Effects of Cognitive Distancing on Intrusive Thought Responses

ABSTRACT

LOOKING OUTSIDE OF SELF AND EXPERIENCE: EFFECTS OF COGNITIVE DISTANCING ON INTRUSIVE THOUGHT RESPONSES

by Sarah Lily Adut

Metacognitive methods that create cognitive distance between an individual and their negative thoughts have demonstrated beneficial effects, including reducing avoidance and distress, and increasing meaning-making in response to negative thoughts. Two dimensions of cognitive distancing, self-distancing and experiential distancing, may help clarify mechanisms through which cognitive distancing leads to adaptive versus harmful outcomes. The current study examined self-distancing and experiential distancing in response to intrusive thoughts, which are unpleasant, unwanted thoughts that have been implicated in the development and maintenance of a variety of clinical problems including obsessive-compulsive disorder. Participants (N=212) wrote about an intrusive thought from one of three perspectives that varied according to whether they were self- immersed or self-distanced, as well as whether they were experientially immersed or distanced. Greater degrees of cognitive distancing were anticipated to reduce negative reactions to an intrusive thought and increase self-compassion. Partial support for the hypotheses was found; simultaneously engaging in self-distancing and experiential distancing increased self-compassion as predicted. Consistent with prior literature, the combination of both distanced perspectives most strongly predicted beneficial outcomes. This study clarifies mechanisms of cognitive distancing and identifies possible benefits of utilizing cognitive distancing in the context of intrusive thoughts.

LOOKING OUTSIDE OF SELF AND EXPERIENCE: EFFECTS OF COGNITIVE DISTANCING ON INTRUSIVE THOUGHT RESPONSES

A Thesis

Submitted to the

Faculty of Miami University

in partial fulfillment of

the requirements for the degree of

Master of Arts

Sarah Lily Adut

Miami University

Oxford, Ohio

2019

Advisor: Joshua C. Magee, Ph.D.

Reader: Terri L. Messman-Moore, Ph.D.

Reader: April R. Smith, Ph.D.

This Thesis titled

LOOKING OUTSIDE OF SELF AND EXPERIENCE: EFFECTS OF COGNITIVE DISTANCING ON INTRUSIVE THOUGHT RESPONSES

Sarah Lily Adut

has been approved for publication by

The College of Arts and Science

and

Department of Psychology

______Joshua C. Magee, Ph.D.

______Terri L. Messman-Moore, Ph.D.

______April R. Smith, Ph.D.

Table of Contents

List of tables………………………………………………………………...iv List of figures……………………………………………………………...... v Introduction………………………………………………………………….1 Method………………………………………………………………………5 Sample………………………………………………………………..5 Intrusive thought and writing task……………………………………6 Materials………………………………………………………………6 Procedure……………………………………………………………10 Analytic Plan………………………………………………………...11 Results……………………………………………………………………...11 Sample characteristics……………………………………………….11 Responses to intrusive thoughts……………………………………..12 Exploratory analyses………………………………………………...13 Discussion………………………………………………………………….14 References………………………………………………………………….20 Appendices…………………………………………………………………24 Appendix A: Tables…………………………………………………24 Appendix B: Figures………………………………………………...27 Appendix C: Measures………………………………………………28

iii

List of Tables

Table 1: Sample Characteristics and Baseline Affect by Condition...... 24 Table 2: Single-Category Implicit Association Test (SC-IAT) Stimuli.…...25 Table 3: Pearson and Spearman correlations between Implicit and Explicit Measures.…………………………………………………………………...26

List of Figures

Figure 1: Sample SC-IAT screen…………………………………………27

Acknowledgments

I would first like to thank Dr. Joshua Magee for his guidance, support, and good humor throughout the course of this project, from its inception to its completion (and beyond). I would also like to thank Drs. April Smith and Terri Messman-Moore for their service on my committee and for their insightful feedback that has strengthened and refined this project significantly. I am similarly grateful for the contributions of the SCOUT lab, its undergraduate and graduate members alike, who have aided in the development and execution of the study and helped foster my growth and well-being as a new researcher and academic. Guidance and insight from the ACE lab have also been foundational to the success of this project. The remainder of my gratitude goes to members of my graduate cohort for the stellar companionship and commiseration that we have shared. And my mom, too.

People relate to their thoughts in different ways, and those metacognitive approaches can meaningfully impact mental health. Individuals may view their thoughts as literal representations of reality or as subjective interpretations (Hayes, Luoma, Bond, Masuda, & Lillis, 2006), from their own point of view or from an outside perspective (Kross, Ayduk, & Mischel, 2005), as meaningful or less meaningful (Hayes et al., 2006), and from any number of other perspectives. An example of the impact of metacognitive perspectives can be found in obsessive-compulsive disorder (OCD), a disorder theorized to result partially from catastrophized interpretations of intrusive thinking (Salkovskis, 1999; Rachman, 1997). Cognitive models of OCD suggest that intrusive, unwanted thoughts, images, and urges are normative and experienced by most healthy individuals without significant distress or impairment (Rachman, 1997). However, interpretations of intrusive thinking as evidence that one is “bad, mad, or dangerous” (Rachman, 1997) or as being one’s fault or responsibility (Salkovskis, 1999) can lead to distress, greater recurrence of the intrusive thoughts, and increased desire to engage in neutralizing behaviors or compulsions. Cognitive therapies for OCD aim to change the interpretations of thoughts through techniques such as cognitive restructuring. These therapies demonstrate similar effectiveness in reducing obsessive-compulsive symptomatology to exposure and response prevention, commonly considered to be the gold standard treatment for OCD (Öst, Havnen, Hansen, & Kvale, 2015). While cognitive theories and treatments for OCD provide examples of metacognitive influences on negative thoughts, other metacognitive approaches may also have the potential to reduce unhelpful interpretations of intrusive thoughts, such as increasing the cognitive distance from which one views those thoughts. Cognitive distancing encompasses many types of distancing, including self-distancing, or witnessing one’s experiences as a third-person observer. When thinking about an experience, individuals may feel very much as though they are experiencing it through their own eyes, or they may view the event from an outsider’s perspective (Kross & Ayduk, 2011). Self-distancing involves shifting one’s perspective from the former to the latter. When reading this paper, for instance, you likely have been relatively self-immersed and focused on the content of this document and your thoughts on it. Self-distancing might instead entail consideration of the way your act of reading appears from an outside perspective. In fact, reading the last two sentences may have caused you to self-distance to some degree. Self-distancing typically reduces affect, arousal, and physiological reactivity to emotional stimuli when compared to self-immersion

