Experiential avoidance

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Experiential avoidance (EA) has been broadly defined as attempts to avoid thoughts, feelings, memories, physical sensations, and other internal experiences — even when doing so creates harm in the long run. [1] The process of EA is thought to be maintained through negative reinforcement — that is, short-term relief of discomfort is achieved through avoidance, thereby increasing the likelihood that the avoidance behavior will persist. Importantly, the current conceptualization of EA suggests that it is not negative thoughts, emotions, and sensations that are problematic, but how one responds to them that can cause difficulties. In particular, a habitual and persistent unwillingness to experience uncomfortable thoughts and feelings (and the associated avoidance and inhibition of these experiences) is thought to be linked to a wide range of problems, as opposed to deliberately choosing discomfort, which only results in discomfort. [2] [3] [4]

Contents

Background

EA has been popularized by recent third-wave cognitive-behavioral theories such as acceptance and commitment therapy (ACT). However, the general concept has roots in many other theories of psychopathology and intervention.

Psychodynamic

Defense mechanisms were originally conceptualized as ways to avoid unpleasant affect and discomfort that resulted from conflicting motivations. [5] These processes were thought to contribute to the expression of various types of psychopathology. Gradual removal of these defensive processes are thought to be a key aspect of treatment and eventually return to psychological health. [6]

Process-experiential

Process-experiential therapy merges client-centered, existential, and Gestalt approaches. [7] Gestalt theory outlines the benefits of being fully aware of and open to one's entire experience. One job of the psychotherapist is to "explore and become fully aware of [the patient's] grounds for avoidance" and to "[lead] the patient back to that which he wishes to avoid" (p. 142). [8] Similar ideas are expressed by early humanistic theory: "Whether the stimulus was the impact of a configuration of form, color, or sound in the environment on the sensory nerves, or a memory trace from the past, or a visceral sensation of fear or pleasure or disgust, the person would be 'living' it, would have it completely available to awareness…he is more open to his feelings of fear and discouragement and pain...he is more able fully to live the experiences of his organism rather than shutting them out of awareness." [9]

Behavioral

Traditional behavior therapy utilizes exposure to habituate the patient to various types of fears and anxieties, [10] [11] eventually resulting in a marked reduction in psychopathology. In this way, exposure can be thought of as "counter-acting" avoidance, in that it involves individuals repeatedly encountering and remaining in contact with that which causes distress and discomfort. [12]

Cognitive

In cognitive theory, avoidance interferes with reappraisals of negative thought patterns and schema, thereby perpetuating distorted beliefs. [13] These distorted beliefs are thought to contribute and maintain many types of psychopathology. [14]

Third-wave cognitive-behavioral

The concept of EA is explicitly described and targeted in more recent CBT modalities including acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), functional analytic psychotherapy (FAP), and behavioral activation (BA).

Associated problems

Empirical evidence

Relevance to psychopathology

Seemingly disparate forms of pathological behavior can be understood by their common function (i.e., attempts to avoid distress). Some examples include:

DiagnosisExample BehaviorsTarget of Avoidance
Major depressive disorder Isolation/suicideFeelings of sadness, guilt, low self-worth
Posttraumatic stress disorder Avoiding trauma reminders, hypervigilanceMemories, anxiety, concerns of safety
Social phobia Avoiding social situationsAnxiety, concerns of judgment from others
Panic disorder Avoiding situations that might induce panicFear, physiological sensations
Agoraphobia Restricting travel outside of home or other "safe areas"Anxiety, fear of having symptoms of panic
Obsessive-compulsive disorder Checking/ritualsWorry of consequences (e.g., "contamination")
Substance use disorders Abusing alcohol/drugsEmotions, memories, withdrawal symptoms
Eating disorders Restricting food intake, purgingWorry about becoming "overweight", fear of losing control
Borderline personality disorder Self-harm (e.g., cutting)High emotional arousal

Relevance to quality of life

Perhaps the most significant impact of EA is its potential to disrupt and interfere with important, valued aspects of an individual's life. [1] That is, EA is seen as particularly problematic when it occurs at the expense of a person's deeply held values. Some examples include:

