Does mindfulness improve inhibitory control in psychotic disorders? A randomized controlled clinical trial

Background/Objective: Impaired Inhibitory Control (IC) is a core feature of psychotic disorders and is related with impaired social functioning in people experiencing psychosis. Despite research showing the benefits of mindfulness over IC in the general population, no study has assessed its effects on IC in psychoses. The aim of our study was to assess the effectiveness of a mindfulness-based intervention combined with integrated rehabilitation treatment in a sample of people diagnosed of psychotic disorders. Method: Fifty-six patients diagnosed with psychotic disorder were recruited and randomly allocated either to integrated rehabilitation treatment or integrated rehabilitation treatment enhanced with 26 mindfulness group sessions. Measures comprised PANSS interview, MAAS scale, and Stroop Color Word Test (SCWT). The primary outcome variable was the performance in the non-congruent trials of the SCWT. Results: There were no differences between groups at baseline. At post-treatment patients allocated to mindfulness group increased their scores in non-congruent trials of SCWT and in MAAS. At post-treatment mindfulness group scored higher than integrated rehabilitation treatment in MAAS. Conclusions: Data suggest that mindfulness added to integrated rehabilitation treatment may improve IC in psychosis. Results are convergent with prior works about the effect of mindfulness over cognitive performance in general population.     

Is schizotypy taxonic? Response to

Beauchaine, Lenzenweger, and Waller (2008) criticize our taxometric study of schizotypy (Rawlings, Williams, Haslam, & Claridge, in press) on a variety of methodological and philosophical grounds. We argue that their critique selectively applies more stringent standards to our work than to studies supporting their view that schizotypy is taxonic (i.e., categorical). Many of their criticisms apply at least equally to existing studies that offer support for a schizotypy taxon, and these studies are vulnerable to biases favouring taxonic conclusions that were controlled for in our study. Contrary to their criticisms, we did not claim to have disconfirmed previous taxonic findings about schizotypy, and our findings positively support dimensional models of schizotypy rather than merely being null results. Similarly, our findings are not artefacts of the sampling or measurement decisions that they question. Even well-replicated taxometric findings are not immune to empirical challenge, and evaluation of such challenges must be even-handed.     

Further evidence for the efficacy of a metacognitive group training in schizophrenia

Metacognitive training (MCT) for patients with schizophrenia is a novel psychological group treatment targeting cognitive biases putatively involved in the pathogenesis of schizophrenia (e.g. jumping to conclusions, overconfidence in errors). Its eight modules are available cost-free online in many languages. In the present study, 36 subacute or remitted patients were randomly allocated to either the MCT or a wait-list group who received treatment-as-usual (TAU). Baseline and post assessments were 8 weeks apart and were performed blind to group status. MCT showed significantly greater improvement on the following parameters relative to the TAU group: delusion distress (PSYRATS), memory and social quality of life. In the MCT group, the rate of jumping to conclusions bias was reduced after training. No differences occurred on the PANSS. The present study confirms prior reports that MCT exerts beneficial effects on some cognitive and symptomatic parameters.     

Life hassles, experiential avoidance and distressing delusional experiences

Life hassles have been implicated in both the formation and maintenance of psychosis symptoms. However, little is understood about the mechanism through which these stressors impact on psychosis. The current study proposed experiential avoidance (EA), a psychological coping style that is a central focus for change in Acceptance and Commitment Therapy (ACT), as a potential mediator of the link between life hassles and both the emergence and maintenance of delusional ideation. Participants were recruited to a non-clinical sample (N = 133) and a clinical sample of psychosis patients (N = 100). All participants completed a self-report questionnaire including a measure of delusions and delusional distress (Peters Delusions Inventory), life hassles (Survey of Recent Life Experiences) and EA (Acceptance and Action Questionnaire-II). Mediation testing (bootstrapping) indicated a significant mediation effect of EA in the relationship between life hassles and both delusions and delusional distress, in both clinical and non-clinical samples. The findings suggest that individuals (irrespective of their diagnostic status) with a tendency to suppress or avoid unwanted thoughts are significantly more likely to experience distressing delusions in response to stressful life occurrences. The use of ACT and Cognitive Behavioural Therapy to reduce EA in those at risk of emerging delusions and in patients with an already established psychosis is discussed.     

