What is the Eysenck Personality Questionnaire?

Introduction

In psychology, the Eysenck Personality Questionnaire (EPQ) is a questionnaire to assess the personality traits of a person. It was devised by psychologists Hans Jürgen Eysenck and Sybil B.G. Eysenck.

Hans Eysenck’s theory is based primarily on physiology and genetics. Although he was a behaviourist who considered learned habits of great importance, he believed that personality differences are determined by genetic inheritance. He is, therefore, primarily interested in temperament. In devising a temperament-based theory, Eysenck did not exclude the possibility that some aspects of personality are learned, but left the consideration of these to other researchers.

Dimensions

Eysenck initially conceptualised personality as two biologically-based independent dimensions of temperament, E and N, measured on a continuum, but then extending this to include a third, P.

E – Extraversion/Introversion

  • Extraversion is characterised by being outgoing, talkative, high on positive affect (feeling good), and in need of external stimulation.
  • According to Eysenck’s arousal theory of extraversion, there is an optimal level of cortical arousal, and performance deteriorates as one becomes more or less aroused than this optimal level.
  • Arousal can be measured by skin conductance, brain waves or sweating.
  • At very low and very high levels of arousal, performance is low, but at a better mid-level of arousal, performance is maximised.
  • Extraverts, according to Eysenck’s theory, are chronically under-aroused and bored and are therefore in need of external stimulation to bring them UP to an optimal level of performance.
  • About 16% of the population tend to fall in this range.
  • Introverts, on the other hand, (also about 16 percent of the population) are chronically over-aroused and jittery and are therefore in need of peace and quietness to bring them DOWN to an optimal level of performance.
  • Most people (about 68% of the population) fall in the midrange of the extraversion/introversion continuum, an area referred to as ambiversion.

N – Neuroticism/Stability

  • Neuroticism or emotionality is characterised by high levels of negative affect such as depression and anxiety.
  • Neuroticism, according to Eysenck’s theory, is based on activation thresholds in the sympathetic nervous system or visceral brain.
  • This is the part of the brain that is responsible for the fight-or-flight response in the face of danger.
  • Activation can be measured by heart rate, blood pressure, cold hands, sweating and muscular tension (especially in the forehead).
  • Neurotic people – who have low activation thresholds, and unable to inhibit or control their emotional reactions, experience negative affect (fight-or-flight) in the face of very minor stressors – are easily nervous or upset.
  • Emotionally stable people – who have high activation thresholds and good emotional control, experience negative affect only in the face of very major stressors – are calm and collected under pressure.

The two dimensions or axes, extraversion-introversion and emotional stability-instability, define four quadrants. These are made up of:

  • Stable extraverts (sanguine qualities such as outgoing, talkative, responsive, easy going, lively, carefree, leadership).
  • Unstable extraverts (choleric qualities such as touchy, restless, excitable, changeable, impulsive, irresponsible).
  • Stable introverts (phlegmatic qualities such as calm, even-tempered, reliable, controlled, peaceful, thoughtful, careful, passive).
  • Unstable introverts (melancholic qualities such as quiet, reserved, pessimistic, sober, rigid, anxious, moody).

Further research demonstrated the need for a third category of temperament:

P – Psychoticism/Socialisation

  • Psychoticism is associated not only with the liability to have a psychotic episode (or break with reality), but also with aggression.
  • Psychotic behaviour is rooted in the characteristics of toughmindedness, non-conformity, inconsideration, recklessness, hostility, anger and impulsiveness.
  • The physiological basis suggested by Eysenck for psychoticism is testosterone, with higher levels of psychoticism associated with higher levels of testosterone.

The following table describes the traits that are associated with the three dimensions in Eysenck’s model of personality.

PsychoticismExtraversionNeuroticism
AggresiveSociableAnxious
AssertiveIrresponsibleDepressed
EgocentricDominantGuilt Feelings
UnsympatheticLack of ReflectionLow Self-Esteem
ManipulativeSensation-SeekingTense
Achievement-OrientatedImpulsiveMoody
DogmaticRisk-TakingHypochondriac
MasculineExpressiveLack of Autonomy
Tough-MindedActiveObsessive

L – Lie/Social Desirability

Although the first 3 scales were predicted upon a biologically based theory of personality, the fourth scale has not been theoretically specified to the same extent, but it was considered to be conceptually strong to the extent that it would demonstrate the same degree of measurement similarity across cultures.

