Psychological Assessment 2015, Vol. 27, No. 2, 403-414

© 2015 American Psychological Association 1040-3590/15/$ 12.00 http://dx.doi.org/10.1037/pas0000046

The Circumscribed Fear Measure: Development and Initial Validation of a Trans-Stimulus Phobia Measure Kathleen S. McCraw and David P. Valentiner Northern Illinois University Extant stimulus-specific fear measures are limited to a small number of stimuli and contain significantly different content. This article describes 2 studies that develop a more flexible fear measure—the Circumscribed Fear Measure (CFM)—and examine its psychometric properties. In Study 1, participants (N = 771) completed an initial item pool while considering their most feared stimulus. Results of factor analyses were used to propose a 25-item, 5-factor measure that would span the domain of specific phobia reactions, applicable to different stimuli. In Study 2, participants (N = 959) completed the 25-item CFM, extant phobia measures, and a measure of disability. The CFM exhibited a 5-scale structure that had an equivalent structure across different stimuli. It showed good factorial validity, reliability, and generally good convergent and discriminant validity. Criterion validity was commensurate with that of extant phobia measures. The use of the measure as an index of an individual’s greatest fear is also discussed. The CFM shows promise and could have substantial research and clinical utility. Keywords: anxiety, phobias, scale development, specific phobia

Specific phobia (SP) is characterized by “marked fear or anxiety about a specific object or situation” (American Psychiatric Asso­ ciation [APA], 2013). SP is relatively common, with an estimated lifetime prevalence between 9.4% and 11.3% in the general pop­ ulation (Curtis, Magee, Eaton, Wittchen, & Kessler, 1998; Stinson et ah, 2007). In addition, a substantial portion of the general population has subclinical fears (Curtis et ah, 1998; Depla, ten Have, van Balkom, & de Graaf, 2008; Iancu et ah, 2007). There are many different types of stimuli that people fear. Stinson et ah (2007) reported that animals were the most com­ monly feared stimulus (50.3% of respondents with lifetime SP), followed by heights (47.9%), enclosed spaces (33.8%), flying, (30.7%), water (26.0%), and the dentist (25.1%). An additional 10.6% of participants endorsed fears of stimuli that did not fit into the categories used by Stinson et ah (2007). The DSM-5 (APA, 2013) currently specifies four different subtypes into which SP can be categorized into: animal, natural environment, blood-injection-injury, and situational. In addition, there is an “other” subtype that comprises any phobias that cannot be categorized under the other four subtypes. Although there are no differences in diagnostic criteria, research has demonstrated significant heterogeneity between and within these subtypes. This heterogeneity includes differences in age of onset (Antony, Brown,

& Barlow, 1997; Ost, 1987), physiological and neural responses to the feared stimulus (Caseras et al., 2010; Lueken et ah, 2011; Marks, 1988; Ost, 1992), treatment response (Choy, Fyer, & Lipsitz, 2007), and relationships with disgust (Cisler, Olatunji, & Lohr, 2009; de Jong and Merkelbach, 1998). There are few self-report instruments available to assess SPs. Existing self-report SP measures largely target the fear of a single type of stimulus (e.g., the Fear of Spiders Questionnaire; Szymanski & O’Donohue, 1995). Although there are multiple measures for spider, blood-injection-injury, and dental phobias, only a “small number” of measures exist for other fears such as heights and snakes (Antony, 2001). No established measures exist for fears of many commonly feared stimuli. For example, there are no established instruments to measure water or storm phobias, which were found in 26.0% and 20.8%, respectively, of the phobic individuals in Stinson et ah’s (2007) sample. This lack of self-report instruments has hampered research on SP, and fears of some stimuli are underrepresented in the research literature. Comparing types of SPs is complicated by the fact that questionnaires assess different things, including the breadth of stimuli that evoke anxiety (e.g.. Claustrophobia Questionnaire, CQ; Radomsky, Rachman, Thordarson, Mclsaac, & Teachman, 2001), cognitions (e.g., Spider Phobia Beliefs Questionnaire; Arntz et ah, 1993; Dental Cognitions Questionnaire; de Jongh, Muris, Schoenmakers, & Ter Horst, 1995), physiological reactions (e.g., Blood-Injection Symptom Scale; Page, Bennett, Carter, Smith, & Woodmore, 1997), and so on. Systems for categorizing SPs are not empirically driven. A measure that incorporates all of these different types of content and that could be used with different stimuli would facil­ itate comparisons of different phobias. A trans-stimulus SP mea­ sure would also facilitate clinical practice, having potential use for screening, diagnosis, treatment planning, and tracking of progress, applicable to fears of a wide variety of stimuli. To address this

This article was published Online First January 5, 2015. Kathleen S. McCraw and David P. Valentiner, Department of Psychol­ ogy, Northern Illinois University. This project was completed in partial fulfillment of the requirements for a Master of Arts degree. We express our gratitude to committee members Dr. Kevin Wu and Dr. Alecia Santuzzi for their contributions to this project. Correspondence concerning this article should be addressed to Kathleen S. McCraw, Department of Psychology, Northern Illinois University, DeKalb, IL 60115. E-mail: [email protected] 403

McCRAW AND VALENTINER

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clear need for a more flexible instrument, two studies were con­ ducted. These studies describe the development and initial evalu­ ation of the Circumscribed Fear Measure (CFM), including initial item development, measure refinement, and measure validation.

questionnaire. Participants were asked to identify their most feared stimulus at the beginning of the measure and respond to all items in reference to that stimulus, then complete the PANAS. Upon completion of the questionnaire, participants were provided a small amount of compensation for their participation.

