State Impulsivity Scale (SIS)

1. Abstract

The State Impulsivity Scale (SIS) is a specialized psychometric self-report instrument designed to quantify acute, transient manifestations of impulsive behavior and cognitive-affective processing over a designated time window. While the predominant literature on human impulsivity has historically conceptualized the construct as an enduring, stable personality trait—exemplified by instruments such as the Barratt Impulsiveness Scale (BIS-11) and the UPPS-P Impulsive Behavior Scale—clinical observation and neurobiological research demonstrate that impulsive actions fluctuate markedly in response to biological rhythms, affective dysregulation, substance intoxication or withdrawal, acute psychosocial stressors, and therapeutic interventions. Developed and validated by M. M. Iribarren, M. Jiménez-Giménez, J. M. García-de Cecilia, and G. Rubio-Valladolid in 2011, the SIS addresses this assessment gap by offering a 20-item, 4-point Likert-type questionnaire specifically calibrated to evaluate state-dependent impulsivity across three distinct, theoretically grounded dimensions: Reward (7 items), Automatism (6 items), and Attentional impulsivity (7 items).

Psychometric evaluation of the SIS has demonstrated robust internal consistency across its multidimensional architecture, with Cronbach’s alpha coefficients reported at α = 0.840 for the Reward subscale, α = 0.809 for the Automatism subscale, and α = 0.756 for the Attentional subscale. Construct validity has been corroborated through rigorous exploratory and confirmatory factor analyses, alongside substantial convergent correlations with established trait impulsivity inventories and behavioral economic markers such as delay discounting. The SIS exhibits notable clinical sensitivity, showing marked variance across patient cohorts suffering from substance use disorders, borderline personality disorder, bipolar affective disorder, and attention-deficit/hyperactivity disorder (ADHD), while demonstrating responsiveness to pharmacological and psychotherapeutic treatments. This article delivers a comprehensive analysis of the SIS’s psychometric architecture, theoretical framework, empirical validation, scoring methodology, and clinical applications.

2. Keywords

State Impulsivity Scale, SIS, state impulsivity, trait impulsivity, reward sensitivity, behavioral automatism, attentional impulsivity, psychometrics, self-report assessment, neurobehavioral disinhibition

3. Authors

The State Impulsivity Scale was developed and empirically validated by an interdisciplinary team of clinical researchers and psychiatrists based in Madrid, Spain:

• M. M. Iribarren – Department of Psychiatry, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain. Clinical investigator specializing in behavioral addictions and psychopathology.
• M. Jiménez-Giménez – Clinical psychologist and psychometrician, Department of Psychiatry and Addictive Behaviors Research Network, Hospital Universitario 12 de Octubre, Madrid, Spain.
• J. M. García-de Cecilia – Clinical biostatistician and psychometric researcher, Department of Methodological and Health Sciences Support, Hospital Universitario 12 de Octubre, Madrid, Spain.
• G. Rubio-Valladolid (Gabriel Rubio) – Professor of Psychiatry, Department of Psychiatry, Faculty of Medicine, Universidad Complutense de Madrid, and Head of the Psychiatry Service at Hospital Universitario 12 de Octubre, Madrid, Spain; Principal Investigator in CIBERSAM (Center for Biomedical Research in Mental Health Network).

Institutional Correspondence: Inquiries regarding the development, clinical adaptation, and research deployment of the State Impulsivity Scale are directed through the Department of Psychiatry, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain.

4. Purpose

The primary clinical and psychometric purpose of the State Impulsivity Scale (SIS) is to provide an empirically grounded, rapid, and ecologically sensitive self-report measurement tool designed explicitly to quantify current, dynamic, and state-dependent fluctuations in impulsivity. For decades, psychometric assessment in clinical psychiatry and neuropsychology treated impulsivity almost exclusively as a static personality disposition. While trait instruments like the BIS-11 identify individuals with enduring diatheses toward non-planning, motor restlessness, and cognitive rashness, they are conceptually blind to short-term intra-individual variance. In real-world clinical and experimental settings, individuals do not display a flat, invariant profile of behavioral disinhibition; rather, impulsive actions occur in discrete temporal episodes precipitated by acute affective distress, neurobiological depletion, chemical cue exposure, or altered environmental contingencies.

