Research

Mindfulness for the Treatment of Psychosis: State of the Art and Future Developments

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Abstract

Recent meta-analyses point towards the effectiveness of mindfulness-based interventions (MBIs) in the treatment of various psychopathologies, particularly anxiety and depression. However, there is a scarcity of research investigating whether mindfulness is an effective treatment for psychosis. This chapter assesses the state of the art of mindfulness applications for the treatment of psychosis and undertakes an analysis and review of both the quantitative and qualitative literature. Quantitative research findings indicate that MBIs lead to an increase in mindfulness competency and quality of life, as well as a reduction in negative symptoms. Meanwhile, qualitative studies indicate that MBIs are well-accepted by patients and play an important role in the way that they relate to and cope with their symptoms. However, despite these promising outcomes, there are several methodological limitations that suggest findings should be treated with caution. Furthermore, although there is currently no data to support an iatrogenic effect of the application of MBIs in psychosis, further empirical examination of this issue is required.

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... As such, screening is encouraged for conditions such as acute psychosis, mania, and suicidality (Dam et al., 2018). However, emergent research (Langer, et al., 2016;Shonin, Gordon & Griffiths, 2014) also indicated potential benefits of MBIs to these populations, therefore, options to either exclude or provide additional supports to these populations should be considered. ...
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Thesis
Postsecondary students’ mental health is a pressing concern on campuses across the country as young adults are experiencing alarmingly high rates of stress-related challenges such as anxiety and depression. A recent report released through the Council of Ontario Universities recommends postsecondary institutions work together with mental health systems to break down silos, find collaborative solutions, and implement programs focused on building resilience. My research study explored the suitability and effectiveness of an innovative mindfulness-based intervention (MBIs) called the Holistic Arts-Based Program (HAP) to teach mindfulness skills to education students. Arts-based methods are enjoyable and engaging, and enable individuals to express feelings/thoughts that might otherwise be difficult to elicit; this information is rich and interesting, even powerful. Results of qualitative thematic analysis of pre- and post-group group interviews led to the development of three main themes: (1) increased self-awareness and mindfulness, (2) benefits of arts-based methods, and (3) benefits of group work. Participation in HAP helped students mitigate the negative impacts of stress, and taught them mindfulness concepts and activities that they were inspired to introduce into their education practicum. My research demonstrates how interventions such as the HAP could make a difference in student’s mental health. As MBIs may not have universal appeal they should not be a mandatory program requirement, but consideration may be given to offer mindfulness interventions as self-care options for postsecondary students.
... In other words, one is able to achieve personal empowerment and stability in life. It is interesting to note that this quality has been observed in people both with and without mental illness, which emphasises that mindfulness is a skill that can be trained in all individuals [46]. This beauty is not limited to a new relationship with thoughts, emotions and feelings. ...
... In the peer-reviewed mental health literature, reports of adverse effects following mindfulness practice are scarce. However, research specifically investigating whether there are health risks associated with participation in MBIs is significantly underdeveloped [1,21,22]. Furthermore, there are a small number of instances where mindfulness-encompassing (but not exclusively mindfulness-based) meditation modalities have precipitated nonsalutary health outcomes. For example, a case study reported that three individuals previously diagnosed with schizophrenia experienced acute psychotic episodes whilst attending meditation retreats [23], and another case study reported that two individuals with a history of schizotypal personality disorder experienced acute psychosis after practicing meditation [24]. ...
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Article
A thriving and evolving pool of research and commentary is emerging in relation to the integration of mindfulness techniques in school and out-of-school settings. In the current study the author explored how experienced mindbody wellness instructors make sense of teaching children mindfulness. The methodology of Interpretative Phenomenological Analysis was used to interview eight teachers teaching mindfulness with children from the United States and Australia. Four thematic categories emerged from the analysis and in this article the author discusses findings related to the theme of, Responsibility for Nurturing a Child’s Wellbeing. It was discovered that having a holistic-wellness-orientated vision was an important aspect of how teachers made sense of mindfulness instruction. The findings showed that teaching children mindfulness has the capacity to raise academic performance while synergistically enhancing a child’s spiritual, environmental, emotional, social, creative and physical wellbeing. It is recommended that mindfulness teacher training programs be established in universities to better prepare students to meet the demands of 21st Century education.
