Psychometric evidence of the Acceptance and Action Questionnaire-II (AAQ-II): an item response theory analysis in university students from Chile.

BACKGROUND: Experiential avoidance (EA) is a psychological mechanism associated with several mental health disorders and is regarded as a relevant target by third-generation cognitive behavioral therapies. It has been mainly assessed through self-report questionnaires, and the AAQ-II is the most used tool. Its psychometric evidence has been mostly tested through the classical test theory (CTT) and very scarcely assessed through Item Response Theory (IRT). METHODS: We used the Graded Response Model to examine its psychometric properties in Spanish-speaking university students (n = 1503; women = 995 (66.2%), mean age = 19.29, SD = 2.45). We tested whether the empirical data fit the model's predictions and estimated the dispersion of persons and items along the experiential avoidance continuum. Moreover, we examined category probability curves to identify the response probability of each answer. Likewise, an item-person map was made where the measurement of persons and items, both on the same scale and along the experiential avoidance continuum, could be observed jointly. Finally, we tested the gender invariance of the scale. RESULTS: We found that the values of the individuals and the items were in the established range to be considered an adequate measure of EA. Additionally, we observed high discrimination indices for all items. The current version with seven answer options could not be optimal and should be tested in future studies. Finally, we found evidence of differential functioning by gender in one of the seven items of the instrument. CONCLUSIONS: Our results indicate that the AAQ-II is a suitable tool for measuring EA and accurately classifying and differentiating EA levels in university students.

Experiential Avoidance and Hyperreflexivity as Variables Associated with Depression: A Process-Based Approach

La depresión es un problema importante de salud pública que afecta a una proporción significativa de adultos jóvenes, como los estudiantes universitarios. Para su estudio se ha propuesto un enfoque basado en procesos, que busca identificar variables psicológicas transdiagnósticas que puedan ser objeto de cambio en las intervenciones psicoterapéuticas. El propósito de este trabajo fue analizar la interrelación entre un conjunto de variables de proceso (fusión cognitiva, rumia y evitación experiencial), así como examinar la relación entre cada una de estas variables y la depresión en 368 estudiantes universitarios de entre 18 y 29 años (M = 21.35, DE = 2.36, 77.7 % mujeres). Se halló que la fusión cognitiva y la rumia conformaban una variable global denominada hiperreflexividad, mientras que la evitación experiencial constituía un constructo diferente. Al analizar un modelo de ecuaciones estructurales, se encontró que solo la hiperreflexividad predecía significativamente la depresión. Se discuten estos resultados y sus posibles implicaciones para la práctica clínica. Se recomienda seguir estudiando la hiperreflexividad como una variable supraordinada de relevancia para la psicopatologia.

Depression is a major public health problem that affects a significant proportion of young adults, such as college students. A process-based approach has been proposed for its study, which seeks to identify transdiagnostic psychological variables that can be the target of change in psychotherapeutic interventions. The purpose of this paper was to analyze the interrelation between a set of process variables (cognitive fusion, rumination, and experiential avoidance), as well as to examine the relationship between each of these variables and depression in 368 college students aged 18-29 years (M = 21.35, SD = 2.36, 77.7% female). Cognitive fusion and rumination were found to comprise an overarching variable termed hyperreflexivity, while experiential avoidance constituted a different construct. By analyzing a structural equation model, it was found that only hyperreflexivity predicted depression significantly. These findings and their possible implications for clinical practice are discussed. Further study of hyperreflexivity as a superordinate variable of relevance to psychopathology is recommended.

Experiential Avoidance in Primary Care Providers: Psychometric Properties of the Brazilian "Acceptance and Action Questionnaire" (AAQ-II) and Its Criterion Validity on Mood Disorder-Related Psychological Distress.

BACKGROUND: A sizeable proportion of Brazilian Primary Care (PC) providers suffer from common mental disorders, such as anxiety and depression. In an effort to cope with job-related distress, PC workers are likely to implement maladaptive strategies such as experiential avoidance (EA). The Acceptance and Action Questionnaire (AAQ-II) is a widely used instrument that evaluates EA but has shown questionable internal consistency in specific populations. This study assesses the psychometric properties of the AAQ-II among Brazilian PC providers, evaluates its convergence and divergence with self-criticism and mindfulness skills, and explores its criterion validity on anxiety and depressive symptoms. METHODS: A cross-sectional design was conducted in Brazilian PC services, and the sample included 407 PC workers. The measures evaluated EA, self-criticism, mindfulness, depression, and anxiety. RESULTS: The one-factor model of the AAQ-II replicated the original version structure. The AAQ-II presented good internal consistency among Brazilian PC providers. A multiple regression model demonstrated higher relationships with self-criticism than mindfulness skills. The criterion validity of the AAQ-II on anxiety and depression was stronger in the context of more severe symptoms. CONCLUSIONS: The AAQ-II is an appropriate questionnaire to measure the lack of psychological flexibility among Brazilian PC workers in the sense of EA.

