Social Phobia and Anxiety Inventory Test Critique
The Social Phobia and Anxiety Inventory (SPAI) was authored by Samuel M. Turner, Ph.D., Deborah C. Beidel, Ph.D., and Constance V. Dancu, Ph.D. and was originally published by Multi-Health Systems in 1989. Further editions of the SPAI include a version for children, (SPAI-C; Beidel, Turner, & Morris, 1995), and a version for parents (SPAI-PV; Beidel et al., 2004). In 2007 an abbreviated version, SPAI-23, was created in order to provide clinicians a quick measure and screen for social anxiety (Roberson-Nay et al., 2007). The cost for the complete SPAI test kit is $133, while the preview set is $82, the SPAI forms are $67, and the SPAI manual is $90 (MHS, n.d.). There is no online version of the SPAI.
The SPAI is an objective measure of social anxiety and fear for ages 14 and older. The first phase of development consisted of gather information and criteria from the Diagnostic and Statistical Manual of Mental Disorders (3rd ed.; American Psychiatric Association, 1980) and the measures and symptomatic complaints of individuals with social anxiety and phobia. In the second phase, anxiety disorder expert psychologists and psychiatrists rated the frequency of item occurrence with their socially anxious clients in order to develop a questionnaire.
The preliminary version of the test was taken by 34 socially anxious college students, 52 college students who were not socially anxious, and 21 patients with social phobia. The third phase of development reduced and removed items through on individual testing of items poor correlation and redundancy (Roberson-Nay et al., 2007). The normative group consisted of 306 college students who were socially anxious and non-socially anxious, as well as a clinical group population including 21 patients with social phobia, 45 patients with panic disorder or with agoraphobia, and 18 patients with obsessive-compulsive disorder. (Turner et al., 1989).
The SPAI was designed to measure social anxiety and its severity in an individual. The key areas that the SPAI measures are Social Phobia and Agoraphobia. The SPAI assesses specific symptoms (somatic symptoms, cognitions and behaviors) across a wide range of social anxiety and fear inducing situations. (MHS, n.d.). While social anxiety and its severity are measured, there is an embedded subscale of agoraphobia in order to reduce the invariance in inflated social phobia results.
This was important in order to determine if fear of being trapped and fear of panic attacks added to the social distress instead of fear of negative evaluation (Roberson-Nay, 2007). The theoretical foundation of the SPAI was originally based on Goldfried and D’Zurilla’s (1969) behavior-analytic methodology. The specific dimensions of social phobia including cognitive, physiological and behavioral implications, were considered in the foundation of the test (Turner et al., 1989). This was achieved through the theoretical and empirical foundation previously described in the three phases of development.
Test Purpose and Structure
The purpose of the SPAI is to assess cognitive, somatic, and behavioral dimensions of social fear. Particularly, the SPAI is helpful in identifying between Panic Disorder, Agoraphobia, and Social Phobia. The test is designed for individuals aged 14 years and older, with a 6th grade reading level. (MHS, n.d.).
The length of the test is 45 items, with subscales Social Phobia (32 items) and Agoraphobia (13 items) (Turner et al., 1989). Furthermore, 21 items include multiple sub-items, resulting in a total of 109 items. Each item is rated on a 7-point Likert-scale, (1= never, 2 = very infrequent, 3 = infrequent, 4 = sometimes, 5 = frequent, 6 = very frequent, 7 = always), which helps determine the severity of the results (Roberson-Nay, 2007).
Test Administration and Scoring
The SPAI is a self-report measure and administration time is approximately 20 to 30 minutes. The SPAI must be administered by a practitioner whose classification is B-level (MHS, n.d). These administrators usually have a graduate degree (psychology, counseling, education or similar disciplines) or are licensed or certified with which documents their assessment experience and training (Drummond et. al, 2016).
The SPAI is hand scored and can be calculated using MHS QuikScore™ Forms (MHS, n.d.). Results are based on separate scoring of the subscales Agoraphobia and Social Phobia. For Social Phobia there are multiple ratings; first the items that call for ratings based on four groups are scored, and for each item a mean rating is calculated. Then the mean scores are calculated for the physiological and cognitive items that require multiple ratings.
The total subscale score for the 32 items for Social Phobia is calculated by adding all the means and subtracting 32, which allows for a minimum subscale score of zero. The maximum score for Social Phobia is 192. Next, in the same manner the 13 Agoraphobia subscales are scored; all means are added and 13 is subtracted, with a minimum of zero and a maximum of 78. The total score is calculated by subtracting the Agoraphobia score from the Social Phobia score, which allows for differentiation between the two conditions (Turner et al., 1989).
