Experiential avoidance and distress in breast cancer patients

Strategies categorized as "avoidant coping" have been identified as important predictors of psychosocial outcomes (distress, anxiety, depression) among individuals with breast cancer. However, there are several different ways that researchers have defined this construct, resulting in the use of differing measures. As such, it is difficult to compare the results from various research studies in order to translate them into clear recommendations for screening and treatment. However, two clearly defined constructs, experiential avoidance and avoidant problem solving style, overlap significantly with avoidant coping and are associated with distress in other populations. The present study had two main aims. First, this study aimed to examine the relationships among several measures of avoidance and distress. Two hundred and thirtythree women with a current or past diagnosis of breast cancer completed measures to assess the outcome variables of generalized distress (NCCN Distress Thermometer), anxiety (HADS-A) and depression (HADS-D), and predictor variables including severity of cancer-related problems (CARES-SF), experiential avoidance (AAQ-II), avoidant problem solving style (SPSI-R-AS) and avoidant coping (COPE scales of Denial, Mental Disengagement and Behavioral Disengagement). When controlling for cancer-related problems, statistically significant positive partial correlations were found between experiential avoidance and distress, anxiety and depression. However, controlling for cancer-related problems significantly weakened, and in most cases completely eliminated, the relationships between traditional avoidant coping strategies and the outcome measures. This suggests that breast cancer patients' self-report of specific avoidant coping strategies may be highly dependent on the severity of cancer-related problems - and that experiential avoidance, which reflects the tendency to utilize these strategies inflexibly, might be a more reliable and useful predictor of distress in this population. The second aim of the study was to explore the underlying factor structure of the five avoidance measures. Principal axis factoring revealed a two-factor solution which explained 40.6% of the variance, and which was consistent with the proposed factor structure of the AAQ-II and the SPSI-R-AS. The solution did not support the structure of the avoidant coping scales as initially proposed by the authors of the COPE, suggesting that these measures should be reevaluated for use in the breast cancer population.