(PS11-94) Temporal Relations Among Changes in Approach, Avoidance, and Anxiety in the Unified Protocol

Emotional disorders are mental health conditions characterized by frequent and intense negative emotions. Emotional disorders are thought to be maintained by a tendency to engage in experiential avoidance (EA), defined as efforts to avoid or suppress internal experiences such as thoughts or urges perceived as uncomfortable or distressing. By contrast, behavioral approach (BA) skills are common therapeutic techniques designed to combat EA, and involve increased engagement in mood-boosting activities designed to lead to positive reinforcement and increased motivation to pursue enjoyable activities. Approach and avoidance are often considered to be two sides of the same transdiagnostic coin. Understanding how approach and avoidance influence each other and emotional disorder symptoms may inform clinicians’ ability to enhance treatment effectiveness and tailor interventions. Therefore, we examined the temporal associations between behavioral approach, experiential avoidance, and anxiety symptoms among participants receiving the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP). The sample included 70 adult participants (M_age = 33.74, 67% female, 74% white, 74% heterosexual) who met criteria for at least one DSM-5 emotional disorder. Participants completed up to 12 sessions of the UP. Before each session, participants reported the severity of experiential avoidance (MEAQ-BA), frequency of behavioral approach (CBTSQ-BA), and anxiety severity (OASIS) in the past week. We conducted three random intercept cross-lagged panel models to explore (1) reciprocal within-person changes in EA and BA, (2) reciprocal within-person changes in EA and anxiety, and (3) reciprocal within-person changes in BA and anxiety, accounting for between-person differences. Across models, people who engaged in more experiential avoidance and who experienced more severe anxiety displayed less frequent approach behaviors (rs: –.57- –.40, ps < .02). Within-person results suggested a bidirectional association between approach and avoidance. When people reported less experiential avoidance than normal, they displayed greater approach at the subsequent session and when people reported greater approach than normal, they displayed less avoidance at the subsequent session. However, the average effect of change in avoidance on change in activation (b = .39) was larger than the reverse direction (b = .12). Therefore, prioritizing reducing avoidance during psychotherapy may be the most efficient to address both processes. There was limited evidence of an association between changes in BA and anxiety. Numerically, the strongest effects occurred within the first three sessions, with greater within-person reductions in anxiety predicting subsequent increases in behavioral activation, βs: .24–.28, ps > .05. There were no significant reciprocal effects of avoidance on anxiety. Numerically, the strongest, effects occurred within the first two sessions, with greater within-person reductions in avoidance predicting subsequent reductions in anxiety, βs: .25–.43, ps > .06. These results may provide insight to clinicians regarding the optimal order of targets and skills to prioritize early in therapy to maximize benefits.