Literature Reviews

Trait Emotional Intelligence, Anxiety Sensitivity, and Experiential Avoidance in Stress Reactivity and Their Improvement Through Psychological Methods

Kenneth Choia, Kristin Vickers*b, Adrianna Tassoneb

Europe's Journal of Psychology, 2014, Vol. 10(2), 376–404,

Received: 2014-01-27. Accepted: 2014-05-12. Published (VoR): 2014-05-28.

Handling Editor: Andrew P. Allen, University College Cork, Cork, Ireland

*Corresponding author at: Department of Psychology and the Institute for Stress and Wellbeing Research, Ryerson University, 350 Victoria St., Toronto, ON M5B2K3, Canada. E-mail:

This is an open access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Stress pervades daily society, often with deleterious consequences for those prone to react intensely to it. Intervention techniques to attenuate stress reactivity are thus paramount. With that goal in mind, researchers have sought to identify and alter malleable psychological dispositional variables that influence stress reactivity. Trait emotional intelligence (TEI), anxiety sensitivity (AS), and experiential avoidance (EA) are increasingly receiving attention in these research efforts. The self-reported emotional component of stress reactivity has been emphasized in investigations and is our focus. Specifically, this paper overviews the role of TEI, AS, and EA in self-reported stress responses. We also discuss empirically supported psychological methods to adjust suboptimal levels of these variables in normal populations. Both psycho-educational (information, skills) and mindfulness-based interventions (specific mindfulness therapies or components) are covered. Findings include that (1) TEI, AS, and EA are each correlated with the emotional component of stress reactivity to both naturalistic and lab-based stressors; (2) preliminary support currently exists for psycho-educational intervention of TEI and AS but is lacking for EA; (3) adequate evidence supports mindfulness-based interventions to target EA, with very limited but encouraging findings suggesting mindfulness methods improve TEI and AS; and (4) although more research is needed, stress management approaches based on mindfulness may well target all three of these psychological variables and thus appear particularly promising. Encouragingly, some methods to modify dispositional variables (e.g., a mindfulness-based format of guided self-help) are easily disseminated and potentially applicable to the general public.

Keywords: stress, emotional intelligence, experiential avoidance, anxiety sensitivity, mindfulness

Many people experience moderate (or higher) stress each day. Indeed, nearly a quarter of people living in North America report high daily stress (American Psychological Association [APA], 2009; Statistics Canada, 2012). It is evident that extensive strain is placed on healthcare systems and economies due to stress (Rosch, 2001). Unfortunately, stress may also exacerbate risk for numerous mental illnesses (such as depression and anxiety) as well as hypertension and heart disease (Barker, 2007; Chu, Williams, Harris, Bryant, & Gatt, 2013; Dressler, 1984). Indeed, the possible deleterious consequences of stress clearly hinder human health; thus, the discovery of viable options to better prepare or protect individuals is essential.

Along those lines, psychologists have increasingly turned their attention to studying stress and its management. A variety of definitions for the term “stress” currently occur in this burgeoning literature. Some researchers conceptualize stress as “a negative emotional experience accompanied by predictable biochemical, physiological, and behavioral changes” (Baum, 1990, p. 653), while others maintain that stress can be a positive experience as well that contributes to growth and development (e.g., Tedeschi & Kilmer, 2005). Still others propose that the term “stress” is too subjective to be useful to researchers (e.g., American Institute of Stress, n.d.) and advocate instead the use of the terms “stressor,” defined as a real or perceived demand on the body or mind, and “stress reactivity,” defined as the emotional and physical responses to the demand (e.g., Blonna, 2007). This terminology is used in this review.

Extensive research has revealed that stress reactivity to a given stressor evidently varies across individuals (e.g., Gelkopf, Berger, Bleich, & Silver, 2012; Lazarus, 1998; Telch, Rosenfield, Lee, & Pai, 2012; Vollrath, 2001). This variance in stress reactivity across individuals likely results from a multitude of interacting physiological, developmental, and psychological factors (for a review, see Wu et al., 2013), thereby offering numerous targets for improving stress reactivity. Complicating interpretation, the components of stress reactivity (e.g., subjective and physiological changes) may themselves diverge within an individual (e.g., Mikolajczak, Petrides, Coumans, & Luminet, 2009). We focus here on self-reported emotional responses to stress.

It is recognized that individual dispositional variables may influence one’s emotional responses to stress (e.g., Wu et al., 2013). For example, higher pessimism is associated with greater stress in parents of children with development disabilities (Wang, Michaels, & Day, 2011). Two methodologies have been heavily used in the research area of stress and dispositional variables. In one approach, researchers have examined how dispositional variables predict subjective reactions to naturalistic stressors (e.g., Schmidt, Lerew, & Jackson, 1997). To illustrate, during academic exam stress, university students with higher neuroticism develop more somatic symptoms (Zunhammer, Eberle, Eichhammer, & Busch, 2013). Another informative approach has used lab-based stressors (for reviews, see Allen, Kennedy, Cryan, Dinan, & Clarke, 2014; Kudielka, Hellhammer, & Kirschbaum, 2007). Although this method reduces ecological validity (e.g., Telman, Holmes, & Lau, 2013), its advantages include permitting a constant external stressor across individuals and also disentangling the possible stress generative effects of psychological variables from their role in stress reactivity (e.g., Vollrath, 2001). For example, using this method, researchers have found that those with high levels of negative affectivity have significantly greater negative mood after high demand laboratory stressors, relative to those with lower negative affectivity (O'Brien, Terry, & Jimmieson, 2008).

Taken together, the findings from this literature indicate that dispositional variables influence stress responses, thereby making stress “a highly personalized process” (Lecic-Tosevski, Vukovic, & Stepanovic, 2011, p. 291). Indeed, a number of potentially malleable dispositional variables influence reactivity to naturalistic and lab-based stressors and are included in two recent reviews (e.g., for a discussion of both negative affectivity and neuroticism, see Lecic-Tosevski et al., 2011; both optimism and coping style are covered in Wu et al., 2013). Three other modifiable dispositional variables – trait emotional intelligence (TEI), anxiety sensitivity (AS), and experiential avoidance (EA) – are increasingly receiving attention in stress research. We overview each below.

Broadly speaking, TEI is a personality trait reflecting individuals’ capacity to perceive, understand, use, and regulate emotions beneficially both within themselves and in others (Schutte, Malouff, & Thorsteinsson, 2013). AS is the fear of bodily symptoms of anxiety based on beliefs the symptoms are harmful or have aversive consequences (Reiss, Peterson, Gursky, & McNally, 1986). EA is the desire to avoid unwanted thoughts, feelings, memories, and physical sensations, plus associated behavioral avoidance (Hayes, Wilson, Gifford, Follette, & Strosahl, 1996; Jacob, Ower, & Buchholz, 2013; for a review, see Chawla & Ostafin, 2007). EA and AS are moderately correlated (r = .43, Bardeen, Fergus, & Orcutt, 2013), and lower EA (e.g., higher acceptance) is associated with higher TEI (r = .40, Donaldson-Feilder & Bond, 2004). To our knowledge, no investigation has examined how TEI correlates with AS.

All three of these dispositional variables are currently conceptualized as important influences on stress reactivity. More specifically, high TEI is posited to buffer individuals from the negative consequences of stress (Ugoji, 2012), while high AS and high EA are conceptualized as vulnerability factors for many forms of anxiety- and stress-related symptoms (Tanay, Lotan, & Bernstein, 2012). Indeed, based on findings that TEI, AS, and EA influence emotional stress reactivity in normal populations, researchers are advocating both psycho-educational intervention (e.g., for EA and AS; Bardeen et al., 2013; Keough & Schmidt, 2012; for TEI; Ugoji, 2012) and also mindfulness-based approaches (e.g., Tanay et al., 2012) as preventative strategies. For example, Ugoji (2012, p. 105) recommends that “stakeholders in education” include emotional intelligence training within the curriculum, and Schmidt, Eggleston, et al. (2007, p. 305) advocate reducing AS a “primary prevention intervention.” Likewise, Bardeen and colleagues (2013, p. 468) suggest “directly target[ing]” high EA in at-risk individuals to reduce perceived stress.

The purpose of this paper is to overview the empirical evidence connecting TEI, EA, and AS to emotional stress reactivity, along with the positive mental health promotion strategies (e.g., Fledderus, Bohlmeijer, Smit, & Westerhof, 2010) that improve them. We omit discussion of the many successful therapeutic techniques that benefit patients in severe distress and instead focus on the two aforementioned broad types of psychological interventions: psycho-educational and mindfulness-based. We define psycho-educational approaches as those that help participants gain information, skills (e.g., through presentations, self-help, or self-reflection) and/or change their behavior (e.g., through adopting an exercise regime or by systematically encountering previously avoided stimuli). These interventions are often designed to improve a particular dispositional variable (e.g., emotional skills training is used for TEI; Slaski & Cartwright, 2003). Health promotion approaches based on mindfulness, in contrast, usually seek to improve quality of life, thus often including many dispositional variables as outcomes. A number of different mindfulness-based interventions are in use. All share extensive emphasis upon “present centered awareness” (Chiesa & Malinowski, 2011, p. 412) but otherwise diverge from one another in philosophical orientation, among other issues (for a review, see Chiesa & Malinowski, 2011). We focus here on practical implementation differences across mindfulness-based health promotion strategies (e.g., whether meditation is included) and describe below the two particular mindfulness-based methods – mindfulness-based stress reduction therapy (MBSR; Kabat-Zinn, 1982, 1990) and acceptance and commitment therapy (ACT; Hayes, Strosahl, & Wilson, 1999) –that are commonly adapted in health promotion research.

MBSR is a particularly well-established approach to lessen stress reactivity (for reviews, see Chiesa & Serretti, 2009, 2010). Influenced by Buddhist philosophy, MBSR focuses on intensive meditation to increase mental and physiological focus on self. Originally designed to help patients with chronic ailments and pain, MBSR has since shown its ability to reduce stress and promote health in normal populations (Chiesa & Serretti, 2009). MBSR is administered in a group setting and relies on four main methods to attenuate stress (Kabat-Zinn, 1990): yoga meditation, walking meditation, body scanning (non-judgemental focus on all bodily parts), and sitting practice (focus on breathing while comfortably seated). An adapted meditation component is sometimes used by itself in “mindfulness meditation” interventions (e.g., Chu, 2010). In MBSR and its adaptations, emphasis is consistently placed on acceptance of experiences in the moment, for their own “pure” (Chiesa & Malinowski, 2011, p. 412) sake.

Acceptance of present experience is also an essential component of ACT, but the purpose of this acceptance is to facilitate behavioral change (Baer & Krietemeyer, 2006; Chiesa & Malinowski, 2011). Indeed, ACT differs notably from other mindfulness-based methods in its inclusion of behavioral-change strategies to affect the content of experience and in fact originated as an individual therapy with specific behavioral strategies tailored to each client. Although ACT is now used in group and workshop format (e.g., Biglan, Layton, Jones, Hankins, & Rusby, 2013; Luoma, Kohlenberg, Hayes, Bunting, & Rye, 2008), its emphasis on personal values, goals, and actions consistent with these values and goals continues to distinguish it from other mindfulness-based methods (Baer & Krietemeyer, 2006). Additionally, ACT does not include formal meditation training and omits Buddhist influence (Chiesa & Malinowski, 2011). The mindfulness exercises included in ACT are thus shorter (Baer & Krietemeyer, 2006) and have far less emphasis on extensive bodily scanning than those of MBSR (Arch & Ayers, 2013).

