Experiential Avoidance as a Transdiagnostic Mediator in the Relationship Between Intolerance of Uncertainty, Maladaptive Perfectionism, and Psychiatric Symptoms: Structural and Causal Mediation Analyses in a Clinical Sample

IF 3.2 3区心理学 Q1 PSYCHOLOGY, CLINICAL

Clinical psychology & psychotherapy Pub Date : 2025-06-19 DOI:10.1002/cpp.70102

Gizem Gerdan, Ebru Salcioglu

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引用次数: 0

Abstract

Anxiety- and depression-related disorders rank among the most prevalent psychological conditions globally. Intolerance of uncertainty (IU), perfectionism, and experiential avoidance (EA) are recognized as transdiagnostic factors contributing to the development and maintenance of these emotional disturbances. However, their interplay remains insufficiently understood and has not been examined within a single research design across clinical samples with varying psychiatric diagnoses. Investigating the relationships and clinical significance of these key transdiagnostic processes in the maintenance of psychiatric symptoms represents a research priority. This study examined the mediating role of EA in the relationship between IU, maladaptive perfectionism (MP), and psychiatric symptoms (PS) using structural equation modeling (SEM) and causal mediation analyses. The sample included 221 participants (18–65 years) with a range of anxiety- and depression-related diagnoses. SEM results showed that EA fully mediated the relationships between IU, MP, and PS. Increased IU and MP were linked to heightened EA, which, in turn, was associated with greater symptom severity. The model explained 54.5% of the variance in EA and 62.5% in PS. Causal mediation analyses showed that EA fully mediated the relationships between IU and PS and MP and PS in two separate models. EA explained 1.254 standard deviations in the IU-PS relationship and 0.871 standard deviations in the MP-PS relationship. Sensitivity analyses (ρ = −0.1) supported the robustness of these effects against potential confounders. These findings underscore the potential utility of assessments and interventions targeting EA to more effectively address the relationship between MP, IU, and anxiety- and depression-related disorders.

Summary

This study is among the first to examine the role of EA in the relationship between intolerance of uncertainty (IU), MP, and PS in individuals with anxiety- and depression-related disorders.
IU and MP are associated with psychiatric PS severity through EA.
Causal mediation analyses confirmed EA as a key mechanism linking IU and MP to PS, with results remaining robust after controlling for potential confounders.
Avoidance behaviors appear to contribute to the maintenance and reinforcement of MP traits and IU, as their direct associations with PS were fully mediated by EA, resulting in increased symptom burden.
In individuals with anxiety- and depression-related disorders, assessing and addressing avoidance strategies may help reduce symptom burden in those with high IU and MP tendencies.

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在不确定性不耐受、适应不良完美主义和精神症状之间的关系中，经验回避作为跨诊断中介：临床样本的结构和因果中介分析

焦虑和抑郁相关疾病是全球最普遍的心理疾病之一。不确定性不耐受（IU）、完美主义和经验回避（EA）被认为是导致这些情绪障碍发展和维持的跨诊断因素。然而，它们之间的相互作用仍然没有得到充分的了解，也没有在不同精神病学诊断的临床样本中进行单一的研究设计。调查这些关键的跨诊断过程在精神症状维持中的关系和临床意义是研究的重点。本研究采用结构方程模型（SEM）和因果中介分析，探讨了EA在IU、适应不良完美主义（MP）和精神症状（PS）之间的中介作用。样本包括221名参与者（18-65岁），他们被诊断为焦虑和抑郁相关。扫描电镜结果显示，EA完全介导了IU、MP和PS之间的关系。IU和MP的增加与EA的升高有关，而EA的升高又与更严重的症状有关。该模型解释了EA的54.5%和PS的62.5%的方差。因果中介分析表明，EA在两个独立的模型中完全介导了IU和PS以及MP和PS之间的关系。EA解释了IU-PS关系的1.254个标准差，MP-PS关系的0.871个标准差。敏感性分析（ρ = - 0.1）支持这些效应对潜在混杂因素的稳健性。这些发现强调了针对EA的评估和干预的潜在效用，以更有效地解决MP， IU和焦虑和抑郁相关障碍之间的关系。本研究是首次研究EA在焦虑和抑郁相关障碍患者不确定性不耐受（IU）、MP和PS之间关系中的作用。通过EA， IU和MP与精神病性PS严重程度相关。因果中介分析证实EA是将IU和MP与PS联系起来的关键机制，在控制了潜在混杂因素后，结果仍然稳固。回避行为似乎有助于MP特征和IU的维持和强化，因为它们与PS的直接关联完全由EA介导，导致症状负担增加。在患有焦虑和抑郁相关障碍的个体中，评估和解决回避策略可能有助于减轻高IU和高MP倾向患者的症状负担。

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来源期刊

Clinical psychology & psychotherapy PSYCHOLOGY, CLINICAL-

CiteScore

6.30

自引率

5.60%

发文量

106

期刊介绍： Clinical Psychology & Psychotherapy aims to keep clinical psychologists and psychotherapists up to date with new developments in their fields. The Journal will provide an integrative impetus both between theory and practice and between different orientations within clinical psychology and psychotherapy. Clinical Psychology & Psychotherapy will be a forum in which practitioners can present their wealth of expertise and innovations in order to make these available to a wider audience. Equally, the Journal will contain reports from researchers who want to address a larger clinical audience with clinically relevant issues and clinically valid research.