Personality and Individual Differences 52 (2012) 329–333

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Mindfulness and emotional distress: The role of negatively biased cognition Laura G. Kiken a,⇑, Natalie J. Shook b a b

Virginia Commonwealth University, Department of Psychology, P.O. Box 842018, Richmond, VA 23284-2018, United States West Virginia University, P.O. Box 6040, Morgantown, WV 26506-6040, United States

a r t i c l e

i n f o

Article history: Received 15 July 2011 Received in revised form 15 October 2011 Accepted 20 October 2011 Available online 16 November 2011 Keywords: Mindfulness Depression Anxiety Cognitive style Negativity bias

a b s t r a c t Mindfulness is a receptive attention to and awareness of events and experiences as they occur. A substantial body of literature supports the usefulness of mindfulness-based approaches for preventing or reducing emotional distress (e.g., depression and anxiety). However, mechanisms by which mindfulness produces these benefits are still being explored. Cognitive theories of emotional disorder implicate negatively biased cognition as a primary source of distress, and the theoretical literature on mindfulness suggests that it may reduce biased thoughts and judgments. Thus, the present research tested a mediation model in which less negatively biased cognition explains the inverse relation between mindfulness and emotional distress. Participants completed multiple standardized measures of trait mindfulness, negatively biased cognition, and emotional distress. The proposed relations between these constructs then were examined using structural equation modeling. Support was found for a partial mediation model, and possible alternative models were ruled out. These findings highlight a previously unidentified cognitive mechanism to explain the relation between mindfulness and reduced emotional distress. Specifically, mindfulness may reduce negative, maladaptive cognitive styles, which in turn may reduce predisposition to emotional disorders. ! 2011 Elsevier Ltd. All rights reserved.

1. Introduction A substantial body of literature supports the usefulness of mindfulness-based approaches for preventing or reducing emotional distress such as depression or anxiety (cf. Brown, Ryan, & Creswell, 2007; Hofmann, Sawyer, & Fang, 2010). However, mechanisms by which mindfulness produces these benefits are still being explored. One possibility is that mindfulness may reduce the negative cognitive biases involved in emotional distress. The present research examined this proposed mechanism for the emotional benefits of mindfulness. Mindfulness has been conceptualized as a receptive attention to and awareness of internal and external experiences as they occur (Brown & Ryan, 2003). Bishop et al. (2004) explain that mindfulness involves a metacognitive process of attention regulation that maintains a nonelaborative stance toward thoughts, feelings, and sensations as they unfold. Thoughts and feelings are simply noticed rather than being entertained or avoided automatically. Mindfulness can be conceptualized on a continuum of being more or less mindful, and it has been studied as a psychological trait on which individuals vary as well as a state or mode that can be heightened (e.g., Brown & Ryan, 2003).

⇑ Corresponding author.

E-mail address: [email protected] (L.G. Kiken).

0191-8869/$ - see front matter ! 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.paid.2011.10.031

The extant literature suggests that mindfulness is beneficial for well-being. Correlational studies have demonstrated that measures of trait mindfulness are associated with lower levels of psychological distress (e.g., depression, stress) and higher levels of psychological well-being (e.g., competence, vitality) (cf. Brown et al., 2007). Further, mindfulness-based interventions have been developed to increase trait mindfulness and address psychological disorders. Growing evidence supports the efficacy of these mindfulness-based treatments for preventing relapse of depression and its promise for anxiety disorders including generalized anxiety disorder (cf. Hofmann et al., 2010). Mechanisms by which mindfulness leads to these benefits have begun to receive attention. One mechanism that has received some empirical support is decreased rumination (e.g., Coffey, Hartman, & Fredrickson, 2010; Ramel, Goldin, Carmona, & McQuaid, 2004). That is, mindfulness may decrease rumination, presumably through greater receptivity but less attachment to thoughts (Brown et al., 2007) thereby reducing the automatic, repetitive elaboration that promotes emotional distress. Mindfulness also appears to facilitate better emotion regulation, or less habitual reactivity to negative emotions, potentially enabling more effective and adaptive coping responses (Coffey et al., 2010). Both of these potential mediators involve how negative thoughts and feelings are processed, as opposed to altering the negativity of thought content. Indeed, it has been theorized that the benefits of mindfulness stem less from changing thoughts than from changing how individuals relate to

