Disordered Eating Cognitions as Predictors of Attitudes toward ...

Int J Adv Counselling (2011) 33:225–234 DOI 10.1007/s10447-011-9127-3 ORIGINAL ARTICLE

Disordered Eating Cognitions as Predictors of Attitudes toward Seeking Professional Psychological Services Keri B. Dotson & Akihiko Masuda & Lindsey L. Cohen

Published online: 12 July 2011 # Springer Science+Business Media, LLC 2011

Abstract The present study investigated whether young adults’ disordered eating cognitions predicted attitudes toward seeking professional psychological services. Two hundred and eighty three 18- to 24-year-old undergraduate students completed a survey package that included measures of disordered eating cognitions and help-seeking attitudes. Hierarchical regression analyses revealed that greater disordered eating cognitions uniquely predicted lower degrees of favorable help-seeking attitudes overall, lower stigma tolerance with respect to seeking professional psychological services, lower interpersonal openness in the context of help-seeking, and lower confidence in psychological professionals. The findings suggest that outreach interventions should, among other things, focus on stigma associated with help-seeking and disordered eating problems. Keywords Attitudes toward seeking professional psychological help . Disordered eating cognitions . Help-seeking . Gender . Ethnicity . Previous help-seeking experience

Introduction Disordered eating problems are common in adolescents and young adults worldwide, especially among females in industrialized nations (Beukes et al. 2010; Greenberg et al. 2007; Hoyt and Ross 2003; Meyer 2005; Prouty et al. 2002). For example, in the U.S., although the majority of adolescents and young adults do not meet the DSM-IV criteria for an eating disorder, research suggests that between 35% and 50% of young females experience some form of disordered eating problem (e.g., Berg et al. 2009; Meyer 2005). Additionally, although U.S.-European American women have been the primary target of disordered eating treatment, young males and ethnic minority females in the U.S. also experience disordered eating problems (e.g., Lavender and Anderson 2010; Rogers and Petrie 2010; Mintz and Kashubeck 1999; Timko et al. 2010). Despite the potential health risks associated with disordered eating (e.g., Tyrka et al. 2003), individuals with such K. B. Dotson : A. Masuda (*) : L. L. Cohen Georgia State University, Atlanta, GA, USA e-mail: [email protected]

226

Int J Adv Counselling (2011) 33:225–234

problems are hesitant to seek professional psychological services (Cachelin and Striegel-Moore 2006; Meyer 2005; Prouty et al. 2002).

Disordered Eating Cognitions Recent evidence suggests that disordered eating cognitions are pervasive among nonclinical college samples (Miller et al. 2009; Masuda and Wendell 2010). Disordered eating cognitions are multi-dimensional and include the fear of gaining weight, perceived importance of having an ideal weight and shape as a means of being accepted by others, and perceived self-worth related to self-control over diet and weight (Fairburn 2008; Fairburn et al. 2003; Mizes et al. 2000). In both clinical and non-clinical samples, research has demonstrated that these cognitions are associated with disordered eating behaviors (Miller et al. 2009), general psychological distress (Masuda et al. 2010; Masuda and Wendell 2010; Stice et al. 1998), and help-seeking behaviors and attitudes (e.g., Cramer 1999; Mond et al. 2009).

Help-Seeking Attitudes Little is known about help-seeking decisions for disordered eating problems. Nevertheless, several factors contribute to barriers against seeking professional psychological services. These include a lack of knowledge of available services (Meyer 2001), a limited awareness of a need for counseling (Cachelin and Striegel-Moore 2006), a fear of social stigmatization (Hepworth and Paxton 2007), and a lack of confidence in psychological professionals or the likely effectiveness of treatment (Meyer 2005). One construct that has been investigated in help-seeking research is attitudes toward seeking professional psychological help (Fischer and Farina 1995; Fischer and Turner 1970; Obasi and Leong 2009; Vogel et al. 2007). According to Fischer and Turner (1970), attitudes toward seeking professional psychological services consist of the following four specific attitudinal factors: (i) recognition of personal need for professional help, (ii) tolerance of stigma associated with psychotherapy, (iii) interpersonal openness regarding one’s problems, and (iv) confidence in the ability of the psychological professional to be of assistance. They also suggest that the combination of recognition of need and confidence in the mental health profession reflects the essence of help-seeking attitudes, which would be most directly associated with actual help-seeking decisions. Research has also demonstrated that gender, previous experience of seeking professional psychological services, and ethnic background are predictors of help-seeking attitudes (Fischer and Farina 1995; Fischer and Turner 1970; Masuda et al. 2005; Masuda et al. 2009a, b).

