Experiential avoidance moderates the association between motivational sensitivity and prolonged grief but not posttraumatic stress symptoms

Williams, Joah L.; Hardt, Madeleine M.; Henschel, Aisling V.; Eddinger, Jasmine R.

doi:10.1016/j.psychres.2019.01.020

Cited by 12 publications

(12 citation statements)

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“…Reinforcement sensitivity generally refers to the extent to which an individual is sensitive to perceived rewards or punishers (Corr & Krupić, 2017). Recent research suggests that individual differences in one key aspect of reward sensitivity—drive sensitivity, or persistence in pursuit of a goal—was associated with greater prolonged grief symptom severity in those high in experiential avoidance (Williams et al, 2019). Since our results suggest experiential avoidance has a mediating effect in the relationship between traumatic distress and yearning, this may aid in explaining why those with high drive sensitivity are likely to demonstrate greater PGD symptom severity.…”

Section: Discussionmentioning

confidence: 99%

The role of experiential avoidance in the relationship between traumatic distress and yearning in sudden and unexpected bereavement

2021

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Background Distressing preoccupation with the circumstances of the death, experiential avoidance, and yearning often manifest in pathological forms of grief following the sudden or unexpected death of a loved one. Traumatic distress—the emotional distress linked to circumstances or reminders of a death—often leads to avoidance behaviors, whereas yearning has been conceptualized as an emotional state which leads to proximity‐seeking behaviors following bereavement. A gap exists in the literature explaining how these variables may interact and perpetuate one another. Aims The present study aims to examine the role of experiential avoidance in the relationship between traumatic distress and yearning in a sample of suddenly and unexpectedly bereaved young adults. Results suggest that the association between traumatic distress and yearning may be partially mediated by experiential avoidance. Implications of these findings for theoretical models of grief and yearning are discussed. Materials & Methods Data include a sample of 606 bereaved young adults (Mage = 21.25; 77.4% female) who participated in a larger, online survey study conducted at two universities in the United States exploring the prevalence of trauma exposure in college students. Results Mediation analysis demonstrated experiential avoidance as partially mediating the relationship between traumatic distress and yearning (ab = .21, SE = .10, 95% CI [.02, .40]) when controlling for presence at the scene of death or injury. This indirect effect accounted for 11.67% of the total effect. An additional moderated mediation analysis indicated this indirect effect was present across all levels of prolonged grief disorder (PGD) symptom severity. Discussion Results indicate that the association between traumatic distress and yearning may be partially mediated by experiential avoidance across all levels of PGD symptom severity. Conclusion Findings suggest that bereaved individuals experiencing recurrent, death‐related intrusive thoughts, imagery, and/or other memories related to the circumstances of the death may be more likely to experience intense yearning for the deceased in part due to attempts to avoid painful internal experiences associated with such cues.

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Section: Discussionmentioning

confidence: 99%

The role of experiential avoidance in the relationship between traumatic distress and yearning in sudden and unexpected bereavement

2021

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“…Using a cut-off score of 32 on the PG-13, with bereavement 6 months or longer, ( n = 27/226) 12% met criteria for PGD. The highest rate of PGD was found by Williams et al (2019) who examined bereavement-related mental health problems in undergraduates from a public Midwestern university with a history of sudden, unexpected death-loss. Using a cut-off score of 26 on the PG-13, ( n = 46/326) 14% met criteria for PGD, however, time since loss was not specified.…”

Section: Introductionmentioning

confidence: 99%

Prolonged Grief Disorder in a Diverse College Student Sample

Glickman

2021

Front. Psychol.

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Objective: The purpose of this study was to explore the rate of prolonged grief disorder (PGD) and associated factors in a large sample of diverse college students. Sources of grief support and perceived helpfulness of support were also examined.Method: An online survey was administered to bereaved students at three colleges at the City University of New York. PGD measured by the Inventory of Complicated Grief was the primary outcome. Chi-squared and t-tests were used to assess the association between PGD and associated factors.Results: A total of n = 899 participants completed the Inventory of Complicated Grief (ICG) based on a significant death loss = >12 months. An estimated 13.4% (n = 120/899) met criteria for PGD. The rate of PGD was associated with race, history of anxiety or depression, trauma other than the death, insecure attachment style, kinship to the deceased, closeness to the deceased, cause of death, and sudden/unexpected death. The majority of students sought grief support from a friend or family member.Conclusion: The rate of PGD in this sample of college students is similar to that of adults and most prevalent for students of color. Identification of those most at risk is critical to referring these students to effective treatments.

