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ViewAttendees 4

Individual Oral Paper

Child / Adolescent - Depression

Topics in Depression

3 - (IOP 36) Temporal Dynamics of Experiential Avoidance and Loneliness in Adolescents with Major Depressive Disorder

Sunday, November 23, 2025
10:30 AM - 10:45 AM CST
Location: Empire A, Level 2
Keywords: Experiential Avoidance, Depression, Emotion Regulation
Recommended Readings: Ng, M. Y., Frederick, J. A., Fisher, A. J., Allen, N. B., Pettit, J. W., & McMakin, D. L. (2024). Identifying Person-Specific Drivers of Depression in Adolescents: Protocol for a Smartphone-Based Ecological Momentary Assessment and Passive Sensing Study. JMIR Research Protocols, 13(1), e43931.,   Cusack, C. E., Ralph-Nearman, C., Christian, C., Fisher, A. J., & Levinson, C. A. (2024). Understanding heterogeneity, comorbidity, and variability in depression: Idiographic models and depression outcomes. Journal of Affective Disorders, 356, 248-256.,   ,   ,  

    author(s)

  • Kelly V. Klein, M.A.

    Clinical Psychology PhD Student
    American University and NIMH
    Washington, D.C, DC, United States

    • Co-Author(s)

  • TG

    Tahjanee Givens, B.A.

    Postbaccalaureate IRTA Fellow
    National Institute of Mental Health
    Bethesda, MD, United States

  • KT

    Kenneth Towbin, M.D.

    Chief, Clinical Child and Adolescent Psychiatry
    National Institute of Mental Health
    Bethesda, MD, United States

  • Daniel S. Pine, M.D.

    Chief, Section on Development and Affective Neuroscience
    National Institute of Mental Health
    Bethesda, MD, United States

  • Katharina Kircanski, Ph.D.

    Research Scientist
    National Institute of Mental Health
    Bethesda, MD, United States

Experiential avoidance (EA), a coping mechanism in which individuals attempt to avoid distressing emotions, thoughts, or experiences, is a common feature of Major Depressive Disorder (MDD) (Mellick et al., 2019). While avoidance may provide temporary relief, it often perpetuates negative emotional states, such as loneliness. Adolescence, a critical developmental period, may be particularly susceptible to these dynamics due to heightened sensitivity to social interactions and self-concept formation. This study examines the association between EA and loneliness in adolescents with MDD, using Ecological Momentary Assessment (EMA) to capture within-person processes in real-time. Specifically, we investigated whether EA predicts loneliness within the same day and whether EA on one day predicts loneliness the next.

Adolescents diagnosed with MDD completed four EMA prompts daily for 30 days. EA was modeled as a latent variable, constructed from items assessing avoidance behaviors: "hide real feelings," "procrastinated," "avoided situations," and "distracted self." Multilevel Structural Equation Modeling (MSEM) was used to examine within persons: (1) the association between same-day EA and loneliness, and (2) the association between previous-day EA and next-day loneliness.

The model revealed significant factor loadings for all four EA indicators, suggesting a coherent latent construct. EA significantly predicted same-day loneliness (β = 0.44, p < 0.01), indicating that adolescents engaging in higher levels of avoidance behaviors experienced heightened loneliness within the same day. Additionally, previous-day EA significantly predicted next-day loneliness (β = 0.17, p < 0.05), suggesting a spillover effect where avoidance behaviors not only impacted same-day experiences, but also influenced feelings of loneliness on the following day.

EA appears to play a role in exacerbating loneliness among adolescents with MDD, both within and across days. These findings emphasize the importance of addressing EA in cognitive-behavioral therapy to reduce loneliness and improve interpersonal functioning. Avoidance may hinder authentic social engagement, reinforcing isolation and interpersonal strain. Integrating strategies that address both emotional regulation and interpersonal processes in treatment could foster better mental health outcomes for adolescents with MDD.

Learning Objectives:

At the end of this session, the learner will be able to:
  1. Describe how avoidance behaviors contribute to social and emotional difficulties in adolescents with MDD, as well as the benefits of intensive longitudinal design.