RUNNING HEAD: MINDFULNESS, ANXIETY, AND PSYCHOSIS
Mindfulness Based Therapy as it relates to Anxiety Reduction in Acute In-Patient Care with
Individuals Who Experience Psychosis
Students Name
CNS 6529 Research and Assessment
June 5, 2016
Dan Lawther, PhD
South University
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MINDFULNESS, ANXIETY, AND PSYCHOSIS
Abstract
Mindfulness is described as “paying attention in a particular way: on purpose, in the present
moment, and non-judgmentally” (Chadwick, Taylor, and Abba p 351, 2005). This study
purposes that mindfulness based training will have a greater effect in reducing anxiety in patients
that are in acute inpatient facilities who are experiencing psychosis better than the facilities
standard training which is rational behavior therapy based. Thirty participants will be asked to
join the study in which fifteen of the participants shall receive mindfulness training while the
other fifteen participants will receive the standard hospital therapy. The participants will be
asked to rate their anxiety levels using State-Trait Anxiety Inventory (STAI) and Beck’s Anxiety
Inventory (BAI) prior to their first group and after their last group has been administered. It is
expected that the mindfulness group will experience greater reduction in anxiety symptoms as
reported by BAI and STAI. This study can help influence future directions in therapy in acute
inpatient facilities.
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MINDFULNESS, ANXIETY, AND PSYCHOSIS
Introduction
Davis, Strasburger, and Brown (2007) used mindfulness training to see if there would be
a reduction in anxiety as it relates to patients who were diagnosed with the DSM IV-TR
definition of schizophrenia. They found that mindfulness training helped to reduce anxiety in
participants with schizophrenia in comparison to intensive therapy (Davis, Stasburger, and
Brown 2007). Mindfulness is defined as “purposefully paying attention in each moment to all
life experiences, regardless of how ordinary” (Davis, Strasburger, and Brown p. 24, 2007).
Although, numerous studies have looked into mindfulness as a way to cope with both
psychological and non-psychological distress, many fail to see how mindfulness can improve the
quality of life in those with psychosis in acute inpatient facilities (Carmody and Baer 2008).This
study seeks to explore mindfulness training and its effects on reduction of anxiety in acute
inpatient, patients that are experiencing psychosis. It is expected that mindfulness training will
help reduce anxiety and increase mindfulness in those participants that are given mindfulness
training.
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MINDFULNESS, ANXIETY, AND PSYCHOSIS
Review of Literature
More holistic approaches have been taken in recent years to improve the quality of life in
those experiencing psychosis (Lukoff, Wallace, Liberman, and Burke 1986). Holistic approaches
tend to involve more than just psychoeducational therapy. The idea is to continue the already
existing continuation of mind and body. Lukoff and colleagues (1986) used a holistic approach
to see if there was a significant reduction in stress, in individuals with schizophrenia. The
comparison group of social skills training and holistic approach to stress reduction showed no
difference in prevention of relapse back into a hospital setting.
From holistic approach, the idea of positive psychology arose as a method to enhance
well-being, both psychological and physical. Positive psychotherapy (PPT) was developed to
increase positive emotion, engagement and meaning (Seligman, Rashid, and Parks 2006).
Positive psychotherapy has been used in various clinical settings and parallels mindfulness in
that it teaches the individual to focus on their well-being and engagement with their body.
Positive psychology interventions are effective in enhancement of subjective well-being,
psychological well-being and reduction of depressive symptoms (Bolier et al 2013). Thus, a
focus on well-being will be beneficial for individuals with psychosis.
It is also important to consider how holistic approaches can be used to prevent
hospitalization. In research conducted by Drvaric, Gerristen, Rashid, Bagby, and Mizrahi (2015)
defined resilience as the ability to adapt to stress and adversity. The study shows that
interventions addressing well-being as it relates to resilience can help people at clinical high risk
for developing psychosis. Well-being is important focus for psychosocial interventions. Thus, it
is important to begin prevention mechanisms in those that are more likely to experience
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MINDFULNESS, ANXIETY, AND PSYCHOSIS
psychosis. Prevention mechanisms like mindfulness may be used to help the individual increase
their well-being and reaction to stress, so resilience to stressful situations can reduce an
individual likelihood of experiencing psychosis and becoming hospitalized.
