{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T23:32:00Z","timestamp":1788478320813,"version":"build-2803163510"},"reference-count":49,"publisher":"IMR Press","issue":"4","license":[{"start":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T00:00:00Z","timestamp":1756080000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Alpha Psychiatry"],"abstract":"<jats:p>Objective: In bipolar disorder, residual mood symptoms often persist even during the euthymic period, impairing functionality in 30\u201360% of patients in clinical remission. Addressing residual symptoms is critical as they are linked to reduced functionality and subjective wellbeing. This cross-sectional study aimed to determine the relationship between mindful attention awareness (MASS) and residual symptom severity in bipolar I disorder. Methods: This study included 100 patients with bipolar I disorder (BD-I) in remission, recruited consecutively from outpatient clinics between December, 2019 and March, 2020. The patients were evaluated using the sociodemographic data form, Hamilton Depression Rating Scale (HAM-D), Young Mania Rating Scale (YMRS), and Mindful Attention Awareness Scale (MAAS). Results: As the MAAS of the patients increases, their depressive symptoms decrease (p &lt; 0.001). As the MAAS of the patients increases, their anxiety symptoms decrease (p &lt; 0.001). No statistically significant relationship was found between the mindful attention awareness of the patients and their manic symptoms (p = 0.161). Two variables (HAM-D and Hamilton Anxiety Rating Scale Scores (HAM-A)) in the multiple linear regression model explain 21.8% of the change in MAAS score. Conclusion: Residual depressive and anxiety symptoms are predictive of lower MAAS in bipolar I disorder. Incorporating strategies to manage residual mood symptoms and improve mindfulness may enhance functionality and facilitate complete remission. However, given the cross-sectional design and the lack of a control group, causal inferences cannot be made. Further longitudinal and interventional studies are needed to explore the efficacy of mindfulness-based approaches in BD-I and determine whether the observed associations are specific to this disorder.<\/jats:p>","DOI":"10.31083\/ap46029","type":"journal-article","created":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T00:39:03Z","timestamp":1757464743000},"source":"Crossref","is-referenced-by-count":2,"title":["Mindful Attention Awareness and Residual Mood and Anxiety Symptoms in Remitted Patients With Bipolar I Disorder"],"prefix":"10.31083","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-4351-3335","authenticated-orcid":true,"given":"Selin","family":"Alkan","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Ezine State Hospital, 17600 Canakkale, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4278-2739","authenticated-orcid":true,"given":"Habib","family":"Erensoy","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Uskudar University, Medical Faculty, 34768 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4341-6826","authenticated-orcid":true,"given":"Tonguc Demir","family":"Berkol","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, 34147 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"16242","published-online":{"date-parts":[[2025,8,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"\u00dcnal \u0130\u00d6. Exploring praxia deficits in bipolar disorder: A cross-sectional analysis of functionality and quality of life. Journal of Surgery & Medicine. 2023; 7: 682\u2013689.","DOI":"10.28982\/josam.7967"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Ruegg H, Watson S, DelBello M, Adler C, Duran LRP. Bipolar Disorder in Primary Care: Considerations in Management. Current Treatment Options in Psychiatry. 2018; 5: 441\u2013451.","DOI":"10.1007\/s40501-018-0160-2"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Vieta E, Torrent C. Functional remediation: the pathway from remission to recovery in bipolar disorder. World Psychiatry: Official Journal of the World Psychiatric Association (WPA). 2016; 15: 288\u2013289.","DOI":"10.1002\/wps.20351"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Akkaya C, Alt\u0131n M, Kora K, Karamustafal\u0131o\u011flu N, Ya\u015fan A, Tomruk N, et al. T\u00fcrkiye\u2019de bipolar I bozuklu\u011fu hastalar\u0131n\u0131n, sosyodemografik ve klinik \u00f6zellikleri-HOME \u00e7al\u0131\u015fmas\u0131. Klinik Psikofarmakoloji B\u00fclteni-Bulletin of Clinical Psychopharmacology. 