The Relations of Anxiety Sensitivity, Experiential Avoidance, and Alexithymic Coping to Young...

BEHAVIOR MODIFICATION / April 2002Stewart et al. / MOTIVATIONS FOR DRINKING

The authors examined whether motivations for drinking alcohol are associated with the anxiety-related dispositional tendencies of anxiety sensitivity, experiential avoidance, and alexithymiccoping. The authors administered the Anxiety Sensitivity Index, Experiential Avoidance Scale,20-item Toronto Alexithymia Scale, Revised Drinking Motives Questionnaire, and a demo-graphics questionnaire to 182 university drinkers. In multiple regressions, the dispositional fac-tors significantly predicted the risky drinking motives of coping, enhancement, and conformity.Coping and enhancement motives were significantly predicted by experiential avoidance. Con-formity motives were significantly and independently predicted by anxiety sensitivity andalexithymia. The process of experiential avoidance mediated the bivariate correlation betweenanxiety sensitivity and coping-motivated drinking to a greater extent than did the process ofalexithymic coping. The authors discuss the observed relations in regard to the psychologicalfunctions of drinking behavior that may portend the development of heavy drinking and alcoholproblems in dispositionally vulnerable individuals. They also review implications for refine-ments of behavior therapy for problem drinkers.

The Relations of Anxiety Sensitivity,Experiential Avoidance, and

Alexithymic Coping to YoungAdults’ Motivations for Drinking

SHERRY H. STEWARTDalhousie University

MICHAEL J. ZVOLENSKYGEORG H. EIFERTWest Virginia University

North American young adults use alcohol more frequently than anyother recreational drug, and heavy use of alcohol is extremely preva-lent among university undergraduates (O’Hare, 1990; Prendergast,1994; Wechsler, Davenport, Dowdall, Moeykens, & Castillo, 1994;Wechsler, Dowdall, Maenner, Gledhill-Hoyt, & Lee, 1998). Although

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AUTHORS’ NOTE: This study was supported, in part, by operating grants from the AlcoholicBeverage Medical Research Council and the Social Sciences and Humanities Research Council

BEHAVIOR MODIFICATION, Vol. 26 No. 2, April 2002 274-296© 2002 Sage Publications

alcohol experimentation may be a normative phase in the transitionfrom adolescence to adulthood (Mann, Chassin, & Sher, 1987), heavydrinking increases individual susceptibility to physical, social, aca-demic, and psychological problems in many university students(Prendergast, 1994; Wechsler et al., 1994, 1998).

In an effort to better understand the origins of heavy drinking andalcohol problems, researchers have started to explore the motiva-tions underlying drinking behavior (Cooper, 1994; Cooper, Russell,Skinner, & Windle, 1992). For example, W. M. Cox and Klinger(1988) proposed a model of alcohol use motivations that contends thatindividuals use alcohol to obtain certain desired outcomes and thatthese desired drinking outcomes involve mood alterations (i.e.,increasing positive mood states or decreasing negative mood states).Expanding on the work of Cox and Klinger, Cooper (1994) proposed afour-factor model of drinking motivations in which reasons for alco-hol use are described along two primary dimensions—valence andsource. With respect to valence of the desired outcome of drinking, aperson might consume alcohol to achieve a positive outcome (positivereinforcement) or avoid or escape a negative outcome (negative rein-forcement). With respect to the source of the desired drinking out-come, a person might drink alcohol to achieve an internal reward (e.g.,manipulation of an emotional state) or external reward (e.g., peerapproval). In total, this categorical system yields four drinkingmotives: (a) internal, positive reinforcement motives (enhancementmotives); (b) external, positive reinforcement motives (socialmotives); (c) internal, negative reinforcement motives (copingmotives); and (d) external, negative reinforcement motives (confor-mity motives).

Research using the Drinking Motives Questionnaire (Cooper et al.,1992; Stewart, Zeitlin, & Samoluk, 1996) or its revised version (the

Stewart et al. / MOTIVATIONS FOR DRINKING 275

of Canada awarded to the first author, by a grant-in-aid-of-research from the Sigma Xi ResearchSociety awarded to the second author, and by a research grant from the Eberly Family Trustawarded to the third author. The authors would like to thank Brent Conrad, Paula MacPherson,and Heather Lee Loughlin for their research assistance at the Dalhousie University site andCourtney Churches for her research assistance at the West Virginia University site. Pleaseaddress all correspondence concerning this article to the first author at the Department of Psy-chology, Dalhousie University, Life Sciences Centre, 1355 Oxford Street, Halifax, Nova Scotia,Canada B3H 4J1; e-mail: [email protected]; fax: 902-494-6585.

Revised Drinking Motives Questionnaire) (Cooper, 1994) has shownthat each of these four drinking motives predicts unique aspects ofdrinking behavior (Carrigan, Samoluk, & Stewart, 1998; Cooper,1994; Cooper et al., 1992; Stewart & Chambers, 2000). Enhancement,coping, and conformity motives have been described as “risky” rea-sons for drinking due to their established associations with drinking-related problems (Cooper, 1994; Cooper et al., 1992). Moreover, thenegative reinforcement coping and conformity motives scores predictdrinking problems even after accounting for levels of alcohol use,whereas the positive reinforcement enhancement and social motivesscores do not. These findings suggest that drinking motivated by adesire to avoid or escape negative consequences may serve a moremaladaptive or pathological function for drinking compared to drink-ing aimed at attaining positive incentives or rewards (Cooper, 1994).With respect to the source dimension, Cooper et al. (1992) have sug-gested that internally motivated drinkers should be more likely thanexternally motivated drinkers to consume alcohol to satisfydispositionally based personal needs, thus accounting for the higherlevels of alcohol use seen in coping- and enhancement-motivateddrinkers (Cooper et al., 1992).

