Prospective associations between disgust proneness and OCD symptoms: Specificity to excessive washing compulsions.

Although considerable evidence has linked disgust proneness (DP) to obsessive-compulsive disorder (OCD), few studies have examined the extent to which DP predicts OCD symptoms over time. Further, it remains unclear if DP is a risk factor for the contamination subtype of OCD specifically or if it is prospectively associated with other OCD symptom subtypes. The present study sought to address these gaps in the literature with a large sample of unselected community participants (n = 497) that completed measures of DP and OCD symptoms monthly over a 6-month period. Latent growth analysis revealed that initial levels of DP were associated with higher initial level of total OCD symptoms when controlling for depression, but not the slope of change in total OCD symptoms over time. Initial levels of total OCD symptoms were also associated with higher initial levels of DP when controlling depression, but not the slope of change in DP over time. Examination of symptom specificity revealed that initial levels of DP were associated with initial levels of washing, neutralizing, obsessing, ordering, and hoarding symptoms. However, initial levels of DP were associated only with the slope of change in the washing subtype when controlling for depression such that high initial levels of DP were associated with steeper increases in washing symptoms of OCD over the 6-month period. These findings suggest that although DP may have concurrent associations with symptoms of OCD more broadly, prospective associations are specific to the contamination/washing subtype of OCD. The implications of these findings for the etiology and treatment of contamination-based OCD are discussed.

What Therapy Practices Do Providers Value in Youth Behavioral Health? A Measure Development Study.

Existing measures of attitudes toward evidence-based practices (EBPs) assess attitudes toward manualized or research-based treatments. Providers of youth behavioral health (N = 282) completed the Valued Practices Inventory (VPI), a new measure of provider attitudes toward specific practices for youth that avoids mention of EBPs by listing specific therapies-some of which are drawn from EBPs (e.g., problem solving) and some of which are not included in EBPs (e.g., dream interpretation). Exploratory factor analysis revealed two factors: practices derived from the evidence base (PDEB) and alternative techniques (AT). The PDEB scale was significantly correlated with scales on the Evidence-Based Practice Attitude Scale-50 (Aarons et al. in Administration and Policy in Mental Health and Mental Health Services Research, 39(5): 331-340, 2012), whereas the AT scale was not. Attitudes toward PDEB and AT were also related to provider characteristics such as years of experience and work setting. The VPI offers a complementary approach to existing measures of attitudes because it avoids mention of EBPs, which may help prevent biases in responses.

Structure, Reliability, Measurement Stability, and Construct Validity of the Polish Version of the Revised Child Anxiety and Depression Scale.

The Revised Child Anxiety and Depression Scale (RCADS) is a self-report questionnaire that aims to assess symptoms of anxiety and depressive disorders in children. Two studies were conducted to evaluate the psychometric properties of the Polish version of the RCADS. Study 1 was conducted to analyze the structural validity and reliability of the RCADS scores and Study 2 assessed the longitudinal measurement of stability over time. Data were collected from a community sample of 501 children and adolescents aged 8 to 14 years in Poland. The original 47-item version of the Polish RCADS was compared with two shortened versions: 30- and 20-item versions. Overall results revealed support for the structural and construct validity, reliability, and stability of the Polish version of the RCADS.

A bifactor model of obsessive beliefs: Specificity in the prediction of obsessive-compulsive disorder symptoms.

