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Impulsivity in Clinical and Non-Clinical Population

Impulsivity in Clinical and Non-Clinical Population

 

Table of Contents

Summary                                                                                                                                 1

Introduction                                                                                                                           3

  • 1.1 Relevance of impulsivity in the field of impulsivity                                                    6
  • 1.2 Definition of impulsivity                                                                                                  7
  • 1.3 Existing Measures of impulsivity based on Western Models                                    8
  • 1.4 Literature Review                                                                                                               15
    • 1.4.1 Summary literature review                                                                                   27
  • 1.5 Rationale of the Research                                                                                                 28
  • 1.6 Implications                                                                                                                      28
  • 1.7 Aims of the research                                                                                                          29

2 Methodology                                                                                                                       31

Study-I- Scale Development

Phase I

  • 2.1.1 Objective                                                                                                                        31
  • 2.1.2 Research Design                                                                                                            31
  • 2.1.3 Research Paradigm                                                                                                        31
  • 2.1.4 Tradition of Inquiry                                                                                                       32
  • 2.1.5 Data Collection strategies                                                                                              32
    • Focused Group Discussion 32
    • In-depth Interviews 37
    • Preliminary questionnaires 40
  • 2.1.6 Construction of item pool                                                                                              41

Phase II                                                                                                                     

  • 2.1.7 Readability and conceptual relevance of items generated                                   42
  • 2.1.8 Pilot Study                                                                                                                     42

Phase III

Main Study: Data Collection and Statistical Analysis                                                           42

  • 2.2.1 Objective                                                                                                                        43
  • 2.2.2 Research Design                                                                                                            43
  • 2.2.3 Sampling strategy                                                                                                          43
  • 2.2.4 Instruments for data Collection                                                                                     44
  • 2.2.5 Procedure                                                                                                                       44
  • 2.2.6 Statistical analysis                                                                                                          45

Study II

Manifestation of impulsivity in clinical and non clinical population

  • 2.3.1 Objective                                                                                                                        45
  • 2.3.2 Measures for data Collection                                                                                         47
  • 2.3.3 Procedure                                                                                                                       48
  • 2.3.4 Statistical Analysis                                                                                                         49

References                                                                                                                             50

Summary

The aim of the present study would be to develop and standardize an indigenous scale for assessment of impulsivity. It would further aimed at exploration of expression of impulsivity in clinical and non clinical populations. The research will consist upon 2 studies. The first study will be carried out to develop an indigenous tool of state trait impulsivity. This study will be carried out in 3 phases. The first phase will be qualitative in nature following constructivism and phenomenology as research paradigm and tradition of inquiry respectively. The aim of first phase will be to generate a culturally relevant item pool. Data will be collected through focused group discussions, in depth interviews, preliminary questionnaires, DSM 5 criteria of disorders that include impulsivity as characteristic symptom and already existing tools of impulsivity. Focused group discussion (FGDs) will be conducted in which individuals from different walks of life will participate and their views regarding definition, expression and manifestation of impulsivity in Pakistani society will be recorded. Moreover, the researcher will also conduct 5 in depth interviews from individuals who might not be available for FGD due to demanding and time consuming nature of their profession. In depth interviews will be conducted from a police personal, an administrator, nurse and 2 individuals high on impulsivity (1 female, 1 male). The analysis of themes emerging from FGDs and in depth interviews will help in generation of items for tool. Preliminary questionnaires will also be used to gather items. In which 50 individuals from general population will be provided with questionnaires consisting upon open ended questions regarding manifestation, triggers and responses towards impulsivity. Their responses will also be then seen for making any further additions in item pool. The analysis of preliminary questionnaires will specifically be helpfull in developing scenarios for assessment of state impulsivity. Items will also be taken from DSM-5 criteria of disorders that have impulsivity as characteristic symptom and existing tools of impulsivity. After generating an item pool, first draft of scale will be written and evaluated for conceptual clarity and formation of sentences in second phase. A pilot study with 30 individuals from normal population (15 males, 15 females, age range 19 to 25) will be conducted and the feedback and suggestions from participants of pilot study would also be incorporated in the questionnaire and final version of tool will be prepared. In the 3rd phase the latent structure of the scale will be explored.  Data will be collected from students of public and private sector universities in equal number. Sample size would be 3 to 5 times number of items in the scale. Age range of the participants will be 19 to 25 years. Corrected item-to-total correlation will be calculated for each scale of newly developed questionnaire. The latent factor structure of the scale will be explored by applying Exploratory Principal Component Factor Analysis with Oblique Rotation method. Scoring guidelines will be devised. The aim of 2nd study will be to establish difference in expression of impulsivity in clinical and non clinical populations. The questionnaire will be administered to two different groups. Clinical group will consist upon 100 patients suffering from psychiatric conditions in which impulsivity tends to be the characteristic symptom such as Substance Related Disorders, Cluster B of Personality Disorders and Anger related problems. Equal number of participants will be included in non-clinical sample, matched with the clinical group on age, gender and socio economic status. Non clinical sample will be taken from same hospitals but from the individuals who would be either coming with minor general health issues or are care takers of patients. Discriminant function analysis will be carried out to investigate the differences in clinical and non clinical samples. T-test and ANOVA will be applied to explore the psychosocial correlates.

Introduction

Much of the human behavior is governed by a systematized and a quite predictable pattern which usually is laid down by the respective society in which an individual resides. The eminence of culture in formation of human experiences, values, beliefs and behaviors has made its understanding an essential prerequisite of assessment and management of different pathologies.

Impulsivity is a multidimensional construct that is of quite importance in the field of psychology for several reasons. Firstly, because it is a personality trait that plays its role in personality differences (Moeller et al., 2001) and social relationships through emotion-regulation in various social situations (Schreiber, Grant & Odlaug, 2012). Impulsivity has also been empirically proven to be a contributing factor in various mental health concerns (Ersche et al., 2010; Bayle et al., 2003). Interestingly, at the same time it remains the characteristic symptom of a number of psychiatric disorders such as antisocial personality disorder, (Swann et al., 2009) and borderline personality disorder,  attention deficit hyperactivity disorder, obsessive compulsive disorder  and bipolar disorders (American Psychiatric Association, 2013). In Diagnostic and Statistical Manual of Mental Disorders (DSM-5), an entire section is dedicated to disruptive, impulse control and conduct disorders (APA, 2013). Given to the multifold nature of the construct, it has variety in its definitions as well.

Different authors has defined and conceptualized the concept of impulsivity according to their specific theoretical and empirical orientations. It is defined as a tendency to act on spur of a moment and acting without any forethought (DSM-5). Some authors have defined it as having attentional, motor and non-planning dimensions (Patton et al., 1995). While some others defined it in terms of urgency, lack of pre determination, lack of perseverance and sensation seeking (Whiteside & Lynam, 2001). Albeit, the consensus of theorists on trait status of impulsivity, efforts have also been made to assess and describe it in terms of state. Although majority of authors have postulated impulsivity as a negative and debilitating trait and underlying cause of many problematic social and psychiatric problems, Dickman (1990) presented the concept differently. According to his conceptualization, impulsivity is not merely a demerit or dysfunction rather it has a functional side as well. If dysfunctional impulsivity is associated with disorderliness, lack of forethought and tendency to process information quickly and erroneous choices or decisions. On the other hand functional impulsivity includes characteristics of being enthusiastic adventuresomeness and quick decision making that can be helpful in many situations. Apart from being a symptom warranting clinical attention, impulsivity is observed in many social behaviors and in current scenario its relevance is even more signified. According to profuse theorists, impulsivity plays a crucial role in developing relationship between personality and social attitudes (Sargoue, 2005) while social attitudes are the byproducts of culture. A number of empirical investigations have revealed cultural differences in manifestations of diverse psychological constructs including impulsivity (Lynn, 1996; Martin, 1995). Prevalence of impulsivity in general population is reported up to 17% however prevalence estimates are much higher in clinical populations (Chamorro et al., 2012).

