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A pilot study of loving-kindness meditation for the negative symptoms of schizophrenia

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Abstract

This pilot study examined loving-kindness meditation (LKM) with 18 participants with schizophrenia-spectrum disorders and significant negative symptoms. Findings indicate that the intervention was feasible and associated with decreased negative symptoms and increased positive emotions and psychological recovery.

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... LKM has shown to be effective in RCTs for chronic pain 93 and self-criticism as a transdiagnostic symptom. 94 Uncontrolled studies suggest possible efficacy for symptoms of PTSD, 95 schizophrenia spectrum disorders, 96 and depression. 97 Positive affect was significantly increased in the studies that assessed this domain. ...
... 97 Positive affect was significantly increased in the studies that assessed this domain. 94,96,97 The results have to be regarded with caution, however, as only two studies used a randomized, controlled design, and none of the studies utilized an active control group. As in clinical research on CBIs, more RCTs are needed at this early stage of investigation. ...
... In addition to reducing the main symptoms of the disorders, LKM has also shown to promote positive affect, 94,96,97 which may contribute to the increase of resilience. 85 Hence, LKM may be useful for patients in therapy who already have achieved some understanding and mastery of their clinical symptoms and would further benefit from increased positive affect (cf. ...
Article
Objectives: This article presents a brief overview of the empirical evidence of well-established mindfulness interventions and an in-depth review of less-established compassion-based interventions (CBIs) and loving-kindness meditation (LKM). Definitions, cognitive and physiological mechanisms, and methods of assessment are discussed. Method: A literature review using the databases Google Scholar, PsycINFO, and PubMed was conducted. Results: Whereas the efficacy of mindfulness-based stress reduction and mindfulness-based cognitive therapy has been documented in many trials, only seven randomized, controlled trials have been completed on CBIs and LKM. In these trials, CBIs were effective in treating psychotic disorders, affective disorders with psychotic features, major depressive disorder, eating disorders, and patients with suicide attempts in the past year; LKM was effective in treating chronic pain; and a combination of both was effective for borderline personality disorder. A larger number of nonrandomized studies indicate that CBIs and LKM may be effective in treating a wide range of clinical conditions, including depression, anxiety disorders, chronic pain, and posttraumatic stress disorder. Conclusions: Further studies are needed to confirm the promising effects of CBIs and LKM. Preliminary evidence suggests that both approaches might be beneficial across various clinical populations. Future studies need to clarify whether these approaches might be options as stand-alone treatments or as adjuncts or augmentation of evidence-based methods in psychotherapy.
... Three studies gave an indication of acceptability and feasibility of compassion-based approaches for individuals with SSD, including CFT, Loving Kindness Meditation (LKM), and a Compassion, Acceptance and Mindfulness (CAM) intervention (Braehler, Gumley, et al., 2013;Braehler, Harper, et al., 2013;Johnson et al., 2011;Khoury et al., 2015). All studies reported good acceptability and feasibility. ...
... All studies reported good acceptability and feasibility. Attendance rates were generally high, ranging between 75 and 91% for treatment completers (Braehler et al., 2013a;Braehler, Harper, et al., 2013;Johnson et al., 2011;Khoury et al., 2015). Braehler et al., (2013aBraehler et al., ( , 2013b reported 18% attrition from CFT (4 of 22 participants), while Johnson et al. (2011) reported 2 of 18 non-completers (11%). ...
... Attendance rates were generally high, ranging between 75 and 91% for treatment completers (Braehler et al., 2013a;Braehler, Harper, et al., 2013;Johnson et al., 2011;Khoury et al., 2015). Braehler et al., (2013aBraehler et al., ( , 2013b reported 18% attrition from CFT (4 of 22 participants), while Johnson et al. (2011) reported 2 of 18 non-completers (11%). CAM was completed by 12 of 17 participants (71%; Khoury et al., 2015). ...
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The purpose of this systematic literature review is to provide an exhaustive summary of current research to explore the prospects of compassion-based approaches in treating persons with Schizophrenia Spectrum Disorders (SSD). Thereby, studies investigating the relationship between clinical parameters and self-compassion in SSD, as well as the acceptability, feasibility, and effects of compassion-based approaches for individuals with SSD were considered. The review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and checklist. Eight studies were included for qualitative synthesis. The results indicate an important role of self-compassion for several clinical parameters, including negative associations to positive symptoms, negative symptoms, cognitive disorganization, and emotional distress. All studies reported good acceptability and feasibility. Regarding the clinical effectiveness of compassion-based approaches, a variety of clinical benefits, such as improvements of mood, affect regulation, positive symptoms, negative symptoms, cognitive disorganization, and variables relating to psychological recovery were found in individuals with SSD. It is concluded that compassion-based approaches are a promising form of intervention in the treatment of SSD. However, further research, especially randomized controlled trials, in this field is needed to understand the full potential of compassion-based approaches for individuals with SSD.
... Resources to help support participants to complete home practice included providing CDs of guided practises, written scripts, handouts, and forms to record home practice. Only five studies reported amount of home practice in a format that allowed for calculation of average numbers of minutes/ day, or days/week [18][19][20][21][22] The frequency which people reported home practice ranged from 3 to 7 days/week, and the average duration of each home practice ranged from 1 to 30 min (we did not calculate a pooled estimate due to heterogeneity between studies, and the sparse data available). None of these five studies reported any analyses which examined the association between home practice completion and treatment outcome. ...
... We extracted qualitative data where available from the 11/43 studies included in the primary research question, categorised as either fully qualitative or mixed methods [18][19][20][21][23][24][25][26][27][28][29]. Additional searches for solely qualitative studies resulted in an additional 6 relevant papers being identified (Additional file 1: Fig. S3). ...
... We then moved on to reviewing the data extracted from the remaining mixed-methods studies, to build on our initial synthesis of findings. We found that the majority of mixed-methods studies yielded limited qualitative data from feedback forms or brief interviews, and did not report any findings specifically about home practice [20,21,[23][24][25][26][36][37][38]. The one exception to this was the study by Tong et al. [27], who conducted a full grounded theory analysis of the experience of 11 group participants. ...
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Background Regular home practice is considered a core component of mindfulness groups and may be associated with better treatment outcomes. This study aimed to (1) review the existing evidence on how much home practice people do in mindfulness-based interventions for psychosis groups, and (2) explore participants’ experiences of the barriers and facilitators to completing home practice in a mindfulness for psychosis group using a qualitative study. Methods In study 1, we conducted a systematic review of mindfulness-based interventions for psychosis studies and extracted data on home practice rates. In study 2, we conducted semi-structured interviews with people who had completed a mindfulness for psychosis group (N = 5) as part of their routine community care, specifically focusing on experiences of home practice. Results Out of 43 studies included in the systematic review, only 5 reported any data on amount of home practice, and none examined the relationship between completion of home practice and treatment outcomes. In the qualitative study, participants described home practice as being difficult but important. Arising themes were similar to findings from previous (non-psychosis) studies suggesting that generic challenges are common, rather than being specific to psychosis. Conclusions We recommend that future mindfulness-based interventions for psychosis studies record data on home practice rates, in order to investigate any association between home practice and treatment outcome. Our qualitative findings suggest home practice can be a valued part of mindfulness for psychosis group, and a normalising approach could be taken when and if participants encounter common challenges.
... PPIs are designed to promote positive cognitions, feelings and behaviours, and improve overall psychological well-being (29). More conventional psychological interventions target the amelioration of speci c de cits (e.g., symptom reduction), but PPI's are designed to increase sense of meaning and purpose in life, connectedness with others, and enhance positive emotions (30)(31)(32). A PPI targeting loneliness will build on participants' social strengths and skills and will encourage the development of positive emotions within existing relationships by supporting users to show more prosocial behaviours towards others. ...
... Peer Tree includes many features from +Connect (31,32) but also includes the personalisation of modules based on user symptom pro les, a peer and clinician moderated chat forum, and animated videos to address loneliness in young people using a positive psychology framework. ...
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Background: Young people are vulnerable to experiencing problematic levels of loneliness which can lead to poor mental health outcomes. Loneliness is a malleable treatment target and preliminary evidence has shown that it can be addressed with digital platforms. Peer Tree is a strengths-based digital smartphone application aimed at reducing loneliness. The study aim is to reduce loneliness, and assess the acceptability, usability, and feasibility of Peer Tree in young people enrolled at university. Methods: This will be a pilot randomised controlled trial (RCT) comparing a strengths-based digital smartphone application (Peer Tree) with a treatment as usual (TAU) condition. Forty-two young people enrolled at university will be recruited for this pilot RCT. Participants with suicidality risk, acute psychiatric symptoms in the past month, or a current diagnosis of a mood or social anxiety disorder will be excluded. Allocation will be made on a 1:1 ratio and will occur after the initial baseline assessment. Assessments are completed at baseline, post-intervention, and at follow-up. Participants in the TAU condition complete the same three assessment sessions. The primary outcomes of the study will be self-reported loneliness as well as the acceptability, usability, feasibility and safety of Peer Tree. Depression, social anxiety, and quality of life variables will also be measured as secondary outcomes. Discussion: This trial will report the findings of implementing Peer Tree, a smartphone application aimed at reducing loneliness in university students. Findings from this trial will highlight the initial efficacy, acceptability and feasibility of using digital positive psychology interventions to reduce subthreshold mental health concerns. Findings from this trial will also describe the safety of Peer Tree as a digital tool. Results will contribute evidence for positive psychology interventions to address mental ill-health. Trial registration: Australian New Zealand Clinical Trial Registry, ACTRN12619000350123. Registered 6th March 2020
... These adaptions comprised the shortening of mindfulness exercises, minimizing periods of silence, include basic anchoring exercises, smaller group sizes (< 6), as well as MBIs delivered by experienced mindfulness practitioners (62). Current meta-analyses demonstrated that those MBIs protocols are effective in reducing psychotic symptoms (57) as well as depressive symptoms in SSDs (57,63), while results are mixed for negative symptoms (57,(64)(65)(66)(67). Additional studies of MBIs have revealed an improvement in social functioning (68) and self-esteem (69). ...
... Since ancient Buddhist times, mindfulness practice has been characterized by these conditions and is further associated with contentment and inner equilibrium. Present outcomes are in line with previous research, (65) with patients having SSDs revealing decreased negative symptoms and increased positive emotions as well as improved overall recovery. The main mechanism behind this effect may lie in the heightened levels of acceptance for psychotic experience and oneself. ...
Article
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In recent years, mindfulness-based interventions (MBI) have gained clinical relevance in the treatment of patients with schizophrenia spectrum disorders (SSDs). Symptom burdens, prolonged hospital stays, and high rates of rehospitalization demonstrate the severity and cost-intensity of these disorders. MBIs have shown promising treatment outcomes in a small number of trials, primarily taking place in English-speaking countries. The current study aims to explore mechanisms and processes as well as adverse effects of MBIs on in-patients with SSDs in a German university hospital setting. A qualitative design based on inductive thematic analysis accompanied by quantitative assessments was chosen. A semi-structured interview guide was developed by psychiatrists and psychologists to assess patient experiences, perceptions, thoughts, and feelings during and after taking part in a MBI. Twenty-seven interviews were conducted between September 2017 and October 2018 with in-patients who are diagnosed with schizophrenia or schizoaffective disorder. Rater-based questionnaires, such as the Positive and Negative Syndrome Scale (PANSS), Montgomery Asberg Depression Rating Scale (MADRS), and Psychotic Symptom Rating Scales-Auditory Hallucination (PSYRATS-AH) were administered at baseline to collect clinical outcomes. Qualitative analysis revealed two domains: content and function. In the first domain related to content with the core elements "detachment and rumination", "presence and getting lost", "non-judgment and judgment", and effects with "emotions", "cognition", and "symptom changes". A second domain related to function was extracted, including the relevance of perception of context and transfer to everyday life. Overall, improvements concerning cognition, distress, and psychopathology were detected, while no adverse effects, such as increased psychotic symptoms, were revealed. As the first study of its kind, mechanisms, processes, and the safety of MBIs were explored and confirmed in a sample of German in-patients with SSDs. The results of this qualitative study are in line with recent findings on MBIs amongst patients with psychotic disorders from other countries. Results lay the ground for future research to focus on the systematic study of MBIs in large samples, its treatment processes, outcomes, and effectiveness for in-patients with SSDs.
