Brandon Gaudiano is a research psychologist at Butler Hospital and associate professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University. He recently edited “Incorporating Acceptance and Mindfulness into the Treatment of Psychosis” a book examining the use of mindfulness in treating psychosis.
PBN: Who in the medical community first explored using mindfulness as a possible therapy to treat psychotic disorders?
GAUDIANO: For decades, mindfulness has been used as a treatment for more common mental health problems such as depression and anxiety. But many credit Dutch psychiatrists Marius Romme and Sandra Escher with first proposing that acceptance of psychotic experiences – a key component of mindfulness practice – could actually be therapeutic. Romme and Escher’s research conducted in the 1980s showed that many people successfully coping with psychosis naturally developed an accepting attitude over time that allowed them to function better.
PBN: Do you run into any kind of resistance among physicians or any other clinicians when it comes to mindfulness as a legitimate component of treatment?
GAUDIANO: Yees, there often is confusion among mental health professionals and patients as to what we mean by “acceptance.” Here acceptance doesn’t mean resignation or “giving in” to symptoms. It simply means bringing a nonjudgmental awareness to psychotic experiences as they occur. Mindfulness training can help to reduce the unhelpful tendency to struggle or fight with the symptoms, which many find unproductive. Being mindful gives people the space to choose a better course of action that is more consistent with their personal values and goals.
PBN: When did you first learn of the strategy and what were your first thoughts on it?
GAUDIANO: While I was attending graduate school, a study was published by psychologists using mindfulness therapy with hospitalized patients with psychotic disorders, showing that it reduced their rehospitalization rates. I was initially skeptical, so my colleagues and I decided to conduct our own study to see if we could get similar results, which we did. Since that time, I’ve been conducting additional research to understand how mindfulness therapy helps people recover from psychosis and how this process works.
PBN: Are there cases where mindfulness has been the only therapy to work for a given patient – can you share one such story?
GAUDIANO: Typically, mindfulness therapy is provided in addition to other forms of counseling and medication treatment. But often patients with psychosis who have tried these standard treatments continue to struggle with their illness and function poorly in the community. I’ve had many cases in which mindfulness therapy has helped patients get back to living their lives more fully, such as going back to school, volunteering or working again, and pursuing meaningful relationships.
PBN: What is the thinking behind why mindfulness can be effective when dealing with such challenging forms of mental illness?
GAUDIANO: Psychosis is scary for the person experiencing it. People initially try to cope by struggling with psychotic experiences or trying to avoid them altogether, but this just tends to make the symptoms worse in the long run. Mindfulness therapy teaches patients to be more open, aware, and accepting of these experiences and to learn to live with them peacefully, instead of against them. Research shows that the symptoms can naturally subside and become less impairing when the person adopts such an approach.
