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Gepubliceerd in: Cognitive Therapy and Research 2/2018

10-11-2017 | Original Article

Increased Attention Regulation from Emotion Regulation Therapy for Generalized Anxiety Disorder

Auteurs: Megan E. Renna, Saren H. Seeley, Richard G. Heimberg, Amit Etkin, David M. Fresco, Douglas S. Mennin

Gepubliceerd in: Cognitive Therapy and Research | Uitgave 2/2018

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Abstract

Dysfunction in the ability to sustain, shift and broaden attention has been proposed as a mechanism of normative emotion regulation that is a common target of cognitive-behavioral therapies. Attention regulation deficits are central to generalized anxiety disorder (GAD) and may contribute to a generally rigid, avoidant, response style that produces substantial decrements in well-being and functioning. Emotion Regulation Therapy draws upon mindfulness-based regulatory skills to facilitate attentional change during an initial phase of treatment. Two studies examined task-based changes in flexibly shifting attention in response to conflicting emotional contexts and sustaining attention despite distressing emotional contexts. In Study 1, at pre-treatment, patients with GAD, as compared to controls performed significantly more poorly on an emotional conflict adaptation task (i.e., less ability to flexibly shift attention) and improved in conflict adaptation by mid-treatment (when attention regulation skills were being trained). This task-related change predicted increases in mindful observing abilities over the course of acute treatment but was not directly associated with clinical outcomes. In Study 2, a choice reaction time (RT) task was utilized to measure the ability to sustain attention by discriminating between two tones while overcoming the interference of aversive visual stimuli. At pre-treatment, participants with GAD demonstrated slower RTs (i.e., more difficulty sustaining attention on the tonal prompt) compared to controls and demonstrated more rapid RTs from pre- to mid-treatment. This improved task performance was related to clinical improvement and decreased functional impairment. RT change was also associated with greater nonreactivity towards experiences. Overall, these findings suggest that targeting mindful regulation skills improve attention regulation in individuals with GAD and may partially account for efficacious clinical outcomes throughout treatment.

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Voetnoten
1
Independent sample t tests indicated that clinic site did not impact any study analyses.
 
2
Independent sample t tests indicated that clinic site did not impact any of the current study analyses.
 
3
Negative images utilized were IAPS numbers 2730, 3030, 3100, 3500, 5972, 6230, 6260, 6300, 6350, 6570.1, 6830, 9050, 9250, and 9921 (Mvalence = 2.41, SDvalence = 1.62; Marousal = 6.67, SDarousal = 2.06; Mdominance = 3.20, SDdominance = 2.20). Neutral IAPS images included numbers 2190, 2200, 2210, 2215, 2221, 2270, 2831, 2383, 2440, 2480, 2495, 2722, 2840, 2850, 2870, 2880, 2890, 5030, 5120, 5130, 5390, 5500, 5800, and 7002 (Mvalence = 5.02, SDvalence = 1.38; Marousal = 2.98, SDarousal = 1.96; Mdominance = 5.87, SDdominance = 2.05).
 
4
We conducted an exploratory post-hoc test of dependent correlations from Study 1 to examine if flexibly shifting attention is more strongly correlated with observing or non-reactivity. Results revealed no significant difference between the relationship of FFMQ Observing and FFMQ Non-Reactivity to conflict adaptation (Z = 1.43, p = .15, Hedge’s g = .73; Steiger 1980) but a large effect size, potentially due to the small sample size. Interestingly, an additional exploratory test of dependent correlations from Study 2 revealed that FFMQ Non-Reactivity was more strongly correlated than FFMQ Observing with sustaining attention (Z = 2.13, p = .03, Hedge’s g = 1.10) for negative images. For neutral images, a similar pattern emerged but the test of dependent correlations just missed significance (Z = 1.74, p = .08, Hedge’s g = .90), but demonstrated a large effect size as well. This pattern of findings may indicate that mindful non-reactivity may contribute to one’s ability to sustain attention regardless of emotional context.
 
