Higher Levels Of Experiential Avoidance Research Articles

Experiential avoidance in participants with borderline personality disorder and other personality disorders

BackgroundThe present study has descriptive and predictive aims. The descriptive aims were to determine if participants with borderline personality disorder (BPD) reported higher levels of experiential avoidance (EA) than participants with other personality disorders (OPD) as well as determine if non-recovered participants with BPD reported higher levels of EA than participants with BPD who have recovered symptomatically and psychosocially. The predictive aim was to determine if the level of EA reported by participants with BPD was predicted by the severity of aspects of childhood or adult adversity and/or aspects of temperament.MethodsThe Overall Anxiety Severity and Impairment Scale (OASIS) was administered to 248 participants at 24-year follow-up in the McLean Study of Adult Development (MSAD). Adversity and temperament were assessed during index admission using interviews (Revised Childhood Experience Questionnaire [CEQ-R], Adult History Interview [AHI], and the NEO-FFI self-report measure).ResultsParticipants with BPD reported significantly higher levels of EA than those with OPD. Within the BPD group, non-recovered participants reported significantly higher levels of EA than recovered participants. Severity of childhood sexual abuse and lower levels of extraversion were found to be significant multivariate predictors of levels of EA in those with BPD.ConclusionsTaken together, these results suggest that EA is a serious problem for participants with BPD, particularly those who have not recovered. They also suggest that both the severity of childhood adversity and a temperament marked by lower levels of extroversion are significantly related to levels of EA reported by participants with BPD.

Experiential Avoidance, Post-Traumatic Stress Symptoms, and Academic Impairment.

The ways in which Posttraumatic Stress Disorder (PTSD) symptoms lead to impairments in functioning, including academic performance, are not well understood. The present study sought to examine the role of a common maladaptive coping strategy, experiential avoidance, as a moderator of the relationship between posttraumatic stress symptoms (PTSS) and academic achievement. Participants (N = 326) were undergraduate students enrolled in introductory psychology courses at a large university in the Midwestern United States who reported at least one event potentially meeting Criterion A for PTSD. The prospective association of PTSS with current and subsequent semester GPAs, and with experiential avoidance as the moderator, were examined. The interaction between PTSS and experiential avoidance significantly predicted both current semester GPA and subsequent semester GPA, with stronger associations between PTSS and GPA being observed at higher levels of experiential avoidance. These results were not fully explained by control variables of high school performance, standardized test scores, and general negative affect. This study found that experiential avoidance significantly moderates the relationship between PTSS and academic performance. These results suggest that interventions that target PTSS and/or experiential avoidance may increase GPA. Limitations and future directions are discussed.

Does Avoiding Distressing Thoughts and Feelings Influence the Relationship between Carer Subjective Burden and Anxiety Symptoms in Family Carers of People with Dementia?

Anxiety remains understudied in family carers of people with dementia. Understanding factors that moderate the relationship between stressors and anxiety symptoms in this population is critical to inform interventions. This study examined whether generic experiential avoidance (AAQ-II) and experiential avoidance specific to caregiving-related thoughts and feelings (EACQ) moderate the relationship between subjective burden (ZBI-12) and anxiety symptoms (GAD-7) in carers of people with dementia. The first model (R2 = .66, ∆R2 = .03) exploring the moderating effect of AAQ-II demonstrated a significant interaction term between AAQ-II and subjective burden. The second model (R2 = .53, ∆R2 = .03), exploring the moderating effect of EACQ, demonstrated a significant interaction term between EACQ and subjective burden. These results provide evidence that carers with higher levels of experiential avoidance may be particularly prone to the negative effect of subjective burden on anxiety symptoms. Clinical implications for assessment of experiential avoidance and its treatment in carers of people with dementia are discussed.

Problematic Smartphone Use Influences the Relationship Between Experiential Avoidance and Anxiety.