Although it stands to reason that different types of individualswould desire different outcomes from drinking (Cooper, 1994), fewresearchers have examined the relations between dispositional vari-ables and drinking motives. Stewart and Devine (2000) conducted astudy using the four-factor Revised Drinking Motives Questionnaire(Cooper, 1994) with undergraduate drinkers to place drinking motiveswithin the five-factor model of personality (Costa & McCrae, 1992).Results indicated that personality variables were significant predic-tors of the internal drinking motives: high levels of neuroticism pre-dicted higher coping motives scores, whereas high extraversion andlow conscientiousness predicted higher enhancement motives scores.Similar to Stewart and Devine’s findings for neuroticism, Stewart andZeitlin (1995) found trait anxiety and anxiety sensitivity were inde-pendent predictors of coping motives scores but shared no linear rela-tion with social or enhancement motives scores of the originalthree-factor Drinking Motives Questionnaire (Cooper et al., 1992).Conrod, Pihl, and Vassileva (1998) replicated the significant relation

276 BEHAVIOR MODIFICATION / April 2002

between coping-motivated drinking and anxiety sensitivity in a studyusing the Anxiety Sensitivity Index (Peterson & Reiss, 1992) and thethree-factor Drinking Motives Questionnaire with young adult men.Similarly, using an author-compiled measure of drinking motives,Stewart, Karp, Pihl, and Peterson (1997) found anxiety sensitivity lev-els were only related to higher levels of coping reasons for drinking.

Although anxiety sensitivity appears to be associated with anincreased tendency to drink to cope with negative affect (Conrod et al.,1998; Stewart, Karp et al., 1997; Stewart & Zeitlin, 1995), anxietysensitivity is also associated with other dispositional variables thatmight account for this association equally well or better. For example,using the Anxiety Sensitivity Index and the 20-item TorontoAlexithymia Scale (Bagby, Parker, & Taylor, 1994), Devine, Stewart,and Watt (1999) found that high levels of anxiety sensitivity wereassociated with an increased tendency to use “alexithymic” copingstrategies (B. J. Cox, Swinson, Shulman, & Bourdeau, 1995). It is pos-sible that a high level of fear of anxiety-related sensations may moti-vate the use of alexithymic coping strategies (emotional constric-tion) to avoid anxiety-related sensations (Devine et al., 1999).Similarly, using the Anxiety Sensitivity Index and the 16-item Experi-ential Avoidance Scale (Hayes, Berg et al., 1996), Forsythe, Parker,and Finlay (in press) found that high anxiety sensitivity levels in sub-stance abusers were significantly associated with experiential avoid-ance—the tendency to attempt to escape or avoid unwanted internalevents (Hayes & Gifford, 1997). Taken together, the dispositional con-structs of alexithymic coping, experiential avoidance, and anxietysensitivity have all been suggested to increase individual susceptibil-ity to excessive drinking and alcohol problems (Finn, Martin, & Pihl,1987; Hayes, Wilson, Gifford, Follette, & Strosahl, 1996; Stewart,Samoluk, & MacDonald, 1999). It further stands to reason that each ofthese dispositional constructs may be linked to certain risky drinkingmotives that in turn could set the occasion for heavy drinking and thedevelopment of alcohol-related problems.

One aim of this study was to extend previous findings of relationsbetween anxiety sensitivity and drinking motives (Conrod et al., 1998;Stewart, Karp et al., 1997; Stewart & Zeitlin, 1995). By using thefour-factor Revised Drinking Motives Questionnaire, which, unlike the


three-factor Drinking Motives Questionnaire, includes a ConformityMotives subscale (Cooper, 1994), we assessed whether anxiety sensi-tivity is related to general negative-reinforcement-motivated drinking(i.e., both coping and conformity motives) or whether it is related onlyto the internal, negative reinforcement motive of coping (Stewart &Devine, 2000). In addition, we included the assessment of alternativedispositional constructs known to be correlated with anxiety sensitiv-ity (i.e., alexithymic coping, experiential avoidance), which them-selves might be related to certain risky drinking motives. We hypothe-sized that anxiety sensitivity, experiential avoidance, and alexithymiccoping would show moderate to high degrees of shared variance (cf.Devine et al., 1999; Forsyth et al., in press). We also hypothesized thatthese dispositional constructs (as a block) would significantly predictthe three risky drinking motives (i.e., coping, conformity, andenhancement motives) (Cooper, 1994) in multiple regressions. Spe-cifically, anxiety sensitivity, alexithymic coping, and experientialavoidance would prove significant and independent predictors of cop-ing motives. Given that anxiety sensitivity includes “social concerns”(McWilliams, Stewart, & MacPherson, 2000; Stewart, Taylor, &Baker, 1997; Zvolensky, McNeil, Porter, & Stewart, 2001), we alsohypothesized that elevated anxiety sensitivity levels would be a signif-icant predictor of conformity motives. Although we expected all of thedispositional constructs to be related to coping motives, only experi-ential avoidance should be associated with both coping and enhance-ment motives (Hayes, Wilson et al., 1996).

