Relating Coping, Fear of Uncertainty and Alexithymia with Psychological Distress: The Mediating Role of Experiential Avoidance
Berrocal, Carmen, Pennato, Tiziana, Bernini, Olivia, Journal of Evidence-Based Psychotherapies
The present study tests the mediating role of experiential avoidance (EA; Hayes, Wilson, Gifford, Follette, & Strosahl, 1996) to account for the relations of avoidant coping, fear of uncertainty, and alexithymia with negative psychological outcomes. Participants were 177 adults (51 males and 126 females; mean age = 34.5). Measures of EA (Acceptance and Action Questionnaire, AAQ), avoidant coping (Brief COPE scale), fear of uncertainty (Temperament and Character Inventory), alexithymia (Toronto Alexithymia Scale), and psychological outcomes (Behavior and Symptom Identification Scale) were obtained from standardized, self-administered questionnaires. Regression analyses were performed to test for mediation models. Results show that the effect of avoidant coping and fear of uncertainty on emotional distress and other negative outcomes decreases when controlling avoidance scores, whereas the latter predicts psychological outcomes. Findings suggest that EA may represent a generalized mechanism through which both avoidant coping and fear of uncertainty take on psychological significance. Results did not support, however, the mediating role of EA for explaining the relations between alexithymia and psychological outcomes.
Keywords: experiential avoidance, coping strategies, alexithymia, mediator
Experiential avoidance (EA) is the process that occurs "when a person is unwilling to remain in contact with particular private experiences (e.g., bodily sensations, emotions, thoughts, memories, images, behavioral predispositions) and takes steps to alter the form or frequency of these experiences or the contexts that occasion them" (Hayes, Strosahl, Wilson, Bissett, Pistorello, Toarmino et al., 2004).
It is considered that EA can become a disorganised process when it is used in an inflexible way, so that a large amount of time, energy, and effort is spent in order to manage, control, or struggle with unwanted private events (Hayes, Jacobson, Follette, & Dougher, 1994; Hayes, Strosahl, & Wilson, 1999;). Experimental research has demonstrated that attempts to inhibit or hide unpleasant feelings, thoughts, and bodily sensations can lead to an increase in the frequency of these same experiences and in the distress that they cause (Cioffi & Holloway, 1993; Gold & Wegner, 1995; Gross, 1998, 2002; Hayes, Wilson, Gifford, Follette, & Strosahl, 1996; Hayes, Bissett, Korn, Zettle, Rosenfarb, & Cooper, 1999; Polusny & Follette, 1995; Purdon, 1999; Roemer & Borkovech, 1994; Salkovskis & Campbell, 1994; Wegner, 1991, 1994; Wegner & Zanakos, 1994; Wenzlaff & Wegner, 2000).
Indeed, emerging empirical evidence supports EA as a broad vulnerability factor for various types of emotional distress. Results from a meta-analysis (Hayes, Luoma, Bond, Masuda, & Lillis, 2006), involving thirty-two studies and 6628 subjects, indicate that EA is negatively associated with quality of life, perceived health, and positive emotional experiences, and positively associated with a wide range of psychopathological measures, including depression, anxiety, somatisation, the "re-experiencing" and "arousal" subscales measuring posttraumatic stress disorder, social phobia, agoraphobia, blood/injury phobia, anxiety sensitivity, suffocation fear, body sensations fear, trichotillomania, stress, trauma symptoms and beliefs, dissociative experiences, alcohol dependence, job induced tension, worries, fear of intimacy, and pain.
These relations have been explained considering the theoretical roots of the Relational Frame Theory (see Hayes, Barnes-Holmes, & Roche, 2001 for a review). Even if on the short run EA can be effective, when efforts to avoid unwanted private events overtake the self (that is, when the subject "lives in her/his head", trying to control private events), the ability to engage in valued life directions is compromised (Eifert & Forsyth, 2005; Hayes, Strosahl, & Wilson, 1999). …