These differences noted, the commonalities between ACT and MBSR are potentially more important (Baer & Krietemeyer, 2006). We adopt this perspective and discuss mindfulness-based methods as a type of health promotion strategy, along with psycho-educational approaches, in relation to TEI, EA, and AS, below. Our general aim is to provide an overview of the concrete, established ways to reduce emotional stress reactivity via modifying these dispositional variables.

Modifiable Dispositional Variables in Stress Reactivity

Trait Emotional Intelligence (TEI)


Emotional intelligence (EI) is a construct that has captivated researchers for decades. Although different models exist (for a review, see Muyia, 2009), most EI models include dimensions assessing one’s capacity to perceive and understand emotions, as well as use and regulate emotions (Schutte et al., 2013). Most models contain both intra- and inter- personal aspects; for example, the EI model proposed by Salovey and Mayer (1989) includes abilities to regulate and appraise emotions in both oneself and in others. Less agreement exists concerning how to assess EI. Some researchers conceptualize EI as an objective cognitive proficiency assessed by performance accuracy; others advocate a subjective personality trait or mixed model (see Muyia, 2009) and use self- (or other-) reports of EI. Scores on measures from each EI type are only moderately correlated (Schutte et al., 2013). We focus here exclusively on subjective EI (referred to as “trait EI”, or TEI, following others, e.g., Arora et al., 2011) because relative to objective EI, TEI is more strongly related to mental health (Martins, Ramalho, & Morin, 2010) and has garnered more attention in stress research (Schneider, Lyons, & Khazon, 2013), including in the mindfulness-based methods we discuss.

Higher TEI has incremental validity (Petrides, Pérez-González, & Furnham, 2007) in relation to many beneficial psychological outcomes (for reviews, see Martins et al., 2010; Zeidner, Matthews, & Roberts, 2012). For example, university students with high TEI are more likely to complete their degree (Keefer, Parker, & Wood, 2012), and adolescents with high TEI have significantly fewer depressive symptoms as well as less disruptive behavior compared to those with lower TEI (Davis & Humphrey, 2012). Complicating interpretation, different measures of TEI with distinct theoretical bases are in use (see Martins et al., 2010; Muyia, 2009). Additionally, cogent concerns have been raised about whether TEI is “pan-cultural” (Schutte et al., 2013, p. 66; for a review, see Matthews, Zeidner, & Roberts, 2012). Research is needed to address this issue (see Matthews et al., 2012). In the meantime, the overall pattern of findings from naturalistic stress studies suggests that higher total TEI beneficially impacts self-reported stress responses. Indeed, higher TEI is associated with less self-reported stress in many samples including nurses (Görgens-Ekermans & Brand, 2012), firefighters (Wagner & Martin, 2012), and human service workers (e.g., physicians, teachers, and managers; Ogińska-Bulik, 2005) and is related to enhanced stress management skills in undergraduates (Ugoji, 2012). That noted, higher scores on the Attention to Feelings subscale of the Trait Meta-Mood Scale (Salovey, Mayer, Goldman, Turvey, & Palfai, 1995) prospectively predicted increased stress in adolescents, suggesting that high scores may not be adaptive on all facets of all TEI measures (e.g., excessive focus on feelings; Salguero, Palomera, & Fernández-Berrocal, 2012).

Studies using lab-based stressors generally indicate that higher TEI (or an aspect thereof) reduces negative emotional stress responses. For example, less negative emotions and intrusive thoughts occurred after a stressful movie clip for those higher in TEI (on the Clarity [mood differentiation] and Repair [mood regulation] subscales of the Trait Meta-Mood Scale) compared to those with lower TEI (Ramos, Fernández-Berrocal, & Extremera, 2007). Likewise, those with higher TEI (on the Repair subscale of the Trait Meta-Mood Scale) characterized repeated lab stressors (adapted from the Trier Social Stress Test [TSST], Kirschbaum, Pirke, & Hellhammer, 1993) as less threatening (Salovey, Stroud, Woolery, & Epel, 2002) and had less worsening in mood after both the TSST (Mikolajczak, Roy, Luminet, Fillée, & de Timary, 2007) and a failure stressor (a difficult test misleadingly presented as easy; Mikolajczak et al., 2009; findings were significant for men and showed a trend for women). Contrastingly, several studies have linked higher TEI to augmented negative mood post-stressor (Arora et al., 2011; Petrides & Furnham, 2003; Sevdalis, Petrides, & Harvey, 2007) including more anxiety in medical students during a simulated surgery (Arora et al., 2011) and more tension, depression, and anger following a stressful movie clip (Petrides & Furnham, 2003). However, in these studies, those with higher TEI recovered faster from their negative moods post-stressor compared to low TEI participants (Arora et al., 2011; Petrides & Furnham, 2003; Sevdalis et al., 2007). Cumulatively, these findings suggest that interventions targeting TEI may benefit emotional stress reactivity over the long-term.

Psycho-educational intervention

Most commonly, TEI intervention has relied on training in emotional skills. The findings overall (for a review covering both ability EI and TEI, see Schutte et al., 2013) indicate that TEI does indeed increase after suitable training across samples including college students (e.g., Schutte & Malouff, 2002) and employees (e.g., Slaski & Cartwright, 2003). For example, both self-reported and informant-rated (spouse or close friend) TEI increased significantly one month after emotional intelligence training, compared to the control condition (Kotsou, Nelis, Grégoire, & Mikolajczak, 2011). Indeed, as shown in Table 1, the effect size estimate for increased self-reported TEI post-intervention was large, and the effect size estimate for informant-rated TEI was moderate. In contrast, both ratings of TEI failed to improve in the control group (and in fact informant-rated TEI decreased significantly; Kotsou et al., 2011). Table 1 summarizes the psycho-educational interventions for TEI that are discussed in this paper. Schutte and colleagues (2013, p. 62) provide a comprehensive review of all psycho-educational EI interventions to date, noting that the findings provide “preliminary evidence” that psycho-educational intervention is effective.

Despite these encouraging results, unanswered questions remain, including about the specific training approach needed for lasting change in TEI. For example, two psycho-educational interventions (Kirk, Schutte, & Hine, 2011; Wing, Schutte, & Byrne, 2006) used expressive writing (20 minutes daily for three days) instead of direct emotional skill instruction. Although TEI improved in both, data collected 2 weeks post intervention (available only in Wing et al., 2006) indicated that the effect was not maintained (although a trend towards significance was shown). In contrast, instructional skills training produced significantly increased TEI both 1-month and also 1-year post-intervention (Kotsou et al., 2011), suggesting that direct skills instruction produces a more durable increase in TEI.

Direct skills training programs, however, have varied in the number and length of sessions (Schutte et al., 2013); to illustrate, Nelis and colleagues (2011) utilized 18 hours of training plus email contact, while Schutte and Malouff (2002) asked students to complete a three-credit university course incorporating emotional skills. Less time-intensive TEI training approaches seem particularly worthy of further investigation. Surprisingly, the literature is largely absent of brief (e.g., one session) TEI interventions (see Carrick, 2010, pp. 50-51). One relevant dissertation used a half-day classroom workshop (plus individual coaching 6 weeks later), finding that several TEI competencies (Table 1) had significantly increased three months after the workshop (Carrick, 2010). Future research using brief TEI workshops is warranted, along with investigations establishing the precise content necessary to cover in TEI interventions (for a review, see Ciarrochi & Mayer, 2007), given different theoretical models (Mayer, Robers, & Barsade, 2008). Also worthy of further investigation is the possibility of briefer assessment measures of TEI. Currently, the most widely used brief measure of TEI contains 33 items (Assessing Emotions Scale; Schutte, Malouff, & Bhullar, 2009); shorter TEI measures, if valid and applicable across diverse settings, would be a welcome addition to this literature from a practical perspective (see Wong & Law, 2002, for a 16-item TEI measure for leadership and management research; for a review of TEI measures, see Pérez, Petrides, & Furnham, 2005).

Mindfulness-based intervention

Research using mindfulness-based methods to target TEI is in its infancy. The studies to date are summarized in Table 1. One pilot study used adapted MBSR to increase TEI in psychology graduate students (Cohen & Miller, 2009). The MBSR adaptation added increased attention to awareness of others (and was therefore called interpersonal mindfulness training [IMT]). Training otherwise closely followed a manualized MBSR (Kabat-Zinn, 1982) and consisted of six 90-minute sessions over six weeks administered in a group format, plus weekly homework on personal experience of mindfulness. The intervention significantly increased TEI, and also decreased perceived stress from baseline to post treatment; however, no control group was included. Experimental research testing whether adapted MBSR benefits TEI seems warranted.

Additional reasons exist to consider targeting TEI via mindfulness. Indeed, experimental evidence indicates that 20 minutes of mindfulness meditation over eight weekly sessions improves TEI in graduate students, compared to relaxation instructions without training (Chu, 2010). Other findings (not summarized in Table 1) are also consistent with meditation benefiting TEI, although the designs are either correlational (Schutte & Malouff, 2011) or impractical to apply to the general population (e.g., 10-day intensive Vipassana meditation retreat; Perelman et al., 2012). Furthermore, several prominent researchers emphasize the potential applicability of mindfulness-based methods to TEI improvement (e.g., see Schutte et al., 2013); along these lines, Ciarrochi and Blackledge (2006) advance a specific type of mindfulness-based method, mindfulness-based emotional intelligence training.


Many studies indicate that greater TEI is linked to decreased emotional stress reactivity, although additional research is needed given discrepant findings. Current preliminary evidence (Schutte et al., 2013) supports the use of psycho-educational emotional skills training to increase TEI. However, the precise nature of the ideal skills training (e.g., content of sessions) is unestablished. Mindfulness-based methods appear promising in TEI amelioration and warrant further consideration given their known benefits on a host of other psychological and physical variables (for a review, see Chiesa & Serretti, 2009).

Table 1

Summary of Psycho-Educational and Mindfulness-Based Interventions for TEI

Study Intervention Sample Sex Distribution Relevant Findings Effect Size Estimate
Schutte & Malouff (2002) Emotional skills training course 152 first year university students 74% female Increased TEI d = .63a
improved retention rate for first year students vs. control group r = .23b
Slaski & Cartwright (2003) 4-week EI training program 120 retail chain managers 40% female Increased TEI n/a, p < .001
improvement in stress n/a, p < .001
well-being vs. control group n/a, p < .001
Kirk et al. (2011) Emotional self-efficacy program via expressive writing 46 working adults (all residents of Australia) 67% female Increased TEI partial η2 = .31
positive affect vs. control group partial η2 = .12
Wing et al. (2006) Positive expressive writing task with or without an emotional regulation cue (ERC) 175 Australian adults 64% female Increased TEI at post-test for experimental groups vs. control but not significant at 2 week follow up partial η2 = .02 for positive writing; partial η2 = .085 for writing with ERC; n/a, p = .08
Kotsou et al. (2011) Instructional skills training aimed at improving five core emotional competencies 72 adults 68% female At post-test improved TEI was noted along with d = .90 self-rated TEI; d = .63 informant-rated TEI;
decreased stress vs. control group; maintained at follow up d = 1.34; all p’s Time 1 to Time 3 < .001
Nelis et al. (2011) 18 hours (4 sessions) of EI training 58 undergraduate university students 72% female Improved TEI vs. control group d = 1.13 Time 1 to Time 2
maintained at follow up d = .91 Time 1 to Time 3
Carrick (2010) 4 hour classroom based learning intervention on EI competencies 11 nurse managers from a university hospital with no previous EI training 100% female Increased EI competencies of impulse control, flexibility, problem solving (no control group) n/a; all p’s < .05
Cohen & Miller (2009) Adapted MBSR 21 graduate psychology students 95% female Increased TEI d = .40
decreased perceived stress pre-post (no control group) d = .55
Chu (2010) Mindfulness meditation 19 graduate students 47% female Increased TEI aspects of
mood regulation d = 1.86a
emotion appraisal d = 1.68a
social skills d = 1.81a
decreased perceived stress vs. control group d = 2.36a

Note. All psycho-educational training studies for TEI are reviewed in Schutte et al. (2013); above we summarize the studies discussed in this paper. TEI = trait emotional intelligence; EI = emotional intelligence; MBSR = mindfulness-based stress reduction; n/a = no effect size in article and not enough information given to calculate an effect size

aEffect size not given; we computed it using an effect size calculator (Becker, 2000).

bEffect size not given; we computed it using Ellis (2009).

