Outline of content of Mindfulness-based Psychoeducation Program

Transcription

1 Data Supplement for Chien et al. ( /appi.ps ) Appendix Outline of content of Mindfulness-based Psychoeducation Program Introduction The Mindfulness-based Psychoeducation Program (MBPP) consists of 12 bi-weekly, two-hour group sessions. Each group contains five to six members, led by a trained psychiatric nurse or mental health professional. The program was developed on the basis of the psychoeducation programs by Chien and Lee (2010) (8) and Lehman et al (2004) (4), and the 8-session Mindfulness-Based Stress Reduction Program by Kabat-Zinn et al (1992) (12). The MBPP was developed to enhance patients understanding about schizophrenia and its treatment and the community services available to them, increase their insights into their illness and its symptoms, and improve their acceptance and control of psychotic symptoms, particularly hallucinations, delusions and related life problems. One specific goal/purpose of this program is to teach patients to become more aware of and to relate differently to their disorganized, unreal and/or negative thoughts, feelings and sensations, rather than identifying with them as accurate readouts on reality. The Mindfulness-based Psychoeducation Program The MBPP is comprised of three phases: Phase I: Orientation and engagement, focused awareness of symptoms and control of psychotic symptoms; Phase II: Educational workshop on schizophrenia and its treatment and care; and Phase III: Strategies in relapse prevention, community support and future plans. The structure and content of the MBPP are outlined in the following table: Phase Component Goals or Rationale Main topics/themes Practice I 1. Orientation a. Establishment of mutual Orientation to the Self-introduction and trust and respect, treatment MBPP and its and game activities engagement (2 sessions) goals and objectives, and expected roles and responsibilities in the group; and b. Understanding of the group program and functions Establishing trust and respect among group members Achieving agreed about their roles and responsibilities in the group, and about schizophrenia and its impacts on 1

2 information about the goals and objectives patients and their illness and its symptoms. Schizophrenia and its families. impacts I 2. Focused Session 1: Stepping out of Body scan, noticing Body scan awareness of bodily sensations, thoughts, feelings and symptoms (3 sessions) automatic pilot and negative thoughts o Mindfulness starts when we recognize the tendency to be on automatic pilot; o Commitment to learning how to step out of it and being aware of each symptom and related experience; and sensations, feelings and thoughts Dealing with barriers to focusing thoughts, emotions and events, particularly pleasurable events Breath and awareness and mindfulness thereof Focusing on both pleasant and annoying events Focused awareness of the body, thoughts and feelings o Practice in purposefully drawing attention to bodily sensations and movements. Session 2: Mindfulness of Awareness of the Seeing/hearing and the breath and staying breath offers an choiceless awareness present anchor to the present of breath, body, (a possibility of being sounds, and thoughts o Becoming familiar with the behavior of the mind more focused and gathered) 3-minute breathing space (awareness of (often being busy and Categorizing body, re-directing scattered); experiences vs. and expanding o The mind is most scattered describing bare attention), opening when trying to cling to sensations/thoughts with out-breath) something and avoid Getting to know the Stretching and others; and territory of breathing o Mindfulness offers a schizophrenia means to stay present by Walking and providing another place focused sensation from which view things. Yoga 2

3 Session 3: Acceptance, Allowing and Exercise on holding, allowing; and accepting attitude awareness of breath, letting be towards the illness and body, thoughts and its symptoms emotions o Relating differently Awareness of and Recognizing and involve bringing to the opening up troubles in discussing experience a sense of the mind; expanded difficulties with allowing it to be as it is, breathing and stress- such awareness without judging it or trying to make it different; and holding space Expanded breathing space opening up o An accepting attitude is a troubles in the mind major part of taking care and settling down of oneself and seeing these troubles clearly what, if anything, needs to change. Mindful walking I 3. Empowerment o Negative thoughts and Thoughts are not facts Expanded breathing of self-control moods that accompany alternative space of psychotic symptom s and negative thoughts (1 session) them color or reduce our ability to relate to experience; o Thoughts are merely thoughts, we can choose whether to engage with them or not; and o The same patterns of thoughts recur again and again, without necessarily having to question them and seek alternatives. perspectives of seeing your thoughts and sensations Options for working with negative and disorganized thoughts Recognizing the recurring thoughts and standing back from them, without questioning them Alternative perspectives and options for working with thoughts Diary writing and awareness of early warning signs of relapse Selection of practices 3

