An examination of mindfulness skills in terms of affect tolerance among individuals with elevated levels of health anxiety.
Open accessAbstract
Background and Objectives: Affect tolerance factors, including anxiety sensitivity, intolerance of uncertainty, and emotional distress tolerance, have been implicated in the exacerbation of health anxiety. Therefore, identifying methods to improve affect tolerance in health anxious populations is imperative. Despite the link between mindfulness and greater affect tolerance in non-clinical populations, no work has examined the role of mindfulness skills in terms of affect tolerance among individuals with elevated health anxiety. The aim of the current study was to examine the unique contribution of mindfulness skills in terms of distress tolerance, anxiety sensitivity, and intolerance of uncertainty.Methods: Participants were 218 undergraduates with clinically elevated levels of health anxiety (75.7% female; Mage = 19.53, SD = 3.16, Range = 18-45) who completed self-report measures for course credit.Results: Findings indicated that, after controlling for theoretically relevant covariates, greater acting with awareness, non-judgment, and non-reactivity were uniquely associated with greater distress tolerance, and greater non-reactivity was associated with lower levels of intolerance of uncertainty. Though none of the mindfulness skills emerged as specific individual predictors of anxiety sensitivity, these skills collectively accounted for unique variance in anxiety sensitivity.Conclusions: These findings suggest that mindfulness skills may be helpful in targeting affect tolerance factors among individuals with elevated health anxiety.
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Claims the paper makes
7 of 43 cited sources checked · 3 supported · 0 flagged · accuracy not yet measured
- Premisecitation
Mindfulness interventions have been shown to successfully decrease health anxiety.
“Although mindfulness interventions have been shown to successfully decrease health anxiety (Eilenberg, Kronstrand, Fink, & Frostholm, 2013; Lovas & Barsky, 2010; McManus, Surawy, Muse, Vazquez-Montes, & Williams, 2012)”
Quote in the paperSubstantial claim1 of 3 sources checked - Premisecitation
Greater levels of observing alone are typically associated with worsened emotional outcomes in non-meditators.
“greater levels of observing alone are typically associated with worsened emotional outcomes in non-meditators (Baer et al., 2006; Baer et al., 2016; Gu et al., 2016).”
Quote in the paperNot a substantial claim1 of 3 sources checked- cites Baer et al., 2006 source
Results and Discussion (p. 15) reports that observing was positively correlated with psychological symptoms, thought suppression, dissociation, and absent-mindedness in the full sample; these correlations were nonsignificant in the subsample with meditation experience. But the paper does not directly report those outcome correlations for non-meditators alone, and observing was also positively correlated with emotional intelligence and self-compassion. The claim overgeneralizes the pattern as typically worse emotional outcomes specifically among non-meditators. (LLM, conf=0.84)
Experimental — accuracy not yet measured - cites Baer et al., 2016
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites Gu et al., 2016
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Findingown data
None of the individual mindfulness skills were significant unique predictors of anxiety sensitivity.
“Although none of the mindfulness skills were significant unique predictors of anxiety sensitivity, non-reactivity (β = −.15, t = −1.92, p = .056) approached significance.”
Quote in the paperNot a substantial claim - Findingown data
After controlling for covariates, greater non-reactivity uniquely predicted lower intolerance of uncertainty.
“Non-reactivity was the only significant unique predictor at this step (β = −.17, t = −2.18, p = .03)”
Quote in the paperSubstantial claim - Findingown data
After controlling for gender, medical conditions, and negative affectivity, greater acting with awareness uniquely predicted greater distress tolerance.
“higher levels of acting with awareness (β = .15, t = 2.48, p = .014), non-judgment (β = .27, t = 4.14, p < .001), and non-reactivity (β = .29, t = 4.81, p < .001) significantly predicted higher levels of distress tolerance.”
Quote in the paperSubstantial claim
- Findingown data
The mindfulness skills collectively accounted for unique variance in anxiety sensitivity.
“these skills collectively accounted for unique variance in anxiety sensitivity.”
Quote in the paperSubstantial claim - Findingown data
The second step as a whole accounted for an additional 6.8% variance in intolerance of uncertainty.
“the second step as a whole accounted for an additional 6.8% variance in intolerance of uncertainty.”
Quote in the paperSubstantial claim - Findingown data
The mindfulness skills collectively accounted for unique variance in distress tolerance.
“Step two was also significant, accounting for an additional 22.1% variance.”
Quote in the paperSubstantial claim - Findingown data
Female gender was significantly correlated with poorer distress tolerance.
“Female gender was significantly correlated with poorer distress tolerance (r = −.18, p = .008).”
Quote in the paperNot a substantial claim - Findingown data
Non-reactivity accounted for 2% of unique variance in intolerance of uncertainty.
“this skill only accounted for 2% of unique variance”
Quote in the paperSubstantial claim - Findingown data
The presence of one or more medical conditions was significantly positively associated with observing.
“The presence of one or more medical conditions was significantly positively associated with observing (r = .17, p = .013).”
Quote in the paperNot a substantial claim - Findingown data
The association between greater observing and lower distress tolerance was trending (β = −.10, p = .085).
“The association between greater levels of observing and lower levels of distress tolerance was trending (β = −.10, t = −1.73, p = .085).”
Quote in the paperNot a substantial claim - Findingown data
In the regression for anxiety sensitivity, step one accounted for 19.2% of the variance.
“For anxiety sensitivity, step one was significant and accounted for 19.2% of the variance.”
Quote in the paperNot a substantial claim - Findingown data
In the regression for distress tolerance, step one accounted for 31.7% of the variance.
“In terms of distress tolerance, step one was significant and accounted for 31.7% of the variance.”
