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Abeditehrani H, Dijk C, Dehghani Neyshabouri M, Arntz A. Effectiveness of cognitive behavioral group therapy, psychodrama, and their integration for treatment of social anxiety disorder: A randomized controlled trial. J Behav Ther Exp Psychiatry 2024; 82:101908. [PMID: 37690886 DOI: 10.1016/j.jbtep.2023.101908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 05/23/2023] [Accepted: 08/26/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Although cognitive behavioral group therapy (CBGT) is an effective treatment for social anxiety disorder, many socially anxious patients are still symptomatic after treatment. A possible improvement for CBGT could come from the more experiential group psychotherapy, psychodrama (PD). The integration of CBGT and PD (labeled CBPT) might offer an even more effective treatment than CBGT or PD alone. With the present study, we investigated first whether three kinds of group therapy (CBGT, PD, and CBPT) are superior to a waitlist (WL). Second, we investigated whether CBPT is more effective than CBGT or PD alone. METHODS One hundred and forty-four social anxiety patients were randomly assigned to three active conditions or a WL. After wait, WL-participants were randomized over the active treatment conditions. RESULTS The results of a multilevel analysis showed that all treatments were superior to WL in reducing social anxiety complaints. Only CBGT and CBPT differed significantly from WL in reducing fear of negative evaluations. There were no significant differences between active conditions in any of the variables after treatment and after six-month follow up, neither were there significant differences in treatment dropout. LIMITATIONS First there is the lack of a long-term follow-up. Second, because of loss of participants, we did not reach the planned numbers in the active treatment groups in comparison to WL. Moreover, this study was not designed as a non-inferiority or equivalence trial. CONCLUSIONS Although the integrative CBPT showed good results, it was not more effective than the other treatments.
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Affiliation(s)
- Hanieh Abeditehrani
- University of Amsterdam, Department of Clinical Psychology, Amsterdam, the Netherlands.
| | - Corine Dijk
- University of Amsterdam, Department of Clinical Psychology, Amsterdam, the Netherlands
| | | | - Arnoud Arntz
- University of Amsterdam, Department of Clinical Psychology, Amsterdam, the Netherlands
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Rader L, Drueke B, Forster SD, Gauggel S, Mainz V. Validation of the factor structure of the Experiences Questionnaire using Exploratory Graph Analysis. Front Psychol 2023; 14:1250802. [PMID: 38034302 PMCID: PMC10684915 DOI: 10.3389/fpsyg.2023.1250802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction Decentering describes the ability to shift the focus away from one's subjective experience onto the experience itself. The Experiences Questionnaire (EQ) is a self-report measure that was developed to systematically assess changes in Decentering ability. Although several studies show the validity of the questionnaire, there are discrepancies between the factorial structure of the Decentering scale of the EQ (EQ-D) found in the initial study (one factor) and other studies (two factors). Therefore, the current study aimed to assess the dimensionality of the EQ-D using Exploratory Graph Analysis (EGA). Methods In total, 1,100 participants were recruited online (790 female, 307 male, 3 non-binary; age 18 to 65 years). Participants completed the EQ and the Rosenberg Self-esteem scale (RSES). Results The bootstrapped EGA results revealed a two-dimensional structure of the EQ-D (Factor 1: Distanced Perspective, DP; Factor 2: Accepting Self-perception, AS) with high structural and item stability (all items > 0.70). The two dimensions of the EQ-D showed a high internal consistency (DP: ω = 0.74; AS: ω = 0.86) and discriminant validity with the rumination items of the EQ. Furthermore, a high convergent validity of the EQ was established, as the AS factor exhibited a significantly stronger correlation with self-esteem than the DP factor (z = 7.98, p < 0.001), which aligns with theoretical considerations suggesting that the AS factor encompasses aspects of self-compassion alongside decentering. We also found measurement invariance of the DP and AS factor across age, gender and country but not for education. Discussion These results support the EQ's validity, demonstrated in a larger sample with a new methodology, aligning with existing two-factor decentering models literature.
