Mindfulness for Schizophrenia

Even though mindfulness has witnessed a surge of academic interest over the past few decades, there are very few studies on mindfulness for schizophrenia. There is considerable empirical evidence nonetheless, demonstrating that mindfulness meditation is an effective therapeutic tool for a range of mental health disorders including generalized anxiety disorder, ADHD, social anxiety disorder and depression as well as being a valuable aid in stress reduction and pain relief.

With schizophrenia however, the opinion about any possible benefits is divided. One school of thought holds that meditation techniques like mindfulness cannot be applied in acute psychosis. While this may be true, a recent study conducted in Hong Kong which tested the effectiveness of a mindfulness based psychoeducation program for outpatients with schizophrenia over an 18 month period suggests otherwise. In this study, 96 patients with schizophrenia were randomly assigned to either the mindfulness-based psychoeducational program or usual psychiatric care. The patients’ mental and psychosocial functioning, insights into illness and rehospitalization rates were measured at the start of the study and at 3 and 18 months postintervention. The investigators discovered that compared to those with usual care, the patients in the mindfulness psychoeducation program showed significantly greater improvements in insights into their illness, symptom severity, functioning, and number and length of rehospitalizations at the 18 month follow up (Chien WT, Lee IY, 2013). While this is good news for proponents of mindfulness therapy for psychosis, directions for future research of mindfulness interventions for schizophrenia need to be explored.

What is mindfulness?

What we currently term mindfulness appears to have originated from eastern psychological practices, specifically Buddhist psychology, which referred to this concept over 2,500 years ago. Mindfulness is a term stemming from the Pali language, whereby Sati is combined with Sampajana, and is translated directly as awareness, circumspection, discernment, and retention. These Pali renderings have been considered by scholars to suggest that mindfulness means to remember to pay attention to what is occurring in one’s immediate experience with care and discernment (Shapiro 2009).

The two components that are common to most definitions of mindfulness are:

The attentional component, which pertains to the ability to intentionally regulate attention and is mediated by a deliberate and sustained observation of thoughts, feelings, physical sensations and other stimuli as they occur in the present moment and,

The acceptance component, which involves maintaining an attitude of openness and receptivity to these experiences rather than judging, ignoring or minimizing them particularly when they are unpleasant (Bishop et al, 2004).

There are a few case reports that describe the clinical applicability of different meditation techniques to individuals suffering from schizophrenia-spectrum disorders with persistent negative symptoms. These investigators claim that meditation in a group setting may have potential in reducing the pervasiveness of negative symptoms like anhedonia ( an inability to feel pleasure) and asociality while enhancing factors that contribute to lasting recovery like hope and purpose in life.

When questioned, individuals suffering from schizophrenia state that continuing with meditative practices can be difficult without guidance and oversight. Many of those who have access to training and supervision affirm strongly that this practice reduces the intensity of persistent symptoms significantly. The debate on the effectiveness of mindfulness for schizophrenia continues, and it is clear that more research needs to be conducted, not only to confirm or refute possible benefits but also to elucidate the mechanisms that underlie the actions of this ancient practice.