The Spence Children’s Anxiety Scale – Parent is completed by a parent of a child between the ages of 6 to 18. The SCAS-Parent provides an overall measure of anxiety together with scores on six sub-scales each tapping a specific aspect of child anxiety.

• Panic attack and agoraphobia
• Separation anxiety
• Physical injury fears
• Social phobia
• Obsessive compulsive
• Generalized anxiety disorder / overanxious disorder

There is also a self-report version (SCAS-Child) of the same assessment. Administering the child and parent reported version and comparing results can be helpful to inform a formulation, particularly when there is a large disparity between scores.

Validity and Reliability

The scales was normed and validated by Nauta, Scholing, Rapee, Abbott, Spence and Waters (2004) with 484 parents of anxiety disordered children and 261 parents in a normal control group. Results of confirmatory factor analysis provided support for six intercorrelated factors, that corresponded with the child self-report as well as with the classification of anxiety disorders by DSM-IV.

Compared to the child version of the same test, parent–child agreement ranged from 0.41 to 0.66 in the anxiety-disordered group, and from 0.23 to 0.60 in the control group.

For comprehensive information visit the Spence Children’s Anxiety Scale website at: www.scaswebsite.com

Scoring and Interpretation

Scores consist of a total raw score (between 0 and 114) and six subscale scores. 

• Panic attack and agoraphobia (items 12,19,25,27,28,30,32,33,34)
• Separation anxiety (items 5,8,11,14,15,38)
• Physical injury fears (items 2,16,21,23,29)
• Social phobia (items 6,7,9,10,26,31)
• Obsessive compulsive (items 13,17,24,35,36,37)
• Generalized anxiety disorder (items 1,3,4,18,20,22)

Results are also converted to percentile ranks based on an Anxiety Disordered Children sample and a Normal Population Children sample, based on the child’s gender and age (Nauta et al., 2004). Percentiles are helpful for interpretation as they contextualise the respondent’s scores in comparison to typical responses from normative groups. A percentile of 50 compared to the anxiety disordered children represents a typical (and clinically significant) pattern of responding among children who have been independently diagnosed with an anxiety disorder.

Any scores more than the 84th percentile (1 standard deviation from the normal population mean) are considered to be clinically significant.

If the scale is administered on multiple occasions a graph is produced to track symptoms over time, representing the respondents scores as a normative percentile.

Developer

Nauta, Scholing, Rapee, Abbott, Spence and Waters. (2004). A parent report measure of children’s anxiety. Behaviour Research and Therapy. 42 (7), 813-839.

References

Nauta, Scholing, Rapee, Abbott, Spence and Waters. (2004). A parent report measure of children’s anxiety. Behaviour Research and Therapy. 42 (7), 813-839.

http://www.scaswebsite.com/

The Supervisory Styles Inventory (SSI) is a 25 item scale which measures the interpersonal or relational aspects of supervisors as perceived by supervisees. The SSI is completed by a supervisee to rate their perceptions of their supervisor’s style based on three subscales: Attractive, Interpersonally Sensitive, and Task-Oriented. This scale can be useful to start a discussion around the preferences a supervisee has for their supervision. 

In addition to being used to rate the supervisor’s style, the scale can be useful during the initial stages of a supervisory relationship to ask the supervisee about their preferences of how they would like supervision to be (as opposed to how supervision actually is). The process of asking for the supervisee’s preferred style before supervision starts can be helpful so the supervisor can tailor their style in accordance to the supervisee’s preferences. In addition, if the scale is administered again during the course of supervision the supervisor can assess the consistency of the supervisee’s preferences versus their experience of supervision. 

In addition, the supervisor may choose to use this scale to self-assess by self rating their supervisory style and compare the results to the perception of the supervisee. 

The SSI has been used in assessing the supervisory relationship with regards to supervisee satisfaction (Fernando & Hulse-Killacky, 2005; Nelson & Friedlander, 2001), the impact of gender and supervisory style on supervisee satisfaction (Rarick & Ladany, 2013), and supervisory style related to perceptions of satisfaction with individual, triadic, and group supervision (Newgent & Davis, 2003).

The style of the supervisor is related to a supervisee’s perception of satisfaction with their supervision as all subscales of the SSI are highly correlated with supervisory satisfaction (Bussey, 2015).  The strongest correlation was that of attractiveness and satisfaction (r=.79) suggesting that a friendly, warm, and supportive supervisor is highly desirable for supervisees in their early stages of development (Bussey, 2015).

Psychometric Properties

Derived from research identifying relationship and relational aspects as an important part of successful supervision, Friedlander and Ward (1984) identified dimensions of supervisory style that were consistent among supervisors and supervisees. Through content analyses of transcribed interviews, a number of items were developed and then assigned a category based on applicability to supervisor or supervisee. The most stable items were kept for use in the instrument, and they found the three underlying constructs (attractive, interpersonally sensitive, task-oriented). 

Herbert and Ward (1995) found the SSI to have internal consistency reliabilities of .93 (Attractiveness), .91 (Interpersonally Sensitive), and .92 (Task-oriented). Test-retest reliabilities are .92 (Friedlander & Ward, 1984) suggesting that the instrument is consistent over time and with various populations.

Research by Bussey (2015) obtained norms from 90 supervisees who were recently graduated or enrolled in a mental health / school counselling program, and their mean subscale scores (and standard deviations) were:

• Attractive: 6.24 (1.02)
• Interpersonally Sensitive: 6.05 (1.08)
• Task-Oriented: 5.57 (1.16)

Note the original version of the SSI had eight items that did not correspond to the above factors, so they have been excluded from the scale on NovoPsych. In addition, the instructions have been modified to ask that at least five questions be rated as average or below, which helps reduce ceiling effects. 

Scoring and Interpretation 

The SSI has three subscales:

• Attractive (items 11, 12, 18, 19, 23, 24, 25): refers to a supervisor who is warm, friendly, supportive, and trust-worthy.
• Interpersonally Sensitive (items 2, 5, 7, 8, 17, 20, 21, 22): refers to attributes such as committed to the relationship, resourceful, and perceptive.
• Task-Oriented (items 1, 3, 4, 6, 9, 10, 13, 14, 15, 16): refers to the attributes such as practical, concrete, evaluative, and focused. 

