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Assessing Positive and Negative Changes in the Aftermath of Adversity: A Short Form of the Changes in Outlook Questionnaire

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Title: Assessing Positive and Negative Changes in the Aftermath of Adversity: A Short Form of the Changes in Outlook Questionnaire
Language: English
Authors: Joseph, Stephen, Linley, P. Alex, Shevlin, Mark, Goodfellow, Barbara, Butler, Lisa D.
Source: Journal of Loss and Trauma. Jan-Mar 2006 11(1):85-99.
Availability: Customer Services for Taylor & Francis Group Journals, 325 Chestnut Street, Suite 800, Philadelphia, PA 19106. Tel: 800-354-1420 (Toll Free); Fax: 215-625-8914.
Peer Reviewed: N
Page Count: 15
Publication Date: 2006
Document Type: Journal Articles
Reports - Research
Descriptors: Validity, Factor Analysis, Posttraumatic Stress Disorder, Factor Structure, College Students, Questionnaires, Reliability, Stress Variables, Attitude Change
ISSN: 1532-5024
Abstract: The aim of this study was the preliminary development of a short 10-item version of the CiOQ. First, 10 items were selected on the basis of their high factor loadings in previously published work. Two studies are then reported. In Study 1, the 10 items were subjected to confirmatory factor analysis using data from a sample of college students (n=336) who had experienced adverse events. Study 2 involved a clinical sample (n=40) of people with posttraumatic stress disorder and examined associations of reported changes with posttraumatic stress symptoms and posttraumatic growth. Evidence is provided for a two-factor structure of the CiOQ Short Form, consisting of positive changes and negatives changes, and for the subscales' internal consistency reliability, convergent validity, and differential associations with clinically meaningful outcomes.
Abstractor: Author
Number of References: 42
Entry Date: 2005
Access URL: https://taylorandfrancis.metapress.com/link.asp?target=contribution&id=T534326203001N15
Accession Number: EJ722044
Database: ERIC
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  Value: <anid>AN0018970025;hzh01jan.06;2019Feb27.14:18;v2.2.500</anid> <title id="AN0018970025-1">ASSESSING POSITIVE AND NEGATIVE CHANGES IN THE AFTERMATH OF ADVERSITY: A SHORT FORM OF THE CHANGES IN OUTLOOK QUESTIONNAIRE. </title> <p>The aim of this study was the preliminary development of a short 10-item version of the CiOQ. First, 10 items were selected on the basis of their high factor loadings in previously published work. Two studies are then reported. In Study 1, the 10 items were subjected to confirmatory factor analysis using data from a sample of college students (n = 336) who had experienced adverse events. Study 2 involved a clinical sample (n = 40) of people with posttraumatic stress disorder and examined associations of reported changes with posttraumatic stress symptoms and posttraumatic growth. Evidence is provided for a two-factor structure of the CiOQ Short Form, consisting of positive changes and negatives changes, and for the subscales' internal consistency reliability, convergent validity, and differential associations with clinically meaningful outcomes.</p> <p>It is now well established that stressful and traumatic events may serve as a trigger toward personal growth and positive change. The topic of growth through adversity has become the focus of much empirical (Linley & Joseph, [<reflink idref="bib25" id="ref1">25</reflink>]; Tedeschi & Calhoun, [<reflink idref="bib41" id="ref2">41</reflink>]) and theoretical (Joseph & Linley, [<reflink idref="bib26" id="ref3">26</reflink>]; Linley & Joseph, [<reflink idref="bib26" id="ref4">26</reflink>]) work. A number of literatures and philosophies throughout human history have conveyed the idea that there is personal gain to be found in suffering (Linley, [<reflink idref="bib29" id="ref5">29</reflink>]). The clinical implications of this work for people who have suffered trauma and adversity are now beginning to be recognized (Calhoun & Tedeschi, [<reflink idref="bib10" id="ref6">10</reflink>]; Joseph, [<reflink idref="bib25" id="ref7">25</reflink>]; Linley & Joseph, [<reflink idref="bib30" id="ref8">30</reflink>]; Tedeschi & Calhoun, [<reflink idref="bib41" id="ref9">41</reflink>]).</p> <p>Within the more recent psychological literature, the positive changes that are observed following these events have been variously labeled posttraumatic growth (Tedeschi & Calhoun, [<reflink idref="bib40" id="ref10">40</reflink>]), stress-related growth (Park, Cohen, & Murch, [<reflink idref="bib37" id="ref11">37</reflink>]), perceived benefits (McMillen & Fisher, [<reflink idref="bib35" id="ref12">35</reflink>]), flourishing (Ryff & Singer, [<reflink idref="bib38" id="ref13">38</reflink>]), thriving (Carver, [<reflink idref="bib11" id="ref14">11</reflink>]; O'Leary & Ickovics, [<reflink idref="bib36" id="ref15">36</reflink>]), and adversarial growth (Joseph & Linley, [<reflink idref="bib26" id="ref16">26</reflink>]; Linley & Joseph, [<reflink idref="bib25" id="ref17">25</reflink>]), to name but some of the terms that have been used interchangeably within the literature. Several psychometric instruments are available to assess positive changes in the aftermath of adversity.