Experiential Avoidance and Emotion Regulation in Borderline Personality Disorder

Many of the severe behavioral difficulties observed among persons with BPD (e.g., self-harm, suicidal behaviors) have been conceptualized as attempts to avoid or escape unwanted emotional experiences. As such, experiential avoidance likely plays a prominent role in the difficulties faced by persons with BPD. Individuals with BPD have demonstrated heightened levels of experiential avoidance in several studies. Several key features of BPD may contribute to experiential avoidance among persons with BPD, including a vulnerability to negative or distressing emotions, difficulty regulating emotions, and distress intolerance. Some research also suggests that a vulnerability to negative emotions among persons with BPD may be partly due to the use of experiential avoidance strategies to cope with emotional experiences. Within this paper, we review the literature on experiential avoidance and possible mechanisms underlying experiential avoidance among persons with BPD, and discuss the research and clinical implications of this literature.     

Running away from unwanted feelings: Culture matters

Findings from past research have suggested a link between experiential avoidance and expressive suppression. However, there is emerging evidence showing that the suppression of emotional expression may have different meanings depending on the specific cultural context. Taking a cultural perspective, the present study aimed to examine whether the link between experiential avoidance and expressive suppression is comparable or divergent between two cultural groups [i.e., European Americans (EAs) and Chinese (CH)] with different cultural norms surrounding emotional expression. We hypothesised that the positive association between experiential avoidance and expressive suppression typically found among EAs would be attenuated among CH. Furthermore, the observed cultural group difference in the experiential avoidance–suppression link was hypothesised to be mediated by beliefs in emotional self-control. Data from 224 EA college students and 190 CH college students provided a clear pattern of support for our hypotheses. Implications for current theories on experiential avoidance are discussed.     

The face of memory: experiential avoidance and facial expressions during the retrieval of autobiographical memories

ABSTRACT

Experiential avoidance refers to attempts to control or suppress unwanted thoughts, feelings and emotions. We investigated whether experiential avoidance is associated with fewer facial expressions during autobiographical retrieval (i.e. retrieval of memory for personal information). We invited participants to retrieve autobiographical memories, and recall was analysed by a facial analysis software that detects and classifies emotional expressions. Participants were divided into high vs. low experiential avoidance. Analysis showed fewer emotional facial expressions in participants with high experiential avoidance than in those with low experiential avoidance during autobiographical retrieval. This low emotional expression can be regarded as an attempt by individuals with high experiential avoidance to avoid communicating the emotional load to others. This low emotional expression can be also regarded as an attempt by individuals with high experiential avoidance to control or suppress the internal events that contribute to the appearance or persistence of unwanted emotional states during retrieval.     

Thought suppression and self-injurious thoughts and behaviors

This study proposes and tests a theoretical model suggesting that the propensity to suppress unwanted thoughts is associated with an increased presence and frequency of self-injurious thoughts and behaviors (SITB). In the model, propensity to suppress unwanted thoughts is hypothesized to be a cognitive mediator of the relationship between emotional reactivity and SITB, and is expected to be related to the extent to which SITB is initiated to escape from aversive emotions. Results of this cross-sectional study of adolescents (N=87) revealed that the self-reported propensity to suppress unwanted thoughts is associated with the presence and frequency of non-suicidal self-injury (NSSI), suicidal ideation, and suicide attempts. Furthermore, thought suppression partially mediates the relationship between emotional reactivity and the frequency of NSSI and suicidal ideation. Finally, adolescents with a higher tendency to suppress unwanted thoughts report engaging in NSSI in order to reduce aversive emotions rather than for social communication. Results are discussed within the framework of the negative reinforcement function of SITB.     

Mindfulness in the Treatment of Suicidal Individuals

Suicidal behavior is exhibited by a diverse population of individuals and spans many diagnostic categories. In order to develop effective prevention and treatment programs, it is important to identify transdiagnostic processes that impact the many pathways to suicidality, are amenable to intervention, and affect clinical outcomes when modified. A growing body of data suggests that experiential avoidance, or the tendency to escape or avoid unwanted psychological experiences, even when such efforts cause harm, may represent one such universal process. This article reviews theory and evidence that support mindfulness and psychological acceptance as a means to target experiential avoidance in suicidal clients and thereby reduce the risk of suicide. The article also provides two case examples of the application of mindfulness to suicidality and discusses how mindfulness may help clinicians in managing the stress associated with treating suicidal clients.     

