Effectiveness of a mindfulness-based psychoeducation group programme for early-stage schizophrenia: An 18-month randomised controlled trial Wai Tong Chien a, ⁎, Ho Yu Cheng a , Terry W. McMaster b , Annie L.K. Yip c , JoJo C.L. Wong a a The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China b Department of Psychology, Concordia University, Montreal H4B 1R6, Quebec, Canada c School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China abstract article info Article history: Received 8 October 2018 Received in revised form 17 April 2019 Accepted 28 July 2019 Available online xxxx Current psychosocial interventions in schizophrenia are evidenced to improve patients' illness-related knowl- edge, mental status and relapse rate, but substantive benefits to patients, such as their functioning and insight into the illness, remain uncertain. This multi-centre randomised clinical trial aimed to examine the effects of mindfulness-based psycho-education group intervention for adult patients with early-stage schizophrenia over an 18-month follow-up. The controlled trial was conducted with a repeated-measure, three-arm design at two psychiatric outpatient clinics in Jilin (China) and Hong Kong. A stratified random sample of 180 outpatients with schizophrenia spectrum disorders (60/group) was randomly assigned to a mindfulness-based psycho- education group programme, psycho-education group and treatment-as-usual group. The primary outcomes on patients' psychosocial functioning and other patient outcomes, such as psychotic symptoms, in the three groups were compared over the 18-month follow-up (baseline and 1-week, 9-month and 18-month post- intervention). One hundred and sixty (89%) patients completed at least two post-tests. Their mean age and du- ration of illness were 25–28 years (SD = 6.1–7.8) and 2.1–2.5 years (SD = 1.3–2.0; range 4–54 months), respec- tively. Compared with the two other groups, the mindfulness-based group exhibited a significantly greater improvement with moderate to large effect sizes (Cohen's d = 0.49–0.98) in functioning (p = 0.005), duration of psychiatric re-hospitalisations (p = 0.007), psychotic symptoms (p = 0.008) and illness insight (p = 0.001) over the 18-month follow-up. Supplementary MRI findings indicated that the mindfulness-based intervention resulted in significant changes in gray matter volume and density in brain regions concerning attention and emo- tional regulation. Mindfulness-oriented psycho-education group intervention can be an effective intervention for adults with early-stage schizophrenia and exert long-term effects on patients' functioning and mental conditions. © 2019 Elsevier B.V. All rights reserved. Keywords: Functioning Mindfulness-based intervention Psycho-education group Psychotic symptoms Schizophrenia 1. Introduction With the continuous reduction in psychiatric institutionalisations, most people with schizophrenia receive community-based rehabilita- tion services after a short acute inpatient treatment. In 2016, about 22 million individuals with this disorder worldwide were diagnosed with a wide range of psychological, volitional and behavioural abnormalities (Owen et al., 2016; World Health Organisation, 2016). Despite the in- creased development of new anti-psychotic medication to reduce psy- chotic symptoms, people with schizophrenia still experience disabling residual symptoms, poor functioning and high risks of relapses (Bellack, 2006; Chien and Yip, 2013). Recent systematic reviews have suggested that psycho-education groups and cognitive-behavioural therapy for schizophrenia can en- hance patients' knowledge of and coping with this illness, medication adherence and relapse prevention (Xia et al., 2011; Zhao et al., 2015). Psycho-education is recommended as an integral part of a comprehen- sive treatment programme for early-stage schizophrenia (National Collaborating Centre for Mental Health, 2014). However, the engage- ment and long-term compliance with community-based psychosocial intervention of schizophrenic patients remain a challenge for healthcare professionals (Bellack, 2006; Chien et al., 2017). The low illness accep- tance and insight, distress over psychotic symptoms, inadequate self- empowerment for illness management, poor volition and concentration and/or lack of interest in lengthy psychosocial intervention of schizo- phrenic patients are attributed to their suboptimal treatment engage- ment and compliance and lead to poor mental and psychosocial conditions (Chien and Chan, 2013; Lee et al., 2006; Zhao et al., 2015). However, these factors in schizophrenia care have received limited re- search attention (Bäuml et al., 2006). In addition, emotional regulation plays an important role in the psychosocial functioning of these pa- tients, but impairment in emotional regulation and control is common amongst psychotic patients (Moran et al., 2018). Thus, an insight- Schizophrenia Research xxx (xxxx) xxx ⁎ Corresponding author. E-mail address: wtchien@cuhk.edu.hk (W.T. Chien). SCHRES-08423; No of Pages 10 https://doi.org/10.1016/j.schres.2019.07.053 0920-9964/© 2019 Elsevier B.V. All rights reserved. Contents lists available at ScienceDirect Schizophrenia Research journal homepage: www.elsevier.com/locate/schres Please cite this article as: W.T. Chien, H.Y. Cheng, T.W. McMaster, et al., Effectiveness of a mindfulness-based psychoeducation group programme for early-stage schizophrenia: ..., Schizophrenia Research, https://doi.org/10.1016/j.schres.2019.07.053