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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
Abstract
Few studies have been conducted on psychological disorders other than post-traumatic stress disorder (PTSD) in war survivors. The aim of this study was to examine PTSD, social anxiety disorder (SAD), and major depressive disorder (MDD) and their associations with distress and quality of life in 174 Albanian civilian survivors of the Kosovo War. This included testing of conceptual models suggesting that experiential avoidance might influence associations between anxiety and mood disorders with psychological functioning. Each of the three psychiatric disorders was associated with greater experiential avoidance and psychological distress, and lower quality of life. Being a refugee was associated with a higher likelihood of having SAD and MDD. We found evidence for experiential avoidance as a partial mediator of the respective effects of SAD and PTSD on quality of life; experiential avoidance did not mediate the effects of disorders on global distress. We also found support for a moderation model showing that only war survivors without SAD and low experiential avoidance reported elevated quality of life; people with either SAD or excessive reliance on experiential avoidance reported compromised, low quality of life. This is the third independent study, each using a different methodology, to find empirical support for this moderation model [Kashdan, T. B., & Breen, W. E. (2008). Social anxiety and positive emotions: a prospective examination of a self-regulatory model with tendencies to suppress or express emotions as a moderating variable. Behavior Therapy, 39, 1-12; Kashdan, T. B., & Steger, M. F. (2006). Expanding the topography of social anxiety: an experience sampling assessment of positive emotions and events, and emotion suppression. Psychological Science, 17, 120-128]. Overall, we provided initial evidence for the importance of addressing PTSD, SAD, MDD, and experiential avoidance in primarily civilian war survivors.
... Experiential avoidance is a compelling candidate mechanism since avoidance behaviors are a key feature of PTSD (American Psychiatric Association, 2013) and play an important role in binge-eating. In terms of PTSD, avoidance behaviors are related to the development of PTSD, as well as functional impairment (Solomon & Mikulincer, 2007) and poor quality of life in persons with PTSD (Kashdan et al., 2009). In a study utilizing ecological momentary assessment among individuals with PTSD, avoidance was the most commonly used emotion regulation strategy among participants, and predicted subsequent increases in PTSD symptom severity (Short et al., 2018). ...
... Our hypothesis that experiential avoidance would mediate the relationship between PTSD symptoms and obesity-related quality of life was supported. Avoidance behaviors among individuals with PTSD are associated with decreased functioning across several domains (Solomon & Mikulincer, 2007), and in one prior study experiential avoidance partially accounted for the relationship between PTSD and quality of life among civilian survivors of the Kosovo war (Kashdan et al., 2009). Kashdan et al. (2009) suggest that PTSD symptoms may contribute to moving away from valued activities, leading to worse quality of life. ...
... Avoidance behaviors among individuals with PTSD are associated with decreased functioning across several domains (Solomon & Mikulincer, 2007), and in one prior study experiential avoidance partially accounted for the relationship between PTSD and quality of life among civilian survivors of the Kosovo war (Kashdan et al., 2009). Kashdan et al. (2009) suggest that PTSD symptoms may contribute to moving away from valued activities, leading to worse quality of life. Our results extend this prior research by showing that experiential avoidance associated with PTSD symptoms among veterans with overweight/obesity may exacerbate the negative impacts of obesity on quality of life. ...
Obesity, binge-eating symptoms, and PTSD symptoms commonly co-occur. Avoidance, a key feature of PTSD and proposed mechanism of binge-eating, is one potential mechanism for explaining this clinical overlap. The purpose of the current study was to: 1) examine the associations between PTSD symptoms (PTSD Checklist-Civilian; PCL-C) and measures of bingeeating symptoms (Binge Eating Scale; BES) and obesity-related quality of life (Obesity Related Well-Being Questionnaire-97; ORWELL-97) in a sample of veterans with overweight or obesity (N = 89), and 2) determine whether experiential avoidance (The Acceptance and Action Questionnaire–II; AAQ-II) explains the relationship between PTSD symptoms and binge-eating symptoms, and PTSD symptoms and obesity-related quality of life, respectively. Scores on the PCL-C, BES, ORWELL-97, and AAQ-II were all significantly correlated. Linear regression analyses indicated that higher PCL-C scores were related to higher scores on the BES and ORWELL-97 after controlling for potentially confounding factors (BMI and race). Effect sizes were in the medium-large range. Further, AAQ-II mediated the relationship between PCL-C and ORWELL-97, but did not mediate the relationship between PCL-C and BES. These findings suggest that experiential avoidance should be considered in interventions addressing co-occurring PTSD, binge-eating, and poor obesity-related well-being. Longitudinal research is needed to better understand directionality of these relationships and changes over time.
... Among proposed mechanisms, we selected the following transdiagnostic mechanisms: experiential avoidance (Craske, 2012;Hayes, Wilson, Gifford, Follette, & Strosahl, 1996;Kashdan, Morina, & Priebe, 2009), rumination (Ehring & Watkins, 2008;McEvoy et al., 2013;Watkins, 2008), and emotion dysregulation (Hofmann, Sawyer, Fang, & Asnaani, 2012;Neacsiu, Eberle, Kramer, Wiesmann, & Linehan, 2014;Werner & Gross, 2010). These transdiagnostic mechanisms were chosen based on the following criteria. ...
... A considerable body of research suggests that experiential avoidance has been associated with a wide range of mental health issues, such as generalized anxiety disorder (GAD; Newman & Llera, 2011), anxiety sensitivity (Tull & Gratz, 2008), depression and avoidance of shame memories (Dinis, 2015), and social anxiety disorder (Kashdan, Breen, Afram, & Terhar, 2010;Kashdan et al., 2009). Furthermore, Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999) targets experiential avoidance, and promotes the tendency to fully experience what is happening in the present moment instead of avoiding them and to act according to one's chosen values. ...
Theoretical accounts and preliminary evidence suggest that Mindfulness-Based Interventions (MBIs) improve cognitive function, but reviews of empirical studies have provided mixed results. To clarify empirical evidence, we conducted a meta-analysis of 25 studies (n = 1439) and examined the effects of MBIs on four cognitive domains: attention, working memory, long-term memory, and executive function. The summary effect sizes indicate that MBIs produce non-significant effects on attention (SMD = 0.07), working memory (SMD = 0.16), and long-term memory (SMD = −0.12), while a small effect was observed for executive function (SMD = 0.29). Given significant heterogeneity across studies, we conducted meta-regression analyses with sample characteristics, age, number of treatment sessions, treatment duration, intervention type, control group type, and study design. We found moderating effects of intervention type on attention and executive function. Although the current study highlights preliminary evidence for improvements in executive function, overall results suggest non-significant findings for attention, working memory, and long-term memory. To draw a firm conclusion, further research is needed to address methodological challenges in meta-analysis and the limitations of existing studies.
... First, anxiety disorders are among the most common psychological disorders, with lifetime prevalence rates estimated to be as high as 28.8% in the general population (Kessler et al., 2005), and rank as the 6th leading cause of disability worldwide (Baxter et al., 2014). Second, there is a strong theoretical association between EA and anxiety which has received a considerable amount of empirical support, both for anxiety broadly (e.g., Kashdan et al., 2008;Tull & Roemer, 2008) as well as for specific anxiety disorders, including generalized anxiety disorder (Roemer et al., 2005), panic disorder (Gloster et al., 2011), posttraumatic stress disorder (Kashdan et al., 2009), social anxiety disorder (Kashdan et al., 2009(Kashdan et al., , 2010, and obsessive-compulsive disorder (Blakely et al., 2015). Finally, the relationships of anxiety disorders with these predictors is well-established in the literature (e.g., Baxter et al., 2014;Kotov et al., 2010;Olatunji et al., 2007). ...
... First, anxiety disorders are among the most common psychological disorders, with lifetime prevalence rates estimated to be as high as 28.8% in the general population (Kessler et al., 2005), and rank as the 6th leading cause of disability worldwide (Baxter et al., 2014). Second, there is a strong theoretical association between EA and anxiety which has received a considerable amount of empirical support, both for anxiety broadly (e.g., Kashdan et al., 2008;Tull & Roemer, 2008) as well as for specific anxiety disorders, including generalized anxiety disorder (Roemer et al., 2005), panic disorder (Gloster et al., 2011), posttraumatic stress disorder (Kashdan et al., 2009), social anxiety disorder (Kashdan et al., 2009(Kashdan et al., , 2010, and obsessive-compulsive disorder (Blakely et al., 2015). Finally, the relationships of anxiety disorders with these predictors is well-established in the literature (e.g., Baxter et al., 2014;Kotov et al., 2010;Olatunji et al., 2007). ...
Experiential avoidance is conceptualized as a core psychopathological process in Acceptance and Commitment Therapy (ACT). Much of the empirical support for the theoretical conceptualization and efficacy of ACT interventions is based on operationally defining experiential avoidance as scores on the Acceptance and Action Questionnaire-II (AAQ-II; Bond et al., 2011) and its predecessor, the AAQ (Hayes et al., 2004). However, both measures have been criticized for exhibiting poor discriminant validity from measures of related constructs. The present study sought to evaluate the incremental predictive validity of the AAQ-II for symptoms of panic, social anxiety, generalized anxiety, obsessive compulsive, and posttraumatic stress disorders after controlling for neuroticism, functional impairment, life satisfaction, anxiety sensitivity, quality of life, positive and negative affect, and distress tolerance in a large sample of adults (n = 552). A series of hierarchical regression analyses revealed that AAQ-II scores uniquely predicted anxiety symptoms over and above measures of related constructs for all outcomes except social anxiety. Relative weights analysis revealed that the AAQ-II accounted for 10.5–17.5% of the variance in outcome scores explained by regression models and emerged as one of the top three predictors by relative weight in all five models. The present findings support the empirical and clinical utility of the AAQ-II and indicate that its predictive power for anxiety disorder symptomology is not simply attributable to overlap with measures of related constructs.
... Through psychological inflexibility, individuals try to circumvent undesirable internal events like distressing emotions, negative thoughts and other private experiences. Post-Traumatic Stress Disorder (PTSD) symptom severity and psychological inflexibility have been tied together through multiple research studies (e.g., Cheng et al., 2021;Kashdan et al., 2009;Orcutt et al., 2005). Evidence (Hayes, Luoma, Bond, Masuda, & Lillis, 2006;Hayes et al., 2004;Jeffords et al., 2020) indicates that psychological flexibility acts as a protective factor in the prevention of PTSD and the development of other clinical conditions. ...
... There are very limited studies that explore PI with other psychological variables, especially with PS and SC. PI has often been linked with distress across studies (Cheng et al., 2021;Hayes et al., 1999;Hayes et al., 2004;Hayes et al., 2006, Kashdan et al., 2009Orcutt et al., 2005;Sairanen, Lappalainen, & Hiltunen, 2018) consistent with current findings. High psychological flexibility has been shown to aid with countering risks and overcoming challenges (Jeffords et al., 2020). ...
Rationale. With social distancing and work from home the COVID-19 (WHO, 2020) pandemic has created a new reality for parents worldwide and brought along significant challenges in their lives. In particular, the process of mothering has been affected during the COVID-19 pandemic with higher physical and emotional labour and a greater responsibility for managing care of the children and household without the usual support system in place. Objective. The primary objective of the current study was to explore the mediating role of Psychological Inflexibility (PI) between the relationship of Parenting Stress (PS) and Self-Compassion (SC) among Indian mothers with children aged under 10 years during the COVID-19 pandemic. Design. Self-reported measures of PI, PS and SC through respective scales were used to collect data from N=552 Indian mothers. Results. The data analysis was indicative of a positive relationship between Self-compassion and Parental Stress and Self-compassion and Psychological Inflexibility. Psychological Inflexibility was found to positively mediate the relationship between Parental Stress and Self Compassion with the mediating effect being close to 31%. Conclusion. Increased parenting stress could have propelled mothers to be more self-compassionate in order to cope with the stress induced by the pandemic.
... Among proposed mechanisms, we selected the following transdiagnostic mechanisms: experiential avoidance (Craske, 2012;Hayes, Wilson, Gifford, Follette, & Strosahl, 1996;Kashdan, Morina, & Priebe, 2009), rumination (Ehring & Watkins, 2008;McEvoy et al., 2013;Watkins, 2008), and emotion dysregulation (Hofmann, Sawyer, Fang, & Asnaani, 2012;Neacsiu, Eberle, Kramer, Wiesmann, & Linehan, 2014;Werner & Gross, 2010). These transdiagnostic mechanisms were chosen based on the following criteria. ...
