Emotional Avoidance Research Articles

Need for Affect, Interpersonal Psychological Theory of Suicide, and Suicide Proneness

The present study expands upon the Interpersonal Psychological Theory of Suicide (IPTS), examining its relationship with the need for affect (NFA), a construct explaining attitudes toward seeking both positive and negative emotions. A sample of 576 emerging adults completed measures of NFA, IPTS, suicide proneness, and demographics online. Findings include NFA accounting for a small significant amount of suicide proneness, a positive association between approaching emotions and one indicator of suicide proneness, negative association between approaching emotions and thwarted belongingness, and positive associations between avoidance of emotions with both perceived burdensomeness and thwarted belongingness. Findings are discussed concerning NFA as a theoretically and practically relevant factor for understanding suicide.

Is avoidance of illness uncertainty associated with distress during oncology treatment? A daily diary study

Objective: The aim of this study was to explore the daily relationship between illness uncertainty, avoidance of uncertainty, well-being and treatment-related distress among patients with cancer receiving treatment with curative intent. It was hypothesised that daily illness uncertainty, daily avoidance of uncertainty and daily treatment-related distress would be negatively associated with daily well-being. It was also hypothesised that daily illness uncertainty and daily avoidance of uncertainty would be positively associated with daily treatment-related distress.Design: Thirty-one patients receiving oncology treatment with curative intent completed a daily diary for seven consecutive days. Data were analysed using multilevel modelling.Main outcome measures: Daily illness uncertainty, avoidance of illness uncertainty, treatment-related distress and well-being.Results: As hypothesised, on days when patients with cancer reported heightened treatment-related distress they experienced diminished well-being. And on days when patients reported more experiential avoidance of illness uncertainty, they also experienced heightened levels of treatment-related distress. No other daily associations were significant.Conclusion: These findings indicate that patients with cancer experience day-to-day fluctuations in distress and well-being throughout oncology treatment. Avoidance of illness uncertainty-related thoughts and/or emotions are associated with daily distress, but not daily well-being.

Internal Working Models of Attachment Relationships and HIV Outcomes Among Women Living With HIV.

Treatment adherence and viral suppression remain suboptimal in the United States. Attachment insecurity may be one understudied factor affecting adherence. According to attachment theory, people develop generalized internal working models of interpersonal relationships, which shape their perceptions of the availability of others at times of stress and how they handle stressors as an individual. Two dimensions of attachment insecurity are attachment-related avoidance (avoidance of intimacy with others and avoidance of negative emotions) and attachment-related anxiety (feeling unable to deal with stressors without others' help). For people living with chronic stressful health conditions that require life-long self-management, attachment-related avoidance and attachment-related anxiety may diminish the ability to cope with stressors as an individual leading to negative health outcomes. We examined cross-sectional associations of the 2 attachment-related insecurity dimensions with antiretroviral treatment (ART) adherence, HIV visit adherence, CD4 cell counts, and viral suppression. Survey and clinical data from 453 women living with HIV in 4 US cities were analyzed controlling for age, education, income, time on ART, illicit drug use, and race. Attachment-related avoidance was the only unique predictor of suboptimal ART adherence, viral failure, and low CD4 count, and attachment-related anxiety was the only unique predictor of missed HIV care visits. These effects were over and above the effects of all covariates. ART adherence mediated the association of attachment-related avoidance with both viral failure and low CD4 counts. Interventions may need to focus on the vulnerable subpopulation with high attachment insecurity and incorporate existing strategies that address insecure attachment models.

Assessment of pain-related fear in individuals with chronic painful conditions.

BackgroundHeightened fear and anxiety related to pain may result in emotional and behavioral avoidance responses causing disability, distress, and depression. Fear and anxiety associated with pain can potentially change the course of the pain experience. It is plausible that fear and anxiety related to pain affect the duration and frequency of pain experienced by the patient.AimThe study aimed to examine the applicability of the Fear of Pain Questionnaire-III (FPQ-III) in identifying who are likely to report longer duration and greater frequency of pain experience.MethodsTo test this hypothesis, a cross-sectional study was conducted with 579 individuals from a community-based sample living with chronic pain. The factor structure and validity of FPQ-III in the community-based sample were also tested.ResultsThe findings suggest higher fear of severe pain but lower fear of medical pain, associated with longer duration and more frequent pain experience. The analysis also confirmed the three-factor structure of FPQ-III, demonstrating good internal consistency for fear of severe pain (0.71) and fear of medical pain (0.73) and acceptable range for fear of minor pain (0.65).ConclusionThese findings suggest that the FPQ-III can be potentially applied to identify individuals at risk for prolonged continuous pain and as a screening tool to measure fear and anxiety related to pain.