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Thesis
Research Background An extraordinary phenomenon has occurred. Teachers, en masse, in various countries around the world are teaching children techniques to cultivate loving kindness, compassion and inner peace. These practices are generally inspired by mindfulness principles and practices, commonly associated with Buddhist traditions. To date, research in this new field has focused on assessing the efficacy of mindfulness programs in child populations, predominately using outcomes-based study designs. There has been less research focussing on the teacher’s experience. In order to deepen and expand our understanding of mindfulness instruction with children, contributors to the topic have highlighted a critical need to understand the teachers’ experience – particularly teachers with experience teaching mindfulness. Research Question In order to understand teachers’ experiences, the following research question was posed, “How do teachers who are experienced MindBody Wellness practitioners make sense of teaching children mindfulness?” Methodology and Methods Interpretative Phenomenological Analysis (IPA), a qualitative methodology, was employed to interview teachers and analyse a range of illustrative material. Eight teachers from Australia and the United States (one male and seven females) were interviewed during 2014. Participants’ teaching experience in schools and out-of-school care settings varied from two years to 25 years. The teachers all had a regular mindfulness practice, but at a minimum, they also practised one other modality, such as yoga. The participants additionally provided demographic information and in some cases, data illustrative of their practice, such as unpublished materials, worksheets, journals and photos. Interviews with participants were facilitated by a method that incorporates authenticity, developing relational flow and mindful communication. Findings Through an in-depth analysis and interpretation of teachers’ texts, it was found that MindBody Wellness practices, such as yoga, meditation and mindfulness played an integral role in teachers’ lives. Four inter-related super-ordinate themes captured the essence of how eight teachers made sense of child-based mindfulness instruction: • Spirituality • Creativity • Responsibility for Nurturing a Child’s Wellbeing • Being a Mindful Role Model. It was found that a regular long-term mindfulness practice led to enhanced levels of wellbeing and connection to the self, others and the planet. The participants, having personally experienced the benefits of MindBody Wellness techniques, felt an inclination to share their wisdom with others, especially children. This inclination was generally supported and encouraged by either the school management or the school community and, when it was not, teachers moved to workplaces where a mindful way of being was valued. Being able to teach mindfulness to children and colleagues further heightened participants’ sense of wellbeing and enabled teachers to feel at home in their work environment, creating a conducive environment for learning and being. Teachers emphasised the importance of teaching mindfulness holistically and nourishing the whole of a child’s wellbeing. They felt that there were many ways to approach child-centric mindfulness instruction. However, in general, it was the participants’ personal and professional view that anyone considering teaching children mindfulness should first come to know and live the practice in his or her own life. A number of other recommendations are suggested for practice, policy and future research.
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Research
Research Background An extraordinary phenomenon has occurred. Teachers, en masse, in various countries around the world are teaching children techniques to cultivate loving kindness, compassion and inner peace. These practices are generally inspired by mindfulness principles and practices, commonly associated with Buddhist traditions. To date, research in this new field has focused on assessing the efficacy of mindfulness programs in child populations, predominately using outcomes-based study designs. There has been less research focussing on the teacher’s experience. In order to deepen and expand our understanding of mindfulness instruction with children, contributors to the topic have highlighted a critical need to understand the teachers’ experience – particularly teachers with experience teaching mindfulness. Research Question In order to understand teachers’ experiences, the following research question was posed, “How do teachers who are experienced MindBody Wellness practitioners make sense of teaching children mindfulness?” Methodology and Methods Interpretative Phenomenological Analysis (IPA), a qualitative methodology, was employed to interview teachers and analyse a range of illustrative material. Eight teachers from Australia and the United States (one male and seven females) were interviewed during 2014. Participants’ teaching experience in schools and out-of-school care settings varied from two years to 25 years. The teachers all had a regular mindfulness practice, but at a minimum, they also practised one other modality, such as yoga. The participants additionally provided demographic information and in some cases, data illustrative of their practice, such as unpublished materials, worksheets, journals and photos. Interviews with participants were facilitated by a method that incorporates authenticity, developing relational flow and mindful communication. Findings Through an in-depth analysis and interpretation of teachers’ texts, it was found that MindBody Wellness practices, such as yoga, meditation and mindfulness played an integral role in teachers’ lives. Four inter-related super-ordinate themes captured the essence of how eight teachers made sense of child-based mindfulness instruction: • Spirituality • Creativity • Responsibility for Nurturing a Child’s Wellbeing • Being a Mindful Role Model. It was found that a regular long-term mindfulness practice led to enhanced levels of wellbeing and connection to the self, others and the planet. The participants, having personally experienced the benefits of MindBody Wellness techniques, felt an inclination to share their wisdom with others, especially children. This inclination was generally supported and encouraged by either the school management or the school community and, when it was not, teachers moved to workplaces where a mindful way of being was valued. Being able to teach mindfulness to children and colleagues further heightened participants’ sense of wellbeing and enabled teachers to feel at home in their work environment, creating a conducive environment for learning and being. Teachers emphasised the importance of teaching mindfulness holistically and nourishing the whole of a child’s wellbeing. They felt that there were many ways to approach child-centric mindfulness instruction. However, in general, it was the participants’ personal and professional view that anyone considering teaching children mindfulness should first come to know and live the practice in his or her own life. A number of other recommendations are suggested for practice, policy and future research.
