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Adaptation of the State Trait Anxiety Inventory in Arabic

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Adaptation of the State Trait Anxiety Inventory in Arabic a comparison with the American STAI
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Abdullatif, Qutayba A
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Arabic
Middle East
language
anxiety
adaptation
cross-cultural
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ABSTRACT: The main goal of the present study was to develop an Arabic adaptation of the State Trait Anxiety Inventory (STAI, Form Y, Spielberger, 1983). In addition, cultural and linguistic influences on the experience and expression of anxiety were assessed. The American STAI and fifty initial Arabic items were administered to 286 university students at the American University of Beirut, Lebanon. The American STAI was also administered to 336 university students at the University of South Florida. Item and factor analyses were conducted on responses of the calibration sample to obtain the final set of Arabic items, which was validated using the responses of the validation sample. In conducting item selection and validation of the Arabic STAI, internal consistency coefficients for subscales, corrected item-total correlations, alpha coefficients if-item-deleted, item-factor loadings, and theoretical meaningfulness were all used as criteria for selection of the best 10 Arabic items to be included in each subscale of the STAI: S-Anxiety Absent, S-Anxiety Present, T-Anxiety Absent, T-Anxiety present. The two-factor solution for the Arabic STAI yielded a simple solution with two distinct factors: Anxiety Present and Anxiety Absent for each of S-Anxiety and T-Anxiety, lending more support to the theoretical distinction of state and trait anxiety. Lebanese students reported significantly higher anxiety levels than their American peers on S-Anxiety Present, T-Anxiety Absent, and T-Anxiety Present, S-Anxiety and T-Anxiety of the American STAI. For S-Anxiety Absent, scores for the Lebanese sample were lower than American students but did not reach significance levels. S-Anxiety Absent and T-Anxiety Absent subscales assessed lower levels of anxiety rather than the higher levels of anxiety assessed by S-Anxiety Present and T-Anxiety Present. Females tend to experience and express higher levels of mild and severe anxiety symptoms as compared to males in both samples. Factor analyses of the American STAI for the American and Lebanese samples revealed similar two and three- factor solutions. For each of the State and trait subscales, three factors emerged: Anxiety Absent, Worry, and Emotionality factors, denoting the importance of cognitions and feelings in the experience and expression of anxiety
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Thesis (M.A.)--University of South Florida, 2004.
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by Qutayba A. Abdullatif.
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Adaptation of the State Trait Anxiety Inventory in Arabic: A Comparison with the American STAI by Qutayba A. Abdullatif A thesis submitted in partial fulfillment of the requirements for the degree of Master of Arts Department of Psychology College of Arts and Sciences University of South Florida Major Professor: Charles D. Spielberger, Ph.D. Michael Brannick, Ph.D. Bill Kinder, Ph.D. Date of Approval: June 2, 2004 Keywords: cross-cultural, adaptation, anxiety, langua ge, Arabic, Middle East Copyright 2004, Qutayba A. Abdullatif

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Dedication I dedicate this cultural bridge to my father, who taught me how to construct it.

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Acknowledgment In am sincerely indebted to my mentor and advisor, professor C D Spielberger, for his priceless wisdom, calming words, a nd unconditional support and availability. I thank him for sharing with me, for free, the knowledge, the hopes and future plans. I am today richer in knowledge than wh at one thesis is worth. My gratitude goes to professor Michael Brannick, whose insightful comments, brotherly support, and genuine interest in my work lifted a lot of weight off my shoulders. I am also thankful to professor Bill Kinder, for his c ontinuous belief in the importance of my work, his generous contributions, and his flexibility. This piece would not have been complete d without the brillia nt contribution and support in data collection and commentary of Dr. Brigitte Khoury, at the American University of Beirut Medical Center. I w ould also like to thank my expert judges for their time and effort that they generously forwarded: Dr. Munir Khani and Dr. Hassan Al Amin at the American University of Beirut Medical Center; Dr. Kr isten Brustad and Dr. Mahmoud Al Batal at Emory University. My love and appreciation go out to my friends, colleagues, research assistants, and students, who helped me deal with the ma dness of data collection, data analyses and the final moments of labor. My eternal love goes to Lara Deeb, for everything she is and is not. Shukran!

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i Table of Contents List of Tables ii Abstract iii Introduction 1 Assessment of Anxiety in Different Cultures and Languages 2 The State-Trait Distincti on in Anxiety measurement 5 Measuring State and Trait Anxiety 6 Arabic Adaptations of the State-Trait Anxiety Inventory 10 Rationale and Design of the Present Study 13 Method 15 15 16 16 16 18 Participants Measures and Item Pool The State Trait Anxiety Inventory Selection of Initial Arabic Item Pool Procedure Methodological Considerations 19 Results 21 Descriptive statistics for the American STAI 22 Age and Gender Comparisons for the American and Lebanese samples 23 Mean Comparisons of the American and Lebanese samples 24 Factor analyses for American and Lebanese samples 25 Selection procedures and Factor Analyses of the Arabic items 30 Selection of the final 40 items Calibration 30 Factor Analyses and Internal consistenc y for the Arabic STAI Validation 33 Discussion 36 References 41 Appendices 45 Appendix A: Minimal informed consent: American Sample 46 Appendix B: Minimal informed consent: Lebanese Sample 48

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ii List of Tables Table 1 Means, standard deviations, and alpha coefficients for Females and Males responding to the American STAI for the Lebanese Sample 22 Table 2 Means, standard deviations, and alpha coefficients for Females and Males responding to the American STAI for the American Sample 23 Table 3 Independent sample T-test across gender for the American and Lebanese samples (American STAI) 24 Table 4 Independent sample T Tests across Lebanese and American Samples (American STAI) 24 Table 5 Loadings and eigenvalues for S-Anxiety for the American sample responding to the American STAI 26 Table 6 Loadings and eigenvalues for T-Anxiety for the American sample responding to the American STAI 27 Table 7 Loadings and eigenvalues for S-Anxiety for the Lebanese sample responding to the American STAI 28 Table 8 Loadings and eigenvalues for T-Anxiety for the Lebanese sample responding to the American STAI 29 Table 9 Corrected Item Total Correlati ons, Alpha Coefficients, and 2 Factor solution for the Initial Arab ic Item Pool-Calibration 31 Table 10 Corrected Item Total Correlati ons, Alpha Coefficients, and 2 Factor solution for the Arabic STAI Validation 35

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iii Adaptation of the State Trait Anxiety Inventory in Arabic: A Comparison with the American STAI Qutayba A. Abdullatif ABSTRACT The main goal of the present study was to develop an Arabic adaptation of the State Trait Anxiety Inventory (STAI, Form Y, Spielberger, 1983). In addition, cultural and linguistic influences on the experience a nd expression of anxiet y were assessed. The American STAI and fifty initial Arabic it ems were administered to 286 university students at the American University of Be irut, Lebanon. The American STAI was also administered to 336 university students at the University of South Florida. Item and factor analyses were conducted on responses of the calibration sample to obtain the final set of Arabic items, whic h was validated using the responses of the validation sample. In conducting item selec tion and validation of the Arabic STAI, internal consistency coefficients for subscal es, corrected item-total correlations, alpha coefficients if-item-deleted, item-factor load ings, and theoretical meaningfulness were all used as criteria for selection of the best 10 Arabic items to be included in each subscale of the STAI: S-Anxiety Absent, S-Anxiet y Present, T-Anxiety Absent, T-Anxiety present. The two-factor solution for the Arab ic STAI yielded a simple solution with two distinct factors: Anxiety Present and A nxiety Absent for each of S-Anxiety and TAnxiety, lending more support to the theoretical distinction of st ate and trait anxiety. Lebanese students reported significantly hi gher anxiety levels than their American

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iv peers on S-Anxiety Present, T-Anxiety Absent and T-Anxiety Presen t, S-Anxiety and TAnxiety of the American STAI. For S-Anxiet y Absent, scores for the Lebanese sample were lower than American students but did not reach significance levels. S-Anxiety Absent and T-Anxiety Absent subscales assessed lower levels of anxiety rather than the higher levels of anxiety assessed by S-A nxiety Present and T-Anxiety Present. Females tend to experience and express higher levels of mild and severe anxiety symptoms as compared to males in both sample s. Factor analyses of the American STAI for the American and Lebanese samples revealed similar two and threefactor solutions. For each of the State and trait subscales, th ree factors emerged: Anxiety Absent, Worry, and Emotionality factors, denoting the impor tance of cognitions and feelings in the experience and expression of anxiety.

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5 Introduction Darwin (1872/1965) considered fear to be a product of evolution. He conceptualized a continuum of tension and anxiety, ranging from mild apprehension to an extreme agony of fear, which was shared by humans and animals. Freud (1924) distinguished three types of anxiety: objective or reality anxiety, neurotic anxiety, and moral anxiety. Objective anxiety was proportion al in its intensity to the objective danger inherent in a particular situation. Neurotic anxiety referred to an emotional reaction that resulted from a conflict between id impulses that were unacceptable to the ego. Moral anxiety, or guilt, resulted from a conflict between the id and the super ego or conscience. Although anxiety is considered to be a universal phenomenon that can be identified in different cultur es, individual differences in how anxiety is experienced differ across situations and are influenced by and cultural background. Cross-cultural research in clinical psychology has focused primarily on assessing the influence of different cultures on personality and behavior in different situations (Fonesca, Yule, & Erol, 1994). Cross-cultural epidemiological studies provide evidence that anxiety disorders can be found in most cultures, and that there are differential prevalence rates across different ethnic and racial groups and So cioeconomic classes (De Sn yder, Diaz-Perez, & Ojeda, 2000; Nazemi, Kleinknecht, Dinnel, Lonner, Nazemi, Shamlo, & Sobhan, 2003; Robins & Reiger, 1991). While these results confirm the universality and prevalence of anxiety disorders, they do not address the experiential and expressive nature of anxiety in terms of the intensity and frequency of symptoms which anxious individuals experience.

