Assessing the Unidimensionality of Trait Reactance Using a Multifaceted Model Assessment Approach

This study employed a multifaceted model assessment approach to investigate the dimensionality and nomological network of a popular measure of trait reactance, the Hong Psychological Reactance Scale (HPRS; Hong &; Page, 1989 Hong, S.-M., &; Page, S. (1989). A psychological reactance scale: Development, factor structure and reliability. Psychological Reports, 64, 1323–1326.[Crossref], [Web of Science ®] , [Google Scholar]). To address confusion regarding the scoring and modeling of the HPRS as well as its limited external validity evidence, we tested competing factor models, diagnosed model–data misfit, examined relationships between competing factor models and key personality traits, and cross-validated the results. Confirmatory factor analytic results supported modeling the HPRS via a bifactor model and, when this model was applied, trait reactance was negatively related to agreeableness, conscientiousness, and conformity, and positively related to entitlement, as expected. However, we also demonstrated the consequences of championing a 1-factor model by highlighting differences in relationships with external variables. Specifically, although modeling the HPRS scores with the bifactor model resulted in greater model–data fit than the 1-factor model, relationships with external variables based on the 2 models differed negligibly. Moreover, bifactor statistical indexes indicted that scores were essentially unidimensional, providing some support that HPRS scores can be treated as unidimensional in structure. Implications for using and scoring the HPRS are discussed.     

Exploring the Assessment of the DSM–5 Alternative Model for Personality Disorders With the Personality Assessment Inventory

Section III of the Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM–5]; American Psychiatric Association, 2013) contains an alternative model for the diagnosis of personality disorder involving the assessment of 25 traits and a global level of overall personality functioning. There is hope that this model will be increasingly used in clinical and research settings, and the ability to apply established instruments to assess these concepts could facilitate this process. This study sought to develop scoring algorithms for these alternative model concepts using scales from the Personality Assessment Inventory (PAI). A multiple regression strategy used to predict scores in 2 undergraduate samples on DSM–5 alternative model instruments: the Personality Inventory for the DSM–5 (PID–5) and the General Personality Pathology scale (GPP; Morey et al., 2011 Morey, L. C., Berghuis, H., Bender, D. S., Verheul, R., Krueger, R. F., &; Skodol, A. E. (2011). Toward a model for assessing level of personality functioning in DSM–5, Part II: Empirical articulation of a core dimension of personality pathology. Journal of Personality Assessment, 93, 347–353.[Taylor &; Francis Online], [Web of Science ®] , [Google Scholar]). These regression functions resulted in scores that demonstrated promising convergent and discriminant validity across the alternative model concepts, as well as a factor structure in a cross-validation sample that was congruent with the putative structure of the alternative model traits. Results were linked to the PAI community normative data to provide normative information regarding these alternative model concepts that can be used to identify elevated traits and personality functioning level scores.     

The Effect of Method Characteristics on Retest Score Gains and Criterion-Related Validity

Purpose

We sought to empirically assess the effect of predictor method characteristics (test form, item-type, and test-type) on retest score change associated with an invariant construct—general mental ability (GMA)—and to evaluate the effect of retesting on the criterion-related validity of assessments that vary in their susceptibility to retest effects.

Design

Three hundred seven individuals completed a battery of GMA assessments. After a 6-week interval, participants returned to the testing site to retest using both alternate and identical forms of the initial assessments.

Findings

Greater score gains were observed on assessments comprising heterogeneous item-types than homogeneous item-types, and on performance-based assessments than self-report assessments. However, despite variations in score gains, the relationships between the initial test scores and criterion scores were no different than the relationships between retest scores and criterion scores for all assessments.

Implications

Tests and procedures that reduce reliance on test- or item-specific knowledge and skill may help minimize score changes due to retesting across multiple administrations. Moreover, under the boundary conditions present in this study, the criterion-related validity of ability assessments may not be affected by increases in test-specific knowledge and skills.

Originality/Value

Despite the prevalence and industry support of retesting, a comprehensive understanding of retest score change still eludes researchers and practitioners. This ambiguity may be due in part to neglecting the method-construct distinctions in the retest literature. This is the first report to explicitly utilize the method-construct distinction in an effort to examine the causes and consequences of retest effects.

