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Article

Uncovering Cognitive Distortions in Adolescents: Cultural Adaptation and Calibration of an Arabic Version of the “How I Think Questionnaire”

by
Fairouz Azaiez
1,2,3,
Amayra Tannoubi
4,
Taoufik Selmi
1,
Frank Quansah
5,
Medina Srem-Sai
6,
John Elvis Hagan, Jr.
7,8,*,
Chiraz Azaiez
1,9,10,
Houda Bougrine
1,11,
Nasr Chalghaf
1,2,3,
Ghada Boussayala
1,3,
Imane Ghalmi
12,
Mazin Inhaier Lami
13,
Mazin Dawood Ahmed AL-Hayali
9,14,
Ahmed Wateed Mazyed Shdr AL-Rubaiawi
9,15 and
Nabee Muttlak Nasser AL-Sadoon
3,16
1
Department of Education, Higher Institute of Sport, and Physical Education of Gafsa, University of Gafsa, Gafsa 2100, Tunisia
2
Postgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, 16126 Genoa, Italy
3
Laboratoire the Maghreb Arabe, Faculty of Human and Social Science of Sfax, Sfax 3029, Tunisia
4
High Institute of Sport and Physical Education of Kef, University of Jendouba, Jendouba 7100, Tunisia
5
Department of Educational Foundations, University of Education, Winneba P.O. Box 25, Ghana
6
Department of Health, Physical Education, Recreation and Sports, University of Education, Winneba P.O. Box 25, Ghana
7
Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast PMB TF0494, Ghana
8
Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sports Science, Bielefeld University, 33501 Bielefeld, Germany
9
High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3000, Tunisia
10
Sociological Research Group on Contemporary Societies (GRESCO), University of Limoges, 87032 Limoges, France
11
Physical Activity Research Unit, Sport, and Health (UR18JS01), National Observatory of Sports, Tunis 1003, Tunisia
12
Department of Fundamental Education in Sciences and Techniques of Physical and Sports Activities, University of Mohamed Cherif Messadia, Souk Ahras 41000, Algeria
13
College of Physical Education and Sports Sciences, University of Wasit, Wasit 52001, Iraq
14
College of Physical Education and Sports Sciences, University of Karbala, Karbala 56001, Iraq
15
Department of Education in Sciences and Techniques of Physical and Sports Activities, University of Baghdad, Baghdad 10071, Iraq
16
Training and Qualification Directoriale, Ministry of Interior, Baghdad 10071, Iraq
 
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Psych 2023, 5(4), 1256-1269; https://0-doi-org.brum.beds.ac.uk/10.3390/psych5040083
Submission received: 18 October 2023 / Revised: 3 December 2023 / Accepted: 6 December 2023 / Published: 15 December 2023
(This article belongs to the Section Psychometrics and Educational Measurement)
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Abstract

:
This study adapted and validated the How I Think Questionnaire (HIT-Q), intending to develop an Arabic version of the measure. The study assessed the (a) factorial structure of the Arabic version of the How I Think Questionnaire (A-HIT-Q), (b) construct validity evidence of the A-HIT-Q based on the internal structure of the scale, and (c) criterion validity evidence, highlighting how the cognitive distortions measure relates to some key theoretical variables such as depression. This study involved 762 Tunisian students aged 15–22 years, using a non-probabilistic sampling method. The students were boys (n = 297) and girls (n = 465). They completed self-report forms on Arabic-HIT-Q, depression (HADS), sleep (ISI), and physical activity participation, adhering to all relevant ethical considerations. Exploratory analysis revealed four factors which accounted for 73.46% of the variations in the distortion measure. Reliability analysis showed good internal consistency (α = 0.915) and temporal stability (r = 0.879). Criterion validity evidence showed cognitive distortion (as measured with the A-HIT-Q) was significantly associated with physical activity participation, anxiety, depression, and insomnia. However, no significant relationship has been observed between cognitive distortion, age, gender, and study levels. The evidence gathered supports the utility of the A-HIT-Q. Thus, the instrument demonstrates high efficacy in assessing the levels of cognitive distortions among adolescent students residing in Arabic-speaking regions.

