Decentering as a potential common mechanism across two therapies for generalized anxiety disorder
Open accessAbstract
Objective: The purpose of this study was to examine decentering as a potential mechanism of action across 2 treatments for generalized anxiety disorder: an acceptance-based behavioral therapy (ABBT) and applied relaxation (AR). Method: Sixty-four individuals who completed at least half of the 16 total sessions of either ABBT or AR (65.6% female; 79.7% identified as White; average age =34.41 years) completed measures of decentering (Experiences Questionnaire) and of symptoms of anxiety (Depression Anxiety Stress Scale-Stress subscale) at 5 time points over the course of therapy, and a measure of worry (Penn State Worry Questionnaire) at pre- and posttreatment. Results: Initial growth curve models showed that decentering increased significantly over therapy (z =7.09), and this increase was associated with a decrease in worry symptoms (Penn State Worry Questionnaire) at posttreatment (z = -8.51). The rate of change did not significantly vary across treatments, Δ χ2/Δdf =0.16/1, p =.69. Further, a series of bivariate latent difference score models indicated that the best-fitting model was one in which decentering was a leading indicator of change in symptoms (DASS-Stress). Allowing this coupling to vary across treatments did not significantly improve the fit of the model, Δ χ2/Δdf = 0.71/1, p =.40. Conclusions: In this sample, results suggest that increased decentering was associated with decreases in anxiety and that changes in decentering appear to precede changes in symptoms within both ABBT and AR, indicating that decentering may be an important common mechanism of action. © 2015 American Psychological Association.
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Claims the paper makes
13 of 49 cited sources checked · 12 supported · 0 flagged · accuracy not yet measured
- Premisecitation
Research has shown that individuals with GAD symptoms report greater negative reactivity towards their emotions than individuals with lower GAD symptomatology.
“research has consistently shown that individuals with symptoms of GAD report greater negative reactivity towards their emotions (Lee et al., 2010; Mennin, Heimberg, Turk, & Fresco, 2005)”
Quote in the paperSubstantial claim1 of 2 sources checked - Premisecitation
Cognitive behavioral therapy for depression led to more significant increases in decentering compared to antidepressant medication.
“cognitive behavioral therapy for depression led to more significant increases in decentering compared to those who received antidepressant medication (Fresco, Segal, Buis, & Kennedy, 2007).”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites Fresco, Segal, Buis, & Kennedy, 2007 source
The Cognitive Change Among Treatment Responders section (p. 5) reports significantly larger gains in decentering for CBT responders than for antidepressant-medication responders. The citing sentence omits the responder qualification, making the comparison sound as though it applies to everyone who received either treatment. (LLM, conf=0.86)
Experimental — accuracy not yet measured
- Premisecitation
A case series of three individuals with GAD showed changes in decentering following applied relaxation.
“a case series presenting three individuals diagnosed with GAD (from the current trial) showed changes in decentering following applied relaxation (Hayes-Skelton, Usmani, Lee, Roemer, & Orsillo, 2012).”
Quote in the paperSubstantial claim1 of 1 sources checked- cites Hayes-Skelton, Usmani, Lee, Roemer, & Orsillo, 2012 source
- Premisecitation
Individuals with GAD report more distress about emotional responses than individuals without GAD.
“Individuals with GAD report more distress about emotional responses (Lee, Orsillo, Roemer, & Allen, 2010)”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites Lee, Orsillo, Roemer, & Allen, 2010 source
- Premisecitation
Individuals with GAD report more experiential avoidance than individuals without GAD.
“more experiential avoidance (Lee et al., 2010)”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites Lee et al., 2010 source
- Interpretationown data
The authors believe this is the first decentering study to satisfy Kazdin's timeline criteria.
“To our knowledge, this is the first study on decentering to meet Kazdin’s timeline criteria.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites Kazdin, 2007 source
- Findingown data
The increase in decentering was associated with a decrease in worry symptoms on the PSWQ at post-treatment.
“this increase was associated with a decrease in worry symptoms (PSWQ) at post-treatment (z = −8.51)”
Quote in the paperSubstantial claim - Findingown data
The rate of change in decentering did not significantly differ between ABBT and AR.
“The rate of change did not significantly vary across treatments (Δχ2/Δdf = 0.16/1, p = 0.69).”
Quote in the paperSubstantial claim - Findingown data
In bivariate latent difference score models, the best fitting model had decentering as a leading indicator of change in DASS-Stress symptoms.
“a series of bivariate latent difference score models indicated that the best fitting model was one in which decentering was a leading indicator of change in symptoms (DASS-Stress).”
Quote in the paperSubstantial claim - Findingown data
Allowing the coupling between decentering and DASS-Stress to vary across treatments did not significantly improve model fit.
“Allowing this coupling to vary across treatments did not significantly improve the fit of the model (Δχ2/Δdf = 0.71/1, p = 0.40).”
Quote in the paperSubstantial claim - Findingown data
In the study sample, decentering increased significantly over the course of therapy.
“Initial growth curve models showed that decentering increased significantly over therapy (z = 7.09)”
Quote in the paperSubstantial claim - Findingown data
The treatment-invariant model for the coupling from EQ to DASS did not differ significantly from the model allowing this coupling to vary across treatments (Δχ2/Δdf = 0.71/1, p = .40), indicating treatment did not significantly affect the decentering-anxiety relationship.
“In support of our hypothesis, the treatment invariant model [χ2 (100) = 317.45] was not significantly different than the same model allowing the coupling from EQ to DASS to vary across treatments [χ2 (99) = 316.74; Δχ2/Δdf = 0.71/1, p = .40] indicating that treatment is not a significant factor in this relationship between decentering and general anxiety symptoms.”
Quote in the paperSubstantial claim - Findingown data
Change in DASS-Stress was significantly related to change in worry as measured by the PSWQ residualized gain score (r = .76).
“As expected, change in DASS-Stress was also significantly related to change in worry as measured by the PSWQ residualized gain score (r = .76).”
Quote in the paperNot a substantial claim - Findingown data
Increasing decentering scores were strongly associated with lower post-treatment worry scores (r = −.74).
“As can be seen in Table 2, increasing decentering scores were strongly associated (r = −.74) with lower worry scores.”
Quote in the paperSubstantial claim - Findingown data
Model 4 also fit significantly worse than Model 2 (Δχ2/Δdf = 6.87/1, p = .01).
“Similarly, Model 4 also provided a significant degradation in fit compared to Model 2 (Δχ2/Δdf = 6.87/1, p = .01).”
Quote in the paperSubstantial claim - Findingown data
With the exception of correlations between DASS-Stress at pre-treatment and sessions 12 and post-treatment, correlations among the same variable over time were moderate to large.
“As can be seen in Table 1, with the exception of correlations with DASS-Stress at pre-treatment to sessions 12 and post-treatment, there were moderate to large correlations among the same variable over time (e.g., EQ at sessions 4 and 8).”
Quote in the paperNot a substantial claim - Findingown data
The full bidirectional change model, including couplings from decentering to general anxiety symptoms and from general anxiety symptoms to decentering, fit the data well.
“The full bidirectional change model (Model 1), which included couplings from decentering to general anxiety symptoms and from general anxiety symptoms to decentering, fit the data well.”
Quote in the paperSubstantial claim - Findingown data
Model 2, with couplings from decentering to general anxiety symptoms, was kept as the best and most parsimonious model.
“Taken together, Model 2, with couplings from decentering to general anxiety symptoms, was retained as the best fitting, most parsimonious model (see Table 4 for parameter estimates for this model)”
Quote in the paperSubstantial claim - Findingown data
The model with no couplings (Model 4) fit significantly worse than Model 1 (p = .01), indicating that dropping both couplings worsened fit.
“As expected, the significant chi-square difference test (p = .01) indicated that removing both couplings significantly degraded the model fit from the base model.”
Quote in the paperSubstantial claim - Findingown data
The treatment-invariant model for linear change in EQ did not differ significantly from the model allowing the slope and variance to vary across treatments (Δχ2/Δdf = 0.54/2, p = .76), indicating treatment did not significantly affect the rate of EQ change.
“The treatment invariant model for linear change in EQ [χ2 (34) = 67.89] was not significantly different than the same model allowing the slope and variance of linear to change to vary across treatments [χ2 (32) = 67.35; Δχ2/Δdf = 0. 54/2, p = .76] indicating that treatment is not a significant factor in the EQ rate of change.”
Quote in the paperSubstantial claim - Premisereasoning
The role of decentering as a treatment mechanism in GAD has not been systematically examined.
“the role of decentering as a treatment mechanism in treatments for GAD has not been systematically examined.”
Quote in the paperSubstantial claim - Interpretationown data
In this sample, increased decentering was associated with decreases in anxiety.
“In this sample, results suggest that increased decentering was associated with decreases in anxiety”
Quote in the paperSubstantial claim- Rests on an assumption: The 64 participants who completed at least half of the sessions are representative of the full intent-to-treat sample for estimating the decentering-anxiety relationship.
- Premisecitation
Initial research on depression treatments has shown that MBSR and MBCT lead to increases in decentering.
