Available online at www.sciencedirect.

com

ScienceDirect
Behavior Therapy 45 (2014) 863 – 871
www.elsevier.com/locate/bt

Assessing Decentering: Validation, Psychometric Properties,

and Clinical Usefulness of the Experiences Questionnaire in a
Spanish Sample
Joaquim Soler
Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona,
Institut d’Investigació Biomèdica Sant Pau–IIB Sant Pau, Centro de Investigación Biomédica en Red de
Salud Mental, CIBERSAM
Alba Franquesa
Universitat Autònoma de Barcelona, Hospital Universitari Parc Taulí
Albert Feliu-Soler
Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona,
Institut d’Investigació Biomèdica Sant Pau–IIB Sant Pau, Centro de Investigación Biomédica en Red de
Salud Mental, CIBERSAM
Ausias Cebolla
Universitat Jaume I. Castelló, CIBEROBN Santiago de Compostela
Javier García-Campayo
Hospital Miguel Servet, Universidad de Zaragoza, Instituto Aragonés de Ciencias de la Salud,
Red de Actividades Preventivas y de Promoción de la Salud (REDIAPP), Zaragoza
Rosa Tejedor
Divisió Salut Mental. Althaia, Xarxa Assistencial Universitaria de Manresa
Marcelo Demarzo
Universidade Federal de Sao Paulo
Rosa Baños
Universitat Jaume I. Castelló, CIBEROBN Santiago de Compostela, Universitat de Valencia
Juan Carlos Pascual
Maria J. Portella
Hospital de la Santa Creu i Sant Pau, Barcelona, Universitat Autònoma de Barcelona,
Institut d’Investigació Biomèdica Sant Pau–IIB Sant Pau, Centro de Investigación Biomédica en Red de
Salud Mental, CIBERSAM
864 soler et al.

contents could be experienced even in the earliest

Decentering is defined as the ability to observe one’s
stages of mindfulness training (Hölzel et al., 2011).
thoughts and feelings in a detached manner. The Experi-
Such an “observer perspective” is commonly
ences Questionnaire (EQ) is a self-report instrument that
referred to as decentering and is defined as “the
originally assessed decentering and rumination. The pur-
ability to observe one’s thoughts and feelings in a
pose of this study was to evaluate the psychometric
detached manner, as temporary events in the mind,
properties of the Spanish version of EQ-Decentering and to
as neither necessarily true nor reflections of the self”
explore its clinical usefulness. The 11-item EQ-Decentering
(Kerr, Josyula, & Littenberg, 2011; Safran & Segal,
subscale was translated into Spanish and psychometric
1990). Enhancement of this ability with mindful-
properties were examined in a sample of 921 adult
ness practice may lead one to respond less
individuals, 231 with psychiatric disorders and 690 without.
emotionally to internal and external experiences
The subsample of nonpsychiatric participants was also split
(Shapiro, Carlson, Astin, & Freedman, 2006). In
according to their previous meditative experience (meditative
this sense, mindfulness effects may derive from
participants, n = 341; and nonmeditative participants, n =
changes in information processing, by cutting off
349). Additionally, differences among these three subgroups
repetitive styles seen in several disorders (Wells,
were explored to determine clinical validity of the scale.
2002). However, decentering is not exclusive to
Finally, EQ-Decentering was administered twice in a group of
mindfulness practice. Other therapies, such as
borderline personality disorder, before and after a 10-week
Acceptance and Commitment Therapy (ACT;
mindfulness intervention. Confirmatory factor analysis indi-
Hayes, Strosahl, & Wilson, 1999) or Metacognitive-
cated acceptable model fit, sbχ 2 = 243.8836 (p b .001),
Based Therapy, utilize decentering as a key process
CFI = .939, GFI = .936, SRMR = .040, and RMSEA = .06
contributing to beneficial effects, without involving
(.060–.077), and psychometric properties were found to be
meditation practices (Moritz et al., 2011; van der
satisfactory (reliability: Cronbach’s α = .893; convergent
Heiden, Muris, & van der Molen, 2012; Wells et al.,
validity: r N .46; and divergent validity: r b − .35). The scale
2010). In this regard, some authors have already
detected changes in decentering after a 10-session intervention
suggested that efficacy of cognitive behavior therapy
in mindfulness (t = −4.692, p b .00001). Differences among
(CBT) to treat depression may rely on metacognitive
groups were significant (F = 134.8, p b .000001), where
awareness rather than on cognitive-content modifica-
psychiatric participants showed the lowest scores compared
tion (Teasdale, Segal, & Williams, 1995). In a
to nonpsychiatric meditative and nonmeditative participants.
posterior study, Teasdale et al. (2002) demonstrated
The Spanish version of the EQ-Decentering is a valid and
that patients with major depression treated with CBT
reliable instrument to assess decentering either in clinical and
showed higher posttreatment metacognitive aware-
nonclinical samples. In addition, the findings show that
ness compared to a group receiving standard clinical
EQ-Decentering seems an adequate outcome instrument to
management. Furthermore, lower levels of metacog-
detect changes after mindfulness-based interventions.
nitive awareness at baseline predicted earlier relapse in
subjects who had recently suffered from major
Keywords: decentering; mindfulness; Experiences Questionnaire;
depression.
metacognitive awareness Teasdale and co-authors initially designed a
measure of metacognitive awareness, but it was so
time-consuming that it precluded its application in
INCREASED METACOGNITIVE AWARENESS HAS BEEN SUG- more practice-oriented settings (Teasdale et al.,
GESTED to underlie the beneficial effects of mindful- 2002). Soon after, an alternative scale, the Experi-
ness trainings (Bieling et al., 2012; Hölzel et al., ences Questionnaire (EQ), was developed and
2011). Metacognitive awareness is defined as the designed to assess decentering so as to operationa-
ability to be unentangled from the contents of lize changes that occurred during metacognitive-
awareness, observing elements of the experience as based therapies. Some studies demonstrated that
events and not as static entities (Olendzki, 2005). In the EQ was able to detect decentering ability in both
a recent comprehensive review of the mechanisms recovery and protection against relapse in a
of mindfulness, Hölzel and colleagues proposed randomized clinical trial with patients suffering
that a deidentification from some parts of mental from major depressive disorder (MDD; Fresco,
Segal, Buis, & Kennedy, 2007; Segal et al. 2006).
CIBEROBN is an initiate of ISCIII.
Particularly, gains in decentering were greater in
Address correspondence to Joaquim Soler, Ph.D., Department of patients who responded to CBT than in those who
Psychiatry, Hospital de la Santa Creu i Sant, Pau. St. Antoni Maria responded to antidepressant medications; and
Claret, 167, 08025, Barcelona, Spain; e-mail: [email protected].
responders to CBT with higher EQ-Decentering
0005-7894/45/863-871/$1.00/0
© 2014 Association for Behavioral and Cognitive Therapies. Published by scores appeared to be more protected against
Elsevier Ltd. All rights reserved. further relapses. Higher decentering scores
 experiences questionnaire in a spanish sample 865

