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Depression and Anxiety Following Psychosis: Associations with Mindfulness and Psychological Flexibility

Published online by Cambridge University Press:  14 May 2012

Ross G. White ,
Andrew I. Gumley ,
Jacqueline McTaggart ,
Lucy Rattrie ,
Deirdre McConville ,
Seonaid Cleare  and
Gordon Mitchell
Ross G. White*
Affiliation:
University of Glasgow, Scotland
Andrew I. Gumley
Affiliation:
University of Glasgow, Scotland
Jacqueline McTaggart
Affiliation:
University of Glasgow, Scotland
Lucy Rattrie
Affiliation:
University of Glasgow, Scotland
Deirdre McConville
Affiliation:
University of Glasgow, Scotland
Seonaid Cleare
Affiliation:
University of Glasgow, Scotland
Gordon Mitchell
Affiliation:
Stratheden Hospital, Cupar, Scotland
*
Reprint requests to Ross White, Clinical Research Fellow, Mental Health and Well-being, Institute of Health and Well-being, Academic Centre, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, Scotland. E-mail: [email protected]
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Abstract

Background: Individuals experiencing psychosis can present with elevated levels of depression and anxiety. Research suggests that aspects of depression and anxiety may serve an avoidant function by limiting the processing of more distressing material. Acceptance and Commitment Therapy suggests that avoidance of aversive mental experiences contributes to psychological inflexibility. Depression and anxiety occurring in the context of psychosis have a limiting effect on quality of life. No research to date has investigated how levels of psychological flexibility and mindfulness are associated with depression and anxiety occurring following psychosis. Aims: This study investigated associations psychological flexibility and mindfulness had with depression and anxiety following psychosis. Method: Thirty participants with psychosis were recruited by consecutive referral on the basis that they were experiencing emotional dysfunction following psychosis. The Hospital Anxiety and Depression Scale (HADS), Positive and Negative Syndrome Scale (PANSS), Acceptance and Action Questionnaire (AAQ-II) and the Kentucky Inventory of Mindfulness Skills (KIMS) were used. A cross-sectional correlational design was used. Results: The depression and anxiety subscales of the HADS both had significant correlations with psychological flexibility (as assessed by the AAQ-II) and aspects of mindfulness (as assessed by the KIMS). Hierarchical regression analyses indicated that psychological flexibility, but not mindfulness, contributed significantly to models predicting 46% of variance in both depression and anxiety scores. Conclusions: Although aspects of mindfulness are associated with depression and anxiety following an episode of psychosis, psychological flexibility appears to account for a larger proportion of variance in depression and anxiety scores in this population.

Keywords

ACTpsychosismindfulness
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 41 , Issue 1 , January 2013 , pp. 34 - 51
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2012

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References

Babyak, M. A. (2004). What you see may not be what you get: a brief, non-technical introduction to over-fitting in regression-type models. Psychosomatic Medicine, 66, 411–421.Google Scholar
Bach, P. and Hayes, S. C. (2002). The use of acceptance and commitment therapy to prevent the re-hospitalization of psychotic patients: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 70, 1129–1139.Google Scholar
Baer, R. A., Smith, G. T. and Allen, K. B. (2004). Assessment of mindfulness by self-report: the Kentucky Inventory of Mindfulness Skills. Assessment, 11, 191–206.Google Scholar
Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J. and Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13, 27–45.Google Scholar
Barnhofer, T., Crane, C., Hargus, E., Amarasinghe, M., Winder, R. and Williams, J. M. G. (2009). Mindfulness-based cognitive therapy as a treatment for chronic depression: a preliminary study. Behaviour Research and Therapy, 47, 366–373.Google Scholar