Higher scores in each subscale indicate supervisee’s / supervisor’s perception of that particular supervisory style. The SSI is scored on a seven point Likert scale. The attractiveness scale has seven questions which are summed and then divided by seven. Interpersonally sensitive scale has eight questions which are summed and divided by eight, and the task oriented scale has 10 questions which are summed and divided by 10. 

The instructions of the scale asked that at least five questions were marked as average or below, which helps the scale discriminate which of the three supervision styles are most and least endorsed. Noting the pattern of the highest and lowest subscale scores can help a supervisor understand the supervisee perceptions, and adjust supervision if appropriate. 

If the scores on all subscales are consistently high (above 6) it may indicate one of the following:

1. The supervisee is extremely happy with the supervision
2. The supervisee did not critically examine the nature of the supervisory relationship
3. The supervisee does not feel comfortable providing critical feedback to the supervisor

Developer

Friedlander, M., & Ward, L. (1984). Development and validation of the Supervisory Styles Inventory. Journal of Counseling Psychology, 31, 541–557. https://doi.org/10.1037/0022-0167.31.4.541

References

Bussey, L. E. (2015). The Supervisory Relationship: How Style and Working Alliance Relate to Satisfaction among Cyber and Face-to-Face Supervisees.  PhD thesis, University of Tennessee, 2015. https://trace.tennessee.edu/utk_graddiss/3564 

Fernando, D. M., & Hulse‐Killacky, D. (2005). The relationship of supervisory styles to satisfaction with supervision and the perceived self‐efficacy of master’s‐level counseling students. Counselor Education and Supervision, 44, 293-304. http://dx.doi.org/10.1002/j.1556-6978.2005.tb01757.x

Herbert, J. T., & Ward, T. J. (1995). Confirmatory factor analysis of the supervisory style inventory and the revised supervision questionnaire. Rehabilitation Counseling Bulletin, 38, 334-339.

Nelson, M., & Friedlander, M. L. (2001). A close look at conflictual supervisory relationships: The trainees’s perspective.Journal of Counseling Psychology,48, 384-395. http://dx.doi.org/10.1037/0022-0167.48.4.384 

Newgent, R. A., Davis, H., & Farley, R. C. (2004). Perceptions of individual, triadic, and group models of supervision. The Clinical Supervisor, 23, 65-79. doi: 10.1300/J001v23n02_05

Rarick, S. L., & Ladany, N. (2012). The relationship of supervisor and trainee gender match and gender attitude match to supervisory style and the supervisory working alliance. Counselling and Psychotherapy Research, 13,138-144. doi: 10.1080/14733145.2012.732592

The Depression Anxiety Stress Scale (DASS-10) is a brief 10-item version of the full version of the Depression Anxiety Stress Scale (DASS-42). The DASS-10 can determine the overall level of distress as well as provides subscale scores for two symptom clusters: Depression and Anxiety/Stress

The scale was designed to be used for routine outcome monitoring in psychology practices and other mental health settings. It provides an overall level of distress that is sensitive to clinical change and can be used to track the effectiveness of treatment. It can be used with people 16 years and older. 

Psychometric Properties

Halford and Frost (2021) developed the DASS-10 as a shorter version of the original DASS-42 and DASS-21 (Lovibond & Lovibond, 1995). EFA and CFA yielded two highly correlated factors: Anxiety-Stress and Depression subscales. Both subscales and the higher-order Distress factor had high internal consistency (Cronbach’s alpha = 0.83, 0.85, & 0.89 respectively; Halford & Frost, 2021).

Based on the above psychometric properties, reliable change was determined to be a five or more point change between first and last DASS-10 administration. 

As expected, the validation study found the DASS-10 was able to discriminate between populations, with a clinical sample scoring significantly higher (mean =  7.67, SD = 4.36) than a community sample (mean = 3.01, SD 3.15). The community sample of newly wedded couples (n = 376) can be used to compute normative percentiles. 

Scoring and Interpretation 

The total score represents overall distress (0 to 30), with higher scores indicating more severe distress or a greater number of symptoms.  Two subscales are presented:

• Anxiety-Stress: Items 1, 4, 6, 7, 8, 9 (raw score range = 0 to 18)
• Depression: Items  2, 3, 5, 10 (raw score range = 0 to 12)

Overall scores can be classified into three severity groups: 

• Mild/subclinical (raw score = 6 or less, average score 0.6 or less; which is equivalent to a percentile of 83 or less)
• Moderate (raw score between 7 and 12, average between 0.7 and 1.2; which is equivalent to a percentile of between 84 and 99.8)
• Severe (raw score 13 or more, average between 1.3 and 3; which is equivalent to a percentile of between of 99.9 or greater)

A normative percentile is computed based on a community sample (Halford & Frost, 2021), indicating how the respondent scored in relation to a typical pattern of responding for adults. For example, a percentile of 83 or less indicates the individual has less distress than 83 percent of the normal population, and puts them in the mild/subclinical category. In mental health settings it is typical to see people with percentiles in the 90s.

In addition to the raw score being computed, average scores are calculated by dividing the raw score by the number of items, giving a sense of the general pattern of responding at the subscale level. Average scores are helpful for interpretation as they allow comparisons between total score and subscales.  When administered more than once, average scores are graphed, showing the change in symptoms over time.

Based on reliable change calculations, interpretive text is provided describing the respondent’s change in symptoms from first to last administrations, as either having experinced:

• deterioration (increase in scores by 5 or more)
• no reliable change (scores changed by 4 or less)
• reliable improvement (scores reduced by 5 or more)
• recovery (scores reduced by 5 or more and most recent score is 6 or less, putting the in the Mild/Subclinical range)

Developer

Halford, W. K., & Frost, A. D. J. (2021). Depression Anxiety Stress Scale-10: A Brief Measure for Routine Psychotherapy Outcome and Progress Assessment. Behaviour Change: Journal of the Australian Behaviour Modification Association, 1–14. https://doi.org/10.1017/bec.2021.12

References

Lovibond S.H. & Lovibond P.F.(1995). Manual for the Depression, Anxiety, Stress Scale. Sydney: Psychology Foundation, University of New South Wales.