     

Reporting Diagnostic Scores in Educational Testing: Temptations,Pitfalls, and Some Solutions

Diagnostic scores are of increasing interest in educational testing due to their potential remedial and instructional benefit. Naturally, the number of educational tests that report diagnostic scores is on the rise, as are the number of research publications on such scores. This article provides a critical evaluation of diagnostic score reporting in educational testing. The existing methods for diagnostic score reporting are discussed. A recent method (Haberman, 2008a Haberman, S. J. 2008a. When can subscores have value?. Journal of Educational and Behavioral Statistics, 33: 204–229. [Crossref], [Web of Science ®] , [Google Scholar]) that examines if diagnostic scores are worth reporting is reviewed. It is demonstrated, using results from operational and simulated data, that diagnostic scores have to be based on a sufficient number of items and have to be sufficiently distinct from each other to be worth reporting and that several operationally reported subscores are actually not worth reporting. Several recommendations are made for those interested to report diagnostic scores for educational tests.     

Psychometric Properties of the Trait Emotional Intelligence Questionnaire: Factor Structure,Reliability, Construct,and Incremental Validity in a French-Speaking Population

In this research, we investigated the psychometrical properties of the Trait Emotional Intelligence Questionnaire (TEIQue, Petrides &; Furnham, 2003 Petrides, K. V. and Furnham, A. 2003. Trait emotional intelligence: Behavioural validation in two studies of emotion recognition and reactivity to mood induction. European Journal of Personality, 17: 39–57. [Crossref], [Web of Science ®] , [Google Scholar]) in a French-speaking population. In summary, we found that (a) TEIQue scores were globally normally distributed and reliable; (b) the United Kingdom four-factor structure (well-being, self-control, emotionality, sociability) replicated in our data; (c) TEIQue scores were dependent on gender but relatively independent of age; (d) there was preliminary evidence of convergent/discriminant validity, with TEIQue scores being independent of nonverbal reasoning (Raven's [1976] Raven, J. C. 1976. Advanced Progressive Matrices Set II, Oxford, , England: Oxford Psychologist Press.  [Google Scholar] matrices) but positively related to some personality dimensions (optimism, agreeableness, openness, conscientiousness) as well as inversely related to others (alexithymia, neuroticism); (e) there was also preliminary evidence of criterion validity, with TEIQue scores predicting depression, anxiety, and social support as well as future state affectivity and emotional reactivity in neutral and stressful situations; (f) TEIQue scores were susceptible to socially desirable responding; however, (g) TEIQue scores had incremental validity to predict emotional reactivity over and above social desirability, alexithymia, and the Five-factor model of personality. Such results constitute encouraging preliminary findings in favor of the use of the TEIQue.     

Resolving Uncertainty About the Intolerance of Uncertainty Scale–12: Application of Modern Psychometric Strategies

In this study, we evaluated the factor structure, reliability estimates, item parameters, and differential correlates of the short form of the Intolerance of Uncertainty Scale (Carleton, Norton, &; Asmundson, 2007 Carleton, R., Norton, P., &; Asmundson, G. (2007). Fearing the unknown. A short version of the Intolerance of Uncertainty Scale. Journal of Anxiety Disorders, 21, 105–117.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]) in samples of undergraduate women (n = 387) and men (n = 276) ranging in age from 18 to 49 years (M = 20.20, SD = 3.91). This instrument was designed to measure 2 facets of intolerance of uncertainty—prospective anxiety and inhibitory anxiety—although total scores on the measure are often used. A major objective of this study was to determine the degree to which derivation of total versus subscale scores is empirically permissible. Comparison of a bifactor model to a unidimensional model and a 2-factor correlated traits model indicated that the bifactor model exhibited superior fit to the sample data. This model provided evidence of a strong general intolerance of uncertainty factor that was more reliable and accounted for significantly more common variance than either subscale factor. Examination of the item response theory slope parameters revealed negligible bias in the measure's items across genders. Finally, a series of simultaneous regression analyses was conducted to examine differential correlates of the measure's total scale scores for men and women.     

