After a stressful life event, a period of emotional processing follows (Rachman,, 1980). People try to “pick up the pieces” and “get over” or “come to terms” with what happened. Emotions are felt, expressed, and dealt with. Most often, the emotional disturbance of a stressful life event is absorbed, and life goes back to normal. However, sometimes, the emotional processing comes to a halt and there can be several signs of unprocessed emotional disturbances. People might start experiencing intrusions of the stressful life event or, in one way or another, and have difficulties controlling their emotions. Feelings can be overwhelming and be avoided or suppressed.
According to the emotional processing model (EPM), acknowledging emotions and finding an adaptive way of expressing them are necessary steps to cope with stressful life events (Baker et al., 2007, 2010). The EPM specifies in what way this process can be disrupted. In essence, avoiding or suppressing emotions will inhibit emotional processing and give rise to difficulties in emotional regulation.
To enable the study of emotional processing in accordance with the EPM, the Emotional Processing Scale (EPS) was developed. The original version of this scale comprised 38 items and 8 subfactors (Baker et al., 2007). This was later shortened to the 25-item Emotional processing scale (EPS-25) which has five subscales, believed to correspond to facets of emotional processing: avoidance, suppression, impoverished emotional experience, signs of unprocessed emotions, and unregulated emotion (Baker et al., 2010). First, avoidance is a way to avoid triggering emotions surrounding an event or situation. Second, suppression measures instances of suppressed feelings for example by trying not to show feelings. The third facet of emotional processing– impoverished emotional experience –captures aspects of “alexithymia”, when a person has difficulties identifying own emotions related to an event. The final two subscales of the EPS-25, signs of unprocessed emotions and unregulated emotions measure consequences of inadequate emotional processing. Signs of unprocessed emotions can, for example, manifest as nightmares whereas unregulated emotions can be expressed in temper tantrums.
Internal consistency and dimensionality
There have been several psychometric studies on the EPS-25, and studies generally report excellent internal consistency for the whole scale and fair to good internal consistency for each subscale (Baker et al., 2010; Gay et al., 2019; Górska, D. & Jasielska, A., 2010; Jasielska, A. & Górska, D., 2013; Kharamin et al., 2021; Lauriola et al., 2021; Orbegozo et al., 2018; Petermann, 2018).
In Baker et al.’s (2010) original article, the EPS-25 was administered to a mixed sample of medical patients, psychiatric patients, and healthy controls (N=690). Exploratory factor analysis revealed the 5-factor structure described above. Moreover, Gay et al. (2019) administered the EPS-25 to a combined sample (N=1176) of medical patients, hospitalised patients with bipolar disorder, city hall employees and students. Using exploratory factor analysis with the number of factors defined as 5 a priori revealed factor loadings relatively similar to those reported by Baker et al. (2010), though five items had cross-loadings over 0.30.
However, other attempts at replicating the original 5-factor solution have failed. Using two community samples (N=1172) Spaapen (2015) conducted a confirmatory factor analysis focusing on a 5-factor solution corresponding to that suggested by Baker et al. (2010). This factor structure did not achieve acceptable fit, either in its original form or based on a model with the 3 most problematic items dropped from the analysis. Orbegozo et al. (2018) administered the EPS-25 to school and university students (N=605) and investigated its factor structure using confirmatory factor analysis. Neither in this study, the original 5-factor model did achieve an acceptable fit. Moreover, neither Kharamin et al. (2021), who used a confirmatory factor analysis, and administered the EPS-25 to university students (N=1283) nor Lauriola et al. (2021), who administered the EPS-25 to a combined sample of gastrointestinal patients and healthy participants (N=696), could replicate the original five factor structure.
Since replication of the original findings of Baker et al. (2010) have proven difficult, several authors have proceeded in trying to find other ways to represent dimensionality. Spaapen (2015) investigated a two-factorial model, with suppression representing one factor, and the other subscales of EPS-25 representing another factor. Confirmatory factor analysis was however not able to establish a convincing model fit. Other authors have added a second-order latent “emotional processing” factor (i.e. a general emotional processing capacity factor) to the five subfactors, which have increased model fit in some studies (Lauriola et al., 2021; Kharamin et al., 2021). Another solution has been to reduce the number of items, and move items from one subfactor to another, to achieve adequate model fit (Orbegozo et al., 2018).