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Affiliation(s)
- Lena Rader
- Institute of Medical Psychology and Medical Sociology, University Hospital RWTH Aachen, Aachen, Germany
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Bennett MP, Knight RC, Dunning D, Archer-Boyd A, Blakemore SJ, Dalmaijer E, Ford T, Williams JMG, Clegg H, Kuyken W, So T, Wright G, Lenaert B, Vainre M, Watson P, Dalgleish T. Protocol for a randomised controlled trial investigating an intervention to boost decentering in response to distressing mental experiences during adolescence: the decentering in adolescence study (DECADES). BMJ Open 2022; 12:e056864. [PMID: 35354620 PMCID: PMC8968529 DOI: 10.1136/bmjopen-2021-056864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Decentering describes the ability to voluntarily adopt an objective self-perspective from which to notice internal, typically distressing, stressors (eg, difficult thoughts, memories and feelings). The reinforcement of this skill may be an active ingredient through which different psychological interventions accrue reductions in anxiety and/or depression. However, it is unclear if decentering can be selectively trained at a young age and if this might reduce psychological distress. The aim of the current trial is to address this research gap. METHODS AND ANALYSIS Adolescents, recruited from schools in the UK and Ireland (n=57 per group, age range=16-19 years), will be randomised to complete 5 weeks of decentering training, or an active control group that will take part in a combination of light physical exercise and cognitive training. The coprimary training outcomes include a self-reported decentering inventory (ie, the Experiences Questionnaire) and the momentary use of decentering in response to psychological stressors, using experience sampling. The secondary mental health outcomes will include self-reported inventories of depression and anxiety symptoms, as well as psychological well-being. Initial statistical analysis will use between-group analysis of covariance to estimate the effect of training condition on self-rated inventories, adjusted for baseline scores. Additionally, experience sampling data will be examined using hierarchical linear models. ETHICS AND DISSEMINATION This study was approved by the Cambridge Psychology Research Ethics Committee, University of Cambridge (PRE.2019.109). Findings will be disseminated through typical academic routes including poster/paper presentations at (inter)national conferences, academic institutes and through publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN14329613.
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Affiliation(s)
| | | | | | | | - Sarah-Jayne Blakemore
- Department of Psychology, University of Cambridge, Cambridge, UK
- UCL Institute of Cognitive Neuroscience, London, UK
| | | | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Hannah Clegg
- MRC Cognition and Brain Sciences Unit, Cambridge, UK
| | - Willem Kuyken
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Gemma Wright
- MRC Cognition and Brain Sciences Unit, Cambridge, UK
| | - Bert Lenaert
- Faculty of Healh, Medicine and Life Sciences, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Maris Vainre
- MRC Cognition and Brain Sciences Unit, Cambridge, UK
| | - Peter Watson
- MRC Cognition and Brain Sciences Unit, Cambridge, UK
| | - Tim Dalgleish
- MRC Cognition and Brain Sciences Unit, Cambridge, UK
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Duncan NS, Zimmer-Gembeck MJ, Gardner AA, Modecki K. The measurement and benefit of decentering for coping self-efficacy, flexibility, and ways of coping with interpersonal stress. PERSONALITY AND INDIVIDUAL DIFFERENCES 2021. [DOI: 10.1016/j.paid.2021.110932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Cognitive Defusion Is a Core Cognitive Mechanism for the Sensory-Affective Uncoupling of Pain During Mindfulness Meditation. Psychosom Med 2021; 83:566-578. [PMID: 33790200 DOI: 10.1097/psy.0000000000000938] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Mindfulness meditation can downregulate the experience of pain. However, its specific underlying regulatory mechanisms are still largely unknown. Here, we aimed to investigate the role of cognitive defusion-a form of psychological distancing from internal experiences-in mindfulness-based pain regulation. METHODS We implemented a thermal heat paradigm that was designed to amplify the cognitive-affective aspects of pain in 43 novice meditators (2-day formal training; 51.2% women; 53.2 ± 7.0 years old) and 27 expert meditators (>10,000-hour practice; 44.4% women; 51.9 ± 8.4 years old). We collected pain intensity and unpleasantness reports and trait measures of pain catastrophizing assessed by the Pain Catastrophizing Scale (PCS), cognitive defusion assessed by the Drexel Defusion Scale (DDS), and cognitive fusion assessed by the Cognitive Fusion Questionnaire, as well as of several other constructs commonly reported in the literature. RESULTS Experts reported lower PCS (6.9 ± 5.2 versus 17.2 ± 8.5, p < .001) but higher DDS (39.4 ± 6.4 versus 28.9 ± 6.6, p < .001) than novices. Across participants, the PCS and DDS were negatively correlated and shared unique variance that survived adjusting for other mindfulness-related and cognitive-emotional constructs (β = -0.64, p < .001). Conversely, the relationships between PCS and other commonly reported constructs did not seem specific, as none of the relationships survived adjusting for DDS (adjusted β < 0.25, p > .05). Further supporting the relevance of DDS to pain, both the DDS and PCS specifically predicted pain unpleasantness as opposed to pain intensity. However, DDS seemed to be a more specific predictor of unpleasantness than PCS, as the relationship between DDS and unpleasantness survived adjusting for PCS (adjusted β = -0.33, p = .016), but not vice versa (adjusted β = 0.20, p = .162). We also found that the Cognitive Fusion Questionnaire showed a similar pattern of associations with PCS and pain self-reports to what was found for the DDS, although these associations were less consistent. CONCLUSIONS Collectively, these findings highlight the central role of cognitive defusion in mindfulness-based pain regulation.
