Symposium at the BABCP National Conference, July 2010, Manchester UK.
This symposium highlights recent UK research in mindfulness and acceptance-based interventions for psychosis.
Convenor: Joe Oliver, South London & Maudsley NHS Foundation Trust
Chair: Eric Morris, South London & Maudsley NHS Foundation Trust
Does self-stigma mediate the effect of mindfulness on social functioning in a First Episode Psychosis sample?
Lucy Mersh, Salomons, Canterbury Christchurch University,
Fergal Jones, Salomons, Canterbury Christchurch University &
Joe Oliver, South London & Maudsley NHS Trust
Luoma et al (2007) describe self stigma as ‘shame, evaluative thoughts, and fear of enacted stigma that results from individuals’ identification with a stigmatised group that serves as a barrier to the pursuit of valued life goals’. Self-stigma has been linked to loss of self-esteem (Wahl, 1999), self-efficacy (Corrigan & Watson, 2002), poor adherence to treatment plans (Sirey et al., 2001) and reduction of the pursuit of employment and independent living (Link, 1982). If an individual accepts stigma their identity may become dominated by their illness (Lally 1989). It has been proposed that the experience of engulfment is especially overwhelming for people experiencing first episode psychosis as they are often also grappling with the challenges of young adulthood.
Research into the reduction of self-stigma has until recently focused on the use of psycho-education and CBT, finding limited success for both interventions (e.g. Alvidrez, Snowden, Rao &and Boccellarialso, 2008; MacInnes & Lewis, 2007). Recently a small amount of research has looked at Acceptance and Commitment Therapy (ACT) to reduce self stigma in substance misuse and obesity. From an ACT perspective the negative effects of self-stigma occur when an individual becomes entangled in their negative self-stigmatising thoughts and emotionally reacts to them. It could be hypothesized that the mindfulness component of ACT would allow individuals to step back from their thoughts and thus be less likely to self-stigmatise. This study explored the relationship between self-stigma and mindfulness, hypothesizing that individuals who were more mindful would be less likely to self-stigmatise and therefore would have higher social functioning. It was also hypothesised that this relationship would be independent of symptom severity. Four standardized measures for self-stigma, mindfulness, social functioning and symptom severity were employed. At the time of writing thirty three participants experiencing first episode psychosis had been recruited. At completion data from forty participants will be analysed using a regression analysis and clinical implications of findings discussed.
Psychological Flexibility and well-being in First Episode Psychosis
Emma O’Donoghue, Royal Holloway, University of London,
Eric Morris, South London & Maudsley NHS Foundation Trust &
Michael Evangeli, Royal Holloway, University of London
Psychological inflexibility is ‘the phenomenon that occurs when one is unwilling to experience particular negative internal experiences and attempts to alter them accordingly’. The concept of psychological flexibility underpins recent empirically derived approaches to psychological intervention (e.g. Mindfulness and Acceptance and Commitment Therapy). These approaches have been found to improve psychological functioning and alleviate a variety of mental health problems including chronic pain, generalised anxiety disorder and depression. Recent research has begun to focus on the usefulness of these interventions with individuals experiencing psychosis and has identified benefits such as improved social impairment and reduction of distress associated with psychotic symptoms. This is a relatively new focus in the treatment of psychosis and to date, no published research has explored these interventions or the concept of psychological flexibility in individuals experiencing first episode of psychosis. These individuals have a high risk of relapse, comorbid symptoms, suicidality when compared with normal controls. Research also indicates that the experience of negative intrusive cognitions, such as positive psychotic symptoms, can have profound implications for an individual’s well-being, social functioning and satisfaction with life. Therefore, further research into effective psychological interventions for this group is warranted. This study explored the mediating effect of psychological flexibility on well-being and social functioning in response to experiencing negative intrusive cognitions (psychotic and non-psychotic) in a sample of individuals experiencing a first episode of psychosis. A purposive sample of forty two individuals (male – 28: female - 14), aged between 18 and 33 years, who were currently being treated for a first episode psychosis completed standardised measures of these constructs. The clinical research implications of these results will be discussed.
Person-based cognitive therapy groups for distressing voices: An evaluation
Laura Dannahy, Hampshire Partnership NHS Foundation Trust,
Clara Strauss, Sussex Partnership NHS Foundation Trust &
Wendy Turton, School of Psychology, University of Southampton
Recent randomised controlled trials of group CBT for psychosis have yielded disappointing results (Barrowclough et al, 2006; Wykes et al, 2005). For this reason, there is increasing interest in the potential benefits of third wave cognitive therapies for psychosis. Person-based cognitive therapy for distressing voices (PBCT; Chadwick, 2006) integrates traditional cognitive therapy with a third wave acceptance based approach, including use of formal mindfulness meditation. By integrating the two in a meaningful way the potential benefits of both approaches are made available to participants. In this presentation outcomes of nine PBCT groups, involving 62 participants, are presented (Dannahy et al, submitted). Following the therapy groups there were significant improvements in psychosocial well-being as well as on measures of voice distress and voice control and these improvements were maintained at a one month follow up. Findings will be discussed in relation the interface between second wave and third wave cognitive therapies and the next step in evaluating PBCT groups for distressing voices will be presented.
References
Chadwick, P. (2006). Person-Based Cognitive Therapy for Distressing Psychosis. Chichester: Wiley
Dannahy, L., Hayward, M., Strauss, C., Turton, W., Harding, E. & Chadwick, P. (2010). Group Person-Based Cognitive Therapy for distressing voices: Pilot data from nine groups. Manuscript submitted to Behaviour Therapy and Experimental Psychiatry.
Predicting Changes in Delusional Ideation: The Role of Mindfulness & Negative Schemas
Joe Oliver, South London & Maudsley NHS Trust, London,
Kennedy McLachlan, Open Polytechnic, New Zealand,
Emmanuelle Peters, Institute of Psychiatry, London &
Paul Jose, Victoria University, New Zealand
Traditional definitions of delusions have described them as discrete entities that exist only within the population of the seriously mentally ill. This definition has been forced into reconsideration as evidence has accumulated to strongly suggest that delusions are in fact multi-dimensional and exist widely in the general population (Bentall & Slade, 1985; Cox & Cowling, 1989; Johns & van Os, 2001; Romme, Honig, Noorthoorn & Escher, 1992). Research demonstrating that normal populations report sub-clinical level delusional ideation was further evidence of a continuum, but also pointed to the possibility that clinical and non-clinical ideation were functionally related.
Several streams of research have suggested that non-clinical levels of delusional ideation are linked to later development of clinically significant delusions (e.g. Krabbendam & van Os, 2005; Poulton, et al. 2000; van Os, Hanssen, Bijl & Ravelli, 2000). A better understanding of factors that worsen non-clinical delusional thinking may provide insight into the aetiological underpinnings and developmental processes involved in clinical symptoms. Two potential factors are negative schemas and psychological inflexibility. This study used a longitudinal design to explore the impact of mindfulness and negative schemas on changes in delusional ideation over time in a sample of 204 college students. Using structural equation modelling, the results indicated that the effect of negative schemas on changes in specifically delusional distress was mediated by mindfulness. Clinical and research implications of these results will be discussed.