1

Development of a Semi-Idiographic Measure of Guilt-Proneness for

Adolescents

Erin Elizabeth Brennan

Submitted for the Degree of

Doctor of Psychology(Clinical Psychology)

School of PsychologyFaculty of Arts and Human Sciences

University of Surrey

Guildford, Surrey

United Kingdom

September 2015

2

ABSTRACT

Objective: Guilt is a self-conscious emotion with cognitive, affective and behavioural

components. In young people, it has been linked with prosocial behaviour and academic

achievement but, when excessively or insufficiently expressed, can adversely impact on

mental health. Most existing measures of guilt-proneness for adolescents have scenario-

based designs, which may not capture unique personal and cultural experiences of guilt.

Semi-idiographic measures, where respondents rate responses based on a subjectively

recalled guilt-experience, have been recommended as an alternative, yet no existing

measure for young people has used this format. The main objective was to therefore

develop, pilot and validate a new semi-idiographic measure of guilt-proneness for

adolescents aged 11 to 18.

Design and Participants: The design comprised two studies. Study one involved

measure development and interviews with nine young people. Items were compiled

using interview data and a review of relevant literature. A subsequent focus group was

conducted, during which the drafted measure was piloted. In Study two, the new guilt

measure was validated against measures of anxiety, depression, self-compassion, shame,

guilt and anger with a sample of 412 young people.

Results: Content analysis was used to extract guilt-related thoughts, feelings and

behaviours from the interviews. The Guilt Scale for Adolescents (GSA) was then

drafted. Exploratory factor analysis was conducted on the GSA to examine its

underlying structure and refine and reduce items. A final 19-item GSA was produced,

with four subscales: ‘Inner Turmoil’, ‘Reparation’, ‘Physiological Reactions’ and

‘Regret and Self-Blame’. Validity and reliability hypotheses were supported.

Conclusions: The GSA is the first semi-idiographic measure of guilt for adolescents. It

uniquely breaks down guilt experiences into four different sub-components and scores.

The GSA therefore has the potential to promote further understanding of guilt-proneness

in young people. Limitations and future implications are discussed.

Keywords: Guilt, Adolescence, Assessment, Self-Conscious Emotions

3

ACKNOWLEDGMENTS

I would like to thank the University of Surrey PsychD course team, including my

clinical tutor, research supervisors and the course administration team. I would also like

to thank my fellow trainees in Cohort 41, as well as the many multidisciplinary teams,

supervisors and service users I have met whilst on clinical placement.

Finally, I would like to thank my husband, mom, dad, brother and friends for their

continued love and support throughout the last three years of training.

4

TABLE OF CONTENTS

Research

MRP Empirical Paper (including abstract) ………………………………………………………………….. 6

MRP Empirical Paper Appendices ……………………………………………………………………………….. 69

MRP Proposal (without appendices) ……………………………………………………………………………. 178

MRP Literature Review ………………………………………………………………………………………………… 201

Clinical

Clinical Experience ……………………………………………………………………………………………………….. 254

Assessments

List of Academic Assessments ……………………………………………………………………………………… 258

5

RESEARCH

6

MRP Empirical Paper (including Abstract)

7

Development of a Semi-idiographic Measure of Guilt-proneness for Adolescents

By

Erin Elizabeth Brennan

Submitted in partial fulfilment of the degree of Doctor of Psychology (Clinical

Psychology)

School of Psychology

Faculty of Arts and Human Sciences

University of Surrey

March 2015

Word Count: 9999

8

ABSTRACT

Objective: Guilt is a self-conscious emotion with cognitive, affective and behavioural

components. In young people, it has been linked with prosocial behaviour and academic

achievement but, when excessively or insufficiently expressed, can adversely impact on

mental health. Most existing measures of guilt-proneness for adolescents have scenario-

based designs, which may not capture unique personal and cultural experiences of guilt.

Semi-idiographic measures, where respondents rate responses based on a subjectively

recalled guilt-experience, have been recommended as an alternative, yet no existing

measure for young people has used this format. The main objective was to therefore

develop, pilot and validate a new semi-idiographic measure of guilt-proneness for

adolescents aged 11 to 18.

Design and Participants: The design comprised two studies. Study one involved

measure development and interviews with nine young people. Items were compiled

using interview data and a review of relevant literature. A subsequent focus group was

conducted, during which the drafted measure was piloted. In Study two, the new guilt

measure was validated against measures of anxiety, depression, self-compassion, shame,

guilt and anger with a sample of 412 young people.

Results: Content analysis was used to extract guilt-related thoughts, feelings and

behaviours from the interviews. The Guilt Scale for Adolescents (GSA) was then

drafted. Exploratory factor analysis was conducted on the GSA to examine its

underlying structure and refine and reduce items. A final 19-item GSA was produced,

with four subscales: ‘Inner Turmoil’, ‘Reparation’, ‘Physiological Reactions’ and

‘Regret and Self-Blame’. Validity and reliability hypotheses were supported.

Conclusions: The GSA is the first semi-idiographic measure of guilt for adolescents. It

uniquely breaks down guilt experiences into four different sub-components and scores.

The GSA therefore has the potential to promote further understanding of guilt-proneness

in young people. Limitations and future implications are discussed.

Keywords: Guilt, Adolescence, Assessment, Self-Conscious Emotions

9

STATEMENT OF JOURNAL CHOICE

This paper will be submitted to the Journal of Adolescence. This journal has a

reasonable impact factor of 1.638. This means that articles published in this journal are

widely disseminated and cited amongst other researchers. It is also an international

journal, so has the scope to reach a wide geographical area. Publications within the

Journal of Adolescence target a range of disciplines including psychologists,

psychiatrists, social workers and youth workers in practice, and university faculty in the

fields of psychology, sociology, education, criminal justice and social work.

Publications within this journal therefore have the possibility of reaching a diverse

audience of readers. One of its main target research areas is adolescent development,

with particular emphasis on social and emotional functioning, which has clear relevance

for a new measure of guilt-proneness for adolescence. They have previously published

other measures for young people, which indicates that they may also show interest in a

new measure of guilt-proneness for adolescents. Please see Appendix Y for the

journal’s Guidelines for Authors.

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ACKNOWLEDGMENTS

I would like to thank my research supervisors, Mary John and Laura Simonds, for all of

their support, guidance and reassurance over the last three years. I would also like to

thank the schools and young people that gave their time and participated in the research,

as well as my fellow trainees in Cohort 41 for providing a space to explore research

highs and lows throughout the process.

Finally, I would like to thank my fiancée for adding love and laughter to the many work-

filled nights and weekends, as well as my mom, dad and brother who, despite being

across the ocean, were always just one telephone call away.

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INTRODUCTION

Guilt is a self-conscious emotion and an integral component of conscience that

regulates human behavior (Bybee, 1998). It is a complex construct with affective,

cognitive and behavioural elements and involves a moral transgression, real or

imaginary, in which people believe their action or inaction contributed to negative

outcomes (Tilghman-Osborne, Cole, & Felton, 2010). For example, when someone

feels guilty they may think that others will be upset with them, which may cause them to

feel regretful and annoyed with themselves, which in turn may influence their actions

and trigger them to seek reparation and forgiveness. Guilt-proneness refers to the

propensity to have a guilt response in a particular guilt-inducing situation (Bybee, 1998).

In the literature, guilt has been viewed as trait-like or state-like; maladaptive or

adaptive (Bybee, 1998). ‘Trait-like’ refers to dispositional and chronic guilt occurring

across many situations, whereas ‘state-like’ guilt is situation and time-specific (Bybee,

1998). The term ‘maladaptive’ refers to guilt’s potential role in the development and

maintenance of psychopathology, while ‘adaptive’ refers to the more protective and

reparative aspects of the emotion (Tilghman-Osborne, et al., 2010). These different

ideas indicate the potential variability of guilt as an individual experience.

Guilt has been linked to increased helping behaviour, less aggression and

academic achievement (Bybee, 1998). It is an emotion that requires a self-appraisal of

actions and behaviors and has been associated with an increased sense of responsibility

and concern for one’s effect on others (Bybee, 1998; Ferguson, Stegge, Miller, & Olsen,

1999). Guilt feelings may be viewed along a continuum, with problems arising at either

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extreme (Baker, Baibazarova, Ktistaki, Shelton, & van Goozen, 2012; Bybee, 1998).

For example, a lack of guilt-proneness has been associated with aggression, hostility and

externalisation of blame (Baker, et al., 2012). In contrast, high levels of guilt can

increase rumination and feelings of remorse and regret, which can adversely impact on

mental health and may even be a factor in suicidality (Bybee, 1998). Individuals with

depression, eating disorders and anxiety frequently describe intense feelings of guilt

(Berghold & Lock, 2002; Bybee, 1998). Guilt may therefore become dysfunctional

when it is expressed intensely, frequently and inappropriately relative to the demands of

the situation (Clark & Watson, 1994).

Guilt versus Shame

Guilt and shame, both self-conscious emotions, are two distinct constructs that

often co-occur (Bybee, 1998). The ‘self versus behaviour’ distinction is used by some

theorists to differentiate the two: when people feel shameful they feel bad about the self,

whereas when people feel guilty they feel bad about a specific behaviour (H. Lewis,

1971). Shame involves a sense of exposure and often motivates an avoidance response

(Bybee, 1998). In contrast, guilt focuses on the specific deed, harm caused to others and

desire to make amends (Bybee, 1998).

Some authors have used Attribution Theory to explain the distinction: shame

emerges if one attributes an event to oneself and sees the characteristic as being global,

stable and enduring; guilt emerges when an event is attributed as being an unstable,

time-limited and specific aspect of the self (Hosser, Windzio, & Greve, 2008; Weiner,

1986). Irrespective of the type of situation, it is therefore the attributional response that

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distinguishes shame and guilt (M. Lewis, 1991). As the same situation can trigger both

emotions, capturing the differentiating response is key in measurement. When

developing a new measure of guilt, it is therefore vital to consider possible

contamination by shame.

Development of Guilt

The expression and capacity to experience guilt appears to change with

developmental stage. In early childhood, guilt is mainly behavioural in nature (e.g.

discomfort shown in facial/bodily distress, apology) and becomes increasingly cognitive

and complex with age and cognitive maturity (Baker, et al., 2012). The Cognitive

Attribution Model states that self-conscious emotions typically arise in the second year

of life because this is when the capacity for self-awareness emerges (M. Lewis, 1991).

A knowledge of standards, rules and goals, and the ability to evaluate oneself in relation

to these standards, also develops and children are able to make the attribution that they

were responsible for the transgression (M. Lewis, 1991).

Hoffman (1984) proposed that, as the self-versus-other distinction develops, the

capacity for empathy and guilt becomes increasingly sophisticated (Hoffman, 1984).

Similarly, within Piaget’s Stages of Cognitive Development, younger children tend to

view the world in more concrete and less abstract ways (Piaget, 1964). After age 10 (as

‘formal operational’ thought develops), children have a greater capacity for abstract

reasoning, information retention and perspective-taking, which has a direct impact on

their appreciation of guilt (Tilghman-Osborne, Cole, & Felton, 2012). Between the ages

of eight and 11, children begin to develop more sophisticated and distinct conceptions of

14

shame and guilt (Bybee, 1998). A conceptual understanding of the emergence of guilt is

critical to the development of psychometrically sound self-report measures of guilt for

young people.

Existing Measures of Guilt

There is only one published review on the measurement of guilt (Tilghman-

Osborne, et al., 2010). This review identified seven measures of guilt for young people.

In 2012, the authors developed an additional measure, totaling eight measures designed

for use with children and adolescents (Appendix A). These included scenario-based,

semi-projective story/play, observational and other informant (e.g. parent-reported)

measures. Of these eight measures, only one (the Test of Self-Conscious Emotions for

Adolescents- Guilt subscale; TOSCA-A) is adolescent-specific.

Having adolescent-specific measurement of guilt is important as, in comparison

to children, adolescents have an increased cognitive ability to engage with concepts

embedded in attribution theory, and recognize less visible failures and transgressions

that transcend time and place (Bybee, 1998). For example, children are often more

inclined to focus on concrete and observable acts, whereas adolescents are more likely to

report guilt over inaction and neglect of responsibilities (Bybee, 1998). The World

Health Organization defines adolescence as young people in between the ages of 10 and

19 and specifies three stages: early adolescence (age 10-13), mid-adolescence (age 14-

15) and later adolescence (age 16-19) (WHO, 2002). It is during these age spans that

noteworthy changes occur in cognitive and emotional development, which results in

increasing moral development and a more complex understanding of right from wrong

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(Tilghman-Osborne, Cole, Felton, & Ciesla, 2008). During adolescence, a variety of

mental health problems (e.g. depression) also become more prevalent (Bybee, 1998).

Similarly, identity and social roles are rapidly changing, with an increasing separation

from the family and integration into the peer group (Bybee, 1998). Social comparison

also becomes more pertinent and associated self-evaluation has a major role in the

development of distress (Tilghman-Osborne, et al., 2010).

Existing child and adolescent measures of guilt have a number of limitations

(Brennan, 2013; Tilghman-Osborne, et al., 2010). For example, data on validity and

reliability are rarely or inconsistently reported and the construct of shame is often

overlooked in the validation process (Brennan, 2013). In addition, items are often

generated using a ‘top-down’ approach (generated by academics, researchers and

clinicians) rather than with young people themselves, and so may therefore measure

adult-driven concepts of guilt rather than accurately capture young people’s experiences.

Most guilt measures are also scenario-based (Brennan, 2013). In these, examples of

guilt-provoking situations are provided and respondents rate the likelihood of a guilt

response if they were in that situation. Since these provide a limited number and type of

scenarios, they may fail to capture unique personal and cultural situations that trigger

guilt. Semi-idiographic measures (e.g. asking a person to recall a time when they felt

self-conscious emotions such as guilt) are recommended as a way to address these issues

(Simonds et al., Under Review), yet no existing guilt measure has used this format

(Brennan, 2013).

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Of the existing eight measures of guilt-proneness for young people, the TOSCA-

A is the most commonly used (Brennan, 2013). It is a situation-based self-report

measure adapted from an existing measure of guilt for children, which itself was

modelled on the adult version of the TOSCA. The TOSCA-A scenarios tap self-

conscious emotional responses, including shame and guilt, but the shame and guilt

subscales overlap considerably, suggesting criterion contamination (Simonds, et al.,

Under Review). In response to shortcomings outlined in their review on the

measurement of guilt, Tilghman-Osborne et al. (2012) developed the Inappropriate and

Excessive Guilt Scale (IEGS) to tap maladaptive forms of guilt based on theories of

guilt, depression and negative cognitive errors (Tilghman-Osborne, et al., 2012).

Although there is evidence supporting the validity and reliability of the measure in a

general youth population, the IEGS was developed based on expert opinion and the

available literature only (e.g. did not conduct interviews with young people) and its

overlap with shame was not assessed in validation. Like the TOSCA-A, it is also a

scenario-based measure. The limitations of these scenario-based measures indicate the

potential value of a semi-idiographic measure of guilt-proneness.

Measure Validation

In addition to considering the overlap between guilt and shame when validating a

new measure of guilt, the available literature indicates that measures of depression,

anxiety, anger and self-compassion are useful in establishing construct validity.

Depressive Symptoms

A positive correlation between depression and guilt has been documented from

pre-school to adulthood (Tilghman-Osborne, et al., 2010). Feelings of guilt can involve

17

the self-blame or rumination that underpin depression, and maladaptive guilt responses

have been documented as being more common in young people at risk for depression

(Tilghman-Osborne, et al., 2012). For example, one study found that high levels of

guilt-proneness were related to the onset of childhood depression (Luby et al., 2009).

Similarly, in a two-wave longitudinal study with 221 adolescents aged 11 to 18,

depressive symptoms were found to be positively correlated with guilt over time

(Tilghman-Osborne, et al., 2008). In previous validation studies of guilt measures for

children, adolescents and adults, guilt has been positively correlated with depressive

symptoms (Averill, Diefenbach, Stanley, Breckenridge, & Lusby, 2002; Kochanska,

DeVet, Goldman, Murray, & Putnam, 1994).

Anxiety

Researchers have found guilt to be positively correlated to symptoms of

generalized anxiety disorder, obsessive compulsive disorder and social anxiety disorder

(Fergus, Valentiner, McGrath, & Jencius, 2010; Gilbert, 2000; Shafran, Watkins, &

Charman, 1996; Tilghman-Osborne, et al., 2010). In studies involving adult and

undergraduate student samples, guilt has been noted to be important in the etiology of

obsessive-compulsive disorder and social anxiety disorder symptoms (Gilbert, 2000;

Shafran, Thordarson, & Rachman, 1996). Guilt-proneness is also significantly

positively correlated to post-traumatic stress symptoms in young people with a history of

interpersonal violence (Kletter, Weems, & Carrion, 2009). As expected, previous guilt

measure validation studies have reported significant positive relationships between guilt

and anxiety (Ferguson, Stegge, & Barrett, 1996; Kochanska, et al., 1994).

18

Anger

A lack of guilt-proneness has been associated with externalizing behaviour,

particularly anger (Stuewig & McCloskey, 2005; Tangney & Dearing, 2002). Lower

guilt scores have been correlated with heightened scores of hostility and anger in both

adults and children (Bybee & Williams, 1995; Tangney, Wagner, & Gramzow, 1992).

Young people who are more guilt-prone are reported to engage less in delinquent

offences, potentially due to an increased ability to anticipate the harmful consequences

of their behaviour (Stuewig & McCloskey, 2005). In a longitudinal study following

children for eight years into adolescence, guilt-proneness was linked to less anger and

delinquent behavior (Stuewig & McCloskey, 2005). It may be that young people more

likely to experience guilt are less likely to externalize blame through anger (Bear, Uribe-

Zarain, Manning, & Shiomi, 2009). In contrast, shame is often associated with outward

anger in interpersonal relationships (Tangney & Dearing, 2002).

This negative correlation between externalised anger and guilt in young people

has been reported in a number of different studies, including validation studies of

previously developed child guilt measures (Bear, et al., 2009; Kochanska, et al., 1994;

Menesini & Camodeca, 2008; Stuewig & McCloskey, 2005). Although there is

relatively little research on the relationship between guilt and different types of anger

(e.g. inwardly versus externally expressed), the available literature appears to indicate

that the ability to control and suppress anger may have a positive relationship with guilt-

proneness (Tangney & Dearing, 2002). Existing theories on guilt support this, as a

common function of guilt is to maintain and repair relationships, and this would be

hindered by the expression of anger towards others (Tilghman-Osborne, et al., 2010).

19

Self-Compassion

Self-compassion involves basic kindness, with a deep awareness of the suffering

of oneself and of other living things, coupled with the wish and effort to relieve it

(Gilbert, 2009a; Neff, 2003b). Only two studies were sourced that examined the

relationship between guilt and self-compassion: the first reported a small positive

correlation (Mosewich, Kowalski, Sabiston, Sedgwick, & Tracy, 2011), whereas the

second reported no evidence of correlation (Barnard & Curry, 2012). Despite these

mixed results and a general paucity of research, theory surrounding self-compassion

suggests that increased guilt, and particularly guilt-based self-attacking and self-blame,

may result in a decreased capacity for self-compassion (Gilbert, 2004). It would

therefore be expected that guilt-proneness would negatively correlate with self-

compassion.

Research Aim and Validity Hypotheses

The primary aim was to develop a semi-idiographic measure of guilt-proneness

for adolescents, tapping cognitive, emotional and behavioural responses to guilt across

personally-defined situations. The intended age range for the measure was 11 to 18

based on the World Health Organisation’s definition of adolescence (WHO, 2002). A

companion measure, the Adolescent Shame-Proneness Scale (ASPS) (Simonds, et al.,

Under Review), which is a semi-idiographic measure of shame-proneness, also utilised

this age range. From a cognitive developmental standpoint, associated literature also

suggests that, by age 11, young people begin to develop a more sophisticated conceptual

understanding of guilt (Bybee, 1998). In the validation of the new measure, the

following validity and reliability hypotheses were tested.

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Concurrent criterion validity

Scores on the Guilt Scale for Adolescents (GSA; new guilt measure) would

positively correlate with scores on another measure of guilt.

Divergent construct validity

Scores on the GSA would be negatively correlated with scores on measures of

trait anger and anger expression scores.

Convergent validity

GSA scores would be positively correlated with scores on measures of

depression and anxiety. It was also expected that GSA scores would be positively

correlated with measures of shame-proneness because, although they are two different

constructs, they are both self-conscious emotions that arise from similar situations. It

was also expected that anger control and anger suppression would be positively

correlated with scores on the GSA, and self-compassion scores would be negatively

correlated with GSA scores.

Reliability

The GSA would have good internal consistency.

Study One

METHODOLOGY

This paper reports two studies: study one involved the development of the GSA;

study two explored its psychometric properties.

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Design

The GSA was created using a cross-sectional interview-based design.

Participants

Participants aged 11 to 18 were recruited to take part in a semi-structured

interview. The aim was to develop a measure that could be used in both non-clinical and

clinical populations; a clinical sample was therefore not required. Similarly, as guilt is a

normative emotion, there is no need to conceptualise it ‘clinically’ (Bybee, 1998). An

inclusive policy was adopted as recruitment was through English educational

establishments, accessing the country’s National curriculum. Young people who had a

known and significant learning disability (as assessed by the school), and were not able

to participate in a regular classroom learning environment, were excluded from the

research.

Recruitment

A primary aim was to recruit a small number of young people in order to gain

their understanding of the concept of guilt and to help generate age-appropriate items for

the new questionnaire. Co-education secondary schools with a diverse representation of

ethnic and religious backgrounds were identified. Information on diversity was obtained

from the Department of Education, Ofsted and individual school websites. The Heads of

School and Heads of Psychology were sent an information letter, followed by a

telephone call. In total, three schools were approached and one agreed to participate. The

Head of Psychology distributed information packs to 15 students, aged 11 to 18, asking

them to participate in the interviews. Nine adolescents aged 12 to 18 were recruited

22

(60% uptake rate). The Head of Psychology collected all returned and signed parental

and pupil consent forms, and organised a time and date for data collection. The sample

consisted of four boys and five girls, with a mean age of 15.44 (Standard

Deviation=1.88) and from a range of ethnic backgrounds (Appendix B). Five of the

adolescents initially interviewed agreed to participate in a subsequent focus group (56%

response rate). The focus group sample included one boy and four girls, aged 12 to 18.

Ethical Approval

A favourable opinion was received from the University of Surrey Faculty of Arts

and Human Sciences Ethics Committee (Appendix C).

Information & Consent Forms

An information sheet was provided to the young person and his or her

parent/legal guardian (Appendix D). Written consent for participation was required

from the young person and their parent (Appendix D).

Materials

Demographic Questionnaire

This form requested background information on participant ethnicity, age, sex

and language (Appendix E).

Procedure: Phase One

Interviews

Study one had two phases: individual interviews (phase 1) and the measure

pilot/focus group (phase 2). Interviews were used to provide participants with a private,

23

confidential space in which to talk about their views on guilt. The semi-structured

interview schedule was developed based on the schedule used by Simonds et al. to

develop the ASPS, the available guilt and shame literature and input from research

supervisors. It was also theoretically driven by Cognitive Attribution theory and

included questions on the cognitive, affective and behavioural aspects of guilt

(Appendix F). In addition, it covered questions on ‘what situations make others feel

guilty’ and ‘differences between shame and guilt’ in order to gauge their conceptual

understanding of guilt. The semi-structured interviews were approximately 30-minutes

each, and took place in a classroom at the participating school. A teacher was in

attendance but wore noise cancelling headphones to ensure confidentiality. Young

people were also asked to complete a demographic questionnaire. Following the

interviews, participants were de-briefed (e.g. who to talk to if distressed, that

questionnaires were not diagnostic and more information on the research aims).

Interview scripts were audio recorded and transcribed verbatim. Content analysis was

conducted and items developed.

Content Analysis

Interview transcripts were read several times by the researcher and initial ideas

noted. Initial codes were then generated, with the codes aiming to encapsulate and

summarise what was being said across the nine interviews. All of the transcripts were

then re-read and subjected to content analysis (Hsieh & Shannon, 2005; Weber, 1990),

where the frequency of all codes was recorded (Appendix G).

24

Content analysis was used to extract five elements:

• Distinctions made between guilt and shame

• Situations that provoke guilt

• Thoughts associated with guilt

• Feelings associated with guilt

• Behaviours associated with guilt

A theory-driven content analysis was therefore employed (Hsieh & Shannon, 2005;

Weber, 1990).

Item Development

Using the thoughts, feelings and behaviours associated with guilt that had been

generated from the content analysis, initial items were then drafted (Appendix H). The

process for checking the extraction of items included reviewing choices with research

supervisors and consulting previously developed guilt measures and the related

literature. A reliability check on the coded interview data was done by the researcher’s

two supervisors.

Procedure: Phase Two

Focus Group

A few months after the interviews, the nine interviewed young people were

invited back for a focus group, with the aim of piloting the newly developed guilt

measure and eliciting their written and verbal feedback on utility. Five young people

(one boy and four girls; mean age 14) agreed to participate. The focus group semi-

25

structured interview schedule was developed based on discussions with research

supervisors (Appendix I). It covered questions on likes and dislikes about the new guilt

measure, areas for improvement and any difficulties or misunderstandings. All data

were collected at the school in a designated classroom. The focus group lasted

approximately 15 minutes. In order to capture the views of adolescents less likely to

contribute in a group setting, an anonymous written feedback form was also

administered individually before the focus group started (Appendix J). The feedback

form contained the same questions asked in the focus group. Following the focus group,

participants were de-briefed (covering the same areas as in phase one). The focus group

was audio recorded and transcribed verbatim. Feedback from the focus group was then

discussed with supervisors, and helped inform the final design of the measure.

RESULTS

Common themes were established based on number of occurrences in the data

across the interviews, rather than number of participants (see coding extract; Appendix

K). The interview data indicated that young people were able to make distinctions

between shame and guilt, and their answers corresponded with related conceptual theory

(Appendix L). In order to develop measure items, and based on Cognitive Attribution

Theory, line by line coding was used to extract guilt-related thoughts, feelings and

behaviours from the data. A theme/category was assigned, an interpretation was made

based on the literature, potential measure items were devised and a final decision (e.g.

whether the item was retained for the final measure) was recorded (Appendix M). From

the interview data, five categories of guilt-related thoughts (Table 1), five categories of

feelings (Table 2) and five categories of behaviours (Table 3) were identified. In

26

addition, four overarching themes of guilt-inducing situations were extracted, indicating

a number of similarities across interviews (Appendix N).

