Validation of the Arabic version of the Embodied Sense of Self Scale (ESSS) in general population adults

Validation of the Arabic version of the Embodied Sense of Self Scale (ESSS) in general population adults | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Validation of the Arabic version of the Embodied Sense of Self Scale (ESSS) in general population adults Feten Fekih-Romdhane, Amira Mohammed Ali, Ghada Amouchi, Majda Cheour, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4762476/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Although the concept of the embodied sense of self (ESS) has attracted considerable interest from researchers around the world over the past years, research in this field is yet to be initiated in Arab countries. To address this gap, and owing to the important role the ESS construct plays in psychopathology, this study proposes to adapt and validate the Embodied Sense of Self Scale (ESSS) to the Arabic context and language by examining its factor structure, reliability, validity, and measurement invariance across sex. Methods A cross-sectional study was performed between March and May 2024 using an online questionnaire and the snowball sampling technique. A total of 502 participants (mean age of 21.74 years, 64.9% females) were included. The ESSS was translated into Arabic using the forward-backward translation method. Results Our study replicated the originally proposed three-factor model (i.e., Ownership, Narrative, and Agency) of the ESSS with an acceptable fit: χ 2 /df = 683.95/272 = 2.52, RMSEA = .055 (90% CI .050, .060), SRMR = .054, CFI = .859, TLI = .845. The reliability analysis was good for the total score (α = .88) and for the three factors (α = .74 − .80). In addition, measurement invariance across sex was established in our sample at the configural, metric, and scalar levels. Findings also showed that empathy positively and weakly correlated with ESSS scores, thus attesting to divergent validity of the Arabic version of the scale. Significant correlations were found between higher ESSS scores and more severe depression, anxiety and stress, whereas no significant correlation was observed between ESSS and self-esteem. Conclusion Findings of the present study indicated that the psychometric properties of our Arabic version of the ESSS were good, suggesting that the scale is valid, reliable and ready for use in Arabic-speaking adults and Arab contexts. The Arabic ESSS can be useful for clinicians and researchers in clarifying the complex role of the ESS in the psychopathology of different mental conditions. Embodiment Sense-of-Self Agency Ownership Narrative Psychometric properties Arabic Figures Figure 1 INTRODUCTION Over the last decade, there has been an increasing interest in the investigation of the self. A sense of self is thought to originate during a critical developmental period in much the same way in each person. It is a hard-to-define concept, as many individuals feel unable or struggle to precisely articulate what their sense of self actually is [ 1 ]. This has led to various ways in which the self was conceptualized, either as one unitary entity (e.g., [ 2 ]), a bidimensional (e.g., [ 3 ]), or a multidimensional construct (e.g., [ 4 ]). According to Klein and Gangi [ 5 ], the self can be defined as a “multiplicity of related, yet separable, processes and contents”. Current neuropsychological, behavioural, and computational theories have attempted to elicit one’s own representation of the self in the brain, or how one may subjectively feel their own body (i.e., the sense of body) or their own action (i.e., the sense of action). The sense of body requires a multimodal integration of sensory information related to proprioception, touch, vision, and the neural system [ 6 ]. The sense of action is characterized by the extent to which intended actions are mirrored by actual outcomes or feedback [ 7 ]. These subjective experiences, which are anchored within the sensorimotor system and the body, are referred to as the “Embodied Sense of Self” (ESS) [ 8 ]. An alteration of one’s ESS implies a detachment of the person from themselves and their actions/experiences. It may involve global changes in the intersubjective and environmental experience of the external world, including anomalies of object perception and self-object relations, as well as an inability to reach an emotional attunement with others [ 9 ]. Therefore, there is evidence to support that the ESS may be altered in several psychiatric conditions, such as depression [ 10 ], borderline personality disorder [ 11 ], and psychosis [ 12 ]. For instance, the self-experience