Application of a mindfulness and compassion‐based approach to the at‐risk mental state

Stakeholder views on mindfulness for youth at risk for psychosis

Interventions incorporating mindfulness for youth identified to be at risk for psychosis show promise for symptom management yet to be addressed by other approaches. Important questions remain as to how to safely and effectively implement these interventions with this cohort. The aim of this research was to collaboratively identify with stakeholders of such interventions, namely youth at risk for psychosis, and practitioners with experience working with youth at risk for psychosis - attitudes towards mindfulness and potential intervention adaptations to ensure the safety, uptake, and effectiveness of mindfulness interventions used with youth at risk for psychosis. Consolidated criteria for reporting qualitative studies were adopted. Eight practitioners and six at risk for psychosis individuals were interviewed. Both groups identified significant potential benefits of mindfulness, for stress and relaxation, managing difficult thoughts and emotions, increasing positive emotions, improving functioning, and patient empowerment within treatment participation. Stakeholders identified the helpfulness of including compassion-based practices, emphasizing experiential and concrete material, shorter and guided exercises, the targeting of anxiety and attenuated psychotic symptomology, and making the goals or intent of practice youth relevant. Significant barriers were identified - poor functioning and low motivation, high self-criticism, concurrent medication and substance use, and perceptions of mindfulness that may impact uptake (e.g. it requires relaxation to work). Formulation of and research into comprehensive clinical guidelines will help ensure the safe and effective use of future mindfulness and compassion-based practices with at risk for psychosis individuals.

The MAC-P program: A pilot study of a mindfulness and compassion program for youth with psychotic experiences

BACKGROUND

The purpose of this pilot study was to determine the feasibility, acceptability and the potential clinical utility of a novel mindfulness and compassion program (MAC-P) designed for youth with a range of psychotic experiences.

METHOD

A non-randomised, non-controlled prospective follow-up study was conducted. Eighteen participants who either met criteria for the 'at risk mental state' or were experiencing a psychotic episode or had a recent diagnosis of schizophrenia attended the 8-week program. Participants completed clinical assessments pre-treatment, post-treatment and at 6-week follow-up which measured a range of symptoms (psychosis, anxiety, depression and stress) and psychosocial outcomes.

RESULTS

Attendance and retention data indicated that MAC-P is a feasible and acceptable program. There was a large significant increase in self-compassion. Mindfulness demonstrated a positive change over time. There was a large significant effect on one subscale-acting with awareness. There were significant reductions in distress associated with psychotic experiences as well as anxiety, depression, stress and self-criticism. Significant improvements in functioning and insecure attachment styles were also found. Regression results demonstrated that self-compassion was associated with a number of these findings.

CONCLUSION

The MAC-P for youth shows potential as a clinically effective intervention provided as an addition to treatment as usual for youth with psychotic experiences. A larger controlled study is needed to validate the effectiveness of this intervention.

Parenting behaviour and paranoia: a network analysis and results from the National Comorbidity Survey-Adolescents (NCS-A)

PURPOSE

Parenting behaviours-including the extent to which parents are protective, hostile, or caring-likely impacts whether a child develops a sense of vulnerability that carries forward into adulthood. Ideas of vulnerability are a contributory factor to the occurrence of paranoia. Our aim was to assess whether there is an association between specific parenting behaviours and paranoia.

METHOD

We examined cross-sectional associations of parenting and paranoia in an epidemiologically representative cohort of 10,148 adolescents (National Comorbidity Survey-Adolescents; NCS-A) and a second dataset of 1286 adults in Oxfordshire. Further, a network analysis was conducted with paranoia, parenting behaviours, and cognitive-affective variables (compassion, self-esteem, anxiety, and depression). Overprotectiveness, verbal abuse, physical abuse, and amount of care were assessed in mothers and fathers separately.

RESULTS

Nearly all parenting variables were significantly associated with paranoia, with parental verbal and physical abuse showing the largest associations. For example, the odds of reporting paranoia was over four times higher for those in the adult sample reporting a lot of paternal verbal abuse, compared to those reporting none (OR = 4.12, p < 0.001, CI 2.47-6.85). Network analyses revealed high interconnectivity between paranoia, parenting behaviours, and cognitive-affective variables. Of the parenting variables, paranoia most strongly interacted with paternal abuse and maternal lack of care.

