Abstract
Introduction
Intrusive thoughts may cause a significant level of distress, since some individuals evaluate the content of those thoughts as aversive. Suppression of intrusive thoughts is one of the strategies adopted by these individuals, which increases the level of distress. Suppression of thoughts may be present as one of the factors that maintain different psychological disorders.
Objective
To describe the translation and adaptation into Brazilian Portuguese of the White Bear Suppression Inventory (WBSI), which measures thought suppression.
Methods
Three translations and back-translations were conducted by independent evaluators. Semantic equivalence was assessed and the three versions were evaluated to produce a synthesized version. Comments from participants on the preliminary version of the questionnaire were examined.
Results
We developed a preliminary Brazilian Portuguese version of the WBSI. It was found that most participants understood the descriptions of cognitions given in the translated questionnaire.
Conclusion
The use of three different versions of translations and back-translations, discussion of the synthetic version and interaction with the target population have conferred viability to the process of semantic equivalence of the Brazilian Portuguese final version of the WBSI.
Keywords
Thought suppression; cross-cultural adaptation; semantic equivalence
Resumo
Introdução
Pensamentos intrusivos podem causar um nível significativo de desconforto, uma vez que alguns indivíduos avaliam o conteúdo desses pensamentos como aversivos. A supressão dos pensamentos intrusivos é uma das estratégias adotadas por esses indivíduos, resultando no aumento do nível de desconforto. Supressão de pensamentos pode estar presente como um dos fatores de manutenção de diferentes transtornos psicológicos.
Objetivos
Descrever a tradução e adaptação para o português brasileiro do White Bear Suppression Inventory (WBSI), que avalia a supressão de pensamentos.
Métodos
Três traduções e retrotraduções foram conduzidas por avaliadores independentes. A equivalência semântica foi analisada e as três versões foram avaliadas para produzir uma versão preliminar. Os comentários dos participantes sobre a versão preliminar do questionário foram examinados.
Resultados
Foi desenvolvida uma versão final em português brasileiro do WBSI. Verificou-se que a maioria dos participantes entendeu as descrições das cognições apresentadas no questionário traduzido.
Conclusão
O uso de três versões diferentes de traduções e retrotraduções, discussão da versão preliminar e interação com a população-alvo conferiu viabilidade ao processo de equivalência semântica da versão final brasileira da WBSI.
Descritores
supressão de pensamentos; adaptação transcultural; equivalência semântica
Introduction
Intrusive thoughts are common in the daily lives of most people. It is estimated that these thoughts are present in 80-99% of the general population.11. Zucker BG, Craske MG, Barrios V, Holguin M. Thought action fusion: can it be corrected? Behav Res Ther. 2002;40:653-64. Some individuals evaluate the content of such thoughts as aversive, and attribute some kind of meaning to them, which results in considerable distress. The attempt to suppress these thoughts is one of the possible strategies adopted by these individuals to decrease the level of associated distress.22. Magee JC, Harden KP, Teachman BA. Psychopathology and thought suppression: a quantitative review. Clin Psychol Rev. 2012;32:189-201. Nevertheless, the suppression of these thoughts may actually result in an increase in their frequency.33. Wegner DM, Schneider DJ, Carter SR, White TL. Paradoxical effects of thought suppression. J Pers Soc Psychol. 1987;53:5-13.,44. Abramowitz JS, Tolin DF, Street GP. Paradoxical effects of thought suppression: a meta-analysis of controlled studies. Clin Psychol Rev. 2001;21:683-703.