Taken together, despite difficulties in replicating Baker et al.’s (2010) original findings, most previous studies speak for a five factor model, either with a second order latent “emotional processing” factor (Lauriola et al., 2021; Orbegozo et al., 2018; Kharamin et al., 2021) or not (Gay et al., 2019; Baker et al., 2o10). However, in order to establish a five factor model, revisions have been made in some studies; such as reducing items (Orbegozo et al., 2018; Spaapen, 2015).
Convergent and discriminant validity
Convergent and discriminant validity concerns the magnitude of correlations between a measure, such as the EPS, and other measures of relevance. Because EPS is a measure of dysfunctional emotional processing, it could be expected to correlate quite consistently with measures of similar constructs such as alexithymia (i.e., difficulties identifying and expression emotions) but should show less overlap with constructs not directly part of emotional processing (such as depression).
The convergent validity of EPS-25 has been studied in relation to concept such as emotional control (Baker et al., 2007) and emotional regulation (Orbegozo et al., 2018; Gay et al., 2019), Moreover, the concepts of emotional processing and alexithymia are believed to partly overlap and hence, in certain aspects, have convergent validity (Baker et al., 2007; 2010). Especially the subfactor Impoverished emotional experience in the EPS-25 has been proposed (Baker et al., 2007; 2010) to be like the alexithymic feature of having difficulties identifying own feelings (measured by the Toronto Alexithymia Scale-20, factor 1). Although theoretically sound, only a rather weak concurrent validity (r=.35) with the TAS-20 subscale Identifying feelings and the EPS-25 subscale Impoverished emotional experience has been found (Gay et al., 2019; 2021).In addition, the capacity for EPS-25 to show an adequate discriminant validity have been mixed, pointing to an inflated relationship between measures of emotional processing and negative affect. EPS-25 has in three studies been found to correlate quite largewith measures of anxiety (r=.47-59) and depressive symptoms (r=.48-63) (Orbegozo et al., 2018; Gay et al., 2019; Kharamin et al., 2021). Emotional processing is also believed to have discriminant validity with facets of the alexithymia construct (Baker et al., 2007), specifically what is coined external oriented thinking (measured by the Toronto Alexithymia Scale-20, factor 3). In line with this, EPS-25-total has been shown to be uncorrelated with this subscale (Gay et al., 2019; 2021).
Only two studies have investigated EPS-25 test-retest reliability. Using a convenience sample of 17 healthy individuals, test–retest reliability was assessed over a 4- to 6-week period (Baker et al., 2010). The Pearson's test–retest correlation coefficient obtained for the entire scale was .74. Moreover, 80 participants were randomly selected from a cohort of 1285 students demonstrating a Pearson's test–retest correlation coefficient for the entire scale of .91 (retest administration made at 4 weeks) (Kharamin et al., 2021).
Aims of the study with hypotheses
The overarching aim of this study was to conduct a structural validation of the EPS-25 in a sample of patients with elevated psychiatric symptoms. We hypothesized that the EPS-25 would follow either a 5-factorial with or without a second-order latent factor or possibly a 2-factorial model. The 2-factorial model would follow Spaapen (2015) description of emotional processing consisting of 2. The 5-factorial model would follow Baker et al.’s, 2010 description of emotional processing consisting of five different facets or subscales. Having a second-order factor would mean that, in addition to the 5 factors, a higher-order or general emotional processing capacity would be found.
We hypothesized that internal consistency for both the EPS would be good (α ≥ 0.80) for the total scale and at least fair for the subscales (α ≥ 0.60). Further, convergent validity of the EPS and the Toronto-Alexithymia Scale-20 (TAS-20) was believed to be quite high (hypothesis: r≈.50-.75 vs. alexithymia – total score and score for TAS-20 factor 1, Identifying feelings). For measures of discriminant validity, anxiety (GAD-7) and depression (PHQ-9) was calculated and believed to be lower than the EPS relationship with TAS-20 (hypothesis: r≈.25-.50 vs. depression, r≈.25-.50 vs. anxiety). Moreover, the EPS was not believed to be correlated with external oriented thinking style from TAS-20, factor 3. A last aim of this study was to evaluate EPS test-retest reliability which was hypothesized to have an adequate test-retest reliability (i.e. ICC≥0.60) over approximately 1 week.
As results of the EPS-25 became clear, a further aim of this study was to investigate whether a shorter version of the EPS-25, the EPS-15, might be created and would be psychometrically sound.