Medicine:Beck Anxiety Inventory

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Beck Anxiety Inventory
Medical diagnostics
Purposemeasure severity of anxiety
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The Beck Anxiety Inventory (BAI), created by Aaron T. Beck and other colleagues, is a 21-question multiple-choice self-report inventory that is used for measuring the severity of anxiety in children and adults.[1][2] The questions used in this measure ask about common symptoms of anxiety that the subject has had during the past week (including the day you take it) (such as numbness and tingling, sweating not due to heat, and fear of the worst happening). It is designed for individuals who are of 17 years of age or older and takes 5 to 10 minutes to complete. Several studies have found the Beck Anxiety Inventory to be an accurate measure of anxiety symptoms in children and adults.[1][3]

The BAI contains 21 questions, each answer being scored on a scale value of 0 (not at all) to 3 (severely). Higher total scores indicate more severe anxiety symptoms. The standardized cutoffs are:

  • 0–7: Minimal
  • 8-15: Mild
  • 16-25: Moderate
  • 26-63: Severe

The BAI has been criticized for its predominant focus on physical symptoms of anxiety (most akin to a panic response). As such, it is often paired with the Penn State Worry Questionnaire, which provides a more accurate assessment of the cognitive components of anxiety (i.e., worry, catastrophizing, etc.) commonly seen in generalized anxiety disorder.

Two factor approach to anxiety

Though anxiety can be thought of as having several components, including cognitive, somatic, affective, and behavioral components, Beck et al. included only two components in the BAI's original proposal: cognitive and somatic.[2] The cognitive subscale provides a measure of fearful thoughts and impaired cognitive functioning, and the somatic subscale measures the symptoms of physiological arousal.[4]

Since the introduction of the BAI, other factor structures have been implemented, including a four factor structure used by Beck and Steer with anxious outpatients that included neurophysiological, autonomic symptoms, subjective, and panic components of anxiety.[5] In 1993, Beck, Steer, and Beck used a three factor structure including subjective, somatic, and panic subscale scores to differentiate among a sample of clinically anxious outpatients[6]

Because the somatic subscale is emphasized on the BAI, with 15 out of 21 items measuring physiological symptoms, perhaps the cognitive, affective, and behavioral components of anxiety are being deemphasized. Therefore, the BAI functions more adequately in anxiety disorders with a high somatic component, such as panic disorder. On the other hand, the BAI won't function as adequately for disorders such as social phobia or obsessive-compulsive disorder, which have a stronger cognitive or behavioral component.[7]

Clinical use

The BAI was specifically designed as "an inventory for measuring clinical anxiety" that minimizes the overlap between depression and anxiety scales.[2] While several studies have shown that anxiety measures, including the State-Trait Anxiety Inventory (STAI), are either highly correlated or indistinguishable from depression,[8][9][10] the BAI is shown to be less contaminated by depressive content.[2][11][12][13][14][15][16][17][18][excessive citations]

Since the BAI only questions symptoms occurring over the last week, it is not a measure of trait anxiety or state anxiety. The BAI can be described as a measure of "prolonged state anxiety", which, in a clinical setting, is an important assessment. A version of the BAI, the Beck Anxiety Inventory-Trait (BAIT), was developed in 2008 to assess trait anxiety rather than immediate or prolonged state anxiety, much like the STAI. However, unlike the STAI, the BAIT was developed to minimize the overlap between anxiety and depression.[19]

A 1999 review found that the BAI was the third most used research measure of anxiety, behind the STAI and the Fear Survey Schedule,[20] which provides quantitative information about how clients react to possible sources of maladaptive emotional reactions.

The BAI has been used in a variety of different patient groups, including adolescents. Though support exists for using the BAI with high-school students and psychiatric inpatient samples of ages 14 to 18 years,[21] the recently developed diagnostic tool, Beck Youth Inventories, Second Edition, contains an anxiety inventory of 20 questions specifically designed for children and adolescents ages 7 to 18 years old.[22]

Limitations

Though the BAI was developed to minimize its overlap with the depression scale as measured by the Beck Depression Inventory, a correlation of r=.66 (p<.01) between the BAI and BDI-II was seen among psychiatric outpatients,[23] suggesting that the BAI and the BDI-II equally discriminate between anxiety and depression.[24]