Beck, A. T., Steer, R. A. and Brown, G. (1996). Beck Depression Inventory II Manual. San Antonio, TX: The Psychological Corporation.Google Scholar
Berking, M., Neacsiu, A., Comtois, K. A. and Linehan, M. M. (2009). The impact of experiential avoidance on the reduction of depression in treatment for borderline personality disorder. Behaviour Research and Therapy, 47, 663–670.Google Scholar
Berman, N. C., Wheaton, M. G., McGrath, P. and Abramowitz, J. S. (2010). Predicting anxiety: the role of experiential avoidance and anxiety sensitivity. Journal of Anxiety Disorders, 24, 109–113.Google Scholar
Birchwood, M. (2003). Pathways to emotional dysfunction in first-episode psychosis. British Journal of Psychiatry, 182, 373–375.Google Scholar
Birchwood, M., Iqbal, Z., Chadwick, P., and Trower, , , P. (2000). Cognitive approach to depression and suicidal thinking in psychosis. I: Ontogeny of post-psychotic depression. British Journal of Psychiatry, 177, 516–528Google Scholar
Birchwood, M., Trower, P., Brunet, K., Gilbert, P., Iqbal, Z. and Jackson, C. (2006). Social anxiety and the shame of psychosis: a study in first episode psychosis. Behaviour Research and Therapy, 45, 1025–1037.Google Scholar
Bishop, M., Lau, S., Shapiro, L., Carlson, N. D., Anderson, J., Carmody, T., et al. (2004). Mindfulness: a proposed operational definition. Clinical Psychology: Science and Practice, 11, 230–241.Google Scholar
Bjelland, I., Dahl, A. A., Haug, T. T. and Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale: an updated literature review. Journal of Psychosomatic Research, 52, 69–77.Google Scholar
Bohlmeijer, E. T., Fledderus, M., Rokx, T. A. J. J. and Pieterse, M. E. (2011). Efficacy of an early intervention based on acceptance and commitment therapy for adults with depressive symptomatology: evaluation in a randomized controlled trial. Behaviour Research and Therapy, 49, 62–67.Google Scholar
Bond, F. W. and Bunce, D. (2003). The role of acceptance and job control in mental health, job satisfaction, and work performance. Journal of Applied Psychology, 88, 1057–1067.Google Scholar
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Orcutt, H. K., Waltz, T., et al. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire – II: a revised measure of psychological flexibility and acceptance. Behaviour Therapy, 42, 676–688.Google Scholar
Borkovec, T. D. (1994). The nature, functions, and origins of worry. In Davey, G. C. L. and Tallis, F. (Eds.), Worry: perspectives on theory, assessment, and treatment. Chichester: Wiley.Google Scholar
Borkovec, T. D. and Roemer, L. (1995). Perceived functions of worry among generalized anxiety disorder subjects: distraction from more emotionally distressing topics? Journal of Behavior Therapy and Experimental Psychiatry, 26, 25–30.Google Scholar
Borkovec, T. D., Ray, W. J. and Stöber, J. (1998). Worry: a cognitive phenomenon intimately linked to affective, physiological, and interpersonal behavioral processes. Cognitive Therapy and Research, 22, 561–576.Google Scholar
Braga, R. J., Mendlowicz, M. V., Marrocos, R. P. and Figueira, I. L. (2005). Anxiety disorder in outpatients with schizophrenia: prevalence and impact on the subjective quality of life. Journal of Psychiatric Research, 39, 409–414.Google Scholar
British Psychological Society (2000). Recent Advances in Understanding Mental Illness and Psychotic Experiences. A report by the British Psychological Society Division of Clinical Psychology. London: BPS.Google Scholar
Brown, L. A., Forman, E. M., Herbert, J. D., Hoffman, K. L., Yuen, E. K. and Goetter, E. M. (2011). A randomized controlled trial of acceptance-based behavior therapy and cognitive therapy for test anxiety: a pilot study. Behavior Modification, 35, 31–53.Google Scholar
Chadwick, P. D. J., Barnbrook, E. and Newman-Taylor, K. (2007). Responding mindfully to distressing voices: links with meaning, affect and relationship with voice. Journal of the Norwegian Psychological Association, 44, 581–588.Google Scholar
Chadwick, P., Hughes, S., Russell, D., Russell, I. and Dagnan, D. (2009). Mindfulness groups for distressing voices and paranoia: a replication and randomized feasibility trial. Behavioural and Cognitive Psychotherapy, 37, 403–412.Google Scholar