Measurement

Self-report

The Acceptance and Action Questionnaire (AAQ) [23] was the first self-report measure explicitly designed to measure EA, but has since been re-conceptualized as a measure of "psychological flexibility". [24] The 62-item Multidimensional Experiential Avoidance Questionnaire (MEAQ) [25] was developed to measure different aspects of EA. The Brief Experiential Avoidance Questionnaire (BEAQ) is a 15-item measure developed using MEAQ items, which has become the most widely used measure of experiential avoidance. [26]

See also

Opposite concepts

Notes

  1. 1 2 Hayes, Steven C.; Strosahl, Kirk D.; Wilson, Kelly G. (1999). Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. New York: Guilford Press. ISBN   1572304812.[ page needed ]
  2. ↑ Hayes, Steven C.; Wilson, Kelly G.; Gifford, Elizabeth V.; Follette, Victoria M.; Strosahl, Kirk (1996). "Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment". Journal of Consulting and Clinical Psychology. 64 (6): 1152–68. CiteSeerX   10.1.1.597.5521 . doi:10.1037/0022-006X.64.6.1152. PMID   8991302.
  3. ↑ Losada, Andrés; Márquez-González, María; Romero-Moreno, Rosa; López, Javier (2014-10-03). "Development and validation of the Experiential Avoidance in Caregiving Questionnaire (EACQ)". Aging & Mental Health. 18 (7): 897–904. doi:10.1080/13607863.2014.896868. ISSN   1360-7863. PMID   24678984.
  4. ↑ Chawla, Neharika; Ostafin, Brian (2007-08-02). "Experiential avoidance as a functional dimensional approach to psychopathology: An empirical review". Journal of Clinical Psychology. 63 (9): 871–890. doi:10.1002/jclp.20400. ISSN   0021-9762. PMID   17674402.
  5. ↑ Freud, A. (1966). The Ego and the Mechanisms of Defense . New York: International Universities Press.[ page needed ]
  6. ↑ Karon, B. P.; Widener, A. J. (1995). Bongar, B.; Beutler, L. E. (eds.). Comprehensive Textbook of Psychotherapy. New York: Oxford University Press. pp. 24–47.
  7. ↑ Greenberg, Leslie S.; Watson, Jeanne C.; Lietaer, Germain (1998). Handbook of Experiential Psychotherapy. Guilford Press. pp. 6–. ISBN   978-1-57230-374-4 . Retrieved 15 September 2013.
  8. ↑ Perls, F. S.; Hefferline, R. F.; Goodman, P. (1951). Gestalt Therapy: Excitement and Growth in the Human Personality. New York: Julian Press.[ page needed ]
  9. ↑ Rogers, C. R. (1961). On Becoming a Person: A Therapist's View of Psychotherapy. Houghton Boston: Mifflin Company. p. 188.
  10. 1 2 Barlow, David H. (1988). Anxiety and its Disorders. New York: Guilford Press. ISBN   0898627206.[ page needed ]
  11. ↑ Craighead, W. E.; Craighead, L. W.; Ilardi, S. S. (1995). "Behavior therapies in historical perspective". In Bongar, B.; Beutler, L. E. (eds.). Comprehensive Textbook of Psychotherapy. New York: Oxford University Press. pp. 64–83.
  12. ↑ Baum, Morrie (1970). "Extinction of avoidance responding through response prevention (flooding)". Psychological Bulletin. 74 (4): 276–84. doi:10.1037/h0029789. PMID   5479591.
  13. ↑ Clark, D. M. (1988). "A cognitive model of panic". In Rachman, S.; Maser, J. (eds.). Panic: Psychological Perspectives. Hillsdale: Erlbaum.[ page needed ]
  14. ↑ Beck, Aaron T. (1976). Cognitive Therapy and the Emotional Disorders. Madison, CT: International Universities Press. ISBN   0823609901.[ page needed ]
