Association between obsessive-compulsive and related disorders and experiential avoidance: A systematic review and meta-analysis
Abstract
The associations between the distinct types of obsessive-compulsive and related disorders and experiential avoidance have received mixed evidence. We, thus, undertook this meta-analysis to i) re-examine the association between obsessive-compulsive disorder and experiential avoidance, ii) extend this association to hoarding disorder, trichotillomania, and body dysmorphic disorder, and iii) identify potential variables affecting these associations. Five databases, including Medline, Embase, PsychINFO, Web of Science and CINAHL, were searched until March 15th, 2021. Meta-analyses based on random-effect models were performed. Heterogeneity and publication bias tests were applied using the I 2 statistic and the Egger's test. Meta-regression analyses were performed to identify potential moderators affecting the strength of these associations. Thirty-six unique studies based on n = 11,859 participants were identified. The association between obsessive-compulsive disorder and experiential avoidance was moderate (SMD = 0.75, 95% CI = 0.57-0.92), whereas the associations between individual obsessive-compulsive symptoms, including obsessions, responsibility for harm, ordering, checking, washing and neutralizing, and experiential avoidance ranged from low to strong (SMD ranged between 0.41 and 1.06, 95% CI = 0.25 to 1.40). The associations between hoarding disorder (SMD = 0.93, 95% CI = 0.46-1.40), trichotillomania (SMD = 0.56, 95% CI = 0.48-0.63), body dysmorphic disorder (SMD = 1.55, 95% CI = 0.72-2.37) and experiential avoidance were moderate to strong. Meta-regression analyses demonstrated that studies using the AAQ/AAQ-II scales for measuring experiential avoidance, and/or self-report scales for assessing OCRDs contributed smaller effect sizes. These findings suggest that reducing experiential avoidance may be a viable way of complementing exposure strategies in alleviating obsessive-compulsive and related symptoms.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Psychological inflexibility and experiential avoidance are associated with obsessive-compulsive symptoms and psychological distress.
“Psychological inflexibility and experiential avoidance are also associated with OCS and psychological distress (Angelakis and Pseftogianni, 2021;Bond et al., 2011).”
From A pilot study of experiencing racial microaggressions, obsessive-compulsive symptoms, and the role of psychological flexibility (2023) · cites this paper as Angelakis and Pseftogianni, 2021
Experiential avoidance plays a crucial role in the development and maintenance of obsessive-compulsive symptoms.
“Experiential avoidance, the avoidance of unpleasant inner experiences such as fear, discomfort and bodily sensations is found to play a crucial role in the development and maintenance of obsessive–compulsive symptoms [15–19].”
The effect of experiential avoidance on obsessive-compulsive symptoms differed between OCD subtypes; patients with a focus on obsessions and responsibility for harm seem to benefit more from a reduction in experiential avoidance.
“Also, meta-analysis showed that this effect differed between the different subtypes of OCD, patients with the focus on obsessions and responsibility for harm seem to benefit more from a reduction in experiential avoidance [17].”
Destructive and rigid experiential avoidance is reflected in transdiagnostic mental illnesses such as depressive disorders, anxiety disorders, obsessive-compulsive disorder, substance use disorder, eating disorders, and post-traumatic stress disorder.
“Various studies have reported the adverse consequences of destructive and rigid EA, which are reflected in transdiagnostic mental illnesses such as depressive disorders [3], anxiety disorders [4], obsessive–compulsive disorder [5], substance use disorder, [6] eating disorders [7], and post-traumatic stress disorder [8].”
