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(p. 178) Self-Focused Attention and Coping: Attending to the Right Things 

(p. 178) Self-Focused Attention and Coping: Attending to the Right Things
Chapter:
(p. 178) Self-Focused Attention and Coping: Attending to the Right Things
Author(s):

Nancy A. Hamilton

and Rick E. Ingram

DOI:
10.1093/med:psych/9780195130447.003.0009
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date: 03 August 2020

Few concepts in psychology are more fundamental than attention and coping. For example, from the earliest experimental psychology approaches to cognition to the most recent cognitive sciences concepts, researchers have consistently emphasized the central role that attention plays in virtually all human (as well as nonhuman) endeavors. Likewise, from the more clinical side of the equation, scholars view coping as central to virtually all theoretical, empirical, and applied features of the mental health professions. Although there have been some attempts in the past (1) to more formally unite cognitive and applied concepts such as attention and coping, these paradigms and their corresponding theories and data have typically developed in isolation from one another, a situation that parallels a large dissociation between cognitive science and clinical psychology in general (2, 3).

Despite this relative isolation, we believe that theory and research on attention and coping have much to offer each other. Elsewhere, we have discussed what clinical efforts such as coping can offer to cognitive science (4). Here, we focus on how theory and research on attention can inform our understanding of effective coping. Although we do not claim that examination of attentional factors will lead to answers for all coping questions, we do believe that the theories and data on attentional focus may help to improve coping efforts for clients in psychological treatment. In addition, to the extent that information on coping can be widely promulgated, we believe that an emphasis on attentional processing may help improve the coping efforts of individuals in the larger population.

(p. 179) Attention: Definitions and Chapter Overview

The concept of attention can encompass numerous attributes. Although several of these attributes may be appropriate to our exploration of coping, we believe that self-focused attention is especially useful in explicating coping variables. We begin with a definition of self-focused attention, which Carver (5), a pioneer of theory and research in this area, defined in this way:

When attention is self-directed, it sometimes takes the form of focus on internal perceptual events, that is, information from those sensory receptors that react to changes in bodily activity. Self-focus may also take the form of an enhanced awareness of one’s present or past physical behavior, that is, a heightened cognizance of what one is doing or what one is like. Alternatively, self-attention can be an awareness of the more or less permanently encoded bits of information that comprises, for example, one’s attitudes. It can even be an enhanced awareness of temporarily encoded bits of information that have been gleaned from previous focus on the environment; subjectively, this would be experienced as a recollection or impression of that past event. (p. 1255)

As can be seen from Carver’s definition, self-focused attention is typically thought to reflect a focus on internal information (e.g., thoughts, beliefs, expectancies, etc.) rather than a focus on other information derived through sensory receptors (“external information”). We do not imply here that self-focus excludes external information, for indeed, external information is critical to functioning and has significant effects on self-focus; rather, because our capacity for attention is limited, individuals tend to be self-focused in that their attention is primarily captured by internal factors. In this chapter, we propose that some types of self-focusing play important roles in the emotional distress to which coping must be directed, and hence, that alterations in the self-focus process may have important implications for effective coping.

To provide a context for our exploration of attention and coping, we discuss clinical theories in which attentional factors are prominently featured. We note in this regard that disturbances in attentional functioning appear to be ubiquitous among numerous forms of psychopathology (1). Nowhere, however, are the ideas of attentional functioning so well developed as in depression theories and, to a lesser degree, in theories of anxiety states. For the most part then, the theories we examine focus on depression. Although our decision to focus on depression may seem too specific for a chapter on coping, depression theorists are inclined to describe factors that characterize generalized psychological or emotional distress; that is, although many of the variables that these theories emphasize are intended to explain depression, they also are just as likely to explain generalized distress as well (6). These theories have broad applicability across numerous (p. 180) human facets of human functioning that involve distress, and arguably are thus related to coping.

Following our discussion of theoretical factors, we next turn to a burgeoning literature on attentional variables in treatment. Again, the focus in much of this treatment is on depression, but the targeted factors have wide applicability across the treatment of numerous forms of emotional distress. Finally, we conclude the chapter by bringing together diverse literatures and perspectives on attention and coping—our goal being to contribute to a better understanding of coping and copers.

