Psychological Assessment Copyright 1995 by the American Psychological Association, Inc.

1995, Vol. 7, No. 4,450-455 1040-3590/95/S3.00

Normative Values for the Beck Anxiety Inventory, Fear Questionnaire,

Penn State Worry Questionnaire, and Social Phobia
and Anxiety Inventory
Martha M. Gillis, David A. F. Haaga, and Gary T. Ford
The American University

Community norms are reported for the Beck Anxiety Inventory (BAI; A. T. Beck, N. Epstein, G.
Brown, & R. A. Steer, 1988), Fear Questionnaire (FQ; I. M. Marks & A. Mathews, 1979), Penn
State Worry Questionnaire (PSWQ; T. J. Meyer, M. L. Miller, R. L. Metzger, & T. D. Borkovec,
1990), and Social Phobia and Anxiety Inventory (SPAI; S. M. Turner, D. C. Beidel, C. V. Dancu, &
M. A. Stanley, 1989). The demographic profile of the samples closely matched the 1990 U.S. na-
tional census. On the SPAI, women scored higher than men on the Agoraphobia subscale, and the
lowest income group scored higher than higher income participants on the Difference and Social
Phobia subscales. Participants under 45 years of age exceeded those aged 45-65 on the BAI, the
PSWQ, and FQ Social Phobia, Blood/Injury, and Total Phobia scores. Percentile scores are provided
for all measures, as well as discussion of their usefulness for assessing clinical significance of therapy
outcomes.

