Quality of life and experiences of psychosis: an examination of research outcomes and a mindfulness-based intervention
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Date
01/12/2021Author
Ridler, Joseph Henry
Metadata
Abstract
Aims
This thesis primarily focuses on examining the role and mechanisms of psychological or
psychosocial interventions in improving quality of life (QoL) for people experiencing
psychosis. The systematic review aimed to meta-analyse studies that reported both QoL and
psychosis symptom outcomes. This allowed comparison of effect sizes between these
separate outcomes, to assess statistically significant differences in these outcomes and
mediating effects of the type of intervention. The empirical study sought to examine the
feasibility of a novel, six-session 1:1 mindfulness-based intervention (MBI) for people
experiencing psychosis. This study also aimed to contribute to the growing MBI literature,
through examining the feasibility of using multilevel modelling to assess between-session
mindfulness practice and metacognitive beliefs as predictors of QoL outcomes of people
experiencing psychosis following MBIs.
Methods
An inclusive systematic review of the literature was conducted to include any study providing
pre-post comparison data for psychological or psychosocial interventions for people
experiencing psychosis, utilising both QoL and psychosis symptom outcomes. Meta-analyses
were conducted on overall outcomes for QoL, and total, positive, and negative psychosis
symptoms. Subgroup analyses examined psychological and psychosocial interventions
separately, while assessing potential moderation of intervention type (e.g., MBIs). The
empirical study assessed feasibility utilising a case series design. Participants were offered
six, 60-minute sessions of 1:1 MBI. Multilevel modelling was applied to QoL and general
functioning outcomes, with between-session practice and metacognitive beliefs as predictors.
All other outcomes were measured pre- and post-intervention.
Results
Meta-analyses utilising 82 pre-post comparisons across 71 studies indicated statistically
significant differences between QoL and total symptom effect sizes. Subgroup analyses
suggested that intervention type moderated these effects. Effect sizes were largely maintained
following sensitivity and outlier analyses. The feasibility study indicated the study is largely
feasible for full trial. However, it is suggested that measures are taken immediately post-intervention and at an extended follow-up, rather than two weeks post-intervention.
Reduction of sessions to 30 minutes with one practice was preferred by most participants.
Therefore, shorter but more frequent sessions are recommended. Between-session practice
adherence was poor for most participants. Metacognitive beliefs improved for all participants
from pre- to mid-intervention, however increased post-intervention. All exploratory
measures, except general wellbeing, demonstrated trends towards improvement.
Discussion
This thesis suggests that while psychological and psychosocial interventions improve QoL,
they have greater effects on psychosis symptom outcomes. This indicates a need for
interventions to be modified in order to address QoL needs more explicitly for people
experiencing psychosis. However, issues around QoL assessment are presented. Feasibility
and acceptability of the study procedures and intervention were partially confirmed, with
some potential adaptations identified. Further research examining metacognitive belief
outcomes and factors influencing between-session practice adherence is also recommended.