Correlational studies

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Correlational studies on ACT-Related Processes by Year

See also the experimental psychopathology page

In Press

  • Kashdan, T.B., Morina, N., & Priebe, S. (in press). Post-traumatic stress disorder, social anxiety disorder, and depression in survivors of the Kosovo War: Experiential avoidance as a contributor to distress and quality of life. Journal of Anxiety Disorders.



  • Boelen, P.A. & Reijntjes, A. (2008). Measuring experiential avoidance: Reliability and validity of the Dutch 9-item acceptance and action questionnaire (AAQ). Journal of Psychopathology and Behavioral Assessment, 30, 241-251.
  • Kashdan, T. B., & Breen, W. E. (2008). Social anxiety and positive emotions: A prospective examination of a self-regulatory model with tendencies to suppress or express emotions as a moderating variable. Behavior Therapy, 39, 1-12.
  • Leonard, L. M., Iverson, K. M. & Follette, V. M. (2008). Sexual functioning and sexual satisfaction among women who report a history of childhood and/or adolescent sexual abuse. Journal of Sex & Marital Therapy, 34, 375-384.
  • McCracken, L. M. & Yang, S. (2008). A Contextual Cognitive-Behavioral Analysis of Rehabilitation Workers’ Health and Well-Being: Influences of Acceptance, Mindfulness, and Values-Based Action. Rehabilitation Psychology, 53(4), 479-485.
  • Ostafin, B. D. & Marlatt, G. A. (2008). Surfing the urge: Experiential acceptance moderates the relation between automatic alcohol motivation and hazardous drinking. Journal of Social and Clinical Psychology, 27(4), 404-418.
  • Tull, M.T. & Gratz, K.L. (2008). Further examination of the relationship between anxiety sensitivity and depression: The mediating role of experiential avoidance and difficulties engaging in goal-directed behavior when distressed. Journal of Anxiety Disorders, 22(2), 199-210.
  • Tull, M.T., Rodman, S.A. & Roemer, L. (2008). An examination of the fear of bodily sensations and body hypervigilance as predictors of emotion regulation difficulties among individuals with a recent history of uncued panic attacks. Journal of Anxiety Disorders, 22(4), 750-760.


  • Andrew, D.H. & Dulin, P.L. (2007). The relationship between self-reported health and mental health problems among older adults in New Zealand: Experiential avoidance as a moderator. Aging and mental health, 11(5), 596-603.
  • Butler, J., & Ciarrochi, J. (2007). Psychological Acceptance and Quality of Life in the Elderly. Quality of Life Research, 16, 607-615.

    In a sample of 187 elderly those higher in psychological acceptance had higher quality of life in the areas of health, safety, community participation and emotional well-being; and had less adverse psychological reactions to decreasing productivity.

  • Chapman, A. L. & Cellucci, T. (2007). The role of antisocial and borderline personality features in substance dependence among incarcerated females. Addictive Behaviors, 32, 1131-1145.
  • Gold, S.D., Marx, B.P. & Lexington, J.M. (2007). Gay male sexual assault survivors: The relations among internalized homophobia, experiential avoidance, and psychological symptom severity. Behaviour Research and Therapy, 45(3), 549-562.
  • Kashdan, T. B., & Breen, W. E. (2007). Materialism and diminished well-being: Experiential avoidance as a mediating mechanism. Journal of Social and Clinical Psychology, 26, 521-539.

    This correlational study examined the hypothesis that experiential avoidance mediates associations between excessively materialistic values and diminished emotional well-being, meaning in life, self-determination, and gratitude. Results indicated that people with high materialistic values reported more negative emotions and less relatedness, autonomy, competence, gratitude, positive emotions, and sense of meaning – all of these relations were mediated by experiential avoidance mediated all of these relations. Emotional disturbances such as social anxiety and depressive symptoms failed to account for these findings after accounting for shared variance with experiential avoidance.

