Mindfulness Skills & Psychological Flexibility with distressing voices
description
Transcript of Mindfulness Skills & Psychological Flexibility with distressing voices
![Page 1: Mindfulness Skills & Psychological Flexibility with distressing voices](https://reader035.fdocuments.net/reader035/viewer/2022062521/5681679d550346895ddce0ec/html5/thumbnails/1.jpg)
Mindfulness Skills & Psychological Flexibility with distressing voices
Eric Morris, Emmanuelle Peters & Philippa GaretyInstitute of Psychiatry, King’s College London
South London & Maudsley NHS Foundation Trust
![Page 2: Mindfulness Skills & Psychological Flexibility with distressing voices](https://reader035.fdocuments.net/reader035/viewer/2022062521/5681679d550346895ddce0ec/html5/thumbnails/2.jpg)
ACT, mindfulness and psychosis• Acceptance based approaches focus on changing
the relationship to thoughts and feelings (rather than directly changing content) to increase behavioural flexibility
• Some preliminary evidence with psychosis (e.g., Bach & Hayes, 2002; Chadwick, Newman Taylor & Abba, 2005; Gaudiano & Herbert, 2006)
• Models consider distress and disability resulting from experiential avoidance, over-literality about thoughts/experiences, inability to persist with valued actions
![Page 3: Mindfulness Skills & Psychological Flexibility with distressing voices](https://reader035.fdocuments.net/reader035/viewer/2022062521/5681679d550346895ddce0ec/html5/thumbnails/3.jpg)
Voice hearing and distress/disability
• Cognitive models suggest that distress and disability associated with voices is partly a function of appraisals of voice power and intentions (e.g., Chadwick & Birchwood, 1994; Beck & Rector, 2003)
• Acceptance models, in addition, consider how people relate to appraisals in general (“fused” literality vs observing, mindful), with the aim of finding ways to influence this relating
![Page 4: Mindfulness Skills & Psychological Flexibility with distressing voices](https://reader035.fdocuments.net/reader035/viewer/2022062521/5681679d550346895ddce0ec/html5/thumbnails/4.jpg)
Relationship of experiential Relationship of experiential avoidance with psychosis?avoidance with psychosis?
Indirect evidence suggesting this:
• people who cope poorly with voices tend to rely largely upon distraction and thought-suppression strategies (Romme and Escher, 1993).
• suppression-based coping strategies may exacerbate intrusive thoughts, psychological distress, autonomic arousal, and auditory hallucinations (Morrison, Haddock and Tarrier, 1995).
• Interventions based on distraction when compared to focusing (Haddock et al., 1998) appear to come at personal cost – with poorer outcomes for self esteem during treatment
![Page 5: Mindfulness Skills & Psychological Flexibility with distressing voices](https://reader035.fdocuments.net/reader035/viewer/2022062521/5681679d550346895ddce0ec/html5/thumbnails/5.jpg)
Focus of the current study
• What relationships are there between psychological flexibility, mindfulness skills and previously found predictors of distress and disability in voice hearing?
• Does acceptance and mindfulness have any additional predictive power?
![Page 6: Mindfulness Skills & Psychological Flexibility with distressing voices](https://reader035.fdocuments.net/reader035/viewer/2022062521/5681679d550346895ddce0ec/html5/thumbnails/6.jpg)
Psychological Flexibility
BehaviouralResponsesto voices
Perceived powerof voices
Distress &