Experiential avoidance (EA), an unwillingness to stay in contact with unwanted inner experiences (e.g., emotions, thoughts, and bodily sensations), has been implicated in the development and maintenance of anxiety. Individuals with high levels of EA are more likely to employ maladaptive coping strategies (i.e., avoidance behaviors), which exacerbates emotional distress and anxious arousal. As smartphone ownership has become increasingly common in recent years, problematic smartphone use (PSU) has been suggested to serve as a "safety behavior" in situations in which individuals believe that they might experience emotional discomfort. That is, individuals experiencing emotional distress and/or anxious arousal may overengage in the use of technology to relieve emotional distress. As such, the purpose of this study was to examine PSU as a moderator of the relationship between EA and anxiety. Adult participants (N = 294) recruited through Amazon's Mechanical Turk (MTurk), an online labor market, completed an online battery of self-reported measures. Results indicated that the relationship between EA and anxiety became significantly stronger as PSU increased, thereby suggesting that PSU may exacerbate the effect of EA on anxiety. These findings are a first step toward the development of risk profiles that incorporate EA and PSU. Such risk profiles may be beneficial for early identification and intervention for individuals at high risk for the development of anxiety.

How do ACT core processes underlie loneliness and psychological health? A study among people with and without physical chronic disease

ABSTRACT Aims: To explore the differences between individuals with and without chronic physical disease regarding cognitive fusion, experiential avoidance, uncommitted action, loneliness, and psychological health. A model that hypothesized that cognitive fusion has an effect on loneliness and psychological health, through higher experiential avoidance and less committed actions was also tested. Method: The sample comprised 765 participants (304 with chronic physical disease, 461 without a chronic physical disease) and completed an online survey. Results: Participants with chronic physical diseases reported higher levels of cognitive fusion, experiential avoidance and loneliness, and lower levels of psychological health, when compared to participants without chronic physical disease. In both groups, cognitive fusion was positively linked with experiential avoidance and loneliness and negatively linked with committed action and psychological health. The model explained 36% of loneliness and 57% of the psychological health’s variances. Cognitive fusion is associated with loneliness and decreased psychological health, through higher levels of experiential avoidance and lower levels of committed action, even controlling for the effect of age. Discussion: Findings offer important suggestions on how the ACT core processes underlie loneliness and psychological health and support the development of interventions that target cognitive defusion, acceptance skills and committed actions to reduce loneliness and increase psychological health.

Trait-level differences in constructs that underpin the contextual behaviour therapies between binge-eating disorder with and without overvaluation of weight and shape

Accumulating evidence suggests that the presence of shape/weight overvaluation in binge-eating disorder (BED) is associated with more severe psychopathology and impairment. To further inform the role of the overvaluation construct in BED, we examined whether those with and without shape/weight overvaluation differ on four core processes that underpin the contextual behaviour therapies: distress tolerance, self-compassion, mindfulness, and experiential avoidance. These four processes were investigated as each are considered important change mechanisms in contextual behavioural therapies and are either compatible or incompatible with the emotion dysregulation known to precipitate binge eating. Participants were categorized into one of four study groups: probable BED with overvaluation (n = 60); probable BED without overvaluation (n = 108); obese control (n = 59); healthy control (n = 123). Analyses of covariance showed that the probable BED with overvaluation group reported lower levels of self-compassion and distress tolerance, and higher levels of experiential avoidance than the three other groups. The probable BED without overvaluation group did not differ to control groups on these processes, except experiential avoidance levels. Findings highlight potentially important intervention targets and constructs among a subgroup of individuals with BED.

The Renfrew Unified Treatment for Eating Disorders and Comorbidity: Long-Term Effects of an Evidence-Based Practice Implementation in Residential Treatment.

Background: The Renfrew Unified Treatment for Eating Disorders and Comorbidity (UT) is a transdiagnostic, emotion-focused treatment adapted for use in residential group treatment. This study examined the effect of UT implementation across five years of treatment delivery.Methods: Data were collected by questionnaire at admission, discharge (DC), and 6-month follow-up (6MFU). Patient outcomes were measured by the Eating Disorder Examination-Questionnaire, Center for Epidemiologic Studies-Depression Scale, Brief Experiential Avoidance Questionnaire (BEAQ), Anxiety Sensitivity Index, and Southampton Mindfulness Scale. Data were analyzed for N = 345 patients treated with treatment-as-usual (TAU), and N = 2,763 treated with the UT in subsequent years.Results: Results from multilevel models demonstrated a significant interaction between implementation status (TAU vs. UT) and time, both linear and quadratic, for the depression, experiential avoidance, anxiety sensitivity, and mindfulness variables. Patients treated with the UT showed more improvement in these variables on average, as well as more rebound between DC and 6MFU. Results from multilevel models examining eating disorder outcome showed no significant difference between the TAU and UT for the full sample, but a significant three-way interaction indicated that the UT produced more improvement in the EDE-Q relative to the TAU particularly for patients who entered treatment with high levels of experiential avoidance (BEAQ score).Conclusion: This long-term study of a transdiagnostic, evidence-based treatment in residential care for eating disorders and comorbidity suggests implementation was associated with beneficial effects on depression and emotion function outcomes, as well as eating disorder severity for patients with high levels of baseline emotion regulation problems. These effects did not appear to diminish in the 5 years following initial implementation.

