Difficulties in Emotion Regulation Scale (DERS): Adaptation and validation for its

use in adults in the Metropolitan Area of Buenos Aires (Argentina)

[Escala de Dificultades en la Regulación Emocional (Difficulties in Emotion Regulation

Scale [DERS]): Adaptación y validación para su uso en adultos en el Área
Metropolitana de Buenos Aires (Argentina)]

Camila Florencia Cremades1, Cristian Javier Garay1, Martín Juan Etchevers1,

Roberto Muiños1, Graciela Mónica Peker1 y Juan Martín Gómez Penedo1,2

1
Universidad de Buenos Aires, Facultad de Psicología, Buenos Aires, Argentina

2
Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET)

Source of financial support:

Beca de Maestría UBACyT

Contact information:

camilacremades@psi.uba.ar,

camilacremades@gmail.com
Abstract

The present study consists of the adaptation and validation of the Difficulties in
Emotion Regulation Scale (DERS; Gratz and Roemer, 2004) for its use in the general
population of the Buenos Aires metropolitan area. A cross-sectional study was
conducted with 315 subjects between 18 and 65 years old. The scale consists of 30
items which, after a confirmatory factor analysis, were found to fit the six original
dimensions. Internal consistency was adequate (α = .936; ω = .938). There is also
evidence of convergent and discriminant validity, items discrimination ability,
differences by sex and age, and normative values for adults in the AMBA. The Spanish
adaptation of the DERS represents a valid and reliable tool to measure different
aspects of the emotional regulation process.

Key words: DERS, Emotion Regulation, Adaptation, Validation, Argentina

Resumen

Escala de Dificultades en la Regulación Emocional (Difficulties in Emotion Regulation

Scale [DERS]): Adaptación y validación para su uso en adultos en el Área
Metropolitana de Buenos Aires (Argentina). El presente trabajo consiste en la
adaptación y validación de la Escala de Dificultades en la Regulación Emocional
(Difficulties in Emotion Regulation Scale [DERS]; Gratz y Roemer, 2004), para ser
usada en población general del área metropolitana de Buenos Aires. Se realizó un
estudio transversal con 315 sujetos entre 18 y 65 años de edad. La escala quedó
conformada por 30 ítems que tras un análisis factorial confirmatorio se evidenció que
se ajustan a las seis dimensiones originales. La consistencia interna resultó adecuada
(α = .936; ω = .938). También se presenta evidencia de validez convergente y
discriminante, la capacidad de discriminación de los ítems, diferencias por sexo y edad
y valores normativos para adultos del AMBA. La adaptación al español de la DERS
representa una herramienta válida y confiable para medir diferentes aspectos del
proceso de regulación emocional.

Palabras clave: DERS, Regulación Emocional, Adaptación, Validación, Argentina

Introduction

Process-based approaches support the idea that there are underlying

processes involved in the emergence and maintenance of various symptoms (Egan et
al., 2011). In the field of mental disorders conceptualisation, Emotional Dysregulation
has been found to be associated with the development and maintenance of about 75%
of the mental disorders present in the Diagnostic and Statistical Manual of Mental
Disorders (DSM) (American Psychological Association [APA], 1994; Gross and
Jazaieri, 2014; Kring and Werner, 2004). In turn, Emotional Dysregulation represents
the most influential process in the phenomenology of emotional disorders, which have
been described as the most prevalent in some epidemiological studies (Cía et al.,
2018; Kessler et al., 2012). Similarly, strong associations have been found between
Emotional Dysregulation and self-esteem (Heimpel et al., 2002; Setliff and Marmurek,
2002). In this sense, instruments that allow the assessment of Emotional Dysregulation
are of particular relevance.

