308 Chapter 7 Measures Mental health symptoms The Depression Anxiety Stress Scale (DASS-21; Lovibond & Lovibond, 1995; Dutch translation from De Beurs, 2010) was used during screening to assess mental health symptoms. This scale consists of three subscales with seven items each to measure depressive symptoms (e.g., “I felt that life was meaningless”; α = .83), anxiety symptoms (e.g., “I felt I was close to panic”; α = .70), and stress symptoms (e.g., “I found it hard to wind down”; α = .79). Participants answered all items on a 4-point Likert scale indicating to what degree each statement applied to them during the past week, with 0 = did not apply to me at all, 1 = applied to me to some degree, or some of the time, 2 = applied to me to a considerable degree, or a good part of the time, and 3 = applied to me very much, or most of the time. Participants were selected for the experimental part of the study based on having at least mildly elevated mental health symptoms on one or more of the subscales, indicated by a summed score of at least 5 for depression, at least 4 for anxiety, or at least 8 for stress (De Beurs, 2010). Motivation to change The University of Rhode Island Change Assessment (URICA; McConnaughy et al., 1983; Dutch translation from De Jonge et al., 2002) was used during screening to assess motivation to change. The questionnaire consists of four subscales with eight items each, measuring the four primary stages of change within the TTM: precontemplation (e.g., “As far as I am concerned, I don’t have any problems that need changing”; α = .77), contemplation (e.g., “I have a problem and I really think I should work at it”; α = .80), action (e.g., “I am really working hard to change”; α = .88), and maintenance (e.g., “I am trying to prevent myself from having a relapse of my problem”; α = .85). The URICA measures only the four stages that have been supported by research among psychotherapy clients and therefore does not include the preparation stage as proposed in the TTM (Mcconnaughy et al., 1989; McConnaughy et al., 1983). In its original form, eight items of the URICA refer to the specific treatment setting a patient is currently in. Because we administered the questionnaire in a community sample outside of a treatment context, we slightly adapted the wording of these items so that they would fit with both individuals currently considering treatment and individuals currently not considering treatment. For example, the item “Maybe this place will be able to help me” was changed into “Maybe someone or something will be able to help me”. Participants indicated on a 5-point Likert scale to what extent they agreed with the statements, ranging
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