Solving the puzzle of deliberate self-harm: the experiential avoidance model

Despite increasing attention to the phenomenon of deliberate self-harm (DSH), the literature currently lacks a unifying, evidence-based, theoretical framework within which to understand the factors that control this behavior. The purpose of the present paper is to outline such a framework-the Experiential Avoidance Model (EAM) of DSH. The EAM poses that DSH is primarily maintained by negative reinforcement in the form of escape from, or avoidance of, unwanted emotional experiences. Literature on factors that may lead to experiential avoidance is reviewed, along with the mounting empirical evidence that DSH functions to help the individual escape from unwanted emotional experiences. The EAM integrates a variety of research on emotions, experiential avoidance, and DSH within a clinically useful framework that sparks novel research directions.     

The role of emotional inexpressivity and experiential avoidance in the relationship between posttraumatic stress disorder symptom severity and aggressive behavior among men exposed to interpersonal violence

Posttraumatic stress disorder (PTSD) has been found to be associated with aggressive behavior. Recent evidence suggests that the ways in which individuals respond to their emotions may account for this relationship. In particular, to the extent that aggressive behaviors serve an emotion regulatory function, responding to emotions with avoidance (i.e., experiential avoidance) or the active suppression of emotional expression may heighten emotion dysregulation, increasing the risk for aggressive behavior as individuals attempt to regulate that dysregulated state. This study examined whether these two ways of responding to emotions account for the relationship between PTSD symptom severity and self-reported engagement in aggressive behavior among a diverse sample of 113 men with past exposure to interpersonal violence. Experiential avoidance and emotional inexpressivity each accounted for a significant amount of unique variance in aggressive behavior, above and beyond PTSD symptom severity and trait anger. Clinical and research implications of findings are discussed.     

Distress and Avoidance in Generalized Anxiety Disorder: Exploring the Relationships with Intolerance of Uncertainty and Worry

Theory and research suggest that treatments targeting experiential avoidance may enhance outcomes for patients with generalized anxiety disorder (GAD). The present study examined the role of experiential avoidance and distress about emotions in a treatment-seeking sample with a principal diagnosis of GAD compared with demographically matched nonanxious controls and sought to explore their shared relationship with two putative psychopathological processes in GAD: intolerance of uncertainty and worry. Patients with GAD reported significantly higher levels of experiential avoidance and distress about emotions compared with nonclinical controls while controlling for depressive symptoms, and measures of these constructs significantly predicted GAD status. Additionally, experiential avoidance and distress about anxious, positive, and angry emotions shared unique variance with intolerance of uncertainty when negative affect was partialed out, whereas only experiential avoidance and distress about anxious emotions shared unique variance with worry. Discussion focuses on implications for treatment as well as future directions for research.     

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.     

Emotion Differentiation as a Protective Factor Against Nonsuicidal Self-Injury in Borderline Personality Disorder

Evidence that nonsuicidal self-injury (NSSI) serves a maladaptive emotion regulation function in borderline personality disorder (BPD) has drawn attention to processes that may increase risk for NSSI by exacerbating negative emotion, such as rumination. However, more adaptive forms of emotion processing, including differentiating broad emotional experiences into nuanced emotion categories, might serve as a protective factor against NSSI. Using an experience-sampling diary, the present study tested whether differentiation of negative emotion was associated with lower frequency of NSSI acts and urges in 38 individuals with BPD who reported histories of NSSI. Participants completed a dispositional measure of rumination and a 21-day experience-sampling diary, which yielded an index of negative emotion differentiation and frequency of NSSI acts and urges. A significant rumination by negative emotion differentiation interaction revealed that rumination predicted higher rates of NSSI acts and urges in participants with difficulty differentiating their negative emotions. The results extend research on emotion differentiation into the clinical literature and provide empirical support for clinical theories that suggest emotion identification and labeling underlie strategies for adaptive self-regulation and decreased NSSI risk in BPD.     