1. Introduction

Cognitive distortions refer to the cognitive processes that have the potential to distort our perception of ourselves, others, and the surrounding environment [1]. The term “cognitive distortions” was initially introduced by Aaron Beck to describe the cognitive processes that consistently lead to recognizable errors in thinking [2]. These distortions, which are commonly addressed in cognitive behavioral therapy [3,4], are characterized by thought patterns that are irrational and unhelpful. These distortions encompass various types of thoughts, such as all-or-nothing thinking, overgeneralization, mental filtering, exclusion of positive aspects, personalization, catastrophism, and emotional reasoning [5,6,7]. Cognitive distortions have the potential to contribute to the experience of negative emotions, the development of distorted beliefs, and the adoption of harmful behavioral patterns [8]. Consequently, it is imperative to address these issues within therapeutic interventions to facilitate the cultivation of more constructive cognitive processes and enhanced overall functioning.
The theoretical framework associated with the concept of cognitive distortion is referred to as the Cognitive Distortions Theory, alternatively known as the Cognitive Distortions, or Cognitive Distortions Model, and Cognitive Behavioral Therapy (CBT) [2,9]. The examination of cognitive distortion in adolescents holds great importance as it pertains to their substantial cognitive and emotional growth [10], which in turn has implications for their mental health and overall well-being [11,12]. These distortions may potentially exacerbate susceptibility to anxiety, depression, self-esteem concerns, and additional mental health conditions [11]. According to various studies, cognitive distortions exert an impact on various cognitive processes, including decision-making, problem-solving, and interpersonal relationships, thereby influencing conflict resolution, peer interactions, and overall social functioning [13,14,15]. The study of cognitive distortions in adolescence has significant long-term implications, as it has the potential to result in the persistence of maladaptive thinking patterns in adulthood [1]. This situation, in turn, can have a detrimental impact on mental health outcomes and life trajectories.
From this perspective, five instruments have been designed to measure cognitive distortions: The Cognitive Distortions Questionnaire (CD-Quest) [16], the Cognitive Error Questionnaire—General Form (CEQ) [17], the Inventory of Cognitive Distortions (ICD) [18], the Cognitive Distortions Scale (CDS) [19], and the How I Think Questionnaire (HIT-Q) [1]. Among these measures, the CDS has received substantial research support and has exhibited favorable internal consistency, as well as convergent and discriminant validity, in both clinical and non-clinical populations such as undergraduate students [20]. The CDS has cited as a valid and reliable measure despite the original intention was used as a two-factor tool for evaluating cognitive distortions in interpersonal and achievement contexts [19].
The HIT-Q has been the subject of recent research in cognitive distortions, which has shown consistent psychometric properties across large and diverse samples, specifically adolescent students. These results have contributed to the growing body of evidence on the validity and reliability of this measure. The existing body of research on the HIT-Q has demonstrated favorable psychometric properties. Barriga et al. [1] assessed the preliminary psychometric properties of the English version of the measure in a sample comprising undergraduate students. The results demonstrated strong validity indicators and internal consistency [1]. Further, the HIT-Q demonstrated the ability to differentiate individuals exhibiting a pronounced cognitive distortion from those who did not exhibit this symptom. Ultimately, the results of the factor analysis supported that the scale should be classified into four distinct components [1,21]. Several versions of the HIT-Q have indeed undergone validation, covering a French version [22,23], an Italian form [24], a Portuguese version [25], a Spanish edition [26], and a German version [27]. The afore-mentioned studies have provided evidence indicating the HIT-Q demonstrated satisfactory levels of reliability and validity when applied to various adolescent populations under investigation.
Although the HIT-Q has shown strong psychometric properties, prior research has also underscored the necessity for enhancements. Continuous adaptation and calibration are crucial for the consistent evaluation of items and factors that are not functioning effectively. Regularly evaluating the elements and factors that are ineffective holds significant importance. It is imperative to recognize the framework of the HIT-Q model within the specific context of the Arab and Tunisian regions for some reasons. For instance, individuals who possess a limited comprehension of the English language may potentially confuse the inquiries, resulting in responses that are not precise [28]. The transcultural adaptation of the HIT-Q facilitates a more comprehensive comprehension of the reproducibility of the inventory within diverse cultural contexts [29]. Moreover, it is important to note that language and culture are intricately interconnected, leading to variations in the interpretation of the HIT-Q items based on the specific language employed and the social setting. Typically, individuals exhibit a strong emotional connection to their native language, leading to a higher likelihood of displaying enthusiasm when responding to a survey conducted in their preferred language.
Moreover, considering the significance of cognitive distortions among adolescent students and the lack of a validated Arabic version of the HIT-Q in the Arab region, it is imperative to undertake this study to offer a culturally appropriate instrument. The study assessed the psychometric properties of the Arabic adaptation of the HIT-Q among adolescent students and to determine its reliability and validity. The study specifically examined the (a) factor structure of the Arabic version of the HIT-Q, (b) construct validity of the Arabic version of the HIT-Q (based on internal structure), and (c) criterion validity evidence of the Arabic version of the HIT-Q (based on external structure).