(Ayduk & Kross, 2008; Gruber, Harvey, & Johnson, 2009). A moderate degree of both self- immersion and self-distancing is normative among healthy individuals across a variety of thought contents, and a degree of each may be beneficial in different contexts (Ayduk & Kross, 2010). When interacting with negative memories, for instance, self-distancing can reduce short- term arousal and blood pressure reactivity, while self-immersion can heighten positive affect when interacting with positive memories (Ayduk & Kross, 2010; Ayduk & Kross, 2008; Gruber et al., 2009). Thus, effective matching of distancing or immersion to the affective tenor of mental experiences may result in enhanced emotional outcomes. For intrusive thinking, which is typically followed by negative emotional reactions, self-distancing may serve to temper the immediate negative emotional impact. Despite the promising implications of self-distancing, the work of Kross, Ayduk, & Mischel (2005) suggests that a self-distanced vantage point alone does not lead to decreased negative affect when interacting with memories. Instead, they suggest that self-distancing may only be effective in conjunction with a particular type of self-focus. Specifically, a self-distanced focus on what happened in a distressing memory (distanced-what) has not been found to reduce negative affect or distress in healthy samples. Only a combination of a self-distanced vantage point and a focus on why events took place and why an emotional reaction was experienced (distanced-why) has been found to reduce negative affect in that context (Kross et al., 2005). When individuals take a distanced-what perspective, concrete and immediate facets of the memory surface that lead to superficial attributions and the reexperiencing of intense and specific emotions (Kross et al., 2005). Together, these features make it more difficult for individuals to maintain psychological distance (Kross et al., 2005). Such research converges with findings that observer perspective (without an explicit why focus), defined as a third-person perspective of one’s experiences, is actually associated with rumination and general and social anxiety (Finnbogadóttir & Berntsen, 2014). In contrast, self-distancing with an integration of a why focus is thought to actually facilitate distancing of the self-perspective, leading to the creation of more abstract representations and the greatest overall degree of psychological distance (Kross et al., 2005). These findings are consistent with construal-level theory (CLT), which proposes that increasing one’s psychological distance from an object leads to increasingly high-level construals of objects or events (Trope & Liberman, 2010). High-level construals involve broad,

2 abstract representations of objects, while low-level construals involve specific, unique, concrete representations. A low-level representation of a goal, for instance, may be: “Email Tom today to catch up with him,” while a high-level representation of the same goal may be: “Communicate with my friend.” High-level construals tend to capture values, morals, and abstract emotions such as pride and shame, while minimizing concrete, proximal details and emotions such as fear (Trope & Liberman, 2010). Shifting construals of intrusive thoughts from lower to higher levels may facilitate adaptive processing of such thoughts, without preserving the specific feared details that may encourage avoidance or compulsions. Evidence for the potential impact of shifting construals on intrusive thoughts can be found in the example of cognitive defusion, or the higher-level recognition of thoughts as subjective, internal events instead of as accurate representations of reality (Naragon-Gainey & DeMarree, 2017). Moving away from concrete, literal meaning and highlighting the abstract, representative nature of thoughts is central to defusion. For instance, one technique to induce defusion, verbal repetition, aims to minimize the impact of the concrete aspects of a thought by causing emotionally charged words to lose their meaning (Watson, Burley, & Purdon, 2010). Individuals repeat a word central to a negative thought (e.g. “fat” as a negative self-referential thought) until the word sounds meaningless to them, to shift their focus away from that literal meaning and towards a higher-level construal of the thought as just being a thought and nothing more. Defusion has been used within Acceptance and Commitment Therapy (ACT) to encourage individuals to accept the presence of difficult thoughts without necessarily allowing those thoughts to dictate one’s behavior (Naragon-Gainey & DeMarree, 2017). Defusion has also demonstrated utility in the context of intrusive thoughts, leading to reductions in negative affect and distress when exposed to such thoughts (Watson, Burley, & Purdon, 2010). These findings suggest that high-level construals, and methods of cognitive distancing that lead to such high- level construals (i.e., defusion), may be helpful when experiencing intrusive thoughts. Several commonly studied methods of cognitive distancing, including decentering and defusion, have similarities to self-distancing and have been operationalized in multiple ways, to sometimes inconsistent ends (Bernstein et al. 2015; Naragon-Gainey & DeMarree, 2017). Common threads between these methods are the acts of 1) separating oneself from the literal, subjective contents of one’s thoughts and memories, and 2) “relating to one’s thoughts and emotions as transitory psychological events rather than as (necessarily) accurate representations

