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Avoidant Automatic Thoughts are Associated with Task Avoidance and Inattention in the Moment

Cognitive Therapy and Research (2023)Cite this article

Abstract

Purpose

Research and clinical attention in psychology has focused heavily on negative automatic thoughts and their role in symptoms of psychopathology and maladaptive behavior; however, the role of thoughts that appear to be overly positive in content has received much less attention. Recent work in the cognitive-behavioral treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) has identified overly positive thoughts that may be associated with avoidance and functional impairment.

Method

We defined, described, and measured Avoidant Automatic Thoughts (AAT) in the daily lives of 101 undergraduate students using ecological momentary assessment and tested hypotheses about the association of these thoughts with ADHD symptoms and in-the-moment avoidance and negative emotion. Data were collected at baseline and up to three times per day for six days and analyzed using multilevel modeling.

Results

We found that AAT were frequent daily occurrences for the undergraduates in our sample and that recent presence of AAT was associated with greater task avoidance and inattentive symptoms at the momentary level. AAT were not, however, associated with momentary negative emotion. Participants’ general level of ADHD symptoms predicted greater momentary AAT, task avoidance, negative emotion and negative thoughts and less positive emotion.

Conclusions

This study introduces AAT as a construct with potential research and clinical utility for understanding, predicting, and intervening in problematic avoidance behaviors that reduce people’s quality of life and prevent them from reaching their meaningful goals.

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Notes

  1. By spontaneous we are not implying that automatic thoughts arise without any perceived relevance to current experience or the task at hand, which is how the term spontaneous is sometimes used in literature on the neuroscience of thought (e.g., Christoff et al., 2016).

References

  • Anastopoulos, A. D., Langberg, J. M., Eddy, L. D., Silvia, P. J., & Labban, J. D. (2021). A randomized controlled trial examining CBT for college students with ADHD. Journal of Consulting and Clinical Psychology, 89(1), 21. https://doi.org/10.1037/ccp0000553.

    Article  PubMed  Google Scholar 

  • Barkley, R. A. (2011). Barkley adult ADHD rating scale-IV (BAARS-IV). Guilford Press.

  • Barkley, R. A. (Ed.). (2015). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment. Guilford Press.

  • Barkley, R. A., Murphy, K. R., & Fischer, M. (2008). ADHD in adults: What the science says. Guilford Press.

  • Barr, D. J., Levy, R., Scheepers, C., & Tily, H. J. (2013). Random effects structure for confirmatory hypothesis testing: Keep it maximal. Journal of Memory and Language, 68(3), https://doi.org/10.1016/j.jml.2012.11.001.

  • Beck, A. T. (1963). Thinking and depression: I. idiosyncratic content and cognitive distortions. Archives of General Psychiatry, 9(4), 324–333. https://doi.org/10.1001/archpsyc.1963.01720160014002.

    Article  CAS  PubMed  Google Scholar 

  • Beck, A. T. (1976). Tapping the internal communications. In Cognitive therapy and the emotional disorders (pp. 24–46). Meridian. https://docs.google.com/document/d/18VtYH_d_PIssP3LggqRln_Hqs0RMHT2pSLRplMtdplk/edit?usp=sharing.

  • Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (Second Edition). Guildford Press.

  • Beck, A. T. (2019). A 60-year evolution of cognitive theory and therapy. Perspectives on Psychological Science, 14(1), 16–20. https://doi.org/10.1177/1745691618804187.

    Article  PubMed  Google Scholar 

  • Beck, A. T., & Haigh, E. A. P. (2014). Advances in cognitive theory and therapy: The generic cognitive model. Annual Review of Clinical Psychology, 10(1), 1–24. https://doi.org/10.1146/annurev-clinpsy-032813-153734.

    Article  PubMed  Google Scholar 

  • Beck, A. T., Rush, A., John, Shaw, Brian, F., & Emery (1979). Cognitive therapy of depression. Gary: Guildford Press.

