Compassion Focused Approaches to Working With Distressing Voices

This paper presents an outline of voice-hearing phenomenology in the context of evolutionary mechanisms for self- and social- monitoring. Special attention is given to evolved systems for monitoring dominant-subordinate social roles and relationships. These provide information relating to the interpersonal motivation of others, such as neutral, friendly or hostile, and thus the interpersonal threat, versus safe, social location. Individuals who perceive themselves as subordinate and dominants as hostile are highly vigilant to down-rank threat and use submissive displays and social spacing as basic defenses. We suggest these defense mechanisms are especially attuned in some individuals with voices, in which this fearful-subordinate – hostile-dominant relationship is played out. Given the evolved motivational system in which voice-hearers can be trapped, one therapeutic solution is to help them switch into different motivational systems, particularly those linked to social caring and support, rather than hostile competition. Compassion focused therapy (CFT) seeks to produce such motivational shifts. Compassion focused therapy aims to help voice-hearers, (i) notice their threat-based (dominant-subordinate) motivational systems when they arise, (ii) understand their function in the context of their lives, and (iii) shift into different motivational patterns that are orientated around safeness and compassion. Voice-hearers are supported to engage with biopsychosocial components of compassionate mind training, which are briefly summarized, and to cultivate an embodied sense of a compassionate self-identity. They are invited to consider, and practice, how they might wish to relate to themselves, their voices, and other people, from the position of their compassionate self. This paper proposes, in line with the broader science of compassion and CFT, that repeated practice of creating internal patterns of safeness and compassion can provide an optimum biopsychosocial environment for affect-regulation, emotional conflict-resolution, and therapeutic change. Examples of specific therapeutic techniques, such as chair-work and talking with voices, are described to illustrate how these might be incorporated in one-to-one sessions of CFT.CH-M was supported by a Medical Research Council Clinical Research Training Fellowship (MR/L01677X/1) to investigate Compassion Focused Therapy for Psychosis

Schizotypy and mindfulness: Magical thinking without suspiciousness characterizes mindfulness meditators

Despite growing evidence for demonstrated efficacy of mindfulness in various disorders, there is a continuous concern about the relationship between mindfulness practice and psychosis. As schizotypy is part of the psychosis spectrum, we examined the relationship between long-term mindfulness practice and schizotypy in two independent studies. Study 1 included 24 experienced mindfulness practitioners (19 males) from the Buddhist tradition (meditators) and 24 meditation-naïve individuals (all males). Study 2 consisted of 28 meditators and 28 meditation-naïve individuals (all males). All participants completed the Schizotypal Personality Questionnaire (Raine, 1991), a self-report scale containing 9 subscales (ideas of reference, excessive social anxiety, magical thinking, unusual perceptual experiences, odd/eccentric behavior, no close friends, odd speech, constricted affect, suspiciousness). Participants of study 2 also completed the Five-Facet Mindfulness Questionnaire which assesses observing (Observe), describing (Describe), acting with awareness (Awareness), non-judging of (Non-judgment) and non-reactivity to inner experience (Non-reactivity) facets of trait mindfulness. In both studies, meditators scored significantly lower on suspiciousness and higher on magical thinking compared to meditation-naïve individuals and showed a trend towards lower scores on excessive social anxiety. Excessive social anxiety correlated neg- atively with Awareness and Non-judgment; and suspiciousness with Awareness, Non-judgment and Non-reactivity facets across both groups. The two groups did not differ in their total schizotypy score. We conclude that mindfulness practice is not associated with an overall increase in schizotypal traits. Instead, the pattern suggests that mindfulness meditation, particularly with an emphasis on the Awareness, Non-judgment and Non-reactivity aspects, may help to reduce suspiciousness and excessive social anxiety

Fostering Self-Compassion and Loving-Kindness in Patients With Borderline Personality Disorder: A Randomized Pilot Study