... A considerable body of research suggests that experiential avoidance has been associated with a wide range of mental health issues, such as generalized anxiety disorder (GAD; Newman & Llera, 2011), anxiety sensitivity (Tull & Gratz, 2008), depression and avoidance of shame memories (Dinis, 2015), and social anxiety disorder (Kashdan, Breen, Afram, & Terhar, 2010;Kashdan et al., 2009). Furthermore, Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999) targets experiential avoidance, and promotes the tendency to fully experience what is happening in the present moment instead of avoiding them and to act according to one's chosen values. ...
High co-morbidity among mental disorders indicates that common transdiagnostic mechanisms underlie various psychopathology, yet there has been little research effort to empirically explicate transdiagnostic processes. A few existing studies are limited in the number of transdiagnostic mechanisms and mental disorder categories explored. The current study addresses these limitations by examining the relationship between three transdiagnostic processes (experiential avoidance, rumination, and emotion dysregulation) and symptom severity of five mental disorders (generalized anxiety disorder, panic disorder, social anxiety disorder, specific phobia, and depression) in a college sample (N=266). Applying Structural Equation Modeling (SEM), three transdiagnostic models were evaluated, with the five latent variables of mental disorder regressed onto each transdiagnostic process. The results showed that all transdiagnostic models--except the emotion dysregulation model--generally fit the data well. Among the tested models, the strongest evidence was found for experiential avoidance as a transdiagnostic mechanism underlying multiple disorders, suggesting the need for further research effort to reduce experiential avoidance in diverse clinical populations.
... Psychological inflexibility, which ACT seeks to reduce, involves attempts to avoid experiencing unwanted internal events, such as distressing thoughts, emotions, and other private experiences (Hayes et al., 1999). Various studies have linked psychological inflexibility with PTSD symptom severity (e.g., Kashdan et al., 2009;Orcutt et al., 2005). There is also evidence that psychological inflexibility is associated with greater PTSD symptom severity in a variety of populations including veterans (e.g., Brockman et al., 2016;Meyer et al., 2013;Meyer et al., 2019), military personnel (Bryan et al., 2015), war survivors (Kashdan et al., 2009), sexual assault survivors (Gold & Marx, 2007), college students Orcutt et al., 2005;Thompson & Waltz, 2010), community members (Bardeen & Fergus, 2016), and adolescents (Shenk et al., 2012). ...
... Various studies have linked psychological inflexibility with PTSD symptom severity (e.g., Kashdan et al., 2009;Orcutt et al., 2005). There is also evidence that psychological inflexibility is associated with greater PTSD symptom severity in a variety of populations including veterans (e.g., Brockman et al., 2016;Meyer et al., 2013;Meyer et al., 2019), military personnel (Bryan et al., 2015), war survivors (Kashdan et al., 2009), sexual assault survivors (Gold & Marx, 2007), college students Orcutt et al., 2005;Thompson & Waltz, 2010), community members (Bardeen & Fergus, 2016), and adolescents (Shenk et al., 2012). Psychological inflexibility can interfere with trauma recovery as it may prevent the emotional processing and new learning opportunities that are critical in the decrease of PTSD symptoms . ...
Psychological inflexibility has been linked to a variety of mental health disorders, including posttraumatic stress disorder (PTSD). The purpose of this cross-sectional self-report study was to examine how psychological inflexibility, along with closely related concepts such as mindfulness and self-compassion, are associated with PTSD among a clinical sample using PTSD DSM-5 criteria. A sample of 200 veterans (mean age = 54.6; 71.0% male, 25.5% female) were recruited from mental health clinics within a Veteran Affairs Medical Center. Controlling for mindfulness and self-compassion, veterans with PTSD had significantly higher levels of psychological inflexibility compared to those without PTSD. In addition, psychological inflexibility was associated with overall PTSD severity, even after controlling for mindfulness, self-compassion, depression, alcohol and substance use, and demographic variables. The observing facet of mindfulness was significantly associated with higher levels of PTSD, while the describing facet was related to lower overall PTSD symptoms. Self-compassion was no longer associated with PTSD symptoms when controlling for other variables. These findings support the relationship between psychological inflexibility and DSM-5 PTSD. Targeting psychological inflexibility may be a key focal point in improving PTSD-related treatment outcomes.
... One of the overarching features of PTSD in humans, in addition to the cognitive alterations previously mentioned, is social impairment 30 . Several clinical reports indicate social withdrawal and social isolation as common hallmarks of PTSD patients [31][32][33] . In the animal model that we had previously validated, we found that rats exposed to footshock trauma paired with social isolation displayed reduced social interaction time in the Social Interaction test and impaired memory processes 22 . ...
Post-traumatic stress disorder (PTSD) is a psychiatric disorder whose pathogenesis relies on a maladaptive expression of the memory for a life-threatening experience, characterized by over-consolidation, generalization, and impaired extinction, which are responsible of dramatic changes in arousal, mood, anxiety, and social behavior. Even if subjects experiencing a traumatic event during lifetime all show an acute response to the trauma, only a subset of them (susceptible) ultimately develops PTSD, meanwhile the others (resilient) fully recover after the first acute response. However, the dynamic relationships between the interacting brain circuits that might potentially link trauma-related experiences to the emergence of susceptible and resilient PTSD phenotypes in individuals is not well understood. Toward the first step to reach this goal, we have implemented our experimental PTSD model previously developed, making it suitable to differentiate between susceptible (high responders, HR) and resilient (low responders, LR) rats in terms of over-consolidation, impaired extinction, and social impairment long after trauma. Rats were exposed to five footshocks paired with social isolation. One week after trauma but before extinction, animals were tested in the Open Field and Social Interaction tasks for the identification of a predictive variable to identify susceptible and resilient animals before the possible appearance of a PTSD-like phenotype. Our findings show that exploratory activity after trauma in a novel environment is a very robust variable to predict susceptibility towards a PTSD-like phenotype. This experimental model is thus able to screen and differentiate, before extinction learning and potential therapeutic intervention, susceptible and resilient PTSD-like rats.
... We also try to understand the variation in prevalence of PTSD in different regions and countries by their socioeconomic structure and health care expenditure (Table 4). Countries with poor socioeconomic structure lower GDP and lower spending on health care expenditure was seen with high prevalence of posttraumatic stress disorder [29][30][31][32]. ...
... 7 Other studies, which focused on specific regions of the country or specific subgroups, found a prevalence of depression which ranged from 29.7% to 66.5%. [8][9][10][11] It is clear that depression is common in Kosovo, far exceeding the global average. Some interpret the high rates of depression as an aftermath to the stressful conditions following the war. ...
Introduction:
With the lowest life expectancy in the Balkans, underlying causes of morbidity in Kosovo remain unclear due to limited epidemiological evidence. The goal of this cohort is to contribute epidemiological evidence for the prevention and control of non-communicable diseases such as depression, hypertension, diabetes and chronic respiratory disease in Kosovo as the basis for policy and decision-making, with a spotlight on the relationships between non-experimental primary healthcare (PHC) interventions and lifestyle changes as well as between depression and the course of blood pressure.
Methods and analysis:
PHC users aged 40 years and above were recruited consecutively between March and October 2019 from 12 main family medicine centres across Kosovo. The data collected through interviews and health examinations included: sociodemographic characteristics, social and environmental factors, comorbidities, health system, lifestyle, psychological factors and clinical attributes (blood pressure, height, weight, waist/hip/neck circumferences, peak expiratory flow and HbA1c measurements). Cohort data were collected annually in two phases, approximately 6 months apart, with an expected total follow-up time of 5 years.
Ethics and dissemination:
Ethical approvals were obtained from the Ethics Committee Northwest and Central Switzerland (Ref. 2018-00994) and the Kosovo Doctors Chamber (Ref. 11/2019). Cohort results will provide novel epidemiological evidence on non-communicable diseases in Kosovo, which will be published in scientific journals. The study will also examine the health needs of the people of Kosovo and provide evidence for health sector decision-makers to improve service responsiveness, which will be shared with stakeholders through reports and presentations.
... It is likely that more complex statistical modeling would reveal how these variables may work together in the generation of NEAs. However, it will be important to consider the operationalization of these variables, especially as the relationships between variables considered part of psychological inflexibility, such as EA, CF, and mindfulness, have been questioned more broadly within the literature [34] and have not previously been explored within this population. It may well be that CF is important at an earlier stage of the process explored, and therefore, was not found to be directly related to any of the explored variables. ...
Background
There is no clear understanding of what causes and maintains nonepileptic attack (NEA) disorder (NEAD), or which psychological therapies may be helpful. The relationships between variables of psychological inflexibility: experiential avoidance (EA), cognitive fusion (CF), mindfulness, and key outcome variables in NEAD: somatization, impact upon life, and NEA frequency were investigated.
Method
Two hundred eighty-five individuals with NEAD completed validated measures online. Linear regression was used to explore which variables predicted somatization and impact upon life. Ordinal regression was used to explore variables of interest in regard to NEA frequency.
Results
Mindfulness, EA, CF, somatization, and impact upon life were all significantly correlated. Mindfulness uniquely predicted somatization when considered in a model with EA and CF. Higher levels of somatization increased the odds of experiencing more NEAs. Individuals who perceived NEAD as having a more significant impact upon their lives had more NEAs, more somatic complaints, and more EA.
Conclusions
Higher levels of CF and EA appear to be related to lower levels of mindfulness. Lower levels of mindfulness predicted greater levels of somatization, and somatization predicted NEA frequency. Interventions that tackle avoidance and increase mindfulness, such as, acceptance and commitment therapy, may be beneficial for individuals with NEAD. Future directions for research are suggested as the results indicate more research is needed.
... The primary outcome measure used in all three trials is quality of life, assessed with the Manchester Short Assessment of Quality of Life (MANSA) [68] at baseline and all follow-ups. MANSA has been successfully used to assess quality of life in individuals with psychotic disorders [69,70] and other forms of mental health problem [71]. The score for MANSA is calculated from the 12 subjective items in Section 3 of the measure [68]. ...
Background:
Mental health recovery narratives have been defined as first-person lived experience accounts of recovery from mental health problems which refer to events or actions over a period of time and which include elements of adversity or struggle, and also self-defined strengths, successes or survival. They are readily available in invariant recorded form, including text, audio or video. Previous studies have provided evidence that receiving recorded recovery narratives can provide benefits to recipients. This protocol describes three pragmatic trials that will be conducted by the Narrative Experiences Online (NEON) study using the NEON Intervention, a web application that delivers recorded recovery narratives to its users. The aim of the NEON Trial is to understand whether receiving online recorded recovery narratives through the NEON Intervention benefits people with experience of psychosis. The aim of the NEON-O and NEON-C trials is to evaluate the feasibility of conducting a definitive trial on the use of the NEON Intervention with people experiencing non-psychosis mental health problems and those who care for others experiencing mental health problems respectively.
Methods:
The NEON Trial will recruit 683 participants with experience of psychosis. The NEON-O Trial will recruit at least 100 participants with experience of non-psychosis mental health problems. The NEON-C Trial will recruit at least 100 participants with experience of caring for others who have experienced mental health problems. In all three trials, participants will be randomly allocated into one of two arms. Intervention arm participants will receive treatment as usual plus immediate access to the NEON Intervention for 1 year. Control arm participants will receive treatment as usual plus access to the NEON Intervention after 1 year. All participants will complete demographics and outcome measures at baseline, 1 week, 12 weeks and 52 weeks. For the NEON Trial, the primary outcome measure is the Manchester Short Assessment of Quality of Life at 52 weeks, and secondary outcome measures are the CORE-10, Herth Hope Index, Mental Health Confidence Scale and Meaning in Life Questionnaire. A cost-effectiveness analysis will be conducted using data collected through the EQ-5D-5 L and the Client Service Receipt Inventory.
Discussion:
NEON Trial analyses will establish both effectiveness and cost-effectiveness of the NEON Intervention for people with experience of psychosis, and hence inform future clinical recommendations for this population.
Trial registration:
All trials were prospectively registered with ISRCTN. NEON Trial: ISRCTN11152837 . Registered on 13 August 2018. NEON-C Trial: ISRCTN76355273 . Registered on 9 January 2020. NEON-O Trial: ISRCTN63197153 . Registered on 9 January 2020.