  • McCracken, L. M., & Vowles, K. E. (2007). Psychological flexibility and traditional pain management strategies in relation to patient functioning with chronic pain: An examination of a revised instrument. Journal of Pain, 8, 339-349.
  • Morina, N. (2007). The role of experiential avoidance in psychological functioning after war-related stress in Kosovar civilians. Journal of Nervous and Mental Disease, 195(8), 697-700.
  • Norberg, M. M., Wetterneck, C. T., Woods, D. W., & Conelea, C. A. (2007). Examination of the mediating role of psychological acceptance in relationships between cognitions and severity of chronic hairpulling. Behavior Modification, 31, 367 – 381.

    Correlational study with 730+ folks suffering from trichotillomania. Experiential avoidance as measured by the AAQ fully mediated the rela¬tionship between hair-pulling and both fears of negative evaluation and feelings of shame and partially mediated the relationship between hair-pulling severity and dysfunctional beliefs about appearance.

  • Tull, M.T., Jakupcak, M. & Paulson, A. (2007). The role of emotional inexpressivity and experiential avoidance in the relationship between posttraumatic stress disorder symptom severity and aggressive behavior among men exposed to interpersonal violence. Anxiety, Stress & Coping: An International Journal, 20(4), 337-351.
  • Tull, M. T., & Roemer, L. (2007). Emotion regulation difficulties associated with the experience of uncued panic attacks: Evidence of experiential avoidance, emotional nonacceptance, and decreased emotional clarity. Behavior Therapy, 38(4), 378-391.


  • Bond, F. W., & Flaxman, P. E. (2006). The Ability of Psychological Flexibility and Job Control to Predict Learning, Job Performance, and Mental Health. Journal of Organizational Behavior Management, 26, 113-130.
  • Flessner, D. A., & Woods, D. W. (2006). Phenomenological characteristics, social problems, and the economic impact associated with chronic skin picking. Behavior Modification, 30, 944-963.

    Found that the impact of skin picking on depression and anxiety was partially mediated by the AAQ in a non-referred sample of chronic skin pickers.

  • Gaudiano, B. A., & Herbert, J. D. (2006). Believability of hallucinations as a potential mediator of their frequency and associated distress in psychotic inpatients. Behavioural and Cognitive Psychotherapy, 34, 497–502.
  • 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, 1301-1320.

    two studies, one correlational and one longitudinal, show that experiential avoidance as measured by the AAQ fully or partially mediated the relationships between coping and emotion regulation strategies on anxiety-related pathology, (Sutdy 1) and psychological distress and hedonic functioning over the course of a 21-day monitoring period (Study 2). The variables examined included maladaptive coping, emotional responses styles, and uncontrollability on anxiety-related distress (e.g., anxiety sensitivity, trait anxiety, suffocation fears, and body sensation fears), and suppression and cognitive reappraisal on daily negative and positive experiences. The data showed that cognitive reappraisal, a primary process of traditional cognitive-behavior therapy, was much less predictive of the quality of psychological experiences and events in everyday life compared with EA.

  • Kashdan, T. B., & Steger, M. (2006). Expanding the topography of social anxiety: An experience sampling assessment of positive emotions and events, and emotion suppression. Psychological Science, 17, 120-128.

    In a 21-day experience sampling study, dispositional social anxiety, emotional suppression, and cognitive reappraisal was compared daily measures of social anxiety. Socially anxious individuals reported the lowest rate of positive events on days when they were more socially anxious and tended to suppress emotions, and the highest rate of positive events on days when they were less socially anxious and more accepting of emotional experiences. Irrespective of dispositional social anxiety, participants reported the most intense positive emotions on days when they were less socially anxious and more accepting of emotional experiences.

