A pilot study of loving-kindness meditation for the negative symptoms of schizophrenia

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Abstract

This pilot study examined loving-kindness meditation (LKM) with 18 participants with schizophrenia-spectrum disorders and significant negative symptoms. Findings indicate that the intervention was feasible and associated with decreased negative symptoms and increased positive emotions and psychological recovery.

Introduction

There is a significant need for research regarding how best to treat the negative symptoms of schizophrenia given these symptoms' association with poor prognosis and the limited efficacy of existing treatments (Buchanan, 2007). Anhedonia, in particular, has a strong association with impaired functioning (e.g., Herbener et al., 2005). Neurobehavioral models supported by animal research suggest distinct types of pleasure as well as unique emotion-regulation systems for different kinds of pleasure. First, regarding the types of pleasure, anticipatory or appetitive pleasure is linked to dopamine and associated with a subjective experience of wanting and desire. Whereas, consummatory pleasure is linked to endogenous opiates and associated with gratification and satiety (see review by Depue and Morrone-Strupinsky, 2005). Studies of individuals with the negative symptoms of schizophrenia demonstrate a deficit in anticipatory pleasure, which has been found to correlate with difficulties in goal oriented behavior and social functioning (Gard et al., 2007, Horan et al., 2006). Indeed this may also explain the common loading of anhedonia, asociality, and avolition on a single factor (Blanchard and Cohen, 2006). Other models of pleasure conceptualize both a drive-excitement system and soothing-contentment system, with implications for different types of positive emotions leading to either activation of incentive motivation/energy or affiliation and safeness (see review by Gilbert, 2010).

Basic affective science provides insight into a potential intervention for targeting negative symptoms, especially anhedonia. The broaden-and-build theory posits that positive emotions broaden an individual's thoughts and behavioral urges; the accrual over time of these broadened mindsets leads an individual to think and behave in ways that build personal resources, such as mindfulness, purpose in life, and social support (Fredrickson, 1998, Fredrickson, 2001). Fredrickson et al. (2008) evaluated whether loving-kindness meditation (LKM; Salzberg, 1995) would facilitate increased positive emotions. The results indicate that those randomized to LKM experienced significantly increased positive emotions compared to a wait-list control group. Additionally, the increase in positive emotions accounted for increases in distinct personal resources, such as the ability to savor the future (i.e. anticipatory pleasure) and psychological well-being (i.e. environmental mastery and self-acceptance). Other studies with non-clinical samples (Hutcherson et al., 2008, Sears and Kraus, 2009) and chronic pain patients (Carson et al., 2005) have replicated the positive impact of LKM on mood and well-being. Likewise, Compassion-Focused Therapy (CFT; Gilbert, 2010), which also emphasizes recognition of self-critical patterns and emotions followed by strategies to enhance self-compassion, was found to have positive results for the well-being of individuals with psychosis (Laithwaite et al., 2009, Mayhew and Gilbert, 2008). Therefore, in accordance with the broaden-and-build theory and existing studies, LKM would be expected to be associated with an increase in participants' experience of positive emotions, which would then be linked to a reduction in negative symptoms and an improvement in psychological well-being.

The purpose of this pilot study was to conduct an initial evaluation of LKM regarding its feasibility and potential clinical utility for individuals with schizophrenia with persistent negative symptoms. We hypothesized that LKM would be 1) feasible and favorably received; and associated with improvements in 2) positive affect; 3) negative symptoms, particularly anhedonia (especially anticipatory pleasure), avolition, and asociality, and 4) psychological recovery (i.e. finding hope, re-establishing identity, finding meaning, and taking responsibility for recovery; Andresen et al., 2003).

Section snippets

Participants

The sample included 18 outpatients with schizophrenia-spectrum disorders based on chart review (44% schizophrenia, 33% schizoaffective disorder, and 22% psychosis NOS or schizophreniform disorder) and significant negative symptoms based on a score of moderate on one domain of the beta version of the Clinical Assessment Interview for Negative Symptoms (CAINS beta; Forbes et al., 2010). The mean age was 29.4 years (SD = 10.2) with 83% male. Self-reported ethnicity was 72% Caucasian and 28%

Results

The following results are based on the intent-to-treat sample, which included both treatment completers (n = 16) and non-completers (n = 2) (attending < 50% of the sessions). Two participants did not complete the 3-month follow-up; results are therefore based on a last observation carried forward procedure.

Discussion

Participants reported large increases in the frequency and intensity of positive emotions and decreases in overall negative symptoms, specifically anhedonia. We found seemingly contradictory results when comparing changes in anticipatory pleasure on the TEPS and SBI. However, the TEPS is a focal measure of physical pleasure (e.g. smell), which was not a specific target in LKM, while the SBI future subscale captures non-specific anticipatory pleasure (i.e. for various aspects of life), which is

Role of funding source

Funding for this study was provided by a 2008 Dissertation Award Grant from the Society for a Science of Clinical Psychology, who had no role in study design, analysis and interpretation of data, writing of the report; nor in the decision to submit the paper for publication.

Contributors

DP and DJ designed the study. LC helped with measure selection and analysis of specific measures. DJ collected/analyzed data and wrote the first draft of the manuscript. MB facilitated the intervention. DP, AK, BF, PM supervised the research project and critically revised the manuscript. All authors contributed to and have approved the final manuscript.

Conflict of interest

All authors report no conflicts of interest relevant to the subject of this article.

Acknowledgements

The authors acknowledge Dr. Tracy Simpson for her helpful comments on an earlier draft of this article.

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