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Cited by 72Mindfulness and Compassion InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and Applications

Decoupling as a Mechanism of Change in Mindfulness and Acceptance: A Literature Review

Open access
Levin, Michael E., Luoma, Jason B., Haeger, Jack A.·2015·Behavior Modification
DOI 10.1177/0145445515603707
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Abstract

A growing body of research within the acceptance and mindfulness-based therapies suggests that these treatments may function in part by reducing or eliminating (i.e., decoupling) the normative relationships between internal experiences and other internal/overt behavior. Examples of decoupling effects found in this review include reduced relationships between urges to smoke and smoking behavior, between dysphoric mood and depressive cognitions, and between pain intensity and persistence in a painful task. A literature review identified 44 studies on acceptance and mindfulness that demonstrated decoupling effects. Overall, preliminary evidence for decoupling effects were found across a broad range of problem areas, including substance abuse, depression, eating disorders, overeating, chronic pain, anxiety, relationships, anger, avoidance behavior, and self-harm, with the strongest evidence currently available in the area of substance abuse. However, the review also notes a general lack of replication studies on decoupling effects and the need for more well-powered and controlled research testing specific decoupling hypotheses. © 2015, © The Author(s) 2015.

Integrity signals

Registry

Crossref · 10.1177/0145445515603707

Cites

69 of 69 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

30 of 111 cited sources checked · 22 supported · 0 flagged · accuracy not yet measured

  • Findingcitation

    In Witkiewitz and Bowen (2010), post treatment depression was less strongly related to substance use at follow up in the MBRP condition relative to TAU.

    “Post treatment depression was also less strongly related to substance use at follow up in the MBRP condition relative to TAU.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Witkiewitz & Bowen, 2010 source
  • Findingcitation

    In Ostafin et al. (2013), significant moderation effects were found with the FFMQ total score and the FFMQ nonjudgmental subscale.

    “Significant moderation effects were found with the FFMQ total score as well as the FFMQ nonjudgmental subscale.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Ostafin et al., 2013 source

      The available passages from the copy (labeled Abstract, no page given) contain bibliographic details and keywords, but no results for the FFMQ. Searches for the FFMQ total score, the nonjudgmental or nonjudging subscale, and moderation effects found no passage that establishes whether either effect was significant. (LLM, conf=0.70)

      Experimental — accuracy not yet measured
  • Findingcitation

    In Ostafin et al. (2013), greater alcohol-positive implicit associations were related to greater preoccupation with alcohol-related thoughts only among those low in total mindfulness or more judgmental.

    “Greater alcohol-positive implicit associations were related to greater preoccupation with alcohol-related thoughts only among those who were low in total mindfulness or more judgmental.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Ostafin et al., 2013 source

      The paper title (unpaginated) says that mindfulness weakens the relation between implicit alcohol valence and preoccupation with alcohol-related thoughts. The available passages do not establish that a positive association occurred only among people low in total mindfulness or those who were more judgmental; searches for those terms returned only bibliographic material. (LLM, conf=0.70)

      Experimental — accuracy not yet measured
  • Findingcitation

    In Bordieri et al. (2014), acceptance moderated the relationship between PTSD symptoms and cannabis dependence such that PTSD symptoms were related to current dependence only among those low in acceptance.

    “Analyses indicated that acceptance moderated the relationship between PTSD symptoms and cannabis dependence such that PTSD symptoms were related to current dependence only among those low in acceptance.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Bordieri et al., 2014 source
  • Findingcitation

    In Witkiewitz and Bowen (2010), intervention condition moderated the relationship between depression severity at post treatment and cravings to use alcohol/drugs at 2-month follow up, such that this relationship was weaker among those in MBRP.

    “Intervention condition moderated the relationship between depression severity at post treatment and cravings to use alcohol/drugs at 2-month follow up, such that this relationship was weaker among those in MBRP (i.e., depression was less strongly related to cravings to use).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Witkiewitz & Bowen, 2010 source
  • May combine two claims. 42
  • Classified as probably not a substantial claim. 22

  • May combine two claims.

    Findingcitation

    In Witkiewitz and Bowen (2010), there was a significant moderated mediation effect such that craving partially mediated the relationship of depression to substance use frequency in the TAU condition but did not in the MBRP condition.

