Measuring emotional invalidation in Iranian populations: Persian version of perceived invalidation of emotion scale (P_PIES)

doi:10.21203/rs.3.rs-4920559/v1

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Measuring emotional invalidation in Iranian populations: Persian version of perceived invalidation of emotion scale (P_PIES)

https://doi.org/10.21203/rs.3.rs-4920559/v1

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The examination of the psychometric properties of the PIES in Eastern cultures has remained unexplored. The current study aims to explore the psychometric features of the PIES in Iranian populations. A total of 2250 participants (clinical sample = 177, student samples = 1762, general population = 311) completed the following questionnaires: Perceived Invalidation of Emotion Scale (PIES), Childhood Trauma Questionnaire-Short form (CTQ-SF), Depression, Anxiety and Stress (DASS-2), and the Difficulties in Emotion Regulation Scale-16 (DERS-16). The psychometric qualities of the PIES were examined using construct, convergent, discriminant, incremental, and predictive validities together with internal consistency and test-retest reliability. The results of exploratory and confirmatory factor analysis revealed that the PIES had a unifactorial structure. Support was found for internal consistency as well as for test-retest reliability. In addition, the PIES scores significantly predicted emotional distress over time and had positive correlations with emotional dysregulation, childhood traumas, anxiety, stress, and depression. The PIES was also found to discriminate the clinical from nonclinical populations. Finally, PIES demonstrated adequate incremental validity. Despite the limitations of the current study and the need for additional research, the findings indicate that the PIES with unifactorial structure is a reliable and valid scale among Iranian populations.

Emotion invalidation

psychometrics

validity

reliability

Humans, similar to many other primates (Kummer, 2017), live in groups and engage in social processes. One of the most important sources of interpersonal process and social sharing is emotional expressions. Evolutionary approach also suggests that not only humans but also animals display facial emotion and specific emotional reactions (Darwin, 1969). However, humans are especially sensitive and vulnerable to the facial expression of emotions and gestural cues made by other individuals, and utilize these signals as guides for their own action (Rimé, 2017). A body of studies on the social sharing of emotion revealed that motions are subject to talking in about 90% of the cases (Rimé, 2009, 2017; Rimé et al., 2011).

A form of social sharing with a special focus on emotional experiences refers to emotional disclosure (Rimé et al., 2020). Negative and positive emotions are shared similarly, where the more intense the emotional experience is, the higher the tendency to conversation about that, and is associated with more emotion regulation effort (Choi & Toma, 2014). Research demonstrated that status that increase emotional experience heighten social sharing and transmission regardless of their valence (Berger, 2011; Van Kleef, 2009). Emotional sharing and disclosure also elicit empathic/supportive processes and boost feelings of unity, prosocial behavior, consolidation of social ties, and social integration, emotional fusion, and validation (Marroquín et al., 2017; Rimé, 2017; Rimé et al., 2011).

Several theories emphasize the importance of validation and emotional connection in the mental health and therapeutic process. For example, Rogers emphasized unconditional positive regard. He proposed that validation (e.g., empathy and accurate reflection) is a key to both normal development and treatment of individuals with emotional distress (Rogers, 1965). Kohut argued that mirroring and empathic failures are often unavoidable elements of the therapeutic relationship (Kohut, 1977). Ginott (1965) also argued strongly about validating and its advantages. In particular, Ginott proposed that validating and understanding the child's emotional experiences serves as an opponent process to contempt, derogation, criticism, and disapproval of the child (Ginott, 1965). Indeed, validation is defined as legitimizing the other individuals, accepting the other individuals, and providing approval or support to the other (Thorp, 2001). According to Linehan (1993), validation occurs when a therapist is able to convey to the patient that their emotions and affects are understandable or his/her responses makes sense and are understandable. In other words, validation is a procedure by which an individual encourages another person to accept and understand their own emotional and private experience by not trying to change the emotion and inner experience (Shenk & Fruzzetti, 2011).

Emotional validation (EV) generally occurs when someone communicates and expresses nonjudgmental reference (acceptance), understanding, and legitimacy in reaction to another individual's emotion or emotional perspective (Linehan, 1993; Shenk & Fruzzetti, 2011). When emotional validation is provided, one is better able to recognize, identify, and control emotions and emotional responses, resulting in emotional regulation (Linehan, 1993), emotional self-efficacy (Witkowski, 2017), mental well-being (LeBlanc et al., 2020), lower stress levels, and better academic performance (Hall & Cook, 2011).

Even though group rituals and emotional sharing may increase the likelihood of survival through cooperation and communication, other people are not always supportive of shared emotions as well as behaviors and may even constitute a threat within a group by invalidating other members (Hillman et al., 2023). Thus, emotions may be invalidated by one’s close family, friends, and other social connections. Emotional invalidation (EI) as a challenge to successful and adaptive emotion regulation, occurring when an individual expresses that another individual’s emotions and private experiences are inaccurate or unacceptable (Linehan, 1993). In other words, EI is defined as interactions during which an individual’s expressed emotions or affective experiences are met with a reaction (verbal or nonverbal) from another person that is perceived by the individual as implying that their emotions or private experiences are unacceptable, inappropriate, unacceptable, inaccurate, or should be concealed (Zielinski & Veilleux, 2018). Thus, children may experience EI directly through punitive and minimizing statements (such as punishing and blaming a child for experiencing negative emotions) and indirectly by observing parents’ distress in reaction to their emotion expression.