Anxiety Sensitivity (AS)


Individuals who report heightened AS are prone to misinterpret somatic feelings and physiological responses to anxiety-related symptoms, often associating these feelings with danger and harm. Consequently, high AS individuals are susceptible to substance abuse, psychological disorders, and maladaptive stress reduction behaviors (Donnell & McNally, 1990; Mitchell, Riccardi, Keough, Timpano, & Schmidt, 2013; Stewart, Peterson, & Pihl, 1995; for a review, see Naragon-Gainey, 2010). For example, prospective research has established that AS predicts the subsequent development of alcohol use disorders in adults two years later (Schmidt, Buckner, & Keough, 2007); similarly, in adolescents (age 9-13), AS predicts the development of anxiety symptoms one year later after controlling for baseline anxiety and depression (Schmidt et al., 2010). The role of AS in panic disorder in particular has received extensive attention (for a review, see McNally, 2002). Findings indicate that AS is a prospective predictor of panic; for example, AS predicts the development of spontaneous panic attacks two years later in those with no history of panic (Schmidt, Zvolensky, & Maner, 2006).

Theoretical conceptualizations of AS (Reiss, 1991) posit that higher AS amplifies emotional responses to stress (Isyanov & Calamari, 2004). Consistent with this idea, greater AS has been associated with heightened perceived stress in several samples including undergraduates (Bardeen et al., 2013; Tull & Gratz, 2008) and first-year medical school and health science graduate students (Isyanov & Calamari, 2004). Additionally, AS likely figures prominently in the appraisal of and reactivity to emotional events (Zvolensky et al., 2002).

In fact, AS has been linked with exacerbated distress and greater susceptibility to psychopathological disorders in volunteers responding to disastrous situations (Hagh-Shenas, Goodarzi, Dehbozorgi, & Farashbandi, 2005; Mitchell, Griffin, Stewart, & Loba, 2004). Likewise, emerging findings indicate that in adolescents, high AS predicts aggravated emotional responses to both natural disasters and also stressful life events (Hensley-Maloney & Varela, 2009; Kadak, Nasıroğlu, Boysan, & Aydın, 2013; McLaughlin & Hatzenbuehler, 2009).

Similar findings have resulted from lab-based stressor research. Indeed, empirical investigations have correlated elevated AS to heightened stress reactivity across experimental stressors, including mental arithmetic, cold pressor task, and the TSST (Gómez-Pérez, López-Martínez, & Asmundson, 2013; Lee, Watson, & Law, 2010; Messenger & Shean, 1998; Rosa Esteve & Camacho, 2008; Shostak & Peterson, 1990; Stewart, Buffett-Jerrott, & Kokaram, 2001; Thompson, Keogh, French, & Davis, 2008; Zvolensky et al., 2002). Furthermore, the link between AS and stress reactivity is of the upmost importance since stressful life events may trigger one’s AS to increase, thereby aggravating vulnerability to numerous psychological disorders (Schmidt et al., 1997; Taylor, Koch, & McNally, 1992; Wheaton, Mahaffey, Timpano, Berman, & Abramowitz, 2012). Importantly, AS is malleable, as amply documented (e.g., Feldner, Zvolensky, Schmidt, & Smith, 2008; Keough & Schmidt, 2012; Korte & Schmidt, 2013).

Psycho-educational intervention

A number of different preventative interventions have targeted AS and are summarized in Table 2. Two interventions are adaptations of therapies, cognitive-behavioral therapy (CBT) and motivational enhancement therapy. The former is well established to reduce AS in clinical patients (for a meta-analysis, see Smits, Berry, Tart, & Powers, 2008). Modifying this approach for wider dissemination, Radhu, Daskalakis, Arpin-Cribbie, Irvine, and Ritvo (2012) used a 12-week web-based CBT intervention to successfully reduce both AS and negative thoughts in perfectionistic university students. With burgeoning Internet use, further research into web-based interventions to lessen AS would be welcome. Motivational enhancement therapy, commonly used to treat substance abuse and eating disorders, increases intrinsic motivation to improve poor lifestyle choices (Ager et al., 2011; Heather & McCambridge, 2013; Lothstein, 2012; Martin & Rehm, 2012). Important new research suggests its applicability to AS reduction as well. Specifically, Korte and Schmidt (2013) determined that a single session of motivational enhancement therapy led to a 26% decrease in AS. Given cost and time limitations, this type of brief intervention seems especially important. Further research examining the durability of the AS reduction obtained from one-session motivational enhancement therapy (Korte & Schmidt, 2013) and web-based CBT (Radhu et al., 2012) is warranted.

Most other AS interventions incorporate cognitive restructuring, which has been shown to improve AS in both adults (e.g., Steinman & Teachman, 2010) and adolescents (for a review, see Lau, 2013). For example, based on the success of anxiety reduction approaches using cognitive bias modification (for a review, see MacLeod & Mathews, 2012), researchers have used positive training, a specific type of interpretive bias modification method, to decrease AS. Positive training is accomplished by having participants add a positive outcome to incomplete anxiety-producing scenarios. For example, the vignette “You are jogging. Your heart starts to beat quickly. This is in_igorating” is completed with “invigorating,” thereby enabling individuals to learn to associate anxiety-related symptoms with positive outcomes. In line with this hypothesis, the AS of nonclinical individuals diminished after positive training (Steinman & Teachman, 2010) compared to control conditions. Likewise, AS reduction (from pre-test to both post-test and to 48 hour follow-up) occurred after a different cognitive bias modification task, which trained participants to associate bodily sensations with neutral interpretations (MacDonald, Koerner, & Antony, 2013). Research investigating the long-term durability of AS reduction after cognitive bias modification would be welcome.

Brief informational interventions targeting AS have also garnered increasing attention. For example, Anxiety Sensitivity Amelioration Training (ASAT; Schmidt, Eggleston, et al., 2007) is comprised of informative presentations regarding stress reactivity, the goal of which is to educate individuals about biological responses to stress and assure them that these reactions are expected and normal. Schmidt, Eggleston, et al. (2007) administered ASAT to high-risk individuals, defined as those who had high AS scores (at least 1.5 standard deviations above the mean for nonclinical community members) but no current or recent (past year) psychological disorder. Promisingly, ASAT produced significant and rapid decreases in AS compared to the control condition (a health and nutrition video). This gain was partially maintained at 24-month follow-up, at which point there was also a significantly decreased incidence of Axis I disorders in participants who received ASAT, compared to those in the control condition. A further strength of ASAT is its ability to form part of a “stepped care” approach, implemented according to the degree of severity of existing issues and modified to suit individual needs (Schmidt, Eggleston, et al., 2007). Along these lines, ASAT has shown success in high AS participants who have experienced traumatic events. Specifically, Vujanovic, Bernstein, Berenz, and Zvolensky (2012) found that a two-hour session of ASAT (tailored for each individual) markedly reduced AS; importantly, the effect was largely maintained at three months post intervention. Due to the small number of participants in this study, a larger study of ASAT is warranted.

Another brief intervention, Keough and Schmidt’s (2012) Anxiety Sensitivity Education and Reduction Training, combines stress information with interoceptive exposure, in which individuals repeatedly experience the bodily sensations they fear (Rapee & Barlow, 1988). Specifically, 50-minute PowerPoint presentations outlining the common physiological reactions to stress are used, along with practice of specific interoceptive exposure examples (tailored to the individual) (see also Carter, Marin, & Murrell, 1999). Recently, Anxiety Sensitivity Education and Reduction Training more rapidly lessened AS than did physical health education training (control group) emphasizing minimal alcohol consumption and adequate exercise and sleep. Importantly, the Anxiety Sensitivity Education and Reduction Training group still had substantially lower AS levels than the control group six months post-intervention (Keough & Schmidt, 2012).

One non-cognitive intervention, physical exercise, also successfully reduces AS (Broman-Fulks, Berman, Rabian, & Webster, 2004; Broman-Fulks & Storey, 2008; Smits, Berry, Rosenfield, et al., 2008), perhaps due partly to interoceptive exposure and also to neurochemical changes, including in the neurotransmission of serotonin, dopamine, and noradrenaline (for a review, see Lin & Kuo, 2013). Findings indicate that the greatest and most rapid reductions in AS occur through repeated sessions of vigorous aerobic exercise (e.g., 20 minutes at 70% of the maximum heart rate, twice weekly for 2 weeks; Smits, Berry, Rosenfield, et al., 2008). Low intensity aerobic exercise seems less potent, although Broman-Fulks et al. (2004) did observe a reduction in AS in the low intensity exercise group (six 20-minute sessions at ‘220-age x .60’ aerobic heart rate over 2 weeks). This finding is encouraging as low intensity exercise may be more feasible or attractive for many individuals than intense aerobic exercise. Indeed, individuals with a high body mass index – precisely those whose physical health would most benefit from exercise – are especially prone to fear feelings of biological arousal from vigorous exercise (Smits, Tart, Presnell, Rosenfield, & Otto, 2010). AS reduction post-exercise has been shown to persist for one (Broman-Fulks & Storey, 2008) to three weeks (Smits, Berry, Rosenfield, et al., 2008).

Mindfulness-based intervention

Although research on mindfulness-based methods to attenuate AS in normal populations is limited (see Table 2), preliminary evidence suggests that MBSR may be effective. Specifically, a recent investigation tested the effect of a brief mindfulness skills training program on both AS and EA (Tanay et al., 2012). Researchers asked university students and community members to attend four weekly 1-hour skills training sessions that focused on mindfulness meditation in the Mahasi tradition, “slightly different” (Tanay et al., 2012, p. 498) from MBSR. Participants also performed 15 minutes of mindfulness exercises four times per week. AS decreased significantly post-intervention in the experimental group, compared to the control group. Further research is warranted. In particular, researchers have questioned whether those with high baseline AS – who are thus especially fearful of bodily sensations – will benefit from mindfulness-based methods (see Rogojanski, Vettese, & Antony, 2011). Along those lines, clinical findings suggest that high AS patients do not benefit as much from MBSR compared to CBT, perhaps due to the extensive body scanning in MBSR that may be arduous for high AS participants (Arch & Ayers, 2013). Consistent with this idea, ACT, which does not include intensive bodily attention, was indeed effective in those with high AS (Wolitzky-Taylor, Arch, Rosenfield, & Craske, 2012). ACT interventions in normal populations to attenuate AS are lacking.


A variety of psycho-educational interventions reduce AS in the short-term. Options for AS improvement include exercise for those able to engage in physical activity, as well as varieties of brief forms of cognitive restructuring. Anxiety Sensitivity Education and Reduction Training and also ASAT have shown at least partial maintenance of AS improvement at 6- and 24-month follow-up, respectively; durability of gains from other methods is not yet established. Other important unanswered questions from the psycho-educational AS reduction research include the populations for whom each method is most effective (e.g., cultural or gender differences). Additional insight into adapted MBSR is needed to determine whether it helps those with high baseline AS. ACT may be a better option than MBSR in those with high AS. Further research will clarify matters.