Initial Item Development Following Clark and Watson’s (1995) recommendation, several established single-stimulus phobia measures were reviewed to determine the types of questions generally used to measure fear in relation to specific stimuli. Four common themes emerged: phys­ iological symptoms upon encountering the stimulus (e.g., sweat­ ing, feeling sick); a subjective sense of anxiety or fear in response to the stimulus; an attempt or desire to avoid the stimulus, either physically or cognitively; and a sense that the stimulus was threat­ ening, either directly (i.e., that the stimulus itself was dangerous) or indirectly (e.g., it might cause the respondent to behave in ways that are detrimental to functioning). Thirty-five items were adapted or developed for the CFM, written to apply to any stimulus, with approximately equal repre­ sentation from each of the four identified categories of symptoms. Following recommendations from Clark and Watson (1995) and Comrey (1988), items that were long and complex or contained slang or colloquial language, double-barreled, or negatively worded (i.e., reverse-scored) were not included. Items were written so that responses could be rated using a 5-point scale, ranging from 1 (strongly disagree) to 5 (strongly agree). The directions asked participants to identify their most feared stimulus, with response options consisting of 12 commonly feared stimuli and an “other” option on which respondents could write in their own responses. Instructions then directed respondents to respond to the following items in reference to their most feared stimulus.

Study 1 Method Participants. Participants (N = 771) were recruited using Amazon Mechanical Turk (MTurk). MTurk samples are likely to be more diverse and more representative of the population at large than a typical convenience sample (e.g., college students) used in similar studies, and provide data that do not differ substantially from data collected through other methods (Berinsky, Huber, & Lenz, 2012). Because this data collection was intended entirely for the purposes of refining the CFM, no demographic data was obtained, though participation was limited to individuals who lived in the United States and were over the age of 18. Materials. Participants completed the 35-item CFM, the Pos­ itive and Negative Affect Schedule (PANAS; Watson, Clark, & Tellegen, 1988) and demographic questions. The PANAS was included because Clark and Watson (1995) noted that the items on many newly created measures may inadvertently reflect general negative affect rather than the more specific constructs being targeted. In the present study, Cronbach’s alphas were .91 for both the Positive Affect (PA) and Negative Affect (NA) scales of the PANAS. Procedure. Individuals who volunteered for the study com­ pleted an online consent form and then completed the online

Results Of the participants who indicated consent for the study (N = 771), 84.0% (n = 648) completed the entire survey. Data from partial completers were excluded from further analyses as it was not possible to determine whether they returned to complete the survey at a different time. Additional cases (n = 66) were excluded due to questionable responses on the first question on the measure, such as listing multiple stimuli or a stimulus that would be unlikely to be classified as an SP stimulus (e.g., social fears). One addi­ tional participant’s data was excluded due to indicating that he or she did not have any fears (i.e., chose “other” for the feared stimulus, answered “nothing” in the fill-in box, and chose “strongly disagree” for the remainder of the phobia measure items). Thus, the final sample used for further analyses consisted of the 581 participants who completed the survey and endorsed a single fear that could reasonably be construed as a possible phobic stimulus. No data were missing for these 581 participants. One item’s item-total correlation did not exceed .30 and it was removed from the item pool (as recommended by Tabachnick & Fidell, 2001). The correlation between each item and the PA and NA scales of the PANAS were calculated; none of these correla­ tions were larger than the items’ corrected item-total correlation. A multiple-group saturated confirmatory factor analysis (CFA) was conducted using LISREL (version 8.80; Joreskog & Sorbom, 2006) to determine whether the factor structure of the CFM varied across groups. To perform this analysis, the sample was split into four groups, dependent on the feared stimulus endorsed: heights (n = 120), snakes (n = 95), spiders (n = 92), and “uncommon” (n = 242). The first three groups represented the three most commonly endorsed fears in the sample. The final group (“uncom­ mon”) consisted of the remainder of the sample (e.g., vomiting, fire, bees, clowns, etc.). A small number of participants (n = 32) endorsed blood fears; this sample size was insufficient to include as a separate group in this analysis. Because of the evidence that blood fears may elicit symptoms that are fairly distinct from other types of phobias (Marks, 1988; Ost, 1992), these data were not included in the larger “uncommon” group; data from participants who endorsed blood fears were excluded from these analyses entirely. The factorial structure underlying the item pool was compared across groups. As no structure had yet been identified, an atheoretical (fully saturated) model was used. All item covariances were restricted to be invariant across the four groups. The overall fit of the model across groups was assessed using the following oftenrecommended fit indices: the comparative fit index (CFI), the nongnormed fit index (NNFI), and the root mean square error of approximation (RMSEA). The \ 2 value for the model was signif­ icant (2825.53, d f= 1785, p < .01). The other fit indices indicated an excellent fit (RMSEA = .037, NNFI = .99, CFI = .99; see Hu & Bender, 1999). Because the multigroup CFA suggested that the factor structure of the measure items did not vary substantially

CIRCUMSCRIBED FEAR MEASURE

across groups, the remaining analyses were performed as single­ group analyses. Next, the underlying factor structure of the items was examined using principal component analysis (PCA). Because the measure items were conceptually related and likely to correlate with each other, an orthogonal rotation (Oblimin in SPSS) was used. The Kaiser-Meyer-Olkin measure of sample adequacy was .935 and Bartlett’s test of sphericity was significant, x2(595) = 10890.822, p < .001, indicating that the data were appropriate for PCA. Because we were interested in assessing a broad range of reactions to feared stimuli, all components with eigenvalues above 1.00 (Kaiser, 1960) were extracted. Using this guideline, seven com­ ponents were extracted. No items loaded saliently (i.e., factor loadings > .40) onto more than one factor. The results of the PCA were used to guide additional item reduction. Two components had only two items with salient load­ ings; these four items were dropped. Another four items that did not load saliently onto any component were dropped. The remain­ ing 26 items appeared to represent five distinct latent variables. These five components were named Escape/Avoidance (five items), Fear/Anxiety (eight items), Physiological Symptoms (five items), Control (four items), and Risk Analysis (four items). To create a measure with a more balanced number of items for each component, three Fear/Anxiety items were omitted, considering both item content and component loadings. An additional item was created for each of the Control and Risk Analysis components. The resulting measure consisted of 25 items tapping five components, each containing five items.

