Photo credit: Schulich School of Medicine & Dentistry
Recognizing the importance of early intervention, Lawson Health Research Institute’s Dr. Arlene MacDougall is studying the positive effects of mindfulness based interventions (MBIs) for youth with early psychosis.
Mindfulness is a meditative practice that promotes focusing on the natural cycles of the breath to bring awareness to the present moment, all while accepting feelings, thoughts and bodily sensations without judgment. Mindfulness based interventions (MBIs) use a variety of exercises such as mindful breathing and listening to achieve self-awareness.
Research shows that MBIs are effective treatments for a variety of mental and psychotic disorders, such as schizophrenia. This is because they can help improve symptoms of psychosis - a loss of contact with reality. Symptoms of psychosis can be divided into positive symptoms and negative symptoms. Positive symptoms represent a change in behavior or thoughts, including hallucinations and delusions. Negative symptoms refer to a withdrawal or lack of function such as a lack of feelings, emotional expression or speech.
While psychosis often first occurs in a person’s late teens or early twenties, there has been little research on MBIs with this population. “We wanted to better understand the impact of MBIs specifically designed for youth in the early phases of psychotic illness,” said Dr. MacDougall, a clinician-researcher at Lawson and a psychiatrist at the Prevention and Early Intervention Program for Psychoses (PEPP) at London Health Sciences Centre (LHSC). “MBIs are a particularly attractive treatment for psychosis because they can help individuals accept their illness, as well as develop the ability to disengage from illness experiences like abnormal beliefs and perceptions.”
Working with Mindfulness without Borders (MWB), a registered charity, Dr. MacDougall and her colleagues adapted an MBI called the Mindfulness Ambassador Council (MAC). Originally developed for high school students, the MAC intervention was adapted to be studied with youth in the mental health care setting.
“We intentionally did not add any references to mental illness or specific symptoms of psychosis,” explains Dr. MacDougall, also an assistant professor in the Departments of Psychiatry and Epidemiology and Biostatistics at Western University’s Schulich School of Medicine & Dentistry. “A primary reason for our attraction to the MAC was that it is not focused on illness or symptoms, but rather on drawing out and building upon individuals’ unique talents and strengths.”
The study recruited 21 patients from LHSC’s PEPP program. Patients were randomly assigned to either receive the adapted MAC intervention or to receive treatment as normal. The MAC intervention consisted of 12 weekly, one-hour sessions that each had a unique focus such as paying attention or practicing gratitude. Each session also included facilitated group learning, discussion, mindfulness skills practice and take-home assignments to reinforce the session’s focus.
Both groups were assessed before beginning and immediately following treatment. Results showed that youth who received the MAC intervention experienced significantly improved levels of tension, depression, anger and fatigue, as well as improved use of the mindfulness skill of accepting or allowing without judgment. In addition, these same youth showed a tendency for greater improvement in self-esteem and the mindfulness skill of acting with awareness.
“This study provides evidence that the MAC intervention translates to improvements in emotional and physical symptoms commonly associated with psychotic disorders, as well as recovery-related issues such as self-acceptance, self-esteem and self-awareness,” says Dr. MacDougall. “MAC participants also reported a very high degree of satisfaction with the MAC intervention. They appreciated how MAC focused on achieving and maintaining wellness rather than on their illness.”
The pilot study’s results have provided the foundation for a larger study on the use of the MAC intervention for early psychosis. Dr. MacDougall and her team are working with Early Psychosis Intervention Program sites across southwestern Ontario as part of a multi-site randomized controlled trial.
“Through this trial, we are hoping to see whether the MAC intervention can improve negative symptoms in young people with early psychosis,” said Dr. MacDougall. Negative symptoms are particularly importance since they are the most important predictor of a person’s future health outcomes and anti-psychotic medications have little effect on them. “We hypothesize that it may take longer to see noticeable changes in negative symptoms and are therefore going to add a follow-up assessment at 3 months.”
This pilot study was funded by Lawson’s Internal Research Fund (IRF), designed to allow Lawson scientists the opportunity to obtain start-up funds for new projects with exciting potential. “Lawson’s IRF enabled us to undertake this study,” said Dr. MacDougall. “We are now building capacity in MBI for early psychosis treatment and are in a position to launch the largest ever trial of an MBI in an early psychosis population.”
Above: Dr. MacDougall recently completed the
Mindfulness Ambassador Council (MAC) training with
mental health clinicians from Early Psychosis Intervention
programs across Southern Ontario. These clinicians will
be taking part in the MAC multi-site trial.