The Role of Experiential Avoidance in the Relationship Between Maladaptive Perfectionism and Worry1

Cognitive Therapy and Research, Vol. 30, No. 3, June 2007 (C 2006) DOI: 10.1007/s10608-006-9000-6

Amanda W. Santanello2,3 and Frank L. Gardner2,4 Published online: 10 March 2006

This study examined the role of experiential avoidance in the relationship between maladaptive perfectionism and worry. The hypothesis was that experiential avoidance would mediate the relationship between maladaptive perfectionism and worry. A total of 125 undergraduate participants completed measures assessing perfectionism, experiential avoidance, worry, depression, and social anxiety. A series of regression analyses showed that maladaptive perfectionism and experiential avoidance were sig- niﬁcantly associated with worry and that experiential avoidance was a partial mediator in the relationship between maladaptive perfectionism and worry. Partial correlations revealed signiﬁcant relationships between experiential avoidance and worry and between one aspect of maladaptive perfectionism and worry independent of depression and social anxiety. Results suggest that experiential avoidance may be an important variable contributing to the occurrence of worry within the context of maladaptive perfectionism.

KEY WORDS: experiential avoidance; perfectionism; worry; mediation.

The role of experiential avoidance in various forms of psychopathology has been the subject of recent behavioral and clinical discussion (Hayes et al., 2004; Hayes, Strosahl, & Wilson, 1999; Hayes, Wilson, Gifford, Follette, & Strosahl, 1996). Experiential avoidance “is the phenomenon that occurs when a person is unwill- ing to remain in contact with particular private experiences (e.g., bodily sensations, emotions, thoughts, memories, behavioral predispositions) and takes steps to alter the form or frequency of these events and the contexts that occasion them” (Hayes et al., 1996, p. 1154). In other words, experiential avoidance involves attempts to avoid uncomfortable internal experiences by trying to suppress or control these unpleasant private events and/or avoid the situations that produce them.

1This research was part of the ﬁrst author’s dissertation. 2Department of Psychology, La Salle University, Philadelphia, Pennsylvania. 3Present address: 52 Meriam Ct., Owings Mills, Maryland, 21117. 4Correspondence should be directed to Frank L. Gardner, Department of Psychology, La Salle Univer- sity, 1900 West Olney Avenue, Philadelphia, Pennsylvania, 19141; e-mail: [email protected].

319

0147-5916/07/0600-0319/1 C 2006 Springer Science+Business Media, Inc. 320 Santanello and Gardner

Individuals often attempt to use strategies to try to control their thoughts and feelings (Hayes et al., 1996, 1999). Because avoidance strategies often briefly and im- mediately diminish unwanted internal events, individuals continue to engage in experiential avoidance without realizing that avoidance strategies are not effective in the long term (Hayes et al., 1996, 2004). Repeated efforts to avoid aversive thoughts or feelings often result in an increase in the thought or feeling that one intends to avoid (Gold & Wegner, 1995). Thus, control strategies may not always be effective in reducing aversive internal events. Persistent experiential avoidance can have maladaptive consequences. There are circumstances in which it is essential to experience certain difficult feelings (e.g., grief), and attempts to avoid such emotions may lead to unhealthy behaviors (e.g., substance abuse; Hayes et al., 1996, 1999). Furthermore, the initial discomfort associated with change may prevent individuals from making constructive changes in their lives (Hayes et al. 1996), and the inhibition of positive behavioral actions may elicit distressful reactions and maladaptive behavior (Polivy, 1990). As men- tioned previously, attempts to control internal experiences actually may increase the targeted private events (Gold & Wegner, 1995). Overall, experiential avoidance may contribute to the development and/or maintenance of psychopathology when individuals continue to engage in efforts to control internal experiences despite unwanted and adverse outcomes. This study focuses on the role of experiential avoidance in the relationship between two variables associated with psychopathology: maladaptive perfectionism and worry. Significant correlations between features of maladaptive perfectionism and worry have been established (Kawamura, Hunt, Frost, & DiBartolo, 2001; Stober¨ & Joormann, 2001). This study attempts to examine the relationship between maladaptive perfectionism and worry further by suggesting that experiential avoidance is a mediator in this relationship. A mediator variable is defined as “the generative mechanism through which the focal independent variable is able to influence the dependent variable of interest” (Baron & Kenny, 1986, p. 1173). In other words, it is proposed that maladaptive perfectionism influences worry through experiential avoidance. Therefore, experiential avoidance must be related to both maladaptive perfectionism and worry.