An investigation of schizotypy in injecting amphetamine users

A fully dimensional view of psychiatric disorder conceptualises schizotypy as both a continuous personality trait and an underlying vulnerability to the development of psychotic illness. Such a model would predict that the structure of schizotypal traits would closely parallel the structure of schizophrenia or psychosis. This was investigated in injecting amphetamine users (N = 322), a clinical population who have high rates of acute psychotic episodes and subclinical schizotypal experiences. Schizotypy was assessed using the Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE), and psychotic symptoms were assessed using the Brief Psychiatric Rating Scale (BPRS). Using confirmatory factor analysis, O-LIFE subscale scores were mapped onto latent variables with their more clinical counterparts from the BPRS. A four-factor model comprising positive schizotypy, disorganisation, negative schizotypy, and disinhibition provided the best model fit, consistent with prior research into the structure of schizotypy. The model provided a good fit to the data, lending support to the theory that schizotypy and psychotic symptoms map onto common underlying dimensions.     

Facial affect recognition deficits: A potential contributor to aggression in psychotic illness

The current literature suggests a relationship between psychosis and the likelihood of engaging in aggressive behavior, though the factors involved are unclear. In this paper we use a social information processing framework to consider mediators of aggressive behavior in psychosis, especially facial affect recognition (FAR) deficits. The theoretical underpinnings of aggressive behavior are explored using the General Aggression Model (GAM) and FAR deficits are posited as a possible contributor to increased aggression in psychosis. Current research investigating the relationship between FAR, psychosis, and aggression is critically examined, and the role of potential confounding variables including positive symptoms, psychopathic personality traits, childhood trauma, and substance use briefly explored. In conclusion, we argue that socioemotional processing deficits, such as impaired FAR, are a fruitful area for research aimed at understanding, and hence reducing the risk of violence in psychosis.     

'Poor girl': a case of active psychosis

The paper provides a structural account of a clinical case of psychosis based on a two-year analysis conducted from a Lacanian perspective. It illustrates the Lacanian theoretical and clinical approach to psychosis through discussing the different phases of the analytic work with the particular analysand from her gradual stabilization to her breakdown and hospitalization. Following through the development of the analysis in a chronological order enables a presentation of the different modalities of psychotic transference at different points in the work as well as a discussion of the mechanisms responsible for stabilization and, conversely, psychotic breakdown. The paper discusses the use of language in psychosis as well as the strategies of binding jouissance that the analysand developed as a means of preventing psychotic crises and maintaining a functional relation to the world. Finally,issues are raised about the aim and direction of psychoanalytic treatment of psychosis.     

Beliefs about hearing voices

People who experience auditory verbal hallucinations (AVHs) vary in whether they believe their AVHs are self-generated or caused by external agents. It remains unclear whether these differences are influenced by the “intensity” of the voices, such as their frequency or volume, or other aspects of their phenomenology. We examined 35 patients with schizophrenia or schizoaffective disorder who experienced AVHs. Patients completed a detailed structured interview about their AVHs, including beliefs about their cause. In response, 20 (57.1%) reported that their AVHs were self-generated, 9 (25.7%) were uncertain, and 6 (17.1%) reported that their AVHs were caused by external agents. Several analytical approaches revealed little or no evidence for associations between either AVH intensity or phenomenology and beliefs about the AVH’s cause; the evidence instead favoured the absence of these associations. Beliefs about the cause of AVHs are thus unlikely to be explained solely by the phenomenological qualities of the AVHs.     

Self-consciousness, self-agency, and schizophrenia

Empirical approaches on topics such as consciousness, self-awareness, or introspective perspective, need a conceptual framework so that the emerging, still unconnected findings can be integrated and put into perspective. We introduce a model of self-consciousness derived from phenomenology, philosophy, the cognitive, and neurosciences. We will then give an overview of research data on one particular aspect of our model, self-agency, trying to link findings from cognitive psychology and neuroscience. Finally, we will expand on pathological aspects of self-agency, and in particular on psychosis in schizophrenia. We show, that a deficient self-monitoring system underlies, in part, hallucinations and formal thought (language) disorder in schizophrenia. We argue, that self-consciousness is a valid construct and can be studied with the instruments of cognitive and neuroscience.     

Mysticism and schizophrenia: A phenomenological exploration of the structure of consciousness in the schizophrenia spectrum disorders

Mysticism and schizophrenia are different categories of human existence and experience. Nonetheless, they exhibit important phenomenological affinities, which, however, remain largely unaddressed. In this study, we explore structural analogies between key features of mysticism and major clinical-phenomenological aspects of the schizophrenia spectrum disorders—i.e. attitudes, the nature of experience, and the ‘other’, mystical or psychotic reality. Not only do these features gravitate around the issue of the basic dimensions of consciousness, they crucially seem to implicate and presuppose a specific alteration of the very structure of consciousness. This finding has bearings for the understanding of consciousness and its psychopathological distortions.