Emotional invalidation has been identified as a major factor for the psycho-social functioning of people. For example, a large body of evidence demonstrates that adult and adolescents who perceive higher levels of EI are at increased risk of BPD (Hope & Chapman, 2019), depression (Yap et al., 2008), PTSD (Westphal et al., 2016), emotion dysregulation (Braden et al., 2021; Yap et al., 2008), and emotional distress (Mohammadkhani et al., 2023; Schreiber & Veilleux, 2022). Additionally, studies have demonstrated that when individuals perceive their emotions as continuously invalidated, they tend to engage in higher levels of suppression and develop more fear of emotions (Sauer & Baer, 2010), together with increased daily negative affective and stress (Zielinski et al., 2023). Recently, Brandao and colleagues suggested that perceived EI in current interpersonal interactions directly associate with more depressive symptoms and indirectly associated with it through emotional dysregulation (Brandão et al., 2023). One's who has experienced stressful and adverse events may not share their private experience (e.g., emotions and feeling) due to a fear of being blamed or unacceptance (Zielinski et al., 2023; Zielinski & Veilleux, 2018; Linehan, 1993). On the contrary, Parents’ supportive/validating responses to children’s negative emotions clearly are associated with children’s emotional expression and regulation (Shenk & Fruzzetti, 2011).

Biopsychosocial theory postulates EI arises in the presence of an invalidating environment (IE). According to this model, IEs are comprised of four key components: oversimplification of problem solving, misattribution, discouraging of negative emotional expression, and communications of inaccuracy. This kind of familial environment, in combination with other vulnerability components of the child forms a "poorness of fit" between the child and his/her context, resulting in emotional dysregulation (Linehan, 1993). A recent meta-analysis has also confirmed these four components of IEs by reviewing 77 studies (Musser et al., 2018). Accordingly, existent instruments measure childhood invalidation retrospectively such as Invalidation Childhood Environment Scale (Mountford et al., 2007), Parental Acceptance-Questionnaire/General Invalidation (Gomez & Rohner, 2011). Invalidation tends to be also assessed in medical contexts such as Illness Invalidation Inventory (Kool et al., 2010). Additionally, Socialization of Emotions Scale (Martins et al., 2018) was developed to assess childhood EI which is not feasible to adapt for use with adults. Thus, a measure for assessing present perceived EI in adults was lacking (Branao et al., 2023). Meanwhile, findings of Elzy and Karver demonstrated that the objective existence of emotionally invalidation behaviors (invalidating behaviors) may not be the same as the experienced perception of EI across individuals (perceptions of invalidation), highlighting the need to test how EI is operationally assessed (Elzy & Karver, 2018). Finally, the perceived emotion invalidation (PIES) (Zielinski & Veilleux, 2018) was developed for assessing current levels of perceived EI in the adults. The PIES consists of 10 items and demonstrated higher levels of internal consistency (alpha = 0.93 and 0.94) in different non-clinical samples. To our knowledge, only one study has established the psychometric qualities of the PIES. The validation of the Portuguese version, with 234 adults, revealed high reliability (alpha = 0.90) and validity. Factor analyses indicated a unidimensional and a good convergent validity by correlating positively with depression, anxiety and stress symptoms, emotion communication, and suppression (Brandão et al., 2022).

Aim of the present study

Although the original and Portuguese versions of PIES have demonstrated promising results, additional studies are warranted to investigate the psychometric qualities of the PIES in other cultures, especially in Eastern culture such as Persian (Iran). Introducing an assessment instrument into Persian study and clinical practice would contribute to the progress of knowledge regarding the impact and consequences of EI. Further, so far, the factor structure of the PIES has not yet been tested with a clinical sample. Thus, the present study aimed to (a) examine the unidimensional structure of the PIES using principal component analysis (PCA) and confirmatory factor analysis (CFA) for non-clinal and clinical samples respectively; (b) explore the convergent validity with psychological maltreatment, emotional dysregulation, depression, depression, anxiety, and stress as well as discriminant validity (the between-sample differences regarding EI); (c) investigate the incremental and predictive validity for non-clinal populations; and (d) inspect the internal consistency and test-retest reliability of the Persian version of the PIES for the both samples. It was hypothesized that the Persian version of the PIES has adequate psychometric properties for clinical and non-clinical samples. We also hypothesized that EI would be positively associated with psychological maltreatment, emotional dysregulation, depression, depression, anxiety, and stress.

Participants

Three samples of participants were recruited. The non-clinical college student sample (sample 1) included 1613 undergraduate and postgraduate students: 1115 (%69.1) women and 495 (%30.9) men, mean age = 22.87, SD = 5.21, range: 18 to 46). The student sample was recruited from nine universities in the north (University of Tehran, Tehran), south (Shahid Chamran University, Ahvaz), west (Razi University, Kermanshah; Azarbaijan Shahid Madani University, Tabriz; Bu-Ali Sina University, Hamadan), east (University of Birjand and Bozorgmehr University, South Khorasan), and center (Yazd University, Yazd; University of Isfahan, Isfahan) of Iran via convenience sampling. The majority of subjects (n = 1392; 86.3%) were single, and a minority were married (n = 221; 13.7%). In terms of ethnicity, 1177 students (73%) identified themselves as Pars, 182 (11.3%) as Turkish, 117 (7.3%) as Kurd, 49 (3.0%) as Lur, and 88 (5.5%) as other ethnicities (e.g., Arab, Bakhtiari, Turkmen, and Baloch).

Sample 2 (n = 338) was drawn from general population located in the Western (Bijar, Kurdistan) and Eastern Iran (Birjand). They were also selected via convenience sampling method. Twenty-seven individuals had missing data on > 10% of the items and were therefore excluded from study. As such, the number of general population sample was 311. The participants were primarily female (n = 216, 69.5%), Pars (n = 236, 75.9%), and married (n = 226, 72.7%), with a mean age of 32.99 (SD = 10.54). Also, 144 (46.3%) subjects completed high school, 132 (42.4%) completed college, and 35 (11.33%) held bachelor degree or higher (See Table 1).

