Viewing Cognitive Conflicts as Dilemmas: Implications for Mental Health

The idea that internal conflicts play a significant role in mental health has been extensively addressed in various psychological traditions, including personal construct theory. In the context of the latter, several measures of conflict have been operationalized using the Repertory Grid Technique (RGT). All of them capture the notion that change, although desirable from the viewpoint of a given set of constructs, becomes undesirable from the perspective of other constructs. The goal of this study is to explore the presence of cognitive conflicts in a clinical sample (n = 284) and compare it to a control sample (n = 322). It is also meant to clarify which among the different types of conflict studied provides a greater clinical value and to investigate its relationship to symptom severity (SCL-90-R). Of the types of cognitive conflict studied, implicative dilemmas were the only ones to discriminate between clinical and nonclinical samples. These dilemmas were found in 34% of the nonclinical sample and in 53% of the clinical sample. Participants with implicative dilemmas showed higher symptom severity, and those from the clinical sample displayed a higher frequency of dilemmas than those from the nonclinical sample.     

Describing suicidality: an investigation of qualitative SSF responses

Given the incidence and seriousness of suicidality in clinical practice, the need for new and better ways to assess suicide risk is clear. While there are many published assessment instruments in the literature, survey data suggest that these measure are not widely used. One possible explanation is that current quantitatively developed assessment instruments may fail to capture something essential about the suicidal patient's experience. The current exploratory study examined a range of open ended qualitative written responses made by suicidal outpatients to five assessment prompts from the Suicide Status Form (SSF)--psychological pain, press, perturbation, hopelessness, and self-hate. Two different samples of suicidal outpatients seeking treatment, including suicidal college students (n = 119) and active duty U.S. Air Force personnel (n = 33), provided a wide range of written responses to the five SSF prompts. A qualitative coding manual was developed through a step-by-step methodology; two naive coders were trained to use the coding system and were able to sort all the patients' written responses into the content categories with very high interrater reliability (Kappa > .80). Certain written qualitative responses of the patients were more frequent than others, both within and across the five SSF constructs. Among a range of specific exploratory findings, one general finding was that two thirds of the 636 obtained written responses could be reliably categorized under four major content headings: relational (22%), role responsibilities (20%), self (15%), and unpleasant internal states (10%). Theoretical, research, and clinical implications of the methodology and data are discussed.     

Psychometric properties of the Observer Alexithymia Scale in a clinical sample

The purpose of this study was to evaluate the psychometric properties of the Observer Alexithymia Scale (OAS; Haviland, Warren, & Riggs, 2000) in a clinical setting. Clinical and counseling psychologists used the OAS to rate outpatients (n = 192) with various Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) diagnoses. Reliability and validity data are similar to the initial nonclinical data (n = 819): OAS scores are reliable (coefficient alpha = .90), and the five-factor structure--Distant, Uninsightful, Somatizing, Humorless, and Rigid--was confirmed. Moreover, the OAS does a relatively good job of differentiating clinical from nonclinical cases. The OAS is psychometrically sound, and it appears to be a useful tool for collecting and evaluating observer data on the clinically relevant, everyday expressions of alexithymia.     

Delineating the contributions of sustained attention and working memory to individual differences in mindfulness

Mindfulness can be deconstructed into two constituent components: present-moment awareness and acceptance. Attention and working memory are theorized to contribute to individual differences in trait mindfulness, although the precise relationship among these constructs remains unclear. The purpose of the present study was to evaluate the association of neurocognitive indices of attention and working memory with a bidimensional trait measure of mindfulness. Fifty-five psychiatrically and neurologically healthy adults completed the Conners Continuous Performance Test, Penn Letter N-back Test, and Philadelphia Mindfulness Scale. Results indicated that present-moment awareness was associated with a response speed variability measure of sustained attention, whereas acceptance was more strongly linked to working memory efficiency, even after accounting for general intellectual ability. These findings suggest that sustained attention and working memory capacities may differentially subserve individual differences in present-moment awareness and acceptance, thereby illuminating our understanding of the cognitive mechanisms which may underlie trait mindfulness.     

