the effects of MBCT-C on outcomes among youth with anxiety disorders and a familial risk for bipolar disorder.Methods: Participants were 10 children/adolescents (Mage=13.17, SD=1.93; 80% girls; 40% White/African-American) who met DSM-IV criteria for an anxiety disorder (i.e., generalized anxiety disorder, separation anxiety disorder, panic disorder or social phobia) and had at least one parent with bipolar I disorder. A within-subjects, pre-post design was used to examine changes in anxiety, mindfulness, and emotion regulation associated with participation in MBCT-C.
Results: Significant decreases were seen in both child-rated (Mpre=18.5 vs. Mpost=4.7, t=10.8, p<.01) and clinician-rated anxiety symptoms (Mpre=11.1 vs. Mpost=4.3, t=6.1, p<.01). Additionally, reductions in clinician-rated anxiety symptoms were significantly correlated with improvements in mindfulness (r=−.69, p<.05) and emotion regulation (r=−.82, p<.05). No significant changes were seen pre-post intervention in depressive symptoms, mania symptoms, mindfulness, or emotion regulation - though all changes were in the expected direction.
Conclusion: Findings support the preliminary efficacy of MBCT-C in reducing anxiety among youth at risk for bipolar disorder, and suggest that changes in anxiety symptoms may be associated with changes in mindfulness and emotion regulation processes. Further research utilizing an active control group, larger sample size, and objective markers is warranted.
Objective: We sought to evaluate the neurophysiology of mindfulness-based cognitive therapy for children (MBCT-C) in youth with generalized, social, and/or separation anxiety disorder who were at risk for developing bipolar disorder.Methods: Nine youth (mean age: 13 ± 2 years) with a generalized, social, and/or separation anxiety disorder and a parent with bipolar disorder completed functional magnetic resonance imaging (fMRI) while performing a continuous processing task with emotional and neutral distractors (CPT-END) prior to and following 12 weeks of MBCT-C.
Results: MBCT-C was associated with increases in activation of the bilateral insula, lentiform nucleus, and thalamus, as well as the left anterior cingulate while viewing emotional stimuli during the CPT-END, and decreases in anxiety were correlated with change in activation in the bilateral insula and anterior cingulate during the viewing of emotional stimuli (p < 0.05, uncorrected; p < 0.005 corrected; cluster size, 37 voxels).
Conclusions: MBCT-C treatment in anxious youth with a familial history of bipolar disorder is associated with increased activation of brain structures that subserve interoception and the processing of internal stimuli—functions that are ostensibly improved by this treatment.