2. Materials and Methods

2.1. Study Design

This study used a validation research design. This design was chosen for its meticulous approach, encompassing every aspect of the scientific process, from careful planning to determining the appropriate sample size, translation, collecting data, and evaluating reliability and validity of the items using various statistical methods [30]. The use of a cross-sectional survey design has been observed in recent validation studies [29,31,32], but there seems to be a recent growing interest in utilizing validation studies as a research design in the literature [33].

2.2. Eligibility Criteria

The study included adolescent males and females who were between the ages of 18 and 22 years. The participants were required to be in optimal physical and mental condition and had no limitations that might hinder the completion of the survey. Furthermore, the study exclusively included students who were adept in Arabic and living in the region of Jendouba, Tunisia.

2.3. Sample Size

In this study, the total sample was divided into two groups to cater for the two major analyses conducted: exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). For this purpose, some researchers recommend that a sample size should be at least between 100 and 200 [34,35]. Comrey and Lee suggest that to conduct an EFA, a sample size of 200 participants is acceptable [36]. Furthermore, Cattell claimed a minimum sample size of 250 as desirable for CFA [37]. Thus, the sample size for the analyses was deemed adequate for precise estimation of the parameters [38].

2.4. Data Collection and Procedures

A convenience non-probabilistic sampling method was used in this investigation. The inclusion of students in the research was facilitated by ensuring the presence of school administrators and obtaining informed parental consent. Participants provided their answers by engaging in the completion of a set of self-report questionnaires that were specifically designed to evaluate various aspects of the research. To uphold the principles of confidentiality and reliability, participants were not provided with any financial incentives, and their identities were kept anonymous. To assess the temporal stability of the questionnaires, a total of 50 participants, consisting of twenty-five females and thirty males were selected to complete the same set of questionnaires two weeks after their initial finalization. This assessment was done to examine the test-retest reliability of the surveys.

2.5. Mesures

Students’ demographic information on gender, age, and study level were obtained. Other key measures included cognitive distortions, anxiety, depression, insomnia, and physical activity participation.

2.5.1. How I Think Questionnaire (HIT-Q)

The How I Think Questionnaire (HIT-Q) [1], with 39 items, was used to assess cognitive distortion characteristics. [27,39,40]. The four areas of cognitive distortions used as the framework for the HIT-Q are egocentric (9 items), blaming others (10 items), minimizing/labeling (9 items), and assuming the worst (11 items). On a six-point Likert scale, participants provided a score for each item (1 being strongly disagree and 6 being strongly agree). High scores denote greater adherence to selfish cognitive distortions and vice versa. Translation was performed on the English version of the HIT-Q into the Arabic language, adhering to the International Test Commission’s guidelines for cross-cultural test adaptation, specifically employing the Hambleton method [41].
The instrument was initially translated by bilingual individuals, constituting a team of translators with a deep understanding of the cultural subtleties and backgrounds of both languages. Furthermore, a panel of proficient individuals (six academic educators/researchers) who were fluent in two languages, knowledgeable in the subject matter, and representative of the intended audience, evaluated the original translation to determine its precision, pertinence, and cultural suitability. Subsequently, a competent translator, who was not affiliated with any organization, proficiently translated the initial version back into the original language to verify the coherence and precision of the conceptual significance. Next, the panel of experts examined any differences between the original version and the back-translated version, to achieve a unanimous decision on the most precise and culturally suitable translation. Finally, the translated version of the instrument was subjected to pilot testing using a representative sample (n = 50) from the intended population to evaluate its comprehensibility, clarity, and relevance.

2.5.2. Hospital Anxiety and Depression Scale (HADS) (Arabic Version)

The Hospital Anxiety and Depression Scale (HADS) [42] includes 14 items in total, which are equally divided into two subscales for depression (HADS-D) and anxiety (HADS-A). A cut-off score of 7 for depression and 7 for anxiety has been recommended for this four-point Likert-style self-report measure. From 0 to 3, the 14 items are rated. The highest score for each question was 21, and there were seven questions associated with anxiety (total A) and seven questions related to depression (total D). The interpretation for each of the scores (A and D) might be suggested as follows to identify anxiety and depressive symptoms: 7 or less: no symptoms; 8 to 10: unsure symptoms; and 11 or more: certain symptoms [42]. The Arabic-validated version of the HADS was used in the study [43], and the internal consistency (Cronbach alpha) for the Arabic version of the questionnaire was considered acceptable reliability. Factor one, the HADS-D with 7 items provided a Cronbach’s alpha of 0.88 whereas factor two, the HADS-A with 7 items was 0.78 [43,44]. These values are considered acceptable [45]. The HADS measure in this research also yielded a reliability greater than 0.75.