... There is a dearth of clinical studies in this area although the practice of loving-kindness meditation has been found to be applicable and beneficial in two studies done by Johnson and his colleagues (2009 and 2011) on small sample sizes of patients having Schizophrenia Spectrum Disorder with prominent negative symptoms. The findings of the studies indicated that practice of loving kindness led to a reduction in negative symptoms, anhedonia, asociality, and avolition in the sample, with simultaneous improvements in positive emotions, hope, environmental mastery, self-acceptance, satisfaction with life, and psychological recovery (Johnson et al., 2009;Johnson et al., 2011). In war veterans with Post-Traumatic Stress Disorder (PTSD), Kearney and his colleagues (2013) found enhanced self-compassion and mindfulness using this approach along with lower levels of depression and PTSD symptoms. ...
... In clinical situation, these modules have been found to be effective in veterans for reducing their PTSD (Kearney et al., 2013) and for reducing negative symptoms in schizophrenia (Johnson et al., 2011). Further, it has been studied in professionals engaged in mental health care, such as using loving-kindness meditation for fostering well-being and cultivating compassion and self-care in trainee psychotherapist (Boellinghaus et al., 2013) and loving-kindness meditation for enhancing cognitive and affective empathy and decreasing personal distress in student counselors (Leppma & Young, 2016). ...
Preprint
In the entire spectrum of available meditations, those focused on interpersonal aspects have been relatively less studied. Such aspects need equal research attention in a world where majority of practitioners live a life populated with interpersonal joys, interactions, concerns and sufferings. The contemplative traditions rooted in India, from Yoga-Vedanta to Buddhism have emphasized development of positive interpersonal qualities, such as maitri, mudita, karuna and upeska. These concepts have been discussed in-depth in the present chapter, along with a review of the available research and future directions.
... In eight studies, participants were recruited from outpatient clinics and specialized centers for psychotic disorders. 3,6,17,[19][20][21]23 In one study, patients were admitted to a psychiatric ward. 22 One study assessed intervention using a smartphone app (+Connect), 23 with aid and support from therapists once a week. ...
... Despite being central to PPT, assessment of character strengths was not present in the selected articles. 4 The SBI is a 24-item scale that assesses the ability to obtain pleasure by anticipating positive future events, savoring positive moments in the present, and recalling past positive experiences, with scores ranging from 1 to 7. 38 This scale was present in the evaluation of five of the nine included studies, 3,6,[17][18][19] which may suggest its superiority in measuring results related to well-being in positive psychology. ...
Article
Full-text available
Objective: Positive psychology interventions (PPIs) incorporate principles of personal strengths with the view that mental health recovery transcends symptom relief. Severe psychiatric conditions, such as schizophrenia, may benefit from such interventions. This study aims to gather the current evidence on the impact of PPIs on increasing well-being in patients on the schizophrenia spectrum and assess reductions in negative or positive symptoms. Methods: A systematic review of PPI studies with schizophrenia-spectrum patients was carried out following PRISMA recommendations. The PubMed, PsycINFO, Web of Science, and Scopus databases were searched for relevant publications in order to understand the possible effects of these interventions on well-being measures and psychotic symptoms in this population. Results: Nine studies (four controlled) were included. Meta-analysis of the controlled studies showed a significant effect (p = 0.04) for improvement of well-being (Z = 2.01). Overall, the reviewed evidence suggests well-being improvement. The effect on reduction of negative symptoms was unclear. Conclusion: Used as an adjunctive therapy, PPIs appear to be a promising resource for patients on the schizophrenia spectrum, with possible effects on well-being and symptom reduction.
... Some authors endorsed longerinterventions to better consolidate practice (n=12, 21% of studies; (Bach et al., 2012;Braehler et al., 2013;Brown et al., 2010;Chadwick et al., 2016;Chien et al., 2017;Davis, 2014;Davis et al., 2007;Davis et al., 2015;Miller, 2011;Shawyer et al., 2017;Spidel et al., 2018)), for example, 20 weeks (Brown et al., 2010), or a twice repeated 32-week curriculum (Davis et al., 2015). Similarly, authors highlighted the potential utility of booster sessions (n=6, or 9% of studies (Bach et al., 2012;Davis et al., 2015;Davis et al., 2007;Johns et al., 2016;Johnson et al., 2011;Ting et al., 2020)) and openended curriculums (n=3; (Brown et al., 2010;Davis et al., 2015;Jacobsen et al., 2011). ...
... Facilitators frequently cited the value of acceptance and compassion practices, alongside mindfulness. Compassion practices, in particular, were emphasized for potential utility (n=13, 20% of studies; Braehler et al., 2013;Brown et al., 2010;Davis, 2014;Davis et al., 2015;Hickey et al., 2019;Jansen & Morris, 2017;Johnson et al., 2011;Khoury et al., 2015;Martins et al., 2017;Miller, 2011;Spidel et al., 2018)). Authors suggested compassion could help drive a sense of belonging and reduce self-stigmatization in early-psychosis cohorts (n=5, 29% of completed FEP studies; (Ashcroft et al., 2012;Hickey et al., 2019;Jansen & Morris, 2017;Khoury et al., 2015;Tong et al., 2016)). ...
Article
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Objectives How to best implement mindfulness interventions within different stages of psychosis (high risk for psychosis, first episode psychosis (FEP), established psychosis) remains relatively unexplored. Understanding where and how mindfulness research has been conducted at different stages of illness can guide future research, and improve intervention acceptability and treatment effects.Methods An evidence mapping approach was taken to systematically search and identify where and how mindfulness research has been conducted across stages of psychosis. Papers were examined for intervention approaches and safety concerns, and content analysis examined practitioner recommendations to identify recommendations within and across stages of illness.ResultsA paucity of research relating to the application of mindfulness in the treatment of psychotic illness exists for the high risk stage, with some research in FEP. The majority of research examines mindfulness approaches for the chronic stage of illness. Intervention formats for different stages of psychosis varied widely. Across all stages of psychosis, authors recommended adaptations for cognitive impairments (e.g., shorter exercises for impacted attention), longer interventions, and more helpful ways of explaining mindfulness and encouraging practice. Few stage-specific recommendations emerged beyond the potential helpfulness of compassion-based practices within earlier stages of illness where self-stigmatization often emerges.Conclusions Recommendations for how to best adapt mindfulness to early intervention in psychosis are needed, and future research needs to better understand risks and utility of different mindfulness practices for different stages of illness.
... The authors point out that as a result of the therapy, the mechanism of recovery is being activated. At the same time, they emphasize that the unsolved problem is the generalization of acquired skills and attitudes to life beyond therapeutic situations [18,19]. ...
... Autorzy zaznaczają, że w wyniku terapii dochodzi do aktywowania mechanizmu zdrowienia. Jednocześnie podkreślają, że jak dotychczas nierozwiązanym problemem jest generalizacja nabytych umiejętności i postaw życiowych poza sytuacje terapeutyczne [18,19]. ...
Article
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Positive psychology directs its research interests primarily to healthy people. The most important goal is to build a positive attitude towards yourself and the surrounding world. Recently, positive psychology has set a new area of research interest, which is clinical psychology. In recent years, several positive psychotherapy programs have been developed for people with schizophrenia experience. The article presents the latest trends in positive psychotherapy for people with schizophrenia. They involve taking into account the individual differences of each patient and the specificity of his / her psychopathology. As far as the therapeutic goals are concerned, there are interventions focused on strategies for enhancing positive emotions and wellbeing or the method of activating the strengths of character. Taking into account the methods of therapeutic work, they can be divided into training methods or those of the behavioral-cognitive psychotherapy as well as those that take into account the various aspects of meditation. The article presents the distribution of therapeutic programs in terms of the range of therapeutic goals in which the most important are: intensification of positive experiences, building of strengths of character and well-being. Therapeutic programs have been shown to focus not only on breaking down negative attitudes towards one's own illness and life, but also on those that try to deal with the unsolved schizophrenia problem - negative symptoms.
... There was no statistically significant difference in positive affect between the experimental and control groups. This result is inconsistent with that of a previous study [50] that observed a change in positive affect after patients with schizophrenia participated in meditation. An explanation for this inconsistency is that the meditation program provided for people with schizophrenia in the previous study [50] mainly consisted of loving-kindness meditation, which focuses on fostering feelings of being happy, cozy, and comfortable. ...
... This result is inconsistent with that of a previous study [50] that observed a change in positive affect after patients with schizophrenia participated in meditation. An explanation for this inconsistency is that the meditation program provided for people with schizophrenia in the previous study [50] mainly consisted of loving-kindness meditation, which focuses on fostering feelings of being happy, cozy, and comfortable. Instead, the MBSR program applied in this study included various elements, such as breath-ing meditation, body scanning, yoga meditation, walking meditation, eating meditation, and loving-kindness meditation. ...
Article
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Mindfulness-based stress reduction programs have been found to be effective in reducing the stress response and improving the psychological wellbeing of various populations. We aimed to confirm the effects of a mindfulness-based stress reduction program on perceived stress, heart rate variability, positive and negative affect, and subjective wellbeing of community-dwelling people with schizophrenia. The participants in this study were 26 people with schizophrenia (experimental group: 14, control group: 12) enrolled in two community mental health centers located in Gyeonggi Province in South Korea. In the experimental group, the mindfulness-based stress reduction program was applied once a week for 60 min over 8 weeks. The experimental group showed a significantly greater decrease in perceived stress and negative affect, as well as significantly greater improvement in heart rate variability than the control group. The mindfulness-based stress reduction program was an effective nursing intervention to reduce stress and negative affect in people with schizophrenia.
... The COMPASS program builds upon the available research on contextual behavioural approaches for psychosis Chadwick, 2014;Johnson et al., 2011;Laithwaite et al., 2009;Martins et al., 2017b). The program's main framework is the affect regulation system's model ( Gilbert, 2005) and the compassion-focused therapy rationale as it was adapted for psychosis (Gumley et al., 2010). ...
... Considering preliminary but encouraging results from Loving- kindness meditation (LKM) in negative symptoms of schizophrenia (Johnson et al., 2011), as well as its theoretical rationale (Johnson et al., 2009), COMPASS also includes brief and simple LKM practices, namely loving kindness to a loved one (person/object/animal) and loving kindness to the self. ...
Article
Described as a contextual behavioural approach, Compassion-focused Therapy (CFT) aims at helping people develop compassionate relationships both with others and with the self. CFT has been used to promote recovery in psychosis with promising results. The development process of the Compassionate Approach to Schizophrenia and Schizoaffective Disorder (COMPASS) builds upon the available research on contextual behavioural approaches for psychosis. Its main framework is the affect regulation system's model and the compassion-focused therapy rationale as it was adapted for psychosis. Other theoretical and empirical influences are presented and innovations regarding CFT protocols for psychosis are highlighted. COMPASS is already being studied and details on the pilot study are provided. With further study and continuing improvement COMPASS has the potential to help foster recovery in psychosis. Keywords Compassion; Mindfulness; Psychosis; Recovery
... The mechanisms underlying this effect of YoGI are not yet established, thus study designs involving a control group that assess a variety of external factors need to follow up the reported experiences to be able to establish causal relationships. However, similar processes have been observed with mindfulness practises showing an increase in positive emotions and anticipatory pleasure (71). Since a lack of anticipatory pleasure has been linked to NS (72,73), interventions facilitating these processes might indirectly target clinical manifestations of SSD. ...
