The Beck Anxiety Inventory (BAI), created by
Aaron T. Beck
Aaron Temkin Beck (July 18, 1921 – November 1, 2021) was an American psychiatrist who was a professor in the department of psychiatry at the University of Pennsylvania. and other colleagues, is a 21-question multiple-choice
self-report inventory
A self-report inventory is a type of psychological test in which a person fills out a survey or questionnaire with or without the help of an investigator. Self-report inventories often ask direct questions about personal interests, values, sympto ...
that is used for measuring the severity of
anxiety
Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...
in adolescents and adults ages 17 and older.
The questions used in this measure ask about common symptoms of
anxiety
Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...
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.
The BAI contains 21 questions, each answer being scored on a scale value of 0 (not at all) to 3 (severely). 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
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.
The cognitive subscale provides a measure of fearful thoughts and impaired cognitive functioning, and the somatic subscale measures the symptoms of physiological arousal.
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
Panic is a sudden sensation of fear, which is so strong as to dominate or prevent reason and logical thinking, replacing it with overwhelming feelings of anxiety and frantic agitation consistent with an animalistic fight-or-flight reactio ...
components of anxiety. 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
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
Panic disorder is a mental and behavioral disorder, specifically an anxiety disorder characterized by reoccurring unexpected panic attacks. Panic attacks are sudden periods of intense fear that may include palpitations, sweating, shaking, short ...
. On the other hand, the BAI won't function as adequately for disorders such as
social phobia
Social anxiety disorder (SAD), also known as social phobia, is an anxiety disorder characterized by sentiments of fear and anxiety in social situations, causing considerable distress and impaired ability to function in at least some aspects o ...
or
obsessive-compulsive disorder, which have a stronger cognitive or behavioral component.
Clinical use
The BAI was specifically designed as "an inventory for measuring clinical anxiety" that minimizes the overlap between depression and anxiety scales.
While several studies have shown that
anxiety
Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...
measures, including the
State-Trait Anxiety Inventory (STAI), are either highly correlated or indistinguishable from
depression, the BAI is shown to be less contaminated by depressive content.
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.
A 1999 review found that the BAI was the third most used research measure of anxiety, behind the STAI and the Fear Survey Schedule, 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, 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.
Limitations
Though the BAI was developed to minimize its overlap with the depression scale as measured by the
Beck Depression Inventory
The Beck Depression Inventory (BDI, BDI-1A, BDI-II), created by Aaron T. Beck, is a 21-question multiple-choice self-report inventory, one of the most widely used psychometric tests for measuring the severity of depression. Its development mar ...
, a
correlation of r=.66 (p<.01) between the BAI and BDI-II was seen among psychiatric outpatients, suggesting that the BAI and the BDI-II equally discriminate between anxiety and depression.
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
Generalized anxiety disorder (GAD) is a mental and behavioral disorder, specifically an anxiety disorder characterized by excessive, uncontrollable and often irrational worry about events or activities. Worry often interferes with daily function ...
, 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.
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.
Many questions of the Beck Anxiety Inventory include physiological symptoms, such as
palpitations,
indigestion
Indigestion, also known as dyspepsia or upset stomach, is a condition of impaired digestion. Symptoms may include upper abdominal fullness, heartburn, nausea, belching, or upper abdominal pain. People may also experience feeling full earlier t ...
, and trouble breathing. Because of this, it has been shown to elevate anxiety measures in those with physical illnesses like
postural orthostatic tachycardia syndrome
Postural orthostatic tachycardia syndrome (POTS) is a condition characterized by an abnormally large increase in heart rate upon standing. Symptoms may include lightheadedness, brain fog, blurred vision, weakness, fatigue, headaches, heart p ...
, when the Anxiety Sensitivity Index did not.
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.
See also
*
Beck Depression Inventory
The Beck Depression Inventory (BDI, BDI-1A, BDI-II), created by Aaron T. Beck, is a 21-question multiple-choice self-report inventory, one of the most widely used psychometric tests for measuring the severity of depression. Its development mar ...
*
Beck Hopelessness Scale
*
Diagnostic classification and rating scales used in psychiatry
Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine " cause and effect". In systems engin ...
*
Major Depression Inventory
References
Further reading
*
External links
{{Wikiversity, Beck Anxiety Inventory
EffectiveChildTherapy.org guidelines on anxiety problems & disordersSociety of Clinical Child and Adolescent PsychologyEffectiveChildTherapy.Org information on fear, worry, and anxiety
Anxiety screening and assessment tools