Mindfulness Intervention Effective for Distressing Voices in Psychosis
Combined cognitive therapy and mindfulness can have lasting positive effects on behavior and mood.
Group person-based cognitive therapy (PBCT), which integrates cognitive therapy with mindfulness, is effective in alleviating distress in individuals with psychosis who are hearing voices, according to a study conducted by a UK-based research team.
Dr Paul Chadwick, of the Department of Psychology, King's College, London, United Kingdom, and colleagues randomly assigned 108 participants (≥ 18 years of age) with a diagnosis of schizophrenia or schizoaffective disorder, who were distressed by hearing voices, to receive either PBCT plus treatment as usual (TAU) or TAU alone. Participants were assessed prior to randomization, as well as 4 months and 10 months postrandomization.
Of the participants 72% completed at least 8 PBCT sessions and were regarded as “completers.” Study retention was 86% at 4-month follow-up and 76% at 10-month follow-up.
The mean score on the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM), a 34-item self-report measure of psychological distress, was lower in the PBCT group compared with the TAU group. The estimated between-group effect size (unstandardized) was -0.14 (95% CI, -0.337 to 0.007; P =.188). The corresponding adjusted between-group effect size was -.157 (95% CI, -0.35 to 0.04).
Participants in PBCT showed significant between-group postintervention benefits on several measurement scales, in voice-related distress, perceived controllability of voices, and recovery, although these findings were not statistically significant across all scales. Participants in the PBCT group reported significantly lower posttreatment levels of depression, with this effect maintained at follow-up.
All PBCT sessions began with a mindfulness practice and discussion, consisting of guidance that included “reference to psychotic experience” and combined “focused attention on body and breath with open awareness.” Additional elements included “drawing out participants' voice-hearing experiences and framing them using a cognitive model” (sessions 1 to 3), exploring “personal control to weaken voice omnipotence and enhance autonomy” (sessions 4 to 6), and focusing on “identifying and de-centering negative schemata and building positive schematic beliefs” (sessions 7 to 12). Participants were encouraged to practice mindfulness daily at home using a supplied 10-minute recording and received an additional assignment each week that related to “work on voices or self.”
“Findings suggest PBCT delivered over 12 weeks effectively impacts key dimensions of the voice hearing experience, supports meaningful behaviour change, and has lasting effects on mood,” the researchers concluded. They noted that, although the effect on depression was maintained at follow-up, other positive effects (eg, delusional beliefs, relationship with positive psychotic symptoms) were not maintained. “Future research should examine a longer intervention phase to consolidate the post-treatment gains,” they stated.
Chadwick P, Strauss C, Jones AM, et al. Group mindfulness-based intervention for distressing voices: a pragmatic randomised controlled trial. Schizophr Res. 2016 Aug;175(1-3):168-173. doi: 10.1016/j.schres.2016.04.001