Although current cognitive-behavioral models suggest that maladaptive "obsessive beliefs" about threat, responsibility, uncertainty, perfectionism, importance, and control of thoughts contributes to the development of obsessive-compulsive disorder (OCD), the structure of such beliefs is unclear. The current study evaluated a bifactor model of obsessive beliefs, as assessed by the Obsessive Beliefs Questionnaire (OBQ-44), and its association with OCD symptoms in clinical (Study 1; N = 264) and nonclinical (Study 2; N = 437) samples. The goals were as follows: (a) to evaluate whether obsessive beliefs should be conceptualized as unidimensional or whether distinct dimensions should be interpreted, and (b) to use structural equation modeling to examine the extent to which distinct beliefs predict OCD symptoms above and beyond a general obsessive belief factor. Results revealed that in both clinical and nonclinical samples, a bifactor model fit the data well and significantly better than a standard three-factor model of the OBQ-44 that specified 3 separate, yet correlated factors (Responsibility/Threat Estimation, Perfectionism/Certainty, and Importance/Control of Thoughts). Despite evidence that the OBQ-44 consists of a general factor and the 3 specific factors, structural equation modeling showed that only the general factor uniquely predicted a broad OCD symptom latent factor in clinical and nonclinical samples. Although obsessive beliefs about Perfectionism/Certainty did predict symmetry and ordering symptoms of OCD when controlling for the general factor in both studies, the general factor was a more robust predictor of specific OCD symptoms than the 3 factors. These findings suggest that the general factor of the OBQ-44 may have more utility than its specific factors in predicting the heterogeneity of OCD symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Depression, Anxiety, and Stress: How Should Clinicians Interpret the Total and Subscale Scores of the 21-Item Depression, Anxiety, and Stress Scales?

The 21-item Depression, Anxiety, and Stress Scales (DASS-21) is a self-report measure that is easy to administer, quick to score, and is freely available. Widely used in diverse settings and populations, confirmatory factor analytic evidence has accumulated for a bifactor model underlying this multidimensional measure. Studies employing an exploratory bifactor approach to more closely examine its underlying structure and inter-relations of factors, however, have been scarce. This is unfortunate because confirmatory techniques often employ indirect ways of handling model misspecification, whereas exploratory methods enable more direct approaches. Moreover, more precise approaches to modeling an exploratory bifactor structure have not been examined with the DASS-21. Based on several large samples of undergraduate students in the United States, the first two parts of the paper (Studies 1 and 2) utilized both exploratory (M = 19.7 years of age) and confirmatory factor analytic methods (M = 19.7 years of age) following those presented by contemporary multidimensional modeling theorists. Building upon these results, the third part of the paper (Study 3; M = 20.0 years of age) examined sensitivity-/specificity-related indices to provide cut-off score recommendations for a revised DASS-21 instrument based on a newly identified and supported bifactor structure. Implications of these results are discussed in terms of taxonomy, challenges inherent in multidimensional modeling, and potential use of the revised DASS-21 measure as a component of an actuarial decision-making strategy to inform clinical referrals.

A re-examination of the BIS/BAS scales: Evidence for BIS and BAS as unidimensional scales.

OBJECTIVES: Carver and White's behavioral inhibition system and behavioral activation system (BIS/BAS) scales are the most widely used to assess constructs of the revised reinforcement sensitivity theory. This study provides a re-examination of the latent structure of the original BIS/BAS scales. METHODS: The interpretability of the three purported BAS subfactors relative to a "general behavioral activation" factor was assessed using Schmid-Leiman and standard confirmatory factor analysis. Regarding the BIS scale, comparisons were made between (a) Carver and White's unidimensional BIS model, (b) Johnson, Turner, and Iwata's 2-factor BIS model, (c) Heym, Ferguson, and Lawrence's alternative 2-factor BIS model, and (d) a modified Heym et al. model (unidimensional) controlling for method effects of reverse-scored items. RESULTS: Results revealed the majority of variance of individual BAS items was accounted for by a common, general BAS dimension. Additionally, for the BIS scale, results of the χ2 difference statistical test supporting the 1-factor model, as well as the noted theoretical and psychometric difficulties in interpreting a multifactor BIS scale, provide converging support that BIS items actually represent a single, unidimensional factor. CONCLUSIONS: The collective results suggested that the BIS and BAS scales should be conceptualized as separate unidimensional measures, which is consistent with theory behind the original development.

Cross-Cultural Validation of the Modified Practice Attitudes Scale: Initial Factor Analysis and a New Factor Model.

