Development of a Scale for Assessing Cognitive

Distortions

Dhaka University LiDrary

466307

A Dissertation
submitted to the Department o f Clinical Psychology, University o f Dhaka, in partial
fulfillment o f the requirements for the degree o f Masters o f Philosophy in
Clinical Psychology

4R630T

Submitted by
Ummey Salma Siddika
M.Phil.(Part-n)
Registration No: 369/2008-09
Department o f Clinical Psychology
University o f Dhaka

April,2013
 Dedicated to

The Core Persons o f

My Life

4^6337

-*rgT^T??
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Approval Sheet

This is to certify that I have read the thesis entitled "Development o f a Scale fo r
Assessing Cognitive Distortions" submitted by Untmey Saima Siddika in partial
fulfillment o f the requirement for the degree o f Master o f Philosophy (M.Phil) in
Clinical Psychology and the research was carried out by my supervision and
guidance.

4G630' ;

Dated, Dhaka
April,2013 Kamal Uddin Ahmed Chowdhury
Associate Professor
Department o f Clinical Psychology
University o f Dhaka

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Abstract

Aim o f the current study was to develop a valid and reliable scale o f cognitive
distortions which is applicable in Bangladesh. Scrupulous review o f the available
literature, research, case reports and expert opinions o f the mental health professionals
about cognitive distortion were used as a basement for the development o f the scale.
The scale was developed through systematic procedure o f item construction, item
selection, item analysis and factor analysis. Initial item pool consisted o f 193 items
which was evaluated by 16 judges in two stages judge evaluation and the item was
reduced into 92 considering the appropriateness. For finalizing the first draft, 92
appropriate items with four point Likert scale were presented for 3rd round judge
evaluation and 69 items were selected based on 90 % judge agreement. Item analysis
was used for selecting those items which were able to fulfill the twofold criterion,
discrimination value (a<0.01) and corrected item-total correlation (a<0.01). A total
o f 168 clinical and non-clinical respondents were used for item and factor analysis.
Through this item analysis all 69 items fulfilled these criteria. To increase clinical
utility, factor analysis was done for item reduction. By factor analysis 39 items having
the factor loading o f 0.55 and above were selected for final scale. For ensuring
psychometric properties the number o f respondents was 478.Content validity was
confirmed through multi stage judge evaluation. Criterion related validity was
established by calculating concurrent and predictive validity which were
(r=0.828,a<0.01) and (r =0.828, r = 0.756, a<0.01) respectively. Construct validity o f
the current scale came from convergent validation and discriminate validation which
were (r=0.670, a<0.01) and (F= 649.564, a<0.01) respectively. Internal consistency
reliability was calculated by Cronbach alpha and it was, a = 0.962, that indicates
excellent level o f internal consistency. Test-retest reliability was also satisfactory (r=
0.890,a<0.01). Finally both screening and severity norms were developed for the
current scale. Screening norm was established using sensitivity and specificity
calculation and the most preferable cut off point o f current scale was 56, with 87%
sensitivity and 88% specificity. This cutoff point can discriminate clinical and non
clinical level o f cognitive distortion. Diagnostic performance o f the current scale was
measured through ROC curve and the area o f ROC curve was 0.949 which was

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significant at a < 0.01, indicating excellent performance. Severity norms were

developed through using percentile method. According to the percentile norm 56 to
72, 73 to 91,92 to 109 and 110 and above score represents mild, moderate, severe and
profound level o f cognitive distortions respectively.
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Acknowledgement

At first I wish to express my deep gratitude to Almighty ALLAH for giving me the
ability to complete this study.

I wish to express my deep and sincere gratitude to my initial supervisor Dr. Roquia
Begum, Professor, Department o f Clinical Psychology, University o f Dhaka .Without
her encouragement, support and inspiration it was not possible to initiate the current
study.

I wish to express my deep gratitude to my supervisor Kamal Uddin Ahmed

Chowdhury,University o f Dhaka for his constant expert supervision, support,
patience, invaluable guidance, advice, suggestion, inspiration tloi'oughout all stages of
this dissertation.

My cordial gratitude and thanks goes next to Md. Shahanur Hossain, Lecturcr,
Department o f Clinical Psychology, and University o f Dhaka. His M.Phil research
helped me to understanding the construct o f Cognitive distortion. I am very grateful to
him for his valuable suggestions, ideas, assistance and inspiration at every phase of
my dissertation.

I am grateful to Md.Zahir Uddin, Assistant Professor o f NIMH, Dhaka, Farha Deeba

and Md Kamruzzaman Mozumder, Assistant Professor, the Dept, o f Clinical
Psychology, University of Dhaka, because o f their research methodology o f scale
development which helps me to conceptualize the methodology o f this study.
Specially, I pay my admiration and thanks to my honorable teacher Md.
Kamruzzaman Mozumder for his valuable ideas and suggestions, which helped me to
cnrich the standard o f this study.

I am especially grateful to Dr. Manirul Islam, Training Physician (TTU), Research

Unit, icddrb and Dr. Wasimul Bari, Professor o f department o f Statistics, University
of Dhaka who were contributed to this research in analysis.

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1 must also have to acknowledge clinical psychologists Mst.Nazma Khatun, Salma

Parveen, S.M. Abul Kalam Azad, Most.Zobeda Khatun, Tarun Kanti Gaycn, Husny
Ara Begum, Md.Abdul Awal Miah, Sabiha Jahan, Tamima Tanjin and Selina Fatema
Binte Shaid for their wise advice and ideas which served as supporting stand for every
^ steps o f my research. I would also pay my special gratitude to Dr. Jhunu
Shamsunnahar and Dr.Md Absus Salam, Professor o f Psychiatry, BSMMU, Dr.Md
Shariful Islam, Assistant Professor o f Psychiatry, BSMMU for giving their valuable
time to improve my study.

I am also very grateful to Awal, Rasel, Shamsunnahar, Kaniz, Arfa, Tuni, Tushi,
Lucky, Mehidi vai, Shanju aunty, Choto fupu and also my family members who
worked vigorously for data collection.

I want to thanks all the staffs o f Department o f ClinicalPsychology, University o f

A Dhaka.

I must have to acknowledge that I am very grateful to all the respondents who
participated in this study and expensing their time.

I am specially thankful to the authorities o f all the institutions who kindly gave me
permission to work in their institutions.

Finally, I want to express my heartiest gratitude to my parents, younger brother and

my husband for their unconditional love, care, sacrifice and also continuous support.

S>oJrr>cx.
Dated; Dhaka ...................................................
April, 2013 Ummey Saima Siddika

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Contents

C ontent Page
^ Approval Sheet III
Abstract IV
Acknowledgement VI
List o f Tables XII
List o f Figures XIII
List o f Appendixes IVX

INTRODUCTION
1.1 Cognitive distortion 2
1.2 Type o f Cognitive distortion 4
^ 1.2.1 All or Nothing /Black & White thinking/Dichotomous 5
Thinking
1.2.2 Disqualifying the Positive 5
1.2.3 Overgeneralization 6

1.2.4 Labeling and Mislabeling 6

1.2.5 Mental Filtering 6

1.2.6 Jumping to Conclusion 7

1.2.7 Emotional Reasoning 8

1.2.8 Magnification/Catastrophizing and Minimization 8

1.2.9 Should Statement 8

1.2.10 Personalization 9
^ 1.3 Relationship Cognitive distortion and psychopalhology 9

1.3.1Cognitive distortion and depression 10

1.3.2Cognitive distortion and panic disorder 10
1.3.3 Cognitive distortion and generalized anxiety disorder 11
1.3.4 Cognitive distortion and obsessive compulsive 11
Disorder

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Content Page
1.3.5 Cognitive distortion and somatofonn disorder 11

1.3.6 Cognitive distortion and substance abuse disorder 11

1.3.7 Cognitive distortion and quality o f life 11

1.4 Assessment o f Cognitive distortion 12

1.4.1 Clinical interview 12
1.4.2 Thought listing 12
1.4.3 Think aloud techniques 13
1.4.4 Thought sampling 13
1.4.5 Questionnaires and scales 13
1.4.5.1 The Cognitive Distortion Scale (CDS) 14
1.4.5.2 The Dysfunctional Attitude Scale (DAS) 14
1.4.5.3 The Automatic 'rhought Questionnaire (ATQ) 15
1.4.5.4 The Inventory o f Cognitive Distortions (ICD) 16
1.4.1.5 Limitations o f Existing Measures o f Cognitive 17
Distortion
1.5 Properties o f Psychometric Scale 18
1.5.1 Validity 19
1.5.1.1 Content Validity 19
1.5.1.2 Criterion-related Validity 20
1.5.1.3 Construct Validity 20
1.5.1.4 Face validity 21

1.5.2 R eliability 22
1.5.2.1 Test-retest reliability 22
1.5.2.2 Parallel form reliability 23
1.5.2.3 Internal consistency reliability 23
1.5.2.4 Inter rater reliability 25
1.5.3 Norms 26
1.5.3.1 Screening norms 26

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Content Page
1.5.3.2 Severity norms 27
1.6 Objectives o f the current study 27
1.7 Rationale o f the current study 28

METHODOLOGY
Stage 1 First draft
2.1 Item construction 31
2.2 Item selection for first draft 33
2.3 Appropriate format o f the current scale 34
2.4 First draft o f the scale 36
2.5 Respondent 37
2.5.1 Clinical respondent 37
2.5.2 Non-clinical respondent 37
2.6 Instruments 38
2.7 Procedure for collecting data 41
2.7.1 Procedure o f collecting data for item analysis 41
2.7.2 Procedure o f collecting data for establishing psychometric 42
properties

ANALYSIS & RESULT

3.1 Item analysis 43

3.1.1 Respondents for Item analysis 43
3.1.2 Result o f item analysis 44
3 . 1 .2 .1 Item total correlation 44
3.1.2.2 Inter item correlation 45
3.1.2.3 Discriminate value 45
3.2 Factor analysis for increasing clinical utility 47
3.3 Psychometric properties/Experimental Tryout 50
3.3.1 Validity: 50
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C ontent Page
3.3.1.1 Content validity 50
3.3.1.2 Criterion related validity 51
3.3.1.3 Construct validity 52
3.3.2 Reliability 53

3.3.2 .1 Internal consistency reliability 53

3.3.2.2 Test-retest reliability 54

3.3.3 Norms 54

3.3.3.1 Screening norm 56

3.3.3.2 Diagnostic performance 58

3.3.3.3 Severity norm. 59

DISCUSSION 61
REFERENCES 68

APPENDIXES 77

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List of Tables

Table no Page
fi- 2.1 Number o f items o f each subscale o f the current scale. 32
2.2 Average o f judge evaluation on the basis o f the appropriateness o f 33
each item o f the current scale.
3.1 Demographical variable o f clinical and non-clinical respondents 43
used in item analysis.
3.2 Results o f item analysis. 46
3.3 Result o f factor analysis (items in which factor loading was and 49
above).
3.4 The demographic variables o f the clinical and non clinical sample 55
used for developing norms.
3.5 Possible outcome o f a psychometric scale with specific cut o ff point 56
3.6 Sensitivity and specificity o f the currcnt scale at different possible 58
cut o ff scores.
3.7 Percentile range and raw score range for corrosponding level o f 60
severity.

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List of Figures

Figure no Page
2.1 Stages o f the development o f the scale for assessing cognitive 30
distortions
3.1 The mean and standard deviations o f the two groups o f respondents. 53
3.2 Normal curve o f the scale scores o f clinical and non clinical 57
respondents used in the current study
3.3 Receiver Operating Characteristic curve (ROC curve ) o f the current 59
scale
I-XII Pie chart of demographical variable o f clinical and non- clinical 136
respondents

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List of Appendixes
Appendix No Page
1 Instruction and Items presented for Judge Evaluation 77
2 First draft o f the scale and demographical questionnaire, used for 89
clinical respondents in first try out
3 First draft o f the scale, GHQ 28 and demographical questionnaire, used 97
for non clinical respondents in first try out
4 Final scale with demographic data sheet used for clinical respondents in 109
experimental tryout
5 Final scale with demographic data sheet used for non clinical 115
respondents in experimental tryout
6 Translated version o f DAS with the instruction for respondents 123
7 Depression Scale with the instruction for respondents 126
8 Anxiety Scale with the instruction for respondents 128
9 Subjective rating o f CBT practitioner about tlie severity level o f 130
cognitive Distortions
10 List o f Judges who participated in this current study 131
11 List o f Hospitals from where clinical respondents were collected 132
12 List o f Research assistants who work for data collection 133
13 Birth district wise distribution o f the respondents (Clinical and Non 134
clinical) participated in developing norm
14 Graphical distribution of respondents (Clinical and Non clinical) 136
participated in developing norm
15 Item to item correlation among 64 cliniccd respondents used in Item 142
Analysis
16 Sensitivity and specificity of the current scale with different provable 151
cutoff point

17 Permission letter for data collection 153

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Chapter 1
Introduction
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Development of a Scale for Assessing Cognitive Distortions

Introduction

"Mr. X, 25 year old, a Muslim young adult with major depressive disorder was
referred to the trainee clinical psychologist, from the outdoor o f the psychiatry
department. In clinical assessment session, he complained o f sleep disturbance,
trembling, palpitation, sweating. He had been experiencing excessive guilt feelings
fo r any mistake occurred in daily life and fe lt blue, empty and hopeless about his
future. He also was suffering from fea r o f d e a t h T h e client was consulting with
several doctors & taking different types o f medicine. He realized that he couldn’t
express his emotion in an appropriate way. He was sometime aggressive and shouting
to others and also destroying household items. The client avoided all types o f social
activities. After several session some cognitive distortions was explored such as 7
lost everything in my life', T think my life is moving to the reverse direction’, 7 am
backdated compared to all other frie n d s’, ‘Nobody loves me', 'My future will become
dark' which made him obsessed and maintained all o f his problem s."

In this case the trainee clinical psychologist used clinical assessment which was very
essential in Cognitive Behavior Therapy. Clinical assessment needs a long time for
assessing cognitive distortion which leads his (Mr. X) psychopathology. Besides this
sometimes, different types o f subjective bias could interrupt in this clinical
assessment. But if the trainee clinical psychologist could use a standardized
psychometric scale for assessing cognitive distortion, in clinical assessment then it
would be possible to assess the components o f cognitive domains more intensively
and more objectively within a short time.

Researchers develop psychometric scales when they want to measure any construct
that they believe to exist on their theoretical understanding, but can't assess directly.
Theoretically, due to cognitive distortion one's perceive the situation unrealistically
and which leads him/her to develop negative and unrealistic view point towards self,
others and the world and have an influence to develop psycho-pathological problems.
But one's cognitive distortions can't be assessed directly, because it's not observable.
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When assessment tools such as a scale is used for measuring cognitive distortions
then the collections o f items intended to reveal the levels o f this phenomena and helps
clinical psychologist to assess this phenomenon o f the clients for their better
intervention.

CBT is an action oriented form o f psychotherapy which assumes that maladaptive,

defective or faulty thinking patterns cause maladaptive behavior and negative
emotions.CBT focuses on changing an individual's inappropriate or irrational thinking
patterns which is called cognitive distortion. Cognitive distortion usually distorts the
reality because it creates unrealistic view o f perception. Therefore people with
cognitive distortion could not see the real picture o f the reality. The therapist o f CBT
assists the clients in identifying & testing the reality, correcting cognitive distortion
and then helps the client to modify those maladaptive thoughts and the behaviors. In a
word, the prime focus o f Cognitive Behavior Therapy is to change individual's
maladaptive behavior and negative emotion through changing cognitive distortion.
The process o f learning to refute these distortions is called "cognitive restructuring".

1.1 Cognitive distortion

Cognitive distortions are simply the ways o f the mind, convinces o f something that
isn’t really true. These inaccurate thoughts are usually used to reinforce negative
thinking or emotions that seem to be sound rational and accurate to someone, but
really it serve only to keep the individual feeling bad about him/herself. The term
cognitive distortion was introduced by Albert Ellis (1962) in his rational emotive
therapy. Later Aaron T. Beck (1963, 1964) also used this term in his cognitive therapy
which is the prime focus in cognitive behavior therapy. The term is traditionally
defined as fallacious reasoning that plays a vital role in the emergence o f certain
mental disorders like depression, anxiety etc.

According to Beck (1979) and Burns (1980), cognitive distortions are those cognition
which-

• are logical but irrational,

• present an unrealistic view o f reahty.
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• are also maladaptive, because they cause negative mood, impair behavioral
fiinctioning, impede productive thinking about the situation and reinforce
underlying irrational beliefs and
• also maintain negative thinking and help to maintain negative emotions.

David Burns and Aaron T. Beck (1979) defined the cognitive distortion as logical but
not rational thinking.

The cognitive distortions can be defined as a type o f reasoning which leads to favor
without objective ground.

According to Hossain and Begum (2008) cognition are distorted when the cognition,

• does not match with reality,

• is not internally consistent,

• is not useful or does not produce practical benefit and

• is not inter subjective and is not shared and uphold by a group o f people.

In this current research, cognitive distortion is operationalized as subjectively right

but not objectively right and maintaining negative emotions and impairing behavioral
functions.

The cognitive structures develop early in life from personal experiences, identification
with others and reinforcement (Beck & Weishaar, 1995). According to Beck, the
cognifions resided mainly outside of conscious control and occurred without volition,
these are labeled as automatic thought. The automatic thoughts are those which arise
from interpretations o f events are themselves based on a network o f secondary beliefs,
assumptions, formulas and rules that are often connected to relevant memories. One’s
belief system can shape experience in ways that are analogous to optical lenses.
Prescription glasses that are carefully crafted to help a child to see the world more
clearly may need to be adjusted as the child matures. Lenses that are not properly
altered may later distort events so drastically that they impair functioning and cause
great distress. In the same way, schemas or subjective beliefs about one’s own self,
shaped by early childhood experience, may develop foster rules, assumptions, and
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expectations. But sometimes that no longer suit the real world. When this occurs,
cognitive distortions may arise that systematically misrepresent reality and which
cause impairment and distress, and prevent individuals from resolving their own
problems, such as “I am unlovable”, “ I am a loser”, “I am worthless”. These
automatic thoughts are subject to specific types o f logical errors or cognitive
distortions, which are labeled as selective abstraction, overgeneralization,
dichotomous thinking, and exaggeration o f the negative aspects o f their experiences
(Beck, 1991). Beside this, the psychoanalytic theory explains that every human being
wants satisfaction in their early life when they arc driven by ID (primary driving force
o f human personality). People seek for pleasure but they often experience their reality
distortedly, cognition becomes distorted.

1.2 Types of Cognitive distortion

Cognitive distortion is classified in various ways. In the currcnt research, cognitive
distortion o f anxiety and depression was assessed by following 10 types o f cognitive
distortions as classified by Bums & Beck (1980)-

• All or nothing/Black & white thinking

• Disqualifying the positive
• Overgeneralization
• Labeling mislabeling
• Mental filtering
• Jumping to conclusion(Mind reading & Fortune teller error)

• Magnification/Catastrophizing and Minimization

• Emotional reasoning
>
• Should statement
• Personalization
It may be mentioned that these 10 types o f cognitive distortions are
sometimes very overlapping.
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1.2.1 All or Nothing/Black & White thinking/Dichotomous thinking

This refers to the tendency to evaluate personal qualities in extreme, black or white
categories. If a situation falls short o f perfect, one see it as a total failure. As for
example “I have lost everything". All or nothing thinking forms the basis for
perfectionism. It causes the individual's to fear any mistake or imperfection because
the individual will then see him/herself as a complete loser and will feel inadequate
and worthless. This way o f evaluating things is unrealistic because life is rarely
completely either one way or the other; for example, no one is absolutely brilliant or
total stupid. This type o f perceptual error is known as 'Dichotomous thinking'.
Absolutes do not exists in this universe, if someone try to force his/her experiences in
to absolute categories, he/she will must be depressed, because his/her perceptions will
not conform to reality. Therefore, all or nothing distorts reality and it is also
emotional arousing which cause over-dreaming and maintains depression. All or
Nothing thinking is found in depressed people all over the World. When faced with a
life-threatening situation; they must make a snap decision and act on it. There is no
time for 'maybe this', or 'may not be this'.