Study 2 Method The revised CFM was administered to a second group of par­ ticipants using procedures similar to those in Study 1. Study 2 examined the CFM’s factorial validity and reliability as well as its convergent, discriminant, and criterion validity. Participants. Of the participants recruited (N = 959), 15% Cn = 150) did not complete the entire survey and were excluded. The majority of the remaining participants (n = 809; Mage = 34.31, SD = 12.16) were female (50.1%), White (83.2%), and non-Hispanic (92.8%). Data from participants whose responses were in conflict with the directions or were not likely to be phobic stimuli (n = 67) were excluded and data from the remaining 742 participants was used for the analyses, unless otherwise noted. Less than 2% of the data fields for these participants were missing. Materials. The Study 2 questionnaires included the 25-item CFM, the PANAS, demographic questions, several extant phobia measures, and a measure of disability. Phobia measures. Established stimulus-specific phobia mea­ sures were included in the study to examine convergent and discriminant validity of the new measure. The Fear of Spiders Questionnaire (FSQ; Szymanski & O’Donohue, 1995), a selfreport measure designed to assess the severity of an individual’s fear of spiders, contains two scales (i.e., Avoidance/Help-Seeking and Fear of Harm). In the present study, Cronbach’s alpha for the FSQ total scale was .98, and .96 for both the Avoidance/HelpSeeking and Fear of Harm scales. The Snake Questionnaire (SNAQ; Klorman, Weerts, Hastings, Melamed, & Lang, 1974)

405

was included as a measure of snake fears. In the present study, Cronbach’s alpha for the SNAQ was .52. The Blood-InjectionInjury Scale (BISS; Page et ah, 1997), included as a measure of blood-injection-injury fears, contains three scales (i.e., Faintness, Anxiety, and Tension). In the present study, Cronbach’s alpha for the BISS Total Score scale was .92, and for the Faintness, Anxiety, and Tension scales was .88, .81, and .73, respectively. The Claus­ trophobia Questionnaire (CLQ; Radomsky et ah, 2001), used to assess claustrophobic fears, has two scales (i.e., Suffocation and Restriction). In the present study, Cronbach’s alpha for the CLQ total scale was .95, and for Suffocation and Restriction was .91 and .94, respectively. Disability. Because SP has been associated with social and occupational impairment (Curtis et ah, 1998; Magee, Eaton, Wittchen, McGonagle, & Kessler, 1996), the Sheehan Disability Scale (SDS; Sheehan, 1983) was included as a criterion measure. In the present study, Cronbach’s alpha for the SDS was .88.

Results Factorial validity. As in Study 1, cases were categorized based on their most feared stimulus. Several multigroup CFAs were conducted to examine the CFM’s factorial invariance across different types of phobias. The groups used for these analyses consisted of the three most frequently endorsed fears (heights [n = 162], spiders [n = 122], and snakes [n = 96]), as well as an additional group containing the other fears that were less fre­ quently endorsed (“uncommon,” n = 330). A small number of participants endorsed blood fears (n = 32) and were again ex­ cluded, as in Study 1. Following the method and terminology used by Siedlecki et ah (2010), three confirmatory factor analyses, each representing in­ creasingly strict types of invariance, were performed. The same fit indices used to assess fit in the previous study were used in the current analyses and the difference in fit between models was examined using the scaled differences in x2 test (Satorra & Bentler, 1994). For each group, the model was a standard CFA, consisting of five latent variables, each with five indictors, and with the correlations among latent variables free to vary. The full results of these analyses are presented in Table 1. The first multigroup CFA was a fully variant model that exam­ ined whether the factors contain the same items across the different groups (configural invariance; Siedlecki et ah, 2010). The CFI and the NNFI indicated good fit; the RMSEA suggested a mediocre to good fit. Overall, the goodness-of-fit indices indicated that the model provided an adequate fit to the data. The next multigroup CFA was a metric invariance model in which the unstandardized factor loadings were constrained to be equal across groups. Thus, this model assessed whether the latent factors being measured hold the same meaning among all the groups (Siedlecki et ah, 2010). Although the scaled differences in X2 test indicated that this model provided a significantly poorer fit to the data than the configural invariance model, the other fit indices indicated a mediocre to good fit. Overall the fit was adequate. For the final CFA, the factor intercorrelations were also con­ strained to be equal across groups to assess the measure’s struc­ tural invariance, or the degree to which the relationships among the latent factors is similar between groups (Siedlecki et ah, 2010).

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Table 1 Comparison o f Study 2 Multigroup Confirmatory Factor Analyses (40

X sb (d f)

Model

Name

x2

df

X s2b

CFI

NNFI

RMSEA

difference vs. I

I II III

Configural invariance Metric invariance Structural invariance

2,650.54 2,835.98 2,590.93

1060 1135 1165

2,042.49 2,212.04 2,356.88

.97 .96 .96

.96 .96 .96

.072 .073 .076

169.55 (75) 314.39 (105)

difference vs. II

_ —

144.84 (30)

Note. Total n = 710 (nhelghls = 162, nspiders = 122, nsnakes = 96, nuncommo„ = 330). y2 values where p < .01 are in boldface type. CFI = comparative fit index; RMSEA = root mean square error of approximation; NNFI = nonnormed fit index.