Emotion regulation and experiential avoidance moderate the association between posttraumatic symptoms and alcohol use disorder among Israeli combat veterans

Introductionthe association between Posttraumatic Stress symptoms (PTSS) and Alcohol Use Disorder (AUD) among combat veterans is well established. However, little is known concerning the intertwining effect of distress oriented coping mechanisms on this association. In this study, we sought to explore the moderating role of experiential avoidance (EA), cognitive reappraisal (CR) and expressive suppression (ES) on the association between PTSS and AUD among Israeli combat veterans. MethodParticipants were 189 Israel Defense Forces (IDF) male combat veterans (mean age = 30.03) who completed a set of validated self-report questionnaires assessing PTSS, AUD, EA, CR and ES. Moderation analyses were conducted using a four-step hierarchical regression analysis and an ordinary least squares regression analysis. ResultsAnalyses indicated that individuals with average or high levels of EA or ES exhibited significant positive association between PTSS and AUD, yet those with low levels of EA or ES exhibited no significant association between PTSS and AUD (b = 0.14,Confidence Interval (CI)[0.06, 0.22, SE = 0.04, t = 3.65, p = .000, 95%] for EA and b = 0.17, CI[0.07, 0.25, SE = 0.04, t = 3.69, p = .000, 95%] for ES). In addition, CR moderated the association between PTSS and AUD (b = 0.18, CI[0.07, 0.29, SE = 0.06, t = 3.24, p = .001, 95%]), so that the association between PTSS and AUD is positive and stronger for higher levels of CR. ConclusionsOur findings imply that EA, ES and CR and emotion regulation may be major facilitators of the association between PTSS and AUD among combat veterans. These findings are discussed in the Israeli context as well as in light of a general psychological perspective.

Trauma symptoms contribute to daily experiential avoidance: Does partner support mitigate risk?

Objective: The present study examined the protective role of partner support in reducing daily experiential avoidance (EA) associated with trauma symptoms in a sample of 154 couples during pregnancy. Background: Although psychological distress during pregnancy may hinder the developing bond between parents and infants after birth, high quality intimate partner support has the potential to enhance psychological wellbeing during pregnancy, particularly in the context of trauma. Specifically, partner support might mitigate the impact of trauma symptoms on maladaptive coping strategies such as EA by enabling individuals to safely encounter their distress. Method: Participants completed a semi-structured clinical interview of support and a PTSD symptom inventory, followed by home surveys of EA over 14 days. We examined growth trajectories of EA over 14 days using latent trajectory modeling within a dyadic framework. Results: Trauma symptom severity was associated with higher levels of EA across the 2 weeks; however, among women, the impact of trauma symptoms on EA was no longer significant when support from a partner was above average quality or higher. Findings also revealed partner effects; to the extent that women reported higher levels of trauma symptoms, their partners had higher levels of EA. Conclusion: Findings highlight the protective role of high quality support from intimate partners and suggest that trauma-related interventions targeting partner support processes, especially those implemented during pregnancy, might enhance recovery and prevent further distress and dysfunction among pregnant women experiencing trauma symptoms.

Being in the Moment So You Can Keep Moving Forward: Mindfulness and Rumination Mediate the Relationship between Attachment Orientations and Negative Conflict Styles.

