Skip to main content
SpringerLink
Log in

Development of the Interpretation Bias Index for PTSD

  • Original Article
  • Published:
Cognitive Therapy and Research Aims and scope Submit manuscript

Abstract

Cognitive models of posttraumatic stress disorder (PTSD) implicate interpretation biases as a maintaining factor of symptoms. Existing measures index symptoms and negative beliefs in PTSD patients, but not threatening interpretation of socially-ambiguous information, which would further inform cognitive models of PTSD. Here we describe the development of a measure of interpretation bias specific to individuals with PTSD. Studies 1 and 2 utilized analog samples to identify the smallest set of items capable of differentiating PTSD-specific interpretation biases. Study 3 utilized a clinical sample to examine the factor structure of the 9-item Interpretation Bias Index for PTSD (IBIP). A bifactor model fit the IBIP best, comprising a general PTSD factor and two subfactors. The IBIP was most strongly related to PTSD symptoms and demonstrated sensitivity and specificity to detecting true PTSD cases. The IBIP has potential clinical utility for tracking interpretation bias in PTSD, or even screening for PTSD diagnoses.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Notes

  1. As an alternative demonstration of discriminant validity, separate hierarchical regression models tested the incremental effect of IBIP total and subscale scores in predicting PSWQ, BDI-II, and PCL-C scores. A similar pattern of results emerged, wherein after controlling for the other two symptom measures in the first step, the IBIP total and ‘hypervigilance/avoidance’ subscale scores contributed the largest amount of additional variance to PCL-C, PSWQ, and BDI-II scores, respectively, but the IBIP ‘intrusions’ subscale contributed unique variance only to PCL-C scores.

References

  • Adkins, J. W., Weathers, F. W., McDevitt-Murphy, M., & Daniels, J. B. (2008). Psychometric properties of seven self-report measures of posttraumatic stress disorder in college students with mixed civilian trauma exposure. Journal of Anxiety Disorders, 22(8), 1393–1402.

    Article  PubMed  Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th edn.). Washington, DC.

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th edn.). Washington, DC.

  • Amir, N., Coles, M. E., & Foa, E. B. (2002). Automatic and strategic activation and inhibition of threat-relevant information in posttraumatic stress disorder. Cognitive Therapy and Research, 26(5), 645–655.

    Article  Google Scholar 

  • Amir, N., Prouvost, C., & Kuckertz, J. M. (2012). Lack of a benign interpretation bias in social anxiety disorder. Cognitive Behaviour Therapy, 41(2), 119–129. https://doi.org/10.1080/16506073.2012.662655.

    Article  PubMed  PubMed Central  Google Scholar 

  • Badura-Brack, A. S., Naim, R., Ryan, T. J., Levy, O., Abend, R., Khanna, M. M., et al. (2015). Effect of attention training on attention bias variability and PTSD symptoms: Randomized controlled trials in Israeli and US combat veterans. American Journal of Psychiatry, 172(12), 1233–1241. https://doi.org/10.1176/appi.ajp.2015.14121578.

    Article  PubMed  Google Scholar 

  • Beard, C., & Amir, N. (2009). Interpretation in social anxiety: When meaning precedes ambiguity. Cognitive Therapy and Research, 33(4), 406–415.

    Article  PubMed  PubMed Central  Google Scholar 

  • Beck, A. T., & Clark, D. A. (1988). Anxiety and depression: An information processing perspective. Anxiety Research, 1(1), 23–36.

    Article  Google Scholar 

  • Beck, A. T., & Clark, D. A. (1997). An information processing model of anxiety: Automatic and strategic processes. Behaviour Research and Therapy, 35(1), 49–58.

    Article  PubMed  CAS  Google Scholar 

  • Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck depression inventory-II. San Antonio, TX.

  • Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society. Series B (Methodological), 57(1), 289–300.