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6 Assessment of Anxiety in Different Cultures and Languages Cross-cultural studies of anxiety are needed to explain and predict the influence of cultural and linguistic differences on the expe rience and expression of anxiety. However, this research requires equivale nt measures that assess the sa me construct of anxiety in different cultures. Most anxiet y measures include items that describe both the presence of anxiety (e.g., I feel nervous) and the absence of anxi ety (e.g., I feel relaxed). Anxiety-absent items, which are substantiall y negatively correlated with anxiety-present items, are especially needed to assess lower levels of the intensity of anxiety reactions. Recent evidence also indicates that anxiety absent items assess positive emotions that reflect a different but related emotional cons truct that is also very important (Iwata & Higuchi, 2000). The importance of distinguishing between presence and absence of anxiety was demonstrated by Iwata and Higuchi (2000), who compared the anxiety responses of Japanese and American college students to a Japanese adaptation of the State-Trait Anxiety Inventory (Spielberger, 1983). Japa nese students scored higher than American students on state and trait anxiety, due prim arily to endorsing fewer anxiety-absent items, such as feeling calm and content. These differences were attributed to sociocultural factors that discourage Japanese peopl e from experiencing positive feelings. In traditional Japan, it is important for psyc hological well being to subordinate ones personal feelings, which requires being sensitiv e and respectful of authority and elderly figures (Iwata & Higuchi, 2000). This entails reporting fewer positive feelings, as represented in anxiety absent items.

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7 Anxiety inventories have been translated and adapted to different languages and cultures in cross-cultural research. In esta blishing linguistic a nd cultural psychometric equivalence of a psychological test, cross-cultural adaptations of assessment instruments have historically relied on the literal translations of items fr om the original to the target language, and back-translation to the original language (Geisinger, 1994). Internal consistency and test-retest stability coefficients are reported as indi cators of the overall reliability of the translated measure. Howe ver, some items cannot be readily translated from the original language into another language due to the lack of equivalent words in the second language. The literal translation of a test item from the or iginal to the target language may also obscure the meaning of an item, for which ther e is no corresponding translation for keywords. Thus, even high-qua lity translations and back translations do not ensure that scores based on the two versions of a test item are psychometrically equivalent (Hulin, 1987). In developing cross-cultural adaptations of anxiety measures, it is important to include items that adhere to c onceptual definitions of the e xperience of anxiety, which is essential in guiding item tran slations, especially the cons truction of new items (C. D. Spielberger, personal communication, Februar y, 2002). When a clear literal translation of an original item is not possible, Spie lberger and Sharma (1976) recommend adapting the original items by selecting keywords with similar meaning or constructing new items based on the underlying construct, which is gene rally required for idiomatic expressions. It is important that the adapta tion be based on the conceptual meaning of the psychological construct. Items whose translations are not in keeping with the conceptual

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8 definition of anxiety as a psychological cons truct should be eliminated in developing a pool of meaningfully equivalent items in the target culture (Hulin, 1987). A problematic issue in cross-cultural assessment arises when distinct experiential characteristics specific to the target culture are not shared with the original culture because of differential perception of anxiet y-provoking situations. Although anxiety as an emotional state or personality trait may be similar in different cultures, the perception of situations that evoke anxi ety may be quite different, thus leading to measurement noise that detracts from the incremental validity of the latent construc t being investigated. Therefore, it is essential in the cross-cu ltural adaptation of an anxiety measure to construct additional items in the target language and culture that reflect the universal meaning of anxiety as a psychological construct. Before describing the major goals of the present study, theoretical and methodological issues in crosscultural assessment of state and trait anxiety will be reviewed. First, the state-trait distin ction will be examined, followed by brief descriptions of the original State-Trait A nxiety Inventory (STAI-Form X, Spielberger, Gorsuch, & Lushene, 1970), and the revised STAI-Form Y (Spielberger, 1983). The development of previous Arabic Adaptations of the STAI will be reviewed and statistical procedures that have been used in cross-cu ltural adaptations of psychological measures will also be considered. The State-Trait Distinction in Anxiety Measurement The state-trait distinction in anxiety re search was first proposed by Cattell (1966; Cattell & Scheier, 1961), and later expa nded and emphasized by Spielberger (1966, 1971,

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9 1972, 1975, 1976). The concept of anxiety require s consideration of both the nature of anxiety as a transitory emotiona l state (S-Anxiety) that varies in intensity and fluctuates over time, and individual differences in a nxiety proneness as a personality trait (TAnxiety). According to Spielberger ( 1972, pp. 39), S-Anxiety can be defined as: a transitory emo tional state or condition of th e organism that varies in intensity and fluctuates over time. This condition is characterized by subjective feelings of tension and apprehension, and activation of the autonomic nervous system. Level of A-St ate should be high in circumstances that are perceived by an individual to be threatening, irrespective of objective danger; A-State intensity should be relativ ely low in nonstressf ul situations, or in circumstances in which existing dange r is not perceived as threatening. Trait anxiety refers to in dividual differences in how often anxiety is generally experienced. Individuals high in T-Anxiety as a personality tr ait tend to perceive a wider range of situations as more threatening than those who are low in T-Anxiety, especially situations involving social ev aluation. As conceptualized by Spielberger (1972, pp. 39), T-Anxiety refers to: relatively stable indivi dual differences in anxiety proneness; that is, to differences in the disposition to perceive a wide range of stimulus situations as dangerous or threatening, and in the tend ency to respond to such threats with the A-State reactions. A-Trait may also be regarded as reflecting individual differences in the frequency with which A-States have been manifested in the past and in the probability that such st ates will be experienced in the future.

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10 Persons who are high in A-Trait tend to perceive a larger num ber of situations as dangerous or threatening than pers ons who are low in A-Trait, and to respond to threatening situations with AState elevations of greater intensity It should be noted that Spie lberger (1966, 1972) initially used A-State and A-Trait in his earlier work to refer to his STAI measures of state and trait anxiety. These acronyms were subsequently replaced w ith S-Anxiety and T-Anxiety to more clearly differentiate between anxiety and state and trait anger. Measuring State and Trait Anxiety The original 40-item STAI (Form X) wa s developed to provide a reliable and valid questionnaire for assessing st ate and trait anxiety in res earch and clinical contexts (Spielberger et. al, 1970). In responding to the 20 S-Anxiety items, subjects are instructed to report the intensit y of their anxiety feelings r ight now, at this moment. The instructions for the 20 T-Anxiety items require respondents to report how often they have generally experienced anxiety. Bartsch and Nesselr oade (1973), in an early investigation of the factor stru cture of the STAI, eliminated the instructions that usually accompany the administration of this inventor y (Spielberger et. al, 1970), but still found strong state and trait anxiety f actors, which added robust supp ort to the validity of the state-trait distinction. Wadsworth, Baker, and Baker (1976) examin ed the factor structure of the STAI for a college sample under naturally occurring stressful conditions (i.e., final exams), and found two factors that supported the state-trai t anxiety distinction. Using a multi-trait multi-method (MTMM) procedure, Martuza an d Kallstrom (1974) assessed discriminant

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11 and convergent validity of the STAI (Form X). The results of this study provided evidence that the STAI was a valid instrument for assessing state and trait anxiety in graduate students in a variety of stressful situations. Additional evidence of the discriminant and convergent validity of the STAI (Form-X) was also reported by Bartsch (1976). Naylor (1987) administered the STAI (Form X) to college students in experimentally manipulated success and failu re conditions, and found three factors: trait anxiety and the presence and absence of st ate anxiety. Although the factors indicating the presence or absence of state anxiety were found to be independent, they were substantially negatively correlated, which was consistent with recent research in which anxiety-absent and anxiety-present factors have been iden tified (e.g., Iwata, Nishima, Shimizu, Mizoue, Fukhura, Hidano, & Spielberger, 1998). Spielberger, Vagg, Barker, Donham, & Westberry (1980) administered the STAIForm X to more than 400 high school student s. Separate factor an alyses were conducted for males and females. The three factors that were identified were somewhat different for males and females: A single S-Anxiety factor, and trait anxiety-present and absent factors were identified for males; For females, anxi ety-absent factor co mprised of S-Anxiety And T-Anxiety items was found, in addition to state anxiety-present and trait anxietypresent factors. They also found that se veral items with excellent psychometric properties for college students in the origin al STAI (Form X) had weaker psychometric properties for high school students. Several items in the original STAI appeared to confound the concept of anxiety with depression (e .g., I feel blue, I feel like crying).

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12 It is especially interesting to know that I feel anxious was interpreted by adolescents to mean eager. Apparently, the meaning of a nxiety as a psychological construct was not clearly recognized by adolescents (Spielbe rger et al., 1980). In revising the STAI (Form X), 30% of th e original items were replaced with new items that were constructed in keeping with the conceptual definitions of S-Anxiety and T-Anxiety as psychological constructs. The final set of items for the revised STAI (From Y) were selected on the basis of factor analyses and internal consistency as reflected in alpha coefficients and item remainder correlations (Spielberger, 1983). Okun, Stein, Bauman, and Silver (1996) co mpared the item content of the STAI (Form Y) with the DSM-IV (APA, 1994) dia gnostic criteria, and with criterion-based symptoms of Generalized Anxiety Disorder. They found that the STAI items met the criteria for 5 of the 8 domains of Ge neralized Anxiety Disorder, supporting the applicability of the STAI for clinical diagnosis and rese arch. The factor structure, validity, and utility of the STAI (Form Y) we re also supported in a study of patients with anxiety disorders (Oei, Evans, & Crook, 1990). In a reliability generalization study, Barn es, Harp, and Jung (2002) reviewed 816 articles published between 1990 and 2000 in whic h internal consiste ncy and test-retest reliability coefficients were reported for the STAI Form X and Form Y. The mean internal consistency alpha coefficient for the T-Anxiety scale was = .89 (SD = .05); for S-Anxiety, the mean alpha was .91 (SD = .05). The test-retest reliabi lity coefficients (r) for the T-Anxiety scale were equally large, ranging from .82 to .94 (mean r = .88; SD = .05); for S-Anxiety, these stability coefficien ts ranged from .34 to .96 (mean r = .70; SD