1.2.2 Disqualifying the positives

This refers to reject the positive experiences by insisting for some reason or other
which is contradictory with everyday experiences such as “What I achieved just
because o f my luck” . Disqualifying the positive is one o f the most destructive forms
of cognitive distortion. This is the most destructive pattern o f cognitive distortion and
an extreme form o f all or nothing thinking in which persons filter out all the positive
evidence about their performance, and only attend to the negative. This cognitive
distortion produces automatic thoughts that reinforce negative feelings and explain
away positive ones. It can be manifested in two ways, if a person ever tried to argue
someone out o f a bad mood, hc/she have probably seen this cognitive distortion from
the outside. And, if a person has ever been in a bad mood him/herself, he/she may
have seen it from the inside. Usually people who are caught up in this cognitive
distortion are genuinely depressed about something, but it may be something that has
no obvious cormection with the reality.
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1.2.3 Ovcrgeneralization

This refers to take the isolated cases and using them to make wide generalization in
faulty way. Building up one thing about oneself or one’s circumstances and ending up
thinking that it represents the whole situation. Every person has to think about new
experiences in terms o f old experiences and to learn new idea or conclusion through
generalizing these old experiences .But when the experience is not enough to make a
general idea or conclusion then it distorts the reality and makes faulty perception
about self, others and future. This type of cognitive distortion called
overgeneralization. For example “Failure in an event means that I will never have
success anywhere "or “I will always be a failure”.

1.2.4 Labeling and mislabeling

Labeling means creating a completely negative self image based on error. This is an
extreme form o f overgeneralization where instead o f describing error, the individuals
attach a negative label to themselves. When performance o f an individual is fallen
down one might label oneself as “I am a failure” instead o f “I made a mistake". When
someone else’s behavior misguides others in a wrong way, they attach a negative
label to him,” He is an evil” . Labeling oneself is not only self-defecting but also
irrational. And mislabeling involves describing an event with language that is highly
colored and emotionally loaded.

1.2.5 Mental filtering

This refers to picking out a negative detail in any situation and dwell on it exclusively,
while filtering out all positive aspects o f a situation, thus perceiving the whole
situation as negative. For instance, a person may pick out a single, unpleasant detail
and dwell on it exclusively so that his vision o f reality becomes darkened or distorted
which in turn leads to suffering much needless anguish. As for example “The world is
full of cruel people” . It may also be true that there are many cruel people in the world,
but the cognitive distortion filter out the good, ideal people in this world. In this
cognitive distortion, someone concentrates so strongly on one aspect o f a task or a
situation that he/she can't even see the rest, automatic thoughts all deal with this one
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concern. When someone is depressed, he/she wears a pair o f eyeglass with special
lenses that filter out anything positive, and this type o f filtering process is called
'selecting abstraction'.

^ 1.2.6 Jum ping to conclusion

This refers to making negative interpretation even though there are no definite facts
convincingly support the conclusion. Without individuals saying so, someone know
what they are feeling and why they act the way they do, this type o f thinking process
is called arbitrary inference. In particular, a person thinks that he/she is able to
determine how people are feeling toward him/her. For example, a person may
conclude that someone is reacting negatively toward them and don’t actually bother to
find out if they are correct. Another example, is a person may anticipate that things
will turn out badly, and will feel convince that his/her prediction is already an
^ established fact. This cognitive distortion consists o f going beyond the evidence the
patients actually have and reaching a conclusion that makes things look worse than
they are. There are two subtypes o f this cognitive distortion as below-

1.2.6.1 M in d reading: Assuming the intentions o f others and

believing that, the individuals know what others are thinking without checking it
out and arbitrarily conclude that someone is reacting negative with him/her. It is
often combined with other cognitive distortions. Persons may use a mental filter to
exclude other people's positive reactions to them and then read a whole set o f
negative reactions into what's left. As for example “Others thinking that I can’t do
anything perfectly". This is referred to as mind reading.

^ 1.2.6.2 The fo rtu n e teller error: Anticipate that things will turn out
badly, exaggerating how things will turn out before they happen and feel
convinced that one’s prediction is an already established fact, even though it
unrealistic. For example-a depressed patient may say “I realize I’ll be depressed
forever. My misery will go on and on.” This negative prediction about his
prognosis caused him to feel hopeless. Fortune telling can be an especially
dangerous cognitive distortion because negative automatic thought about a future
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event can easily become a self- fulfilling prophecy, because when someone's
thinking is "The fortune teller error" then he/she expect to do poorly, he/she don't
try very hard & failed to success.

^ 1.2.7 Emotional reasoning

This refers to making decisions and arguments based on how the person feels rather
than objective reality. This kind of reasoning is misleading because the person's
feelings reflect his/her thoughts and beliefs. If they are distorted, as is quite often in
certain situation, the emotion is not valid and it doesn’t take in to account all the other
factors operating at the time. In emotional reasoning, someone continue to take for
granted the automatic thought that causes his/her negative feeling and try to reason on
the basis o f his/her feelings. Thus emotional reasoning amplifies the effects o f other
cognitive distortions. For example “I feel that I am alone in the world”.

^ 1.2.8 M agnification/ Catastrophizing and Minimization

Magnification/Catastropizing refers to exaggerating the errors, fear or imperfections

and their importance. In the same time minimization refers to minimize one’s
personal strengths, positive qualities, as for example “Others are more intelligence
and skill than me.” Like all-or-nothing thinking, it is a favorite cognitive distortion of
perfectionists. This is also called “Binocular trick” This cognitive distortion consists
o f seeing the positive results of one’s actions as smaller and the negative resuUs as
bigger than they really are. They look at their errors through binoculars, but when
they look at their virtues, they turn the binoculars around and look through the big
end.

1.2.9 Should statement

‘Should statement’ refers to concentrating on what the persons think “ Should “or
‘Ought” to be rather than they face. These kind o f cognitive distortions involve
coming up with rigid rules and expectations for self or others regardless o f the
circumstances. O f course, not everything is black and white. When one try to motivate
oneself by saying “I must do everything perfectly”, that will make him/her pressurize
and resentful and make feel guilty. Paradoxically he/she feels apathetic and
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unmotivated. And when one direct should statements towards other, that will make
him frustrated, as for example “Everybody should loves me". Should statement
generate a lot o f unnecessary emotional turmoil in daily life. Because when the reality
o f one’s own falls short o f one's standards, his/her should and shouldn't create self­
loathing, shame and guilt. And when the all- too-human performance o f others falls
short o f someone's expectations, as is inevitably happen from time to time, he/she
feels bitter and self-righteous.

1.2.10 Personalization

This distortion is the mother o f guilt. The person assumes responsibility for a negative
even when there is no basis for doing so. Someone arbitrarily conclude that what
happened was his/her fault or reflects his/her inadequacy, even when she/he was not
responsible for it. For example “I am the only cause o f my family crisis". When a
mother saw her child’s report card, there was a note from the teacher indicating the
child was not working well. She immediately decided "I must be a bad mother, this
shows how I ’ve failed". Personalization causes someone to feel crippling guilt. One
suffers from paralyzing and burdensome sense o f responsibility that forces him/her to
carry the whole world on his/her shoulders.

1.3 R elationship between cognitive distortions and psychopathology

Aaron T. Beck and colleagues initially developed cognitive therapy as a treatment for
restructuring negative thoughts and behavior (Beck and Burn, 1979). It focuses in
solving current problems and modifying dysfunctional thinking and behavior (Beck,
1964).Cognitive distortions play a fundamental role in the onset, maintenance, and
ultimately, the amelioration of all manner o f psychological dysfunction, in Axis I and
Axis II disorders (Beck, 2004). There is empirical support for the association between
cognitive distortions and a number o f other maladaptive social and clinical conditions,
including sexual assault (Baumcister, Catanese & Wallace, 2002), pathological
gambling (Steenbergh, Meyers, May, & Whelan,2002), adolescent anxiety and
depressive disorders (Kendall, Kortlander, & Brady, 1992), violence and anger in
marital relationships (Ekhardt, Barbour, & Davison, 1998) and adolescent depression
and anxiety (Kolko, Brent, Baugher, Bridge & Birmaher, 2000), depression and
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anxiety (Kolko, Brent, Baugher, Bridge, & Birmaher, 2000). Most studies were
limited to investigations o f circumscribed diagnoses, such as depression or anxiety,
with the possibility o f another added variable, that is, co morbid PDs ( Ilardi and
Craighead, 1999). Different types of cognitive distortions predominantly influence
different types o f disorder. As for example the predominant thinking errors in social
phobia are mind reading, catastrophizing and personalization (Wells, 2004).

1.3.1 Cognitive distortion and depression

Research shows clearly indicate that the experience o f depressive symptoms in

adolescents is associated with cognitive distortion. Furthermore, adolescents who
meet the DSM-III criteria for major depression or dysthymia have significantly more
cognitive distortion than non-depressed psychiatric patients or normal adolescents.
Thus, there may be continuity between depression in adulthood and adolescence in
terms o f the presence o f cognitive distortion (Marton,Churchard, & Kucher, 1993).
Depressed patients have consistently displayed greater cognitive distortion than non­
depressed individuals (Barnett and Gotlib, 1988). .

1.3.2 Cognitive distortion and panic disorder

Selective abstraction, magnification, overgencralization, labeling-mislabeling,

personalization, dichotomous thinking are very common with people who are
suffering from panic disorder. (Corey,2009). They feel anxiety when they perceive
threat to ’themselves from external or internal events, and this occurs if they perceive
their reality distortedly. They also have the tendency o f mental filtering for their
symptom. Cognitive model of panic disorder have proposed that panic attacks result
from the catastrophic misinterpretation o f certain bodily sensations, (Noda, Nakano,
Lee, Ogawa and Kinoshita,2007).In case o f panic disorder, anxiety elicited by bodily
sensations influenced catastrophic beliefs which, in turn increase avoidance and
avoidance increased the anxiety, elicited by bodily sensations (Hoffart, Sexton,
Hedley ,Martinsen ,2008).

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1.3.3 Cognitive distortion and generalized anxiety disorder

People with generalized anxiety disorder have pervasive fear o f danger with
everything. W hen they face different life situations they perceive distortedly and their
anxiety increased. Beck reported that GAD patients have different types o f cognitive
distortion specially catastrophizing, arbitrary inference, personalization, selective
abstraction, overgeneralization, dichotomous thinking, and labeling (Beck, 1995).

1.3.4 Cognitive distortion and obsessive compulsive disorder

Basically the client of OCD distortedly perceives different situations that maintain a
vicious cycle and their problem, so they feel a lot o f pressure to do according to their
obsession. Gorbis reported that there are several cognitive distortions occur in the
minds o f OCD clients in her “intensive OCD program article” (Gorbis and
Ananyev,2008).

1.3.5 Cognitive distortion and somatoform disorder

Main feature o f the people with somatoform is different types o f somatic or physical
complain that is mostly manifested for psychological disturbances. A research
indicates that common errors occur in health anxiety are: catastrophizing,
dichotomous thinking and selective abstraction (Wells, 2004).

1.3.6 Cognitive distortion and substance abuse disorder

The people who are dependent on drugs they are holding different types o f cognitive
distortions to be dependent on drug. Their justification for drug abusing is expression
of cognitive distortion. Research indicates that a very high proportion o f drug abusers
have psychiatric problems, with depressive symptoms particularly common. High
< levels o f cognitive distortion among drug user is comparable with depressed people
(Chabon & Robins, 1986).

1.3.7 Cognitive distortion and Quality of life

A research which objective was to see the impact o f cognitive distortion on quality o f
life, the concept ‘quality of life’ comprises several dimensions (Spilker,1990). And
the findings was the physical condition, the psychological aspect & the social aspect

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were affected by psychiatric illness. If a person does not practice rational thinking,
this will be deduced the quality o f life through a process o f logic and he/she will feel
more stressed and their quality o f mental health will be hampered.

^ 1.4 A ssessm ent o f Cognitive distortions

Although the foundation o f Cognitive Therapy and Cognitive Behavior Therapy is the
exploration and modification o f cognition (Beck, 1979 and Burns, 1999) very few
instruments have been validated to assess detail and adequately one o f the most
fundamental cognitive process, cognitive distortions (Yurica, 2002). Cognitive
distortions are generally assessed by clinical assessment, self-report inventories. Such
as;
1.4.1 Clinical interview

In clinical interview the clinician is allowed to assess as many functional or

^ controlling elements o f the problem as possible. Clinical skill include an ability to
listen in order to understand what the client is saying and experiencing with an ability
to express empathy and support. Physical, emotional, social and cognitive domain o f
an individual is assessed in-depth in clinical interview. Open ended and closed ended
questioning is used to examine the cognitive factors to assess (ask questions related
to) how the individual perceive him/herself, others, and the future. For example, a
individual might describe him/herself as incapable, perceive others to be critical and
also his/her view might be pessimistic about future .In CBT there are various method
which used in clinical interview for assessing cognitive distortion, such as Socratic
questioning, down arrow techniques etc.

^ 1.4.2 Thought listing

One o f the most widely used methods is thought listing. The person is typically asked
to spend two to three minutes recording everything they have been thinking about
prior to exposure to a specified stimulus. Subsequently thought can be rated as either
favorable towards themselves, unfavorable towards themselves or neutral.

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1.4.3 Think aloud tcchniqucs

This technique is to ask the client to verbalize all thoughts and feelings experienced
while completing a task or during a defined time period. Reported thoughts and
feelings are transcribed and content analyzed.

1.4.4. Thought sampling

In this instance the client is interrupted at random intervals and uses recording
instruments for recording what they were thinking immediately prior to the interval.

Although these instruments may illuminate distorted cognition, sometimes they fail to
identify specific cognitive distortions and this task is left to the clinician. Moreover,
even after completing various thought records, the process o f identifying cognitive
distortions is very challenging without any standardized psychometric scale or
questionnaires.

1.4.5 Questionnaires and scales

The instruments have been developed to assess the quantity and content o f positive
and negative cognitions, such as the Automatic Thoughts Questionnaire— Revised
(ATQ-R; Kendall, Howard, & Hayes, 1989), and the Cognitive Triad Inventory (CTI;
Beckham, Leber, Watkins, Boyer & Cook, 1986).As compared to tests o f negative
affect or dysfunctional personality traits, there is a surprising dearth o f clinical,
standardized multi-scale measures of distorted or negative cognitions (Briere, 1997).
A literature review revealed five instruments specifically designed to assess the
construct o f cognitive distortions in a clinical context. These instruments are as
follows: The Dysfunctional Attitude Scale (DAS; Weissman & Beck, 1979), the
Cognitive Distortion Scale (CDS; Briere, 2000) the Automatic Thoughts
Questionnaire— Revised (ATQ-R; Kendall, Howard, & Hayes, 1989, Inventory o f
Cognitive Distortions (Yuriea & DiTomasso, 2002),the Cognitive Error Questionnaire
(CEQ; Lefebvre, 1981).

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1.4.5.1 The Cognitive Distortion Scale (CDS)

Cognitive Distortion Scales™ (CDS™) was developed by John Briere in 2000. The
CDS is a brief, reliable self-assessment o f cognitive distortions in adults. Designed
^ for both clinical and nonclinical contexts, the CDS is effective in testing individuals
with and without histories o f personal trauma. CDS scales reflect five types of
cognitive distortion; Self criticism (SC), self blame (SB), helplessness (HLP),
hopelessness (HOP) and preoccupation with danger (PWD)
Written at a 5th grade reading level; the CDS can be administered to individuals or
groups in 10-15 minutes and hand-scored in 5 minutes. In addition to quick and
convenient administration, the CDS delivers a thorough and reliable profile for every
respondent.

At the completion o f the standardization process, five sub scales o f CDS are analyzed
for internal consistency in normative sample using the alpha statistic. Reliability
coefficient for the CDS scales from 0.89 (for Preoccupation With Danger) to 0.97 (for
Hopelessness), with an overall mean CDS scale alpha o f 0.93.Scale alphas for the
clinical sample ranged from 0.94 (for self blame and Preoccupation With Danger) to
0.98 (for the Hopelessness Scale), with an overall mean alpha o f 0.96.Alpha values of
this magnitude indicate very high internal consistency reliability.

Data on the CDS are presented with reference to three types o f validity -construct,
convergent and discriminate and this validity is in both the general population and in
clinical samples.

1.4.5.2 The Dysfunctional Attitude Scalc (DAS)

The Dysfunctional Attitude Scale was developed by W eissman and Beck in 1978. The
DAS is a 40-item instrument that is designed to identify and measure cognitive
distortions, particularly distortions that may relate to or cause depression. The items
contained on the DAS are based on Beck’s cognitive therapy model and present 7
major value systems: Approval, Love, Achievement, Perfectionism, Entitlement,
Omnipotence, and Autonomy. To obtain the overall score, simply add the score on all
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items (ranging from 1 to 7). When no items are omitted, scores on the DAS range
from 40 to 280. Lower scores represent more adaptive beliefs and fewer cognitive
distortions. Practitioners can also examine other areas where respondents may be
emotionally vulnerable or strong as indicated by their responses to other specific
y items. Treatment can then be targeted to those areas. Reliability o f the DAS is
reported to have very good internal consistency, with alphas ranging from 0.84 to
0.92. The DAS also has excellent stability, with test-retest correlations over 8 weeks
o f 0.80 to 0.84.And DAS has excellent concurrent validity, significantly correlating
with several other measures o f depression, including the Beck Depression Inventory
(BDI). The DAS also significantly aistinguishes between groups diagnosed as
depressed or not depressed on the BDI. The DAS was also found to be sensitive to
change following clinical intervention with depressed outpatients.

The scale was translated into Bengali by una tiegum (2008) so that it can be
administered on Bangladeshi populations. Both English and Bengali scales were
scoring differently and the mean score o f DAS-English was found=I27.88 (sd=26.37)
and Bangla w as=l 19.30 (sd=31.24).The Spearman’s rho correlation coefficient is
calculated as 0.812 which was significant at 0 .0 1 level o f significance in two tailed
test. The original scale was valid to assess dysfunctional cognition and attitude which
was also used by different researchers to assess cognitive distortion (Whisman,
Miller, Norman, William and Keitner,1991). Dysfunctional Attitude Scale was also
found highly correlated with irrational Beliefs scale. Cognitive Error Questionnaire
and such type o f scale which validly measure cognitive distortion (Wertheim
and Poulakis, 2005). Sub-scale and different items o f DAS was found as correlated
with both anxiety and depression symptoms (Dyck, 1992). Therefore, in the present
research Dysfunctional Attitude Scale was used.

1.4.5.3 The Automatic Thought Questionnaire (ATQ)

The ATQ is a 30-item instrument that measures the frequency o f automatic negative
statements about the self. Such statements play an important role in the development,
maintenance and treatment o f various psychopathologies, including depression. ATQ

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taps 4 aspccts o f these automatie thoughts; personal maladjustment and desire for
change (PMDC), negative self-concepts and negative expectations (NSNE), low self
esteem (LSE), and Helplessness. Scoring system o f ATQ is the items are rated on the
frequency o f occurrence from “not at all” to “all the time” . Total scores are the sum o f
all 30 items. Items on each factor are: PMDC: 7, 10, 14, 20, 26; NSNE: 2, 3, 9, 21, 23,
24, 28; LSE: 17, 18; Helplessness: 29, 30. A high total score indicates a high level of
automatic negative self-statements. Reliability o f ATQ has excellent internal
consistency with an alpha coefficient o f .97.The items o f ATQ is significantly
discriminated depressed from non depressed subjects. Has good concurrent validity,
correlating with 2 measures o f depression, the Beck Depression Inventory and the
MMPI Depression scale.

