Hostname: page-component-8448b6f56d-t5pn6 Total loading time: 0 Render date: 2024-04-24T10:39:56.365Z Has data issue: false hasContentIssue false
  • English
  • Français

Mindfulness and relaxation treatment reduce depressive symptoms in individuals with psychosis

Published online by Cambridge University Press:  07 July 2015

S. Moritz ,
B. Cludius ,
B. Hottenrott ,
B.C. Schneider ,
K. Saathoff ,
A.K. Kuelz  and
J. Gallinat
S. Moritz*
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr, 52, Hamburg, Germany
B. Cludius
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr, 52, Hamburg, Germany
B. Hottenrott
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr, 52, Hamburg, Germany
B.C. Schneider
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr, 52, Hamburg, Germany
K. Saathoff
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr, 52, Hamburg, Germany
A.K. Kuelz
Affiliation:
Department of Psychiatry and Psychotherapy, University Hospital Freiburg, Freiburg, Germany
J. Gallinat
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr, 52, Hamburg, Germany
*
*Corresponding author. E-mail address: moritz@uke.uni-hamburg.de (S. Moritz).
Get access

Abstract

Introduction

Self-help is increasingly accepted for the treatment of mental disorders, including psychosis, as both a provisional first step and a way to bridge the large treatment gap. Though mindfulness-based interventions do not belong to first line treatment strategies in psychosis and randomized controlled trials are lacking, encouraging preliminary findings speak for the usefulness of this approach. For the present study, we examined whether patients with psychosis benefit from mindfulness bibliotherapy.

Methods

A sample of 90 patients with psychosis (including a subsample with a verified diagnosis of schizophrenia) took part in the study via the Internet. Following baseline assessment, participants were randomized to either a mindfulness group or a Progressive Muscle Relaxation (PMR) control group and received the respective self-help manual including accompanying audio files. Symptom change was measured six weeks after the baseline assessment with self-rating scales including the Paranoia Checklist. The retention rate was 71%. The quality of the online dataset was confirmed by various strategies (e.g., psychosis lie scale; examination of response biases). The trial was registered at the ISRCTN registry (ISRCTN86762253).

Results

No changes across time or between groups were noted for the Paranoia Checklist. Both conditions showed a decline in depressive and obsessive-compulsive symptoms at a medium effect size (per protocol and intention to treat analyses).

Discussion/conclusion

The study provided partial support for the effectiveness of self-help mindfulness and PMR for depression in psychosis. Whether mindfulness delivered by a licensed therapist might lead to improved treatment adherence and a superior outcome relative to PMR remains to be established. The results underscore that bibliotherapy is a worthwhile approach to narrow the large treatment gap seen in psychosis.

Keywords

PsychosisSchizophreniaMindfulnessRelaxationCognitive-behavioral therapySelf-help intervention
Type
Original article
Information
European Psychiatry , Volume 30 , Issue 6 , September 2015 , pp. 709 - 714
Copyright
Copyright © Elsevier Masson SAS 2015

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

1

The authors have equally contributed to the manuscript and share first authorship. A.K.K. and J.G. also contributed equally.

