University of Leicester
2022CliftonBDClinPsy.pdf (2.61 MB)

Anxiety, Experiential Avoidance, and Physical Health: A Research Portfolio

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posted on 2023-01-10, 09:53 authored by Benjamin Clifton

An established body of literature asserts that elevated anxiety is associated with diminished physical health, especially in long-term conditions. However, less is known about the mechanisms by which anxiety impacts physical health. This thesis begins with a systematic review of the existing literature investigating the interrelations between anxiety, experiential avoidance (EA) and physical health outcomes (Chapter One). The search strategy yielded nine studies which utilized moderation, mediation, and cluster analyses to model the interrelations of anxiety, EA and physical health outcomes within cancer, pain, hypertension, asthma, and a community sample. Results support the notion concurrent heightened anxiety and EA is detrimental to health outcomes. However, findings on the interrelations are disparate, and consensus was not achieved. Results from three studies supported a mediation model whereby anxiety impacted physical health outcomes via the mediating effect of EA, conversely, two further studies did not support this assertion. Further research is required to clarify the interrelations between anxiety, EA, and health outcomes within specific health conditions. Consequently, the relationship between generalised anxiety (GA) and COPD-related health outcomes was investigated in Chapter Two, with self-efficacy (SE) and EA advanced as possible mediators. Forty-two participants offered pulmonary rehabilitation (PR) for COPD completed measures of SE, EA, GA, COPD related quality of life (QoL) and COPD impact. Results suggest GA was significantly associated with SE, EA and QoL. A mediation analysis revealed GA affected PR completion via the mediating effect of EA. Patients with elevated GA, demonstrate a greater tendency to engage in EA, this in turn decreased the likelihood of completing the PR programme. The clinical implications of elevated GA and EA on PR engagement and efficacy are discussed alongside considerations for psychological support within PR.



Noelle Robertson

Date of award


Author affiliation

Neuroscience, Psychology and Behaviour

Awarding institution

University of Leicester

Qualification level

  • Doctoral

Qualification name

  • DClinPsy



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