observed in CBT responders but not in antidepres- asked a series of follow-up questions: “What kind of
sant medication responders may indicate that such meditation?”; “How long have you been practicing
capability is not only mediated by clinical improve- meditation?”; “How often do you practice per
ment, as it normally happens with other psycho- week?”; “How long do you practice in each
logical vulnerability markers (i.e., dysfunctional session?” In the subsample of nonpsychiatric volun-
attitudes or attributional styles; see Ingram, 1990, teers, 341 individuals reported meditative experience
for a revision). It is reasonable to think that (average meditative experience was 7.15 years) and
improvements in decentering may be specific to 349 reported no meditative experience.
psychotherapy. Surprisingly, only a few studies The subsample of patients with psychiatric disor-
have addressed decentering changes, measured with ders was composed of 231 participants (72.7%
EQ-Decentering, related to mindfulness interven- women), with a mean age of 34.5 (SD: 11.3),
tions (Carmody, Baer, Lykins, & Olendzki, 2009; ranging from 18 to 68. These patients were
Fresco, Segal, et al., 2007; Tanay, Lotan, & recruited from the psychiatric outpatient facilities
Bernstein, 2012). of the Hospital de la Santa Creu i Sant Pau and
The EQ is a brief and easy-to-administer scale the Althaia Foundation. Participants met DSM-IV
validated by Fresco and colleagues (Fresco, Moore, criteria for borderline personality disorder (BPD;
et al., 2007). Initial psychometric analyses did not n = 59), MDD (n = 44), eating behavior disorder
confirm a two-factor structure of the original scale, (n = 70), or cocaine dependence (n = 58). None of
but subsequent confirmatory analyses indicated a the patients reported previous meditative experi-
unifactorial decentering construct that fit the data ence. Exclusion criteria for patients were: acute
well. The items of the decentering factor assess three phase of the disease or psychotic disorder, mental
facets: the ability to distinguish one’s self from one’s retardation, sensory deficiencies, or linguistic
thoughts, the ability to not habitually react to one’s difficulties that limit ability to fill out the
negative experiences, and the capacity for self- questionnaires.
compassion (Fresco, Moore, et al., 2007). As The study protocol was approved by the local
mentioned above, decentering seems to be an active Ethical Committee, and all participants signed a
element in both former cognitive therapies and consent form indicating their willingness to partic-
more recent therapies such as mindfulness and ipate. They were informed about the purpose of the
acceptance. Therefore, translation and validation of study and they were told that their answers would
the EQ-Decentering subscale is necessary to provide be treated confidentially.
a measure that truly assesses this construct.
However, the factor structure of the EQ-Decenter- measures
ing subscale has not yet been replicated, and other Decentering Questionnaire
language versions are needed. The purpose of the The EQ (Fresco, Moore, et al., 2007) is a 20-item
current investigation is to study the unifactorial self-report scale in which participants rate items on
structure and the psychometric properties of the a 7-point Likert-type scale (1 = never to 7 = all the
Spanish version of the EQ. Additionally, this study time), assessing decentering and rumination. Based
examines the ability of the EQ to measure on the psychometric characteristics of the original
decentering in meditators, and its use in other scale—which showed poor loadings of other items
psychiatric disorders apart from depression. placed on rumination factor and a robust structure
for decentering factor (Fresco, Moore, et al., 2007)—
Method only the EQ-Decentering is used for the present
participants study. It is an 11-item self-report measure of
The study sample was composed of 921 individuals decentering. Items are rated on a 5-point Likert
(66.8% women) who were invited to participate in scale (1 = never to 5 = always). Original scale of
the present study; they received no monetary EQ showed high internal reliability; Cronbach’s
compensation. The subsample of nonpsychiatric alpha = .90 (Fresco, Moore, et al., 2007).
volunteers comprised 690 subjects (64.8 % women,
mean age of 39.6 [SD: 11.8] ranging from 18 to 75) Mindfulness Measurements
and was recruited from the Nursing and Psychology The Spanish version of the Five Facet Mindfulness
Schools via online recruitment and using an Internet- Questionnaire (FFMQ; Cebolla et al., 2012) is an
based commercial system (www.surveymonkey. instrument based on five independently developed
com). After inclusion into the study, participants mindfulness questionnaires and consists of five
were asked about meditative experience in a closed subscales: observing, describing, acting with aware-
question (“Have you ever practiced any kind of ness, nonjudging of inner experience, and nonreac-
meditation?”). If they responded "yes," they were tivity to inner experience (Baer et al., 2008). This is
866 soler et al.