Experiential Avoidance and Maladaptive Perfectionism Recent research supports the conceptualization of perfectionism as a multidimensional construct. Frost, Marten, Lahart, and Rosenblate (1990) and Hewitt and Flett (1991) have examined multiple dimensions of perfectionism and developed scales to reflect their conceptualizations of perfectionism, both named the Multidi- mensional Perfectionism Scale (MPS). In a factor analysis of the Frost et al. (1990) [MPS (F-MPS)] and Hewitt and Flett (1991) [MPS (H-MPS)], two primary factors emerged, which were labeled Positive Achievement Striving and Maladaptive Evaluation Concerns (Frost, Heimberg, Holt, Mattia, and Neubauer, 1993). Posi- tive Achievement Striving was associated with positive affect, and thus, may be in- terpreted to represent attributes of adaptive perfectionism. The Maladaptive Eval- uation Concerns factor was positively related to measures of negative affect and Perfectionism, Experiential Avoidance, and Worry 321 depression; therefore, it may be considered to reflect aspects of maladaptive perfectionism. A separate confirmatory factor analysis also supported the conceptualization of perfectionism according to two factors, adaptive and maladaptive perfectionism (Bieling, Israeli, & Antony, 2004). Research studies have revealed significant relationships between maladaptive components of perfectionism and various features of psychopathology, including anger, depression, anxiety, social anxiety, obsessions and compulsions, and worry (Bieling et al., 2004; Dunkley & Blankstein, 2000; Kawamura et al., 2001;Stober¨ & Joormann, 2001). Adaptive components of perfectionism, on the other hand, were not significantly correlated with these variables. These findings suggest that maladaptive perfectionism, and not adaptive perfectionism, is associated with psychopathology. As both experiential avoidance and maladaptive perfectionism appear to be linked to aspects of psychopathology, it is interesting to consider a potential relationship between the two. The concept of negative perfectionism, which is similar to maladaptive perfectionism, appears to be connected to avoidance in a model of perfectionism proposed by Slade and Owens (1998). Based on reinforcement theory, the model distinguishes between positive and negative perfectionism. Positive perfectionism is thought to be associated with positive reinforcement, whereas negative perfectionism is assumed to be related to negative reinforcement. In other words, positive perfectionism involves cognitions and behaviors that are focused on reach- ing goals and experiencing positive consequences. Thus, wanting to gain success is a motivation for positive perfectionism. In contrast, negative perfectionism involves cognitions and behaviors focused on achieving goals in order to avoid negative outcomes. Therefore, negative perfectionism appears to be motivated by a desire not to fail. Individuals with high levels of negative perfectionism would be expected to work toward the avoidance of failure and disappointment, potentially linking maladaptive features of perfectionism to experiential avoidance. Additional support for a relationship between maladaptive perfectionism and experiential avoidance comes from research examining perfectionism and procrastination, a form of behavioral avoidance. Studies utilizing multidimensional measures of perfectionism have found that adaptive features of perfectionism are negatively correlated with procrastination and maladaptive features of perfectionism are positively related to procrastination (Flett, Blankstein, Hewitt, & Koledin, 1992; Frost et al., 1990;Stober¨ & Joormann, 2001). Thus, maladaptive aspects of perfectionism are associated with avoidance of completing tasks. On the basis of the information presented earlier, a significant relationship between experiential avoidance and maladaptive perfectionism is proposed.

Experiential Avoidance and Worry Borkovec, Alcaine, and Behar (2004) propose that worry is a cognitive process serving the function of avoidance. Worry, triggered by the perception of threat, is an effort to problem-solve or discern how to cope with negative events. Borkovec and Roemer (1995) found that individuals rated the following as two of the most common reasons that they engage in worry: preparing for potential future danger 322 Santanello and Gardner and figuring out how to avoid or prevent feared events. Additionally, utilizing worry as a distraction from more distressing subject matter differentiated individuals with Generalized Anxiety Disorder (GAD) from nonworried anxious and nonworried individuals. Roemer, Salters, Raffa, and Orsillo (2005) found that both GAD symptoma- tology and excessive worry were significantly correlated with experiential avoidance in a nonclinical sample. Additionally, experiential avoidance was a significant and unique predictor of GAD severity. Thus, empirical research has found a relationship between worry and experiential avoidance, adding support to the theory that worry is an internal avoidance strategy. Additional support for the idea that worry serves an avoidant function includes evidence that worry may assist in diminishing somatic anxiety or uncomfortable physiological sensations (Borkovec & Hu, 1990). Furthermore, worry as a verbal activity has been linked to the avoidance of negative imagery (Borkovec & Inz, 1990;Stober,¨ Tepperwien, & Staak, 2000). Mennin, Heimberg, Turk, and Fresco (2002) also propose that worry may be utilized as a distraction from overwhelming emotions in order to control or avoid uncomfortable emotional experiences. Although worry has been proposed to be an internal avoidance strategy (Borkovec et al., 2004) and found to be correlated with experiential avoidance (Roemer et al., 2005), there is a distinction between the two variables. Experiential avoidance is a pathological process involving a general tendency to avoid unwanted internal experiences, which includes attempts to change the type or frequency of these experiences and/or the situations that elicit such reactions (Hayes et al., 1996, 1999, 2004). Worry, rather than being a general tendency to avoid, is a specific cognitive behavior involving verbal thought activity and problem solving with a probable function of avoiding threat (Borkovec, Ray, & Stober,¨ 1998; Borkovec et al., 2004). Experiential avoidance is a broader construct that includes any behavior aimed at avoiding uncomfortable internal events.