Wegner et al.33. Wegner DM, Schneider DJ, Carter SR, White TL. Paradoxical effects of thought suppression. J Pers Soc Psychol. 1987;53:5-13. conducted an experiment to understand the effects and processes of the suppression of thoughts. First, participants were instructed to report everything that came to their mind. Then, they were told to continue with the task, but warned that they could not think about a white bear. If they did, it should be signaled by ringing a bell. In general, the participants failed to suppress the thoughts of the white bear, which were signaled multiple times. The experiment by Wegner et al.33. Wegner DM, Schneider DJ, Carter SR, White TL. Paradoxical effects of thought suppression. J Pers Soc Psychol. 1987;53:5-13. showed that suppressing thoughts may be successful initially but also produces paradoxical effects by increasing the frequency of these thoughts, resulting in a subsequent rebound effect. Recent studies indicate that thought suppression can be found in different psychological conditions, such as depressive disorder, generalized anxiety disorder, panic disorder, addictive behaviors, and it can also be a predictor of obsessive-compulsive disorder.22. Magee JC, Harden KP, Teachman BA. Psychopathology and thought suppression: a quantitative review. Clin Psychol Rev. 2012;32:189-201.,44. Abramowitz JS, Tolin DF, Street GP. Paradoxical effects of thought suppression: a meta-analysis of controlled studies. Clin Psychol Rev. 2001;21:683-703.
5. Fehm L, Margraf J. Thought suppression: specificity in agoraphobia versus broad impairment in social phobia? Behav Res Ther. 2002;40:57-66.-66. Moss AC, Erskine JA, Albery IP, Allen JR, Georgiou GJ. To suppress, or not to suppress? That is repression: controlling intrusive thoughts in addictive behaviour. Addict Behav, 2015;44:65-70.
Wegner & Zanakos77. Wegner DM, Zanakos S. Chronic thought suppression. J Pers. 1994;62:615-40. developed an instrument, the White Bear Suppression Inventory (WBSI), to examine associations between thought suppression and other measures, as well as to determine whether suppression of thoughts can be understood as a broad risk factor for certain psychological conditions. The WBSI is a Likerttype measurement scale containing 15 items that aim to evaluate the incidence of suppression of thoughts.
The stages of translation and adaptation of the WBSI to the Brazilian Portuguese language are presented in this work. The study aimed to translate and evaluate the semantic equivalence of the WBSI, conducting a pilot study in a Brazilian population sample with different educational levels. Thereby, we sought to develop a preliminary version adapted from the WBSI that can be validated at a later time. A second goal was to evaluate whether the WBSI is applicable to individuals from different educational backgrounds.
Methods
It is recommended that the cross-cultural adaptation process balance literal translation components from one language to the other and that the adaptation process take into account the cultural context and lifestyle of the target population of the version being developed.88. Reichenheim ME, Moraes CL. Operacionalização de adaptação transcultural de instrumentos de aferição usados em epidemiologia. Rev Saude Publica. 2007;41:665-73. In order to do so, the semantic equivalence process – as described by Reichenheim & Moraes88. Reichenheim ME, Moraes CL. Operacionalização de adaptação transcultural de instrumentos de aferição usados em epidemiologia. Rev Saude Publica. 2007;41:665-73. – was used, as it is one of the main steps for the evaluation of cross-cultural equivalence of measurement instruments. This process attempts to use a language that is adapted to the target population.99. Herdman M, Fox-Rushby J, Badia X. A model of equivalence in the cultural adaptation of HRQoL instruments: the universalist approach. Qual Life Res. 1998;7:323-35.
The process of cross-cultural adaptation occurred in four steps: 1) translation process; 2) back-translation; 3) evaluation of the semantic equivalence of the preliminary Brazilian version; and finally 4) pilot study in which 21 participants from different educational levels were invited a) to fill out the translated and adapted questionnaire, and b) to indicate whether they had faced any difficulty filling it out or whether they had any suggestion to improve the clarity of the items. In step 1, two psychologists and one psychology undergraduate student, all native Brazilians who spoke English as a foreign language, independently translated the original instrument in English into Brazilian Portuguese. Each of the collaborators had studied English to an advanced level. The translators were blind to each other. However, these professionals were chosen because they were familiar with the constructs used in the instrument. They were asked to pay attention to the semantic consistency of the terms and the elaboration of sentences.