    “In addition, there was a significant moderated mediation effect such that craving partially mediated the relationship of depression to substance use frequency in the TAU condition, but did not in the MBRP condition.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Witkiewitz & Bowen, 2010 source

  • May combine two claims.

    Findingcitation

    In Elwafi et al. (2013), 33 smokers who completed an eight-session mindfulness treatment demonstrated the normative correlation between cravings and smoking frequency at baseline, but the correlation was no longer present at post treatment.

    “The 33 smokers who completed an eight-session mindfulness treatment (adapted from MBRP) demonstrated the normative correlation between cravings and smoking frequency at baseline, but the correlation was no longer present at the post treatment assessment.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Elwafi et al., 2013 source

      Results §3.2 reports a positive craving–smoking correlation at baseline (r = 0.582) that was no longer statistically significant at the end of treatment (r = 0.126). Methods §2.3 describes an eight-session treatment adapted from a drug-relapse-prevention manual. However, Results §3.1 says 33 participants *initiated* treatment and attended an average of 6.7 of eight sessions; it does not say all 33 completed the treatment or attended every session. (LLM, conf=0.90)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    In Elwafi et al. (2013), frequency of informal meditation practice during the intervention period moderated the relationship between cravings and smoking frequency at post, such that there was a weaker relationship among those who practiced more; this moderation effect was not found with frequency of formal meditation practice.

    “Furthermore, the frequency of informal meditation practice during the intervention period moderated the relationship between cravings and smoking frequency at post, such that there was a weaker relationship between these internal experiences among those who practiced more (although this moderation effect was not found with frequency of formal meditation practice).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Elwafi et al., 2013 source

  • May combine two claims.

    Premisecitation

    In that trial, treatment condition moderated the time-lagged association between paranoia and social acceptance, such that prior to the intervention paranoia at time 1 predicted a decrease in feeling socially accepted at time 2, but this association was no longer present at post for those in MBCT.

    “Furthermore, a decoupling effect was found such that treatment condition moderated the time lagged association between paranoia and social acceptance.Prior to the intervention feeling paranoid (at time 1) predicted a decrease in feeling socially accepted (at time 2), but this association was no longer present at post for those in MBCT.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Collip et al., 2013 source

  • May combine two claims.

    Premisecitation

    In that study, neuroticism no longer predicted depression at the 90th percentile of mindfulness scores, meaning full decoupling was present only among the top 10% in mindfulness.

    “Analyses indicated neuroticism no longer predicted depression at the 90 th percentile of mindfulness scores (i.e., full decoupling was only present among the top 10% in mindfulness).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Barnhofer et al., 2011 source

  • May combine two claims.

    Premisecitation

    In an ecological momentary assessment study with 62 chronic pain participants, acceptance as measured by the ICQ lowered attention paid to pain on average, but did not moderate the association between attention to pain and pain intensity.

    “Acceptance was found to lower the attention paid to pain on average, but it did not moderate the association between attention to pain and pain intensity.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Crombez et al., 2013 source

  • May combine two claims.

    Premisecitation

    In a cross-sectional assessment-only study of 278 college students, mindfulness as measured by the MAAS moderated the relationship between disordered eating cognitions and problem eating behaviors, such that those high in mindfulness had a weaker association.

    “In support of this, there was a significant moderation effect with mindfulness such that those high in mindfulness had a weaker association between disordered eating cognitions and disordered eating behaviors.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Masuda, Price, & Latzman, 2012 source

  • May combine two claims.

    Premisecitation

    In a randomized trial comparing MBCT to a waitlist condition with 130 participants in partial remission from a depressive episode, MBCT reduced paranoia and increased feeling socially accepted relative to waitlist.

    “Results indicated MBCT reduced paranoia and increased feeling socially accepted relative to waitlist.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Collip et al., 2013 source

  • May combine two claims.

    Premisecitation

    In a laboratory-based study with 190 college students, mindful breathing led to significantly greater frequency of repetitive thoughts during the exercise as well as greater self-reported decentering.

    “Results indicated that mindful breathing led to significantly greater frequency of repetitive thoughts during the exercise as well as greater self-reported decentering.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Feldman et al., 2010 source

  • May combine two claims.