1.4.5.4 The Inventory of Cognitive Distortions (ICD)

The ICD (Yurica & DiTomasso, 2002) provides the latest and most comprehensive,
structured, psychometrically validated self-report instrument for measuring cognitive
distortions in a heterogeneous, adult, clinical, outpatient population. The ICD is a 69-
item self-report inventory designed specifically to measure the frequency o f distorted
cognitions in an outpatient clinical population. The instrument consists o f single
sentence items, answered on a five-point Likcrt scale. The ICD provides scores on 11
factors/cognitive distortions. According to Yurica (2002), the ICD was specifically
designed to assess “self-statement cognitive products representative o f particular
types o f cognitive distortions in differing mental health disorders” . CT experts and
factor analysis have established good content validity. Yurica (2002) explicitly
designed the ICD to validate the 16 theorized cognitive distortions(Beck,I979; Bums,
X 1980; Freeman & DeWolf, 1992; Freeman & Oster, 1999).However, o f the original
theorized cognitive distortions, factor analysis revealed 11 fundamental factors that
closely resembled 10 theory-derived cognitive distortion subscales (Externalization of
Self-Worth, Fortune-Telling, Magnification, Labeling, Perfcctionism, Comparison to
Others, Emotional Reasoning, Arbitrary Inference/Jumping to Conclusion,
Minimization, Mind-Reading), in addition to one important new cognitive distortion
(Emotional Reasoning and Decision-Making).
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ICD offers several advantages over other measures o f cognitive distortion. First, it
provides the latest factor analysis of the original theorized cognitive distortions.
Second, it identifies and evaluates a larger number o f cognitive distortions than any of
the other competing instruments. Third, the distortions identified by the ICD have
been demonstrated to span diagnostic categories, rather than being restricted to a
particular diagnosis (Yurica, 2002). The ICD demonstrated impressive internal
consistency, having a total scale estimate o f internal reliability measuring a
Coefficient alpha o f 0.998 (N=28), indicating good homogeneity o f item content.
Additionally, the ICD total scale scores produced test-retest reliability o f r = 0.98,
indicating good stability. However, most o f these instruments suffer from a number o f
critical limitations.

1.4.5.5 Limitations of existing measures of cognitive distortion

Many o f the existing measures o f cognitive distortion have some lacking.

Specifically, the ATQ (Hollon & Kendall, 1980), DAS (W eissman & Beck 1979), and
CEQ (Lefebvre, 1981) were designed for assessing cognitive distortions attendant to
depression. Furthermore, the DAS yields only a total distortion score. This is
problematic in research because the DAS fails to illuminate a clear picture about
which specific distortions correlate with particular disorders. Moreover, in assessment
and clinical practice, the DAS is designed to assess dysfunctional beliefs and fails to
identify many important distortions that may be targeted in treatment.
The existing measures o f cognitive distortion, only the ICD measures 11 different
cognitive distortions on separate subscales, thereby offering a significant advantage
over both the DAS and CEQ, because the DAS is limited to only six types of
distortions (arbitrary inference, overgeneralization, selective abstraction,
magnification or minimization, dichotomous reasoning and personalization), whereas
the CEQ is further limited to only four varieties o f distortion (overgeneralization,
arbitrary inference, selective abstraction, and magnification or minimization).

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Although the CDS (Briere, 2000) is more useful for identifying specific cognitive
distortions, it is still limited because it yields only the following five distortions:
helplessness, hopelessness, self-criticism, self-blame, and preoccupation with danger.
Consequently, the instrument fails to identify a number o f important theoretical
cognitive distortions.
Finally all four instruments lack specificity in their definitions o f the term cognitive
distortions, and suffer from - poor consensus in definition, variable measurement
across instruments, limited applicability, and outdated, limited scope o f the
measurement o f cognitive distortions.

1.5 Properties o f Psychometric Scale

Psychometrics is the ground o f study concerned with the theory and technique o f
psychological measurement, which includes the measurement o f cognition,
knowledge, abilities, attitudes, and personality traits. The field is primarily concerned
with the construction and validation o f measurement instruments, such as scale,
questiormaires and check list. Without it properties any psychometric tools/scale is
good for nothing. Potency and usability o f a scale depends on its psychometric
property. There are three most important property o f any standardized scale are
reliability, validity and norm. A researcher or a clinician use a scale when he become
ensured that the scale is reliable and provide a valid measure what he want to
measure. Not only this but also, another very important property o f a psychometric
scale is norm, because through the norm the scale can interpret an individual's
condition for which the scale developed to assess. So it's very indispensable for a
scale to have a standardized norm. Even though it's not so easy to ensure
psychometric properties o f a scale, a scale is good for nothing or useless or has no
utility without these properties. For this reason, a scale developer always tries to
establish these psychometric properties during different stage o f scale development.

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1.5.1 V alidity

According to American Educational Research Association, validity refers to the

degree to which evidence and theory support the interpretations o f test scores entailed
by the proposed uses o f tests. In other words, validity describes how well one can
legitimately trust the results of a test as interpreted for a specific purpose. The
classical definition o f validity is “whether the measures what it is supposed to
measure". It is the accuracy o f a measurement o f the true state o f phenomenon
(Winter,2000). For example, does a cognitive distortion scale actually measure
cognitive distortion, or does it measure something else, such as aggression or
personality to admit problems. Validity is determined by: 1. scrutinizing content, 2.
relating scores obtained on the test to other test scores or other measures, and 3.
executing a comprehensive analysis o f how scores on the test relate to other scores.
There is various type o f validity, such as- face validity, content validity, criterion
related validity, construct validity. For a psychometric scale development a researcher
must be concern about content, criterion related and construct validity o f the scale.
Because without ensuring these validity a psychometric scale loss its utility.

1.5.1.1 Content Validity

Content validity assess whether the measure adequately covers the different aspects of
the construct what it want to measure. It measures the degree to which the content o f a
test broadly across the domain o f interest. In clinical settings, content validity refers to
the correspondence between test items and the symptom content o f a syndrome. It can
be seen that this is not a statistical concept but a question o f expert judgment (Aiken,
1985). In case o f psychometric test, it involves examining the content o f a test to
determine if the items represent the thing, for which the test or scale is planned to
measure. Content validity is usually established by content experts'. The evaluation of
content validity is a subjective assessment, usually conducted by a panel o f experts
about the appropriateness o f the items included in the instrument. Messick(1995)
classified the content validity in two types-1. Content relevance: each item on the test
should relate to one o f the course objectives, 2 .Content coverage: each part o f the
syllabus (each course objective) should be represented by one or more question.
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1.5.1.2 Criterion-related Validity

Criterion-related validity can be assessed by correlating a measure with a criterion

measure known to be valid. Criterion validity is about prediction rather than
explanation. Criterion draws an inference from test scores to performance. A high
score o f a valid test indicates that the tester has met the performance criteria. Criterion
related validity is two types-

Concurrent Validity

This Validity is demonstrated where a test correlates well with a measure that has
previously been validated. When the criterion measure is collected at the same time
with the valid measure then goal of this validity is established. It refers to the form o f
criterion-related validity that is an index o f the degree to which a test score is related
to some criterion measure obtained at the same time. It indicates the extent to which
test scores may be used to estimate an individual’s present standing on a criterion.

Predictive validity

Predictive validity, where one measure occurs earlier and is meant to predict some
later measure (Mclntire and Miller, 2005).Example; IQ scores o f WASI o f an
adolescent as predictor o f academic performance after school secondary examination
as criterion. When the criterion is collected later the goal is to establish predictive
validity. It refers to the form o f criterion-related validity that is an index o f the degree
to which a test score predicts some criterion measure obtained.

1.5.1.3 Construct Validity

Construct validity refers to a judgment about the appropriateness o f inferences drawn

from test scores regarding individual standings on a variable called a construct. As its
name suggests, it examines the validity o f a construct rather than o f individual
methods of measuring that construct.(Cronbach & M eehl,1955).It is the extent to
which a test or a scale may be said to measure a theoretical construct or
trait.(Anastasi,1988).It Test scores correlate with scores on other tests in accordance

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with what would be expected, would be decreased or increased as a function o f age or

passage o f time as theoretically predicted and obtained by people from distinct groups
vary as predicted by theory. In one classical type o f construct validity study, the
relevant associations are displayed in a multi-trait, multi-method matrix (Campbell &
Fiske, 1959).The matrix reveals the extent to two type o f measures-

Convergent validity

A validity coefficient showing strong relationship between test scores and other
variables with which scores on the test should theoretically be correlated. Convergent
validity consists o f providing evidence those two tests that are believed to measure
closely related phenomena which can be correlated strongly.

Divergent/Discriminate validity

^ A validity coefficient showing little relationship between test scores and other
variables with which scores on the test should not theoretically be correlated.
Discriminate validity, by the same logic, consists o f providing evidence those two
tests that do not measure closely related phenomena skills which do not correlate
strongly.

1.5.1.4 Face validity

Face validity relates more to what a test appears to measure than to what the test
actually measures and this o f validity is important because lack o f it could contribute
to a lack o f confidence with respect to perceived effectiveness o f the te s t, it looks like
a reasonable test for whatever purpose it is being used. The criteria o f validity in tests
y and measurements should go beyond “face”, “appearance”, and “common sense” .
This is the least scientific method o f validity as it is not quantified using statistical
methods. This is not validity in a technical sense o f the term. In research it's never
sufficient to rely on face judgments alone and more quantifiable methods o f validity
are necessary in order to draw acceptable conclusions. The internal structure o f things
may not concur with the appearance. Many times professional knowledge is counter­
common sense. If test takers consider the test to have face validity, they may offer a
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more conscientious effort to complete the test. If a test does not have face validity
they might hurry through a test and take it less seriously.

1.5.2 Reliability

Ghiselli,Campbell and Zedeek (1981) considered reliability, the fundamental issue in

psychological measurement. Reliability means “repeatability” or “consistency” .
Usually it refers to the consistency o f scores obtained by the same persons when they
are re-examined with the same test on different occasions, or with different sets o f
equivalent items, or under other variable examining conditions(Anastasi,
1997).Reliability is the extent to which measurements derived from an instrument are
consistent (Aiken, 1994). In order to the consistency ,stability and repeatability o f
assessment results (Nunnally and Haas,1970).A measure is considered reliable if it
would gives the same result over and over again (assuming that what researchers are
^ measuring isn’t changing).There are four types o f reliability ,l.Test-retest,2.Parallel
forms o f reliablity,3.Internal consistency reliability,4.Inter-rater reliability.

1.5.2.1 Test-retest reliability

Test-retest reliability is when the same test is administered to the same individual (or
sample) on two different occasions separated by a spccificd time interval. Scorcs on
the first occasion are then correlated with scorcs on the sccond. If there were no errors
in the measurement subject would maintain exactly the same distance from each other
which would result in a correlation o f exactly 1.0 .The reliability o f psychological
measures in practice never reaches 1 .0 ,because o f fluctuations in many variables such
as a subject's mood or level o f fatigue. Test-retest reliability is the variation in
y measurements taken by a single person or instrument on the same item and under the
same conditions. Its test-retest reliability (sometimes called the stability coefficient) is
assessed by the correlation between the scorcs from the different time points.
Nunnally (1978) and Kline (1993) recommended that a scale needs to have a minimal

test-retest reliability o f 0.70. According to the Guidelines fo r Evaluating and

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* Expressing the Uncertainly o f N IST Measurement Results, the following conditions

need to be fulfilled in the establishment o f test-retest reliability:

• the same measurement procedure,

• the same observer,
• the same measuring instrument, used under the same conditions,
• the same location,
• Repetition over a short period o f time.

The time interval between the two administrations may range from few days to few
months. (Schutte and Malouff,1995).

I.5.2.2. Parallel from reliability

In parallel forms reliability first administer have to create two parallel forms. One way
to accomplish this is to create a large set o f questions that address the same construct
and then randomly divide the questions into two sets. Then researcher administers
both instruments to the same sample o f people. The correlation between the two
parallel forms is the estimate o f reliability. One major problem with this approach is
that researcher has to be able to generate lots o f items that reflect the same construct.
This is often no easy feat. Furthermore, this approach makes the assumption that the
randomly divided halves are parallel or equivalent. Even by chance this will
sometimes not be the case. The parallel forms approach is very similar to the split-half
reliability.

1.5.2.3 Internal consistency reliability

^ In internal consistency reliability estimation researchers use their single measurement

instrument administered to a group o f people on one occasion to estimate reliability.
In effect they judge the reliability o f the instrument by estimating how well the items
that reflect the same construct yield similar results. Researchers are looking at how
consistent the results are for different items for the same construct within the measure.
There are a wide variety o f internal consistency measures that can be used, such as-

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average inter-item correlation, average item total correlation, split half reliability and
Cronbach's Alpha (a).

Average Inter-item Correlation

The average inter-item correlation uses all o f the items on instrument that are
designed to measure the same construct. In this, each o f every item was correlated
with other ite m s.. Researchers first compute the correlation between each pair o f
items. For example, if they have sixteen items they will have 15 different item
pairings (i.e., 15 correlations). The average inter item correlation is simply the
average or mean o f all these correlations. Expected correlation o f this average inter
item correlation is ranging from 0.84 to 0.95.

Average Item total Correlation

^ This approach also uses the inter-item correlations. In this correlation every items was
correlated with item total o f scale. For example, if researchers compute a total score
for the sixteen items and use that as a eighteen variable as item total in the analysis.
The sixteen item were correlated with-total correlations at the bottom o f the
correlation matrix. They range from 0.82 to 0.88.

Split-Half Reliability

In split-half reliability researchers randomly divide all items that purport to measure
the same construct into two sets and checking the consistency o f the scores obtained
from the two halves. There are several acceptable ways o f splitting a scale into two
equivalent halves such as i) using the odd numbered items for one half o f the scale
X and the even-numbered items for the other half o f the scale, ii) randomly assessing an
equal number o f items to the two halves o f the scale and iii) dividing the scale by
content in such a way that each half contains an equal number of items equivalent in
content and difficulty. Whatever the method used for splitting the scale into two haves
the scale needs to have a minimal level o f test-retest reliability. Researchers
administer the entire instrument to a sample o f people and calculate the total score for

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each randomly divided half. The split-half reliability estimate is simply the correlation
between these two total scores.

Cronbach's Alpha (a)

Researchers compute one split-half reliability and then randomly divide the items into
another set o f split halves and recomputed, and keep doing this until they have
computed all possible split half estimates o f reliability. Cronbach's Alpha is also a
widely used measure o f the homogeneity o f the scale items (Cronbach,1951). As a
correlation, alpha value can range from 0 to l.(w hen items are not positively
correlated with each other then the correlation have negative value).DeVellis (1991)
suggested that an alpha below 0.60 as unacceptable;©.60-0.65 is undesirable; 0.65­
0.70 minimally acceptable; 0.70-0.80 respectable;0.80-0.90 very good and much
above 0.90 is excellent and the test developer may consider shortening the scale.
When developing a scale to contrast groups on some property, an alpha o f 0.85 is
recommended.

1.5.2.4 Inter rater reliability

Inter-rater reliability is the most easily understood form o f reliability, because

everybody has encountered it. In statistics, inter-rater reliability, inter-rater agreement,
or concordance is ' the degree o f agreement among raters. It gives a score o f how
much homogeneity, or consensus, there is in the ratings given by judges. It is useful in
refining the tools given to human judges, for example by determining if a particular
scale is appropriate for measuring a particular variable. There are two major ways to
actually estimate inter-rater reliability. If any measurement consists o f categories - the
raters are checking off which category each observation falls in, it can be calculated
by the percent o f agreement between the raters. The other major way to estimate inter­
rater reliability is appropriate when the measure is a continuous one. There, all
researchers need to do is calculate the correlation between the ratings o f the two
observers. The correlation between these ratings would give the researcher an
estimate of the reliability or consistency between the raters.

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1.5.3 Norms

Psychometric can't meet it purpose when it has no standardized norm. After ensuring
reliability and validity scale developer develop a norm for the usability o f the scale.
Norms is the appropriate interpretation of the psychometric scale scores o f an
individual's. Norms should be standardized on the norm group comparing with other
group o f population. So that it can be representative for the norm group. There are
two types o f demanding norms, screening norms and severity norms.

1.5.3.1 Screening norms

The screening norm is the ability to ensuring that the scale can screen out what it
wants to screening from whole. In clinical practice, screening norms o f a
psychometric scale is the ability to screen the clinical group or maladaptive construct
from normal group or adaptive construct. Through screening norm the scale searches
out a cut-off point. Cut o f point divided two groups. The group who are in below cut­
off point is the one group or the people with a construct, and the group who are in
above o f cut o f point in the another group or the people with the opposite construct.
Screening norms have two properties, i) sensitivity & ii) specificity.

Sensitivity is the ability to identify the clinical group as clinical. In the case o f
sensitivity, it (also called recall rate in some fields) measures the proportion o f actual
positives which are correctly identified. Researchers try to avoid type II error or false
negative. The sensitivity o f the test is defined as the ability o f the test to identify
correctly those have the construct that the scale want to assess. Sensitivity o f 100%
means that the test recognizes all actual positives, all clinical people are recognized as
being psychological problems.

Specificity is the capacity to identify the nonclinical group as nonclinical. Specificity

measures the proportion of negatives which are correctly identified. For ensuring
specificity researcher avoid type I error, means to negative findings not to be positive
or false positive. And the specificity is defined as the ability o f the test to identify
those who do not have the construct that the scale proposed to assess. If a test has high

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specificity, a positive result from the test means a high probability o f the presence of
disease.

1.5.3.2: Severity norms

Severity norm o f a psychometric scale is used for indicating the severe level o f the
problem that the individual is suffering from or the construct which is proposed to
measure through the scale. Severity norms can mostly be measured through two
methods, i) standard deviation method and ii) percentile method. In standard deviation
the severity norm of construct is based on the standard deviations o f the sample scale
scores. And in percentile norm the severity norms based on the percentage o f the
people whose scores falls below particular raw scores. This types o f method of
severity norms divided the sample in to three or four equal sizes o f group which helps
to indicate the severity o f the construct o f the individual that the scale is developed to
assess.

1.6 Objectives o f the current Study

The aim o f the current study was to develop a scale for assessing cognitive distortions
for Bangladeshi culture. The sequential approach was followed for developing the
scale. First o f all construction the items for the scale, through a systematic prccise
items construction, item selection and factor analysis, item analysis. Then reliability,
validity of the present scale was ensured. Finally, for the use o f the current scale in
clinical and research field, screening and severity norms were developed. In concise,
the objectives o f the current study could be described as follows-

General objective

Developing a scale for assessing cognitive distortion.

Specific objectives:

1. Establishing validity of the proposed scale.

2. Establishing reliability o f the proposed scale.
3. Developing norms for the proposed scale.
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1.7 Rationale o f the current study

The prime focus o f Cognitive Behavior Therapy is to change a person’s maladaptive

behavior and negative emotion through changing cognitive distortion. However to
identify cognitive distortion psychometric scales are an essential tools. But it's
surprising that there is very few psychometric scale in this area. There is no
standardized scale in Bangladesh for assessing cognitive distortions. The translated
version o f the DAS is used in clinical practice and research for assessing
dysfunctional attitude. But this scale is only translated, so there is a chance for having
the error o f cultural sensitivity. Beside this, DAS has no standardized norms, so the
capacity o f DAS for assessing dysfunctional thinking in clinical practice and research
is limited.

