Metacognition and Mindfulness Integrated Therapy Reduces Severity of Hallucination in a Patient Not Taking Antipsychotic Medication.

Psychological interventions have proven efficacy in treating psychotic symptoms such as delusions and hallucinations. However, the efficacy of these interventions has primarily been evaluated in the context of their use as an adjunct to antipsychotics or on patients who do not respond to adequate trials of antipsychotics. There is paucity of research about the effectiveness of psychological interventions in patients who do not take antipsychotics either because they are not willing to take medications or are not able to tolerate antipsychotics due to the side effects. We report here the case of a patient who had distressing auditory hallucinations and was not able to take antipsychotic medications because of severe reactions. She responded to metacognition and mindfulness integrated therapy for auditory hallucination. A total of eight sessions of therapy with the major focus on enhancement of metacognitive insight into the mechanisms of genesis and maintenance of hallucinations followed by encouraging the patient to use mindfulness-based strategies and regular self-monitoring of hallucinatory experiences were conducted. The patient was assessed pre-post intervention on the auditory hallucination subscale of the Psychotic Symptom Rating Scale (PSYRATS). There was significant improvement as reflected by more than 50% reduction in the PSYRATS score. This case highlights that metacognition and mindfulness integrated therapy has the potential to help patients with hallucination who do not take antipsychotic medications. The insight building helps in developing a detached approach towards hallucinatory experiences which, in turn, reduces distress caused by the hallucinations.