Laura R. Silberstein PsyD, Dennis D. Tirch PhD & Robert L. Leahy PhD American Institute for Cognitive Therapy

1. Relationships Among Emotional-Schemas, Psychological Flexibility, Dispositional Mindfulness, & Emotion Regulation in Adult Cognitive-Behavioral Therapy Outpatients Laura R. Silberstein PsyD, Dennis D. Tirch PhD & Robert L. Leahy PhD American Institute for Cognitive Therapy

2. Introduction • Mindfulness, psychological flexibility, and emotional schemas have each been related to emotional experiencing and responding, as well as to the alleviation of human suffering (Corrigan, 2004; Hayes, Wilson, Gifford, Follette, and Strosahl, 1996; Martin, 1997; Fulton and Seigel, 2005). • Mindfulness, acceptance and emotional schemas have each been associated with challenging experiential avoidance and contributing to emotion regulation. • This study focuses on the relationships between emotional schemas, psychological flexibility and dispositional mindfulness.

3. Mindfulness • The meta-experiential concept of mindfulness refers to a mode of perception or awareness of the present moment in a nonjudgmental and accepting manner (Kabat-Zinn, 1990). • Dispositional mindfulness is an innate characteristic reflecting an individuals’ natural occurring ability to inhabit this intentional stance of awareness (Brown and Ryan, 2003). • Mindfulness offers a perceptual, rather than cognitive or affective presentation of the current moment as it is. • Dispositional mindfulness has been associated with an increased capacity to let go of negative thoughts and is viewed as a core process in psychological flexibility (Frewen, Evans, Maraj, Dozois, and Partridge, 2008; Hayes, Strosahl and Wilson, 1999).

4. Psychological Flexibility • Psychological flexibilityhas been defined as the ability to fully encounter an experience without gratuitous defense and, depending upon the context, continuing or changing behavior in the pursuit of goals and values (Hayes et al., 2006). • The term psychological flexibility has been used as a general factor to provide a more specific description of the core processes involved in experiential avoidance and experiential acceptance (Hayes et al., 2006). • Experiential avoidance and acceptance are subsumed by psychological flexibility, although they are still useful ways to describe aspects of this construct (Bond, et al., In press).

5. Psychological Flexibility • Experiential acceptance is the practice of just letting things be and experiencing them as they are. It involves being open to an experience and willing to remain in contact with it, even if the experience is unpleasant (Campbell-Sills, Barlow, Brown, and Hofman, 2006). • Acceptance can be described as second-order change or meta-change and is often viewed as preceding behavior or thought changes (Germer, 2005; Hayes, 2001). • The focus is on changing the influence of the thoughts and emotions by shifting one’s response to them and not trying to change or struggle with the thoughts or feelings themselves (Bishop et al., 2004).

6. Psychological Flexibility • Experiential avoidanceresults when an individual is unwilling to remain in contact with a particular experience and attempts to alter the form or frequency of these experiences (Hayes, Wilson, Gifford, Follette, and Strosahl, 1996). • Avoidance can be considered a broad category or class of behaviors that attempt to escape, avoid or modify a particular internal or external stimulus (Chapman, Gratz, and Brown, 2006). • Individuals who engage in experiential avoidance often engage in more control tactics and verbal strategies to regulate their emotions (Campbell-Sills, Barlow, Brown, and Hofman, 2006; Cochrane, Barnes-Holmes, Stewart, and Luciano, 2007). • The negative effects of experiential avoidance result from the ineffective and often paradoxical process of attempts to avoid or alter private events (Wenzlaff and Wegner, 2000).

7. Emotional Schemas • Emotional schemas are defined as plans, concepts, and strategies that an individual utilizes in the event of a certain emotion (Leahy 2002). • Similarly, emotion schemas have also been described as causal or mediating processes that involve the continual dynamic interaction of emotion, cognition and behavior (Izard, 2009). • Emotional schemas can be considered complex emotion-cognition-action systems that, after a period of social and emotional development, inform emotional processing and emotion regulation strategies (Izard, 2009; Leahy, 2002).

