Assessments in
MFT Packet
COU 701
Spring 2007
1
Assessment Packet
Table of Contents
SECTION I: INVENTORIES FROM CLASS PRESENTATIONS
Beck Anxiety Inventory (BAI) ....................................................................................................... 4
Beck Depression Inventory (BDI) .................................................................................................. 7
Differentiation of Self Inventory (Original and Revised versions) .............................................. 10
Eating Attitudes Test-26 ............................................................................................................... 15
Family Adaptability and Cohesion Evaluation Scales (FACES IV) ............................................ 19
General Well-Being Schedule....................................................................................................... 24
McCoy Female Sexuality Questionnaire ...................................................................................... 33
McMaster Family Assessment Device (FAD) .............................................................................. 41
Yale-Brown Obsessive-Compulsive Scale ................................................................................... 46
SECTION II: Other Inventories
Defensive and Supportive Communication Interaction Coding System ...................................... 53
Children's Depression Scale.......................................................................................................... 54
Alcohol Use Inventory (AUI) ....................................................................................................... 55
Family Environment Scale ............................................................................................................ 56
Revised Dyadic Adjustment Scale ................................................................................................ 57
Marital Satisfaction Inventory ...................................................................................................... 58
Parent-Adolescent Communication Scale..................................................................................... 59
Interpersonal Communication Inventory ...................................................................................... 61
Eyberg Child Behavior inventory ................................................................................................. 61
Behavioral and Emotional Rating Scale ....................................................................................... 62
Child Behavioral Checklist ........................................................................................................... 63
Adult Nowicki scale ...................................................................................................................... 64
Depression Anxiety Stress Scale 42 ............................................................................................. 65
Novaco Anger Inventory............................................................................................................... 66
Obsessive Compulsive Inventory ................................................................................................. 67
Thought Control Questionnaire .................................................................................................... 68
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Section I
Inventories from Class
Presentations
3
Beck Anxiety Inventory (BAI)
Prepared by: Ryane Shank and Jenny Quade
1. The Beck Anxiety Inventory (BAI) was developed and published by Aaron T. Beck in
1988.
2. The BAI was developed as part of a series of inventories called “The Beck Scales”. It
was designed to differentiate any overlap of anxiety and depression symptoms. Beck’s
most famous inventory is the Beck Depression Inventory published in 1961, and the BAI
was designed subsequently for anxiety measures.
3. Administration:
a. This test is generally administered with pencil and paper, but can also be orally
administered.
b. It is 21 questions long.
c. Should be administered in a clinical setting, but can be used for research
measurement also.
d. Administered by a therapist, or self-administered.
4. The purpose of the instrument is to gauge anxiety levels in adults and adolescents. It is
also used to measure anxiety treatment outcomes.
5. The test consists of 21 items which gauge both physiological and cognitive components
of anxiety by measuring subjective, somatic, and panic-related symptoms. Each item is
scored on a likert-based scale of 0 to 3. Zero being “Not at all” and three being
“Severely”.
6. This inventory would be completed at the beginning of therapy to gauge intensity of
anxiety, and during therapy to gauge how effective certain treatments are – including
medications.
7. Reliability and validity
a. Yes, it is based on a test-retest reliability of .75 after 7 weeks in its original
research inception. It was also tested using internal consistency with a reliability
of .92.
b. Type of validity
i. The test items are designed to test for anxiety disorders, with emphasis on
general anxiety disorder and panic disorder.
ii. The test has found to not be as accurate at measuring some areas as others,
for instance it measures panic disorders more effectively than ObsessiveCompulsive disorders.
iii. Numerous studies have found evidence for the BAI’s convergent validity
using other similar tests as a measure.
iv. The BAI has been proven to accurately measure the variables to which it
has been aimed in clinical and non-clinical samples.
c. In our opinion, the reliability of this test has been proven effectively. The research
shows that children, adolescents, and ethnically diverse groups have similar
validity as the original samples of largely white adult subjects. This explains why
the test is so widely used, although it is often used in tandem with other tests.
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8. The inventory is used for adults, ages 17-80 and is designed to discriminate anxiety from
depression in individuals. It has been deemed appropriate for use with adolescents 12 and
older as well.
9. The inventory measures the severity of common symptoms of anxiety on a scale from 0
(none) to 3 (severe).
10. Cut-off scores are given to help with the interpretation of the inventory.
a. A sum between 0-21 indicates very low anxiety. That is usually a good thing.
However, it is possible that you might be unrealistic in either your assessment
which would be denial or that you have learned to “mask” the symptoms
commonly associated with anxiety. Too little “anxiety” could indicate that you
are detached from yourself, others, or your environment.
b. A sum between 22-35 indicates moderate anxiety. Your body is trying to tell you
something. Look for patterns as to when and why you experience the symptoms
described above. For example, if it occurs prior to public speaking and your job
requires a lot of presentations you may want to find ways to calm yourself before
speaking or let others do some of the presentations. You may have some conflict
issues that need to be resolved. Clearly, it is not “panic” time but you want to
find ways to manage the stress you feel.
c. A grand sum that exceeds 36 is a potential cause for concern. Again, look for
patterns or times when you tend to feel the symptoms you have circled. Persistent
and high anxiety is not a sign of personal weakness or failure. It is, however,
something that needs to be proactively treated or there could be significant
impacts to you mentally and physically. You may want to consult a physician or
counselor if the feelings persist.
11. Some individuals may think they are experiencing some of the symptoms mentioned in
the inventory but they really aren’t.
12. This is a practical inventory to select. There are a number of symptoms that are listed
and different levels of severity ranging from non-existent to severe.
13. Instructions are as follows: below is a list of common symptoms of anxiety. Please
carefully read each item in the list. Indicate how much you have been bothered by that
symptom during the past month, including today, by circling the number in the
corresponding space in the column next to each symptom.
14.
Not At All
Numbness or
tingling
Fear of the
worst
happening
Difficulty
breathing
0
Mildly, but it
didn’t bother
me much.
1
Moderately – it
wasn’t pleasant
at times
2
Severely – it
bothered me a
lot
3
0
1
2
3
0
1
2
3
5
15. Strengths – there are numerous symptoms the inventory lists that one can experience
when dealing with anxiety and there are different levels of severity//weaknesses – the
level of severity may differ with each individual, one person may think the symptom is
severe and another may think it is mild when they are both experiencing the same level of
the symptom
16. The instrument can be found on the Internet and doesn’t cost anything to download or
purchase.
17. The BAI ranks third in terms of research use, and shows up in over 700 articles on
PSYCH Info as being utilized in published studies. Two of those studies include:
a. Anxiety sensitivity and situation- specific drinking in women with alcohol
problems. The study was published by 5 Canadian professors at Dalhousie
University in Aug 2006. It utilized the BAI along with Beck Depression Inventory
and Anxiety Sensitivity Index to predict frequency of drinking in 60 women. The
findings were that the anxiety and depression inventories did predict drinking
when women had conflicts with others.
b. Mixed anxiety and depression in older adults: clinical characteristics and
management. This study, published in the Journal of Geriatric Psychiatry and
Neurology, utilized the BAI along with the BDI in the pre- and post- testing of a
trial of nefazodone in currently-diagnosed elderly with anxiety disorder. The BAI
indicated significant gains in functioning after the 12 week trial using the drug.
References
Cassidy, E. L., Lauderdale, S., Sheikh, J. I. (2005). Mixed anxiety and depression in older adults:
clinical characteristics and management. Journal of Geriatric Psychiatry and Neurology,
18(2), 83-88.
National Child Traumatic Stress Network. (2005). Beck Anxiety Inventory. Retrieved April 23,
2007, from http://www.nctsnet.org/nctsn_assets/ pdfs/measure/BAI.pdf
Reyno, S. M., Stewart, S. H., Brown, C. G., Horvath, P., Wiens, J. (2006). Anxiety sensitivity
and situation-specific drinking in women with alcohol problems. Brief Treatment and
Crisis Intervention, 6(3), 268-282.
University of Pennsylvania. (n.d.) Introduction to the Beck Scales. Retrieved April 24, 2007,
from http://mail.med.upenn.edu/~abeck/sclaerintro.htm
6
Beck Depression Inventory (BDI)
Prepared by: Mimi Capistrano & Jennifer Smith
1.
Beck Depression Inventory (BDI) was first created by Dr. Aaron T. Beck and first
published in 1961. The publisher was the Center for Cognitive Therapy. The BDI
was then revised in 1971 and made copyright in 1978. The questionnaire is
copyrighted by The Psychological Corporation.
2.
Psychiatrist, Dr. Aaron T. Beck was interested in measuring depression. During the
1950’s. Dr. Beck researched the psychotic depressive moods of five soldiers who
have accidently killed their fellow comrades during war. This research prompted
him to create a more accurate ways to assess depression. Dr. Beck continually
seen patients that were clinically depressed and further developed specific tests
that measured feelings or behaviors that would measure presence and the degree
of depression.
3.
There are various forms and revisions of the BDI. The original BDI, although, is a 21
item self-reporting inventory measuring the characteristics attitudes and
symptoms of depression. There are computerized forms, a card form, and the 13item short form. The more recent is the BDI-11 which is a paper version. The test
takes approximately 10 minutes to take and can be self-administered. The targeted
population is adolescences and adults. The person self-administering the test must
also understand the test only measures manifestations of depression. In order to be
clinically diagnosed and/ or medicated must seek treatment from a licensed
professional.
4.
To measure the presence of depression and produces a single score that can indicate the
intensity of the depressive episode
5.
“The BDI is a self administered 21 item self report scale measuring supposed
manifestations of depression. The BDI takes approximately 10 minutes to
complete, although clients require a fifth-sixth grade reading age to adequately
understand the questions(Groth-Marnat, 1990)”
Each part of the inventory corresponds to specific categories of depressive symptoms and/or
attitudes. Each category in part is to describe specific behaviors that can manifest
depression. And in each category are “graded series of four evaluative
statements”. The statements are ranked in order from neutral to severe. For each
severity are ranked numerical values starting from zero to three.
6.
The BDI has been recommended for use in research and in clinical settings. The use in
therapy can determine the severity of depression in a client.
7.
a. The BDI’s reliability is based on both test-retest and there are alternate forms. The
alternate “acceptable” form would be the use of the 13-item short form as
opposed to the 21 item form.
b.
i. “The content of the BDI was obtained by the consensus from clinicians regarding the
symptoms of depressed patients (Beck et al., 1961)” Six of the nine categories for
the diagnosis of depression are consistent with the new revised version of the
BDI.(Groth-Marnat 1990) This indicates a high content validity.
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ii. In seventh graders the BDI was able to discriminate the level of adjustments. (Groth-Marnat
1990)
iii. Based on criterion-concurrent validity reports moderate correlations.
iv. There is still controversy on whether the revised BDI is measuring state or trait variables. BDI
is suggested to be nor specific to depression.
8.
The tool is used to assess depression in adults and adolescents 13 years of age and
older.
9.
One measure of an instrument’s usefulness is to see how closely it agrees with another,
similar instrument that has been validated against clinical interview by a trained
clinician. In this respect, the BDI-II is positively correlated with the Hamilton
Depression Rating Scale with a Pearson r of 0.71, showing good agreement. The
test was also shown to have a high one-week test-retest reliability (Pearson r=
0.93), suggesting that it was not overly sensitive to daily variations in mood. The
test also has high internal consistency.
10.
The test is very appropriate and user friendly. The standard cut-offs are as follows:
a.
0-13: minimal depression
b.
14-19: mild depression
c.
20-28: moderate depression
d.
29-63: severe depression
11.
Since the test is self-reported, it is free from administration bias.
12.
It is a widely used assessment tool by healthcare professionals and researchers in a
variety of settings. It takes about ten minutes to complete and requires a 5th to 6th
grade reading ability. The test is very practical, but could be used with another
instrument.
13.
There are no standards for administration. It can be administered orally or written.
14.
There are 21 questions on the topics of sadness, pessimism, sense of failure,
dissatisfaction, guilt, expectation of punishment, dislike of self, self accusation,
suicidal ideation, episodes of crying, irritability, social withdrawal,
indecisiveness, change in body image, retardation, insomnia, fatigability, loss of
appetite, loss of weight, somatic preoccupation, and low level of energy. Each
question has a set of at least four possible choices, ranging in intensity. For
example:
a.
(0) I do not feel sad
b.
(1) I feel sad
c.
(2) I am sad all the time and I can’t snap out of it
d.
(3) I am so sad or unhappy that I cannot stand it
15.
There are a few potential pitfalls with this inventory:
a.
The authors warn against the use of this instrument as a sole diagnostic measure, as
depressive symptoms may be part of other primary diagnostic disorders.
b.
The BDI suffers from the same problems as other self-report inventories, in that scores
can be easily exaggerated or minimized by the person completing it.
c.
It has been suggested that the BDI’s reliance on physical symptoms such as fatigue might
be artificially inflated in those clients with physical illness, in that the scores
reflect the illness rather than the depression. In response to this criticism, Beck
and his colleagues have developed a measure called the “Beck Depression
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Inventory for Primary Care.” This is a short screening scale consisting of seven
items from the BDI-II considered to be independent of physical function.
The strengths include:
d.
It is user friendly.
e.
It is reliable and valid.
f.
It can be used for almost anyone and in any setting.
16.
From the Psychological Corporation:
The BDI-II Complete Kit includes the manual and 25 record forms and sells for $83.00.
Additional record forms can be purchased for $27.50 for 25.
From BMC Psychiatry:
Women who go through infertility experience emotional and stressful times. There are
risk factors that can cause depression in infertility, one of course is being a female, repeated
unsuccessful treatment, history of infertility, low socioeconomic status, lack of partner support,
previous depression, or life events leading to depression. The purpose of the article was done to
analyze if the Beck Depression Inventory administered at the beginning and at the end of the
infertility treatment would determine which factors that may influence the BDI score after
treatment. The BDI was used on 251 women who were visited for addicted reproductive
technology infertility treatment. The before-after study was done at a university-affiliated
teaching hospital. Results indicated that the BDI score rose after there was recorded unsuccessful
treatment. And those with successful treatment had lowered BDI scores. Women who had a
higher BDI score before treatment were those with lower education levels.
References
Beck, A.T., Ward, C.H., Mendelson, M., Mock, J., Erbaugh, J. (1961). An inventory for
measuring depression. Archives of General Psychiatry 4, 461-571.
Groth-Marnat, G. (1990). The handbook of psychological assessment (2nd ed.), John Wiley &
Sons, New York.
Khademi, A., Alleyassin, A., Aghahosseini, M., Ramezanzadeh, F., Ahmadi Abhari, A. (2005).
Pretreatment Beck Depression Inventory core is an important predictor for Post-treatment
score in infertile patients: a before-after study. BMC Psychiatry 5:25.
Statistics and Demographics. Retrieved April 22, 2007 from
www.prariepublic.org
Stewart, R. B., Blashfield, R. & Hale, W. E. (1991). Correlates of Beck Depression Inventory
scores in an ambulatory elderly population: symptoms, diseases, laboratory values, and
medications. Journal of Family Practice, 30, 26-33.
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Differentiation of Self Inventory (Original and
Revised versions)
Prepared by: Kim Rogers, John Free, and Oscar Sida
1
The tests discussed in this assignment will include the Differentiation of Self Inventory
(DSI) and the revised version DSI-R.
Skowron, E. A. & Friedlander, M. L. (1998). The differentiation of self inventory: Development
and initial validation. Journal of Counseling Psychology, 45, 235-246.
Skowron, E. A., & Schmitt, T. A. (2003). Assessing interpersonal fusion: Reliability and validity
of a new DSI fusion with others subscale. Journal of Marital and Family Therapy, 29,
209-222.
2
One of the central concepts in Bowen theory is Differentiation of Self. This construct
describes the client’s ability to manage their emotions within interpersonal settings. More
specifically, this concept describes the client’s capacity to think, reflect, and not respond
automatically to emotional pressures. Because Bowen theory encompasses a rather complex set
of interlocking behavioral concepts, a diagnostic tool to evaluate a client’s or client family’s
status in each of the theory’s conceptual areas would be very helpful to a therapist. Skowron &
Friedlander (1998) developed, validated, and published a diagnostic tool to measure
differentiation of self using responses on four subscale concepts relevant to Bowen theory.
These subscales include Emotional Reactivity (ER), I Position (IP), Emotional Cutoff (EC), and
Fusion With Others (FO). Each of these concepts/behavior styles are embedded in Bowen
theory and comprise the concept of differentiation of self. More specifically, (i) for the ER
subscale, the “emotionally reactive person tends to find it difficult to remain calm in response to
the emotionality of others”, (ii) the I Position (IP) subscale refers to “maintaining a clearly
defined sense of self and thoughtfully adhering to personal convictions when pressured by others
to do otherwise”, (iii) Fusion With Others (FO) subscale describes individuals who “have few
firmly held convictions and beliefs, are either dogmatic or compliant, and seek acceptance and
approval above all other goals”, and (iv) Emotional Cutoff (EC) subscale is “personified by the
reactive emotional distancer, who appears aloof and isolated from others and tends to deny the
importance of family”.
In the initial publication of the DSI (Skowron & Friedlander, 1998), the authors suggested that
one of these subscales (FO) was lacking in its internal and external validation. Consequently, in
2003, Skowron & Schmitt revised the FO subscale such that it showed a higher degree of
correlation with other DSI subscales as well as independent personality and relationship test
indicators.