2.5.3. Insomnia Severity Index (ISI) (Arabic Version)

The Insomnia Severity Index (ISI) [46] is a 7-item self-report questionnaire assessing the nature, severity, and impact of insomnia over the past month. The dimensions assessed are the severity of difficulty in falling asleep, maintenance, and early morning wakening, sleep dissatisfaction, interference of sleep problems with daytime functioning, sleep disturbance of others, and distress caused by sleep disturbance. A five-point Likert scale (e.g., 0 = none; 4 = very severe) is used to assess each item, with a total score ranging from 0 to 28, with a higher total score indicating more severe sleep difficulties: no insomnia (0–7), sub-threshold insomnia (8–14), moderate insomnia (15–21), and severe insomnia (22–28) [46]. An Arabic version of the ISI [47] was administered to the participants by the interviewer. This version has acceptable psychometric properties, showing good reliability Cronbach’s alpha coefficient of 0.82 [48]. The reliability estimate for the ISI measure also showed an estimate greater than 0.80.

2.6. Statistical Analysis

In the exploratory phase, we tested the normality of the data [Skewness (0.091)], and [Kurtosis (−0.693)]. The data processing showed that the population follows a normal distribution. Considering the ratio between these values and their standard error are all smaller than 2, we can consider the distribution follows a normal distribution. Then, an EFA of the HIT-Q was conducted to check the factor structure of the scale [49,50]. A random sample of 262 cases was used to perform the EFA, whereas the remaining 500 were used to perform the CFA. To determine whether the data were appropriate for factor analysis, the Kaiser–Meyer–Olkin (KMO) and the Bartlett’s test of sphericity statistics were evaluated. According to Hair et al.’s (2014) recommendations, the KMO value has to be greater than 0.50 for the factorial solution to be acceptable [51,52]. The calculated chi-square value of Bartlett’s test of sphericity [53] yielded a significant result. Factors with an eigenvalue greater than 1 and items with a factor load of less than 0.5, as determined by examining the scree plot, were retained [54]. To determine the factor structure of the measure, the Kaiser eigenvalues, parallel analysis, and the scree plot were compared [45]. This tripartite approach to determining the latent structure of a measure has been endorsed and utilised in other validation studies [55,56].
Regarding the CFA, a four-factor first-order model was fitted to test how well the data collected matched the theoretical model. The first-order confirmatory model was fitted because several studies have established support for the first-order four-factor structure of the instrument [57,58,59]. To this end, model fit indices were reported to assess the extent to which the theoretical model posited a priori correctly reproduced the data: the most common index was Chi-square (χ2). For a better representation of the degree of model fit, the following indices were reported: Goodness of Fit Index (GFI), Root Men Square Error of Approximation (RMSEA), Parsimony Normed Fit Index (PNFI), Normed-Fit Index (NFI), Adjusted Goodness-of-Fit Index (AGFI), Standardized Root Mean Square Residual (SRMR), and Comparative Fit Index (CFI) [60]. Finally, multiple linear regression analysis [61] was used to determine the role of adolescent’s cognitive distortion score in determining depression, sports participation, and sleep.
The EFA, internal consistency indices, and descriptive statistical analyses of item distributions were performed using SPSS for Windows, version 27 (IBM Corp., Armonk, NY, USA). Using SPSS Amos, version 25, we conducted the CFA. Hu and Bentler (1999) claimed a satisfactory fit for CFA indices was indicated by CFI, Tucker-Lewis Index (TLI), and values better than 0.95 and Root Mean Square Error of Approximation (RMSEA) values less than 0.08 [60,62,63].

3. Results

3.1. Demographic Characteristics of Participants

A total of 762 adolescent students participated in this study, with 297 and 465 being boys and girls, respectively. The students were aged between 15 and 22 years, with a mean age of 17.86 years and a standard deviation of 1.46 years. All participants were enrolled in general-education high schools and colleges located in the governorate of Jendouba, Tunisia. The data collection took place during the 2020–2021 school year. After being informed about the confidentiality and anonymity measures in place for their data, every participant voluntarily provided their agreement on a consent form.