Article
Mindfulness derives from Buddhist practice and is fundamentally concerned with the development of present moment awareness. It is arguably one of the fastest growing areas of mental health research with the last decade witnessing a tenfold increase in the number of published scientific papers concerning the applications of mindfulness in mental health contexts. Given the demonstrable growth of interest into the clinical utility of mindfulness, this paper provides a: (i) timely and evidence-based appraisal of current trends and issues in psychopathology-related mindfulness research, and (ii) discussion of whether the empirical evidence for mindfulness-based interventions actually merits their growing popularity and utilization amongst mental health stakeholders. It is concluded that mindfulness-based interventions have the potential to play an important role in psychiatric treatment settings as well as in applied psychological settings more generally. However, due to the rapidity at which mindfulness has been taken out of its traditional Buddhist setting, and what is possibly evidence of media and/or scientific hype concerning the effectiveness of mindfulness, it is recommended that future research seeks to: (i) consolidate and replicate research findings, (ii) assess the maintenance of outcomes over longer time periods, (iii) investigate potential adverse effects, and (iv) fully control for potential performance bias in mindfulness-based intervention studies. It is further recommended that future research seeks to investigate the Buddhist position that sustainable improvements to mental and spiritual health typically require consistent daily mindfulness practice over a period of many years (i.e., they do not arise after attending eight two-hour classes with some self-practice in between).
Article
Mindfulness derives from Buddhist practice and is fundamentally concerned with the development of present moment awareness. It is arguably one of the fastest growing areas of mental health research with the last decade witnessing a tenfold increase in the number of published scientific papers concerning the applications of mindfulness in mental health contexts. Given the demonstrable growth of interest into the clinical utility of mindfulness, this paper provides a: (i) timely and evidence-based appraisal of current trends and issues in psychopathology-related mindfulness research, and (ii) discussion of whether the empirical evidence for mindfulness-based interventions actually merits their growing popularity and utilization amongst mental health stakeholders. It is concluded that mindfulness-based interventions have the potential to play an important role in psychiatric treatment settings as well as in applied psychological settings more generally. However, due to the rapidity at which mindfulness has been taken out of its traditional Buddhist setting, and what is possibly evidence of media and/or scientific hype concerning the effectiveness of mindfulness, it is recommended that future research seeks to: (i) consolidate and replicate research findings, (ii) assess the maintenance of outcomes over longer time periods, (iii) investigate potential adverse effects, and (iv) fully control for potential performance bias in mindfulness-based intervention studies. It is further recommended that future research seeks to investigate the Buddhist position that sustainable improvements to mental and spiritual health typically require consistent daily mindfulness practice over a period of many years (i.e., they do not arise after attending eight two-hour classes with some self-practice in between).