The inclusion of the mind and the body into therapeutic treatment is thought to help
reduce distress. With reduction of distress, people with psychosis may be able to have a higher
functioning life, in which they may be able to even work. Davis and colleagues, (2015) used
mindfulness training to see if individuals with schizophrenia will have better job performance.
Their Mindfulness Intervention for Rehabilitation and Recovery in Schizophrenia (MIRRORS)
program helped increase job performance and job attendance than an intensive support group.
Although, this study used mindfulness in an outpatient setting with participants in stable phase of
schizophrenia it still shows that mindfulness is an effective therapy.
Laithwaite and associates (2009) use compassionate focused therapy in a high security
setting to promote help seeking and to develop compassion towards oneself. It used inpatient
facility to improve the well-being of participants by having them focus on themselves, similarly
to meditation. As Penn and colleagues (2004) have shown, schizophrenia and therapeutic
progress is increased with some type of therapy than with medication alone.
Therefore, mindfulness should be taken into great consideration when working with
populations experiencing psychosis. Kuyken and fellow researchers (2008) used mindfulness
based cognitive therapy (MBCT) to prevent relapse into hospitals. Although, their targeted
population was those with recurrent depression they still found that relapse in those with
medication and MBCT was less than those that just had anti-depressant and standard therapy
(Kuyken et al 2008).
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MINDFULNESS, ANXIETY, AND PSYCHOSIS
In their 2005 study, Chadwick, Taylor and Abba, used mindfulness training to see if
individuals with psychosis could better deal with their psychotic episodes and understand what it
means to be mindful. Although, it was a pilot study they found that the participants seem to have
greater awareness of their psychosis and through mindfulness were able to cope better and not be
distressed by their hallucinations. They were able to maintain their well-being and use their
awareness of their senses to recognize external stimuli from their internal stimuli.
Holistic approaches have been beneficial in continuing the connection between the mind
and body. Mindfulness focuses on this connection in greater detail than other holistic
approaches. Through mindfulness based training, greater awareness to psychosis and dealing
with internal stimuli has been found (Chadwick, Taylor, and Abba 2005). Although, many
studies have found a link between mindfulness and improvement of quality of life they have
neglected to include an environment that many who experience psychosis tend to get counseling
and treatment from, an inpatient facility. Therefore, purpose of this study is to evaluate whether
mindfulness training will reduce anxiety in individuals experiencing psychosis in an acute
inpatient facility.
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MINDFULNESS, ANXIETY, AND PSYCHOSIS
Method
Participants
Thirty participants will be chosen from G. Werber Bryan Psychiatric Hospital (BPH)
from two separate acute in patient lodges; with fifteen participants on each lodge, respectively.
The participants anticipated age range would be from 18 years of age to 59 years of age with an
anticipated average of 32 years of age. The expected gender makeup of the participants would be
twenty-eight men and two women. The participants will be of different ethnicities, but mainly
African American and European American descent. The participants will be chosen based on the
following criteria: at least two weeks of stay at BPH prior to beginning of research with at least
two weeks of stay at BPH before discharge, and the diagnosis of schizophrenia, schizoaffective
disorder, or bipolar one with psychosis as defined by the DSM V. Participants that meet these
requirements will further be eliminated based on their level of cognitive functioning with the
mental status examination.
After selection. The fifteen participants on lodge 1 and lodge 2 will then be randomly
assigned to either Group A, the mindfulness training or Group B, the standard training of BPH.
Both of the groups will be conducted on the participants’ lodges so they did not have to meet
outside of their lodge. On lodge 1, eight participants will be assigned to Group A, while seven
participants will be assigned to Group B. On lodge 2, seven participants will be assigned to
Group A, while eight participants will be assigned to Group B. All participants are anticipated to
stay throughout the intended study time of two weeks.
Materials
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MINDFULNESS, ANXIETY, AND PSYCHOSIS
The Mental Health Status Examination (MHSE) will be used to assess cognitive ability
and memory retention for participants to participate. The inter-rater validity is strong and the
external validity is shown through the wide use in mental health settings.
The State Trait Anxiety Inventory (STAI) will be used prior to first group meeting and
after the last group meeting. This tool is to assess how much the participants’ anxiety levels
decrease. It has validity in the range of 0.69 to 0.89 with test-retest (APA 2016).
