Mindfulness and Appraisal-based Interventions for Promoting Distress Tolerance and Preventing Chronic Illness and Persistent Psychological Distress
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Date
2024-12-19
Authors
Lipsett, Megan
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Publisher
University of Oregon
Abstract
Addressing the psychological and emotional components of chronic physical and mental health issues is crucial for overall well-being and disease management. Psychoeducational interventions that target meta-cognitive skills and are informed by mindfulness and acceptance-based approaches show great promise in enhancing distress tolerance and fostering health-promoting skills. This dissertation explores the efficacy of interventions that pair contemplative practices with psychoeducational programs in two high-risk populations. The first study focuses on a brief, computer-delivered intervention for T2D prevention in a high-risk adult population, while the second study examines the impact of a mindful self-reflection training combined with a positive psychology and neuroscience course for college-transitioning adults at risk for chronic psychological and emotional distress. Study 1 presents findings from a randomized controlled trial (RCT) of a brief (45-min), computer-delivered mindfulness- and acceptance-based intervention for T2D prevention in a screen-identified high-risk population, compared to conventional diabetes prevention education (DPE). Despite strong evidence that Type 2 Diabetes (T2D) can be prevented through lifestyle changes, traditional programs have limited effectiveness in altering behaviors or reducing incidence. Effective, accessible interventions targeting key psychosocial mechanisms and implementable virtually after risk assessments or primary care visits are needed. This intervention aims to enhance meta-cognitive skills (present-moment awareness, psychological flexibility, controllability awareness, experiential acceptance, cognitive defusion, and values identification) and reduce perceptions of threat and diabetes distress, a known barrier to health behavior change. The ACT + DPE group showed significantly higher controllability awareness and emotional acceptance, along with lower state anxiety, perceptions of diabetes risk-related threat, and state stress compared to the DPE-only group. Groups demonstrated equivalent readiness to change, self-management activation, or self-efficacy. This RCT is one of the first to test a brief, web-based, ACT-informed diabetes prevention program, demonstrating its potential to increase specific meta-cognitive skills and reduce anxiety, stress, and diabetes risk-related threat when engaged immediately after learning about being at high risk for diabetes.
Study 2 explores the impact of meta-cognitive skills on college-transitioning adults' well-being through a 4-week mindful self-reflection training combined with a 10-week positive psychology and neuroscience (PPN) course for first-year undergraduate students, compared to a control group (general psychology course). The meta-cognitive skills of mindful awareness and psychological distance are valuable for reflecting on adverse life experiences and promoting emotional and psychological well-being, particularly among college-transitioning adults prone to psychological distress. We employed a multi-modal assessment that included psychological surveys, linguistic analysis, and functional magnetic resonance imaging (fMRI). Both the PPN course alone and the Mindful Self-reflection training + PPN course groups showed significant increases in self-distancing (i.e., reduced psychologically immersed speech and blame attributions) and self-transcendence. The PPN course alone led to greater increases in interpersonal perspective-taking, while the Mindful Self-reflection training + PPN course group showed greater increases in other-focus and well-being (relationship quality, self-acceptance, sense of purpose, and personal growth), as well as decreases in perceived stress, interpersonal distress, and depression. The Mindful Self-reflection training + PPN course group also had greater pre-to-post decreases in neural activity in the posterior precuneus, dmPFC, and TPJ during self-distancing tasks compared to the control group. Training in mindfulness and adaptive self-reflection on emotionally difficult events during the first year of college can alter the thought content and neural mechanisms of meta-cognitive skills, including self-referential processing, self- and other-mentalizing, self-distancing, and emotion regulation, ultimately reducing psychological and interpersonal distress and increasing multiple dimensions of well-being.
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Keywords
Acceptance and Commitment Therapy, Diabetes prevention, Health psychology, Mindfulness, Neuroscience, Psychological Distress