Elsevier

Behavior Therapy

Volume 47, Issue 2, March 2016, Pages 225-238
Behavior Therapy

Mindfulness-Based Exposure Strategies as a Transdiagnostic Mechanism of Change: An Exploratory Alternating Treatment Design

https://doi.org/10.1016/j.beth.2015.10.008Get rights and content

Highlights

  • We explore whether transdiagnostic distress reduction is facilitated by mindfulness.

  • We compare intrasubject mindful versus avoidance strategies during exposures.

  • Mindful strategies are associated with higher yet declining distress levels.

  • Mindful strategies may be effectively applied in treatment of emotional disorders.

  • Results suggest mindfulness practice and duration may be relevant for maximal effect.

Abstract

The present study explored whether distress reduction in response to strong negative emotions, a putative transdiagnostic mechanism of action, is facilitated by mindfulness strategies. Seven patients (mean age = 31.14 years, SD = 12.28, range 19–48 years, 43% female, 86% Caucasian) with heterogeneous anxiety disorders (i.e., panic disorder with or without agoraphobia, social anxiety, generalized anxiety) were assigned a randomized order of weeklong blocks utilizing either mindfulness- or avoidance-based strategies while ascending a 6-week emotion exposure hierarchy. Participants completed three exposures per block and provided distress and avoidance use ratings following each exposure. Anxiety severity, distress aversion, and distraction/suppression tendencies were also assessed at baseline and the conclusion of each block. Visual, descriptive, and effect size results showing exposures utilizing mindfulness were associated with higher overall distress levels, compared with those utilizing avoidance. Within blocks, the majority of participants exhibited declining distress levels when employing mindfulness strategies, as opposed to more static distress levels in the avoidance condition. Systematic changes in anxiety severity, distress aversion, and distraction/suppression were not observed. These results suggest mindfulness strategies may be effective in facilitating emotion exposure; however, a minimum dosage may be necessary to overcome initial distress elevation. Potential transdiagnostic change mechanisms and clinical implications are discussed.

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.

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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.

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