3 a) The DSI is a 43 item (DSI-R, 46 items) paper and pencil inventory.
b)
Neither report listed the average time of completion but since each question can be
answered on a 1-6 Likert-type scale, we would estimate a completion time of 10-15 min.
c)
A Bowenian therapist might use this tool as part of a routine assessment of families along
with a personal interview prior to therapeutic intervention.
d)
The authors of both studies indicated that the DSI is designed to be given and scored by a
therapist “with experience in Bowen theory”. The papers, however, did not specify the
discipline or licensure requirements.
10
4
The stated purpose for the DSI is to test Bowen theory, more specifically, the concept of
differentiation of self, as a clinical assessment tool and as an indicator of psychotherapeutic
outcome.
5
The DSI-R consists of a brief instruction to clients section and a 46 one-sentence
statements that should be responded to by circling responses between the extremes of 1 (Not true
at all of me) to 6 (Very true of me). Between 9-12 questions are presented for each of the four
subscales and are randomly organized in the test. Scoring is done by summing the values for
each of the subscales and dividing by the number of completed responses. A summation average
(DSI score) is also determined for all of the subscales. Normal distributions and standard
deviations are reported for both the DSI Skowron & Friedlander (1998) and DSI-R Skowron &
Schmitt (2003).
6
Reported applications include the following:
Identify individual client (family member) differences in various areas (subscale)
functioning.
Pinpoint areas that are the most problematic (from a Bowen theory perspective).
Identify the most differentiated member of the family. Bowen recommended working
most closely with this individual.
Examine the client’s outcome in therapy.
7 a) The DSI was initially constructed using 96 questions on four subscales which were each
divided into three factor areas. A factor analysis was conducted using the Trait version of the
State-Trait Anxiety Inventory. The strongest relationships between trait factors and subscale
factors were used to construct the final 43 question vision of the DSI. The final version was also
administered to a test population in a separate study. Various subscales were correlated with the
composite DSI scores. The four subscale correlations were fairly high ER=.84, IP=.69, EC=.58,
and FO=.52, although the authors were somewhat concerned with the FO subscale.
b-i)
The content validity for the original version of the DSI was assessed using correlations
with several validated instruments including the General Severity Index (GSI) to measure overall
symptoms, the Discord Assessment Scale (DAS) to assess relationship discord and marital
satisfaction, and the Trait version of the State-Trait Anxiety Inventory. In a subsequent study
(Skowron & Schmitt, 2003) the FO subscale questions were revised (DSI-R) and compared to
the Personal Authority in the Family System Questionnaire (PAFS) and Experiences in Close
Relationships Inventory (ECR). These comparative instruments in both studies seemed to cover
the range of content which is intended to be covered by the DSI-R.
b-ii) Results from correlations of the DSI or DSI-R subscales with the previously mentioned
tests indicated that higher differentiation of self scores predicted less symptomatic distress,
greater marital satisfaction, and greater attachment security.
b-iii) The concept of differentiation of self as a cornerstone of Bowen theory is considered to
be more indicative of a ‘trait’ than ‘state’ characteristic. This construct is not intended to reflect
more variable ‘state’ characteristics. In fact, the DSI was constructed based on ‘trait
characteristics’ and has been shown to predict ‘trait anxiety’. Although differentiation of self is
not considered to be highly malleable, the authors indicated that “it is hoped that a person’s level
of differentiation will increase moderately over the course of psychotherapy”.
b-iv) The degree to which the DSI measures the construct of differentiation of self is difficult
to assess for several reasons. First, there are few if any other measures of differentiation that
cover this concept in such detail (i.e., subscale structure). Next, differentiation of self is a rather
complex multi-parameter construct that overlaps many aspects of personal and family
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functioning. Nevertheless, differentiation of self subscales as outlined in Bowen theory and
measured by the DSI-R are predictors of trait anxiety, self reported symptom severity, and
marital satisfaction.
c)
In our estimation, reliability and validity of the DSI-R are adequate if used along with the
intake interview to clarify various (subscale) areas of functioning within the construct of Bowen
theory. It may also be useful for clinical outcome studies.
8
The population suggested by Skowron & Friedlander (1998) included adults solicited for
this study. Subsequent studies by Knauth & Skowron (2004), suggest that the DSI-R can be used
for adolescent (14-18 y) clients.
9
Given that differentiation of self is defined by Skowron & Friedlander (1998) as “the
degree to which one is able to balance (a) emotional and intellectual functioning and (b) intimacy
and autonomy in relationships”, the DSI-R with its four subscales is likely to provide a therapist
using Bowen theory with important insights into the function of adult individuals in a couples or
family setting. The DSI-R is also likely to provide researchers a quantitative tool with which to
assess the clinical efficacy of the Bowenian approach to therapy.
10
Skowron & Friedlander (1998) report mean and standard deviation values for each of the
subscales for both men and women. Their population demographics indicated that about 10% of
the subjects for their studies were currently undergoing psychotherapy and 60% had previous
experience with therapy. At present, a SCOPUS literature search of the DSI or DSI-R produced
62 citations. Because many of the titles suggest that these journal articles report scores for a
range of psychological problems, populations, and therapeutic outcomes, scoring guidelines are
likely to be found for a range of potential client populations.
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There are at least two issues that should be considered with respect to bias. First, do the
population norms represent a biased sample population and second, how should the subscale
constructs be compared to norm levels and interpreted with respect to gender and various ethnic
and cultural groups. Skowron & Friedlander (1998) reported that the norm population was
primarily white (90%) with more males than females, and were primarily married with children.
Second, although Bowen asserted the differentiation of self is not a gender-biased construct;
feminist theorists such as Carter and McGoldrick suggested that women are more likely to
endorse Emotional Reactivity and men more likely to endorse Emotional Cutoff. Using results
of the DSI, Skowron & Friedlander observed that women scored higher on the Emotional
Reactivity subscale but men did not score higher on the Emotional Cutoff subscale. With respect
to minority populations, Skowron & Friedlander (1998) proposed that for Latino, Native
American or Asian cultures, the Fusion With Others subscale may not correlate with chronic
anxiety or marital satisfaction. They also proposed that for Asian cultures, self assertion (i.e., I
Position subscale) may not be valued as much as in Western societies. In a more recent study,
Knauth & Skowron (2004) show that the DSI-R is highly reliable and valid for a diverse (with
respect to race and ethnicity) adolescent population.
12
The DSI-R is relatively simple to administer and score. Although it is copyrighted
through the journal, it is included with instructions in the article appendix and is apparently free
for use in research and clinical purposes. The client results are likely to be of value not only to
the Bowenian therapist but also to family therapists familiar with Bowen theory and using other
theoretical models.
13
Although standards for administration were not specified for either the DSI or DSI-R,
Skowron & Friedlander (1998) suggest that the therapist be familiar with Bowen theory.
14
One of ten questions in each subscale will be included here.
12
People have remarked that I’m overly emotional.
I tend to remain pretty calm even under stress.
I have difficulty expressing my feelings to people I care for.
I’m likely to smooth over or settle conflicts between two people whom I
care about.
15
Skowron & Friedlander (1998) suggest that the limitations for the use of this instrument
are similar to those for most self-report inventories in that, test result that do not closely reflect
the therapist’s interview results should be re-examined. In addition, as of 2003, the authors
suggested that the DSI-R had not been validated for specific Axis I or Axis II disorders.
16
The DSI-R is found in the appendix of Skowron & Schmitt (2003). It is copyrighted but
apparently can be used free of cost.
17
The DSI-R is a relatively recent development (2003); nevertheless, it has been reported in
more recent literature.
ER-subscale
IP-subscale
EC-subscale
FO-subscale
Knauth, D. G. & Skowron, E. A. (2004). Psychometric evaluation of the differentiation of self
inventory for adolescents. Nursing Research, 53, 163-171.
The purpose of this study was to determine the reliability and validity of the DSI-R with and
ethnically diverse population of adolescents (14-19 y).
For this study, results from the State-Trait Anxiety Inventory (STAI) and the Symptom Pattern
Scale (SPS) were used to slightly reorganize the questions on the four subscales of the DSI-R
into a six factor structure. Each of the factors were designed to better address the study
population and correlated well with similar factors in the STAI and SPS. These factors included
the following: 1)One’s own Emotional Reactiveness (measures the ability to be less emotionally
reactive while maintaining emotional contact), 2) Maintaining a Clear Identity (measures the
ability to maintain a clear identity of oneself), 3) Hypersensitivity With Others (measures
differentiation of emotional system from intellectual system), 4) Seeking Emotional Distance
(measures the use of emotional distance as a means to balance individuality and togetherness in
relationships), 5) emotional Dependence on Others (measures reliance on others to increase self
esteem), 6) Reactive Distancing From a Close Friend (measures emotional cutoff as a means of
dealing with stress in relationships). The findings of this study also “supported the idea that
differentiation of self is one of the mechanisms by which chronic anxiety relates to symptom
development”.
Jenkins, S. M., Buboltz, W. C., Schwartz, J. P. & Johnson, P. (2005). Differentiation of self and
psychosocial development. Contemporary Family Therapy, 27, 251-261.
The purpose of this study was to investigate the relationship between the concepts of
differentiation of self as proposed by Bowen theory and tested using the DSI and Erikson’s
psychosocial stages of development using the Measure of Psychosocial Development (MPD).
The MPD is a self report inventory consisting of 112 items which are divided into eight
resolution areas including Trust vs. Mistrust, Autonomy vs. Shame & Doubt, Initiative vs. Guilt,
Industry vs. Inferiority, Identity vs. Isolation, Generativity vs. Stagnation, Ego Integrity vs.
Despair as well as a Total Score.
The population consisted of 314 volunteer college students.
Results for each on the DSI subscales were correlated with each of the MPD resolution scales
and total score.
13
In general, the results suggested that the level of differentiation of self was predictive of
psychosocial adjustment as measure by the MPD. More specifically, “results suggested that
individuals who respond to emotional stimuli with emotional lability or hypersensitivity are less
confident in their abilities and have less stable identity. The I Position subscale on the DSI also
predicted positive psychosocial adjustment on all eight resolution scales on the MPD.
14
Eating Attitudes Test-26
Prepared by: Schatoya Prince and Erin Schroll
The EAT-26 (Eating Attitudes Test) is used as informational tool for measuring the
symptoms of eating disorder to determine if further medical or clinical intervention is necessary.
The test is designed to evaluate the need for further clinical intervention and the results of the
test cannot serve as a diagnostic tool to substantiate a definitive diagnosis of an eating disorder.
However, this tool can provide a measure to determine the need to further investigate
symptomatic behaviors and concern characteristics associated with eating disorders.
The EAT-26 was originally created by Dr. David Garner in 1982 and was published in
The Journal of Psychological Medicine. The EAT-26 is a derivative of the original 40 question
EAT published in 1979. The original 40 question EAT is a very specific test “designed to test
for signs of anorexia nervosa” (Garner & Garfinkel, 1979). This tool is designed specifically as
an early detection aid, with the assumption that early detection can lead to early treatment and
lessen the long term ramifications associated with eating disorders. The self assessment consists
of a 26 item test designed to serve as part of a two part process to identify individuals displaying
symptoms typically seen in people diagnosed with an eating disorder. The follow up process to
the EAT-26, if warranted by the scoring information obtained by taking the test, involves an
interview with a qualified medical professional to see if the individual meets the diagnostic
criteria for an eating disorder.
According to the scoring and interpretation section of the EAT-26© “the test can be self
administered or can be administered by a variety of people including: health professionals,
school counselors, coaches, camp counselors, or others with an interest in determining if an
individual should be referred to a specialist for evaluation for an eating disorder” (The River
Centre, Scoring and Interpretation, para.2). The test can be administered to an individual or in a
group setting. The EAT-26 is a paper and pencil self assessment with 26 questions rated on a
continuum assessing the frequency of specific behaviors. A sample statement from the EAT-26
would be: “(I) Am terrified of gaining weight”. You would answer with always, usually, often,
sometimes, rarely, never. The scoring scale for questions 1-25 include a range indicating the
frequency of behavior anywhere from always (3), usually (2), often (1), sometimes (0), rarely (0)
to never (0). For question 26 only the scale is always (0), usually (0), often (0), sometimes (1),
rarely (2), to never (3).
The overall score of the test is obtained by adding together the score for each of the
questions. A total score of 20 or higher out of 26 indicates the need for a referral for further
inquiry. The EAT-26 has three separate subscales within the 26 item test to assess an individual
on behaviors and thoughts regarding dieting, bulimia and food preoccupation, and oral control.
To score the EAT-26 subscales the person administering the exam adds the totals for all items
correlated with that particular scale. The dieting scale includes items: 1, 6, 7, 10, 11, 12, 14, 16,
17, 22, 23, 24, and 25. The score for the bulimia and food preoccupation scale includes items: 3,
4, 9, 18, 21, and 26. The oral control subscale consists of items: 2, 5, 8, 13, 19, and 20. The
EAT-26 also includes a behavioral component to “determine the presence of extreme weight
control behaviors and their frequency” (The River Centre, Scoring and Interpretation, para. 4).
As with all self-report assessments there is a great opportunity to gain invaluable and
accurate insight into a person’s behavior; however, there is also a chance the individual will not
be entirely truthful in their assessment. Due to the extreme variability of the answers and the
15
possibility of misinformation conveyed on the test this tool is not designed to provide a definitive
diagnosis but work more as a supplemental aid to flag individuals who are possibly at risk.
The test assesses the presence of behaviors and thought patterns associated with the
presence of eating disorders; but also includes questions about bulimia, use of laxatives, or
previous treatment for any kind of eating disorder. This test does not predict the presence or
absence of an eating disorder, however, a score of a 20 or higher and meeting the threshold on
one or more of the behavior criteria does indicate a need for a referral to a medical professional
specializing in eating disorders. This test is criterion-concurrent provided the respondent is
truthful in their answers to the questions. The questions are designed to provide a complete view
of all relevant behaviors and thought patterns that could be further indicative of the presence of
an eating disorder. There is relatively high construct validity and provided that the person
answers the questions honestly, “the test itself is very reliable and valid”, (Garner, Olmsted,
Bohr, & Garfinkel, 1982; Mintz & O’Halloran, 2000). This test has a high reliability being that
there is a correlation between people who score high on the test and do also later receiving
treatment for an disorder, “of those who score at a 20 or above on the EAT-26 these individuals
are shown that a high percentage have clinical significant eating disorders or partial syndromes
characterized by some, but not all of the symptoms required to meet the full diagnostic criteria”
(www.edreferral.com, Assessment).
The EAT-26 is very different from other assessment tools that are used in diagnosis.
The purpose of the test is not to diagnose the disorder, but more to work as an indicator in
conjunction with other diagnostic tools that will provide a more definitive diagnosis.
A main question that is asked is does the test measure what it intends to measure? The
test does measure the persons eating habits and the feelings they have toward food. This test also
asks behavioral questions, such as the behaviors that are happening with food in the past 6
months. The test includes a scale of Body Mass Index (BMI), which is as numerical calculation
based upon the statistical average of age related norms for all individuals of a specific weight and
height. According to the BMI a person is deemed “significantly underweight” if they have a
BMI under 18.
This test is free of bias. It does not favor a gender or a race; even in the BMI it states
that this is appropriate for both men and women. This is a practical test that is a free test to users
and is self-scoring. One standard for the administrator refers to the fact that this test is not
always accurate. A score above or below twenty should not be the sole or final indicator of
whether or not the individual has an eating disorder. This test is merely a tool to indicate if
seeking help from a qualified mental health professional would be an appropriate next step.
A sample statement from the assessment would include: “(I) am terrified about being
overweight.” The person would answer “Always”, “Usually”, “Often”, “Sometimes”, “Rarely”,
or “Never”.
This test has many strengths including allowing a person to recognize that something
may not be right and it also allows for the professions to see an individual’s real answers to the
tough questions posed. Each question within itself provides the test taker and professional with
valuable information about thoughts and behaviors that can manifest themselves into a bigger
problem if left untreated. For example, when a person answers the question with “sometimes”,
that is scored with a zero but could be red flagged for a problem or at the very least can warrant
continued discussion about the issue. Along with the strengths there are the weaknesses that
include self monitoring. Some people may put down the answer that they know they need to but
down, and not what truly happens. They may be in denial and not recognize some of the
16
symptoms. The EAT-26 is free and can be obtained online. With the test being so easily
accessible it does provide practitioners and concerned individuals the opportunity to assess the
necessity of further intervention allowing information reach an even broader audience.
Two studies done using the EAT-26 included that of the study done by David M. Garner
and Paul E. Garfinkel published in an article called “The Eating Attitudes Test: an index of
symptoms of anorexia nervosa.” This study was the beginning of the development processes of
the EAT-26, which started out as a 40-item measurement tool for the symptoms of anorexia
nervosa. The purpose of the study is to develop a rating scale to administer to target the
behaviors and attitudes found in anorexia nervosa (Garner & Garfinkel, 1979, p. 273).
This study was administered to two groups of females, one was the controlled group and
the other was that of anorexia nervosa patients. The results of the study stated that the two groups
were accurately depicted yet there was more research that need to be done on the EAT. Garner
and Garfinkel stated that there are limitations to the test which include the “self-report inventory
rely on the assumption that subjects will accurately describe their symptoms” (Garner &
Garfinkel, 1979, p. 277).
