(PS12-A23) Changes in Multidimensional Experiential Avoidance and Depression Symptoms During Treatment with a Digital Version of the Unified Protocol

Multidimensional experiential avoidance (MEA) refers to the tendency to avoid negative internal experiences (Gámez et al., 2011). MEA is considered to be a maladaptive coping strategy (Eustis et al., 2019) that contributes to and maintains anxiety and depression symptom severity (Kashdan et al., 2014; Ramalho et al.,2021; Young et al., 2020).

The Unified Protocol (UP) is a transdiagnostic CBT with proven efficacy in targeting mechanisms maintaining emotional disorders, such as MEA (Barlow et al., 2011). A digital version of the UP (iUP) is currently being evaluated in a randomized clinical trial comparing this digital treatment against the iUP+, an enhanced version of the iUP additionally targeting positive emotion regulation.

There is limited research on the relationships between MEA and depression, particularly in clinical samples treated with digital interventions. The present study explores change in MEA and its relationship to depression symptoms during treatment with the iUP/iUP+. We hypothesized that both MEA and depression would decrease during treatment, and that MEA and depression would be positively correlated.

Preliminary data were from 34 participants (M(age)= 35.5, 73.5% White; 70.6% Female) randomized to the iUP or iUP+. Measures included the Patient Health Questionnaire (PHQ-9, Kroenke, Spitzer, & Williams, 2001) administered at baseline and week 12 and the Multidimensional Experiential Avoidance Questionnaire (MEAQ, Gámez et al., 2011), administered at baseline and weeks 4, 8 and 12. 

We conducted mixed ANOVAs for total MEAQ scores and each MEAQ subscale: behavioral avoidance (BA), distress aversion (DA), procrastination (P), distraction and suppression (DS), repression and denial (RD), distress endurance (DE). There was no significant interaction between condition (iUP or iUP+) and time on total MEAQ or MEAQ subscales. The main effect of time showed a statistically significant decrease in mean total MEAQ scores at the different time points: F(3,34) = 217.719, p< .001, partial η2 = .951. Further, there was a statistically significant decrease in mean MEAQ BA, DA, P, RD, DE at the different time points: F(3,34) = 7.845, p< .001, partial η2 = .409; F(3,34) = 9.798, p< .001, partial η2 = .464; F(3,34) = 23.204, p< .001, partial η2 = .672; F(3,34) = 3.127, p=.038, partial η2 = .216; F(3,34) = 3.261, p=.223, partial η2 = .223. DS scores decreased, but this decrease was not statistically significant.

A paired-samples t-test revealed a significant decrease in PHQ-9 scores between pre-treatment (M=11.04, SD=7.02) and post-treatment (M=6.25, SD=5.34) timepoints; t(23)=5.065, p < .001. Further, change in PHQ-9 scores and change in MEAQ scores were found to be moderately positively correlated: r(32)= .364, p=.035.

Preliminary analyses reflect that depression and MEA significantly decrease over time during treatment with iUP/iUP+, and there is a demonstrated relationship between these variables, indicating that MEA could be an important target in the treatment of depression. Further analyses with the complete sample (expected n=120 by September 2023) will examine whether change in MEA predicts change in depression over the course of treatment, and which MEA subscales may account for any changes in depression.