Robust dimensions of anxiety sensitivity: development and initial validation of the Anxiety Sensitivity Index-3

Accumulating evidence suggests that anxiety sensitivity (fear of arousal-related sensations) plays an important role in many clinical conditions, particularly anxiety disorders. Research has increasingly focused on how the basic dimensions of anxiety sensitivity are related to various forms of psychopathology. Such work has been hampered because the original measure--the Anxiety Sensitivity Index (ASI)--was not designed to be multidimensional. Subsequently developed multidimensional measures have unstable factor structures or measure only a subset of the most widely replicated factors. Therefore, the authors developed, via factor analysis of responses from U.S. and Canadian nonclinical participants (n=2,361), an 18-item measure, the ASI-3, which assesses the 3 factors best replicated in previous research: Physical, Cognitive, and Social Concerns. Factorial validity of the ASI-3 was supported by confirmatory factor analyses of 6 replication samples, including nonclinical samples from the United States and Canada, France, Mexico, the Netherlands, and Spain (n=4,494) and a clinical sample from the United States and Canada (n=390). The ASI-3 displayed generally good performance on other indices of reliability and validity, along with evidence of improved psychometric properties over the original ASI.     

Measuring stress in clinical and nonclinical subjects using a German adaptation of the Perceived Stress Scale

Background/Objective: Stress is perceived differently across individuals, which might be particularly true for nonclinical and clinical subjects. For this reason, we tested a German adaption of the 10-item Perceived Stress Scale (PSS-10) for model fit and measurement invariance in a big nonclinical and clinical sample. Method: We (1) conducted multiple confirmatory factor analysis (CFA) in 1,248 nonclinical subjects and 575 outpatients, (2) measurement invariance with multigroup CFA, (3) assessed correlations with relevant constructs and (4) calculated internal consistencies for overall stress and the subscales Helplessness and Self-efficacy. Results: In both samples, CFA revealed a robust two-factorial structure with an excellent model fit. Group comparisons revealed strict measurement invariance. Correlations with associated measures support validity. Internal consistencies were good to very good. Conclusions: We show highly satisfactory psychometric properties of the German PSS-10 for nonclinical and clinical individuals. Measurement invariance analyses demonstrated that varying stress levels of people with a different mental health status are due to true interindividual differences.     

Divergent, criterion-related, and discriminant validities for the Kuwait University Anxiety Scale

Three analyses were carried out. Analysis I estimated the correlation between the total score of the Kuwait University Anxiety Scale and a self-rating scale of happiness with large sample of male (n = 1,312) and female (n = 1,272) Kuwaiti adolescents. Pearson product-moment correlations were -.43 and -.44 (p < .001) for boys and girls, respectively, suggesting divergent validity of the anxiety scale. Analysis II examined the correlations between scores on the Kuwait University Anxiety Scale and the Somatic Symptoms Inventory for a nonclinical sample of women (n = 30), and female outpatients with anxiety disorder (n = 30). Pearson product-moment correlations were, respectively, .85 and .53, (p < .001), which support the criterion-related validity of the Kuwait University Anxiety Scale with respect to the Somatic Symptoms Inventory. In Analysis III a sample of 60 male and female outpatients with anxiety disorder and 60 nonclinical participants were matched on age, education, and occupation. All responded individually to the Kuwait University Anxiety Scale. Significant differences among groups, especially noticeable for men, support the discriminant validity of the scale. So, the clinical as well as research use of the scale can be recommended. By and large, the divergent, discriminant, and criterion-related validities of the scale have been adequately supported so subsequent replication is expected.     