... Therefore, third-wave behavior therapies and other approaches in psychotherapy have focused on this type of emotion regulation as a therapeutic target (Gámez et al., 2011). When a person uses a defective solution like experiential avoidance for regulating emotions there are some consequences such as low life quality (Kashdan et al., 2009); increased severity of psychological symptoms (Thompson and Waltz, 2010) and exacerbation of physical complaints (Andrew and Dulin, 2007). The exact mechanism underlying the association between experiential avoidance and somatic symptoms is not clear (Güney et al., 2019). ...
Research has shown that women are more prone to childhood trauma and this state is associated with somatic symptoms. Also, people who have been exposed to traumatic experiences use experiential avoidance to reduce negative emotions. However, the mediating role of experiential avoidance in the relationship between childhood trauma and somatic symptoms is not clear, so, the present study investigated whether the relationships among different types of childhood trauma and somatic symptoms could be explained by experiential avoidance in female college students. In a cross-sectional study, 251 Iranian female college students with somatic symptoms were recruited from the University of Tabriz. Participants completed self-report scales, including the Persian version of Child Abuse Self-Reported Scale, Acceptance and Action Questionnaire-II (AAQ-II), and the Patient-health questionnaire (PHQ-15). A path analysis was used to empirically explore the relationships. Structural equation modeling analyses confirmed a partial mediation model. Study participants who had a higher level of emotional trauma reported higher levels of somatic symptoms. Emotional and neglect trauma showed significant positive relations with experiential avoidance. Bootstrapping results showed that experiential avoidance partially mediated the relationship between emotional trauma and somatic symptoms. Moreover, the association between neglect and somatic symptoms was fully mediated by experiential avoidance. These findings suggest that experiential avoidance might be one mechanism explaining how adverse emotional and neglect experiences influence somatic symptoms. Interventions addressing experiential avoidance through methods such as emotion-focused therapy and mindfulness are discussed as potential future directions for treating somatic symptoms in females who experienced emotional and neglect trauma.
... Evidence has shown that EA predicts a significant amount of variance in poor mental health status (Chawla & Ostafin, 2007;Fernández-Rodríguez et al., 2018;Ishizu et al., 2017;Losada et al., 2015;Mahaffey et al., 2013;Shahar, 2009) mental health problems (Spinoven et al., 2014), physiological reactivity (Brown, 2018;Choi et al., 2014), and quality of life (Kashdan et al., 2009). Experiential avoidance mediated the effects of anxiety sensitivity on social anxiety in non-clinical samples (Panayiotou et al., 2014). ...
Hypertension is often associated with adverse psychosocial outcomes and psychological factors have been advanced for better explanatory models and to enhance the development of effective interventions in the treatment of hypertensive patients. Although the link between anxiety sensitivity (AS) and poor mental health outcomes has been established, the mechanism through which it results in psychological distress (PD) is not yet well understood. In addition to investigating the direct associations of AS and experiential avoidance (EA) to PD, the present study examines whether AS predicts adverse mental health outcomes via EA. Hypertensive patients (N = 240; women = 135; Mean age = 41.09, SD = 9.11 years) drawn from cardiology unit of a Nigerian teaching hospital completed the following measures: Psychological Distress Scale, Anxiety Sensitivity Index-3, and Acceptance and Action Questionnaire. Results showed that that greater AS and greater EA predicted increased PD, even when controlling for age and gender. The mediation hypothesis was further supported suggesting that the association between AS with increase in PD was a function of heightened EA. These findings are consistent with the notion that acceptance of daily experiences may serve to buffer against the potential adverse mental health outcomes and may be a critical target for interventions to ameliorate PD in patients with chronic health conditions such as hypertension. Psychological interventions that deals with experiential avoidance could be used in the management of distressed hypertensive patients.
... Evidence has shown that EA predicts a significant amount of variance in poor mental health status (Chawla & Ostafin, 2007;Fernández-Rodríguez et al., 2018;Ishizu et al., 2017;Losada et al., 2015;Mahaffey et al., 2013;Shahar, 2009) mental health problems (Spinoven et al., 2014), physiological reactivity (Brown, 2018;Choi et al., 2014), and quality of life (Kashdan et al., 2009). Experiential avoidance mediated the effects of anxiety sensitivity on social anxiety in non-clinical samples (Panayiotou et al., 2014). ...
Hypertension is often associated with adverse psychosocial outcomes and psychological factors have been advanced for better explanatory models and to enhance the development of effective interventions in the treatment of hypertensive patients. Although the link between anxiety sensitivity (AS) and poor mental health outcomes has been established, the mechanism through which it results in psychological distress (PD) is not yet well understood. In addition to investigating the direct associations of AS and experiential avoidance (EA) to PD, the present study examines whether AS predicts adverse mental health outcomes via EA. Hypertensive patients (N = 240; women = 135; Mean age = 41.09, SD = 9.11 years) drawn from cardiology unit of a Nigerian teaching hospital completed the following measures: Psychological Distress Scale, Anxiety Sensitivity Index-3, and Acceptance and Action Questionnaire. Results showed that that greater AS and greater EA predicted increased PD, even when controlling for age and gender. The mediation hypothesis was further supported suggesting that the association between AS with increase in PD was a function of heightened EA. These findings are consistent with the notion that acceptance of daily experiences may serve to buffer against the potential adverse mental health outcomes and may be a critical target for interventions to ameliorate PD in patients with chronic health conditions such as hypertension. Psychological interventions that deals with experiential avoidance could be used in the management of distressed hypertensive patients. ARTICLE HISTORY
... Importantly, while avoidance itself is not intrinsically pathological, it can become problematic when it is both contextually insensitive and relied upon in a chronic manner as a means of regulating unpleasant internal experiences (Forsyth, Eifert, & Barrios, 2006), such as in the case of consistently high EA. Indeed, this is reflected in the consistent finding that higher EA is associated with negative outcomes including greater mental health symptom severity (Gámez et al., 2011;Kashdan et al., 2014;Thompson & Waltz, 2010), lower quality of life (Gámez et al., 2011;Kashdan, Morina, & Priebe, 2009;Kirk, Meyer, Whisman, Deacon, & Arch, 2019), and poorer physical health (Andrew & Dulin, 2007;Berghoff, Tull, DiLillo, Messman-Moore, & Gratz, 2017). Further, high EA has been shown to be associated with a variety of diagnoses including anxiety disorders (Bardeen, Fergus, & Orcutt, 2013;Kashdan et al., 2014;Newman & Llera, 2011;Thompson & Waltz, 2010), depression (Spinhoven, Drost, de Rooij, van Hemert, & Penninx, 2014), alcohol and substance use disorders (Levin et al., 2012;Shorey et al., 2017), and borderline personality disorder (Jacob, Ower, & Buchholz, 2013). ...
Experiential avoidance, a trait-like construct referring to the tendency to rigidly avoid or change unpleasant internal experiences stemming from an unwillingness to experience them, is believed to contribute to the development and maintenance of various forms of psychopathology. Despite significant research on this construct, it remains unclear whether experiential avoidance is dimensional or categorical at the latent level. The current study examined the latent structure of experiential avoidance using three taxometric analytic approaches (MAXimum Eigenvalue, Mean Above Minus Below A Curve, Latent-Mode Factor Analysis) applied to data from two independent samples and using three widely used measures of experiential avoidance. The first sample (n = 922) completed the Multidimensional Experiential Avoidance Questionnaire (Gámez, Chmielewski, Kotov, Ruggero, & Watson, 2011), while the second sample (n = 615) completed the Brief Experiential Avoidance Questionnaire (Gámez et al., 2014) and Acceptance and Action Questionnaire-II (Bond et al., 2011). Across both samples and all three measures, experiential avoidance exhibited a dimensional structure. The clinical and research implications of this finding for experiential avoidance are discussed.
... That is, persons working in public safety tend to experience PPTEs at much higher frequencies than the general public [3][4][5]. Research has also demonstrated that PPTE exposure is associated with an increased risk of negative mental health outcomes, such as symptoms of posttraumatic stress disorder (PTSD; [2]), major depressive disorder (MDD; [6]) panic disorder (PD; [7]), generalized anxiety disorder (GAD; [8]), social anxiety disorder (SAD; [9]), and alcohol use disorder (AUD; [10]). Results from a recent survey with a large Canadian PSP sample indicated that the lifetime average number of different PPTE types experienced was 11.08 out of 16 different assessed PPTEs, with each type having been experienced 11 or more times by up to 71.3% of respondents [11]. ...
Public Safety Personnel (PSP; e.g., correctional workers and officers, firefighters, paramedics, police officers, and public safety communications officials (e.g., call center operators/dispatchers)) are regularly exposed to potentially psychologically traumatic events (PPTEs). PSP also experience other occupational stressors, including organizational (e.g., staff shortages, inconsistent leadership styles) and operational elements (e.g., shift work, public scrutiny). The current research quantified occupational stressors across PSP categories and assessed for relationships with PPTEs and mental health disorders (e.g., anxiety, depression). The participants were 4820 PSP (31.7% women) responding to established self-report measures for PPTEs, occupational stressors, and mental disorder symptoms. PPTEs and occupational stressors were associated with mental health disorder symptoms (ps < 0.001). PSP reported substantial difficulties with occupational stressors associated with mental health disorder symptoms, even after accounting for diverse PPTE exposures. PPTEs may be inevitable for PSP and are related to mental health; however, leadership style, organizational engagement, stigma, sleep, and social environment are modifiable variables that appear significantly related to mental health.
... The avoidance of experiences has been highlighted as a risk factor for psychopathology and worsened well-being. For instance, higher levels of experiential avoidance are present among people with posttraumatic stress disorder, social anxiety, obsessive-compulsive symptoms, stress perceptions, and major depressive disorder, among a variety of psychological disturbances (Bond et al., 2011;Gloster, Klotsche, Chaker, Hummel, & Hoyer, 2011;Kashdan, Morina, & Priebe, 2009;Tyndall et al., 2018). Experiential avoidance also appears to be negatively associated with satisfaction with life, psychological well-being, and quality of life Machell, Goodman, & Kashdan, 2015;Mitmansgruber, Beck, Höfer, & Schüßler, 2009). ...
Objective:
Despite consistent evidence for the beneficial effects of meditation on mental health, little is known about the mechanisms that make mindfulness meditation effective.
Method:
The levels of mental health, self-compassion, presence of meaning in life, and experiential avoidance of meditators (n = 414) and nonmeditators (n = 414) were measured and compared. Bootstrap-based structural equation modeling (SEM) modeling analyses were used to test multiple-step multiple-mediator models.
Results:
Meditation was positively associated with mental health, although the regularity of practice was an influential element to be considered. Significant indirect effects of meditation on mental health through self-compassion, meaning in life, and experiential avoidance were found. SEM models were able to account for 58% of the variance in mental health scores.
Conclusions:
Self-compassion, presence of meaning in life, and reduced experiential avoidance may be active components of healthy meditation practices. Identifying the mechanisms involved in effective meditation practices has relevant implications for well-being and mental health-promoting interventions.
... Third, the present study is the first to evaluate, in isolation, social avoidance as a predictor of long-term functioning related to BDD. Avoidance of emotionally-distressing situations appears to be a key maintenance process across various mental health problems, contributing to worse psychosocial functioning for individuals diagnosed with anxiety-and mood-related disorders (Chawla and Ostafin 2007;Kashdan et al. 2006Kashdan et al. , 2009Levin et al. 2014). For example, in a recent longitudinal study, Hendriks et al. (2016) reported that for individuals diagnosed with panic disorder, social anxiety disorder, and/or generalized anxiety disorder, greater initial avoidance predicted higher rates of long-term disability. ...
Individuals with body dysmorphic disorder (BDD) experience elevated social avoidance, both as a consequence and independent of BDD concerns. To explore how social avoidance relates to the long-term course of functioning for people with BDD, this prospective longitudinal study evaluated the hypothesis that initial social avoidance would predict changes in psychosocial functioning over 3 years, such that greater initial social avoidance would predict worsening functioning. At intake, individuals with BDD (N = 200) completed measures of social avoidance independent of BDD, social avoidance due to BDD or any other source, overall psychosocial functioning, and psychosocial functioning in specific domains. Overall and specific functioning was prospectively evaluated at three subsequent yearly follow-up assessments. Mixed model analyses evaluated the relation between baseline social avoidance and changes in functioning. Results provided mixed support for hypotheses, indicating that higher baseline social avoidance independent of BDD predicted worsening functioning in two of the four overall functioning indices and in both specific domains—interpersonal relationship quality and work/academic/household functioning. Higher global social avoidance (due to BDD or any other source) predicted poorer overall functioning for two of the four global functioning indices but did not predict functioning in either specific domain. Social avoidance, both related and unrelated to body image, might play an important role in the trajectory of psychosocial functioning for people with BDD.
