Cognitive appraisals of dissociation in psychosis: A brief new measure
CERNIS E., Bird J., Molodynski A., EHLERS A., FREEMAN D.
Background Catastrophic cognitive appraisals, similar to those in anxiety disorders, are implicated in depersonalisation, a form of dissociation. No scales exist to measure appraisals of dissociative experiences. Dissociation is common in psychosis. Misinterpretations of dissociative experiences may maintain psychotic symptoms. Therefore, assessing appraisals in this context may be valuable. Aims The primary aim was to develop a measure of key appraisals of dissociation in psychosis. Secondary aims were to test the relationship between appraisals and psychotic experiences (paranoia and hallucinations), and determine whether appraisals explain additional variance in psychotic symptoms above dissociative symptoms. Method Fifty items were generated from transcripts of interviews with patients. The measure was developed and psychometrically validated via factor analysis of data from 9902 general population participants and 1026 patients with psychosis. Convergent validity, test-retest reliability, and internal reliability were assessed. Regression analyses tested relationships with psychotic symptoms. Results A 13-item single-factor measure was developed. Factor analysis indicated good model fit (χ2(65)=247.173, CFI=0.960, RMSEA=0.052). The scale had good convergent validity with a rumination (non-clinical: r=0.71; clinical: r=0.73) and dissociation measure (r=0.81; r=0.80), high internal consistency (α=0.93; α=0.93), and excellent one-week test-retest reliability (ICC=0.90). It explained variance in psychotic symptoms (paranoia: 36.4%; hallucinations: 35.0%), including additional variance compared to dissociation alone (paranoia: 5.3%; hallucinations: 2.3%). Conclusions The Cognitive Appraisals of Dissociation in Psychosis (CAD-P) measure is a psychometrically robust scale identifying appraisals of dissociative experiences in psychosis and is associated with the presence of psychotic experiences. It is likely to prove useful for clinical assessment and research.