Silberstein Presentation

8/13/2019 Silberstein Presentation

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Relationships Among

Emotional-Schemas,Psychological Flexibility,

Dispositional Mindfulness, &

Emotion Regulation in AdultCognitive-Behavioral Therapy

Outpatients

Laura R. Silberstein PsyD,Dennis D. Tirch PhD & Robert L. Leahy PhD

American Institute for Cognitive Therapy


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Introduction

Mindfulness, psychological flexibility, and emotional schemas

have each been related to emotional experiencing and

responding, as well as to the alleviation of human suffering(Corrigan, 2004; Hayes, Wilson, Gifford, Follette, and Strosahl, 1996; Martin, 1997; Fulton and

Seigel, 2005).

Mindfulness, acceptance and emotional schemas have each

been associated with challenging experiential avoidance and

contributing to emotion regulation.

This study focuses on the relationships betweenemotional schemas, psychological flexibility and

dispositional mindfulness.


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Mindfulness

The meta-experiential concept of mindfulness refers to a mode of

perception or awareness of the present moment in a nonjudgmental

and accepting manner (Kabat-Zinn, 1990).

Dispositional mindfulness is an innate characteristic reflecting an

individuals natural occurring ability to inhabit this intentional stance

of awareness (Brown and Ryan, 2003).

Mindfulness offers a perceptual, rather than cognitive or affective

presentation of the current moment as it is.

Dispositional mindfulness has been associated with an increased

capacity to let go of negative thoughts and is viewed as a core

process in psychological flexibility (Frewen, Evans, Maraj, Dozois, and Partridge,2008; Hayes, Strosahl and Wilson, 1999).


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Psychological Flexibility

Psychological f lexibil i tyhas been defined as the ability tofully encounter an experience without gratuitous defense and,depending upon the context, continuing or changing behaviorin the pursuit of goals and values (Hayes et al., 2006).

The term psychological flexibility has been used as a generalfactor to provide a more specific description of the core

processes involved in experiential avoidance and experientialacceptance (Hayes et al., 2006).

Experiential avoidance and acceptance are subsumed bypsychological flexibility, although they are still useful ways todescribe aspects of this construct(Bond, et al., In press).


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Experiential acceptance is the practice of just letting things beand experiencing them as they are. It involves being open toan experience and willing to remain in contact with it, even ifthe experience is unpleasant (Campbell-Sills, Barlow, Brown, and Hofman, 2006).

Acceptance can be described as second-order change or meta-change and is often viewed as preceding behavior or thoughtchanges (Germer, 2005; Hayes, 2001).

The focus is on changing the influence of the thoughts and

emotions by shifting ones response to them and not trying tochange or struggle with the thoughts or feelings themselves(Bishop et al., 2004).


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Exper ienti al avoidanceresults when an individual is unwilling toremain in contact with a particular experience and attempts to alterthe form or frequency of these experiences (Hayes, Wilson, Gifford, Follette, andStrosahl, 1996).

Avoidance can be considered a broad category or class of behaviors

that attempt to escape, avoid or modify a particular internal orexternal stimulus (Chapman, Gratz, and Brown, 2006).

Individuals who engage in experiential avoidance often engage inmore control tactics and verbal strategies to regulate their emotions(Campbell-Sills, Barlow, Brown, and Hofman, 2006; Cochrane, Barnes-Holmes, Stewart, andLuciano, 2007).

The negative effects of experiential avoidance result from theineffective and often paradoxical process of attempts to avoid or alter

private events (Wenzlaff and Wegner, 2000).


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Emotional Schemas

Individuals vary in their perception of emotions as temporary,universal, comprehensible, complex experiencesthat can besubject to acceptance, validation, and expression (Leahy 2007).

Emotional schema dimensions range from flexible and

adaptive to more rigid and maladaptive.

This model of emotional schemas contends that those whoendorse maladaptive emotional schemas are more likely toresist certain emotions and engage in avoidant strategies (Leahy2002).

Also emphasizes the positive implications in overcomingavoidance, increasing emotional processing, and the role ofcognition in emotional experiencing (Leahy 2007).