Quote in the paperNot a substantial claim - Findingown data
Non-reactivity approached significance as a unique predictor of anxiety sensitivity (β = −.15, p = .056).
“non-reactivity (β = −.15, t = −1.92, p = .056) approached significance.”
Quote in the paperNot a substantial claim - Findingown data
In the regression for intolerance of uncertainty, step one accounted for 21.4% of the variance.
“Lastly, in terms of intolerance of uncertainty, step one was significant, accounting for 21.4% variance.”
Quote in the paperNot a substantial claim - Findingown data
Describing approached significance as a unique predictor of intolerance of uncertainty (β = −.13, p = .073).
“describing (β = −.13, t = −1.80, p = .073) approached significance.”
Quote in the paperNot a substantial claim - Findingown data
Negative affect and medical status were the only significant predictors of intolerance of uncertainty at step one.
“Negative affect (β = .45, t = 6.60, p < .001) and medical status (β = −.15, t = −2.18, p = .031) were the only significant predictors at this step.”
Quote in the paperNot a substantial claim - Findingown data
Gender and negative affect were the only significant predictors of distress tolerance at step one.
“Gender (β = −.14, t = −2.30, p = .023) and negative affect (β = −.53, t = −8.52, p < .001) were the only significant predictors at this step.”
Quote in the paperNot a substantial claim - Findingown data
Negative affect was the only significant predictor of anxiety sensitivity at step one.
“Negative affect was the only significant predictor at this step (β = .43, t = 6.30, p < .001).”
Quote in the paperNot a substantial claim - Study design and conductcitation
The sample consisted of 218 undergraduate students with clinically elevated health anxiety, defined as SHAI score of 18 or higher.
“Participants were 218 undergraduate students (75.7% female; Mage = 19.61, SD = 3.27, Range = 18–45) with clinically-elevated levels of health anxiety, as determined by score of 18 or higher on the Short Health Anxiety Inventory (SHAI; Rode, Salkovskis, Dowd & Hanna, 2006; Salkovskis et al., 2002).”
Quote in the paperSubstantial claim0 of 2 sources checked - Premisecitation
A score of 18 on the SHAI reliably discriminates individuals with severe levels of health anxiety.
“A score of 18 on the SHAI has been shown to reliably discriminate individuals with severe levels of health anxiety (Rode, Salkovskis, Dowd & Hanna, 2006)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Rode, Salkovskis, Dowd & Hanna, 2006 source
- Premisecitation
Greater health anxiety is associated with lower distress tolerance.
“lower levels of distress tolerance (Fergus, Bardeen, & Orcutt, 2016)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Fergus, Bardeen, & Orcutt, 2016
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
Greater health anxiety is associated with higher intolerance of uncertainty.
“higher levels of intolerance of uncertainty (Boelen & Carleton, 2012; Fergus & Bardeen, 2013; Fetzner et al., 2014)”
Quote in the paperSubstantial claim0 of 3 sources checked - Premisecitation
Greater health anxiety is associated with greater anxiety sensitivity.
“extant research suggests that greater levels of health anxiety are associated with greater levels of anxiety sensitivity (Fergus & Bardeen, 2013; Olatunji et al., 2009; Wheaton, Berman, & Abramowitz, 2010; Wheaton et al., 2010)”
Quote in the paperNot a substantial claim0 of 3 sources checked - Premisecitation
Kraemer and colleagues (2016) found that mindfulness was associated with lower health anxiety indirectly through decreased intolerance of uncertainty.
“Kraemer and colleagues (2016) found that mindfulness was associated with lower levels of health anxiety indirectly through decreased levels of intolerance of uncertainty.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Kraemer et al., 2016
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationown data
Mindfulness skills may be helpful in targeting affect tolerance factors among individuals with elevated health anxiety.
“These findings suggest that mindfulness skills may be helpful in targeting affect tolerance factors among individuals with elevated health anxiety.”
Quote in the paperSubstantial claim- Rests on an assumption: Mindfulness skills can be learned with practice and are therefore targetable in interventions.
- Interpretationown data
All of the mindfulness skills may be equally important for anxiety sensitivity.
“One interpretation of these results is that all of the mindfulness skills may be equally important for anxiety sensitivity.”
Quote in the paperSubstantial claim - Interpretationown data
A greater ability to notice present moment events, accept them non-judgmentally, and withhold reactivity appears to be most salient for distress tolerance.
“a greater ability to notice present moment events, accept them non-judgmentally, and withhold reactivity appears to be most salient for distress tolerance.”
Quote in the paperSubstantial claim
- Classified as probably not a substantial claim. 21
- May combine two claims. 13
- Borderline: one of the tests for a substantial claim is unclear. 1
- The quote only partly states this claim. 3
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe FFMQ has demonstrated good psychometric properties.
“The FFMQ has demonstrated good psychometric properties (Baer et al., 2006, Baer et al., 2008).”
Quote in the paperNot a substantial claim1 of 2 sources checked- cites Baer et al., 2006 source
The General Discussion (p. 17) says the authors' findings suggest that the FFMQ has reasonable psychometric properties. Calling them definitively good overstates that qualified conclusion, particularly because the authors say the FFMQ needs extensive additional validation in a range of samples. (LLM, conf=0.84)
Experimental — accuracy not yet measured - cites Baer et al., 2008 source
May combine two claims.
PremisecitationIn non-health-anxious samples, higher mindfulness is associated with greater distress tolerance, lower anxiety sensitivity, and greater capacity for tolerating uncertainty.