Evaluations of the efficacy of treatments for psychological
disorders have traditionally asked whether a specific treatment
led to improvements in client functioning or which of several
comparison treatments led to greatest improvement. Answer-
ing such questions via statistical significance testing alone fails
to address the magnitude or meaningfulness of improvement.
A statistically significant result could represent only modest
benefits from therapy if within-group variability is small or
sample size is large. Therefore, treatment research methodolo-
gists have developed criteria for measuring the extent to which
a treatment produces practically meaningful, or clinically sig-
nificant (Jacobson, Follette, & Revenstorf, 1984), benefits.
One influential procedure for estimating the practical mean-
ing of treatment effects considers a patient to have achieved clin-
ically significant change if she or he (a) improves to a statisti-
cally reliable degree and (b) obtains a posttreatment score that
is statistically more likely to stem from the functional popula-
tion's distribution than from that of the pertinent dysfunctional
population (Jacobson & Truax, 1991).
One complication involved in applying this method is the
difficulty of defining and identifying distinct functional and dys-
functional population distributions. A currently common
method of developing dysfunctional norms is to accept the pre-
treatment scores of one's own patient sample as representative
Martha M. Gillis and David A. F. Haaga, Department of Psychology,
The American University; Gary T. Ford, Department of Marketing, The
American University.
This article is based on Martha M. Gillis's master's thesis. We thank
Dianne L. Chambless, who also served as a committee member.
Correspondence concerning this article should be addressed to David
A. F. Haaga, Department of Psychology, The American University, As-
bury Building, Washington, DC 20016-8062. Electronic mail may be
sent via Internet to Dhaaga@american.edu.
450
of the dysfunctional population, which means that the dysfunc-
tional "norms," and therefore the cutoff for clinical signifi-
cance, are different in every study. The functional population is
also not easy to define. Some studies screen for this group by
excluding anyone who has received treatment for the condition
being studied (e.g., Trull & Hillerbrand, 1990). However, hav-
ing received treatment may be imperfectly correlated with being
dysfunctional. The National Comorbidity Survey (NCS; Kes-
sler et al., 1994) estimated, for example, that only 42% of those
with at least one lifetime psychiatric diagnosis had received pro-
fessional treatment and 15% of those with no lifetime diagnosis
had received such treatment (Kessler et al., 1994).
Hollon and Flick (1988) recommended bypassing the com-
plexities involved in defining separate functional and dysfunc-
tional populations by basing norms on unscreened, demograph-
ically representative samples. "Normal" posttreatment scores
would then be referenced solely to this distribution. This is the
approach adopted in the present study.
This study was designed to provide normative information
for four outcome measures used in studies of the treatment of
generalized anxiety disorder, social phobia, agoraphobia, and
other anxiety disorders. The measures selected were the Beck
Anxiety Inventory (BAI; Beck, Epstein, Brown, & Steer, 1988),
the Fear Questionnaire (FQ; Marks & Mathews, 1979), the
Penn State Worry Questionnaire (PSWQ; Meyer, Miller, Metz-
ger, & Borkovec, 1990), and the Social Phobia and Anxiety In-
ventory (SPAI; Turner, Beidel, Dancu, & Stanley, 1989). These
instruments are all self-report measures with evidence of high
reliability and validity, and, with the exception of the FQ, no
established adult community norms.
For the FQ, two extensive normative studies have already
been published (Mizes & Crawford, 1986; Trull & Hillerbrand,
1990), with markedly discrepant results. For example, Trull
and Hillerbrand (1990) reported a mean FQ Total Phobia score
 NORMATIVE VALUES FOR ANXIETY MEASURES
of 46.1 for women,1 compared to Mizes and Crawford's (1986)
score of 21.2. The studies differed in several ways, and it is not
certain why Trull and Hillerbrand (1990) obtained higher FQ
norms. They conducted their study in a larger urban area, col-
lected data by a telephone survey, and excluded participants
with a history of treatment for phobia, whereas Mizes and
Crawford (1986) studied a smaller community with mailed
questionnaires and no exclusion rules. Neither study used a de-
mographically representative, unselected sample. For example,
the Mizes and Crawford (1986) sample was 97% Caucasian.
In addition to providing total-sample norms, we conducted
subgroup comparisons because the Epidemiological Catchment
Area (ECA) project (e.g., Boyd et al., 1990; Regier, Narrow, &
Rae, 1990) and the NCS (Kessler et al., 1994) indicated that
there may be significant age, sex, race, and socioeconomic
differences in the prevalence of anxiety disorders.
In summary, the present study was designed to provide the
first adult community norms for the BAI, SPAI, and PSWQ,2
as well as additional normative data, from an unscreened and
demographically representative group, for the FQ.
Method
Participants
Two nonprobability quota samples were selected. The samples
matched the demographic profile of U.S. adults between the ages of 18
and 65 (U.S. Bureau of the Census, 1990) across four variables: sex,
race, income, and age. The SPAI alone was administered to one sample
(N - 261). The second sample (N = 267) completed in random order
the BAI, the PSWQ, and the FQ. The questionnaires were divided into
two groups to keep administration time manageable, based on the re-
sults of a pilot study.
The target national census quotas were as follows: (a) 49% men and
51% women; (b) 84% Caucasian (9% Hispanic and 75% non-Hispanic),
12% Black, and 3% other; (c) 20% from each of the following annual
household income ranges: 0-$16,000, $16,001-28,000, $28,001-
41,000, $41,001-60,000, and over $60,001; and (d) 32% age 18-29,
38% age 30-44, and 30% age 45-65. Our samples of respondents to
each questionnaire matched these quotas closely (e.g., in each case the
sample was either 84% or 85% Caucasian and either 12% or 13% Black)
and closely resembled U.S. Census data on several nonquota demo-
graphic variables (education level, marital status, and employment).
Slight demographic differences from one questionnaire to another and
from the target quotas resulted from missing or inaccurate data (e.g.,
two numbers circled on one item or responses during oral screening
differing from those provided on the demographic questionnaire).3
Procedure
Potential participants were approached at two shopping malls in the
suburbs outside Washington, DC, by representatives of two professional
marketing firms and asked if they were willing to answer some ques-
tions. Screening questions on the quota variables were asked first. If the
potential participant was under 18 or more than 65 years old, or fit a
demographic category for which our quota had already been reached,
she or he was thanked and the interview was terminated. Remaining
potential participants were asked to take 10 min to fill out some ques-
tionnaires and received a letter explaining the purpose of the study and
its voluntary nature.
Originally, only mall intercepts were planned, but it proved extremely
difficult to locate both Hispanics and lower income (below $28,000)
participants at those locations. As a result, potential participants were
451
approached at a Catholic church, a trailer park, and a homeless shelter,
again in suburbs outside Washington, DC. Most of the participants (n =
435) were offered the incentive of receiving a free District of Columbia
lottery ticket in return for agreeing to complete the questionnaires.
Many of the Hispanic participants recruited through the church did not
read English (SPAI n = 10 of 21; BAI, PSWQ, and FQ, n = 19 of 25),
so the questionnaires were orally translated into Spanish for them, but
they wrote their own responses. A $ 10 donation was made to the church
for each questionnaire this group completed.
Data analyses were primarily descriptive. Means, standard devia-
tions, and percentile scores for all measures, including subscales of the
FQ and SPAI, were computed for the complete samples and separately
for three sets of subgroups defined by sex, race, and income. Subgroup
scores were compared using / tests. The income analyses contrasted
those in the lowest 20% of income with those in the upper 80%; partici-
pant selection had been based on quintile quotas to enable the matching
of sample profiles to published census data (U.S. Bureau of the Census,
1990). ECA data (Regier etal., 1990) suggested that low socioeconomic
status is associated with high prevalence of anxiety disorders and that
the difference between the lowest quartile and all other groups is espe-
cially noticeable. Similarly, age analyses contrasted participants age 18-
44 with those age 45-65. One-month prevalence data of any anxiety
disorder was lower in the age brackets 45 and above than among those
18-44 (Regier etal., 1990).
Measures
Fear Questionnaire. The FQ (Marks & Mathews, 1979) includes
three five-item subscales (for agoraphobia, social phobia, and blood/
injury phobia) measuring phobic avoidance. Scores can range from 0
to 40 on each. The Total Phobia score (possible range of 0 to 120) is the
sum of scores on these three subscales. The FQ and its subscales have
high retest reliability (Marks & Mathews, 1979). Arrindell and Buik-
huisen (1992) reported that, in general, the FQ is unaffected by social
desirability response bias.
Beck Anxiety Inventory. The BAI (Beck etal., 1988) consists of 21
items describing anxiety symptoms. Respondents are asked to rate how
much each symptom bothered them during the previous week. Scores
can range from 0 to 63. The BAI was developed to provide improved
discrimination between depression and anxiety, and it has shown better
ability to make that discrimination than other widely used anxiety mea-
sures (Beck et al., 1988). The BAI has shown high short-term retest
reliability and internal consistency (Beck et al., 1988), as well as evi-
dence of concurrent, convergent, and discriminant validity (Beck &
Steer, 1991;Fydrich,Dowdall,&Chambless, 1992).
Penn State Worry Questionnaire. The PSWQ (Meyer et al., 1990)
is a 16-item measure of concerns associated with generalized anxiety
disorder. Scores can range from 16 to 80. Several studies in both clinical
and nonclinical samples have reported high internal consistency, short-
term retest reliability, and convergent and criterion-related validity
(Brown, Antony, & Barlow, 1992; Davey, 1993).
Social Phobia and Anxiety Inventory. The SPAI (Turner et al.,
1
All references to the results of Trull and Hillerbrand (1990) and
Mizes and Crawford (1986) in this article are based on their adult com-
munity samples, not their student samples.
2
Mean scores from nonclinical groups have been reported for the
PSWQ (e.g., Brown, Antony, & Barlow, 1992), the SPAI (Turner,
Beidel, Long, Turner, & Townsley, 1993), and the BAI (e.g., Burgess &
Haaga, 1994), but in each case the samples have been small (N < 40),
unrepresentative (e.g., only university students), or both.
3
A complete table showing the demographic profile of respondents
to each measure in comparison with the 1990 U.S. Census data can be
obtained from David A. F. Haaga.
452 GILLIS, HAAGA, AND FORD