Article
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Background: Yoga may pose a promising complementary therapy in the multimodal treatment of in-patients with schizophrenia spectrum disorders (SSD). However, to date, no studies have qualitatively examined in-patients' with SSD experiences of Yoga as well as their perceptions of its limitations and benefits as a treatment component. This qualitative study aimed to explore for the first time the mechanisms and processes of Yoga-based Group Intervention (YoGI) for in-patients with SSD in Germany by asking for their subjective experiences. Findings could serve as a preliminary basis for developing an effective and evidence-based YoGI manual tailored to this patient group. Materials and Methods: In total, 25 semi-structured interviews were conducted directly after YoGI, for which responses were either noted down by hand or audio-recorded. The interview guide was pilot-tested and consisted of 14 questions to explore the personal articulated experiences of participation in YoGI from in-patients with SSD. Positive, negative, depressive, and anxiety symptoms were assessed during a diagnostic interview and through questionnaires. The interview data was transcribed, coded by two independent researchers, and analysed using an inductive thematic approach. The research team collaboratively discussed emerging categories to reduce redundancy and form meaningful themes and subthemes. Results: The analysis revealed seven main themes. YoGI was perceived as feasible and focusing on individual adaptation, captured by the theme inclusivity . Nevertheless, participants encountered challenges ; thus, physical limitations need to be considered. While practising together, participants experienced interconnectedness and developed a mindful stance as they accepted their limitations and adapted exercises with self-compassion. Patients described that following the flow of the asanas required physical persistence, which ultimately led many participants to experience confidence and relaxation . YoGI affected symptom representation as heightened awareness led participants to notice impeding as well as improved symptoms. Conclusion: YoGI showed various promising effects on in-patients with SSD. Future research should examine to what extent these effects can be sustained and how the mindful approach during YoGI can be transferred to areas outside the Yoga class. Furthermore, a randomised controlled trial could investigate the effectiveness of a manualised YoGI.
... The LKM has been shown to decrease pain and psychological distress for those with serious health conditions, such as cancer. [13][14][15][16][17] For individuals with breast cancer, a preliminary study found that LKM was associated with reduced pain and improved compassion for patients during biopsy and surgery compared with usual care. 18 In addition, there is a potential for LKM interventions to provide benefit for clinical populations suffering from social anxiety, marital conflict, anger, and strains of long-term caregiving. ...
Article
Objectives: CaringBridge (CB) is an online health community for people undergoing challenging health journeys. Loving Kindness Meditation (LKM) is a systemized mind-body approach developed to increase loving acceptance and has previously been reported to increase resilience in the face of adversity. Materials and Methods: Results of a randomized controlled trial of immediate compared with deferred 21-day LKM intervention in an online community are reported. The deferred group received LKM intervention after a waiting period of 3 weeks. Inclusion criteria were >18 years old, ability to understand English, willingness to participate in a mind-body practice, and use of CB for a cancer journey. Change in perceived stress, self-compassion, social connectedness and assurance, and compassionate love scales from baseline to 21 days was assessed. Results: Of the 979 participants included in the study, 649 (66%) provided 3-week follow-up data and 330 (49%) self-reported engaging in the LKM practice 5 or more days/week. Participants in the immediate LKM group reported medium effect size improvement in stress (0.4), self-compassion (0.5), and social connectedness (0.4) compared with the deferred LKM group. Changes in perceived stress and self-compassion were larger in magnitude and increased with more frequent engagement in LKM. Conclusions: The immediate LKM group showed improvements in stress, self-compassion, and social connectedness compared with the deferred control group. Differential study retention rates by treatment arm and self-reported engagement in LKM subject the results to selection bias. Future research of similar interventions within online health communities might pay greater attention to promoting intervention adherence and engaging a more diverse economic and racial/ethnic population. ClinicalTrials.gov (NCT05002842).
... The possible explanation of these findings is that, the positive emotional program applied in this study included techniques to challenge defeatist thoughts and teaching new skills to anticipate and maintain positive emotions. Johnson et al. (2011) revealed that, large improvements in participants' frequency and intensity of positive emotions at both post-test and three-month follow-up, supporting the first hypothesis. Participants also showed a large decrease in total negative symptoms and anhedonia as well as asociality at post-treatment and three-month follow-up, supporting the second hypothesis. ...
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The purpose of this study was to investigate the effectiveness of positive emotional treatment program on anhedonia and apathy among schizophrenic patients. Setting: The present study was conducted at the Al-Abbassia Mental Health Hospital. Sample: A purposive sample consisted of thirty schizophrenic patients was recruited in the current study. The sample of the current study was divided into experimental and control groups. Methods: A quazi-experimental design was used in this study. Three tools were used to collect the data for the current study, Personal data sheet, Scale for the Assessment of Negative Symptoms and The Savoring Beliefs Inventory. A constructed positive emotional program was designed to help patients to develop necessary skills for modifying defeatist thinking, to learn and practice a new skill to improve their anticipation or maintenance of pleasure. This program was implemented over thirteen sessions, two sessions per week and each session lasted about 60-90 minutes. Pre and post assessments were carried out for the experimental and control groups. Results: The current study results revealed overall significant effects of positive emotional program regarding decreasing patients' negative symptoms and increasing their anticipation or maintenance of pleasure. Socio-demographic data showed no statistically significant in relation to pre and post assessments, however; anhedonia domain was statistically related with level of education. Conclusion and recommendations: the study concluded that, the positive emotional program was effective with schizophrenic patients' concerning reducing negative symptoms and enhancing anticipation or maintenance of pleasure. The study recommended that, the positive emotional program should be incorporated into treatment regimen of schizophrenic patients. In addition, applying techniques that are proven to be positively correlated with emotional regulation enhancement such as mindfulness practice rather than just using medication that have less effect on patient 'emotions.
... The applications issued from positive psychology interventions with patients suffering from schizophrenia are infrequent [63]. The main interventions that have been tested with patients suffering from schizophrenia or related psychosis are mindfulness [64], acceptance and commitment therapy [65], love kindness meditation [66] and compassion therapy [67]. These interventions are difficult to compare with the intervention in the current study; although they involve emotion regulation techniques, PEPS focuses on learning positive emotion regulation skills. ...
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Background: Negative symptoms are frequent in patients with schizophrenia and are associated with marked impairments in social functioning. The efficacy of drug-based treatments and psychological interventions on primary negative symptoms remains limited. The Positive Emotions Programme for Schizophrenia (PEPS) is designed to improve pleasure and motivation in schizophrenia patients by targeting emotion regulation and cognitive skills relevant to apathy and anhedonia. The main hypothesis of this study is that patients who attend 8 one-hour sessions of PEPS and treatment as usual (TAU) will have lower total apathy-avolition and anhedonia-asociality composite scores on the Scale for the Assessment of Negative Symptoms (SANS) than patients who attend only TAU. Methods: Eighty participants diagnosed with schizophrenia or schizoaffective disorder were randomized to receive either TAU or PEPS + TAU. The participants were assessed by independent evaluators before randomization (T0), in a post-test after 8 weeks of treatment (T1) and at a 6-month follow-up (T2). Results: The post-test results and 6-month follow-up assessments according to an intention-to-treat analysis showed that the apathy and anhedonia composite scores on the SANS indicated statistically greater clinical improvements in PEPS participants than in non-PEPS participants. In the post-test, anhedonia but not apathy was significantly improved, thus favouring the PEPS condition. These results were sustained at the 6-month follow-up. Conclusions: PEPS is an effective intervention to reduce anhedonia in schizophrenia. PEPS is a short, easy-to-use, group-based, freely available intervention that is easy to implement in a variety of environments (ClinicalTrials.gov ID: NCT02593058).
... MERIT is based on metacognition (the capacity to think about one's own thinking), and it has proved to be an effective therapy to promote recovery from schizophrenia-spectrum disorders. We also strongly recommend interventions that increase positive affect, such as Loving-Kindness Meditation (LKM; Johnson et al., 2011), which seems to be effective in reducing the negative symptomatology of schizophrenia. Finally, Coming Out Proud (COP; Corrigan et al., 2015) is also an appropriate program to reduce internalized mental illness stigma. ...
Article
Previous research has shown that the internalization of schizophrenia-related stigma is associated with a worse prognosis and more suicidal tendencies. Empirical literature suggests that affective well-being —composed of positive affect (e.g. pride, enthusiasm, vitality, inspiration) and negative affect (e.g. shame, guilt, annoyance, worry)— seems to be the key component which, when being negatively affected by internalized stigma and the subsequent deterioration of self-concept, would lead to more severe symptomatology, lower recovery, and higher risk of suicide. Thus, our aim was to delve into the process by which affective well-being is impacted by the two main dimensions of internalized stigma (stereotype endorsement and alienation), with self-esteem and self-efficacy as mediators. The model was tested by path analysis —maximum likelihood procedure— in a sample of 216 patients. Our results indicate that alienation would entail more damage than stereotype endorsement both on affective well-being and on self-concept. Findings suggest that self-esteem mediates the impact of both internalized stigma dimensions on both types of affect, and that self-efficacy mediates the impact of alienation on positive affect. It is concluded that, in clinical practice, an important effort should be made to prevent internalized stigma (especially, alienation) and to promote positive self-concept of patients (especially, self-esteem).
... In this open trial, people with SZ found ACES feasible and helpful, and reported a reduction in NA after the group ended. Alternatively, Johnson et al. (2011) found that a 6-week loving kindness meditation intervention-a mindfulness practice where individuals focus on feeling compassion toward oneself and others-increased the frequency of experiencing PA and reduced anhedonia posttreatment and at 3-month follow-up in people with SZ. Both of these interventions incorporated techniques that are also used in the BMAC procedure (e.g., mindfulness, positive appraisal, savoring) but over the course of several weeks in a group intervention format-two factors that may be necessary for people with SZ to benefit from such interventions. ...
Article
Previous studies have found that people with schizophrenia report more negative affect (NA) in response to positive and neutral stimuli (incongru-ent NA) than people without schizophrenia, perhaps related to heightened overall NA. We sought to decrease NA and increase positive affect (PA) using the Broad-Minded Affective Coping (BMAC) procedure in people with (n = 29) and without (n = 26) schizophrenia. We also investigated whether decreased NA would contribute to a decrease in incongruent NA in people with schizophrenia. The BMAC procedure increased PA but did not decrease NA in participants, nor did it influence reports of incongruent NA (in response to positive and neutral films) in people with schizophrenia. Baseline NA in people with schizophrenia was correlated with incon-gruent NA and symptom severity. Results indicate that people with schizophrenia report heightened NA that does not readily diminish in the face of heightened PA.
... Consistently, Bdifficulty maintaining cognitive focus^was the most frequently reported issue in another qualitative study that included both the FIM and mindfulness meditations (Sears et al. 2011). Difficulties in generating loving-kindness, or even experiencing negative feelings, have also been qualitatively reported in several studies (e.g., Boellinghaus et al. 2013;Johnson et al. 2011). These widely mentioned problems during FIM meditation match well with the two elements of the FIM (i.e., concentration and attitude) mentioned above. ...
Article
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The Four Immeasurables Meditations (FIM) are a group of meditations rooted in Buddhism that cultivate pro-social attitudes. Previous studies have reported common difficulties during the practice of the FIM, yet there is no specific measure for those difficulties. The current study intended to develop the Difficulties during Meditation involving Immeasurable Attitudes Scale (DMIAS) to measure two aspects of common difficulties during the FIM practice: lack of concentration (LOC) and lack of pro-social attitudes (LOP). A total of 506 meditation novices were used in four studies. In study 1, exploratory factor analysis (EFA) with the data from a one-time practice of loving-kindness meditation was used to produce the 12-item DMIAS with two independent factors that were positively correlated (LOC and LOP). Studies 2, 3, and 4 validated the DMIAS in one-time practices of loving-kindness meditation, appreciative joy meditation, and compassion meditation, respectively. Across studies 2 to 4, confirmatory factor analyses supported the two-factor structure of the DMIAS, and both LOP and LOC had negative correlations with the other-focused positive emotions generated by the meditations. Although manipulations of the target to be blessed (study 3) and the length of practice (study 4) only had small impacts on the effects of meditation, the pattern of correlations between emotional outcomes and certain factors of the DMIAS was significantly different between the manipulated conditions. In summary, the DMIAS is a useful tool in understanding the difficulties during the FIM practice, and the current study also illustrated how technical details of the FIM influences the effects of the FIM practice.