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their thoughts (cf. Ramel et al., 2004). However, the alteration of thought content (i.e., reduction of negatively biased cognitions) may in fact be a mechanism by which mindfulness reduces emotional distress. Emerging evidence does suggest that mindfulness may reduce negatively biased cognitions, which is particularly intriguing given that negatively biased cognitive content is a wellestablished cause of emotional distress in the clinical literature. Cognitive theories of depression and anxiety emphasize a negatively biased, or maladaptive, cognitive style as a key aspect of depression (e.g., Beck, 1987) and anxiety (e.g., Riskind, 1997). Furthermore, evidence supports a causal role of negative cognitive styles in depression and anxiety. Using a prospective design, Alloy et al. (2006) demonstrated that negative inferential tendencies and dysfunctional attitudes predicted onset as well as higher lifetime prevalence of major depressive disorder. Additionally, a recent review concluded that cognitive changes, such as improvements in dysfunctional attitudes and attributions, resulting from cognitive therapy predict improvements in depressive symptoms (Garratt, Ingram, Rand, & Sawalani, 2007). Similarly, a cognitive style characterized by a sense of looming vulnerability (i.e., a dynamic sense of a risk that grows rapidly with time or proximity, and does not correspond to reality) may underlie many cognitive biases that have been implicated in anxiety, such as disproportionate allocation of attention to threats and interpretations biased toward danger (Riskind, Williams, Gessner, Chrosniak, & Cortina, 2000). Also, inducing such biases has been found to cause anxiety (Mathews & MacLeod, 2002). Both theoretical and empirical work suggest that mindfulness may be associated with fewer negative cognitions; therefore, reduction of negatively biased cognition may be a mechanism by which mindfulness reduces emotional distress. However, this mechanism has not been tested. Segal, Williams, and Teasdale (2002) theorized that for depressed or anxious individuals, normal classification of incoming stimuli as pleasant or unpleasant can trigger mental proliferation, similar to mind-wandering, into biased elaborations such as distorted interpretations. Using mindfulness to reduce such mental proliferation and recognize such elaborations, fewer negatively biased cognitions may be affixed automatically to basic observations and more attention can be given to what is actually occurring, including positive and neutral experiences. As such, mindfulness may enable individuals to be less influenced by or susceptible to negativity biases. In a recent study, a brief mindfulness induction as compared to a control condition resulted in less negativity bias on an objective measure of attitude formation, the formation of more positive attitudes, and greater endorsement of optimistic beliefs (Kiken & Shook, 2011). Two studies by Frewen, Evans, Maraj, Dozois, and Partridge (2008) found that individuals who reported higher levels of trait mindfulness also reported less frequent negative thoughts and less difficulty letting go of negative cognitions. After an 8-week mindfulness intervention, a clinical sample reported not only less rumination and symptoms of depression and anxiety but also fewer dysfunctional attitudes, a common measure of negatively biased cognition in emotional disorders (Ramel et al., 2004). Although the study suggested that improvements in dysfunctional attitudes may covary with improvements in emotional disorders, the reduction in dysfunctional attitudes was not tested as a mediator between the effect of the mindfulness intervention on depression and anxiety symptoms. The relations between trait mindfulness, negatively biased cognition, and emotional distress were examined more directly in a recent cross-sectional study (Gilbert & Christopher, 2010). Participants completed self-report measures of trait mindfulness, negative cognitions characteristic of depression, and depression symptoms. Mindfulness was inversely related to negatively biased cognition, and trait mindfulness moderated the link between

depressed mood and negatively biased cognition. That is, mindfulness attenuated the link between depressive symptoms and negatively biased thoughts. Interestingly, however, a post hoc analysis revealed that mindfulness was a significant predictor of depressive symptoms only when not accounting for variance attributable to negatively biased cognition. In other words, mindfulness did not predict depressive symptoms above and beyond negatively biased cognition. These results collectively support that mindfulness is associated with less negatively biased cognition and emotional distress. Moreover, they suggest that the link between mindfulness and emotional distress may at least partially be accounted for by less negatively biased cognitions. However, a mediation model was not tested. In sum, recent evidence suggests that mindfulness can reduce negatively biased cognition, and that this may be a mechanism through which mindfulness reduces emotional distress. This mechanism would align with evidence supporting cognitive theories of depression and anxiety, but negatively biased cognition has not been examined as a mediator between mindfulness and emotional distress. Thus, the present research tested this proposed mediation model using structural equation modeling.