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13 = .20). This pattern of internal consistency a nd test-retest reliability coefficients reported was in keeping with the theoretical distin ction between state a nd trait anxiety, which recognizes differences between transitory and temporary nature of anxiety as an emotional state and individual differences in anxiety as an enduring trait (Spielberger, 1972). The State-Trait Anxiety Inventory (Spielbe rger, 1983; Spielberger, et al, 1970), which is currently the most widely used meas ure of anxiety worldwide, has been used in more than 8,000 published research studies in psychology, education, medicine, and other social sciences disciplines (Sesti, 2000), as well as in numerous unpublished theses and dissertations. The STAI has been translated and adapted in more than 60 languages and dialects, which include Chinese (Shek, 1991) French (Bouchard, Ivers, Gauthier, Pelletier, & Savard, 1998), Japanese (Iwata, & Higuchi 2000), Portuguese (Biaggio, Natalicio, & Spielberger, 1976), and Spanish (Spielberger, Gonzalez-Reigosa, MartinezUrrutia, Natalicio, and Natalicio, 1971). Factor analyses of these adaptations have further confirmed the state-trait distinction while also identifying positive and negative affectivity factors. As previously noted, factor analyses of the STAI revealed positive and negative affect. Iwata et al. (1998) f ound three highly-correlated fact ors for Japanese workers: SAnxiety Present, and T-Anxiety Present, and Anxiety-Absent. The emergence of a single anxiety-absent factor defined by items w ith high loadings for both S-Anxiety and TAnxiety items, was attributed to cultural influences in Japan that govern the expression of positive emotions. Similar findings were reported by Iwata and Higuchis (2000) who

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14 attributed the failure to differentiate between state and trait anxiet y-absent items to a tendency within the Japanese culture to inhibit positive feelings. In a study of the responses to the STAI of Japanese clini cal outpatients, Iwata, Nishima, Obake, Kobayashi, Hashiguchi, and Egashira (2000) found the same three factors that were previously identified by Iwata and Higuchi (1998) for normal persons. The results of these Japanese studies indicate a consistent influence of Japanese culture on experiencing and reporting anxiety symptoms, and the robustness of the factor structure of the STAI across clinical and non-clinical samples within a specific cultural group. Arabic Adaptations of the St ate-Trait Anxiety Inventory The development of at least six Arabic adaptations of the STAI have been reported in studies conducted in Egypt, Jordan, Kuwait, and Lebanon (Abdel-Khalek, 1989). Three of these adaptations were based on the STAI (Form X, Spielberger et al., 1970), and three were adaptations of the STAI (F orm Y, Spielberger, 198 3). In a study of the Arabic adaptation of Form X (Ahlawat, 1986), the American STAI items were translated into Arabic by a psychologist, a psychometrician and two bilingual professors of Arabic, who were educated in the US or England. Each item was translated and backtranslated, and those items for which there was agreement among the translators, were subsequently reviewed and rated by teachers on their degree of difficulty for high school students. Ahlawat (1986) administered this Arabic STAI (Form X) to 473 Jordanian 11 th grade students (314 males, 159 females) unde r neutral conditions. The males scored significantly higher than females on the anxi ety-absent (well-being) items and had lower scores on the anxiety-pres ent items. The author noted two factors, well-being

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15 and anxiety-present, and conc luded that there was strong evidence of the universality and construct validity of anxiety as asse ssed by the STAI. He also emphasized the importance of comparing the responses of males and females and noted several indications of culture-speci fic and linguistic influences for the Jordanian sample. The three Arabic adaptations of the revi sed STAI (Form Y), carried out in Egypt, Jordan and Lebanon, were described briefly in an article published by Abdel-Khalek (1989). In developing his Egyptia n adaptation, Abdel-Khalek (1989) translated STAI (Form-Y) items to Arabic, which were th en evaluated and revised by subject-matter experts, and administered to university students. Three of the four stages of test adaptations recommended by Spielberger and Sharma (1976) were followed: (1) Preparation of a preliminary Arabic translat ion of the STAI (Form Y); (2) evaluation of the adapted instrument by subject-matter experts and selection of a final set of items; and (3) evaluating cross-language equivalence of th e adapted scale with the original scale. The studies of the Arabic adaptations of the STAI (Abdel-Khalek, 1989; Ahlawat, 1986) represent commendable efforts of tr anslating and adapting a Western anxiety measure into Arabic, a language spoken by 300 million people in more than 20 countries. Internal consistency and test-retest stability coefficients, and the factor structure of the Arabic STAI in both studies were similar to those reported for American samples, clearly supporting the universality of anxiety as an em otional state and individual differences in anxiety as a personality trait. Although the studies by Ahlawat (1986) and Abdel-Khalek (1989) followed Spielberger and Sharmas ( 1976) recommendations for cross-cultural adaptations of

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16 psychological measures, they were limited in several respects. The Arabic adaptations of the STAI items that they developed were based primarily on translation and backtranslation f items, and were not guided in their item translations by explicit conceptual definitions of state and trait anxiety. These Arabic adaptations were administered only to monolingual responders, so a comparison of re sponses to the American STAI and the Arabic STAI was not possible, thus limiting conclusions a bout linguistic influences on the experience and expr ession of anxiety. The present study addressed several shortcom ings in the previous development of Arabic adaptations of the STAI. First, the ite ms selected for the Arabic STAI adhered in translation to conceptual definitions of state and trait anxiety as psychological constructs. Second, the item pool included equal number s of T-Anxiety Present and T-Anxiety Absent items, which has been shown to be im portant in previous re search (e.g., Iwata and Higuchi, 1998). Previous Arabic adaptations of the STAI had an unequal number of items for T-Anxiety-Present and T-Anxiety-Abse nt in Form X (13:7) and Form Y (11:9). Third, the Arabic and American STAI items were administered to bilingual Lebanese college students to assess linguistic influen ces. Fourth, the responses of the Lebanese sample to the American STAI were compared to a US sample to assess for cultural influences. Rationale and Design of the Present Study The main goal of the present study was to develop an Arabic adaptation of the STAI (Form Y, Spielberger, 1983), taking in to account the procedures identified as critically important in developing cross-cultural adaptati ons of psychological measures

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17 (Hulin, 1987; Spielberger, 1983; Spielberger & Sharma, 1976). This required developing a pool of items to assess S-Anxiety and T-Anxiety that was consistent with the conceptual definitions of these constructs. The pool of Arabic items was selected from previous Arabic adaptations of the STAI Fo rm X and Form Y that were developed in Egypt, Jordan and Lebanon, and included 25 items for assessing state anxiety and 25 items for assessing trait anxiety. The pool of items consisted of approximately equal numbers of state and trait Anxiety-Present and Anxiety-Absent items. The item pool, along with the conceptual definition of SAnxiety and T-Anxiety, were presented to bilingual subject-matter and linguistics experts who were asked to evaluate the consistency of each item in terms of the c onceptual definitions of S-Anxiety and TAnxiety. These experts also suggested alternat ive translations for items with content that was not considered to be consistent with th e conceptual definitions of the state-trait anxiety. The entire Arabic item pool was administer ed to a sample of bilingual college students in Lebanon along with the American STAI. Analyses of each item and factor analyses were used to select 40 items to be included in the final Arabic STAI. The selected items included the best 20 S-Anxiety items and best 20 T-Anxiety items, with equal number of anxiety present and absent items. For comparison purposes, the STAI was administered to a sample of undergradu ate American college students in the US. The responses of Lebanese students to the Arab ic STAI were compared to their responses to the American STAI. Responses of the US sample to the American STAI were compared to responses of the Lebanese sample on the American STAI.

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18 Method Participants Bilingual college students in Lebanon (N = 282) enro lled in undergraduate courses at the American University of Be irut, responded to the American STAI. The mean age for this sample was 20.2 years (SD = 2.1). There were 156 (55%) females and 126 (45%) males. Participants were not co mpensated or offered any extra credit for participating in this study. Only 200 of the 282 responded to the Arabic item pool. This might have been due to time constraints, opti ng not to respond in Arabic, fi lling only the American STAI and missing the Arabic pool, or due to difficulties with Arabic items. The Lebanese participants responding to the Arabic ite m pool (N=200) were randomly assigned to either of two sub-samples: the calibration sample consisted of 108 participants (54% of total; 50 males, 58 females; mean age = 20.5, SD = 2.2) whose responses were used for the selection of the 40 items for the Arabic STAI; and the validation sample (N=92, 46 % of total; 42 males, 50 females; mean age = 20.2, SD = 2.2) whose responses were used to validate the 40 items selected for the Arabic item pool. The responses of the validation sample were also used to assess for linguistic influences on the experience of anxiety. The US college student sample consis ted of 336 students attending undergraduate level courses at the Un iversity of South Florida, res ponded to the American STAI (Form Y). The mean age for this sample was 20.6 years (SD = 3.2). An attempt was made to

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19 obtain nearly equal numbers of male and fema le participants in both samples yielding 94 males (28%) and 242 females (72%). The American sample was encouraged to participate by being offered extra credit. Measures and Item Pool The State Trait Anxiety Inventory. Participants in the American and Lebanese samples responded to the State Trait Anxiety Inventory (STAI, Form Y, Spielberger, 1983). The STAI is a 40-item inventory that assesses S-Anxiety and T-anxiety by responding to a 4 point Likert scale ( Almost never, sometimes, often, and almost always). The inventory is divided into two subscales of 20 items each, assessing SAnxiety items and T-Anxiety. The STAI has been found to possess excellent test-retest reliability coefficients for T-anxiety (mean r = .88; SD = .05) and Sanxiety (mean r = .70; SD = .20; Barnes et al, 2002). Excellent Internal consistency alpha coefficients were also reported for TAnxiety scale (mean = .89; SD = .05) and for S-Anxiety scale (mean = .91; SD = .05; Barnes et al., 2002). Selection of initial Arabic item pool. The initial Arabic item pool was selected from previous Arabic adaptations of the STAI (Form X and Form Y) that were developed in Egypt, Jordan, and Lebanon, and initially included 25 items for assessing state anxiety and 25 items for assessing trait anxiety. Th e item pool, along with conceptual definitions of S-Anxiety and T-Anxiety, were presente d to bilingual subject-m atter and linguistics experts who evaluated the appr opriateness of the item adaptati ons in the context of the conceptual definitions of S-Anxiety and T-A nxiety. The initial item pool for S-Anxiety

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20 included 12 S-Anxiety Present and 13 S-Anxi ety Absent items. The item pool for Tanxiety included 14 T-Anxiety Presen t and 11 T-Anxiety Absent items. By collaborating with these five bili ngual, linguistic and subject-matter experts and graduate students, items from the ini tial item pool were re-assessed in terms of cultural and linguistic compatib ility. All experts were trai ned in the USA or England, held medical degrees or doctorates in their respective fields, and were active in research and clinical work. The author worked directly with experts on developing these items. A conceptual definition of the state and tr ait anxiety as psychological constructs was provided to the raters following Spielber gers (1972) definition. The items produced by previous Arabic adaptations of the STAI (Form X and Form Y) in Egypt, Jordan and Lebanon served as the initial item pool, and we re presented to the raters, who rated the consistency of the items in the context of the on a 4-point Likert scale of highly consistent, reasonably consistent, marginally consistent, and not consistent. Back translations were provided for items that were rated by three or more raters as highly consistent. Alternative translations were provided by raters for items that were judged to be reasonably consistent or marginally consistent by 3 or more raters. Items rated as not consistent were not be included in the item pool, and raters were be asked to construct new items to replace them, within th e context of the conceptual definitions of state and trait anxiety as psychological constr ucts. Additional items that demonstrated controversy and did not appro ach consensus were re-evaluated before being included in the final item pool.