In the process of studying Emotional Dysregulation, several scales have been

designed (Catanzaro and Mearns, 1990; Garnefski et al., 2001; Gratz and Roemer,
2004; Lavender et al., 2015; Newhill et al., 2004; Niven et al., 2011). As a construct
that was investigated from different theories, there is not an agreed and univocal
definition of Emotional Dysregulation within the scientific community. However, Gratz
and Roemer (2004) reviewed different models of Emotional Dysregulation and
identified some commonalities: (1) the ability to become aware of and understand the
emergence of various emotions; (2) the acceptance of emotions; (3) the ability to act
towards desired goals, after controlling impulsive behaviours, when experiencing
negative emotions; and (4) the ability to use flexible Emotional Regulation strategies to
modulate emotional responses in order to respond to environmental demands and
achieve individual goals (Gratz & Roemer, 2004). Considering these dimensions, the
authors designed the Difficulties in Emotion Regulation Scale (DERS; Gratz and
Roemer, 2004). There have been different adaptations and psychometric studies of this
scale in different cultures, which makes it an instrument with empirical support and
cross-cultural relevance (Coutinho et al., 2009; Dan-Glauser y Scherer, 2012; Giromini
et al., 2012; Guzmán-González et al., 2014; Hallion et al., 2018; Hervás y Jódar, 2008;
Mitsopoulou et al., 2013; Newman et al., 2010; Ruganci y Gencöz, 2010; Tejeda et al.,
2012). In Argentina, the DERS was adapted and validated for its use with university
students in the province of Córdoba (Medrano & Trógolo, 2014). One of the limitations
in psychology research is that university population samples are usually used, which
limits the generalisability of the results (Hanel & Vione, 2016).
 Considering that Emotional Dysregulation is a process involved in the
emergence and maintenance of most mental disorders, quality of life and self-esteem
(Balaguer Pich et al., 2018; Brown and Barlow, 2009), it becomes a construct of great
relevance for clinical psychology. It is for these reasons that the present study aims to
adapt, validate and baremise the Difficulties in Emotional Regulation Scale (DERS) for
its use in adults from the general population of the Metropolitan Area of Buenos Aires
(AMBA), Argentina. This will contribute to the advance of research in this area and
provide a valid and reliable technique for evaluating the effectiveness of clinical
interventions focused on emotional regulation.

Method

Participants

The sample consisted of 315 participants (69.5% female: 219) from the general
population of the Buenos Aires Metropolitan Area. Sampling was non-probabilistic with
a snowball strategy. The mean age of the sample was 32.44 years old (Standard
Deviation: 12.64; range: 18 - 65). Regarding education, 0.6% of the sample had
completed primary school, 7% had completed secondary school, 44.8% had
incomplete tertiary/university studies, 32% had completed tertiary/university studies,
9.2% had incomplete postgraduate studies and 6% had completed postgraduate
studies. In terms of perceived socioeconomic status, 2.5% of the participants reported
low socioeconomic status, 15.2% middle-low socioeconomic status, 59.7% middle
socioeconomic status, 20.3% middle-high socioeconomic status and 2.2% high
socioeconomic status.

Materials

Difficulties in Emotion Regulation Scale ([DERS]; Gratz & Roemer, 2004). The
scale initially developed by Gratz and Roemer (2004) was used, translated and
adapted for its use with adults in the general population of the AMBA (details of
translation and adaptation are provided in the study procedures). It assesses the
degree to which people use various Emotional Regulation strategies. The original scale
has 36 self-administered items with a Likert response format of 5 options from 1
(almost never) to 5 (almost always) and a structure of six factors: (1) Impulse control
difficulties (six items), (2) Limited access to emotional regulation strategies (eight
items), (3) Non acceptance of emotional responses (six items), (4) Difficulties engaging
in goal-directed behavior (five items), (5) Lack of emotional awareness (six items) and
(6) Lack of emotional clarity (five items). The original scale has good internal
consistency (α = .93), and each subscale has an internal consistency with Cronbach's
alpha coefficients greater than .80.

Trait Meta Mood Scale 27 ([TMMS-27]; Salovey et al., 1995; Argentine

adaptation by Mikulic et al., 2019). The instrument assesses individual differences in
the skills with which people are aware of their own emotions, as well as their abilities to
regulate them. The scale has 27 self-administered items with a 5-choice Likert
response format from 1 (strongly disagree) to 5 (strongly agree). It has a three-factor
structure: (1) Emotional Attention (nine items), (2) Emotional Clarity (nine items) and
(3) Emotional Repair (nine items).