Full-text available
Article
Mindfulness derives from Buddhist practice and is fundamentally concerned with the development of present moment awareness. It is arguably one of the fastest growing areas of mental health research with the last decade witnessing a tenfold increase in the number of published scientific papers concerning the applications of mindfulness in mental health contexts. Given the demonstrable growth of interest into the clinical utility of mindfulness, this paper provides a: (i) timely and evidence-based appraisal of current trends and issues in psychopathology-related mindfulness research, and (ii) discussion of whether the empirical evidence for mindfulness-based interventions actually merits their growing popularity and utilization amongst mental health stakeholders. It is concluded that mindfulness-based interventions have the potential to play an important role in psychiatric treatment settings as well as in applied psychological settings more generally. However, due to the rapidity at which mindfulness has been taken out of its traditional Buddhist setting, and what is possibly evidence of media and/or scientific hype concerning the effectiveness of mindfulness, it is recommended that future research seeks to: (i) consolidate and replicate research findings, (ii) assess the maintenance of outcomes over longer time periods, (iii) investigate potential adverse effects, and (iv) fully control for potential performance bias in mindfulness-based intervention studies. It is further recommended that future research seeks to investigate the Buddhist position that sustainable improvements to mental and spiritual health typically require consistent daily mindfulness practice over a period of many years (i.e., they do not arise after attending eight two-hour classes with some self-practice in between).
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Chapter
Over the past half-century, Western Psychology has become increasingly aware of the relevance of Buddhist theory and practice to Western psychopathology and psychotherapy (Watts, 1961; Suzuki, Fromm, & De Martino, 1963; Kornfield, 1993; Epstein, 1995). The Buddha said he taught "suffering and the cessation of suffering" (Alagaddāpama Sutta, 1995, p. 234), and Buddhism can be viewed as a diagnosis and prescription for the relief of certain types of psychological distress. As an approach to the alleviation of human suffering, Buddhism developed prior to and independently from the Western psychotherapeutic tradition, and as such, it provides an external vantage point from which one can illuminate, supplement, or critique Western psychological approaches.
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Mindfulness has been practiced in the Eastern world for over twenty-five centuries but has only recently become popular in the West. Today, interventions such as “Mindfulness-Based Cognitive Therapy” are used within the Western health setting and have proven to be successful techniques for reducing psychological distress. However, a limitation of such interventions is that they tend to apply the practices of mindfulness in an “out of context” manner. To overcome this, a newly formed Meditation Awareness Training (MAT) program focusses on the establishment of solid meditative foundations and integrates various support practices that are traditionally assumed to effectuate a more sustainable quality of well-being. The aim of this pilot study was to assess the feasibility and effectiveness of MAT for improving psychological well-being in a sub-clinical sample of higher education students with issues of stress, anxiety, and low mood. Utilizing a controlled design, participants of the study (n=14) undertook an 8-week MAT program and comparisons were made with a control group (n=11) on measures of self-assessed psychological well-being (emotional distress, positive affect, and negative affect) and dispositional mindfulness. Participants who received MAT showed significant improvements in psychological well-being and dispositional mindfulness over controls. MAT may increase emotion regulation ability in higher education students with issues of stress, anxiety, and low mood. Individuals receiving training in mindfulness meditation may benefit by engendering a broader, more ethically informed, and compassionate intention for their mindfulness practice.
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Interpretative phenomenological analysis (IPA) is an increasingly popular approach to qualitative inquiry. This handy text covers its theoretical foundations and provides a detailed guide to conducting IPA research. Extended worked examples from the authors' own studies in health, sexuality, psychological distress and identity illustrate the breadth and depth of IPA research. Each of the chapters also offers a guide to other good exemplars of IPA research in the designated area. The final section of the book considers how IPA connects with other contemporary qualitative approaches like discourse and narrative analysis and how it addresses issues to do with validity. The book is written in an accessible style and will be extremely useful to students and researchers in psychology and related disciplines in the health and social sciences.
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There are already several existing studies that show the effectiveness of mindfulness-based approaches in varying types of disorders. Only a few studies, however, have analyzed the effectiveness of this intervention in psychosis, and without finding, up to now, significant differences from the control group. The aim of this study is two-fold: to replicate previous studies, and to focus on analyzing the feasibility and effectiveness of applying mindfulness in a group of people with psychosis. Eighteen patients with psychosis were randomly assigned to experimental and control groups. The experimental group received eight 1-hour sessions of Mindfulness-Based Cognitive Therapy (MBCT), while the control group was relegated to a waiting list to receive MBCT therapy. The experimental group scored significantly higher than the control group in their ability to respond mindfully to stressful internal events. Both the usefulness and effectiveness of implementing a mindfulness-based program have been replicated in a controlled manner in patients with psychosis.
