Introduction of the generic sense of ability to adapt scale and validation in a sample of outpatient adults with mental health problems

Katinka Franken, Pauline Schuffelen, Peter Ten Klooster, Karin van Doesum, Gerben Westerhof, Ernst Bohlmeijer, Katinka Franken, Pauline Schuffelen, Peter Ten Klooster, Karin van Doesum, Gerben Westerhof, Ernst Bohlmeijer

Abstract

Introduction: The ability to adapt is a core aspect of daily human life. Recent models and theories emphasize its essential role for health and well-being. It concerns the perceived ability to readjust and actively deal with the psychosocial consequences of challenging events. While many questionnaires measure competences related to adaptability to specific conditions, a scale that measures a generic sense of the ability to adapt is lacking. The aim of the present study is to introduce the Generic Sense of Ability to Adapt Scale (GSAAS) and to examine its psychometric properties.

Methods: The article describes two sub-studies. In the first study the items of the GSAAS were generated and field-tested in a cross-sectional non-clinical sample using item analysis, exploratory factor analysis and Rasch analysis.

Results: This resulted in a 10-item questionnaire measuring a single dimension with good reliability (Cronbach's α = 0.87). In the second study the 10-item scale was validated using a cross-sectional sample of 496 outpatient adults with mental health problems. Confirmatory factor analysis confirmed the unidimensional structure of the GSAAS and the absence of measurement variance across gender, age and education. Reliability was high (α = 0.89) and moderate to strong correlations between the GSAAS and concurrent validation measures confirmed its convergent validity. Regarding incremental validity, the GSAAS accounted for 7.4% additional explained variance in symptomatic distress above and beyond sense of coherence.

Discussion: In conclusion, the GSAAS appears to be a reliable and valid instrument to assess people's generic sense of the ability to adapt. It is a practical and quick tool that can be used to measure a vital aspect of health in research and clinical treatment settings.

Keywords: adaptation; generic sense of ability to adapt scale; mental health problems; positive psychology assessment; reliability; scale development; validation; well-being.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2023 Franken, Schuffelen, ten Klooster, van Doesum, Westerhof and Bohlmeijer.

Figures

Figure 1
Figure 1
Scree plot of observed eigenvalues and average eigenvalues from parallel analysis (50 random datasets).
Figure 2
Figure 2
Frequency distribution of the mean scores of the GSAAS (N = 496).