  • McCracken, L. M. (2006). Toward a fully functional, flexible, and defused approach to pain in young people. Cognitive and Behavioral Practice, 13, 182-184.
  • Reddy, M.K., Pickett, S.M. & Orcutt, H.K. (2006). Experiential avoidance as a mediator in the relationship between childhood psychological abuse and current mental health symptoms in college students. Journal of Emotional Abuse, 6(1), 67-85.
  • Tull, M.T., Gratz, K.L., & Lacroce, D.M. (2006). The role of anxiety sensitivity and lack of emotional approach coping in depressive symptom severity among a non-clinical sample of uncued panickers. Cognitive Behaviour Therapy, 35(2), 74-87.


  • Greco, L. A., Heffner, M., Ritchie, S., Polak, M., Poe, S., & Lynch, S. K., (2005). Maternal adjustment following preterm birth: Contributions of experiential avoidance. Behavior Therapy, 36, 177-184.

    Experiential avoidance as measured by the AAQ correlated positively with post-discharge parental stress and traumatic stress symptoms surrounding preterm birth. Moreover, it partially mediated the association between stress during delivery and later traumatic stress symptoms. This process was not moderated by parent reports of child temperament or perceived social support, suggesting that experiential avoidance plays a mediating role irrespective of child characteristics or perceived support from family members and close friends.

  • Marx, B.P. & Sloan, D.M. (2005). Experiential avoidance, peritraumatic dissociation, and post-traumatic stress disorder. Behaviour Research and Therapy, 43, 569-583.

    185 trauma survivors were assessed for peritraumatic dissociation, experiential avoidance (using the AAQ), and PTSD symptom severity. Both peritraumatic dissociation and experiential avoidance were significantly related to PTSD symptoms at baseline. After the initial levels of PTSD was taken into account, only experiential avoidance was related to PTSD symptoms both 4- and 8-weeks later.

  • McCracken, L. M. (2005). Social context and acceptance of chronic pain: The role of solicitous and punishing responses. Pain, 113, 155-159.
  • Orcutt, H. K., Pickett, S., & Pope, E. (2005). Experiential avoidance and forgiveness as mediators in the relation between traumatic life events and PTSD symptoms. Journal of Social and Clinical Psychology, 24, 1003–1029.
  • Roemer, L., Salters, K., Raffa, S. D., & Orsillo, S. M. (2005). Fear and avoidance of internal experiences in GAD: Preliminary tests of a conceptual model. Cognitive Therapy and Research, 29, 71-88.

    Correlational study. Shows that the AAQ is associated with GAD symptoms in both clinical and non-clinical populations.


  • Begotka, A. M., Woods, D. W., & Wetterneck, C. T. (2004). The relationship between experiential avoidance and the severity of trichotillomania in a nonreferred sample. Journal of Behavior Therapy and Experimental Psychiatry, 35, 17-24.

    In a large sample of adults suffering from trichotillomania, experiential avoidance as measured by the 9 item AAQ correlated with more frequent and intense urges to pull, less ability to control urges, and more pulling-related distress than persons who were not experientially avoidant. Actual pulling did not differ.

  • Donaldson, E. & Bond, F.W. (2004). Psychological acceptance and emotional intelligence in relation to workplace well-being. British Journal of Guidance and Counselling, 32, 187-203.

    Study compared experiential avoidance (as measures by the AAQ) and emotional intelligence in terms of their ability to predict general mental health, physical well-being, and job satisfaction in workers (controlling for the effects of job control since this work organisation variable is consistently associated with occupational health and performance). Results from 290 United Kingdom workers showed that emotional intelligence did not significantly predict any of the well-being outcomes, after accounting for acceptance and job control. Acceptance predicted general mental health and physical well-being but not job satisfaction, Job control was associated with job satisfaction, only. Not controlling one’s thoughts and feelings (as advocated by acceptance) may have greater benefits for mental well-being than attempting consciously to regulate them (as emotional intelligence suggests).

The AAQ validation study. Over 2000 subjects. Validates both a 9 and 16 item version, both single factor.

