Higher levels of experiential avoidance are associated with increased risk for depression. Here, we examined the mediating roles of pre-sleep arousal and sleep quality in the relationship between experiential avoidance and depressive symptoms. Undergraduate students (N = 173) completed self-reports of experiential avoidance, pre-sleep arousal, habitual sleep quality, and depressive symptoms. The indirect effect of experiential avoidance on depressive symptoms through pre-sleep arousal and sleep quality was examined in a set of serial mediation analyses. Effect estimates supported a pathway in which higher experiential avoidance was associated with heightened pre-sleep arousal, and heightened pre-sleep arousal was associated with poor sleep quality. Poor sleep quality, in turn, was associated with increased depressive symptoms. Follow-up analyses showed that the indirect path was driven by cognitive, rather than somatic, arousal. Future research assessing the role of pre-sleep cognitive arousal in the relationship between experiential avoidance and mood disruption using longitudinal design is warranted.
AkbariMSeydaviMHosseiniZS, et al. (2022) Experiential avoidance in depression, anxiety, obsessive-compulsive related, and posttraumatic stress disorders: A comprehensive systematic review and meta-analysis. Journal of Contextual Behavioral Science24: 65–78.
2.
BenhamG (2019) The sleep health index: Correlations with standardized stress and sleep measures in a predominantly Hispanic college student population. Sleep Health5(6): 587–591.
3.
BerghoffCRGratzKLPortzKJ, et al. (2018) The role of emotional avoidance, the patient-provider relationship, and other social support in ART adherence for HIV+ individuals. AIDS and Behavior22(3): 929–938.
4.
BerkingMNeacsiuAComtoisKA, et al. (2009) The impact of experiential avoidance on the reduction of depression in treatment for borderline personality disorder. Behaviour Research and Therapy47(8): 663–670.
5.
BuysseDJReynoldsCF3rdMonkTH, et al. (1989) The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Research28(2): 193–213.
6.
ChiesaAAnselmiRSerrettiA (2014) Psychological mechanisms of mindfulness-based interventions: What do we know?Holistic Nursing Practice28(2): 124–148.
7.
DanielsAPillionMRulloB, et al. (2023) Technology use as a sleep-onset aid: Are adolescents using apps to distract themselves from negative thoughts?SLEEP Advances4(1): zpac047.
8.
DietchJRTaylorDJSethiK, et al. (2016) Psychometric evaluation of the PSQI in U.S. college students. Journal of Clinical Sleep Medicine12(8): 1121–1129.
9.
DindoLVan LiewJRArchJJ (2017) Acceptance and commitment therapy: A transdiagnostic behavioral intervention for mental health and medical conditions. Neurotherapeutics14(3): 546–553.
10.
EisenbergDLipsonSHeinzeJ, et al. (2023) The Healthy Minds Study: National Report 2021-2022. HMN: The Healthy Minds Network.
11.
EustisEHCardonaNNauphalM, et al. (2020) Experiential avoidance as a mechanism of change across cognitive-behavioral therapy in a sample of participants with heterogeneous anxiety disorders. Cognitive Therapy and Research44(2): 275–286.
12.
FahrenkampAJDarlingKERuzickaEB, et al. (2019) Food cravings and eating: The role of experiential avoidance. International Journal of Environmental Research and Public Health16(7): 1181.
13.
FayyazAYusufS (2023) Prediction of adherence through illness appraisal of individuals with diabetes: Role of experiential avoidance. Journal of Professional and Applied Psychology4(2): 140–151.
14.
GámezWChmielewskiMKotovR, et al. (2011) Development of a measure of experiential avoidance: The multidimensional experiential avoidance questionnaire. Psychological Assessment23(3): 692–713.
15.
GámezWChmielewskiMKotovR, et al. (2014) The brief experiential avoidance questionnaire: Development and initial validation. Psychological Assessment26(1): 35–45.
16.
GoodmanEAdlerNEKawachiI, et al. (2001) Adolescents’ perceptions of social status: Development and evaluation of a new indicator. Pediatrics108(2): E31.
17.
