Elsevier

Current Opinion in Psychology

Volume 28, August 2019, Pages 317-320
Current Opinion in Psychology

Mindfulness for psychosis: a humanising therapeutic process

https://doi.org/10.1016/j.copsyc.2019.07.022Get rights and content

Highlights

  • In its adapted form mindfulness practice is safe and therapeutic for people with psychosis.

  • At the heart of mindfulness for psychosis is a humanising therapeutic process.

  • Mindfulness for psychosis supports a new sense of self that is balanced and fluid.

  • Group factors support the change process.

Mindfulness for psychosis has been slow to develop, in part because of the fear and stigma that surrounds psychosis. Breakthrough research showing how to adapt mindfulness groups for people with current distressing psychosis has led to a growing research base and it is now clear that adapted mindfulness for psychosis is both safe and therapeutic. However, how it works is less clear. This article argues that at its heart is a core humanising therapeutic process, characterised by key metacognitive insights and increased acceptance both of psychotic experience and the self. This core therapeutic process is underpinned not only by commitment to mindfulness practice, but also through active, constructive engagement with the group process. Individuals discover that that they are more than the psychosis, and that the self is balanced (positive and negative) and changing. It is recommended that future research explores these intra-personal and inter-personal therapeutic processes alongside outcome trials.

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)

There are more references available in the full text version of this article.

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    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).

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