The aim of this randomized pilot study is to investigate the effects of a short training programme in loving-kindness and compassion meditation (LKM/CM) in patients with borderline personality disorder. Patients were allocated to LKM/CM or mindfulness continuation training (control group). Patients in the LKM/CM group showed greater changes in Acceptance compared with the control group. Remarkable changes in borderline symptomatology, self-criticism and self-kindness were also observed in the LKM/CMgroup. Mechanistic explanations and therapeutic implications of the findings are discussed. Highlights: ¿ Three weeks of loving-kindness and compassion meditations increased acceptance of the present moment experience in patients with borderline personality disorder. ¿ Significant improvements in the severity of borderline symptoms, self-criticism, mindfulness, acceptance and self-kindness were observed after the LKM/CM intervention. ¿ LKM/CM is a promising complementary strategy for inclusion in mindfulness-based interventions and Dialectical Behavioural Therapy for treating core symptoms in borderline personality disorder

Exploring the compatibility of biomedical and psychological approaches to treating psychosis

The recent UK clinical guidelines for psychosis require an integration of biomedical and psychological treatment approaches that may present challenges to the structure and delivery of services. This review briefly outlines these two approaches before presenting arguments both for and against their compatibility. Although this discussion recognises attempts at integrating the approaches in modern mainstream services, it argues that their fundamental theoretical differences entail very different treatment methods, and often require conflicting demands of clients. Not only is this potentially confusing and unhelpful to the clients, but it also interferes with the goals and processes of each approach. Some of the main challenges to integration are discussed, and suggestions are made regarding the future direction of multidisciplinary treatments for psychosis. This review argues that an open, critical examination of existing professional models and practices is required to ensure that optimal service provision

Exploring the theoretical and empirical foundations of a radical normalisation approach to psychosis

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Mysticism and madness:Different aspects of the same human experience?

Associations between mysticism and madness have been made since earliest recorded history, and the striking resemblance between self-reports of both mystical and psychotic experience suggests that similar psychological processes may be involved in their occurrence. By exploring the similarities, and proposing a common element to mystical and psychotic experience (referred to here as the experience of “oneness”), this paper aims to place mysticism and madness onto the same experiential continuum. However, in contrast to much of the previous literature, the intention is not to pathologize mystical experience, but rather to normalize psychotic experience. The paper argues not only that the experience of oneness is entirely genuine and available to all humans, but also that it has an important psychological (and evolutionary) function. Using cognitive terminology, it then attempts to explain the processes determining whether an individual enjoys a fulfilling mystical experience, or suffers a debilitating psychotic breakdown (i.e., how “oneness” is experienced). Finally, this paper turns to look at some of the important implications such an approach might have for clinical practice and for the mental health of people in general

Multi-level models of information processing, and their application to psychosis

Multi-level models have been developed to illustrate the mind's processing of qualitatively different types of information, and therefore provide a useful tool for exploring the actions and interactions of different processing levels within a single theoretical framework. This paper firstly reviews a selection of multi-level models, and then constructs a detailed rationale for applying a multi-level framework to psychosis. The argument draws on a wide psychosis literature, in the areas of positive symptoms, subjective phenomena, risk factors, and cognitive phenomena. In doing so, the discussion highlights some limitations of current (single-level) cognitive models of psychosis, and argues that a multi-level framework not only offers enhanced explanatory power, but also facilitates an integration of the evidence accumulated in different areas of psychosis research. Implications of a multi-level approach are discussed with regards to understanding the 'psychotic-like' experiences of both clinical and non-clinical populations. In particular, the roles of emotional meaning and function of psychotic phenomena are emphasised, and the clinical therapeutic tenet of normalisation is encouraged

Compassion-focused therapy for relating to voices

Compassion-Focused Therapy (CFT) is not a distinct school of therapy, but more a framework for focusing interventions that span across (and have emerged from) multiple different therapy traditions and approaches. In this respect CFT is a process-driven, rather than technique-driven, approach. The process unfolds to create certain contexts and conditions for an individual that will facilitate their mind’s natural adaptive, healing and problem-solving processes. So, essentially, CFT aims to create the conditions within a person’s environment, body and mind that will give them the best chance of working with, and integrating, distressing emotions and experiences. The CFT claim is that whatever threat-related intervention is required in therapy (e.g., addressing a fear, trauma, avoided emotion, behaviour), this will be more successful having first created these ‘optimum’ physiological and motivational conditions