Regulation dimension of the Social-Emotional Competencies Inventory for

Adults ([ICSE]; Mikulic et al., 2015). The instrument was designed to assess
socioemotional competencies. It has 72 self-administered items, with a Likert response
format of 5 options from 1 (Disagree) to 5 (Agree) that account for nine factors (self-
efficacy, optimism, assertiveness, emotional expression, emotional awareness,
empathy, emotional regulation, prosociality and autonomy). Its internal consistency is
adequate with an average Cronbach's alpha coefficient of .72 (ranging from .60 to .87).

Anxiety and Depression dimensions of the Symptom Checklist-90-R (Derogatis,

1994; Argentine adaptation by Casullo & Pérez, 2008). The scale has 90 self-
administered items with a 5-point Likert response format from 0 (Not at all) to 4 (Very
much) based on how you have felt in the last 7 days including today. It consists of 9
primary dimensions (somatization, 12 items; obsessions and compulsions, 10 items;
interpersonal sensitivity, 9 items; depression, 13 items; anxiety, 10 items; hostility, 6
items; phobic anxiety, 7 items; paranoid ideation, 6 items; and psychoticism, 10 items)
and 3 global indices of psychological distress (global severity index, total positive
symptoms and positive symptomatic distress index). Internal consistency has been
evaluated in different samples obtaining Cronbach's alpha coefficients ranging between
.70 and .90, both for the total scale and for the different dimensions.

Neuroticism dimension of the International Personality Item Pool-Five-Factor

Model measure ([IPIP-FFM]; Goldberg, 1999; Argentine adaptation by Gross et al.,
2012). This questionnaire consists of 50 self-administered items with a 5-point Likert
response format from 1 (Strongly disagree with this description of myself) to 5 (Strongly
agree with this description of myself), constructed on the basis of the Big Five Factor
Model (FFM) of personality. Each statement describes typical behaviours of people
linked to the different personality traits proposed by the model: (1) extraversion (10
items), (2) neuroticism (10 items), (3) responsibility (10 items), (4) agreeableness (10
items), and (5) openness to experience or intellect (10 items). The scale has good
internal consistency (α values between 0.75 and 0.86).

Rosenberg self-esteem scale ([RSES]; Rosenberg, 1965; Argentine adaptation

Góngora and Casullo, 2009). The instrument was designed to assess positive or
negative attitude towards the self. It has 10 self-administered items, with a Likert
response format of 4 options from 1 (strongly disagree) to 4 (strongly agree), which
account for one factor. Its internal consistency is adequate with a Cronbach's alpha
coefficient of .70.

Procedure

Linguistic and cultural adaptation

Considering that the original scale was developed by Gratz and Roemer (2004)
in English, the first objective in the adaptation process was to arrive at a Spanish
version which linguistic style was appropriate for the local population. To this end, a
backward translation was carried out. An independent translator with knowledge of
emotional regulation, the target population and psychometrics (International Test
Commission [ITC], 2016) was asked to translate from English to Spanish. Then,
another translator with the same knowledge translated the Spanish version back into
English and it was evaluated that the meaning of the english versions was congruent.

Once a Spanish version was obtained, an expert judgement was carried out to
provide evidence of content validity. Five experts in emotional regulation and with
knowledge of the target population were asked to score the relevance and clarity of the
items between 0 and 2, on the one hand, and to match the items with the dimensions
of the scale, on the other. Aiken's V for relevance for the whole scale was .95 (with
values ranging from .85 to 1 for the different subscales). For clarity, an Aiken's V of .9
was obtained (with values ranging from .8 to .98 for the different subscales). For item-
dimension matching, twelve items obtained an Aiken's V value of 1, eleven items a
value of .8, seven items a value of .6 and six items (8, 17, 30, 33, 34 and 36) obtained
values of .4 or less. The six items with Aiken's V below .6 were discarded as they were
not considered to be adequate indicators of the emotional regulation dimensions
measured in the DERS.
 Subsequently, a pilot test was conducted under saturation criteria. The sample
consisted of 15 subjects belonging to the target population who were administered the
scale and were asked to give their opinion in relation to the clarity (both of the task and
of the items), comfort with the number of response options and other possible
comments.