Experiential Avoidance as a Mediator in the Relationship Between Maladaptive Perfectionism and Pathological Worry It is proposed that maladaptive perfectionism affects experiential avoidance, which in turn, influences worry. Theoretically, there are a few possible explanations of how maladaptive perfectionism may lead to experiential avoidance. Beck (1995) suggests that individuals may develop and engage in compensatory strategies de- signed to help them avoid the activation of painful core beliefs such as, “I am not good enough” or “I am a failure.” Perfectionistic behaviors such as working long hours, rechecking completed assignments, and redoing tasks may be strategies used to deny or distract oneself from unwanted thoughts and feelings (e.g., doubts about one’s abilities, self-critical thoughts, feelings of inadequacy). Additionally, once a perfectionist realizes that a desire to be perfect is unattain- able, reactions of self-criticism, self-doubt, lowered self-respect, and a decreased satisfaction with one’s abilities and performance may be produced (Burns, 1980). These reactions may create a wish to “withdraw from painful circumstances” (Burns, 1980, p. 37). In an attempt to avoid contact with negative emotions, self-critical thoughts, Perfectionism, Experiential Avoidance, and Worry 323 and opportunities for failure, the perfectionist may “give up” or become less likely to begin or complete tasks. This serves as a possible explanation for positive correlations found between maladaptive features of perfectionism and procrastination (Flett et al., 1992; Frost et al., 1990;Stober¨ & Joormann, 2001). Whether individuals constantly engage in work or procrastinate, the behaviors exhibited may reflect experiential avoidance, or the tendency to avoid the negative feelings and thoughts associated with maladaptive perfectionism. As worry has been proposed to be a method utilized by individuals to avoid threat and distract themselves from upsetting topics (Borkovec et al., 2004), it is likely that individuals with traits of maladaptive perfectionism may worry in order to attempt to avoid failure by preparing for future performance situations and/or to distract themselves from negative experiences, such as self-criticism or disappointment in their abilities. Thus, the worry helps such individuals to continue to avoid the experiences with which they do not want to be in contact. When individuals worry and the situation about which they worry rarely happens, the worry is negatively reinforced and seems like an effective strategy to avoid threat (Borkovec et al., 2004). The seeming ability to avoid uncomfortable experiences by worrying maintains this behavior, which illustrates the cyclic connection between experiential avoidance and worry. As types of avoidance appear to be associated with both maladaptive perfectionism and worry, it is proposed that experiential avoidance mediates the relationship between these two variables. Another purpose of this study is to determine whether aspects of maladaptive perfectionism and experiential avoidance are specific characteristics of worry by controlling for other related variables. Stober¨ and Joormann (2001) discuss the importance of controlling for anxiety and depression when examining relationships between worry and perfectionism. The researchers found that after controlling for anxiety and depression, pathological worry remained significantly correlated with overall perfectionism and with aspects of perfectionism reflecting concern over mistakes and doubts about actions. Additionally, Stober¨ and Joormann (2001) suggest that future studies include social anxiety as a control variable, as maladaptive features of perfectionism (concern over mistakes, doubts about actions, and perceptions that others have unreachable expectations) have been found to be related to measures of social anxiety (Saboonchi & Lundh, 1997). This study investigates whether experiential avoidance and aspects of maladaptive perfectionism have unique relationships with worry by controlling for depression and social anxiety. In addition, this study examines whether features of maladaptive perfectionism are specific characteristics of worry by partialing out experiential avoidance in addition to depression and social anxiety.

METHOD

Participants Participants were 125 students attending college in eastern Pennsylvania. A total of 80 were recruited from a small liberal arts university, and 45 were recruited from a community college. The sample included 61 men and 64 women. The average 324 Santanello and Gardner age of participants was 20.1 years (SD = 4.76), with a range from 16 to 47 years. The sample was 84.0% Caucasian, 6.4% African American, 3.2% Asian/Paciﬁc Islander, 3.2% Hispanic/Latino, and 0.8% Native American, with 2.4% classiﬁed as other.