The scaled differences in x2 test indicated that this model provided a significantly poorer fit to the data than the metric invariance model. However, the goodness-of-fit indices were adequate, with the CFI and the NNFI both suggesting good fit and the RMSEA indicating mediocre to good fit. Because these analyses indicated that the CFA model could be constrained across groups without a substantial loss of fit, a single­ group CFA was conducted. Overall, the goodness-of-fit indices (pre­ sented in Table 2) indicated that the model provided an adequate fit to the data. Factor intercorrelations ranged from .53 to .78. Reliability. Cronbach’s alpha internal consistency coeffi­ cients were calculated for each of the five CFM scales and the CFM Total scale. For these analyses, four separate groups were created based on the feared stimulus endorsed at the beginning of the CFM. These groups consisted of individuals who endorsed fears of spiders (n = 122), snakes (n = 96), small spaces (termed the claustrophobia group; n = 59), and blood (n = 32). The

reliabilities for each group are presented in Table 3 (in the diag­ onal). The alphas ranged from .73 to .87 for the Risk Analysis scale, from .79 to .86 for the Physiological Symptoms scale, from .78 to .86 for the Fear/Anxiety scale, from .82 to .90 for the Escape/Avoidance scale, and from .77 to .89 for the Control scale. Alphas for the Total CFM score ranged from .93 to .94. Convergent validity. To examine the convergent validity of the CFM, a series of correlations were completed. These analyses were conducted separately for each of the four groups described above (spiders, snakes, small spaces, and blood). For each of these groups, correlations between scores on the CFM and scores on the corresponding phobia measure (i.e., the SPQ for the spider group, the SNAQ for the snake group, the CLQ for the claustrophobia group, and the BISS for the blood group) were computed. We expected that the majority of these convergent correlations would be positive and significant. The results of these analyses are presented in Table 3.

Table 2 Single Group Confirmatory Factor Analysis Loadings—Standardized Solution Item

M

SD

Risk

1. Is dangerous to me 6. Everything will go wrong 11. No one could encounter without some fear 16. Would harm me 21. Would fear for my safety 2. I sweat 7. Feel faint or dizzy 12. Feel nauseated or sick 17. Trouble breathing 22. Muscles feel tense, sore, or ache 3. I am more afraid than most people are 8. Feel anxious or nervous 13. Would feel very panicky 18. Would be afraid of it 23. Nervous when about to encounter 4. Would immediately try to leave 9. Avoid having to face at all costs 14. If a chance I will encounter it, I will not go 19. Afraid to go somewhere if encountered there before 24. Would probably run away 5. Will behave in a way that will make people think I am crazy 10. Will do something silly or embarrassing 15. Would lose control 20. Would scream 25. Might behave unpredictably

2.85 2.33 2.12 2.42 2.51 2.57 2.19 2.12 2.24 2.29 2.81 3.33 3.07 3.26 3.25 2.90 2.87 2.31

1.18 1.27 1.34 1.26 1.31 1.26 1.36 1.31 1.37 1.34 1.06 0.85 1.07 0.94 0.91 1.18 1.21 1.30

0.75 0.65 0.49 1.01 0.96

2.42 2.26

1.27 1.41

2.23 2.24 2.14 1.66 2.13

1.36 1.31 1.32 1.53 1.32

Physio

Fear/Anxiety

Esc/Avoid

Control

0.80 1.05 1.03 1.09 0.98 0.55 0.53 0.92 0.77 0.68 0.89 0.93 1.03 0.94 1.11 0.96 0.81 1.10 0.97 1.04

Note. N = 710. Item response range: 0 -4 . Fit indices: X2 (265) = 1498.58, p < .01; comparative fit index = .97; nonnormed fit index = .96; root mean square error of approximation = .074. Risk = Risk Analysis; Physio = Physiological Symptoms; Esc/Avoid = Escape/Avoidance.

CIRCUMSCRIBED FEAR MEASURE

407

Table 3 Correlations Between CFM and Convergent and Discriminant Measures CFM scales Correlation

Risk Analysis

Physiological Symptoms

Fear/Anxiety

Escape/Avoidance

Control

Total

Spider group (n ■ = 110-120) CFM Intercorrelations Risk Analysis Physiological Symptoms Fear/Anxiety Escape/Avoidance Control Total Convergent FSQ Avoidance/Help Fear of Harm Total Discriminant SNAQ Total BISS Faintness Anxiety Tension Total CLQ Suffocation Restriction Total Discriminant Weighted Mean Discriminant Range

.78 .53 .47 .55 .60 .79

.86 .43 .51 .66 .81

.69 .53 .76

.66 .84

.86

.93

.52 .62 . 62 =

.46 .55 . 55 °

.71 .58 . 67 “

.78 .69 . 77 “

.58 .58 . 61 “

.75 .75 . 79 “

.24b

.14b

,06b

,21b

.18b

.20b

.16 .03 .13 .14b

.25

.13 .17 .07 .18b

.17 .14 .13 ,18b

.21 .05 .16 .18b

.25

.15 .21

.05 .08 ,07b .15 .05-.21

.15 ,19b . 19b .18 .05—.21

.13 .16 ,16b .20 . 13—.25

.13 .22 ,20b .19 .03-24

.14 .23 ,24b .26

.16 .22b .20 .14-.26

.86

-.1 2 .10 ,01b .08 —.12-18

.82 .81

•25 b

Snake group (n = 76-92) CFM Intercorrelations Risk Analysis Physiological Symptoms Fear/Anxiety Escape/Avoidance Control Total Convergent SNAQ Total Discriminant FSQ Fear of Harm Total BISS Faintness Anxiety Tension Total CLQ Suffocation Restriction Total Discriminant Weighted Mean Discriminant Range

