Nomothetic outcome assessment in counseling and psychotherapy: Development and preliminary psychometric analyses of the Depression/Anxiety Negative Affect Scale

AbstractNegative affect (NA) plays a significant role in the initiation, persistence, and response to psychotherapy of many client problems (Moses & Barlow, 2006). This report describes the development of a brief NA measure, the Depression/Anxiety Negative Affect (DANA) scale, and preliminary analyses of its psychometric properties. An initial pool of DANA items was selected on the basis of a review of relevant literature about emotion science and counseling outcomes, related tests, and feedback from psychotherapists as part of a pilot test. The DANA was evaluated in two representative clinical samples where psychotherapists produced a total of 363 session ratings with 81 clients. DANA scores evidenced adequate internal consistency, evidence of convergent and discriminant validity, and sensitivity to change over the course of psychotherapy. Effect sizes (ES) of DANA scores consistently equaled or exceeded the average ES of .68 found for scales assessing the outcomes of counseling and psychotherapy in meta-analytic studies (Smith & Glass, 1977). ESs greater than 1 were found on DANA variables for clients whose therapists rated them as experiencing, rather than avoiding, NA.Key words: Sensitivity to change, negative affect, counseling and psychotherapy outcomesFor most psychotherapists, working with client affect is an essential element for change (Mergenthaler, 1996; Moses & Barlow, 2006). Teyber and McClure (201 1, p. 184) maintained that "painful feelings lie at the heart of enduring problems, and therapists help clients change when they respond effectively to them." Research indicates that client improvement is associated with verbalization of affect and affective processing (Diener, Hilsenroth, & Weinberger, 2007; Greenberg, Korman, & Paivio, 2001). Depending on the particular client and the therapist's theoretical orientation, this affective focus can help clients work through emotional problems such as depression and anxiety, prepare for behavior change, or stop ruminating so that more adaptive cognitions can occur.Barrett (2006a) suggested that affect "is a neurophysiological barometer of the individual's relation to an environment at a given point in time" (p. 48). Feelings perform a crucial function: They inform individuals about their status in a perceived environment (Campbell-Sills & Barlow, 2007) and subsequently provide powerful motivation for human activity (Frijda, 1986). Izard (2007) wrote that the primacy of emotions as motivation means that feelings influence a wide range of human systems from perception to behavior. Relevant to counseling and psychotherapy, emotion researchers have found negative affect (NA) and positive affect (PA) to be useful descriptions of basic emotions across individuals and cultures (Barrett, 2006b; Izard, 2007). NA refers to emotions experienced as unpleasant or aversive (such as sadness and fear) while PA is affect experienced as pleasant states (such as happiness) (Barrett, 2006b). Two NA states, depression and anxiety, have been described as "the most common reactions to stressful life events" (Carter, 2007, p. 28).NA states such as depression and anxiety are present with most clients at the beginning of therapy and decrease as effective therapy progresses. Vermeersch, Lambert, and Burlingame (2000), Weinstock and Meier (2003), and Vermeersch et al. (2004), for example, conducted outcome analyses that examined change during psychotherapy at the item level on several outcome measures. Assessing a broad range of problem domains in a total of 7,344 clients who received services at university counseling centers, an outpatient clinic, private practitioners, and employee assistance programs, these studies found that depression and anxiety-related items evidence larger effect sizes (ES) than items assessing other domains. Similarly, Krampen (2010) examined change on a brief outcome scale in 2 studies of psychotherapy outpatients and found that the largest changes appeared on items assessing distress and anxiety. …