Top

Journal of Rational-Emotive & Cognitive-Behavior Therapy

Gepubliceerd in:

01-03-2025

Anxiety and Experiential Avoidance Among University Students: The Serial Mediating Role of Optimism and Self-Compassion

Auteurs: Faruk Caner YAM, Burak KÖKSAL, Oğuzhan YILDIRIM

Gepubliceerd in: Journal of Rational-Emotive & Cognitive-Behavior Therapy | Uitgave 1/2025

Abstract

This research aims to investigate the serial mediating role of optimism and self-compassion between anxiety and experiential avoidance among university students. A total of 411 university students participated in the research, with 263 (64%) being female and 148 (36%) being male. According to the results of the mediation analysis, it was seen that both optimism and self-compassion had mediating roles in the relationship between anxiety and experiential avoidance. In addition, it was concluded that the serial mediating role of optimism and self-compassion in the relationship between anxiety and experiential avoidance was significant. The mediation findings obtained in the study reveal that high levels of optimism and self-compassion in university students can help them cope better with anxious situations, reduce their anxiety levels, and therefore reduce experiential avoidance tendencies. This study highlights significant findings regarding the mechanism underlying the relationship between anxiety and experiential avoidance, particularly concerning positive variables.

volgende artikel CANCER. Is this Forever? Examining the Relationship Between Event Centrality and Fear of Cancer Recurrence from a Cognitive-Behavioral Standpoint

Arimitsu, K. (2016). The effects of a program to enhance self-compassion in Japanese individuals: A randomized controlled pilot study. The Journal of Positive Psychology, 11(6), 559–571. https://doi.org/10.1080/17439760.2016.1152593CrossRef

Auerbach, R. P., Mortier, P., Bruffaerts, R., Alonso, J., Benjet, C., Cuijpers, P., Demyttenaere, K., Ebert, D. D., Green, J. G., & Hasking, P. (2018). WHO World Mental Health Surveys International College Student Project: Prevalence and distribution of mental disorders. Journal of Abnormal Psychology, 127(7), 623–638. https://doi.org/10.1037/abn0000362CrossRefPubMedPubMedCentral

Baker, D. A., Caswell, H. L., & Eccles, F. J. (2019). Self-compassion and depression, anxiety, and resilience in adults with epilepsy. Epilepsy & Behavior, 90, 154–161. https://doi.org/10.1016/j.yebeh.2018.11.025CrossRef

Bandelow, B., & Michaelis, S. (2015). Epidemiology of anxiety disorders in the 21st century. Dialogues in Clinical Neuroscience, 17(3), 327–335. https://doi.org/10.31887/dcns.2015.17.3/bbandelowCrossRefPubMedPubMedCentral

Bardeen, J. R., & Fergus, T. A. (2016). The interactive effect of cognitive fusion and experiential avoidance on anxiety, depression, stress and posttraumatic stress symptoms. Journal of Contextual Behavioral Science, 5(1), 1–6. https://doi.org/10.1016/j.jcbs.2016.02.002CrossRef

Baxter, A. J., Vos, T., Scott, K. M., Ferrari, A. J., & Whiteford, H. A. (2014). The global burden of anxiety disorders in 2010. Psychological Medicine, 44(11), 2363–2374. https://doi.org/10.1017/s0033291713003243CrossRefPubMed

Beiter, R., Nash, R., McCrady, M., Rhoades, D., Linscomb, M., Clarahan, M., & Sammut, S. (2015). The prevalence and correlates of depression, anxiety, and stress in a sample of college students. Journal of Affective Disorders, 173, 90–96. https://doi.org/10.1016/j.jad.2014.10.054CrossRefPubMed

Biber, D. D., Melton, B., & Czech, D. R. (2022). The impact of COVID-19 on college anxiety, optimism, gratitude, and course satisfaction. Journal of American College Health, 70(7), 1947–1952. https://doi.org/10.1080/07448481.2020.1842424CrossRefPubMed

Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., & Zettle, R. D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire–II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42(4), 676–688. https://doi.org/10.1016/j.beth.2011.03.007CrossRefPubMed

Çalışkan, H., & Uzunkol, E. (2018). Developing an Optimism-Pessimism Scale in adolescents: Validity and reliability study. The Journal of Happiness & Well-Being, 6(2), 78–95.