Table 1.

Interviews: Guilt-related Thoughts

Category Frequency in data (%)

Definition Examples of terms

Impact of behaviour

(24/81; 30%) Involved thinking about the repercussions and impact of their behaviour

“It may damage my reputation”

Confusion and desire to find a solution

(18/81; 22%) Thoughts in this category reflected a desire to fix the problem but being unsure about how to proceed

“I felt cross-minded”

“How am I going to fix this?”

Responsibility (16/81; 20%) Reflected thinking about consequences, feeling responsible and an awareness of doing something ‘wrong’

“I did something wrong”

Regret (15/81; 19%) Reflected wishing that things had turned out differently and thinking that they could have done something better

“It could have been prevented”

Future orientation

(8/81; 10%) Reflected a desire to learn from mistakes and refrain from similar behaviour in the future

“I shouldn’t do it again”

27

Table 2.

Interviews: Guilt-related Feelings

Category Frequency in data (%)

Definition Examples of terms

Sadness (31/70; 44%) It reflected feeling sadness for self and also for the other person that was wronged

‘Sadness’; ‘upset’; ‘self-pity’; ‘depressed’, ‘low’; ‘disappointment’

Anxiety/fear (14/70; 20%) This category reflected feeling anxious about the repercussions and consequences of an act (e.g. impact on ‘popularity’ and whether ‘forgiveness’ would be achieved)

‘Anxious’; ‘stress’; ‘scared’; ‘nervous’; ‘paranoid’

Anger with self (10/70; 14%) This reflected anger with self about having performed the wrongdoing

‘Annoyed with self’; ‘angry’

Uncomfortable (10/70; 14%) This reflected an internal tension, and a desire to rid oneself of the associated negative feelings

‘Feeling awful’; ‘uncomfortable’; ‘deceitful’; ‘conflicted’; ‘judged’; ‘hurts’; ‘painful’; ‘not proud’

Lost confidence (5/70; 7%) This reflected the transient feelings of disempowerment following the act in question.

‘Lost confidence’; ‘lack of control’

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Table 3.

Interviews: Guilt-related Behaviours

Category Frequencyin data (%)

Definition Examples of Terms

Fixing the problem

(18/44; 41%) Involved thinking about the repercussions and impact of their behavior

‘Fixing the problem’; ‘facing up to the problem’; ‘helping other person’; ‘trying to rebuild the trust’; ‘confront the situation’; ‘introversion’; ‘hiding’; ‘prioritise things’; ‘try to decrease my stress’; ‘owning up to it’; ‘wanting the other person to feel better’.

Compensation (13/44; 30%) It reflected a need to compensate for the wrongdoing.

‘Confessing’; ‘telling the truth’; ‘apologising’; ‘compensating’; ‘try to comfort them’; ‘praying’

Changing future behaviour

(7/44; 16%) It reflected a desire to learn from and not repeat past mistakes.

‘More cautious about what you say and do’; ‘trying not to do it again’.

Rumination (3/44; 7%) It reflected rumination over the wrongdoing, possible solutions and impact of actions

‘Thinking about things constantly’; ‘taking mind off other things’; ‘poor sleep’

Violence (3/44; 7%) It reflected a build-up of frustration and anger from internalised and unresolved guilt, eventually expressed through violence

‘Violence’; ‘killing yourself’

29

The decision-making process (e.g. which items to include in the measure) was

aided by discussions with research supervisors and consultation of the related guilt

literature. Due to the semi-idiographic nature of the measure, and as it is the appraisal

rather than the situation per se that prompts guilt, data collected on specific guilt

situations were therefore not incorporated into questionnaire items. Items were also not

included in the final measure if they reflected shame rather than guilt. The content

validity of the measure was maximised by ensuring items were theoretically grounded

and through consultation with the literature and with child and adolescent mental health

professionals. Furthermore, the knowledge and experiences shared by young people in

the individual interviews provided an important contribution to the content and face

validity of the GSA.

Results from the focus group indicated that the instructions and questionnaire

were easy to understand. Respondents liked the Likert scaling of questions and

questionnaire length. They also reported that they valued generating and using their

own personal guilt-inducing situations to answer the questions, noting that this made the

measure more individualised, capturing genuine experiences.

DISCUSSION

The findings in study one indicate that young people, aged 12 to 18, understand

the concept of guilt and can distinguish guilt from shame. For example, participants

were able to make what Lewis (1971) describes as the ‘self versus other’ distinction for

the two emotions, noting that shame is associated with feeling bad about the self,

whereas guilt is about feeling bad about the specific act of wrongdoing. Similarly, the

30

difference in response (e.g. avoidance and hiding with shame; desire to make amends

with guilt) was noted. Young people also responded that, although distinct, the two

emotions often co-occur, which is significant as the literature notes considerable

conceptual overlap between the two self-conscious emotions (Tilghman-Osborne, et al.,

2010). Another theme that emerged was that shame lasts longer than guilt. This is again

supported by the associated literature, as guilt can be resolved through making amends

whereas shame is often more global, stable and enduring and, as such, may be perceived

as more difficult to resolve (Tangney & Dearing, 2002).

Participants were also able to spontaneously generate a number of guilt-inducing

situations. There were a number of commonalities, and the majority of scenarios related

to damaging relationships. This is expected as guilt most often occurs within the context

of close interpersonal relationships and can have a relationship-mending function (e.g.

through apology and repair) (Bybee, 1998). Failing to take responsibility was the

second most common, which again would be expected as guilt over inaction and neglect

of responsibilities becomes increasingly reported during adolescence (Bybee, 1998).

Interestingly, a number of situations relating to social media were also reported by

young people. This is noteworthy as scenario-based guilt measures, such as the IEGS

and TOSCA-A, do not offer social media scenarios and may therefore fail to capture

contemporary issues in relation to guilt and young people.

Data regarding thoughts, feelings and behaviours associated with guilt also

support young people’s understanding of the concept. For example, common thoughts

surrounded the impact of behaviour and desire to find a solution, and reflected the focus

31

on the specific behaviour rather than a global self-evaluation. The most frequently

reported behaviours included fixing the problem and compensation, and again reflects a

motivation towards approaching the situation rather than avoidance. The majority of

reported feelings included sadness and anxiety, indicating regret over the transgression

and a state of ‘discomfort’ and ‘inner conflict’ in which a solution is eagerly sought in

order to repair the situation. This again reflects the literature, which suggests that such

feelings are highly associated with guilt experiences (Bybee, 1998).

Guilt Scale for Adolescents (GSA)

The Cognitive Attribution Model guided development of the measure, in that it

aimed to tap thoughts, feelings and behaviours (M. Lewis, 1991). Based on the

available conceptual literature it was important to include items representing thoughts

about potential repercussions, taking responsibility, wanting to make amends, regret

over what had happened and not wanting to repeat the act (Tangney & Dearing, 2002).

Similarly, items reflecting attempted problem-solving were also included. These items

differentiate guilt from shame, where the focus in the latter is more on global evaluations

of the self and wanting to hide or avoid rather than approach and fix the situation

(Tangney & Dearing, 2002). Shame-related thoughts and behaviours (e.g. global

negative self-evaluations and avoidance) were not included. Similarly, thoughts

reflecting a ‘damaged reputation’ were not included as they are more likely to arise in

the context of shame (Tangney & Dearing, 2002).

Feelings of anxiety/stress, fear and annoyance with self are consistent with the

experience of ‘inner tension’ that is often associated with guilt (Tangney & Dearing,

32

2002). It was therefore deemed appropriate to include these feelings in the measure.

Feeling ‘awful for what had happened’ reflected a sense of responsibility and regret over

the incident, theoretically-noted aspects of the guilt experience, and were thus deemed

important to include (Tangney & Dearing, 2002). Although sadness, a loss in

confidence and not feeling ‘in control’ can be linked to shame, when they are associated

specifically with an event (rather than global self-evaluations) they are also an aspect of

guilt and were therefore important to capture within the measure (Tangney & Dearing,

2002). Feeling insensitive and angry were not included due to their association with

shame (Tangney & Dearing, 2002).

Regarding behaviours, it was considered crucial to include reparation, rebuilding

trust, confessing and apologising (Tangney & Dearing, 2002). Similarly, a change in

future behaviour (e.g. ‘tried not to do it again’) and rumination over the act and

associated repercussions, commonly associated with guilt, were therefore also included.

The literature notes that rumination can be considered a behaviour or cognition, and in

this case the former categorisation was utilised (Watkins, 2009). ‘Trouble sleeping’ was

an aspect presented within the individual interview data and is an item in the IEGS guilt

measure, so it was included in the drafted GSA. Other physiological expressions of guilt

(e.g. stomach aches, crying and heavy chest) were also included. Introversion (e.g.

‘wanting to go into myself’) and violence were not included in the measure as they are

more often an aspect of shame rather than guilt (Tangney & Dearing, 2002).

The format of the GSA was modelled on the companion ASPS (Simonds, et al.,

Under Review). The content analysis of individual interviews, and associated decision-

33

making process, resulted in the development of 30-items representing cognitive (11-

items), affective (7-items) and behavioural (12-items) components of guilt responses

(Appendix O). Instructions on the GSA were developed to normalise the experience of

guilt, and to remind respondents that guilt can occur as a result of one’s own actions. To

facilitate engagement with the semi-idiographic aspects of the measure, examples of

guilt-inducing situations were provided in the instructions. These were chosen based on

frequency of occurrences in the interviews. Participants are then asked to write down

three of their own personal examples of situations where they had recently felt guilt.

They are then asked to answer the questionnaire items based on how they would

generally think and feel in situations like the ones that they had written down. Items are

rated on a four-point Likert scale: 0 (‘not at all’); 1 (‘a little bit’); 2 (‘quite a bit’); and 3

(‘a lot’). The validation of the measure was then addressed in study two.

Study Two

METHODOLOGY

Design

Validated measures were used in a cross-sectional questionnaire-based design to

assess the psychometric properties of the GSA in a non-clinical population.

Participants

The intended sample was adolescents aged 11 to 18. In total, data were collected

from 412 young people. There were doubts about the responses of one individual, as all

questions were answered with extreme values, so this case was deleted, leaving a total of

411. Of the participants, 261 (64%) were girls and 266 (65%) were White British

34

Appendix P). The mean age was 16.28 (Standard Deviation=1.1), with a range from 12

to 18 years.

Recruitment

Co-education and single-sex schools (secondary schools, sixth-form colleges and

independent schools), from different geographical locations in England, were

approached. The Heads of Psychology or Head Teachers were contacted by telephone

and an information pack was forwarded via email. Twelve schools were contacted and

seven agreed to participate. In total, 430 questionnaire packs were distributed to young

people. Completed packs were returned by 412 adolescents (96% return rate).

Ethical Approval

Ethical approval for study two was gained at the same time as study one.

Information & Consent Forms

Information sheets and consent forms from study one were adapted and provided

to schools and young people (Appendix Q). All school policies were aligned with the

British Psychological Society (BPS)’s recommendations with research conducted in

schools: adolescents aged 16 and older could provide their own informed consent; Heads

of Schools could act in loco parentis for children under 16 if they deemed it part of

normal curriculum (BPS, 2010).

Materials

Demographic Questionnaire

The demographic questionnaire from study one was used again in study two.

35

Measures

1. The Guilt Scale for Adolescents (GSA) – New Guilt Measure

As described in study one.

2. Test of Self-Conscious Affect in Adolescents (TOSCA-A) (Tangney, Wagner, Gavlas,

& Gramzow, 1991)

The TOSCA-A is a scenario-based measure of shame, guilt, pride and

externalisation for young people aged 13 to 18. Previous research has demonstrated its

reliability with adolescents aged 11 to 18 (Simonds et al., Under Review). For the

purpose of this study, only the shame and guilt subscales were used (Appendix R).

Participants are provided with 15 scenarios, with two items relating to each scenario

(one shame response and one guilt response). Items are rated on a five-point Likert scale

with 1=Not at all likely, 2=Unlikely, 3=Maybe, 4=Likely and 5=Very likely; the

subscale scores are the sum of responses for each relevant item. In adolescent samples,

the measure has relatively high predictive and convergent validity (Tangney et al.,

1996). Previous studies have noted its good internal consistency (α=.81 for the guilt

subscale; α=.77 for the shame subscale) (Tangney, 1996). In the present study, the

Cronbach’s alpha was .83 for Guilt and .85 for Shame.

3. The Adolescent Shame-Proneness Scale (ASPS) (Simonds, et al., Under Review)

The ASPS is a semi-idiographic measure of shame-proneness in adolescents,

aged 11 to 18 years old, comprising three components of shame (a total is not

calculated) (Appendix R). Items are rated on a four-point Likert scale with 0=Not at all

likely, 1=A little bit, 2=Quite a bit and 3=A lot; the three subscale scores are the sum of

36

responses for each relevant item. The authors of the measure reported good internal

consistency of the three subscales: Negative Evaluation of Self (α=.90), Humiliated Fury

(α=.82) and Internal Affect (α=.82). Similarly, in the present study, Cronbach’s alphas of

the subscales were as follows: Self Evaluation (α=.85); Humiliated Fury (α=.78); and

Internal Affect (α=.81). The measure has been validated against indices of self-esteem,

anger, shame, guilt and depression.

4. The Revised Child Anxiety and Depression Scale (R-CADS) (Chorpita, Moffitt, &

Gray, 2005)

The R-CADS is self-report questionnaire measuring anxiety and depression in

young people aged six to 18 (Appendix R). Items are rated on a four-point Likert scale

with 0=Never, 1=Sometimes, 2=Often and 3=Always; the six subscale scores are the

sum of responses for each relevant item. It has been shown to have good internal

consistency, convergent and discriminant validity in both community and clinical

samples (Chorpita, et al., 2005; Chorpita, Yim, Moffitt, Umemoto, & Francis, 2000).

Chorpita et al (2005) reported the following values for internal consistency: Social

Phobia (α=.87); Panic Disorder (α=.88); Major Depression (α=.87); Separation Anxiety

(α=.78); Generalised Anxiety (α=.84); and Obsessive Compulsive Anxiety (α=.82).

Similarly, the present study reported the following Cronbach’s alphas: Social Phobia

(α=.87); Panic Disorder (α=.89); Major Depression (α=.87); Separation Anxiety (α=.80);

Generalised Anxiety (α=.82); and Obsessive Compulsive Anxiety (α=.80).

37

5. The Anger Expression Scale for Children (AESC) (Steele, Legerski, Nelson, &

Phipps, 2009)

The AESC is a 26-item self-report measure for young people aged seven to 17

years old that is designed to assess four aspects of anger: Trait Anger, Anger Expression,

Anger Suppression and Anger Control (Appendix R). Previous research has

demonstrated its reliability with adolescents aged 11 to 18 (Simonds et al., Under

Review). Each item on the AESC is scored on a four-point Likert scale of 1=Almost

never, 2=Sometimes, 3=Often and 4=Almost always. The four subscale scores are the

sum of responses for each relevant item. The reliability and validity of the AESC was

explored by Steele et al. (2009) using both healthy children and children with chronic

illnesses. Internal consistencies were found to be: Trait Anger α = .84, Anger Expression

α = .69, Anger Suppression α = .71 and Anger Control α = .79. Test-retest reliability

was found to be adequate, with the trait anger scale showing the greatest stability over

time. Convergent validity for the AESC was investigated and the measure was found to

correlate positively with both parent and child reports of aggression, anger and hostility

when compared to other self-rated anger scales (Steele, et al., 2009). In the present

study, Cronbach’s alphas for the subscales were: Trait Anger (α=.86); Anger Expression

(α=.72); Anger Control (α=.75); Anger Suppression (α=.83).

6. The Self-Compassion Scale (SCS) – Short Form (Neff, 2003a)

The Self-Compassion Scale (SCS), Short Form, is appropriate for ages 14 and

up, so was only used with participants aged 14 to 18 in the current study (Appendix R).

Items are rated on a five-point Likert scale with only the extreme values defined

(1=Almost never; 5=Almost always). It yields a total score of self-compassion, based on

38

12-items that assess self-kindness, common humanity, isolation, mindfulness and over-

identification. Previous studies have reported good validity and internal consistency

(α=.84) of the SCS- Short Form (Neff, 2003a; Raes, 2011). In the present study, a

Cronbach’s alpha of α=.78 was reported. The SCS- Short Form has a near perfect

correlation with the long-form (Neff, 2003a).

Procedure

Data Collection

Data collection involved administering questionnaire packs (completed with

paper and pencil) containing the following: participant information sheet; young

person’s consent form; demographic questionnaire; the GSA (developed in study one);

TOSCA-A; ASPS; R-CADS; AESC; and SCS. Questionnaires were arranged in this

order to ensure young people completed the GSA first and finished the pack with the

self-compassionate questions on the SCS. A crossword puzzle was also included in the

questionnaire pack so that adolescents could choose not to participate without revealing

this to the group. The questionnaire packs took approximately 30-to-45mimutes to

complete and were administered individually in a designated classroom. The primary

researcher was in attendance at all times. As in study one, participants were de-briefed

following data collection (e.g. who to talk to if distressed, that questionnaires not

diagnostic and more information on the research aims).

Statistical Analysis

All analyses were conducted using the statistical programme SPSS version 22.0

(SPSS Inc., 2013).

39

Exploratory Factor Analysis

Principal Axis Factoring (PAF) was employed to examine the underlying

structure of the GSA and to reduce and refine the number of items. Within the literature,

PAF is noted as one of the methods of factor analysis that produces the best results

(Fabrigar, Wegener, MacCallum, & Strahan, 1999). Factor loadings were generated

using oblique rotation (direct oblimin) in order to determine the most interpretable

solution (Floyd & Widaman, 1995). An oblique method of rotation was used as the

psychological constructs being measured were assumed to correlate, and therefore this

method was favoured to an orthogonal technique (Costello & Osborne, 2005; Floyd &

Widaman, 1995).

Reliability

The internal consistency of the GSA was examined using Cronbach’s alpha

coefficients (Cronbach, 1951). Test-retest reliability was not possible due to time

constraints.

Validity

Criterion validity, convergent construct validity and divergent construct validity

were assessed using Pearson’s correlational analyses (Ezekiel & Fox, 1959). With 412

participants, a correlation (two-tailed) of at least 0.2 with 98% Power (alpha=.05) can be

detected (Faul, Erdfelder, Buchner, & Lang, 2009).

40

RESULTS

Suitability of the Data for Factor Analysis

As mean imputation has been criticized within the literature due to its role in

reducing data variability, listwise deletion was used for missing data (Donders, van der

Heijden, Stijnen, & Moons, 2006). There were missing data from 15 participants, and

these cases were therefore not included in the PAF (analysis sample therefore N=396).

The participant to item ratio in the present study was 13:1, which is higher than the

recommended 10:1 rule of thumb (Costello & Osborne, 2005). Tabachnick & Fidell

(2001) report that having at least 300 cases is most preferable for factor analysis.

An examination of the distributions of GSA items suggested that all items were

suitable for factor analysis. The Kaiser-Meyer-Olkin measure of sampling adequacy

was 0.94, exceeding the recommended value of 0.60 (Kaiser, 1960; Tabachnick &

Fidell, 2001). Bartlett’s Test of Sphericity was also highly significant (5993.71,

p<0.001), indicating high sampling adequacy. Most of the inter-item correlations were

above 0.3 but were not above 0.8, and the determinant was >.00001, suggesting no

problems with multicollinearity or singularity. These analyses indicated that this dataset

was suitable for factor analysis.

Exploratory Factor Analysis

The initial analysis indicated five factors with eigenvalues exceeding one,

explaining 58.76% of the variance. Subsequent inspection of the scree plot indicated a

point of inflection at the third and fifth factors (Appendix S) (Cattell, 1966). This

therefore suggested the possibility of three, four and five factor models. After the factor

41

analysis was re-run, the five-factor model was rejected as the fifth factor could not be

interpreted (Appendix T). In comparison to the three-factor model, the four-factor

model highlighted an additional fourth interpretable factor, Regret and Self-Blame

(Appendices T and U). The four-factor model was therefore retained (Table 4).

The extracted four-factor solution explained a total of 55.34% of the variance

(Factor 1 contributing 33.78%; Factor 2: 9.56%; Factor 3: 5.43%; and Factor 4: 3.58%).

The criterion for inclusion of an item in a factor was set at 0.4 in line with

recommendations made by Floyd and Widaman (1995). Seven items did not load at this

level on any factor and were subsequently omitted. An additional two items on Factor 3

(‘I wanted to confess’ and ‘I had trouble thinking straight’) did not fit the factor

category and so were also omitted. This procedure of interpretation, based on the

researcher’s judgment, is advised within the literature (Pallant, 2013). Cross-loading of

one item on Factor 2 and 4 (‘I wanted to be forgiven’) resulted in it also being removed.

The items ‘I tried not to do it again’ and ‘I thought ‘I should not do it again’’ were

considered too similar in nature, risking an over-estimation of internal reliability. The

item ‘I thought ‘I should not do it again’’ had a higher loading and strength than the

item ‘I tried not to do it again’ (0.576 versus 0.465 respectively) and so it was retained.

In total, 11 items were omitted and a total of 19 items were retained.

42

Table 4.

30-Item GSA Factor Loadings and Cronbach’s Alpha for Four Factors

GSA Item Inner Turmoil(α .86)

Reparation(α .83)

Physiological Reactions

(α .85)

Regret and Self-Blame(α .78)

I could not concentrate on school work

.448 .028 - .115 .015

I kept thinking about what had happened

.512 .075 .072 .277

I felt anxious and stressed.

.657 .000 - .075 .067

I felt I was not in control. .668 .066 - .049 - .103

I felt I had lost confidence in myself.

.722 - .013 - .040 - .059

I did not know what to do.

.729 .066 - .075 - .047

I felt scared. .608 - .091 -.193 - .006

I felt sad. .490 .193 - .096 .101

I tried to put things right. .111 .740 .032 - .027

I tried to re-build the trust.

.015 .772 - .147 - .046

I wanted to make it better for the other person.

.177 .733 .056 .026

I had trouble sleeping. .138 .016 - .602 - .030

My heart felt heavy because of what I did.

- .013 .082 - .712 .090

I felt sick in my stomach because of what I did.

.019 - .049 - .837 - .024

I felt like crying. .141 - .064 - .733 - .028

I thought “it was my fault”.

.161 .150 - .120 .409

I thought “I should not do it again”.

- .038 .251 - .011 .576

I regretted what I had done.

- .080 .125 - .099 .714

I thought “I have done something wrong”

.169 - .003 - .060 .486

*Alphas based only on those items loading > 0.4 and were included in the final measure

43

Interpretation of the Factors

Upon examination, all items on Factor 1 (eight items) appeared to reflect the

‘conflicted’ and ‘cross-minded’ (e.g. emotional disequilibrium) nature of guilt that had

been reported in the individual interviews in Study One. It also reflected the

combination of threat, perceived loss of control, negative affect and rumination that can

occur within a guilt experience (Bybee, 1998). This factor was therefore given the label

of ‘Inner Turmoil’. Items in Factor 2 (three items) reflected the desire to fix the

situation and make amends with the other person. It was therefore labelled ‘Reparation’.

Items on Factor 3 (four items) all referred to the physical sensations associated with a

guilt experience, for example trouble sleeping and wanting to cry. It was therefore

labelled ‘Physiological Reactions’. The final and fourth Factor (four items) was

composed of thoughts and feelings such as thinking it was one’s own fault and regret

over what had happened. It was therefore labelled ‘Regret and Self-Blame’. Although

Factors 2, 3 and 4 have only three or four items each, the literature notes that a minimum

of three items per factor is sufficient in identifying common factors (Floyd & Widaman,

1995).

Scoring of the GSA

GSA items are rated on a Likert scale from 0 (‘Not at all’) to 3 (‘A lot’). Higher

scores on each of the four factors/subscales of the GSA are therefore indicative of higher

levels of guilt-proneness. Table 5 shows the mean scores for the four GSA subscales.

Please refer to Appendix V for a copy of the final 19-item GSA.

44

Table 5.

Means and Standard Deviations of GSA Subscales

Factor Number of items

Number of Participants

Scale Mean SD Item Mean

Inner Turmoil 8 408 11.13 5.78 1.39

Reparation 3 406 5.87 2.56 1.96

Physiological Reactions

4 409 5.46 3.96 1.34

Regret and Self-Blame

4 407 8.43 2.79 2.11

TOTAL 19 - - - -

Normality of the GSA and other Measures

The normality of the four GSA subscales was checked by examining histograms,

skewness and kurtosis values, checking for outliers and examining the Kolomorgov-

Smirnov statistic. Although some outliers appeared on the boxplots, the difference

between the 5% trimmed means and means were not substantial. All other measures

involved (e.g. AESC, R-CADS, TOSCA-A and SCS) were similarly investigated and

deemed to be approximately normally distributed (Appendix W). All measures

(including the GSA) had significant Kolomorgov-Smirnov statistics, but this is noted to

be a common occurrence for large sample sizes (Field, 2009). The Kolomorgov-

Smirnov statistic was therefore combined with a visual description of the histogram to

determine normality. Parametric tests are also very robust in nature and can manage

some departure from normality. Furthermore, non-parametric tests were also calculated

45

for the correlational analyses and there was very little difference in results (Appendix

X).

Subscale Inter-correlations

The factor correlation matrix with subscale inter-correlations can be found in

Table 6. All subscales positively correlated with each other with the exception of the

‘Physiological Reactions’ subscale, which was strongly and negatively correlated with

the ‘Internal Turmoil’ (-0.61) and ‘Regret and Self-Blame’ (-0.51) subscales, and

weakly and negatively correlated with the ‘Reparation’ subscale (-0.25). As the four

GSA factors had different numbers of items, a total GSA index score was not derived;

instead, the relevant items in each of the four scales were summed to give four separate

indices of guilt-proneness.

Table 6.

