Mindfulness-based interventions for patients with schizophrenia spectrum disorders: A systematic review of the literature

Michel Sabé; Raoul Kohler; Natacha Perez; Mathilde Sauvain-Sabé; Othman Sentissi; Francoise Jermann; Paco Prada; Nader Perroud; Kerem Böge

doi:10.1016/j.schres.2023.12.011

Mindfulness-based interventions for patients with schizophrenia spectrum disorders: A systematic review of the literature

Schizophr Res. 2024 Feb:264:191-203. doi: 10.1016/j.schres.2023.12.011. Epub 2023 Dec 28.

Authors

Michel Sabé¹, Raoul Kohler², Natacha Perez², Mathilde Sauvain-Sabé², Othman Sentissi³, Francoise Jermann⁴, Paco Prada⁵, Nader Perroud⁴, Kerem Böge⁶

Affiliations

¹ Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226 Thonex, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland. Electronic address: michel.sabe@hcuge.ch.
² Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226 Thonex, Switzerland.
³ Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, 2, Chemin du Petit-Bel-Air, CH-1226 Thonex, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland.
⁴ Division of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Switzerland.
⁵ Consultation Liaison and Crisis Intervention, University Hospitals of Geneva, Switzerland.
⁶ Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin; and Freie Universität Berlin; and Humboldt-Universität zu Berlin; and Berlin Institute of Health, Germany; German Center of Mental Health (DZPG), Germany.

PMID: 38157679
DOI: 10.1016/j.schres.2023.12.011

Abstract

Background: Mindfulness-based interventions (MBIs) have emerged as secular practices, including elements of mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT). While MBIs have been widely adopted for physical and mental illness, only a few available programs are explicitly adapted for psychosis. However, previous reviews have reported the vital heterogeneity regarding treatment program structure. Therefore, this review aims to compare the structure of different mindfulness protocols applied to patients with schizophrenia spectrum disorder (SSD).

Methods: A systematic search was conducted up to March 2023 in PubMed, Embase and PsycInfo. Following our protocol (CRD 42023253356), we followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist.

Results: We included 22 randomized controlled trials (RCTs) involving 1500 patients SSD. All programs varied in structure, session components, duration, and instructor experience. While MBSR-like programs focused on stress reactivity, MBCT-like programs addressed primary symptoms of psychosis and relapse prevention. Despite the heterogeneity of programs, some common mechanisms emerged, including attention training, emotion and stress regulation, decentering, self-compassion, and cognitive restructuring.

Conclusions: The critical heterogeneity found limits the interpretation of results. However, most recent trials present fewer risks of bias and more homogenous programs. Findings suggested potential benefits, such as reduced negative symptoms, increased well-being, and decreased hospitalization rates. For future studies, authors should align on more congruent MBIs programs for patients with SSD. Further research is needed to identify optimal mindfulness teaching approaches for patients with psychosis and investigate specific mechanisms of action, relevant processes, and optimal doses in varying settings.

Keywords: MBCT; MBIs; MBSR; Meditation; Mind-body; Schizophrenia.

Publication types

Systematic Review
Review

MeSH terms

Cognitive Behavioral Therapy* / methods
Emotions
Humans
Mindfulness* / methods
Psychotic Disorders* / therapy
Schizophrenia* / therapy