is found to be fundamentally affected in individuals diagnosed with schizophrenia, often since the prodromal stages of the disease [ 12 ]. It has also been suggested that a more robust sense of self may be regarded as an important restoration factor and internal resource that confers less vulnerability to psychopathology [ 13 ]. Given the clear and important role of ESS in psychopathology [ 14 ], there have been efforts directed towards measuring the ESS construct based on subjective reports [ 15 ]. Sample measures include the Sense of Agency Scale [ 16 ], which is a measure of the subjective aspects of a sense of agency, and the Sense of Agency Rating Scale [ 17 ], which is a measure of agency disruption in hypnosis. Another measure is the Examination of Anomalous Self-Experience [ 18 ], which is a semi structured symptom checklist designed to assess subjective or experiential anomalies of basic self-awareness. However, the subjective SSE can be challenging to explore, as it constitutes an idiosyncratic and variable concept, that might be subject to subjectivity and misinterpretation. Besides, a wide range of functions including body and action are automatically regulated by the brain - unless an “error” processing is detected - [ 19 , 20 ], making the person often unaware of the feeling of self [ 21 , 22 ]. To address these issues, and enable an accurate measurement of the ESS construct, Asai et al. [ 23 ] proposed to rather focus on the “errors”, or the daily experiences resulting from an abnormal ESS, which may, in turn, raise the awareness for the self [ 24 ]. To this end, the authors developed the Embodied Sense of Self Scale (ESSS), a 25-item self-report questionnaire that measures an anomalous ESS through three dimensions, namely Ownership, Narrative, and Agency [ 23 ]. The “Ownership” dimension is composed of nine items (e.g., “Sometimes I sense that my body is very light” or “When I am doing something, it seems like I am observing myself from a distance”) which reflect the sense of the reality or existence of oneself (i.e., selfness) and the sense of ownership over one’s own body. The “Narrative self” dimension contains eight items (e.g., “I feel like sometimes people misunderstand my personality”, “I cannot remember what I did during that period because my memory was fuzzy”) which assesses the uniformity (i.e., uniqueness through personality, identity, and behavioural traits) and continuity (i.e., temporal extension through autobiographical memory) of the self. The “Agency” dimension involves eight items (e.g., “Something may attach itself to me without me realizing it”, “It is difficult to grope around for something without being able to see it”) to measure the sense of controllability of targets, such as the intentionality of one’s own actions and one’s own body [ 23 ]. The ESSS was originally validated through psychometric analyses based on five successive surveys in a large sample of Japanese university student, community adults and patients with schizophrenia (n = 1167). The scale yielded good psychometric properties in terms of factorial structure, clinical validity, and test-retest reliability [ 23 ]. In addition, convergent validity and divergent validity were established through significant correlations between ESSS scores and positive schizotypy symptoms, empathy, self-esteem and self-efficacy [ 23 ]. The ESSS was then translated and validated into the Italian language, and its psychometric properties were tested in a sample of 269 community adults [ 25 ]. The Italian version showed a new 19-item three-factor structure (i.e., self-recognition, self-consistence, and self-awareness), with high internal consistency reliability and good validity (as reflected by positive correlations with schizotypy and aberrant salience, and negative correlations with empathy, generalized self-efficacy, and social self-efficacy) [ 25 ]. However, no psychometrically validated Arabic version of the ESSS is yet available. Rationale of the present study From a cross-cultural perspective, it has been argued that the self is characterized by being “non-individualistic” (or collective), “interdependent”, and “relationship dependent” in non-Western as compared to Western cultures [ 26 – 28 ]. For instance, the role of others in the Arab-Muslim culture plays a crucial role in the formation of the self and in the way one defines themselves [ 29 ]. Lately, the MENA region and many Arab societies have been going through one of the most substantial transformations in history; and some believe that these changes can both be signs of self-change and have important implications to self of