References

Abramowitz, J.S., Deacon, B.J.Psychometric properties and construct validity of the Obsessive-Compulsive Inventory – Revised: replication and extension with a clinical sample. J Anxiety Disord 2006;20:1016–1035.CrossRefGoogle ScholarPubMed
Abramowitz, J.S., Tolin, D., Diefenbach, G.Measuring change in OCD: sensitivity of the Obsessive-Compulsive Inventory-Revised. J Psychopathol Behav Assess 2005;27:317–324.CrossRefGoogle Scholar
Alvarez-Jimenez, M., Alcazar-Corcoles, M.A., Gonzalez-Blanch, C., et al.Online, social media and mobile technologies for psychosis treatment: a systematic review on novel user-led interventions. Schizophr Res 2014;156:96–106.CrossRefGoogle ScholarPubMed
Álvarez-Jiménez, M., Gleeson, J.F., Bendall, S., et al.Internet-based interventions for psychosis: a sneak-peek into the future. Psychiatr Clin North Am 2012;35:735–747.CrossRefGoogle ScholarPubMed
Arch, J.J., Ayers, C.R.Which treatment worked better for whom? Moderators of group cognitive behavioral therapy versus adapted mindfulness based stress reduction for anxiety disorders. Behav Res Ther 2013;51:434–442.CrossRefGoogle ScholarPubMed
Arch, J.J., Ayers, C.R., Baker, A., et al.Randomized clinical trial of adapted mindfulness-based stress reduction versus group cognitive behavioral therapy for heterogeneous anxiety disorders. Behav Res Ther 2013;51:185–196.CrossRefGoogle ScholarPubMed
Bechdolf, A., Klingberg, S.Psychotherapy of schizophrenia: not a problem of evidence, but a problem of implementation [Psychotherapie bei schizophrenen Störungen: Kein Evidenz-, sondern ein Implementierungsproblem]. Psychiatr Prax 2014;41:8–10.Google Scholar
Beck, A.T., Steer, R.A.Beck Depression Inventory Manual. San Antonio: Psychological Corporation; 1993.Google Scholar
Byrne, R., Davies, L., Morrison, A.P.Priorities and preferences for the outcomes of treatment of psychosis: a service user perspective. Psychosis 2010;2:210–217.CrossRefGoogle Scholar
Cavanagh, K., Strauss, C., Forder, L., Jones, F.Can mindfulness and acceptance be learnt by self-help? A systematic review and meta-analysis of mindfulness and acceptance-based self-help interventions. Clin Psychol Rev 2014;34:118–129.CrossRefGoogle ScholarPubMed
Cayoun, B.A.Mindfulness-integrated CBT: principles and practice. Chichester, U.K.: Wiley & Sons; 2011.CrossRefGoogle Scholar
Chadwick, P.Mindfulness for psychosis. Br J Psychiatry 2014;204:333–334.CrossRefGoogle Scholar
Coelho, H.F., Canter, P.H., Ernst, E.Mindfulness-based cognitive therapy: evaluating current evidence and informing future research. Psychol Conscious 2013;1:97–107.Google Scholar
Coles, M.E., Cook, L.M., Blake, T.R.Assessing obsessive compulsive symptoms and cognitions on the Internet: evidence for the comparability of paper and Internet administration. Behav Res Ther 2007;45:2232–2240.CrossRefGoogle ScholarPubMed
Fjorback, L.O., Arendt, M., Ørnbøl, E., et al.Mindfulness-based stress reduction and mindfulness-based cognitive therapy – a systematic review of randomized controlled trials. Acta Psychiatr Scand 2011;124:102–119.CrossRefGoogle ScholarPubMed
Foa, E.B., Huppert, J.D., Leiberg, S., et al.The Obsessive-Compulsive Inventory: development and validation of a short version. Psychol Assess 2002;14:485–496.CrossRefGoogle ScholarPubMed
Fonseca-Pedrero, E., Paino, M., Lemos-Giraldez, S., Muniz, J.Validation of the Community Assessment Psychic Experiences-42 (CAPE-42) in Spanish college students and patients with psychosis. Actas Esp Psiquiatr 2012;40:169–176.Google ScholarPubMed
Freeman, D., Garety, P.A., Bebbington, P.E., et al.Psychological investigation of the structure of paranoia in a non-clinical population. Br J Psychiatry 2005;186:427–435.CrossRefGoogle Scholar
Gönner, S., Leonhart, R., Ecker, W.The Obsessive-Compulsive Inventory-Revised (OCI-R): validation of the German version in a sample of patients with OCD, anxiety disorders, and depressive disorders. J Anxiety Disorders 2008;22:734–749.CrossRefGoogle Scholar