2. Method The purpose of the study was to test a model in which negatively biased cognition mediates the inverse relation between mindfulness and emotional distress. Although depression and anxiety are distinct disorders, both involve cognitive biases toward negativity. Further, measures of depression and anxiety often correlate and these disorders often are co-morbid (e.g., Cairney, Corna, Veldhuizen, Herrmann, & Streiner, 2008); likewise, measures of the negatively biased cognitions found in depression and anxiety tend to positively correlate (Safford, Alloy, Abramson, & Crossfield, 2007). Therefore, symptoms of depression and anxiety were considered together here as indicators of a larger construct of emotional distress; similarly, the negative cognitions associated with depressive and anxious tendencies were considered together as indicators of the larger construct of negatively biased cognition.

2.1. Participants and procedure One hundred and eighty-one undergraduate psychology students participated for course credit (59% male; 55% White; Mage = 19.4, SD = 3.4). Sessions were run in groups of at most six participants. Upon arrival, participants were seated in individual cubicles. Participants completed the measures described below, along with some filler tasks. Participants then were debriefed, thanked, and dismissed.

2.2. Measures 2.2.1. Mindful Attention Awareness Scale (MAAS; Brown & Ryan, 2003) The MAAS is a self-report measure of trait mindfulness. Participants indicate the extent to which they experience 15 statements (a = .91; e.g., ‘‘I find it difficult to stay focused on what’s happening in the present’’) from 1 (almost always) to 6 (almost never). Higher scores reflect higher mindfulness. Exploratory factor analysis with the 15 items indicated a single factor as dominant, based on a scree plot of eigenvalues. Given this support for unidimensionality, three indicators were created from the 15 scale items using a correlational algorithm aimed at maximizing both internal consistency within the indicators (a = .81, .81, and .73) and uniformity among the indicators (r = .74, .70, and .65).

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2.2.2. Dysfunctional Attitudes Scale (DAS; Weissman & Beck, 1978) The DAS is a self-report measure of negatively biased cognition based on Beck’s cognitive theory (1987) of depression. The short form was used, which has 40 items (a = .87) that represent implicit rules and conditions that involve inflexible or unrealistic standards for oneself (e.g., ‘‘I am nothing if a person I love does not love me.’’). Each statement is rated on a scale from 1 (totally agree) to 7 (totally disagree). Higher scores indicate a greater degree of dysfunctional cognitions. 2.2.3. Looming Maladaptive Style Questionnaire (LMSQ; Riskind et al., 2000) This self-report measure is based on the Looming Vulnerability Model (Riskind, 1997) of anxiety and served as a second measure of negatively biased cognition. It assesses the tendency to create mental representations of potentially threatening situations that are rapidly rising in risk or intensifying in danger. Participants read six short vignettes describing potentially stressful situations (e.g., ‘‘You hear a strange engine noise from your car as you are driving on the expressway in heavy rush-hour traffic.’’) and then complete three questions for each vignette on 5-point scales. The three questions are: (1) whether the chances of having difficulty seem to be decreasing or expanding with each moment, (2) if the level of threat seems fairly constant or is growing rapidly larger with each moment, and (3) how much they visualize their problem as not changing or in the act of becoming progressively worse. Responses to the three questions for the six vignettes were combined, 18 items total (a = .70); higher total scores represent more negatively biased threat-related cognitions. 2.2.4. Future Events Scale (FES; Anderson, 1990) As a third measure of negatively biased cognition, the FES is comprised of 26 items divided between two subscales measuring optimism and pessimism. Participants rate the likelihood of specific positive (e.g., ‘‘To live the lifestyle I have always dreamed of’’) and negative (e.g., ‘‘To be responsible for someone’s physical or emotional suffering’’) events happening to them at some point in the future on a scale from !5 (extremely unlikely) to +5 (extremely likely). Ratings were averaged for each subscale (a = .88 for optimism; a = .81 for pessimism), and a difference score between the two subscales was determined by subtracting the average optimism score from the pessimism score. Thus, larger numbers represent more negatively biased cognition. 2.2.5. Beck Depression Inventory-II (BDI; Beck, Steer, & Brown, 1996) The BDI is a routinely used, self-report measure designed to assess the intensity of affective, cognitive, motivational, and physiological symptoms of depression. It consists of 21 items (a = .89), each of which contains four self-evaluative statements that range in intensity from 0 to 3. For example, an item called ‘‘Past Failure’’ ranges from ‘‘I do not feel like a failure’’ (0) to ‘‘I feel I am a total failure as a person’’ (3); higher scores indicate greater depression symptoms. 2.2.6. Beck Anxiety Inventory (BAI; Beck, Epstein, Brown, & Steer, 1988) The BAI is a unidimensional self-report measure of trait anxiety. It was developed specifically to measure severity of anxiety and to discriminate anxiety from depression. The inventory consists of 21 items (a = .90) stating common symptoms of anxiety (e.g., terrified, hands trembling), which are rated from 0 (not at all) to 3 (severely). Higher scores indicate greater anxiety symptoms. 2.2.7. Positive and Negative Affect Schedule (PANAS; Watson, Clark, & Tellegen, 1988) The PANAS assessed state affect to account for the potential role of negative affectivity in the relations between the constructs of

