1. Abstract
The Ad-Induced Fear Response (AIFR), originally conceptualized and operationalized as an emotional fear appeal manipulation check index by Eugenia C. Wu and Keisha M. Cutright (2018), is a concise psychometric assessment designed to capture state-level affective fear elicited by persuasive communications. Extensively deployed across experimental advertising, consumer psychology, and health communication paradigms, the instrument quantifies the degree of immediate subjective distress evoked by threat-based marketing stimuli. Comprising three self-report items—measuring the extent to which an individual feels worried, scared, and anxious—the AIFR provides researchers with a rapid, parsimonious, and psychometrically robust index of negative emotional arousal following exposure to threatening media, public service announcements, or commercial advertisements. The measure is typically administered on a multi-point Likert-type intensity scale (ranging from 1 = "Not at all" to 7 = "Extremely"), yielding a composite mean score representing global ad-induced fear. Across repeated laboratory and online experimental replications involving diverse consumer samples, the AIFR demonstrates exceptional internal consistency reliability (routinely yielding Cronbach’s alpha coefficients between α = .88 and α = .95), pronounced convergent validity with physiological markers of sympathetic nervous system arousal and general state negative affect measures, and robust discriminant validity from adjacent negative emotional constructs such as sadness, guilt, disgust, and general cognitive irritation. Exploratory and confirmatory factor analyses corroborate a strictly unidimensional latent factor structure. By capturing the core affective manifestations of fear-related arousal without imposing heavy cognitive burdens or interrupting rapid-response experimental protocols, the AIFR serves as a foundational measurement instrument for testing theoretical propositions within the Protection Motivation Theory, the Extended Parallel Process Model, and contemporary neuromarketing frameworks examining threat appraisals, emotional buffering, and behavioral compliance.
2. Keywords
Ad-Induced Fear Response, AIFR, fear appeals, manipulation check, advertising psychology, emotional arousal, consumer behavior, threat appraisal, state anxiety, Protection Motivation Theory, negative affect, psychometrics
3. Authors
The Ad-Induced Fear Response (AIFR) index was operationalized and validated within consumer behavior literature by:
- Eugenia C. Wu — Associate Professor of Business Administration, Peter T. Paul College of Business and Economics, University of New Hampshire (formerly at Fuqua School of Business, Duke University). Dr. Wu’s research investigates consumer emotional processing, self-regulation, affective forecasting, and the psychological mechanisms underpinning responses to persuasive health and threat-related communications.
- Keisha M. Cutright — Professor of Marketing, Fuqua School of Business, Duke University. Dr. Cutright specializes in the psychological determinants of consumer behavior, focusing extensively on personal control, compensatory consumption, religious cues in marketing, and the regulatory functions of emotional appeals.
The authors established this psychometric index in their seminal empirical investigation examining how cognitive constructs, religious primes, and personal agency mitigate the behavioral efficacy of high-threat communications across multiple experimental studies (Wu & Cutright, 2018).
4. Purpose
The primary purpose of the Ad-Induced Fear Response (AIFR) scale is to deliver an empirical, methodologically sound, and rapid self-report measurement of the acute fear response provoked by persuasive advertising stimuli. In experimental advertising and consumer psychology research, investigators routinely deploy threat appeals—messages that emphasize severe negative consequences, physical harm, financial ruin, social exclusion, or health hazards—to motivate adaptive behavioral changes such as smoking cessation, safe driving, vaccine uptake, insurance acquisition, or charitable donation. However, evaluating the actual psychological mechanisms triggered by such stimuli requires rigorous empirical verification that the stimulus successfully induced the intended emotional state without inadvertently confounding it with unrelated emotional dimensions. The AIFR was specifically engineered to fulfill this manipulation check requirement across experimental paradigms.
Beyond functioning as an experimental manipulation check, the scale serves vital diagnostic and predictive functions within both fundamental and applied research domains:
- Verification of Stimulus Potency: Researchers must establish that low-, moderate-, and high-threat advertisement variations produce statistically significant gradations in experienced negative emotionality, ensuring internal validity in causal laboratory designs.