Assessing Old Order Amish outpatients with the MCMI-III

In this study, we examined Millon Clinical Multiaxial Inventory-III (MCMI-III; Millon, 2009) characteristics in an Old Order Amish outpatient sample (n = 166), with a comparison group of Old Order Amish who were not receiving mental health treatment at the time of testing (n = 80). We also graphically compared the 2 Amish groups to a non-Amish psychiatric sample in the literature. Consistent with our hypotheses, the Old Order Amish outpatients scored significantly higher than the Old Order Amish comparison group on the majority of MCMI-III scales, with mostly medium effect sizes, suggesting that the MCMI-III is a useful personality instrument in discriminating between Old Order Amish clinical and nonclinical groups. In addition, the Amish outpatients scored similar to a non-Amish psychiatric sample in the literature on most personality scales. Future MCMI-III studies with the Amish are needed to replicate and generalize our findings.     

Differentiating anxiety and depression: the State-Trait Anxiety-Depression Inventory

ABSTRACT

The differentiation of trait anxiety and depression in nonclinical and clinical populations is addressed. Following the tripartite model, it is assumed that anxiety and depression share a large portion of negative affectivity (NA), but differ with respect to bodily hyperarousal (specific to anxiety) and anhedonia (lack of positive affect; specific to depression). In contrast to the tripartite model, NA is subdivided into worry (characteristic for anxiety) and dysthymia (characteristic for depression), which leads to a four-variable model of anxiety and depression encompassing emotionality, worry, dysthymia, and anhedonia. Item-level confirmatory factor analyses and latent class cluster analysis based on a large nation-wide representative German sample (N?=?3150) substantiate the construct validity of the model. Further evidence concerning convergent and discriminant validity with respect to related constructs is obtained in two smaller nonclinical and clinical samples. Factors influencing the association between components of anxiety and depression are discussed.     

Self-reports of depression and state-trait anxiety: evidence for differential assessment.

Several researchers have found anxiety and depression to be indistinguishable in nonclinical samples and have suggested that both constructs may be components of a general psychological distress process. Another possibility is that overlap is due to the psychometric limitations of scales used. A series of exploratory factor analyses were conducted in a nonclinical sample (N = 605) using the Beck Depression Inventory (BDI; Beck, 1978), the State-Trait Anxiety Inventory (STAI; Spielberger, 1983), and the Endler Multidimensional Anxiety Scales (EMAS; Endler, Edwards, & Vitelli, 1991). Both state and trait anxiety and depression could be differentiated with the BDI and the EMAS but not with the STAI. Some theoretical models of negative affectivity or general psychopathology may be premature.     

Viewing Cognitive Conflicts as Dilemmas: Implications for Mental Health

The idea that internal conflicts play a significant role in mental health has been extensively addressed in various psychological traditions, including personal construct theory. In the context of the latter, several measures of conflict have been operationalized using the Repertory Grid Technique (RGT). All of them capture the notion that change, although desirable from the viewpoint of a given set of constructs, becomes undesirable from the perspective of other constructs. The goal of this study is to explore the presence of cognitive conflicts in a clinical sample (n = 284) and compare it to a control sample (n = 322). It is also meant to clarify which among the different types of conflict studied provides a greater clinical value and to investigate its relationship to symptom severity (SCL-90-R). Of the types of cognitive conflict studied, implicative dilemmas were the only ones to discriminate between clinical and nonclinical samples. These dilemmas were found in 34% of the nonclinical sample and in 53% of the clinical sample. Participants with implicative dilemmas showed higher symptom severity, and those from the clinical sample displayed a higher frequency of dilemmas than those from the nonclinical sample.     

The Italian version of the Inventory of Interpersonal Problems Personality Disorders Scales (IIP-47): psychometric properties and clinical usefulness as a screening measure

The Inventory of Interpersonal Problems-47 (IIP-47) is a brief and valid self-report measure for screening Personality Disorders (PDs). This study examined internal consistency, factor structure, criterion validity, temporal stability, and operating characteristics of the Italian version of the IIP-47 in two independent samples: PD subjects (n = 120) and nonclinical subjects (n = 475). Alpha coefficients ranged from .70 to .90. Multiple-Group Confirmatory Factor Analyses showed that the five-correlated-factor model reported in literature had the highest measurement invariance across the two groups. Criterion validity was supported by correlations among IIP-47 scale scores and scores on established measures of personality dimensions and pathology. Test-retest indices ranged from .71 to .95. PD subjects scored significantly higher than nonclinical subjects on all IIP-47 scales and cut-off scores for different levels of specificity and sensibility are reported. It is concluded that the psychometric properties of the original IIP-47 were preserved in its Italian version.     