From Acceptance and Commitment Therapy for Destructive Experiential Avoidance (ACT-DEA): A Feasibility Study (2022) · cites this paper as [5]
Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
Statistical Power Analysis for the Behavioral Sciences
Muller, K. E., & Cohen, J. (1989) · Technometrics · doi:10.2307/1270020 · Cited by 99,588 · see citing works
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & for the PRISMA Group (2009) · BMJ · doi:10.1136/bmj.b2535 · Cited by 83,823 · see citing works
Statistical power analysis for the behavioral sciences
Cohen, J. (1990) · Computers Environment and Urban Systems · doi:10.1016/0198-9715(90)90050-4 · Cited by 65,406 · see citing works
Measuring inconsistency in meta-analyses
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003) · BMJ · doi:10.1136/bmj.327.7414.557 · Cited by 63,139 · see citing works
Bias in meta-analysis detected by a simple, graphical test
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997) · BMJ · doi:10.1136/bmj.315.7109.629 · Cited by 56,722 · see citing works
Diagnostic and Statistical Manual of Mental Disorders
(2012) · Springer eBooks · doi:10.1007/springerreference_121117 · Cited by 20,769 · see citing works
Stroup, D. F. (2000) · JAMA · doi:10.1001/jama.283.15.2008 · Cited by 20,623 · see citing works
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2009.06.005 · Cited by 19,575 · see citing works
Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2009) · doi:10.1002/9780470743386 · Cited by 14,225 · see citing works
Duval, S., & Tweedie, R. (2000) · Biometrics · doi:10.1111/j.0006-341x.2000.00455.x · Cited by 14,099 · see citing works
Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2021) · doi:10.1002/9781119558378 · Cited by 9,799 · see citing works
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R. D. (2011) · Behavior Therapy · doi:10.1016/j.beth.2011.03.007 · Cited by 3,950 · see citing works
Systematic reviews: CRD's guidance for undertaking reviews in health care
Tacconelli, E. (2010) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(10)70065-7 · Cited by 3,237 · see citing works
How should meta‐regression analyses be undertaken and interpreted?
Thompson, S. G., & Higgins, J. P. T. (2002) · Statistics in Medicine · doi:10.1002/sim.1187 · Cited by 3,026 · see citing works
Measuring experiential avoidance: A preliminary test of a working model
Hayes, S. C., Strosahl, K., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., Polusny, M. A., Dykstra, T. A., Batten, S. V., Bergan, J., et al. (2004) · The Psychological Record · doi:10.1007/bf03395492 · Cited by 2,140 · see citing works
Hunter, J. E., & Schmidt, F. L. (2000) · International Journal of Selection and Assessment · doi:10.1111/1468-2389.00156 · Cited by 833 · see citing works
Olatunji, B. O., Davis, M. L., Powers, M. B., & Smits, J. A. J. (2013) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2012.08.020 · Cited by 659 · see citing works
Gámez, W., Chmielewski, M., Kotov, R., Ruggero, C., & Watson, D. (2011) · Psychological Assessment · doi:10.1037/a0023242 · Cited by 524 · see citing works
Levitt, J. T., Brown, T. A., Orsillo, S. M., & Barlow, D. H. (2004) · Behavior Therapy · doi:10.1016/s0005-7894(04)80018-2 · Cited by 479 · see citing works
Arch, J. J., Eifert, G. H., Davies, C., Vilardaga, J. C. P., Rose, R. D., & Craske, M. G. (2012) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0028310 · Cited by 443 · see citing works
Twohig, M. P., Hayes, S. C., Plumb, J. C., Pruitt, L. D., Collins, A. B., Hazlett-Stevens, H., & Woidneck, M. R. (2010) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0020508 · Cited by 434 · see citing works
What Does the Acceptance and Action Questionnaire (AAQ-II) Really Measure?
Wolgast, M. (2014) · Behavior Therapy · doi:10.1016/j.beth.2014.07.002 · Cited by 421 · see citing works
Examining psychological inflexibility as a transdiagnostic process across psychological disorders
Levin, M. E., MacLane, C., Daflos, S., Seeley, J. R., Hayes, S. C., Biglan, A., & Pistorello, J. (2014) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2014.06.003 · Cited by 400 · see citing works
Arch, J. J., & Craske, M. G. (2008) · Clinical Psychology: Science and Practice · doi:10.1111/j.1468-2850.2008.00137.x · Cited by 310 · see citing works
Acceptance and commitment therapy for anxiety and OCD spectrum disorders: An empirical review
Bluett, E. J., Homan, K. J., Morrison, K. L., Levin, M. E., & Twohig, M. P. (2014) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2014.06.008 · Cited by 306 · see citing works
Efficacy of cognitive-behavioral therapy for obsessive-compulsive disorder
McKay, D., Sookman, D., Neziroglu, F., Wilhelm, S., Stein, D. J., Kyrios, M., Matthews, K., & Veale, D. (2015) · Psychiatry Research · doi:10.1016/j.psychres.2014.11.058 · Cited by 283 · see citing works
McManus, F. V., Sacadura, C., & Clark, D. M. (2007) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2006.12.002 · Cited by 265 · see citing works
Assessing Psychological Flexibility: What Does It Add Above and Beyond Existing Constructs?