Relación entre el uso problemático de Facebook y la evitación experiencial en jóvenes colombianos / Relationship between the Problematic Use of Facebook and Experiential Avoidance in Young Colombians

Resumen Las tecnologias facilitan la comunicación y la interacción e influyen en los comportamientos y actitudes. Sin embargo, pueden causar impacto negativo cuando interneren en las actividades cotidianas y afectan la salud mental, física y social. El objetivo del estudio fue analizar la relación entre el uso problemático de Facebook, la evitación experiencial y los componentes de la teoría biopsicosocial. Estudio de tipo correlacional con diseno transversal no experimental. En total participaron 677 jóvenes colombianos, que diligenciaron de manera voluntaria los cuestionarios de datos sociodemográficos, la escala de Aceptación y Acción-II (AAQ-II) y la escala de Adicción a Facebook de Bergen (BFAS). Los resultados muestran que los hombres presentaron mayor uso problemático de la red social y puntuaron más alto en los componentes de abstinencia y conflicto. Se encontró una relación positiva significativa entre el uso problemático, la evitación experiencial y todos los componentes de la teoría biopsicosocial. En conclusión, la evitación experiencial aporta a la comprensión del uso problemático de Facebook desde el análisis funcional y la teoría Biopsicosocial que orienta en la identificación de la sintomatología adictiva; estos hallazgos permiten direccionar futuras intervenciones.

Abstract Technologies facilitate communication and interaction, and influence behavior and attitudes. However, they can have a negative impact when they interfere with everyday activities that affect mental, physical, and social health. The objective of the study was to analyze the relationship between the problematic use Facebook, experiential avoidance, and components of the biopsychosocial theory. This study was of a correlational type with a non-experimental cross-sectional design. A total of 677 young Colombians participated, who voluntarily filled out the socio-demographic data questionnaires, the Acceptance and Action-II scale (AAQ-II), and the Bergen Facebook Addiction Scale (BFAS). The results show that men present more problematic use of the social network and scored higher on the abstinence and conflict components. A significant positive relationship was found between the problematic use, experiential avoidance, and all components of the biopsychosocial theory. In conclusion, the experiential avoidance contributes to the understanding of the problematic use Facebook from the functional analysis, and the biopsychosocial theory guides in the identification of the addictive symptomatology. These findings allow directing future interventions.

Experiential avoidance mediates the association between paranoid ideation and depressive symptoms in a sample from the general population.

Psychotic experiences are prevalent in the general population and are associated with negative outcomes, including depressive symptoms. The mechanisms underlying this relationship remain unclear, but new insights could be obtained by exploring the role of transdiagnostic processes such as experiential avoidance, defined as a person's attempts or desires to suppress unwanted internal experiences like thoughts, emotions, memories, or bodily sensations. Studies analyzing the link between negative emotional states and psychotic experiences are scant. We explored the association between a specific kind of psychotic experience (paranoid ideation), experiential avoidance, and depressive, anxiety, and stress symptoms in a sample from the general population. We found that experiential avoidance partially mediates the associations between paranoid ideation and stress and anxiety symptoms and that it fully mediates the association between paranoid ideation and depressive symptoms. Our results suggest that the presence of paranoid ideation and the usage of experiential avoidance to cope with it are vulnerability factors associated with psychological distress.

Evitación experiencial en el contexto de la contingencia sanitaria por covid-19 / Experiential avoidance in the context of the health contingency by covid-19

Resumen La actual contingencia sanitaria producto del COVID-19 esta impactado significativamente la vida de las personas en todo el mundo, teniendo repercusiones no solo a nivel físico sino también a nivel psicológico. Diversas organizaciones e investigadores a nivel nacional e internacional han llamado la atención sobre las consecuencias a nivel de salud mental que podrían evidenciarse en el corto, mediano y largo plazo. En este contexto, puede evidenciarse la presencia y cronificación de patrones de evitación experiencial a nivel general, en la medida que las personas invierten tiempo y energía en controlar, disminuir, o cambiar sus pensamientos, emociones y sensaciones desagradables frente a la pandemia, el coronavirus-2019 y/o todos los significados que surgen en cada persona. La evitación experiencial o rigidez psicológica puede prolongar el sufrimiento y tener un gran costo psicológico, por lo que la alternativa a este patrón comportamental podría encontrarse en la flexibilidad psicológica.

