Edward S. Kubany

Content Validity in Psychological Assessment: A Functional Approach to Concepts and Methods

This article examines the definition, importance, conceptual basis, and functional nature of content validity, with an emphasis on psychological assessment in clinical situations. The conditional and dynamic nature of content validity is discussed, and multiple elements of content validity along with quantitative and qualitative methods of content validation are reviewed. Finally, several recommendations for reporting and interpreting content validation evidence are offered.

Development and preliminary validation of a brief broad-spectrum measure of trauma exposure : The Traumatic Life Events Questionnaire

This article describes the development and preliminary validation of a brief questionnaire that assesses exposure to a broad range of potentially traumatic events. Items were generated from multiple sources of information. Events were described in behaviorally descriptive terms, consistent with Diagnostic and Statistical Manual of Mental Disorders IV posttraumatic stress disorder stressor criterion A1. When events were endorsed, respondents were asked if they experienced intense fear, helplessness, or horror (stressor criterion A2). In separate studies with college students, Vietnam veterans, battered women, and residents of a substance abuse program, most items possessed adequate to excellent temporal stability. In a study comparing questionnaire and structured-interview inquiries of trauma history, the 2 formats yielded similar rates of disclosure. Preliminary data on positive predictive power are also presented.

Development and Validation of the Trauma-Related Guilt Inventory (TRGI).

The article describes the development and psychometric evaluation of the Trauma-Related Guilt Inventory (TRGI). An initial questionnaire was constructed from multiple sources of information. Three factor analytic studies were conducted to refine the TRGI and determine its factor structure, which consists of a Distress factor and three cognitive factors, Hindsight-Bias/Responsibility, Wrongdoing, and Lack of Justification. The TRGI has high internal consistency and adequate temporal stability. In validity studies with Vietnam veterans and battered women, TRGI scales and subscales were significantly correlated with other measures of guilt and with measures of posttraumatic stress disorder, depression, and other indexes ofadjustment. Findings support the conceptualization of trauma-related guilt as a multidimensional construct and highlight the role of cognitions in the experience of guilt and posttrauma psychopathology.

Cognitive trauma therapy for battered women with PTSD (CTT-BW)

This article describes a second treatment-outcome study of cognitive trauma therapy for battered women with posttraumatic stress disorder (PTSD; CTT-BW). CTT-BW includes trauma history exploration: PTSD education; stress management; exposure to abuse and abuser reminders; self-monitoring of negative self-talk; cognitive therapy for guilt; and modules on self-advocacy, assertiveness, and how to identify perpetrators. One hundred twenty-five ethnically diverse women were randomly assigned to immediate or delayed CTT-BW. PTSD remitted in 87% of women who completed CTT-BW, with large reductions in depression and guilt and substantial increases in self-esteem. White and ethnic minority women benefited equally from CTT-BW. Similar treatment outcomes were obtained by male and female therapists and by therapists with different levels of education and training. Gains were maintained at 3- and 6-month follow-ups.

Cognitive Trauma Therapy for Battered Women with PTSD: Preliminary Findings

CTT-BW includes trauma history exploration, PTSD psychoeducation, stress management, psychoeducation about dysfunctional self-talk and self-monitoring of self-talk, exposure to abuse reminders, Cognitive Therapy for Trauma-Related Guilt (E. S. Kubany & F. P. Manke, 1995), and modules on assertiveness, managing contacts with former partners, self-advocacy strategies, and avoiding revictimization. Thirty-seven ethnically diverse women were assigned to Immediate or Delayed CTT-BW. PTSD remitted in 30 of 32 women who completed CTT-BW. Gains were maintained at 3-month follow-up. CTT-BW was efficacious across ethnic backgrounds. Issues related to disseminability of CTT-BW are discussed.

