Beck Anxiety Inventory

{{Short description|Psychological assessment tool}} {{Distinguish|Beck Depression Inventory|Beck Hopelessness Scale}}

{{Infobox diagnostic | name = Beck Anxiety Inventory | image = | alt = | caption = | pronounce = | purpose =Psychological evaluation, Psychiatric assessment, self-report inventory, rating scale, ordinal scale, Likert scale, questionnaire, scale (social sciences) | test of =Psychopathology, Anxiety, Fear, Worry | based on =Anxiety Checklist, Physician's Desk Reference Checklist, Situational Anxiety Checklist | synonyms =Stress (biology), Psychological stress, Acute stress reaction | reference_range = | calculator = | DiseasesDB =  | ICD10 =  | ICD9 = }} {{Psychology sidebar}}

The '''Beck Anxiety Inventory''' ('''BAI''') is a formative assessment and rating scale of anxiety. This self-report inventory, or 21-item questionnaire uses a scale (social sciences); the ''BAI'' is an ordinal scale; more specifically, a Likert scale that measures the scale quality of magnitude of anxiety.<ref>{{cite book | last1 = Sheperis | first1 = C | last2 = Drummond | first2 = R | last3 = Jones | first3 = K | date = 2020 | title = Assessment Procedures for Counselors and Helping Professionals | url = | edition = 9th | publisher = Pearson | pages = 80, 89}}</ref>

==Overview== {{Broader|Objective test|Standardized test}}

Aaron T. Beck et al. (1988) combined three separate anxiety questionnaires, with 86 original items, to derive the ''BAI'': the ''Anxiety Checklist'', the ''Physician's Desk Reference Checklist'', and the ''Situational Anxiety Checklist''.<ref name="aninventoryfor">{{cite journal | last1 = Beck | first1 = A. | last2 = Epstein | first2 = N. | last3 = Brown | first3 = G. | last4 = Steer | first4 = R. | date = 1988 | title = An Inventory for Measuring Clinical Anxiety: Psychometric Properties | url =https://psycnet.apa.org/record/1989-10559-001 | journal = Journal of Consulting and Clinical Psychology | volume = 56 | issue = 6 | pages = 893–897 | doi = 10.1037/0022-006X.56.6.893 | access-date = 21 April 2023| url-access = subscription }}</ref> The ''BAI'' is used for measuring the severity of anxiety in adolescents and adults ages 17 and older.<ref name=Leyfer>{{cite journal |last1=Leyfer |first1=OT |last2=Ruberg |first2=JL |last3=Woodruff-Borden |first3=J |title=Examination of the utility of the Beck Anxiety Inventory and its factors as a screener for anxiety disorders |journal=Journal of Anxiety Disorders |date=2006 |volume=20 |issue=4 |pages=444–58 |pmid=16005177 |doi=10.1016/j.janxdis.2005.05.004}}</ref><ref name="twofactor">{{cite journal | last1 = Beck | first1 = A. | last2 = Epstein | first2 = N. | last3 = Brown | first3 = G. | last4 = Steer | first4 = R. | date = 1988 | title = An Inventory for Measuring Clinical Anxiety: Psychometric Properties | url =https://psycnet.apa.org/record/1989-10559-001 | journal = Journal of Consulting and Clinical Psychology | volume = 56 | issue = 6 | pages = 893–897 | doi = 10.1037/0022-006X.56.6.893 | access-date = 21 April 2023 |citeseerx=}}</ref> The questions used in this measure ask about common symptoms of anxiety that the subject has had during the past week (including the day you take it) (such as numbness and tingling, sweating not due to heat, and fear of the worst happening). It is designed for individuals who are of 17 years of age or older and takes 5 to 10 minutes to complete. Several studies have found the Beck Anxiety Inventory to be an accurate measure of anxiety symptoms in children and adults.<ref name=Leyfer/><ref>{{cite journal |last1=Osman |first1=A |last2=Hoffman |first2=J |last3=Barrios |first3=FX |last4=Kopper |first4=BA |last5=Breitenstein |first5=JL |last6=Hahn |first6=SK |title=Factor structure, reliability, and validity of the Beck Anxiety Inventory in adolescent psychiatric inpatients |journal=Journal of Clinical Psychology |date=April 2002 |volume=58 |issue=4 |pages=443–56 |pmid=11920696 |doi=10.1002/jclp.1154}}</ref>