Literatuur
go back to reference American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th edn, text revision). Washington DC: American Psychiatric Association. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th edn, text revision). Washington DC: American Psychiatric Association.
go back to reference American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th edn). Washington DC: American Psychiatric Association. CrossRef American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th edn). Washington DC: American Psychiatric Association. CrossRef
go back to reference Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., …. Williams, J. M. G. (2008). Construct validity of the Five Facet Mindfulness Questionnaire in meditating and nonmeditating samples. Assessment, 15, 329–342. doi: 10.​1177/​1073191107313003​. CrossRefPubMed Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., …. Williams, J. M. G. (2008). Construct validity of the Five Facet Mindfulness Questionnaire in meditating and nonmeditating samples. Assessment, 15, 329–342. doi: 10.​1177/​1073191107313003​. CrossRefPubMed
go back to reference Bargh, J. A., & Williams, L. E. (2007). The nonconscious regulation of emotion. In J. J. Gross (Ed.), Handbook of emotion regulation (pp. 429–455). New York: Guilford Press. Bargh, J. A., & Williams, L. E. (2007). The nonconscious regulation of emotion. In J. J. Gross (Ed.), Handbook of emotion regulation (pp. 429–455). New York: Guilford Press.
go back to reference Borkovec, T. D., Alcaine, O., & Behar, E. (2004). Avoidance theory of worry and generalized anxiety disorder. In R. Heimberg, D. Mennin, C. Turk Generalized anxiety disorder: Advances in research and practice. New York: Guilford Borkovec, T. D., Alcaine, O., & Behar, E. (2004). Avoidance theory of worry and generalized anxiety disorder. In R. Heimberg, D. Mennin, C. Turk Generalized anxiety disorder: Advances in research and practice. New York: Guilford
go back to reference Borkovec, T. D., & Ruscio, A. M. (2001). Psychotherapy for generalized anxiety disorder. The Journal of Clinical Psychiatry, 62, 37–42. PubMed Borkovec, T. D., & Ruscio, A. M. (2001). Psychotherapy for generalized anxiety disorder. The Journal of Clinical Psychiatry, 62, 37–42. PubMed
go back to reference Buodo, G., Sarlo, M., & Palomba, D. (2002). Attentional resources measured by reaction times highlight differences within pleasant and unpleasant, high arousing stimuli. Motivation and Emotion, 26, 123–138. doi: 10.​1023/​A:​1019886501965. CrossRef Buodo, G., Sarlo, M., & Palomba, D. (2002). Attentional resources measured by reaction times highlight differences within pleasant and unpleasant, high arousing stimuli. Motivation and Emotion, 26, 123–138. doi: 10.​1023/​A:​1019886501965. CrossRef
go back to reference Chambers, R., Lo, B. C. Y., & Allen, N. B. (2008). The impact of intensive mindfulness training on attentional control, cognitive style, and affect. Cognitive Therapy and Research, 32, 303–322. doi: 10.​1007/​s10608-007-9119-0. CrossRef Chambers, R., Lo, B. C. Y., & Allen, N. B. (2008). The impact of intensive mindfulness training on attentional control, cognitive style, and affect. Cognitive Therapy and Research, 32, 303–322. doi: 10.​1007/​s10608-007-9119-0. CrossRef
go back to reference Craigie, M. A., Rees, C. S., Marsh, A., & Nathan, P. (2008). Mindfulness-based cognitive therapy for generalized anxiety disorder: A preliminary evaluation. Behavioural and Cognitive Psychotherapy, 36(5), 553–568. doi: 10.​1017/​S135246580800458​X. CrossRef Craigie, M. A., Rees, C. S., Marsh, A., & Nathan, P. (2008). Mindfulness-based cognitive therapy for generalized anxiety disorder: A preliminary evaluation. Behavioural and Cognitive Psychotherapy, 36(5), 553–568. doi: 10.​1017/​S135246580800458​X. CrossRef
go back to reference Di Nardo, P. A., Brown, T. A., & Barlow, D. H. (1994). Anxiety disorders interview schedule for DSM-IV: Lifetime version (ADIS-IV-L). New York: Oxford University Press. Di Nardo, P. A., Brown, T. A., & Barlow, D. H. (1994). Anxiety disorders interview schedule for DSM-IV: Lifetime version (ADIS-IV-L). New York: Oxford University Press.