    Premisecitation

    In an EMA study with 34 college students with high BPD symptoms and 50 with low, positive emotion differentiation moderated such that BPD symptom level related to both impulsivity and urges to engage in problem behaviors only among those lower in positive emotion differentiation; these variables were not related at high levels of differentiation.

    “There were two significant moderation effects with positive emotion differentiation such that BPD symptom level related to both impulsivity and urges to engage in problem behaviors only among those lower in positive emotion differentiation; these variables were not related at high levels of differentiation.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Dixon-Gordon et al., 2014 source

  • May combine two claims.

    Interpretationcitation

    This review supports the traditional AMT account, with studies showing decoupling effects are related to improvements in self-compassion from treatment, improvements in decentering following mindful breathing, and amount of meditation practice.

    “This review supports the traditional AMT account, with studies showing decoupling effects are related to improvements in self-compassion from treatment (Kuyken et al., 2010), improvements in decentering following mindful breathing (Feldman et al., 2010) and amount of meditation practice (Elwafi et al., 2013).”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites Kuyken et al., 2010 source
    • cites Feldman et al., 2010 source
    • cites Elwafi et al., 2013 source

      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 measured

  • May combine two claims.

    Findingcitation

    In Minami et al. (in press), the AIS did not moderate the relationship between craving and smoking abstinence, and the general measure of acceptance (AAQ) was not a significant moderator.

    “However, the AIS did not moderate the relationship between craving and smoking abstinence and the general measure of acceptance (AAQ) was not a significant moderator.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Minami et al., in press

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingown data

    The review identified 16 studies testing direct decoupling effects from lab/outcome AMT interventions and 28 studies testing decoupling effects from assessment-only designs.

    “The review identified 16 studies testing direct decoupling effects from lab/outcome AMT interventions and 28 studies testing decoupling effects from assessment-only designs.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Intervention decoupling effects were found for acceptance-based interventions (4 studies), mindful breathing/meditation interventions (3 studies), mindfulness of reactions during lab tasks (3 studies), MBCT (2 studies), MBRP (2 studies), urge surfing (1 study), and body scan mindfulness (1 study).

    “Intervention decoupling effects were found for acceptance-based interventions (4 studies), mindful breathing/meditation interventions (3 studies), mindfulness of reactions during lab tasks (3 studies), MBCT (2 studies), MBRP (2 studies), urge surfing (1 study), and body scan mindfulness (1 study).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The review identified 38 eligible research articles reporting a total of 44 studies.

    “Overall, the review identified 38 eligible research articles reporting a total of 44 studies”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Of the 139 potential articles, 101 were excluded, most commonly because the observed effect referred to responses to an external stressor/stimulus (n = 46).

    “Of the 139 potential articles, 101 were excluded from the review with the most common reason being that the observed effect referred to responses to an external stressor/stimulus (n = 46).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Of the 41 studies demonstrating a decoupling effect, 8 did not find decoupling effects with all AMT measures/subscales or tests conducted, while 33 found a decoupling effect with all reported decoupling tests conducted.

    “Of the 41 studies demonstrating a decoupling effect, 8 did not find decoupling effects with all of the AMT measures/subscales or tests conducted while the other 33 found a decoupling effect with all of the reported decoupling tests conducted.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    In Kuyken et al. (2010), intervention condition moderated the relationship between cognitive reactivity and depressive outcomes; the normative relationship was found in the antidepressant condition such that greater cognitive reactivity at post predicted greater depressive symptoms and relapse at 15-month follow up, but reactivity was not related to either outcome in the MBCT condition.

    “The normative relationship was found in the antidepressant condition such that greater cognitive reactivity at post was predictive of greater depressive symptoms and relapse at 15 month follow up in the antidepressant condition, but reactivity was not related to either outcome in the MBCT condition.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Kuyken et al., 2010 source

  • May combine two claims.

    Findingcitation

    In Adams et al. (2013), mindfulness eliminated the relationship between urges to smoke and smoking behavior following the body image challenge, which was also found in the no instruction condition.

    “Mindfulness also eliminated the relationship between urges to smoke and smoking behavior following the body image challenge (i.e., whether they accepted a cigarette offered by an experimenter), which was also found in the no instruction condition.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Adams et al., 2013

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingown data

    Of 44 studies, 41 found a decoupling effect and 3 found no support for a decoupling effect.