A laboratory-based study of the relationship between childhood abuse and experiential avoidance among inner-city substance users: the role of emotional nonacceptance

Despite the theorized centrality of experiential avoidance in abuse-related psychopathology, empirical examinations of the relationship between childhood abuse and experiential avoidance remain limited. The present study adds to the extant literature on this relationship, providing a laboratory-based investigation of the relationships between childhood sexual, physical, and emotional abuse, experiential avoidance (indexed as unwillingness to persist on 2 psychologically distressing laboratory tasks), and self-reported emotional nonacceptance among a sample of 76 inner-city treatment-seeking substance users. As hypothesized, results provide evidence for heightened experiential avoidance and emotional nonacceptance among individuals with moderate-severe sexual, physical, and emotional abuse (compared to individuals reporting none-low abuse). However, although emotional nonacceptance was associated with increased risk for experiential avoidance, it mediated the relationship between childhood abuse and experiential avoidance only for emotional abuse. As such, results suggest that one mechanism through which emotional abuse in particular leads to experiential avoidance is emotional nonacceptance. Findings suggest the utility of interventions aimed at decreasing experiential avoidance and promoting emotional acceptance among abused individuals.     

Experiential avoidance as a generalized psychological vulnerability: comparisons with coping and emotion regulation strategies

Extending previous work, we conducted two studies concerning the toxic influences of experiential avoidance (EA) as a core mechanism in the development and maintenance of psychological distress, and disruption of pleasant, engaging, and spontaneous activity. Of particular interest was whether EA accounted for relationships between coping and emotion regulation strategies on anxiety-related pathology (Study 1) and psychological distress and hedonic functioning over the course of a 21-day monitoring period (Study 2). In Study 1, EA mediated the effects of maladaptive coping, emotional responses styles, and uncontrollability on anxiety-related distress (e.g., anxiety sensitivity, trait anxiety, suffocation fears, and body sensation fears). In Study 2, EA completely mediated the effects of two emotion regulation strategies (i.e., suppression and reappraisal) on daily negative and positive experiences and was associated with diminished daily positive affective experiences and healthy life appraisals, diminished frequency of positive events and more frequent negative life events, and greater negative affective experiences. The present data show that cognitive reappraisal, a primary process of traditional cognitive-behavior therapy, was much less predictive of the quality of psychological experiences and events in everyday life compared with EA. Further consideration of experiential avoidance as a generalized diathesis and toxic process will be useful in improving our understanding of the etiology, phenomenology, and treatment of anxiety conditions, general human suffering, and disruptions in hedonic capacity.     

THE TROUBLE WITH LANGUAGE:

Abstract— Experiential avoidance is the attempt to escape or avoid certain private experiences, such as particular feelings, memories, behavioral predispositions, or thoughts. In this article, we discuss evidence that experiential avoidance is both pervasive and often harmful to human functioning. We argue that experiential avoidance can be explained by two verbal processes, and we provide basic behavioral evidence on both the bidirectionality of derived stimulus relations in verbal humans and the insensitivity to the effects of responding produced by verbal rules. If this analysis is correct, experiential avoidance is built into human language and thus can be undermined only with difficulty.     

Emotion regulation in action: emotional reactivity in experiential avoidance

The present study examined the relationship between emotional reactivity (self-report and physiological reactivity) to pleasant, unpleasant, and neutral emotion-eliciting stimuli and experiential avoidance (EA). Sixty-two participants were separated into high and low experiential avoiders. Results indicated that high EA participants reported greater emotional experience to both unpleasant and pleasant stimuli compared to low EA participants. In contrast to their heightened reports of emotion, high EA participants displayed attenuated heart rate reactivity to the unpleasant stimuli relative to the low EA participants. These findings are interpreted as reflecting an emotion regulation attempt by high EA participants when confronted with unpleasant emotionally-evocative stimuli.     

The relationship between emotion dysregulation and deliberate self-harm among female undergraduate students at an urban commuter university

Despite the theoretical emphasis on the role of emotion dysregulation in deliberate self-harm (DSH), few studies have examined this relationship. The present study sought to examine the role of emotion dysregulation in DSH by extending the findings of Gratz (2006) regarding the environmental (i.e. childhood maltreatment) and individual (i.e. emotional inexpressivity and affect intensity/reactivity) factors associated with DSH among 249 female undergraduates. Specifically, the present study examined whether emotion dysregulation (a) is associated with DSH above and beyond these other risk factors and (b) mediates the relationship between these risk factors and DSH. Findings indicate that overall emotion dysregulation distinguished women with frequent DSH from those without a history of DSH, adding reliably to the prediction of DSH status above and beyond maltreatment, inexpressivity, and affect intensity/reactivity. Moreover, among self-harming women, emotion dysregulation accounted for a significant amount of additional variance in DSH frequency and mediated the relationship between emotional inexpressivity and DSH frequency. Results also suggest the particular relevance of two specific dimensions of emotion dysregulation to DSH: limited access to effective emotion regulation strategies and a lack of emotional clarity, each of which reliably improved the prediction of DSH status and accounted for unique variance in DSH frequency among self-harming women above and beyond the other risk factors in the models. Results suggest the potential utility of teaching self-harming women more adaptive ways of responding to their emotions, including nonavoidant strategies for modulating emotional arousal and the ability to identify, label, and differentiate among emotional states.     

