LACKNER, RYAN J., Ph.D., August 2019 PSYCHOLOGICAL SCIENCES OUT OF THE MIND AND INTO THE BODY: DOES SWITCHING MODES OF SELF- REFERENCE REDUCE PERSEVERATIVE COGNITION? (89 PP.) Dissertation Advisor: David M. Fresco, Ph.D. The ability to hold one’s “self” in awareness is thought to be a distinguishing feature of human beings, allowing us to mentally reconstruct personal events from the past and construct possible events in the future. Though one of our greatest assets, the wandering mind may also become “stuck” in negative, evaluative forms of self-referential thinking, or perseverative cognition (PC; e.g., worry and rumination). Many psychological disorders share the transdiagnostic feature of PC, and worry and rumination are associated with deleterious psychological and physiological outcomes. Thus, it is important and clinically relevant to deliberately target PC and develop methods to “unstick” the mind. Whereas PC represents a mode of thinking that is negative, evaluative, and for that moment, oriented in the past or future, interoception –awareness of one’s body signals – provides a mode of self-reference that is experiential and present-centered. Interoception is emphasized in many mindfulness-based interventions, and theory suggests the development of interoception facilitates a shift away from neural processes devoted to more abstract, narrative forms of self-reference. Thus, the purpose of the current study was to determine whether engaging interoceptive attention reduces PC. One-hundred fifty-eight participants were randomized to one of three experimental manipulations of attention: (1) interoceptive cues; (2) self-referential cues; or (3) non-self-referential cues. Participants then completed a mind-wandering paradigm interspersed with thought probes, which measured PC. We hypothesized that individuals undergoing the interoception condition would report less PC during mind-wandering, relative to each of the other two conditions. Results indicated no effect of group on reported PC. Limitations and future considerations are discussed. OUT OF THE MIND AND INTO THE BODY: DOES SWITCHING MODES OF SELF- REFERENCE REDUCE PERSEVERATIVE COGNITION? A dissertation submitted to Kent State University in partial fulfillment of the requirements for the degree of Doctor of Philosophy by Ryan J. Lackner August 2019 © Copyright All rights reserved Except for previously published materials Dissertation written by Ryan J. Lackner B.S., Indiana University, 2013 M.A., Kent State University, 2016 Ph.D., Kent State University, 2019 Approved by ______________________________________, Chair, Doctoral Dissertation Committee David M. Fresco, Ph.D. ______________________________________, Members, Doctoral Dissertation Committee Karin G. Coifman, Ph.D. ______________________________________ Christopher A. Was, Ph.D. ______________________________________ Joshua W. Pollock, Ph.D. Accepted by ______________________________________, Chair, Department of Psychological Sciences Maria S. Zaragoza, Ph.D. ______________________________________, Dean, College of Arts and Sciences James L. Blank, Ph.D. TABLE OF CONTENTS………………………………………………………………….......... v LIST OF TABLES……………………………………………………………………………… vi ACKNOWLEDGEMENTS…………………………………………………………………….. vii INTRODUCTION……………………………………………………………………………… 1 METHODS……………………………………………………………………………………… 20 RESULTS………………………………………………………………………………..……… 28 DISCUSSION…………………………………………………………………………………... 39 REFERENCES…………………………………………………………………………………. 49 TABLES………………………………………………………………………………………… 72 FIGURES……………………………………………………………………………………….. 79 APPENDICES A. Mindful Body Breathing Script……………………………………………….….......81 B. Attention to Non-negative, Self-referential Information Script …………………...…84 C. Attention to Non-negative, Non-self-referential Information Script …………...…....86 D. Ordinary Least Squares (OLS) Analyses as Originally Proposed………………...….88 v LIST OF TABLES Table 1. Correlations, Means, Standard Deviations, and Internal Consistencies among All Questionnaires ………………………………………………………………………………….. 72 Table 2. Intercorrelations among Thought Probe Responses ………………………...………… 73 Table 3. Factor Loadings for PSWQ and RSQ Items …………………………….……………. 74 Table 4. Responses to Thought Probes and PC Scores between Groups ………………………. 75 Table 5. Negative Binomial Regression Model Examining Group Differences in PC Thought- Probes …………………………………………………………………………………………... 76 Table 6. Linear Regression Model Examining Group Differences in Stickiness of Thought …. 77 Table 7. Linear Regression Model Examining Group Differences in Intrusiveness of Thought.. 