Claudio Sica

Psychometric validation of the Obsessive Beliefs Questionnaire and the Interpretation of Intrusions Inventory: Part I

This article reports on the validation of the Obsessive Beliefs Questionnaire (OBQ) and Interpretations of Intrusions Inventory (III) developed by the Obsessive Compulsive Cognitions Working Group (OCCWG) to assess the primary beliefs and appraisals considered critical to the pathogenesis of obsessions. A battery of questionnaires that assessed symptoms of anxiety, depression, obsessive-compulsive symptoms and worry was administered to 248 outpatients with a DSM-IV diagnosis of Obsessive-Compulsive Disorder (OCD), 105 non-obsessional anxious patients, 87 non-clinical adults from the community, and 291 undergraduate students. Tests of internal consistency and test-retest reliability indicated that the OBQ and III assessed stable aspects of OC-related thinking. Between-group differences and correlations with existing measures of OC symptoms indicated that the OBQ and III assess core cognitive features of obsessionality. However, the various subscales of the OBQ and III are highly correlated, and both measures evidenced low discriminant validity. The findings are discussed in terms of the relevance and specificity of cognitive constructs like responsibility, control and importance of thoughts, overestimated threat, tolerance of uncertainty and perfectionism for OCD.

The development of a short form of the EMBU: Its appraisal with students in Greece, Guatemala, Hungary and Italy

Abstract Out of the necessity of having an abbreviated form of the EMBU, a measure of perceived parental rearing behaviour, a short form (s-EMBU) consisting of three scales (rejection, emotional warmth and protection) with, respectively, 7, 6 and 9 items (plus 1 unscaled item) was developed from the original 81-item version. The factorial and/or construct validity and reliability of this s-EMBU were examined among samples of 2373 students from Italy, Hungary, Guatemala and Greece. The data were presented for the four national groups separately. The 23-item s-EMBU is recommended as a reliable functional equivalent to the 81-item early EMBU. Attention was drawn to the need for further research to explain some of the observed cross-national differences in the correlations between parental rearing styles and personality.

Religiousness and obsessive-compulsive cognitions and symptoms in an Italian population

Fifty-four individuals with a high degree of religiosity, 47 with a medium degree of religiosity and 64 with low religiosity completed anonymously the Italian versions of well-established measures of obsessive-compulsive (OC) cognitions and symptoms, depression and anxiety. After controlling for anxiety and depression, religious groups scored higher than individuals with a low degree of religiosity on measures of obsessionality, overimportance of thoughts, control of thoughts, perfectionism and responsibility. Moreover, measures of control of thoughts and overimportance of thoughts were associated with OC symptoms only in religious subjects. It is concluded that religion might play a role in obsessive-compulsive disorder phenomenology. Additional research is warranted because it is plausible that only a few aspects of religious teachings (e.g., inflexibility and prohibition) are linked to OC phenomena.

Coping strategies: Evidence for cross-cultural differences? A preliminary study with the Italian version of coping orientations to problems experienced (COPE)

Abstract The internal structure of the COPE inventory (Carver, Scheier & Weintraub, 1989), a questionnaire which measures 15 different coping strategies, was studied. The Italian version of COPE was administered to 521 undergraduate students. Alpha and test-retest reliabilities were very similar to those obtained in the above American study. A rotated factor analysis resulted in 13 factors, which came out in a different order with respect to those obtained in the original study. A second-order factor analysis yielded five factors similar to those obtained by Carver etal., except for ‘Turning to religion’, which was present in the Italian study only. It is concluded that the Italian version of COPE has good construct validity and that the traditional taxonomy of coping strategies should also be studied in the light of transcultural differences.

Predicting Burnout Among HIV/AIDS and Oncology Health Care Workers

Psychological stress and coping strategies in staff working with AIDS and with cancer patients were assessed using self-report methods. The Maslach Burnout Inventory (MBI), Coping Orientations to Problems Experiences (COPE), State-Trait Anxiety Inventory (STAI) and Depression Questionnaire (DQ) were completed by staff from 20 hospitals of North-Center Italy, including 268 doctors and nurses working with people with AIDS and 260 doctors and nurses working in oncology. Few significant differences were found between two units on the MBI, COPE subscale and depression/anxiety. When a Bonferroni corrected p level of p < 0.0025 was used, the difference on Emotional Exhaustion (EE) subscale of MBI still remained statistically significant, indicating greater exhaustion in the oncology staff. The regression analysis suggested that the negative aspects of burnout were predicted primary by professional status (being a doctor), type of unit (oncology), depression and the use of the humor as a coping strategy. In contrast personal accomplishment was better predicted by positive coping strategies (i.e. planning, restraint coping, non-denial) and low level of anxiety.