“initial research on treatments for depression have shown that Mindfulness-based Stress Reduction (MBSR) and MBCT lead to increases in decentering (Bieling et al., 2012; Teasdale et al., 2002)”
Quote in the paperSubstantial claim0 of 2 sources checked - Premisecitation
Decentering and related constructs have been explicit targets of many acceptance-based behavior therapies, including ACT, DBT, and MBCT.
“have been explicit targets of many acceptance-based behavior therapies including: Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999), Dialectic Behavior Therapy (DBT; Linehan, 1993), and Mindfulness Based Cognitive Therapy (MBCT; Segal, Williams, & Teasdale, 2002).”
Quote in the paperSubstantial claim0 of 3 sources checked- cites Hayes, Strosahl, & Wilson, 1999
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites Linehan, 1993
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites Segal, Williams, & Teasdale, 2002
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premiseown data
In the larger randomized clinical trial, there were significant large effects for change over time across all primary outcome measures.
“Within this trial, there were significant large effects for change over time across all primary outcome measures (d’s 1.36 to 1.61)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Hayes-Skelton, Roemer, & Orsillo, 2013
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
Research has shown that individuals with GAD symptoms view their worrisome thoughts as more dangerous and uncontrollable than individuals with lower GAD symptomatology.
“view their worrisome thoughts as more dangerous and uncontrollable (Wells & Carter, 1999) than individuals with lower levels of GAD symptomatology.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Wells & Carter, 1999 source
- Interpretationown data
Decentering may be an important common mechanism of action across ABBT and AR.
“indicating that decentering may be an important common mechanism of action.”
Quote in the paperSubstantial claim- Rests on an assumption: The 64 participants who completed at least half of the sessions are representative of the full intent-to-treat sample for estimating the decentering-anxiety relationship.
- Rests on an assumption: The measurement intervals used for decentering and symptoms are adequate to establish temporal precedence of decentering changes over symptom changes.
- Rests on an assumption: The latent difference score model's coupling parameter reflects a causal influence of decentering on symptoms rather than reverse causation or confounding.
- Premisecitation
According to Rational Frame Theory, fusion with internal experiences leads to more reactivity in response to internal experiences.
“According to RFT, this fusion with internal experiences leads to more reactivity in response to internal experiences.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Hayes et al. 2001
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premiseown data
In the larger randomized clinical trial, there were small, non-significant effects of treatment condition on primary outcome measures.
“small, non-significant effects of treatment condition (d’s 0.002 to 0.24)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Hayes-Skelton, Roemer, & Orsillo, 2013
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationown data
Changes in decentering appear to precede changes in symptoms within both ABBT and AR.
“changes in decentering appear to precede changes in symptoms within both ABBT and AR”
Quote in the paperSubstantial claim- Rests on an assumption: The measurement intervals used for decentering and symptoms are adequate to establish temporal precedence of decentering changes over symptom changes.
- Rests on an assumption: The latent difference score model's coupling parameter reflects a causal influence of decentering on symptoms rather than reverse causation or confounding.
- Interpretationcitation
Other effective treatments may not promote decentering.
“Other effective treatments may not promote decentering.”
Quote in the paperSubstantial claim - Interpretationreasoning
That only one direction of change was supported reduces, in part, worry that self-report response bias explains the results.
“While this study is limited by the use of self-report measures, the fact that direction of change was supported in one, but not both, directions also partially alleviates concern that change was purely due to a response bias in which clients in treatment report global changes when they feel that they are improving.”
Quote in the paperSubstantial claim - Interpretationown data
General anxiety symptoms do not temporally precede changes in decentering.
“indicating that decentering is a leading indicator of change in general anxiety symptoms, while general anxiety symptoms are not a leading indicator of change in decentering.”
Quote in the paperSubstantial claim - Premisecitation
Studies have found that decentering rises over the course of therapy.
“and empirical research has shown that decentering increases across therapy (e.g., Teasdale et al., 2002).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Teasdale et al., 2002 source
- Premisecitation
In a depression trial comparing MBCT with antidepressants, only the MBCT group showed decentering changes during maintenance.
“For example, when MBCT was compared to antidepressant medication for depression, only patients receiving MBCT showed changes in decentering across the maintenance phase (Bieling et al., 2012).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Bieling et al., 2012 source
- Interpretationreasoning
Since every participant had a primary GAD diagnosis, how far the results generalize to other symptom profiles is unclear.
“Similarly, while other studies have focused on changes in decentering in treatments targeting depression (i.e., Bieling et al., 2012; Teasdale et al., 2002), all clients in this study were selected because they had a primary diagnosis of generalized anxiety disorder. Therefore, the extent that these findings can be applied to other symptom profiles remains uncertain.”
Quote in the paperNot a substantial claim - Interpretationown data
Decentering temporally precedes changes in general anxiety symptoms.
“indicating that decentering is a leading indicator of change in general anxiety symptoms, while general anxiety symptoms are not a leading indicator of change in decentering.”
Quote in the paperSubstantial claim - Interpretationown data
Evidence that decentering changes precede later symptom changes, but not vice versa, supports decentering's temporal precedence as a mechanism.
“This finding that changes in decentering lead to future changes in symptoms, but not the reverse provides support for the temporal precedence of decentering as a mechanism of action.”
Quote in the paperSubstantial claim
- Classified as probably not a substantial claim. 34
- May combine two claims. 18
- The quote only partly states this claim. 2
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationIndividuals with GAD report less engagement in meaningful activities than individuals without GAD.
“less engagement in meaningful activities (Michelson, Lee, Orsillo, & Roemer, 2011) than those without a diagnosis of GAD.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites Michelson, Lee, Orsillo, & Roemer, 2011 source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationThe EQ-Decentering subscale has demonstrated good internal consistency in nonclinical and clinical samples.
“The Decentering subscale has demonstrated good internal consistency in both nonclinical and clinical samples with alpha coefficients of .83 and .84, respectively (Fresco, Moore, et al., 2007; Fresco, Segal, et al., 2007).”
Quote in the paperNot a substantial claim1 of 2 sources checked- cites Fresco, Moore, et al., 2007 source
- cites Fresco, Segal, et al., 2007
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).
PremisecitationNo one study can satisfy every criterion for a mechanism.
“As Kazdin mentions, no single study can address all of the criteria.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites Kazdin, 2007 source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationEarlier work showed that, in ABBT for GAD, changes in acceptance and valued action predicted response beyond worry changes.
“Previous research demonstrated that changes in acceptance of internal experiences and engagement in valued action predict responder status over and above changes in worry for clients receiving ABBT for GAD (Hayes, Orsillo, & Roemer, 2010).”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites Hayes, Orsillo, & Roemer, 2010 source
Classified as probably not a substantial claim.
PremisecitationA mechanism of action requires evidence that decentering changes come before symptom changes.
“However, to be considered a mechanism of action, the temporal relationship showing that changes in decentering precede symptom change needs to be established.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites Kazdin, 2007 source
Probably not a substantial claim: may not pass S2 (checkable).
PremisecitationLearning how change mechanisms work will improve existing treatments.
“As has been highlighted by a number of authors (e.g., Hayes, Hope, & Hayes, 2007; Hunsley & Rumstein-McKean, 1999; Kazdin, 2007; Kraemer et al., 2002; Nock, 2007), identifying and understanding mechanisms of change will lead to improvements in our current treatments.”
Quote in the paperNot a substantial claim1 of 3 sources checkedMay combine two claims. The quote only partly states this claim.
InterpretationcitationSimilar decentering change across treatments matches case reports from a small part of this sample by Hayes-Skelton et al. (2012), who found decentering rises in AR.
“This finding is consistent with the cases (from a small subset of this sample) presented in Hayes-Skelton and colleagues (2012) suggesting that decentering increases across AR.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites Hayes-Skelton et al., 2012 source
May combine two claims.
Findingown dataModel 2, with only the coupling from decentering to anxiety, was an equivalent fitting model to the full bidirectional model (p = .15), indicating the anxiety-to-decentering coupling did not significantly improve the model and could be removed.
“The non-significant chi-square difference test (p = .15) indicates that the more parsimonious Model 2 was an equivalent fitting model to the full Model, indicating that the coupling from anxiety to decentering does not significantly add to the model and can be dropped leaving the couplings from decentering to symptoms.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataOn average, clients' DASS-Stress scores began at 22.35 and decreased significantly by 2.63 points every four sessions, ending treatment at approximately 11.83.
“In comparison, clients’ DASS-Stress scores were 22.35 on average at the beginning of treatment. DASS-Stress scores then decreased significantly by 2.63 points every four sessions, ending treatment at approximately 11.83.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataModel 3, with only the coupling from anxiety to decentering, fit significantly worse than Model 1 (p = .04), indicating that removing the decentering-to-anxiety coupling worsened fit, so that coupling should be kept.
“Comparing this model to Model 1, the chi-square difference test was significant (p = .04), indicating that removing the coupling of decentering leading to anxiety did significantly degrade the model fit and therefore this coupling should be retained, providing additional evidence of decentering as a leading indicator of change in anxiety.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataExcept at session 8, correlations across variables at the same time points and between EQ at time t and DASS at time t+1 were moderate to strong.
