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A Taxometric Analysis of Experiential Avoidance BETH-00995; No of Pages 13; 4C: Available online at www.sciencedirect.com ScienceDirect Behavior Therapy xx (xxxx) xxx www.elsevier.com/locate/bt A Taxometric Analysis of Experiential Avoidance Alex Kirk University of Colorado Boulder Joshua J. Broman-Fulks Appalachian State University Joanna J. Arch University of Colorado Boulder University of Colorado Cancer Center EXPERIENTIAL AVOIDANCE (EA) IS defined as an Experiential avoidance, a trait-like construct referring to the unwillingness to confront and remain in contact tendency to rigidly avoid or change unpleasant internal with unpleasant thoughts and emotions, coupled experiences stemming from an unwillingness to experience with attempts to change the form, frequency, or them, is believed to contribute to the development and occurrence of those experiences and the situations maintenance of various forms of psychopathology. Despite that elicit them (Hayes, Wilson, Gifford, Follette, & significant research on this construct, it remains unclear Strosahl, 1996). EA has largely been conceptualized whether experiential avoidance is dimensional or categorical and measured as trait-like (Gámez, Chmielewski, at the latent level. The current study examined the latent Kotov, Ruggero, & Watson, 2011), encompassing structure of experiential avoidance using three taxometric a variety of beliefs and behaviors that promote analytic approaches (MAXimum Eigenvalue, Mean Above avoidance strategies in the context of distressing Minus Below A Curve, Latent-Mode Factor Analysis) situations. Thus, individuals high in EA are more applied to data from two independent samples and using likely to engage in avoidance behaviors (e.g., three widely used measures of experiential avoidance. The leaving a room containing a feared stimulus, first sample (n = 922) completed the Multidimensional distracting oneself from sadness) when distress or Experiential Avoidance Questionnaire (Gámez, Chmie- a distressing situation arises or is anticipated. lewski, Kotov, Ruggero, & Watson, 2011), while the second Importantly, while avoidance itself is not intrinsi- sample (n = 615) completed the Brief Experiential Avoid- cally pathological, it can become problematic when ance Questionnaire (Gámez et al., 2014) and Acceptance it is both contextually insensitive and relied upon in and Action Questionnaire-II (Bond et al., 2011). Across a chronic manner as a means of regulating both samples and all three measures, experiential avoidance unpleasant internal experiences (Forsyth, Eifert, & exhibited a dimensional structure. The clinical and research Barrios, 2006), such as in the case of consistently implications of this finding for experiential avoidance are high EA. Indeed, this is reflected in the consistent discussed. finding that higher EA is associated with negative outcomes including greater mental health symptom severity (Gámez et al., 2011; Kashdan et al., 2014; Keywords: experiential avoidance; taxometrics; MEAQ; BEAQ; Thompson & Waltz, 2010), lower quality of life AAQ-II (Gámez et al., 2011; Kashdan, Morina, & Priebe, 2009; Kirk, Meyer, Whisman, Deacon, & Arch, 2019), and poorer physical health (Andrew & Address correspondence to Alex Kirk, M.A., University of Dulin, 2007; Berghoff, Tull, DiLillo, Messman- Colorado Boulder, 345 Muenzinger, Boulder, CO 80309-0345; Moore, & Gratz, 2017). Further, high EA has been e-mail: [email protected]. shown to be associated with a variety of diagnoses 0005-7894/© 2020 Association for Behavioral and Cognitive Therapies. including anxiety disorders (Bardeen, Fergus, & Published by Elsevier Ltd. All rights reserved. Orcutt, 2013; Kashdan et al., 2014; Newman & Please cite this article as: A. Kirk, J. J. Broman-Fulks and J. J. Arch, A Taxometric Analysis of Experiential Avoidance, Behavior Therapy, https://doi.org/10.1016/j.beth.2020.04.008 2 kirk et al. Llera, 2011; Thompson & Waltz, 2010), depres- individuals can express varying levels of EA, such as sion (Spinhoven, Drost, de Rooij, van Hemert, & “high” or “low” EA (e.g., Kashdan et al., 2014). Penninx, 2014), alcohol and substance use disor- Importantly, when used in this way, “high” or ders (Levin et al., 2012; Shorey et al., 2017), and “low” EA does not reflect qualitatively distinct borderline personality disorder (Jacob, Ower, & types of EA, but rather a shared type of EA with Buchholz, 2013). Taken together, EA can be different levels of severity. Thus, the set of conceptualized as a latent psychological factor experiences and behaviors between “high” and that influences a range of avoidance behaviors in “low” EA individuals is similar, but the frequency distressing contexts and across diverse psycholog- or intensity of those experiences or behaviors differ. ical symptom