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

TY - JOUR

T1 - Understanding agoraphobic avoidance

T2 - the development of the Oxford Cognitions and Defences Questionnaire (O-CDQ)

AU - Rosebrock, Laina

AU - Lambe, Sinéad

AU - Mulhall, Sophie

AU - Petit, Ariane

AU - Loe, Bao S.

AU - Saidel, Simone

AU - Pervez, Maryam

AU - Mitchell, Joanna

AU - Chauhan, Nisha

AU - Prouten, Eloise

AU - Chan, Cindy

AU - Aynsworth, Charlotte

AU - Murphy, Elizabeth

AU - Jones, Julia

AU - Powling, Rosie

AU - Chapman, Kate

AU - Dudley, Robert

AU - Morrison, Anthony

AU - O'regan, Eileen

AU - Clark, David M.

AU - Waite, Felicity

AU - Freeman, Daniel

N1 - Funding Information: This work was funded by the National Institute for Health Research (NIHR) invention for innovation (i4i) programme (project II-C7-0117-20001). It was also supported by the NIHR Oxford Health Biomedical Research Centre (BRC). D.F. and D.C. are NIHR Senior Investigators. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Felicity Waite is funded by a Wellcome Trust Clinical Doctoral Fellowship (102176/B/13/Z). Publisher Copyright: © The Author(s), 2022. Published by Cambridge University Press on behalf of the British Association for Behavioural and Cognitive Psychotherapies

PY - 2022/5/15

Y1 - 2022/5/15

N2 - Abstract 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.

AB - Abstract 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.

KW - Agoraphobic avoidance

KW - Cognitive model

KW - Measure development

KW - Safety-seeking behaviours

KW - Threat cognitions

UR - http://www.scopus.com/inward/record.url?scp=85124942771&partnerID=8YFLogxK

U2 - 10.1017/S1352465822000030

DO - 10.1017/S1352465822000030

M3 - Article

AN - SCOPUS:85124942771

SN - 1352-4658

VL - 50

SP - 257

EP - 268

JO - Behavioural and cognitive psychotherapy

JF - Behavioural and cognitive psychotherapy

IS - 3

ER -