Can we respond mindfully to distressing voices? A systematic review of evidence for engagement, acceptability, effectiveness and mechanisms of change for mindfulness-based interventions for people distressed by hearing voices.
Clara Strauss, Neil Thomas, Mark Hayward
Frontiers in Psychology August 14, 2015 DOI: 10.3389/fpsyg.2015.01154 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review Cross-sectional Qualitative Peer reviewed |
|---|---|
| Sample size | 479 |
| Population | People distressed by hearing voices |
| Intervention | Mindfulness-based interventions |
| Topics | Meditation |
| Keywords | Schizophrenia Psychosis Auditory hallucinations Hearing voices Person-based cognitive therapy |
| Key findings | The review indicates that mindfulness-based interventions are engaging, acceptable, and safe for people distressed by hearing voices, and cross-sectional studies show trait mindfulness is associated with less voice-related distress and disturbance. However, the authors report that no adequately powered randomized controlled trials exist, so effectiveness at reducing distress and disturbance remains unestablished, and mechanisms of change could not be tested; qualitative studies suggest reorientation of attention, decentring, and acceptance of voices as potential processes. |
Abstract
Adapted mindfulness-based interventions (MBIs) could be of benefit for people distressed by hearing voices. This paper presents a systematic review of studies exploring this possibility and we ask five questions: (1) Is trait mindfulness associated with reduced distress and disturbance in relation to hearing voices? (2) Are MBIs feasible for people distressed by hearing voices? (3) Are MBIs acceptable and safe for people distressed by hearing voices? (4) Are MBIs effective at reducing distress and disturbance in people distressed by hearing voices? (5) If effective, what are the mechanisms of change through which MBIs for distressing voices work? Fifteen studies were identified through a systematic search (n = 479). In relation to the five review questions: (1) data from cross-sectional studies showed an association between trait mindfulness and distress and disturbance in relation to hearing voices; (2) evidence from qualitative studies suggested that people distressed by hearing voices could engage meaningfully in mindfulness practice; (3) MBIs were seen as acceptable and safe; (4) there were no adequately powered RCTs allowing conclusions about effectiveness to be drawn; and (5) it was not possible to draw on robust empirical data to comment on potential mechanisms of change although findings from the qualitative studies identified three potential change processes; (i) reorientation of attention; (ii) decentring; and (iii) acceptance of voices. This review provided evidence that MBIs are engaging, acceptable, and safe. Evidence for effectiveness in reducing distress and disturbance is lacking however. We call for funding for adequately powered RCTs that will allow questions of effectiveness, maintenance of effects, mechanisms of change and moderators of outcome to be definitively addressed.
Comparable studies
Other systematic reviews and meta-analyses on meditation, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Meditation Programs for Psychological Stress and Well-being Diverse adult clinical populations | 2014 | Meta-analysis | n = 3,515 |
| Mindfulness-Based Stress Reduction for Stress Management in Healthy People: A Review and Meta-Analysis Healthy subjects | 2009 | Systematic review and meta-analysis | |
| The psychological effects of meditation: A meta-analysis. Nonclinical groups of adult meditators | 2012 | Meta-analysis | n = 163 |
| Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive Relapse Adults with recurrent depression in full or partial remission | 2016 | Meta-analysis of individual patient data from randomized controlled trials | n = 1,258 |
| Mindfulness‐Based Stress Reduction and Mindfulness‐Based Cognitive Therapy – a systematic review of randomized controlled trials | 2011 | Systematic review |
Citations in the library
Cited by 9
- Effects of mindfulness-based interventions (MBIs) on psychotic symptoms and psychological outcomes in patients with schizophrenia spectrum disorders: A systematic review and meta-analysis. Psychiatry Research December 1, 2024
- Hearing voices and other altered perceptual experiences across psychotic, mood, and anxiety disorders: from phenomenology and mechanisms to future directions. Schizophrenia September 29, 2025
- Increased risk of hallucinations among people with cancer: Role of loneliness, job satisfaction, sleep and a moderated-mediated model of anxiety and life satisfaction Journal of Psychiatric Research October 4, 2024
- Mindfulness meditation for Chinese patients with psychosis: A systematic review and meta-analysis. Schizophrenia Research September 9, 2021
- The Acceptability, Feasibility and Potential Outcomes of an Individual Mindfulness-Based Intervention for Hearing Voices. Behavioural and Cognitive Psychotherapy March 2019
and 4 more in the library
Cites 10
- The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology 2003
- Using Self-Report Assessment Methods to Explore Facets of Mindfulness Assessment January 27, 2006
- Assessment of Mindfulness by Self-Report Assessment September 1, 2004
- Mindfulness-based cognitive therapy for depression August 21, 2006
- Mindfulness-based cognitive therapy for depression. Industrial Psychiatry Journal October 29, 2024
and 5 more in the library