==Scale== {{Main|Likert scale}} {{See also|Hamilton Anxiety Rating Scale|Hamilton Rating Scale for Depression}}

{{Blockquote |text=In addition, the BAI was moderately correlated with the revised Hamilton Anxiety Rating Scale [...] and was only mildly correlated with the revised Hamilton Depression Rating Scale<ref name="aninventoryfor" /> |author=Beck et al.}}

The BAI contains 21 questions, each answer being scored on a scale value of 0 ("Not at all") to 3 ("Severely--I could barely stand it").<ref>{{cite journal | last1 = Beck | first1 = A. | last2 = Epstein | first2 = N. | last3 = Brown | first3 = G. | last4 = Steer | first4 = R. | date = 1988 | title = An Inventory for Measuring Clinical Anxiety: Psychometric Properties | url =https://psycnet.apa.org/record/1989-10559-001 | journal = Journal of Consulting and Clinical Psychology | volume = 56 | issue = 6 | pages = 893–897 | doi = 10.1037/0022-006X.56.6.893 | access-date = 21 April 2023 | quote = The final scale consists of 21 items, each describing a common symptom of anxiety [...] over the past week on a 4-point scale ranging from 0 (Not at all) to 3 (Severely--I could barely stand it). The items are summed to obtain a total score that can range from 0 to 63| url-access = subscription }}</ref> Higher total scores indicate more severe anxiety symptoms. The standardized cutoffs are: * 0–7: Minimal * 8-15: Mild * 16-25: Moderate * 26-63: Severe

The BAI has been criticized for its predominant focus on physical symptoms of anxiety (most akin to a panic response). As such, it is often paired with the Penn State Worry Questionnaire, which provides a more accurate assessment of the cognitive components of anxiety (i.e., worry, catastrophizing, etc.) commonly seen in generalized anxiety disorder.

==Two factor approach to anxiety== {{Broader|Variable and attribute (research)}} Though anxiety can be thought of as having several components, including cognitive, somatic, affective, and behavioral components, Beck ''et al.'' included only two components in the BAI's original proposal: cognitive and somatic.<ref name="twofactor"/> The cognitive subscale provides a measure of fearful thoughts and impaired cognitive functioning, and the somatic subscale measures the symptoms of physiological arousal.<ref>{{cite journal |vauthors=Armstrong KA, Khawaja NG |title=Gender differences in anxiety: An investigation of the symptoms, cognitions, and sensitivity towards anxiety in a nonclinical population |journal=Behavioural and Cognitive Psychotherapy |volume=30 |issue=2 |pages=227–231 |year=2002 |doi=10.1017/s1352465802002114|s2cid=142023415 |url=https://eprints.qut.edu.au/4462/1/4462.pdf }}</ref>

Since the introduction of the BAI, other factor structures have been implemented, including a four factor structure used by Beck and Steer with anxious outpatients that included neurophysiological, autonomic symptoms, subjective, and panic components of anxiety.<ref>{{cite journal |vauthors=Beck AT, Steer RA |title=Relationship between the Beck Anxiety Inventory and the Hamilton Anxiety Rating Scale with anxious outpatients |journal=Journal of Anxiety Disorders |volume=5 |issue=3 |pages=213–223 |year=1991 |doi=10.1016/0887-6185(91)90002-b}}</ref> In 1993, Beck, Steer, and Beck used a three factor structure including subjective, somatic, and panic subscale scores to differentiate among a sample of clinically anxious outpatients<ref>{{cite journal |vauthors=Beck AT, Steer R, Beck JS |title=Types of self-reported anxiety in outpatients with ''DSM-IIIR'' anxiety disorders |journal=Anxiety, Stress, & Coping |volume=6 |pages=43–55 |year=1993 |doi=10.1080/10615809308249531}}</ref>