profiles. However, despite this common description of EA, An important finding is that EA does not appear there is insufficient psychometric evidence to to be unidimensional. Though early measures of indicate that EA operates along a single continuum EA assessed it as a single factor, including the of behavior. Indeed, it may be the case that EA Acceptance and Action Questionnaire-II (AAQ-II; functions categorically such that different scores on Bond et al., 2011), later factor analytic studies EA measures reflect qualitatively distinct categories. on measures of EA have found evidence for a Viewed this way, those who are high versus low EA multidimensional structure (Gámez et al., 2011). would then reflect qualitatively distinct groups Specifically, the Multidimensional Experiential characterized by divergent sets of behavior, rather Avoidance Questionnaire (MEAQ; Gámez et al., than a shared set of behaviors that differ only in the 2011) identified six factors of EA, including frequency or intensity with which they are behavioral avoidance, distress aversion, procrasti- expressed. An example of this might be that low nation, distraction/suppression, repression/denial, EA could reflect an adaptive coping style, while and distress endurance. As such, EA appears to be high EA might reflect more pathological avoidance comprised of distinct forms of trait-like avoidance observed in chronic and severe mental health tendencies and does not necessarily operate in the disorders. Such categorical distinctions among same way among different people. Thus, two varying levels of avoidance behaviors have been individuals expressing high levels of EA could discussed within the literature on safety behaviors express distinct dimensions of EA, which influence versus adaptive coping (e.g., Arnaudova, Kindt, avoidance behaviors differently. Importantly, the Fanselow, & Beckers, 2017; Thwaites & Freeston, MEAQ has withstood psychometric scrutiny, 2005), though no clear consensus exists. Elucidat- showing evidence that the overall scale and ing the underlying dimensional or categorical subscales are robust and diverge from constructs structure of EA advances both our theoretical such as distress or negative affectivity (Rochefort, understanding of this construct and our approach Baldwin, & Chmielewski, 2018). The MEAQ also to measuring it. comes in a shortened version, the Brief Experiential Central to determining the categorical or dimen- Avoidance Questionnaire (BEAQ; Gámez et al., sional structure of a construct is the use of taxometric 2014), which retains the same dimensions mea- analyses, a set of statistical procedures that allows sured by the MEAQ though only a single overall researchers to mathematically evaluate the latent score is derived. The AAQ (Hayes et al., 2004)and structure of a given construct (Beauchaine, 2007; AAQ-II (Bond et al., 2011) reflected groundbreak- Meehl, 1995). Through use of taxometrics, con- ing theoretical developments on EA (Hayes et al., structs can be shown to have taxonic (i.e., dichoto- 1996; Hayes et al., 2004) and remain widely used, mous, categorical) or nontaxonic (i.e., continuous, though have not held up as well to psychometric dimensional) structures (Meehl & Golden, 1982). scrutiny (Rochefort et al., 2018; Wolgast, 2014). Taxometric analyses have been applied to various Despite accumulating data on the importance of psychological diagnoses including anxiety disorders EA in predicting critical outcomes, less is known (Kollman, Brown, Liverant, & Hofmann, 2006), about its latent structure. Early work on EA has posttraumatic stress disorder (Broman-Fulks et al., proposed that it exists within a dysfunctional range 2006), obsessive-compulsive disorder (Olatunji, Wil- of normal behavior, implying a more dimensional liams, Haslam, Abramowitz, & Tolin, 2008), major conceptualization (Hayes et al., 1996). That is, depression (Prisciandaro & Roberts, 2005; individuals may exhibit varying levels of EA, but Solomon, Ruscio, Seeley, & Lewinsohn, 2006), only at a sufficiently high level does it influence bipolar disorder (Ahmed, Green, Clark, Stahl, & negative outcomes. Consistent with this dimension- McFarland, 2011; Prisciandaro & Roberts, 2011), al view, researchers have historically referred to EA and eating disorders (Olatunji et al., 2012). Beyond in terms of a given self-report score that exists along formal diagnoses, various studies have also exam- a broader range of scores. For example, different ined the latent structure of mental health constructs Please cite this article as: A. Kirk, J. J. Broman-Fulks and J. J. Arch, A Taxometric Analysis of Experiential Avoidance, Behavior Therapy, https://doi.org/10.1016/j.beth.2020.04.008 taxometrics of experiential avoidance 3 that, like EA, predict the onset and exacerbation
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