The Arousal Modulation Model Questionnaire (AMMQ): Development, validation, and transdiagnostic applications

• Published in: European journal of trauma & dissociation = Revue europâeenne du trauma et de la dissociation Vol. 9; no. 3; p. 100564
• Main Authors: D’Antoni, Fabio, Matiz, Alessio, Crescentini, Cristiano
• Format: Journal Article
• Language: English
• Published: Elsevier Masson SAS 01.09.2025
• Subjects: Arousal modulation; Dissociation; Polyvagal theory; Psychiatric/Mental Health; Psychotherapy; Transdiagnostic assessment; Trauma; Arousal modulation; Psychotherapy; Dissociation; Trauma; Polyvagal theory; Transdiagnostic assessment
• ISSN: 2468-7499; 2468-7499
• DOI: 10.1016/j.ejtd.2025.100564

Trauma emerges as a significant etiological factor associated with a wide range of psychopathologies, including anxiety, mood disorders, impulse dysregulation, psychosis, substance dependence, personality disorders, conduct issues, and suicidal behavior. Furthermore, trauma plays a central role in somatoform and alexithymic disorders, eating disorders, and self-injurious behaviors. Additionally, trauma is linked to the development of various physical health conditions such as cardiovascular, gastrointestinal, endocrine, and inflammatory diseases, as well as cancer. Thus, the negative health consequences of trauma extend beyond PTSD and often manifest in personalized, polysymptomatic, and polysyndromic ways, suggesting the utility of adopting transdiagnostic approaches. This study focuses on validating the Arousal Modulation Model Questionnaire (AMMQ), grounded in Ogden and Minton's Arousal Modulation Model originating from Siegel's concept of the Window of Tolerance. The validation process encompasses multiple facets of questionnaire validation, including construct validity, reliability, and other psychometric properties. Participants included a sample of 304 individuals recruited for this study, with a mean age of 39.36 years (SD = 12.88). Although participants may have experienced one or more traumatic events in their lives, they were currently not under the care of the National Health Service Psychiatry Centers. Construct validity of the AMMQ was assessed through exploratory and confirmatory factor analyses. Initial exploratory factor analysis revealed a coherent factor structure consistent with theoretical expectations derived from the Arousal Modulation Model, yielding four distinct factors: "Optimal Arousal Zone" (OAZ, 7 items), "Fight/Flight" (FF, 4 items), Freeze (Fr, 6 items), and "Feigned Death" (FD, 5 items). Subsequent confirmatory factor analysis supported this structure, demonstrating excellent model fit (χ²(203) = 381.738, p < 0.001; CFI = 0.94; TLI = 0.93; RMSEA = 0.05; SRMR = 0.05). Internal consistency was high, with a mean categorical omega (ω) of 0.83 across all subscales, supporting the reliability of the AMMQ. Convergent validity was assessed by examining the associations between each AMMQ subscale and a set of established external measures. The Optimal Arousal Zone (OAZ) subscale showed strong positive correlations with all dimensions of psychological well-being (PWB-SF) and negative correlations with emotional distress (DASS-21), dissociation (DES-II). Conversely, all three dysregulation subscales—Fight-or-Flight (FF), Freeze (Fr), and Feigned Death (FD)—were positively associated with anxiety, depression, stress, and dissociation, as well as with increased autonomic reactivity measured by the BPQ-22 (all p < 0.001). The AMMQ test-retest reliability was also good (0.83). Overall, the validation results suggest that the Arousal Modulation Model Questionnaire is a reliable and valid instrument for assessing arousal modulation processes within the context of stress reactivity. Its good psychometric properties make it a valuable tool for clinicians and researchers working in trauma-informed assessment and intervention. Finally, robust correlations between all AMMQ factors and the Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM) scales (all p < 0.001) bolster its efficacy for transdiagnostic screening in psychotherapy, clinical research, and various psychological well-being interventions (e.g., mindfulness-based approaches).