A large amount of knowledge in the field of clinical psychology depends on assessment procedures. The need for assessment increases even more when it comes to a phenomenon as diverse and significant as impulsivity. Various scales are developed to evaluate impulsivity according to different perspectives. However, it is worth mentioning that almost all existing scales are somehow narrow in their scope as no scale covers all aspects of impulsivity. Some of the scales for example, focus on cognitive, motor and inattention aspects of impulsivity, while some other assess it in terms of Urgency, lack of predetermination and perseverance, and sensation seeking. A number of personality inventories also contain impulsivity as one of their subscales. However, most of the scales measure impulsivity as a negative personality trait that leads to problems in social life and may end up in development of full blown psychological disorder. But then there is this argument which also carries empirical evidence that impulsivity is not always dysfunctional rather it has also functional aspects. Therefore, there is a need to develop a comprehensive measure of impulsivity that would not only evaluate state plus trait impulsivity but would also point towards a difference between functional and dysfunction culturally relevant patterns in impulsivity. The aim of present research is to construct and standardize a comprehensive indigenous measure of impulsivity that would be according to aspirations of local culture. The present study will serve as a first step in exploration of indigenous meaning and scale development on impulsivity in Pakistan. It would end up with providing a comprehensive indigenous measure of state and trait impulsivity for local population. The tool can further facilitate the future researchers to discover the relationship of impulsivity with various psychiatric conditions and other variables. It could be used in clinical settings in order to identify specific behavioral and cognitive manifestation of impulsivity and device suitable management plans.

The forthcoming section contains a brief review of the relevance of construct in the field of Clinical Psychology. Further, an evolution of various definitions is discussed, followed by a short description of existing measures of impulsivity based on Western models. Establishing culture as a source of variation in experience, expression and manifestation of impulsivity, the need to develop and standardize a comprehensive, sensitive, relevant and representative measure is advocated further.

1.1 Relevance of Impulsivity in the Field of Psychology

Researchers have reported prevalence rates of impulsivity in clinical and non clinical population separately. Chamorro et al., (2012) reported 17% prevalence of impulsivity in general population, more common in males between ages 19 to 25 years. However, prevalence rates are even higher in clinical populations. It is important to investigate the concept of impulsivity in the field of clinical psychology as it is relevant to a number of mental health concerns. Empirical evidence suggests that it contributes importantly to personality differences and externalizing psychiatric disorders (Moeller et al., 2001), such as substance use disorders (Ersche et al., 2010; Moeller et al., 2002), antisocial personality disorder (Swann et al., 2009b), and borderline personality disorder (American Psychiatric Association, 1994). Impulsivity is also associated with risk-taking behaviors, such as driving violations (Paaver et al., 2006), high-risk sexual behaviors (Black et al., 2009), domestic violence (Shorey et al., 2010), gambling (Slutske et al., 2005), kleptomania (Bayle et al., 2003) and with increased probability of adverse outcomes, such as driving-related injuries (Cherpitel, 1999), increased risk of contracting HIV (Bornovalova et al., 2008), being arrested (Nilsson et al., 2010), and undesired pregnancies (Kovacs et al., 1994).  Therefore it represents an important construct contributing to many public health concerns as well.  Because of having a deep impact on everyday living, personality, quality of life and decision-making processes it contributes to psychopathological symptoms and psychiatric illness (Whiteside & Lynam, 2001).  Results of psychiatric epidemiological studies suggest that it is quite common in the general population and it has a great effect on our social relationships through emotion-regulation in various social situations (Schreiber, Grant & Odlaug, 2012).

A profound and lucid understanding of construct of impulsivity is essential for the development of an indigenous tool. As only then one can meet the challenge of operationalizing such a multi-fold construct.

Following section provides definitions of impulsivity according to various symptoms and manifestations.

1.2 Definitions of Impulsivity

According to recent conceptualizations of impulsivity it is a multi-dimensional construct and no one definition covers all aspects of impulsivity. In order to understand the construct of impulsivity fully, one has to consult and combine various definitions.

DSM-5 defines impulsivity as acting on the spur of the moment in response to the stimuli that is immediate, acting quickly without planning or any insight of potential consequences, inability to establish and follow plans (American Psychiatric Association, 2013).

It is also defined as a tendency toward risk taking, lack of planning, and making one’s mind quickly (Eysenck & Eysenck, 1985). According to another definition it refers to novelty seeking (Cloninger, 1987).Impulsivity is also conceptualized as inability to deliberate in comparison to most people of equal ability before taking any action (Dickman, 1990). It also refers to acting on spur of moment, inability to sustain attention and plan ahead (Stanford & Barratt, 1995). Menzies, (1997) defines impulsivity as inability to delay gratification. According to Whiteside and Lyman, (2001) impulsive individuals seek out adventures or thrills.  Impulsivity is further defined as lack of patience, inability to appreciate consequences and propensity for uninhibited behaviors (Reynolds et al., 2001). It also includes a sense of urgency and vulnerability towards self-harm when under stress. (Chamberlain & Sahakian, 2007).  It also comprises giving into cravings, inability to plan or weigh options before deciding (Kirby & Finch, 2010).

Putting all the definitions together impulsivity can be defined as inability to sustain attention, quick responding with little foresight of potential consequences, sense of urgency, impatience, inability to delay gratification and plan ahead. These individuals long for excitement and novelty, get bored easily and are unable to follow routine.

1.3 Existing Measures of Impulsivity Based on Western Models    

Established the multifaceted nature of the phenomenon, a number of efforts have been made to evaluate impulsivity focusing on multiple dimensions. These endeavors have produced a number of different solutions, typically resulting in a two to four lower order impulsivity factors, which can be referred as types of impulsivity as well (Tomko et al., 2013).

Barratt and colleagues (Barratt, 1993; Gerbing, Ahadi & Patton, 1987; Patton, Stanford, & Barratt, 1995; Stanford & Barratt, 1992) have developed one of the most comprehensive approaches to impulsivity by including information from four varied perspectives: the medical model, the psychological model, the behavioral model, and the social model. These researchers (Patton et al., 1995) have identified three factors which they argue, are the different components of impulsivity.

  • Attentional impulsiveness refers to the inability to focus on the tasks at hand and cognitive instability.
  • Motor impulsiveness involves acting on the spur of the moment and lack perseverance.
  • Non-planning type of impulsivity refers to inability to plan ahead, plan tasks carefully and finish the started tasks.

Based on their conceptualization of impulsivity, Barratt and colleagues has developed Barratt Impulsiveness Scale (BIS-11; Patton, Stanford & Barratt, 1995) is a 30 item scale that evaluates 3 dimensions of impulsivity i.e. attentional, cognitive and motor impulsivity. That is so far most frequently used measure of impulsivity.

Five Factor Model of Personality (FFM, Costa & McCare, 1992) is perhaps the most influential and widely accepted model. It describes personality in terms of 5 broader traits, each with 6 sub factors, called facets. The major domains include Neuroticism, Extraversion, Openness to Experience, Agreeableness and Conscientiousness. NEO-Personality Inventory is based on FFM that evaluates personality according to these 5 dimensions. Impulsivity is part of its 4 facets on 3 major domains. It is included in impulsivity facet of neuroticism which assesses an individual’s predisposition towards giving into strong impulses under negative affect such as Depression, Anxiety and Anger. Excitement seeking is facet of Extraversion, which refers to preference for excitement and stimulation. The next two impulsivity related facets are from the dimension of Conscientiousness i.e. self-discipline and deliberation. The former is the ability to complete boring or effort full tasks while later refers to thinking about potential consequences of an action. In this way, FFM comes up with a plan to describe impulsivity and impulsivity related personality traits.

