Posted: 06.12.2014 | by AMRA
Despite advances in the treatment of severe, prolonged psychotic illnesses such as schizophrenia, many if not most patients continue to suffer from residual symptoms, episodic relapses, and significant deficits in psychosocial functioning and well-being.
While mindfulness-based interventions (MBIs) have been of some proven value in the treatment of affective and anxiety disorders, clinicians are often reluctant to employ MBIs for patients with psychotic disorders due to fear that focusing awareness in the context of hallucinations and delusions might exacerbate symptoms of the illness.
Chien and Thompson [British Journal of Psychiatry] conducted a randomized, controlled multisite trial of an MBI with 107 Chinese schizophrenic outpatients in Hong Kong. Patients were assigned to either a Mindfulness-Based Psychoeducation Program (MBPP), a conventional psychoeducation program (CPP), or treatment as usual (TAU) that consisted of monthly psychiatric outpatient clinic visits and access to a variety of clinical support services.
While MBPP and CPP both included illness-specific psychoeducation including symptom management and relapse prevention strategies, MBPP also included focused, guided practice in awareness of bodily sensations, thoughts, and feelings with an emphasis on fostering acceptance and a decentered attitude. MBPP and CPP were administered in twelve 2-hour group sessions over the course of six months, and participants were re-evaluated at 1 week, 12 months, and 24 months post-intervention.
Over the course of two-years, MBPP participants showed significantly fewer psychiatric symptoms, higher levels of psychosocial functioning, higher levels of awareness into the nature of their illness, and shorter duration of hospital stays than did CPP and TAU participants. Effect sizes were all medium-to-large. At two-year follow-up, MBPP participants had average Brief Psychiatric Rating Scale scores of 17 (higher numbers = greater symptomatology), while CPP participants averaged 28, and TAU averaged 36. MBPP participants were hospitalized an average of 11 days, CPP patients 16 days, and TAU patients 21 days.
The study suggests that MBPP may offer benefit to participants over and above current standard treatments, and that fears that MBIs might cause unintended harms in psychotic populations may be unfounded, especially when interventions are modified to take the specific needs of psychotic patients into account.
Chien, W. T., & Thompson, D. R. (2014). Effects of a mindfulness-based psychoeducation programme for Chinese patients with schizophrenia: 2-year follow-up. The British Journal of Psychiatry, 205(1):52-59. [PMID: 24809397]