2012; 22: 31\u201342.","DOI":"10.5455\/bcp.20111222061433"},{"key":"ref5","unstructured":"Sadock BJ, Sadock VA. Kaplan and Sadock\u2019s synopsis of psychiatry: Behavioral sciences\/clinical psychiatry. Lippincott Williams & Wilkins: Philadelphia, PA, USA. 2011."},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Mart\u00ednez-Ar\u00e1n A, Vieta E, Reinares M, Colom F, Torrent C, S\u00e1nchez-Moreno J, et al. Cognitive function across manic or hypomanic, depressed, and euthymic states in bipolar disorder. The American Journal of Psychiatry. 2004; 161: 262\u2013270.","DOI":"10.1176\/appi.ajp.161.2.262"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Quraishi S, Frangou S. Neuropsychology of bipolar disorder: a review. Journal of Affective Disorders. 2002; 72: 209\u2013226.","DOI":"10.1016\/s0165-0327(02)00091-5"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Arts B, Jabben N, Krabbendam L, van Os J. Meta-analyses of cognitive functioning in euthymic bipolar patients and their first-degree relatives. Psychological Medicine. 2008; 38: 771\u2013785.","DOI":"10.1017\/S0033291707001675"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Sanchez-Moreno J, Martinez-Aran A, Tabar\u00e9s-Seisdedos R, Torrent C, Vieta E, Ayuso-Mateos JL. Functioning and disability in bipolar disorder: an extensive review. Psychotherapy and Psychosomatics. 2009; 78: 285\u2013297.","DOI":"10.1159\/000228249"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Kabat-Zinn J. Mindfulness-based interventions in context: past, present, and future. Clinical Psychology: Science and Practice. 2003; 10: 144\u2013156.","DOI":"10.1093\/clipsy.bpg016"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Brown KW, Ryan RM. The benefits of being present: mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology. 2003; 84: 822\u2013848.","DOI":"10.1037\/0022-3514.84.4.822"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Bojic S, Becerra R. Mindfulness-Based Treatment for Bipolar Disorder: A Systematic Review of the Literature. Europe\u2019s Journal of Psychology. 2017; 13: 573\u2013598.","DOI":"10.5964\/ejop.v13i3.1138"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Demir V. Bilin\u00e7li fark\u0131ndal\u0131k temelli bili\u015fsel terapi program\u0131n\u0131n \u00fcniversite \u00f6\u011frencilerinin kayg\u0131 d\u00fczeylerine etkisi. (The effect of a mindfulness-based cognitive therapy program on the anxiety levels of university students. The effect of a mindfulness-based cognitive therapy program on the anxiety levels of university students.) OPUS Uluslararas\u0131 Toplum Ara\u015ft\u0131rmalar\u0131 Dergisi (International Journal of Society Research). 2017; 7: 98\u2013118.","DOI":"10.26466\/opus.294058"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Bishop SR, Lau M, Shapiro S, Carlson L, Anderson ND, Carmody J, et al. Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice. 2004; 11: 230\u2013241.","DOI":"10.1093\/clipsy.bph077"},{"key":"ref15","unstructured":"Germer CK, Siegel R, Fulton P. Mindfulness and psychoNyanaponika Therapy. Guilford Press: New York. 2005."},{"key":"ref16","unstructured":"Deci EL, Ryan RM. Self determination theory: When mind mediates behavior. The Journal of Mind and Behavior. 1980; 1: 33\u201343."},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"Chambers R, Gullone E, Allen NB. Mindful emotion regulation: An integrative review. Clinical Psychology Review. 2009; 29: 560\u2013572.","DOI":"10.1016\/j.cpr.2009.06.005"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"Greeson JM. Mindfulness Research Update: 2008. Complementary Health Practice Review. 2009; 14: 10\u201318.","DOI":"10.1177\/1533210108329862"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"Creswell, JD, Lindsay EK. How does mindfulness training affect health? A mindfulness stress buffering account. Current Directions in Psychological Science. 2014; 23: 401\u2013407.","DOI":"10.1177\/0963721414547415"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"Jacobs TL, Epel ES, Lin J, Blackburn EH, Wolkowitz OM, Bridwell DA, et al. Intensive meditation training, immune cell telomerase activity, and psychological mediators. Psychoneuroendocrinology. 2011; 36: 664\u2013681.","DOI":"10.1016\/j.psyneuen.2010.09.010"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"Perich T, Manicavasagar V, Mitchell PB, Ball JR. The association between meditation practice and treatment outcome in Mindfulness-based Cognitive Therapy for bipolar disorder. Behaviour Research and Therapy. 