“cross-sectional work in non-health anxious samples indicates that higher levels of mindfulness are associated with greater distress tolerance, lower anxiety sensitivity, and a greater capacity for tolerating uncertainty (Brown, Bravo, Roos, & Pearson, 2015; Feldman, Dunn, Stemke, Bell, & Greeson, 2014; Kraemer, O’Bryan, & McLeish, 2016; Luberto, McLeish, Robertson, Avallone, Kraemer, & Jeffries, 2”
Quote in the paperSubstantial claim2 of 3 sources checked- cites Brown et al., 2015 source
The Results (Direct effects; page unavailable) associate several mindfulness facets with lower distress intolerance, supporting the greater-distress-tolerance part of the claim. The Methods (Measures; page unavailable) assess anxiety symptoms as worry, not anxiety sensitivity, and the passages do not report a measure or finding for tolerance of uncertainty. The Participants section describes a college-student sample, but does not establish participants’ health-anxiety status. (LLM, conf=0.89)
Experimental — accuracy not yet measured - cites Feldman et al., 2014 source
The Discussion reports that acting with awareness, one facet of mindfulness, predicted greater persistence on a distress-tolerance task; the Methods describe a sample of female undergraduates. The paper does not report associations with anxiety sensitivity or tolerance of uncertainty, and its finding does not extend to every mindfulness facet. No page numbers are available in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites Kraemer et al., 2016
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
PremisecitationGreater levels of mindfulness are thought to help individuals with health anxiety notice emotional distress and physical sensations in an open and accepting way, preventing catastrophic misinterpretations of bodily sensations and minimizing the need for reassurance-seeking behaviors.
“Greater levels of mindfulness are thought to help individuals with health anxiety notice emotional distress and physical sensations in an open and accepting way, preventing catastrophic misinterpretations of bodily sensations and minimizing the need for reassurance-seeking behaviors (Luberto, Magidson, & Blashill, 2017; Surawy, McManus, Muse, & Williams, 2015).”
Quote in the paperSubstantial claim1 of 2 sources checkedClassified as probably not a substantial claim.
PremisecitationThe observing skill appears, outside the context of other mindfulness skills or a history of meditation training, to be associated with a tendency to observe events in a judgmental fashion.
“The observing skill was hypothesized to have a negative effect given that it appears, outside of the context of other mindfulness skills or a history of meditation training, to be associated with a tendency to observe events in a judgmental fashion (Baer, 2016; Baer et al., 2006; Gu et al., 2016; Luberto et al., 2014).”
Quote in the paperSubstantial claim1 of 3 sources checkedBorderline on S1 (asserted), S3 (load-bearing), S4 (based): unclear from the text. May combine two claims.
Findingnone givenNegative affect was significantly positively correlated with anxiety sensitivity and intolerance of uncertainty, and negatively correlated with distress tolerance.
“Negative affect was significantly positively correlated with anxiety sensitivity (r = .41, p < .001) and intolerance of uncertainty (r = .42, p < .001), and significantly negatively correlated with distress tolerance (r = −.55, p < .001).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataGreater observing was not a unique predictor of any affect tolerance outcome and was not significantly correlated with these outcomes at the bivariate level.
“this skill was not a unique predictor of any affect tolerance outcomes, nor was it significantly correlated with these outcomes at the bivariate level.”
Quote in the paperSubstantial claimThe quote only partly states this claim.
Findingown dataAfter controlling for covariates, greater non-reactivity uniquely predicted greater distress tolerance.
“higher levels of acting with awareness (β = .15, t = 2.48, p = .014), non-judgment (β = .27, t = 4.14, p < .001), and non-reactivity (β = .29, t = 4.81, p < .001) significantly predicted higher levels of distress tolerance.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based). The quote only partly states this claim.
Findingown dataAfter controlling for covariates, greater non-judgment uniquely predicted greater distress tolerance.
“higher levels of acting with awareness (β = .15, t = 2.48, p = .014), non-judgment (β = .27, t = 4.14, p < .001), and non-reactivity (β = .29, t = 4.81, p < .001) significantly predicted higher levels of distress tolerance.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataDescribing was not a significant predictor of greater distress tolerance, lower anxiety sensitivity, or lower intolerance of uncertainty.
“describing was not a significant predictor of greater distress tolerance, lower anxiety sensitivity, or lower intolerance of uncertainty.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataAll mindfulness skills except observing were significantly positively correlated with distress tolerance and negatively correlated with anxiety sensitivity, intolerance of uncertainty, and negative affect.
“All of the mindfulness skills except observing were significantly positively correlated with distress tolerance (range: .29 to .57) and significantly negatively correlated with anxiety sensitivity (range: −.22 to −.37), intolerance of uncertainty (range: −.27 to −.37), and negative affect (range: −.20 to −.45).”
Quote in the paperSubstantial claimThe quote only partly states this claim.
Findingown dataThe mindfulness skills collectively accounted for unique variance in intolerance of uncertainty.
“Step two was also significant and accounted for 6.8% of unique variance.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataAll mindfulness skills were significantly positively correlated with one another except observing, which was only correlated with describing, non-judgment, and non-reactivity.
“All mindfulness skills were significantly positively correlated with one another (range: .21 to .48) except observing, which was only correlated with describing (r = .23, p = .001), non-judgment (r = −.25, p < .001), and non-reactivity (r = .25, p < .001).”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationMindfulness-based interventions successfully increase distress tolerance and reduce anxiety sensitivity in non-health-anxious samples.
“intervention research suggests that mindfulness-based interventions successfully increase distress tolerance and reduce anxiety sensitivity in non-health anxious samples (Kim et al., 2010; Kraemer, Luberto, O’Bryan, Mysinger, & Cotton, 2016; Lotan, Tanay, & Bernstein, 2013; Tull, Schulzinger, Schmidt, Zvolensky, & Lejuez, 2007)”
Quote in the paperSubstantial claim0 of 3 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataInternal consistency for the FFMQ subscales in the current sample was adequate for Observe (α = .72) and Non-reactivity (α = .73), and good for Describe (α = .85), Acting with Awareness (α = .85), and Non-judgment (α = .88).