Table 2

Summary of Psycho-Educational and Mindfulness-Based Interventions for AS

Study Intervention Sample Sex Distribution Relevant Findings Effect Size Estimate
Radhu et al. (2012) 12-week web-based CBT intervention 47 students with high perfectionism scores 72% female Decreased AS in intervention vs. control group η2 = .17
Korte & Schmidt (2013) Motivational enhancement therapy 80 students with high AS 75% female Decreased AS for intervention vs. control group controlling for baseline AS β = .12
Steinman & Teachman (2010) Cognitive bias modification (positive training) 75 students with high AS 69% female Decreased AS for intervention vs. control group controlling for baseline AS ηp2 = .07
MacDonald et al. (2013) Cognitive bias modification (interpretation training) 34 students with high AS 76% female Decreased AS in training condition only from pre-test to post-test d = .82
Schmidt, Eggleston, et al. (2007) Anxiety sensitivity amelioration training 404 students and community members with high AS 61% female Decreased AS post-intervention partial ε2 = .047
Partially maintained at 24-month follow-up n/a, p = .08
Vujanovic et al. (2012) Anxiety sensitivity amelioration training 5 trauma-exposed adults 60% female For 80% of participants, AS decreased to normal level n/a
Keough & Schmidt (2012) Anxiety sensitivity education and reduction training 104 individuals with high AS 84% female Decreased AS for intervention vs. control group
after 1 month and β = -0.54
6 months controlling for baseline AS β = -0.51
Broman-Fulks et al. (2004) Physical exercise (high-intensity or low-intensity) 54 students with high AS 76% female Decreased AS for intervention vs. control for
high-intensity exercise η2 = 0.60
low intensity exercise η2 = 0.36
Broman-Fulks & Storey (2008) Aerobic exercise 24 participants with high AS 79% female Decreased AS for exercise group after 1st session; maintained at follow-up ηp2 = .17
Smits, Berry, Rosenfield, et al. (2008) Exercise with or without cognitive restructuring 60 participants with high AS 75% female Decreased AS for both exercise groups compared to control d = 2.15
Rogojanski et al. (2011) Mindfulness or suppression for cravings 61 smokers 41% female Baseline AS not associated with post-treatment self-efficacy in either group n/a
Arch & Ayers (2013) Adapted MBSR or group CBT 71 patients with an anxiety disorder 21% female CBT outperformed MBSR in post-treatment symptom reduction for high AS patients n/a
Wolitzky-Taylor et al. (2012) ACT or CBT 87 patients with an anxiety disorder 47% female Baseline AS did not affect symptom reduction results of ACT n/a
Tanay et al. (2012) Adapted MBSR 53 adults 65% female Decreased AS in intervention vs. control group d = .61

Note. AS = anxiety sensitivity; ACT = acceptance and commitment therapy; MBSR = mindfulness-based stress reduction; CBT = cognitive behavioral therapy; n/a = no effect size available.

Experiential Avoidance (EA)


Those who report high EA are largely unwilling to experience the physical and mental symptoms resulting from personal experiences, leading to ineffective and maladaptive coping behaviors (Hayes et al., 2004). Similarities exist between EA and the concept of avoidance coping (see Wu et al., 2013), but the two constructs are not identical. Instead, between the two, EA distinctly predicts quality of life (Karekla & Panayiotou, 2011). EA manifests itself across adolescents and adults through the continued suppression of emotions and emotional displays, causing greater re-occurrence in a vicious cycle of negativity and downward moods (e.g., Wegner, Schneider, Carter, & White, 1987).

High EA hinders psychological health and is related to increased pessimism and substance abuse (Fergus, Bardeen, & Orcutt, 2013; Levin et al., 2012), along with self-destruction, denial, self-blame, and behavioral disengagement (Karekla & Panayiotou, 2011). For example, high EA is associated with parental stress and dysphoria in mothers of preschool children in a Head Start program (Shea & Coyne, 2011); among parents of children with cerebral palsy, high EA significantly predicts chronic sorrow symptoms (Whittingham, Wee, Sanders, & Boyd, 2013). In contrast, those with lower EA accept and de-emphasize pain associated with stress (Costa & Pinto-Gouveia, 2011). Along those lines, studies using lab-based stressors report that high (relative to low) EA predicts more negative emotional responses after either unpleasant film clips (Shallcross, Troy, Boland, & Mauss, 2010; Sloan, 2004), inhalation of carbon dioxide-enriched air (which induces breathlessness and other physiological symptoms; Feldner, Zvolensky, Eifert, & Spira, 2003), or dysphoric mood induction (the Velten Mood Induction Procedure [Velten, 1968] accompanied by music; Gird & Zettle, 2009). That noted, studies that instructed participants to use acceptance versus other emotion regulation strategies (e.g., suppression) in the face of discomfort have found mixed results and overall no advantage for acceptance in minimizing negative affect (for a review, see Kohl, Rief, & Glombiewski, 2012); dispositional EA was not considered in the review. Kohl et al. (2012) point to substantial methodological differences among the studies and caution that no conclusion can be drawn yet about whether acceptance influences negative affect post-discomfort. Further research will clarify matters. As Kohl et al. (2012) note, this research line would benefit from identifying how trait levels of avoidance (e.g., EA) may influence effective use of state emotion regulation strategies (e.g., avoidance of provocation-induced emotion). Also important will be testing whether specifically training participants how to use a particular emotional regulation strategy (e.g., acceptance rather than avoidance) enhances the benefits of that strategy.

Research on how EA influences emotional responses to naturalistic stressors indicates that individuals with higher EA report greater distress and stress rumination (Goldstone, Farhall, & Ong, 2011; Morina, 2007). Indeed, a recent correlation between high EA and perceived stress has been reported, indicating that therapeutic methods to lower EA may, in turn, decrease stress reactivity (Bardeen et al., 2013), with a further link with emotional distress (Cristea, Montgomery, Szamoskozi, & David, 2013). An additional reason to target EA to reduce self-reported stress levels is that it moderates the relationship between AS and perceived stress, such that high EA individuals, regardless of AS level, report high perceived stress, whereas among low EA individuals, higher AS is associated with augmented perceived stress (Bardeen et al., 2013). EA thus seems a reasonable candidate for psychological intervention of stress reactivity (Costa & Pinto-Gouveia, 2011).

Psycho-educational intervention

To date, EA has received little effective psycho-educational intervention (please see Table 3 for a summary), unlike TEI and AS. Indeed, the narrative emotional disclosure task has failed to improve EA in several studies (Carpenter, 2000, reviewed in Chawla & Ostafin, 2007; Moore, Brody, & Dierberger, 2009; Wilson, 2012). For example, using this method to target EA, Moore et al. (2009) asked university students to write about either traumatic or neutral events for 20 minutes on three consecutive days; one-month follow-up data revealed that EA did not improve in either group. Behavioral interventions have fared better, although much more research is needed. More specifically, in one investigation, systematic desensitization reduced EA (with results not significantly different from those of the mindfulness-based method ACT, described below; Zettle, 2003; see Chawla & Ostafin, 2007). Additionally, in adolescents with Tourette’s syndrome, a behavioral treatment (habit reversal training) decreased EA to the same extent when administered alone or accompanied by ACT (Best, 2010). As such, the role that exposure techniques can play in reduction of EA is an important, but under-investigated, question (e.g., Gloster, Hummel, Lyudmirskaya, Hauke, & Sonntag, 2012).

Mindfulness-based intervention

ACT was designed explicitly to target EA (e.g., Burrows, 2013), and has thus figured prominently in EA intervention (Chawla & Ostafin, 2007).

Substantial evidence (summarized in Table 3) indicates that ACT decreases EA in both clinical and normal populations, with cost-effective group and self-help formats now available (e.g., Burrows, 2013; Fledderus, Bohlmeijer, Pieterse, & Schreurs, 2012; Luoma et al., 2008). For example, group ACT (“Living to the full” featuring eight 2-hour sessions over two months) significantly improved EA (plus emotional well-being and mental health) at 3-month follow-up, compared to the waitlist (Fledderus et al., 2010). Likewise, promising results were obtained from a guided self-help form of ACT, in which participants engaged in 10-15 minutes of mindfulness exercises daily and each week completed one of the nine self-help modules in an ACT self-help manual (Bohlmeijer & Hulsbergen, 2008); participants also received a weekly support email. Post-intervention results indicated that ACT self-help significantly improved both EA and anxiety, compared to wait-list; 3-month follow-up data from ACT participants indicated that these gains were maintained (Fledderus, Bohlmeijer, et al., 2012). These findings taken together suggest that ACT approaches that are easily disseminated (e.g., Fledderus et al., 2010; Fledderus, Bohlmeijer, et al., 2012) have substantial and durable benefits on both EA and mental health.

MBSR also may effectively reduce EA, although more research is needed. Two studies that did not include a control group (Kearney, McDermott, Malte, Martinez, & Simpson, 2012; Weinrib, 2011) found improved EA (relative to baseline) after manualized MBSR (Kabat-Zinn, 1982). Four months after the end of treatment (Kearney et al., 2012), EA improvement was maintained. Additionally, the aforementioned brief mindfulness skills training program, which did include a control group, also found improved EA after adapted MBSR (Tanay et al., 2012).


High EA is linked to stress reactivity, although no clear advantage has been shown for acceptance versus other strategies to temper negative affect post-discomfort. Substantial evidence indicates ACT significantly improves EA. Adapted MBSR may be effective as well although research is limited. The sparse research on psycho-educational intervention of EA suggests behavioral approaches hold more promise than the narrative emotional disclosure task. Indeed, elements of exposure arguably occur in ACT (Gloster et al., 2012), raising the possibility that exposure itself may ameliorate EA, as suggested by several studies.

Table 3

Summary of Psycho-Educational and Mindfulness-Based Interventions for EA

Study Intervention Sample Sex Distribution Relevant Findings Effect Size Estimate
Tanay et al. (2012) Adapted MBSR 53 adults 65% female Decreased EA in intervention vs. control group d = .60
Carpenter (2000) Narrative emotional disclosure 50 adults 75% female No difference in EA for intervention and control groups controlling for baseline EA n/a
Moore et al. (2009) Narrative emotional disclosure 233 adults 55% female No difference in EA for intervention and control groups n/a
Wilson (2012) Narrative emotional disclosure 315 undergraduate students 49% female No difference in EA for intervention and control groups n/a
Best (2010) Habit reversal training with and without ACT 13 adolescents with tic disorders 15% female No difference in EA between habit reversal training with and without ACT partial eta squared = .05
Zettle (2003) ACT versus systematic desensitization 24 college students 83% female No difference in EA between ACT and systematic desensitization n/a
Burrows (2013) ACT 1 assault survivor (case study) 1 female participant, no males Decreased EA from 1st session to final session; maintained at 8-month follow-up n/a
Fledderus, Bohlmeijer, et al. (2012) ACT (with or without extensive email contact) 376 participants with moderate (not severe) depressive symptoms 70% female Decreased EA in intervention groups vs. control
ACT without extensive email d = .70
For ACT with extensive email d = .63
Luoma et al. (2008) ACT 88 adults in treatment for substance abuse; 48 completers 53% female Decreased EA pre- to post. AAQ and AAQ-II used for EA
For EA (AAQ) d = .56
For EA (AAQ-II) d = .84
Fledderus et al. (2010) ACT (group format) 93 participants with some (but not severe) psychological distress 82% female Decreased EA in intervention vs. control group; gains maintained
Post-treatment d = .51
Follow-up d = .74
Weinrib (2011) MBSR 106 adults 85% female Decreased EA pre- to post-treatment (no control group) Wilks’ Λ = .45
Kearney et al. (2012) MBSR 92 veterans 24% female Decreased EA (no control group)
from baseline to 2 months d = .65
from baseline to 6 months d = .68

Note. EA = experiential avoidance; MBSR = mindfulness-based stress reduction; ACT = acceptance and commitment therapy; AAQ = Acceptance and Action Questionnaire; n/a = no effect size available.

