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 Implications for Trauma-Informed Care:  Adverse Childhood trauma and dissociation in the Lives of Male Sex Offenders?   


Mindfulness Based Therapy as it relates to Anxiety Reduction in Acute In-Patient Care with

Individuals Who Experience Psychosis

Students Name

CNS 6529 Research and Evaluation

June 5, 2016

Dan Lawther, PhD

South University




Mindfulness is described as “paying attention in a particular way: on purpose, in the present

moment, and non-judgmentally” (Chadwick, Taylor, and Abba p 351, 2005). This study

purposes that mindfulness based training will have a greater effect in reducing anxiety in patients

that are in acute inpatient facilities who are experiencing psychosis better than the facilities

standard training which is rational behavior therapy based. Thirty participants will be asked to

join the study in which fifteen of the participants shall receive mindfulness training while the

other fifteen participants will receive the standard hospital therapy. The participants will be

asked to rate their anxiety levels using State-Trait Anxiety Inventory (STAI) and Beck’s Anxiety

Inventory (BAI) prior to their first group and after their last group has been administered. It is

expected that the mindfulness group will experience greater reduction in anxiety symptoms as

reported by BAI and STAI. This study can help influence future directions in therapy in acute

inpatient facilities.




Davis, Strasburger, and Brown (2007) used mindfulness training to see if there would be

a reduction in anxiety as it relates to patients who were diagnosed with the DSM IV-TR

definition of schizophrenia. They found that mindfulness training helped to reduce anxiety in

participants with schizophrenia in comparison to intensive therapy (Davis, Stasburger, and

Brown 2007). Mindfulness is defined as “purposefully paying attention in each moment to all

life experiences, regardless of how ordinary” (Davis, Strasburger, and Brown p. 24, 2007).

Although, numerous studies have looked into mindfulness as a way to cope with both

psychological and non-psychological distress, many fail to see how mindfulness can improve the

quality of life in those with psychosis in acute inpatient facilities (Carmody and Baer 2008).This

study seeks to explore mindfulness training and its effects on reduction of anxiety in acute

inpatient, patients that are experiencing psychosis. It is expected that mindfulness training will

help reduce anxiety and increase mindfulness in those participants that are given mindfulness




Review of Literature

More holistic approaches have been taken in recent years to improve the quality of life in

those experiencing psychosis (Lukoff, Wallace, Liberman, and Burke 1986). Holistic approaches

tend to involve more than just psychoeducational therapy. The idea is to continue the already

existing continuation of mind and body. Lukoff and colleagues (1986) used a holistic approach

to see if there was a significant reduction in stress, in individuals with schizophrenia. The

comparison group of social skills training and holistic approach to stress reduction showed no

difference in prevention of relapse back into a hospital setting.

From holistic approach, the idea of positive psychology arose as a method to enhance

well-being, both psychological and physical. Positive psychotherapy (PPT) was developed to

increase positive emotion, engagement and meaning (Seligman, Rashid, and Parks 2006).

Positive psychotherapy has been used in various clinical settings and parallels mindfulness in

that it teaches the individual to focus on their well-being and engagement with their body.

Positive psychology interventions are effective in enhancement of subjective well-being,

psychological well-being and reduction of depressive symptoms (Bolier et al 2013). Thus, a

focus on well-being will be beneficial for individuals with psychosis.

It is also important to consider how holistic approaches can be used to prevent

hospitalization. In research conducted by Drvaric, Gerristen, Rashid, Bagby, and Mizrahi (2015)

defined resilience as the ability to adapt to stress and adversity. The study shows that

interventions addressing well-being as it relates to resilience can help people at clinical high risk

for developing psychosis. Well-being is important focus for psychosocial interventions. Thus, it

is important to begin prevention mechanisms in those that are more likely to experience



psychosis. Prevention mechanisms like mindfulness may be used to help the individual increase

their well-being and reaction to stress, so resilience to stressful situations can reduce an

individual likelihood of experiencing psychosis and becoming hospitalized.

