DON’T WORRY, BE MINDFUL: MINDFULNESS, PERSEVERATION, AND HEART RATE VARIABILITY

Rolf A. Ritchie

A Thesis

Submitted to the Graduate College of Bowling Green State University in partial fulfillment of the requirements for the degree of

MASTER OF ARTS

August 2016

Committee:

William O'Brien, Advisor

Eric Dubow

Verner Bingman © 2016

Rolf Ritchie

All Rights Reserved iii ABSTRACT

William H. O’Brien, Ph.D., Advisor

Perseverative cognitions have been found to be a significant predictor of cardiovascular reactivity to stress which, in turn, is a predictor of cardiovascular disease. The link between perseveration and cardiovascular reactivity is supported in both laboratory and ambulatory research. Researchers have suggested that mindfulness may mediate the relationship between perseverative cognition and cardiovascular reactivity to stress. In the present study, participants were exposed to a social stressor task and their level of cardiovascular reactivity was analyzed in both an anticipatory and recovery condition. Results indicated that increased levels of mindfulness are associated with more complete recovery following a stressor and that increased levels of perseveration are associated with less complete recovery. iv ACKNOWLEDGEMENTS

First and foremost, I would like to acknowledge my advisor Dr. William O’Brien for his continued guidance and assistance with this project. I would also like to thank my committee members Dr. Verner Bingman and Dr. Eric Dubow for their constructive feedback during the development of this master’s thesis. Furthermore, I would like to thank my research assistants,

Kaitlyn Taddie, Carlie Forster, and Mckenna Freeman. Their assistance, both in the lab and outside of it, were essential to the completion of this project. I would also like to extend a heartfelt thanks to my fiancé Gina Mattei, who assisted with editorial feedback as well as emotional support after long hours in the lab. v

TABLE OF CONTENTS

Page

INTRODUCTION………………………………………………………………………...... 1

METHOD…………………………………………………………………………….…….. 4

Participants……………………………….…………………………………………. 4

Measures.…………………………………………………………………………… 5

Demographics Questionnaire.………………………………………………………. 5

Acceptance and Action Questionnaire II…………………………………………… 5

Five Factor Mindfulness Questionnaire…………………………………………….. 5

Penn State Worry Questionnaire…….……………………………………………… 6

Ruminative Thought Style Questionnaire…..…………………………………...….. 7

Perseverative Thinking Questionnaire…..……………………….……………...….. 7

Heart rate variability………………………..…………………………………...….. 8

Trier Social Stress Test…..……………………………………………………...….. 9

Procedures…………………………………..…………………………………...….. 10

Major Analysis………………………….…..…………………………………...….. 11

Hypothesis One: Perseveration is associated with cardiovascular reactivity

duration…...…………………………………...……………………………. 11

Hypothesis Two: Perseveration is inversely associated with mindfulness…. 11

Hypothesis Three: Mindfulness is inversely associated with cardiovascular

reactivity duration…...……….…………………..…………………………. 12

Hypothesis Four: Mindfulness mediates the relationship between perseverative

cognition and cardiovascular reactivity duration …...…………………… ... 12 vi

RESULTS…………………………………………………………..…………..………… .. 13

Data Reduction……...……………………………………………………………… 13

Preliminary Analysis……...……………………………………………………… ... 13

Demographic variables and HRV………………………………………… .. 13

Correlations Among self-report measures.……………..………………… .. 14

Manipulation Check……………………..……………..…………………… 14

Main Analysis…………….……………………..……………..……...……………. 14

Perseveration and levels of HRV reactivity……………….……...………… 15

Perseveration and duration of HRV reactivity…...……..………...………… 15

Residualized HRV scores and perseveration…….……..………...………… 16

Mindfulness and levels of HRV reactivity……………..………...……… .... 16

Mindfulness and duration of HRV reactivity…………..………...……...... 17

Residualized HRV scores and mindfulness……………..………...... …… ... 18

Mediation analysis……………………………………....………...……… .. 18

Female Participant Analyses…………....………...……………..………...……… .. 18

Correlations Among self-report measures.……………..………………… .. 19

Manipulation Check……………………..……………..…………………… 19

Perseveration and levels of HRV reactivity……………..………...……… .. 19

Perseveration and duration of HRV reactivity…………..………...……… .. 20

Residualized HRV scores and perseveration…….……..………...………… 21

Mindfulness and levels of HRV reactivity……………..………...……… .... 21

Mindfulness and duration of HRV reactivity…………..………...………… 22

Residualized HRV scores and mindfulness……………..………...... …… ... 22 vii

Mediation analysis……………………………………....………...……… .. 22

DISCUSSION.………………..……………………………………..…………..……… ..... 24

Limitations and Future Directions……….…..…...……………..………...……… .. 27

Conclusions………………..…………....………...……………..………...……… .. 28

REFERENCES.……...………..……………………………………..…………..………… 24

APPENDIX A. INITIAL STEPS AND RECRUITMENT FOR NEW PARTICIPANTS… 70

APPENDIX B. INITIAL PROTOCOL………………………………….……..…………… 71

APPENDIX C. DEMOGRAPHIC INVENTORY………..………….………..…………… 72

APPENDIX D. ACCEPTANCE AND ACTION QUESTIONNAIRE-II…...…….……… . 75

APPENDIX E. FIVE FACET MINDFULNESS QUESTIONNAIRE………..…………… 76

APPENDIX F. PENN STATE WORRY QUESTIONNAIRE…….….…………………… 77

APPENDIX G. RUMINATIVE THOUGHT STYLE QUESTIONNAIRE……………..… 78

APPENDIX H. PERSEVERATIVE THINKING QUESTIONNAIRE…….……………… 79

APPENDIX I. PROTOCOLS FOR BIOPAC EQUIPMENT…....….………………...…… 80

APPENDIX J. ELECTRODE PLACEMENT GUIDE………..…………..…..…………… 82

APPENDIX K. RECORDED TRIER SOCIAL STRESS TEST SCRIPT………..….….… 83

APPENDIX L. CONFEDERATE RECRUITMENT AND TRAINING PROTOCOLS… .. 84

APPENDIX M. TRIER SOCIAL STRESS TEST PROTOCOL…………………...……… 85

APPENDIX N. PERSEVERATION AND MINDFULNESS INFORMED CONSENT

FORM ...…....………….………..….….……..……………………………………………. 87

APPENDIX O. POST TEST SELF RATING SCALE……..….….……….……………… 89

APPENDIX P. DEBRIEFING SCRIPT ………….………..….….……..……………… .... 90

APPENDIX Q. …………………………………………………………...... 91 viii

LIST OF TABLES

Table Page

1 Demographic Characteristics of the Sample ...... 40

2 Main Effect Analysis with Gender as a Covariate ...... 41

3 Correlations Between Self-Report Measures of Mindfulness and Perseveration ...... 42

4 Within Group Analyses for Main Effect by Condition ...... 43

5 Between and Within Subject Effects by Self-Report Measure Grouping ...... 44

6 Correlations Between Self-Report Measures of Perseveration and Recovery

Duration…………………………………………………………………………….. 45

7 Correlations Between Self-Report Measures of Perseveration and Residual Recovery

Scores…………………………………………………………………...... 46

8 Within Group Analyses for High Mindfulness Participants by Condition ...... 47

9 Within Group Analyses for Low Mindfulness Participants by Condition ...... 48

10 Correlations Between Self-Report Measures of Mindfulness and Recovery

Duration…………………………………………………………………………….. 49

11 Correlations Between Self-report Measures of Mindfulness and Residual Recovery

Scores………...... 50

12 Mediation Analysis with RTS, FFMQ, and Residual Recovery 1 ...... 51

13 Indirect Effects of Mediation Paths ...... 52

14 Correlations Between Self-Report Measures of Mindfulness and Perseveration Among

Female Participants ...... 53

15 Within Group Analyses of Condition Main Effect for Female Participants ...... 54 ix

16 Between and Within Subject Effects by Self-Report Measure Grouping for Female 54

Participants……………… ...... 55

17 Within Group Analyses for Low RTS by Condition Among Female Participants .... 56

18 Paired Sample t-tests for High RTS by Condition Among Female Participants ...... 57

19 Correlations Between Self-Report Measures of Perseveration and Recovery

Duration Among Female Participants ...... 58

20 Correlations Between Self-Report Measures of Perseveration and Residual Recovery

Periods Among Female Participants ……………… ...... 59

21 Within Group Analyses for High Mindfulness Female Participants by Condition ... 60

22 Within Group Analyses for Low Mindfulness Female Participants by Condition .... 61

23 Correlations Between Self-Report Measures of Mindfulness and Recovery

Duration Among Female Participants……… ...... 62

24 Correlations Between Self-Report Measures of Mindfulness and Residual Recovery

Scores Among Female Participants ……………… ...... 63

25 Mediation Analysis for RTS, FFMQ, and Residual Recovery 1 Among Female

Participants ……………… ...... 64 x

LIST OF FIGURES

Figure Page

1 HRV Condition and Gender ...... 65

2 HRV and Condition ...... 66

3 Mindfulness Levels, HRV, and Condition ...... 67

4 Mediation Analysis for RTS, FFMQ, and Residual Recovery 1 ...... 68

5 Mediation Analysis for RTS, FFMQ, and Residual Recovery 1 Among Female

Participants…...... 69 1 DON’T WORRY, BE MINDFUL

INTRODUCTION Perseverative cognition appears to be a ubiquitous human experience. Behavioral researchers have historically examined perseveration as two separate constructs: worry and rumination. Worry is generally conceptualized as persistent and anxious thoughts about future events and rumination is conceptualized as persistent and anxious thoughts about past events

(Brosschot, Gerin, & Thayer, 2006; Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008). Although worry and rumination each have unique characteristics, they also possess many similarities and tend to affect the body in similar ways (Linden, Earle, Gerin, & Christenfeld, 1997; Segerstrom,

Tsao, Alden, & Craske, 2000). Because of this, some researchers have suggested that they be subsumed under a single term (Brosschot, Pieper, & Thayer, 2005). Furthermore, perseverative cognition has been found to be associated with prolonged cardiovascular reactivity to stress

(Verkuil, Brosschot, de Beurs, & Thayer, 2009), which has been identified as a risk factor for the development of hypertension and cardiovascular disease in cross sectional (Anupama Deepak,

Aithal, Khode, & Nallulwar, 2014; Jaiswal et al., 2013; Kubzansky et al., 1997; Neves et al.,

2012), longitudinal (Chandra et al., 2012; Low, Salomon, & Matthews, 2009), laboratory (Chida,

& Steptoe, 2010) and meta-analytic research (Schuler & O’Brien, 1997).

There are three ways that perseverative cognition may be associated with prolonged cardiovascular reactivity. First, it may be that perseverative cognitions promotes anticipatory cardiovascular reactivity to stress (Barefoot & Schroll 1996; Borkovec, Rodinson, Pruzinsky, &

DePree, 1983; Brosschot, 2010; Brosschot, Van Dijk, & Thayer, 2007; Pieper & Brosschot,

2005). Given that anticipatory cardiovascular reactivity is instigated before the stressor has been encountered, it must be cognitively mediated. This association between anticipatory perseverative cognition and cardiovascular reactivity has been observed in ambulatory and laboratory studies (Brosschot, Dijk, & Thayer 2006; Delgado et al., 2009; Knepp & Friedman, 2 DON’T WORRY, BE MINDFUL

2008; Pieper, Brosschot, Leeden, & Thayer, 2010). Second, perseverative cognition may promote delayed cardiovascular recovery from stress. Recovery can be conceptualized as the period of time it takes for the cardiovascular system to return to baseline after removal of a stressor (Conway, Csank, Holm, & Blake, 2000). Ambulatory research has suggested that there is a relationship between perseverative cognition and delayed recovery following a stressor

(Brosschot, Verkuil, & Thayer, 2010; Radstaak, Geurts, Brosschot, & Cillessen, 2011). In addition to ambulatory studies where participants were exposed to real life stressors, laboratory studies have also reported a relationship between perseverative cognitions and delaying recovery following a stressor (Key, Campbell, Bacon, & Gerin, 2008; McEvoy, Moulds, & Mahoney,

2013). Third, perseveration may promote cardiovascular reactivation. Cardiovascular reactivation has been measured in multiple laboratory studies where research participants engaged in perseveration about past experiences were observed to re-initiate cardiovascular reactivity. This reactivation effect can occur well after the initial stressor had been removed

(Brosschot, 2010; Delgado et al., 2009; Pieper, Brosschot, Leeden, & Thayer 2010). It has also been found that if a participant was sufficiently distracted from their perseverative cognitions, the effects of the reoccurring cardiovascular reactivity were significantly diminished (Ottaviani,

Shapiro, & Couyoumdjian, 2013).

