Academic journal article The International Journal of Behavioral Consultation and Therapy

Measuring Avoidance and Inflexibility in Weight Related Problems

Academic journal article The International Journal of Behavioral Consultation and Therapy

Measuring Avoidance and Inflexibility in Weight Related Problems

Article excerpt

When confronted with difficult thoughts and feelings, some people tend to try and change or avoid these private experiences in an effort to regulate behavior. There is a growing body of evidence that suggests that this process of experiential avoidance is central in the development of a range of mental health and behavioral health problems (Hayes, Luoma, Bond, Masuda & Lillis, 2006; Hayes, Strosahl, Wilson, Bissett, Pistorello et al., 2004; Hayes, Wilson, Gifford, Follette, & Strosahl, 1996).

A number of the newer cognitive behavioral approaches to treatment such as Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999), Mindfulness Based Cognitive Therapy (Segal, Williams, and Teasdale, 2002), and Dialectical Behavior Therapy (Linehan, 1993) directly target experiential avoidance by seeking to alter clients' relationship to difficult thoughts and feelings. In ACT, for example, clients are taught to be more accepting of emotions, defused from thoughts, and more flexibly engaged in valued-based action even when these experiences are encountered. This explicitly functional approach has resulted in positive outcomes across a range of clinical presentations, such as affective disorders (Zettle & Hayes, 1986; Zettle & Rains, 1989), anxiety disorders (Twohig & Woods, 2004; Zettle, 2003), substance abuse (Hayes, Wilson et al., 2004), psychotic disorders (Bach & Hayes, 2002), and others (for recent reviews, see Hayes, Masuda, Bissett, Luoma, & Guerrero, 2004 or Hayes et al., 2006).

The most commonly used general measure of experiential avoidance is the Acceptance and Action Questionnaire (AAQ; Hayes et al., 2004). A recent meta-analysis of correlational studies using the AAQ found that across several thousand participants and scores of studies, the AAQ correlated between .4 and .5 with a wide variety of behavioral health problems (Hayes et al., 2006). Despite the fact that the primary version of the AAQ yields a single factor (Hayes et al., 2004), it contains a variety of different items as its very name (acceptance and action) suggests. Some target emotional acceptance or avoidance; others address the tendency to become entangled with thoughts, to take them literally, or conversely to see them simply as thoughts; still others asks about the ability to take values-based actions in the present of difficult thoughts or the tendency to become inactive or avoidant behaviorally. As a result, while the AAQ and related instruments are sometimes described simply as measures of experiential avoidance, they are increasingly being described as measures of "avoidance and inflexibility" (Gifford, Kohlenberg, Hayes et al., 2004), or "psychological flexibility" (Hayes, Luoma, Bond, Masuda & Lillis, 2006).

The AAQ is a broad measure, and the specific emotions addressed are anxiety and depression. This leads to problems when the AAQ is used as a measure of processes of change, particularly when specific problems are targeted. Previous research with health problems in particular has found that mediation of the impact of specific ACT protocols is better assessed by modifying the general AAQ to target the specific area. For example, a smoking specific measure of avoidance and inflexibility mediated outcomes in a recent trial of ACT for smoking as compared to Nicotine Replacement Therapy, which the general AAQ did not (Gifford et al., 2004). Similar results were found for a diabetes-specific version of the AAQ in a randomized trial of ACT for Type II diabetes management (Gregg, Callaghan, Hayes, & GlennLawson, 2007), and for an epilepsy specific version of the AAQ in a randomized trial of ACT for seizure management (Lundgren, Dahl, & Hayes, in press).

The current study presents a new measure of avoidance and inflexibility in relation to weight-related thoughts and feelings. Research has shown that individuals who are unable to maintain weight loss tend use avoidant (Byrne, Cooper, & Fairburn,2003; Kayman, Bruvold, & Stern, 1990) or impulsive styles of coping (Fassino, Leombruni, Piero et al. …

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