Abstract The current health contingency resulting from COVID-19 is having a significant impact on the lives of people around the world, having repercussions not only on a physical level but also on a psychological level. Various organizations and researchers at national and international level have drawn attention to the consequences at the mental health level that could be evident in the short, medium and long term. In this context, the presence and chronification of patterns of experiential avoidance can be evidenced at a general level, to the extent that people invest time and energy in controlling, reducing, or changing their unpleasant thoughts, emotions and sensations in the face of the pandemic, the coronavirus-2019 and/or all the meanings that arise in each person. Experiential avoidance or psychological rigidity can prolong suffering and have a great psychological cost, so the alternative to this behavioral pattern could be found in psychological fexibility.

El malestar emocional como síntoma de estrés postraumático / Emotional distress as a symptom of post-traumatic stress

El trastorno por estrés postraumático (TEPT) tiene una importante prevalencia en la población, por lo que conocer los mecanismos psicológicos para la vulnerabilidad y el mantenimiento del trastorno es claramente relevante. Entre dichos mecanismos, se ha postulado el constructo de malestar emocional como transdiagnóstico a diversos trastornos mentales. El objetivo del presente estudio fue poner a prueba un modelo hipotético que analizaba la asociación entre tres variables pertenecientes a dicho constructo (evitación experiencial, tolerancia al malestar e intolerancia a la incertidumbre inhibitoria) y el TEPT. Participaron 328 estudiantes universitarios (74.7% mujeres y 25.3% hombres, con una media de edad de 21 años) que habían experimentado al menos un acontecimiento traumático de acuerdo con los criterios del DSM-5, quienes completaron una batería de cuestionarios. Se efectuó un análisis de ecuaciones estructurales cuyos resultados apoyaron parcialmente el modelo hipotético. La evitación experiencial mostró asociarse positiva y significativamente con la tolerancia al malestar, la intolerancia a la incertidumbre inhibitoria y los síntomas del TEPT. La tolerancia al malestar también se vinculó de forma positiva y significativa con dichos síntomas. Sin embargo, la intolerancia a la incertidumbre inhibitoria no mostró relación con esta sintomatología. En apoyo a la evidencia empírica precedente, los hallazgos de este estudio inciden en el papel de la evitación experiencial y la tolerancia al malestar como variables moderadoras de la sintomatología postraumática. Asimismo, apuntan hacia la necesidad de considerar estas variables en las intervenciones psicológicas para el tratamiento del TEPT

Post-traumatic stress disorder or PTSD has an important prevalence in the population, so knowing the psychological mechanisms of vulnerability and maintenance of this disorder is clearly relevant. Among those mechanisms, the emotional distress construct has been postulated as a trans-diagnostic tool related to different mental disorders. The objective of the present study was to test a hypothetical model for the analysis of the association between three variables of this construct (experiential avoidance, distress tolerance, and inhibitory uncertainty intolerance) and PTSD. The subjects of study amounted to 328 university students (74.7% women and 25.3% men, with a median age of 21) who had experienced at least one traumatic event according to the DSM-5 criteria. They were made to complete a set of questionnaires. A structural equation analysis was carried out, with results partially coincident with the hypothetical model. Exponential avoidance showed a positive and significant association with distress tolerance, inhibitory uncertainty intolerance and PTSD symptoms. Distress tolerance was also associated with these symptoms in a positive and significant way. However, inhibitory uncertainty intolerance was not associated with this symptomatology. Following the preexisting empirical evidence, the findings of this study have an impact on the role of experiential avoidance and distress tolerance, as variables that moderate post-traumatic symptomatology. Furthermore, the findings point to the need to consider these variables in psychological interventions for the treatment of PTSD

Incorporación del mindfulness en el aula: un estudio piloto con estudiantes universitarios / Mindfulness Classroom Implementation: A Pilot Study with University Students

Resumen El objetivo del estudio fue analizar los efectos de un programa breve de mindfulness adaptado al contexto del aula, en relación con el nivel de mindfulness (MAAS), evitación experiencial (AAQ-II), ansiedad (STAI) y satisfacción vital (SWLS). La muestra estuvo conformada por 115 estudiantes universitarios. Tras la participación en el programa, los estudiantes aumentaron significativamente los niveles de satisfacción vital y ansiedad estado, no se encontraron diferencias en el resto de variables. Sin embargo, el aumento de la satisfacción vital se relacionó con el aumento del nivel de mindfulness al final del programa (coincidiendo con el inicio de los exámenes). En conclusión, un programa breve de mindfulness mejora la satisfacción vital, aun en un período de alto nivel de ansiedad como es el periodo de exámenes.

Abstract The aim of this pilot study was to analyze the effects of a brief mindfulness program adapted to the academic context, to acknowledge the influence on the level of mindfulness (MAAS), experiential avoidance (AAQ-II), anxiety (STAI) and life satisfaction (SWLS). The sample consisted of 115 college students. After participating in the programme, students showed significantly higher levels of life satisfaction and state anxiety and no differences were found in mindfulness, experiential avoidance and trait anxiety. However, the increase in life satisfaction was related to the increased level of mindfulness at the end of the program (which concurred with the beginning of the exams). In conclusion, a brief mindfulness program improved life satisfaction even in a period of high anxiety, such as the exams period.

