Difficulties in Emotion Regulation Scale DERS

Transcription

1 MEASURE NAME: Acronym: DERS Basic Description Author(s): Author Contact: Author Citation: To Obtain: Gratz, K.L., & Roemer, L. Kim L. Gratz Department of Psychology University of Maryland College Park, MD Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology & Behavioral Assessment, 26(1), the author Website: Cost per copy (in US $): Copyright: Description: None $0.00 No The DERS is a brief, 36-item, self-report questionnaire designed to assess multiple aspects of emotion dysregulation. The measure yields a total score as well as scores on six scales derived through factor analysis: 1. Nonacceptance of emotional responses (NONACCEPTANCE) 2. Difficulties engaging in goal directed behavior (GOALS) 3. Impulse control difficulties (IMPULSE) 4. Lack of emotional awareness (AWARENESS) 5. Limited access to emotion regulation strategies (STRATEGIES) 6. Lack of emotional clarity (CLARITY) Although the measure is psychometrically young, it is promising and taps an important domain for the field of child trauma. Nearly all empirically validated treatments for child trauma seek to make changes in the domain of emotion regulation, but there are few measures that assess this domain. Theoretical Orientation Summary: The DERS has been examined in a sample of college students aged 18 and older and a clinical sample of women with Borderline Personality Disorder; however, the items are simply and clearly written and warrant examination in an adolescent population. The measure is based on conceptual and empirical work that conceptualizes emotion regulation as involving a) awareness 1

2 and understanding of emotions, b) acceptance of emotions, c) ability to control impulsive behaviors and behave in accordance with desired goals when experiencing negative emotions, d) ability to use situationally appropriate emotion regulation strategies flexibly to modulate emotional responses as desired in order to meet individual goals and situational demands. Domains Assessed: Languages Available: Problems in any of these areas would be indicative of emotion regulation difficulties. 1. Emotional/affective regulation (cgiver) 2. Emotional/affective regulation (child) English, German, Turkish Age Range: # of Items: Time to Complete (min): Time to Score (min): Periodicity: Response Format: unknown Measure Type: Measure Format: Reporter: Education Level: General assessment Questionnaire Self point scale: 1=almost never (0-10%), 2=sometimes (11-35%), 3=about half the time (36-65%), 4=most of the time (66-90%), 5=almost always (91-100%) Materials Needed: (check all that apply) Material Notes: Paper and pencil Computer Video equipment Testing stimuli Physiological equipment Other Sample Items: Domains Scale Sample Items Nonacceptance of When I'm upset, I feel guilty for feeling that way. emotional responses (NONACCEPTANCE ) Difficulties engaging When I'm upset, I have difficulty concentrating. in goal-directed behavior (GOALS) Impulse control When I'm upset, I lose control over my behaviors. difficulties (IMPULSE) Lack of emotional I am attentive to my feelings. (reverse) awareness (AWARENESS) Limited access to When I'm upset, I believe that I'll end up feeling very 2

3 emotion regulation strategies (STRATEGIES) Lack of emotional clarity (CLARITY) depressed. I have difficulty making sense out of my feelings. Notes (additional scales and domains): Information Provided: (check all that apply) Diagnostic information DSM-III Diagnostic information DSM-IV Strengths Areas of concerns/risks Program evaluation information Continuous assessment Raw Scores Standard Scores Percentile Graph (e.g., of elevated scale) Dichotomous assessment Clinical friendly output Written feedback Other Training Training to Administer: (check all that apply) None Via manual/video Prior experience psych testing & interpretation Must be a psychologist Training by experienced clinician (<4 hours) Training by experienced clinician ( 4 hours) Training to Interpret: (check all that apply) Training Notes: None Via manual/video Prior experience psych testing & interpretation Must be a psychologist Training by experienced clinician (<4 hours) Training by experienced clinician ( 4 hours) Parallel or Alternate Forms Parallel Forms? No Alternate Forms: No Forms for Different Ages: No If so, are forms comparable: Any Altered Versions of Measure: No Describe: Population Used to Develop Measure The measure was first tested with two samples. Sample 1: 373 undergraduates aged 18 to 55 (M=23.10, SD=5.67; 73% female, 27% male), from the University of Massachusetts, Boston, who returned questionnaire packets distributed during undergraduate psychology courses (response rate=78%: 373 of 479). The ethnicity was 65% White, 17% Asian, 8% African American, 4% Hispanic, 6% other or 3