Criticism

Since the re-evaluation of Eysenck’s work in the 21st century, amidst revelations of data fabrication or fraud committed by Eysenck, the Eysenck Personality Questionnaire has itself come under scrutiny as potentially biased, flawed, or based upon faulty data.

Versions

EPQ also exists in Finnish and Turkish versions.

In 1985 a revised version of EPQ was described – the EPQ-R – with a publication in the journal Personality and Individual Differences. This version has 100 yes/no questions in its full version and 48 yes/no questions in its short scale version. A different approach to personality measurement developed by Eysenck, which distinguishes between different facets of these traits, is the Eysenck Personality Profiler.

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What is the Structured Clinical Interview for DSM?

Introduction

The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) is a diagnostic exam used to determine DSM-IV Axis I disorders (major mental disorders). The SCID-II is a diagnostic exam used to determine Axis II disorders (personality disorders).

Outline

There are at least 700 published studies in which the SCID was the diagnostic instrument used. Major parts of the SCID have been translated into other languages, including Danish, French, German, Greek, Hebrew, Italian, Portuguese, Spanish, Swedish, Turkish, and Zulu.

An Axis I SCID assessment with a psychiatric patient usually takes between 1 and 2 hours, depending on the complexity of the subject’s psychiatric history and their ability to clearly describe episodes of current and past symptoms. A SCID with a non-psychiatric patient takes 1⁄2 hour to 1+1⁄2 hours. (See editions below.) A SCID-II personality assessment takes about 1⁄2 to 1 hour.

The instrument was designed to be administered by a mental health professional, for example a psychologist or psychiatrist. This must be someone who has relevant professional training and has had experience performing unstructured, open-ended question, diagnostic evaluations. However, for the purposes of some research studies, non-clinician research assistants, who have extensive experience with the study population in question, and who have demonstrated competence, have been trained to use the SCID. The less clinical experience and specific education the potential interviewer has had, the more training is required.

DSM-5 Editions of the SCID-5

The SCID-5 for DSM-5 has been published in 2016. The SCID-II has been replaced by the SCID-5-PD, the SCID-I by a clinical (SCID-5-CV) and research version (SCID-5-RV). The clinical version “covers the diagnoses most commonly seen in clinical settings”, while the research version contains more disorders and ” all of the relevant subtypes and severity and course specifiers”.

DSM-IV Editions of SCID-I and SCID-II

There are several editions of the SCID-I addressed to different audiences:

  • Three Research Versions:
    • Patient Edition (SCID-I/P).
    • Patient Edition, with psychotic screen (SCID-I/P W/ PSY SCREEN).
    • Non-patient Edition (SCID-I/NP).
  • A Clinical Trials Version (SCID-CT).
  • Clinician Version (SCID-CV).

The SCID-II for DSM-IV comes in a single edition.

The first version of the SCID for DSM-5, intended for researchers, was released on 24 November 2014. American Psychiatric Association Publishing offers four versions the Structured Clinical Interview for DSM-5 (SCID-5), and pricing varies according to intended use.

DSM-III Editions of SCID-I and SCID-II

The DSM-III SCID had one edition per axis: SCID-P/SCID-NP and SCID-II.

The reliability and validity of the SCID for DSM-III-R has been reported in several published studies. With regard to reliability, the range in reliability is enormous, depending on the type of the sample and research methodology (i.e. joint vs. test-retest, multi-site vs. single site with raters who have worked together, etc.).

SCID-D

The Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) is widely used to diagnose dissociative disorders, especially in research settings. This interview takes about 30 minutes to 1.5 hours, depending on individual’s experiences. The SCID-D has been translated into Dutch and Turkish and is used in the Netherlands and Turkey.

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What is the Severity of Alcohol Dependence Questionnaire?

