Changes In Experiential Avoidance Research Articles

A constructive replication of client change during psychodynamic treatment in an outpatient setting

AbstractWe responded to the need for replication in psychotherapy research by extending a prior naturalistic study documenting the effectiveness of long‐term psychodynamic treatment. We employed three novel analytic strategies and evaluated their influence on substantive interpretations offered in the prior study. The sample consisted of clients (N = 387; Mage = 31.61; SD = 11.13; 58.9% female; 79.1% Caucasian/White) receiving outpatient treatment at a psychodynamic training clinic. Results replicated the original two‐class solutions for social functioning, depression and life satisfaction. Novel to the replication analyses, each trajectory for social functioning and depression exhibited nonlinear change and results advanced research on a theorised mechanism of effective psychodynamic treatment. Results showed that change in experiential avoidance was a possible mechanism between early‐treatment change in social functioning and later‐treatment changes in depression symptoms and life satisfaction. Clinical implications focus on the influence that initial levels of symptoms and well‐being may have on early and later phases of treatment, monitoring progress throughout treatment, and how to promote symptom and well‐being improvement.

The role of experiential avoidance in the early stages of an online mindfulness-based intervention: Two mediation studies

ABSTRACT Objectives There is evidence to suggest that only 2–4 weeks of mindfulness-based interventions (MBIs) can already alleviate emotional stress. The current studies sought to examine whether experiential avoidance mediated the effects of MBIs on emotional distress during an early stage of the intervention. Methods: Chinese participants with high emotional distress were recruited. Study 1 included 324 participants, randomly assigned to an online MBI (N = 171) or a control group (N = 153). Experiential avoidance and general emotional distress were measured at baseline and after the 3rd week of the intervention. Study 2 included 158 participants, randomly assigned to an online MBI (N = 79) or a control group (N = 79). Experiential avoidance and emotional distress were measured at baseline and weekly in the first three weeks. Results: Compared to the control group, experiential avoidance and emotional distress were significantly improved in the MBI group during the first three weeks of the intervention (Cohen’s d = 0.22–0.63). Moreover, changes in experiential avoidance mediated the effects of MBI on emotional distress in the early stage in both contemporary and lagged mediation models. Discussion: Experiential avoidance is an important mediator during the early-stage of MBIs for alleviating emotional distress.

Reductions in experiential avoidance explain changes in anxiety, depression and well-being after a mindfulness and self-compassion (MSC) training.

The mindfulness and self-compassion (MSC) protocol has shown efficacy in reducing mental illness symptoms and increasing well-being. However, little is known on how the positive outcomes are produced. This study explores how reductions in experiential avoidance following MSC training may explain changes in the participants' levels of anxiety, depression, and well-being. The 8-week protocol-based MSC training was delivered to 50 participants, and pre- to post- intervention changes in anxiety, depression, and well-being were measured. A series of mediation models were conducted, with changes in self-compassion as predictor, changes in experiential avoidance as mediator, and changes in mental health and well-being as outcome variables. Point estimates and bootstrap-corrected 95% confidence intervals were calculated to analyse indirect effects through experiential avoidance, by means of structural equation modeling (SEM). Following MSC training, participants increased their levels of self-compassion, reduced experiential avoidance, and enhanced mental health (i.e., anxiety and depression symptoms) and well-being scores. Increases in self-compassion were associated with decreases in experiential avoidance, which in turn were connected with changes in anxiety, depression, and well-being from pre- to post-training. The indirect path through changes in experiential avoidance represented moderate to large proportions of the total effects of self-compassion change-scores on anxiety, depression, and well-being change-scores. Reducing experiential avoidance and increasing psychological flexibility may be a key effect of MSC training linked to improvements of the participants' mental health and well-being scores. Self-compassion practices could exert effects on anxiety, depression and well-being mainly through promoting reductions in experiential avoidance.

Psychometric Properties of the German Brief Experiential Avoidance Questionnaire (BEAQ).

The Brief Experiential Avoidance Questionnaire (BEAQ) is a 15-item short form of the Multidimensional Experiential Avoidance Questionnaire. This study aimed to investigate psychometric properties of a German translation of the BEAQ in a student and a clinical population. The BEAQ showed high internal reliability and overall acceptable convergent and discriminant validity. The BEAQ displayed adequate 7- to 13-day test-retest reliability and captured changes in experiential avoidance when experiential avoidance was targeted in treatment. Confirmatory factor analyses indicated that a bifactor structure where the BEAQ is modeled as one general and five specific factors that correspond to the Multidimensional Experiential Avoidance Questionnaire subscales fit the data adequately. All items (except Item 1 in the clinical population) loaded on the general factor and common variance was approximately equally spread across the general and specific factors. The Distress Endurance subscale was not included in this model, since it is represented by only one item, which showed poor performances and low associations to the BEAQ's total score in both samples. We recommend further research into the BEAQ's factor structure to substantiate our preliminary findings.

