Using meditation in a control vs. acceptance context: A preliminary evaluation of relations with anxiety, depression, and indices of well-being.

BACKGROUND AND OBJECTIVES: Meditation practices have been marketed broadly to ameliorate human suffering. As such, individuals may seek out and use meditation to control or manage unpleasant thoughts and emotions. Emotion and thought control research suggest that meditation used in this way may potentiate unpleasant private experiences and contribute to negative outcomes. We aimed to evaluate the function or purpose guiding meditation and its relations with anxiety, depression, and other indices of well-being. DESIGN AND METHODS: In a cross-sectional design, undergraduate meditators (N = 98) reported intentions guiding their meditation practice (i.e., experiential/emotional control or acceptance/openness) and completed an assessment battery. RESULTS: Most participants (58.2%) indicated using meditation to manage, control, or avoid difficult experiences. Participants using meditation with control-based intentions reported greater worry, anxiety, depression, negative affect, and lower mindfulness relative to their acceptance-guided counterparts. After controlling for level of anxiety, viewing anxiety as a problem increased the likelihood of using meditation with control-based intentions. Similar relations were observed between viewing stress as a problem and the likelihood of using meditation for experiential control. CONCLUSIONS: Findings suggest that (a) how people meditate is significantly related to psychological distress and (b) highlight the importance of evaluating intentions guiding meditative practices, particularly in individuals struggling with unpleasant emotional or psychological experiences.

Evaluating ACT Processes in Relation to Outcome in Self-Help Treatment for Anxiety-Related Problems.

Evaluating how, for whom, and under what conditions psychosocial treatments work is an important component of anxiety disorder treatment development. Yet, research regarding mediators and moderators of self-help interventions is sparse. The current project is a secondary analysis of mediators, moderators, and correlates of outcome of a randomized wait-list-controlled trial assessing acceptance and commitment therapy (ACT) self-help bibliotherapy for anxiety and related problems. Participants (n = 503) were randomized to an immediate workbook (n = 256) or wait-list condition (n = 247). Nonparametric bootstrapped mediation analyses showed that pre-post positive changes in ACT treatment processes accounted for the relation between treatment and pre-post improvement on the primary outcomes of anxiety symptoms, depressive symptoms, and quality of life. Results indicated no baseline variables were significant moderators. Finally, hierarchical regression analyses indicated that the degree of improvement for each primary outcome was positively correlated with the degree to which participants reported applying the workbook material to their day-to-day life, over and above how much of the book they reported reading. This study provided support for the ACT model of change in a self-help context and highlighted the importance of actively applying self-help material, addressing theoretical and practical questions about how and why ACT self-help works.

Evaluation of the contribution of values clarification to a brief mindfulness meditation intervention for anxiety.

OBJECTIVE: Evaluate the incremental effects of a computerized values clarification (VC) activity on anxiety symptomology and quality of life over and above establishment of a mindfulness meditation (MM) practice. METHOD: Anxious participants (N = 120, Female = 86; Mage  = 22.26) were randomly assigned to a 2-week, 10-min daily MM practice + control task or a 2-week, 10-min daily MM practice + VC task. Pre-assessments and post-assessments included well-established and ideographic self-report measures. RESULTS: Overall decreases in past week and past 24-h anxiety symptom frequency, as well as increased quality of life during the previous 24-h cycle only. VC did not have a demonstrable impact on outcomes. CONCLUSIONS: Though findings are preliminary, brief VC exercises may not enhance outcomes that follow from mindfulness practice. Additional research is needed to isolate specific and shared impacts of mindfulness-based and values-based treatment strategies on anxiety symptoms and quality of life.

Evaluating the Effectiveness of ACT for Anxiety Disorders in a Self-Help Context: Outcomes From a Randomized Wait-List Controlled Trial.