OBJECTIVE: The objective of this study was to create the Korean version of the Modified Practice Attitudes Scale (K-MPAS) to measure clinicians' attitudes toward evidence-based treatments (EBTs) in the Korean mental health system. METHOD: Using 189 U.S. therapists and 283 members from the Korean mental health system, we examined the reliability and validity of the MPAS scores. We also conducted the first exploratory and confirmatory factor analysis on the MPAS and compared EBT attitudes across U.S. and Korean therapists. RESULTS: Results revealed that the inclusion of both "reversed-worded" and "non-reversed-worded" items introduced significant method effects that compromised the integrity of the one-factor MPAS model. Problems with the one-factor structure were resolved by eliminating the "non-reversed-worded" items. Reliability and validity were adequate among both Korean and U.S. therapists. Korean therapists also reported significantly more negative attitudes toward EBTs on the MPAS than U.S. therapists. CONCLUSIONS: The K-MPAS is the first questionnaire designed to measure Korean service providers' attitudes toward EBTs to help advance the dissemination of EBTs in Korea. The current study also demonstrated the negative impacts that can be introduced by incorporating oppositely worded items into a scale, particularly with respect to factor structure and detecting significant group differences.

Psychometric investigation of the specific phobia of vomiting inventory: A new factor model.

Well-validated, standardized measures are lacking for the assessment of emetophobia, the specific phobia of vomiting. The Specific Phobia of Vomiting Inventory (SPOVI) was recently developed and shows promise as a useful measure of emetophobia. The goal of the present study was to further examine and investigate the psychometric properties of the SPOVI in a large student sample (n = 1626), specifically focusing on its factor structure, measurement invariance across gender, and convergent/divergent validity. Confirmatory factor analysis results provide support for a one-factor model of the SPOVI, in contrast to the previously proposed two-factor model. Internal consistency of the SPOVI was good (α = 0.89) and measurement invariance across gender invariance was supported. The SPOVI also demonstrated good psychometric properties with respect to convergent and divergent validity. The present study's demonstration of the reliability and validity of the SPOVI suggests that the instrument may be a valuable tool for assessing emetophobia symptoms based on its one-factor structure.

Psychometric Properties of the Parent Version of the Revised Child Anxiety and Depression Scale in a Clinical Sample of Turkish Children and Adolescents.

The Revised Child Anxiety and Depression Scale-Parent version (RCADS-P) is a self-report questionnaire that assesses dimensions of DSM-based anxiety and depressive disorders in children and adolescents. The present study examined the psychometric properties of the Turkish version in a clinical sample of 483 children and adolescents. The child and parent versions of the RCADS, parent versions of the Screen for Child Anxiety Related Emotional Disorders, the Strengths and Difficulties Questionnaire and Adolescent Symptom Inventory-Depression Scale were administered. Current psychiatric diagnoses were assessed via the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present Version. The RCADS-P demonstrated high internal consistency and test-retest reliability, and good convergent, divergent, and discriminant validity. Confirmatory factor analysis supported the DSM-related six-factor structure. With its demonstrated favorable psychometric properties, the Turkish RCADS-P is currently the only validated parent-report instrument that assesses DSM-based anxiety and depressive disorders in children and adolescents in Turkey.

Disgust proneness predicts obsessive-compulsive disorder symptom severity in a clinical sample of youth: Distinctions from negative affect.

BACKGROUND: Although studies have linked disgust proneness to the etiology and maintenance of obsessive-compulsive disorder (OCD) in adults, there remains a paucity of research examining the specificity of this association among youth. METHOD: The present study employed structural equation modeling to examine the association between disgust proneness, negative affect, and OCD symptom severity in a clinical sample of youth admitted to a residential treatment facility (N =471). RESULTS: Results indicate that disgust proneness and negative affect latent factors independently predicted an OCD symptom severity latent factor. However, when both variables were modeled as predictors simultaneously, latent disgust proneness remained significantly associated with OCD symptom severity, whereas the association between latent negative affect and OCD symptom severity became nonsignificant. Tests of mediation converged in support of disgust proneness as a significant intervening variable between negative affect and OCD symptom severity. Subsequent analysis showed that the path from disgust proneness to OCD symptom severity in the structural model was significantly stronger among those without a primary diagnosis of OCD compared to those with a primary diagnosis of OCD. LIMITATIONS: Given the cross-sectional design, the causal inferences that can be made are limited. The present study is also limited by the exclusive reliance on self-report measures. CONCLUSIONS: Disgust proneness may play a uniquely important role in OCD among youth.