The Self-Compassion Scale – Short Form (SCS-SF) is a 12-item self-report measure that is used by adults to measure their capacity for self-compassion – the ability to hold one’s feelings of suffering with a sense of warmth, connection and concern. 

Research has shown that self-compassion is associated with psychological well-being and is an important protective factor that fosters emotional resilience (Raes et al., 2011). For example, higher levels of self-compassion are typically related to greater psychological health as demonstrated by less depression and anxiety and greater happiness and optimism (Raes, 2011; Raes et al., 2011). Scores on the SCS-SF are related to measures of psychological distress, social support, perfectionism, suicide and self-harm (Hayes et al., 2016). It was also found that clients who had previously seriously considered suicide, made a suicide attempt, or engaged in other self-injurious behaviour evidenced more self-disparagement and less self-care, as measured by the SCS-SF, than clients without such histories (Hayes et al., 2016).

The SCS-SF has two subscales:

1. Self-disparagement 
2. Self-care 

Clinicians could administer the SCS-SF repeatedly over the course of treatment to determine if scores are changing. One would hope that the unconditional positive regard that clinicians demonstrate toward clients might be internalised by clients, thereby fostering more accepting and less critical attitudes toward the self.

Psychometric Properties

The SCS–SF demonstrated adequate internal consistency (Cronbach’s alpha ≥ 0.86) and a strong correlation with the long form SCS (r = 0.97; Raes et al., 2011). CFA by Raes et al. (2011) supported the same six-factor structure as found in the long form (Self-Kindness, Self-Judgement, Common Humanity, Isolation, Mindfulness, Over-Identification), as well as a single higher-order factor of self-compassion. However, the internal consistencies for the SCS–SF subscales were relatively low (ranging between 0.54 and 0.75) and it was therefore not recommended to use subscale interpretation for the SCS-SF. For total score information, however, the SCS–SF has good internal consistency and a near-perfect correlation with the long SCS. The test–retest reliability over a span of five months was found to be .71 (Raes et al., 2011).

Hayes et al. (2016) determined, using PCA and CFA with over 1,600 university students who sought psychotherapy, that the SCS-SF has two factors; Self-Care and Self-Disparagement

Percentiles are calculated based on comparison to a clinical sample with no previous suicidal ideation (n = 1054):

• Total Score: mean = 2.94, SD = 0.72
• Self-Disparagement: mean = 3.23, SD = 1.01
• Self-Care: mean = 3.11, SD = 0.76

Scoring and Interpretation 

“Average Scores” are presented, which is the sum of all items divided by the number of items. The total score is an overall indication of self-compassion, with a higher score indicating more self-compassion.

Two subscales are presented:

• Self-Disparagement (Items 1, 4, 8, 9, 11, 12): an indication of how the client views themselves with regard to impatience, disapproval, and judgment toward oneself. A higher score indicates more self-disparagement and self-criticism.
• Self-Care (Items 2, 3, 5, 6, 7, 10): an indication of compassion and how the client views themselves with regard to tenderness, patience, and empathy. A higher score indicates more self-care and self-compassion.

The total score is calculated by summing Self-Care and the inverse of the Self-Disparagement score. High levels of Total Self Compassion are characterised by high Self-Care and low Self-Disparagement.

Norms are presented in comparisons to a clinical sample who were seeking psychotherapy, but who had no previous suicidal ideation (Hayes et al., 2016). A “Clinical Percentile” of 50 indicates an average level of self-compassion, self-disparagement, or self-care compared to this sample of people seeking psychotherapy.

Developer

Raes, F., Pommier, E., Neff,K. D., & Van Gucht, D. (2011). Construction and factorial validation of a short form of the Self-Compassion Scale. Clinical Psychology & Psychotherapy. 18, 250-255.

References

Bratt, A., & Fagerström, C. (2020). Self-compassion in old age: confirmatory factor analysis of the 6-factor model and the internal consistency of the Self-compassion scale-short form. Aging & Mental Health, 24(4), 642–648. https://doi.org/10.1080/13607863.2019.1569588

Hayes, J. A., Lockard, A. J., Janis, R. A., & Locke, B. D. (2016). Construct validity of the Self-Compassion Scale-Short Form among psychotherapy clients. Counselling Psychology Quarterly, 29(4), 405–422. https://doi.org/10.1080/09515070.2016.1138397

Kotera, Y., & Sheffield, D. (2020). Revisiting the Self-compassion Scale-Short Form: Stronger Associations with Self-inadequacy and Resilience. SN Comprehensive Clinical Medicine, 2(6), 761–769. https://doi.org/10.1007/s42399-020-00309-w

Raes, F. (2011). The Effect of Self-Compassion on the Development of Depression Symptoms in a Non-clinical Sample. Clinical Psychology & Psychotherapy, 2, 33–36. https://doi.org/10.1007/s12671-011-0040-y

Sutton, E., Schonert-Reichl, K. A., Wu, A. D., & Lawlor, M. S. (2018). Evaluating the Reliability and Validity of the Self-Compassion Scale Short Form Adapted for Children Ages 8–12. Child Indicators Research, 11(4), 1217–1236. https://doi.org/10.1007/s12187-017-9470-y

The World Health Organisation Disability Assessment Schedule (WHODAS 2.0) is a practical, generic assessment instrument that can measure health and disability at population level or in clinical practice (World Health Organisation (WHO), 2010). This is the self-report version of the WHODAS 2.0 for use by individuals 18 years of age and over. There is also a proxy version, which can be completed by a relative, carer, or friend, or an interviewer version, which can be completed by a clinician.

WHODAS 2.0 captures the level of functioning in six domains of life:

1. Cognition – understanding and communicating
2. Mobility – moving and getting around
3. Self-care – attending to one’s hygiene, dressing, eating and staying alone
4. Getting along – interacting with other people
5. Life activities – domestic responsibilities, leisure, work and school
6. Participation – joining in community activities, participating in society.

WHODAS 2.0 provides a common metric of the impact of any health condition in terms of functioning. Being a generic measure, the instrument does not target a specific disease – it can thus be used to compare disability due to different diseases. WHODAS 2.0 also makes it possible to design and monitor the impact of health and health-related interventions. The instrument has proven useful for assessing health and disability levels in the general population and in specific groups (e.g. people with a range of different mental and physical conditions). Furthermore, WHODAS 2.0 makes it easier to design health and health related interventions, and to monitor their impact.

