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Increased Attention Regulation from Emotion Regulation Therapy for Generalized Anxiety Disorder

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Abstract

Dysfunction in the ability to sustain, shift and broaden attention has been proposed as a mechanism of normative emotion regulation that is a common target of cognitive-behavioral therapies. Attention regulation deficits are central to generalized anxiety disorder (GAD) and may contribute to a generally rigid, avoidant, response style that produces substantial decrements in well-being and functioning. Emotion Regulation Therapy draws upon mindfulness-based regulatory skills to facilitate attentional change during an initial phase of treatment. Two studies examined task-based changes in flexibly shifting attention in response to conflicting emotional contexts and sustaining attention despite distressing emotional contexts. In Study 1, at pre-treatment, patients with GAD, as compared to controls performed significantly more poorly on an emotional conflict adaptation task (i.e., less ability to flexibly shift attention) and improved in conflict adaptation by mid-treatment (when attention regulation skills were being trained). This task-related change predicted increases in mindful observing abilities over the course of acute treatment but was not directly associated with clinical outcomes. In Study 2, a choice reaction time (RT) task was utilized to measure the ability to sustain attention by discriminating between two tones while overcoming the interference of aversive visual stimuli. At pre-treatment, participants with GAD demonstrated slower RTs (i.e., more difficulty sustaining attention on the tonal prompt) compared to controls and demonstrated more rapid RTs from pre- to mid-treatment. This improved task performance was related to clinical improvement and decreased functional impairment. RT change was also associated with greater nonreactivity towards experiences. Overall, these findings suggest that targeting mindful regulation skills improve attention regulation in individuals with GAD and may partially account for efficacious clinical outcomes throughout treatment.

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Notes

  1. Independent sample t tests indicated that clinic site did not impact any study analyses.

  2. Independent sample t tests indicated that clinic site did not impact any of the current study analyses.

  3. Negative images utilized were IAPS numbers 2730, 3030, 3100, 3500, 5972, 6230, 6260, 6300, 6350, 6570.1, 6830, 9050, 9250, and 9921 (Mvalence = 2.41, SDvalence = 1.62; Marousal = 6.67, SDarousal = 2.06; Mdominance = 3.20, SDdominance = 2.20). Neutral IAPS images included numbers 2190, 2200, 2210, 2215, 2221, 2270, 2831, 2383, 2440, 2480, 2495, 2722, 2840, 2850, 2870, 2880, 2890, 5030, 5120, 5130, 5390, 5500, 5800, and 7002 (Mvalence = 5.02, SDvalence = 1.38; Marousal = 2.98, SDarousal = 1.96; Mdominance = 5.87, SDdominance = 2.05).

  4. We conducted an exploratory post-hoc test of dependent correlations from Study 1 to examine if flexibly shifting attention is more strongly correlated with observing or non-reactivity. Results revealed no significant difference between the relationship of FFMQ Observing and FFMQ Non-Reactivity to conflict adaptation (Z = 1.43, p = .15, Hedge’s g = .73; Steiger 1980) but a large effect size, potentially due to the small sample size. Interestingly, an additional exploratory test of dependent correlations from Study 2 revealed that FFMQ Non-Reactivity was more strongly correlated than FFMQ Observing with sustaining attention (Z = 2.13, p = .03, Hedge’s g = 1.10) for negative images. For neutral images, a similar pattern emerged but the test of dependent correlations just missed significance (Z = 1.74, p = .08, Hedge’s g = .90), but demonstrated a large effect size as well. This pattern of findings may indicate that mindful non-reactivity may contribute to one’s ability to sustain attention regardless of emotional context.

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Funding

This study was funded by the National Institute of Mental Health (NIMH; 1R34 MH070682).

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Authors and Affiliations

  1. Teachers College, Columbia University, New York, NY, USA

    Megan E. Renna & Douglas S. Mennin

  2. The University of Arizona, Tucson, AZ, USA

    Saren H. Seeley

  3. Temple University, Philadelphia, PA, USA

    Richard G. Heimberg

  4. Department of Psychiatry and Behavioral Sciences, Stanford Neuroscience Institute, Stanford, CA, USA

    Amit Etkin

  5. Stanford University, Stanford, CA, USA

    Amit Etkin

  6. Sierra Pacific Mental Illness Research Education and Clinical Center, Palo Alto VA, Livermore, CA, USA

    Amit Etkin

  7. Kent State University, Kent, OH, USA

    David M. Fresco

  8. Case Western Reserve Medical Center, Cleveland, OH, USA

    David M. Fresco

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Correspondence to Douglas S. Mennin.

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Conflict of interest

Megan E. Renna, Saren H. Seeley, Richard G. Heimberg, Amit Etkin, David M. Fresco, Douglas S. Mennin declares that they have no conflict of interest.

Ethical Approval

This study was approved by the IRB board of Yale University and Temple University.

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Informed consent was obtained from all individual participants included in the study.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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David M. Fresco was supported by National Heart, Lung, and Blood Institute Grant R01HL119977 and National Institute of Nursing Research Grant P30NR015326.

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Renna, M.E., Seeley, S.H., Heimberg, R.G. et al. Increased Attention Regulation from Emotion Regulation Therapy for Generalized Anxiety Disorder. Cogn Ther Res 42, 121–134 (2018). https://doi.org/10.1007/s10608-017-9872-7

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