The SPAI was originally tested for a normative population of college students. The normative data included 306 college students. This sample consisted of a social phobic subgroup (n = 58), non-socially anxious students (n = 124) and a sample of students recruited from an introductory psychology class, chosen after scores from a screening battery resulted in the designated range (n = 182).
This battery included referral from American and Canadian psychologists and psychiatrists, diagnostic interviews and self-report tests including the State-Trait Anxiety Inventory (Spiel-berger, Gorsuch, & Lushene, 1970), the Social Avoidance and Distress Scale (Watson & Friend, 1969), and the Fear of Negative Evaluation Scale (Watson & Friend, 1969), students who scored below the mean score from previous battery and clinical patients who had social phobia based on the DSM-III and chosen after a semi-structured interview (Turner et al., 1989). All students in the initial norm group completed the final version of the SPAI.
A second norm group was used in the initial study of the test and consisted of 84 clinical patients, including 21 patients with social phobia, 45 patients with panic disorder or panic disorder with agoraphobia, and 18 patients with obsessive-compulsive disorder. These patients had undergone clinical evaluation and were seeking treatment at the WPIC Anxiety Disorders Clinic. Individuals were chosen if they had a primary diagnosis of an anxiety disorder and excluded if they had two or more disorders or comorbidity with any other disorder (Turner et al., 1989).
The initial strategy for creating the SPAI and for the selection of the norm groups was to reflect social phobia, identify a significant percentage of social phobic and socially anxious individuals, to differentiate between social anxious and non-socially anxious individuals, and assess a single construct. Furthermore, after item examination and testing, an Agoraphobia subscale was added to determine and differentiate the source for social distress (Turner et al., 1989).
Based on this data-analytical foundation, the normative sample seems to be adequate based on the representation of socially anxious college students and individuals. However, more emphasis could have been highlighted in the distinction between Social Phobic and Agoraphobic individuals within the group of socially anxious individuals, as well as a larger sample including a wide range of ages.
The SPAI has been the subject of extensive psychometric testing including normative data (Gillis et al., 1995, Turner et al., 1989a), reliability (Turner, Beidel, et al., 1989), convergent validity (Herbert et al., 1991, Osman et al., 1995, Osman et al., 1996), construct validity (Turner, Stanley, Beidel, & Bond, 1989), discriminant validity (Beidel et al., 1989a, Peters, 2000, Osman et al., 1995, Osman et al., 1996, Rodebaugh et al., 2000, Turner et al., 1989a), and robust prediction of social phobia symptoms and diagnosis (Beidel et al., 1989a, Beidel et al., 1989b, Herbert et al., 1991, Rodebaugh et al., 2000).
Quality of Test Materials
The SPAI is a self-report inventory and is intended for ages 14 and older, with a 6th grade reading level (MHS, n.d.). Engelhard (2001) suggests that if there is an individual taking the SPAI with a reading level lower than 6th grade, it should be read aloud to them. While the examinee rates themselves based on a 7-point Likert scale, and questions are straightforward, an area of concern is repetitive nature of many of the items which could potentially lead to response sets variations (Engelhard, 2001).
Furthermore, if the examinee does not press hard enough, the response may not transfer to the QuikScore™ form, and if the top sheet is separate from the following sheets, it could be a major problem to re-order. This form may also have problems with font size, paper color and the limited space between words and lines, which could potentially present reading difficulties for visually challenged or impaired examinees (Walcott, 2001).
Ease of Administration, Scoring and Interpretation
The authors of the SPAI have done a thorough and excellent job in writing the technical manual and could be used as an example for other inventories (Enghelhard, 2001). The test manual impressively and completely provides the administrator with organized information based on Theoretical Rational, Administration and Scoring, Interpretation, Case Studies, Scale Development and Psychometric Properties, and Concluding Comment (Walcott, 2001).
The SPAI, administered by a B level practitioner, takes approximately 20-30 minutes to complete and is hand-scored using the MHS QuikScore™ (MHS, n.d.). This form includes scoring aids and allows scoring time to be rapid and eliminates potential for key error (Walcott, 2001). While administration and scoring are straightforward, the rationale for some of the scoring steps is not clear, and no situation-specific score is given. Clinical interpretation is encouraged based on response patterns (Engelhard, 2001). Based on this interpretation made by individual clinicians/administrators, Engelhard (2001) suggests that an item response theory model be provided in order to encourage stimulating discussions with clinicians and clients/examinees.
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