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Present Study Rationale

The current study aims to explore the relationships between

emotional schemas, psychological flexibility and

dispositional mindfulness.

This research also examines the relative contribution of

mindful awareness and emotional schemas to

psychological flexibility.

The roles of dispositional mindfulness and those emotional

schemas which represent emotion regulation strategies will

be explored in terms of their relationship with psychological

flexibility.


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Current Study

The current research is a cross sectional, observational

study of current patients at the American Institute for

Cognitive Therapy.

202 patients volunteered to complete three brief

measures assessing dispositional mindfulness,

psychological flexibility, and emotional schemas. The

responses are largely from intake assessments, typically

collected at the beginning of therapy.

The cognitive-behavioral therapy offered at this institute

primarily was non-manualized and included elements of

Beckian Cognitive Therapy and integrated with elements

of ACT, DBT, and Buddhist Psychology.


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Measures

Mindfulness Attention and Awareness Scale(MAAS; Brown & Ryan, 2003)

The MAAS is a 15-item self-report scale designed to

assess a core characteristic of dispositional

mindfulness, namely, the general tendency for openor receptive awareness and attention in the present

moment experience of daily life.

This measure has demonstrated construct and

criterion validity in clinical and non-clinical samples


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Measures

Awareness and Attention Questionnaire II(AAQ-II;Bond et al., In Press)

The AAQ-II is 10-item self-report scale designed to

assess psychological flexibility in large population

based studies.

The AAQ-II was developed from the AAQ-I resulting

in enhanced item selection and psychometric

properties.

Further psychometric information can be found athttp://www.contextualpsychology.org
http://www.contextualpsychology.org/http://www.contextualpsychology.org/http://www.contextualpsychology.org/http://www.contextualpsychology.org/


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Measures

The Leahy Emotional Schema Scale (LESS; Leahy,2002)

The LESS is 50-item self-report measure that asks

participants to report how they have dealt with

emotional experiences in the last month.

The scale shows strong psychometric properties and

has been validated with psychiatric outpatient

samples (Leahy, 2002).

It was designed to assess individualsconceptualization of their emotions and utilizes

fourteen dimensions of a cognitive model of

emotional processing.


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Measures

Factors/Dimensions of the LESS

Validation: a belief that other people validate or arereceptive to an individuals emotions.

Comprehensibility: the perception that an individualsemotions make sense.

Guilt: the belief that ones emotions are shameful, wrongor embarrassing.

Simplistic view of emotions: versus complex views andreflects difficulty tolerating ambivalent feelings.

Relationship to higher values: the belief that anemotional experience can provide insight into values

clarification. Controllability: the degree to which an individual

perceives he or she will be in control in the face ofemotion.


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Measures

Factors/Dimensions of the LESS

Numbness: a lack of strong emotions, emotional isolation,and emotional distancing.

Rationality: overreliance on logic or anti-emotionality.

Duration: the prediction of the length of emotionalexperiences.

Consensus: the belief that others share the same feelings.

Acceptance: the degree to which an individual allows versusinhibits an emotion.

Rumination: the tendency to ask unanswerable questionsand dwell on certain emotions.

Expression: willingness to experience and expressemotions.

Blame: the tendency to externalize the source of theemotion.


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Correlational Analyses:

MASS & LESS Dimensions

MASS

Rationality -.248**

Duration -.187**

Consensus .246**

Acceptance .380**

Rumination -.279 **

Expression .228**

Blame -.190***p< .05, **p< .01


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MASS & LESS Correlations

MASS positive

correlations:

Validation

Comprehension Higher values

Control

Consensus

Expression

Acceptance

MASS negative

correlations:

Guilt

Simplistic views ofemotions

Numbness

Rationality

Duration

Rumination

Blame


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MASS & AAQ-II

MASS

AAQ .493**

*p< .05, **p< .01

Dispositional mindfulness as measured by the

MASS appears to be highly correlated to psychological

flexibility as measured by the AAQ-II.