The Abbreviated Character Strengths Test (ACST): A Preliminary Assessment of Test Validity

The 24-item Abbreviated Character Strengths Test (ACST) was developed to efficiently measure character strengths (Peterson, Park, &; Castro, 2011 Peterson, C., Park, N., &; Castro, C. A. (2011). Assessment for the US Army Comprehensive Soldier Fitness program: The Global Assessment Tool. American Psychologist, 66, 10–18.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). However, its validity for this purpose has not yet been sufficiently established. Using confirmatory factor analysis to test a series of structural models, only a modified bifactor model showed reasonably acceptable fit. Further analyses of this model failed to demonstrate measurement invariance between male and female respondents. Relationships between ACST dimension and Big Five personality trait scores were generally weak-to-moderate, and support for hypotheses regarding each ACST virtue's expected correspondence with specific Big Five dimensions was mixed. Finally, scores on ACST dimensions accounted for a combined 12% of the variance in satisfaction with life scores, after controlling for socially desirability. Although an abbreviated measure of character strengths represents a practical need, considerable improvements to the ACST are needed for it to adequately meet this purpose.     

Personality Assessment Inventory Scores as Predictors of Evaluation Referrals,Evaluator Opinions,and Commitment Decisions in Sexually Violent Predator Cases

We used data from more than 1,500 offenders to examine the association between Personality Assessment Inventory (PAI; Morey, 1991 Morey, L. C. (1991). Personality Assessment Inventory: Professional manual. Odessa, FL: Psychological Assessment Resources. [Google Scholar]) scores and progress through the sexually violent predator (SVP) screening, evaluation, and commitment process. There was no clear association between PAI scores and referrals for full evaluations, but PAI scores were small to moderate predictors of evaluator opinions and diagnoses among offenders who underwent full evaluations. Higher Antisocial Features (ANT) scores were associated with diagnoses of antisocial personality disorder, but this association was moderated by offender response style. ANT scores were more strongly associated with antisocial personality disorder diagnoses among those responding defensively (d = .71) than among those responding openly (d = .48). The mean ANT score among defensive responders diagnosed with antisocial personality disorder was about 55T, suggesting that even moderate ANT scale elevations could indicate a clinically significant level of antisocial traits among some offenders.     

An Interrater Reliability Study of Rorschach Performance Assessment System (R–PAS) Raw and Complexity-Adjusted Scores

Recently, the Rorschach Performance Assessment System (R–PAS; Meyer, Viglione, Mihura, Erard, &; Erdberg, 2011 Meyer, G. J., Viglione, D. J., Mihura, J. L., Erard, R. E., &; Erdberg, P. (2011). A manual for the Rorschach Performance Assessment System. Toledo, OH: R–PAS. [Google Scholar]) was introduced to overcome some possible limitations of the Comprehensive System (CS; Exner, 2003 Exner, J. E. (2003). The Rorschach: A comprehensive system. Vol. 1: Basic foundations and principles of interpretation (4th ed.). Hoboken, NJ: Wiley. [Google Scholar]) while continuing its efforts to link Rorschach inferences to their evidence base. An important, technical modification to the scoring system is that R–PAS interpretations are based on both standard scores and complexity-adjusted scores. Two previous U.S. studies reported good to excellent interrater reliability (IRR) for the great majority of R–PAS variables; however, IRR of complexity-adjusted scores has never been investigated. Furthermore, no studies have yet investigated R–PAS IRR in Europe. To extend this literature, we examined R–PAS IRR of Page 1 and Page 2 raw and complexity-adjusted scores with 112 Italian Rorschach protocols. We collected a large sample of both clinical and nonclinical Rorschach protocols, each of which was coded separately by 2 independent raters. Results demonstrated a mean intraclass correlation of .78 (SD = .14) for raw scores and.74 (SD = .14) for complexity-adjusted scores. Overall, for both raw and complexity-adjusted values, most of the variables were characterized by good to excellent IRR.     

