https://doi.org/10.4081/ripppo.2023.659
The associations between interoceptive awareness, emotion regulation, acceptance, and well-being in patients receiving multicomponent treatment: a dynamic panel network model
Submitted: August 8, 2022
Accepted: May 14, 2023
Published: July 26, 2023
Accepted: May 14, 2023
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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Mechanisms of change represent the cornerstone of the therapeutic process. This study aimed to investigate how network models could be used to test mechanisms of change at a group level. A secondary aim was to investigate which of the several hypothesized mechanisms (emotion regulation, interoceptive awareness, and acceptance) are related to changes in psychological well-being. The sample comprised adult patients suffering from psychological disorders (N=444; 70% women) from 7 clinical sites in the Czech Republic who were undergoing groupbased multicomponent treatment composed mainly of psychodynamic psychotherapy (lasting from 4 to 12 weeks depending on the clinical site). Data were collected weekly using the multidimensional assessment of interoceptive awareness, emotion regulation skills questionnaire, chronic pain acceptance questionnaire-symptoms and outcome rating scale. A lag-1 longitudinal network model was employed for exploratory analysis of the panel data. The pruned final model demonstrated a satisfactory fit. Three networks were computed, i.e., temporal, contemporaneous, and between-person networks. The most central node was the modification of negative emotions. Mechanisms that were positively associated with well-being included modification, readiness to confront negative emotions, activity engagement, and trust in bodily signals. Acceptance of negative emotions showed a negative association with well-being. Moreover, noticing bodily sensations, not worrying, and self-regulation contributed indirectly to changes in well-being. In conclusion, the use of network methodology to model panel data helped generate novel hypotheses for future research and practice; for instance, well-being could be actively contributing to other mechanisms, not just a passive outcome.
A-Tjak, J. G., Davis, M. L., Morina, N., Powers, M. B., Smits, J. A., & Emmelkamp, P. M. (2015). A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychotherapy and Psychosomatics, 84(1), 30-36. DOI: 10.1159/000365764.
DOI: https://doi.org/10.1159/000365764
Balzarotti, S., Biassoni, F., Villani, D., Prunas, A., & Velotti, P. (2016). Individual differences in cognitive emotion regulation: implications for subjective and psychological well-being. Journal of Happiness Studies, 17(1), 125-143. DOI: 10.1007/s10902-014-9587-3.
DOI: https://doi.org/10.1007/s10902-014-9587-3
Berking, M., & Znoj, H. (2008). Entwicklung und validierung eines fragebogens zur standardisierten selbsteinschätzung emotionaler kompetenzen (SEK-27). Zeitschrift für Psychiatrie, Psychologie und Psychotherapie, 56(2), 141-153. DOI: 10.1024/1661-4747.56.2.141. [Article in German]
DOI: https://doi.org/10.1024/1661-4747.56.2.141
Bond, F. W., & Bunce, D. (2000). Mediators of change in emotion-focused and problem-focused worksite stress management interventions. Journal of Occupational Health Psychology, 5(1), 156-163. DOI: 10.1037//1076-8998.5.1.156.
DOI: https://doi.org/10.1037/1076-8998.5.1.156
Brani, O., Hefferon, K., Lomas, T., Ivtzan, I., & Painter, J. (2014). The impact of body awareness on subjective wellbeing: the role of mindfulness. International Body Psychotherapy Journal, 13(1), 95-107.
Cisler, J. M., & Olatunji, B. O. (2012). Emotion regulation and anxiety disorders. Current Psychiatry Reports, 14(3), 182-187. DOI: 10.1007/s11920-012-0262-2.
DOI: https://doi.org/10.1007/s11920-012-0262-2
Dan-Glauser, E. S., & Gross, J. J. (2015). The temporal dynamics of emotional acceptance: experience, expression, and physiology. Biological Psychology, 108, 1-12. DOI: 10.1016/j.biopsycho.2015.03.005.
DOI: https://doi.org/10.1016/j.biopsycho.2015.03.005
Durand-Bush, N., McNeill, K., Harding, M., & Dobransky, J. (2015). Investigating stress, psychological well-being, mental health functioning, and self-regulation capacity among university undergraduate students: Is this population optimally functioning? Canadian Journal of Counselling and Psychotherapy, 49(3).
Epskamp, S. (2020). Psychometric network models from time-series and panel data. Psychometrika, 85(1), 206-231. DOI: 10.1007/s11336-020-09697-3.
DOI: https://doi.org/10.1007/s11336-020-09697-3
Epskamp, S., Epskamp, M. S., & Rcpp, L. (2020). Package ‘psychonetrics’. Available from: https://cran.r-project.org/web/packages/psychonetrics/psychonetrics.pdf.