    Google Scholar 

  • Bomyea, J., Risbrough, V., & Lang, A. J. (2012). A consideration of select pre-trauma factors as key vulnerabilities in PTSD. Clinical Psychology Review, 32(7), 630–641. https://doi.org/10.1016/j.cpr.2012.06.008.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bomyea, J., Stein, M. B., & Lang, A. J. (2015). Interference control training for PTSD: A randomized controlled trial of a novel computer-based intervention. Journal of Anxiety Disorders, 34, 33–42. https://doi.org/10.1016/j.janxdis.2015.05.010.

    Article  PubMed  PubMed Central  Google Scholar 

  • Chemtob, C., Roitblat, H. L., Hamada, R. S., Carlson, J. G., & Twentyman, C. T. (1988). A cognitive action theory of post-traumatic stress disorder. Journal of Anxiety Disorders, 2(3), 253–275. https://doi.org/10.1016/0887-6185(88)90006-0.

    Article  Google Scholar 

  • Chen, F. F., Hayes, A., Carver, C. S., Laurenceau, J.-P., & Zhang, Z. (2012). Modeling general and specific variance in multifaceted constructs: A comparison of the bifactor model to other approaches. Journal of Personality, 80(1), 219–251. https://doi.org/10.1111/j.1467-6494.2011.00739.x.

    Article  PubMed  Google Scholar 

  • Dillon, K. H., Allan, N. P., Cougle, J. R., & Fincham, F. D. (2016). Measuring hostile interpretation bias: The WSAP-hostility scale. Assessment, 23(6), 707–719. https://doi.org/10.1177/1073191115599052.

    Article  PubMed  Google Scholar 

  • Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4), 319–345. https://doi.org/10.1016/S0005-7967(99)00123-0.

    Article  PubMed  CAS  Google Scholar 

  • Ehring, T., & Watkins, E. R. (2008). Repetitive negative thinking as a transdiagnostic process. International Journal of Cognitive Therapy, 1(3), 192–205.

    Article  Google Scholar 

  • Elwood, L. S., Williams, N. L., Olatunji, B. O., & Lohr, J. M. (2007). Interpretation biases in victims and non-victims of interpersonal trauma and their relation to symptom development. Journal of Anxiety Disorders, 21(4), 554–567. https://doi.org/10.1016/j.janxdis.2006.08.006.

    Article  PubMed  Google Scholar 

  • First, M. B., Williams, J. B. W., Karg, R. S., & Spitzer, R. L. (2015). Structured clinical interview for DSM-5—Research version (SCID-5-RV). Arlington, VA: American Psychiatric Association.

    Google Scholar 

  • Foa, E. B., Ehlers, A., Clark, D. M., Tolin, D. F., & Orsillo, S. M. (1999). The Posttraumatic Cognitions Inventory (PTCI): Development and validation. Psychological Assessment, 11(3), 303–314. https://doi.org/10.1037/1040-3590.11.3.303.

    Article  Google Scholar 

  • Frans, Ö, Rimmö, P. A., Åberg, L., & Fredrikson, M. (2005). Trauma exposure and post-traumatic stress disorder in the general population. Acta Psychiatrica Scandinavica, 111(4), 291–290. https://doi.org/10.1111/j.1600-0447.2004.00463.x.

    Article  Google Scholar 

  • Fresco, D. M., Heimberg, R. G., Mennin, D. S., & Turk, C. L. (2002). Confirmatory factor analysis of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 40(3), 313–323. https://doi.org/10.1016/S0005-7967(00)00113-3.

    Article  PubMed  Google Scholar 

  • Hayton, J. C., Allen, D. G., & Scarpello, V. (2004). Factor retention decisions in exploratory factor analysis: A tutorial on parallel analysis. Organizational Research Methods, 7(2), 191–205. https://doi.org/10.1177/1094428104263675.

    Article  Google Scholar 

  • Hindash, A. H. C., & Amir, N. (2012). Negative interpretation bias in individuals with depressive symptoms. Cognitive Therapy and Research, 36(5), 502–511.