Metric adaptation

For the metric equivalence, a non-probabilistic sample was used. A Google

Forms survey was created, including an informed consent, sociodemographic data, the
DERS scale, the Trait Meta-Mood Scale (TMMS; Salovey, et al., 1995; Argentine
adaptation by Mikulic, et al., 2019), the Regulation subscale of the Inventory of Social-
Emotional Competencies (ICSE; Mikulic, et al., 2015), the Anxiety and Depression
subscales of the Symptom Checklist-90-R (SCL-90-R; Derogatis, 1994; Argentine
version by Casullo and Pérez, 2004), the Neuroticism subscale of the International
Personality Item Pool Five-Factor Model (IPIP-FFM; Goldberg, 1999; Argentine version
by Gross, et al., 2012) and the Rosenberg Self-Esteem Scale (RSES; Rosenberg,
1965; Argentine adaptation Góngora and Casullo, 2009). The questionnaire was
disseminated through social networks asking people to complete it and forward it to
acquaintances. To guarantee the anonymity of the data, a separate form was
generated with the emails of the participants and their IDs. This form was kept and
accessible only by the principal researcher. In another spreadsheet, the responses to
the questionnaires were identified by the IDs only. All statistical analyses were
performed with the R programming language (R Development Core Team, 2012).

Results

Analysis of internal consistency

For the analysis of internal consistency, Cronbach's alpha coefficient was

calculated for the total scale and for each subscale. The values obtained were: α
= .936 for the total DERS scale, α = .874 for Impulse Control Difficulties, α = .848 for
Limited Access to Emotional Regulation Strategies, α = .907 for Non-Acceptance of
Emotional Responses, α = .880 for Difficulties Engaging in Goal-directed Behavior, α
= .690 for Lack of Emotional Awareness, and α = .810 for Lack of Emotional Clarity.

Also, omega coefficients (McDonald, 1999) were calculated because there is

growing evidence in the literature in favour of its use as a replacement for Cronbach's
alpha in psychological variables measured on ordinal scales (Dunn et al., 2014). The
values obtained were: ω = .938, 95%IC [.93, .95] for the total DERS scale, ω = .881,
95%IC [.85, .91] for Impulse Control Difficulties, ω = .854, 95%IC [.82, .88] for Limited
Access to Emotional Regulation Strategies, ω = . 907, 95%CI [.88, .92] for Non-
Acceptance of Emotional Responses, ω = .884, 95%CI [.86, .90] for Difficulties
Engaging in Goal-directed Behavior, ω = .704, 95%CI [.63, .75] for Lack of Emotional
Awareness, and ω = .814, 95%CI [.77, .85] for Lack of Emotional Clarity.

Analysis of internal structure

To provide evidence of construct validity, the existence of adequate

intercorrelation between items was assessed using the Kaiser-Meyer-Olkin measure of
sampling adequacy and Bartlett's test of sphericity, obtaining evidence suggesting the
feasibility of performing a factor analysis (KMO = .92; χ2 = 1707.183; gl = 435; p
< .001). Then, a confirmatory factor analysis (CFA) was performed with the 30 items to
test whether the factor structure of the DERS in the AMBA population is equivalent to
the original structure. The six latent variables corresponding to those suggested by the
original authors (Gratz and Roemer, 2004) were introduced into the model. The model
fit was determined by the Comparative Fit Index (CFI = .89), the Tucker-Lewis Index
(TLI = .88) and the root mean square error of approximation (RMSEA = .06). Given that
the factor loadings of all the items presented values greater than .4, it was decided to
keep them, leaving a scale integrated by 30 items (See Figure 1).