... One way this could be examined would be to examine the neural correlates of processing positive stimuli in SocAnh and whether this is associated with decreased activity in brain areas associated with higher level conceptual appraisals of positive stimuli (e.g., lateral orbitofrontal cortex; Dixon et al., 2017). Another area of research might be to examine whether interventions that attempt to increase positive affect, such as teaching individuals to recall and savor positive emotional experiences (Johnson et al., 2011;Favrod et al., 2015), are effective in people with elevated levels of SocAnh and whether they could aid in the prevention of the development of schizophrenia-spectrum personality disorders. ...
Article
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Although emotion deficits in schizotypy have been reported, the exact nature of these deficits is now well understood. Specifically, for social anhedonia (SocAnh), there are questions about whether any decrease in positive affect only reflects an explicit bias not observed in other measures (e.g., implicit affect measure). At the same time, for individuals with elevated levels of perceptual aberrations or magical ideation (PerMag), there is some evidence of an increased influence of affect on judgment. It is also possible that the influence of implicit affect on judgment might be especially pronounced in PerMag; however, this has not been previously examined. The current study involved people with elevated levels of SocAnh (n = 95), elevated levels of PerMag (n = 62), and people with average or lower levels of both (n = 246). We found that SocAnh was associated with decreases in both explicit and implicit positive affect. We also found that PerMag was related to stronger relationships between implicit affect, both positive and negative, and a judgment task. These results suggest that decreased positive affect is a core feature of SocAnh and that a heightened influence of affect could be related to the development of peculiar beliefs/experiences associated with PerMag.
... Aufgrund dieser Prozesse könnte LKM auch im Kontext der Behandlung psychischer Störungen einen Ansatzpunkt bieten. Einige Pilot-Studien haben bereits versucht, die LKM auch in die Behandlung von klinischen Populationen, wie zum Beispiel Patientinnen und Patienten mit Posttraumatischer Belastungsstörung (Kearney et al., 2014), negativen Symptomen der Schizophrenie (Johnson et al., 2011) oder chronischen Schmerzen (Carson et al., 2005) zu implementieren. Hierbei konnten signifikante Verbesserungen der Symptomatik erzielt werden. ...
Article
Zusammenfassung. Theoretischer Hintergrund: Chronische Depressionen gehen mit einer langwierigen Belastung einher und verursachen hohe Krankheitskosten. Ein möglicher Ansatz zur Behandlung könnte die Loving Kindness Meditation (LKM) sein. Methode: In dieser Pilot-Studie wurde ein LKM-Gruppenprogramm eingesetzt und bezüglich der Effektivität untersucht. N = 2207 Fälle aus Wartelistendaten wurden stufenweise zu der LKM-Gruppe (n = 12) zugeordnet. Zwei Kontrollgruppen (n = 134 und n = 12) wurden gebildet, indem zunächst die Ein-und Ausschlusskriterien angewandt wurden und dann die verbliebene Stichprobe basierend auf der Kovariatenverteilung mittels Propensity Score Matching (PSM) angepasst wurde. Die Gruppen wurden anhand des OQ-30 verglichen. Ergebnisse: Im Prä-Post-Vergleich zeigten sich im OQ-30 signifikante Verbesserungen. Allerdings zeigte sich das so nicht in den symptomspezifischen Instrumenten (BDI-II und HAM-D). Im Vergleich zu der gesamten Wartelistenstichprobe (n = 134) ergaben sich signifikante Verbesserungen im OQ-30. Verglichen mit der PSM-Wartelistenkontrollgruppe zeigten sich marginal signifikante Unterschiede im OQ-30, signifikante Unterschiede konnten bezüglich der Depressionsitems des OQ-30 nachgewiesen werden. In der Interventionsgruppe ergaben sich mehr reliable Verbesserungen im OQ-30 als in den Wartelistenkontrollgruppen. Schlussfolgerung: Die Pilotstudie zeigte eine geringere Abbruchquote als Vorgängerpilotstudien und eine gute Prä-Post Effektstärke im OQ-30, sowie im Vergleich zu den beiden Wartelistekontrollgruppen. Allerdings zeigten sich keine konsistenten Prä-Post Effekte in den Depressionsskalen. Eine weitere umfangreichere Studie mit aktiver Kontrollgruppe wäre nötig, um das Programm hinsichtlich seiner Effektivität, bezüglich des Abbruchs sowie der Heterogenität der Effekte in den Depressionsskalen weiter untersuchen zu können.
... This design does not allow for an inference about the efficacy of the group intervention. Other pilot studies have used similar methodologies for intervention in an early stage of development (Johnson et al., 2011) and the primary purpose of the study was to assess feasibility and acceptability and so, we consider this design to be justified. However, future studies would need to include a larger sample with a comparison group to determine the effectiveness of this intervention. ...
Article
The promotion of well-being is essential in the recovery process of mental health problems and has been shown to predict remission in psychosis. Even for severe mental illness where there has been and pessimistic view of prognosis, there is an increased awareness in the need for a positive movement, focusing on well-being and positive psychosocial factors in its treatment. The aim of this study is to provide data on the feasibility and acceptability of a manualised group intervention to improve well-being in a sample of patients with paranoid tendencies. Results showed that the protocol was feasible and highly acceptable for participants, showing high attendance and adherence as well as high satisfaction. On completion of group therapy, participants reported a significant improvement in different domains of well-being, with larger effects in self-acceptance and positive relationships with others. There was also significant improvement in self-esteem and significant decrease in paranoid ideation and anxiety. The results indicate that positive psychology group therapy may be a powerful complementary strategy in mental health promotion among people with paranoid tendencies. Though the validity of the study is limited by the lack of a comparison group, the present study will allow optimisation of a future RCTs.
... The post-hoc analyses lend some support to this notion, showing better effect on negative symptoms for interventions delivered in groups compared to interventions delivered individually. Another interpretation is that mindfulness may increase positive emotions and possibly anticipatory pleasure, which is one of the deficits underlying negative symptoms, as suggested by Johnson et al. (2011). A recent review looking at mediation analyses in mindfulness studies also highlighted reduction in cognitive and emotional reactivity and repetitive negative thinking as important underlying mechanisms (Gu et al., 2015). ...
Article
Background: Acceptance- and mindfulness-based approaches have gained popularity in recent years. Objective: A systematic review and meta-analysis of the efficacy and safety of acceptance- and mindfulness-based therapies for persons with a psychotic or schizophrenia spectrum disorder. Methods: Following PRISMA guidelines, relevant databases were searched for published randomized controlled trials (RCTs) up to October 2018. Outcomes were severity of overall symptomatology, hospitalization, positive and negative symptoms, depression, anxiety, social functioning, quality of life, acceptance, mindfulness skills and safety of the interventions. Results: Sixteen studies comprising 1268 people with a schizophrenia spectrum disorder were included in the meta-analyses. Moderate to large effect sizes were found for overall symptomatology and hospitalization at endpoint (SMD .80, 95% CI -1.31, -0.29 and MD 4.38, -5.58, -3.17 respectively) and follow-up (SMD 1.10, -2.09, -0.10 and MD 7.18, -8.67, - 5.68 respectively). There were significant small effects on negative symptoms (SMD .24; -0.44, -0.03), small to moderate effects for depression (SMD .47; -0.80, -0.14), social functioning (SMD .43; -0.75, - 0.12) and mindfulness (SMD .51; -0.97, -0.05), moderate to large effects for acceptance (SMD .78; -1.44, -0.12), while no significant effects for positive symptoms (SMD .27; -0.65, 0.00), anxiety (SMD 2.11; -4.64, 0.42) or quality of life (SMD .43; -0.88, 0.02). Majority of studies (75%) had low risk of bias and sensitivity analyses supported the findings. Conclusion: Acceptance- and mindfulness-based approaches appear to be effective and safe interventions for individuals with schizophrenia spectrum disorders and could be a useful extension of standard casemanagement and psychofarmacology.
... 1-3 In schizophrenic patients, mindfulness intervention leads to better psychosocial functioning, 4 improved positive emotions, 5 and reduced negative symptoms. 6 It is unknown if mindfulness meditation could reduce positive symptoms in the chronic schizophrenia patients. These patients demonstrated severe and drug treatment-resistant hallucination/delusions (score >5; Details in Table 1). ...
... In the years since the introduction of positive psychology (Seligman and Csikszentmihalyi 2000), the need for greater wellbeing in workplaces, communities, and educational institutions has increasingly been recognized as fundamental to human growth and excellence (Allen and McCarthy 2016;Oades et al. 2011;Schueller 2009). In turn, this need has been met by a proliferation of research activity, organizational policies, and programs around the world as wellbeing has been identified as a significant contributor to better learning (Seligman et al. 2009;Suldo et al. 2011), employment and job satisfaction (Haase et al. 2012;Kansky et al. 2016;Luhmann et al. 2013), physical health (Blanchflower et al. 2012;Diener and Chan 2011;Grant et al. 2009), and a range of mental health outcomes (Garland et al. 2010;Johnson et al. 2011;Schrank et al. 2014;Shin and Lyubomirsky 2016). Yet, the research literature on wellbeing and its benefits remains skewed towards, and reflective of, Western initiatives (Bolier et al. 2013;, despite growing interest across the Middle East (Rao et al. 2015). ...
Article
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Wellbeing is predictive of improved learning outcomes, better mental health, prosocial and civic behavior, higher work productivity, and enhanced life satisfaction. Given that literature in support of wellbeing is robust, it is incumbent on local communities to put this research into practice and develop culturally-competent programs that promote the skills to increase it. In collaboration with Alnowair, a non-profit organization committed to increasing wellbeing in Kuwait, a semester-long positive psychology program, called Bareec, was designed to generate positive emotions and increase levels of flourishing in university and secondary school students. The Bareec program consisted of 15-min weekly instructions in positive psychology and positive psychology interventions. To test the program’s efficacy, Bareec was implemented in the national public university and in 10 secondary schools (total N = 977). Relative to control groups, Bareec university participants showed greater levels of flourishing (eudaimonic wellbeing; d = .32), while secondary school participants showed enhanced positive affect (hedonic wellbeing; d = .27) in addition to a small improvement in flourishing (d = .15).
... There were fewer studies about the effectiveness of MBT on negative symptoms. Johnson et al. (2011) reported that negative symptoms had been mitigated at the 3-month follow-up after their mindfulness-based meditation for 18 schizophrenia patients. Khoury et al. (2013) also confirmed the effectiveness of mindfulness on negative symptoms after 8 weeks of MBT. ...
Article
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Background: Evidence of the effectiveness of mindfulness-based training for schizophrenia is accumulating. However, most published studies have small samples, without control groups, and no systematic assessment of patients' symptoms, which leads to poor internal validity and fragmented study results. Thus, we examined the effectiveness of mindfulness-based training (MBT) for schizophrenia using a randomized controlled study and structured interviews to assess both positive and negative symptoms. Methods: Of the originally 60 patients recruited from a hospital for chronic schizophrenia and randomly assigned to the MBT group or the treatment-as-usual (TAU) group, 51 patients completed the study (with 21 in MBT group). After informed consent, all patients were assessed using the positive and negative syndrome scale (PANSS) at baseline, post-treatment, and during the3-month follow-up. To controlled for possible pre-treatment group differences to examine the effectiveness of MBT on the symptoms of schizophrenia, repeated measures analysis of covariance (ANCOVA) (2×2: two treatment groups × two assessment times) with age and PANSS
... Findings indicate that the intervention was feasible and associated with decreased negative symptoms and increased positive emotions. Psychological recovery (Johnson et al. 2011) and ...