Disability is a major health issue. When global assessments are made for burden of disease, more than half of the burden of premature mortality is due to overall disability. People generally seek health services because a disease makes it difficult for them to do what they used to do beforehand (i.e. because they are disabled) rather than because they have a disease. Health-care providers consider a case to be clinically significant when it limits a person’s daily activities, and they use disability information as the basis of their evaluation and planning.  

Psychometric Properties

WHODAS 2.0 has excellent psychometric properties. Test–retest studies of the 36-item scale in countries across the world found it to be highly reliable, with an intra-class coefficient of 0.69–0.89 at item level; 0.93– 0.96 at domain level; and 0.98 at overall level. Cronbach’s alpha levels were generally very high (0.94 – 0.96 for domains and 0.98 for total score; WHO, 2010).

All items were selected on the basis of item-response theory and the instrument as a whole showed a robust factor structure that remained constant across cultures and different types of patient populations. Confirmatory factor analysis showed a rigorous association between the factor structure of the items and the domains, and between the domains and a general disability factor. These results support the unidimensionality of domains.The validation studies also showed that WHODAS 2.0 compared well with other measures of disability or health status, and with clinician and proxy ratings.

The WHODAS 2.0 shows sensitivity to change in people who have certain health conditions (e.g. cataract, hip or knee problems, depression, schizophrenia or alcohol problems), as it can pick up improvements in functioning following treatment.  

Scoring and Interpretation 

There are two scoring methods used for the WHODAS 2.0:

1. Score (and its percentile)
2. Average score (and its descriptor)

The first score is determined using “item-response-theory” (IRT), where it takes into account multiple levels of difficulty for each WHODAS 2.0 item (1-36). This type of scoring for WHODAS 2.0 allows for more fine-grained analyses that make use of the full information of the response categories for comparative analysis across populations or subpopulations. It takes the coding for each item response as “none”, “mild”, “moderate”, “severe” and “extreme” separately, and then summarises the score by differentially weighting the items and the levels of severity. Converting the summary score into a metric ranging from 0 to 100 (where 0 = no disability; 100 = full disability). A percentile is provided that allows for a comparison to a large sample (n = 1,431) from a wide variety of populations (general population, populations with physical problems, populations with mental or emotional problems, populations with alcohol and drug use problems) from over 21 countries (WHO, 2010). A percentile of 50 indicates that an individual is experiencing an average level of disability when compared to other members of the sample.

The average scores are comparable to the WHODAS 5-point scale, which allows the clinician to think of the individual’s disability in terms of none (0-0.49), mild (0.5-1.49), moderate (1.5-2.49), severe (2.5-3.49), or extreme (3.5-4). The average domain and general disability scores were found to be reliable, easy to use, and clinically useful to the clinicians in the DSM-5 Field Trials (APA, 2021). The average domain score is calculated by dividing the raw domain score by the number of items in the domain. The average general disability score is calculated by dividing the raw overall score by number of items in the measure (i.e., 36).

The two scoring methods are used for each of the 6 domains:

1. Cognition – Assesses communication and thinking activities; specific areas assessed include concentrating, remembering, problem solving, learning and communicating.
2. Mobility – Assesses activities such as standing, moving around inside the home, getting out of the home and walking a long distance.
3. Self-care – Assesses hygiene, dressing, eating and staying alone.
4. Getting along – Assesses interactions with other people and difficulties that might be encountered with this life domain due to a health condition; in this context, “other people” includes those known intimately or well (e.g. spouse or partner, family members or close friends) and those not known well (e.g. strangers).
5. Life activities – Assesses difficulty with day-to-day activities (i.e. those that people do on most days, including those associated with domestic responsibilities, leisure, work and school).
6. Participation – Assesses social dimensions, such as community activities; barriers and hindrances in the world around the respondent; and problems with other issues, such as maintaining personal dignity.  

Developer

Ustun, T.B, Kostanjsek, N., Chatterji, S., Rehm, J (Ed.). (2010). Measuring health and disability : manual for WHO Disability Assessment Schedule (‎WHODAS 2.0)‎. World Health Organization. https://www.who.int/publications/i/item/measuring-health-and-disability-manual-for-who-disability-assessment-schedule-(-whodas-2.0)  

References

American Psychiatric Association. Online Assessment Measures. (n.d.). Retrieved November 6, 2021, from https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_WHODAS-2-Self-Administered.pdf  

The Perceived Stress Scale (PSS-10; Cohen, Kamarch, & Mermelstein,1983) is a popular tool for measuring psychological stress. It is a self-reported questionnaire that was designed to measure the degree to which situations in one’s life are appraised as stressful. The PSS-10 determines how unpredictable, uncontrollable, and overloaded respondents find their lives. The scale also includes a number of direct queries about current levels of experienced stress. The PSS was designed for use in community samples with at least some high school education. The assessed items are general in nature rather than focusing on specific events or experiences.

Because levels of appraised stress are influenced by daily hassles, major events, and changes in coping resources, predictive validity of the PSS-10 falls off rapidly after four to eight weeks (Cohen et al., 1983).

Psychometric Properties

There have been three versions of the PSS developed. The original instrument is a 14-item scale (PSS-14) that was developed in English (Cohen et al.,1983), which was subsequently shortened to 10 items (PSS-10) using factor analysis based on data from 2,387 U.S. residents. A four-item PSS (PSS-4) was also introduced (Cohen & Williamson, 1988), but its psychometric properties are questionable (Lee, 2012; Taylor, 2015). According to Cohen’s Laboratory for the Study of Stress, Immunity, and Disease (2021), the PSS is currently translated into 25 languages other than English.

