Beck Anxiety Inventory as it Relates to the Substance Abuse Population Research Paper

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Beck Anxiety Inventory Test

The Beck Anxiety Inventory (BAI) test was created by Dr. Aaron T. Beck and other colleagues, and is a 21-question multiple-choice self-report inventory that is used for measuring the extent and intensity of an individual's anxiety.

The items describe anxiety on four different ways:

(1) Subjective (e.g., "unable to relax"), (2) neurophysiologic (e.g., "numbness or tingling"), (3) autonomic (e.g., "feeling hot") or (4) panic-related (e.g., "fear of losing control." Individuals respond in a range that varies form "not at all" to feeling "severe anxiety"

Anxiety is known to possess various components, but Beck merely introduced two measures, cognitive and somatic. The cognitive scale evaluates impaired thoughts and cognitive processing whereas the somatic scale measures symptoms of physiologic arousal.

The BAI is mostly used in circumstances where somatic arousal is highest, such as with panic disorder, since the majority of the questions (15 out of 21) deal with somatic symptoms. For these reasons to, clinicians find the BAI to be less effective for disorders such as social phobia or obsessive-compulsive disorder that have a higher cognitive substructure.

The BAI is the third most popular tool used for anxiety disorders and ranks behind the STAI and the Fear Survey Schedule in popularity. It is used on all ages (17-80), particularly on adolescents (Grant (nd)), but has been displaced by another on high school students.

Limitations with the BAI include the fact that it only weakly discriminates between depression and anxiety as discovered in at least one study and that the mean and median reliability estimates of the BAI are lower when given to a no psychiatric population (such as college students) than when administered to a psychiatric population (deAyala et al., 2005).

2. Test Description

The Beck Anxiety Inventory (BAI) test was created by Dr. Aaron T. Beck and other colleagues, and is a 21-question multiple-choice self-report inventory that is used for measuring the extent and intensity of an individual's anxiety.

The BAI questions how the individual has been feeling the last week and arranges its questions so that they reflect common symptoms of anxiety. Questions for instance revolve around whether or not the respondent has been feeling examples of the following: numbness and tingling, sweating not due to heat, and fear of the worst happening. The questions are slanted for a 17 -- 80 age range and each question has a range of four possible responses: not at all; mildly; moderately; severely. Each is accorded a specific point with the last ("severely") being accorded the most points: 3.

The maximum score of the BAI is 63 points.

It is graded in the following way:

minimal level of anxiety = 0-7 points mild anxiety = 8-15 points moderate anxiety = 16-

Severe anxiety = 26-63 points (Beck AT, Steer RA (1993). Beck Anxiety Inventory Manual. San Antonio: Harcourt Brace and Company.

The clinicians then examine the responses to see whether they parallel to mostly subjective, neurophysiologic, autonomic, or panic-related symptoms. The entire test -- administered by pen and pencil can be completed in as short as five minutes and requires only basic reading skills. Given its simplicity, it can also be administered orally for sight-impaired individuals

The BAI was tightened by other factor structures that were included later by Beck and Steer's work on anxious outpatients that included neurophysiological, autonomic symptoms, subjective, and panic components of anxiety. In 1993, added panic subscale scores to their cognitive and somatic structures to further differentiate between the various categories of anxiety.

The BAI has since evolved into the BAI-Y, another measure used for youth that consists of twenty self-report items rated on a three point scale that assess a child's fears, worrying, and physiological symptoms associated with anxiety

3. Technical Evaluation

Beck eta l (1988) concluded that the BIO showed high internal consistency (at = .92) and test-retest reliability over 1 week, r (81) = .75. The BAI, they claimed, was able to discriminate between the different types of anxiety (panic disorder, generalized anxiety disorder, etc.) and distinguish them from depression. (other researchers (e.g. Hewitt & Norton, 1999) would find a weaker differentiation). Beck et al. also found the BAI to be moderately correlated with the revised Hamilton Anxiety Rating Scale, r (150) = .51, and to be only mildly correlated with the revised Hamilton Depression Rating Scale, r (153) = .25

Ayala et al. (2005) investigated reliability estimates of the BAI scores and showed that more than 57% of the publications either did not mention reliability estimates for BAI scores or presented secondary reliability estimates. Their metaanalysis showed that most of the literature on BAI suspected that gender and diagnostic classification would influence reliability estimates. Other factors too such as the "SD and mean BAI scores for each study, the type of reliability, participants' language, and the sample size used in the study were expected to influence the magnitude of the reliability estimates" (752). On the whole, internal consistency of the BAI was significant with coefficient alpha values being at least .83 and mean alphas being at least .88. (Grant (nd) assessed internal consistency (Cronbach's alpha) to range from .92 to .94 for adults)

The test-retest reliability estimates were, however, weaker in effect and showed greater variability with values that ranged from .35 to .83. This may be due to wide range of time intervals that elapsed between implementation of BAIs. The researchers were also dubious regarding whether or not gender is related to the magnitude of the reliability estimates of the BAI scores although at least one study has noted that females seem to indicate greater scores in the BAI than do males (Grant, nd). Another aspect that would help us ascertain reliability of the test would be mention of the respondents' ethnicity. Ayala et al. (2005) found that 42.3% of the studies failed to mention the participants' race/ethnic background.

Concurrent validity with the Hamilton Anxiety Rating Scale shows the BAI to have .51. The BAI has also been shown to possess acceptable reliability and convergent and discriminant validity for both adolescents and for inpatients and outpatients (Grant, nd).

4. Practical Evaluation

The BAI can be used in various settings. It can be used as baseline measure and diagnostic assessment as well as post-treatment outcome measure and as measure that assesses effectiveness of treatment as it progresses.

The BAI is mostly used in circumstances where somatic arousal is highest, such as with panic disorder, since the majority of the questions (15 out of 21) deal with somatic symptoms. For these reasons to, clinicians find the BAI to be less effective for disorders such as social phobia or obsessive-compulsive disorder that have a higher cognitive substructure (Leyfer, OT et al. (2006). Subsequently, it may be useful for screening these disorders in community mental health settings although it should be used cautiously in terms of discriminating between depression and anxiety since, contrary to Beck and colleagues' (1998) assertion regarding its ability to make distinctions, many researchers find it unable to do so.

The community agencies may be unable to perform the BAI on every individual that comes into their setting, but it can do so on a selective subsample of clients who indicate these symptoms (Each et al., 2008). It can also be used on primary care patients by means of guidelines, training, and education. When used thusly, many researchers (such as Muntingh et al., 2011) believe that the BAI questionnaires will have a valuable impact on directing treatment and on improving treatment of patients with anxiety disorders.

5. Summary Evaluation and Critique

The Beck Anxiety Inventory is a well-accepted self-report measure of anxiety in adults and adolescents for use in both clinical and research settings. It is a 21-item multiple-choice self-report inventory that measures intensity of anxiety in adults and adolescents. Using the somatic and cognitive descriptors, it is said…[continue]

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