Action Type-Based Factorial Structure of Brief COPE among Hong Kong Chinese

Brief COPE (Carver in International journal of Behavioral Medicine, 4(1), 92–100, 1997) is a multidimensional scale that measures situational and dispositional coping responses. This study evaluated its factor structure and psychometric properties using two Hong Kong college samples (Sample 1; n = 204 & Sample 2; n = 221). Results of confirmatory factor analysis (CFA) indicated that an eleven-factor model, based on action goals (Skinner et al. in Psychological Bulletin, 129(2), 216, 2003), demonstrated a good fit across the two samples. The eleven-factor model fit the data better than five alternative models. We also validated a Traditional Chinese translation of the scale. Multiple-groups CFAs indicated partial scalar invariance across the English and Chinese versions in Hong Kong participants. Nonetheless, convergent validity was supported by the associations between the scores of some, but not all, of the dimensions and related psychological constructs, including psychological distress, optimism, and locus of control. Such associations might help differentiate conceptually distinct coping dimensions. Likewise, our results provided support for the reliability of some, but not all, of the subscale scores. In sum, our results support the multidimensionality of Brief COPE and the use of some of the measure’s factors and subscales. Moreover, Brief COPE and its translated version demonstrated acceptable psychometric properties in Hong Kong Chinese.     

Repeated Measurement of the Components of Attention With Young Children Using the Attention Network Test: Stability,Isolability, Robustness,and Reliability

The current study examined the robustness, stability, reliability, and isolability of the attention network scores (alerting, orienting, and executive control) when young children experienced repeated administrations of the child version of the Attention Network Test (ANT; Rueda et al., 2004 Rueda , M. R. , Fan , J. , McCandliss , B. D. , Halparin , J. D. , Gruber , D. B. , Lercari , L. P. , … Posner , M. I. ( 2004 ). Development of attentional networks in childhood . Neuropsychologia , 42 , 1029 – 1040 .[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). Ten test sessions of the ANT were administered to 12 young children. Participants were asked to indicate the direction of a target fish, flanked by distractors, presented either above or below the fixation cross following different types of visual cues. Network scores, reflecting alerting, orienting, and executive control, were calculated using orthogonal subtractions of performance in selected conditions. Only the alerting network scores remained highly significant across the 10 sessions. The executive network scores showed some practice effects. The reliability of the network scores remained poor regardless of the amount of data. Based on the results, use of the ANT is cautioned against in young children when repeated testing is required.     

The Assessment of Self-Oriented and Socially Prescribed Perfectionism: Subscales Make a Difference

Campbell and Di Paula (2002) Campbell, J. D. and Di Paula, A. 2002. “Perfectionistic self-beliefs: Their relation to personality and goal pursuit”. In Perfectionism, Edited by: Flett, G. L. and Hewitt, P. L. 181–198. Washington, DC: American Psychological Association.  [Google Scholar] suggested differentiating Perfectionistic Striving and Importance of Being Perfect subscales when measuring self-oriented perfectionism and Others’ High Standards and Conditional Acceptance subscales when measuring socially prescribed perfectionism. In this study, we investigated the utility of this differentiation by analyzing data from 1,041 students and examining correlations with positive striving and maladaptive evaluation concerns aspects of perfectionism and with positive and negative indicators of well-being and psychological adjustment. As expected, (a) Perfectionistic Striving scores showed higher correlations with positive striving aspects of perfectionism and with positive indicators of well-being and adjustment than Importance of Being Perfect scores, and (b) Conditional Acceptance scores showed higher correlations with maladaptive evaluation concerns aspects of perfectionism and with negative indicators of well-being and adjustment than Others’ High Standards scores. The findings indicate that Campbell and Di Paula's differentiation provides for a more detailed and informative assessment of multidimensional perfectionism and its different aspects. Moreover, it provides for new insights into self-oriented and socially prescribed perfectionism and their relationships and associations.     

Long-term stability of the French WISC-IV: Standard and CHC index scores

Introduction

The assumption of the stability of intelligence is the source of the predictive value of the Intelligence Quotient (e.g., Full Scale IQ). However, few studies have investigated the long-term stability of one of the most frequently used tests in the field of cognitive assessment: the Wechsler Intelligence Scale for Children – 4th edition (WISC-IV).

Maternal participant experience in a South African birth cohort study enrolling healthy pregnant women and their infants

Background

Critical to conducting high quality research is the ability to attract and retain participants, especially for longitudinal studies. Understanding participant experiences and motivators or barriers to participating in clinical research is crucial. There are limited data on healthy participant experiences in longitudinal research, particularly in low- and middle-income countries. This study aims to investigate quantitatively participant experiences in a South African birth cohort study.

