Improve Psychotic Symptoms with Mindfulness
By John M. de Castro, Ph.D.
“there is now sufficient published research, backed up by considerable clinical experience, to encourage careful clinical practice and research exploring the efficacy and effectiveness of adapted mindfulness interventions for people struggling to cope with psychotic experience.” – Paul Chadwick
Psychoses are mental health problems that cause people to perceive or interpret things differently from those around them. This might involve hallucinations; seeing and, in some cases, feeling, smelling or tasting things that aren’t objectively there, or delusions; unshakable beliefs that, when examined rationally, are obviously untrue. The combination of hallucinations and delusional thinking can often severely disrupt perception, thinking, emotion, and behavior, making it difficult if not impossible to function in society without treatment. Psychoses appear to be highly heritable and involves changes in the brain.
The symptoms of psychoses usually do not appear until late adolescence or early adulthood. There are, however, usually early signs of the onset of psychoses which present as cognitive impairments. Psychoses are very difficult to treat with psychotherapy and are usually treated with antipsychotic drugs. These drugs, however, are not always effective, sometimes lose effectiveness, and can have some difficult side effects. Hence, there is a need for safe and effective alternative treatments for psychosis.
Mindfulness training has been shown to be beneficial with patients with psychosis. In today’s Research News article “Mindfulness- and acceptance-based interventions for psychosis: Our current understanding and a meta-analysis.” (See summary below). Louise and colleagues summarize and perform a meta-analysis on the published research literature on the effectiveness of mindfulness based therapies for the symptoms of psychosis and compare their effectiveness when performed in group vs individual therapies. They identified and included 10 published randomized controlled research studies. About half of the studies used group based mindfulness training while half used individual training. Only 4 studies used and active control group while most used treatment as usual or wait-list control conditions.
They report that the published research indicates that mindfulness based training results in a significant reduction in psychotic symptoms and depression and a significant increase in mindfulness. Group based mindfulness training appeared to be more effective than individual based training. This is confounded, however, as most of the individual based trainings involved a different therapeutic protocol which included mindfulness training, Acceptance and Commitments Therapy.
The published research suggests that mindfulness based training is an effective treatment for the symptoms of psychosis. Mindfulness training has been repeatedly shown to be effective for depression. The current analysis, though, extends this effectiveness to depression in patients with psychosis. There were no specific reported differences between the effects on positive and negative symptoms of psychosis. Hence, mindfulness training was effective for overall psychotic symptoms. It is clear, however, that there is a need for more randomized clinical trials that employ better active control conditions so that placebo, attention, and bias effects can be better eliminated as alternative explanations for the results.
These are exciting findings, however, as psychosis has been found to be difficult to treat with standard psychotherapies. The results suggest that mindfulness techniques may be, at least in part, a solution to the treatment of psychoses.
So, improve psychotic symptoms with mindfulness.
“The decentered awareness in mindfulness facilitates the experience of cognitions as mental events in a broader context, and thereby facilitates a more metacognitive stance of decentering or defusing rather than getting “caught” in or reacting to thoughts or delusions, images, and hallucinated voices. The awareness and acceptance of thoughts, images, sounds, and/or hallucinated voices (positive or negative) diminishes the processes of judgment and self-criticism, including the internalized self-stigma that is so often present in those who experience psychosis.” – NewHarbinger
CMCS – Center for Mindfulness and Contemplative Studies
This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch
Study Summary
Louise, S., et al., Mindfulness- and acceptance-based interventions for psychosis: Our current understanding and a metaanalysis, Schizophr. Res. (2017), http://dx.doi.org/10.1016/j.schres.2017.05.023
Abstract
In promoting optimal recovery in persons with psychosis, psychological interventions have become a key element of treatment, with cognitive behavioural therapy being widely recommended in clinical practice guidelines. One key area of development has been the trialling of “third wave” cognitive behavioural interventions, which promote mindfulness, acceptance and compassion as means of change. Trials to date have demonstrated encouraging findings, with beneficial effects observed on measures of psychotic symptoms. This meta-analysis evaluated the efficacy of third wave interventions for the treatment of psychosis in randomised controlled trials, with psychotic symptoms as the primary outcome. Overall, 10 studies were included. The primary outcome demonstrated a small but significant effect (g=0.29) for third wave interventions compared with control post-treatment. Trials of group format mindfulness-based interventions showed larger effects (g=0.46) than individual acceptance and commitment therapy based interventions (g=0.08), although methodological differences between trials were noted. Among secondary outcomes, a moderate, significant treatment effect (g=0.39) was found for depressive symptoms, but no significant effects were found on specific measures of positive and negative symptoms, hallucination distress, or functioning/disability. A moderate effect on mindfulness (g=0.56) was observed, but not on acceptance. Overall, findings indicate that third wave interventions show beneficial effects on symptoms in persons with psychotic disorders. However, further research is required to determine the efficacy of specific models of treatment.