In another study done using the EAT-26, Noma et al. compared the SCOFF test questions
to that of the EAT-26 questions. The SCOFF test was created by Morgan et al. as a simple fivequestion screening tool for eating disorders. These questions included:
1. Do you make yourself (S) sick because you feel uncomfortably full?
2. Do you worry you have lost (C) control over how much you eat?
3. Have you recently lost more than (O) one stone (13.2 lbs) in 3-month period?
4. Do you believe yourself to be (F) fat when others say you are too thin?
5. Would you say that (F) food dominates your life?
Each question is given one point for each “yes” answer, and a “subject whose score is 2 or more
is judged as likely having an eating disorder.” As far as question 3, because the SCOFF was
translated into Japanese the measurement of “one stone” was used which is equal to 6 kg which
is then equivalent to 13.2 lbs. The test was administered to 80 Japanese female patients with
eating disorders who attended Kyoto University Hospital. The results of the finding were that
the scores from the SCOFF and EAT -26 were “strongly correlated” with each other. They also
stated that even though the SCOFF was a short 5 questions, it used the main characteristics that
were used in the EAT- 26 test. This is why the two screening tests correlated so well, (Noma et
al., 2006).
References:
EAT-26 © Scoring and Interpretation (n.d.) Retrieved on April 5, 2007 from
http://www.river-centre.org/PDFs/EATScoring.pdf
EAT-26© About the EAT (n.d.) Retrieved on April 5, 2007 from
http://www.river-centre.org/abouteat26.html
Garner, D.M. (1997). Psychoeducational principles in treatment. In: D.M. Garner & P.E.
Garfinkel (Eds.) Handbook of Treatment for Eating Disorders, NewYork: Guilford Press.
Garner, D.M., Olmsted, M.P., Bohr, Y. and Garfinkel, P.E. (1982). The eating attitudes
test: Psychometric features and clinical correlates. Psychological Medicine, 12,
871-878.
Garner, D.M., & Garfinkel, P.E. (1979). The Eating Attitudes Test: an index of the of
17
symptoms of anorexia nervosa. Psychological Medicine, 9, 273-279.
Mintz, L. B., & O'Halloran, M. S. (2000). The Eating Attitudes Test: Validation with
DSM-IV eating disorder criteria. Journal of Personality Assessment, 74, 489-503.
Noma, S., Nakai, Y., Hamagaki, S., Uehara, M., Hayashi, A., & Hayashi, T. (2006).
Comparison between the SCOFF Questionnaire and the Eating Attitudes Test in
Patients with eating disorders. International Journal of Psychiatry in Clinical
Practice, 10(1), 27-32.
18
Family Adaptability and Cohesion Evaluation
Scales (FACES IV)
Prepared by: Maggi Ross and Sara Pelton
Background Information: Development and Purpose
In order to understand the development and purpose of the FACES IV assessment
instrument it is important to understand the Circumplex Model of Marital and Family Systems
upon which the assessment is based. The Circumplex Model conceptualizes family functioning
upon three dimensions: cohesion, flexibility, and communication. According to the model a
family’s level of cohesion can range from disengaged to enmeshed and the family’s level of
flexibility can range from rigid to chaotic. The ideal is for a family to be balanced on both
dimensions. Based on these dimensions there are six family types: balanced, rigidly cohesive,
midrange, flexibly unbalance, chaotically disengaged, and unbalanced. FACES IV has been
developed as an instrument with the goal of accurately assessing a family’s cohesion and
flexibility. Both clinical work and research with families are meant to benefit from this
assessment tool. Identifying a family’s levels of cohesion and flexibility helps clinicians and
researchers alike to develop treatment strategies that lead families toward more balanced
relationships (Olson & Gorall, 2006).
Administration Information
Format: Paper and pencil or on-line
Administrator: Therapist, clergy, or counselor
Qualifications: Professional training degree (minimum of Masters) in Psychology or similar area
Required Training: Familiarity with test manual
Administration Time: 15 minutes
Respondents: 12 years old to adult
Place of Administration: In treatment room
Test, Items, & Scoring
FACES IV consists of six scales which assess the dimensions of family cohesion and
family flexibility as outlined in the Circumplex Model. These six scales are labeled: balanced
cohesion, balanced flexibility, disengaged, enmeshed, rigid, and chaotic. Balanced cohesion and
balanced flexibility are referred to as the two balanced scales while the other four scales are
referred to as unbalanced. There are seven items for each scale making a total of 42 items on the
FACES IV. For each item respondents are asked to rate their level of agreement with the
statement on a scale of 1 to 5 (from strongly disagree to strongly agree). Scoring is done using a
cohesion ratio, flexibility ratio, and total Circumplex ratio. The ratio score is obtained by
assessing the balanced score divided by the average unbalanced score for each dimension. The
lower the ratio score, the more unbalanced the system and vice versa (Olson & Gorall, 2006).
The scoring formula is as follows:
Cohesion Ratio = Balanced Cohesion / (Disengaged + Enmeshment / 2)
Flexibility Ratio = Balanced Flexibility / (Rigid + Chaotic / 2)
Total Circumplex Ratio = Balanced Cohesion + Balanced Flexibility /
(Disengaged + Enmeshment + Rigid + Chaotic / 2) OR Cohesion Ratio +
Flexibility Ratio / 2
19
To simplify this scoring process an Excel file has been created to track respondent’s answers and
automatically score the data.
Clinical Application
The Circumplex Model provides a way of conceptualizing and treating family
dysfunction. A family may seek therapy for any number of problems. The Circumplex Model
assumes that family problems are the result of imbalances in a family’s level of cohesion and/or
flexibility. The FACES IV assesses which areas of flexibility and cohesion may be imbalanced
from rigid to chaotic and from disengaged to enmeshed. Based on the FACES IV assessment a
family can fall into one of the following six family types:
Balanced: Characterized by the highest scores on the balanced subscales of cohesion
and flexibility and the lowest scores on all of the unbalanced scales except rigidity,
where the scores are near the lowest.
Rigidly Cohesive: Characterized by high closeness and rigid scores, moderate change
and enmeshed scores, and low disengaged and chaos scores.
Midrange: Characterized by moderate scores on all of the subscales with the exception
of the rigid subscale.
Flexibly Unbalanced: Characterized by high scores on all of the subscales other than
cohesion, where moderate to low scores are characteristic.
Chaotically Disengaged: Characterized by low scores on the balanced subscales, low
scores on the enmeshed and rigid subscales, and high scores on the chaotic and
disengaged subscales.
Unbalanced: Characterized by high scores on all four of the unbalanced scales, and low
scores on the two balanced scales.
The characteristics of each individual family can be studied and analyzed based upon the six
family typologies. Using the FACES IV clinicians are able to identify both family strengths and
family weaknesses (Olson & Gorall, 2006).
Reliability and Validity
FACES IV is based on nearly a decade of research as it is the most recent of a series of
four FACES instruments which began nearly 25 years ago. The development of six family
assessment scales which assess the balanced and unbalanced aspects of family cohesion and
flexibility is the result of current research. Previous versions of the assessment used only two
balanced scales. The use of six scales makes the assessment more comprehensive and detailed
and able to meet the complexities of family life (Gorall, Tiesel, & Olson, 2006).
The alpha reliability ranges from .77 to .89 for each of the six scales. Such scores are
adequate for use in research, assessment, and clinical areas. The six scales of FACES IV have
also been shown to have content, criterion-concurrent, and construct validity. Content validity is
demonstrated in the selection of items for the four unbalanced scales based on the reviews and
ratings of family therapists. The ability of FACES IV to measure a distinct aspect of family
functioning in each of the six scales was shown in a factor analysis. A correlation of the six
FACES IV scales with the validations scales showed construct validity. Criterion-concurrent
validity is indicated by a correlation and discriminate analysis that incorporated other established
family scales and problem assessments (Gorall, Tiesel, & Olson, 2006).
The FACES IV instrument is widely accepted in the field as a respected and effective
assessment tool. We would recommend this tool based upon its impressive research support
from theory to application.
Intended Respondents
20
FACES IV is intended for couples and families of all backgrounds who are experiencing
relationship problems. Any person from 12 years old can respond to the FACES IV items.
Selection Information
FACES IV intends to measure healthy and problematic aspects of family functioning as
related to cohesion (emotional bonding of members-enmeshed or disengaged) and flexibility
(quality and expression of leadership and organization, role relationships, and relationship rules
and negotiations) (Olson & Gorall, 2006). The test does measures what it intends to, but does not
provide a complete picture of family dynamics and functioning.
Interpretation Information
The six subscales are balanced cohesion, balanced flexibility, unbalance disengaged,
unbalanced enmeshed, unbalanced rigid, and unbalanced chaotic. The higher the scores on
balanced cohesion and balanced flexibility, the healthier. Conversely, the lower the score on the
unbalanced disengaged, enmeshed, chaotic and rigid, the more unhealthy. Since these scores on
their own are rather complex, interpretation is made easier by the balanced/unbalanced ratio
score. The higher the ratio score above 1, the more balanced the system; the lower the ratio score
below 1, the more unbalanced the system. This score allows the clinician to chart these ratios on
the Circumplex Model and categorize a family into one of the six clusters of family types:
balanced (score near 2.5), rigidly cohesive (1.3 ratio score), midrange (score near 1), flexibly
unbalanced (.75), chaotically disengaged (.38), and unbalanced (.24).
This test is appropriate for the examinees, since it measures the family’s dynamics, and
leads the clinician to get a picture of the strengths and weaknesses of the family in order to treat
them appropriately. Examinees will need a qualified professional to help in the interpretation, as
this is a bit of a complicated process.
Bias
There is an age bias in this test. According to the directions, only children and family
members over the age of 12 can complete FACES IV.
Since the assessment relies on self-report, the family will have as many different
perspectives as there are family members. When viewing the test results of individuals, the
clinician should be careful not to side or agree with one member, as all perspectives of the family
are valid and should be considered equal.
Translation of questions is available from www.facesiv.com. This test has been
administered in countries outside the US, including Mexico and Japan. Although it seems that
bias is not an issue, it is possible that the differing values of each culture may affect data
analysis. For example, an Asian family who might culturally value strict order may score higher
on the questions that assess rigidity (rules, boundaries, etc.) in reference to cultural norms.
Practicality of Test
FACES IV is a practical one to select when the clinician would like to gather information
on a family’s dynamics. The results will likely help the therapist gain a clear picture of the
family’s levels of flexibility and cohesion, and aid in the development of a treatment plan. This
assessment tool only takes about ten to fifteen minutes to complete, so an entire therapy session
would not be taken up with its use.
Standards for Administration
An administration manual is included in the FACES IV package. It is assumed that
standards for administration are listed in it.
Sample Questions
21
Respondents are asks to respond to each statement on a scale of 1 to 5 from strongly disagree to
strongly agree.
1. Family members are involved in each other’s lives.
5. There are strict consequences for breaking the rules in our family.
10. Family members feel pressured to spend most free time together.
15. Family members feel closer to people outside the family than to other family members.
20. In solving problems, the children’s suggestions are followed.
25. Family members like to spend some of their free time with each other.
30. There is no leadership in this family.
35. It is important to follow the rules in our family.
40. Family members feel guilty if they want to spend time away from the family.
Strengths and Potential Pitfalls of Use
This assessment tool has much strength in its use. FACES IV is based on the Circumplex
Model, which is grounded in systems theory (Olson & Gorall, 2003). This model has continued
to develop over 25 years and has been one of the most researched family models (Olson &
Gorall, 2003). Unlike many assessment tools, FACES IV is sensitive to diversity in terms of
ethnicity, culture, sexual orientation, marital status, developmental stage, social class, education
level, and family structure (Olson & Gorall, 2003). The results of this assessment may help the
clinician in conceptualizing the dynamics of a family and in the formation of a treatment plan.
Additionally, the assessment is a quick way to gather this information, as the test only takes
between ten to fifteen minutes to complete.
One potential pitfall of this assessment is that it relies on self-reporting measures. The
clinician could possibly get four completely different results when utilizing this tool with a
family of four. This may help the therapist get a more complete picture of what is happening in
the family, but in overly rigid or domestic violence families, the self-reporting may be skewed
due to victims’ fear of retaliation. Apathetic teenagers or learning disabled individuals may not
take it seriously or understand the questions, not reading the questions and just putting answers
down.
Additionally, children under the age of 12 are excluded from the assessment, and their
valuable perspectives are automatically discounted.
How to Obtain Assessment Instrument
The FACES IV assessment packet may be obtained from Life Innovations, Inc by
sending an order form to Life Innovations, 2660 Arthur St., Roseville, MN 55113, by fax (651)
636-1668, or by calling 1-800-331-1661. The FACES IV packet costs $95.00 to receive the
information by downloading it and $100.00 to receive the packet on a CD, which has printable
information. Students may purchase the packet for $75.00.
Published Studies
There are numerous studies that have been conducted using the FACES IV model. One of
these studies, conducted by Alan E. Craddock, attempted to investigate the interrelationships
between students’ perception of their family of origin systems and their reports of family quality
and stress (Craddock, 2001) using FACES IV as the main measure instrument. The population
studied consisted of 118 first-year college students enrolled in a Psychology 1001 class. The
population was 80% women and 20% men with a mean age of 19.28 years, consistent with the
class population. Interestingly, 84% of participants were still living with their family of origin
and only 15% were from single-parent households. The sample reflected a high socioeconomic
and well-educated group. Craddock found consistency between his findings and those of Tiesel
22
and Olson in 1997, that a linear relationship between extremity of family system properties and
family stress. Craddock also found that the strongest predictors of family quality were
disengagement and rigidity; family chaos was the strongest predictor of stress. However,
enmeshment appeared to be unrelated to family quality and family stress (Craddock, 2001).
Craddock concluded that FACES IV had consistent reliability and validity.
In another study, Franklin, Streeter, and Springer (2001) attempted to test the validity of
FACES IV by administering the test to 105 individual, females from 11 pregnancy-prevention
programs in Texas. This population had a mean age of 16.4 years, with 40% of the participants
described as Hispanic and 37.1% African-American. They found both corroborating and
contradictory evidence of validity in the subscales, with the most evidence supporting the
Cohesion dimension of the scale. The Chaotic subscale was the challenge, and the researchers
found overlap between the Chaotic and Disengaged subscales. They recommended that Olson
and Tiesel further develop the Flexibility model using structural equation modeling, rather than
more traditional statistical methods and factor analysis.
References
Craddock, A. E. (2001). Family system and family functioning: Circumplex model and FACES
IV. Journal of Family Studies, 7(1), 29-39.
Franklin, C., Streeter, C. L., & Springer, D. W. (2001). Validity of the FACES IV: Family
assessment measure. Research on Social Work Practice, 11(5), 576-596.
Gorall, D. M., Tiesel, J., & Olson, D. H. (2006). FACES IV: Development and validation.
Retrieved April 21, 2007, from Life Innovations, Inc Web Site: http://www.facesiv.com.
Olson, D. H., & Gorall, D. M. (2006). FACES IV & the circumplex model. Retrieved April 21,
2007, from Life Innovations, Inc Web Site: http://www.facesiv.com.
Olson, D. H., & Gorall, D. M. (2003). Circumplex model of marital and family systems. In F.
Walsh (Ed.) Normal Family Processes (3rd ed.). New York: Guilford (pp. 514-547).
23
General Well-Being Schedule
Prepared by: Lisa Barbini, Alyssa M. Demos, & Elizabeth Mercedes Krause-Marcos
1. Name of the instrument, author, publisher, and date of publication:
Name of Instrument: The General Well-Being Schedule (GWB)
Author:
Harold J. Dupuy
Publisher:
The conceptual description of the GWB was not published, but
was presented at the American Public Health Association Meeting
in Los Angeles, California.
Date:
1978
2. Background information:
Dupuy developed the GWB as part of the first Health and Nutrition Examination Survey
(HANES I), which was conducted by the National Center for Health Statistics. The
HANES survey provides current statistical data on the amount, distribution, and effects of
illness and disability in the United States.
3. Administration information:
The GWB is completed on paper, so all participants need is a writing implement.
It takes approximately 10-15 minutes to complete.
The GWB can be administered in any community setting.
It can be administered by researchers, therapists, or anyone who understands how to
score and interpret the results.
4. Purpose of the instrument:
The GWB offers a brief, but broad-ranging indicator of subjective feelings of
psychological well-being and distress. It is an educational/informational screening
strategy used in community settings that is designed to assess how individuals feel about
their inner personal state rather than about external conditions.
5. Description of test, items, and scoring:
The GWB consists of 18 items that include both positive and negative questions for six
dimensions: anxiety, depression, general health, positive well-being, self-control, and
vitality. Each question has a time frame of “during the last month.” The first 14
questions use six-point response scales representing intensity or frequency. The
remaining four questions use a 0 to 10 rating scale defined by adjectives at each end.
Each selected response on the GWB is assigned a numerical value. Scores for each of the
six dimensions are calculated as follows:
24
Sub-Scale
Anxiety
Questions Range of
Scores
2, 5, 8, 16 0 to 25
Depression
4, 12, 18
0 to 20
Positive
WellBeing
1, 6, 11
0 to 15
SelfControl
3, 7, 13
0 to 15
Vitality
9, 14, 17
0 to 20
General
Health
10, 15
0 to 15
Low Score
High Score
Extremely bothered by
nervousness; very tense;
anxious; worried; upset; felt
under heavy pressure.
Intensely or often felt
depressed, down-hearted and
blue, or hopeless.
Low spirits; unhappy; never or
seldom felt life interesting or
cheerful.
