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The impact of experiential avoidance on the reduction of depression in treatment for borderline personality disorder
Open accessAbstract
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 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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“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
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“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]
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“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]
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“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]
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“Research on mechanism of change has revealed that experiential avoidance impedes the reduction of depression in DBT-treatment of BPD and thus should be targeted (Berking et al., 2009).”
From Emotion regulation in schema therapy and dialectical behavior therapy. (2016) · cites this paper as Berking et al., 2009
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“in addition, reductions in experiential avoidance, as measured by the AAQ, predict corresponding reductions in depression amongst DBT patients seeking treatment for Borderline Personality disorder (Berking, Neacsiu, Comtois, & Linehan, 2009).”
From Preliminary Psychometric Properties of the Acceptance and Action Questionnaire–II: A Revised Measure of Psychological Inflexibility and Experiential Avoidance (2011) · cites this paper as Berking, Neacsiu, Comtois, & Linehan, 2009
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“…future studies need to replicate these findings with other indicators of generalized avoidance tendencies (e.g., Berking & Znoj, 2008; Gratz, Rosenthal, Tull, Lejuez, & Gunderson, 2006; Gross & John, 2003; Ottenbreit & Dobson, 2004), with larger sample sizes, and with fewer missing values.”
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“…a continuum of people from clients suffering from severe psychopathology or health conditions (e.g., epilepsy) to relatively high functioning, non-disordered college students (e.g., Berking et al., 2009; Dalrymple & Herbert, 2007; Masuda et al., 2007; Rüsch et al., 2008; Sheldon et al., in press).”
BackgroundThe Nature, Diagnosis, and Treatment of Neuroticism: Back to the Future
Barlow, D. H., Sauer-Zavala, S., Carl, J. R., Bullis, J. R., & Ellard, K. K. (2014) · Clinical Psychological Science · doi:10.1177/2167702613505532 · Cited by 850
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(2010) · Redalyc (Universidad Autónoma del Estado de México) · Cited by 542
Metadata
- Authors
- Berking, M., Neacsiu, A., Comtois, K. A., & Linehan, M. M.
- Affiliations
- University of Washington (US)
- Corresponding author
- Berking, Matthias
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2009-08
- Volume
- 47
- Issue
- 8
- Pages
- 663-670
- ISSN
- 0005-7967 (ISSN-L)
- 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
- green
- www.ncbi.nlm.nih.gov
- 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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