The role of experiential avoidance and cognitive fusion in the development of anxiety symptoms among family carers of people with dementia

Abstract

AbstractBackgroundDespite the high prevalence of anxiety symptoms among family carers of people with dementia (Kaddour & Kishita, 2020), current carer interventions are considered to be not as effective for anxiety as they are for depression (Kishita et al., 2018). Therefore, understanding the mechanism by which a common stressor (i.e. carer subjective burden) and underlying psychological processes influence anxiety symptoms among this population is critical to inform future interventions. In this study, the roles of two psychological processes known to be associated with mental health problems were explored: experiential avoidance in caregiving (an attempt or desire to control or suppress distressing thoughts and feelings related to caregiving) and cognitive fusion (the tendency for one’s behaviour to be overly regulated and influenced by thoughts).MethodWith a sample of seventy‐seven family carers (mean age of 63.47 years (SD = 10.64) and 73% female), this study examined the indirect effect of carer subjective burden (ZBI‐12) on anxiety symptoms (GAD‐7) through experiential avoidance in caregiving (EACQ) and cognitive fusion (CFQ) using a path analysis approach.ResultThe whole sample model showed a good fit to the data. The indirect effect of carer subjective burden on anxiety symptoms through its effect on cognitive fusion (β = .17), and its combined effect on experiential avoidance in caregiving and cognitive fusion (β = .01) were significant. Examined variables accounted for 54% of the variance in anxiety symptoms.ConclusionGiven the higher explanatory value demonstrated for the indirect effect of cognitive fusion alone, facilitating cognitive fusion through psychological interventions may be critical for preventing clinically significant levels of anxiety symptoms, particularly among those carers experiencing high levels of carer subjective burden. The results also demonstrated that family carers with higher experiential avoidance in caregiving may be prone to cognitive fusion, which in turn could lead to higher levels of anxiety symptoms. Therefore, an early intervention targeting experiential avoidance may be beneficial for preventing increased cognitive fusion and anxiety symptoms.