Measures Acceptance and Action Questionnaire The Acceptance and Action Questionnaire (AAQ; Hayes et al., 2004)isaself- report instrument that measures experiential avoidance. Items were developed to assess a need to control thoughts and emotions, avoidance of negative internal experiences, the capability to act despite experiencing emotional distress, and negative appraisals of private events. This study uses the 16-item version of the AAQ. Re- sponses are rated on a 7-point scale from never true (1) to always true (7). The items were coded so that higher scores reﬂect higher levels of experiential avoidance. Example items are “I try to suppress thoughts and feelings that I don’t like by just not thinking about them” and “If I promised to do something, I’ll do it, even if I later don’t feel like it (reverse scored).” A strong relationship between the 16-item AAQ and the ﬁnal nine-item AAQ (r = .89) has been demonstrated (Hayes et al., 2004). Although psychometric research on the AAQ is in its early stages, the measure appears to have adequate validity and internal consistency (Bond & Bunce, 2003; Hayes et al., 2004; Roemer et al., 2005).

Frost Multidimensional Perfectionism Scale The Frost Multidimensional Perfectionism Scale (F-MPS; Frost et al., 1990)is a 35-item questionnaire that assesses perfectionism. The F-MPS includes a 5-point rating scale, ranging from strongly disagree (1) to strongly agree (5). The following four subscales have been shown to reﬂect maladaptive evaluation concerns: Con- cern over Mistakes (CM), Doubts about Actions (DA), Parental Criticism (PC), and Parental Expectations (PE; Frost et al., 1993). Sample items from the CM subscale include “If I fail at work/school, I am a failure as a person” and “I should be upset if I make a mistake.” The DA subscale includes items such as “Even when I do something very carefully, I often feel that it is not quite done right” and “I usually have doubts about the simple everyday things I do.” Items like “As a child, I was punished for doing things less than perfect” and “My parents never tried to under- stand my mistakes” make up the PC subscale. Example items from the PE subscale include “My parents set very high standards for me” and “My parents wanted me to be the best at everything.” Stober¨ (1998) found that the CM and DA subscales best combined into one subscale, Concern over Mistakes and Doubts (CMD), and that the PE and PC subscales are best joined into one subscale, Parental Expecta- tions and Criticism (PEC). Thus, CMD and PEC were used to measure maladaptive perfectionism. The Personal Standards (PS) subscale has been shown to be a component of adaptive perfectionism (Frost et al., 1993). Sample items include “It is important to me that I be thoroughly competent in everything I do” and “I set higher goals than most people.” Research supports the reliability and validity of the Perfectionism, Experiential Avoidance, and Worry 325

F-MPS as a measure of perfectionism (Frost et al., 1990, 1993). High internal consistency has been established for the overall measure and for each subscale (Frost et al., 1990).

Penn State Worry Questionnaire The Penn State Worry Questionnaire (PSWQ; Meyer, Miller, Metzger, & Borkovec, 1990) is a 16-item inventory that measures pathological worry, or persistent, excessive, and uncontrollable worry. Items are rated on a 5-point scale from not at all typical of me (1) to very typical of me (5). Example items include “My wor- ries overwhelm me” and “I know I shouldn’t worry about things, but I just can’t help it.” High internal consistency and good test–retest reliability have been established for the PSWQ (Meyer et al., 1990).

Beck Depression Inventory-II The Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996)isa 21-item self-report instrument assessing the severity of depressive symptoms. The intensity of symptoms is rated on a scale of 0–3. Individuals are asked to choose a statement from each group of statements that best describes their feelings. An example is: 0 = I do not feel sad,1 = I feel sad much of the time,2 = Iamsad all the time, and 3 = I am so sad or unhappy that I can’t stand it. The BDI-II has been shown to have good internal consistency for student (α = .93) and psychiatric (α = .92) samples.

Social Interaction Anxiety Scale The Social Interaction Anxiety Scale (SIAS; Mattick & Clarke, 1998) is a 19- item measure that assesses fear of interacting with others. Items are rated on the following 5-point scale: not at all (0), slightly (1), moderately (2), very (3), and extremely (4). Sample items include “I have difﬁculty talking with other people” and “I worry about expressing myself in case I appear awkward.” According to Heimberg and Turk (2002), a 20-item version, which includes an additional reverse-scored item, “I ﬁnd it easy to make friends my own age,” is used more frequently in research. The SIAS has been shown to have high internal consistency and test-retest reliability (Mattick & Clarke, 1998).

