The Spanish version of the Believability of Anxious Feelings and Thoughts Questionnaire (BAFT)

Full reference: Ruiz, F. J., Odriozola-González, P., & Suárez-Falcón, J. C. (2014). The Spanish version of the Believability of Anxious Feelings and Thoughts Questionnaire. Psicothema, 26(3), 308-313.

Study type: Cross-cultural validation and adaptation with hierarchical factor structure analysis

---

Background and objectives

Cognitive fusion constitutes a central process in the Acceptance and Commitment Therapy (ACT) model of psychopathology and, specifically, in anxiety disorders. It refers to a verbal process whereby individuals become attached to their private experiences (thoughts, memories, sensations) without discriminating that these are merely ongoing psychological experiences that do not necessarily need to guide behavior. When individuals demonstrate cognitive fusion with anxious experiences, they tend to act according to their literal content, which typically leads to the adoption of experiential avoidance strategies (suppression, distraction, worry, rumination) when these experiences carry aversive functions.

Generalized Anxiety Disorder (GAD) exemplifies this pattern: individuals diagnosed with this disorder tend to fuse with uncertain thoughts about the future ("what-if" thoughts) without discriminating that these are merely psychological experiences, and thus do not require particular reactions. As a result, they frequently respond by rigidly applying experiential avoidance strategies (such as worry) that produce immediate but temporary reduction of aversive experiences yet prove ineffective long-term because "what-if thoughts" typically extend, provoking greater cognitive fusion and engagement with worry. Even worse, worry itself becomes a source of suffering, generating counterproductive avoidance cycles.

Given the relevance of analyzing the role of cognitive fusion in anxiety disorders, Herzberg et al. (2012) developed the Believability of Anxious Feelings and Thoughts Questionnaire (BAFT), a self-report instrument to measure cognitive fusion with anxious thoughts and feelings. The BAFT demonstrated excellent internal consistency in undergraduate and highly anxious samples, hierarchical factor structure with three first-order factors (somatic concerns, emotion regulation, negative evaluation) and a second-order factor, strong construct validity, incremental validity relative to anxiety sensitivity, strong test-retest reliability after twelve weeks, and responsiveness to treatment. The objective of this study was to analyze the psychometric properties of the Spanish version of the BAFT using three samples from independent studies (N total = 598).

---

Method

Participants

Sample 1: 105 undergraduate labor science students from southern Spain (74.3% females), aged 19 to 48 years (M = 23.17, SD = 4.41). They completed a questionnaire packet in their respective classrooms.

Sample 2: 204 participants from southern Spain, aged 18 to 68 years (M = 30.4, SD = 10.86). Sixty-one percent were females. Relative educational level: 14.1% primary studies, 27.2% mid-level study graduates, 22.8% undergraduate students, and 35.9% college graduates. Recruited from undergraduate students and personal contacts.

Sample 3: 289 participants (59.5% females) aged 22 to 82 years (M = 35.38, SD = 8.63). Relative educational level: 7.3% primary studies, 32.8% mid-level study graduates, and 59.9% college graduates. Completed an anonymous internet survey distributed via social media. All were Spanish speakers. Thirty-six percent reported having received psychological or psychiatric treatment at some time, but only 6.6% were currently in treatment. Additionally, 4.8% of participants reported consumption of psychotropic medication.

Instrument(s) under study

Believability of Anxious Feelings and Thoughts Questionnaire (BAFT; Herzberg et al., 2012): A self-report measure of cognitive fusion with anxious thoughts and feelings. Consists of 16 items representing different thoughts rated on a 7-point Likert-type scale (1 = not at all believable to 7 = completely believable). The original hierarchical factor structure includes three first-order factors: Somatic Concerns (fusion with somatic concerns: items 8, 9, 10, 11, and 12), Emotion Regulation (fusion with excessive struggle and control of emotions: items 4, 13, 14, 15, and 16), and Negative Evaluation (fusion with negative evaluation of anxious thoughts and feelings: items 1, 2, 3, 5, 6, and 7). Internal consistency of the total BAFT score in original samples was excellent (.90 and .91 in undergraduate and highly anxious samples, respectively). Back-translation was conducted following Muñiz and Hambleton (1996) recommendations, with minimal discrepancies resolved by ACT experts.