... In addition, particular symptoms associated with schizophrenia might be especially related to the extent to which they engage in elaborative processing. For example, decreased ability to savor positive emotions is associated with anhedonia (Applegate et al., 2009), and treatment studies focused on recalling and savoring positive emotional experiences in schizophrenia have led to decreases in anhedonia (Favrod et al., 2015;Johnson et al., 2011). Providing evidence for this theory could be important as 1) low positive affect in people with schizophrenia-spectrum disorders is not well treated with existing interventions (e.g., Grant et al., 2012) and 2) existing interventions targeting increased elaboration on positive information (e.g., McMakin et al., 2011) could be examined in this context. ...
Article
Some individuals with schizophrenia report similar feelings of positive affect "in the moment" compared to control participants but report decreased trait positive affect overall. One possible explanation for this disconnection between state and trait positive affect is the extent to which individuals with schizophrenia engage in elaborative processing of positive stimuli. To assess this, we examined evoked gamma band activity in response to positive words over several seconds in a group with schizophrenia, a group with major depressive disorder, and a healthy control group. From a pre-stimulus baseline to 2000 ms after onset of the stimulus (henceforth, "early period"), the schizophrenia group showed a reliable increase in gamma activity compared to both the control and depressed groups, who did not differ from each other. In contrast, the depressed group showed a reliable increase in gamma activity from 2001 to 8000 ms (henceforth, "late period") compared to the other groups, who did not differ from each other. At the same time, the schizophrenia group showed a reliable decrease from the early to late period while the depressed group showed the opposite pattern. In addition, self-reported depression and social anhedonia in the schizophrenia group were related to decreased gamma band activity over the entire processing window. Overall, these results suggest that schizophrenia is associated with increased initial reactivity but decreased sustained elaborative processing over time, which could be related to decreased trait positive affect. The results also highlight the importance of considering depressive symptomology and anhedonia when examining emotional abnormalities in schizophrenia.
... Over time, this builds durable biopsychosocial resources such as mindfulness, purpose in life and social support, resulting in enhanced social functioning (Fredrickson, 2001). Two pilot trials found that mindfulness, an intervention that promotes positive emotions (Fredrickson et al., 2008;Garland et al., 2015), was associated with improved symptoms, self-esteem, social functioning and wellbeing in patients with psychosis (Johnson et al., 2011;Meyer et al., 2012). These findings are consistent with two recent meta-analyses demonstrating that mindfulness is acceptable, safe and effective in reducing symptoms in this patient population (Cramer et al., 2016;Khoury et al., 2013). ...
Article
Background: Psychological and pharmacological treatments have been shown to reduce rates of transition to psychosis in Ultra High Risk (UHR) young people. However, social functioning deficits have been unresponsive to current treatments. Aims: The study aims were to: i) describe the theoretical basis and therapeutic targets of a novel intervention targeting social functioning in UHR young people; and ii) examine its acceptability, safety and preliminary effect on social functioning. Methods: An international, multidisciplinary team developed a new intervention (MOMENTUM) to improve social functioning in UHR young people. MOMENTUM blends two novel approaches to social recovery: strengths and mindfulness-based intervention embedded within a social media environment, and application of the self-determination theory of motivation. The acceptability and safety of MOMENTUM were tested through a 2-month pilot study with 14 UHR participants. Results: System usage was high, with over 70% of users being actively engaged over the trial. All participants reported a positive experience using MOMENTUM, considered it safe and would recommend it to others. 93% reported it to be helpful. There were large, reliable improvements in social functioning (d = 1.83, p < 0.001) and subjective wellbeing (d = 0.75, p = 0.03) at follow-up. There were significant increases in the mechanisms targeted by the intervention including strengths usage (d = 0.70, p = 0.03), mindfulness skills (d = 0.66, p = 0.04) and components of social support. Social functioning improvement was significantly correlated with indicators of system usage. Conclusion: MOMENTUM is engaging and safe. MOMENTUM appeared to engage the hypothesized mechanisms and showed promise as a new avenue to improve social functioning in UHR young people.
... In order to achieve this, the underlying mechanisms of mindfulness and the factors which moderate its effectiveness must be examined (Hölzel et al. 2011). To that end, studies have examined variations of mindfulness where different elements are emphasised, such as compassion towards the self (Johnson et al. 2011) or acceptance of psychotic experiences (Gaudiano and Herbert 2006). Nevertheless, meditation remains the foundation of mindfulness and yet there is limited research into what aspect of meditation contributes towards mindfulness' success amongst people with schizophrenia. ...
Article
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Brief meditations led by audio versus visual stimuli can lead to differential effects on mood and cognition in healthy people. We examine whether similar effects were evident amongst schizophrenia patients. Forty-three patients underwent either 30-min image- (e.g. a mountain stream; n = 15) or audio-led (e.g. running water; n = 15) meditations or waited 30 min without instructions (n = 13). Prior to and following the meditation/wait, participants completed a self-report measure of positive and negative affect and the Trail Making Test to measure attentional shifting abilities. Participants who underwent a visual-led meditation were significantly more positive than those who underwent an audio-led meditation or if they did not meditate. Irrespective of meditation modality, participants showed significant improvement in attentional shifting abilities. Brief meditative practice amongst patients with schizophrenia may have immediate effects on mood and cognition. Future research must explore these effects in larger mindfulness programmes and with longer follow-up assessments.
... increasing daily experiences of positive emotions (Fredrickson, Cohn, Coffey, Pek & Finkel, 2008); feelings of social connectedness (Hutcherson, Seppala & Gross, 2008); increased positive emotions and decreased negative symptoms associated with schizophrenia (Johnson, et al. 2011); a variety of psychopathologies (Shonin, Van Gordon, Compare, Zangeneh & Griffiths, 2015); and affective learning and cognitive control (Hunsinger, Livingston & Isbell, 2013). It has also been reported that practicing LKM can lead to increased grey matter in the right angular and posterior parahippocampal gyri (Leung, et al. 2013). ...
Thesis
The aim of this thesis was to explore individual differences in the neural correlates of empathy. This was achieved over the course of three experimental studies to gain a better understanding of mirror neuron activity as a putative index of empathy and its relationship with self-report measures of empathy. In the first study we built upon the existing literature by exposing participants to two EEG protocols. Findings demonstrated a more reactive mirror neuron system in response to crying relative to laughing sounds and to painful relative to non-painful imagery. We also found inverse relationships with empathy that could be related to expertise. In our second study we examined the long-term effect of loving-kindness meditation (compared to controls) on empathy by comparing the mirror neuron activity from three EEG protocols. It is argued that we found meaningful differences in mirror neuron activity (for each protocol) that might again be explained by an expertise effect. The final study investigated the potential effect of power-posing on empathy as measured by both EEG and behavioural tasks. Findings demonstrated that those in an open pose (counter to predictions) actually performed better on an empathic accuracy task than those in a closed or control posture. In terms of mirror neuron activity, we find no conclusive evidence to suggest that open posing has a negative effect on empathy, however again we see evidence to suggest that expertise might be driving our data.
... En la misma línea, las intervenciones que emplean la meditación en fortalezas personales como el amor, la amabilidad o la compasión aumentan la frecuencia e intensidad de las emociones positivas, disminuyen los síntomas negativos, principalmente la anhedonia, e incrementan la auto-aceptación, el control percibido y la satisfacción con la vida de las personas con esquizofrenia (Ascone, Sundag, Schlier y Lincoln;2017;Fredrickson, Cohn, Coffey, Pek y Finkel, 2008;Johnson et al., 2011). ...
Article
Background Psychopharmacological medication adherence is essential for psychiatric patients’ treatment and well-being. Objective This review aimed to identify psychological factors related to health control that have been linked to psychopharmacological medication adherence in psychiatric patients. Methods A literature search was performed through the databases Medline, PubMed, PsycINFO, and Google Scholar to identify relevant studies published before October 15th, 2019. Articles published in peer-reviewed journals that analyzed the psychological factors of health belief and health control involved in psychopharmacological medication adherence in a psychiatric population were included. Results The search identified 124 potentially relevant papers, 29 of which met the eligibility criteria. The final sample was 222 adolescents, most with a diagnosis of attention deficit/hyperactivity disorder (ADHD), and 6139 adults diagnosed especially with schizophrenia spectrum disorder, bipolar disorder, or depressive disorder. Results suggested that medication adherence is associated with health beliefs and psychological variables, such as self-efficacy and locus of control. Family support was also positively related to medication adherence. Conclusion Psychopharmacological medication adherence requires a consideration of multicausality, which depends on sociodemographic, clinical, and psychological factors. Practice implications These findings should be considered in the development and implementation of psychological interventions focused on self-control and family support.
... developing awareness of thoughts, feelings, and behaviors) approaches may also be well-suited for use in lifestyle interventions. These interventions, integrated into treatments for schizophrenia and FEP, have been linked to improved negative symptoms, well-being, psychological recovery, and self-esteem (Browne et al. 2018;Johnson et al. 2011;Khoury et al. 2013;Meyer et al. 2015Meyer et al. , 2012. Further, greater self-reported mindfulness was associated with engagement in physical activity among university students in the general population (Ruffault et al. 2016), suggesting that mindfulness skills training and positive psychology interventions in a lifestyle intervention may be beneficial to those with FEP. ...
Article
The mortality disparity for persons with schizophrenia spectrum disorders (SSDs) due to cardiovascular disease is a devastating problem. Many risk factors are present in young adults with psychosis that may be ameliorated with lifestyle interventions. Sixteen participants with SSDs enrolled in an 11-week open trial of a novel lifestyle intervention comprised of group high intensity interval training exercise and health and wellness education. The aims were to evaluate (1) feasibility and (2) impact on sedentary behavior, physical activity, nutritional knowledge, physiological outcomes, and psychological well-being at end of intervention and 11-week follow-up. Attendance rates were 70% or higher for both intervention components and participants reported increased learning about healthy eating and exercise habits. Moderate to large effect sizes were observed for physical activity and sedentary behavior with sustained improvements in sedentary behavior at follow-up. Meaningful changes were not observed in other domains.
... Of these 10 studies, 9 studies utilized randomised Celano et al., 2018;Schrank et al., 2016;Seligman et al., 2006) and one study used a quasi-experimental design (Chaves et al., 2017). Six studies used a pre-post design without a control group (Favrod et al., 2015;Ferguson et al., 2009;Johnson et al., 2011;Lai et al., 2015;Meyer et al., 2012;Painter et al., 2019). Study characteristics are summarized in Table 2. ...
Article
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There is a growing number of studies evaluating the impact of positive psychology interventions (PPI’s) in people with severe mental illnesses (SMI). The results of these studies have not been quantitatively reviewed yet. In this study, we conduct a meta-analysis on the effects of PPI’s on mental health in people with SMI across studies. Sixteen studies are included (nine RCTs), representing 729 patients. Meta-analyses were performed for well-being as the primary outcome at post-treatment. We found no significant effects on both well-being en psychopathology for the PPI’s in comparison with the control conditions. Within-group effects revealed a moderate effect (Hedge’s g = 0.40) on well-being and a large effect on psychopathology (g = 0.70). Though there is at present no evidence that PPIs are more effective in comparison with other active interventions, our findings demonstrated that people with SMI do benefit from PPIs in terms of enhancement of mental health.
... Recent meta-analyses also revealed the feasibility and safety of third-wave interventions for SSD, as well as their effectiveness in reducing positive-, (Cramer, Lauche, Haller, Langhorst, & Dobos, 2016;Louise, Fitzpatrick, Strauss, Rossell, & Thomas, 2017) negative- (Jansen et al., 2020;Khoury, Lecomte, Gaudiano, & Paquin, 2013), and depressive symptoms (Louise et al., 2017). Further research in this field found MBIs to be particularly helpful at reducing psychotic symptoms (Bacon, Farhall, & Fossey, 2014;Gaudiano & Herbert, 2006) and the decreasing severity of negative symptoms (Gaudiano, Nowlan, Brown, Epstein-Lubow, & Miller, 2013;Johnson et al., 2009;Johnson, Penn, Fredrickson, Kring, & Meyer, 2011;White et al., 2011). Some studies also suggest improving social functioning (Gaudiano & Herbert, 2006) and self-esteem (Laithwaite et al., 2009). ...
