Barbara Cludius

Mindfulness and relaxation treatment reduce depressive symptoms in individuals with psychosis

INTRODUCTION Self-help is increasingly accepted for the treatment of mental disorders, including psychosis, as both a provisional first step and a way to bridge the large treatment gap. Though mindfulness-based interventions do not belong to first line treatment strategies in psychosis and randomized controlled trials are lacking, encouraging preliminary findings speak for the usefulness of this approach. For the present study, we examined whether patients with psychosis benefit from mindfulness bibliotherapy. METHODS A sample of 90 patients with psychosis (including a subsample with a verified diagnosis of schizophrenia) took part in the study via the Internet. Following baseline assessment, participants were randomized to either a mindfulness group or a Progressive Muscle Relaxation (PMR) control group and received the respective self-help manual including accompanying audio files. Symptom change was measured six weeks after the baseline assessment with self-rating scales including the Paranoia Checklist. The retention rate was 71%. The quality of the online dataset was confirmed by various strategies (e.g., psychosis lie scale; examination of response biases). The trial was registered at the ISRCTN registry (ISRCTN86762253). RESULTS No changes across time or between groups were noted for the Paranoia Checklist. Both conditions showed a decline in depressive and obsessive-compulsive symptoms at a medium effect size (per protocol and intention to treat analyses). DISCUSSION/CONCLUSION The study provided partial support for the effectiveness of self-help mindfulness and PMR for depression in psychosis. Whether mindfulness delivered by a licensed therapist might lead to improved treatment adherence and a superior outcome relative to PMR remains to be established. The results underscore that bibliotherapy is a worthwhile approach to narrow the large treatment gap seen in psychosis.

Mindfulness-based cognitive therapy in obsessive-compulsive disorder: protocol of a randomized controlled trial.

BackgroundObsessive-compulsive disorder (OCD) is a very disabling condition with a chronic course, if left untreated. Though cognitive behavioral treatment (CBT) with or without selective serotonin reuptake inhibitors (SSRI) is the method of choice, up to one third of individuals with obsessive-compulsive disorder (OCD) do not respond to treatment in terms of at least 35% improvement of symptoms. Mindfulness based cognitive therapy (MBCT) is an 8-week group program that could help OCD patients with no or only partial response to CBT to reduce OC symptoms and develop a helpful attitude towards obsessions and compulsive urges.Methods/designThis study is a prospective, bicentric, assessor-blinded, randomized, actively-controlled clinical trial. 128 patients with primary diagnosis of OCD according to DSM-IV and no or only partial response to CBT will be recruited from in- and outpatient services as well as online forums and the media. Patients will be randomized to either an MBCT intervention group or to a psycho-educative coaching group (OCD-EP) as an active control condition. All participants will undergo eight weekly sessions with a length of 120 minutes each of a structured group program. We hypothesize that MBCT will be superior to OCD-EP in reducing obsessive-compulsive symptoms as measured by the Yale-Brown-Obsessive-Compulsive Scale (Y-BOCS) following the intervention and at 6- and 12-months-follow-up. Secondary outcome measures include depressive symptoms, quality of life, metacognitive beliefs, self-compassion, mindful awareness and approach-avoidance tendencies as measured by an approach avoidance task.DiscussionThe results of this study will elucidate the benefits of MBCT for OCD patients who did not sufficiently benefit from CBT. To our knowledge, this is the first randomized controlled study assessing the effects of MBCT on symptom severity and associated parameters in OCD.Trial registrationGerman Clinical Trials Register DRKS00004525. Registered 19 March 2013.

Self-Reported Symptoms of Attention-Deficit/Hyperactivity Disorder: Rate of Endorsement and Association with Neuropsychological Performance in an Adult Psychiatric Sample

The lack of specificity of attention-deficit/hyperactivity disorder (ADHD) symptoms represents a diagnostic challenge, especially when assessing psychiatric patients reporting a wide range of complaints. Rate of endorsement of ADHD symptoms, and their association with neuropsychological performance, was examined in a psychiatric sample of 71 adults, who had been referred for a neuropsychological evaluation. Patients completed two self-report measures of ADHD symptoms, the ADHD Self-Report Scale (ADHD-SR) and the Wender Utah Rating Scale-Short Form, as well as measures of attention, executive functioning, visuoconstructional ability, and verbal learning and memory. On the ADHD-SR, 74.6% of the sample met the cutoff for inattention or hyperactivity, while 81.7% met the cutoff for impulsivity. Neuropsychological performance was weakly associated with self-reported symptoms. Our results suggest that psychiatric patients commonly report symptoms of inattention, hyperactivity, and impulsivity. Assessment utilizing multiple sources is necessary to confirm whether self-reported symptoms are indicative of ADHD or reflect other causes.

An Investigation of Module-Specific Effects of Metacognitive Training for Psychosis

Metacognitive training for psychosis (MCT) is a group training program that targets cognitive biases, which play a role in the pathogenesis of delusions. It remains unclear to what extent individual MCT modules lead to within- or between-session changes in positive symptoms, sadness, cognitive biases, or theory of mind (ToM) distortions. A one-armed open-label intervention study was conducted with 176 psychiatric inpatients with psychotic symptoms. Patients were asked to fill out a questionnaire on cognitive biases, symptoms, and ToM distortions before and after each session. Multilevel (ML) modeling was used to assess associations between participation in a respective module and subsequent changes in self-reported symptoms. ML analyses indicated an overall improvement in all outcomes as well as within-session decreases in positive symptoms for a module addressing ToM distortions with a small effect. Two MCT modules addressing cognitive biases (jumping to conclusions, a bias against disconfirmatory evidence) were associated with reductions in the module-specific bias with a small and small to medium effect, respectively. The study provides initial evidence regarding module-specific associations with positive symptoms, cognitive biases, and ToM distortions in MCT.

Patients’ Perspectives on Treatment with Metacognitive Training for OCD: Feasibility and Acceptability

Abstract. There is much room for improvement in the treatment of obsessive-compulsive disorder (OCD). The current study introduces a newly developed version of Metacognitive Training for OCD (MCT-O...

Implicit approach and avoidance in patients with obsessive-compulsive disorder

Avoidance is regarded as an important feature for the development and maintenance of obsessive-compulsive disorder (OCD) and is usually assessed using explicit measures such as self-report scales. However, some behavioral schemata are unavailable to introspection, making them partially inaccessible by explicit measures. We used an approach-avoidance task (AAT) as an implicit measure to examine behavioral tendencies in patients with OCD, including patients with checking- and contamination-related symptoms (n = 63), compared with a healthy control group (n = 30). Participants were asked to respond to the color of a stimulus or stimulus frame by pulling a joystick toward themselves or by pushing it away. The stimuli were comprised of checking-related, contamination-related, and neutral pictures and words. Patients with contamination-related symptoms were slower when responding to OCD-related stimuli, independent of approach or avoidance. Unexpectedly, patients with checking-related symptoms were faster at pulling (approaching) and slower at pushing (avoiding) checking-related material compared with neutral stimuli. The slower pushing (avoiding) of checking-related compared with neutral material correlated positively with explicit ratings of avoidance. These results suggest a biased approach-avoidance tendency in patients with checking-related symptoms of OCD, but not in those with contamination-related symptoms of OCD. Future studies are necessary to assess whether the AAT might be useful in the assessment of treatment gains as well as whether it might be a training tool to enhance psychotherapeutic changes in OCD.