Exploring virtue ethics in psychodynamic psychotherapy: latent changes in humility, affect regulation, symptoms and well‐being

AbstractA rising interest in virtues in psychotherapy has spurred empirical exploration of their influence on both mental health symptoms and well‐being. As such, we explored the virtue ethics premise that growth in the virtue of humility may ameliorate mental health symptoms and promote well‐being. We also examined whether change in experiential avoidance was a mechanism of these changes. Using a multiple simultaneous latent change score model, we analysed latent changes among humility, experiential avoidance and the outcomes of symptoms and social well‐being in a sample of clients (N = 778; M = 31.56 years of age; 59.4% female; 78.1% White) who received outpatient contemporary relational psychotherapy at a community mental health training clinic. Results indicated that change in humility corresponded to changes in symptoms and social well‐being through change in experiential avoidance. Clinical implications centre on clinicians attending closely to client experiences of oscillation between self‐abasement and self‐superiority and utilising small ways within the therapeutic encounter to foster humility.

One year follow-up and mediation in cognitive behavioral therapy and acceptance and commitment therapy for adult depression

BackgroundExisting therapies for depression are effective, but many patients fail to recover or relapse. To improve care for patients, more research into the effectiveness and working mechanisms of treatments is needed. We examined the long-term efficacy of Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) for Major Depressive Disorder (MDD), testing the hypothesis that CBT outperforms ACT and that both therapies work through their designated mechanisms of change.MethodsWe conducted a randomized controlled trial with 82 patients suffering from MDD. Data were collected before, during and after treatment, and at 12-month follow-up, assessing symptoms of depression, quality of life, dysfunctional attitudes, decentering, and experiential avoidance.ResultsPatients in both conditions reported significant and large reductions of depressive symptoms (d = − 1.26 to − 1.60) and improvement in quality of life (d = 0.91 to − 1.28) 12 months following treatment. Our findings indicated no significant differences between the two interventions. Dysfunctional attitudes and decentering mediated treatment effects of depressive symptoms in both CBT and ACT, whereas experiential avoidance mediated treatment effects in ACT only.ConclusionsOur results indicate that CBT is not more effective in treating depression than ACT. Both treatments seem to work through changes in dysfunctional attitudes and decentering, even though the treatments differ substantially. Change in experiential avoidance as an underlying mechanism seems to be an ACT-specific process. Further research is needed to investigate whether ACT and CBT may work differently for different groups of patients with depression.Trial registrationclinicaltrials.gov; NCT01517503. Registered 25 January 2012 - Retrospectively registered.

Dialectical behaviour therapy skills training for the treatment of addictive behaviours among individuals with alcohol use disorder: the effect of emotion regulation and experiential avoidance

ABSTRACT Backgrounds Dialectical behavior therapy skills training (DBT-ST) is an effective treatment for alcohol use disorder (AUD). AUD frequently co-occurs with other addictive behaviors. Objective s: These secondary analyses of prior studies on the effectiveness of a 3-month DBT-ST program for AUD investigated pre- post-treatment changes in the severity of concurrent addictive behaviors. The study hypothesized that emotion regulation and experiential avoidance should be the key therapeutic mechanisms involved in the treatment of addictive behaviors. Methods The research included 186 individuals (110 males; 76 females) with a primary diagnosis of AUD. Mediational models were performed considering shorter PROMIS questionnaire subscales (i.e., gambling, sex, shopping, food binging, and starvation) as dependent variables. The difficulties in emotion regulation scale and acceptance and action questionnaire-II total scores were independent and mediator variables, respectively. Results Clinical variables significantly improved during the treatment, independent of baseline levels. Changes in emotion regulation showed significant total effects on improvements in addictive behaviors. Significant indirect effects of changes in experiential avoidance were detected considering compulsive buying and dysfunctional eating behaviors. Conclusion The DBT-ST was a feasible treatment for several addictive behaviors frequently reported by individuals with AUD. The improvements in emotion regulation and experiential avoidance were relevant therapeutic mechanisms involved in the treatment of these conditions. Future controlled trials and follow-up studies are recommended to support the efficacy of DBT-ST as a stand-alone intervention for the treatment of different classes of addictive behaviors.

