Mediating role of interpersonal problems in the relationship between experiential avoidance with depression and anxiety

Document Type : Original Article


Islamic Azad University, Karaj branch


Aim: Study aim was to determine the mediating role of interpersonal problems in the relationship between experiential avoidance with depression and anxiety. Method: Method was correlation and statistical population consisted of all male and female residents of City of Karaj in seven region with the quantity of 124688 in 2016. Sample size of 300 volunteers was determined based on Guadagnoli & Velicer (1998) method. Participants were approached in three parks, chosen at random from a list of public parks in Karaj. These were volunteers and informed consent was obtained from each participant. The tools used in the present study consisted of the following questionnaires: The multidimensional experiential avoidance questionnaire (Gámez, Chmielewski, Kotov, Ruggero & Watson, 2011), the interpersonal difficulties scale-47 (Pilkonis, Kim, Proietti & Barkham, 1996), Beck’s depression scale (Beck, Steer & Brown, 1996) and Beck’s anxiety scale (Beck, Epstein, Brown & Steer, 1988). After 50 questionnaires were excluded of the research process because of distortion, the Mahalanobis distance method showed that none of the subjects in this study were outliers, so structural equation modeling was used to analyze the data of 250 subjects. Results: Indirect path coefficients between behavioral avoidance (β=0.151, P=0.016), distraction/ suppression (β=0.151, P=0.021), distress aversion (β=0.270, P=0.001), distress endurance (β=0.161, P=0.005) components with depression and anxiety were significant. Conclusion: Interpersonal difficulty arises from strategy avoidance of some thoughts, memories and activities that is followed by depression and anxiety in the long term. On the other hand, interpersonal problems may affect response to treatment in people with depression and anxiety. Therefore as far as primary prevention training is concerned, it is essential to teach parents and educators how to deal with experiential avoidance in different stages of development.


  1. آفتاب، رویا.، کربلایی محمدمیگونی، احمد.، و تقی‌لو، صادق. (1393). نقش میانجی‌گر راهبردهای تنظیم هیجانی در رابطه بین شخصیت مرزی و خشونت زناشویی. فصلنامه روان‌شناسی کاربردی، 8(4 پیاپی 32): 27-7.
  2. بشارت، محمدعلی. (1388). رابطه بین سخت‌کوشی و مشکلات بین‌شخصی. مطالعات روان‌شناختی، 5(4): 106-85.
  3. بشارت، محمدعلی.، بهرامی‌زاده، حمید.، فتی، لادن.، و حسن‌آبادی، حمیدرضا. (1394). نقش واسطه‌ای باورهای فراشناختی و حساسیت اضطرابی در رابطه بین روان‌رنجورخویی با همبودی اضطراب و افسردگی. فصلنامه روان‌شناسی کاربردی، 9(2 پیاپی 34): 23-7.
  4. دلاور، علی. (1390). مبانی نظری و عملی پژوهش در علوم انسانی و اجتماعی. تهران: رشد، چاپ نهم.
  5. علی‌پور، فرشید.، و محمدی، شهناز. (1394). نشخوار فکری، نشانه‌های اضطراب و افسردگی در افراد دچار لکنت زبان، اضطراب اجتماعی و بهنجار. فصلنامه روان‌شناسی کاربردی، 9(2 پیاپی 34): 97-114.
  6. میراحمدی، سیده لیلا.، احمدی، سید احمد.، و بهرامی، فاطمه. (1390). اثربخشی زوج درمانی کوتاه‌مدت به‌شیوه خودتنظیمی بر سلامت روان و افسردگی زوجین. فصلنامه روان‌شناسی کاربردی، 5(3 پیاپی 19): 111-99.
  7. Bardeen, J. R., & Fergus, T. A. (2016). The interactive effect of cognitive fusion and experiential avoidance on anxiety, depression, stress and posttraumatic stress symptoms. Journal of contextual behavioral science, 5(1): 1-6.
  8. Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology, 56(6):893-7.