Cultural diversity has an important influence on the expression o f cognitive distortion,

as well as psychopathology. All mental disorders are shaped to some extent by
cultural factors (Draguns, 1994).The DSM-IV incorporates more cultural
considerations than previous editions by listing information regarding cultural
variation o f specific disorders and 25 culture-bound syndromes. Cultural relativism is
the unique aspects o f a particular culture need to be considered when understanding
and identifying behavior.(Castillo, 1997).So definition o f problem varies among
culture to culture. Culture may also play a part in how distress is expressed. Cross-
cultural observations suggest that somatic symptoms are more commonly expressed
by non Western (Marsella, Sartorius, Jablensky, & Fenton, 1985) and specifically
Chinese groups (Parker, Gladstone and Chee, 2001), whereas feelings o f guilt, self-
deprecation, suicidal ideation, and depressed mood are frequently less common
compared with Western groups (Marsella et al, 1985). Culture may play a role in
differences in frequency o f disorders in different groups (Tanaka-Matsumi, 2001). For
this reason, it can be said that if we use an assessment tool from western country, we
may lose important information for this cultural variation. Not only this but also these
scale is not representative of our culture and have a chance to conclude a faulty
conclusion in clinical practice and research which is badly influenced in the

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effectiveness o f CBT as well as ,also very alarming in developing knowledge in our

culture .

So for overcoming those problems the researcher worked on to develop this scale for
assessing cognitive distortions to be used in Bangladesh. The scale will be only
standardized cognitive distortion scale in our culture, it will serve both the practicing
and trainee clinical psychologist and other mental health professions for assessing the
severity level o f cognitive distortions o f clients. Assessing severity level o f cognitive
distortions can help mental health professionals to implement effective treatment for
modifying distorted thought, emotions and behaviors. It will also help them to
monitor the changes after an intervention and thus it serve as a valid indicator for the
effectiveness o f treatment. It can also be used as a research tool for those researchers
of our culture who want to elaborate the existing knowledge on cognitive distortions.

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Chapter 2
Methodology
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Methodology
Scale development is a multi stage process o f quantifying phenomena through multi­
stages judge evaluation and establishing psychometric properties. (DeVellis and
Robert,2003). Sequential system approach o f scale development was followed on
developing the current scale.

The current scale was developed in three stages, hi the first stage, items o f the scale
were constructed, in 2nd stage, items were selected and finally in the 3rd stage,
psychometric properties were ensured. The multi stage procedure implicated in the
scale development is presented in figure 1.1

Figure 2.1: Stages of the development of the scale for assessing cognitive
distortions.
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Stage 1: First D raft

2.1 Item construction

The purpose o f a scale has been clearly articulated, the developer is ready to begin
constructing the items intensively. The first step is to generate a large pool o f items
that are candidates for eventual inclusion in the scale. For constructing item pool, it
was very necessary to understand the phenomena o f cognitive distortion very clearly.
Initial item pool for assessing cognitive distortion were collected from different case
reports o f anxiety and depression (anxiety and depression is the core problems o f all
neurotic problems) and from text and research articles related with cognitive
distortion and psychopathology. The items o f the initial pool were collected also from
expert opinions from Clinical Psychologists.

After careful revision, 193 items were selected for the initial pool o f this current scale.

Before finalizing the items construction, researcher conducted a field testing on 8

clinical respondents with anxiety and depression. Then the researcher administered
the initial pool on them. It was very essential to know how the participants o f our
culture conceptualize and respond to the items o f the scalc, based on cognitive

distortions. All of the participants conceptualize the initial items and responses
appropriately. But as it was an initial pool o f the scale, the items were large in
number, for this reason, the participants became impatient to conclude the total. Then
this data o f the field testing was analyzed. Item analysis was also used to predict the
item consistency o f the current scale. The findings were satisfactory.

After the field testing, in 1st judges’ evaluation, 12 Clinical Psychologists and 4
psychiatrists were requested to give their opinion about each item (Appropriate or
Not appropriate) and also requested to suggest any items which was suitable as an
item o f cognitive distortion, in the context o f our culture . Then after careful revision,
117 items were retained and were clustered in 9 sub scalcs.

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Table 2.1; Number of items o f each subscale o f the currents scale

Sub scale Number Sub scale Number

of Items of Items
1.All or nothing and 19 6 .Emotional 8
disqualifying the reasoning
positives
2 .0 vergenaralization 11 7.Magnification 10
/Catastrophizing
and Minimization
3.Labeling and 14 8 .Should 15
mislabeling statement

4.Mental filtering 10 9.Personalization

5.Jumping to 21
conclusion

In 2nd judges’ evaluation, 117 items were presented in a group judge evaluation. In
this evaluation, six Clinical Psychologists (who were practicing CBT in their clinical
practice and research for mental health profession for a long times) participated in a
group. They revised these 117 items intensively and came in a point o f consensus
about the appropriateness o f each item. Judges were requested to critically analyze the
items and to finalize by assigning the tick (V ) mark whether each item for specific
category was appropriate or not appropriate. If they wanted to change the language o f
any items or if any o f the items was more appropriate in another pattern o f cognitive
distortion, or if any item was replicated then they requested to write on “Com m enf’
option. If they wanted to include any new item then they were requested to write that
on ‘The suggestion section'. Finally they had given their expert opinion for adding,
restructuring and reducing items from the item pool o f 117 items. After this group
judge evaluation, 25 items were reduced and 92 items were retained in 8 subscale o f
the current scale.

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2.2 Item selection for first draft

The item pool o f 92 items was individually presented to nine CBT experts. In this 3rd,
judge evaluation judges were asked for giving their judgm ent on 4 point Likert scale.
For each item, there were four response options namely "Not at all appropriate",
"Appropriate to some extent","Approprite","Most appropriate". They couldn't include
any new item in this step of judge evaluation. But if they wanted to change the
language o f any items then they could write it on.

Finally only those items were selected for first draft which met the criteria o f 90%
agreement o f the judges, about the appropriateness o f the each items. This 90% judge
agreement was ensured when the average o f each item was 3.6 and above.

Table 2.2: Average o f judge evaluation on the basis o f the appropriateness o f each
item o f the current scale

Item Average Item Average Item Average Item Average Item Average

A1 B20 C39 E58 G77

3.777778 3.666667 3.555556 3.666667 3.888889
A2 B21 D40 E59 G78
3.888889 3.666667 3.666667 3.666667 3.888889
A3 B22 D4I E60 3.777778 G79
3.666667 3.222222 3.888889 3.444444
A4 B23 D42 F61 G80
3.666667 3.666667 3.888889 3.666667 3.888889
AS B24 D43 F62 G81
3.666667 3.666667 3.777778 3.444444 3.666667
A6 825 D44 F63 G82
3.444444 3.333333 3.777778 3.777778 3.555556
A7 B26 D45 F64 G83
3.777778 3.111111 3.888889 3.777778 3.111111
A8 B27 D46 F65 G84
3.888889 3.444444 3.777778 3.666667 3.777778
A9 B28 D47 F66 G85
4 3.888889 4 3.666667 3.555556

AlO B29 D48 F67 H86

3.555556 3.666667 3.666667 3.666667 3.666667

A ll B30 D49 F68 H87

3.777778 3.777778 3.666667 3.777778 3.666667
A12 C31 D50 F69 H88
3.555556 3.888889 3.555556 3.444444 3.888889

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Item Average Item Average Item Average Item Average Item Average

A13 C32 D51 F70 H89

3.777778 3.666667 3.888889 3.666667 3.555556
B14 C33 D52 F71 H90
3.777778 3.666667 3.666667 3.222222 3.888889
BIS C34 D53 F72 1191
3.666667 3.888889 3.777778 3.555556 3.888889
B16 C35 E54 3.666667 F73 H92
3.666667 3.333333 3.777778 3.888889
B17 C36 E55 G74
3.222222 3.666667 3.555556 3.666667
B18 C37 E56 G75
3.444444 3.777778 3.777778 3.777778
B19 C38 E57 G76
3.777778 3.666667 3.666667 3.888889

69items(Al ,A2,A3,A4,A5,A7,A8,A9,A1 1,A1 3,B 14,B 15,B 1 6 ,819,320,821 ,B23,B24,

B28,B29,B30,C31,C32,C33,C34,C37,C38,D40,D41,D42,D43,D44,D45,D46,D47,D4
8,D49,D51,D52,D5,E54,E56,E57,E58,E59,E60,F61,F63,F64,F65,F66,F67,F68,F70,F
73,G74,G75,G76,G77,G78, G80,G81,G84,H86,H87,H88,H90,H91,FI92) of this
current scale met the criteria o f 90% agreement o f the judges. In this way, 69 items
were finalized for the next step.

2.3 A p p rop riate form at o f the current scale

There are various type o f response format available for scaling such as checklists,
forced-choice and visual analog measures. But for different problems and limitation
these are not widely used now a days (Bentler,1969; Green, Goldman and Salovey,
1993). Format o f scale can be two types, scales with
1) two choices, known as binary or dichotomous and
2) three or more choices, known as multiple responses.
There may be logical reasons for using a certain number o f responses; some questions
clearly demand a yes/no answer and but some questions can't satisfy with an answer
o f yes/no. However, the selection of the format o f the scale depends on the pmpose o f
the scale. There were two main purposes o f the current scale; the first was screening
and the second was measuring severity o f cognitive distortion. For the screening.

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diehotomous response format (yes/no) is sufficient, because response pattern o f

yes/no can be the good indication o f the absence or presence o f the construct, for
which the scale is being developed. But when the purpose was also for measuring
severity, then this diehotomous format was not sufficient, because in diehotomous
format it was not possible to differentiate the severity level o f cognitive distortion of
individual to individual. Suppose, one person have minimum level o f cognitive
distortion, then he/she will response yes on any item o f the current scale, and the
another person who have maximum level, then he/she will also response yes on that
item, so the diehotomous format can't serve the purpose for measuring severity o f this
current scale. For assessing severity, multi-choice response system is a good option.
There is a wide variety o f scale with multiple response, such as: Guttman scales,
Thurstone scales, Likert scales e.t.c (Nunnally & Bernstein, 1994). But among all
these types o f scales scale, Likert format is widely used in psychometric scale,
because o f its strength, such as; simple to construct, likely to produce a highly reliable
scale and easy to read and complete for participants.

Five point Likert format is developed by Likert in 1932. These scales always ask
people to indicate how much they agree or disagree, approve or disapprove, believe to
be-true or false. In this five point Likert format individuals respond to the each items
o f a scale on any o f five response options which are usually arranged in sequentially
increasing degree in two opposite direction. The common response options for this
format are, 'strongly agree','agree','unccrtain','disagrce' and 'strongly disagree'.
Comrey (1988) have suggested for multi-choice response fomiat instead of
diehotomous format because the prior is more reliable and provides more stable
results. The five point Likert format was also used by previous researchers who
develop the three scales for our culture.(Deeba and Begum,2004;Uddin and
Rahaman,2005;Kamruzzaman and Begum,2006). Beside this, responding o f the
participants o f field testing with similar response pattern was very satisfactory. So, the
five point Likert format was selected for final scale. The response options were
"Never comes to my mind", "hardly its comes to my mind", "comes to my mind
occasionally", "comes to my mind frequently", "always comes to my mind".

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2.4 First draft o f the scale

After judge evaluation, the first draft o f Cognitive distortion scale was constructed
with a total o f 69 items in 8 subscales. These arc mentioned below:

• All or nothing subscale 10 items (items no 1,2,3,4,5,7,8,9,11,13),

• Overgeneralization subscale 11 items (14,15,16,19,20,21,23,24,28,30),
• Mental filtering subscalc 7 items (items no 31,32,33,34,36,37,38),
• Jumping to the conclusion subscalc 13 items (item no
40,41,42,43,44,45,46,47,48,49,51,52,53),

• Emotional reasoning subscale 6 items (item no 55,57,58,59,60,61),

• Magnification/catastrofizing-minimization subscale 8 items (item

63,64,65,66,67,68,70,73),
• Should statement 8 items (item no 74,75,76,77,78,80,81,84) and
• Personalization subscale 6 items (item no 86, 87,88,90,91,92) were retained.

Five point Likert-options was followed in this first draft, the options were:"Never
comes to my mind", "hardly comes to my mind", "comes to my mind occasionally",
"comes to my mind frequently ","always comes to my mind".

Then the draft was administered with an instruction and dcmographical variable sheet
on the respondents. In the instruction, respondents were asked to give tick (V) mark on
any one options o f the five, in which the respondent agree, most o f the time.

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2.5 Respondent

2.5.1 C lin ical respon dent

Clients with anxiety and depression were selected as the respondent in this current
study, because anxiety and depression are the most common among other mental
disorders and can cover the cognitive distortion o f other mental disorders. Practicing
Psychiatrists diagnosed the clients with anxiety disorders and depressive disorders
using DSM-IV (APA, 1994). The inclusion criteria o f clinical respondents were:

1. Respondents who were assessed as the client suffering from anxiety and
depression.
2. All respondents were adult (18 years and above).

And the exclusion criteria o f tlie respondents were:

1. Clients with substance abuse disorder, personality disorder and psychotic

problems were excluded and even anxiety and depression induced by these
disorders were also excluded.

2.5.2 Non-clinical respondent

Non clinical respondents were selected from general population o f our culture.
Purposive sampling method was used for the selection o f non clinical respondents and
they were also matched with the clinical respondents. Inclusion criteria o f the non
clinical respondents were:

1. Respondents who never received any types o f psychiatric care.

2. Respondents with an age o f 18 years and above.

Exclusion criteria o f the respondent was-

1. If the GHQ 28 score o f any individual was above the cutoff point (39) then
he/she was excluded as non clinical respondent.

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2.6 Instrum ents

Different instruments were used in different stages o f developing the current scale
which are described below:

Assessment tools: The clinical respondents were assessed tlirough DSM IV. The
criteria o f DSM IV (Diagnostic and Statistical Manual for Mental Disorder, 4th
edition), for depression and anxiety based disorders was the main assessment tool for
assessing the clinical respondents.

Dcmographical information: A questionnaire with demographical information was

included with the draft o f the current scale. Information such as gender, age, home
district, birth district, marital status, occupation, educational qualification, marital
status, religious, duration of the problems, psychiatric history etc was incorporated
and used to match the non clinical with clinical participants. These demographical
data was also used to assess the heterogeneity o f the respondent.

First draft o f the Cognitive Distortion Scalc: The first draft o f the scale was used
for item selection for final scale. A total o f 69 items o f cognitive distortion was
incorporated in this draft.

Final draft of the Cognitive distortion scalc: The final draft o f the current scale
consisted 39 items. Five point Likert format was followed for rating and the total
score o f this scale is obtained by summing up the score (0, 1, 2, 3, 4) o f each items.
For establishing the psychometric properties the draft was used as an experimental try
out. This draft was used to determine reliability, validity and to develop the norm of
the scale.

DAS (Dysfunctional Attitude Scale, form-A, Weissman and Beck in 1978):

Dysfunctional Attitude Scale, form-A was used to assess the severity o f cognitive
distortion among the respondents. DAS was developed by Weissman and Beck in
1978. It is a seven point rating (1 to 7) scale consists o f forty items which reflect
different patterns o f cognitive distortions. Reliability o f the DAS is reported to have
very good internal consistency, with alphas ranging from 0.84 to 0.92. The DAS also

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has excellent stability, with test-retest correlations over 8 weeks o f 0.80 to 0.84. And
DAS has excellent concurrent validity, significantly correlating with several other
measures o f depression, including the Beck Depression Inventory (BDI). The scale
was translated into Bengali by Hossain and Begum (2008) for use on Bangladeshi
populations. Both English and Bengla scalcs were scoring differently and the mean
score o f DAS-English was found=127.88 (sd-26.37) and Bangle was==l 19.30
(sd=31.24).The Spearman’s rho correlation coefficient is calculated as 0.812 which
was significant at 0.01 level of significance in two tailed test. Dysfunctional Attitude
Scale was also found highly correlated with irrational Beliefs scale. Cognitive En'or
Questionnaire and such type o f scale which validly measure cognitive distortion
(Wertheim and Poulakis, 1992, 2005). Sub-scale and different items o f DAS was
found as correlated with both anxiety and depression symptoms (Dyck, 1992).
Therefore, in the present research Dysfunctional Attitude Scale was used as construct
measure o f cognitive distortions and ensuring the construct validity o f the current
scale.

Anxiety Scale (Deeba & Begum,2004) : A 36-item anxiety scale was used to
measure the presence of anxiety symptoms o f the respondents for establishing the
predictive validity o f the current scale. This scale was developed by Deeba and
Begum (2004) for assessing anxiety symptoms o f Bangladeshi population. Split-half
reliability o f the scale was 0.916 (a =0.001) and the Cronbach's alpha reliability was
0.9468.The test-retest correlation (r =0.688) was also found to be significant (a
=0.01).Three external criterion were found to be positively correlated with this scale
score (Psychiatrist's rating =0.317;patient's self rating =0.591;HADS,r=0.628;a
< 0 .0 1 ).Construct validity was assessed by discriminability o f the scale among clinical
and non clinical (F=60.275 at a=0.01) and item total correlation (which ranged from
r=0.399 t o r =0.748,a<0.01).

D epression Scale (Uddin & Rahman,2005): A 30-item depression scale was used to
measure the presence o f depressive symptoms o f the sample for establishing the
predictive validity of the current scale. Uddin and Rahman (2005) developed this
scale to assess the symptoms o f depression for Bangladeshi population. The split-half
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reliability was 0.7608 and test-retest reliability was 0.599 (significant at a<0.01).The
scale was positively correlated with the psychiatrist's rating of
depression(r=0.558,significant at a<0.01).The scale discriminated between depressed
and non-depressed samples (F=85.86,significant at a<0.01) which were conducted on
a group o f 104 samples.(52 depressed and 52 non depressed samples).A percentile
norm assessing severity of depression was developed based on responses o f 124
depressed samples. A screening norm for depression identification was developed
based on response o f the total 248 samples (124 depressed and 124 non depressed
samples).

The G eneral H ealth Q uestionnaire 28 (GHQ-28, Goldberg & Williams, 1988);

GHQ-28 developed by Goldberg (1988) and translated into Bengali by Banoo (2001)
which was used as an instrument for the current study. It assesses the psychological
disturbances in terms o f both a full-scale score and scores on four subscales, reflecting
somatic symptoms, anxiety and insomnia, social dysfunction and severe depression.
The highest possible score o f GHQ is 84 whereas score below 39 are considered as
not having significant level o f psychiatric disturbance. The score o f 39 and above is
considered as having significant level o f psychiatric disturbance. Score o f 0 to 6

considered as having low stressed, 7 to 13 as moderate stress, and 14 to 21 as severe

stress. Each item consists of a question asking whether the respondent has recently
experienced a particular symptom or item o f behavior on a scale ranging from “less
than usual”, to “much more than usual” on a scale ranging from “0” to “3” . This
measure has been reported to have good psychometric properties.

In this study, GHQ 28 was used for screening individuals as non clinical respondents.

Subjective ra tin g of Clinical Psychologist ab o u t the respondents: Subjective rating

o f clinical psychologists was used as an instrument for ensuring the concurrent
validity o f the current scale. In this subjective rating, clinical psychologists were
requested to give the information about the respondents in 4 indicators (Assessment,
session number, impairment level o f daily life, level o f cognitive distortion).

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Data analysis: Statistical Package for Social Sciences (SPSS 16 version) was used
for analyzing data in different steps o f developing the current scale.

