The Process of Change of Mindfulness-Based Cognitive Therapy for People with Bipolar Disorder: a Qualitative Study
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ORIGINAL PAPER
The Process of Change of Mindfulness-Based Cognitive Therapy for People with Bipolar Disorder: a Qualitative Study Imke Hanssen 1,2 & Marieke Boele 1 & Nicole van der Horst 1 & Marc Lochmann van Bennekom 3 Anne Speckens 1,2
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Eline Regeer 4
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Accepted: 5 November 2020 # The Author(s) 2020
Abstract Objectives Mindfulness-based cognitive therapy (MBCT) is an emerging psychological treatment that might be beneficial for people with bipolar disorder (BD). Neurocognitive studies suggest that MBCT may have important effects on mood regulation and broad attentional and frontal-executive control in BD. In this qualitative study, the process of change of MBCT in people with BD is explored. Methods The current qualitative study was part of a multicenter randomized controlled trial (RCT) on (cost-)effectiveness of MBCT for BD. Semi-structured interviews were conducted with a purposive sample of 16 participants who participated in an 8week MBCT. For reasons of triangulation, teachers were interviewed as well. Results Three themes arose from the data: (1) awareness of thoughts, emotions, bodily sensations, and behavior and insight into their inter-relationship; (2) behavioral change; and (3) positive consequences following MBCT. A distinction was made between general aspects and aspects related specifically to BD. Themes were divided into subthemes. Process of change took place in a non-linear, iterative fashion. Conclusions Qualitative data support the notion that several cognitive and behavioral processes in BD could be potential targets for MBCT. We suggest that future mediation, neuroimaging, and cognitive experimental studies should explore MBCT as an adjunctive treatment strategy for BD by investigating possible working mechanisms of MBCT in BD. Trial Registration ClinicalTrials.gov, NCT03507647. Registered 25th of April 2018, https://clinicaltrials.gov/ct2/show/ NCT03507647 Keywords MBCT . Bipolar disorder . Mindfulness-based cognitive therapy . Process of change . Working mechanisms . Qualitative research
Bipolar disorder (BD) is a severe and chronic mental illness with high recurrence, morbidity, and mortality rates (Novick * Imke Hanssen [email protected] 1
Department of Psychiatry, Centre for Mindfulness, Radboud University Medical Centre, Postbus 9101, 6500 Nijmegen, HB, Netherlands
2
Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
3
Pro Persona Mental Health Care, Outpatient Clinic for Bipolar Disorders, Tarweweg 2, 6534, AM Nijmegen, The Netherlands
4
Altrecht institute for Mental Health Care, Outpatient Clinic for Bipolar Disorder, Lange Nieuwstraat 119, 3512, PG Utrecht, the Netherlands
et al. 2010). Two main clinical subtypes of BD that are recognized include BD type I (e.g., occurrence of at least one manic episode, often accompanied by depressive episodes) and BD type II (e.g., occurrence of at least one hypomanic and at least one depressive episode) (American Psychiatric Association 2013). According to the World Health Org
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