Decentering as a Common Link among Mindfulness, Cognitive Reappraisal, and Social Anxiety

There has been much debate about the role that cognitions play in the maintenance of anxiety, particularly about whether the focus should be on the content of thoughts or the relationship one has with thoughts. This distinction is highlighted when examining the two representative cognitive behavioral models of social anxiety presented below. From a more traditional cognitive behavioral perspective, Rapee and Heimberg (1997)1 view social anxiety as a response to a perceived threat. According to this model, the individual with social anxiety thinks others are critical while also thinking that it is important to be positively appraised by others. The individual’s attention is focused on a mental representation of how the audience perceives him or her, with a bias towards perceived threats. This prediction of negative outcomes leads to physiological, cognitive, and behavioral aspects of anxiety which then become part of the mental representation continuing the cycle of anxiety. In this model, the focus is on the content of the cognitions in that elements of anxiety follow the judgments being made of the likelihood of negative outcomes. In fact, research on social anxiety has examined the role of cognitions in maintaining the disorder (see Heimberg & Becker, 2002 for a review). From this perspective, emotion regulation strategies aimed at reinterpreting the meaning of internal stimuli, termed cognitive reappraisal (Gross, 1998), should be associated with a decrease in anxiety. In fact, in an experimental study comparing emotion regulation strategies, individuals who employed reappraisal prior to giving a speech experienced less anxiety than did those using suppression (Hofmann, Heering, Sawyer, & Asnaani, 2009). In comparison, Herbert and Cardaciotto (2005) present a modification to social anxiety models that incorporates the construct of mindfulness, or a type of awareness characterized by sustained attention to the present moment coupled with an attitude of openness, curiosity, and acceptance (Bishop et al., 2004). According to this model, the anxiety-related thoughts and feelings encountered in an anxiety provoking situation lead to an increase in internal awareness and a decrease in awareness of external cues which trigger a variety of experiential control strategies in an attempt to change or suppress the anxious thoughts and feelings, referred to as experiential avoidance (Hayes, Wilson, Gifford, Follette, & Stosahl, 1996). Although these control strategies sometimes are effective, they often fail, which subsequently leads to an increase in anxious-related arousal and increased self-focused awareness, which then leads to stronger efforts to engage in experiential avoidance, thus perpetuating the cycle of anxiety. Since anxiety is maintained by a self-evaluative internal focus of attention and the subsequent attempts at controlling internal experiences, then those who cultivate a broader and more accepting awareness towards their internal experiences should experience less distressing anxiety. In a laboratory study, Arch and Craske (2010) found that trait mindfulness was associated with diminished anxious responding above and beyond the impact of anxious or depressive symptoms. Likewise, therapy approaches such as Mindfulness Based Stress Reduction, which have a strong mindfulness component, have been shown to reduce social anxiety (Goldin & Gross, 2010). Although these models have their differences, namely in that cognitions are seen to have a more causal role in the Rapee/Heimberg model whereas the relationship with the cognitions is more prominent in the Herbert/Cardaciotto model, they also have commonalities. Most notably, they both focus on an increase in self-focused attention and also a process by which one gets fused with internal experiences. In both models, the individual experiences an increase in internal awareness in which thoughts and images of social failure are seen as truths that either are happening or are going to happen. In the Rapee/Heimberg model, it is the belief that the imagined negative event will occur that leads to the physiological and behavioral responses. Likewise, in the Herbert/Cardaciotto model, when the negative thoughts occur, because they are seen as truths, there is a strong motivation to remove or reduce the thought, setting off the experiential avoidance cycle which results in increased physiological and behavioral responses. On the surface these two perspectives appear to point to disparate emotion regulation strategies (mindfulness vs. reappraisal); however, in looking more closely, both mindfulness and cognitive reappraisal appear to exert their effect on anxiety by allowing for a different perspective in which thoughts are held more loosely so that the possibility that the thought is not truth can be entertained. This process of seeing thoughts or feelings as objective events in the mind rather than personally identifying with them has been called decentering (Safran & Segal, 1990) and is closely related to defusion (Hayes, Strosahl, & Wilson, 1999), meta-cognitive awareness (Teasdale et al., 2002), and reperceiving (Shapiro, Carlson, Astin, & Freedman, 2006). The process of seeing thoughts and feelings as objective events both changes the reaction that one has to thoughts so that thoughts are less likely to trigger attempts to control the experience (Herbert/Cardaciotto model) and also allows for a shift in perspective making it easier to evaluate the accuracy of the thought (Rapee/Heimberg model). Decentering has been described as a potential key mechanism underlying both cognitive reappraisal (Ingram & Hollon, 1986) and mindfulness (Shapiro et al., 2006). In terms of reappraisal, Beck (1970) describes cognitive restructuring as helping individuals to step back from their thoughts to notice them as beliefs rather than facts. Similarly, Fresco, Segal, Buis, and Kennedy (2007) found that clients who received cognitive behavioral therapy for depression, which included cognitive reappraisal, reported significant increases in decentering compared to those who received antidepressant medication. Although there is some preliminary research linking decentering and reappraisal, the link between decentering and mindfulness has been more established. Theoretical models of mindfulness have hypothesized that decentering (reperceiving) may be a meta-mechanism through which mindfulness leads to change (Shaprio et al., 2006). In a test of this model, Carmody, Baer, Lykins and Oldendzki (2009) found a strong correlation between decentering and mindfulness among individuals completing Mindfulness-Based Stress Reduction. Two experimental studies have also examining the relationship between mindfulness and decentering. For example, Erisman and Roemer (2010) found that individuals who received a brief mindfulness induction reported more decentering than those in a control condition. In an active comparison study, Feldman, Greeson, and Senville (2010) found that individuals who received brief mindful breathing instructions reported more decentering than did participants who received either progressive muscle relaxation or loving kindness meditation instructions. Whereas previous studies have examined the relationships between anxiety and cognitive reappraisal or mindfulness separately and other studies have examined the relationship between decentering and cognitive reappraisal or mindfulness, these studies have not examined both cognitive reappraisal and mindfulness simultaneously in relation to social anxiety. Therefore, this study examined the relationships among cognitive reappraisal, mindfulness, decentering, and social anxiety in a cross-sectional study to begin to understand whether or not both reappraisal and mindfulness influence social anxiety through decentering. Consistent with previous research, it was hypothesized that individuals who reported higher trait mindfulness and reappraisal would have lower levels of social anxiety. Since it was hypothesized that mindfulness and reappraisal increase decentering, it was expected that higher scores on mindfulness and reappraisal would be associated with reports of a more decentered perspective.