References

    1. Aldao A., Nolen-Hoeksema S., Schweizer S. (2010). Emotion-regulation strategies across psychopathology: a meta-analytic review. Clin. Psychol. Rev. 30, 217–237. doi: 10.1016/j.cpr.2009.11.004, PMID:
    1. Amati V., Meggiolaro S., Rivellini G., Zaccarin S. (2018). Social relations and life satisfaction: the role of friends. Genus 74, 1–18. doi: 10.1186/s41118-018-0032-z
    1. American Psychiatric Association . (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (Vol. 5). American Psychiatric Association: Washington, DC
    1. Antonovsky A. (1979). Health, stress, and coping: New perspectives on mental and physical well-being. San Francisco, CA: Wiley & Sons; 12–37.
    1. Antonovsky A. (1987). Unraveling the mystery of health: How people manage stress and stay well. San Francisco: Jossey-Bass
    1. Antonovsky A. (1993). The structure and properties of the sense of coherence scale. Soc. Sci. Med. 36, 725–733. doi: 10.1016/0277-9536(93)90033-Z
    1. Antonovsky A. (1996). The salutogenic model as a theory to guide health promotion. Health Promot. Int. 11, 11–18. doi: 10.1093/heapro/11.1.11
    1. Audulv Å., Packer T., Hutchinson S., Roger K. S., Kephart G. (2016). Coping, adapting or self-managing–what is the difference? A concept review based on the neurological literature. J. Adv. Nurs. 72, 2629–2643. doi: 10.1111/jan.13037
    1. Barlow J., Wright C., Sheasby J., Turner A., Hainsworth J. (2002). Self-management approaches for people with chronic conditions: a review. Patient Educ. Couns. 48, 177–187. doi: 10.1016/S0738-3991(02)00032-0
    1. Bjorklund D. F. (2015). Developing adaptations. Dev. Rev. 38, 13–35. doi: 10.1016/j.dr.2015.07.002
    1. Bohlmeijer E., Smit F., Cuijpers P. (2003). Effects of reminiscence and life review on late-life depression: a meta-analysis. Int. J. Geriatr. Psychiatry 18, 1088–1094. doi: 10.1002/gps.1018, PMID:
    1. Bohlmeijer E. T., Westerhof G. J. (2020). A new model for sustainable mental health: Integrating well-being into psychological treatment, Washington, DC: American Psychological Association.
    1. Bohlmeijer E. T., Westerhof G. J. (2021). The model for sustainable mental health: future directions for integrating positive psychology into mental health care. Front. Psychol. 12, 1–10. doi: 10.3389/fpsyg.2021.747999, PMID:
    1. Bond T. G., Fox C. M., Lacey H. (2007). “Applying the Rasch model” in Fundamental measurement in the human sciences. 2nd Edn. (Lawrence Erlbaum Associates Publishers: Psychology Press; ).
    1. Brown K. W., Ryan R. M. (2003). The benefits of being present: mindfulness and its role in psychological well-being. J. Pers. Soc. Psychol. 84, 822–848. doi: 10.1037/0022-3514.84.4.822
    1. Browne M. W., Cudeck R. (1992). Alternative ways of assessing model fit. Sociol. Methods Res. 21, 230–258. doi: 10.1177/0049124192021002005
    1. Brüssow H. (2013). What is health? Microb. Biotechnol. 6, 341–348. doi: 10.1111/1751-7915.12063, PMID:
    1. Cattell R. B. (1966). The scree test for the number of factors. Multivar. Behav. Res. 1, 245–276. doi: 10.1207/s15327906mbr0102_10
    1. Chen F. F. (2007). Sensitivity of goodness of fit indexes to lack of measurement invariance. Struct. Equ. Model. Multidiscip. J. 14, 464–504. doi: 10.1080/10705510701301834
    1. Chesney M. A., Neilands T. B., Chambers D. B., Taylor J. M., Folkman S. (2006). A validity and reliability study of the coping self-efficacy scale. Br. J. Health Psychol. 11, 421–437. doi: 10.1348/135910705X53155, PMID:
    1. Cohen J. (1988). Statistical power analysis for the behavioral sciences. J. Am. Stat. Assoc. 84, 19–74.
    1. Conversano C., Rotondo A., Lensi E., Della Vista O., Arpone F., Reda M. A. (2010). Optimism and its impact on mental and physical well-being. Clin. Pract. Epidemiol. Mental Health 6, 25–29. doi: 10.2174/1745017901006010025, PMID:
    1. Cotton D., Gresty K. (2006). Reflecting on the think-aloud method for evaluating e-learning. Br. J. Educ. Technol. 37, 45–54. doi: 10.1111/j.1467-8535.2005.00521.x