CONCLUSION

There are associations between participants' self-reported experiences of parental behaviours and paranoia. Despite being associated with paranoia, cognitive-affective variables did not appear to mediate the relationship between parenting and paranoia, which is surprising. What might explain the link therefore remains to be determined.

Preventive interventions for individuals at ultra high risk for psychosis: An updated and extended meta-analysis

Intervention at the earliest illness stage, in ultra or clinical high-risk individuals, or indicated prevention, currently represents the most promising strategy to ameliorate, delay or prevent psychosis. We review the current state of evidence and conduct a broad-spectrum meta-analysis of various outcomes: transition to psychosis, attenuated positive and negative psychotic symptoms, mania, depression, anxiety, general psychopathology, symptom-related distress, functioning, quality of life, and treatment acceptability. 26 randomized controlled trials were included. Meta-analytically pooled interventions reduced transition rate (risk ratio [RR] = 0.57, 95%CI 0.41-0.81) and attenuated positive psychotic symptoms at 12-months (standardized mean difference = -0.15, 95%CI = -0.28--0.01). When stratified by intervention type (pharmacological, psychological), only the pooled effect of psychological interventions on transition rate was significant. Cognitive behavioral therapy (CBT) was associated with a reduction in incidence at 12-months (RR = 0.52, 95%CI = 0.33-0.82) and 18-48-months (RR = 0.60, 95%CI = 0.42-0.84), but not 6-months. Findings at 12-months and 18-48-months were robust in sensitivity and subgroup analyses. All other outcomes were non-significant. To date, effects of trialed treatments are specific to transition and, a lesser extent, attenuated positive symptoms, highlighting the future need to target other symptom domains and functional outcomes. Sound evidence supports CBT in reducing transition and the value of intervening at this illness stage. STUDY REGISTRATION: Research Registry ID: reviewregistry907.

Virtual reality clinical-experimental tests of compassion treatment techniques to reduce paranoia

Paranoia may build on negative beliefs held both about the self and others. Compassionate imagery may be one way of reducing such negative beliefs, and hence paranoia. Two studies tested this idea, one targeting compassion for the self and one targeting compassion for others. Two-hundred individuals from the general population scoring highly for paranoia were recruited. The studies used a randomised controlled experimental design, with embedded tests for mediation. Study one targeted self-compassion via creation of a compassionate coach (CC) image. Study two targeted compassion for others via loving kindness meditation (LKM). Individuals repeatedly entered neutral virtual reality social environments. Changes in compassion and paranoia were assessed. Compared to controls, the CC group increased in self-compassion (group difference = 2.12, C.I. = 1.57;2.67, p = <0.0001, d = 1.4) and decreased in paranoia (group difference = -1.73, C.I. = -2.48; -0.98, p = <0.0001, d = 0.8). Change in self-compassion explained 57% of change in paranoia. Compared to controls, the LKM group increased their compassion for others (group difference = 3.26, C.I. = 2.72;3.80, p = <0.0001, d = 1.7), and decreased in paranoia (group difference = -1.70, C.I. = -2.50; -0.89, p = <0.0001, d = 0.8). Change in compassion for others explained 67% of change in paranoia. Targeting negative beliefs about the self and others using compassionate imagery causes reductions in paranoia. Tests in clinical populations are indicated.

Distress related to attenuated psychotic symptoms: Static and dynamic association with transition to psychosis, non-remission and transdiagnostic symptomatology in clinical high-risk patients in an international intervention trial

This study examined whether distress in relation to attenuated psychotic symptoms (DAPS) is associated with clinical outcomes in an ultra-high-risk (UHR) for psychosis sample. We also investigated whether DAPS is associated with cognitive style (attributional style and cognitive biases) and whether amount of psychosocial treatment provided is associated with reduction in DAPS. The study was a secondary analysis of the ‘Neurapro’ clinical trial of omega-3 fatty acids. 304 UHR patients were recruited across ten early intervention services. Data from baseline assessment, regular assessments over 12 months and medium term follow up (mean=3.4 years) were used for analysis. Findings indicated: a positive association between DAPS assessed over time and transition to psychosis; a significant positive association between baseline and longitudinal DAPS and transdiagnostic clinical and functional outcomes; a significant positive association between baseline and longitudinal DAPS and non-remission of UHR status. There was no relationship between severity of DAPS and cognitive style. A greater amount of psychosocial treatment (cognitive-behavioural case management) was associated with an increase in DAPS scores. The study indicates that UHR patients who are more distressed by their attenuated psychotic symptoms are more likely to have a poorer clinical trajectory transdiagnostically. Assessment of DAPS may therefore function as a useful marker of risk for a range of poor outcomes. The findings underline the value of repeated assessment of variables and incorporation of dynamic change into predictive modelling. More research is required into mechanisms driving distress associated with symptoms and the possible bidirectional relationship between symptom severity and associated distress.