Arab people in the foreseen future [ 29 ]. However, there is no (or only scarce) empirical research on the self and the ESS among people of Arab culture. To aid in closing this gap, this study aimed to adapt and validate the ESSS to the Arabic context and language by examining its factor structure, reliability, validity, and measurement invariance across sex. It is hypothesized that the confirmatory factor analysis will support the proposed three-factor solution, and show a good model fit. It is also expected that the Arabic translation of the scale will show good reliability and validity in a sample of Arabic-speaking adults from the general population of Tunisia. Methods Procedures Data for this cross-sectional study was collected via a Google Form link, between March and May 2024. The sample was recruited conveniently; the research team approached people and asked them to fill the survey; those who accepted were asked to forward the link to other people they might know. Inclusion criteria for participation included being of a resident and citizen of Tunisia, aged over 18 years. Excluded were those who refused to fill out the questionnaire. After providing digital informed consent, participants were asked to complete the anonymous survey. Participants completed the survey voluntarily and without remuneration. Participants’ anonymity and confidentiality were preserved. The study protocol was approved by the ethics committee of Razi Hospital. Measures Participants were asked to provide their demographic details consisting of age, and sex in addition to the following scales: The Embodied Sense of Self Scale (ESSS) The ESSS is composed of 25 items, each is rated on a five-point scale as follows: 1 = Strongly disagree, 2 = Disagree somewhat, 3 = Neither disagree nor agree, 4 = Agree somewhat, and 5 = Strongly agree [ 23 ]. Higher scores indicate more anomalous ESS. The ESSS scale was translated and adapted to the Arabic language and context. To this end, it was translated to the Arabic language with the purpose of achieving semantic equivalence between measures in their original and Arabic versions following international norms and recommendations [ 30 ]. For this, the forward and backward translation method was applied. The English version was translated to Arabic by a bilingual expert who was completely unrelated to the study. Afterwards, a Tunisian psychiatrist with a full working proficiency in English, translated the Arabic version back to English. The translation team ensured that any specific and/or literal translation was balanced. The initial (English) and translated (Arabic) versions were compared by a committee of experts to guarantee the accuracy of the translation and eliminate any inconsistencies [ 31 ]. An adaptation of the measure to our specific context was performed; it sought to verify the ease of items interpretation and determine any misunderstanding of the items wording. This allows to ensure the conceptual equivalence of the original and Arabic versions of the ESSS in both contexts [ 32 ]. After the translation and adaptation of the measure, a pilot study was done on 30 adults to ensure all items were well understood; no changes were applied after the pilot study. The depression, Anxiety and Stress Scales (DASS-8) The DASS-8 is an 8-item measure which evaluates levels of psychological distress via three subscales: depression (3 items), anxiety (3 items), and stress (2 items). Items can be rated from 0 (“does not apply to me”) to 3 (“always applies to me”). Higher scores indicate greater depression, anxiety and stress. The scale is validated in the Arabic language [ 55 ]. The Arabic Single Item Trait Empathy Scale (SITES) The SITES is a measure of trait empathy, which consists of the following item: “I am an empathetic person”. Each participant is asked to score the extent to which the statement describes them in a five-point Likert-type scale ranging from 1 (“Not very true of me”) to 5 (“Very true of me”) [ 36 ]. The Arabic version of the SITES was used [ 37 ]. The Arabic Single-Item Self-Esteem Scale (A-SISE) The A-SISE consists of a single item (i.e. “I have high self-esteem”) that should be rated by each respondent from 1 (“not at all true of me”) to 5 (“very true of me”) [ 38 ]. The Arabic validated version was used [ 39 ]. Analytic Strategy There were no missing responses in the dataset. We used data from the total sample to conduct a confirmatory factor analysis (CFA) using the SPSS AMOS v.29 software. The minimum sample size needed was 75–500 participants based on the recommendations of 3–20 times the number of the scale’s items [ 40 ]. Parameter estimates