Category: Health Psychology / Behavioral Medicine - Adult
Experiential avoidance (EA) is characterized by an unwillingness to engage in distressing or aversive private experiences (e.g., bodily sensations, thoughts, memories, emotions) and a tendency to engage in maladaptive behaviors in an attempt to alter the frequency, form, or duration of these experiences (Hayes et al., 1994, 1996, 2004). EA has been implicated in a range of psychological disorders, including anxiety disorders, depression and overall emotional distress (Hayes et al., 2004; Karekla et al., 2004) and has been incorporated as a treatment target in acceptance and mindfulness based interventions. Prescriptive exercise may reduce EA, but remains understudied. Exercise has been shown to reduce anxiety sensitivity (AS) or increase tolerance of anxiety-related sensations (Broman-Fulks et al., 2004; Smits et al., 2008), a construct related to EA (Berman et al., 2010). Preliminary data indicate that prescriptive exercise may also yield improvements in emotional tolerance and EA in individuals with elevated AS (Berry et al., 2008), yet detailed analyses of this relationship have not been reported. This secondary analysis investigated the role of exercise on EA, using the 9-item Acceptance and Action Questionnaire (AAQ; Hayes, 2000; Hayes et al., 2003) and depressive symptom outcome, using the Beck Depression Inventory-II (BDI-II; Beck et al., 1961,1988). The original study examined (n=60) individuals with elevated AS, randomized to the following conditions: prescriptive exercise (six 20-minute sessions of treadmill exercise at 70% of their age-predicted maximum heart rate), exercise plus cognitive restructuring, or wait-list control. All measures were administered pre-treatment, mid-treatment, post-treatment, and at three-week follow up. Since there were no significant differences in outcomes between the two active conditions, the two exercise groups were combined for analyses. Using mixed effects modeling, we found that individuals who received the exercise intervention demonstrated larger reductions in EA relative to those in the control condition (difference in slopes (b)=2.17, t (149) =2.42, p=0.017). At follow-up, there was a 5.65-point mean difference (t (91.73) =3.11, p=0.002) in AAQ scores between the exercise and control conditions, with final AAQ means of 33.65 and 39.30, respectively. Baseline levels of EA, however did not moderate depression outcome, suggesting that EA may be a key treatment target, regardless of baseline status. These findings provide preliminary support for a relationship between exercise and EA and may highlight an important treatment target for other emotional disorders associated with elevated experiential avoidance (e.g., depression). Clinical implications, limitations, and future directions will be discussed.
Michael W. Otto, PhD, is Professor in the Department of Psychological and Brain Sciences at Boston University. He has had a major career focus on developing and validating new psychosocial treatments for anxiety, mood, psychotic, and substance use disorders, with a particular focus on treatment refractory populations. This includes a translational research agenda investigating brain-behavior relationships in therapeutic learning. His focus on hard-to-treat conditions and principles underlying behavior-change failures led him to an additional focus on health behavior promotion, including investigations of addictive behaviors, medication adherence, sleep, and exercise. Across these health behaviors, he has been concerned with cognitive, attention, and affective factors that derail adaptive behaviors, and the factors that can rescue these processes. He also investigates exercise as an intervention for affective and addictive disorders, as well as for cognitive enhancement. He has over 400 publications spanning his research interests, and was identified as a “top producer” in the clinical empirical literature, and an ISI Highly Cited Researcher. He is a Past President of the Association of Behavioral and Cognitive Therapies, and is currently President of Division 12 of the American Psychological Association.