Changes in Risk Factors During the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents

This study aimed to assess whether changes in potentially modifiable risk factors associated with the construct of neuroticism and common to emotional disorders (i.e., poor distress tolerance and heightened avoidance) occur in concordance with the administration of different treatment components of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) and with reductions in emotional disorder symptoms (i.e., anxiety and depressive symptoms) overall. Using single-case analytic strategies, including multiple-baseline design and modeling techniques, the authors treated 8 adolescents with emotional disorder diagnoses and evaluated trajectories of change in distress tolerance and experiential avoidance as well as in the sequencing of such change in regard to change in anxiety and depressive symptoms. Clinical outcomes were favorable based on parent, adolescent, and clinician-rated measures. Treatment-based change was demonstrated, at both group and individual levels, and at expected points in treatment, in regard to facets of neuroticism. Overall, self-reported change in experiential avoidance and distress tolerance tended to occur simultaneously to reductions in emotional disorder symptoms. This study helps to clarify the course of expected change in variables believed to be common among a range of emotional disorders during a transdiagnostic treatment and provides initial information regarding tailoring the UP-A for individuals with different clinical profiles.

Experiential Avoidance as a Mechanism of Change Across Cognitive-Behavioral Therapy in a Sample of Participants with Heterogeneous Anxiety Disorders

Despite the substantial evidence that supports the efficacy of cognitive-behavioral therapy for the treatment of anxiety and related disorders, our understanding of mechanisms of change throughout treatment remains limited. The goal of the current study was to examine changes in experiential avoidance across treatment in a sample of participants (N = 179) with heterogeneous anxiety disorders receiving various cognitive-behavioral therapy protocols. Univariate latent growth curve models were conducted to examine change in experiential avoidance across treatment, followed by parallel process latent growth curve models to examine the relationship between change in experiential avoidance and change in anxiety symptoms. Finally, bivariate latent difference score models were conducted to examine the temporal precedence of change in experiential avoidance and change in anxiety. Results indicated that there were significant reductions in experiential avoidance across cognitive-behavioral treatment, and that change in experiential avoidance was significantly associated with change in anxiety. Results from the latent difference score models indicated that change in experiential avoidance preceded and predicted subsequent changes in anxiety, whereas change in anxiety did not precede and predict subsequent changes in experiential avoidance. Taken together, these results provide additional support for reductions in experiential avoidance as a transdiagnostic mechanism in cognitive-behavioral therapy.

Mindful Parenting in Secondary Child Mental Health: Key Parenting Predictors of Treatment Effects

Emerging evidence supports the positive effects of mindful parenting as a clinical intervention in the context of child psychopathology; however, previous studies have not considered the specific parenting predictors of improvements in child outcomes. Parents accessing a child and youth secondary mental health care center participated in an 8-week mindful parenting training (n = 89). The effects of the mindful parenting training were assessed on parent-reported child’s psychopathology, parents’ own psychopathology, mindfulness, and parenting factors from pre- to post-intervention, 8-week and 1-year follow-up. Multi-level analyses indicated immediate and delayed improvements in most child and parent outcomes. Changes in experiential avoidance in parenting partially predicted improvements in child internalizing problems. In combination with mindful parenting, experiential avoidance in parenting fully accounted for improvements in child attention problems. Changes in parental over-reactivity fully accounted for improvements in child externalizing problems. The mindful parenting training successfully improved the targeted (mindful) parenting factors, which in turn predicted improvements across different child outcomes.

Basal Exposure Therapy: A New Approach for Treatment-Resistant Patients with Severe and Composite Mental Disorders.

New treatment approaches are needed for patients with severe and composite mental disorders who are resistant to conventional treatments. Such treatment-resistant patients often have diagnoses of psychotic or bipolar disorders or severe personality disorders and comorbid conditions. In this study, we evaluate basal exposure therapy (BET), a novel ward-integrated psychotherapeutic approach for these patients. Central to BET is the conceptualization of undifferentiated existential fear as basic to the patients’ problem, exposure to this fear, and the therapeutic platform complementary external regulation, which integrates and governs the totality of interventions throughout the treatment process. BET is administered at a locked-door ward with 6 patient beds and 13.5 full-time employees, including a psychiatrist and 2 psychologists. Thirty-eight patients who had completed BET were included, all but two being female, mean age 29.9 years. Fourteen patients had a diagnosis of schizophrenia or schizoaffective disorder (F20/25), eight had bipolar disorder or recurrent depressive disorder (F31/33), eight had diagnoses in the F40–48 domain (neurotic, stress-related, and somatoform disorders), five were diagnosed with emotionally unstable personality disorder (F60.3), and three patients had other diagnoses. Twenty of the patients (53%) had more than one ICD-10 diagnosis. Average treatment time in BET was 13 months, ranging from 2 to 72 months. Time-series data show significant improvements in symptoms and functioning from enrollment to discharge, with effect sizes at 0.76 for the Dissociation Experience Scale, 0.93 for the Brief Symptom Inventory, 1.47 for the Avoidance and Action Questionnaire, and 1.42 and 1.56, respectively, for the functioning and symptom subscales of the Global Assessment of Functioning Scale. In addition, the patients used significantly less antiepileptic, antipsychotic, anxiolytic, and antidepressant medications at discharge than at treatment enrollment. Patient improvement across treatment was associated with the following duration of time in BET, the successful completions of the exposure component of BET, positive changes in experiential avoidance as measured with the Acceptance and Action Questionnaire, and high symptom levels and low levels of functioning at treatment start. The findings indicate that BET may be a promising inpatient psychotherapeutic approach for previously treatment-resistant patients with severe and comorbid conditions.

