What are the dangers of using mindfulness-based techniques for individuals suffering from Schizophrenia?

Question

I am unable to find much research on the application of mindfulnesss for those suffering from Schizophrenia. A recent study by Chien and Lee (2013) focuses on the application of a psychoeducation program for Chinese patients with Schizophrenia. However, I do not have the pleasure of reading this but findings indicate that it can improve psychosocial functioning (http://www.cme.psychiatryonline.org/article.aspx?articleID=1653271).

Though the study show promising results for alleviating symptoms in Schizophrenic patients, I feel - prima facie - that there might be a risk in exacerbating symptoms by educating Schizophrenic patients to adopt a non-judgmental awareness towards positive symptoms such as hallucinations and delusional thinking. I am a supporter of mindfulness-based interventions except I can't seem to find much literature on its limitations and risks for Schizophrenia.

As the neurological and biological evidence around Schizophrenia is far from conclusive, I am narrowing this down to only psychological and ethical risks/dangers that could potentially arise from mindfulness practice and Schizophrenic individuals. For clarity around the theory underpinning Schizophrenia, I would refer to the Theory of Mind as the overarching philosophical foundation for understanding Schizophrenia and interactions with mindfulness practice. A definition is given by Pedersen et al (2012):

"Theory of mind (ToM), the ability to think about mental states such as thoughts and beliefs in oneself and others, is a complex cognitive function that requires the integration of information from multiple sources. Substantial evidence has accumulated that patients with schizophrenia have impaired ToM functions (Sprong et al., 2007; Bora et al., 2009) that result in social-interactive deficits."

On a cognitive perspective, what dangers does mindfulness pose to a Schizophrenic individual's ability to discern their self-concept and their relations with the world?

Example

This is purely for illustrative purposes.

X suffers from Schizophrenia and visual hallucinations. X does engage in mindfulness practice regularly. His/her mindfulness practice involves paying non-judgmental attention in the present moment. Initially, X paid too much attention to the occasional visual hallucinations through his mindfulness exercises. This triggered a higher amount of distress and anxiety for X and caused him/her to believe in the 'reality' of the hallucination. It could be said that there may be a potential danger that existed in the initial stages of X's introduction to mindfulness practice.

Questions

1. What are the dangers of using mindfulness-based techniques for individuals suffering from Schizophrenia?
2. What are the mechanisms that make mindfulness practice effective when an individual is experiencing a delusional episode?

EDIT:

I have provided some more information around the scope of the question primarily around what type of 'dangers' could result from the interaction between mindfulness practice and those suffering from Schizophrenia.

References

Chien, W.T., Lee, I.Y.M. (2013). The mindfulness-based psychoeducation program for Chinese patients with schizophrenia. Psychiatric Services 2013

Answer 1

I cannot answer your question, because I'm not an expert on schizophrenia, but I would like to point out that the answer will depend on your theory of schizophrenia.

Post-mortem research on the brains of schizophrenic patients has found consistent anomalies:

• widening of the ventricles (meaning a loss of subcortical brain cells)
• structural abnormalities in the subcortical temporal-limbic areas such as the hyppocampus and basal ganglia
• structural abnormalities in the prefrontal and temporal cortex

CT and MRI research on the brains of living schizophrenics has found similar anomalies:

• enlarged ventricles
• loss of cortical substance in the temporal and frontal areas
• reduced volume in the basal ganglia (nucleus caudatus) and limbic structures

It appears that there is a general atrophy of brain tissue in schizophrenics, and from my non-expert knowledge there is nothing you can do to reverse this. Typical therapy in schizophrenia (today) is to give anti-psychotica to reduce symptoms, behavioral therapy to enhance social abilities, and family therapy to reduce hostility, excessive worrying etc. ("expressed emotion" plays a role in the etiology of schizophrenia). So basically what you do is not "heal" the disorder but alleviate the symptoms and help the patients with their everyday problems.

Since cognitive behavioral therapy (in which the patient is encouraged to consciously deal with his thoughts, including, I'd guess, the paranoic ones) is a normal part of clinical routine with schizophrenia, I don't see why mindfulness could not be beneficial. I believe it might well enhance the CBT in the same way as in the therapy of depression, where mindfulness and CBT are successfully applied in conjunction.

Answer 2

To be honest I think it can be very beneficial. Mindfulness is not concentrating on thoughts; it's accepting and labeling thoughts so they can go away.

For example, when someone feels anxiety coming up, they can label it as 'thoughts' and let it go. Labeling thoughts makes them emotionally neutral and stops more thinking about them, therefore it's much easier to let them go drift away. When you have labeled the thought, you should focus on how your belly moves with each breath, so you are totally in this moment again (mindfulness). If you focus on or fight the thoughts, you will make them much worse (the 'don't think of a polar bear' principle).

Stress, panic, anxiety, and depression all have to do either with your past or your future; your past has happened and can't be changed, but your future has not happened yet and can be changed by acting this moment. So live in this moment! Enjoy everything you do, see, hear, feel, taste, and smell at this moment! Negative mental states can only occur by focusing on your past or future, and therefore you will not be able to enjoy the beauty of the present!

This way of thinking can be pretty helpful for schizophrenic patients, since depression, anxiety and stress (this can even trigger an episode) is very common amongst them. Maybe they can even let go of some 'positive symptoms' like delusions when they feel them coming up. Instead of indirectly investing in them by paying attention to them, just don't let the delusions develop. This can be very helpful in combination with a therapist specialised in reality-testing therapy.

Answer 3

I agree with the commenter from Sep. 24, 16:19, except for one point: just because schizophrenic hallucinations are organic does not preclude them from changing through mindfulness. In our current understanding, all mentation is organic, yet we clearly exert conscious influence on thoughts, emotion, and even perception; otherwise all psychotherapy would be useless.

Coeus, it seems like your apprehension may be due to an incomplete understanding of mindfulness and mindfulness training. When dealing with disturbing content, an approach similar to exposure therapy is advised, i.e., gradually ramping up exposure to said content. Furthermore, a key aspect of mindfulness training is nonreaction and nonjudgment; mental experience is to be regarded not as objective but as fleeting, subjective, and ultimately illusory. That said, this is the major challenge with schizophrenia, and it's entirely possible that someone in the midst of psychosis will simply not possess the presence of mind to adapt such a decentered stance.