Maria Karekla

Measuring experiential avoidance: A preliminary test of a working model

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.

Emotional avoidance and panicogenic responding to a biological challenge procedure

Healthy undergraduates high (n = 27) and low (n = 27) in experiential avoidance underwent twelve 20 s inhalations of 20% carbon dioxide-enriched air, while physiological (e.g., skin conductance, heart rate, EMG, and end-tidal CO2) and subjective (e.g., subjective units of distress, evaluative ratings, number and severity of panic symptoms endorsed) reactions were continuously monitored. Individuals high in experiential avoidance endorsed more panic symptoms, more severe cognitive symptoms, and more fear, panic, and uncontrollability than their less avoidant counterparts. Magnitude of autonomic response did not discriminate between groups, nor were the observed effects accounted for by other risk factors for challenge-induced panic such as anxiety sensitivity. Results are discussed in terms of the pathoplastic relation between emotional avoidance and exacerbation of unpleasant emotional responses and the view that emotional avoidance may constitute a risk factor in the development and maintenance of anxiety disorders.

Coping and experiential avoidance: unique or overlapping constructs?

The present study examined associations between coping as measured by the Brief COPE and experiential avoidance as measured by the AAQ-II and the role of both constructs in predicting psychological distress and well-being. Specifically, associations between experiential avoidance and other types of coping were examined, and factor analysis addressed the question of whether experiential avoidance is part of coping or a related but independent construct. Results showed that experiential avoidance loads on the same factor as other emotion-focused and avoidant types of coping. The higher people are in experiential avoidance, the more they tend to utilize these types of coping strategies. Both experiential avoidance and coping predicted psychological distress and well-being, with most variance explained by coping but some additional variance explained by experiential avoidance. ANOVAS also showed gender differences in experiential avoidance and coping approaches. Results are discussed in light of previous relevant findings and future treatment relevant implications.

Implementation intention and planning interventions in Health Psychology: Recommendations from the Synergy Expert Group for research and practice

The current article details a position statement and recommendations for future research and practice on planning and implementation intentions in health contexts endorsed by the Synergy Expert Group. The group comprised world-leading researchers in health and social psychology and behavioural medicine who convened to discuss priority issues in planning interventions in health contexts and develop a set of recommendations for future research and practice. The expert group adopted a nominal groups approach and voting system to elicit and structure priority issues in planning interventions and implementation intentions research. Forty-two priority issues identified in initial discussions were further condensed to 18 key issues, including definitions of planning and implementation intentions and 17 priority research areas. Each issue was subjected to voting for consensus among group members and formed the basis of the position statement and recommendations. Specifically, the expert group endorsed statements and recommendations in the following areas: generic definition of planning and specific definition of implementation intentions, recommendations for better testing of mechanisms, guidance on testing the effects of moderators of planning interventions, recommendations on the social aspects of planning interventions, identification of the preconditions that moderate effectiveness of planning interventions and recommendations for research on how people use plans.

Perceived social support helps, but does not buffer the negative impact of anxiety disorders on quality of life and perceived stress

PurposeAnxiety disorders are prevalent and substantially hinder quality of life, in all domains, including social connections, mental and physical health. Past research on stress indicates that perceived social support improves wellbeing both directly by providing positive experiences and indirectly through buffering the effects of stress. This study examined whether social support moderates the negative impact of anxiety disorders on quality of life.MethodThe study was conducted on a community sample in Cyprus, screened for anxiety disorders. The hypothesized model takes into account potential differences between individuals with and without anxiety in health, tendency to seek support, stressful life events, and depression. Furthermore, differences between different anxiety disorders on these variables were examined.ResultsResults indicate that perceived social support has a positive, direct effect on quality of life and perceived stress for all participants but that it does not appear to moderate the adverse effects of having a disorder on quality of life or stress. The negative effects of anxiety appeared to mostly be carried by comorbid depression.ConclusionsSocial support is important for quality of life. Potential interventions for anxiety disorders should take this into account, as well as the substantially detrimental role of co-morbid depression symptoms on wellbeing outcomes.

A Survey of Graduate Training in Empirically Supported and Manualized Treatments: A Preliminary Report.

The promotion and dissemination of empirically supported (ESTs) and manualized therapies are important, albeit controversial, developments within clinical science and practice. To date, studies evaluating training opportunities and attitudes about such treatments at the graduate, predoctoral internship, and postdoctoral levels have focused on the opinions of training directors and seasoned practitioners. The present study surveyed 172 graduate students from 60 APA-accredited doctoral programs in clinical, counseling, and school psychology programs regarding their knowledge, extent of didactic and practical training experiences, and attitudes about ESTs and treatment manuals. Student knowledge of, and attitudes about, treatment manuals and ESTs varied reliably as a function of self-described theoretical orientation (i.e., cognitive behavioral vs. eclectic) and extent of didactic and applied training experiences. Graduate education and training in ESTs and treatment manuals predicted plans to use and seek out additional training with such methods. We recommend that graduate programs increase efforts to promote, disseminate, and integrate these and other evidentiary procedures into their training curricula.