GorgoniMScarpelliSMangiarugaA, et al. (2021) Pre-sleep arousal and sleep quality during the COVID-19 lockdown in Italy. Sleep Medicine88: 46–57.
18.
GreesonJZarrinHSmoskiM, et al. (2018) Mindfulness meditation targets transdiagnostic symptoms implicated in stress-related disorders: Understanding relationships between changes in mindfulness, sleep quality, and physical symptoms. Evidence-based Complementary and Alternative Medicine2018(3): 4505191.
19.
HarveyAG (2003) The attempted suppression of presleep cognitive activity in insomnia. Cognitive Therapy and Research27(6): 593–602.
20.
HayesA.F., 2022. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. 3rd ed. New York: The Guilford Press.
21.
HayesSCWilsonKGGiffordEV, et al. (1996) Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology64(6): 1152–1168.
22.
HayesSStrosahlKWilsonK (1999) Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. New York, NY: Guilford Press.
23.
HayesSWilsonK (1994) Acceptance and commitment therapy: Altering the verbal support for experiential avoidance. The Behavior Analyst17(2): 289–303.
24.
KalmbachDABuysseDJChengP, et al. (2020) Nocturnal cognitive arousal is associated with objective sleep disturbance and indicators of physiologic hyperarousal in good sleepers and individuals with insomnia disorder. Sleep Medicine71: 151–160.
25.
KalmbachDPillaiVDrakeC (2018) Nocturnal insomnia symptoms and stress-induced cognitive intrusions in risk for depression: A 2-year prospective study. PLoS One13(2): e0192088.
26.
KashdanTBBarriosVForsythJP, et al. (2006) Experiential avoidance as a generalized psychological vulnerability: Comparisons with coping and emotion regulation strategies. Behaviour Research and Therapy44(9): 1301–1320.
27.
KeinonenKPuolakanahoALappalainenP, et al. (2021) Developmental trajectories of experiential avoidance and depressive symptoms and association to health behaviors among adolescents during brief guided online acceptance and commitment therapy. Journal of Contextual Behavioral Science22: 24–31.
28.
KwongASFManleyDTimpsonNJ, et al. (2019) Identifying critical points of trajectories of depressive symptoms from childhood to young adulthood. Journal of Youth and Adolescence48(4): 815–827.
29.
LevinMELillisJSeeleyJ, et al. (2012) Exploring the relationship between experiential avoidance, alcohol use disorders, and alcohol-related problems among first-year college students. Journal of American College Health60(6): 443–448.
30.
MarinoCAndradeBCampisiSC, et al. (2021) Association between disturbed sleep and depression in children and youths: A systematic review and meta-analysis of cohort studies. JAMA Network Open4(3): e212373.
31.
MatthewsKAPatelSRPantescoEJ, et al. (2018) Similarities and differences in estimates of sleep duration by polysomnography, actigraphy, diary, and self-reported habitual sleep in a community sample. Sleep Health4(1): 96–103.
32.
MellickWMillsJKroskaE, et al. (2019) Experiential avoidance predicts persistence of major depressive disorder and generalized anxiety disorder in late adolescence. Journal of Clinical Psychiatry80(6): 18m12265.
33.
MezickEJMatthewsKAHallM, et al. (2008) Influence of race and socioeconomic status on sleep: Pittsburgh sleep SCORE project. Psychosomatic Medicine70(4): 410–416.
34.
MollayevaTThurairajahPBurtonK, et al. (2016) The Pittsburgh sleep quality index as a screening tool for sleep dysfunction in clinical and non-clinical samples: A systematic review and meta-analysis. Sleep Medicine Reviews25: 52–73.
35.
MorinCMRodrigueSIversH (2003) Role of stress, arousal, and coping skills in primary insomnia. Psychosomatic Medicine65(2): 259–267.
36.
MorozMDunkleyDM (2019) Self-critical perfectionism, experiential avoidance, and depressive and anxious symptoms over two years: A three-wave longitudinal study. Behaviour Research and Therapy112: 18–27.
37.