Introduction

The Severity of Alcohol Dependence Questionnaire (SADQ or SAD-Q) is a 20 item clinical screening tool designed to measure the presence and level of alcohol dependence.

It is divided into five sections:

  • Physical withdrawal symptoms.
  • Affective withdrawal symptoms.
  • Craving and relief drinking.
  • Typical daily consumption.
  • Reinstatement of dependence after a period of abstinence.

Each item is scored on a 4-point scale, giving a possible range of 0 to 60. A score of over 30 indicates severe alcohol dependence.

Some local clinical guidelines use the SADQ to predict the levels of medication needed during alcohol detoxification.

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What is the Dissociative Experiences Scale?

Introduction

The Dissociative Experiences Scale (DES) is a psychological self-assessment questionnaire that measures dissociative symptoms.

Background

It contains twenty-eight questions and returns an overall score as well as four sub-scale results.

DES is intended to be a screening test, since only 17% of patients with scores over 30 will be diagnosed with having dissociative identity disorder. Patients with lower scores above normal may have other post-traumatic conditions.

The DES-II contains the same questions but with a different response scale.

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What is the CRAFFT Screening Test?

Introduction

The CRAFFT is a short clinical assessment tool designed to screen for substance-related risks and problems in adolescents.

CRAFFT stands for the key words of the 6 items in the second section of the assessment:

  • Car.
  • Relax.
  • Alone.
  • Forget.
  • Friends.
  • Trouble.

As of 2020, updated versions of the CRAFFT known as the “CRAFFT 2.1” and “CRAFFT 2.1+N” have been released.

The older version of the questionnaire contains 9 items in total, answered in a “yes” or “no” format.

  • The first three items (Part A) evaluate alcohol and drug use over the past year; and
  • The other six (Part B) ask about situations in which the respondent used drugs or alcohol and any consequences of the usage.

The CRAFFT 2.1 screening tool begins with past-12-month frequency items (Part A), rather than the previous “yes/no” question for any use over the past year, and the other six (Part B) questions remain the same.

The CRAFFT can function as a self-report questionnaire or an interview to be administered by a clinician. Both employ a skip pattern: those whose Part A score is “0” (no use) answer the Car question only of Part B, while those who report any use in Part A also answer all six Part B CRAFFT questions. Each “yes” answer is scored as “1” point and a CRAFFT total score of two or higher identifies “high risk” for a substance use disorder and warrants further assessment.

Development and Brief History

The CRAFFT Screening Test was developed by John R Knight, MD and colleagues at the Centre for Adolescent Behavioural Health Research (CABHRe), formerly known as the Centre for Adolescent Substance Abuse Research (CeASAR) at Boston Children’s Hospital. Their goal was to develop a screening tool that – like the CAGE questionnaire used for adults – was brief and easy to administer and score. Unlike the CAGE, the CRAFFT was designed to be developmentally appropriate for adolescents and screen conjointly for both alcohol and drug use. Because motor vehicle crashes are a leading cause of death among adolescents, and often associated with alcohol and drug use, the CRAFFT includes a risk item to evaluate whether an adolescent has ever ridden in a car driven by someone (including themselves) who was under the influence of alcohol or other drugs. It has been established as valid and reliable for identifying youth who need further assessment and therapeutic intervention. The CRAFFT was originally designed to screen adolescents at high risk of substance use disorders in primary medical care offices. However, the necessity for a universal adolescent screening measure was made apparent by research findings suggesting that half of high school students drink, a third binge drink, and a fourth use marijuana. For drug use specifically, studies show that more than half of high school seniors have used an illegal drug of any kind and a fourth have used illegal drugs other than marijuana. In addition, more than two-thirds of high school seniors, half of sophomores, and a third of eighth graders have used alcohol in the past year. These findings also contributed to the identification of a need for a tool like the CRAFFT to be developed and widely implemented.