3 of some larger ‘reality’” (Naragon-Gainey & DeMarree, 2017). These methods appear to involve disidentification from internal processes or an “observer perspective.” They also tend to involve a reduction in reactivity to thought content (Bernstein et al., 2015), which may be a result of the high-level construals that such techniques elicit. Factor analysis has uncovered a lack of discrimination and clarity in these constructs (Naragon-Gainey & DeMarree, 2017), and the frequent conflation of methods of cognitive distancing with the effects of cognitive distancing makes existing constructs less informative about the effects of cognitive distancing on intrusive thoughts. To create and maintain cognitive distance from memories, self-distancing has been found to be helpful but not independently sufficient (Kross et al., 2005). Witnessing one’s experiences as a third-person observer (self-distancing) is one component, and the other necessary component seems to be the mental separation of one’s internal reactions to an event from the event itself (experiential distancing). Bernstein et al. (2015) describe this latter component as the construal of thought contents as interpretations of experiences separate from the experiences themselves. Experimentally, this separation has often been accomplished through the distanced- why perspective described above, which shifted individuals’ focus away from their concrete emotional experiences to more abstract representations of why those experiences took place (Kross et al., 2005). However, other methods and targets of experiential distancing may also be useful, and less tied to self-distancing. Experiential distancing may not necessarily depend upon a logical analysis of why events were experienced the way they were as in the distanced-why perspective. Instead, it may be achieved through more explicit direction. Explicitly directing individuals to experientially distance may help to isolate and clarify the specific processes by which cognitive distance is created and maintained, without the added effects like contemplation or reflection that could come about in the distanced-why instruction. Methods of testing the independent contributions of experiential distancing are critical directions to test, as resulting findings can help tease apart the dimensions of cognitive distancing that may lead to more adaptive responses to the thoughts. Anticipated effects of self- and experiential distancing from intrusive thoughts include the benefits of high-level construals, many of which have already been demonstrated. For instance, in the short term, a distanced-why perspective leads individuals to process and contextualize negative memories instead of simply recounting events when recalling negative

4 memories (Kross & Ayduk, 2011). The distanced-why perspective may also be associated with a short-term decrease in avoidance strategies such as thought suppression and neutralizing behaviors, as intrusive thoughts will likely be appraised as less threatening. Greater spontaneous, self-generated self-distancing from negative memories is associated with less trait rumination and greater long-term problem-solving strategies, suggesting that a self-distanced perspective may be a constructive way to approach negative thoughts without falling into ruminative patterns (Ayduk & Kross, 2010). Additionally, as high-level construals increase the salience of morals and values, cognitive distancing is expected to increase elements of self-compassion, particularly self-kindness, mindfulness, and common humanity (the recognition that suffering is part of the shared human experience) (Neff, Whittaker, & Karl, 2017). Building on prior research, in the current study we examined whether engaging in any degree of cognitive distancing when interacting with intrusive thoughts would lead to more positive outcomes than total cognitive immersion, and whether the combination of experiential distancing and self-distancing, predicted to lead to the greatest degree of cognitive distance, would lead to even greater positive outcomes than engaging in experiential distancing alone. We induced self- and experiential distancing through writing exercises that instructed participants to take on distanced (versus immersed) perspectives. We hypothesized that engaging in both self- distancing and experientially distancing or experientially distancing alone would lead to decreased fear, guilt, and OCD symptoms and increased self-compassion when compared to engaging in self- and experiential immersion. We also expected that combining self- and experiential distancing would lead to greater reductions fear, guilt, and OCD symptoms and higher self-compassion when compared to engaging in only partial distancing. These changes were expected to be reflected in individuals’ cognitive and behavioral responses to an intrusive thought. Method Sample We recruited 256 participants for the study, out of which 212 met inclusion criteria surrounding past car accident experiences (responding “no” to the question, “Has anyone close to you ever died in a serious car accident?”). Participants were recruited from the general undergraduate population and the local southwest Ohio community by advertising at local businesses, bulletin boards, and community centers (mean age = 19.3, SD = 1.29). Participants

5 received course credit (n = 253) or $10 (n = 3) in compensation. Participants were fluent English speakers, to ensure sufficient ability to understand and engage in the writing task. See Table 1 for demographic characteristics. Intrusive Thought and Writing Task During the study, participants interacted with the thought, “I hope my friend is in a car accident.” This thought has been previously used in research as an “obsessional-like unacceptable thought” (Magee & Teachman, 2007; Rachman, Shafran, Mitchell, Trant, & Teachman, 1996). Intrusive thoughts that are perceived as morally unacceptable may uniquely predict distress and threatening interpretations of those thoughts (Audet, Aardema, & Moulding, 2016), making them important potential targets for cognitive distancing methods. Participants were randomly assigned to write about the supplied thought from one of three perspectives. The perspectives examined were 1) self- and experientially distanced (SD/ED), 2) self-immersed and experientially distanced (SI/ED), and 3) self- and experientially immersed (SI/EI). The fourth possible combination, SD/EI, was not examined to maximize the sample size and resulting statistical power available to examine comparisons across the three chosen combinations. In the single self-distanced condition, participants were asked to write in the third person, while in the two self-immersed conditions, participants were asked to write in the first person. In the initial part of the instructions, several words were varied across conditions to emphasize writing in a third vs. first person perspective: “Using the [first/third]-person perspective (e.g. ‘[I/Participant’s name] walk[s] to the store’), write about the thought you wrote on the index card.” For the two experientially distanced conditions, participants were also asked: “As you write, try to describe the event of you focusing on this thought. Separately, describe the ways that you feel, think, or behave in reaction to the thought.” In the experientially immersed condition, participants were asked to do the following: “As you write, try to describe everything you feel and everything that happens as you focus on the thought.” Materials Manipulation check. Cognitive distancing (CDS). Participants completed the 2-item Cognitive Distancing Scale (CDS; adapted from Ayduk & Kross, 2010) to check the extent to which they followed