Based on the initial work of Costa and McCare, (1992), Whiteside and Lynam (2001) discussed that FFM provides 4 distinct pathways to impulsivity, dispersed over its 3 domains and 4 facets. They developed four factor model of impulsivity, through factor analysis of widely used impulsivity scales including 4 scales of NEO-PI. As a result they had clear cut four factor solution and the traits were loaded on unique factors without any overlap. The factors were named as;

  1. Urgency (Impulsiveness, Neuroticism)
  2. (Lack of) Premeditation (Deliberation, Conscientiousness)
  3. (Lack of) Perseverance (Self-Discipline, Conscientiousness)
  4. Sensation Seeking (Excitement Seeking, Extraversion)

Premeditation reflects the ability of an individual to consider and foresee the repercussions of a behavior or act, lack of premeditation however emerges to be the most common expression of impulsivity (Whiteside & Lynam, 2001). Perseverance reflects the capability to stay on a boring or difficult job (Whiteside & Lynam, 2001). The primary feature of the ability of sticking to a boring, difficult and not immediately rewarding task lies in the ability to control the temptation to engage into something that has more immediate gratification associated with.  Sensation Seeking reveals readiness to seek excitement through novel even risky experiences (Zuckerman, Kuhlman, Joireman, Teta, & Kraft, 1993).  Urgency includes the inclination towards having strong impulses often under conditions of negative affect that can cause impulsive behaviors in order to get rid of negative emotional states in spite of damaging consequences in the long run (e.g., overeating, abusing drugs, or speaking or arguing rashly). Nevertheless, after the publication of the original UPPS model a measure of positive urgency was developed based upon the hypothesis that strong positive affect can also cause impulsive actions with detrimental outcomes (such as celebratory binge drinking by college students or resumption of gambling by pathological gamblers) (Cyders et al., 2007). The scale contains 45 items and four subscales i.e. urgency, predetermination, perseverance and sensation seeking.

Zuckerman and colleagues similarly have conferred impulsivity in terms of a general model of personality. Zuckerman, Kuhlman, Thornquist and Kiers (1991) began the development of an alternative five-factor model through the factor analysis of a number of general personality inventories. They identified a factor consisting of the four subscales from Zuckerman’s Sensation Seeking Scale (Zuckerman, 1994). They reported the subscales as thrill and adventure seeking, experience seeking, disinhibition and boredom susceptibility.

Above discussed measures along with many other assess impulsivity in terms of a detrimental and injurious trait that can lead to reckless behavior resulting in unfavorable consequences. Although efforts are being made to explore positive urgency through inclusion of impulsive acts done under positive affect such as euphoria or excitement but in the long run positive urgency also bears negative consequences, which the individual is unable to foresee.

Dickmann (1990) took the stance and presented the concept of impulsivity in a different way. He emphasized that impulsivity has both dysfunctional and functional components.  According to his conceptualization, dysfunctional impulsivity is a tendency to act with less forethought than most people of equal ability when this tendency is a source of difficulty. However, functional impulsivity is defined as a tendency to act with relatively little forethought when such a style is optimal. Functional impulsivity can lead a person towards quick decision making, spontaneity and present mindedness.  He has argued that dysfunctional impulsivity is associated with disorderliness, a tendency to ignore hard facts when making decisions, acting without fore thought, and a tendency to engage in rapid, error prone information processing because of an inability to use a slower, more methodical approach under certain circumstances. On the other hand, functional impulsivity is associated with enthusiasm, adventuresomeness, activity and an ability to engage in rapid error prone information processing when such a strategy is endured optimal by the individual’s other personality traits. Based on his hypothesis of the presence of two different traits: Functional Impulsivity (FI) and Dysfunctional Impulsivity (DI), he fruitfully constructed the Dickman Impulsivity Instrument in order to differentiate between the traits, and established that both differ in their personality and cognitive correlates.

Combining the discussed models and measures based upon them, impulsivity can be referred as tendency to act on cravings, inability to foresee consequences of any behavior, inability to plan ahead, recklessness, inability to delay gratification, boredom proneness and inconsistency in staying with the tasks in hand. It also includes a component of longing for new and exciting experiences. There are also a couple of theories emphasizing on positive dimensions such as positive urgency and functional impulsivity.

According to profuse theorists, impulsivity plays a crucial role in developing relationship between personality and social attitudes (Sargoue, 2005) while social attitudes are the byproducts of culture. The intonation of emotions also differs across the cultures as culture provides individuals with essential guidelines about the ways of evaluating and responding towards a certain situation. Again, the nature of culture determines which emotion to express, where to express and how to express. A number of empirical investigations have revealed cultural differences in manifestations of diverse psychological constructs such as rhetoric, experience, recognition and expression of emotions (Rintell,1984; Britt & Janus, 1940; Dryden 1999; Soto, Levenson & Eling,2005; Matsumoto,2009; Ramirez, Fujihara & Van Goozen,2001; Mesquita & Walker, 2002; Elfenbein & Ambady,2003; Aiozawa & Whatley, 2006), attributional styles (Al Zahrani & Kaplowitz,1993) and emotional intelligence (Gokcen, Furnham, Mavroveli & Petrides, 2014;  Gunkel, Schlagel & Engle, 2014).  A number of studies have reported cross cultural differences on different measures of personality (Barrett, Petrides, Eysenck, & Eysenck, 1998; Furnham, Eysenck, & Saklofske, 2008; McCrae, Terracciano, et al., 2005). Results consistently show that whilst the structure of the personality measure is reliable and similar across countries, there are small, replicable, and meaningful national mean score differences between them. Eysenck big five traits have been explored in its reference to cultures and correlations to sociodemographic variables. Lynn (1981) reported difference on the scores of neuroticism across 22 countries. He attributed these differences to political, social and economical instability along with war and climate of different regions. As all these variables were directly correlated with scores of neuroticism in different countries. Lynn also reported that higher levels of extraversion are found in more affluent nations. Lynn and Martin (1995) reported that national mean scores on Extraversion, Neuroticism and Psychoticism scales of 37 countries correlated with demographic variables such as per capita income, literacy rate, work attitude and anxiety scores. Since big five has been the most influential theory of personality in recent years and impulsivity appears as a facet of at least 2 factors of personality somehow i.e. neuroticism, and extraversion. Hence, it might be fair enough to expect that the local population would manifest impulsivity differently as compared to samples from other parts of the world.

However, one limitation in assessment of impulsivity is dearth of any comprehensive tool for the construct that can measure state and trait impulsivity. Moreover, all the measures described above have been constructed in different parts of the world with entirely different populations.  Since impulsivity is a phenomenon that is influenced by socio cultural factors, so it would not be prudent to study such culturally embedded construct through assessment tools developed somewhere else for some other population. Furthermore, a number of researchers have reported differences on latent factor structure of measures of impulsivity across various cultures. These reported differences on factor structure of impulsivity scales are somehow proportionate to the disparity among respective culture of the respondents. The aims of the present study are therefore multi folded. First of all it is aimed at exploration of phenomenon of impulsivity in cultural context. The resulting information would be used for generating item pool for development of a comprehensive indigenous measure of impulsivity. The measure will further be standardized and norms for local population will be developed.  After that a comparison will be made regarding expression of impulsivity in clinical and non clinical populations.

Literature Review

In the forthcoming section empirical evidence in the form of scientific research literature related to measures of impulsivity is reported. Measures of impulsivity based on Western perspectives are discussed. Indigenous researches exploring the phenomenon of impulsivity in reference to its association with various variables are discussed further.

There is body of evidence that indirectly point to the existence of cultural differences in impulsivity (Dianne, Hermert, Fons, Vijver, Poortinga & Georgas, 2001; Chico, Tous, Lorenzo-Seva & Vigil-Colet, 2003). Cultures differ in appraisals that lead to emotion (Matsumoto, Kudoh, Scherer, & Wallbott, 1988; Mauro, Sato, & Tucker, 1992; Roseman, Dhawan, Rettek, & Naidu, 1995; Scherer, 1997, 1997), and these might correspond with situation selection. Cultures differ in emotional expression (Matsumoto & Kupperbusch, 2001) and in the rules governing their modification called display rules (Matsumoto et al., 2005; Matsumoto, Yoo, Hirayama, & Petrova, 2005).

