Examining the Occurrence and Clinical Impact of Difficult Experiences that Emerge During a Mindfulness-Based Intervention Among Individuals at High Risk of Suicide
Open accessAbstract
Objective Experiences of difficulty (e.g., anxiety, difficult emotions) can occur during mindfulness practice. This study characterized the occurrence of such difficulties, defined as abnormal distress, dysregulation or agitation, among high suicide risk participants during a mindfulness-based intervention. The study also evaluated whether mindfulness difficulties were associated with baseline differences or poorer outcomes during follow-up. Method Participants (n=50; mean age=49 years, 84% male, 24% Latinx) were from the Mindfulness Based Cognitive Therapy for Suicide Prevention (MBCT-S) trial. Occurrences of mindfulness difficulties were identified via systematic review of progress notes. Serious clinical outcomes (suicidal events, suicide attempts, and psychiatric hospitalizations) were tracked over 12-months follow-up. Participants experiencing difficulties during MBCT-S were compared to those who did not on baseline characteristics and serious clinical outcomes. Incidence density sampling and Cox proportional regression analyses tested whether experiencing difficulties during mindfulness increased the risk of subsequent serious clinical outcomes. Results 18% of participants had difficulty during mindfulness practice, which mostly included experiences of anxiety or hallucinations. Those experiencing difficulty showed several diagnostic differences at baseline, but were not at significantly greater risk of a suicidal event, HR 0.62 (95% confidence interval [CI]: 0.14 - 2.71) or an acute psychiatric hospitalization, HR 0.85 (95% CI: 0.19 - 3.82). There were no suicide attempts among the 9 participants who experienced mindfulness difficulty, compared to 5 suicide attempts in those without mindfulness difficulty. Conclusions Difficulties during mindfulness practice were common, but did not show increased risk of serious clinical outcomes in participants at high-risk of suicide. Preregistration This study reports findings from a secondary analyses of a randomized clinical trial that was preregistered at clinicaltrials.gov (NCT01872338).
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Difficulties during mindfulness practice (anxiety or trauma-related intrusive images) were not associated with greater risk of a suicidal event in MBCT-S.
“Despite some patients experiencing difficulties during mindfulness practice (i.e., anxiety or trauma-related intrusive images), these were not associated to greater risk of a suicidal event, underscoring both the safety and therapeutic potential of MBCT-S when implemented with appro -priate support (Interian et al., 2024 )”
From Mapping mindfulness in psychotherapy: a scoping review on conceptualization, applications, and research directions (2026) · cites this paper as Interian et al., 2024
MBCT-S is safe and has therapeutic potential when implemented with appropriate support.
“Despite some patients experiencing difficulties during mindfulness practice (i.e., anxiety or trauma-related intrusive images), these were not associated to greater risk of a suicidal event, underscoring both the safety and therapeutic potential of MBCT-S when implemented with appro -priate support (Interian et al., 2024 )”
From Mapping mindfulness in psychotherapy: a scoping review on conceptualization, applications, and research directions (2026) · cites this paper as Interian et al., 2024
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- Authors
- Interian, A., Miller, R., Dave, C., Latorre, M., Hill, L. S., King, A., Boschulte, D. R., Kline, A., Siegel, D., Sedita, M. M., & Chesin, M. S.
- Affiliations
- Rutgers, The State University of New Jersey (US)
- VA New Jersey Health Care System (US)
- William Paterson University (US)
- Corresponding author
- Interian, Alejandro
- Venue
- Mindfulness
- Published
- 2024-06-18
- Volume
- 15
- Issue
- 7
- Pages
- 1701-1712
- ISSN
- 1868-8527 (ISSN-L)
- 1868-8535
- PMC
- PMC11931679
- OpenAlex
- W4399760801
- Cited by
- 4
- References
- 48
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 1
- FWCI
- 2.01
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Mindfulness (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Health Services Research and Development (IIR 12-134)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- suicide prevention, hallucinations, psychiatric hospitalization, suicide attempts, emotional dysregulation
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