Attachment insecurity has been associated with negative behaviors during conflict and decreased relationship satisfaction. We theorize that individuals high in attachment anxiety and/or avoidance are less mindful during conflict with their romantic partners, and thus more likely to ruminate. Decreased mindfulness and higher levels of rumination may be important mechanisms in the relationship between attachment insecurity and conflict behavior, as it may be more difficult to engage in constructive problem-solving skills when one is distracted from the present moment. We conducted an online survey assessing 360 participants’ attachment orientations, levels of mindfulness and rumination, behavior during conflict, and experience with mindfulness activities. Using a serial mediation model, we found that mindfulness and rumination mediated the relationship between attachment insecurity and negative conflict behaviors. We further discovered that individuals high in attachment insecurity were more likely to report negative experiences with mindfulness activities (i.e., meditation and yoga), and that this relationship was mediated by higher levels of experiential avoidance, or a fear of engaging with one’s own thoughts and feelings. We discuss the importance of increasing mindfulness and decreasing both rumination and experiential avoidance to assist individuals high in attachment insecurity in navigating relationship conflict using more constructive and relationship-promoting strategies.

Hair pulling antecedents in trichotillomania: Their relationship with experiential avoidance.

In this study, 285 adults who met criteria for trichotillomania (TTM) via self-report completed an online, cross-sectional survey examining antecedent phenomenological experiences pertaining to hair pulling along with measures of TTM severity and experiential avoidance (i.e., avoidance of or escape from unwanted thoughts or feelings). Results showed a heterogeneous depiction of antecedent experiences. Subsequent analyses revealed that certain antecedents were not significantly related to TTM severity but were significantly correlated with higher levels of experiential avoidance. In particular, four of five classes of antecedents (i.e., bodily sensations, physical symptoms, mental anxiety, and general uncomfortableness) were significantly related to greater experiential avoidance. The authors conclude that treatments may need to be designed to address specific private antecedents, and that this may be done through targeting experiential avoidance.

Mindfulness, experiential avoidance, and affective experience in older adults

Subjective well-being is comprised of two components: affective experience and life satisfaction. Older adulthood is marked by changes and challenges that have the potential to diminish well-being. As the proportion of older adults in the population rises, it is becoming increasingly important to identify factors that may be protective against these potentially detrimental events. Mindfulness and acceptance constructs have been shown to be associated with affective experience across the lifespan. However, little work has examined which facets of mindfulness drive these associations. The current study aimed to explore the associations between acceptance and mindfulness processes and positive and negative affect in older adults. Eighty-five healthy older adults completed self-report measures of mindfulness, experiential avoidance, and positive and negative affect. Results from linear regression analyses indicated that the act with awareness and nonreactivity facets of mindfulness were particularly important in their contribution to positive affect. Additionally, higher levels of experiential avoidance accounted for significant variance in negative affect. These findings help to elucidate how mindfulness and acceptance processes play a role in affective experience in older adults. Future studies should explore these facets in clinical populations to help create more targeted clinical goals.

Measuring structural model invariance across internet-recruited and hospital-recruited IBD patients: Experiential avoidance’s effect on psychopathological symptoms

Research has questioned whether it is feasible to assess psychosocial variables through web-based recruitment methods. Previous literature on IBD focused exclusively on testing differences on psychosocial scores and did not test the invariance between types of recruitment on the relationships between variables. The aim of the present study is thus to analyse structural invariance between internet-recruited and hospital-recruited groups of IBD patients on a mediation model with theoretical basis on previous studies (experiential avoidance as possible mediator of the association between IBD symptomatology and psychopathology). The internet sample included 137 IBD patients recruited through a patients association, and the hospital sample comprised 66 IBD patients. Structural equation modelling was used; a multiple-group comparison was conducted to examine model invariance between samples. Although the internet sample presented higher levels of experiential avoidance and psychopathological symptoms compared to the hospital sample, the relationships between these variables were invariant across groups. Experiential avoidance partially mediated the impact of IBD symptomatology on levels of stress, anxiety, and depression symptoms in a similar way for online respondents and hospital-recruited patients. This is a new finding that argues for the validity of web-based research methods.

Examining the role of cognitive fusion and experiential avoidance in predicting anxiety and depression.