.73 .84

.57 .51 .66 .62 .82

.55 .51 .60 .83

.74 .51 .79

.59 .83

.83

.93

. 36 “

. 35 “

. 35 “

. 44 “

. 42 “

. 49 “

.21 .25“

.27

.21

.78

.36

.36

. 35 “

. 38 “

.16 .15 .16 .16“

.30 .31 . 31 “

.16 .12 .10 .15“

.32 . 29 “

.32 .41 . 39 “

.27 .15-36

.36 .19-41

.24

.19

.83 .77

.46

.46

. 49 “

. 48 “

.07 .13 .03 .08b

.23 .18 .21 .22b

.26 .26 .20 . 26 “

.33 . 29 “

.29 .40 . 39 “

.35 .35 . 36 a , b

.38 .45 . 45 “

.23 . 10—.33

.26 .07-40

.36 . 18—.49

.40 .20-.48

, 30 “

b

Blood group (n = 25-32) CFM Intercorrelations Risk Analysis Physiological Symptoms Fear/Anxiety Escape/Avoidance Control

.87 .43 .32 .54 .65

.79 .64 .52 .69

.82 .63 .66

.90 .81

.89 (table continues)

McCRAW AND VALENTINER

408 Table 3 (continued)

CFM scales Correlation Total Convergent BISS Faintness Anxiety Tension Total Discriminant FSQ Avoidance/Help Fear of Harm Total SNAQ Total CLQ Suffocation Restriction Total Discriminant Weighted Mean Discriminant Range

Risk Analysis

Physiological Symptoms

Fear/Anxiety

Escape/Avoidance

Control

Total

.76

.78

.74

.86

.94

.94

.17 .05 .32 .21“

.66 .63 .75

.39 .27 .27 .39*

.42 .33

.46 .36

.78“

.35 .32 .42 .41*

.48 . 48“

.55 . 53“

.34 .44 .40*

.27 .12 .25”

.32 .26 .31“

.29 .37 .38*

.26 .33 32“

.39 .41 .43*

.19“

.09b

.26“

.37*

34“

.31“

.27 .15 .24“ .28 .15-44

.13 .30 ,26b .20 .09-30

.23 .36 .34“ .30 .23-36

.13 .23 .22“ .32 .13-38

.18 .25 .25“ .30 .18-34

.25 .36 .36“ 37 .25-43

Claustrophobia group (n = 47-59) CFM Intercorrelations Risk Analysis Physiological Symptoms Fear/Anxiety Escape/Avoidance Control Total Convergent CLQ Suffocation Restriction Total Discriminant FSQ Avoidance/Help Fear of Harm Total SNAQ Total BISS Faintness Anxiety Tension Total Discriminant Weighted Mean Discriminant Range

.73

.50 .60 .62 .67

.80

.78

.64 .67 .76 .84

.83

.73 .65 .81

.86

.76 .90

.27

.29

.20

.19

.48 . 44“

.49 . 44“

.41

.37

.36*

.31*

.20 .12 .15b

.34

.07 -.0 2 ,04b

.19 .13 .16“

.18“'b .07 .07 .10 .18 ,12b .15 .0 1 -2 0

.36 . 36“

,10b .24 .24 .33 .30 .31** .26 .10—.36

- ,0 0 b -.0 4 -.0 4 .14 .05 ,05b .03 -.0 4 - . 14

.10“ -.0 2 -.0 2 .12 .18 .08“ .11 -.0 2 - . 19

.87

.91

.94

.36 .48 . 48“

.29

.39 . 36“

.33 .24 ,29*b

.23“ .14 .14 .28 .27 .23“ .27 - .1 4 - 3 9

,15b .05 .05 .23 .26 .17b .20 .05-33

.30

.50 . 45“

Note. All correlations use pairwise exclusion; thus, the range of n for each group’s analyses is presented. Scale reliabilities on the diagonals. Correlations where p < .01, two-tailed are in boldface type; bold italicized correlations are where p < .05, two-tailed; nonsignificant correlations are in plain type. By the Meng, Rosenthal, and Rubin’s (1992) method of comparing correlated coefficients, correlations between total scores on convergent and discriminant measures in the same column with the same superscript do not differ significantly a tp < .05. CFM = Circumscribed Fear Measure; FSQ = Fear of Spiders Questionnaire; SNAQ = Snake Questionnaire; BISS = Blood-Injection Symptom Scale; CLQ = Claustrophobia Questionnaire.

For all four groups, the total scores for the CFM were signifi­ cantly and positively correlated with the total scores and scale scores on the convergent measures. For the spider group, all convergent correlations were significant (p < .01 ), with medium to large effect sizes (.46-.79). For the snake group, all convergent correlations were significant (p < .05), with medium effect sizes (.35-49). In the blood group and the claustrophobia group, there was some variance in the significance of the scale-level correla­

tions, although the majority of the convergent correlations (83.3% in the claustrophobia group and 62.5% in the blood group) were significant. In the blood group, effect sizes of the correlations were small and nonsignificant on the Risk Analysis subscale of the CFM (.05-32) but generally medium to large on the other scales (.27-.78). The strongest correlations were found between the Physiological Symptoms scale of the CFM and the BISS scores. In the claustrophobia group, the majority of the effect sizes