In the second step, back-translations into English from a preliminarily translated version were made independently and without knowledge of the original scale by a psychologist, a psychology undergraduate student and an economist, all Brazilians and bilingual in English and Portuguese. In step 3, semantic equivalence evaluation was made by the authors of this study, and the Brazilian Portuguese version was improved based on the three translations and back-translations developed and the comparison with the original instrument. To compose the Brazilian Portuguese version of the questionnaire, the items were incorporated from one of the three versions and may have been minimally modified in order to find the best combination of criteria for semantic equivalence.
After the development of the preliminary Brazilian Portuguese version of the WBSI, step 4 consisted of a pilot study with 21 adult participants, who signed a free and informed consent form and were selected from a convenience sample (Table 1) at the Praia Vermelha Campus of Universidade Federal do Rio de Janeiro.
Participants were requested to a) examine the questionnaire and b) report whether each item was clear enough and/or whether they had any suggestions to improve the understanding of the instrument. Participants commented on the preliminary version of the questionnaire pointing out the difficulties for understanding, or agreeing fully with that version. Considering these suggestions, the final Brazilian version of the WBSI was developed.
Results and discussion
The original instrument in English, the translations (T1, T2 and T3), respective back-translations (R1, R2 and R3) and the preliminary version in Brazilian Portuguese are presented in Table 2.
Original version, translations, back-translations and preliminary version of the White Bear Suppression Inventory (WBSI)
The versions revised by the translators coincided with each other in items 5, 12 and 13. Item 15 presented the most significant difference among them, due to a translation error of the word “intruding,” which was translated as “entretidos” (which means “entertained”) by the third translator. The other items showed small differences, which were considered not to alter the overall meaning of the sentences.
Regarding the back-translations, items 10 and 13 coincided with each other. Only item 15 presented a significant difference, due to the above mentioned translation error. The remaining items had similar back-translations, without any interference in their meaning.
Comparing the translations with the original version, only item 15 obtained non-congruent versions regarding the meaning of the terms. It should be noted that in item 9, where the expression “keep jumping” appears, a literal translation – “pulando” (which means “jumping”) – and also an expression closer to the Brazilian Portuguese language – “pipocando” (which means “popping”) – were suggested. Nevertheless, these two terms do not diverge in terms of meaning equivalence of the expressions in both languages. As for the comparison of the back-translations with the original version, only item 15 presented a discrepancy due to the misunderstanding in the translation of one of its terms. The other items did not present differences in the overall meaning of the sentences.
All the items incorporated in the preliminary version coincided with at least one of the three translation versions. In cases of different words that had the same meaning in the Brazilian Portuguese translations, the authors chose to keep the option that was closest to the literal translation of the original version. Thus, in the preliminary Brazilian Portuguese version of the WBSI, in items 4, 7, 8 and 10, the choice for the final translation was due to closeness to the literal meaning of the sentence in the translation from English to Brazilian Portuguese, as there was no semantic divergence between the options used for translation. In item 9, as mentioned above, the choice for “existem pensamentos que vivem ‘pipocando’ em minha cabeça” was due to the judgment that this expression would be more intelligible and usual than “existem pensamentos que vivem pulando em minha cabeça”, due to the fact that the expression “keep jumping” in the English language resembles the Brazilian Portuguese expression “pipocar” (“popping”).
The purpose of this pilot study was to test the comprehensiveness of the preliminary version and to verify the need for possible modifications in any word or sentence that could hinder comprehension. The ultimate goal was to test the possibility of using the questionnaire with a wide range of individuals, with cultural differences and in different educational contexts.
Participants reported that the questionnaire presented was easy to understand, but some suggestions were given. In item 3, four female participants with higher education degrees and one male participant with high school degree reported that the sentence “tenho pensamentos dos quais eu não consigo parar” seemed a bit confusing, even though they understood its meaning. They suggested “tenho pensamentos dos quais não deixo de pensar,” “tenho pensamentos dos quais eu não consigo parar de ter,” “tenho pensamentos dos quais eu não consigo evitar,” “tenho pensamentos dos quais eu não consigo me livrar,” “tenho pensamentos dos quais eu não consigo interromper.” Due to the recurring feedback, the suggestions given were considered in the development of the final version (Table 3) of the WBSI in Brazilian Portuguese. Therefore, the choice of “tenho pensamentos dos quais eu não consigo interromper” for the final version is justified due to the greater approximation of this version to the literal sense of the phrase in the translation from English to Brazilian Portuguese.
