The Questionnaire on Self-Transcendence (QUEST): A Measure of Trait Self-Transcendence Informed by Contextual Cognitive Behavioral Therapies.

Self-transcendence is thought to increase well-being and is implicitly promoted in contextual cognitive behavioral therapies (CCBTs). This study conceptualizes, develops, and validates the first comprehensive CCBT-informed self-transcendence questionnaire. Using a CCBT-informed theory, we propose four self-transcendence facets: distancing oneself from mental content, distinguishing an observer of mental experience that is separate from the content of experience, experiencing innate connectedness with other beings, and noticing the constantly changing nature of experience. We measured these facets with items from existing relevant questionnaires and novel, expert-informed items. Exploratory factor analyses and bifactor exploratory structural equation models supported the first three of these facets. Those factors evidenced convergent validity with decentering, defusion, experiential avoidance, and mindfulness, and criterion and incremental validity in predicting psychological well-being. Our findings support a CCBT-informed model of self-transcendence, introduce the first instrument to comprehensively measure the self-transcendence facets we identified, indicate links with well-being, and suggest future intervention targets.

Affective Neural Mechanisms of a Parenting-Focused Mindfulness Intervention.

OBJECTIVES: Behavioral evidence suggests that parenting-focused mindfulness interventions can improve parenting practices and enhance family wellbeing, potentially operating through altered emotional processing in parents. However, the mechanisms through which parent mindfulness interventions achieve their positive benefits have not yet been empirically tested, knowledge which is key to refine and maximize intervention effects. Thus, as part of a randomized controlled trial, the present study examined the affective mechanisms of an 8-week parenting-focused mindfulness intervention, the Parenting Mindfully (PM) intervention, versus a minimal-intervention parent education control. METHODS: Twenty highly stressed mothers of adolescents completed pre- and post-intervention behavioral and fMRI sessions, in which mothers completed a parent-adolescent conflict interaction, fMRI emotion task, and fMRI resting state scan. Mothers reported on their mindful parenting, and maternal emotional reactivity to the parent-adolescent conflict task was assessed via observed emotion expression, self-reported negative emotion, and salivary cortisol reactivity. RESULTS: Results indicated that the PM intervention increased brain responsivity in left posterior insula in response to negative affective stimuli, and altered resting state functional connectivity in regions involved in self-reference, behavioral regulation, and social-emotional processing. Changes in mothers' brain function and connectivity were associated with increased mindful parenting and decreased emotional reactivity to the parent-adolescent conflict task. CONCLUSIONS: Findings suggest that mindfulness-based changes in maternal emotional awareness at the neurobiological level are associated with decreased emotional reactivity in parenting interactions, illuminating potential neurobiological targets for future parent-focused intervention.

An experimental investigation of the effects of self-criticism and self-compassion on implicit associations with non-suicidal self-injury.

Non-suicidal self-injury (NSSI) is the intentional destruction of bodily tissue in the absence of suicidal motives. Individuals who self-injure often report doing so in order to punish the self or express self-hatred. Self-criticism, or thoughts marked by shame, self-consciousness, and inferiority, is associated with higher rates of NSSI while self-compassion, or the tendency to be sympathetic and caring with oneself, is negatively associated with NSSI. The aim of the present study was to determine whether experimentally-induced self-criticism would increase and self-compassion would decrease implicit identification with NSSI. Participants were randomly assigned to either a self-criticism induction, a self-compassion induction, or a neutral, control condition and completed a measure of strength of the automatic associations that a person holds between themselves and self-harming behaviors before and after the experimental induction. Study hypotheses were partially supported. Results showed that participants in the self-criticism induction experienced an increase in their implicit associations with NSSI while implicit associations in the self-compassion condition did not significantly change. These results highlight the importance of self-criticism in NSSI. Future research should examine increases in self-criticism as a potential precursor of NSSI in longitudinal samples.

The rewarding nature of provocation-focused rumination in women with borderline personality disorder: a preliminary fMRI investigation.