GSA Subscale Inter-correlations

GSA Inner Turmoil

GSA Reparation

GSA Physiological

Reactions

GSA Regret and Self-

BlameGSA Inner Turmoil

1.00 0.31 -0.61 0.40

GSA Reparation

0.31 1.00 -0.25 0.56

GSA Physiological Reactions

-0.61 -0.25 1.00 -0.51

GSA Regret and Self-Blame

0.40 0.56 -0.51 1.00

46

Reliability

Internal Consistency

Please see Table 4 for GSA subscale Cronbach’s alpha values. Internal

consistency is good and all sub-scales are consistently measuring one underlying factor

(Kline, 1994). All inter-item correlations were above .30 and all item-total correlations

were above .50, further supporting the internal reliability of GSA subscales (Appendix

Z) (Pallant, 2013).

Validity

Concurrent Criterion Validity

Criterion validity was investigated by exploring the relationship between the

GSA subscales and the TOSCA-A guilt subscale (Table 7). Pearson’s correlational

analyses were conducted and, as predicted, a significant positive correlation with

moderate effect size was found between the TOSCA-A guilt subscale and the GSA

subscales of ‘Internal Turmoil’, ‘Physiological Reactions’ and ‘Reparation’. A

significant positive correlation, with a large effect size, was found between the TOSCA-

A guilt subscale and the GSA ‘Regret and Self-Blame’ subscale.

47

Table 7.

Pearson’s Correlations between GSA and TOSCA-A Guilt Scale

TOSCA-A Guilt(α .83)

GSA Inner Turmoil .39*, p< .001N=401

GSA Reparation .47*, p< .001N=399

GSA Physiological Reactions .38*, p< .001N=402

GSA Regret and Self-Blame .53*, p< .001N=400

*Statistically significant at p<.001Note. Different sample sizes due to pairwise deletion of missing data

Convergent Validity

Convergent validity was investigated by exploring the relationship between the

GSA subscales and the AESC (Anger Control and Anger Suppression subscales), R-

CADS, SCS, TOSCA-A (Shame subscale) and ASPS scores (Table 8 and 9). Pearson’s

correlational analyses were conducted and, as hypothesised, there was a significant

positive correlation between the AESC Anger Suppression scores and the GSA

‘Reparation’ and ‘Regret and Self-blame’ scores, but the effect size was small. There

was little evidence of correlation between the AESC Anger Suppression subscale and

the GSA ‘Inner Turmoil’ and ‘Physiological Reactions’ subscales. As hypothesised,

there was a positive correlation between AESC Anger Control scores and all four GSA

subscales, but the effect size was small.

48

Table 8.

Pearson’s Correlations between GSA and Measures of Anger, Depression, Anxiety and Self-compassion

GSA Inner Turmoil

GSA Reparation

GSA Physiological

Reactions

GSA Regret and Self-Blame

AESC Trait Anger (α .86)

0.23*, p< .001N=403

- 0.01, p= .753N=400

0.18*, p< .001N=403

0.08, p= .078N=401

AESC Anger Expression (α .72)

0.018, p= .714N=401

- 0.03, p= .466N=399

0.01, p=.811N=402

- 0.03, p=.459N=400

AESC Anger Control (α .75)

0.27*, p<0.001N=406

0.16*, p=0.001N=404

0.18*, p<0.001N=407

0.13*, p<0.008N=405

AESC Anger Suppression (α .83)

0.05, p=0.259N=399

0.20*, p<0.001N=398

0.07, p=0.149N=400

0.18*, p<0.001N=398

SCS Self Compassion (α .78)

-0.40* p<0.001N=387

0.015, p=0.763N=390

- 0.311*, p<0.001N=388

- 0.185*, p<0.005N=389

RCADS Social Phobia (α .87)

0.60*, p<0.001N=396

0.21*, p<0.001N=396

0.49*, p<0.001N=398

0.43*, p<0.001N=396

RCADS Panic Disorder (α .89)

0.54*, p<0.001N=394

0.19*, p<0.001N=394

0.50*, p<0.001N=396

0.28*, p<0.001N=394

RCADS Major Depression (α .87)

0.48*, p<0.001N=393

0.14*, p=0.004N=393

0.44*, p<0.001N=396

0.22*, p<0.001N=394

RCADS Separation Anxiety (α .80)

0.40*, p<0.001N=395

0.12*, p=0.010N=395

0.37*, p<0.001N=398

0.20*, p<0.001N=396

RCADS Generalised Anxiety (α .82)

0.53*, p<0.001N=395

0.18*, p<0.001N=395

0.45*, p<0.001N=398

0.29*, p<0.001N=396

RCADS Obsessive Compulsive Anxiety (α .80)

0.44*, p<0.001N=396

0.15*, p=0.003N=396

0.40*, p<0.001N=399

0.22*, p<0.001N=397

*Statistically Significant at p< .001

49

As predicted, the R-CADS depression and anxiety subscales were all

significantly and positively correlated with the four GSA subscales, with the GSA ‘Inner

Turmoil’ and ‘Physiological Reactions’ subscales yielding the largest effect sizes. As

hypothesised, the SCS scores and GSA ‘Inner Turmoil’ and ‘Physiological Reactions’

scores were significantly and negatively correlated, with moderate effect sizes.

Similarly, the SCS scores and the GSA ‘Regret and Self-Blame’ scores were

significantly and negatively correlated, but had a small effect size. There was no

evidence of correlation between the SCS scores and the GSA ‘Reparation’ scores. As

expected, the four GSA subscale scores and the TOSCA-A shame scores were all

significantly and positively correlated, with effect sizes ranging from small to large

(Table 9). Similarly, the GSA subscales and the ASPS shame scores were significantly

and positively correlated (with effect sizes ranging from small to large), but there was

little evidence of a relationship between the ASPS ‘Humiliated Fury’ scores and the

GSA ‘Reparation’ and ‘Regret and Self-Blame’ scores.

Divergent Validity

Divergent validity, the extent to which traits are distinct (e.g. lack evidence of

correlation), was calculated by exploring the relationship between the GSA guilt

subscales and the AESC Trait Anger and Anger Expression subscales (Table 8)

(Carmines & Zeller, 1979). Contrary to what was hypothesised, the AESC Trait Anger

was positively correlated with the GSA ‘Inner Turmoil’ and ‘Physiological Reactions’

subscales (with small effect size), and there was little evidence of a correlation between

AESC Trait Anger and the GSA ‘Reparation’ and ‘Regret and Self Blame’ subscales.

50

There was also little evidence of correlation between the AESC Anger Expression and

all of the GSA subscales.

Table 9.

Pearson’s Correlations between GSA and TOSCA-A Shame and ASPS Scales GSA Inner Turmoil

GSA Reparation

GSA Physiological Reactions

GSA Regret and Self-Blame

TOSCA-A Shame (α .85)

0.51*, p<0.001N=399

0.22*, p<0.001N=397

0.45*, p<0.001N=400

0.37*, p<0.001N=398

ASPS Self Evaluation (α .91)

0.60*, p<0.001N=401

0.23*, p<0.001N=399

0.57*, p<0.001N=402

0.43*, p<0.001N=400

ASPS Humiliated Fury (α .78)

0.26*, p<0.001N=400

0.04, p=0.365N=398

0.24*, p<0.001N=401

0.05, p=0.314N=399

ASPS Internal Affect(α .81)

0.58*, p<0.001N=403

0.35*, p<0.001N=401

0.52*, p<0.001N=404

0.51*, p<0.001N=402

*Statistically significant at p< 0.001

DISCUSSION

Factor Structure of the new GSA

The exploratory factor analysis yielded a four-factor model for the new GSA.

This resulted in a final 19-item measure with the following subscales: ‘Inner Turmoil’

(8-items); ‘Reparation’ (3-items); ‘Physiological Reactions’ (4-items); and ‘Regret and

Self-Blame’ (4-items). The four factors tapped cognitive, affective and behavioural

aspects of the emotion. The factor ‘Inner Turmoil’ was the most dominant factor, with

the highest number of loadings. This factor captures thoughts and emotions relating to a

sense of ‘moral discomfort’ about the act in question. This corresponds with Lewis’

51

(1971) theory, which suggests that guilt is associated with an inner sense of tension and

a process of mentally undoing some aspect of behaviour. Similarly, Cognitive

Attribution Theory suggests that guilt occurs when the person is negatively evaluated in

connection with a specific activity (H. Lewis, 1971; M. Lewis, 1991). Guilt has also

been described as a form of anxiety, associated with social threats due to misconduct,

and this is captured in the ‘stress’ and ‘anxiety’ items within this factor (Baumeister,

Stillwell, & Heatherton, 1994).

The second factor, ‘Reparation’, included behavioural items that conveyed a

desire to make amends, rebuild the relationship in question and fix the problem.

Reparative responses are considered to be critical and defining elements of guilt

(Tangney & Dearing, 2002). For example, in Cognitive Attribution Theory, guilt arises

from attributing the error to situation-specific factors and motivates the individual to

make amends (M. Lewis, 1991).

The factor ‘Physiological Reactions’ seems novel as very little research has

explored the physiological component of guilt (Baker, et al., 2012). These items were

devised based on the individual interviews and previously developed measures of guilt

in young people. Although younger children have been found to show and report

increased physiological reactions and distress with guilt, little is known about the

physiological response to guilt in adolescents (Bybee, 1998). One study, with a student

population, indicated that young people often subjectively report crying or feeling in

pain in relation to feelings of guilt (Bybee, 1998). Recent research with adult

participants has investigated the relationship between guilt and the Behavioural

52

Inhibition System (BIS), a neuropsychological framework and attentional system that is

sensitive to cues of punishment and which functions to inhibit ongoing behaviour in

order to prepare a response (Fourie et al., 2011). High BIS activation is associated with

increased physiological arousal, vigilance and anxiety (Amodio, Master, Yee, & Taylor,

2008). A positive correlation between BIS activation and increased guilt has been

documented in adults (Fourie, et al., 2011). Guilt may therefore function as a

punishment cue, whereby affective and cognitive components of guilt prompt an

increase in physiological arousal, which inhibits ongoing behaviour and encourages

reparatory behavior in order to decrease distress (Fourie, et al., 2011). The

physiological items in the third factor of the GSA support these ideas and may relate to

some of these experiences.

The factor ‘Regret and Self-Blame’ comprises thoughts and feelings surrounding

responsibility, self-blame and regret. Research exploring guilt in adolescents has found

that regret is the most common reaction to guilt-producing events at every age level, and

that it doubles in prevalence from age 10 to age 16 (Bybee, 1998). Self-blame, with a

focus on ownership and responsibility, is also an important aspect of guilt (Bybee,

1998). In their model of self-conscious emotions and psychopathology, Muris and

Meesters (2014) suggest that self-blame is a secondary appraisal process of guilt that

shapes the individual’s reaction to the social environment. When guilt triggers self-

blame, an individual may be motivated to repair the situation but, if elicited frequently,

can also increase the risk for developing depression and anxiety (Muris & Meesters,

2014).

53

The GSA is a novel measure as all other adolescent guilt scales use a total score

rather than subscale scores. No other existing child and adolescent measure also

quantifies motivation towards reparation with an individual subscale score. The GSA

does not yield a total score, as it would be weighted towards ‘Inner Turmoil’ and might

mask the contributions of other components of guilt. Additionally, a total score would

combine the more unique aspects of guilt (‘Reparation’) with those that overlap with

other emotions (e.g. ‘Physiological Reactions’). This may explain why previous studies

have found shame and guilt to be so similar. The AESC measure has taken a similar

approach for anger, and has subscale scores rather than a total in order to examine the

specific subtypes of the emotion (e.g. anger control, anger expression) (Steele, et al.,

2009).

For the GSA subscale inter-correlations, all subscales were positively correlated

with the exception of ‘Physiological Reactions’ and the other three subscales (‘Inner

Turmoil’, ‘Reparation’ and ‘Regret and Self-Blame’), which were negatively correlated.

The strongest negative correlations were between ‘Physiological Reactions’ and the

‘Inner Turmoil’ and ‘Regret and Self-Blame’ subscales. One possibility may be that

physiological reactions are an externalisation of guilt, whereby an increase results in a

lower sense of internal discomfort (Gross, 2002). Emotional suppression, inhibiting

outward signs of inner feelings, also seems to increase some measures of physiological

activation (e.g. increased heart rate) (Gross, 2002). Consequently, an individual might

theoretically exhibit a physiological arousal reaction without necessarily reporting a

negative emotional state (Campbell & Ehlert, 2012). Further research is needed to

explore the relationship between physiology and other aspects of guilt.

54

Reliability of the GSA

The Cronbach’s alpha of all four subscales demonstrated good internal

consistency. The means and standard deviations of the subscales indicated that the

sample scored typically between ‘1’ (‘a little bit’) and ‘2’ (‘quite a bit’). The

‘Physiological Reactions’ subscale is however noteworthy as its standard deviation was

high in relation to its mean. This indicates more sample variability on this subscale, but

whether this variability would be reported in other samples needs to be reassessed.

Validity of the GSA

The validity hypotheses were generally supported. GSA subscale scores were

positively correlated with another measure of guilt (the TOSCA-A Guilt subscale). GSA

subscale scores were also positively correlated with anxiety, depression and shame, and

negatively correlated with self-compassion. The validity hypotheses for anger were only

supported for Anger Control and Anger Suppression. The literature on the relationship

between guilt and anger is however limited and more research is needed.

GENERAL DISCUSSION

The GSA was designed to tap cognitive, behavioural and affective aspects of

guilt, in line with related conceptual theories, and there is good evidence of its reliability

and validity. The use of individual interviews and a focus group with adolescents

ensured that the language used was understandable and accurately captured young

people’s experiences. In study two, the validation sample size was also much larger

than that of some similar, previous studies (Simonds, et al., Under Review; Tilghman-

Osborne, et al., 2010). Recruitment achieved a sample of young people from diverse

55

cultural and religious backgrounds, around England, which has been a noteworthy

limitation of previously developed guilt measures (Tilghman-Osborne, et al., 2010). For

example 35% of young people in study two were not White British, suggesting the GSA

has validity with different ethnic backgrounds, but further investigation is needed.

The GSA adds significantly to the existing literature, especially as it is the first

semi-idiographic measure of guilt-proneness for adolescents. In comparison to the GSA,

most existing measures of guilt for young people have utilised scenario-based formats.

Scenario-based measures are limited because they soon become dated with the situations

provided and potentially fail to capture personally relevant guilt-inducing experiences.

For example, in the focus group in study one, young people noted that they particularly

liked the GSA’s semi-idiographic format, as it allowed them to tailor the questionnaire

to their own individual experiences. The pre-determined situations in scenario-based

measures are also written from a particular cultural standpoint, and may therefore not

capture other perspectives. This is important as the experience of guilt may be

moderated by cultural context (Bear, et al., 2009; Ferguson, et al., 1999; M. Lewis,

1991). Although the semi-idiographic structure assumes that young people understand

the concept of guilt, there is good evidence to suggest that adolescents aged 11 to 18 are

able to understand the related theoretical underpinnings (Bybee, 1998).

Limitations

Semi-idiographic measures take a relativist stance to the situations that provoke

guilt, but still however take a realist stance to the response (Simonds, et al., Under

Review). This means that, as the response items are fixed and developed from a certain

56

cultural perspective, they may therefore not apply cross-culturally. More research is

needed to determine whether the thoughts, feelings and behaviours tapped by the GSA

are relevant to young people from different cultural backgrounds. Similarly, although

the GSA has space for young people to record their own guilt-inducing situations, a

potential limitation is that the veracity of the situations cannot be established.

Questions might also be raised about the specificity of the GSA ‘Inner Turmoil’

and ‘Physiological Reactions’ subscales to guilt, both conceptually and due to the

overlap with the ASPS and TOSCA-A Shame. It is likely however that these subscales

tap both guilt and shame, which may explain the overlap between these constructs in

other studies (Tilghman-Osborne, et al., 2010). In study one, the measure was also

developed with young people who attended a private fee-paying school, and so may not

be generally representative. Despite this, the interview responses were still consistent

with the conceptual literature on guilt. The sample in study two also had more girls than

boys, but a comparable ratio has been reported in similar published studies (Simonds, et

al., Under Review; Tilghman-Osborne, et al., 2010). Although the sample in study two

was slightly older (mean age=16.28), a longitudinal study tracking the experience of

guilt in adolescents over an eight-year period found that guilt-proneness was remarkably

stable from ages 11 to 18 (Tangney & Dearing, 2002). This suggests that the mean age

in study two is not a major limitation. Test-retest reliability was also not able to be

estimated due to time constraints. Future studies need to address the GSA’s temporal

stability.

57

Implications for Practice and Future Research

More research is needed to look at the applicability of the GSA cross-culturally

and to validate its use in clinical samples. Confirmatory factor analysis would also be

important to confirm the current factor structure of the GSA. Based on the results, guilt

may be negatively correlated with self-compassion. This may be especially true for

those whose guilt-proneness is indicating high ‘Inner Turmoil’ and ‘Physiological

Reactions’. Although Compassion-Focused Therapy has traditionally focused on shame,

perhaps guilt too may benefit (Gilbert, 2009b). More research on this relationship is

therefore warranted. Similarly, the relationship between guilt and different types of

anger needs further investigation. In the past, the lack of a reliable measure of guilt for

young people has resulted in a dearth of research into the relationships between these

different constructs (Tilghman-Osborne, et al., 2010). The GSA will hopefully

encourage further research in the area.

Individual differences in guilt-proneness may contribute to adaptive and

maladaptive interpersonal and intrapersonal processes (Tangney, Wagner, Burggraf,

Gramzow, & Fletcher, 1990). For example, an eight-year longitudinal study found that

10 year-olds with higher guilt-proneness were more likely to later apply to college,

participate in community service and were less likely to use heroin and make suicide

attempts (Tangney & Dearing, 2002). They were also less likely to be arrested,

convicted and incarcerated and had fewer sexual partners. Increased guilt at the

beginning of a prison term has also been correlated with lower rates of recidivism in

youth-offending populations (Ferrer et al., 2010; Hosser, et al., 2008). Although guilt-

58

proneness can be protective, when it is experienced excessively it has been linked to

depression and anxiety (Bybee, 1998).

Guilt-proneness therefore appears central to current conceptualisations of mental

health in adolescents and, trans-diagnostically, individuals may present with varying

levels (Bybee, 1998). The four GSA subscales provide a unique way to breakdown guilt

into subcomponents, allowing for theoretical elaboration and intervention potential (e.g.

by showing which components relate more strongly to indices of psychopathology). For

example, reparation has been noted as a particularly protective and adaptive aspect of

guilt, and the GSA’s corresponding subscale provides a way to capture and measure this

experience (Tangney & Dearing, 2002). In contrast, the ‘Inner Turmoil’, ‘Physiological

Reactions’ and ‘Regret and Self-Blame’ subscales include items relating to rumination,

poor sleep, self-blame, regret and anxiety which, at high levels, have all been linked to

mental health problems (Bybee, 1998). The relative contributions of the different GSA

subscale scores may therefore provide insight into when guilt-proneness becomes more

adaptive or maladaptive for young people. Interactions between subscale scores may

also be useful. For example, scores on ‘Inner Turmoil’ may indicate how levels of inner

tension and anxiety impact a young person’s ability to repair social relationships

(‘Reparation’ score).

The GSA potentially has an advantage over measures such as the TOSCA-A and

IEGS as it does not risk diluting aspects of guilt with a total score. This may allow for

more targeted interventions that explore changes in relation to specific aspects of guilt-

proneness. As the measure was designed to capture the cognitive, affective and

59

behavioural components of guilt, it may also be ideally suited to capture therapeutic

change throughout a Cognitive Behavioural Therapy intervention (Beck, 1979). The

GSA’s application in related clinical settings should therefore be explored in future

research.

60

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Tilghman-Osborne, C., Cole, D. A., & Felton, J. W. (2010). Definition and measurement

of guilt: Implications for clinical research and practice. Clinical Psychology

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Tilghman-Osborne, C., Cole, D. A., Felton, J. W., & Ciesla, J. A. (2008). Relation of

Guilt, Shame, Behavioral and Characterological Self-Blame to Depressive

Symptoms in Adolescents Over Time. Journal of Social and Clinical

Psychology, 27(8), 809-842.

Watkins, E. R. (2009). Depressive Rumination: Investigating Mechanisms to Improve

Cognitive Behavioural Treatments. Cognitive Behaviour Therapy, 38(sup1), 8-

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WHO. (2002). Adolescent Friendly Health Services: An Agenda for Change Geneva,

Switzerland World Health Organisation.

Zahn-Waxler, C., Kochanska, G., Krupnick, J., & McKnew, D. (1990). Patterns of guilt

in children of depressed and well mothers. Developmental Psychology, 26(1), 51.

69

70

MRP Empirical Paper: Appendices

71

APPENDICIES

Appendix A. Existing Child and Adolescent Measures

Appendix B. Study One Demographics: Individual Interviews

Appendix C. Ethical Approval

Appendix D. Study One Information and Consent Forms

Appendix E. Demographic Form

Appendix F. Individual Interview Schedule

Appendix G. Frequency Codes: Individual Interviews

Appendix H. Draft Measure with Three Dimensions

Appendix I. Focus Group Interview Schedule

Appendix J. Focus Group Feedback Form

Appendix K. Interview Coding Extract

Appendix L. Individual Interviews: Shame versus Guilt Themes

Appendix M. Example of Measure Development Decision Making

Appendix N. Individual Interviews: Situation Themes

Appendix O. New Guilt Scale: Ready for Validation

Appendix P. Study Two Demographics: Measure Validation

Appendix Q. Study Two Information and Consent Forms

Appendix R. Other Measures Used in Validation

Appendix S. Scree Plot

Appendix T. 5-Factor and 3-Factor Solutions

Appendix U. 4-Factor Solution

Appendix V. Final Guilt Scale for Adolescents (GSA)

Appendix W. Measure Normality: Histograms

Appendix X. Non-Parametric Tests

Appendix Y. Journal of Adolescence Guidelines for Authors

Appendix Z. GSA Reliability: Correlations

72

Appendix A. Existing Child and Adolescent Guilt Measures

73

1. Story Completion Measure (Hoffman, 1975)

2. My Child Guilt (Kochanska, et al., 1994)*

3. Inappropriate and Excessive Guilt Scale (Tilghman-Osborne et al, 2012)*

4. Clown-Doll Paradigm (Barrett, Zahn-Waxler, & Cole, 1993)*

5. Children’s Interpretations of Interpersonal Distress and Conflict (CIIDC) (Zahn-Waxler,

Kochanska, Krupnick, & McKnew, 1990)*

6. Test of Self-Conscious Emotions- Adolescent Version (TOSCA-A) (Tangney &

Dearing, 2002; Tangney, et al., 1991)*

7. Test of Self-Conscious Emotions- Child Version (TOSCA-C) (Tangney & Dearing,

2002; Tangney, et al., 1990)*

8. Child-Child Attribution and Reaction Survey (C-CARS) (Ferguson, et al., 1999; Stegge

& Ferguson, 1990)*

74

Appendix B. Demographics: Individual Interviews

75

Descriptive Data Study One

GenderFemale 5 (56%)Male 4 (44%)

Age Mean 15.44Mode 14Maximum 18Minimum 12

Ethnicity White British 4 (44%)Asian 2 (22%)Any other ethnic background

2 (22%)

Indian 1 (11%)Religion

Roman Catholic 3 (33%)No Religion 3 (33%)Church of England 2 (22%)Sikh 1 (11%)

76

Appendix C. Ethical Approval

77

78

Appendix D. Study One Information and Consent Forms

79

PARTICIPANT (Young Person) INFORMATION SHEET (Study 1)

Date:

My name is Erin Brennan and I am training to become a clinical psychologist. I would

like to invite you to take part in my research study. Before you decide, you need to

know what you will be asked to do. Please take the time to read this information sheet.

The research

The aim of this study is to develop a new questionnaire that measures guilt in 11-18

year olds.

What will you need to do?

A teacher will have asked some people if they would like to take part in an interview

about guilt, and the teacher will have given you these forms to take home with you.

Please give your parents this information sheet and the letter to read. Once you have

read these forms you might have decided that you would like to take part in the

interviews. If so, then you and your parents will need to sign the consent forms saying

that you have agreed to do the interview. If you have decided to take part, then I will

arrange with your school a good time for you to have this interview. If you want to ask

any questions about this interview before you decide then you can email me on

e.brennan@surrey.ac.uk.

80

I will try and make the interview as relaxed as possible, so it is more like a chat. You will

be asked about what you think guilt is, and you will also be able to talk about different

situations that might make young people feel guilty. You will not have to talk about

personal situations if you do not want to. I just want to get a better idea of things or

situations that make 11-18 year olds experience guilt so I can use these ideas to design

a new questionnaire. You might tell me something personal which I think someone else

needs to know about. It would only be then that I would need to talk to someone at

school about what you have told me.

A few months after the interview, I will return to your school and ask you to fill out the

new guilt questionnaire and give your feedback (what you think about the

questionnaire) in a group of about 9 other young people. This will take place at your

school and again it is your choice whether or not you would like to participate.

I would also like your permission to audio tape the interview and group feedback

session so that I don’t have to remember everything that is said. This also means that I

will not have to write anything down during the interview. The tapes will be stored safely

and destroyed when the study is finished.

Writing up the research

The things that you share during your interview will be used to help me design a new

guilt questionnaire. This questionnaire, when it is finished, might be published in a

scientific journal or be used in the NHS to help health professionals’ work with children

and teenagers. However, nobody will know who took part in the interviews and your

name will not be on any of the information.

Your rights as a participant

If you decide that you would like to take part in this study, this does not mean that you

cannot change your mind. You will not need to tell me why you have changed your

mind; you can just pull out if you wish. If you feel that you need to talk to someone after

you have taken part in this study then please speak to your form tutor or school

counsellor. If you or your parents have any concerns about you taking part in this study,

please contact me on e.brennan@surrey.ac.uk or Ms Mary John (Course Director of

Psych D in Clinical Psychology) on 01483 689 441.

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Consent Form – Person with parental responsibility

I understand that Erin Brennan (Trainee Clinical Psychologist) would like my permission

for …………….…………………………….. to take part in a research study that is

developing a new questionnaire that measures guilt in 11-18 year olds.

I have read and understood the Information Sheet provided. I have therefore been

given a full explanation by the researchers of the nature, purpose, location and likely

duration of the study, and of what my child will be expected to do.

I understand that the written project will not contain any information that would reveal

the identity of my child or their school. The researcher (Erin Brennan) may be given my

child’s name during data collection, but this information will be then anonymised for the

written report.

