Can Mindfulness Self-help Manual Reduce Depressive Symptoms in Patients with Psychosis?
Date of publication of the randomized controlled trial: September 2015
Design
Randomized controlled trial (RCT).
Participants
90 adults (mean age= 37.7 years, male %= 42.2%) diagnosed with psychosis or schizophrenia.
Intervention
Mindfulness self-help manual accompanied by audio instruction files.
Comparator
Comparison 1: Mindfulness self-help manual versus Progressive Muscle Relaxation (PMR).
Major Outcomes
Outcome 1: Symptoms of paranoia assessed by the Paranoia Checklist. Higher scores indicated worse paranoia symptoms.
Outcome 2: Degree and symptoms of Depression measured by the Center for Epidemiological Studies-Depression Scale (CES-D). Higher scores indicated worse degree and symptoms of depression.
Outcome 3: Frequency of obsessive-compulsive disorder measured by the Obsessive-Compulsive Inventory-Revised (OCI-R). Higher scores indicated more frequent occurrence of obsessive-compulsive behaviour.
Settings
This trial was performed in an outpatient setting.
Comparison    Mindfulness self-help manual versus PMR
Main Results
The differences between mindfulness self-help manual and PMR in terms of symptoms of paranoia (p=0.825), degree and symptoms of depression (p=0.703) and frequency of obsessive-compulsive disorder (p=0.819) were not significant.
Comparison: Mindfulness versus PMR among patients with psychosis
Outcomes No. of studies (Total number of participants) Mean score (SD)/ No. of participants Heterogeneity test (I2) MD (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 1 (90) 36.13 (17.77)/ 38 35.33 (16.51)/ 52 Not applicable as there is only 1 study. Not reported 0.825 Low
2 1 (90) 50.53 (17.62)/ 38 52.02 (18.79)/ 52 Not applicable as there is only 1 study. Not reported 0.703 Low
3 1 (90) 19.24 (8.16)/ 38 18.87 (7.13)/ 52 Not applicable as there is only 1 study. Not reported 0.819 Low
Keys: SD = standard deviation; MD = mean difference.
Comparison    Mindfulness self-help manual versus PMR
Main Results
The differences between mindfulness self-help manual and PMR in terms of symptoms of paranoia (p=0.825), degree and symptoms of depression (p=0.703) and frequency of obsessive-compulsive disorder (p=0.819) were not significant.
Comparison: Mindfulness versus PMR among patients with psychosis
Outcomes 1 2 3
No. of studies (Total number of participants) 1 (90) 1 (90) 1 (90)
Mean score (SD)/ No. of participants Intervention 36.13 (17.77)/ 38 50.53 (17.62)/ 38 19.24 (8.16)/ 38
Comparator 35.33 (16.51)/ 52 52.02 (18.79)/ 52 18.87 (7.13)/ 52
MD (95% CI) Not reported Not reported Not reported
p value 0.825 0.703 0.819
Overall quality of evidence* Low Low Low
Keys: SD = standard deviation; MD = mean difference.
Conclusion
Benefits
Compared to PMR, mindfulness self-help manual is not effective in alleviating paranoia, depression and obsessive-compulsive disorder. For Outcome 1-3, the overall quality of evidence is low. Further research is likely to have an important impact on our confidence in this estimate of effect.
Harms
No adverse events were reported.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/26163302
The synopsis is based on the following article:
Moritz S, Cludius B, Hottenrott B, Schneider BC, Saathoff K, Kuelz AK, et al. Mindfulness and relaxation treatment reduce depressive symptoms in individuals with psychosis. European Psychiatry. 2015 Sep;30(6):709-714.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.