Figure 1

Internal structure of the adapted version of the DERS

Descriptive analyses of the items

The mean, standard deviation, skewness and kurtosis of each item were
analysed. All items presented skewness and kurtosis values between -2 and 2,
suggesting a normal distribution (George and Mallery, 2007), with the exception of item
4 ("I have no idea how I feel") which presented a kurtosis value of 2.64. The frequency
distribution of the scale is bell-shaped (M= 65.54; SD= 20.67) with positive skewness
(0.58).

Item discrimination analysis

The level of item discrimination was analysed by the differences in the

responses given to each item between the high and low emotional dysregulation
groups, on the one hand, and by calculating the corrected item-total correlation, on the
other hand. For group differences, a group was created with 25% of the subjects with
the highest emotional dysregulation scores and another with 25% of the subjects with
the lowest emotional dysregulation scores by interquartile difference. A Student's t-test
for two independent samples was then calculated for each item, finding significant
differences in all cases (p < .001) (see Appendix 1). Given that the assumption of
normality was not met, and the possibility that the variable does not have a normal
distribution, a non-parametric test was also calculated (Wilcoxon test for group
difference), corroborating significant differences in all items (p < .001) with effect sizes
between moderate and high. On the other hand, corrected item-total correlations were
calculated, obtaining Pearson's r coefficients greater than .40 in all cases (see
Appendix 1).

Convergent and Discriminant Validity

The relationship with certain variables whose definition resembles the

Emotional Regulation construct, and with those for which an association was
demonstrated in different studies was explored. To this end, Pearson's r correlations
were calculated between the scores of the scales.

a) Anxious and Depressive Symptomatology

In line with previous literature (Egan et al., 2011; Sloan et al., 2017), when
calculating Pearson's r correlations between the DERS scale and the Anxiety and
Depression subdimensions of the SCL-90, direct significant associations were found
(r(114) = .52, p < .01 for anxiety; r(114) = .63, p < .01 for depression).

b) Neuroticism

Different studies have suggested that the personality variable neuroticism is

associated with greater reactivity to stimuli and less capacity for emotional regulation
(DeYoung, 2015). In support of this idea, when calculating a Pearson's r correlation
between scores on the Neuroticism subscale of the IPIP-FFM and the DERS, a
significant direct association was found (r(114) = .71, p < .01).

c) Emotion Regulation Variables (TMMS and ICSE Regulation)

After searching for scales adapted for its use in the general population in
Argentina that measured a construct similar to that of emotion regulation, the TMMS
and the ICSE Regulation subscale were selected. As expected, significant inverse
associations were found both between DERS and TMMS (r(114) = -.46, p < .01), and
between DERS and ICSE Regulation (r(114) = -.65, p < .01).

d) Self-esteem

Previous research has suggested the existence of an inverse relationship

between Self-Esteem and Emotional Dysregulation. In this line, in a 2018 study,
Balaguer Pich et al. found a significant association between scores on the DERS and
those on the Rosenberg Self-Esteem scale. Similarly, this study found a significant
inverse association between both variables (r(114) = -.60, p < .01).
 Covariances between the subscales

On the other hand, covariances between the dimensions of the model were
examined. Values between .50 and .85 were considered as evidence of independence,
values above .85 as indicators of convergent validity and values below .50 as
indicators of discriminant validity (Rial Boubeta et al., 2006). Eight of the 15
covariances integrating the model were within the reference range. Seven were below
the range: strategies-awareness (.37), awareness-impulses (.17), awareness-goals
(.23), awareness-acceptance (.14), impulses-clarity (.45), goals-acceptance (.39), and
clarity-acceptance (.44).

Differences according to age and gender

Finally, it was assessed whether there were significant differences in DERS

scores as a function of age and gender. To assess whether a person's age was a good
predictor of emotional regulation ability, a linear regression was performed including
the emotional dysregulation variable as a dependent variable and the age variable as a
predictor, showing a significant predictive ability (β = -0.54, F(1, 314) = 38, p < .001, R2
= .11).

On the other hand, Wilcoxon tests were performed to compare the scores on
the different subscales of the DERS according to sex. Significant differences were
found in four of the six scales: Strategies (W = 8183.5, p < .01), Non-Acceptance (W =
7962, p < .001), Goals (W = 7657.5, p < .001) and Clarity (W = 7876.5, p < .001). In all
cases, females reported significantly higher scores than males. Non-parametric tests
were performed because the assumption of normality was not met in the different
groups.

