The validity of self-report assessment of avoidance and distress

Both distress and behavioral avoidance have been implicated in the development and maintenance of many forms of psychopathology. However, it is still unclear whether these constructs can be distinguished, or whether both can independently explain comorbid psychopathology (CP) as they are normally assessed (via self-report methods). To help address these questions, we assessed distress and avoidance in relation to phobic situations via structured interview in a sample of college students (N=385) and a sample of psychiatric outpatients (N=288). Various types of psychopathology were also assessed. Structural equation modeling revealed that individuals do not readily distinguish between distress and avoidance, and that self-reported avoidance does not predict the severity of CP after distress associated with avoided situations has been taken into account. These data suggest that situational distress and avoidance cannot be clearly distinguished in self-reported assessments and raise questions concerning the common practice of relying on client report to measure avoidance. Hence, different methods are needed to obtain clinically useful ratings of avoidance.