Mindfulness Improves the Emotion Regulation in Patients with Schizophrenia
By John M. de Castro, Ph.D.
“Mindfulness treatments do not aim to decrease the occurrence or severity of the symptoms of psychosis, but by helping to reduce the distress people experience, many of these treatments help indirectly to alleviate psychotic symptoms as well.” – Tania Lecomte
Schizophrenia is the most common form of psychosis. It effects about 1% of the population worldwide. It appears to be highly heritable and involves changes in the brain. It is characterized by both positive and negative symptoms. Positive symptoms include hallucinations; seeing and, in some cases, feeling, smelling or tasting things that aren’t there, or delusions; unshakable beliefs that, when examined rationally, are obviously untrue. Negative symptoms include a reduced ability to function normally, neglect of personal hygiene, lack of emotion, blank facial expressions, speaking in a monotone, loss of interest in everyday activities, social withdrawal, an inability to experience pleasure, and a lack of insight into their symptoms. The symptoms of schizophrenia usually do not appear until late adolescence or early adulthood.
Schizophrenia is very difficult to treat with psychotherapy and is usually treated with antipsychotic drugs. These drugs, however, are not always effective, sometimes lose effectiveness, and can have some difficult side effects. Mindfulness training has been shown to be beneficial for a variety of mental health problems, including psychosis. Mindfulness has also been shown to associated with lower symptom severity of schizophrenia. Patients with schizophrenia have difficulty regulating emotions and mindfulness training improves emotion regulation. Hence, it makes sense to investigate the effectiveness of mindfulness training in improving emotion regulation in patients with schizophrenia.
In today’s Research News article “The Effectiveness of a Mindfulness-Based Psychoeducation Programme for Emotional Regulation in Individuals with Schizophrenia Spectrum Disorders: A Pilot Randomised Controlled Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7075335/), Lam and colleagues recruited adult patients diagnosed with schizophrenia-spectrum disorders and randomly assigned them to a treatment as usual control condition or to receive a 90 minute once a week for 8 weeks Mindfulness-Based Psychoeducation Program (MBPP) including “engagement and empowerment, mindfulness in daily living and problem solving, mindfulness in illness management and equip and prepare for the future.” Patients also performed daily mindfulness practice. They were measured before and after training and 3 months later for the emotion regulation processes of reappraisal and suppression, rumination, psychotic symptoms, mindfulness, anxiety, and depression.
Engagement in the Mindfulness-Based Psychoeducation Program (MBPP) was high with 85% of participants attending 6 or more sessions with average attendance of 6.88 sessions. The average amount of home practice was 31 minutes per week. Hence the program can be successfully implemented and is acceptable to the patients.
They found that in comparison to baseline and the treatment as usual group after Mindfulness-Based Psychoeducation Program (MBPP) there was a significant improvement in mindfulness and the emotion regulation strategy of reappraisal. These improvements were maintained for 3 months after the end of training. The results suggest that mindfulness training improves the emotion regulation strategy of reappraisal in patients diagnosed with schizophrenia-spectrum disorders.
Reappraisal is a cognitive strategy to reinterpret the origin and meaning of an emotional event to reduce its impact. This is an effective emotion regulation strategy to help the individual cope with emotions. Since, problems with emotions are common in schizophrenia, improving emotion regulation may be of great assistance to them in dealing with the symptoms of the disease.
So, mindfulness improves the emotion regulation in patients with schizophrenia.
“mindfulness-based psycho-educational intervention expressly designed for patients with schizophrenia can be well tolerated and result in better illness outcomes than either standard treatment alone or standard treatment supplemented by a more typical psycho-educational approach. This is an important finding because of the widely held belief that psychotic patients can neither tolerate nor benefit from mindfulness-based interventions.” – American Mindfulness Research Association
CMCS – Center for Mindfulness and Contemplative Studies
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Lam, A., Leung, S. F., Lin, J. J., & Chien, W. T. (2020). The Effectiveness of a Mindfulness-Based Psychoeducation Programme for Emotional Regulation in Individuals with Schizophrenia Spectrum Disorders: A Pilot Randomised Controlled Trial. Neuropsychiatric disease and treatment, 16, 729–747. https://doi.org/10.2147/NDT.S231877
Emotion dysregulation has emerged as a transdiagnostic factor that potentially exacerbates the risk of early-onset, maintenance, and relapse of psychosis. Mindfulness is described as the awareness that emerges from paying attention to the present moment without judgment. It gently pulls the mind out of the negative emotions induced by the disparity between expectation and reality by focusing on the present moment, instead of worrying about the future or regretting the past. However, only a few research has ever focused on the efficacy of using a mindfulness-based intervention to improve emotion regulation in schizophrenia spectrum disorders.
The purpose of this study was to examine the effectiveness of a Mindfulness-Based Psychoeducation Programme (MBPP) on the emotion regulation of individuals with schizophrenia, in particular, to access emotion regulation strategies. The objective of this study was to find out whether MBPP is feasible for improving emotion regulation strategies, in terms of rumination, cognitive reappraisal, and expressive suppression, with a sustainable effect at a three-month follow-up.
Patients and Methods
A single-blinded pilot randomised controlled trial with repeated-measures designs was adopted. Forty-six participants diagnosed with schizophrenia and its subtypes were randomised in either the 8-week mindfulness-based psychoeducation programme or treatment-as-usual (control) group.
The results of the Generalised Estimating Equations test indicated that the MBPP group showed a significant improvement in reappraisal at a three-month follow-up (β = −6.59, Wald’s χ2=4.55, p=0.033), and a significant reduction in rumination across time. However, the Generalised Estimating Equations indicated no significant difference in rumination and expressive suppression in the MBPP group. Two participants reported having unwanted experiences, including feelings of terror and distress during the mindfulness practice.
The MBPP appeared to be effective for improving emotion regulation, which will contribute to future large-scale RCT to confirm the treatment effects in more diverse groups of schizophrenic patients.