... There is a growing body of evidence showing that experiential avoidance (EA) is strongly linked to psychopathology and behavioral problems (Kashdan & Rottenberg, 2010), psychological distress and reduced quality of life (Hayes et al., 2004), anxiety and depression (Forsyth et al., 2003;Kashdan et al., 2009;Tull et al., 2004) and chronic pain (Costa & Pinto-Gouveia, 2013;Zettle et al., 2005). EA was also studied within the college population, including a focus on childhood psychological abuse (Reddy et al., 2006), alcohol-related problems (Levin et al., 2012), and college adjustment (Aydın, 2016). ...
Many different approaches have been used in psychology to determine values and investigate valuing behavior. However, understanding the individual significance of the values is crucial to predict the actions that produce them. A significant number of studies exist in counseling education that focuses on the diverse issues of counselor trainees. These include, but are not limited to, self-efficacy levels, emotional awareness, attachment styles, and supervision experiences in counseling education. During the literature review conducted for this study, it was discovered that there was no investigation of counselor trainees’ values from an Acceptance and Commitment Therapy (ACT) perspective. Using ACT as the overarching framework, the current qualitative study aimed to examine counselor trainees’ values from a psychological flexibility perspective. During the data collection process, all counselor trainees (N = 62) were initially asked to fill both an Acceptance and Action Questionnaire (AAQ-II) that measured their psychological flexibility level and a Valuing Questionnaire (VQ) that measured their valuing levels. Participants were then split into two groups, based on their AAQ and VQ scores regarding either high or low psychological flexibility or values awareness. As a result of the analysis, 18 (15 female, three male) senior counseling students took part in the study, with the data being collected via focus groups and individual interviews. As a result of the study, four main themes were identified following detailed content analysis: (1) perception of values, (2) committed action vs. experiential avoidance moves, (3) present movement awareness and perspective skills, and (4) cognitive defusion and fusion experience. Implications were discussed in light of the relevant literature.
... Psychological inflexibility was related with the onset and severity of PTSD Symptoms in several populations such as veterans (e.g., Brockman et al., 2016;Crabtree et al., 2021;Meyer et al., 2019), war survivors (Kashdan et al., 2009), community members (Bardeen & Fergus, 2016), and inpatient adolescents (Schramm et al., 2020). During the Italian lockdown caused by COVID-19 Pandemic, Pakenham et al. (2020) found that psychological inflexibility exacerbates the adverse effects of several COVID-19 stressful events (e.g., having contracted the COVID-19, having a family members infected, hospitalized, or deceased due to COVID-19) on mental health (i.e., peritraumatic distress, anxiety, and depression). ...
The present study investigates the mediating roles of psychological inflexibility and differential coping strategies on perceived stress and post-traumatic symptoms and growth in the context of COVID-19. Study one recruited 662 participants (54.8% women; Mage = 40.64 years, SD = 13.04) who completed a cross-sectional questionnaire. It was proposed that orientation to the problem, avoidance strategies, psychological inflexibility, and positive attitude were mediators for the positive association between perceived stress and PTSD symptoms. The fit indices for the path model were excellent: CFI = 0.977, TLI = 0.950, RMSEA = 0.057 [90%CI = 0.043–0.081], and SRMS = 0.042. Gender and stressful events encountered had indirect effects on the endogenous variables. In study two, 128 participants (57.8% women; Mage = 42.30, SD = 12.08) were assessed for post-traumatic growth one year later. Psychological inflexibility and orientation acted as mediators between perceived stress and PTSD symptoms. Furthermore, a novel path model was constructed in which psychological inflexibility and orientation to the problem as mediators for perceived stress and PTSD symptoms. The indices for the path model were excellent: CFI = 0.99, TLI = 0.97, RMSEA = 0.055 [90%CI = 0.001–0.144], and SRMS = 0.49. Furthermore, PTSD symptoms, psychological inflexibility, and orientation to the problem predicted post-traumatic growth. Specifically, both orientation to the problem (β = .06 [90%CI: .01;.13]) and psychological inflexibility (β = .14 [90%CI: .08;.26]) had an indirect effect on post-traumatic growth. Overall, these results significantly contribute to the literature as orientation to the problem positively predicted PTSD symptoms and post-traumatic growth one year later while psychological inflexibility predicted PTSD symptoms and less post-traumatic growth one year later. These results underline the importance of assessing both symptomology and psychological growth to determine adaptive coping strategies in specific contexts.
... There are several mechanisms through which ER is affected by PTSD. Individuals who have experienced trauma frequently report difficulty identifying their emotional state (Frewen et al., 2008;McLean et al., 2006), trouble expressing emotions and suppression of negative emotion (Moore et al., 2008;Roemer et al., 2001), avoidance (Kashdan et al., 2009;Marx & Sloan, 2005), and self-reported problems with ER (Tull et al., 2007). PTSD avoidance symptoms have a negative impact on interpersonal relationships, which may influence the maintenance of emotion dysregulation and reduce functional capacity (Cloitre et al., 2002). ...
Objective:
This study examined trauma frequency, alcohol use, and posttraumatic stress disorder (PTSD) symptoms as predictors of emotion regulation (ER) difficulties among post-9/11 Veterans.
Method:
Seventy-four Veterans (95.5% male; mean age = 40; 45.9% Caucasian) completed questionnaires on demographics, PTSD symptoms, ER, trauma frequency, and drinking.
Results:
Positive correlations were observed between PTSD symptom severity and ER difficulties (r = .6, p < .001) and drinking behavior and emotion dysregulation (r = .25, p < .05). PTSD symptoms above the clinical cutoff resulted in significantly higher ER difficulties than subclinical symptoms, t(66) = -2.975, p < .01). Linear regressions revealed that PTSD accounted for 37% of the variance in ER difficulties, F(1, 66) = 37.34, p < .05. Cluster C was the only significant predictor of Difficulties in Emotion Regulation Scale (DERS) total scores (B = 1.40, p < .05). Regression analyses on DERS subscales were also examined. Both PTSD Checklist-Specific (PCL-S) total and Cluster C significantly predicted the subscales of nonacceptance (PCL-S total, B = .30, p < .001; Cluster C, B = .45, p < .05) and clarity (PCL-S total, B = .12, p < .05; Cluster C, B = .31, p < .05). PCL-S total predicted strategies (PCL-S total, B = .43, p < .01). PCL-S total was the only significant predictor of the DERS subscales of goals (B = .21, p < .001) and impulse (B = .27, p < .001). There were no significant predictors for the subscale of awareness.
Conclusion:
The findings will aid the development of targeted intervention strategies in Veterans. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... The special military preparation and the specific personal traits are the reason why we suppose that the effects of war conflicts on soldiers and civil society would be different and thus for the present article are examined only the effects on the Afghan society without particular focus on the military personnel. The most common effects of war on civil society are connected to fear, post-traumatic stress, desire for revenge, identity restructuring, anxiety, hatred, feelings of betrayal, ethnic prejudice, etc.(McAfee 1997; Centers for Disease Control and Prevention 1999; Woodside, Santa Barbara, and Benner 1999; Kaminer et al. 2001;Summerfield 2002;Turton 2002;Cardozo et al. 2004;Kashdan, Morina and Priebe 2009). To confirm whether these effects can also be found in Afghan society, we are asking about the observed effects of the war on the people of Afghanistan. ...
For Afghanistan, security is one of the last things the country can be associated with. Despite the efforts that have been made over the last decade, it is still too early to speak about political, economic, and institutional stability. Against this background of uncertainty, and despite the lack of legislation, funding, and investment tools, Afghanistan's flag is being played in the finals of many international events. Тhis is the phenomenon that provokes our research interest. The present aims to give a brief overview of the country's national sporting achievements and to examine the views of two key experts in the field to identify how the development of sport in the country influences the peace-making processes from a social perspective. The used methodology includes a semi-structured interview conducted independently with both respondents in 2019 which is analyzed in the context of social reconstruction of a war-torn society. The results show that national success in elite international sports events has a high potential to be an effective tool in neutralizing some of the negative social effects of war on the society (like distancing, hatred, identity restructuring, etc.) by bringing hope, creating role models, changing perceptions, uniting people under one flag, creating heroes.
... Experiential avoidance is defined as attempts to avoid private traumatic experiences (i.e., thoughts, feelings, memories, physical sensations), even if doing so causes long-term harm [9]. A growing body of literature suggests that experiential avoidance is the key diagnostic feature of PTSD [10][11][12][13]. ...
While chronic stress increases hyperpolarization-activated current (Ih) in dorsal hippocampal CA1 neurons, the underlying molecular mechanisms are entirely unknown. Following chronic social defeat stress (CSDS), susceptible mice displayed social avoidance and impaired spatial working memory, which were linked to decreased neuronal excitability, increased perisomatic hyperpolarization-activated cyclic nucleotide-gated (HCN) 1 protein expression, and elevated Ih in dorsal but not ventral CA1 neurons. In control mice, bath application of corticosterone reduced neuronal excitability, increased tetratricopeptide repeat–containing Rab8b-interacting protein (TRIP8b) and HCN1 protein expression, and elevated Ih in dorsal but not ventral CA1 region/neurons. Corticosterone-induced upregulation of functional Ih was mediated by the glucocorticoid receptor (GR), HCN channels, and the protein kinase A (PKA) but not the calcium/calmodulin-dependent protein kinase II (CaMKII) pathway. Three months after the end of CSDS, susceptible mice displayed persistent social avoidance when exposed to a novel aggressor. The sustained behavioral deficit was associated with lower neuronal excitability and higher functional Ih in dorsal CA1 neurons, both of which were unaffected by corticosterone treatment. Our findings show that corticosterone treatment mimics the pathophysiological effects of dorsal CA1 neurons/region found in susceptible mice. The aberrant expression of HCN1 protein along the somatodendritic axis of the dorsal hippocampal CA1 region might be the molecular mechanism driving susceptibility to social avoidance.
... ;Iverson, Follette, Pistorello & Fruzzetti, 2012;Jacob, Ower & Buchholz, 2013;Schramm, Venta & Sharp, 2013; Wheaton, Pinton & Wheaton, 2016;Yavuz et al., 2016), eating disorders(Cowdrey & Park, 2012;Fulton et al., 2012;Rawal, Park & Williams, 2010;Spinhoven et al., 2014), psychosis(Castilho et al., 2017;Varese et al., 2011) and mood disorders(Cribb, Moulds & Carter, 2006;Espejo, Gorlick & Castriotta, 2017;Kashdan et al., 2013;Kashdan, Morina & Priebe, 2009; Litwin et al., 2016; Spinhoven, van Hemert & Pennix, 2017;Vorontsova, Garety & Freeman, 2013). ...
People who have serious mental illness experience greater levels of early mortality compared to their mentally healthy counterparts (Chesney, Goodwin & Fazel, 2014). This early death is largely attributed to physical illnesses that are associated with obesity. Individuals who have serious mental illness and who are treated in secure psychiatric hospitals experience significant increases in their weight upon admission. Several factors predispose people with serious mental illness to weight gain and obesity. This thesis explored the factors that mediate weight gain and obesity maintenance in secure psychiatric inpatients. Study 1 used routine patient data to explore changes in body weight following admission into secure services. This established that patient's body weight on admission was a significant predictor of weight gain over the first twelve weeks of secure inpatient treatment. Study 2 explored the influence of cognitive factors known to influence eating behaviour, the data demonstrated that although the patient group displayed attentional bias to food cues this was not predictive of weight gain. Levels of emotional and disinhibited eating were associated with weight gain over 3 months. Study 3 explored psychological predictors of weight gain; it was found that anxious-preoccupied attachment style was associated with weight gain over 6 months. Study 4 explored staff member's views on how the secure psychiatric environment impacts on patient weight gain and obesity. A thematic analysis highlighted 5 themes: secure service culture, food culture, poor diet versus lack of physical activity, poor mental health, and weight management initiatives. The results of this thesis are discussed in terms of theoretical perspectives of psychological factors and the wider implications for understanding secure psychiatric inpatient obesity.
