[203-213]incremental validity of mindfulness in relation to emotional dysregulation among a young...

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Incremental Validity of Mindfulness

Skills in Relation to Emotional

Dysregulation among a Young Adult

Community SampleAnka A. Vujanovic a , Marcel O. Bonn-Miller b , Amit Bernstein c ,

Laura G. McKeed

& Michael J. Zvolenskye

aNational Center for PTSDBehavioral Science Division, VA Boston

Healthcare System, Boston, MA, USAb

National Center for PTSD and Center for Health Care Evaluation,

VA Palo Alto Healthcare System, Palo Alto, CA, USAc

Department of Psychology, University of Haifa, Haifa, Israeld

Center for Developmental Science, University of North

CarolinaChapel Hill, Chapel Hill, NC, USAe

Department of Psychology, University of Vermont, Burlington, VT,

USA

Available online: 24 Feb 2010

To cite this article: Anka A. Vujanovic, Marcel O. Bonn-Miller, Amit Bernstein, Laura G. McKee &

Michael J. Zvolensky (2010): Incremental Validity of Mindfulness Skills in Relation to Emotional

Dysregulation among a Young Adult Community Sample, Cognitive Behaviour Therapy, 39:3, 203-213

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Incremental Validity of Mindfulness Skills in Relationto Emotional Dysregulation among a Young Adult

Community Sample

Anka A. Vujanovic1, Marcel O. Bonn-Miller2, Amit Bernstein3,Laura G. McKee4 and Michael J. Zvolensky5

1National Center for PTSDBehavioral Science Division, VA Boston Healthcare System,Boston, MA, USA; 2National Center for PTSD and Center for Health Care Evaluation,

VA Palo Alto Healthcare System, Palo Alto, CA, USA; 3Department of Psychology,University of Haifa, Haifa, Israel; 4Center for Developmental Science, University of NorthCarolinaChapel Hill, Chapel Hill, NC, USA; 5Department of Psychology, University of

Vermont, Burlington, VT, USA

Abstract. The present investigation examined the incremental predictive validity of mindfulness skills,as measured by the Kentucky Inventory of Mindfulness Skills (KIMS), in relation to multiple facetsof emotional dysregulation, as indexed by the Difficulties in Emotion Regulation Scale (DERS),above and beyond variance explained by negative affectivity, anxiety sensitivity, and distresstolerance. Participants were a nonclinical community sample of 193 young adults (106 women, 87men; Mage 23.91 years). The KIMS Accepting without Judgment subscale was incrementallynegatively predictive of all facets of emotional dysregulation, as measured by the DERS.Furthermore, KIMS Acting with Awareness was incrementally negatively related to difficultiesengaging in goal-directed behavior. Additionally, both observing and describing mindfulness skillswere incrementally negatively related to lack of emotional awareness, and describing skills also were

incrementally negatively related to lack of emotional clarity. Findings are discussed in relation toadvancing scientific understanding of emotional dysregulation from a mindfulness skills-basedframework. Key words: mindfulness; emotional dysregulation; KIMS; DERS; incremental validity.

Received 15 March, 2009; Accepted 26 October, 2009

*Correspondence address: Anka A. Vujanovic, PhD, National Center for PTSDBehavioral ScienceDivision, VA Boston Healthcare System, 150 South Huntington Avenue (116B-2), Boston, MA 02130,USA. Tel: 857 364 5924. FAX: 857 364 4501. E-mail: [email protected]

There has been an increased level of scholarlyand clinical attention focused on what areoften referred to as acceptance and mind-fulness-based behavioral interventions in thestudy and treatment of psychopathology(Bishop et al., 2004; Orsillo & Roemer,2005). These approaches have offered novelinsights and promising solutions to histori-cally difficult-to-treat problems (e.g. substanceuse relapse, deficits in life satisfaction; Eifert &Forsyth, 2005; S. C. Hayes, Strosahl, &Wilson, 1999; Linehan, 1993a). In terms of

emotional psychopathology, a common theme

of these approaches is the view of emotionalexperiences from an adaptive framework(Eifert & Forsyth, 2005). That is, emotionalstates are conceptualized as adaptive aspectsof human experience that help to guideindividuals through challenges or situationaldemands (Bishop et al., 2004). This approachdiffers slightly from many traditional cogni-tive behavioral approaches (Greenberg &Safran, 1987) in its focus on awareness andnonjudgmental acceptance (cf. cognitive affec-tive change strategies; e.g. cognitive restruc-

turing), particularly as related to negative

q 2010 Taylor & Francis ISSN 1650-6073DOI: 10.1080/16506070903441630

Cognitive Behaviour Therapy Vol. 39, No. 3, pp. 203213, 2010

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affective states. Although extant work ispromising, basic research linking acceptanceor mindfulness processes to aspects ofemotional dysregulation is lacking.