  9. Bell, K. M., & Higgins, L. (2015). The impact of childhood emotional abuse and experiential avoidance on maladaptive problem solving and intimate partner violence. Behavioral Sciences, 5(2): 154-175.
  10. Berghoff, C. R., Tull, M. T., DiLillo, D., Messman-Moore, T., & Gratz, K. L. (2016). The role of experiential avoidance in the relation between anxiety disorder diagnoses and future physical health symptoms in a community sample of young adult women. Journal of Contextual Behavioral Science. [In press]
  11. Berman, N. C., Wheaton, M. G., McGrath, P., & Abramowitz, J. S. (2010). Predicting anxiety: the role of experiential avoidance and anxiety sensitivity. Journal of Anxiety Disorders, 24(1): 109-130.
  12. Chawla, N., & Ostafin, B. (2007). Experiential avoidance as a functional dimensional approach to psychopathology: An empirical review. Journal of Clinical Psychology, 63(9): 871-890.
  13. Gamez, W., Chmielewski, M., Kotov, R., Ruggero, C., & Watson, D. (2011). Development of a measure of experiential avoidance: The multidimensional experiential avoidance questionnaire. Psychological Assessment, 23(3): 692-713.
  14. Geisler, F. C. M., & Schroder-Abe, M. (2015). Is emotion suppression beneficial or harmful? It depends on self-regulatory strength. Motivation and Emotion, 39(4): 553-562.
  15. Gerhart, J. A., Baker, C. N., Hoerger, M., & Ronan, G. F. (2014). Experiential avoidance and interpersonal problems: A moderated mediation model. Journal of Contextual Behavioral Science, 3(4): 291-298.
  16. Guadagnoli, E., & Velicer, W. F. (1998). Relation to sample size to the stability of component patterns. Psychological Bulletin, 103(2): 265-275.
  17. Haverkamp, G. L., Torensma, B., Vergouwen, A. C., & Honig, A. (2015). Psychological distress in the hospital setting: A comparison between native Dutch and immigrant patients. PLoS One, 10(6): e0130961.
  18. Hershenberg, R., Mavandadi, S., Wright, E., & Thase, M. E. (2017). Anhedonia in the daily lives of depressed veterans: A pilot report on experiential avoidance as a moderator of emotional reactivity. Journal of Affective Disorders, 208(1): 414-417.
  19. Huh, H. J., Kim, S. Y., Yu, J. J., & Chae, J. H. (2014). Childhood trauma and adult interpersonal relationship problems in patients with depression and anxiety disorders. Annals of general psychiatry, 13(2):26-36.
  20. Joe, S., Woolley, M. E., Brown, G. K., Ghahramanlou-Holloway, M., & Beck, A. T. (2008). Psychometric Properties of the Beck Depression Inventory-II in Low-Income, African American Suicide Attempters. Journal of Personality Assessment, 90(5): 521-523.
  21. Kashdan, T. B., Barrios, V., Forsyth, J. P., & Steger, M. F. (2006). Experiential avoidance as a generalized psychological vulnerability: Comparisons with coping and emotion regulation strategies. Behaviour Research and Therapy, 44(9): 1301-1320.
  22. Kline, R. B. (2005). Principles and practice of structural equation modeling, 2nd edition. New York & London: Guilford press.
  23. Lebowitz, E. R., Shic, F., Campbell, D., Basile, K., & Silverman, W. K. (2015). Anxiety sensitivity moderates behavioral avoidance in anxious youth. Behaviour Research and Therapy, 74(1): 11-17.
  24. Lopez, J. C., Ruiz, F. J., Feder, J., Rubio, A. B., Aguirre, J. J. S., Rodriguez, J. A., & Luciano, C. (2010). The role of experiential avoidance in the performance on a high cognitive demand task. International Journal of Psychology and Psychological Therapy, 10(3): 475-488.
  25. Malinowski, A. S., Veselka, L., Atkinson, B. E. (2017). An investigation of vulnerability factors for depression. Personality and Individual Differences, 107(1): 126-130.
  26. McEvoy, P. M., Burgess, M. M., Nathan, P. (2013). The relationship between interpersonal problems, negative cognitions, and outcomes from cognitive behavioral group therapy for depression. Journal of Affective Disorders, 37(2): 266-275.