Disruption
![Page 7: Mindfulness Skills & Psychological Flexibility with distressing voices](https://reader035.fdocuments.net/reader035/viewer/2022062521/5681679d550346895ddce0ec/html5/thumbnails/7.jpg)
Measuring Psychological Flexibility & Mindfulness
Acceptance and Action Questionnaire – II (Bond et al, submitted) • Measures experiential avoidance/ acceptance and willingness
(based on ACT constructs)
Kentucky Inventory of Mindfulness Skills (Baer, Smith & Allen, 2004)• Measures skills in mindfulness, based on DBT constructs:
Observe, Describe, Act with Awareness, Accept Without Judgement
![Page 8: Mindfulness Skills & Psychological Flexibility with distressing voices](https://reader035.fdocuments.net/reader035/viewer/2022062521/5681679d550346895ddce0ec/html5/thumbnails/8.jpg)
Design & Participants
• Using a cross-sectional design, involving the participation of distressed voice hearers (N = 50)– Diagnosed with mental illness and receiving
treatment for auditory hallucinations– Recruited from community (N=35) and
inpatient settings (N=15)
![Page 9: Mindfulness Skills & Psychological Flexibility with distressing voices](https://reader035.fdocuments.net/reader035/viewer/2022062521/5681679d550346895ddce0ec/html5/thumbnails/9.jpg)
DemographicsDemographics• 33 male, 17 female• Mean age = 31.8 (range 18 – 56)• Mean length of time hearing voices = 9 years (range 3
months – 33 years)• Chart ICD Diagnoses:
– F20 – F29 = 45 (90%)– Mood disorder F30 – 39 = 5 (10%)
• Prescribed current medication for psychosis: 47 (94%)• Ethnicity: White 18 (36%), Black 22 (44%), Mixed 4
(8%), Asian 3 (6%), Other 3 (6%)• Employment: Unemployed 37 (74%), student 7 (14%),
Employed p/t 3 (6%), Employed f/t 3 (6%)
![Page 10: Mindfulness Skills & Psychological Flexibility with distressing voices](https://reader035.fdocuments.net/reader035/viewer/2022062521/5681679d550346895ddce0ec/html5/thumbnails/10.jpg)
Measures• Psychological flexibility & Mindfulness (AAQ-II &
KIMS)
• Voice Appraisals– Beliefs about Voices Questionnaire- Revised (Chadwick, Lees & Birchwood, 2000)
• General Distress - BDI & BAI
• Coping with thoughts - Thought Control Questionnaire (Wells & Davies, 1994)
• Multidimensional assessment of voices - PSYRATS-auditory hallucinations subscale (Haddock et al., 1999)
![Page 11: Mindfulness Skills & Psychological Flexibility with distressing voices](https://reader035.fdocuments.net/reader035/viewer/2022062521/5681679d550346895ddce0ec/html5/thumbnails/11.jpg)
Descriptives for sampleDescriptives for sampleMean s.d. Range (Total)
PSYRATS-AH 29.7 4.7 17 – 39 (44)
BDI 22.4 11.9 0 – 52 (63)
BAI 23.4 13.8 3 – 55 (63)
AAQ-II 37.2 8.2 22 – 58 (70)KIMS-Accept w/o judgement 24.8 8.0 11 – 45 (45)
Omnipotence 10.4 3.8 0 – 17 (18)
Benevolence 4.3 4.6 0 – 16 (18)
Malevolence 9.6 4.1 0 – 17 ( 18)
Resistance (behavioural) 10.4 3.9 2 – 15 (15)
TCQ Punishment 12.4 3.5 6 – 20 ( 24)
TCQ Re-appraisal 14.4 3.5 6 – 20 (24)
Previously published samples: Student (mean = 29.6, s.d. 6.5).
Borderline PD (mean = 21.5, s.d. 7.5)(Baer, Smith & Allen, 2004)
Previous published samples:Student & community (mean = 50.7, s.d. 9.2)
Substance misuse (mean = 39.8, s.d. 12.5)(Bond, et al, submitted)
![Page 12: Mindfulness Skills & Psychological Flexibility with distressing voices](https://reader035.fdocuments.net/reader035/viewer/2022062521/5681679d550346895ddce0ec/html5/thumbnails/12.jpg)
Psychological flexibility (AAQ-II) Pearson’s Correlation
Sig.
