Examining the relationship between anxiety and pathological demand avoidance in adults: a mixed methods approach

Research by Matt Johnson & Helen Saunderson. (2023).

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Why is this research necessary???

This research is crucial because it addresses the gap in understanding how Pathological Demand Avoidance (PDA) presents in adults. While PDA has been studied in children, there needs to be more knowledge about its presence and characteristics in adult populations.???

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What did the researchers do???

The researchers conducted a mixed-methods study with two experiments.??

Experiment 1: Utilised a correlational survey design with 170 adult participants to examine the relationship between PDA, anxiety, intolerance of uncertainty, and anticipatory responses.???

Experiment 2: Conducted semi-structured interviews with a subsample of 13 participants from Experiment 1 to explore their experiential perspectives on anxiety, uncertainty, and anticipation. The interviews were analysed using Interpretive Phenomenological Analysis (IPA) to identify common themes related to these experiences.??

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What did they find???

In Experiment 1, hierarchical regression analysis revealed that anxiety and intolerance of uncertainty significantly predicted PDA behaviours. Anxiety accounted for a larger portion of the variance in PDA behaviours than intolerance of uncertainty. However, anticipatory processes did not significantly add predictive power to the model.??

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In Experiment 2, four main themes emerged from the interviews:??

1. Approach-Avoidance Behavior:???

Participants described using approach behaviours to reduce unknowns and gain control over uncertain situations. Examples included checking their phones, using Google Maps, and performing mental assessments of situations. When approach behaviours failed, participants resorted to avoidance strategies, categorised into cognitive and physical avoidance. Cognitive avoidance involved distracting oneself from thinking about the uncertainty, while physical avoidance involved postponing or avoiding situations altogether, such as delaying appointments to prevent distress.??

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2. Factors Influencing Anticipatory Bias:???

Several factors influenced participants' anticipatory biases, including attention and vigilance, emotional regulation, and perceived cost and probability of events. Prolonged attention to uncertain events led to greater negative affect, obsessive thoughts, and a sense of reduced control. Emotional responses to anticipation varied, with some participants enjoying the excitement of positive events and others struggling with emotional regulation, especially in emotionally charged situations like holidays. The perceived importance of an event influenced the emotional and behavioural responses, with high-impact events causing more stress and requiring more mental energy to manage.??

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3. Vulnerability Factors Associated with Demand Avoidance:???

Participants frequently discussed issues related to fluctuating autonomic arousal, poor tolerance of uncertainty, a need for sameness, and difficulty predicting outcomes. Fluctuating autonomic arousal manifested as physical symptoms like shaking, sweating, and panic attacks during uncertain situations. Participants also expressed a need for predictability and familiarity, avoiding new places to reduce anxiety. Difficulty predicting outcomes often led to increased anxiety and a preference for familiar scenarios. Some participants reported feelings of self-consciousness and social judgment, which influenced their avoidance behaviours and coping strategies.??

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4. Experience-Based Development:???

All participants reported changes in their responses to anxiety, uncertainty, and anticipation as they aged. They described developing strategies to cope with these feelings, such as focusing on the present moment and using stress as motivation. The experience allowed participants to forecast a broader range of possible outcomes and adapt their perspectives, improving their ability to manage anxiety and uncertainty over time. Strategies included attentional control and living in the moment, which helped participants navigate stressful situations more effectively.?

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What does this mean??

The findings suggest that anxiety and intolerance of uncertainty are significant factors in the maintenance of PDA behaviors in adults. While anxiety emerged as a stronger predictor than intolerance of uncertainty, the relationship between these constructs indicates that both play a role in PDA. The qualitative data highlighted how adults with PDA navigate uncertainty and anxiety, emphasising the need for tailored interventions that address these specific challenges. This research provides a foundation for further exploration of PDA in adults and suggests that support strategies should focus on managing anxiety and improving tolerance of uncertainty.?

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Where to from here??

If you are new to PDA and wish to know more, we recommend attending our three-hour upcoming live webcast, PDA: An Introduction. On the same day, we will present a second three-hour course that assumes knowledge about PDA and explores a deeper understanding of the profile, strategies, and support: PDA Going Deeper. We hope you can join us.?

WEBCAST EVENT: PDA and Autism - An Introduction - 22 July 2024 - Attwood and Garnett Events

WEBCAST EVENT: PDA and Autism - Going Deeper - Monday 22 July 2024 - Attwood and Garnett Events?

Reference:?

Matt Johnson, & Helen Saunderson. (2023). Examining the relationship between anxiety and pathological demand avoidance in adults: a mixed methods approach. Frontiers in Education, 8. https://doi.org/10.3389/feduc.2023.1179015?