Investigating the PHQ-9 With Mokken Scale Analysis and Cognitive Interviews.

Scores on the Patient Health Questionnaire-9 (PHQ-9) are frequently used to assess depression both in research and in clinical practice. The aim was to examine the validity of the PHQ-9 sum score by using Mokken scale analysis (Study I) and cognitive interviews (Study II) on the Icelandic version of PHQ-9. A primary care sample of 618 individuals was used in Study I. The results indicate that the PHQ-9 items are not close enough to perfectly unidimensional for their sum score to accurately order people on the depression severity dimension. In Study II, the sample consisted of 53 individuals, with 28 having a history of depression and 25 not. The findings reveal a number of issues concerning respondents' use of the PHQ-9. No systematic differences were found in the results of the two groups. The PHQ-9 sum score should thus be interpreted and used with great care. We provide scale revision recommendations to improve the quality of PHQ-9.

Evaluation of mechanism of change in transdiagnostic cognitive behaviour therapy using single case experimental design.

BACKGROUND AND OBJECTIVES: Transdiagnostic mechanisms of change (txMOC) specific to cognitive behaviour therapy are poorly understood. Salkovskis (1996) proposed one such mechanism in terms of the shift towards an alternative, less negative view of their problems or cognitive flexibility. This hypothesis has been described as involving a shift in beliefs, from "theory A″ to "theory B". The objective of this research was to evaluate this hypothesis. METHODS: Effectiveness of a novel txCBT and temporal changes in process and symptom measures were evaluated using a non-concurrent multiple baseline design and Tau-U calculations with thirteen participants (five with obsessive-compulsive disorder, two with panic disorder with agoraphobia and six with major depressive disorder). As a secondary analysis authors calculated Kendall's - Tau correlation between process and symptom measures, performed the Wilcoxon signed-rank test to assess treatment modules effect on negative thought and calculated Reliable change index (RCI). RESULTS: The txCBT was clearly effective for eight participants. The results varied dependent on the stimuli evaluated as negative or threatening. Level and trend of the ratings of belief in theory A followed the level and trend of symptom measures to a greater extent than the (inverse) level and trend of belief in theory B. LIMITATIONS: Only thirteen participants were recruited and evaluated. CONCLUSIONS: The results are consistent with the view that effective treatment may involve a txMOC characterized by the ability to shift from a relatively fixed negative view of their experience to a less negative psychologically focused alternative.

'You should always look at the washing machine without actually being in it!' Thematic framework analysis of patients' understanding of transdiagnostic cognitive behaviour therapy and its mechanisms.

OBJECTIVE: Transdiagnostic cognitive behaviour therapy (TCBT) is an efficacious treatment for anxiety and depression, but its mechanisms of change remain poorly understood. The current study used thematic framework analysis to analyse how patients, recruited in a recent trial on transdiagnostic group CBT (TGCBT), understood the treatment and its mechanisms. DESIGN: Cross-sectional thematic framework analysis. METHOD: The sample included 24 participants suffering from anxiety and/or depression, divided into two groups by treatment efficacy (i.e., group doing well and group doing not so well) in order to evaluate whether different understandings of the treatment affected its efficacy. The participants were interviewed and completed self-report measures. They were encouraged to discuss what they believed to be helpful and unhelpful in the TGCBT and what they believed to be the mechanisms of change in the treatment. Each interview was recorded, transcribed verbatim and themes were identified. RESULTS: The analysis revealed four overarching themes and 18 subthemes. The overarching themes were as follows: Cognitive and behavioural flexibility, Awareness/understanding of symptoms and triggers, Therapeutic alliance and engagement, and finally Attitudes towards treatment. Four of the 18 subthemes corresponded to a differentiation between the groups: Cognitive flexibility and Comparison with others in the group on the one hand and Cognitive inflexibility and Negative attitudes towards treatment on the other. CONCLUSION: The most important difference between the groups appeared to be CBT-specific, that is, cognitive flexibility that characterized the group doing well where thematic analysis did not indicate that other themes were important. PRACTITIONER POINTS: Findings The analysis revealed four overarching themes and 18 subthemes, four of which corresponded to the difference between the two groups of participants based on treatment efficacy. The four differentiating subthemes were cognitive flexibility and comparison with others, which characterized the group doing well, and cognitive inflexibility and negative attitude towards treatment, which characterized the group doing less well. The theme evaluated as the most important for the efficacy of the transdiagnostic cognitive behaviour therapy and patients' understanding of the treatment was cognitive flexibility, which characterized the group doing well. Limitations Use of qualitative methodology restricts the generalizability of our results. Data are built on answers from only 24 participants.

