132 ASSESSMENT AND INTERVENTION STRATEGIES
(Beck & Steer, 1990), the BAI Total Score means and standard deviations for various
diagnostic groups are as follows: panic disorder with agoraphobia (M = 27.27, SD =
13.11), social phobia (M = 17.77, SD = 11.64), OCD (M = 21.69, SD = 12.42), GAD (M
= 18.83, SD = 9.08), and primary depressive disorder (M = 17.80, SD = 12.20).^1 Factor
analyses indicate that the questionnaire is multidimensional with either a two or a four
factor structure (e.g., Creamer et al., 1995; Hewitt & Norton, 1993; Steer et al., 1993).
However, only one- quarter of the items assess the subjective or more cognitive aspects
of anxiety (e.g., fear of the worst, unable to relax, terrified, nervous, scared) with the
remainder assessing the physiological hyperarousal symptoms of anxiety. Thus the BAI
is a good measure of the physical aspects of anxiety (especially panic disorder) and it is
sensitive to treatment effects, although like most anxiety measures it correlates highly
with self- report depression instruments (e.g., D. A. Clark, Steer, & Beck, 1994). The
BAI is available from Pearson Assessment at pearsonassess.com.
Hamilton Rating Scale of Anxiety
The Hamilton Rating Scale of Anxiety (HRSA; Guy, 1976; Hamilton, 1959) is a 14-item
clinician rating scale that assesses the severity of predominantly biological and behav-
ioral symptoms of anxiety. Each symptom is rated on a severity scale from 0 (“not pres-
ent”) to 4 (“very severe/incapacitating”) with symptomatic descriptions for each item.
A cut-off score of 14 on the HRSA Total Scale differentiates individuals with an anxi-
ety disorder from those with no current diagnosis (Kobak, Reynolds, & Greist, 1993).
The HRSA Total Score has good internal consistency, interrater reliability, and 1-week
test– retest reliability, and it has strong convergent and discriminant validity as well as
sensitivity to treatment (Maier, Buller, Philipp, & Heuser, 1988; Moras, Di Nardo, &
Barlow, 1992; see review by Roemer, 2001). However, the majority of individuals with
major depression score above the cut-off score so the instrument does not accurately
discriminate anxiety from depression (Kobak et al., 1993). Given that some training is
required for the HRSA, the measure could be reserved for cases where a self- assessment
of anxiety might be highly inaccurate (i.e., individuals who minimize or exaggerate
their anxiety). A copy of the HRSA can be found in Appendix B of Antony et al. (2001)
or in the appendix of the ADIS-IV.
Depression Anxiety Stress Scale
The Depression Anxiety Stress Scale (DASS; Lovibond & Lovibond, 1995a, 1995b) is
a 42-item questionnaire with 14 items each assessing the severity of anxiety, depres-
sion, and stress. The anxiety subscale assesses autonomic arousal, skeletal muscula-
ture, situational, and subjective aspects of anxiety. For the DASS Anxiety Scale, 0–7
represents the normal range, 8–9 is mild anxiety, 10–14 is moderate, 15–19 is severe,
and 20+ is extremely severe (see Lovibond & Lovibond, 1995b). The subscale has
good internal consistency, temporal reliability, and convergent validity (Antony, Biel-
ing, Cox, Enns, & Swinson, 1998a; Brown, Chorpita, Korotitsch, & Barlow, 1997;
(^1) The BAI Total Score mean for the primary depressive disorder group (major depression, dysthymia, and
adjustment disorder with depressed mood) was derived from an intake data set (N = 293) from the Center
for Cognitive Therapy, University of Pennsylvania Medical School, that was available to the first author.