Carver, C. S., & Scheier, M. (2017). Optimism, Coping, and Well‐Being. In C. L. Cooper & J. C. Quick (Eds.), The Handbook of Stress and Health: A Guide to Research and Practice (pp. 400–414). Haboken: Wiley. https://doi.org/10.1002/9781118993811.ch24CrossRef

Carver, C. S., Scheier, M. F., & Segerstrom, S. C. (2010). Optimism. Clinical Psychology Review, 30(7), 879–889. https://doi.org/10.1016/j.cpr.2010.01.006CrossRefPubMedPubMedCentral

Chawla, N., & Ostafin, B. (2007). Experiential avoidance as a functional dimensional approach to psychopathology: An empirical review. Journal of Clinical Psychology, 63(9), 871–890. https://doi.org/10.1002/jclp.20400CrossRefPubMed

Craske, M. G., Kircanski, K., Zelikowsky, M., Mystkowski, J., Chowdhury, N., & Baker, A. (2008). Optimizing inhibitory learning during exposure therapy. Behaviour Research and Therapy, 46(1), 5–27. https://doi.org/10.1016/j.brat.2007.10.003CrossRefPubMed

Çutuk, Z. A. (2021). Mediating role of optimism in the relationship between self-compassion and subjective well-being. Journal of Human Sciences, 18(2), 185–198. https://doi.org/10.14687/jhs.v18i2.6139CrossRef

de Souza, L. K., Policarpo, D., & Hutz, C. S. (2020). Self-compassion and Symptoms of Stress, Anxiety, and Depression. Trends in Psychology, 28(1), 85–98. https://doi.org/10.1007/s43076-020-00018-2CrossRef

Dewberry, C., & Richardson, S. (1990). Effect of anxiety on optimism. The Journal of Social Psychology, 130(6), 731–738. https://doi.org/10.1080/00224545.1990.9924625CrossRefPubMed

Duffy, M. E., Twenge, J. M., & Joiner, T. E. (2019). Trends in mood and anxiety symptoms and suicide-related outcomes among US undergraduates, 2007–2018: Evidence from two national surveys. Journal of Adolescent Health, 65(5), 590–598. https://doi.org/10.1016/j.jadohealth.2019.04.033CrossRef

Egan, S. J., Rees, C. S., Delalande, J., Greene, D., Fitzallen, G., Brown, S., Webb, M., & Finlay-Jones, A. (2022). A Review of Self-Compassion as an Active Ingredient in the Prevention and Treatment of Anxiety and Depression in Young People. Administration and Policy in Mental Health and Mental Health Services Research, 49(3), 385–403. https://doi.org/10.1007/s10488-021-01170-2CrossRefPubMed

Eifert, G. H., & Forsyth, J. P. (2005). Acceptance and commitment therapy for anxiety disorders: A practitioner’s treatment guide to using mindfulness, acceptance, and values-based behavior change. Oakland: New Harbinger Publications.

Farr, J., Ononaiye, M., & Irons, C. (2021). Early shaming experiences and psychological distress: The role of experiential avoidance and self-compassion. Psychology and Psychotherapy: Theory, Research and Practice, 94(4), 952–972. https://doi.org/10.1111/papt.12353CrossRef

Ferguson, S. J., & Goodwin, A. D. (2010). Optimism and well-being in older adults: The mediating role of social support and perceived control. The International Journal of Aging and Human Development, 71(1), 43–68. https://doi.org/10.2190/AG.71.1.cCrossRefPubMed

Ferreira, C., Pinto-Gouveia, J., & Duarte, C. (2013). Self-compassion in the face of shame and body image dissatisfaction: Implications for eating disorders. Eating Behaviors, 14(2), 207–210. https://doi.org/10.1016/j.eatbeh.2013.01.005CrossRefPubMed

Forgeard, M. J., & Seligman, M. E. (2012). Seeing the glass half full: A review of the causes and consequences of optimism. Pratiques Psychologiques, 18(2), 107–120. https://doi.org/10.1016/j.prps.2012.02.002CrossRef