... as a post-conflict outcome. Depressive symptoms among PHC users were reported to be about 10% worldwide (10), while the prevalence of depressive symptoms reported in Kosovo far exceeds this, ranging from 30 to 67% (11)(12)(13)(14)(15). Depression has been linked to unhealthy behaviors such as smoking, physical inactivity, poor nutrition and alcohol consumption (16,17). ...
... According to the findings of this study, psychological inflexibility, as a transdiagnostic factor, has a mediating role in the relationship between emotional dysregulation and sleep problems with symptoms of emotional disorders. The findings showed that psychological inflexibility is related to symptoms of emotional disorders, which is consistent with other previous studies demonstrating the transdiagnostic role of psychological inflexibility in various types of psychological problems (Hayes et al., 2006;Kashdan et al., 2009;Giorgio et al., 2010;Newman and Llera, 2011;Fledderus et al., 2012;Levin et al., 2014;Ugur et al., 2021). Psychological inflexibility plays an important role in the development, maintenance, and exacerbation of psychological problems. ...
This study aims to investigate the mediating role of psychological inflexibility as a transdiagnostic factor in the relationship between emotional dysregulation and sleep problems with symptoms of emotional disorders. A total of 500 subjects from three universities were selected by random multistage clustering, and they completed the Pittsburgh Sleep Quality Index, Difficulties in Emotional Regulation Scale, and Acceptance and Action Questionnaire-II, Inventory of Depression and Anxiety Symptoms. The results of correlation coefficients revealed that there is a positive and significant correlation among emotional dysregulation, sleep problems, and psychological inflexibility with emotional disorders. In addition, the results showed that psychological inflexibility acts as a transdiagnostic factor that mediates the relationship between emotional dysregulation and sleep problems with symptoms of emotional disorders. These findings illustrate how emotional dysregulation and sleep problems affect emotional disorders through psychological inflexibility.
... as a post-conflict outcome. Depressive symptoms among PHC users were reported to be about 10% worldwide (10), while the prevalence of depressive symptoms reported in Kosovo far exceeds this, ranging from 30 to 67% (11)(12)(13)(14)(15). Depression has been linked to unhealthy behaviors such as smoking, physical inactivity, poor nutrition and alcohol consumption (16,17). ...
Objectives
Kosovo has the lowest life expectancy in the Balkans. Primary healthcare (PHC) plays an essential role in non-communicable disease (NCD) prevention. We described primary, secondary and tertiary prevention indicators in Kosovo and assessed their association with depressive symptoms.
Methods
PHC users ( n = 977) from the Kosovo NCD cohort baseline study were included. Depressive symptoms were assessed using the Depressive Anxiety Stress Scale-21. Cross-sectional associations between depressive symptoms and prevention indicators were quantified with mixed logistic regression models.
Results
Poor nutrition (85%), physical inactivity (70%), obesity (53%), and smoking (21%) were common NCD risk factors. Many cases of hypertension (19%), diabetes (16%) and Chronic Obstructive Pulmonary Disease (COPD) (45%) remained undetected by a PHC professional. Uncontrolled hypertension (28%), diabetes (79%), and COPD (76%) were also common. Depressive symptoms were positively associated with physical inactivity (OR 1.02; 95% CI 1.00–1.05 per 1-point increase in DASS-21) and undetected COPD (OR 1.07; 95% CI 1.00–1.15), but inversely with undetected diabetes (OR 0.95; 95% CI 0.91–1.00).
Conclusions
Continued attention and tailored modifications to primary, secondary and tertiary prevention in Kosovo are needed to narrow the Balkan health gap.
... This form of avoidance is positive until it limits individuals from performing daily functions [19]. Although escaping from such negative sensation can be regarded as a short form of positive EA, the concept has been linked with negative psychological outcomes, such as depression, anxiety, substance use, eating disorders, and negatively affects the quality of life [20,21]. ...
This study investigated the predictive roles of experiential avoidance on the relationship between death anxiety and health-related quality of life among diabetic patients. A total of one hundred and fi ve (105) participants (62; 58.5% females) participated in the study. The participant ages ranged from 21-75 years with a mean age of 53.45 and a standard deviation of 14.44. Participants were drawn using the convenience sampling technique and were administered the questionnaires before their consultations. Three instruments were used in data collation namely; the Death Anxiety Inventory-Revised (DAI-R), the Acceptance and Action Questionnaire (AAQ), and the Diabetes Quality of Life Questionnaire (DQOLQ). Four hypotheses were tested and the results showed that there was no signifi cant correlation between death anxiety and HRQoL (r=-.036), also, experiential avoidance didn't signifi cantly predict HRQoL (.411, p<.05), experiential avoidance didn't signifi cantly predict death anxiety (.534, p<.05), while experiential avoidance didn't predict the relationship between death anxiety and HRQoL (.757, p<.05). The researchers suggest that medical professionals in charge of diabetic patients should look beyond HRQoL and death anxiety in investigating whether there will be an occurrence of experiential avoidance.
... With regards to psychopathology, maintenance and development of mental health difficulties, avoidance is thought to play a pivotal role within this (Hayes et al., 2012). Kashdan et al. (2009) argued that whilst avoidance may be an adaptive strategy following a traumatic experience (such as direct combat), the learned response to specific emotions and thoughts can present as a challenge in day-to-day life situations. As a result, avoidance can interfere with day-to-day functioning; potentially blocking the pursuit of value-based goals and achieving positive wellbeing (Hayes et al., 2006). ...
Background: The 2019 coronavirus pandemic has posed a challenge to society to cope with an unprecedented threat. Veterans with pre-existing mental health conditions, such as PTSD, may be susceptible to further re-traumatisation due to COVID-19 restrictions and increased anxiety and depression. Bonding and a sense of connectedness with others are seen as basic psychological needs for maintaining wellbeing. Decreased social connectedness can play a significant role in creating barriers to coping and worsening psychological problems. As the pandemic progresses, the current UK restrictions may challenge veterans’ ability to function, and their abilities to cope, stay connected and adapt. Aims: This thesis had three primary aims: (1) to investigate the relationship between coping, depression, anxiety, traumatic stress, coronavirus anxiety, and social connectedness following COVID restrictions using a cross-sectional survey, (2) to use the results from the survey to inform qualitative data collection and recruitment to interviews, and (3) to gain an experiential understanding of the impact that COVID restrictions may have had from the veteran perspective. Method: A two-phase sequential explanatory design was used and involved two phases: (1) a cross-sectional survey exploring social connectedness, anxiety, depression, traumatic stress, coronavirus anxiety, and coping amongst UK veterans from all branches of the military (n=130). Participants were selected for interview from phase one using a ‘participant selection model’, and overall sample data informed the development of the interview schedule (2) a qualitative exploration of the impact of the pandemic on a sub-sample of the population (n=11) using semi-structured interviews, with transcripts being analysed using reflective thematic analysis. Participants were primarily recruited through social media and veteran charities. Maximum variation sampling was used to select participants for interviews. Results: Phase 1: Spearman’s rank correlations demonstrated a negative association between traumatic stress and social connectedness (
... The relationship of the perceptual bias with avoidance is remarkable considering the important role that avoidance coping plays in the development and maintenance of anxiety disorders (Craske et al., 2009;Hofmann, Alpers, & Pauli, 2009;Krypotos, Effting, Kindt, & Beckers, 2015). Moreover, avoidance impairs the quality of life in individuals with anxiety disorders (Kashdan, Morina, & Priebe, 2009) and leads to irrational avoidant decisions which can result in considerable cost. (Hengen & Alpers, 2021;Pittig, Brand, Pawlikowski, & Alpers, 2014). ...
What we see is the result of an efficient selection of cues in the visual stream. Not only physical characteristics but also emotional salience influences this process. Previously, we showed in spider phobic patients that fear-related pictures gain preferential access to consciousness in binocular rivalry. We set out to replicate this in an independent unselected sample and examine the relationship of this perceptual bias with a range of symptom clusters. To this end, we recruited 79 participants with variable degrees of fear of spiders. To induce binocular rivalry, a picture of either a spider or a flower was projected to one eye, and a neutral geometric pattern to the other eye. Participants continuously reported what they saw. We correlated indices of perceptual dominance (first percept, dominance duration) with individual fear of spiders and with scores on specific symptom clusters of fear of spiders (i.e., vigilance, fixation, and avoidance coping). Overall, higher fear of spiders correlates with more predominant spider pictures. In addition, this perceptual bias is uniquely associated with avoidance coping. Interestingly, this demonstrates that a perceptual bias, which is not intentionally controlled, is linked with an instrumental coping behavior, which has been implicated in the maintenance of pathological fear.
... EA reflects the unwillingness to engage with internal experiences that are uncomfortable or painful, including emotions, thoughts, or physical sensations (Hayes et al., 1996). Individuals higher in EA exhibit a tendency to avoid or attempt to control negative internal experiences and the contexts that cause them (Kashdan et al., 2009;Ottenbreit & Dobson, 2004). In non-COVID-19 related work, EA has been related to negative mental health for the Latinx population (Raines et al., 2018;Zvolensky et al., 2015). ...
Background
The outbreak of the novel 2019 SARS2-Coronavirus disease (COVID-19) has led to substantial psychological distress across the United States and the world. However, emerging work suggests that prominent COVID-19 consequences such as fear of COVID-19 infection and emotional distress resulting from economic adversity and social distancing may afflict the Latinx population disproportionately. The current study sought to investigate the influence of experiential avoidance (EA), or an individual’s tendency to rigidly avoid negative internal experiences (i.e. feelings, thoughts, etc.), on the severity of COVID-19 fear and emotional distress symptoms due to economic adversity and social distancing.Method
Participants included 188 Latinx persons recruited via an online survey panel program.ResultsResults indicated that EA was a statistically significant contributing factor to fear of COVID-19 and emotional distress associated with economic adversity and social distancing. These effects were evident over and above the variance accounted for by gender, years living in the United States, education, and COVID-19 related work and home life stress.Conclusions
Overall, the present work is the first to document empirically EA as it relates to fear of COVID-19 infection and related emotional distress resulting from economic adversity and social distancing among Latinx persons.
... Numri i studimeve filloi të zgjerohet, duke tejkaluar fokusin nga ÇSPT në çrregullime të tjera si depresioni, çrregullimet e ankthit social etj. dhe interferimi i tyre me kualitetin e jetës tek të mbijetuarit (Kashdan, Morina & Priebe, 2006). Iniciativa për të studiuar përtej ÇSPT u mbështet nga studime të cilat dokumentuan se spektri i reagimeve ndaj traumës në Kosovë është shumë më i gjerë dhe s'mund të përmblidhet vetëm me ÇSPT (Morina & Ford, 2008). ...
“Duke pasur parasysh faktin se monografia e studion traumën psikologjike dhe transmetimin e saj në kontekstin e Kosovës që historikisht njihet si shtet e territor ku me shekuj janë ballafaquar dhe kanë bashkëjetuar qytetërime me dallime të mëdha etnike, kulturore e fetare, ky studim shkencor fiton në peshë e relevancë për studimet e mëtutjeshme në këtë lëmi. Monografia në fjalë ofron bazament solid e të argumentuar për shqyrtimin e mirëfilltë analitik të aspekteve shumë shtresore të kësaj patologjie poliedrike të shëndetit mendor me implikime të shumëfishta sociale, ekonomike e politike.
Studiuesit, profesionistët e shëndetit mendor dhe politikëbërësit vendor mund të gjejnë, në këtë monografi, burim solid të informatave dhe argumenteve të zgjedhura shkencore përkitazi me traumën psikologjike dhe aspektet e ndryshme të transmetimit të saj në kontekstin Kosovar kundruar nëpër prizmën e studiuesve më eminentë botëror në këtë lëmi. Gjë që mund t’i ndihmojë ata në dizajnimin e intervenimeve adekuate parandaluese dhe terapeutike përkitazi me komorbiditetin e traumës psikologjike me patologjitë e ndryshme të shëndetit mendor, si dhe dizajnimin e modeleve multi-disciplinare të shërbimeve të shëndetit mendor për adresimin e tyre, të bazuara në modelin e reziliencës së familjes dhe komunitetit të gjërë, si dhe intervenimeve inovative parandaluese në komunitetin e mësimdhënësve.