Because the somatic subscale is emphasized on the BAI, with 15 out of 21 items measuring physiological symptoms, perhaps the cognitive, affective, and behavioral components of anxiety are being deemphasized. Therefore, the BAI functions more adequately in anxiety disorders with a high somatic component, such as panic disorder. On the other hand, the BAI won't function as adequately for disorders such as social phobia or obsessive-compulsive disorder, which have a stronger cognitive or behavioral component.<ref name="nonclinical">{{cite journal |vauthors=Creamer M, Foran J, Bell R |title= The Beck Anxiety Inventory in a nonclinical sample |journal=Behav Res Ther |volume=33 |issue=4 |pages=477–485 |year=1995 |doi=10.1016/0005-7967(94)00082-u|pmid= 7755538 }}</ref>

==Clinical use== {{Broader|Level of measurement}}

{{Blockquote |text=The final subsample (n = 160), on which extensive validation of the final BAI was carried out, was made up of groups with primary diagnoses of major depressive disorder (n = 40); dysthymic disorder and atypical depression (n = 11); panic disorder (n = 45); generalized anxiety disorder (n = 18); agoraphobia with panic attacks (n = 18); social and simple phobia (n = 12); and miscellaneous nonanxiety, nondepression disorders such as academic problems and adjustment disorders (n = 16).<ref name="aninventoryfor" /> |author=Beck et al.}} The BAI was specifically designed as "an inventory for measuring clinical anxiety" that minimizes the overlap between depression and anxiety scales.<ref name="twofactor"/> While several studies have shown that anxiety measures, including the State-Trait Anxiety Inventory (STAI), are either highly correlated or indistinguishable from depression,<ref>{{cite journal |vauthors=Dahlquist LM, Czyzewski DI, Jones CL |title=Parents of children with cancer: A longitudinal study of emotional distress, coping style, and marital adjustment two and twenty months after diagnosis |journal=Journal of Pediatric Psychology |volume=21 |issue=4 |pages=541–554 |year=1996 |doi=10.1093/jpepsy/21.4.541|pmid=8863463 |doi-access= }}</ref><ref>{{cite journal |author=Dobson KS |title=An analysis of anxiety and depression scales |journal=Journal of Personality Assessment |volume=49 |issue=5 |pages=522–527 |year=1985 |doi=10.1207/s15327752jpa4905_10|pmid=4067800 }}</ref><ref>{{cite journal |vauthors=Endler NS, Cox BJ, Parker JD, Bagby RM |title=Self-reports of depression and state-trait anxiety: Evidence for differential assessment |journal=Journal of Personality and Social Psychology |volume=63 |issue=5 |pages=832–838 |year=1992 |doi=10.1037/0022-3514.63.5.832|pmid=1447695 }}</ref> the BAI is shown to be less contaminated by depressive content.<ref name="twofactor"/><ref>{{cite journal |vauthors=Clark DA, Steer RA, Beck AT |title=Common and specific dimensions of self-reported anxiety and depression: Implications for the cognitive and tripartite models |journal=Journal of Abnormal Psychology |volume=103 |issue=4 |pages=645–654 |year=1994 |doi=10.1037/0021-843x.103.4.645|pmid=7822565 }}</ref><ref>{{cite journal |vauthors=Enns MW, Cox BJ, Parker JD, Guertin JE |title=Confirmatory factor analysis of the Beck Anxiety and Depression Inventories in patients with major depression |journal=Journal of Affective Disorders |volume=47 |issue=1–3 |pages=195–200 |year=1998 |doi=10.1016/s0165-0327(97)00103-1|pmid=9476761 }}</ref><ref>{{cite journal |vauthors=Fydrich T, Dowdall D, Chambless DL |title=Reliability and validity of the Beck Anxiety Inventory |journal=Journal of Anxiety Disorders |volume=6 |pages=55–61 |year=1992 |doi=10.1016/0887-6185(92)90026-4}}</ref><ref>{{cite journal |vauthors=Hewitt PL, Norton GR |title=The Beck Anxiety Inventory: A psychometric analysis |journal=Psychological Assessment |volume=5 |issue=4 |pages=408–512 |year=1993 |doi=10.1037/1040-3590.5.4.408}}</ref><ref>{{cite journal |vauthors=Osman A, Kopper BA, Barrios FX, Osman JR, Wade T |title=The Beck Anxiety Inventory: Reexamination of structure and psychometric properties |journal=Journal of Clinical Psychology |volume=53 |pages=7–14 |year=1997 |issue=1 |doi=10.1002/(sici)1097-4679(199701)53:1<7::aid-jclp2>3.0.co;2-s|pmid=9120035 }}</ref><ref>{{cite journal |vauthors=Steer RA, Kumar G, Ranieri WF |title=Use of the Beck Anxiety Inventory with adolescent psychiatric outpatients |journal=Psychological Reports |volume=76 |issue=2 |pages=459–465 |year=1995 |doi=10.2466/pr0.1995.76.2.459|pmid=7667457 |s2cid=34671125 }}</ref><ref>{{cite journal |vauthors=Steer RA, Ranieri WF, Beck AT, Clark DA |title=Further evidence for the validity of the Beck Anxiety Inventory with psychiatric outpatients |journal=Journal of Anxiety Disorders |volume=7 |issue=3 |pages=195–205 |year=1993 |doi=10.1016/0887-6185(93)90002-3}}</ref><ref>{{cite journal |vauthors=Wetherell JL, Arean PA |title=Psychometric evaluation of the Beck Anxiety Inventory with older medical patients |journal=Psychological Assessment |volume=9 |issue=2 |pages=136–144 |year=1997 |doi=10.1037/1040-3590.9.2.136}}</ref>

