An Investigation of Sequencing Effects in Combining Cognitive Questioning and Mindful Acceptance
- 14 Downloads
Cognitive-behavioral treatments assume that the mechanisms of change depend on the assessment and questioning of biased beliefs. In contrast, recent developments have emphasized mindful acceptance interventions, in which clients allow thoughts to come and go without questioning them. In order to discuss therapeutic efficacy difference in emotional disorders, we explored the possible normalizing effects of cognitive questioning and mindful acceptance on sympathetic reactivity aroused by recall tasks. We compared the effects of different sequencing of cognitive questioning and mindful acceptance on emotional distress in two groups in which questioning either preceded (group 1) or followed (group 2) acceptance. Thirty-five non-clinical individuals (21 males, 14 females) randomly allocated to either group 1 or 2 participated in the experimental tasks (unpleasant recall, cognitive questioning, and metacognitive acceptance). Sympathetic reactivity levels were measured using galvanic skin response. Results showed that acceptance reduced sympathetic reactivity when compared to questioning. The best sequence was that in which questioning preceded acceptance. By interpreting sympathetic reactivity as a measure of emotional distress and experimental tasks as models for therapeutic approaches, this experiment suggests that acceptance is better than questioning in reducing emotional distress especially when cognitive questioning is followed by mindful acceptance.
KeywordsAcceptance Cognitive therapy Metacognition Questioning Sympathetic reactivity
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflicts of interest.
- Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571. https://doi.org/10.1001/archpsyc.1961.01710120031004.CrossRefPubMedGoogle Scholar
- Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). New York: Guilford.Google Scholar
- Burns, M. K., VanDerHeyden, A. M., & Boice, C. H. (2008). Best practices in intensive academic interventions. In A. Thomas & J. Grimes (Eds.), Best practices in school psychology V (pp. 1151–1162). Bethesda, MD: National Association of School Psychologists.Google Scholar
- Clark, D. A., Beck, A. T., & Alford, B. A. (1999). Scientific foundations of cognitive theory and therapy of depression. New York: Wiley.Google Scholar
- Cuijpers, P., Weitz, E., Twisk, J., Kuehner, C., Cristea, I., David, D., et al. (2014). Gender as predictor and moderator of outcome in cognitive behavior therapy and pharmacotherapy for adult depression: an “individual patient data” meta-analysis. Depression and Anxiety, 31(11), 941–951. https://doi.org/10.1002/da.22328.CrossRefPubMedGoogle Scholar
- DiGiuseppe, R., Doyle, K. A., Dryden, W., & Backx, W. (2014). A practioner’s guide to rational emotive behavior therapy. New York: Oxford University Press.Google Scholar
- Ellis, A. (1962). Reason And emotion in psychotherapy. Secaucus, NJ: The Citadel Press.Google Scholar
- Ellis, A., & Grieger, R. (Eds.). (1977). Handbook of rational emotive therapy. New York: Springer.Google Scholar
- Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and commitment therapy. New York: Guilford.Google Scholar
- Hollon, S. D., Stewart, M. O., & Strunk, D. (2006). Enduring effects for cognitive behavior therapy in the treatment of depression and anxiety. Annual Review of Psychology, 57, 285–315. https://doi.org/10.1146/annurev.psych.57.102904.190044.CrossRefPubMedGoogle Scholar
- Kagan, J., Snidman, N., & Arcus, D. (1998). Childhood derivatives of high and low reactivity in infancy. Child Development, 69, 1483–1493. https://doi.org/10.1111/j.1467-8624.1998.tb06171.x.CrossRefPubMedGoogle Scholar
- Lee, H. J., & Turkel, J. E. (2013). Treatment of anxiety and comorbid cluster a personality disorders. In E. A. Storch & D. McKay (Eds.), Handbook of treating variants and complications in anxiety disorders (pp. 223–241). New York: Springer.Google Scholar
- Levitt, J. T., Brown, T. A., Orsillo, S. M., & Barlow, D. H. (2004). The effects of acceptance versus suppression of emotion on subjective and psychophysiological response to carbon dioxide challenge in patients with panic disorder. Behaviour Therapy, 35, 747–766. https://doi.org/10.1016/s0005-7894(04)80018-2.CrossRefGoogle Scholar
- Molina, S., & Borkovec, T. D. (1994). “The Penn State Worry Questionnaire: Psychometric properties and associated characteristics. In G. Davey & F. Tallis (Eds.), Worrying: Perspectives on theory, assessment and treatment (pp. 265–283). New York: Wiley.Google Scholar
- Otte, C. (2011). Cognitive behavioral therapy in anxiety disorders: Current state of the evidence. Dialogues in Clinical Neurosciences., 13, 413–421.Google Scholar
- Palmieri, R., Gasparre, A., & Lanciano, T. (2007). Una misura disposizionale della ruminazione depressiva: la RRS di Nolen-Hoeksema e Morrow [A questionnaire to assess dispositional depressive rumination: Nolen-Hoeksema and Morrow’s RRS]. Psychofenia, 17, 15–33.Google Scholar
- Pedrabissi, L., & Santinello, M. (1989). STAI manual. Italian adaptation. Firenze: Organizzazioni Speciali.Google Scholar
- Rosenbaum, J. F., Biederman, J., Gersten, M., Hirschfeld-Becker, D. R., Meninger, S. R., Herman, J. B., et al. (1988). Behavioral inhibition in children of parents with panic disorder and agoraphobia: A control study. Archives of General Psychiatry, 45, 463–470. https://doi.org/10.1001/archpsyc.1988.01800290083010.CrossRefPubMedGoogle Scholar
- Spielmans, G. I., Benish, S. G., Marin, C., Bowman, W. M., Menster, M., & Wheeler, A. J. (2013). Specificity of psychological treatments for bulimia nervosa and binge eating disorder? A meta-analysis of direct comparisons. Clinical Psychology Review, 33(3), 460–469. https://doi.org/10.1016/j.cpr.2013.01.008.CrossRefPubMedGoogle Scholar
- Sukhodolsky, D. G., Golub, A., & Cromwell, E. N. (2001). Development and validation of the anger rumination scale. Personality and Individual Differences, 31, 689–700. https://doi.org/10.1016/s0191-8869(00)00171-9. (M. Baldetti, C. Bartolozzi, Trans. (2010). La validazione Italiana della Anger Rumination Scale. [dissertation/master’s thesis]. [Firenze (IT)]: Scuola Cognitiva di Firenze Post Graduate Cognitive Psychotherapy School).
- Wells, A. (2009). Metacognitive therapy for anxiety and depression. New York: Guilford Press.Google Scholar