One promising conceptualization of mind-

fulness has been offered by Baer, Smith, andAllen (2004, p. 193), reflecting the generaltendency to be mindful in daily life across anumber of different domains; this conceptual-ization is distinct from other mindfulnessconstructs (e.g. K. W. Brown & Ryan, 2003;Conte, Ratto, & Karasu, 1996; A. M. Hayes &Feldman, 2004). As measured by the self-report Kentucky Inventory of MindfulnessSkills (KIMS; Baer et al., 2004), mindfulnessskills are conceptualized as both potential risk

factors (lower levels of mindfulness) andprotective factors (higher levels of mindful-ness). The KIMS has been found to index fourinternally consistent factors (Baer et al., 2004):(a) the ability to observe cognitions, emotionsand sensations, and external phenomena suchas sounds and smells (observing); (b) the abilityto apply words to observed phenomena(describing); (c) the ability to limit attentionto the current activity or present moment(acting with awareness); and (d) the ability toexperience the present state without evaluatingor judging its content (accepting without

judgment factor).1 Initial work supports theconvergent and discriminant validity of theKIMS with symptom measures of negativeaffect (Dekeyser, Raes, Leijssen, Leysen, &Dewulf, 2008; McKee, Zvolensky, Solomon,Bernstein, & Leen-Feldner, 2007).

A chiefgapin the existingliterature centers onhow mindfulness processes relate to emotionaldysregulation (Gross & Mun oz, 1995; Zvo-lensky, Feldner, Leen-Feldner, & Yartz, 2005).

Emotional dysregulation is purported to be anintegrative construct of dysfunction that can becharacterized by such processes as heightenedemotional states, limited understanding ofemotions, reactivity to or sensitivity aboutspecific emotional states, and maladapativemanagement tactics for emotional episodes(Mennin, Heimberg, Turk, & Fresco, 2002;Wupperman, Neumann, & Axelrod, 2008).Thus, emotional dysregulation may be appar-ent, to varying degrees, across psychopathology

phenotypes and also understood as a coreexplanatory process in psychological adap-tation more generally (Baer, Smith, Hopkins,Krietemeyer, & Toney, 2006; Gratz & Roemer,

2004; Roemer et al., 2009). Yet it is presentlyunclear how mindfulness processes, accordingto the model set forth by Baer and colleagues(2004), relate to specific aspects of emotionaldysregulation.

The broad-based aim of the current studywas to evaluate whether mindfulness skills, asbased on the Baer and colleagues (2004)model, might serve a theoretically protectivefunction by contributing to adaptive emotionregulation beyond the benefits of distresstolerance abilities and after accounting forthe effects of negative affectivity and anxietysensitivity. Emotional dysregulation wasoperationalized according to the Difficultiesin Emotion Regulation Scale (DERS; Gratz &

Roemer, 2004). The DERS assesses difficul-ties in regulating emotion, as defined by sixdimensions, or facets, of emotional dysregu-lation: (1) lack of emotional clarity; (b) lackof emotional awareness; (c) nonacceptance ofemotional responses; (d) impulse controldifficulties; (e) difficulties engaging in goal-directed behavior; and (f) limited access toemotion regulation strategies. If mindfulnessprocesses are to offer unique explanatoryvalue in terms of emotional dysregulation,such processes should account for variance inaspects of emotional dysregulation not betterexplained by negative affectivity (Vujanovic,Zvolensky, & Bernstein, 2008), anxietysensitivity (Tull, 2006; Vujanovic et al.,2008), and distress tolerance (i.e. ability towithstand experiential discomfort; R. A.Brown, Lejuez, Kahler, Strong, & Zvolensky,2005; Gratz, Rosenthal, Tull, Lejuez, &Gunderson, 2006). Each of these variablesis related to greater degrees of emotionalvulnerability, avoidant-oriented affect regu-

lation processes, and impairment in lifefunctioning (Zvolensky & Otto, 2007);therefore, these factors may serve as compet-ing explanatory factors for emotionaldysregulation.

Together, the aim of the present investigationwas to explore concurrently the uniqueexplanatory value of specific mindfulness skillsin relation to multiple facets of emotionaldysregulation. A nonclinical communitysample was used at this stage of research to

examine the incremental validity of mindfulnessskills in relation to emotional dysregulationwithout the potential confounds (e.g. cognitiveand affective symptoms of psychopathology)

204 Vujanovic, Bonn-Miller, Bernstein, McKee, and Zvolensky COGNITIVE BEHAVIOUR THERAPY

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inherent in clinical samples. It was hypothesizedthat higher levels of the KIMS Acting withAwareness and Accepting without Judgmentsubscales would be incrementally predictive oflower levels of each of the DERS subscales:

(a) Lack of Emotional Clarity, (b) Lack ofEmotional Awareness, (c) Nonacceptance ofEmotional Responses, (d) Impulse ControlDifficulties, (e) Difficulties Engaging in Goal-Directed Behavior, and (f) Limited Access toEmotion Regulation Strategies. These hypoth-eses were driven by dialectical behavior therapy(DBT) theory (Linehan, 1993a), which offersthe most comprehensive theoretical premise todate for understanding associations betweenmindfulness skills and emotional dysregulation.

Acting with awareness and accepting withoutjudgment mindfulness skills, as opposed to theobserving or describing skills, have been foundto relate to negative affectivity and anxietysensitivity (McKee et al., 2007), relevantemotional vulnerability factors. Generally,these skills correspond to DBTs core howmindfulness skills, which require taking anonjudgmental stance and focusing awarenesson activities of the present moment(Linehan, 1993b). Therefore, acting with aware-ness and accepting without judgment skills wereexpected to be related to lower levels ofemotional dysregulation (Linehan, 1993a,1993b) specifically.