Since the BAI only questions symptoms occurring over the last week, it is not a measure of trait anxiety or state anxiety. The BAI can be described as a measure of "prolonged state anxiety", which, in a clinical setting, is an important assessment. A version of the BAI, the Beck Anxiety Inventory-Trait (BAIT), was developed in 2008 to assess trait anxiety rather than immediate or prolonged state anxiety, much like the STAI. However, unlike the STAI, the BAIT was developed to minimize the overlap between anxiety and depression.<ref name="bait">{{cite journal |vauthors=Kohn PM, Kantor L, DeCicco TL, Beck AT |title=The Beck Anxiety Inventory-Trait (BAIT): A measure of dispositional anxiety not contaminated by dispositional depression |journal=Journal of Personality Assessment |volume=90 |issue=5 |pages=499–506 |year=2008 |doi=10.1080/00223890802248844|pmid=18704809 |s2cid=27990503 }}</ref>

A 1999 review found that the BAI was the third most used research measure of anxiety, behind the STAI and the Fear Survey Schedule,<ref>{{cite journal |author=Piotrowski C |title=The status of the Beck Anxiety Inventory in contemporary research |journal=Psychol Rep |volume=85 |issue=1 |pages=261–2 |year=1999 |pmid=10575991 |doi=10.2466/PR0.85.5.261-262}}</ref> which provides quantitative information about how clients react to possible sources of maladaptive emotional reactions.