CIRCUMSCRIBED FEAR MEASURE

were in the medium range (. 19—.50). In this group, the strongest correlations were found between the CFM scores and the Restric­ tion scale of the CLQ. Discriminant validity. To examine the measure’s discrimi­ nant validity, data from the same four groups that were examined in the convergent validity analyses were used. Correlations be­ tween scores on the CFM and scores on the discriminant phobia measures (i.e., the phobia measures that did not correspond with participants’ feared stimulus that they endorsed) were examined. The full results of these analyses are presented in Table 3. Using Meng, Rosenthal, and Rubin’s (1992) formula for comparing correlations, the previously calculated convergent correlations were compared with these discriminant correlations (using total scale scores for the convergent and discriminant measures) to determine if there were any significant differences. A discriminant weighted and pooled mean (i.e., the average correlation between the CFM scores and the discriminant measure scores) was calcu­ lated by using an r-to-Z transformation on the total scores of the discriminant measures, calculating their average, and transforming them back into r values. In comparing the convergent and discrim­ inant correlations, we expected that the majority of the convergent correlations would be larger in magnitude than the discriminant correlations. We also expected that for the majority of these comparisons, the difference between the convergent and discrim­ inant correlations would be significant. For the spider group, all the convergent correlations were sig­ nificantly larger than the discriminant correlations. For the snake group, only two discriminant correlations were significantly smaller than their corresponding convergent correlations. These were (a) the correlation between the total BISS score and the Escape/Avoidance scale of the CFM, and (b) the correlation be­ tween the total BISS score and the Control scale of the CFM. The majority of other discriminant correlations were smaller in mag­ nitude than the corresponding convergent correlations, though not significantly smaller. For the blood group, only three discriminant correlations were significantly smaller than their corresponding convergent correla­ tions. These were the correlations between the Physiological Symptoms scale of the CFM and (a) the total FSQ score, (b) the total SNAQ score, and (c) the total CLQ score. As in the snake group, the majority of discriminant correlations were smaller in magnitude than the corresponding convergent correlations, though not significantly smaller. Finally, in the claustrophobia group, there were multiple discriminant correlations that were signifi­ cantly smaller than the convergent correlations. The only two scales of the CFM on which significant differences between the convergent and any of the discriminant correlations were not found were the Escape/Avoidance and Control scales. Two of the dis­ criminant weighted and pooled means were larger than the con­ vergent correlations (on the Physiological Symptoms scale of the snake group and the Risk scale of the blood group). All other discriminant weighted means were smaller than their correspond­ ing convergent correlations. Criterion validity. The criterion validity of the CFM was examined in the four separate groups. We expected that there would be positive and significant correlations between the CFM and the SDS. We also anticipated that these correlations would be as comparable to (or larger than) the correlations between the SDS and the other stimulus-specific phobia measures.

409

In the spider-fearing group, the correlations of the CFM scale scores with the SDS were .25 (p < .01), .40 (p < .01), .01 (ns), .21 (p < .05), and .31 (p < .01), respectively. The correlations of the FSQ Avoidance/Help-Seeking and Fear of Harm scales were .21 and .31, respectively (both p < .01). The correlations of the CFM total score and the FSQ total score with the SDS were .33 and .29, respectively (both p < .01). Controlling for the FSQ total score, the partial correlation of the CFM total score with the SDS was .17 (ns); controlling for the CFM total score, the partial correlation of the FSQ total score with the SDS was .05 (ns). In the snake-fearing group, the correlations of the CFM scale scores with the SDS were .29 (p < .01), .26 (p < .01), .05 (ns), .02 (ns), and .29 (p < .01), respectively. The correlations of the CFM total score and the SNAQ total score with the SDS were .28 (p < .01) and .12 (ns), respectively. Controlling for the SNAQ total score, the partial correlation of the CFM total score with the SDS was .26 (p < .05); controlling for the CFM total score, the partial correlation of the SNAQ total score with the SDS was -.0 2 (ns). In the blood-fearing group, the correlations of the CFM scale scores with the SDS were .29, .18, -.0 4 , .24, and .16 (all ns), respectively. The correlations of the BISS Faintness, Anxiety, and Tension scales were .29, .07, and .26, respectively (all ns). The correlations of the CFM total score and the BISS total score with the SDS were .25 and .27, respectively (both ns). Control­ ling for the BISS total score, the partial correlation of the CFM total score with the SDS was .13 (ns); controlling for the CFM total score, the partial correlation of the FSQ total score with the SDS was .16 (ns). In the claustrophobia group, the correlations of the CFM scale scores with the SDS were .21 (ns), .42 (p < .01), .23 (ns), .34 (p < .05), and .50 (p < .01), respectively. The correlations of the CLQ Suffocation and Restriction scales were .41 (p < .01) and .23 (ns), respectively. The correlations of the CFM total score and the FSQ total score with the SDS were .40 (p < .01) and .34 (p < .05), respectively. Controlling for the CLQ total score, the partial cor­ relation of the CFM total score with the SDS was .30 (p < .05); controlling for the CFM total score, the partial correlation of the CLQ total score with the SDS was .20 (ns). Severity of the most feared stimulus. Many of the analyses in this study examined how the CFM functions specifically as a measure of snake fear, spider fear, blood-injection-injury fear, or claustrophobia in individuals who identify these as their primary fears. However, we completed additional analyses that allowed us to consider how the CFM functions as a different measure: one that indicates the severity of an individual’s greatest stimulus-specific fear, no matter the identified stimulus. We refer to this measure as the CFM-MF (“most feared”). CFM-MF total and scale scores were calculated the same way as the standard CFM (i.e., the form was the same, and the label “CFM-MF” was applied to indicate a different method of interpreting measures on the scale). The CFM-MF analyses described below use the entire sample except those who endorsed blood fears (n = 710). CFM-MF criterion validity. To examine the criterion validity of the CFM-MF, correlations between the CFM-MF scales and participants’ disability scores (total scores on the SDS) were examined. The Cronbach’s alphas for the CFM scales were .74, .86, .82, .87, and .85, respectively. The alpha for the total CFM score was .94.