go back to reference Ekman, P., & Friesen, W. V. (1975). Pictures of facial affect. Palo Alto, CA: Consulting Psychologists. Ekman, P., & Friesen, W. V. (1975). Pictures of facial affect. Palo Alto, CA: Consulting Psychologists.
go back to reference First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2002). Structured clinical interview for DSM-IV-TR axis I disorders, research version, patient edition with psychotic screen. New York: Biometrics Research, New York State Psychiatric Institute. First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2002). Structured clinical interview for DSM-IV-TR axis I disorders, research version, patient edition with psychotic screen. New York: Biometrics Research, New York State Psychiatric Institute.
go back to reference Frisch, M. B., Cornell, J., Villanueva, M., & Retzlaff, P. J. (1992). Clinical validation of the quality of life inventory: A measure of life satisfaction for use in treatment planning and outcome assessment. Psychological Assessment, 4, 92–101. doi: 10.​1037/​1040-3590. CrossRef Frisch, M. B., Cornell, J., Villanueva, M., & Retzlaff, P. J. (1992). Clinical validation of the quality of life inventory: A measure of life satisfaction for use in treatment planning and outcome assessment. Psychological Assessment, 4, 92–101. doi: 10.​1037/​1040-3590. CrossRef
go back to reference Hayes-Skelton, S. A., Roemer, L., & Orsillo, S. M. (2013). A randomized clinical trial comparing an acceptance-based behavior therapy to applied relaxation for generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 81(5), 761. doi: 10.​1037/​a0032871. CrossRefPubMedPubMedCentral Hayes-Skelton, S. A., Roemer, L., & Orsillo, S. M. (2013). A randomized clinical trial comparing an acceptance-based behavior therapy to applied relaxation for generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 81(5), 761. doi: 10.​1037/​a0032871. CrossRefPubMedPubMedCentral
go back to reference Hoge, E. A., Bui, E., Goetter, E., Robinaugh, D. J., Ojserkis, R. A., Fresco, D. M., & Simon, N. M. (2014). Change in decentering mediates improvement in anxiety in mindfulness-based stress reduction for generalized anxiety disorder. Cognitive Therapy and Research, 39(2), 228–235. doi: 10.​1007/​s10608-014-9646-4. CrossRefPubMedPubMedCentral Hoge, E. A., Bui, E., Goetter, E., Robinaugh, D. J., Ojserkis, R. A., Fresco, D. M., & Simon, N. M. (2014). Change in decentering mediates improvement in anxiety in mindfulness-based stress reduction for generalized anxiety disorder. Cognitive Therapy and Research, 39(2), 228–235. doi: 10.​1007/​s10608-014-9646-4. CrossRefPubMedPubMedCentral
go back to reference Hölzel, B. K., Hoge, E. A., Greve, D. N., Gard, T., Creswell, J. D., Brown, K. W., … & Lazar, S. W. (2013). Neural mechanisms of symptom improvements in generalized anxiety disorder following mindfulness training. NeuroImage: Clinical, 2, 448–458. doi: 10.​1016/​j.​nicl.​2013.​03.​011. CrossRef Hölzel, B. K., Hoge, E. A., Greve, D. N., Gard, T., Creswell, J. D., Brown, K. W., … & Lazar, S. W. (2013). Neural mechanisms of symptom improvements in generalized anxiety disorder following mindfulness training. NeuroImage: Clinical, 2, 448–458. doi: 10.​1016/​j.​nicl.​2013.​03.​011. CrossRef
go back to reference Hölzel, B. K., Lazar, S. W., Gard, T., Schuman-Olivier, Z., Vago, D. R., & Ott, U. (2011). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science, 6(6), 537–559. doi: 10.​1177/​1745691611419671​. CrossRefPubMed Hölzel, B. K., Lazar, S. W., Gard, T., Schuman-Olivier, Z., Vago, D. R., & Ott, U. (2011). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science, 6(6), 537–559. doi: 10.​1177/​1745691611419671​. CrossRefPubMed
