The Beck Anxiety Inventory (BAI) is a widely used 21-item self-report inventory used to assess anxiety levels in adults and adolescents. It has been used in multiple studies, including in treatment-outcome studies for individuals who have experienced traumas. Although the age range for the measure is from 17 to 80, the measure has been used in peer-reviewed studies with younger adolescents aged 12 and older (see Notes under
Beck, A.T., & Steer, R.A. (1993). Beck Anxiety Inventory Manual. San Antonio, TX: Psychological Corporation.
4-point Likert-type scale: Not All (0), Mildly (1), Moderately (2), Severely (3)
The Beck Anxiety Inventory for Youth is for use with children aged 7-14.
T-scores and percentiles are available based on Psych Corp's normal sample of community adults. Normative BAI scores are also presented in Gillis, Haaga, & Ford (1995), which included a sample of 242 individuals aged 18-65. The demographic variables for the 393 patients showed that the BAI is significantly related to gender and age, which has been replicated in numerous studies, suggesting the need for separate norms by gender and age.
Raw scores of 8-15 (mild anxiety), 16-25 (moderate anxiety), & 26-63 (severe anxiety)
Beck et al. (1988) report a test-retest reliability of .75 in a sample of adult psychiatric outpatients. Creamer, Foran, & Bell (1995) report a test-retest correlation of .62 with an interval of 7 weeks, which they viewed as reasonable, given that they considered the measure to tap state anxiety (versus trait anxiety).
Good test-retest reliability and internal consistency have also been found in adolescent samples (see Notes under “Construct Validity”).
With their diagnostically mixed sample of 160 outpatients, Beck, Epstein, Brown, & Steer (1988) reported that the BAI had high internal consistency reliability (alpha=.92). Fydrich, Dowdall, & Chambless (1992) found a slightly higher level of internal consistency (.94) in 40 patients diagnosed as having DSM-III-R anxiety disorders.
Items were selected based upon their consistency with DSM-III-R criteria for anxiety disorders, with emphasis on panic disorder and generalized anxiety disorder.
|Validity Type||Not known||Not found||Nonclinical Samples||Clinical Samples||Diverse Samples|
|Sensitive to Change||Yes||No|
|Sensitive to Theoretically Distinct Groups||Yes||Yes||No|
Given the large number of published studies using the BAI, the summary of the literature (below) focuses on core psychometric studies and studies conducted with adolescents, trauma-exposed, and diverse populations.
Numerous studies have examined the BAI’s relationship to other measures and have found evidence for its convergent and discriminant validity. The BAI has been found to correlate moderately with the Hamilton Anxiety Rating scale (Beck et al., 1988) and the State-Trait Anxiety Inventory (STAI), with no difference between correlations with Trait and State scales (Creamer et al., 1995). The BAI typically shows lower correlations with the BDI than does the STAI or other measures of anxiety, suggesting it has better discriminant validity (Creamer et al., 1995; Fydrich, Dowdall, & Chambless, 1992).
However, factor analysis combining both the BAI and STAI-State scale showed that the two scales load on different factors, suggesting that they tap different constructs (Creamer et al., 1995). A number of studies have suggested that the BAI may be tapping more physiological aspects of anxiety and may function best with anxiety disorders with a strong physiological component, such as panic disorder (Cox, Cohen, Direnfeld, & Swinson, 1996; Creamer et al., 1995). Cox et al. (1996) factor analyzed items from the BAI with items from the Panic Attack Questionnaire (PAQ). They found a 3-factor model best fit the data and was similar to an earlier 3-factor panic model. Items from the BAI and PAQ loaded on each factor. They suggested that the BAI may be measuring panic symptoms and may not tap symptoms associated with other anxiety disorders such as Generalized Anxiety Disorder, PTSD, and Obsessive-Compulsive Disorder.