Table 1

Demographic characteristics and mean of PIES in study samples.
Demographic characteristics	Sample 1 (n = 1613)	Sample 2 (n = 311)	Sample 3 (n = 177)	Sample 4 (n = 149)
Total PIES (Mean ± SD)	22.63 (8.33)	21.03 (8.29)	38.44 (5.51)	21.15 (6.13)
Age (Mean ± SD)	22.87 (5.21)	32.99 (10.54)	32.92 (6.02)	24.03 (6.52)
Gender
Female	1115 (69.1%)	216 (69.5%)	130 (73.4%)	104 (69.8%)
Male	498 (30.9%)	95 (30.5%)	26 (26.6%)	45 (30.2%)
Ethnicity
Pars	1177 (73.0%)	236 (75.9%)	119 (67.2%)	103 (69.1%)
Turkish	182 (11.3%)	52 (16.7%)	21 (11.9%)	18 (12.1%)
Kurd	117 (7.3%)	23 (7.4%)	20 (11.3%)	7 (4.7%)
Lur	49 (3.0%)	-	5 (2.8%)	6 (4.0%)
other ethnicities (Arab, Bakhtiari, Turkmen, and Baloch)	88 (5.5%)	-	12 (6.8%)	15 (10.1%)
Marital Status		-
Single	1392 (86.3%)	85 (27.3%)	153 (67.2%)	125 (83.9%)
Married	221 (13.7%)	226 (72.7%)	58 (32.77%)	24 (16.1%)
University or city
University of Tehran/ Tehran	202 (12.5%)	-	-	-
University of Birjand/ Birjand	238 (14.8%)	182 (58.5%)	177 (100%)	149 (100%)
Bozorgmehr University/Ghaen	163 (10.1%)	-	-	-
Yazd University/Yazd	170 (10.5)	-	-	-
Azarbaijan Shahid Madani University/Tabriz	184 (11.4%)	-	-	-
Razi University/Kermanshah	155 (9.6%)	-	-	-
Bu-Ali Sina University/Hamadan	172 (10.7%)	-	-	-
University of Isfahan/Isfahan	182 (11.3%)	-	-	-
Shahid Chamran University/Ahvaz	147 (9.1%)	-	-	-
Bijar city	-	129 (41.5%)	-	-

Sample 3 (n = 177) was drawn from adults receiving outpatient psychiatric care at three facilities (Counseling center of University of Birjand, Hamrah, and Rah-E-No,) in the Eastern Iran (Birjand). The outpatients met DSM-V criteria for bipolar/unipolar depression (n = 49), anxiety disorders (n = 53), OCD (n = 29), borderline personality disorder (n = 24), and other personality disorders (n = 22). Participants were primarily female (n = 130, 73.4%) and Pars (n = 119, 67.2%) %), with a mean age of 32.92 (SD = 6.02). Subjects were recruited for participation and completed the PIES in person.

Sample 4 included 161 psychology, counseling, and physical education students from University of Birjand who completed the three questionnaires (DERS-16, DASS-21, and PIES) in two Phases (with an interval of 5 weeks). Twelve students had missing data on > 10% of the items and were excluded from study. Thus, the number of subjects in sample 4 was 149. Their demographic characteristics are reported in Table 1.

For exploratory factor analysis and incremental validity, sample 1 data were used, for confirmatory factor analysis, samples 2 and 3 data were utilized, and to determine predictive validity and test-retest reliability, sample 4 data were employed. In order to determine the internal consistency and item-test correlation, all samples were used. All participants (samples 1, 2, 3 and 4) were studied in accordance with the 1989 revision of the Helsinki Declaration.

Perceived Invalidation of Emotion Scale

The PIES is a 10-item self-report measure that currently assesses the perceived invalidation in adults. Participants rate each item on a 5 (Almost never; 0–10%) to 5 (Almost always; 91–100%) Likert-type scale. An example item is “Others make me feel that my emotions are unimportant.” The original version of PIES demonstrated higher levels of internal consistency (α = 0.93 and 0.94), good test-retest reliability (r = 0.67, p < 0.01), and concurrent validity (CMIN/DF = 1.98, NFI = 0.97, CFI = 0.98, RMSEA = 0.056) in different non-clinical samples. The PIES has also indicated good divergent, incremental, and predictive validity among community and student participants.

Depression, Anxiety and Stress

The DASS is a 21-item self-report measure that assesses the three related negative emotional states of depression, anxiety, and stress. The DASS includes 7 items from each of the 3 factors. This measure assesses the prevalence of psychological distress (depression, anxiety, and stress symptoms) along the past weeks. All of the items are rated using a 4-point Likert scale (From 0 = did not apply to me at all to 3 = applied to me very much, or most of the time). Scores for each of the three subscales were calculated by summing up the responses of relevant items, where the maximum sum for each subscale is 21; higher scores represent higher psychological distress. The DASS-21 has also demonstrated good internal consistency (Depression: α = 0.91; anxiety: α = 0.81; stress: α = 89) and convergent validity (correlation coefficient of DASS depression and anxiety subscale with BDI and BAI were 0.81 and 0.74 respectively) (Lovibond & Lovibond, 1995). The Persian version of DASS has demonstrated good internal consistency (Depression: α = 0.93; anxiety: α = 0.79; stress: α = 91), test-retest reliability (ranging from 0.74 to 0.89), and concurrent validity (SRMR = 0.047, TLI = 0.91, CFI = 0.92, RMSEA = 0.078) (Kakemam et al., 2022). In our sample, internal consistency scores were also good (Depression: α = 0.89; anxiety: α = 0.93; stress: α = 0.85).