Not bothered by nerves; low
tension; not anxious; relaxed;
little or no stress or strain.
Very concerned or disturbed
about losing self-control;
seldom felt emotionally stable.
Low in energy; seldom
waking fresh, rested; sluggish;
tired; worn-out.
In definite control of behavior,
thoughts, emotions, and
feelings; emotionally stable.
Full of energy, pep; waking
fresh, rested; felt active,
vigorous; never felt tired or
worn-out.
Rarely, if ever, bothered by
illness; healthy enough to do
things; not fearful or worried
about health.
Often bothered by illness,
bodily disorders; needed help
in caring for self; worried or
fearful about health.
Never or rarely felt depressed,
down-hearted or blue, or
hopeless.
In excellent spirits; happy with
life; daily life interesting; felt
cheerful.
The scores of the six dimensions are added together to obtain the total GWB score which
ranges form 0-110. Dupuy proposed cutting points to represent three levels of distress:
73 to 110 Points = “Positive Well-Being:” 74.1% of the population, during any
one month, falls into this category.
61 to 72 Points = “Moderate Distress:” 16.3% of the population, during any one
month, falls into this category.
0 to 60 Point = “Severe Distress:” 9.6% of the population, during any one month, falls into
this category.
6. Use and application in therapy:
The GWB is not commonly used as a diagnostic tool in therapy, but it could help
therapists in assessing emotional distress and a client’s overall well-being when trying to
determine an effective treatment plan. It may also help therapists and clients with
tracking the client’s progress throughout the therapeutic process.
7. Reliability and validity information:
25
Reliability:
The test-retest reliability coefficients of the GWB range from 0.68 to 0.85.
 Monk, M. (1981). Blood pressure awareness and psychological well-being in the
Health and Nutrition Examination Survey. Clinical and Investigative Medicine,
4(3-4), 183-189.
 Fazio, A. F. (1977). A concurrent validational study of the NCHS General WellBeing Schedule. Hyattsville, MD: U.S. DHEW, National Center for Health
Statistics.
 Edwards, D., Yarvis, R., Mueller, D., Zingale, H., & Wagman, W. (1978). Testtaking and the stability of adjustment scales: Can we assess patient deterioration?
Evaluation Review, 2(2), 275-291.
The reliability alpha coefficient of the GWB ranges from 0.91 to 0.95.
 Fazio, A. F. (1977). A concurrent validational study of the NCHS General WellBeing Schedule. Hyattsville, MD: U.S. DHEW, National Center for Health
Statistics.
 Ware, J., Johnston, S., Davies-Avery, A., & Brook, R. (1979). Conceptualization
and measurement of health for adults in the Health Insurance Study. (Vol. III,
Mental Health). Santa Monica, CA: RAND Corporation.
 Dupuy, H. (1978) Self-representations of general psychological well-being of
America adults. Los Angeles, CA: Paper presented at the American Public Health
Association Meeting.
 Taylor, J., Poston II, W., Haddock, C., Blackburn, G., Heber, D., Heymsfield, S.,
et al. (2003, February). Psychometric characteristics of the General Well-Being
Schedule (GWB) with African-American women. Quality of Life Research, 12(1),
31-39.
 Himmelfarb, S., & Murrell, S. (1983, May). Reliability and validity of five mental
health scales in older persons. Journal of Gerontology, 38(3), 333-339.
 Edwards, D., Yarvis, R., Mueller, D., Zingale, H., & Wagman, W. (1978). Testtaking and the stability of adjustment scales: Can we assess patient deterioration?
Evaluation Review, 2(2), 275-291.
Correlations among the subscale dimensions of the GWB (anxiety, depression, positive
well-being, self-control, vitality, and general health) range from 0.16 to 0.72.
 Fazio, A. F. (1977). A concurrent validational study of the NCHS General WellBeing Schedule. Hyattsville, MD: U.S. DHEW, National Center for Health
Statistics.
Validity:
The GWB score shows good correlational validity with interviewer’s ratings of
depression and other depression and anxiety scales. The GWB score correlated 0.47 with
an interviewer’s rating of depression, 0.66 with Zung’s Self-Rating Depression Scale, and
0.78 with the Personal Feelings Inventory – Depression. The average correlation of the
26
GWB and six independent depression scales was 0.69 and the average correlation was
0.64 with three anxiety scales.
 Fazio, A. F. (1977). A concurrent validational study of the NCHS General WellBeing Schedule. Hyattsville, MD: U.S. DHEW, National Center for Health
Statistics.
The GWB score correlated 0.70 with a ten-item depression score, 0.58 with the Lubin
Depression Adjective Checklist, and 0.80 with Zung’s Self-Rating Depression Scale.
 Simpkins, C., & Burke, F. (1974). Comparative analyses of the NCHS General
Well-Being Schedule: Response distributions, community vs. patient status
discriminations, and content relationships. Nashville, TN: Center for Community
Studies, George Peabody College
Correlations between the GWB subscales (anxiety, depression, positive well-being, selfcontrol, vitality, and general health) and reports of stress at home and at work range from
0.17 to 0.59.
 Brook, R., Ware, J., Davies-Avery, A., Stewart, A., Donald, C., Rogers, W., et al.
(1979, July). Overview of adult health measures fielded in Rand's health
insurance study. Medical Care, 17(7), 1-131.
A Japanese study reported a correlation of -0.76 with the General Health Questionnaire;
-0.67 with the state anxiety scale of the State-Trait Anxiety Inventory, and -0.66 for the
trait scale; -0.59 with the Center for Epidemiologic Studies Depression scale, and -0.55
with Zung’s Self-Rating Depression Scale.
 Nakayama, T., Toyoda, H., Ohno, K., Yoshiike, N., & Futagami, T. (2000, May).
Validity, reliability and acceptability of the Japanese version of the General WellBeing Schedule. Quality of Life Research, 9(5), 529-539.
The GWB demonstrated evidence of concurrent and construct validity when examined in
association with measures of self-concept, depression, and several health behaviors.
 Taylor, J., Poston II, W., Haddock, C., Blackburn, G., Heber, D., Heymsfield, S.,
et al. (2003, February). Psychometric characteristics of the General Well-Being
Schedule (GWB) with African-American women. Quality of Life Research, 12(1),
31-39.
The available GWB reliability and validity tests show good results. Its internal
consistency is higher than for other scales and there is wide evidence of agreement with
other purpose-built depression and anxiety scales. Subsequently, it is our estimation that
the reliability and validity of the GWB is an adequate scale in assessing emotional
distress.
8. Population/situation for whom it is used:
Because of the strong reliability and validity results associated with the GWB, it is
recommended for use where a general population indicator of subjective well-being is
required.
It is appropriate for adults and youth 12 years and older.
27
National, state, and local norms are available for the general population from the HANES
survey.
The GWB is used in national studies planning for mental health insurance.
9. Selection information:
The GWB performed as well as other leading scales in assessing emotional distress,
particularly depression.
 Fazio, A. F. (1977). A concurrent validational study of the NCHS General WellBeing Schedule. Hyattsville, MD: U.S. DHEW, National Center for Health
Statistics.
Although the internal consistency of the GWB is excellent, test-retest reliability is low.
This possible weakness in the performance of the scale may be caused by its sensitivity to
change, but no data have been reported on the responsiveness of the GWB.
 Edwards, D., Yarvis, R., Mueller, D., Zingale, H., & Wagman, W. (1978). Testtaking and the stability of adjustment scales: Can we assess patient deterioration?
Evaluation Review, 2(2), 275-291.
More recent commentators have suggested that the GWB is primarily one-dimensional,
noting the high internal consistency and inconsistent results of factor analyses. Subscores may be redundant given the high internal consistency, which has lead to debate
over the most useful way to score the GWB. Because the GWB has so few items, subscores provide only crude measurements and an overall score is better in assessing
emotional distress.
 Taylor, J., Poston II, W., Haddock, C., Blackburn, G., Heber, D., Heymsfield, S.,
et al. (2003, February). Psychometric characteristics of the General Well-Being
Schedule (GWB) with African-American women. Quality of Life Research, 12(1),
31-39.
 Wan, T., & Livieratos, B. (1978). Interpreting a general index of subjective wellbeing. The Milbank Memorial Fund Quarterly. Health and Society, 56(4), 531556.
 Fazio, A. F. (1977). A concurrent validational study of the NCHS General WellBeing Schedule. Hyattsville, MD: U.S. DHEW, National Center for Health
Statistics.
10. Interpretation (including subscales, cut-off scores, etc.):
Given the quality of the GWB, it is disappointing that it does not benefit from a user’s
manual such as that produced for other scales, i.e. the General Health Questionnaire.
Subsequently, it is the administrator’s responsibility to provide enough information to
people for them to be able to interpret their GWB scores appropriately. If the
administrator provides all of the necessary instruction, scoring, and interpretation
information adequately, then the GWB is appropriate for the examinees who will be
taking it.
28
11. Bias:
Since the GWB is self-administered, it eliminates bias from an outside administrator.
The test is available in many languages including: Japanese, Greek, and Spanish. It has
been testing for validity in these languages, and also within a variety of cultural
communities. These cultural communities include: among women, in the AfricanAmerican community, the Asian-American community, the Hispanic-American
community, and among some American-Indian communities. All studies have shown the
GWB to be free from bias. Personal bias would seem be the only interfering factor with
the results of the assessment.
12. Practicality:
The GWB is very practical because it is easy to attain, administer, and score. This,
combined with the high degree of validity, makes it a practical assessment of emotional
distress.
13. Standards for administration:
Unfortunately, there are no set standards for administering the GWB. General testing
conditions of a quiet environment are to be expected.
For questions 1-14, the directions read as follows:
This section of the schedule contains questions about how you feel and how things
have been going with you. For each question, place a check mark (√) beside the
answers which best applies to you.
For questions 15-18, the directions read as follows:
For each of the four scales below, note that the words at each end of the 0 and 10
scale describing opposite feelings. Place a check mark (√) below the number
along the bar which seems closest to how you have generally felt DURING THE
PAST MONTH.
14. Sample questions:
An example for questions 1-14 is:
Have you felt down- hearted and blue? (DURING THE PAST MONTH)
1____All of the time
2____Most of the time
3____A good bit of the time
4____Some of the time
5____A little of the time
6____None of the time
29
An example for questions 15-18 is:
How much ENERGY, PEP, and VITALITY have you felt? (DURING THE
PAST MONTH)
0
1
2
3
4
5
6
7
8
No energy
AT ALL,
listless
9
10
Very
ENERGETIC,
dynamic
15. Strengths and potential pitfalls of using this instrument:
Strengths:
The GWB shows high validity across linguistic and cultural communities.
It is easy to acquire.
Ease of administering and scoring.
The GWB can be taken as a periodic measure of emotional distress.
Weaknesses:
The GWB is a subjective measure of psychological well-being and distress.
Examinees may feel intimidated or fearful when the test is given by a current or future
employer.
External factors such as use of medications could alter the GWB score.
Many versions of the GWB are available, which may result in confusion in examinees
when taking the assessment, as well as when interpreting the results.
16. How to obtain the instrument:
On-line:
The Medical Algorithms Project:
http://www.medal.org/visitor/www/Active/ch18/ch18.01/ch18.01.01.aspx
Book:
McDowell, I. (2006). Measuring Health: A Guide to Rating Scales and Questionnaires
(Third Edition). New York: Oxford University Press.
Test and scoring information is FREE!
30
17. Research projects/published studies that used this instrument:
Title:
Gender and emotions: Icelandic parents experiencing childhood cancer.
Author:
Erla Kolbrun Svavarsdottir
Purpose:
To evaluate gender differences and the level of well-being among 26
Icelandic parents of children less than 18 years with cancer.
Findings:
The level of well-being was significantly different between parents, 56%
of the mothers showed clinically or problem-indicative stress, compared to
26.3% of the fathers.
Title:
Authors:
Purpose:
Findings:
The effects of two doses of replacement growth hormones on the
biochemical, body composition, and psychological profiles of growth
hormone-deficient adults.
Paul V. Carroll, Richard Littlewood, Andrew J. Weissberger, Paula
Bogalho, Gill McGauley, Peter H. Sonksen, and David L. Russell-Jones
To examine the effects of growth hormone (GH) replacement on the
insulin-like growth factor-I (IGF-I), body composition, and psychological
profiles of GH-deficient adults. Psychological assessments were
performed using the Nottingham Health Profile (NHP) and the General
Well-Being Schedule (GWB).
GH replacement in GH-deficient adults was associated with significant
improvements in self-perceived well-being as well as changes in body
composition and other variables. This improvement was similar at two
different doses of replacement GH. Those patients electing to continue on
long-term replacement did not achieve a demonstrably different
psychological, body composition or biochemical benefit to those patients
deciding to discontinue replacement.
References
Brook, R., Ware, J., Davies-Avery, A., Stewart, A., Donald, C., Rogers, W., et al. (1979, July).
Overview of adult health measures fielded in Rand's health insurance study. Medical
Care, 17(7), 1-131.
Carroll, P., Littlewood, R., Weissberger, A., Bogalho, P., McGauley, G., Sonksen, P., et al.
(1997). The effects of two doses of replacement growth hormones on the biochemical,
body composition, and psychological profiles of growth hormone-deficient adults.
European Journal of Endocrinology, 137, 146-153.
Committee to Develop Criteria for Evaluating the Outcomes of Approaches to Prevent and Treat
Obesity. (1995). Weighing the Options: Criteria for Evaluating Weight-Management
Programs (Thomas, P., Ed.). National Academy Press. Retrieved 04/20/07, from The
National Academies Press:
http://books.nap.edu/openbook.php?record_id=4756&page=R1.
Dupuy, H. (1978) Self-representations of general psychological well-being of America adults.
Los Angeles, CA: Paper presented at the American Public Health Association Meeting.
31
Edwards, D., Yarvis, R., Mueller, D., Zingale, H., & Wagman, W. (1978). Test-taking and the
stability of adjustment scales: Can we assess patient deterioration? Evaluation Review,
2(2), 275-291.
Fazio, A. F. (1977). A concurrent validational study of the NCHS General Well-Being Schedule.
Hyattsville, MD: U.S. DHEW, National Center for Health Statistics.
Himmelfarb, S., & Murrell, S. (1983, May). Reliability and validity of five mental health scales
in older persons. Journal of Gerontology, 38(3), 333-339.
McDowell, I. (2006). Measuring Health: A Guide to Rating Scales and Questionnaires (Third
Edition). New York: Oxford University Press.
Monk, M. (1981). Blood pressure awareness and psychological well-being in the Health and
Nutrition Examination Survey. Clinical and Investigative Medicine, 4(3-4), 183-189.
Nakayama, T., Toyoda, H., Ohno, K., Yoshiike, N., & Futagami, T. (2000, May). Validity,
reliability and acceptability of the Japanese version of the General Well-Being Schedule.
Quality of Life Research, 9(5), 529-539.
Owen, W. (2001). Application of Two Risk Adjustment Techniques in Multi-Agency Outcome
Comparisons. Washington, D.C.: Paper presented at the 50th Annual Conference on
Mental Health Statistics.
Simpkins, C., & Burke, F. (1974). Comparative analyses of the NCHS General Well-Being
Schedule: Response distributions, community vs. patient status discriminations, and
content relationships. Nashville, TN: Center for Community Studies, George Peabody
College.
Svavardottir, E. (2005). Gender and emotions: Icelandic parents experiencing childhood cancer.
International Journal of Nursing Studies, 42, 531-538.
Taylor, J., Poston II, W., Haddock, C., Blackburn, G., Heber, D., Heymsfield, S., et al. (2003,
February). Psychometric characteristics of the General Well-Being Schedule (GWB) with
African-American women. Quality of Life Research, 12(1), 31-39.
The Medical Algorithms Project. (2006-2007). Psychological General Well-Being Schedule. In
Brief Screening Instruments for Mental Health. Houston, TX: Institute for Algorithmic
Medicine.
Wan, T., & Livieratos, B. (1978). Interpreting a general index of subjective well-being. The
Milbank Memorial Fund Quarterly. Health and Society, 56(4), 531-556.
Ware, J., Johnston, S., Davies-Avery, A., & Brook, R. (1979). Conceptualization and
measurement of health for adults in the Health Insurance Study. (Vol. III, Mental Health).
Santa Monica, CA: RAND Corporation.
32
McCoy Female Sexuality Questionnaire
Prepared By: Katie Wilkinson; Jessica Stellberg-Filbert; Deborah Sampson; Shelley Sendak
1. Name of the instrument, author, publisher and date of publication.
The McCoy Female Sexuality Questionnaire was written by Norma L. McCoy. It was
published by Kluwer Academic publishers in 2000.
2. Background information about that manner in which it was developed.
The MFSQ was developed from the questionnaire used in the longitudinal study of the
menopausal transition period conducted in the Physiology Department at Stanford University
from 1979 until 1986. The questionnaire was designed to measure major aspects of female
sexuality and particularly those aspects of female sexuality likely to be affected by changes in
sex hormone levels. Common variables that may affect sexuality as measured by the MFSQ
include menopause, age, the use of exogenous sex hormones and various drugs, as well as
reproductive surgery, and chronic disease. Whereas items 10, 11 and 19 concern the sexual
partner, a woman whose capacity to respond sexually has been diminished may well believe her
partner to be the source of her decreased sexual responsiveness. Thus, such questions are
appropriately included in the MFSQ. Following the longitudinal study of the menopausal
transition, the questionnaire was modified as a result of the experiences gathered during that
study. Revisions involved making sure the questions were simple and easy to understand as well
as making sure that the labels at the ends and middle of the 7-point Likert scales described a
continuum rather than discrete categories. The revised 17-item MFSQ was then used in a study
on the effects of birth control pills on the sexuality of 354 university women ranging in age from
18 to 26 (McCoy, 2001).
