Advertisement

The Roles of Cognitive Flexibility and Experiential Avoidance in Explaining Psychological Distress in Survivors of Interpersonal Victimization

  • Kathleen M. PalmEmail author
  • Victoria M. Follette
Article

Abstract

The long-term negative psychological consequences associated with interpersonal victimization are significant; however a history of interpersonal victimization alone does not necessarily lead to greater long-term psychological distress. The current study examined the relationship between cognitive flexibility, experiential avoidance, and psychological distress among 92 women who reported a history of interpersonal victimization. The findings indicate that both cognitive flexibility and experiential avoidance are significantly related to posttraumatic stress symptomology and depression in this sample. Preliminary evidence is also presented suggesting experiential avoidance maybe a potential mediator between cognitive flexibility and psychological distress in this sample. The current findings suggest that treatments targeting greater emotional acceptance and mindfulness might be useful approaches in working with survivors of interpersonal victimization.

Keywords

Experiential avoidance Cognitive flexibility Interpersonal victimization 

References

  1. Alexander, C. N., Langer, E. J., Newman, R. I., Chandler, H. M., & Davies, J. L. (1989). Transcendental meditation, mindfulness, and longevity: an experimental study with the elderly. Journal of Personality and Social Psychology, 57(6), 950–964.PubMedCrossRefGoogle Scholar
  2. American Psychological Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington: American Psychiatric Association.Google Scholar
  3. Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182.PubMedCrossRefGoogle Scholar
  4. Batten, S. V., & Hayes, S. C. (2005). Acceptance and Commitment Therapy in the treatment of comorbid substance abuse and post-traumatic stress disorder: a case study. Clinical Case Studies, 4, 246–262.CrossRefGoogle Scholar
  5. Batten, S. V., Follette, V. M., & Aban, I. B. (2001). Experimental avoidance and high-risk sexual behavior in survivors of child sexual abuse. Journal of Child Sexual Abuse, 10(2), 101–120.PubMedCrossRefGoogle Scholar
  6. Baumeister, H., & Harter, M. (2007). Prevalence of mental disorders based on general population surveys. Social Psychiatry and Psychiatric Epidemiology, 42(7), 537–546.PubMedCrossRefGoogle Scholar
  7. Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the beck depression inventory — II. San Antonio: Psychological Corporation.Google Scholar
  8. Becker, C. B., & Zayfert, C. (2001). Integrating DBT-Based techniques and concepts to facilitate exposure treatment of PTSD. Cognitive and Behavioral Practice, 8, 107–122.CrossRefGoogle Scholar
  9. Benson, B. J., Gohm, C. L., & Gross, A. M. (2007). College women and sexual assault: the role of sex-related alcohol expectancies. Journal of Family Violence, 22, 341–351.CrossRefGoogle Scholar
  10. Blanchard, E. B., Jones-Alexander, J., Buckley, T. C., & Forneris, C. A. (1996). Psychometric properties of the PTSD Checklist (PCL). Behaviour Research and Therapy, 34(8), 669–673.PubMedCrossRefGoogle Scholar
  11. Bond, F. W., & Bunce, D. (2003). The role of acceptance and job control in mental health, job satisfaction, and work performance. The Journal of Applied Psychology, 88(6), 1057–1067.PubMedCrossRefGoogle Scholar
  12. Breslau, N. (2009). The epidemiology of trauma, PTSD, and other posttrauma disorders. Trauma, Violence & Abuse, 10(3), 198–210.CrossRefGoogle Scholar
  13. Breslau, N., Davis, G. C., Andreski, P., & Peterson, E. (1991). Traumatic events and posttraumatic stress disorder in an urban population of young adults. Archives of General Psychiatry, 48(3), 216–222.PubMedGoogle Scholar