</p> <p>The first instrument to be developed was the Changes in Outlook Questionnaire (CiOQ; Joseph et al., [<reflink idref="bib28" id="ref18">28</reflink>]). The CiOQ consists of an 11-item scale assessing positive changes, Changes in Outlook Positive (CiOP; e.g., "I value my relationships much more now"), and a 15-item scale assessing negative changes, Changes in Outlook Negative (CiON; e.g., "I don't look forward to the future anymore"). Each item is answered on a 6-point scale ranging from <emph>strongly disagree</emph> (<reflink idref="bib1" id="ref19">1</reflink>) to <emph>strongly agree</emph> (<reflink idref="bib6" id="ref20">6</reflink>). This measure has been used in studies with a wide variety of participants following trauma and adversity, including people vicariously exposed to the September 11, 2001, terrorist attacks (Butler, Blasey et al., [<reflink idref="bib8" id="ref21">8</reflink>]; Butler, Koopman et al., [<reflink idref="bib8" id="ref22">8</reflink>]; Linley, Joseph, Cooper, Harris, & Meyer, [<reflink idref="bib33" id="ref23">33</reflink>]); trauma therapists (Linley, Joseph, & Loumidis, [<reflink idref="bib34" id="ref24">34</reflink>]); and members of the general population who have experienced adverse and traumatic events (Joseph et al., [<reflink idref="bib26" id="ref25">26</reflink>]).</p> <p>In previous work, we have reported on the psychometric properties of the CiOQ, its factor structure, internal consistency reliability, and convergent and discriminant validity (see Joseph et al., [<reflink idref="bib26" id="ref26">26</reflink>]). The CiOQ was shown to consist of two factors, corresponding to the CiOP and CiON scales. Both the CiOP and CiON scales were found to possess good internal consistency reliability (ranging from.80 to.87 for the CiOP and.86 to.88 for the CiON across four samples). Evidence for the convergent and discriminant validity of the CiOQ was found when correlations were computed with other more recently developed measures of stress and trauma-related change, that is, the Stress Related Growth Scale (Park et al., [<reflink idref="bib37" id="ref27">37</reflink>]), the Posttraumatic Growth Inventory (Tedeschi & Calhoun, [<reflink idref="bib40" id="ref28">40</reflink>]), the Perceived Benefit Scale (McMillen & Fisher, [<reflink idref="bib35" id="ref29">35</reflink>]), and the Thriving Scale (Abraido-Lanza et al., [<reflink idref="bib1" id="ref30">1</reflink>]). Associations were also reported with measures of distress—the PTSD Symptom Scale (Foa, Riggs, Dancu, & Rothbaum, [<reflink idref="bib15" id="ref31">15</reflink>]), the Impact of Event Scale (Horowitz, Wilner, & Alvarez, [<reflink idref="bib19" id="ref32">19</reflink>]), the General Health Questionnaire (Goldberg & Hillier, [<reflink idref="bib17" id="ref33">17</reflink>]), and the Symptom Checklist (Derogatis, [<reflink idref="bib13" id="ref34">13</reflink>])—showing that CiOP and CiON are not simply opposite sides of the same coin but have a differential relation to distress, with greater distress being related to CiON but not to CiOP.</p> <p>The CiOQ is a well-constructed tool that has much promise for research on responses to stressful events and will be useful for practitioners in documenting change (Joseph et al., [<reflink idref="bib26" id="ref35">26</reflink>]). This is especially the case since analyses have also shown that experiences of positive and negative changes are associated with different clinical prognoses at different times in the aftermath of trauma (Frazier, Conlon, & Glaser, [<reflink idref="bib16" id="ref36">16</reflink>]; see also Linley & Joseph, [<reflink idref="bib25" id="ref37">25</reflink>]). As such, assessment of both positive and negative changes is an important need for both research and clinical practice.</p> <p>However, although the CiOQ promises to be a useful instrument, it is relatively lengthy, with 26 items. A shorter measure of change would be useful, particularly to practitioners and those in need of a rapid means of assessment. One option for those who are interested solely in growth-related aspects might be to administer only the 11 positive items (the CiOP). However, for those who want to assess both positive and negative aspects, there is a need for a shorter version of the CiOQ.