Reduce Hallucinations in Schizophrenia with Mindfulness
By John M. de Castro, Ph.D.
“mindfulness-based interventions can give people a greater acceptance and insight into their experiences of psychosis, so they are less bothered by them, even if hallucinations and other symptoms are not eliminated.” – Adrianna Mendrek
Psychoses are mental health problems that cause people to perceive or interpret things differently from those around them. This might involve hallucinations; seeing, hearing 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.
Mindfulness training has been shown to be beneficial for patients with psychosis including reducing hallucinations. In today’s Research News article “Mindfulness Mediates the Effect of a Psychological Online Intervention for Psychosis on Self-Reported Hallucinations: A Secondary Analysis of Voice Hearers From the EviBaS Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7145894/), Lüdtke and colleagues recruited patients with schizophrenia who have delusions of hearing voices and randomly assigned them to receive online training that included a module on mindfulness or to a waitlist control condition. They completed a online training module online for 8 weeks. The module consisted of trainings on ”mindfulness, worry and rumination, social competence, self-worth, depression, sleep, and metacognitive biases, such as “jumping to conclusions” and took about 1 hour to complete. The mindfulness module consisted of “24 web pages, which contained text, pictures, and audio files.” They were measured before and after training for antipsychotic medication dosage, positive, negative, and global symptoms of schizophrenia, mindfulness, and distress caused by hearing voices.
They found that in comparison to baseline and the waitlist control participants that the online modules training group had significantly higher levels of mindfulness and lower levels of hallucinations. In addition, a mediation analysis found that the reduction in hallucinations was, in part, mediated by mindfulness. That is the training reduced hallucinations directly and also indirectly by increasing mindfulness that, in turn, reduced hallucinations. The online modules were a complex of trainings and mindfulness was just one component. So, it is not possible to ascribe the results to mindfulness training alone.
It was surprising that the online modules training did not reduce distress from hearing voices as was the intent of the study, but rather unexpectedly reduced overall hallucinations in the schizophrenic patients. Previous research has shown that Mindfulness-Based Cognitive Therapy (MBCT) can reduce the distress caused by hearing voices. This suggests that the cognitive therapy component of the treatment which attempts to alter the thought processes used to judge and interpret experiences was critical. Hence, mindfulness training itself may reduce overall hallucinations while alterations of cognitive process is required to decrease the distress produced by hearing voices.
So, reduce hallucinations in schizophrenia with mindfulness.
“mindfulness skills can provide these individuals with an alternative way of relating to their symptoms, moving from a judgemental and controlling stance to a more compassionate, accepting view. The effectiveness of mindfulness-based approaches for people with psychosis has been demonstrated in controlled clinical settings and in the community.” – Carly Samson
CMCS – Center for Mindfulness and Contemplative Studies
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Lüdtke, T., Platow-Kohlschein, H., Rüegg, N., Berger, T., Moritz, S., & Westermann, S. (2020). Mindfulness Mediates the Effect of a Psychological Online Intervention for Psychosis on Self-Reported Hallucinations: A Secondary Analysis of Voice Hearers From the EviBaS Trial. Frontiers in Psychiatry, 11, 228. https://doi.org/10.3389/fpsyt.2020.00228
Psychological online interventions (POIs) could represent a promising approach to narrow the treatment gap in psychosis but it remains unclear whether improving mindfulness functions as a mechanism of change in POIs. For the present study, we examined if mindfulness mediates the effect of a comprehensive POI on distressing (auditory) hallucinations.
We conducted a secondary analysis on voice hearers (n = 55) from a randomized controlled trial evaluating a POI for psychosis (EviBaS; trial registration NCT02974400, clinicaltrials.gov). The POI includes a module on mindfulness and we only considered POI participants in our analyses who completed the mindfulness module (n = 16).
Participants who completed the mindfulness module reported higher mindfulness (p = 0.015) and lower hallucinations (p = 0.001) at post assessment, compared to controls, but there was no effect on distress by voices (p = 0.598). Mindfulness mediated the POI’s effect on hallucinations (b = −1.618, LLCI = −3.747, ULCI = −0.054) but not on distress by voices (b = −0.057, LLCI = −0.640, ULCI = 0.915).
Limitations and Discussion
Completion of the mindfulness module was not randomized. Hence, we cannot draw causal inferences. Even if we assumed causality, it remains unclear which contents of the POI could have resulted in increased mindfulness and reduced hallucinations, as participants completed other modules as well. In addition, confounding variables could explain the mediation and the sample size was small. Nonetheless, the overall pattern of results indicates that the POI is likely to improve mindfulness, and that increased mindfulness could partially explain the POI’s efficacy.