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The full-group correlations of the CFM scales with disability scores were .23, .38, .16, .26, and .39, respectively (all ps < .01). The full-group correlation of the total CFM score with the disabil­ ity score was .37 (p < .01). The five component scales accounted for 20% of the variance in disability scores (p < .01). After controlling for the FSQ, SNAQ, and CLQ, the five CFM compo­ nent scales accounted for an additional 14% of the variance (p < .01). Controlling for positive and negative affect did not result in a substantial difference in these correlations. CFM-MF gender differences. To examine gender differences in CFM-MF responses, several independent-sample t tests were conducted comparing males’ (n = 348) and females’ (n = 355) total and scale scores on the CFM-MF as well as the PA and NA scales of the PANAS. Data from participants who did not identify themselves as either male or female (n = 7) were excluded. The results of these tests indicated that females’ total scores on the CFM-MF were significantly larger than the males’ total scores. In addition, females’ scores on all of the scales of the CFM-MF were significantly larger than males’ scores on the scales. No significant differences were found between males’ and females’ scores on the PA and NA scales. The results of these analyses can be found in Table 4. Controlling for PA and NA did not change the relationships between gender and any of the CFM-MF scales. A series of univariate analyses of variance were conducted to determine whether the gender differences in each of the CFM-MF scales were mediated by any of the other CFM-MF scales. The gender differences in three of the CFM-MF scales (Risk Analysis, Physiological Symptoms, and Escape/Avoidance) were rendered nonsignificant by controlling for Fear/Anxiety, Control, or both. The association between gender and Fear/Anxiety remained sig­ nificant after controlling for the other four scales, as did the association between gender and Control.

Discussion The CFM is a trans-stimulus measure with promising psycho­ metric properties. The five CFM component scales appear to cover the domain of the DSM-5 diagnostic criteria for SP (APA, 2013) and are at least as comprehensive as existing stimulus-specific SP measures (e.g., the FSQ, the SNAQ). The CFM shows factorial

Table 4 Gender Differences in Circumscribed Fear Measure (CFM) Scores Scale CFM Total Score CFM Risk CFM Physiological Symptoms CFM Fear/Anxiety CFM Escape/Avoidance CFM Control PANAS Positive Affect PANAS Negative Affect

Male M (SD)

Female M (SD)

df

t

56.87(18.96) 11.73(4.20)

67.71 (18.79) 12.61 (4.60)

643 686

7.29 2.61

10.25 (5.06) 14.67 (3.84) 11.56(4.91) 8.97 (5.10) 21.73 (8.62) 9.63 (8.14)

12.48 (5.29) 16.73 (3.29) 13.84 (5.18) 11.75 (5.34) 21.76 (8.69) 10.57 (8.57)

689 687 684 689 680 685

5.67 7.61 5.91 6.99 0.04 1.47

Note. Equal variances not assumed. T-values where p < .01, two-tailed are in boldface type. Possible range of CFM total scores = 0-100; possible range of CFM scale scores = 0-20; possible range of Positive and Negative Affect Schedule (PANAS) scales = 0 -4 0 .

validity, with equivalent configural, metric, and structural proper­ ties across different types of stimuli; good reliability; and generally good construct and criterion validity. The five scales of the CFM are Risk Analysis (the belief that the stimulus is dangerous), Physiological Symptoms (bodily symp­ toms in the presence of the stimulus), Fear/Anxiety (subjective fear or anxiety in response to the stimulus), Escape/Avoidance (at­ tempts to avoid or escape from the stimulus), and Control (the belief that the stimulus will cause the respondent to behave in an embarrassing or out-of-control manner). The Control scale taps a symptom dimension that is not specifically outlined in the DSM-5 criteria and not commonly represented in other phobia measures. Flowever, the results of the present studies suggest that it is a distinct and potentially important symptom dimension. The results of the multigroup CFAs provided evidence that the factors contained the same items and held the same meanings across groups. In addition, the relationships between the factors were similar across groups. These results suggest that the CFM functions equivalently with different types of stimuli and provides additional justification for aggregating these fears into a single diagnostic category in the DSM. This result does not mean that there are not important differences between types of phobias, but rather that this measure functions similarly across groups that identify different stimuli as their most feared stimulus. In fact, one of the intended purposes of this measure is to use it in research studies that directly compare different types of phobias. The results of the factorial invariance CFAs indicate that the CFM is appro­ priate for this use. However, we also acknowledge that there are a variety of ways in which researchers examine applicability of measures across groups (cf. Vandenberg & Lance, 2000), and future studies with the CFM could assess this using an alternative method. In addition, the current study did not examine whether this CFM operates similarly when assessing blood-injection-injury fears; that is a potential topic for future research. Correlations between CFM scores and the corresponding stimulus-specific measures demonstrated generally good conver­ gent and discriminant validity, particularly for the spider and claustrophobia groups. Convergent validity was also good for the snake group, though discriminant validity was somewhat more modest. In the blood group, convergent validity was modest whereas discriminant validity was low, suggesting the CFM should be further evaluated before it is used with this group. The different patterns of convergence between groups may also reflect varying content across the phobia measures used. For example, the BISS— which solely measures physiological symptoms of blood-injectioninjury phobia— exhibited strongest correlations with the Physio­ logical Symptoms scale of the CFM. One difference in patterns of convergence that did not seem attributable to limited content of existing SP measures is that in the claustrophobia domain the CFM showed closer associations with fears of restriction than with fears of suffocation. This difference may be related to the use of a nonclinical sample, in which restriction concerns may be relatively more common than suffocation concerns. Although not all of the convergent correlations were significantly larger than the discrim­ inant correlations, the majority of the convergent correlations were larger in value than the discriminant correlations. Overall, the CFM appears to exhibit good convergent validity, particularly the total measure scores.

