Cognitive Defusion Versus Thought Distraction in the Mitigation of Learned Helplessness

Transcription

1 The Psychological Record, 2013, 63, 1 10 Cognitive Defusion Versus Thought Distraction in the Mitigation of Learned Helplessness Nic Hooper Middle East Technical University, Northern Cyprus Campus Louise McHugh University College Dublin Recent research suggests that attempting to avoid unwanted psychological events is maladaptive. Contrastingly, cognitive defusion, which is an acceptance-based method for managing unwanted thoughts, may provide a plausible alternative. The current study was designed to compare defusion and experiential avoidance as strategies for coping with unwanted thoughts during a learned helplessness preparation. Before entering the learned helplessness preparation, participants were provided with 1 of 3 instructions: defusion, experiential avoidance (via a thought distraction instruction), or control (i.e., no instruction). Directly after the learned helplessness preparation, participants were instructed to attempt a pen-and-paper maze task, where their completion time was recorded. Results indicated that participants who received the defusion instruction produced maze times that were significantly shorter than the thought distraction and control groups. Results are discussed in terms of the efficacy of defusion instructions in the management of unwanted thoughts and the maladaptive nature of engaging in experiential avoidance. Key words: defusion, acceptance, thought distraction, learned helplessness Over the past decade, increasing empirical support has emerged for acceptance and commitment therapy (ACT; Hayes, Strosahl, & Wilson, 1999), a form of third-wave cognitive behavior psychotherapy. ACT suggests that the dominant verbal system within which humans exist promulgates the message that undesirable psychological content (e.g., negative thoughts, feelings, and sensations) is a barrier to effective living and that in order to begin to live effectively, we must eliminate and/or change such content. For instance, advocates of positive thinking typically suggest that negative thoughts such as, I am not good enough should be excised and that positive thoughts such as, I am perfect or I can do anything that I put my mind to should replace them (Lightsey, 1994; Wood, Perunovic, & Lee, 2009). However, research suggests that attempting to alter or avoid unwanted negative content can increase its presence (Deacon, Fawzy, Lickel, & Wolitzky- Taylor, 2011; Hooper, Saunders, & McHugh, 2010). An alternative strategy for coping with undesirable content from the ACT perspective is cognitive defusion. Cognitive defusion involves undermining negative effects of Correspondence concerning this article should be addressed to Nic Hooper, Department of Psychology, Middle East Technical University, Northern Cyprus Campus, Kalkanli, Northern Cyprus, Via Mersin 10, Turkey. Hooper@metu.edu.tr

2 2 Hooper and McHugh language by teaching clients to distance themselves from their thoughts. More specifically, cognitive defusion is the process of undermining the behavior regulatory functions and literal believability of thoughts (Twohig, Masuda, Varra, & Hayes, 2005). ACT clinicians encourage clients to defuse from their negative content by viewing their thoughts as just thoughts rather than considering them to have literal meaning (Healy et al., 2008). Previous research on defusion has used Titchener s (1916) word-repetition exercise. The word-repetition exercise involves repeating a word until it loses its semantic meaning (Masuda, Hayes, Sackett, & Twohig, 2004). Masuda et al. (2004), in a series of single-case alternating treatment designs, compared three techniques in the management of unwanted thoughts: (a) defusion, (b) thought distraction, and (c) thought control. In the defusion condition, participants were instructed to generate two self-relevant negative thoughts and reduce them to one word. For example, the thought I am a bad person was reduced simply to bad. Subsequently, participants were required to repeat that word over a 30-s period. The findings indicated that the defusion instruction produced a significant reduction in both the believability and the distress levels associated with the thought, compared to both the thought distraction and thought control groups. In an extension of this work, Masuda et al. (2009) investigated the impact of exercise length on associated distress and believability of the thought. Their findings indicated that distress levels were reduced after just 3 to 10 s, and believability was reduced after 20 to 30 s. Healy et al. (2008) investigated the impact of an alternative defusion technique on self-negative statements. Rather than using Titchener s (1916) word-repetition exercise, these researchers instructed participants to rate the believability of I am a bad person (a nondefusion statement) compared to I am having the thought that I am a bad person (a defusion statement). Findings from this study demonstrated that the defusion statements were rated as lower in believability and in level of associated distress, compared to nondefusion statements, thus providing further evidence that defusion may be useful in the management of unwanted negative thoughts. More recently, a growing number of studies have demonstrated the efficacy of defusion in the laboratory with nonclinical populations (see Deacon et al., 2011; De Young, Lavender, Washington, Looby, & Anderson, 2010; Masuda, Feinstein, Wendell, & Sheehan, 2010; Masuda, Twohig, et al., 2010). While reductions in believability and distress are noteworthy dependent measures, the validity of self-report measures has often been questioned (Gannon, 2006). Perhaps a more interesting dependent measure would involve the demonstration of a postdefusion overt behavioral change. Recently, Hooper, Sandoz, Ashton, Clarke, and McHugh (2012) used a postdefusion behavioral measure. Specifically, they demonstrated that a brief defusion intervention for managing chocolate cravings altered the amount of postintervention chocolate eaten by participants in this group, compared to those in thought suppression and control groups. An experimental method of inducing a depressed-like state and negative psychological content involves exposing participants to an unsolvable task, or an uncontrollable relationship between an action and its outcome (Teasdale & Fogarty, 1979). Prior experience with uncontrollable events has been demonstrated to retard the acquisition of subsequent new responses (Overmier & Seligman, 1967; Seligman, 1975), such as response times to completion on a maze task (Reed, Frasquillo, Colkin, Liemann, & Colbert, 2001), performance on discrimination (Hiroto & Seligman, 1975), and judgment of control tasks (Maldonado, Martos, & Ramírez, 1991). This effect has been termed learned helplessness (Seligman, 1975). Attribution-style accounts of learned helplessness have directly linked negative self-evaluations to subsequent hampered performance, thus providing theoretical support that language processes contribute to the aftereffects of learned helplessness in humans (Teasdale & Fogarty, 1979). In the current study, participants were randomly assigned to one of three groups (i.e., defusion, distraction, or control). The defusion group received a defusion instruction, the thought distraction group received a thought distraction instruction, and the control group received no instruction. After the instruction/no instruction phase, all participants