“Additionally, with the exception of session 8, there were moderate to strong correlations across variables at the same time points (e.g., EQ and DASS at session 4) and with EQ at time t and DASS at time t+1 (e.g. EQ at pre and DASS at session 4).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataOn average, clients began treatment with an EQ-decentering score of 29.35, which increased significantly by 1.58 points every four sessions, ending treatment at approximately 35.67.
“As shown in Table 2, on average, clients began treatment with an average EQ-decentering score of 29.35 which increased significantly by an average of 1.58 points every four sessions ending treatment at approximately 35.67.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationThe DASS-21 Stress subscale discriminates between clients with GAD and those with panic disorder, social phobia, and specific phobia.
“it has been shown to discriminate between clients with GAD and those with panic disorder, social phobia, and specific phobia (Brown, Chorpita, Korotitsch, & Barlow, 1997).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Brown, Chorpita, Korotitsch, & Barlow, 1997 source
Classified as probably not a substantial claim.
PremisecitationAccording to acceptance-based behavioral theory, GAD is maintained by rigid experiential avoidance.
“2) rigid experiential avoidance, or the tendency to want to avoid or change one’s experience (Hayes, Strosahl, & Wilson, 1999)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Hayes, Strosahl, & Wilson, 1999
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Classified as probably not a substantial claim. May combine two claims.
Study design and conductcitationThe DASS-21 Stress subscale has demonstrated good internal consistency and construct validity and is sensitive to change.
“The subscales have demonstrated good internal consistency and construct validity (Antony, Bieling, et al., 1998) and have been shown to be sensitive to change across hospitalization for clients with a primary diagnosis of depression (Page, Hooke, & Morrison, 2007).”
Quote in the paperSubstantial claim0 of 2 sources checkedClassified as probably not a substantial claim.
PremisecitationAccording to acceptance-based behavioral theory, GAD is maintained by a reactive, judgmental, and fused relationship with internal experiences.
“GAD is maintained by: 1) a reactive, judgmental, and fused relationship with internal experiences”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Roemer & Orsillo, 2014
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationAccording to acceptance-based behavioral theory, GAD is maintained by a constriction in the amount and types of behaviors one engages in.
“3) a constriction in the amount and types of behaviors that one engages in.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Roemer & Orsillo, 2014
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Classified as probably not a substantial claim. May combine two claims.
PremisecitationAccording to theory, fused responses to internal experiences lead to rigid efforts to avoid or control these experiences, paradoxically increasing reactivity, fusions, and further attempts at experiential avoidance.
“According to theory, these fused responses to internal experiences then naturally lead to rigid efforts to avoid (control) these experiences, paradoxically increasing reactivity, fusions, and further attempts at experiential avoidance (Roemer & Orsillo, 2014).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Roemer & Orsillo, 2014
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Classified as probably not a substantial claim.
PremisecitationDecentering has been theorized to be a change agent in cognitive therapies.
“Similarly, decentering has been theorized to be a change agent in cognitive therapies (Beck, 1970; Heimberg & Ritter, 2008; Ingram & Hollon, 1986).”
Quote in the paperSubstantial claim0 of 3 sources checkedClassified as probably not a substantial claim.
PremisecitationCognitive defusion is a mediator of change in ACT.
“cognitive defusion is a mediator of change in ACT (Zettle et al., 2011).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Zettle et al., 2011 source
Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.
Study design and conductown dataThe EQ-Decentering subscale had internal consistency in the current sample ranging from .86 to .94.
“The EQ was assessed at pre-treatment, sessions 4, 8, and 12, and at post-treatment (internal consistencies in the current sample from .86 to .94).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataLess than 2% of cases were missing at any time point.
“Data were missing for less than 2% of cases at any time point.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable).
PremisecitationFinding shared change mechanisms can reduce the number of separate manuals for similar outcomes by emphasizing what approaches have in common.
“As highlighted by these authors and others, identifying common mechanisms of change will help to consolidate the proliferation of specific treatment manuals that lead to similar outcomes by highlighting the commonalities among the approaches.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable).
InterpretationreasoningFocusing on specific mechanisms may make therapy more efficient and effective by allowing time to be spent on active ingredients and less on unnecessary parts.
“Related, targeting these specific mechanisms within treatment is likely to increase the efficiency and efficacy of treatment since more session time will be spent on treatment elements directly leading to change and less essential elements could be dropped or reduced.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataAR therapist competency ratings averaged 2.38, with 89.8% good or excellent, 9.1% acceptable, and 1.1% poor.
“The average score across skills was 2.38 (SD = 0.69) with 168 of the 187 ratings (89.8%) being good or excellent, 17 (9.1%) being acceptable, and 2 (1.1%) being poor.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataIn ABBT, adherence ratings showed allowed components were addressed in detail and executed skillfully, and only one session had a forbidden strategy.
“In the ABBT condition, the allowed components were rated as being addressed in detail [means from 1.67 (SD=0.66) to 1.96 (SD=0.20)] and executed skillfully [means from 1.85 (SD=0.36) to 1.98 (SD=0.14)]. Only one session had a forbidden strategy (use of relaxation as a form of anxiety control).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).
InterpretationreasoningA mechanism focus may aid dissemination, letting clinicians adapt techniques to clients and contexts instead of using a different package for each presentation.
“Finally, the focus on treatment mechanisms will likely foster dissemination as clinicians could focus on the underlying mechanisms and then adapt the specific approaches and techniques to better match specific clients and contexts as opposed to having a separate treatment package for each client presentation.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationcitationThe observed rise in decentering and its link to symptom reduction resembles results reported for MBSR/MBCT and ACT.
“Adding further support for the consistency of this proposed mechanism, this finding is similar to reported findings on the role of decentering in treatment studies focusing on Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy (Bieling et al., 2012; Carmody, Baer, Lykins & Oldendzki, 2009; Teasdale et al., 2002) and Acceptance and Commitment Therapy (Zettle et al., 2011).”
Quote in the paperSubstantial claim0 of 3 sources checkedMay combine two claims.
Interpretationown dataTreatment did not significantly affect either the decentering slope or its link to symptoms, suggesting similar decentering change in ABBT and AR.
“As hypothesized, allowing either the slope of decentering or the relationship between decentering and symptoms to vary across treatments did not significantly alter the fit of the models. This indicates that treatment was not a significant factor in these two parameters, providing evidence that decentering is changing similarly across ABBT and AR.”
Quote in the paperSubstantial claimMay combine two claims.
Interpretationown dataTaken together, the results support decentering as a mechanism in both a therapy that targets it directly and one that does not.
“Overall, these finding support the theory that decentering is a mechanism across two treatments, one that explicitly targets decentering and one that does not.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
PremisecitationA model is considered to have good fit when RMSEA is below .06 and CFI and TLI are above .95.
“A model is considered to have good fit when the RMSEA is below .06, and the CFI and TLI are above .95 (Hu & Bentler, 1999).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Hu & Bentler, 1999 source
Classified as probably not a substantial claim.
Study design and conductnone givenClients were randomized to receive 16 sessions of either ABBT or AR.
“Clients were randomized to receive 16 sessions of either ABBT or AR.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenStudy procedures were approved by university institutional review boards and a Data Safety and Monitoring Board.
“All study procedures were approved by the [removed for blinding] University Internal Review Boards as well as by a Data Safety and Monitoring Board.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
InterpretationreasoningPracticing awareness of early anxiety signals might foster decentering much as mindfulness is thought to do in ABBT.
“The repeated practice of noticing early cues of anxiety may promote decentering in a similar manner to how it is hypothesized the mindfulness promotes decentering in ABBT.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).
PremisecitationBetter knowledge of how treatments work will allow more effective and efficient therapies to be developed and delivered.
“Having a stronger understanding of the mechanisms underlying treatments will enable the development and delivery of more effective and efficient therapies (Kraemer, Wilson, Fairburn, & Agras, 2002).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Kraemer, Wilson, Fairburn, & Agras, 2002 source
Probably not a substantial claim: may not pass S2 (checkable).
InterpretationreasoningFrequent measurement of proposed mechanisms is necessary to study how their change unfolds over time.
“Without designing studies to assess potential mechanisms frequently, it would not be possible to examine the time course of change in a potential mechanism.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataIn AR, adherence ratings showed allowed components were addressed in detail and executed skillfully, and no sessions had a forbidden strategy.
“Similarly, in the AR condition, the allowed components were typically rated as being addressed in detail [means from 1.89 (SD=0.37) to 1.96 (SD=0.20)] and executed skillfully [means from 1.91 (SD=0.29) to 1.97 (SD=0.17)]. No AR sessions had a forbidden strategy.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S1 (asserted), S4 (based).
PremisereasoningA common mechanism would show the same pattern across different therapies.
“Additionally, if decentering is a common mechanism, then this pattern should be consistent across therapies.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim. May combine two claims.
Interpretationown dataBecause decentering preceded change in both therapies, including one that does not directly address it, promoting decentering across GAD treatments may be worthwhile.
