The Adolescent Distress-Eustress Scale: Designing, Evaluating, and Utilising a Holistic Measure of Adolescent Stress Victoria Branson School of Psychology, The University of Adelaide November 2019 Thesis submitted for the degree of Doctor of Philosophy/Masters of Psychology (Clinical) i CONTENTS List of Tables ..................................................................................................................... v List of Figures .................................................................................................................. ix List of Abbreviations ....................................................................................................... xi Abstract ........................................................................................................................... xii Declaration ..................................................................................................................... xiv Acknowledgements ....................................................................................................... xvii Thesis Overview ............................................................................................................. xix Chapter 1. Introduction ............................................................................................... 1 1.1 Brief Definition of Stress ......................................................................................... 1 1.2 The Clinical Relevance of Stress in Adolescence .................................................... 2 1.3 Measuring Adolescent Stress ............................................................................... 14 1.4 Rationale and Overarching Aim for the Current Research ................................... 40 Chapter 2. Theoretical Paradigm and Methodological Framework.............................. 43 2.1 Theoretical Paradigm: Positive Psychology .......................................................... 43 2.2 Criticism of Positive Psychology ........................................................................... 51 2.3 Methodological Framework for the Current Research ........................................ 52 Chapter 3. Defining Distress and Eustress .................................................................. 75 3.1 Classic Stress Theory: Hans Selye ......................................................................... 76 3.2 Prominent Contemporary Stress Theories ........................................................... 79 3.3 Partial-Consensus Definition of Stress ................................................................. 93 Chapter 4. A Qualitative Examination of the Indicators of Distress and Eustress in Adolescence ............................................................................................................... 97 ii 4.1 Theoretical Background: Paper 1 .......................................................................... 98 4.2 Methodology: Paper 1 ........................................................................................ 100 4.3 Paper 1 - How do young people experience stress? A qualitative examination of the indicators of distress and eustress in adolescence ...................................... 106 Chapter 5. Creating the Adolescent Distress-Eustress Scale ...................................... 138 5.1 Format of Measurement ..................................................................................... 138 5.2 Generating the Initial Item Pool ......................................................................... 144 5.3 Response Option Format .................................................................................... 149 5.4 Summary ............................................................................................................. 152 Chapter 6. Reviewing the Adolescent Distress-Eustress Scale ................................... 153 6.1 Subject Matter Expert Review ............................................................................ 154 6.2 Readability Review .............................................................................................. 160 6.3 Cognitive Interview Review ................................................................................ 162 6.4 Summary ............................................................................................................. 180 Chapter 7. Evaluation of the Adolescent Distress-Eustress Scale ............................... 181 7.1 Methodology: Paper 2 ........................................................................................ 181 7.2 Paper 2 - The Adolescent Distress-Eustress Scale: Development and Validation ............................................................................................................ 193 7.3 Further Evaluation of the Adolescent Distress-Eustress Scale ........................... 227 Chapter 8. A Holistic Understanding of the Effect of Stress on Adolescent Wellbeing 250 8.1 Theoretical Background: Paper 3 ........................................................................ 250 8.2 Methodology: Paper 3 ........................................................................................ 255 iii 8.3 Paper 3 - A holistic understanding of the effect of stress on adolescent wellbeing: A conditional process analysis .......................................................... 262 Chapter 9. Overall Discussion .................................................................................. 296 9.1 Synthesis, Significance, and Contributions of Thesis Findings ........................... 296 9.2 Clinical Implications ............................................................................................ 300 9.3 Strengths ............................................................................................................. 306 9.4 Limitations .......................................................................................................... 308 9.5 Additional Prospects for Future Research .......................................................... 315 9.6 Conclusion .......................................................................................................... 317 Appendices .............................................................................................................. 319 Appendix A. Paper 1 (Chapter 4) in Published Format ............................................... 319 Appendix B. Online Supplemental Material Paper 1: Relevant Citations for Table 8 (Chapter 4, Section 4.3.2) ............................................................................................ 332 Appendix C. Interview Guide for Paper 1 (Chapter 4) Qualitative Interviews ............ 335 Appendix D. Initial Adolescent Distress-Eustress Scale Item Pool .............................. 339 Appendix E. Interview Guide for Chapter 6 Cognitive Interview Review ................... 347 Appendix F. Problems Identified with Draft Adolescent Distress-Eustress Scale Items during the Cognitive Interview Review (Chapter 6) ..................................................... 351 Appendix G. Rationale for Expected Pattern of Relationships between the Adolescent Distress-Eustress Scale and Validation Constructs in Paper 2 (Chapter 7) .................. 369 Appendix H. Paper 2 (Chapter 7) in Published Format ............................................... 374 Appendix I. Online Supplemental Material Paper 2: Discriminant Validity of Established Stress Scales .............................................................................................. 388 Appendix J. The Adolescent Distress-Eustress Scale Manual .................................... 389 iv Appendix K. Paper 3 (Chapter 8) in Published Format ................................................ 398 Appendix L. Principal Components Analysis Extracting Wellbeing and Illbeing for Paper 3 (Chapter 8) ...................................................................................................... 414 Appendix M. Online Supplemental Material Paper 3: Descriptive Statistics for Gender- Diverse Participants ...................................................................................................... 416 References ............................................................................................................... 418 v LIST OF TABLES Table 1. Negative Physiological Effects Associated with Prolonged and/or Uncontrollable Activation of the SAM and HPA Axes .......................................................................... 7 Table 2. Examples of Stimulus-Oriented Stress Measures Appropriate for Use in Populations of Young People .................................................................................... 19 Table 3. Stimulus-Oriented Stress Measures that Differentiate between Positive and Negative Valanced Stressors ..................................................................................... 23 Table 4. Response-Oriented Measures of the Negative Stress Response Appropriate for Use in Populations of Young People ......................................................................... 30 Table 5. Stimulus-Response Interaction-Oriented Stress Measures Appropriate for Use in Populations of Young People .................................................................................... 37 Table 6. Structure of the Current Thesis According to DeVellis’s (2012) Framework for Scale Development ...................................................................................................