Other outcome measures

Acceptance and Action Questionnaire-II (AAQ-II; Bond et al., 2011): A 7-item, 7-point Likert-type measure of experiential avoidance and psychological inflexibility (Spanish mean alpha: .88).

Penn State Worry Questionnaire (PSWQ; Meyer et al., 1990): A 16-item, 5-point Likert-type self-report instrument designed for evaluating the permanent and nonspecific degree of worry characteristic of GAD. High internal consistency (alpha range .93 to .95). Spanish version administered.

Anxiety Sensitivity Index (ASI; Peterson & Reiss, 1992): A 16-item, 5-point Likert-type scale measuring fear of experiencing anxiety symptoms. Spanish version demonstrates good psychometric properties in clinical and normal populations.

Five Facets Mindfulness Questionnaire (FFMQ; Baer et al., 2006): A 39-item, 5-point Likert-type scale assessing five facets of mindfulness (observing, describing, acting with awareness, nonjudging of inner experience, nonreactivity to inner experience). Spanish version demonstrates good internal consistency (alphas .81 to .91).

Metacognitions Questionnaire-30 (MCQ-30; Wells & Cartwright-Hatton, 2004): A 30-item, 4-point Likert-type scale. Only the first three factors were administered: Positive Beliefs about Worry, Negative Beliefs about Uncontrollability and Danger of Worry, and Beliefs about the Need to Control Thoughts. Adequate internal consistency (alphas .78 to .84) in Spanish version.

Beck Anxiety Inventory (BAI; Beck & Steer, 1990): A 21-item, 4-point Likert-type scale measuring anxious symptomatology. Spanish version demonstrates adequate reliability (alpha .93) and established validity.

Depression Anxiety and Stress Scales-21 (DASS-21; Antony et al., 1998): A 21-item, 4-point Likert-type scale with three subscales (Depression, Anxiety, Stress). Spanish version demonstrates good psychometric properties (subscale alphas .73 to .81).

Data analysis

Factor analyses were computed with Factor 9.2© while remaining data analyses were conducted with SPSS 17.0©. Kaiser-Meyer-Olkin index and Bartlett sphericity test were calculated to determine whether data were suitable for factor analysis. An exploratory maximum likelihood factor analysis with direct oblimin rotation was conducted allowing correlations between factors. The number of factors extracted was determined according to parallel analysis. The Schmid-Leiman transformation was computed to assess the presence of a higher-order factor. An internal replication analysis of the exploratory factor analysis was conducted by randomly splitting the entire dataset into two samples and comparing their factor structures. Cronbach's alphas were computed with confidence intervals. Descriptive data were calculated, and BAFT scores were compared between participants scoring above and below cutoffs using Student's t-test. Zero-order correlations between BAFT and other scales were computed. Incremental validity of the BAFT relative to anxiety sensitivity was analyzed by computing partial correlations while controlling for the ASI.

---

Results

Data were appropriate for factor analysis according to the Kaiser-Meyer-Olkin index (.92) and Bartlett sphericity test (χ² = 5035.6, p < .0001). Parallel analysis extracted two factors accounting for 56.4% of the variance. The first factor represented twelve items and was labeled Negative Evaluation, containing all items from the Somatic Concerns and Negative Evaluation subscales of the original version plus one item from the original Emotion Regulation subscale. The second factor consisted of four of the five items from the original Emotion Regulation subscale. Scores on both factors were highly correlated with each other (r = .54) and with the BAFT total score (r = .96 and .76, respectively).

The Schmid-Leiman transformation showed that all items represented the general factor as they displayed loadings above .30, with the general factor accounting for 52% of the variance, a proportion above the range considered indicative of the presence of a general factor (40%-50%). In the internal replication analysis, strong replication was found because the two random samples had identical basic factor structures, items were grouped in the same factors, and factor loadings were roughly equivalent in magnitude (higher squared difference was .017).