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Bennett MP, Knight R, Patel S, So T, Dunning D, Barnhofer T, Smith P, Kuyken W, Ford T, Dalgleish T. Decentering as a core component in the psychological treatment and prevention of youth anxiety and depression: a narrative review and insight report. Transl Psychiatry 2021; 11:288. [PMID: 33990541 PMCID: PMC8121888 DOI: 10.1038/s41398-021-01397-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 12/12/2022] Open
Abstract
Decentering is a ubiquitous therapeutic concept featuring in multiple schools of psychological intervention and science. It describes an ability to notice to day-to-day psychological stressors (negative thoughts, feelings, and memories) from an objective self-perspective and without perseverating on the themes they represent. Thus, decentering dampens the impact and distress associated with psychological stressors that can otherwise increase mental ill health in vulnerable individuals. Importantly, the strengthening of decentering-related abilities has been flagged as a core component of psychological interventions that treat and prevent anxiety and depression. We provide an in-depth review evidence of the salutary effects of decentering with a special focus on youth mental health. This is because adolescence is a critical window for the development of psychopathology but is often under-represented in this research line. A narrative synthesis is presented that integrates and summarizes findings on a range of decentering-related abilities. Section 1 reviews extant conceptualizations of decentering and data-driven approaches to characterize its characteristic. A novel definition is then offered to guide future empirical research. Section 2 overviews laboratory-based research into the development of decentering as well as its relationship with anxiety and depression. Section 3 examines the role decentering-related skills play in psychological interventions for anxiety and depression. Critically, we review evidence that treatment-related increases in decentering predict latter reductions in anxiety and depression severity. Each section highlights important areas for future research. The report concludes by addressing the vital questions of whether, how, why and when decentering alleviates youth anxiety and depression.
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Affiliation(s)
- Marc P Bennett
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.
| | - Rachel Knight
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Shivam Patel
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Tierney So
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Darren Dunning
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | | | - Patrick Smith
- Institute of Psychiatry, Kings College London, London, UK
| | - Willem Kuyken
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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Roca P, Vazquez C, Diez G, Brito-Pons G, McNally RJ. Not all types of meditation are the same: Mediators of change in mindfulness and compassion meditation interventions. J Affect Disord 2021; 283:354-362. [PMID: 33578349 DOI: 10.1016/j.jad.2021.01.070] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 12/31/2020] [Accepted: 01/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The general aim of the study was to examine the relative effectiveness and mediators of change in standardized mindfulness and compassion interventions. METHODS A sample of 431 participants enrolled in a Mindfulness-Based Stress Reduction program (MBSR = 277) and a Compassion Cultivation Training (CCT = 154). The assessment before and after the program included a set of outcomes and mediators measures. A three-step data analysis plan was followed: ANCOVAs, Reliable Change Index, and mediations (simple and multiple). RESULTS Both interventions yielded increased mindfulness, decentering, body awareness, and self-compassion. Yet, present-moment awareness improvements (i.e., decentering, and body awareness) were significantly larger in the MBSR than in CCT, whereas socio-emotional changes (i.e., common humanity and empathic concern) were larger in the CCT than in MBSR. The magnitude of effect sizes ranged from medium to large. Furthermore, both mindfulness and compassion interventions yielded similar changes in psychological distress (i.e., stress, anxiety, and depression), maladaptive cognitive processes (i.e., rumination and thought suppression), and well-being. The mediation models showed that although the MBSR program seemingly relies on changes in present-moment awareness mechanisms (i.e., decentering and body awareness) to reduce psychological distress and to improve well-being, the CCT program seemingly achieves the same positive outcomes through changes in socio-emotional mechanisms (i.e., common-humanity and empathy concern). LIMITATIONS Due to our naturalistic design in real-world community setting, it was infeasible to randomly assign participants to conditions. CONCLUSIONS Our results suggest that mindfulness and compassion programs operate through different pathways to reduce psychological distress and to promote well-being.