2013; 51: 338\u2013343.","DOI":"10.1016\/j.brat.2013.03.006"},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"Chu CS, Stubbs B, Chen TY, Tang CH, Li DJ, Yang WC, et al. The effectiveness of adjunct mindfulness-based intervention in treatment of bipolar disorder: A systematic review and meta-analysis. Journal of Affective Disorders. 2018; 225: 234\u2013245.","DOI":"10.1016\/j.jad.2017.08.025"},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"Perich T, Manicavasagar V, Mitchell PB, Ball JR, Hadzi-Pavlovic D. A randomized controlled trial of mindfulness-based cognitive therapy for bipolar disorder. Acta Psychiatrica Scandinavica. 2013; 127: 333\u2013343.","DOI":"10.1111\/acps.12033"},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"Howells FM, Laurie Rauch HG, Ives-Deliperi VL, Horn NR, Stein DJ. Mindfulness based cognitive therapy may improve emotional processing in bipolar disorder: pilot ERP and HRV study. Metabolic Brain Disease. 2014; 29: 367\u2013375.","DOI":"10.1007\/s11011-013-9462-7"},{"key":"ref25","doi-asserted-by":"publisher","unstructured":"Lovas DA, Schuman-Olivier Z. Mindfulness-based cognitive therapy for bipolar disorder: A systematic review. Journal of Affective Disorders. 2018; 240: 247\u2013261.","DOI":"10.1016\/j.jad.2018.06.017"},{"key":"ref26","unstructured":"Cohen J. Statistical power analysis for the behavioral sciences. 2nd edn. Lawrence Erlbaum Associates: Hillsdale, NJ. 1988."},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"Andreasen NC, Pressler M, Nopoulos P, Miller D, Ho BC. Antipsychotic dose equivalents and dose-years: a standardized method for comparing exposure to different drugs. Biological Psychiatry. 2010; 67: 255\u2013262.","DOI":"10.1016\/j.biopsych.2009.08.040"},{"key":"ref28","unstructured":"Akdemir A, Orsel SD, Dag I, Turk\u00e7apar MH, \u0130scan N, \u00d6zbay H. Reliabilty, validity, and clinical application of Hamilton Depression Rating Scale in Turkish sample. Journal of Psychiatry, Psychology and Psychopharmacology. 1996; 4: 251\u2013259."},{"key":"ref29","unstructured":"Karada\u011f F, Oral ET, Aran Yal\u00e7\u0131n F, Erten E. Young mani derecelendirme \u00f6l\u00e7e\u011finin T\u00fcrkiye\u2019de ge\u00e7erlik ve g\u00fcvenilirli\u011fi. T\u00fcrk Psikiyatri Dergisi. 2001; 13: 107\u2013114."},{"key":"ref30","unstructured":"Yaz\u0131c\u0131 MK, Demir B, Tanr\u0131verdi N, Karaa\u011faoglu E, Yola\u00e7 P. Validity and inter-rater reliability of Hamilton Anxiety Rating Scale [Turkish]. Turk Psikiyatri Dergisi. 1998; 9: 114\u2013117."},{"key":"ref31","unstructured":"\u00d6zye\u015fil Z, Arslan C, Kesici \u015e, Deniz ME. Bilin\u00e7li fark\u0131ndal\u0131k \u00f6l\u00e7e\u011fi\u2019ni T\u00fcrk\u00e7eye uyarlama \u00e7al\u0131\u015fmas\u0131. E\u011fitim ve Bilim. 2011; 36."},{"key":"ref32","doi-asserted-by":"crossref","unstructured":"Guy W. ECDEU Assessment Manual for Psychopharmacology. 1st ed. US Department of Health, Education, and Welfare: Washington, DC, USA. 1976.","DOI":"10.1037\/e591322011-001"},{"key":"ref33","unstructured":"American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. American Pyschiatric Association: Washington, D.C. 1994."},{"key":"ref34","doi-asserted-by":"crossref","unstructured":"Kessler RC, Nelson CB, McGonagle KA, Liu J, Swartz M, Blazer DG. Comorbidity of DSM-III-R major depressive disorder in the general population: results from the US National Comorbidity Survey. The British Journal of Psychiatry. Supplement. 1996; 17\u201330.","DOI":"10.1192\/S0007125000298371"},{"key":"ref35","doi-asserted-by":"publisher","unstructured":"Berkol TD, \u00d6z\u00f6nder \u00dcnal I. Exploring the clinical characteristics and etiological factors of comorbid major depressive disorder and social anxiety disorder. Biomolecules & Biomedicine. 2023; 23: 1136\u20131145.","DOI":"10.17305\/bb.2023.9690"},{"key":"ref36","doi-asserted-by":"publisher","unstructured":"Miklowitz DJ, Alatiq Y, Goodwin GM, Geddes JR, Fennell MJV, Dimidjian S, et al. A Pilot Study of Mindfulness-Based Cognitive Therapy for Bipolar Disorder. International Journal of Cognitive Therapy. 2009; 2: 373\u2013382.","DOI":"10.1521\/ijct.2009.2.4.373"},{"key":"ref37","doi-asserted-by":"publisher","unstructured":"Bowlin SL, Baer RA. Relationship between mindfulness, self-control, and psychological functioning. Personality and Individual Differences. 