Experiential avoidance in depression, anxiety, obsessive-compulsive related, and posttraumatic stress disorders: A comprehensive systematic review and meta-analysis

Although numerous studies on experiential avoidance and its relationship to psychopathology have been conducted, systematic summaries of this research are lacking. The current systematic review and meta-analysis evaluated the transdiagnostic role of experiential avoidance across depression, anxiety and related disorders (obsessive-compulsive and related disorders [OCRDs] and post-traumatic stress disorder [PTSD]) as well as potential moderators of these relations. A total of 441 eligible studies including 135,347 participants (66.16% female, mean age = 31.53) and 899 effect-sizes were summarized. Results indicated a moderate-to-large association of experiential avoidance with anxiety (r = 0.506) and depressive symptoms (r = 0.562), major depressive disorder (r = 0.453), worry (r = 0.516), generalized anxiety disorder (r = 0.588), social anxiety disorder (r = 0.461), panic and agoraphobia (r = 0.340), specific phobias (r = 0.431), OCRDs (r = 0.406), and PTSD (r = 0.489). Anxiety sensitivity moderated the relationship of experiential avoidance to anxiety and depression. Moreover, depression moderated the relationship of experiential avoidance to generalized anxiety disorder and OCRDs. Correlations varied by mean experiential avoidance value, suggesting a potentially nonlinear relationship of experiential avoidance to psychological symptoms. Other potential moderators including type of population, type of measure, comorbidity, and clinical status were investigated. Results support the hypothesized role of experiential avoidance as a transdiagnostic and transcultural process relevant to depression, anxiety, OCRDs, and PTSD. However, experiential avoidance has largely been measured as a generalized trait; future research would be enhanced by measuring experiential avoidance as a dynamic and contextualized process.