Adverse or therapeutic? A mixed-methods study investigating adverse effects of Mindfulness-Based Cognitive Therapy in bipolar disorder.
Imke Hanssen, Vera Scheepbouwer, Marloes Huijbers, Eline Regeer, Marc Lochmann van Bennekom, Ralph Kupka, Anne Speckens
PLoS ONE December 2, 2021 Peer reviewed DOI: 10.1371/journal.pone.0259167 via DOAJ
Summary
Adverse effects (AEs) during Mindfulness-Based Cognitive Therapy (MBCT) were reported by 29 out of 144 patients with bipolar disorder, particularly peaking in the first three weeks. While some patients viewed AEs negatively, over half considered them therapeutic. Baseline anxiety was identified as a risk factor for developing AEs. The study documented seven domains of AEs, but overall, they were not serious or lasting.
Study at a glance
| Design | randomized controlled trial |
|---|---|
| Sample size | 144 |
| Population | patients with bipolar disorder |
| Key finding | Although adverse effects in MBCT for patients with bipolar disorder are not rare, most were perceived as part of a therapeutic process rather than harmful. |
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.