Me gjuhën e saj të kuptueshme, qasjen integrative shumë sektoriale dhe paraqitjen sistematike të të dhënave relevante, monografia paraqet tekst të rëndësishëm akademik edhe për studentët, në veçanti ata të mjekësisë, psikologjisë, shkencave sociale, politike dhe të edukimit, duke u ofruar atyre mundësi për zhvillimin e të menduarit gjithëpërfshirës analitik në fushën e një teme me rëndësi strategjike për shtetin dhe shoqërinë.”
Prof. Ass. Dr. Sc. FERID AGANI
Recensent
Background: The devastation of the Syrian war can lead to a drastic re-evaluation of oneself and alteration in self-capacities. Yet, little is known regarding its impact on these domains among Syrian refugees.
Aims: To investigate the inter-relationship between trauma characteristics, trauma centrality, self-efficacy, emotional suppression, PTSD and psychiatric co-morbidity among Syrian refugees.
Methods: 1197 refugees from Turkey and Sweden completed the Harvard Trauma Questionnaire, General Health Questionnaire-28, Centrality of Event Scale, Generalized Self-Efficacy Scale and Courtauld Emotional Control Scale.
Results: Using the DSM-IV criteria for PTSD from the Harvard Trauma Questionnaire, 43% met the criteria. The PTSD group reported significantly higher levels of trauma characteristics, trauma centrality and psychiatric co-morbidity but a lower level of self-efficacy than the non-PTSD group. Trauma characteristics were positively associated with trauma centrality; trauma centrality was negatively correlated with self-efficacy. Contrary to hypothesis, self-efficacy was positively correlated with emotional suppression which was positively correlated with psychiatric co-morbidity but not PTSD.
Conclusions: The experience of war can lead to the emergence of PTSD among Syrian refugees. Exposure to war can alter self-perception, belief of personal mastery over one’s future and the way emotion is expressed, all of which can have specific effects on general psychological symptoms.
Intrapersonal affective styles and emotion regulation strategies have been studied at length and identified as predictors of affective distress (i.e., depression and anxiety symptoms). Less research has evaluated the extent to which distress is predicted by interpersonal factors, like how others respond to people's emotions. Perceived emotion invalidation is one interpersonal factor that occurs when people feel others have negatively evaluated their emotions as unacceptable. Across three studies with both online and college student samples, the current research evaluated perceived invalidation as a predictor of psychological distress while controlling for intrapersonal styles and emotion regulation strategies known to predict distress. Results revealed that perceived emotion invalidation predicted greater affective distress above and beyond: emotional reactivity and expressivity, negative affect, and emotion dysregulation (Study 1); cognitive and behavioral emotion regulation strategies (Study 2); and self-compassion, emotional intelligence, and experiential avoidance (Study 3). These findings suggest that how people perceive others to respond to their emotions contributes to distress more so than simply how people respond to or regulate their own emotions.
An in-depth review of the related literature shows that no scales or questionnaires have yet been designed on students’ attitudes towards Teacher’s Pet Phenomenon (TPP). To address this gap, this research aims to devise an instrument of students’ attitudes towards TPP and examines the role of students’ levels of study and Grade-Point-Average in their scores on the newly-designed scale. To this end, first, 30 graduate- and undergraduate students along with 15 university instructors were interviewed. Then, based on the identified themes, a scale was designed and 476 English language students participated in the quantitative phase. The findings demonstrated that the scale was reliable and valid, and the higher a student’s level of study and GPA, the more pet-prone s/he became, the more negative attitude s/he held, and the less probable it would be for him/her to be influenced by the unpleasant effects of TPP.
Military parents’ combat-related posttraumatic stress disorder (PTSD) symptoms have been linked to poor parenting and child maladjustment. Emotion regulation (ER) difficulties are thought to underlie PTSD symptoms, and research has begun to link parental ER to parenting behaviors. Little empirical evidence exists regarding whether fathers’ ER is associated with child adjustment and what may be the underlying mechanism for this association. This study investigated whether deployed fathers’ ER was associated with child emotional and behavioral problems, and whether the associations were mediated by coercive parenting behaviors. The sample consisted of 181 deployed fathers with non-deployed female partners and their 4- to 13-year-old children. Families were assessed at three time points over 2 years. ER was measured using a latent construct of fathers’ self-reports of their experiential avoidance, trait mindfulness, and difficulties in emotion regulation. Coercive parenting was observed via a series of home-based family interaction tasks. Child behaviors were assessed through parent- and child-report. Structural equation modeling revealed that fathers with poorer ER at baseline exhibited higher coercive parenting at 1-year follow-up, which was associated with more emotional and behavioral problems in children at 2-year follow-up. The indirect effect of coercive parenting was statistically significant. These findings suggest that fathers’ difficulties in ER may impede their effective parenting behaviors, and children’s adjustment problems might be amplified as a result of coercive interactions. Implications for the role of paternal ER on parenting interventions are discussed.
Social avoidance in the concept of “avoidance of corrective emotional experience” is regarded as one of the pathogenetic factors that aff ect the course and development of mental disorders and increase distress. We conducted a review of studies that studied the role of social avoidance in social anxiety disorder among individuals with or without post-traumatic experience. Inclusion criteria were: 1) subjects were diagnosed with social anxiety disorder; 2) social anxiety disorder and/or post-traumatic stress was a focus of the study; 3) some assessment or review impact of social avoidance was made; 4) subjects were adolescents or adults. The study of the role of avoiding social events as a traumatic trigger and related socially signifi cant factors (stigma, discrimination, living at constant risk, etc.) indicates a correlation between the pathogenesis of social phobia and comorbid symptoms of post-traumatic distress. Managing social avoidance strategies and accepting the conscious experience of social interaction presupposes a person’s readiness to react fl exibly, stay in contact with their emotions and thoughts, and not spend internal resources to get rid of the inner concerns. In our opinion, this will help reduce the perception of social events as a traumatic (retraumatic) factor, reduce clinically signifi cant manifestations of social anxiety and prevent the development of post-traumatic distress. Limitations and implications of these fi ndings for the psychological support and modifying psychotherapeutic interventions of social anxiety disorder are discussed.
This study examined the relations among psychological inflexibility (PI), symptoms, and quality of life dimensions in psychiatric patients. It also explored how PI was associated with coping and the mediating effect of coping on the relationships of PI to symptoms and quality of life dimensions. The sample was composed of 164 psychiatric patients. Before starting cognitive-behavior therapy, patients completed the measures of PI, coping, symptoms, and quality of life. PI positively correlated with symptoms, denial, venting, behavioral disengagement, and self-blame. It was also related to lowered dimensions of quality of life, positive reframing, and acceptance. Denial and venting mediated the association of PI with somatic symptoms, whereas acceptance mediated the impact of PI on depressive symptoms. These results evidence the linkages between PI and unhelpful coping strategies and highlight how these maladaptive strategies can also influence the negative effect of PI on symptoms and quality of life in psychiatric patients.
Aim(s): The war and its resulting stresses caused mental disorders as a prevalent problem in disabled veterans and their families. The aim of this study was to investigate the effectiveness of the spiritual-Islamic healing group therapy on increasing the resilience and life expectancy of veterans with mental disorders.
Instruments & Methods: This semi-experimental study with the pretest-posttest design was carried out on 30 people of veterans with mental disorders in Maragheh city in 2018. The subjects were selected by convenience sampling method and randomly assigned in to the two control and experimental groups (n=15 in each group). The research instruments were the Connor-Davidson resilience scale and Schneider life expectancy scale. The spiritual-Islamic healing group therapy was implemented for the experimental group in 8 sessions-in 90 minutes during the 10 weeks. Data were analyzed through SPSS 21 software using multivariable analysis of covariance test (MANCOVA).
Findings: By controlling the effect of the pretest, there was a significant difference between the mean scores of the posttest stage in the life expectancy and resilience in the control and experimental groups. After the intervention, the mean scores of these variables in the experimental group was higher than the control group (p
Acculturation processes are a key part of settling down in the new country although there are huge variations in responses and the pace at which people acculturate. In this chapter we use the example of Kosovan women after migration to the UK to explore the experiences of acculturation and its perceived impact on their psychological well-being. Six participants were interviewed, and transcripts were analyzed using interpretative phenomenological analysis. Four major themes emerged: decisions influencing migration, the early phase of UK life, the process of acculturating and implications of the acculturation experience for oneself. The psychological impact of acculturation and migration process was ascertained through their understanding of acculturation and their relationships with Kosovo and the UK. Acculturation was experienced as both an accomplishment and as an emotional challenge in response to conflicts and tensions related to their sense of ethnic identity and belonging. Not surprisingly these participants employed a number of strategies to cope with their migration difficulties and positioned themselves positively towards new cultures, revealing an appreciation of the UK’s multiculturalism. Theoretical implications and relevance of the findings to the field of mental health are described with suggestions for further exploration.
Acculturation processes are a key part of settling down in the new country although there are huge variations in responses and the pace at which people acculturate. In this chapter we use the example of Kosovan women after migration to the UK to explore the experiences of acculturation and its perceived impact on their psychological well-being was conducted. Six participants were interviewed, and transcripts were analyzed using interpretative phenomenological analysis. Four major themes emerged: decisions influencing migration, early phase of UK life, the process of acculturating and implications of the acculturation experience for oneself. The psychological impact of acculturation and migration process was ascertained through their understanding of acculturation and their relationships with Kosovo and the UK. Acculturation was experienced as both an accomplishment and as an emotional challenge in response to conflicts and tensions related to their sense of ethnic identity and belonging. Not surprisingly these participants employed a number of strategies to cope with their migration difficulties and positioned themselves positively towards new cultures, revealing an appreciation of the UK’s multiculturalism. Theoretical implications and relevance of the findings to the field of counselling psychology are described with suggestions for further exploration.
Introduction: Mental health in Kashmir remains a concern and is threatening to become an ever-increasing epidemic. The changing social structure and the low-intensity armed conflict have become the basis of a deteriorating state of mental health among Kashmiris. In addition to this, the other factors are widespread poverty, uncertainty, grief, oppression, fear and high unemployment with limited employment generating sectors. Aim: To assess the depression, anxiety and mental distress among the adult population of Budgam district, Kashmir, India. Materials and Methods: A cross-sectional study was conducted at the community level in District Budgam, Jammu and Kashmir, India, from December 2019 to March 2020. Total three Investigators, one Senior Research Fellow (SRF) and two Junior Research Fellow (JRF) collected the data. The SRF was a Clinical Psychologist while the JRF were trained social workers. A door to door survey was conducted in the villages which were selected randomly from the list of the villages.The probability random sampling technique was used for the research purpose. Hopkins Symptoms Checklist-25 (HSCL-25) was used in the study and whereby after analysing the scores of the scale, results were derived. Chi-square and t-test were applied for statistical comparison. Results: Out of 133 individuals, 55 were males and 78 were females.The age of the sample ranged from 18 to 45 years, with a mean age of 37 years. Total 29.32% of the adults scored above the cut-off for anxiety symptoms and 34.58% scored above the cut-off for depressive symptoms, while 39% of these adults fall above the cut-off for mental distress scores.The validated cut-off score for the anxiety was 1.75 and for the depression was 1.57. Feeling tense, being worried, nervousness and low energy were reported as the symptoms of the mental distress among the people. Females, unemployed and individuals from lower socio-economic status reported higher degree of mental distress than others. Conclusion: Mental health issues in terms of anxiety, depression, and mental distress are found among the adult population in district Budgam. There was a significant mean difference in the mental distress levels concerning various socio-demographic variables. The study concluded that being female, having some medical condition, being unemployed, belonging to lower socioeconomic status, belonging to nuclear family predict mental health distress.
This study investigated the predictive roles of experiential avoidance on the relationship between death anxiety and health-related quality of life among diabetic patients. A total of one hundred and five (105) participants (62; 58.5% females) participated in the study. The participant ages ranged from 21-75 years with a mean age of 53.45 and a standard deviation of 14.44. Participants were drawn using the convenience sampling technique and were administered the questionnaires before their consultations. Three instruments were used in data collation namely; the Death Anxiety Inventory-Revised (DAI-R), the Acceptance and Action Questionnaire (AAQ), and the Diabetes Quality of Life Questionnaire (DQOLQ). Four hypotheses were tested and the results showed that there was no significant correlation between death anxiety and HRQoL (r=-.036), also, experiential avoidance didn’t significantly predict HRQoL (.411, p<.05), experiential avoidance didn’t significantly predict death anxiety (.534, p<.05), while experiential avoidance didn’t predict the relationship between death anxiety and HRQoL (.757, p<.05). The researchers suggest that medical professionals in charge of diabetic patients should look beyond HRQoL and death anxiety in investigating whether there will be an occurrence of experiential avoidance.