Disordered Eating Problems and Help-Seeking Attitudes Evidence regarding the link between disordered eating problems and help-seeking attitudes is limited. A recent study (Hackler et al. 2010) indicated that disordered eating symptoms, which involve both cognitive and behavioral elements, are not associated with attitudes toward seeking counseling. However, previous literature suggests an inverse association between symptoms of severity of disordered eating and help-seeking attitudes (Meyer 2005; Mond et al. 2009). Clearly, additional research is needed in order to help resolve such a


227

discrepancy in findings. Further, it is unclear whether the cognitive domain of disordered eating is associated with help-seeking attitudes overall, and whether these cognitions differentially predict specific forms of help-seeking attitudes, such as recognition of need and confidence in psychological services.

Present Study There are no published data examining associations between disordered eating cognitions and help-seeking attitudes. Studying these variables in young adults would be important given the pervasiveness of disordered eating problems in this population (Hoyt and Ross 2003) and the fact that that disordered eating cognitions are a major component of such problems in young adults (Miller et al. 2009). In the present study we investigated whether disordered eating cognitions are associated with overall help-seeking attitudes, as well as with specific help-seeking attitudes of recognition of need, stigma tolerance, interpersonal openness, and confidence in psychological professionals in the context of seeking professional psychological services. Consistent with the literature (e.g., Meyer 2005; Mond et al. 2009), it was predicted that disordered eating cognitions would be inversely associated with favorable help-seeking attitudes overall and with specific help-seeking attitudes in particular. Similarly, these questions in regard to the relation between cognitions and attitudes were considered while controlling for effects of gender, ethnicity, and previous help-seeking experience.

Method Participants The study was conducted at a large, public, 4-year university in Georgia, USA. Participants were recruited from undergraduate psychology courses. Four hundred and one participants completed the data instruments, with a mean completion time of 30 min (SD=15.56). Those who completed the measures in less than 15 min or more than 45 min were removed from the sample because of the questionable validity of their responses (n=84). Three hundred and seventeen participants remained (nFemale =234), ranging in age from 17 to 46 (M=20.88, SD= 4.30). Thirty-three participants who were younger than 18 years or older than 25 years were excluded based on outlier analyses of age. The final sample consisted of 283 participants (nfemale=213) ranging in age from 18 to 25 (M=19.67, SD=1.44). The sample was ethnically diverse, reflecting the demographics of the city where the University is located, with 41% (n=117) identifying as “European American,” 28% (n=80) identifying as “African American,” 18% (n=52) identifying as “Asian American,” 4% (n=12) identifying as “Hispanic American,” and 8% (n=22) identifying as “bicultural” or “other.” Measures Disordered Eating Cognitions The Mizes Anorectic Cognitions Questionnaire-Revised (MAC-R; Mizes et al. 2000) is a 24-item self-report questionnaire designed to assess distorted cognitions related to all eating

