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Mindfulness Skills, Anxiety Sensitivity, and Cognitive Reactivity in Patients with Posttraumatic Stress Disorder

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Abstract

In trauma-exposed individuals, those with relatively high levels of mindfulness skills tend to have lower levels of symptoms. Mindfulness has also been associated with decreased anxiety sensitivity and cognitive reactivity, and vulnerability factors related to posttraumatic and depressive symptom severity. In this cross-sectional study, our aim was to further investigate the associations among mindfulness skills, anxiety sensitivity, cognitive reactivity, and symptom severity in patients with posttraumatic stress disorder (PTSD). Outpatients with PTSD (N = 101) filled out questionnaires. All facets of mindfulness correlated negatively with reactivity measures and with symptom severity, except for the facet observe. In hierarchical multiple regression analysis, describe, non-judgment, and non-reactivity predicted PTSD symptom severity above and beyond anxiety sensitivity and trauma exposure severity. Describe, act with awareness, and non-judgment also predicted depressive symptom severity above and beyond cognitive reactivity and number of experienced traumatic events. In conclusion, mindfulness skills were indeed uniquely related to symptom severity and cognitive reactivity measures. Our results furthermore support a five-facet model of mindfulness. In addition, the outcomes are a cross-cultural contribution to research on the relevance of mindfulness skills in the treatment of PTSD.

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References

  • American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.) Washington, DC: Author.

  • Andrews, B., Brewin, C. R., Rose, S., & Kirk, M. (2000). Predicting PTSD symptoms in of victims of violent crime: the role of shame, anger and childhood abuse. Journal of Abnormal Psychology, 109, 69–73.

    Article  PubMed  Google Scholar 

  • Arch, J. J., & Craske, M. G. (2010). Laboratory stressors in clinically anxious and non-anxious individuals: the moderating role of mindfulness. Behaviour Research and Therapy, 48, 495–505.

    Article  PubMed  Google Scholar 

  • Arrindell, W. A., & Albersnagel, F. A. (1987). Anxiety sensitivity inventory. Groningen: International Diagnostic Systems.

    Google Scholar 

  • Baer, R. A., & Smith, G. T. (2004). Assessment of mindfulness by self report: the Kentucky inventory of mindfulness skills. Assessment, 11, 191–206.

    Article  PubMed  Google Scholar 

  • Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13, 27–45.

    Article  PubMed  Google Scholar 

  • Batten, S. V., Orsillo, S. M., & Walser, R. D. (2006). Acceptance and mindfulness-based approaches to the treatment of posttraumatic stress disorder. In S. M. Orsillo & L. Roemer (Eds.), Acceptance- and mindfulness-based approaches to anxiety: conceptualization and treatment (pp. 241–269). New York: Springer.

    Google Scholar 

  • Baum, C., Kuyken, W., Bohus, M., Heidenreich, T., Michalak, J., & Steil, R. (2009). The psychometric properties of the Kentucky inventory of mindfulness skills in clinical populations. Assessment, 17, 220–229.

    Article  PubMed  Google Scholar 

  • Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck depression inventory (2nd ed.). San Antonio: The Psychological Corporation.

    Google Scholar 

  • Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., Segal, Z. V., Abbey, S., Speca, M., Velting, D., & Devins, G. (2004). Mindfulness: a proposed operational definition. Clinical Psychology: Science and Practice, 11(3), 230–241.

    Google Scholar 

  • Blake, D.D., Weathers, F.W., Nagy, L.N., Kaloupek, D.G., Klauminzer, G., Charney, D.S., & Keane, T.M. (1990). Clinician Administered PTSD Scale (CAPS). National Center for Posttraumatic Stress Disorder, Behavioral Science Division-Boston.

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

  • Bryant, R. A., & Guthrie, R. M. (2007). Maladaptive self-appraisals before trauma exposure predict posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 75(5), 812–815.

    Article  PubMed  Google Scholar 

  • Cardaciotto, L., Herbert, J. D., Forman, E. M., Moitra, E., & Farrow, V. (2008). The assessment of present-moment awareness and acceptance: the Philadelphia mindfulness scale. Assessment, 15(2), 204–223. doi:10.1177/1073191107311467.