There are a number of factors that may moderate the effect of perseveration on duration of cardiovascular reactivity. Researchers have suggested that mindfulness may be one of these important moderators (Jacobs et al., 2013). This suggestion is based on research demonstrating that mindfulness has been associated with lower levels of worry (Delgado, Guerra, Perakakis, &

Vera, 2010; Fisak & Lehe, 2012; Roemer et al., 2009; Ruiz, 2014; Verplanken & Fisher, 2014) and rumination (Alleva, Roelofs, Voncken, & Meevissen, 2014; Deyo, Wilson, Ong, & 3 DON’T WORRY, BE MINDFUL

Koopman, 2009; Gilbert & Gruber, 2014; Hawley, Schwartz, Bieling, & Irving, 2014; Jain,

Shapiro, Swanick, & Roesch, 2007; Labelle, Campbell, & Carlson, 2010). Furthermore, mindfulness has been associated with reduced anticipatory cardiovascular reactivity and more complete and/or faster cardiovascular recovery from stressor exposure (Burg, Wolf, & Michalak,

2012; Delgado, Guerra, Perakakis, & Vera, 2010; Joo, Lee, Chung, & Shin, 2010; Mankus,

Aldao, Kerns, & Mayville, 2013; Prazak, Critelli, Martin, & Miranda, 2012). However, to date, there has not been a direct evaluation of the interactions between perseverative cognitions, mindfulness, and duration of cardiovascular reactivity to stress.

In summary, perseveration (i.e. a combination of worry and rumination) has been associated with increases in cardiovascular reactivity, which has been linked to increased risk for cardiovascular disease. In addition, research suggests mindfulness may mediate the relationship between perseveration and cardiovascular reactivity, although the moderation has not yet been directly evaluated. Thus, the aim of the current study is to specifically examine the extent to which mindfulness may mediate the association between perseverative cognition and the duration of cardiovascular reactivity to a stressor. It was specifically hypothesized that:

(a) Perseveration will be positively associated with levels of cardiovascular reactivity that

occur before and after exposure to a laboratory stressor.

(b) Perseveration will be inversely associated with mindfulness.

(c) Mindfulness will be inversely associated with levels of cardiovascular reactivity that

occur before and after exposure to a laboratory stressor.

(d) Mindfulness will mediate the relationship between perseverative cognition and levels of

cardiovascular reactivity that occur before and after exposure to a laboratory stressor.

4 DON’T WORRY, BE MINDFUL

METHOD

Participants

Participants were recruited from the Bowling Green State University undergraduate student body population (see Appendix A). Bowling Green State University’s student population is comparable in diversity to the greater United States and is approximately 80% White, 10%

Black, 4% Hispanic, and 6% other. Gender is also evenly distributed, with 44% of the campus identifying as male and 56% identifying as female. Students were compensated with SONA credits or $10 for their participation. 42 participants were brought into the Bowling Green State

University Behavioral Medicine Lab to complete questionnaires and establish baseline measurements before engaging in experimental conditions (see Appendix B). 1 participant did not complete the protocol and elected to stop during the anticipation condition.

Measurement of Heart Rate Variability (HRV) is sensitive to a number of environmental factors. In order to account for this sensitivity, participants were asked to abstain from: caffeine, alcohol, and marijuana for 24 hours prior to the laboratory assessment. Three participants were excluded from analyses due to excessive artifacts in HRV data. Additionally, participants were excluded from participating in the study if they report any of the following: a history of cardiovascular disease, diabetes, a history of severe mental illness, current use of medications that directly affect cardiac functioning (e.g. beta blockers), if they smoke or chew tobacco, if they have a body mass index over 30, if they are over 30 years of age, or if they have had a recent major surgery. Two participants met exclusion criteria due to smoking cigarettes and were not included in analyses. Demographic data for the 38 participants included in analyses is presented in Table 1.

5 DON’T WORRY, BE MINDFUL

Measures

Demographics questionnaire. Demographic data was collected using a demographic survey (see Appendix C). Information included: age, sex, race, marital status, education level, and occupation. In addition, medical information including history of mental illness, cardiovascular disease, and substance abuse, as well as daily exercise routine and current medication use was evaluated. The participant’s history of exposure to mindfulness practice was also collected.

Acceptance and Action Questionnaire II. The acceptance and action questionnaire II

(AAQ-II) is a 7-item questionnaire that assesses the participant’s level of psychological flexibility (Appendix D), which is defined as the ability to maintain contact with thoughts and feelings in the present moment as well as orienting one’s self to his or her values (Bond et al.,

2011; Hayes 2006).

The AAQ-II assesses psychological flexibility as a single construct and was found to have a Cronbach α of .88, with strong convergent, predictive and criterion-related validities

(Bond et al., 2011). The AAQ-II was also found to correlate with multiple other measures of subjective stress experience including the Beck Depression Inventory-II (correlation coefficient

= .71).

Five Factor Mindfulness Questionnaire. The five factor mindfulness questionnaire

(FFMQ) is a widely used scale designed to assess an individual’s tendency to engage in mindful behaviors in everyday life (Baer et al. 2008; Christopher, Neuser, Michael, & Baitmangalkar,

2012). The FFMQ consists of 39 items derived from a factor analysis of 112 items that were collected from five other measures of mindfulness (Appendix E). The 39 items comprise five subscales, each measuring a different aspect of mindfulness: observing, describing, acting with 6 DON’T WORRY, BE MINDFUL awareness, non-judging of inner experience, and non-reactivity to inner experience. The construct of observing is conceptualized as noticing or attending to internal experiences such as bodily sensations or thoughts, while describing is defined as the ability to recount internal experiences. Acting with awareness involves attending to moment-to-moment activities and avoiding automaticity. Nonjudgment of inner experience can be understood as engaging in an open non-evaluative stance toward thoughts, while nonreactivity to inner experience involves not attaching one’s self to any particular thought (Baer et al. 2008).

These subscales have repeatedly demonstrated adequate psychometric properties for measuring the construct of mindfulness (Baer et al. 2008). The five factors of the FFMQ also display an adequate to good range of internal consistency for each of its indices (Cronbach’s α =

0.75 - .91; Christopher et al., 2012). Multiple hierarchical modeling tests have demonstrated that the five factors of the FFMQ are indicators of an overall mindfulness construct (Baer et al. 2008;

Christopher et al., 2012). The five factor model has been found to fit data well with a

Comparative Fit Index of .90. Furthermore, three of the four tested factors significantly predicted overall mental health: acting with awareness, nonjudgment, and nonreactivity. (Baer et al. 2008).

Penn State Worry Questionnaire. The Penn State Worry Questionnaire (PSWQ) is a

16-item measure that assesses trait worry. The measure initially contained 161 items and used a five-point scale. After preliminary psychometric evaluations of the PSWQ, the 161 items were reduced to the current 16-item version (Meyer, Miller, Metzger, & Borkovec, 1990; Appendix

F).

The PSWQ has demonstrated excellent psychometric qualities and recent analysis has shown that the PSWQ assesses a unitary construct of trait worry (Hazlett-Stevens, Ullman, &

Craske, 2004). Other testing has revealed that the PSWQ has high internal consistency (α = .93) 7 DON’T WORRY, BE MINDFUL and high test-retest reliability (r = .92) with an 8 to 10 week test-retest interval (Rijsoort,

Vervaeke, & Emmelkamp, 1999).

Ruminative Thought Style Questionnaire. The ruminative thought style questionnaire

(RTS) is a 20-item self-report questionnaire that assesses rumination utilizing 4 factors: repetitive thoughts, counterfactual thinking, problem-focused thoughts, and anticipatory thoughts

(Tanner, Voon, Hasking, & Martin, 2013; Appendix G). The repetitive thought section is considered to reflect traditional conceptions of rumination and the questions contained in this factor refers to how rumination may be intrusive, persistent, and automatic in nature. The counterfactual thinking portion of the RTS assesses if participants are likely to engage in wishful thinking about alternative outcomes. The problem focused thoughts section of the RTS examines participant’s propensity to engage in non-productive coping strategies, such as repetitive problem based thinking. The fourth factor, anticipatory thoughts, assesses future- oriented ruminative thinking, which may overlap with the construct of worry. However, the anticipatory thoughts factor is considered to assess the persistent and predictable nature of ruminative thinking when confronted with future difficulties (Brinker & Dozois, 2009).

The RTS has demonstrated excellent internal validity (coefficient α = .92; Tanner, Voon,

Hasking, & Martin, 2013). Additionally, the RTS was positively correlated with depressed mood and anxiety as well as other measures of repetitive thinking. Test-retest was also high (r = .80) as was internal validity (.89). The RTS was also predictive of future negative mood when controlling for current depressed mood in a longitudinal study at the 1-week (β = .20, p > .01) and the 3-week follow-up (β = .32, p > .01; Brinker & Dozois, 2009).

Perseverative Thinking Questionnaire. The perseverative thinking questionnaire (PTQ) is a recently developed measure that assesses repetitive negative thinking. The perseverative 8 DON’T WORRY, BE MINDFUL thinking questionnaire contains 15 items in three factors: the core features of repetitive negative thinking (repetitiveness, intrusiveness, and difficulties with disengagement), unproductiveness of repetitive negative thinking, and mental capacity (perceived interference with a participants thinking) captured by repetitive negative thinking (Ehring et al., 2011; Appendix H).

The PTQ has demonstrated excellent internal consistency (α = .95) and test–retest reliability (PTQ total score test-retest reliability across 4 weeks was reported to be .69; p < .001;

Ehring et al., 2011). The PSQ also demonstrated significant correlations with measures of related constructs, such as the Penn State Worry Questionnaire and the rumination scale from the

Response Styles Questionnaire. Higher scores on the PTQ were also associated with depression symptoms on the Beck Depression Inventory (r=.54; Ehring et al., 2011).

Heart rate variability. Heart rate variability (HRV) or the variation of time between heart beats was collected using a Biopac Systems MP135 and Biopac analysis software.

Electrocardiograph (ECG) electrodes was attached to the participant using a Lead II configuration (see Appendix I for equipment protocols). The negative electrode was placed on the left collar bone (white), while the positive electrode (red) was placed on the left side of the thorax, and the ground electrode (black) was placed on the right collar bone (see Appendix J).

The Biopac MP135 samples ECG activity at a rate of 1000Hz which is higher than the suggested sampling rate of 500Hz which is required to accurately measure HRV (Allen et al., 2007;

Bernston, Cacioppo, & Quigley, 1991).

HRV was calculated by assessing the differences in frequency among the time periods between heartbeats. Specifically, the Biopac AcqKnowledge software utilizes template matching software to isolate individual heart beats and the time intervals (in milliseconds) between them

(R-R intervals). If artifacts were present, filtering was used to generate accurate HRV data. In 9 DON’T WORRY, BE MINDFUL order to filter the data, band pass filters with values between 0.5 and 35Hz were used. This removed baseline drift and high-frequency noise from the ECG data. After the signals were filtered, template matching was used to identify individual QRS complexes. Using spectral analysis, the R-R intervals were partitioned into Very Low Frequency (.0033 to 0.04 Hz), Low

Frequency (0.04 to 0.15 Hz), and High Frequency (0.15 to .4 Hz). Very Low Frequency HRV is considered a measure of thermoregulation and blood pressure (Tripathi, 2011), Low Frequency

HRV is considered a measure of sympathetic influences on heart rate, and High Frequency HRV is a measure of autonomic influences on heart rate (Agelink et al., 2001). However, only the

High was examined in this study. This frequency band has shown excellent validity in measuring autonomic influences on cardiovascular functioning (Agelink et al., 2001).

