Posted 01.19.2017 | by AMRA

Schizophrenia is a severe, prolonged psychiatric illness affecting over 3,000,000 Americans with symptoms including delusions, hallucinations, apathy, and social withdrawal. The standard treatment for schizophrenia involves medication, education, and social support. Despite treatment, most patients suffer from residual symptoms that can negatively impact vocational and social functioning and quality of life.

Using a randomized, controlled, multisite design, Wang et al. [Neuropsychiatric Disease and Treatment] compared the efficacy of a novel six-month mindfulness-based psycho-educational program in reducing schizophrenic symptoms and disability to that of standard psychiatric care with and without conventional psycho-education.

The researchers recruited 138 patients with schizophrenic-spectrum disorders (52% male, average age = 24) from two Hong Kong outpatient clinics and randomly assigned them to one of three conditions: 1) a Mindfulness-Based Psycho-educational Group (MBPG), 2) a Conventional Psycho-educational Group (CPG) or 3) treatment-as-usual (TAU) alone. MBPG and CPG were both offered as supplements to treatment-as-usual, and were delivered in twelve two-hour bimonthly sessions over the course of six months.

MBPG focused on increasing awareness of bodily sensations, thoughts, and feelings relating to illness, controlling negative thoughts and perceptions, and enhancing illness management, problem-solving and relapse prevention. It emphasized acceptance and de-centering strategies and included mindfulness home practice. CPG emphasized education on schizophrenia, survival and life skills, relapse prevention, and resilience promotion. TAU included medication, psychiatric consultation, brief education about illness and treatment, nurse and social work services, and referrals for medical treatment and psychological counseling as indicated.

Outcome measures were obtained at baseline, and at 1 week and 6 months after intervention completion. Measures included psychosocial functioning, re-hospitalization, psychiatric symptoms, insight into illness/treatment, recovery, and mindfulness (the Five Facet Mindfulness Questionnaire of FFMQ).

The MBPG patients showed significantly greater improvement in psychosocial functioning, positive and negative symptoms, recovery, and insight into their illness (overall partial η2 = .54) than either the CPG or TAU patients. These patients were also significantly less likely to be re-hospitalized: 37% of the TAU, 27% of the CPG, and 11% of the MBGP patients were re-hospitalized during the 6-month follow-up. The magnitude of differences between the groups was moderate-to-large. For example, on the Positive and Negative Symptoms Scale at 6-month follow-up, MBGP patients earned lower average symptom scores (70) than either CGP (84) or TAU (97) patients.

MBGP patients showed significant increases in mindfulness on the FFMQ, which was not administered to the other groups. Ninety-five percent of the patients successfully completed the six-month interventions (they attended at least 7 classes and were available for follow-up data collection). No adverse reactions were observed for any group.

This study shows that a 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.

The study is limited by the fact that older schizophrenic patients with longer disease courses are underrepresented in its sample, and that the advanced practice nurses running the different groups may not have had an equivalent extent of training in the interventions used.

Reference:

Wang, L. Q., Chien, W. T., Yip, L. K., & Karatzias, T. (2016). A randomized controlled trial of a mindfulness-based intervention program for people with schizophrenia: 6-month follow-up. Neuropsychiatric Disease and Treatment, 12, 3097-3110.

[Link to abstract]