Method

ParticipantsA total of 193 young adults (106 women, 87men; Mage 23.91 years, SD 9.45) wererecruited through the general community inVermont for participation in a studyon emotion

that involved the completion of a battery oftheoretically relevant measures as the first partof a larger laboratory investigation. The presentdata have not been previously reported anddiffer from previous mindfulness work (onseparate samples) by our team (McKee et al.,2007; Vujanovic et al., 2008; Vujanovic,Zvolensky, Bernstein, Feldner, & McLeish,2007). The racial composition generallyreflected that of the local population (State ofVermont Department of Health, 2007):

approximately 93% (n 179) of participantsidentified as Caucasian, 4% (n 8) as AfricanAmerican, 1.0% (n 2) as Asian, 1.0% (n 2)as Hispanic, and 1.0% (n 2) as other.

Participants were excluded on the basis of(a) limited mental competency or the inability toprovide informed, written consent; (b) currentsuicidal ideation; (c) current or history ofpsychotic spectrum symptoms; and (d) current

Axis I psychopathology, as assessed by theStructured Clinical Interview for DSM-IV,Non-Patient Version (SCID-NP; First, Spitzer,Gibbon, & Williams, 1995). These exclusionarycriteria helped to ensure that any of theobservedfindings could not simply be attributedto preexisting psychological conditions(Forsyth & Zvolensky, 2002).

MeasuresSCID-NP (First et al., 1995). Assessment and

screening of Axis I psychopathology wasdetermined using the SCID-NP; participantswere excluded if they met criteria for any AxisI disorder. The SCID-NP was used becausestudy participants were not identified as beinga clinical population per se (i.e. recruitedthrough the community).Positive Affect Negative Affect Scale(PANAS; Watson, Clark, & Tellegen, 1988).The PANAS is a 20-item measure on whichrespondents indicate, using a 5-point Likert-type scale (1 very slightly or not at all to5 extremely), the extent to which theygenerally experience emotions (e.g. hostile).The PANAS is a well-established affectivemeasure. A large body of literature supportsthe psychometric properties of the PANAS(see Watson, 2000). For the purposes of thisstudy, only the Negative Affectivity subscale(PANAS-NA) was used to assess the traitliketendency to experience negative affect states.Anxiety Sensitivity Index (ASI; Reiss, Peter-son, Gursky, & McNally, 1986). The ASI is a

16-item measure on which respondents indi-cate, using a 5-point Likert-type scale(0 very little, 4 very much), the degree towhich they fear the potential negative con-sequences of anxiety-related symptoms andsensations. The ASI consists of one higherorder factor (ASI total score) and three lowerorder factors: physical, psychological, andsocial concerns (Zinbarg, Barlow, & Brown,1997). In the present investigation, we used thetotal ASI score because it represents the global

AS factor and, therefore, reflects the differenttypes of lower order fears.Distress Tolerance Scale (DTS; Simons &Gaher, 2005). The DTS is a self-report measure

VOL 39, NO 3, 2010 Mindfulness and emotional dysregulation 205

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on which respondents indicate, using a 5-pointLikert-style scale (1 strongly agree, 5 strongly disagree), their perceived ability totolerate emotional distress. The DTS has fourfirst-order (tolerance, appraisal, absorption,

and regulation) and one higher-order (generaldistress tolerance) factors and good psycho-metric properties (Simons & Gaher, 2005).In the present study, we administered a 14-itemversion of the DTS (a .81).Kentucky Inventory of Mindfulness Skills(KIMS). The KIMS is a 39-item question-naire on which respondents indicate, using a5-point Likert-type scale (1 never or veryrarely true, 5 almost always or always true),the general tendency to be mindful in daily life

(Baer et al., 2004). Factor analysis of themeasure indicates that it has four factors:Observing (e.g. I pay attention to how myemotions affect my thoughts and behavior),Describing (e.g. Im good at finding thewords to describe my feelings), Acting withAwareness (e.g. When Im doing something,Im only focused on what Im doing andnothing else), and Accepting without Judg-ment (e.g. I criticize myself for havingirrational or inappropriate emotions [reversescored]). The KIMS appears to have goodinternal consistency, with alpha coefficientscalculated from an undergraduate sample forObserving, Describing, Acting with Aware-ness, and Accepting without Judgment of.91, .84, .83, and .87, respectively (Baer et al.,2004).Difficulties in Emotion Regulation Scale(DERS; Gratz & Roemer, 2004). The DERSis a 36-item self-report measure on whichrespondents indicate, using a 5-point Likert-style scale (1 almost never, 5 almost

always), how often each item applies tothem. The DERS is multidimensional inthat it is composed of six subscales inaddition to a total score: (1) Nonacceptanceof Emotional Responses, (2) DifficultiesEngaging in Goal-Directed Behavior, (3)Impulse Control Difficulties, (4) Lack ofEmotional Awareness, (5) Limited Access toEmotion Regulation Strategies, and (6)Lack of Emotional Clarity. The DERS hashigh levels of internal inc onsistency

(a .93, Gratz & Roemer, 2004) andadequate test retest reliability over a 4- to8-week period (r .88, Gratz & Roemer,2004).

ProcedureParticipants responding to community-basedadvertisements for the study were scheduledfor an individual appointment by a trainedresearch assistant. At this appointment, upon

receiving a description of the study, partici-pants provided verbal and written consent andthen we re assessed for c urrent Axis Ipsychopathology using the SCID-NP. Ineligi-ble participants were discontinued. All eligibleparticipants completed a self-report battery ofmeasures related to emotional vulnerability.Upon completion of the study, participantswere debriefed regarding the aims of the studyand monetarily compensated for their efforts.

