A longitudinal preliminary analysis on the role of experiential avoidance in breast cancer patients' reported health outcomes

Experiential avoidance is defined as when an individual is “unwilling to remain in contact with private experiences (e.g., bodily sensations, emotions, thoughts, memories, or behavioral predispositions) and takes steps to alter the form or frequency of these events and the contexts that occasion them. ” A significant amount of evidence shows that experiential avoidance is a maladaptive process that has been shown to influence several psychosocial outcomes, such as quality of life, anxiety, depression, or disease self-management. In the breast cancer context, a recent study demonstrated that experiential avoidance predicted changes in emotional well-being and QoL after a psychological intervention, beyond that caused by cancer. These findings appear to indicate that the attempt to control cancer-related internal experiences may increase the intensity and frequency of those experiences—which in turn might exacerbate psychopathological symptoms. The majority of the studies on experiential avoidance have nonetheless been cross-sectional. Further, the need to conduct longitudinal studies on how psychological factors influence pathways towards health and recovery in breast cancer has been highlighted. The aim of the current study was thus to conduct a preliminary analysis of the influence of experiential avoidance on self-reported psychological and physical health outcomes measured 6 months later in a sample of women with breast cancer. This study was approved by the Ethics Committees of the involved institutions. The sample recruitment was conducted at the Radiotherapy Service of the Coimbra University Hospital, Portugal. Two assessments at two different time points (T1 and T2), spaced 6 months apart, were conducted. The sample comprised 40 female nonmetastatic breast cancer patients (stages I-III), aged between 36 and 85 (M = 60; SD = 10.13). No participant was receiving psychosocial treatment during the study time frame. The average time since diagnosis was 6.70 (SD = 4.26) months. Participants filled out a short sociodemographic questionnaire and self-report instruments—Acceptance and Action Questionnaire (AAQ-7; to measure experiential avoidance), Depression Anxiety and Stress Scales (DASS-21), and World Health Organization Quality of Life-BREF (WHOQOL-BREF)—at the two assessments. Hierarchical regression analyses were performed to examine whether experiential avoidance at baseline (T1) presented significant effects on self-reported depressive symptoms, stress, and physical health at the 6-month assessment (T2), controlling for the effects of each outcome at T1 and experiential avoidance at T2. Cancer stage and age were not included in the analyses, given their nonsignificant correlations with the outcomes (Table 1). The results of the regression analyses can be seen in Table 2. Altogether, results showed that experiential avoidance was a predictor of self-reported depressive symptoms and stress, but not physical health. Interestingly, while experiential avoidance at T1 significantly predicted depressive symptoms and stress at T2, depressive symptoms and stress at T1 and experiential avoidance at T2 did not. Experiential avoidance at T1 seems therefore to predict depressive symptoms and stress over and above baseline depressive symptoms and perceived stress and follow-up levels of experiential avoidance. This last-mentioned finding may be explained by the decrease of experiential avoidance levels between baseline and follow-up (although nonsignificant, probably because due to small sample size). Further research is needed to clarify this finding. Received: 4 September 2019 Revised: 5 December 2019 Accepted: 27 December 2019