Epskamp, S., & Fried, E. I. (2018). A tutorial on regularized partial correlation networks. Psychological Methods, 23(4), 617-634. DOI: 10.1037/met0000167.
DOI: https://doi.org/10.1037/met0000167
Epskamp, S., Waldorp, L. J., Mõttus, R., & Borsboom, D. (2018). The Gaussian graphical model in cross-sectional and time-series data. Multivariate Behavioral Research, 53(4), 453-480. DOI: 10.1080/00273171.2018.1454823.
DOI: https://doi.org/10.1080/00273171.2018.1454823
Falkenström, F., Solomonov, N., & Rubel, J. (2020). Using time-lagged panel data analysis to study mechanisms of change in psychotherapy research: methodological recommendations. Counselling and Psychotherapy Research, 20(3), 435-441. DOI: 10.1002/capr.12293.
DOI: https://doi.org/10.1002/capr.12293
Ferentzi, E., Horváth, Á., & Köteles, F. (2019). Do body-related sensations make feel us better? Subjective well-being is associated only with the subjective aspect of interoception. Psychophysiology, 56(4), e13319. DOI: 10.1111/psyp.13319.
DOI: https://doi.org/10.1111/psyp.13319
Flaxman, P. E., & Bond, F. W. (2010). Worksite stress management training: moderated effects and clinical significance. Journal of Occupational Health Psychology, 15(4), 347-358. DOI: 10.1037/a0020522.
DOI: https://doi.org/10.1037/a0020522
Goyal, M., Singh, S., Sibinga, E. M., Gould, N. F., Rowland-Seymour, A., Sharma, R., Berger, Z., Sleicher, D., Maron, D. D., Shihab, H. M., Ranasinghe, P. D., Linn, S., Saha, S., Bass, E. B., & Haythornthwaite, J. A. (2014). Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Internal Medicine, 174(3), 357-368. DOI: 10.1001/jamainternmed.2013.13018.
DOI: https://doi.org/10.1001/jamainternmed.2013.13018
Granger, C. W. J. (1969). Investigating causal relations by econometric models and cross-spectral methods. Econometrica, 37(3), 424-438. DOI: 10.2307/1912791.
DOI: https://doi.org/10.2307/1912791
Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85(2), 348-362. DOI: 10.1037/0022-3514.85.2.348.
DOI: https://doi.org/10.1037/0022-3514.85.2.348
Hanley, A. W., Mehling, W. E., & Garland, E. L. (2017). Holding the body in mind: interoceptive awareness, dispositional mindfulness and psychological well-being. Journal of Psychosomatic Research, 99, 13-20. DOI: 10.1016/j.jpsychores.2017.05.014.
DOI: https://doi.org/10.1016/j.jpsychores.2017.05.014
Hayes, A. M., Laurenceau, J. P., Feldman, G., Strauss, J. L., & Cardaciotto, L. (2007). Change is not always linear: the study of nonlinear and discontinuous patterns of change in psychotherapy. Clinical Psychology Review, 27(6), 715-723. DOI: 10.1016/j.cpr.2007.01.008.
DOI: https://doi.org/10.1016/j.cpr.2007.01.008
Hayes, S. C. (2004). Acceptance and commitment therapy and the new behavior therapies: mindfulness, acceptance, and relationship. In Hayes, S. C., Follette V. M., & Linehan M. M. (Eds.). Mindfulness and acceptance: expanding the cognitive-behavioral tradition (pp. 1-29). New York, Guilford Press.
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1-25. DOI: 10.1016/j.brat.2005.06.006.
DOI: https://doi.org/10.1016/j.brat.2005.06.006
Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1-55. DOI: 10.1080/10705519909540118.
DOI: https://doi.org/10.1080/10705519909540118
Joormann, J., & Gotlib, I. H. (2010). Emotion regulation in depression: relation to cognitive inhibition. Cognition & Emotion, 24(2), 281-298. DOI: 10.1080/02699930903407948
DOI: https://doi.org/10.1080/02699930903407948
Juhová, D. S., Řiháček, T., Cígler, H., Dubovská, E., Saic, M., Černý, M., Dufek, J., & Miller, S. D. (2021). Czech version of the outcome rating scale: Selected psychometric properties. Československá Psychologie, 65(4), 353–368. https://doi.org/10.51561/cspsych.65.4.353
DOI: https://doi.org/10.51561/cspsych.65.4.353
Kashdan, T. B., Barrios, V., Forsyth, J. P., & Steger, M. F. (2006). Experiential avoidance as a generalized psychological vulnerability: comparisons with coping and emotion regulation strategies. Behaviour Research and Therapy, 44(9), 1301-1320. DOI: 10.1016/j.brat.2005.10.003.