were obtained using the maximum likelihood method. The normed model chi-square (χ²/df; ≤5), the Steiger-Lind root mean square error of approximation (RMSEA; ≤ .08), the standardized root mean square residual (SRMR; ≤ .05), the Tucker-Lewis Index (TLI) and the comparative fit index (CFI) (≥ .90 for both) [ 41 ]. Multivariate normality was not verified at first (Bollen-Stine bootstrap p = .002); therefore, we performed non-parametric bootstrapping procedure. Sex invariance. To examine sex invariance of ESSS scores, we conducted multi-group CFA [ 42 ] using the total sample. Measurement invariance was assessed at the configural, metric, and scalar levels [ 43 ] and verified if ΔCFI ≤ .010 and ΔRMSEA ≤ .015 or ΔSRMR ≤ .010 [ 44 ]. Composite reliability was assessed using McDonald’s ω and Cronbach’s α, with values greater than .70 reflecting adequate composite reliability [ 45 ]. Normality was verified since the skewness and kurtosis values for each item of the scale varied between − 1 and + 1 [ 46 ]. Pearson test was used to correlate the ESSS scores with other scores. Student t test was used to compare two means. According to Cohen, values ≤ .10 were considered weak, ~ .30 were considered moderate, and ~ .50 were considered strong correlations. Results Five hundred two participants completed the survey, with a mean age of 21.74 ± 2.65 years, 64.9% females and 98.4% single. Confirmatory Factor Analysis of the ESSS scale The fit of the three-factor model was acceptable: χ 2 /df = 683.95/272 = 2.52, RMSEA = .055 (90% CI .050, .060), SRMR = .054, CFI = .859, TLI = .845. The second-order CFA showed the same values for the fit indices. The standardised estimates of factor loadings were all adequate (Fig. 1 ). The reliability analysis was good for the total score (ω = .88 / α = .88) and for the three factors [Factor 1 (ω = .77 / α = .76), Factor 2 (ω = .80 / α = .80) and Factor 3 (ω = .74 / α = .74)]. Sex invariance We were able to show the invariance across sex at the configural, metric, and scalar levels (Table 1 ). No significant difference was seen between males and females in terms of ESSS total scores (73.66 ± 17.70 vs 71.85 ± 17.51; t (500) = 1.10; p = .272). Table 1 Measurement Invariance of the Embodied Sense of Self Scale across Gender. Model CFI RMSEA SRMR Model Comparison ΔCFI ΔRMSEA ΔSRMR Configural .849 .040 .067 Metric .854 .039 .069 Configural vs metric .005 .001 .002 Scalar .854 .038 .069 Metric vs scalar < .001 .001 < .001 Note. CFI = Comparative fit index; RMSEA = Steiger-Lind root mean square error of approximation; SRMR = Standardised root mean square residual. Convergent and divergent validity Table 2 illustrates the Pearson correlation matrix. Higher ESSS scores were significantly and weakly associated with higher empathy (r = .18; p < .001), and moderately associated with higher depression (r = .45; p < .001), anxiety (r = .55; p < .001) and stress (r = .47; p < .001), but not with self-esteem (r = − .01; p = .905). Table 2 Pearson correlation matrix. 1. ESSS total score 1 2. ESSS - Ownership .84*** 1 3. ESSS - Narrative .84*** .56*** 1 4. ESSS - Agency .82*** .53*** .56*** 1 5. Depression .45*** .41*** .42*** .31*** 1 6. Anxiety .55*** .49*** .43*** .46*** .63*** 1 7. Stress .47*** .40*** .43*** .35*** .61*** .59*** 1 8. Empathy .18*** .12** .18*** .14** .10* .23*** .23*** 1 9. Self-esteem − .01 − .01 .02 − .03 − .19*** − .19*** − .09 − .07 **p < .01; ***p < .001. ESSS: The Embodied Sense of Self Scale. DISCUSSION Although the concept of the ESS has attracted considerable interest from researchers around the world over the past years, research in this field is yet to be initiated in Arab countries. To address this gap, and owing to the important role the ESS construct plays in psychopathology, this study proposes to provide, for the first time, an Arabic validated measure of ESS for use among Arabic-speaking adults. Findings showed that the validity and reliability of the Arabic ESSS were at a good level, suggesting its suitability for use among Arabic-speaking adults to assess daily experiences induced by an anomalous ESS. Our study replicated the three-factor model (i.e., Ownership, Narrative, and Agency) of the ESSS as proposed by Asai et al. [ 23 ] and initially tested in a Japanese (non-Western, collectivist) population, with the same distribution of the items and without any modification or removal items. The original 25-item English-language version of the ESSS was developed based on an initial pool of 120 items [ 23 ], and its three factors were extracted following theoretical discussions on the core components of the ESS construct by prominent researchers