Gloster, A. T., Klotsche, J., Chaker, S., Hummel, K. V., & Hoyer, J. (2011) · Psychological Assessment · doi:10.1037/a0024135 · Cited by 206 · see citing works
Flessner, C. A., & Woods, D. W. (2006) · Behavior Modification · doi:10.1177/0145445506294083 · Cited by 202 · see citing works
Ong, C. W., Clyde, J. W., Bluett, E. J., Levin, M. E., & Twohig, M. P. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.03.006 · Cited by 160 · see citing works
Twohig, M. P., Abramowitz, J. S., Smith, B. M., Fabricant, L. E., Jacoby, R. J., Morrison, K. L., Bluett, E. J., Reuman, L., Blakey, S. M., & Ledermann, T. (2018) · Behaviour Research and Therapy · doi:10.1016/j.brat.2018.06.005 · Cited by 156 · see citing works
Briggs, E. S., & Price, I. R. (2009) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2009.07.004 · Cited by 148 · see citing works
Begotka, A. M., Woods, D. W., & Wetterneck, C. T. (2004) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2004.02.001 · Cited by 132 · see citing works
Obsessive–compulsive symptoms: The contribution of obsessional beliefs and experiential avoidance
Abramowitz, J. S., Lackey, G. R., & Wheaton, M. G. (2009) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2008.06.003 · Cited by 130 · see citing works
Affective regulation in trichotillomania: Evidence from a large-scale internet survey
Shusterman, A., Feld, L., Baer, L., & Keuthen, N. (2009) · Behaviour Research and Therapy · doi:10.1016/j.brat.2009.04.004 · Cited by 127 · see citing works
Experiential avoidance and emotion regulation difficulties in hoarding disorder
Fernández de la Cruz, L., Landau, D., Iervolino, A. C., Santo, S., Pertusa, A., Singh, S., & Mataix-Cols, D. (2013) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2013.01.004 · Cited by 124 · see citing works
BEGOTKA, A. (2004) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/s0005-7916(04)00017-5 · Cited by 98 · see citing works
Experiential avoidance as a mediator of relationships between cognitions and hair-pulling severity
Norberg, M. M., Wetterneck, C. T., Woods, D. W., & Conelea, C. A. (2007) · Behavior Modification · doi:10.1177/0145445506297343 · Cited by 86 · see citing works
Kroska, E. B., Miller, M. L., Roche, A. I., Kroska, S. K., & O’Hara, M. W. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.08.039 · Cited by 80 · see citing works
Wheaton, M. G., Galfalvy, H., Steinman, S. A., Wall, M. M., Foa, E. B., & Simpson, H. B. (2016) · Behaviour Research and Therapy · doi:10.1016/j.brat.2016.07.010 · Cited by 79 · see citing works
Naragon-Gainey, K., & Watson, D. (2018) · Assessment · doi:10.1177/1073191116659741 · Cited by 67 · see citing works
Behavioral and experiential avoidance in patients with hoarding disorder
Ayers, C. R., Castriotta, N., Dozier, M. E., Espejo, E. P., & Porter, B. (2014) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2014.04.005 · Cited by 55 · see citing works
Manos, R. C., Cahill, S. P., Wetterneck, C. T., Conelea, C. A., Ross, A. R., & Riemann, B. C. (2010) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2010.05.001 · Cited by 55 · see citing works
Experiential Avoidance and Saving Cognitions in the Prediction of Hoarding Symptoms
Wheaton, M. G., Abramowitz, J. S., Franklin, J. C., Berman, N. C., & Fabricant, L. E. (2010) · Cognitive Therapy and Research · doi:10.1007/s10608-010-9338-7 · Cited by 51 · see citing works
Reuman, L., Buchholz, J. L., & Abramowitz, J. S. (2018) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2018.06.001 · Cited by 49 · see citing works
Emotion regulation in individuals with and without trichotillomania
Arabatzoudis, T., Rehm, I. C., Nedeljkovic, M., & Moulding, R. (2017) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2017.01.003 · Cited by 48 · see citing works
