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A Measure of Cognitive Vulnerability: Development and Validation of The A Measure of Cognitive Vulnerability: Development and Validation of the Anxiety Attitude and Belief Scale Solveig E. Jónsdóttir July, 2008 Submitted in partial fulfilment of the requirements for the degree of Doctor in Clinical Psychology (DClinPsy), Royal Holloway, University of London. 1 Abstract The cognitive model of emotional disorders has inspired considerable research effort, much of it self-report and questionnaire-based. This methodological focus has been criticized on several grounds and poses a challenge for those attempting to index relevant cognitive constructs. The aim of the study described here is to further develop and validate the Anxiety Attitude and Belief Scale-Revised (AABS-R). The measure was designed to index attitudes and beliefs that may represent a cognitive vulnerability to anxiety problems. The development of the scale involved an emphasis on avoiding confounding with affect, thus averting some of the criticisms of self-report cognitive measures. First, construct validation through cognitive interviewing was undertaken. Four undergraduate students completed 53 questions on the AABS-R while thinking aloud. The ensuing verbal protocols were coded by a blind rater according to the specific cognitive processes participants engaged in. Results indicated that items generally tap into cognitive rather than affective processes. Subsequently, the reliability, psychometric properties and validity of the scale were investigated in an online anxiety disorder support group and student sample. Participants (N = 346) completed an online battery of tests, which included the AABS-R as well as criterion measures. Exploratory factor analyses suggested the existence of five factors, which index domains of theoretical interest. The final 33-item measure total and factor scores demonstrated adequate internal consistency. A correlational analysis was consistent with convergent, but only partly with the discriminant validity of the AABS-33. As predicted, the AABS-33 appears to be a reliable, valid and potentially clinically useful index of anxiety vulnerability, which may overcome the shortcomings of well- established anxiety measures. The findings are discussed within the broader literature on cognitive theory and its’ operationalization, ‘transdiagnostic processes’ and notions of validity. 2 Acknowledgements Many thanks to Dr Gary Brown for suggesting a project, which interested me and engaged on so many levels. Thanks also to Mr Philip Tata and Dr Lorna Farquharson for their support in the field, and to Dr Hawkes for his help and expertise on cognitive interviewing. Sincere appreciation and thanks also to Emma Reilly for her support, practical and otherwise. This study was carried out with the aid of a research grant from the University of London Central Research Fund. I would like to express particular thanks and gratitude to the various online forums and communities that participated and welcomed me. Elsku Steini og Jón Bjartur, milljón sinnum takk fyrir allt! 3 List of Tables Table Page 1. Full Sample Status on Gender, Ethnicity, Education level 48 Employment Status, Marital Status and Recruitment Source 2. Predetermined Cognitive Interview Probes 59 3. The Cognitive Interview Coding System 62 4. Cognitive Interviewing Item Evaluation Criteria 67 5. Means and Standard Deviations for AABS-R Items, Item- 72 Total Correlations and Cronbach’s Alpa if Item Deleted 6. Eigenvalues and Total Explained Variance for the Five-Factor 79 Solution 7. AABS-33 item analysis 82 8. Differences in AABS-33 Scores Across Gender, Ethnicity and 86 Recruitment Source 9. AABS-33 Means and Standard Deviations Across Education 88 Level, Employment Status and Marital Status 10. Descriptive Statistics and Reliability for the BIPS, BARS and 90 BSBS 11. Descriptive Statistics and Reliability for the ASI-3, DASS-21, 91 PSWQ, TAFS-R and BFNE-II 12. Hypothesized relationships between AABS-33 Factors, BIPS 93 BARS, BSBS, BFNE-II, PSWQ and the ASI-3 13. AABS-33, BIPS, BARS and BSBS correlations 95 4 14. AABS-33, BFNE-II, PSWQ, TAFS-R and ASI-3 Correlations 98 15. AABS-33 and DASS-21 Correlations 101 16. Descriptive Statistics for the AABS-33 and DASS-21 Anxiety, 103 Depression and Stress Scales, for the Student, Anxiety and Total Group Samples 17. Differences in DASS-21 Scores Across Student and Anxiety 104 Groups 18. AABS-33 and DASS-21 Correlations for the Student, Anxiety 105 and Total Group Samples 19. Differences in AABS-33 Subscale Scores Across Groups 108 20. Descriptive Statistics for the DASS-21 Depression, Anxiety 110 and Stress Scales and AABS-33 across the NOS, Social Anxiety, OCD, Phobia and Panic Groups 21. DASS-21 Depression, Anxiety and Stress Scale and AABS-33 112 scores for NOS, Social Anxiety, OCD, Phobia, Panic and Student Groups 22. AABS-33, BIPS, BARS and BSBS Partial Correlations 115 5 List of Figures Figure Page 1. AABS – R Scree Plot 77 6 Table of Contents INTRODUCTION ................................................................................................................................... 9 ANXIETY, PREVALENCE AND COST ..................................................................................................... 10 COGNITIVE MODELS OF ANXIETY ....................................................................................................... 10 Cognitive mediation ....................................................................................................................... 11 Cognitive content-specificity.......................................................................................................... 12 Cognitive vulnerability to anxiety .................................................................................................. 19 Cognitive vulnerability-stress models: Stressful life events ........................................................... 24 A TRANSDIAGNOSTIC PERSPECTIVE .................................................................................................... 24 COGNITIVE VULNERABILITY: METHODOLOGICAL ISSUES .................................................................... 28 Self-report ...................................................................................................................................... 28 Anxiety Sensitivity Index ................................................................................................................ 31 The Anxiety Attitude and Belief Scale ............................................................................................ 32 Reliability and validity................................................................................................................... 34 Studies of process........................................................................................................................... 37 RATIONALE FOR A MEASURE OF ANXIETY-RELATED ATTITUDES AND BELIEFS.................................. 37 AIMS.................................................................................................................................................... 38 METHOD............................................................................................................................................... 43 OVERVIEW........................................................................................................................................... 43 PARTICIPANTS ..................................................................................................................................... 44 Recruitment of participants for the main study.............................................................................. 45 Full sample participant demographics .......................................................................................... 47 Sub-sample participant demographics........................................................................................... 48 Sampling procedure and sample rationale .................................................................................... 50 ETHICAL CONSIDERATIONS ................................................................................................................. 50 MEASURES .......................................................................................................................................... 51 Provisional scales .......................................................................................................................... 51 Established scales .......................................................................................................................... 54 PROCEDURE......................................................................................................................................... 57 Cognitive interviewing study.......................................................................................................... 57 Validation study ............................................................................................................................. 63 RESULTS............................................................................................................................................... 65 OVERVIEW........................................................................................................................................... 65 OPERATIONALIZING EVIDENCE IN THE COGNITIVE INTERVIEW PROTOCOLS ....................................... 65 QUANTITATIVE ANALYSIS..................................................................................................................
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