    “In terms of decoupling findings, 41 of 44 studies found a decoupling effect, with 3 of 44 studies finding no support for a decoupling effect.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The review identified 139 potentially eligible articles testing a possible decoupling effect.

    “In total, 139 potentially eligible articles were identified testing a possible decoupling effect.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Assessment-only decoupling effects were found for measures of emotion differentiation (8 studies), AAQ acceptance (7 studies), MAAS awareness of the present (5 studies), and FFMQ facets of mindfulness (5 studies).

    “Assessment-only decoupling effects were found for measures of emotion differentiation (8 studies), acceptance as measured by versions of the Acceptance and Action Questionnaire (AAQ; 7 studies), awareness of the present as measured by the Mindful Attention and Awareness Scale (MAAS; 5 studies) and various facets of mindfulness as measured by versions of the Five Facet Mindfulness Questionnaire (FF”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    Several studies were underpowered to test decoupling effects and it was often not clear the degree to which they were specifically designed to test a priori hypotheses for decoupling.

    “several studies were underpowered to test decoupling effects and it was often not clear the degree to which they were specifically designed to test apriori hypotheses for decoupling.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    In one study mindfulness reduced cognitive reactivity to depressed affect but not in a second.

    “in one study mindfulness reduced cognitive reactivity to depressed affect (Gilbert & Christopher, 2009) but not in a second (Kuyken et al., 2010).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Gilbert & Christopher, 2009

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Kuyken et al., 2010 source

  • Classified as probably not a substantial claim.

    Findingnone given

    The review found a lack of common terminology to orient researchers to this important set of studies and phenomenon.

    “the review found a lack of common terminology to orient researchers to this important set of studies and phenomenon.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Many of the excluded studies touch on important areas for further research such as responses to exposure procedures, stressful events, and exposure to racism.

    “many of the excluded studies touch on important areas for further research such as responses to exposure procedures (e.g., Eifert et al., 2003), stressful events (e.g., Ciesla et al., 2012), and exposure to racism (e.g., West et al., 2013).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Eifert et al., 2003 source
    • cites Ciesla et al., 2012 source
    • cites West et al., 2013 source

  • May combine two claims.

    Findingown data

    This review combined a variety of AMT interventions and measures, with results showing decoupling from mindful awareness of the present moment, acceptance, being nonjudgmental of inner experiences, differentiating emotional experiences, among others.

    “This review combined a variety of AMT interventions and measures, with results showing decoupling from mindful awareness of the present moment, acceptance, being nonjudgmental of inner experiences, differentiating emotional experiences, among others (see Table 1).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Several studies demonstrated decoupling between negative affect and cravings, suggesting AMTs may change how individuals relate to aversive emotions such that they no longer respond by wanting to use substances to avoid/escape these experiences.

    “Several studies also demonstrated decoupling between negative affect and cravings, further suggesting AMTs may change how individuals relate to aversive emotions such that they no longer respond by wanting to use substances to avoid/escape these experiences.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Common to AMT approaches is a focus on the use of experiential methods to change the function of one's internal experiences so as to achieve a compassionate and decentered awareness of these experiences without giving them undue influence over one's behavior.

    “Common to the AMT approaches is a focus on the use of experiential methods to change the function of one's internal experiences (i.e., how one relates to thoughts and feelings) so as to achieve a compassionate and decentered awareness of these experiences without giving them undue influence over one's behavior (Hayes, Villatte et al., 2011).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Hayes, Villatte et al., 2011 source

  • May combine two claims.

    Interpretationreasoning

    Overall, preliminary studies suggest that AMTs might decouple the normative relationships between disordered eating cognitions and problem eating behaviors as well as between hunger and unhealthy eating, but one study indicated contradictory results with distress and emotional eating.

    “Overall these preliminary studies suggest that AMTs might decouple the normative relationships between disordered eating cognitions and problem eating behaviors as well as between hunger and unhealthy eating.One study was found that indicated contradictory results with distress and emotional eating however.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Moderation effects in the reviewed studies validly indicate decoupling of the relationship between internal experiences and outcomes.

  • May combine two claims.