Theories Incorporating Attentional Variables: Theoretical Perspectives on Self-Focus and Distress

Many theories of depression focus on cognitive functioning. In our estimation, the theories that have the most applicability for elucidating attentional factors are those proposed by Beck (7, 8), Teasdale (9, 10), Ingram (6, 11), Nolen-Hoeksema (12, 13), and Pyszczynski and Greenberg (14, 15). Additionally, while not proposed as a theory per se, Kendall (16, 17) also has offered important theoretical ideas on the specificity of attentional functioning in different affective states. We examine these theoretical ideas in general and concentrate in particular on what they have to say about attention-related variables.

Schemas and Automatic Thinking

Beck (7, 8) was among the first to propose a psychological theory of depression, and he almost certainly was the first to propose a theory of depression with an emphasis on cognitive factors (18). The central element of Beck’s and indeed of many cognitive theories (6) is the schema. There are numerous definitions of schemas, but for our proposes, schemas are conceptualized as cognitive structures that guide the processing of information. More specifically, schemas structurally constitute the cognitive residual of our past interactions in the form of stored experiences that establish a “relatively cohesive and persistent body of knowledge capable of guiding subsequent perception and appraisal” (19, p. 147). Although it is important to note that the idea of an organizational information processing structure such as a schema was not originally developed by Beck, it was Beck’s work that propelled the idea of schemas into much of clinical psychology and thus into a psychological domain concerned with coping (see 20).

In addition to guiding our perceptual activity, schemas also underlie a number of other cognitive functions. For example, theories propose, and research shows, that negatively oriented self-schemas become activated in emotional distress (21) and that they lead to a perceptual negative cognitive (p. 181) triad. In such a triad, individuals tend to see themselves, others, and their world in a negative fashion. Part of these negative appraisals stem from attentional variables; as schemas evidence an increasingly negative organization, attention correspondingly is devoted to negative situations and appraisals. Based on various clinical conceptualizations of schemas, it also appears that these structures perpetuate themselves in that the information that is processed becomes increasingly organized within these negative structures, which in turn provides access to similarly toned negative information.

Automatic Thinking: Interpretation

Although there are numerous cognitive functions ascribed to schemas in contemporary accounts of emotional distress, for our purposes, schema-linked cognition has one extremely important function: automatic thinking. Automatic thinking, in turn, has two important attentional attributes; it filters the interpretation of events, which we will briefly describe here, and it has a ruminative nature, upon which we more exclusively focus in this chapter.

Sometimes referred to as cognitive self-statements (22), automatic thinking refers to ongoing internal dialogues that occur at the periphery of awareness for individuals. Such peripheral awareness, however, does not mean that these thoughts cannot reach awareness; in fact, they can and do come into awareness. More important, however, automatic thoughts underlie our reactions to stressful events—they guide how we interpret the things that happen to us. As a result, the interpretation of events through automatic thinking can have an enormous effect on both human emotions and behaviors. In the face of stressful events, for example, individuals who are vulnerable to exacerbated emotional distress engage in a dialogue that is negative, maladaptive, and, quite possibly, unrealistic and distorted (6). In such a case, the thoughts that automatically accompany stressful events are negative and self-defeating, and effective coping is consequently impaired by such thoughts.

To illustrate, consider a common experience among virtually all professionals that requires coping—a presentation at a conference or meeting. In the case of ineffective coping, emotional dysregulation at the prospect of this presentation is fueled by a self-focus on the potential negatives of the experience (e.g., “What if this doesn’t go well?”; “What if people think I’m stupid?”; or “What if I don’t have much to say?”). Maladaptive self-statements also can darken our appraisals of the actual event (e.g., “The yawning in the back of the room means I’m boring”; “The person whispering to the other is making disparaging remarks about me”). These negative self-statements, in turn, lead to emotional distress, that may have little correspondence to actual performance. Our point is that it is not the actual events but the interpretation of the event that determines the emotional reaction. This point virtually all cognitive theorists emphasize; in the parlance of Beck’s theory, it is the automatic thinking that leads to stress, not the event per se.

