Exploring Sequencing Effects of Cognitive Techniques: An Experimental Investigation of Cognitive Restructuring and Detached Mindfulness

Background The sequence in which psychological interventions are delivered may influence their efficacy. Therefore, the current study investigated the sequencing effect of cognitive restructuring (CR) and detached mindfulness (DM), hypothesizing that only the sequence of CR-DM would lead to additional improvement. Methods Across two experiments, 188 participants from a community sample underwent a speech (Experiment A) or worry (Experiment B) manipulation and were then introduced to CR and DM in a counterbalanced order. Primary outcomes were state anxiety (Experiment A) and worry (Experiment B). Results Multilevel models revealed that when delivered alone, the two techniques produced similar changes in the outcome measures across both experiments. When delivered as the second technique, there was a statistically significant sequencing effect in Experiment B, t (93.0) = 2.0, p = .048, d = 0.42 in the predicted direction, showing further reduction in worry in participants receiving CR-DM but not those receiving DM-CR. Due to a lack of manipulation effect in the second speech of Experiment A, sequencing effects could not fully be explored here. Conclusions The findings suggest that, in a worry context, there may be little reason to use the sequence of DM-CR, whereas there may be further benefit of the CR-DM sequence. For Experiment A, the lack of manipulation effects precludes conclusions regarding sequencing effects. The results should be understood in light of the community sample and lack of neutral control condition but offer a useful starting point for further examining sequencing effects in clinical populations.