Procedure After signing a consent form, participants completed a packet including a demographic questionnaire and ﬁve self-report questionnaires (AAQ, BDI-II, F-MPS, PSWQ, and SIAS). The demographic questionnaire was presented ﬁrst, with the re- maining questionnaires counterbalanced to control for order effects. Packets were distributed in classes and athletic study halls. 326 Santanello and Gardner

RESULTS

Descriptive statistics for the F-MPS, AAQ, PSWQ, BDI-II, and SIAS are presented in Table I. Pearson product-moment correlations were computed to determine whether there were any significant relationships between variables (see Table I). To test the hypothesis that experiential avoidance mediates the relationship between maladaptive perfectionism and worry, Baron and Kenny’s method for test- ing mediation (Baron & Kenny, 1986; Holmbeck, 1997) was utilized. The following four conditions had to be met: (1) the predictor variable (maladaptive perfectionism) must be significantly associated with the mediator (experiential avoidance), (2) the predictor variable must be significantly associated with the criterion variable (worry), (3) the mediator must be significantly associated with the criterion variable, and (4) the impact of the predictor variable on the criterion variable must be less after controlling for the mediator. To examine whether the criteria for mediation were met, three separate regression analyses were conducted (Baron & Kenny, 1986; Holmbeck, 1997). The first regression analysis showed that maladaptive perfectionism significantly predicted experiential avoidance, and the second regression equation indicated that maladaptive perfectionism significantly predicted worry (see Table II). In the third regression equation, maladaptive perfectionism and experiential avoidance were used as predictors of worry (see Table III). Experiential avoidance was significantly related to worry, and the relationship between maladaptive perfectionism and worry was less in this third equation (β = .17, p = .05) than in the second equation (β = .33, p<.001). Given that the association between maladaptive perfectionism and worry remained significant, results suggest that experiential avoidance is a partial mediator in this relationship.

Table I. Pearson Product-Moment Correlations and Descriptives Correlation Variable AAQ PSWQ BDI-II SIAS MSD F-MPS Total .37∗∗∗ .31∗∗∗ .25∗∗ .23∗∗ 81.49 19.05 PS .14 .14 .08 .09 25.18 5.25 CMD .42∗∗∗ .42∗∗∗ .35∗∗∗ .32∗∗∗ 32.69 9.87 PEC .22∗ .14 .12 .12 23.57 7.68 CMD + PEC .37∗∗∗ .33∗∗∗ .27∗∗ .25∗∗ 56.30 15.68 AAQ .46∗∗∗ .52∗∗∗ .25∗∗ 69.65 9.28 PSWQ .51∗∗∗ .36∗∗∗48.67 14.07 BDI-II .29∗∗ 10.22 8.96 SIAS 21.92 12.01 Note. F-MPS: Frost Multidimensional Perfectionism Scale; Total: Total score; PS: Per- sonal Standards (Adaptive Perfectionism); CMD: Concern over Mistakes and Doubts; PEC: Parental Expectations and Criticism; CMD + PEC: Concern over Mistakes and Doubts plus Parental Expectations and Criticism (Maladaptive Perfectionism); AAQ: Ac- ceptance and Action Questionnaire; PSWQ: Penn State Worry Questionnaire; BDI-II: Beck Depression Inventory II; SIAS: Social Interaction Anxiety Scale. ∗ p <. 05. ∗∗p < .01. ∗∗∗p < .001. Perfectionism, Experiential Avoidance, and Worry 327

Table II. Regression Results for Prediction of Experiential Avoidance and Worry from Maladaptive Perfectionism Variable β RR2 F DV—Experiential avoidance Maladaptive perfectionism .37 .37 .14 19.60∗∗∗ DV—Worry Maladaptive perfectionism .33 .33 .11 14.98∗∗∗ Note. Beta weights are standardized. ∗∗∗p < .001.

Following the series of multiple regression equations, a test for the indirect effect of the predictor variable on the criterion variable via the mediator was calculated. The Aroian version (Aroian, 1944/1947) of the Sobel test (Sobel, 1982) was used, as recommended by Baron and Kenny (1986). Results indicated a significant indirect effect of maladaptive perfectionism on worry via experiential avoidance, z = 3.16, p < .01. Thus, the association between maladaptive perfectionism and worry was significantly reduced by the inclusion of experiential avoidance. Partial correlations were conducted in order to determine whether aspects of maladaptive perfectionism and experiential avoidance have unique associations with worry (see Table IV). The correlations revealed that experiential avoidance and CMD remained significantly associated with worry after depression and social anxiety were partialed out. Additionally, partial correlations were conducted between worry and aspects of maladaptive perfectionism while controlling for depression, social anxiety, and experiential avoidance. Only CMD remained significantly related to worry.

DISCUSSION

This study examined the hypothesis that the relationship between maladaptive perfectionism and worry would be mediated by experiential avoidance. Results suggest that experiential avoidance may partially, rather than fully, mediate the relationship between maladaptive perfectionism and worry. These ﬁndings highlight the importance of the role that experiential avoidance plays in the relationship between maladaptive perfectionism and worry while at the same time suggest that other factors also may inﬂuence this relationship.