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AAQ-II & LESS Dimensions

AAQ-II

Validation .507**

Comprehension .578**

Guilt -.642**Simplistic view of emotions -.392**

Values .274**

Control .602**

Numbness -.230**

*p< .05, **p< .01


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AAQ-II

Rationality -.237**

Duration -.237**

Consensus .495**

Acceptance .373**

Rumination -.497 **

Expression .163*

Blame -.364***p< .05, **p< .01


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AAQ-II positive

correlations:

Validation

Comprehension Higher values

Control

Consensus

Expression

Acceptance

AAQ-II negative

correlations:

Guilt

Simplistic views ofemotions

Numbness

Rationality

Duration

Rumination

Blame


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Results

Our findings suggests that individuals who endorsed a

higher capacity for mindfulness and those who reported

a higher degree of psychological flexibility reported:

Other people will validate or be receptive to their emotions

Their emotions make sense

Emotional experiences provide insight into their values

They can control over their emotions

Their emotions are normal or shared by others Acceptance of their emotional experiences

Willingness to experience and express their emotions


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Results

Our findings suggest that individuals who reported lowerdegrees of dispositional mindfulness and thoseendorsing lower degrees of psychological flexibilityreported:

Guilt or shame in regards to their emotions Difficulty tolerating ambivalent feelings

Lacking strong emotional experiences

Engaging in emotional distancing

Rationalization or dwelling on their emotions Their emotions last for a long time

Externalizing the source of their emotional experiences


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Results

The results of this study also revealed a positive

correlation between psychological flexibility as

measured by the AAQ-II and dispositional

mindfulness as measured by the MASS.

This indicates that individuals who endorsed a high

degree of dispositional mindfulness also reported:

More psychological flexibility

Less experiential avoidance

More acceptance of their experiences


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Stepwise Multiple Regression

Factors of the LESS that represent emotion

regulation strategies: Rational, Expression,

Rumination, and Acceptance

Dependent Variable - Psychological Flexibility(AAQ- II)

Independent Variables - Dispositional Mindfulness

(MAAS) and Emotional Schema (LESS) dimensions

related directly to emotion regulation strategies

(Rumination, Expression, Rational, Acceptance of

Feelings)


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Results: Stepwise Multiple

Regression


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Regression


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Regression The LESS factors Expression, and Rationalwere not

significant predictors in this analysis and not included in the

model.

A model including the LESS factors Rumination and

Acceptance of Feelings, as well as dispositional mindfulness,

as measured by the MAAS accounted for a significant

proportion of the variance inpsychological flexibility as

compared to the other LESS factors hypothesized to be

involved in emotion regulation strategies.

Rumination was included in the first step of this model,

followed by Acceptance of Feelings and then by

dispositional mindfulness. The addition of each variable

resulted in statistically significant change.


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Regression These results suggest that emotion regulation

strategies involving letting go of a ruminative

thinking style, accepting and allowing emotions as

they arrive, and an active attending to the present

moment, interact significantly with psychologicalflexibility.

The degree to which a person is or is not overly-

rational, or verbally expressive appears to be less

important in regards to psychological flexibility.


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Discussion

The correlational results of this study imply a strong

relationship between dispositional mindfulness,

psychological flexibility and emotional schemas in adults

seeking outpatient therapy.

We also found some evidence for the relationships

between mindfulness, emotional schema dimensions

related to emotion regulation strategies and

psychological flexibility.

Thus, it may be possible that dispositional mindfulness

and certain emotional schemas are interacting

processes involved in the establishment and

maintenance of psychological flexibility and adaptive

functioning.


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Discussion A possible function of more adaptive emotional

schemas is a greater degree of psychological

flexibility and a greater receptive attention to and

awareness of present experiences.