Fowler, S. L., & Geers, A. L. (2015). Dispositional and comparative optimism interact to predict avoidance of a looming health threat. Psychology & Health, 30(4), 456–474. https://doi.org/10.1080/08870446.2014.977282CrossRef

Gaibor-González, I., & Moreta-Herrera, R. (2020). Dispositional optimism anxiety depression and stress in a sample of Ecuador Inter-gender and prediction analysis. Actualidades En Psicología, 34(129), 17–31. https://doi.org/10.15517/ap.v34i129.35148CrossRef

Gibbons, C. (2023). Untangling the role of optimism, pessimism and coping influences on student mood, motivation and satisfaction. Innovations in Education and Teaching International. https://doi.org/10.1080/14703297.2023.2260780CrossRef

Golestanibakht, T., Babaie, E., Karimi, M., & Ahmadi, A. (2022). The Relationship between self-compassion and optimism in students: The Mediating role of social adjustment. Social Psychology Research, 12(45), 65–84. https://doi.org/10.22034/spr.2022.314005.1699CrossRef

Grunberg, V. A., Bakhshaie, J., Manglani, H., Hooker, J., Rochon, E. A., & Vranceanu, A. M. (2024). Mindfulness, coping, and optimism as mechanisms of change in the 3RP-NF intervention. Journal of Clinical Psychology, 80(2), 456–470. https://doi.org/10.1002/jclp.23623CrossRefPubMed

Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York: Guilford Press.

Hayes, A. F. (2018). Partial, conditional, and moderated moderated mediation: Quantification, inference, and interpretation. Communication Monographs, 85(1), 4–40. https://doi.org/10.1080/03637751.2017.1352100CrossRef

Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1–25. https://doi.org/10.1016/j.brat.2005.06.006CrossRefPubMed

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(6), 1152–1168. https://doi.org/10.1037/0022-006x.64.6.1152CrossRefPubMed

He, F., Cao, R., Feng, Z., Guan, H., & Peng, J. (2013). The impacts of dispositional optimism and psychological resilience on the subjective well-being of burn patients: A structural equation modelling analysis. PLoS ONE, 8(12), e82939. https://doi.org/10.1371/journal.pone.0082939CrossRefPubMedPubMedCentral

Hendriks, S. M., Spijker, J., Licht, C. M., Hardeveld, F., Graaf, R., Batelaan, N. M., Penninx, B. W., & Beekman, A. T. (2016). Long-term disability in anxiety disorders. BMC Psychiatry, 16(1), 1–8. https://doi.org/10.1186/s12888-016-0946-yCrossRef

Henry, J. D., & Crawford, J. R. (2005). The short- form version of the Depression Anxiety Stress Scales (DASS- 21): Construct validity and normative data in a large non- clinical sample. British Journal of Clinical Psychology, 44(2), 227–239. https://doi.org/10.1348/014466505X29657CrossRefPubMed

Icekson, T., Roskes, M., & Moran, S. (2014). Effects of optimism on creativity under approach and avoidance motivation. Frontiers in Human Neuroscience, 8, 105. https://doi.org/10.3389/fnhum.2014.00105CrossRefPubMedPubMedCentral

Kashdan, T. B., Barrios, V., Forsyth, J. P., & Steger, M. F. (2006). Experiential avoidance as a generalized psychological vulnerability: Comparisons with coping and emotion regulation strategies. Behaviour Research and Therapy, 44(9), 1301–1320. https://doi.org/10.1016/j.brat.2005.10.003CrossRefPubMed

Kessler, R. C., Ruscio, A. M., Shear, K., & Wittchen, H. U. (2010). Epidemiology of anxiety disorders. Behavioral Neurobiology of Anxiety and Its Treatment. https://doi.org/10.1007/7854_2009_9CrossRef

Keyte, R., Mullis, L., Egan, H., Hussain, M., Cook, A., & Mantzios, M. (2021). Self-compassion and instagram use is explained by the relation to anxiety, depression, and stress. Journal of Technology in Behavioral Science, 6(2), 436–441. https://doi.org/10.1007/s41347-020-00186-zCrossRef