</p> <p>There are several arguments in support of developing a short version. First, in research with particular populations (e.g., those with memory impairments and attention limitations), shortened versions are essential to gather data in a limited amount of time. Second, the problems of time-limited data collection can be exacerbated when data must be collected via interview formats (e.g., with low literacy populations or in telephone interviews). Interviews take considerably longer than traditional paper-and-pencil self-report contexts, and hence shorter versions of scales can be particularly useful. Third, shortened versions can also be useful to reduce participant burden when measurement of a number of variables is necessary and considerable questionnaire space cannot be dedicated to any one variable. The benefit of short scales is that a larger number of variables can be measured for the same "cost" as a smaller number of full scales. Fourth, a short version of the CiOQ also promises to be useful for practitioners who want to be able to assess change, but who want to keep the completion of self-report measures during the therapy session to a minimum. For example, there is increasing use of single-case time series methodologies that require respondents to complete measures repeatedly at several points in time in order to document change in relation to therapeutic interventions. Even relatively brief self-report instruments consisting of 20–30 items may be cumbersome for this purpose. Shorter and more rapid assessment methods are needed.</p> <p>As well as these more general reasons, the use of short scales in trauma research should be encouraged because questionnaire fatigue and distress is an issue of justifiable concern in people following trauma (Griffin, Resick, Waldrop, & Mechanic, [<reflink idref="bib18" id="ref38">18</reflink>]), especially when the questions pertain to their experiences and reactions following the traumatic event. The aim of the present article is to present preliminary results on a new brief method for assessing changes following adversity.</p> <hd id="AN0018970025-2">Study 1: Development of the 10-Item CiOQ</hd> <p>In order to select items for the short CiOQ (CiOQ-S), we inspected the two-component structure of the 26 CiOQ items previously reported (see Joseph et al., [<reflink idref="bib26" id="ref39">26</reflink>], Study 1). This exploratory principal components analysis employed data from 176 adults who had experienced a wide range of distressing events in order to explore the component structure of the CiOQ. Inspection of the scree plot, following the recommendations of Cattell ([<reflink idref="bib12" id="ref40">12</reflink>]), showed a marked division between the first two components and the remaining components, suggesting that two components provide a parsimonious solution. (Inspection of the scree plot is the recommended method for determining the number of factors to extract, since the eigenvalues-greater-than-one criterion is known potentially to inflate the number of factors extracted [Zwick & Velicer, [<reflink idref="bib42" id="ref41">42</reflink>]]). A two-component solution was therefore sought. Results replicated the proposed scoring system of the CiOQ; Component 1 was characterized as negative changes in outlook and Component 2 as positive changes in outlook. This component structure was supported in a subsequent study using confirmatory factor analysis (Joseph et al., [<reflink idref="bib26" id="ref42">26</reflink>], Study 2). On the basis of this two-component structure, we chose the five highest loading items from the positive component and the five highest loading items from the negative component (see Appendix). We decided a priori on a total of 10 items, with 5 items per scale, because criticisms have been made of scales consisting of less than 5 items (e.g., Endler & Parker, [<reflink idref="bib14" id="ref43">14</reflink>]).</p> <p>Having selected these 10 items, the aim of the present study was to validate the two-factor structure of the short form of the CiOQ. The statistical separability of positive and negative attitudinal scales has been an issue of much debate (see Cacioppo & Berntson, [<reflink idref="bib9" id="ref44">9</reflink>]). Attitudes have traditionally been conceptualized as falling along a bipolar dimension, although Cacioppo and Berntson ([<reflink idref="bib9" id="ref45">9</reflink>]) have argued that bipolarity is insufficient to portray comprehensively the positive and negative evaluative processes. For this reason, we chose to test both one-and two-factor models. The two-factor model specified that all of the negative items load on one factor and all of the positive items load on a separate factor. The one-factor model specified that all of the positive and negative items load on the same factor, thus supposing a continuum ranging from negative changes to positive changes. This is an important distinction, since it has previously been shown that positive and negative changes following trauma and adversity are independent dimensions of experience that may have a range of possible associations, rather than being bipolar ends of a single continuum of experience (Frazier et al., [<reflink idref="bib16" id="ref46">16</reflink>]; Linley & Joseph, [<reflink idref="bib25" id="ref47">25</reflink>]).