6 experiential distancing vs. immersion and self-distancing vs. immersion instructions. Self- distancing vs. immersion was assessed with the item: “To what extent did you describe the event of you focusing the thought from a first-person perspective, compared to a third-person perspective?,” while experiential distancing vs. immersion was be assessed with the item: “To what extent did you describe the event of you focusing on the thought separately from the thoughts, feelings, and behaviors with which you responded to the thought?.” The items were rated on a 1-7 Likert scale (1 = completely separately/entirely first-person, 7 = not at all separately/entirely third-person). State fear and guilt (PANAS-X). Participants completed the 6-item Fear subscale and the 6-item Guilt subscale of the Positive and Negative Affect Schedule – Expanded Form (PANAS- X; Watson & Clark, 1999) to evaluate their current fear and guilt. For each item, they were asked to rate the extent to which they felt descriptors in the present moment (e.g. afraid, ashamed). Items were rated on a 5-point Likert scale, from Very Slightly or Not at All to Extremely. The PANAS has excellent convergent and discriminant correlations with lengthier measures of mood (Watson & Clark, 1999). Within the current study, Cronbach’s alphas for the fear and guilt subscales ranged from  =.89 to  =.96 across the three timepoints, indicating good to excellent internal consistency. The two subscales were analyzed separately. State self-compassion. Participants completed the 16-item State Self-Compassion Scale (SCS, Breines & Chen, 2013) to evaluate the degree of self-compassion they experienced at the moment (e.g. “Right now, I’m being understanding towards myself”). Items were rated on a 1 (strongly disagree) to 7 (strongly agree) scale. This scale has demonstrated significant convergence with the trait form. Reliability in the current study was questionable (=.67). Implicit associations. In addition to explicit evaluations concerning intrusive thinking and the self that are accessible to self-report, there is also evidence of evaluations that involve relatively automatic associations (Teachman, Woody, & Magee, 2006; Teachman & Clerkin, 2007). The Single Category Implicit-Association Test (SC-IAT) is a computerized reaction time task designed to measure the relative strength of such automatic associations between concepts in memory (Karpinski & Steinman, 2006). As an implicit measure, the SC-IAT minimizes the influences of conscious control and self-presentation on results, while providing data on areas of cognition that may fall outside awareness. It was developed to extend the application of the traditional (dual category) IAT, which examines the relative strength of associations between

7 two opposite attitude objects. The SC-IAT uses a within-participant design to examine associations with a single attitude object, enabling exploration of implicit attitudes towards objects with no meaningful opposites. In the current SC-IAT, we compared the strength of associations between OCD-relevant concepts (fear, guilt, danger) and the self. To measure the strength of associations, participants were instructed to sort target words that appear on the monitor into the appropriate categories by pressing one of two keyboard keys. Greater associations between concepts are reflected by faster classification times for stimuli into the appropriate categories. As seen in Table 2, the negative stimuli were intended to capture 1) fear, 2) guilt, and 3) danger in relation to the self, with each stimulus category containing four words. Stimuli for "me" and “fear” were adapted from Hadash, Plonsker, Vago, & Bernstein (2016) to capture the degree of self-distancing and the fear response, also explicitly captured in the PANAS-X fear subscale. Minor substitutions were made (e.g. “alarmed” for “apprehension”), and the form of the fear words were changed from nouns to adjectives to be consistent with the other stimuli. Guilt stimuli were developed to capture feelings of guilt and responsibility in response to thoughts (explicitly captured in the PANAS-X guilt subscale), with reading level, word length, word meaning, and meaning intensity considered in word selection. Danger stimuli were adapted from Teachman, Woody, & Magee (2006), to implicitly identify the degree of threat an individual associates with their self. The stimulus “risky” was substituted for “violent” to keep the focus on present-moment threat and not potential future threat. For neutral stimuli, “office equipment” stimuli were also adapted from Hadash et al. (2016), with the addition of “envelope” for the number of stimuli to be consistent. A practice block preceded the testing block to establish familiarity with the measure. On the screen, participants were shown one stimulus category word on the upper left chosen at random (either “me” or “office equipment”) and the remaining category word (either “me” or “office equipment”) on the upper right (see Figure 1 for an example). A negative stimulus category (either fear, guilt, or danger) was paired with either “me” or “office equipment” during the block, such that the left side of the screen might say “Me or Danger” and the right side “Office equipment.” After a fixation cross appeared, then one stimulus appeared in the center of the screen at a time, and participants sorted them into their correct categories using keyboard keys. For instance, in this example “I” or “Violent” would be sorted to the left side of the screen,

8 while “Paper” would be sorted to the right side. Feedback immediately appeared based on whether participants sorted words into the correct categories. Participants completed three stages of two blocks each, with each block consisting of 30 trials. Each stage displayed a different negative stimulus category: danger, then guilt, then fear. The order of these categories was consistent across participants. One of the two blocks (ordered at random) paired the negative stimulus category with “me,” and the other block paired the negative stimuli with “office equipment.” This procedure allows us to determine the relative strength of the relationship between “me” and negative stimuli compared to the relationship between the neutral “office equipment” and negative stimuli, to test the hypothesis that greater cognitive distancing reduces the strength of associations between the self and each negative element. Participants with error rates greater than 20% were excluded from analyses of strength of implicit associations (Karpinski & Steinman, 2006). In the current study, exclusion percentage per subtest ranged between 6% (guilt and danger) and 9% (fear). Neutralizing urges and behaviors. Based on Clerkin, Magee, & Parsons (2014), we asked participants a series of 8 questions about the strength of their general and specific urges to neutralize, or reduce distress associated with, the thought (e.g. “At its strongest point after the writing exercise, how strong was your urge to say a prayer?”). A Neutralizing Urges index score was calculated by averaging items. Internal consistency was good in the current study (=.84). We also asked participants whether they actually completed any of 7 neutralizing behaviors. Participants who endorsed engaging in neutralizing behaviors were then asked which behaviors they engaged in, to create a Neutralizing Behaviors score ranging from 0 (engaged in no behaviors) to 7 (engaged in every behavior listed). Dissociative experiences. To explore the relation between different types of cognitive distancing and dissociation, dissociative symptoms were assessed with the 28-item Dissociative Experiences Scale (DES; Bernstein & Putnam, 1986). Participants were asked to rate how often they have various dissociative experiences (e.g. “Some people have the experience of being in a familiar place but finding it strange and unfamiliar.”). Responses are rated on a 0% (never) to 100% (all the time) scale based on what percentage of the time they have the experience. In the current study, internal consistency was excellent (=.95). Mindfulness. Due to its relation to metacognitive perspectives, mindfulness was also examined as an exploratory measure, to examine how it connects to cognitive distancing