Konnopka, A., & König, H. (2020). Economic burden of anxiety disorders: A systematic review and meta-analysis. PharmacoEconomics, 38(1), 25–37. https://doi.org/10.1007/s40273-019-00849-7CrossRefPubMed

Krypel, M. N., & Henderson-King, D. (2010). Stress, coping styles, and optimism: Are they related to meaning of education in students’ lives? Social Psychology of Education, 13, 409–424. https://doi.org/10.1007/s11218-010-9132-0CrossRef

Leary, M. R., Tate, E. B., Adams, C. E., Batts Allen, A., & Hancock, J. (2007). Self-compassion and reactions to unpleasant self-relevant events: The implicatio’ns of treating oneself kindly. Journal of Personality and Social Psychology, 92(5), 887–904. https://doi.org/10.1037/0022-3514.92.5.887CrossRefPubMed

Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33(3), 335–343. https://doi.org/10.1016/0005-7967(94)00075-UCrossRefPubMed

Luoma, J. B., Hayes, S. C., & Walser, R. D. (2007). Learning ACT: An acceptance & commitment therapy skills-training manual for therapists. Oakland: New Harbinger Publications.

MacBeth, A., & Gumley, A. (2012). Exploring compassion: A meta-analysis of the association between self-compassion and psychopathology. Clinical Psychology Review, 32(6), 545–552. https://doi.org/10.1016/j.cpr.2012.06.003CrossRefPubMed

Mahoney, C. T., Segal, D. L., & Coolidge, F. L. (2015). Anxiety sensitivity, experiential avoidance, and mindfulness among younger and older adults: Age differences in risk factors for anxiety symptoms. The International Journal of Aging and Human Development, 81(4), 217–240. https://doi.org/10.1177/0091415015621309CrossRefPubMed

Martínez-Moreno, A., Ibáñez-Pérez, R. J., Cavas-García, F., & Cano-Noguera, F. (2020). Older adults’ gender, age and physical activity effects on anxiety, optimism, resilience and engagement. International Journal of Environmental Research and Public Health, 17(20), 7561–7576. https://doi.org/10.3390/ijerph17207561CrossRefPubMedPubMedCentral

Martínez-Rubio, D., Colomer-Carbonell, A., Sanabria-Mazo, J. P., Pérez-Aranda, A., Navarrete, J., Martínez-Brotóns, C., & Feliu-Soler, A. (2023). How mindfulness, self-compassion, and experiential avoidance are related to perceived stress in a sample of university students. PLoS ONE, 18(2), e0280791. https://doi.org/10.1371/journal.pone.0280791CrossRefPubMedPubMedCentral

Masuda, A., & Tully, E. C. (2012). The Role of Mindfulness and Psychological Flexibility in Somatization, Depression, Anxiety, and General Psychological Distress in a Nonclinical College Sample. Journal of Evidence-Based Complementary & Alternative Medicine, 17(1), 66–71. https://doi.org/10.1177/2156587211423400CrossRef

Neff, K. D. (2003a). The development and validation of a scale to measure selfcompassion. Self and Identity, 2(3), 223–250. https://doi.org/10.1080/15298860309027CrossRef

Neff, K. D. (2003b). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2(2), 85–102. https://doi.org/10.1080/15298860309032CrossRef

Neff, K. D., Hsieh, Y.-P., & Dejitterat, K. (2005). Self-compassion, achievement goals, and coping with academic failure. Self and Identity, 4(3), 263–287. https://doi.org/10.1080/13576500444000317CrossRef

Neff, K. D., Kirkpatrick, K. L., & Rude, S. S. (2007a). Self-compassion and adaptive psychological functioning. Journal of Research in Personality, 41(1), 139–154. https://doi.org/10.1016/j.jrp.2006.03.004CrossRef

Neff, K. D., Rude, S. S., & Kirkpatrick, K. L. (2007b). An examination of self-compassion in relation to positive psychological functioning and personality traits. Journal of Research in Personality, 41(4), 908–916. https://doi.org/10.1016/j.jrp.2006.08.002CrossRef