    Google Scholar 

  • Beck, A. T., Wright, F. D., Newman, C. F., & Liese, B. S. (2001). Cognitive therapy of substance abuse. Guilford Press.

  • Bolger, N., & Laurenceau, J. P. (2013). Intensive longitudinal methods: An introduction to Diary and Experience Sampling Research. Guilford Press.

  • Christoff, K., Irving, Z. C., Fox, K. C. R., Spreng, R. N., & Andrews-Hanna, J. R. (2016). Mind-wandering as spontaneous thought: A dynamic framework. Nature Reviews Neuroscience, 17(11), 718–731. https://doi.org/10.1038/nrn.2016.113.

    Article  CAS  PubMed  Google Scholar 

  • Clark, L. A., & Watson, D. (1994). The panas-x: Manual for the positive and negative affect schedule - expanded form. University of Iowa. https://doi.org/10.17077/48vt-m4t2.

  • Colombo, D., Fernández-Álvarez, J., Suso-Ribera, C., Cipresso, P., Valev, H., Leufkens, T., Sas, C., Garcia-Palacios, A., Riva, G., & Botella, C. (2020). The need for change: Understanding emotion regulation antecedents and consequences using ecological momentary assessment. Emotion, 20(1), 30–36. https://doi.org/10.1037/emo0000671.

    Article  PubMed  Google Scholar 

  • Cortese, S., Kelly, C., Chabernaud, C., Proal, E., Di Martino, A., Milham, M. P., & Castellanos, F. X. (2012). Toward systems neuroscience of adhd: A Meta-analysis of 55 fmri studies. American Journal of Psychiatry, 169(10), 1038–1055. https://doi.org/10.1176/appi.ajp.2012.11101521.

    Article  PubMed  Google Scholar 

  • Cortese, S., Adamo, N., Del Giovane, C., Mohr-Jensen, C., Hayes, A. J., Carucci, S., Atkinson, L. Z., Tessari, L., Banaschewski, T., Coghill, D., Hollis, C., Simonoff, E., Zuddas, A., Barbui, C., Purgato, M., Steinhausen, H. C., Shokraneh, F., Xia, J., & Cipriani, A. (2018). Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: A systematic review and network meta-analysis. The Lancet Psychiatry, 5(9), 727–738. https://doi.org/10.1016/S2215-0366(18)30269-4.

    Article  PubMed  PubMed Central  Google Scholar 

  • Danielson, M. L., Bitsko, R. H., Ghandour, R. M., Holbrook, J. R., Kogan, M. D., & Blumberg, S. J. (2018). Prevalence of parent-reported adhd diagnosis and associated treatment among u.s. children and adolescents, 2016. Journal of Clinical Child & Adolescent Psychology, 47(2), 199–212. https://doi.org/10.1080/15374416.2017.1417860.

    Article  Google Scholar 

  • DataCombine (version 0.2.21). (n.d.). Retrieved June 20, from https://www.rdocumentation.org/packages/DataCombine/versions/0.2.21/topics/slide.

  • Del Boca, F. K., Darkes, J., Greenbaum, P. E., & Goldman, M. S. (2004). Up close and personal: Temporal variability in the drinking of individual college students during their first year. Journal of Consulting and Clinical Psychology, 72(2), 155–164. https://doi.org/10.1037/0022-006X.72.2.155.

    Article  PubMed  Google Scholar 

  • Dobson, K. S., Poole, J., & Beck, J. S. (2018). The fundamental cognitive model. In R. L. Leahy (Ed.), Science and practice in cognitive therapy: Foundations, mechanisms, and applications (pp. 29–47). Guildford Press.

  • Ehring, T., & Watkins, E. R. (2008). Repetitive negative thinking as a transdiagnostic process. International Journal of Cognitive Therapy, 1(3), 192–205. https://doi.org/10.1680/ijct.2008.1.3.192.