CRAFFT 2.1

This revised version of the CRAFFT screening tool incorporates changes that enhance the sensitivity of the system in terms of identifying adolescents with substance use, and presents new recommended clinician talking points, informed by the latest science and clinician feedback, to guide a brief discussion about substance use with adolescents. The CRAFFT 2.1 provides an updated and revised version of this well-validated and widely utilised adolescent substance use screening protocol. Although the previous version of the CRAFFT will still be available, CABHRe recommends that clinicians transition to using version 2.1.

The CRAFFT 2.1 screening tool begins with past-12-month frequency items, rather than the previous “yes/no” question for any use over the past year. A recent study examining these opening yes/no questions found that they had relatively low sensitivity in identifying youth with any past-12-month alcohol or marijuana use (62% and 72%, respectively). Research also has suggested that yes/no questions may contribute to lower sensitivity on certain measures by inhibiting disclosure of less socially desirable behaviours; i.e. they may be more prone to social desirability bias.

Alternatively, questions that ask “how many” or “how often” implicitly imply an expectation of the behaviour, and may thus mitigate discomfort around disclosure. The instruction, “Say ‘0’ if none” follows each question to convey that non-use is also normative. The CRAFFT 2.1 begins with past-12-month frequency items; i.e. “During the past 12 months, on how many days did you … [drink/use substance name]?”

This new set of frequency questions was tested in a recent study of 708 adolescent primary care patients ages 12-18 that found a sensitivity of 96% and specificity of 81% for detecting past-12-month use of any substance, suggesting better performance in identifying substance use compared to that of the “yes/no” questions found in the prior study.

The CRAFFT 2.1 has been translated into the following languages: Albanian, Arabic, Burmese, Simplified Chinese, Traditional Chinese, Cape Verdean Creole, Haitian Creole, Dutch, French, German, Greek, Hebrew, Hindi, Japanese, Khmer, Korean, Laotian, Lithuanian, Nepali, Portuguese (Brazil), Portuguese (Portugal), Romanian, Russian, Somali, Spanish (Latin Am), Spanish (Spain), Swahili, Telugu, Turkish, Twi, and Vietnamese.

CRAFFT 2.1+N

The CRAFFT 2.1+N expands upon the content from the CRAFFT 2.1 with the inclusion of the Hooked On Nicotine Checklist (HONC), which is a 10-item questionnaire that screens for dependence on tobacco and nicotine. If a teen indicates use of a vaping device containing nicotine and/or flavours or any tobacco products within the frequency questions, they are prompted to answer the HONC questions as well. A positive response to one or more of the items calls for further assessment regarding a serious problem with nicotine.

Psychometrics

Research has shown that CRAFFT has relatively high sensitivity and specificity, internal consistency, and test-retest reliability as a screener for alcohol and substance misuse. The CRAFFT questionnaire has been validated against the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and demonstrates good ability to distinguish between those with and without clinical levels of any DSM-5 substance use disorder. It is supported by many studies as a reliable and valid assessment of substance use and misuse in adolescents and is considered an effective tool for assessing whether further assessment is warranted. It has been well-validated against criterion standard psychological tests and structured psychiatric diagnostic interviews. It has been recommended by the American Academy of Paediatrics’ Committee on Substance Abuse for use with adolescents. Findings suggest that paediatricians should regularly screen for substance use disorders in adolescents using the CRAFFT.

The CRAFFT has been translated into many languages, including Albanian, Arabic, Burmese, Simplified Chinese, Traditional Chinese, Cape Verdean Creole, Haitian Creole, Dutch, French, German, Greek, Hebrew, Hindi, Japanese, Khmer, Korean, Laotian, Lithuanian, Nepali, Portuguese (Brazil), Portuguese (Portugal), Romanian, Russian, Somali, Spanish (Latin Am), Spanish (Spain), Swahili, Telugu, Turkish, Twi, and Vietnamese. Studies attest to its validity and reliability across cultures.

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What is the Michigan Alcoholism Screening Test?

Introduction

The Michigan Alcoholism Screening Test (MAST) screening tool was developed in 1971, and is one of the oldest alcoholism-screening tests for identifying dependent drinkers.

Background

Its use is constructed for the general population. There are other versions of the MAST screening tool, all of which can be self-administered or via interview with someone who is trained in the tool being used. All MAST screening tools are scored on a point scale system.