I understand that the only people that will have access to the information collected

during this study will be the researcher and her supervisors at the University of Surrey. I

understand that any published work that may result from this study will not contain any

identifiable information about any of the participants.

I understand that the project (and material relating to it) is kept in securely locked

premises.

I understand that my child is free to withdraw from the study at any time without needing

to justify their decision.

I confirm that I have read and understood the above and freely consent to my child

participating in this study.

Name:

Signed:

Date:

Name of researcher: Erin Brennan

Signed:

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Date:

Assent Form – Young person

I agree to take part in this study that is developing a new guilt questionnaire.

I have read and understood the Information Sheet provided. I have been given a

full explanation of the study and I understand what I need to do.

I understand that the project will not contain any information that will reveal my

name or the name of my school.

I understand that the only people that will have access to the information collected

during this study will be Erin Brennan and her supervisors at the University of

Surrey. I understand that the questionnaire might become a published piece of

work. If this happens, nobody will know the names of the people that took part in the

study.

I understand that the project (and material relating to it) is kept in securely locked

premises.

I understand that I can change my mind at any time and decide that I do not want to

take part anymore. I will not need to say why I have changed my mind.

I confirm that I have read and understood the above and freely agree to take part in

this study.

Name:

Signed:

Date:

Name of researcher: Erin Brennan

Signed:

Date:

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Consent Form – Young person (Aged 16+ years)

I agree to take part in this study that is developing a new guilt questionnaire.

I have read and understood the Information Sheet provided. I have been given a

full explanation of the study and I understand what I need to do.

I understand that the project will not contain any information that will reveal my

name or the name of my school.

I understand that the only people that will have access to the information collected

during this study will be Erin Brennan and her supervisors at the University of

Surrey. I understand that the questionnaire might become a published piece of

work. If this happens, nobody will know the names of the people that took part in the

study.

I understand that the project (and material relating to it) is kept in securely locked

premises.

I understand that I can change my mind at any time and decide that I do not want to

take part anymore. I will not need to say why I have changed my mind.

I confirm that I have read and understood the above and freely agree to take part in

this study.

Name:

Signed:

Date:

Name of researcher: Erin Brennan

Signed:

Date:

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Appendix E. Demographic Form

85

BACKGROUND INFORMATION

Today’s Date: __________________________ ID Number: __________________________

1. Your age: _________________________

2. Date of Birth: _________________________

3. Are you (please check one):

Male Female

4. What year are you in school? _________________________

5. Ethnicity (please check one that best applies):

White British

White Irish

British other

Black Caribbean

Black African

Asian

Indian

Pakistani

Other

(Please specify: __________________)

6. Language (please check the language that you use most often at home and at school):

English

Polish

French

Punjabi

Spanish

Chinese

Arabic

Other

85

Religion (please check one that best applies):

Church of England

Roman Catholic

Other Christian

Buddhist

Hindu

Jewish

Muslim

Sikh

No Religion

Another Religion (Please specify):

______________________________________________________________________________

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Appendix F. Individual Interview Schedule

87

Individual Interview Semi-structured Schedule

(Adapted from Simonds et al., Under Review)

Why did you decide to take part in this interview?

What does the word guilt mean to you?

Tell them a definition if needed…ask if they agree/disagree.

What do you think the difference between shame and guilt is?

Again, tell them definitions…ask if they agree/disagree.

Can you each describe a situation that might make someone feel guilty?

What are your experiences of guilt (if want to share)?

What does guilt feel like? In mind? In body?

What does guilt make you think? Examples to get them thinking.

What does guilt make you feel like doing? Does it make you want to hide? Does it

make you angry? What else does it make you feel like doing?

What is the guiltiest thing you can think of?

Who feels guilty? Are some people more prone to feeling like this?

Is there a difference in guilty situations between boys and girls?

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Appendix G. Frequency Codes: Individual Interviews

89

Codes and Frequencies from the Content Analysis: Study One

What is Guilt?

Caused by something you did (10) Doing something bad (4) Sometimes you feel cool about it 1 You have guilt because of the people you have affected (1) Judged by other people… makes people feel guilty (1) With girls… it is more peer pressure and groups… more mental rather than anything

else (1) You can’t feel guilty for someone else (1) Worse on social media (7) More about how you feel about what happened to the other person (1) You want to make it better with the other person and you are worried about how they

feel (2) Made a mistake but still a good person (1) Lapse in judgment (1) More if it is someone close to you (4) Always when someone else is involved (1) Worse in real life than on social media (2) I know I have done something wrong (3) Big driving factor in peoples’ lives (3) Wrong against your conscience (1) Internal conflict (3) Causes damage (2) Can lead to a positive consequence (1) Cognitive process (1) Damages someone’s reputation (1) Hurting someone else (2) Teaches you a lesson not to do it again (3)

Shame and Guilt

Shame is more to do with yourself (2) Guilt you act on it more (1) Shame you hide from things more (2) Shame is more about you and guilt is more about how you feel about what happened

to the other person (1) Guilt is more about the people you have affected (1) Shame is based on judgement and guilt is based on internal conflict (1) You can feel guilt and shame in the same situation (7) Guilt is more about doing something wrong (1) With guilt you want to put things right (1)

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Shame is more related to how you feel… guilt is more about someone else and what you have done to them (1)

Shame is predominantly anger with yourself… guilt is more….you want to make it better for the other person (1)

Shame lasts longer (3) If you feel guilty about something then it is easier for you and anyone else involved

because it is a quicker recovery (1) Guilt you feel like you are a bad person but only momentarily, like you feel like you

have made a mistake, and it reflects badly on your character, but like you are still a good person you just had a lapse in judgment. But shame is more like, you are innately a bad person (1)

Guilt is when you know you’ve done it and like you know it’s wrong. And shame is something more embarrassing. (1)

Guilty you can tell someone, laugh about it, but if you are ashamed about something you wouldn’t tell (1)

Shame is more private (3) Shame is more inside of you (1) Guilt makes you feel more cautious about what you do…. Shame makes you feel

embarrassed (1) Shame is about forgiving yourself, guilt you also want forgiveness but you also feel

angry at yourself because you did something bad (1) Shame you see yourself more as… something bad, disappointment. And guilty… you

see yourself as disappointment because you did something bad (1) Shame is more embarrassment… guilt is the outright knowledge that you have done

something really really bad (1) Shame is worse than guilt (2) Shame is… outright I’m a bad person… guilt is more justifiable (1)

Guilt Situations

Hurting someone physically or emotionally (6) Not doing chores (3) Forgetting to do things (1) Bullying (2) Breaking up with girlfriend (1) Lies (18) Not doing homework/prep (8) Playing games when you are supposed to be studying (2) Robbery, stealing (5) Litter (1) Vandalism (3) Being rude to neighbour (1) Doing something without someone's permission (1) Not revising (1) Hiding something from someone (1) Upset family (1)

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Do something really bad and have to go to court for it (1) If you don’t confess (1) If you are dragged into doing something (2) Took something without asking (1) Lost something that belonged to someone (1) If you upset someone you care about (1) If you do badly at school (1) If you get in arguments with your friends and someone gets upset (1) If they don’t do something properly, which has an effect on the community (1) Do things behind people's backs (2) Double-faced person (2) If you have duties to do and tell someone else to do them for you (1) Eat chocolates and sweets behind your mum's back and she doesn’t know what you

are eating (1) Telling my brother to do stuff that he shouldn’t be doing (1) Took someone’s book or charger without asking (1) Did something they shouldn't have done like having a house party (1) Did something to jeopardise someone's life like rumours (1) Parents might feel guilty if they are alcoholics, get drunk in front of children (1) Saying you would get good grades and then not get them (2) Kill someone (3) Betray someone (2) Not meeting someone's expectations (1) Modelling unhelpful behaviour (1) Intentionally not help someone (1) Broke someone's belongings (1) Not having said something they should have said (1) Allow someone else to take the blame (3) Skiving class (1) Being found out for not completing an activity (1) Use neighbour's bins instead of your own (1) Waste the teachers time (1) If you are late (1) Making someone else look bad (1) Room untidy (1) Upset a teacher (1) Try to make someone feel bad about themselves (2) Telling people secrets (1) Shout at children (1) Gossip (2) Disappointing someone (1) Didn’t do well in exams because didn't revise (2) Did something bad and sister learnt from me and did the same thing (1) Don't apologise (1) Stay out late (1) Cause your parents to worry (1)

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Goofing off in class (1) Getting someone else in trouble (1) Social Media (20)

o Posting something on someone's facebook wall without permission (4)o Send something bad to someone (1)o Find out something about someone (1)o Posting something that isn't true (2)o Said something nasty about someone and then that person found out (2)o Put funny comments that you know won't be funny for other person (1)o Cross the line with a joke (1)o Cyber bullying (2)o Commenting on picture, like you are ugly (3)o Publish a negative photo or a very personal photo (1)o Hacking other people's accounts (1)o Posting something that is secretive (1)

Feelings associated with Guilt

Feel awful (1) Anxious (4) Stress (5) Lost confidence (4) Scared (2) Angry (5) Annoyed with self (5) Sadness (13) Upset (5) Disappointment (4) Paranoid (2) Uncomfortable (1) Deceitful (1) Self-pity (2) Not proud (2) Depressed (6) Conflicted (1) Judged (2) Hurts (1) Painful (1) Nervous (1) Lack of control (1) Low (1)

Thoughts associated with Guilt

Could have been prevented (1) Could have done better (3) I was not in control (1)

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I am responsible (5) Thinking about consequences (1) Think of plan (1) Conflicting arguments (2) Cross minded (2) Will I ever regain their trust? (2) I made a mistake (1) No one will like me (1) I am going to get into trouble (1) How am I going to fix this? (1) I could have done better (1) I shouldn't do it again (2) I didn't meet someone's expectations (1) Learn from mistakes (1) Kept thinking about what happened (1) I am insensitive (1) I thought I had damaged relationships (1) Don't know what to do (1) I did something wrong (1) Lapse in judgment (1) Making someone else look bad (1) I was the cause (1) Mixed messages (1) It may damage my reputation (2) Question my own ability (1) It was not my fault (2) Worried that they would be angry with me (1) I hadn't done enough (1) How can I make it up to the other person? (1) I disappointed them (1) What have I done? (1) This is really bad (1) Would you like people doing it to you? (1) Makes me look like a horrible person (1) Please forgive me (1) I want forgiveness (3) Is something bad going to happen to me that is going to change my life? (1) How am I going to sort the situation out? (1) Plays on your mind (3) That was a really stupid thing to do (3) I broke a trust (1) I shouldn’t do it again (3) I am responsible (1) I feel sorry for them (1) I made a mistake (1) I am sorry for what I did (1)

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I desperately want to improve (1) Someone else is going to get into trouble (3) I have done something bad that will have repercussions (4) My mum's going to kill me (2) I never want to do through that again (1) What I did was really wrong (1)

Behaviours Associated with Guilt

Thinking about things constantly (1) Want to help/for the other person to feel better (9) Face up to the problem (2) Compensate for the guilt (5) Confess (3) Try to fix the problem (2) Try not to do it again (1) Try to rebuild the trust (1) Change my future behaviours (1) Tell the truth (1) Apologise (1) More cautious about what you say and do (3) Prayed (2) Couldn't sleep (1) Affects academically, takes mind off things (1) Confront the situation (1) Prioritise things (1) Try to decrease my stress (1) Strive to be better in front of other people (1) Try to comfort them (1) Kill themselves (3) Violent (1) Owning up to it (1)

Appendix H. Draft Measure with Three Dimensions

95

Initially Developed 30-Item GSA Derived from the Three Dimensions

Cognitive Dimension

1. I thought “others will be disappointed in me” 2. I did not know what to do 3. I thought “I have done something wrong” 4. I thought “I might never be trusted again”

96

5. I thought “it was my fault” 6. I wanted to be forgiven 7. I thought “I should not do it again”8. I thought “I am going to get into trouble” 9. I regretted what I had done 10. I wanted to make it better for the other person 11. I could not concentrate on school work

Affective Dimension

1. I felt awful because of what I had done 2. I felt anxious and stressed 3. I felt I was not in control 4. I felt I had lost confidence in myself 5. I felt scared 6. I felt sad7. I felt annoyed with myself

Behavioural/Physiological Dimension

1. I needed to do something to make myself feel better 2. I tried to put things right 3. I tried not to do it again 4. I tried to rebuild the trust 5. I wanted to confess 6. I had trouble sleeping 7. I wanted to apologise 8. My heart felt heavy because of what I did 9. I felt sick in my stomach because of what I did 10. I felt like crying 11. I had trouble thinking straight 12. I kept thinking about what happened

Appendix I. Focus Group Interview Schedule

97

Focus Group Schedule

Ask the group the following questions:

1. What did you like about the questionnaire?

2. What did you feel could be improved on the questionnaire?

3. Is there anything you think is missing about guilt on the questionnaire?

98

4. What do you think might be difficult about filling in this questionnaire?

5. Any difficulties or misunderstandings?

6. Is there anything else you would like to add?

Appendix J. Focus Group Feedback Form

99

Focus Group Anonymous Feedback Form

Date:

ID Number:

100

1. What did you like about the questionnaire?

2. What did you feel could be improved on the questionnaire?

3. Is there anything you think is missing about guilt on the questionnaire?

4. What do you think might be difficult about filling in this questionnaire?

5. Any difficulties or misunderstandings?

6. Is there anything else you would like to add?

101

Appendix K. Interview Coding Extract

102

103

Appendix L. Individual Interviews: Shame versus Guilt Themes

104

Guilt versus Shame Themes Extracted from the Interviews

Category Frequency in

data (%)

Example from Interviews

Shame is private and internal,

whereas guilt is a more public

emotion that is about the ‘other

person’.

15/49 (31%) “Shame is more about you and guilt is

more about how you feel about what

happened to the other person”

Shame makes you feel like a

bad person, whereas guilt is

about doing something wrong

and making a mistake

14/49 (29%) “Guilt you feel like you are a bad person

but only momentarily, like you feel that you

made a mistake and it reflects badly on

your character, but like you are still a

good person you just had a lapse in

judgment. But like shame is more like, you

feel like you are innately a bad person.”

Guilt and shame can occur at

the same time

7/49 (14%) “I think guilt and shame can happen

together… that they do hand in hand”.

Guilt is about wanting to make

amends and make things right

for the other person, whereas

shame is about wanting to hide

and avoid

7/49 (14%) “… with guilt like you feel so terrible for

the other person you just want to make it

better for the other person as quickly as

possible” versus “Yeah, if you are

ashamed of yourself, you don’t want to be

yourself you want to sort of hide away”.

Shame lasts longer than guilt 6/49 (12%) “If you feel guilty then it is easier for you

and anyone else involved because it is a

quicker recovery”.

105

Appendix M. Example of Measure Development Decision Making

106

Examples of Item Development Decision Making Process

Statement from Interview Theme/Category Interpretation Measure Item Final Decision

“Um it made me feel sort of anxious and deceitful and bad… feel like a bad person.”

Measure Development: Feelings

Uncomfortable: Deceitful It made me feel deceitful. Not used in measure: too complex

“And I think guilt is something that… drives you to show a particular behaviour. For example you might perform suspiciously or try to do something to compensate the guilt…”

Measure Development: Behaviour

Compensation I tried to compensate for what I had done

Not used in measure: duplication

“Um well I guess like when I feel guilty I do feel really bad about myself, which I suppose is shame, like I don’t feel, yeah I do feel like ashamed of myself. So I think that’s probably normal when you feel guilty.”

Conceptual Framework Guilt and shame can co-occur

N/A N/A

“Guilt… I mean… I think it made me a bit more reclusive to be honest… a bit more introverted. I don’t really want to say depressed, but along those lines. Um. Just mainly negative feelings. Anything else you know…. Yeah… a lot more introverted I

Measure Development: Behaviours

Fixing the problem: Introversion

It made me go into myself Not used: more shame-like

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think.” IEGS Measure Item Alternative items from other

sourcesN/A I had trouble thinking

straight.Used in measure

“Whether …. you like will ever regain their trust or whether it was broken forever.”

Measure Development: Thoughts Impact of Behaviour: Trust

I thought I might never be trusted again. Used in measure

108

Appendix N. Individual Interviews: Situation Themes

109

Guilt-inducing Situations Extracted from Interviews

Category Frequency in

data (%)

Types of Situations

(and number of occurrences)

Damaging relationships 57/134 (43%) - Bullying (20)

- Lying (20)

- Disappointing someone (6)

- Arguments with loved ones (5)

- Betrayal (3)

- Arguments with others (2)

- Breaking up with boyfriend/girlfriend (1)

Failing to fulfill

duties/take responsibility

(43/134; 32%) - Not performing well in school (21)

- Not taking ownership of actions (8)

- Not meeting someone else’s expectations (5)

- Modelling unhelpful behavior (4)

- Not doing household chores (4)

- Having a house party when parents are away

(1)

Social Media (20/134; 15%) - Cyber-bullying (18)

- Making a secret public online (2)

Breaking the Law (14/134; 10%) - Stealing (6)

- Vandalism (3)

- Murder (3)

- Littering (1)

- Having to go to court (1)

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Appendix O. New Guilt Scale: Ready for Validation

111

GSA

It is common for young people to experience feelings of guilt. However, people vary in the type of situation that makes them feel guilt or guilty. Guilt can occur when you have done something that you think you should not have done, and it makes you feel bad in some way. Here are some examples of situations that might make young people feel guilt:

You bully someone You lie to your friend, teacher or a family member You post something hurtful on someone’s Facebook wall You do badly in a test or examination You steal something that is not yours You blame someone else for something you did

IMPORTANT

Can you think of some situations that have happened recently where you have felt guilt? Please write down a few situations like the examples above.

1.

2.

3.

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Now read each item below and circle the box next to how you would generally think and feel in situations like the ones you have written down.

EXAMPLE: Thinking back to times when you have felt guilt, if you very often think “I am disappointed in myself” then you would circle the number 3, as shown below.

Not at all A little bit

Quite a bit A lot

I thought “I am disappointed in myself” 0 1 2

Complete the statements below thinking back to the times you have felt guilt.

When I felt guilt……. Not at all

A little bit

Quite a bit

A lot

I could not concentrate on school work. 0 1 2 3

I kept thinking about what had happened. 0 1 2 3

I felt awful because of what I had done. 0 1 2 3

I thought “others will be disappointed in me”. 0 1 2 3

I needed to do something to make myself feel better.

0 1 2 3

I felt anxious and stressed. 0 1 2 3

I felt I was not in control. 0 1 2 3

I felt I had lost confidence in myself. 0 1 2 3

I did not know what to do. 0 1 2 3

I felt scared. 0 1 2 3

I thought “I have done something wrong” 0 1 2 3

I tried to put things right. 0 1 2 3

I thought “I might never be trusted again”. 0 1 2 3

I felt sad. 0 1 2 3

I felt annoyed with myself. 0 1 2 3

I tried not to do it again. 0 1 2 3

I tried to re-build the trust. 0 1 2 3

I wanted to make it better for the other person. 0 1 2 3

I thought “it was my fault”. 0 1 2 3

I wanted to be forgiven. 0 1 2 3

3

113

I thought “I should not do it again”. 0 1 2 3

I thought “I am going to get into trouble”. 0 1 2 3

I wanted to confess. 0 1 2 3

I regretted what I had done. 0 1 2 3

I had trouble sleeping. 0 1 2 3

I wanted to apologise. 0 1 2 3

My heart felt heavy because of what I did. 0 1 2 3

I felt sick in my stomach because of what I did. 0 1 2 3

I felt like crying. 0 1 2 3

I had trouble thinking straight 0 1 2 3

114

Appendix P. Study Two Demographics: Measure Validation

115

Descriptive Data Study Two: Whole Sample

GenderFemale 261 (64%)Male 149 (36%)

Age Mean 16.28Mode 17Maximum 18Minimum 12

Ethnicity White British 266 (65%)Any other ethnic background

51 (12%)

Black African 23 (6%)Asian 21 (5%)British Other 13 (3%)Indian 12 (3%)White Irish 9 (2%)Black Caribbean 5 (1%)Pakistani 5 (1%)Missing 4 (1%)

Religion No Religion 219 (53%)Roman Catholic 56 (14%)Church of England 45 (11%)Muslim 42 (10%)Other Christian 18 (4%)Hindu 12 (3%)Another Religion 8 (2%)Missing 6 (2%)Sikh 2 (1%)Jewish 1 (0.2%)

*Note. Data from seven schools included: 2 co-educational Sixth Form Colleges; 1 independent girls’ school; 1 co-educational independent school; 3 co-educational secondary schools.

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Appendix Q. Study Two Information and Consent Forms

117

Information Sheet for Young People

Hello. My name is Erin Brennan and I am training to become a Clinical Psychologist. I would like

to invite you to take part in my research study. Before you decide, you need to know what you

will be asked to do. Please take the time to read this information sheet.

The research

The aim of this study is to develop a new questionnaire that measures guilt in 11-18 year olds.

What you will be asked to do?

I am going to ask young people from your school to fill in some questionnaires. These

questionnaires look at different feelings and emotions including guilt, shame, mood and anger. I

have designed one of these questionnaires and as part of my research I need to check if my

questionnaire is working okay. To do this I need lots of 11-18 year olds to fill in the

questionnaires.

You do not have to take part in this study, but if you do want to take part you will need to sign a

consent form (please see the attached forms).

Writing up the research

I am hoping the questionnaire I have designed will be good at measuring guilt. If it is, then my

questionnaire might be published in a scientific journal. It might also be used to help

professionals’ work with children and teenagers who are experiencing problems in their lives.

However, nobody will know who took part in this research, and your name or school will not be

on any of the information that is published or available to others.

Your rights as a participant

If you decide that you would like to take part in this study, this does not mean that you cannot change

your mind. You will not need to tell the researcher why you have changed your mind; you can just pull

out if you wish. If you feel that you need to talk to someone after you have taken part in this study then

118

please speak to your form tutor or school counsellor. If you or your parents have any questions or

concerns about you taking part in this study, please contact me on e.brennan@surrey.ac.uk.

Consent Form – Young person

I agree to take part in this study that is developing a new guilt questionnaire.

I have read and understood the Information Sheet provided. I have been given a full

explanation of the study and I understand what I need to do.

I understand that the project will not contain any information that will reveal my name or

the name of my school.

I understand that the only people that will have access to the information collected during

this study will be Erin Brennan and her supervisors at the University of Surrey. I

understand that the questionnaire might become a published piece of work. If this

happens, nobody will know the names of the people that took part in the study.

I understand that the project (and material relating to it) is kept in securely locked

premises.

I understand that I can change my mind at any time and decide that I do not want to take

part anymore. I will not need to say why I have changed my mind.

I confirm that I have read and understood the above and freely agree to take part in this

study.

Name:

Signed:

Date:

Name of researcher: Erin Brennan

Signed:

Date:

119

Appendix R. Other Measures Used in Validation

120

Test of Self-Conscious Emotion for Adolescents (TOSCA-A): Guilt and Shame Subscales Date:

Name/ID:

Below are descriptions of a variety of situations. After each situation you will see two statements about different ways that people might think or feel. As you read each statement, really imagine that you are in that situation now. Please indicate which box (with a tick) describes how likely it is that the statement would be true for you.

EXAMPLE:

You wake up early one morning on a school day.

Not at all

likely

Unlikely Maybe(half and half)

Likely Very likely

I would eat breakfast right away.

I would feel like staying in bed.

Now look at the situations below and mark with a tick how true each statement is for you:

1. You trip in the cafeteria and spill your friend’s drink.

Not at all

likely

Unlikely Maybe(half and half)

Likely Very likely

I would be thinking that everyone is watching me and laughing.I would feel very sorry. I should have watched where I was going.

2. For several days you put off talking to a teacher about a missed assignment. At the last minute you talk to the teacher about it, and all goes well.

Not at all

likely

Unlikely Maybe(half and half)

Likely Very likely

121

I would regret that I put it off.

I would feel like a coward.

3. While playing around, you throw a ball and it hits your friend in the face.

Not at all

likely

Unlikely Maybe(half and half)

Likely Very likely

I would feel stupid that I can’t even throw a ball.I would apologise and make sure my friend feels better.

4. You and a group of classmates worked very hard on a project. Your teacher singles you out for a better grade than anyone else.

Not at all

likely

Unlikely Maybe(half and half)

Likely Very likely

I would feel alone and apart from my classmates.I would tell the teacher that everyone should get the same grade.

5. You break something at a friend’s house and then hide it.Not at

all likely

Unlikely Maybe(half and half)

Likely Very likely

I would think ‘This is making me anxious. I need to either fix it or replace it.’I would avoid seeing that friend for a while.

6. At school, you wait until the last minute to plan a project, and it turns out badly.Not at

all likely

Unlikely Maybe(half and half)

Likely Very likely

I would feel useless and incompetent.

I would feel that I deserve a bad grade.

7. You wake up one morning and remember it’s your mother’s birthday. You forgot to get her something.

Not at all

likely

Unlikely Maybe(half and half)

Likely Very likely

I would think “After everything she has done for me, how could I forget her

122

birthday?”I would feel irresponsible and thoughtless.

8. You walk out of a test thinking you did extremely well. Then you find out you did poorly.

Not at all

likely

Unlikely Maybe(half and half)

Likely Very likely

I would feel that I should have done better. I should have studied more.I would feel stupid.

9. You make a mistake at school and find out a classmate is blamed for the error.

Not at all

likely

Unlikely Maybe(half and half)

Likely Very likely

I would keep quiet and avoid the classmate.

I would feel unhappy and eager to correct the situation.

10. You were talking in class, and your friend got blamed. You go to the teacher and tell him the truth.

Not at all

likely

Unlikely Maybe(half and half)

Likely Very likely

I would feel like I always get people in trouble.I would think “I’m the one who should get into trouble. I shouldn’t have been talking in the first place.”

11. You and a friend are talking in class, and you get in trouble.Not at

all likely

Unlikely Maybe(half and half)

Likely Very likely

I would think “I should know better. I deserve to get into trouble.”I would feel like everyone in the class was looking at me and they were about to laugh.

12. You make plans to meet a friend. Later you realise you stood your friend up. Not at

all likely

Unlikely Maybe(half and

Likely Very likely

123

half)I would think “I’m inconsiderate.”

I would try to make it up to my friend as soon as possible.