Thesis
In recent years, Mindfulness-Based Interventions (MBI) have gained popularity as a modern psychotherapeutic approach, primarily in English-speaking countries. A growing body of evidence demonstrates the clinical benefits of MBI for a wide range of symptoms experienced in Schizophrenia Spectrum Disorders (SSD). However, research in German speaking countries remains scarce. Against this background, the present dissertation aims to contribute to the available body of literature by developing and validating a Mindfulness-Based Group Therapy (MBGT) for the treatment of inpatients with schizophrenia spectrum disorders. This comprehensive research study will include both qualitative and quantitative data analysis concerning the three subprojects revealed below. A qualitative research design based on inductive thematic analysis in the form of a semistructured interview guide was developed and 27 interviews were conducted with inpatients having SSD after attending a mindfulness-based intervention in study one. Analyses revealed two domains (content and function) of MBI. The domain content had further subcategories, including core elements, as well as effects on emotions, cognition, and symptoms changes. The second domain was related to the relevance of perception of context and transfer to everyday life. Overall, individuals reported improvements on several clinical parameters and gave an indepth understanding of underlying processes and mechanisms at action. Based on these outcomes, a novel Mindfulness-Based Group Therapy (MBGT) was developed for the first time in the German language through a fundamental participatory and iterative research process and finally published in a manual's printed book form. Moreover, historical concerns regarding the therapeutic utility of mindfulness for SSD are discussed, while recommendations and careful adaptations are given to implement MBI in inpatient and outpatient settings as a part of an editorial article. In study two, the newly translated German version of the Southampton Mindfulness Questionnaire (SMQ) was validated regarding convergent and divergent validity, reliability, factor structure, and treatment sensitivity while providing evidence for clinical practice and research for healthy individuals, mediators, and clinical groups. In the third study, a rater-blinded randomized controlled trial was conducted to assess the feasibility, acceptability, and preliminary outcomes of MBGT with inpatients having SSD. Results showed high protocol adherence and retention rates indicating feasibility and acceptability. Furthermore, various improvements were revealed on clinical- and process dimensions compared with treatment-as-usual. Overall, the present dissertation gives compelling evidence regarding the effects of mindfulness for SSD and adds a modern psychological treatment option for this marginalized patient group.
... Findings from this preliminary RCT that I-CAT reduces negative symptoms, with maintenance of these improvements beyond treatment, supports I-CAT as a promising early intervention with the potential to improve long-term functioning Note: d = Cohen's effect size, p = p-value, LSM = least squares means, LSMD = least squares means differences; Bold values indicate significant change from baseline (LSM) or significant treatment condition by time interaction (LSMD), p < .05. in SSD. Alleviation of negative symptoms and improved well-being through a mindfulness and positive psychotherapy intervention replicates findings of smaller-scale studies and extends previous work with I-CAT as a novel intervention integrating these approaches in the early stages of SSD (e.g., Johnson et al., 2011;Louise et al., 2018;Meyer et al., 2012). Alleviation of negative symptoms, along with promising occupational and well-being outcomes, may also suggest I-CAT directly addresses recovery with increased engagement in life activities and well-being. ...
Article
Individuals with schizophrenia spectrum disorders (SSD) are at heightened risk for exposure to stressful life events which can lead to increased sensitivity to stress and a dysregulated stress response, which are in turn associated with poor long-term functioning. Stress reactivity is thus a promising treatment target in the early stages of SSD. Integrated-Coping Awareness Therapy (I-CAT) is a manualized intervention integrating mind-fulness and positive psychology to target a dysregulated stress response in SSD. The current study is a preliminary randomized-controlled trial (RCT) comparing I-CAT (n = 18) with treatment as usual (TAU; n = 18) in individuals in the early stages of SSD. I-CAT was hypothesized to be more effective than TAU on primary outcomes: increasing positive emotions, decreasing negative emotions, reducing stress, and improving functioning and quality of life; and secondary outcomes: reducing symptoms, increasing mindfulness, and improving overall well-being. Excellent therapy attendance rates, low study attrition, and positive participant feedback demonstrated that I-CAT was a feasible and well-tolerated psychosocial intervention. Results suggest I-CAT led to greater reduction in symptoms (i.e., overall, negative, and disorganized symptoms), increased observational mindful-ness, increased endorsement of a sense of purpose in life, and preservation of work abilities and school social functioning compared with TAU. Future work should replicate and extend these findings in a larger-scale RCT.
... Findings indicate that the intervention was feasible and associated with decreased negative symptoms and increased positive emotions. Psychological recovery (Johnson et al. 2011) and ...
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Humankind faces many problems like terrorism, crime, the collapse of the family unit,drug abuse, war, theft, etc. I suggest delusional thoughts and decisions, which are declined of intelligence, mainly cause by psychological mind viruses (MV) that impact psychological, physical, and social well-being. Such MV might scan by healthy mind viruses (HMV). The intelligent learning, training (meditation), and decisions might play a significant role in HMV. In addition to the nature and nurture human brain, a another microscopic, unknown matter be there, which I call X-ultra quantum conscious particle genome (X-UQCPG); all these three factors seem to be interdepended. The X-UQCPGmight bond with the X-ultra quantum unique conscious particle (X-UQUCP) that might not impact on nature and nurture . Here, I show the unearthed core of early Buddhistteachings, training (meditation), and decisions inclusive of the 8-fold path may be an efficient methodology for Intelligence evolution. The human intelligence evolution,psychological well-being might represent a theoretical 3D graph[SDKL1] of nature, nurture, X-UQCPG. If life after death occurs, the clinical death of a person's finally evolved level of the key (X-ultra-quantum consciousness particle genome) X- UQCPG (+X- UQCUP) might be the crucial natural transmission. And bond with a matching vacant zygote/early embryo of its X-ultra quantum particles and its new conscious state might depend on the lastly evolve genome of the X-UQCPG. However, there are many more mysterious issues to be solved in future researches, so this might not be a theory of everything on the central theme.
... Bireyleri şimdiki zamana odaklamak için bilinçli farkındalık (mindfullness) ile başlayan senaryolardan oluşan,on sekiz şizofreni tanısı almış birey ile yapılan bir araştırmada, imgeleme çalışmasının negatif semptomları azalttığı, pozitif duyguları ve psikolojik iyileşmeyi arttırdığı sonucuna varılmıştır. [19] Bireylerin her uygulama sonrası yazdıkları değerlendirme notlarına göre ve öznel iyileşmeyi değerlendirme ölçeği puan ortalamalarındaki artışa bakarak psikolojik iyileşmeyi sağladığı söylenebilir. Şizofreni tanılı bireylerde anksiyeteye yönelik bilinçli farkındalık meditasyonunun etkisinin araştırıldığı bir pilot çalışmada sonuçlar, bilinçli farkındalık meditasyon eğitiminin tüm katılımcılar için kabul edilebilir olduğunu ileri sürmüştür; meditasyon yaparken psikotik veya diğer belirtilerin kötüleştiğini bildiren bulgular tespit edilmemiştir. ...
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Mental health, once defined in terms of absence of illness, has gradually become understood in a more holistic way, which includes the positive qualities that help people flourish. This evolving definition of mental health has led to an exploration of other traditions and practices, including mindfulness meditation, which for thousands of years have been devoted to developing an expanded vision of human potential. One result was the introduction of the practice of mindfulness into Western scientific study. However, the original intentions of mindfulness meditation, to catalyze our potential for healing and development, have been largely ignored by the scientific community. Yet a small number of researchers and theorists have explored and continue to explore the positive effects of mindfulness practice. The chapter focuses on this pioneering work.
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Loving‐kindness and compassion meditation (LKCM) was a promising intervention for improving life satisfaction, but previous findings have been inconsistent. The current study provides a systematic review and meta‐analysis, including 23 empirical studies on LKCM with life satisfaction as an outcome variable. The primary meta‐analysis indicated that LKCM significantly enhanced life satisfaction in pre‐post design (g = 0.312, k = 15, n = 451), but the significance disappeared in the additional meta‐analysis based on randomized controlled trials (g = 0.106, k = 6, n = 404). Moderator analyses found significant effects for type of control (i.e., the effects of LKCM were inferior to active control group, but superior to waitlist condition), but not for other moderators (i.e., participant type, previous meditation experience, specific protocol, components of LKCM, combination with mindfulness mediation, and intervention length). Narrative review identified self‐compassion and positive emotions as important mediators. The practice time of LKCM had indirect but not direct association with life satisfaction. The findings supported that LKCM is promising in increasing life satisfaction, but more studies are needed to investigate the effects with more rigorous designs. Future studies should investigate other potential mechanisms and clarify whether LKCM change the reality or the perception of life.
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PTSD is a complex psychiatric disorder with common comorbidities that can be difficult to treat. Conventional evidence-based therapies include trauma-focused cognitive behavioral therapy and certain antidepressants, but these treatments may not be tolerated or preferred for a variety of reasons, or they may only be partially effective. This lesson familiarizes the clinician with a variety of CAM treatment options for PTSD as well as the rapidly growing use of transcranial magnetic stimulation (TMS) for PTSD. We review the basics of various meditation practices, animal-assisted therapy, acupuncture, and TMS and potential ways they can be incorporated into practice. We also briefly discuss what is known about the use of cannabinoids for PTSD.
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In 2015, we launched the first issue of the Middle East Journal of Positive Psychology with the intent of developing an indigenous positive psychology across the Middle East/North Africa (MENA) region. We felt it was imperative to do so, not only to counter the indiscriminate use of Western positive psychological models and interventions in the region, but equally, to encourage the growth of this new science of wellbeing by offering a platform for regional research to be showcased. As our work grew, it became clear that more was needed to help the field prosper; in particular, a focus on science was missing with many consultants speaking louder than academics and setting the dominant tone for the field by focusing on the “positive”, but overlooking the “psychology”. This book grew out of those concerns. In it, we offer a variety of chapters across the many growing domains of positive psychology, such as positive education, positive organizational development, positive clinical psychology and positive health. We also take a look at a number of growing themes in the field, such as the use of Big Data, the building of happy cities, and the use of happiness research to inform national policy to name a few. In this manner, we explore what makes life meaningful, worth living and what leads to conditions of social, national and individual flourishing.
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Purpose Loneliness is a challenge for individuals with psychosis; however, interventions rarely target loneliness in this group. Method We developed a pilot positive psychology group intervention designed to reduce loneliness in psychosis and examined its feasibility and acceptability. Results Sixteen participants attended 5.38 (SD = 0.70) out of six sessions, with a dropout rate of 10%. Participants were significantly less lonely at post-treatment (p < 0.001, d = 1.51), and maintained their improvements from post-treatment to follow-up (p = 0.81, d = 0.07). Conclusions Loneliness may be a feasible and acceptable treatment target within psychosocial treatments.
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Treatment of psychotic disorders including schizophrenia is less than optimal with an emphasis on biological treatments. Psychosocial interventions including different psychotherapies are increasingly recognized as an important component of treatment. Positive psychotherapy (PPT after Seligman/Rashid) is a modality of therapy that focuses on the healthy aspect of individual helping to unearth positive affect and strengths of character and through this mitigates symptoms and improves outcomes. The last decade has seen a significant growth in the interest in PPT, and several trials have been conducted to demonstrate its efficacy when provided in individual format and group therapy format. The efficacy data is meaningful and impacts client care when it is shown to be effective in real-world situations. This chapter pulls together the conceptual framework, the current evidence base, and clinical applications of PPT for psychotic conditions. The clinical examples of real-world scenarios show how these interventions can be used by the entire treatment team within their regular workflow so that these interventions can be sustainable. The chapter also talks about the existing limitations in evidence for PPT interventions and suggests directions for future research.