The Beck’s Anxiety Inventory (BAI) will be used prior to the first group meeting and
after the last group meeting to make sure that the mindfulness addresses physical attributes of
anxiety. It is a 21-item self-report inventory with a high internal consistency (alpha=0.92) and a
high test-retest reliability of 0.75 over one-week period (Beck, Epstein, Brown, and Steer 1988).
The Cognitive and Affective Mindfulness Scale-Revised (CAMS-R) is a 12-item selfreport inventory that will be used to see if participants understand mindfulness. It has an
acceptable internal consistency and will only be given to only participants in Group A during the
first group and after the last group has been administered. [Feldman, Hayes, Kumar, Greeson,
and Laureanceau 2007]
Design
This study will be a between-subjects, experimental design. The independent variables
are the two following groups: mindfulness training and standard BPH training. The dependent
variable is the amount of anxiety reduction experienced by the participants. By having two
groups a day one in the morning and one in the afternoon, it will help control for participants that
may not be “morning” people.
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MINDFULNESS, ANXIETY, AND PSYCHOSIS
Procedures
After getting permission from Bryan G. Werber Psyhiatric Hospital Institutional Review
Board and South Carolina Department of Mental Health Institutional Review Board,
respectively, participants will be chosen with help of treatment team members on each acute
lodge. The patients will then be asked to participate in the study with the knowledge of getting a
credit at the canteen for two items three days a week for the two-week time period the groups are
administered. The participants will be given the informed consent and will be given the option to
participate in the study.
After all consents are signed. The participants will be randomly assigned into either
mindfulness training group, Group A, or standard training group, Group B. The groups will meet
twice a day on Monday-Friday and once a day on Saturday, for a two-week time period.
Group A: Mindfulness Training
This group training was modeled from Chadwick, Hughes, Russell, Russell, and Dagnan
(2009), mindfulness groups and will be conducted by the author of this paper. The groups will
meet twice a day: in the morning, focus will be on the body and the sensations that are a part of
it; and in the afternoon, focus will be on the participants’ psychosis and how to change their
reaction to their internal stimuli. Each group will be 45 minutes in length, with 15 minutes
dedicated to reflection of the content of group. At least one time a week, if weather permits the
groups will be held outside. Homework to continue body scans and observations of senses will
be given to the participants at the end of both groups.
Group B: Standard Training
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MINDFULNESS, ANXIETY, AND PSYCHOSIS
Like Group A, this group will meet twice a day and will continue to focus on the rational
behavior therapy that BPH teaches. This group will continue to be taught by the same clinical
counselor who has facilitated groups there prior to start of this study to maintain consistency
between both lodges.
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MINDFULNESS, ANXIETY, AND PSYCHOSIS
Expected Results
Based on prior research, I expect to see some improvement in anxiety as it relates to
psychosis in the individuals that are in Group A. I expect to use a two-way ANOVA analysis in
excel to compare the before and after of STAI with both groups. I will also use ANOVA to
compare before and after BAI results. I also expect to use a t-test to compare CAMS-R from
before and after mindfulness groups are administered. I expect to see a larger decrease in anxiety
with individuals in Group A than in individuals in Group B. I also expect to see an increase in
mindfulness after the groups have been administered than before in participants of Group A. I
expect to see a very small p-value (0.05 or smaller) to support that training in mindfulness does
reduce anxiety in participants in that population so my null hypothesis of no change between
groups in reduction anxiety can be rejected with confidence. I also expect to see that the t-value
for my t-test will be 0.05 or smaller to show significance difference of knowledge of
mindfulness.
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MINDFULNESS, ANXIETY, AND PSYCHOSIS
Discussion
Although, this study has not been actively conducted, it is believed it will serve as a great
contribution to the hospital setting. Many patients experiencing psychosis, do not get a holistic
approach to their treatment. The symptoms are treated, but the mind and body are not allowed to
be connected together for better health and well-being in patients. If anxiety is reduced when this
study is actually conducted, another factor that can be added to better enhance future studies is
the amount of time for relapse. If relapse back into the hospital is reduced due to patients’ ability
to use mindfulness training outside of inpatient facilities, it would be a better investment and
could lead to lower costs for insurance companies in the long run. It will also be crucial to try
and include more women and diversity into these future inpatient facilities study. This study can
also be changed for the purpose of not including psychosis and looking into mindfulness training
for other patients who are in psychiatric inpatient facilities.
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MINDFULNESS, ANXIETY, AND PSYCHOSIS
References
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