“Internal consistency was adequate for the Observe (α = .72) and Non-reactivity (α = .73) subscales, and good for the Describe (α = .85), Acting with Awareness (α = .85), and Non-judgment (α = .88) subscales.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataInternal consistency for the PANAS-NA in the current sample was adequate (α = .82).
“Internal consistency for the PANAS-NA in the current sample was adequate (α = .82).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe ASI-3 has demonstrated excellent psychometric properties.
“The ASI-3 has demonstrated excellent psychometric properties (Taylor et al., 2007).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Taylor et al., 2007 source
Probably not a substantial claim: may not pass S4 (based). May combine two claims.
Premisenone givenPrevious research has not examined the role of mindfulness skills in terms of multiple affect tolerance factors or studied these relationships in individuals with high health anxiety.
“previous research has not examined the role of mindfulness skills in terms of multiple affect tolerance factors or studied these relationships in individuals with high health anxiety.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe PANAS has well-documented validity.
“The validity of the PANAS has been well-documented (Watson, 2000; Watson et al., 1988).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Watson, 2000
- cites Watson et al., 1988 source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataInternal consistency for the SHAI in the current sample was adequate (α = .74).
“Internal consistency for the current sample was adequate (α = .74).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataInternal consistency for the ASI-3 in the current sample was good (α = .88).
“Internal consistency for the ASI-3 in the current sample was good (α = .88).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe DTS has demonstrated strong psychometric properties.
“The DTS has demonstrated strong psychometric properties (Simons & Gaher, 2005).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Simons & Gaher, 2005 source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe IUS-12 has demonstrated strong psychometric properties.
“The IUS-12 has demonstrated strong psychometric properties (Carleton et al., 2007).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Carleton et al., 2007 source
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataThe study used a cross-sectional design and relied solely on self-report indices of mindfulness and affect tolerance.
“the current study relied solely on self-report indices of mindfulness and affect tolerance and regulation and utilized a cross-sectional design.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductcitationMissing data were approximately 5% or less for each study variable, and listwise deletion was used.
“Approximately 5% of data or less were missing for each study variable, indicating that listwise deletion would be an appropriate method for handling missing data (Tabachnick & Fidell, 2007); as such, results of all statistical tests are reflective of individuals who had adequate data for the specified analysis.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Tabachnick & Fidell, 2007
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).
Study design and conductown dataInternal consistency for the DTS in the current sample was excellent (α = .91).
“Internal consistency for the current sample was excellent (α = .91).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe SHAI is valid for use in medical populations.
“research has indicated that the SHAI is valid for use in medical populations (LeBouthillier, Thibodeau, Alberts, Hadjistavropoulos, & Asmundson, 2015)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites LeBouthillier et al., 2015 source
Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
Study design and conductown dataInternal consistency for the IUS-12 in the current sample was excellent (α = .91).
“Internal consistency for the current sample was excellent (α = .91).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationPsychopathology typically emerges in young adulthood.
“this population may be important given that psychopathology typically emerges in young adulthood (Kessler et al., 2005).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Kessler et al., 2005 source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe use of undergraduate samples in the study of health anxiety can be helpful because they are less confounded with serious medical problems.
“it has been suggested that the use of undergraduate samples in the study of health anxiety can be helpful due to the fact that they are less confounded with serious medical problems (Kaur, Butow, & Sharpe, 2013).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Kaur, Butow, & Sharpe, 2013 source
Classified as probably not a substantial claim.
Study design and conductcitationCovariates were chosen on an a priori basis given their relevance to health anxiety and affect tolerance.
“Covariates were chosen on an a priori basis given their relevance to health anxiety and affect tolerance (e.g., Abramowitz, Olatunji, & Deacon, 2007; Freeston, Rheaume, Letarte, Dugas, & Ladouceur, 1994; Jang, Stein, Taylor, & Livesley, 1998; MacSwain et al., 2009; McLeish, Luberto, & O’Bryan, 2015; O’Cleirigh, Ironson, & Smits, 2007; Roy-Byrne et al., 2008; Simons & Gaher, 2005).”
Quote in the paperSubstantial claim0 of 3 sources checkedProbably not a substantial claim: may not pass S4 (based).
Premisenone givenThere has been little exploration of the relationship between mindfulness and the affect tolerance factors that underlie health anxiety.
“there has been little exploration of the relationship between mindfulness and the affect tolerance factors that underlie health anxiety.”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationown dataGreater mindfulness, in general, is related to greater distress tolerance and lower anxiety sensitivity and intolerance of uncertainty among individuals who are high in health anxiety.
“results of the current study suggest that greater mindfulness, in general, is related to greater distress tolerance and lower anxiety sensitivity and intolerance of uncertainty among individuals who are high in health anxiety.”
Quote in the paperSubstantial claim- Rests on an assumption: Mindfulness skills can be learned with practice and are therefore targetable in interventions.
Classified as probably not a substantial claim.
Study design and conductcitationNegative affect was controlled to more precisely estimate the relationship between mindfulness and affect tolerance.
“Specifically, we controlled for negative affect to more precisely estimate the relationship between mindfulness and affect tolerance, given that the general tendency to experience negative affect is related to the ability to tolerate affect (Simons & Gaher, 2005).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Simons & Gaher, 2005 source
The paper relies on this without support.
Mindfulness skills can be learned with practice and are therefore targetable in interventions.
“in clinical applications, is thought to consist of several skills that can be learned with practice.”
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?