Verbal emotional expressiveness in women with eating disorders: recalling autobiographical memories.

This study aimed to study autobiographical memories in women with eating disorders regarding emotional verbal expression, according to age. Our hypotheses are threefold: due to the emotional avoidance that occurs in women with eating disorders, in the younger ages, it was hypothesized that younger participants with anorexia and bulimia nervosa will present a lower number of emotional expressions in the descriptions of their memories than women without eating disorders; that older participants with anorexia and bulimia nervosa will present a greater number of negative verbal expressions in the reports of their memories than women without eating disorders, given the development of negative bias that occurs with age in women with eating disorders; and that women with eating disorders will use more words in a description of their sad memories than women without eating disorders because of the existence of negative bias. With a sample of 90 women and combining age and the presence or absence of eating disorders, we formed four groups. The task that they had to perform was to recall a sad and a happy life event. The younger women used more words than the older women to describe their memories, and women with eating disorders used more words in their descriptions of the sad memories. However, there were no differences in terms of the number of positive and negative expressions. Women with eating disorders exhibit higher levels of cognitive reappraisal and thus use more positive expressions and fewer negative expressions. Level V, Descriptive study.

Thinking about feeling: Using trait emotional intelligence in understanding the associations between early maladaptive schemas and coping styles.

ObjectivesMaladaptive interpersonal schemas can trigger distressing emotions and drive dysfunctional behaviour that leads to difficulties in interpersonal relationships and perpetuates the original maladaptive schemas. This study sought to identify patterns of association between trait emotional intelligence (TEI), early maladaptive schemas (EMS), and coping styles in a non‐clinical sample. Emotionality profiles were hypothesized to be associated with EMS severity and poorer coping, as early experiences can shape an individual's self‐perceptions through reinforcement by maladaptive responses.DesignCross‐sectional study with 142 undergraduate students.MethodsWe obtained self‐reports of TEI, coping styles, and EMS.ResultsDisengagement coping was strongly correlated with EMS severity (r = .565, p < .01). TEI was negatively correlated with EMS (r = −.660, p < .01) and Disengagement (r = −.405, p < .01). Emotionality, Impaired Autonomy, and Overvigilance partially mediated the relationship between Disconnection and Emotion‐Focused Disengagement. Self‐Control fully mediated the relationship between Impaired Limits and Problem‐Focused Disengagement.ConclusionsThe findings suggest that lower TEI is associated with the likelihood for maladaptive coping in response to EMS. The preference for certain coping styles associated with a particular domain of EMS may be explained by an individual's perceived metacognitive ability to regulate their stress and emotions. When individuals’ needs for love, safety, and acceptance from others are not met, there might be poorer perceived self‐efficacies in Emotionality and the tendency to cope through emotional avoidance. Individuals with difficulties establishing internal limits are more likely to respond with problem avoidance, possibly due to deficient distress tolerance. Longitudinal studies with a clinical population are warranted to replicate these findings.Practitioner points Clinicians will likely find it helpful to consider their clients’ TEI to facilitate more individualized formulation and treatment planning, by considering whether related emotional regulation problems might be innate or a deficit in skillsImplies the need to do more basic emotional regulation work to supplement and strengthen the established imagery work in schema therapy (ST).

The influence of resilience and coping strategies on suicidal ideation among Chinese undergraduate freshmen in Hong Kong.

The purpose of this study was to examine the relationship between resilience and suicidal ideation, with coping strategies regarded as a mediator. A total of 422 Hong Kong undergraduate students were recruited with convenience sampling. Simple linear regression was used to verify the negative relationship between resilience and suicidal ideation (P<0.001). The results revealed that two out of four tested mediation models were accepted, with the coping strategies of approach and reappraisal acting as mediators (P<0.001); the other two models were rejected when the coping strategies of emotional regulation and avoidance were the mediators. Regression analysis was performed to explore the effectiveness in reducing suicidal ideation in terms of the reappraisal coping strategy and the approach coping strategy, and the results indicated that the reappraisal coping strategy had greater effects than the approach coping strategy. Overall, the results of this study confirmed previous findings in the literature that resilience can alleviate the degree of suicidal ideation. Additionally, these results suggest further implications that adopting the approach and reappraisal coping strategies might make significant contributions to reducing the number of suicidal cases in society.

The Influence of Maladaptive Perfectism on Worry of Adolescents: the Mediating Effects of Emotional Distress Tolerance and Experiential Avoidance

The Influence of Maladaptive Perfectism on Worry of Adolescents: the Mediating Effects of Emotional Distress Tolerance and Experiential Avoidance

Personality and Coping: Individual Differences in Responses to Emotion.

