Top

Gepubliceerd in:

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

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.

vorige artikel Introduction to the Special Issue on Processes of Cognitive Behavioral Therapy: Does “Necessary, But Not Sufficient” Still Capture It?

volgende artikel Expectancies, Working Alliance, and Outcome in Transdiagnostic and Single Diagnosis Treatment for Anxiety Disorders: An Investigation of Mediation

Independent sample t tests indicated that clinic site did not impact any study analyses.

Independent sample t tests indicated that clinic site did not impact any of the current study analyses.

Negative images utilized were IAPS numbers 2730, 3030, 3100, 3500, 5972, 6230, 6260, 6300, 6350, 6570.1, 6830, 9050, 9250, and 9921 (M_valence = 2.41, SD_valence = 1.62; M_arousal = 6.67, SD_arousal = 2.06; M_dominance = 3.20, SD_dominance = 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 (M_valence = 5.02, SD_valence = 1.38; M_arousal = 2.98, SD_arousal = 1.96; M_dominance = 5.87, SD_dominance = 2.05).

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.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th edn, text revision). Washington DC: American Psychiatric Association.

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th edn). Washington DC: American Psychiatric Association.CrossRef

Amir, N., Beard, C., Burns, M., & Bomyea, J. (2009). Attention modification program in individuals with generalized anxiety disorder. Journal of Abnormal Psychology, 118(1), 28.doi:10.1037/a0012589.CrossRefPubMedPubMedCentral

Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13, 27–45. doi:10.1177/1073191105283504.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

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.

Bar-Haim, Y. (2010). Research review: Attention bias modification (ABM): A novel treatment for anxiety disorders. Journal of Child Psychology and Psychiatry, 51(8), 859–870. doi:10.1111/j.1469-7610.2010.02251.x.CrossRefPubMed

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., & Ruscio, A. M. (2001). Psychotherapy for generalized anxiety disorder. The Journal of Clinical Psychiatry, 62, 37–42.PubMed

Braver, T. S. (2012). The variable nature of cognitive control: A dual mechanisms framework. Trends in Cognitive Sciences, 16(2), 106–113. doi:10.1016/j.tics.2011.12.010.CrossRefPubMedPubMedCentral

Britton, J. C., Taylor, S. F., Sudheimer, K. D., & Liberzon, I. (2006). Facial expressions and complex IAPS pictures: Common and differential networks. NeuroImage, 31(2), 906–919. doi:10.1016/j.neuroimage.2005.12.050.CrossRefPubMed

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

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

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/S135246580800458X.CrossRef

Derakshan, N., & Eysenck, M. W. (2009). Anxiety, processing efficiency, and cognitive performance: New developments from attentional control theory. European Psychologist, 14(2), 168–176. doi:10.1027/1016-9040.14.2.168.CrossRef

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.

Egner, T. (2007). Congruency sequence effects and cognitive control. Cognitive, Affective, & Behavioral Neuroscience, 7(4), 380–390. doi:10.3758/CABN.7.4.380.CrossRef

Ehring, T., & Watkins, E. R. (2008). Repetitive negative thinking as a transdiagnostic process. International Journal of Cognitive Therapy, 1(3), 192–205. doi:10.1521/ijct.2008.1.3.192.CrossRef

Ekman, P., & Friesen, W. V. (1975). Pictures of facial affect. Palo Alto, CA: Consulting Psychologists.

Etkin, A., Egner, T., Peraza, D. M., Kandel, E. R., & Hirsch, J. (2006). Resolving emotional conflict: A role for the rostral anterior cingulate cortex in modulating activity in the amygdala. Neuron, 51(6), 871–882. doi:10.1016/j.neuron.2006.07.029.CrossRefPubMed

Etkin, A., Prater, K. E., Hoeft, F., Menon, V., & Schatzberg, A. F. (2010). Failure of anterior cingulate activation and connectivity with the amygdala during implicit regulation of emotional processing in generalized anxiety disorder. American Journal of Psychiatry, 167(5), 545–554. doi:10.1176/appi.ajp.2009.09070931.CrossRefPubMedPubMedCentral

Etkin, A., & Schatzberg, A. F. (2011). Common abnormalities and disorder-specific compensation during implicit regulation of emotional processing in generalized anxiety and major depressive disorders. American Journal of Psychiatry, 168(9), 968–978. doi:10.1176/appi.ajp.2011.10091290.CrossRefPubMed

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.