Another study indicates that, in primary care patients with different anxiety disorders including social phobia, panic disorder, panic disorder with or without agoraphobia, agoraphobia, or generalized anxiety disorder, the BAI seemed to measure the severity of depression. This suggests that perhaps the BAI cannot adequately differentiate between depression and anxiety in a primary care population.[25]

In a study examining the BAI's use on older adults with generalized anxiety disorder, no discriminant validity was seen between the BAI and measures of depression. This could perhaps be due to the increased difficulty in discriminating between anxiety and depression in older adults due to "de-differentiation" of the symptoms of anxiety with the aging process, as hypothesized by Krasucki et al.[26]

Many questions of the Beck Anxiety Inventory include physiological symptoms, such as palpitations, indigestion, and trouble breathing.[27] Because of this, it has been shown to elevate anxiety measures in those with physical illnesses like postural orthostatic tachycardia syndrome, when the Anxiety Sensitivity Index did not.[28]

Finally, the mean and median reliability estimates of the BAI tend to be lower when given to a nonpsychiatric population, such as college students, than when given to a psychiatric population.[29][30]

See also

  • Beck Depression Inventory
  • Beck Hopelessness Scale
  • Diagnostic classification and rating scales used in psychiatry
  • Major Depression Inventory

References

  1. ↑ 1.0 1.1 Leyfer, OT; Ruberg, JL; 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): 444–58. doi:10.1016/j.janxdis.2005.05.004. PMID 16005177. 
  2. ↑ 2.0 2.1 2.2 2.3 "An inventory for measuring clinical anxiety: Psychometric properties". Journal of Consulting and Clinical Psychology 56 (6): 893–897. 1988. doi:10.1037/0022-006x.56.6.893. PMID 3204199. 
  3. ↑ Osman, A; Hoffman, J; Barrios, FX; Kopper, BA; Breitenstein, JL; Hahn, SK (April 2002). "Factor structure, reliability, and validity of the Beck Anxiety Inventory in adolescent psychiatric inpatients.". Journal of Clinical Psychology 58 (4): 443–56. doi:10.1002/jclp.1154. PMID 11920696. 
  4. ↑ "Gender differences in anxiety: An investigation of the symptoms, cognitions, and sensitivity towards anxiety in a nonclinical population". Behavioural and Cognitive Psychotherapy 30 (2): 227–231. 2002. doi:10.1017/s1352465802002114. https://eprints.qut.edu.au/4462/1/4462.pdf. 
  5. ↑ "Relationship between the Beck Anxiety Inventory and the Hamilton Anxiety Rating Scale with anxious outpatients". Journal of Anxiety Disorders 5 (3): 213–223. 1991. doi:10.1016/0887-6185(91)90002-b. 
  6. ↑ "Types of self-reported anxiety in outpatients with DSM-IIIR anxiety disorders". Anxiety, Stress, & Coping 6: 43–55. 1993. doi:10.1080/10615809308249531. 
  7. ↑ "The Beck Anxiety Inventory in a nonclinical sample". Behav Res Ther 33 (4): 477–485. 1995. doi:10.1016/0005-7967(94)00082-u. PMID 7755538. 
  8. ↑ "Parents of children with cancer: A longitudinal study of emotional distress, coping style, and marital adjustment two and twenty months after diagnosis". Journal of Pediatric Psychology 21 (4): 541–554. 1996. doi:10.1093/jpepsy/21.4.541. PMID 8863463. 
  9. ↑ Dobson KS (1985). "An analysis of anxiety and depression scales". Journal of Personality Assessment 49 (5): 522–527. doi:10.1207/s15327752jpa4905_10. PMID 4067800. 
  10. ↑ "Self-reports of depression and state-trait anxiety: Evidence for differential assessment". Journal of Personality and Social Psychology 63 (5): 832–838. 1992. doi:10.1037/0022-3514.63.5.832. PMID 1447695. 
