Mindfulness-Based Exposure Strategies as a Transdiagnostic Mechanism of Change: An Exploratory Alternating Treatment Design☆
Section snippets
Participants
Participants were recruited from a pool of individuals seeking treatment at the Center for Anxiety and Related Disorders (CARD) at Boston University (BU). The study was fully approved by the BU Institutional Review Board. Inclusion criteria included a principal diagnosis of social anxiety disorder (SOC), panic disorder with or without agoraphobia (PD/A), generalized anxiety disorder (GAD), or OCD, based on a clinician-administered assessment using the Anxiety Disorders Interview Schedule for
Strategy Adherence
Figure 2 provides visual displays of participants’ avoidance strategy use. Separate line graphs represent patterns of mean-level change for each condition, both in-session and during homework periods. Ideally, participants would provide higher scores during avoidance conditions, compared to low scores for mindfulness phases. Visual inspection suggested the majority did adhere to block instructions, particularly in session. Additionally, three participants (01, 03, and 06) showed greater
Discussion
A strong foundation in transdiagnostic theory is essential in order to develop novel treatment research, enhance treatment strategies, and effectively target underlying vulnerabilities among disorders. The UP is an extension of this bottom-up approach, designed to treat common neurotic tendencies in emotionally disordered individuals by extinguishing distress associated with strong negative emotions. By isolating two core UP modules, our study aimed to test the potential for mindfulness-based
Conclusion
Despite these limitations, we believe the present study provides important contributions toward understanding functional relationships between mindfulness and emotion exposure, as well as transdiagnostic treatment of emotional disorders and neuroticism. Future research should continue to explore instruction and dosage effects that may optimize mindfulness strategies. If a minimum dose of mindfulness practice does indeed facilitate beneficial exposure outcomes above and beyond avoidance
Conflict of Interest Statement
The authors declare that there are no conflicts of interest.
References (49)
- et al.
Anxiety sensitivity and interoceptive exposure: A transdiagnostic construct and change strategy
Behavior Therapy
(2013) - et al.
A preliminary investigation of the effects of the Unified Protocol on temperament
Comprehensive Psychiatry
(2014) - et al.
Mindfulness: Top-down or bottom-up emotion regulation strategy?
Clinical Psychology Review
(2013) - et al.
Maximizing exposure therapy: An inhibitory learning approach
Behaviour Research and Therapy
(2014) - et al.
Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment
Behaviour Research and Therapy
(2003) - et al.
Unified protocol for transdiagnostic treatment of emotional disorders: A randomized controlled trial
Behavior Therapy
(2012) Mindfulness, Big Five personality, and affect: A meta-analysis
Personality and Individual Differences
(2009)- et al.
Psychometrics of a brief measure of anxiety to detect severity and impairment: The Overall Anxiety Severity and Impairment Scale (OASIS)
Journal of Psychiatric Research
(2011) - et al.
The association between meditation practice and treatment outcome in mindfulness-based cognitive therapy for bipolar disorder
Behaviour Research and Therapy
(2013) - et al.
Mindfulness and emotion regulation difficulties in generalized anxiety disorder: Preliminary evidence for independent and overlapping contributions
Behavior Therapy
(2009)
An experimental investigation of the role of safety-seeking behaviours in the maintenance of panic disorder with agoraphobia
Behaviour Research and Therapy
Belief disconfirmation versus habituation approaches to situational exposure in panic disorder with agoraphobia: A pilot study
Behaviour Research and Therapy
Diagnostic and statistical manual of mental disorders
Mindfulness training as a clinical intervention: A conceptual and empirical review
Clinical Psychology: Science and Practice
Weekly change in mindfulness and perceived stress in a mindfulness-based stress reduction program
Journal of Clinical Psychology
Assessment of mindfulness by self-report: The Kentucky Inventory of Mindfulness Skills
Assessment
Using self-report assessment methods to explore facets of mindfulness
Assessment
Unraveling the mysteries of anxiety and its disorders from the perspective of emotion theory
American Psychologist
Anxiety and its disorders: The nature and treatment of anxiety and panic
Psychological treatments for panic disorders, phobias, and generalized anxiety disorder
Unified protocol for transdiagnostic treatment of emotional disorders: Client workbook
Unified protocol for transdiagnostic treatment of emotional disorders: Therapist guide
Alternating treatments design: One strategy for comparing the effects of two treatments in a single subject
Journal of Applied Behavior Analysis
Single case experimental designs: Strategies for studying behavior change
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2019, Current Opinion in PsychologyCitation Excerpt :Expert meditators with mental health issues are typically excluded from research, resulting in a selective representation of the effects from long-term practice [52]. While a few studies have shown worse average outcomes (increased negative effects) for mindfulness training compared to control conditions [6•,7•,40,51], the use of means and effect sizes typically obscures individual differences and extreme scores [60]. Recommendations for improved detection of negative effects include visual inspection of data, qualitative descriptions or detailed case studies of outliers, including reasons for attrition or noncompliance, and displaying outcome data in quartiles [54,60].
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2019, Behavior TherapyCitation Excerpt :Given the impact of mindfulness on DT shown in the present study, mindfulness training may positively impact exposure therapy by helping individuals engage in more effective exposures. This idea is also supported by research showing mindfulness-based strategies during exposure are associated with declining distress levels (Brake et al., 2016), and that changes in mindful nonreactivity mediate the effect of exposure therapy on health anxiety (Hedman, Hesser, Andersson, Axelsson, & Ljótsson, 2017). Beyond these two studies, however, there is little research directly examining how mindfulness may impact exposure (Treanor, 2011).
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2019, Current Opinion in PsychologyCitation Excerpt :The dynamic nature of the insecure cycle is also evident in research that differentiates between state and trait views of attachment insecurity. Intervention studies suggest that temporary changes in IWM's can be facilitated by experimental interventions that target defensive strategies [32], interpretation biases [33] or expectancies for caregiver availability [34]. Priming studies illustrate the promise of interventions that target automatic expectancies and interpretative biases rather than defensive strategies [7,33].
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2018, Behavior TherapyCitation Excerpt :However, as Herwig et al. did not induce negative emotions, the study does not allow for conclusions about the temporal mode of action with respect to mindfulness and negative emotions. In patients with anxiety disorders, Brake et al. (2016) found immediate positive effects of mindfulness (with a focus on different objects) on distress in response to anxiety-related stimuli. The difference between this outcome and our results might be explained by the different study samples.
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This research was supported by a National Institute of Mental Health (NIMH) grant awarded to Dr. David H. Barlow (R01MH090053–S1) as part of the National Institutes of Health (NIH) Science of Behavior Change Initiative. The content reported here is solely the responsibility of the authors and does not necessarily represent the official views of the NIMH or the NIH.