The latest revision of the MFSQ addressed the lack of questions measuring sexual
attractiveness. In 1976, Beach described the three components of the sexuality of female
mammals. These components were (1) proceptivity or sexual interest and behavior indicating
sexual interest, (2) responsivity or sexual response and (3) attractivity or sexual attractiveness.
The original sex questionnaire had many questions concerning sexual interest and
response but only one question that appeared to deal with attractivity (item 9). Thus, when the
questionnaire was revised, two new questions dealing with sexual attractiveness (items 7 and 8)
were added (McCoy, 2001).
3. Administration information.
A. Pencil, paper, computer etc.
As it is not otherwise explicitly stated, it can be assumed that the questionnaire is usually
given in a paper and pencil format.
B. Duration of test.
Depending on one’s reading level and comfort level with sexuality, the test should not
take longer than ten minutes to administer (McCoy, 2001).
C. Where it should be administered.
Since it is a self report questionnaire, the home or a clinical setting would best fit this
questionnaire.
D. Who should be administering it?
This questionnaire should be administered by qualified personnel, such as a sex
researcher, doctor, or marriage therapist who is interested in female sexuality and the effects of
changing hormone levels on female sexuality. Due to the sensitivity of the subject area,
33
researchers need to be informed regarding confidentiality. A good way to ensure qualification to
administer this test would be to request CITI training from each person involved. CITI is an
online training program for the Protection of Human Research Subjects, which teaches
researchers about ethical research for more information look at http://www.citiprogram.org/
4. Stated purpose of the instrument.
It is virtually indisputable that the quality of a woman's sexual life plays a significant role
in her general or overall quality of life. The problem has been valid measurement of the quality
of a woman's sexual life. This instrument was designed to measure the changes in female
sexuality resulting from hormonal changes. The MFSQ can be used with women who are preand post- menopausal, who are using oral contraceptives, or who had a hysterectomy to gain
some understanding into their sexual satisfaction (McCoy, 2001).
5. Description of test, items, and scoring
The MFSQ is comprised of 19 questions, all but one scored on a Likert Scale, that are
interested in the respondent’s sexuality activity and interest. The test can be administered to both
heterosexual and lesbian women. Questions 1-11 are interested in the respondent’s general
sexuality and sexual interest. Question 12, the only answer not scored on a scale, asks about the
respondent’s sexual intercourse frequency over the past 4 weeks. Questions 13-19 inquire about
the respondent’s experience with sexual intercourse. The MFSQ typically takes 10 minutes to
administer, depending on the respondent’s reading ability and sexual comfort (McCoy, 2001).
Typically, the test is interested in sexual activity over the last 4 weeks. If a participant has
not been heterosexually active in the last 4 weeks, she is instructed to stop after answering
question 12. Even though this test can be used with both lesbian and heterosexual females,
questions 13-19 assume heterosexual intercourse (McCoy, 2001).
The test is scored using the 7-point Likert scale. These scales are labeled at the
beginning, middle and end spanning extremes. The participants rate their answers on a scale of 1
to 7 and the final score for each respondent is determined by totaling all of their answers
(Research Methods Knowledge Base). Question 16 of the MFSQ requires a reversed score if a
total score is to be obtained (McCoy, 2001). That is, if the respondent gave a 1, you make it a 7;
if they gave a 2 you make it a 6; 3 = 5; 4 = 4; 5 = 3; 6 = 2; and 7 = 1 (Research Methods
Knowledge Base).
6. Use and application in therapy
The quality of a woman’s sexual life is a significant determinant of her overall quality of
life (McCoy, 2001). The MFSQ is often administered to women who experience hormonal
changes that affect their sexuality. In many menopausal clinics, sexual problems are among the
most frequent complaints (Dennerstein, Alexander, & Kotz, 2003). The MFSQ was developed
from a questionnaire which was used in a longitudinal study of the menopausal transition and
aspects of sexuality presumedly affected by changing hormones. The MFSQ can be used with
women who are pre- and post- menopausal, are using oral contraceptives, or had a hysterectomy
to gain some understanding into their sexual satisfaction.
Therapists can gain information about how these types of hormonal changes affect
women’s sexual life. From the results the therapist can work with couples to determine ways for
couples to continue to enjoy sex during and after these changes. If women choose to go through
hormonal therapy accessing couples’ therapy can help them and their partner understand and
manage the affects of the hormones on their sexual activities.
7. Reliability and validity information
34
Reliability: Tests of reliability were conducted with a number of different versions and
populations with alphas of internal consistency ranging from 0.74 to 0.76, with a range of one to
two weeks between test and retest (McCoy, 2000, p. 741). As a minimum alpha of 0.70 is
typically required, we may deem the MFSQ reliable, but just so. While individual items showed
greater reliability (based on a 2 week interval test-retest of a convenience sample, individuals
items had an average of α = 0.83), there is dramatic variation in the alpha scores when reliability
is being established with different populations. In an Italian sample (Rellini, Nappi, Vaccaro,
Ferdeghini, Abbiati & Meston, 2005, p. 643), Cronbach’s Alpha was calculated only for a new
two factor structure (sexuality and partnership) as factor analysis in the non-US sample did not
support McCoy’s original five dimensions (Rellini et al, 2005, p. 643).
Face validity: According to the instrument’s author, the MFSQ “appears to have face and
content validity in that the sexual topics covered are viewed as important by consensus of
researchers in the field” (McCoy, 2000, p. 741 ). However, the researchers are not identified and
McCoy’s claim comes prior to a consensus panel by leading researchers (Basson, Berman,
Burnett, Derogatis, Ferguson Fourcroy et a., 2000) which “divided female sexual dysfunction
into disorders of sexual desire, arousal, orgasm and sexual pain” (Dennerstein, Anderson-Hunt &
Dudley, 2002, p. 389-390). The MFSQ uses five factors: sexual interest; satisfaction frequency
sexual activity; vaginal lubrication; orgasm; and sex partner (McCoy, 2000), of which sexual
partner is not noted as important to sexual dysfunction, and of which sexual pain is
conspicuously absent. That both sexuality and menopause are culturally and socially constructed
is becoming more widely recognized (Tiefer, 2001; Astbury-Ward, 2003), so face validity is very
much in the eyes of the beholder. As Symonds, Boolelle and Quirk note:
It is generally perceived that adequate sexual functioning is important for overall
life satisfaction and general quality of life. However, there is little in the way of
empirical evidence to support this assumption, and in instances in which the
concept of QOL has been addressed in relation to sexual function, the
methodology has often been less than optimal. (2005, p. 385)
Criterion-validity: The majority of the research cited in support of the MFSQ’s validity comes
in the form of known-groups validity, where studies have demonstrated differences in test scores
between menopausal women using an estrogen path and women not receiving one and between
university-aged women taking oral contraceptives and those who do not. While there were
significant differences in several items with all of these studies, the items that showed a
significant difference varied across the studies (i.e., in only two studies was there a significant
difference between the scores for item 18: painful sexual intercourse). Moreover the differences
noted by the instrument between college-aged women using and not using contraceptives may be
spurious, as it can be inferred that at least some of the college-aged women not using oral
contraception are not sexually active. In other words, the instrument may be picking up
differences that are not due to hormonal status at all, but something else entirely.
Construct & Discriminant validity: As women’s sexuality is an understudied and undertheorized area in the social, behavioral and physical sciences, measures of female sexuality may
suffer from a lack of discriminant validity, as there is little clear understanding on the
distinctions between sexual satisfaction and relationship satisfaction, for example. Discriminant
validity, i.e., the ability of the MFSQ to distinguish a difference between various different classes
and test score, is questionable. For example the MFSQ is not able to discriminate between
menopause’s effect upon the factors body esteem and sexually attractive, generally in any clear
35
way. An Italian study of this U.S. instrument showed that the instrument’s five factors were not
supported in an non-US sample, noting that “the model used to understand female sexuality may
not even be an adequate depiction of the sexual experience of North American women” (Rellini
et al, 2005, p. 647).
8. Population/situation for whom it is used?
The MFSQ can be used to measure general sexuality and sexual interest in sexually
active women experiencing hormonal changes. It has been used in studies around the affects of
menopause, contraceptives, and hysterectomies on sexuality (McCoy, 2001). It can be
administered to both lesbian and heterosexual women. The MFSQ has been used with women
ranging in ages of 17 to 70 years old. Ideally, the women taking the test will have been sexually
active in the four weeks prior to the administration.
9. Selection information
As alluded to in question 7 above, the MFSQ may not measure what it is intended to
measure, as the quality of a woman’s sexual life is complex, multi-faceted and made up of
elements that vary between women and within an individual woman’s life over the course of her
lifespan. There is only a very weak theory behind McCoy’s instrument; “major aspects of female
sexuality…[are] likely to be affected by changes sex hormone levels” (McCoy, 2000, p. 740).
The most current version of the MFSQ adopts a triune understanding of sexuality with
proceptivity, responsivity and attractivity being the key components to female sexuality (McCoy,
2000, p. 741). The equation of sexual attractiveness to the quality of a woman’s sexual life is not
only highly insulting, but would make it logically impossible to assess a woman’s sexual life
through her self reports. It would be better if items 7) sexually attractive, generally and 8)
sexually attractive, to partner were answered by a panel of past, current, and prospective sexual
partners! The implication is that not only is female sexuality literally in the eyes of the beholder,
but the hypothesized correlation of menopausal status/age and lower MFSQ scores suggests a
rather ageist assumption that with age, women are less sexually attractive and less sexually
satisfied.
Additionally, the factor analysis shows that vaginal lubrication and orgasm, which are
most clearly linked in the literature to menopausal status, surgery (hysterectomy, etc.) and age
actually explain the least amount of the variance (8.3% and 7.7% respectively, compared to
23.1% for sexual interest).
10. Interpretation information
As McCoy has noted, in the nearly two decades since the MFSQ was developed, many
researchers have used selected items, have changed the scaling and have added additional
questions: “it is not unusual for some of the items to be omitted due to cultural sensitivity or the
belief on the part of the investigators that certain items will not be acceptable to their subjects”
(McCoy, 2000, p. 744). Rellini et al., 2005 noted that the questionnaire was not appropriate for
an Italian sample; although it has been used in other European countries (see McCoy, 2000).
Dennerstein et al., 2002 changed the likert scaling, which suggests they experienced problems
with the instrument’s sensitivity. And in order to develop cut-off scores, they compared mean
scores at three different sites: a family planning clinic; a sex therapy group; and a private
psychiatric practice with the explanation that “we made the broad assumption that women in the
sex therapy and psychiatric groups were sexually dysfunctional and that women in the family
planning group were sexually functional” (Dennerstein et al., p. 393). As though the only
36
problem a woman could possibly face would be a sexual one and that needing contraceptives or
treatment for Chlamydia is evidence of sexual well-being. Clearly, there are problems in
interpreting this instrument and the constructs it purports to measure.
The explanation that “sexuality is inherently a sensitive area wherein many relevant
questions may be viewed as an invasion of privacy” (McCoy, p. 739) points to the largest
problem in appropriate interpretation; sex is considered by many to be private and therefore an
inappropriate topic for any type of discussion or inquiry. The problem then, would not lie so
much with the instrument’s construction, but in the way sexuality is researched and the way
sexuality is able to be researched—an issue of social and cultural mores that are probably not
easily changed to fit research agendas.
11. Is the test free from bias?
The MFSQ itself appears to be relatively fair and general in the questions it poses.
However, the use of the MFSQ provides biases for administrators to be aware of. The
populations it is used with can hold biases depending on the diversity or lack there of among the
respondents or from selection bias because of the inclusion and exclusion criteria. Dennerstein
et al. (2003) determine that “the effects of the selection bias are to create a homogenous group of
individuals who may bear little resemblance to the majority of those who would approach their
general practitioner about a particular health problem” (pg. 68). The biases of the MFSQ are
dependent on the groups the researchers administer it to.
12. Is it a practical test to use?
The MFSQ is a practical test to use. As noted above, despite some weaknesses it has
demonstrated acceptable reliability, internal consistency, face and content validity, and construct
validity evidenced from the published research. McCoy (2001) found that it was currently being
used in a number of ongoing projects ranging from studying hormonal replacement therapy in
postmenopausal women and female dialysis patients to treatment of women with rectal cancer
(McCoy, 2001). Despite the fact that with changes, validity cannot be assumed, administrators
have omitted some of the questions if they did not fit with the population they are studying,
which may seem to add to its versatility. Of the seven published studies in 2001 using the
MFSQ, not one used all 19 questions.
13. Are standards for administration listed? If so, what are they?
There are no administration standards listed.
14. Sample Questions
The questions on the MFSQ are divided into two categories. The first category regards
questions about the general sexuality or sexual interest of the participant. The other category
consists out of questions regarding sexual intercourse. Possible answers on a 7-point Likert scale
are offered, which are labeled in the middle and at the ends.
37
Questionnaire items
General sexuality/sexual interest
Likert scale labels for 1 and 7
1. How enjoyable has sexual activity been for you?
Not at all enjoyable – extremely
enjoyable
4. How excited have you been during sexual activity? (For
instance increased heartbeat/flushing/heavy breathing, etc.)?
Not at all excited – extremely
excited
5. How would you describe your level of sexual interest (i.e.
sex drive) during the past four weeks?
Extremely low – extremely high
7. How sexually attractive do you feel you are?
Not at all sexually attractive –
extremely sexually attractive
10. How satisfied are you with your primary partner as a
lover?
Not at all satisfied – extremely
satisfied
Sexual intercourse (past 4 weeks)
12. How often did you engage in sexual intercourse in the past
four weeks?
14. How often have you had an orgasm during sexual
Never – every time
intercourse?
18. How often have you had pain during sexual intercourse?
Every time - never
15. Strengths and potential pitfalls of using this instrument
One of the possible pitfalls of using this instrument is its subject. Due to the sensitivity of
the subject of sexuality, some questions may be regarded as an intrusion into privacy. Women
may not answer the questions accurately because of embarrassment or societal unacceptability
(McCoy, 2000). Researchers, however, will face this problem with almost any of the possible
instruments to assess for sexuality.
Societal acceptability of sexual topics varies across cultures and subcultures which may
even coexist in the same country (Rellini et al., 2005). Measures often do not control for this
difference, making outcome analyses difficult and unsound. Additionally, only a limited number
of measures are available in more than one language. One of the strengths of the MFSQ lies in its
availability in different languages. Besides English, the MFSQ is also available in French, Dutch,
Swedish, Norwegian, Finnish, German, Greek, Portuguese, Spanish, Danish, and Italian (Mapi
Research Institute, 2006). However, although the MFSQ is available in different languages only
the French and the German translations include the original nineteen items (Rellini et al., 2005).
All others only include seven to nine items. This may be due to the aforementioned sensitivity of
the subject. For the same reason and probably because many variables were studied at the same
time, none of the published studies included all nineteen items (McCoy, 2000).
16. Information about how to obtain the instrument
The MFSQ is distributed by the Mapi Research Trust, located in Lyon, France. To order
the MFSQ, interested individuals have to fill out a user agreement that is obtainable on the
38
organization’s web-site. This user agreement has to be sent or faxed to the organization (Mapi
Research Trust, Ms Christelle BERNE, 27 rue de la Villette, F - 69003 LYON, Tel: +33 4 72 13
65 75, Fax: +33 4 72 13 66 82, e-mail: cberne@mapi.fr). The use of the MFSQ in commercial
studies is subject to Author's royalties fees, of an amount $2,500 US per study. The invoice will be
directly sent to the user by Norma McCoy according to the information mentioned in the user
agreement. Access is free of charge in the framework of not-funded academic research and
individual clinical practice. Access to the MFSQ for use in funded academic research is subject
to a distribution fee payable to Mapi Research Trust, in the amount of 250 Euro per study plus an
additional 20 Euro per language version requested. Mapi Research Trust also requests payment if
the MFSQ is to be used in commercial studies involving “for profit” organizations. This payment
is of the amount of 400 Euros per study plus an additional 50 Euros per language version.
17. Locate at least TWO research projects/published studies that used this instrument.
Talk about the purpose of the studies, who conducted them, with what population, and the
findings.
Aziz, Bergquist, Brännström, Nordholm, and Silfverstolpe (2005) conducted research in
Sweden, comparing the preoperative characteristics of women who choose to undergo
prophylactic oophorectomy with the corresponding characteristics of women who choose to
retain their ovaries when undergoing an elective hysterectomy. Their study population consisted
out of 323 women aged 45-55, who had their last menstruation less than 12 months ago and who
were scheduled for an elective hysterectomy within the following two months.
The researchers found clear differences in several aspects of personality and sexuality
between the women who chose a removal of their ovaries along with a hysterectomy and those
who chose to retain their ovaries. Women who chose to keep their ovaries scored significantly
higher on the MFSQ suggesting higher levels of sexual satisfaction, enjoyment, and arousal, as
well as higher coital and orgasmic frequency and a good relationship to the partner as a lover.
