The Mediating Role of Self-Esteem in the Relationship between Experiential Avoidance and Emotional Disorders in Community Mental Health Patients

• Vázquez-Morejón, Raquel ^[1] ; León Rubio, Jose María ^[1] ; Martín Rodríguez, Agustín ; Vázquez Morejón, Antonio J.
  1. [1] Universidad de Sevilla

     Universidad de Sevilla

     Sevilla, España

     
• Localización: The Spanish Journal of Psychology, ISSN 1138-7416, Nº 28, 2025
• Idioma: inglés
• DOI: 10.1017/SJP.2025.10006
• Enlaces
  • Texto completo
• Resumen

  • Given the growing global prevalence and significant impact of depression and anxiety, both in general and within the workplace, understanding the underlying mechanisms contributing to emotional disorders is essential. This study examined whether self-esteem mediates the relationship between experiential avoidance and emotional disorders, focusing on depression and anxiety. We conducted a cross-sectional analysis of 174 outpatients from a community mental health center, who completed self-report measures of experiential avoidance, self-esteem, depression, and anxiety. We used the PROCESS macro for mediation analysis, and the results indicated that self-esteem significantly mediated the relationship between experiential avoidance and both depression and anxiety. We analyzed the mediation model within the framework of self-determination theory, which suggested that interventions aimed at reducing experiential avoidance and enhancing self-esteem could be effective for emotional disorders. In this study, we highlight the importance of addressing both experiential avoidance and self-esteem in the therapeutic context. We also discuss implications for clinical practice and limitations of the current study.