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Affiliation(s)
- Pablo Roca
- School of Psychology, Complutense University of Madrid, Spain.
| | - Carmelo Vazquez
- School of Psychology, Complutense University of Madrid, Spain
| | - Gustavo Diez
- Nirakara Lab, Complutense University of Madrid, Spain
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Wilmer MT, Anderson K, Reynolds M. Correlates of Quality of Life in Anxiety Disorders: Review of Recent Research. Curr Psychiatry Rep 2021; 23:77. [PMID: 34613508 PMCID: PMC8493947 DOI: 10.1007/s11920-021-01290-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW Anxiety disorders are highly prevalent conditions that have a detrimental impact on quality of life (QOL), particularly when left untreated. In the present review, we summarize recent literature, published within the last 3 years, on QOL in anxiety disorders, with a focus on factors that may play a role in the relationship between anxiety and QOL. RECENT FINDINGS We organize our findings into four categories: (1) subjective distress, (2) behavioral responses, (3) functional impairment, and (4) clinical factors. Results indicate that greater anxiety symptom severity is linked with poorer QOL, and cognitive behavioral therapies for anxiety yield positive effects on QOL. Additional transdiagnostic mechanisms are highlighted, including anxiety sensitivity, distress tolerance, emotion regulation, and avoidant coping. We examine the role of functional impairment, and we discuss factors related to treatment, including comorbidity and longitudinal effects. We also consider early research from the COVID-19 pandemic. Understanding the underlying factors that contribute to QOL detriments provides important insight into the impact of anxiety disorders and identifies targets for enhancing QOL through treatment.
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Affiliation(s)
- M. Taylor Wilmer
- Center for Anxiety and Behavioral Change, 1487 Chain Bridge Road, Suite #203, McLean, VA 22101 USA
| | - Kelley Anderson
- Center for Anxiety and Behavioral Change, 1487 Chain Bridge Road, Suite #203, McLean, VA 22101 USA
| | - Monique Reynolds
- Center for Anxiety and Behavioral Change, 1487 Chain Bridge Road, Suite #203, McLean, VA 22101 USA
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Koszycki D, Guérin E, DiMillo J, Bradwejn J. Randomized trial of cognitive behaviour group therapy and a mindfulness‐based intervention for social anxiety disorder: Preliminary findings. Clin Psychol Psychother 2020; 28:200-218. [DOI: 10.1002/cpp.2502] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 07/05/2020] [Accepted: 08/18/2020] [Indexed: 01/07/2023]
Affiliation(s)
- Diana Koszycki
- Faculty of Education (Counselling Psychology) University of Ottawa Ottawa Ontario Canada
- Faculty of Medicine (Psychiatry) University of Ottawa Ottawa Ontario
- Montfort Hospital Institut du Savoir Montfort Ottawa Ontario Canada
- University of Ottawa Brain and Mind Research Institute Ottawa Ontario Canada
| | - Eva Guérin
- Montfort Hospital Institut du Savoir Montfort Ottawa Ontario Canada
| | - Julia DiMillo
- Montfort Hospital Institut du Savoir Montfort Ottawa Ontario Canada
| | - Jacques Bradwejn
- Faculty of Medicine (Psychiatry) University of Ottawa Ottawa Ontario
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Integrating cognitive behavioral group therapy and psychodrama for social anxiety disorder: An intervention description and an uncontrolled pilot trial. CLINICAL PSYCHOLOGY IN EUROPE 2020; 2:e2693. [DOI: 10.32872/cpe.v2i1.2693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 11/16/2019] [Indexed: 01/04/2023] Open
Abstract
Background
Cognitive behavioral therapy (CBT) is generally considered to be the most effective psychological treatment for social anxiety disorder (SAD). Nevertheless, many patients with SAD are still symptomatic after treatment. The present pilot study aimed to examine integrating CBT, with a focus on cognitive and behavioral techniques, and psychodrama, which focuses more on experiential techniques into a combined treatment (CBPT) for social anxious patients in a group format. This new intervention for SAD is described session-by-session.
