Examining the effects of punishment schedule density on the development and maintenance of avoidance and safety behaviours: Implications for exposure therapies

Experiential avoidance in non-suicidal self-injury and suicide experiences: A systematic review and meta-analysis

INTRODUCTION

This systematic review and meta-analysis aimed to (i) examine the associations between experiential avoidance (EA), non-suicidal self-injury (NSSI), and suicide experiences, and (ii) identify sample- and methodological-related variables affecting the strength of these associations.

METHOD

Medline, Embase, PsychINFO, Web of Science, and CINAHL were searched until April 2020. Random-effect meta-analyses were applied. The I² statistic and the Egger's test assessed heterogeneity and publication bias. Meta-regression analyses were used to evaluate the impact of moderator variables on the strength of these associations.

RESULTS

Data from 19 independent studies based on n = 9900 participants were pooled. The analyses demonstrated a weak but significant association between EA and NSSI. None of the examined moderator variables influenced the strength of this relationship. There was an indication of publication bias, suggesting that this association may have been inflated. The associations between EA, and suicide ideation and behaviors were moderate to strong.

DISCUSSION

The current study concluded that (i) the EA model for NSSI should be revised by incorporating new evidence implicating feelings of relief in NSSI, and (ii) future studies should examine interactive factors between EA and key psychological components in the pathways to suicide experiences because these findings have direct clinical implications.

Association between obsessive-compulsive and related disorders and experiential avoidance: A systematic review and meta-analysis

The associations between the distinct types of obsessive-compulsive and related disorders and experiential avoidance have received mixed evidence. We, thus, undertook this meta-analysis to i) re-examine the association between obsessive-compulsive disorder and experiential avoidance, ii) extend this association to hoarding disorder, trichotillomania, and body dysmorphic disorder, and iii) identify potential variables affecting these associations. Five databases, including Medline, Embase, PsychINFO, Web of Science and CINAHL, were searched until March 15th, 2021. Meta-analyses based on random-effect models were performed. Heterogeneity and publication bias tests were applied using the I² statistic and the Egger's test. Meta-regression analyses were performed to identify potential moderators affecting the strength of these associations. Thirty-six unique studies based on n = 11,859 participants were identified. The association between obsessive-compulsive disorder and experiential avoidance was moderate (SMD = 0.75, 95% CI = 0.57-0.92), whereas the associations between individual obsessive-compulsive symptoms, including obsessions, responsibility for harm, ordering, checking, washing and neutralizing, and experiential avoidance ranged from low to strong (SMD ranged between 0.41 and 1.06, 95% CI = 0.25 to 1.40). The associations between hoarding disorder (SMD = 0.93, 95% CI = 0.46-1.40), trichotillomania (SMD = 0.56, 95% CI = 0.48-0.63), body dysmorphic disorder (SMD = 1.55, 95% CI = 0.72-2.37) and experiential avoidance were moderate to strong. Meta-regression analyses demonstrated that studies using the AAQ/AAQ-II scales for measuring experiential avoidance, and/or self-report scales for assessing OCRDs contributed smaller effect sizes. These findings suggest that reducing experiential avoidance may be a viable way of complementing exposure strategies in alleviating obsessive-compulsive and related symptoms.

Obsessive-Compulsive Disorder and Suicidal Experiences: The Role of Experiential Avoidance

OBJECTIVE

Obsessive-compulsive disorder (OCD) is a disabling mental health problem that affects a significant proportion of the general population. Experiential avoidance appears to account for the development of anxiety and depressive symptoms. However, its relationship with OCD has yielded contradictory results. Furthermore, although OCD-specific thoughts and behaviors, including obsessing, checking, washing, and ordering, have been suggested to significantly predict suicidal ideation and behaviors, this line of research has received scant empirical attention. The overarching aim of this study was to explore the relationship between OCD, OCD-specific behaviors, experiential avoidance, and suicidal experiences.

METHODS

Overall, 1,046 adults from the community who completed self-report scales participated.

RESULTS

Strong links between overall OCD severity, obsessing, experiential avoidance, and suicidal experiences were established. Results from mediational analyses showed that overall OCD severity and individual obsessive-compulsive thoughts and behaviors were both directly and indirectly linked with suicidal experiences, via experiential avoidance. Obsessing was among the critical obsessive-compulsive symptoms leading to suicidal experiences.

CONCLUSIONS

These findings are important because they identify experiential avoidance as a potential key explanatory construct in accounting for the development of OCD and suicidal experiences. However, future research using longitudinal and/or experimental designs is needed to infer causality.