a 39-item scale rated on a 5-point Likert scale (1 = procedure

never or very rarely true to 5 = very often or always Nonpsychiatric participants (n = 690) filled out the
true). Cronbach’s α for the Spanish version of questionnaires online (following an Internet proto-
FFMQ range from .8 to .91 (Cebolla et al., 2012). col) or on paper in a university classroom. Subjects of
The Spanish version of the Mindful Attention the clinical subsample (n = 231) completed all the
Awareness Scale (MAAS; Brown & Ryan, 2003; questionnaires during an outpatient clinic visit at the
Soler, Tejodor, et al., 2012) is a 15-item self-report hospital. EQ-Decentering was translated from En-
measure that assesses frequency of mindfulness glish into Spanish by two native bilingual English
states in daily life. Items are rated on a 6-point Spanish speakers. An English native speaker—with
Likert scale (1 = never, 6 = always). Reliability of experience in translating scientific texts—back-trans-
the Spanish MAAS scale is high (α = .89; Soler, lated the resulting Spanish version into English. Any
Tejedor, et al.). discrepancies between the Spanish and English
Acceptance and Action Questionnaire versions were resolved by agreement. The AAQ-II,
The Spanish version of Acceptance and Action MAAS, STAI-S, and CES-D were only obtained from
Questionnaire (AAQ-II; Hayes et al., 2004; Ruiz, the clinical sample. DASS was only administered to
Langer Herrera, Luciano, Cangas, & Beltrán, nonpsychiatric participants for an easy assessment of
2013) is a 9-item self-report measure of experiential affective symptoms. A subsample of 42 BPD patients
avoidance. Items are rated on a 7-point Likert scale underwent a 10-session dialectical behavior therapy
(1 = never true, 7 = always true) with higher scores mindfulness module (Soler, Valdepérez, et al., 2012)
indicating greater experiential avoidance. The and EQ-Decentering was administered before and
Spanish version of this scale has a Cronbach’s α after this module.
between .75 and .93 (Ruiz et al., 2013). data analyses
Clinical Severity Scales A Confirmatory Factor Analysis (CFA) was applied
The State subscale of the Spanish version of to test whether the data fit the unifactorial model of
the Spielberger State Anxiety Inventory (STAI-S; the EQ-Decentering using the whole sample (n =
Guillén-Riquelme & Buela-Casal, 2011) is com- 921). Maximum likelihood CFA was conducted
posed by 20 items based on a 4-point Likert scale using the EQS 6.1 program (Bentler, 1985).
and it was designed to assess current anxiety level. Following Kline's (2010) recommendations, a
Reliability for the State subscale of the STAI is .94. combination of statistics was used to estimate the
The Spanish version of the Center of Epidemiologic goodness of fit. Maximum likelihood with robust
Studies–Depression scale (CES-D; Soler et al., correction was used to avoid distributional prob-
1997) is a self-administered instrument that evalu- lems of data set. Therefore, the following indexes
ates depressive symptomatology in the previous were used: Satorra-Bentler chi-square (sbχ 2 ), which
week. It is a 20-item scale rated from 0 (never or less incorporates a scaling correction for the chi-square
than a day) to 3 (a lot, always or between 5 and statistic when distributional assumptions are vio-
7 days). Cronbach’s α of the Spanish version is .90. lated; comparative fit index (CFI) to assess the
Spanish version of Depression, Anxiety and Stress adequacy of each model, which compares the fit of
Scales short-form (DASS-21; Bados, Solanas, & the model to a null model and establishes the
Andrés, 2005; Lovibond & Lovibond, 1995) is a set absence of relationships among the variables;
of three self-report scales where respondents rate goodness of fit index (GFI) was also used to
the extent to which they have experienced depres- measure the proportion of variance-covariance
sion, anxiety, and stress using a 4-point severity/ accounted for by the proposed model (CFI and
frequency scale over the past week. Cronbach’s α GFI N .90); standardized root mean square residual
values for Depression, Anxiety and Stress subscales (SRMS) and root mean squared error of approxi-
are, respectively: .84, .70, and .82. The Borderline mation (RMSEA), which penalize models that are
Symptom List–23 (BSL-23; Bohus et al., 2008; Soler not parsimonious and are sensitive to misspecified
et al., 2013) is a 23-item self-rating instrument used factor covariance (RMSEA and SRMR b .08).
to assess the typical symptomatology and severity These fit statistics and the chi-square were selected
of BPD. The original instrument and the validated based on their performance and stability (Bentler &
Spanish version have shown good psychometric Bonet, 1980).
properties, with high internal consistency and Internal reliability of the EQ-Decentering sub-
capacity to discriminate BPD from other Axis I scale was explored with Cronbach’s α coefficient as
diagnosis (Bohus et al., 2008) and levels of severity well as with the method of two halves with
among patients with BPD. The scale shows high Spearman-Brown correction. Test-retest reliability
reliability (Cronbach’s α = .95). of the EQ-Decentering was studied by means of a
 experiences questionnaire in a spanish sample 867

