Mindfulness for psychosis: a humanising therapeutic process
Section snippets
Background
In 1985, when I began developing cognitive therapy for psychosis, received clinical wisdom was that it was untherapeutic to talk with people with psychosis about their symptoms. It was considered at best to be futile (at that time ‘delusions’ were defined as unmodifiable), likely to provoke psychological reactance (e.g. a hardening of paranoia), and at worst might lead to an inner collapse (the ‘psychosis as vital defence’ position). The argument ran that talking about distressing experiences
Meet the person, not the problem
The labels schizophrenia and psychosis can evoke strong fear and self-doubt in therapists, in mindfulness teachers, in us all. We fear not being able to connect with the person, saying the wrong thing, feeling lost, making the person worse not better. These fears if unacknowledged shape our behaviour; people with psychosis pick up on this, creating a vicious cycle. When leading groups we seek to be mindful of our internal experience and thereby limit the potential impact of our fears and
Adapting mindfulness: practice, enquiry and metacognitive insight
Psychosis from a mindfulness perspective can be defined as the presence in awareness of certain experiences (voices, paranoid intrusions, tactile or visual ‘hallucinations’, sensations of passivity, confusion…). The aim is not to try and get rid of or stop these experiences. As always in mindfulness, the key is not the presence of unpleasant sensations but the response to them — how they are held in awareness, the degree to which they trigger self-defeating reactions and shape a sense of self.
Mindfulness for psychosis is a therapeutic process
Another distinctive feature of our approach was to explicitly frame mindfulness groups as facilitating a therapeutic process rather than being a skills class. Framing is significant because it shapes our behaviour and what we pay attention to. There were four reasons for this decision.
Firstly, people primarily come to our groups because of suffering: distress, difficulty coping and living with psychosis, and lack of self-acceptance. To frame the groups as facilitating a therapeutic process
Evidence and research directions
The evidence base for mindfulness for psychosis is growing steadily. The first meta-analysis of mindfulness for psychosis [11•] included data from 468 participants drawn from seven randomised controlled-trials (RCTs) and 6 uncontrolled trials: the authors concluded that mindfulness interventions were moderately effective in reducing negative and affective symptoms, and in increasing functioning and quality of life. Two subsequent meta-analyses reported similarly promising conclusions. Cramer et
Coda
People often have said to me over the years that to offer mindfulness for psychosis takes courage. I see it differently. What empowers me is trust; trust in people with psychosis individually and in a group, trust in mindfulness, and trust in the core humanising therapeutic process. To truly offer mindfulness for psychosis in any moment requires that we free ourselves from fear and prejudice and reach out to the person; and that we trust in the person’s capacity to connect with us in this way,
Conflict of interest statement
Nothing declared.
References and recommended reading
Papers of particular interest, published within the period of review, have been highlighted as:
• of special interest
References (13)
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Mindfulness- and acceptance-based interventions for psychosis: our current understanding and a meta-analysis
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Mindfulness groups for people with distressing psychosis
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(2005) - et al.
Mindfulness groups for distressing voices and paranoia: a replication and feasibility trial
Behav Cogn Psychother
(2009) Person-Based Cognitive Therapy for Distressing Psychosis
(2006)
Cited by (15)
Ecological momentary assessment of state fluctuations in mindfulness and symptoms in psychotic disorders
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2022, International Journal of Clinical and Health PsychologyAn emotional regulation approach to psychosis recovery: The Living Through Psychosis group programme
2021, Journal of Behavior Therapy and Experimental PsychiatryCitation Excerpt :A key development in psychological interventions for psychosis has been the effective application of ‘third wave’ cognitive behavioural therapies, with a focus on transdiagnostic skills of mindfulness, acceptance and emotional regulation, which aim to alter one's relationship to symptoms (Chadwick, 2019; Khoury, Lecomte, Gaudiano, & Paquin, 2013; Louise, Fitzpatrick, Strauss, Rossell, & Thomas, 2018).
Does mindfulness improve inhibitory control in psychotic disorders? A randomized controlled clinical trial
2020, International Journal of Clinical and Health Psychology