What’s in a Measure? Developing the Trauma Appraisal Questionnaire

Clinicians and researchers have long recognized that violence and abuse affect how people make meaning — of the world and themselves. For example, survivors might blame themselves or feel rage at others. Those appraisals of the trauma can, in turn, affect psychological distress and healing. Measuring appraisals, then, can be important to both clinical work and research.

What would it take, though, to develop a self-report measure of posttraumatic thoughts and feelings that clients could fill out for clinical assessments or research? Here’s your answer!

Back in 2004, we set out to design a way to quickly and easily measure survivors’ posttraumatic appraisals. We hoped having a self-report measure of appraisals would help clinicians and researchers better explore the ways that thoughts and feelings were linked to psychological distress and even physical health. Eventually, our efforts would lead to the Trauma Appraisal Questionnaire, or TAQ.

In the late 1990s, much of the traumatic stress studies field was focused on fear, anger, and horror after trauma – inspired, at least in part, by a focus on combat trauma and the criteria at the time for posttraumatic stress disorder (PTSD). Other researchers, though, were hearing from survivors of intimate violence who were grappling with feelings of betrayal, self-blame and shame.

Ever wondered what it would take to develop a self-report measure?

For example, Dr. Susan Roth (Duke University) was among those in the United States who pioneered research on sexual abuse and violence. In focus groups with women who had been sexually assaulted, Roth and colleagues heard about all sorts of reactions – many of which were also attracting the attention of other researchers, such as shame and self-blame. Roth’s team also heard women talking about feeling alienated; however, researchers rarely focused on alienation as the literature on posttraumatic thoughts and feelings grew.

Roth and her team’s approach to studying women’s thoughts and feelings after sexual violence was incredibly time intensive. Researchers had to make word-for-word transcriptions in order to carefully code the many themes that women described in focus groups and interviews. This made measuring thoughts and feelings as part of routine clinical work or research terribly infeasible. Building on Roth’s work, though, my team was interested in developing a self-report measure that would allow researchers and clinicians to readily measure survivors’ self-reports of their thoughts and emotions. We received a grant from the National Institute of Mental Health to do so.

Developing a self-report survey requires many iterative steps – and our work on the TAQ was no different. We started by asking two key questions. First, what thoughts and feelings should be included in a new measure? And second, how should those thoughts and feelings be phrased? To answer these questions, we turned to survivors. We interviewed more than 70 people who had survived all sorts of traumas, from combat and natural disasters to sexual assault, child abuse, and domestic violence. We asked them to talk about whichever thoughts and feelings were important to them — and we transcribed everything they said.

From the transcripts, we identified the thoughts and feelings that survivors had in common and that they said were important. Using interviews was an essential step in making sure that we prioritized survivors’ voices instead of relying on what thoughts and feelings researchers believed were important. We then brought survivors’ own words into the process of drafting items that could be used in the self-report measure. We checked in with expert researchers along the way to help us edit, combine, and refine what was initially a very long list of potential items for the measure.

Once we had a strong list of items that seemed to cover the many thoughts and feelings survivors told us were important, we asked more than 700 college students to fill out a measure that listed all the items. We also asked the students about their own experiences of trauma.

And so began the process we used to determine if the items we had developed were working the way we hoped they would. For example, survivors told us self-blame was important during the interviews. Therefore, we had drafted several items that we thought measured different aspects of self-blame. With the large sample of college students who filled out the measure, we could examine patterns to figure out if people answered all of the items that we thought measured self-blame in a similar way. If, however, people answered any one item quite differently than the others, that would tell us that the item might actually be measuring something other than self-blame.

Next, we continued the process of evaluating whether the items really measured what we hoped they would measure. We invited more than 100 survivors from the community to fill out the new measure as well as take part in an interview about their thoughts and feelings. We transcribed and carefully coded survivors’ interviews to evaluate whether what they said in the interview — when they had lots of time to explain themselves — corresponded with their responses to the TAQ items. This was a critical test to see if a handful of self-report items could capture the complexity of thoughts and feelings described in an interview. The TAQ passed this critical test.

By going through this multi-year, multi-step process, we arrived at a final version of the TAQ. We also learned a lot along the way about meaning-making after intimate abuse and violence. For example, we discovered that fear, shame, self-blame, anger, betrayal, and alienation were all common appraisals described by survivors. However, survivors of interpersonal violence rarely described feeling horror, which had been central to PTSD research and diagnosis for so long.

Since we published the TAQ in 2010, other research teams have translated the measure into multiple languages. Today, the TAQ is being used around the globe to answer questions about coping and healing in the aftermath of trauma. For example, you can read more here about what a team in Northern Ireland just learned about trauma, alienation, and posttraumatic symptoms.

If you’re interested in seeing or using the TAQ, just click here.