Table 1 Zero-order correlations, means, and standard deviations for all measures.

1. MAAS 2. DAS 3. FES 4. LMSQ 5. BDI 6. BAI 7. NA Mean SD

1

2

3

4

5

6

7

1.00 !.29** !.34** !.18* !.47** !.48** !.23** 3.89 .98

1.00 .36** .20** .30** .22** .42** 121.90 26.96

1.00 .28** .37** .35** .24** !2.94 2.59

1.00 .27** .20** .16* 56.30 9.10

1.00 .92** .39** 12.46 9.11

1.00 .35** 13.38 9.70

1.00 16.42 5.61

MAAS = Mindful Attention Awareness Scale; DAS = Dysfunctional Attitudes Scale; LMSQ = Looming Maladaptive Style Questionnaire; FES = Future Events Scale; BDI = Beck Depression Inventory-II; BAI = Beck Anxiety Inventory; NA = Negative State Affect (from PANAS). * p < .05. ** p < .01.

interest. Although the PANAS contains two subscales to assess both positive and negative affect, we used only scores from the negative affect subscale because it consistently relates to the three main constructs of interest (e.g., Brown et al., 2007; Fresco, Heimberg, Abramowitz, & Bertram, 2006; Watson et al., 1988) and was correlated with measures of the constructs in the present research. Positive affect, on the other hand, did not correlate with all measures of the main constructs of interest. Therefore, negative affect could provide an alternative explanation for relations between the main constructs. For the negative affect subscale, participants rated each of 10 negative adjectives (e.g., distressed) using a scale ranging from 1 (very slightly or not at all) to 5 (very much), to indicate the extent to which they are currently experiencing the descriptor. Exploratory factor analysis with the 10 negative affect subscale items indicated a dominant single factor, based on a scree plot of eigenvalues. As with the MAAS, three indicators were created from the scale items using a correlational algorithm aimed at maximizing both internal consistency within the indicators (a = .78, .71, and .62) and uniformity among the indicators (r = .45, .49, and .63). 3. Results Means, standard deviations, and correlations for all measures are presented in Table 1. Mindfulness was inversely correlated with each measure of negative cognitive style, emotional distress, and negative affect. The measures of negative cognitive style, emotional distress, and negative affect were all positively correlated.1 3.1. Model testing The relations between constructs were investigated using structural equation modeling with latent variables in LISREL 8.8. Mindfulness was measured with three indicators, created from MAAS items as previously described. Negative cognitive style also was measured with three indicators, scores from the DAS, LMSQ, and FES. Emotional distress was measured with two indicators, scores from the BDI and BAI. Negative affect, when included, was measured with three indicators, created from PANAS items as previously described. Model fit was determined by examining the chi-square, RMSEA, CFI, and RMSR values. An acceptable fit between the data and the model is indicated by a nonsignificant chi-square, an RMSEA value of less than .06, an SRMR value of less than .08, and a CFI value greater than .95 (Hu & Bentler, 1999). The significance and 1 T-tests revealed no significant differences for any of the indicators as a function of gender (ps > .18).