3.2. Exploratory Factor Analysis

Findings from the EFA indicated that the HIT-Q [1] effectively reproduces the previously tested theoretical model, specifically in terms of item homogeneity. Furthermore, Bartlett’s sphericity test (KMO) provided a sampling adequacy value of 0.938, which was found to be statistically significant (χ2 = 29,725.491, df = 741, p < 0.001).
Subsequently, a parallel analysis was performed on a sample of 1000 simulated random datasets to determine the number of factors and components to retain. The outcome of the parallel analysis revealed the real data factor eigenvalues for the first four factors were greater than their corresponding simulated data mean eigenvalues (see Figure 1). Exploratory Factor Analysis (EFA) was conducted using the Unweighted Least Squares method. A Direct-Oblimin rotation and Kaiser normalization were applied. Comparing the output from the parallel analysis to Kaiser’s eigenvalues and the scree plot, we confirmed the four-factor structure of the HIT-Q (see Figure 1) [45]. The presence of the four (4) factors explained about 73.46% of the variance distribution. It was identified that the eigenvalue of the first component was 9.48, which accounted for 24.35% of the total variance. The second component accounted for a total of 7.06 units of variance, which represented approximately 18.11% of the total variance. The third component accounts for a variance of 6.17 units, which corresponds to 18.83% of the total variance. The fourth component had a value of 5.91, which accounted for 15.16% of the total variance. The factor matrices after the factor rotation of the A-HIT-Q dimensions used 39 items [51,64] (see Table A1 in Appendix A). The factor loading of the items per factor, which is used to reduce the weight of the table’s content, is determined by the 0.40 criteria, as also employed by Preacher and MacCallum [64].

3.3. Confirmatory Factor Analysis

3.3.1. Construct Validity Evidence of the Arabic-HIT-Q

A first-order CFA verified the four-dimensional factor structure with thirty-nine items. For this purpose, fit indices for the model constructed were reported. The cut-off values listed are generally accepted for model fit indices, according to Hu and Bentler (1999): fit index (GFI), where values greater than 0.90 indicate an acceptable fit and values greater than 0.95 indicate a good fit; normalized root mean square residual (SRMR), where values less than 0.10 indicate an acceptable fit and values below 0.05 indicate a good fit; and root-mean-square error of approximation (RMSEA), where values below 0.08 indicate an acceptable fit and values below 0.05 indicating a good fit [65] (see Table 1). Furthermore, the original structure of the Arabic version of the four-factor A-HIT-Q received better statistical support and the factor loadings varied between 0.69–0.94 for the four A-HIT-Q factors (see Figure A1 in Appendix B).

3.3.2. Reliability Analysis of Arabic-HIT-Q

The reliability analysis of the A-HIT-Q indicates the measure demonstrates satisfactory levels of temporal stability (test-retest, r = 0.879). The internal consistency of the A-HIT-Q was excellent, with a Cronbach’s Alpha (α = 0.915). Additionally, each dimension of the A-HIT-Q demonstrates excellent internal consistency, with coefficients of 0.941 (assuming the worst), 0.969 (egocentric), 0.969 (minimizing/labeling), and 0.954 (blaming others).

3.3.3. Criterion Validity Evidence

To establish some level of criterion validity evidence, we examined how cognitive distortions (using the A-HIT-Q) related to carefully selected key variables in the literature, including gender, age, study levels, sleep patterns, anxiety, depression, and physical activity participation. This analysis is important as it provided information on how the conceptualization of the cognitive distortions variable reflects established, theoretically related concepts like anxiety and depression.
The study employed multiple linear regression analysis [61] to establish the relationship between cognitive distortion measures and gender, age, study levels, sleep patterns, anxiety, depression, and physical activity participation. The results revealed VIF values less than 1, which signified the absence of multicollinearity [66]. The model has statistical significance, F (7, 754) = 30.967, p < 0.001, indicating there is a relationship between the predictors and the outcome variable. The R2 value of 0.223 indicates the predictors (i.e., gender, age, study levels, sleep patterns, anxiety, depression, and physical activity participation) explain 22.3% of the variance in the outcome variable.
The results, as shown in Table 2, revealed insomnia [t = 8.570, p < 0.001], anxiety [t = 3.953, p < 0.001], and depression [t = 2.690, p = 0.007] were positive and significant predictors of cognitive distortions in adolescents. These results indicate the greater presence of insomnia, anxiety, and depression are strongly linked to the occurrence of cognitive distortion among adolescents. Physical activity participation, on the other hand, was found to have a negative prediction of cognitive distortions [t = −4.000, p < 0.001], indicating higher participation in physical or sporting activity was significantly associated with lower levels of cognitive distortion. The results further discovered gender, age, and study levels failed to significantly predict cognitive distortion in adolescents (see Table 2).

