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Experiential Avoidance, Posttraumatic Stress Disorder, and Self-Injurious Thoughts and Behaviors: A Moderation Analysis in a National Veteran Sample

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Abstract 

Experiential avoidance (EA) is associated with posttraumatic stress disorder (PTSD) and self-injurious thoughts and behaviors (SITBs) across different populations, and extant literature has demonstrated a strong relationship between PTSD and SITBs. However, no study has explored the potential moderating role EA plays in the association of PTSD with nonsuicidal self-injury (NSSI), suicidal ideation, and suicide attempts. The objective of the present study was to determine if EA would moderate the association with PTSD and SITBs such that the association between PTSD and individuals SITBs would be stronger among individuals with higher EA. In a large national sample of Gulf War Era veterans (N = 1,138), EA was associated with PTSD, lifetime and past-year NSSI, current suicidal ideation, and lifetime suicide attempts in bivariate analyses. Multivariate analyses detected a significant EA by PTSD interaction on lifetime NSSI (AOR = 0.96), past-year NSSI (AOR = 1.03), and suicide attempts (AOR = 1.03). Probing of the interactions revealed that the respective associations between PTSD, lifetime and past-year NSSI, and suicide attempts were stronger at lower levels of EA (i.e., better), counter to our hypotheses. These preliminary findings contextualize the relationship between these variables in a Gulf War veterans sample and signal the need to further investigate these relationships. Further, these findings highlight the need for advancement in assessment and intervention of EA and SITBs.

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Data Availability

Data for the present study are not publically available. Please contact corresponding author for any inqueries.

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Acknowledgements

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the United States Government or Department of Veterans Affairs (VA). This work was supported by grant I01HX001682 from the Health Services Research and Development Service from the VA Office of Research and Development, which was awarded to Drs. Kimbrel and Pugh. Dr. Beckham was supported by a Senior Research Career Scientist award from VA Clinical Sciences Research and Development (IK6BX00377). Dr. Pugh was funded by a Research Career Scientist Award from VA Health Services Research and Development (IK6HX002608). Dr. Halverson was supported by a VA Office of Academic Affiliations Advanced Fellowship in Mental Illness Research and Treatment.

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Authors and Affiliations

  1. Department of Psychology, Florida State University, 1107 W Call St., Tallahassee, FL, 32304, USA

    Tapan A. Patel

  2. RTI International, Research Triangle Park, Raleigh, NC, USA

    Shannon M. Blakey

  3. Durham VA Health Care System, Durham, NC, USA

    Tate F. Halverson, Patrick S. Calhoun, Jean C. Beckham & Nathan A. Kimbrel

  4. VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA

    Tate F. Halverson, Patrick S. Calhoun, Jean C. Beckham & Nathan A. Kimbrel

  5. Department of Psychology, University of Toledo, Toledo, OH, USA

    Adam J. D. Mann

  6. Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA

    Patrick S. Calhoun, Jean C. Beckham & Nathan A. Kimbrel

  7. VA Salt Lake City Healthcare System, Salt Lake City, UT, USA

    Mary J. Pugh

  8. University of Utah School of Medicine Department of Medicine, Salt Lake City, UT, USA

    Mary J. Pugh

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Patel, T.A., Blakey, S.M., Halverson, T.F. et al. Experiential Avoidance, Posttraumatic Stress Disorder, and Self-Injurious Thoughts and Behaviors: A Moderation Analysis in a National Veteran Sample. J Cogn Ther 16, 340–355 (2023). https://doi.org/10.1007/s41811-023-00164-2

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