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Published in: Cognitive Therapy and Research 2/2016

Open Access 01-04-2016 | Original Article

Is Experiential Avoidance a Mediating, Moderating, Independent, Overlapping, or Proxy Risk Factor in the Onset, Relapse and Maintenance of Depressive Disorders?

Authors: Philip Spinhoven, Jolijn Drost, Mark de Rooij, Albert M. van Hemert, Brenda W. J. H. Penninx

Published in: Cognitive Therapy and Research | Issue 2/2016

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Abstract

Our study aim was to investigate how experiential avoidance ‘works together’ with bordering psychological constructs (i.e., rumination, worry and neuroticism) in predicting the onset, relapse and maintenance of depressive disorders. We performed a longitudinal cohort study with repeated assessments after 2 and 4 years in a sample of 737 persons with a 6-month recency dysthymic and/or major depressive disorder, a sample of 1150 remitted persons with a history of previous depressive disorders; and a sample of 626 persons with no 6-month recency depressive or anxiety disorders and no previous depressive disorders. Experiential avoidance predicted onset, relapse as well as maintenance of depressive disorders during the 4-year follow-up period. However, after controlling for rumination, worry and neuroticism, experiential avoidance no longer significantly predicted onset, relapse or maintenance of depressive disorders in contrast to repetitive thinking in the form of rumination or worry. Experiential avoidance also did not mediate or moderate the effect of rumination, worry and neuroticism.
Literature
go back to reference American Psychiatric Association. (APA). (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. American Psychiatric Association. (APA). (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
go back to reference Baer, R. A. (2007). Mindfulness, assessment, and transdiagnostic processes. Psychological Inquiry, 18(4), 238–242.CrossRef Baer, R. A. (2007). Mindfulness, assessment, and transdiagnostic processes. Psychological Inquiry, 18(4), 238–242.CrossRef
go back to reference Bardeen, J. R., Fergus, T. A., & Orcutt, H. K. (2014). The moderating role of experiential avoidance in the prospective relationship between anxiety sensitivity and anxiety. Cognitive Therapy and Research, 38, 465–471. doi:10.1007/s10608-014-9614-z.CrossRef Bardeen, J. R., Fergus, T. A., & Orcutt, H. K. (2014). The moderating role of experiential avoidance in the prospective relationship between anxiety sensitivity and anxiety. Cognitive Therapy and Research, 38, 465–471. doi:10.​1007/​s10608-014-9614-z.CrossRef
go back to reference Barlow, D. H., Sauer-Zavala, S., Carl, J. R., Bullis, J. R., & Ellard, K. K. (2014). The nature, diagnosis, and treatment of neuroticism: back to the future Clinical. Psychological Science, 2, 344–365. doi:10.1177/2167702613505532. Barlow, D. H., Sauer-Zavala, S., Carl, J. R., Bullis, J. R., & Ellard, K. K. (2014). The nature, diagnosis, and treatment of neuroticism: back to the future Clinical. Psychological Science, 2, 344–365. doi:10.​1177/​2167702613505532​.
go back to reference Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182. doi:10.1037/0022-3514.51.6.1173.CrossRefPubMed Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182. doi:10.​1037/​0022-3514.​51.​6.​1173.CrossRefPubMed
go back to reference Bijl, R. V., van Zessen, G., Ravelli, A., de Rijk, C., & Langendoen, Y. (1998). The Netherlands Mental Health Survey and Incidence Study (NEMESIS): Objectives and design. Social Psychiatry and Psychiatric Epidemiology, 33, 581–586. doi:10.1007/s001270050097.CrossRefPubMed Bijl, R. V., van Zessen, G., Ravelli, A., de Rijk, C., & Langendoen, Y. (1998). The Netherlands Mental Health Survey and Incidence Study (NEMESIS): Objectives and design. Social Psychiatry and Psychiatric Epidemiology, 33, 581–586. doi:10.​1007/​s001270050097.CrossRefPubMed
go back to reference Bjornsson, A., Carey, G., Hauser, M., Karris, A., Kaufmann, V., Sheets, E., & Craighead, W. E. (2010). The effects of experiential avoidance and rumination on depression among college students. International Journal of Cognitive Therapy, 3, 389–401. doi:10.1521/ijct.2010.3.4.389.CrossRef Bjornsson, A., Carey, G., Hauser, M., Karris, A., Kaufmann, V., Sheets, E., & Craighead, W. E. (2010). The effects of experiential avoidance and rumination on depression among college students. International Journal of Cognitive Therapy, 3, 389–401. doi:10.​1521/​ijct.​2010.​3.​4.​389.CrossRef