Lee (2012) conducted a review of the psychometric properties of all three versions of the PSS and found that the psychometric properties of the PSS-10 are superior to those of the PSS-14 and PSS-4. The Cronbach’s alpha of the PSS-10 was evaluated at >.70 in all 12 studies in which it was used. The test-retest reliability of the PSS-10 was assessed in four studies, and met the criterion of >.70 in all cases. The criterion validity of PSS-10 was evaluated and it was strongly correlated with the mental component of health status as measured by the Medical Outcomes Study – Short Form 36 (Ware, Snow, Kosinski, & Grandek, 1993). The PSS was either moderately or strongly correlated with the hypothesised emotional variables, such as depression or anxiety, as measured using the Center for Epidemiologic Studies Depression Scale (Radloff, 1977), Inventory to Diagnose Depression (Zimmerman & Coryell, 1987), Beck Depression Inventory (Beck, Steer, & Garbin, 1988), Hospital Anxiety and Depression Scale (Zigmond & Snaith, 1983), State-Trait Anxiety Inventory (Spielberger, 1983), General Health Questionnaire (Goldberg & Williams, 1991), Edinburgh Postnatal Depression Scale (Cox, Holden, & Sagovsky,1987), Thai Depression Inventory (Lotrakul & Sukanich, 1999), and Depression Anxiety Stress Scale – 21 (Lyrakos, Arvaniti, Smyrnioti, & Kostopanahiotou, 2011).

A CFA by Taylor (2015) found that a 2 factor model best describes the PSS-10:

1. Perceived helplessness
2. Lack of self-efficacy

Norms were determined for the total score (by age) for a sample of 2,000 community-based respondents in the US (Cohen & Janicki-Deverts, 2012):

• < 25 years old (mean = 16.78, SD = 6.86)
• 25-34 years old (mean = 17.46, SD = 7.31)
• 35-44 years old (mean = 16.38, SD = 7.07)
• 45-54 years old (mean = 16.94, SD = 7.83)
• 55-64 years old (mean = 14.50, SD = 7.20)
• > 64 years old (mean = 11.09, SD = 6.77)

Scoring and Interpretation 

A total PSS-10 score from 0 to 40 is presented, with higher scores representing higher levels of stress. Percentiles are also presented, comparing the results to a community sample (Cohen & Janicki-Deverts, 2012). A percentile of 50 indicates that an individual is experiencing an average level of stress when compared to other members of society. Average scores are also calculated by summing the scores divided by the number of items, and is a useful metric for ascertaining the general level of agreement on the likert scale (where 0 = Never and 4 = Very Often), as well as comparing sub-scale scores using a consistent metric.

There are two subscales in the PSS-10:

1. Perceived helplessness (items 1, 2, 3, 6, 9, 10) – measuring an individual’s feelings of a lack of control over their circumstances or their own emotions or reactions.
2. Lack of self-efficacy (items 4, 5, 7, 8) – measuring an individual’s perceived inability to handle problems.

Higher levels of psychological stress as measured by the PSS-10 have been associated with elevated markers of biological aging, higher cortisol levels, as well as suppressed immune function, greater infection-induced release of pro-inflammatory cytokines, greater susceptibility to infectious disease, slower wound healing, and higher prostate-specific antigen levels (Cohen & Janicki-Deverts, 2012). Persons who score higher on the PSS also report poorer health practices, such as sleeping fewer hours, skipping breakfast, and consuming greater quantities of alcohol (Cohen &Williamson, 1988).

Developer

Cohen, S., & Williamson, G. (1988). Perceived stress in a probability sample of the United States. In S. Spacapan & S. Oskamp (Eds.), The social psychology of health: Claremont Symposium on applied social psychology. Newbury Park, CA: Sage.

References

Cohen, S., & Janicki-Deverts, D. (2012). Who’s stressed? Distributions of psychological stress in the United States in probability samples from 1983, 2006, and 20091. Journal of Applied Social Psychology, 42(6), 1320–1334. https://doi.org/10.1111/j.1559-1816.2012.00900.x

Cohen, S., Kamarch, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385.

Cohen’s Laboratory for the Study of Stress, Immunity and Disease. (2021). Dr.Cohen’s Scales. Retrieved Oct 9, 2021, from https://www.cmu.edu/dietrich/psychology/stress-immunity-disease-lab/scales/index.html

Cohen, S., & Williamson, G. (1988). Perceived stress in a probability sample of the United States. In S. Spacapan, & S. Oskamp (Eds.),The social psychology of health: Claremont symposium on applied social psychology. Newbury Park, CA: Sage.

Lee, E.-H. (2012). Review of the psychometric evidence of the perceived stress scale. Asian Nursing Research, 6(4), 121–127. https://doi.org/10.1016/j.anr.2012.08.004

Taylor, J. M. (2015). Psychometric analysis of the Ten-Item Perceived Stress Scale. Psychological Assessment, 27(1), 90–101. https://doi.org/10.1037/a0038100

The World Health Organisation Disability Assessment Schedule (WHODAS 2.0) is a practical, generic assessment instrument that can measure health and disability at population level or in clinical practice (World Health Organisation (WHO), 2010). This is the proxy version, which can be completed by a relative, carer, or friend, or there is an interviewer version, which can be completed by a clinician. There is also a self-report version of the WHODAS 2.0 for use by individuals 18 years of age and over.

WHODAS 2.0 captures the level of functioning in six domains of life:

1. Cognition – understanding and communicating
2. Mobility – moving and getting around
3. Self-care – attending to one’s hygiene, dressing, eating and staying alone
4. Getting along – interacting with other people
5. Life activities – domestic responsibilities, leisure, work and school
6. Participation – joining in community activities, participating in society.

WHODAS 2.0 provides a common metric of the impact of any health condition in terms of functioning. Being a generic measure, the instrument does not target a specific disease – it can thus be used to compare disability due to different diseases. WHODAS 2.0 also makes it possible to design and monitor the impact of health and health-related interventions. The instrument has proven useful for assessing health and disability levels in the general population and in specific groups (e.g. people with a range of different mental and physical conditions). Furthermore, WHODAS 2.0 makes it easier to design health and health related interventions, and to monitor their impact.

Disability is a major health issue. When global assessments are made for burden of disease, more than half of the burden of premature mortality is due to overall disability. People generally seek health services because a disease makes it difficult for them to do what they used to do beforehand (i.e. because they are disabled) rather than because they have a disease. Health-care providers consider a case to be clinically significant when it limits a person’s daily activities, and they use disability information as the basis of their evaluation and planning.