    Article  PubMed  Google Scholar 

  • Cash, M., & Wittingham, K. (2010). What facets of mindfulness contribute to psychological well-being and depressive, anxious, and stress-related symptomatology? Mindfulness, 1(3), 177–182.

  • Chiesa, A., & Serreti, A. (2011). Mindfulness-based cognitive therapy for psychiatric disorders: a systematic review and meta-analysis. Psychiatry Research, 187, 441–453. doi:10.1016/j. psychres.2010.08.011.

    Article  PubMed  Google Scholar 

  • Davidson, J. R. T., & Foa, E. B. (Eds.). (1993). Posttraumatic stress disorder: DSM-IV and beyond. Washington: American Psychiatric Press.

    Google Scholar 

  • Dekeyser, M., Raes, F., Leissen, M., Leysen, S., & Dewulf, D. (2008). Mindfulness and interpersonal behaviour: evaluation of the Dutch version of the Kentucky inventory of mindfulness skills (KIMS). Personality and Individual Differences, 44, 1235–1245.

    Article  Google Scholar 

  • Fjorback, L. O., Arendt, M., Ørnbøl, E., Fink, P., & Walach, H. (2011). Mindfulness-based stress reduction and mindfulness-based cognitive therapy—a systematic review of randomized controlled trials. Acta Psychiatrica Scandinavica, 124, 102–119. doi:10.1111/j.1600-0447.2011.01704.x.

    Article  PubMed  Google Scholar 

  • Foa, E. B., Tolin, D. F., Ehlers, A., Clark, D. M., & Orsillo, S. M. (1999). The posttraumatic cognitions inventory (PTCI): development and validation. Psychological Assessment, 11, 303–314.

    Article  Google Scholar 

  • Foa, E. B., Keane, T. M., & Friedman, M. J. (Eds.). (2004). Effective treatments for PTSD. New York: The Guilford Press.

    Google Scholar 

  • Folette, V., Palm, K. M., & Rasmussen Hall, M. L. (2004). Mindfulness and trauma: implications for treatment. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 24(4), 315–336.

    Google Scholar 

  • Friedman, M. J., Keane, T. M., & Resick, P. A. (2007). Handbook of PTSD, science and practice. New York: The Guilford Press.

    Google Scholar 

  • Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. Journal of Consulting and Clinical Psychology, 78, 169–183.

    Article  PubMed Central  PubMed  Google Scholar 

  • Horowitz, M. J., Wilner, M., & Alvarez, W. (1979). Impact of event scale: a measure of subjective stress. Psychosomatic Medicine, 41, 209–218.

    Article  PubMed  Google Scholar 

  • Hovens, J. E., Bramsen, I., & Van Der Ploeg, H. M. (2000). Zelfinventarisatielijst posttraumatische stressstoornis (ZIL). Lisse: Swets Test Publishers. 2000.

    Google Scholar 

  • Hovens, J. E., Bramsen, I., & Van Der Ploeg, H. M. (2002). Zelfinventarisatielijst voor de Posttraumatische Stressstoornis. Tijdschrift Klinische Psychologie, 32(3), 176–180.

    Google Scholar 

  • Hovens, J. E., Luinge, B., & van Minnen, A. (2005). Het klinisch interview voor PTSS (KIP). Nijmegen: Cure & Care Publishers.

    Google Scholar 

  • Imel, Z. E., Laska, K., Jakupcak, M., & Simpson, T. L. (2013). Meta-analysis of dropout in treatments for posttraumatic stress disorder. Journal of Consulting and Clinical Psychology. doi:10.1037/a0031474. Advance online publication.

    PubMed Central  Google Scholar 

  • Kabat-Zinn, J. (1982). An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. General Hospital Psychiatry, 4(1), 33–47.

    Article  PubMed  Google Scholar 

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

    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. doi:10.1002/jclp.20853.

    Article  PubMed  Google Scholar 

  • Kearney, D. J., Mc Dermott, K., Malte, C., Martinez, M., & Simpson, T. L. (2013). Effects of participation in a mindfulness program for veterans with posttraumatic stress disorder: a randomized controlled pilot study. Journal of Clinical Psychology, 69(1), 14–27. doi:10.1002/jclp.21911.

