Effect of Applying Nursing-based Cognitive Defusion Techniques on Mindful Awareness, Cognitive Fusion, and Believability of Delusions Among Clients with Schizophrenia: a Randomized Control Trial

Overview

Journal Front Psychiatry

Specialty Psychiatry

Date 2024 May 13

PMID 38736628

Authors

Ayman Mohamed El-Ashry

Eman Sameh Abd Elhay

Samah Mohamed Taha

Mahmoud Abdelwahab Khedr

Feby Saad Attalla Mansour

Amany Anwar Saeed Alabdullah

Sally Mohammed Farghaly Abdelaliem

Mona Metwally El-Sayed

Affiliations

Soon will be listed here.

Abstract

Background: Applying cognitive defusion techniques to enduring psychotic symptoms, such as delusions, presents both a challenge and a promising opportunity for psychiatric nurses to manage delusions among schizophrenia clients.

Objective: This study aimed to examine the impact of cognitive defusion techniques on psychological flexibility, mindful awareness, cognitive fusion, and the believability of delusions in schizophrenia clients.

Methodology: This study used a single-blind, parallel-arm Randomized Controlled Trial design. Over five weeks, 70 clients with schizophrenia were randomized to either the cognitive defusion intervention group (n = 35) or the control group (n = 35).

Findings: The participants showed significant reductions in the believability of delusions, cognitive fusion, and psychological inflexibility immediately after the intervention and at follow-up. Notable enhancements were observed in cognitive defusion and mindfulness awareness abilities.

Conclusion: Cognitive defusion techniques positively affect schizophrenia clients who struggle with persistent delusional beliefs. This underscores the importance of further investigating this approach to decrease the intensity of delusions as part of a comprehensive therapeutic intervention. Psychiatric nurses must receive training in "cognitive defusion skills" to aid schizophrenia clients in becoming more aware of their emotions and modifying their coping strategies for delusional beliefs. On August 3, 2023, the research was retrospectively registered under the reference number NCT05759091 as a randomized clinical trial.

Clinical Trial Registration: https://classic.clinicaltrials.gov/ct2/show/NCT05759091, identifier NCT05759091.

Citing Articles

The role of mindfulness and cognitive fusion in predicting self-compassion among patients with schizophrenia: a cross-sectional study.

Hamed W, Kamel N, Kappi A, Babegi A, Dailah H, El-Etreby R BMC Psychiatry. 2024; 24(1):769.

PMID: 39506716 PMC: 11539431. DOI: 10.1186/s12888-024-06204-1.

References

McCutcheon R, Marques T, Howes O . Schizophrenia-An Overview. JAMA Psychiatry. 2019; 77(2):201-210. DOI: 10.1001/jamapsychiatry.2019.3360. View

Bond F, Hayes S, Baer R, Carpenter K, Guenole N, Orcutt H . Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: a revised measure of psychological inflexibility and experiential avoidance. Behav Ther. 2011; 42(4):676-88. DOI: 10.1016/j.beth.2011.03.007. View

Bacon T, Farhall J, Fossey E . The active therapeutic processes of acceptance and commitment therapy for persistent symptoms of psychosis: clients' perspectives. Behav Cogn Psychother. 2013; 42(4):402-20. DOI: 10.1017/S1352465813000209. View

Masuda A, Hayes S, Twohig M, Drossel C, Lillis J, Washio Y . A parametric study of cognitive defusion and the believability and discomfort of negative self-relevant thoughts. Behav Modif. 2008; 33(2):250-62. DOI: 10.1177/0145445508326259. View

Bach P, Hayes S . The use of acceptance and commitment therapy to prevent the rehospitalization of psychotic patients: a randomized controlled trial. J Consult Clin Psychol. 2002; 70(5):1129-39. DOI: 10.1037//0022-006x.70.5.1129. View

El Ashry A, Abd El Dayem S, Ramadan F . EFFECT OF APPLYING "ACCEPTANCE AND COMMITMENT THERAPY" ON AUDITORY HALLUCINATIONS AMONG PATIENTS WITH SCHIZOPHRENIA. Arch Psychiatr Nurs. 2021; 35(2):141-152. DOI: 10.1016/j.apnu.2021.01.003. View

