Fear of self and obsessionality: development and validation of the Fear of Self Questionnaire

Obsessions – particularly those directly relating to causing harm – often contain or imply evaluative dimensions about the self, reflecting a fear as to who the person might be – or might become. Following from research indicating that such beliefs are relevant to OCD, and the wider literature in social psychology regarding ‘feared’ or ‘undesired’ self-guides, the current study describes the development and validation of a new questionnaire—the Fear of Self Questionnaire, in 8- and 20-item versions.

The questionnaire was piloted in two non-clinical samples (n=258; n=292). Exploratory and confirmatory factor analyses supported the unidimensionality of the measure. The questionnaire showed a strong internal inconsistency, and good divergent and convergent validity, including strong relationships to obsessional symptoms and with other processes implicated in cognitive models of OCD (e.g. obsessive beliefs, inferential confusion). Implications are discussed.

Fear of self and unacceptable thoughts in obsessive-compulsive disorder

Cognitive-behavioural models have linked unacceptable or repugnant thoughts in obsessive-compulsive disorder (OCD) with vulnerable self-themes and fear-of-self concerns. To investigate this notion, Aardema and coworkers recently developed and validated the Fear of Self-Questionnaire (FSQ) in non-clinical samples, finding it had strong internal inconsistency, and good divergent and convergent validity, including strong relationships to obsessional symptoms and with other processes implicated in cognitive models of OCD (e.g., obsessive beliefs and inferential confusion). The current article describes two studies that aim to replicate and extend these findings in clinical OCD and non-clinical samples. Study 1 investigated the psychometric properties of an Italian translation of the FSQ in a non-clinical sample (n=405). Results of confirmatory factor analysis supported the unidimensionality of the scale; the FSQ also showed very good internal consistency and temporal stability. Study 2 investigated the role of fear of self in OCD symptoms, and unacceptable thoughts and repugnant obsessions in particular, using a clinical OCD sample (n=76). As expected, fear of self was a unique, major predictor of unacceptable thoughts independent of negative mood states and obsessive beliefs. Moreover, even when considered with obsessive beliefs, anxiety and depression, the feared self was the only unique predictor of obsessionality, providing support for the notion that self-themes could explain why some intrusions convert into obsessions, whereas others do not. Implications for current cognitive-behavioural models are discussed.

Psychometric properties of the Swedish version of the Fear of Complications Questionnaire

Objectives: To translate and evaluate the psychometric properties of the Swedish version of the Fear of Complications Questionnaire. Design: Cross-sectional study design and scale development. Settings: Totally, 469 adults (response rate 63.5%) with Type 1 diabetes completed the questionnaires. Participants were recruited from two university hospitals in Sweden. Participants: Eligible patients were those who met the following inclusion criteria: diagnosed with Type 1 diabetes, diabetes duration of at least 1 year and aged at least 18 years. Methods: The Fear of Complications Questionnaire was translated using the forward-backward translation method. Factor analyses of the questionnaire were performed in two steps using both exploratory and confirmatory factor analysis. Convergent validity was examined using the Hospital Anxiety and Depression Scale and the Fear of Hypoglycaemia Fear Survey. Internal consistency was estimated using Cronbach’s alpha.Results: Exploratory factor analysis supported a two-factor solution. One factor contained three items having to do with fear of kidney-related complications and one factor included the rest of items concerning fear of other diabetes-related complications, as well as fear of complications in general. Internal consistency was high Cronbach’s alpha 0.96. The findings also gave support for convergent validity, with significant positive correlations between measures (r = 0.51 to 0.54). Conclusion: The clinical relevance of the identified two-factor model with a structure of one dominant subdomain may be considered. We suggest, however a one-factor model covering all the items as a relevant basis to assess fear of complications among people with Type 1 diabetes.