The inclusion of the mind and the body into therapeutic treatment is thought to help

reduce distress. With reduction of distress, people with psychosis may be able to have a higher

functioning life, in which they may be able to even work. Davis and colleagues, (2015) used

mindfulness training to see if individuals with schizophrenia will have better job performance.

Their Mindfulness Intervention for Rehabilitation and Recovery in Schizophrenia (MIRRORS)

program helped increase job performance and job attendance than an intensive support group.

Although, this study used mindfulness in an outpatient setting with participants in stable phase of

schizophrenia it still shows that mindfulness is an effective therapy.

Laithwaite and associates (2009) use compassionate focused therapy in a high security

setting to promote help seeking and to develop compassion towards oneself. It used inpatient

facility to improve the well-being of participants by having them focus on themselves, similarly

to meditation. As Penn and colleagues (2004) have shown, schizophrenia and therapeutic

progress is increased with some type of therapy than with medication alone.

Therefore, mindfulness should be taken into great consideration when working with

populations experiencing psychosis. Kuyken and fellow researchers (2008) used mindfulness

based cognitive therapy (MBCT) to prevent relapse into hospitals. Although, their targeted

population was those with recurrent depression they still found that relapse in those with

medication and MBCT was less than those that just had anti-depressant and standard therapy

(Kuyken et al 2008).



In their 2005 study, Chadwick, Taylor and Abba, used mindfulness training to see if

individuals with psychosis could better deal with their psychotic episodes and understand what it

means to be mindful. Although, it was a pilot study they found that the participants seem to have

greater awareness of their psychosis and through mindfulness were able to cope better and not be

distressed by their hallucinations. They were able to maintain their well-being and use their

awareness of their senses to recognize external stimuli from their internal stimuli.

Holistic approaches have been beneficial in continuing the connection between the mind

and body. Mindfulness focuses on this connection in greater detail than other holistic

approaches. Through mindfulness based training, greater awareness to psychosis and dealing

with internal stimuli has been found (Chadwick, Taylor, and Abba 2005). Although, many

studies have found a link between mindfulness and improvement of quality of life they have

neglected to include an environment that many who experience psychosis tend to get counseling

and treatment from, an inpatient facility. Therefore, purpose of this study is to evaluate whether

mindfulness training will reduce anxiety in individuals experiencing psychosis in an acute

inpatient facility.





Thirty participants will be chosen from G. Werber Bryan Psychiatric Hospital (BPH)

from two separate acute in patient lodges; with fifteen participants on each lodge, respectively.

The participants anticipated age range would be from 18 years of age to 59 years of age with an

anticipated average of 32 years of age. The expected gender makeup of the participants would be

twenty-eight men and two women. The participants will be of different ethnicities, but mainly

African American and European American descent. The participants will be chosen based on the

following criteria: at least two weeks of stay at BPH prior to beginning of research with at least

two weeks of stay at BPH before discharge, and the diagnosis of schizophrenia, schizoaffective

disorder, or bipolar one with psychosis as defined by the DSM V. Participants that meet these

requirements will further be eliminated based on their level of cognitive functioning with the

mental status examination.

After selection. The fifteen participants on lodge 1 and lodge 2 will then be randomly

assigned to either Group A, the mindfulness training or Group B, the standard training of BPH.

Both of the groups will be conducted on the participants’ lodges so they did not have to meet

outside of their lodge. On lodge 1, eight participants will be assigned to Group A, while seven

participants will be assigned to Group B. On lodge 2, seven participants will be assigned to

Group A, while eight participants will be assigned to Group B. All participants are anticipated to

stay throughout the intended study time of two weeks.




The Mental Health Status Examination (MHSE) will be used to assess cognitive ability

and memory retention for participants to participate. The inter-rater validity is strong and the

external validity is shown through the wide use in mental health settings.

The State Trait Anxiety Inventory (STAI) will be used prior to first group meeting and

after the last group meeting. This tool is to assess how much the participants’ anxiety levels

decrease. It has validity in the range of 0.69 to 0.89 with test-retest (APA 2016).

