Comparing paths to quality of life: Contributions of ACT and cognitive therapy intervention targets in two highly anxious samples

Anxiety disorders are associated with numerous costs and poor quality of life (QOL), and yet are highly treatable. The present study evaluated the relations between putative change processes, anxiety symptom severity, and QOL by employing path analysis to compare two theoretically-derived models of anxious psychopathology in an examination of pre-intervention data from two self-help effectiveness studies. Consistent with expectation, symptom severity predicted QOL in a model derived from cognitive therapy principles, though the model did not provide a good fit to the data. A model derived from Acceptance and Commitment Therapy principles suggested that the impact of experiential avoidance (EA) on QOL was independent of symptom severity and provided a better fit to the data. In fact, the path from anxious symptomatology to QOL became non-significant when EA was allowed to relate to QOL directly. Cognitive fusion strongly predicted anxiety sensitivity which, in turn, significantly predicted symptoms. Theoretical and practical implications of the findings are discussed in the context of improving available treatments for anxiety-related disorders.