Conclusions and Limitations

Collectively, this review focused on the role of TEI, AS, and EA in self-reported stress responses. Empirically supported psychological methods to adjust suboptimal levels of these variables in normal populations were overviewed as well. Since summaries of our findings for each variable were included above, we now draw attention to four major conclusions that emerge from examination of this general literature.

First, the current literature generally supports the conclusion that self-reported stress reactivity is influenced by each of these dispositional variables, with emotional stress reaction decreasing as TEI, AS, and EA improve. Unfortunately, unresolved issues, particularly for TEI, complicate interpretation. Studies that operationalize TEI as a single total score report that higher levels predict decreased emotional stress reactivity. However, investigation into the facets of TEI may importantly refine this finding. Indeed, greater attention to feelings was recently shown to prospectively predict intensified emotional stress (Salguero et al., 2012), perhaps by aggravating a tendency to ruminate, exacerbating risk for depression (Salguero, Extrema, & Fernández-Berrocal, 2013). Notably, although EA is unidimensional (Fledderus, Oude Voshaar, ten Klooster, & Bohlmeijer, 2012), AS is also a multifaceted construct (physiological, mental, and social concerns; Naragon-Gainey, 2010) but is largely viewed as a single entity in stress investigations to date (but see Broman-Fulks & Storey, 2008). Thus, further research that delves into the facets of TEI and AS and subjective stress reactivity would be welcome. Overall, the current findings support the objective of targeting each of these dispositional variables to reduce emotional stress reactivity, as a number of researchers have done.

The second conclusion this literature review permits is that preliminary support currently exists for psycho-educational intervention of both TEI and AS but is lacking for EA. Indeed, unsuccessful findings have consistently occurred after use of the narrative writing task to target EA, and other psycho-educational methods have been under-investigated. Limited findings suggest behavioral interventions such as exposure may in fact reduce EA, but the paucity of studies and the specialized populations studied (e.g., adolescents with Tourette’s syndrome; Best, 2010) indicate the need for more research. In contrast to EA, effective psycho-educational interventions for both TEI and AS abound. Nevertheless, a number of questions remain. In particular, data establishing the necessary and sufficient parameters of effective psycho-educational approaches to target TEI and AS are largely absent. Also scarce in the literature are studies directly comparing which approach works best and for whom. Further research using psycho-educational interventions will undoubtedly clarify matters.

Third, adequate evidence supports a specific type of mindfulness-based method, ACT, to target EA, while mindfulness-based methods investigations are just beginning for TEI and AS, with encouraging preliminary findings. Nevertheless, caution is warranted in generalizing from these early mindfulness findings for TEI and AS. Indeed, the only MBSR study targeting TEI of which we are aware lacked a control group (Cohen & Miller, 2009). Furthermore, although the MBSR intervention of AS was a true experimental design with successful results (Tanay et al., 2012), concerns have been raised about whether individuals with extremely high baseline AS will be able to remain in an MBSR program that by definition requires extensive focus on bodily sensations, precisely that which is feared by high AS individuals (Arch & Ayers, 2013). ACT interventions for high AS have thus been posited as a better mindfulness-based method option than MBSR (Wolitzky-Taylor et al., 2012). Empirical investigation will shed light on this and other important unresolved issues.

Fourth, although the early state of the literature does not permit a conclusion concerning which intervention is “best,” arguably reasons exist to consider using mindfulness-based methods in particular to target these dispositional variables. Mindfulness-based methods are known to have a vast array of psychological and physiological benefits (for a review, see Chiesa & Serretti, 2009, 2010), and exciting evidence continues to accrue along these lines. For example, MBSR was recently shown to successfully reduce physiological reactivity to stress through pro-inflammatory down regulation of the transcription factor NF-kB (Creswell et al., 2012), with subsequent increases in gray matter and improvement of neural circuits in the brain across both genders (Goldin, Ramel, & Gross, 2009; Kerr, Sacchet, Lazar, Moore, & Jones, 2013). Mindfulness-based methods may improve numerous dispositional variables implicated in stress reactivity, in addition to their other beneficial effects (e.g., Tanay et al., 2012). That noted, using a specific psycho-educational technique to target a particular dispositional variable makes sense to achieve the other beneficial outcomes associated with improved levels of the dispositional variable, in addition to reduced stress reactivity. For example, increased TEI may improve workplace civility (Kirk et al., 2011). Likewise, suboptimal levels of EA and AS are empirically documented risk factors for psychopathology (for reviews, see Chawla & Ostafin, 2007; Naragon-Gainey, 2010, respectively).

Mindfulness-based methods have been less studied with regard to these dispositional variables than have psycho-educational methods. Consequently, there are numerous unanswered questions concerning the aspects of mindfulness-based methods that are both necessary and sufficient to include; dismantling studies will undoubtedly illuminate which components (e.g., mediation, included in MBSR but not ACT) affect dispositional variables. Continued investigation into brief and easily disseminated forms of mindfulness-based methods also seems warranted. ACT self-help (Fledderus, Bohlmeijer, et al., 2012) is an important step in this direction. Likewise, exciting new work suggests that MBSR is beneficial when administered through telehealth (Niles, Vujanovic, Silberbogen, Seligowski, & Potter, 2013) and also when less time commitment is required (e.g., one hour instead of three hour weekly meetings; Klatt, Buckworth, & Malarkey, 2009). Ongoing investigations will undoubtedly advance the understanding of easily disseminated forms of mindfulness-based methods.

Future research directions include whether there are gender or cultural differences influencing response to these interventions. Overall, studies to date have tended to include more women than men; for example, the only MBSR intervention to date that examined changes in TEI included only one male participant (Cohen & Miller, 2009). Similarly, many intervention studies discussed in this work focused on North American samples. Along those lines, all the psycho-educational interventions for AS reviewed above used North American samples. The extent to which these findings will generalize to other cultures is an empirical question warranting scrutiny.

This paper has strengths. It adds to the existing literature on dispositional variables and stress (for reviews, see Lecic-Tosevski et al., 2011; Wu et al., 2013) by discussing three other modifiable psychological factors influencing stress reactivity, TEI, AS, and EA, each of which is increasingly receiving attention in stress research. We delineated the health promotion techniques that improve TEI, AS, and EA, covering both psycho-education and mindfulness methods. Particular emphasis was placed on interventions that are applicable to the general population and easily disseminated. Throughout, we drew heavily on current literature and sought to provide thorough coverage of the relevant scholarly works.

Despite these strengths, this review has limitations. The dispositional variables and intervention methods covered each comprise their own specialized area of study, and we did not focus on distinctions these literatures make, for example, in the different models of TEI or in the practical and theoretical differences among adapted MBSR approaches. Numerous other dispositional variables (e.g., objective ability EI, Davis & Humphrey, 2012) importantly influence stress responses and were not included in this review. Likewise, we covered a limited number of intervention techniques and did not consider other well-established approaches that have proven efficacy. In particular, mindfulness-based cognitive therapy (Segal, Williams, & Teasdale, 2002) is a potent program that greatly reduces the risk of relapse in those with three or more depressive episodes (Galante, Iribarren, & Pearce, 2013). We were unable to cover physiological components of the stress response and likewise omitted both the rich literature on traumatic stressors and the burgeoning research on how these dispositional variables may be modified in those with psychopathology. Some studies yielding null results may have been inadvertently excluded (e.g., the file drawer problem, Rosenthal, 1979). Finally, in emphasizing reduced stress reactivity, we did not discuss how minimal stress reactivity might in fact be suboptimal (e.g., Lovallo, 2011). Future research will help to illuminate the precise level of stress reactivity that most promotes maximal health benefits over the long-term.


Kenneth Choi received funding from the Ryerson Summer Student Research Opportunities Program of the Office of the Vice President of Research and Innovation at Ryerson University.

Competing Interests

The authors have declared that no competing interests exist.


The authors have no support to report.


  • Ager, R., Roahen-Harrison, S., Toriello, P. J., Kissinger, P., Morse, P., Morse, E., . . . Rice, J., (2011). Predictors of adopting motivational enhancement therapy. Research on Social Work Practice, 21(1), 65-76.

  • Allen, A. P., Kennedy, P. J., Cryan, J. F., Dinan, T. G., & Clarke, G. (2014). Biological and psychological markers of stress in humans: Focus on the Trier Social Stress Test. Neuroscience and Biobehavioral Reviews, 38, 94-124.

  • American Institute of Stress. (n.d.). What is stress? Retrieved from

  • American Psychological Association. (2009). Stress in America 2009 (Report). Retrieved from

  • Arch, J. J., & Ayers, C. R. (2013). Which treatment worked better for whom? Moderators of group cognitive behavioral therapy versus adapted mindfulness based stress reduction for anxiety disorders. Behaviour Research and Therapy, 51(8), 434-442.

  • Arora, S., Russ, S., Petrides, K. V., Sirimanna, P., Aggarwal, R., Darzi, A., & Sevdalis, N. (2011). Emotional intelligence and stress in medical students performing surgical tasks. Academic Medicine, 86(10), 1311-1317.

  • Baer, R. A., & Krietemeyer, J. (2006). Overview of mindfulness- and acceptance-based treatment approaches. In R. A. Baer (Ed.), Mindfulness-based treatment approaches: Clinician’s guide to evidence base and applications (pp. 3-27). Burlington, MA: Academic Press.

  • Bardeen, J. R., Fergus, T. A., & Orcutt, H. K. (2013). Experiential avoidance as a moderator of the relationship between anxiety sensitivity and perceived stress. Behavior Therapy, 44(3), 459-469.

  • Barker, D. B. (2007). Antecedents of stressful experiences: Depressive symptoms, self-esteem, gender, and coping. International Journal of Stress Management, 14(4), 333-349.

  • Baum, A. (1990). Stress, intrusive imagery, and chronic distress. Health Psychology, 9(6), 653-675.

  • Becker, L. A. (2000). Effect size calculators. Retrieved from

  • Best, S. H. (2010). Experiential avoidance in chronic tic disorders: An online survey and pilot treatment study using habit reversal and acceptance and commitment therapy (Doctoral dissertation). Available from ProQuest Dissertations and Theses database. (UMI No. 3366736)

  • Biglan, A., Layton, G. L., Jones, L. B., Hankins, M., & Rusby, J. C. (2013). The value of workshops on psychological flexibility for early childhood special education staff. Topics in Early Childhood Special Education, 32, 196-210.

  • Blonna, R. (2007). Coping with stress in a changing world (4th ed.) Boston, MA: McGraw-Hill.

  • Bohlmeijer, E. T., & Hulsbergen, M. (2008). Voluit leven: Mindfulness of de kunst van het aanvaarden, nu als praktisch hulpboek [Living to the full: Mindfulness or the art of acceptance, now as a practical help book]. Amsterdam, The Netherlands: Boom.

  • Broman-Fulks, J. J., Berman, M. E., Rabian, B., & Webster, M. J. (2004). Effects of aerobic exercise on anxiety sensitivity. Behaviour Research and Therapy, 42, 125-136.

  • Broman-Fulks, J. J., & Storey, K. M. (2008). Evaluation of a brief aerobic exercise intervention for high anxiety sensitivity. Anxiety, Stress, and Coping, 21(2), 117-128.