BACKGROUND: Understanding why individuals with borderline personality disorder (BPD) ruminate on prior provocations, despite its negative outcomes, is crucial to improving interventions. Provocation-focused rumination may be rewarding in the short term by amplifying anger and producing feelings of justification, validation, and increased energy, while reducing self-directed negative affect. If provocation-focused rumination is utilized regularly as a rewarding emotion regulation strategy, it could result in increased activation in reward-related neural regions. The present pilot study examined neural correlates of provocation-focused rumination, relative to other forms of thought, in BPD. METHOD: Functional magnetic resonance imaging (fMRI) was utilized to examine this theory in a pilot study of women diagnosed with BPD (n = 13) and healthy controls (n = 16). All participants received highly critical feedback on a previously written essay in the scanner, followed by prompts to engage in provocation-focused, self-focused, and neutral thought. RESULTS: Whole-brain analyses showed that in response to the provocation, participants with BPD (compared to controls) demonstrated increased activation in the ventrolateral prefrontal cortex (PFC). BPD participants also showed greater activation in the dorsomedial PFC during provocation-focused rumination (relative to neutral-focus). Subsequent ROI analyses revealed that provocation-focused rumination (compared to neutral-focus) increased activation in the nucleus accumbens for the BPD group only. CONCLUSIONS: These findings, while preliminary due to the small sample size and limitations of the protocol, provide initial data consistent with the proposed neurobiological mechanism promoting provocation-focused rumination in BPD. Directions for further research are discussed.

Characteristics of Repetitive Thought Associated with Borderline Personality Features: A Multimodal Investigation of Ruminative Content and Style.

Increased ruminative style of thought has been well documented in borderline personality disorder (BPD); however, less is known about how the content of rumination relates to domains of BPD features. Relationships between forms of rumination and BPD features were examined in an undergraduate sample with a wide range of BPD features. Participants completed self-report measures of rumination and a free-writing task about their repetitive thought. Rumination on specific themes, including anger rumination, depressive brooding, rumination on interpersonal situations, anxious rumination, and stress-reactive rumination were significantly associated with most BPD features after controlling for general rumination. Coded writing samples suggested that BPD features are associated with repetitive thought that is negative in valence, difficult to control, prolonged, unhelpful, and unresolved. Although rumination is often described as a form of self-focused attention, BPD relationship difficulties were correlated with greater other-focus in the writing samples, which may reflect more interpersonal themes. Across both self-reports and the writing task, the BPD feature of self-destructive behavior was associated specifically with anger and hostility, suggesting this content may play a particularly important role in fueling impulsive behavior. These findings suggest that both the style and the content of repetitive thought may play a role in BPD features.

Mindfulness-Based Interventions for Older Adults: A Review of the Effects on Physical and Emotional Well-being.

This comprehensive review examined the effects of mindfulness-based interventions on the physical and emotional wellbeing of older adults, a rapidly growing segment of the general population. Search procedures yielded 15 treatment outcome studies meeting inclusion criteria. Support was found for the feasibility and acceptability of mindfulness-based interventions with older adults. Physical and emotional wellbeing outcome variables offered mixed support for the use of mindfulness-based interventions with older adults. Potential explanations of mixed findings may include methodological flaws, study limitations, and inconsistent modifications of protocols. These are discussed in detail and future avenues of research are discussed, emphasizing the need to incorporate geriatric populations into future mindfulness-based empirical research.

Development and Validation of a Measure of Self-Critical Rumination.

Self-criticism is a form of negative self-evaluation that has strong associations with many forms of psychopathology. Rumination is a maladaptive form of repetitive thinking that is associated with many psychological disorders. Although measures of several different types of rumination (e.g., general rumination, depressive rumination, anger rumination) have been developed, none focuses specifically on self-critical rumination. An initial pool of items addressing self-critical rumination was developed by adapting items from existing rumination measures and through a writing task administered to both student and clinical samples. Following an evaluation of content validity, 24 items were administered to a large sample of undergraduates along with measures of related constructs. The final 10-item version of the Self-Critical Rumination Scale showed excellent internal consistency, a clear single-factor structure, convergent relationships with related constructs, and incremental validity over other measures of self-criticism and rumination in predicting both general distress and features of borderline personality disorder.

Anger Rumination as a Mediator of the Relationship Between Mindfulness and Aggression: The Utility of a Multidimensional Mindfulness Model.