</p> <hd id="AN0018970025-3">Method</hd> <p>Three hundred thirty-six college students from the University of Leicester and the University of Warwick were recruited as part of a wider study on the correlates of adversarial growth. Questionnaires were completed as part of university classes, although participation was voluntary; the response rate was 96%. Participants (280 women and 56 men) were between 17 and 54 years of age (<emph>M</emph> = 21.61 years, <emph>SD</emph> = 5.35); were primarily White (87%), Indian (6%), or Pakistani (2%); and were mostly single (90%), married (2%), or separated (3%).</p> <p>All 336 participants reviewed a checklist of 14 distressing events (e.g., serious accident, large fire or explosion, violent crime, natural disaster, unwanted sexual experience, military combat) and were asked to indicate which of these events they had experienced during the course of their life. If participants indicated more than one of the events, they were asked to specify which event they had found the most distressing. Participants reported experiencing between 1 and 11 of these distressing events (<emph>M</emph> = 3, <emph>SD</emph> = 2) and indicated that the events had occurred, on average, 4 years 8 months previously (<emph>SD</emph> = 5 years). The most distressing events reported by the sample were unexpected bereavement (26%), events that fell within these categories but which participants did not wish to describe (20%), witnessing others at the time they experienced a traumatic event (13%), and unwanted sexual experiences (9%).</p> <p>Data on the full 26-item version of the CiOQ using this sample have been reported elsewhere (Joseph et al., [<reflink idref="bib26" id="ref48">26</reflink>]). Here we present a reanalysis of these data in order to test the factor structure of the short 10-item CiOQ, the internal consistency reliability of this short form, and convergent validity of the short form with the full CiOQ. These analyses have not been presented elsewhere, although we used the data from the same respondents in a confirmatory factor analysis to test the two-factor structure of the full 26-item CiOQ (Joseph et al., [<reflink idref="bib26" id="ref49">26</reflink>]).</p> <hd id="AN0018970025-4">Results</hd> <p>A matrix of polychoric correlations and an asymptotic weight matrix were calculated using PRELIS 2.3 (Jöreskog & Sörbom, [<reflink idref="bib23" id="ref50">23</reflink>]). Two confirmatory factor models were specified and estimated by weighted least squares using LISREL 8.3 (Jöreskog & Sörbom, [<reflink idref="bib24" id="ref51">24</reflink>]). Model 1 specified a single factor model. Model 2 specified two uncorrelated factors with the negative items loading on the first factor (Negative) and the positive items loading on the second factor (Positive).</p> <p>Following the guidelines suggested by Hoyle and Panter ([<reflink idref="bib20" id="ref52">20</reflink>]), the goodness of fit for each model was assessed using the chi-square test, the goodness of fit index (GFI; Jöreskog & Sörbom, [<reflink idref="bib21" id="ref53">21</reflink>]), the incremental fit index (IFI; Bollen, [<reflink idref="bib5" id="ref54">5</reflink>]), and the comparative fit index (CFI; Bentler, [<reflink idref="bib4" id="ref55">4</reflink>]). A nonsignificant chi-square and values greater than.90 for the GFI, IFI, and CFI are considered to reflect good model fit, and values between.85 and.90 indicate moderate model fit (Jöreskog & Sörbom, [<reflink idref="bib22" id="ref56">22</reflink>]). In addition, the root mean square error of approximation (RMSEA; Steiger, [<reflink idref="bib39" id="ref57">39</reflink>]) with 90% confidence intervals was calculated, where a value less than.05 indicates good fit and values up to.08 indicate moderate fit (Browne & Cudeck, [<reflink idref="bib6" id="ref58">6</reflink>]). The comparative fit of the models was assessed using the expected cross validation index (ECVI; Browne & Cudeck, [<reflink idref="bib5" id="ref59">5</reflink>]), used for the purposes of model comparison; the smallest value is indicative of the best fitting model.