Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-22T15:16:25.626Z Has data issue: false hasContentIssue false
  • English
  • Français

The Relative Contributions of Experiential Avoidance and Distress Tolerance to OC Symptoms

Published online by Cambridge University Press:  07 December 2015

Shannon M. Blakey ,
Ryan J. Jacoby ,
Lillian Reuman  and
Jonathan S. Abramowitz
Shannon M. Blakey
Affiliation:
University of North Carolina at Chapel Hill, USA
Ryan J. Jacoby
Affiliation:
University of North Carolina at Chapel Hill, USA
Lillian Reuman
Affiliation:
University of North Carolina at Chapel Hill, USA
Jonathan S. Abramowitz*
Affiliation:
University of North Carolina at Chapel Hill, USA
*
Reprint requests to Jonathan Abramowitz, University of North Carolina at Chapel Hill, C.B. # 3270 (Davie Hall), Chapel Hill, NC 27599, USA. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Obsessive beliefs account for substantial (but not all) obsessive-compulsive (OC) symptoms. Intolerance of internal experiences (IIE), which encompasses the constructs of experiential avoidance (EA) and distress tolerance (DT), refers to difficulty managing unwanted thoughts, emotions, and other internal states, and might add to current explanatory models. Although IIE appears to be conceptually relevant to obsessive-compulsive (OC) symptoms, scant research has examined this relationship empirically. Aim: The present study examined the relative contributions of EA and DT as predictors of OC symptom dimensions. Method: A nonclinical sample (n = 496) completed self-report questionnaires measuring general distress, EA, DT and OC symptom dimensions. Results: All variables of interest were significantly (all ps ≤ .001) correlated with one another, such that higher general distress, higher EA, and lower DT were associated with greater OC symptom severity for all symptom dimensions; however, only EA independently predicted obsessional symptoms, but not other OC symptom dimensions. Conclusions: One's willingness to endure (i.e. EA), rather than their ability to tolerate (i.e. DT) unpleasant internal experiences best predicts obsessional symptoms (i.e. obsessing) above and beyond general distress. Potential implications for understanding, assessing, and treating OC symptoms are discussed.