The BAI has been used in a variety of different patient groups, including adolescents. Though support exists for using the BAI with high-school students and psychiatric inpatient samples of ages 14 to 18 years,<ref>{{cite journal |vauthors=Osman A, Hoffman J, Barrios FX, Kopper BA, Breitenstein JL, Hahn SK |title=Factor structure, reliability, and validity of the Beck Anxiety Inventory in adolescent psychiatric inpatients |journal=J Clin Psychol |volume=58 |issue=4 |pages=443–56 |year=2002 |pmid=11920696 |doi=10.1002/jclp.1154}}</ref> the recently developed diagnostic tool, Beck Youth Inventories, Second Edition, contains an anxiety inventory of 20 questions specifically designed for children and adolescents ages 7 to 18 years old.<ref>{{cite book |vauthors=Beck JS, Beck AT, Jolly JB, Steer RA |title=Beck Youth Inventories-Second Edition for Children and Adolescents Manual |location=San Antonio |publisher=PsychCorp| year=2005|title-link=Beck Youth Inventories-Second Edition for Children and Adolescents Manual }}</ref>

A systematic review reported limited and inconclusive evidence regarding the accuracy of the Beck Anxiety Inventory for screening anxiety disorders in adults, largely due to the small number and low quality of available studies conducted in specialized clinical settings.<ref>{{Cite journal |last=Eck |first=Stefanie |last2=Dümmler |first2=Daniel |last3=Aktürk |first3=Zekeriya |last4=Korman |first4=Maxim |last5=Dawson |first5=Sarah |last6=Schneider |first6=Antonius |last7=Hapfelmeier |first7=Alexander |last8=Linde |first8=Klaus |last9=Fomenko |first9=Alexey |date=2025-12-12 |editor-last=Cochrane Central Editorial Service |title=Beck Anxiety Inventory (BAI) for detecting anxiety disorders in adults |url=http://doi.wiley.com/10.1002/14651858.CD015457 |journal=Cochrane Database of Systematic Reviews |language=en |volume=2025 |issue=12 |doi=10.1002/14651858.CD015457}}</ref>

==Reliability== {{Blockquote |text=Three samples of [1,086] psychiatric outpatients [456 men, mean age 36.35; and 630 women, mean age 35.69] [...] at the Center for Cognitive Therapy in Philadelphia, Pennsylvania, from [1980 to 1986.] [...] The resulting Beck Anxiety Inventory (BAI) is a 21-item scale that showed high internal consistency (a = .92) and test-retest reliability over 1 week, r(81) = .75<ref name="aninventoryfor" /> |author=Beck et al.}}

Though the BAI was developed to minimize its overlap with the depression scale as measured by the Beck Depression Inventory, a correlation of r=.66 (p<.01) between the BAI and BDI-II was seen among psychiatric outpatients,<ref>{{cite journal |vauthors=Beck AT, Steer RA, Ball R, Ranieri WF |title=Comparison of Beck Depression Inventories-IA and -II in psychiatric outpatients |journal=Journal of Personality Assessment |volume=67 |issue=3 |pages=588–597 |year=1996 |doi=10.1207/s15327752jpa6703_13 |pmid=8991972}}</ref> suggesting that the BAI and the BDI-II equally discriminate between anxiety and depression.<ref>{{cite journal |vauthors=Stulz N, Crits-Christoph P |title=Distinguishing anxiety and depression in self-report: Purification of the Beck Anxiety Inventory and Beck Depression Inventory-II |journal=Journal of Clinical Psychology |volume=66 |issue=9 |pages=927–940 |year=2010|doi=10.1002/jclp.20701 |pmid=20694959 }}</ref>

Another study indicates that, in primary care patients with different anxiety disorders including social phobia, panic disorder, panic disorder with or without agoraphobia, agoraphobia, or generalized anxiety disorder, the BAI seemed to measure the severity of depression. This suggests that perhaps the BAI cannot adequately differentiate between depression and anxiety in a primary care population.<ref>{{cite journal |author1=Muntingh ADT |author2=van der Feltz-Cornelis CM |author3=van Marwijk HWJ |author4=Spinhoven P |author5=Penninx BWJH |author6=van Balkom AJLM |title=Is the beck anxiety inventory a good tool to assess the severity of anxiety? A primary care study in The Netherlands study of depression and anxiety (NESDA) |journal=BMC Family Practice |volume=12 |issue=66 |pages=66 |year=2011|doi=10.1186/1471-2296-12-66 |pmid=21726443 |pmc=3224107 |doi-access=free }}</ref>