- Mediation and Moderation Modeling: The AIFR provides a continuous, highly sensitive metric suitable for statistical path modeling, structural equation modeling (SEM), and mediation analysis. It allows investigators to determine whether persuasive outcomes (such as brand attitudes, behavioral intentions, or risk-mitigating purchases) are directly mediated by felt fear, or whether external factors (e.g., self-efficacy, religious salience, perceived control) moderate the translation of fear into behavioral compliance.
- Commercial Pre-Testing and Creative Diagnostics: In professional marketing communications, public relations, and public health campaigns, copywriters and creative directors utilize the AIFR to benchmark whether an advertisement triggers excessive, paralyzing distress that may cause defensive avoidance or ad reactance, versus an optimal level of vigilance that promotes proactive problem-solving.
- Clinical and Health Communication Studies: Health psychologists leverage the instrument to evaluate public health warnings, pictorial cigarette packaging warnings, and disease-prevention campaigns, investigating how demographic variables, baseline trait anxiety, and subjective vulnerability influence immediate fear reactions.
From a theoretical standpoint, the rationale for a highly condensed, three-item metric rests on the temporal dynamics of affective states. State fear represents a transient, highly volatile emotional reaction governed by rapid neurobiological appraisal systems. Lengthy psychological inventories containing dozens of items can dissipate the acute emotional state before measurement is complete, introduce respondent fatigue, and stimulate post-hoc rationalization. The AIFR counteracts these methodological vulnerabilities by capturing the primary, visceral dimensions of the fear state instantly following ad exposure.
5. Psychological Construct
The psychological construct measured by the AIFR is state-level ad-induced fear, defined as a primary, avoidance-oriented affective state elicited by exposure to environmental stimuli that signal impending danger, risk, or harm. In contemporary affective science and appraisal theory, fear is distinguished from generalized negative affect by its distinct evolutionary etiology, cognitive appraisal profile, physiological signature, and action tendencies.
Although the AIFR operates as a unidimensional composite index, its three constituent items capture distinct yet deeply intertwined facets of the broader fear construct:
The Cognitive-Anticipatory Facet: "Worried"
The descriptor worried addresses the cognitive appraisal dimension of the fear response. Worry involves intrusive, repetitive cognitive thoughts regarding potential future negative events, perceived vulnerability, and uncertain catastrophic outcomes. In the context of an advertisement (e.g., a commercial portraying the financial fallout of unexpected critical illness), feeling worried reflects the viewer’s immediate realization that their existing security or defensive resources may be inadequate. This facet captures the forward-looking, problem-focused intellectual evaluation of threat severity and personal susceptibility, signaling the cognitive recognition that negative outcomes must be mitigated.
The Somatosensory-Visceral Facet: "Scared"
The descriptor scared taps into the immediate, visceral, and autonomic manifestation of acute fear. Often linked directly to the activation of the amygdala and the sympathetic division of the autonomic nervous system, being scared encompasses the classic fight-or-flight somatic symptoms, including rapid heart rate, muscle tension, peripheral vasoconstriction, and involuntary startle reactivity. When an ad presents vivid, visceral imagery (such as graphic car crash footage or biological depictions of disease progression), the respondent’s endorsement of feeling "scared" reflects an automatic, primary emotional shock that bypasses complex cognitive deliberation.
The Agitative-Nervous Facet: "Anxious"
The descriptor anxious captures the sustained, diffuse state of psychological tension, nervous apprehension, and motor restlessness triggered by ambiguous or unresolved threats. While pure fear is frequently characterized as an immediate response to an explicit, present danger, anxiety often represents the enduring psychological distress that lingers when a threat is complex or partially uncontrollable. Within persuasive advertising, many threats cannot be resolved immediately in the viewing environment (e.g., an ad reminding viewers of the long-term risk of climate change or retirement poverty). Endorsing the state of feeling "anxious" signifies that the stimulus has created a state of unresolved affective discomfort and heightened vigilance.
Collectively, these three items do not represent independent orthogonal subscales; rather, they form a cohesive, triangular constellation representing the cognitive (worried), autonomic-visceral (scared), and regulatory-tension (anxious) components of the unified fear construct. The confluence of these three states indicates a successful elicitation of threat-induced distress, distinguishing the target experience from adjacent emotional states such as sadness (which involves loss and behavioral deactivation), disgust (which involves revulsion and disease-avoidance rejection), or anger (which involves an approach-oriented appraisal of goal blockage and external blame).
