title: Approach-Avoidance Attitudes Associated with Initial Therapy Appointment Attendance: A Prospective Study.
abstract: BACKGROUND
  Initial therapy appointments have high nonattendance rates yet the reasons remain poorly understood.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: University of Manchester,UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Murphy
authors.affiliation: University of Manchester,UK.
authors.forename: Warren
authors.initials: W
authors.lastname: Mansell
authors.affiliation: University of Manchester,UK.
authors.forename: Sally
authors.initials: S
authors.lastname: Craven
authors.affiliation: Six Degrees Social Enterprise CIC,Salford,UK.
authors.forename: Phil
authors.initials: P
authors.lastname: McEvoy
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000523:psychology / Q000628:therapy; D001071:Appointments and Schedules; D001362:Avoidance Learning; D015928:Cognitive Behavioral Therapy; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D000067455:No-Show Patients / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011446:Prospective Studies; D012650:Self Disclosure; D011795:Surveys and Questionnaires
keywords: IAPT; Nonattendance; attitudes; cognitive behavioural therapy; control theory