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.
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Beck, A. T., Steer, R. A., & Garbin, M. G. (1988). Psychometric properties of the Beck depression inventory: Twenty-five years of evaluation. Clinical Psychology Review, 8, 77–100. https://doi.org/10.1016/0272-7358(88)90050-5.
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.
Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). New York: Guilford.
Braithwaite, J. J., Watson, D. G., Jones, R., & Rowe, M. (2013). A guide for analysing electrodermal activity (EDA) & skin conductance responses (SCRs) for psychological experiments. Psychophysiology, 49, 1017–1034. https://doi.org/10.1007/s10439-016-1606-6.
Burns, A., O’Mahen, H., Baxter, H., Bennert, K., Wiles, N., Ramchandani, P., et al. (2013). A pilot randomised controlled trial of cognitive behavioural therapy for antenatal depression. BMC Psychiatry, 13, 33. https://doi.org/10.1186/1471-244x-13-33.
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.
Clark, D. A., Beck, A. T., & Alford, B. A. (1999). Scientific foundations of cognitive theory and therapy of depression. New York: Wiley.
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.
DiGiuseppe, R., Doyle, K. A., Dryden, W., & Backx, W. (2014). A practioner’s guide to rational emotive behavior therapy. New York: Oxford University Press.
Dobson, D. J. G. (2013a). In-session structure and collaborative empiricism. Cognitive Behavioral Practice, 20, 410–418. https://doi.org/10.1016/j.cbpra.2012.11.002.
Dobson, D. J. G. (2013b). The effects of acceptance versus control contexts on avoidance of panic-related symptoms. Journal of Behavioral Therapy and Experimental Psychology, 34, 293–312. https://doi.org/10.1016/j.jbtep.2003.11.001.
Ellis, A. (1962). Reason And emotion in psychotherapy. Secaucus, NJ: The Citadel Press.
Ellis, A., & Grieger, R. (Eds.). (1977). Handbook of rational emotive therapy. New York: Springer.
Emmelkamp, P. M. G. (1993). Technical advances in behavioral psychotherapy of obsessive-compulsive disorders. Psychotherapy and Psychosomatics, 60, 57–61. https://doi.org/10.1159/000288680.
Fonagy, P., & Bateman, A. W. (2006). Mechanisms of change in mentalization-based treatment of BPD. Journal of Clinical Psychology, 62, 411–430. https://doi.org/10.1002/jclp.20241.
Gkika, S., & Wells, A. (2015). How to deal with negative thoughts? A preliminary comparison of detached mindfulness and thought evaluation in socially anxious individuals. Cognitive and Therapy Research, 39, 23–30. https://doi.org/10.1007/s10608-014-9637-5.
Grant, A., Townend, M., Mulhern, R., & Short, N. (2010). Cognitive behavioural therapy in mental health care (2nd ed.). London: Sage.
Gutiérrez, O., Luciano, C., Rodríguez-Valverde, M., & Fink, B. C. (2004). Comparison between an acceptance-based and a cognitive-control-based protocol for coping with pain. Behaviour Therapy, 35, 767–783. https://doi.org/10.1016/s0005-7894(04)80019-4.
Haaga, D. A., Dyck, M. J., & Ernst, D. (1991). Empirical status of cognitive theory of depression. Psychoogical Bullettin, 110(2), 215–236. https://doi.org/10.1037/0033-2909.110.2.215.
Hayes, S. C., Luoma, J., Bond, F., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes, and outcomes. Behaviour Research and Therapy, 44(1), 1–25. https://doi.org/10.1016/j.brat.2005.06.006.
Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and commitment therapy. New York: Guilford.
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.
Just and Alloy. (1997). The response styles theory of depression: Tests and an extension of the theory. Journal of Abnormal Psychology, 106(2), 221–229.
Kagan, J., & Snidman, N. (1999). Early childhood predictors of adult anxiety disorders. Biological Psychiatry, 46, 1536–1541. https://doi.org/10.1016/s0006-3223(99)00137-7.
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.
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.
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.
Lo Verde, R., Sarracino, D., & Vigorelli, M. (2012). Therapeutic cycles and referential activity in the analysis of the therapeutic process. Research in Psychotherapy: Psychopathology, Process and Outcome, 15(1), 22–31. https://doi.org/10.4081/ripppo.2012.99.