Childhood Trauma Questionnaire-Short form

The CTQ-SF is a 28-item self-administered questionnaire that assesses child abuse and neglect. The CTQ-SF also yields a total score (childhood maltreatment) and scores for five factors retrospectively measuring five components of childhood traumas: emotional abuse (EA), physical abuse (PA), sexual abuse (SA), emotional neglect (EN), and physical neglect (PN). It is recommended to be used from the age of twelve (Bernstein et al., 2003). All 28 items are constructed as statements beginning with the phrase ‘When I was growing up…’ and they are scored on a five-point Likert scale from “never true” (= 1) to “very often true” (= 5). Each subscale is represented by 5 items with the scores ranging from 5 to 25, after reversing 7 items. Higher scores on the instrument indicate higher levels of reported childhood trauma. Three items are also designed to measure minimization/denial. The scoring of M/D subscale is different, since only the highest positive scores (very often true = 5) are scored, and it can vary from 0 to 3. In other words, anything less is scored a 0; a total of one (1) or greater indicates the potential underreporting of childhood maltreatments (false negatives). The CTQ-SF has shown acceptable internal consistency (EA = 0.84–0.89; PA = 0.83–0.86; SA = 0.92–0.95; EN = 0.85–0.91; PN = 0.61–0.78) and construct validity (RMSEA = 0.05–0.06) in clinical and community samples (Bernstein et al., 2003). The Persian version of CTQ-SF has acceptable psychometric properties (Nobakht et al., 2021). In the current study, estimates of test score reliability (Cronbach’s alpha) were good (EA = 0.88, PA = 0.84, SA = 0.76, EN = 0.80, PN = 0.81, CTQ-SF total scores = 0.91).

Difficulties in Emotion Regulation Scale-16

The DERS-16 is a 16 item self-report measure assessing individuals’ typical levels of difficulties in emotion regulation. Participants rate items on a 5-point Likert-type scale ranging from 5 (Almost never; 0–10%) to 5 (Almost always; 91–100%), where higher scores indicate greater levels of difficulties in emotion regulation. Factor analysis supports a five-factor (non-acceptance of emotional responses, difficulty engaging in goal-directed behavior, impulse control difficulties, limited access to emotion regulation strategies, lack of emotional clarity) structure, and it has revealed excellent internal consistency (α = 0.92 and 0.94), plus good test-retest reliability (ρ_I = 0.85; p < 0.001), convergent validity, and discriminant validity in clinical and community samples (Bjureberg et al., 2016). The Persian version of DERS-16 has also demonstrated adequate internal consistency (α = 0.71 and 0.91), good test–retest reliability (r₁₂ = 0.74 to 0.94; ρ_I = 0.92; p < .001), and good concurrent validity (Shahabi et al., 2020).

Procedure

Once permission was received from the developers, the original/English version of the PIES was translated into Persian/Farsi by three bilingual psychologists. According to Gudmundsson (2009) and Byrne (Byrne, 2016), the following phases were followed: (1) a parallel translation of the original version for Persian was performed independently by the second author and a bilingual psychologist (associate professor). All psychologist familiar with the purpose of the PIES and fluent in the Persian and English; (2) all translated versions were reviewed and a consensual version was obtained. Five assistant or associate professors of psychology who were familiar in childhood traumas and emotional invalidation and were native in Persian reviewed the translated version to ensure the content validity and fluency of the questions. The back-translation into English was also conducted by an independent associate professor of clinical psychology, who was fluent in the Persian and English; (3) a pilot study of Persian version was conducted with students (men = 6, women = 6) and general population (n = 12, men = 6, women = 6) to obtain feedback about the comprehensibility and clarity of questions. (4) Finally, feedback and comments from pilot subjects were taken into consideration (Byrne, 2016; Gudmundsson, 2009).

The data were collected between December 2023 and April 2024. The data collection from the college student sample (sample 1) occurred through a web link directing the students to the study website. Indeed, students were invited to participate in the investigation using advertisements, whereby a web link directed the students to the study website. For this purpose, the link of the questionnaire was placed on virtual networks (Telegram, Eitaa, and Instagram) of the mentioned universities and it was advertised once a week for 20 days. The first page of the study website described the aim of the study as follows: "Examining the psychometric properties of the Persian (Iranian) version of the Perceived Emotional Invalidation Scale". Students were directed to the next page if they consented to participate in the study. The second page asked about demographic characteristics and then other questionnaire items (PEIS, CTQ, DASS, and DERS-16) were displayed in order. If the participants did not answer an item, the next item would not be shown to them.

The data collection from the general population (sample 2), conducted by the first and second authors and two M.Sc. psychologists was done from a population of visitors in health centers (Bijar and Birjand center), cultural house (cultural house of Amir), and parks of Bijar and Birjand, Iran. The data collection from the clinical sample (sample 3) was performed by the second and third authors (assistant professors of psychology), at three facilities (Hamrah, Rah-E-No, and Counseling Center of University of Birjand) in Birjand, Iran. In this regard, the first and second authors approached the clients and illustrated the aim of investigation. They then instructed the clients about the PIES and asked them to fill it. Finally, data collection from the sample 4 was conducted by the second and third authors in five different classrooms.