    Article  Google Scholar 

  • Enders, C. K., & Tofighi, D. (2007). Centering predictor variables in cross-sectional multilevel models: A new look at an old issue. Psychological Methods, 12(2), 121–138. https://doi.org/10.1037/1082-989X.12.2.121.

    Article  PubMed  Google Scholar 

  • Faraone, S. V., & Larsson, H. (2019). Genetics of attention deficit hyperactivity disorder. Molecular Psychiatry, 24(4), 562. https://doi.org/10.1038/s41380-018-0070-0.

    Article  CAS  PubMed  Google Scholar 

  • Hofmann, S. G., & Hayes, S. C. (2019). The future of intervention science: Process-based therapy. Clinical Psychological Science, 7(1), 37–50. https://doi.org/10.1177/2167702618772296.

    Article  PubMed  Google Scholar 

  • Hollon, S. D., & Kendall, P. C. (1980). Cognitive self-statements in depression: Development of an automatic thoughts questionnaire. Cognitive Therapy and Research, 4(4), 383–395.

    Article  Google Scholar 

  • Johnson, S., & Tran, T. (2007). Bipolar disorder: What can psychotherapists learn from the cognitive research? Journal of Clinical Psychology, 63(5), 425–432. https://doi.org/10.1002/jclp.20361.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kam, J. W. Y., Irving, Z. C., Mills, C., Patel, S., Gopnik, A., & Knight, R. T. (2021). Distinct electrophysiological signatures of task-unrelated and dynamic thoughts. Proceedings of the National Academy of Sciences, 118(4), e2011796118. https://doi.org/10.1073/pnas.2011796118.

  • Kessler, R. C., Adler, L., Barkley, R., Biederman, J., Conners, C. K., Demler, O., Faraone, S. V., Greenhill, L. L., Howes, M. J., Secnik, K., Spencer, T., Ustun, T. B., Walters, E. E., & Zaslavsky, A. M. (2006). The prevalence and correlates of adult adhd in the united states: Results from the national comorbidity survey replication. The American Journal of Psychiatry, 163(4), 716–723. https://doi.org/10.1176/appi.ajp.163.4.716.

    Article  PubMed  PubMed Central  Google Scholar 

  • Knouse, L. E., & Mitchell, J. T. (2015). Incautiously optimistic: Positively valenced cognitive avoidance in adult adhd. Cognitive and Behavioral Practice, 22(2), 192–202. https://doi.org/10.1016/j.cbpra.2014.06.003.

    Article  PubMed  PubMed Central  Google Scholar 

  • Knouse, L. E., Zvorsky, I., & Safren, S. A. (2013). Depression in adults with Attention-Deficit/Hyperactivity disorder (ADHD): The mediating role of cognitive-behavioral factors. Cognitive Therapy and Research, 1–13. https://doi.org/10.1007/s10608-013-9569-5.

  • Knouse, L. E., Teller, J., & Brooks, M. A. (2017). Meta-analysis of cognitive–behavioral treatments for adult ADHD. Journal of Consulting and Clinical Psychology, 85(7), 737–750. https://doi.org/10.1037/ccp0000216.

    Article  PubMed  Google Scholar 

  • Knouse, L. E., Mitchell, J. T., Kimbrel, N. A., & Anastopoulos, A. D. (2019). Development and evaluation of the adhd cognitions scale for adults. Journal of Attention Disorders, 23(10), 1090–1100. https://doi.org/10.1177/1087054717707580.

    Article  PubMed  Google Scholar 

  • Maggs, J. L., Williams, L. R., & Lee, C. M. (2011). Ups and downs of alcohol use among first-year college students: Number of drinks, heavy drinking, and stumble and pass out drinking days. Addictive Behaviors, 36(3), 197–202. https://doi.org/10.1016/j.addbeh.2010.10.005.

