Publications by authors named "Chad Ebesutani"

49 Publications

Prospective associations between disgust proneness and OCD symptoms: Specificity to excessive washing compulsions.

J Anxiety Disord 2019 06 25;65:34-40. Epub 2019 May 25.

Duksung Women's University, Republic of Korea.

Although considerable evidence has linked disgust proneness (DP) to obsessive-compulsive disorder (OCD), few studies have examined the extent to which DP predicts OCD symptoms over time. Further, it remains unclear if DP is a risk factor for the contamination subtype of OCD specifically or if it is prospectively associated with other OCD symptom subtypes. The present study sought to address these gaps in the literature with a large sample of unselected community participants (n = 497) that completed measures of DP and OCD symptoms monthly over a 6-month period. Latent growth analysis revealed that initial levels of DP were associated with higher initial level of total OCD symptoms when controlling for depression, but not the slope of change in total OCD symptoms over time. Initial levels of total OCD symptoms were also associated with higher initial levels of DP when controlling depression, but not the slope of change in DP over time. Examination of symptom specificity revealed that initial levels of DP were associated with initial levels of washing, neutralizing, obsessing, ordering, and hoarding symptoms. However, initial levels of DP were associated only with the slope of change in the washing subtype when controlling for depression such that high initial levels of DP were associated with steeper increases in washing symptoms of OCD over the 6-month period. These findings suggest that although DP may have concurrent associations with symptoms of OCD more broadly, prospective associations are specific to the contamination/washing subtype of OCD. The implications of these findings for the etiology and treatment of contamination-based OCD are discussed.
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http://dx.doi.org/10.1016/j.janxdis.2019.05.003DOI Listing
June 2019

What Therapy Practices Do Providers Value in Youth Behavioral Health? A Measure Development Study.

J Behav Health Serv Res 2019 10;46(4):607-624

Hathaway-Sycamores Child and Family Services, Pasadena, CA, USA.

Existing measures of attitudes toward evidence-based practices (EBPs) assess attitudes toward manualized or research-based treatments. Providers of youth behavioral health (N = 282) completed the Valued Practices Inventory (VPI), a new measure of provider attitudes toward specific practices for youth that avoids mention of EBPs by listing specific therapies-some of which are drawn from EBPs (e.g., problem solving) and some of which are not included in EBPs (e.g., dream interpretation). Exploratory factor analysis revealed two factors: practices derived from the evidence base (PDEB) and alternative techniques (AT). The PDEB scale was significantly correlated with scales on the Evidence-Based Practice Attitude Scale-50 (Aarons et al. in Administration and Policy in Mental Health and Mental Health Services Research, 39(5): 331-340, 2012), whereas the AT scale was not. Attitudes toward PDEB and AT were also related to provider characteristics such as years of experience and work setting. The VPI offers a complementary approach to existing measures of attitudes because it avoids mention of EBPs, which may help prevent biases in responses.
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http://dx.doi.org/10.1007/s11414-019-09651-xDOI Listing
October 2019

A bifactor model of obsessive beliefs: Specificity in the prediction of obsessive-compulsive disorder symptoms.

Psychol Assess 2019 Feb 11;31(2):210-225. Epub 2018 Oct 11.

Anxiety Disorders Center & Center for Cognitive Behavioral Therapy, Institute of Living.

Although current cognitive-behavioral models suggest that maladaptive "obsessive beliefs" about threat, responsibility, uncertainty, perfectionism, importance, and control of thoughts contributes to the development of obsessive-compulsive disorder (OCD), the structure of such beliefs is unclear. The current study evaluated a bifactor model of obsessive beliefs, as assessed by the Obsessive Beliefs Questionnaire (OBQ-44), and its association with OCD symptoms in clinical (Study 1; N = 264) and nonclinical (Study 2; N = 437) samples. The goals were as follows: (a) to evaluate whether obsessive beliefs should be conceptualized as unidimensional or whether distinct dimensions should be interpreted, and (b) to use structural equation modeling to examine the extent to which distinct beliefs predict OCD symptoms above and beyond a general obsessive belief factor. Results revealed that in both clinical and nonclinical samples, a bifactor model fit the data well and significantly better than a standard three-factor model of the OBQ-44 that specified 3 separate, yet correlated factors (Responsibility/Threat Estimation, Perfectionism/Certainty, and Importance/Control of Thoughts). Despite evidence that the OBQ-44 consists of a general factor and the 3 specific factors, structural equation modeling showed that only the general factor uniquely predicted a broad OCD symptom latent factor in clinical and nonclinical samples. Although obsessive beliefs about Perfectionism/Certainty did predict symmetry and ordering symptoms of OCD when controlling for the general factor in both studies, the general factor was a more robust predictor of specific OCD symptoms than the 3 factors. These findings suggest that the general factor of the OBQ-44 may have more utility than its specific factors in predicting the heterogeneity of OCD symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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http://dx.doi.org/10.1037/pas0000660DOI Listing
February 2019

Depression, Anxiety, and Stress: How Should Clinicians Interpret the Total and Subscale Scores of the 21-Item Depression, Anxiety, and Stress Scales?

Psychol Rep 2019 Aug 22;122(4):1550-1575. Epub 2018 Jun 22.

Department of Psychology, University of Mississippi, Oxford, MS, USA.