(p. 182) Let us offer one more definition of the power of automatic thinking to determine our emotional reactions to events. One of the most convincing definitions and illustrations of this process is found in Freud’s distinction between mourning (normal mood reactions) and melancholia (dysfunctional mood reactions). In mourning, the person’s predominant thought is “this is bad” while in melancholia, the predominant thought is “I am bad.” It is easy to see how these different automatic thoughts lead to fundamentally different emotional and behavioral paths.

Automatic Thinking: Rumination

Although Beck alluded to the importance of ruminative processes, he originally focused more exclusively on the content of thoughts, and how that content influenced the interpretation of events. Although the interpretation of events is important in determining stressful reactions, we believe that the real power of cognitive variables such as automatic thinking in creating stress lies in the rumination that occurs after the stressful event has occurred; automatic thinking does not only refer to the content of thoughts, but also to their recurrence, repetition, and persistence. Thus, while emotional reactions to difficult life events are certainly linked to the thoughts that greet their occurrence, the continual rumination that follows these events amplifies and extends the negative emotional reactions to such events. Indeed, it may be that there is more stress linked to the rumination than to the interpretational aspects of automatic thinking. Thus, in our example of the stress associated with a conference presentation, it is less maladaptive to interpret the situation as suggesting incompetence and to then “cognitively move on,” but quite another to continue these dysfunctional automatic thoughts long after the talk is over.

In our previous discussion we do not mean to downplay the importance of initial appraisal processes in interpreting stressful events, nor to suggest that coping does not need to accompany these actual events in order to function effectively and avoid acute emotional distress. Rather, we believe that the long-term emotional effects of these events are the most psychologically problematic aspects of stress. This distinction has yet to receive widespread attention in the coping literature. Moreover, such chronic negative effects may initiate a new set of persistent dysfunctional thoughts; “It went badly, and I am therefore incompetent or stupid” (see our earlier example of Freud’s conception of melancholia). No doubt, this ruminative process influences the short-term processes for future stressful events which, in turn, may amplify and extend long-term negative consequences. Ruminative processes thus give rise to a vicious cognitive-emotional cycle that can prove difficult, but not impossible, to escape.

Differential Activation Processes

Beck’s theoretical ideas have spawned a host of related theories of depression and emotional distress. Although the proponents of these theories (p. 183) adopt the major elements of Beck’s theory, many have clarified, amplified, augmented, or extended Beck’s propositions. Of interest in the current context, the ideas proposed by Teasdale have contributed substantially to the theoretical understanding of cognition and emotional distress, and by extension, coping with emotional distress.

In particular, Teasdale (9) and Teasdale and Barnard (10) have proposed the “Interacting Cognitive Subsystems” (ICS) model to examine the cognitive and emotional features of emotional distress and their interaction. Although Teasdale and Barnards’ models describes a number of quite complex cognitive relationships and functions, for our purposes it is important to note that they suggest that rumination is linked to the maintenance of dysfunctional emotional states. For example, Teasdale and Barnard argue that “The ICS analysis suggests that (extended emotional distress) … depends, to a considerable extent, on the establishment of self-perpetuating processing configurations that continue to regenerate depressogenic schematic models” (3, p. 33), or within the rubric of automatic thinking, emotional distress “seems to be maintained, not so much by negative environmental events, as by persistent streams of negative ruminative thoughts” (3, p. 33). Thus, negative automatic thinking is again proposed to play a powerful role in coping (or the lack thereof) with stressful events, long after the actual event has passed.

Teasdale has also suggested that differential activation is an important aspect of this process that leads to severely dysfunctional emotional states (such as depression). All individuals experience negative mood states. Such mood states may be quite uncomfortable, but they are typically resolved in a relatively short period of time, perhaps through effective coping. For some individuals, however, these states lead to dysfunctional cognitive processes. Thus, by suggesting differential activation Teasdale argues that negative mood states in certain individuals initiate negative cognitive processes that lead to a downward spiral into clinically severe emotional distress. Although this downward spiral is quite similar to that proposed by Beck, Teadale’s differential activation hypothesis provides a more detailed description of the underlying mechanisms that are responsible for this spiral and for whom it will affect.