Osman et al. (2002) examined the factor structure of the BAI with adolescents and suggested that the BAI taps the construct of anxious arousal but not cognitive or behavioral dimensions of anxiety. Numerous factor analyses have been conducted with the BAI. While many identify a 2-factor structure similar to that reported by Beck et al. (1988), others have found a 4- or 5- factor structure (Beck & Steer, 1991; Borden, Peterson, & Jackson, 1991; Osman, Kopper, Barrios, Osman, & Wade, 2002). A study by Creamer et al. (1995) provides a potential explanation. Maximum likelihood factor analysis using BAI data collected from normal undergrads at a time of presumably low stress (midsemester) resulted in a different factor structure than the same analysis using data collected on the same undergrads two weeks prior to exams. The data collected under more stressful conditions resulted in a factor structure similar to that identified in the original sample and in other clinical samples (Beck et al., 1988).
Numerous studies, including in other cultures, have identified a gender difference, with females scoring higher than males, in both adult and adolescent samples (e.g., Creamer et al., 1995; Jolly, Aruffo, Wherry, & Livingston, 1993; Osman et al., 2002). Osman et al. (2002) suggest that this difference suggests the need for validating the BAI separately by gender.
In a study of older adults, Wetherell & Gatz (2005) found that in normal older adult controls BAI symptoms were associated with measures of health status.
STUDIES WITH ADOLESCENTS
- Osman et al. (2002) studied the reliability, validity, and factor structure of the BAI with a group of adolescents. They included 125 boys and 115 girls aged 14-17 who were inpatients at a Midwestern state psychiatric hospital. The comparison group included 167 adolescents aged 14 to 18 from a universityaffiliated high school. Both groups were predominantly White. BAI scores differentiated between the psychiatric and comparison groups in both boys and girls. All groups, examined separately by gender, showed good internal consistency (alpha>.88), and the clinical sample showed good 1-week test-retest reliability (r=.71). BAI scores correlated with BDI scores (males: r=.58***, females r=.65***). Examination of BAI correlations with MMPI-A scales provided good evidence of convergent and discriminant validity for boys but low evidence for discriminant validity for girls (due to correlations with all MMPI-A scales). Using confirmatory factor analysis they were unable to replicate the 2-factor structure found in other investigations and instead identified a 4-factor structure using exploratory factor analysis. Further analysis identified a higher-order factor structure, which suggested that the BAI taps a single anxiety construct they termed Anxious Arousal. They suggested the BAI may be a useful screener for anxiety but other measures would be needed to comprehensively assess for anxiety.
- Kumar, Steer, & Beck (1993) evaluated the use of the BAI with 108 adolescent psychiatric inpatients aged 12-17 and reported excellent internal consistency (alpha=.91). Principal factor analysis identified 2 factors, with a factor structure similar to what is found in adult outpatients.
- Jolly et al. (1993) examined the use of the BAI with 80 adolescent psychiatric inpatients. They found excellent internal consistency (alpha=.94). BAI scores correlated moderately with the Revised Children’s Manifest Anxiety Scale (r=.58). The BAI also correlated with adolescents’ scores on the Children’s Depression Inventory (r=.49).
- Steer, Kumar, Ranieri, & Beck (1995) examined the use of BAI in a sample of 105 adolescent outpatients aged 13-17. Using principal factor analysis they found a similar factor structure as that previously found for adolescent inpatients and adult outpatients.
STUDIES WITH TRAUMA-EXPOSED INDIVIDUALS
The BAI has been used in numerous studies with trauma-exposed individuals. A PsychInfo search of “Beck Anxiety Inventory” or “BAI” AND “trauma” yielded 58 peer-reviewed journal articles (6/05).
- The BAI has been found to be sensitive to intervention effects in numerous randomized trials with individuals with diagnosed PTSD (e.g., Bryant, Moulds, Guthrie, & Nixon, 2005; Ehlers, Clark, Hackmann, McManus, & Fennel, 2005) and continued to show intervention effects at follow-up assessments.