Pearson’s correlation in a subsample of 33 subjects Table 2

of the nonmeditative experienced group that were Item Factor Loadings
evaluated twice in a 1–2 week interval. Convergent EQ items M ± SD λ rtot
construct validity of the EQ-Decentering was 1- Soy más capaz de aceptarme 3.69 ± 1.03 .759 .694
calculated using Pearson’s correlations with a mí mismo como soy.
subscales of the FFMQ and MAAS. Divergent 2- Puedo enlentecer mi 3.08 ± 0.95 .606 .575
validity was assessed by correlating EQ-Decentering pensamiento en momentos
with DASS-21, STAI-S, and AAQ scales. We de estrés.
hypothesized that decentering may demonstrate a 3- Me doy cuenta de que no 3.19 ± 1.01 .672 .631
significant positive correlation with mindfulness me tomo las dificultades de
scales and significant negative correlations with forma tan personal.
4- Puedo separar mis pensamientos 2.94 ± 1.03 .740 .708
experiential avoidance (AAQ-II) and clinical scales
y sentimientos de mi mismo.
(i.e., DASS-21 and STAI-S). 5- Puedo tomarme tiempo 3.37 ± 0.92 .722 .675
The usefulness of the EQ-Decentering as an para responder a las dificultades.
outcome measure was explored with a Student’s t 6- Me puedo tratar de forma amable. 3.67 ± 0.96 .760 .697
means comparison in the subsample that received 7- Puedo observar sentimientos 3.29 ± 0.95 .722 .681
10 weeks of mindfulness intervention. To finally desagradables sin ser arrastrado
determine whether response to treatment entailed hacia ellos.
both gains in decentering and in psychiatric 8- Tengo la sensación de que soy 3.64 ± 0.85 .499 .482
symptoms, patients were split into responders and completamente consciente de lo
nonresponders using the median score on BSL-23 que está sucediendo a mi
(median = 1.57; BSL-23 b = 1.6 responders; alrededor y dentro de mí.
9- Veo que, en realidad, no 3.22 ± 1.11 .485 .470
BSL-23 N 1.6 nonresponders). Similar to Fresco,
soy mis pensamientos.
Moore, et al. (2007), clinical validity of the scale 10- Soy consciente de sentir 3.42 ± 1.12 .587 .565
was also examined by comparing the EQ-Decenter- mi cuerpo como un todo.
ing scores of nonpsychiatric participants—with and 11- Veo las cosas desde 3.59 ± 0.95 .770 .731
without meditative experience—and patients. This una perspectiva más amplia.
analysis was performed by means of a one-way Note. Means (M), standard deviations (SD), standardized factor
ANOVA. Post hoc t-test analyses were also loadings (λ one-factor solution), and corrected item-total correla-
performed in order to acknowledge differences tions (rtot) for EQ items.
among clinical and control groups. All data were
analyzed using the PASW Statistics 19.0 software
package for Windows. Two additional CFA models were performed for
clinical and nonclinical participants, using the same
Results
criteria. Both CFA revealed a unifactorial structure of
All demographics and clinical data of all partici- the EQ-Decentering subscale with acceptable
pants are displayed in Table 1. goodness fit indexes: sbχ2 = 67.1797 (p b .001),
Following the criteria mentioned above, CFA CFI =.971, GFI = .931, SRMR = .046, and
revealed a unifactorial structure of the EQ-Decen- RMSEA =.073 (.053–.092); sbχ2 = 216.9789
tering subscale, in which all goodness fit indexes fell (p b .001), CFI = .904, GFI = .919, SRMR = .052,
within the cutoff range for acceptable fit: sbχ 2 = and RMSEA = .077 (.067–.087), respectively.
243.8836 (p b .001), CFI = .939, GFI = .936, The EQ-Decentering demonstrated good internal
SRMR = .040, and RMSEA = .06 (.060–.077). consistency in the whole sample (Cronbach’s α =
The factor loadings of all EQ-Decentering items .893). Split-halves reliability coefficient with the
are shown in Table 2. Spearman-Brown correction confirmed reliability
findings for the whole sample with a value of .868.
Table 1 Regarding test-retest reliability, a correlation of
Demographics of All Participating Subjects (n = 921) .876 (p b .001) was found between first and second
Psychiatric Nonpsychiatric p assessment, providing good temporal stability.
Sample Sample The EQ-Decentering results correlated positively
(n = 231) (n = 690) and significantly with measures of mindfulness with
Gender (% women) 72.7% 64.8% .029 r values above .46 (individual r values for each
Age 34.49 ± 11.3 39.57 ± 11.8 b .001 measure are displayed in Table 3). Besides, statis-
Years of education 10.03 ± 3.6 15.95 ± 2.97 b .001 tically significant negative correlations were found
Note. Values represent means and SD (±) or percentages when between EQ-Decentering and measures of anxiety
appropriated. (STAI-S, DASS-21 anxiety), depression (CES-D,
868 soler et al.