As stated on the Project Cork website (now archived), there are 25 questions to the MAST screening tool. The tool’s length makes administering it inconvenient in many busy primary health care and emergency department settings. The tool also mainly focuses on the patient’s problems throughout their lifetime, rather than the problems currently displayed by the patient. The questions throughout the screening tool operate in the past tense, which means that it is less likely to detect any problems with alcohol in its early stages, according to T. Buddy. The extended questioning is a benefit in a sense that one accomplishes a bit of the assessment section when conducting the screening; furthermore, it allows the individual conducting the screening to achieve better communication and rapport with the client.

The MAST-G screening tool is directed towards screening geriatric clients and has one less question than the MAST tool. There has always been an underlying concern as to the sensitivity and reliability when questioning geriatric clients.

Another related screening tool is the “brief MAST”, which is much shorter than the previous tests at 10 questions. There is also the Short-MAST tool similar to the brief test; it contains 13 questions. Which tool to use is decided by the screener.

Variations

  • MAST.
  • MAST-G.
  • Brief MAST.
  • Short-MAST.
  • Short-MAST-G.

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What is the Hospital Anxiety and Depression Scale?

Introduction

Hospital Anxiety and Depression Scale (HADS) was originally developed by Zigmond and Snaith (1983) and is commonly used by doctors to determine the levels of anxiety and depression that a person is experiencing.

The HADS is a fourteen item scale that generates: Seven of the items that relate to anxiety and seven that relate to depression. Zigmond and Snaith created this outcome measure specifically to avoid reliance on aspects of these conditions that are also common somatic symptoms of illness, for example fatigue and insomnia or hypersomnia. This, it was hoped, would create a tool for the detection of anxiety and depression in people with physical health problems.

Items on the Questionnaire

The items on the questionnaire that relate to anxiety are

  • I feel tense or wound up.
  • I get a sort of frightened feeling as if something awful is about to happen.
  • Worrying thoughts go through my mind.
  • I can sit at ease and feel relaxed.
  • I get a sort of frightened feeling like ‘butterflies’ in the stomach.
  • I feel restless as I have to be on the move.
  • I get sudden feelings of panic.

The items that relate to depression are:

  • I still enjoy the things I used to enjoy.
  • I can laugh and see the funny side of things.
  • I feel cheerful.
  • I feel as if I am slowed down.
  • I have lost interest in my appearance.
  • I look forward with enjoyment to things.
  • I can enjoy a good book or radio or TV programme.

Scoring the Questionnaire

Each item on the questionnaire is scored from 0-3 and this means that a person can score between 0 and 21 for either anxiety or depression.

Caseness of Anxiety and Depression

A number of researchers have explored HADS data to establish the cut-off points for caseness of anxiety or depression. Bjelland et al. (2002) through a literature review of a large number of studies identified a cut-off point of 8/21 for anxiety or depression. For anxiety (HADS-A) this gave a specificity of 0.78 and a sensitivity of 0.9. For depression (HADS-D) this gave a specificity of 0.79 and a sensitivity of 0.83.

Factor Structure

There are a large number of studies that have explored the underlying factor structure of the HADS. Many support the two-factor structure but there are others that suggest a three or four factor structure. Some argue that the tool is best used as a unidimensional measure of psychological distress.

Criticisms

The factor structure of the HADS has been questioned. Coyne and Sonderen argue in a letter published in the same issue, that Cosco, et al. provides grounds for abandoning HADS altogether. The HADS has also been criticised for its over reliance on anhedonia as being the core symptom of depression, how single-item measures of depression may have the same predictive value as the HADS scale, as well as its use of British colloquial expressions which can be difficult to translate.

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Clinical Institute Withdrawal Assessment for Alcohol?

Introduction

The Clinical Institute Withdrawal Assessment for Alcohol, commonly abbreviated as CIWA or CIWA-Ar (revised version), is a 10-item scale used in the assessment and management of alcohol withdrawal.

