Changes in Decentering and Reappraisal Temporally Precede Symptom Reduction During Emotion Regulation Therapy for Generalized Anxiety Disorder With and Without Co-Occurring Depression☆
Section snippets
Participants and Procedures
Participants (N = 31) were treatment-seeking young adults (age between 18 and 29 years old), enrolled in a large, urban, and diverse university in the northeastern United States. The main inclusion criterion was the presence of a GAD diagnosis (primary or secondary). Other comorbid mood and anxiety disorders were allowed. Current and lifetime diagnostic history was determined with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID; First, Spitzer, Gibbon, & Williams, 2002).
Results
Participants’ mean age was 22.3 years old (SD = 2.5), the majority was female (n = 22, 71.0%), and demonstrated racial, ethnic, and sociodemographic diversity (for more details see Renna et al., 2018). Of the 31 participants in the study, 97% (n = 30) had a primary or co-primary diagnosis of GAD, and 3% (n = 1) had GAD as a secondary diagnosis. Co-primary MDD was present in 19% (n = 6) of participants, while 13 patients endorsed a secondary diagnosis of MDD. One participant was prescribed a
Discussion
Individuals with GAD demonstrate both excessive worry and lack of healthy metacognitive skills. Accordingly, CBTs for GAD include a variety of metacognitive components aimed at improving metacognitive abilities (Cuijpers et al., 2014, Hayes-Skelton et al., 2013, Mennin et al., 2018, Wells et al., 2010). However, although metacognitive skills are considered crucial in producing change in these treatments for GAD, much is yet to be understood in terms of how and why these treatments work.
Conflict of Interest Statement
The authors declare that there are no conflicts of interest.
References (75)
- et al.
Longitudinal treatment mediation of traditional cognitive behavioral therapy and acceptance and commitment therapy for anxiety disorders
Behaviour Research and Therapy
(2012) An initiation-termination two-phase model of worrying
Clinical Psychology Review
(2010)- et al.
The state-trait anxiety inventory, trait version: Structure and content re-examined
Behaviour Research and Therapy
(1998) - et al.
Psychological treatment of generalized anxiety disorder: A meta-analysis
Clinical Psychology Review
(2014) - et al.
Cognitive therapy for anxious depression in STAR(*) D: what have we learned?
Journal of Affective Disorders
(2012) - et al.
Initial psychometric properties of the experiences questionnaire: Validation of a self-report measure of decentering
Behavior Therapy
(2007) - et al.
Changes in decentering across cognitive behavioral group therapy for social anxiety disorder
Behavior Therapy
(2018) - et al.
The contribution of attentional bias to worry: distinguishing the roles of selective engagement and disengagement
Journal of Anxiety Disorders
(2011) - et al.
A cognitive model of pathological worry
Behaviour Research and Therapy
(2012) - et al.
The Lancet Psychiatry Commission on psychological treatments research in tomorrow’s science
The Lancet Psychiatry
(2018)
United we stand: Emphasizing commonalities across cognitive-behavioral therapies
Behavior Therapy
Development and validation of the Penn State Worry Questionnaire
Behaviour Research and Therapy
A novel theory of experiential avoidance in generalized anxiety disorder: A review and synthesis of research supporting a contrast avoidance model of worry
Clinical Psychology Review
Diagnostic comorbidity in adults with generalized anxiety disorder: Impact of comorbidity on psychotherapy outcome and impact of psychotherapy on comorbid diagnoses
Behavior Therapy
Efficacy of cognitive behavioral therapy for anxiety disorders: A review of meta-analytic findings
Psychiatric Clinics of North America
A pilot study of Emotion Regulation Therapy for generalized anxiety and depression: Findings from a diverse sample of young adults
Behavior Therapy
Weekly assessment of worry: An adaptation of the Penn State Worry Questionnaire for monitoring changes during treatment
Behaviour Research and Therapy
A pilot randomized trial of metacognitive therapy vs applied relaxation in the treatment of adults with generalized anxiety disorder
Behaviour Research and Therapy
Emotion regulation flexibility
Cognitive Therapy and Research
Diagnostic and statistical manual of mental disorders
Meeting of minds: The medial frontal cortex and social cognition
Nature Reviews: Neuroscience
From a distance: Implications of spontaneous self-distancing for adaptive self-reflection
Journal of Personality and Social Psychology
Epidemiology of anxiety disorders in the 21st century
Dialogues in Clinical Neuroscience
Decentering and related constructs: A critical review and metacognitive processes model
Perspectives on Psychological Science
Avoidance theory of worry and generalized anxiety disorder
Cognitive therapy of anxiety disorders: Science and practice
Statistical power analysis for the behavioral sciences
Optimization of multicomponent behavioral, biobehavioral, and biomedical interventions: The Multiphase Optimization Strategy (MOST)