4 unspecified background. The sample was predominantly heterosexual (90%). Sample 2: Recruited for the purpose of examining test-retest reliability. Of 194 participants, 21 agreed to complete measures a second time. Participants were aged (M=25.95, SD=8.94); 62% female, 38% male; 67% White, 24% African American, 5% Asian/Pacific Islander, and 5% unspecified background. Psychometrics Global Rating (scale based on Hudall Stamm, 1996): Basic properties established by author(s) Norms: No For separate age groups: For clinical populations: Separate for men and women: For other demographic groups: Notes: A mean score of approximately 120 has been found in three samples of patients. One study is in press (Gratz & Gunderson, in press). The author says that the other two are currently in preparation. Clinical Cutoffs: Specify Cutoffs: Used in Major Studies: Specify Studies: No 4

5 Reliability: Type: Rating Statistics Min Max Avg Test-Retest-# days: 42 Acceptable Intraclass correlation Internal Consistency: Inter-Rater: Acceptable Cronbach's alpha Parallel/Alternate Forms: Notes: TEST-RETEST RELIABILITY (Gratz & Roemer, 2004): n=21, time period=4-8 weeks, measured using an intraclass correlation coefficient Total DERS (.88), NONACCEPTANCE (.69), GOALS (.69), IMPULSE (.57), AWARENESS (.68), STRATEGIES (.89), and CLARITY (.80). INTERNAL CONSISTENCY: (Cronbach s alpha) Gratz & Roemer, 2004, DERS total (.93), NONACCEPTANCE (.85), GOALS (.89), IMPULSE (.86), AWARENESS (.80), STRATEGIES (.88), CLARITY (.84) In a sample of 325 participants aged (50.8% White, 21.5% Black, 8.6% Asian/Pacific Islander, 6.5% Hispanic/Latino, 5.2% multiracial, and 3.1% other) recruited from a large urban university, Salters, Roemer, Tull, Rucker, & Mennin (in press) reported good internal consistency for the total score (alpha=.89) and subscale scores (alpha>.77). Content Validity: Gratz & Roemer (2004) The initial 41 items were developed and selected based on conversations with colleagues well versed in the emotion regulation literature. The Generalized Expectancy for Negative Mood Regulation Scale was used as a template for the structure of some of the items (although not the content of the items). Items were selected to reflect difficulties within the following dimensions of emotion regulation: a) awareness and understanding of emotions; b) acceptance of emotions; c) the ability to engage in goal-directed behavior, and refrain from impulsive behavior, when experiencing negative emotions; and d) access to emotion regulation strategies perceived as effective. Scales and items were further refined using factor analysis. One item was eliminated due to low correlations for other items and the total score, and 4 items eliminated because they loaded on two factors or failed to load above.50 on any factor. 5

6 Construct Validity: (check all that apply) Validity Type Convergent/Concurrent Discriminant Sensitive to Change Intervention Effects Longitudinal/Maturation Effects Sensitive to Theoretically Distinct Groups Factorial Validity Notes: Not known Not found Nonclinical Clinical Samples Samples Diverse Samples Gratz & Roemer (2004) DERS total and subscale scores were significantly correlated with the Generalized Expectancy for Negative Mood Regulation Scale (NMR), with the STRATEGIES scale showing the highest correlation with the NMR and with the Acceptance and Action Questionnaire (AAQ). Scales also correlated with the Emotional Expressivity Scale (EES). Salters, Roemer, Tull, Rucker, & Mennin (in press) found that the DERS total was significantly correlated with the Penn State Worry Questionnaire (r=.51, p<.001) as were all DERS scales excepting the Lack of Awareness scale. Participants with probable GAD, assessed using the Generalize Anxiety Disorder Questionnaire-IV, reported significantly higher scores on the DERS total score as well as the Nonacceptance, Goals, Impulse, and Strategies scales. The relationship between DERS scales and GAD diagnosis remained significant even after controlling for negative affect, assessed using the Positive Affect Scale and Negative Affect Scale. The measure was developed using factor analysis (Gratz & Roemer, 2004). A common factor analysis using principal axis factoring and a promax oblique rotation resulted in a 6-factor solution, based on the scree test and interpretability, accounting for 55.68% of the variance: 1) Nonacceptance of emotional responses, 2) Difficulties engaging in goal-directed behavior, 3) Impulse control difficulties, 4) Lack of emotional awareness, 5) Limited access to emotion regulation strategies, and 6) Lack of emotional clarity. The DERS has been shown to be sensitive to change in a randomized trial of a 14-week group treatment for Borderline Personality Disorder that targeted emotion dysregulation. Women (n=12) assigned to the group plus treatment as usual showed significant improvement on DERS scores while the women (n=10) assigned to the wait list plus treatment did not (Gratz & Gunderson, in press). The author also reports that a second article, currently in preparation, shows changes in the DERS following specialized BPD treatment at the partial hospitalization and intensive outpatient levels of care. A final study, also in preparation, indicates significantly higher DERS scores among a sample of BPD outpatients, compared to outpatients without a personality disorder. 6