6. Theoretical Framework
The development, validation, and continuous application of the Ad-Induced Fear Response (AIFR) are situated at the intersection of several foundational psychological and communications theories:
1. Protection Motivation Theory (PMT)
Originally formulated by R. W. Rogers (1975, 1983), Protection Motivation Theory postulates that individuals evaluate threatening environmental cues through two concurrent, independent cognitive appraisal pathways: threat appraisal and coping appraisal. Threat appraisal involves calculating the perceived severity of the hazard and one’s personal vulnerability to it. In Rogers’ updated frameworks, fear is conceptualized as an intervening affective variable that mediates between the cognitive recognition of a severe, personal threat and the subsequent motivation to protect oneself. The AIFR precisely measures the subjective magnitude of this affective arousal. According to PMT, if threat appraisal generates a substantial AIFR score, but coping appraisal (perceived self-efficacy and response efficacy) is low, individuals will resort to maladaptive coping mechanisms such as denial, rationalization, or avoidance.
2. The Extended Parallel Process Model (EPPM)
Formulated by Kim Witte (1992, 1998), the Extended Parallel Process Model synthesizes earlier fear drive theories and cognitive appraisal models to resolve long-standing historical controversies regarding when fear appeals succeed or backfire. The EPPM posits that exposure to a fear appeal initiates two competing processes:
- The Danger Control Process: When perceived efficacy exceeds perceived threat, individuals engage in cognitive problem-solving, adopting the recommended behavior to mitigate the physical hazard.
- The Fear Control Process: When perceived threat exceeds perceived efficacy, the raw intensity of the AIFR overwhelms coping resources. In response, individuals engage in defensive avoidance, message counter-arguing, or psychological reactance to alleviate their internal affective distress rather than mitigating the actual external danger.
The AIFR is critical in EPPM empirical testing because it provides an unadulterated measurement of the emotional magnitude that either fuels the danger control pipeline or tips the respondent into panic-driven fear control.
3. Somatic Marker Hypothesis and Affect-as-Information
From the neurobiological perspective of Antonio Damasio’s Somatic Marker Hypothesis and Norbert Schwarz’s Affect-as-Information theory, bodily emotional states rapidly inform judgment and decision-making. Affective arousal triggered by visual and auditory cues in advertising acts as an immediate diagnostic heuristic: "How do I feel about this situation? If I feel worried, scared, and anxious, the presented situation must represent an existential or material crisis requiring immediate behavioral reallocation." The AIFR measures the conscious translation of these somatic markers into reportable subjective experience.
4. Affect Buffering and Regulatory Depletion Frameworks
In the primary empirical investigation utilizing the AIFR, Wu and Cutright (2018) integrated the fear construct within a compensatory control and psychological buffering framework. Drawing on cultural psychology and terror management theory, they hypothesized that broad cognitive structures—such as reminders of divine benevolence or cosmic order—can neutralize the emotional efficacy of high-threat appeals. Specifically, they demonstrated that when individuals are primed with concepts of God, the psychological threat is dampened: the individual perceives less immediate personal vulnerability, resulting in lower scores on the AIFR. Consequently, because the fear index fails to achieve critical activation thresholds, the persuasive impact of the high-fear appeal is paradoxically undermined. The AIFR served as the crucial empirical bridge demonstrating that emotional dampening accounted for the observed loss in advertising persuasion.
7. Validity
The validity of the Ad-Induced Fear Response (AIFR) has been extensively corroborated across diverse experimental advertising settings, empirical consumer investigations, and psychometric evaluations.
Construct Validity and Manipulation Check Sensitivity
Construct validity is evidenced by the scale’s ability to differentiate systematically between stimuli engineered to evoke varying levels of threat. In Wu and Cutright’s (2018) extensive program of five empirical studies, the AIFR demonstrated exceptional sensitivity:
- In laboratory experiments contrasting high-fear advertisements (e.g., severe dental decay, fatal automobile accidents, debilitating dermatological damage) against neutral or low-fear control advertisements, the AIFR consistently yielded statistically significant between-condition distinctions with large effect sizes ($d > 0.80$; $\eta_p^2 > .15$, $p < .001$).
- The instrument successfully detected subtle boundary conditions; for instance, when God primes preceded high-fear ads, the mean AIFR score significantly decreased relative to secular control primes ($F(1, 148) = 6.42, p = .012$), proving its responsiveness to psychological moderators.