go back to reference Boelen, P. A., & Reijntjes, A. (2008). Measuring experiential avoidance: Reliability and validity of the Dutch 9-item Acceptance and Action Questionnaire (AAQ). Journal of Psychopathology and Behavioral Assessment, 30, 241–251. doi:10.1007/s10862-008-9082-4.CrossRef Boelen, P. A., & Reijntjes, A. (2008). Measuring experiential avoidance: Reliability and validity of the Dutch 9-item Acceptance and Action Questionnaire (AAQ). Journal of Psychopathology and Behavioral Assessment, 30, 241–251. doi:10.​1007/​s10862-008-9082-4.CrossRef
go back to reference Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., & Zettle, R. D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42, 676–688. doi:10.1016/j.beth.2011.03.007.CrossRefPubMed Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., & Zettle, R. D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42, 676–688. doi:10.​1016/​j.​beth.​2011.​03.​007.CrossRefPubMed
go back to reference Borkovec, T. D. (1994). The nature, functions, and origins of worry. In G. C. L. D. F. Tallis (Ed.), Worrying: Perspectives on theory, assessment, and treatment (pp. 5–34). New York: Wiley. Borkovec, T. D. (1994). The nature, functions, and origins of worry. In G. C. L. D. F. Tallis (Ed.), Worrying: Perspectives on theory, assessment, and treatment (pp. 5–34). New York: Wiley.
go back to reference IBM Corp. (2012). SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp. IBM Corp. (2012). SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.
go back to reference Costa, P. T., & McCrae, R. R. (1992). NEO-PI-R professional manual. Odessa: Psychological Assesment Resources. Costa, P. T., & McCrae, R. R. (1992). NEO-PI-R professional manual. Odessa: Psychological Assesment Resources.
go back to reference Drost, J., van der Does, W., van Hemert, A. M., Penninx, B. W., & Spinhoven, P. (2014). Repetitive negative thinking as a transdiagnostic factor in depression and anxiety: A conceptual replication. Behaviour Research and Therapy, 63, 177–183. doi:10.1016/j.brat.2014.06.004.CrossRef Drost, J., van der Does, W., van Hemert, A. M., Penninx, B. W., & Spinhoven, P. (2014). Repetitive negative thinking as a transdiagnostic factor in depression and anxiety: A conceptual replication. Behaviour Research and Therapy, 63, 177–183. doi:10.​1016/​j.​brat.​2014.​06.​004.CrossRef
go back to reference Eisma, M. C., Stroebe, M. S., Schut, H. A., Stroebe, W., Boelen, P. A., & van den Bout, J. (2013). Avoidance processes mediate the relationship between rumination and symptoms of complicated grief and depression following loss. Journal of Abnormal Psychology, 122, 961–970. doi:10.1037/a0034051.CrossRefPubMed Eisma, M. C., Stroebe, M. S., Schut, H. A., Stroebe, W., Boelen, P. A., & van den Bout, J. (2013). Avoidance processes mediate the relationship between rumination and symptoms of complicated grief and depression following loss. Journal of Abnormal Psychology, 122, 961–970. doi:10.​1037/​a0034051.CrossRefPubMed
go back to reference Glick, D. M., & Orsillo, S. M. (2011). Relationships among social anxiety, self-focused attention, and experiential distress and avoidance. Journal of Cognitive and Behavioral Psychotherapies, 11, 1–12. Glick, D. M., & Orsillo, S. M. (2011). Relationships among social anxiety, self-focused attention, and experiential distress and avoidance. Journal of Cognitive and Behavioral Psychotherapies, 11, 1–12.
go back to reference Harvey, A. G., Watkins, E., Mansell, W., & Shafran, R. (2004). Cognitive behavioural processes across psychological disorders. Oxford: Oxford University Press.CrossRef Harvey, A. G., Watkins, E., Mansell, W., & Shafran, R. (2004). Cognitive behavioural processes across psychological disorders. Oxford: Oxford University Press.CrossRef
go back to reference Hayes, S. C., Strosahl, K., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., & McCurry, S. M. (2004). Measuring experiential avoidance: A preliminary test of a workingmodel. The Psychological Record, 54, 553–578. Hayes, S. C., Strosahl, K., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., & McCurry, S. M. (2004). Measuring experiential avoidance: A preliminary test of a workingmodel. The Psychological Record, 54, 553–578.