78 Table D1. Linear Regression Model Examining Group Differences in PC Thought-Probes…....89 vi Acknowledgements I wish to thank my dissertation committee for their time and helpful comments. I would especially like to thank Dr. David M. Fresco for his vital contribution toward my development as a critical thinker, researcher, and aspiring clinical psychologist. Finally, I would like to thank my father, Larry, and mother, Luann, for their perpetual love and support. vii Out of the Mind and into the Body: Does Switching Modes of Self-reference Reduce Perseverative Cognition? As human beings, much of our time is spent contemplating the past, wondering about the future, and engaging in mental busywork aimed at avoiding certain experiences while maximizing the chance that more favorable ones occur. Although the ability to hold one’s “self” in awareness has allowed us to enjoy the benefits associated with imagining and predicting possibilities for reward and threat, considerable suffering may occur when the mind becomes dominated by negative self-referential activity. This quality of thinking (i.e., “negative self- referential processing [NSRP]; Northoff et al., 2006) is an encompassing characteristic of individuals with mood and anxiety disorders (e.g., major depressive disorder and generalized anxiety disorder), which have also been called misery or distress disorders (e.g., Watson, 2005). Importantly, previous work has established that NSRP is an individual difference factor across many forms of emotional disorders, complicates clinical presentation and treatment, and appears to be a crucial target to address if treatment gains are to be gained and maintained (Mennin & Fresco, 2013). Recent developments in affective science have given us new perspectives from which to consider misery and distress disorders, as well as NSRP. For instance, a recent neuroanatomical and processing model of depression and anxiety proposes that dysfunction arises from aberrant self-referential processing (Paulus & Stein, 2010). Specifically, the model incorporates 1 interactions between NSRP and processing related to the “material self” (Craig, 2002), or the awareness of the physiological condition of the body (i.e., interoception). Coinciding with theoretical developments, clinical initiatives deliberately targeting NSRP are increasingly appearing within the treatment literature, many of which employ mindfulness to reduce reliance on self-referentiality in favor of an orientation that is nonjudgmental, nonreactive, and present centered (Mennin & Fresco, 2013). Generally, these treatments target attention and metacognition, which have been theorized to underlie NSRP (Mennin, Ellard, Fresco, & Gross, 2013), by cultivating interoception in response to stress (Farb, Segal, & Anderson, 2012). In doing so, an implicit objective of mindfulness-based treatments is to assist individuals in becoming more unbiased observers of their own internal experience and promote more adaptive ways of relating to self-relevant information (Mennin, Ellard et al., 2013; Teasdale, 1999). Joining in this objective, we endeavor to better understand NSRP, interoception, and how examining these various aspects of self may improve treatment for disorders characterized by NSRP. The primary goal of the current study is to investigate whether attending to interoceptive cues may reduce NSRP. First, we give an account of the burden of affective disorders, followed by a contextualization of the current study within a transdiagnostic framework. We then offer a brief history of the self as a construct of psychological inquiry. Next, we elucidate normative aspects of self-reference, including interoception, and describe how psychopathology is linked to aberrations of this normative framework. Subsequently, we characterize NSRP and discuss its psychological and physiological impact. We then examine current treatments and consider why cultivating interoception may counteract NSRP and state objectives and hypotheses of the current study. 2 The Burden of Misery A subset of psychiatric conditions, often referred to as misery or distress disorders (e.g., Watson, 2005) place widespread burden on society and induce considerable human suffering. According to recent reports, two of the most common distress disorders are major depressive disorder (MDD) and generalized anxiety disorder (GAD; Grant et al., 2009). Both disorders impair cognitive, affective, and somatic domains of functioning. Specifically, MDD is characterized by sustained depressed mood and/or loss of interest or pleasure in activities of daily living, and symptoms including changes in appetite, sleep disturbance, changes in activity levels, loss of energy, feelings of guilt or worthlessness, difficulties concentrating, and suicidality (Diagnostic and Statistical Manual of Mental Disorders 5th edition; DSM-5; American Psychiatric Association [APA], 2013). GAD is characterized by excessive worry that