Cross-cultural relevance of the Interpersonal Theory of suicide across Korean and U.S. undergraduate students.

This study investigated the cross-cultural relevance and validity of the Interpersonal Theory of Suicide (ITS) utilizing young adult samples from South Korea (n =554) and the United States (U.S.; n =390). To examine the ITS, all participants completed self-report questionnaires measuring Thwarted Belongingness, Perceived Burdensomeness, and Capability for Suicide. We examined whether each construct significantly predicted the severity of suicidal risk in both samples. We also determined whether the strength of the effects of Thwarted Belongingness and Perceived Burdensomeness on suicidal ideation differed between the two samples due to the greater degree of importance placed on interpersonal relationships in collectivistic cultures such as South Korea. Structural equation modeling was used to examine these hypotheses. Thwarted Belongingness, Perceived Burdensomeness, and Capability for Suicide significantly predicted elevated suicidal risk. However, there were no significant differences in the paths from Thwarted Belongingness or Perceived Burdensomeness to suicide risk between the South Korean and U.S. SAMPLES: These findings support the cross-cultural relevance and applicability of the ITS, whereby Thwarted Belongingness and Perceived Burdensomeness serve as indicators of suicide risk in both Western (U.S.) and East Asian (Korean) samples.

The Child PTSD Symptom Scale: An Investigation of Its Psychometric Properties.

The current study addresses the need for accurate measurement of posttraumatic stress disorder (PTSD) symptoms in youth by investigating the psychometric properties of the Child PTSD Symptom Scale (CPSS). The factor structure, reliability, and concurrent and discriminant validity of the CPSS were investigated in a sample of 206 6th- to 12th-grade adolescents. Exploratory and confirmatory factor analysis supported a single-factor structure, which was contrary to the hypothesized three-factor structure. Scores comprising this one-factor structure were also associated with high reliability (α = .93), and tests of concurrent and discriminant validity were also strong. The implications of these findings are discussed, with particular emphasis on future directions for research on self-report measures for adolescent PTSD symptoms.

Examination of a Bifactor Model of Obsessive-Compulsive Symptom Dimensions.

Although obsessive-compulsive (OC) symptoms are observed along four dimensions (contamination, responsibility for harm, order/symmetry, and unacceptable thoughts), the structure of the dimensions remains unclear. The current study evaluated a bifactor model of OC symptoms among those with and without obsessive-compulsive disorder (OCD). The goals were (a) to evaluate if OC symptoms should be conceptualized as unidimensional or whether distinct dimensions should be interpreted and (b) to use structural equation modeling to examine the convergence of the OC dimensions above and beyond a general dimension with related criteria. Results revealed that a bifactor model fit the data well and that OC symptoms were influenced by a general dimension and by four dimensions. Measurement invariance of the bifactor model was also supported among those with and without OCD. However, the general OC dimension accounted for only half of the variability in OC symptoms, with the remaining variability accounted for by distinct dimensions. Despite evidence of multidimensionality, the dimensions were unreliable after covarying for the general OC dimension. However, the four dimensions did significantly converge with a latent OC spectrum factor above and beyond the general OC dimension. The implications of these findings for conceptualizing the structure of OCD are discussed.

The Loneliness Questionnaire: Establishing Measurement Invariance Across Ethnic Groups.