The 21-item Depression, Anxiety, and Stress Scales (DASS-21) is a self-report measure that is easy to administer, quick to score, and is freely available. Widely used in diverse settings and populations, confirmatory factor analytic evidence has accumulated for a bifactor model underlying this multidimensional measure. Studies employing an exploratory bifactor approach to more closely examine its underlying structure and inter-relations of factors, however, have been scarce. This is unfortunate because confirmatory techniques often employ indirect ways of handling model misspecification, whereas exploratory methods enable more direct approaches. Moreover, more precise approaches to modeling an exploratory bifactor structure have not been examined with the DASS-21. Based on several large samples of undergraduate students in the United States, the first two parts of the paper (Studies 1 and 2) utilized both exploratory ( = 19.7 years of age) and confirmatory factor analytic methods ( = 19.7 years of age) following those presented by contemporary multidimensional modeling theorists. Building upon these results, the third part of the paper (Study 3;  = 20.0 years of age) examined sensitivity-/specificity-related indices to provide cut-off score recommendations for a revised DASS-21 instrument based on a newly identified and supported bifactor structure. Implications of these results are discussed in terms of taxonomy, challenges inherent in multidimensional modeling, and potential use of the revised DASS-21 measure as a component of an actuarial decision-making strategy to inform clinical referrals.
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http://dx.doi.org/10.1177/0033294118783508DOI Listing
August 2019

A re-examination of the BIS/BAS scales: Evidence for BIS and BAS as unidimensional scales.

Int J Methods Psychiatr Res 2018 Jun 25;27(2):e1612. Epub 2018 Mar 25.

Psychology, Duksung Women's University, Seoul, Korea.

Objectives: Carver and White's behavioral inhibition system and behavioral activation system (BIS/BAS) scales are the most widely used to assess constructs of the revised reinforcement sensitivity theory. This study provides a re-examination of the latent structure of the original BIS/BAS scales.

Methods: The interpretability of the three purported BAS subfactors relative to a "general behavioral activation" factor was assessed using Schmid-Leiman and standard confirmatory factor analysis. Regarding the BIS scale, comparisons were made between (a) Carver and White's unidimensional BIS model, (b) Johnson, Turner, and Iwata's 2-factor BIS model, (c) Heym, Ferguson, and Lawrence's alternative 2-factor BIS model, and (d) a modified Heym et al. model (unidimensional) controlling for method effects of reverse-scored items.

Results: Results revealed the majority of variance of individual BAS items was accounted for by a common, general BAS dimension. Additionally, for the BIS scale, results of the χ difference statistical test supporting the 1-factor model, as well as the noted theoretical and psychometric difficulties in interpreting a multifactor BIS scale, provide converging support that BIS items actually represent a single, unidimensional factor.

Conclusions: The collective results suggested that the BIS and BAS scales should be conceptualized as separate unidimensional measures, which is consistent with theory behind the original development.
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http://dx.doi.org/10.1002/mpr.1612DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6877112PMC
June 2018

Psychometric investigation of the specific phobia of vomiting inventory: A new factor model.

Int J Methods Psychiatr Res 2018 03 25;27(1). Epub 2017 Jul 25.

Department of Psychology, University of Mississippi, Mississippi, USA.

Well-validated, standardized measures are lacking for the assessment of emetophobia, the specific phobia of vomiting. The Specific Phobia of Vomiting Inventory (SPOVI) was recently developed and shows promise as a useful measure of emetophobia. The goal of the present study was to further examine and investigate the psychometric properties of the SPOVI in a large student sample (n = 1626), specifically focusing on its factor structure, measurement invariance across gender, and convergent/divergent validity. Confirmatory factor analysis results provide support for a one-factor model of the SPOVI, in contrast to the previously proposed two-factor model. Internal consistency of the SPOVI was good (α = 0.89) and measurement invariance across gender invariance was supported. The SPOVI also demonstrated good psychometric properties with respect to convergent and divergent validity. The present study's demonstration of the reliability and validity of the SPOVI suggests that the instrument may be a valuable tool for assessing emetophobia symptoms based on its one-factor structure.
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http://dx.doi.org/10.1002/mpr.1574DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6877170PMC
March 2018

Structure, Reliability, Measurement Stability, and Construct Validity of the Polish Version of the Revised Child Anxiety and Depression Scale.

Assessment 2019 12 26;26(8):1492-1503. Epub 2017 May 26.

University of California, Los Angeles, CA, USA.

The Revised Child Anxiety and Depression Scale (RCADS) is a self-report questionnaire that aims to assess symptoms of anxiety and depressive disorders in children. Two studies were conducted to evaluate the psychometric properties of the Polish version of the RCADS. Study 1 was conducted to analyze the structural validity and reliability of the RCADS scores and Study 2 assessed the longitudinal measurement of stability over time. Data were collected from a community sample of 501 children and adolescents aged 8 to 14 years in Poland. The original 47-item version of the Polish RCADS was compared with two shortened versions: 30- and 20-item versions. Overall results revealed support for the structural and construct validity, reliability, and stability of the Polish version of the RCADS.
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http://dx.doi.org/10.1177/1073191117711019DOI Listing
December 2019

Psychometric Properties of the Parent Version of the Revised Child Anxiety and Depression Scale in a Clinical Sample of Turkish Children and Adolescents.

Child Psychiatry Hum Dev 2017 12;48(6):922-933

Department of Psychology, University of California, Los Angeles, CA, 90095, USA.