3 Defusion Versus Thought Distraction completed a learned helplessness preparation prior to a pencil-and-paper maze task. The aims of the current study were twofold. First, the study aimed to model the effect of defusion in dealing with unwanted psychological content by providing a behavioral measure of the effectiveness of this technique. Second, the study sought to provide the first comparison of defusion with the commonly used technique of thought distraction (Rachman & De Silva, 1978), in coping with a learned helplessness preparation. We predicted that participants who received the brief defusion instruction would perform significantly better on the maze task than would those receiving a thought distraction instruction/no instruction. Specifically, we expected that the defusion process would circumvent fusion with negative content (i.e., thoughts) that would otherwise hinder maze task performance. Method Participants Students from Swansea University (N = 74) volunteered to participate in the study, for which they received course credit. Participants (57 female and 17 male) ranged in age from 18 to 27 years (M = 20.9, SD = 4.72). The sample was nonclinical. Due to links between learned helplessness and depression (Seligman, 1975), participants were screened for depressive tendencies. Subsequently, the maze times of nine participants were excluded from the study due to high scores (a score of 15 or more warranted exclusion) on the Beck Depression Inventory II (BDI II; Beck, Steer, & Brown, 1996). In terms of group numbers, this left 23 participants in the defusion instruction group, 22 participants in the thought distraction instruction group, and 20 participants in the control group. Design The study involved a between-subject experimental design, with participants randomly assigned to technique instruction (i.e., defusion, thought distraction, or control) as the between-subject independent variable; time to complete the maze task served as the dependent measure. Measures and Materials The stopwatch used to measure the maze performance was a grey event timer, Model A paper-and-pencil maze task was used as the dependent measure (a Small s Hampton Court Maze, originally printed in Boakes, 1984). Finally the BDI II (Beck et al., 1996) was used to exclude those scoring high in depressive tendencies and to assess any pre-experimental differences in levels of depression between the three groups that may have served to confound the results. The BDI II is a 21-item measure, with each item rated on a 4-point Likert-type scale. Data suggest strong psychometric reliability (α =.92) and validity. Procedure On commencing the study, each participant was given an information sheet outlining the broad purpose of the research. The outline described the experiment as investigating different ways of dealing with unwanted thoughts. They were asked to read through the information sheet and to sign the consent form if they were willing to proceed. All participants were then given a copy of the BDI II to complete. Upon completion of the measure, each participant was assigned at random to one of the three groups (i.e., defusion, thought distraction, or control). Instructions. Participants assigned to the defusion group received a copy of the following instructions: 3

