Cited by 163Psychotherapy Techniques and ApplicationsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health via Writing

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Avoidance and processing as predictors of symptom change and positive growth in an integrative therapy for depression

Hayes, Adele M., Beevers, Christopher G., Feldman, Greg C., Laurenceau, Jean-Philippe, Perlman, Carol·2005·International Journal of Behavioral Medicine

DOI 10.1207/s15327558ijbm1202_9

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Abstract

Depression is a leading cause of disability worldwide and can worsen the course of a variety of medical illnesses. There is a clear need to develop more potent treatments for this debilitating disorder and prevent its return. We are developing a promising psychotherapy that integrates components of current, empirically supported therapies for depression and also teaches healthy lifestyle and emotion regulation habits to promote psychological health. In the 1st open trial, growth curve analyses revealed a significant linear decrease in symptoms of depression in a sample of 29 clients who completed the therapy. Participants wrote essays about their depression each week, and the content was analyzed using a new coding system of change processes. Hierarchical linear modeling (HLM) revealed that peak levels of processing in the essays were associated with more improvement in depression and with the expression of more hope and of both negative and positive views of the self, presumably as clients explored their depressive views of self. Peak levels of avoidance were associated with less improvement in depression and with more hopelessness and negative views of the self. These preliminary results suggest possible targets of change that can facilitate symptom reduction and perhaps also promote psychological health.

