Introduction: Generalized Anxiety Disorder (GAD) and Major Depressive Disorder (MDD) are prevalent mental health conditions, and low self-esteem is considered a vulnerability factor for psychological distress. However, the relationship between self-esteem and symptom severity remains unclear, as evidence regarding the nature of this association is still insufficient. On the other hand, experiential avoidance is recognized as a transdiagnostic variable closely linked to clinical outcomes and individual characteristics, while also being associated with psychological resilience. This study investigates the serial mediating roles of experiential avoidance and psychological resilience in the relationship between self-esteem and the severity of anxiety and depressive symptoms in individuals diagnosed with GAD and MDD.
Methods: The study was conducted with 201 voluntary participants aged between 18 and 65 who had been diagnosed with either GAD (n = 90) or MDD (n = 111) and were being monitored accordingly. Participants were assessed using a sociodemographic and clinical data form prepared by the interviewer, along with the Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, Psychological Resilience Scale, Rosenberg Self-Esteem Scale, and the Multidimensional Experiential Avoidance Questionnaire.
Results: The results indicate an indirect relationship between self-esteem and anxiety and depressive symptoms, mediated by experiential avoidance and psychological resilience. This mediation effect was found to be complete for anxiety and partial for depression. Sensitivity analysis confirmed the robustness of the mediation findings.
Conclusion: The findings suggest that individuals diagnosed with GAD and MDD tend to adopt more experiential avoidance strategies in relation to low self-esteem, which in turn leads to a decrease in psychological resilience and an increase in symptom severity. Accordingly, interventions targeting experiential avoidance in the context of self-esteem may contribute to symptom reduction by enhancing psychological resilience.
Keywords: Experiential avoidance, generalized anxiety disorder, major