Bodily Threat Monitoring Scale (BTMS)

Abstract

The Bodily Threat Monitoring Scale (BTMS), developed by Heathcote et al. (2023), is a specialized psychological instrument designed to quantify the degree to which individuals actively monitor their body for uncertain symptoms and subsequently interpret these sensations as signs of serious physical harm or illness. This construct, known as bodily threat monitoring, is considered a core clinical feature in conditions such as Fear of Cancer Recurrence (FCR). The initial pool of items was compiled from existing psychological questionnaires and refined based on expert panel feedback. The final 19-item BTMS was validated in diverse cancer survivor populations, including adult survivors of breast and gynecological cancers, as well as childhood cancer survivors, with comprehensive psychometric results reported for reliability, validity, and factor structure.

Keywords

Bodily Monitoring, Bodily Threat Appraisals, Fear of Cancer Recurrence, Health Anxiety, Body Vigilance, Psycho-Oncology, Psychological Assessment

Authors

Heathcote, Lauren C., Webster, Sarah N., Loecher, Nele, Spunt, Sheri L., Simon, Pamela, Pradhan, Poorva, Coutts‐Bain, Daelin, Sharpe, Louise, Tutelman, Perri R., Simons, Laura E.

Purpose

The primary purpose of the BTMS is to provide a standardized, psychometrically sound measure of bodily threat monitoring. This specific psychological process—the sustained hypervigilance toward and catastrophic interpretation of ambiguous physical sensations—is recognized as a pivotal clinical feature underlying intense Fear of Cancer Recurrence (FCR).

The scale aids clinicians and researchers in quantifying this specific aspect of health anxiety, allowing for the development, implementation, and evaluation of targeted psychological interventions, particularly within oncology survivor populations who may experience heightened somatic awareness and distress.

Construct

The BTMS measures the psychological construct of Bodily Threat Monitoring, which encompasses both attentional mechanisms and cognitive appraisals related to physical health and potential illness. This construct is operationalized through two distinct, yet correlated, dimensions identified via factor analysis: Bodily Monitoring and Bodily Threat Appraisals.

Bodily Monitoring refers to the behavioral component, specifically the active, often compulsive, checking and tracking of internal or external bodily signs and symptoms. Bodily Threat Appraisals relate to the cognitive component, reflecting the tendency to interpret uncertain or ambiguous physical sensations as definitive indicators that something serious or life-threatening is wrong with the body.

Validity

The preliminary validation studies conducted by Heathcote et al. (2023) demonstrated strong psychometric evidence for the validity of the BTMS across several dimensions in cancer survivor cohorts.

Construct Validity: The BTMS showed significant positive correlations with theoretically related psychological constructs, namely body vigilance and high levels of anxiety sensitivity, confirming that it measures related but distinct facets of health-related distress. Criterion Validity: The scale proved effective in predicting relevant clinical outcomes. It demonstrated significant associations with overall FCR severity, intolerance of uncertainty, elevated help-seeking behaviours, and diminished quality of life. Importantly, the BTMS maintained a unique and significant association with FCR even when statistically controlling for body vigilance and anxiety sensitivity, underscoring its specific, theory-informed contribution to measuring this form of cancer-related distress.

Reliability

The BTMS demonstrates robust reliability metrics, confirming the stability and internal consistency of the measurement tool across different populations.

Internal Consistency: The scale demonstrated excellent internal consistency across both adult and childhood cancer survivor samples, with Cronbach’s alpha coefficients ranging from 0.90 to 0.96. This high range indicates a strong degree of homogeneity among the 19 items. Test-Retest Reliability: Stability over time was confirmed by a significant correlation between total scores and subscale scores measured at baseline and again two weeks later. Furthermore, analysis showed no significant differences in the mean BTMS total scores or subscale scores across these two time points (BTMS total: t(60) = −1.33, p = 0.19; bodily monitoring: t(58) = −1.17, p = 0.25; bodily threat appraisals: t(60) = −1.21, p = 0.23), suggesting stability for scores over a short interval.

Factor Analysis

Scale development included an Exploratory Factor Analysis (EFA) to determine the underlying structure of the items. Although initial analysis suggested three factors based on Eigenvalues greater than one, the third factor was deemed unstable as it did not contain unique item loadings and was therefore considered residual.

