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Trait Mindfulness and Emotion Regulation in Bipolar Disorder

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Study data published in the Journal of Affective Disorders describe the impact of dispositional mindfulness on depressive symptoms and quality of life in patients with bipolar disorder. Dispositional mindfulness was associated with reduced mood symptoms and improved quality of life, though its impact was significantly mediated by emotion regulation difficulties.

This cross-sectional study recruited individuals with and without bipolar disorder from the metropolitan area of Melbourne, Australia. The presence of bipolar disorder was confirmed at enrollment using the Mini International Neuropsychiatric Interview.

Patients were stable at the time of assessment and had not experienced a mood episode in the prior three weeks. Dispositional mindfulness was captured using the Mindfulness Attention Awareness Scale (MAAS), a 15-item self-report measure of participants’ likelihood to reflect on current and past experiences. 

Emotion regulation tendencies were measured using the Difficulties in Emotion Regulation Scale (DERS). Finally, manic and depressive tendencies and subjective quality of life were measured using the 7 Up Seven 7 scale and the Quality of Life in Bipolar Disorder Questionnaire, respectively. Mood and quality of life variables were entered into a series of mediation models to assess their respective relationships in bipolar disorder.

The study cohort comprised 66 outpatients with bipolar disorder and 28 control participants. Mean age was 37.7 ± 11.6 years in the patient group and 35.1 ± 11.7 years in the control group. A total of 32 patients (48.5%) and 16 (57.1%) healthy controls were women.

Mean MAAS scores were significantly lower in patients with bipolar disorder compared with control patients (56.6 ± 11.8 vs 69.6 ± 10.8). Among patients with bipolar disorder, lower MAAS scores significantly predicted worse scores on all 5 DERS subscales, including emotional Clarity, Goals, Impulse, Non-acceptance, and Strategies (all <.001). Further, lower MAAS scores significantly predicted higher 7 Down scores, indicating greater depressive symptoms.

In the fully adjusted model, the DERS Strategies subscale score completely mediated the relationship between MAAS score and depressive symptoms. Similarly, while lower MAAS scores predicted lower quality of life, this relationship was fully mediated by the DERS Clarity subscale. The fully adjusted model found no significant direct effect of MAAS on manic symptoms, nor any indirect effect via emotion regulation.

Results from these mediation models suggest that while trait mindfulness may predict better outcomes in bipolar disorder, emotion regulation difficulties mediate the relationship. The models highlighted specific difficulties — including clarity about emotions and regulation strategies — as important influences. Regarding study limitations, authors noted the cross-sectional design, small sample size, and the use of self-report measures to capture symptoms, which may be less accurate than clinical scales.

“[O]ur findings provide further support for the use of formal mindfulness training as an alternative or adjunct therapy for [bipolar disorder],” the investigators wrote. “By therapeutically raising resting mindfulness levels in…patients via formal training, it is likely that a range of clinical, affective, and psychosocial benefits will arise.”


Carruthers SP, Rossell SL, Murray G, Karantonis J, Furlong LS, Van Rheenen TE. Mindfulness, mood symptom tendencies and quality of life in bipolar disorder: An examination of the mediating influence of emotion regulation difficulties. J Affect Disord. Published online October 27, 2021. doi: 10.1016/j.jad.2021.10.107

This article originally appeared on Psychiatry Advisor

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Schedule24 Sep 2023