“The finding that decentering was a leading indicator of change across treatments, particularly a treatment that does not explicitly address decentering, points to the potential value of promoting decentering throughout treatments for GAD.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisereasoningDecentering is just one among several proposed change mechanisms in anxiety treatment.
“For example, decentering is only one of many hypothesized mechanisms of change in treatments for anxiety (e.g., increased psychological flexibility, reduced physical tension, decreased experiential avoidance).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataTherapists were post-doctoral fellows or advanced doctoral students supervised by the study authors and trained by experts in applied relaxation and mindfulness therapies.
“Therapists were post-doctoral fellows (n = 3) or advanced doctoral students (n = 8), supervised by the study authors. The initial therapists and the supervisors were trained by Dr. Tom Borkovec in Applied Relaxation and Dr. Zindel Segal in mindfulness therapies.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
PremisecitationPrior theory proposes decentering as a mechanism in acceptance/mindfulness-based and cognitive behavioral therapies.
“Decentering has been theorized to be a mechanism in both acceptance and mindfulness based therapies and in cognitive behavioral therapies (e.g. Hayes et al., 1999; Heimberg & Ritter, 2008; Ingram & Hollon, 1986; Roemer & Orsillo, 2003)”
Quote in the paperSubstantial claim0 of 3 sources checked- cites Hayes et al., 1999
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites Heimberg & Ritter, 2008 source
- cites Ingram & Hollon, 1986
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductcitationThe PSWQ has demonstrated high internal consistency and test-retest reliability and discriminates GAD from other anxiety disorders.
“The PSWQ is a 16-item self-report measure of trait levels of worry, which has demonstrated high internal consistency and test-retest reliability (Molina & Borkovec, 1994) and been found to discriminate GAD from other anxiety disorders (Brown, Antony, & Barlow, 1992).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Molina & Borkovec, 1994
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites Brown, Antony, & Barlow, 1992 source
The paper relies on this without support.
The 64 participants who completed at least half of the sessions are representative of the full intent-to-treat sample for estimating the decentering-anxiety relationship.
“Participants are a subsample of 64 individuals (out of the 81 in the intent-to-treat sample) who completed at least half of the 16-sessions”
The paper relies on this without support.
The measurement intervals used for decentering and symptoms are adequate to establish temporal precedence of decentering changes over symptom changes.
“The DASS was assessed at pre-treatment, sessions 4, 8, and 12, and at post-treatment”
The paper relies on this without support.
The latent difference score model's coupling parameter reflects a causal influence of decentering on symptoms rather than reverse causation or confounding.
“the best fitting model was one in which decentering was a leading indicator of change in symptoms (DASS-Stress).”
The authors state this as an assumption.
In the bivariate latent difference score model, the coupling parameter stands for one variable's effect on change in the other.
“It is this coupling parameter that represents the influence of one variable on change in the second variable.”
The authors state this as an assumption.
Latent change scores equal the initial-state score plus all accumulated latent changes to that point.
“These latent change scores are based on the score at the initial state plus all latent changes that have accumulated up to that point.”
The authors state this as an assumption.
A bivariate model adds prior scores of the other variable to the accumulated change in the focal variable.
“In a bivariate model, in addition to the accumulated change on the variable of interest, previous scores of a second variable are also included.”
The authors state this as an assumption.
Each latent variable depends on three parts: the linear slope, the focal variable's prior score, and the other variable's prior score.
“Each of these latent variables are a function of three components: 1) the linear slope or average rate of change in the given variable, α; 2) the previous score of the variable of interest, β; and 3) the score of the other variable at the previous time point, γ, which is typically referred to as the coupling parameter.”
The authors state this as an assumption.
A chi-square difference test between nested models indicates whether freeing a parameter significantly improves fit.
“The chi-square difference between these two nested models provides information regarding whether or not allowing the parameter of interest to vary significantly adds to the model fit.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Greater increases in decentering were found across ACT relative to CBT or relaxation training, but findings are equivocal with others reporting non-significant effects of intervention-type on decentering.
“Greater increases in decentering were found across ACT relative to CBT73,89 or relaxation training80.”
From Decentering as a core component in the psychological treatment and prevention of youth anxiety and depression: a narrative review and insight report (2021) · cites this paper as [82]
The cited paper does not report greater increases in decentering for ACT than for relaxation training. Its Abstract Results report that decentering increased, but the rate of change did not significantly differ between the treatments studied: acceptance-based behavioral therapy (ABBT) and applied relaxation (AR). The Present Study section identifies those treatments; ACT was not a treatment arm. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredIn Hayes-Skelton and colleagues' study, decentering was a common mediator across acceptance-based behavior therapy and applied relaxation; decentering increased in both conditions and predicted better symptom outcomes.
“Decentering was found to be a common mediator across both treatment conditions. Decentering significantly increased across both treatment conditions, and this increase predicted better symptom outcomes.”
From Changes in Decentering and Reappraisal Temporally Precede Symptom Reduction During Emotion Regulation Therapy for Generalized Anxiety Disorder With and Without Co-Occurring Depression. (2019) · cites this paper as Hayes-Skelton et al., 2015
The Results report a significant increase in decentering, an association with reduced worry symptoms, and no significant difference in its rate of change between acceptance-based behavioral therapy and applied relaxation. The Discussion also reports that changes in decentering preceded changes in anxiety symptoms across treatments. However, the authors describe these findings as support for a potential common mechanism, not as establishing decentering as a common mediator. (LLM, conf=0.85)
Experimental — accuracy not yet measuredSome prior studies have found that metacognitive abilities mediate outcomes in other cognitive behavioral therapies for generalized anxiety disorder.
“A few studies thus far have demonstrated a mediating role for these metacognitive abilities in other cognitive behavioral therapies (CBTs) for GAD.”
From Changes in Decentering and Reappraisal Temporally Precede Symptom Reduction During Emotion Regulation Therapy for Generalized Anxiety Disorder With and Without Co-Occurring Depression. (2019) · cites this paper as Hayes-Skelton et al., 2015
The Discussion reports that, in this study of GAD, changes in decentering preceded changes in anxiety symptoms across acceptance-based behavioral therapy and applied relaxation. But the paper does not establish that a few prior studies demonstrated mediation in CBTs specifically for GAD: its discussion of a prior ACT-versus-CBT mediation finding concerns anxiety disorders more broadly, and it says decentering had not been systematically examined as a treatment mechanism for GAD. (LLM, conf=0.85)
Experimental — accuracy not yet measuredIn a secondary analysis of the same RCT, decentering was a common mechanism of change across ABBT and AR.
“A recent secondary data analysis from the same RCT as the current study, comparing ABBT and Applied Relaxation (AR) in a sample with GAD found decentering to be a common mechanism of change across both treatment conditions (Hayes-Skelton, Calloway, Roemer, & Orsillo, 2015).”
From Reductions in experiential avoidance as a mediator of change in symptom outcome and quality of life in acceptance-based behavior therapy and applied relaxation for generalized anxiety disorder (2016) · cites this paper as Hayes-Skelton, Calloway, Roemer, & Orsillo, 2015
The Present Study section identifies this as an analysis of data from an RCT comparing ABBT and AR in people with GAD. The Results and Discussion report a similar relationship between decentering and later anxiety symptoms across both treatments, but describe this as support for a *potential* common mechanism, not a definitive finding that the mechanism was established. (LLM, conf=0.84)
Experimental — accuracy not yet measuredEQ scores improve over the course of behavioural and cognitive therapies, and the magnitude of such change is associated with key outcomes like symptom severity and quality of life.
“Finally, EQ scores improve over the course of behavioural and cognitive therapies; the magnitude of such change is associated with key outcomes like symptom severity and quality of life.23 26 27 36 37”
From Protocol for a randomised controlled trial investigating an intervention to boost decentering in response to distressing mental experiences during adolescence: the decentering in adolescence study (DECADES) (2022) · cites this paper as [26]
The Results section (page unavailable) reports that EQ-decentering scores increased during treatment and that greater increases were strongly associated with lower post-treatment worry scores. The study examined acceptance-based behavioral therapy and applied relaxation, not cognitive therapy, and the passages found do not report an association with quality of life. (LLM, conf=0.88)
Experimental — accuracy not yet measured
In adults with anxiety, EQ scores increase by 0.49-0.66 per CBT session and 1.5 per four ACT sessions; baseline EQ scores are around 29.32-34.99 and grow by 0.37-0.66 per session.
“In adults with anxiety, EQ scores increased by a unit of 0.49–0.66 per session of CBT and 1.5 per four sessions of Acceptance and Commitment Therapy (ACT).”
From Decentering as a core component in the psychological treatment and prevention of youth anxiety and depression: a narrative review and insight report (2021) · cites this paper as [82]
The Results section (page unavailable) reports a baseline EQ-decentering score of 29.35 and an average increase of 1.58 points every four sessions, broadly supporting the claim of an increase of about 1.5 points. But the Methods identify the treatments as acceptance-based behavioral therapy and applied relaxation, not ACT and CBT. Our copy does not substantiate the claimed CBT-specific increase of 0.49–0.66 per session or the full baseline range of 29.32–34.99. (LLM, conf=0.88)
Experimental — accuracy not yet measuredTreatment-related increases in decentering mediated the impact of mindfulness training on anxiety severity in adults with GAD; rate of decentering increase was associated with decreases in worry and stress; session-by-session increases predicted decreases in social anxiety in CBT.
