Development and Preliminary Psychometric Evaluation of Decisional Balance and Self-Efficacy Measures for Managing Anxiety in a National Sample of Clinically Anxious Adults.
Anxiety is the most common and costly mental illness in the United States. Reducing avoidance is a core element of evidence-based treatments. Past research shows readiness to address avoidance affects outcomes. Investigating avoidance from a transtheoretical model (TTM) perspective could facilitate tailored approaches for individuals with low readiness. This study developed and examined psychometric properties of TTM measures for addressing anxiety-based avoidance.



Cross-sectional survey.



Community centers, online survey.



Five hundred ninety-four individuals aged 18 to 70 with clinically significant anxiety.



Overall Anxiety Severity Questionnaire, stages of change, decisional balance, and self-efficacy.



The sample was randomly split into halves for principal component analyses (PCAs) and confirmatory factor analyses (CFAs) to test measurement models. Further analyses examined relationships between constructs.



For decisional balance, PCA indicated two 5-item factors (pros and cons). Confirmatory factor analysis supported a 2-factor correlated model, Satorra-Bentler scaled chi-square [Formula: see text], comparative fit index (CFI = 0.94), root mean square error of approximation (RMSEA = 0.07), pros: α = 0.87, ρ = 0.87, cons: α = 0.75, and ρ = 0.75. For self-efficacy, PCA indicated one 6-item factor supported by CFA, [Formula: see text], P < .01, CFI = 0.98, RMSEA = 0.09, α = 0.90, ρ = 0.87. As hypothesized, significant cross-stage differences were observed for pros and self-efficacy, and significant relationships between anxiety severity and pros, cons, and self-efficacy were found.



Findings show strong psychometric properties and support the application of a readiness-based model to anxiety. In contrast to findings of other behaviors, cons remain high in action and maintenance. These measures provide a solid empirical foundation to develop TTM-tailored interventions to enhance engagement in treatment.
1 Boston VA Healthcare System, Jamaica Plain, MA, USA.
Jessica M
JM
Lipschitz
2 Cancer Prevention Research Center, University of Rhode Island, Kingston, RI, USA.
Andrea L
AL
Paiva
2 Cancer Prevention Research Center, University of Rhode Island, Kingston, RI, USA.
Colleen A
CA
Redding
2 Cancer Prevention Research Center, University of Rhode Island, Kingston, RI, USA.
Deborah
D
Levesque
2 Cancer Prevention Research Center, University of Rhode Island, Kingston, RI, USA.
Joseph S
JS
Rossi
1 Boston VA Healthcare System, Jamaica Plain, MA, USA.
Risa B
RB
Weisberg
2 Cancer Prevention Research Center, University of Rhode Island, Kingston, RI, USA.
James O
JO
Prochaska
D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000453:epidemiology* / Q000628:therapy*; D001521:Behavior Therapy / Q000379:methods*; D003430:Cross-Sectional Studies; D003657:Decision Making; D005163:Factor Analysis, Statistical; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D055815:Young Adult
anxiety; decisional balance; exposure therapy; self-efficacy; stages of change; transtheoretical model