DOI: https://doi.org/10.1016/j.brat.2005.10.003
Keyes, C. L., Dhingra, S. S., & Simoes, E. J. (2010). Change in level of positive mental health as a predictor of future risk of mental illness. American Journal of Public Health, 100(12), 2366-2371. DOI: 10.2105/ajph.2010.192245.
DOI: https://doi.org/10.2105/AJPH.2010.192245
Klocek, A., Řiháček, T., & Cígler, H. (2022). Czech version of the Emotion Regulation Skills Questionnaire (ERSQ): Psychometric evaluation and network model in an adult clinical sample. Psychological Assessment, 34(6), e55–e64. https://doi.org/10.1037/pas0001132
DOI: https://doi.org/10.1037/pas0001132
Klocek, A., Řiháček, T., & Cígler, H. (2023). Measuring symptom acceptance: Psychometric evaluation of ‘chronic pain acceptance questionnaire–symptoms’ in a Czech clinical sample. Československá psychologie, 67(1), 50-62. https://doi.org/10.51561/cspsych.67.1.50
DOI: https://doi.org/10.51561/cspsych.67.1.50
Klocek, A., Řiháček, T., & Cígler, H. (n.d.). Czech version of the Multidimensional Assessment of Interoceptive Awareness (MAIA): Psychometric evaluation and network model. Unpublished.
Kotsou, I., Leys, C., & Fossion, P. (2018). Acceptance alone is a better predictor of psychopathology and well-being than emotional competence, emotion regulation and mindfulness. Journal of Affective Disorders, 226, 142-145. DOI: 10.1016/j.jad.2017.09.047.
DOI: https://doi.org/10.1016/j.jad.2017.09.047
Kraiss, J. T., Ten Klooster, P. M., Moskowitz, J. T., & Bohlmeijer, E. T. (2020). The relationship between emotion regulation and well-being in patients with mental disorders: a meta-analysis. Comprehensive Psychiatry, 102, 152189. DOI: 10.1016/j.comppsych.2020.152189.
DOI: https://doi.org/10.1016/j.comppsych.2020.152189
Krishnamoorthy, A., & Menon, D. (2013). Matrix inversion using Cholesky decomposition. In 2013 signal processing: algorithms, architectures, arrangements, and applications (SPA) (pp. 70-72). DOI: 10.48550/arXiv.1111.4144.
Lamers, S. M. A., Westerhof, G. J., Glas, C. A. W., & Bohlmeijer, E. T. (2015). The bidirectional relation between positive mental health and psychopathology in a longitudinal representative panel study. The Journal of Positive Psychology, 10(6), 553-560. DOI: 10.1080/17439760.2015.1015156.
DOI: https://doi.org/10.1080/17439760.2015.1015156
McCracken, L. M., Vowles, K. E., & Zhao-O'Brien, J. (2010). Further development of an instrument to assess psychological flexibility in people with chronic pain. Journal of Behavioral Medicine, 33(5), 346-354. DOI: 10.1007/s10865-010-9264-x.
DOI: https://doi.org/10.1007/s10865-010-9264-x
McDonald, R.P. (1999). Test theory: A unified treatment. Hillsdale: Erlbaum.
Mehling, W. E., Price, C., Daubenmier, J. J., Acree, M., Bartmess, E., & Stewart, A. (2012). The multidimensional assessment of interoceptive awareness (MAIA). PLoS One, 7(11), e48230. DOI: 10.1371/journal.pone.0048230.
DOI: https://doi.org/10.1371/journal.pone.0048230
Miller, S. D., Duncan, B. L., Brown, J., Sparks, J. A., & Claud, D. A. (2003). The outcome rating scale: A preliminary study of the reliability, validity, and feasibility of a brief visual analog measure. Journal of brief Therapy, 2(2), 91-100.
Mutch, V., Evans, S., & Wyka, K. (2021). The role of acceptance in mood improvement during mindfulness‐based stress reduction. Journal of Clinical Psychology, 77(1), 7-19. DOI: 10.1002/jclp.23017.
DOI: https://doi.org/10.1002/jclp.23017
Pearl, J. (2009). Causality. Cambridge, Cambridge University Press.
DOI: https://doi.org/10.1017/CBO9780511803161
Pennanen, P. (2017). Subjective body awareness, interoceptive accuracy and well-being. Available from: https://jyx.jyu.fi/bitstream/handle/123456789/53440/URN:NBN:fi:jyu-201703311853.pdf.
Pourová, M., Klocek, A., Řiháček, T., & Čevelíček, M. (2020). Therapeutic change mechanisms in adults with medically unexplained physical symptoms: a systematic review. Journal of Psychosomatic Research, 134, 110124. DOI: 10.1016/j.jpsychores.2020.110124.