Each item on the scale is scored independently, and the summation of the scores yields an aggregate value that correlates to the severity of alcohol withdrawal, with ranges of scores designed to prompt specific management decisions such as the administration of benzodiazepines. The maximum score is 67; Mild alcohol withdrawal is defined with a score less than or equal to 10, moderate with scores 11 to 15, and severe with any score equal to or greater than 16.

CIWA-Ar

The CIWA-Ar is actually a shortened, improved version of the CIWA, geared towards objectifying alcohol withdrawal symptom severity. It retains validity, usefulness and reliability between rater’s. This revised version is the most commonly used scale in alcohol withdrawal, and was developed at the Addiction Research Foundation (now Centre for Addiction and Mental Health).

Scale

The ten items evaluated on the scale are common symptoms and signs of alcohol withdrawal, and are as follows:

  • Nausea and vomiting.
  • Tremor.
  • Paroxysmal sweats.
  • Anxiety.
  • Agitation.
  • Tactile disturbances.
  • Auditory disturbances.
  • Visual disturbances.
  • Headache.
  • Orientation and clouded sensorium.

Scoring

All items are scored from 0-7, with the exception of the orientation category, scored from 0-4. The CIWA scale is validated and has high inter-rater reliability. A randomised, double blind trial published in JAMA in 1994 showed that management for alcohol withdrawal that was guided by the CIWA scale resulted in decreased treatment duration and total use of benzodiazepines. The goal of the CIWA scale is to provide an efficient and objective means of assessing alcohol withdrawal. Studies have shown that use of the scale in management of alcohol withdrawal leads to decreased frequency of over-sedation with benzodiazepines in patients with milder alcohol withdrawal than would otherwise be detected without use of the scale, and decreased frequency of under-treatment in patients with greater severity of withdrawal than would otherwise be determined without the scale.

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What is the Positive and Negative Syndrome Scale?

Introduction

The Positive and Negative Syndrome Scale (PANSS) is a medical scale used for measuring symptom severity of patients with schizophrenia.

It was published in 1987 by Stanley Kay, Lewis Opler, and Abraham Fiszbein. It is widely used in the study of antipsychotic therapy. The scale is known as the “gold standard” that all assessments of psychotic behavioural disorders should follow.

The name refers to the two types of symptoms in schizophrenia, as defined by the American Psychiatric Association:

  • Positive symptoms, which refer to an excess or distortion of normal functions (e.g. hallucinations and delusions); and
  • Negative symptoms, which represent a diminution or loss of normal functions.

Some of these functions which may be lost include normal thoughts, actions, ability to tell fantasies from reality, and the ability to properly express emotions.

The PANSS is a relatively brief interview, requiring 45 to 50 minutes to administer. The interviewer must be trained to a standardised level of reliability.

Interview Items

To assess a patient using PANSS, an approximately 45-minute clinical interview is conducted. The patient is rated from 1 to 7 on 30 different symptoms based on the interview as well as reports of family members or primary care hospital workers.

  • Positive scale:
    • 7 Items, (minimum score = 7, maximum score = 49):
      • Delusions.
      • Conceptual disorganisation.
      • Hallucinations.
      • Excitement.
      • Grandiosity.
      • Suspiciousness/persecution.
      • Hostility.
  • Negative scale:
    • 7 Items, (minimum score = 7, maximum score = 49):
      • Blunted affect.
      • Emotional withdrawal.
      • Poor rapport.
      • Passive/apathetic social withdrawal.
      • Difficulty in abstract thinking.
      • Lack of spontaneity and flow of conversation.
      • Stereotyped thinking.
  • General Psychopathology scale:
    • 16 Items, (minimum score = 16, maximum score = 112):
      • Somatic concern.
      • Anxiety.
      • Guilt feelings.
      • Tension.
      • Mannerisms and posturing.
      • Depression.
      • Motor retardation.
      • Uncooperativeness.
      • Unusual thought content.
      • Disorientation.
      • Poor attention.
      • Lack of judgement and insight.
      • Disturbance of volition.
      • Poor impulse control.
      • Preoccupation.
      • Active social avoidance.