Jacoby, R. J., Abramowitz, J. S., Buchholz, J. L., Reuman, L., & Blakey, S. M. (2018) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2018.07.003 · Cited by 43 · see citing works
Acceptance-based exposure therapy for body dysmorphic disorder: A pilot study
Linde, J., Rück, C., Bjureberg, J., Ivanov, V. Z., Djurfeldt, D. R., & Ramnerö, J. (2015) · Behavior Therapy · doi:10.1016/j.beth.2015.05.002 · Cited by 41 · see citing works
The Relative Contributions of Experiential Avoidance and Distress Tolerance to OC Symptoms
Blakey, S. M., Jacoby, R. J., Reuman, L., & Abramowitz, J. S. (2016) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465815000703 · Cited by 38 · see citing works
Papachristou, H., Theodorou, M., Neophytou, K., & Panayiotou, G. (2018) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2018.03.001 · Cited by 33 · see citing works
Experiential avoidance in symptom dimensions of OCD
Wetterneck, C. T., Steinberg, D. S., & Hart, J. (2014) · Bulletin of the Menninger Clinic · doi:10.1521/bumc.2014.78.3.253 · Cited by 32 · see citing works
Obsessive–Compulsive Disorder and Suicidal Experiences: The Role of Experiential Avoidance
Angelakis, I., & Gooding, P. (2020) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12593 · Cited by 32 · see citing works
Self-citationOuden, L. D., Tiego, J., Lee, R. S. C., Albertella, L., Greenwood, L., Fontenelle, L. F., Yücel, M., & Segrave, R. A. (2020) · Addictive Behaviors · doi:10.1016/j.addbeh.2020.106464 · Cited by 32 · see citing works
Callaghan, G. M., Duenas, J. A., Nadeau, S. E., Darrow, S. M., der Merwe, J. V., & Misko, J. (2012) · International Journal of Behavioral Consultation and Therapy · doi:10.1037/h0100932 · Cited by 31 · see citing works
Ong, C. W., Blakey, S. M., Smith, B. M., Morrison, K. L., Bluett, E. J., Abramowitz, J. S., & Twohig, M. P. (2020) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2019.100499 · Cited by 28 · see citing works
Hair pulling antecedents in trichotillomania: Their relationship with experiential avoidance
Wetterneck, C. T., Singh, R. S., & Woods, D. W. (2020) · Bulletin of the Menninger Clinic · doi:10.1521/bumc_2020_84_01 · Cited by 28 · see citing works
Experiential Avoidance in Individuals with Hoarding Disorder
Wheaton, M. G., Fabricant, L. E., Berman, N. C., & Abramowitz, J. S. (2012) · Cognitive Therapy and Research · doi:10.1007/s10608-012-9511-2 · Cited by 27 · see citing works
The heterogeneous course of OCD – A scoping review on the variety of definitions
Kühne, F., Ay-Bryson, D. S., Marschner, L., & Weck, F. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.112821 · Cited by 27 · see citing works
Emotion regulation and hoarding symptoms
Taylor, J. K., Moulding, R., & Nedeljkovic, M. (2018) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2018.03.003 · Cited by 26 · see citing works
Ojalehto, H. J., Abramowitz, J. S., Hellberg, S. N., Buchholz, J. L., & Twohig, M. P. (2020) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2020.102210 · Cited by 25 · see citing works
Mental contamination obsessions: An examination across the obsessive-compulsive symptom dimensions
Jacoby, R. J., Blakey, S. M., Reuman, L., & Abramowitz, J. S. (2017) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2017.08.005 · Cited by 23 · see citing works
Experiential avoidance in body dysmorphic disorder
Wilson, A. C., Wilhelm, S., & Hartmann, A. S. (2014) · Body Image · doi:10.1016/j.bodyim.2014.06.006 · Cited by 18 · see citing works
Krafft, J., Ong, C. W., Twohig, M. P., & Levin, M. E. (2019) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2018.08.003 · Cited by 18 · see citing works
An examination of the role of psychological inflexibility in hoarding using multiple mediator models