The role of avoidance of emotional material in the anxiety disorders

Many psychotherapeutic traditions have conceptualized clinical levels of anxiety as resulting from the avoidance of threatening or emotional material. In this paper, we examine behavioral models of avoidance of emotions and emotional material, integrating findings that support established behavioral theories of emotional avoidance and anxiety, and that extend these theories to further explain the intense, intrusive, and interfering nature of clinical anxiety. Research on the suppression and avoidance of emotional material suggests that emotional avoidance and thought suppression may not only hinder the learning process and maintain anxious responding, but may also (a) paradoxically heighten anxious responding to threatening cues and (b) interfere with emotion functionality, thereby further impeding adaptive responding. Findings are discussed in terms of future research and implications for clinical treatment of anxiety disorders.     

自尊、体验回避和抑郁在自杀意念形成中的作用

使用自尊量表、接受和行动问卷、症状自评量表和贝克抑郁自评问卷对河南省某高校778名本科生和研究生进行问卷调查,探讨自尊、体验回避和抑郁在自杀意念形成中的作用。结果显示:(1)保护性因素自尊能够负向预测自杀意念。自尊水平越高,个体的自杀意念水平越低;(2)抑郁中介了风险性因素体验回避对自杀意念的影响作用。体验回避程度越高,抑郁程度越高,相应的自杀意念水平越高;(3)保护性因素自尊可以缓冲风险因素体验回避和抑郁对自杀意念的作用。保护性因素自尊能够负向预测体验回避和抑郁,既自尊水平越高,体验回避和抑郁倾向越弱。保护性因素自尊通过抑制风险性因素来缓冲其对自杀意念的作用。     

A Taxometric Analysis of Experiential Avoidance

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.     

The gray area: exploring attitudes toward infidelity and the development of the Perceptions of Dating Infidelity Scale

Prior research has distinguished between emotional versus sexual infidelity. Two studies examined the development of the Perceptions of Dating Infidelity Scale (PDIS) to assess attitudes toward specific behaviors that constitute these types of infidelity in romantic relationships. Exploratory and confirmatory factor analyses indicated three factors to the scale: Ambiguous, Deceptive, and Explicit behaviors. In both studies, there were gender differences on ratings of the behaviors. The construct validity of the scale was assessed with measures of sociosexual orientation, guilt, and coping with unwanted sexual situations. It was found that the Ambiguous behaviors were positively correlated with avoidance of unwanted sexual situations, while the Deceptive and Explicit scales were positively correlated with guilt and avoidance and negatively associated with an unrestricted sociosexual orientation and acting on attractions toward friends.     

A longitudinal investigation of the role of perceived autonomy support from coaches in reducing athletes’ experiential avoidance: The mediating role of subjective vitality

Experiential avoidance, a personality trait that refers to individuals’ tendency to avoid negative experiences, can have a negative impact on athletes’ goal achievement. For this reason, it is crucial to identify the factors that can mitigate such a tendency. Drawing on self-determination theory and referring specifically to the function of subjective vitality, we first hypothesize that perceived autonomy support from coaches is positively associated with athletes’ subjective vitality, which in turn is negatively associated with athletes’ experiential avoidance. Data were collected from one hundred eighty-five high school athletes in Taiwan using a three-wave, time-lagged survey design spanning a period of seven months. These athletes were drawn from ten senior high schools and were in their second year of high school. The results of regression analysis showed that perceived autonomy support from coaches at Time 1 was associated with higher vitality among athletes at Time 2, which was, in turn, associated with lower levels of experiential avoidance at Time 3, conditional on the athletes’ experiential avoidance at Time 2. While perceived autonomy support from coaches at Time 1 was also associated with lower experiential avoidance at Time 2, experiential avoidance at Time 2 was not associated with vitality at Time 3 after controlling for vitality at Time 2. The results of mediation analysis further supported the claim that vitality is a critical mediator of the relationship between perceived autonomy support from coaches and athletes’ experiential avoidance. Implications concerning the identification of this mediator are discussed.     