- In a study of 205 female rape victims aged 15 and older (48% of whom were African American) who were randomly assigned to a standard postrape control condition or an intervention designed to prevent postrape distress, the BAI was sensitive to intervention effects. In addition, postexam BAI scores were associated with 6-week follow-up PTSD scores and depression symptomatology (Resnick, Acierno, Kilpatrick, & Holmes, 2005).
STUDIES WITH OTHER CULTURAL GROUPS
- Contreras, Fernanedez, Malcarne, Ingram, & Vaccarino (2004) examined the reliability and validity of the BAI and BDI in a sample of 1,110 Latino and 2,703 Caucasian undergraduate students. Scales for both groups had good internal consistencies. They also found similar factor structures for both groups, providing evidence of factorial validity, Although they used the original BDI in this study, they suggested that results would generalize to the BDI-II given the overlap between the two.
- Sanz & Navarro (2003) examined the psychometric properties of the Spanish BAI with a sample of 590 Spanish university students and found good internal consistency and a similar factor structure as found in other studies. They provided norms for the university students and separate norms for males and females because females scored higher than did males.
- Robles, Varela, Jurado, & Páez (2001) examined the psychometrics of the Mexican version of the BAI in multiple samples of individuals aged 15-80. They found good evidence of internal consistency, reliability, and convergent validity, and a similar factor structure as that found in English-speaking samples.
- Cheng, Wong, Wong, Chong, Tak-Po, Chang, Wong, Chan, & Wu (2002) examined the psychometric properties of the Chinese Version of the BAI (BAIC). They found good internal consistency and a factor structure similar to that found in English-speaking samples.
- Al-Issa, Al Zubaidi, Bakai, & Fung (2000) examined the psychometric properties of the translated Arabic BAI with a sample of 240 undergraduate students. They compared results to those found in Lebanese and Canadian students and found similar internal consistencies. Arab students scored higher than Canadian students.
- Yook & Kim (1997) examined the factorial structure of the Korean BAI. They found similar factor structures in patient and nonpatient groups. Patient groups scored significantly higher than nonpatients.
- Freeston, Ladouceur, Thibodeau, Gagnon, & Rheaume (1994) reported good internal consistency, reliability, and convergent, discriminant, and factorial validity using the French-Canadian version with Canadian university students and adults. 8. BAI scores are related to scores on the Adolescent Dissociative Experiences Scale in a sample of Turkish adolescents (Sayar, Kose, Grabe, & Murat, 2005).
|Not Known||Not Found||Nonclinical Samples||Clinical Samples||Diverse Samples|
There is no known information pertaining to Sensitivity and Specificity.
- In general, scoring is based on raw scores although there are T-scores and percentiles available based on Psych Corp's normal sample of community adults. Research suggests that norms are really needed by age and gender, given age and gender differences found across samples.
- The measure was developed without incorporating diverse populations.
|Language:||Translated||Back Translated||Reliable||Good Psychometrics||Similar Factor Structure||Norms Available||Measure Developed for this Group|
|3. French (Canadian)||Yes||Yes||Yes||Yes||Yes||No||No|
Beck, A.T., Epstein, N., Brown, G., & Steer, R.A. (1988) drew three successive samples of psychiatric outpatients. A total of 1,086 patients included 456 men (42%, mean age = 36.4 years, SD=12.4) and 630 women (58%, mean age = 35.7 years, SD=12.1). The patients were predominantly diagnosed with mood and anxiety disorders, but other nonspecific disorders were also represented. Less than 1% of the sample was diagnosed as psychotic. The ethnic composition of the sample is unknown.
|Population Type||Measure Used with Members of this Group||Members of this Group Studied in Peer-Reviewed Journals||Reliable||Good Psychometrics||Norms Available||Measure Developed for this Group|
|1. Developmental disability||Yes||No||No||No||No||No|
|3. Lower socio-economic status||Yes||No||No||No||No||No|
|4. Rural populations||No||No||No||No||No||No|
|5. Traumatized Children/Parents||Yes||Yes||No||No||No||No|
- This measure is a quick screening measure used to identify anxiety symptoms in individuals.