Keywords

Obsessive-compulsive disorderobsessionsexperiential avoidancedistress tolerance
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 44 , Issue 4 , July 2016 , pp. 460 - 471
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abramowitz, J. S. and Arch, J. J. (2014). Strategies for improving long-term outcomes in cognitive behavioral therapy for obsessive-compulsive disorder: insights from learning theory. Cognitive and Behavioral Practice, 21, 20–31. http://doi.org/10.1016/j.cbpra.2013.06.004 Google Scholar
Abramowitz, J. S., Fabricant, L. E., Taylor, S., Deacon, B. J., McKay, D. and Storch, E. A. (2014). The relevance of analogue studies for understanding obsessions and compulsions. Clinical Psychology Review, 34, 206–217. doi: 10.1016/j.cpr.2014.01.004 Google Scholar
Abramowitz, J. S., Lackey, G. R. and Wheaton, M. G. (2009). Obsessive-compulsive symptoms: the contribution of obsessional beliefs and experiential avoidance. Journal of Anxiety Disorders, 23, 160–166. doi:10.1016/j.janxdis.2008.06.003 Google Scholar
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: Author.Google Scholar
Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W. and Swinson, R. P. (1998). Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychological Assessment, 10, 176–181.CrossRefGoogle Scholar
Bernstein, A., Zvolensky, M. J., Vujanovic, A. A. and Moos, R. (2009). Integrating anxiety sensitivity, distress tolerance, and discomfort intolerance: a hierarchical model of affect sensitivity and tolerance. Behavior Therapy, 40, 291–301. doi:10.1016/j.beth.2008.08.001 Google Scholar
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., et al. (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 Google Scholar
Briggs, E. S. and Price, I. R. (2009). The relationship between adverse childhood experience and obsessive-compulsive symptoms and beliefs: the role of anxiety, depression, and experiential avoidance. Journal of Anxiety Disorders, 23, 1037–1046. doi:10.1016/j.janxdis.2009.07.004 CrossRefGoogle ScholarPubMed
Chawla, N. and Ostafin, B. (2007). Experiential avoidance as a functional dimensional approach to psychopathology: an empirical review. Journal of Clinical Psychology, 63, 871–890. doi:10.1002/jclp.20400 Google Scholar
Cougle, J. R., Timpano, K. R., Fitch, K. E. and Hawkins, K. A. (2011). Distress tolerance and obsessions: an integrative analysis. Depression and Anxiety, 28, 906–914. doi:10.1002/da.20846 Google Scholar
Cougle, J. R., Timpano, K. R. and Goetz, A. R. (2012). Exploring the unique and interactive roles of distress tolerance and negative urgency in obsessions. Personality and Individual Differences, 52, 515–520. doi:10.1016/j.paid.2011.11.017 CrossRefGoogle Scholar
Foa, E. B., Huppert, J. D., Leiberg, S., Langer, R., Kichic, R., Hajcak, G., et al. (2002). The Obsessive-Compulsive Inventory: development and validation of a short version. Psychological Assessment, 14, 485–496. doi:10.1037/1040-3590.14.4.485 CrossRefGoogle ScholarPubMed
Forsyth, J. P., Eifert, G. H. and Barrios, V. (2006). Fear conditioning in an emotion regulation context: a fresh perspective on the origins of anxiety disorders. In Craske, M. G., Hermans, D. and Vansteenwegen, D. (Eds.), Fear and Learning: from basic processes to clinical implications (pp. 133–153). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A. and Lillis, J. (2006). Acceptance and commitment therapy: model, processes and outcomes. Behaviour Research and Therapy, 44, 1–25.CrossRefGoogle ScholarPubMed
Hayes, S. C., Strosahl, K. D. and Wilson, K. G. (1999). Acceptance and Commitment Therapy: an experiential approach to behavior change. New York: Guilford Press.Google Scholar
Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M. and Strosahl, K. (1996). Experiential 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 Google Scholar
Henry, J. D. and Crawford, J. R. (2005). The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. British Journal of Clinical Psychology, 44, 227–239.Google Scholar
Hezel, D. M., Riemann, B. C. and McNally, R. J. (2012). Emotional distress and pain tolerance in obsessive-compulsive disorder. Journal of Behavior Therapy and Experimental Psychiatry, 43, 981–987. doi:10.1016/j.jbtep.2012.03.005 Google Scholar
Keough, M. E., Riccardi, C. J., Timpano, K. R., Mitchell, M. A. and Schmidt, N. B. (2010). Anxiety symptomatology: the association with distress tolerance and anxiety sensitivity. Behavior Therapy, 41, 567–574. doi:10.1016/j.beth.2010.04.002 Google Scholar
Kline, R. B. (2005). Principles and Practices of Structural Equation Modeling (2nd edition). New York: Guilford Press.Google Scholar
Lee, H. J. and Kwon, S. M. (2003). Two different types of obsession: autogenous obsessions and reactive obsessions. Behaviour Research and Therapy, 41, 11–29. doi:10.1016/S0005-7967(01)00101-2 CrossRefGoogle ScholarPubMed
Leyro, T. M., Zvolensky, M. J. and Bernstein, A. (2010). Distress tolerance and psychopathological symptoms and disorders: a review of the empirical literature among adults. Psychological Bulletin, 136, 576–600. doi:10.1037/a0019712 Google Scholar