A state of loneliness describes an individual's perception of having dissatisfying social connections to others. Though it is notable across the life span, it may have particularly deleterious effects in childhood and adolescence, leading to increased risk of emotional impairment. The current study evaluates a widely used test of loneliness, the Loneliness Questionnaire, for measurement invariance across ethnic groups in a large, representative sample of youth in the 2nd to 12th grades ( N = 12,344; 41% African American) in Mississippi. Analyses were conducted using multigroup confirmatory factor analysis following a published, sequential method to examine invariance in form, factor loadings, and item intercepts. Overall, our results indicated that the instrument was invariant across ethnicities, suggesting that youth with equivalent manifest scores can be discerned as having comparable levels of latent loneliness. The loneliness scores also corresponded significantly with depression and anxiety scores for most subsamples, with one exception. These findings are discussed in the context of previous results comparing levels of loneliness across ethnicities. Additionally, the broader context of the need to expand invariance studies in instrumentation work is highlighted.

The Revised Child Anxiety and Depression Scale 25-Parent Version: Scale Development and Validation in a School-Based and Clinical Sample.

To help facilitate the dissemination and implementation of evidence-based assessment practices, we examined the psychometric properties of the shortened 25-item version of the Revised Child Anxiety and Depression Scale-parent report (RCADS-25-P), which was based on the same items as the previously published shortened 25-item child version. We used two independent samples of youth-a school sample ( N = 967, Grades 3-12) and clinical sample ( N = 433; 6-18 years)-to examine the factor structure, reliability, and validity of the RCADS-25-P scale scores. Results revealed that the two-factor structure (i.e., depression and broad anxiety factor) fit the data well in both the school and clinical sample. All reliability estimates, including test-retest indices, exceeded benchmark for good reliability. In the school sample, the RCADS-25-P scale scores converged significantly with related criterion measures and diverged with nonrelated criterion measures. In the clinical sample, the RCADS-25-P scale scores successfully discriminated between those with and without target problem diagnoses. In both samples, child-parent agreement indices were in the expected ranges. Normative data were also reported. The RCADS-25-P thus demonstrated robust psychometric properties across both a school and clinical sample as an effective brief screening instrument to assess for depression and anxiety in children and adolescents.

Does the measure matter? On the association between disgust proneness and OCD symptoms.

Although some studies suggest that the association between disgust proneness (DP) and obsessive-compulsive symptoms (OCS) is specific to the contamination subtype, others suggest that DP is associated with OCS more broadly. To examine if the discrepant findings may partially reflect differences in self-report measures used, this investigation employed structural equation modeling to examine the association between DP and OCS in three samples that completed different combinations of measures of DP, OCS, and anxiety/negative affect. In Study 1 (n=626), the path from DP to contamination-based OCS was significantly stronger than the path from DP to non-contamination OCS when controlling for anxiety sensitivity. In Study 2 (n=403), the results showed that the path from DP to contamination-based OCS did not significantly differ from the path from DP to non-contamination OCS when controlling for negative affect. Lastly, Study 3 (n=296) showed that the path from DP to contamination-based OCS was significantly weaker than the path from DP to non-contamination OCS. These findings highlight that the self-report measures employed is an important moderator when making inferences about the association between DP and contamination-based OCS and non-contamination OCS.

The utility of the bifactor model in understanding unique components of anxiety sensitivity in a South Korean sample.

The present study was the first to examine the applicability of the bifactor structure underlying the Anxiety Sensitivity Index-3 (ASI-3) in an East Asian (South Korean) sample and to determine which factors in the bifactor model were significantly associated with anxiety, depression, and negative affect. Using a sample of 289 South Korean university students, we compared (a) the original 3-factor AS model, (b) a 3-group bifactor AS model, and (c) a 2-group bifactor AS model (with only the physical and social concern group factors present). Results revealed that the 2-group bifactor AS model fit the ASI-3 data the best. Relatedly, although all ASI-3 items loaded on the general AS factor, the Cognitive Concern group factor was not defined in the bifactor model and may therefore need to be omitted in order to accurately model AS when conducting factor analysis and structural equation modeling (SEM) in cross cultural contexts. SEM results also revealed that the general AS factor was the only factor from the 2-group bifactor model that significantly predicted anxiety, depression, and negative affect. Implications and importance of this new bifactor structure of Anxiety Sensitivity in East Asian samples are discussed.