A forced two-factor solution was subsequently adopted, which provided a good fit to the empirical data. This solution accounted for 65.5% of the total variance, with all factor loadings exceeding 0.5. This analysis confirmed the presence of the two core theoretical components of the scale:

• Bodily Monitoring
• Bodily Threat Appraisals

Instrument

Test Type: Original Inventory/Questionnaire.

Format: Items are rated on a 5-point Likert scale: 0=Not at all like me, 1=A little bit like me, 2=Moderately like me, 3=Very like me, and 4=Entirely like me.

Language Available: English.

Population Group: Human (Male and Female).

Age Group: Childhood (birth-12 yrs), School Age (6-12 yrs), Adolescence (13-17 yrs), Adulthood (18 yrs & older), Young Adulthood (18-29 yrs), Thirties (30-39 yrs), Middle Age (40-64 yrs), Aged (65 yrs & older).

Population Details: The scale has been evaluated in adult survivors of breast and gynecological cancers (Age = 37–81 Years) and childhood cancer survivors (Age = 10–25 Years) from Australia, Canada, and the United States.

Test Methodology: Test Validity, Construct Validity, Criterion Validity, Test Reliability, Internal Consistency, Test-Retest Reliability, Factor Analysis, Exploratory Factor Analysis.

Keywords

Health Anxiety, Body Awareness, Illness Behavior, Neoplasms, Self-Monitoring, Psychological Assessment, Cancer Survivorship

Authors

Author ORCID Identifier:

• Heathcote, Lauren C.: orcid.org/0000-0003-2515-3102
• Sharpe, Louise: orcid.org/0000-0002-8790-6272

Affiliation Email addresses:

• Heathcote, Lauren C.: Health Psychology Section, Department of Psychology Institute of Psychiatry Psychology and Neuroscience, King’s College London. Email: [email protected]
• Webster, Sarah N.: Department of Anesthesiology, Perioperative, and Pain Medicine Stanford University School of Medicine.
• Loecher, Nele: Department of Psychology and Behavioral Sciences St Jude’s Children’s Research Hospital.
• Spunt, Sheri L.: Department of Pediatric Oncology Stanford University School of Medicine.
• Simon, Pamela: Department of Pediatric Oncology Stanford University School of Medicine.
• Pradhan, Poorva: School of Psychology, University of Sydney.
• Coutts‐Bain, Daelin: School of Psychology, University of Sydney.
• Sharpe, Louise: School of Psychology, University of Sydney.
• Tutelman, Perri R.: Department of Psychology and Neuroscience, Dalhousie University.
• Simons, Laura E.: Department of Anesthesiology, Perioperative, and Pain Medicine Stanford University School of Medicine.

Correspondence Address:

Heathcote, Lauren C.: Guy’s Hospital, 5th Floor Bermondsey Wing, Great Maze Pond, London, London, City of, United Kingdom, SE19RT, [email protected]

Permissions & Fee and Test Year

Permissions: May use for Research/Teaching.

Fee: No

Test Year: 2023

Web Site: creativecommons.org/licenses/by/4.0/deed.en

Commercial Use: No

Reference’s

Heathcote, L. C., Webster, S. N., Loecher, N., Spunt, S. L., Simon, P., Pradhan, P., Coutts‐Bain, D., Sharpe, L., Tutelman, P. R., & Simons, L. E. (2023). The Bodily Threat Monitoring Scale: Development and preliminary validation in adult and childhood cancer survivors. Psycho-Oncology, 32(12), 1885–1894. DOI: doi.org/10.1002/pon.6236

Items of the Bodily Threat Monitoring Scale (BTMS)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

This is a 19-item scale. The test items are available in the Supplemental Material of the source reference (Pages 2-3).

Bodily Threat Monitoring Scale (BTMS)

We are interested in how you think and feel about your body and the sensations inside your body. Bodily sensations include things like aches and pains, discomfort, feeling sick, feeling itchy, feeling tired, feeling hot, and feeling dizzy. These are just some examples; there are many others.

When you answer the questions below, think about the bodily sensations that are most relevant for you. For each question, choose the number that shows how much each statement is like you.