Examining the Occurrence and Clinical Impact of Difficult Experiences that Emerge during a Mindfulness-Based Intervention among Individuals at High-Risk of Suicide.

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).