累积创伤对儿童复杂性创伤后应激障碍的影响：经验回避与消极认知情绪调节策略的中介作用

为探讨儿童的累积创伤与复杂性创伤后应激障碍(CPTSD)的关系机制,研究以方便取样法选取河南省7所小学的3478名4~5年级、有创伤经历的儿童为被试,采用创伤经历核查表、抑郁的行为激活问卷、认知情绪调节问卷和国际创伤问卷进行测试。结果发现:(1)累积创伤、经验回避、消极认知情绪调节策略和CPTSD之间具有显著相关性,且累积创伤能够显著正向预测CPTSD;(2)经验回避和消极认知情绪调节策略在累积创伤和CPTSD之间起显著的中介作用。具体为:一是经验回避的中介作用;二是灾难化的中介作用;三是经验回避-自责、经验回避-沉思、经验回避-灾难化的链式中介作用。因此,减少创伤事件的发生,激活儿童行为,调整消极认知情绪是改善和预防儿童CPTSD的重要途径。     

Suicidal and deliberate self-harm ideation among patients with physical illness: the role of coping styles

The relationship between coping styles and suicidal ideation (SI) or deliberate self-harm (DSH) ideation among patients with physical illness was examined. Four hundred fifteen adult male medical inpatients completed the Coping Styles Questionnaire. Patients with and without SI, and with and without DSH, were compared on coping styles. Sixteen percent of patients (n = 67) had SI and 18.3% (n = 76) had DSH. SI was associated with higher scores on emotional coping and lower scores on rational and detachment coping styles, compared with those without SI. DSH, compared with those without DSH, was associated with significantly higher scores on avoidance coping strategies. These data suggest coping styles among medical patients with and without SI or DSH may differ. The mechanism of this link is not entirely clear, but it may be that coping styles reflect one possible pathway of the association between poor physical health and SI and DSH. Replication of these results in a longitudinal study is needed. If replicated, incorporation of these data into the development of intervention strategies focused on improving coping strategies may be worthwhile.     

When Does Dispositional Gratitude Help Athletes Move Away From Experiential Avoidance? The Moderating Role of Perceived Autonomy Support From Coaches

Experiential avoidance, the attempt to avoid negative experiences, can prevent athletes from reaching their goals. To mitigate this tendency, the authors offer a relational approach and propose that dispositional gratitude and perceived autonomy support from coaches will have an interaction effect in mitigating experiential avoidance. Time-lagged data from 140 athletes were analyzed. Dispositional gratitude and perceived coach autonomy support had a significant interaction effect on predicting experiential avoidance when Time 1 experiential avoidance was controlled. Those high in dispositional gratitude and perceived coach autonomy support decreased their experiential avoidance over time. Implications and application for experiential avoidance and gratitude are discussed.     

Predicting self-injury in BPD: an investigation of the experiential avoidance model

This study investigated the contribution of indices of experiential avoidance to prediction of frequency and lethality of self-injurious behaviour (SIB) in a female BPD sample (N = 71) with high levels of SIB and histories of poor treatment outcomes. The experiential avoidance model (EAM) tested included motivations for SIB, coping style and DSM-IV Avoidant PD criteria. Distinct findings for suicidal and non-suicidal SIB were noted. In partial support of the model, motivations related to relief from negative emotions positively predicted frequency of non-suicidal, but not suicidal, SIB. Avoidant PD traits predicted a pattern of more frequent, less risky non-suicidal SIB. However, reliance on avoidant coping strategies predicted lethality but not frequency of SIB, while self-blaming coping and SIB motivations related to a desire to influence others predicted frequency of non-suicidal SIB. Results suggest the need for investigation of a more complex model of the antecedents and functions of SIB that includes the contribution of Avoidant PD traits.     

On boredom: Lack of challenge and meaning as distinct boredom experiences

Boredom is a common experience that affects people on multiple levels, including their thoughts, feelings, motivations, and actions. Not much research, however, has examined what makes the experience of boredom distinct from other affective experiences. Based on earlier research on boredom and our meaning-regulation framework, we conducted a series of four studies that demonstrate the distinct experiential content of boredom. More than other negative affective experiences (sadness, anger, and frustration), boredom makes people feel unchallenged while they think that the situation and their actions are meaningless (Study 1). The distinct experiential content of boredom is associated with boredom proneness (Study 2) and with state boredom experiences (Study 3). In addition, the distinct experiential content of boredom is affected by contextual features (Study 4). This series of studies provides a systematic understanding of what people feel, think, and want to do when bored, distinctive from other negative experiences.