The Beck’s Anxiety Inventory (BAI) will be used prior to the first group meeting and

after the last group meeting to make sure that the mindfulness addresses physical attributes of

anxiety. It is a 21-item self-report inventory with a high internal consistency (alpha=0.92) and a

high test-retest reliability of 0.75 over one-week period (Beck, Epstein, Brown, and Steer 1988).

The Cognitive and Affective Mindfulness Scale-Revised (CAMS-R) is a 12-item self-

report inventory that will be used to see if participants understand mindfulness. It has an

acceptable internal consistency and will only be given to only participants in Group A during the

first group and after the last group has been administered. [Feldman, Hayes, Kumar, Greeson,

and Laureanceau 2007]


This study will be a between-subjects, experimental design. The independent variables

are the two following groups: mindfulness training and standard BPH training. The dependent

variable is the amount of anxiety reduction experienced by the participants. By having two

groups a day one in the morning and one in the afternoon, it will help control for participants that

may not be “morning” people.




After getting permission from Bryan G. Werber Psyhiatric Hospital Institutional Review

Board and South Carolina Department of Mental Health Institutional Review Board,

respectively, participants will be chosen with help of treatment team members on each acute

lodge. The patients will then be asked to participate in the study with the knowledge of getting a

credit at the canteen for two items three days a week for the two-week time period the groups are

administered. The participants will be given the informed consent and will be given the option to

participate in the study.

After all consents are signed. The participants will be randomly assigned into either

mindfulness training group, Group A, or standard training group, Group B. The groups will meet

twice a day on Monday-Friday and once a day on Saturday, for a two-week time period.

Group A: Mindfulness Training

This group training was modeled from Chadwick, Hughes, Russell, Russell, and Dagnan

(2009), mindfulness groups and will be conducted by the author of this paper. The groups will

meet twice a day: in the morning, focus will be on the body and the sensations that are a part of

it; and in the afternoon, focus will be on the participants’ psychosis and how to change their

reaction to their internal stimuli. Each group will be 45 minutes in length, with 15 minutes

dedicated to reflection of the content of group. At least one time a week, if weather permits the

groups will be held outside. Homework to continue body scans and observations of senses will

be given to the participants at the end of both groups.

Group B: Standard Training



Like Group A, this group will meet twice a day and will continue to focus on the rational

behavior therapy that BPH teaches. This group will continue to be taught by the same clinical

counselor who has facilitated groups there prior to start of this study to maintain consistency

between both lodges.



Expected Results

Based on prior research, I expect to see some improvement in anxiety as it relates to

psychosis in the individuals that are in Group A. I expect to use a two-way ANOVA analysis in

excel to compare the before and after of STAI with both groups. I will also use ANOVA to

compare before and after BAI results. I also expect to use a t-test to compare CAMS-R from

before and after mindfulness groups are administered. I expect to see a larger decrease in anxiety

with individuals in Group A than in individuals in Group B. I also expect to see an increase in

mindfulness after the groups have been administered than before in participants of Group A. I

expect to see a very small p-value (0.05 or smaller) to support that training in mindfulness does

reduce anxiety in participants in that population so my null hypothesis of no change between

groups in reduction anxiety can be rejected with confidence. I also expect to see that the t-value

for my t-test will be 0.05 or smaller to show significance difference of knowledge of





Although, this study has not been actively conducted, it is believed it will serve as a great

contribution to the hospital setting. Many patients experiencing psychosis, do not get a holistic

approach to their treatment. The symptoms are treated, but the mind and body are not allowed to

be connected together for better health and well-being in patients. If anxiety is reduced when this

study is actually conducted, another factor that can be added to better enhance future studies is

the amount of time for relapse. If relapse back into the hospital is reduced due to patients’ ability

to use mindfulness training outside of inpatient facilities, it would be a better investment and

could lead to lower costs for insurance companies in the long run. It will also be crucial to try

and include more women and diversity into these future inpatient facilities study. This study can

also be changed for the purpose of not including psychosis and looking into mindfulness training

for other patients who are in psychiatric inpatient facilities.




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