Anxiety Programme Outcome Measures
The following section presents a summary of the routine clinical outcome measures for the Anxiety Disorders Programme achieved in 2016. All service users attending the Anxiety Programme complete (or are rated on) the following measures, before starting the programme, after completing level one of the programme and again after completing level two (if they have attended this level).
Beck Anxiety Inventory
The Beck Anxiety Inventory (BAI: Beck & Steer, 1993) is a 21-item multiple-choice self-report inventory that measures the severity of anxiety in adults and adolescents. The respondent is asked to rate how much each of the 21 symptoms has bothered him/her in the past week. The symptoms are rated on a four-point scale, ranging from ‘‘not at all’’ (0) to ‘‘severely’’ (3). The BAI scores range from 0 – 63 and scores can be interpreted in relation to four qualitative categories: minimal level anxiety (0-7), mild anxiety (8-15), moderate anxiety (16-25) and severe anxiety (26-63). The instrument has excellent internal consistency (α= .92) and high test–retest reliability (r = .75) (Beck & Steer, 1990).
Beck Depression Inventory
The Beck Depression Inventory (BDI: Beck et al 1996) is a 21-item questionnaire developed to measure the intensity, severity, and depth of depression symptoms in patients with psychiatric diagnoses. Individual questions on the BDI assess mood, pessimism, sense of failure, self-dissatisfaction, guilt, punishment, self-dislike, self-accusation, suicidal ideas, crying, irritability, social withdrawal, body image, work difficulties, insomnia, fatigue, appetite, weight loss, bodily pre-occupation, and loss of libido. Items 1 to 13 assess symptoms that are psychological in nature, while items 14 to 21 assess physical symptoms. Scores range from 0 – 63, where higher scores indicate, increased depressive symptoms. Scores can be interpreted in four qualitative categories: minimal depression (0-9), mild depression (10-18), moderate depression (19-29) and severe depression (30-63).
The Fear Questionnaire (FQ: Marks & Matthews, 1979) consists of 23 items which measure the extent to which potentially anxiety provoking situations are avoided using a 9-point Likert scale ranging from 0 “Would not avoid” to 8 “Always avoid”. Four scores can be obtained from the Fear Questionnaire: Main Phobia Level of Avoidance, Total Phobia Score, Global Phobia Rating and Associated Anxiety and Depression. For the purposes of this analysis the Total Phobia Score, was used. This measure has been found to be psychometrically sound with good discriminant validity and internal consistencies from .71 to .83 (Oei, Moylan, & Evans, 1991).
Yale Brown Obsessive Compulsive Scale
Yale Brown Obsessive Compulsive Scale (Y-BOCS: Goodman et al., 1989) is widely considered the best available measure for assessing the severity of OCD and to measure the response to treatment. It was designed specifically to measure the severity of OCD regardless of the type of obsessions and compulsions. The Y-BOCS enables the clinician to rate the severity of the obsessions and compulsions separately e.g. (five items assess obsessions and five items assess compulsions) which enables the clinician to discern between the severity of obsessions and compulsions as well as have a global score of severity and response by adding the two separate scores.
Obsessions and compulsions are each assessed on a 5-point scale ranging from 0 “no symptoms” to 4 “severe symptoms” measuring the following: time spent engaging with obsessions and / or compulsions, the level of distress, the ability to resist and level of control over obsessions and compulsions. Scores are rated across five levels: Sub-clinical: 0 – 7; Mild: 8 – 14; Moderate: 16 – 23; Severe: 24 – 31; Extreme: 32 – 40. Taylor (1995, p. 289) states that: “When breadth of measurement, reliability, validity, and sensitivity to treatment effects are considered together, the YBOCS appears to be the best available measure for treatment outcome research”.
Penn State Worry Questionnaire
The Penn State Worry Questionnaire (PSWQ: Meyer, Miller, Metzger, & Borkovec, 1990) is designed to capture the generality, excessiveness, and uncontrollability of pathological worry. The PSWQ allows clinicians to identify individuals with Generalised Anxiety Disorder (GAD) who present for treatment for anxiety disorders (Fresco et al, 2003).
The PSWQ is a 16-item self-report measure. Participants are asked to rate worries on a 5-point scale ranging from ‘Not at all typical of me’ to ‘Very typical of me’, capturing the generality, excessiveness, and uncontrollability of pathological worry. Total scores range from 16 to 80, with higher scores indicating greater worry. The reliability and validity of the PSWQ has been widely researched, positively correlating with other self-report measures of worry and aggregate peer ratings showing it to be of sound psychometric properties.
Social Safeness and Pleasure Scale (SSPS)
The Social Safeness and Pleasure Scale (SSPS; Gilbert et al., 2009), aims to measure service users’ feelings of safety, warmth, acceptance, and belonging within their social world. The measure is a brief 11-item, 5-point Likert scale, with responses ranging from 0 ‘Almost never’ to 4 ‘Almost all the time’. Previous research has suggested that this scale’s psychometric reliability is good (alpha=.92; Gilbert et al., 2009). This instrument was administered at time points, pre and post level 2.
Social Phobia Inventory (SPIN)
The Social Phobia Inventory (SPIN; Connors et al., 2000) is a 17-item questionnaire developed by the Psychiatry and Behavioural Sciences Department at Duke University. The Social Phobia Inventory (SPIN) provides a patient-rated assessment of the three clinically important symptom domains of social phobia (Fear, Avoidance and Physiological Symptoms), with the practical advantages of brevity, simplicity and ease of scoring. The SPIN demonstrates solid psychometric properties, can be used as a valid measure of severity of social phobia symptoms, and is sensitive to the reduction in symptoms over time.
The Work and Social Adjustment Scale (WSAS)
The Work and Social Adjustment Scale (WSAS) is a simple 5-item patient self-report measure, which assesses the impact of a person’s mental health difficulties on their ability to function in terms of work, home management, social leisure, private leisure and personal or family relationships. Participants are asked to rate impairment in each domain on a 9-point Likert scale from 0 “Not at all” to 8 “Very severely”. Total scores for the measure can range from 0 to 40, with higher scores indicating greater impairment in functioning.
In a study including participants with Obsessive Compulsive Disorder or Depression, the scale developers report that “A WSAS score above 20 appears to suggest moderately severe psychopathology. Scores between 10 and 20 are associated with significant functional impairment but less severe clinical symptomatology. Scores below 10 appear to be associated with sub-clinical populations (p. 463, Mundt, Marks, Shear & Greist, 2002). The WSAS is used for all patients with depression or anxiety as well as phobic disorders and has shown good validity and reliability (Mundt, Mark, Shear & Greist, 2002). The scores on the WSAS have been shown to be sensitive to patient differences in disorder severity and treatment-related change.