Cross-cultural adaptation and psychometric properties of the Cognitive Behavioral Avoidance Scale- CBAS in Brazilian adults

Abstract

Background

Avoidance behavior, defined as a tendency to escape or disengage from negative stimuli, is an important psychosocial component in Major Depressive Disorder (MDD), related to its maintenance and severity.

Objective

The importance of measuring this variable to enhance results in clinical interventions, this study realized a cross-cultural adaptation of the CBAS into Brazilian-Portuguese (CBAS-BR) and investigated its psychometric properties in clinical and non-clinical samples.

Methods

After the translation-back translation process by an expert committee review, the CBAS-BR was applied to a total of 310 adults (67 with major depressive disorder; 243 healthy controls). The Beck Depression Inventory-II (BDI-II), Montgomery–Åsberg Depression Rating Scale (MADRS), and the Depression Thought Scale (DTS) were also applied. Internal consistency (Cronbach’s α, McDonald’s ω), confirmatory factor analysis (CFA), and convergent validity were examined.

Results

The original four-factor structure (Behavioral Social, Behavioral non-social, Cognitive Social, and Cognitive non-social) showed excellent fit (CFI = 0.981, TLI = 0.979, RMSEA = 0.046, 90 % CI = 0.039–0.053 [p = 0.85]). Internal consistency was high for the total scale (Cronbach’s α = 0.96; McDonald’s ω = 0.96) and for each subscale (α = 0.86–0.92). The CBAS-BR has moderate to strong correlations with the DTS, BDI II, and MADRS, supporting convergent validity.

Conclusions

The CBAS-BR is a reliable and valid measure for assessing cognitive-behavioral avoidance in Brazilian adults. It’s expected that its use may contribute to detecting maladaptive avoidance patterns and to proposing more targeted activation strategies to reduce symptoms or relapses in MDD.