The Revised Child Anxiety and Depression Scale-Parent version (RCADS-P) is a self-report questionnaire that assesses dimensions of DSM-based anxiety and depressive disorders in children and adolescents. The present study examined the psychometric properties of the Turkish version in a clinical sample of 483 children and adolescents. The child and parent versions of the RCADS, parent versions of the Screen for Child Anxiety Related Emotional Disorders, the Strengths and Difficulties Questionnaire and Adolescent Symptom Inventory-Depression Scale were administered. Current psychiatric diagnoses were assessed via the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present Version. The RCADS-P demonstrated high internal consistency and test-retest reliability, and good convergent, divergent, and discriminant validity. Confirmatory factor analysis supported the DSM-related six-factor structure. With its demonstrated favorable psychometric properties, the Turkish RCADS-P is currently the only validated parent-report instrument that assesses DSM-based anxiety and depressive disorders in children and adolescents in Turkey.
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http://dx.doi.org/10.1007/s10578-017-0716-1DOI Listing
December 2017

Disgust proneness predicts obsessive-compulsive disorder symptom severity in a clinical sample of youth: Distinctions from negative affect.

J Affect Disord 2017 Apr 14;213:118-125. Epub 2017 Feb 14.

Rogers Memorial Hospital, USA.

Background: Although studies have linked disgust proneness to the etiology and maintenance of obsessive-compulsive disorder (OCD) in adults, there remains a paucity of research examining the specificity of this association among youth.

Method: The present study employed structural equation modeling to examine the association between disgust proneness, negative affect, and OCD symptom severity in a clinical sample of youth admitted to a residential treatment facility (N =471).

Results: Results indicate that disgust proneness and negative affect latent factors independently predicted an OCD symptom severity latent factor. However, when both variables were modeled as predictors simultaneously, latent disgust proneness remained significantly associated with OCD symptom severity, whereas the association between latent negative affect and OCD symptom severity became nonsignificant. Tests of mediation converged in support of disgust proneness as a significant intervening variable between negative affect and OCD symptom severity. Subsequent analysis showed that the path from disgust proneness to OCD symptom severity in the structural model was significantly stronger among those without a primary diagnosis of OCD compared to those with a primary diagnosis of OCD.

Limitations: Given the cross-sectional design, the causal inferences that can be made are limited. The present study is also limited by the exclusive reliance on self-report measures.

Conclusions: Disgust proneness may play a uniquely important role in OCD among youth.
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http://dx.doi.org/10.1016/j.jad.2017.02.017DOI Listing
April 2017

Disgust proneness predicts obsessive-compulsive disorder symptom severity in a clinical sample of youth: Distinctions from negative affect.

J Affect Disord 2017 Apr 14;213:118-125. Epub 2017 Feb 14.

Rogers Memorial Hospital, USA.

Background: Although studies have linked disgust proneness to the etiology and maintenance of obsessive-compulsive disorder (OCD) in adults, there remains a paucity of research examining the specificity of this association among youth.

Method: The present study employed structural equation modeling to examine the association between disgust proneness, negative affect, and OCD symptom severity in a clinical sample of youth admitted to a residential treatment facility (N =471).

Results: Results indicate that disgust proneness and negative affect latent factors independently predicted an OCD symptom severity latent factor. However, when both variables were modeled as predictors simultaneously, latent disgust proneness remained significantly associated with OCD symptom severity, whereas the association between latent negative affect and OCD symptom severity became nonsignificant. Tests of mediation converged in support of disgust proneness as a significant intervening variable between negative affect and OCD symptom severity. Subsequent analysis showed that the path from disgust proneness to OCD symptom severity in the structural model was significantly stronger among those without a primary diagnosis of OCD compared to those with a primary diagnosis of OCD.

Limitations: Given the cross-sectional design, the causal inferences that can be made are limited. The present study is also limited by the exclusive reliance on self-report measures.

Conclusions: Disgust proneness may play a uniquely important role in OCD among youth.
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http://dx.doi.org/10.1016/j.jad.2017.02.017DOI Listing
April 2017

Does the measure matter? On the association between disgust proneness and OCD symptoms.

J Anxiety Disord 2016 12 19;44:63-72. Epub 2016 Oct 19.

VA Tennessee Valley Healthcare System, United States.

Although some studies suggest that the association between disgust proneness (DP) and obsessive-compulsive symptoms (OCS) is specific to the contamination subtype, others suggest that DP is associated with OCS more broadly. To examine if the discrepant findings may partially reflect differences in self-report measures used, this investigation employed structural equation modeling to examine the association between DP and OCS in three samples that completed different combinations of measures of DP, OCS, and anxiety/negative affect. In Study 1 (n=626), the path from DP to contamination-based OCS was significantly stronger than the path from DP to non-contamination OCS when controlling for anxiety sensitivity. In Study 2 (n=403), the results showed that the path from DP to contamination-based OCS did not significantly differ from the path from DP to non-contamination OCS when controlling for negative affect. Lastly, Study 3 (n=296) showed that the path from DP to contamination-based OCS was significantly weaker than the path from DP to non-contamination OCS. These findings highlight that the self-report measures employed is an important moderator when making inferences about the association between DP and contamination-based OCS and non-contamination OCS.
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http://dx.doi.org/10.1016/j.janxdis.2016.10.010DOI Listing
December 2016

The utility of the bifactor model in understanding unique components of anxiety sensitivity in a South Korean sample.

Asian J Psychiatr 2016 Aug 25;22:116-23. Epub 2016 Jun 25.

