The use of mindfulness-based stress reduction and mindfulness-based cognitive therapy in psychosis

INTRODUCTION: Psychosis is a complex and severe psychiatric condition whose treatment has recently included psychotherapeutic interventions. Among the evidence-based approaches, mindfulness-based interventions (MBIs) have been receiving a growing interest albeit studies on their feasibility and effectiveness on psychosis are relatively recent. The present review aims at investigating the application of the two main manualized MBIs known as mindfulness-based stress reduction (MBSR) and mindfulness based cognitive therapy (MBCT) to psychosis. EVIDENCE ACQUISITION: Data search was conducted in March 2022 on the PubMed database. After thorough research, we finally included twelve studies examining the efficacy and feasibility of MBSR and MBCT or very similar interventions in terms of structure and content. EVIDENCE SYNTHESIS: Overall, our review suggests that the use of MBSR/MBCT adapted for psychosis is safe and acceptable in this population of patients. Included studies showed that structured mindfulness protocols positively impact on clinical, psychological, and socio-occupational measures, compared to treatment as usual or other treatments. Patients’ stress, positive and negative symptomatology were reduced. As for cognitive measures, formal mindfulness practice appeared to improve cognitive flexibility, whereas it has been hypothesized to reduce attention, working memory and social cognition deficits. CONCLUSIONS: Despite the examined studies are favorable to the use of manualized mindfulness protocols in psychosis, further studies in larger and better-characterized samples are warranted, particularly to explore the impact of mindfulness on the cognitive dimensions, and the associated neural correlates. Also, longitudinal randomized controlled trial, differentiating between affective and non-affective psychoses and limiting clinical and methodological heterogeneity, are needed.