Results

See Table 1 for a summary of all zero-ordercorrelations. Criterion variables included eachof the six DERS subscales. The main effects ofnegative affectivity (PANAS-NA), anxietysensitivity (ASI total score), and distresstolerance (DTS total sore) were enteredsimultaneously at Step 1 of the model. Themain effects for the four factors of the KIMSwere entered simultaneously at Step 2. SeeTable 2 for a summary of the hierarchicalregression analyses. Alpha correction was notused for these analyses in order to minimizethe risk of Type II error (Keppel & Wickens,2004). According to Keppel and Wickens,alpha correction is more appropriate whenexamining post hoc differences betweengroups; in the case of a priori, theoreticallyspecified, planned comparisons, the risk ofType I error (p , .05) is consideredacceptable.

In terms of the DERS Lack of EmotionalClarity scale, Step 1 of the model accountedfor 26% of the variance, and both negativeaffectivity (b .24, p , .05) and anxietysensitivity (b .24, p , .05) were significantunivariate predictors. The second step of themodel accounted for an additional andsignificant 20% of unique variance inpredicting lack of emotional clarity aboveand beyond the variance accounted for bythe main effects at Step 1. The Describing

(b 2 .30, p , .01) and Accepting withoutJudgment (b 2 .25, p , .01) subscalesof the KIMS were unique predictors (seeTable 2).


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Table1.D

escriptivedataandzero-orderrelationsamongtheoreticallyrelevantvariables

Variable

1

2

3

4

5

6

7

8

9

10

11

12

13

M(SD)

1.

NA

2.4

0**

.67**

.15

2.1

8*

2.2

8**

2.4

4**

.45**

2.0

2

.53**

.53**

.49**

.71**

19.8

0(7.7

9)

2.

ASI-T

2.4

1**

.12

2.1

4

2.3

4**

2.4

3**

.44**

2.0

1

.46**

.47**

.44**

.61**

20.4

9(13.4

5)

3.

DTS-T

2.0

1

.18*

.15

.41**

2.3

3**

2.1

6*

2.3

6**

2.3

6**

2.3

6**

2.5

0**

3.6

1(0.8

3)

4.

KIMS

-O

.38**

.08

2.1

7*

2.1

2

2.3

8**

.02

.04

.10

.04

36.6

4(9.0

7)

5.

KIMS

-D

.32**

.32**

2.5

1**

2.4

8**

2.2

3**

2.3

2**

2.1

5

2.2

9**

27.2

1(6.7

0)

6.

KIMS

-Aw

.34**

2.3

3**

2.2

0**

2.2

8**

2.3

1**

2.3

7**

2.3

2**

29.0

2(5.7

8)

7.

KIMS

-Ac

2.5

0**

2.1

8*

2.4

3**

2.6

2**

2.2

1**

2.5

1**

33.2

0(8.0

6)

8.

DERS

-C

.47**

.51**

.59**

.30**

.56**

10.8

0(3.6

5)

9.

DERS

-EA

.20**

.31**

2.0

8

.14

15.7

9(5.2

5)

10.

DERS

-NA

.44**

.32**

.60**

11.5

4(5.5

7)

11.

DERS

-I

.43**

.66**

10.9

7(4.1

0)

12.

DERS

-G

.57**

14.2

2(4.8

3)

13.

DERS

-S

15.7

8(6.6

4)

Note.N

A,NegativeAffectivitysubscaleofthePositiveAffectNegativeAffect

Scale;ASI-T,AnxietySensitivityI

ndextotalscore;DTS-T,DistressToleranceScale

totalscore;KIMS,KentuckyInventoryof

MindfulnessSkills;O,Observingsubscale;D,Describingsubscale;Aw,ActingwithAwarenesssubscale;Ac,Accepting

withoutJudgmentsubscale;DERS,DifficultiesinEmotionRegulationScale;C,LackofEmotionalClaritysubscale;EA,LackofEmotionalAwarenes

ssubscale;NA,

NonacceptanceofEmotionalResponsessubscale;I,ImpulseControlDifficultiessubscale;G,DifficultiesEngaginginGoal-DirectedBehaviorsubsc

ale;S,Limited

AccesstoEmotionRegulationStrategiessubscale.*p,

.05.**p,

.01.


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Table 2. Mindfulness predicts emotion dysregulation

Criterion variable DR 2 ta b sr2 p

DERSLack of Emotional Clarity

Step 1 .26 , .01NA 2.54 .24 .05 , .05ASI-T 2.51 .24 .04 , .05DTS-T 21.86 2 .15 .02 ns

Step 2 .20 , .01KIMS-O 21.31 2 .10 .01 nsKIMS-D 23.88 2 .30 .10 , .01KIMS-Aw 20.59 2 .04 .00 nsKIMS-Ac 23.06 2 .25 .07 , .01

DERSLack of Emotional Awareness

Step 1 .04 nsNA 20.83 2 .09 .01 nsASI-T 20.14 2 .01 .00 nsDTS-T 22.43 2 .23 .04 , .05

Step 2 .27 , .01KIMS-O 22.72 2 .22 .05 , .01KIMS-D 23.68 2 .32 .09 , .01KIMS-Aw 20.46 2 .04 .00 nsKIMS-Ac 22.39 2 .22 .04 , .05