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Dieses Kapitel stellt die Bedeutung von Selbstmitgefühl und liebevoller Güte im Rahmen von Achtsamkeit in der Psychotherapie vor. Dafür wird nach einer kurzen Begriffseinführung und einer Einordnung von Achtsamkeit in die aktuelle Psychotherapie zunächst das Begriffsverständnis von Mitgefühl und Selbstmitgefühl differenziert. Anschließend werden aktuelle Entwicklungen und Behandlungskonzepte sowie ihre Evidenzbasierung vorgestellt. Zum Abschluss werden vor diesem Hintergrund zukünftige Entwicklungen und offene Fragen diskutiert.
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Schizophrenia is a major mental illness with a disease course that is influenced by lifestyle. The risk-benefit ratio for alternative interventions is more favorable than for antipsychotics in long-term treatment. Dietary interventions may target autoimmune features, vitamin or mineral deficiencies, abnormal lipid metabolism, gluten sensitivity, or others. Examples of interventions involving diet, physical activity, or physical processes or social interventions including talk therapy exist in the literature. Notwithstanding, the general utility of these types of interventions remains inconclusive, awaiting long-term randomized trials. A perspective that separates the cause of the disease from its symptoms may be helpful in treatment planning and is warranted to distinguish between short-term and long-term recovery goals.
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Introduction: The therapeutic approaches of the so-called "third wave" of clinical cognitivism have assumed increasing relevance in recent years alongside cognitive-behavioral therapy in the treatment of psychosis. Aims: To evaluate the efficacy of some of the most relevant third wave cognitive-behavioral approaches (metacognitive interventions and therapies based on mindfulness and acceptance) in the treatment of psychosis. Method: A systematic research was carried out for systematic reviews and meta-analysis on the efficacy of metacognitive interventions and mindfulness- and acceptance-based therapies in the treatment of psychosis, published from 1 January 2009 to 31 December 2018. The selected studies were evaluated using AMSTAR 2, a valid and reliable tool composed of 16 items to measure the methodological quality of systematic reviews and meta-analysis. Results: 7 meta-analysis were selected: 4 for metacognitive therapies (3 of low quality, 1 of critically low quality) and 3 for mindfulness- and acceptance-based therapies (1 of medium quality, 2 of low quality). Discussion and conclusions: Among metacognitive therapies, metacognitive training has shown promising results on positive symptoms and in particular on the psychopathology of delusions. Mindfulness- and acceptance-based therapies have shown mild to moderate effects on general and positive symptoms as well as some effects on negative symptoms, depressive symptoms, hospitalization rates and length. However, further research is needed to confirm overall the encouraging results of both metacognitive training and mindfulness- and acceptance-based therapies as the small number of randomized controlled trials and the low methodological quality of most meta-analysis realized up to date does not allow to draw yet sufficiently solid conclusions on their efficacy in the treatment of psychosis.
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This study tested the effects of mindfulness-based stress reduction (MBSR) training on multiple outcomes in patients with schizophrenia. We compared MBSR, psychoeducation, and control groups in a randomized controlled research design. Outcome measures assessed hope, psychological wellbeing, and functional recovery over three time points in 137 participants. The results of this study indicate that MBSR training was more effective in terms of increasing the level of hope, psychological well-being, and functional recovery of schizophrenia patients when compared with psychoeducation and control patients.
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Third-Wave CBT interventions for psychosis are united in their use of mindfulness and acceptance techniques, which are designed to alter the way in which individuals relate to their psychotic experiences. In this chapter, we will introduce some of the key third-wave CBT therapies, and outline how they have been developed/adapted for people with psychosis. The chapter will focus on Person-Based Cognitive Therapy (PBCT), Metacognitive Therapy (MCT), Acceptance and Commitment Therapy (ACT), and Compassion-Focused Therapy (CFT). The chapter will first summarise each therapy and the associated adaptations for this client group. It will then review the emerging evidence base for each of the four therapies, which will include a summary of limitations. Collectively, the evidence suggests that third-wave interventions hold promise for individuals with psychosis. However, it is clear that more research is required in order to examine the specific impact of each therapy.
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Background: Research has shown that beliefs about one's capacity to savour positive outcomes, a form of perceived control over positive emotions, are largely independent of beliefs about coping, a form of perceived control over negative emotions. Aim: To describe a new measure of savouring beliefs, the Savoring Beliefs Inventory (SBI). Method: Six studies validating the SBI that is designed to assess individuals' perceptions of their ability to derive pleasure through anticipating upcoming positive events, savouring positive moments, and reminiscing about past positive experiences. Results: SBI scores were found to be: (a) positively correlated with affect intensity, extraversion, optimism, internal locus of control, reported self-control behaviours, life satisfaction, value fulfilment, self-esteem, and intensity and frequency of happiness; (b) negatively correlated with neuroticism, guilt, physical and social anhedonia, hopelessness, depression, and the frequency of unhappy and neutral affect; and (c) uncorrelated with socially desirable responding. SBI was validated prospec-tively by first measuring college students' savouring beliefs and then later assessing their behaviours and affects in looking forward to, enjoying the actual experience of, and looking back on their Christmas vacation. Within each of the three time frames, the relevant SBI subscale generally predicted behaviours and affects more strongly than did the subscales associated with the other two temporal orientations. Finally, SBI was cross-validated in a sample of older adults. Conclusion: These results provide strong evidence that the SBI is a valid and reliable measure of individuals' beliefs about their capacity to savour positive experiences through anticipation, present enjoyment, and reminiscence.
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The Temporal Experience of Pleasure Scale (TEPS) was designed to measure individual trait dispositions in both anticipatory and consummatory experiences of pleasure. From an initial pool of theory-based items, we developed a 10-item anticipatory pleasure scale and an 8-item consummatory pleasure scale using several large college-age samples; the two scales were both internally consistent and temporally stable. As expected, these two scales were moderately, positively correlated with each other. Examination of convergent and discriminant validity indicated that the two scales measured distinct and specific constructs. In particular the anticipatory scale was related to reward responsiveness and imagery, while consummatory pleasure was related to openness to different experiences, and appreciation of positive stimuli. Potential applications of the TEPS, particularly in psychopathology research, are discussed.
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Negative symptoms in schizophrenia are related to poor functional outcome, persistent over time, a source of burden for caregivers, and only minimally responsive to currently available medications. A major challenge to developing efficacious interventions concerns the valid and reliable assessment of negative symptoms. In a recent consensus statement on negative symptoms, a central recommendation was the need to develop new assessment approaches that address the limitations of existing instruments. In the current report, we summarize the background and rationale for the Collaboration to Advance Negative Symptom Assessment in Schizophrenia (CANSAS). The CANSAS project is an National Institute of Mental Health-funded multisite study that is constructing a next-generation negative symptom scale, the Clinical Assessment Interview for Negative Symptoms (CAINS). The CAINS is being developed within a data-driven iterative process that seeks to ensure the measure's reliability, validity, and utility for both basic psychopathology and treatment development research.
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The aim of the study was to evaluate the effectiveness of a recovery group intervention based on compassionate mind training, for individuals with psychosis. In particular, the objective was to improve depression, to develop compassion towards self, and to promote help seeking. A within-subjects design was used. Participants were assessed at the start of group, mid-group (5 weeks), the end of the programme and at 6 week follow-up. Three group programmes were run over the course of a year. Nineteen participants commenced the intervention and 18 completed the programme. Significant improvements were found on the Social Comparison Scale; the Beck Depression Inventory; Other As Shamer Scale; the Rosenberg Self-Esteem Inventory and the General Psychopathology Scale from the Positive and Negative Syndrome Scale. The results provide initial indications of the effectiveness of a group intervention based on the principles of compassionate focused therapy for this population. The findings of this study, alongside implications of further research are discussed.
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B. L. Fredrickson's (1998, 2001) broaden-and-build theory of positive emotions asserts that people's daily experiences of positive emotions compound over time to build a variety of consequential personal resources. The authors tested this build hypothesis in a field experiment with working adults (n = 139), half of whom were randomly-assigned to begin a practice of loving-kindness meditation. Results showed that this meditation practice produced increases over time in daily experiences of positive emotions, which, in turn, produced increases in a wide range of personal resources (e.g., increased mindfulness, purpose in life, social support, decreased illness symptoms). In turn, these increments in personal resources predicted increased life satisfaction and reduced depressive symptoms. Discussion centers on how positive emotions are the mechanism of change for the type of mind-training practice studied here and how loving-kindness meditation is an intervention strategy that produces positive emotions in a way that outpaces the hedonic treadmill effect.
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The need for social connection is a fundamental human motive, and it is increasingly clear that feeling socially connected confers mental and physical health benefits. However, in many cultures, societal changes are leading to growing social distrust and alienation. Can feelings of social connection and positivity toward others be increased? Is it possible to self-generate these feelings? In this study, the authors used a brief loving-kindness meditation exercise to examine whether social connection could be created toward strangers in a controlled laboratory context. Compared with a closely matched control task, even just a few minutes of loving-kindness meditation increased feelings of social connection and positivity toward novel individuals on both explicit and implicit levels. These results suggest that this easily implemented technique may help to increase positive social emotions and decrease social isolation.
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Extrapolating from B. L. Fredrickson's (1998, 2001) broaden-and-build theory of positive emotions, the authors hypothesized that positive emotions are active ingredients within trait resilience. U.S. college students (18 men and 28 women) were tested in early 2001 and again in the weeks following the September 11th terrorist attacks. Mediational analyses showed that positive emotions experienced in the wake of the attacks--gratitude, interest, love, and so forth--fully accounted for the relations between (a) precrisis resilience and later development of depressive symptoms and (b) precrisis resilience and postcrisis growth in psychological resources. Findings suggest that positive emotions in the aftermath of crises buffer resilient people against depression and fuel thriving, consistent with the broaden-and-build theory. Discussion touches on implications for coping.
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Loving-kindness meditation has been used for centuries in the Buddhist tradition to develop love and transform anger into compassion. This pilot study tested an 8-week loving-kindness program for chronic low back pain patients. Patients (N = 43) were randomly assigned to the intervention or standard care. Standardized measures assessed patients' pain, anger, and psychological distress. Post and follow-up analyses showed significant improvements in pain and psychological distress in the loving-kindness group, but no changes in the usual care group. Multilevel analyses of daily data showed that more loving-kindness practice on a given day was related to lower pain that day and lower anger the next day. Preliminary results suggest that the loving-kindness program can be beneficial in reducing pain, anger, and psychological distress in patients with persistent low back pain. Clinicians may find loving-kindness meditation helpful in the treatment of patients with persistent pain.
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Anhedonia, the diminished capacity to experience pleasant emotions, is a common, treatment-resistant feature of schizophrenia that is often included among the negative symptoms of this disorder. This selective review describes the 3 most commonly used approaches to assess anhedonia in schizophrenia: interview-based measures, self-report trait questionnaires, and laboratory-based assessments of emotional experience. For each assessment approach, psychometric properties, relationships to other symptoms and features of schizophrenia, and relationships with the other assessment approaches are evaluated. It is concluded that anhedonia can be reliably assessed and constitutes a distinctive, clinically important aspect of schizophrenia that should be included in a comprehensive evaluation of negative symptoms. Current efforts to define more precisely the nature of the hedonic deficit in schizophrenia are discussed, and recommendations for optimal assessment of anhedonia in clinical trials of novel treatments for negative symptoms are provided.
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This article reports the development and validation of a scale to measure global life satisfaction, the Satisfaction With Life Scale (SWLS). Among the various components of subjective well-being, the SWLS is narrowly focused to assess global life satisfaction and does not tap related constructs such as positive affect or loneliness. The SWLS is shown to have favorable psychometric properties, including high internal consistency and high temporal reliability. Scores on the SWLS correlate moderately to highly with other measures of subjective well-being, and correlate predictably with specific personality characteristics. It is noted that the SWLS is Suited for use with different age groups, and other potential uses of the scale are discussed.
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This article reports the development and validation of a scale to measure global life satisfaction, the Satisfaction With Life Scale (SWLS). Among the various components of subjective well-being, the SWLS is narrowly focused to assess global life satisfaction and does not tap related constructs such as positive affect or loneliness. The SWLS is shown to have favorable psychometric properties, including high internal consistency and high temporal reliability. Scores on the SWLS correlate moderately to highly with other measures of subjective well-being, and correlate predictably with specific personality characteristics. It is noted that the SWLS is suited for use with different age groups, and other potential uses of the scale are discussed.