Individuals (samples 2, 3, and 4) who consented to participate first provided written informed consent and were then requested to fill in the questionnaires. The current investigation was also conducted under a master’s project in psychology and was approved by the scientific committee of the School of Psychology of the University of Birjand. Table 1 reports the demographic characteristics of the study samples.

Insert here Table 1

Statistical Analysis

Statistical analyses were conducted using SPSS version 26 and AMOS (version 24.0, IBM SPSS, Inc. in Chicago, IL). Initial data screening (Sample 1) demonstrated that distributions of the PIES items were acceptable in terms of skewness (< 2.0; range − 0.04_1.28) and kurtosis (< 2.0; range − 1.04_0.99). Principal component analysis (PCA), using direct oblimin rotation, was conducted on the student sample to test the factor structure (construct validity) of the 10 items of the PIES. Parallel analysis was employed to determine the number of factors or principal components to retain in the initial step of exploratory factor analysis. Parallel analysis indicated a unidimensional solution to the data. The Bartlett’s test of sphericity and Kaiser–Meyer–Olkin (KMO) test were performed to examine the adequacy of the PCA. Pattern factor loadings of 0.40 or higher (> 0.40) were considered meaningful and were chosen (Pituch & Stevens, 2015).

After initial data screening and confirmation of normal distributions (Sample 2: skewness < 0.2.0, range 0.21–1.40; kurtosis < 2.0, range − 1.25–0.71; Sample 3: M = 0.58, SD = 0.89, range − 1.07 to − 0.16; kurtosis < 2.0, range − 1.07–0.87), confirmatory factor analysis (CFA) was conducted using a maximum likelihood estimation (MLE) method, to examine the unidimensional structure of the PIES items on the general population (Sample 2) and clinical (Sample 3) samples. Goodness-of-fit indices were evaluated against the following criteria: the X²/df statistic (with values < 5 indicating good fit), the goodness of fit index (GFI), Incremental Fit Index (IFI), the Bentler comparative fit index (CFI) (in three cases with ≥ 0.90 indicating acceptable fit), the root mean square error of approximation (RMSEA; with values value ≤ 0.08 indicating adequate fit), and residual (SRMR; with values value ≤ 0.08 indicating good fit) (Hu & Bentler, 1999; Meyers et al., 2016). The convergent validity was examined using Pearson correlation coefficient. Discriminative validity was tested using Kruskal-Wallis test among three samples. Hierarchical regression was employed to test incremental validity of PIES. Finally, the reliability was estimated by internal consistency (Cronbach's alpha and McDonald's Omega) and test-retest reliability. The significance level of 0.05 was used.

Construct validity: Principal component analysis (PCA)

In order to examine the factor structure of the Persian PIES, scores of student sample (N = 1613) were analyzed through exploratory factor analysis (EFA) using oblique rotation. The Bartlett's test of sphericity (χ2 ₍₄₅₎ = 8469.05, p < 0.0001) and Kaiser-Meyer-Olkin measure of sampling adequacy (KMO = 0.937) for the Persian PIES indicated that factor analyses were appropriate. Additionally, results of Scree test (See Fig. 1) (Cattell, 1966) and a parallel analysis indicated a unidimensional solution which accounted for 55.62% of the variance (eigenvalues of 5.56) (see Fig. 1). The item loadings also ranged from 0.66 (item 1) to 0.84 (item 5).

Insert here Fig. 1

Construct validity: Confirmatory factor analysis (CFA)

We examined the fit of the unidimensional structure of Persian PIES through CFAs using maximum likelihood estimation. The CFAs were computed for the Persian PIES with the general population (n = 311) and clinical (n = 177) samples. The Persian PIES measurement model yielded good fit with the data in general population (χ2 = 102.33 p < 0.001, χ2/df ₍₃₅₎ = 2.92, GFI = 94, CFI = 0.95; TLI = 0.94; SRMR = 0.059, RMSEA = 0.079 (90%: .05–.06). The item loadings ranged from 0.42 (item 2) to 0.81 (items 5 and 10), all well above acceptable levels (see Fig. 2).

Insert here Fig. 2

Consistent with the results for general population, the Persian PIES yielded acceptable fit with the data in clinical sample (χ2 ₍₃₅₎ = 101.16, p < 0.001; χ2/df = 2.89, GFI = 0.93, CFI = 0.96; IFI = 0.96; SRMR = 0.05, RMSEA = 0.077) where the item loadings ranged from 0.49 (item 2) to 0.86 (items 5 and 10) (see Fig. 3).

Insert here Fig. 3

Reliability

Reliability data for the Persian PIES are outlined in Table 2. According to Hunsley & Mash (Hunsley & Mash, 2008) guideline (0.70 < α < 0.79 = adequate; 0.80 < α < 0.89 = good; and 0.90 ⩽ α = excellent internal), analyses of Cronbach's alpha and McDonald's Omega revealed good internal consistency for the Persian PIES in different samples (α = 0.89–0.91). Test-retest reliability was examined on a subsample of 149 college students (45 men, 104 women) over a 5-week interval and were found to be good (r₁₂ = 0.63 p < 0.0001). Finally, item-test correlations (r _it; the correlations among items and the total score of scale) were found to be good (ranged from 0.42 to 0.79, p < 0.001), indicating that the PIES is homogeneous and all items should be retained (See Table 2).

Table 2

Means, Standard Deviations, McDonald's Omega, Cronbach’s α, Item-Test Correlations, and Test–Retest Reliability Coefficients for the Persian PIES.
Reliability	Sample 1 (n = 1613)	Sample 2 (n = 311)	Sample 3 (n = 177)	Sample 4 (n = 149)
McDonald's Omega	0.91	0.90	0.90	0.89
α	0.91	0.90	0.90	0.89
Rang of r _it	0.54–0.78	0.42–0.74	0.49–0.79	0.54–0.79
r₁₂	-	-	-	0.63
Note. α = Cronbach's alpha; r_it = item-test correlation; r₁₂ = test–retest coefficient.