Discussion

This paper presents the conceptual, linguistic and metric adaptation of the
Difficulties in Emotional Regulation Scale (Gratz & Roemer, 2004) for its use in the
adult population of the metropolitan area of Buenos Aires, Argentina. The aim of the
study was: a) to arrive at a Spanish version whose linguistic style was appropriate for
the local population; b) to examine evidence of content validity; c) to study the internal
consistency of the scores; d) to provide evidence of construct validity; e) to analyse the
discriminative ability of the items; f) to provide evidence of convergent and discriminant
validity; and g) to establish normative values.
 The adapted scale consists of 30 items distributed in the 6 dimensions
proposed by the original authors: impulse control difficulties, limited access to
emotional regulation strategies, non-acceptance of emotional responses, difficulties
engaging in goal-directed behavior, lack of emotional awareness, and lack of emotional
clarity (Gratz & Roemer, 2004) (see Appendix 2).

When analysing content validity, the six items with Aiken's V. less than .6 ("I
care about how I feel", "When I am upset, I think my feelings are valid and important",
"When I am upset, I start to feel bad about myself", "When I am upset, I have difficulty
thinking about something else", "When I am upset, I take time to understand what I
really feel" and "When I am upset, my emotions get the better of me") were discarded.
These items were considered to be inadequate indicators of the dimensions to which
they were assigned by the original authors. When assessing internal consistency, the
indices obtained with both Cronbach's alpha and the Omega (coefficients ranging
from .70 to .91) were good in all dimensions, even in those where some items have
been removed (Campo-Arias and Oviedo, 2008).

Model fit was determined by the Comparative Fit Index (CFI; good fit
≥ .85), the Tucker-Lewis Index (TLI; exact fit > .99, very good fit = .95 - .99,
acceptable fit = .90 - .95) and the root mean squared error of approximation
(RMSEA; exact fit < .01, very good fit = .06 - .01, acceptable fit = .08 - .06)
(Brown, 2015). While the values obtained are not ideal (CFI = .89; TLI = .88;
RMSEA = .06), they are close to those proposed by the literature. The
structure of the DERS is a controversial issue given that in its different
adaptations, distinct structures were found. The Portuguese (Coutinho et al.,
2009), German (Newman et al., 2010), Turkish (Ruganci and Gencöz, 2010),
Italian (Giromini et al., 2012), French (Dan-Glauser and Scherer, 2012),
Greek (Mitsopoulou et al., 2013), and Cordoba, Argentina (Medrano and
Trógolo, 2014) versions retain a six-factor structure. The Spanish version
(Hervás and Jódar, 2008), the Chilean version (Guzmán-González et al.,
2014), and the United States version (Hallion et al., 2018) are made up of 5
dimensions. Finally, the Mexican version (Tejeda et al., 2012) includes four
factors.

In terms of item discrimination, all items showed good discriminatory ability. In

all cases, significant differences were found between the group with higher scores on
the scale and the group with lower scores (Muñiz, 2005). In turn, when calculating the
corrected item-total correlations, Pearson's r coefficients greater than .40 were
obtained in all cases, indicating a very good level of discrimination (Cristobal et al.,
2007).

Within process-based approaches, emotional dysregulation has been

conceptualised as the process of greatest involvement in the emergence and
maintenance of emotional disorders (anxiety and depression being the most prevalent)
(Sloan et al., 2017). In line with previous literature, significant direct associations were
found with anxiety, depression and neuroticism; and significant inverse relationships
with measures of regulation and self-esteem. These results not only provide evidence
of convergent and discriminant validity of the scale, but also support existing evidence
on the importance of emotion regulation. The fact that such high correlations were
found with measures of anxiety and depression supports the theory that emotion
regulation may be a process underlying emotional disorders (Sloan et al., 2017). And
the strong association between high scores on difficulties in emotion regulation and low
scores on self-esteem suggests that people with emotion dysregulation tend to have a
negative perception of themselves, which may lead to lower rates of personal
satisfaction and quality of life (Balaguer Pich et al., 2018).

