The Structure of Avoidance Following Trauma

Abstract

Avoidance is a key maintenance factor in traumatic reactions but currently no satisfactory measures of it exist. Previous factor analytic studies have demonstrated a distinction between conscious attempts to avoid trauma-related stimuli (e.g., trying not to talk or think about the event) versus nonconscious avoidance processes (e.g., emotional numbing, amnesia). Here we develop and validate a multidimensional measure of trauma-related avoidance across two samples. In Sample 1, 485 emergency service personnel completed a 44-item self-report measure of avoidance in relation to an identified occupational trauma. Principal components analysis provided evidence for a distinction between controlled and automatic avoidance. On the basis of these results a 20-item measure, the Posttraumatic Avoidance Scale (PAS), was constructed. The predictive validity of the PAS was established in a longitudinal study utilizing 6-month follow-up data from the emergency service personnel sample. Test-retest reliability was found to be very good for this 6-month period (correlations > .70) for both PAS controlled and automatic avoidance subscales. Sample 2 illustrated the transdiagnostic potential of the PAS in an eating disordered sample, all of whom reported to have experienced at least one traumatic event. Support was found for the two-factor structure of the PAS as well as for the convergent validity within this sample. The internal consistency of the PAS was assessed within both samples (Cronbach’s alphas > .80) for both controlled and automatic avoidance subscales. This measure of trauma-related avoidance is the first to intentionally assess trauma-related avoidance symptoms in this bidimensional manner.