Engagement, clinical outcomes and therapeutic process in online mindfulness for psychosis groups delivered in routine care.

OBJECTIVES: There is growing evidence for the benefit of mindfulness-based interventions (MBI) for people with psychosis. However, research is yet to evaluate the clinical benefit of delivering MBI groups online. We examine engagement, clinical outcomes, participant experience and therapeutic process of delivering therapy groups online in routine clinical practice. METHODS: The study used an uncontrolled pre-post design to examine engagement, therapeutic benefits (depression, anxiety, beliefs about voices) and group process in a 12-session online mindfulness group for individuals with a schizophrenia spectrum diagnosis with current distressing voices. Qualitative data on participant experience of online group therapy were analysed using Thematic Analysis. RESULTS: 17/21 participants (81%) completed one of three consecutively run therapy groups. For completers there were significant reductions pre-post in depression, anxiety, beliefs about voices and voice-related negative affect, with medium to large effect sizes. There were individuals showing reliable and clinically significant improvements in each clinical outcome, and none showing reliable or clinically significant deterioriation. Participants' rankings of the importance of different group therapeutic factors were very similar to those observed in face-to-face mindfulness for psychosis groups. Qualitative analysis of participant feedback identified three themes: 'experience of online delivery', 'therapeutic benefits' and 'feeling connected to people in the group'. CONCLUSIONS: Findings in relation to therapy engagement, clinical benefits, participant experience and group process offer encouragement that online delivery of mindfulness for psychosis groups may be a useful addition to mental health services for people with distressing voices.

Group mindfulness-based intervention for distressing voices: A pragmatic randomised controlled trial.

Group Person-Based Cognitive Therapy (PBCT) integrates cognitive therapy and mindfulness to target distinct sources of distress in psychosis. The present study presents data from the first randomised controlled trial investigating group PBCT in people distressed by hearing voices. One-hundred and eight participants were randomised to receive either group PBCT and Treatment As Usual (TAU) or TAU only. While there was no significant effect on the primary outcome, a measure of general psychological distress, results showed significant between-group post-intervention benefits in voice-related distress, perceived controllability of voices and recovery. Participants in the PBCT group reported significantly lower post-treatment levels of depression, with this effect maintained at six-month follow-up. Findings suggest PBCT delivered over 12weeks effectively impacts key dimensions of the voice hearing experience, supports meaningful behaviour change, and has lasting effects on mood.

Group person-based cognitive therapy for distressing voices: Pilot data from nine groups.

The present study examines the impact of group Person-Based Cognitive Therapy (PBCT) for distressing voices within an uncontrolled evaluation. In particular it utilizes a framework of acceptance of voices and self to enhance well-being and reduce distress and perceived voice-control. Sixty-two participants entered one of nine PBCT groups conducted over 8-12 sessions. Fifty participants completed therapy. Measures of well-being, distress, control and relating characteristics were completed pre- and post-therapy and at brief follow-up. Data were subjected to an intention-to-treat analysis. The groups achieved significant benefits in terms of well-being, distress, control and dependence upon the voice. The present study is the first to report significant improvement in both distress and control. Consequently, Group PBCT for distressing voices may prove a useful addition to existing psychological interventions and is worthy of further investigation. The findings are discussed in relation to clinical implications and limitations.

Group person-based cognitive therapy for distressing voices: views from the hearers.

This study investigated the experiences of people who received a contemporary form of cognitive therapy for distressing voices. Eighteen people who heard distressing voices participated in an 8-session person-based cognitive therapy (PBCT) group and were then interviewed to elicit their experiences from the group. Data were gathered during a series of five posttherapy focus groups based on a semistructured interview schedule. A grounded theory approach was used to generate, work with, and understand the data. Four categories emerged: two representing the context for reflection and change and two representing the acceptance of voices and self and the changing sense of self. The conceptual and clinical implications of the findings are discussed.

Post-event processing in social anxiety.

Clark and Wells' [1995. A cognitive model of social phobia. In: R. Heimberg, M. Liebowitz, D.A. Hope, & F.R. Schneier (Eds.) Social phobia: Diagnosis, assessment and treatment (pp. 69-93). New York: Guildford Press.] cognitive model of social phobia proposes that following a social event, individuals with social phobia will engage in post-event processing, during which they conduct a detailed review of the event. This study investigated the relationship between self-appraisals of performance and post-event processing in individuals high and low in social anxiety. Participants appraised their performance immediately after a conversation with an unknown individual and prior to an anticipated second conversation task 1 week later. The frequency and valence of post-event processing during the week following the conversation was also assessed. The study also explored differences in the metacognitive processes of high and low socially anxious participants. The high socially anxious group experienced more anxiety, predicted worse performance, underestimated their actual performance, and engaged in more post-event processing than low socially anxious participants. The degree of negative post-event processing was linked to the extent of social anxiety and negative appraisals of performance, both immediately after the conversation task and 1 week later. Differences were also observed in some metacognitive processes. The results are discussed in relation to current theory and previous research.