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Relationships among Stress, Experiential Avoidance and Depression in Psychiatric Patients

Published online by Cambridge University Press:  23 May 2016

Beatriz Rueda*
Affiliation:
UNED (Spain)
Esperanza Valls
Affiliation:
Actur Sur Centro de Salud Mental (Spain)
*
*Correspondence concerning this article should be addressed to Beatriz Rueda. UNED - Personality Psychology. Assessment and Psychological Treatment. Madrid (Spain). E-mail: [email protected]

Abstract

This study investigated the specific association of stressful life events (SLE) and experiential avoidance (EA) with depression in patients with mental disorders. It also analyzed the possible mediating role of depression in the relation of EA to well-being and life satisfaction. A total of 147 patients (mean age = 40.16 years) diagnosed with anxiety, mood or adjustment disorder were recruited from a mental health centre. They completed measures of SLE, EA, depression, well-being and life satisfaction. Regression analyses showed that SLE and EA were positively related to depression (R2 = .45), although the contribution made by EA was higher (β = .61, p < .001) than the one made by SLE (β = .19, p < .01). Bootstrap mediation analyses revealed that there was an indirect effect from EA to physical well-being (B = –4.52, SE = .70, p < .001, 95% CI [–6.03, –3.20]) and satisfaction (B = –.14, SE = .02, p < .001, 95%, CI [–.19 –.09]) through depression. This indirect effect was less consistently supported with respect to emotional well-being (B = –3.33, SE = .48, p < .001, 95%, CI [–4.30, –2.41]). These findings give support to the hypothesis that EA could be an important factor contributing to depression in patients with mental disorders. The results also provide evidence that depression seems to play an important mediational role when considering the negative impact that EA exerts on patients´ well-being and satisfaction.

Type
Research Article
Copyright
Copyright © Universidad Complutense de Madrid and Colegio Oficial de Psicólogos de Madrid 2016 