In a meta-analysis Dianne et al., (2002) explored the psychological meanings of individual and country level scores on Eysenck Personality Questionnaire (EPQ). They explored the data of 24 countries including Australia, Bangladesh, Brazil, Bulgaria, Canada, Chile, China, Czechoslovakia, Egypt, Finland, France, Greece, Hong Kong, Hungary, Iceland, India, Iran, Ireland, Israel, Italy, Japan, Netherlands, Nigeria, Norway, Poland, Puerto Rico, Russia, Saudi-Arabia, Singapore, Spain, Sri Lanka, Sweden, Uganda, United Kingdom, United States, West-Germany, Yugoslavia and Zimbabwe. The studies were included in which EPQ was administered on non clinical populations. 153 studies were analyzed in total. A multistep analysis was used to calculate results. The latent factor structure of the entire data was explored through exploratory factor analysis.  In the next step, pooled within country correlation matrix for individual level scores were calculated based on inter correlations for each country. The results showed that in certain countries such as China, India, Japan, and Uganda the correlations of the four EPQ scales were different from others. The researchers postulated that those differences could have been due to translations, characteristics of the sample, variety in administration or difference in construct. However, specific sources of differences were not discussed by the authors. The results further revealed that constructs of extraversion and neuroticism had similar psychological meaning within and across countries; however psychoticism and social desirability had different meanings in different countries. The researchers concluded that factorial structure of EPQ scales were different at individual and country levels. The contributing factors towards the difference were reported to be education level, per capita income, perception and existence of democracy and collectivistic or individualistic nature of society. Since impulsivity has been conceptualized as a personality trait in Eysenck’s personality taxonomy ( Eysenck and Eysenck, 1963; 1985)  so when we say that variability exists in meaning and expression of big five personality traits across the cultures that applies to the construct of impulsivity as well (Chico, Tous, Lorenzo-Seva & Vigil-Colet, 2003).

Lecrubier, Braconnier, Said and  Payan (1995) reported preliminary results of  a new scale named as Impulsivity Rating Scale (IRS). The aim of their study was to develop a hetro-evaluation instrument to measure state impulsivity in real life situations. They authors presented impulsivity as a heterogeneous construct that is present in a variety of behaviors. They based their item pool on commonly reported dimensions of impulsivity i.e. difficulty in delay, poor control of behavior, rapid responses towards a situation without evaluating the consequences, crankiness and hostility. Those dimensions were chosen because they can be easily translated in to observable behaviors. The earlier version of scale had 10 items, 3 were excluded because of lack of specificity and loading on multiple factors. The final version consisted upon 7 items that evaluate impulsivity in terms of irritability, patience-impatience, time needed for decision making, capacity to pursue an activity, aggressivity, control of response and capacity for delay. In order to assess current behavior, items were generated applying one week rule i.e. the respondents had to answer the question keeping in mind last week.  The scale was administered on 5 different samples. The first group of participants included 31 patients of different psychiatric disorders with impulsivity being the characteristic symptom. The patients were included in this group irrespective of their diagnosis. This group was evaluated by a clinical expert of impulsivity through a visual analogue scale. The second group included 36 adult patients of major depression disorder. Their diagnosis was confirmed using DSM-III criteria. The third group had 15 normal controls. The IRS was administered on these three groups once; however the sensitivity of the scale was assessed by repeated administration on two groups. One group included depressed adolescents n= 47. This group was assessed before and after 4 weeks use of antidepressants in order to evaluate change in scores obtained over the treatment period (decrease in total impulsivity score was expected). The second group was of smokers n=56, who were assessed before and one week after cessation of tobacco (when they were under withdrawal) to explore the difference in scores (increase in impulsivity scores were expected). Impulsive vs. non impulsive groups were compared. The correlations between expert opinion (visual analogue) and total score on IRS were calculated that revealed validity of scale. A principal component analysis using varimax rotation was calculated using data from impulsive and smokers only, as in non-impulsive control groups scores on most of the individual items were close to 0. Number of factors was determined using Kaiser’s criteria (Kaiser, 1970). The results revealed that in impulsive group the intercorrelations between total score on IRS and evaluation by clinical experts (visual analogue scale) were 0.76 that indicates satisfactory criterion validity. The total scores of depressed adolescents were different at pre and post level however very small difference was observer in smokers group. Principal component analysis (without rotation) showed that one main factor explained 37% variance in smokers group and 55% in impulsive group. A second factor that was related to two items is needed to re confirm in larger samples however.

Maloney, Grawitch and Barber (2011) employed a research to access the uni-dimentionaility and validity of Brief Self –Control scale (BSCS; Tangney, Baumeister, & Boone, 2004). Three samples were chosen to define, revise and test a multi factor version of BSCS. Sample 1 consists of 909 adults across the Midwest, of the age range 30 (75%) and 76% were females. Subjects were recruited for four separate surveys research studies. Three studies were done on samples (n=379, n= 96, n=104) chosen via a departmental research pool whereas fourth study was done on sample (n=330) of working adults who were contacted by email or to participate online. Sample 2 consist of 364 students (predominantly 68% females) of age range 19.88 (S.D=1.90) from a private Midwestern university by departmental research pool to complete online survey design. Sample 3 included 175 public sector employees (51% females) of average age range 45.06 years old (S.D=10.08)., All the three samples filled the online survey The BSCS (Tangney et al., 2004) whereas third sample also completed the measures of counter productive workplace behavior checklist (Spector et al., 2006) and the Emotional Exhaustion Scale of the Maslach Burnout Inventory-General Survey (Maslach & Jackson, 1986). Principle axis factoring (PAF) with Direct Oblimin rotation was used initially on sample 1a (n=455), confirmatory factor analysis CFA was used to construct measurement for each factor in sample 1b (n = 454). When items appropriateness was identified in sample 1, CFA was used to examine model fit and compare the revised model to two 1-factor models in sample 2. Path analysis was conducted on sample 3 to predict self-report affective and behavioral outcome. Restraint and impulsivity were identified in result of study 1; results of study 2 demonstrated that 2 factor structure is more appropriate than 1 factor structure. Whereas result of study 3 emphasize on the utility of multi factor BSCS. Results suggested that rather than aggregating these factors in a single scale, it would be more appropriate to test these factors individually to test previous theories and to get precise results.

Schmidta, Fallonb and Coccaroa (2004) conducted a research to construct a tool (Lifetime History of Impulsive Behaviors; LHIB) and presented its psychometric properties for clinically significant impulsive behavior. Two groups comprised of personality disorder and control group were included in the study.22 Participants (male; n=7, females; n=15) age 21-56 years with mean age (39.29) completed a semi structured interview to measure impulsivity. After completing the structured clinical interview.11 participants were found with personality disorder diagnosis according to DSM-IV.  Self-report measures of depression, anxiety and social desirability. Self-report and laboratory analogue measures of impulsivity and LHIB were administered to both groups. Internal consistency was calculated by using cronbech alpha. Test retest reliability was assessed by pearson product moment correlation coefficient and paired t-tests.  LHIB had a high internal consistency and acceptable test retest reliability. Concurrent construct validity was also validated when LHIB was correlated with other self-report measures. No significant difference was observed between informant and subject interviews by using paired t-test. MANCOVA was administered to determine discriminant function and scores showed a correct classification of subjects. Discriminant validity was evaluated by Beck Depression Inventory, State Trait anxiety inventory and empathy with LHIB. There was no relationship found between LHIB and laboratory analogue measures because laboratory measures might have observe some aspects of broad construct of impulsivity. Results suggested LHIB as promising and suitable tool for measuring impulsivity.

Billieux et al., (2012) conducted a study to develop a brief 20 item French version of UPPS-P. Laynam et. al. (2006) developed a 59 item UPPS-P scale to measure five components of impulsivity, negative urgency, positive urgency, lack of premeditation, lack of perseverance, and sensation seeking. 650 undergraduate psychology students with fluent French speaking (84.77%) female age range 17-25 years (mean=21.97, S.D= 4.89) were included in study. The participants filled UPPS-P at their university class rooms. A subgroup was (n=145) used to check the test retest reliability after duration of two weeks. External validity of scale was determined by using Alcohol use Disorder Identification test, trait anxiety inventory and beck depression inventory on another subgroup of 105 participants. Confirmatory factor analysis (CFA) was used in the current study. Four models were used to consider the relationship of 4 components of impulsivity. First model identified single unitary impulsivity construct, second model identified 5 interrelated impulsivity constructs, third model identified 3 interrelated factors (namely urgency, sensation seeking, lack of conscientiousness) and forth model identified lack of premeditation and lack of perseverance respectively. Two tailed Pearson correlation was used to find the relationship of facets of UPPS-P. Results demonstrated that short French version of UPPS-P is a valid tool for both clinical and research use.