1989) contains 45 items related to somatic symptoms, cognitions, anx- Table 2

iety, and escape or avoidance behaviors associated with social phobia. Percentile Scores for the BAI and the PSWQfor the Complete
The SPAI has two subscales, one for agoraphobia (possible scores range Sample and for Age-Defined Subgroups
from 0 to 78) and one for social phobia (scores ranging from 0 to 192),
and a Total or Difference score obtained by subtracting the Agoraphobia BAI PSWQ
subscale score from the Social Phobia subscale score. Through this pro-
cedure, the Agoraphobia subscale score serves "as a suppressor vari- Percentile All 18-44 45-65 All 18-44 45-65
able" allowing "finer differentiation between these two conditions"
(Turner et al., 1989, p. 37). However, Herbert, Bellack, and Hope 10th 0 0 0 28 29 28
(1991) caution that, in participants with symptoms of both agorapho- 20th 0 0 0 32 32 31
bia and social phobia, using the Difference score may produce false 25th 0 1 0 33 34 32
30th 1 2 0 35 35 33
negatives. 40th 2 3 1 37 39 35
The SPAI has discriminated the socially anxious from other anxiety 50th 3 4 2 41 44 37
groups diagnosed by clinical interviews (Beidel, Turner, Stanley, & 60th 5 6 3 44 46 38
Dancu, 1989; Turner et al., 1989). It has high short-term retest reliabil- 70th 7 9 5 48 49 41
ity (Turner et al., 1989) and good convergent validity with a number 75th 8 10 6 49 50 43
of other measures of social anxiety (Clark et al., 1994; Herbert et al., 80th 10 12 6 51 53 44
1991). 90th 17 19 9 57 60 50

