تحلیل مجدد روانسنجی هراس آلبانی و پرسشنامه هراس

The psychometric properties of the 27-item Albany Panic and Phobia Questionnaire (APPQ) were evaluated in 1930 outpatients with DSM-IV anxiety and mood disorders. Although prior findings of a 3-factor latent structure were upheld in several replications (Social Phobia, Agoraphobia, Interoceptive), three items failed to load on their predicted factor (Interoceptive). Multiple-groups CFAs indicated that the measurement properties of the APPQ were invariant in male and female patients, with the exception of an intercept of one item from the Agoraphobia scale which evidenced bias against females. The three APPQ dimensions were consistently associated with high levels of scale reliability and factor determinacy. Strong evidence of concurrent validity of the Social Phobia and Agoraphobia factors was obtained in relation to interview and questionnaire measures. Although the Interoceptive factor was more strongly related to criterion measures of anxiety sensitivity and fear of panic than Social Phobia, the Agoraphobia factor had the strongest relationships with these validity indices. The results are discussed in regard to psychometric implications for the APPQ and conceptual issues pertaining to the discriminant validity of fear of agoraphobic situations and fear of sensation-producing activities.

Fear and avoidance are hallmark features of the phobic disorders (panic disorder with agoraphobia, social phobia, specific phobia). The breadth and depth of the fear and avoidance can range from overt situational avoidance (e.g., public speaking, heights) to more subtle fears of substances or situations that may provoke autonomic symptoms similar to anxiety and panic (e.g., caffeine, aerobic activity). This distinction between the obvious and subtle forms of fear and avoidance is particularly evident in panic disorder. Phobic avoidance in panic disorder (i.e., agoraphobia) can be established from any one of the following criteria: (1) situational avoidance, (2) anxiety and distress in the phobic situation, or (3) requiring the presence of a companion in the phobic situation ( American Psychiatric Association, 1994). As such, an individual may have no or few overtly avoided situations but may still have considerable fear, distress, and subtle avoidance behavior in the phobic situation. In short, the fear associated with agoraphobia is focused on the onset of distressing symptoms in situations, not the avoided situation itself. Because of this “fear of fear” ( Goldstein & Chambless, 1978), a continuum of situational fears and restrictions may develop. Whereas early conceptualizations of panic disorder with agoraphobia (PDA) centered on overt situational avoidance (e.g., Marks, 1969; Snaith, 1968), contemporary theories of PDA have emphasized the fears of autonomic sensations that are similar to those of a panic attack (Barlow, 2002; Clark, 1986). Indeed, many modern empirically supported treatments target exposure to both the phobic situations as well as the autonomic (or interoceptive) symptoms and situations (Barlow, Gorman, Shear, & Woods, 2000; Spiegel & Barlow, 2000). Because of the important role of interoceptive fear and avoidance in the development and treatment of PDA, thorough assessment of the feared sensations and activities that may produce them are essential. From a clinical standpoint, this assessment can serve as the foundation for designing interoceptive exposure exercises—a vital treatment component for decreasing a patient's anxiety about and sensitivity to physical sensations (Craske & Barlow, 2001; White & Barlow, 2002). In addition to its clinical importance, comprehensive assessment of dimensions of phobic fear and avoidance may have significant etiological and theoretical relevance for research in understanding PDA and the phobias. Although a number of scales have been developed to assess integral aspects of PDA (cf. Antony, 2001), the assessment of interoceptive fear and avoidance has been largely neglected. An exception is the Albany Panic and Phobia Questionnaire (APPQ; Rapee, Craske, & Barlow, 1994/1995), a scale that was designed to measure the distinct dimension of fear of sensation-producing activities, in addition to fear of common agoraphobic and social phobic situations. Using principal components analysis (PCA) with equamax rotation, Rapee et al. (1994/1995) reported findings in support of the posited 3-factor solution in a sample of 405 patients with anxiety disorders and 33 persons with no mental disorder. After examination of internal consistency and factor structure (and removal of items failing to meet salient loading criteria), the final scale consisted of 27 items forming three subscales, interpreted as reflecting fear of agoraphobic situations (“Agoraphobia,” 9 items), fear of activities that produce somatic sensations (“Interoceptive,” 8 items), and fear of social situations (“Social Phobia,” 10 items). Rapee et al. (1994/1995) subjected the APPQ to additional tests of internal consistency, temporal stability, validity, and sensitivity to change during treatment, and all evidences attested to the favorable psychometric qualities of the scale (e.g., αsαs ranged from .87 to .90). For instance, support for the convergent/discriminant validity of the APPQ was evidenced by a differential pattern of correlations with other clinical ratings and self-report measures of social phobia and panic disorder and agoraphobia in the predicted direction (e.g., APPQ-Social Phobia was more strongly associated with presence/absence of social phobia and a social anxiety questionnaire than was APPQ-Agoraphobia and APPQ-Interoceptive). Moreover, a significant decrease in all three subscales was observed following cognitive-behavioral treatment of 45 patients with panic disorder with or without agoraphobia, lending support for the utility of the APPQ as a treatment outcome measure (Rapee et al., 1994/1995). More recently, Novy, Stanley, Averill, and Daza (2001) extended these results by reporting equivalent reliability and norms, as well as favorable convergent and discriminant validity, for an English and Spanish language translation of the APPQ in a bilingual sample. However, the small sample size (N=98N=98) restricted this investigation to predominantly descriptive and univariate analyses of the scale (e.g., no replication of factor structure). Since its development, the APPQ has been used in a wide variety of contexts (cf. Antony, 2001), including large-scale treatment outcome studies (e.g., Barlow et al., 2000), latent structural analyses of the DSM-IV anxiety and mood disorder constructs (e.g., Brown, Chorpita, & Barlow, 1998), and analog (e.g., Veljaca & Rapee, 1998) and cross-cultural research ( Novy et al., 2001). Nevertheless, this applied research has proceeded in absence of comprehensive examination of the measurement properties of the APPQ. For instance, Rapee et al. (1994/1995) represent the only published study to date that has examined the latent structure of the APPQ. Unfortunately, these analyses were limited in several ways, including: (a) use of PCA as the method of extraction, a procedure that is not based on the common factor model (cf. Fabrigar, Wegener, MacCallum, & Strahan, 1999; Thurstone, 1947; Widaman, 1993); (b) retention in the final solution of several items with salient loadings (>.30) on nonprimary factors; and (c) inability to cross-validate the final solution in independent samples. Moreover, Rapee et al. (1994/1995) aimed to evaluate the “factorial invariance” of the final solution between males and females. However, this objective was addressed simply by visual inspection of the structural similarities of PCAs conducted separately for males and females. Thus, the primary aim of the current study was to provide a thorough evaluation of the latent structure of the APPQ in a large sample of patients with anxiety and mood disorders. Given the aforementioned methodological limitations of Rapee et al. (1994/1995), we began by conducting cross-validated exploratory factor analyses to better ascertain the latent form of the APPQ and to identify any poorly behaved items. Subsequent analyses on independent samples were conducted in the confirmatory factor analysis (CFA) framework which provided further replication of factor structure, and allowed for the evaluation of potential nonrandom measurement error, scale reliability, and direct statistical examination of the form and measurement invariance of the APPQ between male and female patients. Moreover, the convergent and discriminant validity of the APPQ dimensions were examined in context of the CFA solutions.