Ong, C. W., Krafft, J., Levin, M. E., & Twohig, M. P. (2018) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.32.2.97 · Cited by 15 · see citing works
Blakey, S. M., Reuman, L., Buchholz, J. L., & Abramowitz, J. S. (2017) · Body Image · doi:10.1016/j.bodyim.2017.06.003 · Cited by 12 · see citing works
Angelakis, I., & Austin, J. L. (2018) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2017.12.005 · Cited by 12 · see citing works
Self-citationTwohig, M., Morrison, K., & Bluet, E. (2014) · Current Psychiatry Reviews · doi:10.2174/1573400510666140714172145 · Cited by 11 · see citing works
An Ecological Momentary Assessment Study Investigating the Function of Hoarding
Krafft, J., Ong, C. W., Cruz, R. A., Twohig, M. P., & Levin, M. E. (2019) · Behavior Therapy · doi:10.1016/j.beth.2019.10.006 · Cited by 11 · see citing works
Wetterneck, C. T., Lee, E. B., Flessner, C. A., Leonard, R. C., & Woods, D. W. (2015) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2015.12.003 · Cited by 10 · see citing works
Maintenance of Safety Behaviors via Response-Produced Stimuli
Angelakis, I., & Austin, J. L. (2015) · Behavior Modification · doi:10.1177/0145445515610314 · Cited by 9 · see citing works
Self-citationSlikboer, R., Castle, D., Nedeljkovic, M., & Rossell, S. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2017.12.056 · Cited by 9 · see citing works
Conley, S. L., Lee, S. R., Martyn, H. F., & Wu, K. D. (2019) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2019.100453 · Cited by 7 · see citing works
A virtual reality study of experiential avoidance, emotional experiences, and hoarding symptoms
McCabe‐Bennett, H., Provost-Walker, O., Lachman, R., Girard, T. A., & Antony, M. M. (2020) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2020.100590 · Cited by 6 · see citing works
Aversive Events as Positive Reinforcers: An Investigation of Avoidance and Safety Signals in Humans
Angelakis, I., & Austin, J. L. (2015) · The Psychological Record · doi:10.1007/s40732-015-0133-4 · Cited by 4 · see citing works
Self-citationAngelakis, I., Lewis, V., Austin, J. L., & Panagioti, M. (2018) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2018.08.003 · Cited by 4 · see citing works
Self-citationEppingstall, J., Xenos, S., & Yap, K. (2019) · Australian Psychologist · doi:10.1111/ap.12438 · Cited by 4 · see citing works
Behavioral Treatment of Trichotillomania in a College Woman: A Case Study
Boppana, S., & Gross, A. (2019) · Clinical Case Studies · doi:10.1177/1534650119864440 · Cited by 3 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Angelakis, I., & Gooding, P. (2021) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12784 · Cited by 79 · see citing works
Self-citationProvenza, N. R., Reddy, S., Allam, A. K., Rajesh, S. V., Diab, N., Reyes, G., Caston, R. M., Katlowitz, K. A., Gandhi, A. D., Bechtold, R. A., et al. (2024) · Nature Medicine · doi:10.1038/s41591-024-03125-0 · Cited by 68 · see citing works
“Unlike disorders of addiction in which behavior is reward seeking, OCD-related compulsions are difficult-to-control avoidant responses to internal thoughts or external triggers that develop to evade distress or harm 5,6 .”
Zeifman, R. J., Wagner, A. C., Monson, C. M., & Carhart-Harris, R. L. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.04.105 · Cited by 65 · see citing works
Effortless training of attention and self-control: mechanisms and applications
Tang, Y.-Y., Tang, R., Posner, M. I., & Gross, J. J. (2022) · Trends in Cognitive Sciences · doi:10.1016/j.tics.2022.04.006 · Cited by 60 · see citing works
“Research has shown that experiential avoidance is linked to a wide range of behavioral problems and disorders and can be harmful in the long run [27 – 30].”