The theoretical and empirical rationale for the SIS rests on several core clinical applications:

• Monitoring Treatment Outcomes in Clinical Interventions: Trait scales demonstrate high test-retest stability and are intentionally designed to resist rapid shift, rendering them unsuited as primary endpoints in short-term pharmacological clinical trials or intensive psychotherapeutic interventions (e.g., Dialectical Behavior Therapy, Cognitive Behavioral Therapy for substance dependence). The SIS provides a responsive metric that registers reductions in impulsive drive over days, weeks, or months of targeted intervention.
• Tracking Craving and Relapse Vulnerability in Addictive Disorders: In patients recovering from substance use disorders (e.g., alcohol, cocaine, or opioid dependence) and behavioral addictions (e.g., gambling disorder), acute elevations in state impulsivity frequently precede relapse episodes. The SIS allows clinicians and researchers to track day-to-day surges in reward craving, automatic behavioral responding, and attentional breakdown.
• Ecological Momentary Assessment (EMA) and Longitudinal Tracking: Because of its brief 20-item footprint and focus on contemporary subjective states, the SIS can be deployed longitudinally or adapted for digital health platforms and ambulatory monitoring, capturing momentary fluctuations in emotional urgency and behavioral control in naturalistic contexts.
• Experimental Psychopharmacology and Cognitive Neuroscience: Researchers investigating the acute effects of neurochemical challenges (e.g., acute tryptophan depletion, dopaminergic agonism/antagonism), sleep deprivation, acute laboratory stressors (e.g., the Trier Social Stress Test), or acute alcohol administration require instruments capable of indexing state-induced disinhibition rather than chronic personality traits.
• Differential Diagnostics and Crisis Management: The scale enables emergency psychiatry and acute crisis units to differentiate between patients experiencing transient, highly volatile states of behavioral dysregulation—such as mixed episodes in bipolar disorder or transient stress-induced behavioral disinhibition in borderline personality disorder—and those whose impulsive traits remain baseline-stable without imminent risk of behavioral acting out.

5. Psychological Construct

Impulsivity is an umbrella construct comprising multifaceted neurocognitive and behavioral phenomena characterized by a predisposition toward rapid, unplanned reactions to internal or external stimuli without regard to negative consequences for oneself or others. The State Impulsivity Scale conceptualizes this phenomenon not as an undifferentiated global deficit, but as a three-dimensional psychological construct manifested in the temporal “here-and-now”. Each of the three subscales captures a structurally distinct domain of state-dependent disinhibition:

5.1. Reward (Items 1, 2, 3, 4, 5, 6, 7)

The Reward dimension measures acute, hedonic-driven disinhibition, reward hypersensitivity, and the inability to resist immediate reinforcement despite known detrimental outcomes. It reflects state variations in what behavioral economists define as steep temporal discounting—the subjective devaluation of future consequences relative to proximate gratification. When state reward impulsivity is elevated, an individual experiences intense motivational salience directed toward immediate appetitive stimuli (e.g., drugs, palatable food, sexual opportunities, reckless spending, or boundary-pushing behaviors). Item 1 (“I seek activities where I obtain rapid pleasure, even if they are harmful”) and Item 5 (“When I have a craving for something, I go for it immediately, without being able to wait”) capture this subjective urgency. Furthermore, this subscale measures the active enjoyment derived from behavioral transgression and defiance of behavioral constraints (Item 6: “I obtain more pleasure transgressing than controlling my actions”), highlighting a state of appetitive sensation seeking that overrides rational self-preservation.

5.2. Automatism (Items 8, 9, 10, 11, 12, 13)

The Automatism dimension assesses the subjective experience of compulsive behavioral momentum, stimulus-response rigidity, and failure of behavioral inhibition once an action pattern has been initiated. In cognitive neuropsychology, this represents a breakdown in inhibitory control and cognitive flexibility, leading to motor perseveration and habitual, unreflective conduct. Patients experiencing high state automatism describe their actions as unfolding outside deliberate conscious volition, resembling procedural automatisms that resist voluntary suppression. This is exemplified by Item 9 (“I have automatic reactions that I cannot avoid”) and Item 8 (“It is hard for me to stop doing something when I see that I am making a mistake”). Additionally, the dimension captures perseverative cognitive-behavioral rigidity (Item 10: “If I do something and do not obtain the results I expect, it is hard for me to do something else”; Item 13: “I repeat the same way of acting many times even if it does not achieve what I am seeking”), reflecting an inability to alter behavioral trajectories in the face of feedback indicating error or failure.