Fear of self, doubt and obsessive compulsive symptoms

BACKGROUND AND OBJECTIVES: Following observations in the literature that obsessions often contain or imply negative evaluative information about the self, Aardema et al. (2013) recently developed a measure of feared-self relevant to OCD. The current study aimed to provide further examination of the relevance of such feared self-beliefs to obsessive compulsive processes - in particular whether they partially underlie doubt in OCD-relevant situations. METHOD: Nonclinical participants (N = 463; 291 females; Mage = 25.17, SD = 7.47), were presented with three vignettes, related to washing, checking and non-OCD relevant themes, which assessed doubt through providing alternating sensory and possibility-based information. RESULTS: Higher levels of OCD symptoms and feared-self beliefs both significantly predicted both higher baseline levels of doubt and greater fluctuation in levels of doubt in both the contamination and checking scenarios, and to a much lesser extent in the control scenario. Feared-self beliefs did not predict fluctuation in doubt over-and-above OCD symptoms, consistent with a mediation model. LIMITATIONS: The main limitation was the use of a non-clinical sample, although this allowed sufficient participant numbers to test hypotheses. CONCLUSIONS: The findings provided further experimental support for reasoning processes in OCD, and suggested that feared self-beliefs may make individuals vulnerable to experiencing doubt. Additionally, these results suggested that individuals with high OCD symptoms and those with high feared self-beliefs are unable to recognise the improbable nature of possibility-based statements. Implications for treatment and theory are discussed.

The role of fear of self and responsibility in obsessional doubt processes: a bayesian hierarchical model

The literature concerning obsessive-compulsive disorder (OCD) indicates that obsessions frequently imply negative evaluative beliefs regarding the self. The construct of the feared self has been used to describe the set of harmful attributes an individual worries they may possess. This study aimed to partially replicate previous research that demonstrated a relationship between feared-self beliefs and obsessional doubt in OCD-relevant contexts. The relationship between perceptions of personal responsibility and associated levels of doubt was also examined. Nonclinical participants (N = 221; 155 female; Mage = 26.4, SD = 9.2) were presented with vignettes related to checking and non OCD-relevant themes, which quantified doubt through the presentation of alternating reality-based (i.e., sensory) and possibility-based information. Of the total sample, 112 participants were randomly allocated to a personally relevant condition (in which the action implied in the vignettes was completed by the reader), and 109 were allocated to a second, other-relevant, condition (in which the action implied in the vignettes was completed by a proximal other). The results provided support for reasoning processes implicated in OCD, suggesting that feared-self beliefs may partially contribute to heightened levels of doubt in response to possibility vs. reality-based information in OCD-relevant contexts. Personal relevance contributed to greater baseline levels of doubt, but not to greater responses to the reality- and possibility-based statements accompanying the OCD-relevant vignette. Implications for theory and future research are discussed.

Impact of the ego-dystonic nature of obsessions on treatment outcome in eating disorders

Il s'agit d'une hypothèse largement répandue que l’égo-dystonie et l’égo-syntonie caractérisent les obsessions dans les troubles des conduites alimentaires (TCA) et que ces facteurs sont cliniquement pertinents pour la conceptualisation et le traitement des TCA. Cependant, les résultats empiriques sur ce sujet sont rares. Compte tenu du chevauchement reconnu entre les TCA, notamment l'anorexie et la boulimie (BN), et le trouble obsessionnel-compulsif (TOC) dans la phénoménologie et les caractéristiques psychologiques, un programme de thérapie cognitive basée sur les inférences (TBI) de 24 semaines, démontré efficace dans le traitement des TOC, a été adapté pour traiter les TCA. La recherche sur le TOC suggère que la transformation des pensées intrusives en obsessions est liée à la mesure dans laquelle les pensées intrusives menacent des perceptions fondamentales du soi et de l’identité. Cette thèse a pour objectif d'examiner le lien entre l’égo-dystonie et les TCA. Pour se faire, nous avons exploré le lien entre la nature égo-dystone des obsessions chez les patients souffrant d'un TCA et la peur de l'image de soi. Nous avons également étudié la relation entre la sévérité des symptômes TCA et l’égo-dystonie dans les obsessions. En outre, nous avons investigué les différences dans la présence de pensées égo-dystones et de peur face à son identité entre des sujets non-cliniques et des personnes atteintes d’un TCA. Enfin, nous avons comparé le degré d’égo-dystonie dans les pensées de personnes atteintes d’un TCA à celui dans les pensées d’individus souffrant d’un TOC. L’égo-dystonie dans les pensées a été mesurée par l'Ego Dystonicity Questionnaire (EDQ) et le degré de peur face à l’identité a été mesuré par le Fear of Self Questionnaire (FSQ) d’une part dans un échantillon de femmes souffrant d’un TCA (n = 57) et d’autre part dans un échantillon de participantes non-cliniques (n = 45). Les résultats révèlent que l’égo-dystonie et la peur face à l’identité étaient fortement corrélées à la fois dans l’échantillon clinique et non-clinique. Les scores de l’EDQ n’étaient pas significativement corrélés à la sévérité des symptômes TCA à l'exception de la sous-échelle d’irrationalité de l’EDQ qui était fortement associée à la sévérité des comportements compulsifs compensatoires. Les participantes souffrant d'un TCA avaient des scores significativement plus élevés à l’EDQ et au FSQ que les sujets non-cliniques. Ensuite, une étude de cas décrit l’application du programme de thérapie cognitive TBI pour une femme de 35 ans avec un diagnostic de BN. La pathologie TCA s’est significativement améliorée au cours de la TBI et six mois suivant la thérapie. Cette étude de cas met en évidence l'importance de cibler les idées surévaluées, les doutes et le raisonnement face au soi et à l’identité dans le traitement psychologique pour les TCA. Enfin, l’objectif final de cette thèse était d’examiner les changements au niveau (1) des symptômes TCA, (2) du degré d’égo-syntonie dans les obsessions, et (3) des mesures de peur face à l’identité, de motivation, d’humeur et d’anxiété au cours de la TBI et au suivi post six mois. L’égo-dystonie, la peur face à l’identité, les symptômes TCA et le stade motivationnel ont été mesurés chez 15 femmes souffrant de BN au cours du traitement et six mois après la TBI. Quatre vingt pourcent de l’échantillon, soit 12 des 15 participantes, ont démontré une diminution cliniquement significative des symptômes TCA et 53% ont cessé leurs comportements compensatoires au suivi post six mois. Les retombées cliniques relatives au traitement des TCA sont discutées.