“Treatment-related increases in decentering mediated the impact of mindfulness training on anxiety severity in adults seeking treatment for generalized anxiety disorder (GAD) (37.6 ± 11.6 years)87.”
From Decentering as a core component in the psychological treatment and prevention of youth anxiety and depression: a narrative review and insight report (2021) · cites this paper as [82]
Split into 3 atoms — 0 confirmed, 3 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredStudies point to a lack of specificity across several trials, finding similar mediating effects of mediators assumed to be specific to acceptance and mindfulness-based therapies in both contemporary acceptance and mindfulness-based therapies and traditional CBTs.
“Empirically, studies point to a lack of specificity across several trials, finding similar mediating effects of mediators assumed to be specific to acceptance and mindfulness-based therapies in both contemporary acceptance and mindfulness-based therapies and traditional CBTs (e.g., Goldin et al., 2016; Hayes-Skelton et al., 2015; Kocovski et al., 2015).”
From Mediators of acceptance and mindfulness-based therapies for anxiety and depression: A systematic review and meta-analysis (2022) · cites this paper as Hayes-Skelton et al., 2015
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredHayes-Skelton et al., 2015 propose that increases in decentering precede changes in acceptance.
“Likewise, Hayes-Skelton et al., 2015 propose that increases in decentering precedes changes in acceptance; namely that viewing internal experiences from a different perspective may produce fewer attempts to control or avoid.”
From Mediators of acceptance and mindfulness-based therapies for anxiety and depression: A systematic review and meta-analysis (2022) · cites this paper as Hayes-Skelton et al., 2015
The passage labeled Abstract > Conclusions proposes that viewing internal experiences from a decentered perspective may reduce efforts to control or avoid them. The Discussion reports that changes in decentering preceded changes in anxiety symptoms, not changes in acceptance; the paper does not establish the claimed temporal order between decentering and acceptance. Page numbers were not supplied. (LLM, conf=0.88)
Experimental — accuracy not yet measuredFor GAD, decentering preceded symptom change in applied relaxation and acceptance-based behavior therapy, and the reverse pattern was not significant.
“To examine the time course of change in decentering, decentering was a leading indicator of symptom change for individuals receiving either applied relaxation or an acceptance-based behavior therapy for GAD, with no evidence for the reverse pattern (symptoms leading to decentering) being significant (Hayes-Skelton, Calloway, Roemer, & Orsillo, 2015).”
From Changes in Decentering Across Cognitive Behavioral Group Therapy for Social Anxiety Disorder (2018) · cites this paper as Hayes-Skelton, Calloway, Roemer, & Orsillo, 2015
Decentering changes correlate with worry changes in GAD clients.
“changes in decentering are related to changes in worry in clients with generalized anxiety disorder (Hayes-Skelton et al., 2015)”
From Examining the Interrelation Among Change Processes: Decentering and Anticipatory Processing Across Cognitive Behavioral Therapy for Social Anxiety Disorder. (2019) · cites this paper as Hayes-Skelton et al., 2015
It is possible that because therapists were also trained in ABBT, they modeled experiential acceptance and decentering despite not explicitly discussing it; client reports of experiential acceptance predict outcomes across both therapies, and decentering increased and led to improved symptoms across both therapies.
“It is also possible that because our therapists were also trained in ABBT, they modeled experiential acceptance and decentering despite the fact that it was not explicitly discussed; client reports of experiential acceptance do predict outcomes across both therapies in this trial (Eustis, Hayes-Skelton, Roemer, & Orsillo, 2016) and decentering increased and led to improved symtoms across both”
From Do treatment responders maintain their gains following a randomized clinical trial comparing an acceptance-based behavior therapy to applied relaxation for generalized anxiety disorder? (2025) · cites this paper as Hayes-Skelton, Calloway, Roemer, & Orsillo, 2015
Empirical evidence suggests that a fundamental shift in one's relationship to internal experience precedes and significantly predicts improvements in anxiety symptoms, and may further enhance self-regulation and cognitive-behavioral flexibility, promoting gains in positive psychological functioning.
“Empirical evidence suggests that this fundamental shift in one’s relationship to internal experience not only precedes but also significantly predicts improvements in anxiety symptoms (Hayes-Skelton et al., 2015), but may also further enhance self-regulation and cognitive-behavioral flexibility, thereby broadly promoting gains in positive psychological functioning (Carmody et al., 2009).”
From Mindfulness- and acceptance-based interventions for music performance anxiety: a three-level meta-analysis of therapeutic effects, mechanisms, and boundary conditions (2026) · cites this paper as Hayes-Skelton et al., 2015
Decentering increases as a result of cognitive behavioral therapies, emotion regulation therapy, and mindfulness-based interventions, and contributes to the beneficial effects of mindfulness-based approaches.
“Decentering increases as a result of cognitive behavioral therapies (Fresco et al., 2007; Hayes-Skelton et al., 2015), emotion regulation therapy (ERT; Mennin et al., 2018; O’Toole et al., 2019), and MBIs (Bieling et al., 2012; Carmody et al., 2009) and contributes to the beneficial effects of mindfulness-based approaches (Hoge et al., 2015).”
From Measuring Decentering – Development and Validation of the French Version of the Experiences Questionnaire (EQ-F) (2024) · cites this paper as Hayes-Skelton et al., 2015
Increased self-rated decentering is also reported following emotion regulation training and relaxation training.
“Increased self-rated decentering is also reported following emotion regulation training81 and relaxation training80,82.”
From Decentering as a core component in the psychological treatment and prevention of youth anxiety and depression: a narrative review and insight report (2021) · cites this paper as [82]
In adults with GAD, a unidirectional relationship between improved decentering and reduced stress was identified during acceptance-based treatments and applied relaxation, with decreases in stress occurring downstream to increased EQ scores.
“In adults with GAD, a unidirectional relationship between improved decentering and reduced stress was identified during acceptance-based treatments and applied relaxation. This was characterized by decreases in stress occurring downstream to increased EQ scores (34.41 ± 12.14 years)82.”
From Decentering as a core component in the psychological treatment and prevention of youth anxiety and depression: a narrative review and insight report (2021) · cites this paper as [82]
Studies have indicated that the proposed mediators may drive treatment gains.
“Studies have indicated that the proposed mediators outlined above may indeed drive treatment gains (e.g., Arch, Eifert, et al., 2012; Hayes-Skelton et al., 2015; Kuyken et al., 2010; Mennin et al., 2018; Shahar et al., 2010).”
From Mediators of acceptance and mindfulness-based therapies for anxiety and depression: A systematic review and meta-analysis (2022) · cites this paper as Hayes-Skelton et al., 2015
Decentering contributes to the salutary benefits of meditation training, MBIs, and mindfulness-enriched CBTs.
“Decentering contributes to the salutary benefits of meditation training [48], MBIs [33, 54, 57, 58] and mindfulness enriched CBTs [59–63].”
From All together now: utilizing common functional change principles to unify cognitive behavioral and mindfulness-based therapies (2019) · cites this paper as [60]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Conflicting claims about evidence for a gradient
MinorThe discussion says this study demonstrates a gradient relationship, then says future research is needed to explicitly address the gradient component. It is unclear whether the authors consider that criterion addressed by this study.
“this study demonstrates: a strong association and gradient relationship between decentering and general anxiety symptoms”
“Therefore, future research is need that explicitly addresses the specificity, experimental manipulation, and gradient components.”
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BackgroundHayes-Skelton, S. A., Roemer, L., & Orsillo, S. M. (2013) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0032871 · Cited by 153 · see citing works
Self-citationDecentering as a Common Link among Mindfulness, Cognitive Reappraisal, and Social Anxiety
Hayes-Skelton, S., & Graham, J. (2013) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465812000902 · Cited by 134 · cited 1× · see citing works
“For additional methodological details of the study, please see Hayes-Skelton, Roemer, and Orsillo (2013).”
MethodSelf-citationBlackledge, J. T. (2007) · The Psychological Record · doi:10.1007/bf03395595 · Cited by 130 · see citing works
Hayes, S. A., Orsillo, S. M., & Roemer, L. (2010) · Behaviour Research and Therapy · doi:10.1016/j.brat.2009.11.006 · Cited by 129 · see citing works
Self-citationLee, J. K., Orsillo, S. M., Roemer, L., & Allen, L. B. (2010) · Cognitive Behaviour Therapy · doi:10.1080/16506070902966918 · Cited by 124 · cited 2× · see citing works
“…one engages in. Individuals with GAD report more distress about emotional responses (Lee, Orsillo, Roemer, & Allen, 2010), more experiential avoidance (Lee et al., 2010), and less engagement in meaningful activities (Michelson, Lee, Orsillo, & Roemer, 2011) than those without a diagnosis of GAD.”
BackgroundResultSelf-citationThe role of values-consistent behavior in generalized anxiety disorder.