Psychometric Properties

WHODAS 2.0 has excellent psychometric properties. Test–retest studies of the 36-item scale in countries across the world found it to be highly reliable, with an intra-class coefficient of 0.69–0.89 at item level; 0.93– 0.96 at domain level; and 0.98 at overall level. Cronbach’s alpha levels were generally very high (0.94 – 0.96 for domains and 0.98 for total score; WHO, 2010).

All items were selected on the basis of item-response theory and the instrument as a whole showed a robust factor structure that remained constant across cultures and different types of patient populations. Confirmatory factor analysis showed a rigorous association between the factor structure of the items and the domains, and between the domains and a general disability factor. These results support the unidimensionality of domains.The validation studies also showed that WHODAS 2.0 compared well with other measures of disability or health status, and with clinician and proxy ratings.

The WHODAS 2.0 shows sensitivity to change in people who have certain health conditions (e.g. cataract, hip or knee problems, depression, schizophrenia or alcohol problems), as it can pick up improvements in functioning following treatment.

Scoring and Interpretation 

There are three scoring methods used for the WHODAS 2.0:

1. Simple score
2. Complex score (and its percentile)
3. Average score (and its descriptor)

In simple scoring, the scores assigned to each of the items (1-36) are simply added up without recoding or collapsing of response categories; thus, there is no weighting of individual items. Simple scoring of WHODAS is specific to the sample at hand and should not be assumed to be comparable across populations. The simple sum of the scores of the items across all domains constitutes a statistic that is sufficient to describe the degree of functional limitations. The domain scores provide more detailed information than the summary score and may be useful for comparing individuals or groups against one another or against population standards, and across time (e.g. before and after interventions or other comparisons).

The more complex method of scoring is called “item-response-theory” (IRT) based scoring; it takes into account multiple levels of difficulty for each WHODAS 2.0 item (1-36). This type of scoring for WHODAS 2.0 allows for more fine-grained analyses that make use of the full information of the response categories for comparative analysis across populations or subpopulations. It takes the coding for each item response as “none”, “mild”, “moderate”, “severe” and “extreme” separately, and then summarises the score by differentially weighting the items and the levels of severity. Converting the summary score into a metric ranging from 0 to 100 (where 0 = no disability; 100 = full disability). A percentile is provided that allows for a comparison to a large sample (n = 1,431) from a wide variety of populations (general population, populations with physical problems, populations with mental or emotional problems, populations with alcohol and drug use problems) from over 21 countries (WHO, 2010). A percentile of 50 indicates that an individual is experiencing an average level of disability when compared to other members of the sample.

The average scores are comparable to the WHODAS 5-point scale, which allows the clinician to think of the individual’s disability in terms of none (0-0.49), mild (0.5-1.49), moderate (1.5-2.49), severe (2.5-3.49), or extreme (3.5-4). The average domain and general disability scores were found to be reliable, easy to use, and clinically useful to the clinicians in the DSM-5 Field Trials (APA, 2021). The average domain score is calculated by dividing the raw domain score by the number of items in the domain (e.g., if all the items within the “understanding and communicating” domain are rated as being moderate then the average domain score would be 18/6 = 3, indicating moderate disability). The average general disability score is calculated by dividing the raw overall score by number of items in the measure (i.e., 36).

The three scoring methods are used for each of the 6 domains:

1. Cognition – Assesses communication and thinking activities; specific areas assessed include concentrating, remembering, problem solving, learning and communicating.
2. Mobility – Assesses activities such as standing, moving around inside the home, getting out of the home and walking a long distance.
3. Self-care – Assesses hygiene, dressing, eating and staying alone.
4. Getting along – Assesses interactions with other people and difficulties that might be encountered with this life domain due to a health condition; in this context, “other people” includes those known intimately or well (e.g. spouse or partner, family members or close friends) and those not known well (e.g. strangers).
5. Life activities – Assesses difficulty with day-to-day activities (i.e. those that people do on most days, including those associated with domestic responsibilities, leisure, work and school).
6. Participation – Assesses social dimensions, such as community activities; barriers and hindrances in the world around the respondent; and problems with other issues, such as maintaining personal dignity.

Developer

Ustun, T.B, Kostanjsek, N., Chatterji, S., Rehm, J (Ed.). (2010). Measuring health and disability : manual for WHO Disability Assessment Schedule (‎WHODAS 2.0)‎. World Health Organization. https://www.who.int/publications/i/item/measuring-health-and-disability-manual-for-who-disability-assessment-schedule-(-whodas-2.0)

References

American Psychiatric Association. Online Assessment Measures. (n.d.). Retrieved November 6, 2021, from https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_WHODAS-2-Self-Administered.pdf

The World Health Organisation Disability Assessment Schedule (WHODAS 2.0) is a practical, generic assessment instrument that can measure health and disability at population level or in clinical practice (World Health Organisation (WHO), 2010). This is the interview version of the WHODAS 2.0, which can be completed by a clinician. There is also a proxy version, which can be completed by a relative, carer, or friend, or a self-report version, which can be completed by individuals 18 years of age and over.

WHODAS 2.0 captures the level of functioning in six domains of life:

1. Cognition – understanding and communicating
2. Mobility – moving and getting around
3. Self-care – attending to one’s hygiene, dressing, eating and staying alone
4. Getting along – interacting with other people
5. Life activities – domestic responsibilities, leisure, work and school
6. Participation – joining in community activities, participating in society.

WHODAS 2.0 provides a common metric of the impact of any health condition in terms of functioning. Being a generic measure, the instrument does not target a specific disease – it can thus be used to compare disability due to different diseases. WHODAS 2.0 also makes it possible to design and monitor the impact of health and health-related interventions. The instrument has proven useful for assessing health and disability levels in the general population and in specific groups (e.g. people with a range of different mental and physical conditions). Furthermore, WHODAS 2.0 makes it easier to design health and health related interventions, and to monitor their impact.

Disability is a major health issue. When global assessments are made for burden of disease, more than half of the burden of premature mortality is due to overall disability. People generally seek health services because a disease makes it difficult for them to do what they used to do beforehand (i.e. because they are disabled) rather than because they have a disease. Health-care providers consider a case to be clinically significant when it limits a person’s daily activities, and they use disability information as the basis of their evaluation and planning.