DERS Nonacceptance of Emotional Responses

Step 1 .35 , .01NA 4.29 .38 .12 , .01ASI-T 1.99 .18 .03 , .05

DTS-T 22.00 2 .16 .03 , .05Step 2 .21 , .01

KIMS-O 20.43 2 .03 .00 nsKIMS-D 21.43 2 .10 .02 nsKIMS-Aw 0.14 .01 .00 nsKIMS-Ac 26.66 2 .49 .25 , .01

DERS Impulse Control Difficulties

Step 1 .36 , .01NA 4.07 .36 .11 , .01ASI-T 2.43 .22 .04 , .05DTS-T 21.85 2 .14 .02 ns

Step 2 .04 nsKIM-O 20.72 2 .06 .00 nsKIMS-D 0.34 .03 .00 nsKIMS-Aw 20.96 2 .07 .01 nsKIMS-Ac 22.37 2 .20 .04 , .05

DERS Difficulties Engaging in Goal-Directed Behavior

Step 1 .29 , .01NA 3.35 .31 .08 , .01ASI-T 1.77 .16 .02 nsDTS-T 22.22 2 .18 .03 , .05

Step 2 .07 , .01KIMS-O 1.12 .09 .01 ns

KIMS-D 20.38 2 .03 .00 nsKIMS-Aw 23.31 2 .26 .08 , .01KIMS-Ac 22.42 2 .21 .04 , .05


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For the DERS Lack of Emotional Aware-ness scale, Step 1 of the model accounted for4% of the variance, with distress tolerance(b 2 .23, p , .05) as the only significantpredictor. The second step of the modelaccounted for an additional and significant27% of unique variance in predicting lack of

emotional awareness above and beyond thevariance accounted for by the main effects atStep 1. The Observing (b 2 .22, p , .01),Describing (b 2 .32, p , .01), and Accept-ing without Judgment (b 2 .22, p , .05)subscales of the KIMS each were uniquepredictors (see Table 2).

In regard to the DERS Nonacceptance ofEmotional Responses scale, Step 1 of themodel accounted for 35% of the variance,with negative affectivity (b .38, p , .01),

anxiety sensitivity (b .18, p , .05), anddistress tolerance (b 2 .16, p , .05) assignificant predictors. The second step of themodel accounted for an additional andsignificant 21% of unique variance in predict-ing nonacceptance of emotional responsesabove and beyond the variance accounted forby the main effects at Step 1. Again, only theAccepting without Judgment (b 2 .49,

p , .01) subscale of the KIMS was a uniquepredictor (see Table 2).

In terms of DERS Impulse Control Diffi-culties scale, Step 1 of the model accounted for36% of the variance, and both negativeaffectivity (b .36, p , .01) and anxiety

sensitivity (b .22, p , .05) were significantpredictors. The second step of the modelaccounted for an additional 4% of uniquevariance in predicting impulse control diffi-culties above and beyond the varianceaccounted for by the main effects at Step 1.Only the Accepting without Judgment

(b 2 .20, p , .05) subscale of the KIMSwas a unique predictor (see Table 2).

For the DERS Difficulties Engaging inGoal-Directed Behavior scale, Step 1 of themodel accounted for 29% of the variance, andboth negative affectivity (b .31, p , .01)and distress tolerance (b 2 .18, p , .05)were significant predictors. The second step ofthe model accounted for an additional andsignificant 7% of unique variance in predictingdifficulties engaging in goal-directed behavior

above and beyond the variance accounted forby the main effects at Step 1. The Acting withAwareness (b 2 .26, p , .01) and Accept-ing without Judgment (b 2 .21, p , .05)subscales of the KIMS were unique predictors(see Table 2).

Finally, in terms of DERS Limited Accessto Emotion Regulation Strategies scale, Step 1of the model accounted for 61% of thevariance, with negative affectivity (b .49,

p , .01), anxiety sensitivity (b .23, p , .01),

and distress tolerance (b 2 .23, p , .01) assignificant predictors. The second step of themodel accounted for an additional andsignificant 3% of unique variance in predicting

Table 2. Continued

Criterion variable DR 2 ta b sr2 p

DERSLimited Access to Emotion Regulation Strategies

Step 1 .61 , .01NA 7.07 .49 .27 , .01ASI-T 3.35 .23 .08 , .01DTS-T 23.76 2 .23 .10 , .05

Step 2 .03 , .05KIMS-O 20.45 2 .03 .00 nsKIMS-D 20.60 2 .04 .00 nsKIMS-Aw 21.22 2 .07 .01 nsKIMS-Ac 22.45 2 .16 .04 , .05

Note. b standardized beta weight; sr2 squared semipartial correlation; NA, Negative Affectivity subscale

of the Positive Affect Negative Affect Scale; ASI-T, Anxiety Sensitivity Index total score; DTS-T, DistressTolerance Scale total score; KIMS, Kentucky Inventory of Mindfulness Skills; O, Observing subscale; D,

Describing subscale; Aw, Acting with Awareness subscale; Ac, Accepting without Judgment subscale; DERS,Difficulties in Emotion Regulation Scale.a Each predictor.


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limited access to emotion regulation strategiesabove and beyond the variance accounted forby the main effects at Step 1. As before, onlythe Accepting without Judgment (b 2 .16,

p , .05) subscale of the KIMS was a unique

predictor (see Table 2).