While test-retest reliability over long periods for HRV is difficult to establish (as many external factors can affect it), measuring HRV divergence from baseline in the short-term is a well-validated method of assessing both autonomic and sympathetic activity. Additionally, there is not one universally agreed upon method to obtain HRV values. Despite this, the different methods produce highly correlated results (Electrophysiology, 1996). For example, researchers conducted a study that assessed 96 participants and examined their results using two different approaches to calculate HRV. The results of this comparison demonstrated that these different approaches across two conditions produced results with correlations between .992 and .995 respectively (Allen, Chambers, & Towers, 2007).

Trier Social Stress Test. The Trier Social Stress Test (TSST) consists of two separate conditions: anticipation and performance. During the anticipation condition, participants are informed via audio recording that they will be conducting a mock interview and that they must present a five-minute speech to two confederate judges (see Appendix K for audio recording 10 DON’T WORRY, BE MINDFUL script). These judges will be research assistants recruited from the BGSU undergraduate population (Appendix L). The participants are then given 10 minutes to prepare their speech and then five minutes to deliver it. After the public speaking task, the participants are instructed to start at 1022 and subtract 13 concurrently from this number. If participants make any errors they were asked to restart this task from the beginning, continuing until the 5 minutes has elapsed (B.

M. Kudielka, 2007, see Appendix M for TSST protocol). These two activities together are referred to as the performance section of the task.

Researchers have shown that the Trier Social Stress Test can reliably instigate stress responses in both of the main stress pathways (hypothalamic-pituitary –adrenal axis and the sympathetic-adrenal-medullary system; Allen, Kennedy, Cryan, Dinan, & Clarke, 2014).

Furthermore, compared to a control condition where participants were allowed to speak freely before engaging in simple mental math problems, the Trier Social Stress Test generated significantly larger stress responses (Het, Rohleder, Schoofs, Kirschbaum, & Wolf, 2009).

Procedures

The testing periods occurred at multiple times throughout the week to better fit student schedules; however, these testing periods occurred in the same 3 hour block each day to better control for circadian rhythm effects on HRV. Upon arrival, participants were given an informed consent document (Appendix N) as well as the other self-report measures. After they completed the self-report measures, participants were asked to remove their shoes, and their weight and height was measured in order to calculate a BMI score. Participants were seated upright in a reclining chair and the EKG electrodes were attached. Following a one-minute period to ensure proper electrode adhesion, participants were instructed to sit as still as possible in order to avoid creating artifacts in the recording process. 11 DON’T WORRY, BE MINDFUL

The laboratory procedure consisted of four conditions: a 15-minute resting Baseline condition, the first portion of the Trier Social Stress Test (which served as a 10-minute anticipation condition), the second portion of the Trier Social Stress Test (which served as a 10- minute social performance stressor), and a 10-minute recovery period. Heart rate data was collected throughout the experiment.

During the resting Baseline condition, participants were asked to keep their eyes closed, stay relaxed, and to focus on their breathing. During the TSST, participants followed the prompts given according to the TSST protocol. During the recovery period, participants were told that a score profile assessing their performance on the math and speech tasks would be generated. At the conclusion of the Recovery conditions, electrodes were removed and participants were asked to rate from 1-10 how much they worried in the anticipatory condition and how much they ruminated during the recovery condition (Appendix O). Participants were then given a debriefing form (Appendix P), and given compensation for their participation in this study.

Major Analyses

Hypothesis One: Perseveration is associated with cardiovascular reactivity duration.

It was predicted that higher levels of perseveration (measured by the PTQ, PSWQ, and RTS) would be associated with an increased duration of cardiovascular reactivity during the anticipation and recovery portion of the experiment. Linear regression was used to test if the relationship between scores and cardiovascular duration were significant. A p-value of .05 was used to indicate significance.

Hypothesis Two: Perseveration is inversely associated with mindfulness. It was predicted that higher levels of mindfulness (measured by scores on the FFMQ and AAQ-II) would be associated with decreased scores on the PTQ, PSWQ, and RTS. Linear regression was 12 DON’T WORRY, BE MINDFUL used to test if the relationship between scores of mindfulness and perseveration were significant.

A p-value of .05 was used to indicate significance.

Hypothesis Three: Mindfulness is inversely associated with cardiovascular reactivity duration. It was predicted that increased levels of mindfulness (measured by the FFMQ and

AAQ-II) would be associated with decreased duration of cardiovascular reactivity in the anticipatory and recovery periods of the experiment. Linear regression was used to test if the relationship between scores and mindfulness and perseveration were significant. A p-value of .05 was used to indicate significance.

Hypothesis Four: Mindfulness mediates the relationship between perseverative cognition and cardiovascular reactivity. It was predicted that after controlling for mindfulness, the regression coefficient between perseveration and cardiovascular reactivity duration would be reduced. If this occurs, mindfulness is likely moderating the relationship between perseveration and cardiovascular reactivity. 13 DON’T WORRY, BE MINDFUL

RESULTS Data Reduction

High frequency heartrate variability (HRV) was calculated using Fourier transformations and subsequently averaged across each condition of the experiment. This averaging procedure for HRV generated six conditions: baseline, anticipation, speech, math, recovery 1, and recovery

2. In order to allow for an adaptation period, only HRV from the last ten minutes of the 15- minute baseline condition was used. The 10-minute recovery condition was split into two five- minute epochs: recovery 1 (minutes 1-5) and recovery 2 (minutes 6-10).

Preliminary Analyses

Demographic variables and HRV. A 1 x 6 repeated measures ANOVA with BMI as a covariate was conducted to examine the relationship between BMI, experimental condition, and

HRV. Results indicated that BMI, condition, and HRV were not related, either as a main effect F

(1, 36) = 1.15, p = .291 or interaction F (1.97, 70.77) = .11, p = .897. A 1 x 6 repeated measures

ANOVA was conducted using age as a covariate was conducted to examine the relationship between age, condition, and HRV. Results indicated that age was not significantly associated with HRV either as a main effect F (1, 36) = 1.05, p = .31 or interaction F (1.97, 70.75) = .50, p

= .603. A 2 x 6 repeated measures ANOVA was used to examine the relationship between gender, condition, and HRV. Gender was associated with HRV, F (1, 36) = 5.12, p = .03, such that women had higher HRV across condition, but not as an interaction F (1.98, 71.30) = 1.32, p

= .274 (see Table 2; Figure 1).

An independent samples t-test was conducted between gender and each level of the experimental condition (i.e. baseline, anticipation, speech, math, recovery 1 and recovery 2). A

Bonferroni adjusted alpha was used p = .008 (.05/6). Results indicated that women (M = 14 DON’T WORRY, BE MINDFUL

1674.99, SD = 1368.66) had significantly higher HRV compared to men (M = 611.47, SD =

417.59) at recovery 2, t (34.55) = -3.64 p = .001.

Correlations among self-report measures. All of the mindfulness measures (FFMQ,

AAQ, and MAAS) were significantly correlated with all of the perseveration measures (PSWQ,

PTQ, and RTS). The directions of the observed correlations were consistent with expectations that higher perseveration would be associated with lower mindfulness. It is important to note that on the MAAS, lower scores indicate higher mindfulness, which accounts for the mix of negative and positive correlations depicted (see Table 3).

Manipulation check. In order to test if participants had reacted to the Tier Social

Stressor Task, a 1 x 6 repeated measures ANOVA was conducted. Mauchly’s test indicated that the assumption of sphericity had been violated, X2 (14) = 118.18, p < .001. Therefore, the

Greenhouse-Geisser correction was used to modify degrees of freedom and the critical values used to determine significance (ε = .034). After adjusting for sphericity, there was a significant main effect for condition on HRV, F (1.97, 72.93) = 9.88 (see Figure 2).

A series of planned comparisons using paired-samples t-tests were conducted to evaluate the main effect for condition. Tests of the twelve comparisons were conducted using Bonferroni adjusted alpha levels of .004 per test (.05/12; See Table 4). Results indicated that there were significant within-group differences in reactivity between baseline and anticipation, speech, math, and recovery 1. Recovery 2 was not significantly different from baseline.

Main Analyses

Preliminary analyses indicated that when gender was used as a covariate, the relationship between perseveration, mindfulness, and HRV reactivity was significantly altered. In order to account for this, the main analyses were conducted first using both men and women (N = 38), 15 DON’T WORRY, BE MINDFUL and then again on a female only group (n = 27). Male-only hypotheses tests could not be conducted due to the small sample size (n = 11).

Perseveration and levels of HRV reactivity. In order to determine the association between perseveration and HRV, participants were separated into high-perseveration and low- perseveration groups using a median split of the PTQ. A 2 x 6 repeated measures ANOVA was conducted (high/low perseveration x condition: baseline, stressor anticipation, speech task, math task, recovery 1, and recovery 2). Mauchly’s test indicated that the assumption of sphericity had been violated, X2(5) = 115.82, p < .001. Therefore, the Greenhouse-Geisser correction was used to modify both degrees of freedom and the critical values used to determine significance (ε =

.033). After adjusting for sphericity, there continued to be a significant main effect for condition on HRV, F (1.98, 71.32) = 10.35, p < .001. There were no significant interaction effects observed with the PTQ groupings. These results are depicted in Table 5.

Groups were also formed using median splits based on the PSWQ and RTS. Two 2 x 6 repeated measures ANOVA were conducted using HRV as the dependent variable to evaluate the relationship between the above variables and HRV across conditions (high/low median split groupings x condition: baseline, stressor anticipation, speech task, math task, recovery 1 and recovery 2). While the main effect for condition was again present for each analysis, no interaction effects were found to be significant (See Table 5).

Perseveration and duration of HRV reactivity. In order to determine the association between perseveration and the duration of cardiovascular reactivity, duration measures were first calculated. To calculate duration measures, each participant’s HRV at baseline was subtracted from HRV at Recovery1 and Recovery 2. These difference scores were then classified as

“recovered” (coded as a 0) when the difference scores were 0 or less or “not recovered” (coded 16 DON’T WORRY, BE MINDFUL as a 1) when the difference score was greater than 0. The PWSQ, PTQ, and RTS were then correlated with these recovery scores. None of the observed correlations were significant, although most were in the expected direction (See Table 6)

Residualized HRV scores and perseveration. In order to test the hypothesis that perseveration was associated with less complete recovery following a stressor, standardized

HRV residual scores were calculated. Standardized residual scores were generated by regressing the mean level of HRV during each recovery period on the mean levels of HRV during the serial subtraction task. These standardized HRV residual scores provided an index of recovery that was statistically uncorrelated with stressor HRV. Next, correlations were calculated to evaluate the relationship between perseveration measures and the HRV residual scores. Consistent with predictions, higher scores on the RTS were significantly correlated with less HRV recovery during Recovery 1 (See Table 7).

Mindfulness and levels of HRV reactivity. Participants were separated into a high- mindfulness and low-mindfulness groups using a median split of the total FFMQ score. A 2 x 6 repeated measures ANOVA using HRV as the dependent variable was conducted to evaluate the relationship between mindfulness and HRV across conditions (high/low mindfulness x condition: baseline, stressor anticipation, speech task, math task, recovery 1, and recovery 2. Mauchly’s test indicated that the assumption of sphericity had been violated, X2 (5) = 104.11, p < .001.

Therefore, the Greenhouse-Geisser correction was used to modify both the degrees of freedom and the critical values used to determine significance (ε = .047). After adjusting for sphericity, there continued to be a significant main effect for condition (as described earlier) on HRV, F

(2.11, 75.90) = 10.00, p < .001. Additionally, an interaction effect was observed F (2.11, 75.90)

= 3.94, p = .022 (See Table 5 and Figure 3). 17 DON’T WORRY, BE MINDFUL

Two sets of follow-up analyses of the interaction between FFMQ scores and HRV were conducted. First, between group pairwise comparisons were conducted for each condition. None of the comparisons were significant using the Bonferroni criterion of .008 (.05/6). However, using a conventional .05 alpha level, those in the high-mindfulness group (M = 2402.89, SD =

2151.18) demonstrated higher HRV than those in the low mindfulness group (M = 1301.24, SD =

825.85), F (1) = 4.159, p = .049 during the baseline condition.