Fresco, D. M., Mennin, D. S., Heimberg, R. G., & Ritter, M. (2013). Emotion regulation therapy for generalized anxiety disorder. Cognitive and Behavioral Practice, 20(3), 282–300. doi:10.1016/j.cbpra.2013.02.001.CrossRefPubMedPubMedCentral

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

Gross, J. J. (1998). Antecedent- and response-focused emotion regulation: Divergent consequences for experience, expression, and physiology. Journal of Personality and Social Psychology, 74, 224–237. doi:10.1037/0022-3514.74.1.224.CrossRefPubMed

Hambrick, J. P., Turk, C. L., Heimberg, R. G., Schneier, F. R., & Liebowitz, M. R. (2004). Psychometric properties of disability measures among patients with social anxiety disorder. Journal of Anxiety Disorders, 18(6), 825–839. doi:10.1016/j.janxdis.2003.10.004.CrossRefPubMed

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

Hirsch, C. R., MacLeod, C., Mathews, A., Sandher, O., Siyani, A., & Hayes, S. (2011). The contribution of attentional bias to worry: Distinguishing the roles of selective engagement and disengagement. Journal of Anxiety Disorders, 25(2), 272–277. doi:10.1016/j.janxdis.2010.09.013.CrossRefPubMedPubMedCentral

Hofmann, S. G., Sawyer, A. T., Fang, A., & Asnaani, A. (2012). Emotion dysregulation model of mood and anxiety disorders. Depression and Anxiety, 29(5), 409–416. doi:10.1002/da.21888.CrossRefPubMed

Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. Journal of Consulting and Clinical Psychology, 78, 169–183. doi:10.1037/a0018555.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

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., 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

Insel, T., Cuthbert, B., Garvey, M., Heinssen, R., Pine, D. S., Quinn, K., … Wang, P. (2010). Research domain criteria (RDoC): Toward a new classification framework for research on mental disorders. American Journal of Psychiatry, 167(7), 748–751. doi:10.1176/appi.ajp.2010.09091379.CrossRefPubMed

Koole, S. L. (2009). The psychology of emotion regulation: An integrative review. Cognition and Emotion, 23, 4–41. doi:10.1080/02699930802619031.CrossRef

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.

Lee, Y., & Chao, H. (2012). The role of active inhibitory control in psychological well-being a mindfulness. Personality and Individual Differences, 53, 618–621. doi:10.1016/j.paid.2012.05.001.CrossRef

Maier, M. E., & Di Pellegrino, G. (2012). Impaired conflict adaptation in an emotional task context following rostral anterior cingulate cortex lesions in humans. Journal of Cognitive Neuroscience, 24(10), 2070–2079. doi:10.1162/jocn_a_00266.CrossRefPubMed

Matthews, A., & MacLeod, C. (2005). Cognitive vulnerability to emotional disorders. Annual Review of Clinical Psychology, 1, 167–195. doi:10.1146/annurev.clinpsy.1.102803.143916.CrossRef

Mauss, I. B., Bunge, S. A., & Gross, J. J. (2007). Automatic emotion regulation. Social and Personality Psychology Compass, 1, 146–167. doi:10.1111/j.1751-9004.2007.CrossRef

Mennin, D. S., Ellard, K. K., Fresco, D. M., & Gross, J. J. (2013). United we stand: Emphasizing commonalities across cognitive-behavioral therapies. Behavior Therapy, 44(2), 234–248. doi:10.1016/j.beth.2013.02.004.CrossRefPubMedPubMedCentral

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., Ritter, M., & Heimberg, R. G. (2015). An open trial of emotion regulation therapy for generalized anxiety disorder with and without comorbid major depression. Depression and Anxiety, 32(8), 614–623. doi:10.1002/da.22377.CrossRefPubMedPubMedCentral

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

Mogg, K., & Bradley, B. P. (2005). Attentional bias in generalized anxiety disorder versus depressive disorder. Cognitive Therapy and Research, 29(1), 29–45. doi:10.1007/s10608-005-1646-7.CrossRef

Mogg, K., Waters, A. M., & Bradley, B. P. (2017). Attention bias modification (ABM): Review of effects of multisession ABM training on anxiety and threat-related attention in high-anxious individuals. Clinical Psychological Science, 5(4), 698–717. doi:10.1177/2167702617696359.CrossRefPubMedPubMedCentral

Moore, A., & Malinowski, P. (2009). Meditation, mindfulness, and cognitive flexibility. Consciousness and Cognition, 18, 176–186. doi:10.1016/j.concog.2008.12.008.CrossRefPubMed