    Article  PubMed  Google Scholar 

  • Khoury, B., Lecomte, T., Fortin, G., Masse, M., Therien, P., Bouchard, V., Chapleau, M., Paquin, K., & Hofmann, S. G. (2013). Mindfulness-based therapy: a comprehensive meta-analysis. Clinical Psychology Review, 33, 763–771. doi:10.1016/j.cpr.2013.05.005.

    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. M., Robinson, E., Kulkarni, M., & Liberzon, I. (2012). A pilot study of group mindfulness-based cognitive therapy (MBCT) for combat veterans with posttraumatic stress disorder (PTSD). Depression and Anxiety, 30, 638–645. doi:10.1002/da.22104.

    Article  Google Scholar 

  • Koren, D., Arnon, I., & Klein, E. (1999). Acute stress response and posttraumatic stress disorder in traffic accident victims: a one-year prospective, follow-up study. American Journal of Psychiatry, 156, 367–373.

    PubMed  Google Scholar 

  • Kruijt, A. W., Antypa, N., Booij, L., de Jong, P. J., Glashouwer, K., Penninx, B. W. J. H., & Van der Does, W. (2013). Cognitive reactivity, implicit associations and the incidence of depression: a two-year prospective study. PLoS One, 8(7), 1–6.

    Article  Google Scholar 

  • Kuyken, W., Watkins, E., Holden, E., White, K., Taylor, R. S., Byford, S., Evans, A., Radford, S., Teasdale, J. D., & Dalgliesh, T. (2010). How does mindfulness-based cognitive therapy work? Behaviour Research and Therapy, 48, 1105–1112. doi:10.1016/j.brat.2010.08.003.

    Article  PubMed  Google Scholar 

  • Lau, M. A., Segal, Z. V., & Williams, J. M. G. (2004). Teasdale’s differential activation hypothesis: implications for mechanisms of depressive relapse and suicidal behaviour. Behaviour Research and Therapy, 42, 1001–1017.

    Article  PubMed  Google Scholar 

  • Lieberman, M. D., Eisenberger, N. I., Crockett, M. J., Tom, S. M., Pfeifer, J. H., & Way, B. M. (2007). Putting feelings into words: affect labeling disrupts amygdale activity to affective stimuli. Psychological Science, 18, 421–442.

    Article  PubMed  Google Scholar 

  • Marshall, G. N., Miles, J. N. M., & Stewart, S. H. (2010). Anxiety sensitivity and PTSD symptom severity are reciprocally related: evidence from a longitudinal study of physical trauma survivors. Journal of Abnormal Psychology, 119(1), 143–150.

    Article  PubMed Central  PubMed  Google Scholar 

  • McKee, L., Zvolensky, M. J., Solomon, S. E., Bernstein, A., & Leen-Feldner, E. (2007). Cognitive Behaviour Therapy, 36(2), 91–101.

    Article  PubMed  Google Scholar 

  • Mor, N., & Winqust, J. (2002). Self-focused attention and negative affect: a meta-analysis. Psychological Bulletin, 128, 638–662.

  • Naragon-Gainey, K. (2010). Meta-analysis of the relations of anxiety sensitivity to the depressive and anxiety disorders. Psychological Bulletin, 136(1), 128–150.

    Article  PubMed  Google Scholar 

  • Owens, G. P., & Chard, K. M. (2006). PTSD severity and cognitive reactions to trauma among a college sample: an explanatory study. Journal of Aggression, Maltreatment & Trauma, 13, 23–36. doi:10.1300/J146v13n02_02.

    Article  Google Scholar 

  • Piet, J., & Hougaard, E. (2011). The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: a systematic review and meta-analysis. Clinical Psychology Review, 31, 1032–1040.

    Article  PubMed  Google Scholar 

  • Power, M. J., & Fyvie, C. (2013). The role of emotion in PTSD: two preliminary studies. Behavioural and Cognitive Psychotherapy, 41(2), 162–172.

    Article  PubMed  Google Scholar 

  • Raes, F., Dewulf, D., van Heeringen, C., & Williams, J. M. G. (2009). Mindfulness and reduced cognitive reactivity to sad mood: evidence from a correlational study and a non-randomized waiting list controlled study. Behaviour Research and Therapy, 47, 623–627.