The use of behavioural and mindful coping strategies may help alleviate anxiety through a process akin to acceptance and active engagement.
“The use of behavioural and mindful coping strategies may help alleviate anxiety, through a process akin to acceptance and active engagement, supporting previous research on the putative benefits of mindfulness [64] and Acceptance and Commitment Therapy (ACT) [65] for health anxiety.”
From Health anxiety, coping mechanisms and COVID 19: An Indian community sample at week 1 of lockdown (2021) · cites this paper as [64]
The Discussion (page not available) links mindful awareness and nonjudgment with greater tolerance of distress in people with elevated health anxiety, and proposes acceptance as a possible mechanism. It suggests mindfulness training may improve related factors, but the study was cross-sectional and did not test whether coping strategies alleviate anxiety. The separate ACT citation is not attributed to this source. (LLM, conf=0.82)
Experimental — accuracy not yet measuredMindfulness-based strategies may reduce health anxiety by increasing tolerance of uncertainty experienced during the COVID-19 pandemic.
“Mindfulness-based strategies may reduce health anxiety by increasing tolerance of uncertainty experienced during the COVID 19 pandemic.”
From Health anxiety, coping mechanisms and COVID 19: An Indian community sample at week 1 of lockdown (2021) · cites this paper as [64]
The Discussion (page unavailable) reports that greater mindfulness was associated with lower intolerance of uncertainty in people with elevated health anxiety and suggests mindfulness training may help. But the study was cross-sectional: it did not show that a strategy reduces health anxiety through that mechanism, and it did not study uncertainty during the COVID-19 pandemic. (LLM, conf=0.88)
Experimental — accuracy not yet measured
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.
Participant age differs between abstract and method section
MinorThe abstract reports one mean age for the sample, while the Participants subsection reports a different mean age for the same 218 undergraduates. This is an internal inconsistency in the description of the sample.
“Participants were 218 undergraduates with clinically-elevated levels of health anxiety (75.7% female; Mage = 19.53, SD = 3.16, Range = 18-45)”
“Participants were 218 undergraduate students (75.7% female; Mage = 19.61, SD = 3.27, Range = 18–45) with clinically-elevated levels of health anxiety, as determined by score of 18 or higher on the Short Health Anxiety Inventory (SHAI; Rode, Salkovskis, Dowd & Hanna, 2006; Salkovskis et al., 2002).”
Condition frequencies do not support the reported average
MinorThe listed condition percentages sum to 95.4%, implying about 0.954 listed conditions per participant, rather than the reported average of 1.24.
“frequent or severe headaches (20.2%), asthma (20.8%), chronic lung disease (1.4%), back or neck problems (25.0%), chronic pain (9.6%), kidney problems (2.8%), ulcers (3.7%), arthritis/rheumatism (4.1%), epilepsy/seizures (1.4%), cancer (1.8%), heart disease (.9%), high blood pressure (2.8%), and diabetes (.9%).”
“On average, participants had 1.24 (SD = 1.26) of these chronic medical conditions.”
Participant age statistics differ between the abstract and methods
MinorThe same 218-participant sample is assigned a mean age of 19.53 years and SD of 3.16 in the abstract, but a mean of 19.61 and SD of 3.27 in the methods.
“Participants were 218 undergraduates with clinically-elevated levels of health anxiety (75.7% female; Mage = 19.53, SD = 3.16, Range = 18-45)”
“Participants were 218 undergraduate students (75.7% female; Mage = 19.61, SD = 3.27, Range = 18–45)”
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MethodInfluentialDevelopment and validation of brief measures of positive and negative affect: The PANAS scales.
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“Note: Gender: 1 = male, 2 = female; Medical problems: 0 = no reported medical conditions, 1 = presence of one or more medical conditions; PANAS-NA: Positive Affect Negative Affect Schedule-Negative Affect subscale (Watson et al., 1988); DTS: Distress Tolerance Scale (Simons & Gaher, 2005); ASI-3: Anxiety Sensitivity I…”
BackgroundApplied Multiple Regression/Correlation Analysis for the Behavioral Sciences
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“Moreover, this population may be important given that psychopathology typically emerges in young adulthood (Kessler et al., 2005).”
BackgroundThe benefits of being present: Mindfulness and its role in psychological well-being
Brown, K. W., & Ryan, R. M. (2003) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.84.4.822 · Cited by 13,448 · see citing works
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“The observing skill was hypothesized to have a negative effect given that it appears, outside of the context of other mindfulness skills or a history of meditation training, to be associated with a tendency to observe events in a judgmental fashion (Baer, 2016; Baer et al., 2006; Gu et al., 2016; Luberto et al., 2014).”
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“The FFMQ has demonstrated good psychometric properties (Baer et al., 2006; Baer et al., 2008).”
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“Intolerance of Uncertainty Scale-Short Form (IUS-12).”
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“Separate models were constructed for distress tolerance (DTS), anxiety sensitivity (ASI-3), and intolerance of uncertainty (IUS-12).”
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“Separate models were constructed for distress tolerance (DTS), anxiety sensitivity (ASI-3), and intolerance of uncertainty (IUS-12).”
MethodInfluentialSALKOVSKIS, P. M., RIMES, K. A., WARWICK, H. M. C., & CLARK, D. M. (2002) · Psychological Medicine · doi:10.1017/s0033291702005822 · Cited by 1,351 · cited 9× · see citing works
“First, although the current study utilized a well-established cut-off score on the SHAI for identifying clinically elevated health anxiety, future work should consider utilizing structured clinical interviews for identifying the most extreme levels of health anxiety (e.g., hypochondriasis, illness anxiety disorder, so…”
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Carleton, R. N. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.02.007 · Cited by 1,104 · cited 2× · see citing works
“…emotional distress; Simons & Gaher, 2005) and intolerance of uncertainty (difficulty tolerating emotional reactions to perceived uncertainty; Carleton, 2016a; Carleton, 2016b) motivate individuals to engage in reassuranceseeking behaviors in order to alleviate anxiety and gain information…”
BackgroundGeneralized anxiety disorder: advances in research and practice
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“their perceived negative physical, social, or psychological consequences (McNally, 2002; Reiss & McNally, 1985; Taylor et al., 2007).”