Abundant evidence links personality with emotion via coping. Alternatively, personality can be viewed as an emergent property of responses to the experience of emotion. Dispositions to control, approach, escape, and avoid one's emotional experience underlie diverse traits, including positive and negative urgency, trait emotional approach and avoidance, alexithymia, and emotional expressiveness. In this review, we consider the neurobiological underpinnings of these dispositions and the nature (e.g., stability) and adaptiveness of the associated traits. Important future directions for research in this area include the roles of development, intraindividual variability and flexibility, and the intensity and structure of emotional experience.

Preparation and Planning for Future Care in the Deep South: Adapting a Validated Tool for Cultural Sensitivity.

This study describes the adaptation and validation of Sörensen et al. (2017)'s preparation for future care (PFC) scale with diverse samples including rural dwelling African Americans and certified nursing assistants (CNAs), and subsequent psychometric development. Responses to the five-subscale PFC survey from 33 rural African American men across 12 months and cognitive interviews with a subset of 12 of these men are described. Psychometric refinement included descriptive qualitative analyses of consultations with experienced lay research advisors (N = 4 and N = 7) regarding potential changes to the PFC and a confirmatory factor analysis of the resultant scale (N = 138). Cognitive interviews with rural African American men revealed difficulty understanding Eurocentric questions. Emergent themes included emotional avoidance of planning, considerations of nursing homes and possible care providers, and coping strategies. In two consultation meetings, trained lay research advisors recommended language modifications to the original questions and response options. Factor analyzing the resultant scale revealed support for the original subscale constructs (acceptable fit: χ2 = 205.03, df = 124, p < .001; root mean square error of approximation = .069 [.052-.085]; comparative fit index = .93; Tucker-Lewis index = .91). PFC and engagement in advance care planning is uncommon among African Americans, possibly due to distrust of and lack of cultural competency among health care professionals. The resulting tool and response options may be used as an interview guide/survey with African Americans to gain understanding about their preparation for future health care needs.

Multisite Randomized Clinical Trial Evaluating an Online Self-Management Program for Adolescents With Juvenile Idiopathic Arthritis.

To determine the efficacy in improving pain and health-related quality of life (HRQOL) of an online self-management program for adolescents with juvenile idiopathic arthritis (JIA). Youth ages 12-18 years with JIA were recruited from 10 rheumatology clinics across the United States and randomized to complete an online self-management program (n = 144) or an online disease education program (n = 145). Participants in the self-management group worked through multimedia-based modules comprising psychoeducation, training in cognitive-behavioral coping skills and stress management, and other self-management topics over a 12-week period. Participants in the control group viewed a series of preselected quality educational websites about JIA over the same interval. Online content for both groups was made available in English and Spanish to facilitate inclusion of Hispanic participants. Blinded assessment of main outcomes (pain intensity, pain interference, and HRQOL) and process outcomes (disease knowledge, self-efficacy, pain coping, and emotional adjustment) occurred at baseline, posttreatment, and at 6- and 12-month postrandomization follow-up visits. Participants on average demonstrated significant improvements over the study period in the main outcomes, with no significant group differences in the degree of improvement. Effect sizes for these improvements were small. The amount of improvement in self-efficacy, emotional avoidance coping, disease knowledge, and emotional functioning in part predicted improvement in pain and HRQOL outcomes. Primarily self-directed online self-management training and online disease education comparably and modestly improve pain and HRQOL in youth with JIA.

직장인의 애착회피가 대인관계능력에 미치는 영향 : 정서표현양가성과 경험회피의 매개효과

본 연구는 직장인을 대상으로 애착회피가 대인관계능력에 미치는 영향과 그 과정을 밝히는 것에 목적이 있다. 이를 위해 국내에서 다양한 직종에 종사하는 400명의 직장인들을 대상으로 온라인 설문조사를 실시하였다. 연구결과, 변인들 간의 상관은 애착회피가 대인관계능력과 정서표현양가성, 경험회피, 정서표현양가성의 하위변인인 자기방어적양가성과 상관이 있는 것으로 나타났다. 개별매개효과를 살펴본 결과, 경험회피는 유의하였으며 정서표현양가성은 대인관계능력에 유의미한 영향을 미치지 않았지만 하위요인 중 자기방어적양가성이 유의미한 영향을 미치는 것으로 나타났다. 또한 애착회피가 정서표현양가성을 예측하고 순차적으로 경험회피를 거쳐 대인관계능력에 미치는 영향이 유의한 것으로 나타났다. 추가적으로 애착회피가 자기방어적양가성과 경험회피를 순차적으로 거쳐 대인관계능력에 미치는 영향 역시 유의한 것으로 나타났다. 마지막으로 본 연구의 의의 및 제한점과 추후연구에 대한 제언을 논의하였다.