Discussion

Three core findings emerged from the investi-gation. First, accepting without judgment wasthe most robust and consistent mindfulnessskill with regard to demonstrating incrementalassociations with (lower levels of) multipleemotional regulation difficulties. Indeed, find-ings indicated that higher levels of accepting

without judgment were a significant incremen-tal predictor of lower levels of all DERScriterion variables after controlling for nega-tive affectivity, anxiety sensitivity, and distresstolerance. The size of the observed incrementaleffects (at Step 2 of the respective models)ranged from 3% to 27% of the variance. Theseresults, which are generally in accord withacceptance-oriented perspectives on psycho-pathology (Eifert & Forsyth, 2005; S. C. Hayeset al., 1999; Linehan, 1993a; Wupperman et al.,2008), provide novel, descriptive evidence ofthe concurrent association between higherlevels of acceptance and lower facets ofemotional dysregulation. The most robustincremental effect (b 2 .49) was apparentfor the KIMS Accepting without Judgmentand the DERS Nonacceptance of EmotionResponses subscales. Although acceptance isincluded in the operationalization of both, theytheoretically measure different constructs. Forexample, while the KIMS Accepting withoutJudgment subscale measures accepting,

allowing, or being nonjudgmental or none-valuative about present-moment experience(Baer e t al., 2004, p. 194), the DERSNonacceptance of Emotional Responsesassesses a tendency to have negative second-ary emotional responses to ones negativeemotions, or nonaccepting reactions to onesdistress (Gratz & Roemer, 2004, p. 47).Also, at the zero-order-level, the two scaleswere only moderately correlated (r 2 .43),suggesting they are related, but not fully

overlapping, factors. Overall, these findingssuggest that higher levels of mindfulness-basedacceptance are concurrently associated with adecreased propensity toward emotional dysre-

gulation. Such results are consistent with thepossibility that mindfulness skills may serve aprotective role with regard to psychologicalfunctioning.

A second observation was that higher levels

of KIMS Acting with Awareness skills weresignificant incremental predictors of only theDERS Difficulties Engaging in Goal-DirectedBehavior subscale; inconsistent with predic-tion, this KIMS subscale was not associatedwith the DERS Lack of Emotional Clarity,Lack of Emotional Awareness, Nonaccep-tance of Emotional Responses, Impulse Con-trol Difficulties, or Limited Access to EmotionRegulation Strategies scales. The specific(negative) incremental association of the

KIMS Acting with Awareness, or engagingfully in ones current activity with undividedattention (Baer et al., 2004, p. 193), and theDERS Difficulties Engaging in Goal-DirectedBehavior might be related to the emphasis ofthis DERS subscale on difficulties concen-trating and accomplishing tasks when experi-encing negative emotions (Gratz & Roemer,2004, p. 47). This association may berepresentative of construct overlap. However,these variables were only moderately corre-lated (r 2 .37) at the zero-order level, andtheir incremental association was only mod-erately strong (b 2 .26). This significantassociation between Acting with Awarenessand Difficulties Engaging in Goal-DirectedBehavior may be the result of constructoverlap, shared method variance, or both;and this Acting with Awareness skill offersonly limited unique explanatory value in termsof affect regulation, once the varianceaccounted for by negative affectivity, anxietysensitivity, and distress tolerance is con-

sidered. Acting with Awareness skills wereconsiderably less potent in terms of theirincremental associations with emotional dys-regulation. This finding may indicate thatbeing able to limit ones attention to thepresent moment (acting with awareness) maynot be strongly associated with emotionregulatory difficulties, while the ability toaccept ones experiences in the presentmoment may be of more clinically significantemotion regulatory utility (S. C. Hayes et al.,

1999; Linehan, 1993a, 1993b). Alternatively, ifawareness is arguably a process necessaryfor the manifestation of more sophisticatedmindfulness skills, such as mindful-based


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acceptance, then when awareness and accep-tance are entered into a regression modeltogether, awareness may not demonstrate anyunique, incremental effect beyond acceptance.The lack of an incremental effect for aware-

ness may not necessarily indicate its lack ofimportance in mindfulness-related protectiveprocesses, but rather highlight its protectiveeffects via its foundational relations withtheoretically more sophisticated mindfulnessskills such as mindful acceptance. Together,acute awareness of internal and external cuesmay not necessarily yield lower levels ofemotional dysregulation in and of itself.

A third observation was that Observingskills were incrementally related to lower levels

of Lack of Emotional Awareness, andDescribing skills were incrementally relatedto lower levels of Lack of Emotional Clarityand Lack of Emotional Awareness. Althoughthese findings were not expected on an a prioribasis, because of the conceptualization ofthese skills as only facets of more sophisticatedmindfulness-based processesnamely Actingwith Awareness and Accepting without Judg-mentthese findings are perhaps consistentwith skills-based mindfulness treatments (e.g.Linehan, 1993a). It could be expected thatgreater levels of Observing skills would berelated to greater levels of emotion-relevantawareness and, by extension, that Describingskills would be related to greater emotionalclarity and emotional awareness. For instance,if an individual is able to observe her internalcues in the present moment (e.g. noticinglocation, intensity, or duration of sensations),then she is likely to be more attentive to, andacknowledging of, her affective experience(emotional awareness). If this same individual

is able to describe her present experience bylabeling or noting observed phenomena (e.g.Here is sadness), then not only might she bemore aware of the present moment, but heremotional experience also may be more clear(emotional clarity) given her ability toverbalize her internal experience (e.g. Linehan,1993a, 1993b). In contrast to these relations,because of the somewhat basic nature of theObserving and Describing skills, it is consist-ent with theory (Linehan, 1993a, 1993b) that

such skills would not be associated withhigher-order affect regulatory phenomena(i.e. acceptance, impulse control, goal-directedbehavior, emotion regulatory strategies).