13. You volunteer to help raise money for a good cause. Later you want to quit, but you know your help is important.

Not at all

likely

Unlikely Maybe(half and half)

Likely Very likely

I would feel selfish, and I’d think I am basically lazy.I would think “I should be more concerned about doing whatever I can to help.”

14. Your report isn’t as good as you wanted. You show it to your parents when you get home.Not at

all likely

Unlikely Maybe(half and half)

Likely Very likely

Now that I got a bad report, I would feel worthless.I would think “I should listen to everything the teacher says and study harder.”

15. You have recently moved to a new school, and everyone has been helpful. A few times you had to ask some big favours, but you returned the favours as soon as you could.

Not at all

likely

Unlikely Maybe(half and half)

Likely Very likely

I would feel like a failure.

I would be especially nice to the people who had helped me.

124

Adolescent Shame-Proneness Scale (ASPS)

It is common for young people to experience feelings of shame. However, people vary in the type of situation that makes them feel shame or ashamed. Shame can occur when you have done something or when someone else has done something to you. Here are some examples of situations that might make young people feel shame:

You are being bullied You make a mistake in front of your whole class and everyone laughs You do badly in a test or examination Your family can’t afford to buy you all the newest gadgets or most fashionable clothes You are horrible about your best friend behind his/her back

IMPORTANT

Can you think of some situations that have happened recently where you have felt shame? Please write down a few situations like the examples above.

1.

2.

3.

125

Now read each item below and circle the box next to how you would generally think and feel in situations like the ones you have written down.

EXAMPLE: Thinking back to times when you have felt shame, if very often think “I am rubbish at everything” then you would circle the number 3, as shown below.

Not at all A little bit

Quite a bit A lot

I thought “I am rubbish at everything” 0 1 2

Complete the statements below thinking back to the times you have felt shame.

When I felt shame……. Not at all

A little bit

Quite a bit

A lot

I thought “I have let other people down” 0 1 2 3

I felt worthless and small 0 1 2 3

I thought “Other people must think I am no good” 0 1 2 3

I thought “I am a nasty person” 0 1 2 3

I wanted to shout and scream 0 1 2 3

I felt angry at other people 0 1 2 3

I wanted to seek revenge 0 1 2 3

I thought “No one likes me” 0 1 2 3

I felt disappointed 0 1 2 3

I thought “Other people must think I am stupid” 0 1 2 3

I wanted to punch walls or break things 0 1 2 3

I felt sad 0 1 2 3

I had a horrible feeling inside 0 1 2 3

I thought “I am no good” 0 1 2 3

I felt embarrassed 0 1 2 3

I thought “Other people must think I am nasty” 0 1 2 3

I thought “I am stupid” 0 1 2 3

3

126

I felt frustrated 0 1 2 3

I thought “It is better if I was not around” 0 1 2 3

Revised Child Anxiety and Depression Scale (R-CADS)

Date:

Name/ID:

Please put a circle around the word that shows how often each of these things happen to you. There are no right or wrong answers.

1. I worry about things…. Never Sometimes Often Always

2. I feel sad or empty…. Never Sometimes Often Always

3. When I have a problem, I get a funny feeling in my stomach….

Never Sometimes Often Always

4. I worry when I think I have done poorly at something….

Never Sometimes Often Always

5. I would feel afraid of being on my own at home….

Never Sometimes Often Always

6. Nothing is much fun anymore….

Never Sometimes Often Always

7. I feel scared when I have to take a test….

Never Sometimes Often Always

8. I feel worried when I think someone is mad at me….

Never Sometimes Often Always

9. I worry about being away from my parents….

Never Sometimes Often Always

10. I get bothered by bad or silly thoughts or pictures in my mind….

Never Sometimes Often Always

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11. I have trouble sleeping…. Never Sometimes Often Always

12. I worry that I will do badly in my school work….

Never Sometimes Often Always

13. I worry that something awful will happen to someone in my family….

Never Sometimes Often Always

14. I suddenly feel as if I can’t breathe when there is no reason for this….

Never Sometimes Often Always

15. I have problems with my appetite….

Never Sometimes Often Always

16. I have to keep checking I have done things right (like the switch is off, or the door is locked)….

Never Sometimes Often Always

17. I feel scared if I have to sleep on my own….

Never Sometimes Often Always

18. I have trouble going to school in the mornings because I feel nervous or afraid....

Never Sometimes Often Always

19. I have no energy for things….

Never Sometimes Often Always

20. I worry I might look foolish….

Never Sometimes Often Always

21. I am tired a lot…. Never Sometimes Often Always

22. I worry that bad things will happen to me….

Never Sometimes Often Always

23. I can’t seem to get bad or silly thoughts out of my head….

Never Sometimes Often Always

24. When I have a problem, my heart beats really fast….

Never Sometimes Often Always

25. I cannot think clearly…. Never Sometimes Often Always

26. I suddenly start to tremble or shake when there is no

Never Sometimes Often Always

128

reason for this….

27. I worry that something bad will happen to me….

Never Sometimes Often Always

28. When I have a problem, I feel shaky….

Never Sometimes Often Always

29. I feel worthless…. Never Sometimes Often Always

30. I worry about making mistakes….

Never Sometimes Often Always

31. I have to think of special thoughts (like numbers or words) to stop bad things from happening….

Never Sometimes Often Always

32. I worry about what other people think about me….

Never Sometimes Often Always

33. I am afraid of being in crowded places (like shopping centers, the movies, buses, busy playgrounds)….

Never Sometimes Often Always

34. All of a sudden I feel really scared for no reason at all….

Never Sometimes Often Always

35. I worry about what is going to happen….

Never Sometimes Often Always

36. I suddenly become dizzy or faint when there is no reason for this….

Never Sometimes Often Always

37. I think about death…. Never Sometimes Often Always

38. I feel afraid if I have to talk in front of my class….

Never Sometimes Often Always

39. My heart suddenly starts to beat too quickly for no reason….

Never Sometimes Often Always

40. I feel like I don’t want to move….

Never Sometimes Often Always

41. I feel that I will suddenly get a scared feeling when

Never Sometimes Often Always

129

there is nothing to be afraid of….

42. I have to do some things over and over again (like washing my hands, cleaning or putting things in a certain order)….

Never Sometimes Often Always

43. I feel afraid that I will make a fool of myself in front of certain people….

Never Sometimes Often Always

44. I have to do some things in just the right way to stop bad things from happening….

Never Sometimes Often Always

45. I worry when I go to bed at night….

Never Sometimes Often Always

46. I would feel scared if I had to stay away from home overnight….

Never Sometimes Often Always

47. I feel restless…. Never Sometimes Often Always

130

Anger Expression Scale for Children (AESC)

Date:

Name/ID:

Everyone feels angry from time to time, but people differ in how they act when they are angry. Below are some statements that people might use to describe themselves and how they act when they feel angry. Read each statement and describe how often the statement applies to you when you feel angry. You should circle the number in the box that you think is true for you.

Almost never

Some-times

Often Almost always

I feel angry. 1 2 3 4

I feel like yelling at someone. 1 2 3 4

I get very impatient if I have to wait for something.

1 2 3 4

I lose my temper easily. 1 2 3 4

I feel like breaking things. 1 2 3 4

I feel grouchy or irritable. 1 2 3 4

I get in a bad mood when things don’t go my way.

1 2 3 4

I have a bad temper. 1 2 3 4

I get very angry if my parent or teacher criticises me.

1 2 3 4

I get in a bad mood easily. 1 2 3 4

I slam doors or stomp my feet. 1 2 3 4

I keep it to myself. 1 2 3 4

I control my temper. 1 2 3 4

I let everybody know it. 1 2 3 4

I try to be patient. 1 2 3 4

131

I argue or fight back. 1 2 3 4

I keep my cool. 1 2 3 4

I hit things or people. 1 2 3 4

I feel it inside, but I don’t show it. 1 2 3 4

I stay well behaved. 1 2 3 4

I say mean or nasty things. 1 2 3 4

I stay mad at people but keep it a secret. 1 2 3 4

I try to stay calm and settle the problem. 1 2 3 4

I have a temper tantrum. 1 2 3 4

I hold my anger in. 1 2 3 4

I try to control my anger feelings. 1 2 3 4

132

Self-Compassion Scale – Short Form (SCS)

HOW I TYPICALLY ACT TOWARDS MYSELF IN DIFFICULT TIMES

Please read each statement carefully before answering. To the left of each item, indicate how often you behave in the stated manner, using the following scale:

Almost Almost

never always

1 2 3 4 5

_____1. When I fail at something important to me I become consumed by feelings of inadequacy.

_____2. I try to be understanding and patient towards those aspects of my personality I don’t like.

_____3. When something painful happens I try to take a balanced view of the situation.

_____4. When I’m feeling down, I tend to feel like most other people are probably happier than I

am.

_____5. I try to see my failings as part of the human condition.

_____6. When I’m going through a very hard time, I give myself the caring and tenderness I need.

_____7. When something upsets me I try to keep my emotions in balance.

_____8. When I fail at something that’s important to me, I tend to feel alone in my failure

_____9. When I’m feeling down I tend to obsess and fixate on everything that’s wrong.

_____10. When I feel inadequate in some way, I try to remind myself that feelings of inadequacy are

shared by most people.

133

_____11. I’m disapproving and judgmental about my own flaws and inadequacies.

_____12. I’m intolerant and impatient towards those aspects of my personality I don’t like.

Appendix S. Scree Plot

134

135

Appendix T. 5-Factor and 3-Factor Solutions

136

Five Factor Solution

GSA Item Factor 1 Factor 2 Factor 3 Factor 4 Factor 5

I could not concentrate on school work

.451 .061 -.083 -.044 .147

I kept thinking about what had happened

.446 .111 .037 .246 .116

I felt awful because of what I had done

.184 .183 -.164 .279 .104

I thought "others will be disappointed in me"

.241 .049 -.200 .114 .215

I needed to do something to make myself feel better.

.283 .182 .047 .030 .122

I felt anxious and stressed.

.602 .022 -.106 .095 .049

I felt I was not in control.

.635 .087 -.069 -.051 -.008

I felt I had lost confidence in myself.

.654 -.008 -.103 .057 -.082

I did not know what to do.

.679 .084 -.108 .019 -.007

I felt scared. .597 -.068 -.175 -.032 .135

I thought “I have done something wrong”

.104 .036 -.092 .376 .198

I tried to put things right.

.125 .791 .066 -.068 .005

I thought “I might never be trusted again”.

.089 .109 -.309 -.005 .297

I felt sad. .388 .126 -.198 .377 -.255

I felt annoyed with myself.

.361 -.082 -.092 .601 -.164

137

I tried not to do it again.

-.006 .454 .050 .300 .014

I tried to re-build the trust.

.031 .777 -.102 -.041 -.011

I wanted to make it better for the other person.

.143 .717 .045 .122 -.103

I thought “it was my fault”.

.088 .156 -.160 .389 .099

I wanted to be forgiven.

.042 .326 -.003 .337 .195

I thought “I should not do it again”.

-.082 .282 .004 .428 .275

I thought “I am going to get into trouble”.

.183 -.143 -.068 .099 .566

I wanted to confess. -.117 .303 -.361 .029 .237

I regretted what I had done.

-.173 .143 -.147 .610 .204

I had trouble sleeping. .125 .002 -.605 .000 .000

I wanted to apologise. -.219 .455 -.370 .247 .025

My heart felt heavy because of what I did.

-.043 .065 -.735 .107 -.001

I felt sick in my stomach because of what I did.

.012 -.069 -.838 -.009 .010

I felt like crying. .127 -.073 -.742 -.012 .009

I had trouble thinking straight

.195 -.026 -.694 -.019 -.005

138

Three Factor Solution

GSA Item Factor 1 Factor 2 Factor 3

I could not concentrate on school work

.456 .026 -.137

I kept thinking about what had happened

.482 .280 -.033

I felt awful because of what I had done

.213 .416 -.201

I thought "others will be disappointed in me"

.234 .212 -.298

I needed to do something to make myself feel better.

.302 .193 .013

I felt anxious and stressed. .651 .032 -.109

I felt I was not in control. .689 -.030 .007

I felt I had lost confidence in myself.

.725 -.062 -.019

I did not know what to do. .752 .014 -.038

I felt scared. .652 -.098 -.183

I thought “I have done something wrong”

.129 .365 -.218

I tried to put things right. .135 .700 .219

I thought “I might never be trusted again”.

.096 .208 -.371

I felt sad. .494 .256 -.082

I felt annoyed with myself. .427 .256 -.117

139

I tried not to do it again. .023 .666 .102

I tried to re-build the trust. .074 .706 .080

I wanted to make it better for the other person.

.191 .736 .218

I thought “it was my fault”. .137 .455 -.218

I wanted to be forgiven. .074 .610 -.079

I thought “I should not do it again”.

-.078 .684 -.137

I thought “I am going to get into trouble”.

.139 .096 -.334

I wanted to confess. -.069 .409 -.352

I regretted what I had done. -.145 .660 -.297

I had trouble sleeping. .214 .000 -.537

I wanted to apologise. -.151 .666 -.292

My heart felt heavy because of what I did.

.075 .153 -.654

I felt sick in my stomach because of what I did.

.127 -.050 -.751

I felt like crying. .248 -.084 -.663

I had trouble thinking straight .328 -.080 -.607

140

Appendix U. 4-Factor Solution

141

30-item GSA factor loadings and Cronbach’s alpha* for four factors

GSA Item Inner Turmoil(α .86)

Reparation(α .83)

Physiological Reactions

(α .85)

Regret and Self-Blame

(α .78)I could not concentrate on school work .448 .028 - .115 .015

I kept thinking about what had happened .512 .075 .072 .277

I felt anxious and stressed. .657 .000 - .075 .067

I felt I was not in control..668 .066 - .049 - .103

I felt I had lost confidence in myself. .722 - .013 - .040 - .059

I did not know what to do. .729 .066 - .075 - .047

I felt scared..608 - .091 -.193 - .006

I felt sad..490 .193 - .096 .101

I tried to put things right..111 .740 .032 - .027

I tried to re-build the trust. .015 .772 - .147 - .046

I wanted to make it better for the other person. .177 .733 .056 .026

I had trouble sleeping..138 .016 - .602 - .030

My heart felt heavy because of what I did. - .013 .082 - .712 .090

142

I felt sick in my stomach because of what I did. .019 - .049 - .837 - .024

I felt like crying..141 - .064 - .733 - .028

I thought “it was my fault”. .161 .150 - .120 .409

I thought “I should not do it again”. - .038 .251 - .011 .576

I regretted what I had done. - .080 .125 - .099 .714

I thought “I have done something wrong”

.169 - .003 - .060 .486

Items not loading at >.4/ Did not fit factor category/ Cross-loading

I wanted to confess.- .132 .247 - .406 .222

I thought “I am going to get into trouble”. .143 - .172 - .195 .376

I wanted to apologise.- .177 .444 - .346 .283

I wanted to be forgiven..082 .303 - .012 .430

I felt annoyed with myself. .480 .023 - .003 .307

I tried not to do it again..042 .465 .064 .270

I thought “I might never be trusted again”. .069 .050 - .364 .201

I had trouble thinking straight .211 - .013 - .687 - .056I felt awful because of what I had done .248 .143 - .120 .341I thought "others will be disappointed in me" .262 - .005 - .208 .249I needed to do something to make myself feel better.

.287 .152 .022 .086

Appendix V. Final Guilt Scale for Adolescents (GSA)

143

144

Guilt Scale for Adolescents (GSA)

It is common for young people to experience feelings of guilt. However, people vary in the type of situation that makes them feel guilt or guilty. Guilt can occur when you have done something that you think you should not have done, and it makes you feel bad in some way. Here are some examples of situations that might make young people feel guilt:

You bully someone You lie to your friend, teacher or a family member You post something hurtful on someone’s Facebook wall You do badly in a test or examination You steal something that is not yours You blame someone else for something you did

IMPORTANT

Can you think of some situations that have happened recently where you have felt guilt? Please write down a few situations like the examples above.

1.

2.

3.

145

Now read each item below and circle the box next to how you would generally think and feel in situations like the ones you have written down.

EXAMPLE: Thinking back to times when you have felt guilt, if you very often think “I am disappointed in myself” then you would circle the number 3, as shown below.

Not at all A little bit

Quite a bit A lot

I thought “I am disappointed in myself” 0 1 2

Complete the statements below thinking back to the times you have felt guilt.

When I felt guilt……. Not at all

A little bit

Quite a bit

A lot

I could not concentrate on school work. 0 1 2 3

I kept thinking about what had happened. 0 1 2 3

I felt anxious and stressed. 0 1 2 3

I felt I was not in control. 0 1 2 3

I felt I had lost confidence in myself. 0 1 2 3

I did not know what to do. 0 1 2 3

I felt scared. 0 1 2 3

I thought “I have done something wrong” 0 1 2 3

I tried to put things right. 0 1 2 3

I felt sad. 0 1 2 3

I tried to re-build the trust. 0 1 2 3

I wanted to make it better for the other person. 0 1 2 3

I thought “it was my fault”. 0 1 2 3

I thought “I should not do it again”. 0 1 2 3

I regretted what I had done. 0 1 2 3

I had trouble sleeping. 0 1 2 3

My heart felt heavy because of what I did. 0 1 2 3

I felt sick in my stomach because of what I did. 0 1 2 3

I felt like crying. 0 1 2 3

3

146

Appendix W. Measure Normality: Histograms

147

GSA Subscale 1

GSA Subscale 2

148

GSA Subscale 3

GSA Subscale 4

149

*Note. ASPS was previously known as the Shame Scale for Adolescents (SSA)

ASPS Subscale 1

ASPS Subscale 2

150

ASPS Subscale 3

AESC Subscale 1

151

AESC Subscale 2

AESC Subscale 3

152

AESC Subscale 4

SCS Total

153

R-CADS Subscale 1

R-CADS Subscale 2

154

R-CADS Subscale 3

R-CADS Subscale 4

155

R-CADS Subscale 5

R-CADS Subscale 6

156

TOSCA-A Guilt

TOSCA-A Shame

157

Appendix X. Non-Parametric Tests

158

Table I.

Spearman’s Rho between GSA and TOSCA-A Guilt Scale

TOSCA-A Guilt(α .83)

GSA Inner Turmoil .37*, p< .001N=401

GSA Reparation .42*, p< .001N=399

GSA Physiological Reactions .38*, p< .001N=402

GSA Regret and Self-Blame .46*, p< .001N=400

*Statistically significant at p<.001

Table II.

Spearman’s Rho between GSA and TOSCA-Shame, SCS, ASPS, AESC and RCADS

GSA Inner GSA Reparation GSA GSA Regret and

159

Turmoil Physiological Reactions

Self-Blame

AESC Trait Anger (α .86)

0.22*, p< .001N=403

- 0.02, p= .661N=400

0.17*, p< .001N=403

0.08, p= .074N=401

AESC Anger Expression (α .72)

0.01, p= .808N=401

- 0.02, p= .604N=399

0.01, p=.906N=402

- 0.03, p=.444N=400

AESC Anger Control (α .75)

0.26*, p<0.001N=406

0.15*, p=0.001N=404

0.17*, p<0.001N=407

0.10*, p<0.008N=405

AESC Anger Suppression (α .83)

0.05, p=0.288N=399

0.20*, p<0.001N=398

0.06, p=0.166N=400

0.17*, p<0.001N=398

SCS Self Compassion(α .78)

-0.38*, p<0.001N=387

0.01, p=.826N=385

-0.29*, p<0.001N=388

-0.18*, p<0.001N=387

RCADS Social Phobia (α .87)

0.59*, p<0.001N=396

0.20*, p<0.001N=396

0.49*, p<0.001N=398

0.41*, p<0.001N=396

RCADS Panic Disorder (α .89)

0.55*, p<0.001N=394

0.20*, p<0.001N=394

0.51*, p<0.001N=396

0.29*, p<0.001N=394

RCADS Major Depression (α .87)

0.46*, p<0.001N=393

0.15*, p=0.004N=393

0.43*, p<0.001N=396

0.21*, p<0.001N=394

RCADS Separation Anxiety (α .80)

0.43*, p<0.001N=395

0.13*, p=0.010N=395

0.39*, p<0.001N=398

0.22*, p<0.001N=396

RCADS Generalised Anxiety (α .82)

0.51*, p<0.001N=395

0.18*, p<0.001N=395

0.46*, p<0.001N=398

0.29*, p<0.001N=396

RCADS Obsessive Compulsive Anxiety (α .80)

0.43*, p<0.001N=396

0.12*, p=0.003N=396

0.39*, p<0.001N=399

0.23*, p<0.001N=397

TOSCA-A

Shame

(α .85)

0.49*, p<0.001N=399

0.19*, p<0.001N=397

0.46*, p<0.001N=400

0.35*, p<0.001N=398

ASPS Self

Evaluation

(α .91)

0.59*, p<0.001N=401

0.21*, p<0.001N=399

0.57*, p<0.001N=402

0.44*, p<0.001N=400

ASPS

Humiliated Fury

(α .78)

0.27*, p<0.001N=400

0.05, p=0.285N=398

0.27*, p<0.001N=401

0.07, p=0.159N=399

160

ASPS Internal

Affect

(α .81)

0.57*, p<0.001N=403

0.32*, p<0.001N=401

0.52*, p<0.001N=404

0.50*, p<0.001N=402

*Statistically significant at p< 0.001

Appendix Y. Journal of Adolescence Guidelines for Authors

161

162

163

164

165

166

167

168

169

170

171

172

173

Appendix Z: GSA Reliability: Correlations

174

GSA Reliability: Item-Total and Inter-item Correlations

GSA Factor 1: Inner Turmoil

Inter-Item Correlation Matrix

I could not

concentrate on

school work

I kept thinking

about what had

happened

I felt anxious and

stressed.

I felt I was not in

control.

I felt I had lost

confidence in

myself.

I did not know

what to do. I felt scared.

I could not concentrate on

school work1.000 .417 .391 .376 .360 .397 .366

I kept thinking about what had

happened.417 1.000 .488 .312 .364 .476 .393

I felt anxious and stressed. .391 .488 1.000 .533 .516 .511 .472

I felt I was not in control. .376 .312 .533 1.000 .562 .543 .476

I felt I had lost confidence in

myself..360 .364 .516 .562 1.000 .591 .479

I did not know what to do. .397 .476 .511 .543 .591 1.000 .627

I felt scared. .366 .393 .472 .476 .479 .627 1.000

175

Item-Total Statistics

Scale Mean if

Item Deleted

Scale Variance if

Item Deleted

Corrected Item-

Total Correlation

Squared Multiple

Correlation

Cronbach's

Alpha if Item

Deleted

I could not concentrate on

school work8.45 21.388 .504 .270 .853

I kept thinking about what

had happened7.55 21.197 .539 .349 .848

I felt anxious and stressed. 7.85 19.124 .660 .452 .832

I felt I was not in control. 8.43 19.169 .639 .448 .835

I felt I had lost confidence in

myself.8.34 18.867 .655 .462 .833

I did not know what to do. 8.30 18.987 .724 .558 .822

I felt scared. 8.58 19.606 .636 .445 .835

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GSA Factor 2: Reparation

Inter-Item Correlation Matrix

I tried to put

things right.

I tried to re-build

the trust.

I wanted to

make it better for

the other

person.

I tried to put things right. 1.000 .621 .589

I tried to re-build the trust. .621 1.000 .633

I wanted to make it better for

the other person..589 .633 1.000

Item-Total Statistics

Scale Mean if

Item Deleted

Scale Variance if

Item Deleted

Corrected Item-

Total Correlation

Squared Multiple

Correlation

Cronbach's

Alpha if Item

Deleted

I tried to put things right. 3.97 3.150 .670 .450 .775

I tried to re-build the trust. 4.01 3.111 .703 .495 .741

I wanted to make it better for

the other person.3.76 3.267 .678 .463 .766

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GSA Factor 3: Physiological Reactions

Inter-Item Correlation Matrix

I had trouble

sleeping.

My heart felt

heavy because

of what I did.

I felt sick in my

stomach

because of what

I did. I felt like crying.

I had trouble sleeping. 1.000 .527 .547 .534

My heart felt heavy because

of what I did..527 1.000 .692 .577

I felt sick in my stomach

because of what I did..547 .692 1.000 .649

I felt like crying. .534 .577 .649 1.000

Item-Total Statistics

Scale Mean if

Item Deleted

Scale Variance if

Item Deleted

Corrected Item-

Total Correlation

Squared Multiple

Correlation

Cronbach's

Alpha if Item

Deleted

I had trouble sleeping. 4.22 9.671 .615 .379 .841

My heart felt heavy because

of what I did.3.90 9.515 .706 .525 .804

I felt sick in my stomach

because of what I did.4.11 8.758 .752 .587 .782

I felt like crying. 4.17 9.041 .690 .484 .810

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GSA Factor 4: Regret and Self-Blame

Inter-Item Correlation Matrix

I thought “I have

done something

wrong”

I thought “it was

my fault”.

I thought “I

should not do it

again”.

I regretted what I

had done.

I thought “I have done

something wrong”1.000 .472 .383 .446

I thought “it was my fault”. .472 1.000 .447 .512

I thought “I should not do it

again”..383 .447 1.000 .584

I regretted what I had done. .446 .512 .584 1.000

Item-Total Statistics

Scale Mean if

Item Deleted

Scale Variance if

Item Deleted

Corrected Item-

Total Correlation

Squared Multiple

Correlation

Cronbach's

Alpha if Item

Deleted

I thought “I have done

something wrong”6.40 5.000 .529 .288 .759

I thought “it was my fault”. 6.39 4.504 .592 .355 .728

I thought “I should not do it

again”.6.24 4.745 .583 .379 .732

I regretted what I had done. 6.28 4.583 .651 .442 .697

178

MRP Proposal (without Appendices)

179

School of Psychology Coursework Form

PSYCHD CLINICAL PSYCHOLOGY

MRP PROPOSAL

September 2013

Year 1

Assignment Title: The development of a new measure of guilt proneness

for adolescents

Student URN: 6243093

Word Count (excluding Title Page, Abstract, Table of Contents,

References and Appendices) = 2995

180

Background and Theoretical Rationale

Guilt, a self-conscious emotion, is an important component of conscience that

regulates human behaviour (Bybee, 1998). It is has cognitive, affective and

behavioural components and involves a moral transgression, real or imaginary, in

which people believe their action or inaction contributed to negative outcomes

(Tilghman-Osborne, et al., 2010). A general consensus on the construct is however

lacking; some view guilt as trait-like (stable across many situations), whereas others

see it as state-like (dependent on circumstances) (Tilghman-Osborne, et al., 2010).