2.7 Procedure for collecting data

f
2.7.1 P roced u re for collecting data for item analysis

During data collection a written inform consent form was given to all respondents
where purpose o f the study, confidentiality, freedom o f choice and all other ethical
issues were described. After kjnowing everything about the study respondents had
given their consent and agreed to participate and then researcher administered the
scale along with relevant demographical information. Researcher and 4 research
assistants were engaged in this data collection. Most o f the research assistants
completed their graduate and post graduate from Psychology and Clinical
Psychology. They were trained in interviewing techniques, about the concept o f
"V Cognitive distortion and the issues o f inform consent .And they were also trained on
minimizing the experimenter bias. It must be mentioned that for collecting data from
non clinical respondents, GHQ 28 was additionally administered to non clinical
population for selecting non-clinical respondents. Non-clinical respondent was
matched with clinical respondent in respect o f gender, age, religion, marital status,
occupation and living distinct.

2.7.2 P roced u re for collecting data for estab lish in g psychom etric
properties

Procedure o f the collecting data from clinical and non-clinical respondents for
establishing psychometric properties o f the current scale is almost same as the
procedure for collecting data for item analysis. Researcher provided intensive training
and supervision (as given in collecting data for item analysis) to two research
assistants for collecting data from the clinical respondents and in this phase o f data
collection they were additionally trained about the psychometric scales which were
used in this study. After collecting data from clinical respondents, 7 research
assistants helped the researcher for collecting data from non-clinical respondents. In

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this step, non-clinical respondents were matched with clinical in respect o f age level,
educational level, marital status, family pattern and religion.

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Chapter 3
Analysis and Result

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Analysis and Result

Stage 2 •
3.1 Item analysis

Item analysis is a statistical analysis in which items are narrowed down to select more
appropriate items for measuring the construct. The term ‘internal consistency’ has
been used extensively in classical psychometrics to refer to the reliability o f a scale
based on the degree o f within scale item inter correlation, as measured by Cronbach's
alpha.(Cronbach, 1951).

3.1.1 Respondents for Item analysis

One hundred and twenty eight respondents (64 clinical and 64 non-clinical) were
the participated in this phase o f item analysis. Non-clinical respondents were selected
after the clinical respondents and they were matched with respect to gender, age,
occupation, marital status, and religion and living district with clinical respondents.
The details o f the demographic variables o f participants are presented in Table-3.1

Table 3.1 : Demographical variable o f clinical and non-clinical respondents

for item analysis
V a r ia b le s F r c q u c n c y (% )

C lin ic a l N o n - c lin ic a l
r e s p o n d e n ts r e s p o n d e n ts
M ale 34 (53.1) 35(54.7)
u
o
"O F em a le 30 (46.9) 29 (45.3)
c

18 to 30 47 (73.4) 49(76.6)

31 to 4 0 12(18.8) 7(10.9)

41 to 50 5(7.8) 8(12.5)
St)
< 51 to 6 0 - -

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 Development o f a Scale for Assessing Cognitive Distortions
Dhaka University Institutional Repository

V a r ia b le s F r c q u c n c y (% )

C lin ic a l N o n - c lin ic a l r e s p o n d e n ts
r e s p o n d e n ts
U n e m p lo y e d 1(1.6) -

B u sin essm a n 5(7.8) 5(1.6)

S e r v ic e h old er 12(18.8) 12(18.8)

c
o
a H o u se w ife 13(20.3) 13(20.3)
Q.

S tu d en t 33(51.6) 34(53.1)
o
D hak a 44(68.8) 46 (71.9)
Si) o
.5 ’C
O ut o f D hak a 20(31.2) 18(28.1)

U nm arried 37(53.8) 3 8(59.4)

c/) M arried 25(39.1) 2 5 (3 9 .1 )

S

t/) S ep aration or d iv o rc e 1(1.6) -

*2
'C W id o w or w id o w e r 1(1.6) 1(1.6)
a
s
Islam 61(95.3) 6 0(93.8)

B H indu 3(4.7) 4(6.2)

O
;Sd
C hristian - -

3.1.2 Result of Item analysis

In item analysis, internal consistency o f the items of the current scale is ensured
through inter item, item total and discriminate value.

3.1.2.1 Item total correlation

The item total correlation is the correlation between the each item and the overall
score. The item total correlation is a measure o f the reliability o f a multi-item scale
and a tool for improving psychometric properties o f the scales. In general, item total
correlation is computed between the item score and the total score o f the scale,
including the score of the specific item which item total is being measured. But this
makes a bias in which that particular item influences the total score to some extent. To
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unravel this type o f bias, in this study, corrected item total correlation was computed
for each item. In corrected item total correlation, the item score was deleted from the
total score before correlating with total score. The present scale consists with 69
items; which means that there would be 69-item total correlations. For item 1,
correlation was between item 1 and the sum o f the other 68 items. A small item-
correlation provides empirical evidence that the item is not measuring the same
construct measured by the other items. A correlation value less than 0.2 or 0.3
indicates that the corresponding item does not correlate very well with the overall
scale and, thus, it may be dropped. In this current scale, correlation value o f all 69
item was above 0.55.So its mean all 69 items were correlated very well with the total
score.

3.1.2.2 Inter item correlation

y Inter item correlation indicates the correlation among the items with each other. A
high positive inter item correlation indicates the coherence o f the items o f a scale in
measuring a construct. Ideally each item should be correlated highly with the other
items measuring the same construct. Items that do not correlate with the other items
measuring the same construct can be dropped without reducing the scale's reliability.
Inter item correlations was of current scale was found 0.988 through using item
analysis. The average inter-item correlation is simply the mean o f all these
correlations.

3.1.2.3 Discriminate value

Discriminate value o f a psychometric scale refers to the capacity o f each item for
discriminating two groups based on a variable. Discriminate value was chosen as a
method o f items selection in this current scale, because through discriminate value the
items were selected which had discriminate capacity o f cognitive distortions between
clients o f anxiety-depression and individual who had no psychiatric problem. For
assessing discriminate value of each item, the first draft o f the scale was administered
to two group o f respondents comprising a total o f 168 respondents (64 clients with
anxiety and depression and 64 individual who had no psychiatric problems).One way
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analysis o f variance (ANOVA) was used to computed discriminate value (F value) at

99% confidence interval on the two groups. All 69 items had significant discriminate
value according to the finding o f this analysis, so there was not a single item that
could be discarded. The results are presented in the Table (3.2)

Table 3.2 : Results o f item analysis

Items Discrimination Items Discrimination

Corrected item Corrected item
value value
total correlation total correlation
A1 .755 **♦ 113.979 ♦** D36 .834 *** 167.831 ***

A2 618 53.531 *** D37 .715 *** 83.631 ***

A3 .798 106.424 *** D38 .781 *** 117.364 ***

A4 .766 ♦** 101.954 D39 .808 *** 93.817 ***

A5 .558 32.142 *** D40 696 46.306 ***

A6 .675 *** 51.535 *** D41 .626 *** 54.305 ***

A7 .779 ♦♦♦ 117.879 *** E42 .723 *** 9 8.740 ***

A8 816 *♦* 168.048 *** E43 .740 *** 99.492 ***

A9 .713 *** 88.767 *** E44 .730 *** 106.761***

AlO .738 *♦* 130.662 *** E45 .748 *** 8 7 .6 1 6 * * *

B 11 792 105.000 *♦* F46 .817 *** 115.566 ***

B12 .757 *♦* 73.153 *** F47 .799 *** 142.408***

B13 .742 *** 100.940 *** F48 .805 *** 119.403 ***

B14 760 *** 81.936 *** F49 .790 *** 68.500 ***

B15 .769 115.122*** F50 .783 *** 71.952 ***

B16 .769 96.252 *** F51 .834 *** 117.460 ***

B17 .781 127.678 *** F52 .779 *** 92.317 ***

B18 .798 *** 150.929 *** F53 .781 *** 119.531 ***

B19 .805 **♦ 137.555 *** F54 .794 *** 81.013 ***

B20 .823 **♦ 112.913 *** F55 .798 *** 159.029 ***

B21 .805 ♦** 171.444*** G56 .683 *** 68.166 ***

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Items Discrimination Items Corrected item Discrimination

Corrected item
value total value
total correlation
correlation
C22 .648 63.542 *** G57 .679 67.822

C23 .739 109.262 *** G58 .626 56.910 ***

C24 .714 64.499 ♦** G59 .574 52.825

C25 .772 105.722 *** G60 .688 ***

C26 .736 73.520 *** G61 .654 74.753 ***

C27 .634^ 72.835 *** G62 .650 60.763 ***

C28 .861 244.775 G63 .735 125.288

D29 .705 67.345 *** H64 .742 84.228

D 30 .742 100.413 *** H65 .737 78.586 ***

D31 .776 113.830 *** H66 .721 136.597 ***

D32 .790 123.790 *** H67 .699 *** 93.349 ***

D33 .713 49.392 H68 .747 97.252

D34 .767 95.932 *** H69 .621 46.200

D35 .866 218.928 ***

*** a <0.01

3.2 Factor analysis for increasing clinical utility

Factor analysis is a statistical method used to describe variability among observed and
correlated variables in terms o f a potentially lower number o f unobserved variables
called factors. In this factor analysis, when the variations in three or four observed
variables mainly reflect the variations in fewer unobserved variables, then more valid
variables is retained and represent to others less valid variables. Every step o f current
scale development was aimed to develop a scale, which is psychometrieally sound
and clinically useful for assessing cognitive distortions. But although high internal
consistency and significant discriminate value o f a scale with 69 items, clinically
utility might be less than a scale with a small number o f items for assessing cognitive
distortions in people. The Clinical Psychologists might be found this current scale, too
long for clinical utility. Even if excellent psychometric qualities have been
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established, a scale is o f no use if it is not easy to use in clinical practice. This implies
that a scale has to be brief, easy to administer and not too time-consuming. Factor
loading o f factor analysis is used for selecting more valid items and increasing clinical
utility o f any psychometric scale (Zwakhalen, Jan & Berger, 2007).For this reason,
factor analysis was used to reduce items for increasing the clinical utility o f the scale
In the factor analysis Principal Component Analysis with varimax rotation was used.
According to author o f Guidelines for Reporting Scale Development and Validation
(Cabrera,E 2010), when the sample size is less than 200, then the factor loading
should be above 0.6. But 0.7 standard is a high one and real-life data may well not
meet this criterion, so why some researchers, particularly in research on social
sciences, use a 0.25 to 0.6 factor loading. In this current study the number o f the
respondent for factor analysis was 128, so that 0.55 factor loading was used for
selecting more sensitive and specific items. And in this way, out o f 69 items 39 items
were retained with 8 factors. Factors were not used in this study, as subscales because
of the disequilibrium o f the number o f items o f each factor and also the purpose o f the
factor analysis o f the study was only for item reduction. So, 39 items in total were
selected for final scale. After factor analysis, internal consistency o f the scale o f 39
items is higher and discriminate value is more significant than the scale o f 69 items.

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Table 3.3: Result o f factor analysis (items o f having factor loading 0.55 and above)
Items Factor Items Factor Items Factor Items Factor Items Factor
loading loading loading loading loading

A1 B15 D29 E43 G57

.625 .607 .631

A2 B16 D30 E44 G58

.650 .581 .668
A3 .696 317 D31 E45 G59
.564 .699
A4 .568 B18 D32 E46 G60
.709 .729
AS 819 D34 E47 G61
.559 .744

A6 B20 D35 F48 G62

.631 .610 .681
A7 B21 D36 F49 G63
.679 .633
A8 C22 D36 F50 H64
.726 .579

A9 C23 D37 F51 H65

.762 .608 .698
AlO .663 C24 D38 F52 H66
.603 .620 .598

B ll C25 D39 F53 H67

.749 .576 .563

B12 .671 C26 D40 F54 H68

.567 .577
B13 .601 C27 .762 D41 F55 H69
.567 .644
B14 C28 E42 G56
.562 .553

Thus the final scale contained 39

item s(l,3,4,10,12,13,16,20,23,24,25,28,29,30,31,32,34,36,37,39,41,47,50,51,53,56,57
,58,59,60,61,62,63,65,66,67,68 and 69) o f the first draft o f the current scale.

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Stage 3

3.3 Psychom etric propcrties/Experimcntal Tryout

In this experimental try out, there was no chance to change any type o f change in
items o f the scale. Only psychometric properties o f the current scale was established
which ensured the strength and usability o f the scale. Without these psychometric
properties a psychometric scale is good for nothing. The considerations o f validity
and reliability typically are viewed as essential elements for determining the quality of
any test. A measure may be reliable without being valid. However, reliability is
necessary, but not sufficient than validity. For establishing the psychometric
properties o f this current scale 478 respondents (239 clinical and 239 non clinical)
were participated in this study. In this stage the new scale was verified with different
types o f standard measurements and justified its reliability with different procedure.
Finally norms o f the current scale were established, for assessing cognitive distortion
of Bangladeshi population.

3.3.1 V alid ity

“Validity” refers to the degree to which the conclusions (interpretations) derived from
the results of any assessment are well-grounded or justifiable, being at once relevant
and meaningful. The current scale was verified with different types o f standard
measurements. Content, criterion related and construct validity o f this current scale
were ensured in this study.

3.3.1.1 Content validity

Content validity is usually established by content experts. Newcomer, Barenbaum &

Bryant(1994) argued that content validity o f a test is to be built during construction,
which indicates that a scale's content validity can be ensured through systematic item
construction, selection and analysis. In content validity evidence is obtained by
looking for agreement in judgments by expert's panel. Content validity is not a
statistical concept but a question o f expert judgment. (Aiken, 1985). In this study,
items o f the current scale were constructed through 3 steps rigorous judge evaluation.
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And finally after 3rd judge evaluation, those items were selected in which, 90%
judges canie in to agreement based on the appropriateness for assessing cognitive
distortions. If more than half the panelists indicate that an item is essential, that item
has at least some contcnt validity (Lawshe,1975). Greater levels o f content validity
exist in larger numbers o f panelist's agreement. So, for the purpose o f the selection of
the items, 90% judge agreement about the appropriateness provides a strong evidence
for the content validity o f the current scale.

3.3.1.2 Criterion related validity

Criterion draws an inference from test scores to performance. A high score o f a valid
test indicates that the test has met the performance criteria. In this current study, two
types o f criterion related validity-concurrent and predictive validity was assessed.

Concurrent validity

The term "concurrent validity" is reserved for demonstrations relating a measure to

other concrete criteria assessed simultaneously. Concurrent validity is demonstrated
where a test correlates well with a measure o f the same construct that has previously
validated . In the present study the new scale was administered on 26 clients with
anxiety and depression. Concurrently CBT experts evaluated the severity level of
cognitive distortion o f those clients on 5 point subjective rating (0 to 4). Then the
correlation between the scores o f new scale and the subjective rating score was
calculated, using Pearson product-moment coefficient. Correlation was significant
correlation (r=0.828 at a<0.01), which ensured the concurrent validity o f the current
scale. So it was strong evidence that there is high concurrent validity between the
expert rating and scale rating o f same criterion, cognitive distortion.

Predictive validity

Predictive validity refers to the degree to which any measure can predict future or
independent events. These variables are often represented as “intermediate” and
“ultimate” criteria. Cognitive distortion in one o f the independent variable for
psychopathology. So, the current scale and anxiety scale (Deeba & Begum,2004)
were administered among 47 clients o f anxiety based disorder and the correlation was

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found significant (r=0.756 at a<0.01). For the same, current scale and depression
scale (Uddin & Rahman,2005) were administered on 46 clients o f depression and the
correlation between those scale was significant (r=0.841,a<0.01). This means that
when the score o f cognitive distortion o f a person is high, then it can be predicted, that
person can be suffered from anxiety and depression.

3.3.1.3 Construct validity

Construct validity refers to a judgment about the appropriateness o f inferences drawn

from test scores regarding individual standings on a variable called a construct. For
the present scale construct validity was assessed by convergent and divergent
validation.

Convergent validity

If a test is valid construct, then it should expect that the test's scores will correlate
strongly with the scores on other standardized tests o f which measures the same types
o f construct, but not same construct. Dysfunctional attitude is similar type o f construct
o f cognitive distortion. So, for ensuring this validity o f the current scale, 120 clients
of anxiety and depression was participated. The new scale and DAS Dysfunctional
Attitude Scale, form-A, Weissman and Beck (1978) were administered on them. The
correlation between the score o f two scales was calculated using Pearson-moment
product coefficient. Significant (r=0.670, a<0.01) correlation was found which
provides the evidence o f convergent validity.

Discriminate validity/Divergent validity

It is the opposite o f convergent validity. If different constructs are not considered to

be related then it should expect to find no correlation between test scores measuring
these different constructs. There is no standardized psychometric scale in Bangladesh
which can assess the opposite construct o f cognitive distortion. For this reason, in this
study, cognition o f the non clinical population was selected as the opposite construct
to the cognition o f clinical population. For assessing discriminate value/divergent
validity o f the current scale, the ability to discriminate clinical (239 clinical
respondents) and non clinical (239 non clinical respondents) o f the current scale was
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o f a Scale for Assessing Cognitive Distortions

assessed. This calculation was done by using ANOVA (F value) and the discriminate
value was, F=649,564 which was significant at a<0.01. Mean and standard deviation
o f the clinical and non clinical resondents is presented in figure (3.1). As the current
scale confirmed both convergent and discriminant validity it indicats that the scale has
construct validity.

M ean & SD of the current scale

I C lm iid l r fip o n d o iU I N o il clinic<il re s p o n d e n t

88.1046

28.36574
20.34937

M oon CDS SD CD S

Figure(3.1) The mean and standard deviations o f the clinical and non clinical
respondents.

3.3.2 Reliability of the Scale

Reliability o f the current scale was assessed through internal consistency and test
retest method.The procedure and resuU o f these relaibility presented in details in
following:

33.2.1 Internal consistency reliability

Split half and Combach alpha is the widly used procedure for measuring internal
consistency reliability.In this current scale,split half reliability couldn't aseessed
because the items o f the scale is odd in number. So only Cronbach alpha was used for
measuring internal consistency.The calculation was done on the data collected on 478
respondents.For the analysis SPSS 16 was used.

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Cronbach Alpha: Cronbach alpha assumes all items are equivalent and measure
a single construct. It's the most extensively used procedure. For the current scale
Cronbach Alpha was found 0.962, which indicates excellent level o f internal
consistency (DeVellis,1991) and its means that all items o f cognitive distortion o f the
scale are equivalent and measure cognitive distortion excellently.

3.3.2.2 Test-rctest reliability

When the same test is administered to the same individual (or respondents) on two
different interval o f time and gives similar respond. Test-retest reliability is desirable
in measures o f constructs that are not expected to change over time. For establishing
the reliability o f the current scale in assessing cognitive distortion over time, test-
retest reliability was used. A total o f 62 non clinical individuals participated as
respondents. The scale was administered on the participants two times with an
interval o f two to three weeks and the correlation (r=0.890, a<0.01) was significant. A
scale needs to have a minimal test-retest reliability o f 0.70 (Nunnally,1978 and
Kline, 1993).

3.3.3 Norms o f the Scalc

For the usability o f a psychometric scale is nothing without standardized norm. In this
current scale screening and severity nonns were established. The norms were
developed on a total o f 478 respondents, among them 239 clinical (119 clients of
anxiety, 119 clients o f depression and a clients with co morbid o f anxiety and
depression) and 239 non clinical individual (who have never received psychiatric
treatment and score o f GHQ-28 was below cutoff point). Detail o f demographic
variables o f total respondents o f this study is presented in Table (3.4)

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Table 3.4; The demographic variables o f the clinical and non clinical sample for
norms developing.