go back to reference Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experimental avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64, 1152–1168. doi:10.1037//0022-006X.64.6.1152.CrossRefPubMed Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experimental avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64, 1152–1168. doi:10.​1037/​/​0022-006X.​64.​6.​1152.CrossRefPubMed
go back to reference Hoekstra, H. A., Ormel, J., & Fruyt, Fd. (1996). Handleiding NEO Persoonlijkheidsvragenlijsten. Lisse: Swets Test Services. Hoekstra, H. A., Ormel, J., & Fruyt, Fd. (1996). Handleiding NEO Persoonlijkheidsvragenlijsten. Lisse: Swets Test Services.
go back to reference Hong, R. Y., & Cheung, M. W.-L. (2014). The structure of cognitive vulnerabilities to depression and anxiety: Evidence for a common core etiologic process based on a meta-analytic review. Clinical Psychological Science,. doi:10.1177/2167702614553789. Hong, R. Y., & Cheung, M. W.-L. (2014). The structure of cognitive vulnerabilities to depression and anxiety: Evidence for a common core etiologic process based on a meta-analytic review. Clinical Psychological Science,. doi:10.​1177/​2167702614553789​.
go back to reference Kashdan, T. B., Barrios, V., Forsyth, J. P., & Steger, M. F. (2006). Experiential avoidance as a generalized psychological vulnerability: Comparisons with coping and emotion regulation strategies. Behaviour Research and Therapy, 44, 1301–1320. doi:10.1016/j.brat.2005.10.003.CrossRefPubMed Kashdan, T. B., Barrios, V., Forsyth, J. P., & Steger, M. F. (2006). Experiential avoidance as a generalized psychological vulnerability: Comparisons with coping and emotion regulation strategies. Behaviour Research and Therapy, 44, 1301–1320. doi:10.​1016/​j.​brat.​2005.​10.​003.CrossRefPubMed
go back to reference Kotov, R., Gamez, W., Schmidt, F., & Watson, D. (2010). Linking “big” personality traits to anxiety, depressive, and substance use disorders: A meta-analysis. Psychological Bulletin, 136, 768–821. doi:10.1037/a0020327.CrossRefPubMed Kotov, R., Gamez, W., Schmidt, F., & Watson, D. (2010). Linking “big” personality traits to anxiety, depressive, and substance use disorders: A meta-analysis. Psychological Bulletin, 136, 768–821. doi:10.​1037/​a0020327.CrossRefPubMed
go back to reference Landman-Peeters, K. M., Hartman, C. A., van der Pompe, G., den Boer, J. A., Minderaa, R. B., & Ormel, J. (2005). Gender differences in the relation between social support, problems in parent–offspring communication, and depression and anxiety. Social Science and Medicine, 60, 2549–2559. doi:10.1016/j.socscimed.2004.10.024.CrossRefPubMed Landman-Peeters, K. M., Hartman, C. A., van der Pompe, G., den Boer, J. A., Minderaa, R. B., & Ormel, J. (2005). Gender differences in the relation between social support, problems in parent–offspring communication, and depression and anxiety. Social Science and Medicine, 60, 2549–2559. doi:10.​1016/​j.​socscimed.​2004.​10.​024.CrossRefPubMed
go back to reference Nolen-Hoeksema, S., & Watkins, E. R. (2011). A heuristic for developing transdiagnostic models of psychopathology: Explaining multifinality and divergent trajectories. Perspectives on Psychological Science, 6, 589–609. doi:10.1177/1745691611419672.CrossRefPubMed Nolen-Hoeksema, S., & Watkins, E. R. (2011). A heuristic for developing transdiagnostic models of psychopathology: Explaining multifinality and divergent trajectories. Perspectives on Psychological Science, 6, 589–609. doi:10.​1177/​1745691611419672​.CrossRefPubMed
go back to reference Olatunji, B. O., Naragon-Gainey, K., & Wolitzky-Taylor, K. B. (2013). Specificity of rumination in anxiety and depression: A multimodal meta-analysis. Clinical Psychology: Science and Practice, 20, 225–257. doi:10.1111/cpsp.12037. Olatunji, B. O., Naragon-Gainey, K., & Wolitzky-Taylor, K. B. (2013). Specificity of rumination in anxiety and depression: A multimodal meta-analysis. Clinical Psychology: Science and Practice, 20, 225–257. doi:10.​1111/​cpsp.​12037.
go back to reference Penninx, B. W., Beekman, A. T., Smit, J. H., Zitman, F. G., Nolen, W. A., Spinhoven, P., & Van Dyck, R. (2008). The Netherlands Study of Depression and Anxiety (NESDA): Rationale, objectives and methods. International Journal of Methods in Psychiatric Research, 17, 121–140. doi:10.1002/mpr.256.CrossRefPubMed Penninx, B. W., Beekman, A. T., Smit, J. H., Zitman, F. G., Nolen, W. A., Spinhoven, P., & Van Dyck, R. (2008). The Netherlands Study of Depression and Anxiety (NESDA): Rationale, objectives and methods. International Journal of Methods in Psychiatric Research, 17, 121–140. doi:10.​1002/​mpr.​256.CrossRefPubMed