  14. Breslau, N., Kessler, R. C., Chilcoat, H. D., Schultz, L. R., Davis, G. C., & Andreski, P. (1998). Trauma and posttraumatic stress disorder in the community: the 1996 detroit area survey of trauma. Archives of General Psychiatry, 55(7), 626–632.PubMedCrossRefGoogle Scholar
  15. Breslau, N., Davis, G. C., & Schultz, L. R. (2003). Posttraumatic stress disorder and the incidence of nicotine, alcohol, and other drug disorders in persons who have experienced trauma. Archives of General Psychiatry, 60(3), 289–294.PubMedCrossRefGoogle Scholar
  16. Briere, J., & Runtz, M. (1993). Child sexual abuse: long-term sequelae and implications for psychological assessment. Journal of Interpersonal Violence, 8, 312–330.CrossRefGoogle Scholar
  17. Chawla, N., & Ostafin, B. (2007). Experiential avoidance as a functional dimensional approach to psychopathology: an empirical review. Journal of Clinical Psychology, 63(9), 871–890.PubMedCrossRefGoogle Scholar
  18. Elliott, D. M., Mok, D. S., & Briere, J. (2004). Adult sexual assault: prevalence, symptomatology, and sex differences in the general population. Journal of Traumatic Stress, 17(3), 203–211.PubMedCrossRefGoogle Scholar
  19. Fresco, D. M., Heimberg, R. G., Abramowitz, A., & Bertram, T. L. (2006a). The effect of a negative mood priming challenge on dysfunctional attitudes, explanatory style, and explanatory flexibility. The British Journal of Clinical Psychology, 45(Pt 2), 167–183.PubMedCrossRefGoogle Scholar
  20. Fresco, D. M., Williams, N. L., & Nugent, N. R. (2006b). Association of explanatory flexibility and coping flexibility to each other and to depression and anxiety. Cognitive Therapy and Research, 30, 201–210.CrossRefGoogle Scholar
  21. Gratz, K. L., Bornovalova, M. A., Delany-Brumsey, A., Nick, B., & Lejuez, C. W. (2007). A laboratory-based study of the relationship between childhood abuse and experiential avoidance among inner-city substance users: the role of emotional nonacceptance. Behavior Therapy, 38(3), 256–268.PubMedCrossRefGoogle Scholar
  22. Green, B. L., Goodman, L. A., Krupnick, J. L., Corcoran, C. B., Petty, R. M., Stockton, P., et al. (2000). Outcomes of single versus multiple trauma exposure in a screening sample. Journal of Traumatic Stress, 13(2), 271–286.PubMedCrossRefGoogle Scholar
  23. Hayes, S.C. (2004). Acceptance and commitment therapy and the new behavior therapies: Mindfulness, acceptance, and relationship. In S.C. Hayes, V.M. Follette, and M.M. Linehan (eds.) (pp.1-29). Mindfulness and Acceptance: Expanding the Cognitive-Behavioral Tradition. New York: Guilford.Google Scholar
  24. Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experimental avoidance and behavioral disorders: a functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64(6), 1152–1168.PubMedCrossRefGoogle Scholar
  25. Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York: The Guilford Press.Google Scholar
  26. Hayes, S. C., Strosahl, K., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, S., et al. (2004). Measuring experiential avoidance: a preliminary test of a working model. Psychological Record, 54(4), 553–578.Google Scholar
  27. Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1–25.PubMedCrossRefGoogle Scholar
  28. Helzer, J. E., Robins, L. N., & McEvoy, L. (1987). Post-traumatic stress disorder in the general population. Findings of the epidemiologic catchment area survey. New England Journal of Medicine, 317(26), 1630–1634.PubMedCrossRefGoogle Scholar
  29. Holmbeck, G. N. (1997). Toward terminological, conceptual, and statistical clarity in the study of mediators and moderators: examples from the child-clinical and pediatric psychology literatures. Journal of Consulting and Clinical Psychology, 65(4), 599–610.PubMedCrossRefGoogle Scholar