The Italian version of the Obsessive Compulsive Inventory: Its psychometric properties on community and clinical samples

The aim of the study was to evaluate psychometric properties of the Obsessive Compulsive Inventory (OCI) on Italian community and clinical samples. The Italian version of the 42-item OCI was administered to a sample of 340 individuals belonging to the general population and to 88 patients with obsessive compulsive (OCD) or other anxiety disorders. Four different internal structures of the OCI were compared through confirmatory factor analysis (CFA): the figures for the model with six factors and 18 items (OCI-R) met the best criteria for adequacy of fit. The six scales showed on average a 10% of common variance in the community sample and 8% in the clinical sample. The OCI-R subscales showed good internal consistency and temporal stability, with the exception of washing and mental neutralizing subscales which showed a strong alpha coefficient only in the OCD sample. Psychometric data for the OCI-R were insensitive to age and sex, whereas an effect of education was found. Concurrent validity was demonstrated, since the OCI-R subscales showed a pattern of specific correlations with another conceptually related self-report measure. Moreover, although the OCI-R was positively correlated with measures of depression, anxiety, and worry, the correlations were weaker than those with the other measure of OCD symptoms. The OCI-R clearly differentiated OCD patients from non-OCD anxious patients and nonclinical controls with the exception of hoarding subscale. However, the hoarding scale discriminated OCD patients who presented hoarding symptoms from OCD counterparts without such symptoms. Thus, the OCI-R proved to be a reliable and valid measure of obsessive compulsive symptoms in the Italian context.

Posttraumatic Stress Disorder and Chronic Pain Arising from Motor Vehicle Accidents: Efficacy of Interoceptive Exposure Plus Trauma-Related Exposure Therapy

Preliminary data are presented on the pattern of treatment response of combining interoceptive exposure (IE) with trauma-related exposure therapy (TRE) in five female patients with posttraumatic stress disorder (PTSD) and comorbid chronic musculoskeletal pain originating from motor vehicle accidents. Treatment consisted of four sessions of IE followed by eight sessions of TRE. Four participants reported a reduction in PTSD symptoms after completing treatment, and three no longer met diagnostic criteria for PTSD. Although both interventions were associated with reductions in PTSD symptoms, TRE was associated with greater reductions in PTSD symptoms than IE and was particularly effective at reducing avoidance. IE was associated with larger reductions in anxiety sensitivity than TRE. Pain symptoms lessened slightly during IE and then worsened following TRE. Anxiety decreased after completing treatment, whereas panic and depressive symptoms responded less so. Three individuals completed a 3-month follow-up assessment. There was no change in their PTSD diagnostic status, and all experienced a slight loss of pre–post gains, particularly involving the return of pain. Clinical and research implications are discussed.

The Italian version of the Depression Anxiety Stress Scales-21: Factor structure and psychometric properties on community and clinical samples

OBJECTIVE The Depression Anxiety Stress Scales-21 (DASS-21) is the short version of a self-report measure that was originally developed to provide maximum differentiation between depressive and anxious symptoms. Despite encouraging evidence, the factor structure and other features of the DASS-21 are yet to be firmly established. METHOD A community sample of 417 participants and two clinical groups (32 depressive patients and 25 anxious patients) completed the Italian version of the DASS-21 along with several measures of psychopathology. RESULTS Confirmatory factor analyses suggested that the DASS-21 is a measure of general distress plus three additional orthogonal dimensions (anxiety, depression, and stress). The internal consistency and temporal stability of the measure were good; each DASS-21 scale correlated more strongly with a measure of a similar construct, demonstrating good convergent and divergent validity. Lastly, the DASS-21 demonstrated good criterion-oriented validity. CONCLUSION The validity of the Italian DASS-21 and its utility, both for community and clinical individuals, are supported.

Phobic anxiety in 11 nations. Part I: Dimensional constancy of the five-factor model

The Fear Survey Schedule-III (FSS-III) was administered to a total of 5491 students in Australia, East Germany, Great Britain, Greece, Guatemala, Hungary, Italy, Japan, Spain, Sweden, and Venezuela, and submitted to the multiple group method of confirmatory analysis (MGM) in order to determine the cross-national dimensional constancy of the five-factor model of self-assessed fears originally established in Dutch, British, and Canadian samples. The model comprises fears of bodily injury-illness-death, agoraphobic fears, social fears, fears of sexual and aggressive scenes, and harmless animals fears. Close correspondence between the factors was demonstrated across national samples. In each country, the corresponding scales were internally consistent, were intercorrelated at magnitudes comparable to those yielded in the original samples, and yielded (in 93% of the total number of 55 comparisons) sex differences in line with the usual finding (higher scores for females). In each country, the relatively largest sex differences were obtained on harmless animals fears. The organization of self-assessed fears is sufficiently similar across nations to warrant the use of the same weight matrix (scoring key) for the FSS-III in the different countries and to make cross-national comparisons feasible. This opens the way to further studies that attempt to predict (on an a priori basis) cross-national variations in fear levels with dimensions of national cultures.

Masculinity-femininity as a national characteristic and its relationship with national agoraphobic fear levels: Fodor's sex role hypothesis revitalized

Hofstedes dimension of national culture termed Masculinity-Femininity [. Cultures and organizations: software of the mind. London: McGraw-Hill] is proposed to be of relevance for understanding national-level differences in self-assessed agoraphobic fears. This prediction is based on the classical work of Fodor [. In: V. Franks & V. Burtle (Eds.), Women in therapy: new psychotherapies for a changing society. New York: Brunner/Mazel]. A unique data set comprising 11 countries (total N=5491 students) provided the opportunity of scrutinizing this issue. It was hypothesized and found that national Masculinity (the degree to which cultures delineate sex roles, with masculine or tough societies making clearer differentiations between the sexes than feminine or modest societies do) would correlate positively with national agoraphobic fear levels (as assessed with the Fear Survey Schedule-III). Following the correction for sex and age differences across national samples, a significant and large effect-sized national-level (ecological) r=+0.67 (P=0.01) was found. A highly feminine society such as Sweden had the lowest, whereas the champion among the masculine societies, Japan, had the highest national Agoraphobic fear score.