Direct and indirect predictors of social anxiety: The role of anxiety sensitivity, behavioral inhibition, experiential avoidance and self-consciousness

Using mediated and moderated regression, this study examined the hypothesis that anxiety sensitivity, the tendency to be concerned about anxiety symptoms, and behavioral inhibition, the tendency to withdraw from novel and potentially dangerous stimuli, predict social anxiety indirectly through experiential avoidance as measured by the Acceptance and Action Questionnaire-II and self-consciousness, as measured by the Self-Consciousness Scale. Behavioral inhibition and anxiety sensitivity are operationalized as temperamental traits, while experiential avoidance and self-consciousness are seen as learned emotion regulation strategies. Study 1 included college student groups from Cyprus scoring high and low on social anxiety (N=64 and N=63) as measured by the Social Phobia and Anxiety Inventory. Study 2 examined a random community sample aged 18-65 (N=324) treating variables as continuous and using the Psychiatric Disorders Screening Questionnaire to screen for social anxiety. Results suggest that experiential avoidance, but not self-consciousness mediates the effects of anxiety sensitivity on predicting social anxiety status, but that behavioral inhibition predicts social anxiety directly and not through the proposed mediators. Moderation effects were not supported. Overall, the study finds that social anxiety symptomatology is predicted not only by behavioral inhibition, but also anxiety sensitivity, when individuals take actions to avoid anxious experiences. Modifying such avoidant coping approaches may be more beneficial for psychological treatments than attempts to change long-standing, temperamental personality traits.

Experiential Avoidance as a Common Psychological Process in European Cultures

Experiential avoidance, the tendency to rigidly escape or avoid private psychological experiences, represents one of the most prominent transdiagnostic psychological processes with a known role in a wide variety of psychological disorders and practical contexts. Experiential avoidance is argued to be based on a fundamental verbal/cognitive process: an overextension of verbal problem solving into the world within. Although cultures apparently differ in their patterns of emotional expression, to the extent that experiential avoidance is based on a fundamental verbal/cognitive process, measures of this process should be comparable across countries, with similar relationships to health outcomes regardless of the language community. This research tests this view in European countries. The psychometric properties of the Acceptance and Action Questionnaire-II, a measure of experiential avoidance, are compared across six languages and seven European countries, for a total of 2,170 nonclinical participants. Multiple group analysis showed that the instrument can be considered invariant across the language samples. The questionnaire constitutes a unidimensional instrument with similar relationships to psychopathology, and has good and very similar psychometric properties in each assessed country. Experiential avoidance reveals not just as transdiagnostic, but also as a transcultural process independent of a specific language community.

Patient Health Questionnaire: Greek language validation and subscale factor structure

This study aimed to assess the reliability, validity, and factor structure of the Greek translation of the Patient Health Questionnaire (PHQ) in a sample of Cypriot, Greek-speaking university students. This is the first study to examine PHQ psychometric properties in Greek and to investigate the factor structure of the PHQ subscales. A total of 520 participants (73.9% women; M(Age) = 21.57; SD, 4.94) completed the PHQ and assessment tools used for convergent validity analysis. Patient Health Questionnaire was translated and culturally adapted according to international standards. Overall, PHQ subscales in Greek language demonstrated good internal consistency (mean Cronbach α = .75, P < .001) and convergent validity with the following: Alcohol Use Disorders Identification Test, Beck Depression Inventory, Psychiatric Diagnostic Screening Questionnaire (panic disorder, somatization, bulimia, and binge eating), and Anxiety Sensitivity Index (overall mean, r = 0.52; P < .001). The relation between the PHQ subscale diagnoses and functional impairment, as assessed by the 12-item Health Survey 12, was comparable with the original validation results for all subscales except alcohol. The depression, alcohol, and anxiety subscales exhibited single-factor structures. Subscales assessing eating disorders, panic disorder, and somatization difficulties exhibited 2-, 3-, and 4-factor structures, respectively. Overall, PHQ subscales demonstrated good psychometric properties, with the exception of the subscale examining problematic alcohol use. Overall, PHQ demonstrates good reliability, validity, and appropriate factor structure in a Greek-speaking college population. Psychometric research is needed on the Greek PHQ in primary care settings.

Smoking prevalence and tobacco exposure among adolescents in Cyprus

BACKGROUND Smoking has been internationally recognized as an epidemic contributing to major health problems. Smoking contributes to most of the preventable deaths worldwide. Although Cyprus is considered among developed countries with high smoking prevalence (estimates of 25-35% of the population), not much has been done for the systematic scientific study of this problem, especially in adolescence. The present study aimed to investigate smoking prevalence and related factors among Cypriot adolescents. METHODS Participants were selected through stratified random sampling. The final sample included two subpopulations: middle (n = 1085) and high (n = 767) school students. RESULTS Six percent of middle school students reported being regular smokers. This climbed to 24% among high school students. Smoking prevalence increases with age, and appears higher in boys than in girls. Smoking is quite common in the participants families, particularly among fathers. Cigarette and smoke exposure in the home was high, as only a fifth of the students reported smoking never being allowed in the home. Exposure to actors smoking on television was the norm (62-67%) with low reported exposure to anti-smoking messages. Having friends who smoke, exposure to others smoking and low educational aspirations were significant predictors of smoking for both groups. Additional predictors, which were different for middle and high school students, were identified. CONCLUSION Further research to investigate the nature of these effects is required and to provide further insight into the psychosocial parameters affecting smoking. These results can guide possible prevention and intervention programs for adolescents, and suggest the importance of following a systemic approach.