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This study analysed the correlation between contemplation and psychosis from three cases of patients presenting psychotic symptoms subsequent to practising meditation. Sleep loss following a wrong doing in meditation was found to be the main cause in the first two cases, and drug withdrawal was found to be the principal factor in causing a psychotic eruption in the third case. In this last case, sleep deprivation subsequent to meditation was only a minor influence. Discussion regarding the correlation between meditation and psychosis is presented in this study.
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This study sought to develop further understandings of the relationships that people can develop with the voices they hear, and to explore the development of these relationships over time. Qualitative data was gathered from 12 people attending peer support groups. A semi-structured interview was used to facilitate the interviews and analysis of the transcripts was guided by the principles of Thematic Analysis. Four themes emerged and suggested that the relationships between hearers and their voices can have a variable trajectory which is influenced by stress, talking with and about voices, and the acceptance of voices and/or resistance. Clinically, the findings have implications for the training of frontline staff, the provision of peer support and the adaptation of psychological therapies. Future studies should assess whether our findings generalise to more diverse samples of voice hearers and use longitudinal qualitative and quantitative designs to explore change processes in-depth from early to later stages of psychosis.
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Mindfulness treatments and research have burgeoned over the past decade. With psychosis, progress has been slow and likely held back by clinicians' belief that mindfulness may be harmful for this client group. There is emerging evidence that mindfulness for psychosis - when used in an adapted form - is safe and therapeutic.
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This study sets out to develop an understanding of participants’ experiences of person-based cognitive therapy groups for distressing voices, a therapy that integrates cognitive therapy with mindfulness principles and practice. Qualitative data were gathered during 10 interviews with participants, most of whom had a diagnosis of psychosis. A semi-structured schedule was used to guide the interviews and data were analysed using thematic analysis. Three themes unique to PBCT emerged: Relating to voices, Relating to self and Relating to others. The value of a mindfulness approach and the importance of changed beliefs about voice strength and power emerged as sub-themes in the “Relating to voices” theme. A sense of self-separate to voices and a developing positive view of self-emerged as sub-themes in the “Relating to self” theme. The “Relating to others” theme referred to changed social relationships during and following the group. The study provided support for the value of PBCT groups for distressing voices. Findings from the study supported the mechanisms of change suggested by the therapy model, namely, that benefit is gained through re-evaluating beliefs about voices, strengthening positive self-schema, mindfulness practice and principles and moving towards a symbolic sense of self.
The spiritual tradition of Buddhism differs from the prevalent tendency in the West to separate mind and body, self and other. Consciousness is viewed as a vast interconnected field of which all of us are a part. There are subliminal aspects of this consciousness that contain our deepest health and wellbeing. These become obscured by the conditions of our existence, especially the personality processes and self-constellations that develop in defence of basic wounding at the level of our being. Psychotherapy and Buddhism meet in an understanding of human suffering that can be described in terms of a self, being and source axis along which we all exist. In this model, self is like the tip of the iceberg. If we are recognised and received at a being level early in our lives, there will be an open and fluid alignment between the self through which we mediate with the world, our being-nature and the deepest ground of inter-connection. Most of us are not fully met at a being level when we first need to be and we come to identify as a separate and fixed self which has cut loose from its deeper moorings in being and source. In this embodied life, however, we have access to subliminal depths through an ever-present faculty of awareness, which can be cultivated through mindfulness practices. Psychotherapists and counsellors can learn these inner practices and facilitate a being-to-being meeting in which their clients can have an experience of their human beingness that is beyond words.
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Purpose – There is an increasingly active area of research indicating that interventions incorporating mindfulness can be beneficial for individuals distressed by experiences of psychosis. However, there is little qualitative information regarding clients' experiences of mindfulness groups. This paper aims to fill this gap. Design/methodology/approach – To explore the subjective experience of mindfulness groups for people experiencing distressing psychosis. Three participants, who had attended a mindfulness for psychosis group, were interviewed and data were analysed using Interpretative Phenomenological Analysis. Findings – Four main themes were identified: “experiencing distress”, “group as beneficial”, “mindfulness as beneficial”, and “mindfulness groups as part of the process of recovery”. Originality/value – The mindfulness groups appeared to support participants' journeys of recovery through: promoting choice and control in relating differently to distress; providing space to socially construct shared meanings; and enhancing a sense of agency in “moving on”.