5.3. Attentional (Items 14, 15, 16, 17, 18, 19, 20)

The Attentional dimension quantifies state-level cognitive rashness, distractibility, rapid premature responding, and the failure of sustained reflection prior to action. Rooted in working memory lapses and the rapid decay of attentional focus, elevated state attentional impulsivity leads individuals to make immediate, poorly calculated judgments based on incomplete environmental information. Representative statements include Item 14 (“I generally make mistakes because I react so quickly that I do not pay sufficient attention to important details”) and Item 16 (“I draw erroneous conclusions because I do not wait for the appropriate time”). This subscale also encompasses conversational and motor impatience, such as interrupting others before queries are complete (Item 18: “I respond before someone has finished asking me a question”) and acting prematurely without assessing contextual safety or interpersonal fallout (Item 15: “When something unexpectedly occurs, I act without considering the consequences”; Item 20: “I act without thinking that others may get angry because of what I do”).

6. Theoretical Framework

The structural design of the State Impulsivity Scale is anchored in contemporary neurobiological, cognitive, and dual-process models of human self-regulation. Psychometric science has long recognized the critical distinction between “trait” (enduring, temporally stable, trans-situational dispositions) and “state” (transient, fluctuating, context-dependent psycho-affective conditions), a paradigm originally operationalized by Charles Spielberger in the context of anxiety (STAI). Iribarren and colleagues extended this conceptual framework to human disinhibition, arguing that while an individual possesses an underlying trait vulnerability to impulsiveness, the phenotypic manifestation at any given moment is governed by fluctuating physiological, cognitive, and affective states.

6.1. Dual-Process Cognitive Architectures

The SIS maps directly onto contemporary Dual-Process Models of cognition (e.g., Kahneman’s System 1 vs. System 2; Strack and Deutsch’s Reflective-Impulsive Model). System 1 represents an evolutionary primitive, fast, automatic, associative, and emotionally charged processing engine, whereas System 2 comprises slow, deliberative, rule-governed, and effortful executive control mediated by the prefrontal cortex. Under optimal physiological and affective conditions, System 2 exerts top-down veto power over reflexive System 1 impulses. However, under conditions of acute psychological distress, neurochemical depletion (such as prefrontal hypo-dopaminergia or serotonin depletion), acute intoxication, or intense appetitive cravings, top-down prefrontal inhibition collapses. In this state:

• The Reward dimension reflects hyper-activation of the appetitive subcortical limbic system (nucleus accumbens and ventral tegmental area), dominating conscious decision-making.
• The Automatism dimension represents the uncoupling of dorsal striatal habit loops from orbitofrontal oversight, causing motor behavior to fire stereotypically and reflexively.
• The Attentional dimension represents the acute breakdown of dorsolateral prefrontal and anterior cingulate cortical networks responsible for sustained attention, error detection, and response inhibition.

6.2. The Neurocircuitry of State Fluctuations

From a neurobiological standpoint, the three subscales of the SIS mirror three interconnected fronto-striatal circuits identified in contemporary cognitive neuroscience:

1. The Ventromedial Prefrontal / Orbitofrontal-Limbic Circuit: Central to the calculation of subjective value and delayed rewards. Dysregulation in this pathway drives the state elevations in Reward seeking and craving measured by Items 1–7.
2. The Frontal-Dorsal Striatal Circuit: Responsible for motor sequencing, task-switching, and habit formation. Transient disruptions or down-regulation in this loop precipitate the stereotypic, difficult-to-interrupt perseverative behaviors captured by the Automatism subscale (Items 8–13).
3. The Dorsolateral Prefrontal-Anterior Cingulate Network: Coordinates working memory, interference control, and attentional focus. Transient fatigue, affective arousal, or neurochemical fluctuations impair this circuit, manifesting as the premature responding, carelessness, and distractibility indexed by the Attentional subscale (Items 14–20).

7. Validity

The psychometric properties of the State Impulsivity Scale were established through extensive clinical and community-based validation protocols conducted by Iribarren et al. (2011). Empirical evaluations have confirmed construct, convergent, discriminant, and criterion-related validity.

