Thanks for the very interesting article! I am not as familiar with the mindfulness literature, so this was a good introduction. I had some of the same reactions as you did in terms of the possible mechanisms of change. As it stands, there's no way to tell which of the active components of the intervention are driving the change. An interesting way to test this might be to have pre- and post-treatment measures of knowledge about schizophrenia (to get at psychoeducation), as well as ability to use mindfulness and problem solving skills (perhaps in a stressor-task). You could then see how changes in these areas predict treatment outcomes.
I agree that only having self-report measures is problematic, and it seems that it would have been easy to have one of the professionals involved in the usual care piece (psychiatrist, nurse, or social worker) complete a brief rating scale on symptom severity, functioning, etc. They could easily have been kept blind from whether the patient was also receiving the mindfulness-based intervention. And they had monthly appointments, so the authors could model change over time.
A couple of other thoughts I had:
The authors don't specify if there are treatment group differences on sociodemographic variables, they only state that there are no differences between participants and non-participants. Similarly, while they state that there are no differences between study groups on baseline outcome measures, we don't know how these measures might differ between those who volunteered to be in the study and those who did not. It could be that only those with high insight are the ones who enrolled, which would greatly limit the generalizability of the intervention.
Also, the lack of a measure of medication adherence seems to me to be a huge limitation of this study.
Thanks for the very interesting article! I am not as familiar with the mindfulness literature, so this was a good introduction. I had some of the same reactions as you did in terms of the possible mechanisms of change. As it stands, there's no way to tell which of the active components of the intervention are driving the change. An interesting way to test this might be to have pre- and post-treatment measures of knowledge about schizophrenia (to get at psychoeducation), as well as ability to use mindfulness and problem solving skills (perhaps in a stressor-task). You could then see how changes in these areas predict treatment outcomes.
ReplyDeleteI agree that only having self-report measures is problematic, and it seems that it would have been easy to have one of the professionals involved in the usual care piece (psychiatrist, nurse, or social worker) complete a brief rating scale on symptom severity, functioning, etc. They could easily have been kept blind from whether the patient was also receiving the mindfulness-based intervention. And they had monthly appointments, so the authors could model change over time.
A couple of other thoughts I had:
The authors don't specify if there are treatment group differences on sociodemographic variables, they only state that there are no differences between participants and non-participants. Similarly, while they state that there are no differences between study groups on baseline outcome measures, we don't know how these measures might differ between those who volunteered to be in the study and those who did not. It could be that only those with high insight are the ones who enrolled, which would greatly limit the generalizability of the intervention.
Also, the lack of a measure of medication adherence seems to me to be a huge limitation of this study.