The M3 program provided a 6-week mindfulness and lifestyle intervention for youth ages 15-25 experiencing first episode psychosis. It included mindfulness techniques, nutrition education, cooking skills, and physical activity. Participants enrolled with a study partner and took part in all activities. Qualitative research explored what components participants found most meaningful, motivating, and led to sustained behavior change. Key findings were that the safe, dignified environment built resilience by reducing stigma and empowering independent identities separate from diagnoses. Participants were motivated to attend to foster hope in improving health and were able to make some lasting lifestyle changes post-intervention.

1. About the M3
Program
M3
is a mindfulness and healthy lifestyle intervention program geared towards
youth (ages 15-25) with First Episode Psychosis (FEP).
The intervention occurred once per week for 4 hours and lasted for a duration of 6
weeks.
The curriculum included mindfulness techniques, nutrition education and cooking
skills, and an array of ways to increase physical activity.
Each participant enrolled with a study partner of their choosing who fully
participated in all program activities.
Andie Thompson, MScN², Angela Senders, ND, MCR²,
³, Alena Borgatti, BA², Kathryn Bodden, BS³,
Craigan Usher, MD1
, Celeste Seibel, MS4
, Lynne Shinto, ND, MPH²
1
Department of Psychiatry, Oregon Health & Science University, ²Department of Neurology, Oregon Health & Science University,
³National University of Natural Medicine, 4
Portland State University
On ‘Dignity’ and Finding a ‘New Path’:
A Qualitative Analysis of Participant
Experiences in the M³ Program
Holistic lifestyle training programs may reduce the cardiometabolic risk factors associated with
psychosis and further compounded by the use of antipsychotic medication. While multi-modal
approaches are showing promise (see references), there is limited information on the specific
features of such programs that create positive benefits for youth experiencing first episode
psychosis (FEP). Qualitative research can serve to illuminate these features and increase the
likelihood that FEP programs will be successful at improving the wellbeing of participants.
Introduction & Background
• The primary objective of the M3
pilot study was to assess feasibility based on attendance as
well as the physiological, anthropometric, and psychological effects (see poster B132).
• The qualitative component, presented here, sought to understand the participant experience
of the M3 program, including:
Objective
What program components
did participants find most
meaningful?
A
What motivated
participants to continue
to attend the program
once enrolled?
B
Was there a sustained
behavior change post
intervention?
C
Methods
What participants found meaningful about the M3 Program
Findings
• De-constructing the social
expectations of a “clinical
environment” reduced stigma
experienced by participants and
created a perception of a “safe
space”.
• Integrated participation
including all staff members and
collaborative activities fostered
dignity and empowered an
identity separate from diagnosis.
A
• The safe and dignified
environment provided by
the program motivated
participants to attend the
weekly sessions.
• The desire to attend was
furthered by successful
engagement in activities and
increasing hopefulness in
one’s own abilities to improve
health and wellbeing.
B • At 6+ weeks post intervention
all participants report having
made some level of behavior
change, namely around food
choices and utilization of
resources but the majority also
report not being able to sustain
changes.
• There is desire for follow-
up sessions and ways for
continued social engagement.
C
Results
Knowledge of the meaningful design components included in holistic lifestyle training programs
has the potential to help future programming be more feasible, engaging, and ultimately more ef-
fective at increasing resilience and improving the health and wellbeing of youth experiencing FEP.
The future of M3
In order to promote longer-term behavior change the following are being considered.
Conclusion
The M3
project and associated studies were funded by Fran and John von Schlegell through the OHSU
foundation. We would like to express our sincere gratitude to the von Schlegell family for their generous
gift. Additionally, this project would not have occurred without our program partner, The Early Assessment
Support Alliance (EASA) of Oregon. Finally, thank you to the program participants, their friends, and family
members who helped us see the work we do through their lens.
Acknowledgments
Bonfioli, E., L. Berti, C. Goss, F. Muraro, and L. Burti.
2012. ‘Health promotion lifestyle interventions for weight
management in psychosis: a systematic review and meta-
analysis of randomised controlled trials’, BMC Psychiatry,
12: 78.
Wardig, R. E., A. Foldemo, S. Hultsjo, T. Lindstrom, and M.
Bachrach-Lindstrom. 2016. ‘An Intervention with Physical
Activity and Lifestyle Counseling Improves Health-
Related Quality of Life and Shows Small Improvements
in Metabolic Risks in Persons with Psychosis’, Issues Ment
Health Nurs, 37: 43-52.