Gao, Zhang and Cuhxian  (2011) evaluated the validity of Dickman impulsivity instrument by using impulsivity traits for suicide victims and living controls in rural china. Psychological autopsy was used on the 392 suicide victims and 416 controls participants. Exploratory factor analysis was used to hypothesize the validity. Internal consistency was determined using Cronbach’s alpha. Spearman rank correlation coefficients between STAI Trait Anxiety Inventory, Coping Responses Inventory and Dickman Impulsivity Instrument were calculated to assess the convergent validity. In order to find the results functional and dysfunctional impulsivity was extracted from both samples. The mean of DI (Dysfunctional impulsivity) scores in suicide cases was more than that in controls, but it was inverted for FI (Functional impulsivity). There were no significant differences between DI and FI in suicide cases, but in controls the mean of DI scores was significantly smaller than that of FI. The results showed that Dickman impulsivity instrument can be used to determine the impulsivity trait in China, because the current results are similar as given in other international studies.

Standfort & Barrat (1995) employed a research study to revise Barrat impulsiveness scale (version 10). In tenth version, scale measured the impulsivity factors of normal individuals whereas in 11th version, the impulsivity scores of normal individuals are compared with psychiatric patients and prisoners. Group 1 consisted of 412 college undergraduates (279 females, 130 males, 3 student didn’t mentioned their gender), group 2 consisted of 248 psychiatric patients and 73 male prisoners were included in the study. Pearson product moment, t-tests, exploratory principal component analysis (PCA) were chosen for study. Inter-correlation matrix was employed to primary factors to explore the high order factors. Internal consistency was explored with the help of cronbach alpha. ANOVAs were used to find out the significance of between group differences. Two of the three proposed subsets by Barrat were consistent as hypothesized but no cognitive impulsivity was evidenced in the results. Results explored internal consistency of Barrat Impulsivity Scale 11 and it was suggested as a useful tool to measure impulsivity for clinical patients and prisoners.

Pentz and Willis (2012) developed a scale to measure impulsivity. Previous literature was consulted to explore the four dimensions of trait impulsivity. These dimensions were comprised of sensation seeking, lack of premeditation, lack of perseverance, and urgency. A tool was developed on the basis of these dimensions. 40 college students were included in the study initially but due to missing data, 32 students were included in study. BIS-11 was employed on the subjects as it is pre validated scale for impulsivity. Internal consistency was explored by Cronbach alpha. Correlation between the two scales, BIS and CCK was significant. Hence results suggested a higher external validity of CCK impulsivity scale validation.

Caci, Nadalet, Bayle, Rober and Boyer (2003), explored the factor stability of Impulsiveness-Venturesome-Empathy Questionnaire (IVE-7; Ganansia , Eysenck , Eysenck 1971) in English and German cultures. The IVE-7 is a 54-item questionnaire in a yes/no format that includes three scales: Impulsiveness (19 items), Venturesomeness (16 items), and Empathy (19). It was translated into French and back translated into English. The sample consisted upon students of Nice- Sophia Antpolis University. 561 students, 197 males and 364 females (with their majors in Psychology, Nursing, Medicine and Management Sciences) participated in the study voluntarily.  Data were collected through IVE-7, Barratt’s Impulsivity Scale (BIS-10; Patton, Stanford & Barrat, 1995) and State Trait Anxiety Inventory (Spielberger, 1983). Students filled out the French version of IVE-7 and other questionnaires, and data were analyzed for males and females separately. The scales reliabilities are similar between languages for IMP and VENT. The exploratory factor analyses revealed two acceptable three factor solutions, although they failed to clearly identify the third factor. The factor similarity between genders was found very satisfactory using three different methods. The French and English factorial solutions also showed a very good level of similarity in each gender. Finally, the IMP was positively correlated with the Motor Impulsivity subscale of the Barratt Impulsivity Scale-10 (BIS-10) and with Dickman’s Dysfunctional Impulsivity scale, and independent of the Spielberger Trait-Anxiety Inventory (TAI). It was concluded that IMP and VENT are relatively stable between cultures and can be used reliably in French speaking samples. However, the information related to Asian cultures in this regard is missing.

Chahin, Cosi, Lorenzo-Seva and Vigil-Colet (2010) investigated the stability of the factor structure of Barrat’s Impulsivity Scales for children across cultures by comparing the samples from Spain and Colombia. The study had two main objectives i.e. to adapt the BIS 11-c to a culture other than the Spanish one and to assess its factorial structure. While the second objective was to compare the factor structure obtained from the Spanish sample with the factor structure obtained from the Colombian sample. The participants were 616 children (306 boys and 310 girls) aged between 8 and 16 years with a mean of 13 years (SD=2 .38) from one private and two state schools in Bucaramanga (Colombia). They were from medium-low and low social classes, respectively.  The sample used for comparison (Cosi et al., 2008) consisted of 413 children (186 boys and 227 girls) aged between 9 and 13 years with a mean of 11 years (SD= .92). The children came from thirteen schools in Reus (Spain), which were randomly chosen from the state schools and state-subsidized private schools in the town. Barrat Impulsivity Scales-11 for children (Cosi et al. 2008) was administered in class room setting. The BIS-11c consisted of 30 items with a 4-point response format (Never/Almost Never, Sometimes, Often, Always / Almost always). Answers were scored with 0, 1, 2 and 3, respectively. Consensus Oblimin Method was used to analyze the data that is a multi-step method. 21 items out of 26 were modified to have similar factor structure, after which both adaptations came up with almost same number of factors and patterns of factor loadings. However, the results reflected bad fit for strong invariance model, which was attributed to test bias, procedural differences and differences in sample characteristics by the authors. The researchers emphasized the importance of considering linguistic and cultural issues during test adaptation even in similar cultures.

One of the conceptual definitions of impulsivity is inability to delay gratification (Ersche et al., 2010; Moeller et al., 2002), which is often manifested in form of overspending and impulsive buying. Impulsive buying is defined as “an unplanned purchase” that is characterized by relatively rapid decision-making and a subjective bias in favor of immediate possession (Rook & Gardner, 1993; Rook, 1987; Rook & Hoch, 1985). It is described as more arousing, less deliberate, and more irresistible buying behavior compared to planned purchasing behavior. Cacen and Lee (2002) conducted a research to explore the effect of culture on consumer’s impulsive buying behavior. The study was conducted in two phases. The first phase involved preliminary study. The data was collected from 4 countries; 2 from individualistic cultures i.e. Australia (n=131) and United States114 (n=) and 2 from collectivist cultures i.e. Singapore (n=184) and Malaysia (n=160) (Hofstede, 1991). Sample consisted upon 706 students and non students. The participants were to respond on a set of questions that included questions on impulsive purchasing behavior, respondents’ independent and interdependent self-concept (Singelis, 1994), trait buying impulsiveness (Rook & Fisher, 1995), and demographic items including the country in which respondent currently lives, and whether this country is the one she or he has lived in most of his or her life. The findings highlighted a significant difference impulsive buying between consumers in Western versus Eastern cultures. In the main study, a survey was administered to 481 students at large universities in five countries: Australia (n = 61), the Midwestern United States (n = 168), Singapore (n = 72), Malaysia (n = 53), and Hong Kong (n = 62). The mean age across all respondents was 24 years (range 19 to 45 years). As part of a larger study, participants were asked to respond to questions concerning a recent spontaneous clothing purchase, and then to answer a more general set of questions relevant to this study regarding their trait and behavioral impulsiveness. The word “impulsive” was more value-laden in some cultures so the more neutral “spontaneous” was used, consistent with the historical operationalization of impulsive buying as “a purchase characterized by spontaneity” (O’Guinn & Faber, 1989). Fisher’s z test and moderated regression analysis were used to analyze that data. The associations between trait buying impulsiveness and impulsive buying behavior were explored in terms of cultural region (individualist–collectivist), ethnicity (Caucasian–Asian), and individual difference (independent–interdependent self-concept). The results of the main study provide further evidence that culture affects the relationship between trait buying impulsiveness and impulsive buying behavior at the cultural grouping and individual difference levels. Compared to Caucasians, Asians engage in less impulse buying behavior due to trait buying impulsiveness.