Lincoln T, Dollfus S, Lyne J . Current developments and challenges in the assessment of negative symptoms. Schizophr Res. 2016; 186:8-18. DOI: 10.1016/j.schres.2016.02.035. View

Costa J, Maroco J, Pinto-Gouveia J . Validation of the psychometric properties of cognitive fusion questionnaire. A study of the factorial validity and factorial invariance of the measure among osteoarticular disease, diabetes mellitus, obesity, depressive disorder, and general.... Clin Psychol Psychother. 2017; 24(5):1121-1129. DOI: 10.1002/cpp.2077. View

. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018; 392(10159):1789-1858. PMC: 6227754. DOI: 10.1016/S0140-6736(18)32279-7. View

10.

Haddock G, McCarron J, Tarrier N, Faragher E . Scales to measure dimensions of hallucinations and delusions: the psychotic symptom rating scales (PSYRATS). Psychol Med. 1999; 29(4):879-89. DOI: 10.1017/s0033291799008661. View

11.

Sim J, Lewis M . The size of a pilot study for a clinical trial should be calculated in relation to considerations of precision and efficiency. J Clin Epidemiol. 2011; 65(3):301-8. DOI: 10.1016/j.jclinepi.2011.07.011. View

12.

Yu L, Norton S, McCracken L . Change in "Self-as-Context" ("Perspective-Taking") Occurs in Acceptance and Commitment Therapy for People With Chronic Pain and Is Associated With Improved Functioning. J Pain. 2017; 18(6):664-672. DOI: 10.1016/j.jpain.2017.01.005. View

13.

Louise S, Fitzpatrick M, Strauss C, Rossell S, Thomas N . Mindfulness- and acceptance-based interventions for psychosis: Our current understanding and a meta-analysis. Schizophr Res. 2017; 192:57-63. DOI: 10.1016/j.schres.2017.05.023. View

14.

Chadwick P, Hember M, Symes J, Peters E, Kuipers E, Dagnan D . Responding mindfully to unpleasant thoughts and images: reliability and validity of the Southampton mindfulness questionnaire (SMQ). Br J Clin Psychol. 2008; 47(Pt 4):451-5. DOI: 10.1348/014466508X314891. View

15.

Ross K, Freeman D, Dunn G, Garety P . A randomized experimental investigation of reasoning training for people with delusions. Schizophr Bull. 2009; 37(2):324-33. PMC: 3044626. DOI: 10.1093/schbul/sbn165. View

16.

Maj M . Karl Jaspers and the genesis of delusions in schizophrenia. Schizophr Bull. 2013; 39(2):242-3. PMC: 3576171. DOI: 10.1093/schbul/sbs190. View

17.

McClain L, Mansour H, Ibrahim I, Klei L, Fathi W, Wood J . Age dependent association of inbreeding with risk for schizophrenia in Egypt. Schizophr Res. 2020; 216:450-459. PMC: 8054776. DOI: 10.1016/j.schres.2019.10.039. View

18.

Masuda A, Feinstein A, Wendell J, Sheehan S . Cognitive defusion versus thought distraction: a clinical rationale, training, and experiential exercise in altering psychological impacts of negative self-referential thoughts. Behav Modif. 2010; 34(6):520-38. DOI: 10.1177/0145445510379632. View

19.

Masuda A, Hayes S, Sackett C, Twohig M . Cognitive defusion and self-relevant negative thoughts: examining the impact of a ninety year old technique. Behav Res Ther. 2004; 42(4):477-85. DOI: 10.1016/j.brat.2003.10.008. View

20.

Kashdan T, Disabato D, Goodman F, Doorley J, McKnight P . Understanding psychological flexibility: A multimethod exploration of pursuing valued goals despite the presence of distress. Psychol Assess. 2020; 32(9):829-850. DOI: 10.1037/pas0000834. View