Methods

Maternal participant experience was evaluated by a self-administered survey in the Drakenstein Child Health Study, a longitudinal birth cohort study investigating the early life determinants of child health. Pregnant mothers, enrolled during the second trimester, were followed through childbirth and the early childhood years. Satisfaction scores were derived from the participant experience survey and quantitatively analyzed; associations between satisfaction scores and sociodemographic variables were then investigated using a linear regression model.

Results

Data were included from 585 pregnant mothers (median age 26.6 years), who had participated in the study for a median time of 16 months. Overall participant satisfaction was high (median score 51/60) and associated with increased attendance of study visits. Reasons for participating were a belief that involvement would improve their health, their child’s health or the health of family and friends. Potential reasons for leaving the study were inconvenience, not receiving clinical or study results, and unexpected changes in study visits or procedures. Variables associated with higher overall satisfaction scores were no prior participation in research, higher socioeconomic status, less intensive follow-up schedules and having experienced stressful life events in the past year.

Conclusions

Satisfaction scores were high and associated with increased visit attendance. Participants’ perceived benefits of study participation, most notably the potential for an improvement in the health of their child, were a significant motivator to enroll and remain in the study. The consistent theme of perceived health benefits as a motivator to join and remain in the study raises the question of whether participation in research results in actual improvements in health.

     

Measuring Positive Affect,Negative Affect,and Physiological Hyperarousal among Italian Youth: Translations of the PANAS-C and PH-C

Italian-language versions of the Positive and Negative Affect Scale for Children (PANAS-C; Laurent et al. Psychological Assessment, 11, 326–338, 1999) and Physiological Hyperarousal Scale for Children (PH-C; Laurent et al. Psychological Assessment, 16, 373–380, 2004) were developed. Students (N = 1026; M age = 12.05 years, SD = 1.49) from central Italy completed these scales. Measures were evaluated based on criteria from previous studies resulting in an 11-item PANAS-C PA scale (α = .88), a 13-item PANAS-C NA scale (α = .87), and a 14-item PH-C (α = .85). Confirmatory factor analyses resulted in best-fit indices that favored a 3-factor model consistent with the tripartite model of anxiety and depression. Similar to results reported with the original English-language and other translations of these measures, scores on the PA scale were lower and scores on the NA and PH scales were higher for older girls than older boys and younger boys and girls. Findings suggested that the psychometric properties of the Italian-language versions of the PANAS-C and PH-C were similar to the English-language versions and other translated versions of the measures.     

The organization of children's secure base behaviour in two-parent Portuguese families and father's participation in child-related activities

The organization of children's secure base behaviour was studied in two-parent Portuguese families, with 44 father–child and mother–child dyads, children's age was on average 31.91 months. An analysis of Attachment Q-sort (AQS; Waters, 1995 Waters, E. 1995. “Appendix A: Attachment Q-set (version 3.0)”. In Caregiving, cultural, and cognitive perspectives on secure base behavior and working models: New growing points of attachment theory and research Edited by: Waters, E., Vaughn, B. E., Posada, G. and Kondon-Ikemura, K. Monographs of the Society for Research in the Child Development, 60(2–3), 234–246 [Google Scholar]) data revealed no significant differences in security scores for mothers and fathers. Both parents independently responded to a questionnaire about their participation in child-related activities, relative to their spouse's participation in these activities. A traditional division in the Care/Organization tasks and a shared participation in the Play/Leisure activities emerged. Fathers with higher scores for both types of activities tended to have children with higher security scores. Fathers' participation in Play/Leisure activities was associated with children's AQS scores with their mothers. In this sample father's participation is positively associated with the quality of secure base relationships within the family context.     

Extending Structural Analyses of the Rosenberg Self-Esteem Scale to Consider Criterion-Related Validity: Can Composite Self-Esteem Scores Be Good Enough?