There are many studies that have documented cross-cultural differences on many variables conceptually related to personality, such as self-enhancement or optimism-pessimism (Heine et al.,2001; Heine & Lehman, 1995), self-esteem (Kitayama, Markus, & Lieberman, 1995), emotion and affect (Iwata & Higuchi, 2000; Kitayama et al., 1995b; Mesquita, 2001; Mesquita & Karasawa, 2002), attributions (Miller, 1984) emotional regulation (Matsumotto, 2006) and religiosity (Pearson, Francis & Lightbown, 1986; Saroglou, 2002). These previous findings have been invariably interpreted to have occurred because of cultural variables.

In Pakistan, phenomenon of impulsivity has been explored in combination with various other variables such as impulsive buying ( Bashir, Zeeshan, Sabbar, Hussain & Sarki 2013; Shajahan, Qureshi & SaifUllah, 2013) driving anger and frustration tolerance.  Sitwat & Manzoor, (2009) studied the relationship of Frustration Tolerance and Impulsivity with Driving Anger A Purposive sample of 279 participants was taken from University of the Punjab, Lahore which included 179 students, 50 teachers and 50 employees. The mean age of the sample was 27 years. Measures used in the study included Driving Anger Scale, new self-report measure of Impulsivity and Frustration Tolerance Scale of Symptom Checklist-R. After taking consent from the participants’ data was collected. Regression analysis showed that impulsivity was a significant predictor of driving anger in students whereas in employees’ frustration tolerance was a significant predictor of driving anger. None of the variables predicted driving anger in teachers’ group.

Another indigenous study was conducted by Jafri and Yousaf (2013) with an aim to explore the relationship between impulsivity, anger and attitudes towards suicide among adolescents. The study was carried out using a within group design. A sample of 265 adolescents (15-19yrs) 129 boy and 135 girls was taken through disproportionate random sampling from different schools and colleges of 4 towns of Lahore. Barratt’s impulsivity scale (BIS; Patton, Stanford & Barrat, 1995), Multidimensional anger inventory (MAI- Seigel, 1986) and Attitudes towards suicide (ATTS; Renberg & Jacobson, 2003) were used to collect data. Correlation analysis revealed that anger out subscale of anger inventory was most significantly correlated with attitudes towards suicide. There was no gender differences found on the variables.  

 1.4.1 Summary of Literature Review

Impulsivity is a widely researched construct. Extensive research has been carried out in order to explore its relationship and association with different personality traits and disorders (Evenden, 1999). Focus of most of research in the area of impulsivity has been the outcomes or consequences of impulsivity. Substantial number of empirical evidence exists regarding where does impulsivity lead to. Putting together all the researches discussed above it can be summarized that indirect evidence (difference in factor structure of similar measures across the cultures) exists regarding cultural differences in phenomena, perception and meanings of impulsivity that is revealed through variation in scores on impulsivity scales across different populations. Even if differences are reported in manifestation of impulsivity across the cultures, most of the researches do not specifically address the sources of difference. Researches have attributed these differences to probable methodological problems such as translations, sample characteristics, differences in administration, or differences in construct. Moreover, very few comparisons are made between the cultures that are diametrically different to each other. Most studies are carried out in west where populations share similar societal features. Very few comparisons are made among western and non-western cultures. Studies have reported differences in presentation of constructs similar to impulsivity as well.  Such as manifestation of anger and situations that provoke anger in individuals vary across cultures.

1.5 Rationale of the Research

It is important to investigate the concept of impulsivity in the field of clinical psychology as it is increasing over the world, moreover; it also contributes importantly to personality differences and externalizing psychiatric disorders (Moeller et al., 2001). Cultural variation is most pronounced in reactive and neurotic disorders but the influence of culture is also significant in the major psychoses and can even be recognized in organic brain syndromes (Wolfgang, 2001).

Although different impulsivity scales are present, however indirect evidence of cultural differences in the construct and manifestation of impulsivity and absence of any comprehensive measure of impulsivity develops a need to explore the construct in cultural context and develop an indigenous measure of impulsivity. Impulsivity has been studied in different age groups. The influence of culture on expression and manifestation of impulsivity further endorses the need to assess the phenomenon through culturally relevant and sensitive measures. Further, a review of existing measures of impulsivity reveals that most of them are somehow limited in their scope. Each scale measures some specific aspect of impulsivity. No one scale measures state and trait impulsivity in its functional and dysfunctional nature which may help to identify impulsivity of clinical relevance. A pilot work carried out for this study also reflected differences in manifestations of impulsivity from what was reported in other cultures. Therefore it seems pertinent to develop a comprehensive culturally relevant measure of state trait impulsivity that would tap its functional and dysfunctional aspects.  Impulsivity has been studied in different age groups, a number of researches have shown that it is most prevalent in adolescent to young adulthood.  Therefore the present study aims to target this particular group.

1.6 Implications

The present study will help to identify unique manifestations of impulsivity. Construction of the scale on clinical and non clinical populations will enable to identify the patterns and combinations of subscales of impulsivity in both groups later on that may also help clinicians in making a better management plan. Moreover availability of an indigenous measure will enable the researchers to explore different dimensions of impulsivity in a culturally relevant manner.

1.7 Aims of the Research
  • To explore the construct and manifestation of impulsivity in reference to Pakistani Perspective.
  • Development of an indigenous scale for the measurement of state trait impulsivity.
  • To standardize the indigenous scale for state trait impulsivity
  • To determine psychometric properties of state trait scale of impulsivity.
  • To compare expression of impulsivity in clinical and non clinical populations.
  • To explore psychosocial correlates of impulsivity
METHODOLOGY

The research will consist upon 2 studies, namely

  • Development of a scale of state trait impulsivity
  • Manifestation of impulsivity in clinical and non clinical population of Pakistan

STUDY- I

Scale Development

Phase I

2.1.1 Objective

Development of an item pool for indigenous measure of state trait impulsivity

2.1.2 Research Design

The study one is based on qualitative approach due to its exploratory nature. It aims to generate an item pool for impulsivity scale.

2.1.3 Research Paradigm

The present inquiry is based on Constructivism because; I intend to inquire reality of every participant. Construct of impulsivity is elastic and diverse across the participants from varied backgrounds.  The analysis will be based on the concept of relativism, i.e. reality exists in relative terms and holds a different meaning for different participants. They will elucidate the phenomenon according to their unique worldviews.

2.1.4 Tradition of inquiry: Phenomenology

According to Welman and Kruger (1999, p. 189) “the phenomenologists are concerned with understanding social and psychological phenomena from the perspectives of people involved”. It is turned “toward the ways in which ordinary members of society attend to their everyday lives” (Gubrium & Holstein, 2000, pp. 488-489). A researcher applying phenomenology is concerned with the lived experiences of the people (Greene, 1997; Holloway, 1997; Kruger, 1988; Kvale, 1996; Maypole & Davies, 2001; Robinson & Reed, 1998) involved, or who were involved, with the issue that is being researched.  In the light of these definitions phenomenology seems to be the best suited tradition of inquiry for current research as it intends to explore the construct of impulsivity with reference to the lived experiences of the individuals going through that phenomenon in their everyday lives. Moreover IPA assures personal perception regarding certain experience rather than previously formed categories (Smith et al., 2009).

2.1.5 Data cCollection Strategies:

Data collection will be done through

  • Focused Group Discussion
  • In-depth Interviews
  • Preliminary questionnaires

2.1.5.1 Focused Group Discussion

The first mode of data collection would be focused group discussion.

Sampling strategy

Convenient sampling will be used to collect data from individuals from different walks of life. The sample will consist upon a total of 10 to 12 participants.

Participation criteria

Individuals from general population will be included in the study as participants. Both males and females will be included. Among participants, those individuals will be included who may interact with different people as a part of their profession, such as, doctor, psychologist, sociologist, teacher, lawyer, journalist, religious scholar, a shop keeper, rikshaw driver, a house wife, and  student.  8 to 10 participants will be included in FGD.

Procedure

A qualified Clinical Psychologist with at least 18 years of education will work as assistant moderator in FGD. S/he will be provided detailed information related to research along with nature and purpose of FGD. Written consent will be taken to ensure the confidentiality of participants. In the consent form written permission for audio recording of FGD will also be sought from each participant. The assistant moderator will also be provided with a clear set of instructions regarding his/her responsibilities during the FGD.