9 strategies. Trait mindfulness was assessed with the 39-item Five Facet Mindfulness Questionnaire (FFMQ; Baer, Smith, Hopkins, Krietemeyer, & Toney, 2006). Participants were asked to rate their opinion of what is generally true for their experiences (e.g. “I perceive my feelings and emotions without having to react to them.”). Responses are rated on a 1 (never or very rarely true) to 5 (very often or always true) scale. The five facets of mindfulness assessed were Observe, Describe, Act with Awareness, Non-judgment (Nonjudge), and Non-reactivity (Nonreact), and each was assessed with 7-8 questions in the scale. In the current study, internal consistency of mindfulness facets fell between =.75 (Nonreact) and =.89 (Nonjudge), indicating acceptable to good internal consistency. Obsessive-compulsive symptoms. Also as an exploratory measure, obsessive-compulsive symptoms were assessed with the 18-item Obsessive Compulsive Inventory-Revised (OCI-R; Foa et al., 2002). The OCI-R has six subscales: Checking, Obsessing, Neutralizing, Ordering, Washing, and Hoarding (e.g. “I have saved up so many things that they get in the way.”). Responses were rated on a 0 (not at all) to 4 (extremely) scale based on how distressing or bothersome it has been for them in the past month. In the current study, internal consistency was good (=.84). Procedure All procedures were approved by the institutional review board. Participants were informed of general study procedures and any potential risks that participation may entail. After agreeing to participate, they received a copy of the consent form for their records. Following informed consent, participants completed an initial measure of fear and guilt (PANAS-X). Next, participants interacted with an intrusive thought through a 4-minute writing task. In this task, participants were first presented with the intrusive thought described above and asked to write down the thought on an index card and focus on it. Participants then completed the PANAS-X again to capture their initial emotional responses to the thought stimulus. For the next 3 minutes, they wrote about the thought while following a randomly assigned writing prompt about their experience with the thought, placing them in one of three distancing categories (described above). This was followed by another assessment of fear and guilt (PANAS-X) and a manipulation check (CDS), and then the SC-IAT. Finally, participants reported neutralizing urges and behaviors, followed by measures of state self-compassion (SCS), dissociative experiences (DES), mindfulness (FFMQ), obsessive-compulsive symptoms (OCI-R), and

10 demographics. Participants were then be fully debriefed and thanked for their time, and provided with resources to utilize if experiencing continued distress over the negative thought or participation in the study. Analytic Plan To test the hypothesis that greater cognitive distancing reduces distress and OCD symptoms and increases state self-compassion when responding to an intrusive thought, we used two analytic approaches matched to the number of measurements: Generalized Linear Models (GZLM) for single-timepoint measures and Generalized Estimating Equations (GEE) for repeated measures. Analyses used contrast codes to compare the effects of 1) any form of experiential distancing vs. total immersion (SI/ED and SD/ED vs. SI/EI) and 2) self-distancing vs. self-immersion (SD/ED vs. SI/ED). For dependent variables with one time point, we conducted GZLM analyses to examine differences across the two contrast codes while accounting for non-normal distributions and pre-manipulation condition differences in guilt. State self-compassion and IAT scores were normally distributed, while OCI, FFMQ, Neutralizing Urges, Neutralizing Behaviors, and DES were all negatively skewed. Significant omnibus tests were followed up with Least Significant Difference (LSD) post-hoc tests to determine the source of effects. For fear and guilt, which were measured at three time points, we conducted GEE analyses, in which the two contrast codes were between-subjects factors and time point was a within-subjects factor. If significant omnibus interactions and main effects were found, they were followed up with additional GZLMs, GEEs, and LSD post-hoc tests to understand and isolate the sources of the effects. These tests helped us examine whether the degree and type of cognitive distancing predicts differences in fear or guilt following interaction with an intrusive thought. Results Sample Characteristics We first checked whether distancing conditions differed in sample characteristics or in pre-elaboration affect. The three conditions did not differ from each other in terms of gender, age, race, marital status, or education (ps > .15). Conditions varied significantly in how many participants identified as Hispanic/Latino, with five in the SI/EI condition, ten in the SI/ED

11 condition, and one in the SD/ED condition (2 = 7.52, p < .05)1. Conditions also displayed differences in guilt prior to random assignment. At timepoint 2, immediately after exposure to the intrusive thought and before the writing task, self-distanced and self-immersed conditions differed in guilt (Wald 2 = 5.39, p < .05). Any experiential distancing did not differ from total immersion (Wald 2 = 3.15, p = .08). Thus, randomization was largely effective at minimizing pre-manipulation group differences. To account for preexisting differences in guilt between conditions, we controlled for time 2 guilt in all non-affect analyses. Manipulation check. As for the manipulation check, condition significantly predicted responses to the question assessing first- vs. third-person perspective used (F=141.8, p < .01). Post-hoc comparisons revealed that as expected, the SD/ED condition reported higher use of third-person perspective than either the SI/ED or SI/EI conditions. Unexpectedly, the question assessing experiential distancing was not answered differently across conditions (F=.072, p = .93).2 This result means that it is not certain that participants shifted their experiential distancing in response to the manipulation, although we did find several differences potentially linked to the experiential distancing manipulation below. Responses to Intrusive Thoughts Neutralizing urges and behaviors. We first tested the effect of distancing conditions on neutralizing urges following intrusive thought exposure. No significant main effects were found for either contrast (ps > .20). Additionally, no main effects were found for neutralizing behaviors (ps > .15). This indicates that contrary to hypotheses, cognitive distancing did not impact urges to neutralize or neutralizing behaviors following intrusive thought exposure. State self-compassion. We next tested whether distancing condition impacted state self- compassion following intrusive thought exposure. Supportive of our hypothesis, we found that self-distancing led to higher state self-compassion (Wald 2 = 6.91, p < .01; Exp(b)=.04) than self-immersion. Engaging in any experiential distancing did not differentially impact self- compassion (ps > .35). Thus, it was self-distancing specifically that led to greater state self- compassion, versus an effect shared across types of cognitive distancing.