    Article  PubMed  Google Scholar 

  • Reiss, S., Peterson, R. A., Gursky, D. M., & McNally, R. J. (1986). Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behaviour Research and Therapy, 24(1), 1–8.

    Article  PubMed  Google Scholar 

  • Schottenbauer, M. A., Glass, C. R., Arnkhoff, D. B., Tendick, V., & Hafter Gray, S. (2008). Nonresponse and drop out rates in outcome studies in PTSD: review and methodological considerations. Psychiatry, 71(2), 134–168.

    Article  PubMed  Google Scholar 

  • Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: a new approach to preventing relapse. New York: The Guilford Press.

    Google Scholar 

  • Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Janays, J., Weiller, E., Hergueta, T., Baker, R., & Dunbar, G. C. (1998). The MINI international neuropsychiatric interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, 22–33.

    PubMed  Google Scholar 

  • Sullivan Kalill, K., Treanor, M., & Roemer, L. (2014). The importance of non-reactivity to posttraumatic stress symptoms: a case for mindfulness. Mindfulness, 5, 314–321. doi:10.1007/s12671-012-0182-6.

    Article  Google Scholar 

  • 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, 492–505.

    Article  PubMed  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, 24, 409–415.

    Article  PubMed  Google Scholar 

  • Tull, M. T., Barrett, H. M., McMillan, E. S., & Roemer, L. (2007). A preliminary investigation of the relationship between emotion regulation difficulties and posttraumatic stress symptoms. Behavior Therapy, 38, 303–313.

    Article  PubMed  Google Scholar 

  • Van Der Does, A. J. W. (2002a). Handleiding van de Nederlandse bewerking van de BDI-II. [Manual of the Dutch version of the BDI-II]. San Antonio: The Psychological Corporation.

    Google Scholar 

  • Van Der Does, A. J. W. (2002b). Cognitive reactivity to sad mood: structure and validity of a new measure. Behaviour Therapy and Research, 40, 105–120.

    Article  Google Scholar 

  • Van Minnen, A., & Hagenaars, H. (2002). Fear activation and habituation patterns as early process predictors of response to prolonged exposure treatment in PTSD. Journal of Traumatic Stress, 15, 359–367.

    Article  PubMed  Google Scholar 

  • Vujanovic, A. A., Zvolensky, M. J., Bernstein, A., Feldner, M. T., & McLeish, A. C. (2007). A test of the interactive effects of anxiety sensitivity and mindfulness in the prediction of anxious arousal, agoraphobic cognitions, and body vigilance. Behaviour Research and Therapy, 45, 1393–1400.

    Article  PubMed  Google Scholar 

  • 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, 23, 297–303.

    Article  PubMed Central  PubMed  Google Scholar 

  • Wahbeh, H., Lu, M., & Oken, B. (2011). Mindful awareness and non-judging in relation to posttraumatic stress disorder symptoms. Mindfulness, 2, 219–227.

    Article  PubMed Central  PubMed  Google Scholar 

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

    Google Scholar 

  • Williams, J. M. G., Van der Does, A. J. W., Barnhofer, T., Crane, C., & Segal, Z. V. (2008). Cognitive reactivity, suicidal ideation and future fluency: investigating a differential activation theory of suicidality. Cognitive Therapy and Research, 32, 83–104.

    Article  Google Scholar 

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Acknowledgments

Funded by the Netherlands Organization of Scientific Research (M.S. ZonMW-OOG grant #100002039 and W.V.D.D. NWO-VICI # 453-06-005). M.S. is also financially supported by PsyQ Haaglanden, ParnassiaBavogroep, the Netherlands. The funding agencies had no involvement in the research. The authors gratefully acknowledge the assistance of Jacqueline van Hees. We want to express our special gratitude to the patients that participated in this study.

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Schoorl, M., Van Mil-Klinkenberg, L. & Van Der Does, W. Mindfulness Skills, Anxiety Sensitivity, and Cognitive Reactivity in Patients with Posttraumatic Stress Disorder. Mindfulness 6, 1004–1011 (2015). https://doi.org/10.1007/s12671-014-0346-7

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