BackgroundAnxiety disorders and comorbid medical illness
Roy-Byrne, P. P., Davidson, K. W., Kessler, R. C., Asmundson, G. J. G., Goodwin, R. D., Kubzansky, L., Lydiard, R. B., Massie, M. J., Katon, W., Laden, S. K., et al. (2008) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2007.12.006 · Cited by 668 · cited 2× · see citing works
“Covariates were chosen on an a priori basis given their relevance to health anxiety and affect tolerance (e.g., Abramowitz, Olatunji, & Deacon, 2007b; Freeston, Rhéaume, Letarte, Dugas, & Ladouceur, 1994; Jang, Stein, Taylor, & Livesley, 1998; MacSwain et al., 2009; McLeish, Luberto, & O’Bryan, 2016; O’Cleirigh, Irons…”
Fear of the unknown: One fear to rule them all?
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“…emotional distress; Simons & Gaher, 2005) and intolerance of uncertainty (difficulty tolerating emotional reactions to perceived uncertainty; Carleton, 2016a; Carleton, 2016b) motivate individuals to engage in reassuranceseeking behaviors in order to alleviate anxiety and gain information…”
BackgroundWarwick, H. M. C., & Salkovskis, P. M. (1990) · Behaviour Research and Therapy · doi:10.1016/0005-7967(90)90023-c · Cited by 587 · cited 2× · see citing works
“In an effort to reduce the anxiety and gain certainty about health status, these individuals engage in safety-seeking behaviors, such as visiting medical providers, obsessively checking their body, or searching health information on the internet (Abramowitz et al., 2002; Warwick & Salkovskis, 1990).”
BackgroundGrossman, P., & Van Dam, N. T. (2011) · Contemporary Buddhism · doi:10.1080/14639947.2011.564841 · Cited by 548 · cited 1× · see citing works
“Thus, mindfulness-based interventions to reduce anxiety sensitivity would need to teach mindfulness as a unified process of interacting components that are each equally important, rather than as a set of distinct skills individuals can pick and choose from (Grossman & Van Dam, 2011).”
BackgroundGu, J., Strauss, C., Crane, C., Barnhofer, T., Karl, A., Cavanagh, K., & Kuyken, W. (2016) · Psychological Assessment · doi:10.1037/pas0000263 · Cited by 431 · cited 3× · see citing works
“Indeed, greater levels of observing alone are typically associated with worsened emotional outcomes in non-meditators (Baer et al., 2006, 2016; Gu et al., 2016).”
BackgroundResource Utilization of Patients With Hypochondriacal Health Anxiety and Somatization
Barsky, A. J., Ettner, S. L., Horsky, J., & Bates, D. W. (2001) · Medical Care · doi:10.1097/00005650-200107000-00007 · Cited by 309 · see citing works
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A contemporary conceptual model of hypochondriasis
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“health status, these individuals engage in safety-seeking behaviors, such as visiting medical providers, obsessively checking their body, or searching health information on the internet (Abramowitz et al., 2002; Warwick & Salkovskis, 1990).”
BackgroundO’Cleirigh, C. M., Ironson, G. H., & Smits, J. A. J. (2007) · Behavior Therapy · doi:10.1016/j.beth.2006.11.001 · Cited by 105 · see citing works
Health anxiety levels in chronic pain clinic attenders
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“A score of 18 on the SHAI has been shown to reliably discriminate individuals with severe levels of health anxiety (Rode et al., 2006), and research has indicated that the SHAI is valid for use in medical populations (LeBouthillier, Thibodeau, Alberts, Hadjistavropoulos, & Asmundson, 2015).”
BackgroundKim, B., Lee, S.-H., Kim, Y. W., Choi, T. K., Yook, K., Suh, S. Y., Cho, S. J., & Yook, K.-H. (2010) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2010.03.019 · Cited by 102 · cited 1× · see citing works
“…suggests that mindfulness-based interventions successfully increase distress tolerance and reduce anxiety sensitivity in non-health anxious samples (Kim et al., 2010; Kraemer, Luberto, O’Bryan, Mysinger, & Cotton, 2016a; Lotan, Tanay, & Bernstein, 2013; Tull, Schulzinger, Schmidt, Zvolensky, &…”
Mindfulness-based cognitive therapy for hypochondriasis, or severe health anxiety: A pilot study
Lovas, D. A., & Barsky, A. J. (2010) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2010.06.019 · Cited by 100 · cited 1× · see citing works
“Although mindfulness interventions have been shown to successfully decrease health anxiety (Eilenberg, Kronstrand, Fink, & Frostholm, 2013; Lovas & Barsky, 2010; McManus, Surawy, Muse, Vazquez-Montes, & Williams, 2012), there has been little exploration of the relationship between mindfulness and…”
BackgroundFergus, T. A., & Bardeen, J. R. (2013) · Personality and Individual Differences · doi:10.1016/j.paid.2013.05.016 · Cited by 97 · cited 2× · see citing works
“…2013; Olatunji et al., 2009; Wheaton, Berman, & Abramowitz, 2010; Wheaton, Berman, & Abramowitz, 2010), lower levels of distress tolerance (Fergus, Bardeen, & Orcutt, 2015), and higher levels of intolerance of uncertainty (Boelen & Carleton, 2012; Fergus & Bardeen, 2013; Fetzner et al., 2014).”