4. Discussion

This research adapted and validated the HIT-Q, with the aim of developing an Arabic version of the measure as well as gathering psychometric evidence to support the functionality and utilization of the measure within the Arabic culture. Explicitly, the study assessed the (a) factorial structure of the A-HIT-Q, (b) construct validity evidence of the A-HIT-Q based on the internal structure of the scale, and (c) criterion validity evidence, highlighting how the cognitive distortion measure associated with some key variables like gender, age, study levels, anxiety, depression, insomnia, and physical activity. The preliminary statistical analysis indicated the measurement scale (and the data, thereof) was suitable for conducting EFA. The empirical data associated with the thirty-nine items exhibited a strong alignment with the four factors proposed by the original HIT-Q, namely egocentric, blaming others, minimizing/labeling, and assuming the worst. Consequently, there has been no elimination of any item. Based on the findings of the EFA, it was observed that the four factors accounted for 73.46% of the total variances in cognitive distortion. The stability of the first-order solution, which yielded satisfactory fit indices, serves to reinforce these outcomes. These results were in line with the findings of earlier studies that developed and validated the scale [23,25,67].
The results of the reliability analysis indicated good scores for internal consistency and temporal stability, as evidenced by the satisfactory inter-item correlations and the consistency of test-retest measurements. The findings of the exploratory analysis indicated the A-HIT-Q [1] demonstrated item homogeneity and exhibited satisfactory internal consistency across the various dimensions of the scale. The reliability estimates have also been confirmed in previous studies (e.g., [23,25,67]). The strong internal consistency reliability confirms the items on the A-HIT-Q and for the respective domains offer a high level of precision with low measurement errors when used to measure the construct in question.
The results from the CFA demonstrated the robustness of the measurement of the A-HIT-Q. These results are in line with those of previous studies evaluating the psychometric properties of the HIT-Q and validating the instrument among different adolescent populations. Several versions of the HIT-Q have been developed, including French [22,23], Italian [40], Portuguese [25], Spanish [26], and German [27]. These studies have shown the HIT-Q had acceptable reliability and validity indicators in relation to different adolescent populations concerned. Furthermore, in their meta-analysis study conducted in 2015, Gini and Pozzoli confirmed that the reliability indices of the four subscale scores from the HIT-Q were adequate in terms of assessing cognitive distortions [39]. In addition, several other studies conducted to validate the HIT-Q with students, also confirmed a similar pattern of results in terms of construct validity, supporting the first-order four-factor structure [57,58,59].
The second objective determined the criterion validity of the HIT-Q measure by examining the association between cognitive distortions and other key variables, namely, gender, age, study levels, anxiety, depression, and insomnia. The results obtained showed that these distortions varied according to physical/sporting activity participation, anxiety, depression, and insomnia. Cognitive distortions increased with lower levels of physical/sporting activity participation and higher levels of anxiety, depression and insomnia. Our findings are consistent with those of several recent studies showing that cognitive distortions are related to insomnia, depression, and anxiety [67,68,69,70]. School adolescents suffering from insomnia and/or anxiety and depression generate higher cognitive distortions than those who are not suffering. In this study, we found depression as a significant predictor of cognitive distortion, just like physical activity and sports participation. Relatedly, other scholars have confirmed the findings in this study, indicating that the presence of cognitive distortions was more closely associated with severe depression, anxiety, and insomnia [71,72].
The result also established the existence of a non-significant association of cognitive distortions with gender, age, and study levels; this result contradicts what is found in several previous studies [73,74]. Interestingly, pieces of research evidence in the literature have found that cognitive distortion did not vary based on gender, age, and study levels of adolescent learners [75,76]. Several reasons could explain the non-significant variations in distortion levels of adolescents based on gender, age, and study levels. A key factor is the element of culture; these adolescents, regardless of their demographic background are influenced by cultural variables. This understanding is based on the notion that culture shapes cognitive distortion and thus, how individuals think can be a function of the way of life, values, and beliefs of the society they find themselves [77]. We also emphasize that, unlike psychological distress levels or sleep patterns that are situation-specific and that the individuals could control, individuals do not have control over their demographic variables like gender, age, and study levels. This link might also possibly explain the non-significant prediction of these variables on cognitive distortions [78]. Other statistical determinants can also be strongly linked to these non-variations of cognitive distortion based on demographic variables. For example, the age variability distribution of the adolescents (i.e., 15–22 years) in this study is narrow, and this might explain the non-significant results.
Although the present investigation represents the initial psychometric evaluation of a newly developed Arabic version of the HIT-Q, it is important to acknowledge its inherent limitations. First, the sample size utilized in this study may be relatively small, which could potentially restrict the extent to which the findings can be applied to a broader population of Arabic-speaking countries. Additionally, the representativeness of participants can be influenced by sampling bias [79]. Lastly, it is important to note the generalizability of the findings to different populations or age groups may be restricted, and the potential impact of external factors on the observed associations has not been explicitly examined.