Table 3 were significantly different between responders and

Correlations of the EQ With Clinical Measures and nonresponders (mean = 33.1, SD = 5.3 and
Mindfulness Measures mean = 23.1, SD = 6.7, respectively; F = 18.9;
EQ df = 1, 26; p = .0001; Cohen’s d = 1.66).
Convergent Validity One-way ANOVA showed a significant main
MAAS .576** effect of group (F = 134.8; df = 2, 902;
FFMQ Observe .463** p b .000001). Post hoc Bonferroni analyses of
FFMQ Describe .507** group differences pointed that all groups differed
FFMQ Act awareness .540** significantly among them (p b .001), where the
FFMQ Nonjudge .586** most significant difference was between patients
FFMQ Nonreact .723** and meditative participants (Table 4).
Divergent Validity
Discussion
STAI-S -.351*
CESD -.497** The results reveal that the Spanish version of the
DASS-21 Depre. -.538** EQ-Decentering has a confirmed one-factor struc-
DASS-21 Anx. -.468** ture with acceptable fit indexes and shows similar
DASS-21 Stress -.563** psychometric characteristics of the original measure
AAQ -.655** (Fresco, Moore, et al., 2007). The 11-item scale has
Note. MAAS = Mindful Attention Awareness Scale; FFMQ = Five good internal and test-retest reliability and fine
Facet Mindfulness Questionnaire; STAI-S = Spielberger State Anxi- convergent and divergent validity with other scales
ety Inventory; CESD = Center of Epidemiologic Studies–Depression of mindfulness and clinical screening, respectively.
scale; DASS-21 = Depression, Anxiety and Stress Scales short-form;
In addition, the EQ-Decentering subscale demon-
AAQ = Acceptance and Action Questionnaire.
* p b 0.005, ** p b 0.001. strates a capability to distinguish between psychi-
atric and nonpsychiatric subjects. These findings
bring about a useful and clinically relevant measure
DASS-21 depression), stress (DASS-21 stress) and of decentering, a construct likely to underlie the
experiential avoidance (AAQ-II; see Table 3). effectiveness of meta-cognition-based therapies,
Additionally, correlations with mindfulness scales mindfulness interventions, and even CBT (Leigh
were carried out by splitting the whole sample & Bowen, 2005; Mac Killop & Anderson, 2007).
among psychiatric patients, nonmeditative experi- Correlation results showed very satisfactory
enced individuals, and meditative experienced convergent and divergent validities. Indeed, scores
participants. The results showed that EQ-Decentering on EQ-Decentering subscale were positively corre-
correlated similarly with MAAS and four of the lated with all measures of mindfulness: FFMQ
FFMQ facets (r N .3; p b .005), with the exception of subscales (observe, describe, act with awareness,
the Observe facet, in which meditative experienced nonjudge, nonreactivity to inner experience) and
participants showed the highest correlation (r = .5, MAAS. By contrast, EQ-Decentering was negative-
p b .001) while psychiatric participants showed the ly correlated with measures of anxiety, depression,
lowest (r = .2, p b .05). stress, and avoidance (STAI-S, DASS, CES-D, and
Mean EQ-Decentering score at baseline was AAQ). These findings are in complete accordance
25.59 (SD: 7.23) and 30.05 (SD: 7.46) posttreat- with the original validation of the scale, where
ment. These results showed that EQ-Decentering negative correlations with experiential avoidance,
was able to detect improvements in decentering anxiety, and depression symptoms were reported,
after the mindfulness intervention with significant as well as positive correlations with reappraisal
mean differences between pre- and postintervention ability to emotion regulation (Fresco, Moore, et al.,
(t = − 4.692; df = 41, p b .00001) with a medium 2007). When exploring relations between EQ-
effect size (d = .60). The scores on EQ-Decentering Decentering and FFMQ facets separating

Table 4
EQ Scores Among Patients (n = 216), Participants With Meditative Experience (ME; n = 341) and Without Meditative Experience
(NME; n = 348)
Patients ME NME ANOVA Post hoc d
EQ Mean ± SD 31.926 ± 7.85 41.196 ± 5.99 36.836 ± 6.12 F = 134.8 Clinical b ME* − 1.33
p b .000001 Clinical b NME* − 0.7
ME N NME* 0.72
Note. Means and SD are reported. ANOVA and Bonferroni post hoc analyses and effect sizes (Cohen’s d) are represented. *p b .001.
 experiences questionnaire in a spanish sample 869