    Article  PubMed  Google Scholar 

  • Miguelez-Fernandez, C., de Leon, S. J., Baltasar-Tello, I., Peñuelas-Calvo, I., Barrigon, M. L., Capdevila, A. S., Delgado-Gómez, D., Baca-García, E., & Carballo, J. J. (2018). Evaluating attention-deficit/hyperactivity disorder using ecological momentary assessment: A systematic review. ADHD Attention Deficit and Hyperactivity Disorders, 10(4), 247–265. https://doi.org/10.1007/s12402-018-0261-1.

    Article  PubMed  Google Scholar 

  • Mitchell, J. T., Nelson-Gray, R. O., & Anastopoulos, A. D. (2008). Adapting an emerging empirically supported cognitive-behavioral therapy for adults with ADHD and comorbid complications: An example of two case studies. Clinical Case Studies, 7, 423–448.

    Article  Google Scholar 

  • Mitchell, J. T., Benson, J., Knouse, L. E., Kimbrel, N. A., & Anastopoulos, A. D. (2013). Are negative automatic thoughts associated with ADHD in adulthood? Cognitive Therapy and Research. https://doi.org/10.1007/s10608-013-9525-4.

    Article  Google Scholar 

  • Moerbeek, M. (2004). The consequence of ignoring a level of nesting in multilevel analysis. Multivariate Behavioral Research, 39(1), 129–149. https://doi.org/10.1207/s15327906mbr3901_5.

    Article  PubMed  Google Scholar 

  • Pickel, C. T., & Toback, L. M. (2019). How positive are overly-positive automatic thoughts? Atlanta, GA: Annual Convention of the Association for Behavioral and Cognitive Therapies. [Poster presentation]https://oucirs.org/?s=overly-positive.

    Google Scholar 

  • Prince, J., Wilens, T., Spencer, T., & Biederman, J. (2015). Pharmacotherapy of ADHD in adults. In R. A. Barkley (Ed.), Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (4th ed., pp. 826–860). Guilford.

  • Pychyl, T. A., & Sirois, F. M. (2016). Procrastination, emotion regulation, and well-being. In F. M. Sirois & T. A. Pychyl (Eds.), Procrastination, Health, and Well-Being (pp. 163–188). Elsevier. https://doi.org/10.1016/B978-0-12-802862-9.00008-6.

  • Ramsay, J. R. (2020). Rethinking adult ADHD: Helping clients turn intentions into actions. American Psychological Association.

  • Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models: Applications and data analysis methods. SAGE.

  • Raugh, I. M., Chapman, H. C., Bartolomeo, L. A., Gonzalez, C., & Strauss, G. P. (2019). A comprehensive review of psychophysiological applications for ecological momentary assessment in psychiatric populations. Psychological Assessment, 31(3), 304–317. https://doi.org/10.1037/pas0000651.

    Article  PubMed  Google Scholar 

  • Rehm, I. C., Nedeljkovic, M., Thomas, A., & Moulding, R. (2015). The role of cognitions and beliefs in trichotillomania: A qualitative study using interpretative phenomenological analysis. Behaviour Change, 32(04), 209–230. https://doi.org/10.1017/bec.2015.11.

    Article  Google Scholar 

  • Ryan, R. M., Bernstein, J. H., & Brown, K. W. (2010). Weekends, work, and well-being: Psychological need satisfactions and day of the week effects on mood, vitality, and physical symptoms. Journal of Social and Clinical Psychology, 29(1), 95–122. https://doi.org/10.1521/jscp.2010.29.1.95.

    Article  Google Scholar 

  • Safren, S. A., Sprich, S., Perlman, C. A., & Otto, M. W. (2017). Mastering your adult ADHD: A cognitive behavioral treatment program, therapist guide (2nd ed.). Oxford University Press.

  • Shiffman, S., Stone, A. A., & Hufford, M. R. (2008). Ecological momentary assessment. Annual Review of Clinical Psychology, 4(1), 1–32. https://doi.org/10.1146/annurev.clinpsy.3.022806.091415.