A second aim of this study was to examine the role of experientialavoidance and alexithymic coping in mediating the hypothesized rela-tions between anxiety sensitivity and coping-motivated drinking.Both experiential avoidance and alexithymic coping have been con-ceptualized by some researchers as process variables that may con-tribute to anxiety-based psychopathology (Devine et al., 1999; Hayes& Gifford, 1997). For example, ineffective internally oriented avoid-ance responding may paradoxically increase the probability andintensity of the feared internal events, potentially leading to adversepsychological outcomes (Eifert, Forsyth, Zvolensky, & Lejuez, 1999;Hayes & Gifford, 1997; Zvolensky, Lejuez, & Eifert, 1998). Given thestrong relations between anxiety sensitivity and the processes of


alexithymic coping and experiential avoidance observed in previousresearch (e.g., Devine et al., 1999; Forsyth et al., in press), alexithymiccoping and/or experiential avoidance processes may at least partiallymediate the well-documented relation between anxiety sensitivity andcoping-motivated drinking (Stewart & Zeitlin, 1995). According tosuch a model, high levels of anxiety sensitivity could motivate individ-uals to avoid certain unwanted private events (experiential avoidance)and/or to constrict emotions (alexithymic coping) to avoid fearedanxiety-related bodily sensations; these cognitive-emotional pro-cesses may, in turn, be at least partially responsible for the higher lev-els of coping-motivated drinking previously observed among highanxiety-sensitive individuals (Stewart & Zeitlin, 1995).

METHOD

PARTICIPANTS

A total of 205 undergraduate students from Dalhousie and WestVirginia Universities voluntarily participated in this study. Partici-pants were primarily Caucasian. Of these 205 students, 89% wereself-classified as “drinkers” (i.e., having consumed alcohol at leastonce during the past year). These 182 drinkers (109 women, 73 men)had a mean age of 22.3 (SD = 5.4) years. Only the data from theself-classified drinkers were employed in subsequent analyses, ascompletion of the Revised Drinking Motives Questionnaire requiresthat the respondent have consumed at least some alcohol within thepast year (Stewart et al., 1996).

MATERIALS

Experiential Avoidance Scale. The Experiential Avoidance Scale(Hayes, Bergan et al., 1996) is a relatively new 16-item self-reportmeasure of experiential avoidance. The questionnaire contains 10 itemspertaining to experiential avoidance (e.g., “I try to suppress thoughtsand feelings that I don’t like by just not thinking about them”) and 6items pertaining to psychological acceptance (e.g., “It’s OK to feel


depressed or anxious”). Respondents rate the degree to which eachstatement is true of them on a Likert-type scale ranging from 1 (nevertrue) to 7 (always true). A confirmatory factor analysis of ExperientialAvoidance Scale item responses provided support for a 2-factor solu-tion (i.e., avoidance/immobility vs. acceptance/action). However, abipolar single-factor solution provided the best model fit, with avoid-ance/immobility items loading positively at one end and accep-tance/action items loading negatively at the other (Walser, Townsend,Wilson, & Hayes, 1996), supporting the use of a total score on thismeasure with acceptance/action items being reverse scored. The totalscore on this scale shows good concurrent validity in terms of its abil-ity to predict higher levels of depression, anxiety, and general psycho-logical distress (Hayes, Bergan et al., 1996). In the present study, onlyExperiential Avoidance Scale total scores were used.

Toronto Alexithymia Scale–20 item version. The TorontoAlexithymia Scale–20 (Bagby, Parker et al., 1994) is a self-reportmeasure of alexithymia, consisting of seven items pertaining to diffi-culty identifying emotions (e.g., “I have feelings that I can’t quiteidentify”), five items pertaining to difficulty describing emotions(e.g., “It is difficult for me to find the right words for my feelings”),and eight items pertaining to external-oriented thinking (e.g., “I preferto just let things happen rather than to understand why they turned outthat way”). Respondents rate each item on a Likert-type scale rangingfrom 1 (strongly disagree) to 4 (strongly agree). The scale consists ofthree factors that are significantly intercorrelated, justifying the use ofa single summary score for some research purposes (Bagby, Parkeret al., 1994). The Toronto Alexithymia Scale–20 total score, whichwas used in the present study, has good internal consistency and hightest-retest reliability (Bagby, Parker et al., 1994). High total scores onthis scale have been shown to be associated with high anxiety, depres-sion, self-consciousness, and vulnerability and with low receptivity toone’s own inner feelings (Bagby, Taylor, & Parker, 1994). The totalscore on the Toronto Alexithymia Scale–20 also correlates positivelywith observer ratings of alexithymia (Bagby, Taylor et al., 1994).


Revised Drinking Motives Questionnaire. The Revised DrinkingMotives Questionnaire (Cooper, 1994) is a 20-item self-report mea-sure of the relative frequency of drinking for four conceptually andempirically distinct reasons: enhancement motives (e.g., “because itsfun”), social motives (e.g., “to celebrate a special occasion withfriends”), conformity motives (e.g., “to fit in with a group you like”),and coping motives (e.g., “to forget about your problems”). Individ-uals indicate their relative frequency of alcohol use for each of theindicated reasons when they drink. Each scale consists of five itemsthat are rated on an idiographic, relative frequency scale ranging from1 (almost never/never) to 5 (almost always/always). Subscale scoreswere computed as the mean of the relative frequency ratings for eachof the five items on each subscale (possible range of 1 to 5) (Cooper,1994). Thus, high scores on a particular drinking motive subscalerefer to individuals who usually attribute their drinking to that motive,independent of how often they drink.