BackgroundNa, E., Lee, K., Jeon, B.-H., Jo, C., Kwak, U.-H., Jeon, Y., Yang, K., Lee, E. J., & Jeong, J. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192416434 · Cited by 21 · see citing works
“Various studies have reported the adverse consequences of destructive and rigid EA, which are reflected in transdiagnostic mental illnesses such as depressive disorders [3], anxiety disorders [4], obsessive–compulsive disorder [5], substance use disorder, [6] eating disorders [7], and posttraumatic stress disorder [8].”
BackgroundPrevalence and correlates of suicidality in obsessive-compulsive disorder
Hellberg, S. N., Buchholz, J. L., Ojalehto, H. J., Butcher, M. W., Riemann, B. C., & Abramowitz, J. S. (2022) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2022.100711 · Cited by 15 · see citing works
Thompson, E. M., Brierley, M., Destrée, L., Albertella, L., & Fontenelle, L. F. (2021) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2021.11.004 · Cited by 16 · see citing works
Twohig, M. P., Capel, L. K., & Levin, M. E. (2024) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2024.04.013 · Cited by 10 · see citing works
Ding, Z., Shang, T., Ding, Z., Yang, X., Qi, J., Qin, X., Chen, Y., Lv, D., Li, T., Ma, J., et al. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.03.011 · Cited by 9 · see citing works
Shemrani, S., Najafi, M., & Khosravani, V. (2025) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/s10942-025-00584-3 · Cited by 10 · see citing works
“However, the role of experiential avoidance that is strongly linked to OCD (Akbari et al., 2022; Angelakis & Pseftogianni, 2021; Briggs & Price, 2009) has not been examined as other important self-regulatory mechanisms linking thought-action fusion to OCD symptoms.”
Thompson, E. M., Albertella, L., Viskovich, S., Pakenham, K. I., & Fontenelle, L. F. (2024) · Behaviour Research and Therapy · doi:10.1016/j.brat.2024.104595 · Cited by 8 · see citing works
Patel, T. A., Blakey, S. M., Halverson, T. F., Mann, A. J., Calhoun, P. S., Beckham, J. C., Pugh, M. J., & Kimbrel, N. A. (2023) · International Journal of Cognitive Therapy · doi:10.1007/s41811-023-00164-2 · Cited by 8 · see citing works
Ching, T. H. W., Stahnke, B., Shnayder, S., Agin-Liebes, G., Adams, T. G., Amoroso, L., Baiz, O., Belser, A., Bohner, C., Burke, M., et al. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1726818 · Cited by 6 · see citing works
Co-occurring Obsessive-Compulsive Disorder and Hoarding Disorder: A Review of the Current Literature
Worden, B. L., & Tolin, D. F. (2022) · Journal of Cognitive Psychotherapy · doi:10.1891/jcp-2021-0010 · Cited by 8 · see citing works
Incremental validity of the AAQ-II for anxiety disorder symptomology
Broman- Fulks, J. J., Hall, C. A., Kelso, K. C., & Kundert, C. (2021) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2021.09.007 · Cited by 5 · see citing works
Hellberg, S. N., DuBois, C. M., Myers, N. S., Rodriguez, C., Butcher, M. W., Ojalehto, H. J., Riemann, B. C., & Abramowitz, J. S. (2023) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2023.102728 · Cited by 6 · see citing works
Soumee, Z. N., Rasouli, A., Krafft, J., & Mousavi, S. E. (2025) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.70065 · Cited by 5 · see citing works
Browning, M. E., Lloyd-Richardson, E. E., Satterfield, S. L., & Trisal, A. V. (2023) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465823000188 · Cited by 4 · see citing works
“Generally, we expected (based on past research) that experiences of racial microaggressions would relate positively and strongly to total OCS and all subscales in addition to psychological distress (Angelakis and Pseftogianni, 2021; Williams et al., 2017b).”
BackgroundRodgers, R. F. (2025) · Body Image · doi:10.1016/j.bodyim.2025.101930 · Cited by 4 · see citing works
Cervin, M., Andrén, P., & Perrin, S. G. (2025) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.70184 · Cited by 3 · see citing works
Khosravani, V., Sharifibastan, F., Ardestani, S. M. S., & Wahl, K. (2024) · International Journal of Cognitive Therapy · doi:10.1007/s41811-024-00224-1 · Cited by 3 · see citing works
“…used in the treatment of OCD (Bluett et al., 2014; Twohig et al., 2018), which encourage OCD patients to confront their obsessional thoughts and accept their unpleasant internal experiences, rather than avoiding them, may be effective in alleviating OCD symptoms (Angelakis & Pseftogianni, 2021).”