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21 Raters were encouraged to recommend any additional items that they judged to be linguistically and culturally relevant to the construct of state-trait anxiety in their respective culture or language. The final step for the raters was to back-translate the Arabic items into English and compare them to the original items of the American STAI. Items that include idiomatic expressions in the English were adapted into Arabic by translating the meaning of the expression. Procedure Participants in the American sample we re recruited by requesting volunteers from classes to stay in their classrooms either of the remainder of the class or after the class was over to respond to the STAI for extra credit. A special effort wa s made to increase the number of males in the study. Participants in the Lebanese sample were recruited in a similar manner, without being offered ex tra credit or monetary compensation. Alternatively, the importance of conducting cros s-cultural research was emphasized in an attempt to encourage them to participate. At the beginning of the data colle ction period, the purpose of the study was described as an attempt to learn about the f eelings and cognitions of college students in each sample, with an aim at comparing cross-cultural responses in the US and Lebanon. Consent forms were then distributed and part icipants were allowed some time to read them and ask any relevant questions. Upon signing the consent forms, the Am erican STAI was distributed to the American sample participants and they were en couraged to read the instructions for each subscale. For the Lebanese sample, half of the participants received the American STAI

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22 first and then received the initial 50 Arabic item pool af ter completing the American STAI. The other half of part icipants received the 50 Arabic item pool first, followed by the American STAI. All participants in both samples were then handed a brief debriefing containing information about their research participati on, the major goals of the study, and contact numbers in the US and Lebanon. Methodological Considerations: Conducting cross-cultural measurement of a psychological trait or construct relates to the issue of unive rsality of the psychological construct and its equivalence cross-culturally. Assuming that a given psychological construct exis ts in two different populations, the question becomes whether or not the construct bear s the same meaning in both cultures. Equivalence of the meaning of the construc t across cultures needs to be addressed before any valid conclusions can be made regarding that construct. In selfreport instruments, the reliance is on items, analyzed both individua lly and collectively. The integrity of the overall construct of anxiety per se relies heavily on item characteristics. In the current study, there were two types of items: translated items that were common to both versions of the STAI (common items) and differed only in terms of language, and items specific to each version (unique items) that differed in language and cultural influences. It was expected that some of the common items adapted from English to Arabic might not be salient to re sponders in Lebanon, even after being judged by experts to be relevant. Furthermore, a dding cultural-specific items to the pool of

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23 Arabic items might have allowed for a unique factor structure unde rlying the experience of anxiety that is conceptually different than the American-based stru cture. This factor structure might also have been sample specif ic, and thus, may have inhibited conclusions about cross-validation of the factor structure in similar samples. Hence, the response data from the Lebanese sample to the Arabic STAI were randomly split into two parts for analyses purposes: one part ( calibration sample) was factorand item-analyzed to select the best 40 Arabic items to assess S-Anxiety and T-anxiety; the other part (validation sample) included factorand item-analyses of the 40 items selected in the first step to validate the 40 items selected in the calibration sample.

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24 Results The main goal of the present study is to develop an Arabic adaptation of the STAI (Form Y, Spielberger, 1983), taking into accoun t the procedures identified as critically important in developing cro ss-cultural adaptations of ps ychological measures (Hulin, 1987; Spielberger, 1983; Spielberger and Sh arma, 1976). Cultural influences on the experience and expression of State and Tra it anxiety were explored by comparing the American to the Lebanese samples. Linguist ic influences were examined within the Lebanese sample responding to the American STAI and the Arabic Adaptation of the STAI. The presentation of the results has a twofold focus depending on the inventory used: American sample responding to the American STAI, and a Lebanese sample responding to the Arabic STAI and American STAI. First, descriptive statistics for responses to the American STAI in American and Lebanese samples will be presented, followed by mean comparisons by gender on all scales and subscales of the American STAI in Lebanese and American samples. Means, standard deviations, alpha-coefficients, t-tests, and correlation coefficients will be summarized and compared. Factor analyses of the S-Anxiety and T-Anxiety will be presented for Lebanese and American samp les responding to the American STAI. Second, the means, standard deviations, internal reliability estimates, mean comparisons by gender, corrected item-total co rrelations coefficients, and item-factor loadings of the 50 Arabic items will be presented. The criteria for selecting the final 40

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25 items of the STAI will be discussed, and the final 40 Arabic Items will be factor and item analyzed. Descriptive Statistics for the American STAI For the American sample, means, standard deviations, and alpha coefficients for the STAI subscales are reported in Table (1 ). Females scored on average higher than males on both subscales and three of the subs cales. Males scored higher than females only on S-Anxiety Absent. The alpha coeffici ents for S-Anxiety (.93 for females, .95 for males) and T-Anxiety (.91 for females, .92 for males) were quite strong. Median alpha for females was .905; for males, it was .91. Table 1 Means, standard deviations, and alpha coeffici ents for Females and Males responding to the American STAI for the Lebanese Sample Females (N = 156) Males (N=130) Scale Mean SD Alpha Mean SD Alpha S-Anxiety 43.20 12.26 .93 41.14 11.98 .93 S-Anxiety-Absent 20.07 6.55 .90 21.98 6.64 .92 S-Anxiety Present 23.13 6.85 .88 19.17 6.60 .89 T-Anxiety 43.77 11.20 .93 42.23 10.95 .93 T-Anxiety-Absent 20.60 5.71 .91 19.95 5.38 .89 T Anxiety-Present 23.17 6.52 .88 22.28 6.94 .90 For the Lebanese sample responding to th e American STAI, de scriptive statistics such as means, standard deviations, and al pha coefficients for the STAI subscales are reported in Table (2). Females scored on average higher than males on all scales and subscales. Alpha coefficients were calculated for S-Anxiety (93 for females, .93 for males) and T-Anxiety (.93 for females, .93 for males). Median Alpha for females was .89; for males, it was .91. Table 2

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26 Means, standard deviations, and alpha coeffici ents for Females and Males responding to the American STAI for the American Sample Females (N = 242) Males (N=94) Scale Mean SD Alpha Mean SD Alpha S-Anxiety 39.77 11.14 .93 38.23 12.35 .95 S-Anxiety-Absent 22.13 6.47 .91 20.98 7.15 .93 S-Anxiety Present 17.64 5.78 .86 17.26 6.01 .89 T-Anxiety 39.48 9.26 .91 38.70 9.89 .92 T-Anxiety-Absent 19.09 4.79 .87 18.68 5.24 .90 T Anxiety-Present 20.39 5.36 .84 20.02 5.66 .86 Age and Gender Comparisons for th e American and Lebanese samples Independent sample t-tests were carried out to test for signi ficant differences on S-anxiety, T-Anxiety, S-Anxiet y Present, S-Anxiety Absent T-Anxiety Present, and TAnxiety Absent across gender within the Amer ican and Lebanese samples responding to the American STAI. The results are summarized in Table 3. As noted, males responded consistently with lower scores than females in both samples but these differences did not reach significant levels. Pearson Product Moment Correlations were calculated to assess the strength and significance of the correlations between age of the respondent and levels of S-anxiety, TAnxiety, S-Anxiety Present, S-Anxiety Absent, T-Anxiety Present, and T-Anxiety Absent subscales within males and females in each sample. For the American sample, there were no significant correlations for fema les or males. For the Lebanese sample, there was no significant correlation for females. However, for the Lebanese males, there was a significant, yet weak negative correlati on between age and T-Anxiety Present (r = .197, p <.05). Table 3

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27 Independent sample T-test across gende r for the American and Lebanese samples (American STAI) American Sample Lebanese Sample t df Sig. t df Sig. S-Anxiety -1.10 334 .271 -1.33 262 .185 S-Anxiety-Absent -1.42 334 .157 -1.47 262 .143 S-Anxiety Present -.55 334 .584 -.96 262 .338 T-Anxiety -.68 331 .499 -1.01 263 .315 T-Anxiety-Absent -.68 331 .495 -.77 263 .439 T Anxiety-Present -.56 331 .578 -1.03 263 .303 P = .05 Females scored consistently higher than males (Tables 1 & 2) Mean Comparisons of the American and Lebanese samples Comparisons of the American and Lebanese samples responding to the American STAI are presented in Table 4. Lebanese responders scored consistently and significantly higher on S-anxiety, T-Anxiety, SAnxiety Present, T-Anxiety Present, and T-Anxiety Absent. There we re no significant differences between the two samples on SAnxiety Absent. A 2X2 ANOVA (Age X gende r) analysis was conducted but did not reveal any significant differences. Table 4 Independent sample T Tests across Lebane se and American Samples (American STAI) American sample means (SD) N=336 Lebanese sample means (SD) N = 282 Independent sample t (df) Significance (2 tailed) S-Anxiety 39.34 (11.5) 42.28 (12.2) 3.08 (615) .002* S-Anxiety-Absent 21.81 (6.7) 22.61 (6.6) 1.50 (615) .134 S-Anxiety Present 17.54 (5.8) 19.67 (6.7) 4.20 (615) .000* T-Anxiety 39.26 (9.4) 43.09 (11.1) 4.62 (613) .000* T-Anxiety-Absent 20.31 (4.9) 20.31 (5.6) 3.17 (613) .002* T Anxiety-Present 20.29 (5.4) 22.77 (6.7) 5.071 (613) .000* Significant p < .05

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28 Factor Analyses for American and Lebanese Samples Responses to the 20 S-Anxiety and 20 T-Anxiety items were factor analyzed for both samples. A Generalized Least Squares extraction method was used to extract communalities, and a Promax Oblique rotati on was conducted. Twoand three-factor solutions were carried out separately for S-Anxiety and T-Anxiety scales. Two and three-factor solutions for the American Sample for S-Anxiety and TAnxiety are shown in Table 4 and Table 5 Respectively. As shown, the three largest eigenvalues were 8.93, 1.7, and 1.14. The number of factors was indicated by the Kaiser criterion of eigenvalues more than one and a scree plot indicating a drop after the third factor, indicating a three-factor solution. However, by use of parallel tests and theoretical meaningfulness, the two-factor solution was also examined. Items are listed in the order of descending magnitude of th eir dominant salient loading on the two-factor solution. The two-factor solution of S-Anxiety (Table 4) for the American sample yielded S-Anxiety Absent (e.g.: I feel content) and S-Anxiety Present (e.g.: I am worried). The three-factor solution produced S-Anxiet y Absent (e.g.: I feel pleasant), Worry (e.g.: I am presently worrying over possible mi sfortunes) and Emotio nality (e.g.: I am tense). Two items had dual salient factor lo adings: I feel at ease loaded on S-Anxiety Absent and Emotionality fact ors; I feel nervous loaded on Worry and Emotionality factors. The Worry factor included ite ms reflecting cognitive and evaluative components. The emotionality factor included items that described feelings and physiological sensations (Table 5).