Evitación experiencial, afrontamiento y ansiedad en estudiantes de una universidad pública de Lima Metropolitana / Experiential avoidance, coping, and anxiety in students from a public university in Lima

La evitación experiencial (EE) ­o (in)flexibilidad psicológica­ es un concepto central en las terapias contextuales y ha sido propuesta como una dimensión transdiagnóstica de la psicopatología. En el presente estudio, se buscó probar si la EE y otras estrategias de afrontamiento predicen independientemente la ansiedad-estado y la ansiedad-rasgo. Se aplicó un conjunto de medidas (el AAQ-II, una versión modificada del COPE breve, y el IDARE) a 284 estudiantes de pregrado de una universidad pública de Lima. De acuerdo con los resultados, la ansiedad (estado y rasgo) mostró correlaciones significativas con la EE, la baja actitud de solución de problemas, la autoculpa y el uso de sustancias. Sin embargo, al someter estas variables a análisis de regresión múltiple, solo la EE, la baja actitud de solución de problemas y la autoculpa resultaron predictores significativos de la ansiedad-rasgo; de estos, solo la EE contribuyó de manera importante al modelo (ΔR² = .16). Por otra parte, ninguna de las variables estudiadas predijo de manera significativa la ansiedad-estado. Se concluye que el intento de evitar los pensamientos y emociones desagradables constituye un elemento fundamental de la ansiedad-rasgo. Se discute este hallazgo en relación con estudios previos y se brindan sugerencias para nuevas investigaciones

Experiential avoidance (EA)­or psychological (in)flexibility­is a central concept in contextual therapies, and it has been proposed as a transdiagnostic dimension of psychopathology. We intended to test whether EA and other coping strategies independently predict both state and trait-anxiety. We administered a set of measures (the AAQ-II, a modified version of the Brief COPE, and the STAI) to 284 undergraduates from a public university in Lima, Peru. Results showed that EA, lack of problem solving, self-blame, and substance use were all significantly related to state and trait-anxiety. However, after submitting these variables to multiple regression analyses, only EA, lack of problem solving, and self-blame remained significant predictors of trait-anxiety; of these, only EA made a significant improvement to the model (ΔR² = .16). On the other hand, none of the variables under study were significant predictors of state-anxiety. We concluded that the effort to avoid unpleasant thoughts and emotions constitutes a central aspect of trait-anxiety. We discussed these findings in light of previous studies, and gave suggestions for future research.

Transtorno dismórfico corporal sob a perspectiva da análise do comportamento / Body dysmorphic disorder under the perspective of the behavior analysis

O objetivo do trabalho foi investigar comportamentos classificados como Transtorno Dismórfico Corporal e suas contingências de desenvolvimento e manutenção. Foi um estudo descritivo-exploratório por meio de entrevistas, com sete participantes e seus familiares, para levantar algumas hipóteses baseadas nos princípios teóricos do Behaviorismo Radical. Encontraram-se comportamentos depressivos, obsessivos, compulsivos e delirantes; de esquiva social; checagem no espelho e rituais de camuflagem. Nas histórias de vida, identificaram-se: educação coercitiva, grande valorização da beleza, reduzidas interações sociais, acidentes ocorridos, comentários sobre parte do corpo e cirurgias. Sob o controle de estímulos específicos, como o defeito alegado e o olhar dos outros, muitas classes de comportamentos tinham a função de fuga/esquiva. Os comportamentos eram reforçados negativamente, porque evitavam a exposição aos outros e críticas. Alguns comportamentos foram descritos por meio da esquiva experiencial, pois tinham a função de evitar o contato com experiências privadas aversivas, trazendo grandes prejuízos nas áreas social, ocupacional e familiar.

The objective of this study was the investigation of behaviors classified as Body Dysmorphic Disorder and the contingencies of its development and maintenance. A descriptive exploratory study was done using the interviews with seven patients and their families to raise some hypothesis based on the theoretical principles of Radical Behaviorism. Checking the supposed defect in the mirror; camouflage rituals; social avoidance; depressive behaviors; obsessive-compulsive behaviors and delusions was found. Their life history indicated a coercive education, great emphasis on beauty, restrictive social interactions, accidents and commentary on parts of the body by others and many plastic surgeries. Under the specific stimulus control like his own alleged defect and the regard of others, many participants' classes of behavior had the function of escape/avoidance and was negatively reinforced, preventing participants from exposing themselves to others and being criticized. Some behaviors were described as experiential avoidance, as they had the function of avoiding their private aversive condition bringing some major consequences in social, personal and occupational areas.