Approach-avoidance attitudes associated with initial therapy appointment attendance in a low-intensity service: A prospective study

Background: Initial therapy appointments have high nonattendance rates. Few studies examine psychological predictors and theory-based studies are scarce. Aims: 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. Method: A prospective study was used to identify predictors of first (n = 96) and second appointment (n = 85) attendance in a primary care mental health service. Measured factors included attitudes towards therapy, depression and anxiety scales, and demographic variables. Results: The results showed that 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. A shorter time interval between appointments predicted second appointment attendance. Conclusions: These results show that self-disclosure concerns may contribute to therapy avoidance. They also suggest that approach motivation for therapy includes having goals for self-reflection; however, this has less impact among more highly depressed people.