    1. Cuijpers P., Karyotaki E., Ciharova M., Miguel C., Noma H., Furukawa T. A. (2021). The effects of psychotherapies for depression on response, remission, reliable change, and deterioration: a meta-analysis. Acta Psychiatr. Scand. 144, 288–299. doi: 10.1111/acps.13335, PMID:
    1. Cummins R. A. (2010). Subjective wellbeing, Homeostatically protected mood and depression: a synthesis. J. Happiness Stud. 11, 1–17. doi: 10.1007/s10902-009-9167-0
    1. De Beurs E., Kosterman S., Anten S., Bohlmeijer E., Westerhof G. J. (2022). Psychometrische evaluatie van de Mental Health Continuum–Short Form (MHC-SF). Constructvaliditeit, responsiviteit voor verandering, normen en T-scores. Gedragstherapie 55, 1–32.
    1. De Jong K., Nugter M. A., Polak M. G., Wagenborg J. E. A., Spinhoven P., Heiser W. J. (2007). The outcome questionnaire (OQ-45) in a Dutch population: a cross-cultural validation. Clin. Psychol. Psychother. Int. J. Theory Pract. 14, 288–301. doi: 10.1002/cpp.529
    1. De Vos J. A., LaMarre A., Radstaak M., Bijkerk C. A., Bohlmeijer E. T., Westerhof G. J. (2017). Identifying fundamental criteria for eating disorder recovery: a systematic review and qualitative meta-analysis. J. Eat. Disord. 5, 1–14. doi: 10.1186/s40337-017-0164-0
    1. Diener E. (1984). Subjective well-being. Psychol. Bull. 95, 542–575. doi: 10.1037/0033-2909.95.3.542
    1. Dodge R., Daly A. P., Huyton J. L., Sanders L. (2012). The challenge of defining wellbeing. Int. J. Wellbeing 2, 222–235. doi: 10.5502/ijw.v2i3.4
    1. Drageset J., Haugan G. (2016). Psychometric properties of the orientation to life questionnaire in nursing home residents. Scand. J. Caring Sci. 30, 623–630. doi: 10.1111/scs.12271, PMID:
    1. Dunn W. (2007). Supporting children to participate successfully in everyday life by using sensory processing knowledge. Infants Young Child. 20, 84–101. doi: 10.1097/01.IYC.0000264477.05076.5d
    1. Eriksson M., Lindström B. (2007). Antonovsky’s sense of coherence scale and its relation with quality of life: a systematic review. J. Epidemiol. Community Health 61, 938–944. doi: 10.1136/jech.2006.056028, PMID:
    1. Eriksson M., Mittelmark M. B. (2017). “The sense of coherence and its measurement” in The handbook of salutogenesis (Cham: Springer; ), 97–106.
    1. Floyd F. J., Widaman K. F. (1995). Factor analysis in the development and refinement of clinical assessment instruments. Psychol. Assess. 7, 286–299. doi: 10.1037/1040-3590.7.3.286
    1. Franken K., Lamers S. M. A., Ten Klooster P. M., Bohlmeijer E. T., Westerhof G. J. (2018). Validation of the mental health continuum-short form and the dual continua model of well-being and psychopathology in an adult mental health setting. J. Clin. Psychol. 74, 2187–2202. doi: 10.1002/jclp.22659, PMID:
    1. Fredrickson B. L. (2001). The role of positive emotions in positive psychology: the broaden-and-build theory of positive emotions. Am. Psychol. 56, 218–226. doi: 10.1037/0003-066X.56.3.218
    1. Getnet B., Alem A. (2019). Construct validity and factor structure of sense of coherence (SoC-13) scale as a measure of resilience in Eritrean refugees living in Ethiopia. Confl. Heal. 13, 1–14. doi: 10.1186/s13031-019-0185-1
    1. González-López J. R., Serrano-Gómez D., Velasco-González V., Alconero-Camarero A. R., Cuesta-Lozano D., García-García E., et al. . (2022). Design and validation of a questionnaire on risk perception, coping behaviors and preventive knowledge against COVID-19 among nursing students. J. Pers. Med. 12:515. doi: 10.3390/jpm12040515, PMID:
    1. Greenaway K. H., Louis W. R., Parker S. L., Kalokerinos E. K., Smith J. R., Terry D. J. (2015). “Measures of coping for psychological well-being” in Measures of personality and social psychological constructs. eds. Boyle G. J., Saklofske D. H., Matthews G. (Elsevier; ), 322–351.
    1. Grevenstein D., Bluemke M., Kroeninger-Jungaberle H. (2016). Incremental validity of sense of coherence, neuroticism, extraversion, and general self-efficacy: longitudinal prediction of substance use frequency and mental health. Health Qual. Life Outcomes 14, 1–14. doi: 10.1186/s12955-016-0412-z