Hale, L., Strauss, C., Taylor, B.L.The effectiveness and acceptability of mindfulness-based therapy for obsessive compulsive disorder: a review of the literature. Mindfulness 2013;4:375–382.CrossRefGoogle Scholar
Hautzinger, M., Brähler, M.Allgemeine Depressionsskala (ADS) [General Depression Scale]. Göttingen: Hogrefe; 1993.Google Scholar
Heidenreich, T., Michalak, J.Achtsamkeitsbasierte Psychotherapie – Chancen und Grenzen der dritten Generation der Verhaltenstherapie [Mindfulness-based psychotherapy – opportunities and limits of the third generation of behavior therapy]. Sucht 2014;60:7–12.CrossRefGoogle Scholar
Huppert, J.D., Walther, M.R., Hajcak, G., et al.The OCI-R: validation of the subscales in a clinical sample. J Anxiety Disord 2007;21:394–406.CrossRefGoogle Scholar
Kabat-Zinn, J.Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. New York, N.Y.: Delta Trade Paperbacks; 1991.Google Scholar
Kahl, K.G., Winter, L., Schweiger, U.The third wave of cognitive behavioural therapies: what is new and what is effective?. Curr Opin Psychiatry 2012;25:522–528.CrossRefGoogle ScholarPubMed
Keefe, R.S.E., Harvey, P.D.Cognitive impairment in schizophreniaGeyer, M.A.Gross, G.Novel antischizophrenia treatments. Handbook of experimental pharmacology. Berlin: Springer; 2012. p. 11–37.CrossRefGoogle Scholar
Kinnear, P.R., Gray, C.D.SPSS 16 – Made Simple. London: Taylor & Francis; 2009.Google Scholar
Konings, M., Bak, M., Hanssen, M., et al.Validity and reliability of the CAPE: a self-report instrument for the measurement of psychotic experiences in the general population. Acta Psychiatr Scand 2006;114:55–61.CrossRefGoogle ScholarPubMed
Lincoln, T.M., Peter, N., Schafer, M., Moritz, S.From stress to paranoia: an experimental investigation of the moderating and mediating role of reasoning biases. Psychol Med 2010;40:169–171.CrossRefGoogle ScholarPubMed
Lincoln, T.M., Ziegler, M., Lullmann, E., et al.Can delusions be self-assessed? Concordance between self- and observer-rated delusions in schizophrenia. Psychiatry Res 2010;178:249–254.CrossRefGoogle Scholar
Lora, A., Kohn, R., Levav, I., et al.Service availability and utilization and treatment gap for schizophrenic disorders: a survey in 50 low- and middle-income countries. Bull World Health Organ 2012;90:47–54. [54A-54B].CrossRefGoogle ScholarPubMed
Ma, S.H., Teasdale, J.D.Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects. J Consult Clin Psychol 2004;72:31–40.CrossRefGoogle ScholarPubMed
McCarney, R., Schulz, J., Grey, A.Effectiveness of mindfulness-based therapies in reducing symptoms of depression: a meta-analysis. Eur J Psychother Couns 2012;14:279–299.CrossRefGoogle Scholar
Moritz, S., Jelinek, L., Hauschildt, M., Naber, D.How to treat the untreated: effectiveness of a self-help metacognitive training program (myMCT) for obsessive-compulsive disorder. Dialogues Clin Neurosci 2010;12:209–220.Google ScholarPubMed
Moritz, S., Wittekind, C.E., Hauschildt, M., Timpano, K.R.Do it yourself? Self-help and online therapy for people with obsessive-compulsive disorder. Curr Opin Psychiatry 2011;24:541–548.CrossRefGoogle ScholarPubMed
Moritz, S., Wess, N., Treszl, A., Jelinek, L.The attention training technique as an attempt to decrease intrusive thoughts in obsessive-compulsive disorder (OCD): from cognitive theory to practice and back. J Contemp Psychotherapy 2011;41:135–143.CrossRefGoogle Scholar
Moritz, S., Van Quaquebeke, N., Lincoln, T.M.Jumping to conclusions is associated with paranoia but not general suspiciousness: a comparison of two versions of the probabilistic reasoning paradigm. Schizophr Res Treat 2012;2012:384039.Google Scholar
Moritz, S., Favrod, J., Andreou, C., et al.Beyond the usual suspects: positive attitudes towards positive symptoms is associated with medication noncompliance in psychosis. Schizophr Bull 2013;39:917–922.CrossRefGoogle ScholarPubMed