LAY SUMMARY
Interdisciplinary pain rehabilitation programs are effective in treating chronic pain. Not many studies have explored how Veterans differ from civilians in responding to treatment. In this study, several measures were administered at different time points to examine and compare the long-term treatment outcomes of Veteran and civilian men and women. Results from 67 participants showed an overall long-term improvement in levels of pain-related disability, anxiety, and depression, as well as many other pain-related variables. While no differences in treatment outcomes between Veterans and civilians were found, men and women showed some differences. Women reported higher depressive symptoms overall and more pain-related disability than men at follow-up from the program. This study demonstrates the long-term effectiveness of interdisciplinary pain management programs regardless of Veteran status. It highlights some differences between genders. Previous studies have not compared the long-term outcomes of Veterans and civilians from an interdisciplinary program.
Values-based interventions encourage engagement in valued living as a means to promote psychological well-being. Valued living is best operationalized as ongoing, reinforcing behavioral patterns consistent with idiographic values that facilitate psychological well-being and improved mental health. Cross-sectional research illustrates positive associations between valued living and well-being and negative associations between valued living and psychopathology. However, it is important to have an understanding of different daily-level factors that predict fluctuations in valued living. Consistent with cognitive and behavioral models, meaning may positively relate to engagement in valued living, while experiential avoidance negatively relates to valued living. To address these relationships at the daily level, we systematically examined valued living, meaning, and experiential avoidance using ecological momentary assessment across 14 days with 73 college students. Multilevel modeling supported a positive relationship between meaning (i.e., at both the within- and between-person level) and daily valued living, above and beyond the within-person effects of experiential avoidance. The results elucidate a daily link between valued living and aspects of well-being. Further, these results show that constructs commonly assessed cross-sectionally fluctuate at the daily level, which sets the stage for future research programs that examine factors promoting and inhibiting fluctuations in meaning, experiential avoidance, and valued living. These results have important implications for prevention of mental health problems and promotion of psychological well-being.
Aims: The psychological effects of war, such as post-traumatic stress disorder, may persist for years after the war. The aim of this study was to estimate the rate of post-traumatic stress disorder and its related factors in the elderly survivors of the bombing in Ilam.
Instrument & Methods: The present study was performed by retrospective cohort method on 227 elderly survivors of the imposed war living in Ilam City, Iran, in 2019 who were selected by multi-stage proportional random sampling. The NSESSS-PTSD instrument was used to measure post-traumatic stress disorder. Used descriptive and inferential statistics (independent t-test, ANOVA, and Correlation) for data analysis by SPSS 23 software.
Findings: The mean age of the elderly participating in the study was 66.67±7.16 years. 54.2% of participants were female. There was a significant relationship between marital status, employment, witnessing injuries and deaths, age at wartime and gender, and post-traumatic stress disorder. There was a significant relationship between current chronic patients and post-traumatic stress disorder.
Conclusion: 16.3% of the elderly survivors of the bombing of the Iran-Iraq war in Ilam have post-traumatic stress disorder.
Refugees endure incredible adversity, including torture. Although many refugees report traumatic stress reactions, they also demonstrate considerable resilience. Among refugees, torture survivors have demonstrated greater symptom severity as well as greater resilience than those who have not reported torture. The contrast of these results suggests potential mediators. Psychological inflexibility is one process predictive of posttraumatic stress symptoms. However, this process has rarely been studied among refugees or survivors of torture. Thus, we examined psychological inflexibility as a mediator between torture and traumatic stress symptoms among resettled refugees (n = 71; 55% female; mean age = 41.48; 63% reported torture). Psychological inflexibility fully mediated the relationship between torture status and traumatic stress symptoms in two simple mediation models. Results demonstrate the impact of psychological inflexibility on refugee mental health and have implications for clinical care.
Evidence-based treatments for posttraumatic stress disorder (PTSD) are available for veterans, but many do not benefit due to low treatment engagement. This may be partially due to avoidance behaviors characteristic of individuals with PTSD. Acceptance and Commitment Therapy (ACT) is a transdiagnostic treatment approach that aims to reduce avoidance. The authors propose the use of adjunctive ACT techniques to enhance engagement with treatment for PTSD. ACT techniques such as cognitive defusion and values clarification have been shown to promote engagement with other cognitive-behavioral treatments, but no studies to date have examined these techniques as adjuncts to treatment for PTSD. Because of its focus on reducing avoidance, ACT is uniquely suited for promoting treatment engagement with the "gold standard" treatments for PTSD. The authors review the existing research on ACT as an adjunctive intervention, discuss specific concepts and techniques from ACT that are relevant to PTSD, and provide recommendations for future research.
The original version of this article unfortunately contained a mistake.
Posttraumatic stress disorder (PTSD) is a common reaction to traumatic events. Many people recover in the ensuing months, but in a significant subgroup the symptoms persist, often for years. A cognitive model of persistence of PTSD is proposed. It is suggested that PTSD becomes persistent when individuals process the trauma in a way that leads to a sense of serious, current threat. The sense of threat arises as a consequence of: (1) excessively negative appraisals of the trauma and/or ist sequelae and (2) a disturbance of autobiographical memory characterised by poor elaboration and contextualisation, strong associative memory and strong perceptual priming. Change in the negative appraisals and the trauma memory are prevented by a series of problematic behavioural and cognitive strategies. The model is consistent with the main clinical features of PTSD, helps explain several apparently puzzling phenomena and provides a framework for treatment by identifying three key targets for change. Recent studies provided preliminary support for several aspects of the model.
In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators. (46 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The present study describes the development of a short, general measure of experiential avoidance, based on a specific theoretical approach to this process. A theoretically driven iterative exploratory analysis using structural equation modeling on data from a clinical sample yielded a single factor comprising 9 items, A fully confirmatory factor analysis upheld this same 9-item factor in an independent clinical sample. The operational characteristics of the Acceptance and Action Questionnaire (AAO) were then examined in 8 additional samples. All totaled, over 2,400
The present study describes the development of a short, general measure of experiential avoidance, based on a specific theoretical approach to this process. A theoretically driven iterative exploratory analysis using structural equation modeling on data from a clinical sample yielded a single factor comprising 9 items. A fully confirmatory factor analysis upheld this same 9-item factor in an independent clinical sample. The operational characteristics of the Acceptance and Action Questionnaire (AAQ) were then examined in 8 additional samples. All totaled, over 2,400 participants were studied. As expected, higher levels of experiential avoidance were associated with higher levels of general psychopathology, depression, anxiety, a variety of specific fears, trauma, and a lower quality of life. The AAQ related to more specific measures of avoidant coping and to self-deceptive positivity, but the relation to psychopathology could not be fully accounted for by these alternative measures. The data provide some initial support for the model of experiential avoidance based on Relational Frame Theory that is incorporated into Acceptance and Commitment Therapy, and provides researchers with a preliminary measure for use in population-based studies on experiential avoidance.
Syndromal classification is a well-developed diagnostic system but has failed to deliver on its promise of the identification of functional pathological processes. Functional analysis is tightly connected to treatment but has failed to develop testable, replicable classification systems. Functional diagnostic dimensions are suggested as a way to develop the functional classification approach, and experiential avoidance is described as 1 such dimension. A wide range of research is reviewed showing that many forms of psychopathology can be conceptualized as unhealthy efforts to escape and avoid emotions, thoughts, memories, and other private experiences. It is argued that experiential avoidance, as a functional diagnostic dimension, has the potential to integrate the efforts and findings of researchers from a wide variety of theoretical paradigms, research interests, and clinical domains and to lead to testable new approaches to the analysis and treatment of behavioral disorders. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The present study investigates experiential avoidance and forgiveness, two general
response styles to emotional distress that may impact reactions to trauma exposure,
as potential mediators of the link between interpersonal trauma exposure and
Posttraumatic Stress Disorder (PTSD) symptoms in a cross–sectional survey of 229
undergraduate students reporting interpersonal trauma exposure. Utilizing structural
equation modeling techniques, both constructs were found to significantly
partially mediate the relation between interpersonal trauma exposure and PTSD
symptoms; experiential avoidance reduced the relation between interpersonal
trauma exposure and PTSD symptoms by 22% while forgiveness reduced this relation
by 14%. Thus, individuals who were lower in forgiveness and higher in experiential
avoidance reported higher PTSD symptoms than those higher in forgiveness
and lower in experiential avoidance. Implications for treatment and prevention of
PTSD symptoms are discussed.
Psychological abuse in childhood has been linked to psychological
distress in adulthood, although the interceding variables or
possible mediators for the adult distress have not been adequately examined.
Identification of mediating variables may provide important opportunities
for targeting intervention and prevention efforts following
psychological abuse. Experiential avoidance, a response style characterized
by avoidance of negative private events, was examined as a potential
mediator of the relationship between reports of childhood psychological
abuse and current mental health symptoms in a cross-sectional
sample of 987 college undergraduates. Utilizing structural equation
modeling techniques, experiential avoidance was found to significantly
mediate the relationship between childhood psychological abuse and
current mental health symptoms, reducing the direct effect by 77%. A
history of childhood psychological abuse was related to increased levels
of experiential avoidance and current mental health symptoms, and experiential
avoidance was also directly related to increased levels of current
mental health symptoms. Implications for treatment following
psychological abuse are discussed.
Analytical solutions for point and variance estimators of the mediated effect, the ratio of the mediated to the direct effect, and the proportion of the total effect that is mediated were studied with statistical simulations. We compared several approximate solutions based on the multivariate delta method and second order Taylor series expansions to the empirical standard deviation of each estimator and theoretical standard error when available. The simulations consisted of 500 replications of three normally distributed variables for eight sample sizes (N = 10, 25, 50, 100, 500, 1000, and 5000) and 64 parameter value combinations. The different solutions for the standard error of the indirect effect were very similar for sample sizes of at least 50, except when the independent variable was dichotomized. A sample size of at least 500 was needed for accurate point and variance estimates of the proportion mediated. The point and variance estimates of the ratio of the mediated to nonmediated effect did not stabilize until the sample size was 2,000 for the all continuous variable case. Implications for the estimation of mediated effects in experimental and nonexperimental studies are discussed.
This study aimed at examining diagnostic concordance between Prolonged Grief Disorder (PGD), Major Depressive Disorder (MDD), and Posttraumatic Stress Disorder (PTSD) among bereaved war survivors who had lost relatives due to war-related violence.
We investigated the rates of PGD and its association with PTSD and MDD among 60 bereaved people who had lost first-degree relatives due to war-related violence seven years ago and had also experienced other war-related events.
The results indicated that 38.3% of the sample fulfilled the criteria for PGD, 55.0% for PTSD, and 38.3% for MDD. Thirty per cent of the participants without PTSD and 21.6% of those without MDD met criteria for PGD. Women were more likely to have PGD than men. The immediate threat to life was significantly associated with an elevated risk for PTSD and MDD, but not PGD.
The findings suggest that many cases of PGD would be missed by an exclusive focus on PTSD among bereaved war survivors.
The impact of war trauma on civilians may include, but also extend beyond, post-traumatic stress disorder (PTSD) to include complex sequelae such as those described by the syndrome of Disorders of Extreme Stress Not Otherwise Specified (DESNOS).
In the present study, 102 civilian war victims were interviewed in Kosovo, assessing traumatic life events, PTSD, DESNOS, and depression.
Full DESNOS rarely occurred (2% prevalence), however, clinically significant DESNOS symptoms of somatization, altered relationships, and altered systems of meaning were reported by between 24-42% of respondents. Although DESNOS symptoms were correlated with PTSD symptoms, DESNOS symptoms were associated with poorer overall psychological functioning, self-evaluations, satisfaction with life, and social support independent of the effects of PTSD.
The findings suggest that DESNOS warrants attention in addition to PTSD in the assessment and treatment of civilians who have been exposed to war and genocide.
Extrapolating from B. L. Fredrickson's (1998, 2001) broaden-and-build theory of positive emotions, the authors hypothesized that positive emotions are active ingredients within trait resilience. U.S. college students (18 men and 28 women) were tested in early 2001 and again in the weeks following the September 11th terrorist attacks. Mediational analyses showed that positive emotions experienced in the wake of the attacks - gratitude, interest, love, and so forth - fully accounted for the relations between (a) precrisis resilience and later development of depressive symptoms and (b) precrisis resilience and postcrisis growth in psychological resources. Findings suggest that positive emotions in the aftermath of crises buffer resilient people against depression and fuel thriving, consistent with the broaden-and-build theory. Discussion touches on implications for coping.