On the other hand, when assessing the presence of differences between

groups, it was found that men have better levels of acceptance, clarity, goal orientation
and use of flexible strategies than women. These results disagree somewhat with what
was found in the original study (Gratz and Roemer, 2004) where differences were only
found on the clarity scale. However, the differences found in this study have small
effect sizes.

Finally, it was observed that 11% of the variability in emotion regulation scores
is explained by age. These scores decrease as people get older. These data are
consistent with what has been reported in other research where inverse associations
were found between age and emotion dysregulation (Hallion et al., 2018; Ortega,
2009).

In relation to the objective of providing normative values, percentile scores are

offered for three age groups (18-30, 31-45 and 46-65), obtained from the application of
the DERS to 315 subjects from the general population of the metropolitan area of
Buenos Aires, Argentina (See Appendix 3). Although the normative values presented
can be taken as indicative, they should be interpreted with caution due to the small
sample size and the non-representativeness of the sample.

The sample size and the non-probability sampling is a limitation not only for the
interpretation of the normative values, but also for the conclusions in general. Future
research could evaluate the psychometric properties of the adaptation in larger and
more representative samples and in different areas of the country in order to have a
global view of the construct of emotion dysregulation in Argentina.

In conclusion, the adaptation of the Gratz and Roemer’s Difficulties in Emotion

Regulation Scale (2004) for its use in the general population of the AMBA is an
instrument that has shown evidence of validity and reliability for measuring difficulties in
different processes of emotion regulation. Given that emotion regulation has been
identified as a process involved in the emergence and maintenance of most mental
disorders, quality of life and self-esteem (Balaguer Pich et al., 2018; Brown and Barlow,
2009), the scale has great relevance in different areas. On the one hand, it can be a
great tool for the evaluation of progress in psychotherapeutic processes. On the other
hand, it can be used to measure a relevant construct in the investigation of factors that
modulate the presence of symptomatology and levels of quality of life.

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Appendix 1

Item discrimination analysis

Análisis de discriminación de los ítems

T-test r

Ítem t p Effect size

DERS 1 9.55 <.001 .61 .73
DERS 2 6.34 <.001 .44 .85
DERS 3 12.23 <.001 .72 .64
DERS 4 8.17 <.001 .62 .71
DERS 5 11.93 <.001 .73 .78
DERS 6 4.67 <.001 .36 .80
DERS 7 9.93 <.001 .62 .77
DERS 8 11.71 <.001 .72 .77
DERS 9 7.73 <.001 .54 .73
DERS 10 12.33 <.001 .68 .79
DERS 11 12.17 <.001 .72 .88
DERS 12 13.97 <.001 .73 .86
DERS 13 11.13 <.001 .68 .85
DERS 14 14.99 <.001 .81 .80
DERS 15 13.35 <.001 .76 .75
DERS 16 15.07 <.001 .76 .89
DERS 17 13.05 <.001 .78 .85
DERS 18 10.13 <.001 .62 .79
DERS 19 12.23 <.001 .74 .87
DERS 20 10.29 <.001 .66 .62
DERS 21 13.59 <.001 .75 .71
DERS 22 11.21 <.001 .67 .65
DERS 23 11.32 <.001 .67 .86
DERS 24 14.77 <.001 .76 .89
DERS 25 12.85 <.001 .74 .86
DERS 26 15.22 <.001 .81 .85
DERS 27 13.50 <.001 .77 .87
DERS 28 12.92 <.001 .76 .77
DERS 29 11.51 <.001 .71 .86
DERS 30 12.87 <.001 .74 .74

Note. T-test for independent samples between the group with high scores and the group with
low scores on the DERS by interquartile difference. r = corrected item-total correlations.
 Appendix 2

Spanish version of the Difficulties in Emotion Regulation Scale adapted for its use in
AMBA, Argentina

Escala de Dificultades en la Regulación Emocional (DERS)

Por favor indique qué tan seguido aplican a usted las próximas afirmaciones:
1- Casi nunca (0-10%) 2- A veces (11-35%) 3- La mitad del tiempo (35-65%) 4- La mayor
parte del tiempo (66-90%) 5- Casi siempre (91-100%)

1 2 3 4 5
(Casi (A (La mitad (La mayor (Casi
nunca) veces) del parte del siempre)
tiempo) tiempo)

1. Entiendo con claridad mis sentimientos.

2. Presto atención a cómo me siento.

3. Experimento mis emociones como abrumadoras

y fuera de control.