    1. Gross J. J., John O. P. (2003). Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. J. Pers. Soc. Psychol. 85, 348–362. doi: 10.1037/0022-3514.85.2.348, PMID:
    1. Hair J. F., Black W. C., Babin B. J., Anderson R. E., Tatham R. L. (2006). Multivariate data analysis, Vol. 6.
    1. Hayes S. C. (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behav. Ther. 35, 639–665. doi: 10.1016/S0005-7894(04)80013-3
    1. Headey B., Wearing A. (1991). “Subjective well-being: a stocks and flows framework” in Subjective well-being: An interdisciplinary perspective. eds. Strack F., Argyle M., Schwarz N., Vol. 21 (Oxford: Pergamon Press; ), 49–73.
    1. Helgeson V. S. (1999). Applicability of cognitive adaptation theory to predicting adjustment to heart disease after coronary angioplasty. Health Psychol. 18, 561–569. doi: 10.1037/0278-6133.18.6.561, PMID:
    1. Helgeson V. S., Reynolds K. A., Siminerio L. M., Becker D. J., Escobar O. (2014). Cognitive adaptation theory as a predictor of adjustment to emerging adulthood for youth with and without type 1 diabetes. J. Psychosom. Res. 77, 484–491. doi: 10.1016/j.jpsychores.2014.09.013, PMID:
    1. Holeva V., Tarrier N., Wells A. (2001). Prevalence and predictors of acute stress disorder and PTSD following road traffic accidents: thought control strategies and social support. Behav. Ther. 32, 65–83. doi: 10.1016/S0005-7894(01)80044-7
    1. Horn J. (1965). A rationale and test for the number of components from the matrix of partial correlations. Psychometrika 30, 179–185. doi: 10.1007/BF02289447
    1. Hu L.-T., Bentler P. M. (1998). Fit indices in covariance structure modeling: sensitivity to underparameterized model misspecification. Psychol. Methods 3, 424–453. doi: 10.1037/1082-989X.3.4.424
    1. Hu L. T., Bentler P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct. Equ. Model. Multidiscip. J. 6, 1–55. doi: 10.1080/10705519909540118
    1. Huber M., Knottnerus J., Green L., van der Horst H., Jadad A. R., Kromhout D., et al. . (2011). How should we define health. BMJ 2011:343 doi: 10.1136/bmj.d4163
    1. Huber M., van Vliet M., Giezenberg M., Winkens B., Heerkens Y., Dagnelie P., et al. . (2016). Towards a ‘patient-centred’ operationalisation of the new dynamic concept of health: a mixed methods study. BMJ Open 6:e010091. doi: 10.1136/bmjopen-2015-010091, PMID:
    1. Jambroes M., Nederland T., Kaljouw M., Van Vliet K., Essink-Bot M.-L., Ruwaard D. (2016). Implications of health as ‘the ability to adapt and self-manage’ for public health policy: a qualitative study. Eur. J. Public Health 26, 412–416. doi: 10.1093/eurpub/ckv206, PMID:
    1. Joshi A., Kale S., Chandel S., Pal D. K. (2015). Likert scale: explored and explained. Br. J. Appl. Sci. Technol 7, 396–403. doi: 10.9734/BJAST/2015/14975
    1. Kashdan T. B., Rottenberg J. (2010). Psychological flexibility as a fundamental aspect of health. Clin. Psychol. Rev. 30, 865–878. doi: 10.1016/j.cpr.2010.03.001, PMID:
    1. Keyes C. L. (1998). Social well-being. Soc. Psychol. Q. 61, 121–140. doi: 10.2307/2787065
    1. Keyes C. L. (2002). The mental health continuum: from languishing to flourishing in life. J. Health Soc. Behav. 43, 207–222. doi: 10.2307/3090197, PMID:
    1. Keyes C. L., Wissing M., Potgieter J. P., Temane M., Kruger A., Van Rooy S. (2008). Evaluation of the mental health continuum–short form (MHC–SF) in setswana-speaking south Africans. Clin. Psychol. Psychother. 15, 181–192. doi: 10.1002/cpp.572, PMID:
    1. Klepp O. M., Mastekaasa A., Sørensen T., Sandanger I., Kleiner R. (2007). Structure analysis of Antonovsky's sense of coherence from an epidemiological mental health survey with a brief nine-item sense of coherence scale. Int. J. Methods Psychiatr. Res. 16, 11–22. doi: 10.1002/mpr.197, PMID:
    1. Kline P. (2000). Handbook of psychological testing. London: Routledge.
    1. Kloep M., Hendry L., Saunders D. (2009). A new perspective on human development. Int. J. Arts Sci. 1, 332–343.