Attachment, fear of intimacy and differentiation of self among clients in substance disorder treatment facilities

Attachment, fear of intimacy and differentiation of self were examined by means of self-report questionnaires in 158 volunteers, including 99 clients enrolled in addiction treatment programs. As expected, clients (who were undergoing treatment for alcoholism, heroin addiction, amphetamine/cocaine addiction or cannabis abuse) reported higher levels of insecure attachment and fear of intimacy, and lower levels of secure attachment and differentiation of self, compared to controls. Insecure attachment, high fear of intimacy and low self-differentiation appear to characterize clients enrolled in addiction treatment programs. Such characteristics may reflect a predisposition to substance problems, an effect of chronic substance problems, or conceivably both.

The relationship between self-reported animal fear and ERP modulation : Evidence for enhanced processing and fear of harmless invertebrates in snake- and spider-fearful individuals

The present study used ERPs to compare processing of fear-relevant (FR) animals (snakes and spiders) and non-fear-relevant (NFR) animals similar in appearance (worms and beetles). EEG was recorded from 18 undergraduate participants (10 females) as they completed two animal-viewing tasks that required simple categorization decisions. Participants were divided on a post hoc basis into low snake/spider fear and high snake/spider fear groups. Overall, FR animals were rated higher on fear and elicited a larger LPC. However, individual differences qualified these effects. Participants in the low fear group showed clear differentiation between FR and NFR animals on subjective ratings of fear and LPC modulation. In contrast, participants in the high fear group did not show such differentiation between FR and NFR animals. These findings suggest that the salience of feared-FR animals may generalize on both a behavioural and electro-cortical level to other animals of similar appearance but of a non-harmful nature.

Development of self-efficacy questionnaire for Chinese family caregivers

The purpose of this study was to develop a Self-Efficacy Questionnaire for Chinese Family Caregivers. Semi-structured interviews with 10 family caregivers of people with dementia were conducted to explore how Chinese caregivers manage caregiving and what difficulties they face. The findings of the study assisted in the development of the instrument. Five categories of caregiver behaviours were identified from the qualitative data: gathering information about treatment, symptoms, and health care; obtaining support; responding to behaviour disturbances; managing household, personal, and medical care; and managing distress associated with caregiving. The challenges of caregiving were also identified, including deterioration of care recipients, particularly their behaviour disturbances, a shortage of supportive resources, stigmatization of dementia among the general population, as well as increased distress and decreased social activities due to increased care demand. The findings were used to develop the Self-Efficacy Questionnaire for Chinese Family Caregivers, and 35 items comprising five subscales (representing the above five categories of caregiver behaviour) were generated.

Preliminary analysis of self-report questionnaire with young drivers in Oman. Fourth report of the novice driver safety research in Oman project for the Research Council of Oman

This report document the recent progress (current as of December 2014) of the research project investigating novice driver safety in Oman. Included in this report is a summary of progress with publications to date, as well as description of the preliminary results of the first phase of the quantitative survey with young drivers. With regards to the publications which have resulted from this research, two journal articles have been published in print, one is under review, and a fourth is in the late stages of development for submission...