Associative Network Models

Teasdale’s original cognitive model (9) appeared in 1983 and was based heavily on both Beck’s work and that of cognitive psychologist Bower (23). Independent of Teasdale, in 1984 Ingram (11) proposed a cognitive model of depression that also was based on Bower’s proposals, as well as on models developed by other cognitive psychologists (e.g., 24, 25, 26). In brief, Ingram (6, 11) suggested that emotionally and distressing events activate various affective and cognitive structures that, in turn, produce spreading activation throughout the cognitive system. This spread of activation is proposed (p. 184) to have a number of effects on exacerbating or maintaining emotional distress.

One key aspect of spreading activation is the creation of a “cognitive loop” in which thoughts and memories associated with the person’s predominant mood state become continually accessible. Such “cognitive recycling” also occupies the individual’s limited cognitive capacity, leaving fewer possibilities for attending to external events (e.g., attending to the information necessary to successfully perform tasks). Ingram (11) suggested that individuals phenomenologically experience this cognitive looping process as the occurrence of memories and thoughts that are negative, continual, intrusive, and difficult to inhibit—a process that serves to maintain the person’s negative emotional state. Such a process is conceptually identical to several aspects of self-focused attention (1) in that “…individuals … have a high degree of attention focused upon themselves and their cognitions as available capacity becomes increasingly occupied by spreading activation” (11, p. 455). Thus, this model clearly implicates automatic thinking, and self-focused attention, in dysfunctional emotional responsivity to events. By extension, it is easy to see how such heightened self-focused attention impedes effective coping.

Ruminative Response Styles

Nolen-Hoeksema (12, 27), in an approach she has termed the response styles theory, has proposed that individuals who are vulnerable to the maintenance of negative affective states differ in their responses to aversive situations from people who cope effectively with these situations. In particular, she suggests that people who tend to ruminate are more likely to maintain negative affect than are those who are able to cognitively individuals distract themselves. Those who focus their attention externally are thus more able to engage in adaptive activities and to cope effectively. Again, we see in Nolen-Hoeksema’s theory that rumination response styles is posited to cause and intensified dysfunctional emotional responses. The response styles theory is, we suggest, highly similar to self-focused attention models of affective distress.

Self-Regulatory Perseveration

In their self-regulatory perseveration model, Pyszczynski and Greenberg (14, 15) also accord a central role to self-focused attention in the onset and maintenance of emotional distress. Although they proposed a number of variables that are linked to the exacerbation and maintenance of emotional states such as depression, for our purposes, the important point is the emphasis on self-focused attention. Specifically, Pyszczynski and Greenberg suggested that when experiencing a stressful event in a life domain that is central to self-worth, the person begins a self-focusing processing that is linked to self-evaluation. It is posited that emotionally distressed individuals (p. 185) perseverate in this self-focusing process; in turn, individuals with this attentional style have limited cognitive access to positive information and unfettered access to negative information. As such, self-focused people have both impaired coping and perpetuated emotional distress.

Self-Statement Specificity in Emotional Distress

A final set of theoretical ideas that we briefly examine concerns the specificity of automatic thinking in emotional states. Although the previous theories that we have reviewed were developed specifically to account for depression, their applicability is not necessarily limited to depression. Moreover, most theorists and researchers acknowledge the tremendous overlap in varying forms of emotional disorders. For example, anxiety commonly cooccurs with depression, as do other dysfunctional psychological states (28, 29). In several respects, such comorbidity (where emotional states frequently occur in conjunction with one another [30]) provides greater generality across psychological conditions.

Despite the frequent comorbidity of many emotional states such as depression and anxiety, in some situations these states occur relatively independently of each other (31, 32, 33, 34). Correspondingly, at least some theoretical explanation is necessary for such specificity (1). On this point Kendall (16, 17) differentiates between the statements seen primarily in anxiety versus those seen primarily in depression. In particular, Kendall suggests that the form of these self-statements differ, with depressive self-statements having a declarative nature (“I am incompetent”) and anxiety self-statements taking the form of questions (“Am I incompetent?”). This distinction prompted Kendall to label this latter process automatic questioning. It is important to note, however, that these questions should be differentiated from the healthy and adaptive ones when attempting to effectively handle various stressors. Kendall argues that automatic questioning occurs with such rapidity that it prevents the requisite thoughtful reflection necessary to answer such questions and to then formulate a plan of action based on a lucid understanding of the situation. As such, persons experiencing automatic questioning retain a sense of uncertainty in situations that continues to arouse anxiety and inhibit effective coping strategies. Although different in form, both automatic thoughts and automatic questioning precipitate heightened self-focus and a consequent inability to cope effectively.