  27. McEvoy, P. M., Burgess, M. M., Page, A. C., Nathan, P., & Fursland, A. (2013). Interpersonal problems across anxiety, depression, and eating disorders: a transdiagnostic examination. British Journal of Clinical Psychology, 52(2):129-47.
  28. McMullen, S., Taylor, J., Hunter, M. (2015). Experiential avoidance and psychopathology: A unidimensional or multidimensional construct. Acta Psychopathologica, 1(16): 1-6.
  29. Meyers, L. S., Gamst, G., & Guarino, A. J. (2006). Applied multivariate research, design and interpretation. London: Sage publication.
  30. Mohammadkhani, P., Abasi, I., Pourshahbaz, A., Mohammadi, A., & Fatehi, M. (2016). The role of neuroticism and experiential avoidance in predicting anxiety and depression symptoms: Mediating effect of emotion regulation. Iranian Journal of Psychiatry and Behavioral Sciences, 10(3): 47-50.
  31. Oemig Dworsky, C. K., Pargament, K. I., Wong, S., Exline, J. J. (2016). Suppressing spiritual struggles: The role of experiential avoidance in mental health. Journal of Contextual Behavioral Science. [In Press].
  32. Pilkonis, P. A., Kim, Y., Proietti, J. M., & Barkham, M. (1996). Scales for personality disorders developed from the inventory of interpersonal problems. Journal of Personality Disorders, 10(4): 355-369.
  33. Quilty, L. C., Mainland, B. J., McBride, C., & Bagby, R. M. (2013). Interpersonal problems and impacts: Further evidence for the role of interpersonal functioning in treatment outcome in major depressive disorder. Journal of Affective Disorders, 52(2): 393-400.
  34. Rezaei, M., Ghazanfari, F., & Rezaee, F. (2016). The role of childhood trauma, early maladaptive schemas, emotional schemas and experimental avoidance on depression: A structural equation modeling. Psychiatry Research, 85(1): 407-414.
  35. Rozental, A., Forsell, E., Svensson, A., Forsstrom, D., Andersson, G., & Carlbring, P. (2015). Differentiating procrastinators from each other: A cluster analysis. Cognitive Behaviour Therapy, 44(6): 480-90.
  36. Schmalz, J, E., & Murrell, A. R. (2010). Measuring experiential avoidance in adults: The avoidance and fusion questionnaire. International Journal of Behavioral Consultation and Therapy, 6(3): 198-213.
  37. Schut, D., & Boelen, P. (2016). The relative importance of rumination, experiential avoidance and mindfulness as predictors of depressive symptoms. Journal of Contextual Behavioral Science. [In Press].
  38. Spinhoven, P., Drost, J., Rooij, M., van Hemert, A. M., & Penninx, B. W. (2014). A Longitudinal Study of Experiential Avoidance in Emotional Disorders. Behavior Therapy, 45(6): 840-850.
  39. Starr, L. R., Stroud, C. B., Li, Y. L. (2016). Predicting the transition from anxiety to depressive symptoms in early adolescence: Negative anxiety response style as a moderator of sequential comorbidity. Journal of Affective Disorders, 190(1): 757-763.
  40. Stonerock, G. L., Hoffman, B. M., Smith, P. J., & Blumenthal, J. A. (2015). Exercise as treatment for anxiety: Systematic review and analysis. Annals of Behavioral Medicine: A Publication of the Society of Behavioral Medicine, 49(4): 542-556.
  41. Uhmann, S., Beesdo-Baum, K., Becker, E. S., & Hoyer, J. (2010). Specificity of interpersonal problems in generalized anxiety disorder versus other anxiety disorders and depression. The Journal of nervous and mental disease, 198(11):846-51.
  42. Wagener, A., Baeyens, C., & Blairy, S. (2016). Depressive symptomatology and the influence of the behavioral avoidance and activation: A gender-specific investigation. Journal of Affective Disorders, 193(1): 123-129.
  43. ***