Dispositional Mindfulness and Psychotic Symptoms in Schizophrenia Spectrum Disorders: The Mediating Roles of Rumination and Negative Emotion

Abstract

Introduction:Studies have shown that rumination plays a significant mediating role between dispositional mindfulness (DM) and psychopathological symptoms in both clinical and non-clinical populations. However, no studies have examined this pathway in people with schizophrenia spectrum disorders (SSDs). Methods: A cross-sectional, clinician-administered survey was conducted among people with SSDs (n = 52) in a community setting. Participants completed the Chinese versions of the Depression Anxiety Stress Scale, Five Facet Mindfulness Questionnaire-Short Form, Psychotic Symptom Rating Scale and Scale for the Assessment of Negative Symptoms. Structural equation modelling was performed to examine the pathways of mindfulness facets, rumination, negative emotions and psychotic symptoms. Results: Two facets of mindfulness (nonjudging and acting with awareness) reduced rumination and negative emotional status. Rumination fully mediated the relationship between nonjudging and negative emotions and partially mediated the relationship between acting with awareness and negative emotions. Furthermore, rumination and negative emotions sequentially mediated the relationship between acting with awareness and hallucination (B = −0.44, 95% confidence interval [CI] = −0.338 to −0.045, p = 0.01) and between nonjudging and hallucination (B = −0.356, 95% CI = −0.255 to −0.008, p = 0.034). The model fit the data well (χ 2 (2) = 1.318, p = 0.517, Tucker-Lewis index = 1.075, comparative fit index = 1, standardised root mean residual = 0.0251, root mean square error of approximation = 0.0001). Conclusion: Rumination and negative emotions serially mediated the relationship between DM and hallucination. The findings support the contribution of changes across transdiagnostic mediators underlying the therapeutic effects of mindfulness training. Further research examining the transdiagnostic processes of DM in influencing clinical outcomes in SSDs is warranted.

Rumination as a Transdiagnostic Phenomenon in the 21st Century: The Flow Model of Rumination

“…Indeed, rumination has been linked to proneness to psychosis and psychosis disorders, plausibly via the fixation on negative information and excessive cognitive load [101][102][103].…”

Eight‐month intensive meditation‐based intervention improves refractory hallucinations and delusions and quality of life in male inpatients with schizophrenia: a randomized controlled trial

“…34 Studies show that breath-focused meditation can enhance emotional regulation, particularly in reducing worry and rumination in SZ. 35,36 These effects might occur through the modulation of emotion-generative brain regions through 'top-down' and 'bottom-up' neurological mechanisms induced by meditation. 37 In addition, difficulties in emotion regulation have been linked to development of anxiety and depression.…”

“…Patients with high emotion reactivity are more prone to experience worsened delusions and hallucinations during stressful life events 34 . Studies show that breath‐focused meditation can enhance emotional regulation, particularly in reducing worry and rumination in SZ 35,36 . These effects might occur through the modulation of emotion‐generative brain regions through ‘top‐down’ and ‘bottom‐up’ neurological mechanisms induced by meditation 37 .…”