    1. Kramer L. (2014). Learning emotional understanding and emotion regulation through sibling interaction. Early Educ. Dev. 25, 160–184. doi: 10.1080/10409289.2014.838824
    1. Lamers S. M., Westerhof G. J., Bohlmeijer E. T., ten Klooster P. M., Keyes C. L. (2011). Evaluating the psychometric properties of the mental health continuum-short form (MHC-SF). J. Clin. Psychol. 67, 99–110. doi: 10.1002/jclp.20741, PMID:
    1. Länsimies H., Pietilä A. M., Hietasola-Husu S., Kangasniemi M. (2017). A systematic review of adolescents’ sense of coherence and health. Scand. J. Caring Sci. 31, 651–661. doi: 10.1111/scs.12402, PMID:
    1. Linacre J. M. (1991). A user’s guide to Winsteps Ministeps Rasch-model computer programs. Chicago, IL: John M. Linacre.
    1. Lindström B., Eriksson M. (2010). The hitchhiker’s guide to salutogenesis. Salutogenic pathways to health promotion. Helsinki: Folkhälsan Research Centre.
    1. Livneh H. (2001). Psychosocial adaptation to chronic illness and disability: a conceptual framework. Rehab. Couns. Bull. 44, 151–160. doi: 10.1177/003435520104400305
    1. Londono Y., McMillan D. E. (2015). Psychosocial adaptation: an evolutionary concept analysis exploring a common multidisciplinary language. J. Adv. Nurs. 71, 2504–2519. doi: 10.1111/jan.12723, PMID:
    1. Lorig K. R., Holman H. R. (2003). Self-management education: history, definition, outcomes, and mechanisms. Ann. Behav. Med. 26, 1–7. doi: 10.1207/S15324796ABM2601_01, PMID:
    1. Lu L. (1991). Daily hassles and mental health: a longitudinal study. Br. J. Psychol. 82, 441–447. doi: 10.1111/j.2044-8295.1991.tb02411.x, PMID:
    1. McCracken L. M., Chilcot J., Norton S. (2015). Further development in the assessment of psychological flexibility: a shortened committed action questionnaire (CAQ-8). Eur. J. Pain 19, 677–685. doi: 10.1002/ejp.589, PMID:
    1. McCracken L. M., Yang S.-Y. (2006). The role of values in a contextual cognitive-behavioral approach to chronic pain. Pain 123, 137–145. doi: 10.1016/j.pain.2006.02.021
    1. Mittelmark M. B., Sagy S., Eriksson M., Bauer G. F., Pelikan J. M., Lindström B., Espnes G. A. eds (2016). “The sense of coherence and its measurement” in The Handbook of Salutogenesis (Cham: Springer; ), 1–461.
    1. Morita Y., Ohta M., Inoue T., Honda T., Konno Y., Eguchi Y., et al. . (2014). Sense of coherence is significantly associated with both metabolic syndrome and lifestyle in Japanese computer software office workers. Int. J. Occup. Med. Environ. Health 27, 967–979. doi: 10.2478/s13382-014-0322-4, PMID:
    1. Muthén L. K., Muthén B. O. (1998). Mplus user’s guide. Los Angeles. CA: Muthén & Muthén.
    1. Nayback A. M. (2009). PTSD in the combat veteran: using Roy's adaptation model to examine the combat veteran as a human adaptive system. Issues Ment. Health Nurs. 30, 304–310. doi: 10.1080/01612840902754404, PMID:
    1. Perrig-Chiello P., Hutchison S., Morselli D. (2015). Patterns of psychological adaptation to divorce after a long-term marriage. J. Soc. Pers. Relationsh. 32, 386–405. doi: 10.1177/0265407514533769
    1. Perry J. C., Banon E., Bond M. (2020). Change in defense mechanisms and depression in a pilot study of antidepressive medications plus 20 sessions of psychotherapy for recurrent major depression. J. Nerv. Ment. Dis. 208, 261–268. doi: 10.1097/NMD.0000000000001112, PMID:
    1. Pinquart M., Forstmeier S. (2012). Effects of reminiscence interventions on psychosocial outcomes: a meta-analysis. Aging Ment. Health 16, 541–558. doi: 10.1080/13607863.2011.651434, PMID:
    1. Prinsen C. A., Terwee C. B. (2019). Measuring positive health: for now, a bridge too far. Public Health 170, 70–77. doi: 10.1016/j.puhe.2019.02.024, PMID:
    1. Rice T. R., Hoffman L. (2014). Defense mechanisms and implicit emotion regulation: a comparison of a psychodynamic construct with one from contemporary neuroscience. J. Am. Psychoanal. Assoc. 62, 693–708. doi: 10.1177/0003065114546746, PMID:
