{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T04:52:19Z","timestamp":1791607939669,"version":"4.3.4"},"reference-count":57,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2019,4,17]],"date-time":"2019-04-17T00:00:00Z","timestamp":1555459200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["bpspsychub.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Psychol Psychother"],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      Acceptance and Commitment Therapy (\n                      <jats:styled-content style=\"fixed-case\">ACT<\/jats:styled-content>\n                      ) proposes that cognitive fusion and experiential avoidance are inter\u2010related processes underpinning distress. This study investigated whether worry, rumination, and stressful life events on the one hand and anxiety and depression on the other hand were mediated by cognitive fusion and experiential avoidance (bidirectional serial association).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>\n                      A questionnaire design was conducted cross\u2010sectionally in a clinical sample (study 1;\n                      <jats:italic>N<\/jats:italic>\n                      \u00a0=\u00a057) and cross\u2010sectionally and longitudinally in a non\u2010clinical student sample (study 2;\n                      <jats:italic>N<\/jats:italic>\n                      \u00a0=\u00a0106 and\n                      <jats:italic>N<\/jats:italic>\n                      \u00a0=\u00a097 respectively).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Participants completed measures of worry, rumination, stressful life events (predictors), cognitive fusion, experiential avoidance (mediators), anxiety, and depression (outcomes) at T1. In study 2, anxiety and depression were measured again 6\u00a0weeks later.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the clinical sample, the bidirectional relationship between experiential avoidance and cognitive fusion accounted for a significant proportion of the association between rumination and depression, and stressful life events and anxiety and depression. The association between worry and anxiety was mediated by cognitive fusion\u00a0\u2192\u00a0experiential avoidance only. In the non\u2010clinical sample, in both cross\u2010sectional and longitudinal analyses, cognitive fusion independently mediated the association between predictors and outcomes, as well as the experiential avoidance\u00a0\u2192\u00a0cognitive fusion pathway.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The bidirectional association between cognitive fusion and experiential avoidance was most predictive of distress in the clinical sample. In the non\u2010clinical sample, cognitive fusion and the experiential avoidance\u00a0\u2192\u00a0cognitive fusion pathway demonstrated more explanatory value. Given the cross\u2010sectional nature of most of the data, the findings provide theoretical (as opposed to empirical) support for the models tested.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Practitioner points<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Interventions designed to reduce cognitive fusion may be a useful early intervention for sub\u2010clinical anxiety and depression.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Interventions focused on reducing both cognitive fusion and experiential avoidance may be helpful for individuals presenting with clinical anxiety and depression.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Individuals presenting with particularly high levels of experiential avoidance may benefit from initial work defusing from difficult thoughts, as an inroad for reducing experiential avoidance, anxiety, and depression. Likewise, those with rigid cognitive fusion may benefit from initial work around acceptance skills to create a context that better supports defusion.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/papt.12233","type":"journal-article","created":{"date-parts":[[2019,4,17]],"date-time":"2019-04-17T05:54:39Z","timestamp":1555480479000},"page":"456-473","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":92,"title":["Examining the role of cognitive fusion and experiential avoidance in predicting anxiety and depression"],"prefix":"10.1111","volume":"93","author":[{"given":"Camilla","family":"Cookson","sequence":"first","affiliation":[{"name":"Royal Holloway University of London Egham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Luzon","sequence":"additional","affiliation":[{"name":"Royal Holloway University of London Egham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Newland","sequence":"additional","affiliation":[{"name":"Centre for Psychology London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1142-8083","authenticated-orcid":false,"given":"Jessica","family":"Kingston","sequence":"additional","affiliation":[{"name":"Royal Holloway University of London Egham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,4,17]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcbs.2016.02.002"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcbs.2018.07.005"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/0145445517747287"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1352465815000703"},{"key":"e_1_2_10_7_1","first-page":"5","volume-title":"Wiley series in clinical psychology. 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