  15. ↑ Wegner, Daniel M.; Schneider, David J.; Carter, Samuel R.; White, Teri L. (1987). "Paradoxical effects of thought suppression". Journal of Personality and Social Psychology. 53 (1): 5–13. doi:10.1037/0022-3514.53.1.5. PMID   3612492.
  16. ↑ Gross, James J.; Levenson, Robert W. (1997). "Hiding feelings: The acute effects of inhibiting negative and positive emotion". Journal of Abnormal Psychology. 106 (1): 95–103. doi:10.1037/0021-843X.106.1.95. PMID   9103721.
  17. ↑ Cioffi, Delia; Holloway, James (1993). "Delayed costs of suppressed pain". Journal of Personality and Social Psychology. 64 (2): 274–82. doi:10.1037/0022-3514.64.2.274. PMID   8433273.
  18. ↑ Hughes, Cheryl F.; Uhlmann, Carmen; Pennebaker, James W. (1994). "The Body's Response to Processing Emotional Trauma: Linking Verbal Text with Autonomic Activity". Journal of Personality. 62 (4): 565–85. doi:10.1111/j.1467-6494.1994.tb00309.x. PMID   7861305.
  19. ↑ Abramowitz, Jonathan S.; Lackey, Gerald R.; Wheaton, Michael G. (2009). "Obsessive–compulsive symptoms: The contribution of obsessional beliefs and experiential avoidance". Journal of Anxiety Disorders. 23 (2): 160–6. doi:10.1016/j.janxdis.2008.06.003. PMID   18657382.
  20. ↑ Forsyth, John P.; Parker, Jefferson D.; Finlay, Carlos G. (2003). "Anxiety sensitivity, controllability, and experiential avoidance and their relation to drug of choice and addiction severity in a residential sample of substance-abusing veterans". Addictive Behaviors. 28 (5): 851–70. doi:10.1016/S0306-4603(02)00216-2. PMID   12788261.
  21. ↑ MMarx, Brian P.; Sloan, Denise M. (2005). "Peritraumatic dissociation and experiential avoidance as predictors of posttraumatic stress symptomatology". Behaviour Research and Therapy. 43 (5): 569–83. doi:10.1016/j.brat.2004.04.004. PMID   15865913.
  22. ↑ Gratz, Kim L.; Rosenthal, M. Zachary; Tull, Matthew T.; Lejuez, C. W.; Gunderson, John G. (2006). "An experimental investigation of emotion dysregulation in borderline personality disorder". Journal of Abnormal Psychology. 115 (4): 850–5. doi:10.1037/0021-843X.115.4.850. PMID   17100543.
  23. ↑ Hayes, Steven C.; Strosahl, Kirk; Wilson, Kelly G.; Bissett, Richard T.; Pistorello, Jacqueline; Toarmino, Dosheen; Polusny, Melissa A.; Dykstra, Thane A.; Batten, Sonja V. (2004). "Measuring Experiential Avoidance: A Preliminary Test of a Working Model". The Psychological Record. 54 (4): 553–78. doi:10.1007/BF03395492.
  24. ↑ Hayes, Steven (December 27, 2009). "Acceptance and Action Questionnaire (AAQ) and Variations". Association for Contextual Behavioral Science. Retrieved November 12, 2012.
  25. ↑ Gámez, Wakiza; Chmielewski, Michael; Kotov, Roman; Ruggero, Camilo; Watson, David (2011). "Development of a measure of experiential avoidance: The Multidimensional Experiential Avoidance Questionnaire". Psychological Assessment. 23 (3): 692–713. doi:10.1037/a0023242. PMID   21534697.
  26. ↑ Gámez, Wakiza; Chmielewski, Michael; Kotov, Roman; Ruggero, Camilo; Suzuki, Nadia; Watson, David (March 2014). "The Brief Experiential Avoidance Questionnaire: Development and initial validation". Psychological Assessment. 26 (1): 35–45. doi:10.1037/a0034473. ISSN   1939-134X. PMID   24059474.

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References

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