Why Mindfulness Doesn't Work for Everyone: Networked Lived Tensions in a Reflexive Thematic Study Across Psychiatric...

A significant proportion of individuals receiving mindfulness-based interventions (MBIs) do not experience meaningful clinical improvement, and understanding these nonresponses is critical for enhancing the adaptability, precision and inclusivity of MBI approaches. This study aimed to systematically investigate the subjective and process-related obstacles reported by individuals who failed to respond adequately to standard MBIs. A reflexive thematic analysis (RTA) design was employed in a large clinical sample of 194 participants (mean age = 36.4; 58.9% female), diagnosed with a range of psychiatric conditions. Participants were classified into four nonresponse subtypes: symptom nonresponses, early relapses, functional nonresponses and treatment dropouts. Analysis identified five interrelated themes: cognitive rigidity and effortful control, emotional avoidance and fear of exposure, meta-awareness fatigue, contextual alienation and relational distrust and identity threat with self-critical resistance. Reflexive analysis revealed these themes as dynamically intertwined, forming patterns that participants described as interconnected, in which cognitive overcontrol appeared linked to emotional avoidance, greater fatigue, heightened social alienation and increased identity vulnerability. Intersections highlighted the relational, sociocultural and motivational dimensions of nonresponse, with variability across diagnostic, gender, educational and prior treatment histories. Nonresponse was associated with adaptive, contextually mediated strategies to maintain psychological safety and self-coherence. Implications for enhancing MBI design and delivery include attention to identity, relational safety, metacognitive load and culturally informed facilitation strategies to support adaptive engagement and minimize inadvertent harm.