Psychometric Properties

WHODAS 2.0 has excellent psychometric properties. Test–retest studies of the 36-item scale in countries across the world found it to be highly reliable, with an intra-class coefficient of 0.69–0.89 at item level; 0.93– 0.96 at domain level; and 0.98 at overall level. Cronbach’s alpha levels were generally very high (0.94 – 0.96 for domains and 0.98 for total score; WHO, 2010).

All items were selected on the basis of item-response theory and the instrument as a whole showed a robust factor structure that remained constant across cultures and different types of patient populations. Confirmatory factor analysis showed a rigorous association between the factor structure of the items and the domains, and between the domains and a general disability factor. These results support the unidimensionality of domains.The validation studies also showed that WHODAS 2.0 compared well with other measures of disability or health status, and with clinician and proxy ratings.

The WHODAS 2.0 shows sensitivity to change in people who have certain health conditions (e.g. cataract, hip or knee problems, depression, schizophrenia or alcohol problems), as it can pick up improvements in functioning following treatment.

Scoring and Interpretation 

There are three scoring methods used for the WHODAS 2.0:

1. Simple score
2. Complex score (and its percentile)
3. Average score (and its descriptor)

In simple scoring, the scores assigned to each of the items (1-36) are simply added up without recoding or collapsing of response categories; thus, there is no weighting of individual items. Simple scoring of WHODAS is specific to the sample at hand and should not be assumed to be comparable across populations. The simple sum of the scores of the items across all domains constitutes a statistic that is sufficient to describe the degree of functional limitations. The domain scores provide more detailed information than the summary score and may be useful for comparing individuals or groups against one another or against population standards, and across time (e.g. before and after interventions or other comparisons).

The more complex method of scoring is called “item-response-theory” (IRT) based scoring; it takes into account multiple levels of difficulty for each WHODAS 2.0 item (1-36). This type of scoring for WHODAS 2.0 allows for more fine-grained analyses that make use of the full information of the response categories for comparative analysis across populations or subpopulations. It takes the coding for each item response as “none”, “mild”, “moderate”, “severe” and “extreme” separately, and then summarises the score by differentially weighting the items and the levels of severity. Converting the summary score into a metric ranging from 0 to 100 (where 0 = no disability; 100 = full disability). A percentile is provided that allows for a comparison to a large sample (n = 1,431) from a wide variety of populations (general population, populations with physical problems, populations with mental or emotional problems, populations with alcohol and drug use problems) from over 21 countries (WHO, 2010). A percentile of 50 indicates that an individual is experiencing an average level of disability when compared to other members of the sample.

The average scores are comparable to the WHODAS 5-point scale, which allows the clinician to think of the individual’s disability in terms of none (0-0.49), mild (0.5-1.49), moderate (1.5-2.49), severe (2.5-3.49), or extreme (3.5-4). The average domain and general disability scores were found to be reliable, easy to use, and clinically useful to the clinicians in the DSM-5 Field Trials (APA, 2021). The average domain score is calculated by dividing the raw domain score by the number of items in the domain (e.g., if all the items within the “understanding and communicating” domain are rated as being moderate then the average domain score would be 18/6 = 3, indicating moderate disability). The average general disability score is calculated by dividing the raw overall score by number of items in the measure (i.e., 36).

The three scoring methods are used for each of the 6 domains:

1. Cognition – Assesses communication and thinking activities; specific areas assessed include concentrating, remembering, problem solving, learning and communicating.
2. Mobility – Assesses activities such as standing, moving around inside the home, getting out of the home and walking a long distance.
3. Self-care – Assesses hygiene, dressing, eating and staying alone.
4. Getting along – Assesses interactions with other people and difficulties that might be encountered with this life domain due to a health condition; in this context, “other people” includes those known intimately or well (e.g. spouse or partner, family members or close friends) and those not known well (e.g. strangers).
5. Life activities – Assesses difficulty with day-to-day activities (i.e. those that people do on most days, including those associated with domestic responsibilities, leisure, work and school).
6. Participation – Assesses social dimensions, such as community activities; barriers and hindrances in the world around the respondent; and problems with other issues, such as maintaining personal dignity.

Developer

Ustun, T.B, Kostanjsek, N., Chatterji, S., Rehm, J (Ed.). (2010). Measuring health and disability : manual for WHO Disability Assessment Schedule (‎WHODAS 2.0)‎. World Health Organization. https://www.who.int/publications/i/item/measuring-health-and-disability-manual-for-who-disability-assessment-schedule-(-whodas-2.0)

References

American Psychiatric Association. Online Assessment Measures. (n.d.). Retrieved November 6, 2021, from https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_WHODAS-2-Self-Administered.pdf

The Automatic Thoughts Questionnaire – Believability (ATQ-B-15) (Netemeyer et al., 2002) is a 15-item self-report measure designed to assess the degree of believability of cognitions associated with depression. The scale does not measure the frequency of unhelpful thoughts, but rather measures the extent to which the client believes the thoughts to be true.

The ATQ-B a frequently used tool in Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 199). Consistent with the ACT concept of fusion, the ATQ-B asks how much the client believed a thought when they felt depressed/sad. Given that changes in believability of unhelpful thoughts occur independently of reductions in their frequency (Zettle & Hayes, 1986), the believability and fusion of thoughts is an important aspect to target in therapy (Zettle, Rains & Hayes, 2011).

The scale can also be integrated into treatment using Cognitive Behaviour Therapy.

The ATQ has been found to be a reliable measure of cognitive change in depression in response to ACT and can therefore be a useful measure of progress in therapy (Zettle et al., 2011).

Psychometric Properties

Psychometric evaluation of the ATQ-B 30-item version showed that it had good internal stability in both clinical (n = 177) and nonclinical (n = 249) populations (Cronbach’s alpha = .95 and .97, respectively; Zettle, 2010, as cited in Zettle et al., 2011). Test–retest reliability for the ATQ-B over 3 months with a non-clinical sample was .85 and it correlated significantly with the BDI for both populations (r = .53 and .58, respectively), providing evidence of the measure’s construct validity.