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References

Alonso, J., Prieto, L., & Anto, J. M. (1995). La versión española del SF-36 Health Survey (Cuestionario de Salud SF-36): Un instrumento para la medida de los resultados clínicos [The Spanish version of the SF-36 Health Survey (the SF-36 health questionnaire): An instrument for measuring clinical results]. Medicina Clínica, 104, 771776.Google Scholar
Anders, S. L., Frazier, P. A., & Shallcross, S. L. (2012). Prevalence and effects of life event exposure among undergraduate and community college students. Journal of Counseling Psychology 59, 449457. http://dx.doi.org/10.1037/a0027753 Google Scholar
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561571. http://dx.doi.org/10.1001/archpsyc.1961.01710120031004 Google Scholar
Bjornsson, A., Carey, G., Hauser, M., Karris, A., Kaufmann, V., & Sheets, E. (2010). The effects of experiential avoidance and rumination on depression among college students. International Journal of Cognitive Therapy, 3, 389401. http://dx.doi.org/10.1521/ijct.2010.3.4.389 Google Scholar
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 flexibility and acceptance. Behaviour Therapy, 42, 676688.Google Scholar
Cabañero, M. J., Richart, M., Cabrero, J., Orts, M. I., Reig, A., & Tosal, B. (2004). Fiabilidad y validez de la Escala de Satisfacción Vital de Diener en una muestra de mujeres embarazadas y puérperas [Reliability and validity of the Satisfaction with Life Scale of Diener in pregnant and puerperium women]. Psicothema, 16, 448455.Google Scholar
Campbell-Sills, L., Barlow, D. H., Brown, T. A., & Hofmann, S. G. (2006). Effects of suppression and acceptance on emotional suppression of individuals with anxiety and mood disorders. Behaviour Research and Therapy, 44, 12511263. http://dx.doi.org/10.1016/j.brat.2005.10.001 Google Scholar
Conde, V., & Useros, E. (1975). Adaptación castellana de la Escala de Evaluación Conductual para la Depresión de Beck [Spanish adaptation of Beck’s Depression Inventory]. Revista de Psiquiatría y Psicología Médica de Europa y América Latina, 12, 217236.Google Scholar
Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The Satisfaction with Life Scale. Journal of Personality Assessment, 49, 7175. http://dx.doi.org/10.1207/s15327752jpa4901_13 Google Scholar
Eaton, W. W., Regier, D. A., Locke, B. Z., & Taube, C. A. (1981). The epidemiologic catchment area program of the National Institute of Mental Health. Public Health Reports, 96, 319325.Google Scholar
Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64, 11521168. http://dx.doi.org/10.1037/0022-006X.64.6.1152 Google Scholar
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes, and outcomes. Behaviour Research and Therapy, 44, 125. http://dx.doi.org/10.1016/j.brat.2005.06.006 Google Scholar
Hofmann, S. G., Heering, S., Sawyer, A. T., & Asnaani, A. (2009). How to handle anxiety: The effects of reappraisal, acceptance, and suppression strategies on anxious arousal. Behaviour Research and Therapy, 47, 399–394. http://dx.doi.org/10.1016/j.brat.2009.02.010 Google Scholar
Holmes, T. H., & Rahe, R. H. (1967). The Social Readjustment Rating Scale. Journal of Psychosomatic Research, 11, 213218. http://dx.doi.org/10.1016/0022-3999(67)90010-4 Google Scholar
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. Behavior Research and Therapy, 44, 13011320. http://dx.doi.org/10.1016/j.brat.2005.10.003 Google Scholar
Kashdan, T. B., Morina, N., & Priebe, S. (2009). Post-traumatic stress disorder, social anxiety disorder, and depression in survivors of the Kosovo War: Experiential avoidance as a contributor to distress and quality of life. Journal of Anxiety Disorders, 23, 185196. http://dx.doi.org/10.1016/j.janxdis.2008.06.006 Google Scholar
Kashdan, T. B., Ferssizidis, P., Collins, R. L., & Muraven, M. (2010). Emotion differentiation as resilience against excessive alcohol use: An ecological momentary assessment in underage social drinkers. Psychological Science, 21, 13411347. http://dx.doi.org/10.1177/0956797610379863 Google Scholar
Keyes, C. L. M. (2007). Promoting and protecting mental health as flourishing: A complementary strategy for improving national mental health. American Psychologist, 62, 95108. http://dx.doi.org/10.1037/0003-066X.62.2.95 Google Scholar
Kohl, A., Rief, W., & Glombiewski, J. A. (2012). How effective are acceptance strategies? A meta-analytic review of experimental results. Journal of Behavior Therapy and Experimental Psychiatry, 43, 9881001. http://dx.doi.org/10.1016/j.jbtep.2012.03.004 Google Scholar
Linehan, M. M. (2003) Manual de tratamiento de los trastornos de personalidad límite [Skills training manual for treating borderline personality disorder]. Barcelona, Spain: Paidós Ibérica.Google Scholar
Mitmansgruber, H., Beck, T. N., & Schüβler, G. (2008). “Mindful helpers”: Experiential avoidance, meta-emotions, and emotion regulation in paramedics. Journal of Research in Personality, 42, 13581363.Google Scholar
Monroe, S. M., Torres, L. D., Guillaumot, J., Harkness, K., Roberts, J., Frank, E., … Kupfer, D. (2006). Life stress and the long-term treatment course of recurrent depression. Non-severe life events predict recurrence for medicated patients over 3 years. Journal of Consulting and Clinical Psychology, 74, 112120.Google Scholar
Muscatell, K. A., Slavich, G. M., Monroe, S. M., & Gotlib, I. H. (2009). Stressful life events, chronic difficulties and symptoms of clinical depression. Journal of Nervous & Mental Disease 197, 154160. http://dx.doi.org/10.1097/NMD.0b013e318199f77b Google Scholar
Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Method, 40, 879891. http://dx.doi.org/10.3758/BRM.40.3.879 Google Scholar
Ruiz, F. J., Langer Herrera, A. I., Luciano, C., Cangas, A. J., & Beltrán, I. (2013). Measuring experiential avoidance and psychological inflexibility: The Spanish version of the Acceptance and Action Questionnaire-II. Psicothema, 25, 123129. http://dx.doi.org/10.7334/psicothema2011.239 Google Scholar
Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2006). Terapia cognitiva de la depresión basada en la consciencia plena. Un nuevo abordaje para la prevención de recaídas [Mindfulness based cognitive therapy for depression: A new approach to preventing relapse]. Bilbao, Spain: Descleé de Brouwer.Google Scholar
Shallcross, A. J., Troy, A. S., Boland, M., & Mauss, I. B. (2010). Let it be: Accepting negative emotional experiences predicts decreased negative affect and depressive symptoms. Behavior Research and Therapy 48, 921929. http://dx.doi.org/10.1016/j.brat.2010.05.025 Google Scholar
Shrout, P. E., & Bolger, N. (2002). Mediation in experimental and nonexperimental studies: New procedures and recommendations. Psychological Methods, 7, 422445. http://dx.doi.org/10.1037//1082-989x.7.4.422 Google Scholar
Singer, A. R., & Dobson, K. S. (2007). An experimental investigation of the cognitive vulnerability to depression. Behaviour Research Therapy, 45, 563575. http://dx.doi.org/10.1016/j.brat.2006.05.007 Google Scholar
Spinhoven, P., Elzinga, B. M., Hovens, J. G. F. M., Roelofs, K., van Oppen, P., Zitman, F. G., … Penninx, B. W. J. H. (2011). Positive and negative life events and personality traits in predicting course of depression and anxiety. Acta Psychiatrica Scandinavica, 124, 462473. http://dx.doi.org/10.1111/j.1600-0447.2011.01753.x Google Scholar
Tao, M., Li, Y., Xie, D., Wang, Z., Qiu, J., Wu, W., ... Gao, J. (2011). Examining the relationship between lifetime stressful life events and the onset of major depression in Chinese women. Journal of Affective Disorders, 135, 9599. http://dx.doi.org/10.1016/j.jad.2011.06.054 Google Scholar
Trew, J. L. (2011). Exploring the roles of approach and avoidance in depression: An integrative model. Clinical Psychology Review, 31, 11561168. http://dx.doi.org/10.1016/j.cpr.2011.07.007 Google Scholar
Ware, J. E. Jr., Snow, K. K., Kosinski, M., & Gandek, B. (1993). SF-36 Health Survey: Manual and interpretation guide. Boston, MA: New England Medical Center.Google Scholar
Wells, A. (2009). Metacognitive therapy for anxiety and depression. New York, NY: Guilford.Google Scholar
Zimmerman, M., McGlinchery, J. B., Posternak, M. A., Friedman, M., Attiullah, N., & Boerescu, D. (2006). How should remission from depression be defined? The depressed patient´s perspective. American Journal of Psychiatry, 163, 148150.Google Scholar