Duksung Women's University, South Korea.

The present study was the first to examine the applicability of the bifactor structure underlying the Anxiety Sensitivity Index-3 (ASI-3) in an East Asian (South Korean) sample and to determine which factors in the bifactor model were significantly associated with anxiety, depression, and negative affect. Using a sample of 289 South Korean university students, we compared (a) the original 3-factor AS model, (b) a 3-group bifactor AS model, and (c) a 2-group bifactor AS model (with only the physical and social concern group factors present). Results revealed that the 2-group bifactor AS model fit the ASI-3 data the best. Relatedly, although all ASI-3 items loaded on the general AS factor, the Cognitive Concern group factor was not defined in the bifactor model and may therefore need to be omitted in order to accurately model AS when conducting factor analysis and structural equation modeling (SEM) in cross cultural contexts. SEM results also revealed that the general AS factor was the only factor from the 2-group bifactor model that significantly predicted anxiety, depression, and negative affect. Implications and importance of this new bifactor structure of Anxiety Sensitivity in East Asian samples are discussed.
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http://dx.doi.org/10.1016/j.ajp.2016.06.005DOI Listing
August 2016

Cross-Cultural Validation of the Modified Practice Attitudes Scale: Initial Factor Analysis and a New Factor Model.

Assessment 2018 Jan 11;25(1):126-138. Epub 2016 Mar 11.

4 University of Montana, Missoula, MT, USA.

Objective: The objective of this study was to create the Korean version of the Modified Practice Attitudes Scale (K-MPAS) to measure clinicians' attitudes toward evidence-based treatments (EBTs) in the Korean mental health system.

Method: Using 189 U.S. therapists and 283 members from the Korean mental health system, we examined the reliability and validity of the MPAS scores. We also conducted the first exploratory and confirmatory factor analysis on the MPAS and compared EBT attitudes across U.S. and Korean therapists.

Results: Results revealed that the inclusion of both "reversed-worded" and "non-reversed-worded" items introduced significant method effects that compromised the integrity of the one-factor MPAS model. Problems with the one-factor structure were resolved by eliminating the "non-reversed-worded" items. Reliability and validity were adequate among both Korean and U.S. therapists. Korean therapists also reported significantly more negative attitudes toward EBTs on the MPAS than U.S. therapists.

Conclusions: The K-MPAS is the first questionnaire designed to measure Korean service providers' attitudes toward EBTs to help advance the dissemination of EBTs in Korea. The current study also demonstrated the negative impacts that can be introduced by incorporating oppositely worded items into a scale, particularly with respect to factor structure and detecting significant group differences.
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http://dx.doi.org/10.1177/1073191116634202DOI Listing
January 2018

Training children's theory-of-mind: A meta-analysis of controlled studies.

Cognition 2016 May 20;150:200-12. Epub 2016 Feb 20.

Graduate School of Education, Harvard University, 503A Larsen Hall, Appian Way, Cambridge, MA 02138, USA. Electronic address:

Background: Theory-of-mind (ToM) refers to knowledge and awareness of mental states in oneself and others. Various training programs have been developed to improve ToM in children.

Objectives: In the present study, we conducted a quantitative review of ToM training programs that have been tested in controlled studies.

Data Sources: A literature search was conducted using PubMed, PsycInfo, the Cochrane Library, and manual searches.

Review Methods: We identified 32 papers with 45 studies or experiments that included 1529 children with an average age of 63 months (SD=28.7).

Results: ToM training procedures were more effective than control procedures and their aggregate effect size was moderately strong (Hedges' g=0.75, CI=0.60-0.89, p<.001). Moderator analyses revealed that although ToM training programs were generally effective, ToM skill-related outcomes increased with length of training sessions and were significantly higher in active control studies.

Conclusion: ToM training procedures can effectively enhance ToM in children.
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http://dx.doi.org/10.1016/j.cognition.2016.01.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4792776PMC
May 2016

The Revised Child Anxiety and Depression Scale 25-Parent Version: Scale Development and Validation in a School-Based and Clinical Sample.

Assessment 2017 Sep 1;24(6):712-728. Epub 2016 Feb 1.

4 University of California, Los Angeles, CA, USA.

To help facilitate the dissemination and implementation of evidence-based assessment practices, we examined the psychometric properties of the shortened 25-item version of the Revised Child Anxiety and Depression Scale-parent report (RCADS-25-P), which was based on the same items as the previously published shortened 25-item child version. We used two independent samples of youth-a school sample ( N = 967, Grades 3-12) and clinical sample ( N = 433; 6-18 years)-to examine the factor structure, reliability, and validity of the RCADS-25-P scale scores. Results revealed that the two-factor structure (i.e., depression and broad anxiety factor) fit the data well in both the school and clinical sample. All reliability estimates, including test-retest indices, exceeded benchmark for good reliability. In the school sample, the RCADS-25-P scale scores converged significantly with related criterion measures and diverged with nonrelated criterion measures. In the clinical sample, the RCADS-25-P scale scores successfully discriminated between those with and without target problem diagnoses. In both samples, child-parent agreement indices were in the expected ranges. Normative data were also reported. The RCADS-25-P thus demonstrated robust psychometric properties across both a school and clinical sample as an effective brief screening instrument to assess for depression and anxiety in children and adolescents.
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http://dx.doi.org/10.1177/1073191115627012DOI Listing
September 2017

The Loneliness Questionnaire: Establishing Measurement Invariance Across Ethnic Groups.