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“…Furthermore, given that experiential avoidance is an important predictor of psychiatric disorders, including depression, anxiety, prolonged grief, and PTSD (Marx & Sloan, 2005b;Serrano-Ibanez et al, 2021;Spinhoven et al, 2016;Spinhoven et al, 2017;Williams et al, 2019), reducing such avoidance may have longer-term psychological benefits.…”

Section: Discussionmentioning

confidence: 99%

“…The focus on providing individually-tailored tools for higher-risk individuals distinguishes EMPOWER from interventions like critical incident stress debriefing (Gartlehner et al, 2013;Mitchell & Everly, 1995). Ultimately, EMPOWER aims to help surrogates make difficult decisions by building tolerance for painful feelings and negative intrusive thoughts, and EMPOWER FOR SURROGATES OF CRITICALLY ILL PATIENTS by minimizing future chronic avoidance (e.g., of emotional triggers), so that normative acute stress and grief responses do not escalate into pathological reactions like PTSD and PGD (Bishop et al, 2018;Marx & Sloan, 2005a;Serrano-Ibanez et al, 2021;Williams et al, 2019).…”

Section: Intervention and Conceptual Model Descriptionmentioning

confidence: 99%

“…Our conceptual model posits that symptoms of grief, anxiety, traumatic stress, and related maladaptive coping reactions such as dissociation and avoidance, interfere with engaging in value-concordant and empowered end-of-life decision-making (Glick et al, 2018). We highlight the role in coping of experiential avoidance, which is the natural tendency to avoid unpleasant feelings and consideration of negative outcomes (Gamez et al, 2014;Gamez et al, 2011;Plumb et al, 2004) and which has been associated with PTSD and PGD (Bishop et al, 2018;Marx & Sloan, 2005a;Serrano-Ibanez et al, 2021;Williams et al, 2019). There are many subtle ways avoidance may manifest for surrogates.…”

Section: Introductionmentioning

confidence: 99%

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Development and preliminary evaluation of EMPOWER for surrogate decision-makers of critically ill patients

et al. 2021

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Objective The objectives of this study were to develop and refine EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), a brief manualized cognitive-behavioral, acceptance-based intervention for surrogate decision-makers of critically ill patients and to evaluate its preliminary feasibility, acceptability, and promise in improving surrogates’ mental health and patient outcomes. Method Part 1 involved obtaining qualitative stakeholder feedback from 5 bereaved surrogates and 10 critical care and mental health clinicians. Stakeholders were provided with the manual and prompted for feedback on its content, format, and language. Feedback was organized and incorporated into the manual, which was then re-circulated until consensus. In Part 2, surrogates of critically ill patients admitted to an intensive care unit (ICU) reporting moderate anxiety or close attachment were enrolled in an open trial of EMPOWER. Surrogates completed six, 15–20 min modules, totaling 1.5–2 h. Surrogates were administered measures of peritraumatic distress, experiential avoidance, prolonged grief, distress tolerance, anxiety, and depression at pre-intervention, post-intervention, and at 1-month and 3-month follow-up assessments. Results Part 1 resulted in changes to the EMPOWER manual, including reducing jargon, improving navigability, making EMPOWER applicable for a range of illness scenarios, rearranging the modules, and adding further instructions and psychoeducation. Part 2 findings suggested that EMPOWER is feasible, with 100% of participants completing all modules. The acceptability of EMPOWER appeared strong, with high ratings of effectiveness and helpfulness (M = 8/10). Results showed immediate post-intervention improvements in anxiety (d = −0.41), peritraumatic distress (d = −0.24), and experiential avoidance (d = −0.23). At the 3-month follow-up assessments, surrogates exhibited improvements in prolonged grief symptoms (d = −0.94), depression (d = −0.23), anxiety (d = −0.29), and experiential avoidance (d = −0.30). Significance of results Preliminary data suggest that EMPOWER is feasible, acceptable, and associated with notable improvements in psychological symptoms among surrogates. Future research should examine EMPOWER with a larger sample in a randomized controlled trial.

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Experiential avoidance moderates the association between motivational sensitivity and prolonged grief but not posttraumatic stress symptoms

Cited by 12 publications

References 34 publications

The role of experiential avoidance in the relationship between traumatic distress and yearning in sudden and unexpected bereavement

The role of experiential avoidance in the relationship between traumatic distress and yearning in sudden and unexpected bereavement

Prolonged Grief Disorder in a Diverse College Student Sample

Development and preliminary evaluation of EMPOWER for surrogate decision-makers of critically ill patients

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