• Referencias bibliográficas
  • Acar, I. H., Avcılar, G., Yazıcı, G., & Bostancı, S. (2022). The roles of adolescents’ emotional problems and social media addiction on...
  • Akbari, M., Seydavi, M., Hosseini, Z. S., Krafft, J., & Levin, M. E. (2022). Experiential avoidance in depression, anxiety, obsessive-compulsive...
  • Al-Jabari, R. (2012). Relationships among self-esteem, psychological and cognitive flexibility and psychological symptomatology [doctoral...
  • Berghoff, C. R., Tull, M. T., DiLillo, D., Messman-Moore, T., & Gratz, K. L. (2017). The role of experiential avoidance in the relation...
  • Branden, N. (1995). Los seis pilares de la autoestima [The Six Pilars of Self-Esteem]. (Trad. J. Vigil Rubio). Paidós. (Original de 1994).
  • Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality...
  • Chawla, N., & Ostafin, B. (2007). Experiential avoidance as a functional dimensional approach to psychopathology: An empirical review....
  • Cheung, R. Y., & Ng, M. C. (2019). Mindfulness and symptoms of depression and anxiety: The underlying roles of awareness, acceptance,...
  • Chisholm, D., Sweeny, K., Sheehan, P., Rasmussen, B., Smit, F., Cuijpers, P., & Saxena, S. (2016). Scaling-up treatment of depression...
  • Cookson, C., Luzon, O., Newland, J., & Kingston, J. (2020). Examining the role of cognitive fusion and experiential avoidance in predicting...
  • Deci, E. L., & Ryan, R. M. (1985). The general causality orientations scale: Self-determination in personality. Journal of Research in...
  • Defar, S., Abraham, Y., Reta, Y., Deribe, B., Jisso, M., Yeheyis, T., & Kebede, K. M. (2023). Health related quality of life among people...
  • Eifert, G. H., & Heffner, M. (2003). The effects of acceptance versus control contexts on avoidance of panic-related symptoms. Journal...
  • Eustis, E. H., Cardona, N., Nauphal, M., Sauer-Zavala, S., Rosellini, A. J., Farchione, T. J., & Barlow, D. H. (2020). Experiential avoidance...
  • Fledderus, M., Bohlmeijer, E. T., & Pieterse, M. E. (2010). Does experiential avoidance mediate the effects of maladaptive coping styles...
  • Gámez, W., Chmielewski, M., Kotov, R., Ruggero, C., Suzuki, N., & Watson, D. (2014). The Brief Experiential Avoidance Questionnaire: Development...
  • Gámez, W., Chmielewski, M., Kotov, R., Ruggero, C., & Watson, D. (2011). Development of a measure of experiential avoidance: The Multidimensional...
  • García-Campayo, J., Zamorano, E., Ruiz, M. A., Pardo, A., Pérez-Páramo, M., López-Gómez, V., Freire, O., & Rejas, J. (2010). Cultural...
  • Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis. The Guilford Press.
  • Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes....
  • Hayes, S. C., Strosahl, K., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., Polusny, M. A., Dykstra, T. A., Batten, S. V., Bergan,...
  • Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders:...
  • John, O. P., & Gross, J. J. (2004). Healthy and unhealthy emotion regulation: Personality processes, individual differences, and life...
  • Karekla, M., Forsyth, J. P., & Kelly, M. M. (2004). Emotional avoidance and panicogenic responding to a biological challenge procedure....
  • Karekla, M., & Panayiotou, G. (2011). Coping and experiential avoidance: Unique or overlapping constructs? Journal of Behavior Therapy...
  • Kessler, R. C., Walters, E. E., & Forthofer, M. S. (1998). The social consequences of psychiatric disorders, III: Probability of marital...
  • Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9. Validity of a brief depression severity measure. Journal of General...
  • Kvarstein, E. H., Langsrud, T., Hummelen, B., & Pedersen, G. (2023). Mental health disorders, functioning and health-related quality of...
  • Lee, J. K., Orsillo, S. M., Roemer, L., & Allen, L. B. (2010). Distress and avoidance in generalized anxiety disorder: Exploring the relationships...
  • Levin, M. E., Krafft, J., Pierce, B., & Potts, S. (2018). When is experiential avoidance harmful in the moment? Examining global experiential...
  • Lewis, M. M. (2012). An investigation of the role of experiential avoidance in posttraumatic stress disorder [honors thesis]. Western Michigan...
  • Michalak, J., Teismann, T., Heidenreich, T., Ströhle, G., & Vocks, S. (2011). Buffering low self-esteem: The effect of mindful acceptance...
  • Mineka, S., Watson, D., & Clark, L. A. (1998). Comorbidity of anxiety and unipolar mood disorders. Annual Review of Psychology, 49, 377–412....
  • Moroz, M., & Dunkley, D. M. (2015). Self-critical perfectionism and depressive symptoms: Low self-esteem and experiential avoidance as...
  • Mruk, C. (1998). Auto-estima. Investigación, teoría y práctica [Self-esteem: Research, theory, and practice]. (Trad. J. Aldekoa). Desclée...
  • Ng, J. Y. Y., Ntoumanis, N., Thøgersen-Ntoumani, C., Deci, E. L., Ryan, R. M., Duda, J. L., & Williams, G. C. (2012). Self-determination...
  • Obeid, S., Lahoud, N., Haddad, C., Sacre, H., Fares, K., Akel, M., … & Hallit, S. (2020). Factors associated with anxiety among the Lebanese...
  • Orth, U., & Robins, R. W. (2014). The development of self-esteem. Current Directions in Psychological Science, 23(5), 381–387. https://doi.org/10.1177/0963721414547414
  • Pepping, C. A., O’Donovan, A., & Davis, P. J. (2013). The positive effects of mindfulness on self-esteem. The Journal of Positive Psychology,...
  • Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research...
  • Randal, C., Pratt, D., & Bucci, S. (2015). Mindfulness and self-esteem: A systematic review. Mindfulness, 6(6), 1366–1378. https://doi.org/10.1007/s12671-015-0407-6
  • Rosenberg, M. (1973). La autoimagen del adolescente y la sociedad [Adolescent self-image and society]. Paidós. (Original work published 1965.)
  • Ryan, R. M. (2017). Self-determination theory: Basic psychological needs in motivation, development, and wellness. Guilford Press.10.1521/978.14625/28806
  • Ryan, R. M., & Brown, K. W. (2006). What is optimal self-esteem? The cultivation and consequences of contingent vs. true self-esteem as...
  • Silverstone, P. H., & Salsali, M. (2003). Low self-esteem and psychiatric patients: Part I – The relationship between low self-esteem...
  • Spinhoven, P., Drost, J., de Rooij, M., van Hemert, A. M., & Penninx, B. W. J. H. (2016). Is experiential avoidance a mediating, moderating,...
  • Spitzer, R. L., Kroenke, K., & Williams, J. B. W. (1999). Validation and utility of a self-report version of PRIME-MD: The PHQ Primary...
  • Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing Generalized Anxiety Disorder: The GAD-7....
  • Udachina, A., Thewissen, V., Myin-Germeys, I., Fitzpatrick, S., O’kane, A., & Bentall, R. P. (2009). Understanding the relationships between...
  • Udachina, A., Varese, F., Myin-Germeys, I., & Bentall, R. P. (2014). The role of experiential avoidance in paranoid delusions: An experience...
  • Vázquez, A. J., Castillo, E., Segura, I., & Salas, R. (2014). PHQ-9: Aportaciones sobre sus características psicométricas en población...
  • Vazquez Morejon, A. J., Jimenez García-Bóveda, R., & Vazquez-Morejon, R. (2004). Escala de autoestima de Rosenberg: Fiabilidad y validez...
  • Vázquez-Morejón, R., León Rubio, J. M., Martín Rodríguez, A., & Vázquez Morejón, A. J. (2019). Validation of a Spanish version of the...
  • Wagener, A., Baeyens, C., & Blairy, S. (2016). Depressive symptomatology and the influence of the behavioral avoidance and activation:...
  • World Health Organization. (1992). The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines....
  • World Health Organization. (2016). Investing in treatment for depression and anxiety leads to a 400% return. WHO. http://www.who.int/mediacentre/news/releases/2016/depression-anxiety-treatment/en/#.VyyewbHoSD8.mendeley
  • World Health Organization. (2022a). COVID-19 pandemic triggers 25% increase in prevalence of anxiety and depression worldwide. WHO. https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide
  • World Health Organization. (2022b). Mental health at work. WHO. https://www.who.int/news-room/fact-sheets/detail/mental-health-at-work
  • Williams, G. C., Hedberg, V. A., Cox, E. M., & Deci, E. L. (2000). Extrinsic life goals and health-risk behaviors in adolescents. Journal...
  • Wolgast, M. (2014). What does the acceptance and action questionnaire (AAQ-II) really measure? Behavior Therapy, 45(6), 831–839. https://doi.org/10.1016/j.beth.2014.07.002
  • Zeigler-Hill, V. (2011). The connections between self-esteem and psychopathology. Journal of Contemporary Psychotherapy, 41, 157–164. https://doi.org/10.1007/s10879-010-9167-8