Assessment 2017 Sep 13;24(6):798-809. Epub 2016 Jan 13.

4 University of Mississippi, Oxford, MS, USA.

A state of loneliness describes an individual's perception of having dissatisfying social connections to others. Though it is notable across the life span, it may have particularly deleterious effects in childhood and adolescence, leading to increased risk of emotional impairment. The current study evaluates a widely used test of loneliness, the Loneliness Questionnaire, for measurement invariance across ethnic groups in a large, representative sample of youth in the 2nd to 12th grades ( N = 12,344; 41% African American) in Mississippi. Analyses were conducted using multigroup confirmatory factor analysis following a published, sequential method to examine invariance in form, factor loadings, and item intercepts. Overall, our results indicated that the instrument was invariant across ethnicities, suggesting that youth with equivalent manifest scores can be discerned as having comparable levels of latent loneliness. The loneliness scores also corresponded significantly with depression and anxiety scores for most subsamples, with one exception. These findings are discussed in the context of previous results comparing levels of loneliness across ethnicities. Additionally, the broader context of the need to expand invariance studies in instrumentation work is highlighted.
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http://dx.doi.org/10.1177/1073191115625799DOI Listing
September 2017

The Revised Child Anxiety and Depression Scale - Parent Version: Extended Applicability and Validity for Use with Younger Youth and Children with Histories of Early-Life Caregiver Neglect.

J Psychopathol Behav Assess 2015 Dec 29;37(4):705-718. Epub 2015 May 29.

Department of Psychology, University of California, Los Angeles, CA, USA.

The Revised Child Anxiety and Depression Scale - Parent Version (RCADS-P) is a widely used parent-report measure, initially developed to assess anxiety and depression in youth in grades 3-12 from school-based and clinic-referred settings. It is important however to be able to assess these problems in even younger children due to the need for earlier understanding, identification, intervention and prevention efforts of anxiety and depression in younger children, and continual monitoring of these problems across the youth life span. For the present study, we used a sample of 307 children and adolescents ages 3.0 to 17.5 years old (=8.68, =4.10). For the first set of analyses, we divided the sample into Younger youth (kindergarten to grade 2; n=152) and Older youth (grade 3 to 12; n=155) to see whether each group independently met benchmarks for acceptable reliability and validity. Given the number of children who also develop anxiety and depression following early-life adversities and adverse care (such as caregiver neglect), we also divided our sample differently into a Post-Institutionalized group (i.e., previously institutionalized youth; n=100) and a Comparison group (i.e., youth without histories of early-life caregiver neglect; n=195) to examine whether each of these groups also met benchmarks for acceptable reliability and validity. Specifically, in each of these grade and experience groups, we examined the factor structure (including measurement invariance), internal consistency and convergent and discriminant validity of the RCADS-P anxiety and depression scales scores. Results demonstrated that younger youth RCADS-P reports were associated with acceptable reliability and validity estimates. Similar support for the RCADS-P scores was found for the Post-Institutionalized youth. The present study therefore extends needed support for the use of the RCADS-P to assess and monitor these two new and important youth groups.
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http://dx.doi.org/10.1007/s10862-015-9494-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6197808PMC
December 2015

Children's emotion understanding: A meta-analysis of training studies.

Dev Rev 2015 Sep;37:41-65

Department of Psychological and Brain Sciences, Boston University (USA).

Background: In the course of development, children show increased insight and understanding of emotions-both of their own emotions and those of others. However, little is known about the efficacy of training programs aimed at improving children's understanding of emotion.

Objectives: To conduct an effect size analysis of trainings aimed at three aspects of emotion understanding: external aspects (i.e., the recognition of emotional expressions, understanding external causes of emotion, understanding the influence of reminders on present emotions); mental aspects (i.e., understanding desire-based emotions, understanding belief-based emotions, understanding hidden emotions); and reflective aspects (i.e., understanding the regulation of an emotion, understanding mixed emotions, understanding moral emotions).

Data Sources: A literature search was conducted using PubMed, PsycInfo, the Cochrane Library, and manual searches.

Review Methods: The search identified 19 studies or experiments including a total of 749 children with an average age of 86 months (.=30.71) from seven different countries.

Results: Emotion understanding training procedures are effective for improving external (Hedge's = 0.62), mental (Hedge's = 0.31), and reflective (Hedge's = 0.64) aspects of emotion understanding. These effect sizes were robust and generally unrelated to the number and lengths of training sessions, length of the training period, year of publication, and sample type. However, training setting and social setting moderated the effect of emotion understanding training on the understanding of external aspects of emotion. For the length of training session and social setting, we observed significant moderator effects of training on reflective aspects of emotion.

Conclusion: Emotion understanding training may be a promising tool for both preventive intervention and the psychotherapeutic process. However, more well-controlled studies are needed.
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http://dx.doi.org/10.1016/j.dr.2015.05.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4576850PMC
September 2015

Examination of a Bifactor Model of Obsessive-Compulsive Symptom Dimensions.

Assessment 2017 Jan 25;24(1):45-59. Epub 2015 Aug 25.