The second set of follow-up analyses involved conducting within-group paired samples t- tests. These comparisons were conducted using Bonferroni adjusted alpha levels of .004 per test

(.05/12; See Table 8). Results indicated that participants in the high mindfulness group reacted more and recovered more during the stressor conditions and recovery conditions. Conversely, the low mindfulness group was less reactive overall (see Table 9).

Following the FFMQ and HRV 2 x 6 repeated measures ANOVA, groups were also formed using median splits based on the MAAS and AAQ. Two 2 x 6 repeated measures

ANOVA were conducted using HRV as the dependent variable to evaluate the relationship between the above variables and HRV across conditions (high/low median split groupings x condition: baseline, stressor anticipation, speech task, math task, recovery 1 minutes 0-5, and recovery 2 minutes 6-10). While the main effect for condition was present in each measure based grouping, no interaction effects were found to be significant (See Table 5).

Mindfulness and duration of HRV reactivity. In order to determine the association between mindfulness and the duration of cardiovascular reactivity, the duration measures

(described earlier) were correlated with the FFMQ, AAQ, and MAAS. None of the observed correlations were significant, although most were in the expected direction (See Table 10). 18 DON’T WORRY, BE MINDFUL

Residualized HRV scores and mindfulness. Correlations were used to determine the interrelatedness of mindfulness and HRV residual scores (see Table 11). The directions of the observed correlations were consistent with expectations. Scores on the FFMQ were significantly positively correlated with HRV residual scores and scores on the MAAS were negatively correlated with HRV residual scores during the first five minutes of the recovery period only.

The direction of these correlations indicated that higher levels of mindfulness were associated with more complete recovery following the stressor. The AAQ was not significantly correlated with recovery at either time point.

Mediation analysis. The correlational analyses indicated that the RTS and the FFMQ were significant predictors of residualized HRV scores. Therefore, a mediation analysis was conducted using the RTS as the predictor variable, the FFMQ as a mediator, and the recovery 1 residualized change score as the outcome variable. The mediation approach used followed the recommendations outlined by Preacher and Hayes (2008) who suggested that a bootstrapping method is particularly well suited for estimating direct and indirect effects with small samples.

The results of these analyses indicated that FFMQ scores did not mediate the relationship between RTS scores and the recovery 1 residualized change score. The mediation results for the

RTS, FFMQ, and recovery 1 residualized change score are presented in Table 12, Table 13 and

Figure 4.

Female Participant Analyses

The preliminary analyses indicated that there was a significant difference in HRV when gender was included as a covariate. In order to further evaluate the association between gender and

HRV, female only (n = 27) analyses were conducted. All of the analyses reported above were reanalyzed using only female participants. 19 DON’T WORRY, BE MINDFUL

Correlations among self-report measures. The results from the female only analyses of self-report measures were congruent with the total sample gender results. All relationships that were significant above retained their significance and direction such that all of the mindfulness measures (FFMQ, AAQ, and MAAS) were significantly correlated with perseveration measures

(PSWQ, PTQ, and RTS). Furthermore, measures of mindfulness were significantly intercorrelated with each other, as were the measures of perseveration (see Table 14).

Manipulation check. In order to test if the all-female participant group had reacted to the

Tier Social Stressor Task, a 1 x 6 repeated measures ANOVA was conducted with HRV across conditions (condition: baseline, stressor anticipation, speech task, math task, recovery 1 minutes, and recovery 2). Mauchly’s test indicated that the assumption of sphericity had been violated, X2

(5) = 86.81, p < .001. Therefore, the Greenhouse-Geisser correction was used to modify both the degrees of freedom and the critical values used to determine significance (ε = .027). After adjusting for sphericity, there was a significant main effect for condition on HRV, F (1.92,

49.84) = 7.94, p < .001. This result is congruent with the total sample analyses.

A series of planned comparisons using paired-samples t-tests were conducted to evaluate the main effect for condition. Tests of the twelve comparisons were conducted using Bonferroni adjusted alpha levels of .004 per test (.05/12). Results were mostly congruent with the male and female analysis however, the baseline to anticipation pairing t (26) = 3.01, p = .006, the baseline to math pairing t (26) = 3.05, p = .005, and the baseline to recovery 1 pairing t (26) = 2.76, p =

.011, were no longer significant. The within-group differences from baseline to speech, recovery

2 to speech, and recovery 2 to math were maintained (see Table 15).

Perseveration and levels of HRV reactivity. In order to determine the association between perseveration and HRV in the female only sample, participants were separated into 20 DON’T WORRY, BE MINDFUL high-perseveration and low-perseveration groups using median splits of the perseveration measures (PTQ, PSWQ, and the PTQ). 2 x 6 repeated measures ANOVAs were conducted

(high/low perseveration x condition: baseline, stressor anticipation, speech task, math task, recovery 1, and recovery 2).

A main effect for condition was present in each 2 x 6 repeated measures ANOVA and consistent with the total sample analyses, no within-group or between-group differences for perseveration were detected (Table 16). However, for the RTS measure, a marginally significant interaction was observed F (1.96, 48.97) = 2.38, p = .104 (after correcting for sphericity).

Consequently, exploratory follow-up pairwise comparisons were conducted to examine within- group and between group differences.

Two sets of follow-up analyses of the interaction were conducted. First, between group pairwise comparisons were conducted for each condition. None of the comparisons were nonsignificant using the Bonferroni criterion .008 (.05/6). However, using a conventional .05 alpha level, those in the low-rumination group (M = 1955.50, SD = 1118.47) demonstrated higher HRV than those in the high-rumination group (M = 984.70, SD = 825.53), t (25) = 2.36, p

= .016 during the recovery 1 condition.

The second set of follow-up analyses involved conducting within-group paired samples t- tests. These comparisons were conducted using Bonferroni adjusted alpha levels of .004 per test

(.05/12). Results indicated that those in the low-rumination group reacted and recovered more

(see Table 17), while those in the high rumination group reacted and recovered less (See Table

18).

Perseveration and duration of HRV reactivity. In order to determine the association between and the duration of cardiovascular reactivity, the duration measures (described earlier) 21 DON’T WORRY, BE MINDFUL the PWSQ, PTQ, and RTS were correlated with recovery scores. The results were congruent with the total sample findings, however the PSWQ was now marginally significant r (27) = .25, p = .11 (see Table 19).

Residualized HRV scores and perseveration. Correlations were calculated to evaluate the relationship between perseveration measures and HRV residual scores (described earlier).

Consistent with the total sample results, the RTS was still associated with Recovery 1, but at a more significant level, r (27) = -.43, p = .013. Additionally, the PSWQ was now found to be significantly related with Recovery 1, r (27) = -.33, p = .045 (See Table 20).

Mindfulness and levels of HRV reactivity. Female participants were separated into a high-mindfulness and low-mindfulness groups using a median split of the total FFMQ score. A 2 x 6 repeated measures ANOVA using HRV as the dependent variable was conducted to evaluate the relationship between mindfulness and HRV across conditions (high/low mindfulness x condition: baseline, stressor anticipation, speech task, math task, recovery 1, and recovery 2).

After adjusting for sphericity, there was a significant main effect for condition (as described earlier) on HRV. The interaction effect compared to the total sample results became less significant, F (1.99, 49.76) = 2.66, p = .081. However, the follow-up analyses were congruent with the total sample results except for the Recovery 1 to Speech comparison in the high mindfulness group, which became less significant t (13) = 3.16, p = .008. Consequently, the finding that participants in the high mindfulness group reacted more and recovered more during the stressor conditions and recovery conditions was maintained (see Table 21). The low mindfulness group demonstrated the same within group difference pattern as the total sample

(See Table 22). 22 DON’T WORRY, BE MINDFUL

Following the FFMQ and HRV 2 x 6 repeated measures ANOVA, groups were also formed using median splits based on the MAAS and AAQ. Two 2 x 6 repeated measures

ANOVA were conducted using HRV as the dependent variable to evaluate the relationship between the above variables and HRV across conditions (high/low median split groupings x condition: baseline, stressor anticipation, speech task, math task, recovery 1, and recovery 2).

While the main effect for condition was present in each measure based grouping, no interaction effects were found to be significant (See Table 16).

Mindfulness and duration of HRV reactivity. In order to determine the association between mindfulness and the duration of cardiovascular reactivity, the duration measures

(described earlier) were correlated with the FFMQ, AAQ, and MAAS. While the FFMQ and

AAQ remained non-significant for both recovery conditions, the MAAS and recovery 1 correlation was marginally significant r (27) = .091 p = .09 (see Table 23).

Residualized HRV scores and mindfulness. Correlations were calculated to determine the relationships between mindfulness and HRV. The directions of the observed correlations were consistent with the total sample results. Scores on the FFMQ were significantly positively correlated with HRV residual scores and scores on the MAAS were negatively correlated with

HRV residual scores during the first five minutes of the recovery period only. The AAQ was not significantly correlated with recovery at either time point (see Table 24).

Mediation analysis. The above correlational analyses indicated that the RTS and the

FFMQ were significant predictors of residualized HRV scores. Therefore, mediation analysis was conducted using the RTS as the predictor variable, the FFMQ as a mediator, and the recovery 1 residualized change score as the outcome variable. The mediation approach used followed the recommendations outlined by Preacher and Hayes (2008) who suggested that a 23 DON’T WORRY, BE MINDFUL bootstrapping method is particularly well suited for estimating direct and indirect effects with small samples.

The results of these analyses indicated that FFMQ scores did not mediate the relationship between RTS scores and the recovery 1 residualized change score and the indirect effect was non-significant. The mediation results for the RTS, FFMQ, and recovery 1 residualized change scores and interaction effect are presented in Table 25, Table 13 and Figure 5.

24 DON’T WORRY, BE MINDFUL

DISCUSSION

This study had two primary aims. The first was to examine associations between mindfulness, perseveration, reactivity, and recovery. In order to test hypotheses related to reactivity and recovery, sufficient reactivity must be generated; results indicated that the TSST generated significant reactivity in participants. Preliminary analyses indicated that self-report measures of perseveration and mindfulness were significantly associated in the expected direction. Specifically, higher levels of perseveration were associated with lower levels of mindfulness. The second aim of the study was to determine whether mindfulness mediates the relation between perseveration and HRV. The mediation analysis indicated that: (a) perseveration was associated with less complete cardiovascular recovery from the TSST during the five minute period that immediately followed the stressor, (b) mindfulness was associated with more complete levels of cardiovascular recovery from the TSST during the five minute period that immediately followed the stressor, (c) mediation results failed to support the hypotheses that mindfulness mediates the relation between perseverative cognition and levels of cardiovascular reactivity. Analysis of the female-only sub-sample were largely congruent with the mixed sample results (PSWQ was found to be an additional predictor of recovery for the female only sample).

Self-report measures of perseveration were not related to cardiovascular reactivity during the anticipation condition despite this relation being supported in previous research (e.g.

Barefoot & Schroll 1996; Borkovec, Rodinson, Pruzinsky, & DePree, 1983; Brosschot, 2010;

Brosschot, Van Dijk, & Thayer, 2007; Pieper & Brosschot, 2005). A possible explanation for this finding is that participants may have reached the upper limit (the ceiling effect) for HRV reactivity in the anticipation condition. HRV reactivity is a measure of parasympathetic influence 25 DON’T WORRY, BE MINDFUL on heart rate. When participants experience significant stress, parasympathetic influences are withdrawn and sympathetic influences increase. Consequently, the intensity of the stressor may have reduced variability between the high and low perseveration group’s HRV reactivity, as both groups experienced sympathetic dominance reducing the ability of HRV measures to detect between group differences in reactivity. This lack of between group HRV reactivity differences due to the intensity of an anticipation condition has been supported in previous literature (Cristea et al., 2014).

While self-report measures of perseveration and levels of cardiovascular reactivity were not significantly associated, perseveration as measured by the RTS and recovery were. The RTS was most likely associated with HRV recovery because it assesses a participant’s self-reported tendency to maintain cognitive representations of a stressor after the stressor itself has ended

(e.g. “When I feel I have had a bad interaction with someone, I tend to imagine various scenarios where I would have acted differently”; Tanner, Voon, Hasking, & Martin, 2013). This representation may have extended participants’ exposure to the stressor and subsequently resulted in less complete HRV recovery. While the RTS was related to HRV recovery, perseveration as measured by the PTQ and PSWQ were not. Results indicated that these three self-report measures were highly intercorrelated; however, when examining the PTQ and PSWQ at an item level, it is possible that these questionnaires assessed different aspects of perseveration that may be less related to HRV recovery. Items on the PTQ are more general and focus on repeated or uncontrollable thinking (e.g. “My thoughts repeat themselves”; Ehring et al., 2011).