Examining the role of emotional avoidance in the relationship between posttraumatic stress disorder symptom severity and worry

A growing body of literature suggests that worry is a cognitive activity functioning to avoid unpleasant internal experiences such as negative thoughts, emotions, and somatic responses. Given the highly aversive internal events associated with posttraumatic stress disorder (PTSD), individuals experiencing PTSD symptoms following exposure to a traumatic event may be particularly motivated to engage in avoidant regulation strategies such as worry. Surprisingly, however, few studies to date have examined the relationship between PTSD and worry as well as potential factors that might explain this association. Therefore, the goal of this study was to examine the association between PTSD symptom severity and worry and the extent to which emotional avoidance explains this relationship. To this end, 207 college students with a history of traumatic exposure (meeting Criterion A for a PTSD diagnosis) completed a series of questionnaires assessing history of exposure to potentially traumatic events, PTSD symptom severity, emotional avoidance tendencies, and worry. Results demonstrated that PTSD symptom severity was positively associated with worry and emotional avoidance. Further, emotional avoidance was found to fully account for this relationship, providing support for the proposed emotionally avoidant function of worry. The implications of these findings for future research and the treatment of worry among individuals with a history of traumatic exposure 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.     

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.     

The Emotion Mapping Activity: Preliminary evaluation of a mindfulness‐informed exercise to improve emotion labeling in alexithymic persons

Alexithymia is a psychoemotional trait associated with many treatment‐resistant psychological and social difficulties. Research suggests that these difficulties stem primarily from an inability to appropriately apply linguistic labels to emotional experiences and content. The present research introduces and preliminarily evaluates a novel mindfulness‐informed exercise to improve emotion‐labeling ability in alexithymic persons. Based in culturally universal patterns of somatic experience, the Emotion Mapping Activity (EMA ) directs alexithymic persons to reflect on their internal, somatic experiences as a source of information for interpreting and labeling emotional experiences. In the present study, 67 alexithymic persons completed a series of emotion‐labeling tasks either with or without assistance of the EMA . Results suggest that completion of the EMA may improve ability to label emotions that would be otherwise misinterpreted – without interfering with labeling that is already intact. Though further research is necessary, the present study suggests that the EMA may hold the potential to be incorporated into psychotherapy protocols as an exercise for improving emotion‐labeling ability in alexithymic clients.     

Temperamental and environmental risk factors for borderline personality disorder among inner-city substance users in residential treatment

Borderline Personality Disorder (BPD) is widely considered the result of biological vulnerability and environmental adversity. Despite growing evidence for the role of several temperamental and environmental risk factors in the development of BPD, the unique contribution of each to the development of this disorder remains unclear. Furthermore, the extent to which these factors are associated with BPD among underserved and diverse populations is unknown. The current study examined the temperamental and environmental factors uniquely associated with BPD among a sample of 93 inner-city individuals receiving residential substance use treatment. Results indicate that BPD was associated with higher impulsivity and emotional instability/vulnerability, lower well-being, and several interpersonal manifestations of positive and negative temperament (i.e., greater alienation and lower achievement and social closeness). BPD was also associated with several forms of childhood maltreatment, including emotional and physical abuse and neglect. However, only emotional instability or vulnerability, impulsivity, and emotional abuse emerged as unique predictors of BPD status.     

Emotional processing and panic

In this paper Rachman's concept of emotional processing was extended and a model highlighting the psychological operations underpinning processing was specified. Using this model, the aim was to investigate, by means of a questionnaire, whether patients with panic disorder (n=50) have more emotional processing difficulties than two samples of healthy controls (London, n=406; Aberdeen, n=125). The panic disorder group did have significantly more emotional processing difficulties than the control groups, showing a marked tendency to control feelings of anger, unhappiness and anxiety. Three emotional processing dimensions distinguished the panic from the control groups: greater control of emotional experiences ('smothering' or 'bottling up' emotions), greater awareness of feelings and more difficulties in labelling emotions. The authors hypothesise that emotional processing deficits act as a vulnerability factor for developing panic attacks.     