    Premisecitation

    In that study, induced negative emotion was predictive of avoidance in the reappraisal and no instruction conditions, but negative emotion was not related to avoidance in the acceptance condition.

    “However, a decoupling effect was found such that induced negative emotion was predictive of avoidance in the reappraisal and no instruction condition, but negative emotion was not related to avoidance in the acceptance condition.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Wolgast et al., 2011 source

  • May combine two claims.

    Interpretationcitation

    Thus, although both reappraisal and acceptance reduced avoidance, it may have occurred through distinct mechanisms with only acceptance leading to a decoupling between experiencing aversive emotions and being willing to watch the clip again.

    “Thus, although both reappraisal and acceptance reduced avoidance, it may have occurred through distinct mechanisms with only acceptance leading to a decoupling between experiencing aversive emotions and being willing to watch the clip again.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Moderation effects in the reviewed studies validly indicate decoupling of the relationship between internal experiences and outcomes.

  • May combine two claims.

    Interpretationreasoning

    Overall, preliminary data suggest that AMTs can decouple the relationship between internal risk factors for depression (cognitive reactivity, neuroticism) and depressive outcomes as well as other related symptoms (social acceptance and paranoia).

    “Overall, there is some preliminary data suggesting that AMTs can decouple the relationship between internal risk factors for depression (i.e., cognitive reactivity, neuroticism) and depressive outcomes as well as with other related symptoms (i.e., social acceptance and paranoia).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Moderation effects in the reviewed studies validly indicate decoupling of the relationship between internal experiences and outcomes.

  • May combine two claims.

    Interpretationreasoning

    Some studies suggest that AMTs might decouple the relation between pain intensity and overt behaviors, although few studies have tested this directly.

    “There are also some studies suggesting AMTs might decouple the relation between pain intensity and overt behaviors, although few studies have tested this directly.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Moderation effects in the reviewed studies validly indicate decoupling of the relationship between internal experiences and outcomes.
    • Rests on an assumption: AMTs for chronic pain work in part by decoupling the impact of pain on behavioral functioning, mental health, and quality of life.

  • May combine two claims.

    Interpretationcitation

    This suggests that although individuals may continue to attend to pain in response to pain intensity, acceptance reduces fearful thoughts in response to pain.

    “This suggests that although individuals may continue to attend to pain in response to pain intensity, acceptance reduces fearful thoughts in response to pain.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Moderation effects in the reviewed studies validly indicate decoupling of the relationship between internal experiences and outcomes.

  • May combine two claims.

    Premisecitation

    In that study, although mindfulness decreased emotional eating among those lower in distress, at high levels of distress the pattern of emotional eating was similar irrespective of mindfulness score.

    “Although mindfulness decreased emotional eating among those lower in distress, at high levels of distress the pattern of emotional eating was similar irrespective of mindfulness score.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Pidgeon et al., 2013 source

  • May combine two claims.

    Premisecitation

    In a cross-sectional assessment-only community sample of 679 participants, acceptance as measured by the BI-AAQ moderated the relationship between body image dissatisfaction and disordered eating behaviors, such that body image dissatisfaction was associated with drive for thinness and problem eating behaviors only among those low in acceptance.

    “Results indicated a significant moderation effect such that body image dissatisfaction was associated with both drive for thinness and problem eating behaviors only among those low in acceptance.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Ferreira et al. 2011

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationreasoning

    Each of these accounts still leads to decoupling effects, but highlights different pathways for doing so (i.e., altering the function of inner experiences, improving self-control, emotion regulation).

    “Each of these accounts still lead to decoupling effects, but highlight different pathways for doing so (i.e., altering the function of inner experiences, improving self-control, emotion regulation).”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Decoupling effects represent an alternative method for addressing internal experiences that elicit maladaptive responding.

    “Decoupling effects represent an alternative method for addressing internal experiences that elicit maladaptive responding.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    This would differ notably from a typical AMT model as it suggests decoupling may occur due to increased control over psychological reactions rather than changes in their function.

    “This would differ notably from a typical AMT model as it suggests decoupling may occur due to increased control over psychological reactions rather than changes in their function.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In that study, there was no significant moderation effect on potential partner selection, but casual sex motivation was only associated with selecting more people as potential partners in the control condition and not in the mindfulness condition.