Posttraumatic stress disorder (PTSD) is a psychiatric condition that is directly precipitated by an event that threatens a person's life or physical integrity and that invokes a response of fear, helplessness, or horror. In recent years it has become clear that only a proportion of those exposed to fear-producing events develop or sustain PTSD. Thus, it seems that an important challenge is to elucidate aberrations in the normal fear response that might precipitate trauma-related psychiatric disorder. This paper summarizes the findings from recent studies that examined the acute and longer term biological response to traumatic stress in people appearing to the emergency room immediately following trauma exposure. In the aggregate, these studies have demonstrated increased heart rate and lower cortisol levels at the time of the traumatic event in those who have PTSD at a follow-up time compared to those who do not. In contrast, certain features associated with PTSD, such as intrusive symptoms and exaggerated startle responses, are only manifest weeks after the trauma. The findings suggest that the development of PTSD may be facilitated by an atypical biological response in the immediate aftermath of a traumatic event, which in turn leads to a maladaptive psychological state.
Confirmatory factor analysis was used to compare 6 models of posttraumatic Stress disorder (PTSD) symptoms, ranging from I to 4 factors, in a sample of 3,695 deployed Gulf War veterans (N = 1,896) and nondeployed controls (N = 1,799). The 4 correlated factors-intrusions, avoidance, hyperarousal; and dysphoria-provided the best fit. The dysphoria factor combined traditional markers of numbing and hyperarousal. Model superiority was cross-validated in multiple subsamples, including a subset of deployed participants who were exposed to traumatic combat stressors. Moreover, convergent and discriminant validity correlations suggested that intrusions may be relatively specific to PTSD, whereas dysphoria may represent a nonspecific component of many disorders. Results are discussed in the context of hierarchical models of anxiety and depression.
The authors examined the relationship over time of posttraumatic stress disorder (PTSD) and depression symptoms in a sample of Gulf War veterans. A large sample (N = 2,949) of Gulf War veterans was assessed immediately following their return from the Gulf region. and 18-24 months later. Participants completed a number of self-report questionnaires including the Mississippi Scale for Combat-Related PTSD (T. M. Keane, J. M. Caddell, & K. L. Taylor, 1988) and the Brief Symptom Inventory (L. R. Derogatis & N. Melisaratos, 1983) at both time points and an extended and updated version of the Laufer Combat Scale (M. Gallops, R. S. Laufer, & T. Yager, 1981) at the initial assessment. A latent-variable, cross-lag panel model found evidence for a reciprocal relation between PTSD and Depression. Follow-up models examining reexperiencing, avoidance-numbing, and hyperarousal symptoms separately showed that for reexperiencing and avoidance-numbing symptoms, the overall reciprocal relation held. For hyperarousal symptoms, however, the association was from early hyperarousal to later depression symptoms only.
Worldwide, post-traumatic stress disorder (PTSD) is among the most common psychological disorders; over the past three decades researchers have made considerable progress in understanding the prevalence of PTSD and its psychological and biological underpinnings, while developing methods for its assessment and treatment. Only included in the diagnostic nomenclature since 1980, the history of PTSD extends as far back as the oldest literature in Western civilization. Homer's Iliad and Odyssey capture the impact of war on combatants and civilians, as do many of the works of writers and artists across the centuries. The focus of this chapter is on the integration of contemporary work on traumatic stress exposure, psychological dissociation, and the development of PTSD, a disorder characterized by concurrent high levels of anxiety and depression and, in many instances, considerable chronicity and disability. More than 50 randomized controlled treatment outcome studies suggest that cognitivebehavioral treatments are especially effective, and support the use of exposure therapy, stress management therapy, cognitive therapy, cognitive processing therapy, and eye movement desensitization and reprocessing in treating PTSD. All these approaches constitute key evidence-based psychological treatments for PTSD. Future work will determine which treatments used by which therapists are best for patients with specific symptoms and concomitant conditions.
Errors in Byline, Author Affiliations, and Acknowledgment. In the Original Article titled “Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication,” published in the June issue of the ARCHIVES (2005;62:617-627), an author’s name was inadvertently omitted from the byline on page 617. The byline should have appeared as follows: “Ronald C. Kessler, PhD; Wai Tat Chiu, AM; Olga Demler, MA, MS; Kathleen R. Merikangas, PhD; Ellen E. Walters, MS.” Also on that page, the affiliations paragraph should have appeared as follows: Department of Health Care Policy, Harvard Medical School, Boston, Mass (Drs Kessler, Chiu, Demler, and Walters); Section on Developmental Genetic Epidemiology, National Institute of Mental Health, Bethesda, Md (Dr Merikangas). On page 626, the acknowledgment paragraph should have appeared as follows: We thank Jerry Garcia, BA, Sara Belopavlovich, BA, Eric Bourke, BA, and Todd Strauss, MAT, for assistance with manuscript preparation and the staff of the WMH Data Collection and Data Analysis Coordination Centres for assistance with instrumentation, fieldwork, and consultation on the data analysis. We appreciate the helpful comments of William Eaton, PhD, Michael Von Korff, ScD, and Hans-Ulrich Wittchen, PhD, on earlier manuscripts. Online versions of this article on the Archives of General Psychiatry Web site were corrected on June 10, 2005.
In this commentary we review the theoretical positions of Roemer and Orsillo and identify several key issues. First, the specificity of their arguments to generalized anxiety disorder (CAD) compared to the other anxiety disorders are explored. For example, the proposed distinctions between worry in CAD and worry associated with the other anxiety disorders are examined in light of available empirical evidence. Second, the proposed disjunctions between mental content and both actual experience and emotional/physiological responding are placed in the context of current theoretical and empirical work. Finally, possible therapeutic mechanisms of change for mindfulness/acceptance-based treatments and the roles of control and predictability in anxiety disorder treatment are discussed.
Errors in Byline, Author Affiliations, and Acknowledgment. In the Original Article titled “Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication,” published in the June issue of the ARCHIVES (2005;62:593-602), an author’s name was inadvertently omitted from the byline and author affiliations footnote on page 592, and another author’s affiliation was listed incorrectly. The byline should have appeared as follows: “Ronald C. Kessler, PhD; Patricia Berglund, MBA; Olga Demler, MA, MS; Robert Jin, MA; Kathleen R. Merikangas, PhD; Ellen E. Walters, MS.” The author affiliations footnote should have appeared as follows: “Author Affiliations: Department of Health Care Policy, Harvard Medical School, Boston, Mass (Dr Kessler; Mss Demler and Walters; and Mr Jin); Institute for Social Research, University of Michigan, Ann Arbor (Ms Berglund); and Section on Developmental Genetic Epidemiology, National Institute of Mental Health, Rockville, Md (Dr Merikangas).” On page 601, the first sentence of the acknowledgment should have appeared as follows: “The authors appreciate the helpful comments of William Eaton, PhD, and Michael Von Korff, ScD.” Online versions of this article on the Archives of General Psychiatry Web site were corrected on June 10, 2005.
The ascendance of emotion theory recent advances in cognitive science and neuroscience, and increasingly important findings from developmental psychology and learning make possible an integrative account of the nature and etiology of anxiety and its disorders. This model specifies an integrated set of triple vulnerabilities: a generalized biological (heritable) vulnerability, a generalized psychological vulnerability based on early experiences in developing a sense of control over salient events, and a more specific psychological vulnerability in which one learns to focus anxiety on specific objects or situations. The author recounts rite development of anxiety and related disorders based on these triple vulnerabilities and discusses implications for the classification of emotional disorders.
Armed conflict is a major cause of injury and death worldwide, but we need much better methods of quantification before we can accurately assess its effectArmed conflict between warring states and groups within states have been major causes of ill health and mortality for most of human history. Conflict obviously causes deaths and injuries on the battlefield, but also health consequences from the displacement of populations, the breakdown of health and social services, and the heightened risk of disease transmission. Despite the size of the health consequences, military conflict has not received the same attention from public health research and policy as many other causes of illness and death. In contrast, political scientists have long studied the causes of war but have primarily been interested in the decision of elite groups to go to war, not in human death and misery.We review the limited knowledge on the health consequences of conflict, suggest ways to improve measurement, and discuss the potential for risk assessment and for preventing and ameliorating the consequences of conflict. Summary points Conflict related death and injury are major contributors to the global burden of disease Information systems break down during conflict, leading to great uncertainty in the magnitude of mortality and disability The World Health Survey may provide a reliable and valid basis for assessing conflict related mortality and disability Forecasting models may provide a plausible basis for assessing risk of conflict and thus prevention Improved collaboration between political scientists and experts in public health would benefit measurement, prediction, and prevention of conflict related death
The Mini International Neuropsychiatric Interview (MINI) is a short diagnostic structured interview (DSI) developed in France and the United States to explore 17 disorders according to Diagnostic and Statistical Manual (DSM)-III-R diagnostic criteria. It is fully structured to allow administration by non-specialized interviewers. In order to keep it short it focuses on the existence of current disorders. For each disorder, one or two screening questions rule out the diagnosis when answered negatively. Probes for severity, disability or medically explained symptoms are not explored symptom-by-symptom. Two joint papers present the inter-rater and test-retest reliability of the Mini the validity versus the Composite International Diagnostic Interview (CIDI) (this paper) and the Structured Clinical Interview for DSM-IH-R patients (SCID) (joint paper). Three-hundred and forty-six patients (296 psychiatric and 50 non-psychiatric) were administered the MINI and the CIDI ‘gold standard’. Forty two were interviewed by two investigators and 42 interviewed subsequently within two days. Interviewers were trained to use both instruments. The mean duration of the interview was 21 min with the MINI and 92 for corresponding sections of the CIDI. Kappa coefficient, sensitivity and specificity were good or very good for all diagnoses with the exception of generalized anxietydisorder (GAD) (kappa = 0.36), agoraphobia (sensitivity = 0.59) and bulimia (kappa = 0.53). Inter-rater and test-retest reliability were good. The main reasons for discrepancies were identified. The MINI provided reliable DSM-HI-R diagnoses within a short time frame, The study permitted improvements in the formulations for GAD and agoraphobia in the current DSM-IV version of the MINI.
This study investigated 3 broad classes of individual-differences variables (job-search motives, competencies, and constraints) as predictors of job-search intensity among 292 unemployed job seekers. Also assessed was the relationship between job-search intensity and reemployment success in a longitudinal context. Results show significant relationships between the predictors employment commitment, financial hardship, job-search self-efficacy, and motivation control and the outcome job-search intensity. Support was not found for a relationship between perceived job-search constraints and job-search intensity. Motivation control was highlighted as the only lagged predictor of job-search intensity over time for those who were continuously unemployed. Job-search intensity predicted Time 2 reemployment status for the sample as a whole, but not reemployment quality for those who found jobs over the study's duration. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The present article reports on the development and validation of a self-report measure of posttraumatic stress disorder (PTSD), the Posttraumatic Diagnostic Scale (PTDS), that yields both a PTSD diagnosis according to
Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994
DSM-IV) criteria and a measure of PTSD symptom severity. Two-hundred forty-eight participants who had experienced a wide variety of traumas (e.g., accident, fire, natural disaster, assault, combat) were administered the PTSD module of the Structured Clinical Interview (SCID; Spitzer, Williams, Gibbons, & First, 1990), the PTDS, and scales measuring trauma-related psychopathology. The PTDS demonstrated high internal consistency and test-retest reliability, high diagnostic agreement with SCID, and good sensitivity and specificity. The satisfactory validity of the PTDS was further supported by its high correlations with other measures of trauma-related psychopathology. Therefore, the PTDS appears to be a useful tool for screening and assessing current PTSD in clinical and research settings. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Reports on the development of the Lancashire Quality of Life Profile by G. W. Torrance (1987) for evaluating services to the chronically mentally ill. The term "quality of life" is defined and its components enumerated. The process of questionnaire piloting is recounted, and the results of reliability and validity testing procedures are presented and discussed. The profile was found to be reliable and valid to acceptable levels, easy to administer, and well received by clients. However, problems have been encountered in worker compliance with routine evaluation within service settings that can affect implementation. (PsycINFO Database Record (c) 2012 APA, all rights reserved)