There are a number of interpretive caveatsof the present study. First, the current findingswere based on a community sample ofrelatively homogeneous young adults. It maybe important for future work to examine the

associations of mindfulness and emotionalregulation among clinical participants as wellas among ethnically and more developmen-tally diverse individuals. Second, because ofthe cross-sectional and correlational nature ofthe present research design, it is not possible tomake definitive, causal statements concerningthe relations between the studied variables.For example, although we oriented the studyon mindfulness processes impacting emotionaldysregulation, the opposite relation is possible

(e.g. emotional dysregulation impacting mind-fulness proceses; Wupperman et al., 2008).One important next step in this line of inquirywould be to use prospective research method-ologies and evaluate the consistency of thepresent findings over time. Another approachwould be to experimentally manipulateemotion dysregulation in the laboratory andthen test the effects of specific mindfulness-based processes on physiological and emotion-al down-regulation (e.g. Arch & Craske,2006). Third, the emotional dysregulationsubscales are interrelated with one another(see Table 1). Future research could perhapsbenefit by controlling for all other aspects ofemotional dysregulation in efforts to parcelout shared variance with particular emotionaldysregulation processes. Finally, the KIMSand DERS were utilized in the presentinvestigation because they represent two ofthe most theoretically promising self-reportmeasures of mindfulness skills and emotionaldysregulation. Yet these tools naturally

represent only one set of measurement devices.Future work could, therefore, benefit byreplicating and extending this research usingalternative measurement indices developedfrom distinct conceptual bases.

Acknowledgements

This research was supported, in part, byNational Institute of Health Grant 1 R01MH076629-01 to Michael J. Zvolensky.

Marcel O. Bonn-Miller acknowledges theDepartment of Veterans Affairs HealthServices Research and Development Servicefunds.


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This work was conducted in the Anxietyand Health Research Laboratory at theUniversity of Vermont and approved by theuniversitys Institutional Review Board. Theviews expressed here are those of the authors

and do not necessarily represent those of theDepartment of Veterans Affairs.

Note1. Baer, Smith, Hopkins, Krietemeyer, and Toney

(2006) recently developed another self-reportmeasure of mindfulness skills, the Five FactorMindfulness Questionnaire (FFMQ), whichconsists of the four mindfulness factors indexedby the KIMS in addition to a fifth factor:nonreactivity to inner experience. Yet Baer et al.

(2006) caution that the FFMQ requiresextensive additional validation in a range ofsamples (p. 43), and they continue to promotethe utility of the KIMS in measuring four of thefive identified mindfulness facets at the presentstage of research. At the time of the conduct ofthe present study, only the original four-factorKIMS measure was available.

ReferencesArch, J. J., & Craske, M. G. (2006). Mechanisms of

mindfulness: Emotion regulation following afocused breathing induction. BehaviourResearch and Therapy, 44, 18491858.

Baer, R. A., Smith, G. T., & Allen, K. B. (2004).Assessment of mindfulness by self-report: TheKentucky Inventory of Mindfulness Skills.Assessment, 11, 191203.

Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer,J., & Toney, L. (2006). Using self-reportassessment methods to explore facets of mind-fulness. Assessment, 13, 27 45.

Bishop, S. R., Lau, M., Shapiro, S., Carlson, L.,Anderson, N. D., Carmody, J., et al., (2004).Mindfulness: A proposed operational defi-nition. Clinical Psychology: Science and Prac-tice, 11, 230 241.

Brown, K. W., & Ryan, R. M. (2003). The benefitsof being present: Mindfulness and its role inpsychological well-being. Journal of Personalityand Social Psychology, 84, 822848.

Brown, R. A., Lejuez, C. W., Kahler, C. W.,Strong, D. R., & Zvolensky, M. J. (2005).Distress tolerance and early smoking lapse.Clinical Psychology Review, 25, 713733.

Conte, H. R., Ratto, R., & Karasu, T. B. (1996).The Psychological Mindedness Scale. Journal ofPsychotherapy Practice and Research, 5,

250259.Dekeyser, M., Raes, F., Leijssen, M., Leysen, S., &Dewulf, D. (2008). Mindfulness skills andinterpersonal behavior. Personality and Individ-ual Differences, 44, 12351245.

Eifert, G. H., & Forsyth, J. P. (2005). Acceptance andcommitment therapy for anxiety disorders:A practitioners treatment guide to using mindfulness, acceptance, and values-based behaviorchange strategies. Oakland, CA: New Harbinger.

First, M., Spitzer, R., Gibbon, M., & Williams, J.

(1995). Structured Clinical Interview for DSM-IV (nonpatient edition). New York: BiometricsResearch Department, New York StatePsychiatric Institute.

