Mechanisms of action and processes of yoga-based group intervention for inpatients with schizophrenia spectrum disorders–A longitudinal qualitative study

Background: Research exploring the effects of yoga therapy (YT) on individuals with schizophrenia spectrum disorders (SSD) is scarce. Therefore, the current study aimed to explore possible mechanisms of actions and processes, as well as adverse effects of a novel yoga-based group intervention (YoGI) for in-patients with SSD in a German university hospital setting. Material and methods: A longitudinal qualitative study was integrated into a rater-blinded randomized controlled trial, exploring the impact of a 4-week YoGI as add-on treatment. In-depth interviews were conducted with participants receiving YoGI (n = 19) in addition to treatment as usual (TAU) and a control group (n = 14) which only received TAU. Interviews were conducted at baseline (n = 33) and 4 weeks post-intervention (N = 28) to assess the participant's experiences and how they changed over time. The interviews (N = 61) were audio-taped, translated, coded, and analyzed by means of inductive thematic analysis. Separate case summaries were prepared for each participant to analyze longitudinal changes within subjects. The research team members collaboratively discussed the final list of themes and subcodes. Rater-based questionnaires, such as the Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale for Schizophrenia (CDSS), and Personal and Social Performance Scale (PSP) were administered at baseline to assess clinical outcomes. Results: At baseline, participants reported a desire to improve their stress- and symptom management. A minority of participants expressed reservations toward yoga, and several psychosocial barriers were named, including worries about symptom exacerbation. At post-intervention, four mechanisms of change became evident from the interviews: (1) acquiring competence in relaxation, (2) increased interoceptive awareness, (3) feeling connected, and (4) a sense of spiritual wellbeing. A small number of participants reported difficulties with YoGI. Conclusion: Generally, YoGI positively influenced participants' experiences of their inpatient stay, regarding distress, self- and body awareness, social connectedness, and spiritual wellbeing. However, participants also illuminated necessary adjustments to improve the intervention. YoGI will therefore be adapted and further developed in an iterative process based on a participant involvement approach. The efficacy regarding outcomes and processes needs to be investigated in a future larger-scaled randomized controlled trial

Compassion-based approaches:a systematic review of their effectiveness and acceptability in schizophrenia spectrum disorders

The purpose of this systematic literature review is to provide an exhaustive summary of current research to explore the prospects of compassion-based approaches in treating persons with Schizophrenia Spectrum Disorders (SSD). Thereby, studies investigating the relationship between clinical parameters and self-compassion in SSD, as well as the acceptability, feasibility, and effects of compassion-based approaches for individuals with SSD were considered. The review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and checklist. Eight studies were included for qualitative synthesis. The results indicate an important role of self-compassion for several clinical parameters, including negative associations to positive symptoms, negative symptoms, cognitive disorganization, and emotional distress. All studies reported good acceptability and feasibility. Regarding the clinical effectiveness of compassion-based approaches, a variety of clinical benefits, such as improvements of mood, affect regulation, positive symptoms, negative symptoms, cognitive disorganization, and variables relating to psychological recovery were found in individuals with SSD. It is concluded that compassion-based approaches are a promising form of intervention in the treatment of SSD. However, further research, especially randomized controlled trials, in this field is needed to understand the full potential of compassion-based approaches for individuals with SSD.</p

Prevalence, predictors and types of unpleasant and adverse effects of meditation in regular meditators: international cross-sectional study

Background: Meditation is commonly implemented in psychological therapies since the ‘third wave’ of cognitive–behavioural therapy has increased the focus on mindfulness-based interventions. Although extensive research literature demonstrates its benefits, little is known about potential adverse effects. Aims: The aim of this study is to report the prevalence, type and severity of particularly unpleasant meditation-related experiences in the largest cross-sectional study on this topic to date, with 1370 regular meditators. Method: The participants were asked whether they ever encountered particularly unpleasant experiences as a result of their meditation experience. For the first time, the type and severity of those experiences were assessed and the association with several predictors, such as pre-existing mental disorders, were explored via logistic and linear regression. Results: Similar to previous studies, 22% of participants (95% CI 20–24) reported having encountered unpleasant meditation-related experiences, and 13% of participants (95% CI 3–5) reported experiences that were categorised as adverse. Those were mostly of affective, somatic and cognitive nature. Unpleasant meditation-related experiences were more likely to occur in participants with pre-existing mental illnesses (P = 0.000, 95% CI 1.25–2.12). Conclusions: This study demonstrates that unpleasant meditation-related experiences are prevalent among meditators and, to a relevant extent, severe enough to warrant further scientific inquiry. Longitudinal studies are needed to examine whether the unpleasant meditation-related experiences are merely negative and thus should be avoided, or are an inherent part of the contemplative path