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29 Table 5 Loadings and eigenvalues for S-Anxiety for the American sample responding to the American STAI 3 Factor Solution 2 Factor Solution S-Anxiety Absent Worry Emotionality S-Anxiety Absent S-Anxiety Present I feel content .776 .855 I feel pleasant .709 .119 .824 I feel steady .639 .117 .203 .791 I am relaxed .531 .102 .490 .786 .107 I feel comfortable .639 .176 .773 I feel satisfied .721 .151 .709 I feel secure .639 .171 .672 I feel strained .385 .469 .610 I feel self-confident .735 .247 .352 .608 I feel calm .259 .634 .555 .239 I am presently worrying over possible misfortunes .586 .150 .716 I feel upset .530 .222 .695 I am worried .505 .235 .677 I feel nervous .381 .446 .668 I am jittery .164 .239 581 .622 I am tense .193 .659 .153 .618 I feel frightened .525 .105 .612 I feel confused .644 .608 I feel strained .233 .509 .151 .571 I feel indecisive .392 .434 Eigenvalues 8.931 1.702 1.141 8.931 1.702 Factor Loadings < .10 were not reported The two-factor solution of T-Anxiety (Table 6) for the American sample yielded T-Anxiety Absent (e.g.: I am content) and T-Anxiety Present (e.g.: I feel that difficulties are piling up so that I cannot overcome them). The three-factor solution produced T-Anxiety Absent (e.g.: I am a st eady person), emotiona lity (e.g.: I feel nervous and restless), and worry (e.g.: I am presently worrying over possible misfortunes).

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30 Two items had dual salient factor loadings: I feel satisfied with myself loaded on S-Anxiety Absent and Emotionality factors; I feel that difficulties are piling up so that I cannot overcome them loaded on Worry and Emotionality factors. The Worry factor included items reflecting cognitive a nd evaluative components. The emotionality factor included items that described feelings and physiological sensations (Table 6). Table 6 Loadings and eigenvalues for T-Anxiety for the American sample responding to the American STAI 3 Factor Solution 2 Factor Solution S-Anxiety Absent Emotionality Worry S-Anxiety Absent S-Anxiety Present I feel pleasant .849 -.169 .820 -.190 I am content .688 .145 .758 I am a steady person .744 .753 I am happy .630 .176 .714 I am calm, cool, and collected .679 .141 .679 I feel secure .630 .672 I feel satisfied with myself .476 .429 -.144 .638 .112 I feel rested .541 .544 I make decisions easily .326 .166 .342 .182 I feel that difficulties are piling up so that I cannot overcome them -.104 .440 .419 .748 I worry too much over something that really doesnt matter .774 .728 I take disappointments so keenly that I cant put them out of my mind -.146 .234 .458 -.155 .651 I get in a state of tension or turmoil as I think over my recent concerns and interests .616 .570 Some unimportant thought runs through my mind and bothers me .101 -.106 .647 .558 I wish I could be as happy as others seem to be .387 .226 .169 .500 I feel nervous and restless .119 .337 .212 .187 .450 I feel like a failure .866 .103 .224 .445 I feel inadequate .657 .203 .417 I have disturbing thoughts .362 .105 .181 .346 I lack self-confidence .136 .435 .269 .320 Eigenvalues 7.596 1.665 1.154 7.596 1.665 Factor Loadings < .10 were not reported

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31 For the Lebanese sample responses to th e American STAI, a two-factor solution of S-Anxiety (Table 7) for the American samp le yielded S-Anxiety Absent (e.g.: I feel content) and S-Anxiety Present (e.g.: I am worried). Table 7 Loadings and eigenvalues for S-Anxiety for the Lebanese sample responding to the American STAI 3 Factor Solution 2 Factor Solution S-Anxiety Absent Worry Emotionality S-Anxiety Absent S-Anxiety Present I feel pleasant .803 .859 I feel content .785 .826 -.166 I am relaxed .738 .209 .814 I feel satisfied .769 -.138 .759 I feel comfortable .662 .696 I feel at ease .580 .152 .360 .677 I feel calm .499 -.119 .389 .595 .145 I feel steady .590 .142 .593 I feel self-confident .602 .329 .311 .519 I feel secure .515 .177 .511 .155 I feel nervous -.112 .409 .509 .791 I am jittery .146 .410 .390 -.126 .712 I am worried .132 .579 .176 .117 .687 I feel frightened .677 .683 I feel confused .108 .630 .653 I feel indecisive .684 .607 I am tense .848 .153 .571 I am presently worrying over possible misfortunes .126 .486 .111 .101 .555 I feel strained .723 .187 .517 I feel upset .113 .525 .141 .493 Eigenvalues 8.675 1.855 1.324 8.675 1.855 Factor Loadings < .10 were not reported The three-factor solution produced S-Anxi ety Absent (e.g.: I feel pleasant), Worry (e.g.: I am worried) and emotionality (e.g.: I am tense). Two items had dual salient factor loadings: I feel at ease loaded on S-Anxiety Absent and Emotionality factors; I feel nervous loaded on Worry a nd Emotionality factors. The Worry factor

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32 included items reflecting cognitive and evalua tive components. The emotionality factor included items that described feelings and physiological sensations (Table 7). The two-factor solution of T-Anxiety (Table 8) for the Lebanese sample responses to the American STAI yielded T-Anxiety Absent (e.g.: I am content) and TAnxiety Present (e.g.: I feel that difficu lties are piling up so that I cannot overcome them). Table 8 Loadings and eigenvalues for T-Anxiety for the Lebanese sample responding to the American STAI 3 Factor Solution 2 Factor Solution S-Anxiety Absent Worry Emotionality S-Anxiety Absent S-Anxiety Present I feel pleasant .872 .875 -.147 I am happy .789 .799 I am content .795 .794 I feel satisfied with myself .671 -.212 .321 .741 I feel secure .701 .714 I am calm, cool, and collected .717 .161 .124 .679 I feel rested .713 .153 -.219 .648 I am a steady person .560 .175 .588 .119 I make decisions easily .357 .102 .125 .367 .199 I feel that difficulties are piling up so that I cannot overcome them .428 .419 .753 I have disturbing thoughts .588 .177 .716 Some unimportant thought runs through my mind and bothers me .810 .116 .702 I get in a state of tension or turmoil as I think over my recent concerns .607 .685 I worry too much over something that really doesnt matter .808 -.165 -.114 .668 I take disappointments so keenly that I cant put them out of my mind .494 .184 .637 I feel inadequate .319 .385 .615 I feel like a failure .742 .580 I feel nervous and restless .203 .459 .111 .174 .561 I lack self-confidence .835 .120 .484 I wish I could be as happy as others seem to be .212 .405 .273 .375 Eigenvalues 8.421 1.976 1.184 8.421 1.976 Factor Loadings < .10 were not reported

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33 The three-factor solution produced T-A nxiety Absent (e.g.: I am content), Emotionality (e.g.: I feel nervous and rest less ), and Worry (e.g.: I worry too much over something that really doesnt matter). Two items had dual salient factor loadings: I feel inadequate loaded on S-Anxiety Absent and Emotionality factors; I feel that difficulties are piling up so that I cannot overcome them loaded on Worry and Emotionality factors. The Worry factor included items reflecting cognitive and evaluative components. The emotionality fact or included items that described feelings and physiological sensations (Table 8). Selection Procedures and Factor Analyses of the Arabic items Selection of the final 40 items Calibration. The criteria for selection of the final 40 Arabic items aimed at reducing the initia l 50item pool (25 in S-Anxiety and 25 in Tanxiety) to 20 items in each scale (S-Anxiety and T-Anxiety), and having 10 items in each subscale (S-Anxiety Absent, S-Anxiety Present, T-Anxiety Ab sent, and T-Anxiety Present). An item may be discarded from the in itial Arabic item pool if: a) there are more than 10 items in any subscale; b) items dis carded have the lowest corrected-item total correlations; c) items have low item-factor lo adings on their respect ive factors; and d) internal consistency coefficients of their resp ective subscales increase with their removal. It should be noted, however, that theoretical meaningfulness is a general governing rule for item selection. Item characteristics such as corrected item-total correlation, alpha coefficients if-item-deleted fo r each of the items in the four subscales (S-Anxiety Absent, S-Anxiety Present, T-Anxiety Absent, and T-Anxiety Present) are presented in Table 9.

