Experiential avoidance may be a strong predictor of major depressive disorder (MDD) and generalized anxiety disorder (GAD) in late adolescence, according to study results published in the Journal of Clinical Psychiatry. While experiential avoidance may offer short-term relief from distress, in the long run it may allow psychopathological symptoms to persist, as individuals do not fully process their distress.
William H. Mellick, PhD, of the department of psychiatry and behavioral sciences at the Medical University of South Carolina in Charleston, led a study to capture experiential avoidance in older adolescents (aged 15 to 20 years). Patients underwent a baseline assessment and were followed-up every 4 months thereafter.
At baseline, the Beck Depression Inventory-II, Beck Anxiety Inventory, and the Acceptance and Action Questionnaire, second edition (AAQ-II) were administered to capture depressive symptoms, anxiety symptoms, and experiential avoidance, respectively. The AAQ was re-administered once a mean of 342.1±56.7 days after initial AAQ assessment. Demographic and clinical factors were also extracted at baseline.
Group-based trajectory modeling identified 4 group clusters and cross-lagged autoregressive structural equation modeling analyses were performed to examine longitudinal associations. Lastly, hierarchical linear regression models were constructed to assess the predictive validity of AAQ for MDD and GAD symptom trajectories. The models were adjusted for age, sex, and cumulative exposure to selective serotonin reuptake inhibitors (SSRIs).
A total of 183 patients (mean age 18.95±1.61 years; 77.6% white; 61.7% women) provided complete data. Symptom trajectory modeling identified 4 combined MDD/GAD trajectories: (1) Persistent, describing patients who maintained elevated MDD/GAD symptoms (n=81); (2) High-Decreasing, describing a decline in symptoms from a clinically significant baseline (n=44); (3) Normal-Increasing, describing moderate baseline symptoms that increased over time (n=37); and (4) Minimal, describing low to absent symptoms over time (n=21).
Patients in the Persistent group had higher experiential avoidance than the other 3 trajectories (all P ≤.001). Compared with the High-Decreasing group, the Persistent group had greater experiential avoidance stability across assessments (P =.008). In hierarchical models, scores from both AAQ assessments predicted anxiety and depression symptoms (all P ≤.005). Of note, anxiety and depressive symptoms did not predict experiential avoidance scores. After adjustments for baseline depression, anxiety and other confounders, experiential avoidance scores were the only significant symptom-level predictor of MDD/GAD trajectories (all P <.001).
Overall, these data describe experiential avoidance as a powerful predictor of anxiety and depression in late adolescence. “The findings of [this study] suggest that an intervention targeting [experiential avoidance] in adolescents may lead to valuable outcomes,” the investigators wrote.
As a study limitation, investigators noted that a substantial percentage of study patients were taking selective serotonin reuptake inhibitors, which may have moderated the relationship between experiential avoidance and MDD/GAD even after adjustments. The narrow racial makeup of the study cohort may also limit generalizability of the results.
The researchers also suggested a potential treatment modality in light of their findings. They wrote, “Acceptance and commitment therapy…is a behavioral intervention that aims to help patients overcome [experiential avoidance] with acceptance, mindfulness, and behavioral change strategies.”
Mellick WH, Mills JA, Kroska EB, Calarge CA, Sharp C, Dindo LN. Experiential avoidance predicts persistence of major depressive disorder and generalized anxiety disorder in late adolescence [published online October 22, 2019]. J Clin Psychiatry. doi:10.4088/JCP.18m12265