Michelson, S. E., Lee, J. K., Orsillo, S. M., & Roemer, L. (2011) · Depression and Anxiety · doi:10.1002/da.20793 · Cited by 84 · see citing works
Self-citation(1986) · Cited by 82 · see citing works
The Mindful Way through Anxiety: Break Free from Chronic Worry and Reclaim Your Life
Roemer, L., & Orsillo, S. M. (2011) · Cited by 59 · see citing works
Self-citationOrsillo, S. M., Roemer, L., Block‐Lerner, J., & Tull, M. T. (2004) · Cited by 55 · see citing works
Self-citationA Contemporary View of Applied Relaxation for Generalized Anxiety Disorder
Hayes-Skelton, S., Roemer, L., Orsillo, S., & Borkovec, T. (2013) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2013.777106 · Cited by 54 · see citing works
Self-citationMindfulness and acceptance-based behavioral therapies for anxiety disorders.
Roemer, L., Williston, S. K., Eustis, E. H., & Orsillo, S. M. (2013) · Current Psychiatry Reports · doi:10.1007/s11920-013-0410-3 · Cited by 46 · see citing works
Self-citationHayes-Skelton, S. A., Usmani, A., Lee, J. K., Roemer, L., & Orsillo, S. M. (2012) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2011.12.005 · Cited by 29 · cited 1× · see citing works
“Given that decentering increases even in some treatments that do not explicitly target it (Hayes-Skelton et al., 2012), it may be difficult, if not impossible, to design a study in which individuals are randomized to a treatment that does not lead to decentering.”
BackgroundSelf-citationHeimberg, R. G., & Ritter, M. R. (2008) · Clinical Psychology: Science and Practice · doi:10.1111/j.1468-2850.2008.00140.x · Cited by 21 · cited 2× · see citing works
“Similarly, decentering has been theorized to be a change agent in cognitive therapies (Beck, 1970; Heimberg & Ritter, 2008; Ingram & Hollon, 1986).”
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Ayahuasca: pharmacology, neuroscience and therapeutic potential
Domínguez-Clavé, E., Soler, J., Elices, M., Pascual, J. C., Álvarez, E., de la Fuente Revenga, M., Friedlander, P., Feilding, A., & Riba, J. (2016) · Brain Research Bulletin · doi:10.1016/j.brainresbull.2016.03.002 · Cited by 226 · see citing works
“…(Bieling et al., 2012; Fresco et al., 2007b; Gecht, 2014; Hargus et al., 2010; Teasdale et al., 2002), but also in generalized anxiety disorder (Hayes-Skelton et al., 2015; Hoge et al., 2015), social anxiety (Hayes-Skelton and Graham, 2013), eating disorders, substance use disorders (Shapiro…”
BackgroundSoler, J., Elices, M., Franquesa, A., Barker, S., Friedlander, P., Feilding, A., Pascual, J. C., & Riba, J. (2016) · Psychopharmacology · doi:10.1007/s00213-015-4162-0 · Cited by 209 · see citing works
“Increases in decentering have been observed after cognitive behavioral therapy for depression and also after mindfulness-based interventions (Bliss and McCardle 2013; Hayes-skelton et al. 2014).”
BackgroundHayes-Skelton, S. A., Roemer, L., & Orsillo, S. M. (2013) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0032871 · Cited by 153 · see citing works
Self-citationJohannsen, M., Nissen, E. R., Lundorff, M., & O'Toole, M. S. (2022) · Clinical Psychology Review · doi:10.1016/j.cpr.2022.102156 · Cited by 116 · see citing works
Slatyer, S., Craigie, M. A., Heritage, B., Davis, S., & Rees, C. S. (2017) · Mindfulness · doi:10.1007/s12671-017-0795-x · Cited by 111 · see citing works
A Perspective on the Similarities and Differences Between Mindfulness and Relaxation
Luberto, C. M., Hall, D. L., Park, E. R., Haramati, A., & Cotton, S. (2020) · Global Advances in Health and Medicine · doi:10.1177/2164956120905597 · Cited by 104 · see citing works
“Moreover, changes in cognitive decentering and experiential avoidance served as mechanisms of effects on anxiety symptoms in both treatment groups.(84,85) One difference between this trial and some of those that found differential improvements is the length of the mindfulness and relaxation training: here, participant…”
MethodBennett, M. P., Knight, R., Patel, S., So, T., Dunning, D., Barnhofer, T., Smith, P., Kuyken, W., Ford, T., & Dalgleish, T. (2021) · Translational Psychiatry · doi:10.1038/s41398-021-01397-5 · Cited by 81 · see citing works
Conklin, L. R., Cassiello-Robbins, C., Brake, C. A., Sauer-Zavala, S., Farchione, T. J., Ciraulo, D. A., & Barlow, D. H. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.08.001 · Cited by 76 · see citing works
Impact of mindfulness training on borderline personality disorder: a randomized trial
Elices, M., Pascual, J. C., Portella, M. J., Feliu-Soler, A., Martín-Blanco, A., Carmona, C., & Soler, J. (2016) · Mindfulness · doi:10.1007/s12671-016-0492-1 · Cited by 72 · see citing works
Eustis, E. H., Hayes-Skelton, S. A., Roemer, L., & Orsillo, S. M. (2016) · Behaviour Research and Therapy · doi:10.1016/j.brat.2016.09.012 · Cited by 70 · see citing works
“…gets closer to temporal precedence, it does not fully achieve temporal precedence since outcomes are examined at post treatment while accounting for pre-treatment scores, but they do not take into account the rate of change over time as some other approaches do (e.g., Hayes-Skelton et al., 2015).”
MethodResultSelf-citationO’Toole, M. S., Renna, M. E., Mennin, D. S., & Fresco, D. M. (2019) · Behavior Therapy · doi:10.1016/j.beth.2018.12.005 · Cited by 66 · see citing works
Thorp, S. R., Glassman, L. H., Wells, S. Y., Walter, K. H., Gebhardt, H. M., Twamley, E. W., Golshan, S., Pittman, J. O. E., Penski, K., Allard, C. B., et al. (2019) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2019.02.003 · Cited by 63 · see citing works
Structure and validity of measures of decentering and defusion
Naragon-Gainey, K., & DeMarree, K. G. (2017) · Psychological Assessment · doi:10.1037/pas0000405 · Cited by 56 · see citing works
Zhang, C., Li, X., Chung, P., Huang, Z., Bu, D., Wang, D., Guo, Y., Wang, X., & Si, G. (2021) · Mindfulness · doi:10.1007/s12671-021-01644-2 · Cited by 49 · see citing works
Zainal, N. H., & Newman, M. G. (2019) · Journal of Abnormal Psychology · doi:10.1037/abn0000428 · Cited by 45 · see citing works
Eleftheriou, M. E., & Thomas, E. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.707057 · Cited by 39 · see citing works
“Pathological rumination and reduced decentring ability have been linked with many psychiatric disorders, including major depression, eating and cocaine use disorders (98), while both psychological and pharmacological treatments, including CBT, antidepressants and mindfulnessbased interventions, have all been linked to…”
BackgroundA randomized controlled trial of a smartphone-based application for the treatment of anxiety
Newman, M. G., Jacobson, N. C., Rackoff, G. N., Bell, M. J., & Taylor, C. B. (2021) · Psychotherapy Research · doi:10.1080/10503307.2020.1790688 · Cited by 37 · see citing works
“The scale has been used in several GAD treatment studies as a primary outcome measure (HayesSkelton et al., 2013; Hayes-Skelton et al., 2015).”
