Does Avoiding Distressing Thoughts and Feelings Influence the Relationship between Carer Subjective Burden and Anxiety Symptoms in Family Carers of People with Dementia?
Open accessAbstract
Anxiety remains understudied in family carers of people with dementia. Understanding factors that moderate the relationship between stressors and anxiety symptoms in this population is critical to inform interventions. This study examined whether generic experiential avoidance (AAQ-II) and experiential avoidance specific to caregiving-related thoughts and feelings (EACQ) moderate the relationship between subjective burden (ZBI-12) and anxiety symptoms (GAD-7) in carers of people with dementia. The first model ( R 2 = .66, ∆R 2 = .03) exploring the moderating effect of AAQ-II demonstrated a significant interaction term between AAQ-II and subjective burden. The second model ( R 2 = .53, ∆R 2 = .03), exploring the moderating effect of EACQ, demonstrated a significant interaction term between EACQ and subjective burden. These results provide evidence that carers with higher levels of experiential avoidance may be particularly prone to the negative effect of subjective burden on anxiety symptoms. Clinical implications for assessment of experiential avoidance and its treatment in carers of people with dementia are discussed.
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Previous studies within dementia caregiving have separately investigated mediating roles of experiential avoidance or cognitive fusion in the association between caregiving stressors and mental health outcomes.
“Previous studies within dementia caregiving have separately investigated mediating roles of experiential avoidance or cognitive fusion in the association between caregiving stressors and mental health outcomes (Barrera- Caballero et al., 2021; Mausbach et al., 2012; Van Hout et al., 2023).”
From The role of experiential avoidance and cognitive fusion in the development of anxiety symptoms among family carers of people with dementia (2024) · cites this paper as Van Hout et al., 2023
The Abstract and Introduction say Van Hout et al. examined whether experiential avoidance *moderates* the relationship between carer subjective burden and anxiety symptoms, not whether it mediates that relationship. The Discussion proposes studying cognitive fusion in future work rather than reporting a caregiving analysis of it. (LLM, conf=0.90)
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Experimental — accuracy not yet measuredIncreased caregiver subjective burden has been linked to augmented levels of experiential avoidance in previous literature.
“which has been linked to augmented levels of experiential avoidance in previous literature (Van Hout et al., 2023).”
From The role of experiential avoidance and cognitive fusion in the development of anxiety symptoms among family carers of people with dementia (2024) · cites this paper as Van Hout et al., 2023
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Cites
(2013) · Cited by 44,563 · see citing works
A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006) · Archives of Internal Medicine · doi:10.1001/archinte.166.10.1092 · Cited by 31,765 · see citing works
Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences
Kemp, F. (2003) · Journal of the Royal Statistical Society Series D (The Statistician) · doi:10.1046/j.1467-9884.2003.t01-2-00383_4.x · Cited by 9,294 · 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
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
Detecting Multicollinearity in Regression Analysis
Shrestha, N. (2020) · American Journal of Applied Mathematics and Statistics · doi:10.12691/ajams-8-2-1 · Cited by 1,800 · see citing works
Bédard, M., Molloy, D. W., Squire, L., Dubois, S., Lever, J. A., & O'Donnell, M. (2001) · The Gerontologist · doi:10.1093/geront/41.5.652 · Cited by 1,691 · see citing works
Bolin, J. H. (2014) · Journal of Educational Measurement · doi:10.1111/jedm.12050 · Cited by 1,515 · see citing works
Hayes, S. C., Levin, M. E., Plumb-Vilardaga, J., Villatte, J. L., & Pistorello, J. (2013) · Behavior Therapy · doi:10.1016/j.beth.2009.08.002 · Cited by 1,120 · cited 3× · see citing works
“Cognitive fusion refers to our tendency to become entangled with thoughts and inability to step back from such restricting beliefs (Hayes et al., 2013).”