The researchers concluded that women with higher levels of sexual interest and
satisfaction may be less inclined to undergo removal of their ovaries because of the generally
held opinion that sexuality may deteriorate after ovaries have been removed. Women who are
less sexually interested or satisfied, on the other hand, would therefore be more likely to consider
an elective oopherectomy.
In a second study, McCoy and Matyas (1996) conducted research regarding the
relationship between the use of oral contraceptives and sexuality in university women. The goal
of the study was to further clarify the role of hormones in female sexuality (i.e. sexual interest
and response). McCoy and Matyas hypothesized that the use of oral contraceptives would
decrease sexual interest, sexual thoughts and fantasies, and vaginal lubrication.
The participants of this study were sexually active women aged 18 to 26, attending San
Francisco State University. The sample size was 364 women. Out of these 364 women, at least
30% of subjects at each age were using oral contraceptives. Contrary to the researchers’
predictions, the women who used oral contraceptives reported significantly greater frequencies
of sexual thoughts and fantasies as well as more sexual interest than the women not using oral
contraceptives. Women who used oral contraceptives also had higher rates of sexual interest. The
researchers’ prediction regarding less vaginal lubrication, on the other hand, was supported in the
study.
References
Astbury-Ward, E. M. (2003). Menopause, sexuality and culture: is there a universal experience?
Sexual and Relationship Therapy, 18, 437-445.
39
Aziz, A., Berquist, C., Brännström, M., Nordholm, L., & Silfverstolpe, G. (2005). Differences in
aspects of personality and sexuality between perimenopausal women making different
choices regarding prophylactic oophorectomy at elective hysterectomy. Acta Obstet
Gynecol Scand, 84, 854-859.
Basson, R., Berman, J. R., Brunett, A., Derogatis, L., Ferguson, D., Fourcroy, J., et al. (2000).
Consensus panel: Report of the international consensus development conference on
female sexual dysfunction. The Journal of Urology, 163, 888-893.
Dennerstein, L., Alexander, J. L., & Kotz, K. (2003). The menopause and sexual functioning: A
review of population-based studies. Annual Review of Sex Research, 14, 64-82.
Dennerstein, L., Anderson-Hunt, M., & Dudley, E. (2002). Evaluation of a short scale to assess
female sexual functioning. Journal of Sex & Marital Therapy, 28, 389-397.
Mapi Research Institute. (2006). McCoy Female Sexuality Questionnaire. Retrieved April 14,
2007, from http://www.proqolid.org/instruments/mccoy_female_sexuality_questionnaire
_mfsq
Mapi Research Trust. (2007). McCoy Female Sexuality Questionnaire. Retrieved April 14, 2007,
from http://www.mapi-research.fr/t_03_serv_dist_Cduse_mfsq.htm
McCoy, N. L. (2000). The McCoy female sexuality questionnaire. Quality of Life Research, 9,
739-745.
McCoy, N. L., & Matyas, J. R. (1996). Oral contraceptives and sexuality in university women.
Archives of Sexual Behavior, 25(1), 73-90.
Rellini, A. h., Rossella E. N., Vaccaro, P., Ferdeghini, F., Abbiati, I., & Meston, C. M. (2005).
Validation of the McCoy female sexuality questionnaire in an Italian sample. Archives of
Sexual Behavior, 34(6), 641-647.
Research Methods Knowledge Base. Likert Scaling. Retrieved April 21, 2007 from:
http://www.socialresearchmethods.net/kb/scallik.php
Symonds, T., Boolell, M., & Quirk, F. (2005). Development of a questionnaire on sexual quality
of life in women. Journal of Sex & Marital Therapy, 31, 385-397.
Tiefer, L. (2001). New view of women's sexual problems: Why new? Why now? Journal of Sex
Research, 38, 89-96.
40
McMaster Family Assessment Device (FAD)
Prepared by: Andrea Hally and Lindsay Haywood
1) Assessment Instrument: McMaster Family Assessment Device
Authors: N. Epstein, L. Baldwin, and D. Bishop
Publisher: Journal of Marital and Family Therapy
Date of publication: 1983
2) The Family Assessment Device was developed to assess the different dimensions of the
McMaster Model according to the perceptions of each family member. “The McMaster
Approach to Families was to delineate the basic concepts of family functioning and
family treatment, which, if consistently applied, would allow therapists to provide
effective treatment for families” (Miller, Ryan, Keitner, Bishop, & Epstein, 2000). The
approach includes a theory of family functioning, assessment instruments (including the
FAD, the McMaster Structured Family Interview for Families (McSIFF), and the
McMaster Clinical Rating Scale (MCRS)), and a well-defined method of family
treatment. The McMaster Approach is based on the general principles of systems theory.
3) Administration information:
a) Pencil/pen and paper
b) Consists of 60 questions and takes approximately 15-20 minutes to complete
c) Clinical office, hospitals, schools…
d) Therapists/clinicians, case workers, receptionists…
4) The purpose of this instrument is to measure 6 domains of family functioning with an
additional dimension assessing general family functioning in order for therapists to
provide the most effective clinical treatment.
5) This assessment tool consists of subscales which assess 6 dimensions of the McMaster
Model plus the general functioning scale which assesses the overall functioning of a
family. The FAD has a total of 60 statements that describe various aspects of family
functioning. The number of items in each subscale range from 6-12 statements. Each
family member 12 years old and over will rate how well each statement describes their
family. To rate the description they will select from 4 different responses: strongly agree,
agree, disagree, and strongly disagree. The 6 subscales include: roles, communication,
behavioral control, problem solving, affective involvement, and affective responsiveness.
Once the assessment is filled out it is scored by summing the endorsed responses (1-4)
for each subscale (negatively worded statements are reversed) and dividing by the
number of items in each scale. The higher the score the worse the level of functioning is
(Miller et al., 2000).
6 Dimensions as defined by Miller et al. (2000):
Problem solving: A family’s ability to resolve problems at a level that maintains
effective family functioning.

Instrumental type- mechanical problems of everyday life (money, where to
live, etc.)

Affective type- related to feelings and emotional experience.
Communication: How information is exchanged within a family.
41

Instrumental type

Affective type
Roles: The recurrent patterns of behavior by which individuals fulfill family
functions.

Instrumental
1) Necessary family functions
2) Other family functions

Affective
1) Necessary family functions
2) Other family functions
Affective responsiveness: The ability of the family to respond to a range of stimuli with
the appropriate quality and quantity of feelings.

Quality- Do family members respond with the full spectrum of feelings?

Quantity- Degree of response on continuum from non/under-responsiveness to
expected responsiveness to over-responsiveness.
Affective involvement: The degree to which the family as a whole shows interest
in and values the activities and interests of individual family members.
Behavior control: The pattern a family adopts for handling behavior in three types of
situations.

Physically dangerous situations

Situations which involves meeting and expressing psychobiological needs or
drives

Situations involving interpersonal socializing behavior
6) Clinically, this device serves as a consistent, practical and empirically validated method
to assess families. It also provides clinicians with an integrated assessment approach and is a
comprehensive model. It was developed around a clinical model and based on clinical
experience. The assessment device was designed to be clear in order to allow easy
implementation of the various aspects based around the McMaster Approach.
7) Reliability and Validity:
a) The FAD has acceptable levels of test-retest reliability and found to have high
levels of consistency across a variety of different types of families. Alternate forms
include those translated into 14 different languages (Miller et al., 2000).
b) The FAD seems to be valid because:
i.Content: The 6 dimensions are comprehensive in conceptualizing family
functioning. However, these dimensions do not necessarily represent all aspects of
family functioning, just those that are useful in a clinical context.
ii. Criterion-predictive: We could not find sufficient empirical evidence to support
or not support that the score on this assessment can predict the individual/family’s
score in some other area. However, since the test has shown that it is empirically
valid, one can assume that it would correlate with the family’s current state and
therefore would predict another test in some other area to conclude similar results.
iii. Criterion-concurrent: Barney and Max (2004) found in their study that there
was a significant correlation between the FAD and the McSIFF according to the
42
MCRS. Therefore, if the self-report assessment device (FAD) found that a family was
unhealthy, it is likely that the clinician’s impression of the family’s functioning
(McSIFF) also found the family to be unhealthy. Therefore, it can be said that scores
on the FAD accurately predict the family’s current state of functioning.
iv. Construct: In areas as complex as families, assessment can often be difficult
and complicated. However, the FAD’s use of 6 dimensions plus a 7th seem to provide
a comprehensive understanding of whether a family is healthy or unhealthy. Included
in the FAD are statements related to known patterns of dysfunctional family
interactions as well as healthy family interactions. By gaining information on both
healthy and unhealthy family practices, it appears as if the FAD measures family
functioning on a large continuum and therefore to a good degree.
c) We feel that the reliability and validity of the McMaster FAD is adequate. This
conclusion is based on the content mentioned above.
8) The FAD can be used for a clinical or a non-clinical population. All of the family
members 12 and older should complete the FAD. The McMaster Approach has often been
used among populations including adult psychiatric patients, particularly those who have
mood disorders, adults with chronic illness, and children (Miller et al., 2000).
9) Selection information: The test appears to measure what it intends to measure and is
widely used among family clinicians. It provides clinicians with consistent, practical, and
empirically validated methods to assess and treat families (Miller et al., 2000)
10) There are 6 different domains and one overall family functioning domain which equals a
total of 7 domains or subscales. The differing cut-off scores are as follows: general family
functioning is 2.00, communication, affective responsiveness and problem solving are all
2.20, roles are 2.30, behavior control is 1.90, and affective involvement is 2.10 (Epstein,
Baldwin, & Bishop, 1983). The statements used in the FAD relate to the different aspects of
family dynamics and are clear and concise. Therefore it can be administered to many
different types of families.
11) The FAD has been translated into 14 languages and has been used in over 40 research
studies. We must keep in mind that no test is free from bias, however this one comes as close
as possible based on the generalized nature of the statements used. These statements can be
applied to many different types of families.
12) This test is practical and highly useful for MFTs in particular. It can also be used by
pastors, psychologists, social workers, health practitioners, etc. If used in a family therapy
setting, this assessment proves to be most pertinent.
13) The only standard of administration for the McMaster FAD is that all members of the
family over 12 years of age should complete the test (Miller et al., 2000).
14) A sample question from each subscale:
e) Problem Solving: We usually act on our decisions regarding problems (Question
#1)
f) Communication: You can’t tell how a person is feeling from what they are
saying (Question #9)
g) Roles: When you ask someone to do something, you have to check that they did it
(Question #3)
h) Affective Responsiveness: We are reluctant to show our affection for one another
(Question #4)
43
i) Affective Involvement: We show interest in each other when we can get
something out of it personally (Question #33)
j) Behavior Control: You can easily get away with breaking the rules (Question
#13)
k) General Family Functioning: There are lots of bad feelings in the family
(Question #39) (Epstein et al.,1983).
15) Strengths and limitations: An apparent strength is that this assessment includes 6 different
dimensions plus an overall dimension to provide a comprehensive interpretation of family
functioning by looking at various areas. A second strength is that it is easy to understand, has
direct clinical application, can be administered in 14 different languages, and is easy to
administer. Even though the FAD is available in 14 different languages, the pitfall is that it
has historically only been used with a non-clinical sample of mostly Caucasian and middle
class families. Second, the reliability and validity of translated versions have not yet been
established. Lastly, the 6 separate dimensions are not independent of each other, but rather
they are correlated. Therefore, if a family’s problem exists in one domain, it will probably
exist in other domains as well (Miller et al., 2000).
16) How to obtain this assessment tool: This assessment tool is available through the Journal
of Marital and Family Therapy. The cost is associated with purchasing a subscription to the
journal.
17) One research study using the McMaster FAD was A Psychometric Study of the
McMaster Family Assessment Device in Psychiatric, Medical, and Nonclinical Samples
conducted by Kabacoff, Miller, Bishop, Epstein, and Keitner (1990). The purpose of their
study was to investigate a multi-dimensional measure of family functioning. Internal scale
reliabilities and factorial validity were assessed for each group and results were compared
across groups. The population was selected from a large sample of clinical, non-clinical, and
medical groups. The findings included families with a psychiatric member reported
significantly greater difficulties across all scales than families in medical or non-clinical
samples. No significant differences were found between non-clinical families and medical
families (Kabacoff et al., 1990).
44
A second research study conducted by Barney and Max (2004) investigated the potential
correlation between the FAD and the McMaster Structured Interview for Families (Mc-SIFF)
as scored by the McMaster Clinical Rating Scale (MCRS). The sample population included
50 children and adolescents (ages 6-14) with traumatic brain injury (TBI). 72 children,
including 24 with severe TBI were individually matched to a comparison group of 24
children with mild TBI, and a control group of 24 orthopedic patients. This study found a
significant correlation between the FAD and the MCRS. Family function variables from the
FAD and the clinician’s rating from the structured interview as determined by the MCRS
have low to moderate correlations. The second finding suggested that categorical ratings
(healthy family versus non-healthy family) derived from the FAD and the structured
interview as determined by the MCRS have statistically significant correlation (Barney &
Max, 2004).
References
Barney, M., & Max, J. (2004). The McMaster family assessment device and clinical
rating
scale: Questionnaire vs interview in childhood brain injury. Journal of Brain Injury,
19(10), 801-809.
Epstein, N., Baldwin, L., & Bishop, D. (1983). The McMaster family assessment device. Journal
of Marital and Family Therapy, 9, 19-31.
Kabacoff, R., Miller, I., Bishop, D., Epstein, N., & Keitner, G. (1990). A psychometric study
of the McMaster family assessment device in psychiatric, medical, and nonclinical
samples. Journal of Family Psychology, 3(4), 431-439.
Miller, I., Ryan, C., Keitner, G., Bishop, D., & Epstein, N. (2000). The McMaster approach to
families: theory, assessment, treatment and research. Journal of Family Therapy, 22, 168189.
45
Yale-Brown Obsessive-Compulsive Scale
Prepared by: Kali Schmidt, Dawn MacKay, Jamie Trevino
1. Name of instrument – Yale-Brown Obsessive-Compulsive Scale (Y-BOCS)
Author – Wayne K. Goodman, Stephen A. Rasmussen, Lawrence H. Price
Publisher – Department of Psychiatry, Yale University School of Medicine and the
Connecticut Mental Health Center.
Date of publication – 1989
2. Background information about manner in which it was developed – Items were selected
based on widespread clinical experience of the authors. Several versions of the scale were
formed over a 6 month period until the current form was completed. Items that reflected
symptoms of depression or other anxiety disorders were excluded. Items intended to measure
putative state variables were included in the main portion of the test while those items thought to
reflect personality traits were thrown out. The investigational component of the Y-BOCS
included certain clinical features that are associated with OCD, but not necessarily related to the
severity of the illness. The test was created as an observer-rater instrument due to evidence on
other disorders of ratings based solely on self-report correlating poorly with objective
evaluations.
3. Administration information –
a. Pencil, paper, computer, etc. – The Y-BOCS started as a paper and pencil based
test, but there are now versions (such as the IVR) that can be obtained and completed
as a self-administered test on the computer with the assistance of a clinician.
b. Duration of test – Should take 5-10 minutes
c. Where it should be administered – In a clinical setting.
d. Who should administer it – Clinician administered/rated.
4. Stated purpose of test – The purpose of the Y-BOCS is to quantify the severity of the
symptoms of OCD in patients who have already been diagnosed with the illness independent of
the number and type of obsessions and compulsions present. It also assesses the patient’s
response to treatment.
5. Description of the test, items, and scoring – The test consists of 10 items that are rated on a
scale of 0 to 4. 0 would mean no symptoms and 4 would be extreme symptoms. There are two
separate subtotals for the severity of obsessions and compulsions. The obsessions and
compulsions are rated according to the amount of control over, distress over, resistance to,
interference from, and the time spent on them.
6. Use and application in therapy – The Y-BOCS is intended to be used on people with OCD.
The test was not designed to diagnose the disease; it merely was created to determine the
severity. The original version was intended to be used with adults or older children. Later
versions were created for younger children by changing some of the language. If using the YBOCS to assess the response of OCD symptoms, the test should be administered weekly with
46
small variations in the wording. To start, the client is asked to list their current compulsions and
obsessions. This list is then used as a basis for the severity ratings. Throughout administering the
test, if new symptoms appear, they are then added to the list. To then ensure that symptoms are
not overlooked, the Y-BOCS Symptom Checklist is used. This consists of 50 types of obsessions
and compulsions. The Y-BOCS application in therapy is primarily to assess the severity of the
symptoms within an OCD patient and then assess their response to treatment. This allows the
patient to then get the best and most affective treatment possible.
7. Reliability and validity a. Reliability based on – Interrater reliability and internal consistency was used. This
measured the reliability in administration as well as consistency of the content.
b. Type of validity – Convergent (construct) and discriminant validity were obtained
from baseline ratings of patients with obsessive-compulsive disorder. Content validity
was well covered by the extensive selection process and research of the initial items
therefore was not further tested.
b. Is the reliability and validity adequate? – The reliability is adequate for the type of
test that the Y-BOCS is (a measure of symptom severity). The interratter reliability
was excellent (r=.85) and there was a high degree of homogeneity among all scores by
using Cronbach’s a coefficient. The Validity is adequate for assessing OCD symptom
severity as well as an outcome measure in drug trials of OCD. Based on three cohorts
of OCD patients, there were significant and moderately strong correlations between
the Y-BOCS and two other measures of OCD.
