Mindfulness-based exposure strategies as a transdiagnostic mechanism of change: an exploratory alternating treatment design
Open accessAbstract
The present study explored whether distress reduction in response to strong negative emotions, a putative transdiagnostic mechanism of action, is facilitated by mindfulness strategies. Seven patients (mean age=31.14years, SD=12.28, range 19-48 years, 43% female, 86% Caucasian) with heterogeneous anxiety disorders (i.e., panic disorder with or without agoraphobia, social anxiety, generalized anxiety) were assigned a randomized order of weeklong blocks utilizing either mindfulness- or avoidance-based strategies while ascending a 6-week emotion exposure hierarchy. Participants completed three exposures per block and provided distress and avoidance use ratings following each exposure. Anxiety severity, distress aversion, and distraction/suppression tendencies were also assessed at baseline and the conclusion of each block. Visual, descriptive, and effect size results showing exposures utilizing mindfulness were associated with higher overall distress levels, compared with those utilizing avoidance. Within blocks, the majority of participants exhibited declining distress levels when employing mindfulness strategies, as opposed to more static distress levels in the avoidance condition. Systematic changes in anxiety severity, distress aversion, and distraction/suppression were not observed. These results suggest mindfulness strategies may be effective in facilitating emotion exposure; however, a minimum dosage may be necessary to overcome initial distress elevation. Potential transdiagnostic change mechanisms and clinical implications are discussed.
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Mindfulness meditation has promise to help POC cope with race-related stress.
“Despite extensive evidence showing the negative mental health effects of race-related stress in POC [6-11,14-17] and the promise of mindfulness meditation to help these individuals cope [20-24,26,30-32,79], this evidence-based treatment continues to be understudied among this high-risk population in both traditional [30,35,36] and digital formats [46-48].”
From App-Based Mindfulness Meditation for People of Color Who Experience Race-Related Stress: Protocol for a Randomized Controlled Trial (2022) · cites this paper as [26]
The Discussion (Changes in Distress and Experiential Avoidance; page not provided) suggests that mindfulness strategies may help reduce distress during repeated emotion exposures. The study tested exposure-based strategies in seven patients with anxiety disorders, six of whom were Caucasian; it did not examine mindfulness meditation as a way for people of color to cope with race-related stress. (LLM, conf=0.87)
Experimental — accuracy not yet measuredMindfulness-based strategies during exposure are associated with declining distress levels.
“This idea is also supported by research showing mindfulness-based strategies during exposure are associated with declining distress levels (Brake et al., 2016)”
From The Effect of a Brief Mindfulness Training on Distress Tolerance and Stress Reactivity. (2019) · cites this paper as Brake et al., 2016
Mindfulness training may positively impact exposure therapy by helping individuals engage in more effective exposures.
“Given the impact of mindfulness on DT shown in the present study, mindfulness training may positively impact exposure therapy by helping individuals engage in more effective exposures.”
From The Effect of a Brief Mindfulness Training on Distress Tolerance and Stress Reactivity. (2019) · cites this paper as Brake et al., 2016
Mindfulness meditation, with its emphasis on bringing awareness to all experiences regardless of negative valence, may serve as an exposure strategy that reduces avoidance, leading to decreases in psychological distress.
“As such, mindfulness meditation, with its emphasis on bringing awareness to all experiences regardless of their negative valance, may serve as an exposure strategy that reduces avoidance, leading to decreases in psychological distress [26].”
From App-Based Mindfulness Meditation for People of Color Who Experience Race-Related Stress: Protocol for a Randomized Controlled Trial (2022) · cites this paper as [26]
Mindfulness is thought to exert transdiagnostic benefits by facilitating extinction of distress in response to strong emotions, leading to reduced emotional avoidance and disorder symptoms.
“By intentionally and consistently using an “approach orientation” [37], “turning towards the difficult,” and experiencing one’s negative emotions fully, mindfulness is thought to exert transdiagnostic benefits by “facilitating extinction of distress in response to strong emotions, leading to reduced emotional avoidance and, consequently, disorder symptoms” [40].”
From Can mindfulness be too much of a good thing? The value of a middle way (2019) · cites this paper as [40]
A few studies have shown worse average outcomes (increased negative effects) for mindfulness training compared to control conditions.
“While a few studies have shown worse average outcomes (increased negative effects) for mindfulness training compared to control conditions [6,7,40,51], the use of means and effect sizes typically obscures individual differences and extreme scores [60].”
From Can mindfulness be too much of a good thing? The value of a middle way (2019) · cites this paper as [40]
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- Authors
- Alex Brake, C., Sauer-Zavala, S., Boswell, J. F., Gallagher, M. W., Farchione, T. J., & Barlow, D. H.
- Affiliations
- Boston University (US)
- University at Albany, State University of New York (US)
- University of Houston (US)
- Venue
- Behavior Therapy
- Publisher
- Elsevier BV
- Published
- 2016-03
- Volume
- 47
- Issue
- 2
- Pages
- 225-238
- ISSN
- 0005-7894 (ISSN-L)
- PMC
- PMC8177505
- OpenAlex
- W2099594722
- Cited by
- 58
- References
- 52
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 5 · 2023: 6 · 2022: 4 · 2021: 5 · 2020: 11 · 2019: 3 · 2018: 5 · 2017: 5 · 2016: 5
- FWCI
- 7.53
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Behavior Therapy (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01MH090053–S1)
- National Institutes of Health (R01MH090053–S1)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- anxiety disorders, avoidance, distress reduction, panic disorder, social anxiety, generalized anxiety disorder, exposure hierarchy, alternating treatments design
- MeSH terms
- Adult, Anxiety, Anxiety Disorders, Emotions, Female, Humans, Male, Middle Aged, Cognitive Behavioral Therapy, Treatment Outcome, Young Adult, Mindfulness
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