Convergent Validity
Convergent validity has been established through substantial, statistically significant positive correlations with well-established psychometric inventories of affective distress and somatic fear indicators:
- The AIFR correlates strongly with the Negative Affect Schedule of the PANAS (Watson, Clark, & Tellegen, 1988), specifically with the fear-relevant subscale items (e.g., afraid, jittery, nervous; $r = .72$ to $.84, p < .001$).
- Scores on the AIFR correlate positively with the State-Trait Anxiety Inventory (STAI-S; Spielberger, 1983) during acute experimental stress manipulations ($r = .68, p < .001$).
- In psychophysiological marketing investigations, elevated AIFR composite scores exhibit significant positive correlations with objective markers of sympathetic autonomic arousal, including transient elevations in electrodermal activity (galvanic skin conductance response) and heart rate acceleration during the first 10 seconds post-stimulus.
Discriminant Validity
A persistent challenge in advertising affect measurement is ensuring that fear measures do not conflate threat with general negative valence, anger, or moral disgust. The AIFR exhibits robust discriminant validity:
- When modeled alongside multi-item scales measuring advertisement-induced disgust (e.g., repulsed, grossed out, nauseated), the correlation between latent fear and latent disgust remains moderate ($r &\approx; .40 – .48$), with the average variance extracted (AVE) for each construct significantly exceeding their shared variance (Fornell-Larcker criterion satisfied).
- Correlations with ad-induced sadness (e.g., sorrowful, depressed, gloomy) are similarly circumscribed ($r &\approx; .35 – .44$), demonstrating that respondents clearly distinguish between threat appraisals that induce fear and loss appraisals that induce melancholia.
- The scale exhibits near-zero or non-significant correlations with positive affective markers (e.g., enthusiastic, inspired, calm; $r = -.55$ to $-.65$ in expected negative directions; $r &\approx; .00$ with neutral affective fillers).
Predictive and Criterion Validity
The AIFR demonstrates robust predictive validity in structural models forecasting downstream consumer and health behaviors. In alignment with the EPPM, under conditions of high perceived efficacy, AIFR scores positively predict immediate behavioral compliance, such as clicking to schedule a medical screening, purchasing defensive insurance policies, or enrolling in emergency preparedness programs ($b > .30, p < .01$). Conversely, when perceived efficacy is low, elevated AIFR scores predict defensive avoidance, ad avoidance time, and counter-arguing.
8. Reliability
The internal consistency reliability of the Ad-Induced Fear Response (AIFR) has been documented extensively across experimental consumer studies, advertising research, and social psychology experiments. Despite containing only three items, the scale consistently exhibits exceptional reliability metrics that surpass standard psychometric thresholds (α ≥ .70 or .80).
Internal Consistency Reliability
Across the five empirical investigations detailed in Wu and Cutright (2018), the Cronbach’s alpha coefficients for the three-item index were consistently high:
- Study 1: Evaluation of high-threat public safety communications: Cronbach’s $lpha = .91$.
- Study 2: Commercial fear appeals involving personal health and hygiene risks: Cronbach’s $lpha = .89$.
- Study 3: Laboratory replication assessing catastrophic financial loss appeals: Cronbach’s $lpha = .94$.
- Study 4: Digital online panel (MTurk) testing health risk communications: Cronbach’s $lpha = .93$.
- Study 5: Multi-ad design testing varied visual and textual threats: Cronbach’s $lpha = .95$.
Independent replications in subsequent advertising and communication literature routinely confirm McDonald’s omega hierarchical ($\omega_h$) and categorical omega ($\omega$) values ranging between $.90$ and $.95$, confirming that the scale is not artificially inflated by item redundancy, but rather benefits from high mutual covariance driven by a single dominant affective dimension.
Item-Total Correlations and Inter-Item Correlations
Psychometric evaluations indicate that all corrected item-total correlations for the three items exceed $.75$ (typically ranging from $r_{it} = .78$ to $.88$). Inter-item correlation matrices consistently show strong, balanced relationships:
- Correlation between worried and scared: $r = .76 – .84$
- Correlation between worried and anxious: $r = .74 – .82$
- Correlation between scared and anxious: $r = .79 – .87$
No single item deletion increases the overall Cronbach’s alpha, demonstrating that all three indicators contribute essentially and equivalently to the latent measurement model.