  • Mairal, J. B. (2004). Spanish Adaptation of the Acceptance and Action Questionnaire (AAQ). International Journal of Psychology and Psychological Therapy, 4, 505-515.
  • Plumb, J. C., Orsillo, S. M., & Luterek, J. A. (2004). A preliminary test of the role of experiential avoidance in post-event functioning. Journal of Behavior Therapy and Experimental Psychiatry, 35, 245-257.

    Correlational study. Showed that experiential avoidance was correlated with post-traumatic symptomatology over and above other measures of psychological functioning.

  • Tull, M. T., Gratz, K. L., Salters, K., & Roemer, L. (2004). The role of experiential avoidance in posttraumatic stress symptoms and symptoms of depression, anxiety, and somatization. Journal of Nervous & Mental Disease, 192(11), 754-761.

    Correlational study. Among a sample of individuals exposed to multiple potentially traumatic events, general experiential avoidance (but not thought suppression in particular), predicted symptoms of depression, anxiety, and somatization when controlling for posttraumatic stress symptom severity. Thought suppression (but not experiential avoidance) was associated with severity of posttraumatic stress symptoms when controlling for their shared relationship with general psychiatric symptom severity.


  • Bond, F. W. & Bunce, D. (2003). The role of acceptance and job control in mental health, job satisfaction, and work performance. Journal of Applied Psychology, 88, 1057-1067.

    Shows that AAQ predicts positive work outcomes (mental health, satisfaction, performance) even one year later, especially in combination with job control. Re-factors the AAQ and shows that a two factor solution can work on a slightly different 16 item version.

  • Forsyth, J. P., Parker, J. D., & Finlay, C. G. (2003). Anxiety sensitivity, controllability, and experiential avoidance and their relation to drug of choice and addiction severity in a residential sample of substance-abusing veterans. Addictive Behaviors, 28(5), 851-870.
  • Tull, M.T., & Roemer, L. (2003). Alternative explanations for emotional numbing of posttraumatic stress disorder: An examination of hyperarousal and experiential avoidance. Journal of Psychopathology and Behavioral Assessment, 25, 147-154.


  • Marx, B. P. & Sloan, D. M. (2002). The role of emotion in the psychological functioning of adult survivors of childhood sexual abuse. Behavior Therapy, 33, 563-577.

    Correlational study showing that childhood sexual abuse (CSA), experiential avoidance and emotional expressivity were significantly related to psychological distress. However, only experiential avoidance mediated the relationship between CSA and current distress.


  • Batten, S. V., Follette, V.M., & Aban, I (2001). Experiential Avoidance and high risk sexual behavior in survivors of child sexual abuse. Journal of Child Sexual Abuse, 10(2), 101-120.

    This is a correlational study (N = 283) showing that generalized experiential avoidance accounted for 67% of the variance in distress in a sexually abused population.

1999 and earlier

  • McCracken, L. M. (1999). Behavioral constituents of chronic pain acceptance: Results from factor analysis of the Chronic Pain Acceptance Questionnaire. Journal of Back & Musculoskeletal Rehabilitation, 13, 93-100.
  • McCracken, L. M. (1998). Learning to live with the pain: acceptance of pain predicts adjustment in persons with chronic pain. Pain, 74, 21-27.

    This study is based on a pain related early version of the AAQ. Greater acceptance of pain was associated with reports of lower pain intensity, less pain-related anxiety and avoidance, less depression, less physical and psychosocial disability, more daily uptime, and better work status. A relatively low correlation between acceptance and pain intensity showed that acceptance is not simply a function of having a low level of pain. Regression analyses showed that acceptance of pain predicted better adjustment on all other measures of patient function, independent of perceived pain intensity. This work is replicated, refined and extended in McCracken, L. M. & Eccleston, C. (2003). Coping or acceptance: What to do about chronic pain. Pain, 105, 197-204. and McCracken, L. M. , Vowles, K. E., & Eccleston, C. (2004). Acceptance of chronic pain: Component analysis and a revised assessment method. Pain, 107, 159-166.