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34 Table 9 Corrected Item Total Correlations, Alpha Co efficients, and 2 Factor solution for the Initial Arabic Item Pool-Calibration Item Corrected Item Total corr. Alpha if item deleted 2 Factor Solution Item Corrected Item Total corr. Alpha if item deleted 2 Factor Solution S-Anxiety Absent = .924 SAnxiety Absent Factor SAnxiety Present Factor T-Anxiety Absent = .906 TAnxiety Absent Factor TAnxiety Present Factor Arabic 1 .74 .916 .614 .240 Arabic 26 .62 .900 .655 Arabic 2 .64 .920 .533 .212 Arabic 28 .69 .896 .630 Arabic 5 .83 .920 .607 Arabic 31 .71 .895 .670 Arabic 8 .60 .921 .591 Arabic 32 .57 .902 .611 Arabic 10 .69 .918 .652 Arabic 35 .77 .890 .840 Arabic 11 .48 .924 .472 Arabic 38 .74 .893 .705 Arabic 15 .76 .915 .618 .230 Arabic 39 .38 .913 .343 Arabic 16 .66 .919 .687 Arabic 41 .73 .893 .895 .189 Arabic 19 .68 .918 .763 .117 Arabic 44 .58 .901 .718 Arabic 20 .76 .915 .787 Arabic 49 .73 .984 .786 Arabic 22 .79 .914 .877 Arabic 50 .67 .987 .588 .139 Arabic 23 .71 .917 .812 -.124 Arabic 25 .58 .922 .632 S-Anxiety Present = .880 T-Anxiety Present = .892 Arabic 3 .68 .865 .770 Arabic 27 .61 .883 .106 .577 Arabic 4 .35 .884 .350 Arabic 29 .54 .886 .374 .371 Arabic 6 .65 .866 .127 .611 Arabic 30 .41 .891 .358 Arabic 7 .46 .878 .510 Arabic 33 .61 .883 .203 .490 Arabic 9 .55 .872 .683 Arabic 34 .56 .885 .808 Arabic 12 .60 .869 .103 .622 Arabic 36 .76 .875 .773 Arabic 13 .63 .868 .630 Arabic 37 .39 .896 .247 .463 Arabic 14 .56 .872 .687 Arabic 40 .45 .890 .317 .302 Arabic 17 .70 .863 .708 Arabic 42 .58 .884 .815 Arabic 18 .73 .861 .796 Arabic 43 .66 .881 .733 Arabic 21 .67 .865 .749 Arabic 45 .56 .885 .609 Arabic 24 .40 .882 .432 Arabic 46 .65 .888 .134 .648 Arabic 47 .60 .883 .169 .878 Arabic 48 .64 .882 .674 Eigenvalues 9.89 2.5 Eigenvalues 9.56 2.6 Factor Loadings < .10 were not reported Initial Arabic item pool for S-Anxiety Absent included 13 items. Items with the three lowest corrected itemtotal correlation with S-A nxiety Absent subscale were discarded (8. ashur bil-iktif , I feel content; 1 1. ashur bil-thiqa f nafs I feel self-

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35 confident; and ashur bil-r ha al-jasad yya, I feel physically comfortable). Two of the discarded items (8, 11) were translated from the American STAI, whereas item 25 is from the pool of additional Arabic items provided by the experts. Item 11 had the lowest item-factor loading on S-Anxiety Absent fact or, item 8 had third lowest item-factor loading on S-Anxiety Absent factor, and item 25 had seventh lowest item-factor loading on S-Anxiety Absent factor. None of the di scarded items had dual item-factor loadings on S-Anxiety Absent and SAnxiety Absent factors. Initial Arabic item pool for S-Anxiety Pr esent included 12 items. The items with the two lowest corrected item-total correlation with S-Anxiety Present subscale were discarded (. ashur bil-ijh d, I feel strained; and ashur bi-adam al-qudra al ittikh dh qar r, I feel incapable of making decisions ). Item 4 was translated from the American STAI and had the lowest item-fact or loading on S-Anxiety Present, whereas item 11 was from the pool of additional Arabic items provided by the experts and had the second lowest corrected item-total correlation and the second lowest item-factor loading on S-Anxiety Present factor. None of the di scarded items had dual item-factor loadings on S-Anxiety Absent and S-A nxiety Present factors. Initial Arabic item pool for T-Anxiety Ab sent included 11 items. The item with the lowest corrected item-total correlation w ith T-Anxiety Absent s ubscale was discarded (. Ana datan attakhidh al-qar r t bi-suh la wa bi-sura, I make decisions easily). Item 39 was translated from the American ST AI, had the lowest it em-factor loading on SAnxiety Absent, and did not have a du al loading on T-Anxiety Present..

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36 Initial Arabic item pool for T-Anxiety Pr esent included 14 items. The items with the four lowest corrected item-total correla tions with T-Anxiety Present subscale were discarded (. Ana datan ataman law kuntu sa dan mithl alkhar n, I wish I could be as happy as others seem to be; Ana datan ashur annan f shil f hay t I feel like a failure; Ana datan ashur annan ghayr kafu, I feel in adequate; and Ana datan tankusuni al-thiqa f nafs I lack self-confidence ). Items 37, 30, 40, and 29 were translated from the American STAI a nd had the lowest, second lowest, third lowest, and fourth lowest item-factor loadings on TAnxiety Present, respectively. Three items (29, 37, 40) had dual item-factor loadings on S-Anxiety Present and T-Anxiety Absent. Factor Analyses and Internal Consiste ncy for the Arabic STAI Validation. The initial Arabic item pool was reduced form 50 items to 40 items in the Arabic STAI to match the American STAI. As compared to the American STAI, however, there are 10 items for each subscale (S-Anxiety Absent, SAnxiety Present, T-Anxiety Absent, and TAnxiety Present). In order to validate the selection process, a similar process to that completed in the calibration sample was followed for validation sample. Corrected item-total correlations, Alpha coefficients for subscales alpha coefficients if-item-deleted, and 2 factor solution are presented in Table 10. Initial Arabic item pool for S-Anxiety Absent included 13 items. Items with the three lowest corrected itemtotal correlation with S-A nxiety Absent subscale were discarded (8. ashur bil-iktif , I feel content; 1 1. ashur bil-thiqa f nafs I feel selfconfident; and ashur bil-r ha al-jasad yya, I feel physically comfortable). Two of

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37 the discarded items (8, 11) were translated from the American STAI, whereas item 25 is from the pool of additional Arabic items provided by the experts. Item 11 had the lowest item-factor loading on S-Anxiety Absent fact or, item 8 had third lowest item-factor loading on S-Anxiety Absent factor, and item 25 had seventh lowest item-factor loading on S-Anxiety Absent factor. None of the di scarded items had dual item-factor loadings on S-Anxiety Absent and SAnxiety Absent factors. Internal consistency coefficients for S-Anxiety Absent, S-Anxiety Present, TAnxiety Absent, and T-Anxiety Present are .926, .911, .910, and .905, respectively, as compared to those in the calibration sample (.924, .880, .906, and .892, respectively), which indicates a noticeable increase in intern al consistency for each o these subscales. More notably were the increases in internal consistency coefficients on both S-Anxiety Present (.880 to .911), and T-Anxiety Presen t (.892 to .905). In addition, none of the corrected item-total corr elations for the 40 items was less than .53, which is significantly higher than the .30 cutoff point proposed by Nunnally and Bernstein ( 1994) to indicate a weak item. The 40 items are hencefor th referred to as the Arabic STAI. The two-factor solution of S-Anxiety (Table 10) for the Lebanese sample responses to the Arabic ST AI yielded S-Anxiety Absent (e.g.: Ashur bil-am n, I feel secure) and S-Anxiety Present (e.g.: Ashur bil-khawf, I f eel frightened). The two-factor solution of T-Anxiety (Table 9) for the Lebanese sample responses to the Arabic STAI yielded T-Anxiety Absent (e.g.: Ana datan sa d, I am happy) and S-Anxiety Present (e.g.: 47. Tashghalun datan um r t fiha, I am usually preoccupied

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38 with unimportant things). None of the 40 items had significant dual loadings on any of the two factors, which appr oached a simple solution. Table 10 Corrected Item Total Correlations, Alpha Co efficients, and 2 Factor solution for the Arabic STAI Validation Item Corrected Item Total correlation Alpha if item deleted 2 Factor Solution Item Corrected Item Total corr. Alpha if item deleted 2 Factor Solution SAnxiety Absent = .926 SAnxiety Absent Factor S-Anxiety Present Factor TAnxiety Absent = .910 T-Anxiety Absent Factor TAnxi ety Prese nt Facto r Arabic 1 .64 .922 .481 .275 Arabic 26 .57 .907 .627 Arabic 2 .63 .923 .650 Arabic 28 .68 .900 .723 Arabic 5 .68 .921 .504 .299 Arabic 31 .78 .895 .744 Arabic 10 .75 .917 .656 .121 Arabic 32 .53 .912 .448 .198 Arabic 15 .73 .918 .579 .285 Arabic 35 .93 .891 .804 .105 Arabic 16 .71 .919 .846 -.170 Arabic 38 .63 .903 .641 Arabic 19 .71 .919 .704 Arabic 41 .81 .893 .982 -.287 Arabic 20 .78 .915 .913 -.126 Arabic 44 .66 .902 .671 Arabic 22 .83 .912 .976 -.119 Arabic 49 .77 .895 .715 .113 Arabic 23 .72 .918 .894 -.108 Arabic 50 .56 .908 .432 .220 S-Anxiety Present = .911 TAnxiety Present = .905 Arabic 3 .69 .901 .183 .663 Arabic 27 .56 .901 .178 .523 Arabic 6 .66 .903 .247 .564 Arabic 33 .72 .891 .145 .676 Arabic 7 .63 .905 -.142 .738 Arabic 34 .73 .891 .831 Arabic 9 .64 .904 -.242 .820 Arabic 36 .60 .899 .209 .512 Arabic 12 .59 .907 .114 .613 Arabic 42 .73 .891 -.122 .851 Arabic 13 .68 .902 .718 Arabic 43 .63 .898 .628 Arabic 14 .59 .907 .623 Arabic 45 .61 .898 .206 .533 Arabic 17 .77 .896 .866 Arabic 46 .65 .896 .703 Arabic 18 .69 .901 .695 Arabic 47 .68 .893 -.152 .842 Arabic 21 .81 .893 .119 .822 Arabic 48 .70 .893 .778 Eigenvalues 9.04 2.81 Eigenvalues 8.56 2.68 Factor Loadings < .10 were not reported