Insert here Table 2

Convergent validity

To assess convergent validity, we examined the relationship between the Persian PIES and the difficulties in emotion regulation scale-16 (DERS-16), depression, anxiety and stress (DASS-21), and childhood trauma questionnaire-short form (CTQ-SF) among the student and general population samples (Samples 1, 2, and 4) at the same time. In the three samples, the Persian PIES showed a positive significant correlation with measures of DERS-16 (ranged from 0.48 to 0.59, p < 0.001), DASS-21 (ranged from 0.53 to 0.60, p < 0.001), and CTQ-SF (r = 0.40 and 0.52, p < 0.00) (see Table 3).

Table 3

Correlation between PIES and measures of Emotion Dysregulation (DERS-16), Childhood Trauma Questionnaire-Short Form (CTQ-SF), and Emotional Distress (DASS-21)
Measures	Sample 1 (Students; n = 1613)	Sample 2 (General population)	Sample 4 (Students; n = 149)
Emotional abuse	0.40	0.52	-
Sexual abuse	0.15	0. 31	-
Physical abuse	0. 24	0.47	-
Emotional neglect	0.37	0.34	-
Physical neglect	0.33	0.43	-
Total CTQ-SF	0.40	0.52	-
Depression	0.49	0.56	0.56
Anxiety	0.46	0.55	0.51
Stress	0.48	0.52	0.54
Total DASS-21	0.53	0.61	0.60
Non-acceptance of emotional responses	0.42	0.49	0.44
Difficulty engaging in goal-directed behavior	0.33	0.53	0.41
Impulse control difficulties	0.36	0.49	0.42
Limited access to emotion regulation strategies	0.48	0.60	0.51
Lack of emotional clarity	0.41	0.41	0.42
Total DERS-16	0.48	0.59	0.52

Insert here Table 3.

Discriminant validity

In order to determine and examine discriminant validity of the Persian PIES, scores of three samples of clinical, general population, and students (sample 2, 3 and 4) were compared using one-way Kruskal-Wallis. The result of Kruskal-Wallis indicated that there were differences among the three groups (Kruskal-Wallis H ₍₂₎ = 312.95, p = 0.0001). Mann–Whitney U test revealed that the general population student (Mann–Whitney U = 3386.50, Z = -16.13, p = 0.0001) and student (Mann–Whitney U = 561.50, Z = -14.90, p = 0.0001) scored significantly lower on the PIES than the clinical sample, while there was no significant difference between general population and student samples (Mann–Whitney U = 21231.0, Z = -1.45, p = 0.146)

Incremental Validity

Incremental validity was examined on a sample of 1613 college students (Sample 1) and general population (Sample 2). Hierarchical regression analysis was conducted to test whether PIES would predict outcomes beyond what can be accounted for by childhood traumas (physical, sexual, and emotional abuse; physical and emotional neglect). Two independent hierarchical regression analyses examined emotional distress (i.e., total score of DASS-21) and emotional dysregulation (i.e., total score of DERS-16) as criterion variables separately. The five components of childhood traumas: emotional abuse (EA), physical abuse (PA), sexual abuse (SA), emotional neglect (EN), and physical neglect (PN) and perceived emotion invalidation (PIES) were predictor variables in the regression models. The components of childhood traumas were entered at Step 1, while the PIES was entered at Step 2. The components of childhood traumas significantly predicted outcome variables (DASS-21 and DERS-16) at Step 1. Addition of PIES to the model (Step 2) enhanced the proportion of predicted variance to 17% in emotional distress (multiple R = 0.57, R² = 0.32, F _{(1, 1610)} = 395.08, p < 0.0001) and 15% in emotional dysregulation (multiple R = 0.50, R² = 0.25, F _{(1, 1610)} = 317.38, p < 0.0001) in sample 1 (student sample). Another Hierarchical regression revealed that addition of PIES to the model (Step 2) elevated the proportion of predicted variance to 24% in emotional distress (multiple R = 0.62, R² = 0.34, F _{(1, 308)} = 119.96, p < 0.0001) and 19% in emotional dysregulation (multiple R = 0.53, R² = 0.28, F _{(1, 308)} = 83.27, p < 0.0001) (See Table 4) in sample 2 (general population) (See Table 4). Tolerance (ranged 0.34 to 0.81) and VIF (ranged 1.22 to 2.93) for both samples indicated that there was no multiple collinearity.

Table 4

Hierarchical Regressions Predicting Emotion Dysregulation (DERS-16) and Emotional Distress (DASS-21) through childhood traumas and emotional invalidation (n = 1613).
Outcome variables		Sample 1 (n = 1613)			Sample 2 (n = 311)
	SE	β	t	SE	β	t
Predicting DASS-21; Step 1	R² = 0.16*			R² = 14^*
Childhood trauma	0.02	.39	17.34*	0.05	0.37	7.19*
Predicting DASS-21; Step 2	ΔR² = 0.17*			ΔR² = 24^*
Childhood trauma	0.02	0.22	9.87*	0.04	0.15	3.12*
PIES	0.03	0.44	19.87*	0.08	0.53	10.95*
Predicting DERS-16; Step 1	R² = 0.11			R² = 0.09*
Childhood trauma	0.02	0.31	13.33*	0.06	0.29	5.41*
Predicting DERS-16; Step 2:	ΔR² = 0.15			ΔR² = 0.19*
Childhood trauma	0.02	0.15	6.31*	0.05	0.09	1.72
PIES	0.04	0.42	17.81*	0.10	0.48	9.12*
* p < 0.01

Insert here Table 4.