Note. BAI = Beck Anxiety Inventory; PSWQ = Penn State Worry

Results Questionnaire.
Inclusion or exclusion of the church-recruited Hispanic par-
ticipants did not significantly alter results despite the differences
in assessment and sampling procedures. The results reported
Beck Anxiety Inventory
therefore include their data.
For the overall BAI sample (n = 242), the range of scores was
Fear Questionnaire 0-43 (M = 6.6, SD = 8.1). There were no significant sex, race,
The overall sample (n = 242 usable responses) obtained an or income differences on the BAI. However, younger partici-
FQ Total Phobia mean of 28.6 (SD = 18.5, range 0-86). There pants (age 18-44) scored higher (M = 7.3, SD = 8.4) than did
were no significant sex, race, or income differences on the FQ the older subgroup (M = 4.4, SD = 6.3), /(240) = 2.90, p <
and no significant age differences on the Agoraphobia subscale. .01. Percentile scores for the BAI for the complete sample and
Younger participants scored significantly higher (M = 11.4, SD for age-defined subgroups appear in Table 2.
= 6.9) than did participants 45 or older (M = 9.3, SD = 6.2),
t( 240) = 2.10, p < .04, on the Social Phobia subscale. Similarly, Penn State Worry Questionnaire
younger participants scored significantly higher on the Blood/
Injury Phobia subscale (M= \2.\,SD = 8.4 vs. M= 9.3, SD = For the PSWQ, the range of total scores obtained from the
undivided sample (n = 244) was 18-76 (M= 42.2, SD = 11.5).
7.0, respectively), t(240) = 2.40, p < .02, and on Total Phobia
As in the case of the BAI, there were no significant sex, race, or
(M = 30.2, SD = 19.0 vs. M = 24.2, SD = 16.4, respectively),
income effects, but younger participants (M = 43.5, SD= 12.1)
i(240) = 2.07,p < .04. Percentile scores for the overall FQ sam-
significantly exceeded those age 45 and above (M= 38.9, SD =
ple, and for age-defined subgroups on the variables showing sig-
9.0), t(242) = 3.21,p < .01, in PSWQ scores. Percentile scores
nificant age differences, are presented in Table 1.
are presented for the whole sample and for age subgroups in
Table 2.
Table 1
Percentile Scores on the Fear Questionnaire for the Complete Social Phobia and Anxiety Inventory
Sample and for Age-Defined Subgroups
On the SPAI, Social Phobia subscale scores ranged from 0 to
Overall Age 18-44 Age 45-65 175, and Agoraphobia subscale scores ranged from 0 to 76. In
contrast to the other anxiety measures, there were no significant
Percentile AG SP BI TOT SP BI TOT SP BI TOT age differences on the SPAI, but there were several significant
10th 0 2 1 7 2 1 9 1 1 4 subgroup differences relating to other demographic variables.
20th 0 5 5 14 5 5 15 4 3 10 Women (M = 2l.l,SD= 16.8) scored significantly higher than
25th 0 6 5 16 6 5 17 4 4 12 did men (M = 14.9, SD = 10.6) on the Agoraphobia subscale,
30th 1 7 6 18 7 7 18 5 5 14 t(236) = 3.4, p < .01, but sex differences were nonsignificant
40th 3 8 8 21 10 8 24 7 6 19 on the Social Phobia subscale and the Difference score, the main
50th 4 9 10 25 10 10 27 8 7 22
60th 5 11 12 28 12 13 30 9 9 24 uses of the SPAI. Those in the lowest income quintile (M =
70th 7 13 13 34 14 15 36 11 11 28 77.9, SD = 39.1) scored significantly higher than did others (M
75th 8 15 15 37 15 16 38 13 12 31 = 63.0, SD = 32.6) on the Social Phobia subscale, r(230) = 2.3,
80th 10 16 17 42 16 18 43 14 13 34 p < .01. Likewise, Difference scores were significantly higher for
90th 16 20 22 53 21 24 55 18 18 49 the lowest-income participants (M = 57.6, SD = 31.5) than for
Note. AG = Agoraphobia subscale; SP = Social Phobia subscale; BI = those in the highest 80% of the income distribution (M = 45.5,
Blood/Injury Phobia subscale; TOT = Total Phobia score. SD = 27.9), f(230) = 2.3,p < .01.
 NORMATIVE VALUES FOR ANXIETY MEASURES 453