Furthermore, the PTQ does not evaluate participants’ tendencies to engage in negative evaluative thinking following a stressor. Similarly, the PSWQ does not contain questions assessing thoughts 26 DON’T WORRY, BE MINDFUL pertaining to a previously experienced stressor and instead assesses anticipatory thoughts about upcoming stressors.

Mindfulness was found to be associated with greater HRV recovery following a stressor, and this relation has been observed in prior studies (Delgado, Guerra, Perakakis, & Vera, 2010;

Garland, 2011, Nyklíček, Mommersteeg, Van Beugen, Ramakers, & Van Boxtel, 2013; Watford

& Stafford, 2015). Present findings indicated that self-reports of mindfulness and perseveration were inversely correlated. Taken together, participants who were more mindful may have perseverated less, resulting in reduced cognitive representations of the stressor tasks, which would then be associated with more complete recovery. This explanation of higher mindfulness being related to less perseveration is supported by significant inverse correlations between these measures.

One unique contribution of this study is the use of a fairly intense stressor to examine the relation between mindfulness and HRV. The TSST is considered the gold standard of stressors as it elicits significant cardiovascular reactivity. Most researchers do not use complex social stressors like the TSST (Kudielka, 2007). Instead, they tend to use cold pressor tasks (Evans,

Eisenlohr-Moul, Button, Baer, & Segerstrom, 2014; Liu, Wang, Chang, Chen, & Si, 2013) or have participants imagine situations where they might worry or ruminate (Britton, Phan, Taylor,

Fig, & Liberzon, 2005; Sack, Cillien, & Hopper, 2012). The TSST demonstrates two significant advantages over these other types of stressors: first, that exposure to the stressor and stressor duration are highly controlled (e.g. timing and recorded script) and, second, that the TSST puts participants through a personally relevant stressful experience (i.e. participants interviewing for their dream job), rather than having participants imagine a stressor. These advantages could translate to greater external validity as they mimic real world situations and experiences. 27 DON’T WORRY, BE MINDFUL

Additionally, this study is unique in that at the start of the recovery 1 condition, participants were told that a score detailing their performance would be generated. In most other laboratory studies, participants are informed that the experiment is over and to sit quietly for a given time period. Thus, in the present study, the recovery condition was designed to elicit perseveration. The advantage to this approach is that it provides evaluative cognitive content to which participants can expose themselves, potentially inhibiting recovery.

Limitations and Future Directions

There were three major limitations in this study: relatively small sample size, covariation of gender and HRV, and baseline differences between high and low mindfulness participants.

First, while there were multiple significant effects detected, a sample size of 38 and a female- only sub-sample of 27 did not provide enough power to detect small to moderate effect sizes. We predict that with an increased sample size, a number of observed relationships would have likely been found to be significant (assuming that the pattern of results remained the same with an increased number of participants).

Second, the finding that gender was significantly related to HRV is a potential limitation of the study. It may be that the observed gender effects were due to male participants being exposed to female evaluators. Previous research with the TSST has indicated that men are more reactive when they are judged by women in the TSST (Duchesne, Tessera, Dedovic, Engert, &

Pruessner, 2012), which may explain why men had lower HRV in all conditions. Removing male participants from the follow-up exploratory analyses addressed gender’s relationship with HRV, but compounded the low sample size concerns.

Finally, there were significant baseline HRV differences between the high and low mindfulness groupings. While this suggests that participants in the high mindfulness group have 28 DON’T WORRY, BE MINDFUL healthier cardiovascular functioning, it also creates difficulties when interpreting HRV reactivity scores. Participants who have significantly lower baseline HRV may appear to react less because they are closer to the lower limit for HRV (the floor effect). Additionally, low mindfulness participants would appear to recover less as their baseline level of functioning is lower than that of the high mindfulness group. Consequently, when participants in the low mindfulness group recover and regress towards their average levels of functioning, they appear to recover less. This relation between reduced recovery and reactivity in participants with lower resting HRV has been supported in the literature (Low, Salomon, & Matthews, 2009; Neves et al., 2012).

Physiologically, a lower resting HRV indicates a diminished ability to generate the physiological responses necessary to deal with stressors, which would be evidenced by reduced reactivity.

Future researchers examining TSST and recovery may benefit from including a condition where participants are told that the experiment has concluded. This would provide a recovery condition where participants would be less likely to perseverate. This type of recovery condition could then be contrasted with a recovery condition similar to the one used in this study. By directly comparing these two recovery conditions researchers would be better able to determine if perseveration drives level of recovery following a stressor.

Conclusions

The present study examined the relationship between perseveration, mindfulness, and

HRV. Overall, the results indicated that perseveration was associated with less complete recovery from a social evaluative stressor and that mindfulness is associated with better recovery. This study adds to the growing literature that examines the relation between perseverative thinking, cardiovascular reactivity, and inhibited recovery. It also provides insight into what types of adaptive cognitions promote healthy cardiovascular functioning. While 29 DON’T WORRY, BE MINDFUL baseline differences in resting HRV presented a difficulty in evaluating stress responses, this result further promotes the idea that mindfulness is associated with better cardiovascular health, even before a stressor takes place. Additionally, the result that mindfulness is associated with reduced reactivity and increased recovery also promotes the idea that mindfulness is a healthy coping strategy for chronic stress as well as acute stress.

30 DON’T WORRY, BE MINDFUL

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40 DON’T WORRY, BE MINDFUL

Table 1

Demographic Characteristics of the Sample

Demographic n Percent Gender Male 11 28.9 Female 27 71.1 Race/Ethnicity White 29 78.9 African American 6 13.2 Asian 1 2.6 Hispanic/Latino 1 2.6 American Indian/Alaska Native 1 2.6 Years of College First Year 15 39.5 One or two 9 23.7 Three or four 8 21.1 Post-Graduate 4 5.3 41 DON’T WORRY, BE MINDFUL

Table 2

Main Effect Analysis with Gender as a Covariate

Source Type III SS df F p Between Subject Effects Age 5269780.90 1 1.05 .313 BMI 5771982.97 1 1.15 .291 Gender 23251178.39 1 5.12 .030 Within Subject Effects Age 1722757.12 1.97 .50 .603 BMI 364463.15 1.96 .11 .897 Gender 3126969.75 1.98 1.32 .274 All within Subject Effects use Greenhouse-Geisser correction for sphericity

42 DON’T WORRY, BE MINDFUL

Table 3

Correlations Between Self-Report Measures of Mindfulness and Perseveration

Measure FFMQ PTQ RTS PSWQ AAQ MAAS

FFMQ -

PTQ -.77** -

RTS -.52** .77** -

PSWQ -.57** .70** .64** -

AAQ -.75** .75** .47** .61** -

MAAS -.75** .66** .62** .52** .43* -

** Correlation is significant at the .01 level. * Correlation is significant at the .05 level.

43 DON’T WORRY, BE MINDFUL

Table 4

Within Group Analyses for Main Effect by Condition

Paired t df Sig. (2.tailed) Dif Condition Mean Pair 1 Baseline - Anticipation 835.69 3.55 37 .001* Pair 2 Baseline - Speech 1141.52 3.88 37 .001* Pair 3 Baseline -Math 1064.80 3.48 37 .001* Pair 4 Baseline – Recovery 1 620.07 3.01 37 .004* Pair 5 Baseline – Recovery 2 513.93 2.49 37 .017 Pair 6 Recovery 1 - Anticipation 215.61 1.48 37 .148 Pair 7 Recovery 1 – Speech 521.45 3.10 37 .004* Pair 8 Recovery 1 – Math 444.73 2.43 37 .020* Pair 9 Recovery 2 – Anticipation 321.76 2.67 37 .011 Pair 10 Recovery 2 – Speech 627.59 3.79 37 .001* Pair 11 Recovery 2 – Math 550.88 3.38 37 .002* Pair 12 Recovery 2 – Recovery 1 106.15 .655 37 .516 N=37 *Correlations Significant after Bonferroni correction .004 (.05/12)

44 DON’T WORRY, BE MINDFUL

Table 5

Between and Within Subject Effects by Self-Report Measure Grouping

Source Type III SS df F p Between Subject Effects FFMQ 2660486.67 1 .52 .457 AAQ 11352248.10 1 2.33 .136 MAAS 307573.84 1 .059 .809 PSWQ 26528.04 1 .005 .943 PTQ 416953.74 1 .08 .778 RTS 184313754.80 1 .46 .503 Within Subject Effects FFMQ x Condition 3126969.75 2.11 3.94 .022* AAQ x Condition 934042.13 2.0 .27 .759 MAAS x Condition 6576869.638 2.0 2.0 .142 PSWQ x Condition 6103757.99 2.0 1.85 .165 PTQ x Condition 5033295.34 2.0 1.51 .227 RTS x Condition 1850036.03 2.0 1.57 .216 All within Subject Effects use Green-Geisser correction for sphericity

45 DON’T WORRY, BE MINDFUL

Table 6

Correlations Between Self-Report Measures of Perseveration and Recovery Duration

Measure RTS PTQ PSWQ

Recovery 1 -.10 -.18 -.15

Recovery 2 -.03 .13 .10

*. Correlation is significant at the .05 level.

46 DON’T WORRY, BE MINDFUL

Table 7

Correlations Between Self-Report Measures of Perseveration and Residual Recovery Scores

Condition PSWQ PTQ RTS

Recovery 1 -.21* -.14 -.31**

Recovery 2 -.11 -.14 -.05

** Correlation is significant at the .05 level * Correlation is significant at the .10 level

47 DON’T WORRY, BE MINDFUL

Table 8

Within Group Analyses for High Mindfulness Participants by Condition

Paired Dif t df Sig. (2.tailed) High Mindfulness Group (FFMQ) Mean Pair 1 Baseline - Anticipation 1267.98 3.97 19 .001* Pair 2 Baseline - Speech 1786.69 4.22 19 .000* Pair 3 Baseline -Math 1714.00 4.12 19 .001* Pair 4 Baseline – Recovery 1 943.03 2.78 19 .012 Pair 5 Baseline – Recovery 2 980.46 4.29 19 .000* Pair 6 Recovery 1 - Anticipation 324.95 1.96 19 .065 Pair 7 Recovery 1 – Speech 843.66 3.84 19 .001* Pair 8 Recovery 1 – Math 770.96 4.08 19 .001* Pair 9 Recovery 2 – Anticipation 287.52 1.48 19 .155 Pair 10 Recovery 2 – Speech 806.23 2.95 19 .008 Pair 11 Recovery 2 – Math 733.54 2.94 19 .008 Pair 12 Recovery 2 – Recovery 1 37.42 .168 19 .869 n=19 *Correlations Significant after Bonferroni correction .004 (.05/12)

48 DON’T WORRY, BE MINDFUL

Table 9

Within Group Analyses for Low Mindfulness Participants by Condition

Paired Dif t DF Sig. (2.tailed) Low Mindfulness Group (FFMQ) Mean Pair 1 Baseline - Anticipation 355.36 1.11 17 .282 Pair 2 Baseline - Speech 424.66 1.29 17 .233 Pair 3 Baseline -Math 343.47 .87 17 .398 Pair 4 Baseline – Recovery 1 261.23 1.47 17 .160 Pair 5 Baseline – Recovery 2 -4.44 -.01 17 .989 Pair 6 Recovery 1 - Anticipation 94.13 .38 17 .710 Pair 7 Recovery 1 – Speech 163.44 .69 17 .497 Pair 8 Recovery 1 – Math 82.24 .27 17 .793 Pair 9 Recovery 2 – Anticipation 359.80 2.56 17 .020 Pair 10 Recovery 2 – Speech 429.11 2.55 17 .021 Pair 11 Recovery 2 – Math 347.91 1.74 17 .100 Pair 12 Recovery 2 – Recovery 1 -265.67 -1.12 17 .277 n=17 *Correlations Significant after Bonferroni correction .004 (.05/12)