  30. Howard, L. M., Trevillion, K., Khalifeh, H., Woodall, A., Agnew-Davies, R., & Feder, G. (2010). Domestic violence and severe psychiatric disorders: prevalence and interventions. Psychological Medicine, 40(6), 881–893.PubMedCrossRefGoogle Scholar
  31. Jaycox, L. H., Ebener, P., Damesek, L., & Becker, K. (2004). Trauma exposure and retention in adolescent substance abuse treatment. Journal of Traumatic Stress, 17(2), 113–121.PubMedCrossRefGoogle Scholar
  32. Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52(12), 1048–1060.PubMedGoogle Scholar
  33. Kilpatrick, D. G., Ruggiero, K. J., Acierno, R., Saunders, B. E., Resnick, H. S., & Best, C. L. (2003). Violence and risk of PTSD, major depression, substance abuse/dependence, and comorbidity: results from the National Survey of Adolescents. Journal of Consulting and Clinical Psychology, 71(4), 692–700.PubMedCrossRefGoogle Scholar
  34. Kingston, J., Clarke, S., & Remington, B. (2010). Experiential avoidance and problem behavior: a mediational analysis. Behavior Modification, 34(2), 145–163.PubMedCrossRefGoogle Scholar
  35. Lang, A. J., Laffaye, C., Satz, L. E., Dresselhaus, T. R., & Stein, M. B. (2003). Sensitivity and specificity of the PTSD checklist in detecting PTSD in female veterans in primary care. Journal of Traumatic Stress, 16(3), 257–264.PubMedCrossRefGoogle Scholar
  36. Langer, E. J. (1989). Mindfulness. Reading: Addison Wesley.Google Scholar
  37. Linehan, M. M. (1993). Cognitive behavioral treatment of borderline personality disorder. New York: Guilford Press.Google Scholar
  38. MacKinnon, D. P., Lockwood, C. M., Hoffman, J. M., West, S. G., & Sheets, V. (2002). A comparison of methods to test mediation and other intervening variable effects. Psychological Methods, 7(1), 83–104.PubMedCrossRefGoogle Scholar
  39. Martin, M. M., & Anderson, C. M. (1998). The cognitive flexibility scale: three validty studies. Communication Reports, 11, 1–9.Google Scholar
  40. Martin, M. M., & Rubin, R. B. (1995). A new measure of cognitive flexibility. Psychological Reports, 76, 623–626.Google Scholar
  41. Marx, B. P., & Sloan, D. M. (2005). Peritraumatic dissociation and experiential avoidance as predictors of posttraumatic stress symptomatology. Behaviour Research and Therapy, 43(5), 569–583.PubMedCrossRefGoogle Scholar
  42. Merwin, R. W., Rosenthal, M. Z., & Coffey, K. A. (2009). Experiential avoidance mediates the relationship between sexual victimization and psychological symptoms: replicating findings with an ethnically diverse sample. Cognitive Therapy and Research, 33, 537–542.CrossRefGoogle Scholar
  43. Morina, N. (2007). The role of experiential avoidance in psychological functioning after war-related stress in Kosovar civilians. The Journal of Nervous and Mental Disease, 195(8), 697–700.PubMedCrossRefGoogle Scholar
  44. Orcutt, H. K., Pickett, S. M., & Pope, E. B. (2005). Experiential avoidance and forgiveness as mediators in the relation between traumatic interpersonal events and posttraumatic stress disorder symptoms. Journal of Social and Clinical Psychology, 24, 1003–1029.CrossRefGoogle Scholar
  45. Orsillo, S. M., & Batten, S. V. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29(1), 95–129.PubMedCrossRefGoogle Scholar
  46. Palm, K. M., & Follette, V. M. (2008). Sexual victimization and physical health: an examination of explanatory mechanisms. Journal of Child Sexual Abuse, 17(2), 117–132.PubMedCrossRefGoogle Scholar
  47. Peterson, C., Bishop, M. P., Fletcher, C. W., Kaplan, M. R., Yesko, E. S., Moon, C. H., et al. (2001). Explanatory style as a risk factor for traumatic mishaps. Cognitive Therapy and Research, 25, 633–649.CrossRefGoogle Scholar
  48. Plumb, J. C., Orsillo, S. M., & Luterek, J. A. (2004). A preliminary test of the role of experiential avoidance in post-event functioning. Journal of Behavior Therapy and Experimental Psychiatry, 35(3), 245–257.PubMedCrossRefGoogle Scholar