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“27,51,52], or suggests that coherence is a consequence or symptom of different forms of psychopathology [66–68], for instance mediated by working memory load [69–71], avoidance [72] or cognitive impairment [73].”
Background
Emotion and the Acceptance-Based Approaches to the Anxiety Disorders
Mennin, D. S. (2007) · Springer eBooks · doi:10.1007/0-387-25989-9_2 · Cited by 34
Constructive and Unproductive Processing of Traumatic Experiences in Trauma-Focused Cognitive-Behavioral Therapy for Youth
Hayes, A. M., Yasinski, C. W., Grasso, D. J., Ready, C. B., Alpert, E., McCauley, T. G., Webb, C. P. M., & Deblinger, E. (2016) · Behavior Therapy · doi:10.1016/j.beth.2016.06.004 · Cited by 39
Self-citation
Expressive writing in psychotherapy: A tool to promote and track therapeutic change.
Cummings, J. A., Hayes, A. M., Saint, D. S., & Park, J. (2014) · Professional Psychology Research and Practice · doi:10.1037/a0037682 · Cited by 31
Self-citation
Changes in affective and cognitive distortion symptoms of depression are reciprocally related during cognitive behavior therapy.
Persons, J., Marker, C., & Bailey, E. (2023) · Behaviour Research and Therapy · doi:10.1016/j.brat.2023.104338 · Cited by 22
Anxiety and Depression in a Non-Clinical Sample of Young Polish Adults: Presence of Meaning in Life as a Mediator
Szczęśniak, M., Falewicz, A., Strochalska, K., & Rybarski, R. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19106065 · Cited by 33
“For example, among patients diagnosed with depression, it has been noted that higher levels of meaning making were related to subsequent reductions in depression [85].”
Background
Measuring the Bright Side of Being Blue: A New Tool for Assessing Analytical Rumination in Depression
Barbic, S. P., Durisko, Z., & Andrews, P. W. (2014) · PLoS ONE · doi:10.1371/journal.pone.0112077 · Cited by 32
Enhancing the efficacy of integrative improvisational music therapy in the treatment of depression: study protocol for a randomised controlled trial
Erkkilä, J., Brabant, O., Saarikallio, S. H., Ala-Ruona, E., Hartmann, M., Letulė, N., Geretsegger, M., & Gold, C. (2019) · Trials · doi:10.1186/s13063-019-3323-6 · Cited by 34
Sudden gains in two trauma-focused treatments for posttraumatic stress disorder
Sloan, D., Thompson-Hollands, J., Hayes, A. M., Lee, D. J., Alpert, E., & Marx, B. P. (2021) · The Behavior Therapist · doi:10.1016/j.beth.2021.08.003 · Cited by 21
Self-citation
Therapeutic effects of extinction learning as a model of exposure therapy in rats
Fucich, E. A., Paredes, D., & Morilak, D. A. (2016) · Neuropsychopharmacology · doi:10.1038/npp.2016.127 · Cited by 24
Systematic Review of In-Session Affect Experience in Cognitive Behavioral Therapy for Depression
Doorn, K. A., & Barber, J. P. (2017) · Cognitive Therapy and Research · doi:10.1007/s10608-017-9865-6 · Cited by 27
Using the Personalized Advantage Index for individual treatment allocation to cognitive behavioral therapy (CBT) or a CBT with integrated exposure and emotion-focused elements (CBT-EE)
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“Even though the application of exposure principles in depression treatment is fairly new, EBCT-R has been associated with significant reductions in depressive symptoms and has shown to be equally effective as CBT and produce effect sizes of similar size (Grosse Holtforth et al., 2012; Grosse Holtforth et al., 2019; Ha…”
Method
Processes of Change in Trauma-Focused Cognitive Behavioral Therapy for Youths: An Approach Informed by Emotional Processing Theory
Alpert, E., Hayes, A. M., Yasinski, C. W., Webb, C. P. M., & Deblinger, E. (2021) · Clinical Psychological Science · doi:10.1177/2167702620957315 · Cited by 24
Self-citation
Restoring meaning in life by meaning‐focused coping: The role of self‐distancing
Wang, Y., Lippke, S., Miao, M., & Gan, Y. (2019) · PsyCh Journal · doi:10.1002/pchj.296 · Cited by 30
An interview study investigating experiences of psychological change without psychotherapy
Gianakis, M., & Carey, T. A. (2011) · Psychology and Psychotherapy: Theory, Research and Practice · doi:10.1111/j.2044-8341.2010.02002.x · Cited by 34
Examining emotional processing theory and predictors of outcome in prolonged exposure for PTSD
Alpert, E., Hayes, A. M., & Foa, E. B. (2023) · Behaviour Research and Therapy · doi:10.1016/j.brat.2023.104341 · Cited by 21
Self-citation
Vermeidung und Depression
Röthlin, P., Holtforth, M. G., Bergomi, C. R., Berking, M., Ottenbreit, N. D., & Caspar, F. (2010) · Diagnostica · doi:10.1026/0012-1924/a000008 · Cited by 21
Evolutionary psychiatry and depression: testing two hypotheses
Varga, S. (2011) · Medicine Health Care and Philosophy · doi:10.1007/s11019-010-9305-9 · Cited by 21
Aberrant Long-Range Temporal Correlations in Depression Are Attenuated after Psychological Treatment
Gärtner, M., Irrmischer, M., Winnebeck, E., Fissler, M., Huntenburg, J. M., Schroeter, T. A., Bajbouj, M., Linkenkaer-Hansen, K., Nikulin, V., & Barnhofer, T. (2017) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2017.00340 · Cited by 21
“Clinical interventions in acutely depressed patients tend to produce strong effects at the early stages of the interventions, a phenomenon that is referred to as early gains (Hayes et al., 2005), and it is possible that the strong reductions in symptoms observed in our study might have overshadowedmore specific effect…”
Background
A Latent Profile Analysis of Implicit and Explicit Cognitions Associated with Depression
Phillips, W. J., Hine, D. W., & Bhullar, N. (2011) · Cognitive Therapy and Research · doi:10.1007/s10608-011-9381-z · Cited by 21
“For example, Emotion-Focused Therapy (Greenberg and Watson 2005) and Exposure-Based Cognitive Therapy (Hayes et al. 2005) aim to generate new cognitive structures by focussing on emotional experiences and the meanings attributed to them.”
Background
Psychotherapy, Symptom Outcomes, and Role Functioning Over One Year Among Patients With Bipolar Disorder
Miklowitz, D. J., Otto, M. W., Wisniewski, S. R., Araga, M., Frank, E., Reilly-Harrington, N. A., Lembke, A., & Sachs, G. S. (2006) · Psychiatric Services · doi:10.1176/ps.2006.57.7.959 · Cited by 20
Shape of change in internet based behavioral activation treatment for depression
O'Mahen, H. A., Wilkinson, E., Bagnall, K., Richards, D. A., & Swales, A. (2017) · Behaviour Research and Therapy · doi:10.1016/j.brat.2017.05.011 · Cited by 25
Disabled at Work: Body-Centric Cycles of Meaning-Making
Zeyen, A., & Branzei, O. (2023) · Journal of Business Ethics · doi:10.1007/s10551-023-05344-w · Cited by 24
“Meaning-making has been extensively studied in response to a broad range of dramatic and traumatic life events that directly affect one’s own body, such as miscarriage (Nikčević & Nicolaides, 2014), depression (Hayes et al., 2005), and cancer (Park et al.”
Background
Emotion suppression, not reappraisal, predicts psychotherapy outcome
Scherer, A., Boecker, M., Pawelzik, M. R., Gauggel, S., & Forkmann, T. (2015) · Psychotherapy Research · doi:10.1080/10503307.2015.1080875 · Cited by 19
Schema Therapy with Emotionally Inhibited and Fearful Patients
Faßbinder, E., & Arntz, A. R. (2018) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-018-9396-9 · Cited by 18
Caregiver Behaviors and Child Distress in Trauma Narration and Processing Sessions of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
Canale, C. A., Hayes, A. M., Yasinski, C., Grasso, D. J., Webb, C. P. M., & Deblinger, E. (2021) · Behavior Therapy · doi:10.1016/j.beth.2021.06.001 · Cited by 17
Self-citation
Depression: Is Rumination Really Adaptive?
Kennair, L. E. O., Kleppestø, T. H., Larsen, S. M., & Jørgensen, B. E. G. (2017) · Evolutionary psychology · doi:10.1007/978-3-319-60576-0_3 · Cited by 17
Processing and Resolving Major Life Stressors: An Examination of Meaning-Making Strategies
Lachnit, I., Park, C. L., & George, L. S. (2020) · Cognitive Therapy and Research · doi:10.1007/s10608-020-10110-7 · Cited by 17
Tracking the implicit self using event-related potentials
Egenolf, Y., Stein, M., Koenig, T. W., Holtforth, M. G., Dierks, T., & Caspar, F. (2013) · Cognitive Affective & Behavioral Neuroscience · doi:10.3758/s13415-013-0169-3 · Cited by 18
Clients' and therapists' stories about psychotherapy.
Adler, J. M. (2013) · Journal of Personality · doi:10.1111/j.1467-6494.2012.00803.x · Cited by 18
Expressive suppression of emotion is a moderator of anxiety in a unified protocol for transdiagnostic treatment of anxiety and depressive disorders: A secondary analysis
Hosogoshi, H., Takebayashi, Y., Ito, M., Fujisato, H., Kato, N., Nakajima, S., Oe, Y., Miyamae, M., Kanie, A., & Horikoshi, M. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.07.132 · Cited by 17