4 II 1. Knowledge of o Understanding psychotic Patients individual schizophrenia symptoms and individual health needs in relation and video watching and its care (2 sessions) psychosocial health concerns; o Understanding cultural issues within family and society; and o Identifying important needs for patients, self and family. to schizophrenia care Information sharing of schizophrenia and its treatment Sharing of behavioral and perceptual problems, intense emotions, and Information search from internet and health care organizations Expert (both expatients and professionals) sharing feelings about illness Selection of management mindfulness Discussing ways to practices learned deal with negative thoughts and Communication and emotions, cultural social skills training issues and beliefs of mental illness, stigma and family Information about medication and its effects, self-care, daily activities and functioning, and illness and home management. II 2. Illness o Information about self- Enhancing social management management of support, stress coping and video watching and problem solving (1 session) schizophrenia and its related behavioral problems; and and problem solving skills by working on each member s life Ex-patients sharing of illness management o Learning effective coping situations experiences and problem solving skills. Performing behavioral Role play on coping rehearsals of social and problem- interactions with co- solving skills 4

5 patients (and invited Practices of coping family members) skills learned within groups Review of real-life practice of coping skills learned in group sessions III 1. Behavioral Session 1: How can I best Identifying signs of rehearsal of relapse prevention (2 sessions) take care of myself? o Specific things can be done when psychotic relapse and associated factors Reflect on daily activities, stressors Role play and behavioral rehearsals of coping skills and self- symptoms threaten my and accompanying reflection living and functioning; emotions (i.e., Awareness of o Taking a breathing space nourishing vs. breath, body, first and then deciding depleting activities) sounds, thoughts, what action to take; Evaluation of self- difficulty, and o Each patient has his/her care, illness social support own unique patterns of management, coping Breathing space and symptoms and relapse and skills and selecting forms of thus also his/her own interpersonal practice to continue prevention strategies; and o Group members can provide support and help each other to plan the best relationships Continuous practice of coping skills learned self-care. Session 2: Using learned What thing(s) in our Body scan, sitting skills to deal with future life do you value and walking problems in thoughts and most and what can the mindfulness moods practice help you Best wishing and with? positive thinking o Maintaining balance in life is helped by regular mindfulness practice; and Preparing for future life problems and relapse prevention about future problems o Good intentions can be Consolidation of Continuous practice 5

6 strengthened by linking selected and practiced of selected practice with positive coping and mindfulness thoughts and reasons for mindfulness skills strategies taking care of oneself. III 2. Community o Being familiar with Summary of the main Body scan and resources and community support issues and topics mindful walking future plans (1 session) services and resources for schizophrenia care; covered and knowledge and skills Discussion about learning from the o Review of main issues and learned program and plan those skills learned and selected for practices; and o Planning for future independent living. Introduction of available community support resources Issues expected in for the future Checking each person s support resources / future life and mechanisms psychological and Invitation to behavioral outcome assessment preparations for the and interviews future Action plans for illness management and the future Questions and comments from group members and specific requests for follow-up 6

7 Table: Baseline sociodemographic characteristics of trial participants who received mindfulness-based psychoeducation (MBPP) or only usual care and of nonparticipants MBPP (N=48) a Usual Care (N=48) a Nonparticipants (N=241) a Test Variable N % N % N % value b p Gender Male Female Age (M±SD; range) ; ; ; Education level Primary school or below Secondary school University or above Monthly household income, 11,240 2,034 11,935 2,015 12,510 2, HK$ (M±SD) 5,000 10, ,001 15, ,001 25, ,001 35, Duration of illness (M±SD; ; ; ; range) 5 years 4.5 years years 3 months 1 year years years years

8 Number of family members living with patient Use of psychiatric services Medication consultation and treatment planning Nursing advice on services Brief family education Types of medication Conventional antipsychotics (e.g., haloperidol) Atypical antipsychotics (e.g., risperidone) Antidepressants (e.g., Prozac) Blended mode Dosage of medication High Medium Low MBPP, Mindfulness-Based Psychoeducation Program. a Denotes frequency (f %) or mean standard deviation, and range. b An analysis of variance (F-test, df=335) or the Kruskal-Wallis test by ranks (H statistic, df=2) was used to compare the socio-demographic variables of patients among the three groups. c US$1 = HK$7.8 d Patients were taking more than one type of psychotropic medication such as the use of both conventional and atypical antipsychotics or an atypical antipsychotic together with one antidepressant. e Dosage levels of neuroleptic medication were compared with the average dosage of medication taken by schizophrenic patients in Haloperidol-equivalent mean values (1,8). 8