Similarly, inconsistencies have been noted on guilt’s relationship with mental health.

Some authors consider guilt to be adaptive, protective and associated with pro-social

behaviour and academic/vocational achievement (Bybee, 1998). Others have noted

its maladaptive consequences (e.g. association with eating disorders, depression and

antisocial behaviour) when expressed chronically or in an excessive or deficient

manner (Tangney & Dearing, 2002). For example, the Diagnostic and Statistical

Manual (Fourth-Version) (DSM-IV) specifies ‘excessive or inappropriate guilt’ as a

symptom of depression (APA, 2000).

Shame, also a self-conscious emotion, is distinct from guilt yet often co-

occurs (Tangney & Dearing, 2002). Generally, the focus of evaluation for shame is

on the global self, whereas the focus for guilt is on the specific behaviour (e.g. ‘I did

that horrible thing’ versus ‘I did that horrible thing’) (Tangney & Dearing, 2002).

Behaviourally, shame is accompanied by a desire to hide or escape whereas guilt is

often associated with a desire to confess, apologise or repair (Tangney & Dearing,

2002). Associations with psychopathology are also different, with many authors

suggesting shame is more maladaptive than guilt; that guilt is only detrimental when

181

fused with shame (Ferguson, et al., 1999). This finding has however been disputed

by research that has demonstrated chronic and excessive guilt to be associated with

mental health problems even when shame is partialled out (Bybee, 1998).

Another way to differentiate shame and guilt may be through self-

compassion. Self-compassion involves basic kindness, with a deep awareness of the

suffering of oneself and of other living things, coupled with the wish and effort to

relieve it (Gilbert, 2009a; Neff, 2003b). Research surrounding self-compassion has

generally focused on shame rather than guilt (Gilbert, 2009a). Only two studies

examining the relationship of shame, guilt and self-compassion were found in the

literature: the first study (examining self-compassion in female athletes) found that

guilt and self-compassion were positively correlated and shame and self-compassion

were negatively correlated with each other, whereas the second study (an

investigation of Clergy burnout) found that shame was negatively correlated with

self-compassion but that guilt was not related to self-compassion (Barnard & Curry,

2012; Mosewich, Kowalski, Sabiston, Sedgwick, & Tracy, 2011). Due to the paucity

of research, self-compassion’s potential role in differentiating guilt and shame is an

area deserving of future research (Mosewich, et al., 2011).

Similar inconsistencies have been noted in the measurement of guilt, which

remains especially problematic in younger populations (Tilghman-Osborne, et al.,

2010). A recent unpublished review of the literature identified 19 child and

adolescent guilt measures, although only 10 of these were accessible (see Appendix

A) (Brennan, 2013). This review concluded that, due to questionable validity,

reliability and poor research designs, a gold standard for the measurement of guilt in

young people does not exist. For example, data on validity and reliability were

182

rarely and inconsistently reported and measure development did not enhance

construct validity (overlooking important confounding factors). No paper considered

all four of the most common confounding factors (anxiety, depression, anger and

shame) in their analyses (Tilghman-Osborne, et al., 2010). Similarly, only one

measure examined the impact of social desirability (whether young people were

reporting what they thought researchers wanted to hear) (Tilghman-Osborne, et al.,

2010). All of the measures were developed in the USA with samples of primarily

White, Christian, Middle-Class young people and often un-equal representations of

boys and girls. They may therefore be limited in ecological validity and cross-

cultural application.

Very few of the existing measures were piloted during the development stage

and items were generated using a ‘top-down’ approach (generated by academics,

researchers and clinicians rather than young people). The majority of measures were

also scenario-based, where examples of guilt-provoking situations are provided

followed by a Likert-scale of response options. Most were however developed in the

1990s and so may not provide situations that capture accurate experiences of guilt

(e.g. scenarios relating to social media and other technologies). They also provide a

limited number and type of scenarios and may therefore fail to capture unique

personal experiences of guilt. Semi-idiographic measures (e.g. asking a person to

recall a time when they felt guilty) are recommended in the literature as a way to

overcome these issues, yet no existing measure has used this format (John et al.,

2013).

Finally, despite changes in the experience of guilt across development

(becoming increasingly complex with age and cognitive maturity), the review

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sourced only one measure for adolescence- and it was limited as it was adapted from

an existing child measure, which itself was modified from an adult guilt measure

(Baker, et al., 2012; Tangney, et al., 1991). John et al (2013)’s review states that the

development of a new adolescent guilt measure is therefore a high priority for future

research. Implications include improving clinical interventions and informing

service developments.

Research Questions/Aims

The main research question asks what a new semi-idiographic self-report

measure of guilt-proneness would look like for adolescents. The primary research

aim is therefore to develop the measure and, subsequently, establish its internal

reliability and validity. Influence of social desirability bias will also be considered.

This measure will serve as a compliment to the Shame Scale for Adolescents (SSA),

previously designed within the Department (Simonds et al., Under Review). A

secondary research question will be whether self-compassion differentiates shame

and guilt.

Main Hypotheses

Concurrent criterion validity will be assessed by correlating the New Guilt

Measure (NGM) scores with scores on the guilt subscale of the Test of Self-

Conscious Affect in Adolescents (TOSCA-A); it is expected that the two measures

will be positively correlated. Divergent construct validity will be investigated by

exploring the relationship between the NGM scores and scores from the shame

subscale of the TOSCA-A. A positive correlation is expected. Convergent validity

will be assessed by exploring the relationship between NGM scores and scores on the

Anger Expression Scale for Children (AESC) and Revised Child Anxiety and

184

Depression Scale (R-CADS). Based on the literature, it is expected that the NGM

scores will be positively correlated with R-CADS scores and negatively correlated

with AESC scores (Bybee, 1998). The influence of social desirability will be

investigated by exploring the relationship between the NGM and Children’s Social

Desirability (CSD) scores; a negative correlation is expected. The hypothesis for the

secondary research question, based on Mosewich et al (2011), is that self-compassion

will differentiate guilt and shame by being positively correlated with guilt and

negatively correlated with shame, thus serving to further demonstrate the NGM’s

construct validity.

Method

Participants Adolescents aged 11 to 18 will be recruited. This age range was decided

based on the World Health Organisation’s definition of adolescence and also the age

range used for recruitment in the SSA study (Simonds, et al., Under Review; WHO,

2002). Sampling will take place in non-clinical (school) settings. As per similar

studies, approximately 10 adolescents will be recruited for the measure development

stage and 500 adolescents for measure validation (Simonds, et al., 2010). The

literature has noted that 50% (equivalent to 255 students) is a reasonable response

rate for academic papers, however the SSA study was able to recruit a much higher

number (420 young people from four schools) (Baruch, 1999; Simonds, et al., 2010).

Exclusion criteria will be young people who have a known and significant learning

disability (as assessed by the school) and are not able to participate in a regular

classroom learning environment.

Design

A cross-sectional measure development design will be employed.

185

Measures

See Appendix E for a copy of all measures.

Procedure

See Appendix B for a flow-chart documenting the project’s three stages. A data

collection timeline is outlined in Appendix C.

Stage One This stage will involve measure development. Recruitment will focus on

identifying a co-education secondary school with a diverse representation of ethnic,

socioeconomic and religious backgrounds. Information on diversity will be obtained

from the Department of Education, Ofsted and individual school websites. After a

school has been identified, the head teacher will be sent an information letter (with

Special Education Needs Coordinators and school counsellors copied in as

applicable) followed by a subsequent telephone call. Upon the school’s approval, all

staff will be emailed with the project’s information and printed packs will be

available for the teachers to collect from the head teacher’s office. Two options will

then be presented to the schools: form tutors/teachers can distribute information

packs (with consent forms) to interested students or the researcher can present the

project in a school assembly and ask interested students to take an information pack.

Schools may also be asked to post printed adverts of the study in the school. Consent

forms can be returned to a box in the school office or to individual classroom

teachers and will be collected by the researcher one-week before data collection.

The school can then arrange a time and place for the researcher to interview the

young people who provided consent.

186

Semi-structured interviews will be conducted with approximately 10

adolescents at their school (approximately 30-minutes each), where they will be

asked questions in relation to their understanding and experience of guilt (Appendix

D). They will also be administered a demographic questionnaire (Appendix E).

Interview scripts will then be analysed and items generated. Once the draft measure

has been developed, a focus group (with either the 10 adolescents initially

interviewed or a new set of young people) will be conducted in which participants

will be asked to complete the new questionnaire individually and then feedback

comments as a group (approximately 15minutes) (Appendix F). In order to capture

the experiences of adolescents less likely to contribute in a group setting, an

anonymous written feedback form will also be administered individually (Appendix

G). The interviews and focus group will be audio recorded and transcribed verbatim.

Stage Two Five-hundred adolescents will be recruited for stage two. Recruitment will

target a range of co-education and single-sex schools (secondary schools, sixth-form

colleges and independent schools), both public and private, from different

geographical locations in England and with students from diverse ethnic,

socioeconomic and religious backgrounds. Schools will be identified and contacted

(and information packs distributed/data collection times organised) in the same way

as stage one. Data collection will involve administering questionnaire packs

(completed with paper and pencil) containing the following: Demographic

Questionnaire; the NGM (developed in stage one); TOSCA-A; SSA; R-CADS;

AESC; and CSD. All of the measures have good validity and reliability (see

Appendix H for more information). It is anticipated that the questionnaire pack will

take approximately 30-to-45mimutes to complete.

187

Stage Three Stage three will be run concurrently with stage two. The Self-Compassion

Scale (SCS) (or the short form- SCS-SF) will be administered alongside the other

above-mentioned measures (Neff, 2003a; Raes, Pommier, Neff, & Van Gucht, 2011).

This measure is appropriate for ages 14 and up, so will only be used with participants

aged 14 to 18. A new youth measure is in the early development stages (as per email

correspondence with Kristen Neff, the measure’s developer, on 20th July 2013) but

may not be available in time for the present study. If the measure is available in

time, the whole sample will be administered the new youth self-compassion

questionnaire. The SCS and SCS-SF have reported good validity and reliability

(Neff, 2003a).

Ethical Considerations

An application for ethical approval will be submitted to the University of

Surrey Faculty of Arts and Human Sciences Ethics Committee. Informed consent is

a primary ethical consideration. If the school’s policy is aligned with the British

Psychological Society (BPS)’s recommendations with research conducted in schools

(that heads of schools can allow children under 16 to provide consent if they deem it

part of normal curriculum), consent forms will be provided to the school for the head

teacher and also the individual students (BPS, 2010). If the school’s policy is that

parental consent be provided for students under 16, an ‘opt-out’ form will be

discussed with the head teacher (where parents are sent a text, email or letter in

which the project is described and they are provided with contact information or a

form to return to the school to ask that their child not participate in the study). If

parents at such schools want to allow their children to participate, they would not

need to sign or return anything. Finally, in the case where an opt-out procedure does

188

not align with school policy, ‘opt-in’ written consent will be requested from the

parents/caregivers (where a written consent form is returned to the school if parents

agree for their child to participate). Based on the BPS’s guidelines, adolescents who

are aged 16 and older will be allowed to provide their own informed consent (BPS,

2010).

In case of disclosure, or any other safeguarding issue, the school’s

safeguarding policy will be followed. Mary John, Registered Psychologist and

supervisor, will also be contactable. Participants will be informed, before data

collection begins, that if the researcher becomes concerned or worried about them or

others at any point, someone else at the school would need to become involved. If

required, usual referral paths will be followed. Immediately after data collection, all

young people will be de-briefed (where the researcher will discuss how the

questionnaires are not diagnostic, that there are no right or wrong answers and that

completing such questionnaires often causes increased personal reflection). A plan

of action will be verbally discussed in case students feel they need extra support (e.g.

Childline number, contact names at school) and a written de-brief form (providing

the same) will also be distributed.

In order to not disrupt classroom time, the study will be conducted during a

scheduled break within regular school hours. If this does not suit the school, after or

before school slots can be arranged. Breaks will be offered to young people if they

feel they need to leave the room at any point. Written puzzles will also be included

in the questionnaire pack, so that adolescents can choose not to participate without

revealing this to the group. All participants will be provided with the option to

decline/withdraw from the study at any time. Overall, risk of psychological distress

189

is low and there is no evidence (from other measure development studies in the

literature) that administering similar types and quantities of questionnaires has been

distressing/not tolerated by young participants (Simonds, et al., Under Review;

Tilghman-Osborne, et al., 2012).

Proposed Data Analysis

Statistical analyses will be conducted using SPSS version-19.0 (SPSS Inc.,

2013). Demographic data will be analysed descriptively. Following the initial

interviews and focus groups, a content analysis will be conducted of transcribed

scripts, followed by an exploratory factor analysis to devise measure items (B. G.

Tabachnick, Fidell, & Osterlind, 2001; Weber, 1990). This type of data analysis has

been cited in similar measure development studies (Simonds, et al., Under Review;

Tilghman-Osborne, et al., 2012). Best practice guidelines for exploratory factor

analysis state that the required sample size should be a participant to item ratio of 2:1

to 5:1 (Costello & Osborne, 2005). As shorter measures are generally more

favourable in younger populations, the maximum length of the present measure will

be approximately 20 items (Bybee, 1998). With an estimated sample size of 500,

this would provide 2.5 participants per item (2.5:1), which falls within the literature’s

recommendations (Costello & Osborne, 2005). Although this is at the smaller end of

the required sample size, it is similar to other published studies (Costello & Osborne,

2005).

Data will be checked to ensure no data entry errors or missing data. If

assumptions are met, hypotheses surrounding social desirability and validity will be

addressed using Pearson’s correlations (Ezekiel & Fox, 1959). Correlational

analyses will also be run on the SCS, NGM and SSA to address the study’s second

190

aim (and hypotheses in relation to self-compassion, shame and guilt). With 500

participants, a correlation (two-tailed) of at least 0.2 with 99% Power (alpha at 0.05)

can be detected (Faul, Erdfelder, Buchner, & Lang, 2009). The correlations for

validity are expected to be higher than this (Simonds, et al., Under Review).

Therefore, 500 participants would yield sufficient Power. Internal reliability will be

investigated using Cronbach’s alpha co-efficients (Cronbach, 1951).

Service User and Carer Consultation/Involvement

This proposal has been discussed with a service user and carer representative

at the University. Feedback will continue to be gained from the Co-ordinator of

Service User & Carer Involvement on the University PsychD programme. In

addition to this, the questionnaires pack will be piloted with a small group of

adolescents (children of University staff) prior to the main study. Consent will be

obtained prior to receiving any feedback.

Feasibility Issues

Recruitment and a low response rate may be potential issues. In order to

overcome this, University staff may be emailed during stages two and three,

requesting the participation of their children (aged 11 to 18). If interest is expressed,

information and consent forms can then be provided. Another option to aid

recruitment may be to provide an online option for questionnaire completion.

Psychology A-Level classes may also be particularly interested in the study and

provide a more feasible recruitment route. As an extra incentive, all participating

schools will be offered a free presentation to young people on ‘What is Clinical

Psychology’ (given by the researcher) after the study. In order to make recruitment

191

during stages two and three more manageable, a Psychology undergraduate student

at the University may be involved in data collection.

Dissemination Strategy

A finalised paper will be submitted for publication to a peer-reviewed journal

and presented at an international conference on child and adolescent

psychopathology.

Study Timeline

Please see Gantt chart for the project timeline (Appendix I).

.

192

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MRP Literature Review (with Appendices)

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School of Psychology Coursework Form

PSYCHD CLINICAL PSYCHOLOGY

Literature Review

April 2013

Year 1

Assignment Title: The Measurement of Guilt in Children and Adolescents:

a Literature Review

Student URN: 6243093

Word Count (excluding Title Page, Abstract, Table of Contents,

References and Appendices) = 7994

This review will be submitted to the Clinical Psychology Review for publication. There are

a number of reasons as to why this is the journal of choice. The Clinical Psychology Review

is a very high-impact journal with a rating of 7.071. This means that articles published in

this journal are widely disseminated and cited amongst other researchers. Reviews

published in this journal also have a clear and substantial link to the field of Clinical

203

Psychology. The only other review paper that has examined the measurement of guilt

(across the lifespan) was published in the Clinical Psychology Review in 2010, suggesting

that this journal has an interest in the area.

ABSTRACT

Guilt is a self-conscious emotion that has recently received a surge in

research attention, yet its implications for child and adolescent wellbeing and

adjustment are often debated (Bybee, 1998). Some authors suggest that it is an

adaptive emotion with protective properties, whereas others argue for its maladaptive

features and link with psychopathology (Tangney & Dearing, 2002). Its

measurement is also controversial, with a variety of definitions and methodologies

employed. Ten published journal articles and one edited book in Pubmed,

PsycINFO, MEDLINE, Web of Knowledge databases and from the author’s own

knowledge of the area were sourced and reviewed. The definition of guilt

employed, measure type, design/evaluation methodologies and considerations given

to issues of diversity and culture were specifically examined. Findings highlighted

considerable inconsistencies in the available data and a general paucity of research in

the area. Implications and future recommendations are discussed.

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INTRODUCTION

Guilt is an integral component of conscience that regulates human behaviour

(Bybee, 1998). It is a complex construct with affective, cognitive and behavioural

components and involves a moral transgression (real or imaginary) in which people

believe their action or inaction contributed to negative outcomes (Tilghman-Osborne,

Cole, & Felton, 2010). In the literature, guilt has been viewed as trait-like or state-

like; maladaptive or adaptive (Bybee, 1998). Trait-like refers to dispositional and

chronic guilt occurring across many situations, whereas state-like guilt is situation

and time-specific (Bybee, 1998). A general consensus on the construct is lacking. In

their review of the definition and measurement of guilt, Tilghman-Osborne et al

(2010) noted that such a discrepancy is rare in the social sciences and should be a

reason for concern.

In its adaptive form, guilt is considered protective and associated with pro-

social behaviour, less aggression, academic/vocational achievement and increased

helping rates (Bybee, 1998). ‘Pre-dispositional guilt’, considered to be largely

adaptive, is associated with temperament and arises in response to specific events

(Bybee, 1998). When triggered, it often results in responses that are reconciliatory in

nature (e.g. apologising) and serves to rectify the precipitating event (Bybee, 1998).

Views on pre-dispositional guilt are conflicting however. For example, Bybee

(1998) noted that it is adaptive in individuals who are not depressed, but maladaptive

in individuals who score high on depression.

Some authors suggest that guilt becomes maladaptive when generalised to the

self, whereas others state that it is the extremes in guilt (excessive or deficient) that

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are detrimental and associated with later psychopathology (Baker, Baibazarova,

Ktistaki, Shelton, & van Goozen, 2012; Ferguson, Stegge, Miller, & Olsen, 1999).

The distinctness, consistency and consensual nature of the emotion and its related

behaviour are also key in determining whether guilt is maladaptive or adaptive

(Bybee, 1998). For example, if someone were to display guilt-relevant behaviours in

the presence of different people, in an inconsistent manner and if few others

responded with the same behaviours in similar situations, it might be concluded that

the presenting guilt is maladaptive. Similarly, ‘Chronic Guilt’ has been described in

the literature and relates to unresolved, undirected and unalleviated guilt; an ongoing

condition of guiltiness unattached to a triggering incident (Bybee, 1998). It has been

linked with poor coping strategies and mental health difficulties (Bybee, 1998).

Some authors have suggested that guilt is only maladaptive when it is fused with

shame (Ferguson, et al., 1999). Others have disputed this, indicating that chronic

guilt continues to be related to psychopathology (e.g. anxiety, eating disturbances)

even when shame is partialled out (Bybee, 1998). Associations of guilt and

psychopathology are clearly inconsistent in the literature.

Guilt and shame, both self-conscious emotions, are two distinct constructs

that often co-occur (Bybee, 1998). Although making a clear distinction between the

two is essential, the available research has typically focused on one emotion while

ignoring the other (Tilghman-Osborne, et al., 2010). Many studies use the ‘self

versus behaviour’ distinction in defining shame and guilt: when people feel shameful

they feel bad about the self, whereas when people feel guilty they feel bad about a

specific behaviour (Lewis, 1971). Shame involves a sense of exposure before an

audience, real or imagined, and often motivates an avoidance response (Bybee,

1998). In contrast, guilt focuses on the specific deed, harm caused to others, and

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desire to make amends (Bybee, 1998). Some authors have described this distinction

in terms of Attribution Theory: shame emerges if one attributes an event to oneself

and sees the characteristic as being global, stable and enduring; guilt emerges when

an event is attributed as being an unstable, time-limited and specific aspect of the self

(Hosser, Windzio, & Greve, 2008; Weiner, 1986).

Other theoretical frameworks have also been applied within guilt research.

The Functionalist Approach has been used to promote a more balanced view of guilt,

stating that emotions themselves are not dysfunctional but can become so when

expressed intensively, frequently and inappropriately relative to situational demands

(Campos, Mumme, Kermoian, & Campos, 1994). Beck (1967)’s Cognitive Theory,

which describes cognitive errors associated with depression, has also been applied to

guilt. Based on this work, definitions of ‘inappropriate guilt’ ( thoughts associated

with an incorrect assumption of responsibility) and ‘excessive guilt’ (the

disproportionate negative affect in response to an incident for which one has

assumed such responsibility) have evolved (Tilghman-Osborne, Cole, & Felton,

2012). Developmental Cognitive Theories suggest that broad cognitive abilities are

required in order for guilt to be experienced (Tilghman-Osborne, et al., 2012). For

example, within Piaget’s Stages of Cognitive Development, younger children tend to

view the world in more concrete and less abstract ways (Piaget, 1964). After age 10

(as ‘formal operational’ thought develops), children have a greater capacity for

abstract reasoning, information retention and perspective-taking, which has a direct

impact on their appreciation of guilt (Tilghman-Osborne, et al., 2012).

Although more research is needed on developmental differences in the

experience of guilt, it is becoming increasingly apparent that an appreciation of age

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and cognitive capacity are essential. In comparison to adolescents and adults, the

definition of guilt is more likely to have an adaptive and reparative function when

applied to children (Tilghman-Osborne, et al., 2010). Similarly, guilt may be more

normative for children under the age of 10 (Tilghman-Osborne, et al., 2010). In early

childhood, guilt is mainly behavioural in nature (e.g. discomfort shown in

facial/bodily distress, apology) and becomes increasingly cognitive and complex

with age and cognitive maturity (Baker, et al., 2012). Between the ages of eight and

11, children begin to develop more sophisticated distinct conceptions of shame and

guilt (Bybee, 1998). The frequency and intensity of guilt also changes along the

lifespan- increasing in childhood, declining in early adolescence and then increasing

again in later adolescence as adulthood approaches (Bybee, 1998).

The World Health Organization defines adolescence as young people in

between the ages of 10 and 19 and specifies three different stages: early adolescence

(age 10-13), mid-adolescence (age 14-15) and later adolescence (age 16-19) (WHO,

2002). It is during this age span that noteworthy changes occur in cognitive and

emotional development, which results in increasing moral development and a more

complex understanding of right from wrong (Tilghman-Osborne, Cole, Felton, &

Ciesla, 2008). During adolescence, a variety of mental health problems (e.g.

depression) also become more prevalent (Bybee, 1998). Similarly, identity and

social roles are rapidly changing, with an increasing separation from the family and

integration into the peer group (Bybee, 1998). An attention to adolescence within the

guilt literature is lacking and warrants more research.

Culture and diversity issues (e.g. gender, sexuality and religion) may also

influence the measurement of guilt. Guilt is a concept heavily influenced by

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morality, often defined or expressed within a religion and culture. For example,

some researchers have suggested that guilt is fundamentally different in Asian as

opposed to Western cultures (Tilghman-Osborne, et al., 2010). Similarly, gender

may influence guilt experiences (Bybee, 1998). For example, females often report

more intense and frequent feelings of guilt, especially from adolescence onwards

(Bybee, 1998; Silfver & Helkama, 2007). In comparison to males, they also tend to

experience more guilt in the context of interpersonal relationships (Walter &

Burnaford, 2006). In terms of religion, different affiliations have varying

conceptualizations of guilt and use a variety of processes or rituals to alleviate guilt

(Bybee, 1998). Personal experiences of religion may therefore help shape the

construct of guilt. Similarly, guilt and sexuality, particularly in adolescents, is an

area that is under-explored in the literature (Bybee, 1998).

These issues all impact the measurement of guilt. There has been only one

published review on the measurement of guilt, reflecting the general lack of research

in the area (Tilghman-Osborne, et al., 2010). This review was limited in that it did

not investigate issues relating to culture and diversity. It also examined the

measurement of guilt across the lifespan. Although this perspective is important,

particularly as adult measures are often applied to children and adolescents (see

Appendix A for full list), specific attention to guilt measurement in young people is

warranted. The aim of the present study is to therefore explore these issues in more

detail and to address how guilt is measured in children and adolescents.

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METHOD

An electronic search of four search engines was performed (PsycINFO, Pubmed,

Web of Knowledge and MEDLINE) in November 2012. Titles of papers were

searched using the following terms:

“guilt” and “child*”/“children”/ “youth”/ “paediatrics”/ “juvenile”/

“adolescent”;

“guilt” and “child*”/“children”/ “youth”/ “paediatrics”/ “juvenile”/

“adolescent” and “measure*”/ “outcome”/ “psychometric”/

“instrument”/“questionnaire”.

The inclusion criteria included:

Published after (and including) the year 1990.

English language only.

Children and adolescents only (newborn to age 18); studies with life-range

(e.g. children, adolescents and adults) were not included. Studies with

participants aged 19 to 20 were included if they were defined as adolescents.

Journal articles and book chapters needed to be publically available. Journal

articles needed to be peer-reviewed; dissertations were not considered.

The article’s focus needed to be on the measurement of guilt.

The measure must have a primary focus of guilt. Measures with a secondary

focus (e.g. emotional regulation) were not considered.

If multiple versions of a measure existed, a focus was placed on most recent

publications, therefore concentrating on definitions and measures that were

most completely informed by the author’s research (Tilghman-Osborne, et

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al., 2010). This was on the condition however that the most up-to-date

measure was publically available.