The link between hoarding symptoms and interpersonal difficulties during the COVID-19 pandemic
Broos, H. C., Kushner, M. L., Stamatis, C. A., & Timpano, K. (2024) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2024.100899 · Cited by 3 · see citing works
Miegel, F. S., Schröder, J., Schultz, J., Müller, J. C., & Jelinek, L. (2023) · International Journal of Psychology · doi:10.1002/ijop.12919 · Cited by 3 · see citing works
Gamlı, İ. S., Kaçar, A. Ş., Eyupoglu, N., Karakuş, O. B., & Adak, İ. (2025) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.70083 · Cited by 3 · see citing works
Soumee, Z. N., Rasouli, A., Lee, E. B., & Mousavi, S. E. (2025) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2025.100924 · Cited by 2 · see citing works
Rehm, I. C., Moulding, R., & Nedeljkovic, M. (2024) · Australian Psychologist · doi:10.1080/00050067.2024.2376881 · Cited by 2 · see citing works
“Following a meta-analysis that indicated the relationship between experiential avoidance and HPD severity is of moderate effect size, Angelakis and Pseftogianni (2021) cautioned the AAQ/AAQ-II may primarily measure psychological distress and negative affectivity rather than experiential avoidance…”
Wheaton, M. G. (2025) · CBT: science into practice · doi:10.1007/978-3-031-91439-3_14 · Cited by 2 · see citing works
Bewley, A., & Taylor, R. E. (2024) · doi:10.1002/9781119709268.rook084 · Cited by 2 · see citing works
Hoogerwerf, E., Greeven, A., Goekoop, R., & Spinhoven, P. (2024) · Trials · doi:10.1186/s13063-023-07780-5 · Cited by 1 · see citing works
“Also, meta-analysis showed that this effect differed between the different subtypes of OCD, patients with the focus on obsessions and responsibility for harm seem to benefit more from a reduction in experiential avoidance [17].”
BackgroundTreating Adolescent OCD: Recommendations for Systemic Clinical Competence
Smedley, D. K., Lovell, T. W., & Bean, R. A. (2024) · American Journal of Family Therapy · doi:10.1080/01926187.2024.2354323 · Cited by 1 · see citing works
“It is suggested that this reluctance is associated with the therapist’s level of experiential avoidance (defined as “the inability to tolerate unpleasant thoughts, emotions and/ or bodily sensations,” (Angelakis & Pseftogianni, 2021).”
Loureiro, C. P., dos Santos‐Ribeiro, S., Moreira‐de‐Oliveira, M. E., Laurito, L. D., Hühne, V., Torres, B., Twohig, M. P., de Menezes, G. B., & Fontenelle, L. F. (2026) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2026.01.035 · Cited by 2 · see citing works
Assessing Experiential Avoidance: Further Testing of the AAQ-II and the MEAQ
Jimenez, A., Rochefort, C., & Chmielewski, M. S. (2026) · Assessment · doi:10.1177/10731911261423143 · Cited by 1 · see citing works
Lewis, M. M., Naugle, A. E., DiBacco, T. A., Katte, K., Smith, C. A., & Blematl, A. R. (2022) · Current Psychology · doi:10.1007/s12144-022-03447-7
Nazari, F., Gharraee, B., & Tajrishi, K. Z. (2023) · Iranian Journal of Psychiatry and Clinical Psychology · doi:10.32598/ijpcp.28.4.4377.1
Dissociative episodes characterised by hair-pulling in a late adolescent woman
Healey, D. N., Lee, J. J., Testa, E. G., & Gautam, R. (2023) · BMJ Case Reports · doi:10.1136/bcr-2022-254100
The Effect of Compulsive Hoarding Behavior on Consumers’ Two-Sided Responses
Lee, E.-K., & Park, H.-H. (2025) · Sustainability · doi:10.3390/su17052230 · Cited by 1 · see citing works
Shahri, G. N. K., Khorasgani, E. G., Mohammadi, S. M., Asl, F. M., & Afsarpour, S. A. (2025) · Quarterly Journal of Child Mental Health · doi:10.61882/jcmh.12.1.117 · Cited by 1 · see citing works
Hummelen, B., Brovold, F., Moen, E. M., Meland, K. J., Andersen, A., Johnsen, D. S., Dammen, T., Woods, D. W., & Grøtte, T. (2025) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2025.100972
Hoogerwerf, E., Greeven, A., Goekoop, R., & Spinhoven, P. (2024) · Figshare · doi:10.6084/m9.figshare.24993705
Deniz, E. A., & Eker, S. S. (2025) · Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry · doi:10.18863/pgy.1659447
“Experiential avoidance, defined as the struggle to tolerate distressing internal experiences, has been shown to play a significant role in the development and persistence of OCD (Arabatzoudis et al. 2017 , Blakey et al. 2017 , Angelakis and Gooding 2020 , Angelakis and Pseftogianni 2021).”