OBJECTIVES: Mindfulness training reduces anger and aggression, but the mechanisms of these effects are unclear. Mindfulness may reduce anger expression and hostility via reductions in anger rumination, a process of thinking repetitively about angry episodes that increases anger. Previous research supports this theory but used measures of general rumination and assessed only the present-centered awareness component of mindfulness. The present study investigated associations between various aspects of mindfulness, anger rumination, and components of aggression. METHOD: The present study used self-report measures of these constructs in a cross-sectional sample of 823 students. RESULTS: Structural equation modeling revealed that anger rumination accounts for a significant component of the relationship between mindfulness and aggression, with the largest effect sizes demonstrated for the nonjudgment of inner experiences facet of mindfulness. CONCLUSION: Nonjudgment and present-centered awareness may influence aggression via reduced anger rumination. The importance of examining mindfulness as a multidimensional construct is discussed.

Dysfunctional responses to emotion mediate the cross-sectional relationship between rejection sensitivity and borderline personality features.

A growing body of evidence has tied borderline personality disorder (BPD) to heightened sensitivity to rejection; however, mechanisms through which rejection sensitivity contributes to BPD features have not been identified. Rejection may lead to the dysfunctional emotion regulation strategies common in BPD, such as impulsive responses to distress, anger rumination, difficulties engaging in goal-oriented behavior, nonacceptance of emotions, and low emotional clarity. The present study used self-report measures and bootstrapping procedures to investigate the role of difficulties in emotional regulation in the relationship between rejection sensitivity and borderline personality features in a cross-sectional sample of 410 undergraduates. Difficulties in emotion regulation accounted for significant variance in the relationships between rejection sensitivity and BPD features, with varying sets of deficits in emotion regulation skills accounting for associations with specific BPD features. Potential clinical implications and the need for replication in longitudinal studies are discussed.

Shame and borderline personality features: the potential mediating role of anger and anger rumination.

Two prominent emotions in borderline personality disorder (BPD) are shame and anger. Rumination has been demonstrated to occur in response to shame and to escalate anger, and rumination, particularly anger rumination, has been shown to predict BPD symptoms. The present study tested a structural equation model in which shame leads to the features of BPD via increased anger and anger rumination. A sample of 823 undergraduates completed self-report measures of shame, trait-level anger, anger rumination, and BPD features. The hypothesized model of shame to anger and anger rumination to BPD features was largely supported. Bootstrapping was used to establish significant indirect effects from both situational and global forms of shame via anger rumination to BPD features, and from global shame via anger to most BPD features. The alternative hypothesis that anger and anger rumination contribute to BPD features via increased shame was also examined, with no significant indirect effects found. Recognizing this function of anger and anger rumination may be important in understanding the relationship between shame-proneness and BPD features and may have implications for treatment. Further research into determining other ways individuals maladaptively respond to shame, and understanding the functions of anger and anger rumination, is recommended.

Self-Regulatory Deficits Associated with Unpracticed Mindfulness Strategies for Coping with Acute Pain.

Training in mindfulness is a well-supported therapeutic strategy for pain conditions, though short-term mindfulness training for acute pain is not always effective. To explore the possibility that initial attempts at mindfulness in people without previous training may drain self-regulatory resources, the current study used a student sample (N=63) to test the hypothesis that brief instruction in mindfulness would lead to reduced pain tolerance on a cold pressor task (CPT), compared to more familiar strategies for coping with acute pain. We also investigated whether high heart rate variability (HRV), a physiological indicator of self-regulatory capacity, would predict pain tolerance. Higher HRV predicted greater pain tolerance only in the control group, suggesting that applying unfamiliar mindfulness strategies while attempting to tolerate pain more rapidly sapped self-regulatory strength.

Relationships among maladaptive cognitive content, dysfunctional cognitive processes, and borderline personality features.

