Mindfulness Training to Reduce Anxiety in Socially Isolated Individuals with Schizophrenia: A Case Study

Hardiyati Hardiyati ^1,2, Iyus Yosep ^3,†,*, Meita Dhamayanti ^4,†, Veranita Pandia ^5,†, Rohman Hikmat ^6,†

1. Doctoral Students, Faculty of Medicine, Universitas Padjadjaran, Sumedang, West Java, 45363, Indonesia

2. Nursing Department, Poltekkes Kemenkes Mamuju, Mamuju, Sulawesi Barat, 60172, Indonesia

3. Department of Mental Health, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Jawa Barat, Indonesia

4. Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Sumedang, West Java, 45363, Indonesia

5. Department of Mental Health, Faculty of Medicine, Universitas Padjadjaran, Sumedang, West Java, 45363, Indonesia

6. Doctoral Students of Nursing, Faculty of Nursing, Prince of Songkla University, Hat Yai District, Songkhla 90110, Thailand

† These authors contributed equally to this work.

* Correspondence: Iyus Yosep

Academic Editor: Bart Ellenbroek

Received: May 17, 2025 | Accepted: September 11, 2025 | Published: September 15, 2025

OBM Neurobiology 2025, Volume 9, Issue 3, doi:10.21926/obm.neurobiol.2503301

Recommended citation: Hardiyati H, Yosep I, Dhamayanti M, Pandia V, Hikmat R. Mindfulness Training to Reduce Anxiety in Socially Isolated Individuals with Schizophrenia: A Case Study. OBM Neurobiology 2025; 9(3): 301; doi:10.21926/obm.neurobiol.2503301.

© 2025 by the authors. This is an open access article distributed under the conditions of the Creative Commons by Attribution License, which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is correctly cited.

1. Introduction

Schizophrenia is a chronic and severe mental disorder characterized by significant disturbances in thinking, perception, emotion, and behavior [1]. The disorder typically presents with positive symptoms such as hallucinations and delusions, as well as negative symptoms such as social withdrawal, flat affect, and decreased motivation [2]. Cognitive impairments, such as disorganized thinking patterns and difficulties with executive functioning, are also common and have a significant impact on an individual's ability to function in daily life. The combination of these symptoms causes severe difficulties in maintaining social relationships, continuing education or employment, and participating in meaningful activities [3]. As a result, the quality of life of people with schizophrenia is often drastically reduced.

Schizophrenia is often accompanied by conditions of social isolation and anxiety disorders that reinforce each other. Individuals with schizophrenia tend to withdraw from social environments due to symptoms such as paranoid delusions, hallucinations, or difficulties in communicating [4]. This withdrawal can worsen feelings of loneliness and increase anxiety levels, creating a psychological cycle that further hinders recovery. Studies show that comorbidity between schizophrenia and anxiety disorders such as generalized anxiety disorder (GAD), social anxiety disorder (SAD), and panic disorder is relatively high and has a significant impact on the psychosocial functioning of sufferers [5]. This condition becomes even more complex in adolescents, who are a vulnerable age group because they are in a critical period of social development. Untreated isolation and anxiety in this group can hinder the formation of self-identity, worsen psychotic symptoms, and lead to the risk of more severe mental disorders in the future [6].

Anxiety disorders are among the most common mental health disorders in adolescents and can have a profound impact on many aspects of their lives. Adolescents who experience excessive anxiety often have difficulty interacting socially, experience decreased academic performance, and have a decreased overall quality of life [7]. Despite their high prevalence, symptoms of anxiety disorders often go undetected or inadequately treated, mainly due to stigma or a lack of understanding of mental health. This condition is exacerbated when anxiety occurs in combination with social isolation, which reinforces feelings of loneliness and helplessness [8]. Several studies have also shown a link between anxiety, social isolation, and increased risk of suicide, especially in adolescents who lack adequate social support or access to mental health services [9,10].