8. Population/situation – The Y-BOCS scale is used in treating patients already diagnosed with
obsessive-compulsive disorder. This disorder is characterized by repetitive thoughts and
behaviors within the patient which interfere with their everyday life and cause them anxiety and
distress. Examples of OCD symptoms might include recurrent irrational violent thoughts,
repeated cleansing rituals, preoccupation with unfounded fears, somatic physical symptoms, and
ritualized eating behaviors.
9. Selection information – The Yale-Brown Obsessive-Compulsive Scale does what it is
designed to do; measures the severity and type of symptoms associated with OCD. It provides
the clinician with an overall picture of what the patient is dealing with and assists him/her in
designing a specific treatment plan. The Y-BOCS, in fact, has the reputation of being the “gold
standard” for rating the severity and symptomology of OCD (Frost, Steketee, Krause &
Trepanier, 1995).
10. Interpretation – After the patient has completed the 10 question Y-BOCS scale, the
clinician interprets the information. Each of the 10 items is scored between 0 and 4 points. The
first five items on the scale assess for obsessions, while the second five are concerned with
compulsions. The total score possible for the 10 items ranges from 0 to 40 points. The following
chart shows the interpretation of the results (Stanford School of Medicine, n.d.):
47
Points
Assessment
0-7
subclinical
8-15
mild
16-23
moderate
24-31
severe
32-40
extreme
Since the point range is clearly set out, the Y-BOCS provides the clinician with enough
information to be able to interpret the test results appropriately. The Y-BOCS instrument is
designed especially for individuals who have been diagnosed with OCD, and is effective and
appropriate for the examinees.
11. Bias – The accuracy of the Y-BOCS scale relies mainly upon the patient’s accurate report of
their own symptoms. For this reason, this instrument may have some potential to bias if an
examinee is less than candid in their response to the questions. However, even in that case, a
skilled clinician can combine the test results with thorough interviewing techniques, reducing the
likelihood of bias.
12. Practicality – The Y-BOCS is a very practical choice as a measurement tool for OCD. The
test is relatively simple to administer, not overly complicated to interpret, and is easily
assessable. It uses straightforward wording and can be administered in a short amount of time.
The 10 items on the Y-BOCS scale are worded in an objective, non-confrontive manner, making
it non-threatening to the patient. The fact that clinicians are encouraged to administer the scale to
their patients on a weekly basis also demonstrates it’s practicality.
13. Standards for administration – The clinician should administer the Y-BOCS using the four
step outline below:
1. Establish the diagnosis of obsessive-compulsive disorder.
2. Using the Y-BOCS Symptom Checklist, ascertain current and past
symptoms.
3. Administer the 10-item Y-BOCS severity ratings to assess the severity of
the OCD during the last week.
4. Readminister the Y-BOCS Severity Rating Scale to monitor progress.
14. Sample questions from the Y-BOCS - (Jha, S. K., 2004)
INTERFERENCE DUE TO OBSESSIVE THOUGHTS
0 = None. 1 = Mild, slight interference with social or occupational activities, but overall
performance not impaired. 2 = Moderate, definite interference with social or occupational
performance, but still manageable. 3 = Severe, causes substantial impairment in social or
occupational performance. 4 - Extreme, incapacitating.
48
Q: How much do your obsessive thoughts interfere with your social or work (or role)
functioning? Is there anything that you don't do because of them?
0
1
2
3
4
DEGREE OF CONTROL OVER OBSESSIVE THOUGHTS
0 = Complete control. 1 = Much control, usually able to stop or divert obsessions with some
effort and concentration. 2 = Moderate control, sometimes able to stop or divert obsessions.
3 = Little control, rarely successful in stopping or dismissing obsessions, can only divert
attention with difficulty. 4 = No control, experienced as completely involuntary, rarely able to
even momentarily alter obsessive thinking.
Q: How much control do you have over your obsessive thoughts? How successful are
you in stopping or diverting your obsessive thinking?
0
1
2
3
4
TIME SPENT PERFORMING COMPULSIVE BEHAVIORS
0 = None. 1 = Mild (spends less than 1 hr/day performing compulsions), or occasional
performance of compulsive behaviors. 2 = Moderate (spends from 1 to 3 hrs/day performing
compulsions), or frequent performance of compulsive behaviors. 3 = Severe (spends more than 3
and up to 8 hrs/day performing compulsions), or very frequent performance of compulsive
behaviors. 4 = Extreme (spends more than 8 hrs/day performing compulsions), or near constant
performance of compulsive behaviors (too numerous to count).
Q: How much time do you spend performing compulsive behaviors? How frequently
do you perform compulsions?
0
1
2
3
4
RESISTANCE AGAINST COMPULSIONS
0 = Makes an effort to always resist, or symptoms so minimal doesn't need to actively resist.
1 = Tries to resist most of the time. 2 = Makes some effort to resist. 3 = Yields to almost all
compulsions without attempting to control them, but does so with some reluctance.
4 = Completely and willingly yields to all compulsions.
Q: How much of an effort do you make to resist the compulsions?
0
1
2
3
4
49
15. Strengths and pitfalls - Strengths: it is considered the gold standard in obsessivecompulsive disorder assessments, there has not been another assessment since the Y-BOCS to
accurately test for obsessive-compulsive symptoms, it is well known throughout the world, the
interrater reliability is excellent, the scale is completed in a short amount of time, it is easy to
understand and readily accessible. Weaknesses: some feel that the Y-BOCS may discriminate
against gay and lesbian individuals, it may not apply to all ethnic cultures, and some feel it
should be updated.
16. Obtaining the instrument - The written version may be purchased by writing to Dr.
Goodman at: The University of Florida School of Medicine, P. O. Box 100256, Gainesville, FL
32610. The desktop IVR version may be taken for a fee at a number of online companies
offering assessment tools, one of which is Healthcare Technology Systems at
http://www.healthtechsys.com/ivr/assess/ivrybocs.html
There is also a free online version which is shorter and less detailed available at many websites,
one of which is Brain Physics Mental Health Resource at
http://www.brainphysics.com/ybocs.php
A children’s version is also available (CY-BOCS) at many websites, one of which is
Massachusetts General Hospital School Psychiatry Program
http://www.massgeneral.org/schoolpsychiatry/screening_ocd.asp
17. Published research studies
Study I “Relationship between obsessive–compulsive symptoms and smoking habits amongst
schizophrenic patients”
Researchers knew that patients with schizophrenia and schizoaffective disorder have a high
rate of smoking cigarettes and patients with obsessive-compulsive disorder smoked less than the
general population. Patients with schizophrenia and schizoaffective disorder have a higher rate
of obsessive-compulsive disorder symptoms. In this study, researchers hypothesized that
patients with schizophrenia and schizoaffective disorder who have obsessive–compulsive
symptoms will
have lower smoking rates than patients without obsessive–compulsive symptoms. Researchers
used the Y-BOCS to assess obsessive-compulsive symptoms in this study. In a sample of 100
patients, two groups were formed. Group 1 consisted of patients who scored lower than a 16 on
the Y-BOCS and Group 2 consisted of patients who scored 16 or more on the Y-BOCS.
Findings of the study showed there was no real correlation in obsessive–compulsive symptoms
and smoking when it came to patients with schizophrenia and schizoaffective disorder.
Study II “Addition of cognitive-behavior therapy for cognitive-behavior therapy patients nonresponding to fluoxetine”
In this study, researchers wanted to verify that when fluoxetine was not successful alone to
treat obsessive-compulsive disorder that cognitive-behavior therapy would help treat severe
obsessive-compulsive disorder along with fluoxetine. Fifty-six patients were treated with
fluoxentine alone for 12 weeks. Fourteen of the 56 patients were considered non-responders due
to a reduction of less than 25% on the Y-BOCS. The 14 patients went through an additional
twelve weeks of cognitive-behavior therapy. Of the 14 patients, a mean reduction of symptoms
declined 8.5% on the Y-BOCS after the first twelve week phase and a mean reduction of 41% on
50
the Y-BOCS after the second twelve week phase. Thus, the study reconfirmed that cognitivebehavior therapy is helpful to reduce symptoms of severe obsessive-compulsive disorder along
with fluoxentine.
References
Dome, P., Teleki, Z., Gonda, X., Gaszner, G., Mandl, P., & Rihmer, Z. (2006). Relationship
between obsessive-compulsive symptoms and smoking habits amongst schizophrenic
patients. Psychiatry Research, 144(2-3), 227-231. Retrieved March 17, 2007 from the
Academic Search Premier database.
Frost, R.O., Steketee, G., Krause, M. S., & Trepanier, K. L. (1995). The relationship of the
yale-brown obsessive-compulsive scale (YBOCS) to other measures of obsessivecompulsive symptoms in a nonclinical population [Electronic version]. Journal of
Personality Assessment, 65, 158-168. Retrieved March 30, 2007, from
http://www.leaonline.com/doi/abs/10.1207/s15327752jpa6501_12
Goodman W.K., Price L.H., Rasmussen S.A., Mazure C., Fleischman R.L., Hill C.L., Heninger
G.R., Charney D.S. (1989). The Yale-Brown Obsessive Compulsive Scale, I:
development, use, and reliability [Electronic version]. Arch Gen Psychiatry, 48, 10061011.
Goodman W.K., Price L.H., Rasmussen S.A., Mazure C., Delgado P., Heninger G.R., Charney
D.S. (1989). The Yale-Brown Obsessive Compulsive Scale, II: validity [Electronic
version]. Arch Gen Psychiatry, 46, 1012-1016.
Jha, S. K. (2004, August 19). OCD scale; CNS forum by the lundbeck institute. Retrieved
April 1, 2007 from http://www.cnsforum.com/clinicalresources/ratingscales/
ratingpsychiatry/ocd/#YBOCS
Kampman, M., Keijsers, G., Hoogduin, C., & Verbraak, M. (2002). Addition of cognitivebehaviour therapy for obsessive-compulsive disorder patients non-responding to
fluoxetine. Acta Psychiatrica Scandinavica, 106(4), 314-319. Retrieved March 17, 2007
from the Academic Search Premier database.
Stanford School of Medicine. (n.d.) OCD assessment instruments. Obsessive-compulsive and
related disorders research program. Retrieved April 1, 2007, from
http://ocd.stanford.edu/about/diagnosis.html
51
Section II
Other Inventories
52
Defensive and Supportive Communication
Interaction Coding System
Purpose: This assessment examines eight behavior types within a family-four
representing the defensiveness construct (judgmental-dogmatism, control-strategy, indifference,
superiority) and four types that represent supportiveness construct (genuine information
seeking/giving, spontaneous problem solving, empathic understanding, equality). The frequency
and reciprocity of defensive and supportive family interactions are scored as indicators of family
adaptiveness (a behavior is coded every 10 seconds for each family member).
Population: The basis for this assessment assumes that inappropriate behavior of
children correlates with the atmosphere of their family. This assessment allows the therapist to
discover if a home environment provides a defensive or supportive atmosphere. It is appropriate
in family therapy for families with children with behavioral problems.
Reliability: Interrater reliability ranges from .83-1.00.
Validity: There was an inverse correlation found between child aggressiveness and father
supportiveness (r=-.41). Mother to child defensiveness correlated positively with child’s
aggression (r=.63, p<.05). Total family defensiveness and child aggression correlation was r=.20.
No Sample Items Available
Alexander, F. J. (1973). Defensive and supportive communication in family systems.
Journal of Marriage and the Family, 35(4), 613-717.
Grotevant, H. D., & Carlson, C. I. (1987). Family interaction coding systems: A
descriptive review. Family Process, 26, 49-74.
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53
Children's Depression Scale
Purpose: This assessment is used to measure depression in children, as well as providing
sub-scales of depressive symptomatology. The sub-scales are:
Depressive sub-scales (D):
1) Affective Response –AR (feeling, state, mood of respondent – 8 items)
2) Social Problems – SP (social interaction, loneliness, isolation – 8 items)
3) Self-Esteem – SE (attitudes and concepts in relation to own worth and value – 8 items)
4) Preoccupation with Sickness and Death – SD (7 items)
5) Guilt – GL (self-blame – 8 items)
Miscellaneous D Items – MD (9 items)
Positive sub-scales (P):
1) Pleasure and Enjoyment – PE (fun, enjoyment, happiness – 8 items)
Miscellaneous P Items – MP (10 items)
Population: The CDS was devised for use with children and adolescents ranging in age
from 9-16 years old, and purports to measure depression in children, as well as providing subscales of depressive symptomatology. The revised edition includes a format for parents, siblings,
teachers, or significant others
Reliability: Internal consistency ranged from .82-.97. Test-retest is .74.
Validity: Significant correlations (p<.001) were reported with regard to psychiatric
diagnoses as a criterion for validity, obtained by experienced clinicians who knew the subject via
detailed case histories and discussion with colleagues. The depressive scale and positive scale
correlated well negatively (r=-.53), but the sub-scales of the CDS are not well supported in the
literature. Comparisons of the CDS and CDI have yielded correlations of 0.48, 0.76, and 0.84.
No Sample Items Available due to copyright.
information retrieved from
http://www.swin.edu.au/victims/resources/assessment/affect/cds.html
on March 23, 2006
54
Alcohol Use Inventory (AUI)
Purpose: This test provides a basis for describing different ways in which individuals use
alcohol, the benefits they derive from such use, the negative consequences associated with its
use, and the degree of concern individuals express about the use of alcohol and its consequences.
Population: The AUI test can be used by psychologists, social workers, chemical
dependency counselors, and physicians to help assess anyone over 16 years old that may have
problems with alcohol use.
Reliability/Validity: Not available.
Sample Items: No items available; general information about test items are questions
about duration and frequency of use of alcohol, and reported use and perceived problems with
drugs.
Retrieved on April 12, 2006 from
http://www.pearsonassessments.com/tests/aui.htm#scales
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55
Family Environment Scale
Purpose: The Family Environment Scale (FES) was developed to measure social and
environmental characteristics of families. The scale is based on a three-dimensional
conceptualization of families. Additionally, three separate forms of the FES are available that
correspondingly measure different aspects of these dimensions. The Real Form (Form R)
measures people’s perceptions of their actual family environments, the Ideal Form (Form I)
rewords items to assess individuals’ perceptions of their ideal family environment, and the
Expectations Form (Form E) instructs respondents to indicate what they expect a family
environment will be like under, for example, anticipated family changes.
Population: Members of a family/used to study family systems.
Reliability: Internal consistency reliability estimates for the Form R subscales range
from .61 to .78. Intercorrelations among these 10 subscales range from -.53 to .45. These data
suggest that the scales are measuring relatively distinct characteristics of family environment and
with reasonable consistency. Test-retest reliabilities for the Form R subscales for 2-month, 3month, and 12-month intervals range from .52 to .91. These estimates suggest that the scale is
reasonably stable across these time intervals.
Validity:. The face and content validity of the instrument are supported by clear
statements about family situations that relate to subscale domains. Evidence of construct validity
is presented in the manual through comparative descriptions of distressed and normal family
samples; comparisons of parent responses with those of their adolescent children; descriptions of
responses by families with two to six or more members; and descriptions of families with a
single parent, of minority families, and of older families. Additional validity evidence is
provided in the manual through summaries or references to approximately 150 additional
research studies.
Sample Items :
Real Form
Family members really help and support one another T F
Family members often keep their feelings to themselves T F
Ideal Form
Family members will really help and support one another T F
Family members will often keep their feelings to themselves T F
04/25/06 Retrieved from http://www.cps.nova.edu/~cpphelp/FES.html
04/25/06 Retrieved from http://www.mindgarden.com/products/fescs.htm
56
Revised Dyadic Adjustment Scale
Purpose: This is a frequently used instrument used to measure adjustment in
relationships.
Population: Couples.
Reliability: Cronbach’s alpha=.90; Guttman’s Split-half=.94, Spearman-Brown SplitHalf=.95.
Validity: Crieterion validity was measured by comparing the RDAS to similar tests, such
as the correlation coefficient between the RDAS and the MAT was .66 (p<.01); construct
validity was established by comparing the RDAS with previous studies using the DAS, in which
the correlation was .97 (p<.01).
Sample Items: 1-4 Likert Scale (Idisagree/I agree)
1. It feels relaxing and good to be close to someone.
2. I often worry that my partner doesn’t love me.
3. I find others reluctant to get as close as I would like.
Busby, D. M., Christensen, C., Crane, R., & Larson, J. H. (1995). A revision of the
Dyadic Adjustment Scale for use with distressed and nondistressed couples:
Construct hierarchy and multidimensional scales. Journal of Marital and
Family Therapy, 21(3), 291-308.
Hollist, C. S., Miller, R. B. (2005). Perceptions of attachment style and marital quality
in midlife marriage. Family Relations, 54, 46-57.
Outcome questionnaire (OQ-45)
Purpose: Three subscales representing broad content areas are assessed: (1) symptom
distress, (2) interpersonal relations, and (3) social role (dissatisfaction and distress in tasks
related to work, family roles, and leisure life). Assets of the OQ-45 include: (1) it provides
multidimensional measures of key functional and symptomatic areas, (2) it is broadly applicable
across ages, diagnoses, treatment modalities and clinician orientations, (3) it was designed for
repeat administration during and after treatment, (4) it has been shown to be sensitive to change
in symptoms and functioning that result from behavioral health treatments, (5) tracking alerts can
be provided that compare patient progress to recovery curves of similar patients, taking into
consideration the patient's initial status on the OQ-45, the number of treatment sessions the
patient has received, and the direction and amount of change.
Population: This is generally used for clinical outcomes assessment, used for adults in
treatment.
