Supervision of psychotherapy for psychosis: A meaning-making approach.

Despite its importance in the provision of mental health treatment, the availability of high-quality clinical supervision faces numerous threats in the public sector. Access to high-quality supervision may be especially important for therapists providing services to persons with psychosis. Here, we detail one supervisory approach that has been developed with these considerations in mind; namely, the supervision approach associated with the recovery-oriented integrative therapy metacognitive reflection and insight therapy. We detail three aspects of this approach that have broad appeal and could be easily incorporated into other psychotherapy approaches which include (a) reflecting with supervisees about their experience of the patient, themselves, and the therapeutic relationship, (b) helping supervisees respond to patients' pain and fragmentation with interventions that promote challenge and joint meaning-making, and (c) dealing with threats to this process from both internal pressures within supervisees as well as those posed externally from their agencies. Limitations of this approach and future directions are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Independent Relationships of Metacognition, Mindfulness, and Cognitive Insight to Self-Compassion in Schizophrenia.

The debilitating nature of psychosis may be exacerbated by societal stigma and feelings of social isolation over and above positive (e.g., hallucinations) and negative (e.g., flat affect) symptoms. Thus, recovery may be facilitated by increasing self-compassion, the ability to respond with a nonjudgmental attitude of kindness toward oneself as a result of connecting with one's own inadequacies and suffering. We conducted a stepwise regression in individuals with schizophrenia-spectrum disorders (n = 92) to determine the unique contributions of cognitive variables in predicting self-compassion, such as metacognition (the ability to form complex and integrated ideas about oneself and others), mindfulness, and cognitive insight. Results indicated that increased metacognitive awareness of others and mindfulness uniquely predicted greater self-compassion (i.e., self-kindness), whereas increased cognitive insight predicted greater lack of self-compassion (i.e., self-judgment). These findings suggest the potential for mindfulness and metacognitive interventions to increase positive self-compassion and promote recovery in psychosis.

Effect of mindfulness on vocational rehabilitation outcomes in stable phase schizophrenia.

This report describes the results of a randomized controlled feasibility study of the Mindfulness Intervention for Rehabilitation and Recovery in Schizophrenia (MIRRORS). MIRRORS is an adaptation of Mindfulness-Based Stress Reduction designed to help persons with schizophrenia to persist and perform better at work. Thirty-four participants with schizophrenia or schizoaffective disorder who were engaged in outpatient services were enrolled in a vocational rehabilitation program that included a job placement and then were randomized to receive MIRRORS (n = 18) or Intensive Support (n = 16) over a period of 16 weeks. The number of hours worked was recorded weekly and job performance was assessed monthly using the Work Behavior Inventory. Results of t-tests revealed that participants in the MIRRORS group worked a significantly greater number of hours and performed significantly better at the end of the 4-month intervention than those in the Intensive Support condition. Repeated-measures analysis of variance revealed that the MIRRORS group worked more hours each week on average and that this difference increased over time as well as having generally better work performance compared with the Intensive Support group. Results suggest a link between MIRRORS and higher levels of work performance and persistence in people with schizophrenia. Further research is indicated to evaluate MIRRORS in a fully powered randomized controlled trial.

Computer-assisted cognitive remediation for schizophrenia: a randomized single-blind pilot study.

Cognitive impairment is a core symptom in schizophrenia that has a significant impact on psychosocial function, but shows a weak response to pharmacological treatment. Consequently, a variety of cognitive remediation strategies have been evaluated to improve cognitive function in schizophrenia. The efficacy of computer-based cognitive remediation as a stand-alone intervention on general measures of neuropsychological function remains unclear. We tested the effectiveness of biweekly training using computerized cognitive remediation programs on neuropsychological and event-related potential outcome measures. Schizophrenia patients were randomly assigned to cognitive remediation training (N=17), active control (TV-watching; N=17), or treatment-as-usual (N=10) groups for ten weeks and run in parallel. Cognitive and ERP measures revealed no differential improvement over time in the cognitive remediation group. Practice effects might explain change over time on several cognitive measures for all groups, consistent with studies indicating task-specific improvement. Computer-assisted cognitive remediation alone may not be sufficient for robust or generalized effects on cognitive and electrophysiological measures in schizophrenia patients.

EEG synchronization to modulated auditory tones in schizophrenia, schizoaffective disorder, and schizotypal personality disorder.

OBJECTIVE: The authors tested whether neural synchronization deficits were present in subjects with schizophrenia and schizotypal personality disorder. METHOD: Amplitude-modulated tones were used to evaluate auditory steady-state evoked potential entrainment in a combined group of 21 subjects with schizophrenia or schizoaffective disorder, 11 subjects with schizotypal personality disorder, and 22 nonpsychiatric comparison subjects. RESULTS: The schizophrenia or schizoaffective disorder group exhibited decreased power compared to the schizotypal personality disorder and nonpsychiatric comparison groups. There were no differences between groups in N100 amplitude. CONCLUSIONS: Subjects with schizophrenia but not subjects with schizotypal personality disorder have deficits in steady-state responses to periodic stimuli, despite an intact response to sensory-evoked potentials (N100). These deficits reflect aberrant neural synchronization or resolution and may contribute to disturbed perceptual and cognitive integration in schizophrenia.