49 DON’T WORRY, BE MINDFUL

Table 10

Correlations Between Self-Report Measures of Mindfulness and Recovery Duration

Condition FFMQ MAAS AAQ

Recovery 1 .15 -.04 -.08

Recovery 2 -.13 .23 .01

*. Correlation is significant at the .05 level. 50 DON’T WORRY, BE MINDFUL

Table 11

Correlations Between Self-report Measures of Mindfulness and Residual Recovery Scores

Condition FFMQ MAAS AAQ

Residual recovery 1 .31** -.29** -.15

Residual recovery 2 .22* -.18 -.18

** Correlation is significant at the .05 level * Correlation is significant at the .10 level

51 DON’T WORRY, BE MINDFUL

Table 12 Mediation Analysis with RTS, FFMQ, and Residual Recovery 1

Consequent

M (FFMQ) Y (HRV) Antecedent Coeff. SE p Coeff. SE p X (RTS) a -.595 .163 .001 c’ -.013 .013 .296 M (FFMQ ------b .012 .011 .271

constant i1 165.275 11.386 <.001 i2 -.619 1.97 .756 Direct Effect ------c 1.420 .756 .063 R2= .271 R2= .124 F (1, 36) = 13.383 p = .001 F (2, 35) = 2.478 p = .099

52 DON’T WORRY, BE MINDFUL

Table 13

Indirect Effects of Mediation Paths

Bias Corrected Confidence Intervals Sample Point SE Lower CI Upper CI Estimate All Participants -.007 .008 -.043 .001 Female -.006 .008 -.032 .004 Participants 53 DON’T WORRY, BE MINDFUL

Table 14

Correlations Between Self-Report Measures of Mindfulness and Perseveration Among Female Participants

Measure FFMQ PTQ RTS PSWQ AAQ MAAS

FFMQ -

PTQ -.72** -

RTS -.48* .76** -

PSWQ -.62** .79** .60** -

AAQ -.72** .78** .45* .66** -

MAAS -.80* .66** .60** .59** .45* -

** Correlation is significant at the .001 level * Correlation is significant at the .05 level.

54 DON’T WORRY, BE MINDFUL

Table 15

Within Group Analyses of Condition Main Effect for Female Participants

Paired t df Sig. (2.tailed) Dif Condition Mean Pair 1 Baseline – Anticipation 971.40 3.00 26 .006 Pair 2 Baseline – Speech 1379.32 3.43 26 .002* Pair 3 Baseline -Math 1276.75 3.05 26 .005 Pair 4 Baseline – Recovery 1 756.30 2.76 26 .011 Pair 5 Baseline – Recovery 2 533.43 1.87 26 .073 Pair 6 Recovery 1 – Anticipation 215.10 1.06 26 .301 Pair 7 Recovery 1 – Speech 623.03 2.67 26 .013 Pair 8 Recovery 1 – Math 520.45 2.06 26 .049 Pair 9 Recovery 2 – Anticipation 437.97 2.81 26 .009 Pair 10 Recovery 2 – Speech 627.59 3.90 26 .001* Pair 11 Recovery 2 – Math 550.88 3.51 26 .002* Pair 12 Recovery 2 – Recovery 1 222.87 1.03 26 .314 N=37 *Correlations Significant after Bonferroni correction .004 (.05/12) 55 DON’T WORRY, BE MINDFUL

Table 16

Between and Within Subject Effects by Self-Report Measure Grouping for Female Participants

Source Type III SS df F p Between Subject Effects FFMQ 26457.789 1 .004 .949 AAQ 12479458.63 1 2.17 .153 MAAS 59713.34 1 .01 .923 PSWQ 550809.56 1 .088 .769 PTQ 2405472.43 1 .391 .538 RTS 7752934.10 1 1.31 .264 Within Subject Effects FFMQ x Condition 11058563.36 1.99 2.66 .081 AAQ x Condition 1802725.23 1.88 .397 .662 MAAS x Condition 10097239.31 2.0 2.40 .101 PSWQ x Condition 7396046.08 1.93 1.72 .187 PTQ x Condition 3071067.04 1.95 .69 .521 RTS x Condition 10011029.68 1.96 2.38 .104 All within Subject Effects use Green-Geisser correction for sphericity

56 DON’T WORRY, BE MINDFUL

Table 17

Within Group Analyses for Low RTS by Condition Among Female Participants

Paired Dif t df Sig. (2.tailed) Low Rumination Group (RTS) Mean Pair 1 Baseline - Anticipation 1439.03 3.94 13 .002* Pair 2 Baseline - Speech 2085.44 3.84 13 .002* Pair 3 Baseline -Math 2036.91 3.72 13 .003* Pair 4 Baseline – Recovery 1 1246.03 2.93 13 .012 Pair 5 Baseline – Recovery 2 1173.71 3.83 13 .002* Pair 6 Recovery 1 - Anticipation 193.00 1.08 13 .302 Pair 7 Recovery 1 – Speech 839.41 3.16 13 .008 Pair 8 Recovery 1 – Math 790.88 3.68 13 .003* Pair 9 Recovery 2 – Anticipation 265.33 1.45 13 .791 Pair 10 Recovery 2 – Speech 911.73 2.58 13 .023 Pair 11 Recovery 2 – Math 863.21 2.58 13 .023 Pair 12 Recovery 2 – Recovery 1 72.32 .271 13 .172 n = 13 *Correlations Significant after Bonferroni correction .004 (.05/12)

57 DON’T WORRY, BE MINDFUL

Table 18

Paired Sample t-tests for High RTS by Condition Among Female Participants

Paired Dif t df Sig. (2.tailed) High Rumination Group (RTS) Mean Pair 1 Baseline - Anticipation 631.77 1.19 13 .257 Pair 2 Baseline - Speech 752.84 1.31 13 .214 Pair 3 Baseline -Math 658.68 1.03 13 .321 Pair 4 Baseline – Recovery 1 656.27 1.64 13 .126 Pair 5 Baseline – Recovery 2 77.78 .19 13 .854 Pair 6 Recovery 1 - Anticipation -24.50 -.07 13 .945 Pair 7 Recovery 1 – Speech 95.57 .33 13 .746 Pair 8 Recovery 1 – Math 2.41 .01 13 .995 Pair 9 Recovery 2 – Anticipation 553.99 2.21 13 .045 Pair 10 Recovery 2 – Speech 675.06 2.433 13 .030 Pair 11 Recovery 2 – Math 580.90 1.82 13 .091 Pair 12 Recovery 2 – Recovery 1 578.49 1.69 13 .114 n = 12 *Correlations Significant after Bonferroni correction .004 (.05/12)

58 DON’T WORRY, BE MINDFUL

Table 19

Correlations Between Self-Report Measures of Perseveration and Recovery Duration Among Female Participants

Measure RTS PTQ PSWQ

Recovery 1 -.06 -.12 -.14

Recovery 2 -.02 .17 .25*

*. Correlation is significant at the .1 level.

59 DON’T WORRY, BE MINDFUL

Table 20

Correlations Between Self-Report Measures of Perseveration and Residual Recovery Periods Among Female Participants

Condition PSWQ PTQ RTS

Recovery 1 -.33* -.19 -.43*

Recovery 2 -.17 -.14 -.11

* Correlation is significant at the .05 level

60 DON’T WORRY, BE MINDFUL

Table 21

Within Group Analyses for High Mindfulness Female Participants by Condition

Paired Dif T df Sig. (2.tailed) High Mindfulness Group (FFMQ) Mean Pair 1 Baseline - Anticipation 1439.03 3.94 13 .002* Pair 2 Baseline - Speech 2085.44 3.84 13 .002* Pair 3 Baseline -Math 2036.91 3.72 13 .003* Pair 4 Baseline – Recovery 1 1246.03 2.93 13 .012 Pair 5 Baseline – Recovery 2 1173.71 3.83 13 .002* Pair 6 Recovery 1 - Anticipation 193.00 1.08 13 .302 Pair 7 Recovery 1 – Speech 839.41 3.16 13 .008 Pair 8 Recovery 1 – Math 790.88 3.68 13 .003* Pair 9 Recovery 2 – Anticipation 265.33 1.45 13 .791 Pair 10 Recovery 2 – Speech 911.73 2.58 13 .023 Pair 11 Recovery 2 – Math 863.21 2.58 13 .023 Pair 12 Recovery 2 – Recovery 1 72.32 .271 13 .172 n = 13 *Correlations Significant after Bonferroni correction .004 (.05/12)

61 DON’T WORRY, BE MINDFUL

Table 22

Within Group Analyses for Low Mindfulness Female Participants by Condition

Paired Dif t df Sig. (2.tailed) Low Mindfulness Group (FFMQ) Mean Pair 1 Baseline - Anticipation 467.79 .90 12 .338 Pair 2 Baseline - Speech 618.89 1.15 12 .274 Pair 3 Baseline -Math 458.10 .796 12 .442 Pair 4 Baseline – Recovery 1 228.89 .798 12 .440 Pair 5 Baseline – Recovery 2 -156.10 -.366 12 .721 Pair 6 Recovery 1 - Anticipation 238.90 .619 12 .548 Pair 7 Recovery 1 – Speech 390.00 .995 12 .339 Pair 8 Recovery 1 – Math 229.21 .490 12 .633 Pair 9 Recovery 2 – Anticipation 623.89 2.45 12 .030 Pair 10 Recovery 2 – Speech 775.00 2.58 12 .010 Pair 11 Recovery 2 – Math 614.21 2.58 12 .037 Pair 12 Recovery 2 – Recovery 1 72.32 1.09 12 .296 n = 12 *Correlations Significant after Bonferroni correction .004 (.05/12)

62 DON’T WORRY, BE MINDFUL

Table 23

Correlations Between Self-Report Measures of Mindfulness and Recovery Duration Among Female Participants

Condition FFMQ MAAS AAQ

Recovery 1 .04 -.03 -.01

Recovery 2 -.16 .27* .06

*. Correlation is significant at the .10 level. **. Correlation is significant at the .05 level. 63 DON’T WORRY, BE MINDFUL

Table 24

Correlations Between Self-Report Measures of Mindfulness and Residual Recovery Scores Among Female Participants

Condition FFMQ MAAS AAQ

Recovery 1 .34* -.37* -.17

Recovery 2 .23 -.24 -.16

* Correlation is significant at the .05 level

64 DON’T WORRY, BE MINDFUL

Table 25

Mediation Analysis for RTS, FFMQ, and Residual Recovery 1 Among Female Participants

Consequent M (FFMQ) Y (HRV) Antecedent Coeff. SE P Coeff. SE p X (RTS) a -.559 .203 .011 c’ -.026 .016 .105 M (FFMQ b .011 .013 .428

constant i1 164.482 14.384 <.001 i2 .614 2.39 .800 Direct effect c -.032 .014 .025

R2= .232 R2= .207 F(1, 25) = 7.56 p = .011 F(2, 24) = 3.13 p = .062

65 DON’T WORRY, BE MINDFUL

Figure 1. HRV, Condition, and Gender. 66 DON’T WORRY, BE MINDFUL

Figure 2. HRV and Condition.

67 DON’T WORRY, BE MINDFUL

Figure 3. Mindfulness Levels, HRV, and Condition. 68 DON’T WORRY, BE MINDFUL

Direct Path -.021 (.06) Residual RTS Recovery 1

Mediated Path FFMQ

-.60 .012 (.01) (.27)

Residual RTS -.013 Recovery 1 (.30)

Figure 4. Mediation Analysis for RTS, FFMQ, and Residual Recovery 1. βs from path analysis are listed above p values, which are included in parenthesis. This figure shows the mediation analysis for the above variables and indicates that mindfulness did not significantly mediate the relationship between perseveration and HRV recovery. 69 DON’T WORRY, BE MINDFUL

Direct Path

-.03 (.03) Residual RTS Recovery 1

Mediated Path FFMQ

-.55 .01 (.01) (.43)

Residual RTS -.03 Recovery 1

(.10)

Figure 5. Mediation Analysis for RTS, FFMQ, and Residual Recovery 1 among female participants. βs from path analysis are listed above p values, which are included in parenthesis. This figure shows the mediation analysis for the above variables and indicates that mindfulness did not significantly not mediate the relationship between perseveration and HRV recovery.