Family Strain Predicts Subsequent Depressive Symptoms in Middle-aged Adults: Hope Mediates and Self-compassion Moderates the Relation

Introduction

Interpersonal strain is linked with depressive symptoms in middle-aged adults. One possible mechanism accounting for this relation is a reduction in hope, defined as the belief in one's capacity both to reach and to generate a variety of ways to obtain goals. The strength of the strain-depressive symptoms relation is not uniform across individuals, however, pointing to the likelihood that individual differences in the ability to successfully navigate relationship strain play a role in mitigating its negative effects. One potential moderator of the strain - depressive symptoms relation is self-compassion, which encompasses the capacity to respond to one's own negative thoughts and experiences in a kind and nonjudgmental way. Although theory and empirical evidence suggest that self-compassion is protective against the impact of stress on mental health outcomes, little research has investigated how self-compassion operates in the context of relationship strain. In addition, few studies have examined psychological mechanisms by which self-compassion protects against mental health outcomes, depression in particular. Thus, this study examined 1) the extent to which hope mediates the relation between family strain and depressive symptoms, and 2) whether these indirect effects are conditional on self-compassion in a community sample of middle-aged adults.

Methods

Self-reported family strain, self-compassion, hope, and depressive symptoms were assessed in a community sample of 762 middle-aged adults aged 40-65. Follow-up measures of depressive symptoms were assessed approximately 20 months later.

Results

Results from structural equation models indicated that hope mediated the relation between family strain and depressive symptoms and the indirect effect was conditional on levels of self-compassion. For individuals high versus low in self-compassion, strain-related declines in hope predicted smaller increases in depressive symptoms.

Discussion

Taken together, the findings suggest that family strain may lead individuals to experience less hope and subsequent increases in depressive symptoms. However, a self-compassionate attitude may serve as a resilience resource, weakening the hope - depressive symptoms relation, a finding that holds promise for future research on the development and refinement of self-compassion interventions.

The link between self-compassion and psychotic-like experiences: A matter of distress?

OBJECTIVES

Self-shaming and self-criticism have been shown to contribute to the emergence of distressing psychotic symptoms and psychotic-like experiences (PLEs). In contrast, a self-compassionate mindset may protect against negative evaluations in response to PLEs leading to less distress. This study explores the association between self-compassion, the frequency of PLEs, and their associated distress.

DESIGN

The study used a correlational, cross-sectional design on a German community sample.

METHODS

A total of 234 participants completed the self-compassion scale (SCS), the Peters' Delusions Inventory, and a modified version of the Launay-Slade Hallucination Scale that measures frequency and distress of hallucinatory experiences. Pearson correlations between SCS and frequency of PLEs as well as between SCS and PLE-distress were compared. Additionally, network analyses of SCS and PLE-measures were calculated.

RESULTS

Self-compassion was associated with less-frequent PLEs and with less PLE-distress, with stronger correlations between self-compassion and PLE-distress. The network analysis showed the self-compassion facets isolation and overidentification to be the closest links to PLE-distress.

CONCLUSIONS

Self-compassion is associated with less PLE related distress. Prevention programmes and interventions that target the negative facets associated with lack of self-compassion may be promising. However, future studies need to explore the causal role of self-compassion facets in the formation of PLE-distress.

PRACTITIONER POINTS

Low levels of self-compassion are associated with being more distressed by psychotic experiences. As the self-compassion facets isolation and overidentification are most strongly related to distress, prevention and intervention programmes may benefit from focusing on these negative facets.