    Article  Google Scholar 

  • Kaiser, H. F. (1960). The application of electronic computers to factor analysis. Educational and Psychological Measurement, 20, 141–151. https://doi.org/10.1177/001316446002000116.

    Article  Google Scholar 

  • Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). LIfetime prevalence and age-of-onset distributions of dsm-iv disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62(6), 593–602. https://doi.org/10.1001/archpsyc.62.6.593.

    Article  PubMed  Google Scholar 

  • Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). POsttraumatic stress disorder in the national comorbidity survey. Archives of General Psychiatry, 52(12), 1048–1060. https://doi.org/10.1001/archpsyc.1995.03950240066012.

    Article  PubMed  CAS  Google Scholar 

  • Kimble, M., Batterink, L., Marks, E., Ross, C., & Fleming, K. (2012). Negative expectancies in posttraumatic stress disorder: Neurophysiological (N400) and behavioral evidence. Journal of Psychiatric Research, 46(7), 849–855. https://doi.org/10.1016/j.jpsychires.2012.03.023.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kuckertz, J. M., Amir, N., Boffa, J. W., Warren, C. K., Rindt, S. E. M., Norman, S.,.. . McLay, R. (2014). The effectiveness of an attention bias modification program as an adjunctive treatment for Post-Traumatic Stress Disorder. Behaviour Research and Therapy, 63, 25–35. https://doi.org/10.1016/j.brat.2014.09.002.

    Article  PubMed  Google Scholar 

  • Kuckertz, J. M., Amir, N., Tobin, A. C., & Najmi, S. (2013). Interpretation of Ambiguity in Individuals with Obsessive-Compulsive Symptoms. Cognitive Therapy and Research, 37(2), 232–241. https://doi.org/10.1007/s10608-012-9478-z.

    Article  Google Scholar 

  • MacCallum, R. C., Browne, M. W., & Sugawara, H. M. (1996). Power analysis and determination of sample size for covariance structure modeling. Psychological Methods, 1(2), 130.

    Article  Google Scholar 

  • Matsunaga, M. (2010). How to factor-analyze your data right: Do’s, don’ts, and how-to’s. International Journal of Psychological Research, 3(1), 97–110.

    Article  Google Scholar 

  • Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the Penn State worry questionnaire. Behaviour Research and Therapy, 28(6), 487–495. https://doi.org/10.1016/0005-7967(90)90135-6.

    Article  PubMed  CAS  Google Scholar 

  • Muthén, L. K., & Muthén, B. O. (1998–2011). Mplus User’s Guide. Sixth Edition. Los Angeles, CA: Muthén & Muthén.

  • Nanney, J. T., Constans, J. I., Kimbrell, T. A., Kramer, T. L., & Pyne, J. M. (2015). Differentiating between appraisal process and product in cognitive theories of posttraumatic stress. Psychological Trauma: Theory, Research, Practice, and Policy, 7(4), 372–381.

    Article  Google Scholar 

  • Preacher, K. J., & Coffman, D. L. (2006). Computing power and minimum sample size for RMSEA. [Computer software]. http://quantpsy.org.

  • Reardon, J. M., & Williams, N. L. (2007). The specificity of cognitive vulnerabilities to emotional disorders: Anxiety sensitivity, looming vulnerability and explanatory style. Journal of Anxiety Disorders, 21(5), 625–643.

    Article  PubMed  Google Scholar 

  • Reise, S. P. (2012). The Rediscovery of Bifactor Measurement Models. Multivariate Behavioral Research, 47(5), 667–696. https://doi.org/10.1080/00273171.2012.715555.

    Article  PubMed  PubMed Central  Google Scholar 

  • Salemink, E., Kindt, M., Rienties, H., & van den Hout, M. (2014). Internet-based Cognitive Bias Modification of Interpretations in patients with anxiety disorders: A randomised controlled trial. Journal of Behavior Therapy and Experimental Psychiatry, 45(1), 186–195. https://doi.org/10.1016/j.jbtep.2013.10.005.