Moore, A. W., Gruber, T., Derose, J., & Malinowski, P. (2012). Regular, brief mindfulness meditation practice improves electrophysiological markers of attentional control. Frontiers in Human Neuroscience, 6, 18. doi:10.3389/fnhum.2012.00018.CrossRefPubMedPubMedCentral

Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking rumination. Perspectives on Psychological Science, 3(5), 400–424. doi:10.1111/j.1745-6924.2008.00088.x.CrossRefPubMed

Ortner, C. N., Kilner, S. J., & Zelazo, P. D. (2007). Mindfulness meditation and reduced emotional interference on a cognitive task. Motivation and Emotion, 31, 271–283. doi:10.1007/s11031-007-9076-7.CrossRef

Posner, M. I., & Rothbart, M. K. (1992). Attentional regulation-from mechanism to culture. International Journal of Psychology, 27(3).

Renna, M. E., Quintero, J. M., Fresco, D. M., & Mennin, D. S. (2017). Emotion regulation therapy: A mechanism-targeted treatment for disorders of distress. Frontiers in Psychology. doi:10.3389/fpsyg.2017.00098.PubMedPubMedCentral

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.

Sheehan, D. V. (1983). The Anxiety Disease. New York: Charles Scribner’s Sons.

Stefanopoulou, E., Hirsch, C. R., Hayes, S., Adlam, A., & Coker, S. (2014). Are attentional control resources reduced by worry in generalized anxiety disorder? Journal of Abnormal Psychology, 123(2), 330. doi:10.1037/a0036343.CrossRefPubMedPubMedCentral

Steiger, J. H. (1980). Tests for comparing elements of a correlation matrix. Psychological Bulletin, 87, 245–251.CrossRef

Stroop, J. R. (1935). Studies of interference in serial verbal reactions. Journal of Experimental Psychology, 18(6), 643.CrossRef

Szymura, B., Śmigasiewicz, K., & Corr, P. (2007). Psychoticism and attentional flexibility. Personality and Individual Differences, 43(8), 2033–2046. doi:10.1016/j.paid.2007.06.023.CrossRef

Tang, Y. Y., Hölzel, B. K., & Posner, M. I. (2015). The neuroscience of mindfulness meditation. Nature Reviews Neuroscience, 16(4), 213–225. doi:10.1038/nrn3916.CrossRefPubMed

Thorpe, S., Fize, D., & Marlot, C. (1996). Speed of processing in the human visual system. Nature, 381, 520–522.CrossRefPubMed

Wadlinger, H. A., & Isaacowitz, D. M. (2011). Fixing our focus: Training attention to regulate emotion. Personality and Social Psychology Review, 15, 75–102. doi:10.1177/1088868310365565.CrossRefPubMed

Watson, D., & Clark, L. A. (1991). The mood and anxiety symptom questionnaire. Iowa City, IA: University of Iowa.

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

Williams, M. O., Mathews, A., & Hirsch, C. R. (2014). Verbal worry facilitates attention to threat in high-worriers. Journal of Behavior Therapy and Experimental Psychiatry, 45(1), 8–14. doi:10.1016/j.jbtep.2013.05.006.CrossRefPubMedPubMedCentral

Witkiewitz, K., Marlatt, G. A., & Walker, D. (2005). Mindfulness-based relapse prevention for alcohol and substance use disorders. Journal of Cognitive Psychotherapy: An International Quarterly, 19, 211–228. doi:10.1891/jcop.2005.19.3.211.CrossRef

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

Bohn Stafleu van Loghum

Deel dit onderdeel of sectie (kopieer de link)

Abstract

Log in om toegang te krijgen

Andere artikelen Uitgave 2/2018

Reports of Therapy Skill Use and Their Efficacy in Daily Life in the Short-Term Treatment of Depression

Introduction to the Special Issue on Processes of Cognitive Behavioral Therapy: Does “Necessary, But Not Sufficient” Still Capture It?

Methods of Delivering Progress Feedback to Optimise Patient Outcomes: The Value of Expected Treatment Trajectories

Not Just a Non-specific Factor: Moderators of the Effect of Within- and Between-Clients Alliance on Outcome in CBT

When is it Effective to Focus on the Alliance? Analysis of a Within-Client Moderator

Process Factors Associated with Improved Outcomes in CBT for Anxious Youth: Therapeutic Content, Alliance, and Therapist Actions