    1. Roos A.-L., Goetz T., Krannich M., Jarrell A., Donker M., Mainhard T. (2021). Test anxiety components: an intra-individual approach testing their control antecedents and effects on performance. Anxiety Stress Coping 34, 279–298. doi: 10.1080/10615806.2020.1850700, PMID:
    1. Roy C. (2009). The Roy adaptation model. Upper Saddle River, N.J.: Pearson Education.
    1. Ryff C. D. (1989). Happiness is everything, or is it? Explorations on the meaning of psychological well-being. J. Pers. Soc. Psychol. 57, 1069–1081. doi: 10.1037/0022-3514.57.6.1069
    1. Schiavon C. C., Marchetti E., Gurgel L. G., Busnello F. M., Reppold C. T. (2017). Optimism and hope in chronic disease: a systematic review. Front. Psychol. 7:2022. doi: 10.3389/fpsyg.2016.02022
    1. Schulte-Mecklenbeck M., Kühberger A., Johnson J. G. (2011). A handbook of process tracing methods for decision research: A critical review and user’s guide. Oxford: Psychology Press.
    1. Stanton A. L., Revenson T. A., Tennen H. (2007). Health psychology: psychological adjustment to chronic disease. Annu. Rev. Psychol. 58, 565–592. doi: 10.1146/annurev.psych.58.110405.085615
    1. Suh E., Diener E., Fujita F. (1996). Events and subjective well-being: only recent events matter. J. Pers. Soc. Psychol. 70, 1091–1102. doi: 10.1037/0022-3514.70.5.1091, PMID:
    1. Taylor S. E. (1983). Adjustment to threatening events: a theory of cognitive adaptation. Am. Psychol. 38, 1161–1173. doi: 10.1037/0003-066X.38.11.1161
    1. Terhorst Y., Baumeister H., McCracken L. M., Lin J. (2020). Further development in the assessment of psychological flexibility: validation of the German committed action questionnaire. Health Qual. Life Outcomes 18, 1–9. doi: 10.1186/s12955-020-01497-8
    1. Vaillant G. E. (2000). Adaptive mental mechanisms: their role in a positive psychology. Am. Psychol. 55, 89–98. doi: 10.1037/0003-066X.55.1.89, PMID:
    1. Van Bon-Martens M., Kleinjan M., Hipple Walters B., Shields-Zeeman L., Van den Brink C. (2022). Delphistudie 'Definitie Mentale Gezondheid': Resultaten van een consensusprocedure met verschillende perspectieven. Utrecht: Trimbos-instituut.
    1. van Leeuwen C., Post M. W., Van Der Woude L. H., De Groot S., Smit C., Van Kuppevelt D., et al. . (2012). Changes in life satisfaction in persons with spinal cord injury during and after inpatient rehabilitation: adaptation or measurement bias? Qual. Life Res. 21, 1499–1508. doi: 10.1007/s11136-011-0073-7, PMID:
    1. Van Loan C. L., Garwood J. D. (2020). Facilitating high-quality relationships for students with emotional and behavioral disorders in crisis. Interv. Sch. Clin. 55, 253–256. doi: 10.1177/1053451219855740
    1. Vowles K. E., McCracken L. M., McLeod C., Eccleston C. (2008). The chronic pain acceptance questionnaire: confirmatory factor analysis and identification of patient subgroups. Pain 140, 284–291. doi: 10.1016/j.pain.2008.08.012, PMID:
    1. Watkins D. (1989). The role of confirmatory factor analysis in cross-cultural research. Int. J. Psychol. 24, 685–701. doi: 10.1080/00207598908246806
    1. Wicksell R. K., Lekander M., Sorjonen K., Olsson G. L. (2010). The psychological inflexibility in pain scale (PIPS)–statistical properties and model fit of an instrument to assess change processes in pain related disability. Eur. J. Pain 14, 771.e1–771.e14. doi: 10.1016/j.ejpain.2009.11.015
    1. Willis K. D., Burnett H. J. (2016). The power of stress: perceived stress and its relationship with rumination, self-concept clarity, and resilience. N. Am. J. Psychol. 18, 483–498.
    1. Wright B. (1994). Reasonable mean-square fit values. Rasch Meas Trans 8:370.
    1. Yu L., McCracken L. M., Norton S. (2016). The self experiences questionnaire (SEQ): preliminary analyses for a measure of self in people with chronic pain. J. Contextual Behav. Sci. 5, 127–133. doi: 10.1016/j.jcbs.2016.07.006
    1. Yu L., Norton S., McCracken L. M. (2017). Change in “self-as-context”(“perspective-taking”) occurs in acceptance and commitment therapy for people with chronic pain and is associated with improved functioning. J. Pain 18, 664–672. doi: 10.1016/j.jpain.2017.01.005, PMID:

Source: PubMed

Подписаться