Experiential avoidance and psychopathology: a unidimensional or multidimensional construct?

Professional Doctorate - Doctor of Clinical Psychology (DCP)Experiential Avoidance (EA) results from an individual being unwilling to approach or remain in contact with internal experiences such as emotions, thoughts, bodily sensations, memories or urges (Hayes, Wilson, Gifford, Follette, & Strosahl, 1996). This aversion or unwillingness leads to maladaptive efforts to avoid, or escape such experiences (Hayes, et al., 1996). EA is ubiquitous and has been shown to result in a paradoxical increase in the incidence of the feared experiences and in the distress they cause (e.g., Hayes, et al., 1996). EA in itself is not pathogenic in definition (Boelen & Reijntjes, 2008). However, chronic or excessive use of EA has been considered a fundamental psychological vulnerability underlying the onset and/or maintenance of a variety of clinical problems and disorders (Hayes, et al., 1999). It has been suggested that EA has been recognised, implicitly or explicitly, within most systems of therapy (e.g., Blackledge & Hayes, 2001; Freud, 1937; Rogers, 1961). Measuring EA has been shown to be a complicated task as it encompasses such a wide variety of behaviours (Shahar & Herr, 2011). Recent research has questioned the validity of the measurement of EA as a single construct, and has suggested EA may actually be a multifaceted construct with a number of different components (Chawla & Ostafin, 2007). The purpose of this study was to explore whether changes in scores on measures of EA as a single construct (the Action and Avoidance Questionnaire; AAQ-II; Bond, Hayes, Baer, Carpenter, Guenole, Orcutt, et al., 2009), were reflected in changes in scores on assessment tools measuring thought control (the White Bear Suppression Inventory; Wegner & Zanakos, 1994), and emotion control (the Difficulties in Emotion Regulation Scale; DERS; Gratz & Roemer, 2004). Hence, exploring whether EA can be viewed as a unidimensional construct or a multidimensional construct. 82 participants currently engaged in therapy interventions at two acute community mental health services and two psychiatric rehabilitation services completed the AAQ-II, the WBSI, and the DERS at a baseline interval, and again after three months. Therapists completed a brief questionnaire regarding their impressions of the participants’ EA. The data was analysed using Structural Equation Modelling to estimate the relationships among variables considering all relationships simultaneously and minimising the effects of measurement error. Changes in EA, as measured by the AAQ-II, were strongly related to emotion control scores, although not as strongly related to thought control scores. Further examination of EA as a construct indicated that emotion control scores, in particular a lack of access to strategies, non-acceptance of emotions, and difficulty maintaining goal-directed behaviour when distressed, appeared to be more related to the construct of EA than scores on the measure designed to be a general measure of EA, the AAQ-II. Hence, this study provides some preliminary evidence for the notion that EA may be a multifaceted construct with a number of different components rather than a broad extensive construct that incorporates a variety of other strategies. This study provides some preliminary exploration of factors involved in refining the operalization of the construct of EA. It is hoped that by informing our understanding and operalization of the definition of EA, we can more fully assess how we may target interventions appropriately to undo the detrimental effects of EA