5. Conclusions

The study adapted and validated the HIT-Q in the Arabic language using adolescent school children. The results indicate the A-HIT-Q scale demonstrates a first-order, four-factor structure that is appropriate for assessing cognitive distortions in the adolescent population. The instrument demonstrates a high level of reliability and exhibits strong construct validity. The A-HIT-Q is correlated with anxiety, depression, insomnia, and physical activity participation, thus demonstrating its criterion validity. The A-HIT-Q is a psychometric tool that demonstrates high efficacy in assessing the levels of cognitive distortions among adolescent students residing in Arabic-speaking regions.

Author Contributions

Conceptualization, F.A., A.T. and T.S.; methodology, F.A. and T.S.; software, F.A. and A.T.; validation, F.A., A.T. and T.S.; formal analysis, F.A.; investigation, F.A. and T.S.; resources, F.A. and A.T.; data curation, F.A., A.T. and T.S.; writing—original draft preparation, F.A. and A.T.; writing—review and editing, F.Q., M.S.-S., J.E.H.J., C.A., H.B., N.C., G.B., I.G., M.I.L., M.D.A.A.-H., A.W.M.S.A.-R. and N.M.N.A.-S.; supervision, F.A.; funding acquisition, J.E.H.J. All authors have read and agreed to the published version of the manuscript.

Funding

This study received no external funding. However, the authors sincerely thank Bielefeld University, Germany, for providing financial support through the Institutional Open Access Publication Fund for the article-processing charge (APC).

Institutional Review Board Statement

Following adherence to the last Declaration of Helsinki (2013), the protocol was fully approved by a local research ethics committee of the High Institute of Sport and Physical Education of Kef, University of Jendouba, kef, Tunisia, with reference number (n◦ 035/2020) dated 30 October 2020.

Informed Consent Statement

An informed consent form was received and completed by each participant.

Data Availability Statement

The original contributions presented in the study are included in the article. Further inquiries can be directed to the corresponding author.

Acknowledgments

The authors would like to thank all those who participated in this study.

Conflicts of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest.

Appendix A. Factor Matrices of the Dimensions of the Arabic-How I Think Questionnaire

Table A1. Factor matrices of the dimensions of the Arabic-How I Think Questionnaire.
Table A1. Factor matrices of the dimensions of the Arabic-How I Think Questionnaire.
Factors
1234
ANT10.0290.0730.0000.793
ANT20.0030.049−0.0400.750
ANT3−0.0250.047−0.0210.830
ANT40.0400.070−0.0260.842
ANT50.0210.086−0.0210.888
ANT60.0450.073−0.0110.781
ANT70.062−0.0090.0190.792
ANT80.0300.0100.0230.816
ANT90.0430.0320.0220.785
ANT100.0960.0260.0190.713
ANT11−0.0220.0020.0440.765
EGO120.0510.9040.0700.026
EGO130.0920.8730.0320.076
EGO140.1000.8790.0510.036
EGO150.0490.8980.0110.071
EGO160.0900.8860.0630.075
EGO170.0890.8970.0500.044
EGO180.1000.8780.0060.043
EGO190.0920.8900.0360.059
EGO200.0420.9130.0500.029
MINI210.9040.0910.077−0.005
MINI220.9330.0820.0810.053
MINI230.9060.1060.0480.057
MINI240.8770.0600.061−0.010
MINI250.9060.0770.0620.050
MINI260.8910.0650.0860.025
MINI270.8680.0830.0260.057
MINI280.8980.0970.0540.092
MINI290.8390.0500.0200.016
BLAM300.0510.0480.8400.004
BLAM310.0700.0750.8430.016
BLAM32−0.0030.0020.8130.006
BLAM330.0660.0520.8370.005
BLAM340.0810.0280.8370.021
BLAM350.0360.0470.831−0.031
BLAM360.0640.0410.830−0.031
BLAM370.0110.0200.851−0.001
BLAM380.0580.0420.8590.032
BLAM390.0690.0100.841−0.010
Footnote: (ANT): assuming the worst; (EGO): egocentric; (MINI): minimizing; (BLAM): blaming others.

