Beck Anxiety Inventory

BAI and M.I.N.I.

Beck Anxiety Inventory

• M.I.N.I. = short, diagnostic questionnaire assessing a wide range of disorders

• Similarities:
• administration time
• self-report questionnaire

• Differences:
• Likert scale
• severity
• many subsets of M.I.N.I.

• Strengths of M.I.N.I.:
• Targets specific disorders
• Length and numbers of items

• Weakness = lack of severity

Strengths

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• Commonly accepted measure of anxiety

1. Restlessness or feeling keyed up or on edge.

3. Difficulty concentrating or mind going blank.

4. Irritability.

5. Muscle tension.

6. Sleep disturbance.

2. Being easily fatigued.

• Brief

One study developed cut-off scores to differentiate anxious conditions, but the scores correctly diagnosed less than half the time.

• 4 categories of symptoms (specific treatment)
• subjective
• neurophysiologic
• autonomic
• panic-related

• Wide age range

Reliability

• Ability to assess severity

• High internal consistency reliability

• Beck, Epstein, et al. (1988): 160 patients
• Cronbach coefficient alpha = .92

Weaknesses

• Fydrich et al. (1990), 40 patients
• Cronbach coefficient alpha = .94

• Subsample of 83 patients from Beck: correlation between intake and one-week BAI scores = 0.75

• Limited scope of symptoms (mainly somatic)

Content Validity

• Moderate correlation between BAI/BDI-II

• BAI content corresponds to symptom criteria in DSM-III-R; guidelines for diagnosing patients with anxiety disorders

• Lack of differentiation between disorders

Test Reliability & Validity

• Reliability of test items:
• .85 (GAD)
• .91 (social phobia)
• .91 (OCD)
• .92 (panic w/o agoraphobia)
• .93 (panic w/ agoraphobia)

• Samples not ethnically/socio-economically diverse

• Range of high scores quite large (26-63)

Development

• Potential for misdiagnosis

• Beck, Epstein, Brown, and Steer (1988)

• Items taken from three earlier anxiety measuring instruments:
• Anxiety Check List (ACL)
• PDR Check List
• Situational Anxiety Checklist (SAC)
• BAI examines four aspects: neurophysiologic, subjective, panic, autonomic
• Clients rate 21 descriptive statements of anxiety on a 4-point Likert scale

• Fydrich, Dowdall, and Chambless (1990)

• BAI Manual (1993)

Concurrent Validity

• Hamilton Anxiety Rating Scale - Revised: .51

• Cognition Check List: .51

• Beck, Epstein, et al. (1988): three successive samples, 1086 patients (456 m/630 w)

• State-Trait Anxiety Inventory (Form Y): .58 (Trait subscale), .47 (State subscale)

Overview

• BAI significantly/substantially related to other anxiety measures

http://goo.gl/VUEoPN

• Measures self-reported severity of anxiety

• 21-item scale

Interpretation

• Only an estimate of the severity of anxiety

• Used with adolescents and adults

• Clinicians should keep in mind other aspects of psychological functioning

• Clinicians should be prepared to provide appropriate therapeutic intervention

• Examiners should inspect scores for patterns of symptom complaints

Test Uses

• Developed by Aaron Beck and colleagues in 1988

Construct Validity

Implications

• Other anxiety measures have been highly related to depression measures

• Created by Beck in 1988 to discriminate anxiety from depression

• Correlations between BAI and depression measures (e.g. BDI) < correlations to other self-report anxiety measures

• Measure of client's self-reported anxiety

Scoring

Panic vs. Anxiety

• studies suggest BAI does not measure general anxiety, but panic symptoms (Leyfer, Ruberg, & Woodruff-Borden, 2006; Cox, Cohen, Direnfeld, & Swinson 1996)

• significantly higher scores on BAI for those with panic disorder

• Leyfer et. al. – best used to assess panic symptoms or as a screening tool

• anxiety symptoms with depression overlap excluded

" ... the BAI does not provide a truly valid quantitative assessment of anxiety symptamotology, but rather an appraisal of one as of anxiety that may need to be augmented with other forms of data collection"

(Leyfer et al., 2006, p. 457)

• Measures symptoms of anxiety that are minimally measured by BDI

• Items scored on 4-point scale ranging from 0-3
• "Not at all" - 0 points
• "Mildly; it did not bother me much" - 1 point
• "Moderately; it was unpleasant, but I could stand it" - 2 points
• "Severely; I could barely stand it" - 3 points

• Expect to use it more than once

• Total score = sum of ratings of 21 items
• Maximum total score = 63

• Assess anxiety treatment outcome

• Significantly and substantially related to other accepted measures of anxiety

These scoring guidelines from the 1993 manual differ slightly from previous editions.

