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Reduced Reactivity to and Suppression of Thoughts Mediate the Effects of Mindfulness Training on Recovery Outcomes Following Exposure to Potentially Traumatic Stress

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Abstract

We tested whether reduced thought suppression and reactivity to thought content (i.e., cognitive defusion) mediate the effects of a four-session mindfulness training intervention on clinical outcomes important to recovery in a general community-sample of adults (N = 38) recently exposed to potentially traumatic event (PTE). Thought suppression mediated the effects of mindfulness training on all studied distal risk factors and symptom outcomes—anxiety sensitivity, rumination, and negative affect, as well as posttraumatic stress and depression symptoms. Cognitive defusion mediated the effects of mindfulness training on anxiety sensitivity, negative affect, and posttraumatic stress symptoms, but not rumination or depression symptoms. Thus, we found that reduced reactivity to and reduced suppression of thoughts mediated the effects of mindfulness training on recovery outcomes following exposure to PTE. Findings are discussed with respect to their theoretical and clinical implications for the potential role and mediating mechanisms of mindfulness in recovery following trauma.

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References

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

  • Baker, T. B., McFall, R. M., & Shoham, V. (2008). Current status and future prospects of clinical psychology toward a scientifically principled approach to mental and behavioral health care. Psychological Science in the Public Interest, 9(2), 67–103.

    Article  PubMed  Google Scholar 

  • Bernstein, A., Hadash, Y., Lichtash, Y., Tanay, G., Shepherd, K., & Fresco, D. M. (2015). Decentering and related constructs a critical review and metacognitive processes model. Perspectives on Psychological Science, 10(5), 599–617.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bernstein, A., Tanay, G., & Vujanovic, A. A. (2011). Concurrent relations between mindful attention and awareness and psychopathology among trauma-exposed adults: preliminary evidence of transdiagnostic resilience. Journal of Cognitive Psychotherapy, 25(2), 99–113.

    Article  Google Scholar 

  • Boden, M. T., Bernstein, A., Walser, R. D., Bui, L., Alvarez, J., & Bonn-Miller, M. O. (2012). Changes in facets of mindfulness and posttraumatic stress disorder treatment outcome. Psychiatry Research, 200(2), 609–613.

    Article  Google Scholar 

  • Bomyea, J., Risbrough, V., & Lang, A. J. (2012). A consideration of select pre-trauma factors as key vulnerabilities in PTSD. Clinical Psychology Review, 32(7), 630–641.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bonanno, G. A. (2005). Resilience in the face of potential trauma. Current Directions in Psychological Science, 14(3), 135–138.

    Article  Google Scholar 

  • Bowen, S., Witkiewitz, K., Dillworth, T. M., & Marlatt, G. A. (2007). The role of thought suppression in the relationship between mindfulness meditation and alcohol use. Addictive Behaviors, 32(10), 2324–2328.

    Article  PubMed  PubMed Central  Google Scholar 

  • Breslau, N., Davis, G. C., Peterson, E. L., & Schultz, L. R. (2000). A second look at comorbidity in victims of trauma: the posttraumatic stress disorder–major depression connection. Biological Psychiatry, 48(9), 902–909.

    Article  PubMed  Google Scholar 

  • Brislin, R. W. (1970). Back-translation for cross-cultural research. Journal of Cross-Cultural Psychology, 1(3), 185–216.

    Article  Google Scholar 

  • 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;Journal of Personality and Social Psychology, 84(4), 822–848.

    Article  Google Scholar 

  • Brugha, T., Bebbington, P., Tennant, C., & Hurry, J. (1985). The list of threatening experiences: a subset of 12 life event categories with considerable long-term contextual threat. Psychological Medicine, 15(1), 189–194.

    Article  PubMed  Google Scholar 

  • Call, D., Pitcock, J., & Pyne, J. (2015). Longitudinal evaluation of the relationship between mindfulness, general distress, anxiety, and ptsd in a recently deployed national guard sample. Mindfulness, 6, 1303–1312.

  • Chopko, B. A., & Schwartz, R. C. (2013). The relation between mindfulness and posttraumatic stress symptoms among police officers. Journal of Loss and Trauma, 18(1), 1–9.