</p> <p>As can be seen in Table 1, the ECVI value for Model 2 was smaller than that for Model 1, providing evidence that Model 2 had a superior fit to that of Model 1. The chi-square value was also lower in Model 2 than in Model 1, although it remained statistically significant. A chi-square difference test showed that Model 2 represented a better explanation of the data than Model 1 (Δχ<sups>2</sups> = 665, Δdf = 2, <emph>p</emph> < .05). The other indices of GFI, IFI, and CFI showed that the two-factor model had a good fit, with values of around.9. The RMSEA also indicated a close fit for the two-factor model (Browne & Cudeck, [<reflink idref="bib6" id="ref60">6</reflink>]).</p> <p>TABLE 1 Fit Indices for the One- and Two-Factor Models of the CiOQ Short Form</p> <p> <ephtml> <table><thead valign="bottom"><tr><td>Model</td><td>χ<sup>2</sup></td><td><italic>df</italic></td><td><italic>p</italic></td><td>GFI</td><td>IFI</td><td>CFI</td><td>RMSEA (90% CI)</td><td>ECVI</td></tr></thead><tbody><tr><td>1-factor model</td><td char="." charoff="50">721.40</td><td>35</td><td char="." charoff="50">.00</td><td char="." charoff="50">.64</td><td char="." charoff="50">.54</td><td char="." charoff="50">.54</td><td char="." charoff="50">.26 (0.24–0.28)</td><td char="." charoff="50">2.59</td></tr><tr><td>2-factor model</td><td char="." charoff="50">56.10</td><td>33</td><td char="." charoff="50">.00</td><td char="." charoff="50">.97</td><td char="." charoff="50">.98</td><td char="." charoff="50">.98</td><td char="." charoff="50">.04 (.015–.061)</td><td char="." charoff="50">0.28</td></tr><tr><td /></tr></tbody></table> </ephtml> </p> <p>The adequacy of this model must also be considered in terms of the parameter estimates: All of the factor loadings were positive and statistically significant (<emph>p</emph> < .05). The completely standardized factor loadings are reported in Table 2.</p> <p>TABLE 2 Factor Loadings for the Two-Factor Model of the CiOQ Short Form</p> <p> <ephtml> <table><thead valign="bottom"><tr><td>Item</td><td>Negative</td><td>Positive</td></tr></thead><tbody><tr><td> 1</td><td char="." charoff="50">.52</td><td /></tr><tr><td> 2</td><td char="." charoff="50">.53</td><td /></tr><tr><td> 3</td><td /><td char="." charoff="50">.58</td></tr><tr><td> 4</td><td /><td char="." charoff="50">.75</td></tr><tr><td> 5</td><td /><td char="." charoff="50">.61</td></tr><tr><td> 6</td><td /><td char="." charoff="50">.78</td></tr><tr><td> 7</td><td char="." charoff="50">.61</td><td /></tr><tr><td> 8</td><td char="." charoff="50">.74</td><td /></tr><tr><td> 9</td><td char="." charoff="50">.76</td><td /></tr><tr><td>10</td><td /><td char="." charoff="50">.80</td></tr></tbody></table> </ephtml> </p> <p>Analyses also indicated acceptable internal consistency reliability for both short form subscales. Cronbach's alpha was.78 for Factor 1 (Positive) and.83 for Factor 2 (Negative), and the subscales were uncorrelated (<emph>r</emph> = .06, <emph>ns</emph>). CiOP Short (<emph>M</emph> = 19.51, <emph>SD</emph> = 5.35) was correlated with the full 11-item CiOP (<emph>r</emph> = .93, <emph>p</emph> < .001), and CiON Short (<emph>M</emph> = 9.51, <emph>SD</emph> = 4.27) was correlated with the full 15-item CiON (<emph>r</emph> = .89, <emph>p</emph> < .001).</p> <p>The results provide evidence for the psychometric properties of the short CiOQ. The short CiOQ was shown to consist of two factors comprising positive and negative changes and to have internal consistency reliability and convergent validity with the full CiOQ.</p> <hd id="AN0018970025-5">Study 2: Use of the CiOQ-S with Clinical Participants</hd> <p>The short CiOQ is potentially useful to researchers who are in need of a rapid method of assessing positive and negative changes, and is also of great potential clinical utility to practitioners who are in need of a brief tool to assess positive and negative changes following trauma and other adversity. In this study, we tested the properties of internal consistency reliability and convergent validity with a help-seeking sample that had experienced traumatic events, in order to establish the utility of the measures with a clinical group. This is important because clinicians are in need of shorter measures that can be administered at regular intervals, along with other measures, often in a short period of time, and with people who are highly distressed and often reluctant to complete homework assignments or engage with upsetting material. Thus, it is important that we are able to show that the short CiOQ has internal consistency reliability and convergent validity with clinical respondents.