Reliability/Validity: The psychometric characteristics of the OQ-45 are very sound. The
internal consistency (Cronbach's alpha) of this total score has been reported to be .93 and testretest reliability is .84. The total score also correlates highly with other measures of symptoms,
interpersonal functioning, and social adjustment.
Sample Items: None available.
Retrieved on 04/26/06 from
http://www.bpsys.org/PMTools.html
57
Marital Satisfaction Inventory
Purpose: Widely used to assess the nature and extent of conflict within a marriage or
relationship and to help couples communicate hard-to-express feelings. Assesses the following
dimensions of a relationship: affective communication, role orientation, problem-solving
communication, aggression, family history of distress, time together, dissatisfaction with
children, disagreement about finances, conflict over child rearing, sexual dissatisfaction, global
distress.
Population: Couples who are married or have been living together for at least six
months.
Reliability: Internal consistency ranges from .80-.97. Test-retest ranges from .84-.94.
Validity: Validation studies generally indicate high correlations with other measures
of marital satisfaction for scales from the MSI that purport to measure general satisfaction.
Sample Items : (T/F)
There is never a moment I don’t feel “head over heels” in love with my mate.
My marriage has been disappointing in several ways.
My spouse doesn’t take me seriously enough sometimes.
My spouse sometimes shows too little enthusiasm for sex.
I was very anxious as a young person to get away from my family.
Having children has not brought all the satisfactions I hoped it would.
Minor disagreements with my spouse often end up in big arguments.
My spouse and I don’t have much in common to talk about.
It is hard to discuss finances without getting upset with each other.
Snyder, D. K. (1979). Multidimensional assessment of marital satisfaction. Journal of
Marriage and the Family, 45, 813-823.
and other information retrieved 04/27/06 from
https://www3.parinc.com/products/product.aspx?Productid=MSI-R
http://www.drmillslmu.com/Testing/SPR2000/msi.htm
58
Parent-Adolescent Communication Scale
Purpose: This 20 item, 5-point Likert-type scale is composed of two subscales which
measure degree of openness and extent of problems in family communication. This scale is often
used in conjunction with the Family Adaptability and Cohesion Evaluation Scales (FACES)
according to the Circumplex Model of Marital and Family Systems.
Population: Adolescents and their primary caregivers.
Reliability: Alpha reliabilties for each subscale are .87 and .78; test-retest reliabilties are
.78 and .77.
Scale items for adolescents:
1. I would be embarrassed talking to my mother about sex and birth control.
2. My mother would not want to answer my questions about sex and birth control.
3. My mother would only lecture me if I tried to talk to her about sex and birth control.
4. I don't need to talk to my mother about sex and birth control; I know what I need to
know.
5. My mother doesn't know enough for me to want to talk with her about sex and birth
control.
6. My mother would not be honest with me if I talked with her about sex and birth control.
7. My mother is too old to be able to relate to me about sex and birth control.
8. I would only make my mother suspicious of me if I tried to talk to her about sex and birth
control.
9. It would be difficult to find a convenient time and place to talk to my mother about sex
and birth control.
10. My mother is just too busy to talk to me about sex and birth control.
11. My mother would ask me too many personal questions if I tried to talk with her about sex
and birth control.
12. My mother doesn't want to hear what I have to say when it comes to sex and birth
control.
13. My mother and I would only argue if we were to talk about sex and birth control.
14. My mother would be embarrassed talking to me about sex and birth control.
15. I would have a difficult time being honest about my behavior with my mother if we were
to talk about sex and birth control.
16. My mother would get angry if I tried to talk to her about sex and birth control.
Scale items for mothers or caregivers.
1. I really don't know enough about sex and birth control to talk about it with my son.
2. It would embarrass me to talk about sex and birth control with my son.
3. It would embarrass my son to talk with me about sex and birth control.
4. My son would not take me seriously if I tried to talk with him about sex and birth control.
5. It would be difficult for me to explain things it I talked with my son about sex and birth
control.
59
6. My son will get the information somewhere else, so I don't really need to talk with him
about sex and birth control.
7. It wouldn't do much good if I talked with my son about sex and birth control.
8. I don't need to talk with my son about sex and birth control; he knows what he needs to
know.
9. My son would not be honest with me if I talked with him about sex and birth control.
10. My son will think that I do not trust him if I try to talk to him about sex and birth control.
11. It would be difficult to find a convenient time and place to talk to my son about sex and
birth control.
12. My son is just too busy to talk to me about sex and birth control.
13. My son would ask me too many personal questions if I tried to talk with him about sex
and birth control.
14. My son does not want to hear what I have to say when it comes to talking about sex and
birth control.
15. My son and I would only argue if we were to try and talk about sex and birth control.
16. I would have a difficult time being honest about my behavior with my son if we were to
talk about sex and birth control.
17. My son would think that I was nosy if I tried to talk to him about sex and birth control.
18. If I talked about sex and birth control with my son, he might ask me something I don't
know the answer to.
19. If I talked to my son about sex and birth control, he would think I approve of him having
sex.
20. Talking about birth control with my son will only encourage him to have sex.
21. My son would just make fun of me if I tried to talk with him about sex and birth control.
Retrieved 03/27/06 from http://www.nncc.org/Evaluation/topic2.html and
http://chipts.ucla.edu/assessment/Assessment_Instruments/Assessment_files_new/assess_pacj.ht
m

60
Interpersonal Communication Inventory
Purpose: This 50 item, 3-point Likert type self-inventory was developed to measure the
process of communication as an element of social interaction. It is intended to identify not
content, but patterns, characteristics, and styles of communication. Such areas as the ability to
listen, to empathize, to understand, to deal with angry feelings, and to express oneself are
explored.
Population: Individuals high-school age or older.
Reliability/Validity: Face validity by a panel of sociologists, psychologists and
specialists in the field of human relations. Evidence of discriminant validity.
Sample Items:
Retrieved 04/27/06 from
http://www.nncc.org/Evaluation/topic2.html
Eyberg Child Behavior inventory
Purpose: The Eyberg Child Behavior Inventory (ECBI), designed to assess parental
report of conduct behavioral problems in children and adolescents ages 2-16, measures the
number of difficult behavior problems and the frequency with which they occur. Studies have
indicated that the ECBI has good reliability and validity. The instrument takes five minutes to
complete and five minutes to score.
Population: Age Range: 2 through 16 years old
Reliability: Test-retest ranges from .86-.88. Inter-rater ranges from .79-.86. Internal
consistency ranges from .88-.95.
Validity: Criterion validity was assessed and found to be acceptable.
Sample Items:
This assessment asks parents to rate their children’s behaviors as to how
frequently they occur and whether the parents perceive them to be problematic.
Retrieved 04/27/06 from
http://vinst.umdnj.edu/VAID/TestReport.asp?Code=ECBI
61
Behavioral and Emotional Rating Scale
Purpose: The Behavioral and Emotional Rating Scale (BERS) helps to measure the
personal strengths of children. It measures five aspects of a child's strength: interpersonal
strength, family involvement, intrapersonal strength, school functioning, and affective strength.
The scale can be completed by teachers, parents, counselors, or other persons knowledgeable
about the child. Information from the BERS is useful in evaluating children for prereferral
services and placing children for specialized services. It can be used in schools, mental health
clinics, and child welfare agencies.
Population: Children ages 5 through 18.
Reliability: Test-retest ranges from .85-.89. Inter-rater ranges from .83-.88. Internal
consistency ranges from .77-.99.
Validity: Three studies were conducted to determine the concurrent validity of the BERS. For
each study, teachers of students with emotional or behavioral disorders completed the BERS and
the Teacher Report Form (Achenbach, 1991) (N=83), a measure of emotional and behavioral
problems; the Self-Perception Profile for Children (Harter, 1985) (N=78), a measure of
children's global self-esteem; or the Walker-McConnell Scale of Social Competence and School
Adjustment (Walker & McConnell, 1998) (N=71), a measure of social skills and social
competence. Correlational analyses indicated a moderate to high relationship between the BERS
and these three other measures.
Construct validity was determined by comparing the mean standard scores of the two groups of
students used to norm the BERS (NEBD and EBD). Overall, children and adolescents with
emotional and behavioral disorders scored one standard deviation lower than the children
without disabilities. For each of the subscales and overall strength quotient, the results of the
analyses indicated that these differences were statistically significant. No data are presented for
cross-group validation with new groups of students who were not used to establish the BERS
norms, which is a serious omission, given the probable attenuation.
Sample Items: The first area, Interpersonal Strength has 14 items (e.g., accepts criticism,
accepts responsibility for own actions) that assess a child’s ability to interact with others in social
situations. Family Involvement includes 10 items (e.g., trusts a significant person in his or her
life, participates in family activities) that measure a child’s relationship with or commitment to
his or her family. Intrapersonal Strength has 11 items (e.g., talks about the positive aspects of
life, identifies personal strength) that focus in a general way on how a child perceives his or her
own functioning. School Functioning includes 9 items (e.g., completes school tasks on time,
attends school regularly) that assess a child’s performance and competence in school. Affective
Strength includes 7 items (e.g., shows concern for the feelings of others, expresses affection for
others) that measure a child’s ability to give affection to and receive affection from others.
Retrieved 04/27/06 from
http://vinst.umdnj.edu/VAID/TestReport.asp?Code=BERS
and
http://www.nasponline.org/publications/cq287Test.html
62
Child Behavioral Checklist
Purpose: designed to address the problem of defining child behavior problems
empirically. It is based on a careful review of the literature and carefully conducted empirical
studies. It is designed to assess in a standardized format the behavioral problems and social
competencies of children as reported by parents.
Population: children with behavioral problems.
Reliability: Individual item intraclass correlations (ICC) of greater than .90 were
obtained "between item scores obtained from mothers filling out the CBCL at 1-week intervals,
mothers and fathers filling out the CBCL on their clinically-referred children, and three different
interviewers obtaining CBCLs from parents of demographically matched triads of children."
Stability of ICCs over a 3-month period were .84 for behavior problems and .97 for social
competencies. Test-retest reliability of mothers’ ratings were .89. Some differences were found
between mothers’ and fathers’ individual ratings.
Validity: Several studies have supported the construct validity of the instrument.
Tests of criterion-related validity using clinical status as the criterion (referred/non-referred) also
support the validity of the instrument. Importantly, demographic variables such as race and SES
accounted for a relatively small proportion of score variance.
Sample Items: Not available.
Retrieved 04/27/06 from
http://cps.nova.edu/~cpphelp/CBCL.html and
http://www.pubpol.duke.edu/centers/child/fasttrack/techrept/c/cbc/cbc8tech.pdf
63
Adult Nowicki scale
Purpose: This assessment measures locus of control. People who believe that an
outcome is largely contingent upon their own behaviour are seen as having a more internal locus
of control, whereas those who believe that luck, fate, chance or powerful others largely
determine an outcome are considered to be more external. Measures of internality and externality
have been shown to be associated with a number of different factors, including academic
achievement, psychological well-being and beliefs
Population: Adults.
Sample Items: the adult version of the Nowicki-Strickland Internal-External locus of
control scales. The ANSIE (Nowicki & Duke 1974) comprises 40 items in a yes/no format which
assess perceived control (e.g. ‘Do you believe that whether or not people like you depends on
how you act?’ and ‘Do you believe that when bad things are going to happen they are just going
to happen no matter what you try to do to stop them?).
Retrieved 04/27/06 from
http://www.alspac.bris.ac.uk/protocol/Appendix%204_files.htm#locus_of_control
64
Depression Anxiety Stress Scale 42
Psychometric Properties of the Depression Anxiety Stress Scale 42 (DASS). The DASS is a
42 item self-report inventory that yields 3 factors: Depression; Anxiety; and Stress. This measure
proposes that physical anxiety (fear symptomatology) and mental stress (nervous tension and
nervous energy) factor-out as two distinct domains. This screening and outcome measure reflects
the past 7 days. Gamma coefficients that represent the loading of each scale on the overall factor
(total score) are .71 for depression, .86 for anxiety, and .88 for stress. One would expect anxiety
and stress to load higher than depression on the common factor as they are more highly
correlated and, therefore, dominate the definition of this common factor (Lovibond and
Lovibond, 1995). Reliability of the three scales is considered adequate and test-retest reliability
is likewise considered adequate with .71 for depression, .79 for anxiety and .81 for stress (Brown
et al., 1997). Exploratory and confirmatory factor analyses have sustained the proposition of the
three factors (p < .05; Brown et al., 1997). The DASS anxiety scale correlates .81 with the Beck
Anxiety Inventory (BAI), and the DASS Depression scale correlates .74 with the Beck
Depression Scale (BDI).
Retrieved 04/26/06 from
http://www.swin.edu.au/victims/resources/assessment/affect/dass42.html
65
Novaco Anger Inventory
Psychometric Properties of The Novaco Anger Inventory - Short Form. The Novaco Anger
Inventory - short form, was adapted from the long form (Novaco, 1975) and contains 25 of the
original 90 items. The NAI - Long Form - purports to measure the degree of provocation or
anger people would feel if placed in certain situations. This scale displays a convergent validity
of .46 with the Buss-Durke Hostility Inventory, and .41 with the Aggression subscale of the
Personality Research Form (Huss, Leak and Davis, 1993) as well as a test-retest reliability of
between .78 and .91 (Mills, Kroner and Forth, 1998). In order to ascertain the validity of the
Short Form a factor analysis was applied to the current full data set at intake (N = 207) and 4
factors with an eigenvalue above 1.00 were derived. However one factor derived an eigenvalue
of 12.62 and accounted for over 50% of the variance. Only one item had a higher factor loading
on any of the factors other than factor one. The factor loadings for factor one ranged between .53
and .79, with an average loading of .71. It is suggested that this scale, therefore, reliably only
consists of one factor (anger). A Cronbach’s alpha of .96 was derived for the scale with an
average inter-item correlation of .49, an item-total correlation of between .50 and .77, and a splithalf reliability of .93. No test-retest reliability is available at this time.
Retrieved 04/27/05 from http://www.swin.edu.au/victims/resources/assessment/affect/nai25.html
66
Obsessive Compulsive Inventory
A new self-report inventory for determining the diagnosis and overall severity of obsessivecompulsive disorder (OCD), and yields a profile of frequency and distress for each symptom
class. Intended to be applicable to the general population in assessing subclinical obsessional
thoughts and behaviours. Full scales and most subscales have satisfactory internal consistency.
The alpha coefficients of the full scale for each group were all high (range .86 to .95), indicating
the distress and frequency items within each subscale converge on a common construct.
Regarding the subscales - All but 6 of the 56 coefficients exceeded .70.
Content Validity: Foa, Kozak and Salkovskis formulated the original item pool. Seven
subscales were constructed to represent the major symptoms of OCD as found in DSM-IV (APA,
1994) field trial for OCD (Foa et al., 1995). Convergent Validity: The Y-BOC, MOCI, and
CAC were used to assess the convergence of the OCI with existing measures of OCD. The OCI
correlates well with other measures of OCD symptoms and distinguishes individuals with OCD
from those with other anxiety disorders and controls. Positive correlations of the OCI total score
with the total scores of the MOCI and the CAC. These findings suggest that athough the OCI
assesses a wider range of OCD symptoms than other OCD questionnaires, this does not
compromise reliability in assessing OCD severity. The Washing and Checking subscales of the
MOCI are also positively correlated. Discriminant Validity: Measures used to assess the
divergence of the OCI from measures of depression (BDI and HAM-D), severity of anxiety
(BAI), and state and trait anxiety (STAI).
Retrieved 04/27/06 from
http://www.swin.edu.au/victims/resources/assessment/affect/oci.html

67
Thought Control Questionnaire
The Thought Control Questionnaire (TCQ) is a 30-item instrument devised by Adrian Wells and
Mark I. Davies (1994) to assess the effectiveness of strategies used for the control of unpleasant
and unwanted thoughts.
Reliability
Internal Consistency of subscales: The Cronbach Alpha scores (n = 229) obtained for
the subscales were as follows: Distraction = .72; Social Control = .79; Worry = .71;
Punishment = .64; Re-appraisal = .67. As a .8 alpha score indicates high internal
reliability, the scores obtained suggest fair to good internal consistency. This means that
individual items did relate to the entire sub-scale The alpha for the total score was not
reported.
Subscale inter-correlations: The correlations between individual subscales ranged from
r = -0.02 to r = 0.27. With the highest correlation being between the punishment and
worry sub-scales (r=0.27). However, as the co-efficients were generally low it suggests
that each sub-scale is measuring a distinctly different dimension.
Test-Retest Reliability: At six-weeks apart the test-retest correlations ranged from .67 to
.83 for the subscales. With the total score being .83, indicating that it is a stable measure.
Validity
Predictive Validity: The TCQ scores were correlated with scores on a variety of other measures.
There were 50 subjects, 18 of whom were males. Their age range was 22-43 years. The
measures selected were: Padua Inventory, The Anxious Thoughts Inventory Self-consciousness
scale, Penn State Worry Questionnaire, The Eysenck Personality Inventory and the Spielberger
Trait anxiety subscale. The results were consistent with the prediction that a relationship existed
between dimensions of thought control and perceived impaired control of thought . Furthermore
significant correlations were obtained with neuroticism, public self-consciousness and traitanxiety. The total score specifically taps into control strategies associated with intrusive thoughts
rather than urges and impulses (Wells & Davies, 1994).
Retrieved 04/27/06 from
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