Anxiety Sensitivity Index. The Anxiety Sensitivity Index (Peterson &Reiss, 1992) is a 16-item self-report questionnaire that assesses anindividual’s fear of anxiety sensations (e.g., rapid heartbeat, nausea)based on the belief that these symptoms have negative consequences(e.g., embarrassment, mental incapacitation, physical illness). Eachitem describes fear about bodily sensations or consequences of anxi-ety. Respondents rate the degree to which they agree or disagree witheach item on a Likert-type scale ranging from 0 (very little) to 4 (verymuch). This index has excellent internal consistency and goodtest-retest reliability for up to 3 years (Peterson & Reiss, 1992). Anxi-ety Sensitivity Index scores are both conceptually and empirically dis-tinct from scores on trait anxiety measures (Peterson & Reiss, 1992).Total scores on this index are elevated among patients with anxietydisorders and alcohol use disorders (Peterson & Reiss, 1992).

Demographics measure. An author-compiled questionnaire soughtinformation on three basic demographic characteristics: age, gender,and current year of university program.


PROCEDURE

The study was presented to students as a project investigating rela-tions between dispositional variables and reasons for drinking alco-hol. After providing informed consent, participants completed ques-tionnaires anonymously during class time in the above-listed order.Participants were debriefed as to study objectives and hypothesesprior to their departure.

RESULTS

SAMPLE MEANS

Table 1 presents sample means (and standard deviations) on thesubscales of the Revised Drinking Motives Questionnaires; all areconsistent with scores previously reported for nonclinical samples(e.g., Cooper, 1994; Stewart & Devine, 2000). Table 1 also presentssample means (and standard deviations) on the dispositional measures(Toronto Alexithymia Scale–20, Experiential Avoidance Scale, Anxi-ety Sensitivity Index), all of which are within the ranges previouslyreported for college student samples on these same measures (e.g.,Bagby, Parker et al., 1994; R. T. Bissett & S. C. Hayes, personal com-munication, October 1998; Peterson & Reiss, 1992). Coefficient alphaswere calculated for each measure for the total sample of drinkers (seeTable 1). All subscales of the Revised Drinking Motives Question-naire showed good levels of internal consistency, and the dispositionalmeasures showed acceptable to good levels of internal consistency(Nunnally & Bernstein, 1994).

BIVARIATE CORRELATIONS

Table 1 also presents the bivariate correlations between the threedispositional measures and the four Revised Drinking Motives Ques-tionnaire subscale scores. Given the number of correlations examined,a stringent alpha of p < .01 was employed to reduce the probability ofType I error. Anxiety sensitivity, experiential avoidance, andalexithymia all showed significant positive correlations with coping


motives scores. Anxiety sensitivity, alexithymia, and experientialavoidance also correlated with conformity motives scores.1 Asexpected, experiential avoidance, but not alexithymic coping or anxi-ety sensitivity, was correlated with enhancement motives. Contrary toour original hypotheses, experiential avoidance and alexithymia werecorrelated with social motives scores.

As hypothesized, all three dispositional measures revealed signifi-cant positive intercorrelations and shared from 24% to 35% overlap-ping variance. Anxiety sensitivity and alexithymia showed a correla-tion of r = 0.49 (p < .001), anxiety sensitivity and experientialavoidance showed a correlation of r = 0.58 (p < .001), and alexithymiaand experiential avoidance (both measures designed to tap aspects ofavoidant coping processes) showed a correlation of r= 0.59 (p< .001).Given this significant shared variance between dispositional mea-sures, it was important to determine the degree to which the bivariatecorrelations between the dispositional measures and drinking motivescould be attributed to unique variance associated with eachdispositional measure. Thus, we performed a series of multipleregression analyses.


TABLE 1Sample Means and Standard Deviations and Bivariate

Correlations Between Dispositional Constructs andDrinking Motives (N = 182 drinkers)

Drinking Motives

Dispositional Coping Conformity Enhancement Social

Construct Motives Motives Motives Motives M SD α

Anxiety sensitivity 0.33**** 0.29**** 0.00 0.08 16.31 9.14 0.88Experiential avoidance 0.43**** 0.21*** 0.17* 0.19* 49.23 11.42 0.77Alexithymic coping 0.28**** 0.29**** 0.07 0.18* 46.77 10.71 0.81M 1.88 1.46 2.71 3.22SD 0.83 0.65 1.10 0.98α 0.80 0.81 0.89 0.86

NOTE: Drinking motives were assessed with the four subscales of the Revised Drinking MotivesQuestionnaire (Cooper, 1994); anxiety sensitivity was assessed with the Anxiety SensitivityIndex (Peterson & Reiss, 1992); experiential avoidance was assessed with the ExperientialAvoidance Scale (Hayes, Bergan et al., 1996); alexithymic coping was assessed with the 20-itemversion of the Toronto Alexithymia Scale (Bagby, Parker, & Taylor, 1994).*p < .01. ***p < .005. ****p < .001.