Meloni, F., & Gana, K. (2001). Wording effects in the Italian version of the Penn State Worry Questionnaire. Clinical Psychology and Psychotherapy, 8(4), 282–287. https://doi.org/10.1002/cpp.294.
Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research Therapy, 28, 487–495. https://doi.org/10.1016/0005-7967(90)90135-6.
Mick, M. A., & Telch, M. J. (1998). Social anxiety and the history of behavioral inhibition in young adults. Journal of Anxiety Disorders, 12, 1–20. https://doi.org/10.1016/s0887-6185(97)00046-7.
Molenaar, I., & Chiu, M. M. (2014). Dissecting sequences of regulation and cognition: statistical discourse analysis of primary school children’s collaborative learning. Metacognition and Learning, 9, 137–190. https://doi.org/10.1007/s11409-013-9105-8.
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.
Montague, M. (1992). The effects of cognitive and metacognitive strategy instruction on the mathematical problem solving of middle school students with learning disabilities. Journal of Learning Disabilities, 25, 230–248. https://doi.org/10.1177/002221949202500404.
Montague, M., & Dietz, S. (2009). Evaluating the evidence base for cognitive strategy instruction an mathematical problem solving. Exceptional Children, 75, 285–302. https://doi.org/10.1177/001440290907500302.
Nolan, S. A., Roberts, J. E., & Gotlib, I. H. (1998). Neuroticism and ruminative response style as predictors of change in depressive symptomatology. Cognitive Therapy and Research, 22, 445–455. https://doi.org/10.1023/a:1018769531641.
Nolen-Hoeksema, S., & Davis, C. G. (1999). ‘Thanks for sharing that’: Ruminators and their social support network. Journal Personality and Social Psychology, 77, 801–814. https://doi.org/10.1037/0022-3518.104.22.1681.
Nolen-Hoeksema, S., & Morrow, J. A. (1991). Prospective study of depression and posttraumatic stress symptoms after a natural disaster: The 1989 Loma Prieta earthquake. Journal Personality and Social Psychology., 61, 115–121. https://doi.org/10.1037/0022-3522.214.171.124.
Otte, C. (2011). Cognitive behavioral therapy in anxiety disorders: Current state of the evidence. Dialogues in Clinical Neurosciences., 13, 413–421.
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.
Pedrabissi, L., & Santinello, M. (1989). STAI manual. Italian adaptation. Firenze: Organizzazioni Speciali.
Perrin, S., & Last, C. G. (1992). Do childhood anxiety measures measure anxiety? Journal of Abnormal Child Psychology, 20, 567–578. https://doi.org/10.1007/bf00911241.
Renaud, J., Dobson, K. S., & Drapeau, M. (2013). Cognitive therapy for depression: Coping style matters. Counselling and Psychotherapy Research, 14(1), 42–47. https://doi.org/10.1080/14733145.2012.758754.
Richards, J. C., & Bertram, S. (2000). Anxiety sensitivity, state and trait anxiety, and perception of change in sympathetic nervous system arousal. Journal of Anxiety Disorders, 14, 413–427.
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.
Roth, W. T., Doberenz, S., Dietel, A., Conrad, A., Mueller, A., Wollburg, E., et al. (2008). Sympathetic activation in broadly defined generalized anxiety disorder. Journal of Psychiatric Research, 42, 205–212. https://doi.org/10.1016/j.jpsychires.2006.12.003.
Shurick, A. A., Hamilton, J. R., Harris, L. T., Roy, A. K., Gross, J. J., & Phelps, E. A. (2012). Durable effects of cognitive restructuring on conditioned fear. Emotion, 12(6), 1393–1397. https://doi.org/10.1037/a0029143. Epub 2012 Jul 9.
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.
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. (2005). Detached mindfulness in cognitive therapy: A metacognitive analysis and ten techniques. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 23, 337–355. https://doi.org/10.1080/14733145.2012.758754.
Wells, A. (2009). Metacognitive therapy for anxiety and depression. New York: Guilford Press.
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Borlimi, R., Benetka, G., Brighetti, G. et al. An Investigation of Sequencing Effects in Combining Cognitive Questioning and Mindful Acceptance. J Rat-Emo Cognitive-Behav Ther 37, 284–298 (2019). https://doi.org/10.1007/s10942-018-0312-8
- Cognitive therapy
- Sympathetic reactivity