The Role of Mindfulness and Contrast Avoidance in Individuals' Attitudes Toward Psychotherapy

Abstract

The Contrast Avoidance Model is a contemporary model proposing that individuals maintain a negative affective state because they perceive emotional fluctuations as threatening and consider remaining in this state potentially beneficial. Maintaining a chronic negative mood can prevent diverse emotional experiences during the psychotherapy process or lead to the avoidance of positive emotions that could potentially emerge with recovery. This can lead to the emergence of negative beliefs and attitudes about the therapy process and, indirectly, lead to the termination of the therapy process. In this context, mindfulness is thought to be a significant determinant of individuals' thoughts about psychotherapy, but this relationship may be shaped by the tendencies toward contrast avoidance. Therefore, this study aimed to examine the mediating role of contrast avoidance in the effect of mindfulness on thoughts about psychotherapy. The study sample consisted of 281 female and 124 male participants aged 18–60 years, with a mean age of 29.39 years (SD = 8.26). The study utilized the Thoughts About Psychotherapy Scale, the Contrast Avoidance Scale, and the Mindful Attention Awareness Scale. Structural equation modeling was used to analyze the data. Data were analyzed using SPSS and AMOS. The study found a significant relationship between mindful awareness, contrast avoidance, and thoughts about psychotherapy. The study revealed that contrast avoidance mediated the effect of mindfulness on attitudes toward psychotherapy. These results suggest that mindfulness practices can contribute to the therapy process by reducing individuals' tendencies toward contrast avoidance behaviors.

Keywords

• Mindfulness
• contrast avoidance
• thoughts on psychotherapy

Bireylerin Psikoterapi Hakkındaki Düşüncelerinde Bilinçli Farkındalık ve Kontrasttan Kaçınmanın Rolü

Abstract

Kontrasttan kaçınma modeli, duygusal dalgalanmanın tehdit olarak algılanması ve olumsuz duygulanımda kalmanın potansiyel faydaları sebebiyle mevcut duygulanımın sürdürülmesi üzerine temellendirilen güncel bir modeldir. Olumsuz duygudurumun uzun bir süre boyunca devam etmesi, psikoterapi sürecinde birçok farklı duygusal deneyimin yaşanmasına engel olabilir ya da potansiyel iyileşme ile birlikte ortaya çıkabilecek olumlu duygulardan kaçınılmasına neden olabilir. Bu durum, terapi süreci hakkında olumsuz inanç ve tutumların ortaya çıkmasına ve dolaylı olarak terapi sürecinin sonlanmasına sebebiyet verebilir. Bu bağlamda, bireylerin psikoterapiye dair düşüncelerinde bilinçli farkındalığın önemli bir belirleyici olduğu, ancak bu ilişkinin kontrasttan kaçınma eğilimi aracılığıyla şekillenebileceği düşünülmektedir. Bu doğrultuda, bilinçli farkındalığın psikoterapi hakkındaki düşünceler üzerindeki etkisinde kontrasttan kaçınmanın aracı rolünün incelenmesi amaçlanmıştır. Araştırmanın örneklem grubunda, 18-60 yaş aralığında, yaş ortalaması 29.39 olan, 281 kadın ve 124 erkek katılımcı bulunmaktadır. Araştırma verileri toplamak için, Psikoterapi Hakkındaki Düşünceler Ölçeği, Kontrasttan Kaçınma Ölçeği ve Bilinçli Farkındalık Ölçeği kullanılmıştır. Verilerin analizinde yapısal eşitlik modellemesi kullanılmıştır. Veriler SPSS ve AMOS programlarında analiz edilmiştir. Araştırma sonucunda, bilinçli farkındalık, kontrasttan kaçınma ve psikoterapi hakkındaki düşünceler arasında anlamlı bir ilişki olduğu görülmüştür. Ayrıca, bilinçli farkındalığın psikoterapi hakkındaki düşünceler üzerindeki etkisinde kontrasttan kaçınmanın aracı rolü olduğu belirlenmiştir. Aracılık modelindeki bu sonuçlar, bilinçli farkındalık uygulamalarının bireylerin kontrasttan kaçınma davranışlarını azaltma yoluyla terapi sürecine katkıda bulunabileceğini göstermektedir.