    Article  Google Scholar 

  • Desbordes, G., Gard, T., Hoge, E. A., Hölzel, B. K., Kerr, C., Lazar, S. W., … & Vago, D. R. (2014). Moving beyond mindfulness: defining equanimity as an outcome measure in meditation and contemplative research. Mindfulness, 6(2), 356–372.

  • Dunmore, E., Clark, D. M., & Ehlers, A. (2001). A prospective investigation of the role of cognitive factors in persistent posttraumatic stress disorder (PTSD) after physical or sexual assault. Behaviour Research and Therapy, 39(9), 1063–1084.

    Article  PubMed  Google Scholar 

  • Elwood, L. S., Hahn, K. S., Olatunji, B. O., & Williams, N. L. (2009). Cognitive vulnerabilities to the development of PTSD: a review of four vulnerabilities and the proposal of an integrative vulnerability model. Clinical Psychology Review;Clinical Psychology Review, 29(1), 87–100.

    Article  Google Scholar 

  • Feldner, M. T., Babson, K. A., Zvolensky, M. J., Vujanovic, A. A., Lewis, S. F., Gibson, L. E., et al. (2007a). Posttraumatic stress symptoms and smoking to reduce negative affect: an investigation of trauma-exposed daily smokers. Addictive Behaviors, 32(2), 214–227.

    Article  PubMed  Google Scholar 

  • Feldner, M. T., Monson, C. M., & Friedman, M. J. (2007b). A critical analysis of approaches to targeted PTSD prevention: current status and theoretically derived future directions. Behavior Modification;Behavior Modification, 31(1), 80–116.

    Article  Google Scholar 

  • Foa, E. B., Cashman, L., Jaycox, L., & Perry, K. (1997). The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. Psychological Assessment, 9(4), 445–451.

    Article  Google Scholar 

  • Foa, E. B., Riggs, D. S., Massie, E. D., & Yarczower, M. (1995). The impact of fear activation and anger on the efficacy of exposure treatment for posttraumatic stress disorder. Behavior Therapy, 26(3), 487–499.

    Article  Google Scholar 

  • Follette, V., Palm, K. M., & Pearson, A. N. (2006). Mindfulness and trauma: implications for treatment. Journal of Rational-Emotive & Cognitive Behavior Therapy, 24(1), 45–61.

    Article  Google Scholar 

  • Frewen, P., Lundberg, E., MacKinley, J., & Wrath, A. (2011). Assessment of response to mindfulness meditation: meditation breath attention scores in association with subjective measures of state and trait mindfulness and difficulty letting go of depressive cognition. Mindfulness, 2(4), 254–269.

    Article  Google Scholar 

  • Geschwind, N., Peeters, F., Drukker, M., van Os, J., & Wichers, M. (2011). Mindfulness training increases momentary positive emotions and reward experience in adults vulnerable to depression: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 79(5), 618–628.

    Article  PubMed  Google Scholar 

  • Gillanders, D. T., Bolderston, H., Bond, F. W., Dempster, M., Flaxman, P. E., Campbell, L., et al. (2014). The development and initial validation of the cognitive fusion questionnaire. Behavior Therapy, 45(1), 83–101.

    Article  PubMed  Google Scholar 

  • Gilpin, R. (2008). The use of theravāda buddhist practices and perspectives in mindfulness-based cognitive therapy. Contemporary Buddhism, 9(2), 227–251.

    Article  Google Scholar 

  • Grossman, P. (2011). Defining mindfulness by how poorly I think I pay attention during everyday awareness and other intractable problems for psychology’s (re) invention of mindfulness: comment on brown et al. (2011). Psychological Assessment, 23(4), 1034–1040.

    Article  PubMed  Google Scholar 

  • Hadash, Y., Plonsker, R., Vago, D. R., & Bernstein, A. (2016). Experiential self-referential and selfless processing in mindfulness and mental health: conceptual model and implicit measurement methodology. Psychological Assessment, 28, 856–869.

    Article  PubMed  Google Scholar 

  • Hayes, S. C., Strosahl, K., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., et al. (2004). Measuring experiential avoidance: a preliminary test of a working model. The Psychological Record, 54(4), 553–578.

    Article  Google Scholar 

  • Hölzel, B. K., Lazar, S. W., Gard, T., Schuman-Olivier, Z., Vago, D. R., & Ott, U. (2011). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science, 6(6), 537–559.