in the field (i.e., [ 47 – 49 ]). In contrast, the original three-factor structure failed to be replicated in an Italian (Western, individualist) sample [ 25 ], where satisfactory goodness-of-fit and good internal consistency were achieved only after removal of six items. As a result, three new factors emerged. The first factor was labelled “self-recognition”; it consists of eight items which assess one’s capacity to recognize external or internal objects as real or belonging to the self, thus reflecting experiences of derealization and depersonalization. The second factor was labelled “self-consistence”; it consists of seven items which measure the uniformity and continuity of the embodied self, and reflect aspects of the temporal homogeneity of one’s thoughts, actions, and personality. The third factor was labelled “self-awareness”; it consists of four items which evaluate feelings of being consciously aware of one’s own body, thus reflecting the sense of proprioceptive coenesthetic and connection with the body [ 25 ]. Overall, findings reported in the current and previous studies suggest that the ESSS in the three-factorial solution is rather culture-dependent (not universal). This implies that the factor structure of the ESSS should be tested in a given cultural context before concluding which ESS dimensions could be measured and whether the scores obtained could be trusted, in order to guarantee a certain degree of confidence in the scale before using it. The Arabic ESSS showed good reliability (α = .88 for the total score, and α = .74 − .80 for the three factors), offering additional support to Asai et al.’s findings that the ESSS was highly consistent in measuring the ESS concept through the constructs of Ownership, Narrative, and Agency [ 23 ]. The original version ESSS had good internal consistency reliability coefficients in a sample of 718 university students (α ranging from .74 to .84 for the three subscales) [ 23 ]. As for the Italian version, reliability coefficients were also high for the total score (α = .889) and all three dimensions (α = .763-.827) [ 25 ]. Furthermore, measurement invariance across sex was established in our sample at the configural, metric, and scalar levels. Establishing measurement invariance is essential to ensure that patterns of responding are similar between male and female respondents. Ensuring that the ESSS is valid across sex groups enables meaningful comparisons of ESSS total and subscale scores to be made between males and females. No significant difference in ESSS scores was observed between male and female adults, which concurs with the results of Asai et al. [ 23 ] who also found no statistical sex difference in the ESSS total score in a sample of 718 Japanese university students. As our study is the first to establish sex invariance of the ESSS, future studies are called to test this important psychometric property before any conclusions can be made about potential sex differences. Our study examined the relationship between the ESSS in its Arabic version and other relevant measures. As expected, we found that the SITES, a measure of trait empathy, positively and weakly correlated with the ESSS, thus attesting to divergent validity of the Arabic version of the ESSS. In the initial validation study by Asai et al. [ 23 ], the ESSS scores superficially correlated with those of empathy, thus supporting that the scale adequately discriminates two somehow related concepts, i.e. the sense or awareness of others (or empathy) and the sense of self (as reflected by ESSS scores) [ 50 ]. Moreover, no significant correlation was observed between ESSS and self-esteem, which suggests criterion-related validity of the Arabic version of the ESSS. The ESS has a concept similar to, but still distinguishable from, self-esteem. Consistent with our results, the original validation findings in a Japanese adult community sample found no more than a weak negative correlation between ESSS and self-esteem [ 23 ], suggesting that anomalous ESS might cause lower self-esteem. From a theoretical perspective, self-esteem reflects high evaluation and self-respect [ 51 ], and should therefore be more related to narrative self (personality and identity) than Agency or Ownership. The lack of a statistically significant correlation between self-esteem and ESS in our sample can be explained by cultural influences, as self-esteem is known to be constructed differently across cultures [ 52 ]; hence, it can relate to the ESS construct in a different manner from one culture to another. Finally, findings revealed significant correlations between higher ESSS scores and more