Donders Institute for Brain, Cognition and Behaviour
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Thesis defense Imke Hanssen (Donders series 563)

8 July 2022

Promotors:  Prof. Dr. Anne Speckens,  Prof. Dr. Ralph Kupka 
Co-promotors: Dr. Marloes Huijbers, Dr. Eline Regeer

In search of balance: Mindfulness-Based Cognitive Therapy for Bipolar Disorder

Despite multiple evidence-based treatment options, many patients with bipolar disorder suffer from high recurrence risk and residual symptoms, resulting in significant functional impairment. Mindfulness-Based Cognitive Therapy (MBCT) has been proposed as an addition to the treatment guidelines of bipolar disorder, as it has been found to be effective in the clinical, functional, and personal recovery of patients with recurrent depression. To date, research on the effectiveness of MBCT for patients with bipolar disorder remains inconclusive. Using an quantitative and qualitative approach, the aim of the current thesis is to increase our understanding and applicability of MBCT for patients with bipolar disorder.
First, in order to being able to optimize MBCT for bipolar disorder, we studied whether there are differences in positive emotion regulation and effects of MBCT between patients with bipolar disorder and recurrent depression. Second, a multicenter randomized controlled trial on the effectiveness of MBCT for bipolar disorder was conducted. Results indicated that MBCT was not effective for all patients with bipolar disorder, but that patients with more depressive symptoms and higher functional impairment at baseline benefitted from MBCT. Furthermore, qualitative results indicated that MBCT was feasible and acceptable for patients with bipolar disorder, but specific barriers to participation, such as current depressive symptoms, have to be taken into account. Moreover, a second qualitative study revealed potential working mechanisms of MBCT in bipolar disorder, such as increased awareness and emotion regulation and a reduction of intrusive negative thoughts, which can drive future studies exploring underlying working mechanisms of MBCT in bipolar disorder. Finally, with regard to safety, a mixed-methods study on the prevalence and course of adverse effects during MBCT was conducted. Results showed that adverse effects following MBCT in bipolar disorder are prevalent, but that with hindsight more than half of patients indicated that these adverse effects were considered to be therapeutic rather than harmful. Overall, this thesis shows that MBCT can be a valuable addition to current treatment guidelines for patients with bipolar disorder.