Social isolation is a significant psychological risk factor and can be categorized into several dimensions, namely subjective, interpersonal, and structural isolation [11]. Subjective isolation refers to feelings of loneliness and lack of emotional connection. In contrast, interpersonal isolation relates to limited meaningful social interactions, and structural isolation includes limited access to social networks or participation in the community. Several studies have shown that all three types of isolation contribute to increased risk of anxiety disorders, both in the short and long term [12]. Individuals who experience isolation, especially subjective isolation, are more likely to develop disorders such as generalized anxiety disorder and panic disorder. In addition, social isolation has been shown to worsen overall mental health outcomes, delay recovery, and increase vulnerability to other emotional disorders such as depression and post-traumatic stress disorder [13].

Adolescents with schizophrenia are a group that is particularly vulnerable to anxiety disorders and social isolation, which, if left untreated, can have serious long-term consequences. During adolescence, individuals are going through an essential phase in the formation of self-identity and the development of social skills [9]. When schizophrenia appears during this period, symptoms such as delusions, hallucinations, and withdrawal can significantly hinder these developmental processes. The combination of psychotic and anxiety disorders can worsen social dysfunction, reduce self-confidence, and increase the risk of depression and suicidal thoughts [14]. Therefore, psychological interventions that target the emotional and social dimensions are needed so that adolescents with schizophrenia can obtain adequate support, better manage symptoms, and prevent a decline in psychosocial functioning in adulthood [15].

Mindfulness is a form of intentional, present-moment, nonjudgmental attention to ongoing experiences, both internal and external [16,17]. The practice has its roots in Buddhist traditions but has been widely adopted in modern psychological approaches as a method for improving mental well-being. In recent decades, mindfulness has been effective in reducing stress, anxiety, and other symptoms of mental disorders, including in populations with severe mental illnesses such as schizophrenia [18]. Through regular practice, mindfulness helps individuals develop awareness of their thoughts and emotions without overreaction, thereby strengthening their self-regulation abilities [19].

Mindfulness activities generally involve exercises such as breathing meditation, body scans, non-judgmental observation of thoughts, and mindfulness in daily activities. In intervention sessions, participants are invited to sit quietly and direct their attention to their breath, bodily sensations, or sounds around them, while observing the emergence of thoughts or emotions with an open and non-reactive attitude [20]. This exercise aims to train individuals to be able to recognize automatic thought patterns that trigger anxiety or stress, and to respond to them more calmly and adaptively [21]. For adolescents with schizophrenia, mindfulness activities provide a safe space to grow self-awareness, reduce over-identification with delusional thoughts, and improve emotion regulation [7].

This study aims to examine the role of mindfulness training in supporting individuals experiencing social isolation, especially adolescents with schizophrenia who show symptoms of anxiety. This study focuses on efforts to understand the hopes and concerns felt by adolescents through mindfulness activities, including breathing meditation, awareness of body sensations, body detection with an attitude of appreciation, opening of awareness, and acceptance of thoughts and feelings that arise. A case study approach is used to describe in depth the application of mindfulness training in the context of adolescents experiencing anxiety due to social isolation, while exploring the psychological mechanisms that allow this intervention to contribute to reducing anxiety symptoms. In clinical research, case study methodology involves an in-depth examination of a single patient or a small group of patients to explore clinical phenomena, generate hypotheses, and illustrate therapeutic processes that may not be captured in large-scale trials. It is hoped that the findings of this study can broaden the understanding of the effectiveness of mindfulness as a relevant therapeutic strategy for adolescent populations with complex psychosocial conditions.

2. Case Study

Mr. A, a 17-year-old male adolescent, was admitted to a psychiatric hospital on February 10, 2025, upon referral from community health services for showing symptoms of a psychotic disorder accompanied by anxiety and social isolation. He came with the main complaints of excessive fear, intense shyness, withdrawal from social environments, and difficulty interacting with others. Based on initial observations, Mr. A showed excessive worry, difficulty concentrating, irritability, and experienced physical symptoms such as palpitations, rapid breathing, sleep disturbances, and a tendency to be alone for a long time.