V a r ia b le s F r e q u e n c y (% )

C lin ic a l N o n - c lin ic a l r e s p o n d e n ts
r e s p o n d e n ts
M a le 1 5 6 ( 6 5 .3 ) 101 ( 4 2 .3 )
T3 F e m a le 83 (3 4 .7 ) 138 ( 5 7 .7 )
C
o
18 to 30 163 (6 8 .2 ) 149 ( 6 2 .3 )
31 to 4 0 3 9 ( 1 6 .3 ) 4 3 ( 1 8 .0 )
>
41 to 50 3 1 (1 3 .0 ) 2 9 ( 1 2 .1 )
eX) 51 to 6 0 5 ( 2 .1 ) 1 0 ( 7 .5 )
< 61 to 70 1 (0 .4 ) -
U n e m p lo y e d 2 1 (8 .8 ) 1 3 (5 .4 )
S3
o B u sin e ssm a n 2 5 ( 1 9 .5 ) 1 4 ( 5 .9 )
S e r v ic e h old er 3 7 ( 1 5 .5 ) 7 4 ( 3 1 .0 )
s H o u se w ife 5 6 ( 2 3 .4 ) 2 6 ( 1 0 .9 )
u
CJ
O S tu d en t 100 (4 1 .8 ) 1 1 2 ( 4 6 .9 )

Illiterate 1 5 (6 .3 ) 8 (3 .3 )
c
o C la ss 1 to c la s s 5 2 3 (9 .6 ) 5 ( 2 .1 )
u C la ss 6 to S .S .C 4 5 ( 1 8 .8 ) 1 2 ( 5 .0 )
3 H .S .C to graduate 1 1 8 ( 4 9 .4 )
-o 133 ( 5 5 .6 )
P o st graduate and a b o v e 3 8 ( 1 5 .9 ) 8 1 (3 3 .9 )
U nm arried 131 (5 4 .8 ) 124 ( 5 1 .9 )
C9
M arried 100 (4 1 .8 ) 1 1 0 ( 4 6 .0 )

II
S c«
S ep aration or d iv o rce
W id o w or w id o w e r
6 ( 2 .5 )
2 (0 .8 )
-
5 (2 .1 )
C Islam 2 2 3 (9 3 .3 ) 2 2 3 ( 9 3 .3 )
.2 H indu 1 4 ( 5 .9 ) 1 5 (6 .3 )

C hristian 2 (0 .8 ) 1 (0 .4 )
Pi
H a v e no in co m e 145 (6 0 .7 ) 127 ( 5 3 .1 )
(U
g 5 0 0 -5 0 0 0 4 4 ( 1 8 .4 ) 4 0 ( 1 6 .7 )
O 5 0 0 1 -1 5 0 0 0 3 0 ( 1 2 .6 ) 4 5 (1 8 .8 )
c 1 5 0 0 1 -2 5 0 0 0 11 (4 .6 ) 1 5 (6 .3 )
2 5 0 0 1 -1 0 0 0 0 0 7 ( 2 .9 ) 1 0 ( 4 .2 )
A b o v e 100001 2 (0 .8 ) 2 (0 .8 )
5 0 0 -5 0 0 0 2 0 (8 .4 ) 1 1 (4 .6 )
5 0 0 1 -1 5 0 0 0 7 9 (3 3 .1 ) 6 7 (2 8 .0 )
= E
E o 1 5 0 0 1 -2 5 0 0 0 6 2 (2 5 .9 ) 7 1 (2 9 .7 )
ta .S 2 5 0 0 1 -1 0 0 0 0 0 5 5 (2 3 .0 ) 6 0 ( 2 5 .1 )
A b o v e than 100001 2 3 (9 .6 ) 3 0 ( 1 2 .6 )
o< S in g le 1 7 0 (7 1 .1 ) 1 8 0 (7 5 .7 )
~>> (U
•- b
C o m b in ed 6 9 (2 8 .9 ) 5 8 (2 4 .3 )
S C
rt «
b Q.

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 Developm ent o f a Scale for A ssessin g C o gnitive Distortions
Dhaka University Institutional Repository

A s e t o f p resen ta tio n o f d e m o g r a p h ic d istrib u tio n o f re sp o n d en ts is attached w ith

A p p e n d ix ( 1 4 )

3.3.3.1 Screening norm

W h en a resu lt o f a s p e c ific p sy c h o m e tr ic sc a le is c o n sid e r e d in tw o ty p e o f p o p u la tio n

(w ith a p ro b lem and w ith o u t that p ro b lem ), then there is a p e r le c t sep aration b etw e en

t w o gro u p s. T h e te st o u tc o m e can b e p o s itiv e (p r e d ic tin g that the p erson h as th e

p ro b le m ) or n e g a tiv e (p r ed ictin g that th e p erso n d o e s n ot h a v e the p ro b lem ).W h en a

p articu lar cu t o f f p o in t d iffer en tia te tw o g r o u p s o f p o p u la tio n , s o m e c a s e s w ith h a v in g

p ro b lem w ill b e a b s o lu te ly c la s s ifie d p o s itiv e , its k n o w n as true p o s itiv e but so m e

c a s e s w ith h a v in g p ro b lem w ill be c la s s ifie d n e g a tiv e , w h ic h k n o w n a s fa lse n e g a tiv e .

O n th e o th er hand , s o m e c a s e s w ith o u t h a v in g an y p ro b lem w ill be c la s s ifie d p o sitiv e ,

its k n o w n a s fa ls e p o s itiv e and s o m e c a s e s w ith o u t h a v in g p ro b lem w ill c la s s ifie d a s

n e g a tiv e , w h ic h k n o w n as true n e g a tiv e . T h u s fou r c o m b in a tio n s o f o u tc o m e m a y

o c c u r w ith e v e r y c u t o f f p o in t o f a p sy c h o m c tr ic s c a le .

T a b le (3 .5 ) P o s s ib le outcome o f a p sy c h o m e tr ic s c a le w ith s p e c ific cu t o ff point

H a v in g p ro b lem

P resen t A b sen ce

R esu lt o f a S cre en ed P o sitiv e T rue P o sitiv e F a lse P o sitiv e

p sy c h o m e tr ic sc a le S c r e e n e d N e g a tiv e F a lse N e g a tiv e T rue N e g a tiv e

S o w h e n a s c r e e n in g norm o f s c a le is d e v e lo p e d th en re sea rch cr w a n t to d eter m in e

su ch a s p e c ific cu t o f f p o in t w h ic h h a v e m in im a l fa ls e p o sitiv e , fa lse n e g a tiv e and

h a v in g m a x im u m true p o sitiv e , true n e g a tiv e . T h is ca n be d o n e by c a lc u la tin g

s e n s itiv ity and s p e c ific it y o f a sc a le .

S e n s itiv ity r e la tes to th e test's a b ility to id en tify th e in d iv id u a ls w h o h a v e p o sitiv e

re su lts for h a v in g p ro b lem s. S e n s itiv ity can b e c a lc u la te d through d iv id e d o f th e

n u m b er o f t h e s e true p o s itiv e by th e su m m a tio n o f n u m b er o f true p o sitiv e and

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number o f false positive This can also be written as: Sensitivity =Number o f true
positive / Number o f true positive +number offalse negative.

If a test has high sensitivity then a negative result would suggest the absence o f
V-
disease. For example, a sensitivity o f 100% means that the test recognizes all actual
positives, all problematic individual are recognized as being problem.

Specificity relates to the ability o f the test to identify the individuals who have
negative results for not having problem. This can also be written as, specificity =
Number o f true negatives /Number o f true negative + Number offalse positives.

If a test has high specificity, a positive result fi-om the test means a high probability o f
the presence o f problems.

In summary, the rates o f correct identification o f individuals with and without the
disease are known as sensitivity and specificity, respectiveIy.(Bland and
Altman, 1994).For a standardized scale its very essential for having a specific cut off
point which have high sensitivity and high specificity.

Figure 3.2: Normal curve o f the scale scores o f clinical and non clinical respondents
used in the current study.

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o f a Scale for Assessing Cognitive Distortions

For the current scale the sensitivity and specificity for was calculated for different
possible cut o ff score, as given below on table (3.6)

Table (3.6) Sensitivity and specificity o f the current scale at different possible cut off
scores

C utoff Sensitivity Specificity Cut off Sensitivity Specificity

point (%) (%) point (%) (%)
50 91 83 57 85 90
51 90 83 58 84 90
52 89 85 59 82 90
53 88 85 59 82 90
54 87 86 60 81 91
55 87 87 61 79 93
56 87 88

From the table (3.6) it is found that the optimal cut o ff score for the current scale was
56, which achieved 87% sensitivity and 88% specificity for screening cognitive
distortions. This means, the current scale can assess 87% clinical level o f cognitive
distortions as clinical level. All cut o ff score are presented on Appendix 16.

3 3 3 .2 Diagnostic Performance o f tlie scale

The diagnostic performance is the ability o f a scale or test to discriminate clinical

population from normal individual. It is usually evaluated using 'Receiver Operating
Characteristic' (ROC) curve analysis. (Metz, 1978). A good test will resuh in a ROC
that rises to the upper left hand comer very quickly.

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ROC Curve

ROC curve analysis:

Area under ROC curve
was 0.949 which was
significant at a < 0.01,
indicate excellent
performance.

1 - SpacMlclty

Diagonal s«gm«nts ara produced by ti«s.

Figure:(3.3):ROC curve o f the current scale

The diagnostic performance o f a scale can be judged by the position o f the receiver
operating characteristic line. A scale with poor performance have line close to the
rising diagonal ,where a line o f a scale with perfect performance is rising steeply and
pass close to the top left hand comer, where both sensitivity and specificity are 1. The
area under the curve is a measure o f the quality o f the test diagnostic. The larger the
area, the better the diagnostic test: area is 1.0 represent 100% sensitivity and 100%
specificity which known as excellent performance o f a scale. Usually for a scale an
area o f 0.90 to 1 is indicates as excellent,0.80 to 0.90 is as good,0.70 to 0.80 is as fair
,0.60 to 0.70 is as poor and 0.50 to 0.60 is as a fail performance o f a scale. For the
current scale area o f the ROC curve o f the scale was 0.949 (significant at a<0.01)
which represent a scale o f cognitive distortion with excellent performance.

3 3 3 3 Seveity norms

For developing severity norm o f the cognitive distortion scale percentile norm is
used. This is the most common way o f presenting normative data. 478 ( 239 clinical
and 239 non clinical) respondents were used for establishing this norm.Raw score o f
the respondents were converted in three percentile point ( 25'*' ,50* ,75***) which

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divided the scores in four percentile (0 to 25"^ ,26 to 50*'’ ,51 to 75*'’ and 76 to
100‘'’).These percentile levels were represented the level of severity
namely,mild,moderate,severe and profound. Finally the norm o f the scale for assesing
cognitive distortion is mild,moderate,severe and profound when range o f the raw
score is 56 to 72, 73 to 91, 92 to 109 and 110 to above respectcdly.(Table:3.7).

Table(3.7)Percentile range and raw score range for corresponding level o f severity

Level of Severity Percentile Correspond score on

Cognitive distortion scale

Mild 0-25 56 to 72

Moderate 26-50 73 to 91

Severe 50-75 92 to 109

Profound 76-100 110 to above

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Chapter 4
Discussion
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Discussion

The current study was designed for developing a new scale which assesses cognitive
distortion o f the clients having neurotic disorder for Bangladeshi culture. Sequential
system approach for scale development was followed in the construction o f the
current scale. There were three stages for the construction o f the current scale. In the
first stage, items o f the scale were constructed through systematic evaluation o f
cognitive distortion from case reports, texts, research on cognitive distortion and
initial items were selected through systematic three stage judge evaluation. The items
were selected for final scale through item analysis and factor analysis in 2nd stage.
Finally in 3rd stage psychometric properties, such as different types o f validity and
reliability were ensured and norms were established. Objective and procedure o f these
three stages is described below:

First stage:

Item construction is the foundation of the scale development. All the properties and
usability o f scale depend on the nature and construction o f items. At first, for
constructing appropriate items o f the current scale, literatures review, case studies etc
were done to conceptualize the construct. Moreover, expert opinions were also taken
from clinical psychologists and psychiatrists. Thus, initial items pool o f 193 items was
constructed.

During 1st and 2nd judges’ evaluation, the content and the cultural expression o f
cognitive distortion were checked and ensured. In the first judge evaluation sixteen
mental health professional (twelve Clinical Psychologists and four Psychiatrists) and
in 2nd judge evaluation six Clinical Psychologists participated as expert for
evaluating the items intensively. Then in 3rd judge evaluation ,to eradicate the bias of
researcher and to decrease the subjectivity in the selection o f the items, draft o f 92
was presented to nine Clinical Psychologists and they evaluated each items. This draft
consists with four point Likert format, according to the degree o f appropriateness such
as "Not totally appropriate". Not appropriate", "Appropriate" and "Most appropriate".

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Finally those 69 items were selected as first draft which got 90% judge agreement
(Table 2.2).

Second stage:

The second stage comprised o f item analysis and factor analysis. In item analysis the
first draft o f the scale was administered on 128 respondents, among them 62 were
diagnosed with anxiety & depressive disorder and 62 were non clinical individual
(Table 3.1).Item analysis was done on the basis o f three criteria namely, discriminate
value(ANOVA F), inter item and item total correlation . After item analysis all 69
items were selected for final scale, because all 69 items had high discriminate value
and also had significant correlation in item total and inter item at a<0.01. But, when
it’s the measurement o f cognitive distortion then individual take longer time for
responding each item o f the scale. So it would also very tough for the respondents to
ventilate themselves as well as responding a scale o f 69 items on cognitive distortions
in a session. Beside this, CBT session consist specific time frame and structure. For
this reason, 69 items o f this current scale might be too long for clinical practice in
CBT. Even if excellent psychometric qualities have been established; a scale is o f no
use if it is not easy to use in clinical practice. This implies that a scale has to be brief,
easy to administer and not too time-consuming.(Zwakhalen, Hamers &
Berger,2007).Many studies have suggested that the scale with short number o f items
performs as well as or even better than the scale with large items.(Zigmond and
smaith, 1983).For increasing clinical utility it was necessary to reduce items. For this
item reduction factor analysis was done and only those items were selected in which
factor loading was 0.55 and above 0.55.This way 39 items were selected for the final
scale for assessing cognitive distortions.

Third stage:

Psychometric properties such as validity, reliability were ensured and standardized

norms were developed.

For ensuring psychometric properties content, criterion related and construct validity
were assessed.
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Content validity o f the scale was ensured during the different steps o f development of
the scale. Items construction, item selection, item analysis and factor analysis, all
these every steps was done rigorously. In three stages o f judge evaluation expert and
experienced Clinical Psychologists were engaged for evaluating the items
construction and item selection. Finally after 3rd judge evaluation only those items
were selected which got 90 % judge agreement. This systematic judge evaluation
confirmed the content validity o f the current scale.

In this current scale, criterion related validity was confirmed through assessing
concurrent and predictive validity. For ensuring concurrent validity 26 clients with
anxiety and depression were participated. The new scale was administered on those
clients and concurrently CBT experts express their subjective evaluation on (0 to 4)
rating scale about the severity level o f the clients. Then the correlation between the
new scale and the score o f subjective rating was correlated and the correlation was
significant, (r=0.828, a<0.01) which was an indication o f ensuring concurrent validity
o f the current scale. It is often said that the correlation between two measurements
should be high but not too high, because a too high correlation poses questions about
the necessity o f the new measurement. (Anatasi,1988). For establishing predictive
validity o f the scale o f cognitive distortion was correlated with psychopathology such
as anxiety and depression. That’s why, in this study, the current scale and anxiety
scale (Deeba & Begum,2004) were administered among 47 client with anxiety based
disorder. The correlation between the score o f current scale o f cognitive distortion and
anxiety was 0.756 which indicate the significant correlation between anxiety and
cognitive distortion. In the same way, current scale and depression scale (Uddin &
Rahman,2005) were also administered on 46 clients with depression and the
correlation between the score o f these scales was 0.841 which indicate significant
correlation between depression and cognitive distortion. So, it can be predict that if an
individual get high score on the scale o f cognitive distortion, then this individual
might be suffered from some forms o f psychopathology.

Verification o f the construct validity of the current scale was accumulated from
convergent and divergent validity (Anatasi,1988). Convergent validity confirmed with

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the significant correlation between the test and a standard measurement on the same
types o f construct. So, for assessing convergent validity, the current scale and DAS
(Dysfunctional Attitude Scale, form-A, Weissman and Beck, 1978) were administered
on 120 clients with anxiety and depressive disorder and the correlation o f these scales
was 0.670 which was significant at a<0.01. Divergent validity o f the current scale was
calculated on the score o f 239 clinical and 239 non clinical respondents and a
significant difference (F=649.564 at a<0.01) was found which indicating that the
current scale can discriminate cognitive distortions between clinical and non clinical
populations. This findings confirmed divergent validity o f the current scale.

Reliability o f the present scale was calculated through internal consistency reliability
and test-retest reliability. For internal consistency, the scale was assessed by using
Cronbach Alpha. This was assessed on the 239 clinical and 239 non clinical
respondents and Cronbach Alpha for the total scale was 0.962 which indicating the
excellent internal consistency. DeVellis (1991) suggested that an alpha below 0.60 as
unacceptable; 0.60-0.65 is undesirable; 0.65-0.70 minimally acceptable; 0.70-0.80
respectable; 0.80-0.90 very good and much above 0.90 is excellent.

The current scale was administered twice on 62 non clinical individuals for assessing
test-retest reliability o f the scale. The interval o f the administration was two to three
weeks and the correlation coefficient between the score o f two administration was
found significant (r=0.890, at a<0.01).

For developing standard norm for the currcnt scale, screening and severity norm were
established. Norm o f the scale was developed based on the score o f 478 respondents
(239 clinical and 239 non clinical).Screening norm consists o f sensitivity and
specificity analysis. The cut off points for the current scale is 56 because this cut off
point confirmed 87% sensitivity and 88% specificity which was more optimal than
others provable cutoff point. Sensitivity o f the scale is 87%, its mean that this scale
will assess correctly 87% the cases as case and only 13% o f the cases will missed.
And the specificity o f the scale is 88%,its mean that 88% non cases will assessed as
non case but 12% non cases might be assessed wrongly as case. 100% sensitivity and
100% specificity is impossible in behavioral science even its also rare in pure science.
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A list o f different level o f sensitivity and specificity is presented in response to

different cut o ff point in Appendix 16. The diagnostic performance o f the current
scale was assessed through ROC curve (Figure 3.3).The area o f the ROC curve o f the
scale was 0.949 which was significant at a< 0.01, indicating excellent performance.

Percentile norm is mostly used for assessing the severity. In this scale o f cognitive
distortion, percentile norm was used. Using percentile norm, it was very easy to
computation and understanding for an individual, even who have no technical
knowledge or training. Severity o f the scale was categorized on four levels namely,
mild, moderate, severe and profound and corresponding scores o f these different
severity level are 56 to 72,73 to 91,92 to 109 and above 110 respectively.

The new scale will be used as an assessment tool for the Clinical Psychologists in
Bangladesh. The current scale is a moderate length scale containing 39 items o f
cognitive distortions. This moderate length scale would be an effective assessment
tool with clinical interview for screening cognitive distortion appropriately. It is a self
administered assessment tool, but when an individual can't read and write, and then
any other can administered the scale on that individual. For the administration
individual does not need any expertise, but must have a clear knowledge about the
instruction o f the scale. For self administration o f this current scale only 10 to 15
minutes is required.

There are very few assessment tools for CBT practice in our Bangladesh. The clinical
psychologists have already developed three scales for assessing depression (Uddin
and Mahamud,2005), anxiety (Deeba & Begum,2004) and OCD (Mozumder and
Begum,2005) and also a self report problem behavior checklist for adolescents
(Anjuman and Begum,2002) for our culture. DAS was developed by W eissman and
Beck (Weissman and Beck, 1978) in 1978 for the clients o f depression, but now
worldwide this scale is used in research and clinical practices to assess the
dysfunctional assumption o f all other neurotic patients. In the same way although the
current scale was developed on the clients with having anxiety and depression, this
scale might be applicable for assessing cognitive distortion o f all other neurotic
disorder. From many years the Clinical Psychologist and the trainee Clinical
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Psychologist o f our country felt necessary for having a psychometric scale which can
assess the cognitive distortion appropriately in short time. The current scale will fulfill
the demand because it was developed on the basis o f Bangladeshi population and it
also ensured all psychometric properties as well as it has standardized norms. So the
current scale will be another complete assessment tool for assessing cognitive
distortion in our cultural context.