</p> <hd id="AN0018970025-6">Method</hd> <p>A notice was placed in the newsletter of a trauma support organization based in the United Kingdom. One hundred eighty-two questionnaire packs were distributed to members along with the organization's regular newsletter. Participants were invited to take part in a study of "Psychological processes following trauma." No incentives were given for participation. Participants were invited, but not obliged, to provide their name and address if they were prepared to take part in a further follow-up study. Those who volunteered to participate in the follow-up study were entered, as an incentive, into a lottery with a small cash prize. For the purposes of this study, we report only on the follow-up data; the full results of this survey are available elsewhere (Linley, [<reflink idref="bib29" id="ref61">29</reflink>]).</p> <p>Forty (33 women and 7 men) participants, ranging in age from 21 to 71 years (<emph>M</emph> = 45.53, <emph>SD</emph> = 11.98), replied and were asked to complete and return by mail a questionnaire battery. The battery, along with the CiOQ, included the PTSD Symptom Scale (PSS) and the Posttraumatic Growth Inventory (PTGI).</p> <p>The PSS (Foa et al., [<reflink idref="bib15" id="ref62">15</reflink>]) is a 17-item measure scored on a 4-point scale (0–3). The questions are designed to assess PTSD as characterized by the three types of symptoms described in the <emph>DSM-III-R</emph> (American Psychiatric Association, [<reflink idref="bib2" id="ref63">2</reflink>]), but they can also assess PTSD as defined in the <emph>DSM-IV</emph> (American Psychiatric Association, [<reflink idref="bib3" id="ref64">3</reflink>]) by scoring Item 17 as an intrusion symptom as opposed to an arousal symptom. The total scale has a score range of 0–51. Foa et al. ([<reflink idref="bib15" id="ref65">15</reflink>]) reported the alpha for the scale total as.91. Alpha coefficients for the intrusion, avoidance, and arousal sub scales were.78,.80, and.82, respectively. Higher scores indicate greater posttraumatic stress symptoms.</p> <p>The PTGI (Tedeschi & Calhoun, [<reflink idref="bib40" id="ref66">40</reflink>]) is a 21-item self-report measure of positive changes following traumatic experience, scored using a 6-point Likert format scale (0 = <emph>I did not experience this change as a result of the event I described above</emph>, 5 = <emph>I experienced this change to a very great degree as a result of the event I described above</emph>). Sample items include "I discovered that I'm stronger than I thought I was," "A sense of closeness with others," and "Appreciating each day." The inventory yields a potential total score range of 0–105, with a higher score indicating greater experience of posttraumatic growth.</p> <hd id="AN0018970025-7">Results</hd> <p>All respondents met <emph>DSM</emph> criteria for PTSD,[<reflink idref="bib2" id="ref67">2</reflink>] with scores on the PSS ranging between 11 and 51, demonstrating that the sample had a high rate of trauma-related psychopathology. Cronbach's alpha was.76 for CiOP-S and.82 for CiON-S.</p> <p>Scores on the CiON-S were strongly associated with scores on the PSS, whereas scores on the CiOP-S were associated with scores on the PTGI (see Table 3). These results provide evidence for the convergent validity of the short CiOQ subscales with measures of posttraumatic stress and posttraumatic growth.</p> <p>TABLE 3 Correlations Among the CiOQ Short Form, Posttraumatic Stress, and Posttraumatic Growth</p> <p> <ephtml> <table><thead valign="bottom"><tr><td /><td><italic>M</italic></td><td><italic>SD</italic></td><td>CIOP-S</td><td>CiON-S</td><td>PTGI</td><td>PSS</td></tr></thead><tbody><tr><td>CiOP-S</td><td char="." charoff="50">20.50</td><td char="." charoff="50">5.40</td><td>—</td><td>−.32<xref ref-type="fn" rid="fn4" /></td><td char="." charoff="50">.46<xref ref-type="fn" rid="fn5" /></td><td char="." charoff="50">−.30</td></tr><tr><td>CiON-S</td><td char="." charoff="50">21.13</td><td char="." charoff="50">6.09</td><td /><td>—</td><td char="." charoff="50">−.22</td><td char="." charoff="50">.61<xref ref-type="fn" rid="fn6" /></td></tr><tr><td>PTGI</td><td char="." charoff="50">54.63</td><td char="." charoff="50">22.81</td><td /><td /><td>—</td><td char="." charoff="50">−.24</td></tr><tr><td>PSS</td><td char="." charoff="50">32.25</td><td char="." charoff="50">11.67</td><td /><td /><td /><td>—</td></tr><tr><td /></tr><tr><td /></tr></tbody></table> </ephtml> </p> <hd id="AN0018970025-8">General Discussion</hd> <p>We selected the 10 highest loading items on the CiOQ from previously published factor analytic work (Joseph et al., [<reflink idref="bib26" id="ref68">26</reflink>]) to compose a short form of the measure. In the present work, two studies have been reported that investigated the operation of these 10 items. The results from the confirmatory factor analysis provides evidence that the short CiOQ consists of two factors, labeled as positive changes and negative changes. Further, the results of Study 2 show that the short CiOQ relates meaningfully to other variables of interest in clinical samples. Scores on the CiOP-S are related to posttraumatic growth but not to posttraumatic stress, while scores on the CiON-S are related to posttraumatic stress but not to posttraumatic growth.