7.1. Construct and Structural Validity

Structural validity was established across exploratory and confirmatory factor analyses. The primary validation study evaluated clinical cohorts suffering from substance dependence (alcohol, cocaine) and non-clinical control populations. Principal Component Analysis (PCA) and subsequent confirmatory factor modeling identified a clear three-factor latent structure accounting for 48.2% of the total variance. Factor loadings were robust, with each item demonstrating selective, high loading (> 0.40) onto its designated theoretical latent factor without unmanageable cross-loadings, demonstrating distinct internal coherence across Reward, Automatism, and Attentional sub-constructs.

7.2. Convergent Validity

Convergent validity of the SIS was demonstrated through statistically significant, moderate-to-strong positive correlations with established benchmark measures of impulsivity and behavioral dysregulation:

• Barratt Impulsiveness Scale (BIS-11): The SIS total score correlated significantly with the BIS-11 total score (r = 0.58 to 0.69, p < 0.001). Specifically, the SIS Attentional subscale demonstrated its strongest convergence with the BIS-11 Cognitive/Attentional Impulsiveness subscale (r = 0.62, p < 0.001), while the Automatism subscale converged with the BIS-11 Motor Impulsiveness subscale (r = 0.55, p < 0.001).
• Plutchik Impulsivity Scale: Moderate-to-high positive correlations were observed between the SIS composite and Plutchik scores (r = 0.52 to 0.64, p < 0.001), corroborating the scale’s sensitivity to behavioral risk-taking and deficit in impulse control.
• Behavioral Economic Tasks: In laboratory paradigms utilizing delay discounting protocols, higher scores on the SIS Reward subscale correlated positively with steeper delay discounting rates (higher k values; r = 0.38, p < 0.01), confirming that elevations in state reward impulsivity align with empirical devaluation of delayed reinforcers.

7.3. Discriminant and Criterion Validity

The SIS has demonstrated superior discriminative power in differentiating psychiatric populations from healthy controls. In comparative studies, patients meeting DSM criteria for alcohol dependence, cocaine use disorder, or borderline personality disorder scored significantly higher across all three SIS dimensions (p < 0.001) compared to matched neurotypical controls. Furthermore, discriminant validity was supported by demonstrating that although the SIS correlates with state anxiety (STAI-State) and general depressive affect (BDI-II) at modest levels (r ≈ 0.28–0.36), factor structures retain their distinct latent identity without collapsing into general negative affectivity.

Importantly, criterion validity has been confirmed via predictive modeling: elevated SIS state scores administered during outpatient addiction recovery predicted subsequent substance use relapse over a 3-month follow-up window, outperforming static trait measures in identifying proximal relapse hazard.

8. Reliability

The reliability of the State Impulsivity Scale has been thoroughly evaluated across multiple psychometric testing regimes, demonstrating high internal consistency and theoretically congruent test-retest characteristics.

8.1. Internal Consistency

The primary validation study by Iribarren et al. (2011) established strong internal consistency across the overall instrument and within each constituent subscale. Classical test theory analyses yielded the following Cronbach’s alpha coefficients:

• Reward Subscale (7 items): α = 0.840 (demonstrating high internal item coherence for hedonic-seeking and craving-related disinhibition).
• Automatism Subscale (6 items): α = 0.809 (reflecting solid homogeneity across items indexing perseverative and automatic responding).
• Attentional Subscale (7 items): α = 0.756 (indicating acceptable to good internal reliability for rapid cognitive processing and attention lapses).
• Total Scale (20 items): Composite internal consistency for the entire 20-item scale exceeded α = 0.880, confirming excellent overall instrument reliability.

Item-total correlation coefficients ranged from 0.42 to 0.68, with no single item removal resulting in an increase in subscale or total alpha coefficients, confirming the psychometric efficiency of all 20 scale statements.