Physical examination did not show any significant clinical abnormalities: weight 44 kg, height 159 cm, blood pressure 100/90 mmHg, pulse 110 beats per minute, body temperature 36°C, and respiratory rate 24 breaths per minute. Bruises were found on the left hand, which were suspected to be due to aggressive behavior towards himself. In the initial interview, the patient expressed feelings of deep shame towards his family and fear of being blamed, especially by his parents and siblings. He felt very guilty about his life experiences and stated that he was not worthy of returning to the social environment.

Mental status assessment conducted through structured observation and interview revealed signs of mild psychotic disorder accompanied by high anxiety. The patient often appeared withdrawn, avoided eye contact, and showed anxious responses when spoken to. The assessment included various aspects, such as thought content, thought processes, mood, motor activity, affect, perception, and orientation. Although the patient still maintained personal hygiene and was able to communicate cooperatively, he showed a hunched posture, blunted affect, and decreased social initiative. No active perceptual disturbances or delusions were found at the time of evaluation, but profound psychosocial distress, shame, and social isolation were very prominent. These factors are thought to amplify the anxiety condition and worsen the social isolation experienced.

In addition to pharmacological and supportive therapy, Mr. A participated in a structured mindfulness training program that was delivered individually over four sessions during his hospitalization. Each session lasted approximately 10–15 minutes and was adapted to his psychological condition and developmental stage. The practices combined breathing meditation to help regulate physiological arousal and reduce palpitations, awareness of bodily sensations to recognize and release tension, body scanning with an appreciative attitude to foster acceptance and reduce self-criticism, and moment-to-moment awareness to shift attention from guilt and fear of judgment toward present experiences. Over the course of the sessions, Mr. A showed gradual improvement. Initially, he appeared reluctant and passive, but by the second session, he began to engage more consistently in breathing exercises. In the third session, he demonstrated greater openness by sharing his emotional responses during practice, and by the fourth session, he reported feeling calmer, with fewer anxious thoughts. Clinician notes also indicated positive behavioral changes, including increased eye contact, reduced avoidance, and a greater willingness to initiate short conversations after the sessions.

2.1 The Impact of Mindfulness Training on Mr. A

To strengthen the clinical impression, a standardized psychometric instrument was also administered. At admission on February 10, 2025, Mr. A obtained a score of 16 on the GAD-7 (Generalized Anxiety Disorder-7), which indicates severe anxiety. After four weeks of treatment consisting of low-dose antipsychotic medication, supportive psychotherapy, and structured psychosocial rehabilitation, a follow-up assessment on March 10, 2025, showed a decrease in the GAD-7 score to 8, indicating mild anxiety. This improvement reflects a significant reduction in anxiety symptoms and provides objective evidence of treatment effectiveness.

The decrease in GAD-7 score from 16 to 8 highlights measurable clinical progress and supports the effectiveness of the combined interventions. Even within the scope of a single-case study, the inclusion of pre- and post-standardized assessments enhances the reliability of findings, offers a more objective evaluation of symptom change, and strengthens the academic value of the report.

Written informed consent was obtained from both the participant and his legal guardian before the intervention and publication of this case study.

3. Discussion

The observed therapeutic change in Mr. A can also be understood through established psychological frameworks. Mindfulness practices facilitated metacognitive awareness and decentering, enabling him to observe thoughts and emotions without excessive identification, which reduced his anxiety intensity. In addition, emotion regulation models explain how mindfulness promotes adaptive strategies such as acceptance and reduced avoidance, allowing Mr. A to face rather than withdraw from social interactions. These mechanisms are consistent with his observed behavioral improvements, including increased eye contact, reduced avoidance, and greater willingness to communicate.