Table 3 Discussion
Percentile Scores on the SPAIfor the Complete Sample, for
This study provides normative data for the BAI, PSWQ, FQ,
Blacks, and for Caucasians and SPAI. The results can facilitate assessment of the clinical
Overall Blacks Caucasians significance of treatment effects. Technical details on the com-
putation of clinical significance may be found elsewhere
Percentile SP AG DIP SP AG DIP SP AG DIP (Jacobson & Truax, 1991; see also Hsu, 1989, and Speer, 1992,
11 for suggested alternative means of evaluating the statistical reli-
10th 19 3 10 12 0 6 23 3
20th 35 6 21 17 1 14 38 7 24 ability of change; Jacobson & Revenstorf, 1988, on consider-
25th 40 8 26 34 4 15 44 8 33 ation of multiple outcome measures; and Nietzel & Trull, 1988,
30th 46 9 31 37 7 16 47 9 36 for an approach based on group average data rather than indi-
40th 55 12 39 44 13 28 57 11 43 vidual patients). In this discussion we concern ourselves with
50th 63 14 46 48 16 30 68 13 49
60th 73 18 53 55 18 32 76 16 57 the prior questions of whether the norms from this study may
70th 83 21 62 60 22 37 85 20 65 be depended on, and if so, which ones.
75th 91 23 67 69 25 42 92 22 68
80th 96 26 70 71 27 47 97 24 73
90th 114 37 87 89 35 64 115 34 88 Are the Present Norms Dependable?
Strengths of this study include adequate sample size and a
Note. SPAI = Social Phobia and Anxiety Inventory; SP = Social Pho-
bia subscale; AG = Agoraphobia subscale; DIP = Difference score (SP close match with the 1990 U.S. census on demographic vari-
minus AG). ables. Accordingly, we believe that treatment researchers work-
ing with adult (nonelderly) samples could reasonably evaluate
the clinical significance of their findings in terms of, for exam-
ple, the proportion of patients reaching the median score from
Caucasians (M= 68.1, SD = 34.7) scored significantly higher our sample by the end of treatment.
than did Blacks4 (M = 50.4, SD = 29.5) on the Social Phobia However, several limitations of the study should be noted.
subscale, i(208) = 2.6, p < .01, and on the Difference score First, we were unable to execute the original sampling plan
(Caucasian M= 50.8, SD = 29.1; Black M= 32.6, SD = 21.5), mall intercepts onlybecause of the paucity of Hispanic and
f(208) = 3.2, p < .01. The race difference is in the opposite lower income participants recruited in this manner. The
direction to what would be expected on the basis of EGA data. church-recruited Hispanic participants, for instance, differed
In the SPAI sample, however, mean income of Blacks exceeded from other participants in recruitment method, incentive for
that of Caucasians by $4,000. The NCS (Kessler et al., 1994) participation, and in some cases, the procedure for administer-
found that anxiety disorders were significantly associated with ing measures (i.e., oral administration of Spanish translations
low income but not with race. Therefore, the race differences of the scales).
we obtained may well have been artifacts of the income differ- More generally, matching the U.S. demographic profile for
ences on the SPAI. nonelderly adults does not ensure a representative sample in the
Percentile scores for the SPAI are presented for the entire way that random sampling (and a 100% response rate among
sample and for Blacks and Caucasians separately in Table 3; those selected) would. For instance, only one metropolitan area
scores for the lowest income quintile and the upper 80% of the was sampled, from the Northeast, which showed the highest
income distribution are shown separately in Table 4. prevalence of anxiety disorders among U.S. regions in the NCS
(Kessler et al., 1994). Tending to bias the results in the opposite
direction, most participants were recruited at sites likely to be
Table 4 avoided by agoraphobics, and the screening interview was a sit-
Percentile Scores on the SPAIfor Income-Defined Subgroups uation that the more socially phobic potential participants
might avoid.
Lowest 20% income Upper 80% income One way to evaluate the dependability of our data is to com-
pare them with past findings. We obtained a sex difference only
Percentile SP AG DIP SP AG DIP
on the SPAI Agoraphobia subscale, whereas prior research sug-
10th 24 2 16 16 2 8 gests a higher prevalence of anxiety disorders among women
20th 44 6 30 32 6 18 than men (e.g., Kessler et al., 1994), as well as higher anxiety
25th 48 9 33 37 8 23 symptom scores for women in both clinical (e.g., Hewitt & Nor-
30th 57 10 37 43 8 28
40th 71
ton, 1993) and nonclinical (e.g., De Beurs, Van Dyck, Van Bal-
12 48 50 11 37
50th 74 15 56 62 14 46 kom, Lange, & Koele, 1994; Trull & Hillerbrand, 1990) sam-
60th 81 21 62 71 17 52 ples. The finding here is not unique, however, as Mizes and
70th 98 23 68 81 21 60 Crawford (1986) also found no significant differences between
75th 100 25 74 88 22 66 men and women on the FQ in their nonstudent community
80th 113 32 82 94 25 70
90th 139 49 104 105 35 84 sample. Moreover, we found age differences on several mea-

