| I. |
1. Orientation and engagement (two sessions) |
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a.
Establishment of mutual trust and respect, treatment goals and objectives, and expected roles and responsibilities in the group; and
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b.
Understanding of the group programme and information about the illness and its symptoms
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•
Orientation to the MBPEG and its functions
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Establishing trust and respect among group members
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Achieving agreed goals and objectives
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Schizophrenia and its impacts
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i.
Self-introduction and game activities
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ii.
Group discussion about their roles and responsibilities in the group, and about schizophrenia and its impacts on patients and their families
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2. Focused awareness of bodily sensations, thoughts, feelings and symptoms (three sessions) |
Session 1: Stepping out of automatic pilot and negative thoughts Rationale:
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a.
Mindfulness starts when we recognize the tendency to be on automatic pilot;
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b.
Commitment to learning how to step out of it and being aware of each symptom and related experience; and
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c.
Practice in purposefully drawing attention to bodily sensations and movements
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•
Body scan, noticing sensations, feelings and thoughts
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Dealing with barriers to focusing thoughts, emotions and events, particularly pleasurable events
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i.
Body scan
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ii.
Breath and awareness and mindfulness thereof
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iii.
Focusing on both pleasant and annoying events
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iv.
Focused awareness of the body, thoughts and feelings (homework)
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Session 2: Mindfulness of the breath and staying present Rationale:
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a.
Becoming familiar with the behaviour of the mind (often being busy and scattered);
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b.
The mind is most scattered when trying to cling to something and avoid others; and
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c.
Mindfulness offers a means to stay present by providing another place from which to view things
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•
Awareness of the breath offers an anchor to the present (a possibility of being more focused and gathered)
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•
Categorizing experiences v. describing bare sensations/thoughts
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•
Getting to know the territory of schizophrenia
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i.
Seeing/hearing and intentional awareness of breath, body, sounds and thoughts
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ii.
3-min breathing space (awareness of body, re-directing and expanding attention), opening (controlling breath)
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iii.
Stretching and breathing (homework)
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iv.
Walking and focused sensation
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v.
Yoga (homework)
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Session 3: Acceptance, holding, allowing; and letting be Rationale:
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a.
Relating differently involves bringing to the experience a sense of allowing it to be as it is, without judging it or trying to make it different; and
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b.
An accepting attitude is a major part of taking care of oneself and seeing clearly what, if anything, needs to change
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i.
Exercise on awareness of breath, body, thoughts and emotions
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ii.
Recognizing and discussing difficulties with such awareness
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iii.
Expanded breathing space – opening up troubles in the mind and settling down these troubles
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iv.
Mindful walking
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3. Empowerment of self-control of psychotic symptoms and negative thoughts (one session) |
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a.
Negative thoughts and moods that accompany them colour or reduce our ability to relate to experiences;
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b.
Thoughts are merely thoughts, we can choose whether to engage with them or not; and
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c.
The same patterns of thoughts recur again and again, without necessarily having to question them and seek alternatives
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•
Thoughts are not facts – alternative perspectives of seeing your thoughts and sensations
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•
Options for working with negative and disorganized thoughts
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•
Recognizing the recurring thoughts and standing back from them, without questioning them
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i.
Expanded breathing space
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ii.
Alternative perspectives and options for working with thoughts
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iii.
Diary writing and awareness of early warning signs of relapse
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iv.
Selection of practices (homework)
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| II. |
1. Knowledge of schizophrenia and its care (two sessions) |
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a.
Understanding psychotic symptoms and individual psychosocial health concerns;
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b.
Understanding cultural issues within family and society; and
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c.
Identifying important needs for patients, self and family
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•
Patients’ individual health needs in relation to schizophrenia care
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•
Information sharing of schizophrenia and its treatment
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Sharing of behavioural and perceptual problems, intense emotions, and feelings about illness management
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•
Discussing ways to deal with negative thoughts and emotions, cultural issues and beliefs of mental illness, stigma and family
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•
Information about medication and its effects, self-care, daily activities and functioning, and illness and home management
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i.
Group discussion and video watching
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ii.
Information search from Internet and health care organizations
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iii.
Expert (both ex-patients and professionals) sharing
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iv.
Selection of mindfulness practices learned (homework)
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v.
Communication and social skills training
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2. Illness management and problem solving (one session) |
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•
Enhancing social support, stress coping and problem-solving skills by working on each member's life situations
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Performing behavioural rehearsals of social interactions with co-patients (and invited family members) within groups
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•
Review of real-life practice of coping skills learned in group sessions
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i.
Group discussion and video watching
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ii.
Ex-patients’ sharing of illness management experiences
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iii.
Role play on coping and problem-solving skills
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iv.
Practices of coping skills learned (homework)
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| III. |
1. Behavioural rehearsal of relapse prevention (two sessions) |
Session 1: How can I best take care of myself? Rationale:
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a.
Specific things can be done when psychotic symptoms threaten my living and functioning;
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b.
Taking a breathing space first and then deciding what action to take;
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c.
Each patient has his/her own unique patterns of symptoms and relapse and thus also his/her own prevention strategies; and
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d.
Group members can provide support and help each other to plan the best self-care
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•
Identifying signs of relapse and associated factors
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Reflect on daily activities, stressors and accompanying emotions (i.e. nourishing v. depleting activities)
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•
Evaluation of self-care, illness management, coping skills and interpersonal relationships
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i.
Group discussion
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ii.
Role play and behavioural rehearsals of coping skills and self-reflection
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iii.
Awareness of breath, body, sounds, thoughts, difficulty, and social support
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iv.
Breathing space and selecting forms of practice to continue
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v.
Continuous practice of coping skills learned (homework)
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Session 2: Using learned skills to deal with future problems in thoughts and moods Rationale:
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•
What thing(s) in our life do you value most and what can the practice help you with?
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•
Preparing for future life problems and relapse prevention
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•
Consolidation of selected and practiced coping and mindfulness skills
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i.
Body scan, sitting and walking mindfulness
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ii.
Best wishing and positive thinking
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iii.
Group discussion about future problems
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iv.
Continuous practice of selected mindfulness strategies (homework)
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2. Community resources and future plans (one session) |
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a.
Being familiar with community support services and resources for schizophrenia care;
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b.
Review of main issues and those skills learned and selected for practices; and
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c.
Planning for future independent living
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•
Summary of the main issues and topics covered and knowledge and skills learned
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•
Introduction of available community support resources
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Issues expected in future life and psychological and behavioural preparations for the future
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•
Action plans for illness management and the future
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•
Questions and comments from group members and specific requests for follow-up
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i.
Body scan and mindful walking
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ii.
Discussion about learning from the programme and plan for the future
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iii.
Checking each person's support resources/mechanisms
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iv.
Invitation to outcome assessment and interviews
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