Rigorous evaluations of cognitive behavioral self-help books for anxiety in pure self-help contexts are lacking. The present study evaluated the effectiveness of an Acceptance and Commitment Therapy (ACT) self-help workbook for anxiety-related concerns, with no therapist contact, in an international sample. Participants (N=503; 94% mental health diagnosis) were randomized to an immediate workbook (n=256) or wait-list condition (n=247). Assessments at pretreatment, 12weeks, 6months, and 9months evaluated anxiety and related symptoms, quality of life, and ACT treatment processes (e.g., psychological flexibility). Participants in the wait-list arm crossed over to the workbook following the 12-week assessment. The workbook condition yielded significant improvements on all assessments from pre- to posttreatment relative to wait-list, and these gains were maintained at follow-ups. The pattern observed in the wait-list condition was virtually identical to the active treatment arm after receiving the workbook, but not before. Attrition was notable, but supplemental analyses suggested dropout did not influence treatment effects for all but one measure. Overall, findings provide preliminary support for the effectiveness of this self-help workbook and suggest ACT-based self-help bibliotherapy might be a promising low-cost intervention for people experiencing significant anxiety-related concerns.

Acceptance and commitment therapy smoking cessation treatment for veterans with posttraumatic stress disorder: a pilot study.

OBJECTIVE: Veterans with PTSD smoke at rates two to three times higher than the general population, while their quit rate is less than half that of the general population. The present study evaluated the feasibility, acceptability, and preliminary efficacy of Acceptance and Commitment Therapy for Veterans With Posttraumatic Stress Disorder (PTSD) and Tobacco Addiction (ACT-PT), which focuses on helping veterans overcome emotional challenges to quitting smoking. METHODS: Veterans with current PTSD who smoked 15 or more cigarettes/day (N = 19) participated in an open trial of ACT-PT. Participants attended nine weekly individual counseling sessions and received eight weeks of nicotine patch therapy. Primary outcomes included feasibility and acceptability of the intervention, and secondary outcomes included expired-air carbon monoxide confirmed seven-day point prevalence abstinence, cravings, and PTSD symptoms. RESULTS: The retention rate for ACT-PT was good (74%) and client satisfaction ratings were high. Participants made multiple quit attempts (M = 3.6, SD = 4.2) during the study period and were significantly more confident that they could quit smoking at three-month follow-up. At the end of treatment, 37% of participants were abstinent from smoking and 16% were abstinent at three-month follow-up. Overall, participants reduced their smoking by 62% at the end of treatment and 43% at three-month follow-up. PTSD symptoms and smoking urges significantly decreased from baseline to the end of treatment and three-month follow-up. CONCLUSIONS: ACT-PT appears to be a promising smoking cessation treatment for veterans with PTSD. Future research should evaluate ACT-PT in a randomized controlled trial.

Using panicogenic inhalations of carbon dioxide enriched air to induce attentional bias for threat: Implications for the development of anxiety disorders.

The tendency for anxious individuals to selectively attend to threatening information is believed to cause and exacerbate anxious emotional responding in a self-perpetuating cycle. The present study sought to examine the relation between differential interoceptive conditioning (IC) using carbon dioxide inhalation as a panicogenic unconditioned stimulus (US) and the development of Stroop colour-naming interference to various non-word conditioned stimuli (CSs). Healthy university students (N = 27) underwent the assessment of colour-naming interference to reinforced CS+ and non-reinforced CS- non-words prior to and following differential fear conditioning. Participants showed greater magnitude electrodermal and verbal-evaluative responses to the CS+ over the CS- non-word following IC, and demonstrated the expected slower colour-naming latencies to the CS+ compared to the CS- non-word from baseline to post-conditioning. We discuss the relation between fear learning and the emergence of attentional bias for threat to further understand the maintenance of anxiety disorders.

Improving base rate estimation of alcohol misuse in the military: a preliminary report.