Mindfulness training had a direct impact on reducing Mr. A’s severe anxiety symptoms. At admission, he presented with excessive worry, palpitations, rapid breathing, and restlessness. After four sessions of mindfulness training, his GAD-7 score decreased from 16 (severe anxiety) to 8 (mild anxiety). This quantitative change was supported by qualitative observations, including calmer breathing patterns and reduced agitation noted during and after sessions. The combination of mild psychotic symptoms, psychosocial distress, and fear of social rejection demonstrates the importance of a holistic approach to assessment and intervention [14]. The relevance of this case lies in the need for an early detection system that is sensitive to affective symptoms and withdrawal behavior, which are often the initial manifestations of a deeper mental disorder.

The observed therapeutic change in Mr. A can also be understood through established psychological frameworks. Metacognitive awareness and decentering processes, fostered by mindfulness, enabled the patient to observe his own thoughts and emotions without excessive identification, thereby reducing the intensity of negative affect. At the same time, mindfulness practices supported emotion regulation, allowing Mr. A to shift from maladaptive avoidance strategies toward more adaptive acceptance-based coping. These mechanisms help explain the reduction in anxiety symptoms and the gradual improvement in social engagement observed during the intervention [17,22].

Mindfulness training also positively influenced Mr. A’s social withdrawal and avoidance behaviors. Initially, he avoided eye contact, rarely spoke, and preferred to isolate himself. Over the course of the sessions, however, session logs recorded gradual improvements in eye contact, increased willingness to engage in short conversations, and reduced avoidance of social interactions in the ward [23,24]. These changes may be explained by mindfulness practices that promote decentering (the ability to observe distressing thoughts such as “I will be judged” without over-identifying with them), thereby lowering social fear and making space for social reconnection [9].

Emotional regulation was another area of improvement. At the start, Mr. A expressed profound shame, guilt, and fear of being blamed by his family, which contributed to his blunted affect and passive posture. Through mindfulness practices such as body scanning with an appreciative attitude and acceptance of thoughts without judgment, he gradually reported feeling “calmer” and better able to tolerate negative emotions. This reflects a shift from maladaptive avoidance strategies to adaptive acceptance, aligning with emotion regulation models of mindfulness [25,26,27].

The somatic symptoms experienced by Mr. A, such as palpitations, rapid breathing, sleep disturbances, and agitation, are typical manifestations of the autonomic nervous system response to severe anxiety. Excessive activation of the sympathetic nervous system under psychological stress conditions can trigger increased heart rate (tachycardia), hyperventilation, and sleep pattern disturbances, all of which are clearly seen in this case. These symptoms not only strengthen the diagnosis of anxiety but also indicate a physiological imbalance that contributes to the patient's emotional discomfort [23]. In addition, psychomotor agitation and difficulty concentrating demonstrate the impact of anxiety on daily neurocognitive function. The correlation between these physical symptoms and emotional components indicates a significant involvement of the autonomic nervous system in the pathophysiology of anxiety disorders, which ultimately worsens the patient's quality of life and adds to the psychological burden felt [28].

Mindfulness training is a psychological intervention that is increasingly being used to manage a variety of mental disorders, including anxiety and social isolation, which are often experienced by people with psychotic disorders such as schizophrenia [17,29]. It teaches people to focus their attention non-judgmentally on their present moment experiences, including thoughts, feelings, and bodily sensations. By increasing self-awareness and acceptance of mental states without overreacting, mindfulness can help reduce negative thought patterns and anxiety that often exacerbate social isolation [30]. This approach emphasizes the ability to be “present” and accept oneself, which can psychologically reduce stress and improve emotion regulation.

Research shows that mindfulness training is effective in reducing anxiety symptoms in patients with severe mental illness, including those with psychotic disorders. By practicing present-moment awareness, patients can minimize excessive worry and obsession with negative experiences that often reinforce shyness and social fear [5,16,31]. This process allows them to observe their thoughts and feelings without getting caught up in maladaptive thought patterns, thereby reducing the intensity of anxiety and making room for more adaptive emotional responses [7]. In the context of social isolation, mindfulness can also help patients to accept their circumstances without judgment, which in turn opens up opportunities for better social engagement [18].