PANSS Total score minimum = 30, maximum = 210

Scoring

As 1 rather than 0 is given as the lowest score for each item, a patient can not score lower than 30 for the total PANSS score. Scores are often given separately for the positive items, negative items, and general psychopathology. In their original publication on the PANSS scale, Stanley Kay and colleagues tested the scale on 101 adult patients (20-68 years-old) with schizophrenia and the mean scores were,

  • Positive scale = 18.20.
  • Negative scale = 21.01.
  • General psychopathology = 37.74.

Based on meta-analytic results, an alternative five-factor solution of the PANSS was proposed with positive symptoms, negative symptoms, disorganisation, excitement, and emotional distress.

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What is the Subjective Units of Distress Scale?

Introduction

A Subjective Units of Distress Scale (SUDS), also known as the Subjective Units of Disturbance Scale), is a scale ranging from 0 to 10 measuring the subjective intensity of disturbance or distress currently experienced by an individual.

Respondents provide a self report of where they are on the scale. The SUDS may be used as a benchmark for a professional or observer to evaluate the progress of treatment. In desensitisation-based therapies, and the patients’ regular self assessments enable them to guide the clinician repeatedly as part of the therapeutic dialogue.

The SUD-level was developed by Joseph Wolpe in 1969. It has been used in cognitive-behavioural treatments for anxiety disorders (e.g. exposure practices and hierarchy) and for research purposes.

There is no hard and fast rule by which a patient can self assign a SUDS rating to his or her disturbance or distress, hence the name subjective.

Some guidelines are:

  • The intensity recorded must be as it is experienced now.
  • Constriction or congestion or tensing of body parts indicates a higher SUDS than that reported.

The Scale

There a number of version of the scale, and the below is for illustration only:

  • 10 = Feels unbearably bad, beside yourself, out of control as in a nervous breakdown, overwhelmed, at the end of your rope. You may feel so upset that you don’t want to talk because you can’t imagine how anyone could possibly understand your agitation.
  • 9 = Feeling desperate. What most people call a 10 is actually a 9. Feeling extremely freaked out to the point that it almost feels unbearable and you are getting scared of what you might do. Feeling very, very bad, losing control of your emotions.
  • 8 = Freaking out. The beginning of alienation.
  • 7 = Starting to freak out, on the edge of some definitely bad feelings. You can maintain control with difficulty.
  • 6 = Feeling bad to the point that you begin to think something ought to be done about the way you feel.
  • 5 = Moderately upset, uncomfortable. Unpleasant feelings are still manageable with some effort.
  • 4 = Somewhat upset to the point that you cannot easily ignore an unpleasant thought. You can handle it OK but don’t feel good.
  • 3 = Mildly upset. Worried, bothered to the point that you notice it.
  • 2 = A little bit upset, but not noticeable unless you took care to pay attention to your feelings and then realize, “yes” there is something bothering me.
  • 1 = No acute distress and feeling basically good. If you took special effort you might feel something unpleasant but not much.
  • 0 = Peace, serenity, total relief. No more anxiety of any kind about any particular issue.

Utility Does Not Require Precision

In using SUDS in a therapeutic setting, the therapist does not necessarily define the scale, because one of the benefits of asking a patient or client for a SUDS score is that it is simple. Typically, you can ask the client, “On a scale of zero to ten, where zero is the best you can feel and ten is the worst, how do you feel right now?”

The purpose of this question is to enable the patient or client to notice improvements, and the inherent difference between one person’s subjective scale and another person’s is irrelevant to therapy with either individual. Our brains are sophisticated enough that they can usually summarize a large amount of data very quickly, and often accurately.

There is a possibility that in some forms of therapy, the patient will want to see progress and will therefore report progress that isn’t objectively present – a type one error from a statistical point of view. While both type I and type II errors are important in research situations, type one errors can have a therapeutic utility in clinical situations, in which they can provide an indirect opportunity for positive autosuggestion – much like the indirect suggestions employed in Eriksonian hypnosis.

Thus, since the main use of SUDS is for clinical purposes, rather than research purposes, the imprecise nature of the scale is relatively unimportant to its main users: patients and clinicians.

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