</p> <hd id="AN0018970025-9">Clinical Applications of the CiOQ Short Form</hd> <p>The short CiOQ therefore promises to be a useful research tool with which to assess changes that develop over time following trauma and adversity and to examine the personality and social psychological variables related to these changes. It may also prove to be a useful tool for investigations into the ability of positive and negative changes to predict subsequent well-being. We encourage clinicians to adopt a positive psychological perspective in the treatment of trauma and to make the promotion of growth, as well as the alleviation of posttraumatic stress, the target of their therapeutic work (see Tedeschi & Calhoun, [<reflink idref="bib41" id="ref69">41</reflink>]). We believe that the short CiOQ provides a means to assess the effectiveness of such efforts.</p> <p>The results reported here suggest that posttraumatic growth and posttraumatic stress are not simply opposite ends of a single continuum but, rather, represent separate dimensions of experience. Although negatively correlated in Study 2, they shared little common variance. Thus, it follows that alleviation of posttraumatic stress will not automatically lead to facilitation of growth. For clinical purposes, the CiOQ-S might be used to observe changes over time that relate to both the alleviation of posttraumatic stress and the facilitation of posttraumatic growth, as well as to assess changes related to specific interventions aimed at those objectives.</p> <hd id="AN0018970025-10">Limitations and Research Directions</hd> <p>The two studies reported here represent a significant step toward the development of a short measure of positive and negative changes following adversity, but there is further work to be done to replicate and extend our research. We would now encourage further research to confirm the psychometric properties—reliability, validity, and clinical utility—of the CiOQ-S. There is a need for further survey-based research with large samples in order to investigate the relation of the CIOQ-S to other personality and social psychological variables. In particular, there is a need to collect longitudinal data with the CiOQ-S. This is necessary to be able to demonstrate that the CiOQ-S is able to document changes over time as we expect and to test the causal relation between scores on the CIOQ-S and other variables. We would, however, particularly encourage small-scale and single-case clinical and health-related research projects to demonstrate the repeated use of the CiOQ-S, as we think the measure is likely to be most useful to clinical and health psychologists in their practice contexts.</p> <p>In sum, there are considerable potential advantages to employing the short CiOQ in clinical settings, when time is short, when there are multiple measures, or when measures need to be completed at regular intervals. However, short versions also have disadvantages, and the short form of the CiOQ would not appear to be quite as robust in its psychometric properties as the full version; thus, we would recommend that, when possible, the longer version be used.</p> <hd id="AN0018970025-11">Appendix: Items Comprising the Changes in Outlook Questionnaire Short Form</hd> <p></p> <ulist> <item> 1. I don't look forward to the future anymore.</item> <p></p> <item> 2. My life has no meaning anymore.</item> <p></p> <item> 3. I don't take life for granted anymore.</item> <p></p> <item> 4. I value my relationships much more now.</item> <p></p> <item> 5. I'm a more understanding and tolerant person now.</item> <p></p> <item> 6. I no longer take people or things for granted.</item> <p></p> <item> 7. I have very little trust in other people now.</item> <p></p> <item> 8. I feel very much as if I'm in limbo.</item> <p></p> <item> 9. I have very little trust in myself now.</item> <p></p> <item> 10. I value other people more now.</item> </ulist> <ref id="AN0018970025-12"> <title> References </title> <blist> <bibl id="bib1" idref="ref19" type="bt">1</bibl> <bibtext> Abraido-Lanza, A. F., Guier, C., & Colon, R. M. (1998). Psychological thriving among Latinas with chronic illness. Journal of Social Issues, 54, 405–424.[CSA]</bibtext> </blist> <blist> <bibl id="bib2" idref="ref63" type="bt">2</bibl> <bibtext> American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders , (rev. 3rd ed.). Washington, DC: Author.</bibtext> </blist> <blist> <bibl id="bib3" idref="ref64" type="bt">3</bibl> <bibtext> American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders , (4th ed.). Washington, DC: Author.