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-.25*

Mindfulness .82* MAAS1

.86*

.82*

MAAS2

MAAS3

-.57*

Negatively biased cognition 1.0

.65*

DAS

.45*

.42*

FES

LMSQ

Emotional distress 1.0

BDI

.93*

BAI

Fig. 1. Negatively biased cognition as a partial mediator of the inverse relation between mindfulness and emotional distress. All paths shown were estimated, except for some standard fixed parameters: The factor loadings (LY 1, 1, from negatively biased cognition to the DAS; and LY 4, 2, from emotional distress to the BDI) which were fixed at 1.0 for identification, and the factor loadings of the error terms which were fixed at 1.0 as is standard. The variance of the mindfulness factor, not depicted in the diagram, also was fixed at 1.0 for identification. In sum, a total of 19 parameters were estimated with 17 degrees of freedom.

standardized values of the parameter estimates also were examined to determine the fit of specific paths. We first tested the proposed mediation model (i.e., negatively biased cognition mediates the relation between mindfulness and emotional distress). As other, albeit related, mediators (e.g., rumination, emotion regulation) also have empirical support (e.g., Coffey et al., 2010), we examined both partial mediation and full mediation models. The partial mediation model, depicted in Fig. 1, adequately fit the data, v2 (17, N = 181) = 33.40, p = .01; RMSEA = .07 (90% CI = .03–.11); CFI = .98; SRMR = .04. In the measurement model, all of the factor loadings were significant. The standardized factor loadings for mindfulness and emotional distress were large. For negatively biased cognition, the standardized factor loadings were relatively smaller, particularly for the LMSQ, but were not poor. This might be due to the anxiety-specific nature of the LMSQ. For the path model, there were significant inverse relations between mindfulness and negatively biased cognition as well as mindfulness and emotional distress, as predicted. Also, as predicted, the path from negatively biased cognition to emotional distress was significant. Altogether, there were significant indirect (!.26) and direct (!.51) effects. These results support that negatively biased cognition partially mediated the inverse relation between mindfulness and emotional distress. The full mediation model also adequately fit the data, but with slightly worse fit statistics, v2 (18, N = 181) = 36.80, p = .01; RMSEA = .08 (90% CI = .04–.11); CFI = .98; SRMR = .05. However, the chi-square difference test for these two models was not significant, Dv2 (1, N = 181) = 3.4, p > .05, indicating some statistical support for the more parsimonious full mediation model. Because the data were cross-sectional, we also tested an additional model to rule out an alternative order in which the variables could be placed. In this model, mindfulness mediates the relation between negative cognitive style and emotional distress. This model is consistent with prior research that has demonstrated that (a) negative cognitive style precedes and perpetuates emotional distress, and (b) mindfulness reduces emotional distress. It tested the order of the mindfulness and negative cognitive style variables. Comparing the model fit indices, v2 (18, N = 181) = 47.01, p < .001; RMSEA = .10 (90% CI = .06–.13); CFI = .97; SRMR = .07, this alternative order model did not fit the data as well as the partial mediation model (Dv2 [1, N = 181] = 13.61, p < .001), or the full mediation model. Finally, we included negative state affect in the model as an additional mediator between mindfulness and emotional distress. Negative affect correlated inversely with mindfulness and positively with measures of negative cognitive style and emotional distress. Thus, it was conceivable that negative affect accounted for the apparent relations between the main constructs of interest. This model tested whether these relations of interest remained

significant after accounting for the role of negative state affect. This model fit the data, v2 (39, N = 181) = 65.03, p = .01; RMSEA = .06 (90% CI = .03–.09); CFI = .98; SRMR = .05, but did not alter the significance of the structural parameters between mindfulness, negatively biased cognition, and emotional distress. Further, the relation between negative affect and emotional distress was no longer significant when accounting for negatively biased cognition, providing further support for the role of cognition in emotional distress. Testing this model therefore revealed that although negative affect may play some role in the relation between mindfulness and negatively biased cognition, it does not fully account for that relation or the link to emotional distress.2