OBJECTIVE: Stigma associated with behavioral health problems in the military pose challenges to accurate base rate estimations. Recent work has highlighted the importance of anonymous assessment methods, yet no study to date has assessed the ability of anonymous self-report measures to mitigate the impact of stigma on honest reporting. This study used the unmatched count technique (UCT), a form of randomized response techniques, to gain information about the accuracy of base rate estimates of alcohol misuse derived via anonymous assessment of Operation Enduring Freedom/Operation Iraqi Freedom active duty service members. METHOD: A cross-sectional, convenience sample of 184 active-duty service members, recruited via online websites for military populations, provided data on two facets of alcohol misuse (drinking more than intended and feeling the need to reduce use) via traditional self-report and the UCT. RESULTS: The UCT revealed significantly higher rates relative to traditional anonymous assessment for both drinking more than intended (51.9% vs. 23.4%) and feeling the need to reduce use (39.3% vs. 18.2%). CONCLUSIONS: These data suggest that anonymity does not completely mitigate the impact of stigma on endorsing behavioral health concerns in the military. Our results, although preliminary, suggest that published rates of alcohol misuse in the military may underestimate the true rates of these concerns. The UCT has significant potential to improve base rate estimation of sensitive behaviors in the military.

The Believability of Anxious Feelings and Thoughts Questionnaire (BAFT): a psychometric evaluation of cognitive fusion in a nonclinical and highly anxious community sample.

Cognitive fusion--or the tendency to buy into the literal meaning of thoughts, feelings, and bodily sensations--plays an important role in the etiology and maintenance of anxiety disorders and figures prominently in third-generation behavior therapies such as acceptance and commitment therapy (ACT). Nonetheless, there is a lack of validated self-report measures of cognitive fusion/defusion, particularly in the area of anxiety disorders. We attempted to fill this gap with the development and validation of a self-report cognitive fusion measure, the Believability of Anxious Feelings and Thoughts Questionnaire (BAFT), in both a healthy undergraduate sample (N = 432) and highly anxious community sample (N = 503) undergoing a 12-week online ACT intervention. Results suggested a hierarchical factor structure of the BAFT with three lower order factors and one hierarchical factor and excellent internal consistency for the total BAFT score (i.e., αs = .90 and .91 for the undergraduate and highly anxious samples, respectively) and for its factors. Additionally, the BAFT and all of its factors consistently showed strong construct validity with other relevant process and outcome measures in both samples, strong 12-week test-retest reliability (r = .77) in our highly anxious waitlist control subsample and responsiveness to treatment in our highly anxious intervention subsample. These findings suggest that the BAFT is a reliable and valid measure of cognitive fusion in both healthy and clinical populations.

Interoceptive fear conditioning and panic disorder: the role of conditioned stimulus-unconditioned stimulus predictability.

Interoceptive fear conditioning is at the core of contemporary behavioral accounts of panic disorder. Yet, to date only one study has attempted to evaluate interoceptive fear conditioning in humans (see Acheson, Forsyth, Prenoveau, & Bouton, 2007). That study used brief (physiologically inert) and longer-duration (panicogenic) inhalations of 20% CO(2)-enriched air as an interoceptive conditioned (CS) and unconditioned (US) stimulus and evaluated fear learning in three conditions: CS only, CS-US paired, and CS-US unpaired. Results showed fear conditioning in the paired condition, and fearful responding and resistance to extinction in an unpaired condition. The authors speculated that such effects may be due to difficulty discriminating between the CS and the US. The aims of the present study are to (a) replicate and expand this line of work using an improved methodology, and (b) clarify the role of CS-US discrimination difficulties in either potentiating or depotentiating fear learning. Healthy participants (N=104) were randomly assigned to one of four conditions: (a) CS only, (b) contingent CS-US pairings, (c) unpaired CS and US presentations, or (d) an unpaired "discrimination" contingency, which included an exteroceptive discrimination cue concurrently with CS onset. Electrodermal and self-report ratings served as indices of conditioned responding. Consistent with expectation, the paired contingency and unpaired contingencies yielded elevated fearful responding to the CS alone. Moreover, adding a discrimination cue to the unpaired contingency effectively attenuated fearful responding. Overall, findings are consistent with modern learning theory accounts of panic and highlight the role of interoceptive conditioning and unpredictability in the etiology of panic disorder.