    Article  PubMed  Google Scholar 

  • Schmidt, N. B., Norr, A. M., Allan, N. P., Raines, A. M., & Capron, D. W. (2017). A randomized clinical trial targeting anxiety sensitivity for patients with suicidal ideation. Journal of Consulting and Clinical Psychology, 85(6), 596–610. https://doi.org/10.1037/ccp0000195.

    Article  PubMed  Google Scholar 

  • Steer, R. A., & Clark, D. A. (1997). Psychometric characteristics of the Beck Depression Inventory-II with college students. Measurement and Evaluation in Counseling and Development, 30(3), 128.

    Google Scholar 

  • Watson, D. (2005). Rethinking the mood and anxiety disorders: A quantitative hierarchical model for DSM-V. Journal of Abnormal Psychology, 114(4), 522–536. https://doi.org/10.1037/0021-843X.114.4.522.

    Article  PubMed  Google Scholar 

  • Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993). The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. In Paper presented at the annual convention of the international society for traumatic stress studies.

  • Williams, N. L., Shahar, G., Riskind, J. H., & Joiner, T. E. Jr. (2005). The looming maladaptive style predicts shared variance in anxiety disorder symptoms: Further support for a cognitive model of vulnerability to anxiety. Journal of Anxiety Disorders, 19(2), 157–175.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported in part by the National Institute of Mental Health (Award No. T32 MH93311) and by the Military Suicide Research Consortium (MSRC), an effort supported by the Office of the Assistant Secretary of Defense for Health Affairs (Award No. W81XH-16-2-0003). Opinions, interpretations, and recommendations are those of the authors and are not necessarily endorsed by the U.S. Government, MSRC, or Department of Defense. Funding sources had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report, or in the decision to submit the article for publication. Dr. Amir was formerly a part owner of Cognitive Retraining Technologies, LLC (“CRT”), a company that marketed anxiety relief products. Dr. Amir’s ownership interest in CRT was extinguished on January 29, 2016, when CRT was acquired by another entity. Dr. Amir has an interest in royalty income generated by the marketing of anxiety relief products by this entity.

Funding

All other authors report no financial relationships with commercial interests.

Author information

Authors and Affiliations

  1. Department of Psychology, Florida State University, Tallahassee, FL, 32306, USA

    Joseph W. Boffa, Jamie L. Tock & Norman B. Schmidt

  2. VA Puget Sound Health Care System, Seattle, WA, USA

    Aaron M. Norr

  3. University of Washington School of Medicine, Seattle, WA, USA

    Aaron M. Norr

  4. San Diego State University, San Diego, CA, USA

    Nader Amir

  5. University of California San Diego, San Diego, CA, USA

    Nader Amir

Authors
  1. Joseph W. Boffa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aaron M. Norr
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jamie L. Tock
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nader Amir
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Norman B. Schmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Norman B. Schmidt.

Ethics declarations

Conflict of Interest

JB has received research grants from the National Institute of Mental Health. NS has received research grants from the Military Suicide Research Consortium, an effort supported by the Office of the Assistant Secretary of Defense for Health Affairs. NA was formerly a part owner of Cognitive Retraining Technologies, LLC, and has an interest in royalty income generated by the marketing of anxiety relief products by this entity. AN declares that he has no conflicts of interest. JT declares that he has no conflicts of interest.

Informed Consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Animal Rights

No animal studies were carried out by the authors for this article.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Boffa, J.W., Norr, A.M., Tock, J.L. et al. Development of the Interpretation Bias Index for PTSD. Cogn Ther Res 42, 720–734 (2018). https://doi.org/10.1007/s10608-018-9915-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10608-018-9915-8

Keywords

Search

Navigation