Forsyth, J. P., & Zvolensky, M. J. (2002).Experimental psychopathology, clinical science,and practice: An irrelevant and indispensablealliance? Applied and Preventive Psychology:Current Scientific Perspectives, 10, 243 264.

Gratz, K. L., & Roemer, L. (2004). Multidimen-sional assessment of emotion regulation anddysregulation: Development, factor structure,and initial validation of the Difficulties inEmotion Regulation Scale. Journal of Psycho-pathology and Behavioral Assessment, 26, 4154.

Gratz, K. L., Rosenthal, M. Z., Tull, M. T., Lejuez,C. W., & Gunderson, J. G. (2006). Anexperimental investigation of emotion dysregu-lation in borderline personality disorder. Journalof Abnormal Psychology, 115, 850855.

Greenberg, L. S., & Safran, J. D. (1987). Emotion inpsychotherapy: Affect, cognition, and the processof change. New York: Guilford Press.

Gross, J. J., & Mun oz, R. F. (1995). Emotion regula-tion and mental health. Clinical Psychology:Science & Practice, 2, 151164.

Hayes, A. M., & Feldman, G. (2004). Clarifying the

construct of mindfulness in the context ofemotion regulation and the process of change intherapy. Clinical Psychology: Science andPractice, 11, 255262.

Hayes, S. C., Strosahl, K. D., & Wilson, K. G.(1999). Acceptance and commitment therapy.New York: Guilford Press.

Keppel, G., & Wickens, T. D. (2004). Design andanalysis: A researchers handbook (4th ed.).Upper Saddle River, NJ: Pearson.

Linehan, M. M. (1993a). Cognitive-behavioraltreatment of borderline personality disorder.New York: Guilford Press.

Linehan, M. M. (1993b). Skills training manual

for treating borderline personality disorder.New York: Guildford Press.

McKee, L., Zvolensky, M. J., Solomon, S. E.,Bernstein, A., & Leen-Feldner, E. W. (2007).Emotional vulnerability and mindfulness:Associations between negative affectivity,anxiety sensitivity, and mindfulness skills.Cognitive Behaviour Therapy, 36, 91 101.

Mennin, D. S., Heimberg, R. G., Turk, C. L., &Fresco, D. M. (2002). Applying an emotionregulation framework to integrative approachesto generalized anxiety disorder. ClinicalPsychology: Science and Practice, 9, 8590.

Orsillo, S. M., & Roemer, L. (Eds.). (2005).Acceptance and mindfulness-based approachesto anxiety: New directions in conceptualizationand treatment. New York: Kluwer Academic/-Plenum.


y


13/13

Reiss, S., Peterson, R. A., Gursky, M., &McNally, R. J. (1986). Anxiety, sensitivity,anxiety frequency, and the prediction offearfulness. Behaviour Research and Therapy,24, 18.

Roemer, L., Lee, J. K., Salters-Pedneault, K.,

Erisman, S. M., Orsillo, S. M., & Mennin, D. S.(2009). Mindfulness and emotion regulationdifficulties in generalized anxiety disorder:Preliminary evidence for independent andoverlapping contributions. Behavior Therapy,40, 142154.

Simons, J. S., & Gaher, R. M. (2005). The DistressTolerance Scale: Development and validation ofa self-report measure. Motivation and Emotion,29, 83 102.

State of Vermont Department of Health (2007).Vermont population estimates. RetrievedDecember 28, 2009, from http://healthvermont.gov/research

Tull, M. T. (2006). Expanding the anxietysensitivity model of uncued panic attackfrequency and symptom severity: The role ofemotion dysregulation. Cognitive Therapy andResearch, 30, 177184.

Vujanovic, A. A., Zvolensky, M. J., & Bernstein, A.(2008). The interactive effects of anxietysensitivity and emotion dysregulation in pre-dicting anxiety-related cognitive and affectivesymptoms. Cognitive Therapy and Research, 32,803817.

Vujanovic, A. A., Zvolensky, M. J., Bernstein, A.,Feldner, M. T., & McLeish, A. C. (2007). A test

of the interactive effects of anxiety sensitivityand mindfulness in the prediction of anxiousarousal, agoraphobic cognitions, and bodyvigilance. Behaviour Research and Therapy, 45,13931400.

Watson, D. (2000). Mood and temperament.

New York: Guilford Press.Watson, D., Clark, L. A., & Tellegen, A. (1988).

Development and validation of brief measuresof positive and negative affect: The PANASscales. Journal of Personality and SocialPsychology, 54, 10631070.

Wupperman, P., Neumann, C. S., & Axelrod, S. R.(2008). Do deficits in mindfulness underlieborderline personality features and core diffi-culties? Journal of Personality Disorders, 22,466482.

Zinbarg, R., Barlow, D. H., & Brown, T. (1997).The hierarchical structure and general factorsaturation of the Anxiety Sensitivity Index:

Evidence and implications. PsychologicalAssessment, 9, 277 284.

Zvolensky, M. J., Feldner, M. T., Leen-Feldner, E.,& Yartz, A. R. (2005). Exploring basicprocesses underlying acceptance and mind-fulness. In S. Orsillo & L. Roemer (Eds.),Acceptance and mindfulness-based approaches toanxiety: Conceptualization and treatment(pp. 325359). New York: Springer.

Zvolensky, M. J., & Otto, M. W. (2007). Affectiveintolerance, sensitivity, and processing:Advances in clinical science. Behavior Therapy,38, 228233.


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