Changes in threat-related cognitions and experiential avoidance in group-based transdiagnostic CBT for anxiety disorders

Group-based Transdiagnostic Cognitive Behavioral Therapy (TCBT) for anxiety disorders aims to target common factors to produce beneficial effects on multiple anxiety disorders at once. While there is growing evidence that various anxiety disorders can be effectively treated by this approach, the common factors contributing to these treatment effects are not well delineated. In a sample of 48 Veterans who completed Group-based TCBT, the current study examined change in threat perception and change in experiential avoidance pre to post-treatment and as potential mediators of changes in negative affect and personalized fear ratings. Results indicated that both threat perception and experiential avoidance were significantly reduced during treatment. Additionally, reductions in both threat perception and experiential avoidance significantly predicted reductions in negative affect and fear ratings. When change in threat perception and change in experiential avoidance were examined simultaneously, both remained significant predictors of changes in negative affect though only experiential avoidance predicted changes in fear ratings. Thus, both reductions in threat perception and experiential avoidance may mediate the broad treatment effects observed in group-based TCBT. Directions for future research are discussed.

Change in Experiential Avoidance is Associated with Reduced Suicidal Ideation over the Course of Psychiatric Hospitalization

Growing empirical literature in recent years indicates that experiential avoidance plays a role in a wide variety of psychological disorders and psychotherapeutic interventions. This study explored the view of suicidal ideation as a form of experiential avoidance by examining the association between suicidal ideation and therapeutic change in a sample of 189 adult psychiatric inpatients. Results were consistent with predictions, showing a statistically significant association between scores on the Beck Scale for Suicidal Ideation and the Acceptance and Action Questionnaire-II (AAQ-II). It was further shown that change in AAQ-II scores over the course of hospitalization was associated with change in suicidality, independent of changes in depression severity and hopelessness. Moreover, treatment responders (patients whose suicidal ideation scores dropped significantly over the course of treatment) showed greater drops in experiential avoidance relative to nonresponders. These results are consistent with a view of suicidal ideation (and, by extension, suicide) as a form of experiential avoidance and potentially a therapeutic approach that specifically seeks to reduce experiential avoidance.

Cognitive-behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for dementia family caregivers with significant depressive symptoms: Results of a randomized clinical trial.

The differential efficacy of acceptance and commitment therapy (ACT) and cognitive-behavioral therapy (CBT) for dementia family caregivers' is analyzed through a randomized controlled trial. Participants were 135 caregivers with high depressive symptomatology who were randomly allocated to the intervention conditions or a control group (CG). Pre-, postintervention, and follow-up measurements assessed depressive symptomatology, anxiety, leisure, dysfunctional thoughts, and experiential avoidance. Depression: Significant effects of interventions compared with CG were found for CBT (p < .001, d = 0.98, number needed to treat [NNT] = 3.61) and ACT (p < .001, d = 1.17, NNT = 3.53) at postintervention, but were maintained only at follow-up for CBT (p = .02, d = 0.74, NNT = 9.71). Clinically significant change was observed in 26.7% participants in CBT, 24.2% in ACT, and 0% in CG. At follow-up, 10.53% in CBT and 4% in ACT were recovered (0% CG). Anxiety: At postintervention, ACT participants showed lower anxiety than CBT participants (p < .05, d = 0.50) and CG participants (p < .01, d = 0.79, NNT = 3.86), with no effects at follow-up. At postintervention, 23.33% in CBT, 36.36% in ACT, and 6.45% in CG showed clinically significant change. At follow-up, 26.32% in CBT, 36% in ACT, and 13.64% in CG were recovered. Significant changes at postintervention were found in leisure and dysfunctional thoughts in both ACT and CBT, with changes in experiential avoidance only for ACT. Similar results were obtained for ACT and CBT. ACT seems to be a viable and effective treatment for dementia caregivers.