I m p lic a tio n

Implication o f this current scale is given below;

It will help the professionals to assess the components o f cognitive domains

more intensively and more objectively within a short time

The current scale will be an important assessment tool to determine the

severity level o f cognitive distortions.

It will help to monitor the effectiveness o f the treatment in changing

maladaptive thoughts.

• It will help the future researcher for conducting quantitative research on

cognitive distortion.

• It will help to validate other new scale related to cognitive distortions.

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Recom m endation

Every scale needs to be more effective through review and enrich by follow up
studies. Here are some recommendations for the enhancement of the current scale:

• The current scale may be enriched through focusing on the assessment o f the
different patterns o f cognitive distortions.

• Reviewing the predictive validity is recommended.

• The current scale should be reviewed after few years.

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Chapter 5
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 Development o f a Scale for Assessing Cognitive Distortions
Dhaka University Institutional Repository

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Dissertation Abstracts (3-b), 1389-1390. '

Weissman, A. N., & Beck, A. T. (1978). Development and validation o f the

Dysfunctional Attitude Scale. Paper presented at the annual meeting o f the
American Educational Research Association, Toronto, Canada.

Wertheim, E.H .& Poulakis, Z. (1992). The relationships among the general attitude
and belief scale, other dysfunctional cognition measures, and depressive or
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4,10,219-233.

Wertheim, E.H.& Poulakis, Z. (2005). The relationships among the general attitude
and belief scale, other dysfunctional cognition measures, and depressive or
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February 02.

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 Development
Dhaka o f a Scale
University Institutional for
Repository Assessing Cognitive Distortions

Winter,G.(2000) .A comparative discussion o f the notion o f validity in qualitative and

quantitative research. The qualitative Report,4(3/4).Retrieved February
03,2003,from http://www.nova.edu/ssss/QR/QR4-3/winter.html

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(2002). Inventory o f Cognitive Distortions: Validation o f a Psychometric Test fo r

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Test fo r the Measurement o f Cognitive Distortions. Unpublished doctoral
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Pi/j/a/^67,361-370.

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76
 Dhaka University Institutional Repository

Appendixes
 Development o f a Scale for Assessing Cognitive Distortions
Dhaka University Institutional Repository

Appendix 1

Instruction and Items presented for Judge Evaluation

Dear Sir/Madam,

I am conducting my M.Phil research under the supervision o f Professor Dr.Roquia

Begum, Department o f Clinical Psychology. 1 would like to develop a scale for
assessing cognitive distortion as my M.Phil research.

In this research, cognitive distortion is operationalzed according to Beck,1979;Beck et

al,1979;Bums, 1980.According to them, cognitive distortions are those cognition
which

• Are logical but irrational

• present an unrealistic view of reality
• are maladaptive, because they cause negative mood, impair behavioral
functioning, impede productive thinking about the situation and reinforce
underlying irrational beliefs
• also maintain negative thinking and help to maintain negative emotions

In the present research, cognitive distortion for anxiety and depression will be
assessed by following 10 types o f cognitive distortion as classified by Burns &
Beck (1980)

• All or nothing/Black & white thinking

• Disqualifying the positive
• Overgeneralization
• Labeling mislabeling
• Mental filtering
• Jumping to conclusion(Mind reading & Fortune teller error)
• Magnification/Catastrophizing and Minimization
• Emotional reasoning
• Should statement
• Personalization
It may be mentioned that these 10 types of cognitive distortions are
sometimes very overlapping. So, in this proposed scalc, the items of
overlapping pattern of this classification arc merged.

77
 Development o f a Scale for Assessing Cognitive Distortions
Dhaka University Institutional Repository

Note: These patterns o f cognitive distortion arc operationally defined above the
items o f each type.

For the purpose o f developing the proposed scale, I have complied a list o f items
gathered from case re4ports o f anxiety & depression, written by the trainee clinical
psychologists o f Dhaka University and also from different books and journals of
clinical psychology and psychiatry and from CBT expert which is attached with this
letter. For each item, there are four options, “Most appropriate”, “Appropriate”,”
Appropriate to some extent” and “Not at all appropriate” Please go through the list
and give your valued judgm ent by choosing one o f the four options for each item.

Thank you for your co-operation.

Umniey Saima Siddika

MPhil-II

Dept.of Clinical Psychology

University o f Dhaka

78
 Development o f a Scale for Assessing Cognitive Distortions
Dhaka University Institutional Repository

All o r N othing/B lack & W hite thinking: This refers to the tendency to evaluate
personal qualities in extreme, black or white categories. All or nothing thinking forms
the basis for pcrfectionism

D isqualifying the positives: This refers to reject the positive experiences by insisting
for some reason or other which is contradictory with everyday experiences such as
“What I achieved just for my luck” . In this cognitive distortion, the patient’s act on
finding evidence to support some pet hypothesis. The hypothesis that dominates the
patient’s depressive thinking. Both All or nothing and disqualifying positive are
related with evaluating personal qualities. So these two types o f cognitive distortions
are merged .

Please put a tick (V) mark on any of the four responses according to your judgment
about appropriateness o f each item as “ All o r no nothing” cognitive distortion

No Items N ot at all Appropriate Appropriate M ost C om m ent

appropriate to some appropriate
extent

1 < p |R R

3 ^ ? |5 - ^ (5(rtv|

5 «i1 'ai

CSftC^ 1

8 <Ft^ ^ii t(m\

79
 Development o f a Scale for Assessing Cognitive Distortions
Dhaka University Institutional Repository

No Items N ot at all Appropriate A ppropriate M ost C om m ent

appropriate to some appropriate
extent

10 CTO? <P?1(.'6
■
’Hi?

11

12 'SHNt CfTflT
cm^ti ^

13

Ovcrgeneralization: This refers to take the isolated cases and using them to make
wide generalization in faulty way. Building up one thing about oneself or one’s
circumstances and ending up thinking that it represents the whole situation. For
example “Failure in an event means that I never success anywhere “or “I am always
be a failure person”

Labeling and mislabeling: This is the extreme form o f overgeneralization. Instead of

describing error; the patients attach a negative label to themselves, When the
performance of job down instead o f up, one might label oneself as “I am a failure”
instead o f “I made a mistake. When someone else’s behavior misguides others into a
wrong way, they attach a negative label to him,” He is an evil”. As labeling is the
ultimate result o f overgeneralization,so,they merged in same category.

80
 Development o f a Scale for Assessing Cognitive Distortions
Dhaka University Institutional Repository

Please put a tick (V) mark on any o f the four responses according to your judgment
about appropriateness o f each item as “ O vcrgeneralization” cognitive distortion
No Items Not at all A ppropriate A ppropriate M ost C om m ent
appropriate to some appropriate
extent

1
^
1

2 ^WJ<1 ^ ^511 HI

3
'STTsms ’ tni.’S T ^ 'Sllfvi filW ftw
^rc<n ^mi’i >jrwi

4
'niviH ^ ^

5 CTR <jsf
4'^i5R ^srcirt’ti

6 ■<Pt(;^ 3iR;i7n->i^wh^v6i
-f{\ 'Stt'Tlfte
■sp^ef i£i^ '5;c?I ■*JK

7
f t w ■?Tt

8 WtCTS W5JHI 2)1^ 'Sft^ <P51(.« ^

‘'TRIW 'i||iJl?l

9 ^l(vi 'sitsrt? M(5^rc?Rl

^ 4"at\s ^|iJl<l ■^R<5|w <i (SRI
^rtf^ Ibis'S

10 <^«1W ->i*5l<i Hi ■^'a’Tt ‘jIc.'i;?,

XSJift

11 c‘^c<p|'i ‘Pic.'iit ^IWH)

fftW 'IIW

12 ^l«rpTt ^ 'J>(Nlc<P ^5tW?t "TfD^

<i)<5^l<t wf la

81
 Development o f a Scale for Assessing Cognitive Distortions
Dhaka University Institutional Repository

No Items N ot at all A ppropriate A ppropriate M ost Com m ent

appropriate to some appropriate
extent

13
^rsrrw

14

15 c^TCg;'stmi?
I

16 C<M'( CSR^

5.'e'?n'5isi^'srtfii ■JN ^sri 'smsSre

17 'snfit
I

Mental filtering: This refers to pick out a negative detail in any situation and dwell
on it exclusively, thus perception that the whole situation is negative. As for example
“The world is full o f cruel people’Mt may also be true that there are many cruel
people in the world, but the cognitive distortion filter out the good, ideal people in this
world.Please put a tick (V ) mark on any o f the four responses according to your
judgm ent about appropriateness o f each item as “Mental filtering” .

No Items Not at all Appropria A ppropriate M ost Com m ent

appropriate te appropriate
to som e
extent
1 ■
’rt?n®t 's r a i

2 <jf«l5l(.'s (.51 '^i»ii(,<p

4 'infii fSiT ■'Si-rcttn

5 fiiw ftw 's.ra

6 ^ C«fW 'Sflft 1

7 ^sft^ ^naj^ >lttil^

9 ’ic r t ’>TRrt'^ wRi’tt 1

82
 Development o f a Scale for Assessing Cognitive Distortions
Dhaka University Institutional Repository

Ju m pin g to conclusion: This refers to mak'e negative interpretation even though

there are no definite facts convincingly support the conclusion. This cognitive
distortion consists o f going beyond the evidence the patients actually have and
reaching a conclusion that makes things look worse than they are. There are two
subtypes o f this cognitive distortion as below-

M in d reading: Assuming the intentions o f others and believing that the

patients know what others are thinking without checking it out, as for example
“Others thinking that I can’t do anything perfectly “This is referred to as mind reading

The fo rtu n e teller error: Anticipate that things will turn out badly, and feel convinced
that one’s prediction is an already established fact, even though I unrealistic. For
example-a depressed patient may say “I realize I’ll be depressed forever. My misery
will go on and on.”

Please put a tick (V) mark on any o f the four responses according to your judgment
about appropriateness o f each item as “Ju m p in g to conclusion” cognitive distortion

No Items Not at all Appropriate A ppropriate M ost Com m ent

appropriate to some appropriate
extent

1 CT, ^
'STW 'l l R ' T t i

2 c<l<M 'tsiW 1

3 'Si H h I

4 <pw 1

5 ’STfsrl? ^1? ^ 1

6 'siw

9
'I K W ^ 1

83
 Development o f a Scale for Assessing Cognitive Distortions
Dhaka University Institutional Repository

No Items Not at all Appropriate A ppropriate M ost Com m ent

appropriate to some appropriate
extent

10 ^ ^

11

^ 1

12 's(P)tc«Ti ijw

13

14 >i<'3=(ira

Emotional reasoning: This refers to make decisions and arguments based on how the
patients feel rather than objective reality. This reasoning doesn’t work because the
only evidence used is way they fell in a certain situation and it doesn’t take in to
account all the other factors operating at the time. For example “I feel that I am alone
in the world”

Please put a tick (V ) mark on any o f the four responses according to your judgment
about appropriateness o f each item as “Emotional reasoning” cognitive distortion.

No Items Not at all Appropriate Appropriate M ost C om m ent

appropriate to some appropriate
extent

1 c'-<rc<p '^<111

2
1

4 ^ifij »)i '<)w <pf^

6 ^ 'it'S'snt ■<>«

5Tt

84
 Development o f a Scale for Assessing Cognitive Distortions
Dhaka University Institutional Repository

No Items Not at all Appropriate A ppropriate M ost Com m ent

appropriate to some appropriate
extent

M agnification/Catastrophizing and Minimization: Magnification/catastropizing

refers to exaggerate the errors, fear or imperfections and their importance, And, in the
same time minimization refers to minimize one’s personal strengthen, good points, as
for example “Others are more intelligence and skill than mc.” This is also called
“Binocular trick” This cognitive distortion consists o f seeing the positive results of
one’s actions as smaller and the negative results as bigger than they really are.

Please put a tick (V ) mark on any o f the four responses according to your judgment
about appropriateness o f each item as “Magnification/Catastrophizing and
M inimization” cognitive distortion

No Items Not at all Appropriate A ppropriate M ost C om m ent

appropriate to some appropriate
extent

1
'b iw WCVii
■51^ ^ 1

2 C«IW

4 's rtf t ^

5 'S ltft Cb'Bl W H

'<MCSi< K t f ^ f t w 'A|

6 c ro t

7 'K!V(M

era

8 ^

9 'SRTil'I '3TPrr<I '3

85
 Development o f a Scale for Assessing Cognitive Distortions
Dhaka University Institutional Repository

No Items Not at all A ppropriate Appropriate M ost Com m ent

appropriate to some appropriate
extent

10

'srmra 'sn^n?

12 'SIM?! '5TW? WiW

'5ir<^»iH ^

13
'snft ■»i«i ^rfSt I

Should statem ent: Should statement refer to concentrate on what the patient think
“Should “or ‘Ought” to be rather than they face. When one try to motivate oneself by
saying “I must do everything perfectly”, will make him pressurize and resentful. And
when one direct should statements towards other, will make him frustrated, as for
example “Everybody should loves me”

Please put a tick (V) mark on any o f the four responses according to your judgment
about appropriateness o f each item as “ Should statem en t” cognitive distortion

No Items N ot at all Appropriate Appropriate M ost Com m ent

appropriate to some appropriate
extent

2 'ilWM

3 'oiiR

4 ^ f<l&'•<!>*1 S.C'S 5.0*1 1

5 'SftXl? >IvS!'B <>W

6 ciiwW JKCbcy

7 '5Rr*ii^ >i4*^131 '5iisiC'^

■ sn ^ 1

86
 Development o f a Scale for Assessing Cognitive Distortions
Dhaka University Institutional Repository

No Items Not at all Appropriate Appropriate M ost Com m ent

appropriate to some appropriate
extent

10

12 'siwi? •q»iSc<p^ 'iiNi^ OT?n

Personalization: This distortion is the mother o f guilt. The patient’s assume

responsibility for a negative even when there is no basis for doing so. For example “I
am the only cause o f my family crisis “When a mother saw her child’s report card,
there was a note from the teacher indicating the child was not working well. She
immediately decided ,”I must be a bad mother, this shows how I’ve failed”

Please put a tick (V) mark on any o f the four responses according to your judgment
about appropriateness o f each item as “ P ersonalization” cognitive distortion

No Items Not at all Appropriate Appropriate M ost Com m ent

appropriate to some appropriate
extent

1 'strsTRi

'St'fJ 1

2 ^ w i c w 'a ern:^

3 'srlTn?! vsnfil 1

4 'SIlsrRi <‘lCfe^< CT

t 's f ? '35^ ^ 'srisiT^ ‘p I'SK.m^ '531

5 'sri^rt? ’ rrc’ i? i i P ' ^

'a r W w i

6
^TSstUl '5;?I 1

87
 Development o f a Scale for Assessing Cognitive Distortions
Dhaka University Institutional Repository

No Items Not at all Appropriate A ppropriate M ost Com m ent

appropriate to some appropriate
extent
7

Suggestions (If any):

Name of the judge: Date

Designation: Institution:
 Development o f a Scale for Assessing Cognitive Distortions
Dhaka University Institutional Repository

Appendix 2

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91
 Development o f a Scale for Assessing Cognitive Distortions
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Name o f Placement:

Diagnosis by:Dr. Diagnosis:

96
 Development o f a Scale for Assessing Cognitive Distortions
Dhaka University Institutional Repository

Appendix 3

oiifi) ij|<M c*r^ i

'srwa ^^rr< Cognitive d isto rtio n (^t% i

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97
 Development o f a Scale for Assessing Cognitive Distortions
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Bengali translated version of General Health Questionnaire, GHQ-28

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Appendix 4

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Appendix 5

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Appendix 8

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Appendix 9

Assessment:

Session no:

Therapist rating about the client:

Severity level o f impairment in daily life (5 point

rating scale)

1 2 3 4 5
M inimal Mild M oderate Severe Profound

Severity level o f cognitive distortion (5 point

rating scale)

0 1 2 3 4
Minimal Mild M oderate Severe Profound

Many thanks for your co-operation.

Name o f Clinical Psychologist/Trainee Clinical Psychologist:

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Appendix 10
List of Judges

Clinical Psychologists:

1. Kamal Uddin Ahmed Chowdhury,Associate Professor,Clinical Psychology,DU

2. Md.Zahir Uddin, Assistant Professor,NIMH

3. Tarun Kanti Gayen,Clinical Psychologist, Part time Lecturer,Clinical

Psychology,DU

4. Salma Parveen,Clinical Psychologist,Part time Lecturcr,Clinical Psychology,DU

5. Husney Ara Begum, Psychologist, Shamsumiahar Hall, DU

6. Md.Kamruzzaman Mozumder, Assistant Professor, Clinical Psychology,DU

7. Tamima Tanjin,Psychologist,Roquia Hall,DU

8. Abul Kalam Azad, Assistant Professor,Clinical Psychology,DU

9. Most.Nazma Khatun, Assistant Professor,Clinical Psychology,DU

10. M ost.Jobeda Khatun,Lecturer,Clinical Psychology,DU

11. Md.Shahanur Hossain, Lecturer,Clinical Psychology,DU

12. Md.Abdul Awal Miya, HIV Counseling Officer,icddrb,Dhaka

13. Sabiha Khatun,Psychologist,Kueit Mottri Hall,DU

Psychiatrists

1.Dr.Jhunu Shamsunnahar,Professor,Dept, o f Psychiatry,BSMMU

2.Dr.Abdus Salam,Professor ,Dept. o f Psychiatry,BSMMU

3.Dr.Shariful Islam, Assistant Professor, ,Dept. o f Psychiatry,BSMMU

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Repository

Appendix 11

L is t o f h o s p it a ls / m e n t a l h ea lth u n it fr o m w h e r e c lin ic a l r e s p o n d e n t s
w e r e c o lle c te d

1. Bongo Bondhu Sheikh Mujib Medical University (BSMMU)

Both Out-Patient and In-Patient department

2. National Institute of Mental Health,(NIMH) Dhaka

Both Out-Patient and In-Patient department

3. Mental health unit o f CREA (Community-health Rehabilitation Education

and Awareness),Dhaka

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Appendix 12

N a m e o f r e s e a r c h a s s is ta n ts w h o w e r e c o lle c t in g c lin ic a l a n d n o n
c lin ic a l d a ta :

1.Md Abdul Awal,Trainee Clinical Psychologist

2. Md.Saidul Islam,Psychologist

3. Kanij Phatema,Trainee Clinical Psychologist

4. Shamsunnahar, Trainee Clinical Psychologist

5. Most.Hasina Khatun, Psychologist

6. Israt Jahan,Psychologist

y.Md.Jahid Habib, Trainee Clinical Psychologist

8. Md.Abdul Awal Miya,Clinical Psychologist

9.Salma Parvin,Clinical Psychologist

10.Md.Zahir Uddin, Clinical Psychologist

11.Roksana Akter, Trainee Clinical Psychologist

12.Arfa Islam, Trainee Clinical Psychologist

13. Dr.Md Shamsul Islam, Retried Medical Officer, Rangpur Medical College.

14. Selina Banu, Assistant Professor, Carmichael College, Rangpur.

15. Md.Shahanur Hossain,Clinical Psychologist.

16. Naser Md.Shayem,Student, Dhaka Medical College.

17. Shanju Ara Begum, Head Teacher, Changmari Govt. Primary

School,Bodarganj,Rangpur.