Dispositional mindfulness, self-compassion, and compassion from others as moderators between stress and depression in caregivers of patients with lung cancer

OBJECTIVE

The present study aimed to identify the most important protective factors predicting caregivers' depressive symptoms among factors of caregivers' dispositional mindfulness, self-compassion, compassion from others, and patients' dispositional mindfulness and their moderator effects on the relationship between caregiving stress and depressive symptoms.

METHODS

A total of 72 lung cancer outpatients and their family caregivers participated in this study. Family caregivers completed the Kingston Caregiver Stress Scale, Beck Depression Inventory-II (BDI-II), Five Facet Mindfulness Questionnaire (FFMQ), Self-Compassion Scale, and Compassion from Others Scale. Patients completed the EORTC Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), BDI-II, and FFMQ.

RESULTS

After controlling for patients' factors (treatment status, symptom distress, and depressive symptoms) and caregivers' health status, caregivers' stress and dispositional mindfulness, the domain of mindful awareness, and self-compassionate action were significantly associated with their depressive symptoms. Further analysis indicated that mindful awareness or self-compassionate action could buffer the effect of caregiving stress on depressive symptoms. When the two moderators, mindful awareness and self-compassionate action, were tested simultaneously, only self-compassionate action remained as a significant moderating effect.

CONCLUSIONS

Caregivers' mindful awareness and self-compassionate action were protective factors, which mitigate the impact of caregiving stress on their depressive symptoms. Therefore, the future supportive program aims at training the competencies of self-compassionate action with mindful awareness, which may enhance caregivers' coping resources.

Clinical Effects of Mindfulness-Based Intervention in Patients With First Episode Psychosis and in Individuals With Ultra-High Risk for Transition to Psychosis: A Review

Objectives: Recent clinical studies and meta-analyses have reported the clinical effects of mindfulness-based interventions as a complementary treatment for patients with schizophrenia, but their possible efficacy in patients with first episode of psychosis (FEP) and in individuals with ultra-high risk (UHR) of transition to psychosis is less clear. Here, we investigated the current evidence on the usefulness of mindfulness-based interventions in these two populations. Methods: We conducted a systematic search of the literature according to the PRISMA guidelines. Results: Among the 102 references retrieved, 9 responded to the inclusion criteria (8 in FEP patients and 1 in UHR individuals). In FEP patients, mindfulness interventions are well-tolerated and have a satisfactory level of adherence. The clinical benefits consist primarily of reduced anxiety and sadness and improved quality of life. None of the studies reported any increase in positive symptoms. Conclusion: Future sham-controlled studies with large sample sizes are needed to definitively conclude on the clinical interest of mindfulness-based interventions in FEP patients and UHR individuals as well as to understand their underlying mechanisms of action.

Enhancing social functioning in young people at Ultra High Risk (UHR) for psychosis: A pilot study of a novel strengths and mindfulness-based online social therapy

BACKGROUND

Psychological and pharmacological treatments have been shown to reduce rates of transition to psychosis in Ultra High Risk (UHR) young people. However, social functioning deficits have been unresponsive to current treatments.

AIMS

The study aims were to: i) describe the theoretical basis and therapeutic targets of a novel intervention targeting social functioning in UHR young people; and ii) examine its acceptability, safety and preliminary effect on social functioning.

METHODS

An international, multidisciplinary team developed a new intervention (MOMENTUM) to improve social functioning in UHR young people. MOMENTUM blends two novel approaches to social recovery: strengths and mindfulness-based intervention embedded within a social media environment, and application of the self-determination theory of motivation. The acceptability and safety of MOMENTUM were tested through a 2-month pilot study with 14 UHR participants.

RESULTS

System usage was high, with over 70% of users being actively engaged over the trial. All participants reported a positive experience using MOMENTUM, considered it safe and would recommend it to others. 93% reported it to be helpful. There were large, reliable improvements in social functioning (d = 1.83, p < 0.001) and subjective wellbeing (d = 0.75, p = 0.03) at follow-up. There were significant increases in the mechanisms targeted by the intervention including strengths usage (d = 0.70, p = 0.03), mindfulness skills (d = 0.66, p = 0.04) and components of social support. Social functioning improvement was significantly correlated with indicators of system usage.

CONCLUSION

MOMENTUM is engaging and safe. MOMENTUM appeared to engage the hypothesized mechanisms and showed promise as a new avenue to improve social functioning in UHR young people.