M INDFULNESS & P SYCHOSIS Dr Katherine Newman Taylor Consultant Clinical Psychologist, Hampshire...
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Transcript of M INDFULNESS & P SYCHOSIS Dr Katherine Newman Taylor Consultant Clinical Psychologist, Hampshire...
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
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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!