Table III. Regression Results for Prediction of Worry from Maladaptive Perfectionism and Experiential Avoidance Variable β R for set R2 for set F for set Maladaptive perfectionism .17 .49 .24 18.70∗∗∗ Experiential avoidance .40 Note. Beta weights are standardized. ∗∗∗p < .001. 328 Santanello and Gardner

Table IV. Partial Correlations PSWQ Controlling for depression, Controlling for depression social Anxiety, and Variable and social anxiety experiential avoidance AAQ .26∗∗∗ — F-MPS Total .17 .12 CMD .23∗∗ .18∗ CMD + PEC .17 .12 Note. AAQ: Acceptance and Action Questionnaire; F-MPS: Frost Multidimensional Per- fectionism Scale; Total: Total score; CMD: Concern over Mistakes and Doubts; CMD + PEC: Concern over Mistakes and Doubts plus Parental Expectations and Criticism (Mal- adaptive Perfectionism); PSWQ: Penn State Worry Questionnaire. ∗ p = .05. ∗∗p < .05. ∗∗∗p < .01.

Similar to research results showing relationships between aspects of perfectionism and avoidance coping (Dunkley & Blankstein, 2000; O’Connor & O’Connor, 2003), this study found that maladaptive perfectionism was significantly related to experiential avoidance. As levels of maladaptive evaluation concerns increased, so did a tendency to avoid aversive thoughts and feelings. Additionally, a significant relationship was found between experiential avoidance and worry in that higher levels of experiential avoidance were associated with higher levels of worry. This significant correlation is consistent with findings from Roemer et al. (2005) and with the assertion that experiential avoidance is associated with various forms of psychopathology (Hayes et al., 1996, 1999). When predicting worry from maladaptive perfectionism and experiential avoidance, the addition of experiential avoidance reduced the association between maladaptive perfectionism and worry. The relationship between maladaptive perfectionism and worry remained significant, suggesting that experiential avoidance only partially mediates this relationship. However, experiential avoidance was shown to play an important role in the relationship between maladaptive perfectionism and worry, as a significant indirect effect of maladaptive perfectionism on worry via experiential avoidance was found. Dunkley and Blankstein (2000) found that maladaptive coping, which included but was not limited to avoidance coping, fully mediated the relationship between self-critical perfectionism and distress. Endler and Parker (1990, 1999) have shown that high levels of emotion-oriented and distraction avoidance coping along with low levels of task-focused coping, as measured by the Coping Inventory for Stressful Situations (CISS; Endler & Parker, 1990), are related to distress. As avoidance appears to be only one aspect of maladaptive coping, this may explain why experiential avoidance partially, but not fully, mediated the relationship between maladaptive perfectionism and worry, a form of distress. Perhaps the examination of multiple aspects of maladaptive coping (avoidance, emotion-oriented, and task-focused) would show that overall coping style fully mediates the relationship between maladaptive perfectionism and worry, with separate coping types serving as partial mediators. This could be a topic for future research Perfectionism, Experiential Avoidance, and Worry 329 studies. Additionally, the measure of experiential avoidance used in this study, the AAQ, has been found to be related to avoidance subscales of the Ways of Coping Questionnaire (WOC; Folkman & Lazarus, 1988). Future research could also inves- tigate whether the avoidance subscales of the CISS are associated with the AAQ, which would add support to the notion that experiential avoidance is one aspect of maladaptive coping. Partial correlations showed that experiential avoidance remained significantly associated with worry after controlling for depression and social anxiety. This finding suggests that experiential avoidance has a unique relationship with worry independent of depression and social anxiety, adding further support to Borkovec et al.’s (2004) theory that worry has a unique avoidant function. Additionally, a unique association was found between a feature of maladaptive perfectionism and worry. Concern over mistakes and doubts (the tendency to become upset when making mistakes, to believe that mistakes equal failure, to think that other people will react negatively to one’s mistakes, and to lack confidence in the ability to perform tasks competently) was related to worry not only after partialing out depression and social anxiety but also after controlling for depression, social anxiety, and experiential avoidance. Being overly concerned about making mistakes and doubting the ability to complete tasks proficiently seems to play an important role in worry. The direct effect between maladaptive perfectionism and worry remained significant after the inclusion of experiential avoidance, which may be due to the dis- tinctive relationship between concern over mistakes and doubts about actions and worry. This finding may explain why experiential avoidance partially, rather than fully, mediated the relationship between maladaptive perfectionism and worry. Al- ternatively, there also is a possibility that a variable not examined in this study influences the relationship between maladaptive perfectionism and worry, contributing to the finding of partial, rather than full, mediation. Weaknesses of this study should be addressed. First, the generalizability of the findings may be limited, as the sample was composed of college students. Future studies should examine the role of experiential avoidance in the relationship between maladaptive perfectionism and worry in other groups, especially clinical pop- ulations (e.g., individuals with GAD). Second, the use of self-report measures may have limited the accuracy of the data due to factors such as social desirability. Third, a cross-sectional research design was used in this study; therefore, it is not possible to determine if changes in the predictor variable (i.e., maladaptive perfectionism) pre- ceded changes in the criterion variable (i.e., worry). Without establishing temporal precedence, causal relationships among variables cannot be assumed. An additional limitation of this study involves the measurement of maladaptive perfectionism. This study measured maladaptive perfectionism in the same manner as Kawamura et al. (2001), by using subscales of the F-MPS. In the Frost et al. (1990) factor analysis of the F-MPS and the H-MPS, the Maladaptive Evaluation Concerns factor was comprised of not only the CM, DA, PC, and PE subscales of the F-MPS but also the Socially Prescribed Perfectionism (SPP) component of the H-MPS. Including both the F-MPS and H-MPS in future studies would provide a more complete method of measuring maladaptive perfectionism. 330 Santanello and Gardner