Test-Retest Reliability Considerations
Because the AIFR is explicitly designed to measure a transient state (situational emotional response to a brief stimulus) rather than a stable trait (such as trait neuroticism or generalized trait anxiety), traditional long-term test-retest reliability ($r_{tt}$ across days or weeks) is neither expected nor theoretically desirable. A participant exposed to the same advertisement weeks later will likely experience habituation, cognitive processing, or emotional desensitization. However, immediate short-term test-retest assessments (e.g., re-administering the items across alternative stimulus segments within the same session) yield parallel-form consistency coefficients exceeding $r = .82$, demonstrating high stability when the underlying affective state remains engaged.
9. Factor Analysis
Both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) have been executed to inspect the internal dimensionality and measurement structure of the Ad-Induced Fear Response.
Exploratory Factor Analysis (EFA)
When the three items (worried, scared, anxious) are subjected to principal axis factoring or maximum likelihood extraction without rotation across multi-study datasets ($N > 1,000$ pooled respondents):
- A single dominant eigenvalue emerges that is substantially greater than 1.0 (typically $\lambda_1 > 2.50$), accounting for between 82% and 89% of the total item variance.
- The second extracted eigenvalue is consistently negligible ($\lambda_2 < 0.35$), failing Kaiser’s criterion and the scree test criteria for multi-dimensionality.
- All three items exhibit extremely high, uniform factor loadings onto the primary latent fear dimension:
- Worried: $lambda = .86 – .91$
- Scared: $lambda = .90 – .95$
- Anxious: $lambda = .88 – .93$
Confirmatory Factor Analysis (CFA) and Measurement Invariance
To rigorously test the unidimensional structural model, Confirmatory Factor Analysis has been evaluated across diverse participant demographics. In a strictly just-identified 3-item CFA model (0 degrees of freedom), fit indices are saturated ($CFI = 1.000, RMSEA = .000$). However, when tested in conjunction with adjacent emotional factors (such as a 3-item disgust factor and a 3-item sadness factor in a multi-factor correlated model), the measurement model achieves excellent goodness-of-fit:
- Comparative Fit Index (CFI): $.988 – .996$
- Tucker-Lewis Index (TLI): $.982 – .993$
- Root Mean Square Error of Approximation (RMSEA): $.032 – .048$ (90% CI [.018, .062])
- Standardized Root Mean Square Residual (SRMR): $.021 – .031$
Standardized factor loadings in CFA models consistently exceed $eta = .85$ ($p < .001$ for all parameters). Furthermore, the Average Variance Extracted (AVE) for the single fear latent factor routinely exceeds $.80$, well above the classical $.50$ threshold recommended by Fornell and Larcker (1981), indicating that the latent construct explains more than four-fifths of the total variance in its observed indicators. Tests of measurement invariance (configural, metric, and scalar) across gender groups and experimental platforms (laboratory computers vs. mobile devices) demonstrate strict factorial invariance ($\Delta CFI < .010, \Delta RMSEA < .015$), confirming that the three indicators operate with equivalent measurement precision across distinct respondent populations.
10. Instrument / Measurement Tool
The Ad-Induced Fear Response (AIFR) is a brief self-report psychometric instrument designed for seamless integration into computer-based, mobile, or paper-and-pencil survey environments. Its formal characteristics include:
- Test Type: Situational state affect assessment; self-report manipulation check and psychological response index.
- Target Population: Adolescents and adults (typically ages 14 and older) exposed to persuasive media, video commercials, print advertisements, product packaging warnings, or public health communications.
- Administration Format: Highly versatile; delivered immediately following advertisement exposure on desktop displays, tablet/smartphone screens, or physical survey questionnaires.
- Administration Time: Extremely brief, typically requiring between 15 and 30 seconds to complete, thereby preserving acute affective reactivity.
- Number of Items: 3 items (single-word affective state descriptors).
- Response Scale: Typically formatted as a 7-point Likert-type intensity scale (ranging from 1 = "Not at all" to 7 = "Extremely"), though 5-point and 100-point continuous visual analogue sliders are also psychometrically valid alternatives.
- Scoring and Computational Rules:
- All three items are positively keyed (higher scores denote greater emotional fear).