In a study examining the BAI's use on older adults with generalized anxiety disorder, no discriminant validity was seen between the BAI and measures of depression. This could perhaps be due to the increased difficulty in discriminating between anxiety and depression in older adults due to "de-differentiation" of the symptoms of anxiety with the aging process, as hypothesized by Krasucki et al.<ref>{{cite journal |vauthors=Krasucki C, Howard R, Mann A |title=The relationship between anxiety disorders and age |journal=International Journal of Geriatric Psychiatry |volume=13 |issue=2 |pages=79–99 |year=1998 |doi=10.1002/(sici)1099-1166(199802)13:2<79::aid-gps739>3.0.co;2-g|pmid=9526178 |s2cid=28548833 }}</ref>

Many questions of the Beck Anxiety Inventory include physiological symptoms, such as palpitations, indigestion, and trouble breathing.<ref>{{Cite web|url=http://www.brandeis.edu/roybal/docs/BAI_website_PDF.pdf|title=Beck Anxiety Inventory (BAI)|website=Brandeis University|archive-url=https://web.archive.org/web/20170516170538/http://www.brandeis.edu/roybal/docs/BAI_website_PDF.pdf|archive-date=16 May 2017|access-date=5 March 2017|url-status=dead}}</ref> Because of this, it has been shown to elevate anxiety measures in those with physical illnesses like postural orthostatic tachycardia syndrome, when the Anxiety Sensitivity Index did not.<ref>{{Cite journal|last=Raj|first=Satish R|date=2006-04-01|title=The Postural Tachycardia Syndrome (POTS): Pathophysiology, Diagnosis & Management|journal=Indian Pacing and Electrophysiology Journal|volume=6|issue=2|pages=84–99|issn=0972-6292|pmc=1501099|pmid=16943900}}</ref>

Finally, the mean and median reliability estimates of the BAI tend to be lower when given to a nonpsychiatric population, such as college students, than when given to a psychiatric population.<ref>{{cite journal |vauthors=deAyala RJ, Vonderharr-Carlson DJ, Kim D |title=Assessing the reliability of The Beck Anxiety Inventory Scores |journal=Educational and Psychological Measurement |volume=65 |issue=5 |pages=742–756 |year=2005 |doi=10.1177/0013164405278557|s2cid=145800792 }}</ref><ref>{{cite journal |vauthors=Wetherell JL, Gatz M |title=The Beck Anxiety Inventory in Older Adults with Generalized Anxiety Disorder |journal=Journal of Psychopathology and Behavioral Assessment |volume=27 |issue=1 |pages=17–24 |year=2005 |doi=10.1007/s10862-005-3261-3|citeseerx=|s2cid=31519510 }}</ref>

==References== <references />

==Further reading== * {{cite journal |last1=Connolly |first1=Sucheta D. |last2=Bernstein |first2=Gail A. |author3=Work Group on Quality Issues |date=February 2007 |title=Practice parameter for the assessment and treatment of children and adolescents with anxiety disorders |journal=Journal of the American Academy of Child and Adolescent Psychiatry |volume=46 |issue=2 |pages=267–83 |doi=10.1097/01.chi.0000246070.23695.06 |doi-access=free |pmid=17242630 |url=http://www.jaacap.com/article/S0890-8567(09)61838-4/fulltext }}

==External links== {{Wikiversity|Beck Anxiety Inventory}} * [http://effectivechildtherapy.org/concerns-symptoms-disorders/disorders/fear-worry-and-anxiety/ EffectiveChildTherapy.org guidelines on anxiety problems & disorders] * [https://sccap53.org Society of Clinical Child and Adolescent Psychology] * [http://effectivechildtherapy.org/concerns-symptoms-disorders/disorders/fear-worry-and-anxiety/ EffectiveChildTherapy.Org information on fear, worry, and anxiety]

Category:Applied psychology Category:Standardized tests Category:Anxiety self-report inventories

Beck Anxiety Inventory

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