Self-compassion is a better predictor than mindfulness of symptom severity and quality of life in mixed anxiety and depression.

Mindfulness has received considerable attention as a correlate of psychological well-being and potential mechanism for the success of mindfulness-based interventions (MBIs). Despite a common emphasis of mindfulness, at least in name, among MBIs, mindfulness proves difficult to assess, warranting consideration of other common components. Self-compassion, an important construct that relates to many of the theoretical and practical components of MBIs, may be an important predictor of psychological health. The present study compared ability of the Self-Compassion Scale (SCS) and the Mindful Attention Awareness Scale (MAAS) to predict anxiety, depression, worry, and quality of life in a large community sample seeking self-help for anxious distress (N = 504). Multivariate and univariate analyses showed that self-compassion is a robust predictor of symptom severity and quality of life, accounting for as much as ten times more unique variance in the dependent variables than mindfulness. Of particular predictive utility are the self-judgment and isolation subscales of the SCS. These findings suggest that self-compassion is a robust and important predictor of psychological health that may be an important component of MBIs for anxiety and depression.

Sex differences in salivary cortisol in response to acute stressors among healthy participants, in recreational or pathological gamblers, and in those with posttraumatic stress disorder.

Sex differences in incidence and severity of some stress-related, neuropsychiatric disorders are often reported to favor men, suggesting that women may be more vulnerable to aberrant hypothalamic-pituitary-adrenal (HPA) axis responses to stress. In this review, we discuss several investigations that we, and others, have conducted assessing salivary cortisol as a measure of HPA function. We have examined basal cortisol among healthy men and women and also following acute exposure to stressors. Among healthy participants, men had higher basal cortisol levels than did women. In response to acute stressors, such as carbon dioxide or noise, respectively, cortisol levels were comparable between men and women or higher among women. We have also examined cortisol levels among those with problem eating, gambling, or posttraumatic stress disorder (PTSD). Women with restrained eating habits have higher basal cortisol levels than do women without restrained eating habits. Pathological gamblers have more aberrant stress response to gambling stimuli than do recreational gamblers, and these effects are more prominent among men than women. Men who have motor vehicle accident related PTSD, demonstrate more aberrant cortisol function, than do their female counterparts. Although these sex differences in cortisol seem to vary with type of stress exposure and/or pathophysiological status of the individual, other hormones may influence cortisol response. To address this, cortisol levels among boys and girls with different stress-related experiences, will be the subject of future investigation.

Context and renewal of conditioned fear: an experimental evaluation using 20% carbon dioxide-enriched air as an unconditioned stimulus.

This analogue experiment used fear conditioning and extinction procedures to establish and reduce fearful responding and then test for fear renewal following a context change. Healthy undergraduates (N=61) underwent a differential fear conditioning procedure using geometric shapes as conditioned stimuli (CS) and inhalations of 20% CO(2)-enriched air as an aversive unconditioned stimulus (US). Across phases (i.e., habituation, acquisition, extinction, and test), red and green ambient lighting served as contextual stimuli, and electrodermal and evaluative ratings were assessed as indices of conditioned fear. The control group underwent extinction and test phases under identical conditions (i.e., no context changes). The experimental groups either underwent acquisition and test phases in one context and the intervening extinction phase in a different context (A-B-A), or underwent acquisition and extinction phases in one context and the test phase in a novel context (A-A-B). Consistent with expectation, fear renewal was observed when the test context matched the acquisition context. This effect was modest for electrodermal responses, but reasonably robust for evaluative responses. The role of context in the subsequent renewal of fear following exposure-based treatment is discussed.

