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

Eustis, Elizabeth H.; Cardona, Nicole D.; Nauphal, Maya; Sauer‐Zavala, Shannon; Rosellini, Anthony J.; Farchione, Todd J.; Barlow, David H.

doi:10.1007/s10608-019-10063-6

Cited by 48 publications

(39 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Empirical evidence points to EA as a transtheoretical mechanism of change in the treatment of anxiety, depression, substance use disorder, eating and borderline personality disorders, with additional implications for increased well-being (Boettcher et al, 2019;Eustis et al, 2016Eustis et al, , 2020. Building on this affect regulation-mental health symptom link, we tested a virtue ethics informed model that considered the influence of humility, not only on affect regulation and symptoms but also on social well-being.…”

Section: Link S B E T Ween H Umilit Y and Affec T Reg Ul Ationmentioning

confidence: 99%

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

Jankowski

Captari

Sandage

2021

Couns and Psychother Res

View full text Add to dashboard Cite

A virtue ethics premise is that flourishing cannot be achieved solely through symptom reduction, but, rather, is inextricably connected with the development of 'qualities of human character and excellence which enhance the capacity to live well' (Sandage & Hill, 2001, p. 243). Sometimes also described as character strengths, virtues are grounded in motivational, affective, cognitive, relational, behavioural and contextual dimensions of human functioning, and thus hold important implications for therapists' clinical formulation and treatment approaches. Virtues orient clients to reflect on who they are and are becoming in relation to others (McMinn et al., 2016). While numerous virtue-based interventions exist (e.g. keeping a gratitude journal), considerably less attention has been given to understanding the complex and often implicit psychotherapeutic processes that promote or impede virtue development (Jankowski et al., 2020). Rowden and colleagues (2014) described a shift from 'focusing exclusively on what people do in relationships (action oriented or skills training approaches) to addressing who people are (character, affective, and motivational domains)' (p. 380). It is this focus on who people are in relation to others that is consistent with a psychodynamic understanding of virtue development (Akhtar, 2019; Summers & Barber, 2010), and frames our current study.Recent psychotherapy research suggests the importance of dual-factor models that attend to both mental health symptoms

show abstract

Section: Link S B E T Ween H Umilit Y and Affec T Reg Ul Ationmentioning

confidence: 99%

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

Jankowski

Captari

Sandage

2021

Couns and Psychother Res

View full text Add to dashboard Cite

show abstract

“…In single case experimental design studies, experiential avoidance did not exhibit substantial changes following treatment (Boswell et al, 2014;Brake et al, 2016) and did not predict or proceed changes in anxiety or depression in an individual with comorbid depression and generalized anxiety (Boswell et al, 2014). In a larger RCT, Eustis et al (2019) investigated the mediating effect of experiential avoidance across the UP and single-disorder treatment protocols for mixed anxiety disorders. In contrast to these single case studies, experiential avoidance mediated and preceded changes across the UP and single-disorder protocols, suggesting that experiential avoidance is a general transdiagnostic mechanism in CBT (Eustis et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Transdiagnostic Processes as Mediators of Change in an Internet-Delivered Intervention Based on the Unified Protocol

Schaeuffele

Buengener

et al. 2021

Cogn Ther Res

View full text Add to dashboard Cite

Background Transdiagnostic treatments target shared mechanisms between disorders to facilitate change across diagnoses. The Unified Protocol (UP) aims at changing dysfunctional reactions towards emotions by increasing mindful emotion awareness and cognitive flexibility, as well as decreasing anxiety sensitivity and emotion avoidance. Method We investigated whether these transdiagnostic processes were malleable by treatment and mediated the relationship between treatment and outcome in an internet-delivered adaptation of the UP. N = 129 participants with mixed anxiety, depressive, and somatic symptom disorders were randomized to treatment or waitlist. Results The treatment yielded significant changes in all transdiagnostic processes over time in comparison to a waitlist condition. In separate mediator models, significant mediating effects were found for mindfulness, cognitive flexibility, behavioral activation, and experiential avoidance. When all mediators were combined in a multiple mediator model, the indirect effects through mindfulness and cognitive flexibility emerged as significant. Conclusion These findings add to the growing body of research on transdiagnostic processes as mediators of change and emphasize mindfulness and cognitive flexibility as a transdiagnostic treatment target. However, these results should be interpreted cautiously, as temporal precedence could not be established.

show abstract

“…Aversive reactions may take many forms, including experiential avoidance, emotional suppression, worry, rumination, or distraction -any behavior used to escape or distract from one's emotions. Recent evidence suggests that reductions in certain forms of aversive reactions (e.g., experiential avoidance, anxiety sensitivity) precede and predict reductions in anxiety symptoms in CBT [ (20)(21)(22)(23)(24)(25); cf. (26)].…”

Section: Evaluating Mechanisms Of Action Using Smartsmentioning

confidence: 99%

“…To measure aversive reactivity, participants in our SMART are completing the Distress Aversion subscale of the Multidimensional Experiential Avoidance Questionnaire [MEAQ-DA; (27)] before every weekly therapy session. The MEAQ-DA is a 13-item self-report measure designed to assess negative evaluations of and attitudes toward distress that has demonstrated good internal consistency across clinical samples (23,27). The MEAQ-DA is sensitive to change in response to CBT for anxiety disorders [d = 0.82; (23)] and scores can range from 13-78.…”

Section: Evaluating Mechanisms Of Action Using Smartsmentioning

confidence: 99%

“…The MEAQ-DA is a 13-item self-report measure designed to assess negative evaluations of and attitudes toward distress that has demonstrated good internal consistency across clinical samples (23,27). The MEAQ-DA is sensitive to change in response to CBT for anxiety disorders [d = 0.82; (23)] and scores can range from 13-78.…”

Section: Evaluating Mechanisms Of Action Using Smartsmentioning

confidence: 99%

See 1 more Smart Citation

Experimental Manipulations to Test Theory-Driven Mechanisms of Cognitive Behavior Therapy

Southward

Sauer‐Zavala

2020

Front. Psychiatry

Self Cite

View full text Add to dashboard Cite

Despite decades of randomized-controlled trials demonstrating the efficacy of cognitive-behavior therapy (CBT), the mechanisms by which CBT achieves its effects remain unclear. Here, we describe how one adaptive intervention, the sequential multiple assignment randomized trial (SMART), can be used to randomize patients at multiple decision points in treatment to draw stronger causal claims about mechanisms unfolding in the course of CBT. We illustrate this design using preliminary data and case examples from an ongoing SMART in which we are testing the role of aversive reactions to negative emotions as a hypothesized mechanism of change in the Unified Protocol. Finally, we address common concerns with SMARTs and highlight how mechanistic research serves to personalize and optimize the delivery of CBT.

show abstract

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

Abstract: OpenBU http://open.bu.edu Psychological and Brain Sciences BU Open Access Articles 2020-04 Experiential avoidance as a mechanism of change across cognitive-behavioral therapy i...

Cited by 48 publications

References 49 publications

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

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

Transdiagnostic Processes as Mediators of Change in an Internet-Delivered Intervention Based on the Unified Protocol

Experimental Manipulations to Test Theory-Driven Mechanisms of Cognitive Behavior Therapy

Contact Info

Product

Resources

About