Cribb, G., Moulds, M. L. and Carter, S. (2006). Rumination and experiential avoidance in depression. Behaviour Change, 23, 165–176.Google Scholar
Dalrymple, K. L. and Herbert, J. D. (2007). Acceptance and Commitment Therapy for Generalized Social Anxiety Disorder: a pilot study. Behavior Modification, 31, 543–568.Google Scholar
Drake, R. E., Gates, C., Whitaker, A. and Cotton, P. G. (1985) Suicide among schizophrenics: a review. Comprehensive Psychiatry, 26, 90–100.Google Scholar
Ehlers, A. and Steil, R. (1995). Maintenance of intrusive memories in posttraumatic stress disorder: a cognitive approach. Behavioural and Cognitive Psychotherapy, 23, 217–249.Google Scholar
Emsley, R., Oosthuizen, P., Joubert, A., Roberts, M. and Stein, D. (1999). Depressive and anxiety symptoms in patients with schizophrenia and schizophreniform disorder. Journal of Clinical Psychiatry, 60, 747–751.Google Scholar
Ferster, C. B. (1973). A functional analysis of depression. American Psychologist, 28, 857–870.Google Scholar
Forman, E. M., Herbert, J. D., Moitra, E., Yeomans, P. D. and Geller, P. A. (2007). A randomized controlled effectiveness trial of Acceptance and Commitment Therapy and Cognitive Therapy for anxiety and depression. Behavior Modification, 31, 772–799.Google Scholar
Gaudiano, B. A. and Herbert, J. D. (2006). Acute treatment of inpatients with psychotic symptoms using Acceptance and Commitment Therapy: pilot results. Behaviour Research and Therapy, 44, 415–437.Google Scholar
Giorgio, J. M., Sanflippo, J., Kleiman, E., Reilly, D., Bender, E. R., Wagner, C. A., et al. (2010). An experiential avoidance conceptualization of depressive rumination: three tests of the model. Behaviour Research and Therapy, 48, 1021–1031.Google Scholar
Gumley, A., Braehler, C., Laithwaite, H., McBeth, A. and Gilbert, P. (2010) A compassion focused model of recovery after psychosis. International Journal of Cognitive Therapy, 3, 186–201.Google Scholar
Hayes, S. C., Strosahl, K. D. and Wilson, K. G. (1999). Acceptance and Commitment Therapy: an experiential approach to behavior change. New York: Guilford.Google Scholar
Hayes, S. C., Luoma, J., Bond, F., Masuda, A. and Lillis, J. (2006). Acceptance and Commitment Therapy: model, processes, and outcomes. Behaviour Research and Therapy, 44, 1–25.Google Scholar
Hayes, S. C., Masuda, A. and De Mey, H. (2003). Acceptance and Commitment Therapy and the third wave of behavior therapy. Gedragstherapie (Dutch Journal of Behavior Therapy), 2, 69–96.Google Scholar
Hayes, S. C. and Smith, S. (2005). Get Out of Your Mind and into Your Life: the new Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.Google Scholar
Hayes, S. C., Strosahl, K. D., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., et al. (2004). Measuring experiential avoidance: a preliminary test of a working model. The Psychological Record, 54, 553–578.Google Scholar
Hoffmann, S. G., Sawyer, A. T., Witt, A. A. and Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. Journal of Consulting and Clinical Psychology, 78, 169–183.Google Scholar
Huppert, J. D. and Smith, T. E. (2001). Longitudinal analysis of subjective quality of life in schizophrenia: anxiety as the best symptom predictor. The Journal of Nervous and Mental Disease, 189, 669–675.Google Scholar
Huppert, J. D. and Smith, T. E. (2005). Anxiety and schizophrenia: the interaction of subtypes of anxiety and psychotic symptoms. CNS Spectrums, 10, 721–731.Google Scholar
Huppert, J. D., Weiss, K. A., Lim, R., Pratt, S. and Smith, T. E. (2001). Quality of life in schizophrenia: contributions of anxiety and depression. Schizophrenia Research, 51, 171–180.Google Scholar
Jacobson, N. S., Martell, C. R. and Dimidjian, S. (2001). Behavioral activation treatment for depression: returning to contextual roots. Clinical Psychology: Science and Practice, 8, 255–270.Google Scholar
Just, K. and Alloy, L. B. (1997). The response styles theory of depression: tests and an extension of the theory. Journal of Abnormal Psychology, 106, 221–229.Google Scholar
Kay, S. R., Fiszbein, A. and Opler, L. A. (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 261–276.Google Scholar
Kay, S., Opler, L. and Lindenmayer, J. (1988). Reliability and validity of the Positive and Negative Syndrome Scale for schizophrenia. Psychiatry Research, 23, 99–110.Google Scholar