4. No tengo idea de cómo me siento.

5. Tengo dificultades para encontrarle el sentido a

mis sentimientos.

6. Estoy atento a mis sentimientos.

7. Sé exactamente cómo me siento.

8. Estoy confundido en relación a cómo me siento.

9. Cuándo estoy molesto, reconozco mis

emociones.

10. Cuándo estoy molesto, me enojo conmigo

mismo por sentirme de esa forma.

11. Cuándo estoy molesto, me avergüenzo por

sentirme de esa forma.

12. Cuándo estoy molesto, tengo dificultades en

terminar mis tareas.

13. Cuándo estoy molesto, pierdo el control.

14. Cuándo estoy molesto, pienso que voy a

permanecer de ese modo por un largo tiempo.

15. Cuándo estoy molesto, pienso que voy a

terminar sintiéndome muy deprimido.

16. Cuándo estoy molesto, tengo dificultades para

concentrarme en otras cosas.

17. Cuándo estoy molesto, me siento fuera de

control.

18. A pesar de estar molesto, puedo realizar mis

cosas.

19. Cuando estoy molesto, me avergüenzo de mí

mismo por sentirme así.

20. Cuándo estoy molesto, sé que puedo

encontrar una forma para sentirme mejor
eventualmente.

21. Cuándo estoy molesto, siento que soy débil.

22. Cuándo estoy molesto, siento que puedo

mantener el control de mi comportamiento.

23. Cuándo estoy molesto, me siento culpable por

sentirme de esa forma.

24. Cuándo estoy molesto, tengo dificultades para

concentrarme.

25. Cuándo estoy molesto, tengo dificultades para

controlar mi comportamiento.

26. Cuándo estoy molesto, pienso que no hay

nada que pueda hacer para sentirme mejor.

27. Cuándo estoy molesto, me enojo conmigo

mismo por sentirme de esa forma.

28. Cuándo estoy molesto, creo que sumergirme

en ese estado es todo lo que puedo hacer.

29. Cuándo estoy molesto, pierdo el control sobre

mi comportamiento.

30. Cuándo estoy molesto, me toma mucho tiempo

volver a sentirme mejor.

Ítems inversos: 1, 2, 6, 7, 9, 18, 20 y 22.

Puntuación: la escala brinda un puntaje total y un puntaje para cada una de las seis subescalas:
Dificultades en el control de impulsos (Impulsos): 3, 13, 17, 22R, 25, 29

Acceso limitado a estrategias de regulación emocional (Estrategias): 14, 15, 20R, 26, 28, 30

Falta de aceptación emocional (Aceptación): 10, 11, 19, 21, 23, 27

Interferencia en conductas dirigidas a metas (Metas): 12, 16, 18R, 24

Falta de conciencia emocional (Conciencia): 2R, 6R, 9R

Falta de claridad emocional (Claridad): 1R, 4, 5, 7R, 8

**”R” indica ítems con puntaje inverso.

Appendix 3

Percentile distribution for adults in three age groups

Percentil Puntaje 18-30 Puntaje 31-45 Puntaje 46-65

10 45 42 37

15 48 43 39

20 52 44 39

25 54 47 41

30 57 49 43

35 58 51 44

40 61 52 47

45 63 62 48

50 66 63 51

55 69 65 53

60 72 67 55

65 76 69 56

70 78 70 59

75 84 73 64

80 92 77 66

85 96 82 72

90 100 90 78

95 106 104 91

99 113 107 105