Preliminary Psychometric Evidence for Distinct Affective and Cognitive Mechanisms Mediating Contamination Aversion

Contamination aversion is implicated in a range of psychological disorders, such as obsessive-compulsive disorder and health anxiety. Despite broad implications, the core mechanisms mediating contamination aversion are mixed and have not clearly been elucidated. The present studies are psychometric investigations of the components of contamination aversion and tests of the different mechanisms that mediate the severity of these components. In Study 1, items from existing measures of contamination aversion were compiled into one measure and administered to a large sample of nonclinical participants (N?=?1,286). Exploratory factor analyses demonstrated a two-factor structure, with one factor comprised of items related to intrinsically (direct) contaminated objects and the other factor comprised of items related to extrinsically (indirect) contaminated objects. In Study 2, items were added and confirmatory factor analyses supported a two-factor model in another large nonclinical sample (N?=?612). In Study 3 (N?=?471), structural modeling demonstrated distinct relations between the two factors and affective and cognitive constructs. Affective constructs related more to aversions toward more directly contaminated objects and situations while cognitive constructs related more to aversions toward more indirectly contaminated objects and situations. The present studies help clarify and articulate the unique roles of cognition and affect in specific contamination aversions, and, as such, have important implications for conceptual modeling of contamination-related psychopathology.     

The Construct Validity of Acceptance: A Multitrait-Multimethod Investigation

Despite increasing clinical and empirical attention, the construct validity of acceptance has not been extensively investigated. The present study utilized a multitrait-multimethod design and a correlated trait-correlated method minus one [CT-C(M-1)] confirmatory factor analytic model to assess acceptance's convergent validity across methods and discriminant validity in comparison to cognitive reappraisal and perceived emotional control in a sample of 210 outpatients with anxiety and mood disorders. In addition, the study evaluated acceptance's concurrent validity by investigating the extent to which it was associated with variables of clinical interest over and above the two rival constructs. Results of confirmatory factor analyses supported acceptance's convergent and discriminant validity in comparison to the two neighboring constructs, and thereby provided partial support for its construct validity. However, contrary to prediction, acceptance was not significantly associated with concurrent validation measures. These results are discussed in the context of acceptance's potential therapeutic utility and functional relationships with associated constructs.     

Psychometric evaluation of the behavioral inhibition/behavioral activation scales in a large sample of outpatients with anxiety and mood disorders

The latent structure, reliability, and validity of the Behavioral Inhibition/Behavioral Activation Scales (BIS/BAS; C. L. Carver and T. L. White, 1994) were examined in a large sample of outpatients (N = 1,825) with anxiety and mood disorders. Four subsamples were used for exploratory and confirmatory factor analyses. In addition to generally upholding a latent structure found previously in nonclinical samples, results indicated measurement invariance of the BIS/BAS between genders and a higher order structure of the BAS scales. Convergent and discriminant validity of the BIS/BAS were supported by findings that the subscales correlated most strongly with measures of neighboring personality constructs (e.g., BIS with neuroticism, BAS with positive affect) than with measures of current anxiety and depression symptoms. Overall, the results support the psychometric properties of the BIS/BAS in this clinical sample.     

