A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience
Issue link: https://innovationscns.epubxp.com/i/555782
[ V O L U M E 1 2 , N U M B E R 7 – 8 , J U L Y – A U G U S T 2 0 1 5 ] Innovations in CLINICAL NEUROSCIENCE 21 about 29 percent of the data variance. A confirmatory factor analysis showed that all the regression coefficients are greater t han or equal to 0.40 Conclusion: The original Brazilian version of the Cognitive Distortions Questionnaire is adequate for use in the context of national undergraduate students and is able to separate different cognitive distortions. However, further studies using clinical samples are needed. INTRODUCTION It has been shown that cognition influences emotion, behavior, and interpersonal relationships and facilitates information processing at implicit (nonconscious) and explicit (conscious) levels of awareness. 1 Thus, when information is processed in a biased way, consequent emotional and behavioral responses may be dysfunctional and negatively impact interpersonal relationships and one's well-being. 2 The ability to identify and correct biases in thinking is essential in the practice of cognitive behavioral therapy (CBT). 3 Cognitive behavioral therapists have identified three levels of cognition. At the most superficial level, automatic thoughts (ATs)— considered to be situation-specific— are the easiest to identify and modify. Negative ATs are thought to be mostly the consequence of an underlying error in reasoning. Such cognitions can be assessed with the Automatic Thoughts Questionnaire (ATQ-30), a 30-item questionnaire developed by Hollon and Kendall 4 to measure the frequency of occurrence. Other measures to assess cognitive errors have been developed, including the Cognitive Bias Questionnaire (CBQ) 5 and the Cognitive Errors Questionnaire. 6 More recently, Covin et al 3 developed the Cognitive Distortions Scale (CDS), an instrument that measures the tendency to make 10 cognitive distortions in interpersonal and achievement domains. Cognitions occurring at an intermediate level, characterized by underlying assumptions and rules, can be assessed by the Dysfunctional Attitude Scale, designed to assess negative attitudes of patients with d epression toward self, outside world, and the future. 7 The deepest level of cognition comprises schemas and core beliefs, and these constructs can be measured using the Personality Beliefs Questionnaire 8 and the Young Schema Questionnaire. 9 This study focuses on the first and more easily accessed, although not less important, level of cognition—ATs. According to cognitive theory, patients with mental health disorders demonstrate negatively biased information processing, which in turn influences the nature of the thoughts they experience in specific situations. 2 In many instances, these ATs are characterized by one or more errors in thinking that results from biased information processing. These cognitive errors, also called cognitive distortions, are easily identified and labeled by patients as part of the treatment. 10 The purpose of developing the Cognitive Distortions Questionnaire (CD-Quest) was to create an instrument to be used by patients during the course of CBT treatment in order to facilitate connections between cognitive errors and their consequent emotional states as well as dysfunctional behaviors. The instrument was also designed to be used by therapists in order to obtain quantitative estimates of the frequency and intensity of their patients' cognitive errors and the manner these variables respond to CBT over time. Although the English 11,12 and the Brazilian Portuguese 13 versions of the CD-Quest were constructed simultaneously by the first author (I.R.O.), the objective of this study was to analyze the psychometric properties of the Brazilian version regarding internal consistency, test- retest properties, concurrent validity, construct validity, and discriminant validity. METHODS This study was conducted in two phases, separately described in this section. The objective of Phase I was t o construct the CD-Quest, and the objective of Phase II was to assess its properties in a sample of undergraduate medical and psychology students. Phase I: Development of the CD-Quest. The first author (I.R.O.) reviewed cognitive therapy books 2 ,10,14–17 that included a list of cognitive distortions and their definitions, organized known cognitive distortions in a preliminary list with clinical examples, put them together in a grid similar to that devised by Williams et al 18 for the Hamilton Depression Rating Scale, 19 organized them in two dimensions (frequency and intensity of the belief), and made it available to be examined by members of the Academy of Cognitive Therapy (www.academyofct.org) through its listserv. After review and suggestions given by several members, a final 15- item questionnaire was compiled. The Brazilian Portuguese version was designed at the same time as the English version by the first author (I.R.O.). Each item score ranged from 0 to 5, measured both dimensions simultaneously, and was presented as a grid (Figure 1). Phase II: Assessment of a sample. Undergraduate medical (58.0%) and psychology (42.0%) students comprised the sample of participants for the study. There was a preponderance of female subjects (67%), and the mean (± standard deviation [SD]) sample age was 21.85±3.37 years. All subjects volunteered to participate and signed an informed consent. Instruments. In addition to the CD-Quest, the following questionnaires were administered: The Beck Depression Inventory (BDI), 20,21 the Brazilian version of which was translated and adapted to Brazilian Portuguese, 22 is a 21-item, self-report questionnaire that measures the severity of depressive symptoms and of which total scores