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Cited by 124Personality Disorders and PsychopathologyAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and Applications

The impact of experiential avoidance on the reduction of depression in treatment for borderline personality disorder

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Berking, Matthias, Neacsiu, Andrada, Comtois, Katherine Anne, Linehan, Marsha Marie·2009·Behaviour Research and Therapy
DOI 10.1016/j.brat.2009.04.011PMC PMC2771266
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Abstract

Background Reducing symptoms of depression is an important target in the treatment of borderline personality disorder (BPD). Although current treatments for BPD are effective in reducing depression, the average post-treatment level of depression remains high.Aim To test whether experiential avoidance (EA) impedes the reduction of depression during treatment for BPD.Method EA and depression were assessed in 81 clients at baseline and 4-month intervals during 1 year of therapy. Simple correlations, hierarchical linear modeling, and latent difference score models were used to investigate the association between self-reports of EA and both self-reports and observer-based ratings of depression.Results EA was positively associated with greater severity of depression at all points of assessment, and changes in EA were positively associated with changes in depression. Moreover, EA significantly predicted less subsequent reduction in depression whereas no such effect was found for depression on subsequent EA.Conclusion The findings are consistent with the hypothesis that EA impedes the reduction of depression in the treatment of BPD and should thus be considered an important treatment target.

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  • Contextual Cognitive Behavioral Therapies including ACT, Dialectical Behavior Therapy, mindfulness-based therapies, and certain exposure-based therapies have been found to impact a variety of clinical problems by reducing psychological inflexibility.

    “Contextual Cognitive Behavioral Therapies including ACT, Dialectical Behavior Therapy, mindfulness-based therapies, and certain types of exposure-based therapies have been found to impact a variety of clinical problems by reducing psychological inflexibility (Berking et al., 2009; Bowen et al., 2007; Hayes, Villatte et al., 2011; Sauer-Zavala, Boswell, Gallagher, Bentley, Ametaj, & Barlow, 2012).”

    From Examining psychological inflexibility as a transdiagnostic process across psychological disorders (2014) · cites this paper as Berking et al., 2009

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  • Experiential avoidance makes treatment progress more difficult.

    “and makes progress in treatment more difficult (Berking, Neacsiu, Comtois, & Linehan, 2009).”

    From Impact of dialectical behavior therapy versus community treatment by experts on emotional experience, expression, and acceptance in borderline personality disorder (2014) · cites this paper as Berking, Neacsiu, Comtois, & Linehan, 2009

    The Abstract conclusion says the findings are consistent with experiential avoidance impeding the reduction of depression during treatment for borderline personality disorder. The claim broadens this to treatment progress generally; the Discussion says outcomes other than depression and other BPD populations still need investigation. (LLM, conf=0.85)

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  • Experimental investigations have shown that dialectical behavior therapy affects experiential avoidance in adults diagnosed with BPD.

    “While the role of EA has been a central organizing principle of ACT [42], it is also implicated in Linehan’s biosocial theory [18] and experimental investigations have demonstrated effects for DBT on EA in adults diagnosed with BPD.”

    From First evidence of a prospective relation between avoidance of internal states and borderline personality disorder features in adolescents. (2015) · cites this paper as [43]

    The Methods (Participants; page unavailable) describe adults with BPD assigned to DBT or treatment by community experts. The Results report that experiential avoidance decreased during treatment, and that changes in avoidance significantly mediated depression improvement in the DBT group. They do not establish a DBT-specific causal effect on experiential avoidance relative to the comparison treatment; the sample was also limited to women with a history of self-injury or suicide attempts. (LLM, conf=0.84)

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  • In a randomized controlled trial, reductions in experiential avoidance were related to reductions in depression, and failure to reduce experiential avoidance impeded depression reduction.

    “For instance, during a recent randomized controlled trial [43], it was demonstrated that in DBT treatment for BPD, a reduction in EA levels related to a reduction in depression levels. Conversely, failure to reduce EA levels impeded the reduction of depression scores.”

    From First evidence of a prospective relation between avoidance of internal states and borderline personality disorder features in adolescents. (2015) · cites this paper as [43]

    Methods > Participants (page unavailable) identifies the randomized trial comparing DBT with treatment by community experts. The Discussion (page unavailable) reports that reductions in experiential avoidance were associated with reductions in depression, and that higher avoidance predicted less subsequent depression reduction. But it describes impediment as a supported hypothesis, not a demonstrated causal effect; it also says the analysis of subsequent reduction was not conducted separately for DBT. (LLM, conf=0.84)

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  • In an ACT-based treatment study of patients with borderline personality disorder, improvements in psychological flexibility were found to predict improvements in depressive symptoms.

    “For example, in an ACT-based treatment study of patients with borderline personality disorder, improvements in psychological flexibility were found to predict improvements in depressive symptoms [74].”

    From Acceptance and Commitment Therapy: A Transdiagnostic Behavioral Intervention for Mental Health and Medical Conditions. (2017) · cites this paper as [74]

    The Results report that experiential avoidance predicted less subsequent reduction in depression, supporting the claimed relationship between changes in avoidance and depressive symptoms. But the Methods (Participants) describe a study comparing dialectical behavioral therapy with treatment by community experts, not an ACT-based treatment study. The paper measured experiential avoidance rather than psychological flexibility directly. (LLM, conf=0.92)

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Authors
Berking, M., Neacsiu, A., Comtois, K. A., & Linehan, M. M.
Affiliations
University of Washington (US)
Corresponding author
Berking, Matthias
ORCID
Venue
Behaviour Research and Therapy
Publisher
Elsevier BV
Published
2009-08
Volume
47
Issue
8
Pages
663-670
ISSN
0005-7967 (ISSN-L)
DOI
10.1016/j.brat.2009.04.011
PMC
PMC2771266
OpenAlex
W1976699371
Cited by
124
References
103
Citations by year
2026: 3 · 2025: 5 · 2024: 8 · 2023: 6 · 2022: 1 · 2021: 8 · 2020: 5 · 2019: 8 · 2018: 6 · 2017: 5 · 2016: 9 · 2015: 10 · 2014: 13 · 2013: 11 · 2012: 10
FWCI
9.18
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Behaviour Research and Therapy (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • University of Washington
  • Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung
  • National Institutes of Health
  • National Institute of Mental Health (MH01593, MH-34486, R01MH034486, K05MH001593)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
experiential avoidance, depression, borderline personality disorder, treatment response, psychotherapy, treatment goals, depression severity, observer ratings
MeSH terms
Adolescent, Adult, Avoidance Learning, Behavior Therapy, Borderline Personality Disorder, Depression, Female, Humans, Models, Psychological, Self Report

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