4. Discussion The purpose of the present research was to test a model in which mindfulness reduces emotional distress in part because it fosters less negatively biased cognition. This partial mediation model was supported by the results. A full mediation model was acceptable statistically, but partial mediation is more consistent with the current literature on additional potential mechanisms of mindfulness, such as rumination and emotion regulation (Coffey et al., 2010; Ramel et al., 2004). In either case, these findings suggest that as mindfulness increases, negatively biased cognition decreases, and this contributes to lower emotional distress. These findings are in accord with Ramel et al. (2004) finding that a mindfulness intervention reduced dysfunctional attitudes. Further, this study provided greater evidence that mindfulness may reduce negatively biased cognition overall and, critically, that this may account for reduced emotional distress. Considering the present findings and those of Gilbert and Christopher (2010), it appears that less negatively biased cognition may help to explain how mindfulness protects against the perpetuation of depression and anxiety symptoms, even when accounting for negative state affect. The present findings, although preliminary and based on a measure of trait mindfulness, may have implications for mindfulness-based therapies for emotional distress. Given that reduction of negatively biased cognition is a goal of cognitive therapy (e.g., Beck, 1987), mindfulness practice may facilitate this process. This is interesting to consider amidst some debate about whether mindfulness-based approaches constitute a ‘‘new-wave’’ of therapies or should be considered an extension of cognitive-behavioral therapies (e.g., Hofmann et al., 2010). The present findings also stretch conceptualizations of how mindfulness relates to cognition 2 A model with negative affect as the only mediator between mindfulness and emotional distress also was tested and did not fit the data well, v2 (41, N = 181) = 112.77, p < .001; RMSEA = .10 (.08–.12); CFI = .94; SRMR = .17.

L.G. Kiken, N.J. Shook / Personality and Individual Differences 52 (2012) 329–333

and mood. That is, beyond altering just thought context (cf. Ramel et al., 2004), mindfulness may also alter thought content. 4.1. Limitations and future directions The study was correlational because it was a first step in specifically testing if negatively biased cognition is an underlying mechanism for the inverse relation between mindfulness and emotional distress. Because this study was cross-sectional, the mediation model was not tested with data which could account for temporal order as would be possible with longitudinal data. Further, mindfulness was not manipulated and potential extraneous influences were not controlled. However, alternative models in which mindfulness was the mediator between negative cognitive style and emotional distress did not fit the data as well, and the directions of all three relations were based on prior causal evidence. Still, causality cannot be concluded from these data. Another limitation is that the data relied exclusively on self-report measures. Although the measures were selected for their reliability and validity, and non-self-report measures of mindfulness are not available, self-report measures are subjective by nature and vulnerable to bias. Generalizability of the current findings also should be considered. These data were not from a clinical sample, so it is uncertain whether these results would generalize to a clinical population. However, some evidence suggests that cognitive vulnerabilities to symptoms of emotional disorder in nonclinical samples resemble those in clinical samples (Fresco et al., 2006). Additionally, the present findings are based on a single unidimensional measure of mindfulness; it may be helpful to also examine other operationalizations of mindfulness. Multidimensional operationalizations suggest that present-moment attention and awareness is just one of multiple facets of mindfulness (or of multiple skills resulting from mindfulness interventions) that may reduce emotional distress. Future research could further clarify which dimensions relate to negatively biased cognition as well as other potential mechanisms of mindfulness. Another specific area for further empirical clarification, in terms of mechanisms of mindfulness, is to tease apart the roles of negatively biased cognition and the repetitive, attachment to thoughts in rumination. It is plausible that reductions in repetitive attachment to thoughts reduce the intensity of negative thought content (cf. Ramel et al., 2004). As we did not assess rumination, it is not clear whether these potential mechanisms work separately or in conjunction. 5. Conclusions The present research is an important first step in testing a new mechanism by which mindfulness may reduce emotional distress. Specifically, negatively biased cognition may mediate the inverse relation between mindfulness and emotional distress. Additional research is needed to confirm these findings, particularly using longitudinal and experimental designs as well as clinical samples. However, the present research suggests that mindfulness may affect cognitive content to produce psychological benefits. More research should examine similar cognitive effects of mindfulness. In conclusion, this research may have important implications for understanding how mindfulness contributes to psychological well-being.

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