An Investigation of the Relationships among Negative Affect, Difficulties in Emotion Regulation, and Features of Borderline Personality Disorder

This study investigated the indirect effects of problematic emotion regulation on features of Borderline Personality Disorder (BPD) when accounting for negative affect in 456 participants from two distinct geographic regions. Participants completed the Affect Intensity Measure (AIM), Difficulties in Emotion Regulation Scale (DERS), the Emotion Regulation Questionnaire (ERQ), and the Borderline Symptom List (BSL). Results from this study supported a model in which there were significant indirect effects of both a lack of emotional clarity and limited access to emotion regulation strategies on features of BPD when accounting for negative affective intensity. Results also supported a second model in which there were significant indirect effects of both limited access to emotion regulation strategies and difficulties engaging in goal-directed behavior on features of BPD when accounting for negative affective reactivity. The results highlight important inter-relationships among features of BPD, difficulties regulating emotions, and negative affective intensity and reactivity.     

Misery has more company than people think: underestimating the prevalence of others' negative emotions

Four studies document underestimations of the prevalence of others' negative emotions and suggest causes and correlates of these erroneous perceptions. In Study 1a, participants reported that their negative emotions were more private or hidden than were their positive emotions; in Study 1b, participants underestimated the peer prevalence of common negative, but not positive, experiences described in Study 1a. In Study 2, people underestimated negative emotions and overestimated positive emotions even for well-known peers, and this effect was partially mediated by the degree to which those peers reported suppression of negative (vs. positive) emotions. Study 3 showed that lower estimations of the prevalence of negative emotional experiences predicted greater loneliness and rumination and lower life satisfaction and that higher estimations for positive emotional experiences predicted lower life satisfaction. Taken together, these studies suggest that people may think they are more alone in their emotional difficulties than they really are.     

Emotional dysfunction in avoidant compared to borderline personality disorder: A study of affect consciousness

Knowledge of emotional dysfunction in patients with avoidant personality disorder (APD) is much needed. The present study examined affect consciousness (AC) in patients with APD compared to borderline personality disorder (BPD). AC, defined as capacity to perceive, reflect on, tolerate, and express emotional experiences, is assumed to be central to structure‐building in personality. The study tested the hypotheses that patients with APD have lower general AC and lower AC for pleasant affects compared to BPD. Fifty‐nine patients, 26 with APD and 33 with BPD were rated on several aspects of AC using the specialized AC interview. The structured interview SCID‐II was applied for diagnostic evaluations. The APD group had significantly lower levels of global AC and conceptual expressivity compared to the BPD group. Among 11 specific affects the APD group had significantly lower AC for interest and contempt. Emotional dysfunction is an important feature of APD and the findings indicate that psychotherapies for APD patients should focus on emotional experiences, aiming to improve emotional awareness, tolerance, and expressivity. The notion of a general avoidance of positive emotions in APD needs further exploration, including a possible dysfunction in the evolutionary based neuro‐affective Seeking system.     

A Methodological Examination of Emotion Inductions in Borderline Personality Disorder: A Comparison of Standardized Versus Idiographic Stimuli

Emotional reactivity is conceptualized as a core feature of borderline personality disorder (BPD) and has been subject to substantial empirical research. The laboratory methods used to elicit emotional reactivity in BPD have varied and findings across studies have been mixed. At present, there is little research evaluating the relative efficacy of different methods in eliciting emotional reactivity in BPD. Thus, the current study examined differences in emotional reactivity among individuals with BPD in response to standardized and idiographic stimuli, and across three specific emotions (sadness, fear, and anger). Individuals with BPD, social anxiety disorder, and healthy controls viewed film clips (i.e., standardized stimuli) or engaged in a personally-relevant imagery task (i.e., idiographic stimuli) while self-reported and physiological indices (skin conductance response and respiratory sinus arrhythmia) of emotion were collected. Results indicated that BPD participants displayed greater reactivity of sadness and anger (but not fear) in response to the idiographic versus standardized stimuli, a pattern that was not exhibited by the other two groups. These findings might explain some of the mixed evidence to date and suggest that idiographic sadness and fear inductions may be more effective for individuals with BPD.     