Converging Theories and Ideas: Self-Focus and Coping with Distress

We believe that two important points emerge from our review of cognitive theories of emotional distress. First, although differing in some theoretical (p. 186) details, the proponents of these theories argue that cognitions play a central role in precipitating and maintaining emotional distress. Moreover, the defining features of these problematic cognitions are not only that they are negative and self-defeating, but also that they are persistent.

A second point is that these negative and persistent cognitions can be understood within the framework of self-focused attention. It is important to note at this juncture, however, that not all self-focused attention is dysfunctional. Indeed, self-focusing can be a healthy cognitive process that is part of adapting successfully to changing circumstances. What the authors of each of these theories either implicitly or explicitly suggest, however, is that self-focused attention that is heightened, tends to be negative, is less flexible, and because it is sustained over a relatively lengthy period of time, is not adaptive (1).

As such, self-focused attention can be seen as a mediator of the coping process. That is, to the extent that self-focusing is not too lengthy, elevated, or overly negative, it should enhance problem solving and coping efforts. Conversely, when self-focused attention is extremely heightened, persistent, negative, and intransigent, it becomes a cognitive impediment to effective coping; moreover, in the wake of stressful events, this type of self-focused attention sustains emotional distress and interferes with cognitions and behaviors that are necessary for adaptation. We thus propose that self-focused attention at least partially regulates the effectiveness of coping.

Our discussion of the mediational role of self-focused attention in relation to coping is a significant departure from the norms in much of the current coping theory and research. Coping research tends to be event based; that is, researchers frequent emphasis on coping is in the context of relatively discrete stressful events. But as we have concluded from the literature on emotional dysfunction, what is so problematic about the emotional distress that sometimes leads to psychological disorders, is not the distress per se, but the fact that it lasts for an extended period of time. For example, depression can result from a significant loss in an individual’s life. What is problematic about this depression, however, is not that it occurs, but that it can and often does last for many months (and sometimes years) after the loss. As another example, Post-Traumatic Stress Disorder (PTSD), based on a single traumatic event, can remain for years. In this case, coping with the trigger event is less important than the coping that needs to take place to help alleviate the PTSD. Thus, we strongly believe that long-term effects or “emotional half-life” of aversive events need to be addressed in the coping literature. We have proposed one mechanism—self-focused attention—that we can use to better our understanding of how distress is experienced, as well as how it influences coping, sometimes well after the stressful event has occurred.

(p. 187) Steps Toward Effective Coping: Self-Focused Attention, Distraction, and Mindfulness

Now that we have examined some of the ways in which self-focusing processes are linked to the distress that surrounds the occurrence and afterlife of stressful events, what can we suggest for understanding and improving effective coping? We think that several provocative and potentially exciting answers to these questions can be derived from a recently burgeoning theoretical and research literature.

De-Self-Focusing: Distraction and Coping

The natural answer to a problem of too much self-focused attention is less self-focused attention. Such de-self-focusing can be found under the rubric of distraction. As we shall see, however, distraction is not merely a matter of consciously diverting attention elsewhere, but rather as a strategy for effective coping to occur, the person must figure out how best to accomplish this diversionary task. We will focus on distraction as it affects the psychological states that are caused by stress, which as we have seen, means emotional distress.

We start by asking two simple questions: “What is distraction?” and “Is distraction effective for mood management or for coping with stress?” The answer to the first question is fairly simple and straightforward. Distraction, as a method for managing noxious internal states such as a negative mood, rests on the assumption that attentional capacity is finite (35). Because we can only attend to a limited amount of information, attention focused outwardly toward others, or on more positive elements of ourselves, reduces the amount of attention that we can devote to a negative mood state.