Although the Rosenberg Self-Esteem Scale (RSES) is the most widely used measure of global self-esteem in the literature, there are ongoing disagreements about its factor structure. This methodological debate informs how the measure should be used in substantive research. Using a sample of 1,127 college students, we test the overall fit of previously specified models for the RSES, including a newly proposed bifactor solution (McKay, Boduszek, &; Harvey, 2014 McKay, M. T., Boduszek, D., &; Harvey, S. (2014). The Rosenberg Self-Esteem Scale: A bifactor answer to a two-factor question? Journal of Personality Assessment, 96, 654–660.[Taylor &; Francis Online], [Web of Science ®] , [Google Scholar]). We extend previous work by evaluating how various latent factors from these structural models are related to a set of criterion variables frequently studied in the self-esteem literature. A strict unidimensional model poorly fit the data, whereas models that accounted for correlations between negatively and positively keyed items tended to fit better. However, global factors from viable structural models had similar levels of association with criterion variables and with the pattern of results obtained with a composite global self-esteem variable calculated from observed scores. Thus, we did not find compelling evidence that different structural models had substantive implications, thereby reducing (but not eliminating) concerns about the integrity of the self-esteem literature based on overall composite scores for the RSES.     

A Psychometric Evaluation of the Behavioral Inhibition Questionnaire in a Non-Clinical Sample of Israeli Children and Adolescents

This study examined the psychometric properties of a Hebrew version of the Behavioral Inhibition Questionnaire (BIQ) in a non-clinical sample of Israeli children and adolescents. We produced a Hebrew translation of the BIQ and collected 227 responses to it from parents of children aged 4–15. Some respondents in the larger sample also completed the Screen for Child Anxiety Related Emotional Disorders (SCARED) questionnaire (n?=?91) and the Conners’ Abbreviated Parent-Teacher (CONNERS) questionnaire (n?=?39), in addition to the BIQ. Lastly, 21 children of BIQ respondents (aged 8–14) completed a self-report version of the questionnaire. Confirmatory factor analysis (CFA) was performed to assess how well the established six correlated factor model of the BIQ applied to the sample data. The Hebrew BIQ demonstrated good internal consistency (Chronbach’s α?=?.94, n?=?227) and 3 month test–retest reliability, (r?=?.95, p?<?.001, n?=?21). It also showed both convergent validity, as scores on the BIQ were correlated with the SCARED (r?=?.66, p?<?.01. n?=?91), and discriminant validity, as BIQ scores were not correlated with the CONNERS (r?=?.24, n?=?39). Finally, mother reports of BI were significantly correlated to child reports of BI via the BIQ (r?=?.60, p?<?.01, n?=?21). Thus, through this preliminary study we demonstrated that the Hebrew version of the BIQ is an effective tool for screening for BI among Israeli children, making it a useful instrument for future research.     

Parent and Teacher Ratings on the IOWA Conners Rating Scale

The IOWA Conners Rating Scale is a widely used brief measure of inattentive-impulsive-overactive (IO) and oppositional-defiant (OD) behavior in children. This study examined the psychometric properties of this measure when completed by mothers and teachers. Results of confirmatory factor analyses indicated that a three-factor solution, conforming to current DSM-IV formulations of the disruptive behavior disorders, provided a better fit to the observed data than the currently used two-factor model, in which no distinction is made between inattentive and hyperactive-impulsive behaviors. Both new and currently used scale scores had good internal consistency and test–retest reliability and showed that boys’ scores were significantly higher than girls’ scores. Results held for both mother and teacher ratings. Clinical cutoff scores were proposed and performed reasonably well to screen for ADHD and ODD. Results support the IOWA Conners as a screening measure for the disruptive behavior disorders or as a tool for monitoring treatment response.

An alternative to current psychiatric classifications: a psychological landscape hypothesis based on an integrative,dynamical and multidimensional approach

Background

Mental disorders as defined by current classifications are not fully supported by scientific evidence. It is unclear whether main disorders should be broken down into separate categories or disposed along a continuous spectrum. In the near future, new classes of mental disorders could be defined through associations of so-called abnormalities observed at the genetic, molecular and neuronal circuitry levels.

Methods

We propose an alternative hypothesis to these classifications based on an integrative, dynamical and multidimensional approach.

Results

We suggest that observed data collected in the general population can be used to build a psychological landscape. Innovative techniques issued from information processing and system dynamics can prove helpful in this task. Information preserving techniques can reduce the high dimensional data collected and provide an intrinsic map for psychological characteristics or behaviors. Dynamical patterns called attractors, which are linked to each other through continuous pathways, can be identified. Specific attractors can define mental disorders. Their causal structure can be investigated with causal networks.

Conclusions

Powerful and reliable tools are available so that an alternative to current psychiatric classifications can be built based on a genuine biopsychosocial model. The proposed model is ready to be tested on real data.