  49. Polusny, M. A., & Follette, V. (1995). Long-term correlates of child sexual abuse: theory and review of the empirical literature. Applied and Preventive Psychology, 4, 143–166.CrossRefGoogle Scholar
  50. Polusny, M. A., Rosenthal, M. Z., Aban, I., & Follette, V. M. (2004). Experimental avoidance as a mediator of the effects of adolescent sexual victimization on negative adult outcomes. Violence and Victims, 19(1), 109–120.PubMedCrossRefGoogle Scholar
  51. Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments, & Computers, 36(4), 717–731.CrossRefGoogle Scholar
  52. Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40(3), 879–891.PubMedCrossRefGoogle Scholar
  53. Rosenthal, M. Z., Rasmussen Hall, M. L., Palm, K. M., Batten, S. V., & Follette, V. (2005). Chronic avoidance helps explain the relationship between severity of childhood sexual abuse and psychological distress in adulthood. Journal of Child Sexual Abuse, 14(4), 25–41.PubMedCrossRefGoogle Scholar
  54. Roy-Byrne, P. P., Russo, J., Michelson, E., Zatzick, D., Pitman, R. K., & Berliner, L. (2004). Risk factors and outcome in ambulatory assault victims presenting to the acute emergency department setting: implications for secondary prevention studies in PTSD. Depression and Anxiety, 19(2), 77–84.PubMedCrossRefGoogle Scholar
  55. Ruggiero, K. J., Del Ben, K., Scotti, J. R., & Rabalais, A. E. (2003). Psychometric properties of the PTSD Checklist-Civilian Version. Journal of Traumatic Stress, 16(5), 495–502.PubMedCrossRefGoogle Scholar
  56. Silverman, R. J., & Peterson, C. (1993). Explanatory style of schizophrenic and depressed outpatients. Cognitive Therapy and Research, 17, 457–470.CrossRefGoogle Scholar
  57. Smith, P. H., Thornton, G. E., DeVellis, R., Earp, J. A. L., & Coker, A. L. (2002). A population-based study of the prevalence and distinctiveness of battering, physical assault, and sexual assault in intimate relationships. Violence Against Women, 8, 1208–1232.CrossRefGoogle Scholar
  58. Sobel, M. E. (1982). Aysymptomatic confidence intervals for indirect effects in structural equation models. In S. Leinhart (Ed.), Sociological Methodology 1982 (pp. 290–312). San Francisco: Jossey-Bass.Google Scholar
  59. Sorenson, S. B., Stein, J. A., Siegel, J. M., Golding, J. M., & Burnam, M. A. (1987). The prevalence of adult sexual assault. The Los Angeles epidemiologic catchment area project. American Journal of Epidemiology, 126(6), 1154–1164.PubMedGoogle Scholar
  60. Tabachnick, B.G., & Fidell, L.S. (2000). Using multivariate statistics (4th ed.). Boston: Allyn & Bacon.Google Scholar
  61. Thompson, B. L., & Waltz, J. (2010). Mindfulness and experiential avoidance as predictors of posttraumatic stress disorder avoidance symptom severity. Journal of Anxiety Disorders, 24(4), 409–415.PubMedCrossRefGoogle Scholar
  62. Ullman, S. E., & Siegel, J. M. (1994). Predictors of exposure to traumatic events and posttraumatic stress sequelae. Journal of Community Psychology, 22, 328–338.CrossRefGoogle Scholar
  63. Ullman, S. E., Karabatsos, G., & Koss, M. P. (1999). Alcohol and sexual assault in a national sample of college women. Journal of Interpersonal Violence, 14, 603–625.CrossRefGoogle Scholar
  64. Walser, R. D., & Westrup, D. (2007). Acceptance & commitment therapy for the treatment of post-traumatic stress disorder: A practitioner’s guide to using mindfulness & acceptance strategies. Oakland: New Harbinger Publications, Inc.Google Scholar
  65. Weathers, F. W., Litz, B., Huska, J., & Keane, T. M. (1994). PTSD Checklist (PCL). Boston: National Center for PTSD — Behavioral Science Division.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of PsychologyClark UniversityWorcesterUSA
  2. 2.Department of PsychologyUniversity of NevadaRenoUSA

Personalised recommendations