Experiential Avoidance and Bordering Psychological Constructs as Predictors of the Onset, Relapse and Maintenance of Anxiety Disorders: One or Many?

Publication Type:

Journal Article


Cognitive Therapy and Research, Volume 41, p.867-880 (2017)




Experiential avoidance; Neuroticism; Rumination; Worry; Anxiety sensitivity; Anxiety; Vulnerability


To investigate (a) the incremental predictive
validity of experiential avoidance over and above bordering
psychological constructs (i.e., rumination, worry, neuroticism
and anxiety sensitivity) in predicting onset, relapse
and maintenance of anxiety disorders; and (b) whether
these related constructs can be represented by a single,
higher-order latent factor with similar predictive power as
the separate psychological constructs while offering a more
parsimonious predictive model. Longitudinal cohort study
with repeated assessments after 4 years in a sample of 2157
adults aged 18–65, consisting of 1614 persons with past
or current anxiety disorder (Panic Disorder with or without
Agoraphobia, Social Anxiety Disorder, Generalized
Anxiety Disorder, Agoraphobia without panic) according
to the Composite Interview Diagnostic Instrument
(CIDI) and 543 controls. Experiential avoidance (Acceptance
and Action Questionnaire-I) manifested substantial
overlap with bordering cognitive constructs. Experiential
avoidance and anxiety sensitivity both uniquely predicted
maintenance of anxiety disorders and neuroticism uniquelypredicted relapse of anxiety disorders, over and above the
effect of the other cognitive constructs. Moreover, a latent
factor of psychological vulnerability loaded strongly on
each of these psychological constructs. This latent factor
predicted onset, maintenance and relapse of anxiety disorders.
The tendency to frequently experience strong negative
emotions, to evaluate these experiences as aversive and to
engage in avoidant coping strategies may constitute a transdiagnostic
factor predictive of anxiety disorders. Further
developing and testing of interventions targeting transdiagnostic
construct underlying anxiety and mood disorders
seem warranted.