8. Emotional Schemas • Individuals vary in their perception of emotions as temporary, universal, comprehensible, complex experiences that can be subject to acceptance, validation, and expression (Leahy 2007). • Emotional schema dimensions range from flexible and adaptive to more rigid and maladaptive. • This model of emotional schemas contends that those who endorse maladaptive emotional schemas are more likely to resist certain emotions and engage in avoidant strategies (Leahy 2002). • Also emphasizes the positive implications in overcoming avoidance, increasing emotional processing, and the role of cognition in emotional experiencing (Leahy 2007).

9. Present Study Rationale • The current study aims to explore the relationships between emotional schemas, psychological flexibility and dispositional mindfulness. • This research also examines the relative contribution of mindful awareness and emotional schemas to psychological flexibility. • The roles of dispositional mindfulness and those emotional schemas which represent emotion regulation strategies will be explored in terms of their relationship with psychological flexibility.

10. Current Study • The current research is a cross sectional, observational study of current patients at the American Institute for Cognitive Therapy. • 202 patients volunteered to complete three brief measures assessing dispositional mindfulness, psychological flexibility, and emotional schemas. The responses are largely from intake assessments, typically collected at the beginning of therapy. • The cognitive-behavioral therapy offered at this institute primarily was non-manualized and included elements of Beckian Cognitive Therapy and integrated with elements of ACT, DBT, and Buddhist Psychology.

11. Measures • Mindfulness Attention and Awareness Scale(MAAS; Brown & Ryan, 2003) • The MAAS is a 15-item self-report scale designed to assess a core characteristic of dispositional mindfulness, namely, the general tendency for open or receptive awareness and attention in the present moment experience of daily life. • This measure has demonstrated construct and criterion validity in clinical and non-clinical samples

12. Measures • Awareness and Attention Questionnaire II(AAQ-II; Bond et al., In Press) • The AAQ-II is 10-item self-report scale designed to assess psychological flexibility in large population based studies. • The AAQ-II was developed from the AAQ-I resulting in enhanced item selection and psychometric properties. • Further psychometric information can be found at http://www.contextualpsychology.org

13. Measures • The Leahy Emotional Schema Scale (LESS; Leahy, 2002) • The LESS is 50-item self-report measure that asks participants to report how they have dealt with emotional experiences in the last month. • The scale shows strong psychometric properties and has been validated with psychiatric outpatient samples (Leahy, 2002). • It was designed to assess individual’s conceptualization of their emotions and utilizes fourteen dimensions of a cognitive model of emotional processing.

14. Measures • Factors/Dimensions of the LESS • Validation: a belief that other people validate or are receptive to an individual’s emotions. • Comprehensibility: the perception that an individual’s emotions make sense. • Guilt: the belief that one’s emotions are shameful, wrong or embarrassing. • Simplistic view of emotions: versus complex views and reflects difficulty tolerating ambivalent feelings. • Relationship to higher values: the belief that an emotional experience can provide insight into values clarification. • Controllability: the degree to which an individual perceives he or she will be in control in the face of emotion.

15. Measures • Factors/Dimensions of the LESS • Numbness: a lack of strong emotions, emotional isolation, and emotional distancing. • Rationality: overreliance on logic or ‘anti-emotionality.’ • Duration: the prediction of the length of emotional experiences. • Consensus: the belief that others share the same feelings. • Acceptance: the degree to which an individual allows versus inhibits an emotion. • Rumination: the tendency to ask unanswerable questions and dwell on certain emotions. • Expression: willingness to experience and express emotions. • Blame: the tendency to externalize the source of the emotion.

16. Correlational Analyses: MASS & LESS Dimensions * p < .05, ** p < .01

17. Correlational Analyses: MASS & LESS Dimensions * p < .05, ** p < .01

18. MASS & LESS Correlations • MASS positive correlations: • Validation • Comprehension • Higher values • Control • Consensus • Expression • Acceptance • MASS negative correlations: • Guilt • Simplistic views of emotions • Numbness • Rationality • Duration • Rumination • Blame

19. Correlational Analyses: MASS & AAQ-II * p < .05, ** p < .01 • Dispositional mindfulness as measured by the MASS appears to be highly correlated to psychological flexibility as measured by the AAQ-II.