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Objectives: This study tested the effectiveness of a mindfulness-based psychoeducation program for Chinese outpatients with schizophrenia over an 18-month follow-up. The program is a psychoeducational program that addresses patients' awareness and knowledge of schizophrenia and builds skills for illness management. Methods: A multisite controlled trial was conducted with 96 Chinese patients with schizophrenia in Hong Kong. They were randomly assigned to either the mindfulness-based psychoeducation program or usual psychiatric care. The patients' mental and psychosocial functioning, insights into illness, and rehospitalization rates were measured at recruitment and at three and 18 months postintervention. Results: Compared with those in usual care, the patients in the mindfulness psychoeducation program showed significantly greater improvements in their illness insights, symptom severity, functioning, and number and length of rehospitalizations at the 18-month follow-up. Conclusions: The findings provide evidence that the mindfulness-based education program can improve Chinese schizophrenia sufferers' psychosocial functioning and reduce their illness relapse.
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Mindfulness meditation training has been found to be helpful across a range of mental and physical health conditions. Research testing mindfulness-based interventions in the psychiatric rehabilitation context has been rare, however—possibly due to concerns about the potential for exacerbation of psychotic symptoms during meditation practice. Fifteen individuals diagnosed with schizophrenia spectrum disorders participated in a pilot study testing a mindfulness-based intervention to reduce anxiety. In this descriptive study of program evaluation interview responses, we examined the feedback participants had provided in face-to-face interviews to determine the degree to which individuals reported finding mindfulness training acceptable and helpful. Two raters systematically coded the data independently. The combined findings led to the identification of themes that surfaced most often overall and the context in which these themes had emerged. Outcomes mentioned most frequently by participants were relaxation, relief from psychological symptoms, cognitive changes, and focus on the present. These findings were consistent with extant literature identifying similar constructs as active ingredients of mindfulness-based interventions. Results suggested that mindfulness meditation training was acceptable to all participants; no one reported worsening of psychotic or other symptoms while meditating. We concluded that mindfulness meditation training should be further tested for its potential to be helpful in recovery from psychiatric disability.
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The aim of the study was to explore experiences of practising mindfulness in participants within an early intervention for psychosis (EIP) service. A qualitative research methodology was used - that of grounded theory. This was chosen as it enabled examination of clients' experiences of mindfulness practice. The experience of mindfulness among nine people within an EIP service who had been practising mindfulness for at least 20 weeks was investigated. Semi-structured interviews exploring how mindfulness practice related to psychosis and day-to-day life were recorded verbatim, transcribed, and analysed. Four main categories emerged: being able to use mindfulness, making sense of mindfulness and coping, relating to people differently, and increased self-understanding and acceptance. All participants reported subjective benefits and challenges of mindfulness practice, and gave insights into processes of change. These preliminary data suggest mindfulness can be of use to individuals experiencing their first episode of psychosis.
Chapter
In the last years, mindfulness significantly contributed to promote the ultimate goal of all medical and psychological treatments: easing patients’ suffering (Segal, Williams, & Teasdale, 2002).
Article
Aim: Recently, a mindfulness therapy for people with psychotic disorders was developed. However, clinicians and researchers are cautious given case reports in which extensive meditation provoked psychotic symptoms in people with a psychotic disorder. The purpose of this study was to examine the feasibility, adverse effects and possible favourable effects of mindfulness-based therapy (MBT) in people recently recovering from a first episode of psychosis. Method: A nonrandomized, non-controlled prospective follow-up study. Patients were offered an MBT that consisted of eight 1-hour sessions within a 4-week time span. Positive and Negative Syndrome Scale, Symptoms Checklist 90 and the Southampton Mindfulness Questionnaire were assessed before and after the therapy. Results: Of the 16 persons who started MBT, 13 completed (81.5%) the therapy. No significant increase in psychotic symptoms was found. Between two meetings, one participant initially misunderstood the mindfulness instructions, which led to an increase in distress. No increased awareness of intrusive thoughts or visual or auditory hallucinations was reported by participants. We found a decrease in agoraphobic symptoms (p < 0.028) and in psychoneuroticism (P < 0.025). Conclusion: The MBT had no significant adverse effect on psychotic symptoms in patients in this small pilot study, neither did it raise the level of mindfulness in the participants. A decrease in psychological symptoms was found, although one patient experienced an increase in symptoms of distress. Our study demonstrates that therapists should be cautious that therapy and practice instructions are understood properly. Future studies are feasible and needed, in larger samples with an RCT design, in order to draw conclusions regarding the effects of the MBT.