Item 5 (“meus pensamentos frequentemente retornam a uma ideia”) also received feedback from three female and two male participants with higher education degrees, for the same reasons as in item 3. Four of these participants suggested that “meus pensamentos frequentemente retornam a uma mesma ideia” would be easier to understand. For this reason, this was chosen as the final version.
A female participant with higher education degree commented that, in item 4, the term “apagar” (which means “erase”) could be replaced with “esquecer” (which means “forget”), but the authors decided to maintain the item unchanged, respecting the option that was closest to the original.
In item 9, two participants, both with higher education degrees, suggested changing the term “pipocando” to “brotando” and “surgindo”. Also in this case, the authors chose to keep the item unchanged, respecting the translation option that was closest to the original.
Thus, in the final version of the WBSI, changes were made only to items 3 and 5, according to feedback from the participants, as presented in Table 3. The other items remained unchanged.
Conclusion
The translation and cross-cultural adaptation process of the WBSI was compatible with the current recommendations in the literature. Its final Brazilian Portuguese version was obtained through a careful process of translation and back-translation, study of semantic equivalence and a pilot study for evaluation of the understanding and clarity of the items in the questionnaire. It was verified that the participants understood the descriptions of the cognitions exposed in the Brazilian Portuguese questionnaire. Then, final adjustments were made based on their feedbacks. Thus, this version seems to be adequate in relation to the process of semantic equivalence and may be applicable to individuals of different educational levels, as observed in the sample.
It is important to emphasize that for a research instrument to be used, it must be valid and reliable, as well as sensitive and specific. The processes of cross-cultural adaptation and semantic equivalence are fundamental for the validation of a questionnaire, but they are only the initial stage. Future studies should test the factorial structure and consistency of the Brazilian Portuguese version of the WBSI here presented and evaluate its convergent and divergent validity.
References
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1Zucker BG, Craske MG, Barrios V, Holguin M. Thought action fusion: can it be corrected? Behav Res Ther. 2002;40:653-64.
-
2Magee JC, Harden KP, Teachman BA. Psychopathology and thought suppression: a quantitative review. Clin Psychol Rev. 2012;32:189-201.
-
3Wegner DM, Schneider DJ, Carter SR, White TL. Paradoxical effects of thought suppression. J Pers Soc Psychol. 1987;53:5-13.
-
4Abramowitz JS, Tolin DF, Street GP. Paradoxical effects of thought suppression: a meta-analysis of controlled studies. Clin Psychol Rev. 2001;21:683-703.
-
5Fehm L, Margraf J. Thought suppression: specificity in agoraphobia versus broad impairment in social phobia? Behav Res Ther. 2002;40:57-66.
-
6Moss AC, Erskine JA, Albery IP, Allen JR, Georgiou GJ. To suppress, or not to suppress? That is repression: controlling intrusive thoughts in addictive behaviour. Addict Behav, 2015;44:65-70.
-
7Wegner DM, Zanakos S. Chronic thought suppression. J Pers. 1994;62:615-40.
-
8Reichenheim ME, Moraes CL. Operacionalização de adaptação transcultural de instrumentos de aferição usados em epidemiologia. Rev Saude Publica. 2007;41:665-73.
-
9Herdman M, Fox-Rushby J, Badia X. A model of equivalence in the cultural adaptation of HRQoL instruments: the universalist approach. Qual Life Res. 1998;7:323-35.
Publication Dates
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Publication in this collection
Jan-Mar 2018
History
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Received
28 June 2017 -
Accepted
15 Nov 2017