Kay, S., Opler, L. and Lindenmayer, J. (1989). The Positive and Negative Syndrome Scale (PANSS): rationale and standardisation. British Journal of Psychiatry, 155, 59–67.Google Scholar
Kay, S., Opler, L., Spitzer, R., Williams, J., Fiszbein, A. and Gorelick, A. (1991). SCID-PANSS: two tier diagnostic system for psychotic disorders. Comprehensive Psychiatry, 32, 355–361.Google Scholar
Lambert, T. (1996). Inter-Rater Reliability and the PANSS. Poster presented at the CINP Congress, Melbourne, Australia.Google Scholar
Lappalainen, R., Lehtonen, T., Skarp, E., Taubert, E., Ojanen, M. and Hayes, S. C. (2007). The impact of CBT and ACT models using psychology trainee therapists: a preliminary controlled effectiveness trial. Behaviour Modification, 31, 488–511.Google Scholar
Lysaker, P. H., Davis, L. D., Lightfoot, J., Hunter, N. L. and Strasburger, A. (2005). Association of neurocognition, anxiety, positive and negative symptoms with coping preference in schizophrenia spectrum disorders. Schizophrenia Research, 80, 163–171.Google Scholar
Martell, C. R., Addis, M. E. and Jacobson, N. S. (2001). Depression in Context: strategies for guided action. New York: W. W. Norton.Google Scholar
Meijer, C. J., Koeter, M. W. J., Sprangers, M. A. G. and Schene, A. H. (2009). Predictors of general quality of life and the mediating role of health related quality of life in patients with schizophrenia. Social Psychiatry and Psychiatric Epidemiology, 44, 361–368.Google Scholar
Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology, 100, 569–582.Google Scholar
Nolen-Hoeksema, S. (2000). The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. Journal of Abnormal Psychology, 109, 504–511.Google Scholar
Nolen-Hoeksema, S., Larson, J. and Grayson, C. (1999). Explaining the gender difference in depressive symptoms. Journal of Personality and Social Psychology, 77, 101–107.Google Scholar
Nolen-Hoeksema, S., Morrow, J. and Fredrickson, B. L. (1993). Response styles and the duration of episodes of depressed mood. Journal of Abnormal Psychology, 102, 20–28.Google Scholar
Norman, R., Malla, A., Cortese, L. and Diaz, F. A. (1996) A study of the interrelationship between and comparative interrater reliability of the SAPS, SANS and PANSS. Schizophrenia Research, 19, 73–85.Google Scholar
Palmer, B. A., Pankratz, V. S. and Bostwick, J. M. (2005). The lifetime risk of suicide in schizophrenia: a re-examination. Archives of General Psychiatry, 62, 247–253.Google Scholar
Petersen, C. L. (2007). Treatment of comorbid depression and alcohol use disorders in an inpatient setting: comparison of acceptance and commitment therapy versus treatment as usual. Ph.D.thesis, Wichita State University, College of Liberal Arts and Sciences, Dept. of Psychology.Google Scholar
Pokos, V. and Castle, D. J. (2006). Prevalence of comorbid anxiety disorders in schizophrenia spectrum disorders: a literature review. Current Psychiatry Reviews, 2, 285–307.Google Scholar
Roemer, L., Orsillo, S. M. and Salters-Pedneault, K. (2008). Efficacy of an acceptance-based behavior therapy for generalized anxiety disorder: evaluation in a randomized controlled trial. Journal of Consulting and Clinical Psychology, 76, 1083–1089.Google Scholar
Saarni, S. I., Viertiö, S., Perälä, J., Koskinen, S., Lönnqvist, J. and Suvisaari, J. (2010). Quality of life of people with schizophrenia, bipolar disorder and other psychotic disorders. British Journal of Psychiatry, 197, 386–394.Google Scholar
Shawyer, F., Ratcliff, K., Mackinnon, A., Farhall, J., Hayes, S. C. and Copolov, D. (2007). The voices acceptance and action scale (VAAS): pilot data. Journal of Clinical Psychology, 63, 593–606.Google Scholar
Skinner, T. C., Roberton, T., Allison, G. T., Dunlop, S. and Bucks, R. S. (2010). Experiential avoidance, mindfulness and depression in spinal cord injuries: a preliminary study. Australian Journal of Rehabilitation Counselling, 16, 27–35.Google Scholar
Tarrier, N., Haddock, G., Lewis, S., Drake, R., Gregg, L. and the Socrates Trial Group (2006). Suicide behaviour over 18 months in recent onset schizophrenic patients: the effects of CBT. Schizophrenia Research, 83, 15–27.Google Scholar