CIRCUMSCRIBED FEAR MEASURE

The relationship between the CFM and the SDS was examined in four separate groups to compare the measure’s criterion validity with the other phobia measures included in the study. In the spider-fearing group, the CFM’s relationship with the SDS was similar to that of the FSQ. In the snake-fearing and claustrophobia groups, the CFM still exhibited a significant relationship with the SDS after controlling for the SNAQ and the CLQ, respectively. In the blood-fearing group, neither the CFM correlations nor the BISS correlations were significant. Although the correlations be­ tween the CFM total scores and the SDS scores were modest, all were larger in magnitude than or comparable to the correlations between the SDS and the other phobia measures. This suggests that the CFM exhibited criterion validity that was at least as good as that of existing measures. However, given the modest effect sizes of these correlations, future research could further investigate the criterion validity of the CFM, particularly in a clinical population.

Severity of the Most Feared Stimulus (CFM-MF) By combining groups, a novel index was created. The CFM-MF measures the severity of individuals’ most severe fear, regardless of the stimulus identified. Combining measures from different stimuli seems appropriate because the CFM’s factor structure was quite comparable across stimuli. The CFM-MF was found to have good reliability and criterion validity. We are not aware of any existing measure that assesses a comparable construct. Our hope is that the CFM-MF would be particularly useful in studies investi­ gating the heritability common to SPs (i.e., comparing the severity of stimulus-specific fear among family members, even if they do not have the same feared stimulus). Gender differences in CFM-MF scores found that female par­ ticipants were found to have higher scores than male participants on all of the CFM-MF scales. This pattern of results is consistent with prior research, which has indicated that females are more likely to have SP (Stinson et al., 2007) and also report more severe levels of stimulus-specific fear (Fredrikson, Annas, Fischer, & Wik, 1996). In addition, analyses indicated that these gender differences were not due to positive or negative affect. The pattern of results suggest that gender differences in the Fear/Anxiety and Control scales were most pronounced, and these scales appeared to mediate the effects of gender on the other CFM scales. These findings somewhat contradict past research, which has found no gender differences in fear-related items reflecting loss of control (Baker & Stewart, 1996, as cited in Stewart, Taylor, & Baker, 1997). However, true gender differences in these symptoms could be difficult to discern, as Pierce and Kirkpatrick (1992) found that males may underreport fear symptoms. More research on the CFM-MF is needed.

Limitations and Future Directions Several factors may limit the generalizability or interpretability of the results. First, the data collected on the CFM only reflected participants’ most significant fear. Future studies could include an unselected sample and assess fears of a number of different stimuli to examine the generality of the current study’s findings. Many issues related to the CFM were not examined in this study. This study included a comparison of the CFM across groups that identified spiders, snakes, and enclosed spaces as their most

411

feared stimulus, and a partial comparison to those that identified blood as their most feared stimulus, but other stimuli were not examined. It was beyond the scope of the present study to examine the CFM’s utility for screening and diagnosis, sensitivity to treat­ ment, psychometric properties in a clinical sample, applicability to other phobic stimuli (especially blood), and applicability to other disorders (e.g., social phobia). The CFM’s utility for treatment planning was also not examined. Additional evidence of criterion validity, such as the CFM’s ability to predict physiological and behavioral responses to feared stimuli, is needed.

Conclusion At present, the CFM is the only measure that we are aware of that is designed to measure the severity of any type of SP. It is relatively comprehensive and shows good psychometric proper­ ties. The CFM’s apparent applicability to a wide variety of stimuli suggests that it potentially has substantial clinical and research utility.

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Appendix Circumscribed Fear Measure Please choose the object or situation that you are most afraid of. If the object or situation that you are most afraid of is not on the list, please write it on the blank line. □ □ □ □

spiders snakes dogs other:

□ storms O water □ the dark

□ flying □ heights □ small spaces

□ getting blood drawn □ going to the dentist □ going to the doctor

Thinking about the object or situation that you checked above, please check an answer for each of the following statements to indicate how much you agree with the statement: Strongly Disagree

Somewhat Disagree

Neither Agree nor Disagree

Somewhat Agree

Strongly Agree

1. I believe that the object or situation is dangerous to me.

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2. When I am faced with that object or situation, I sweat.

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3. I am more afraid of that object or situation than most people are.

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4. If faced with the object or situation, I would immediately try to leave.

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5. When faced with the object or situation, I worry that I will behave in a way that will make people think that I am crazy.

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6. I think that if I encounter the object or situation, everything will go wrong.

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7. When I am faced with that object or situation, I feel faint or dizzy.

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8. I feel anxious or nervous when faced with the object or situation.

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9. I avoid having to face this object or situation at all costs.

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10. When faced with the object or situation, I worry that I will do something silly or embarrassing.

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11. I don’t believe anyone could encounter the object or situation without some fear.

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12. When I am faced with that object or situation, I feel nauseated or sick.

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(Appendix continues)

McCRAW AND VALENTINER

414 Appendix (continued)

Strongly Disagree

Somewhat Disagree

Neither Agree nor Disagree

Somewhat Agree

Strongly Agree

13. If I encountered the object or situation right now, I would feel very panicky.

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14. If I believe that there is even a chance that I will encounter the object or situation somewhere, I will not go.

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15. If I encountered this object or situation right now, I worry I would lose control.

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16. If I encountered the object or situation, I think it would harm me.

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17. When I am faced with that object or situation, I feel like I have trouble breathing.

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18. If I encountered the object or situation right now, I would be afraid of it.

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19. I am afraid to go somewhere if I have encountered the object or situation there before.

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20. If I encountered this object or situation right now, I worry I would scream.

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21. If I encountered the object or situation right now, I would fear for my safety.

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22. When I am faced with that object or situation, my muscles feel tense, sore, or ache.

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23. I become nervous when I am about to encounter this object or situation.

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24. If faced with the object or situation, I would probably run away.

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25. If I encountered the object or situation right now, I might behave unpredictably.

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Received June 18, 2014 Revision received September 18, 2014 Accepted September 22, 2014 ■

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