Predictive validity

Predictive validity was examined on a subsample of 149 college students. In this regard, two another hierarchical regression analyses were conducted to test the ability of the Persian PIES as a predictive variable, for predicting changes in emotional distress (DASS-21 in time 2) and difficulties in emotion regulation (i.e., total score of DERS-16 in time 2) over a 5-week interval. The Time 1 scores for the emotional distress (DASS-21 in time 1) and difficulties in emotion regulation (DERS-16 in time 1) were entered in Step 1, and Time 1 score for the Persian PIES was entered in Step 2. Results showed that high currently perceived invalidation predicted increased emotional distress (Step 1_DASS-21 time 1: β = 0.86, SE = 0.11, t = 20.58, R = 0.86, R² = 0.74, p = 0 .0001; Step 2_PIES time 1: β = 0.19, SE = 0.13, t = 15.80, R = 0.88, R² = 0.77, ΔR² = 0.03, p = 0 .0001) and emotional dysregulation (Step 1_DERS-16 time 1: β = 0.77, SE = 0.36, t = 14.71, R = 0.77, R² = 0.60, p = 0.0001; Step 2_ PIES time 1: β = 0.26, SE = 0.10, t = 4.47, R = 0.80, R² = 0.64, ΔR² = 0.05, p = 0 .0001), when DASS-21 and DERS-16 Time 1 scores were controlled.

To the best of the authors' knowledge, the present study is the first to examine the psychometric qualities of the PIES in an Eastern culture. Validity and reliability of the Persian PIES were tested in three different samples (students, general population, and clinical) and findings provided early evidence for acceptable psychometric properties of the Persian PIES. In line with the original version of the PIES (Zielinski & Veilleux, 2018), a unifactorial solution was obtained.

Indeed, results from the exploratory factor analysis (EFA) led to a unidimensional structure and then unifactorial solution of the Persian PIES was confirmed through the confirmatory factor analysis (CFA). In other words, the CFA results demonstrated that the unifactorial structure model of the Persian PIES provided good fit with the data in the two different samples (general population, clinical sample). Previously, to our knowledge, only one study had tested the factor structure of the PIES using non-clinical adults (Brandao et al., 2023). These results were in line with original version (Zielinski & Veilleux, 2018), showing a unidimensional solution. This finding is also in line with the Portuguese version (Brandao et al., 2023) which obtained a unidimensional model of the PIES. Contrary to our findings, item 2 (“When I share how I’m feeling, others want me to get over it or accept it and move on”) was removed in the Portuguese version since it had a low factor loading (factor loading = 0.22) and lower discrimination (α1 > 0.40). In sum, the results pf principal component and confirmatory factor analyses confirmed the construct validity of the Persian PIES. Thus, PIES has a comparable structure in Iranian, Portuguese, and original versions.

The current study revealed the good internal consistency reliability (Cronbach's alpha; ranged from 0.89–0.91) of the PIES. The test-retest reliability (r₁₂ = 0.63) of the Persian PIES over a 5-week interval was also found to be acceptable in the non-clinical sample. These findings are comparable with findings from previous studies (e.g., Brandao et al., 2023), suggesting good internal consistency and test-retest reliability for the Portuguese PIES or the original version of PIES (Zielinski & Veilleux, 2018). In other words, the current test-retest correlation coefficients were found to be similar to Zielinski & Veilleux (2018) as well as Brandao et al. (2023). Therefore, our findings provide additional support for the robustness of the PIES in clinical on non-clinical adults.

The convergent validity of the Persian PIES was supported in the present study through its positive significant correlations with the CTQ-SF, the DESR-16, and the DASS-21. In other words, the relationship between PIES and the three scales (CTQ-SF, DESR-16, and DASS-21) was investigated in order to examine the convergent validity. As expected, the PIES was positively correlated with childhood trauma (CTQ-SF) in both student and general populations (Samples 1 and 2), especially with emotional abuse and neglect subscale. This finding is consistent with Linehan’s biopsychosocial theory (1993) and some research (Brandao et al., 2023; Hope & Chapman, 2019; Westphal et al., 2016) demonstrating the relationship between adverse childhood events and emotional invalidation. Linehan (1993) proposed that children raised in invalidating environments (IEs) will catch the messages that their emotions and feelings are defective and eventually begin to self-invalidate. Similarly, Wetphal and colleagues (2016) suggested that parental abuse and indifference were significantly related to perceived emotional invalidation. Hope and Chapman (2019) also found that recalled experiences of childhood trauma, emotional invalidation, parental psychological control, and BPD features were positively correlated. Thus, it can be stated that children exposed to environments characterized by neglect or abuse would develop critical and negative attitudes toward their own emotions.