Training children's theory-of-mind: A meta-analysis of controlled studies.

BACKGROUND: Theory-of-mind (ToM) refers to knowledge and awareness of mental states in oneself and others. Various training programs have been developed to improve ToM in children. OBJECTIVES: In the present study, we conducted a quantitative review of ToM training programs that have been tested in controlled studies. DATA SOURCES: A literature search was conducted using PubMed, PsycInfo, the Cochrane Library, and manual searches. REVIEW METHODS: We identified 32 papers with 45 studies or experiments that included 1529 children with an average age of 63 months (SD=28.7). RESULTS: ToM training procedures were more effective than control procedures and their aggregate effect size was moderately strong (Hedges' g=0.75, CI=0.60-0.89, p<.001). Moderator analyses revealed that although ToM training programs were generally effective, ToM skill-related outcomes increased with length of training sessions and were significantly higher in active control studies. CONCLUSION: ToM training procedures can effectively enhance ToM in children.

Children's emotion understanding: A meta-analysis of training studies.

BACKGROUND: In the course of development, children show increased insight and understanding of emotions-both of their own emotions and those of others. However, little is known about the efficacy of training programs aimed at improving children's understanding of emotion. OBJECTIVES: To conduct an effect size analysis of trainings aimed at three aspects of emotion understanding: external aspects (i.e., the recognition of emotional expressions, understanding external causes of emotion, understanding the influence of reminders on present emotions); mental aspects (i.e., understanding desire-based emotions, understanding belief-based emotions, understanding hidden emotions); and reflective aspects (i.e., understanding the regulation of an emotion, understanding mixed emotions, understanding moral emotions). DATA SOURCES: A literature search was conducted using PubMed, PsycInfo, the Cochrane Library, and manual searches. REVIEW METHODS: The search identified 19 studies or experiments including a total of 749 children with an average age of 86 months (S.D.=30.71) from seven different countries. RESULTS: Emotion understanding training procedures are effective for improving external (Hedge's g = 0.62), mental (Hedge's g = 0.31), and reflective (Hedge's g = 0.64) aspects of emotion understanding. These effect sizes were robust and generally unrelated to the number and lengths of training sessions, length of the training period, year of publication, and sample type. However, training setting and social setting moderated the effect of emotion understanding training on the understanding of external aspects of emotion. For the length of training session and social setting, we observed significant moderator effects of training on reflective aspects of emotion. CONCLUSION: Emotion understanding training may be a promising tool for both preventive intervention and the psychotherapeutic process. However, more well-controlled studies are needed.

Building an evidence-informed service array: Considering evidence-based programs as well as their practice elements.

OBJECTIVE: This study empirically examined options for building an evidence-informed service array, comparing strategies to maximize the application of evidence-based treatment literature in a clinical service system. The overall goal was to determine the smallest set of treatments that could serve the largest percentage of clients. Solutions to this problem differ depending on how one defines "treatment." METHOD: Treatments were conceptualized as (a) programs (integrated treatments produced by specific research laboratories or investigators), and (b) collections of their constituent common procedures, referred to as practice elements. Programs listed by 2 separate government-sanctioned registries were selected to illustrate the effects of "program" conceptualizations, and all available clinical trials testing the programs were analyzed. Practice elements were identified from these same studies and from studies of other treatments that met a standard of evidence but had not been organized into programs on these lists. Relevance mapping methodology was used to identify optimal sets of programs and practice elements. RESULTS: Among a large, diverse clinical population, results identified 11%-22% of youths for whom practice elements provide an evidence-informed treatment option whereas no programs meeting the standard of evidence were available on the registries. Results for the practice elements were able to be matched by a hybrid combination: "best" programs, which were then extended by practice elements. CONCLUSIONS: These results demonstrated that there are multiple ways to conceptualize treatments when planning a service array, and these options have significant implications regarding who can be served by treatments supported by evidence.