7 Criterion Validity: (check all that apply) Measures used as criterion: Deliberate Self Harm Inventory (DSHI), Abuse-Perpetration Inventory (API); Gratz & Roemer, 2004) Not known Not found Nonclinical Clinical Diverse Samples Samples Samples Predictive Validity: Postdictive Validity: Sensitivity Rate(s): Specificity Rate(s): Positive Predictive Power: Negative Predictive Power: Notes: No information available. Limitations of Psychometrics and Other Comments Regarding Psychometrics: 1. Gratz & Roemer (2004) report analyses that suggest that the DERS accounts for unique variance in clinically relevant behaviors above that accounted for by the Generalized Expectancy for Negative Mood Regulation Scale (NMR), an existing measure of affect regulation. 2. Although the measure was tested with a sample of college students, a significant number (24% of women and 17% of men) had a history of intimate partner violence. In addition: 35% of the women and 44% of the men reported a history of at least one incident of self-harm, and emotion dysregulation scores were related to self-harm behaviors in this sample; 86 women reported a history of sexual or physical abuse; and Affect Regulation scores were related to self-harm behaviors in this sample. Consumer Satisfaction No information available 7

8 Languages Other than English Language: Translation Quality (check all that apply) 1= Has been translated 2= Has been translated and back translated - translation appears good and valid. 3= Measure has been found to be reliable with this language group. 4= Psychometric properties overall appear to be good for this language group. 5= Factor structure is similar for this language group as it is for the development group. 6 = Norms are available for this language group. 7= Measure was developed for this language group German Turkish Use with Trauma Populations Populations for which measure has demonstrated evidence of reliability and validity: Physical abuse Sexual abuse Neglect Natural disaster Accidents Imprisonment Terrorism Immigration related trauma Kidnapping/hostage Use with Diverse Populations Population Type: Domestic Violence Community violence Medical trauma Witness death Assault War/combat Degree of Usage: (check all that apply) Traumatic loss (death) Other USE WITH DIVERSE POPULATIONS RATING SCALE 1. Measure is known (personal communication, conference presentation) to have been used with members of this group. 2=Studies in peer-reviewed journals have included members of this group who have completed the measure. 3=Measures have been found to be reliable with this group. 4=Psychometric properties well established with this group. 5=Norms are available for this group (or norms include a significant proportion of individuals from this group) 6=Measure was developed specifically for this group Developmental disability 2. Disabilities 3. Lower socio-economic status 4. Rural populations Notes (including other diverse populations): 8

9 Pros and Cons/Qualitative Impression Pros: 1. The measure focuses on emotion regulation, an extremely important domain for the field of child trauma, and its theoretical foundation is consistent with that of empirically validated trauma focused interventions. 2. The measure contributes additional variance in clinically relevant behaviors, beyond that explained by an existing emotion regulation measure. 3. The measure appears to be related to self-harm behaviors in women with a history of childhood sexual or physical abuse. 4. The measure is free. Cons: 1. The measure is new and psychometrically young, but it is promising. 2. The measure has yet to be normed, and there are no clinical cutoffs to help with interpretation of scores. 9

10 References (Representative sampling of publications, presentations, psychometric references) Published References: A PsychInfo literature search (6/05) of the words "" or DERS revealed that the measure has been referenced in 1 peer-reviewed journal article. The author provided two additional articles that are currently in press. 1. Gratz, K.L., & Roemer, L. (in press). Preliminary data on an acceptance-based emotion regulation group intervention for deliberate self-harm among women with borderline personality disorder. Behavior Therapy. 2. Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology & Behavioral Assessment, 26(1), Salters, K., Roemer, L., Tull, M.T., Rucker, L., & Mennin, D.S. (in press). Evidence of broad deficits in emotion regulation associated with chronic worry and generalized anxiety disorder. Cognitive Therapy and Research. Unpublished References: A PsychInfo literature search (6/05) of the words "" and DERS revealed that the measure has been referenced in 1 conference and 0 dissertations. 1. Gratz, K.L, & Tull, M.T. (2004, November). Differential correlates of self-harm among abused and non-abused women. Poster presented at the annual meeting of the International Society for Traumatic Stress Studies, New Orleans, LA. Number of Published References: (based on author provided information and a PsychInfo search, not including dissertations) Number of Unpublished References: (based on a PsychInfo search of unpublished doctoral dissertations) Author Comments: The author provided comments, which were integrated. 3 1 Citation for Review: Editor of Review: Last Updated: PDF Available: Chandra Ghosh Ippen, Ph.D. Chandra Ghosh Ippen, Ph.D. 6/20/2005 yes This project was funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). The views, policies and opinions expressed are those of the authors and do not necessarily reflect those of SAMHSA or HHS. 10