Experiential avoidance as an early mechanism of an online mindfulness-based intervention for emotional distress: evidence from a behavioral paradigm in a randomized controlled trial
Zitong Xin, Mengyao He, Jialu Jin, Stefan G Hofmann, Xinghua Liu
BMC Psychology September 19, 2026 DOI: 10.1186/s40359-026-05121-0 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 81 |
| Population | Adults experiencing high emotional distress |
| Intervention | Mindfulness Intervention for Emotional Distress (MIED) |
| Duration | 8-week intervention, with measurements at baseline and week 3 |
| Measures | AAQ-II, BEAQ, image rating task |
| Topics | Meditation |
| Registration | NCT05891015 |
| Key findings | Compared with a waitlist control, an 8-week online mindfulness intervention produced greater reductions at week 3 in emotional distress, anxiety, depression, and self-reported and behavioral experiential avoidance. Reductions in behavioral avoidance partially mediated improvements in distress and anxiety, but not depression. The authors argue experiential avoidance is a promising early target in mindfulness-based interventions. |
Abstract
Given the substantial burden of global emotional distress and the proven efficacy of mindfulness-based interventions (MBIs), identifying early mechanisms of MBIs is critical for optimizing treatment adherence and outcomes. This study employed behavioral measures to investigate experiential avoidance as an early mechanism in an online MBI. Eighty-one participants experiencing high emotional distress were recruited. First, the image rating task was conducted at baseline to examine its convergent validity to assess participants’ experiential avoidance. Convergent validity was examined using established self-report measures of experiential avoidance (e.g., AAQ-II and BEAQ). Then, participants were randomly assigned to an 8-week online Mindfulness Intervention for Emotional Distress (MIED) group ( N = 41) or a waitlist control group ( N = 40). Experiential avoidance (both self-reported and behaviorally measured), general emotional distress, anxiety and depression were measured at baseline and week 3 of the 8-week intervention. Results indicated an avoidance-related response pattern, where participants responded faster to negative versus neutral images ( p < .001), and the difference in reaction times between negative and neutral images was significantly correlated with the scores of self-reported experiential avoidance (ps < 0.01). Compared to the waitlist control group, the participants in the MIED group showed significant reductions in general emotional distress, anxiety, depression, and both self-reported and behavioral measures of experiential avoidance at Week 3 ( p s < 0.01). Mediation analyses revealed that reductions in behavioral measures of experiential avoidance partially mediated the effects of the MIED on the reductions in emotional distress and anxiety but not depression at Week 3. The present study provides preliminary evidence for the convergent validity of the image rating task for assessing experiential avoidance. Furthermore, it provides preliminary behavioral evidence supporting a mediational account of experiential avoidance in the early stages of MBIs. These findings suggest that experiential avoidance is a promising early intervention target in MBIs. This study was prospectively registered at ClinicalTrials.gov (NCT05891015). The study was submitted to the registry on May 26, 2023, and first published on June 5, 2023.
Comparable studies
Other randomized controlled trials on meditation, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Alterations in Brain and Immune Function Produced by Mindfulness Meditation Healthy employees in a work environment | 2003 | Randomized controlled trial | n = 41 |
| Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Recovered recurrently depressed patients | 2000 | Randomized controlled trial | n = 145 |
| Open hearts build lives: Positive emotions, induced through loving-kindness meditation, build consequential personal resources. Working adults | 2008 | Randomized controlled trial | n = 139 |
| Short-term meditation training improves attention and self-regulation Undergraduate Chinese students | 2007 | Randomized controlled trial | n = 40 |
| Mindfulness-Based Cognitive Therapy for Depression: Replication and Exploration of Differential Relapse Prevention Effects. Recovered recurrently depressed patients | 2004 | Randomized controlled trial | n = 73 |