Experiential Avoidance and Bordering Psychological Constructs as Predictors of the Onset, Relapse and Maintenance of Anxiety Disorders: One or Many?

Philip Spinhoven,Albert M Van Hemert,Brenda W J H Penninx

doi:10.1007/s10608-017-9856-7

Abstract

To investigate (a) the incremental predictive validity of experiential avoidance over and above bordering psychological constructs (i.e., rumination, worry, neuroticism and anxiety sensitivity) in predicting onset, relapse and maintenance of anxiety disorders; and (b) whether these related constructs can be represented by a single, higher-order latent factor with similar predictive power as the separate psychological constructs while offering a more parsimonious predictive model. Longitudinal cohort study with repeated assessments after 4 years in a sample of 2157 adults aged 18–65, consisting of 1614 persons with past or current anxiety disorder (Panic Disorder with or without Agoraphobia, Social Anxiety Disorder, Generalized Anxiety Disorder, Agoraphobia without panic) according to the Composite Interview Diagnostic Instrument (CIDI) and 543 controls. Experiential avoidance (Acceptance and Action Questionnaire-I) manifested substantial overlap with bordering cognitive constructs. Experiential avoidance and anxiety sensitivity both uniquely predicted maintenance of anxiety disorders and neuroticism uniquely predicted relapse of anxiety disorders, over and above the effect of the other cognitive constructs. Moreover, a latent factor of psychological vulnerability loaded strongly on each of these psychological constructs. This latent factor predicted onset, maintenance and relapse of anxiety disorders. The tendency to frequently experience strong negative emotions, to evaluate these experiences as aversive and to engage in avoidant coping strategies may constitute a transdiagnostic factor predictive of anxiety disorders. Further developing and testing of interventions targeting transdiagnostic construct underlying anxiety and mood disorders seem warranted.

Highlights

Experiential avoidance is described as consisting of two related parts: (a) the unwillingness to remain in contact with aversive private experience, and (b) action taken to alter the aversive experiences or the events that elicit them (Hayes et al 1996)
In a previous study based on data derived from the Netherlands Study of Depression and Anxiety (NESDA), we showed that experiential avoidance predicted onset, relapse as well as maintenance of depressive disorders during a 4-year follow-up period
As experiential avoidance has been implicated in the onset and development of anxiety, the present study aims to examine the incremental predictive value of experiential avoidance for anxiety disorders, as well as the interrelatedness of experiential avoidance with bordering psychological constructs

Summary

Introduction

Experiential avoidance is described as consisting of two related parts: (a) the unwillingness to remain in contact with aversive private experience (including bodily sensations, emotions, thoughts, memories, and behavioral predispositions), and (b) action taken to alter the aversive experiences or the events that elicit them (Hayes et al 1996). Cogn Ther Res (2017) 41:867–880 with higher levels of neuroticism have a tendency to frequently experience strong negative emotions and to evaluate these experiences as aversive Such individuals may be more likely to engage in avoidant coping strategies (such as rumination, worry, emotion suppression, experiential avoidance, anxiety sensitivity) to manage their emotions, which paradoxically may increase the frequency/intensity of these negative emotions After controlling for rumination, worry and neuroticism, experiential avoidance no longer significantly predicted onset, relapse or maintenance of depressive disorders (Spinhoven et al 2016) These results suggested that it may be fruitful to study the high interrelatedness of psychological vulnerabilities and their common core rather than psychological vulnerabilities such as experiential avoidance in isolation (Bird et al 2012; Hong and Cheung 2015). It has been found that the effect of anxiety sensitivity and behavioral inhibition on concurrent social anxiety disorder was not moderated by level of experiential avoidance (Panayiotou et al 2014)

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Conclusion