Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
J Anxiety Disord. 2017 Aug;50:15-22. doi: 10.1016/j.janxdis.2017.04.007. Epub 2017 May 2.
Exposure-based cognitive behavior therapy (CBT) has been shown to be effective in the treatment of severe health anxiety, but little is known about mediators of treatment effect. The aim of the present study was to investigate mindful non-reactivity as a putative mediator of health anxiety outcome using data from a large scale randomized controlled trial. We assessed mindful non-reactivity using the Five Facets Mindfulness Questionnaire-Non-Reactivity scale (FFMQ-NR) and health anxiety with the Short Health Anxiety Inventory (SHAI). Participants with severe health anxiety (N=158) were randomized to internet-delivered exposure-based CBT or behavioral stress management (BSM) and throughout the treatment, both the mediator and outcome were measured weekly. As previously reported, exposure-based CBT was more effective than BSM in reducing health anxiety. In the present study, latent process growth modeling showed that treatment condition had a significant effect on the FFMQ-NR growth trajectory (α-path), estimate=0.18, 95% CI [0.04, 0.32], p=.015, indicating a larger increase in mindful non-reactivity among participants receiving exposure-based CBT compared to the BSM group. The FFMQ-NR growth trajectory was significantly correlated with the SHAI trajectory (β-path estimate=-1.82, 95% CI [-2.15, -1.48], p<.001. Test of the indirect effect, i.e. the estimated mediation effect (αβ) revealed a significant cross product of -0.32, which was statistically significant different from zero based on the asymmetric confidence interval method, 95% CI [-0.59, -0.06]. We conclude that increasing mindful non-reactivity may be of importance for achieving successful treatment outcomes in exposure-based CBT for severe health anxiety.
暴露为基础的认知行为疗法（CBT）已被证明在治疗严重的健康焦虑症方面是有效的，但对于治疗效果的中介因素知之甚少。本研究的目的是使用大规模随机对照试验的数据，调查正念的非反应性作为健康焦虑结果的一个潜在中介因素。我们使用五因素正念问卷-非反应量表（FFMQ-NR）评估正念的非反应性，使用简短健康焦虑量表（SHAI）评估健康焦虑。有严重健康焦虑的参与者（N=158）被随机分配到基于互联网的暴露为基础的 CBT 或行为压力管理（BSM），在整个治疗过程中，每周都测量中介因素和结果。如前所述，暴露为基础的 CBT 比 BSM 更能有效降低健康焦虑。在本研究中，潜在过程增长模型显示，治疗条件对 FFMQ-NR 增长轨迹（α路径）有显著影响，估计值为 0.18，95%置信区间为[0.04, 0.32]，p=.015，表明接受暴露为基础的 CBT 的参与者的正念非反应性增长幅度大于 BSM 组。FFMQ-NR 增长轨迹与 SHAI 轨迹显著相关（β路径估计值=-1.82，95%置信区间[-2.15, -1.48]，p<.001。间接效应检验，即估计的中介效应（αβ）显示，交叉乘积为-0.32，基于不对称置信区间方法，这在统计学上显著不同于零，95%置信区间[-0.59, -0.06]。我们得出结论，在暴露为基础的 CBT 治疗严重健康焦虑症中，增加正念的非反应性可能对获得成功的治疗结果很重要。