Method
Five adult female patients diagnosed with social anxiety disorder participated in a twelve-session CBPT in a group format. Pretest and posttest scores of social anxiety, avoidance, spontaneity, cost and probability estimates of negative social events, depression, and quality of life were compared, as were weekly assessments of fear of negative evaluation.
Results
Results demonstrated a significant reduction of the fear of negative evaluation and social anxiety symptoms. It is noteworthy that also the scores of the probability and cost estimates decreased. However, there were no significant differences between pre and post measures in any of other measures.
Conclusion
The current study suggests that group CBPT might be an effective treatment for SAD. However, our sample size was small and this was an uncontrolled study. Therefore, it is necessary to test this intervention in a randomized controlled trial with follow-up assessments.
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O’Toole MS, Renna ME, Mennin DS, Fresco DM. Changes in Decentering and Reappraisal Temporally Precede Symptom Reduction During Emotion Regulation Therapy for Generalized Anxiety Disorder With and Without Co-Occurring Depression. Behav Ther 2019; 50:1042-1052. [PMID: 31735240 PMCID: PMC7441462 DOI: 10.1016/j.beth.2018.12.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/21/2018] [Accepted: 12/22/2018] [Indexed: 12/18/2022]
Abstract
Emotion Regulation Therapy (ERT) has demonstrated efficacy in both open and randomized trials for generalized anxiety disorder (GAD) with and without co-occurring depression. An important goal in ERT is to teach clients adaptive emotion regulation, including healthier metacognitive abilities such as decentering and cognitive reappraisal. A few studies thus far have demonstrated a mediating role for these metacognitive abilities in other cognitive behavioral therapies (CBTs) for GAD. However, a drawback to most of these has been the ability to demonstrate a causal role for improved metacognitive abilities in outcome. In the present study, we utilized multilevel time-lagged segment analyses to explore the temporal dynamics between session-by-session changes in metacognition and anxiety outcomes from ERT. Thirty-one young adults diagnosed with GAD with and without co-occurring depression received 16 sessions of ERT. Prior to each session, participants completed questionnaires pertaining to metacognition (i.e., decentering and cognitive reappraisal) and anxiety symptoms (i.e., worry, trait anxiousness, and generalized anxiety). Changes in decentering temporally preceded changes in worry and trait anxiousness of a medium to large magnitude, and changes in cognitive reappraisal temporally preceded changes in all three outcomes of a medium to large magnitude. The reverse direction, where mediators were predicted by outcomes, was nonsignificant. These findings support the notion that adaptive metacognitive emotion regulation is involved in reducing worry and anxiety in GAD. Having a clearer understanding of the temporal dynamics between metacognitive abilities and symptoms of anxiety can inform and improve not only ERT but other CBTs for GAD, as well.
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Affiliation(s)
| | | | | | - David M. Fresco
- Kent State University & Case Western Reserve University School of Medicine
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Hayes-Skelton SA, Marando-Blanck S. Examining the Interrelation Among Change Processes: Decentering and Anticipatory Processing Across Cognitive Behavioral Therapy for Social Anxiety Disorder. Behav Ther 2019; 50:1075-1086. [PMID: 31735243 PMCID: PMC6866667 DOI: 10.1016/j.beth.2019.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 03/15/2019] [Accepted: 03/18/2019] [Indexed: 11/25/2022]
Abstract
As evidence grows supporting certain mechanisms of change in psychological treatments and we improve statistical approaches to measuring them, it is important that we also explore how mechanisms and processes are related to each other, and how they together affect treatment outcomes. To answer these questions about interrelating processes and mechanisms, we need to take advantage of frequent assessment and modeling techniques that allow for an examination of the influence of one mechanism on another over time. Within cognitive behavioral therapy, studies have shown support for both decentering, the ability to observe thoughts and feelings as objective events in the mind, and anticipatory processing, the repetitive thinking about upcoming social situations, as potentially related mechanisms of change. Therefore, the current study examined weekly ratings of decentering and a single-item anticipatory processing question to examine the interrelation among these change mechanisms in 59 individuals who received a 12-weeks of Cognitive Behavioral Group Therapy for social anxiety disorder. Overall, these results found that both anticipatory processing and decentering changed over the course therapy for clients. Change in both anticipatory processing and decentering was related to outcome. The bivariate latent difference score analysis showed that anticipatory processing was a leading indicator of change in decentering, but not the reverse, indicating that change in anticipatory processing is leading to change in decentering. It may be that with the focus on cognitive reappraisal in this treatment, that reducing anticipatory processing is freeing up the cognitive resources for decentering to occur.