Lovibond, S. H. and Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scales (2nd ed.) Sydney: Psychology Foundation.Google Scholar
Macatee, R. J., Capron, D. W., Schmidt, N. B. and Cougle, J. R. (2013). An examination of low distress tolerance and life stressors as factors underlying obsessions. Journal of Psychiatric Research, 47, 1462–1468. doi:10.1016/j.jpsychires.2013.06.019 Google Scholar
MacKenzie, M. B. and Kocovski, N. L. (2010). Self-reported acceptance of social anxiety symptoms: development and validation of the Social Anxiety – Acceptance and Action Questionnaire. International Journal of Behavioral Consultation and Therapy, 6, 214–232.CrossRefGoogle Scholar
Manos, R. C., Cahill, S. P., Wetterneck, C. T., Conelea, C. A., Ross, A. R. and Riemann, B. C. (2010). The impact of experiential avoidance and obsessive beliefs on obsessive-compulsive symptoms in a severe clinical sample. Journal of Anxiety Disorders, 24, 700–708. doi:10.1016/j.janxdis.2010.05.001 Google Scholar
Obsessive Compulsive Cognitions Working Group (OCCWG) (1997). Cognitive assessment of obsessive-compulsive disorder. Behaviour Research and Therapy, 35, 667–681. doi:10.1016/S0005-7967(97)00017-X Google Scholar
Obsessive Compulsive Cognitions Working Group (OCCWG) (2001). Development and initial validation of the Obsessive Beliefs Questionnaire and the interpretation of intrusions inventory. Behaviour Research and Therapy, 39, 987–1006. doi:10.1016/S0005-7967(00)00085-1 CrossRefGoogle Scholar
Obsessive Compulsive Cognitions Working Group (OCCWG) (2003). Psychometric validation of the Obsessive Beliefs Questionnaire and the Interpretation of Intrusions Inventory: Part I. Behaviour Research and Therapy, 41, 863. doi:10.1016/S0005-7967(02)00099-2 Google Scholar
Obsessive Compulsive Cognitions Group Working (OCCWG) (2005). Psychometric validation of the Obsessive Belief Questionnaire and Interpretation of Intrusions Inventory. Part 2. Factor analyses and testing of a brief version. Behaviour Research and Therapy, 43, 1527–1542. doi:10.1016/j.brat.2004.07.010 Google Scholar
Page, A. C. Hooke, G. R. and Morrison, D. L. (2007). Psychometric properties of the Depression Anxiety Stress Scales (DASS) in depressed clinical samples. British Journal of Clinical Psychology, 46, 283–297.Google Scholar
Rachman, S. J. and de Silva, P. (1978). Abnormal and normal obsessions. Behaviour Research and Therapy, 16, 233–248. doi:10.1016/0005-7967(78)90022-0 Google Scholar
Ricciardi, J. N. and McNally, R. J. (1995). Depressed mood is related to obsessions, but not to compulsions, in obsessive-compulsive disorder. Journal of Anxiety Disorders, 9, 249–256. doi:10.1016/0887-6185(95)00006-A Google Scholar
Robinson, L. J. and Freeston, M. H. (2014). Emotion and internal experience in Obsessive Compulsive Disorder: reviewing the role of alexithymia, anxiety sensitivity and distress tolerance. Clinical Psychology Review, 34, 256–271. doi:10.1016/j.cpr.2014.03.003 Google Scholar
Salkovskis, P. M. (1999). Understanding and treating obsessive-compulsive disorder. Behaviour Research and Therapy, 37 (Suppl 1), S29–S52. doi:10.1016/S0005-7967(99)00049-2 Google Scholar
Salkovskis, P. M. and Harrison, J. (1984). Abnormal and normal obsessions: a replication. Behaviour Research and Therapy, 22, 549–552. doi:10.1016/0005-7967(84)90057-3 Google Scholar
Simons, J. S. and Gaher, R. M. (2005). The Distress Tolerance Scale: development and validation of a self-report measure. Motivation and Emotion, 29, 83–102. doi:10.1007/s11031-005-7955-3 Google Scholar
Teasdale, J. D. (1974). Learning models of obsessive-compulsive disorder. In Beech, H. R. (Ed.), Obsessional States. London: Methuen.Google Scholar
Twohig, M. (2009). The application of Acceptance and Commitment Therapy to obsessive-compulsive disorder. Cognitive and Behavioral Practice, 16, 18–28. doi: 10.1016/j.cbpra. 2008.02.008.Google Scholar
Twohig, M. P., Abramowitz, J. S., Bluett, E. J., Fabricant, L. E., Jacoby, R. J., Morrison, K. L., et al. (in press). Exposure therapy for OCD from an acceptance and commitment therapy framework. Journal of Obsessive-Compulsive and Related Disorders. doi:10.1016/j.jocrd.2014.12.007 Google Scholar
Twohig, M. P., Hayes, S. C. and Masuda, A. (2006). Increasing willingness to experience obsessions: acceptance and commitment therapy as a treatment for obsessive compulsive disorder. Behavior Therapy, 37, 3–13. doi:10.1016/j.beth.2005.02.001 Google Scholar
Wetterneck, C. T., Steinberg, D. S. and Hart, J. (2014). Experiential avoidance in symptom dimensions of OCD. Bulletin of the Menninger Clinic, 78, 253–269. doi:10.1521/bumc.2014.78.3.253 Google Scholar
Wolgast, M. (2014). What does the Acceptance and Action Questionnaire (AAQ-II) really measure? Behavior Therapy, 45, 831–839. doi:10.1016/j.beth.2014.07.002 Google Scholar
Wu, K. D. and Carter, S. A. (2008). Further investigation of the Obsessive Beliefs Questionnaire: factor structure and specificity of relations with OCD symptoms. Journal of Anxiety Disorders, 22, 824–836. doi:10.1016/j.janxdis.2007.08.008 Google Scholar
Submit a response

Comments

No Comments have been published for this article.