subsamples, convergent validity was confirmed, with intervention. Remarkably, Bieling et al. (2012)
with the exception of Observe facet, where the best found that depressed patients who received acute
correlations appeared in those participants with antidepressant medication experienced increased
meditative experience. This seems to confirm some decentering, and the authors suggested that this
kind of specificity of observation in meditative increase may be a by-product of depressive improve-
experience but not in decentering itself. Accordingly, ment. By contrast, long-term decentering increases
Baer and colleagues (Baer, Smith, Hopkins, were only observed in remitted patients receiving a
Krietemeyer, & Toney, 2006) found that only four mindfulness-based cognitive therapy, but not in those
of the FFMQ facets (i.e., all except Observe) were remitted patients with medication alone. Such
truly components of an overall mindfulness con- increases in decentering were predicitive of depressive
struct. symptoms after 6-month follow-up, and could,
As previously mentioned, decentering is sensitive therefore, be useful in preventing relapses. Therefore,
to meditation practice. However, EQ had not been although low decentering appears to be a character-
previously used to compare this ability between istic of clinical conditions, this capability might be
individuals with and without meditation experi- trainable. In this regard, those patients who under-
ence. Our findings showed that individuals with went a 10-week mindfulness intervention significant-
meditative experience had significantly higher ly improved decentering, for which EQ-Decentering
decentering ability than the comparative groups showed a capacity to detect such changes. Finally,
(i.e., nonmeditative individuals and patients). In- increments in decentering capability might underlie
terestingly, EQ-Decentering scores showed the more durable treatment response, as indicated by
highest correlation with nonreactivity to inner Fresco, Segal, et al. (2007), and EQ-Decentering is the
experience of the FFMQ, suggesting that this assessment instrument of choice.
mindfulness facet resembles one of the elements of There are some methodological issues that
decentering, that is, the ability not to habitually deserve comment. First, recruitment of the sample
react to one's negative experience. Scores in other was heterogeneous as participants were enrolled
mindfulness facets and MAAS also showed signif- from different pools by convenience sampling. In
icant correlations with EQ-Decentering, indicating addition, measurement invariance was not tested
again some overlap between mindfulness and and constitutes a limitation as it is not possible to
decentering. In this regard, most of the contempo- know whether EQ behaves similarly across pop-
rary psychological models describe mindfulness as a ulations, raising questions about the appropriate-
meta-cognitive process where a given subject ness of using the scale in different samples.
approaches any mental experience independent of However, the advantage of this type of sampling
the content but as the experience itself (Teasdale, is the ease with which data can be gathered, but the
1999). Indeed, any mindfulness-based intervention disadvantage is the lack of representativeness of
highlights the idea that “thoughts are not facts.” the sample. Linked to this issue, recruiting part of
And what is more, other mindfulness question- the sample online might have biased the results.
naires (e.g., Toronto Mindfulness Scale) assess Second, alternative solutions were not tested with
decentering, although not as a core aspect of the CFA, although other factor solutions might
mindfulness but a by-product of the training itself have provided similar or enhanced model fits.
(Tanay, Lotan, & Bernstein, 2012). However, 1-factor structure adhered to the theo-
Our findings also showed that the lowest scores in retical model proposed by Fresco and colleagues.
decentering corresponded to patients suffering from Third, it is not possible to assure that nonpsychi-
different psychiatric conditions (i.e., cocaine depen- atric participants were completely healthy and not
dence, eating disorders, and borderline personality suffering from any mental illnesses. Finally,
disorder) and not exclusively MDD, as reported by changes in EQ-Decentering after a mindfulness
Teasdale and colleagues (Fresco, Moore, et al., 2007; intervention were explored in the subsample of
Teasdale et al., 2002). Such low scores may be patients with BPD, providing a moderate effect
indicative of poor decentering as a transdiagnostic size. However, the results still offered valuable
vulnerability factor, similar to self-focused attention, information regarding the psychometric charac-
that could be shared among mental disorders teristics of the EQ-Decentering, as patients with
(Ingram, 1990). Altogether, this is congruent with BPD are seriously disturbed clients with difficulties
Fresco’s conceptualization of decentering as a neces- engaging in meditation (Dimidjian & Linehan,
sary capability for healthy cognitive, psychological, 2003).
and social functioning. As Teasdale et al. suggested, In summary, the Spanish version of the EQ-
increases in meta-awareness after standard CBT Decentering is a valid and reliable instrument to
could underlie later clinical improvements associated measure decentering either in clinical and nonclinical
870 soler et al.