BackgroundInfluentialCaregiver burden: A concept analysis
Liu, Z., Heffernan, C., & Tan, J. (2020) · International Journal of Nursing Sciences · doi:10.1016/j.ijnss.2020.07.012 · Cited by 749 · see citing works
Abdi, S., Spann, A., Borilovic, J., de Witte, L., & Hawley, M. (2019) · BMC Geriatrics · doi:10.1186/s12877-019-1189-9 · Cited by 623 · 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
Measures of Clinical Significance
KRAEMER, H. C., MORGAN, G. A., LEECH, N. L., GLINER, J. A., VASKE, J. J., & HARMON, R. J. (2003) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200312000-00022 · Cited by 367 · see citing works
del-Pino-Casado, R., Priego-Cubero, E., López-Martínez, C., & Orgeta, V. (2021) · PLOS ONE · doi:10.1371/journal.pone.0247143 · Cited by 331 · see citing works
Tyndall, I., Waldeck, D., Pancani, L., Whelan, R., Roche, B., & Dawson, D. L. (2019) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2018.09.005 · Cited by 303 · cited 2× · see citing works
“, 2017), highlighting that the concept measured by the AAQ-II may overlap with the underlying concept of the measures of psychological distress (Tyndall et al., 2019).”
BackgroundThe Global Prevalence of Anxiety and Depressive Symptoms Among Caregivers of Stroke Survivors
Loh, A. Z., Tan, J. S., Zhang, M. W., & Ho, R. C. (2017) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2016.08.014 · Cited by 303 · see citing works
Improving Present Practices in the Visual Display of Interactions
McCabe, C. J., Kim, D., & King, K. (2018) · Advances in Methods and Practices in Psychological Science · doi:10.1177/2515245917746792 · Cited by 258 · see citing works
A Longitudinal Study of Experiential Avoidance in Emotional Disorders
Spinhoven, P., Drost, J., de Rooij, M., van Hemert, A. M., & Penninx, B. W. (2014) · Behavior Therapy · doi:10.1016/j.beth.2014.07.001 · Cited by 241 · see citing works
Clarifying the role of mean centring in multicollinearity of interaction effects
Shieh, G. (2011) · British Journal of Mathematical and Statistical Psychology · doi:10.1111/j.2044-8317.2010.02002.x · Cited by 200 · see citing works
Family members of cancer patients: Needs, quality of life and symptoms of anxiety and depression
Friðriksdóttir, N., Sævarsdóttir, Þ., Halfdánardóttir, S. Í., Jónsdóttir, A., Magnúsdóttir, H., Ólafsdóttir, K. L., Guðmundsdóttir, G., & Gunnarsdóttir, S. (2011) · Acta Oncologica · doi:10.3109/0284186x.2010.529821 · Cited by 196 · see citing works
Further evaluation of the psychometric properties of the acceptance and action questionnaire-II
Fledderus, M., Oude Voshaar, M. A. H., ten Klooster, P. M., & Bohlmeijer, E. T. (2012) · Psychological Assessment · doi:10.1037/a0028200 · Cited by 195 · cited 3× · see citing works
“The AAQ-II is considered a generic measure of experiential avoidance and has been validated across various populations (Bond et al., 2011; Fledderus et al., 2012).”
BackgroundEffect of Financial Costs on Caregiving Burden of Family Caregivers of Older Adults
Lai, D. (2012) · SAGE Open · doi:10.1177/2158244012470467 · Cited by 173 · see citing works
A review of AAQ variants and other context-specific measures of psychological flexibility
Ong, C. W., Lee, E. B., Levin, M. E., & Twohig, M. P. (2019) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2019.02.007 · Cited by 142 · see citing works
Kishita, N., Hammond, L., Dietrich, C. M., Mioshi, E., Haapala, I., Biggs, S., & Kurrle, S. (2018) · International Psychogeriatrics · doi:10.1017/s1041610218000947 · Cited by 119 · cited 1× · see citing works
“In addition, existing carer interventions, such as Cognitive Behavioral Therapy (CBT), are considered to be not as effective for anxiety as for depression in family carers of people with dementia (Kishita et al., 2018).”
