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Access Type

WSU Access

Date of Award

January 2021

Degree Type

Dissertation

Degree Name

Ph.D.

Department

Psychology

First Advisor

Mark A. Lumley

Abstract

This trial evaluated the efficacy of two conceptually different, three-session interventions for university students with at least moderate symptoms of anxiety and somatic symptoms such as headaches, back pain, or digestive system difficulties. Eligible students (N = 52) were randomly assigned to receive a mindfulness-based intervention (MMT) (n = 19), an emotional awareness and expression intervention (EAET) (n = 15), or to a waitlist control condition (WLC) (n = 18). Assessments of physical, social, and psychological functioning were conducted immediately before randomization, again 4 weeks later, and finally 8 weeks after randomization. Participants in the control condition were invited to receive the intervention of their choice after completing the final assessment. Despite the fact that the COVID-19 pandemic interrupted this trial when it was just over half completed, and the resulting sample size lacks statistical power to detect small effects, the results are noteworthy and often statistically significant. The MMT intervention was highly effective in improving a wide range of outcomes in this population. This intervention led to significantly greater improvements than did the control condition on both primary outcomes, somatic symptoms and anxiety, as well as on all secondary outcomes (depression, interpersonal sensitivity, perceived stress, positive and negative affect, and life satisfaction), and with large effect sizes. The effects of the EAET intervention were somewhat modest and not consistent across measures. The intervention was significantly superior to the control condition in improving depression and positive affect, as well as anxiety and negative affect, and interpersonal sensitivity, with moderate to large effect sizes. However, EAET did not improve the primary outcome of somatic symptoms (only small effects), nor did EAET improve perceived stress or life satisfaction, compared to the control condition. Although it was expected that both active treatments would lead to comparable improvements in clinical outcomes, impressively, MMT led to significantly greater improvements than did EAET on somatic symptoms, interpersonal sensitivity, and life satisfaction, with large effect sizes. These results suggest that each of these interventions are appropriate for anxious college students, but that the MMT intervention may be more broadly effective. Changes in proposed process measures were not found to be specific to treatment condition. It was hypothesized that the MMT intervention would lead to decreases in experiential avoidance and increases in mindfulness, and that the EAET intervention would lead to increases in emotional expressivity and emotional approach coping. Although the MMT intervention was effective in decreasing experiential avoidance and in increasing mindfulness, as hypothesized, it also resulted in increases in emotional approach coping and in emotional expressivity. The EAET intervention was effective in increasing emotional expressivity and emotional approach coping, but EAET also led to reductions in experiential avoidance and increases in mindfulness. When compared to each other, the two interventions had similar effects on all four process measures. These results suggest that, although very different from one another, these two interventions may share some common pathways. For example, both interventions support increasing emotional awareness and decreasing avoidance of uncomfortable emotions, which might provide one explanation for the observed effects of both interventions on experiential avoidance and mindfulness. It is also the case that when novel interventions are developed, it is not uncommon for researchers to use different jargon to refer to processes of interest that are addressed by other older therapies. In the present case, the term “experiential avoidance” may be analogous to terms used by short-term dynamic therapies such as “removal of defenses” or “approaching avoided affects.”

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