4 4 Hooper and McHugh The next task will last between 2 and 10 minutes depending on your performance. It is a simple task. Your job during this task is to notice your thoughts as they show up. As you do this, try not to get caught in believing any one of these thoughts; instead, see them as thoughts and not reality. The exercise below will help you to do this: Notice each of your thoughts as they pop into your head. The thought may be this is too easy, I am very bad at this exercise, or I don t know what I m thinking! One by one, notice each thought that you have and let them just pass by your consciousness. It may even be helpful to alter the thought from this is too easy/i am very bad at this exercise to right now, I am having the thought that this is too easy/i am having the thought that I am very bad at this exercise. Participants assigned to the thought distraction group received a copy of the following instructions: The next task will last between 2 and 10 minutes depending on your performance. It is a simple task. Your job during this task is to notice your thoughts as they show up. As you do this, do not let those thoughts affect you, simply suppress all thoughts and stay focused on the task. The exercise below will help you to do this: Think of a good thought. Keep that thought in mind. Anytime bad thoughts come into your mind, immediately replace them with the good thought. Suppress all negative thoughts and allow the good thought to remain. Participants assigned to the control group were given no instruction and proceeded directly to the next step in the experiment. Participants were then asked to complete the learned helplessness computer task while incorporating their respective instruction. Learned helplessness. Each participant read through the instructions on the computer screen that corresponded with the learned helplessness preparation (the preparation was a direct replication of that used by Maldonado et al., 1991). Only the unsolvable version of the task was used. The instructions were as follows: In this experiment, you will be looking at a series of computer-presented images. Each image will involve two stimulus patterns on it. One to the left and another to the right. The stimulus patterns are composed of four different dimensions, with two values associated with each dimension. For each presentation, I have chosen one of the eight values as being correct. For each image, I want you to choose which side contains this value. To do this, you must click on one of the buttons presented underneath the image (left or right). If your choice is incorrect, a noise comes on through the speakers, but if you choose the correct side, there will be no noise. Your task is to learn the predetermined value by your response, according to whether or not the noise is heard. The current experiment is adapted from a standard intelligence test. Most people learn to respond appropriately to the task with relative ease. See Figure 1 for a visual representation of the learned helplessness program. Participants were asked to choose between two panels that could differ from each other across four different dimensions, each of which encompassed two values: (a) color (red vs. green), (b) shape (square vs. circle), (c) font size (large vs. small), and (d) letter ( T vs. A ). Participants had to determine which of the four dimensions had been preselected by the administrator within a given set of trials (e.g., letter) and which value within the dimension was the correct one (e.g., T ). In this example, because letter not font size is the relevant dimension, selecting the panel that contained a large T rather than the other panel that presented a small A would be a correct response, whereas selecting a panel with a large A rather than the one with a small T would constitute an error.

5 Defusion Versus Thought Distraction 5 T A Figure 1. A sample screen from the learned helplessness preparation. Each participant completed 4 sets of 10 trials. In essence, via trial and error, each participant had to work out which one of two values within four different dimensions was correct in each set. The participants were instructed that if they chose the correct value, no noise occurred, whereas if they chose an incorrect value, a loud noise was played through the speakers of the computer. Unbeknownst to the participants, however, they had no control over the preparation. In order to induce learned helplessness, the incorrect noise was presented on 50% of the trials, regardless of the buttons the participants pressed. Feedback throughout the experiment was random and not contingent on any particular value. Prior to beginning the preparation, all participants were asked if the instructions were understood, and they were given time to ask questions and receive further explanation of what was necessary to conduct the task. Maze task. Upon completion of the learned helplessness preparation, a page with a maze task was placed on the desk in front of the participant. Each participant was instructed to complete the maze and told that his or her completion time would be recorded. The instructions were as follows: Please complete the maze on the table in front of you in the quickest time possible. Your time will be recorded. In order to complete the maze task, you have to begin at the X marked on the perimeter of the maze and work your way to the center. As soon as you begin, I will start the stopwatch. The time taken to complete the maze was recorded by a researcher who was blind to the experimental group the participant had been assigned to. At the end of the experiment, participants were fully debriefed. Results Questionnaires Nine participants scored highly on the BDI II. The remainder of the participants fell within a normal range (M = 4.73, SD = 4.06). A one-way analysis of variance (ANOVA), designed to determine any pre-experimental differences in BDI II scores, revealed no significant difference, F(2, 64) = 1.754, p > 0.05, between the defusion group (M = 4.62, SD = 2.40), the thought distraction group (M = 5.53, SD = 3.92), and the control group (M = 5.43, SD = 2.39).

