The MAC-P program: A pilot study of a mindfulness and compassion program for youth with psychotic experiences.

BACKGROUND: The purpose of this pilot study was to determine the feasibility, acceptability and the potential clinical utility of a novel mindfulness and compassion program (MAC-P) designed for youth with a range of psychotic experiences. METHOD: A non-randomised, non-controlled prospective follow-up study was conducted. Eighteen participants who either met criteria for the 'at risk mental state' or were experiencing a psychotic episode or had a recent diagnosis of schizophrenia attended the 8-week program. Participants completed clinical assessments pre-treatment, post-treatment and at 6-week follow-up which measured a range of symptoms (psychosis, anxiety, depression and stress) and psychosocial outcomes. RESULTS: Attendance and retention data indicated that MAC-P is a feasible and acceptable program. There was a large significant increase in self-compassion. Mindfulness demonstrated a positive change over time. There was a large significant effect on one subscale-acting with awareness. There were significant reductions in distress associated with psychotic experiences as well as anxiety, depression, stress and self-criticism. Significant improvements in functioning and insecure attachment styles were also found. Regression results demonstrated that self-compassion was associated with a number of these findings. CONCLUSION: The MAC-P for youth shows potential as a clinically effective intervention provided as an addition to treatment as usual for youth with psychotic experiences. A larger controlled study is needed to validate the effectiveness of this intervention.

Onset of remission and relapse in depression: testing operational criteria through course description in a second Dublin cohort of first-admission participants.

BACKGROUND: This paper extends previous work describing course in depression using a recommended operational model that defines remission onset and relapse. We test whether a similar course pattern would emerge using this model in a new cohort of depressed participants. METHODS: We recruited a cohort of 86 participants, first-time inpatients, with DSM-IV major depression. Outcome was assessed prospectively over a 13-month minimum follow-up period. Remission onset was defined as a Ham-D score <8 for two consecutive weeks; relapse as a Ham-D score >16 for two consecutive weeks and meeting DSM-IV criteria for major depressive disorder. RESULTS: The cumulative probability of remission onset was 0.62 (SE=0.05) and 0.80 (SE=0.05) at 3 and 6 months following study entry. The relapse risk was 0.28 (SE=0.05) at 6 months post remission onset; 53% of those relapsing did so in the first 2 months post remission onset. Predictors of longer times to remission onset included: longer illness length, higher anxiety scores and unemployment; higher anxiety scores predicted relapse. The course pattern is similar to that reported previously. LIMITATIONS: These findings apply to inpatients only. Course was not rated blind to all of the participants' baseline data. CONCLUSIONS: Defining remission onset and relapse using this model is associated with a replicable course pattern. A singular clinical advantage of the model is the identification of those participants at highest risk of relapse 2 months post remission onset.