In addition, our findings suggested that PIES is linked to DERS-16 and symptoms of depression, anxiety, and stress in both student and general populations. These results align with the previous studies that have demonstrated emotional invalidation to be a contributing factor to the development and persistence of emotional dysregulation (Braden et al., 2021; Brandão et al., 2023; Sauer & Baer, 2010; Yap et al., 2008), as well as a predictor of the severity of daily negative affect and emotional disorders (Mohammadkhani et al., 2023; Schreiber & Veilleux, 2022; Shenk and Fruzzetti, 2011; Zielinski et al., 2023). For example, Shenk and Fruzzetti (2011) demonstrated that participants who were exposed to invalidating responses experienced noticeably higher levels of negative affect, heart rate, and skin conductance than participants who were exposed to validating responses. Another study by Brandao and colleagues (2023) found a direct correlation between higher levels of emotional invalidation experienced and depressive symptoms in interpersonal interactions, as well as an indirect correlation through challenges with emotion regulation. The relations of the PIES to the DERS-16 and the DASS-21 indicate that those who experience emotional invalidation may have maladaptive emotion regulation strategies and engage in emotional distress and psychopathology. In summary, the invalidating environment can expectedly cause a child to acquire the belief that feelings and emotions are unacceptable, shameful, and lack legitimacy. Hence, it is possible that adult emotion dysregulation and psychopathology are influenced by early invalidating environments (Linehan, 1993).

Our findings provide additional support for the robustness of the PIES; this is the first study to provide evidence that PIES has acceptable discriminant validity. The results of the current study revealed that, although there was no significant difference between student and general populations, the PIES significantly distinguished between clinical and non-clinical populations. The patients' scores were significantly higher than those of the non-clinical populations. This supports the hypothesis that emotional invalidation as assessed by the PIES is associated with psychopathology.

This study also expanded on the evidence for incremental validity of the PIES and provided additional evidence for its unique predictive effects. The results from the student and general populations (Samples 1 and 2) presented here demonstrated that the PIES could consistently predict incremental variance in construct-relevant criteria beyond childhood traumas (CTQ-SF) and difficulties in emotion regulation (DERS-16). Incremental effects in terms of criterion variance explained were found to be 0.15–24% in student and general populations. This finding is consistent with original version (Zielinski & Veilleux, 2018). In a similar study, Westphal and colleagues (2016) found that emotional invalidation predicts emotional distress even after controlling for perceived parental abuse. Similarly, Schreiber and Veilleux (2022) found that perceived emotion invalidation predicted greater emotional distress above and beyond emotional reactivity, negative affect, emotion dysregulation, cognitive and behavioral emotion regulation strategies, self-compassion, and experiential avoidance. Another study found that the childhood trauma related to psychopathology after controlling difficulties regulating emotions (Hope & Chapman, 2019). Consequently, PIES is a relatively new instrument that can be used to measure emotional invalidation.

Finally, we found preliminary evidence indicating that higher levels of emotional invalidation (PIES) at time 1 are associated with emotional distress (DASS-21) later at time 2 when controlling for time 1 DASS-21 and DERS-16. In other words, the results of the present study provided support for the high predictive power of the PIES over and beyond the DASS-21 and DERS-16 over a 5-week interval. Indeed, the predictive effect in terms of criterion variance explained was found to be 0.03 to 0.05% in student population. Thus, current emotional invalidation is clearly a significant predictor of future emotional distress. Contrary to our findings, in the original version the PIES was only able to predict relatively small increases (0.01%) in additional emotional distress at Time 2 when controlling for Time 1 emotional distress (Zielinski & Veilleux, 2018).

The present study had some strengths and limitations. Its strengths included three distinct and large sample sizes (students, general population, and inpatient populations) from different ethnicities, comprehensive consideration of language translation concerns, and appropriate statistical methods. Conversely, the limitations of this study were as follows: First, the cross-sectional nature of the current study prevented it from reporting causal correlations. Secondly, a convenience sampling method was used and not all measures could be included for all participants. so, its findings may not be generalized to the entire Iranian population. Further, the current investigation did not contain any instruments that could be considered as theoretically distinct from emotional invalidation. As a result, no evidence was provided to support the divergent validity. In addition, test-retest reliability of the PIES was only assessed in the student college population. Also, the instruments used in the present study were self-report in format. Moreover, the current study did not investigate the sensitivity of the PIES to treatment, so the efficacy of the instrument as a measure of therapeutic change has not yet been determined. Finally, the Iranian sample was not compared to a reference sample from another context, suggesting future research should analyze measurement invariance across different samples for cross-cultural evidence.

The Persian version of PIES demonstrated a unifactorial structure in a large student sample. Additionally, the unifactorial structure of PIES was confirmed through CFA in both clinical and non-clinical samples. The reliability (internal consistency and test-retest) of the PIES, as well as its convergent, discriminant, incremental, and predictive validity, were confirmed. Overall, the PIES, with its unifactorial structure, appears to be a valid measurement across the Iranian population.

Author Contribution

All authors contributed to the study conception and design. Zahra Paripishbar and Mehdi Rezaei designed the study. Zahra Paripishbar and Samaneh Khazaei managed the literature searches and analyses. Zahra Paripishbar and Mehdi Rezaei undertook the statistical analysis, and Mehdi Rezaei wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript

Acknowledgement

We would like to thank Ahamad Khamesan, Mohammad Hosein Salarifar, Hadi Samadieh, Hamid Amiri, and all study participants for their kind participation

Data Availability

Data was provided within the manuscript

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No competing interests reported.

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Measuring emotional invalidation in Iranian populations: Persian version of perceived invalidation of emotion scale (P_PIES)

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Abstract

Figures

Introduction

Aim of the present study

Methods

Participants

Perceived Invalidation of Emotion Scale

Depression, Anxiety and Stress

Childhood Trauma Questionnaire-Short form

Difficulties in Emotion Regulation Scale-16

Procedure

Statistical Analysis

Results

Construct validity: Principal component analysis (PCA)

Construct validity: Confirmatory factor analysis (CFA)

Reliability

Convergent validity

Discriminant validity

Incremental Validity

Predictive validity

Discussion

Conclusions

Declarations

Author Contribution

Acknowledgement

Data Availability

References

Additional Declarations

Status:

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