  11. ↑ "Common and specific dimensions of self-reported anxiety and depression: Implications for the cognitive and tripartite models". Journal of Abnormal Psychology 103 (4): 645–654. 1994. doi:10.1037/0021-843x.103.4.645. PMID 7822565. 
  12. ↑ "Confirmatory factor analysis of the Beck Anxiety and Depression Inventories in patients with major depression". Journal of Affective Disorders 47 (1–3): 195–200. 1998. doi:10.1016/s0165-0327(97)00103-1. PMID 9476761. 
  13. ↑ "Reliability and validity of the Beck Anxiety Inventory". Journal of Anxiety Disorders 6: 55–61. 1992. doi:10.1016/0887-6185(92)90026-4. 
  14. ↑ "The Beck Anxiety Inventory: A psychometric analysis". Psychological Assessment 5 (4): 408–512. 1993. doi:10.1037/1040-3590.5.4.408. 
  15. ↑ "The Beck Anxiety Inventory: Reexamination of structure and psychometric properties". Journal of Clinical Psychology 53: 7–14. 1997. doi:10.1002/(sici)1097-4679(199701)53:1<7::aid-jclp2>3.0.co;2-s. 
  16. ↑ "Use of the Beck Anxiety Inventory with adolescent psychiatric outpatients". Psychological Reports 76 (2): 459–465. 1995. doi:10.2466/pr0.1995.76.2.459. PMID 7667457. 
  17. ↑ "Further evidence for the validity of the Beck Anxiety Inventory with psychiatric outpatients". Journal of Anxiety Disorders 7 (3): 195–205. 1993. doi:10.1016/0887-6185(93)90002-3. 
  18. ↑ "Psychometric evaluation of the Beck Anxiety Inventory with older medical patients". Psychological Assessment 9 (2): 136–144. 1997. doi:10.1037/1040-3590.9.2.136. 
  19. ↑ "The Beck Anxiety Inventory-Trait (BAIT): A measure of dispositional anxiety not contaminated by dispositional depression". Journal of Personality Assessment 90 (5): 499–506. 2008. doi:10.1080/00223890802248844. PMID 18704809. 
  20. ↑ Piotrowski C (1999). "The status of the Beck Anxiety Inventory in contemporary research". Psychol Rep 85 (1): 261–2. doi:10.2466/PR0.85.5.261-262. PMID 10575991. 
  21. ↑ "Factor structure, reliability, and validity of the Beck Anxiety Inventory in adolescent psychiatric inpatients". J Clin Psychol 58 (4): 443–56. 2002. doi:10.1002/jclp.1154. PMID 11920696. 
  22. ↑ Beck Youth Inventories-Second Edition for Children and Adolescents Manual. San Antonio: PsychCorp. 2005. 
  23. ↑ "Comparison of Beck Depression Inventories-IA and -II in psychiatric outpatients". Journal of Personality Assessment 67 (3): 588–597. 1996. doi:10.1207/s15327752jpa6703_13. PMID 8991972. 
  24. ↑ "Distinguishing anxiety and depression in self-report: Purification of the Beck Anxiety Inventory and Beck Depression Inventory-II". Journal of Clinical Psychology 66 (9): 927–940. 2010. doi:10.1002/jclp.20701. PMID 20694959. 
  25. ↑ Muntingh ADT; van der Feltz-Cornelis CM; van Marwijk HWJ; Spinhoven P; Penninx BWJH; van Balkom AJLM (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 (NESDA)". BMC Family Practice 12 (66): 66. doi:10.1186/1471-2296-12-66. PMID 21726443. 
  26. ↑ "The relationship between anxiety disorders and age". International Journal of Geriatric Psychiatry 13 (2): 79–99. 1998. doi:10.1002/(sici)1099-1166(199802)13:2<79::aid-gps739>3.0.co;2-g. PMID 9526178. 
  27. ↑ "Beck Anxiety Inventory (BAI)". http://www.brandeis.edu/roybal/docs/BAI_website_PDF.pdf. 
  28. ↑ Raj, Satish R (2006-04-01). "The Postural Tachycardia Syndrome (POTS): Pathophysiology, Diagnosis & Management". Indian Pacing and Electrophysiology Journal 6 (2): 84–99. ISSN 0972-6292. PMID 16943900. 
  29. ↑ "Assessing the reliability of The Beck Anxiety Inventory Scores". Educational and Psychological Measurement 65 (5): 742–756. 2005. doi:10.1177/0013164405278557. 
  30. ↑ "The Beck Anxiety Inventory in Older Adults with Generalized Anxiety Disorder". Journal of Psychopathology and Behavioral Assessment 27 (1): 17–24. 2005. doi:10.1007/s10862-005-3261-3. 

Further reading

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