MULTIPLE REGRESSIONS

Separate hierarchical multiple regressions were conducted to testdemographics and dispositional measures as predictors of scores onthe four subscales of the Revised Drinking Motives Questionnaire(Tabachnick & Fidell, 1989). In all four equations, age, gender, andyear of university were entered as a block in Step 1 because demo-graphic variables have previously been shown to be significantlyrelated to certain drinking motives (e.g., Cooper, 1994; Cooper et al.,1992; Stewart et al., 1996). Scores on the three dispositional measures(i.e., Anxiety Sensitivity Index, Experiential Avoidance Scale,Toronto Alexithymia Scale–20) were then entered together as a blockin Step 2 to determine if they predict drinking motives scores aboveand beyond demographic information.

Taken together in the final equations, demographics anddispositional measure scores explained 22.7% of the variance in cop-ing motives scores, F(6, 175) = 8.56, p < .0001; 14.1% of the variancein conformity motives scores, F(6, 175) = 4.78, p < .0005; 11.3% ofthe variance in enhancement motives scores, F(6, 175) = 3.72, p <.005; and 8.8% of the variance in social motives scores, F(6, 175) =2.81, p < .05. In Step 1, the block of demographic variables were sig-nificant predictors of coping motives, R2 = 0.059, F(3, 178) = 3.73, p <0.05; enhancement motives,R2 = 0.074,F(3, 178) = 4.75, p< .005; andsocial motives, R2 = 0.054, F(3, 178) = 3.41, p < .05. However, theblock of demographic variables did not predict conformity motivesscores, R2 = 0.027, F(3, 178) = 1.67, ns. When the block ofdispositional variables were added in Step 2, the dispositional mea-sures predicted an additional 16.8% of the variance in coping motivesscores, Finc(3, 175) = 14.00, p < .001; an additional 11.4% of the vari-ance in conformity motives scores,Finc(3, 175) = 7.60, p< .001; and anadditional 3.9% of the variance in enhancement motives scores,Finc(3,175) = 2.60, p < .05, above and beyond demographic information.However, the block of dispositional variables did not add significantlyto the prediction of social motives scores above and beyond demo-graphic information, Finc(3, 175) = 2.20, ns.

As expected, in the hierarchical regression predicting copingmotives, examination of the univariate effects of each predictor in thefinal equation indicated that high experiential avoidance (partial r =


0.29, p < .001) was a significant predictor of scores on the CopingDrinking Motives subscale. Contrary to our original hypothesis, anxi-ety sensitivity and alexithymia scores were unrelated to coping motivesin the context of the other predictors. Although the demographic vari-ables as a block proved significant predictors of coping motives, exami-nation of the univariate effects of each demographic variable in the finalmodel indicated that none of the demographic variables predicted cop-ing motives in the context of the other variables.

As hypothesized, in the hierarchical regression predicting confor-mity motives, examination of the univariate effects of each predictorin the final model indicated that high anxiety sensitivity (partial r =0.19, p < .05) was a dispositional predictor of conformity motives.Interestingly, high levels of alexithymic coping (partial r = 0.15, p <.05) also proved an independent significant dispositional predictor ofconformity motives. Of the three demographic measures, only malegender independently predicted conformity motives in the final model(partial r = –0.18, p < .05).2

As hypothesized, in the hierarchical regression predicting enhance-ment motives, examination of the univariate effects of each predictorindicated that high experiential avoidance (partial r = 0.21, p < .01)was the only significant dispositional predictor of scores on theEnhancement Motives subscale. In addition, younger age (partial r =–0.21, p < .01) and male gender (partial r = –0.19, p < .05) also inde-pendently predicted enhancement motives in the final model.

In the hierarchical regression predicting social motives, examina-tion of the univariate effects of each predictor indicated that none ofthe dispositional measures predicted social motives, as had beenhypothesized. However, younger age (partial r = –0.15, p < .05) andmale gender (partial r = –0.15, p < .05) independently predicted socialmotives in the final model.

MEDIATOR ANALYSES

We tested the hypothesized mediating roles (Baron & Kenny, 1986)of experiential avoidance and alexithymic coping processes, respec-tively, in explaining the significant bivariate correlation observedbetween anxiety sensitivity and coping-motivated drinking (see Table


1). The results of the set of regressions testing the mediating role ofexperiential avoidance are depicted in the upper portion of Figure 1.The results of the set of regressions testing the mediating role ofalexithymic coping are depicted in the lower portion of Figure 1. Inthis figure, partial correlation coefficients are displayed in parenthe-ses. In the upper portion of Figure 1 (test of the mediating role of expe-riential avoidance) are the partial correlation between anxiety sensi-tivity and coping motives controls for levels of experiential avoidanceand the partial correlation between experiential avoidance and copingmotives controls for anxiety sensitivity. In the lower portion of Figure1 (test of the mediating role of alexithymic coping) are the partial cor-relation between anxiety sensitivity and coping motives controls forlevels of alexithymic coping and the partial correlation betweenalexithymic coping and coping motives controls for anxietysensitivity.

For the set of regressions testing the mediating role of experientialavoidance, coping motives scores were first regressed on AnxietySensitivity Index scores. Anxiety sensitivity levels predicted CopingMotives scores, F(1, 180) = 21.70, p < .0001 (see Figure 1). Next,Experiential Avoidance Scale scores were regressed on Anxiety Sen-sitivity Index scores showing that higher anxiety sensitivity levels pre-dicted greater levels of experiential avoidance, F(1, 180) = 90.17, p <.0001 (see Figure 1). Finally, Coping Motives scores were regressedon Anxiety Sensitivity Index scores and Experiential Avoidance Scalescores simultaneously. Examination of the univariate effects of eachvariable indicated that experiential avoidance predicted scores on theCoping Motives subscale, p < .0001, whereas anxiety sensitivity nolonger predicted Coping Motives scores after accounting for the influ-ences of experiential avoidance (see Figure 1). This finding supportsthe mediating role of experiential avoidance processes in explainingthe relation between elevated anxiety sensitivity and increased coping-motivated drinking.