Cognitive Mediators of Treatment for Social Anxiety Disorder: Comparing Acceptance and Commitment Therapy and Cognitive-Behavioral Therapy

ObjectiveTo assess the relationship between session-by-session mediators and treatment outcomes in traditional cognitive-behavioral therapy (CBT) and acceptance and commitment therapy (ACT) for social anxiety disorder. MethodSession-by-session changes in negative cognitions (a theorized mediator of CBT) and experiential avoidance (a theorized mediator of ACT) were assessed in 50 adult outpatients randomized to CBT (n=25) or ACT (n=25) for DSM-IV social anxiety disorder. ResultsMultilevel modeling analyses revealed significant nonlinear decreases in the proposed mediators in both treatments, with ACT showing steeper decline than CBT at the beginning of treatment and CBT showing steeper decline than ACT at the end of treatment. Curvature (or the nonlinear effect) of experiential avoidance during treatment significantly mediated posttreatment social anxiety symptoms and anhedonic depression in ACT, but not in CBT, with steeper decline of the Acceptance and Action Questionnaire at the beginning of treatment predicting fewer symptoms in ACT only. Curvature of negative cognitions during both treatments predicted outcome, with steeper decline of negative cognitions at the beginning of treatment predicting lower posttreatment social anxiety and depressive symptoms. ConclusionsRate of change in negative cognitions at the beginning of treatment is an important predictor of change across both ACT and CBT, whereas rate of change in experiential avoidance at the beginning of treatment is a mechanism specific to ACT.

A pilot of an acceptance-based risk reduction program for relational aggression for adolescents

Psychosocial consequences of relational aggression have garnered significant attention. Although most adolescents are targets of relational aggression at some point, only a sub-group experience significant psychological distress and impaired functioning, with research linking experiential avoidance to negative outcomes. The present study sought to develop and pilot a school-based risk-reduction program informed by acceptance-based behavioral theory aimed to reduce experiential avoidance and increase acceptance- and action-based coping to reduce psychosocial distress. Eight 7th grade classrooms comprising of 210 participants with a mean age of 12.45 were group-randomized to either immediate or waitlist condition. Multiple regressions were conducted on baseline and three-month follow-up measures of peer victimization, peer aggression, experiential avoidance, psychopathology, and coping style. Baseline experiential avoidance was significantly associated both the extent to which a student engaged in, and was the victim of, both relational and physical aggression. The program group engaged in more problem-solving coping compared to the waitlist group at follow-up. Change in experiential avoidance predicted negative outcomes at follow-up across domains regardless of group assignment. Implications and recommendations for future studies are discussed.

Binge Eating and Weight Control: The Role of Experiential Avoidance

Two thirds of the adults in the United States are overweight or obese. Binge eating is a barrier to treatment adherence and sustained weight loss, and can be seen as a form of experiential avoidance. The current study analyzed the impact of binge eating on weight reduction in a previously published study of a 1-day acceptance and commitment therapy (ACT) workshop (N = 83) and the psychological processes accounting for the binge-eating results. ACT participants reported less binge eating, which in turn significantly mediated changes in weight. Mediation analyses also showed that reductions in binge eating were mediated by changes in experiential avoidance. The study suggests that ACT and its targeted processes of change may be particularly relevant to binge eating, and that targeting binging is a possible pathway for improving weight management.

Acceptance and Commitment Therapy for Generalized Social Anxiety Disorder

Despite the demonstrated efficacy of cognitive-behavior therapy (CBT) for social anxiety disorder (SAD), many individuals do not respond to treatment or demonstrate residual symptoms and impairment posttreatment. Preliminary evidence indicates that acceptance-based approaches (e.g., acceptance and commitment therapy; ACT) can be helpful for a variety of disorders and emphasize exposure-based strategies and processes. Nineteen individuals diagnosed with SAD participated in a 12-week program integrating exposure therapy and ACT. Results revealed no changes across a 4-week baseline control period. From pretreatment to follow-up, significant improvements occurred in social anxiety symptoms and quality of life, yielding large effect size gains. Significant changes also were found in ACT-consistent process measures, and earlier changes in experiential avoidance predicted later changes in symptom severity. Results suggest the acceptability and potential efficacy of ACT for SAD and highlight the need for future research examining both the efficacy and mechanisms of change of acceptance-based programs for SAD.