Associations between emotional avoidance, anxiety sensitivity, and reactions to an observational fear challenge procedure.

Research has shown that emotional avoidance and anxiety sensitivity are associated with more self-reported fear and distress in response to laboratory fear challenge procedures. The present study aimed to expand upon this work and examined how emotional avoidance and anxiety sensitivity are related to emotional and physiological responses to an observational fear challenge procedure. To accomplish this aim, a carefully screened, non-clinical sample (N=43) was administered the Acceptance and Action Questionnaire (AAQ), a measure of emotional avoidance, and the Anxiety Sensitivity Index (ASI). Participants then engaged in an observational fear challenge paradigm. During the fear challenge, participants watched mock panic attacks while emotional (e.g., fear and panic) and skin conductance levels were assessed. Consistent with expectation, emotional avoidance and anxiety sensitivity were positively associated with more self-reported fear and more severe panic symptoms to the challenge procedure. However, anxiety sensitivity was more highly associated with self-reported fear and panic symptoms in response to the challenge procedure than emotional avoidance. Emotional avoidance and anxiety sensitivity were not associated with levels of physiological arousal to the observational fear challenge procedure. Discussion focuses on the interplay between emotional avoidance, anxiety sensitivity, and the development of vicarious fear responses and how these constructs may contribute to the pathogenesis of anxiety disorders.

Gender bias in the sixteen-item Anxiety Sensitivity Index: an application of polytomous differential item functioning.

Gender differences in measures of anxiety sensitivity (AS) are similar to gender differences across anxiety disorders; females exhibit higher levels of AS and a greater prevalence of anxiety disorders than males. The current study confirms higher scores on the Anxiety Sensitivity Index (ASI) in females. Further analysis reveals, however, that gender differences on the ASI may arise from a single item's bias against women. Four different statistics examining differential item functioning (DIF) indicate that women are more likely to endorse the item, "It scares me when I feel faint", even if they score no higher on the ASI than males. Removing this biased item does not alter internal consistency of the scale, but eliminates the significant gender difference. The results suggest that differences on the ASI require careful interpretation as item bias may artificially inflate ASI scores in females.

A comparative evaluation of panicogenic processes and quality of life in a sample of non-clinical panickers and age and sex matched non-panicking controls.

Contemporary models of panic attacks suggest that panic problems exist on a continuum and highlight the need to understand what differentiates persons who have never had a panic attack versus persons who have had panic attacks but have not yet developed panic disorder (i.e., non-clinical panickers). Accordingly, the present study evaluated several theoretically-relevant factors that were expected to distinguish a sample of (conservatively defined) non-clinical panickers (n=72) from an age and sex-matched comparison sample of non-panicking controls (n=72). As expected, panickers were characterized by higher levels of anxiety sensitivity, perceived uncontrollability, and state and trait anxiety relative to their non-panic counterparts. Moreover, higher levels of trait anxiety emerged as a predictor of poorer quality of life among panickers. Results are considered within the context of biopsychosocial continuum models of panic attacks and panic disorder and future directions for research are suggested.

Sex differences in response to an observational fear conditioning procedure.

The present study evaluated sex differences in observational fear conditioning using modeled "mock" panic attacks as an unconditioned stimulus (UCS). Fifty-nine carefully prescreened healthy undergraduate participants (30 women) underwent 3 consecutive differential conditioning phases: habituation, acquisition, and extinction. It was expected that participants watching a confederate display mock panic attacks (UCS) paired with a previously neutral stimulus (CS(+)) would learn to respond fearfully to the CS(+), but not to the CS(-) (i.e., a stimulus never associated with displays of panic). Women also were expected to report more distress and ratings of panic to the CS(+) than the CS(-) compared to men, but no sex differences were anticipated on autonomic indices of conditioning (i.e., electrodermal responses). Consistent with expectation, aversive conditioning was demonstrated by greater magnitude electrodermal and verbal-evaluative (e.g., subjective units of distress scale, panic ratings) responses to the CS(+) over the CS(-), with women reporting more distress to the CS(+) over the CS(-), but not greater autonomic conditioning, compared to men. Overall, the results support the notion that modeled panic attacks can serve as a potent UCS for both men and women. Discussion focuses on sex differences in observational fear conditioning and its relation to the clinical presentation of anxiety disorders.