- The measure can either be self-reported or orally administered.
- The 21 questions are accurate predictors of anxiety disorders, which makes this screening tool useful in diagnosing clients.
- The BAI is a useful tool to determine client baselines. Throughout the course of therapy, the BAI can be helpful for ongoing assessment of the client's symptomatology.
- Compared to other measures of anxiety, the BAI better discriminates anxiety symptoms from depression.
- The measure has been validated in other countries, with studies suggesting that the measure is reliable and valid in numerous cultures.
- While many items tap the somatic symptoms of anxiety, this measure fails to assess other anxiety symptoms that commonly appear in trauma-exposed individuals.
- A number of researchers have suggested that the BAI may be tapping more physiological aspects of anxiety such as panic. The physiological aspect of anxiety is, however, an important aspect to assess in PTSD, given the high comorbidity of PTSD and panic and research studies showing that many individuals experience panic symptoms during trauma exposure and that such symptoms are related to later symptomatology (Bryant & Panasetis, 2001; Nixon & Bryant, 2003).
- BAI symptoms have been found to be associated with measures of health status (Wetherell & Gatz, 2005), suggesting that in samples with health problems (e.g., medical trauma) an anxiety measure that taps cognitive rather than somatic aspects of anxiety may be important.
- Given the research suggesting that females score higher than males, separate norms are needed by gender.
- Psychometric studies involving U.S. adolescents have involved predominantly White samples. More research is needed involving samples with greater ethnic and socioeconomic diversity.
The manual is: Beck, A.T., & Steer, R.A. (1993). Beck Anxiety Inventory Manual. San Antonio, TX: Psychological Corporation.
A PsychInfo search (6/05) searching for “Beck Anxiety Inventory Manual” or “BAI” anywhere revealed that the measure has referenced in 725 peer-reviewed journal articles. Below is a sampling of these articles:
- Al-Issa, I., Al Zubaidi, A., Bakai, D., & Fung, T.S. (2000). Beck Anxiety Inventory symptoms in Arab college students. Arab Journal of Psychiatry, 11(1), 41-47.
- Barlow, D.H., DiNardo, P.A., Vermilyea, B.B., Vermilyea, J.A., & Blanchard, E.B. (1986). Co-morbidity and depression among the anxiety disorders: Issues in diagnosis and classification. Journal of Nervous and Mental Disease, 174, 63-72.
- Beck, A.T., Brown, G., Steer, R.A., Eidelson, J.I., & Riskind, J.H. (1987). Differentiating anxiety and depression: A test of the cognitive content specificity hypothesis. Journal of Abnormal Psychology, 96, 179-183.
- Beck, A.T., Epstein, N., Brown, G., & Steer, R.A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893-897.
- Beck, A.T., & Steer, R.A. (1991). Relationship between the Beck Anxiety Inventory and the Hamilton Anxiety Rating Scale with anxious outpatients. Journal of Anxiety Disorders, 5, 213-223.
- Borden, J.W., Peterson, D.R., & Jackson, E.A. (1991). The Beck Anxiety Inventory in nonclinical sample: Initial psychometric properties. Journal of Psychopathology and Behavioral Assessment, 13, 345-356.
- Brierm A., Charney, D.S., Heninger, & G.R. (1985). The diagnostic validity of anxiety disorders and their relationship to depressive illness. American Journal of Psychiatry, 142, 787-797.
- Bryant, R.A., Moulds, M.L., Guthrie, R.M., & Nixon, R.D.V. (2005). The additive benefit of hypnosis and cognitive-behavioral therapy in treating acute stress disorder. Journal of Consulting and Clinical Psychology, 73(2), 334-340.
- Bryant, R.A., & Panasetis, P. (2001). Panic symptoms during trauma and acute stress disorder. Behavior Research and Therapy, 39, 961-966.
