Anxious and depressive avoidance behavior in post-loss psychopathology: a longitudinal study
Open accessAbstract
Background Avoidance behavior is a central component of cognitive behavioral theories of bereavement-related psychopathology. Yet, its role is still not well understood. This study examined associations of anxious and depressive avoidance behaviors with concurrently and prospectively assessed symptom-levels of prolonged grief disorder (PGD), depression, and posttraumatic stress disorder (PTSD). Design and methods Two hundred and ninety-one individuals, confronted with loss maximally three years earlier, completed self-report measures of anxious and depressive avoidance and emotional distress and again completed distress measures one year later. Results Anxious and depressive avoidance were concurrently associated with symptom-levels of PGD, depression, and PTSD, even when controlling for the shared variance between both forms of avoidance and relevant socio-demographic and loss-related variables. Prospective analyses showed that baseline anxious avoidance predicted increased symptom-levels of PGD, depression, and PTSD one year later, among participants who were in their first year of bereavement but not among those who were beyond this first year. Baseline depressive avoidance was significantly associated with elevated PTSD one year later, irrespective of time since loss. Conclusions Both anxious and depressive avoidance are associated with different indices of poor long-term adjustment following loss. However, anxious avoidance seems primarily detrimental in the first year o…
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The positive association between loss-related cognitive avoidance and complicated grief symptoms holds while controlling for baseline symptoms.
“also while controlling for baseline symptoms (Boelen & Eisma, 2015).”
From Emotion Regulatory Strategies in Complicated Grief: A Systematic Review (2021) · cites this paper as Boelen & Eisma, 2015
Surveys show moderate to large positive concurrent relationships between loss-related cognitive avoidance and complicated grief symptoms.
“Surveys demonstrated moderate to large positive relationships between loss-related cognitive avoidance (e.g., memory avoidance; thought suppression) and CG symptoms concurrently (Boelen et al., 2015; Boelen & Eisma, 2015; Boelen & van den Bout, 2010; Eisma et al., 2013)”
From Emotion Regulatory Strategies in Complicated Grief: A Systematic Review (2021) · cites this paper as Boelen & Eisma, 2015
Surveys show moderate to large positive concurrent relationships between loss-related cognitive avoidance and complicated grief symptoms.
“Surveys demonstrated moderate to large positive relationships between loss-related cognitive avoidance (e.g., memory avoidance; thought suppression) and CG symptoms concurrently (Boelen et al., 2015; Boelen & Eisma, 2015; Boelen & van den Bout, 2010; Eisma et al., 2013)”
From Emotion Regulatory Strategies in Complicated Grief: A Systematic Review (2021) · cites this paper as Boelen et al., 2015
Surveys demonstrated moderate to large positive associations between depressive avoidance and complicated grief symptoms concurrently and longitudinally.
“Surveys demonstrated moderate to large positive associations between depressive avoidance and CG symptoms concurrently (Boelen, 2012; Boelen et al., 2015; Boelen & Eisma, 2015; Boelen & van den Bout, 2010; Eisma et al., 2013) and longitudinally (Eisma et al., 2013).”
From Emotion Regulatory Strategies in Complicated Grief: A Systematic Review (2021) · cites this paper as Boelen et al., 2015
In a longitudinal analysis controlling for baseline symptoms and loss-related avoidance, depressive avoidance did not predict complicated grief symptoms.
“However, in a longitudinal analysis controlling for baseline symptoms and loss-related avoidance, depressive avoidance did not predict CG symptoms (Boelen & Eisma, 2015).”
From Emotion Regulatory Strategies in Complicated Grief: A Systematic Review (2021) · cites this paper as Boelen & Eisma, 2015
Surveys demonstrated moderate to large positive associations between depressive avoidance and complicated grief symptoms concurrently and longitudinally.
“Surveys demonstrated moderate to large positive associations between depressive avoidance and CG symptoms concurrently (Boelen, 2012; Boelen et al., 2015; Boelen & Eisma, 2015; Boelen & van den Bout, 2010; Eisma et al., 2013) and longitudinally (Eisma et al., 2013).”
From Emotion Regulatory Strategies in Complicated Grief: A Systematic Review (2021) · cites this paper as Boelen & Eisma, 2015
Longitudinal associations between experiential avoidance and complicated grief sometimes did and sometimes did not hold when controlling for baseline symptoms.
“However, longitudinal associations between experiential avoidance and CG sometimes did (Boelen & Eisma, 2015), and sometimes did not (Boelen et al., 2010) hold when controlling for baseline symptoms.”
From Emotion Regulatory Strategies in Complicated Grief: A Systematic Review (2021) · cites this paper as Boelen & Eisma, 2015
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“Anxious avoidance refers to specifically avoiding reminders associated with a loss, due to the fear of what might happen if the individual comes into cues associated with the loss (Boelen & Eisma, 2015).”