University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Although obsessive-compulsive (OC) symptoms are observed along four dimensions (contamination, responsibility for harm, order/symmetry, and unacceptable thoughts), the structure of the dimensions remains unclear. The current study evaluated a bifactor model of OC symptoms among those with and without obsessive-compulsive disorder (OCD). The goals were (a) to evaluate if OC symptoms should be conceptualized as unidimensional or whether distinct dimensions should be interpreted and (b) to use structural equation modeling to examine the convergence of the OC dimensions above and beyond a general dimension with related criteria. Results revealed that a bifactor model fit the data well and that OC symptoms were influenced by a general dimension and by four dimensions. Measurement invariance of the bifactor model was also supported among those with and without OCD. However, the general OC dimension accounted for only half of the variability in OC symptoms, with the remaining variability accounted for by distinct dimensions. Despite evidence of multidimensionality, the dimensions were unreliable after covarying for the general OC dimension. However, the four dimensions did significantly converge with a latent OC spectrum factor above and beyond the general OC dimension. The implications of these findings for conceptualizing the structure of OCD are discussed.
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http://dx.doi.org/10.1177/1073191115601207DOI Listing
January 2017

The Child PTSD Symptom Scale: An Investigation of Its Psychometric Properties.

J Interpers Violence 2017 08 12;32(15):2237-2256. Epub 2015 Aug 12.

4 University of Mississippi, Oxford, MS, USA.

The current study addresses the need for accurate measurement of posttraumatic stress disorder (PTSD) symptoms in youth by investigating the psychometric properties of the Child PTSD Symptom Scale (CPSS). The factor structure, reliability, and concurrent and discriminant validity of the CPSS were investigated in a sample of 206 6th- to 12th-grade adolescents. Exploratory and confirmatory factor analysis supported a single-factor structure, which was contrary to the hypothesized three-factor structure. Scores comprising this one-factor structure were also associated with high reliability (α = .93), and tests of concurrent and discriminant validity were also strong. The implications of these findings are discussed, with particular emphasis on future directions for research on self-report measures for adolescent PTSD symptoms.
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http://dx.doi.org/10.1177/0886260515596536DOI Listing
August 2017

Building an evidence-informed service array: Considering evidence-based programs as well as their practice elements.

J Consult Clin Psychol 2015 Dec 1;83(6):1085-96. Epub 2015 Jun 1.

Department of Psychiatry, University of California, San Francisco.

Objective: This study empirically examined options for building an evidence-informed service array, comparing strategies to maximize the application of evidence-based treatment literature in a clinical service system. The overall goal was to determine the smallest set of treatments that could serve the largest percentage of clients. Solutions to this problem differ depending on how one defines "treatment."

Method: Treatments were conceptualized as (a) programs (integrated treatments produced by specific research laboratories or investigators), and (b) collections of their constituent common procedures, referred to as practice elements. Programs listed by 2 separate government-sanctioned registries were selected to illustrate the effects of "program" conceptualizations, and all available clinical trials testing the programs were analyzed. Practice elements were identified from these same studies and from studies of other treatments that met a standard of evidence but had not been organized into programs on these lists. Relevance mapping methodology was used to identify optimal sets of programs and practice elements.

Results: Among a large, diverse clinical population, results identified 11%-22% of youths for whom practice elements provide an evidence-informed treatment option whereas no programs meeting the standard of evidence were available on the registries. Results for the practice elements were able to be matched by a hybrid combination: "best" programs, which were then extended by practice elements.

Conclusions: These results demonstrated that there are multiple ways to conceptualize treatments when planning a service array, and these options have significant implications regarding who can be served by treatments supported by evidence.
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http://dx.doi.org/10.1037/ccp0000029DOI Listing
December 2015

Self-harm history predicts resistance to inpatient treatment of body shape aversion in women with eating disorders: The role of negative affect.

J Psychiatr Res 2015 Jun 27;65:37-46. Epub 2015 Mar 27.

Remuda Ranch Programs for Eating Disorders, USA.

Although self-harm has been observed among patients with eating disorders, the effects of such tendencies on treatment outcomes are unclear. The current study employed structural equation modeling to (a) evaluate the relationship between self-harm and changes in body dissatisfaction and drive for thinness in a large sample of patients (n = 2061) who underwent inpatient treatment, and (b) to examine whether the relationship between self-harm and changes in body dissatisfaction and drive for thinness during inpatient treatment remains significant when controlling for change in negative affect during treatment. Results revealed that patients with a history of self-harm reported significantly less reduction in body dissatisfaction and drive for thinness following treatment. Patients experiencing less change in negative affect also reported significantly less reduction in body dissatisfaction and drive for thinness after discharge from treatment. However, the association between history of self-harm and reduction in body dissatisfaction and drive for thinness after treatment became non-significant when controlling for change in negative affect. This pattern of findings was also replicated among patients with a primary diagnosis of anorexia nervosa (n = 845), bulimia nervosa (n = 565), and eating disorder not otherwise specified (n = 651). The implications of these findings for delineating the specific role of self-harm in the nature and treatment of eating disorders are discussed.
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http://dx.doi.org/10.1016/j.jpsychires.2015.03.016DOI Listing
June 2015

Development and initial validation of the Child Disgust Scale.

Psychol Assess 2015 Sep 6;27(3):1082-96. Epub 2015 Apr 6.

Department of Psychology, Vanderbilt University.