- Cheng, S.K., Wong, C., Wong, K., Chong, G.S., Tak-Po, W., Chang, S.S., Wong, S., Chan, C.K., & Wu, K. (2002). A study of the psychometric properties, normative scores, and factor structure of the Beck Anxiety Inventory – the Chinese version. Chinese Journal of Clinical Psychology, 10(1), 4-6.
- Clark, L. A. (1989). The anxiety and depressive disorders: Descriptive psychopathology and differential diagnosis. In P.C. Kendall & D. Watson (Eds.), Anxiety and depression: Distinctive and overlapping features (pp. 83-129). New York: Academic Press.
- Contreras, S., Fernanedez, S., Malcarne, V.L., Ingram, R.E., & Vaccarino, V.R. (2004). Reliability and validity of the Beck Depression and Anxiety Inventories in Caucasian Americans and Latinos. Hispanic Journal of Behavioral Sciences, 26(4), 446-462.
- Cox, B.J., Cohen, E., Direnfeld, D.M., & Swinson, E.P. (1996). Does the Beck Anxiety Inventory measure anything beyond panic attack symptoms? Behavior Research and Therapy, 34(11), 949-954.
- Creamer, M., Foran, J., & Bell, R. (1995). The Beck Anxiety Inventory in a non-clinical sample. Behavior Research and Therapy, 33(4), 477-485.
- de Beurs, E., Wilson, K.A., Chambless, D.L., Goldstein, A.J., & Feske, U. (1997). Convergent and divergent validity of the Beck Anxiety Inventory for patients with panic disorder and agoraphobia. Depression and Anxiety, 6(4), 140-146.
- Dent, H.R., & Salkovskis, P.M. (1986). Clinical measures of depression, anxiety and obsessionality in nonclinical populations. Behavioral Research and Therapy, 24, 689-691.
- Dobson, K.S. (1985). The relationship between anxiety and depression. Clinical Psychology Review, 5, 307-324.
- Ehlers, A., Clark, D. Hackmann, A., McManus, F., & Fennel, M. (2005). Cognitive therapy for post-traumatic stress disorder. Behaviour Research & Therapy, 43(4), 413-431.
- Foa, E.B., & Foa, U.G. (1982). Differentiating anxiety and depression: Is it possible? Is it useful? Psychopharmacology Bulletin, 18, 62-68.
- Frank, E., Shear, K., Rucci, P., Banti, S., Mauri, M., Maser, J.D., Kupfer, D.J., Miniati, M., Fagiolini, A., & Cassano, G.B. (2005). Cross-cultural validity of the Structured Clinical Interview for Panic-Agoraphobic Spectrum. Social Psychiatry and Psychiatric Epidemiology, 40(4), 283-290.
- Freeston, M.H., Ladouceur, R., Thibodeau, N., Gagnon, F. & Rheaume, J. (1994). The Beck Anxiety Inventory. Psychometric properties of a French translation. Encephale, 20(1), 47-55.
- Fydrich, T., Dowdall, D., & Chambless, D.L. (1992). Reliability and validity of the Beck Anxiety Inventory. Journal of Anxiety Disorders, 6, 55-61.
- Gillis, M.M, Haaga, D.A.F., & Ford, G.T. (1995). Normative values for the Beck Anxiety Inventory, Fear Questionnaire, Penn State Worry Questionnaire, and Social Phobia Anxiety Inventory. Psychological Assessment, 7(4), 450-455.
- Hamilton, M. (1959). The assessment of anxiety states by rating. British Journal of Medical Psychology, 32, 50-55.
- Jolly, J.B., Aruffo, J.F., Wherry, J.N., & Livingston, R. (1993). The utility of the Beck Anxiety Inventory with inpatient adolescents. Journal of Anxiety Disorders, 7, 95-106.
- Kabacoff, R.I., Segal, D.L., Hersen, M., & Van Hasselt, V.B. (1997). Psychometric properties and diagnostic utility of the Beck Anxiety Inventory and the State-Trait Anxiety Inventory with older adult psychiatric outpatients. Journal of Anxiety Disorders, 11(1), 33-47.
