Third-wave strategies for emotion regulation in early psychosis: a pilot study (2015)

Third-wave strategies for emotion regulation in early psychosis: a pilot study

Aim: Emerging evidence supports the priority of integrating emotion regulation strategies in cognitive behaviour therapy for early psychosis, which is a period of intense distress. Therefore, we developed a new treatment for emotional regulation combining third-wave strategies, namely compassion, acceptance, and mindfulness (CAM) for individuals with early psychosis. The purpose of this study was to examine the acceptability, feasibility and potential clinical utility of CAM.

Method: A non-randomized, non-controlled prospective follow-up study was conducted. Outpatients from the First Psychotic Episode Clinic in Montreal were offered CAM, which consisted of 8-week 60–75 min weekly group sessions. Measures of adherence to medication, symptoms, emotional regulation, distress, insight, social functioning and mindfulness were administered at baseline, post-treatment and at 3-month follow up. A short feedback interview was also conducted after the treatment.

Results: Of the 17 individuals who started CAM, 12 (70.6%) completed the therapy. Average class attendance was 77%. Post-treatment feedback indicated that participants found the intervention acceptable and helpful. Quantitative results suggest the intervention was feasible and associated with a large increase in emotional self-regulation, a decrease in psychological symptoms, especially anxiety, depression, and somatic concerns, and improvements in self-care.

Conclusion: Overall results support the acceptability, feasibility and potential clinical utility of the new developed treatment. A significant increase in emotional self-regulation and a decrease in affective symptoms were found. No significant changes were observed on measures of mindfulness, insight, distress and social functioning. Controlled research is warranted to validate the effectiveness of the new treatment.

“…participants reported large improvements in regulating negative emotions (specifically self-blaming, rumination, and catastrophizing), and moderate to large improvements on affective symptoms (specifically depression, anxiety, and somatic concerns).”

Automatic thoughts may mediate the relationship between self-compassion and affect:

“…self-compassion and self-esteem increased positive automatic thoughts and decreased trait anxiety, whereas only self-esteem increased life satisfaction and decreased depression directly. Positive automatic thoughts increased life satisfaction and decreased depression and trait anxiety, and positive automatic thoughts mediated the relationship between self-compassion and negative affect. These findings suggest that both positive and negative automatic thoughts mediate the relationship between self-compassion and affect” [1]

fMRI studies have shed some light on the compassionate brain:

“…Imaging results showed that Compassion, relative to both passive-viewing and Reappraisal increased activation in regions involved in affiliation, positive affect and reward processing including ventral striatum and medial OFC. This network was shown to be active prior to stimulus presentation, suggesting that the regulatory mechanism of Compassion is the stimulus-independent endogenous generation of positive affect.” [2]

Similarly, Mindfulness Meditation has been studied:

“…recent functional imaging studies have identified the putative neurofunctional signatures of the change in the perspective on the self brought about by Mindfulness Meditation (MM). In particular, it has been claimed that during MM states detachment from identification with a static sense of self associates with a diminished self-referential, narrative/autobiographical, processing paired with enhanced present-based, experiential processing of the self. In the brain, this has been shown to reflect in decreased activity in self-referential cortical midline structures (e.g., medial prefrontal cortex) and enhanced activity in lateral structures such as the insula and the somatosensory cortex associated more with momentary interoceptive and exteroceptive self-awareness” [3]

Mindfulness meditation may also improve self-control via altered reward processing:

“…experienced mindfulness meditators are able to attenuate reward prediction signals to valenced stimuli, which may be related to interoceptive processes encoded in the posterior insula.” [4]

Cognitively-Based Compassion Training uses analytical and didactic techniques to reorient one’s perspective on his or her relationship with others. It is through this active analytical process and reorientation that empathy and compassion are cultivated. The instruction unfolds in the following order:

1: Developing Attention and Stability of Mind

2: Cultivating Insight into the Nature of Mental Experience

3: Cultivating Self-Compassion

4: Developing Equanimity

5: Developing Appreciation and Gratitude for Others

6: Developing Affection and Empathy

7: Realising Wishing and Aspirational Compassion

8: Realising Active Compassion for Others

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