04/09/2019

The science of decentering

Ruth Baer
Oxford Mindfulness Centre
Summer School 2019

Outline

• How decentering is understood

• CBT
• MBCT

• Research on decentering
• Assessment
• Decentering as a mechanism of change

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Decentering in psychotherapy

Decentering is a change process

of ubiquitous significance in
psychotherapy and one that has
been described in different
terms by therapists of different
orientations.

Safran & Segal, 1990

Decentering in CBT

• Emphasis on thoughts
• “thoughts as psychological phenomena rather than as
identical to reality” (Beck, 1976)

• Similar terms
• meta-cognitive awareness
• distancing

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Role of decentering in CBT

Decentering helps with changing the content of thoughts

Role of decentering in CBT

Decentering helps with changing the content of thoughts

I’m incompetent, It’s OK to make

there’s no point mistakes, that’s
in trying how we learn

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Role of decentering in CBT

• To change thoughts
• first we have to recognize them

Situation Thoughts Feelings

I got something I’m incompetent. I Sad, depressed,
wrong in a shouldn’t be giving heavy, fatigued
presentation presentations

Role of decentering in CBT

• Then we can develop more rational, balanced

thoughts

Everyone makes mistakes.

My presentations are
interesting and people
appreciate them.

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Decentering in CBT

• Focuses on thoughts
• Implicit
• Means to an end
• Part of effective
treatment approach

Decentering in MBCT
History

• Developing a new approach for relapse of

depression

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Decentering in MBCT
History

• CBT reduces relapse of depression

• How?

Older idea
(not accurate)

• Changing dysfunctional attitudes prevents relapse

Asking for help is a sign

of weakness
I can’t be happy if
anyone dislikes me

Successful people
don’t make mistakes

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Research findings

• Changing dysfunctional
attitudes is not the key to
preventing relapse
• Medication and CBT reduce
these attitudes equally well
• CBT is much better for
preventing relapse

New idea

• Decentering is the key to long-term effectiveness

Thoughts are just

thoughts!

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If decentering is the key

• We don’t have to change thought content

• We can shift to a decentered perspective

I’m incompetent, Self-critical

there’s no point thoughts are
in trying here

If decentering is the key

• How to teach it effectively?

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Decentering in MBCT

• Taught explicitly
• Mindfulness practices
• Cognitive exercises
• Metaphors
• Poems

Decentering in MBCT

• Not limited to thoughts

• Applies to the whole mind-body state
• Thoughts
• Emotions
• Sensations
• Impulses

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Decentering in MBCT

• Has particular qualities

• Openness
• Allowing
Welcome and
• Welcoming entertain them all

• Nonjudgment Rumi
• Gentleness
• Compassion

Do MBCT participants learn

decentering?

How would we know?

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Measuring decentering

• Questionnaires
• Experiences Questionnaire (EQ; Fresco et al., 2007)
• Toronto Mindfulness Scale (TMS; Lau et al., 2006)

• Interview
• Measure of Awareness and Coping in Autobiographical
Memory (MACAM; Moore, Hayhurst, & Teasdale, 1996)

Experiences Questionnaire

• Example items
• I can separate myself from my thoughts and feelings
• I can observe unpleasant feelings without being drawn
into them
• I can treat myself kindly

1 2 3 4 5
Never Rarely Sometimes Often Very often

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Toronto Mindfulness Scale

• Designed to follow a silent meditation session

• 2 subscales: decentering and curiosity

For the next 3 minutes, please pay attention to your breathing

and anything that might arise during your experience.

Toronto Mindfulness Scale

• Example decentering items

• I was more concerned with being open to my experiences than
controlling or changing them
• I was open to taking notice of anything that might come up
• I experienced my thoughts more as events in my mind than as a
necessarily accurate reflection of the way things ‘really’ are
• I experienced myself as separate from my changing thoughts and
feelings

0 1 2 3 4
Not at all A little Moderately Quite a bit Very much

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MACAM
interview

Imagine yourself
Recall Describe your
in a distressing
something from feelings in this
situation
your own life situation and
that the how you
Friend doesn’t
emotions bring responded to
show up for a
to mind them
lunch date

Responses rated for degree of decentering

MACAM responses
from a study of suicide crises

Exercise:
Rank these MACAM responses on degree of decentering
1 = least decentered, 5 = most decentered

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Exercise:
Rank these MACAM responses on degree of decentering
1 = least decentered, 5 = most decentered

Statement Rank
A. I was anxious and tense and wound up and fidgety.
B. I got irritable in situations I am normally able to control.
C. I kept thinking, “what’s the point?” But I knew it was the
depression talking and eventually it would pass.
D. I’m a failure.
E. I thought, “I don’t want to do this.”

