Reduce Hallucinations in Schizophrenia with Mindfulness

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:, 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


This and other Contemplative Studies posts are also available on Google+ and on Twitter @MindfulResearch


Study Summary


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.




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, 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.


Decrease Distress from Hearing Voices with Mindfulness

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By John M. de Castro, Ph.D.


The mindfulness-based psychoeducation group reported significantly greater improvements in psychiatric symptoms, psychosocial functioning, insight into illness/treatment and duration of readmissions to hospital.” – Wai Chien


Hearing voices (auditory hallucinations) is seen as a prime symptom of psychosis and is considered a first rank symptom of schizophrenia. Neuroimaging has demonstrated that the voices that people hear are experienced as if there were a real person talking to them with the same brain areas becoming active during voice hearing as during listening to actual speech. So, it would appear that voice hearers are actually experiencing voices.


Hearing voices, however, is not always indicative of psychosis. Around 2% – 4% of the population reports hearing voices. But, only about a third of voice hearers are considered psychotic. On the other hand, about two thirds of voice hearers are quite healthy and function well. They cope effectively with the voices they’re hearing, do not receive the diagnosis of psychosis, and do not require psychiatric care. The differences between people with psychoses and healthy people who hear voices, is not in the form but the content of the heard speech. Non-psychotic individuals hear voices both inside and outside their head just like the psychotic patients but either the content is positive or the individual feels positive about the voice or that they are in control of it. By contrast the psychotic patients are frightened of the voices, the voices are more malevolent, and they feel less control over them.


Mindfulness has been shown to be negatively related to the distress felt by the individual about hearing voices, such that the higher the level of mindfulness, the lower the level of distress. But, it has not been demonstrated that increasing mindfulness with training can produce decreases in distress. Cognitive Behavioral Therapy (CBT) has been shown repeatedly to help relieve the symptoms of psychosis. So, it would seem reasonable to test the ability of a mindfulness based form of CBT to relieve the distress produced by hearing voices.


In today’s Research News article “Group mindfulness-based intervention for distressing voices: A pragmatic randomised controlled trial.” See:

or see summary below or view the full text of the study at:

Chadwick and colleagues recruited participants who had reported hearing voices at least over the last year. The participants were randomly assigned to receive either treatment as usual or a Mindfulness-Based Cognitive Therapy (MBCT) program administered in a group format, weekly for 1.5 hours over 12 weeks. Before and after therapy and 6 months later the participants were measured for auditory hallucinations, anxiety, depression, and psychological distress. They found that the participants who received MBCT had significantly lower depression levels after treatment and 6 months later. In addition, the therapy produced a significant decrease in the distress felt about hearing voices and the participants perceived ability to control the voices.


These are interesting results that replicate the frequent finding that MBCT is effective in reducing depression. In addition, MBCT did not affect the severity of the voices heard. Rather it changed how people felt about the voices reducing how distressful they were to the individual and how well they felt that they could control them. So, MBCT doesn’t cause the voices to be heard differently, rather it simply helps the individuals to suffer less from the voices they hear. Being in the present moment may allow the voice hearer to feel more in control and to simply hear the voices without associating them with past or future problems making them much less distressful.


So, decrease distress from hearing voices with mindfulness.


mindfulness with individuals with psychosis can facilitate a decrease in overall symptoms, and can promote a reduction in subjective distress and the believability of symptoms. Mindfulness has also been shown to provide participants with a sense of calm and relaxation, while also instilling a sense of power over their experience. Thus, mindfulness-based treatment interventions may be an effective adjunctive treatment approach for individuals with psychotic illnesses.” – Kolina Delgado


CMCS – Center for Mindfulness and Contemplative Studies


This and other Contemplative Studies posts are also available on Google+


Study Summary

Chadwick, P., Strauss, C., Jones, A.-M., Kingdon, D., Ellett, L., Dannahy, L., & Hayward, M. (2016). Group mindfulness-based intervention for distressing voices: A pragmatic randomised controlled trial. Schizophrenia Research, 175(1-3), 168–173.



Group Person-Based Cognitive Therapy (PBCT) integrates cognitive therapy and mindfulness to target distinct sources of distress in psychosis. The present study presents data from the first randomised controlled trial investigating group PBCT in people distressed by hearing voices. One-hundred and eight participants were randomised to receive either group PBCT and Treatment As Usual (TAU) or TAU only. While there was no significant effect on the primary outcome, a measure of general psychological distress, results showed significant between-group post-intervention benefits in voice-related distress, perceived controllability of voices and recovery. Participants in the PBCT group reported significantly lower post-treatment levels of depression, with this effect maintained at six-month follow-up. Findings suggest PBCT delivered over 12 weeks effectively impacts key dimensions of the voice hearing experience, supports meaningful behaviour change, and has lasting effects on mood.