Transforming Sensory Cues into Aversive Emotion via Septal-Habenular Pathway

Emotions evoked by environmental cues are important for animal survival and life quality. However, neural circuits responsible for transforming sensory signals to aversive emotion and behavioral avoidance remain unclear. Here, we found that medial septum (MS) mediates aversion induced by both auditory and somatosensory stimuli. Ablation of glutamatergic or GABAergic MS neurons results in impaired or strengthened aversion, respectively. Optogenetic activation of the two cell types results in place avoidance and preference, respectively. Cell-type-specific screening reveals that glutamatergic MS projections to the lateral habenula (LHb) are responsible for the induction of aversion, which can be antagonized by GABAergic MS projections to LHb. Additionally, the sensory-induced place avoidance is facilitated by enhanced locomotion mediated by glutamatergic MS projections to the preoptic area. Thus, MS can transmit innately aversive signals via a bottom-up multimodal sensory pathway and produce concurrent emotional and motional effects, allowing animals to efficiently avoid unfavorable environments.

Mindfulness and avoidance mediate the relationship between yoga practice and anxiety

ObjectivesThere is accumulating evidence that yoga and mindfulness meditation can alleviate symptoms of anxiety, although the mechanisms by which this occurs remain unclear. The purpose of this study was to examine the relationship between yoga practice and self-reported anxiety as well as the potential mediating roles of mindfulness and emotional avoidance. MethodsUsing a cross-sectional design, 367 participants were recruited online and completed measures of anxiety, avoidance, and mindfulness. ResultsResults showed that length of yoga practice was significantly correlated with lower anxiety in yoga practitioners. Avoidance and mindfulness mediated the relationship between length of yoga practice and anxiety, shedding light on possible mechanisms by which these practices reduce anxiety. ConclusionsFuture experimental and longitudinal research is needed to examine the causal role of mindfulness and avoidance in the relationship between yoga practice and anxiety, and whether yoga is a useful adjunct to cognitive behaviour therapy for anxiety disorders.

Schema Therapy with Emotionally Inhibited and Fearful Patients

Emotional inhibition and avoidance are frequent problems in psychotherapy and often block the therapeutic process. Most often patients learnt these behavioral patterns early in childhood as coping strategies to protect themselves from painful emotions such as fear, sadness or shame. Schema therapy (ST) was specifically designed for patients with such rigid and hard to break through behavioral patterns and has shown to be a successful treatment for patients with cluster-C-personality disorders, which extensively display inhibited and fearful behavior. ST provides a set of techniques to address emotional inhibition and avoidance. The schema mode model helps patients to understand the origin and persistence of their problems and therapists can directly apply specific techniques for each mode. The therapist creates a caring, warm, parent-like relationship (‘limited reparenting’) and by this helps the patient to feel safer with emotions and with other people. Simultaneously, the therapist empathically confronts the patient with the problematic consequences of his behavior and pushes for change. Moreover, experiential techniques are frequently applied to help the patient experience and regulate emotions and needs in a safe way. By this, the patient loses fear of emotions, the meaning of emotions is changed and, thus, the patient can reduce using dysfunctional coping mechanisms. In this article, we describe the rational and the specific techniques of ST and illustrate them with a case example.

Factors related to parent-child communication about end-of-life care -A survey of adult children with an elderly parent

In Japan, because adult children are expected to perform a key role in decision-making on end-of-life care for older adults, conversing with parents on their wished-for end-of-life care can help these children to become prepared for this filial responsibility. Our aim in this study was to explore how likely Japanese adult children were to discuss end-of-life care with their parents as well as correlates of such discussions. We conducted an online survey using a sample of 1,590 adult children with at least one living parent aged 65 or older. We analyzed data from 1,010 children who responded during three consecutive days in October, 2015. A small portion of our participants (22.8%) had discussed end-of-life care with their parents. Logistic regression analysis revealed that such discussions were likely in son-mother (Odds Ratio 〈OR〉 = 3.01) and daughter-mother (OR = 3.15) dyads compared with son-father ones as the reference. Occurrence of such discussions was also associated with having older parents (OR = 1.03), parental experience of severe diseases (OR = 1.47), parent-child coresiding (OR = 2.08), a higher level of perceived necessity for (OR = 1.36) and a lower level of emotional avoidance of (OR = 0.68) end-of-life communication. Generally, adult children rarely discuss end-of-life care with their aging parents, suggesting the need to promote such familial communication while considering both children's and parents' circumstances.