Previous research has demonstrated that maladaptive cognitive content, including dysfunctional attitudes and negative automatic thoughts, is associated with emotional distress. Similarly, dysfunctional cognitive processes, including thought suppression and rumination, have been shown to intensify psychological difficulties. Although maladaptive cognitive content and dysfunctional processes have been linked to borderline personality disorder (BPD), most research has been conducted with Axis I disorders. This study examined the incremental validity of dysfunctional cognitive content and processes in predicting BPD symptom severity, controlling for trait negative affect, in a sample of undergraduate students (N = 85), including many with high levels of BPD features. Although nearly all variables were significantly correlated with BPD features, final regression models suggest that rumination and thought suppression are stronger independent predictors of BPD features than automatic thoughts, dysfunctional attitudes, and trait negative affect. These results suggest the importance of targeting thought suppression and rumination in BPD.

The effect of anger rumination in the relationship between borderline personality disorder symptoms and precursors.

Previous research has identified an invalidating childhood environment and a biological predisposition for affective instability to be two precursors for the development of borderline personality disorder (BPD). In addition, rumination, particularly in response to anger, is significantly associated with symptom severity and dysregulated behavior in BPD. This study examined whether a significant relationship between childhood precursors and current BPD symptom severity could be accounted for by the tendency to engage in anger rumination in a sample of undergraduate students (N = 342), including many with high BPD features. Results showed a significant indirect effect of anger rumination in the relationship between self-reported childhood emotional vulnerability (but not invalidating childhood environment) and BPD symptom severity. This finding suggests that anger rumination could be a risk factor for BPD. These results suggest the importance of continued research on the role of anger rumination in the development and exacerbation of BPD symptoms.

Brief report: relationships between facets of impulsivity and borderline personality features.

Relationships between specific borderline personality disorder (BPD) features and facets of impulsivity (negative and positive urgency, premeditation, perseverance, and sensation seeking) were examined in a sample of 227 undergraduate students, oversampled to include many with elevations on a measure of borderline features. Most facets of impulsivity were positively correlated with borderline features, except for sensation seeking, which showed a mixed pattern of relationships with specific BPD features. In regression models, negative urgency was the strongest predictor of all BPD features scales, including affective instability, identity problems, negative relationships, and self-harm. Premeditation, positive urgency, and sensation seeking demonstrated incremental validity over negative urgency in predicting some BPD features; however, significant beta weights were negative for sensation seeking, suggesting that it may be protective or adaptive for BPD, unlike other forms of impulsivity. This study provides evidence for variation in how types of impulsivity contribute to different BPD features and demonstrates the importance of examining BPD features on the subscale level.

Weekly change in mindfulness and perceived stress in a mindfulness-based stress reduction program.

OBJECTIVE: The purpose of the study was to examine weekly change in self-reported mindfulness and perceived stress in participants who completed an 8-week course in mindfulness-based stress reduction (MBSR). METHOD: Participants were 87 adults with problematic levels of stress related to chronic illness, chronic pain, and other life circumstances (mean age = 49 years, 67% female) participating in MBSR in an academic medical center. They completed weekly self-report assessments of mindfulness skills and perceived stress. It was hypothesized that significant improvement in mindfulness skills would precede significant change in stress. RESULTS: Mindfulness skills and perceived stress both changed significantly from pretreatment to posttreatment. Significant increases in mindfulness occurred by the second week of the program, whereas significant improvements in perceived stress did not occur until week 4. Extent of change in mindfulness skills during the first three weeks predicted change in perceived stress over the course of the intervention. CONCLUSIONS: Evidence that changes in mindfulness precede changes in perceived stress in a standard MBSR course is consistent with previous studies suggesting that improvements in mindfulness skills may mediate the effects of mindfulness training on mental health outcomes.

The "what" and the "how" of dispositional mindfulness: using interactions among subscales of the five-facet mindfulness questionnaire to understand its relation to substance use.

Although self-report measures of dispositional mindfulness have good psychometric properties, a few studies have shown unexpected positive correlations between substance use and mindfulness scales measuring observation of present-moment experience. The current study tested the hypothesis that the relationship between present-moment observation and substance use is moderated by the tendency to be nonjudgmental and nonreactive toward the observed stimuli. Two hundred and ninety-six undergraduates completed the five-facet mindfulness questionnaire (FFMQ), a calendar measuring periods of substance use, and a measure of the five-factor model of personality. Controlling for FFMQ and personality subscales, significant interactions between the observing and nonreactivity subscales indicated that the observing subscale was negatively associated with substance use at higher levels of nonreactivity but positively associated with periods of substance use at lower levels of nonreactivity. Results support the use of statistical interactions among FFMQ subscales to test for the presence of interactive effects of different aspects of mindfulness.