  • Burrows, C. J. (2013). Acceptance and commitment therapy with survivors of adult sexual assault: A case study. Clinical Case Studies, 12, 246-259.

  • Carpenter, K. M. (2000). Change mechanisms and clinical utility of written self-disclosure in a behavioral medicine setting (Doctoral dissertation). Available from ProQuest Dissertation and Theses database. (UMI No. 9988061)

  • Carrick, L. A. (2010). Understanding the impact of a half day learning intervention on emotional intelligence competencies: An exploratory study (Doctoral dissertation). Available from ProQuest Dissertations and Theses database. (UMI No. 3410485)

  • Carter, M. M., Marin, N. W., & Murrell, K. L. (1999). The efficacy of habituation in decreasing subjective distress among high anxiety-sensitive college students. Journal of Anxiety Disorders, 13(6), 575-589.

  • Chawla, N., & Ostafin, B. (2007). Experiential avoidance as a functional dimensional approach to psychopathology. Journal of Clinical Psychology, 63(9), 871-890.

  • Chiesa, A., & Malinowski, P. (2011). Mindfulness-based approaches: Are they all the same? Journal of Clinical Psychology, 67, 404-424.

  • Chiesa, A., & Serretti, A. (2009). Mindfulness-based stress reduction for stress management in healthy people: A review and meta-analysis. The Journal of Alternative and Complementary Medicine, 15, 593-600.

  • Chiesa, A., & Serretti, A. (2010). A systematic review of neurobiological and clinical features of mindfulness meditations. Psychological Medicine, 40(8), 1239-1252.

  • Chu, D. A., Williams, L. M., Harris, A. W. F., Bryant, R. A., & Gatt, J. M. (2013). Early life trauma predicts self-reported levels of depressive and anxiety symptoms in nonclinical community adults: Relative contributions of early life stressor types and adult trauma exposure. Journal of Psychiatric Research, 47(1), 23-32.

  • Chu, L.-C. (2010). The benefits of meditation vis-à-vis emotional intelligence, perceived stress and negative mental health. Stress and Health: Journal of the International Society for the Investigation of Stress, 26(2), 169-180.

  • Ciarrochi, J., & Blackledge, J. T. (2006). Mindfulness-based emotional intelligence training: A new approach to reducing human suffering and promoting effectiveness. In J. Ciarrochi, J. P. Forgas, & J. D. Mayer (Eds.), Emotional intelligence in everyday life: A scientific inquiry (2nd ed., pp. 206-228). Hove, England: Psychology Press.

  • Ciarrochi, J., & Mayer, J. D. (2007). The key ingredients of emotional intelligence interventions: Similarities and differences. In J. Ciarrochi & J. Mayer (Eds.), Applying emotional intelligence: A practitioner's guide (pp. 144-156). New York, NY, Psychology Press.

  • Cohen, J. S., & Miller, L. J. (2009). Interpersonal mindfulness training for well-being: A pilot study with psychology graduate students. Teachers College Record, 111(12), 2760-2774.

  • Costa, J., & Pinto-Gouveia, J. (2011). The mediation effect of experiential avoidance between coping and psychopathology in chronic pain. Clinical Psychology & Psychotherapy, 18(1), 34-47.

  • Creswell, J. D., Irwin, M. R., Burklund, L. J., Lieberman, M. D., Arevalo, J. M. G., Ma, J., . . . Cole, S. W., (2012). Mindfulness-based stress reduction training reduces loneliness and pro-inflammatory gene expression in older adults: A small randomized controlled trial. Brain, Behavior, and Immunity, 26(7), 1095-1101.

  • Cristea, I. A., Montgomery, G. H., Szamoskozi, Ş., & David, D. (2013). Key constructs in “classical” and “new wave” cognitive behavioral psychotherapies: Relationships among each other and with emotional distress. Journal of Clinical Psychology, 69(6), 584-599.

  • Davis, S. K., & Humphrey, N. (2012). Emotional intelligence predicts adolescent mental health beyond personality and cognitive ability. Personality and Individual Differences, 52(2), 144-149.

  • Donaldson-Feilder, E. J., & Bond, F. W. (2004). The relative importance of psychological acceptance and emotional intelligence to workplace well-being. British Journal of Guidance & Counselling, 32(2), 187-203.

  • Donnell, C. D., & McNally, R. J. (1990). Anxiety sensitivity and panic attacks in a nonclinical population. Behaviour Research and Therapy, 28(1), 83-85.

  • Dressler, W. W. (1984). Hypertension and perceived stress: A St. Lucian example. Ethos, 12, 265-283.

  • Ellis, P. D. (2009). Effect size calculators. Retrieved from

  • Feldner, M. T., Zvolensky, M. J., Eifert, G. H., & Spira, A. P. (2003). Emotional avoidance: An experimental test of individual differences and response suppression using biological challenge. Behaviour Research and Therapy, 41(4), 403-411.

  • Feldner, M. T., Zvolensky, M. J., Schmidt, N. B., & Smith, R. C. (2008). A prospective test of anxiety sensitivity as a moderator of the relation between gender and posttraumatic symptom maintenance among high anxiety sensitive young adults. Depression and Anxiety, 25(3), 190-199.

  • Fergus, T. A., Bardeen, J. R., & Orcutt, H. K. (2013). Experiential avoidance and negative emotional experiences: The moderating role of expectancies about emotion regulation strategies. Cognitive Therapy and Research, 37(2), 352-362.

  • Fledderus, M., Bohlmeijer, E. T., Pieterse, M. E., & Schreurs, K. M. G. (2012). Acceptance and commitment therapy as guided self-help for psychological distress and positive mental health: A randomized controlled trial. Psychological Medicine, 42(3), 485-495.

  • Fledderus, M., Bohlmeijer, E. T., Smit, F., & Westerhof, G. J. (2010). Mental health promotion as a new goal in public mental health care: A randomized controlled trial of an intervention enhancing psychological flexibility. American Journal of Public Health, 100(12), 2372-2378.

  • Fledderus, M., Oude Voshaar, M. A. H., ten Klooster, P. M., & Bohlmeijer, E. T. (2012). Further evaluation of the psychometric properties of the acceptance and action Questionnaire–II. Psychological Assessment, 24(4), 925-936.

  • Galante, J., Iribarren, S. J., & Pearce, P. F. (2013). Effects of mindfulness-based cognitive therapy on mental disorders: A systematic review and meta-analysis of randomised controlled trials. Journal of Research in Nursing, 18(2), 133-155.

  • Gelkopf, M., Berger, R., Bleich, A., & Silver, R. C. (2012). Protective factors and predictors of vulnerability to chronic stress: A comparative study of 4 communities after 7 years of continuous rocket fire. Social Science & Medicine, 74(5), 757-766.

  • Gird, S., & Zettle, R. D. (2009). Differential response to a dysphoric mood induction procedure as a function of level of experiential avoidance. The Psychological Record, 59, 537-550. Retrieved from

  • Gloster, A. T., Hummel, K. V., Lyudmirskaya, I., Hauke, C., & Sonntag, R. F. (2012). Aspects of exposure therapy in acceptance and commitment therapy. In P. Neudeck & H.-U. Wittchen (Eds.), Exposure therapy: Rethinking the modelRefining the method (pp. 127-152). New York, NY: Springer.

  • Goldin, P., Ramel, W., & Gross, J. (2009). Mindfulness meditation training and self-referential processing in social anxiety disorder: Behavioral and neural effects. Journal of Cognitive Psychotherapy, 23(3), 242-257.

  • Goldstone, E., Farhall, J., & Ong, B. (2011). Life hassles, experiential avoidance and distressing delusional experiences. Behaviour Research and Therapy, 49(4), 260-266.

  • Gómez-Pérez, L., López-Martínez, A. E., & Asmundson, G. J. G. (2013). Predictors of trait dissociation and peritraumatic dissociation induced via cold pressor. Psychiatry Research, 210, 274-280.

  • Görgens-Ekermans, G., & Brand, T. (2012). Emotional intelligence as a moderator in the stress–burnout relationship: A questionnaire study on nurses. Journal of Clinical Nursing, 21(15-16), 2275-2285.

  • Hagh-Shenas, H., Goodarzi, M. A., Dehbozorgi, G., & Farashbandi, H. (2005). Psychological consequences of the Bam earthquake on professional and nonprofessional helpers. Journal of Traumatic Stress, 18(5), 477-483.

  • Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York, NY: Guilford Press.

  • Hayes, S. C., Strosahl, K., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., & McCurry, S. M. (2004). Measuring experiential avoidance: A preliminary test of a working model. Psychological Record, 54, 553-578.

  • Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64, 1152-1168.

  • Heather, N., & McCambridge, J. (2013). Post-treatment stage of change predicts 12-month outcome of treatment for alcohol problems. Alcohol and Alcoholism, 48(3), 329-336.

  • Hensley-Maloney, L., & Varela, R. E. (2009). The influence of hurricane exposure and anxiety sensitivity on panic symptoms. Child and Youth Care Forum, 38(3), 135-149.

  • Isyanov, E. V., & Calamari, J. E. (2004). Does stress perception mediate the relationship between anxiety sensitivity and anxiety and depression symptoms? Anxiety, Stress, and Coping, 17(2), 153-162.

  • Jacob, G. A., Ower, N., & Buchholz, A. (2013). The role of experiential avoidance, psychopathology, and borderline personality features in experiencing positive emotions: A path analysis. Journal of Behavior Therapy and Experimental Psychiatry, 44(1), 61-68.

  • Kabat-Zinn, J. (1982). An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness mediation: Theoretical considerations and preliminary results. General Hospital Psychiatry, 4, 33-47.

  • Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. New York, NY: Delacourt.

  • Kadak, M. T., Nasıroğlu, S., Boysan, M., & Aydın, A. (2013). Risk factors predicting posttraumatic stress reactions in adolescents after 2011 Van earthquake. Comprehensive Psychiatry, 54(7), 982-990.

  • Karekla, M., & Panayiotou, G. (2011). Coping and experiential avoidance: Unique or overlapping constructs? Journal of Behavior Therapy and Experimental Psychiatry, 42, 163-170.

  • Kearney, D. J., McDermott, K., Malte, C., Martinez, M., & Simpson, T. L. (2012). Association of participation in a mindfulness program with measures of PTSD, depression and quality of life in a veteran sample. Journal of Clinical Psychology, 68(1), 101-116.

  • Keefer, K. V., Parker, J. D. A., & Wood, L. M. (2012). Trait emotional intelligence and university graduation outcomes: Using latent profile analysis to identify students at risk for degree noncompletion. Journal of Psychoeducational Assessment, 30(4), 402-413.

  • Keough, M. E., & Schmidt, N. B. (2012). Refinement of a brief anxiety sensitivity reduction intervention. Journal of Consulting and Clinical Psychology, 80(5), 766-772.

  • Kerr, C. E., Sacchet, M. D., Lazar, S. W., Moore, C. I., & Jones, S. R. (2013). Mindfulness starts with the body: Somatosensory attention and top-down modulation of cortical alpha rhythms in mindfulness meditation. Frontiers in Human Neuroscience, 7, Article 12.

  • Kirk, B. A., Schutte, N. S., & Hine, D. W. (2011). The effect of an expressive-writing intervention for employees on emotional self-efficacy, emotional intelligence, affect, and workplace incivility. Journal of Applied Social Psychology, 41(1), 179-195.

  • Kirschbaum, C., Pirke, K.-M., & Hellhammer, D. H. (1993). The "Trier Social Stress Test": A tool for investigating psychobiological stress responses in a laboratory setting. Neuropsychobiology, 28(1-2), 76-81.