    “Although there was no significant moderation effect on potential partner selection, casual sex motivation was only associated with selecting more people as potential partners in the control condition and not in the mindfulness condition.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Papies et al., in press

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationreasoning

    These preliminary results highlight potential areas for decoupling effects related to aversive emotions and avoidance behavior, reactions to repetitive thoughts, anxiety sensitivity and anxious symptoms, the impact of anxious attachment on relationship functioning, sexual motivation and attraction, and neuroticism and anger.

    “These preliminary results highlight potential areas for decoupling effects related to aversive emotions and avoidance behavior, reactions to repetitive thoughts, anxiety sensitivity and anxious symptoms, the impact of anxious attachment on relationship functioning, sexual motivation and attraction, and neuroticism and anger.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Moderation effects in the reviewed studies validly indicate decoupling of the relationship between internal experiences and outcomes.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    A major limitation of this review is the difficulty identifying studies that failed to find a decoupling effect.

    “A major limitation of this review is the difficulty identifying studies that failed to find a decoupling effect.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationcitation

    Another explanation is that acceptance and mindfulness processes might enhance one's ability to use effective emotion regulation strategies to reduce/change internal experiences.

    “Another explanation is that acceptance and mindfulness processes might enhance one's ability to use effective emotion regulation strategies to reduce/change internal experiences.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    These findings are consistent with many AMT models, which generally theorize that these intervention methods change how individuals relate to their inner experiences, promoting an accepting, nonreactive and nonjudgmental awareness of them simply for what they are.

    “These findings are consistent with many of the AMT models, which generally theorize that these intervention methods change how individuals' relate to their inner experiences, promoting an accepting, nonreactive and nonjudgmental awareness of them simply for what they are.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In that study, those low in mindfulness demonstrated the expected relationship between anxious attachment and greater probability of breaking up, but these variables were not correlated among those high in mindfulness.

    “Those low in mindfulness demonstrated the expected relationship between anxious attachment and greater probability of breaking up, but these variables were not correlated among those high in mindfulness.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Saavedra et al., 2010 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Thus, emotion differentiation might produce similar decoupling effects as mindfulness.

    “Thus emotion differentiation might produce similar decoupling effects as mindfulness.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Moderation effects in the reviewed studies validly indicate decoupling of the relationship between internal experiences and outcomes.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    These counterintuitive findings might suggest that decoupling effects vary based on construct measured.

    “These counterintuitive findings might suggest that decoupling effects vary based on construct measured, but it also raises concerns regarding the stability and replicability of some decoupling findings.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Moderation effects in the reviewed studies validly indicate decoupling of the relationship between internal experiences and outcomes.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    One alternative account may be that decoupling effects are due to an increase in self-control and capacity to inhibit maladaptive responses, such as through improved executive functioning or self-control resources.

    “One alternative account may be that decoupling effects are due to an increase in self-control and capacity to inhibit maladaptive responses, such as through improved executive functioning or self-control resources.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In an EMA study with 38 participants diagnosed with BPD, emotion differentiation moderated the relationship between rumination and nonsuicidal self-injury, such that higher rumination was not predictive of self-injury among those high in emotion differentiation, but it was among those low in differentiation.

    “Results indicated that higher rumination was not predictive of self-injury among those high in emotion differentiation, but it was among those low in differentiation (Zaki et al., 2013).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Zaki et al., 2013 source

  • May combine two claims.

    Interpretationreasoning

    In this exploratory, diverse area, studies are rarely developed specifically to test for a decoupling effect and may not be reported as part of study results in the absence of a significant finding.

    “it is particularly notable in an exploratory, diverse area such as this in which studies are rarely developed specifically to test for a decoupling effect and may not be reported as part of study results in the absence of a significant finding (i.e., file drawer effect).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Underpowered studies tend to lead researchers to only publish studies that demonstrate a decoupling effect despite low power, while those that fail to demonstrate an effect remain unpublished.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    Theoretically, decoupling might be an empirical signature of changes in the function of internal experiences and might predict later treatment gains.

    “Theoretically, decoupling might be an empirical signature of changes in the function of internal experiences and might predict later treatment gains.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The review purposefully excluded those studies which tested how AMTs alter responses to external stressors/stimuli.