The answer to the second question is a bit more complex. Researchers examining distraction probably would concur with the conclusion that some forms of distraction are effective some of the time. The effectiveness of distraction as a mood management strategy seems to vary depending on the nature of the distractor, the strength of the stressor, and the intensity of the emotional response. In the following sections we will review research on these variables. Specifically, we will examine how researchers have characterized effective distractors as positive events and cognitions (13), internal sensations, (36, 37), and cognitively demanding tasks (38).

Positive Events and Cognitions

Pleasurable distractions may be particularly effective in regulating affect in the face of uncontrollable stressors. Nolen-Hoeksema (13) defines such distraction as enjoyable activities and cognitions that focus attention away from the current mood and self-focus. To illustrate, in an interesting study of distraction to a severe stressor, Nolen-Hoeksema studied San Francisco residents’ responses to the Loma Prieta earthquake and discovered that pleasurable distractions were associated (p. 188) with less psychological distress for up to 10 days following the quake (27). Distraction was not related to adjustment seven weeks after the earthquake, but this finding must be viewed with caution because only 25% of the original sample could be located and assessed again. Based on Nolen-Hoeksema’s data, however, some immediate relief seems to be related to decreasing self-focusing; more specifically, pleasurable distraction can be used to effectively cope with stress.

Goal Directed Self-Regulation of Mood

Based on data indicating that reducing self-focus through distraction may be an effective coping method, we might reasonably conclude that distraction may be the mood change strategy of choice when people cope with a negative event. When the need for coping arises, therefore, does it make sense to simply decide not to think about the negative effects of stressful events? Probably not; effective distraction entails more than simply deciding not to think about negative things. Analogous to the notion that nature abhors a vacuum, one cannot simply instruct oneself to “not be in a bad mood” or “not think about a distressing event.” Instead, one must think of a specific distractor or try to invoke a different mood (via distracting thoughts).

Some may see distraction as an attempt to “will” one’s self into a different mood or to suppress distressing thoughts. Research has indicated, however, that these attempts may not only be ineffective, but they may also have unintentional or ironic effects (36, 37, 39). For example, Wegner (39) has shown that attempting to suppress the thoughts that are associated with a given mood may in fact lead, ironically, to an increase rather than a reduction in these thoughts. To illustrate, in a well-known set of experiments, Wegner asked research participants specifically not to think about a white bear. Demonstrating the ironic effect of attempted suppression, Wegner’s participants overwhelmingly reported thinking about a white bear. Thus, distraction via suppression seems to be a particularly poor coping method.

It also is important to note that not all distractors are created equal. Although suppression is not a good coping strategy, other types of distractions, such as focusing on cognitively demanding external tasks, may be more effective coping strategies. For example, Erber (40, 41) suggested that certain types of non-self-focused distractions “absorb” mood. Erber argued that moods are maintained via working memory. When working memory becomes occupied by a demanding external task, negative mood-related cognitions cannot be processed efficiently. Mood is thus attenuated or “absorbed” by the externally focused cognitive task. Erber emphasized, however, that not all tasks (or distractors) absorb mood. Simple distractors (e.g., watching a movie) require little in terms of cognitive processing and leave plenty of working memory free to process mood-related information. In contrast, demanding distractors may promote effective coping with negative affect because they occupy a significant amount of working memory. For example, exercise, a demanding task by most accounts, has been found to help manage moods (42).

(p. 189) Turning Self-Focus into an Adaptive State: Mindfulness Meditation

As an alternative to traditional distraction in which attention is focused on external stimuli, Cioffi (35) advocates somatic awareness. Somatic awareness is the active ingredient in a coping paradigm known as mindfulness meditation (43, 44). Although perhaps counterintuitive from the perspective of research on the dysfunctional effects of self-focused attention, proponents of this strategy characterize sensory awareness as a form of distraction (35). Mindfulness meditation involves focusing attention on the here and now, to the exclusion of all metacognition or thoughts about one’s cognitions. From a clinical coping perspective, mindfulness meditation has demonstrated measurable success as a method for treating chronic pain (43, 44). Additionally, in conjunction with phototherapy and photochemotherapy, mindfulness meditation has been used as a treatment for psoriasis (45).