go back to reference Roemer, L., Salters, K., Raffa, S. D., & Orsillo, S. M. (2005). Fear and avoidance of internal experiences in GAD: Preliminary tests of a conceptual model. Cognitive Therapy and Research, 29, 71–88. doi:10.1007/s10608-005-1650-2.CrossRef Roemer, L., Salters, K., Raffa, S. D., & Orsillo, S. M. (2005). Fear and avoidance of internal experiences in GAD: Preliminary tests of a conceptual model. Cognitive Therapy and Research, 29, 71–88. doi:10.​1007/​s10608-005-1650-2.CrossRef
go back to reference Rush, A. J., Gullion, C. M., Basco, M. R., Jarrett, R. B., & Trivedi, M. H. (1996). The inventory of depressive symptomatology (IDS): Psychometric properties. Psychological Medicine, 26, 477–486.CrossRefPubMed Rush, A. J., Gullion, C. M., Basco, M. R., Jarrett, R. B., & Trivedi, M. H. (1996). The inventory of depressive symptomatology (IDS): Psychometric properties. Psychological Medicine, 26, 477–486.CrossRefPubMed
go back to reference Santanello, A. W., & Gardner, F. L. (2007). The role of experiential avoidance in the relationship between maladaptive perfectionism and worry. Cognitive Therapy and Research, 31, 319–332. doi:10.1007/s10608-006-9000-6.CrossRef Santanello, A. W., & Gardner, F. L. (2007). The role of experiential avoidance in the relationship between maladaptive perfectionism and worry. Cognitive Therapy and Research, 31, 319–332. doi:10.​1007/​s10608-006-9000-6.CrossRef
go back to reference Spinhoven, P., Drost, J., de Rooij, M., van Hemert, A. M., & Penninx, B. W. (2014). A longitudinal study of experiential avoidance in emotional disorders. Behavior Therapy, 45, 840–850.CrossRefPubMed Spinhoven, P., Drost, J., de Rooij, M., van Hemert, A. M., & Penninx, B. W. (2014). A longitudinal study of experiential avoidance in emotional disorders. Behavior Therapy, 45, 840–850.CrossRefPubMed
go back to reference Tull, M. T., & Gratz, K. L. (2008). Further examination of the relationship between anxiety sensitivity and depression: The mediating role of experiential avoidance and difficulties engaging in goal-directed behavior when distressed. Journal of Anxiety Disorders, 22, 199–210. doi:10.1016/j.janxdis.2007.03.005.CrossRefPubMed Tull, M. T., & Gratz, K. L. (2008). Further examination of the relationship between anxiety sensitivity and depression: The mediating role of experiential avoidance and difficulties engaging in goal-directed behavior when distressed. Journal of Anxiety Disorders, 22, 199–210. doi:10.​1016/​j.​janxdis.​2007.​03.​005.CrossRefPubMed
go back to reference Wells, A., & Carter, K. (2009). Maladaptive thought control strategies in generalized anxiety disorder, major depressive disorder, and nonpatient groups and relationships to trait anxiety. International Journal of Cognitive Therapy, 2, 224–234.CrossRef Wells, A., & Carter, K. (2009). Maladaptive thought control strategies in generalized anxiety disorder, major depressive disorder, and nonpatient groups and relationships to trait anxiety. International Journal of Cognitive Therapy, 2, 224–234.CrossRef
go back to reference Williams, J. M. G., Van der Does, A. J. W., Barnhofer, T., Crane, C., & Segal, Z. S. (2008). Cognitive reactivity, suicidal ideation and future fluency: Preliminary investigation of a differential activation theory of hopelessness/suicidality. Cognitive Therapy and Research, 32, 83–104. doi:10.1007/s10608-006-9105-y.CrossRef Williams, J. M. G., Van der Does, A. J. W., Barnhofer, T., Crane, C., & Segal, Z. S. (2008). Cognitive reactivity, suicidal ideation and future fluency: Preliminary investigation of a differential activation theory of hopelessness/suicidality. Cognitive Therapy and Research, 32, 83–104. doi:10.​1007/​s10608-006-9105-y.CrossRef
Metadata
Title
Is Experiential Avoidance a Mediating, Moderating, Independent, Overlapping, or Proxy Risk Factor in the Onset, Relapse and Maintenance of Depressive Disorders?
Authors
Philip Spinhoven
Jolijn Drost
Mark de Rooij
Albert M. van Hemert
Brenda W. J. H. Penninx
Publication date
01-04-2016
Publisher
Springer US
Published in
Cognitive Therapy and Research / Issue 2/2016
Print ISSN: 0147-5916
Electronic ISSN: 1573-2819
DOI
https://doi.org/10.1007/s10608-015-9747-8

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