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In this article, the author describes a new theoretical perspective on positive emotions and situates this new perspective within the emerging field of positive psychology. The broaden-and-build theory posits that experiences of positive emotions broaden people's momentary thought-action repertoires, which in turn serves to build their enduring personal resources, ranging from physical and intellectual resources to social and psychological resources. Preliminary empirical evidence supporting the broaden-and-build theory is reviewed, and open empirical questions that remain to be tested are identified. The theory and findings suggest that the capacity to experience positive emotions may be a fundamental human strength central to the study of human flourishing.
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This article opens by noting that positive emotions do not fit existing models of emotions. Consequently, a new model is advanced to describe the form and function of a subset of positive emotions, including joy, interest, contentment, and love. This new model posits that these positive emotions serve to broaden an individual's momentary thought-action repertoire, which in turn has the effect of building that individual's physical, intellectual, and social resources. Empirical evidence to support this broaden-and-build model of positive emotions is reviewed, and implications for emotion regulation and health promotion are discussed.
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As part of an ongoing scale development process, this study provides an initial examination of the psychometric properties and validity of a new interview-based negative symptom instrument, the Clinical Assessment Interview for Negative Symptoms (CAINS), in outpatients with schizophrenia or schizoaffective disorder (N = 37). The scale was designed to address limitations of existing measures and to comprehensively assess five consensus-based negative symptoms: asociality, avolition, anhedonia (consummatory and anticipatory), affective flattening, and alogia. Results indicated satisfactory internal consistency reliability for the total CAINS scale score and promising inter-rater agreement, with clear areas identified in need of improvement. Convergent validity was evident in general agreement between the CAINS and alternative negative symptom measures. Further, CAINS subscales significantly correlated with relevant self-report emotional experience measures as well as with social functioning. Discriminant validity of the CAINS was strongly supported by its small, non-significant relations with positive symptoms, general psychiatric symptoms, and depression. These preliminary data on an early beta-version of the CAINS provide initial support for this new assessment approach to negative symptoms and suggest directions for further scale development.
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In this article, we describe the clinical applicability of loving-kindness meditation (LKM) to individuals suffering from schizophrenia-spectrum disorders with persistent negative symptoms. LKM may have potential for reducing negative symptoms such as anhedonia, avolition, and asociality while enhancing factors consistent with psychological recovery such as hope and purpose in life. Case studies will illustrate how to conduct this group treatment with clients with negative symptoms, the potential benefits to the client, and difficulties that may arise. Although LKM requires further empirical support, it promises to be an important intervention since there are few treatments for clients afflicted with negative symptoms.
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This study examined cognitive distortions and coping styles as potential mediators for the effects of mindfulness meditation on anxiety, negative affect, positive affect, and hope in college students. Our pre- and postintervention design had four conditions: control, brief meditation focused on attention, brief meditation focused on loving kindness, and longer meditation combining both attentional and loving kindness aspects of mindfulness. Each group met weekly over the course of a semester. Longer combined meditation significantly reduced anxiety and negative affect and increased hope. Changes in cognitive distortions mediated intervention effects for anxiety, negative affect, and hope. Further research is needed to determine differential effects of types of meditation.
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This paper presents a series of case studies to explore the understanding, acceptance and value of compassionate mind training (CMT) with psychotic voice hearers. We were interested in the degree to which such people are able to access and feel the positive emotions of 'warmth' and 'contentment' to become more self-compassionate. We also explored how CMT affected participants' hostile voices, their levels of anxiety, depression, paranoia and self-criticism. Participants were invited to offer suggestions for tailoring this approach for voice hearers. Results showed decreases for all participants in depression, psychoticism, anxiety, paranoia, Obsessive-Compulsive Disorder and interpersonal sensitivity. All participants' auditory hallucinations became less malevolent, less persecuting and more reassuring.
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Recent research has suggested that the measure most commonly used to assess rumination, the Response Style Questionnaire (RSQ; L. D. Butler & S. Nolen-Hoeksema, 1994), may be heavily biased by depressive symptoms, thereby restricting the scope of research exploring this construct. This article offers a broader conceptualization of rumination, which includes positive, negative, and neutral thoughts as well as past and future-oriented thoughts. The first two studies describe the development and evaluation of the Ruminative Thought Style Questionnaire (RTS), a psychometrically sound measure of the general tendency to ruminate. Further, the scale is comprised of a single factor and shows high internal consistency, suggesting that rumination does encompasses the factors mentioned. The final study involved a longitudinal diary investigation of rumination and mood over time. Results suggest that the RTS assesses a related, but separate, construct than does the RSQ. RTS scores predicted future depressed mood beyond the variance accounted for by initial depressed mood whereas RSQ scores did not. The implications of these results and directions for future research are discussed.
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Defining hope as a cognitive set that is composed of a reciprocally derived sense of successful (a) agency (goal-directed determination) and (b) pathways (planning of ways to meet goals), an individual-differences measure is developed. Studies demonstrate acceptable internal consistency and test-retest reliability, and the factor structure identifies the agency and pathways components of the Hope Scale. Convergent and discriminant validity are documented, along with evidence suggesting that Hope Scale scores augmented the prediction of goal-related activities and coping strategies beyond other self-report measures. Construct validational support is provided in regard to predicted goal-setting behaviors; moreover, the hypothesized goal appraisal processes that accompany the various levels of hope are corroborated.
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The consumer movement is advocating that rehabilitation services become recovery-orientated. The objectives of this study are to gain a better understanding of the concept of recovery by: (i) identifying a definition of recovery that reflects consumer accounts; and (ii) developing a conceptual model of recovery to guide research, training and inform clinical practice. A review was conducted of published experiential accounts of recovery by people with schizophrenia or other serious mental illness, consumer articles on the concept of recovery, and qualitative research and theoretical literature on recovery. Meanings of recovery used by consumers were sought to identify a definition of recovery. Common themes identified in this literature were used to construct a conceptual model reflecting the personal experiences of consumers. The definition of recovery used by consumers was identified as psychological recovery from the consequences of the illness. Four key processes of recovery were identified: (i) finding hope; (ii) re-establishment of identity; (iii) finding meaning in life; and (iv) taking responsibility for recovery. Five stages were identified: (i) moratorium; (ii) awareness; (iii) preparation; (iv) rebuilding; and (v) growth. A five-stage model compatible with psychological recovery is proposed, which offers a way forward for attaining recovery-orientated outcomes. After further empirical investigation, a version of this model could be utilized in quantitative research, clinical training and consumer education.
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Although early theorists suggested that deficits in emotional experience be considered a hallmark characteristic of schizophrenia, there has been limited research, and inconsistent findings, on the relationship between anhedonia and functional capacity in individuals after the onset of schizophrenia. Stronger relationships have typically been reported for chronic samples in contrast to first episode samples, although it is not clear whether this is due to selection biases that influence recruitment in these different groups, or whether results reflect a change over the course of illness. The current longitudinal study examined the relationship between physical anhedonia and functional status in a sample of 61 individuals with schizophrenia at regular intervals over a 20-year period. Subjects were recruited into the study during an index hospitalization and completed assessments at 2-, 4.5-, 7.5-, 10-, 15-, and 20-year follow-ups. Analyses indicate that the relationship between anhedonia and impairments increases over time, although mean performance on these measures is stable across this same time period. These results suggest increasing convergence of impairments in emotional, adaptive, and cognitive capacities over time, with physical anhedonia associated with poorer outcome.
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Because little is known about the human trait of affiliation, we provide a novel neurobehavioral model of affiliative bonding. Discussion is organized around processes of reward and memory formation that occur during approach and consummatory phases of affiliation. Appetitive and consummatory reward processes are mediated independently by the activity of the ventral tegmental area (VTA) dopamine (DA)-nucleus accumbens shell (NAS) pathway and the central corticolimbic projections of the u-opiate system of the medial basal arcuate nucleus, respectively, although these two projection systems functionally interact across time. We next explicate the manner in which DA and glutamate interact in both the VTA and NAS to form incentive-encoded contextual memory ensembles that are predictive of reward derived from affiliative objects. Affiliative stimuli, in particular, are incorporated within contextual ensembles predictive of affiliative reward via: (a) the binding of affiliative stimuli in the rostral circuit of the medial extended amygdala and subsequent transmission to the NAS shell; (b) affiliative stimulus-induced opiate potentiation of DA processes in the VTA and NAS; and (c) permissive or facilitatory effects of gonadal steroids, oxytocin (in interaction with DA), and vasopressin on (i) sensory, perceptual, and attentional processing of affiliative stimuli and (ii) formation of social memories. Among these various processes, we propose that the capacity to experience affiliative reward via opiate functioning has a disproportionate weight in determining individual differences in affiliation. We delineate sources of these individual differences, and provide the first human data that support an association between opiate functioning and variation in trait affiliation.
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Persistent negative symptoms represent an alternative approach for assessing negative symptoms in the context of clinical trials. Persistent negative symptoms are designed to capture those symptoms that lead to functional impairment but are currently understudied and for which there are no currently available effective treatments. Persistent negative symptoms differ from the 2 most commonly used approaches: primary, enduring negative symptoms or deficit symptoms and negative symptoms broadly defined to include negative symptoms, regardless of their etiology or duration. In contrast to deficit symptoms, persistent negative symptoms may include secondary negative symptoms. However, in contrast to negative symptoms broadly defined, the secondary negative symptoms included in the assessment of persistent negative symptoms only include those that have failed to respond to usual treatments for secondary negative symptoms. In consequence, the presence of persistent negative symptoms identifies a patient population with clinically relevant symptomatology, which is larger than the one with the deficit syndrome but less heterogeneous than that captured through the use of a nonrestrictive definition of negative symptoms. This may facilitate the selection of subjects for inclusion into research and efforts to develop new pharmacological treatments and enhance our understanding of a relevant clinical problem. Ultimately, the investigation of the different entities characterized by negative symptoms, such as persistent negative symptoms, and the enhanced understanding of their biological and clinical characteristics may help to unravel the psychopathological and biological heterogeneity of schizophrenia.
Article
Research on anhedonia in schizophrenia has revealed mixed results, with patients reporting greater anhedonia than healthy controls on self-report measures and semi-structured interviews, but also reporting comparable experiences of positive emotions in response to pleasurable stimuli. Basic science points to the importance of distinguishing between anticipatory and consummatory (or in-the-moment) pleasure experiences, and this distinction may help to reconcile the mixed findings on anhedonia in schizophrenia. In two studies, we tested the hypothesis that anhedonia in schizophrenia reflects a deficit in anticipatory pleasure but not consummatory pleasure. In Study 1, we used experience sampling methodology to assess reported experiences of consummatory and anticipated pleasure among schizophrenia patients and controls. In Study 2, schizophrenia patients and controls completed a self-report trait measure of anticipatory and consummatory pleasure and interviews that assessed negative symptoms, including anhedonia, and community functioning. In both studies, we found evidence for an anticipatory but not a consummatory pleasure deficit in schizophrenia. In addition, anticipatory pleasure was related to clinical ratings of anhedonia and functional outcome. Clinical and research implications of these findings are discussed.
The Gift of Loving-Kindness: 100 Meditations on Compassion, Generosity, and Forgiveness
  • M Brantley
  • T Hanauer
Brantley, M., Hanauer, T., 2008. The Gift of Loving-Kindness: 100 Meditations on Compassion, Generosity, and Forgiveness. New Harbinger Publications, Oakland, CA.
  • D P Johnson
D.P. Johnson et al. / Schizophrenia Research 129 (2011) 137–140
Wechsler Abbreviated Scale of Intelligence (WASI) Harcourt Assessment
  • D Wechsler
Wechsler, D., 1999. Wechsler Abbreviated Scale of Intelligence (WASI). Harcourt Assessment, San Antonio, TX.