K Newman-Taylor Minfdulness with psychosis - Ipswich

Report
MINDFULNESS & PSYCHOSIS
Dr Katherine Newman Taylor
Consultant Clinical Psychologist,
Hampshire Partnership Foundation Trust
& Lecturer in CBT, University of Southampton
Ipswich, July 2010
Getting started
Evidence;
outcome & process
Experiential
exercise
What is mindfulness?
Mindfulness
for psychosis
Why mindfulness
with psychosis?
Why not?
Model & implications for practice
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
CHADWICK (2006)
TO PSYCHOTIC SENSATIONS?
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: OUTCOME
Chadwick, P., Newman Taylor, K & Abba, N (2005)
Mindfulness groups for people with psychosis.
Behavioural & Cognitive Psychotherapy, 33, 351-359


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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, .....


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Two case studies, tracking change over time
Taught mindfulness of the breath
Reduction in distress associated with voices & belief conviction
EVIDENCE: OUTCOME
distress of voices
belief conviction
Participant A
9
8
7
6
5
4
3
2
1
week
18
17
16
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
0
0
distress and belief conviction
10
EVIDENCE: OUTCOME
distress of voices
belief conviction
Participant B
9
8
7
6
5
4
3
2
1
week
18
17
16
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
0
0
distress and belief conviction
10
EVIDENCE: PROCESS
Abba. N., Chadwick, P., & Stevenson, C. (2008)
Responding mindfully to psychosis: A grounded
theory analysis. Psychotherapy Research, 18(1), 77-87


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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
Opening awareness
to include the
unpleasant
Anchoring
awareness in
breath and
body
Concentrating
gently
on
what
is
present
Beginning
again
and
again
Not
trying
too
hard
Reconnecting
with
present
experience
Allowing voices, thoughts, images to come and go
without reacting/struggle
Letting go of judgment,
fight, worry,
analysis
Catching
myself in
habitual
reactions
Relaxing
into a peaceful,calm
state
Seeing my
role
in alleviating distress
Recognizing
consequences of
reacting
Realizing emotional
consequences of
letting go of
habitual reactions
Reclaiming power through acceptance
Accepting
voices,
thoughts, images
Feeling
more in control
of my mind
Deflating
psychosis
Accepting
myself
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!

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