    Article  PubMed  Google Scholar 

  • Jha, A. P., Stanley, E. A., Kiyonaga, A., Wong, L., & Gelfand, L. (2010). Examining the protective effects of mindfulness training on working memory capacity and affective experience. Emotion, 10(1), 54–64.

    Article  PubMed  Google Scholar 

  • Josefsson, T., Lindwall, M., & Broberg, A. G. (2014). The effects of a short-term mindfulness based intervention on self-reported mindfulness, decentering, executive attention, psychological health, and coping style: examining unique mindfulness effects and mediators. Mindfulness, 5(1), 18–35.

    Article  Google Scholar 

  • Kabat-Zinn, J. (1990). Full catastrophe living: using the wisdom of your mind and body to face stress, pain, and illness. New York: Delacorte.

  • Kalill, K. S., Treanor, M., & Roemer, L. (2014). The importance of non-reactivity to posttraumatic stress symptoms: a case for mindfulness. Mindfulness, 5, 314–321.

    Article  Google Scholar 

  • Kearney, D. J., McDermott, K., Malte, C., Martinez, M., & Simpson, T. L. (2012). Association of participation in a mindfulness program with measures of PTSD, depression and quality of life in a veteran sample. Journal of Clinical Psychology, 68(1), 101–116.

    Article  PubMed  Google Scholar 

  • Kenny, D. A., Korchmaros, J. D., & Bolger, N. (2003). Lower level mediation in multilevel models. Psychological Methods, 8(2), 115–128.

    Article  PubMed  Google Scholar 

  • Kimbrough, E., Magyari, T., Langenberg, P., Chesney, M., & Berman, B. (2010). Mindfulness intervention for child abuse survivors. Journal of Clinical Psychology, 66(1), 17–33.

    PubMed  Google Scholar 

  • King, A. P., Erickson, T. M., Giardino, N. D., Favorite, T., Rauch, S. A., Robinson, E., & Liberzon, I. (2013). A pilot study of group mindfulness-based cognitive therapy (MBCT) for combat veterans with posttraumatic stress disorder (PTSD). Depression and Anxiety, 30(7), 638–645.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kiyota, M. (1991). Mahayana buddhist meditation: theory and practice. Motilal Banarsidass Publ.

  • Knowles, R., Tai, S., Christensen, I., & Bentall, R. (2005). Coping with depression and vulnerability to mania: a factor analytic study of the Nolen-Hoeksema (1991) response styles questionnaire. British Journal of Clinical Psychology, 44(1), 99–112.

    Article  PubMed  Google Scholar 

  • MacKinnon, D. P., Fritz, M. S., Williams, J., & Lockwood, C. M. (2007). Distribution of the product confidence limits for the indirect effect: program PRODCLIN. Behavior Research Methods, 39(3), 384–389.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mahasi, S. (1978). Practical vipassanā meditational exercises. Rangoon, MM: Buddhasāsanānuggaha Association.

  • Manicavasagar, V., Perich, T., & Parker, G. (2012). Cognitive predictors of change in cognitive behaviour therapy and mindfulness-based cognitive therapy for depression. Behavioural and Cognitive Psychotherapy, 40(2), 227–232.

    Article  PubMed  Google Scholar 

  • McFarlane, A. C., & Yehuda, R. A. (1996). Resilience, vulnerability, and the course of posttraumatic reactions. In B. A. van der kolk, A. C. McFarlane, & L. Weisaeth (Eds.), Traumatic stress (pp. 155–181). New York: Guilford press.

    Google Scholar 

  • Mennin, D. S., & Fresco, D. M. (2013). What, me worry and ruminate about DSM-5 and RDoC? The importance of targeting negative self-referential processing. Clinical Psychology: Science and Practice, 20(3), 258–267.

    Google Scholar 

  • Nitzan-Assayag, Y., Aderka, I. M., & Bernstein, A. (2015). Dispositional mindfulness in trauma recovery: prospective relations and mediating mechanisms. Journal of Anxiety Disorders, 36, 25–32.

    Article  PubMed  Google Scholar 

  • Nolen-Hoeksema, S., & Morrow, J. (1991). A prospective study of depression and posttraumatic stress symptoms after a natural disaster: the 1989 Loma prieta earthquake. Journal of Personality and Social Psychology, 61(1), 115–121.