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APPENDIX A. INITIAL STEPS AND RECRUITMENT FOR NEW PARTICIPANTS

1. Participants will be recruited from Bowling Green State University (BGSU) via email a. Students from BGSU will be emailed information about the study and participants will be asked to provide their availability for the semester. b. An appointment for the experimental portion of the study will then be scheduled. c. Participants will be compensated with SONA credits and $10 at the completion of the experimental portion of the study.

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APPENDIX B. INITIAL PROTOCOL 1. Two times a week, participants will be brought into the Psychology building to participate in the experimental portion of the study. a. Timing of the experimental portion will be based off of availability of confederates and the principle investigator, but will occur at the same time each day. b. Confederates and the primary investigator will meet 15 minutes prior to participant arrival to prepare experimental environment and equipment. c. The room the experiment is occurring in has a chair for the participant to sit in and adjacent to the chair is the Biopac machine used for recording HRV/Cardiac Reactivity. Across from the chair is a short desk with two chairs facing the participant. 2. After Participant arrival, the participant will then fill out the following surveys. a. Demographic Questionnaire b. AAQ-II c. FFMQ d. PSWQ e. RTS f. PTQ 3. After finishing the surveys, 15 minutes of baseline resting HRV/Cardiac Reactivity using BioPac equipment will be recorded. During the baseline portion of the experiment, the participant will be instructed to keep their eyes closed, stay relaxed, and to focus on their breathing.

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APPENDIX C. DEMOGRAPHIC INVENTORY Participant Number: ______Demographic Inventory The following questions ask for you to provide a wide range of information about yourself such as: health history, family background, age, etc. These questions will be kept confidential. We ask that you be as honest as possible throughout the survey. 1. What is your age? ______2. What is your gender? ____ Male ____ Female 3. What is your race? ____African American ____Asian ____Caucasian ____Hispanic or Latino/a ____American Indian or Alaska Native ____Bi-Racial ____Native American or other Pacific Islander ____Other ______4. What is your marital status? ____ Single ____ Co-habitating with a Partner ____ Married ____ Separated ____ Divorced ____ Widowed 5. What is the highest grade or year you finished and received credit for in school or college? ____ One or two years of college ____ Three to four years of college ____ College graduate ____ Post-Graduate Education 6. What is your family’s estimated yearly income? _____ 10,000 – 20,000 _____ 20,000 – 40,000 _____ 40,000 – 60,000 _____ 60,000 – 80,000 _____ 80,000 – 100,000 _____ 100,000+ 7. What religion do you identify with the most ______8. How religious are you? Please circle one: 73 DON’T WORRY, BE MINDFUL

(Not very religious) 1 2 3 4 5 6 7 (Very religious) 9. Do you smoke cigarettes? ____ Yes ____ No If so, how many cigarettes do you smoke per day (there are usually 20 cigarettes in a pack)? ______10. How many times during the week do you exercise on average? ______11. How often do you drink caffeinated beverages (pop/soda, energy drinks, and coffee)? ______never ______once a week ______a few times a week ______once a day ______multiple times a day 12. Have you had any caffeinated beverages today? ______13. How may alcoholic beverages do you drink a week? ______none ______1-2 ______3-6 ______6-12 ______12+ 14. How often do smoke marijuana? ______never ______once a week ______a few times a week ______every day ______multiple times a day 15. Do you have any of the following: heart conditions, diabetes, a mental health diagnosis, or high blood pressure? ____ Yes ____ No If so, what condition(s) do you have? ______16. Are you currently taking any medication? 74 DON’T WORRY, BE MINDFUL

____ Yes ____ No If so, what are you taking? Medication 1: ______Dose: ______Medication 2: ______Dose: ______Medication 3: ______Dose: ______Medication 4: ______Dose: ______17. Do you actively practice Yoga more than once a week? Yes No 18. Do you consider yourself a worrier? Yes No 19. Would you say you’re exceptionally mindful? Yes No 20. Do you have extensive public speaking experience? Yes No 21. Would you say you’re good at math? Yes No 22. What is your dream or ideal job? ______75 DON’T WORRY, BE MINDFUL

APPENDIX D. ACCEPTANCE AND ACTION QUESTIONNAIRE-II

Below you will find a list of statements. Please rate how true each statement is for you by circling a number next to it. Use the scale below to make your choice.

1 2 3 4 5 6 7 Never true Very Seldom Sometimes Frequently Almost Always seldom true true true always true true true

1. My painful experiences and memories make it difficult for me to live a life that I would value. 1 2 3 4 5 6 7 2. I’m afraid of my feelings. 1 2 3 4 5 6 7 3. I worry about not being able to control my worries and feelings. 1 2 3 4 5 6 7 4. My painful memories prevent me from having a fulfilling life. 1 2 3 4 5 6 7 5. Emotions cause problems in my life. 1 2 3 4 5 6 7 6. It seems like most people are handling their lives better than I am. 1 2 3 4 5 6 7 7. Worries get in the way of my success. 1 2 3 4 5 6 7

This is a one-factor measure of psychological inflexibility, or experiential avoidance. Score the scale by summing the seven items. Higher scores equal greater levels of psychological inflexibility.

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APPENDIX E. FIVE FACET MINDFULNESS QUESTIONNAIRE

Please rate each of the following statements using the scale provided. Write the number in the blank that best describes your own opinion of what is generally true for you.

1 2 3 4 5 never or very rarely sometimes often very often or Rarely true true true true always true

____ 1. When I’m walking, I deliberately notice the sensations of my body moving. ____ 2. I’m good at finding words to describe my feelings. ____ 3. I criticize myself for having irrational or inappropriate emotions. ____ 4. I perceive my feelings and emotions without having to react to them. ____ 5. When I do things, my mind wanders off and I’m easily distracted. ____ 6. When I take a shower or bath, I stay alert to the sensations of water on my body. ____ 7. I can easily put my beliefs, opinions, and expectations into words. ____ 8. I don’t pay attention to what I’m doing because I’m daydreaming, worrying, or otherwise distracted. ____ 9. I watch my feelings without getting lost in them ____ 10. I tell myself I shouldn’t be feeling the way I’m Feeling. ____ 11. I notice how foods and drinks affect my thoughts, bodily sensations, and emotions. ____ 12. It’s hard for me to find the words to describe what I’m thinking. ____ 13. I am easily distracted. ____ 14. I believe some of my thoughts are abnormal or bad and I shouldn’t think that way. 77 DON’T WORRY, BE MINDFUL

APPENDIX F. THE PENN STATE WORRY QUESTIONNAIRE

Instructions: Rate each of the following statements on a scale of 1 (“not typical of me”) to 5 (“very typical of me”). Please do not leave items blank.

Not at all Typical Very typical of me of me

1. If I do not have enough time to do 1 2 3 4 5 everything, I do not worry about it. 2. My worries overwhelm me. 1 2 3 4 5 3. I do not tend to worry about things. 1 2 3 4 5 4. Many situations make me worry. 1 2 3 4 5 5. I know I should not worry about 1 2 3 4 5 things, but I just cannot help it. 6. When I am under pressure I worry 1 2 3 4 5 a lot. 7. I am always worrying about 1 2 3 4 5 something. 8. I find it easy to dismiss worrisome 1 2 3 4 5 thoughts. 9. As soon as I finish one task, I start 1 2 3 4 5 to worry about everything else I have to do. 10. I never worry about anything. 1 2 3 4 5 11. When there is nothing more I can 1 2 3 4 5 do about a concern, I do not worry about it anymore. 12. I have been a worrier all my life. 1 2 3 4 5 13. I notice that I have been worrying 1 2 3 4 5 about things. 14. Once I start worrying about 1 2 3 4 5 things, I cannot stop. 15. I worry all the time. 1 2 3 4 5 16. I worry about projects until they 1 2 3 4 5 are done.

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APPENDIX G. RUMINATIVE THOUGHT STYLE QUESTIONNAIRE

Not at all Typical Very typical of of me me

1. I find that my mind goes over things again and again. 1 2 3 4 5 6 7 2. When I have a problem, it will gnaw on my mind for a long 1 2 3 4 5 6 7 time. 3. I find that some thoughts come to my mind over and over 1 2 3 4 5 6 7 throughout the day 4. I can’t stop thinking about some things. 1 2 3 4 5 6 7 5. When I am expecting to meet someone, I will imagine every 1 2 3 4 5 6 7 possible scenario and conversation. 6. I tend to replay past events as I would have liked them to 1 2 3 4 5 6 7 happen. 7. I find myself daydreaming about things I wish I had done. 1 2 3 4 5 6 7 8. When I feel I have had a bad interaction with someone, I tend 1 2 3 4 5 6 7 to imagine various scenarios where I would have acted differently. 9. When trying to solve a complicated problem, I find that I just 1 2 3 4 5 6 7 keep coming back to the beginning without ever finding a solution. 10. If there is an important event coming up, I think about it so 1 2 3 4 5 6 7 much I work myself up. 11. I have never been able to distract myself from unwanted 1 2 3 4 5 6 7 thoughts. 12. Even if I think about a problem for hours, I still have a hard 1 2 3 4 5 6 7 time coming to a clear understanding. 13. It is very difficult for me to come to a clear conclusion about 1 2 3 4 5 6 7 some problems, no matter how much I think about it. 14. Sometimes I realize I have been sitting and thinking about 1 2 3 4 5 6 7 something for hours. 15. When I am trying to work out a problem, it is like I have a 1 2 3 4 5 6 7 long debate in my mind where I keep going over different points. 16. I like to sit and think about pleasant events from the past. 1 2 3 4 5 6 7 17. When I am looking forward to an exciting event, thoughts of 1 2 3 4 5 6 7 it interfere with what I am working on. 18. Sometimes even during a conversation, I find unrelated 1 2 3 4 5 6 7 thoughts popping into my head. 19. When I have an important conversation coming up, I tend to 1 2 3 4 5 6 7 go over it in my mind again and again. 20. If I have an important event coming up, I can’t stop thinking 1 2 3 4 5 6 7 about it. 79 DON’T WORRY, BE MINDFUL

APPENDIX H. PERSEVERATIVE THINKING QUESTIONNAIRE never rarely sometimes often almost always 1. The same thoughts keep going through my 0 1 2 3 4 mind again and again. 2. Thoughts intrude into my mind. 0 1 2 3 4 3. I can’t stop dwelling on them. 0 1 2 3 4 4. I think about many problems without solving 0 1 2 3 4 any of them. 5. I can’t do anything else while thinking about 0 1 2 3 4 my problems. 6. My thoughts repeat themselves. 0 1 2 3 4 7. Thoughts come to my mind without met 0 1 2 3 4 wanting them to. 8. I get stuck on certain issues and can’t move 0 1 2 3 4 on. 9. I keep asking myself questions without 0 1 2 3 4 finding an answer. 10. My thoughts prevent me from focusing on 0 1 2 3 4 other things. 11 I keep thinking about the same issue all the 0 1 2 3 4 time. 12. Thoughts just pop into my mind. 0 1 2 3 4 13. I feel driven to continue dwelling on the same 0 1 2 3 4 issue. 14. My thoughts are not much help to me. 0 1 2 3 4 15. My thoughts take up all my attention 0 1 2 3 4

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APPENDIX I. PROTOCOLS FOR BIOPAC EQUIPMENT 1. Supply power to the necessary components. a. Plug the MP 150 BIOPAC system into a free wall outlet. b. Plug the Laptop in c. Turn on MP150 BIOPAC system by depressing button on the back of the unit d. Turn on the laptop and wait for the laptop to boot 2. Log in to laptop by entering in username “ ./Bmed “ and password “ Bmed “ 3. Setup the Acqknowledge program a. Select the Acqknowledge icon from the desktop b. Select recent files and click the first file template from the list 4. ECG Prep Setup a. Take the alcohol gel and swab the areas where the ECG lead pads will be attached i. Swab under the left and right collar bones ii. Under the heart to the left of the belly button iii. Wait for it to dry b. Insert the ECG leads into the ECG slot on the BIOnomadix wireless receiver c. Turn on the receiver using the switch on the receiver’s face there should be a blinking green light d. Place electrode pads on the cleaned spaces 5. ECG Attachment a. Attach the wire leads to the ECG pads ensuring the metal clip is face down and securely attached to the metal nipple on the pad i. Place the red wire on the cleaned under heart location ii. Place the black wire on the over heart location under the left collar bone iii. Place the white lead under the right collar bone 6. Instruct the subject to remain as still as possible for the 15 minute (900 second) recording period. 7. Click the start button on the top left of the Acqknowledge computer program, click continue 8. Observe the two lines that appear there should be a heartbeat visible on the graph and a thin red line above it 9. After 15 minutes (900 seconds) press the stop button on the Acqknowledge program 10. Unhook the leads from the subject a. Throw out ECG pads