6 6 Hooper and McHugh Maze Task The amount of time taken to complete the maze task across the three groups is presented in Figure 2. From Figure 2, it can be seen that the defusion group (M = 39 s) took less time to complete the maze than both the thought distraction group (M = 52.5 s) and the control group (M = 49.1 s). This suggests that the participants who received the defusion instruction were least affected by the learned helplessness preparation in the subsequent behavioral task. 60 Seconds Taken To Complete the Maze Task Defusion Distraction Control Figure 2. Mean (standard error) amount of time taken to complete the maze task across the defusion, distraction, and control conditions. A one-way between-subjects ANOVA revealed a statistically significant main effect for maze completion time, F(2, 64) = 6.147, p <.005, η 2 =.17. A series of post-hoc Tukey HSD tests were conducted in order to determine where these differences emerged. Results from the defusion versus thought distraction analysis revealed a significant difference (p =.004, SE = 4.08) in completion time, suggesting that participants in the thought distraction group completed the maze in a significantly slower time than did those in the defusion group. Additionally, the defusion group completed the maze in significantly less time than did the control group (p =.043, SE = 4.18). However, there was no significant difference between the thought distraction group and the control group (p =.701, SE = 4.22). Discussion The current study aimed to compare the effectiveness of defusion versus thought distraction in dealing with the negative psychological content associated with attempting to complete an unsolvable task (i.e., a learned helplessness induction). The effects of learned helplessness are demonstrated in the literature by impaired performance on a subsequent task. For example, previous research by Reed et al. (2001) demonstrated significantly slower response times to completion on a post learned helplessness maze task. The results of the current study showed that participants who received a brief defusion instruction performed significantly better on the maze task, after having completed a learned helplessness preparation, when compared to those in the thought distraction group and the control group. This finding suggests that the typical effects of completing an unsolvable task on subsequent task performance were reduced by the defusion instruction. The results reflect previous work that has demonstrated the possible positive effects of engaging in defusion-based strategies (Healy et al., 2008; Hooper et al., 2012; Masuda et al., 2004, 2009).

7 Defusion Versus Thought Distraction As a piece of preliminary research, the results of the current study are encouraging. However, there are three limitations that may compromise the internal and external validity of the study. First, the instruction for the defusion group was slightly longer (63 words) than that of the thought distraction group. Most people (80%) report using thought distraction as a coping strategy for dealing with unwanted thoughts (Rachman & De Silva, 1978). Therefore, it is likely that participants in the current study were already proficient in distraction-based techniques for managing unwanted thoughts. However, exposure to acceptance-based techniques like defusion presumably would be limited by comparison given the counterintuitive nature of these techniques. Nevertheless, this does not remove the potential confound that longer instructions may have contributed to greater treatment adherence to the defusion over the thought distraction instruction. In order to overcome this difficulty, future research could include instructions that are the same length. This would involve either shortening the defusion instructions or lengthening the thought distraction instructions. The latter option seems more plausible given the already brief nature of the interventions and the participants likely lack of history with defusion as a coping strategy. Additionally, it is possible that longer instructions may have favored the defusion participants in two distinct but possibly related ways. First, longer defusion instructions could have resulted in participants being more compliant. The inclusion of an interview as a check of treatment integrity after the helplessness-inducing task could help determine whether the apparent effect of defusion on time to task completion resulted from participants being more likely to engage in defusion than in distraction. Second, the longer defusion instruction could have been perceived as more credible to participants. A credibility check on the defusion and distraction conditions that documented no differences between them would further minimize the necessity of equating the length of their instructions. Such a check might be conducted in two ways. As with the assessment of treatment integrity, participants could be asked after completion of the helplessnessinducing task how credible they found the instructions they were given (e.g., Before you began the computerized task, how helpful did you think the suggestions you were given about how to handle unwanted thoughts during the task would be to you? ). Alternatively, another group of students comparable to the participants in this study could be asked to simply rate the credibility of the two sets of instructions. The second limitation that may also have compromised the internal validity of the study concerns the lack of treatment adherence. The current study did not conduct a posttask interview with the participants to determine how they managed the unwanted thoughts that arose from attempting to complete the unsolvable task. Although the behavioral results of the study are consistent with pre-experimental predictions, without a treatment adherence check, it is impossible to know for certain whether the participants from any of the groups engaged in their respective instructions. Future research should include a posttask assessment of treatment adherence in order to improve the internal validity of the study. Finally, previous defusion-based studies use thought believability and distress measures pre- and postexperimentally in order to gauge the efficacy of the defusion technique. Although the behavioral effects of the current study are interesting in their own right, future research should include separate believability and distress measures. This would not only supplement the findings of the behavioral measure but also allow a comparison between the findings of the current study and those of previous defusion-based studies. References Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck Depression Inventory II manual. San Antonio TX: Psychological Corporation. Boakes, R. A. (1984). From Darwin to behaviourism. Cambridge, England: Cambridge University Press. 7