Health-related quality of life in Huntington’s Disease patients: a comparison of proxy assessment and patient self-rating using the disease-specific Huntington’s Disease health-related quality of life questionnaire (HDQoL)

Huntington’s disease (HD) is a fatal, neurodegenerative disease for which there is no known cure. Proxy evaluation is relevant for HD as its manifestation might limit the ability of persons to report their health-related quality of life (HrQoL). This study explored patient–proxy ratings of HrQoL of persons at different stages of HD, and examined factors that may affect proxy ratings. A total of 105 patient–proxy pairs completed the Huntington’s disease health-related quality of life questionnaire (HDQoL) and other established HrQoL measures (EQ-5D and SF-12v2). Proxy–patient agreement was assessed in terms of absolute level (mean ratings) and intraclass correlation. Proxies’ ratings were at a similar level to patients’ self-ratings on an overall Summary Score and on most of the six Specific Scales of the HDQoL. On the Specific Hopes and Worries Scale, proxies on average rated HrQoL as better than patients’ self-ratings, while on both the Specific Cognitive Scale and Specific Physical and Functional Scale proxies tended to rate HrQoL more poorly than patients themselves. The patient’s disease stage and mental wellbeing (SF-12 Mental Component scale) were the two factors that primarily affected proxy assessment. Proxy scores were strongly correlated with patients’ self-ratings of HrQoL, on the Summary Scale and all Specific Scales. The patient–proxy correlation was lower for patients at moderate stages of HD compared to patients at early and advanced stages. The proxy report version of the HDQoL is a useful complementary tool to self-assessment, and a promising alternative when individual patients with advanced HD are unable to self-report.

Adaptation and validation of the Japanese version of the health education impact questionnaire (heiQ-J) for the evaluation of self-management education interventions

Aim:  

Assessment of proximal outcomes of self-management programs : translation and psychometric evaluation of a German version of the Health Education Impact Questionnaire (heiQtm)

Purpose This paper describes the translation, cultural adaption, and psychometric evaluation of a German version of the Health Education Impact Questionnaire (heiQ™), a widely used generic instrument assessing a wide range of proximal outcomes of self-management programs.

Methods The translation was carried out according to international standards and included forward and backward translations. Comprehensibility and content validity were tested using cognitive interviews with 10 rehabilitation inpatients. Psychometric properties were examined in rehabilitation inpatients (n = 1,202) with a range of chronic conditions. Factorial validity was assessed using confirmatory factor analysis; concurrent validity was explored by correlations with comparator scales.

Results The items of the German heiQ™ were well understood by rehabilitation inpatients. The structure of the eight heiQ™ scales was replicated after minor adjustment. heiQ™ scales had higher correlations with comparator scales with similar constructs, particularly mental health concepts than with physical health. Moreover, all heiQ™ scales differentiated between individuals across different levels of depression.

Conclusion The German heiQ™ is comprehensible for German-speaking patients suffering from different types of chronic conditions; it assesses relevant outcomes of self-management programs in a reliable and valid manner. Further studies involving its practical application are warranted.

Measurement of stable changes of self-management skills after rehabilitation: a latent state-trait analysis of the Health Education Impact Questionnaire (heiQ™)

To assess stable effects of self-management programs, measurement instruments should primarily capture the attributes of interest, for example, the self-management skills of the measured persons. However, measurements of psychological constructs are always influenced by both aspects of the situation (states) and aspects of the person (traits). This study tests whether the Health Education Impact Questionnaire (heiQ™), an instrument assessing a wide range of proximal outcomes of self-management programs, is primarily influenced by person factors instead of situational factors. Furthermore, measurement invariance over time, changes in traits and predictors of change for each heiQ™ scale were examined.

Measurement of stable changes of self-management skills after rehabilitation: a latent state–trait analysis of the Health Education Impact Questionnaire (heiQ™)

Methods: Subjects were N = 580 patients with rheumatism, asthma, orthopedic conditions or inflammatory bowel disease, who filled out the heiQ™ at the beginning, the end of and 3 months after a disease-specific inpatient rehabilitation program in Germany. Structural equation modeling techniques were used to estimate latent trait-change models and test for measurement invariance in each heiQ™ scale. Coefficients of consistency, occasion specificity and reliability were computed.