MethodSelf-citationAnxiety in Informal Dementia Carers: A Meta-Analysis of Prevalence
Kaddour, L., & Kishita, N. (2020) · Journal of Geriatric Psychiatry and Neurology · doi:10.1177/0891988719868313 · Cited by 98 · see citing works
Self-citationCookson, C., Luzon, O., Newland, J., & Kingston, J. (2020) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12233 · Cited by 98 · cited 3× · see citing works
“…role of experiential avoidance and cognitive fusion in a non-clinical sample concluded that experiential avoidance indirectly contributed to depression and anxiety through cognitive fusion rather than experiential avoidance directly affecting depression and anxiety (Cookson et al., 2020).”
BackgroundTrindade, I. A., Mendes, A. L., & Ferreira, N. B. (2019) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2019.12.001 · Cited by 75 · see citing works
Measuring experiential avoidance in adults: the Avoidance and Fusion Questionnaire
Schmalz, J. E., & Murrell, A. R. (2010) · International Journal of Behavioral Consultation and Therapy · doi:10.1037/h0100908 · Cited by 65 · see citing works
Development and validation of the experiential avoidance in caregiving questionnaire (EACQ)
Losada, A., Márquez-González, M., Romero-Moreno, R., & López, J. (2014) · Aging & Mental Health · doi:10.1080/13607863.2014.896868 · Cited by 64 · cited 8× · see citing works
“Of the 79 participants, one respondent did not complete the Experiential Avoidance Caregiving Questionnaire (EACQ) while another respondent did not complete both the Zarit Burden Interview (ZBI-12) and the Experiential Avoidance Caregiving Questionnaire (EACQ).”
BackgroundMethodInfluentialLiving Through the Pandemic: The Voices of Persons With Dementia and Their Caregivers
Rising, K. L., Salcedo, V. J., Amadio, G., Casten, R. J., Chang, A., Gentsch, A. T., O’Hayer, C. V., Sarpoulaki, N., Worster, B. K., & Gerolamo, A. M. (2021) · Journal of Applied Gerontology · doi:10.1177/07334648211036399 · Cited by 41 · see citing works
Psychological Flexibility under Fire: Testing the Incremental Validity of Experiential Avoidance
Vaughan-Johnston, T. I., Quickert, R. E., & MacDonald, T. K. (2017) · Personality and Individual Differences · doi:10.1016/j.paid.2016.10.011 · Cited by 39 · see citing works
Fauth, E. B., Novak, J. R., & Levin, M. E. (2022) · Aging & Mental Health · doi:10.1080/13607863.2021.1942432 · Cited by 38 · see citing works
Kishita, N., Contreras, M. L., West, J., & Mioshi, E. (2020) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2020.07.005 · Cited by 37 · cited 1× · see citing works
“Recently, studies have shown that experiential avoidance is significantly associated with psychological wellbeing among family carers of people with dementia (Cookson et al., 2020; Kishita et al., 2020).”
BackgroundSelf-citationFroelich, L., Lladó, A., Khandker, R. K., Pedrós, M., Black, C. M., Sánchez Díaz, E. J., Chekani, F., & Ambegaonkar, B. (2021) · Journal of Alzheimer s Disease Reports · doi:10.3233/adr-210025 · Cited by 34 · see citing works
Kishita, N., Gould, R. L., Farquhar, M., Contreras, M., Van Hout, E., Losada, A., Cabrera, I., Hornberger, M., Richmond, E., & McCracken, L. M. (2022) · Aging & Mental Health · doi:10.1080/13607863.2021.1985966 · Cited by 30 · cited 2× · see citing works
“Recent studies found that acceptance and commitment therapy is effective for improving mental health problems among family carers of people with dementia (Fauth et al., 2022; Kishita et al., 2022).”