For the set of regressions testing the mediating role of alexithymiccoping, Coping Motives scores were first regressed on Anxiety Sensi-tivity Index scores, again showing that elevated anxiety sensitivitylevels predicted increased coping motives, F(1, 180) = 21.70, p <.0001 (see Figure 1). Regressing Toronto Alexithymia Scale– 20


scores on Anxiety Sensitivity Index scores revealed that increasedanxiety sensitivity levels significantly predicted greater alexithymiccoping, F(1, 180) = 57.18, p < .0001 (see Figure 1). Finally, copingmotives scores were regressed on Anxiety Sensitivity Index andToronto Alexithymia Scale–20 scores simultaneously. Examinationof the univariate effects of each variable indicated that higher levels ofanxiety sensitivity continued to predict greater scores on the CopingMotives subscale after the effects of alexithymia were accounted for,p < .005, whereas alexithymia was a significant, independent predic-tor of Coping Motives scores, p= .05 in the context of anxiety sensitiv-ity. Because the magnitude of the relation between anxiety sensitivityand coping motives was substantially reduced after accounting for thecontributions of alexithymic coping (see Figure 1), this finding sup-ports the process of alexithymic coping as a “partial mediator” (Baron& Kenny, 1986) of the relation between anxiety sensitivity and cop-ing-motivated drinking.

DISCUSSION

The results of this study provide further support for the contentionthat motivations for drinking alcohol are associated with anxiety-


ExperientialAvoidance

0.58**** 0.43**** (0.32)****Anxiety 0.33**** (0.13) CopingSensitivity Drinking Motives

0.33**** (0.23)***0.49**** 0.28**** (0.14)**

AlexithymicCoping

Figure 1. Summary of regression analyses evaluating the potential mediating roles ofexperiential avoidance and alexithymic coping processes in explaining relationsbetween anxiety sensitivity and coping-motivated drinking.

NOTE: Partial correlation coefficients are displayed in parentheses. Levels of significance of allbivariate and partial correlation coefficients are indicated via asterisks.**p < .05. ***p < .005. ****p < .001.

related dispositional tendencies (Conrod et al., 1998; Stewart &Devine, 2000; Stewart, Karp et al., 1997; Stewart & Zeitlin, 1995). Inparticular, coping motives correlated with anxiety sensitivity (Conrodet al., 1998; Stewart, Karp et al., 1997; Stewart & Zeitlin, 1995),alexithymic coping, and experiential avoidance. However, only expe-riential avoidance predicted Coping Motives scores in the multipleregression, suggesting that the correlations observed between anxietysensitivity and alexithymia with Coping Motives scores were due toshared variance of these dispositional measures with experientialavoidance. Thus, consistent with the suggestions of Hayes, Wilsonet al. (1996), experiential avoidance may be an important motivationalfactor for coping-related alcohol use.

We also found strong support for the mediational role of experien-tial avoidance and additional support for alexithymic coping pro-cesses as a partial mediator in explaining the relation between anxietysensitivity and coping drinking motives. Specifically, anxiety sensi-tivity failed to predict coping-motivated drinking after accounting forthe influences of experiential avoidance, and the magnitude of therelation between anxiety sensitivity and coping drinking motives wassubstantially reduced after accounting for alexithymic coping. Thefinding that experiential avoidance proved a stronger mediator thanalexithymic coping may suggest that experiential avoidance is abroader and more comprehensive construct than alexithymia, becauseexperiential avoidance includes (but is not limited to) emotional con-striction (Hayes, Wilson et al., 1996). The results of the presentmediational analyses are consistent with recent suggestions thatanxiety-based pathology may be a function, in part, of ineffectivecontrol-related responding rigidly applied to unwanted thoughts orfeelings (Hayes, Wilson et al., 1996; Zvolensky et al., 1998). In par-ticular, within an experiential avoidance context, an individual’sunwillingness to experience and attempts to control aversive innerevents is problematic, not the thoughts and feelings themselves (seeForsyth & Eifert, 1996; Friman, Hayes, & Wilson, 1998, for reviews).Accordingly, anxiety sensitivity may be best understood as a risk fac-tor for alcohol misuse (Stewart et al., 1999) when considered withinthe context of high anxiety-sensitive individuals’ higher levels ofexperiential avoidance. In other words, high anxiety-sensitive individ-


uals’ increased likelihood of coping-motivated drinking may beexplained by these individuals’ greater attempts to control aversiveinner experiences more generally. Although our results offer prelimi-nary support for such interpretations, due to the correlational nature ofthe present study, these findings require more controlled experimentalinvestigation.