Behavioral indicators of emotional avoidance and subsequent worry in generalized anxiety disorder and depression
Journal of Experimental Psychopathology
Structured Clinical Interview for DSM-IV-TR Axis I Disorders—Research version, non-patient edition with psychotic screen
Enhancing the personalization of psychotherapy with dynamic assessment and modeling
Assessment
Distinct functional connectivities predict clinical response with Emotion Regulation Therapy
Frontiers in Human Neuroscience
Emotion regulation in adulthood: Timing is everything
Current Directions in Psychological Science
Emotion regulation: Conceptual and empirical foundations
Emotion regulation: Current status and future prospects
Psychological Inquiry
Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being
Journal of Personality and Social Psychology
Cited by (35)
A randomized controlled trial of emotion regulation therapy for cancer caregivers: A mechanism-targeted approach to addressing caregiver distress
2022, Contemporary Clinical TrialsCitation Excerpt :Notably, although caregiver distress often negatively impacts cancer patients' functioning and well-being [42,43], our pilot RCT with 81 caregivers of patients with various sites and stages of cancer revealed that the identified cancer patients of caregivers receiving ERT-C also experienced a large increase in quality of life (QOL) compared to patients whose caregivers were in a waitlist condition (Hedge's g = 0.90). Our recent work suggests that ERT-C confers clinical benefit via increases in attentional and metacognitive regulatory ability [33,35,41]. Furthermore, participation in ERT-C or CBT-C may lead to reductions in biomarkers of stress and systemic inflammation in caregivers.
Mediators of acceptance and mindfulness-based therapies for anxiety and depression: A systematic review and meta-analysis
2022, Clinical Psychology ReviewCitation Excerpt :Given the embedment of mediation studies in parent trials with the primary aim of establishing main effects, study designs often only include pre- and post-assessments of the putative mediators and outcome, which precludes the ability to establish temporal precedence. As an alternative to this, a recent open trial, investigating mediators of the effect of ERT on generalized anxiety disorder (GAD) with and without comorbid depression, employed so-called time-lagged segment models, where the mediator at sessionX, controlled for sessionX-1, predicts outcome at sessionX+1, controlled for outcome at sessionX (O'Toole, Renna, Mennin, & Fresco, 2019). With no overlap in time between segments, the study ensured temporal precedence and demonstrated how changes in decentering preceded changes in anxiety outcomes.
Decentering predicts attenuated perseverative thought and internalizing symptoms following stress exposure: A multi-level, multi-wave study
2022, Behaviour Research and TherapyCitation Excerpt :That is, adopting a decentered perspective may facilitate cognitive reappraisal, by allowing one to notice and question the accuracy of negative thought content, thereby reducing the need to cognitively elaborate or emotionally react. Indeed, in an open trial of Emotion Regulation Therapy, improvements in decentering predicted improvements in cognitive reappraisal, an important facilitator in symptom change in anxiety and mood disorders (Forkmann et al., 2014; O’Toole, Renna, Mennin, & Fresco, 2019; Smits, Julian, Rosenfield, & Powers, 2012). The current findings lend support for the role of decentering in determining whether exposure to negative experiences will lead to adaptive or maladaptive forms of self-reflection.
The measurement and benefit of decentering for coping self-efficacy, flexibility, and ways of coping with interpersonal stress
2021, Personality and Individual DifferencesCitation Excerpt :These findings suggest that future studies of decentering, as a beneficial trait, should consider the capacity for taking an observer perspective (including meta-awareness and disidentification from internal experience) separate from the capacity for regulating thought content. It is possible that differential associations with other outcomes, such as well-being or psychopathology, could be found as has been shown in previous research where individuals with general anxiety disorder whose improvements in the observer perspective aspect of decentering was associated with reductions in anxiety symptoms (O'Toole et al., 2019). Whilst transcendent life reflection did not align with the 3-process model of decentering (Bernstein et al., 2015), it was a factor represented by items from a measure that has been used to measure decentering.
The Mediating Role of Emotion Regulation in the Relationship Between Sexual Mindfulness and Relational Quality in a Sample of Iranian Women
2024, Journal of Sex and Marital Therapy
- ☆
David M. Fresco was supported by National Heart, Lung, and Blood Institute Grant R01HL119977, National Institute of Nursing Research Grant P30NR015326, and National Center for Complimentary and Integrative Health Grant 1R61AT009867.