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The present study examines the impact of group Person-Based Cognitive Therapy (PBCT) for distressing voices within an uncontrolled evaluation. In particular it utilizes a framework of acceptance of voices and self to enhance well-being and reduce distress and perceived voice-control. Sixty-two participants entered one of nine PBCT groups conducted over 8-12 sessions. Fifty participants completed therapy. Measures of well-being, distress, control and relating characteristics were completed pre- and post-therapy and at brief follow-up. Data were subjected to an intention-to-treat analysis. The groups achieved significant benefits in terms of well-being, distress, control and dependence upon the voice. The present study is the first to report significant improvement in both distress and control. Consequently, Group PBCT for distressing voices may prove a useful addition to existing psychological interventions and is worthy of further investigation. The findings are discussed in relation to clinical implications and limitations.
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The Buddhist notion of "nonattachment" (release from mental fixations) is related to but distinguishable from the Western construct of attachment. Secure (or insecure) attachment is based on internal working models related to security (or insecurity), whereas nonattachment is based on insight into the constructed and impermanent nature of mental representations. Based on historical and contemporary Buddhist scholarship, we designed the Nonattachment Scale and evaluated its psychometric properties in various samples. We also present evidence consistent with Buddhist theory that nonattachment is psychologically and socially adaptive, and we offer directions for further research on nonattachment.
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This study investigates the psychological process involved when people with current distressing psychosis learned to respond mindfully to unpleasant psychotic sensations (voices, thoughts, and images). Sixteen participants were interviewed on completion of a mindfulness group program. Grounded theory methodology was used to generate a theory of the core psychological process using a systematically applied set of methods linking analysis with data collection. The theory inducted describes the experience of relating differently to psychosis through a three-stage process: centering in awareness of psychosis; allowing voices, thoughts, and images to come and go without reacting or struggle; and reclaiming power through acceptance of psychosis and the self. The conceptual and clinical applications of the theory and its limits are discussed.
Article
These cases suggest that the combination of intensive meditation, fasting, sleep deprivation, a history of schizophrenia, and the discontinuation of maintenance doses of phenothiazines can be hazardous. Schizophrenic episodes can be precipitated by almost any severe stress, including a range of intensive therapeutic modalities, and the combination of intensive meditation practice, together with sleep and food deprivation, is certainly demanding. On the other hand, some data suggest that meditation in moderation can be useful in treating a range of psychopathology, including schizophrenia. The population at risk for the syndrome we have described seems to include only people with a history of schizophrenia, for whom maintenance medication, adequate food and sleep, and a less intensive approach to meditation are indicated.
Article
Cognitive behavior therapy (CBT) has been demonstrated in a number of randomized controlled trials to be efficacious as an adjunctive treatment for psychotic disorders. Emerging evidence suggests the usefulness of CBT interventions that incorporate acceptance/mindfulness-based approaches for this population. The current study extended previous research by Bach and Hayes (2002. The use of Acceptance and Commitment Therapy to prevent the rehospitalization of psychotic patients: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 70, 1129-1139) using Acceptance and Commitment Therapy (ACT) in the treatment of psychosis. Psychiatric inpatients with psychotic symptoms were randomly assigned to enhanced treatment as usual (ETAU) or ETAU plus individual sessions of ACT. At discharge from the hospital, results suggested short-term advantages in the ACT group in affective symptoms, overall improvement, social impairment, and distress associated with hallucinations. In addition, more participants in the ACT condition reached clinically significant symptom improvement at discharge. Although 4-month rehospitalization rates were lower in the ACT group, these differences did not reach statistical significance. Decreases in the believability of hallucinations during treatment were observed only in the ACT condition, and change in believability was strongly associated with change in distress after controlling for change in the frequency of hallucinations. Results are interpreted as largely consistent with the findings of Bach and Hayes and warrant further investigations with larger samples.