Preliminary data on an acceptance-based emotion regulation group intervention for deliberate self-harm among women with borderline personality disorder

Borderline personality disorder (BPD) and deliberate self-harm are clinically important conditions for which additional economically and clinically feasible interventions are needed. Literature on both the emotion regulating and experientially avoidant function of self-harm and the role of emotional dysfunction in BPD provided the rationale for developing a group intervention targeting emotion dysregulation among self-harming women with BPD. This study provides preliminary data on the efficacy of this new, 14-week, emotion regulation group intervention, designed to teach self-harming women with BPD more adaptive ways of responding to their emotions so as to reduce the frequency of their self-harm behavior. Participants were matched on level of emotion dysregulation and lifetime frequency of self-harm and randomly assigned to receive this group in addition to their current outpatient therapy (N = 12), or to continue with their current outpatient therapy alone for 14 weeks (N = 10). Results indicate that the group intervention had positive effects on self-harm, emotion dysregulation, experiential avoidance, and BPD-specific symptoms, as well as symptoms of depression, anxiety, and stress. Participants in the group treatment condition evidenced significant changes over time on all measures, and reached normative levels of functioning on most. While these preliminary results are promising, the study's limitations require their replication in a larger-scale randomized controlled trial.     

Inertia of negative emotions at work: Correlates of inflexible emotion dynamics in the workplace*

Emotional inertia is a central feature of emotion dynamics and it refers to the degree to which emotional states are self-predictive and linger over time, describing their resistance to change. It is related to several indicators of maladjustment, yet there is limited research on its correlates in the workplace, where it may be particularly relevant as emotional experiences deeply influence organizational life. In two experience-sampling studies, we studied temporal dependency of negative emotional states at work in terms of emotional inertia. In a first study (n = 128), we investigated the association between exhaustion, the core dimension of burnout, with inertia of negative emotions. In a second study (n = 116), we aimed to replicate findings from the first study and additionally examined the moderating role of inertia of negative emotions in the relationship between negative emotions at work and counterproductive work behaviour. The findings show that exhaustion is consistently associated with inertia of negative emotions, and that inertia of negative emotions aggravates the relation between negative emotions and workers' counterproductive work behaviour.     

Impulsivity and emotion dysregulation in Borderline Personality Disorder

This study examined the association of borderline personality disorder (BPD) and negative emotional states with impulsivity in the laboratory. Undergraduate participants who were high in BPD features (high-BPD; n = 39) and controls who were low in BPD features (low-BPD; n = 56) completed measures of negative emotional state before a laboratory measure of impulsivity--a passive avoidance learning task. Controlling for psychopathology, high-BPD participants committed a greater number of impulsive responses than did low-BPD participants. Negative emotional state moderated the effect of BPD on impulsive responses. High-BPD participants who were in a negative emotional state committed fewer impulsive responses than high-BPD participants who were low in negative emotional state. Fear, nervousness, and shame negatively correlated with impulsivity among high-BPD participants but not among low-BPD participants. In addition, high-BPD participants reported greater emotion dysregulation in a variety of domains, compared with low-BPD participants.     

Borderline Personality Disorder and Deliberate Self‐Harm: Does Experiential Avoidance Play a Role?

The theory that borderline personality disorder (BPD) is associated with experiential avoidance, and that experiential avoidance mediates the association between BPD and deliberate, nonsuicidal self-harm was examined. Female inmate participants (N = 105) were given structured diagnostic assessments of BPD, as well as several measures of experiential avoidance. There was a high lifetime prevalence of past self-harm (47.6%). Higher dimensional scores representing BPD severity were associated with higher self-harm frequency and greater experiential avoidance. Structural equation modeling analyses indicated that experiential avoidance did not mediate the association between BPD and self-harm, although thought suppression was associated with self-harm frequency.