Role of psychological flexibility and negative self-schemas in distressing auditory hallucinations: a systematic review and empirical study
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Objectives. Mindfulness and acceptance-based therapies are becoming increasingly popular in practise and meta-analyses have been conducted to evaluate their effects on a range of mental health difficulties. The purpose of this review was to evaluate the evidence base for mindfulness and acceptance-based therapies in the treatment of distressing auditory hallucinations. Method. Five electronic databases were searched in addition to an internet search engine. Authors of included studies were contacted and reference lists were reviewed. Quality criteria were developed and studies were rated independently by three raters. Results. Nine studies met the inclusion criteria; four controlled studies and five case studies. There was substantial variation in study design and outcomes. Overall, the quality of the studies was poor. Reductions in hallucination-related distress, belief conviction, cognitive appraisals and hallucination proneness were noted. Participants’ ability to respond mindfully to hallucinations increased. Conclusion. Although the results of this review suggest that mindfulness and acceptance-based therapies may result in several beneficial effects, the quality of these studies was poor and the results are likely to have been subject to considerable bias. More research is needed before such therapies can be considered evidence-based treatments for distressing hallucinations. Suggestions for future research are made.