The Cognitive & Behavioural Responses to Symptoms Questionnaire (CBRQ): Development, reliability and validity... 2023 Picariello, Chalder, Moss-Morris

Andy

Andy

Retired committee member
Full title: The Cognitive and Behavioural Responses to Symptoms Questionnaire (CBRQ): Development, reliability and validity across several long-term conditions

Abstract

Objectives
Cognitive and behavioural responses to symptoms can worsen or maintain the severity of symptoms across long-term conditions (LTCs). Although the Cognitive and Behavioural Responses Questionnaire (CBRQ) has been used in research, its original development and psychometric properties as a transdiagnostic measure have not been reported. Our aim was to evaluate the psychometric properties of the CBRQ and a recently proposed short version, across different LTCs.

Design
Psychometric validation study.

Methods
Confirmatory factor analysis (CFA) tested the factor structure of the CBRQ in two datasets from the CBRQ's original development; (chronic fatigue syndrome, N = 230; and multiple sclerosis, N = 221) and in additional groups: haemodialysis (N = 174), inflammatory bowel disease (N = 182) and chronic dizziness (N = 185). Scale reliability and construct validity were assessed. The factor structure of the shortened CBRQ (CBRQ-SF) was also assessed.

Results
CFA revealed that a 7-or 8-factor structure had generally appropriate fit supporting the originally proposed 7 factors (Fear avoidance, Damage beliefs, Catastrophising, Embarrassment avoidance, Symptom focusing, All-or-nothing behaviour and Avoidance/Resting behaviour). Omega coefficients indicated satisfactory internal reliability. Correlations with related constructs suggested construct validity. The scale appeared sensitive to change. The CBRQ-SF also displayed good psychometric quality, with a better model fit than the CBRQ.

Conclusions
The CBRQ and the shortened version were shown to be reliable and valid at assessing a range of cognitive and behavioural responses to symptoms, highlighting the multi-symptom, transdiagnostic properties of this questionnaire. Further research is necessary to determine the test–retest reliability and sensitivity to change of the CBRQ and CBRQ-SF and a thorough evaluation of the content validity of the items.


Statement of Contribution
What is already known on this subject?
  • Cognitive and behavioural responses to symptoms can worsen or maintain the severity of symptoms across long-term conditions (LTCs).
  • The Cognitive and Behavioural Responses Questionnaire (CBRQ) has been used in research, however its original development, and psychometric properties as a transdiagnostic measure have not been reported.
What this study adds?
  • The CBRQ and a shortened version (CBRQ-SF) were shown to be reliable and valid at assessing a range of cognitive and behavioural responses to symptoms, highlighting the multi-symptom, transdiagnostic properties of these measures.
  • Whilst both versions capture clinically important cognitive and behavioural constructs, we recommend using the CBRQ-SF given its stronger factor structure and brevity.
  • Further research is necessary to determine the content validity, test–retest reliability and sensitivity to change of the CBRQ and CBRQ-SF.
Open access, https://bpspsychub.onlinelibrary.wiley.com/doi/10.1111/bjhp.12644
 
cbt watch

The Hijacking of Fatigue by CBT To Foster Expansionism

A just published paper by Picariello et al 2023 singles out fatigue across 5 disorders, suggesting that certain cognitions and behaviours play a pivotal role in the worsening or maintaining of this symptom. In addition it is suggested that targeting such cognitions and behaviours would make a clinically significant difference to associated low mood and anxiety. The cognitions and behaviours are enshrined in the authors Cognitive and Behavioural response to Symptoms Questionnaire (CBRSQ-SF) short form. The authors posit that the scale could be a therapeutic aid, indicating treatment targets. Further they suggest that it may facilitate the development of a low intensity treatment for these conditions.

But the data Picariello et al 2023 present is all correlational, it does not establish causation. To establish causation it would be necessary to demonstrate that amongst those who had remitted from the conditions a high score on the CBRQ-SF was predictive of fatigue score, controlling first for the effect of mood. [Dysfuntional attitudes are known to be correlated with mood]. The partial correlation analysis would then need to be repeated with low mood and anxiety as the dependent variables. The danger is that the CBRQ-SF is promoted on the basis of its face validity and used to justify the expansion of psychological therapy into the Long Term Conditions Arena. Given that 43% the population of England have at least one LTC there is the prospect of rich pickings for service providers, such as the Improving Access to Psychological Therapies Service. One of the authors of the Picariello et al 2023 Trudie Chalder is a regular presenter to IAPT staff on the treatment of LTC’s.
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full post here
http://www.cbtwatch.com/the-hijacking-of-fatigue-by-cbt-to-foster-expansionism/
 
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