A novel approach-avoidance task to study decision making under outcome uncertainty
Cheng, Z., Ging-Jehli, N. R., Tarlow, M., Kim, J., Chase, H. W., Arora, M., Bonar, L. K., Stiffler, R., Grattery, A., Graur, S., et al. (2026) · Psychonomic Bulletin & Review · doi:10.3758/s13423-026-02885-9
“Suboptimal evaluation or integration of these factors may lead to maladaptive motivated behavior and prolonged negative mood (Angelakis & Pseftogianni, 2021; Akbari et al., 2022; Loijen et al., 2020; Trew, 2011).”
Nielsen, S. K. K., Stuart, A. C., Pedersen, M. Ø., Winding, C., Rosenberg, N., Hageman, I., Jørgensen, M. B., & Vangkilde, S. (2026) · Psychotherapy Research · doi:10.1080/10503307.2026.2671186
Hamre, T. A., Kutcher, T., Hanish, R. R., Soubra, S. S., Bentley, H., Mansourian, K. A., Nitcheu, G. L. T., Belavadi, V., Chamarthi, S., Jourahmad, Z., et al. (2026) · medRxiv · doi:10.64898/2026.07.20.26357997
Abramowitz, J. S., Myers, N. S., Hord, C. M., Friedman, J. B., Juel, E. K., Laskowski, G. E., & Receveur, A. M. (2026) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2026.101048
The indirect effects of trauma-related shame and experiential avoidance on PTSD and suicidality
Quiroga, J., Johnson, D. H., & Albanese, B. J. (2026) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2026.2736051
From Topography to Function: Rethinking the Conceptualization of Obsessive-Compulsive Disorder
Abramowitz, J. S., & Melli, G. (2026) · Behavior Therapy · doi:10.1016/j.beth.2026.10.001
Patel, R., & Lippert, A. M. (2026) · Journal of American College Health · doi:10.1080/07448481.2026.2745120
- Authors
- Angelakis, I., & Pseftogianni, F.
- Affiliations
- University of South Wales (GB)
- Norfolk and Suffolk NHS Foundation Trust (GB)
- Corresponding author
- Angelakis, Ioannis
- ORCID
- Angelakis, Ioannis
- Venue
- Journal of Psychiatric Research
- Publisher
- Elsevier BV
- Published
- 2021-06
- Volume
- 138
- Pages
- 228-239
- ISSN
- 0022-3956 (ISSN-L)
- OpenAlex
- W3139885204
- Cited by
- 47
- References
- 77
- Citations by year
- 2026: 9 · 2025: 12 · 2024: 11 · 2023: 7 · 2022: 5 · 2021: 3
- FWCI
- 0.86
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Journal of Psychiatric Research (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- obsessive-compulsive and related disorders, experiential avoidance, obsessive-compulsive disorder, hoarding disorder, trichotillomania, body dysmorphic disorder, obsession, exposure therapy, acceptance and commitment therapy
- MeSH terms
- Hoarding Disorder, Humans, Obsessive-Compulsive Disorder, Trichotillomania, Body Dysmorphic Disorders, Self Report
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