BackgroundMindfulness and rumination as predictors of persistence with a distress tolerance task
Feldman, G., Dunn, E., Stemke, C., Bell, K., & Greeson, J. (2014) · Personality and Individual Differences · doi:10.1016/j.paid.2013.08.040 · Cited by 90 · see citing works
Intolerance of Uncertainty, Hypochondriacal Concerns, Obsessive-Compulsive Symptoms, and Worry
Boelen, P. A., & Carleton, R. N. (2012) · Journal of Nervous & Mental Disease · doi:10.1097/nmd.0b013e318247cb17 · Cited by 90 · cited 1× · see citing works
“…2013; Olatunji et al., 2009; Wheaton, Berman, & Abramowitz, 2010; Wheaton, Berman, & Abramowitz, 2010), lower levels of distress tolerance (Fergus, Bardeen, & Orcutt, 2015), and higher levels of intolerance of uncertainty (Boelen & Carleton, 2012; Fergus & Bardeen, 2013; Fetzner et al., 2014).”
Gender differences in health anxiety: An investigation of the interpersonal model of health anxiety
MacSwain, K. L. H., Sherry, S., Stewart, S. H., Watt, M. C., Hadjistavropoulos, H. D., & Graham, A. R. (2009) · Personality and Individual Differences · doi:10.1016/j.paid.2009.07.020 · Cited by 87 · cited 2× · see citing works
“Covariates were chosen on an a priori basis given their relevance to health anxiety and affect tolerance (e.g., Abramowitz, Olatunji, & Deacon, 2007b; Freeston, Rhéaume, Letarte, Dugas, & Ladouceur, 1994; Jang, Stein, Taylor, & Livesley, 1998; MacSwain et al., 2009; McLeish, Luberto, & O’Bryan, 2016; O’Cleirigh, Irons…”
Mind–Body Skills Training to Improve Distress Tolerance in Medical Students: A Pilot Study
Kraemer, K. M., Luberto, C. M., O’Bryan, E. M., Mysinger, E., & Cotton, S. (2016) · Teaching and Learning in Medicine · doi:10.1080/10401334.2016.1146605 · Cited by 83 · cited 1× · see citing works
“Kraemer et al. (2016b) found that mindfulness was associated with lower levels of health anxiety indirectly through decreased levels of intolerance of uncertainty.”
BackgroundSelf-citationWheaton, M. G., Berman, N. C., Franklin, J. C., & Abramowitz, J. S. (2010) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-010-9179-4 · Cited by 77 · see citing works
Health Anxiety and Disability Pension Award: The HUSK Study
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“Left untreated, symptoms can become increasingly severe, leading to significant distress, functional impairment, and significant healthcare costs (Barsky, Ettner, Horsky, & Bates, 2001; Fink, Ørnbøl, & Christensen, 2010; Mykletun et al., 2009; Sunderland, Newby, & Andrews, 2013).”
BackgroundGender differences in the etiology of anxiety sensitivity: a twin study.
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Anxiety Sensitivity and Reactivity to Asthma-Like Sensations Among Young Adults With Asthma
McLeish, A. C., Luberto, C. M., & O’Bryan, E. M. (2015) · Behavior Modification · doi:10.1177/0145445515607047 · Cited by 56 · see citing works
Self-citationOlatunji, B. O., Wolitzky-Taylor, K. B., Elwood, L., Connolly, K., Gonzales, B., & Armstrong, T. (2009) · Cognitive Therapy and Research · doi:10.1007/s10608-008-9188-8 · Cited by 53 · cited 1× · see citing works
“Indeed, extant research suggests that greater levels of health anxiety are associated with greater levels of anxiety sensitivity (Fergus & Bardeen, 2013; Olatunji et al., 2009; Wheaton, Berman, & Abramowitz, 2010; Wheaton, Berman, & Abramowitz, 2010), lower levels of distress tolerance (Fergus, Bardeen, & Orcutt, 2015…”
BackgroundIntolerance of Uncertainty as a Mediator of the Relationship between Mindfulness and Health Anxiety
Kraemer, K. M., O’Bryan, E. M., & McLeish, A. C. (2016) · Mindfulness · doi:10.1007/s12671-016-0524-x · Cited by 51 · cited 1× · see citing works
“Kraemer et al. (2016b) found that mindfulness was associated with lower levels of health anxiety indirectly through decreased levels of intolerance of uncertainty.”
BackgroundSelf-citationSurawy, C., McManus, F., Muse, K., & Williams, J. M. G. (2015) · Mindfulness · doi:10.1007/s12671-013-0271-1 · Cited by 50 · see citing works
Acceptance and commitment group therapy for health anxiety - Results from a pilot study
Eilenberg, T., Kronstrand, L., Fink, P., & Frostholm, L. (2013) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2013.06.001 · Cited by 38 · see citing works
Fetzner, M. G., Asmundson, G. J. G., Carey, C., Thibodeau, M. A., Brandt, C., Zvolensky, M. J., & Carleton, R. N. (2014) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2014.929170 · Cited by 38 · cited 2× · see citing works
“…2013; Olatunji et al., 2009; Wheaton, Berman, & Abramowitz, 2010; Wheaton, Berman, & Abramowitz, 2010), lower levels of distress tolerance (Fergus, Bardeen, & Orcutt, 2015), and higher levels of intolerance of uncertainty (Boelen & Carleton, 2012; Fergus & Bardeen, 2013; Fetzner et al., 2014).”
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Assessment of mindfulness and closely related constructs: Introduction to the special issue.