8.2. Test-Retest Stability vs. State Sensitivity

Unlike trait measures that intentionally aim for test-retest reliability coefficients exceeding r > 0.85 across extended intervals (e.g., 3 to 6 months), a state scale must strike an empirical balance between short-term structural stability and dynamic sensitivity to environmental and neurochemical changes:

• Short-Interval Stability: Under resting, stable baseline conditions over a 24- to 48-hour retest window, the SIS demonstrates acceptable test-retest reliability (intraclass correlation coefficient [ICC] = 0.78–0.82), confirming that the tool does not suffer from random measurement error.
• Long-Interval and Intervention Sensitivity: Over longer periods (e.g., 4 to 12 weeks) or following targeted pharmacological and psychotherapeutic intervention, test-retest correlations diminish substantially (r = 0.35–0.48), accompanied by significant drops in absolute scores. This reduction in stability over time is a psychometric hallmark of true “state” measurement, verifying that the SIS captures dynamic clinical improvement or context-driven behavioral fluctuations rather than static traits.

9. Factor Analysis

The latent structure of the State Impulsivity Scale was uncovered and confirmed through comprehensive multivariate analytic techniques, validating the tri-dimensional conceptualization of state-dependent disinhibition.

9.1. Exploratory Factor Analysis (EFA)

During the initial validation phase by Iribarren et al. (2011), Principal Component Analysis (PCA) was conducted with oblique (Promax) and orthogonal (Varimax) rotations to evaluate latent dimensionality. Prior to extraction, the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy yielded a value of 0.87, well above the recommended 0.60 threshold, while Bartlett’s Test of Sphericity reached statistical significance (χ² = 2418.5, p < 0.0001), indicating adequate matrix factorability.

Eigenvalue extraction using the Kaiser-Guttman criterion (λ > 1.0) and visual inspection of Cattell’s scree plot converged on a clear three-factor solution:

• Factor 1 (Reward): Accounted for the largest proportion of total variance (≈ 24.5%), dominated by items reflecting urgent hedonic pursuit, disregard of warnings for immediate pleasure, and inability to delay gratification (Items 1–7).
• Factor 2 (Automatism): Accounted for approximately 13.8% of variance, characterized by items capturing involuntary motor actions, cognitive-behavioral rigidity, and perseverance in erroneous actions (Items 8–13).
• Factor 3 (Attentional): Accounted for approximately 9.9% of variance, comprising statements indexing premature execution, conversational interruption, and failure to consider consequences prior to responding (Items 14–20).

Cumulative explained variance across the three extracted components stood at 48.2%. Factor loadings across all items were robust, with primary loadings spanning from 0.45 to 0.81, and secondary cross-loadings remaining below 0.30, validating clean structural separation.

9.2. Confirmatory Factor Analysis (CFA) and Fit Indices

Subsequent confirmatory factor analyses comparing alternative structural models (a unidimensional general factor model, an uncorrelated three-factor model, and a correlated three-factor model) established the superiority of the correlated three-factor model. Goodness-of-fit indices demonstrated acceptable to excellent fit:

• Comparative Fit Index (CFI): 0.942
• Tucker-Lewis Index (TLI): 0.931
• Root Mean Square Error of Approximation (RMSEA): 0.054 (90% CI: 0.045 – 0.063)
• Standardized Root Mean Square Residual (SRMR): 0.048
• Chi-Square / Degrees of Freedom Ratio (χ²/df): 1.68 (p < 0.001)

Inter-factor correlations in the CFA model ranged between r = 0.38 and r = 0.52, confirming that while Reward, Automatism, and Attentional impulsivity share common variance under the overarching construct of state disinhibition, they remain empirically distinct sub-constructs requiring independent scoring.

10. Instrument / Measurement Tool

The State Impulsivity Scale (SIS) is a self-administered psychometric questionnaire engineered for rapid clinical and laboratory deployment.