    Article  PubMed  Google Scholar 

  • Nolen-Hoeksema, S., Parker, L. E., & Larson, J. (1994). Ruminative coping with depressed mood following loss. Journal of Personality and Social Psychology, 67(1), 92–104.

    Article  PubMed  Google Scholar 

  • Ogden, P., Pain, C., & Fisher, J. (2006). A sensorimotor approach to the treatment of trauma and dissociation. Psychiatric Clinics of North America, 29(1), 263–279.

    Article  PubMed  Google Scholar 

  • Owens, G. P., Walter, K. H., Chard, K. M., & Davis, P. A. (2012). Changes in mindfulness skills and treatment response among veterans in residential PTSD treatment. Psychological Trauma: Theory, Research, Practice, and Policy, 4(2), 221–228.

    Article  Google Scholar 

  • Polusny, M. A., Erbes, C. R., Thuras, P., Moran, A., Lamberty, G. J., Collins, R. C., … & Lim, K. O. (2015). Mindfulness-based stress reduction for posttraumatic stress disorder among veterans: a randomized clinical trial. JAMA, 314(5), 456–465.

  • Possemato, K., Bergen-Cico, D., Treatman, S., Allen, C., Wade, M., & Pigeon, W. (2016). A randomized clinical trial of primary care brief mindfulness training for veterans with PTSD. Journal of Clinical Psychology, 72(3), 179–193.

    Article  PubMed  Google Scholar 

  • Rose, S. C., Bisson, J., Churchill, R., & Wessely, S. (2002). Psychological debriefing for preventing post traumatic stress disorder (PTSD). The Cochrane Library.

  • Sayadaw U Pandita (2002). The meaning of satipatthāna. Bangkok, Thailand: Sahadhammika.

  • Schoorl, M., Van Mil-Klinkenberg, L., & Van Der Does, W. (2015). Mindfulness skills, anxiety sensitivity, and cognitive reactivity in patients with posttraumatic stress disorder. Mindfulness, 6(5), 1004–1011.

    Article  Google Scholar 

  • Shalev, A. Y., Ankri, Y. L. E., Peleg, T., Israeli-Shalev, Y., & Freedman, S. (2011). Barriers to receiving early care for PTSD: results from the Jerusalem trauma outreach and prevention study. Psychiatric Services, 62(7), 765–773.

    Article  PubMed  Google Scholar 

  • Shalev, A. Y., Ankri, Y., Israeli-Shalev, Y., Peleg, T., Adessky, R., & Freedman, S. (2012). Prevention of posttraumatic stress disorder by early treatment: results from the Jerusalem trauma outreach and prevention study. Archives of General Psychiatry, 69(2), 166–176.

    Article  PubMed  Google Scholar 

  • Shoham, V., & Insel, T. R. (2011). Rebooting for whom? Portfolios, technology, and personalized intervention. Perspectives on Psychological Science, 6(5), 478–482.

    Article  PubMed  Google Scholar 

  • Shulman, E. (2010). Mindful wisdom: the sati-Patthāna-Sutta on mindfulness, memory, and liberation. History of Religions, 49(4), 393–420.

    Article  Google Scholar 

  • Singer, J. D., & Willett, J. B. (2003). Applied longitudinal data analysis: modeling change and event occurrence Oxford University Press, USA.

  • Tanay, G., Lotan, G., & Bernstein, A. (2012). Salutary proximal processes and distal mood and anxiety vulnerability outcomes of mindfulness training: a pilot preventive intervention. Behavior Therapy, 43(3), 492–505.

    Article  PubMed  Google Scholar 

  • Tanay, G., & Bernstein, A. (2013). State mindfulness scale (SMS): development and initial validation. Psychological Assessment, 25(4), 1286–1299.

    Article  PubMed  Google Scholar 

  • Taylor, S., Zvolensky, M. J., Cox, B. J., Deacon, B., Heimberg, R. G., Ledley, D. R., et al. (2007). Robust dimensions of anxiety sensitivity: development and initial validation of the anxiety sensitivity index-3. Psychological Assessment, 19(2), 176–188.