Nes, L. S., & Segerstrom, S. C. (2006). Dispositional optimism and coping: A meta-analytic review. Personality and Social Psychology Review, 10(3), 235–251. https://doi.org/10.1207/s15327957pspr1003_3CrossRefPubMed

Pavani, J. B., & Colombo, D. (2023). Appreciation and rumination, not problem solving and avoidance, mediate the effect of optimism on emotional wellbeing. Personality and Individual Differences, 205, 112094. https://doi.org/10.1016/j.paid.2023.112094CrossRef

Raes, F. (2010). Rumination and worry as mediators of the relationship between self-compassion and depression and anxiety. Personality and Individual Differences, 48(6), 757–761. https://doi.org/10.1016/j.paid.2010.01.023CrossRef

Raes, F., Pommier, E., Neff, K. D., & Van Gucht, D. (2011). Construction and factorial validation of a short form of the self-compassion scale. Clinical Psychology & Psychotherapy, 18(3), 250–255. https://doi.org/10.1002/cpp.702CrossRef

Sadock, B. J., & Sadock, V. A. (2008). Kaplan & Sadock’s concise textbook of clinical psychiatry. Philadelphia: Lippincott Williams & Wilkins.

Segerstrom, S. C., Carver, C. S., & Scheier, M. F. (2017). Optimism. In M. D. Robinson & M. Eid (Eds.), The happy mind: Cognitive contributions to well-Being (pp. 195–215). Cham: Springer International Publishing.CrossRef

Sheldon, E., Simmonds-Buckley, M., Bone, C., Mascarenhas, T., Chan, N., Wincott, M., & Barkham, M. (2021). Prevalence and risk factors for mental health problems in university undergraduate students: A systematic review with meta-analysis. Journal of Affective Disorders, 287, 282–292. https://doi.org/10.1016/j.jad.2021.03.054CrossRefPubMed

Soltani, E., Hosseini, Z., & Naghizadeh, P. (2018). Relationship between experiential avoidance and cognitive fusion to Social Interaction Anxiety in Students. Shiraz E-Medical Journal. https://doi.org/10.5812/semj.62496CrossRef

Srivastava, S., & Angelo, K. M. (2009). Optimism, effects on relationships. In H. T. Reis & S. K. Sprecher (Eds.), Encyclopedia of human relationships. Tousand Oaks: Sage.

Tabachnick, B. G., Fidell, L. S., & Ullman, J. B. (2013). Using multivariate statistics (Vol. 6, pp. 497–516). MA: Pearson.

Venta, A., Sharp, C., & Hart, J. (2012). The relation between anxiety disorder and experiential avoidance in inpatient adolescents. Psychological Assessment, 24(1), 240–248. https://doi.org/10.1037/a0025362CrossRefPubMed

World Health Organization (WHO). (2022). Mental disorders. Retrieved January 11, 2024. https://www.who.int/news-room/fact-sheets/detail/mental-disorders.

Yavuz, F., Ulusoy, S., Iskin, M., Esen, F. B., Burhan, H. S., Karadere, M. E., & Yavuz, N. (2016). Turkish version of Acceptance and Action Questionnaire-II (AAQ-II): A reliability and validity analysis in clinical and non-clinical samples. Bulletin of Clinical Psychopharmacology, 26(4), 397–408. https://doi.org/10.5455/bcp.20160223124107CrossRef

Yela, J. R., Crego, A., Buz, J., Sánchez-Zaballos, E., & Gómez-Martínez, M. Á. (2022). Reductions in experiential avoidance explain changes in anxiety, depression and well-being after a mindfulness and self-compassion (MSC) training. Psychology and Psychotherapy: Theory, Research and Practice, 95(2), 402–422. https://doi.org/10.1111/papt.12375CrossRef

Yıldırım, M., & Sarı, T. (2018). Adaptation of the short form of self-compassıon scale into Turkish: A validıiy and reliability study. Abant İzzet Baysal Üniversitesi Eğitim Fakültesi Dergisi, 18(4), 2502–2517.CrossRef

Yılmaz, Ö., Boz, H., & Arslan, A. (2017). THE validity and reliability of depression stress and anxıety scale (dass21) Turkish short form. Finans Ekonomi Ve Sosyal Araştırmalar Dergisi, 2(2), 78–91.