If further study supports the hypothesized relationships, this would hold impli- cations for the treatment of worry within the context of maladaptive perfectionism. For example, it may be beneﬁcial for clinicians to increase research on the utility of interventions that directly target experiential avoidance, such as Accep- tance and Commitment Therapy (ACT; Hayes et al., 1999), for individuals exhibit- ing high levels of maladaptive perfectionism and worry. The cognitive-behavioral methods for coping with perfectionism introduced by Antony and Swinson (1998) may be enhanced by the addition of therapeutic elements aimed at decreasing experiential avoidance. Additionally, the incorporation of acceptance-based therapeutic strategies and mindfulness techniques has shown promise in the treatment of GAD (Orsillo, Roemer, & Barlow, 2003). These interventions could be investigated in the treatment of individuals experiencing difﬁculties with maladaptive perfectionism as well as excessive worry. The results of this study also highlight the potential importance of examining the role of experiential avoidance in the relationship between maladaptive perfectionism and other forms of psychopathology.

Acknowledgments

The authors thank Cynthia L. Turk and Randy Fingerhut for their helpful feedback on this research project. Many thanks also to Chad Morrow, Sharon Armstrong, and Montgomery County Community College for assistance with data collection

References

Antony, M. M., & Swinson, R. P. (1998). When perfect isn’t good enough: Strategies for coping with perfectionism. Oakland, CA: New Harbinger. Aroian, L. A. (1944–1947). The probability function of the product of two normally distributed variables. Annals of Mathematical Statistics, 18, 265–271. Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182. Beck, A. T., Steer, R. A., & Brown, G. K. (1996). The Beck Depression Inventory-II: Manual.SanAnto- nio, TX: Psychological Corporation. Beck, J. S. (1995). Cognitive therapy: Basics and beyond.NewYork:GuilfordPress. Bieling, P. J., Israeli, A. L., & Antony, M. M. (2004). Is perfectionism good, bad, or both? Examining models of the perfectionism construct. Personality and Individual Differences, 36, 1373–1385. Bond, F. W., & Bunce, D. (2003). The role of acceptance and job control in mental health, job satisfaction, and work performance. Journal of Applied Psychology, 88, 1057–1067. Borkovec, T. D., Alcaine, O. M., & Behar, E. (2004). Avoidance theory of worry and generalized anxiety disorder. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 77–108). New York: Guilford Press. Borkovec, T. D., & Hu, S. (1990). The effect of worry on cardiovascular response to phobic imagery. Behaviour Research and Therapy, 28, 69–73. Borkovec, T. D., & Inz, J. (1990). The nature of worry in generalized anxiety disorder: A predominance of thought activity. Behaviour Research and Therapy, 28, 153–158. Borkovec, T. D., Ray, W. J., & Stober,¨ J. (1998). Worry: A cognitive phenomenon intimately linked to affective, physiological, and interpersonal behavioral processes. Cognitive Therapy and Research, 22, 561–576. Perfectionism, Experiential Avoidance, and Worry 331