Note. SPAI = Social Phobia and Anxiety Inventory; SP = Social Pho-

4
bia subscale; AG = Agoraphobia subscale; DIP = Difference score (SP We are using the term Black rather than African American to take
minus AG). into account the presence of a few non-American participants.
454 GILLIS, HAAGA, AND FORD
sures, with participants aged 18-44 years being more anxious
than those 45-65. These results are consistent with the 1 -month
prevalence rates for any anxiety disorder from the EGA (Regier
et al., 1990) and are broadly consistent with the inverse relation
of age with 12-month prevalence of anxiety disorders in the
NCS (Kessler et al., 1994), though the NCS used different age
categories and a younger overall age range (15-54) than our
study.
The two earlier normative studies of the FQ also provide
points of comparison. Our FQ Total Phobia mean of 28.6 falls
between that of Trull and Hillerbrand (1990; 40.4) and that
of Mizes and Crawford (1986; 22.0). Trends were similar on
subscale scores. As discussed earlier, the studies differ in loca-
tion, recruitment method, screening procedures, and sample
demographics, so it is difficult to explain the score differences
conclusively. One possibility is that there is nothing substantive
to explain; our results are within the 90% confidence intervals
for both of the earlier studies. The differences may be the result
of normal sampling error in a population with high variance.
This possibility underscores the need for replication of our re-
sults, which are novel for the BAI, PSWQ, and SPAI.
Which Norm or Norms Should Be Used?
Provided that one concludes that the present results can be
used to interpret treatment outcome results, the next question
is whether a treated patient should be compared to our overall
sample or to a subgroup when significant subgroup differences
exist. It is sometimes stated without qualification that individu-
als should be compared to their own demographic subgroup
when subgroup scores differ (e.g., Mizes & Crawford, 1986),
but we believe that this issue merits further debate. One com-
plication in using subgroup norms as reference points is how to
decide which, or which combination, of the multiple subgroups
to which a person belongs (one's race, socioeconomic status,
sex, age, extraversion level, etc.) is relevant (Hayes & Haas,
1988).
Even if there were just one known subgroup difference to con-
sider, it is not necessarily the case that treatment effects are best
judged by referring to subgroup norms. For example, the lowest
income group exceeded others in social phobia symptoms as
measured by the SPAI. However, taking into consideration the
possibility that social anxiety might hamper job searching or
job performance, it seems plausible that a low-income patient
(and his or her therapist) might prefer to peg improvement cri-
teria to the norms of the total population rather than the more
lenient standard of the norms of the lowest income group. Such
decisions may rest on the individual circumstances of patients
and the goals they set in collaboration with their therapists.
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Received August 1,1994
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Accepted February 6,1995

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