Close Others as Context: Understanding Treatment Attitudes in Anxiety and Related Disorders

Abstract

Up to one-quarter of the North American population suffers from excessive anxiety and the associated impaired quality of life. While there is evidence that anxiety treatment is effective, it is underutilized, with most sufferers avoiding treatment or dropping out early. The Theory of Reasoned Action (Ajzen & Fishbein, 1980) points to social norms and treatment attitudes as major factors in one’s treatment interest and engagement. Of course, these two factors are not completely independent, and this thesis highlights their intersection through investigating how the behaviour of one’s social network relates to treatment attitudes. We focus on two types of behaviour that have been documented as important variables in anxiety maintenance and treatment: criticism and accommodation of anxiety symptoms. This series of studies is the first to investigate the relationships between criticism, accommodation, and treatment attitudes of adult anxiety sufferers themselves, as well as treatment attitudes of their close others. In study one, participants with excessive anxiety completed measures of treatment ambivalence, perceived criticism, and accommodation of symptoms. Regression analysis revealed that accommodation and criticism were both significantly positively related to treatment fears, even when therapy history, sample type (clinical/analogue), and demographic factors were controlled for. To explore this relationship in close others, a measure of close others’ treatment concerns needed to be developed; this was the focus of study two. Close others’ qualitative responses about their treatment concerns were coded to reveal seven major themes, which were then used to develop measure items. These items were administered to a large sample and exploratory factor analysis indicated four internally consistent factors – Adverse Reactions, Personal/Family Consequences, Lack of Commitment, and Ineffectiveness. The new 17-item measure (Treatment Concerns Questionnaire – Close Others, or TCQ-C) showed strong internal reliability, convergent validity, and discriminant validity. In study three, this measure, as well as measures of self-reported criticism and accommodation, were administered to a sample of close others of those with anxiety. Regression analysis demonstrated a similar finding to study one, in that close others’ treatment fears were significantly positively related to their criticism and accommodation, even when controlling for demographic variables. Altogether, this research adds to the literature on the deleterious effects of criticism and accommodation, but in the novel domain of treatment attitudes. That criticism and accommodation are related to increased treatment ambivalence is perhaps unsurprising when these behaviours are conceptualized as representing underlying negative attributions of sufferers. These findings suggest that while close others may be trying to help or support their loved ones through engaging in criticism and/or accommodation, these behaviours may in fact have the opposite effect in that they may discourage wellness efforts. In addition, while families with high amounts of criticism and/or accommodation are ideal candidates for system-focused interventions, these individuals may show the most treatment resistance. Thus, this work has clear clinical implications and suggests the need to take the social system into account when treating anxiety. Methods for addressing treatment concerns, criticism, and accommodation are discussed, as well as limitations of these studies and future directions for research.