Disconnected - Impaired Interoceptive Accuracy and Its Association With Self-Perception and Cardiac Vagal Tone in Patients With Dissociative Disorder.

Patients suffering from dissociative disorders are characterized by an avoidance of aversive stimuli. This includes the avoidance of emotions and, in particular, bodily perceptions. In the present pilot study, we explored the potential interoceptive accuracy deficit of patients suffering from dissociative disorders in a heartbeat detection task. Moreover, we investigated the impact of facial mirror-confrontation on interoceptive accuracy and the potential association between cardiac vagal tone derived from heart rate variability and interoceptive accuracy. Eighteen patients suffering from dissociative disorders and 18 healthy controls were assessed with the Mental Tracking Paradigm by Schandry for heartbeat detection at baseline and after confrontations exposing them to their own faces in a mirror (2 min each, accompanied by a negative or positive cognition). During the experiment, cardiac vagal tone was assessed. We used Pearson correlations to calculate potential associations between cardiac vagal tone and interoceptive accuracy. Patients performed significantly worse than the healthy controls in the heartbeat detection task at baseline. They displayed no significant increase in interoceptive accuracy following facial mirror-confrontation. In the patient group, higher cardiac vagal tone was associated with a more precise heartbeat detection performance. Dissociative disorder patients showed a considerable deficit in interoceptive accuracy. Our results fit with the assumption that highly dissociative patients tend to tune out the perceiving of bodily signals. To the extent that bodily signal perception may play a causal role in these disorders, therapeutic approaches enhancing interoceptive accuracy and cardiac vagal tone may be considered important and practicable steps to improve the therapy outcome of this patient group.

Are socio-emotional and neurocognitive functioning predictors of therapeutic outcomes for adults with anorexia nervosa?

Emotional, social, and neurocognitive factors are theorised to maintain anorexia nervosa (AN). Yet whether they predict outcomes or relate to clinical change remains unclear. Seventy-one consecutive adult outpatient eating disorder service referrals presenting with AN, who participated in a randomised controlled trial comparing 2 psychotherapies, were assessed for emotional processing, social cognition, and neurocognition pretherapy and posttherapy. Intention-to-treat analysis employed maximum-likelihood methods to model missing data. Baseline self-reported emotional processing, social cognitive, or neurocognitive task performance was entered into forward stepwise regression models with posttreatment clinical outcomes (weight, eating disorder psychopathology, psychosocial functioning) as dependent variables. Correlation analyses examined relationships between clinical and self-report/task score change. Self-reported emotional avoidance (behavioural/cognitive avoidance, low acceptance) and submissive behaviour predicted clinical outcomes. Social cognitive (emotion recognition, emotional theory of mind) and neurocognitive performance (set-shifting, detail focus) had limited predictive ability. Emotional avoidance and submissiveness may represent maintenance factors for AN.

Interpersonal problems amongst mental health carers: a qualitative study

ABSTRACTMental health carers are affected by the relationship with the person for whom they provide care, and these interpersonal aspects of caregiving have received limited attention. This article explores mental health carer’s experiences of interpersonal problems within their caring relationship. Qualitative methodology was used, with semi-structured interviews based on biographical narrative and Core Conflictual Relationship Theme framework. Participants were 28 adult carers of people with mental health problems. Thematic analysis identified the following themes: emotion management, aggression, avoidance, responsibility, control, communication, and role challenges. Findings indicate mental health caregivers experience a myriad of interpersonal problems and raise implications for policy and clinical practice.

Childhood emotional maltreatment, anxiety, attachment, and mindfulness: Associations with facial emotion recognition

The current study investigated factors thought to contribute to facial emotion processing. Female university students (N = 126) completed self-report measures of childhood emotional maltreatment, anxiety symptoms, attachment anxiety and avoidance, and trait mindfulness before completing a facial emotion recognition task, where they viewed sequences of faces that incorporated progressively more emotional content until they were able to correctly identify the emotion. They completed the task under low and high cognitive load conditions to distinguish between relatively effortful versus automatic processing abilities. Regression analyses revealed that under low cognitive load, attachment avoidance and mindfulness predicted quicker identification of fear (i.e., with less perceptual information), whereas anxiety predicted slower identification of fear (i.e., with more perceptual information). In the high cognitive load condition, emotional maltreatment and mindfulness predicted quicker identification of fear, and anxiety and mindfulness predicted faster identification of emotions overall. Although current findings are correlational, most of these effects were specific to fearful faces, suggesting that experiences of childhood emotional maltreatment and associated socio-emotional sequelae are related to heightened processing of threat-related information.