Cognitive therapy for trauma-related guilt: Conceptual bases and treatment outlines

There is consistent agreement that guilt has both affective and cognitive dimensions. We describe a conceptualization of event-related guilt in which cognitive elements play a crucial role. Factors posited as primary cognitive components or determinants of guilt include perceived wrongdoing, acceptance of responsibility, perceived lack of justification, and false beliefs about preoutcome knowledge caused by hindsight bias. Each cognitive component can be manifested as an irrational belief or faulty conclusion that can vary in magnitude. Numerous errors of logic that can lead trauma victims to draw faulty conclusions about their role in traumatic events are identified. Within the proposed model, correcting these thinking errors is considered the best way to alleviate guilt and is the primary task of cognitive therapy for trauma-related guilt (CT-TRG). With each guilt issue, a debriefing/imaginal exposure exercise precedes cognitive therapy. CT-TRG proper involves considerable psychoeducation and collaborative examination of each guilt component. Procedures are described for teaching clients to distinguish what they knew “then” from what they know “now” and to reassess perceptions of responsibility, justification, and wrongdoing in light of beliefs held and knowledge possessed when the trauma occurred. Several issues regarding applicability of the treatment model are discussed.

Validation of a brief measure of posttraumatic stress disorder: the Distressing Event Questionnaire (DEQ).

The Distressing Event Questionnaire (DEQ) is a brief instrument for assessing posttraumatic stress disorder (PTSD) according to criteria provided in Diagnostic and Statistical Manual of Mental Disorders (4th ed.). The DEQ possesses high internal consistency and exhibited satisfactory short-term temporal stability in studies with Vietnam War combat veterans and battered women. In a sample of Vietnam War veterans and 4 separate samples of abused women (with histories of incest, rape, intimate partner abuse, or prostitution and abuse), the DEQ exhibited very good discriminative validity when judged against structured interview assessment of PTSD. The DEQ exhibited strong convergent validity with other PTSD measures and other indexes of adjustment and also exhibited strong convergent validity as a measure of PTSD across ethnic groups in both the veteran sample and the combined womens sample.

A cognitive model of guilt typology in combat-related PTSD

Dysfunctional guilt is a prominent feature of combat-related, post-traumatic stress disorder (PTSD). The present article describes a model of combat-related guilt that distinguishes guilt types on the basis of specific false assumptions and errors of logic that are frequently associated with different kinds of traumatic circumstances. Two common types of combat-related guilt based on this conceptualization are described and cognitive relabeling treatment strategies which have a “type” specific focus are outlined. The needs for research on guilt assessment among trauma survivors and for interventions that focus explicitly on guilt management are discussed.

Relationship of cynical hostility and PTSD among vietnam veterans

The personality construct of cynical hostility, as measured by the Cook-Medley scale (an MMPI subscale), has been implicated as a risk factor for cardiovascular disease. A literature review suggests that Vietnam veterans exhibit many cynical hostility-like characteristics. We examined the association between Cook-Medley scores and PTSD among Vietnam and other-era veterans. Study 1 involved analyses of data from 1293 MMPIs administered at Department of Veterans Affairs in Honolulu between 1986–1991. Cook-Medley scores were highly correlated with MMPI PTSD scores, and Vietnam Era veterans obtained higher scores than veterans from other eras. In Study 2, twenty nine Vietnam veterans with PTSD disability ratings obtained very high Cook-Medley scores which were higher than Vietnam Era veterans without rated PTSD. Findings indicate that the cynical hostility literature has considerable relevance for study of PTSD and suggest that PTSD veterans may have heightened risk for developing cardiovascular disease. Several directions for future research are suggested.

Development and validation of the sources of trauma-related guilt survey—war-zone version

Despite clinical observations that many veterans have multiple sources of war-related guilt, many problematic guilt issues are commonly not treated or even detected by clinicians. We describe development of a survey that systematically assesses idiosyncratic sources of guilt across the spectrum of events that are potential sources of trauma-related guilt from the war-zone. A multimethod strategy was used to develop a survey with strong content validity-Results indicate the survey is temporally stable, substantially correlated with other measures of guilt, and highly correlated with measures of posttraumatic stress disorder (PTSD) and depression. Findings confirm that many Vietnam veterans have multiple sources of severe war-related guilt. The survey may have important clinical utility for problem identification, treatment planning, and evaluating treatment efficacy.