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      A pilot study of the Portuguese version of the Voices Acceptance and Action Scale: Psychometric properties in a clinical sample with psychosis-spectrum disorders Translated title: Estudo piloto da versão portuguesa da Escala de Aceitação e Ação para as Vozes: Propriedades psicométricas numa amostra clínica com perturbações do espectro da psicose

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          Abstract

          Given the recent interest in acceptance-based interventions for psychosis, it has been recommended that coping with voices mechanisms, namely experiential acceptance, are routinely assessed in clinical and research settings. The Voices Acceptance and Action Scale (VAAS-12) is a self-report measure developed to specifically assess acceptance-based or action-based beliefs in relation to verbal auditory hallucinations. This study aimed to translate, adapt and study the psychometric properties of the Portuguese version of the VAAS-12 in a clinical sample within the psychosis-spectrum disorders. The VAAS-12 was translated and adapted to Portuguese. Its psychometric properties were then studied in a sample of fifty-four male participants, mostly single, unemployed, and with a last week voice hearing experience. Confirmatory analysis was performed for the one-factor and two-factor structure suggested for the VAAS in previous studies. Both had unacceptable fit indicators. Exploratory analysis then yield an alternative two-factor structure (“Non-interference and action” and “Acceptance and Life functioning” subscales) with adequate fit. Adequate internal consistency and construct validity were found, with the VAAS being negatively associated with perception of voices as hostile-dominant and resistance regarding voices. The VAAS-12 seems adequate to use in clinical and research studies, although further study is needed particularly regarding subscale “Acceptance and Life functioning”.

          Translated abstract

          Tendo em conta o interesse recente nas intervenções baseadas na aceitação para a psicose, tem sido recomendado que os mecanismos de coping com as vozes, nomeadamente a aceitação experiencial, sejam avaliados no contexto clínico e de investigação. A Escala de Aceitação e Ação em relação às Vozes (VAAS-12) é um instrumento de autorresposta especificamente desenvolvido para avaliar as crenças baseadas na aceitação ou na ação em relação às alucinações auditivo-verbais. O presente estudo tem como objetivo a tradução, adaptação e estudo das propriedades psicométricas da versão portuguesa da VAAS-12 numa amostra clínica dentro do espectro das perturbações psicóticas. A VAAS-12 foi traduzida e adaptada para Português. As suas propriedades psicométricas foram posteriormente estudadas numa amostra de cinquenta e quatro participantes do sexo masculino, maioritariamente solteiros, desempregados e com uma experiência de ouvir vozes na última semana. Foram realizadas análises fatoriais confirmatórias para as estruturas de um e dois fatores sugeridas em estudos prévios, sendo que ambas apresentaram índices de ajustamento inaceitáveis. A análise fatorial exploratória realizada posteriormente revelou uma estrutura alternativa de dois fatores (“Não interferência e ação” e “Aceitação e Funcionamento”) que obteve ajustamento adequado. Foi encontrada adequada consistência interna e validade de constructo, tendo sido encontradas associações negativas com a perceção das vozes como hostis-dominantes e resistência em relação às vozes. A VAAS-12 parece ser adequada para uso em contexto clínico e de investigação, embora mais estudos sejam necessários particularmente no que diz respeito à subescala “Aceitação e Funcionamento”.

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          Best Alternatives to Cronbach's Alpha Reliability in Realistic Conditions: Congeneric and Asymmetrical Measurements

          The Cronbach's alpha is the most widely used method for estimating internal consistency reliability. This procedure has proved very resistant to the passage of time, even if its limitations are well documented and although there are better options as omega coefficient or the different versions of glb, with obvious advantages especially for applied research in which the ítems differ in quality or have skewed distributions. In this paper, using Monte Carlo simulation, the performance of these reliability coefficients under a one-dimensional model is evaluated in terms of skewness and no tau-equivalence. The results show that omega coefficient is always better choice than alpha and in the presence of skew items is preferable to use omega and glb coefficients even in small samples.
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            The omnipotence of voices. A cognitive approach to auditory hallucinations.

            We offer provisional support for a new cognitive approach to understanding and treating drug-resistant auditory hallucinations in people with a diagnosis of schizophrenia. Study 1 emphasises the relevance of the cognitive model by detailing the behavioural, cognitive and affective responses to persistent voices in 26 patients, demonstrating that highly disparate relationships with voices-fear, reassurance, engagement and resistance-reflect vital differences in beliefs about the voices. All patients viewed their voices as omnipotent and omniscient. However, beliefs about the voice's identity and meaning led to voices being construed as either 'benevolent' or 'malevolent'. Patients provided cogent reasons (evidence) for these beliefs which were not always linked to voice content; indeed in 31% of cases beliefs were incongruous with content, as would be anticipated by a cognitive model. Without fail, voices believed to be malevolent provoked fear and were resisted and those perceived as benevolent were courted. However, in the case of imperative voices, the primary influence on whether commands were obeyed was the severity of the command. Study 2 illustrates how these core beliefs about voices may become a new target for treatment. We describe the application of an adapted version of cognitive therapy (CT) to the treatment of four patients' drug-resistant voices. Where patients were on medication, this was held constant while beliefs about the voices' omnipotence, identity, and purpose were systematically disputed and tested. Large and stable reductions in conviction in these beliefs were reported, and these were associated with reduced distress, increased adaptive behaviour, and unexpectedly, a fall in voice activity. These changes were corroborated by the responsible psychiatrists. Collectively, the cases attest to the promise of CT as a treatment for auditory hallucinations.
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              Hearing Voices

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                aps
                Análise Psicológica
                Aná. Psicológica
                Instituto Superior de Psicologia Aplicada (Lisboa, , Portugal )
                0870-8231
                1646-6020
                March 2019
                : 37
                : 1
                : 107-118
                Affiliations
                [01] Coimbra orgnameUniversity of Coimbra orgdiv1Faculty of Psychology and Educational Sciences orgdiv2Center for Research in Neuropsychology and Cognitive and Behavioral Intervention Portugal
                [05] Ponta Delgada orgnameUniversity of Azores orgdiv1Faculty of Human and Social Sciences orgdiv2Department of Psychology Portugal
                [04] Coimbra orgnameUniversity of Coimbra orgdiv1Faculty of Psychology and Educational Sciences Portugal
                [03] Porto orgnameUniversidade Portucalense orgdiv1Faculty of Medicine orgdiv2Portucalense Institute for Human Development Portugal
                [02] Coimbra orgnameUniversity of Coimbra orgdiv1Faculty of Medicine orgdiv2Department of Psychological Medicine Portugal
                Article
                S0870-82312019000100009
                10.14417/ap.1561
                a24b7306-d403-4cb7-92c2-624afe775a90

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 21 March 2018
                : 23 July 2018
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 23, Pages: 12
                Product

                SciELO Portugal


                Acceptance,Committed action,Assessment,Psychometrics,Psychosis,Aceitação,Ação com compromisso,Avaliação,Psicometria,Psicose

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