Tibbo, P., Swainson, J., Chue, P. and LeMelledo, J. M. (2003). Prevalence and relationship to delusions and hallucinations of anxiety disorders in schizophrenia. Depression and Anxiety, 17, 65–72.Google Scholar
Tull, M. T. and Gratz, K. L. (2008). Further examination of the relationship between anxiety sensitivity and depression: the mediating role of experiential avoidance and difficulties engaging in goal-directed behavior when distressed. Journal of Anxiety Disorders, 22, 199–210.Google Scholar
Twohig, M. P., Hayes, S. C. and Masuda, A. (2006). Increasing willingness to experience obsessions: Acceptance and Commitment Therapy as a treatment for obsessive compulsive disorder. Behavior Therapy, 37, 3–13.Google Scholar
Twohig, M. P., Hayes, S. C., Plumb, J. C., Pruitt, L. D., Collins, A. B., Hazlett-Stevens, H., et al. (2010). A randomized clinical trial of acceptance and commitment therapy versus progressive relaxation training for obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 78, 705–716.Google Scholar
Walther, M. R., Ricketts, E. J., Conelea, C. A. and Woods, D. W. (2010). Recent advances in the understanding and treatment of trichotillomania. Journal of Cognitive Psychotherapy, 24, 46–64.Google Scholar
Watkins, E. and Moulds, M. (2005). Distinct modes of ruminative self-focus: impact of abstract vs. concrete rumination on problem solving in depression. Emotion, 5, 319–328.Google Scholar
White, R. G., McCreery, M., Gumley, A. I. and Mulholland, C. (2007). Hopelessness in schizophrenia: the impact of symptoms and beliefs about illness. Journal of Nervous and Mental Disease, 195, 968–975.Google Scholar
White, R. G., Gumley, A. I., McTaggart, J., Rattrie, L., McConville, D., Cleare, S., et al. (2011). A feasibility study of Acceptance and Commitment Therapy for emotional adaptation following psychosis. Behaviour Research and Therapy, 49, 901–907.Google Scholar
Whitehead, C., Moss, S., Cardno, A. and Lewis, G. (2002). Antidepressant Medication for People with both Schizophrenia and Depression (Cochrane Review). The Cochrane Library Issue 2.Google Scholar
Williams, J. M. (2010). Mindfulness and psychological process. Emotion, 10, 1–7.Google Scholar
Williams, J. M., Alatiq, Y., Crane, C., Barnhofer, T., Fennell, M. J., Duggan, D. S., et al. (2008). Mindfulness-based cognitive therapy (MBCT) in bipolar disorder: preliminary evaluation of immediate effects on between-episode functioning. Journal of Affective Disorders, 107, 275–279.Google Scholar
Wilson, K. G., Bordieri, M. J., Maureen, K. F., Lucas, N. N. and Slater, R. M. (2011). Understanding Acceptance and Commitment Therapy in context: a history of similarities and differences with other cognitive behavior therapies. In Herbert, J. D. and Forman, E. M. (Eds.), Acceptance and Mindfulness in Behavior Therapy: understanding and applying the new therapies. Hoboken, NJ: John Wiley and Sons, Inc.Google Scholar
World Health Organization (1992). The ICD-IO Classification of Mental and Behavioral Disorders: clinical descriptions and diagnostic guidelines. Geneva: AuthorGoogle Scholar
Wykes, T., Steel, C., Everitt, B. and Tarrier, N. (2008). Cognitive behavior therapy for schizophrenia effect sizes, clinical models, and methodological rigor. Schizophrenia Bulletin, 34, 523–537.Google Scholar
Zettle, R. D. (2003). Acceptance and commitment therapy vs. systematic desensitization in treatment of mathematics anxiety. The Psychological Record, 53, 197–215.Google Scholar
Zettle, R. D. and Hayes, S. C. (1986). Dysfunctional control by client verbal behavior: the context of reason giving. The Analysis of Verbal Behavior, 4, 30–38.Google Scholar
Zettle, R. D. and Raines, J. C. (1989). Group cognitive and contextual therapies in treatment of depression. Journal of Clinical Psychology, 45, 438–445.Google Scholar
Ziedonis, D. M., Smelson, D., Rosenthal, R. N., Batki, S. L., Green, A. I., Henry, R. J., et al. (2005). Improving the care of individuals with schizophrenia and substance use disorders: consensus recommendations. Journal of Psychiatric Practice, 11, 315–339.Google Scholar
Zigmond, A. S. and Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandanavica, 67, 361–370.Google Scholar
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