</bibtext> </blist> <blist> <bibl id="bib4" idref="ref55" type="bt">4</bibl> <bibtext> Bentler, P. M. (1990). Comparative fit indices in structural models. 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Comparison of five rules for determining the number of components to retain. Psychological Bulletin, 99, 432–442.[CROSSREF][CSA]</bibtext> </blist> </ref> <ref id="AN0018970025-13"> <title> Footnotes </title> <blist> <bibtext> <emph>Note</emph>. GFI = goodness of fit index; IFI = incremental fit index; CFI = comparative fit index; RMSEA = root mean square error of approximation; ECVI = expected cross validation index.</bibtext> </blist> <blist> <bibtext> <sups>1</sups>Consistent with the <emph>DSM-IV</emph>, a diagnosis of PTSD may be made when at least one re-experiencing symptom, three avoidance symptoms, and two arousal symptoms are endorsed at a frequency of 2–4 times per week on the PSS.</bibtext> </blist> <blist> <bibtext> <emph>Note</emph>. CiOP-S = Positive Changes in Outlook Short Form; CiON-S = Negative Changes in Outlook Short Form; PTGI = Posttraumatic Growth Inventory; PSS = PTSD Symptom Scale.</bibtext> </blist> <blist> <bibtext> *<emph>p</emph> < .05;</bibtext> </blist> <blist> <bibtext> **<emph>p</emph> < .01;</bibtext> </blist> <blist> <bibtext> ***<emph>p</emph> < .001.</bibtext> </blist> </ref> <aug> <p>By Stephen Joseph; P. Alex Linley; Mark Shevlin; Barbara Goodfellow and LisaD. Butler</p> <p>Reported by Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib25" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib41" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib26" firstref="ref3"></nolink> <nolink nlid="nl4" bibid="bib29" firstref="ref5"></nolink> <nolink nlid="nl5" bibid="bib10" firstref="ref6"></nolink> <nolink nlid="nl6" bibid="bib30" firstref="ref8"></nolink> <nolink nlid="nl7" bibid="bib40" firstref="ref10"></nolink> <nolink nlid="nl8" bibid="bib37" firstref="ref11"></nolink> <nolink nlid="nl9" bibid="bib35" firstref="ref12"></nolink> <nolink nlid="nl10" bibid="bib38" firstref="ref13"></nolink> <nolink nlid="nl11" bibid="bib11" firstref="ref14"></nolink> <nolink nlid="nl12" bibid="bib36" firstref="ref15"></nolink> <nolink nlid="nl13" bibid="bib28" firstref="ref18"></nolink> <nolink nlid="nl14" bibid="bib33" firstref="ref23"></nolink> <nolink nlid="nl15" bibid="bib34" firstref="ref24"></nolink> <nolink nlid="nl16" bibid="bib15" firstref="ref31"></nolink> <nolink nlid="nl17" bibid="bib19" firstref="ref32"></nolink> <nolink nlid="nl18" bibid="bib17" firstref="ref33"></nolink> <nolink nlid="nl19" bibid="bib13" firstref="ref34"></nolink> <nolink nlid="nl20" bibid="bib16" firstref="ref36"></nolink> <nolink nlid="nl21" bibid="bib18" firstref="ref38"></nolink> <nolink nlid="nl22" bibid="bib12" firstref="ref40"></nolink> <nolink nlid="nl23" bibid="bib42" firstref="ref41"></nolink> <nolink nlid="nl24" bibid="bib14" firstref="ref43"></nolink> <nolink nlid="nl25" bibid="bib23" firstref="ref50"></nolink> <nolink nlid="nl26" bibid="bib24" firstref="ref51"></nolink> <nolink nlid="nl27" bibid="bib20" firstref="ref52"></nolink> <nolink nlid="nl28" bibid="bib21" firstref="ref53"></nolink> <nolink nlid="nl29" bibid="bib22" firstref="ref56"></nolink> <nolink nlid="nl30" bibid="bib39" firstref="ref57"></nolink>
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  Data: The aim of this study was the preliminary development of a short 10-item version of the CiOQ. First, 10 items were selected on the basis of their high factor loadings in previously published work. Two studies are then reported. In Study 1, the 10 items were subjected to confirmatory factor analysis using data from a sample of college students (n=336) who had experienced adverse events. Study 2 involved a clinical sample (n=40) of people with posttraumatic stress disorder and examined associations of reported changes with posttraumatic stress symptoms and posttraumatic growth. Evidence is provided for a two-factor structure of the CiOQ Short Form, consisting of positive changes and negatives changes, and for the subscales' internal consistency reliability, convergent validity, and differential associations with clinically meaningful outcomes.
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      – TitleFull: Assessing Positive and Negative Changes in the Aftermath of Adversity: A Short Form of the Changes in Outlook Questionnaire
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          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2006
          Identifiers:
            – Type: issn-print
              Value: 1532-5024
          Numbering:
            – Type: volume
              Value: 11
            – Type: issue
              Value: 1
          Titles:
            – TitleFull: Journal of Loss and Trauma
              Type: main
ResultId 1