samples (meditative naïve or not). In addition, the Initial psychometric properties of the experiences question-
findings also show that EQ-Decentering is an naire: Validation of a self-report measure of decentering.
Behavior Therapy, 38(3), 234–246. http://dx.doi.org/10.
adequate outcome instrument to detect changes after 1016/j.beth.2006.08.003.
metacognition-based therapies and mindfulness- Fresco, D. M., Segal, Z. V., Buis, T., & Kennedy, S. (2007).
based interventions. Relationship of posttreatment decentering and cognitive
reactivity to relapse in major depression. Journal of Consulting
Conflict of Interest Statement and Clinical Psychology, 75(3), 447–455. http://dx.doi.org/10.
1037/0022-006x.75.3.447.
The authors declare that there are no conflicts of interest.
Guillén-Riquelme, A., & Buela-Casal, G. (2011). Actualización
psicométrica y funcionamiento diferencial de los ítems en el
References State Trait Anxiety Inventory (STAI). Psicothema, 23(3),
510–515.
Bados, A., Solanas, A., & Andrés, R. (2005). Psychometric Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance
properties of the Spanish version of Depression, Anxiety and and commitment therapy: An experiential approach to
Stress Scales (DASS). Psicothema, 17(4), 679–683. behavior change. New York, NY: Guilford Press.
Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. Hayes, S. C., Strosahl, K., Wilson, K. G., Bissett, R. T.,
(2006). Using self-report assessment methods to explore facets Pistorello, J., Toarmino, D., … McCurry, S. M. (2004).
of mindfulness. Assessment, 13(1), 27–45. http://dx.doi.org/ Measuring Experiential Avoidance: A preliminary test of a
10.1177/1073191105283504. working model. Psychological Record, 54(4).
Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Hölzel, B. K., Lazar, S. W., Gard, T., Schuman-Olivier, Z., Vago,
Sauer, S., … Williams, J. M. G. (2008). Construct validity D. R., & Ott, U. (2011). How does mindfulness meditation
of the five facet mindfulness questionnaire in meditating work? Proposing mechanisms of action from a conceptual and
and nonmeditating samples. Assessment, 15(3), 329–342. neural perspective. Perspectives on Psychological Science, 6(6),
http://dx.doi.org/10.1177/1073191107313003. 537–559. http://dx.doi.org/10.1177/1745691611419671.
Bentler, P. M. (1985). Theory and implementation of EQS: A Ingram, R. E. (1990). Self-focused attention in clinical disorders:
structural equations program. Los Angeles, LA: BMPD Review and a conceptual model. Psychological Bulletin, 107(2),
Statistical Software. 156. http://dx.doi.org/10.1037//0033-2909.107.2.156.
Bentler, P. M., & Bonet, D. G. (1980). Significance tests and Kerr, C. E., Josyula, K., & Littenberg, R. (2011). Developing an
goodness of fit in the analysis of covariance structures. observing attitude: An analysis of meditation diaries in an
Psychological Bulletin, 88, 588–606. http://dx.doi.org/10. MBSR clinical trial. Clinical Psychology and Psychotherapy,
1037/0033-2909.88.3.588. 18(1), 80–93. http://dx.doi.org/10.1002/cpp.700.
Bieling, P. J., Hawley, L. L., Bloch, R. T., Corcoran, K. M., Kline, R. B. (2010). Principles and practice of structural
Levitan, R. D., Young, L. T., … Segal, Z. V. (2012). equation modeling (3rd ed.). New York, NY: Guilford Press.
Treatment-specific changes in decentering following mind- Leigh, J., & Bowen, S. (2005). Spirituality, mindfulness and
fulness-based cognitive therapy versus antidepressant med- substance abuse. Addictive Behaviors, 30(7), 1335–1341.
ication or placebo for prevention of depressive relapse. http://dx.doi.org/10.1016/j.addbeh.2005.01.010.
Journal of Consulting and Clinical Psychology, 80(3), 365. Lovibond, P. F., & Lovibond, S. H. (1995). Manual for the
http://dx.doi.org/10.1037/a0028245. Depression Anxiety Stress Scales. Sydney: Psychology
Bohus, M., Kleindienst, N., Limberger, M. F., Stieglitz, R. D., Foundation of Australia.
Domsalla, M., Chapman, A. L., … Wolf, M. (2008). The Mac Killop, J., & Anderson, E. J. (2007). Further psycho-
short version of the Borderline Symptom List (BSL-23): metric validation of the mindful attention awareness
Development and initial data on psychometric properties. scale (MAAS). Journal of Psychopathology and Behav-
Psychopathology, 42(1), 32–39. http://dx.doi.org/10. ioral Assessment, 29(4), 289–293. http:
1159/000173701. //dx.doi.org/10.1007/s10862-007-9045-1.
Brown, K. W., & Ryan, R. M. (2003). The benefits of Moritz, S., Kerstan, A., Veckenstedt, R., Randjbar, S., Vitzthum,
being present: Mindfulness and its role in psychological F., Schmidt, C., … Woodward, T. S. (2011). Further evidence
well-being. Journal of Personality and Social Psychology, for the efficacy of a metacognitive group training in
84(4), 822. http://dx.doi.org/10.1037/0022-3514. schizophrenia. Behaviour Research and Therapy, 49(3),
84.4.822. 151–157. http://dx.doi.org/10.1016/j.brat.2010.11.010.
Carmody, J., Baer, R. A., Lykins, E., & Olendzki, N. (2009). An Olendzki, A. (2005). The transformative impact of non-self. In
empirical study of the mechanisms of mindfulness in a D. K. Nauriyal, M. Drummond, & Y. B. Lal (Eds.),
mindfulness-based stress reduction program. Journal of Clinical Buddhist thought and applied psychological research:
Psychology, 65(6), 613–626. http://dx.doi.org/10. Transcending the boundaries (pp. 250–261). New York,
1002/jclp.20579. NY: Taylor and Francis Routledge.
Cebolla, A., Garcia-Palacios, R., Soler, J., Guillen, V., Baños, Ruiz, F. J., Langer Herrera, A. I., Luciano, C., Cangas, A. J., &
R., & Botella, C. (2012). Psychometric properties of the Beltrán, I. (2013). Measuring experiential avoidance and
Spanish validation of the Five Facets of Mindfulness psychological inflexibility: The Spanish version of the Accep-
Questionnaire (FFMQ). European Journal of Psychiatry, tance and Action Questionnaire - II. Psicothema, 25(1),
26(2), 118–126. http://dx.doi.org/10.4321/s0213- 123–129. http://dx.doi.org/10.7334/psicothema2011.239.
61632012000200005. Safran, J. D., & Segal, Z. V. (1990). Interpersonal process in
Dimidjian, S., & Linehan, M. M. (2003). Defining an agenda cognitive therapy. New York, NY: Guilford Press.
for future research on the clinical application of mindfulness Segal, Z. V., Kennedy, S., Gemar, M., Hood, K., Pedersen, R., &
practice. Clinical Psychology: Science and Practice, 10(2), Buis, T. (2006). Cognitive reactivity to sad mood provocation
166–171. http://dx.doi.org/10.1093/clipsy.bpg019. and the prediction of depressive relapse. Archives of General
Fresco, D. M., Moore, M. T., van Dulmen, M. H., Segal, Z. V., Psychiatry, 63, 749–755. http://dx.doi.org/10.1001/
Ma, S. H., Teasdale, J. D., & Williams, J. M. G. (2007). archpsyc.63.7.749.
 experiences questionnaire in a spanish sample 871