2012; 52: 411\u2013415.","DOI":"10.1016\/j.paid.2011.10.050"},{"key":"ref38","doi-asserted-by":"publisher","unstructured":"Goldberg SB, Tucker RP, Greene PA, Davidson RJ, Wampold BE, Kearney DJ, et al. Mindfulness-based interventions for psychiatric disorders: A systematic review and meta-analysis. Clinical Psychology Review. 2018; 59: 52\u201360.","DOI":"10.1016\/j.cpr.2017.10.011"},{"key":"ref39","doi-asserted-by":"publisher","unstructured":"Fjorback LO, Arendt M, Ornb\u00f8l E, Fink P, Walach H. Mindfulness-based stress reduction and mindfulness-based cognitive therapy: a systematic review of randomized controlled trials. Acta Psychiatrica Scandinavica. 2011; 124: 102\u2013119.","DOI":"10.1111\/j.1600-0447.2011.01704.x"},{"key":"ref40","doi-asserted-by":"publisher","unstructured":"Deckersbach T, H\u00f6lzel BK, Eisner LR, Stange JP, Peckham AD, Dougherty DD, et al. Mindfulness-based cognitive therapy for nonremitted patients with bipolar disorder. CNS Neuroscience & Therapeutics. 2012; 18: 133\u2013141.","DOI":"10.1111\/j.1755-5949.2011.00236.x"},{"key":"ref41","doi-asserted-by":"publisher","unstructured":"Falcone G, Jerram M. Brain activity in mindfulness depends on experience: a meta-analysis of fMRI studies. Mindfulness. 2018; 9: 1319\u20131329.","DOI":"10.1007\/s12671-018-0884-5"},{"key":"ref42","doi-asserted-by":"publisher","unstructured":"Marchand WR. Neural mechanisms of mindfulness and meditation: Evidence from neuroimaging studies. World Journal of Radiology. 2014; 6: 471\u2013479.","DOI":"10.4329\/wjr.v6.i7.471"},{"key":"ref43","doi-asserted-by":"publisher","unstructured":"Wheeler MS, Arnkoff DB, Glass CR. The neuroscience of mindfulness: How mindfulness alters the brain and facilitates emotion regulation. Mindfulness. 2017; 8: 1471\u20131487.","DOI":"10.1007\/s12671-017-0742-x"},{"key":"ref44","doi-asserted-by":"publisher","unstructured":"Haase L, Thom NJ, Shukla A, Davenport PW, Simmons AN, Stanley EA, et al. Mindfulness-based training attenuates insula response to an aversive interoceptive challenge. Social Cognitive and Affective Neuroscience. 2016; 11: 182\u2013190.","DOI":"10.1093\/scan\/nsu042"},{"key":"ref45","doi-asserted-by":"publisher","unstructured":"Treves IN, Pichappan K, Hammoud J, Bauer CCC, Ehmann S, Sacchet MD, et al. The Mindful Brain: A Systematic Review of the Neural Correlates of Trait Mindfulness. Journal of Cognitive Neuroscience. 2024; 36: 2518\u20132555.","DOI":"10.1162\/jocn_a_02230"},{"key":"ref46","doi-asserted-by":"publisher","unstructured":"Ives-Deliperi VL, Howells F, Stein DJ, Meintjes EM, Horn N. The effects of mindfulness-based cognitive therapy in patients with bipolar disorder: a controlled functional MRI investigation. Journal of Affective Disorders. 2013; 150: 1152\u20131157.","DOI":"10.1016\/j.jad.2013.05.074"},{"key":"ref47","doi-asserted-by":"publisher","unstructured":"Rantala MJ, Luoto S, Borr\u00e1z-Le\u00f3n JI, Krams I. Bipolar disorder: An evolutionary psychoneuroimmunological approach. Neuroscience and Biobehavioral Reviews. 2021; 122: 28\u201337.","DOI":"10.1016\/j.neubiorev.2020.12.031"},{"key":"ref48","doi-asserted-by":"publisher","unstructured":"Spinhoven P, Huijbers MJ, Ormel J, Speckens AEM. Improvement of mindfulness skills during Mindfulness-Based Cognitive Therapy predicts long-term reductions of neuroticism in persons with recurrent depression in remission. Journal of Affective Disorders. 2017; 213: 112\u2013117.","DOI":"10.1016\/j.jad.2017.02.011"},{"key":"ref49","doi-asserted-by":"publisher","unstructured":"Boostani A, Tabatabaeinejad FS. Effectiveness of positive-focused mindfulness therapy on mental well-being, quality of life, and stress coping strategies in women with bipolar disorder. KMAN Counseling & Psychology Nexus. 2023; 1: 74\u201383.","DOI":"10.61838\/kman.psychnexus.1.1.9"}],"container-title":["Alpha Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.imrpress.com\/journal\/AP\/26\/4\/10.31083\/AP46029","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T01:03:53Z","timestamp":1757466233000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.imrpress.com\/journal\/AP\/26\/4\/10.31083\/AP46029"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,25]]},"references-count":49,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025]]}},"alternative-id":["S2757-8038(25)02078-6"],"URL":"https:\/\/doi.org\/10.31083\/ap46029","relation":{},"ISSN":["2757-8038"],"issn-type":[{"value":"2757-8038","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,25]]},"article-number":"46029"}}