BackgroundMethodSelf-citationSmith, K. J., George, C., Ferreira, N. B., Haapala, I., Biggs, S., & Kurrle, S. (2018) · International Psychogeriatrics · doi:10.1017/s1041610218000315 · Cited by 30 · see citing works
Liu, H., Yang, C., Wang, Y., Hsu, W., Huang, T., Lin, Y., Liu, C., & Shyu, Y. L. (2017) · Journal of Advanced Nursing · doi:10.1111/jan.13379 · Cited by 19 · see citing works
Caregiving in dementia: Emotional and behavioral challenges
Ali, S. A., & Bokharey, I. Z. (2016) · Educational Gerontology · doi:10.1080/03601277.2016.1156375 · Cited by 16 · see citing works
Carer burden and positive gain in dementia
George, C., & Ferreira, N. B. (2020) · Working with Older People · doi:10.1108/wwop-02-2020-0009 · Cited by 6 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- Alzheimer’s Society. (2014). Dementia UK: 2014 edition. Alzheimer’s Society.
Cited by
Sorted by citations
Duangjina, T., Jeamjitvibool, T., Park, C., Raszewski, R., Gruss, V. A., & Fritschi, C. (2025) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2025.105977 · Cited by 31 · see citing works
Gallego‐Alberto, L., Martínez‐Huertas, J. Á., Márquez‐González, M., Cabrera, I., Olazarán, J., & Losada‐Baltar, A. (2024) · Aging & Mental Health · doi:10.1080/13607863.2024.2430530 · Cited by 5 · see citing works
Van Hout, E., Contreras, M., Mioshi, E., & Kishita, N. (2024) · Journal of Behavioral and Cognitive Therapy · doi:10.1016/j.jbct.2023.12.001 · Cited by 4 · see citing works
Self-citationHan, A., Lee, H. K., & Hong, I. (2025) · Clinical Gerontologist · doi:10.1080/07317115.2025.2464868 · Cited by 4 · see citing works
Accepting and committing to caregiving for schizophrenia—a mixed method pilot study
Chakraborty, A., Mitra, S., & Ray, D. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-05993-9 · Cited by 4 · see citing works
Ahn, A., Eldridge, T., Torres, D., & Ratcliff, C. G. (2025) · The Journal of Behavioral Health Services & Research · doi:10.1007/s11414-025-09976-w · Cited by 2 · see citing works
Zhou, X., Zou, N., Shi, C., Chen, S., & Shi, J. (2026) · Aging & Mental Health · doi:10.1080/13607863.2025.2573071 · Cited by 1 · see citing works
- Authors
- Van Hout, E., Contreras, M. L., Mioshi, E., & Kishita, N.
- Affiliations
- School of Health Sciences, University of East Anglia, Norwich, UK
- University of East Anglia (GB)
- Corresponding author
- Kishita, Naoko
- Venue
- Journal of Applied Gerontology
- Publisher
- SAGE Publications
- Published
- 2023-02-09
- Volume
- 42
- Issue
- 8
- Pages
- 1760-1769
- ISSN
- 0733-4648 (ISSN-L)
- 1552-4523
- PMC
- PMC10394954
- OpenAlex
- W4319821915
- Cited by
- 7
- References
- 38
- Citations by year
- 2025: 4 · 2024: 3
- FWCI
- 1.43
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Journal of Applied Gerontology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UEA Digital Repository (University of East Anglia) (submittedVersion)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
- Funders
- National Institute for Health and Care Research (PB-PG-0418-20001)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Clinical Psychology › Family Caregiving in Mental Illness
- Keywords
- experiential avoidance, family caregivers, dementia, subjective burden, anxiety symptoms, moderating effect, caregiver stress, Acceptance and Action Questionnaire-II, Zarit Burden Interview, Generalized Anxiety Disorder-7
- MeSH terms
- Optimism, Anxiety, Dementia, Emotions, Humans, Stress, Psychological, Caregivers
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