Experiential avoidance and cognitive fusion mediate the relationship between body evaluation and unhelpful body image coping strategies in individuals with visible differences
Open accessAbstract
Psychological flexibility, the capacity to be open to any internal stimuli and act in accordance with valued ends, has been identified as an explanatory variable in how people cope with body concerns. The role of psychological flexibility is unexplored in adults with an atypical appearance due to a health condition, injury, or medical treatment (collectively visible difference), who often encounter multiple day-to-day body image threats. Testing two core components of psychological flexibility, namely experiential avoidance (a desire to avoid or get rid of unpleasant internal experiences) and cognitive fusion (taking thoughts literally), can also provide a more precise theoretical model, with clearer implications for psychological intervention. This survey study investigated whether each psychological flexibility component mediated the relationship between body evaluation and two unhelpful body image coping strategies (behavioural avoidance and appearance-fixing behaviours) in 220 adults with various causes of visible difference. Controlling for demographic variables and subjective noticeability of visible difference, results suggest that cognitive fusion partially mediated the relationship for both body image coping strategies, and experiential avoidance partially mediated behavioural avoidance but not appearance-fixing behaviours. Cognitive fusion may be a particularly important cognitive process in the mechanisms underpinning unhelpful body image coping strategies in this population.
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Experiential avoidance partially mediated disengagement but not appearance-fixing behaviors.
“They also found that experiential avoidance (an unwillingness to remain in contact with unwanted internal experiences) partially mediated disengagement but not appearance-fixing behaviors.”
From An Acceptance and Commitment Therapy Prototype Mobile Program for Individuals with a Visible Difference: Mixed Methods Feasibility Study (2022) · cites this paper as [14]
The Body Esteem for Adolescents and Adults-Appearance subscale has shown good reliability and validity in young adults and good reliability in samples with visible differences.
“The subscale has shown good reliability and validity in young adults [45] and good reliability in samples with visible differences [14,46].”
From An Acceptance and Commitment Therapy Prototype Mobile Program for Individuals with a Visible Difference: Mixed Methods Feasibility Study (2022) · cites this paper as [14]
The Cognitive Fusion Questionnaire has good validity and reliability in clinical and nonclinical adult samples and showed strong reliability in a visibly different population.
“The CFQ has good validity and reliability in clinical and nonclinical adult samples [49] and showed strong reliability in a visibly different population [14].”
From An Acceptance and Commitment Therapy Prototype Mobile Program for Individuals with a Visible Difference: Mixed Methods Feasibility Study (2022) · cites this paper as [14]
The BICSI-AF demonstrated good reliability and validity in college students and strong reliability in visibly different populations.
“The BICSI-AF demonstrated good reliability and validity in college students [15] and strong reliability in visibly different populations [14,43].”
From An Acceptance and Commitment Therapy Prototype Mobile Program for Individuals with a Visible Difference: Mixed Methods Feasibility Study (2022) · cites this paper as [14]
Cognitive fusion mediated the relationship between appearance evaluation and appearance-related life disengagement and appearance-fixing behaviors in individuals with a range of visible differences.
“The authors found that cognitive fusion (taking thoughts as factual statements to be acted on) mediated the relationship between appearance evaluation and 2 unhelpful coping strategies in the form of appearance-related life disengagement (physically avoiding situations because of appearance concerns) and appearance-fixing behaviors (eg, compulsive concealment of the visible difference).”
From An Acceptance and Commitment Therapy Prototype Mobile Program for Individuals with a Visible Difference: Mixed Methods Feasibility Study (2022) · cites this paper as [14]
The 11-item modified Body Image Life Disengagement Questionnaire has been used in a previous study with visibly different participants, showing good reliability.
“The 11-item modified version of the 10-item original version that includes a population-specific item (use public transport) has been used in a previous study with visibly different participants, showing good reliability [14].”
From An Acceptance and Commitment Therapy Prototype Mobile Program for Individuals with a Visible Difference: Mixed Methods Feasibility Study (2022) · cites this paper as [14]
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- Authors
- Zucchelli, F., White, P., & Williamson, H.
- Affiliations
- University of the West of England (GB)
- Corresponding author
- Zucchelli, Fabio
- Venue
- Body Image
- Publisher
- Elsevier BV
- Published
- 2020-03
- Volume
- 32
- Pages
- 121-127
- ISSN
- 1740-1445 (ISSN-L)
- OpenAlex
- W2995287916
- Cited by
- 41
- References
- 45
- Citations by year
- 2026: 9 · 2025: 10 · 2024: 4 · 2023: 5 · 2022: 6 · 2021: 4 · 2020: 3
- FWCI
- 3.80
- Type
- journal article
- Language
- en
- Open access
- Licence
- Locations
- Body Image (publishedVersion)
- PubMed (publishedVersion)
- UWE Research Repository (UWE Bristol) (acceptedVersion, cc-by-nc-nd)
- Funders
- Meningitis Research Foundation
- Dystrophic Epidermolysis Bullosa Research Association
- British Burn Association
- University of the West of England
- Topics
- Social Sciences › Psychology › Clinical Psychology › Body Image and Dysmorphia Studies
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Keywords
- experiential avoidance, cognitive fusion, psychological flexibility, body evaluation, avoidance behavior, visible difference, body image concern
- MeSH terms
- Adaptation, Psychological, Adult, Avoidance Learning, Body Image, Female, Humans, Male, Thinking
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