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The mediating effect of mindful non-reactivity in exposure-based cognitive behavior therapy for severe health anxiety
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.ORCID iD: 0000-0002-9736-8228
Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
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2017 (English)In: Journal of Anxiety Disorders, ISSN 0887-6185, E-ISSN 1873-7897, Vol. 50, p. 15-22Article in journal (Refereed) Published
Abstract [en]

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 (alpha-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 (13 -path estimate = -1.82, 95% CI [-2.15, -1.48], p <.001. Test of the indirect effect, i.e. the estimated mediation effect (an) 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.

Place, publisher, year, edition, pages
Elsevier, 2017. Vol. 50, p. 15-22
Keywords [en]
Severe health anxiety, Exposure, Cognitive behavior therapy, Mediator, Mindful non-reactivity
National Category
Applied Psychology
Identifiers
URN: urn:nbn:se:oru:diva-78076DOI: 10.1016/j.janxdis.2017.04.007ISI: 000408400900003PubMedID: 28528015Scopus ID: 2-s2.0-85019647523OAI: oai:DiVA.org:oru-78076DiVA, id: diva2:1387638
Funder
The Karolinska Institutet's Research FoundationStockholm County CouncilAvailable from: 2020-01-22 Created: 2020-01-22 Last updated: 2024-01-11Bibliographically approved

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