Authors: Hayes, A. M., Beevers, C. G., Feldman, G. C., Laurenceau, J.-P., & Perlman, C.
Affiliations: University of Delaware (US)
The University of Texas at Austin (US)
University of Miami (US)
Massachusetts General Hospital (US)
Corresponding author: Hayes, Adele M.
ORCID: Hayes, Adele M.
Beevers, Christopher G.
Feldman, Greg C.
Laurenceau, Jean-Philippe
Venue: International Journal of Behavioral Medicine
Publisher: Springer Science and Business Media LLC
Published: 2005-06
Volume: 12
Issue: 2
Pages: 111-122
ISSN: 1070-5503 (ISSN-L)
1532-7558
DOI: 10.1207/s15327558ijbm1202_9
OpenAlex: W1998058368
Cited by: 163
References: 106
Citations by year: 2025: 4 · 2024: 4 · 2023: 8 · 2022: 4 · 2021: 12 · 2020: 11 · 2019: 9 · 2018: 6 · 2017: 11 · 2016: 13 · 2015: 14 · 2014: 10 · 2013: 8 · 2012: 10
FWCI: 6.94
Type: journal article
Language: en
Open access: closed
Locations: International Journal of Behavioral Medicine (publishedVersion)
PubMed (publishedVersion)
Funders: National Institute of Mental Health (R21MH062662, R21-MH62662)
Topics: Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Social Psychology › Mental Health via Writing
Keywords: depression, integrative psychotherapy, avoidance, processing, symptom change, positive growth, hope, hopelessness, self-view, emotion regulation, healthy lifestyle, change processes
MeSH terms: Affect, Cognition, Major Depressive Disorder, Depressive Disorder, Major, Female, Humans, Male, Perception, Social Behavior, Verbal Behavior

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Avoidance and processing as predictors of symptom change and positive growth in an integrative therapy for depression

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