Keywords

• Bilinçli farkındalık
• Kontrasttan Kaçınma
• Psikoterapi Hakkındaki Düşünceler

References

1. Andrade, L. H., Alonso, J., Mneimneh, Z., Wells, J. E., Al-Hamzawi, A., Borges, G., Bromet, E., Bruffaerts, R., de Girolamo, G., de Graaf, R., Florescu, S., Gureje, O., Hinkov, H. R., Hu, C., Huang, Y., Hwang, I., Jin, R., Karam, E. G., Kovess-Masfety, V., … Kessler, R. C. (2013). Barriers to mental health treatment: results from the WHO World Mental Health surveys. Psychological Medicine, 44(6), 1303–1317. https://doi.org/10.1017/s0033291713001943
2. Bacon, M. M., Rood, E. A., & Washburn, M. F. (1914). A study of affective contrast. The American Journal of Psychology, 25(2), 290–293. https://doi.org/10.2307/1413417
3. Baekeland, F., & Lundwall, L. (1975). Dropping out of treatment: A critical review. Psychological Bulletin, 82(5), 738–783. https://doi.org/10.1037/h0077132
4. Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13(1), 27–45. https://doi.org/10.1037/0022-3514.84.4.822
5. Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., Segal, Z. V., Abbey, S., Speca, M., Velting, D., & Devins, G. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11(3), 230–241. https://doi.org/10.1093/clipsy.bph077
6. Brenner, R. E., Cornish, M. A., Heath, P. J., Lannin, D. G., & Losby, M. M. (2020). Seeking help despite the stigma: Experiential avoidance as a moderated mediator. Journal of Counseling Psychology, 67(1), 132–140. https://doi.org/10.1037/cou0000365
7. Brown, K. W. ve Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84, 822-848. https://doi.org/10.1037/0022-3514.84.4.822
8. Brown, K. W., Ryan, R. M. ve Creswell, J. D. (2007). Mindfulness: Theoretical foundations and evidence for its salutary effects. Psychological Inquiry, 18(4), 211–237. https://doi.org/10.1080/10478400701598298

