Experiential avoidance moderates improvement in affect through a CBT-focused ecological momentary intervention

Ecological momentary interventions (EMIs) can deliver coping skills in real time. Experiential avoidance (EA), the tendency to evade distressing internal experiences, is a transdiagnostic process linked to emotional disorders and suicide risk that may influence responsiveness to momentary interventions. This study examined whether baseline EA moderated changes in momentary affect during a four-week Cognitive Behavioral Therapy (CBT)-based EMI among adults recently discharged from psychiatric hospitalization.

Adults hospitalized for emotional difficulties and/or suicide risk (N = 76) completed up to three sessions of CBT skills while hospitalized or shortly after discharge via telehealth, followed by a 28-day EMI protocol prompting skill use via smart phone app. The Brief Experiential Avoidance Questionnaire measured EA. Positive and negative affect were assessed before and after each EMI prompt.

EA significantly moderated changes in positive and negative affect. Individuals with high EA showed greater increases in positive affect and greater decreases in negative affect following skill practice. Effects were significant across all levels of EA for negative affect but only at average and high EA levels for positive affect. Sensitivity analyses suggested that all-in-person participation and calendar time partially accounted for EA-related differences in negative affect.

There is preliminary evidence that CBT-based interventions may be associated with greater within-episode improvements in affect among individuals high in experiential avoidance following psychiatric hospitalization. Targeting avoidance-related processes via interventions that include digital components may offer preliminary affective benefits for high-risk clinical populations.