    Article  PubMed  Google Scholar 

  • Sirois, F. M., & Pychyl, T. (2013). Procrastination and the priority of short-term mood regulation: Consequences for future self. Social and Personality Psychology Compass, 7(2), 115–127. https://doi.org/10.1111/spc3.12011.

    Article  Google Scholar 

  • Thiessen, C. N., & Wymbs, B. T. (2018). Development of the automatic cognitions vignette measure. Washington, D.C.: Annual convention of the Association for Behavioral andCognitive Therapies, ADHD Special Interest Group Meeting.

    Google Scholar 

  • Torrente, F., López, P., Alvarez Prado, D., Kichic, R., Cetkovich-Bakmas, M., Lischinsky, A., & Manes, F. (2014). Dysfunctional cognitions and their emotional, behavioral, and functional correlates in adults with attention deficit hyperactivity disorder (adhd): Is the cognitive-behavioral model valid? Journal of Attention Disorders, 18(5), 412–424. https://doi.org/10.1177/1087054712443153.

    Article  PubMed  Google Scholar 

  • Wahl, K., Ehring, T., Kley, H., Lieb, R., Meyer, A., Kordon, A., Heinzel, C. V., Mazanec, M., & Schönfeld, S. (2019). Is repetitive negative thinking a transdiagnostic process? A comparison of key processes of RNT in depression, generalized anxiety disorder, obsessive-compulsive disorder, and community controls. Journal of Behavior Therapy and Experimental Psychiatry, 64, 45–53. https://doi.org/10.1016/j.jbtep.2019.02.006.

    Article  PubMed  Google Scholar 

  • Wenze, S. J., Gaugler, T. L., Sheets, E. S., & DeCicco, J. M. (2018). Momentary experiential avoidance: Within-person correlates, antecedents, and consequences and between-person moderators. Behaviour Research and Therapy, 107, 42–52. https://doi.org/10.1016/j.brat.2018.05.011.

    Article  PubMed  Google Scholar 

  • Wright, F. F., Beck, A. T., Newman, C. F., & Liese, B. F. (1993). Cognitive therapy of substance abuse: Theoretical rationale. In L. S. Onken, J. D. Blaine, & J. J. Boren (Eds.), Behavioral treatments for drug abuse and dependence (137 vol., pp. 123–146). National Institute on Drug Abuse.

  • Young, J. E., & Lindemann, M. D. (1992). An integrative schema-focused model for personality disorders. Journal of Cognitive Psychotherapy, 6(1), 11–23. https://doi.org/10.1891/0889-8391.6.1.11.

    Article  Google Scholar 

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Acknowledgements

The authors would like to thank Dr. Alex Schoemann and Dr. L. Andrew Bell for assisting the first author in learning multilevel modeling and visualization techniques in R. They would also like to thank Dr. Susan Wenze for consultation on ecological momentary assessment and Dr. J. Russell Ramsay for helpful comments on a draft of the manuscript. The authors also thank the undergraduate researchers who assisted with data collection: Julia Evans, Destiny Hunt, Zodok Martinez, Malcolm Pittman, Celia Satter, Caitlin Wiegert, and Ryan Wigginton.

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  1. Department of Psychology, University of Richmond, Richmond, VA, United States of America

    Laura E. Knouse, Mamie Ziegler, Ilana Lavine, Junming Zhang, Yixue Cheng & Hoor Ul Ain

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  1. Laura E. Knouse
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  2. Mamie Ziegler
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  3. Ilana Lavine
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Correspondence to Laura E. Knouse.

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Competing interests

L. Knouse is a member of the Professional Advisory Board of Children and Adults with ADHD (CHADD) and is a clinical and research consultant for Get Inflow, LTD. The other authors have no competing interests to declare.

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Knouse, L.E., Ziegler, M., Lavine, I. et al. Avoidant Automatic Thoughts are Associated with Task Avoidance and Inattention in the Moment. Cogn Ther Res (2023). https://doi.org/10.1007/s10608-023-10410-8

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