Borkovec, T. D. & Roemer, L. (1995). Perceived functions of worry among generalized anxiety disorder subjects: Distraction from more emotional topics? Journal of Behaviour Therapy and Experimental Psychiatry, 26, 25–30. Burns, D. (1980). The perfectionist’s script for self-defeat. Psychology Today, November, 34–52. Dunkley, D. M., & Blankstein, K. R. (2000). Self-critical perfectionism, coping, hassles, and current distress: A structural equation modeling approach. Cognitive Therapy and Research, 24, 713– 730. Endler, N. S., & Parker, J. D. A. (1990). Multidimensional assessment of coping: A critical evaluation. Journal of Personality and Social Psychology, 58, 844–854. Endler, N. S., & Parker, J. D. A. (1999). Coping inventory for stressful situations (CISS): Manual. Toronto: Multi-Health Systems, Inc. Flett, G. L., Blankstein, K. L., Hewitt, P. L., & Koledin, S. (1992). Components of perfectionism and procrastination in college students. Social Behavior and Personality, 20, 85–94. Folkman, S., & Lazarus, R. S. (1988). Ways of coping questionnaire manual. Palo Alto, CA: MindGarden. Frost, R. O., Heimberg, R. G., Holt, C. S., Mattia, J. I., & Neubauer, A. L. (1993). A comparison of two measures of perfectionism. Personality and Individual Differences, 14, 119–126. Frost, R. O., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism. Cognitive Therapy and Research, 4, 449–468. Gold, D. B., & Wegner, D. M. (1995). Origins of ruminative thought: Trauma, incompleteness, nondis- closure, and suppression. Journal of Applied Social Psychology, 25, 1245–1261. Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York: Guilford Press. Hayes, S. C., Strosahl, K., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., et al. (2004). Mea- suring experiential avoidance: A preliminary test of a working model. The Psychological Record, 54, 553–578. 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, 1152–1168. Heimberg, R.G., & Turk, C. L. (2002). Assessment of social phobia. In R. G. Heimberg & R. E. Becker, Cognitive-behavioral group therapy for social phobia: Basic mechanisms and clinical strategies (pp. 107–126). New York: Guilford Press. Hewitt, P. L., & Flett, G. L. (1991). Perfectionism in the self and social contexts: Conceptualization, assessment, and association with psychopathology. Journal of Personality and Social Psychology, 60, 456–470. Holmbeck, G. N. (1997). Toward terminological, conceptual, and statistical clarity in the study of mediators and moderators: Examples from the child-clinical and pediatric psychology literatures. Journal of Consulting and Clinical Psychology, 65, 599–610. Kawamura, K. Y., Hunt, S. L., Frost, R. O., & DiBartolo, P. M. (2001). Perfectionism, anxiety, and depression: Are the relationships independent? Cognitive Therapy and Research, 25, 291–301. Mattick, R. P., & Clarke, C. J. (1998). Development and validation of measures of social phobia, scrutiny fear, and social interaction anxiety. Behaviour Research and Therapy, 36, 455–470. Mennin, D. S., Heimberg, R. G., Turk, C. L., & Fresco, D. M. (2002). Applying an emotion regulation framework to integrative approaches to generalized anxiety disorder. Clinical Psychology: Science and Practice, 9, 85–90. Meyer, T., Miller, M., Metzger, R. L., & Borkovec, T. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28, 487–495. O’Connor, R. C., & O’Connor, D. B. (2003). Predicting hopelessness and psychological distress: The role of perfectionism and coping. Journal of Counseling Psychology, 50, 362–372. Orsillo, S. M., Roemer, L., & Barlow, D. H. (2003). Integrating acceptance and mindfulness into existing cognitive-behavioral treatment for GAD: A case study. Cognitive and Behavioral Practice, 10, 223– 230. Polivy, J. (1990). Inhibition of internally cued behavior. In E. T. Higgins & R. M. Sorrentino (Eds.), Handbook of motivation and cognition: Foundations of social behavior (pp. 131–147). New York: Guilford Press. Roemer, L., Salters, K., Raffa, S., & Orsillo, S. M. (2005). Fear and avoidance of internal experiences in GAD: Preliminary tests of a conceptual model. Cognitive Therapy and Research, 29, 71–88. Saboonchi, F., & Lundh, L. G. (1997). Perfectionism, self-consciousness, and anxiety. Personality and Individual Differences, 22, 921–928. Slade, P. D., & Owens, R. G. (1998). A dual process model of perfectionism based on reinforcement theory. Behavior Modiﬁcation, 22, 372–390. 332 Santanello and Gardner

Sobel, M. E. (1982). Asymptomatic intervals for indirect effects in structural equations models. In S. Leinhart (Ed.), Sociological methodology 1982 (pp. 290–312). San Francisco: Jossey-Bass. Stober,¨ J. (1998). The Frost Multidimensional Scale: More perfect with four (instead of six) dimensions. Personality and Individual Differences, 24, 481–491. Stober,¨ J., & Joormann, J. (2001). Worry, procrastination, and perfectionism: Differentiating amount of worry, pathological worry, anxiety, and depression. Cognitive Therapy and Research, 25, 49–60. Stober,¨ J., Tepperwien, S., & Staak, M. (2000). Worrying leads to reduced concreteness of problem elab- orations: Evidence for the avoidance theory of worry. Anxiety, Stress, and Coping, 13, 217–227.