11. Output Data a. Click on file on the top tool bar of the Acqknowldege program and select “save as” Save the raw output in the desktop folder labeled “DWBH Raw Output” the name of the file is the subject number b. Close the Acqknowledge program 81 DON’T WORRY, BE MINDFUL

12. Shut down procedures a. Turn off the MP150 BIOPAC machine by depressing the button on the back b. Switch off the wireless BIOnomadix receiver after removing the ECG leads c. Take the BIOnomadix receiver charger and plug it into the wireless unit d. Shut down laptop

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APPENDIX J. ELECTRODE PLACEMENT GUIDE

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APPENDIX K. RECORDED TRIER SOCIAL STRESS TEST SCRIPT

“These two trained interviewers are here to assess how capable you are in situations in which you must project yourself as an expert. In this hypothetical situation, you are applying for your ideal job. So please take a moment to think of your perfect job. This is the job, that if your life went perfectly, you would find yourself working at, it is your dream job. The job pays well and you are competing against a lot of other highly qualified candidates. The final selection will be made based on your ability to convince the interviewers of how your experiences, abilities, and education make you a better candidate than the others. You will try to convince these interviewers that you are the best candidate for the position. You will have 10 minutes to prepare a detailed speech. After the preparation time has elapsed, the interviewers will return and you will deliver your speech to them. These interviewers are specially trained to monitor and rate your speech for its believability and convincingness. They will compare your performance to others who perform this speech. Also, you will be videotaped during the speech so that the interviewers can review your speech and rate the quality of your speech as well as your nonverbal behavior. Your speech should explain why you are the best candidate to get the job. Remember, try to perform better than all of the other participants. They will now leave the room and you will have 10 minutes to prepare for the speech. Please remain seated and move as little as possible.”

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APPENDIX L. CONFEDERATE RECRUITMENT AND TRAINING PROTOCOLS

1. Confederates will be recruited from the BGSU junior and senior undergraduate population.

a. An email requesting undergraduate research assistants will be sent out. This email will detail the particular skills required by the study, such as the ability to remain non-reactive in social situations.

b. Confederates will be interviewed and run through a mock trial of the experiment to assess their non-reactive abilities.

c. 6 of the most non-reactive undergraduates will be selected to receive further training and assist in the study.

2. Confederates will be trained by running them through mock versions of the experiment.

a. The confederate must be able to participate in the Trier Social Stressor Task without providing any verbal or non-verbal feedback (i.e. head nodding, smiling, facial expressions of any kind, or hand gestures).

b. The confederate must also be able to deliver the appropriate prompts in response to participant questions/statements as detailed above with no speech errors.

c. Confederates will also be trained to maintain prolonged eye contact through exposure based training.

d. If a confederate is unable to perform these tasks other potential candidates will be contacted.

e. Once all 6 confederates are capable of completing their duties they will be split into two teams of three, one team for each day the experimental portion is run. The additional confederate will serve as an alternate if one of the three is unable to attend an experimental period.

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APPENDIX M. TRIER SOCIAL STRESS TEST PROTOCOL Adapted from Birkett, M. A. (2011). The Trier Social Stress Test Protocol for Inducing Psychological Stress. Journal of Visualized Experiments : JoVE, (56), 3238. doi:10.3791/3238 Trier Social Stress Procedure. Retrieved January 8, 2015, from http://iniastress.org/tssp

1. Two undergraduate confederates (confederate A and confederate B) and a video camera will be brought into the room. The two confederates will maintain a neutral presentation and maintain eye contact with the participant as much as possible and sit in the two seats behind the desk opposite the participant. a. The video camera will be placed facing the participant. b. The participant will be told via tape recording that the confederates are staff managers looking to fill a vacancy in a job and that the participant will give a 5 minute speech intended to convince the managers that they are the perfect applicant for their ideal job. c. The participant will also be informed via tape that the managers have been specially trained to monitor nonverbal behavior and that video analysis of the participant’s performance will be conducted as well. d. After the introduction, the participant will be told via tape that they have 10 minutes to mentally prepare and the confederates will leave the room. If the participant asks any questions the principle investigator will respond “Do whatever you think is best” and “I do not know other details.” e. During this 10 minute period, HRV data will be collected and the participant will be told to move as little as possible. f. Once 10 minutes has passed an alarm will sound and the confederates will return. The confederates will then turn on the video camera and instruct the participant to deliver the 5 minute speech from a seated position by saying “please begin.” i. Both confederates will maintain a neutral non-responsive expression and as much eye contact as possible throughout the speech condition. ii. Confederate A will take notes approximately every minute jotting down a sentence or two before returning to prolonged eye contact. iii. If the participant fails to use the full 5 minutes the male confederate will prompt the participant to continue by saying “Do whatever you think is best,” “Say whatever comes to your mind,” or “Be as creative as you like.” iv. After the task is complete an alarm will sound and confederate B will say “Your time is up.” 2. Trier Serial Subtraction Task a. After the speech portion of the task, the participant is then told by confederate A that “Now we would like you to subtract the number 13 from 1022, and to keep 86 DON’T WORRY, BE MINDFUL

subtracting 13 from the remainder until we tell you to stop. You should do the subtraction as fast and as accurate as possible.” i. If an error is made confederate A instructs the subject "That’s incorrect. Please start again from the beginning." If the subject has forgotten the starting number, confederate A provides the number (1022) again. ii. Approximately every minute confederate B will take down a short note then return to sustained eye contact with the participant. iii. If the participant asks questions about their performance confederate A states “I am not allowed to tell you that. Someone will give you that information later.” iv. After five minutes, an alarm goes off ending the task. b. After serial subtraction, the participant is told that the managers will review their data and that a score profile will be given reflecting their total achievement for the task. c. The confederates will then leave the room after ensuring the electrodes have maintained proper adhesion. 3. 15 minutes of recovery data will then be collected during which the participant will be instructed by the principle investigator to keep their eyes closed, stay relaxed, and to focus on their breathing. a. After the recovery data is collected, participants will be asked to rate on a 1-10 scale how much they worried in the anticipatory condition and how much they ruminated in the recovery condition. 4. Participants will then be de-briefed and informed of the nature of the study before being dismissed.

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APPENDIX N. PERSEVERATION AND MINDFULNESS INFORMED CONSENT FORM

This research study is designed to increase knowledge of how different thoughts and personality factors affect the functioning of the heart and cardiovascular activity. The researcher responsible for this project is Rolf Ritchie B.A. and will be supervised by William H. O’Brien, Ph.D., who is a clinical psychologist and faculty member in the Psychology Department at Bowling Green State University. Other graduate and undergraduate students at BGSU will assist with the study as well. All assistants will be supervised by Rolf Ritchie and Dr. O’Brien.

As a participant in this treatment study, you will be asked to (a) complete several questionnaires that measure perseveration, mindfulness, and a number of their component parts such as, worry and rumination, which will take approximately thirty minutes to complete. Your height and weight will also be recorded as a measure of body composition, and (b) be exposed to stressful situations. The entire procedure will take about one hour. The entire experiment will take place in the psychophysiology lab at Bowling Green State University. The primary benefit of this study is that it will advance understanding of how different thoughts (perseveration and mindfulness) affect heart rate and cardiovascular health. Participants will be provided extra SONA credit or $10 as compensation.

There are no known risks associated with participation in this study.

All information collected in this study is confidential. However, there are certain situations when confidentiality may need to be broken. Such situations include threats to harm someone else or yourself, circumstances involving child or elder abuse, or legal circumstances where a group member uses psychological information in a defense or prosecution of a crime. In order to protect your confidentiality, all information collected in this study will contain a unique identification number and any information linking your name to this identification number will only be accessible by the primary investigators of this study. All identifying information will be destroyed after the completion of this study. During the study, all records will be strictly safeguarded and kept in a locked office accessible only to the investigators of this study.

Should the results of the study be published in scientific journals, your anonymity will be assured. By participating in this study, you agree to permit Bowling Green State University to compile and publish data at conclusion of the study.

Participation in this study is voluntary and you are free to withdraw from the study at any time without explanation or penalty. Additionally, you have the right to refuse to take part in any activity in which you feel uncomfortable. If any questions or concerns arise during the course of this study, you may contact William H. O’Brien, Ph.D. at 419-372-2974 ([email protected]), Rolf Ritchie B.A. at 567-277-2139 (rolfrbgsu.edu), or the Chair of the Human Subjects Review Board at Bowling Green State University at 419-372-7716 ([email protected]). 88 DON’T WORRY, BE MINDFUL

By signing this form you are indicating that you have read this document, had all of your questions answered, and agree to participate in this study.

______Participant Signature Date ______Researcher Signature Date

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APPENDIX O. POST TEST SELF RATING SCALE

Please rate out of 10 how much you worried while you prepared for your interview. (I did not worry) (I worried a lot) 1 2 3 4 5 6 7 8 9 10

Please rate out of 10 how much you thought negatively about your speech and math performance after you completed them. (I did not ruminate) (I ruminated a lot) 1 2 3 4 5 6 7 8 9 10 90 DON’T WORRY, BE MINDFUL

APPENDIX P. DEBRIEFING SCRIPT

“You were not actually being evaluated or scored over the course of this experiment and you were not actually being compared to other participants. The purpose of the study was to see what personality and character traits may alter how you respond to stressful situations. We wanted to see what happens to your heart rate under stress, that’s why we have been collecting data from you. You did a good job. Thank you for participating. Do you feel okay to go home/leave?” 91 DON’T WORRY, BE MINDFUL

APPENDIX Q.

DATE: June 8, 2015

TO: Rolf Ritchie, BA FROM: Bowling Green State University Human Subjects Review Board

PROJECT TITLE: [721304-3] Don't Worry, Be Mindful SUBMISSION TYPE: Revision

ACTION: APPROVED APPROVAL DATE: June 5, 2015 EXPIRATION DATE: April 13, 2016 REVIEW TYPE: Expedited Review

REVIEW CATEGORY: Expedited review category # 7

Thank you for your submission of Revision materials for this project. The Bowling Green State University Human Subjects Review Board has APPROVED your submission. This approval is based on an appropriate risk/benefit ratio and a project design wherein the risks have been minimized. All research must be conducted in accordance with this approved submission.

The final approved version of the consent document(s) is available as a published Board Document in the Review Details page. You must use the approved version of the consent document when obtaining consent from participants. Informed consent must continue throughout the project via a dialogue between the researcher and research participant. Federal regulations require that each participant receives a copy of the consent document.

Please note that you are responsible to conduct the study as approved by the HSRB. If you seek to make any changes in your project activities or procedures, those modifications must be approved by this committee prior to initiation. Please use the modification request form for this procedure.

You have been approved to enroll 100 participants. If you wish to enroll additional participants you must seek approval from the HSRB.

All UNANTICIPATED PROBLEMS involving risks to subjects or others and SERIOUS and UNEXPECTED adverse events must be reported promptly to this office. All NON-COMPLIANCE issues or COMPLAINTS regarding this project must also be reported promptly to this office.

This approval expires on April 13, 2016. You will receive a continuing review notice before your project expires. If you wish to continue your work after the expiration date, your documentation for continuing review must be received with sufficient time for review and continued approval before the expiration date.

Good luck with your work. If you have any questions, please contact the Office of Research Compliance at 419-372-7716 or [email protected]. Please include your project title and reference number in all correspondence regarding this project. 92 DON’T WORRY, BE MINDFUL

This letter has been electronically signed in accordance with all applicable regulations, and a copy is retained within Bowling Green State University Human Subjects Review Board's records.