The adverse consequences of posttraumatic stress on quality of life have been well documented. It is, however, possible that it is not the intrusive re-experiencing and hyperarousal posttraumatic stress symptoms that have an impact on quality of life per se, but the inflexible efforts to avoid internal experiences and emotions related to the traumatic event, and the way these emotions are expressed and experienced. Previous research shows that both experiential avoidance and emotion regulation have been found to be etiologically central to the development and maintenance of psychological problems in trauma survivors. The degree to which experiential avoidance and emotion regulation act together as toxic underlying mechanisms to explain the relationship between posttraumatic stress and quality of life is, however, yet to be examined. Quality of life is now regarded as an important outcome variable across a broad range of conditions and problem areas. The quality of life concept has generated a large body of research and yet its assessment has been a challenge for researchers. The WHOQOL-BREF is considered to be one of the few genuine quality of life measures but it has received much criticism, especially regarding the poor psychometric performance of its social relationships domain. The aim of the current thesis was twofold. The first aim involved the revision of the WHOQOL-BREF through the enhancement of the social relationships domain. In Study I 986 ill and healthy individuals from five countries worldwide completed the Pilot Revised WHOQOL-BREF (WHOQOL-BREF-R) along with measures of life satisfaction, anxiety, and depression for the detailed psychometric analysis of the scale. Study I confirmed the limitations of the social relationships domain, and despite its improvement, the performance of the overall scale was found to be poor. In fact, findings from modern and robust techniques challenged the 4-factor structure of the WHOQOL-BREF. Instead, results supported the performance of a 3-factor solution, which led to the development of a psychometrically sound measure. Study II is preceded by a systematic review of the literature investigating experiential avoidance as a mediator in trauma survivors with posttraumatic stress. Ten studies were identified and organised in two categories assessing experiential avoidance as a mediator between: 1) trauma exposure and posttraumatic stress, and 2) posttraumatic stress and maladaptive behaviours. Findings suggest that the development and maintenance of posttraumatic stress symptoms and maladaptive behaviours in the aftermath of trauma can be explained through the use of experiential avoidance. Methodological limitations and future directions for research are discussed. The WHOQOL-BREF-R was then used in Study II, which explored an integrative mediation model whereby experiential avoidance and emotion regulation were tested as mediators in the relationship between posttraumatic stress symptomatology and quality of life in trauma exposed adults. The two mediators were also explored for their overlapping relationship. A total of 360 participants from the community completed self-report measures of posttraumatic stress, experiential avoidance, emotion regulation, and quality of life. With the use of path analysis Study II found experiential avoidance and emotion regulation to be two distinct constructs that together act as an underlying mechanism explaining the impact of posttraumatic stress on quality of life. Alternative mediating models were explored. The current study makes an important contribution in the area of trauma and in the conceptualisation and assessment of quality of life. Findings can be considered as a first step towards an integrative mediation model of toxic mechanisms in trauma and quality of life. Additionally, the favourable psychometric properties of the WHOQOL-BREF-R make it a powerful tool for use in quality of life research.

Repetitive self-mutilation (RSM) has become increasingly prevalent among adolescents. Empirical research has pinpointed several correlates of this behavior, but the initiation and maintenance of RSM among adolescents are not well understood. The experiential avoidance model (EAM) proposes that self-mutilation is a behavior that allows for the avoidance or alteration of unwanted internal experiences, and that it is negatively reinforced with repetition. The current study explored the usefulness of the EAM as an explanatory theory for adolescent RSM, with the additional incorporation of issues of social context. Adolescents (N = 211) from three school-based samples completed self-report questionnaires. One-third of students reported at least one incident of purposeful, non-suicidal self-mutilation and 16% had engaged in self-mutilation repeatedly within the past 6 months. Both regression and group analyses indicated that adolescents who engage in RSM report greater psychological distress, a greater incidence of functionally equivalent behaviors, and greater exposure to self-mutilation among peers and/or in the media, when compared to their counterparts who have not engaged in RSM. Suicidal ideation/behaviors were consistently the strongest predictors of current self-mutilation behaviors. Clinical implications, limitations, and suggestions for future research are discussed.

Interpersonal functioning can be conceptualized as being comprised of social skills, connectedness, social cognition, and intimacy. A concept that is related to an examination of interpersonal functioning is experiential avoidance (EA), which can be defined as an unwillingness to experience or remain in contact with unpleasant private events through attempts to avoid or escape from these experience. An examination of EA and interpersonal functioning has not previously taken place. This study thus sought to fill that gap in the literature. The availability of a behavioral-oriented measure of interpersonal functioning aided in this investigation. The relationship of EA and interpersonal functioning to depression and anxiety were also examined, in order to evaluate their relative contributions to psychopathology. Overall, it was found that EA and interpersonal functioning were significantly related. However, the dimensions of EA varied in strength with respect to their relationships with interpersonal functioning. Further, it was found that interpersonal functioning predicted unique variance in both depression and anxiety, and partially mediated the relationship between EA and both anxiety and depression. These results might guide the development of treatment programs and add support to the use of treatments with trans-diagnostic targets.