MethodFresco, D. M., & Mennin, D. S. (2019) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2018.10.014 · Cited by 36 · see citing works
A neurobehavioral account for decentering as the salve for the distressed mind
King, A. P., & Fresco, D. M. (2019) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2019.02.009 · Cited by 36 · see citing works
McEvoy, P. M., Graville, R., Hayes, S., Kane, R. T., & Foster, J. K. (2017) · Behavior Therapy · doi:10.1016/j.beth.2017.04.001 · Cited by 34 · see citing works
Decentering Attenuates the Associations of Negative Affect and Positive Affect With Psychopathology
Naragon-Gainey, K., & DeMarree, K. G. (2017) · Clinical Psychological Science · doi:10.1177/2167702617719758 · Cited by 34 · see citing works
Millstein, D. J., Orsillo, S. M., Hayes-Skelton, S. A., & Roemer, L. (2015) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2015.1060255 · Cited by 31 · see citing works
Self-citationChanges in Decentering Across Cognitive Behavioral Group Therapy for Social Anxiety Disorder
Hayes-Skelton, S. A., & Lee, C. S. (2018) · Behavior Therapy · doi:10.1016/j.beth.2018.01.005 · Cited by 28 · see citing works
Self-citationDonald, J. N., Atkins, P. W. B., Parker, P. D., Christie, A. M., & Guo, J. (2017) · Journal of Personality · doi:10.1111/jopy.12279 · Cited by 28 · see citing works
Decentering From Emotions in Daily Life: Dynamic Associations With Affect, Symptoms, and Well-Being
Naragon‐Gainey, K., DeMarree, K. G., Kyron, M. J., McMahon, T. P., Park, J., & Biehler, K. M. (2023) · Clinical Psychological Science · doi:10.1177/21677026221147262 · Cited by 24 · see citing works
Zhang, C.-Q., Chung, P.-K., Si, G., & Gucciardi, D. F. (2016) · Psychology of sport and exercise · doi:10.1016/j.psychsport.2016.02.006 · Cited by 21 · see citing works
Mechanisms of change in acceptance and commitment therapy for primary headaches
Vasiliou, V. S., Karademas, E. C., Christou, Y., Papacostas, S., & Karekla, M. (2022) · European Journal of Pain · doi:10.1002/ejp.1851 · Cited by 21 · see citing works
Mindfulness in Borderline Personality Disorder: Decentering Mediates the Effectiveness
Schmidt, C., Soler, J., Carmona, C., Elices, M., Domínguez‐Clavé, E., Vega, D., & Pascual, J. C. (2021) · Psicothema · doi:10.7334/psicothema2020.437 · Cited by 22 · see citing works
Solastalgia: Climatic Anxiety—An Emotional Geography to Find Our Way Out
Ferrarello, S. (2023) · The Journal of Medicine and Philosophy A Forum for Bioethics and Philosophy of Medicine · doi:10.1093/jmp/jhad006 · Cited by 20 · see citing works
Hoover, E. B., Butaney, B., Bernard, K. S., Coplan, B. H., LeLacheur, S., Straker, H. O., Carr, C., Blesse-Hampton, L., Naidu, A., & LaRue, A. (2022) · Medical Science Educator · doi:10.1007/s40670-022-01554-5 · Cited by 19 · see citing works
“Decentering has been found to decrease rumination and anxiety [10].”
BackgroundHoge, E. A., Reese, H. E., Oliva, I. A., Gabriel, C. D., Guidos, B. M., Bui, É., Simon, N. M., & Dutton, M. A. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.00082 · Cited by 18 · see citing works
“Cognitive-behavioral models of anxiety disorders (Hirsch and Mathews, 2012) propose that the way in which an individual interprets ambiguous information in the world around them has direct consequences for their emotional state, physiological arousal, and subsequent behavior.”
BackgroundHayes-Skelton, S. A., & Marando-Blanck, S. (2019) · Behavior Therapy · doi:10.1016/j.beth.2019.03.004 · Cited by 14 · see citing works
“Given that changes in decentering are related to changes in worry in clients with generalized anxiety disorder (Hayes-Skelton et al., 2015), it is possible that decentering influences social anxiety through its relation with the cognitive rumination process that occurs before individuals with…”
BackgroundSelf-citationHayes-Skelton, S. A., & Lee, C. S. (2020) · Behavior Modification · doi:10.1177/0145445519850744 · Cited by 13 · see citing works
Self-citationAssessing Decentering Capacity in Athletes: A Moderated Mediation Model
Diotaiuti, P., Valente, G., Corrado, S., & Mancone, S. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20043324 · Cited by 13 · see citing works
Guo, L. (2024) · Mindfulness · doi:10.1007/s12671-024-02395-6 · Cited by 19 · see citing works
“Notably, decentering was found to be a shared mechanism across mindfulness-based stress reduction and mindfulness-based cognitive therapies (e.g., Hayes-Skelton & Graham, 2013; Hayes-Skelton & Lee, 2020; Hayes-Skelton et al., 2015).”
Wu, J., Hamilton, J. L., Fresco, D. M., Alloy, L. B., & Stange, J. P. (2021) · Behaviour Research and Therapy · doi:10.1016/j.brat.2021.104017 · Cited by 14 · see citing works
Web-based training for post-secondary student well-being during the pandemic: a randomized trial
Wang, Y., & Farb, N. A. S. (2022) · Anxiety Stress & Coping · doi:10.1080/10615806.2022.2079637 · Cited by 13 · see citing works
Wellness in Physician Assistant Education: Exploring Mindfulness, Well-Being, and Stress
Hoover, E. B., Butaney, B., LeLacheur, S., Straker, H. O., Bernard, K. S., Coplan, B. H., Carr, C., Blesse-Hampton, L., & Naidu, A. (2022) · The Journal of Physician Assistant Education · doi:10.1097/jpa.0000000000000427 · Cited by 11 · see citing works
“An individual may also recognize that not all thoughts represent truth; labeling thoughts as temporary rather than permanent can lead to decreased rumination and anxiety.(19) Several aspects to mindfulness have been found to promote personal health benefits, which include improved interpersonal relationships, decrease…”
BackgroundTelehealth: the general practice perspective.
McPhee, E. (2014) · PubMed · Cited by 8 · see citing works
Sousa, M., Gonçalves, T., Caridade, S., Rodrigues, A. D. C., Maia, Â., & Cunha, O. S. (2025) · Trauma Violence & Abuse · doi:10.1177/15248380251397413 · Cited by 7 · see citing works
Foundational Skill-Building in a Novel Well-being Curriculum
Neary, S. L., Ruggeri, M., Roman, C., Hoover, E. B., Butaney, B., & Weller, I. (2023) · The Journal of Physician Assistant Education · doi:10.1097/jpa.0000000000000510 · Cited by 7 · see citing works
“Another skill-based component of mindfulness, decentering ability, helps individuals become aware of subjective thoughts and feelings and separate them from objective perceptions of current circumstances.(13) In doing so, individuals become aware that subjective thoughts and feelings are temporary rather than permanen…”
BackgroundWang, Z., Tang, X., Hu, A., Chiu, W., Hofmann, S. G., & Liu, X. (2025) · Psychotherapy Research · doi:10.1080/10503307.2024.2426562 · Cited by 6 · see citing works
“The results indicated that increases in decentering during MBIs significantly predicted lower depression relapse rates (Moore et al., 2022) and general anxiety symptoms (Hayes-Skelton et al., 2015) at follow-up and post-intervention.”
Wells, S. Y., Walter, K. H., Dedert, E. A., Strasshofer, D. R., Schnitzer, J. S., Thorp, S. R., Morland, L. A., & Glassman, L. H. (2021) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0001119 · Cited by 6 · see citing works
Acceptance-based behavioral therapies for generalized anxiety disorder (GAD)
Roemer, L., & Orsillo, S. M. (2020) · Generalized Anxiety Disorder and Worrying · doi:10.1002/9781119189909.ch12 · Cited by 5 · see citing works
Self-citationGender Gap in Mindfulness Assessment Among Italian Nurses: A Pilot Descriptive Study
Vitale, E. (2021) · Journal of Evidence-Based Psychotherapies · doi:10.24193/jebp.2021.2.12 · Cited by 5 · see citing works
Abasi, I., Dolatshahi, B., Farazmand, S., Pourshahbaz, A., & Tamanaeefar, S. (2018) · Europe PMC (PubMed Central) · Cited by 5 · see citing works
Costa, M. D. A., Russell, T. A., Gosmann, N. P., Gonçalves, F., Tatton‐Ramos, T., de Oliveira, F. B., & Manfro, G. G. (2023) · British Journal of Clinical Psychology · doi:10.1111/bjc.12402 · Cited by 4 · see citing works
Bennett, M. P., Knight, R. C., Dunning, D., Archer-Boyd, A., Blakemore, S.-J., Dalmaijer, E., Ford, T., Williams, J. M. G., Clegg, H., Kuyken, W., et al. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-056864 · Cited by 4 · see citing works
Anxiety and physical inactivity: breaking the vicious circle
Logan, J. G., Kim, S., Lee, M., & Yeo, S. (2018) · Mental Health Practice · doi:10.7748/mhp.2018.e1267 · Cited by 4 · see citing works
Zhang, C., Shan, X., Zhang, H., Zhang, M., & Zhou, H. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1851221 · Cited by 4 · see citing works
Abbott, D., & Lack, C. W. (2020) · Current Psychiatry Research and Reviews · doi:10.2174/2666082216666200220121648 · Cited by 3 · see citing works
Decentering as a Facilitator of Psychological Well-Being
Milosch, J. (2019) · The Keep (Eastern Illinois University) · Cited by 3 · see citing works
Mindfulness-based approaches to mental health
Nauphal, M., Cardona, N. D., Morgan, L. P. K., & Eustis, E. H. (2023) · Encyclopedia of Mental Health · doi:10.1016/b978-0-323-91497-0.00053-9 · Cited by 2 · see citing works
Clayton, M., Renna, M. E., Weingast, L. T., Panjwani, A. A., Spaeth, P. E., Heimberg, R. G., Fresco, D. M., & Mennin, D. S. (2023) · Journal of Emotion and Psychopathology · doi:10.55913/joep.v1i1.36 · Cited by 2 · see citing works
“Emotion regulation skill-building is a central component of cognitive behavioral interventions and there is evidence that reappraisal and decentering mediate GAD symptom reduction during treatment (Hayes-Skelton et al., 2015; O'Toole et al., 2019b).”
BackgroundResultAsselmann, E., Rückert, F., Kische, H., Zenker, M., Pieper, L., & Beesdo‐Baum, K. (2024) · Journal of Mood and Anxiety Disorders · doi:10.1016/j.xjmad.2024.100055 · Cited by 2 · see citing works
“In addition, improvements in decentering preceded improvements in anxiety symptoms [30], and improvements in experiential avoidance preceded improvements in worry and quality of life [26].”
