Clinical Handbook of Mindfulness (94 page)

Schwartz, J., Gullifor, E. Z., Stier, J., & Thienemann, M. (2005a).
Mindful aware-

ness and self directed neuroplasticity: Integrating psychospiritual and biolog-

ical approach to mental health with focus on obsessive compulsive disorder
.

Haworth Press.

Schwartz, J. M., & Beyette, B. (1997).
Brain lock: Free yourself from obsessive-

compulsive behavior
. New York: Harper Collins.

Schwartz, J. M., Stapp, H. P., & Beauregard, M. (2005b). Quantum physics in neuro-

science and psychology: a neurophysical model of mind-brain interaction.
Philo-

sophical Transactions of the Royal Society of London. Series B: Biological

Sciences, 360
(1458), 1309–1327.

Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002).
Mindfulness-based cogni-

tive therapy for depression: A new approach for preventing relapse
. New York:

Guilford Press.

Seidman, L. J. (2006). Neuropsychological functioning in people with ADHD across

the lifespan.
Clinical Psychology Review, 26
(4), 466–485.

Seidman, L. J., Biederman, J., Faraone, S. V., Weber, W., & Ouellette, C. (1997).

Toward defining a neuropsychology of attention deficit-hyperactivity disorder: per-

formance of children and adolescents from a large clinically referred sample.
Jour-

nal of Consulting and Clinical Psychology, 65
(1), 150–160.

Shapiro, D. H. (1982). Clinical and physiological comparison of meditation and other

self-control strategies.
Am Journal Psychiatry, 139
, 267–274.

Chapter 17 Mindful Awareness and ADHD

337

Shekim, W. O., Asarnow, R. F., Hess, E., Zaucha, K., & Wheeler, N. (1990). A clinical

and demographic profile of a sample of adults with attention deficit hyperactivity

disorder, residual state.
Comprehensive Psychiatry, 31
(5), 416–425.

Singh, N., Lancioni, G. E., Joy, S. D. S., Winton, A. S. W., Sabaawi, M., Wahler, R. G.,

et al. (2007). Adolescents with Conduct Disorder Can be Mindful of Their Aggres-

sive Behavior.
Journal of Emotional and Behavioral Disorders, 15
(1), 56–63.

Skounti, M., Philalithis, A., & Galanakis, E. (2007). Variations in prevalence of atten-

tion deficit hyperactivity disorder worldwide.
European Journal of Pediatrics,

166
(2), 117–123.

Slagter, H. A., Lutz, A., Greischar, L. L., Francis, A. D., Nieuwenhuis, S., Davis, J. M.,

et al. (2007). Mental Training Affects Distribution of Limited Brain Resources.
PLoS

Biology, 5
(6), e138.

Smalley, S. L. (2008). Reframing ADHD in the Genomic Era.
Psychiatric Times, 25(7)
.

Smalley, S. L., McGough, J. J., Moilanen, I. K., Loo, S. K., Taanila, A., Ebeling, H., et al.

(2007). Prevalence and Psychiatric Comorbidity of Attention Deficit Hyperactivity

Disorder in Adolescent Finnish Population.
Journal of the American Academy of

Child and Adolescent Psychiatry, 46(12)
, 1572–1583.

Sondeijker, F. E., Ferdinand, R. F., Oldehinkel, A. J., Veenstra, R., Tiemeier, H., Ormel,

J., et al. (2007). Disruptive behaviors and HPA-axis activity in young adolescent

boys and girls from the general population.
Journal of Psychiatric Research, 41
(7),

570–578.

Stadler, C., Sterzer, P., Schmeck, K., Krebs, A., Kleinschmidt, A., Poustka, F. (2007).

Reduced anterior cingulate activation in aggressive children and adolescents during

affective stimulation: Association with temperament Traits.
Journal of Psychiatry

Research, 41
(5), 410–417.

Stevenson, C. S., Whitmont, S., Bornholt, L., Livesey, D., & Stevenson, R. J. (2002).

A cognitive remediation programme for adults with Attention Deficit Hyperactivity

Disorder.
Australian and New Zealand Journal of Psychiatry, 36
(5), 610–616.