The selected participants will be contacted via official letters that would include detailed description of aims and objectives of FGD. It would also be addressing important ethical considerations such as confidentiality, voluntary participation, and right to withdraw. After finalization of the participants of FGD, written informed consent will be taken from them on the devised form. The duration of each FGD would be 90-120 minutes. More than one FGDs may be conducted, to ensure saturation. As according to Morgan (1997) more than one focused group discussions are required to ensure sufficient exploration and trustworthiness of research data.  However, no explicit number of FGDs is recommended in literature rather a number of authors (e.g. Creswell, 1998; Morgan, 1997; Ressel et al., 2002) suggest the researcher should keep on going back to participants until and unless the information sought from the FGD starts repeating itself and it appears that participants have nothing new to add into already achieved information.

Inquiry Questions

The few inquiry questions would be:

  • As per your own view point, what do you mean or understand by word: impulsivity?
  • How do people around you manifest impulsivity in everyday life?
  • Please provide some examples of impulsive behavior of people that you have noticed?
  • How do you behave when people behave impulsively with you?
  • What reasons people generally provide for their impulsive behavior?
  • Provide examples of impulsive behaviors of people who behave in this way all the time in every situation.
  • Provide examples of impulsive behaviors of people who behave in this way in some specific situations only.
  • Did you find yourself behaving impulsively at times; how?
  • What were the situations in which you behaved impulsively?
  • What thoughts did you have when you acted impulsively?
  • What did you feel inside on that occasion?
  • Did you ever tried to control your impulsive behavior? How?
  • How did other people respond towards you when you behaved impulsively?
  • What do you think are the reasons of impulsivity
  • What could be done in order to reduce impulsivity in people/our society?
  • Did you ever have to face favorable or unfavorable consequences as a result of impulsivity?

All the questions will be phrased and asked in Urdu, to ensure comprehensibility and enlightened responding from the participants.

Steps for Data Analysis

Data will be analyzed through following steps:

  • Step I: Transcription and highlighting:

The recorded FGD will be transcribed at the very first place. The transcriptions will then be read over and over again. Important words and phrases will be highlighted with different colors.

  • Step II: Free contextual analysis and theme identification

At the very first place all the transcriptions will be read and gone through several times. Left margins will be used to make notes. Rhetoric of the transcripts would be noticed, such as similarities, differences, analogies and metaphors and contradictory statements. The right margins will be used to write emerging themes after initial readings. These initial themes and highlighted material will be helpful in rich thick description.

  • Step III: Clustering of themes

            All the initial themes will be written on a separate piece of paper. Themes that would have similar content will be clustered together. Superordinate and subordinate themes will be identified. The themes will be cross checked with the narratives to rule out any discrepancy and establish congruency. Same procedure will be used for analysis of data collected from all FGDs.

  • Step IV: Integration of summary tables of all groups

The themes that will emerge from transcripts of first FGD will be used in the analysis of later ones (Smith & Osborn, 2003). A table of the themes obtained from the first FGD will be used as a guide in the analysis of next FGD. It would be helpful in comparing themes obtained from all groups and identify repetitions, contradictions and redundancies.  In this way the analysis of transcripts will be done.

Quality and Validity of the Inquiry

There are 7 important methods to ensure quality and validity of a qualitative inquiry.

I would be using credibility, transferability, dependability and conformability in current research.

  • Credibility

Credibility refers to the degree to which results of an inquiry are realistic and authentic (Van der Riet & Durrheim, 2006). I will be using two methods for ensuring credibility that is peer review and member evaluation. For member evaluation, during the FGD reflecting technique will be used from time to time and reassurance will be sought from the participants about truthfulness of the themes. The participants will also be encouraged to summarize the discussion after each FGD. As a final step, some of the participants will be approached after analysis of narratives and requested to comment on similarity of narrative and results.

For peer review, at least two clinical psychologists will be contacted and their views about likeness of narratives and analysis will be invited.

  •  Transferability

            Transferability is the generalizabilty of a research to the segments of population other then the sample (Babbi & Mounton, 2001). In reference to qualitative research, it can be attained through reliable reporting of varied features of research. To match up with this requirement of validity, best efforts will be made to explain and report each step of the research in translucent manner, maintaining the ethical boundaries.

  • Dependability

            To increase the dependability of the research, rich thick description will be used. The verbatim of participants will be used generously and the findings will be explained in elaborate details. Moreover I will read the transcripts several times so that lucidity could be ensured. A twofold process can also be used to ascertain dependability that is getting back to data after an interval during which no interface with data was made.

2.1.5.2 In-depth Interviews

The next strategy for data collection will be in-depth interviews. In-depth interviews are more like conversations with the research participants so the participant’s perspective regarding phenomena of interest unfolds (Marshall & Rossman, 1995). In present research, in-depth interviews will be conducted in order to take the views of Professionals who might not be available at the time of FGDs. Moreover it will also help to generate a rich item pool.

Participant Criteria

The participants will be selected through convenient sampling. 5 in-depth interviews will be conducted in this phase. The interviews will be conducted from

  • Police/ traffic police personal
  • Administrator
  • Nurse
  • 2 individuals high on impulsivity

All the professionals must have at least 5 years of experience in their relevant field.

The last 2 interviews will be conducted with 2 individuals from general population, high on impulsivity to get a more detailed understanding of lived experiences of individuals experiencing the phenomenon. The selection of the participants for in-depth interview will be made through screening procedure. In the screening procedure, the translated version of Barratt Impulsiveness Scale (BIS-11; Patton, Stanford & Barratt, 1995) will be used administered on a group of 40 university students (20 males, 20 females) selected through convenient sampling between 19 to 25 years of age. The participants will be taken from 2 public and 2 private sector universities (10 from each university). BIS-11 is a 30 item scale that evaluates 3 dimensions of impulsivity i.e. attentional, cognitive and motor impulsivity. Items are responded on a 4 point likert scale from Never to Always.  The said scale possesses sound psychometric properties, Cronbach’s alpha coefficients ranging from .79 to .83 in clinical and community (non clinical) samples. Mean 63.82, SD 10.17 for student population, in the present research 2 SD above MEAN will be used as selection criterion for impulsive individuals. In case of unavailability of the person with highest score, the researcher will contact the next highest scorer on impulsivity scale in the group. In this way the participants for the last in-depth interview will be screened out.

 Procedure

The potential participants of the interviews will be approached through official letters and time and place of interviews will be decided as per convenience of both, the researcher and the participant. The interviews will be audio recorded with consent of participants. The participants will be asked a set of open ended questions almost same as that of FGDs.

 Explicitation of the data

For analysis of data explicitation method will be used (Hycner, 1999 as cited in Groenewald, 2004). The explicitation method involves following steps that would be followed for the analysis of interviews. In the first step the transcripts will be read several times and significant statements will be highlighted. I will be developing a rough coding system for each interview.  In the next step, I would develop units of meanings for each interview and extract themes from those units of meanings. Once extraction of themes from interviews of all participants will be done, a collective chart will be tabulated to outline themes of all interviews. Those themes would then be revisited in order to form an amalgamated pattern, involving major themes and sub themes. Questions will be formulated on the base of themes emerging.

To ensure validity of procedure, credibility, transferability, dependability and conformability will be used as verification criteria.

2.1.5.3 Preliminary Questionnaires

The next method for data collection will be preliminary questionnaires. A preliminary questionnaire will be developed to extract questions for item pool.  It would contain open ended questions related to real life situations in which the participants behaved impulsively in a period of two weeks. The questions asked would be related to situation that lead to impulsive behavior, behavioral manifestation of impulsivity, thoughts, feelings and expectations while behaving impulsively. The preliminary questionnaire will be filled by 50 university students between age 19 to 25, (25 males and 25 females) to get an insight into the triggering factors of impulsivity along with associated behavioral acts, thoughts, feelings and expectations.

The participants will be provided with preliminary questionnaires and will be requested to fill them keeping in mind situations from last 2 weeks where they behaved impulsively or others behaved impulsively with them.

