Approach-Avoidance Attitudes Associated with Initial Therapy Appointment Attendance: A Prospective Study.

BACKGROUND: Initial therapy appointments have high nonattendance rates yet the reasons remain poorly understood. AIMS: This study aimed to identify positive and negative attitudes towards therapy that predicted initial attendance, informed by a perceptual control theory account of approach-avoidance conflicts in help-seeking. METHOD: A prospective study was conducted within a low intensity CBT service using first appointment attendance (n = 96) as an outcome. Measures included attitudes towards therapy, depression and anxiety scales, and demographic variables. RESULTS: Endorsement of a negative attitude item representing concern about self-disclosure was independently predictive of nonattendance. Positive attitudes predicted increased attendance, especially endorsement of motives for self-reflection, but only among less depressed individuals. CONCLUSIONS: Self-disclosure concerns contribute to therapy avoidance and having goals for self-reflection may represent approach motivation for therapy; however, the latter has less impact among more highly depressed people.

Pilot study of an investigation of psychological factors associated with first appointment nonattendance in a low-intensity service.

BACKGROUND: Nonattendance rates remain high for first therapy appointments, despite initiatives to increase access to psychological therapy. The reasons for nonattendance are poorly understood and studies of demographic and clinical predictors have produced conflicting findings. AIMS: We aimed to pilot a method for investigating psychological factors associated with first appointment attendance in a primary care mental health service. METHOD: Questionnaires were completed by individuals at the point of referral to CBT with a low-intensity service in one general practice (n = 67), including a measure of beliefs, goals and attitudes towards therapy, as well as anxiety and depression scales. Subsequent attendance at the first appointment was used as an outcome. RESULTS: Preliminary results showed that attendance was not associated with age or gender, severity of distress, or overall ratings for positive or negative attitudes towards therapy; although distress itself was associated with increased endorsement of negative attitudes. However, one specific psychological item, "Talking to a therapist will help me understand better how my mind works" had a significant association with subsequent attendance. CONCLUSIONS: The psychological factor that was associated with increased attendance may reflect the concept of psychological mindedness; however, this requires replication in a larger study. A full-scale study was deemed to be warranted based on this prospective design.