The ATQ-15 was developed by Netemeyer et al. (2002) from the original 30-item version (Hollon & Kendall, 1980). Netemeyer et al. (2002) assessed the ATQ-15 using two samples (N=434 and N=419) and found that it had a single factor, with an alpha of .96. Two additional cross-validation samples (N=163 and N=91) also showed support for the 15-item reduced version (Netemeyer et al.,2002).

The ATQ-15 was found to be negatively correlated with self-esteem (r = -.63) and childhood wellbeing (r = -.38) and positively correlated to social anxiety (r = .56), neurotic / obsessive thoughts (r = .70) , and pathological gambling (r = .46; Netemeyer et al., 2002).

Scoring and Interpretation 

The respondent is asked to rate how much he/she BELIEVED a given thought when they had it on a 5-point scale (1 = Not at all, to 5 = Totally). Scores are summed across the 15 items to form an ATQ-B index ranging from 15 to 75. A higher score indicates a higher level of cognitive fusion with depressive thoughts.

A descriptor is provided to give an overall indication of how ‘fused’ the client is to these thoughts. This descriptor is determined by the average response to the questions.

ATQ-B scores can be used to track progress in therapy over time. Successful therapy should see ATQ-B scores reduce over time, reflecting a reduction in fusion.

Based on ACT theory, a client’s ability to distance themselves from depressive thoughts would decrease the control exerted by these thoughts and result in a reduction of depression symptomatology.

Note that the ATQ-B does not measure the frequency of unhelpful thoughts, but rather the extent to which unhelpful thoughts are believed.

Developer

Netemeyer, R. G., Williamson, D. A., Burton, S., Biswas, D., Jindal, S., Landreth, S., Mills, G., & Primeaux, S. (2002). Psychometric properties of shortened versions of the automatic thoughts questionnaire. Educational and Psychological Measurement, 62(1), 111–129. https://doi.org/10.1177/0013164402062001008

References

Hollon, S. D., & Kendall, P. C. (1980). Cognitive self-statements in depression: Development of an Automatic Thoughts Questionnaire.Cognitive Therapy and Research,4, 383-395.

Netemeyer, R. G., Williamson, D. A., Burton, S., Biswas, D., Jindal, S., Landreth, S., Mills, G., & Primeaux, S. (2002). Psychometric properties of shortened versions of the automatic thoughts questionnaire. Educational and Psychological Measurement, 62(1), 111–129. https://doi.org/10.1177/0013164402062001008

Zettle, R. D., & Hayes, S. C. (1986). Dysfunctional control by client verbal behavior: The context of reason-giving. The Analysis of Verbal Behavior, 4, 30–38. https://doi.org/10.1007/BF03392813

Zettle, R. D., Rains, J. C., & Hayes, S. C. (2011). Processes of change in acceptance and commitment therapy and cognitive therapy for depression: a mediation reanalysis of Zettle and Rains. Behavior Modification, 35(3), 265–283. https://doi.org/10.1177/0145445511398344

The Cognitive Flexibility Inventory (CFI) is a 20-item self-report measure to monitor how often individuals engaged in cognitive behavioural thought challenging interventions (Dennis & Vander Wal, 2010). Cognitive flexibility enables individuals to think adaptively when encountering stressful life events, and is a core skill that helps individuals avoid becoming stuck in maladaptive patterns of thinking. The CFI measures two aspects of cognitive flexibility:

1. Alternatives – the adaptive ability to perceive multiple alternative explanations for life occurrences and the ability to generate multiple alternative solutions to difficult situations.
2. Control – having an internal locus of control, or the tendency to perceive difficult situations as somewhat controllable.

Individuals with high cognitive flexibility are more likely to react adaptively in response to difficult life experiences, while cognitively inflexible individuals are more susceptible to experiencing pathological reactions. The CFI has been shown to differentiate between a clinical group (anxiety and depression) and a non-clinical sample (Johnco, Wuthrich, & Rapee, 2014), with a clinical group showing significantly lower CFI total and subscale scores than the non-clinical group. When administered multiple times during a course of cognitive behavioural therapy the scale can be useful in indicating treatment response.

Psychometric Properties

The 20-item CFI showed high test-retest reliability for the full score (r = .81), Alternatives subscale (r = .75), and Control subscale (r = .77; Dennis & Vander Wal, 2010). Cronbach’s alpha ranged from good to excellent, for the Alternatives subscale (alpha = .91), Control subscale (alpha = .86), and the full score (alpha = .90; Dennis & Vander Wal, 2010). Furthermore, evidence was obtained for the convergent construct validity of the CFI and its two subscales via their associations with other measures of cognitive flexibility, depressive symptomatology, and coping (Dennis & Vander Wal, 2010).

In a sample of 196 university students (Dennis & Vander Wal, 2010), the mean scores where as follows:

• CFI total – 102.98 (SD = 13.91)
• Alternatives Subscale – 67.59 (SD = 9.41)
• Control Subscale 35.35 (SD = 7.02)

Scoring and Interpretation 

Scores consist of a total CFI score and two subscale scores, a higher score indicating more cognitive flexibility.

Alternatives (sum items 1, 3, 5, 6, 8, 10, 12, 13, 14, 16,18, 19, 20): measuring the ability to perceive multiple alternative explanations for life occurrences and human behaviour and the ability to generate multiple alternative solutions to difficult situations.

Control (sum items 2, 4, 7, 9, 11, 15, 17): measuring the tendency to perceive difficult situations as controllable.

A normative percentile for the total score and subscales are calculated, comparing the respondents scores to a sample of university students (Dennis & Vander Wal, 2010). Percentiles help contextualise how the respondent scored in relation to a typical pattern of responding. For example, a percentile of 83 or less indicates the individual has more cognitive flexibility than 83 percent of the normal population.

Note that items 2, 4, 7, 9, 11, & 17 are reverse scored.

Developer

Dennis, J. P., & Vander Wal, J. S. (2010). The cognitive flexibility inventory: Instrument development and estimates of reliability and validity. Cognitive Therapy and Research, 34(3), 241–253. https://doi.org/10.1007/s10608-009-9276-4

References

Johnco, C., Wuthrich, V. M., & Rapee, R. M. (2014). Reliability and validity of two self-report measures of cognitive flexibility. Psychological Assessment, 26(4), 1381–1387. https://doi.org/10.1037/a0038009