1 Because of differences in the number of Hispanic/Latino individuals across conditions, analyses were run both including and excluding Hispanic/Latino participants. No differences emerged, and Hispanic/Latino participants were included in all reported analyses. 2 Because the conditions did not differ in their responses to the experiential distancing manipulation check, analyses were run both with and without controlling for responses on the manipulation check. No differences emerged, so we report only results without this covariate. 12

Fear and guilt over time. To test our hypothesis that different types and degrees of cognitive distancing impact individuals’ affective responses to intrusive thoughts, we examined fear and guilt trajectories across conditions over the three timepoints, with a goal of identifying whether distancing conditions affected these trajectories. For fear, there were no main effects of the any experiential distancing (Wald 2 = .35, p > .55) or self-distancing (Wald 2 = .20, p > .65) contrasts, and no interactions between these contrasts and time (ps > .50). For guilt, there was a significant main effect of self-distancing (Wald 2 = 4.00, p < .05; Exp(b)=.88). That is, across all timepoints (including before the manipulation), individuals who self-distanced between the second and third timepoints reported less guilt than those who engaged in self-immersion. The main effect of experiential distancing was not significant (Wald 2 = 3.42, p = .06; Exp(b)=1.12). Contrary to hypotheses, there were no interactions between these contrasts and time (p > .05), indicating that fear and guilt did not differentially shift by distancing conditions once individuals received instructions to distance versus immerse. Implicit associations. Finally, we examined implicit associations between the self and the three targets (fear, guilt, danger) that were contrasted with a fourth, neutral target stimulus (office supplies) to examine whether differences emerged across writing conditions. On the SC- IAT, scores describing response accuracy as well as scores assessing the relative strength of associations were collected, with higher scores indicating stronger associations between the “self” and either fear, guilt, or danger. For self/fear associations (n=189), there was no significant main effect of either contrast on association strength (ps > .15). For self/danger associations (n=192), there was also no main effect of condition across contrasts (ps > .45). However, for self/guilt associations (n=194), a significant main effect of self-distancing emerged (Wald 2 = 4.33, p = .04; Exp(b)=.89), such that self-distancing led to stronger associations between the self and guilt. These findings were unexpected, given our hypothesis that cognitive distancing would weaken the implicit associations between the self and negative stimuli. Engaging in any experiential distancing did not significantly impact this association (p > .70). As is common in research on implicit associations (e.g. Teachman & Clerkin, 2007), there was significant divergence between the implicit and explicit measures: correlations between implicit associations and explicit variables were nonsignificant (see Table 3). Exploratory analyses

Obsessive-compulsive symptoms. We next examined whether distancing conditions led to different self-reported obsessive-compulsive symptoms following intrusive thought exposure. Engaging in either type of experiential distancing significantly decreased total OCI-R scores (Wald 2 = 7.12, p < .01; Exp(b)=1.13). This was surprising because this was expected to be a trait measure of OC symptoms; however, these effects of experiential distancing on OC symptoms are in line with our hypothesis. Self-distancing did not significantly impact OCI-R scores (Wald 2 = 2.09, p > .10; Exp(b)=1.08). Thus, while the effect of either type of experiential distancing reduced obsessive-compulsive symptoms, the specific effect of self- distancing did not appear to drive the difference. Mindfulness. As an exploratory analysis, we tested whether conditions differed in mindfulness. Among the five facets of mindfulness, Observing, Acting with Awareness, Describing, and Nonjudging did not differ across either contrast (ps > .06), and Nonreactivity was not affected by experiential distancing (Wald 2 = 2.11, p = .15). Self-distancing did lead to greater Nonreactivity (Wald 2 = 4.29, p =.04), aligning with our general predictions. Dissociative experiences. Finally, we explored whether distancing conditions impacted dissociative experiences following intrusive thought exposure. Across both contrasts, neither experiential distancing nor self-distancing led to different endorsement of dissociative experiences (ps > .05). Discussion In the current study we examined the impact of two forms of cognitive distancing, self- distancing and experiential distancing, on responses to an OC-relevant intrusive thought. We expected that greater cognitive distance would predict fewer negative outcomes (including neutralizing urges and behaviors, implicit associations between the self and negative stimuli, and increases in negative affect over time), and more positive outcomes (state self-compassion) compared to cognitive immersion. Partial support for our hypotheses were found. Overall, neither total distancing, partial distancing, nor total immersion consistently led to negative or positive outcomes. Instead, both self-distancing and engaging in any degree of experiential distancing led to varied outcomes. Self-distancing emerged as a relatively more powerful predictor of beneficial outcomes, while engaging in any degree of cognitive distancing only impacted one dependent variable, obsessive-compulsive symptoms. Partial and total immersion led to comparatively higher obsessive-compulsive symptoms and emotional reactivity and lower