Experiential avoidance was also the only significant dispositionalpredictor of both coping- and enhancement-motivated drinking. Thisfinding is consistent with Hayes, Wilson et al.’s (1996) suggestion thatexperiential avoidance can be aimed at both decreasing negative emo-tions and increasing positive affect. Experientially avoidant individu-als may be less willing than others to experience negative emotionssuch as anxiety and depression (which they attempt to control withcoping-motivated alcohol use) and less willing to tolerate the absenceof positive emotions (e.g., attempting to eliminate states such as bore-dom through enhancement-motivated alcohol use). In contrast, eventhough experiential avoidance and anxiety sensitivity were highlyintercorrelated, anxiety sensitivity was related to coping motives butnot enhancement motives (see Table 1) (Stewart, Taylor et al., 1997;Stewart & Zeitlin, 1995). This suggests that unlike experiential avoid-ance, the fear of anxiety-related sensations may specifically promotedrinking that is motivated by a desire to decrease anxiety anddepression.

Cooper (1994) has suggested that internal motivations to drink arecritical to coping- and enhancement-related drinking but that suchinternal influences should be negligible for conformity and sociallymotivated drinking behavior. Our results provided only partial supportfor Cooper’s notion that dispositional influences should be virtuallyabsent for externally motivated drinkers. Specifically, although noneof the three dispositional constructs examined in the present studywere significant predictors of social motives, both anxiety sensitivityand alexithymic coping were significant independent predictors ofconformity motives. This latter finding suggests that conformity-motivated drinking may be influenced not only by external, environ-mental cues (e.g., social pressures to conform) but also by internal fac-tors. The results suggest that these internal motivating factors mayinclude a fear of anxiety-related bodily sensations and the tendency to


constrict emotions to cope (Zvolensky & Raulin, 1999). The findingthat high alexithymia predicted conformity motives scores above andbeyond demographics and anxiety sensitivity was unexpected. Thisresult suggests that alexithymic individuals (who are high in self-consciousness and low in self-awareness) (Bagby, Taylor et al., 1994)may be particularly likely to use the behavior of peers as a model forhow to behave (e.g., whether or not to drink). Future research couldbenefit by examining whether high anxiety-sensitive and/oralexithymic individuals are more susceptible than others to modelinginfluences on their drinking behavior, using lab-based experimentalmethodologies (e.g., Caudill & Marlatt, 1975). The findings also rep-licate and extend prior work suggesting that the previously establishedrelation between anxiety sensitivity and coping-motivated drinking(Stewart & Zeitlin, 1995) extends to increased drinking for generalnegative reinforcement purposes. Anxiety sensitivity may be relatedto increased conformity motives scores, as the Anxiety SensitivityIndex includes social concerns such as fear of embarrassment or ridi-cule (McWilliams et al., 2000; Stewart, Taylor et al., 1997; Zvolenskyet al., 2001). However, consistent with the internal-external drinkingmotives distinction proposed by Cooper (1994), the present set ofdispositional factors as a block tended to account for a larger propor-tion of the variance in Coping Motives scores (internal motives) thanin the case of Conformity Motives scores (external motives).

The results are also consistent with previous research in suggestingthat male gender is associated with increased drinking for social, con-formity, and enhancement motives and that younger age is associatedwith increased drinking for social and enhancement reasons (Cooper,1994; Cooper et al., 1992; Stewart et al., 1996). However, thedispositional variables were more strongly predictive of risky drink-ing motives (i.e., coping, conformity, and enhancement) than weredemographics (Stewart & Devine, 2000), albeit still accounting foronly a relatively small proportion of the total variance for these drink-ing motives. This finding is not surprising when one considers thatmany factors (including but not limited to dispositional factors) con-tribute to risky drinking behavior. Despite the relatively low magni-tude of the relations between the dispositional variables and the drink-ing motives, the findings are nevertheless important in demonstrating


several relations between certain anxiety-related dispositional factorsand risky reasons for alcohol use that have not been reported previ-ously. Although we focused on three conceptually relevantdispositional constructs, the relative degree of prediction might beenhanced by the inclusion of other theoretically relevant personal-ity/individual difference variables in future research (e.g., sensationseeking) (Zuckerman, 1971).

There are a number of caveats in interpreting the results. First, thecorrelational nature of the study precludes causal interpretations ofthe observed relations between specific dispositional characteristicsand drinking motives. Although the results are consistent with thecontention that dispositional vulnerability factors contribute to drink-ing for specific reasons, third variable or reverse-causation explana-tions are possible (e.g., coping-motivated drinking causing increasedanxiety sensitivity by way of coping motives’ association withincreased anxiety symptoms during alcohol withdrawal) (Cooper,1994). Second, the relatively small sample size (N= 182 drinkers) pre-vented the examination of relations between the four drinking motivesand the lower order dimensions of anxiety sensitivity (social concerns vs.physical concerns vs. psychological concerns) (McWilliams et al.,2000; Stewart, Taylor et al., 1997; Zvolensky et al., 2001), alexithymiccoping (difficulty identifying emotions vs. difficulty describing emo-tions vs. external-oriented thinking) (Bagby, Parker et al., 1994), andexperiential avoidance (avoidance/immobility vs. acceptance/action)(Walser et al., 1996). To enhance generalizability, the sample wasdrawn from two different student populations (American and Cana-dian) and represented a wide range of drinking behavior (i.e., onlyselection criteria was self-reported status as a “drinker”). Nonethe-less, the relatively homogeneous demographic composition andnonclinical status of our sample may limit the generalizability of thefindings, particularly to ethnic minority groups (McNeil et al., 1997;McNeil, Kee, & Zvolensky, 1999; Zvolensky et al., 2001) and/or toclinical populations. Moreover, given the preliminary nature of thestudy, we relied solely on self-report methodology. This assessmentstrategy may be associated with extraneous variance associated withmethod-content confounds (Eifert & Wilson, 1991) and/or limitationsin the accuracy of self-report (e.g., Nisbett & Wilson, 1977). Further