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“…research has found grief-related appraisals and coping strategies to be important in the prediction of PGD (Boelen, de Keijser, & Smid, 2015; Boelen & Eisma, 2015; Boelen, van den Bout, & van den Hout, 2003a) but few studies have investigated a number of cognitive predictors for their…”
BackgroundHow thinking hurts: Rumination, worry, and avoidance processes in adjustment to bereavement
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“Moreover, behavioural avoidance and post-loss mental health problems are strongly associated (e.g., Boelen & Eisma, 2015; Boelen & Van den Bout, 2010; Monk, Houck, & Katherine Shear, 2006; Stahl & Schulz, 2018), and behavioural activation reduced prolonged grief and rumination in two randomized…”
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“Even though avoidance can be an adaptive response immediately following the death, deliberate grief avoidance is associated with prolonged grief as it impedes processing of the loss (Boelen & Eisma, 2015).”
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InfluentialSelf-citationNetwork analysis of PGD, PTSD and insomnia symptoms in Chinese shidu parents with PGD
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“Although avoidance may effectively relieve emotional pain in a short time, theoretical models and empirical evidence demonstrate that avoidance can interfere with adapting to the loss in the long run (Boelen et al., 2006; Boelen & Eisma, 2015; Lechner-Meichsner, Mauro, Skritskaya, & Shear, 2021).”
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“This was due to the close association between the instruments' subscale measures (avoidance, intrusion, and hyper‐arousal) with grief symptoms (e.g., Boelen & Eisma, 2015; Boelen, Huntjens, van Deursen, & van den Hout, 2010).”
BackgroundSelf-citationFrom loss to disorder: The influence of maladaptive coping on prolonged grief
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“This shift underscores the importance of longitudinal assessment in understanding the transient dynamics of grief and related coping strategies and points to the potential of measuring maladaptive coping as an early indicator of later PGD.”
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“Accordingly, depressive avoidance relates to more severe mental health outcomes concurrently and longitudinally (e.g., Boelen & Bout, 2013; Boelen & Eisma, 2015; for a review: Eisma & Stroebe, 2021).”
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“2006), showed that negative cognitions and avoidance behavior are related to symptom levels of not only PGD but also PTSD and MDD concurrently and prospectively in people who experienced the death of a loved one (Boelen et al. 2015; Boelen and Eisma 2015; Boelen and van den Bout 2010; Eisma et al. 2013; van der Houwen…”
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“Another explanation may be that avoiding stimuli associated with the loss may protect them from the fear of confronting these reminders (Boelen and Eisma, 2015).”
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“In the present study, we used the four items measuring anxious avoidance, defined as deliberate avoidance of stimuli associated with the loss, driven by the fear of what will happen on confrontation with these reminders (Boelen & Eisma, 2015).”
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“Avoidance behaviour is also associated with psychopathology following loss (Boelen & Eisma, 2015; Boelen & van den Bout, 2010), including depressive avoidance (i.e. withdrawal from previous fulfilling activities because of the belief that these activities are pointless since the loss) and anxious…”
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“Avoiding loss-related stimuli during the period of recovery may lead to more distress (Boelen & Eisma, 2015).”
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“In our opinion, the group setting is an effective tool in addressing common problems associated with grief complications, that is, avoidance of the reality of the loss and the painful feelings associated with grief, and the feeling of being alone with one’s grief (Boelen & Eisma, 2015; Shear, 2015).”
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“Moreover, prolonged grief disorder is associated with avoidance of recreational, social, and occupational activities (known as depressive avoidance; 46–48).”
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“The latter refers to avoidance of stimuli associated with the loss due to the fear that confrontation with these reminders will be unbearable [13].”
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“The findings are also broadly consistent with research showing that avoidance early in the grieving process contributes to longer-term stagnation in grieving (Boelen and Eisma, 2015; Bonanno et al., 2005).”
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“Avoidance is a risk factor in depressive disorders, anxiety disorders, eating disorders and personality disorders, and it has been suggested that avoidance may be a transdiagnostic factor across psychiatric disorders (Barlow and Farchione, 2017; Boelen and Eisma, 2015; Wheaton and Pinto, 2019).”
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- Authors
- Boelen, P. A., & Eisma, M. C.
- Affiliations
- Utrecht University (NL)
- Corresponding author
- Boelen, Paul A.
- Venue
- Anxiety, Stress, & Coping
- Publisher
- Informa UK Limited
- Published
- 2015-02-04
- Volume
- 28
- Issue
- 5
- Pages
- 587-600
- ISSN
- 1061-5806 (ISSN-L)
- 1477-2205
- OpenAlex
- W2068025873
- Cited by
- 54
- References
- 0
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 4 · 2023: 6 · 2022: 8 · 2021: 6 · 2020: 4 · 2019: 4 · 2018: 2 · 2017: 3 · 2016: 3 · 2015: 1
- FWCI
- 3.72
- Type
- journal article
- Language
- en
- Open access
- green
- dspace.library.uu.nl
- Licence
- other-oa
- Locations
- Anxiety Stress & Coping (publishedVersion)
- PubMed (publishedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Utrecht University Repository (Utrecht University) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
- Social Sciences › Anthropology › Death, Funerary Practices, and Mourning
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Keywords
- avoidance behavior, bereavement, prolonged grief disorder, depression, post-traumatic stress disorder, loss, long-term adjustment, emotional distress
- MeSH terms
- Anxiety Disorders, Attitude to Death, Avoidance Learning, Bereavement, Depressive Disorder, Female, Humans, Life Change Events, Longitudinal Studies, Male, Middle Aged, Prospective Studies, Stress Disorders, Post-Traumatic
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