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39 Discussion The main goal of the present study was to develop an Arabic adaptation of the STAI (Form Y, Spielberger, 1983). Of e qual interest was assessing cultural and linguistic influences on the e xperience and expression of anxiety. The study followed procedures identified as critically important in developing cross-cult ural adaptations of psychological measures (Hulin, 1987; Spielb erger, 1983; Spielberger & Sharma, 1976). By collaborating with bilingual linguisti c and subject-matter experts, and by adhering to conceptual definitions of state and trait anxiety, an initial pool of Arabic items was developed and administered to a sample of bilingual Lebanese college students, along with the American STAI. Th e American STAI was also administered to an American sample of college students. Item and factor analyses were conducted on responses of the calibration sample to obtain the final set of Arabic items, whic h was validated using the responses of the validation sample. The present study demonstrates severa l advantages over previous Arabic adaptations of the STAI. First is adhering to conceptual definitions of state and trait anxiety as psychological constr ucts in item development. Second is collaborating with experts and using a calibration and validation samples for the final Arabic pool (Arabic STAI). Third is assessing for linguistic a nd cultural differences in the experience and expression of anxiety. Fourth, including equal numbers of T-Anxiety Present and T-

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40 Anxiety Absent items, which is an advantag e over previous adaptations and the American STAI. The results of this study can be discusse d in two major parts, cross-cultural and linguistic comparisons and the development of the Arabic STAI. Results for the Lebanese and American samples responding to the American STAI indicate that Lebanese students reported significantly higher anxiety levels than their American peers on S-Anxiety Present, T-Anxiety Absent, and T-Anxiety Present, S-Anxiety and T-Anxiety. For SAnxiety Absent, scores for the Lebanese samp le were lower than American students but did not reach significance levels. This is similar to recent fi ndings of Japanese students scoring higher on levels of a nxiety as compared to their American peers (Iwata et al, 1998). It should be noted that S-Anxiety Ab sent and T-Anxiety Ab sent subscales assess lower levels of anxiety rather than the hi gher levels of anxiet y assessed by S-Anxiety Present and T-Anxiety Present, which indi cates that Lebanese college students experience higher levels of mild a nxiety and severe anxiety symptoms. Taken together, these results call the attention for a universal finding that American college students tend to experien ce and report anxiety less often and with lower levels than other cultural groups. This could be due to either lower levels of anxiety in Americans as compared to Arabic speaking Lebanese coll ege students or that Arabic speaking Lebanese sample experience and express more anxiety levels. Although the former is more speculative, the latter coul d be attributed to soci o-political influences such as recent civil wars, high unemploymen t rate, and high inflation indices, which may have affected levels of anxiety in Lebanese college students.

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41 Comparing across gender for each of the American and Lebanese samples revealed that females tend to experience and express higher levels of mild and severe anxiety symptoms as compared to males wi thin their respective cultures. These differences did not reach si gnificance levels, however, but still possess a useful qualitative nature that ca n be addressed in research and clinical settings. The results from the factor analyses of the American STAI for the American and Lebanese samples revealed a strikingly sim ilar two and threefact or solutions. The twofactor solution has been found in previous res earch with cross-cultural adaptations of the STAI, and represented a simple and very strong solution yielding Anxiety Absent and Anxiety Present factors for each of th e state and trait anxiety scales for both samples. For each of the State and trait s ubscales, three factors emerge d: Anxiety Absent, Worry, and Emotionality factors, denoting the importa nce of cognitions and feelings in the experience and expression of anxiety. This three-factor soluti on has been found with research using the Test Anxiety Inventor y, but it has not, however, been found in previous research with the STAI to date. Although the Emotionality factor included items indicating feelings, some items simultaneously denoted elements of cogniti ons. For example, I feel inadequate included feel which denoted a specific qua lity f feelings, yet also included inadequate which implies a c ognitive evaluation of ones self-worth and adequacy. Similarly, the Worry factor included items denoting cognitive qualities in addition to emotional qualities. An example of these it ems is I feel confused, which included confused as a cognitive state and feel as a quality of feeling. Taken together, the

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42 results of the three-factor so lution in this study represent a first step towards revising the STAI (Form Y) to include equal numbers of anxiety present and anxiety absent items and equal and distinct items refl ecting cognitions and feelings. In conducting item selection and valida tion of the Arabic STAI, internal consistency coefficients for subscales, correct ed item-total correlations, alpha coefficients if-item-deleted, item-factor lo adings, and theoretical meani ngfulness were all used as criteria for selection of the best 40 Arabic ite ms to be included in the final Arabic pool (i.e.: Arabic STAI). The resulting 40-ite m Arabic STAI showed improvement in the validation sample after the extra 10 items were removed, as indicated by internal consistency coefficients and f actor loadings on the two-factor solution. The two factor solution for the Arabic STAI yielded a simple solution with two distinct factors: Anxiety Present and Anxiety Absent for each of SAnxiety and T-Anxiety, lending more support to the theoretical distinction of state and trait anxiety. The current study has several limitations. The sample size for the Lebanese sample was not large enough for the purposes of this study. Specifically, the number of Lebanese respondents to the initial Arabic pool of items was smaller than planned, due logistical problems. More validity of the cu rrent results would have been obtained with a larger sample. Another limitation was the us e of college populations in both samples, which does not represent the general populati on in terms of intellectual and education levels. A third limitation was the number of additional alternative translations for items suggested by the experts. Despite the attemp t to encourage the experts to offer as many alternative possible translations, only 10 items were suggested. This small number of

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43 alternative translations may have attenuated a more comp rehensive list of cultureappropriate items from being included in the initial Arabic pool. A fourth limitation relates to having unequal numbers of males a nd females in the American sample, which may have affected some conclusions regarding the levels of experi ential and expressive anxiety. Future studies would benefit form a dhering to the methodological framework constructed for this study. A range of possibl e applications of this framework includes but is not limited to validation of the Arab ic STAI in other Arab Speaking countries, adapting the STAI into other languages or re vising previous adaptations, adapting other measures of anxiety and or depression in a similar fashion to allow for conclusion regarding the convergent and discriminant va lidities f the concept of anxiety as an emotional state and a personality trait. The current study represents a pioneer effort for cross-cultural cl inical research in the Middle East. This region has been t hus far underrepresented in cross-cultural research in clinical psychology. With a population of more than 300 million people, sharing a common language and a cultural he ritage for more than 1000 years, it represents a fertile yet still unexplored grounds for the advancement of cross-cultural psychology aimed at understanding cultural and linguistic differences, especially in our tumultuous times of cultural sensitivity and mistrust. The time has come for establishing channels for cultural understanding and bridging many illusory differences. Salam alaikom : Peace be with you!

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44 References Barnes, L. L. B., Harp, D., Jung, W. S. (2002). Reliability generalizatio n of scores on the Spielberger state-trait anxiety inventory. Educational and Psychological Measurement, 62(4), 603-618. Bartsch, T. W., & Nesselroade, J. R. (1973). Test of state-trai t anxiety distinction using a manipulative factor analysis design. Journal of Personality and Social Psychology, 27, 58-64. Bartsch, T. W. (1976). A manipulative study of the effect of inst ructional set on the convergent and discriminant va lidity of questionnaire m easures of state and trait anxiety: A comparative f actor analytic approach. Educational and Psychological Measurement, 36, 885-898. Bouchard S. P., Ivers H., Gauthier J. G ., Pelletier M. H., & Savard J. (1998). Psychometric properties of the French version of the State-Trait Anxiety Inventory (form Y) adapted for older adult. Canadian Journal on Aging, 17(4), 440-453. Browne, M., Cudech, A., Tateneni, K. & Mels, G. (1998). CEFA: comprehensive Exploratory Factor Analysis [Computer software and manual] Retrieved from http://quantrm2.psy.ohio-state.edu/browne/. Cattell, R. B., & Scheier, I. H. (1961). The meaning and measurement of neuroticism and anxiety. New York: Ronald Press.

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45 Cattell, R. B. (1966). Anxiety and motivation: theory and crucial experiments. In C. D. Spielberger (Ed.), Anxiety and Behavior (pp. 23-62). New York: academic Press. De Snyder, V. N. S., Diaz-Perez, D. & Ojeda, V. D. (2000) The prevalence of Nervios and associated symptomatology among inhabitants of Mexican rural communities. Culture, Medicine, and Psychiatry, 24, 453-470. Fonesca, A. C., Yule, W., & Erol, N. (1994). Cross-Cultural issues. In T. H. Ollendick, N. J. King, & W. Yule (Eds.), International handbook of phobic and anxiety disorders in children and adolescents (pp. 67-84). Freud, S., (1924). A general introduction to psychoanalysis Washington Square Press, New York Geisinger, K. F. (1994). Cross-cultural nor mative assessment translation and adaptation issues influencing the normative inte rpretation of assessment instruments. Psychological Assessment, 6(4), 304-312. Hulin, C. L. (1987). A psychometric theory of evaluations of item and scale translations: fidelity across languages. Journal of Cross-Cultural Psychology, 18(2), 115-142. Iwata, N., Nishima, N., Shimizu, T., Mizoue T., Fukhura, M., Hidano, T., & Spielberger, C. D. (1998). Positive and negative affect in the factor structure of the State-Trait Anxiety Inventory for Japanese workers. Psychological Reports, 82(2), 651-656. Martuza, V. R., & Kallstrom, D. W. (1974). Va lidity of the State-Trait Anxiety Inventory in an academic setting. Psyhcological Reports, 35, 363-366. Nazemi, H., Kleinknecht, R. A., Dinnel, D. L ., Lonner, W. J., Nazemi, S., Shamlo, S., & Sobhan, A. (2003). A study of panic atta ck sin university students of Iran. Journal

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46 of Psychopathology and Behavioral Assessment, 25(3), 191-201. Nunnally,J. C., & Bernstein, I. H. (1994). Psychometric Theory (3 rd Edition). New York: McGraw-Hill Oei, T. P. S., Evans, L., & Crook, G. M. ( 1990). Utility and validity of the STAI with anxiety disorder patients. British Journal of Clinical Psychology, 29, 429-432. Okun, A., Stein, R. E. K., Bauman, L. J., & S ilver, E. J. (1996). Content validity of the Psychiatric Symptom Index, CES-Depres sion scale, and State-Trait Anxiety Inventory from the perspective of the DSM-IV. Psychological Reports, 79, 10591069. Sesti, A. (2000). State Trait Anxiety I nventory in medication clinical trials. Quality of Life Newsletter, 25, 15-16. Spielberger, C. D. (1966a). A nxiety and behavior. New York: Academic Press. Spielberger, C. D. (1971). Traitsate anxiety and motor behavior. Journal of Motor behavior, 3, 265-279. Spielberger, C. D. (1976a). The nature and m easurement of anxiety. In C. D. Spielberger, & R. Diaz Guerrero (Eds.), Series in clinical and community psychology (pp. 312). Washington, DC: Hemisphere Publishing Corporation, Spielberger, C. D. (1972). Conceptual and me thodological issues in anxiety research. In C. D. Spielberger (Ed.), Anxiety: Current trends in theory and research (pp. New York: Academic Press. Spielberger, C. D., Gonzalez-Reigosa, F., Ma rtinez-Urrutia, A., Natalicio, L. & Natalicio,