14 self-compassion, conceptualized as more harmful outcomes, but weaker implicit associations between the self and guilt, conceptualized as beneficial. This paints a picture of cognitive distancing as being a predominantly helpful strategy to utilize when experiencing unwanted, immoral intrusive thoughts, yet with nuanced differences between engaging in any cognitive distancing versus self-distancing specifically. Engaging in self-distancing increased state self-compassion and the nonreactivity facet of mindfulness, while unexpectedly increasing the implicit association between the self and guilt. This was unexpected because the self-distancing task was designed to create cognitive distance between one’s subjective internal experience and their sense of self, and implicitly, the opposite happened for guilt. One reason why self-distancing may have been implicitly associated with more guilt could be that guilt has been described in previous literature as a negative evaluation of a specific behavior or transgression one engaged in, while shame has been described as a negative evaluation of the self (Niedenthal, Tangney, & Gavanski, 1994). Shame was not assessed in the current study, but self-distancing could have reduced shame and increased guilt by shifting the focus away from the self. Another possibility is that conscious, effortful self- distancing actually increases implicit immersion for guilt. Perhaps the act of trying to self- distance from one’s internal experiences may cause a degree of implicit guilt if individuals believe that engaging with those experiences from an immersed perspective is deserved or proper. While self-distancing has been previously associated with reductions in both explicit and implicit aggression (Mischkowski, Kross, & Bushman, 2012), it is possible that guilt operates differently due to its self-focused nature. Construal-level theory posits that higher-level construals, consistent with greater cognitive distance, lead to more severe moral judgments than low-level construals (Eyal, Liberman, & Trope, 2008). Stronger self-guilt implicit associations following self-distancing may reflect a moral drive for atonement that has been heightened by a higher-level construal. There are also some consistencies with thought suppression literature, which finds when self-relevant suppressed thoughts are pushed out of mind (i.e., consciously distanced from the self), they may initially be more accessible at an automatic, implicit level (Klein, 2007; Najmi & Wegner, 2008). The finding is also interesting because self-distancing led to both increased self- compassion and increased associations between the “self” and guilt. Self-compassion involves an attitude of being accepting and understanding towards one’s own actions. Guilt, in contrast,

15 has been defined as “the dysphoric feeling associated with the recognition that one has violated a personally relevant moral or social standard” (Kugler & Jones, 1992, p. 318). While the two are not opposites, associations between trait self-compassion and reduced guilt in response to events have been found (Valdez & Lilly, 2018). Our finding may in part be explained by the state nature of our self-compassion measure. Our questions assessed the degree to which individuals were responding in a self-compassionate manner to the current situation (e.g. “I’m trying to be kind and reassuring to myself”). It is possible that individuals may not noticeably engage in self- compassion unless they experience sufficiently negative emotions to which they could respond self-compassionately. For instance, they may not endorse that they are being reassuring to themselves unless they already feel the negative emotion and accompanying need to reassure themselves to begin with. In the current study, feeling heightened associations between oneself and guilt may instigate a self-compassionate response. A few caveats are worth noting for these patterns of results. Notably, across all affective target stimuli, individuals actually demonstrated stronger implicit associations between their “self” and the neutral target stimuli (office supplies) than they did between “self” and affective stimuli, and for guilt stimuli, this effect was simply less pronounced. Implicit fear and guilt associations were not only weak in an absolute sense, but uncorrelated with explicit measures of the same affective states that were unaffected by writing condition. This may indicate a fairly high degree of implicit and explicit emotional health within the current sample. Additionally, the questionable internal consistency of the state self- compassion scale and the exploratory nature of the mindfulness variables may qualify these findings. Participants who engaged in any type of cognitive distancing reported significantly lower OC symptoms than those who totally immersed. Interestingly, only responses on the OCI-R scale were affected by distancing, whereas OC symptoms as assessed by neutralizing urges and behaviors were not. This is surprising primarily because the OCI-R purports to capture how often symptoms have bothered individuals in the past month, not solely current experiences. However, the directionality was consistent with our initial hypotheses. Importantly, the OCI-R has been better validated (Foa et al., 2002; Abramowitz, Tolin, & Diefenbach, 2004; Abramowitz & Deacon, 2006) and has been found to be sensitive to changes in OC symptoms across treatment (Abramowitz et al., 2004), while the current measure of neutralizing urges and behaviors is relatively unestablished; this may partially explain why the OCI-R was more sensitive to

16 manipulation. The OCI-R also assessed a broader range of experiences than the measure of neutralizing urges by asking about emotions and feelings of distress in response to thoughts. It is interesting that the OCI-R was the only measure affected by any form of cognitive distancing that did not show a specific effect of self-distancing. While we could not directly examine the sole, specific effects of experiential distancing using our chosen contrast codes, this pattern implies that experiential distancing may have particular relevance for this outcome. Examining one’s thoughts, feelings, and behaviors as they relate to an event may focus an individual’s attention on aspects of causality in protective ways. Certain belief domains, including responsibility and importance and control of thoughts, have been linked to increased OC symptoms (Obsessive Compulsive Cognitions Working Group, 2005). Describing an event separately from one’s reactions to that event may reduce feelings of responsibility or valuation of the importance of one’s thoughts, particularly in situations where the causal force was not consciously chosen by the individual. It is also important to note that both of the distanced perspectives examined in the current study (SI/ED and SD/ED) included the component of experiential distance. Experiential distancing, therefore, may be a unique cause of OC symptom reduction in the context of intrusive thoughts. In examining the results, an important point of clarification surrounds the language used to describe contrast codes. While we described one contrast (SD/ED vs. SI/ED) as “self- distancing,” this comparison reflected self-distancing vs. self-immersion while both sides of the comparison were paired with experiential distancing. As prior research reflects (Kross, Ayduk, & Mischel, 2005), the effects of self-distancing are anticipated to differ by the perspective it is paired with, conceptualized in the current study as the experiential perspective. The novelty of the current experiential distancing induction is also worth considering. While the experimental distancing instruction converges with existing constructs and experimental manipulations and were designed to evoke similar responses (e.g. Kross, Ayduk, & Mischel, 2005), being instructed to experimentally distance did not relate to the degree to which participants reported experientially distancing in the manipulation check. This was a limitation, as adherence to the instructions and the actual levels of experiential distancing were unclear. The lack of a relationship may have been caused by poor fidelity to instructions, low self-perceived success at following the instructions, or lack of clarity about what the writing instructions were asking participants to write. However, there were effects involving experiential distancing, while