Emotion-related cognitive processes in borderline personality disorder: a review of the empirical literature.

Maladaptive cognitive processes, including selective attention and memory, distorted beliefs and interpretations, and thinking processes such as rumination and thought suppression, are strongly associated with many emotional disorders. This paper reviews research that extends these findings to the emotional dysfunction characteristic of borderline personality disorder (BPD). Results suggest that people with BPD habitually attend to negative stimuli, have disproportionate access to negative memories, endorse a range of BPD-consistent negative beliefs about themselves, the world, and other people, and make negatively biased interpretations and evaluations of neutral or ambiguous stimuli. They also engage in thought suppression and rumination and these tendencies are significantly associated with the severity of their BPD symptoms. It remains unclear whether maladaptive cognitive processes play a causal role in the development and maintenance of BPD or are correlates or consequences of having the disorder. Continued study of emotion-related cognitive processing in BPD may improve understanding and treatment of this severe disorder.

Ruminative and mindful self-focused attention in borderline personality disorder.

The current study investigated the short-term effects of mindful and ruminative forms of self-focused attention on a behavioral measure of distress tolerance in individuals with borderline personality disorder (BPD) who had completed an angry mood induction. Participants included 40 individuals who met criteria for BPD and were currently involved in mental health treatment. Each completed an individual 1-hr session. Following an angry mood induction, each participant was randomly assigned to engage in ruminative or mindful self-focus for several minutes. All participants then completed the computerized Paced Auditory Serial Addition Test (PASAT-C), a behavioral measure of willingness to tolerate distress in the service of goal-directed behavior. The mindfulness group persisted significantly longer than the rumination group on the distress tolerance task and reported significantly lower levels of anger following the self-focus period. Results are consistent with previous studies in suggesting that distinct forms of self-focused attention have distinct outcomes and that, for people with BPD, mindful self-observation is an adaptive alternative to rumination when feeling angry.

Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: a revised measure of psychological inflexibility and experiential avoidance.

The present research describes the development and psychometric evaluation of a second version of the Acceptance and Action Questionnaire (AAQ-II), which assesses the construct referred to as, variously, acceptance, experiential avoidance, and psychological inflexibility. Results from 2,816 participants across six samples indicate the satisfactory structure, reliability, and validity of this measure. For example, the mean alpha coefficient is .84 (.78-.88), and the 3- and 12-month test-retest reliability is .81 and .79, respectively. Results indicate that AAQ-II scores concurrently, longitudinally, and incrementally predict a range of outcomes, from mental health to work absence rates, that are consistent with its underlying theory. The AAQ-II also demonstrates appropriate discriminant validity. The AAQ-II appears to measure the same concept as the AAQ-I (r=.97) but with better psychometric consistency.

Assessing mindfulness in children and adolescents: development and validation of the Child and Adolescent Mindfulness Measure (CAMM).

This article presents 4 studies (N = 1,413) describing the development and validation of the Child and Adolescent Mindfulness Measure (CAMM). In Study 1 (n = 428), the authors determined procedures for item development and examined comprehensibility of the initial 25 items. In Study 2 (n = 334), they reduced the initial item pool from 25 to 10 items through exploratory factor analysis. Study 3 (n = 332) evaluated the final 10-item measure in a cross-validation sample, and Study 4 (n = 319) determined validity coefficients for the CAMM using bivariate and partial correlations with relevant variables. Results suggest that the CAMM is a developmentally appropriate measure with adequate internal consistency. As expected, CAMM scores were positively correlated with quality of life, academic competence, and social skills and negatively correlated with somatic complaints, internalizing symptoms, and externalizing behavior problems. Correlations were reduced but generally still significant after controlling for the effects of 2 overlapping processes (thought suppression and psychological inflexibility). Overall, results suggest that the CAMM may be a useful measure of mindfulness skills for school-aged children and adolescents.