18. Tahmida Ali,Student,Bodhurnessa Women's College

19. Sabrina Ali,Teacher,Udayan Kinder Garden,Old Dhaka,Dhaka

20. Mehidi Hasan,Lecturer,Faridpur Women's College

21. Taslima Begum,Teacher,Barganj Model Govt. Primary School,Rangpur

22. Shananaj Parvin,Teacher,Khashipur Govt. Primary School,Faridpur,Pabna

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Appendix 13

Birth districts wise distribution of participants (Clinical & non

clin ical) used in developing norms

SL Birth district of Number of SL Birth district

Percentages Number of Percentages
« the respondents of the
respondents of respondents respondents of
respondents respondents
(%) (%)
1 B.Baria 8 1.7 28 Kishorganj 6 1.3
2 Bagerhaat 3 .6 29 Kustia 3 .6
3 Bagura 2 .4 30 Lakhipur 7 1.5
4 Bakerganj 31 Lalmonirha
1 .2 3 .6
at
5 Bari sal 14 2.9 32 Libia 1 .2
6 Bogura 4 .8 33 M adaripur 5 1.0
7 Borguna 2 .4 34 Magura 2 .4
8 Caadpur 11 2.3 35 Manikganj 7 1.5
9 Capainobabga 1 .2 36 Munshiganj 4 .8 .
10 Chitag 11 2.3 37 Mymensing 3 .6
11 Comilla 17 3.6 38 Naranganj 12 2.5
12 Cuadangga 2 .4 39 Nator 2 .4
13 Curigram 4 .8 40 Netrokona 4 .8
14 Dhaka 89 18.6 41 Nilphamari 3 .6
15 Dinajpur 10 2.1 42 Noakhali 12 2.5
16 Faridpur 7 1.5 43 Nobabganj 1 .2
17 Gafurga 1 .2 44 Nooga 4 .8
18 Gaibandha 2 .4 45 Norail 1 .2
19 Gajipur 5 1.0 46 Norshingdi 12 2.5
20 Gopalganj 5 1.0 47 Pabna 43 9.0
21 Hobiganj 5 1.0 48 Pakistan 1 .2
22 Jalokati 2 .4 49 Panchagarh 5 1.0
23 Jamalpur 4 .8 50 Pirojpur 2 .4
24 Jenaedaa 4 .8 51 Potuakhali 5 1.0
25 Jhalokati 1 .2 52 Rajshahi 4 .8
26 Josshor 3 .6 53 Rangpur 67 14.0
27 Khulna 10 2.1 54 Satkhera 1 .2

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SL Birth district of Number of SL Birth district

Percentages Number of Percentages
the respondents of the
respondents of respondents respondents of
respondents respondents
(%) (%)
55 Shariatpur 4 .8
56 Shirajganj 6 1.3
57 Sylhet 4 .8
58 Takurgha 2 .4
59 Tangail 9 1.9
60 Voirob 1 .2
61 Vela 4 .8

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o f a Scale for Assessing Cognitive Distortions

Appendix 14
Demographical variables (in %) o f clinical and non clinical
respondents for norm developing.

Fig.l-Distribution of clinical respondents according to

age level
2.1 0.4

■ 18 to iO
16.3 ■ 31 to 40

■ 41 to SO

■ 51 to 60
68.2
■ 61 to 70

Flg.ll-Distribution of non clinical respondents

according to age level

11810 30
13110 40
I 41 to 50
62.3
15110 60

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o f a Scale for Assessing Cognitive Distortions

Fig.lll-Distribution of clinical respondents

according to educational level

I lllit e r .it o

I C lo s s 1 to S

I C Ijs s 6 to S .S .C
X 8.8
I II .S .C to g r j t u j l c

I P o s t )>rotu<]lo j i i d d b iv o

49.4

of non clinical respondents

Fig.lV-Dlstribution
according to educational level
3.3 2.1

33.9 I illilerdtc

I 1 to 5

I Class 6 to S.S.C

I H.S C to grjtu<ito

I Post f,ratuato and above

55.6

13;
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o f a Scale for Assessing Cognitive Distortions

Fig.V-Distribution of clinical respondents

according to marital status

2.5 0.8

I U n m a r r ie d
41.8
I M o rn cd

54.8 S o p a ra lio n o r d iv o r c c

I W id o w o r w id o w o r

Fig.VI-Distribution of non clinical

respondents according to marital status

0 . 2.1

I U n m a r r ie d

I M a r r ie d
51.9
I S e p a r a t io n o r d iv o r c e

I W id o w o r w id o w e r
 Dhaka University Institutional
Development Repository
o f a Scale for Assessing Cognitive Distortions

Fig.VII-Distribution of clinical respondents

according to religion

5.9 0.8

I Islo m

I H in d u

I C h r is t ia n

93.3

Fig.VIII-Distribution of non clinical

respondents according to religion

6.3 0.4

I Is la m

I H in d u

I C h r is t ia n

93.3

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 Development
Dhaka o f a Scale
University Institutional for
Repository Assessing Cognitive Distortions

Fig.IX-Distribution of clinical respondents

according to family pattern

I s iiip jc

Ic o in b iiK l

71.1

Fig. X-Distribution of non clinical

respondents according to family pattern

I S in g le

I C o m bind

75.7

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o f a Scale for Assessing Cognitive Distortions

Fig.XI-Gender wise distribution of clinical

respondents

I M an

I F c n u lc

65.3

Fig.XII-Gender wise distribution of non clinical

respondents

42.3

■ M jn

■ F c m o lc 57.7

14;i
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Dhaka University Institutional Repository

Appendix 15

Item to Item correlation among 64 clinical respondents used in item

analysis

I te m 1 Item 2 Ite m 3 I te m 4 I te m 5

Item 1 1.000

Item 2 .735 1.000

Item 3 .643 .712 1.000

Item 4 .639 .668 .685 1.000

Item 5 .563 .645 .745 .545 1.000

Item 6 .558 .721 .571 .535 .682

Item 7 .540 .683 .624 .469 .673

Item 8 .630 .644 .628 .584 .671

Item 9 .590 .544 .502 .499 .561

Item 10 .535 .580 .531 .539 .577

Item 11 .595 .512 .507 .563 .550

Item 12 .428 .467 .466 .550 .421

Item 13 .674 .652 .631 .705 .617

Item 14 .532 .611 .542 .535 .497

Item 15 .595 .558 .506 .513 .561

Item 16 .557 .573 .595 .492 .624

Item 17 .565 .555 .644 .647 .613

Item 18 .535 .593 .577 .513 .692

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I te m 1 Item 2 Item 3 Ite m 4 Ite m 5

Item 19 .587 .606 .660 .606 .691

Item 20 .535 .534 .648 .510 .578

Item 21 .558 .673 .649 .509 .683

Item 22 .435 .459 .420 .331 .498

Item 23 .621 .620 .680 .682 .535

Item 24 .531 .606 .621 .525 .571

Item 25 .659 .661 .668 .632 .661

Item 26 .541 .569 .535 .635 .530

Item 27 .447 .516 .417 .451 .431

Item28 .559 .571 .471 .507 .431

Item 29 .490 .509 .366 .426 .368

Item 30 .479 .419 .288 .397 .278

Item 31 .557 .607 .416 .505 .444

Item 32 .547 .574 .386 .454 .365

Item 33 .500 .517 .431 .453 .372

Item 34 .570 .618 A ll .606 .464

Item 35 .503 .556 .579 .527 .598

Item 36 .591 .562 .627 .526 .569

Item 37 .506 .542 .531 .550 .506

Item 38 .545 .509 .572 .531 .633

Item 39 .489 .419 .496 .420 .468

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Ite m 6 Ite m 7 Ite m 8 I te m 9 Ite m 10

Item 6 1.000

Item 7 .657 1.000

Item 8 .611 .714 1.000

Item 9 .514 .587 .698 1.000

Item 10 .493 .542 .691 .668 1.000

Item 11 .530 .598 .769 .722 .703

Item 12 .474 .403 .494 .469 .450

Item 13 .586 .640 .776 .740 .664

Item 14 .508 .540 .555 .556 .514

Item 15 .513 .537 .598 .563 .511

Item 16 .610 .674 .621 .577 .529

Item 17 .512 .545 .684 .623 .596

Item 18 .550 .653 .596 .540 .556

Item 19 .578 .624 .705 .619 .651

Item 20 .545 .549 .609 .415 .532

Item 21 .656 .695 .741 .613 .651

Item 22 .469 .496 .525 .568 .394

Item 23 .500 .573 .629 .546 .519

Item 24 .533 .588 .599 .459 .567

Item 25 .644 .646 .716 .522 .552

Item 26 .603 .531 .579 .566 .546

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Item 6 Item 7 Item 8 Item 9 Item 10

Item 27 .562 .524 .522 .508 .451

Item28 .592 .534 .492 .504 .471

Item 29 .536 .491 .472 .547 .448

Item 30 .413 .457 .386 .460 .334

Item 31 .588 .528 .467 .497 .417

Item 32 .517 .538 .482 .521 .433

Item 33 .518 .513 .457 .460 .447

Item 34 .629 .565 .538 .482 .475

Item 35 .466 .540 .534 .537 .500

Item 36 .545 .487 .565 .524 .438

Item 37 .528 .506 .530 .393 .390

Item 38 .499 .525 .642 .512 .524

Item 39 .422 .343 .526 .466 .430

Item 11 Item 12 Item 13 Item 14 Item 15

Item 11 1.000

Item 12 .465 1.000

Item 13 .746 .548 1.000

Item 14 .594 .352 .588 1.000

Item 15 .685 .425 .629 .666 1.000

Item 16 .620 .456 .662 .591 .675

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Item 11 Item 12 Item 13 Item 14 Item 15

Item 17 .618 .505 .814 .572 .595

Item 18 .616 .433 .630 .590 .661

Item 19 .676 .554 .866 .544 .593

Item 20 .544 .407 .673 .465 .484

Item 21 .614 .461 .666 .573 .595

Item 22 .530 .410 .503 .429 .501

Item 23 .652 .539 .747 .619 .579

Item 24 .587 .421 .634 .638 .634

Item 25 .661 .522 .691 .656 .716

Item 26 .597 .503 .686 .614 .623

Item 27 .492 .543 .547 .500 .528

Item28 .542 .504 .500 .486 .485

Item 29 .510 .449 .538 .418 .385

Item 30 .422 .510 .479 .389 .411

Item 31 .495 .459 .552 .490 .490

Item 32 .518 .498 .572 .432 .489

Item 33 .488 .428 .532 .487 .512

Item 34 .504 .560 .609 .492 .512

Item 35 .553 .400 .556 .604 .643

Item 36 .452 .569 .611 .475 .576

Item 37 .454 .554 .616 .431 .448

Item 38 .541 .470 .667 .568 .619

Item 39 .487 .311 .599 .456 .454

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Item 16 Item 17 Item 18 Item 19 Item 20

Item 16 1.000

Item 17 .608 1.000

Item 18 .713 .576 1.000

Item 19 .701 .827 .674 1.000

Item 20 .636 .724 .589 .765 1.000

Item 21 .728 .636 .688 .722 .660

Item 22 .547 .437 .593 .519 .446

Item 23 .618 .694 .628 .727 .581

Item 24 .643 .654 .710 .713 .656

Item 25 .661 .686 .697 .717 .590

Item 26 .543 .708 .512 .661 .544

Item 27 .504 .512 .481 .519 .382

Item28 .465 .451 .457 .451 .396

Item 29 .541 .495 .410 .515 .380

Item 30 .406 .386 .384 .422 .303

Item 31 .566 .444 .547 .519 .411

Item 32 .467 .382 .451 .483 .368

Item 33 .419 .444 459 .471 .342

Item 34 .548 .493 .553 .575 .448

Item 35 .593 .581 .610 .621 .413

Item 36 .625 .659 .572 .602 .603

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I te m 16 Item 17 I te m 18 I te m 19 Ite m 2 0

Item 37 .580 .622 .572 .644 .660

Item 38 .604 .733 .649 .684 .647

Item 39 .468 .554 .521 .599 .672

I te m 21 Item 22 Ite m 2 3 I te m 2 4 I te m 25

Item 21 1.000

Item 22 .663 1.000

Item 23 .628 .520 1.000

Item 24 .700 .487 .700 1.000

Item 25 .682 .479 .710 .773 1.000

Item 26 .567 .439 .654 .633 .721

Item 27 .470 .391 .561 .497 .563

Item28 .460 .457 .520 .477 .499

Item 29 .449 .432 .482 .402 .435

Item 30 .366 .387 .455 .373 .413

Item 31 .512 .431 .565 .445 .547

Item 32 .444 .432 .521 .403 .496

Item 33 .411 .360 .566 .491 .569

Item 34 .524 .485 .629 .520 .609

Item 35 .614 .490 .629 .689 .687

Item 36 .585 .527 .544 .537 .566

Item 37 .505 .411 .572 .526 .539

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Item 21 Item 22 Item 23 Item 24 Item 25

Item 38 .644 .509 .606 .603 .665

Item 39 .518 .433 .544 .598 .485

Item 26 Item 27 Item 28 Item 29 Item 30

Item 26 1.000

Item 27 .625 1.000

Item 28 .530 .647 1.000

Item 29 .503 .606 .754 1.000

Item 30 .503 .672 .666 .623 1.000

Item 31 .590 .671 .594 .641 .634

Item 32 .562 .729 .631 .659 .773

Item 33 .601 .727 .613 .617 .675

Item 34 .604 .721 .667 .645 .654

Item 35 .676 .554 .448 .403 .357

Item 36 .601 .454 .416 .356 .437

Item 37 .548 .458 .473 .418 .510

Item 38 .628 .496 .390 .387 .368

Item 39 .535 .359 .331 .293 .301

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Ite m 31 Item 32 Item 33 Item 3 4 Ite m 3 5

Item 31 1.000

Item 32 .756 1.000

Item 33 .673 .768 1.000

Item 34 .685 .720 .737 1.000

Item 35 .470 .387 .527 .524 1.000

Item 36 .448 .367 .373 .520 .562

Item 37 .508 .424 .411 .556 .457

Item 38 .466 .351 .376 .459 .606

Item 39
.387 .281 .323 .290 .472

I te m 3 6 I te m 37 I te m 38 I te m 39

Item 36 1.000

Item 37 .700 1.000

Item 38 .647 .638 1.000

Item 39 .573 .515 .612 1.000

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Appendix 16
Sensitivity and specificity o f the current scale with different provable cutoff point

CulofT Sensitivity Spccificity Cutoff Sensitivity Spccificity

point (%) point (%) (%)
(%)

-1 100 0 40 91 82

1 100 11 50 91 83

3 100 12 51 90 83

4 100 12 52 89 85

5 100 13 53 88 86

6 100 14 54 87 87

7 iOO 15 55 87 88

8 100 15 56 ,V7 HH

9 100 17 «5 }l‘f

10 100 18 58 84 89

11 100 21 59 82 90

12 100 21 60 81 91

14 100 23 61 79 93

15 100 25 62 77 93

16 100 25 63 77 94

17 100 28 64 76 94

18 100 28 65 75 95

19 100 31 66 74 96

20 100 32 67 73 96

21 100 32 68 72 96

22 100 33 69 71 96

23 99 35 71 71 96

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Cul olT Sensilivily Specilkity Culoir Sensitivity Specificity

point (%) point (%) (%)
(%)

24 99 36 72 70 97

25 99 37 73 68 97

26 99 40 75 66 98

27 99 42 76 65 98

28 99 44 77 64 98

29 99 47 78 63 99

30 99 48 79 63 99

31 99 50 80 62 99

32 99 51 81 62 99

33 99 54 82 59 99

34 99 56 83 58 99

35 98 57 84 57 99

36 98 59 85 54. 99

37 9s 62 86 53 99

38 97 63 87 52 99

39 97 66 88 51 99

40 97 68 90 50 99

41 96 71 91 48 99

42 96 73 92 46 99

43 95 75 93 46 99

44 94 77 94 45 99

45 94 78 95 43 99

46 93 79 96 43 99

47 93 80 97 41 99

48 92 80 98 40 99

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Appendix 17
Date:

To

The chairman,

Dept, of Psychiatry,

Bangabondhu Shekh Mujib Medical University (BSMMU).

Dhaka-1000

Bangladesh.

Subject: Prayer for the permission of data collection for M. Phil research.

Sir,

With due respect to state that I am an M. Phil researcher of Dhaka University under the
supervision of Associate Professor , Kamal Uddin Ahamed Chowdhury ,Dept. of Clinical
Psychology, University of Dhaka. I am going to conduct a research for the partial fulfillment
of my M. Phil degree in clinical psychology. My research title is “Development of a scale for
assessing Cognitive Distortions”. I will use the proposed scale as the methodology for this
research. For data collection phase of this research I am in greatly need to have some
diagnosed patients with anxiety and depression from your department. The period of data
collection phase may range from two to three months.

In this circumstance 1 pray and hope that you would be kind enough to grant me a permission
to collect data from diagnosed indoor and/or outdoor patients from your department.

Sincerely yours

Ummey Saima Siddika

M. Phil part-Il, Dept, of Clinical Psychology

University of Dhaka.

RecommenAssociate Professor

Kamal Uddin Ahmed Chowdhury

Dept, of Clinical psychology. D.U.

153
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Dhaka University Institutional Repository

Date:

To

The Director,

National Institute o f Mental Health(NIMH), Dhaka.

Bangladesh.

Subject: Prayer for the permission o f data collection for M. Phil research.

Sir,

W ith due respect to state that I am an M. Phil researcher o f Dhaka University under
the supervision o f Associate Professor Kamal Uddin Ahamed Chowdhury, Dept, o f
Clinical Psychology, University o f Dhaka. I am going to conduct a research for the
partial fulfillment o f my M. Phil degree in clinical psychology. My research title is
“Development o f a scale for assessing Cognitive Distortions”. I will use the proposed
psychometric scale as the methodology o f this research. For data collection phase o f
this research I am in greatly need to have some diagnosed patients with anxiety and
depression from your institute. The period o f data collection phase may range from
two months.

In this circumstance I pray and hope that you would be kind enough to grant me
permission to collect data from diagnosed indoor and/or outdoor patients from your
Institute.

Sincerely yours

Ummy Saima Siddika

M. Phil part-II, Dept, o f Clinical Psychology

University o f Dhaka.

Recommended by

Associate Professor

Kamal Uddin Ahmed Chowdhury

Dept, o f Clinical psychology. D.U.

15^
 Development o f a Scale for Assessing Cognitive Distortions
Dhaka University Institutional Repository

Date:

To

The Director,

Community-health Rehabilitation Education and Awareness(CREA),

Dhaka

Bangladesh.

Subject: Prayer for the permission o f data collection for M. Phil research.

Sir,

With due respect to state that I am an M. Phil researcher o f Dhaka University under
the supervision o f Associate Professor Kamal Uddin Ahamed Chowdhury, Dept, o f
Clinical Psychology, University o f Dhaka. I am going to conduct a research for the
partial fulfillment o f my M. Phil degree in clinical psychology. My reseeirch title is
“Development o f a scale for assessing Cognitive Distortions”. I will use the proposed
psychometric scale as the methodology o f this research. For data collection phase o f
this research I am in greatly need to have some diagnosed patients with anxiety and
depression from your institute. The period o f data collection phase may range from
two months.

In this circumstance I pray and hope that you would be kind enough to grant me
permission to collect data from diagnosed out patients from your mental health unit o f
your Institute.

Sincerely yours
Ummy Saima Siddika
M. Phil part-II, Dept, o f Clinical Psychology
University o f Dhaka.
Recommended by

Associate Professor
Kamal Uddin Ahmed Chowdhury
Dept, o f Clinical psychology. D.U.

15>5