Depression -.65 p < .001
Anxiety -.48 p < .001
KIMS – Accept Without Judgement .53 p < .001
Acceptance without judgement (KIMS)Depression -.40 p < .01
Anxiety -.38 p < .01
Thought Control: Punishment -.59 p < .001
Thought Control: Re-appraisal -.44 p < .01
Voice Omnipotence -.41 p < .01
Resistance to voices (behavioural) -.45 p < .001
![Page 13: Mindfulness Skills & Psychological Flexibility with distressing voices](https://reader035.fdocuments.net/reader035/viewer/2022062521/5681679d550346895ddce0ec/html5/thumbnails/13.jpg)
Data analysis strategy
• To assess the study questions a series of hierarchical regression analyses were conducted
• Independent variables were chosen on the basis of correlation statistical significance with the dependent variable, and entered in Step 1
• Then as Step 2 the KIMS (Acceptance) and AAQ-II (Psychological Flexibility) variables were entered
![Page 14: Mindfulness Skills & Psychological Flexibility with distressing voices](https://reader035.fdocuments.net/reader035/viewer/2022062521/5681679d550346895ddce0ec/html5/thumbnails/14.jpg)
Appraisals of omnipotence
Model Predictors AdjustedR2 p1 Appraisals Malevolence
Benevolence.48.50
.30 .001
2 Appraisals + Acceptance
MalevolenceBenevolenceAcceptance (KIMS)Psych Flex (AAQ)
.48
.48-.39
-.01
.43 F changep < .01
![Page 15: Mindfulness Skills & Psychological Flexibility with distressing voices](https://reader035.fdocuments.net/reader035/viewer/2022062521/5681679d550346895ddce0ec/html5/thumbnails/15.jpg)
Amount of voice distressModel Predictors AdjustedR2 p
1 MalevolenceDegree of –ve contentBehavioural resistance
.26
.14
.20
.15 .05
2Adding
Acceptance
MalevolenceDegree of –ve contentBehavioural resistance Acceptance (KIMS)Psych Flexibility (AAQ)
.20
.04
.35-.32-.44
.26 F changep< .05
![Page 16: Mindfulness Skills & Psychological Flexibility with distressing voices](https://reader035.fdocuments.net/reader035/viewer/2022062521/5681679d550346895ddce0ec/html5/thumbnails/16.jpg)
Life disruption from voices
Model Predictors AdjustedR2 p1 Degree of –ve content
Omnipotence.33.27
.16 .01
2Adding
Acceptance
Degree of –ve contentOmnipotenceAcceptance (KIMS)Psych Flexibility (AAQ)
.24
.37-.38-.24
.23 F changen.s.(.07)
![Page 17: Mindfulness Skills & Psychological Flexibility with distressing voices](https://reader035.fdocuments.net/reader035/viewer/2022062521/5681679d550346895ddce0ec/html5/thumbnails/17.jpg)
Responding to voicesDependent variable
Predictors AdjustedR2 p
Behavioural Resistance
1
OmnipotenceThoughts: PunishmentMalevolence
.26
.24
.23
.27 <.001
2Adding
Acceptance
OmnipotenceThoughts: PunishmentMalevolenceAcceptance (KIMS)Psych Flexibility (AAQ)
.14
.01
.14-.39-.05
.36 F change n.s. (.06)
Behavioural Engagement
Benevolence .65 .43 <.001
![Page 18: Mindfulness Skills & Psychological Flexibility with distressing voices](https://reader035.fdocuments.net/reader035/viewer/2022062521/5681679d550346895ddce0ec/html5/thumbnails/18.jpg)
General distress (BDI+BAI)Model Predictors AdjustedR2 p
1 OmnipotenceThoughts:Punishment
.07
.45.20 .01
2Adding
Acceptance
OmnipotenceThoughts:PunishmentAcceptance (KIMS)Psych Flexibility (AAQ)
-.01 .33 .02-.54
.44 F changep < .001
![Page 19: Mindfulness Skills & Psychological Flexibility with distressing voices](https://reader035.fdocuments.net/reader035/viewer/2022062521/5681679d550346895ddce0ec/html5/thumbnails/19.jpg)
Summary of ResultsAcceptance and psychological flexibility add
modest predictive power for: • general distress, • voice-specific amount of distress, • and appraisals of omnipotence. when combined with previously identified
independent variables in cognitive models. Non-significant, but “trend”, relationships for
predicting disruption and resistance to voices.
![Page 20: Mindfulness Skills & Psychological Flexibility with distressing voices](https://reader035.fdocuments.net/reader035/viewer/2022062521/5681679d550346895ddce0ec/html5/thumbnails/20.jpg)
Study limitations
• Cross-sectional design• Sample (distressed voice hearers)• Use of general measures of mindfulness and
psychological flexibility (compared to symptom specific measures, e.g. Voices Acceptance and Action Scale; Shawyer et al., 2007)
• Using topographic rather than “contextual” measures
![Page 21: Mindfulness Skills & Psychological Flexibility with distressing voices](https://reader035.fdocuments.net/reader035/viewer/2022062521/5681679d550346895ddce0ec/html5/thumbnails/21.jpg)
Clinical Implications/Questions• What does the AAQ-2 measure? (links with affect)• There may be some modest predictive power in
incorporating mindfulness and acceptance for understanding some aspects of distressed voice hearing (taking just a predictive model stance)
• But from a contextual CBT stance we are also looking for variables to influence, not simply explain…
• ACT model suggests that non-judgemental awareness of experiences is a skill that can be taught – can this be done with distressed voice hearers and does it allow them to have greater response flexibility?
![Page 22: Mindfulness Skills & Psychological Flexibility with distressing voices](https://reader035.fdocuments.net/reader035/viewer/2022062521/5681679d550346895ddce0ec/html5/thumbnails/22.jpg)