severe psychological distress (i.e. depression, anxiety and stress). This is consistent with the growing body of literature indicating that the loss of self is a common experience encountered in people with depression [ 53 , 54 ], and it has been associated with the loss of certain identities and roles [ 55 ]. In addition, people with depression report the loss of their own bodies’ control [ 56 , 57 ], as well as disruptions of the relationship between the self, the body and subsequently the world, which affect, in turn, the way how they perceive themselves and interact with their social context [ 58 ]. Moreover, it is well-established that anxiety and stress are both contributors to an array of psychopathology which entail breakdowns of the self [ 59 ]. Altogether, the results provide support for the validity of the Arabic version of the ESSS. Study limitations There are some limitations that may affect the interpretation and generalizability of the present findings, and that need to be acknowledged. First, the study did not examine some psychometric properties, such as test-retest reliability which is important to ensure the temporal stability of the Arabic ESSS. Second, only community adults were included, which prevented us from exploring clinical validity of the scale. This limitation should be addressed by considering the inclusion of a clinical sample (e.g., patients with schizophrenia) in future validation studies. Third, data were collected using an online questionnaire and the snowball sampling method, which might limit the generalizability of findings to the wider general population. Practical and research implications Given the increasing acknowledgement within the scientific community of the importance of the ESS construct and its impact on clinical and behavioural outcomes, its evaluation through a reliable, succinct, and cost-effective self-report tool such as the ESSS is imperative for clinical practice. Findings of the present study indicated that the psychometric properties of our Arabic version of the ESSS were good, suggesting that the scale is valid, reliable and ready for use in Arabic-speaking adults and Arab contexts. Making available an Arabic-language measure of the ESS will hopefully enable to investigate the structure of the subjectivity of the self in a new context and population, and advance knowledge on how each ESS factor is represented in one’s brain. This can help to remove some of the mystery that has been surrounding the origin of the self for decades now through the embodiment approach [ 60 ], which considers that that the body and action, but not the self, are embedded within the brain [ 61 , 62 ]. The Arabic ESSS can also be useful for clinicians and researchers in clarifying the complex role of the ESS in the psychopathology of different mental conditions, such as schizophrenia and depression. Finally, and because only little psychometric information is currently available on the ESSS, future studies in different cultural contexts are needed to further analyse the structural validity the three-factor model proposed by the theory, in order to generalize its adequate psychometric properties and expand its use in clinical and research practices globally. CONCLUSION This study is the first to explore the psychometric properties of an Arabic version of the ESSS, and the first, to date, to provide a validated self-report instrument to measure embodiment abnormalities in Arabic-speaking individuals and Arab settings, which are little-represented in the ESS research literature. Future studies addressing the present limitations and testing the validity and reliability of the ESSS in different languages, cultures, and countries device are warranted. Declarations Ethics Approval and Consent to Participate: Each participant provided a voluntary oral informed consent before beginning the survey. The research protocol was approved by the ethics committee of the Razi psychiatric hospital, Manouba, Tunisia. The study was performed following the standards for medical research involving human subjects recommended by the Declaration of Helsinki for human research. Consent for publication: Not applicable. Competing interests: The authors have nothing to disclose. Funding: None. Author Contribution FFR designed the study; GA processed the data; FFR and SH drafted the manuscript; SH carried out the analysis and interpreted the results; AMA and MC reviewed the paper for intellectual content; all authors reviewed the final manuscript and gave their consent. Acknowledgement The authors would like to thank all participants. 