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“The observing skill was hypothesized to have a negative effect given that it appears, outside of the context of other mindfulness skills or a history of meditation training, to be associated with a tendency to observe events in a judgmental fashion (Baer, 2016; Baer et al., 2006; Gu et al., 2016; Luberto et al., 2014).”
BackgroundExamining the Specific Facets of Distress Tolerance That Are Relevant to Health Anxiety
Fergus, T. A., Bardeen, J. R., & Orcutt, H. K. (2015) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.29.1.32 · Cited by 25 · see citing works
Luberto, C. M., McLeish, A. C., Robertson, S. A., Avallone, K. M., Kraemer, K. M., & Jeffries, E. R. (2014) · The American Journal on Addictions · doi:10.1111/j.1521-0391.2013.12096.x · Cited by 25 · cited 1× · see citing works
“The observing skill was hypothesized to have a negative effect given that it appears, outside of the context of other mindfulness skills or a history of meditation training, to be associated with a tendency to observe events in a judgmental fashion (Baer, 2016; Baer et al., 2006; Gu et al., 2016; Luberto et al., 2014).”
BackgroundSelf-citationHealth threat increases attentional bias for negative stimuli
Kaur, A., Butow, P. N., & Sharpe, L. (2013) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2013.06.003 · Cited by 20 · see citing works
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- Jang K. L., 1998, The Journal of Gender-Specific Medicine, 2, 39
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Lengacher, C. A., Gruss, L. F., Kip, K. E., Reich, R. R., Chauca, K. G., Moscoso, M. S., Joshi, A., Tinsley, S., Shani, B., Cousin, L., et al. (2021) · Journal of Behavioral Medicine · doi:10.1007/s10865-021-00214-0 · Cited by 40 · see citing works
Facing epistemic and complex uncertainty in serious illness: The role of mindfulness and shared mind
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Health anxiety, coping mechanisms and COVID 19: An Indian community sample at week 1 of lockdown
Barron Millar, E., Singhal, D., Vijayaraghavan, P., Seshadri, S., Smith, E., Dixon, P., Humble, S., Rodgers, J., & Sharma, A. N. (2021) · PLoS ONE · doi:10.1371/journal.pone.0250336 · Cited by 21 · see citing works
“The use of behavioural and mindful coping strategies may help alleviate anxiety, through a process akin to acceptance and active engagement, supporting previous research on the putative benefits of mindfulness [64] and Acceptance and Commitment Therapy (ACT) [65] for health anxiety.”
ResultBerens, S., Schaefert, R., Ehrenthal, J. C., Baumeister, D., Eich, W., & Tesarz, J. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.625381 · Cited by 9 · see citing works
“Furthermore, illness anxiety can be seen as an inability to tolerate distressing emotions in an adaptive way (O’Bryan et al., 2018).”
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“Mindfulness is defined as an attribute related to the state of being attentive to and being aware of the present (Brown & Ryan, 2003) and can uniquely predict anxiety, distress tolerance and uncertainty-related stress (O’Bryan et al., 2018).”
O’Bryan, E. M., Davis, E., Beadel, J. R., & Tolin, D. F. (2023) · Anxiety, Stress, & Coping · doi:10.1080/10615806.2022.2117305 · Cited by 5 · see citing works
“…to lower levels of anxiety (e.g., Hofmann et al., 2010; Van Dam et al., 2011), as well as an emerging body of research demonstrating associations between mindfulness and transdiagnostic anxiety-related vulnerabilities (Kraemer et al., 2016; Luberto et al., 2014; O’Bryan et al., 2018).”
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Yıldırım, D., Bahar, Z., Coşkun, Z., Yılmaz, H., & Ergün, I. (2026) · International Journal of Nursing Practice · doi:10.1111/ijn.70167
Predicting Health Anxiety Based on Mindfulness and Mental Toughness in Women with Breast Cancer
Hatami, A., Shokrgozar, A., & Hidaji, M. B. (2026) · Iranian Journal of Breast Diseases · doi:10.66224/ijbd.19.2.5
Engle, J., Commerce, E., Mezhenska, M., & Neumann, C. S. (2025) · Mindfulness · doi:10.1007/s12671-025-02724-3
“As such, studies show that PMA and DT are positively correlated, and both have inverse associations with symptoms of psychopathology (Arnaudova & Amaro, 2020; Li et al., 2023; O’Bryan et al., 2018).”
- Authors
- O’Bryan, E. M., Luberto, C. M., Kraemer, K. M., & McLeish, A. C.
- Affiliations
- University of Cincinnati (US)
- Harvard University (US)
- Beth Israel Deaconess Medical Center (US)
- University of Louisville (US)
- Corresponding author
- McLeish, Alison C.
- Venue
- Anxiety, Stress, & Coping
- Publisher
- Informa UK Limited
- Published
- 2018-09-11
- Volume
- 31
- Issue
- 6
- Pages
- 702-713
- ISSN
- 1061-5806 (ISSN-L)
- 1477-2205
- PMC
- PMC6540987
- OpenAlex
- W2891007037
- Cited by
- 11
- References
- 67
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 1 · 2023: 1 · 2022: 1 · 2021: 5
- FWCI
- 1.47
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Anxiety Stress & Coping (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Center for Clinical and Translational Science and Training Grant (UL-RR026314)
- National Center for Complementary and Integrative Health (NCCIH T32AT000051-16)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- mindfulness skills, affect tolerance, health anxiety, anxiety sensitivity, intolerance of uncertainty, distress tolerance, non-judgment, non-reactivity, acting with awareness
- MeSH terms
- Adolescent, Adult, Affect, Anxiety Disorders, Attitude to Health, Female, Humans, Male, Middle Aged, Students, Universities, Uncertainty, Young Adult, Self Report, Mindfulness
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Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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