Understanding agoraphobic avoidance: the development of the Oxford Cognitions and Defences Questionnaire (O-CDQ),Behavioural and Cognitive Psychotherapy

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Understanding agoraphobic avoidance: the development of the Oxford Cognitions and Defences Questionnaire (O-CDQ)
Behavioural and Cognitive Psychotherapy ( IF 2.467 ) Pub Date : 2022-02-15 , DOI: 10.1017/s1352465822000030
Laina Rosebrock _{1,

2,

3} , Sinéad Lambe _{1,

2,

3} , Sophie Mulhall _{1,

2} , Ariane Petit _{1,

2,

3} , Bao S Loe ₄ , Simone Saidel _{1,

2} , Maryam Pervez ₅ , Joanna Mitchell _{1,

2} , Nisha Chauhan ₆ , Eloise Prouten ₇ , Cindy Chan ₆ , Charlotte Aynsworth ₅ , Elizabeth Murphy ₆ , Julia Jones ₇ , Rosie Powling ₈ , Kate Chapman ₈ , Robert Dudley _{5,

9} , Anthony Morrison _{6,

10} , Eileen O'Regan ₇ , David M Clark _{2,

3,

11} , Felicity Waite _{1,

2,

3} , Daniel Freeman _{1,

2,

3}

Affiliation

Department of Psychiatry, University of Oxford, Oxford, UK.
Oxford Health NHS Foundation Trust, Oxford, UK.
NIHR Oxford Health Biomedical Research Centre, Oxford, UK.
The Psychometrics Centre, University of Cambridge, Cambridge, UK.
Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK.
Greater Manchester Mental Health Foundation Trust, Manchester, UK.
Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK.
Avon and Wiltshire Mental Health Partnership (AWP) NHS Trust, Bath, UK.
University of Newcastle, Newcastle upon Tyne, UK.
Division of Psychology and Mental Health, University of Manchester, Manchester, UK.
Department of Experimental Psychology, University of Oxford, Oxford, UK.

Background:

Many patients with mental health disorders become increasingly isolated at home due to anxiety about going outside. A cognitive perspective on this difficulty is that threat cognitions lead to the safety-seeking behavioural response of agoraphobic avoidance.

Aims:

We sought to develop a brief questionnaire, suitable for research and clinical practice, to assess a wide range of cognitions likely to lead to agoraphobic avoidance. We also included two additional subscales assessing two types of safety-seeking defensive responses: anxious avoidance and within-situation safety behaviours.

Method:

198 patients with psychosis and agoraphobic avoidance and 1947 non-clinical individuals completed the item pool and measures of agoraphobic avoidance, generalised anxiety, social anxiety, depression and paranoia. Factor analyses were used to derive the Oxford Cognitions and Defences Questionnaire (O-CDQ).

Results:

The O-CDQ consists of three subscales: threat cognitions (14 items), anxious avoidance (11 items), and within-situation safety behaviours (8 items). Separate confirmatory factor analyses demonstrated a good model fit for all subscales. The cognitions subscale was significantly associated with agoraphobic avoidance (r = .672, p < .001), social anxiety (r = .617, p < .001), generalized anxiety (r = .746, p < .001), depression (r = .619, p < .001) and paranoia (r = .655, p < .001). Additionally, both the O-CDQ avoidance (r = .867, p < .001) and within-situation safety behaviours (r = .757, p < .001) subscales were highly correlated with agoraphobic avoidance. The O-CDQ demonstrated excellent internal consistency (cognitions Cronbach’s alpha = .93, avoidance Cronbach’s alpha = .94, within-situation Cronbach’s alpha = .93) and test–re-test reliability (cognitions ICC = 0.88, avoidance ICC = 0.92, within-situation ICC = 0.89).

Conclusions:

The O-CDQ, consisting of three separate scales, has excellent psychometric properties and may prove a helpful tool for understanding agoraphobic avoidance across mental health disorders.

中文翻译：

了解避免广场恐惧症：牛津认知和防御问卷 (O-CDQ) 的发展

背景：

由于对外出的焦虑，许多患有精神疾病的患者在家中变得越来越孤立。对这一困难的认知观点是，威胁认知导致了广场恐惧回避的寻求安全的行为反应。

目标：

我们试图开发一个适合研究和临床实践的简短问卷，以评估可能导致避免广场恐惧症的广泛认知。我们还包括两个额外的分量表，评估两种寻求安全的防御反应：焦虑回避和情境内安全行为。

方法：

198 名患有精神病和广场恐惧症回避的患者和 1947 名非临床个体完成了项目池和对广场恐惧症回避、广泛性焦虑、社交焦虑、抑郁和妄想症的测量。因素分析用于得出牛津认知和防御问卷 (O-CDQ)。

结果：

O-CDQ由三个分量表组成：威胁认知（14项）、焦虑回避（11项）和情境内安全行为（8项）。单独的验证性因素分析表明模型适合所有分量表。认知分量表与避免广场恐惧症 ( r = .672, p < .001)、社交焦虑 ( r = .617, p < .001)、广泛性焦虑 ( r = .746, p < .001)、抑郁显着相关( r = .619, p < .001) 和偏执狂 ( r = .655, p < .001)。此外，O-CDQ 避免 ( r = .867, p< .001) 和情境内安全行为 ( r = .757, p < .001) 分量表与避免广场恐惧症高度相关。O-CDQ 表现出出色的内部一致性（认知 Cronbach α = .93，回避 Cronbach α = .94，情境内 Cronbach α = .93）和重测信度（认知 ICC = 0.88，回避 ICC = 0.92，情境内 ICC = 0.89）。