Transformation of avoidance response functions in accordance with same and opposite relational frames.

Research on the emergence of human avoidance behavior in the absence of direct contact with an aversive event is somewhat limited. Consistent with work on derived relational responding, the present study sought to investigate the transformation of avoidance response functions in accordance with the relational frames of Same and Opposite. Participants were first exposed to nonarbitrary and arbitrary relational training and testing in order to establish Same and Opposite relations among arbitrary stimuli. The training tasks were; Same-A1-B1, Same-A1-C1, Opposite-A1-B2, Opposite-A1-C2. Next, all possible combinatorially entailed (i.e., B-C and C-B) relations were tested. During the avoidance-conditioning phase, one stimulus (B1) from the relational network signaled a simple avoidance response that cancelled a scheduled presentation of an aversive image and sound. All but one of the participants who met the criteria for conditioned avoidance also demonstrated derived avoidance by emitting the avoidance response in the presence of C1 and the nonavoidance response in the presence of C2. Control participants who were not exposed to relational training and testing did not show derived avoidance. Implications of the findings for understanding clinically significant avoidance behavior are discussed.

Interoceptive fear conditioning as a learning model of panic disorder: an experimental evaluation using 20% CO(2)-enriched air in a non-clinical sample.

Despite the role afforded interoceptive fear conditioning in etiologic accounts of panic disorder, there are no good experimental demonstrations of such learning in humans. The aim of the present study was to evaluate the interoceptive conditioning account using 20% carbon dioxide (CO(2))-enriched air as an interoceptive conditioned stimulus (CS) (i.e., physiologically inert 5-s exposures) and unconditioned stimulus (US) (i.e., physiologically prepotent 15-s exposures). Healthy participants (N=42) were randomly assigned to one of three conditions: a CS-only, contingent CS-US pairings, or unpaired/non-contingent CS and US presentations. Electrodermal and self-report (e.g., distress, fear) served as indices of conditioned emotional responding. Results showed greater magnitude electrodermal and evaluative fear conditioning in the paired relative to the CS-only condition. The explicitly unpaired condition showed even greater electrodermal and evaluative responding during acquisition, and marked resistance to extinction. The latter results are consistent with the possibility that the unpaired procedure constituted a partial reinforcement procedure in which CO(2) onset was paired with more extended CO(2) exposure on 50% of the trials. Overall, the findings are consistent with contemporary learning theory accounts of panic.

Observational fear conditioning in the acquisition and extinction of attentional bias for threat: an experimental evaluation.

Anxious persons show automatic and strategic attentional biases for threatening information. Yet, the mechanisms and processes that underlie such biases remain unclear. The central aim of the present study was to elucidate the relation between observational threat learning and the acquisition and extinction of biased threat processing by integrating emotional Stroop color naming tasks within an observational differential fear conditioning procedure. Forty-three healthy female participants underwent several consecutive observational fear conditioning phases. During acquisition, participants watched a confederate displaying mock panic attacks (UCS) paired with a verbal stimulus (CS+), but not with a second nonreinforced verbal stimulus (CS-). As expected, participants showed greater magnitude electrodermal and verbal-evaluative (e.g., distress, fear) conditioned responses to the CS+ over the CS- word. Participants also demonstrated slower color-naming latencies to CS+ compared to the CS- word following acquisition and showed attenuation of this preferential processing bias for threat following extinction. Findings are discussed broadly in the context of the interplay between fear learning and processing biases for threat as observed in persons suffering from anxiety disorders.