investigations with multiple methods of assessment, particularly inexperimental contexts, will be beneficial (e.g., Samoluk, Stewart,Sweet, & MacDonald, 1999). Finally, the study examined associa-tions between theoretically relevant dispositional variables and drink-ing motives but did not examine relations of these variables to drink-ing levels or drinking problems. Further research including measuresof dispositional variables, drinking motives, drinking levels, and alco-hol-related problems in a single study is needed to evaluate our sug-gestion that the psychological dispositions of anxiety sensitivity,experiential avoidance, and/or alexithymic coping may increase riskfor heavy drinking and the development of drinking-related problemsby way of their associations with coping, conformity, and/or enhance-ment drinking motives.

In summary, our results suggest that elevated levels of anxiety sen-sitivity, alexithymic coping, and experiential avoidance are associatedwith an increased likelihood of drinking for negative-reinforcementreasons (i.e., coping or conformity motives). Elevated levels of experi-ential avoidance also appear to increase the probability of drinking forinternal reasons in general (i.e., coping and enhancement). Althoughthese data are correlational in nature, it is possible such psychologicaldispositions may place certain individuals at greater risk for heavydrinking and the development of drinking-related problems by way oftheir association with risky drinking motives. For example, individu-als who are high in experiential avoidance are more likely than othersto drink for internal reasons (i.e., coping and enhancement motives)and therefore may be prone to drink more heavily (Cooper, 1994).Although experimental research will need to clarify these findings, itis possible that idiographic approaches targeting specific drinkingmotives and/or dispositional vulnerabilities may be particularly bene-ficial in the prevention and treatment of alcohol-related problems(Eifert, Schulte, Zvolensky, Lejuez, & Lau, 1997). For example,motive-specific interventions (Conrod et al., 2000) could be devel-oped and targeted toward young adults displaying particulardispositional risk profiles, such as tendencies toward avoidingunwanted private events, rather than intervening solely at the level ofdrinking behavior (cf. Forsyth et al., in press; Strosahl, Hayes, Bergan,& Romano, 1998).


NOTES

1. The skewness of scores on the dispositional variables and Revised Drinking MotivesQuestionnaire subscales was generally within acceptable limits (i.e., between –1 and +1). How-ever, Conformity Motives scores showed moderate positive skew (skew = +2.0). Thus, correla-tions between the scores on the dispositional variables and scores on the Conformity Motivessubscale were also calculated following square root transformations of Conformity Motivesscores. Although this transformation was successful in reducing skew in the distribution of Con-formity Motives scores, it had a minimal impact on this subscale’s relations to the dispositionalvariables. The magnitude and levels of significance of the correlations between ConformityMotives scores and the dispositional variables remained essentially identical to those reported inTable 1: Conformity scores remained significantly positively correlated with scores on the Anxi-ety Sensitivity Index (r = 0.29, p < .001), the Experiential Avoidance Scale (r = 0.22, p < .005),and the Toronto Alexithymia Scale–20 (r = 0.31, p < .001).

2. Given the moderate departure from normality seen in the distribution of ConformityMotives scores, as described in Note 1, the hierarchical multiple regression predicting confor-mity drinking was also conducted using square-root transformations of the Conformity Motivesscores as the criterion. Once again, dispositional variables predicted a significant additional12.2% of the variance in Conformity Motives scores above and beyond that explained by demo-graphics. Demographics and dispositional variables together explained a significant 15.2% ofthe variance in Conformity Motives scores, F(6, 175) = 5.25, p < .0005. At the univariate level,high anxiety sensitivity (partial r = 0.19, p < .05), high alexithymic coping (partial r = 0.17, p <.05), and male gender (partial r = –0.19, p < .05) were once again the only significant predictorsof square-root transformed Conformity Motives scores in the final model. Thus, the resultsremained essentially identical to those reported in the text using untransformed scores as thecriterion.

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Sherry H. Stewart obtained her Ph.D. at McGill University in Canada. She is an associ-ate professor of psychology and psychiatry at Dalhousie University in Halifax, Canada.She also runs a private practice in clinical psychology, specializing in therapy for clientswith anxiety and substance use disorders. Her research focuses on understanding themechanisms underlying comorbidity of mental health and addictive disorders.

Michael J. Zovolensky received his Ph.D. from West Virginia University in 2001. He iscurrently an assistant professor of Psychology and director of the Anxiety and HealthResearch laboratory/clinic at the University of Vermont. His research pertains to emo-tion reactivity and regulatory processes in anxiety-related disorders, particularly panicdisorder. He has authored or coauthored over 50 scientific articles. Current studies inZvolensky’s laboratory examine the negative impact of nicotine dependence on thedevelopment and maintenance of panic disorder.

GeorgH. Eifert obtained his Ph.D. at theUniversity of Frankfurt in Germany. Currently,he is chair of the psychology department at Chapman University in Orange, California.Previously, he was a distinguished professor of clinical psychology atWest Virginia Uni-versity, Morgantown, chief of psychology at the University of Mississippi Medical Cen-ter, and head of psychology at James Cook University of North Queensland, Australia.His main research interests are integrative behavioral models and treatments of anxietydisorders.


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