Shapiro, S. L., Carlson, L. E., Astin, J. A., & Freedman, B. (2006). Psychotherapy, 6(2), 146–155. http://dx.doi.org/10.1002/
Mechanisms of mindfulness. Journal of clinical psychology, (sici)1099-0879(199905)6:2b146::aid-cpp195N3.0.co;2-e.
62(3), 373–386. http://dx.doi.org/10.1002/jclp.20237. Teasdale, J. D., Moore, R. G., Hayhurst, H., Pope, M., Williams,
Soler, J., Pérez-Sola, V., Puigdemont, D., Pérez-Blanco, J., S., & Segal, Z. V. (2002). Metacognitive awareness and
Figueres, M., & Avlarez, E. (1997). Estudio de validación prevention of relapse in depression: Empirical evidence.
del center of epidemiologic Studies-Depression (CES-D) en Journal of Consulting and Clinical Psychology, 70(2),
una población española de pacientes con trastornos 275–287. http://dx.doi.org/10.1037/0022-006x.70.2.275.
afectivos. Actas luso-españolas de neurología, psiquiatría y Teasdale, J. D., Segal, Z., & Williams, M. J. (1995). How does
ciencias afines, 25, 243–249. cognitive therapy prevent depressive relapse and why should
Soler, J., Tejedor, R., Feliu-Sol, A., Pascual, J. C., Cebolla, A., attentional control (mindfulness) training help? Behavior
Soriano, J., … Pérez, V. (2012). Propiedades psicométricas de Research and, Therapy, 33(1), 25–39. http://dx.doi.org/10.
la versión española de la escala Mindful Attention Awareness 1016/0005-7967(94), e0011-7.
Scale (MAAS). Actas españolas de psiquiatría, 40(1), 19–26. van der Heiden, C., Muris, P., & van der Molen, H. T. (2012).
Soler, J., Valdepérez, A., Feliu-Soler, A., Pascual, J. C., Portella, Randomized controlled trial on the effectiveness of metacog-
M. J., Martín-Blanco, A., … Pérez, V. (2012). Effects of the nitive therapy and intolerance-of-uncertainty therapy for
dialectical behavioral therapy-mindfulness module on atten- generalized anxiety disorder. Behaviour Research and Ther-
tion in patients with borderline personality disorder. Behaviour apy, 50(2), 100–109. http://dx.doi.org/10.1016/j.brat.2011.
Research and Therapy, 50(2), 150–157. http://dx.doi.org/ 12.005.
10.1016/j.brat.2011.12.002. Wells, A. (2002). Emotional disorders and metacognition:
Soler, J., Vega, D., Feliu-Soler, A., Trujols, J., Soto, Á., Elices, Innovative cognitive therapy. Hoboken, NJ: John Wiley &
M., … Pascual, J. C. (2013). Validation of the Spanish version Sons.
of the borderline symptom list, short form (BSL-23). BMC Wells, A., Welford, M., King, P., Papageorgiou, C., Wisely, J., &
Psychiatry, 13(1), 139. http://dx.doi.org/10.1186/1471-244x- Mendel, E. (2010). A pilot randomized trial of metacognitive
13-139. therapy vs applied relaxation in the treatment of adults with
Tanay, G., Lotan, G., & Bernstein, A. (2012). Salutary proximal generalized anxiety disorder. Behaviour Research and Therapy,
processes and distal mood and anxiety vulnerability outcomes 48(5), 429–434. http://dx.doi.org/10.1016/j.brat.2009.11.013.
of mindfulness training: A pilot preventive intervention.
Behavior Therapy, 43(3), 492–505. http://dx.doi.org/10.1016/
j.beth.2011.06.003. R E C E I V E D : December 13, 2013
Teasdale, J. D. (1999). Metacognition, mindfulness and the A C C E P T E D : May 22, 2014
modification of mood disorders. Clinical Psychology & Available online 2 June 2014