Additionally, mindfulness training fosters the development of adaptive coping skills through meditation practices, conscious breathing exercises, and sensory awareness exercises. These techniques help patients develop better self-control over emotional and physical reactions to social stress, such as increased heart rate or avoidance tendencies [32]. With more effective anxiety management, patients can gradually reduce withdrawal behaviors and increase participation in social interactions. This is especially important in the recovery process of schizophrenia, where social isolation is a significant risk factor that worsens the prognosis and quality of life of patients [30].

The implementation of mindfulness training in clinical settings also requires a holistic and personalized approach, given the complexity of the condition of patients with schizophrenia. Assistance by trained mental health workers is essential for this training to be carried out consistently and effectively. Family involvement and additional social support can strengthen the intervention results by providing a safe and supportive environment for mindfulness practice. Overall, mindfulness training offers a promising strategy as part of a multimodal therapeutic approach to reduce anxiety and overcome social isolation in individuals with psychotic disorders, as reflected in the case of Mr. A.

3.1 Limitations and Future Directions

This study is limited by its single-case design and short duration, which restricts generalizability to broader populations. The findings should therefore be interpreted with caution. Moreover, the improvements observed may have been influenced by other therapeutic components, such as pharmacological treatment and general psychosocial support, making it difficult to isolate the specific effect of mindfulness. However, given the limitations of this single-case design and the absence of multiple standardized outcome measurements, these findings should be interpreted with caution. Further research with larger samples, control groups, and rigorous methodology is recommended to explore the broader applicability and effectiveness of mindfulness-based interventions in clinical mental health settings. Future research should include larger sample sizes, longer follow-up, and controlled comparisons with other psychosocial interventions to establish the robustness and replicability of mindfulness training for adolescents with schizophrenia and comorbid anxiety.

4. Conclusions

Mindfulness training in this case study shows potential effectiveness as a supportive therapy in managing anxiety and social isolation in individuals with schizophrenia, especially in those with a history of severe communication problems and significant social isolation. In the case of An. A, the mindfulness therapy process included training in recognizing hopes and worries, breathing meditation, awareness of body sensations, and an attitude of acceptance of thoughts and feelings experienced. However, considering that this study was only based on a single case, these findings need to be interpreted with caution and require further verification.

Mindfulness-based therapy may be a promising complementary psychosocial intervention, especially for incarcerated adolescents, as an adjunct to conventional medical treatment for individuals with schizophrenia and a tendency to experience anxiety and social isolation. Larger sample sizes and more rigorous methodological studies are needed to test the effectiveness and consistency of the results of this therapy. Further studies should also explore the impact of mindfulness on other psychological aspects, such as major anxiety disorders and major depression, and compare its effectiveness with other relevant psychosocial interventions in juvenile correctional settings.

Thus, the results of this study open up opportunities for the development of mindfulness therapy as part of a holistic approach to mental health care in unique and challenging settings such as juvenile correctional facilities, while also providing an essential contribution to the literature on the treatment of psychotic disorders with comorbid anxiety and social isolation.

Acknowledgments

All authors would like to thank Universitas Padjadjaran for giving us the opportunity to conduct this research.

Author Contributions

Made substantial contributions to the conception and design, or acquisition of data, or analysis and interpretation of data: HH, IY, MD, VP; Involved in drafting the manuscript or critically revising it for important intellectual content: HH, IY, VP, RH; Gave final approval of the version to be published. Each author must have participated sufficiently in the work to take public responsibility for the appropriate portion of the content: HH, RH; Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: HH, RH, IY.

Funding

This research did not receive external funding.

Competing Interests

The authors have declared that there is no conflict of interest.