Who Benefits?

• Age 17 and up

• It is NOT a diagnostic tool – it is a pre-screening tool for the presence of an anxiety disorder

• Psychiatric outpatients (Beck), but current research indicates it is also beneficial for clinical and psychotherapy populations

• Correlations between other instruments related to both self-reported and clinically related anxiety

• 16 and under may benefit (recent study)

• Needs further study as populations taking the test grow

• Used for informative purposes

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Ayala, R.J. De, Vonderharr-Carlson, D.J., & Kim, D. (2005). Assessing the reliability of the Beck anxiety inventory scores. Educational and Psychological Measurement, 65(5), 836-850.

Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology, 56(6), 893-897. Retrieved from http://mbh.hku.hk/icourse/documents/backup/MSBH7002%20-%20Beck%20(Anxiety)%201988.pdf.

Cox, B.J., Cohen, E., Direnfeld, D.M. & Swinson, R.P. (1996). Does the Beck anxiety inventory measure anything beyond panic attack symptoms? Behaviour Research and Therapy, 34(11/12), 949-954.

Fydrich T., Dowdall D., & Chambless D.L. (1992). Reality and validity of the Beck anxiety inventory. Journal of Anxiety Disorders, 6(1), 55-61.

Grant, M.M. (n.d.). Beck Anxiety Inventory. Myrtle Beach, SC: Coastal Centre for Cognitive Therapy, PA. Retrieved 7 October 2014 from http://goo.gl/Wx6mIM.

Julian, L.J. (2011). Measures of anxiety. Arthritis Care Res (Hoboken), 63, 0-11.

Leyfer, O.T., Ruberg, J.L., & Woodruff-Borden, J. (2006). Examination of the utility of the Beck anxiety inventory and its factors as a screener for anxiety disorders. Journal of Anxiety Disorders, 20(4), 444-458.

Muntingh, A.D.T., van der Feltz-Cornelis, C.M., van Marwijk, H.W.J., Spinhoven, P., Penninx, B.W.J.H., & van Balkom, A.J.L.M. (2011). Is the Beck anxiety inventory a good tool to assess the severity of anxiety? A primary care study in the Netherlands study of depression and anxiety. BMC Family Practice, 12(66).

Piotrowski, C. (1999). The status of the Beck anxiety inventory in contemporary research. Psychological Reports, 85(1), 261-262. Retrieved from http://goo.gl/uCRdZ6.

Sheppard, G., Schulz, W., & McMahon, S. (2007). The Code of Ethics. Retrieved 19 October 2014 from http://www.ccacc.ca/_documents/CodeofEthics_en_new.pdf.

• Not meant to be rushed or to provide a quantitative assessment of anxiety

Administration

Implications Cont.

Why Use BAI?

• Use with other forms of data collection

• Self-administered (5-10 minutes)

• Self-reported anxiety

• Common symptoms

• Orally administered (10 minutes)

• Moderate overlap between BAI scores and ability to discriminate combinations of primary mental and primary depressive disorders

• Repeatability

• Well-lit, quiet testing environment

• Distinguishes anxiety from depression, panic, and suicidal ideation

How to Approach the BAI

• Response Sets

• Appropriate therapeutic interventions

• Show connection between body & mind

• Holistically

• 13 languages

• Caution, not a sole determinant of information

Ethical Standards

• Use in conjunction with other scales

• Consider other aspects of psychological functioning

• Fundamental principles of CCPA:
• Beneficence
• Fidelity
• Non-maleficence
• Autonomy
• Justice
• Social Interest

• Unexpected high scoring might be related to:
• Undetected medical conditions
• An abnormal week prior to the test (uncommon events or circumstances)
• Other reasons?

Interpretation

What do these scores suggest?

Meditation Time!

• 21 items based on a 4-point Likert scale:
• 0-7 minimal anxiety
• 8-15 mild
• 16-25 moderate
• 26-63 severe

• Research finds common reasons for falling within a particular range