Although disgust sensitivity (DS) has been implicated in the development of anxiety disorders in children, the absence of a measure of DS specifically for children has not allowed for an adequate test of this claim. To fill this important gap in the literature, this investigation presents a series of studies on the development and examination of the psychometric properties (including reliability, validity, and factor structure) of scores on a newly developed Child Disgust Scale (CDS). Exploratory factor analysis in Study 1 (N = 1,500) found that a bifactor model, which allows for a "g" DS factor in addition to 2 distinct factors of Disgust Avoidance and Disgust Affect, was the best fit for the data. Study 2 (N = 573) confirmed a two-factor bifactor model above and beyond a 1-factor model that controlled for method effects due to reverse-worded items. Results from Study 3 (N = 50) provided support for convergent and discriminant validity such that scores on the CDS were significantly correlated with measures of anxiety and fear, but not depression. Finally, Study 4 (N = 86) found that the CDS differentiated children with a diagnosis of specific phobia (n = 43) from a matched nonclinical community sample of children (n = 43), such that those with a specific phobia reported greater DS compared with controls. Results from these studies suggest that the CDS is a developmentally appropriate measure with good psychometric properties that can aid research on the role of disgust sensitivity in anxiety-related disorders in children.
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http://dx.doi.org/10.1037/a0038925DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4821989PMC
September 2015

Examination of a bifactor model of the Three Domains of Disgust Scale: specificity in relation to obsessive-compulsive symptoms.

Psychol Assess 2015 Mar 17;27(1):102-13. Epub 2014 Nov 17.

Department of Psychiatry, Veterans Affairs Tennessee Valley Healthcare System.

The current research evaluated a bifactor model for the Three Domains of Disgust Scale (TDDS) in 2 undergraduate samples. The goals were (a) to evaluate whether the TDDS should be scored as a unidimensional scale or whether subscales of pathogen, sex, and moral disgust should be additionally interpreted, and (b) to examine the utility of the TDDS subscales above and beyond the total score in predicting obsessive-compulsive disorder (OCD) symptoms. Results in Study 1 and Study 2 revealed that a bifactor model fit the TDDS data well and that all items were influenced by a general disgust dimension and by 1 of 3 content dimensions. However, model-based reliability estimated via omega hierarchical for the total score suggested that TDDS items are highly multidimensional. That is, the general disgust dimension only accounts for about half of the variability in the items of the total score, with the remaining variability accounted for by the specific disgust domains and other sources of variance. Despite the high degree of multidimensionality underlying the TDDS items, the pathogen and sex subscale scores were found to be relatively unreliable after controlling for the general disgust factor. Among the 3 domains, pathogen disgust had the most consistently significant relationship with an OCD symptom latent factor above and beyond the general disgust factor. The strengths and limitations of the TDDS are discussed in the context of these findings, and the implications for better understanding the structure of disgust and its relationship with OCD are outlined.
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http://dx.doi.org/10.1037/pas0000039DOI Listing
March 2015

Self-consciousness and social anxiety in youth: the Revised Self-Consciousness Scales for Children.

Psychol Assess 2014 Dec 28;26(4):1292-306. Epub 2014 Jul 28.

Department of Psychology, University of California.

Despite the established relationship between self-consciousness (SC) and anxiety and depression in adults, there is a paucity of research examining SC in children and adolescents. We therefore sought to examine the factor structure, reliability, and validity of scores for a revised version of the Self-Consciousness Scales for Children, a measure of SC in youth. The Revised Self-Consciousness Scale for Children (R-SCS-C) was examined in 2 studies using a community sample of children and adolescents. In the 1st study, 1,207 youth (685 girls) ages 7 to 18 completed the R-SCS-C as well as measures of imaginary audience, anxiety, depression, and positive and negative affect. Results of an exploratory factor analysis of the R-SCS-C conducted on a randomly selected subsample (n = 603) supported a 3-factor solution, including the subscales of Public Self-Consciousness, Private Self-Consciousness, and Social Anxiety. A subsequent confirmatory factor analysis (CFA) conducted on the remaining half of the sample (n = 604) revealed that this model fit the data well. Additionally, subsequent multigroup CFAs by gender and age demonstrated good model fit across both gender and younger (ages 7 to 12 years) and older (ages 13 to 18 years) cohorts. In the 2nd study, 245 youth completed the R-SCS-C twice, approximately 2 weeks apart. The R-SCS-C scores in these samples demonstrated acceptable internal consistency, convergent and divergent validity, and test-retest reliability. Implications of these findings and directions for future research are discussed.
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http://dx.doi.org/10.1037/a0037386DOI Listing
December 2014

A bifactor model of disgust proneness: examination of the Disgust Emotion Scale.

Assessment 2015 Apr 7;22(2):248-62. Epub 2014 Jul 7.

University of California-Los Angeles, Los Angeles, CA, USA.

The current research evaluated a bifactor model for the Disgust Emotion Scale (DES) in three samples: N = 1,318 nonclinical participants, N = 152 clinic-referred patients, and N = 352 nonclinical participants. The primary goals were to (a) use bifactor modeling to examine the latent structure of the DES and in turn (b) evaluate whether the DES should be scored as a unidimensional scale or whether subscales should also be interpreted. Results suggested that a bifactor model fit the DES data well and that all DES items were strongly influenced by a general disgust proneness dimension and by five content dimensions. Moreover, model-based reliability analyses suggested that scoring a general disgust dimension is justified despite the confirmed multidimensional structure. However, subscales were found to be unreliable after controlling for the general disgust factor with the potential exception of the Mutilation/Death and Animals subscale. Subsequent analysis also showed that only the general disgust factor robustly predicted an obsessive-compulsive disorder symptom latent factor-a clinical condition closely related to disgust proneness; latent variables representing DES domains displayed weak relations with an obsessive-compulsive disorder factor above and beyond the general disgust factor. Implications for better understanding the structure of DES responses and its use in clinical research are discussed.
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http://dx.doi.org/10.1177/1073191114541673DOI Listing
April 2015

Specificity of disgust domains in the prediction of contamination anxiety and avoidance: a multimodal examination.