228


disorders. The cognitions involved are the fear of weight gain (e.g., “When I see someone who is overweight, I worry that I will be like him/her”), the importance of being thin or attractive to be socially accepted (“No one likes fat people; therefore, I must remain thin to be liked by others”), and self-esteem based on controlled eating habits and weight gain (“If my weight goes up, my self-esteem goes down”). Each item is scored on a 5-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree), with a total score derived from the sum of all responses. Total scores range from 24 to 120 with higher scores indicating greater disordered eating-related dysfunctional cognitions. Prior research has demonstrated good internal consistency of the MAC-R, with a Cronbach’s alpha of .90 (Mizes et al. 2000). Help-Seeking Attitudes The Attitudes toward Seeking Professional Psychological Help (ATSPPH; Fischer and Turner 1970) was used to measure various help-seeking related attitudes. The ATSPPH Scale consists of 29 items and each item contains a statement scored on a 4-point scale ranging from 0 (strongly disagree) to 3 (strongly agree). Consistent with modifications by Atkinson and Gim (1989), the ATSPPH version utilised substituted the words psychologist-counselor and psychological counseling center for psychiatrist and mental health center, respectively. The modified version was used because the current study was with college students and focused on mild psychological conflicts rather than severe psychological disorders. In addition to a Total score, the ATSPPH produces the following four subscale scores: (i) Recognition of Need, (ii) Stigma Tolerance, (iii) Interpersonal Openness, and (iv) Confidence. The Total scale score consists of the sum of all items, with higher scores suggesting greater positive attitudes overall toward seeking professional psychological services. The Recognition of Need subscale consists of eight items and is designed to measure awareness of need for psychological help (e.g., “A person with a strong character can get over mental conflicts by herself or himself, and would have little need of a psychologist-counselor”). The Stigma Tolerance subscale consists of five items assessing the tolerance of stigma associated with seeking professional psychological help (e.g., “I would feel uneasy going to a psychologist-counselor because of what some people would think”). The Interpersonal Openness subscale contains seven items and measures interpersonal openness with respect to sharing one’s personal problem with a psychological professional (e.g., “I would willingly confide intimate matters to an appropriate person if I thought it might help me or a member of my family”). Finally, the Confidence subscale, including nine items, is designed to measure an individual’s confidence in psychological health professionals (“If a good friend asked my advice about a mental problem, I might recommend that she or he see a psychologist-counselor”). The ATSPPH Scale has moderately high reliability (Fischer and Turner 1970), with a Total score Cronbach’s alpha of .83 and subscale score alphas ranging from .62 to .74. Testretest reliability estimates of .73 to .89 have been found for the Total score when examined from 5 days to 2 months respectively (Fischer and Turner 1970). Procedure As mentioned earlier, participants were recruited from undergraduate psychology courses through a web-based research participant pool. Those, who enrolled in the study, were asked to complete an anonymous web-based survey. Prior to the start of the survey itself, information relevant to the study was presented on the computer screen explaining the


229

purpose of the study and providing instructions regarding how to respond. Participants anonymously provided demographic information and then completed the measures.

Results Descriptive statistics and correlations among the variables are shown in Table 1. In the present analyses, gender was dummy coded as 1 = male and 2 = female, ethnicity as 1 = non-Hispanic European American and 2 = ethnic minority American, and previous helpseeking experience as 1 = past experience and 2 = no past experience. Disordered eating cognitions (MAC-R) were found to be negatively associated with help-seeking attitudes overall, and with stigma tolerance, interpersonal openness, and confidence regarding seeking professional psychological services. Gender was found to be associated with the help-seeking attitudes overall, and with personal recognition of need of seeking professional services, and interpersonal openness. Being a female was associated with more positive help-seeking attitudes overall, and with greater recognition of need, and greater interpersonal openness. Ethnicity and past experience were both found to be associated with attitudes overall, and with all of the specific help-seeking attitudes. Thus, being a European American and having previous help-seeking experience was related to more positive help-seeking attitudes overall, and with greater recognition of need, greater stigma tolerance, greater interpersonal openness and greater confidence in seeking professional psychological services. A series of hierarchical regressions controlling for gender, ethnic background, and past experience of seeking professional psychological services was conducted to investigate whether disordered eating cognitions uniquely predicted overall and specific help-seeking attitudes (Table 2). In each regression analysis, gender, ethnicity, and past experience were entered in the first step, followed by disordered eating cognitions in the second step.

Table 1 Means, standard deviations, coefficient alphas, and zero-order relations between all variables 1 1. ATSPPH Total 2. ATSPPH-RN

2

– .83**

3

4

5

6

7

–

.69**

.38**

4. ATSPPH-IPO

.71**

.41**

.43**

5. ATSPPH-C

.86**

.68**

.49**

.40**

−.28**

−.17**

−.13*

−.15*

.08

.09

−.20**

−.03

−.07 −.05

– –

6. MAC-R

−.15*

.05

7. Gender

−.14*

.16**

.03

8. Ethnicity

−.31**

−.27**

−.24**

−.24** 50.32

−.33** 12.28

−.14* 9.52

−.14* 12.10

−.12* 16.43

−.15* 61.15

11.79

4.25

2.89

3.59

4.34

15.07

.86

.71

.65

.63

.73

.89

SD α

9

–

3. ATSPPH-ST

9. Past Experience M

8

.27**

– – – .25**

–

ATSPPH Attitudes toward Seeking Professional Psychological Help; RN Recognition of Need; ST Stigma Tolerance; IPO Interpersonal Openness; C Confidence; MAC-R Mizes Anorectic Cognition-Revised N=283; *p