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

Abstract

Angie Ho Yan Lam,1 Yee Tak Derek Cheung,1 Kwan Ho Wong,2 Sau Fong Leung,3 Wai Tong Chien4 1School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region; 2Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; 3School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region; 4The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong Special Administrative RegionCorrespondence: Angie Ho Yan LamSchool of Nursing, LKS Faculty of Medicine, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong Special Administrative RegionEmail [email protected]: 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 (χ2(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.Keywords: schizophrenia spectrum disorders, psychosis, negative emotions, depression, anxiety, stress, rumination, psychotic symptoms, mindfulness

Keywords

• • schizophrenia spectrum disorders • psychosis • negative emotions • depression • anxiety • stress • rumination • psychotic symptoms • mindfulness