Acceptance and Commitment Therapy (ACT) proposes that cognitive fusion and experiential avoidance are inter-related processes underpinning distress. This study investigated whether worry, rumination, and stressful life events on the one hand and anxiety and depression on the other hand were mediated by cognitive fusion and experiential avoidance (bidirectional serial association). A questionnaire design was conducted cross-sectionally in a clinical sample (study 1; N=57) and cross-sectionally and longitudinally in a non-clinical student sample (study 2; N=106 and N=97 respectively). Participants completed measures of worry, rumination, stressful life events (predictors), cognitive fusion, experiential avoidance (mediators), anxiety, and depression (outcomes) at T1. In study 2, anxiety and depression were measured again 6weeks later. In the clinical sample, the bidirectional relationship between experiential avoidance and cognitive fusion accounted for a significant proportion of the association between rumination and depression, and stressful life events and anxiety and depression. The association between worry and anxiety was mediated by cognitive fusion→experiential avoidance only. In the non-clinical sample, in both cross-sectional and longitudinal analyses, cognitive fusion independently mediated the association between predictors and outcomes, as well as the experiential avoidance→cognitive fusion pathway. The bidirectional association between cognitive fusion and experiential avoidance was most predictive of distress in the clinical sample. In the non-clinical sample, cognitive fusion and the experiential avoidance→cognitive fusion pathway demonstrated more explanatory value. Given the cross-sectional nature of most of the data, the findings provide theoretical (as opposed to empirical) support for the models tested. Interventions designed to reduce cognitive fusion may be a useful early intervention for sub-clinical anxiety and depression. Interventions focused on reducing both cognitive fusion and experiential avoidance may be helpful for individuals presenting with clinical anxiety and depression. Individuals presenting with particularly high levels of experiential avoidance may benefit from initial work defusing from difficult thoughts, as an inroad for reducing experiential avoidance, anxiety, and depression. Likewise, those with rigid cognitive fusion may benefit from initial work around acceptance skills to create a context that better supports defusion.

A Preliminary Examination of an Acceptance and Commitment Therapy-Based Program for Incarcerated Domestic Violence Offenders.

Batterers intervention programs (BIPs) have only a marginal impact on domestic violence (DV) recidivism, in part because treatment attrition is high. The current study evaluates a new BIP based on Acceptance and Commitment Therapy (called ACTV, Achieving Change Through Values-Based Behavior) in a sample of incarcerated DV offenders who failed to complete community-based BIP (N = 23). The current study examined participants' risk factors and assessed criminal justice outcomes in the 1 year following treatment completion. The men exhibited high levels of experiential avoidance, adverse childhood experiences, psychopathy, and attachment when compared to clinical and forensic samples from past research. Consistent with the theory underlying ACTV, experiential avoidance decreased significantly over the course of treatment. In addition, 1 out of 22 (4.5%) had a domestic assault charge in the 1-year follow-up period. Overall, the current study offers preliminary support for the use of ACTV with noncompliant, incarcerated offenders.

Is emotion regulation associated with cancer-related psychological symptoms?

Objectives: This study examined the cross-sectional and prospective relationships between subjective (cognitive reappraisal, expressive suppression and experiential avoidance) and objective (high-frequency heart rate variability [HF-HRV]) measures of emotion regulation (ER) and a set of psychological symptoms (anxiety, depression, fear of cancer recurrence [FCR], insomnia, fatigue, pain, and cognitive impairments) among women receiving radiation therapy for non-metastatic breast cancer.Design: Eighty-one participants completed a battery of self-report scales within 10 days before the start of radiotherapy (T1) and within 10 days after its end (T2; approximately 6 weeks after T1). HF-HRV at rest was measured at T1.Results: Canonical correlation analyses revealed that higher levels of experiential avoidance and expressive suppression were cross-sectionally associated with higher levels of all symptoms, except pain, at T1 and at T2 (both p’s < 0.0001). Higher levels of suppression and reappraisal at T1 were marginally associated with reduced FCR and with increased depression and fatigue between T1 and T2 (p = 0.07). HF-HRV was not associated with symptoms cross-sectionally or prospectively.Conclusions: Although preliminary, these results are consistent with the hypothesis that maladaptive ER strategies, assessed subjectively, may cross-sectionally act as a transdiagnostic mechanism underlying several cancer-related psychological symptoms.

Improving parental emotion socialization in military families: Results of a randomized controlled trial.