    “The review purposefully excluded those studies which tested how AMTs alter responses to external stressors/stimuli given this phenomena can be accounted for by a number of processes (e.g., decoupling, distress reduction, cognitive restructuring).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    EMA also provides intensive longitudinal data to better examine mediators of decoupling effects.

    “EMA also provides intensive longitudinal data to better examine mediators of decoupling effects (e.g., Pond et al., 2012).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Pond et al., 2012 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    This may be due to the cognitive distancing component of CT.

    “This may be due to the cognitive distancing component of CT, which served as one foundation for the later development of ACT and involves”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    This review did include emotion differentiation studies, which significantly overlap with the awareness and describing facets of mindfulness.

    “This review did include emotion differentiation studies, which significantly overlap with the awareness and describing facets of mindfulness.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationreasoning

    Theoretically, clarifying and connecting with personal values may produce similar decoupling effects as behavior becomes less under the control of certain internal experiences and is guided more by one's stated values.

    “Theoretically, clarifying and connecting with personal values may produce similar decoupling effects as behavior becomes less under the control of certain internal experiences and is guided more by one's stated values.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The current review was limited to decoupling effects produced through acceptance and mindfulness processes.

    “The current review was limited to decoupling effects produced through acceptance and mindfulness processes.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    These studies were included in part because they exemplify the strategic methods and in-depth questions that may be examined with decoupling effects.

    “These studies were included in part because they exemplify the strategic methods and in-depth questions that may be examined with decoupling effects.”
    Quote in the paperNot a substantial claim
59 of 59

  • The paper relies on this without support.

    No reviews to date have been conducted on decoupling effects across the range of psychological problems to which AMTs have been applied.

    “We are not aware of any reviews to date that have been conducted on decoupling effects across the range of psychological problems to which AMTs have been applied.”

  • The paper relies on this without support.

    The normative relationships between internal experiences and problem behaviors are causal/functional such that decoupling them is clinically meaningful.

    “This review highlights the breadth of emerging research indicating that AMTs may decouple the normative behavioral relations between internal experiences and other internal experiences/overt behaviors.”

  • The paper relies on this without support.

    Moderation effects in the reviewed studies validly indicate decoupling of the relationship between internal experiences and outcomes.

    “Furthermore, a decoupling effect was found such that treatment condition moderated the time lagged association between paranoia and social acceptance.”

  • The paper relies on this without support.

    AMTs for chronic pain work in part by decoupling the impact of pain on behavioral functioning, mental health, and quality of life.

    “Theoretically, AMTs for chronic pain work in part by decoupling the impact of pain on behavioral functioning, mental health, and quality of life.”

  • The paper relies on this without support.

    Anxiety sensitivity is strongly related to anxious symptomatology.

    “Although distinct from anxious symptoms themselves, research has consistently found anxiety sensitivity to be strongly related to anxious symptomatology.”

  • The paper relies on this without support.

    There are a number of unreported, well-powered and controlled studies that have failed to find decoupling effects.

    “raises further concerns about the number of unreported studies, that are well powered and controlled, which have failed to find decoupling effects”

  • The paper relies on this without support.

    Underpowered studies tend to lead researchers to only publish studies that demonstrate a decoupling effect despite low power, while those that fail to demonstrate an effect remain unpublished.

    “The use of such underpowered studies has the tendency to lead researchers to only publish studies that manage to demonstrate a decoupling effect despite low power, while those that fail to demonstrate an effect remain unpublished.”

  • The authors state this as an assumption.

    CT assumes maladaptive thoughts need to be changed in order to change symptoms.

    “However, CT assumes maladaptive thoughts need to be changed in order to change symptoms.”
8 of 8

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 field lacks knowledge about specific mechanisms responsible for changes during anxiety disorder treatment.

    “As a field, we lack information about specific mechanisms that are responsible for changes that occur over the course of treatments for anxiety disorders (Kazdin, 2007).”

    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 Levin, Luoma, & Haeger, 2015

    The paper’s introductory text (indexed under Abstract; page unavailable) says that growing outcome research creates a need for a more refined examination of mechanisms of change in acceptance and mindfulness-based therapies. That supports a gap in mechanism research, but it does not establish the claim for anxiety-disorder treatments as a whole. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • The finding that Pavlovian extinction does not consistently lead to a decrease in escape and avoidance behavior is a demonstration of the phenomenon known as decoupling.