Zessin, U., Dickhäuser, O., & Garbade, S. (2015). The relationship between self-compassion and well-being: A meta-analysis. Applied Psychology: Health and Well-Being, 7(3), 340–364. https://doi.org/10.1111/aphw.12051CrossRefPubMed

Titel: Anxiety and Experiential Avoidance Among University Students: The Serial Mediating Role of Optimism and Self-Compassion
Auteurs: Faruk Caner YAM
Burak KÖKSAL
Oğuzhan YILDIRIM
Publicatiedatum: 01-03-2025
Uitgeverij: Springer US
Gepubliceerd in: Journal of Rational-Emotive & Cognitive-Behavior Therapy / Uitgave 1/2025
Print ISSN: 0894-9085
Elektronisch ISSN: 1573-6563
DOI: https://doi.org/10.1007/s10942-024-00564-z

Andere artikelen Uitgave 1/2025

CANCER. Is this Forever? Examining the Relationship Between Event Centrality and Fear of Cancer Recurrence from a Cognitive-Behavioral Standpoint

Open Access

Social Support and Flourishing Among Adolescents: The Multiple Mediating Roles of Self-Compassion and Sense of Coherence

From Hero to Zero: A Serial Mediation Model Between Narcissistic Perfectionism and Psychological Distress

Perfectionism and Suicidal Ideation in Outpatient Depressed Adults: The Moderating Role of Self-Esteem, Loneliness and Rumination

Open Access

REBT and the Treatment of Emotional Disturbance Related to Estrangement from Adult Children

Thought-Action Fusion Associated with Obsessive–Compulsive Symptomatology in OCD Patients: The Pathways from Experiential Avoidance, Thought Suppression, and Depression

Bohn Stafleu van Loghum

Welkom bij THIM Hogeschool voor Fysiotherapie & Bohn Stafleu van Loghum

Registreer

Login

Anxiety and Experiential Avoidance Among University Students: The Serial Mediating Role of Optimism and Self-Compassion

Abstract

Andere artikelen Uitgave 1/2025

CANCER. Is this Forever? Examining the Relationship Between Event Centrality and Fear of Cancer Recurrence from a Cognitive-Behavioral Standpoint

Social Support and Flourishing Among Adolescents: The Multiple Mediating Roles of Self-Compassion and Sense of Coherence

From Hero to Zero: A Serial Mediation Model Between Narcissistic Perfectionism and Psychological Distress

Perfectionism and Suicidal Ideation in Outpatient Depressed Adults: The Moderating Role of Self-Esteem, Loneliness and Rumination

REBT and the Treatment of Emotional Disturbance Related to Estrangement from Adult Children

Thought-Action Fusion Associated with Obsessive–Compulsive Symptomatology in OCD Patients: The Pathways from Experiential Avoidance, Thought Suppression, and Depression

Bohn Stafleu van Loghum

Welkom bij THIM Hogeschool voor Fysiotherapie & Bohn Stafleu van Loghum

Registreer

Login

Deel dit onderdeel of sectie (kopieer de link)

Abstract

Log in om toegang te krijgen

CANCER. Is this Forever? Examining the Relationship Between Event Centrality and Fear of Cancer Recurrence from a Cognitive-Behavioral Standpoint

Social Support and Flourishing Among Adolescents: The Multiple Mediating Roles of Self-Compassion and Sense of Coherence

From Hero to Zero: A Serial Mediation Model Between Narcissistic Perfectionism and Psychological Distress

Perfectionism and Suicidal Ideation in Outpatient Depressed Adults: The Moderating Role of Self-Esteem, Loneliness and Rumination

REBT and the Treatment of Emotional Disturbance Related to Estrangement from Adult Children

Thought-Action Fusion Associated with Obsessive–Compulsive Symptomatology in OCD Patients: The Pathways from Experiential Avoidance, Thought Suppression, and Depression