Parsing the Longitudinal Relationship Between Avoidant Automatic Thoughts and Avoidance

Avoidant automatic thoughts (AAT) have been proposed as a mechanism of problematic avoidance in ADHD. AAT are positively associated with task avoidance in the moment; however, the longitudinal and directional nature of this relationship has yet to be explored.

The current study examines whether AAT better predicts future avoidance or if avoidance better predicts future AAT.

Using a longitudinal ecological momentary assessment (EMA) design, we measured AAT and avoidance for 97 undergraduate participants with and without ADHD at baseline and across each of the following 6 days, five times per day.

AAT at baseline predicted average avoidance across the 6 days above and beyond baseline avoidance but procrastination at baseline did not predict average future AAT frequency above AAT at baseline. ADHD diagnosis did not moderate either relationship. Lagged analyses revealed that task avoidance in a given moment predicts AAT at the next observation, even when controlling for AAT while the inverse relationship was not significant.

This study evaluates the CBT notion that thoughts influence future behavior and reveals that conclusions may depend on the time-scale of the analysis and whether between- or within-person effects are evaluated. The findings may have clinical implications for CBT and other skills-based treatments of avoidance, especially for those with ADHD.