    “The finding that Pavlovian extinction does not consistently lead to a decrease in escape and avoidance behavior is a demonstration of the phenomenon known as 'decoupling,'”

    From Relapse of anxiety-related fear and avoidance: Conceptual analysis of treatment with acceptance and commitment therapy (2020) · cites this paper as Levin, Luoma, & Haeger, 2015

    The “Other decoupling effects” section (page unavailable) describes decoupling between aversive emotion and avoidance behavior. It does not discuss Pavlovian extinction or report that extinction fails to consistently reduce escape and avoidance, so the specific example attributed to this paper is unsupported. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • ACT alters the context of relating to internal experiences so that they have less influence on behavior, a decoupling effect.

    “This is sometimes referred to as a “decoupling” effect 10 in that ACT alters the context of relating to internal experiences such that they have less influence on behavior (e.g., self-critical thoughts are noticed as just thoughts, while one chooses to engage in social activities).”

    From Acceptance and Commitment Therapy as a Treatment for Anxiety and Depression (2017) · cites this paper as [10]

  • Research on decoupling effects suggests that acceptance and mindfulness can change the function of implicit cognitions so they no longer influence behavior.

    “For example, research on decoupling effects (Levin, Luoma & Haeger, 2015) suggest that acceptance and mindfulness can change the function of implicit cognitions so they no longer influence behavior (see Ostafin et al., 2012 for an example).”

    From Examining the Role of Implicit Emotional Judgments in Social Anxiety and Experiential Avoidance (2017) · cites this paper as Levin, Luoma & Haeger, 2015

  • ACT posits a great emphasis in promoting cognitive defusion, which is the process of taking a detached perspective on private experiences, and unhooking behavior from said events, such that other sources of stimulus control influence behavior in accordance with personal values instead of experiential avoidance.

    “Given the prominence of cognitive fusion in the underlying theory, ACT posits a great emphasis in promoting cognitive defusion, which is the process of taking a detached perspective on private experiences, and unhooking behavior from said events, such that other sources of stimulus control influence behavior in accordance with personal values instead of experiential avoidance (Levin, Luoma, & Haeg”

    From Psychometric properties of the Cognitive Fusion Questionnaire in Colombia (2017) · cites this paper as Levin, Luoma, & Haeger, 2015

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.

  • Adams et al. (2013) sample size differs between text and table

    Minor

    The text reports 65 students in the laboratory study, while Table 1 lists 64 for the same study.

1 of 1

Cites

Flagged first, then by citations

2 of the 71 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Ferreira C., 2011, International Journal of Psychology and Psychological Therapy, 11, 327

Cited by

Sorted by citations

Related

Authors
Levin, M. E., Luoma, J. B., & Haeger, J. A.
Affiliations
  • Utah State University (US)
  • Portland Psychotherapy Clinic, Research, and Training Center, OR, USA
Corresponding author
Levin, Michael E.
ORCID
Venue
Behavior Modification
Publisher
SAGE Publications
Published
2015-09-08
Volume
39
Issue
6
Pages
870-911
ISSN
  • 0145-4455 (ISSN-L)
  • 1552-4167
DOI
10.1177/0145445515603707
OpenAlex
W1821829665
Cited by
71
References
71
Citations by year
2026: 1 · 2025: 10 · 2024: 4 · 2023: 6 · 2022: 6 · 2021: 9 · 2020: 7 · 2019: 6 · 2018: 5 · 2017: 8 · 2016: 9
FWCI
9.09
Type
journal article
Language
en
Open access
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • Behavior Modification (publishedVersion)
  • PubMed (publishedVersion)
  • Digital Commons - USU (Utah State University) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
decoupling, mindfulness-based interventions, acceptance-based therapy, smoking urges, dysphoric mood, depressive cognitions, substance abuse, depression, eating disorders, overeating, anxiety, avoidance behavior, self-harm, anger
MeSH terms
Anxiety, Anxiety Disorders, Depression, Depressive Disorder, Humans, Cognitive Behavioral Therapy, Mindfulness, Acceptance and Commitment Therapy

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Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

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