پردازش شناختی و ارتفاع هراسی: اعتبار پرسشنامه تفسیر ارتفاع

Three studies were conducted to examine the psychometric properties of a new scale: the Heights Interpretation Questionnaire (HIQ). This scale was designed to measure height fear-relevant interpretation bias to help assess the relationship between biased interpretations and acrophobia symptoms. Studies 1 (N = 553) and 2 (N = 308) established the scale's factor structure and convergent and discriminant validity among two large undergraduate samples. Study 3 (N = 48) evaluated the predictive validity of the HIQ by examining how well the scale predicted subjective distress and avoidance on actual heights. Factor analysis resulted in four distinct factors, and results suggest that each of the factors, along with the full HIQ, have good reliability and validity. Additionally, the scale predicts subjective distress and avoidance on heights beyond self-reported acrophobia symptoms. Overall, the HIQ shows promise as a new tool to investigate cognitive processing biases in acrophobia.

There is evidence that acrophobic individuals have biases in interpretation and judgment such that they tend to overestimate danger and doubt their ability to cope with anxiety in height-relevant situations (e.g., Menzies & Clark, 1995). However, there are no published measures (to our knowledge) that assess height-relevant interpretation biases in a standardized way. Given that biased interpretations are a critical component of cognitive models of anxiety (e.g., Beck & Clark, 1997) and treatment of anxiety disorders (e.g., Barlow, 2002), a simple way to measure height-relevant interpretation biases would provide a useful research and clinical tool. In this article, we report on a series of studies evaluating the factor structure, reliability and validity of a new scale: the Heights Interpretation Questionnaire (HIQ). Lack of height-relevant interpretation bias questionnaires is surprising, given the centrality of biased interpretations in cognitive models of anxiety. These models posit that a maladaptive schema leads to biases in the ways fearful individuals interpret, attend to, and remember information, such that threatening information is kept salient, which increases anxiety and promotes avoidance (Beck and Clark, 1997 and Williams et al., 1997). Moreover, cognitive-behavioral therapy and cognitive therapy for anxiety both have a strong emphasis on changing interpretations (e.g., Barlow, 2002). In fact, Beck and Clark state that “it is the propensity of this information processing apparatus to inappropriately generate threat meaning assignments to innocuous stimuli that is the main problem that must be rectified in the treatment of anxiety disorders” (p. 51). This is important even in exposure-based therapies, in which one of the desired outcomes of interacting with the feared object is the chance to disconfirm feared expectations and learn to make less threatening interpretations of the situation (e.g., Teachman & Smith-Janik, 2005). Therefore, a simple assessment of interpretations can be useful for both research purposes and for clinical practice to evaluate progress in treatment. Although we know of no published questionnaires measuring height-relevant interpretation biases, a small number of studies have used height-relevant anxiety provocations (e.g., climbing ladders, looking over balcony railings) as a method of evaluating individuals’ anticipatory and on-line judgments of physical danger and ability to cope with anxiety (Clerkin et al., 2009, Menzies and Clark, 1995 and Teachman et al., 2008). For instance, when anticipating climbing a ladder, acrophobic individuals gave higher estimates of the probability of falling from the ladder and gave higher estimates of the injuries that would result from falling (compared to non-fearful control participants; Menzies & Clark, 1995). Additionally, when asked to stand on a balcony, height-fearful individuals more strongly endorsed experiencing thoughts related to danger (e.g., “The railing will not protect me”) and their inability to cope with anxiety (“I will be paralyzed by fear”), compared to low fear participants (Clerkin et al., 2009 and Teachman et al., 2008). Together, these results provide evidence, consistent with cognitive models, that when confronted with an actual height, height fearful individuals interpret the height to be dangerous and doubt their ability to cope. Similarly, Williams and Watson (1985) asked acrophobic individuals to provide ratings of perceived danger and ratings of self-efficacy (e.g., confidence in their ability to climb stairs) while anticipating a behavioral test involving climbing and looking over the railings of progressively higher balconies. Instead of comparing acrophobic individuals’ ratings to those of a control group, the authors evaluated how well the acrophobic individuals’ ratings predicted actual behavior while on a height. Ratings of self-efficacy (and ratings of perceived danger, to a lesser extent) predicted avoidance during the behavioral task. The current study builds on this research by validating a questionnaire that can be used to evaluate the relationship between height fear and interpretation biases without the need for a height-relevant anxiety provocation. In this way, the measure can be used across settings without the need for equipment or a special environment, and the measure can also be used for screening purposes. By examining a broad range of interpretations (including those related to perceived danger, physical consequences of anxiety, and emotional consequences of anxiety), the HIQ aims to provide a multi-faceted measure of height-relevant interpretation bias. Additionally, unlike past studies that compare relatively small groups of height fearful to non-height fearful individuals, the current study uses multiple large samples with a continuous range of height fear to permit a more comprehensive examination of the psychometric properties of the HIQ (e.g., this design allows for examination of the factor structure of the measure in addition to other standard measures of reliability and validity). The HIQ asks individuals to read and imagine themselves in height-relevant scenarios and then rate the likelihood of interpretations related to each scenario. In Study 1, we determine the factor structure of the HIQ and examine the psychometric properties of the scale in terms of its relationship to acrophobic and other symptom domains. Study 2 attempts to reproduce the factor structure found in Study 1 and replicate the findings for convergent and discriminant validity. Study 3 evaluates the predictive validity of the HIQ by examining how well the scale predicts emotional vulnerability on actual heights. Additionally, Study 3 includes a highly fearful sample. Based on the prior research demonstrating biases associated with acrophobia (e.g., Menzies & Clark, 1995), we expect the factor analyses in studies 1 and 2 to reveal factors related to dangerousness of being on a height (e.g., falling), physical consequences of anxiety (e.g., fainting), and emotional consequences of anxiety (e.g., fears of not being able to cope). Regarding psychometric properties, we predict the HIQ will have strong reliability based on inter-item consistency, and good convergent, discriminant, incremental, and predictive validity across studies.