  • Klatt, M. D., Buckworth, J., & Malarkey, W. B. (2009). Effects of low-dose mindfulness-based stress reduction (MBSR-ld) on working adults. Health Education & Behavior, 36(3), 601-614.

  • Kohl, A., Rief, W., & Glombiewski, J. A. (2012). How effective are acceptance strategies? A meta-analytic review of experimental results. Journal of Behavior Therapy and Experimental Psychiatry, 43(4), 988-1001.

  • Korte, K. J., & Schmidt, N. B. (2013). Motivational enhancement therapy reduces anxiety sensitivity. Cognitive Therapy and Research, 37, 1140-1150.

  • Kotsou, I., Nelis, D., Grégoire, J., & Mikolajczak, M. (2011). Emotional plasticity: Conditions and effects of improving emotional competence in adulthood. The Journal of Applied Psychology, 96(4), 827-839.

  • Kudielka, B. M., Hellhammer, D. H., & Kirschbaum, C. (2007). Ten years of research with the Trier Social Stress Test–revisited. In E. Harmon-Jones & P. Winkielman (Eds.), Social neuroscience: Integrating biological and psychological explanations of social behavior (pp. 56-83). New York, NY: Guilford Press.

  • Lau, J. Y. F. (2013). Cognitive bias modification of interpretations: A viable treatment for child and adolescent anxiety? Behaviour Research and Therapy, 51(10), 614-622.

  • Lazarus, R. (1998). Fifty years of research and theory by R. S. Lazarus: An analysis of historical and perennial issues. Mahwah, NJ: Erlbaum.

  • Lecic-Tosevski, D., Vukovic, O., & Stepanovic, J. (2011). Stress and personality. Psychiatriki, 22(4), 290-297.

  • Lee, J. E., Watson, D., & Law, L. A. F. (2010). Lower-order pain-related constructs are more predictive of cold pressor pain ratings than higher-order personality traits. The Journal of Pain, 11(7), 681-691.

  • Levin, M. E., Lillis, J., Seeley, J., Hayes, S. C., Pistorello, J., & Biglan, A. (2012). Exploring the relationship between experiential avoidance, alcohol use disorders, and alcohol-related problems among first-year college students. Journal of American College Health, 60(6), 443-448.

  • Lin, T.-W., & Kuo, Y.-M. (2013). Exercise benefits brain function: The monoamine connection. Brain Sciences, 3(1), 39-53.

  • Lothstein, L. M. (2012). Group therapy for patients suffering from eating disorders. International Journal of Group Psychotherapy, 62(3), 473-476.

  • Lovallo, W. R. (2011). Do low levels of stress reactivity signal poor states of health? Biological Psychology, 86, 121-128.

  • Luoma, J. B., Kohlenberg, B. S., Hayes, S. C., Bunting, K., & Rye, A. K. (2008). Reducing self-stigma in substance abuse through acceptance and commitment therapy: Model, manual development, and pilot outcomes. Addiction Research and Theory, 16(2), 149-165.

  • MacDonald, E. M., Koerner, N., & Antony, M. M. (2013). Modification of interpretive bias: Impact on anxiety sensitivity, information processing and response to induced bodily sensations. Cognitive Therapy and Research, 37(4), 860-871.

  • MacLeod, C., & Mathews, A. (2012). Cognitive bias modification approaches to anxiety. Annual Review of Clinical Psychology, 8, 189-217.

  • Martin, G. W., & Rehm, J. (2012). The effectiveness of psychosocial modalities in the treatment of alcohol problems in adults: A review of the evidence. Canadian Journal of Psychiatry, 57(6), 350-358.

  • Martins, A., Ramalho, N., & Morin, E. (2010). A comprehensive meta-analysis of the relationship between emotional intelligence and health. Personality and Individual Differences, 49(6), 554-564.

  • Matthews, G., Zeidner, M., & Roberts, R. D. (2012). Emotional intelligence: A promise unfulfilled? Japanese Psychological Research, 54(2), 105-127.

  • Mayer, J. D., Robers, R. D., & Barsade, S. G. (2008). Human abilities: Emotional intelligence. Annual Review of Psychology, 59, 507-536.

  • McLaughlin, K. A., & Hatzenbuehler, M. L. (2009). Stressful life events, anxiety sensitivity, and internalizing symptoms in adolescents. Journal of Abnormal Psychology, 118(3), 659-669.

  • McNally, R. J. (2002). Anxiety sensitivity and panic disorder. Biological Psychiatry, 52(10), 938-946.

  • Messenger, C., & Shean, G. (1998). The effects of anxiety sensitivity and history of panic on reactions to stressors in a non-clinical sample. Journal of Behavior Therapy and Experimental Psychiatry, 29(4), 279-288.

  • Mikolajczak, M., Petrides, K. V., Coumans, N., & Luminet, O. (2009). The moderating effect of trait emotional intelligence on mood deterioration following laboratory-induced stress. International Journal of Clinical and Health Psychology, 9(3), 455-477. Retrieved from

  • Mikolajczak, M., Roy, E., Luminet, O., Fillée, C., & de Timary, P. (2007). The moderating impact of emotional intelligence on free cortisol responses to stress. Psychoneuroendocrinology, 32(8-10), 1000-1012.

  • Mitchell, M. A., Riccardi, C. J., Keough, M. E., Timpano, K. R., & Schmidt, N. B. (2013). Understanding the associations among anxiety sensitivity, distress tolerance, and discomfort intolerance: A comparison of three models. Journal of Anxiety Disorders, 27(1), 147-154.

  • Mitchell, T. L., Griffin, K., Stewart, S. H., & Loba, P. (2004). 'We will never ever forget...': The Swissair flight 111 disaster and its impact on volunteers and communities. Journal of Health Psychology, 9(2), 245-262.

  • Moore, S. D., Brody, L. R., & Dierberger, A. E. (2009). Mindfulness and experiential avoidance as predictors and outcomes of the narrative emotional disclosure task. Journal of Clinical Psychology, 65(9), 971-988.

  • Morina, N. (2007). The role of experiential avoidance in psychological functioning after war-related stress in Kosovar civilians. The Journal of Nervous and Mental Disease, 195(8), 697-700.

  • Muyia, H. M. (2009). Approaches to and instruments for measuring emotional intelligence: A review of selected literature. Advances in Developing Human Resources, 11(6), 690-702.

  • Naragon-Gainey, K. (2010). Meta-analysis of the relations of anxiety sensitivity to the depressive and anxiety disorders. Psychological Bulletin, 136(1), 128-150.

  • Nelis, D., Kotsou, I., Quoidbach, J., Hansenne, M., Weytens, F., Dupuis, P., & Mikolajczak, M. (2011). Increasing emotional competence improves psychological and physical well-being, social relationships, and employability. Emotion, 11, 354-366.

  • Niles, B. L., Vujanovic, A. A., Silberbogen, A. K., Seligowski, A. V., & Potter, C. M. (2013). Changes in mindfulness following a mindfulness telehealth intervention. Mindfulness, 4, 301-310.

  • O'Brien, A., Terry, D. J., & Jimmieson, N. L. (2008). Negative affectivity and responses to work stressors: An experimental study. Anxiety, Stress, and Coping, 21(1), 55-83.

  • Ogińska-Bulik, N. (2005). Emotional intelligence in the workplace: Exploring its effects on occupational stress and health outcomes in human service workers. International Journal of Occupational Medicine and Environmental Health, 18, 167-175.

  • Perelman, A. M., Miller, S. L., Clements, C. B., Rodriguez, A., Allen, K., & Cavanaugh, R. (2012). Meditation in a deep south prison: A longitudinal study of the effects of Vipassana. Journal of Offender Rehabilitation, 51(3), 176-198.

  • Pérez, J. C., Petrides, K. V., & Furnham, A. (2005). Measuring trait emotional intelligence. In R. Schulze & R. D. Roberts (Eds.), Emotional intelligence: An international handbook (pp. 181-201). Ashland, OH: Hogrefe & Huber Publishers.

  • Petrides, K. V., & Furnham, A. (2003). Trait emotional intelligence: Behavioural validation in two studies of emotion recognition and reactivity to mood induction. European Journal of Personality, 17(1), 39-57.

  • Petrides, K. V., Pérez-González, J. C., & Furnham, A. (2007). On the criterion and incremental validity of trait emotional intelligence. Cognition and Emotion, 21(1), 26-55.

  • Radhu, N., Daskalakis, Z. J., Arpin-Cribbie, C., Irvine, J., & Ritvo, P. (2012). Evaluating a web-based cognitive-behavioral therapy for maladaptive perfectionism in university students. Journal of American College Health, 60, 357-366.

  • Ramos, N. S., Fernández-Berrocal, P., & Extremera, N. (2007). Perceived emotional intelligence facilitates cognitive-emotional processes of adaptation to an acute stressor. Cognition and Emotion, 21(4), 758-772.

  • Rapee, R. M., & Barlow, D. H. (1988). Cognitive-behavioral treatment. Psychiatric Annals, 18(8), 473-477.

  • Reiss, S. (1991). Expectancy model of fear, anxiety, and panic. Clinical Psychology Review, 11(2), 141-153.

  • Reiss, S., Peterson, R. A., Gursky, D. M., & McNally, R. J. (1986). Anxiety sensitivity, anxiety frequency, and the prediction of fearfulness. Behaviour Research and Therapy, 24, 1-8.

  • Rogojanski, J., Vettese, L. C., & Antony, M. M. (2011). Role of sensitivity to anxiety symptoms in responsiveness to mindfulness versus suppression strategies for coping with smoking cravings. Journal of Clinical Psychology, 67, 439-445.

  • Rosa Esteve, M., & Camacho, L. (2008). Anxiety sensitivity, body vigilance and fear of pain. Behaviour Research and Therapy, 46, 715-727.

  • Rosch, P. J. (2001, March). The quandary of job stress compensation. Health and Stress, 3, 1-4. Retrieved from

  • Rosenthal, R. (1979). The file drawer problem and tolerance for null results. Psychological Bulletin, 86(3), 638-641.

  • Salguero, J. M., Extrema, N., & Fernández-Berrocal, P. (2013). A meta-mood model of rumination and depression: Preliminary test in a non-clinical population. Scandinavian Journal of Psychology, 54(2), 166-172.

  • Salguero, J. M., Palomera, R., & Fernández-Berrocal, P. (2012). Perceived emotional intelligence as predictor of psychological adjustment in adolescents: A 1-year prospective study. European Journal of Psychology of Education, 27(1), 21-34.

  • Salovey, P., & Mayer, J. D. (1989). Emotional intelligence. Imagination, Cognition and Personality, 9(3), 185-211.

  • Salovey, P., Mayer, J., Goldman, S. L., Turvey, C., & Palfai, T. P. (1995). Emotional attention, clarity, and repair: Exploring emotional intelligence using the Trait Meta-Mood Scale. In J. W. Pennebaker (Ed.), Emotion, disclosure, and health (pp. 125-154). Washington, DC: American Psychological Association.

  • Salovey, P., Stroud, L. R., Woolery, A., & Epel, E. S. (2002). Perceived emotional intelligence, stress reactivity, and symptom reports: Further explorations using the Trait Meta-Mood Scale. Psychology & Health, 17(5), 611-627.

  • Schmidt, N. B., Buckner, J. D., & Keough, M. E. (2007). Anxiety sensitivity as a prospective predictor of alcohol use disorders. Behavior Modification, 31(2), 202-219.