- Kumar, G., Steer, R.,A., & Beck, A.T. (1993). Factor structure of the Beck Anxiety Inventory with adolescent psychiatry inpatients. Anxiety, Stress & Coping: An International Journal, 6(2), 125-131.
- Nixon, R.D.V., & Bryant, R.A. (2003). Peritraumatic and persistent panic attacks in acute stress disorder. Behavior Research and Therapy, 41, 1237-1242.
- Novy, D.M., Stanley, M.A., Averill, P., & Daza, P. (2001). Psychometric comparability of English- and Spanish-language measures of anxiety and related affective symptoms. Psychological Assessment, 13(3), 347-355.
- Osman, A., Hoffman, J., Barrios, F.X., Kopper, B.A., Breitenstein, J.L. & Hahn, S. (2002). Factor structure, reliability and validity of the Beck Anxiety Inventory in adolescent psychiatric inpatients. Journal of Clinical Psychology, 58(4), 443-456.
- Osman, A., Kopper, B.A., Barrios, F.X., Osman, J.R., & Wade, T. (1997). The Beck Anxiety Inventory: Reexamination of factor structure and psychometric properties. Journal of Clinical Psychology, 53(1), 7-14.
- Piotrowski, C. (1999). The status of the Beck Anxiety Inventory in contemporary research. Psychological Reports, 85(1), 261-262.
- Reich, J. (1986). The epidemiology of anxiety. Journal of Nervous and Mental Disease, 174, 129-136.
- Resnick, H., Acierno, R., Kilpatrick, D.G., & Holmes, M. (2005). Description of an early intervention program to prevent substance abuse and psychopathology in recent rape victims. Behavior Modification, 29(1), 156-188.
- Robles, R., Varela, R., Jurado, S., & Páez, F. (2001). The Mexican version of the Beck Anxiety Inventory: Psychometric properties/Versión Mexicana del Inventario de Ansiedad de Beck: Propriedades Psicométricas. Revista Mexicana de Psicologia, 18(2), 211-218.
- Sanz, J., & Navarro, M.E. (2003). The psychometric properties of a Spanish version of the Beck Anxiety Inventory (BAI) in a university student sample/Propriedades psicométricas de una version española del inventario de ansidedad de Beck (BAI) en estudiantes universitarios. Ansiedad y Estres, 9(1), 59-84.
- Sayar, K., Kose, S., Grabe, H.J., & Murat, T. (2005). Alexithymia and dissociative tendencies in an adolescent sample from Eastern Turkey. Psychiatry & Clinical Neurosciences, 59(2), 127-134.
- Snaith, R.P., & Taylor, C.M. (1985). Rating scales for depression and anxiety: A current perspective. British Journal of Clinical Pharmacology, 19, 17S-20S.
- Steer, R.A., Clark, D.A., Beck, A.T. & Raniere, W.F. (1999). Common and specific dimensions of self-reported anxiety and depression: the BDI-II versus the BDI-IA. Behaviour Research and Therapy, 37(2), 183-190.
- Steer, R.A., Kumar, G., Ranieri, W., & Beck, A.T. (1995). Use of the Beck Anxiety Inventory with adolescent psychiatric outpatients. Psychological Reports, 76(2), 459-465.
- Wetherell, J.L., & Gatz, M. (2005). The Beck Anxiety Inventory in older adults with Generalized Anxiety Disorder. Journal of Psychopathology and Behavioral Assessment, 27(1), 17-24.
- Yook, S.P., & Kim, Z.S. (1997). A clinical study on the Korean version of the Beck Anxiety Inventory comparative study of patient and non-patient. Korean Journal of Clinical Psychology, 16(1), 185-197.
- Zayfert, C., DeViva, J.C., & Hofmann, S.G. (2005). Comorbid PTSD and Social Phobia in a treatment-seeking population: An exploratory study. Journal of Nervous & MentalDisease, 193(2), 93-101.