Prior research indicates that children of deployed parents are at risk for emotional problems, suggesting the utility of preventive efforts for military families. Effective parental socialization of children's emotions is protective for children's development, and parental experiential avoidance may impede parental emotion socialization, yet intervention studies in this area are lacking. This study examined the impact of a parenting program, After Deployment Adaptive Parenting Tools (ADAPT), on parental emotion socialization postintervention (6 months postbaseline) and whether intervention effects were moderated by parental experiential avoidance. The sample included 336 families (294 fathers and 313 mothers) with at least 1 deployed parent and a focal child aged 4-12. Families were randomized into either ADAPT (a 14-week group-based intervention) or control group. Self-reported data on parental emotion socialization and experiential avoidance were analyzed using structural equation modeling. Results showed that mothers who were assigned to the intervention had significant improved supportive emotion socialization and reduced nonsupportive emotion socialization at postintervention compared with controls. Mothers with higher levels of experiential avoidance assigned to the intervention group had higher levels of supportive emotion socialization at postintervention. No significant intervention effects were found in fathers. This study provides support for the effects of the ADAPT program on maternal emotion socialization at 6-month postbaseline, and the role of experiential avoidance as a moderator. We discuss findings in relation to the different parental roles that mothers and fathers play in postdeployed families, as well as implications for personalized intervention programming. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Correction: Exploring the Relationship between Experiential Avoidance, Coping Functions and the Recency and Frequency of Self-Harm.

[This corrects the article DOI: 10.1371/journal.pone.0159854.].

The impact of experiential avoidance on the relations between illness representations, pain catastrophising and pain interference in chronic pain

Objective: The aim of this study was to examine the effects of experiential avoidance (EA) on the indirect relationship of chronic pain patients’ illness representations to pain interference, through pain catastrophisingDesign and main outcome measure: The sample consisted of 162 patients diagnosed with an arthritis-related or a musculoskeletal disorder. The effects of EA on the pathway between illness representations, pain catastrophising and pain interference were examined with PROCESS, a computational tool for SPSSResults: After controlling for patient and illness-related variables and pain severity, the ‘illness representations–pain catastrophising–pain interference’ pathway was interrupted at the higher levels of EA. The reason was that, at the high levels of EA, either the relation of illness representations to pain catastrophising or the relation of pain catastrophising to pain interference was not statistically significant.Conclusion: The findings indicate that EA is not a generalised negative response to highly aversive conditions, at least as far as the factors examined in this study are concerned. EA may rather reflect a coping reaction, the impact of which depends on its specific interactions with the other aspects of the self-regulation mechanism. At least in chronic pain, EA should become the focus of potential intervention only when its interaction with the illness-related self-regulation mechanism results in negative outcomes.

Characteristics of adults with overweight/obesity and high internal disinhibition: do they fit with targets for acceptance-based interventions?

SummaryObjectiveAdults with overweight/obesity reporting high levels of internal disinhibition (ID) tend to do poorly in standard behavioural weight loss programmes. The current study sought to compare a sample of individuals with overweight/obesity selected on the basis of high ID with an unselected treatment‐seeking sample of adults with overweight/obesity on characteristics that might make acceptance‐based treatments particularly appropriate for those with high ID.MethodsSample 1 included 162 treatment‐seeking adults with overweight/obesity who were selected for high ID; sample 2 included 194 unselected treatment‐seeking adults with overweight/obesity. First, the two samples were compared on levels of general and weight‐related experiential avoidance, and values‐consistent behaviour, both of which are targeted in acceptance‐based treatments, and on other general psychological characteristics. Next, the unselected sample was split into two groups, those meeting criteria for high (N = 105; sample 2/high ID) vs. low (N = 89; sample 2/low ID) ID, and the three groups were compared on the same characteristics.ResultsSample 1 reported higher levels of both general and weight‐related experiential avoidance as well as less values‐consistent behaviour than sample 2. They reported greater psychological impairment in quality of life, depression and anxiety. Within sample 2, 54% met the criteria for high ID. Both sample 1 and sample 2/high ID reported higher levels of experiential avoidance and less values‐consistent behaviour than did the sample 2/low ID. The two high ID samples also reported greater psychological impairment in quality of life, depression and anxiety than sample 2/low ID.ConclusionsAdults with overweight/obesity who report high levels of ID were characterized by higher levels of experiential avoidance, lower levels of values‐consistent behaviour, and more psychosocial impairment as compared with other adults with overweight/obesity. As these are important targets of acceptance‐based approaches, this subgroup may benefit from the integration of such approaches into behavioural weight loss programmes.