Exercise:
Rank these MACAM responses on degree of decentering
1 = least decentered, 5 = most decentered

Statement Rank
A. I was anxious and tense and wound up and fidgety. 2
B. I got irritable in situations I am normally able to control. 4
C. I kept thinking, “what’s the point?” But I knew it was the 5
depression talking and eventually it would pass.
D. I’m a failure. 1
E. I thought, “I don’t want to do this.” 3

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Research findings
Decentering

Study using EQ
Bieling et al 2012

• MBCT for depressive relapse

• Decentering scores improved with MBCT
• Not with medication or placebo
• Higher decentering → less depression 6 months later

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Study using EQ
Bieling et al 2012

• MBCT for depressive relapse

• Decentering scores improved with MBCT
• Not with medication or placebo
• Higher decentering → less depression 6 months later
• Conclusion
• An increased capacity for decentering may be fostered
during MBCT and may underlie its effectiveness

Study using MACAM

Hargus, Crane, Barnhofer, & Williams, 2010

MBCT + TAU
27 depressed
Repeat
adults
interview:
Interview:
describe same
warning signs for
suicide crisis
last suicide crisis
TAU only

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Hargus et al 2010
Results

• Decentering
improved in
MBCT
• Not in TAU

Another study of decentering

Farb et al, 2018

MBCT
166 adults 8-week
remitted depression group Followed for 2 years

Measures of: Relapse

Depression Decentering
Decentering CT Dysfunctional attitudes
Dysfunctional attitudes 8-week
group

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Farb et al, 2018

• Results for depressive relapse

Group % relapsed in 2 years

MBCT 22%
CT 21%

Farb et al, 2018

• Both groups improved in decentering

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Farb et al, 2018

• Both groups improved in decentering

• More decentering → less chance of relapse

Farb et al, 2018

• Both groups improved in decentering

• More decentering → less chance of relapse

• Dysfunctional attitudes reduced for CT only

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Farb et al, 2018

• Both groups improved in decentering

• More decentering → less chance of relapse

• Dysfunctional attitudes reduced for CT only

• Dysfunctional attitudes not related to relapse

Farb et al., 2018

Conclusions

Both MBCT and CT teach decentering

Decentering protects against depressive relapse

Response to dysfunctional thoughts is more

important than occurrence of dysfunctional thoughts

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Home practice
Same participants (Segal et al 2019)

More home practice

during 2-year follow-up
Greater
CT practice
goal setting, cognitive increase in
decentering Less relapse
restructuring, etc
over 2 years
MBCT practice
formal, informal,
breathing spaces

Home practice
Same participants

More home practice

during 2-year follow-up*

CT practice
Greater
goal setting, cognitive increase in
Less relapse
restructuring, etc decentering
over 2 years
MBCT practice
formal, informal, breathing
spaces

*Home practice during 8 weeks not significant

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Home practice
Same participants

More home practice

during 2-year follow-up
Greater
CT practice
goal setting, cognitive increase in
decentering Less relapse
restructuring, etc
over 2 years
MBCT practice
formal, informal,
breathing spaces

nonsig

Other findings about decentering

• Mechanism of change in CBT for social anxiety

• Leads to reduced worry, rumination, and anxiety in ERT
• Reduces association between weight/shape/shame and
disordered eating
• Reduces food cravings and unhealthy food choices
• Protects ability to clear irrelevant information from
working memory under negative emotional conditions

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Conclusions

• Decentering is an important psychological process

• There is more than one way to teach it
• Learning decentering skills improves mental health

Questions and discussion

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