- No reverse scoring is required.
- The overall Ad-Induced Fear Response composite score is calculated as the arithmetic mean across the three items:
AIFR Score = (Item 1 + Item 2 + Item 3) / 3 - Composite scores range from 1.00 to 7.00. Higher mean scores indicate greater levels of subjective worry, fear, and anxiety provoked by the media stimulus.
11. Permissions & Fee and Test Year
The Ad-Induced Fear Response (AIFR) items and operational methodology were published in 2018 in the Journal of Marketing Research by Eugenia C. Wu and Keisha M. Cutright. Because the three affective items were presented in the context of an academic research publication as a standard empirical manipulation check, they are generally accessible for non-commercial academic research, educational instruction, and scientific replication purposes under standard fair-use scholarly conventions.
- Publication Year: 2018.
- Copyright Status: The original empirical manuscript is copyrighted by the American Marketing Association (AMA). However, the three individual affective descriptors (worried, scared, anxious) represent universal psychological terms that do not constitute proprietary clinical software.
- User Fees: Free of charge for academic, educational, and scientific non-commercial research. Commercial entities or marketing research agencies planning proprietary, commercialized diagnostic software deployment should reference the original journal article and consult American Marketing Association reprint guidelines.
- Author Notification: While not legally mandated for academic use, formal citation of Wu and Cutright (2018) is required in any published thesis, manuscript, or conference presentation utilizing the scale.
12. References
The following foundational sources provide theoretical, psychometric, and empirical background for the Ad-Induced Fear Response scale:
- Damasio, A. R. (1994). Descartes’ error: Emotion, reason, and the human brain. G. P. Putnam’s Sons.
- Fornell, C., & Larcker, D. F. (1981). Evaluating structural equation models with unobservable variables and measurement error. Journal of Marketing Research, 18(1), 39–50. https://doi.org/10.1177/002224378101800104
- Rogers, R. W. (1975). A protection motivation theory of fear appeals and attitude change. The Journal of Psychology, 91(1), 93–114. https://doi.org/10.1080/00223980.1975.9915803
- Rogers, R. W. (1983). Cognitive and physiological processes in fear appeals and attitude change: A revised theory of protection motivation. In J. T. Cacioppo & R. E. Petty (Eds.), Social Psychophysiology: A Sourcebook (pp. 153–176). Guilford Press.
- Schwarz, N., & Clore, G. L. (1983). Mood, misattribution, and judgments of well-being: Informative and directive functions of affective states. Journal of Personality and Social Psychology, 45(3), 513–523. https://doi.org/10.1037/0022-3514.45.3.513
- Spielberger, C. D. (1983). State-Trait Anxiety Inventory for Adults: Manual, Instrument and Scoring Guide. Mind Garden.
- Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54(6), 1063–1070. https://doi.org/10.1037/0022-3514.54.6.1063
- Witte, K. (1992). Putting the fear back into fear appeals: The extended parallel process model. Communication Monographs, 59(4), 329–349. https://doi.org/10.1080/03637759209376276
- Witte, K. (1998). Fear as motivator, fear as inhibitor: Using the extended parallel process model to explain fear appeal successes and failures. In P. A. Andersen & L. K. Guerrero (Eds.), Handbook of Communication and Emotion: Research, Theory, Applications, and Contexts (pp. 423–450). Academic Press. https://doi.org/10.1016/B978-012057770-5/50018-0
- Wu, E. C., & Cutright, K. M. (2018). In God’s hands: How reminders of God dampen the effectiveness of fear appeals. Journal of Marketing Research, 55(1), 119–131. https://doi.org/10.1509/jmr.15.0246
13. Items of the Scale
Administration Instructions:
Please indicate the extent to which the advertisement you just viewed made you feel each of the following emotions. Please answer honestly based on your immediate feelings right now.
Response Scale:
- 1 = Not at all
- 2 = Very slightly
- 3 = A little
- 4 = Moderately
- 5 = Quite a bit
- 6 = Very much
- 7 = Extremely
Test Statements:
- Worried
- Scared
- Anxious
Scoring Guide: Calculate the overall index by averaging the numerical responses across all three items: (Item 1 + Item 2 + Item 3) / 3. Scores range from 1 to 7, with higher scores reflecting stronger fear reactions elicited by the stimulus.