NicassioPMMendlowitzDRFussellJJ, et al. (1985) The phenomenology of the pre-sleep state: The development of the pre-sleep arousal scale. Behaviour Research and Therapy23(3): 263–271.
38.
NicholsonLRLewisRThomasKG, et al. (2021) Influence of poor emotion regulation on disrupted sleep and subsequent psychiatric symptoms in university students. South African Journal of Psychology51(1): 6–20.
39.
OngJCUlmerCSManberR (2012) Improving sleep with mindfulness and acceptance: A metacognitive model of insomnia. Behaviour Research and Therapy50(11): 651–660.
40.
PeltzJSRoggeRDBodenlosJS, et al. (2020) Changes in psychological inflexibility as a potential mediator of longitudinal links between college students’ sleep problems and depressive symptoms. Journal of Contextual Behavioral Science15: 110–122.
41.
PuzinoKAmatrudoGSullivanA, et al. (2020) Clinical significance and cut-off scores for the pre-sleep arousal scale in chronic insomnia disorder: A replication in a clinical sample. Behavioral Sleep Medicine18(6): 705–718.
42.
PuzinoKFryeSSLaGrotteCA, et al. (2019) Am I (hyper)aroused or anxious? Clinical significance of pre-sleep somatic arousal in young adults. Journal of Sleep Research28(4): e12829.
43.
QuickertREVaughan-JohnstonTIMacDonaldTK (2020) Noticing negativity: Exploring the relationship between experiential avoidance and mood-relevant thinking. Personality and Individual Differences152: 109592.
44.
RadloffLS (1977) The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement1(3): 385–401.
45.
RobertsonJABroomfieldNMEspieCA (2007) Prospective comparison of subjective arousal during the pre-sleep period in primary sleep-onset insomnia and normal sleepers. Journal of Sleep Research16(2): 230–238.
46.
SchmidtREGendollaGH (2018) Dreaming of white bears: The return of the suppressed at sleep onset. Consciousness and Cognition17(3): 714–724.
47.
SchmidtREHarveyAGVan der LindenM (2011) Cognitive and affective control in insomnia. Frontiers in Psychology2: 349.
48.
SpinhovenPDrostJde RooijM, et al. (2014) A longitudinal study of experiential avoidance in emotional disorders. Behavior Therapy45(6): 840–850.
49.
SpitzerRLKroenkeKWilliamsJB, et al. (2006) A brief measure for assessing generalized anxiety disorder: The GAD-7. Archive of Internal Medicine166(10): 1092–1097.
50.
TangNKYSaconiBJansson-FröjmarkM, et al. (2023) Cognitive factors and processes in models of insomnia: A systematic review. Journal of Sleep Research32(6): e13923.
51.
WarnkeAMarkarianSPickettS (2017) 1096 Experiential avoidance predicts depression through perceived stress, pre-sleep arousal, and poor sleep quality. Sleep40(suppl_1): A408–A409.
52.
WenzlaffRMWegnerDM (2000) Thought suppression. Annual Review of Psychology51(1): 59–91.
53.
WinzelerKVoellminASchäferV, et al. (2014) Daily stress, presleep arousal, and sleep in healthy young women: A daily life computerized sleep diary and actigraphy study. Sleep Medicine15(3): 359–366.
54.
WuytsJDe ValckEVandekerckhoveM, et al. (2012) The influence of pre-sleep cognitive arousal on sleep onset processes. International Journal of Psychophysiology83(1): 8–15.
55.
ZakieiAKhazaieHReshadatS, et al. (2020) The comparison of emotional dysregulation and experiential avoidance in patients with insomnia and non-clinical population. Journal of Caring Sciences9(2): 87–92.
56.
ZakieiAKhazaieHRostampourM, et al. (2021) Acceptance and commitment therapy (ACT) improves sleep quality, experiential avoidance, and emotion regulation in individuals with insomnia-results from a randomized interventional study. Life11(2): 133.
57.
ZhangM-MMaYDuL-T, et al. (2022) Sleep disorders and non-sleep circadian disorders predict depression: A systematic review and meta-analysis of longitudinal studies. Neuroscience and Biobehavioral Reviews134: 104532.