Strayhorn, J. M., Jr. (2002). Self-control: toward systematic training programs.
Journal

of the American Academy of Child and Adolescent Psychiatry, 41
(1), 17–27.

Swanson, J. M., Schuck, S., Mann, M., Carlson, C. L., Hartman, C. A., Sergeant, J.

A., et al. (2001). Categorical and dimensional definitions and evaluations of symp-

toms of ADHD: The SNAP and SWAN ratings scales. Retrieved June 6, 2006., from

http://adhd.net

Talge, N. M., Neale, C., & Glover, V. (2007). Early Stress, Translational Research and

Prevention Science Network: Fetal and Neonatal Experience on Child and Adoles-

cent Mental Health.
Journal of Child and Psychology and Psychiatry, 48
(3–4),

245–261.

Teasdale, J. D., Scott, J., Moore, R. G., Hayhurst, H., Pope, M., & Paykel, E. S. (2001).

How does cognitive therapy prevent relapse in residual depression? Evidence from

a controlled trial.
Journal of Consulting and Clinical Psychology, 69
(3), 347–357.

Teasdale, J. D., Segal, Z. V., Williams, J. M., Ridgeway, V. A., Soulsby, J. M., & Lau, M.

A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-

based cognitive therapy.
Journal of Consulting and Clinical Psychology, 68
(4),

615–623.

Teasdale, J. D., Segal, Z. V., & Williams, J. M. G. (2003). Mindfulness training and

problem formulation.
Clinical Psychology Science and Practice, 10
(2), 157–160.

Tyrka, A. R., Mello, A.F., Mello, M.F., Gagne, G.G., Grover, K.E., Anderson, G.M., Price,

L.H., Carpenter, L.L. (2006). Temperament and hypothalamic-pituitary-adrenal axis

function in healthy adults.
Psychoneuroendocrinology, 31
(9), 1036–1045.

Urry, H. L., van Reekum, C. M., Johnstone, T., Kalin, N. H., Thurow, M. E., Schae-

fer, H. S., et al. (2006). Amygdala and ventromedial prefrontal cortex are inversely

coupled during regulation of negative affect and predict the diurnal pattern of cor-

tisol secretion among older adults.
Journal of Neuroscience, 26
(16), 4415–4425.

338

L. Zylowska, S.L. Smalley, and J.M. Schwartz

Verte, S., Geurts, H. M., Roeyers, H., Oosterlaan, J., & Sergeant, J. A. (2006). The

relationship of working memory, inhibition, and response variability in child psy-

chopathology.
Journal of Neuroscience Methods, 151
(1), 5–14.

Wasserstein, J., & Lynn, A. (2001). Metacognitive remediation in adult ADHD. Treat-

ing executive function deficits via executive functions.
Annals of the New York

Academy of Sciences, 931
, 376–384.

Wender, P. H. (1998). Pharmacotherapy of attention-deficit/hyperactivity disorder in

adults.
Journal of Clinical Psychiatry, 59 Suppl 7
, 76–79.

Wilens, T. E., Biederman, J., & Spencer, T. J. (2002). Attention deficit/hyperactivity

disorder across the lifespan.
Annual Review of Medicine, 53
, 113–131.

Winston, D. (2003).
Wide Awake: A Buddhist Guide for Teens
: Perigee Trade.

Yuill, N., & Lyon, J. (2007). Selective difficulty in recognising facial expressions

of emotion in boys with ADHD: General performance impairments or specific

problems in social cognition?
European Child and Adolescent Psychiatry, 16
(6),

398–404.

Zuddas, A., Ancilletta, B., Muglia, P., & Cianchetti, C. (2000). Attention-

deficit/hyperactivity disorder: A neuropsychiatric disorder with childhood onset.

European Journal of Paediatric Neurology, 4
(2), 53–62.

Zylowska, L., Ackerman, D. L., Yang, M. H., Futrell, J. L., Horton, N. L., Hale, T. S.,

et al. (2008). Behavioral and cognitive changes in Attention Deficit Hyperactivity

Disorder using a mindfulness meditation approach.
Journal of Attention Disorders,

11(6)
, 737–746.

18

Mindfulness and Psychosis

Antonio Pinto

Homo

sum.