Appendix B. Model of the Confirmatory Factor Analysis of the Arabic-How I Think Questionnaire

Psych 05 00083 g0a1
Figure A1. Model of the confirmatory factor analysis of the Arabic-How I Think Questionnaire.
Figure A1. Model of the confirmatory factor analysis of the Arabic-How I Think Questionnaire.
Psych 05 00083 g0a1

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Psych 05 00083 g001
Figure 1. Scree plot with eigenvalues and parallel analysis output.
Figure 1. Scree plot with eigenvalues and parallel analysis output.
Psych 05 00083 g001
Table 1. Fit indices of the confirmatory factorial analysis of the Arabic-How I Think Questionnaire.
Table 1. Fit indices of the confirmatory factorial analysis of the Arabic-How I Think Questionnaire.
Indicesχ2dfχ2/dfGFINFIAGFISRMRCFIPNFIRMRRMSEA
Model1603.796682.400.9030.9470.8870.0280.9680.9680.0400.043
Footnote: N = 762, χ2: Chi-Square, df: Degree of Freedom, GFI: Goodness of Fit Index, NFI: Normed-Fit Index, AGFI: Adjusted Goodness-of-Fit Index, SRMR: Standardized Root Mean Square Residual, CFI: Comparative Fit Index, PNFI: Parsimony Normal Fit Index, RMSEA: Root Mean Square Error of Approximation.
Table 2. Parameter estimates for the prediction of gender, study levels, age, anxiety, depression, insomnia, and physical activity on cognitive distortion.
Table 2. Parameter estimates for the prediction of gender, study levels, age, anxiety, depression, insomnia, and physical activity on cognitive distortion.
ParameterBStd. ErrortSig.95% Confidence Interval
Lower BoundUpper Bound
Intercept2.1510.21010.2400.0001.7392.563
[Gender = Male]0.0460.0351.2930.196−0.0240.115
[Gender = Female]0 an/an/an/an/an/a
Age−0.0130.011−1.2570.209−0.0350.008
Study levels−0.0180.011−1.6890.092−0.0390.003
Physical Activity−0.1010.025−4.0000.000−0.051−0.150
Anxiety0.0250.0063.9530.0000.0130.037
Depression0.0140.0052.6900.0070.0040.024
Insomnia0.0260.0038.5700.0000.0200.032
a This parameter is set to zero because it is redundant; all other estimates are not applicable (n/a). Outcome variable: Cognitive distortion.
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MDPI and ACS Style

Azaiez, F.; Tannoubi, A.; Selmi, T.; Quansah, F.; Srem-Sai, M.; Hagan, J.E., Jr.; Azaiez, C.; Bougrine, H.; Chalghaf, N.; Boussayala, G.; et al. Uncovering Cognitive Distortions in Adolescents: Cultural Adaptation and Calibration of an Arabic Version of the “How I Think Questionnaire”. Psych 2023, 5, 1256-1269. https://0-doi-org.brum.beds.ac.uk/10.3390/psych5040083

AMA Style

Azaiez F, Tannoubi A, Selmi T, Quansah F, Srem-Sai M, Hagan JE Jr., Azaiez C, Bougrine H, Chalghaf N, Boussayala G, et al. Uncovering Cognitive Distortions in Adolescents: Cultural Adaptation and Calibration of an Arabic Version of the “How I Think Questionnaire”. Psych. 2023; 5(4):1256-1269. https://0-doi-org.brum.beds.ac.uk/10.3390/psych5040083

Chicago/Turabian Style

Azaiez, Fairouz, Amayra Tannoubi, Taoufik Selmi, Frank Quansah, Medina Srem-Sai, John Elvis Hagan, Jr., Chiraz Azaiez, Houda Bougrine, Nasr Chalghaf, Ghada Boussayala, and et al. 2023. "Uncovering Cognitive Distortions in Adolescents: Cultural Adaptation and Calibration of an Arabic Version of the “How I Think Questionnaire”" Psych 5, no. 4: 1256-1269. https://0-doi-org.brum.beds.ac.uk/10.3390/psych5040083

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