Elsevier

Journal of Affective Disorders

Volume 165, 20 August 2014, Pages 31-37
Journal of Affective Disorders

Research report
Observing nonreactively: A conditional process model linking mindfulness facets, cognitive emotion regulation strategies, and depression and anxiety symptoms

https://doi.org/10.1016/j.jad.2014.04.024Get rights and content

Abstract

Background

Mindfulness-based interventions for depression and anxiety emphasize the importance of observing present moment experience, but observing has often been positively related to anxiety and unrelated to depression symptoms. The current study sought to better understand the conditions and mechanism through which observing relates to symptoms by examining six conditional process models in which (1) nonreactivity moderates the direct effect of observing on symptoms of anxiety and depression symptoms and (2) nonreactivity moderates the indirect effect of observing on anxiety and depression via cognitive emotion regulation strategies (i.e. rumination, worry, and reappraisal).

Methods

A clinical sample of 189 adults with anxiety and depressive disorders completed the Five Facet Mindfulness Questionnaire, Mood and Anxiety Symptom Questionnaire, Penn State Worry Questionnaire, Ruminative Responses Scale, and Emotion Regulation Questionnaire.

Results

Conditional process models showed that nonreactivity significantly moderated the direct effect of observing on symptoms of depression, but not anxiety. Additionally, nonreactivity significantly moderated the indirect effect of observing on symptoms of depression through rumination and reappraisal, but not worry. For anxiety, nonreactivity significantly moderated the indirect effect of observing on symptoms through worry and rumination, but not reappraisal.

Limitations

Causal interpretations of results are limited.

Conclusion

Findings suggest that the relationship between observing and symptoms of depression and anxiety depends on the capacity to observe nonreactively, which may influence symptoms directly and indirectly through cognitive emotion regulation strategies. Findings raise important implications for tailoring mindfulness-based treatments for anxiety and depression symptoms.

Introduction

The ability to be mindful has been identified as a robust predictor of mental health, with higher levels of mindfulness consistently predicting less depressive and anxious symptomatology (Hofmann et al., 2010, Greeson, 2009). One essential component of mindfulness, by definition, is the capacity to observe or attend to present moment experience, and cultivating this ability is a core component of mindfulness-based treatments for depression and anxiety (e.g., Mindfulness-based Cognitive Therapy (MBCT), Mindfulness-based Stress Reduction (MBSR)). However, the trait tendency to observe one׳s experience (assessed independently of the other mindfulness facets) has shown surprising and somewhat counterintuitive relationships to psychopathology measures. Anxiety symptoms and general psychological distress have been associated with higher levels of the tendency to observe (Baer et al., 2006, Baer et al., 2008, Desrosiers et al., 2013a), whereas depression symptoms have been uncorrelated with observing (Barnhofer et al., 2011, Cash and Whittingham, 2010) or positively correlated with it (Christopher et al., 2012). Given the inconsistency of these relationships, it is important to better understand under what conditions, and through which mechanisms, observing is beneficial. Addressing this gap will have implications for clinicians utilizing mindfulness-based interventions for depression and anxiety because the process of observing present moment experience may not be universally helpful for all patients with these symptoms.

One explanation for the inconsistent relationship between observing and symptoms of depression and anxiety is the “what” versus “how” distinction that is sometimes made when discussing mindfulness (Baer et al., 2008, Linehan, 1993, Mor and Winquist, 2002). In other words, it matters not only whether individuals tend to observe their experiences, but also the way in which they observe. For example, in both Dialectical Behavior Therapy (DBT) and MBCT, patients are instructed to observe their thoughts and feelings in a particular way: allowing them to pass through their minds without an immediate second-order reaction (Linehan, 1998, Segal et al., 2002). This ability to notice or observe internal and external experience without “getting stuck” or fixated is also called nonreactivity (Baer et al., 2006). Although the tendency to observe present moment experience is commonly espoused as beneficial, it may actually be a liability for people without the ability to be nonreactive to their observations, and may only be helpful to those who can observe without reacting. This notion has been explored in substance use disorders, where it appears that effects of observing depended on levels of nonreactivity (i.e., observing was positively related to substance use when nonreactivity was low) (Eisenlohr-Moul et al., 2012). However, the interaction of observing and nonreactivity has not yet been studied with respect to depression and anxiety symptoms.

The reason why observing nonreactively may be beneficial, whereas observing reactively may be a liability, is likely related to processes mediating the relationship of these variables to anxiety and depression symptoms. According to dual-process models of cognition, human beings process information in quick or automatic ways before advancing to more controlled forms of thinking (Chaiken and Trope, 1999; Baumeister and Heatherton, 1996). We propose that observing present moment experience may set the stage for more elaborative cognitive emotion regulatory processes that may follow, such as rumination, worry, and reappraisal. These strategies may be the links that help explain why observing reactively is likely detrimental for mood and anxiety symptoms, while observing nonreactively is likely beneficial. Rumination and worry both involve repetitive negative thinking, with rumination focused more on past experience (Nolen-Hoeksema et al., 2008) and worry focused more on future threats (Borkovec et al., 1983, Borkovec et al., 1998, Watkins, 2008); reappraisal involves reframing emotional experience in a way that positively alters the impact of that experience (Gross, 1998). People who react immediately to their observations may become stuck worrying or ruminating about them. For instance, a reactive individual may notice an interoceptive sensation such as shortness of breath and begin worrying about its implications, thus elevating anxiety (Dunn et al., 2010, Brosschot et al., 2006). Another reactive individual might observe a mood state such as sadness and begin ruminating about what caused the feeling, thereby elevating depression (Nolen-Hoeksema et al., 2008). In contrast, the ability to observe nonreactively might allow an individual to “pause” after making an observation, interrupting the link to these maladaptive forms of elaborative processing and creating an opportunity for more adaptive forms of thinking like reappraisal.