However, as correlations do not establish causality

or direction, it is also possible that, by providing an

accepting and unbiased emotional experience,

dispositional mindfulness and psychological

flexibility allow individuals to perceive the

uniqueness of a current emotion and respond in a

flexible and adaptive manner


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Discussion One possible interpretation of the results of the

stepwise multiple regression would suggest that the

foundation of psychological flexibility is informed by

emotion regulation strategies that involve:

Letting go of a ruminative thinking style

Acceptance and openness towards emotions

Active, non-evaluative attending to the present

moment


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DiscussionThis interpretationwould support thehypothesis inherent inthe ACT hexaflex

model, thatacceptance, defusion,andcontact with thepresent moment arefundamental

components ofpsychologicalflexibility.


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Study Limitations

Small sample size and clinical population limits

generalizablilty

Self-report assessment measures

No causality can be assumed

Additional variables maybe responsible for the

relationships observed in this study

Therefore, there is a need for continued research


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For copies of this presentation

Please contact me at:

[email protected]


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References

Bishop, S.R., Lau, M., Shapiro, S., Carlson, L., Anderson, N.D., Carmody, J.C., Segal, Z.V., Abbey, S., Speca,M., Velting, D. & Devnis, G. (2004) Mindfulness: A proposed operational definition. Clinical Psychology:Science and Practice,11, 230-241.

Bond, F.W., Hayes, S.C., Baer, R.A., Carpenter, K.M., Orcutt, H.K., Waltz, T. & Zettle, R.D. (In press).Preliminary psychometric properties of the Acceptance and Action QuestionnaireII: A revised measureof psychological flexibility and acceptance.

Brown, K.W. & Ryan, R.M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84, 822-848.

Campbell-Sills, L., Barlow, D.H., Brown, T.A., & Hofman, S.G. (2006). Effects of suppression and acceptanceon emotional responses of individuals with anxiety and mood disorders. Behavior Research andTherapy, 44,125-1263.

Chapman, A.L., Gratz, K.L., & Brown, M.Z. (2006). Solving the puzzle of deliberate self harm: The experientialavoidance model. Behavior Research and Therapy, 44, 371-394.

Cochrane, A., Barnes-Holmes, D., Barnes-Holms, Y., Stewart, I., & Luciano, C., (2007). Experiential avoidanceand aversive visual images: Response delays and event-related potentials on a simple task. BehavioralResearch and Therapy, 45,1379-1388.

Frewen, P.A., Evans, E.M., Maraj, N., Dozois, D.J.A., & Partridge, K. (2008). Letting go: Mindfulness andnegative automatic thinking. Cognitive Therapy Research, 32, 758-774.

Germer, C.K. (2005). Mindfulness: What is it? Does it matter? In C.K. Germer, R.D. Seigel, & P.R. Fulton (Eds.)Mindfulness and Psychotherapy(pp.3-27) New York: Guilford Press.


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References

Hayes, S.C. (2001). Psychology of acceptance and change. In N.J. Smelser & P.B. Baltes (Eds.)International encyclopedia of social & behavioral sciences(pp 27-30).Oxford: Elsevier ScienceLtd.

Hayes, S. C., Luoma, J., Bond, F., Masuda, A., & Lillis, J. (2006). Acceptance and CommitmentTherapy: Model, processes, and outcomes. Behaviour Research and Therapy, 44(1), 1-25.

Hayes, S.C., Strosahl K.D. & Wilson, K.G., (1999).Acceptance and Commitment Therapy: An

experiential approach to behavior change. New York: Guilford.

Hayes, S.C., Wilson, K.G., Gifford, E.V., Follette, V.M., & Strosahl, K., (1996). Experiential avoidanceand behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journalof Consulting and Clinical Psychology, 64,1152-1168.

Izard, C.E. (2009). Emotion theory and research: Highlights, unanswered questions, and emergingissues.Annual Review of Psychology, 60,1-25.

Kabat-Zinn, J. (1990). Full Catastrophe Living: Using the wisdom of your body and mind to face stress,pain, and illness. New York: Bantam Dell.

Leahy, R. L. (2002). A model of emotional schemas. Cognitive & Behavioral Practice, 9,177-190.

Leahy, R.L. (2007). Emotion and Psychotherapy. Clinical Psychology: Science and Practice, 14,353-357.

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Silberstein Presentation