9. Cardaciotto, L., Herbert, J. D., Forman, E. M., Moitra, E., & Farrow, V. (2008). The Assessment of Present-Moment Awareness and Acceptance. Assessment, 15(2), 204–223. https://doi.org/10.1177/1073191107311467
10. Cooper, A. A., & Conklin, L. R. (2015). Dropout from individual psychotherapy for major depression: A meta-analysis of randomized clinical trials. Clinical Psychology Review, 40, 57-65. https://doi.org/10.1016/j.cpr.2015.05.001
11. Corrigan, P. (2004). How stigma interferes with mental health care. American Psychologist, 59(7), 614–625. https://doi.org/10.1037/0003-066x.59.7.614
12. Cömertoğlu, S. (2020). Adaptation, validity and reliability of the Turkish version of Contrast Avoidance Questionnaire (Master's thesis), İstanbul Medipol University
13. Falb, M. D., & Pargament, K. I. (2012). Relational mindfulness, spirituality, and the therapeutic bond. Asian Journal of Psychiatry, 5(4), 351-354. https://doi.org/10.1016/j.ajp.2012.07.008
14. Gámez, W., Chmielewski, M., Kotov, R., Ruggero, C., & Watson, D. (2011). Development of a measure of experiential avoidance: the Multidimensional Experiential Avoidance Questionnaire. Psychological Assessment, 23(3), 692–713. https://doi.org/10.1037/a0023242
15. Garrote‐Caparrós, E., Bellosta‐Batalla, M., Moya‐Albiol, L., & Cebolla, A. (2022). Effectiveness of mindfulness‐based interventions on psychotherapy processes: A systematic review. Clinical Psychology & Psychotherapy, 29(3), 783-798. https://doi.org/10.1002/cpp.2676.
16. Germer, C. K., Siegel, R. D., & Fulton, P. R. (2005). Mindfulness and psychotherapy. Guilford Pub. Gürbüz, S. (2019). Structural equation modeling with AMOS. Seçkin Pub.
17. Hayes, S. C. (2019). Acceptance and commitment therapy: towards a unified model of behavior change. World Psychiatry, 18(2), 226-227. https://doi.org/10.1002/wps.20626
18. Hayes, S. C., Levin, M. E., Plumb-Vilardaga, J., Villatte, J. L., & Pistorello, J. (2013). Acceptance and commitment therapy and contextual behavioral science: Examining the progress of a distinctive model of behavioral and cognitive therapy. Behavior Therapy, 44(2), 180-198. https://doi.org/10.1016/j.beth.2009.08.002
19. Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1-25. https://doi.org/10.1016/j.brat.2005.06.006
20. Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64(6), 1152–1168. https://doi.org/10.1037/0022-006x.64.6.1152
21. Hofmann, S. G., & Asmundson, G. J. (2008). Acceptance and mindfulness-based therapy: new wave or old hat?. Clinical Psychology Review, 28(1), 1-16. https://doi.org/10.1016/j.cpr.2007.09.003
22. Kabat-Zinn, J. (1994). Wherever you go, you are there. Mindfulness meditation in everyday life. Hyperion Pub.
23. Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144–156. https://doi.org/10.1093/clipsy.bpg016
24. Kabat-Zinn, J. (2005). Coming to our senses: Healing ourselves and the world through mindfulness. Hyperion Pub.
25. Kushner, M. G., & Sher, K. J. (1989). Fears of psychological treatment and its relation to mental health service avoidance. Professional Psychology: Research and Practice, 20(4), 251–257. https://doi.org/10.1037/0735-7028.20.4.251
26. LaFreniere, L. S., & Newman, M. G. (2023). Upregulating positive emotion in generalized anxiety disorder: A randomized controlled trial of the SkillJoy ecological momentary intervention. Journal of Consulting and Clinical Psychology, 91(6), 381-387. https://doi.org/10.1037/ccp0000794
27. Leonard, H. D., Campbell, K., & Gonzalez, V. M. (2018). The relationships among clinician self-report of empathy, mindfulness, and therapeutic alliance. Mindfulness, 9(6), 1837-1844. https://doi.org/10.1007/s12671-018-0926-z
28. Llera, S. J. ve Newman, M. G. (2017). Development and validation of two measures of emotional contrast avoidance: The contrast avoidance questionnaires. Journal of Anxiety Disorders, 49, 114-127. https://doi.org/10.1016/j.janxdis.2017.04.008
29. Llera, S. J., & Newman, M. G. (2014). Rethinking the role of worry in generalized anxiety disorder: Evidence supporting a model of emotional contrast avoidance. Behavior Therapy, 45(3), 283-299. https://doi.org/10.1016/j.beth.2013.12.011