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Katz DE, Cassin S, Weerasinghe R, Rector NA. Changes in post-event processing during cognitive behavioural therapy for social anxiety disorder: A longitudinal analysis using post-session measurement and experience sampling methodology. J Anxiety Disord 2019; 66:102107. [PMID: 31284123 DOI: 10.1016/j.janxdis.2019.102107] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/24/2019] [Accepted: 06/07/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Post-event processing (PEP) is posited to be an important factor in the maintenance of social anxiety symptoms. Previous research has demonstrated that general PEP tendencies are sensitive to treatment. However, it remains unclear how momentary PEP following social interactions changes over the course of treatment for social anxiety disorder. The purpose of the present study was to examine how both momentary and general PEP change over the course of treatment, and how such changes predict treatment outcome. METHOD Participants (N = 60) with social anxiety disorder were enrolled in group cognitive behavioural therapy. All participants completed measures of PEP and social anxiety symptom severity at five time points over treatment. A subset (N = 33) also completed repeated experience sampling measurements of PEP following social interactions across the course of treatment. RESULTS Both general and momentary PEP decreased over the course of treatment. Decreases in both types of PEP predicted lower social anxiety symptom severity following treatment. CONCLUSION The results of the study demonstrate that momentary experiences of PEP can be influenced by treatment, and can in turn impact treatment outcome. The findings have significant clinical and theoretical implications.
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Affiliation(s)
- Danielle E Katz
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Stephanie Cassin
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Rashmi Weerasinghe
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Neil A Rector
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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Hayes-Skelton SA, Lee CS. Decentering in Mindfulness and Cognitive Restructuring for Social Anxiety: An Experimental Study of a Potential Common Mechanism. Behav Modif 2019; 44:817-840. [PMID: 31129975 DOI: 10.1177/0145445519850744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The present study examined whether cognitive restructuring (CR) or mindfulness led to increases in decentering and whether changes in decentering were related to changes in anxiety and willingness to approach anxiety-provoking situations. Forty-six individuals with social anxiety completed speaking tasks before and after receiving CR, mindfulness, or control instructions. Overall, anxiety decreased and willingness increased from the first to second speech, with no differences across conditions. Decentering (measured by the Toronto Mindfulness Scale [TMS]) increased, with those in the mindfulness condition reporting more decentering. There was a nonsignificant, medium-sized effect on decentering, as measured by the Experiences Questionnaire (EQ)-Decentering factor, with those in CR reporting more decentering. Increases in decentering were associated with changes in self-reported anxiety and willingness. Findings indicate that mindfulness and CR led to changes in decentering, and that changes in decentering were related to changes in some, but not all, measures of anxiety.
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Fresco DM, Mennin DS. All together now: utilizing common functional change principles to unify cognitive behavioral and mindfulness-based therapies. Curr Opin Psychol 2018; 28:65-70. [PMID: 30502664 DOI: 10.1016/j.copsyc.2018.10.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 10/26/2018] [Indexed: 12/29/2022]
Abstract
Cognitive behavior therapy (CBT) and mindfulness-based interventions (MBI) have made important contributions to resolving the global burden of mental illness. However, response rates are comparatively more modest for the distress disorders. Newer CBTs enriched with MBI components have emerged with promising findings for distress disorders but with a high degree of heterogeneity and, subsequently, an unclear path for determining the unique and synergistic contributions from CBTs and MBIs. We propose that one way to elucidate and improve upon this union is to identify common overarching principles (i.e. attention change; metacognitive change) that guide both approaches and to refine therapeutic processes to optimally reflect these common targets and their interplay (e.g. sequencing and dosing).
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Affiliation(s)
- David M Fresco
- Kent State University, Case Western Reserve University, United States.
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