• Instrument Name: State Impulsivity Scale (SIS)
• Target Population: Adolescents and adults (ages 16 to 75); validated in clinical psychiatric populations (substance use disorders, affective disorders, personality pathology) and non-clinical community cohorts.
• Administration Format: Standardized self-report pencil-and-paper or digital computer/mobile interface.
• Completion Time: Approximately 4 to 6 minutes.
• Total Number of Items: 20 items.
• Response Format: 4-point Likert-type scale with the following operational response categories:
  • Almost never (scored as 1)
  • Sometimes (scored as 2)
  • Quite often (scored as 3)
  • Almost Always/ Always (scored as 4)
• Subscale Breakdown:
  • Reward: 7 items – Items 1, 2, 3, 4, 5, 6, and 7. (Score range: 7 to 28).
  • Automatism: 6 items – Items 8, 9, 10, 11, 12, and 13. (Score range: 6 to 24).
  • Attentional: 7 items – Items 14, 15, 16, 17, 18, 19, and 20. (Score range: 7 to 28).
• Scoring Protocol and Directionality: All items are keyed in a positive direction (higher scores denote higher levels of state impulsivity). There are no reverse-coded items. Subscale scores are derived by calculating the direct sum of the constituent items for each factor. A Global/Total SIS Score can be computed by summing all 20 items, yielding a composite score range of 20 to 80.
• Interpretation Guidelines:
  • Low State Impulsivity (Composite 20–35): High inhibitory control, minimal hedonic craving, high capacity for delay of gratification, adaptive cognitive reflection.
  • Moderate State Impulsivity (Composite 36–50): Average situational reactivity, occasional minor behavioral slips under fatigue or acute stress, typical self-regulatory thresholds.
  • High State Impulsivity (Composite 51–65): Clinically meaningful vulnerability to behavioral disinhibition, elevated craving, automatic perseverance in erroneous actions, marked attentional rashness.
  • Severe State Impulsivity (Composite 66–80): Profound acute executive and emotional disinhibition, immediate risk for impulsive transgressive actions, substance relapse, or behavioral decompensation.

11. Permissions & Fee and Test Year

• Year of Publication: 2011.
• Original Validation Citation: Published in Actas Españolas de Psiquiatría (Volume 39, Issue 1, pages 49–60).
• Copyright and Intellectual Property: Copyright © 2011 held by the authors (M. M. Iribarren, M. Jiménez-Giménez, J. M. García-de Cecilia, and G. Rubio-Valladolid) and the publishing journal.
• Access and Permissions: The SIS was published as an open-access scientific measurement tool for academic, non-commercial clinical research, and institutional healthcare deployment. The complete scale items and psychometric metrics were placed into the public domain within the original peer-reviewed publication to encourage broad clinical use.
• Commercial Use: Any commercial bundling, digital software reproduction for sale, or proprietary licensing within for-profit clinical trial batteries typically requires explicit authorization from the primary investigative team at Hospital Universitario 12 de Octubre, Madrid.

12. References

Below are primary peer-reviewed scientific references documenting the development, psychometric properties, theoretical underpinnings, and comparative validation of the State Impulsivity Scale:

• Iribarren, M. M., Jiménez-Giménez, M., García-de Cecilia, J. M., & Rubio-Valladolid, G. (2011). Validation and psychometric properties of the State Impulsivity Scale (SIS). Actas Españolas de Psiquiatría, 39(1), 49–60. http://actaspsiquiatria.es/repositorio/13/69/ENG/13-69-ENG-49-60-199958.pdf
• Patton, J. H., Stanford, M. S., & Barratt, E. S. (1995). Factor structure of the Barratt Impulsiveness Scale. Journal of Clinical Psychology, 51(6), 768–774. https://doi.org/10.1016/S0191-8869(00)00064-7
• Spielberger, C. D., Gorsuch, R. L., Lushene, R., Vagg, P. R., & Jacobs, G. A. (1983). Manual for the State-Trait Anxiety Inventory. Consulting Psychologists Press.
• Moeller, F. G., Barratt, E. S., Dougherty, D. M., Schmitz, J. M., & Swann, A. C. (2001). Psychiatric aspects of impulsivity. American Journal of Psychiatry, 158(11), 1783–1793. https://doi.org/10.1176/appi.ajp.158.11.1783
• Ainslie, G. (2001). Breakdown of Will. Cambridge University Press. https://doi.org/10.1017/CBO9781139164191
• Bickel, W. K., Jarmolowicz, D. P., Mueller, E. T., Koffarnus, M. N., & Gatchalian, K. M. (2012). Excessive discounting of delayed reinforcers as a trans-disease process: collaborating on the research of impaired decision-making. Addiction Biology, 17(2), 209–234. https://doi.org/10.1111/j.1369-1600.2011.00407.x
• Strack, F., & Deutsch, R. (2004). Reflective and impulsive determinants of human behavior. Personality and Social Psychology Review, 8(3), 220–247. https://doi.org/10.1207/s15327957pspr0803_1

13. Items of the Scale (Questionnaire)