Self-Referential Thinking, Suicide, and Function of the Cortical Midline Structures and Striatum in Mood Disorders: Possible Implications for Treatment Studies of Mindfulness-Based Interventions for Bipolar Depression

Bipolar depression often resists treatment and commonly involves anxiety and elevated suicide risk, creating a need for adjunctive therapies that address both mood and suicide-related thoughts. Mindfulness-based interventions show promise, and this paper reviews evidence to support their study in bipolar disorder. The review finds that cortical midline structures (CMS) link abnormal self-referential thinking to emotional dysregulation in mood disorders, and that CMS and striatal dysfunction may underlie suicide-related thoughts and behaviors. Combining mindfulness interventions targeting self-referential thinking with functional imaging of CMS and striatal function could clarify the neurobiological mechanisms of these treatments.

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Abstract

Bipolar depression is often refractory to treatment and is frequently associated with anxiety symptoms and elevated suicide risk. There is a great need for adjunctive psychotherapeutic interventions. Treatments with effectiveness for depressive and anxiety symptoms as well as suicide-related thoughts and behaviors would be particularly beneficial. Mindfulness-based interventions hold promise, and studies of these approaches for bipolar disorder are warranted. The aim of this paper is to provide a conceptual background for such studies by reviewing key findings from diverse lines of investigation. Results of that review indicate that cortical midline structures (CMS) appear to link abnormal self-referential thinking to emotional dysregulation in mood disorders. Furthermore, CMS and striatal dysfunction may play a role in the neuropathology underlying suicide-related thoughts and behaviors. Thus, combining studies of mindfulness interventions targeting abnormal self-referential thinking with functional imaging of CMS and striatal function may help delineate the neurobiological mechanisms of action of these treatments