Cronbach's alpha of the overall BAFT ranged from .88 (Sample 2) to .93 (Sample 3), with an overall alpha of .92, 95% CI [.91, .93]. Compared to BAFT scores in the nonclinical sample of the original study (M = 50.1, SD = 16.9), scores in Samples 1 (M = 59.99, SD = 18.2) and 2 (M = 58.71, SD = 16.7) were slightly higher, whereas scores in Sample 3 were slightly lower (M = 47.4, SD = 19.9). Participants in Sample 3 showed lower scores than participants in Samples 1 and 2 (p < .001).

Participants with scores above cutoffs on the BAI, PSWQ, and DASS-21 scored statistically significantly higher on the BAFT than those with scores below these cutoffs. Additionally, participants receiving psychological/psychiatric treatment in Sample 3 showed higher scores on the BAFT than those not receiving it. The overall BAFT score was correlated with all other assessed constructs in theoretically coherent ways, demonstrating strong correlations with anxiety and depression symptoms (BAI, PSWQ, DASS-21). The Negative Evaluation factor demonstrated generally higher correlations with anxious symptomatology than the Emotion Regulation factor. The BAFT total score demonstrated incremental validity relative to anxiety sensitivity, maintaining significant correlations with other relevant measures even after controlling for the ASI. In Sample 1, BAFT scores showed significant partial correlations with AAQ-II (.34), PSWQ (.36), BAI (.48), Acting with Awareness (-.31), and Nonjudging (-.62). In Sample 2, BAFT scores remained significantly correlated with AAQ-II (.50), DASS-21 total score (.34), and its Depression, Anxiety, and Stress subscales (.28, .23, and .35, respectively).

---

Discussion and conclusions

The data obtained provide promising evidence that this Spanish version of the BAFT is a valid and reliable measure of cognitive fusion with anxious thoughts and feelings. Overall, the current data are very similar to those obtained by Herzberg et al. (2012). Specifically, results demonstrated that the BAFT possesses very good internal consistency (overall α = .92), construct validity (correlations in expected directions with anxiety and depression symptoms and related constructs), criterion validity (participants receiving psychological/psychiatric treatment or experiencing mild levels of anxiety symptoms scored significantly higher on the BAFT), and incremental validity (BAFT scores associated with other variables even when controlling for anxiety sensitivity).

The factor structure found in this study differs slightly from that obtained by Herzberg et al. (2012). According to parallel analysis, only two correlated factors were extracted from the overall data. However, these two factors largely overlapped with the three factors extracted in the original study. The first factor consisted of twelve elements including all items from the Somatic Concerns and Negative Evaluation subscales plus one item from Emotion Regulation. The second factor was significantly smaller. These results can be seen as relatively consistent with Herzberg et al. when considering that the Somatic Concerns and Negative Evaluation subscales functioned very similarly in that study in terms of correlations with other constructs, and their third factor explained only 6.88% of variance. The label Negative Evaluation was maintained as it appears to better represent this factor. Similar to the original study, results suggested the presence of a hierarchical factor structure with two first-order factors and a higher-order general cognitive fusion factor. The Emotion Regulation factor showed generally lower correlations with anxious symptomatology and related constructs, consistent with Herzberg et al. (2012) in their nonclinical sample. Given the factor analysis, it could be argued that the Negative Evaluation factor might be used as a reduced 12-item version of the BAFT excluding fusion with counterproductive emotion regulation strategies, meriting future empirical investigation.

Limitations include: (1) BAFT functioning tested only in nonclinical samples, requiring future research in clinical samples; (2) no information about diagnosis and treatment course for participants in treatment in Sample 3; (3) being a compilation of three samples from independent studies, no methodological rationale guided sample and measure selection. Although a clear limitation, it can also be seen as a virtue because BAFT demonstrated good properties in different contexts administered in different forms.

---

Significance and contribution

This Spanish version of the BAFT emerges as a reliable and valid measure of cognitive fusion with anxious thoughts and feelings, constituting a useful tool for assessing the degree of cognitive fusion in the context of understanding the etiology, maintenance, and treatment of anxiety disorders. By validating this instrument in a Spanish-speaking population, the study contributes to the field of anxiety psychopathology by providing a measurement tool that enables precise assessment of a cognitive process relevant to understanding how individuals interact with their anxious thoughts and feelings.