    Article  PubMed  Google Scholar 

  • Thompson, R. W., Arnkoff, D. B., & Glass, C. R. (2011). Conceptualizing mindfulness and acceptance as components of psychological resilience to trauma. Trauma, Violence, & Abuse, 12(4), 220–235.

    Article  Google Scholar 

  • Thompson, B. L., & Waltz, J. (2010). Mindfulness and experiential avoidance as predictors of posttraumatic stress disorder avoidance symptom severity. Journal of Anxiety Disorders;Journal of Anxiety Disorders, 24(4), 409–415.

    Article  Google Scholar 

  • Tofighi, D., & MacKinnon, D. P. (2011). RMediation: an R package for mediation analysis confidence intervals. Behavior Research Methods, 43(3), 692–700.

    Article  PubMed  PubMed Central  Google Scholar 

  • Vago, D. R., & Silbersweig, D. A. (2012). Self-awareness, self-regulation, and self-transcendence (S-ART): a framework for understanding the neurobiological mechanisms of mindfulness. Frontiers in Human Neuroscience, 6, 296.

    Article  PubMed  PubMed Central  Google Scholar 

  • Vujanovic, A. A., Niles, B., Pietrefesa, A., Schmertz, S. K., & Potter, C. M. (2013). Mindfulness in the treatment of posttraumatic stress disorder among military veterans. Spirituality in Clinical Practice, (1)15–25.

  • Vujanovic, A. A., Youngwirth, N. E., Johnson, K. A., & Zvolensky, M. J. (2009). Mindfulness-based acceptance and posttraumatic stress symptoms among trauma-exposed adults without axis I psychopathology. Journal of Anxiety Disorders;Journal of Anxiety Disorders, 23(2), 297–303.

    Article  Google Scholar 

  • Walser, R. D., & Westrup, D. (2007). Acceptance & commitment therapy for the treatment of post-traumatic stress disorder and trauma-related problems: a practitioner’s guide to using mindfulness and acceptance strategies. Oakland, CA, US: New Harbinger Publications.

    Google Scholar 

  • Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: the PANAS scales. Journal of Personality and Social Psychology, 54(6), 1063–1075.

    Article  PubMed  Google Scholar 

  • Watson, D., O’Hara, M. W., Simms, L. J., Kotov, R., Chmielewski, M., McDade-Montez, E. A., et al. (2007). Development and validation of the inventory of depression and anxiety symptoms (IDAS). Psychological Assessment, 19(3), 253–268.

  • Watson, D. (2000). Mood and temperament. New York: Guilford Press.

  • Wegner, D. M., & Zanakos, S. (1994). Chronic thought suppression. Journal of Personality, 62(4), 615–640.

    Article  Google Scholar 

  • Weinstein, N., Brown, K. W., & Ryan, R. M. (2009). A multi-method examination of the effects of mindfulness on stress attribution, coping, and emotional well-being. Journal of Research in Personality, 43(3), 374–385.

    Article  Google Scholar 

  • Wenzlaff, R. M., & Wegner, D. M. (2000). Thought suppression. Annual Review of Psychology, 51(1), 59–91.

    Article  PubMed  Google Scholar 

  • Whitfield-Gabrieli, S., & Ford, J. M. (2012). Default mode network activity and connectivit in psychopathology. Annual Review of Clinical Psychology, 8, 49–76.

    Article  PubMed  Google Scholar 

  • Williams, J. M. G., Crane, C., Barnhofer, T., Brennan, K., Duggan, D. S., Fennell, M. J., et al. (2014). Mindfulness-based cognitive therapy for preventing relapse in recurrent depression: a randomized dismantling trial. Journal of Consulting and Clinical Psychology, 82(2), 275–286.

  • Zvolensky, M. J., Schmidt, N. B., Bernstein, A., & Keough, M. E. (2006). Risk-factor research and prevention programs for anxiety disorders: a translational research framework. Behaviour Research and Therapy, 44(9), 1219–1239.

    Article  PubMed  Google Scholar 

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Nitzan-Assayag, Y., Yuval, K., Tanay, G. et al. Reduced Reactivity to and Suppression of Thoughts Mediate the Effects of Mindfulness Training on Recovery Outcomes Following Exposure to Potentially Traumatic Stress. Mindfulness 8, 920–932 (2017). https://doi.org/10.1007/s12671-016-0666-x

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