Schizophrenia is a persistent mental illness with positive (hallucinations and delusions), negative (lack of motivation, social withdrawal, flat affect) and cognitive (impaired executive functioning) symptoms. While medications can often reduce positive symptoms, negative and cognitive symptoms often persist. Psychiatrists are interested in psychosocial treatments that can reduce these residual symptoms. 

Mindfulness training targets emotion regulation and executive functioning and may serve as an adjunctive treatment for schizophrenia. Shen et al. [Psychological Medicine] conducted a randomized controlled trial to test the effect of mindfulness training on residual negative and cognitive symptoms beyond the combined effects of routine medication and psychosocial rehabilitation among patient with schizophrenia. 

The researchers randomly assigned 100 Han Chinese patients with non-acute schizophrenia and residual symptoms (68% male; average age = 60 years) to a 6-week general rehabilitation control or a 6-week general rehabilitation plus mindfulness group.

Controls attended 90-minute general rehabilitation group workshops on weekdays, while the mindfulness group attended daily general rehabilitation (45 minutes) and mindfulness training (45 minutes) group workshops. 

General rehabilitation included health education, reading, painting, gardening, manual work, and daily life skill training. Mindfulness training included didactic material on mindfulness and rumination, focusing on sensations and thoughts, identifying emotions, self-acceptance, and relapse prevention.

All participants continued their prior psychotropic medications throughout the study as usual. Participants were assessed on clinical positive and negative symptoms and neuropsychological functioning at baseline and immediately following the intervention period.

After treatment, the mindfulness group showed moderate-sized improvements in total symptoms (Cohen’s d=0.51), depression (d=0.41), and anxiety (d=0.42) relative to controls and had significantly fewer negative symptoms.

The mindfulness group also showed small-sized relative improvements in general cognitive functioning (d=0.26), especially with regard to being able to remember verbal and visual information immediately after hearing or seeing it (d=0.31) and after a time delay (d=0.29).

The study shows adjunctive mindfulness training in a psychiatric treatment setting can reduce affective and cognitive symptoms in patients with non-acute schizophrenia above and beyond general rehabilitation and medication alone.

These findings are important because negative symptoms are often treatment-resistant, and mindfulness training can be an important new add-on modality to the treatment of schizophrenia. The study is limited by the absence of long-term follow-up.

Reference:

Shen, H., Zhang, L., Li, Y., Zheng, D., Du, L., Xu, F., Xu, C., Liu, Y., Shen, J., Li, Z., & Cui, D. (2021). Mindfulness-based intervention improves residual negative symptoms and cognitive impairment in schizophrenia: A randomized controlled follow-up study. Psychological Medicine.

Link to study