An expert (research supervisor) in the field provided recommended readings

and the reference lists of all articles were hand-searched. The search produced 10

articles and one edited book (see strategy, Figure 1). Ten child and adolescent

measures were sourced from eight of these articles and the edited book (see Table 1).

The remaining two articles outlined the influence of culture on the measurement of

guilt in children and adolescents and are described in Appendix C. Dates of all

publications ranged from 1990 to 2012. Most of the measures were dated from the

1990s; only two measures were from the late 2000s (Donatelli, Bybee, & Buka,

2007; Tilghman-Osborne, et al., 2012). Papers were synthesized using a thematic

approach (Cronin, Ryan, & Coughlan, 2008). After an initial reading of the core

papers (10 articles and one edited book), key themes were identified and used to

structure the present review. These themes included definitions employed, measure

type, measure development/evaluation and appreciation of culture and diversity.

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Figure 1. Search Strategy

Articles Excluded:

Inclusion Criteria not met: n=12,020

Articles Assessed Using Full-Text Review n=15

Included Articles n=9

12,035 Sources for Review of Title and Abstract after Removing Duplicates

Hand-Searched Article Reference Lists, n=10 New Articles Found

Articles Excluded:

Articles not publically available: n=9

Included Articles n=10 Articles

Articles Excluded:

Inclusion Criteria not met: n=6

1 Edited Book Provided by Supervisor

36,646 Total Papers (all searches combined)

Pubmed n=8,599 PsycINFO n=7,010 MEDLINE n=12,459 Web of Knowledge n=8,515

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RESULTS

Type of Measure

Measures were scenario-based, semi-projective, observational or parent-

reported. No global checklist or semi-idiographic guilt measures were sourced.

Scenario-based measures presented specific and common situations, followed by

Likert-scale questions that captured the cognitive, behavioural and affective aspects

of guilt (Tangney & Dearing, 2002). Semi-projective measures presented

photographs depicting ambiguous situations, followed by a series of questions

(Tangney & Dearing, 2002). Observational measures were used by experimenters to

code children’s guilt-relevant behaviours (Barrett, Zahn-waxler, & Cole, 1993).

Scenario-Based

Six scenario-based measures were found. The Test of Self-Conscious Affect

for Children (TOSCA-C) was originally developed in 1990 for children aged eight to

12 and is a scenario-based self-report measure in which 10 negative and five positive

scenarios are presented (Tangney & Dearing, 2002). Children rate on a five-point

Likert scale the extent to which they would feel guilt, shame, pride, detachment and

externalization in relation to each situation. ‘Guilt’ and ‘shame’ terms are not

explicitly used in the measure. The TOSCA-C was adapted for adolescents to

produce the Test of Self-Conscious Affect for Children (TOSCA-A); its structure and

coding are the same (Tangney & Dearing, 2002).

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The Child-Child Attribution and Reaction Survey (C-CARS) is an

interview-based measure (developed in 1990) intended for children aged five to 12

years (Ferguson, et al., 1999). It was adapted from the TOSCA-C. A scenario is

provided (written and pictorial representations) and the child responds on a five-point

Likert scale to questions relating to shame, guilt or externalisation. The Shame and

Guilt Questionnaire (SGQ), similar to the C-CARS, is a Dutch measure developed in

2000 for children aged six to 11 (Olthof, Schouten, Kuiper, Stegge, & Jennekens‐Schinkel, 2000). It has been translated into English but has yet to be validated in an

English-speaking population. The experimenter presents 10 situations (five ‘shame-

only’; five ‘shame-and-guilt’) which feature a protagonist the same sex as the child.

The child then responds, on a five-point Likert scale, the degree to which the

protagonist would experience shame and/or guilt. The Maladaptive Guilt Induction

Measure (MGI) was developed in 2007 and is specifically intended for adolescents

aged 12 to 20 years (Donatelli, et al., 2007). It is a 22-item self-report questionnaire

that examines the young person’s perceived level of parental guilt induction (extent

to which parents make them feel guilty). The respondent is presented with a series of

statements and asked to rate how true/untrue they are on a seven-point Likert scale.

The Inappropriate and Excessive Guilt Scale (IEGS) was developed in 2012

and assesses inappropriate and excessive guilt in young people aged seven to 16

years old (Tilghman-Osborne, et al., 2012). The measure is composed of 24

scenarios with negative outcomes and ambiguous faults; the young person rates on a

three-point Likert scale how they would think/feel if it had happened to them. It is

the first measure to look specifically at maladaptive guilt and its relation to

depression.

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Semi-ProjectiveOne semi-projective measure was located in the literature. The Children’s

Interpretations of Interpersonal Distress and Conflict (CIIDC), developed in 1990, is

a semi-projective narrative measure in which children aged three to nine respond to a

series of questions after viewing four photographs of ambiguous situations (Zahn-

Waxler, Kochanska, Krupnick, & McKnew, 1990).

Observational/Behavioural The Clown-Doll Paradigm was developed in 1993 for children aged 17 to 36

months (Barrett, et al., 1993). Children are invited to play with a toy while the

experimenter goes into another room. Unknown to the child, the toy is already

broken so when the child picks it up, it breaks apart. The child’s behaviours are

coded before and after the incident and before and after the experimenter returns.

The Mishap Guilt paradigm, adapted from the Clown-Doll Paradigm, was developed

in 2002 (Barrett, et al., 1993; Kochanska, Gross, Lin, & Nichols, 2002). It was

designed for the slightly older age bracket of 22 to 45 months old and uses a similar

design to the Clown-Doll Paradigm.

Other Informants The majority of the measures were self-report. Only two measures were

coded by the experimenter (Clown-Doll Paradigm and Mishap Guilt Paradigm) and

one was a parent-reported measure (My Child). My Child was developed in 1994

and is composed of 100 items (expressed as 10 scales) (Kochanska, DeVet,

Goldman, Murray, & Putnam, 1994). Parents rate the child’s experience of guilt,

discomfort or anxiety in response to a real or anticipated transgression, as well as

their ability to self-regulate or refrain from acting on impulses (Kochanska, et al.,

1994). The measure has since been adapted, but the newer version could not be

sourced.

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Measure Development

Definition of Guilt Two measures defined guilt as maladaptive, six defined it as adaptive and two

defined it as being both maladaptive and adaptive. Similarly, eight measures saw

guilt as being a state, whereas two saw it as a trait. The majority of measures

(TOSCA-A, TOSCA-C, C-CARS, SGQ, My Child, Clown-Doll Paradigm) examined

guilt in conjunction with other constructs- most commonly shame, anxiety, pride,

externalization and detachment. Only the IEGS, CIIDC, MGI and Mishap Guilt

Paradigm measured guilt alone.

Target Age

Ages ranged from 25 months to 20 years old. The most commonly targeted

age group was that of young children (aged five to 12 years), used by four measures.

In comparison, only two measures specifically targeted adolescents (aged 12 to 20)

(Donatelli, et al., 2007; Tangney & Dearing, 2002). Of these two, one measured

perceived level of parental guilt induction whereas the other looked at guilt in

addition to shame, externalization, detachment and pride. Neither of these measures

considered different subsets or stages/age brackets of adolescence. Three studies

looked specifically at toddlers (aged 21 to 70 months old) and one measure (IEGS)

was designed for use with a mixture of children and adolescents (aged seven to 16)

(Barrett, et al., 1993; Kochanska, et al., 1994; Kochanska, et al., 2002; Tilghman-

Osborne, et al., 2012). Measures for younger children were observational and

parent-reported, whereas for older children/adolescents measures were self-report

only.

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Item Generation

All measures found, with the exception of the TOSCA-A and TOSCA-C,

used experimenter-generated items (rather than child/adolescent-informed items).

The TOSCA-C and TOSCA-A employed interviews with young people to generate

personal narratives of shame, guilt and pride. Data from those interviews were then

used to develop measure items. My Child, the only parent-reported measure, also

conducted initial interviews with mothers to generate measure items. In contrast,

experimenter-generated measures involved pooling items from the literature and

expert opinion. A few of the measures did not specify how items were generated.

Many of the available child and adolescent measures had been adapted from

previously existing adult measures (e.g. TOSCA-C was adapted from the adult

TOSCA) (Tangney & Dearing, 2002). Others were adapted from earlier child and

adolescent measures (e.g. TOSCA-A and C-CARS were adapted from the TOSCA-

C).

Theoretical Orientation

All but two studies used an established theoretical basis to define guilt and

aid measure development (Donatelli, et al., 2007; Olthof, et al., 2000). The most

common theoretical bases included Lewis (1971)’s Shame versus Guilt distinction

and theories of cognitive development (Kochanska, et al., 2002; Tilghman-Osborne,

et al., 2012; Zahn-Waxler, et al., 1990). Psychodynamic principles were mentioned

in one study- the oldest sourced measure published in 1990 (Freud, 1961; Zahn-

Waxler, et al., 1990). A Mediational Model (stating that fearful temperament

contributes to guilt proneness which serves to inhibit children’s tendency to violate

rules) was noted in the only behavioural/observational measure (Kochanska, et al.,

2002). The most recently developed measure (IEGS) employed Beckian and

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developmental cognitive theories (A. T. Beck, 1967; Piaget, 1964; Tilghman-

Osborne, et al., 2012).

Evaluation of Measure

Only two studies described piloting the measure (Tangney & Dearing, 2002;

Tilghman-Osborne, et al., 2012). Similarly, only two studies (IEGS and My Child)

described validation procedures; the remaining measures discussed development

only. Sample sizes ranged from 43 to 370. All studies, with the exception of

Kochanska et al (2002)’s Mishap Paradigm evaluation, were cross-sectional in

nature. Kochanska et al (2002)’s evaluation was longitudinal and evaluated the

Mishap Guilt Paradigm over the course of 38 months.

Most of the studies were conducted in either research laboratories or schools.

Only one study was conducted in a youth outpatient mental health facility

(Tilghman-Osborne, et al., 2012). The majority were also conducted in urban

locations and only one study administered the measure in the young person’s home

(Donatelli, et al., 2007). Available information on reliability and validity are listed in

Table 1. Data were inconsistently reported. Generally, measures reported good

internal consistency reliability. Studies varied in their reporting of Cronbach alphas:

some reported for subscales only, whereas others reported total scales only. The

majority of papers did not report on convergent, construct, discriminant and

incremental validity. Effect sizes were not reported by any of the studies. All the

measures, with the exception of the MGI, were validated in English-speaking

populations.

Only two of the studies ran comparisons to other, more established, guilt

measures for children and adolescents (Ferguson, et al., 1999; Tilghman-Osborne, et

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al., 2012). Data were not available for the TOSCA-A and TOSCA-C. The IEGS

measure was examined most comprehensively and was compared to the TOSCA-C

and Adult Shame and Guilt Scale (Tilghman-Osborne, et al., 2012). Correlational

data on these comparisons indicated that the guilt measures were significantly and

positively related (ranging from r=0.39 to 0.54).

Confounding Factors

Shame was the most common confounding factor examined, but was still

only considered in six studies. In these six studies, shame was found to highly

covary with guilt. The influence of social desirability, depression, fear and empathy

were mentioned in only a few. Anxiety was also overlooked. The only measure that

considered the construct of anxiety was the IEGS, and even with this measure it was

only considered during the item development stage (not during instrument

validation). Due to the significant variability between studies, a comparison based

on confounding factors was not possible.

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Table 1.

Child and Adolescent Guilt Measures

Author/Date Country Measure Sample Size/Age

Theoretical Basis Ethnicity, Gender & SES

Design/Evaluation Validity/Reliability

Tilghman-Osborne et al. 2012

USA IEGS (Inappropriate and Excessive Guilt Scale)

Pilot: 25 (7-14years).

Validation: 370 (7-16years).

Cognitive (Beckian & Developmental) theories.

94%White; 54% Female; middle to medium-low SES

Scenario-based. Piloted with clinical sample. Validated in non-clinical school sample.

Compared to shame/guilt (TOSCA-C and SGS), social desirability and depression measures.

Good convergent validity: (r=0.43-0.52, p<0.01).

Good construct validity (significantly related to measures of cognitive errors: r= 0.54, p<0.01 and depression, r=0.39, p<0.05).

Good discriminant validity (measure was not related to measure of social desirability, r= -0.05, not statistically significant).

Incremental validity of the IEGS was over-and-above other measures of guilt.

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Reliability not reported.

Positive correlations with other guilt measures, ranging from r=0.39 to 0.54, p<0.01.

Olthof et al. 2000 Netherlands SGQ (Shame and Guilt Questionnaire)

48 (6-11years)

N/A Ethnicity: N/A 50% Male

‘mixed’ SES

Scenario-based. Non-clinical (schools) setting.

Validity and reliability not reported.

Not validated in English-speaking population.

Donatelli et al.

2007

USA MGI (Maladaptive Guilt Induction Measure)

43 children: 12-20 years

43 mothers: 34-42years

N/A Depressed Mothers group: 70% Caucasian; Non-Depressed Mothers Group: 74% Caucasian.

Adolescent Group: 53.4% female.

Scenario-based. Clinical and Non-clinical groups (children of mothers with & without history of depression).

Compared to established depression measure.

MGI- good internal consistency on ‘dispargement’ and ‘self-serving elicitation’ subscales (Cronbach alphas of 0.86 and 0.82 respectively).

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SES: N/A

Zahn-Waxler et al. (1990)

USA CIIDC (Children’s Interpretations of Interpersonal Distress and Conflict)

87 (5-9years) Cognitive-Developmental Theory & Psychodynamic Theory.

Ethnicity: N/A

55% Female

SES: Middle-class

Semi-Projective. Clinical and non-clinical sample (children of depressed and non-depressed mothers).

Good Inter-rater reliability: Cohen’s kappas for 3 pairs of coders: 0.87, 0.90, 0.83.

Poor-to-Good Internal consistency reliability: 50-90% (kappas)

Tangney et al (1996)

USA TOSCA-C (Test of Self-Conscious Emotions Affect for Children)

‘Several hundred’

Lewis(1971)Theory

‘Diverse sample’; N/A

Scenario-based. Modeled after the SCAAI (Adult Self Conscious Affect and Attribution Inventory). .

TOSCA-C Guilt- Acceptable Internal consistency reliability: Cronbach alpha 0.79

TOSCA-C Acceptable Shame- Internal consistency reliability: Cronbach alpha 0.78

Tangney et al (1996)

USA TOSCA-A (Test of Self-Conscious Emotions Affect for Adolescents)

223 (7-16years)

Lewis(1971)Theory

N/A Scenario-based. Developed from the TOSCA (adult version) and TOSCA-C. Piloted in one-to-one interviews with adolescents. Validated with students in urban school.

TOSCA-A Guilt- Good Internal consistency reliability: Cronbach alpha 0.81

TOSCA-A Shame- Acceptable Internal consistency reliability:

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Cronbach alpha 0.77

Kochanska et al 1994

USA My Child Study 1: 171 mother-child dyads (21-70months).

Study 2: 102 mother-child dyads (26-41months).

Cognitive-Developmental Theory

Study 1: Ethnicity ‘mostly Caucasian’. Gender: 53% male children and all mothers. SES- ‘varied’.

Study 2: Ethnicity- 80% Caucasian. Gender: 50% male children and all mothers. SES-mixed.

Parent-Reported.

Study 1: measure development

Study 2: measure validation.

Correlations between maternal reports and child behavior.

Poor-Good Test-retest reliability: 0.29-0.79

Questionable Internal consistency: 0.60

Kochanska et al 2002

USA Mishap Guilt Paradigm

106 children (22-45months)

Mediational Model Ethnicity: 97% White

Gender: 49% female

SES: Majority Middle Class

Observational. Longitudinal (met with researcher at 18, 22, 33 45 and 56-months old). Adapted from Barrett 1993. Children led to believe they damaged object. Behaviour and responses coded. My Child also administered.

Good Internal consistency: Cronbach alpha 0.83

Ferguson et al (1999)

USA C-CARS (Child-Child Attribution and Reaction Survey)

86 children (5-12years)

Functionalist Approach

Ethnicity: 100% White

Gender: 51%

Scenario-based. Based on TOSCA-C.

Good Internal consistency reliability- Guilt: Cronbach alpha 0.86

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male

SES: Lower-Middle Class

Good Internal consistency reliability- Shame: Cronbach alpha 0.81

Good Inter-rater reliability: 0.85

Correlations between shame and guilt: r=0.60, p<0.01

Correlation with CIIDC: r=0.31, p<0.01

Barrett et al (1993) USA Clown-Doll Paradigm

44 Toddlers (25-36months)

Ethnicity: ‘predominantly Caucasian’; 50% Male; SES: Middle-Upper Class

Observational. Modeled after the SCAAI (Adult Self Conscious Affect and Attribution Inventory)

Good Inter-rater reliability: 0.80

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Diversity and Culture

Data on sample gender were available for eight of the 10 measures; information could

not be sourced for the TOSCA-C and TOSCA-A evaluations. Only two studies had samples

with equal representation of males and females (Barrett, et al., 1993; Olthof, et al., 2000).

The remaining six were split- three had more females; three had more males. Six measures

considered the influence of gender in their analyses. Of these six papers, four found a

significant influence of gender, but the associated interpretations of results varied (e.g. some

reported that females demonstrated higher guilt than males, others found the opposite). None

of the studies reported on the sample’s religious background or sexuality. All, except for one,

of the 10 child and adolescent measures were developed and validated in American

populations. No papers were found for United Kingdom (UK) populations. Very few studies

had culturally diverse samples, with the majority being predominantly White and Middle

class.

Two cross-cultural papers of the TOSCA-C were found (Bear, Uribe-Zarain,

Manning, & Shiomi, 2009; Furukawa, Tangney, & Higashibara, 2011). This was the only

child and adolescent measure to be examined cross-culturally in the literature. In Furukawa

et al (2011)’s paper, the TOSCA-C was administered to 144 Japanese, 180 Korean and 688

American children (aged eight to 11 years). Ethnicity was reported only in the American

sample, and was 60% White. There were more females in all three samples (65.2%, 52.2%

and 53.7% in the Japanese, Korean and American samples respectively). Information on

socio-economic status (SES) was reported for the Japanese sample only and ranged from

working class to upper-middle class. Data were collected for the American sample from

1990-1991, from the Japanese sample in 2001-2002 and from the Korean sample in 2002-

2003. Significant group differences were found: Japanese children scored the highest on

shame, Korean children scored the highest on guilt and American children scored the highest

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on pride. Still, the authors stated that correlation patterns were more similar than different

across cultures (e.g. guilt-proneness was associated with a tendency to take responsibility for

transgressions in all groups) and that the TOSCA-C could therefore be effectively applied

cross-culturally (Furukawa, et al., 2011).

In comparison, the second cross-cultural paper compared the TOSCA-C in a sample

of Japanese versus American children, aged nine to 10 years (Bear, et al., 2009). The

Japanese sample was composed of 118 children (100% native Japanese) and the USA sample

was 130 children (89% Caucasian). Both samples were of mainly middle/average SES

background and were recruited from rural schools. The American sample was 69.5% male

and the Japanese sample was 52.3% male. The results indicated that the Japanese children

were more likely to experience shame, guilt and anger and were less likely to externalize

blame. In contrast to the American children, guilt (not shame) was directly negatively related

to anger. These authors suggested that culture may moderate expression of guilt (Bear, et al.,

2009).

DISCUSSION

Results demonstrate the highly inconsistent nature of the literature on guilt

measurement in children and adolescents. A variety of guilt definitions were employed by

the 10 measures. Similarly, the type of measurement used (scenario-based, semi-projective,

observational or parent-reported) was changeable. Measures were generally poorly designed

(e.g. using experimenter rather than respondent/child-generated items) and varying

definitions of guilt, settings and theoretical bases made comparisons difficult. Very few

measures were piloted and data on validity and reliability were inconsistently reported. A

consideration of diversity and culture was also lacking. Overall, the paucity of available

research has been highlighted.

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Definition of Guilt

The definition of guilt directly impacted on the utility of the measure. All ten

measures varied considerably in their definitions of guilt. Some of the measures defined guilt

as being primarily adaptive, others considered it as maladaptive and linked to

psychopathology and the remainder took a more balanced, spectrum view of guilt.

Similarly, some researchers viewed guilt as being a stable trait whereas others saw it as being

situation-specific. This lack of consensus inhibited comparisons between the measures.

Also, although shame has been found to covary highly with guilt, very few measures

considered a definition of guilt within the context of, and in comparison to, shame. In not

making this distinction, these measures were therefore at risk of poor discriminate validity-

essentially measuring shame when the goal was to examine guilt (Tilghman-Osborne, et al.,

2012). Despite adopting a particular definition of guilt, the type of measure further

influenced the form of guilt captured from respondents. For example, it has been argued that

scenario-based measures often tap into more adaptive forms of the construct (Tangney &

Dearing, 2002). Therefore, even if researchers define guilt as being both maladaptive and

adaptive, the instrument itself may be biased towards capturing more adaptive features due to

the scenarios presented.

Definitions were also influenced by overarching theoretical perspectives. A variety of

approaches were used by the 10 measures, but the Functionalist Approach appears to hold

greatest utility for guilt measurement. Allowing for a more balanced perspective of guilt,

incorporating both maladaptive and adaptive properties, may increase the scope and validity

of guilt measures (Bybee, 1998). Still, even within this Functionalist Approach, a variety of

limitations are noteworthy. For example, developmental and diversity-related issues remain

neglected. The Functionalist Approach, like many of the other approaches, is based more on

therapeutic rather than Applied Psychology principles (Ferguson, et al., 1999). Future

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research should address these requirements through the development of a new, more

comprehensive model of guilt in young people.

Developmental Considerations

The definition and measurement of guilt changes as a young person develops. An

appreciation of associated age and cognitive capacity is therefore vital. Despite this, some

studies used samples in which children and adolescents were grouped together (Tilghman-

Osborne, et al., 2010). Similarly, adult measures were often applied and adapted for use with

children and adolescents, without assessing the developmental influences underlying the

construct (Tilghman-Osborne, et al., 2010).

The type of informant is also noteworthy, changing from observational and parent-

reported to self reported with age. Comparing guilt measures for toddlers with similar

measures for children or adolescents was therefore difficult. Guilt in toddlers was often

measured through parent-reported or observational methods. Self-report was generally

introduced to school-age children- the most commonly sampled age group of the 10

measures. Self-report is however complicated with young children by the fact that

respondents may lack the linguistic sophistication necessary to understand the multiple and

sometimes ambiguous definitions of guilt (Bybee, 1998).

There was also a substantial gap in adolescent-specific measures. Only two measures

focused specifically on adolescents and both were limited in scope: one looked at perceived

parental guilt induction whilst the other, although validated in a large adolescent sample, was

adapted from a pre-existing child measure (Donatelli, et al., 2007; Tangney & Dearing,

2002). Adolescents were often caught in the middle of child and adult measures, with neither

fully capturing their unique experiences. The transition issues related to adolescence,

including changing identities and responsibilities, are likely to have a unique relationship

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with guilt. Indeed, guilt has been reported to increase in complexity during this age span

(Bybee, 1998). Adolescence is also a time in which many mental health disorders, such as

depression and eating disorders, emerge for the first time (Bybee, 1998). A better

understanding of guilt and its measurement during this age span is vital.

Type of Measure

A variety of formats were used by the 10 measures, including self-reported scenario-

based and semi-projective, observational and parent-reported measures. The self-reported

measures often used Likert scales, but these varied from three-point scales to seven-point

scales and so were difficult to compare. A benefit of using semi-projective measures is that

they may be more likely to capture the young person’s private world and experiences (Zahn-

Waxler, et al., 1990). Socially-desirable responses are also less common as children ascribe

feelings to a fictional story character rather than to themselves (Ferguson, et al., 1999).

Research indicates that children are more likely to admit to negative emotions when they are

not portrayed as the main character (Bybee, 1998). This strategy is most commonly used by

semi-projective measures and, consequently, these measures tend to capture more

maladaptive features of guilt (Zahn-Waxler, et al., 1990).

Semi-projective measures may however not be accurate in predicting children’s actual

behaviour (Bybee, 1998). In contrast, an advantage of using observational methods is that

they increase the ecological validity of results (recording behaviour in real-life situations)

(Kochanska, et al., 2002). Like semi-projective measures, observational data also appear to

capture maladaptive patterns of guilt (Kochanska, et al., 2002). Observational data are

however more difficult to obtain and may not be practical for older children. The relationship

between observational data and self or parent-reported data is unclear and should be further

researched. As only a limited number of semi-projective and observational measures were

sourced, generalizations and trends were difficult to determine.

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In comparison, scenario-based measures were most commonly reported. Scenario-

based measures allow the experimenter to measure guilt in relation to specific behaviours

(Tangney & Dearing, 2002). They therefore do not rely on the respondent’s ability to define

guilt or to distinguish it from related constructs such as shame (Tangney & Dearing, 2002).

This increases the measure’s adaptability to younger age groups (Tangney & Dearing, 2002).

In comparison to check-list type measures, they are also less likely to evoke defensive

reactions or denial responses (Tangney & Dearing, 2002).

Despite these advantages, scenario-based measures also possess significant

limitations, including a failure to grasp whether the young person has ever been involved in

the situation presented. The portrayed situations are also limited in variety and diversity.

This applies to different cultures as well, as the majority of scenario-based measures were

developed and validated in American samples (and so situations may be particularly relevant

to this culture only). They may also measure moral standards, social adjustment and

consensual societal values rather than the personal construct of guilt itself, thereby potentially

biasing adaptive guilt and failing to capture more maladaptive forms (Tangney & Dearing,

2002). The different scenario-based measures also differed in their use of pictorial aids; these

images are culturally bound and may have influenced responses. Furthermore, some of the

most commonly used scenario-based measures, such as the TOSCA-C and TOSCA-A, were

developed over two decades ago. The applicability of associated situations is questionable in

more current cohorts. For example, these measures do not consider technological influences

of social media, which is highly relevant for many young people in today’s society. Despite

these limitations, scenario-based measures appear to be the most appropriate measure for

school-aged children and adolescents.

