Adverse or therapeutic? A mixed-methods study investigating adverse effects of Mindfulness-Based Cognitive Therapy in bipolar disorder.
Imke Hanssen, Vera Scheepbouwer, Marloes J. Huijbers, Eline Regeer, Marc Lochmann van Bennekom, Ralph Kupka, Anne E. M. Speckens
PLoS One December 2, 2021 DOI: 10.1371/journal.pone.0259167 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Mixed-methods study embedded in a randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 144 |
| Population | Patients with bipolar disorder |
| Intervention | Mindfulness-Based Cognitive Therapy (MBCT) |
| Topics | Meditation |
| Citations | 12 |
| Registration | NCT03507647 |
| Key findings | Adverse effects during MBCT for bipolar disorder are common but mostly transient and often later considered therapeutic by patients. |
Abstract
BackgroundMindfulness-Based Interventions (MBIs) are widely used in clinical and non-clinical populations, but little attention has been given to potential adverse effects (AEs).AimsThis study aimed to gain insight in the prevalence and course of AEs during Mindfulness-Based Cognitive Therapy (MBCT) for patients with bipolar disorder (BD).MethodThe current mixed-methods study was conducted as part of a RCT on (cost-) effectiveness of MBCT in 144 patients with BD (Trial registered on 25th of April 2018, ClinicalTrials.gov, NCT03507647). During MBCT, occurrence of AEs was monitored prospectively, systematically, and actively (n = 72). Patients who reported AEs were invited for semi-structured interviews after completing MBCT (n = 29). Interviews were analysed with directed content analysis, using an existing framework by Lindahl et al.ResultsAEs were reported by 29 patients, in seven of whom the experiences could not be attributed to MBCT during the interview. AEs were reported most frequently up to week 3 and declined afterwards. Baseline anxiety appeared to be a risk factor for developing AEs. Seven existing domains of AEs were observed: cognitive, perceptual, affective, somatic, conative, sense of self, and social. Influencing factors were subdivided into predisposing, precipitating, perpetuating, and mitigating factors. With hindsight, more than half of patients considered the reported AEs as therapeutic rather than harmful.ConclusionsAlthough the occurrence of AEs in MBCT for patients with BD is not rare, even in this population with severe mental illness they were not serious or had lasting bad effects. In fact, most of them were seen by the patients as being part of a therapeutic process, although some patients only experienced AEs as negative.
Comparable studies
Other randomized controlled trials on meditation, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Alterations in Brain and Immune Function Produced by Mindfulness Meditation Healthy employees in a work environment | 2003 | Randomized controlled trial | n = 41 |
| Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Recovered recurrently depressed patients | 2000 | Randomized controlled trial | n = 145 |
| Open hearts build lives: Positive emotions, induced through loving-kindness meditation, build consequential personal resources. Working adults | 2008 | Randomized controlled trial | n = 139 |
| Short-term meditation training improves attention and self-regulation Undergraduate Chinese students | 2007 | Randomized controlled trial | n = 40 |
| Mindfulness-Based Cognitive Therapy for Depression: Replication and Exploration of Differential Relapse Prevention Effects. Recovered recurrently depressed patients | 2004 | Randomized controlled trial | n = 73 |
Citations in the library
Cited by 7
- Incidence and Predictors of Meditation-Related Unusual Experiences and Adverse Effects in a Representative Sample of Meditators in the United States Clinical Psychological Science January 6, 2025
- Mindfulness-based cognitive therapy v. treatment as usual in people with bipolar disorder: A multicentre, randomised controlled trial. Psychological Medicine October 1, 2023
- Unexpected side effects: A cautionary note on challenges of persistent self-transcendence International Journal of Transpersonal Studies April 26, 2023
- Prevalence and Predictors of Self-Reported Adverse Experiences in Digital Meditation Training: 2 Randomized Controlled Trials JMIR Mental Health June 12, 2026
- Barriers and Facilitators to Mindfulness-Based Interventions in Diabetic Peripheral Neuropathy: A Qualitative Inquiry to Inform Intervention Design Mindfulness August 21, 2026
and 2 more in the library
Cites 10
- Mindfulness-based cognitive therapy for depression August 21, 2006
- The varieties of contemplative experience: A mixed-methods study of meditation-related challenges in Western Buddhists PLoS One May 24, 2017
- Prevalence of meditation-related adverse effects in a population-based sample in the United States Psychotherapy Research June 2, 2021
- Are People Mindful in Different Ways? Disentangling the Quantity and Quality of Mindfulness in Latent Profiles and Exploring Their Links to Mental Health and Life Effectiveness European Journal of Personality June 15, 2017
- Examining the Occurrence and Clinical Impact of Difficult Experiences that Emerge during a Mindfulness-Based Intervention among Individuals at High-Risk of Suicide. Mindfulness June 18, 2024
and 5 more in the library