The University of Texas at Austin, Austin, Texas, USA.
Stanford University School of Medicine, Stanford, California, USA.
Cogn Behav Ther. 2020 Jan;49(1):41-54. doi: 10.1080/16506073.2018.1546768. Epub 2018 Dec 3.
Initial evidence suggests that experiential avoidance (EA) mediates the relation between anxiety sensitivity (AS) and depression. We examined the AS-EA-depression pathway, examining both concurrent, and prospective (cross-lag), mediation models. Utilizing data from a study that examined the effects of exercise on AS ( = 60), we modeled depressive symptoms, EA, and AS over four time points. Time-varying predictors were disaggregated into between-subjects (each person's mean level of the predictor) and within-subjects change (each person's deviations, at each time point, from their mean level on the predictor) components. Tests of the concurrent relations were partially consistent with predictions, with mean EA levels, but not within-subjects changes in EA, partially mediating the relation between AS and depression symptom severity. However, the prospective, cross-lag mediation model, in which AS predicted future EA controlling for previous EA, and EA predicted future depression, controlling for previous depression, yielded no significant effects. These results suggest that observed between-subjects mediation findings, found here and in previous studies, may not replicate using more stringent, quasi-causal, cross-lag mediation analyses. These results highlight the importance of estimating causal pathways in mediation analyses. Clinical implications and directions for future research are discussed.
初步证据表明,经验回避(EA)在焦虑敏感(AS)和抑郁之间起中介作用。我们考察了 AS-EA-抑郁的途径,同时考察了并发和前瞻性(交叉滞后)的中介模型。利用一项研究的数据分析,该研究考察了运动对 AS 的影响(n=60),我们在四个时间点上对抑郁症状、EA 和 AS 进行建模。时变预测因子分为组间(每个个体预测因子的平均水平)和组内变化(每个个体在每个时间点上,与预测因子的平均水平相比的偏差)成分。对并发关系的测试部分符合预测,平均 EA 水平,但 EA 的组内变化不能部分中介 AS 和抑郁症状严重程度之间的关系。然而,前瞻性的交叉滞后中介模型中,AS 预测未来的 EA,控制先前的 EA,而 EA 预测未来的抑郁,控制先前的抑郁,没有产生显著的影响。这些结果表明,在使用更严格的、准因果的交叉滞后中介分析时,可能无法复制这里和之前研究中观察到的组间中介发现。这些结果强调了在中介分析中估计因果途径的重要性。讨论了临床意义和未来研究的方向。