Semi-idiographic measures (e.g. asking a person to recall a time when they felt guilty)

were not mentioned in the literature. As they may provide more personally relevant data,

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their complementary use with other forms of guilt measures should be considered in future

research. Only one parent-reported measure, My Child, was available. Unlike child and

adolescent measures within other areas, such as the Achenbach Child Behavior Checklist and

Teacher Report Form, no complementary parent- and teacher-reported guilt measures were

found (Achenbach, McConaughy, & Howell, 1987). Similarly, joint child/adolescent and

parent-reported guilt measure sets were not found in the literature. This trend expands to

other informants, such as siblings and peers, and should be explored in future research.

Item Generation

Many of the measures were based on previously developed child and adolescent

instruments, often adapted without addressing original flaws. Many measures were therefore

constrained by limitations of their predecessors, contributing limited new knowledge to the

research base. The majority of measures also employed experimenter-generated items. This

process significantly limits the ecological validity of the measure, potentially failing to

capture young people’s experiences (Tangney & Dearing, 2002). Measures should instead be

developed from interviews with children and adolescents.

Measure Evaluation

Very few studies piloted their measure. Pilots allow researchers to test and revise

materials before larger validation studies are conducted. Although they are often more costly

and time-consuming, they can help refine measures and ensure validity (Tilghman-Osborne,

et al., 2012). The majority of measures were examined cross-sectionally only. Continued

research should look at how the measurement of guilt changes in children and adolescents

over time. Measures were also often evaluated with small sample sizes and in urban settings,

thus limiting the generalisability of results.

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Data on reliability and validity were inconsistent and difficult to compare. Very few

studies reported on validity. The majority of measures noted good Cronbach alphas,

indicating that they were internally consistent. No effect sizes were reported and even an

attempt to generate effect sizes was problematic due to the lack of data. Discriminant validity

(e.g. whether the measure is capturing guilt or shame) was of particular concern as many of

the measures did not report on the value. Very few studies outlined their validation

procedures. Similarly, few measures were validated against qualitative measures such as

semi-structured interviews or behavioural methods. Future studies should aim to explicitly

address validity and reliability.

A consideration of confounding factors such as shame, anger, anxiety, worry,

depression, embarrassment, fear and empathy are vital in preventing inflated estimates of

guilt (Tilghman-Osborne, et al., 2010). The majority of measures contained items that

confounded guilt with other constructs. Shame, as it is so closely related to guilt, is one of

the most important confounding factors to consider. Social desirability is also important

because young people may provide the answer that they feel the experimenter, most likely an

adult, wants to hear (Tangney & Dearing, 2002). They may also be defensive about guilt and

under-report to preserve self-image (responses essentially influenced by feelings of guilt).

None of the measures looked at the confounding factors of shame, anxiety and depression

together. These factors have important implications clinically, with all four constructs being

highly related, and should be addressed in future research (Tilghman-Osborne, et al., 2012).

Cultural & Diversity Issues

Gender differences in the experience of guilt were inconsistent and highly dependent

on the type of measure used. An investigation of gender differences specifically during

adolescence was not found. Of the studies that did find significant influences of gender, there

were conflicting reports as to whether guilt was reported more often by males or females.

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This may have been influenced by unequal sample distributions: the majority of papers in this

review (including cross-cultural papers) recruited more females than males during measure

development and/or validation. Consequently, the current measures of guilt may be gender-

biased. Scenario-based measures in particular may be presenting stereotypical notions of

femininity and masculinity. For example, situations that are more interpersonal in nature

(e.g. evoking the ‘carer’ image often associated with females) may be biased towards female

respondents. The type of situation is therefore very important in capturing gender

differences.

In terms of gender and responses to acts of wrongdoing, none of the measures

specifically examined relational forms of aggression. This type of aggression (in which harm

is caused by injuring or manipulating a relationship) is most commonly used by females;

physical aggression (harming or threatening to harm through physical damage) is in contrast

much more common in males (Young, Boye, & Nelson, 2006). Examples of relational

aggression include isolating/excluding peers or gossiping (Young, et al., 2006). Excessively

inducing guilt in peers may also be a form of relational aggression. The measurement of guilt

in situations surrounding relational aggression is therefore an area that should be explored in

future research.

The influence of sexuality and religion on the measurement of guilt in young people

has been essentially ignored by researchers. Questions remain in relation to if (and how)

young people experience guilt in relation to issues such as promiscuity, orientation, gender

identity and teenage pregnancy. Similarly, different religions approach guilt, sins and

forgiveness in varying ways, potentially influencing personal experiences and reporting of

guilt. In terms of SES, the majority of measures recruited from middle-upper class

backgrounds. This lack of diversity limits the generalisability of the available measures to

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young people from more disadvantaged backgrounds. Future research should be cognisant of

this fact.

Only one measure was developed and validated in a non-American population

(Olthof, et al., 2000). Consequently, the current definition and measurement of the construct

may be essentially American. Future investigations should be conducted within a UK child

and adolescent population. Aspects such as the UK schooling system and its historical

Church of England influence may shape cultural experience of guilt. Similarly, Britain’s

history of colonialism may have unique inter-generational implications for the collective

expression and understanding of guilt. Stylistic differences in written language have also

been noted; American English uses more “mood”-related words than British English (Acerbi,

Lampos, Garnett, & Bentley, 2013). This may translate to a decreased acceptability of

emotional expression within British culture and has implications for the cross-cultural utility

of the available guilt measures.

The majority of child and adolescent guilt measures were also developed and

validated in non-diverse American samples of primarily White ethnicity. Validity in

ethnically diverse populations is therefore questionable. No study made specific mention of

second-generation immigrants, who may struggle with unique aspects of guilt (not captured

in available measures) in relation to personal identities and the process of assimilating old

and new cultural values. The TOSCA-C was the only child and adolescent measure to be

evaluated cross-culturally. The two studies however had conflicting results: Bear et al (2009)

reported that culture did have an impact on the construct and measurement of guilt, whereas

Furukawa et al (2011) noted more similarities than differences.

The results of Furukawa et al (2011) should be examined with caution, as the

American sample was far more representative than the Japanese and Korean samples (688

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children versus 144 and 180 children respectively). The American data were also collected a

decade earlier than the Japanese and Korean data, so cohort effects may have been present.

Important global events may have differentially impacted guilt conversations in the 1990s

(e.g. reunification of Germany) and the early-2000s (e.g. American World Trade Center

terrorist attacks). Appreciation of the influence of socio-cultural context was essentially

ignored, as the authors attempted to compare datasets regardless of these differences. Data

were also collected from urban school settings only. Urban Korean and Japanese settings

may have more exposure to technology and other sources of globalisation than rural areas,

therefore potentially failing to capture more diverse cultural experiences of guilt.

Additional limitations are common to both cross-cultural studies. Most importantly,

the TOSCA-C was validated in an American English-speaking population and so the

scenarios listed may not be relevant or applicable to other cultures. In terms of design, both

studies were correlational and so a consideration of causation was not possible. The samples

of both studies had unequal representations of male and female participants and were non-

clinical (thus lacking generalisability to clinical groups). Both samples also compared

American samples to Asian cultures only; consideration was not given to other cultures.

Given these methodological limitations, conclusions on the cross-cultural validity of

available child and adolescent guilt measures cannot be made. Current measures may be

lacking culturally sensitive scenarios and language; more research is urgently needed.

Development of a Robust Measure

Following their review in 2010, Tilghman-Osborne et al went on to develop a child

and adolescent guilt measure in 2012. This measure (IEGS) was developed in response to the

numerous discrepancies and limitations noted in the 2010 review (Tilghman-Osborne, et al.,

2012). This study was well-designed with a strong theoretical basis, careful consideration of

the construct of guilt, large sample size and was piloted in a clinical sample (Tilghman-

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Osborne, et al., 2012). It addressed many of the confounding factors that had influenced

other guilt measures. It was well evaluated, demonstrating good construct, incremental,

discriminant and convergent validity (Tilghman-Osborne, et al., 2012).

Still, it is not without its limitations. The measure itself is very specific, designed to

capture inappropriate and excessive guilt (as it relates to the diagnosis of depression), rather

than transdiagnostic. Items were generated by researchers rather than young people, meaning

that the construct of guilt may not be age-appropriate. Reliability of the measure was not

reported. Furthermore, the measure grouped children and adolescents together, not allowing

for developmental considerations across these age groups. The sample also lacked diversity

(e.g. 94% White) and, like the majority of measures, was developed and validated in an

American population. It was also the only measure in which monetary benefit was provided

to participants, which may have influenced participation and responses. Although it is of

high quality in comparison to the other available measures, there remains a significant gap for

a gold standard child and adolescent measure.

Implications & Utility of Measure

These findings have potential implications for parenting and clinical practice.

Parental guilt induction, as addressed in Donatelli et al (2007)’s MGI measure, has been

briefly considered in the guilt literature, but is deserving of more attention. Used

appropriately, and within the context of stable and loving relationships, it may contribute to

the young person’s wellbeing and social adjustment (Bybee, 1998). This has further

implications for parental involvement and training in prevention, early intervention and

treatment programmes for children. More research is needed on the effectiveness of parental

guilt induction, including its application, measurement and acceptability in different cultural

backgrounds.

236

Influences of parental mental health were also largely neglected in the literature

(considered only in two studies, both restricted to maternal depression only) (Donatelli, et al.,

2007; Zahn-Waxler, et al., 1990). A young person with a mentally unwell parent may take on

more responsibility at home, which may in turn influence their experience of guilt (and

associated wellbeing). The development of a new and robust guilt measure may provide

better insight and understanding into the therapeutic management of child and adolescent

emotional and behavioural responses (e.g. depression, antisocial behaviour) (Bybee, 1998).

Empirically-valid measures provide rich information for clinical assessment and treatment

and are actively encouraged as best practice in the UK National Health Service (NHS)

(Goldbeck-Wood & Fonagy, 2004). A measure for the clinical context is therefore needed,

particularly for adolescence when many mental health difficulties initially arise (Bybee,

1998).

Limitations

Accessibility to the literature is a primary limitation. In their review, Tilghman-

Osborne et al noted that, despite finding eight measures for young people, additional

measures were identified but unobtainable. This experience was mirrored in the present

review, as 19 child and adolescent measure citations were located in the literature but access

was granted to only ten (see Appendix B). The remaining papers were unpublished and

inaccessible within the public domain. For some of the measures (e.g. My Child), newer

adaptations have been constructed and validated but were not accessible and so not included

in the present review. Some of the original papers (TOSCA-C, TOSCA-A and C-CARS)

were not publically accessible and so subsequently published papers describing development

and validation of the measure were used instead. Despite these limitations, a number of

strengths are noteworthy. Most importantly, this is the first review to look specifically at the

237

measurement of guilt in child and adolescent populations. The above findings (especially

with regard to diversity and culture) are therefore novel within the literature.

Concluding Thoughts

The aim of the present review was to examine how guilt is measured in children and

adolescents. Due to a general lack of research in the field, more questions than answers

remain. From the present findings, four central questions emerge for future research: how

should guilt be measured across adolescence, does the measurement of guilt in children and

adolescents change cross-culturally, what implications does guilt have on the mental health of

children and adolescents and what would a new theoretical model of guilt for children and

adolescents look like. Continued research will enhance Psychology’s understanding of the

construct of guilt, its measurement and applications for the early intervention and treatment

of associated difficulties in children and adolescents.

238

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APPENDIX A. Measures of Guilt- Adults

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1. Personal Feelings Questionnaire (‘PFQ’) (Harder & Zalma, 1990)

2. Test of Self-Conscious Emotions (TOSCA) (Tangney, Wagner, & Gramzow, 1989)

3. The Guilt Inventory (Kugler & Jones, 1992)

4. Interpersonal Guilt Questionnaire (O'Connor, Berry, Weiss, Bush, & Sampson, 1997)

5. Trauma-Related Guilt Inventory (Kubany et al., 1996)

6. The Guilt and Shame Proneness Scale (‘GASP’) (Cohen, Wolf, Panter, & Insko, 2011)

7. Shame and Guilt Scale (SGS) (Alexander, Brewin, Vearnals, Wolff, & Leff, 1999)

8. Guilt and Shame Vignettes (GSV) (Benetti-McQuoid & Bursik, 2002)

9. Feelings of Guilt in Major Depression (FGMD) (Berrios et al., 1992)

10. Fear of Punishment and Need for Reparation Scales (FPNR) (Caprara, Manzi, & Perugini, 1992)

11. Guilt and Shame (Hogan & Cheek, 1983)

12. Beall Shame-Guilt Test (Beall, 1972)

13. Reaction Inventory (RI) (Evans, Jessup, & Hearn, 1975)

14. Adapted Shame/Guilt Scale (ASGS) (Hoblitzelle, 1982)

15. Differential Emotional Scale-IV (DES-IV) (Blumberg & Izard, 1986)

16. Dimensions of Consciousness Questionnaire (DCQ) (Johnson et al., 1987)

17. Shame and Guilt Scale (SGS) (Klass, 1987)

18. Revised Mosher Forced-Choice Guilt Inventory (RMFCGI) (Mosher, 1966)

19. Perceived Guilt Inventory (PGI) (Otterbacher & Munz, 1973)

20. Positive and Negative Affect Scale-Extended (PANAS-X) (Watson, Clark, & Tellegen, 1988)

21. Emotional Experience Questionnaire (EEQ) (Scherer, 1986)

22. Weight- And Body- Related Shame and Guilt Scale (WEB-SG) (Conradt et al., 2007)

23. The Offence-Related Shame and Guilt Scale (Wright & Gudjonsson, 2007)

24. The Shame and Guilt Scale (Gilbert, Allan, & Pehl, 1991)

25. Buss and Durkee Guilt Scale (Buss & Durkee, 1957)

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APPENDIX B. Measures of Guilt- Children and Adolescents

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9. Self-Conscious Emotions Questionnaire for Children (Dissertation) (Haimowitz, 1996)

10. Story Completion Measure (Hoffman, 1975)

11. My Child Guilt (Kockanska et al., 1994)*

12. My Child-Shame; My Child-Guilt (Ferguson, Stegge, & Barrett, 1996)

13. Inappropriate and Excessive Guilt Scale (Tilghman-Osborne et al 2012)*

14. Interpersonal Guilt Questionnaire – Adolescent Adaptation, Dissertation (Smith, 1998)

15. Clown-Doll Paradigm (Barrett et al., 1993)*

16. State Shame and Guilt Scale (SSGS) (Marschall, Sanftner, & Tangney, 1994)

17. Children’s Interpretations of Interpersonal Distress and Conflict (CIIDC) (Zahn-

Waxler et al., 1990)*

18. Shame and Guilt Questionnaire (Olthof et al 2000)*

19. Trait Affect Measure (Bybee & Williams, 1995)

20. Test of Self-Conscious Emotions- Adolescent Version (TOSCA-A) (Tangney & Dearing,

2002; Tangney, Wagner, Gavlas, & Gramzow, 1991)*

21. Test of Self-Conscious Emotions- Child Version (TOSCA-C) (Tangney & Dearing, 2002;

Tangney, Wagner, Burggraf, Gramzow, & Fletcher, 1990)*

22. Child-Child Attribution and Reaction Survey (C-CARS) (Ferguson, et al., 1999; Stegge

& Ferguson, 1990)*

23. Self Conscious Emotions, Maladaptive and Adaptive Scale (SCEMAS) (Stegge & Ferguson,

1994)

24. Children’s Guilt Inventory (J. Bybee, Williams, & Merisca, 1996)

25. The Maladaptive Guilt Induction Measure (Donatelli et al., 2007)*

*Articles publically available and sourced for review

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APPENDIX C. Additional Papers Sourced for Review

250

Additional Papers Sourced for ReviewAuthor (Date) Title Country Aim Sample Size and

AgeMeasure Setting Design and

Evaluation Methods

Outcome

Baker et al (2012)

Development of fear and guilt in young children: stability over time and relations with psychopathology

Wales To examine association between behaviour and physiological measures of fear and guilt and whether fear in infancy predicts guilt in toddlers.

70 mother-child dyads. Children were aged 1 to 3.

Behavioural Coding (Lab-TAB Fear Paradigm and Mishap Guilt Paradigm), Mother-Reported Fear (Infant Behaviour Questionnaire Revised), Physiological Reactivity (skin conductance level and heart rate) and Mother-Reported Psychopathology (The Child Behaviour Checklist).

Local nurseries and play centres/non-clinical.

Longitudinal; quantitative. Children were seen three times- at ages 1, 2 and 3.

Fear and guilt were significantly associated across measures. Assessments of children in infancy are predictive of how children react 2 years later and therefore lend support to the idea that the emotional thermostat is set in that first 3 years of life. Infant fear is a predictor of guilt, which is an emotion that develops later.

Hosser et al (2008)

Guilt and shame as predictors of recidivism: a longitudinal study with young prisoners.

Germany To examine to what extent feelings of shame and guilt experienced during a prison term influenced recidivism after release.

1243 young people aged 14-24

EMO-16-Week Scale (a German measure; addresses frequency of occurrence of 16 emotions- shame and guilt included) and

Prison- male youth offenders

Longitudinal Feelings of guilt at the beginning of a prison term correlated with lower rates of recidivism, and feelings of shame correlated with higher rates. Feelings of guilt are a protective factor and feelings of shame

251

interviews. are destructive.

Tilghman-Osborne et al (2008)

Relation of Guilt, Shame, Behavioural and Characterological Self-Blame to Depressive Symptoms in Adolescents Over Time.

USA To examine the relation of depressive symptoms and depressive cognitions to shame, guilt, CSB (characterological self-blame) and BSB (behavioral self blame); to estimate the longitudinal relations between depressive symptoms and measures of shame, guilt, BSB and CSB; and to assess the convergent and discriminant validity of shame/CSB measures and guilt/BSB measures.

221 adolescents

(aged 11-18)

TOSCA-A, State Shame and Guilt Scale (SSGS), Self-Blame Measures, Attributional Blame Questionnaire, Child Depression Inventory (CDI), Center for Epidemiological Studies Depression Scale for Children (CES-DC).

High schools- non clinical

Longitudinal (over 5-months).

Shame and CSB converge onto a common construct and are significantly related to depressive symptoms and cognitions. Convergence of guilt and BSB, however, was limited to particular pairs of measures.

Walter and Burnaford (2006)

Developmental Changes in Adolescents' Guilt and Shame: The role of family climate and gender.

USA To explore the relationship between family closeness and self conscious emotions (e.g. shame and guilt)

176 adolescents aged 12-20years

TOSCA-A, Family Closeness Questionnaire

Non-clinical; schools.

Cross-sectional, quantitative

Adolescents from divorced/separated families and those from intact families did not differ in their reported levels of shame and guilt.

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across adolescence, later adolescence and young adulthood.

Guilt increased with age, but the developmental progression of shame varied by gender. Girls reported more shame and guilt than did boys.

Bear et al (2009) Shame, guilt, blaming and anger: differences between children in Japan and the US.

USA and Japan

To examine the cultural differences (between Japan and USA) in anger, shame, guilt and externalisation of blame.

USA Sample: 130; Japanese Sample: 118. Children aged 9 to 10 years.

Multidimensional School Anger Inventory, TOSCA-C.

Schools, non-clinical.

Cross-cultural cross-sectional comparison.

Compared to American children, Japanese children were more prone to experience shame and guilt and less likely to externalise blame. They were also more likely to experience anger.

Furukawa et al (2011)

Cross-cultural continuities and discontinuities in shame, guilt and pride: a study of children residing in Japan, Korea and the USA

USA, Japan, Korea

To examine cross-cultural continuities and discontinuities in shame, guilt and pride in children residing in Japan, Korea and the USA.

144 Japanese, 180 Korean, 688 USA. Aged 8 to 11 years.

TOSCA-C, Children's Inventory of Anger-Short Form, Anger Response Inventory-Children, Teacher's Child Behaviour Checklist, Devereux

Schools, non-clinical.

Cross-cultural, cross-sectional comparison.

Results supported the cross-cultural equivalence of the TOSCA-C.

Significant differences were observed, with Japanese children scoring highest on shame, Korean

253

Behaviour Rating Scale- School Form.

children scoring highest on guilt, and American children scoring highest on pride.

Patterns of correlations were however more similar than different across cultures.

254

CLINICAL EXPERIENCE

255

My first, year-long, placement was in a working-age adult community mental health

team (CMHT). In this placement, I co-facilitated three different groups: Cognitive

Behavioural Therapy (CBT) for Insomnia, CBT for Bipolar and a CBT coping skills groups.

I also conducted individual interventions using a range of different models, including CBT,

Systemic, Compassion-Focused Therapy (CFT) and Mindfulness-Based Cognitive Therapy

(MBCT). My caseload included service users with a range of presentations and diverse ethnic

and socioeconomic backgrounds. I also gained experience with a range of cognitive

assessments, outcome measures, was involved in initial assessments and had the opportunity

to supervise an assistant psychologist on a piece of clinical work.

For my six-month Child and Family placement, I was split between a Child and

Adolescent Mental Health Service (CAMHS) and a Looked After Children’s (LAC) Service.

This placement involved staff consultations, as well as direct work with foster carers and

young people in care. I gained experience with a wide range of models, including Dyadic

Developmental Psychotherapy (DDP), Systemic theory, Narrative approaches, Social

Constructionist approaches, CBT and Behavioural Therapy. The young people I worked with

were from diverse backgrounds and often had very complex histories and presentations,

which encouraged me to think critically about the available evidence base for looked after

children as well as how outcome measures are applied and interpreted in such settings. My

involvement would also often involve navigating and containing complex networks around

the child, which developed my leadership, reflective and communication skills. I also gained

experience of conducting a range of cognitive assessments, was involved in initial

assessments and further developed my formulation and teaching skills.

In my six-month Older Adults placement, I was split between an Older Adults

community mental health team (CMHT) for adults over the age of 75 with mental health

problems, a Memory Assessment service (e.g. dementia assessments) and a challenging

256

behaviour service (with work based mainly in care homes). I gained experience of working

indirectly with care staff and family members and directly with older adults. I conducted a

range of cognitive assessments and employed systemic, narrative, CBT and psychodynamic

models in supervision and clinical work. I continued to build up my confidence as a

clinician, and began to work more flexibly, creatively and independently. I also supervised

an Assistant Psychologist on a service evaluation research project concerning challenging

behaviour and staff burnout. In addition to this, my teaching, assessment, intervention and

complex formulation skills continued to develop.

In my learning disabilities placement, I was split between Psychology and

Challenging Behaviour teams within a local council’s learning disabilities service. As this

was a social care setting, I was given the opportunity to further develop my multidisciplinary

team working skills. I also learnt to tailor my use of language depending on client cognitive

and language abilities and staff/client group (e.g. with day centre staff, family members,

Psychology network meetings). I worked directly with clients with learning disabilities and

indirectly with care staff and family members in a range of settings. I had the opportunity of

working with transition clients (aged 18-21), as well as adult clients, with diverse

backgrounds and a range of presentations. I also gained experience of using a range of

assessment tools (e.g. supporting the diagnosis of learning disabilities, assessment of sexual

knowledge, autism screenings) and conducting interventions using behavioural, CBT and

systemic models. The placement provided me with opportunities to conduct training

workshops for other professionals, joined-up partnership working and learning more about

service delivery and development.

In my final six-month specialist placement, I split my time between a national

specialist inpatient unit for Deaf children and adolescents (aged six to eighteen), a national

inpatient service for young people with eating disorders and a national outpatient service for

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Deaf children and adolescents. My clinical work included direct individual and group

interventions, clinical assessments (e.g. formal observations, functional assessments,

cognitive assessments, gathering information from the Team Around the Child) and indirect

work with staff (e.g. staff consultation, formulation meetings and facilitating weekly

reflective groups for ward nursing staff). The inpatient settings provided opportunities to

work with young people with a range of acute mental health difficulties, who were often

under section. I gained exposure to a variety of therapeutic models, including CBT,

Dialectical Behaviour Therapy (DBT), Cognitive Remediation Therapy (CRT), systemic,

Mentalization Based Therapy (MBT) and Behavioural therapy. As I was new to the Deaf

community, I also started learning British Sign Language alongside the placement, which

allowed me to explore how to work therapeutically in a new culture and with a different

language, as well as adjusting and adapting to working with interpreters. My formulation,

leadership and supervisory skills also developed in this placement, and I chaired many team

and wider network meetings. As most interventions, assessment tools and outcome measures

have not been standardised for Deaf young people, I also learnt how to tailor these elements

to the individual child and family.

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ASSESSMENTS

259

Year I Assessments

PROGRAMME COMPONENT

TITLE OF ASSIGNMENT

Fundamentals of Theory and Practice in Clinical Psychology (FTPCP)

Short report of WAIS-III data and practice administration

Practice case report Cognitive Behavioural intervention with an older woman presenting with Bipolar Disorder

Problem Based Learning – Reflective Account

The Relationship to Change

Research – Literature Review

The measurement of guilt in children and adolescents: a literature review

Adult – case report Cognitive Behavioural intervention with young woman diagnosed with Psychotic Illness

Adult – case report Mindfulness-Based Cognitive Therapy intervention with young woman diagnosed with Postnatal Depression

Research – Qualitative Research Project

Trainee Clinical Psychologists’ experiences of religion: An Interpretive Phenomenological Analysis

Research – Major Research Project Proposal

The development of a new measure of guilt-proneness for adolescents

Year II Assessments

PROGRAMME COMPONENT

TITLE OF ASSESSMENT

Research - SRRP An evaluation of an informational DVD for service users in a Traumatic Stress Service

Research Research Methods and Statistics test

Professional Issues Essay ‘Physical contact with clients/service users is never acceptable. Discuss this statement in the context of clinical psychology practice across the lifespan and specialities’

Problem Based Learning – Reflective Account

PBL Reflective Account: ‘The Stride Family’

People with Learning Disabilities/Child and Family/Older People – Case Report

Integrative intervention with a young person within a Looked After Children’s service

260

Personal and Professional Learning Discussion Groups – Process Account

Process Account

People with Learning Disabilities/Child and Family/Older People – Oral Presentation of Clinical Activity

Development of my systemic intervention skills as a Trainee Clinical Psychologist

Year III Assessments

PROGRAMME COMPONENT

ASSESSMENT TITLE

Research – MRP Portfolio Development of a semi-idiographic measure of guilt-proneness for adolescents

Personal and Professional Learning – Final Reflective Account

On becoming a clinical psychologist: A retrospective, developmental, reflective account of the experience of training

Child and Family/People with Learning Disabilities/ Older People/Specialist – Case Report

Neuropsychological assessment with a middle-aged man with a suspected learning disability and autism spectrum disorder