The association between meditation practice and treatment outcome in Mindfulness-based Cognitive Therapy for bipolar disorder Tania Perich a, b, * , Vijaya Manicavasagar a, b , Philip B. Mitchell a, b , Jillian R. Ball b a Black Dog Institute, Hospital Rd, Randwick, NSW, Australia b School of Psychiatry, University of New South Wales, Randwick, NSW, Australia article info Article history: Received 11 October 2012 Received in revised form 12 March 2013 Accepted 13 March 2013 Keywords: Mindfulness-based Cognitive Therapy Bipolar disorder Mindfulness Meditation MBCT abstract This study aimed to examine the impact of quantity of mindfulness meditation practice on the outcome of psychiatric symptoms following Mindfulness-based Cognitive Therapy (MBCT) for those diagnosed with bipolar disorder. Meditation homework was collected at the beginning of each session for the MBCT program to assess quantity of meditation practice. Clinician-administered measures of hypo/mania and depression along with self-report anxiety, depression and stress symptom questionnaires were admin- istered pre-, post-treatment and at 12-month follow-up. A significant correlation was found between a greater number of days meditated throughout the 8-week trial and clinician-rated depression scores on the Montgomery-Åsberg Depression Rating Scale at 12-month follow-up. There were significant differ- ences found between those who meditated for 3 days a week or more and those who meditated less often on trait anxiety post-treatment and clinician-rated depression at 12-month follow-up whilst trends were noted for self-reported depression. A greater number of days meditated during the 8-week MBCT program was related to lower depression scores at 12-month follow-up, and there was evidence to suggest that mindfulness meditation practice was associated with improvements in depression and anxiety symptoms if a certain minimum amount (3 times a week or more) was practiced weekly throughout the 8-week MBCT program. Ó 2013 Elsevier Ltd. All rights reserved. Introduction According to Cahn and Polich (2006), meditation affects in- dividuals at two levels. The first is through their immediate sub- jective state which occurs during the meditation practice itself and includes subjective experiences of calmness, peacefulness, a slow- ing or cessation of thoughts and increased perceptual clarity (Cahn & Polich, 2006). The second is at the trait level, which comprises accrued benefits of meditation practice over time. This includes changes in relationships to thoughts, feelings and internal experi- ences which, in turn, lead to the experience of a deeper sense of calm, sense of comfort and heightened sensory awareness outside the meditation practice (Cahn & Polich, 2006). Mindfulness meditation is one of the main components of Mindfulness-based Cognitive Therapy (MBCT) which was originally designed to treat patients with recurrent depressive episodes in order to prevent relapse (Segal, Williams, & Teasdale, 2002). MBCT comprises an 8-week group therapy program that combines cognitive therapy with the principles, concepts and mindfulness meditation exercises of the Mindfulness-based Stress Reduction (MBSR) program, originally developed by Kabat-Zinn (1990). Mindfulness meditation involves concentrating on the breath or body while maintaining a non-judgmental stance towards thoughts and feelings (Kabat-Zinn, 1990; Segal, Williams, et al., 2002). Mindfulness meditations in MBCT and MBSR include the Body Scan Technique e involving the non-judgmental observation of bodily sensations; the Sitting Meditation e observation of breathing in the abdominal region and any thoughts or feelings that arise; and the 3- min breathing space e a short meditation focussing on observing physical sensations, the breath and the body, in a non-judgmental way (Kabat-Zinn, 1990; Segal, Williams, et al., 2002). Greater frequency of practice of the Body Scan meditation has been found to be associated with lower anxiety and interpersonal sensitivity scores after an MBSR program (Carmody & Baer, 2008). Others examining MBSR have also noted correlations between greater time spent in meditation and lower somatization symp- toms, higher self-rated health and lower psychological distress scores for pain patients (Rosenzweig et al., 2010). * Corresponding author. School of Psychiatry, University of New South Wales, Randwick, NSW 2031, Australia. Tel.: þ61 2 9382 3841; fax: þ61 2 9382 3712. E-mail address: t.perich@unsw.edu.au (T. Perich). Contents lists available at SciVerse ScienceDirect Behaviour Research and Therapy journal homepage: www.elsevier.com/locate/brat 0005-7967/$ e see front matter Ó 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.brat.2013.03.006 Behaviour Research and Therapy 51 (2013) 338e343