As described by Kabat-Zinn (43), mindfulness meditation involves focusing attention on thoughts, affect, and bodily sensations without evaluation or infusion with meaning. The goal is to become a detached observer of one’s own conscious experience. Clinical training in mindfulness meditation involves two steps. Students first learn to focus on breathing. As thoughts or moods come into consciousness, they are acknowledged and attention is returned to breathing. The second step involves expanding attention to include awareness of thoughts, affect, physical sensations, and external events as they occur in time. If a practitioner becomes aware of evaluative or meaning-oriented thoughts, these thoughts are acknowledged and attention is returned to breathing. After such attention is “stabilized,” attention is again allowed to expand to other sensations, moods, cognition, and external events. Kabat-Zinn refers to the state of nonevaluative self-observance as “bare attention.” By giving only bare attention to internal and external events, practitioners report being able to separate physical sensations from affect and cognition.

We have referred to mindfulness meditation as a type of distraction (35). Traditional forms of distraction involve directing attention away from somatic and affective states and toward another external event. The goal of mindfulness meditation is to call attention toward somatic and affective states and, by doing so, to reduce the processing space for other types of evaluative processing such as self-focused rumination and catastrophizing. Thus, the practice of mindfulness meditation is a form of distraction in the sense that intensive attention to the here and now prevents (distracts) one from rumination, or from the self-focused thoughts that tend to worsen the mood-producing results of stressful events.

In addition to diverting attention from maladaptive self-focused thoughts, another way to understand mindfulness is to contrast it with a state of “mindlessness” (43). Kabat-Zinn argues that mindlessness is a state in which attention is diffusely focused on here-and-now events, evaluations of the event, memories of similar events, and expectations for the future (i.e., self-focused attention). In a mindless state, here-and-now events are not fully experienced and are likely to be biased by affective states, memory, (p. 190) and speculation. In contrast, the goal of mindfulness meditation is to keep attention strictly in the moment and, by so doing, distracting oneself from the dysfunctional processes that exacerbate emotional responses to stress. Recall, for instance, that we noted that one of the cognitive functions of the schemas associated with depression is to produce the cognitive triad in which people see themselves, others, and their world, in a negative manner. By staying in the here and now, mindfulness promotes a type of attention that helps to diffuse this dysfunctional triad.

Mindfulness meditation has several advantages over other forms of distraction. First, mindfulness meditation emphasizes acceptance of moods, cognitions, and somatic states and eschews goal (or future) oriented cognition. Because the emphasis is on acceptance, mindfulness meditation should not trigger the negative effects seen in efforts to suppress thinking or to will oneself into a positive mood (39). Second, mindfulness meditation is a general strategy and can be used in any context and as a method for coping with a range of life-stressors from pain management to job-stress (43). Third, the practice of mindfulness meditation actually should enhance the performance of other activities. Traditional distraction involves turning attention away from distressing situations. Although active distractions such as taking a walk in the park or cognitive distractions such as daydreaming may have long-term benefits, these strategies are more costly in the short term, temporarily halting or inhibiting progress on other activities. Fourth, Kabat-Zinn (43) theorized that the practice of mindfulness meditation is likely to prevent “thoughtless coping.” As a result of the here and now focus of mindfulness meditation, what we ordinarily think of as coping responses are temporarily inhibited. Taking time to meditate before responding to an event may prevent the use of habitual and dispositional coping strategies that are inconsistent with a flexible response to stress (46). Thus, mindfulness meditation may, in some cases, be superior to other forms of distraction.

Some Clinical Coping Applications of Mindfulness Meditation

Clinically oriented researchers recently have developed a model that integrates mindfulness meditation training with an information processing model of mood and mood-change (47). Recall our discussion of the ICS model proposed by Teasdale and Barnard (3, 10). In this model it is suggested that mood is the outcome of implicit meanings attached to visual, acoustic, and somatic stimuli (what we see, hear, and feel). In addition, within the ICS model for those vulnerable to negative affect states such as depression, negative events trigger the “depressive interlock” of two interrelated feedback loops involving negative implicit meanings, negative mood states, low somatic arousal, and negative automatic thoughts. Or, in other words, depressive interlock occurs when individuals experience “persistent streams of negative ruminative thoughts.”