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<p>Among some researchers, there is an emerging conceptualization of chronic tic disorders (CTDs) as conditions that are partially rooted in avoidance of tic-related private experiences (i.e., painful or difficult thoughts and feelings) and internal sensations (i.e., premonitory urges to tic). The first specific aim of the present research was to investigate the possibility that experiential avoidance is related to tic severity and perceived quality of life in individuals with CTDs. The second aim was to determine whether the efficacy of Habit Reversal Training (HRT), the most prevalent and effective behavioral intervention for CTDs to date, might be enhanced by combining it with Acceptance and Commitment Therapy (ACT), an intervention that directly targets experiential avoidance. These aims were addressed by conducting two related studies. Study I, an online survey, included 239 adults (<italic>M</italic> = 37.6 years; <italic>SD</italic> = 13.8 years) who reported having been previously diagnosed with a CTD. Results showed that levels of premonitory urges, as well as both general and tic-specific experiential avoidance, were significantly positively related to tic severity. General and tic-specific experiential avoidance were also significantly negatively related to perceived quality of life. Psychometric analyses of two novel measures developed for Study I (i.e., the Yale Global Tic Severity Scale-Self-Report Version and the Acceptance and Action Questionnaire-Tic-Specific Version) demonstrated excellent internal consistency and convergent validity. Study II, a multi-site pilot investigation, involved 13 adolescents (<italic>M</italic> = 15.4 years; <italic>SD</italic> = 1.3 years) who were treated with either HRT alone or a novel HRT+ACT intervention. Results suggest that the HRT+ACT treatment is feasible, highly acceptable to both patients and parents, and as effective as HRT alone at reducing tic severity from pre-treatment through week 22 follow-up. Participants in both groups reported clinically significant post-treatment decreases in general and tic-specific experiential avoidance and improvements in overall functioning. Researchers concluded that experiential avoidance plays an important role in tic expression and overall functioning for individuals with CTDs. Results support additional development and testing of the promising HRT+ACT intervention, to evaluate its efficacy alone and in comparison to other relevant psychosocial and pharmacological interventions.</p> / Dissertation

Pathologische Sorgen sind ungenau definiert. Für die Behandlungsplanung bleiben wichtige Fragen offen: Welche Merkmale sind für die Unterscheidung zwischen behandlungsbedürftigen und nicht behandlungsbedürftigen Sorgen relevant? Welche Art von Sorgen muss wie behandelt werden? Und: Welche Art von Sorgen gilt es eher zu akzeptieren? Wir machen praxisnahe Vorschläge dafür, wie Sorgen mittels einer einfachen Heuristik auch vom Patienten selbst als «pathologisch» identifiziert werden können. Im Sinne eines therapeutischen Arbeitsmodells ergeben sich differentielle Bearbeitungsstrategien, je nachdem, ob es sich um wichtige oder weniger wichtige, auf lösbare oder unlösbare Probleme bezogene sowie angemessene oder überzogene Sorgen handelt. Das vorgestellte Arbeitsblatt zu den Sorgen soll vor allem die wahrgenommene Kontrolle des Patienten stärken und die Psychoedukation zur Generalisierten Angststörung erleichtern. / Pathological worries have not yet been clearly defined. As a consequence, practically relevant questions remain open: Which characteristics distinguish worries relevant for treatment from those which are not? What kind of worries has to be treated in which way? And: What kind of worries is rather to be accepted? We propose a simple rationale which helps the therapist and the patient to identify pathological worries. According to this working model, different treatment strategies result depending on whether worries are central or not, whether they relate to a problem which can be solved or not, and whether they seem proportionate or exaggerated. The presented worksheet is meant to strengthen the perceived control of the patient and to help facilitate psychoeducation for generalised anxiety disorder. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

La presente investigación busca describir la evitación experiencial en el proceso de duelo en sobrevivientes a pérdida por suicidio. Esta se define como el fenómeno en el que la persona evita conectarse con experiencias privadas (pensamientos, recuerdos, emociones y sensaciones corporales) alterando la forma o frecuencia del contexto que las ocasiona. Se trabajó desde el paradigma cualitativo con un diseño fenomenológico, en el que participaron cinco personas en duelo por suicidio. El instrumento utilizado fue la entrevista semiestructurada. Los resultados permiten ver dos ejes importantes. El primero, respecto al uso de estrategias de control con la finalidad de desconectarse de aquellas experiencias privadas que les generan malestar. El segundo sobre las características particulares que se da en el duelo de cada persona. Se concluye que cuando la evitación experiencial media en el proceso de duelo por suicidio, tiene consecuencias psicológicas desfavorables incluido el duelo complicado. / The present research seeks to describe the experiential avoidance in the grieving process of survivors of suicide loss. This is defined as the phenomenon in which the person avoids connecting with private experiences (thoughts, memories, emotions and bodily sensations) by altering the form or frequency of the context that causes them. We worked from the qualitative paradigm with a phenomenological design, in which five people in mourning for suicide participated. The instrument used was the semi-structured interview. The results show two important axes. The first regarding the use of control strategies in order to disconnect from those private experiences that cause discomfort. The second on the particular characteristics that occurs in the mourning of each person. It can be concluded that experiential avoidance mediates the suicide grief process and this has unfavorable psychological consequences, including complicated grief. / Tesis