Mindfulness-Based Cognitive Behavioral Treatments
Roemer, L., Arbid, N., Martinez, J. H., & Orsillo, S. M. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-803457-6.00008-8 · Cited by 2 · see citing works
Self-citationExperiences Questionnaire (EQ)
Naragon-Gainey, K., McMahon, T. P., Park, J., & Fresco, D. M. (2022) · Handbook of Assessment in Mindfulness Research · doi:10.1007/978-3-030-77644-2_42-1 · Cited by 2 · see citing works
Lalande, L. (2017) · Queensland University of Technology · doi:10.5204/thesis.eprints.103980 · Cited by 2 · see citing works
The Psychological Treatment of Generalized Anxiety Disorder
McCabe‐Bennett, H., Fracalanza, K., & Antony, M. M. (2017) · Wiley eBooks · doi:10.1002/9781119462996.ch5 · Cited by 2 · see citing works
Moore, M., Lau, M. A., Haigh, E. A. P., et al. (2022) · doi:10.31231/osf.io/mx32f · Cited by 2 · see citing works
Gamaiunova, L., Shankland, R., Moore, M., Mayor, E., Dessart, G., Kotsou, I., & Fresco, D. (2024) · Psychological Test Adaptation and Development · doi:10.1027/2698-1866/a000083 · Cited by 1 · see citing works
Marando-Blanck, S., Hayes‐Skelton, S. A., Roemer, L., & Orsillo, S. M. (2024) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2024.2423654 · Cited by 2 · see citing works
“This approach is consistent with other studies examining mechanisms within ABBT (e.g., Hayes-Skelton et al., 2015).”
Self-citationBernabé, J. R. Y., Buz, J., Crego, A., Gregoris, L., & Alonso, M. (2026) · Scientific Reports · doi:10.1038/s41598-026-46387-z · Cited by 1 · see citing works
“Longitudinal studies on ACT-based interventions also highlight the reduction of cognitive fusion as an effective mechanism for reducing anxiety 36 , noting that changes in psychological flexibility precede symptom reduction 37 .”
Efectos y Particularidades del Uso del Mindfulness en el Trastorno Límite de la Personalidad
Elices, M., Carmona, C., Martín‐Blanco, A., Pascual, J. C., & Soler, J. (2016) · Revista de Psicoterapia · doi:10.33898/rdp.v27i103.106 · Cited by 1 · see citing works
THERAPEUTIC INTERVENTIONS FOR ANXIETY DISORDERS: AN INTEGRATIVE REVIEW
Amaral, R. I., Flores, L. C. M., Kowalczuk, L., Paz, A. A., & Viana, A. C. W. (2022) · RECISATEC - REVISTA CIENTÍFICA SAÚDE E TECNOLOGIA · doi:10.53612/recisatec.v2i10.200 · Cited by 1 · see citing works
“Decentering as a potential common mechanism across two therapies for generalized anxiety disorder Hayes-Skelton et al. (2013) To examine whether a treatment combining mindfulness (Applied Relaxation) and acceptance-based strategies with behavioral approaches would improve outcomes in Generalized Anxiety Disorder RCT 1…”
MethodResultInfluentialIntégration des psychédéliques dans la TCC : effets sur la décentration
Penzenstadler, L. E., ZULLINO, D. F., Seragnoli, F., Brakha, T. A., & Thorens, G. (2025) · Psychotropes · doi:10.3917/psyt.304.0093 · Cited by 1 · see citing works
Hoover, E. B., & Bernard, K. S. (2021) · Physician Assistant Clinics · doi:10.1016/j.cpha.2021.08.002 · Cited by 1 · see citing works
MINDFULNESS, AORTIC WAVE REFLECTION, AND ARTERIAL STIFFNESS
LewAllen, S. E. (2020) · doi:10.37099/mtu.dc.etdr/1053 · Cited by 1 · see citing works
“Improvements in all aspects of mindfulness typically occur, but anxiety tends to correlate specifically with decentering (25-27).”
BackgroundHayes-Skelton, S. A., Roemer, L., & Orsillo, S. M. (2025) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2024.2417423
“…and decentering despite the fact that it was not explicitly discussed; client reports of experiential acceptance do predict outcomes across both therapies in this trial (Eustis et al., 2016) and decentering increased and led to improved symptoms across both therapies (Hayes-Skelton et al., 2015).”
Self-citationThe impact of reformulation on insight and symptom change in cognitive analytic therapy
Tyrer, R. A. (2017) · White Rose eTheses Online (University of Leeds, The University of Sheffield, University of York)
Ayahuasca as a Versatile Therapeutic Agent: From Molecules to Metacognition and Back
Valle, M., Domínguez‐Clavé, E., Elices, M., Pascual, J. C., Soler, J., Morales-Garcia, J. A., Pérez‐Castillo, A., & Jordi Riba, A. (2021) · Springer eBooks · doi:10.1007/978-3-030-55688-4_1
Knight, R., Bennett, M., Dunning, D. L., Archer-Boyd, A. W., Blakemore, S., Dalmaijer, E. S., Ford, T. J., Williams, J. M. G., Clegg, H., Kuyken, W., et al. (2022) · doi:10.31219/osf.io/u9n5y
Blázquez, F. P., Montoya-Pérez, R. D. C., & Medina, M. P. M. (2024) · Caleidoscopio - Revista Semestral de Ciencias Sociales y Humanidades · doi:10.33064/51crscsh4998
Roemer, L., Eustis, E. H., & González-Garzón, A. M. (2025) · CBT: science into practice · doi:10.1007/978-3-031-91439-3_12
Self-citationExperiences Questionnaire (EQ)
Naragon‐Gainey, K., McMahon, T. P., Park, J., & Fresco, D. M. (2025) · Springer eBooks · doi:10.1007/978-3-031-47219-0_42
Knight, R., Clegg, H., Dalmaijer, E. S., Dunning, D. L., Franckel, G., Lenaert, B., Sakol, A., Sandhu, T., Vainre, M., Watson, P., et al. (2025) · SSRN Electronic Journal · doi:10.2139/ssrn.5379889
Quigley, L., Kulke, M. F., & Levin, K. K. (2025) · Mindfulness · doi:10.1007/s12671-025-02720-7
“Increases in decentering during psychotherapy have been found to predict symptom improvement for patients with generalized anxiety disorder (Hayes-Skelton et al., 2015) and social anxiety disorder (Hayes-Skelton & Lee, 2018), and reduce the risk of relapse among previously depressed individuals…”
Forchuk, C. A., Mongrain, M., Mirbozorgi, B., & Gargala, D. (2025) · Mindfulness · doi:10.1007/s12671-025-02729-y
“…toward negative thoughts and feelings may reduce the intensity of associated physiological and affective responses (Ayduk & Kross, 2008; Kross & Ayduk, 2009; Lebois et al., 2015) and facilitate adaptive engagement with stressful material (Duncan et al., 2021; Hayes-Skelton et al., 2015).”
Ribeyron, J., Duriez, N., & Shankland, R. (2026) · medRxiv · doi:10.64898/2026.04.03.26346604
Knight, R., Clegg, H., Dalmaijer, E. S., Dunning, D. L., Franckel, G., Lenaert, B., Sakol, A., Sandhu, T., Vainre, M., Watson, P., et al. (2026) · EClinicalMedicine · doi:10.1016/j.eclinm.2026.103971
“13 15 Previous research suggests that changes in psychological decentering occur before clinical outcomes, 27 but these findings were not replicated in the current study.”
Sampaio, T. P. D. A., Jansson‐Fröjmark, M., Martins, D. S., Lundgren, T., Hayes‐Skelton, S. A., & Neto, F. L. (2026) · Jornal Brasileiro de Psiquiatria · doi:10.1590/0047-2085-2025-0069
Self-citation
- Authors
- Hayes-Skelton, S. A., Calloway, A., Roemer, L., & Orsillo, S. M.
- Affiliations
- University of Massachusetts Boston (US)
- Suffolk University (US)
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2015-04
- Volume
- 83
- Issue
- 2
- Pages
- 395-404
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- PMC
- PMC4380615
- OpenAlex
- W2313117470
- Cited by
- 83
- References
- 51
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 7 · 2023: 5 · 2022: 10 · 2021: 10 · 2020: 6 · 2019: 7 · 2018: 5 · 2017: 9 · 2016: 7 · 2015: 3 · 2014: 1 · 2013: 1
- FWCI
- 9.26
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (MH085060, MH074589)
- 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
- decentering, generalized anxiety disorder, applied relaxation, worry, anxiety symptoms, Penn State Worry Questionnaire, treatment response
- MeSH terms
- Adult, Anxiety Disorders, Behavior Therapy, Female, Humans, Male, Middle Aged, Models, Psychological, Surveys and Questionnaires, Relaxation Therapy, Treatment Outcome, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-09-28.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.
Cited sources are checked by gpt-6-sol.
Statistics and arithmetic are recomputed, not judged.
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