The Relationship Between Mindfulness, Depression, Anxiety, and Quality of Life in Individuals With Schizophrenia Spectrum Disorders

Background: Schizophrenia spectrum disorders (SSD) are frequently accompanied by comorbid depressive and anxiety symptoms, as well as impaired quality of life (QoL). A growing body of evidence has demonstrated the relevance of mindfulness for SSD in recent years. The study examined the association between mindfulness, depression, anxiety, and QoL. Materials and Methods: A total of 83 participants with SSD were recruited at the in- and outpatient psychiatric hospital care. Participants completed the Southampton Mindfulness Questionnaire, Comprehensive Inventory for Mindful Experiences, and Freiburger Mindfulness Inventory, the Depression, Anxiety, Stress Scale to assess depression and anxiety, and the WHO-QoL Questionnaire. Multiple regression analyses examined the relationship between mindfulness and QoL and the mediating role of depression and anxiety. Results: Mindfulness had a significant statistical positive effect on QoL domains physical health, psychological, and environmental QoL in patients with SSD. Depression was identified as a significant mediator of this relationship. Conclusion: This study provides novel insight into mindfulness' mechanisms and paves the way for a process-oriented approach to treat SSD. The results provide first evidence for the process-based value of mindfulness for SSD; future studies can focus on the role of mindfulness for central therapeutic processes of change by employing longitudinal designs

Validation of the German version of the Southampton mindfulness questionnaire (SMQ)

Objectives: The aim of the study was to assess the convergent and divergent validity, reliability, utility, and treatment sensitivity of a newly translated German version of the Southampton Mindfulness Questionnaire (SMQ). The SMQ is a 16-item instrument measuring mindful awareness of distressing thoughts, images, and perceptions, developed originally within the mindfulness for psychosis field. Methods: Overall, three studies were conducted, comprising (1) a non-clinical sample of n = 848 (638 community sample and 210 meditators); (2) a clinical sample of n = 213 (106 schizophrenia and 107 depression); and (3) a clinical sample with n = 122 participants with emotional disorders within a randomized controlled study, of which 30 participants were also included in study 2. To assess convergent validity, participants completed the SMQ, Freiburg Mindfulness Inventory (FMI), and Comprehensive Inventory of Mindfulness Experiences (CHIME). To measure divergent validity, participants completed the Brief Symptom Inventory 18 (BSI-18), Positive and Negative Affect Schedule (PANAS), Brief Experiential Avoidance Questionnaires (BEAQ), and Anxiety Sensitivity Index 3 (ASI-3). Results: Mean internal consistency (α = 0.89) and convergent (r = 0.66 to 0.73) and divergent validity (r = − 0.09 to − 0.50) were established and sensitivity to change over time following treatment (d = 0.86) was shown. For the clinical sample, a single-factor structure is suggested by principal component analysis. Conclusions: Results provide first evidence for the utility of the German version of the SMQ for clinical practice and research in healthy individuals, meditators, and clinical groups. Further research is needed to examine the underlying construct of mindfulness

Cognitive fusion and personality traits in the context of mindfulness: A cross-sectional study

Objectives Meditation and mindfulness, though rooted in eastern traditions, have been increasingly embraced in western psychology. However, questions remain regarding the mechanisms through which the beneficial effects of mindfulness occur. The present study aimed to address cognitive fusion as a potential mediator between mindfulness and negative affect and whether the mindfulness-cognitive fusion link is moderated by personality factors in an international sample of frequent meditators. Methods An international sample of 739 frequent meditators completed measures of mindfulness (Southampton Mindfulness Questionnaire), cognitive fusion (Cognitive Fusion Questionnaire), negative affect (Brief Symptom Checklist), and personality (Big Five Inventory) in an online survey. Using SPSS Process Macro, cognitive fusion was examined as a mediator between mindfulness and negative affect. Furthermore, Extraversion, Conscientiousness, and Neuroticism were investigated as moderators in the mediation model. Results Cognitive fusion was found to be a partial mediator between mindfulness and negative affect (b = -0.249; 95% CI, [-0.289, -0.203]), whereas the examined personality factors were not found to moderate the present model (E: t(734) = 0.951, p = .342); C: t(734) = -0.042, p = .967; N: t(734) = -2.271, p = .023). Conclusions This study suggests that cognitive fusion plays a significant role in the association between mindfulness and negative affect. These findings indicate the importance of how individuals internally respond and relate to experiences and the instrumental value of mindfulness effects beyond and outside of mindfulness-based interventions

Sociodemographic and meditation-related characteristics.

Sociodemographic and meditation-related characteristics.</p

Overview of meditation types in detail.

N = 739. b Participants could choose multiple options; the total percentage may exceed 100%. (DOCX)</p

Correlations between predictors.

Correlations between predictors.</p