Adverse effects of Mindfulness-Based Cognitive Therapy in bipolar disorder

Mindfulness is often described as “being aware of our present moment experience, in a friendly and non-judgmental way”. Not really something you would expect to have adverse effects, do you? As research into mindfulness, and psychotherapy in general, has mainly been focused on positive outcomes, not much is known about the possibility of having adverse effects when practicing mindfulness.

The authors of current publication decided to dive into the unknown and investigated the occurrence and course of adverse effects in patients with bipolar disorder who participated in an eight-week mindfulness training. The research group, led by Anne Speckens from the Radboudumc Centre for Mindfulness, Department of Psychiatry, in collaboration with several bipolar outpatient clinics throughout the Netherlands, published the results on the 4^th of November in Plos One.

The researchers conducted a mixed-methods study, assessing the occurrence and nature of adverse effects in 72 bipolar patients. They found a prevalence of 38%, with self-related doubts, feelings of depression and anxiety, and re-experiencing of traumatic events being the most prevalent. Interviews were conducted with all patients who reported adverse effects, which provided valuable information on predisposing, precipitating, perpetuating, and mitigating factors.

Interestingly, looking back at them, more than half of patients considered the reported adverse effects as therapeutic rather than harmful. They described that mindfulness worked as a magnifying glass; by directing attention to their present moment experience, negative thoughts or feelings initially worsened, evoking fear and depression. However, as time passed, these adverse effects helped them to develop specific mindfulness skills, such as acceptance and compassion, which were helpful to deal with these and future difficult situations.

In this way, this study provides valuable implications for clinical practice. For example, it is important that patients are informed about the possibility of occurring adverse effects when practicing mindfulness, so they can come to a balanced and shared decision whether mindfulness is suitable for them at this specific moment. As a next step, they will write an instruction manual on how to prevent or manage adverse effects in mindfulness, which will become available for mindfulness trainers and clinicians in the Netherlands.

Publication

Imke Hanssen, Vera Scheepbouwer, Marloes Huijbers, Eline Regeer, Marc Lochmann van Bennekom, Ralph Kupka & Anne Speckens (2021). Adverse or therapeutic? A mixed-methods study investigating adverse effects of Mindfulness-Based Cognitive Therapy in bipolar disorder. Plos One. DOI: 10.1371/journal.pone.0259167