We synthesize our predictions in the moderated mediation (or “conditional process”) model, depicted conceptually in Fig. 1. We posit that the ability to be nonreactive moderates the relationship between observing and symptoms of depression and anxiety, and that this relationship is mediated by cognitive emotion regulatory responses such as worry, rumination, and reappraisal. These predictions are consistent with existing theory and research on the mechanisms of mindfulness. Theoretically, cultivating mindfulness is considered helpful because it decreases overengagement with distressing thoughts and emotions (e.g., worry, rumination) (Segal et al., 2002, Kabat-Zinn, 1990, Teasdale, 1999) and facilitates positive or neutral appraisals of experience (e.g., reappraisal) (Garland et al., 2011). Accordingly, the cognitive emotion regulation strategies rumination, worry, and reappraisal have been previously identified as possible mechanisms through which trait mindfulness influences symptom levels (Garland et al., 2011, Hölzel et al., 2011, Desrosiers et al., 2013b). Rumination significantly mediated associations between trait mindfulness and both anxiety and depression symptoms, reappraisal significantly mediated associations between mindfulness and depression symptoms, and worry mediated associations between mindfulness and anxiety symptoms (Desrosiers et al., 2013b). Additionally, reductions in rumination and worry during MBCT mediated reductions in depression symptoms (Van Aalderen et al., 2012), and increases in reappraisal and decreases in rumination during Mindfulness and Acceptance-based Group Therapy (MAGT) predicted decreased anxiety symptoms (Kocovski et al., 2013). However, the mediating roles of rumination, worry, and reappraisal have only been investigated to date with respect to mindfulness more broadly, not the observing component of mindfulness specifically. Scholars now widely advocate a more fine-grained analysis of the facets of mindfulness as a means of discovering how this complex phenomenon works and for informing mindfulness-based interventions (Baer et al., 2008, Fernandez et al., 2010, Kuyken et al., 2010). In the present study, we embrace this fine-grained approach by focusing on the interactive relationship between two mindfulness facets, observing and nonreactivity, and the cognitive processes that may explain its relation to depression and anxiety symptoms.

The current investigation aimed to address gaps in existing knowledge about the relationship between observing and depression and anxiety symptoms by examining a novel conditional process model in a clinical sample of adults. Based on previous research and theory, we hypothesized that: (a) nonreactivity would moderate the effects of observing on both anxiety and depression symptoms; (b) nonreactivity would moderate the effects of observing on cognitive emotion regulation variables: reappraisal, rumination, worry; and (c) nonreactivity would moderate the mediation effects on depression and anxiety symptoms by cognitive emotion regulation variables (reappraisal, rumination, and worry). Specifically, we predicted that conditional effects on rumination and reappraisal would mediate effects of observing on depression, and conditional effects on rumination and worry would mediate effects of observing on anxiety. These hypotheses draw on previous findings that rumination operates as a transdiagnostic mediator with respect to depression and anxiety symptoms (Desrosiers et al., 2013b, McLaughlin and Nolen-Hoeksema, 2011), whereas reappraisal is more specific to depression and worry more specific to anxiety (Watkins, 2008, Desrosiers et al., 2013b, Aldao and Nolen-Hoeksema, 2010). Regarding moderation effects, we predicted that observing would be negatively related to maladaptive indices (i.e., depression, anxiety, rumination, and worry) among reactive individuals (i.e., those low in nonreactivity), and positively related to reappraisal among nonreactive individuals.

We examined these hypotheses in a clinical sample because of the high clinical relevance of our research question. Understanding the mechanisms through which observing may alleviate or exacerbate symptoms of depression and anxiety and the conditions under which this occurs is essential for identifying “what works and for whom” in a treatment context. Additionally, it is possible that the conditions under which observing is beneficial may differ between clinical and community samples.

Section snippets

Participants

The sample comprised 189 adults ages 18–71 (M=38, SD=14.2) presenting for treatment at a mood and anxiety disorders clinic in Connecticut. Women constituted 64.6% of the sample. Participants identified as white (non-Hispanic; 78.8%), African-American (7.4%), Hispanic (8.5%), and ‘other (3.7%). According to structured clinical interviews for DSM-IV Axis I disorders (SCID-I) [34] administered by advanced doctoral student clinicians, the most prevalent Axis I diagnoses were generalized anxiety

Preliminary analyses

Descriptive statistics and bivariate correlations for all study variables are presented in Table 1. Independent samples t-tests showed no significant differences in mean scores according to gender. Age and race were not significantly correlated with any study variables.

Conditional direct effects: depression and anxiety symptoms

Results from the six moderated mediation models were largely consistent with our prediction that observing nonreactively would be positively associated with adaptive outcomes and negatively associated with maladaptive outcomes.

Discussion

The present study provides the first systematic examination of the inconsistent, and sometimes counterintuitive, relationship found to date between observing and symptoms of depression and anxiety (Baer et al., 2006, Baer et al., 2008, Desrosiers et al., 2013a, Brosschot et al., 2006, Cash and Whittingham, 2010, Christopher et al., 2012). We proposed that symptom levels depend not only on the tendency to observe, but also on the ability to observe without reacting to observations immediately,

Role of funding source

The authors confirm that there was no funding source supporting the current study.

Conflict of interest

The authors confirm that we have no conflicts of interest that could be interpreted as influencing the current research.

Acknowledgments

The authors wish to acknowledge the support of the research staff at Yale Anxiety and Mood Disorder Services for their assistance in collection of data analyzed in this paper.

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