Experiential avoidance moderates the association between motivational sensitivity and prolonged grief but not posttraumatic stress symptoms
Open accessAbstract
Within the current theoretical frameworks used in grief and bereavement research, it remains unclear which individual factors confer risk for specific bereavement-related mental health problems, such as posttraumatic stress disorder (PTSD) and prolonged grief disorder. The present study investigated individual differences in motivational sensitivity and self-regulatory processes in a sample of 326 bereaved individuals who experienced sudden and/or unexpected death losses. We (1) examined associations between behavioral activation system (i.e., orientation to rewarding stimuli) and behavioral inhibition system (i.e., orientation to aversive stimuli) sensitivity and bereavement-related mental health problems (i.e., PTSD and prolonged grief symptoms), and (2) explored whether experiential avoidance (i.e., effortful avoidance of internal stimuli) would moderate such associations. Results revealed PTSD was more strongly associated with behavioral inhibition system sensitivity, while prolonged grief symptoms more strongly associated with behavioral activation system sensitivity. In particular, drive sensitivity - a dimension of the behavioral activation system - appeared uniquely associated with prolonged grief symptoms, especially in those who endorsed high experiential avoidance. Findings support a theoretical reconceptualization of prolonged grief as a reward system disorder. This reconceptualization may aid in further understanding mechanisms of bereavement-related mental health problems and related risk factors.
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Experiential avoidance can paradoxically maintain psychological distress, including symptoms of PTSD and Prolonged Grief Disorder, among surrogate decision-makers in ICU settings.
“Unsurprisingly, experiential avoidance can paradoxically maintain psychological distress (28, 29), including symptoms of PTSD and Prolonged Grief Disorder (30, 31) among surrogate decision-makers in ICU settings.”
From EMPOWER: A Multi-Site Pilot Trial to Reduce Distress in Surrogate Decision-Makers in the ICU (2024) · cites this paper as [31]
The Discussion reports that experiential avoidance was associated with both PTSD and prolonged grief symptoms. But the Methods describe undergraduate participants with a history of sudden loss, not ICU surrogate decision-makers; the study's association also does not establish that avoidance maintains their distress. The cited paper therefore supports the symptom association, but not the setting or causal implication. (LLM, conf=0.87)
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“We highlight the role in coping of experiential avoidance, which is the natural tendency to avoid unpleasant feelings and consideration of negative outcomes (Plumb et al., 2004; Gamez et al., 2011, 2014) and which has been associated with PTSD and PGD (Marx and Sloan, 2005; Bishop et al., 2018; Williams et al., 2019;…”
InfluentialEMPOWER: A Multi-Site Pilot Trial to Reduce Distress in Surrogate Decision-Makers in the ICU
Lichtenthal, W. G., Lief, L., Rogers, M., Russell, D., Viola, M., Winoker, H., Kakarala, S., Traube, C., Coats, T., Fadalla, C., et al. (2024) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2024.03.002 · Cited by 17 · see citing works
- Authors
- Williams, J. L., Hardt, M. M., Henschel, A. V., & Eddinger, J. R.
- Affiliations
- University of Missouri–Kansas City (US)
- Corresponding author
- Williams, Joah L.
- Venue
- Psychiatry Research
- Publisher
- Elsevier BV
- Published
- 2019-03
- Volume
- 273
- Pages
- 336-342
- ISSN
- 0165-1781 (ISSN-L)
- PMC
- PMC6561785
- OpenAlex
- W2908569507
- Cited by
- 21
- References
- 37
- Citations by year
- 2026: 1 · 2025: 7 · 2024: 2 · 2023: 3 · 2022: 2 · 2021: 3 · 2020: 3
- FWCI
- 2.34
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychiatry Research (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- NIH (L30 MH104802)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
- Social Sciences › Psychology › Social Psychology › Death Anxiety and Social Exclusion
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Keywords
- experiential avoidance, prolonged grief disorder, post-traumatic stress disorder, bereavement, sudden unexpected death, behavioral activation system, behavioral inhibition system, self-regulation
- MeSH terms
- Adult, Avoidance Learning, Female, Grief, Humans, Male, Middle Aged, Motivation, Risk Factors, Stress Disorders, Post-Traumatic
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