17 statistically controlling for individuals’ responses to the experiential distancing manipulation check did not impact results. Together, this suggests that the instructions may have induced changes that were not adequately detected by the manipulation check item. The current study’s results also converge and diverge from existing literature on cognitive distancing and construal level theory with noteworthy implications. First, this study largely supports previous literature on decentering, defusion, and self-distancing in concluding that a combination of self- and experiential distance more powerfully predicted beneficial outcomes than total or partial cognitive immersion. This aligns with the work of Naragon-Gainey and DeMarree (2017), which found that separation from the subjective contents of one’s thoughts, paired with the viewing of thoughts as psychological events separate from objective reality, led to the most consistently beneficial effects. Although the current study was limited by the manipulation check issue raised above, it also raised the possibility that experiential distancing can be evoked not only through tasks directly asking individuals to examine the “why” of a situation, as in Kross and colleagues’ work (e.g. Kross et al., 2005) but by eliciting the separation of one’s interpretations and responses to experiences from the experiences themselves. That the combination of self- and experiential distancing instructions led to the most positive outcomes overall parallels the beneficial effects of a “distanced-why” found by Kross and colleagues. The current study also identified that a specific “why” focus may not be as necessary for distancing as may be the underlying separation of one’s responses to an event from the event itself. Finally, it extended these findings into the realm of OC-relevant intrusive thoughts. Isolating this type of experiential distancing may encourage further exploration of ways to adapt this perspective for diverse therapeutic interventions in the future, to target obsessive-compulsive symptoms among others. Further research should seek to continue to identify and refine the beneficial mechanisms of cognitive distancing and examine their utility in the context of obsessive-compulsive disorder. While the contrast grouping including the combination of self- and experiential distancing were found to be the strongest predictor of beneficial outcomes, the finding that engaging in experiential distancing with or without simultaneously self-distancing reduced OC symptoms indicates that experiential distancing may be particularly beneficial in the context of intrusive thoughts. This was found despite an unclear degree of fidelity to experiential distancing instruction. Future work should seek to identify more powerful ways to instill experiential

18 distancing, and continue to test their effectiveness across OC-relevant intrusive thoughts. Due to impacts of higher construals on perceptions of morality, this may be examined across intrusive thoughts with varying moral relevance, to determine whether responses to intrusive thoughts are impacted differently via distancing when those thoughts are more or less morally relevant. The unique effect of combining self-distancing and experiential immersion was not examined in the current study, and future work may also examine effects of that combined perspective to further clarify which dimensions of distancing are the most helpful. Finally, this work should be examined across different populations, including individuals diagnosed with OCD, individuals trained in mindfulness, and individuals of varying ethnic and cultural backgrounds, to clarify how generalizable these effects may be.

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Appendices

Appendix A: Tables

Table 1.

Sample Characteristics and Baseline Affect by Condition

SI/EI SI/ED SD/ED Total (n = 72) (n = 73) (n =67) (N = 212)

M or (SD) or M or n (SD) or M or n (SD) or M or n (SD) or

n (%) (%) (%) (%)

Age 19.28 (1.22) 19.19 (1.02) 19.55 (1.61) 19.32 (1.29)

Gender 38 (52.8) 40 (54.8) 29 (43.3) 129 50.4

(Female)

Race

White 54 (75) 63 (86.3) 49 (73.1) 198 (77.3)

Asian 9 (12.5) 3 (4.1) 11 (16.4) 27 (10.5)

Black 4 (5.6) 3 (4.1) 2 (3.0) 13 (5.1)

Multi 4 (15.6) 4 (5.5) 4 (6) 16 (6.3)

Other 1 (1.4) 0 (0) 1 (1.5) 2 (0.8)

Fear Time 2 11.01 (4.91) 9.99 (4.94) 11.43 (6.26) 10.79 (5.39)

Guilt Time 2 12.89 (7.01) 10.40 (5.57) 12.52 (6.43) 11.92 (6.42)

Note. Black = Black/African American; Multi = Biracial or multiracial. The totals may not sum to the actual number of participants as some participants did not complete all of the items.

Table 2.

Single-Category Implicit Association Test (SC-IAT) Stimuli Category Label Stimuli to be classified Me I Me Myself Mine Office equipment Notebook Folder Paper Envelope Fear Frightened Panicked Alarmed Afraid Guilt Guilty Blamed Responsible At fault Danger Violent Hurtful Dangerous Unsafe

Table 3. Pearson and Spearman correlations between Implicit and Explicit Measures

1 2 3 4 5 6 7 8 9 10 11 12 1. Fear D-score - 2. Guilt D-score .35** - 3. Danger D-score .16* .26** - 4. Dissociative .07 .09 .09 - Experiences 5. Self-compassion .02 -.05 -.02 -.29** - 6. Neutralizing Urges .09 -.06 .00 .22** -.07 - 7. Obsessive -.2** .17* - -.06 -.01 -.07 .51** Compulsive Inventory 8. Observe .04 .05 .14* .17** .14* .10 .17** - 9. Describe -.06 -.06 0.05 -.2** .24** .00 -.18** .27** - 10. Acting with .19** -.08 -.39** -.2** .25** - -.08 -.08 -.2** -.6** Awareness 11. Nonjudgment -.01 .01 -.06 -.41** .32** -.16* -.47** -.3** .13* .49** - 12. Nonreactivity .05 -.06 .02 -.07 .25** -.05 .05 .34** .17** -.07 -.14* - Note. * p < .05 **p < 0.01. Pearson correlations are underlined. All other coefficients are Spearman correlations to account for skew in at least one variable.

Appendix B: Figures Figure 1.

Figure 1. Sample SC-IAT screen. E and I refer to the keyboard keys with which participants sorted stimuli. “Me,” “Danger,” and “Office Equipment,” are the categories that participants sorted stimulus words into, while “Paper” is the stimulus to be sorted. In this example, a participant would press the I key to sort “Paper” into the “Office Equipment” category.

Appendix C: Measures

Cognitive distancing scale (CDS)

Please rate the following statements on a 1-7 scale.

“To what extent did you describe the event of you reading the thought separately from the thoughts, feelings, and behaviors with which you responded to the thought?”

1 2 3 4 5 6 7 Completely Not at all separately separately

“To what extent did you describe the event of you reading the thought from a first-person perspective, compared to a third-person perspective?”

1 2 3 4 5 6 7 Entirely Entirely third- first-person person