Humani

nihil

a

me

alienum

puto

(Heautonti-

moroumenos) (163 A.C.) I am human. Nothing human can be alien

to me.

Terentius

Introduction

In the last years, mindfulness significantly contributed to promote the

ultimate goal of all medical and psychological treatments: easing patients’

suffering
(Segal, Williams, & Teasdale, 2002).

Indeed, patients with disorders of whatever cause or nature all raise the

same desperate and hopeful cry: “help me feel better, help me live better,”

which all the while points out the intolerability of their material condition of

being ill, as well as the existential one of being sufferers.

Thus, all psychotherapies are called upon to deal with the issue and causes

of suffering.

There are no doubt innumerable causes of suffering, such as stress, ill-

nesses, people, one’s own feelings, goals and wishes. Yet most of the times

we suffer occur when different factors combine in a non-harmonious way.

While psychotherapies help people solve, work on, remove or better cope

with what causes their suffering, mindfulness introduces a new important

element: helping its practitioners and patients change their attitude towards

suffering itself. It helps develop the necessary skills to be less reactive to

what is occurring at the moment, allowing us to deal with different types

of experiences in a way that lowers our levels of suffering, while a sense of

well-being is enhanced
(Germer, 2005).

Mindfulness also involves gaining greater acceptance and awareness.

Acceptance of things as they are, without immediately judging and/or reject-

ing them; acceptance of one’s self and others’ selves, which means greater

benevolence towards one’s nature, limits, feelings and thoughts
(Kabat-Zinn,

2005).

It is possible to practice mindfulness with varying degrees of intensity:

from everyday practice in our habitual environment, allowing us to expe-

rience mindful moments, to the more intense and continuous one of the

monks or practitioners of meditation who live in extraordinary contexts.

Whatever the level and degree of intensity of our practice, mindfulness

allows us to reach a higher level of awareness of thought, feeling, emotion,

wishes and actions, as well as suffering itself
(Kabat-Zinn, 1990).

339

340

Antonio Pinto

As mentioned before, suffering is a constant in the human condition

and the more it is approached as nonsensical and meaningless, the more

unbearable it is, for the possibility to communicate and share it becomes

lower, which slowly and inevitably leads sufferers to shut themselves away

in a desperate attempt to find possible causes and solutions. Experiencing

suffering merely as an inner private dimension shifts people away from their

possibility to be comforted and open to a relational dialogue that is based

most of all on mutual sharing and understanding (Bowlby, 1969).

Severe Patients

This is the typical inner experience of life of many severe patients who,

besides their great suffering, present a series of issues that thwart treatment

effectiveness, such as poor or absent illness insight, mood instability, wither-

ing emotional intensity, bizarre and hardly understandable behaviours (even-

tually violent towards themselves and others) and a tendency to bring rejec-

tion and to become an outcast. Furthermore, such patients often live within

family environments with predominating high levels of expressed emotions

(EE), which together with criticism and communication problems cause the

pathology to worsen or relapse
(Falloon I. et al., 1985).
These patients’ ascertained deficits make it hard for them to use some metacognitive functions

that are necessary for their therapy to be successful, such as decentraliza-

tion, distancing, mastery and other skills
(Linehan, 1993).
Traditional psychotherapies have proved to be scarcely effective in these cases, as shown

by the high dropout or clinical ineffectiveness levels. Even the widely vali-

dated cognitive-behavioural therapy (CBT) is not enough with patients of this

kind and adjustments in the standard protocol become necessary. The first

change to make is surely the introduction of a monitoring of the therapeutic

relationship and the therapist’s relational stance towards that particular type

of patient, as a source for learning and changing within the psychotherapy.

Creating a quiet, safe and validating therapeutic environment, in order to

make patients feel safe and trustful towards the therapist, is therefore a cru-

cial step for achieving clinical changes (Bowlby, 1988).

What we have said so far explains and motivates what, in our opinion,

the difficulties are in treating and trying to help these particular patients

return to a living path that is characterized by lower levels of suffering. In

order to achieve this, we believe mindfulness might be a helpful additional

tool that could integrate those kinds of therapies that have already been

shown to be effective.

In fact, owing to what has already been explained, not all psychotic

patients might be eligible for or able to bear mindfulness protocols in the