20. Correlational Analyses: AAQ-II & LESS Dimensions * p < .05, ** p < .01

21. Correlational Analyses: AAQ-II & LESS Dimensions * p < .05, ** p < .01

22. AAQ-II & LESS Dimensions • AAQ-II positive correlations: • Validation • Comprehension • Higher values • Control • Consensus • Expression • Acceptance • AAQ-II negative correlations: • Guilt • Simplistic views of emotions • Numbness • Rationality • Duration • Rumination • Blame

23. Results • Our findings suggests that individuals who endorsed a higher capacity for mindfulness and those who reported a higher degree of psychological flexibility reported: • Other people will validate or be receptive to their emotions • Their emotions make sense • Emotional experiences provide insight into their values • They can control over their emotions • Their emotions are normal or shared by others • Acceptance of their emotional experiences • Willingness to experience and express their emotions

24. Results • Our findings suggest that individuals who reported lower degrees of dispositional mindfulness and those endorsing lower degrees of psychological flexibility reported: • Guilt or shame in regards to their emotions • Difficulty tolerating ambivalent feelings • Lacking strong emotional experiences • Engaging in emotional distancing • Rationalization or dwelling on their emotions • Their emotions last for a long time • Externalizing the source of their emotional experiences

25. Results • The results of this study also revealed a positive correlation between psychological flexibility as measured by the AAQ-II and dispositional mindfulness as measured by the MASS. • This indicates that individuals who endorsed a high degree of dispositional mindfulness also reported: • More psychological flexibility • Less experiential avoidance • More acceptance of their experiences

26. Stepwise Multiple Regression • Factors of the LESS that represent emotion regulation strategies: Rational, Expression, Rumination, and Acceptance • Dependent Variable - Psychological Flexibility (AAQ- II) • Independent Variables - Dispositional Mindfulness (MAAS) and Emotional Schema (LESS) dimensions related directly to emotion regulation strategies (Rumination, Expression, Rational, Acceptance of Feelings)

27. Results: Stepwise Multiple Regression

28. Results: Stepwise Multiple Regression

29. Results: Stepwise Multiple Regression • The LESS factors Expression, and Rational were not significant predictors in this analysis and not included in the model. • A model including the LESS factors Rumination and Acceptance of Feelings, as well as dispositional mindfulness, as measured by the MAAS accounted for a significant proportion of the variance in psychological flexibility as compared to the other LESS factors hypothesized to be involved in emotion regulation strategies. • “Rumination” was included in the first step of this model, followed by “Acceptance of Feelings” and then by dispositional mindfulness. The addition of each variable resulted in statistically significant change.

30. Results: Stepwise Multiple Regression • These results suggest that emotion regulation strategies involving letting go of a ruminative thinking style, accepting and allowing emotions as they arrive, and an active attending to the present moment, interact significantly with psychological flexibility. • The degree to which a person is or is not overly-rational, or verbally expressive appears to be less important in regards to psychological flexibility.

31. Discussion • The correlational results of this study imply a strong relationship between dispositional mindfulness, psychological flexibility and emotional schemas in adults seeking outpatient therapy. • We also found some evidence for the relationships between mindfulness, emotional schema dimensions related to emotion regulation strategies and psychological flexibility. • Thus, it may be possible that dispositional mindfulness and certain emotional schemas are interacting processes involved in the establishment and maintenance of psychological flexibility and adaptive functioning.

32. Discussion • A possible function of more adaptive emotional schemas is a greater degree of psychological flexibility and a greater receptive attention to and awareness of present experiences. • However, as correlations do not establish causality or direction, it is also possible that, by providing an accepting and unbiased emotional experience, dispositional mindfulness and psychological flexibility allow individuals to perceive the uniqueness of a current emotion and respond in a flexible and adaptive manner

33. Discussion • One possible interpretation of the results of the stepwise multiple regression would suggest that the foundation of psychological flexibility is informed by emotion regulation strategies that involve: • Letting go of a ruminative thinking style • Acceptance and openness towards emotions • Active, non-evaluative attending to the present moment

34. Discussion This interpretation would support the hypothesis inherent in the ACT hexaflex model, that acceptance, defusion, and contact with the present moment are fundamental components of psychological flexibility.

35. Study Limitations • Small sample size and clinical population limits generalizablilty • Self-report assessment measures • No causality can be assumed • Additional variables maybe responsible for the relationships observed in this study • Therefore, there is a need for continued research

36. For copies of this presentation Please contact me at: l_silberstein@yahoo.com

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