Thwarted belongingness and perceived burdensomeness: construct validity and psychometric properties of the Interpersonal Needs Questionnaire

The present study examined the psychometric properties and construct validity of scores derived from the Interpersonal Needs Questionnaire (INQ) using latent variable modeling with 5 independent samples varying in age and level of psychopathology. The INQ was derived from the interpersonal theory of suicide and was developed to measure thwarted belongingness and perceived burdensomeness-both proximal causes of desire for suicide. Results support that thwarted belongingness and perceived burdensomeness are distinct but related constructs and that they can be reliably measured. Further, multiple-group analyses were consistent with invariance for young versus older adults and nonclinical versus clinical populations, thereby supporting the relevance of these constructs to diverse populations. Finally, both constructs demonstrated convergent associations with related interpersonal constructs-including loneliness and social support for belongingness and social worth and death ideation for burdensomeness--as well as prospective associations with suicidal ideation.     

Assessment of mindfulness by self-report: the Kentucky inventory of mindfulness skills

A self-report inventory for the assessment of mindfulness skills was developed, and its psychometric characteristics and relationships with other constructs were examined. Participants included three samples of undergraduate students and a sample of outpatients with borderline personality disorder Based on discussions of mindfulness in the current literature, four mindfulness skills were specified: observing, describing, acting with awareness, and accepting without judgment. Scales designed to measure each skill were developed and evaluated. Results showed good internal consistency and test-retest reliability and a clear factor structure. Most expected relationships with other constructs were significant. Findings suggest that mindfulness skills are differentially related to aspects of personality and mental health, including neuroticism, psychological symptoms, emotional intelligence, alexithymia, experiential avoidance, dissociation, and absorption.     

Clinical Validation of the Swedish Version of the Quality of Life Inventory in Crime Victims with Posttraumatic Stress Disorder and a Nonclinical Sample

The Swedish version of the Quality of Life Inventory (QOLI) was cross-culturally validated with a crime victim sample (N = 53) with posttraumatic stress disorder (PTSD) and a nonclinical group (N = 100) with no lifetime and current psychiatric disorder from the general population in the Stockholm county of Sweden. The QOLI showed excellent internal consistencies in the clinical and the nonclinical sample. In addition, PTSD participants displayed a significantly lower self-perceived quality of life in 13 out of 16 domains of life than the nonclinical individuals. Furthermore, the QOLI was inversely correlated with interview and self-report measures of PTSD symptoms, depression, and anxiety. Overall, the results support the utility of the Swedish QOLI version as a potentially useful measure of self-perceived quality of life in Swedish clinical and nonclinical samples. The results are discussed in relation to the Swedish cross-cultural validation of the QOLI, methodological limitations and future directions.     

Factor structure of the Wechsler Adult Intelligence Scale-III in schizophrenia

This report examines and compares the factor structure of the new edition of the Wechsler Adult Intelligence Scale (WAIS-III) in a sample of chronic schizophrenia and schizoaffective disorder outpatients (n = 120) and an age-matched sample of individuals drawn from the WAIS-III standardization sample (n = 200). Exploratory and confirmatory factor analyses similar to those reported by the developers of the scale suggested that a model of WAIS-III performance with correlated factors for verbal comprehension, perceptual organization, working memory, and processing speed fit the data from the schizophrenia sample as well as it fit the nonclinical comparison sample and fit the data from both samples better than alternative models.     

The Roles of Persistence and Perseveration in Psychopathology

Two constructs were hypothesized to be of importance in psychological disorders: persistence (the ability to keep going to reach a goal, even when the task is difficult or drawn out) and perseveration (the tendency to continue a behavior, even when it ceases to be effective or rewarding). These are contrasted with perfectionism (having high standards for oneself or others). A measure was developed to address these constructs (the Persistence, Perseveration and Perfectionism Questionnaire; PPPQ). The PPPQ was administered to 325 nonclinical participants, alongside a measure of psychological disturbance. Factor analysis resulted in a 22-item version of the measure, consisting of subscales with good psychometric properties corresponding to the 3 theoretical constructs. Persistence was associated with lower levels of psychopathology, whereas perseveration was associated with higher levels of psychopathology. Perfectionism was weakly associated with psychopathology. Further work is needed to develop these constructs with clinical groups, but the findings support the hypothesis that persistence is an adaptive construct whereas perseveration is maladaptive.