In accordance with these ideas, three methods for changing mood are specified in the ICS model. First, distraction can prevent depressive interlock (p. 191) by redirecting cognitive resources (e.g., working memory) away from stressful situations and toward positive or neutral stimuli. Second, cognitive restructuring can be used so that people can reconceptualize stressful circumstances into less psychologically threatening situations, and also can reconceptualize the potentially long-term effects of stressful events into more realistic and manageable situations. Third, somatic and behavioral responses to depressogenic stimuli can be modified directly.

Applying the ICS model to mindfulness meditation, Teasdale has suggested that mindfulness meditation would be likely to have immediate effects as a distractor and would serve as a method for altering somatic and behavioral responses and delayed effects on cognitive schemas (47). Specifically, bare attention to sensations, perceptions, and affective responses as they occur in real time requires all available processing space, effectively “jamming” the feedback loops that maintain emotional distress. In addition, the practice of mindfulness meditation is relaxing, a state that is inconsistent with emotional upset and with dysfunctional self-focused attention. Finally, learning to observe rather than evaluate stimuli may fundamentally change implicit belief systems about what is meaningful and important. In all, mindfulness meditation may be a method to take the “dysfunctional” out of dysfunctional self-focused attention.

Summary and Conclusions

In this chapter we have summarized the theory and research showing the negative implications of self-focused attention. We have reviewed several theories that, although differing in their terminology (automatic thoughts, self-statements, rumination, depressive interlock, etc.), all converge on the idea that self-focused attention can produce maladaptive negative affect in the face of stressful events. Perhaps more important, we have examined the fact that self-focused attention can serve to maintain negative affect over an extended period of time. We then argued that attempts to reduce this state have significant implications for ideas on how we cope, and we also suggested that a focus on self-focus, and the long-term consequences of stressful events, takes us into a fundamentally different arena than is typically addressed by coping researchers. That is, coping researchers typically emphasize coping around some discrete stressful event(s). To the contrary, however, we believe that coping with the extended effects of these events is where the real coping action needs to be.

We also suggested some ways to conceptualize coping from these longer term perspectives and argued that one (but certainly not the only) way to effectively cope was to reduce the chronic, heightened self-focusing that comes with the type of emotional distress that is produced by stress. Although many researchers in this area have focused on individuals who are vulnerable to severe emotional reactions from stress, we believe that these processes are also applicable for the coping efforts of all people as they (p. 192) attempt to negotiate life’s vicissitudes. Based on theory and research in the realm of self-focused attention, we suggest that one way to quiet the emotional distress that is maintained via self-focus is to reduce the self-focus through external distraction. Although we do not believe that this method alone is a sufficient answer for individuals who are severely distressed, we believe that it is one of the many cognitive, emotional, and behavioral methods that can contribute to recovery from such states. Likewise, although there are numerous coping methods that may help people who are within the “normal” range of distress from negative life events, we believe that distractions can significantly help reduce negative mood states, and thus promote positive and adaptive living that was typical before stressful events took their psychological toll.

We briefly explored how various forms of distraction are not equally effective and discussed how some are downright ineffective. For example, suppressing, or just not thinking about negative things, may be a “common-sense” coping strategy, but based on theory and research we conclude that such efforts may in fact increase negative affect. Finally, we discussed a coping paradigm that is beginning to receive a great deal of interest in the clinical literature—mindfulness meditation.

Mindfulness meditation may seem counterintuitive to our discussion of self-focused attention because it increases self-focus. Indeed, this is the case, but it is designed to increase self-focus in a way that reduces the maladaptive aspects of this process. Although early in this chapter we noted that while self-focus contributes to many kinds of psychopathology, we also emphasized that self-focus can be adaptive. Mindfulness meditation offers, we believe, one method to help transform such a condition into a state that is not only more adaptive, but also perhaps necessary when difficult situations are encountered. Certainly under the right circumstances, self-focus is probably necessary for the self-reflection and problem solving that must contribute to the resolution of the many problems in our lives. And, in fact, researchers have found great promise in mindfulness meditation for helping to alleviate clinically significant emotional mood states. Moreover, mindfulness meditation is currently being explored by investigators as a means to not only treat these states, but also to help prevent their relapse and recurrence. In mindfulness meditation, then, we may find one way to help us attend to the right things in life.

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