Behav Ther 2014 Jul 16;45(4):469-81. Epub 2014 Feb 16.

Mayo Clinic.

Although core, animal-reminder, and contamination disgust are viewed as distinct "types" of disgust vulnerabilities, the extent to which individual differences in the three disgust domains uniquely predict contamination-related anxiety and avoidance remains unclear. Three studies were conducted to fill this important gap in the literature. Study 1 was conducted to first determine if the three types of disgust could be replicated in a larger and more heterogeneous sample. Confirmatory factor analysis revealed that a bifactor model consisting of a "general disgust" dimension and the three distinct disgust dimensions yielded a better fit than a one-factor model. Structural equation modeling in Study 2 showed that while latent core, animal-reminder, and contamination disgust factors each uniquely predicted a latent "contamination anxiety" factor above and beyond general disgust, only animal-reminder uniquely predicted a latent "non-contamination anxiety" factor above and beyond general disgust. However, Study 3 found that only contamination disgust uniquely predicted behavioral avoidance in a public restroom where contamination concerns are salient. These findings suggest that although the three disgust domains are associated with contamination anxiety and avoidance, individual differences in contamination disgust sensitivity appear to be most uniquely predictive of contamination-related distress. The implications of these findings for the development and maintenance of anxiety-related disorders marked by excessive contamination concerns are discussed.
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http://dx.doi.org/10.1016/j.beth.2014.02.006DOI Listing
July 2014

Program and practice elements for placement prevention: a review of interventions and their effectiveness in promoting home-based care.

Am J Orthopsychiatry 2014 May;84(3):244-56

School of Social Work, University of Maryland.

Preventing unnecessary out-of-home placement for youth with behavioral and emotional needs is a goal of several public child-serving services, including child welfare, juvenile justice, and child mental health. Although a small number of manualized interventions have been created to promote family driven and community-based services and have empirical support, other less established programs have been initiated by local jurisdictions to prevent out-of-home placement. To synthesize what is known about efforts to prevent placement, this article describes the common program and practice elements of interventions described in 37 studies (published in 51 articles) that measured placement prevention outcomes for youth at risk for out-of-home care because of behavioral or mental health needs. The most common program elements across published interventions were program monitoring, case management, and accessibility promotion. The most common clinical practice elements for working with youth were assessment and individual therapy; for caregivers, problem solving skills were most frequently included; and family therapy was most common for the family unit. Effect size estimates for placement-related outcomes (decreased out-of-home placement, decreased hospitalization, decreased incarceration, and decreased costs) were calculated to estimate the treatment effectiveness of the interventions in which the program components and clinical practices are embedded.
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http://dx.doi.org/10.1037/h0099811DOI Listing
May 2014

The role of violence exposure and negative affect in understanding child and adolescent aggression.

Child Psychiatry Hum Dev 2014 Dec;45(6):736-45

Department of Psychology, Duksung Women's University, Seoul, Korea,

Aggressive behaviors in youth tend to be relatively stable across the lifespan and are associated with maladaptive functioning later in life. Researchers have recently identified that both violence exposure and negative affective experiences are related to the development of aggressive behaviors. Children exposed to violence also often experience negative affect (NA) in the form of anxiety and depression. Bringing these findings together, the current study used a clinical sample of youth (N = 199; ages 7-17 years) referred to a psychiatric residential treatment facility to examine the specific contributions of NA and exposure to violence on the development of aggressive behaviors in youth. Using structural equation modeling, both NA and recent exposure to violence significantly predicted aggressive behaviors. More importantly, negative affect partially mediated the relationship between exposure to violence and aggression. Implications of these findings from a clinical perspective and future directions for research on aggression are discussed.
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http://dx.doi.org/10.1007/s10578-014-0442-xDOI Listing
December 2014

The Development and Psychometric Investigation of the Cyberbullying Scale.

J Interpers Violence 2014 Aug 14;29(12):2218-2238. Epub 2014 Jan 14.

University of Mississippi, University, USA.

Accurate assessment of cyberbullying is essential for intervention planning and evaluation. Limitations to many currently available self-report measures of cyberbullying victimization include a lack of psychometric information and a limited scope (i.e., not assessing multiple electronic mediums of cybervictimization). To address these limitations, we developed and investigated the psychometric properties of a broad self-report measure of cyberbullying, the Cyberbullying Scale (CBS). We examined the factor structure and reliability of the CBS across 736 students in Grades 6 to 12 in six Northern Mississippi schools. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) results indicated that the structure of the CBS was best represented by a one-factor model. The finding of a single-factor structure suggests that cyberbullying is a unidimensional construct, which is consistent with previous research. In the current sample, the CBS demonstrated strong psychometric properties, including excellent internal consistency (Cronbach's α = .94) and significant positive correlations with related constructs of anxiety, depression, and loneliness. Results from the present study provide initial support for the CBS as a measure of cybervictimization among adolescents.
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http://dx.doi.org/10.1177/0886260513517552DOI Listing
August 2014