go back to reference Lang, P. J., Bradley, M. M., & Cuthbert, B. N. (2008). International affective picture system (IAPS): Affective ratings of pictures and instruction manual. Technical Report A-8. University of Florida, Gainesville, FL. Lang, P. J., Bradley, M. M., & Cuthbert, B. N. (2008). International affective picture system (IAPS): Affective ratings of pictures and instruction manual. Technical Report A-8. University of Florida, Gainesville, FL.
go back to reference Mennin, D. S., & Fresco, D. M. (2013). Emotion regulation 1309 therapy. In J. J. Gross (Ed.), Handbook of emotion regulation 1310 (2nd ed., pp. 469–490). New York, NY: Guilford Press. Mennin, D. S., & Fresco, D. M. (2013). Emotion regulation 1309 therapy. In J. J. Gross (Ed.), Handbook of emotion regulation 1310 (2nd ed., pp. 469–490). New York, NY: Guilford Press.
go back to reference Miller, J. E., Carlson, L. A., & McAuley, J. D. (2013). When what you hear influences when you see: Listening to an auditory rhythm influences the temporal allocation of visual attention. Psychological Science, 24, 11–18. doi: 10.​1177/​0956797612446707​. CrossRefPubMed Miller, J. E., Carlson, L. A., & McAuley, J. D. (2013). When what you hear influences when you see: Listening to an auditory rhythm influences the temporal allocation of visual attention. Psychological Science, 24, 11–18. doi: 10.​1177/​0956797612446707​. CrossRefPubMed
go back to reference Posner, M. I., & Rothbart, M. K. (1992). Attentional regulation-from mechanism to culture. International Journal of Psychology, 27(3). Posner, M. I., & Rothbart, M. K. (1992). Attentional regulation-from mechanism to culture. International Journal of Psychology, 27(3).
go back to reference Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York: Guilford Press. Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York: Guilford Press.
go back to reference Sheehan, D. V. (1983). The Anxiety Disease. New York: Charles Scribner’s Sons. Sheehan, D. V. (1983). The Anxiety Disease. New York: Charles Scribner’s Sons.
go back to reference Steiger, J. H. (1980). Tests for comparing elements of a correlation matrix. Psychological Bulletin, 87, 245–251. CrossRef Steiger, J. H. (1980). Tests for comparing elements of a correlation matrix. Psychological Bulletin, 87, 245–251. CrossRef
go back to reference Stroop, J. R. (1935). Studies of interference in serial verbal reactions. Journal of Experimental Psychology, 18(6), 643. CrossRef Stroop, J. R. (1935). Studies of interference in serial verbal reactions. Journal of Experimental Psychology, 18(6), 643. CrossRef
go back to reference Thorpe, S., Fize, D., & Marlot, C. (1996). Speed of processing in the human visual system. Nature, 381, 520–522. CrossRefPubMed Thorpe, S., Fize, D., & Marlot, C. (1996). Speed of processing in the human visual system. Nature, 381, 520–522. CrossRefPubMed
go back to reference Watson, D., & Clark, L. A. (1991). The mood and anxiety symptom questionnaire. Iowa City, IA: University of Iowa. Watson, D., & Clark, L. A. (1991). The mood and anxiety symptom questionnaire. Iowa City, IA: University of Iowa.
go back to reference Wells, A., Welford, M., King, P., Papageorgiou, C., Wisely, J., & Mendel, E. (2010). A pilot randomized trial of metacognitive therapy vs applied relaxation in the treatment of adults with generalized anxiety disorder. Behaviour Research and Therapy, 48(5), 429–434. doi: 10.​1016/​j.​brat.​2009.​11.​013. CrossRefPubMed Wells, A., Welford, M., King, P., Papageorgiou, C., Wisely, J., & Mendel, E. (2010). A pilot randomized trial of metacognitive therapy vs applied relaxation in the treatment of adults with generalized anxiety disorder. Behaviour Research and Therapy, 48(5), 429–434. doi: 10.​1016/​j.​brat.​2009.​11.​013. CrossRefPubMed
Metagegevens
Titel
Increased Attention Regulation from Emotion Regulation Therapy for Generalized Anxiety Disorder
Auteurs
Megan E. Renna
Saren H. Seeley
Richard G. Heimberg
Amit Etkin
David M. Fresco
Douglas S. Mennin
Publicatiedatum
10-11-2017
Uitgeverij
Springer US
Gepubliceerd in
Cognitive Therapy and Research / Uitgave 2/2018
Print ISSN: 0147-5916
Elektronisch ISSN: 1573-2819
DOI
https://doi.org/10.1007/s10608-017-9872-7