 Content Analysis

Preliminary questionnaires will be analyzed through content analysis. It refers to a process of methodical coding and classification approach which can be used to explore large amount of existing information in form of text aimed at illumination of trends and patterns of words used along with their frequency. The scope of content analysis remains enumeration. However it is sometimes combined with thematic analysis (Grbich, 2013). Since the aim of getting preliminary questionnaires filled by individuals from target population is to extract symptoms and expression of impulsivity for item generation.  Thus content analysis seems to be appropriate option for analysis. For analysis of preliminary questionnaires, firstly all of the filled questionnaires will be thoroughly and repeatedly read. The words describing construct and expression of impulsivity will be highlighted. After identification of key words, the frequency of the key words will be calculated from all the questionnaires. Further, similar words and synonyms will be sought and clusters will be made. Finally a list of most frequently occurring expressions will be completed to be added in item pool.

Once key words will be identified, the analysis will also validated by using Nvivo qualitative data management programme.

Questions and scenarios will be extracted in this way with the help of content analysis of responses on preliminary questionnaires.

2.1.6 Construction of item pool

After collecting data for item generation, the item pool will be finalized. Questions will be generated around the themes emerged from FGDs, interviews and preliminary questionnaires. Separate questions will be generated to measure trait impulsivity (questions addressing traits or general behaviors of individuals) and state impulsivity (questions involving scenarios/ situations taken from daily life situations and inquiring participants potential response over that). The responses of the participants will be taken on a 4 point likert scale where 1 would mean rarely, 2 sometimes, 3 often and 4 would mean almost always.

Phase II

2.1.7 Readability and conceptual relevance of items generated

Prior to final compilation, readability and theoretical clarity of the items will be evaluated. The items will be judged by a panel of two clinical psychologists. The judges will rate the items for their sentence construction, wording and conceptual clarity on a 0 to 10 scale. The items with average ratings 8 and above will be included in the questionnaire. They will also be checked for their inter rater congruence for relevance and readability.

2.1.8 Pilot study

For pilot study 30 students (15 males and15 females) ages between 19 to 25 years, will be taken. The participants will be requested for their feedback about the questionnaire through a written feedback form. The suggested changes will be incorporated in the questionnaire and a final version will be prepared in this way.

Phase III

Main study: Data Collection and Statistical Analysis

2.2.1 Objective
  • Exploration of latent structure of indigenous measure of state trait impulsivity

After finalizing the items, the data will be collected to explore the latent structure and underlying factors of the scale.

2.2.2 Research Design

The research will apply an ex-post facto research design. As condition of interest i.e. enrollment of students in a public or private university preexists in the population.

2.2.3 Sampling Strategy

The sample size will be 3 to 5 times number of the items. First of all list of all HEC recognized public and private sector universities and colleges offering graduate and post graduate programs in Lahore will be viewed. Purposive sampling will be used to select institutions for data collection from that list. The universities and colleges would be selected on the basis of permission for data collection from administration, and ease of access. In the next step, the departments of respective institutions will be selected randomly. Data will be collected from the selected departments from Undergraduate (BS honors), Graduate (Masters) and Postgraduate (MPhil) levels in proportion to number of students in relevant departments. The age range of the participants will be 19 to 25. Equal number of data will be collected for male and female participants.  While selecting institutions, efforts would be made to include those institutes where expression of impulsivity is predominant. These institutions will be selected on the basis of characteristics of the students studying. A number of researchers have discussed the demographic characteristics of highly impulsive individuals. It has been reported that impulsivity is more prevalent in males from less privileged areas and lower socioeconomic status, these individuals tend to be low on academic achievement as well (Semple, Zians, Grant & Patterson, 2006). Therefore, data will also be collected from institutions with low fee structure and merit in order to approach the desired sample.

2.2.4 Instruments for Data Collection

Data will be collected through following instruments.

  • Demographic Questionnaire

Demographic questionnaire will be developed by the researcher. It would include questions related to gender, age, years of education, socioeconomic status, information related to family and other personal characteristics of the participants.

  • Impulsivity Scale

The final version of newly developed scale of impulsivity will also be administered.

2.2.5 Procedure

After getting written permission from administration of selected universities, the list of faculties of each selected university will be viewed and the departments offering undergraduate, graduate and postgraduate programmes would be selected randomly. The students will be approached in their classes. They will be briefed about the objective of research. Confidentiality will be ensured and students will be told that their participation will be on voluntary basis and they do have a right to withdraw their participation at any time. Queries will be answered if any. The scales will be administered in group.

2.2.6 Statistical analysis

Item, Factor and Reliability Analysis

Corrected item-to-total correlation will be calculated for each scale of newly developed questionnaire. Items with .30 and less corrected item-to-total correlation will be excluded from the scale (Field, 2009).

The latent factor structure of the scale will be explored by applying Exploratory Principal Component Factor Analysis with Oblique Rotation method. The number of factors will be decided by using Eigen values greater than 1 as criteria. According to item loadings on different factors and related themes subscales will be determined.  Factor analysis will be performed separately for trait and state impulsivity scales. Descriptive statistics will be applied for analysis of demographic variables. Gender wise comparisons will be done through t test. Age wise comparisons will be done using ANOVA.

Study II

Manifestation of Impulsivity in Clinical and Non-Clinical Population

2.3.1 Objective:

Exploration of manifestations of impulsivity in clinical and non-clinical population.

The scale will be administered on two different samples; clinical and non-clinical. Independent group design will be used to carry out this phase.

Clinical Sample

Clinical sample will consist upon 100 patients suffering from psychiatric conditions in which impulsivity is the characteristic feature such as substance related disorders, cluster B of personality disorders and anger related problems. The data for clinical sample will be collected from psychiatric units of teaching hospitals. The hospital administration would be asked for permission to collect data from psychiatric wards. The patients will be approached through clinical psychologists. Patients diagnosed by the clinical psychologists with any of above mentioned problems will be included in the sample. Their diagnosis will be validated by asking them questions based on DSM-V criteria of disorders related to their presenting complaints.  Age range of the patients will be from 19 to 25 years. Best efforts would be made to include equal number of males and females.

Inclusion criteria for clinical sample

            Inclusion criteria for Clinical sample would be

  • Age between 19 to 25 years
  • Comprehension and understanding of Urdu

Exclusion criteria for clinical sample

  • Presence of any psychotic condition
  • Presence of any organicity

Non Clinical Sample

Non clinical sample will consist upon 100 individuals from general population. The participants of non-clinical group will be matched with the clinical group on age, gender and socio economic status. Data for non-clinical sample will be collected from same hospitals but from the individuals who would be either coming with minor general health issues or as care takers of patients.

Inclusion criteria for non-clinical sample

         Inclusion criteria for non-clinical sample would be

  • Age between 19 to 25 years
  • Comprehension and understanding of Urdu
  • Absence of any psychiatric condition

Exclusion criteria for clinical sample

  • Presence of any psychiatric condition

2.3.2 Measures for Data Collection

Data will be collected through following measures.

  • Demographic Questionnaire

Demographic questionnaire will be developed by the researcher. It would include questions related to gender, age, years of education, socioeconomic status, information related to family and other personal characteristics of the participants.

  • Impulsivity Scale

The final version of newly developed indigenous measure of state trait impulsivity will also be administered.

  • Screening and Diagnostic Questionnaire for Psychiatric Disorders

Screening and diagnostic questionnaire for psychiatric disorders [unpublished observations] will be administered on research participants of non clinical sample to rule out presence of any psychiatric condition. Screening questionnaire for psychiatric disorders is comprised of 16 screening questions used to screen out participants with different psychiatric disorders. Participant’s responses are rated on 4 point likert scale ranging from 0-3 (0 = not at all to 3 = very much) and few questions were on dichotomous scale (yes/no).

2.3.3 Procedure

The clinical sample will be approached through clinical psychologists in the psychiatry wards of teaching hospitals after seeking permission for data collection. They would be briefed about aims and objectives of the research and confidentiality will be assured.  They will be informed the voluntary nature of participation and also about their right to withdraw from the participation at any stage. Written informed consent will be obtained from the willing participants, and queries will be answered if any. After that their diagnosis will be validated through questions based on DSM 5 criteria. After confirmation of diagnosis, the measures will be individually administered on participants and data would be collected.

2.3.4 Statistical Analysis

Discriminant function analysis will be carried out to investigate the differences in clinical and non clinical samples. T-test and ANOVA will be applied to explore the psychosocial correlates.

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