  • Schmidt, N. B., Eggleston, A. M., Woolaway-Bickel, K., Fitzpatrick, K. K., Vasey, M. W., & Richey, J. A. (2007). Anxiety sensitivity amelioration training (ASAT): A longitudinal primary prevention program targeting cognitive vulnerability. Journal of Anxiety Disorders, 21(3), 302-319.

  • Schmidt, N. B., Keough, M. E., Mitchell, M. A., Reynolds, E. K., MacPherson, L., Zvolensky, M. J., & Lejuez, C. W. (2010). Anxiety sensitivity: Prospective prediction of anxiety among early adolescents. Journal of Anxiety Disorders, 24(5), 503-508.

  • Schmidt, N. B., Lerew, D. R., & Jackson, R. J. (1997). The role of anxiety sensitivity in the pathogenesis of panic: Prospective evaluation of spontaneous panic attacks during acute stress. Journal of Abnormal Psychology, 106(3), 355-364.

  • Schmidt, N. B., Zvolensky, M. J., & Maner, J. K. (2006). Anxiety sensitivity: Prospective prediction of panic attacks and axis I pathology. Journal of Psychiatric Research, 40(8), 691-699.

  • Schneider, T. R., Lyons, J. B., & Khazon, S. (2013). Emotional intelligence and resilience. Personality and Individual Differences, 55, 909-914.

  • Schutte, N. S., & Malouff, J. M. (2002). Incorporating emotional skills content in a college transition course enhances student retention. Journal of the First-Year Experience & Students in Transition, 14, 7-21.

  • Schutte, N. S., & Malouff, J. M. (2011). Emotional intelligence mediates the relationship between mindfulness and subjective well-being. Personality and Individual Differences, 50(7), 1116-1119.

  • Schutte, N. S., Malouff, J. M., & Bhullar, N. (2009). The Assessing Emotions Scale. In C. Stough, D. Saklofske, & J. Parker (Eds.), The Assessment of emotional intelligence (pp. 119-135). New York, NY: Springer.

  • Schutte, N. S., Malouff, J. M., & Thorsteinsson, E. B. (2013). Increasing emotional intelligence through training: Current status and future directions. International Journal of Emotional Education, 5(1), 56-72.

  • Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York, NY: Guilford Press.

  • Sevdalis, N., Petrides, K. V., & Harvey, N. (2007). Trait emotional intelligence and decision-related emotions. Personality and Individual Differences, 42(7), 1347-1358.

  • Shallcross, A. J., Troy, A. S., Boland, M., & Mauss, I. B. (2010). Let it be: Accepting negative emotional experiences predicts decreased negative affect and depressive symptoms. Behaviour Research and Therapy, 48(9), 921-929.

  • Shea, S. E., & Coyne, L. W. (2011). Maternal dysphoric mood, stress, and parenting practices in mothers of head start preschoolers: The role of experiential avoidance. Child & Family Behavior Therapy, 33(3), 231-247.

  • Shostak, B. B., & Peterson, R. A. (1990). Effects of anxiety sensitivity on emotional response to a stress task. Behaviour Research and Therapy, 28(6), 513-521.

  • Slaski, M., & Cartwright, S. (2003). Emotional intelligence training and its implications for stress, health and performance. Stress and Health: Journal of the International Society for the Investigation of Stress, 19(4), 233-239.

  • Sloan, D. M. (2004). Emotion regulation in action: Emotional reactivity in experiential avoidance. Behaviour Research and Therapy, 42(11), 1257-1270.

  • Smits, J. A. J., Berry, A. C., Rosenfield, D., Powers, M. B., Behar, E., & Otto, M. W. (2008). Reducing anxiety sensitivity with exercise. Depression and Anxiety, 25(8), 689-699.

  • Smits, J. A. J., Berry, A. C., Tart, C. D., & Powers, M. B. (2008). The efficacy of cognitive-behavioral interventions for reducing anxiety sensitivity: A meta-analytic review. Behaviour Research and Therapy, 46(9), 1047-1054.

  • Smits, J. A. J., Tart, C. D., Presnell, K., Rosenfield, D., & Otto, M. W. (2010). Identifying potential barriers to physical activity adherence: Anxiety sensitivity and body mass as predictors of fear during exercise. Cognitive Behaviour Therapy, 39(1), 28-36.

  • Statistics Canada. (2012). Perceived life stress, 2011 (Catalogue # 82-625-XWE). Retrieved from

  • Steinman, S. A., & Teachman, B. A. (2010). Modifying interpretations among individuals high in anxiety sensitivity. Journal of Anxiety Disorders, 24(1), 71-78.

  • Stewart, S. H., Buffett-Jerrott, S., & Kokaram, R. (2001). Heartbeat awareness and heart rate reactivity in anxiety sensitivity: A further investigation. Journal of Anxiety Disorders, 15(6), 535-553.

  • Stewart, S. H., Peterson, J. B., & Pihl, R. O. (1995). Anxiety sensitivity and self-reported alcohol consumption rates in university women. Journal of Anxiety Disorders, 9, 283-292.

  • Tanay, G., Lotan, G., & Bernstein, A. (2012). Salutary proximal processes and distal mood and anxiety vulnerability outcomes of mindfulness training: A pilot preventive intervention. Behavior Therapy, 43, 492-505.

  • Taylor, S., Koch, W. J., & McNally, R. J. (1992). How does anxiety sensitivity vary across the anxiety disorders? Journal of Anxiety Disorders, 6(3), 249-259.

  • Tedeschi, R. G., & Kilmer, R. P. (2005). Assessing strengths, resilience, and growth to guide clinical interventions. Professional Psychology, Research and Practice, 36(3), 230-237.

  • Telch, M. J., Rosenfield, D., Lee, H.-J., & Pai, A. (2012). Emotional reactivity to a single inhalation of 35% carbon dioxide and its association with later symptoms of posttraumatic stress disorder and anxiety in soldiers deployed to Iraq. JAMA Psychiatry, 69(11), 1161-1168.

  • Telman, M. D., Holmes, E. A., & Lau, J. Y. F. (2013). Modifying adolescent interpretation biases through cognitive training: Effects on negative affect and stress appraisals. Child Psychiatry and Human Development, 44, 602-611.

  • Thompson, T., Keogh, E., French, C. C., & Davis, R. (2008). Anxiety sensitivity and pain: Generalisability across noxious stimuli. Pain, 134(1-2), 187-196.

  • Tull, M. T., & Gratz, K. L. (2008). Further examination of the relationship between anxiety sensitivity and depression: The mediating role of experiential avoidance and difficulties engaging in goal-directed behavior when distressed. Journal of Anxiety Disorders, 22(2), 199-210.

  • Ugoji, N. (2012). Perceived emotional intelligence and stress management among undergraduate students. IFE Psychologia: An International Journal, 20(2), 148-155.

  • Velten, E. (1968). A laboratory task for induction of mood states. Behaviour Research and Therapy, 6(4), 473-482.

  • Vollrath, M. (2001). Personality and stress. Scandinavian Journal of Psychology, 42, 335-347.

  • Vujanovic, A. A., Bernstein, A., Berenz, E. C., & Zvolensky, M. J. (2012). Single-session anxiety sensitivity reduction program for trauma-exposed adults: A case series documenting feasibility and initial efficacy. Behavior Therapy, 43(3), 482-491.

  • Wagner, S. L., & Martin, C. A. (2012). Can firefighters’ mental health be predicted by emotional intelligence and proactive coping? Journal of Loss and Trauma, 17(1), 56-72.

  • Wang, P., Michaels, C. A., & Day, M. S. (2011). Stresses and coping strategies of Chinese families with children with autism and other developmental disabilities. Journal of Autism and Developmental Disorders, 41(6), 783-795.

  • Wegner, D. M., Schneider, D. J., Carter, S. R., & White, T. L. (1987). Paradoxical effects of thought suppression. Journal of Personality and Social Psychology, 53, 5-13.

  • Weinrib, A. Z. (2011). Investigating experiential avoidance as a mechanism of action in a mindfulness intervention (Doctoral dissertation). Available from ProQuest Dissertations and Theses database. (UMI No. 3461426)

  • Wheaton, M. G., Mahaffey, B., Timpano, K. R., Berman, N. C., & Abramowitz, J. S. (2012). The relationship between anxiety sensitivity and obsessive-compulsive symptom dimensions. Journal of Behavior Therapy and Experimental Psychiatry, 43(3), 891-896.

  • Whittingham, K., Wee, D., Sanders, M. R., & Boyd, R. (2013). Predictors of psychological adjustment, experienced parenting burden and chronic sorrow symptoms in parents of children with cerebral palsy. Child: Care, Health and Development, 39(3), 366-373.

  • Wilson, V. R. (2012). Attachment, experiential avoidance, and mindfulness in the narrative disclosure task (Doctoral dissertation). Available from ProQuest Dissertations and Theses database. (UMI No. 3500656)

  • Wing, J. F., Schutte, N. S., & Byrne, B. (2006). The effect of positive writing on emotional intelligence and life satisfaction. Journal of Clinical Psychology, 62(10), 1291-1302.

  • Wolitzky-Taylor, K. B., Arch, J. J., Rosenfield, D., & Craske, M. G. (2012). Moderators and non-specific predictors of treatment outcome for anxiety disorders: A comparison of cognitive behavioral therapy to acceptance and commitment therapy. Journal of Consulting and Clinical Psychology, 80(5), 786-799.

  • Wong, C.-S., & Law, K. S. (2002). The effects of leader and follower emotional intelligence on performance and attitude: An exploratory study. The Leadership Quarterly, 13(3), 243-274.

  • Wu, G., Feder, A., Cohen, H., Kim, J. J., Calderon, S., Charney, D. S., & Mathé, A. A. (2013). Understanding resilience. Frontiers in Behavioral Neuroscience, 7, Article 10.

  • Zeidner, M., Matthews, G., & Roberts, R. D. (2012). The emotional intelligence, health, and well-being nexus: What have we learned and what have we missed? Applied Psychology: Health and Well-Being, 4(1), 1-30.

  • Zettle, R. D. (2003). Acceptance and commitment therapy (ACT) vs. systematic desensitization in treatment of mathematics anxiety. The Psychological Record, 53, 197-215.

  • Zunhammer, M., Eberle, H., Eichhammer, P., & Busch, V. (2013). Somatic symptoms evoked by exam stress in university students: The role of alexithymia, neuroticism, anxiety and depression. PLoS ONE, 8(12), e84911.

  • Zvolensky, M. J., Goodie, J. L., Ruggiero, K. J., Black, A. L., Larkin, K. T., & Taylor, B. K. (2002). Perceived stress and anxiety sensitivity in the prediction of anxiety-related responding: A multichallenge evaluation. Anxiety, Stress, and Coping, 15(3), 211-229.

About the Authors

Kenneth Choi is presently completing a B.Eng in Chemical Engineering at Ryerson University. He discovered his interest for Psychology through an introductory undergraduate course, and this passion has continued to flourish as a member of Dr. Kristin Vickers’ lab. He is currently involved in research that explores distractions in academic classrooms and serves as research assistant for a study of neurocognition in OCD.

Kristin Vickers is an associate professor in Psychology at Ryerson University. Her research focuses on the anxiety disorder area, with a specific emphasis on understanding the causes and correlates of unexpected panic attacks. Her enthusiasm for research in this area was incited early in graduate school as she sat in a course on Anxiety Disorders taught by her graduate school adviser, Dr. Richard J. McNally. She is also interested in furthering understanding of risk and resilience factors in stress responses through the biological provocation of stress.

Adrianna Tassone is a third year Psychology undergraduate student at Ryerson University. She is engaged in on-going psychological research at the university, from arranging fieldwork to data inputing and analysis.