30. Meier, S. T. (2014). Rediscovering the role of avoidance in psychotherapy progress and outcome. Professional Psychology: Research and Practice, 45(3), 212-217.https://doi.org/10.1037/a0036916
31. Moore, S. D., Brody, L. R., & Dierberger, A. E. (2009). Mindfulness and experiential avoidance as predictors and outcomes of the narrative emotional disclosure task. Journal of Clinical Psychology, 65(9), 971-988. https://doi.org/10.1002/jclp.20600
32. Newman, M. G., & Llera, S. J. (2011). A novel theory of experiential avoidance in generalized anxiety disorder: A review and synthesis of research supporting a contrast avoidance model of worry. Clinical Psychology Review, 31(3), 371-382. https://doi.org/10.1016/j.cpr.2011.01.008Ong,
33. C. W., Lee, E. B., & Twohig, M. P. (2018). A meta-analysis of dropout rates in acceptance and commitment therapy. Behaviour Research and Therapy, 104, 14-33. https://doi.org/10.1016/j.brat.2018.02.004
34. Özyeşil, Z., Arslan, C., Kesici, S., & Deniz, M. E. (2011). Adaptation of the mindful attention awareness scale into Turkish. Education and Science, 36(160), 224-235.
35. Pierson, M. M., Roche, A. I., & Denburg, N. L. (2019). Mindfulness, experiential avoidance, and affective experience in older adults. Journal of Contextual Behavioral Science, 14, 32-36. https://doi.org/10.1016/j.jcbs.2019.08.007
36. Przeworski, A., & Newman, M. G. (2024). The Contrast Avoidance Model: Conclusion and synthesis of new research in the special issue. Journal of Anxiety Disorders, 102, 102830. https://doi.org/10.1016/j.janxdis.2024.102830
37. Rashtbari, A., & Saed, O. (2020). Contrast avoidance model of worry and generalized anxiety disorder: A theoretical perspective. Cogent Psychology, 7(1), 1800262. https://doi.org/10.1080/23311908.2020.1800262
38. Rüsch, N., Schiel, S., Corrigan, P. W., Leihener, F., Jacob, G. A., Olschewski, M., Lieb, K., & Bohus, M. (2008). Predictors of dropout from inpatient dialectical behavior therapy among women with borderline personality disorder. Journal of Behavior Therapy and Experimental Psychiatry, 39(4), 497–503. https://doi.org/10.1016/j.jbtep.2007.11.006
39. Shokrgozar, A., & Niyari, M. G. (2023). Predicting treatment plan adherence based on mindfulness and self-efficacy beliefs in patients with chronic pain. Thrita Journal of Neuron, 12(12).
40. Swift, J. K., & Greenberg, R. P. (2012). Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology, 80(4), 547–559. https://doi.org/10.1037/a0028226
41. Şimşek, Ö. F. (2020). Introduction to Structural Equation Modeling: Basic Principles and LISREL Applications. Tabachnick, B. G., & Fidell, L. S. (2013). Using multivariate statistics. Pearson.
42. Topkaya, N. (2011). Structural equation analysis of willingness to seek psychological help by the roles of social stigma, treatment fears, anticipated benefits, risks, and attitudes toward therapy [Doctoral dissertation]. Ege University.
43. Turan, M. E. (2020). Validity and reliability study of Mindful Attention Awareness Scale Adolescent Form. OPUS International Journal of Society Researches, 16 (Special Issue on Education and Society), 5608-5625. https://doi.org/10.26466/opus.683364
44. Twohig, M. P. (2012). Acceptance and commitment therapy: Introduction. Cognitive and Behavioral Practice, 19(4), 499-507. https://doi.org/10.1016/j.cbpra.2012.04.003.
45. Twohig, M. P., Hayes, S. C., & Masuda, A. (2006). Increasing willingness to experience obsessions: Acceptance and commitment therapy as a treatment for obsessive-compulsive disorder. Behavior Therapy, 37(1), 3–13. https://doi.org/10.1016/j.beth.2005.02.001
46. Vogel, D. L., Wade, N. G., & Hackler, A. H. (2007). Perceived public stigma and the willingness to seek counseling: The mediating roles of self-stigma and attitudes toward counseling. Journal of Counseling Psychology, 54(1), 40–50. https://doi.org/10.1037/0022-0167.54.1.40
47. Wexler, J. (2006). The relationship between therapist mindfulness and the therapeutic alliance. Massachusetts School of Professional Psychology.
48. Wierzbicki, M., & Pekarik, G. (1993). A meta-analysis of psychotherapy dropout. Professional Psychology: Research and Practice, 24(2), 190-195. https://doi.org/10.1037/0735-7028.24.2.190
49. Yazıcıoğlu, Y. & Erdoğan, S. (2004). Scientific Research Methods with SPSS Applications. Detay Pub.