Social Desirability in Spouse Ratings.

Whether or not socially desirable responding is a cause for concern in personality assessment has long been debated. For many researchers, McCrae and Costa laid the issue to rest when they showed that correcting for socially desirable responding in self-reports did not improve the agreement with spouse ratings on the Neuroticism, Extraversion, and Openness to Experience Personality Inventory. However, their findings rest on the assumption that observer ratings in general, and spouse ratings in particular, are an unbiased external criterion. If spouse ratings are also susceptible to socially desirable responding, correcting for the bias in self-rated measures cannot be assumed to increase agreement between self-reports and spouse ratings, and thus failure to do so should not be taken as evidence for the ineffectiveness of measuring and correcting for socially desirable responding. In the present study, McCrae and Costa's influential study was replicated with the exception of measuring socially desirable responding with the Marlowe-Crowne Social Desirability Scale, in both self-reports and spouse ratings. Analyses were based on responses from 70 couples who had lived together for at least one year. The results showed that both self-reports and spouse ratings are susceptible to socially desirable responding and thus McCrae and Costa's conclusion is drawn into question.

Questions on honest responding.

This article presents a new method for reducing socially desirable responding in Internet self-reports of desirable and undesirable behavior. The method is based on moving the request for honest responding, often included in the introduction to surveys, to the questioning phase of the survey. Over a quarter of Internet survey participants do not read survey instructions, and therefore, instead of asking respondents to answer honestly, they were asked whether they responded honestly. Posing the honesty message in the form of questions on honest responding draws attention to the message, increases the processing of it, and puts subsequent questions in context with the questions on honest responding. In three studies (nStudy I = 475, nStudy II = 1,015, nStudy III = 899), we tested whether presenting the questions on honest responding before questions on desirable and undesirable behavior could increase the honesty of responses, under the assumption that less attribution of desirable behavior and/or admitting to more undesirable behavior could be taken to indicate more honest responses. In all studies the participants who were presented with the questions on honest responding before questions on the target behavior produced, on average, significantly less socially desirable responses, though the effect sizes were small in all cases (Cohen's d ranging between 0.02 and 0.28 for single items, and from 0.17 to 0.34 for sum scores). The overall findings and the possible mechanisms behind the influence of the questions concerning honest responding on subsequent questions are discussed, and suggestions are made for future research.

The factor structure of the Children's Eating Behaviour Questionnaire: A comparison of four models using confirmatory factor analysis.

AIMS: The Child Eating Behavior Questionnaire (CEBQ) consists of 8 subscales measuring different aspects of eating behavior and is a widely used instrument in pediatric settings, both in relation to eating disorders and overweight/obesity. However, despite its widespread usage, research results have, to this date, been inconsistent in regard to the factor structure of the CEBQ, with several factorial models suggested. The purpose of this study was to systematically compare the 4 factor structures commonly reported in the literature on the 35-item CEBQ, using confirmatory factor analysis in the same sample. METHODS AND RESULTS: In total, parents of 560 children aged 5 to 12 years old completed the CEBQ; 70 questionnaires were incomplete, resulting in a final sample of 490. Confirmatory factor analyses tested the 4 competing models: a 6-factor model, 2 seven-factor models, and an 8-factor model. The 8-factor model provided an acceptable fit to the data and turned out to be the best fitting model. Correlation coefficients between the 8 factors never exceeded r = .77, supporting the construct uniqueness of the 8 subscales. Results also indicated that the CEBQ subscales have good factorial validity and internal reliability (α ≥ .75). CONCLUSION: In summary, this study of Icelandic children supports the appropriateness of using the CEBQ as a measure of 8 distinct dimensions of eating behavior style in school-aged children.