Examining the Role of Emotional Avoidance in the Relationship Between Posttraumatic Stress Disorder Symptom Severity and Worry

Abstract

A growing body of literature suggests that worry is a cognitive activity functioning to avoid unpleasant internal experiences such as negative thoughts, emotions, and somatic responses. Given the highly aversive internal events associated with posttraumatic stress disorder (PTSD), individuals experiencing PTSD symptoms following exposure to a traumatic event may be particularly motivated to engage in avoidant regulation strategies such as worry. Surprisingly, however, few studies to date have examined the relationship between PTSD and worry as well as potential factors that might explain this association. Therefore, the goal of this study was to examine the association between PTSD symptom severity and worry and the extent to which emotional avoidance explains this relationship. To this end, 207 college students with a history of traumatic exposure (meeting Criterion A for a PTSD diagnosis) completed a series of questionnaires assessing history of exposure to potentially traumatic events, PTSD symptom severity, emotional avoidance tendencies, and worry. Results demonstrated that PTSD symptom severity was positively associated with worry and emotional avoidance. Further, emotional avoidance was found to fully account for this relationship, providing support for the proposed emotionally avoidant function of worry. The implications of these findings for future research and the treatment of worry among individuals with a history of traumatic exposure are discussed.

Keywords:

• emotional avoidance
• mediation
• posttraumatic stress disorder
• trauma
• worry

Notes

1. It is important to note that the Marx & Sloan (2002) and Tull et al. (2004) studies focused their attention on experiential avoidance in general versus emotional avoidance more specifically. However, there is substantial overlap between these constructs. Experiential avoidance refers to a general tendency to avoid any aspect of internal experience evaluated as aversive (Hayes, Strosahl, & Wilson, 1999). However, Hayes et al. (1999) argue that emotional experiences are the primary events that most individuals try to avoid, alter, or control through experiential avoidance. In addition, the measure of experiential avoidance used in the cited studies, the Acceptance and Action Questionnaire (Hayes et al., 2004), places an emphasis on the avoidance of emotions. Consequently, the findings from these studies can be used as support for an association between PTSD and emotional avoidance.