Mueser, K. T., and J. A. Cook. 2014. ‘Rising to the challenge
of first episode psychosis: the NIMH Recovery After Initial
Schizophrenia Episode (RAISE) initiative’, Psychiatr Rehabil
J, 37: 267-9.
Rosenbaum, S., L. X. Lim, H. Newall, J. Curtis, A. Watkins, K.
Samaras, and P. B. Ward. 2014. ‘Observation to action:
progressive implementation of lifestyle interventions to
improve physical health outcomes in a community-based
early psychosis treatment program’, Aust N Z J Psychiatry,
48: 1063-4.
References
Booster
sessions
based on the
principles of
M3
.
Peer Support
Wellness
Educators
training for M3
graduates.
A mobile
application to
provide resources
and social
connectivity.
Conducted in partnership with the Early Assessment & Support Alliance (EASA), a
support and transitional program for youth who have experienced psychosis.
Focus groups held at last
program session (week 6),
participants and partners
were separated.
Open coded in
Dedoose software
by multiple coders.
Discussed with the
Principle Investigators
until consensus was
reached.
n=4 (focus groups)
13 participants
11 study partners
A theoretical framework
using grounded theory
methods was developed
and refined through
multiple iterations.
Focus groups were
audio recorded and
transcribed verbatim.
Formal code book
formulated based on
categories through
inductive interpretation.
Open coded in
Dedoose software
by multiple coders.
Assessed for inter-
rater reliability and
transcripts
re-coded.
Content
analysis
performed.
Individual semi-structured
interviews conducted
at least six weeks post
program (week 12+).
Audio recorded
over the telephone
and transcribed
verbatim.
The M3
Pilot Study Focus Groups:
Program Evaluation
Individual Interviews:
Behavior Change Assessment
A&B C
Inclusion criteria:
• Diagnosis of psychosis
within 3 years
• Enrollment or a graduate
of the EASA Program
• Able to enroll with a
study partner
Exclusion criteria:
• Risk of danger to self or
others.
Average Age
19.5 years
(range 13-27)
65% Female
29% Male
6% Other
64.7% Diverse racial
& ethnic backgrounds
35.3% White
82.4%
Medicated on
neuroleptics
Participant
Diversity
n=17
n=11 (interviews)
participants only
And so, like, for her I know that she didn’t know
what everyone else’s issues were, but she knew that
something was there, so we all have some issue
but for her it was like everyone else, like, they act
normal. “They act just like I do”, and so that really,
that helped her a lot because she didn’t feel like she
was being like put under a microscope, so to speak.
- Study Partner
Figure 1: Created based on the focus group data using grounded theory, the model illustrates the ways in which the program provided a
meaningful experience for participants. Our analysis identified two main themes: 1.) building dignity and 2.) building resilience as the theoretical
foundation from which underlying concepts could be organized and understood.
In their own words...
What participants had to say post intervention: What worked,
what didn’t, and what’s next?
A&B C
Figure 2: A thematic content analysis based on the individual follow-up interviews. Findings offer insight into components participants found
useful in creating positive health behavior change as well as the barriers experienced and participant ideas for sustaining change.
I think the thing that helped me out the most was the mindfulness part, more about the sort of meditation therapy and you know, you
can look in your environment more, and stuff. I think that’s really helped me to be able to cope with more situations that I found stress-
ful before. Like especially a lot of traffic on the highway or lots of stress studying for exams and stuff.
“
”
Uh, yeah, I mean immediately after the
program it was easier to stick with cooking but
that kind of went away after a while, I haven’t
done that lately.
“
”
Well…uh, I’ve actually gained a few pounds since then and I’ve been trying
really hard to eat healthy like M3 taught us. And to exercise more often. So
I’ve been going to the gym lately. And been trying to eat less carbs and eating
healthier and a large variety of foods.
“
”
“
”
…these really useful tips you take away you should really know how to
balance you’re eating and you’re exercising and that could really change
the way you live. That you don’t have to survive off McDonalds or fast food.
That is how I used to be. I wasn’t like, in shape, my whole life... And it wasn’t
like “oh I don’t want to be this person and I just hate myself” it was more
like a positive outlook. Like, “I think I’m going to change for the better”...You
know. I am my own person. I want people to respect that. And I will respect
others as I want them to respect me.
- Participant
“
”
B136