Table 3 Themes and subthemes of facilitators and barriers during MBCT and corresponding quotations

1. Training

 Setting

   Location

The location is easy accessible, both by car and public transport. I have a strong feeling, probably party due to my bipolar disorder, that in advance I worry too much about the accessibility (..) so bad accessibility can be an important reason for not joining the training (16)

The entrance of the hospital, also the smell, sometimes I am very sensible for this. That was what I felt, it was no aversion, but (..), when you go to the hospital, other associations take place (..) and that made it sometimes difficult for me (5)

   Space

The location was nice; a quiet surrounding, a bright environment, sometimes they put some nice flowers in the room (..) and that felt good (6)

What I found difficult (..) I think interpersonal space is important to me, and with those kind of practices you need to feel safe in the room. And when you’re very close to each other, I don’t feel relaxed (1)

   Time

Frequency: I thought the frequency of the training was good; once a week was fine for me. I think when the frequency would be once in 2 weeks, there would have been too much time between the sessions. For me personally, I benefit more from regular contacts (..) so for me it was important that the training had recurring sessions (5)

Strict attendance: It was possible to skip some of the sessions (..). Maybe it would have been more useful when we only could continue with the training when we participated in contiguous sessions. Right now it is too easy to continue when you miss some of the sessions. For me, a more strict approach is helpful to continue participation (1)

 Content

   Physical content

Silent day: It wasn’t a big challenge for me to be quiet the whole day. Instead, I got the opportunity to attain a state of deep meditation as a result of the sequence of the practices. This made me think: “I would like to do this again, I think it is quite healthy” (13)

Follow-up session: I thought it would be nice if there would be another session after one month or so. Right now, the training was very intense and then it was suddenly finished.. You try to go on yourself but I thought it was a big transition (3)

   Materials

Audio tapes: The audio tapes helped me; they made it possible to try another exercise every time (..). You have to try what suits you, and how you relate to it, and those tapes helped me with this (13)

Homework forms: The structure of those homework forms could be more clear. Right now, the answers could go anywhere (3)

   Homework

Homework was another reason to reflect on the training. Besides, you have to practice with the things you have learned during the training (..). You are practicing to have more awareness, so I think doing your homework is an important part of this (10)

When I didn’t do my homework, the teachers did not seem to care (..). For me, it works better when homework is an obligation and they just say: “when you don’t do your homework, you have to stop with the training”. Homework is part of the training and when you don’t do this, there is no use to attend the course.. So, a more strict approach would be helpful (1)

 Teacher

I think that it’s an added value that the teacher has a lot of experience with the limitations of the group—that the teacher has both knowledge of mindfulness and bipolar disorder, with regard to the symptoms and limitations of patients (7)

In my opinion the teacher paid too much attention to manic symptoms, which I didn’t like that much (10)

 Peer group

During the training you are together with other people with a bipolar disorder; some of them a bit more hypomanic, others more depressive, so there is always someone you can relate to (..). Maybe I was longing for silence together with other people whose life is not always as easy. (9)

One person in the group was very present. When you gave her a little bit of attention, she wasn’t able to stop talking (..). I thought it was very annoying (9)

2. Psychosocial

 Close relatives

My wife encouraged me to do my homework every day. I have a tendency to forget things like this when I feel stable, she helped me to think about the homework so I could actually do it (3)

I recognize that it is difficult for me to keep on practicing at home. I think this is also because my family doesn’t have any interest in mindfulness and make a bit fun of it.. I think because of that, my enthusiasm dropped (7)

 Social contacts

Many of my friends have experience with mindfulness. They all are healthy, but most of them have relational problems for which they followed a mindfulness training. They were very enthusiastic about it, which made me really enthusiastic as well (10)

I went to see my nurse and she asked me: “this mindfulness training, does it suite you?” I said: “no, I don’t think so”. Then she said:”No, I don’t believe it either. Shouldn’t you stop?” So I stopped (11)

 Time available

I don’t have a job at the moment, so I have more time available then other people. This really gave me the opportunity to attend the training. Otherwise, you have to do the training between all other obligations (2)

I didn’t do my homework because I had too many other obligations which had priority (1)

 Work

Not applicable

I was very busy with work, so during the meditation a lot of thoughts related to my job arose (..). It felt like a cyclone, it went faster and faster. This all happened when I was just lying down on the floor (3)

3. Personal characteristics

 Mindset

Positive mindset: I managed to keep on going because I had the conviction that the training would have lots of positive effects (3)

Negative mindset: I didn’t take the time during the week to practice (..), it took too much time. Actually, it doesn’t take that much time, but that is what I thought (2)

 Personality

Perseverance: If I start something, I finish it. When I have started something, I will go every session and I will never cancel when I don’t feel like it (9)

Impatience: I am very impatient. I also feel like this with the audio recordings, like “come on, I know this already, hurry up” and then I press fast forward (16)

 Comorbid symptoms

Not applicable

Physical condition: I have a bowel disorder (..) and you could imagine, every time you sit or lie down and you constantly have to stop the practice because you have to go to the toilet, doesn’t help. This is not only disturbing for me, but for everyone in the room (4)

4. Bipolar disorder

 (Hypo)manic symptoms

When I feel hypomanic I have more energy to really focus on the present, to be able to keep coming back to the present instead of drifting off and getting distracted all the time (14)

During the hypomanic period my mind was very busy and I didn’t feel the rest to attend the training (1)

 Depressive symptoms

Not applicable

Difficulties with thinking, bad concentration (..), that caused a lot of difficulty for me to attend the training. When my energy level was really low I had thoughts like: “Do I really want this?” (9)

 Stable mood

During the period of the training I had a stable mood. Because of this, I really enjoyed participating (12)

But yes.. the danger lies within the moment when you don’t really need it because your mood is stable (..), therefore I wasn’t motivated to practice (6)

 Medication

Not applicable

Because of the medication I was less active and it was harder to feel my emotions (7)