DOI: https://doi.org/10.1016/j.jpsychores.2020.110124
Prochaska, J. O., & DiClemente, C. C. (2005). The transtheoretical approach. In Goldfried M. R. (Ed.). Handbook of psychotherapy integration (pp. 147-171). New York, Dow Jones-Irvin.
DOI: https://doi.org/10.1093/med:psych/9780195165791.003.0007
Quoidbach, J., Berry, E. V., Hansenne, M., & Mikolajczak, M. (2010). Positive emotion regulation and well-being: comparing the impact of eight savoring and dampening strategies. Personality and individual differences, 49(5), 368-373. DOI: 10.1016/j.paid.2010.03.048.
DOI: https://doi.org/10.1016/j.paid.2010.03.048
R Core Team (2020). R: a language and environment for statistical computing. Available from: https://www.R-project.org/.
Řiháček, T. (2019). Effectiveness of psychotherapy in patients with medically unexplained physical symptoms: A multi-site naturalistic study. https://osf.io/dfrma
DOI: https://doi.org/10.1186/ISRCTN13532466
Řiháček, T., Čevelíček, M., Boehnke, J. R., Pourová, M., & Roubal, J. (2022). Mechanisms of change in multicomponent group-based treatment for patients suffering from medically unexplained physical symptoms. Psychotherapy Research, 32(8), 1-18. https://doi.org/10.1080/10503307.2022.2061874
DOI: https://doi.org/10.1080/10503307.2022.2061874
Saxena, P., Dubey, A., & Pandey, R. (2011). Role of emotion regulation difficulties in predicting mental health and well-being. Journal of Projective Psychology & Mental Health, 18(2), 147-155.
Selig, J. P., & Little, T. D. (2012). Autoregressive and cross-lagged panel analysis for longitudinal data. In Laursen, B., Little, T. D., & Card N. A. (Eds.). Handbook of developmental research methods (pp. 265-278). New York, The Guilford Press.
Tihanyi, B., Böőr, P., Emanuelsen, L., & Köteles, F. (2016). Mediators between yoga practice and psychological well-being: mindfulness, body awareness, and satisfaction with body image. European Journal of Mental Health, 11(01-02), 112-127. DOI: 10.5708/EJMH.11.2016.1-2.7.
DOI: https://doi.org/10.5708/EJMH.11.2016.1-2.7
Trompetter, H. R., Bohlmeijer, E. T., Lamers, S. M., & Schreurs, K. M. (2016). Positive psychological wellbeing is required for online self-help acceptance and commitment therapy for chronic pain to be effective. Frontiers in Psychology, 7, 353. DOI: 10.3389/fpsyg.2016.00353.
DOI: https://doi.org/10.3389/fpsyg.2016.00353
Van der Krieke, L., Emerencia, A. C., Bos, E. H., Rosmalen, J. G., Riese, H., Aiello, M., Sytema, S., & de Jonge, P. (2015). Ecological momentary assessments and automated time series analysis to promote tailored health care: a proof-of-principle study. JMIR Research Protocols, 4(3), e100. DOI: 10.2196/resprot.4000.
DOI: https://doi.org/10.2196/resprot.4000
Vowles, K. E., & McCracken, L. M. (2008). Acceptance and values-based action in chronic pain: a study of treatment effectiveness and process. Journal of Consulting and Clinical Psychology, 76(3), 397-407. DOI: 10.1037/0022-006x.76.3.397.
DOI: https://doi.org/10.1037/0022-006X.76.3.397
Wampold, B. E. (2013). The great psychotherapy debate: models, methods, and findings. New York, Routledge.
DOI: https://doi.org/10.4324/9780203893340
Wersebe, H., Lieb, R., Meyer, A. H., Hofer, P., & Gloster, A. T. (2018). The link between stress, well-being, and psychological flexibility during an acceptance and commitment therapy self-help intervention. International Journal of Clinical and Health Psychology, 18(1), 60-68. DOI: 10.1016/j.ijchp.2017.09.002.
DOI: https://doi.org/10.1016/j.ijchp.2017.09.002
World Health Organization. (2004). ICD-10: international statistical classification of diseases and related health problems: Tenth revision (2nd ed.). Available from: https://apps.who.int/iris/handle/10665/42980.
Supporting Agencies
this study was funded by the Internal Grant Agency of Masaryk University, grant no. CZ.02.2.69/0.0/0.0/19_073/ 0016943. Data collection was funded by the Czech Science Foundation, grant no. GA18-08512SHow to Cite
Klocek, A., & Řiháček, T. (2023). The associations between interoceptive awareness, emotion regulation, acceptance, and well-being in patients receiving multicomponent treatment: a dynamic panel network model. Research in Psychotherapy: Psychopathology, Process and Outcome, 26(2). https://doi.org/10.4081/ripppo.2023.659
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