8 8 Hooper and McHugh Deacon, B. J., Fawzy, T. I., Lickel, J. J., & Wolitzky-Taylor, K. B. (2011). Cognitive defusion versus cognitive restructuring in the treatment of negative selfreferential thoughts: An investigation of process and outcome. Journal of Cognitive Psychotherapy, 25, De Young, K. P., Lavender, J. M., Washington, L. A., Looby, A. A., & Anderson, D. A. (2010). A controlled comparison of the word repeating technique with a word association task. Journal of Behavior Therapy and Experimental Psychiatry, 41, doi: /j.jbtep Gannon, T. A. (2006). Increasing honest responding on cognitive distortions in child molesters: The bogus pipeline procedure. Journal of Interpersonal Violence, 21, Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York, NY: Guilford Press. Healy, H. A., Barnes-Holmes, Y., Barnes-Holmes, D., Keogh, C., Luciano, C., & Wilson, K. (2008). An experimental test of a cognitive defusion exercise: Coping with negative and positive self-statements. The Psychological Record, 58, Hiroto, D. S., & Seligman, M. E. P. (1975). Generality of learned helplessness in man. Journal of Personality and Social Psychology, 31, Hooper, N., Sandoz, E., Ashton, J., Clarke, A., & McHugh, L. (2012). Comparing thought suppression and acceptance as coping techniques for food cravings. Eating Behaviors, 13, doi: /j.eatbeh Hooper, N., Saunders, J., & McHugh, L. (2010). The derived generalization of thought suppression. Learning and Behavior, 38, doi: /lb Lightsey, O. R. (1994). Positive thoughts versus states of mind ratio as a stress moderator: Findings across four studies. Cognitive Therapy and Research, 23, Maldonado, A., Martos, R., & Ramírez, E. (1991). Human judgements of control: The interaction of the current contingency and previous controllability. Quarterly Journal of Experimental Psychology, 43B, Masuda, A., Feinstein, A. B., Wendell, J. W., & Sheehan, S. T. (2010). Cognitive defusion versus thought distraction: A clinical rationale, training, and experiential exercise in altering psychological impacts of negative self-referential thoughts. Behavior Modification, 34, doi: / Masuda, A., Hayes, S. C., Sackett, C. F., & Twohig, M. P. (2004). Cognitive defusion and self-relevant negative thoughts: Examining the impact of a ninety year old technique. Behaviour Research and Therapy, 42, Masuda, A., Hayes, S. C., Twohig, M. P., Drossel, C., Lillis, J., & Washio, Y. (2009). A parametric study of cognitive defusion and the believability and discomfort of negative self-relevant thoughts. Behavior Modification, 33, Masuda, A., Twohig, M. P., Stormo, A. R., Feinstein, A. B., Chou, Y., & Wendell, J. W. (2010). The effects of cognitive defusion and thought distraction on emotional discomfort and believability of negative self-referential thoughts. Journal of Behavior Therapy and Experimental Psychiatry, 41, doi: /j. jbtep Overmier, J. B., & Seligman, M. E. P. (1967). Effects of inescapable shock upon subsequent escape and avoidance responding. Journal of Comparative and Physiological Psychology, 63, Rachman, S., & de Silva, P. (1978). Abnormal and normal obsessions. Behavior Research and Therapy, 16,

9 Defusion Versus Thought Distraction Reed, P., Frasquillo, F., Colkin, C., Liemann, V., & Colbert, S. (2001). Interference with judgements of control and learning as a result of prior exposure to controllable and controllable feedback during concept learning tasks. Quarterly Journal of Experimental Psychology, 54B, Seligman, M. E. P. (1975). Helplessness. San Francisco, CA: Freeman. Teasdale, J. D., & Fogarty, S. J. (1979). Differential effects of induced mood on retrieval of pleasant and unpleasant events from episodic memory. Journal of Abnormal Psychology, 88, Titchener, E. B. (1916). A text-book of psychology. New York, NY: MacMillan. Twohig, M. P., Masuda, A., Varra, A. A., & Hayes, S. C. (2005). Acceptance and commitment therapy as a treatment for anxiety disorders. In S. M. Orsillo & L. Roemer (Eds.), Acceptance and mindfulness-based approaches to anxiety: Conceptualization and treatment (pp ). New York, NY: Kluwer/Springer- Verlag. Wood, J. V., Perunovic, W. Q. E., & Lee, J. W. (2009). Positive self-statements: Power for some, peril for others. Psychological Science, 20,

10 10