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47 D. (1971). Development of the Spanish edition of the State-Trait Anxiety Inventory. Interamerican Journal of Psychology, 5, 3-4. Spielberger, C. D., Gorsuch, R., Lushene, R., Vagg, P. R., & Jacobs, G. A. (1983). Manual for the State-Trait Anxiety Inventory (Form Y). (Palo Alto, CA: Consulting Psychologists Press.) Spielberger, C. D., & Sharma, S. (1976). Cross cultural measurement of anxiety. In C. D. Spielberger, & R. Diaz Guerrero (Eds.), Series in clinical and community psychology (pp. 13-25). Washington, DC: Hemis phere Publishing Corporation Spielberger, C. D., Sydeman, S. (1994). Stat e-Trait Anxiety Invent ory and State-Trait Anger Expression Inventory. In M. E. Maruish (Ed.), The use of psychological testing for the tr eatment planning and outcome assessment. Lawrence Erlbaum Associates, Inc. Hillsdale, NJ. Spielberger, C. D., Vagg, P. R., Barker, L. R., Donham, G. W., & Westberry (1980). The factor structure of the Stat e-Trait Anxiety Inventory. In I. G. Sarason, & C. D. Spielberger (Eds.), Stress and Anxiety, (vol. 7). Hemisphere, Washington, D.C. Wadsworth, P. A., Barker, H. R., & Barker, B. M. (1976). Factor structure of the StateTrait Anxiety Inventory under c onditions of variable stress. Journal of Clinical Psychology, 32(2), 576-579.

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48 Appendices

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49 Appendix A Informed ConsentUSF Site Social and Behavioral Sciences University of South Florida In collaboration with Psychiatry Department at the American University of Beirut Medical Center. Information for People Who Take Part in Research Studies The following information is being presented to help you decide whether or not you want to take part in a minimal risk research study. Please read this carefully. If you do not understand anything, ask the person in charge of the study. Title of Study: Adaptation of the State Trait Anxiety Inventory in Arabic: A Comparison with the American STAI Principal Investigator: Qutayba Abdullatif, MA Study Location(s): University of South Florida You are being asked to participate because you are a college student between the ages of 18 and 25 years. General Information about the Research Study The purpose of this research study is to assess anxiety feelings due to everyday experiences as emotional states (how you feel right now) and personality traits (how you feel generally). Plan of Study You will be asked to respond to 40-item questionnaire that will take around 20 minutes of your time. Payment for Participation You will not be paid for your participation in this study Benefits of Being a Part of this Research Study By participating in this study, you will be able to contribute to psychological research on cross-cultural anxiety. In addition, you will receive one extra credit point. Risks of Being a Part of this Research Study We expect no risk associated with participating in this study beyond what is caused by daily life experiences. These are 40 non-intrusive items about how you generally feel and think and do not ask about critical or private information. Confidentiality of Your Records Your privacy and research records will be kept confidential to the extent of the law. Authorized research personnel, employees of the Department of Health and Human Services, and the USF Institutional Review Board may inspect the records from this research project.

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50 Appendix A. (continued) The results of this study may be published. However, the data obtained from you will be combined with data from others in the pub lication. The published re sults will not include your name or any other information that would personally identify you in any way. No identifying information will be required of you on the questionnaire. This Informed consent will be separated form your responses. Only the Principal investigator and his major faculty advisor will have access to your information. Records will be kept under lock and key. Volunteering to Be Part of this Research Study You are free to withdraw at any time. Ther e will be no penalty or loss of benefits to which you are entitled if you stop participating. Questions and Contacts If you have any questions about this re search study, contac t Qutayba Abdullatif, MA. at 1-813-974-3082 (e-mail address: qutaybaa@mail.usf.edu ) or Brigitte Khoury, Ph.D., at +961-1-355-650/1. If you have questions about your rights as a person who is taking part in a research study, you may contact the Division of Research Compliance of the University of South Florida at 1-813-974-5638. Consent to Take Part in This Research Study By signing this form I agree that: I have fully read or have had read and e xplained to me this informed consent form describing this research project. I have had the opportunity to question one of the persons in charge of this research and have received satisfactory answers. I understand that I am being asked to pa rticipate in research. I understand the risks and benefits, and I freely give my consent to participate in the research project outlined in this form, unde r the conditions indicated in it. I have been given a signed copy of this informed consent form, which is mine to keep. ______________ _______________ _______ Signature of Participant Printed Name of Participant Date Investigator Statement I have carefully explained to the subject the nature of the above re search study. I hereby certify that to the best of my knowledge the subject signing this consent form understands the nature, demands, risks, and benefits involved in participating in this study. ___________________ ________________ _______ Signature of Investigator Printe d Name of Investigator Date

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51 Appendix B Informed ConsentAmerican University of Beirut Site Social and Behavioral Sciences University of South Florida In collaboration with Psychiatry Department at the American University of Beirut Medical Center. Information for People Who Take Part in Research Studies The following information is being presented to help you decide whether or not you want to take part in a minimal risk research study. Please read this carefully. If you do not understand anything, ask the person in charge of the study. Title of Study: Adaptation of the State Trait Anxiety Inventory in Arabic: A Comparison with the American STAI Principal Investigator: Qutayba Abdullatif, MA Study Location(s): American University of Beirut, Beirut, Lebanon. You are being asked to participate because you are a college student between the ages of 18 and 25 years. General Information about the Research Study The purpose of this research study is to assess anxiety feelings due to everyday experiences as emotional states (how you feel right now) and personality traits (how you feel generally). Plan of Study You will be asked to respond to 40-item questionnaire that will take around 20 minutes of your time. Payment for Participation You will not be paid for your participation in this study Benefits of Being a Part of this Research Study By participating in this study, you will be able to contribute to psychological research on cross-cultural anxiety. Risks of Being a Part of this Research Study We expect no risk associated with participating in this study beyond what is caused by daily life experiences. These are 40 non-intrusive items about how you generally feel and think and do not ask about critical or private information. Confidentiality of Your Records Your privacy and research records will be kept confidential to the extent of the law. Authorized research personnel, employees of the Department of Health and Human Services, and the USF Institutional Review Board may inspect the records from this research project.

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52 Appendix B. (continued) The results of this study may be published. However, the data obtained from you will be combined with data from others in the pub lication. The published re sults will not include your name or any other information that would personally identify you in any way. No identifying information w ill be required of you on the que stionnaire. This Informed consent will be separated form your responses. Only the Principal investigator and his major faculty advisor will have access to your information. Records will be kept under lock and key. Volunteering to Be Part of this Research Study You are free to withdraw at any time. Ther e will be no penalty or loss of benefits to which you are entitled if you stop participating. Questions and Contacts If you have any questions about this re search study, contac t Qutayba Abdullatif, MA. at 1-813-974-3082 (e-mail address: qutaybaa@mail.usf.edu ) or Brigitte Khoury, Ph.D., at +961-1-355-650/1. If you have questions about your rights as a person who is taking part in a research study, you may contact the Division of Research Compliance of the University of South Florida at 1-813-974-5638. Consent to Take Part in This Research Study By signing this form I agree that: I have fully read or have had read and e xplained to me this informed consent form describing this research project. I have had the opportunity to question one of the persons in charge of this research and have received satisfactory answers. I understand that I am being asked to pa rticipate in research. I understand the risks and benefits, and I freely give my consent to participate in the research project outlined in this form, unde r the conditions indicated in it. I have been given a signed copy of this informed consent form, which is mine to keep. __________________ ____________________ ________ Signature of Participant Printed Name of Participant Date Investigator Statement I have carefully explained to the subject the nature of the above re search study. I hereby certify that to the best of my knowledge the subject signing this consent form understands the nature, demands, risks, and benefits involved in participating in this study. _________________ _____________________ ________ Signature of Investigator Printe d Name of Investigator Date


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ABSTRACT: The main goal of the present study was to develop an Arabic adaptation of the State Trait Anxiety Inventory (STAI, Form Y, Spielberger, 1983). In addition, cultural and linguistic influences on the experience and expression of anxiety were assessed. The American STAI and fifty initial Arabic items were administered to 286 university students at the American University of Beirut, Lebanon. The American STAI was also administered to 336 university students at the University of South Florida. Item and factor analyses were conducted on responses of the calibration sample to obtain the final set of Arabic items, which was validated using the responses of the validation sample. In conducting item selection and validation of the Arabic STAI, internal consistency coefficients for subscales, corrected item-total correlations, alpha coefficients if-item-deleted, item-factor loadings, and theoretical meaningfulness were all used as criteria for selection of the best 10 Arabic items to be included in each subscale of the STAI: S-Anxiety Absent, S-Anxiety Present, T-Anxiety Absent, T-Anxiety present. The two-factor solution for the Arabic STAI yielded a simple solution with two distinct factors: Anxiety Present and Anxiety Absent for each of S-Anxiety and T-Anxiety, lending more support to the theoretical distinction of state and trait anxiety. Lebanese students reported significantly higher anxiety levels than their American peers on S-Anxiety Present, T-Anxiety Absent, and T-Anxiety Present, S-Anxiety and T-Anxiety of the American STAI. For S-Anxiety Absent, scores for the Lebanese sample were lower than American students but did not reach significance levels. S-Anxiety Absent and T-Anxiety Absent subscales assessed lower levels of anxiety rather than the higher levels of anxiety assessed by S-Anxiety Present and T-Anxiety Present. Females tend to experience and express higher levels of mild and severe anxiety symptoms as compared to males in both samples. Factor analyses of the American STAI for the American and Lebanese samples revealed similar two and three- factor solutions. For each of the State and trait subscales, three factors emerged: Anxiety Absent, Worry, and Emotionality factors, denoting the importance of cognitions and feelings in the experience and expression of anxiety
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