Moritz, S., Van Quaquebeke, N., Lincoln, T.M., et al.Can we trust the Internet to measure psychotic symptoms?. Schizophr Res Treat 2013;2013:457010.Google ScholarPubMed
Moritz, S., Voigt, M., Kother, U., et al.Can virtual reality reduce reality distortion? Impact of performance feedback on symptom change in schizophrenia patients. J Behav Ther Exp Psychiatry 2014;45:267–271.CrossRefGoogle ScholarPubMed
Morris, E.M., Garety, P., Peters, E.Psychological flexibility and nonjudgemental acceptance in voice hearers: relationships with omnipotence and distress. Aust N Z J Psychiatry 2014;48:1150–1162.CrossRefGoogle ScholarPubMed
Müller, H., Laier, S., Bechdolf, A.Evidence-based psychotherapy for the prevention and treatment of first-episode psychosis. Eur Arch Psychiatry Clin Neurosci 2014;264(Suppl. 1):17–25.CrossRefGoogle ScholarPubMed
Perich, T., Manicavasagar, V., Mitchell, P.B., Ball, J.R.Mindfulness-based approaches in the treatment of bipolar disorder: potential mechanisms and effects. Mindfulness 2012;5:186–191.CrossRefGoogle Scholar
Poyurovsky, M., Zohar, J., Glick, I., et al.Obsessive-compulsive symptoms in schizophrenia: implications for future psychiatric classifications. Compr Psychiatry 2012;53:480–483.CrossRefGoogle ScholarPubMed
Radloff, L.S.The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1977;1:385–401.CrossRefGoogle Scholar
Ree, M.J., Craigie, M.A.Outcomes following mindfulness-based cognitive therapy in a heterogeneous sample of adult outpatients. Behav Change 2007;24:70–86.CrossRefGoogle Scholar
Sarris, J., Camfield, D., Berk, M.Complementary medicine, self-help, and lifestyle interventions for obsessive compulsive disorder (OCD) and the OCD spectrum: a systematic review. J Affect Disord 2012;138:213–221.CrossRefGoogle ScholarPubMed
Schirmbeck, F., Rausch, F., Englisch, S., et al.Stable cognitive deficits in schizophrenia patients with comorbid obsessive-compulsive symptoms: a 12-month longitudinal study. Schizophr Bull 2013;39:1261–1271.CrossRefGoogle ScholarPubMed
Schneider, B.C., Wittekind, C.E., Talhof, A., et al.Competitive Memory Training (COMET) for OCD: a self-treatment approach to obsessions. Cogn Behav Ther 2015;44:142–152.CrossRefGoogle ScholarPubMed
Shafran, R., Clark, D.M., Fairburn, C.G., et al.Mind the gap: Improving the dissemination of CBT. Behav Res Ther 2009;47:902–909.CrossRefGoogle ScholarPubMed
Shonin, E., Van Gordon, W., Griffiths, M.D.Do mindfulness-based therapies have a role in the treatment of psychosis?. Aust N Z J Psychiatry 2014;48:124–127.CrossRefGoogle ScholarPubMed
Teasdale, J.D., Segal, Z.V., Williams, J.M., et al.Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. J Consult Clin Psychol 2000;68:615–623.CrossRefGoogle ScholarPubMed
Turner, D.T., van der Gaag, M., Karyotaki, E., Cuijpers, P.Psychological interventions for psychosis: a meta-analysis of comparative outcome studies. Am J Psychiatry 2014;171:523–538.CrossRefGoogle ScholarPubMed
Van Dam, N., Hobkirk, A., Sheppard, S., et al.How does mindfulness reduce anxiety, depression, and stress? An exploratory examination of change processes in wait-list controlled mindfulness meditation training. Mindfulness 2014;5:574–588.CrossRefGoogle Scholar
van der Valk, R., van de Waerdt, S., Meijer, C.J., et al.Feasibility of mindfulness-based therapy in patients recovering from a first psychotic episode: a pilot study. Early Interv Psychiatry 2013;7:64–70.CrossRefGoogle ScholarPubMed
Williams, J.M., Crane, C., Barnhofer, T., et al.Mindfulness-based cognitive therapy for preventing relapse in recurrent depression: a randomized dismantling trial. J Consult Clin Psychol 2014;82:275–286.CrossRefGoogle ScholarPubMed
Wykes, T., Steel, C., Everitt, B., Tarrier, N.Cognitive behavior therapy for schizophrenia: effect sizes, clinical models, and methodological rigor. Schizophr Bull 2008;34:523–537.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.