MINDFULNESS & PSYCHOSIS

Dr Katherine Newman Taylor

Consultant Clinical Psychologist, Hampshire Partnership Foundation Trust

& Lecturer in CBT, University of Southampton

Ipswich, July 2010

Mindfulnessfor psychosis

What is mindfulness?

Why not?

Model & implications for practice

Experientialexercise

Why mindfulnesswith psychosis?

Evidence;outcome & process

Getting started

WHAT IS MINDFULNESS?

Origins in Buddhism

Psychological practice that can sit outside Buddhism

Based on premise that distress is exacerbated and maintained by our reactions to experience

Kabat Zinn (1990) ‘Paying attention in a particular way to what is happening right now, in the present moment, non-judgementally.’

Teasdale, Williams and colleagues (eg 2000) To ‘decentre’ or ‘step back’ and learn to observe thoughts as events in the mind rather than necessarily accurate reflections of self or reality

WHY MINDFULNESS WITH PSYCHOSIS?

Limitations of medication for many people Research indicates that certain types of

cognitive reaction (suppression, rumination, confrontation) are associated with increased distress in relation to psychotic symptoms

Recognition that relationship with experience, as well as content, is key in cognitive therapy

Mindfulness rationale is consistent with clinical observation that people learn to live with voices and paranoia when their relationship with these internal experiences changes

WHY NOT?

Literature for mindfulness / meditation with psychosis is limited and generally cautionary (Deatherage & Lethbridge, 1975; Yorston, 2001)

Individuals with psychosis are often deemed vulnerable, with concerns that the practice may increase distress to become overwhelming

The question posed by this literature is:

How can mindfulness safely and therapeutically be introduced to people with psychosis?

HOW DO WE REACT TO PSYCHOTIC SENSATIONS?CHADWICK (2006)

MINDFULNESS PRACTICE FOR PSYCHOSIS

Therapists practice mindfulness with service users

Ground awareness in the body with brief body scan Anchor awareness in breathing

Invited to ‘turn toward’ sensations that enter awareness

Note and ‘let go’ of reactions eg avoidance, struggle, rumination, judgement

MINDFULNESS PRACTICE FOR PSYCHOSIS

Brief guidance or comments frequently – an important grounding method

Length of practice limited to 10 minutes rather than the traditional 20-45 minutes

People encouraged to close eyes to reduce sensory stimulation if happy to do so

Reflective discussion key to learning after the practice

Usually two practices per session

Experiential exercise

MINDFULNESS ISN’T ...

Relaxation

Distraction

Passive

Getting rid of experience

About feeling good

EVIDENCE: OUTCOMEChadwick, P., Newman Taylor, K & Abba, N (2005)

Mindfulness groups for people with psychosis. Behavioural & Cognitive Psychotherapy, 33, 351-359

Pilot study of 10 people with distressing psychosis Taught mindfulness of the breath Significant improvement in mindfulness skills & reduction in

CORE

Newman Taylor, K., Chadwick, P. & Harper, S. (2009) The impact of mindfulness on affect and meaning in psychosis. Behavioural and Cognitive Psychotherapy, .....

Two case studies, tracking change over time Taught mindfulness of the breath Reduction in distress associated with voices & belief conviction

EVIDENCE: OUTCOME

Participant A

0

1

2

3

4

5

6

7

8

9

10

week

dist

ress

and

bel

ief

conv

icti

on

distress of voices

belief conviction

EVIDENCE: OUTCOME

Participant B

0

1

2

3

4

5

6

7

8

9

10

week

dist

ress

and

bel

ief c

onvi

ctio

n

distress of voices

belief conviction

EVIDENCE: PROCESS Abba. N., Chadwick, P., & Stevenson, C. (2008)

Responding mindfully to psychosis: A grounded theory analysis. Psychotherapy Research, 18(1), 77-87

Used Grounded Theory to investigate the psychological processes involved in responding mindfully to unpleasant psychotic sensations – voices, thoughts and images

Grounded Theory chosen because, as well as providing a rich description of participants’ experience, it produces a theory of the phenomenon under study – what is actually going on

16 people with current distressing psychosis interviewed after completion of a mindfulness group programme

FINDINGS - CORE PROCESS

Experiencing how to relate differently to psychosis

Centering in awareness of voices, thoughts, images in the moment

Allowing voices, thoughts, images to come and go without reacting/struggle

Reclaiming power through acceptance

Opening awareness to include the unpleasant

Beginning again and again

Letting go of judgment, fight, worry,

analysis

Seeing my role

in alleviating distress

Accepting voices,

thoughts, imagesAccepting

myself

Anchoring awareness in

breath and body

Concentrating gently

on what

is present

Nottryingtoo

hard

Reconnecting with

present experience

Catching myself in habitual

reactions

Relaxinginto a

peaceful,calm state

Recognizing consequences of

reacting

Realizing emotional consequences of

letting go of habitual reactions

Feelingmore in control

of my mind

Deflatingpsychosis

Knowing I am more than

my psychosis

Discovering that I am not

different

CONCLUSIONS

Key problem for people with psychosis is a distressing and tyrannical relationship with psychosis

People are attempting to manage and resolve this tyrannical relationship

Mindfulness is not a cure for psychosis – psychotic sensations remain but with support, people can learn to respond differently to them

Acceptance of psychotic sensations and self supported by ‘metacognitive insight’ – developed through direct practice and reflection

GETTING STARTED

Personal practice

CDs – eg Williams, Kabat-Zinn

Join a mindfulness group – as participant, co-facilitator

Talk to others – psychologist? – about starting a group

Reading

SUMMARY Emerging evidence that mindfulness can be

useful for people with psychosis

Relationship with experience is key

Rationale for using Mindfulness with any given person needs to be incorporated into individual formulation and can be one component of a CBT intervention

Personal practice is the starting point!