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Fekih-Romdhane F, Jahrami H, Alhuwailah A, Fawaz M, Shuwiekh HAM, Helmy M, Mohammed Hassan IH, Naser AY, Zarrouq B, Chebly M: Cross-country validation of the Arabic Version of the Prodromal Questionnaire–Brief (PQ‐B) in young adults from the general population of the Middle East and North Africa (MENA) region . International Journal of Mental Health and Addiction 2023:1-21. Konrath S, Meier BP, Bushman BJ: Development and validation of the Single Item Trait Empathy Scale (SITES) . J Res Pers 2018, 73 :111-122. Fekih-Romdhane F: Psychometric validation of an Arabic-language version of the Pictorial Empathy Test (PET) and the single-item empathy scale (SITES) for adults . 2024. Brailovskaia J, Margraf J: How to measure self-esteem with one item? Validation of the German Single-Item Self-Esteem Scale (G-SISE) . Current Psychology: A Journal for Diverse Perspectives on Diverse Psychological Issues 2020, 39 :2192-2202. Fekih-Romdhane F, Bitar Z, Rogoza R, Sarray El Dine A, Malaeb D, Rashid T, Obeid S, Hallit S: Validity and reliability of the arabic version of the self-report single-item self-esteem scale (A-SISE) . BMC psychiatry 2023, 23 (1):351. Mundfrom DJ, Shaw DG, Ke TL: Minimum sample size recommendations for conducting factor analyses . International journal of testing 2005, 5 (2):159-168. Hu Lt, Bentler PM: Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives . Structural equation modeling: a multidisciplinary journal 1999, 6 (1):1-55. Chen FF: Sensitivity of goodness of fit indexes to lack of measurement invariance . Structural equation modeling: a multidisciplinary journal 2007, 14 (3):464-504. Vadenberg R, Lance C: A review and synthesis of the measurement in variance literature: Suggestions, practices, and recommendations for organizational research . Organ Res Methods 2000, 3 :4-70. Swami V, Todd J, Azzi V, Malaeb D, El Dine AS, Obeid S, Hallit S: Psychometric properties of an Arabic translation of the Functionality Appreciation Scale (FAS) in Lebanese adults . Body Image 2022, 42 :361-369. Dunn TJ, Baguley T, Brunsden V: From alpha to omega: A practical solution to the pervasive problem of internal consistency estimation . British journal of psychology 2014, 105 (3):399-412. Hair Jr JF, Sarstedt M, Ringle CM, Gudergan SP: Advanced issues in partial least squares structural equation modeling : saGe publications; 2017. Ramachandran V, Blakeslee S, Dolan RJ: Phantoms in the brain probing the mysteries of the human mind . Nature 1998, 396 (6712):639-640. Gallagher S: Philosophical conceptions of the self: implications for cognitive science . Trends in cognitive sciences 2000, 4 (1):14-21. Damasio AR: The feeling of what happens: Body and emotion in the making of consciousness : Houghton Mifflin Harcourt; 1999. Sinigaglia C, Rizzolatti G: Through the looking glass: Self and others . Consciousness and cognition 2011, 20 (1):64-74. Rosenberg M: Society and Adolescent Self-image . Princeton University 1965. Salzman MB: Culture and Self-Esteem . In: A Psychology of Culture. edn. Edited by Salzman MB. Cham: Springer International Publishing; 2018: 43-54. Rivest MP, Roy M, Moreau N, Martel A, Negura L, Nault G, Larose-Hébert K: “If You’re a Parasite, Then You’re Not Normal”: Exploring Perceptions of Normality with Individuals who have Experienced Depression . Sociología y tecnociencia 2018, 8 (2):41-66. Woodgate RL: Living in the shadow of fear: adolescents’ lived experience of depression . Journal of Advanced Nursing 2006, 56 (3):261-269. Ridge D: Recovery from depression using the narrative approach: A guide for doctors, complementary therapists and mental health professionals : Jessica Kingsley Publishers; 2008. Ratcliffe M: Experiences of depression: A study in phenomenology : OUP Oxford; 2014. Rhodes JE, Hackney SJ, Smith JA: Emptiness, engulfment, and life struggle: an interpretative phenomenological analysis of chronic depression . Journal of Constructivist Psychology 2019, 32 (4):390-407. Orphanidou M, Kadianaki I, O'Connor C: Depression as an Embodied Experience: Identifying the Central Role of the Body in Meaning-Making and Identity Processes . Qual Health Res 2023, 33 (6):509-520. Stern Y, Koren D, Moebus R, Panishev G, Salomon R: Assessing the Relationship between Sense of Agency, the Bodily-Self and Stress: Four Virtual-Reality Experiments in Healthy Individuals . J Clin Med 2020, 9 (9). Niedenthal PM, Barsalou LW, Winkielman P, Krauth-Gruber S, Ric F: Embodiment in attitudes, social perception, and emotion . Personality and social psychology review 2005, 9 (3):184-211. Caspar EA, Cleeremans A, Haggard P: The relationship between human agency and embodiment . Consciousness and cognition 2015, 33 :226-236. Blanke O, Slater M, Serino A: Behavioral, neural, and computational principles of bodily self-consciousness . Neuron 2015, 88 (1):145-166. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4762476","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":330207972,"identity":"56a8cc7d-2dbc-427d-b087-99775155716d","order_by":0,"name":"Feten Fekih-Romdhane","email":"","orcid":"","institution":"Razi hospital","correspondingAuthor":false,"prefix":"","firstName":"Feten","middleName":"","lastName":"Fekih-Romdhane","suffix":""},{"id":330207973,"identity":"cd41befd-f9ed-4328-b4ba-28f440f26518","order_by":1,"name":"Amira Mohammed Ali","email":"","orcid":"","institution":"Alexandria University","correspondingAuthor":false,"prefix":"","firstName":"Amira","middleName":"Mohammed","lastName":"Ali","suffix":""},{"id":330207974,"identity":"a0e11316-2f3d-4977-a069-ec9712df66b0","order_by":2,"name":"Ghada Amouchi","email":"","orcid":"","institution":"Tunis El Manar University","correspondingAuthor":false,"prefix":"","firstName":"Ghada","middleName":"","lastName":"Amouchi","suffix":""},{"id":330207975,"identity":"db044688-2a77-443a-8479-f8dc7e201d6e","order_by":3,"name":"Majda Cheour","email":"","orcid":"","institution":"Razi hospital","correspondingAuthor":false,"prefix":"","firstName":"Majda","middleName":"","lastName":"Cheour","suffix":""},{"id":330207976,"identity":"637a5a5e-69bd-4693-8dc3-3aa52b46ac69","order_by":4,"name":"Souheil Hallit","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBklEQVRIiWNgGAWjYHACNgYGA4sEBnbmhgMMFUA+DwTLGODXIpHAwMzYcODAGYQWHvxaGCBaGA62EaFFvr3H7MGHAok8/mbGxsMf5x225+c5wPjgbRsDjzkOLQZnzpgbzjCQKJY4DHTYwW2HE2f2NjAbzgVqsWzAoUUix0yax0AisQGqJcHgPAObNC9Qi8EBHA6bAdTyB6hlPljLnMP29ucZ2H/j08JwA6gFaFfiBrAWoF0beBvYmPFpMThzrEyyB6hlI0jLmWPpiTPOHGyWnHNOAqdf5Nubt0n8+GOTOO948+EPFTXW9vw9yQc/vCmzkcMVYtgAI8h4CRI0jIJRMApGwShABwD8Clzecqzy/AAAAABJRU5ErkJggg==","orcid":"","institution":"Holy Spirit University of Kaslik","correspondingAuthor":true,"prefix":"","firstName":"Souheil","middleName":"","lastName":"Hallit","suffix":""}],"badges":[],"createdAt":"2024-07-18 12:03:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4762476/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4762476/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":63156851,"identity":"13241810-31b3-4ac0-ba43-97268927b0fc","added_by":"auto","created_at":"2024-08-23 21:22:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":211730,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eStandardized loading factors of the Embodied Sense of Self Scale items in Arabic.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4762476/v1/6b5c35ebf792c80dd6dbd603.png"},{"id":64797628,"identity":"6c8d0856-7cf1-4515-bc89-fc04560a47c3","added_by":"auto","created_at":"2024-09-19 02:19:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2063107,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4762476/v1/f86e647a-e48f-4ecc-8f80-e887961b505b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Validation of the Arabic version of the Embodied Sense of Self Scale (ESSS) in general population adults","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eOver the last decade, there has been an increasing interest in the investigation of the self. A sense of self is thought to originate during a critical developmental period in much the same way in each person. It is a hard-to-define concept, as many individuals feel unable or struggle to precisely articulate what their sense of self actually is [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This has led to various ways in which the self was conceptualized, either as one unitary entity (e.g., [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]), a bidimensional (e.g., [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]), or a multidimensional construct (e.g., [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]). According to Klein and Gangi [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], the self can be defined as a \u0026ldquo;multiplicity of related, yet separable, processes and contents\u0026rdquo;. Current neuropsychological, behavioural, and computational theories have attempted to elicit one\u0026rsquo;s own representation of the self in the brain, or how one may subjectively feel their own body (i.e., the sense of body) or their own action (i.e., the sense of action). The sense of body requires a multimodal integration of sensory information related to proprioception, touch, vision, and the neural system [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The sense of action is characterized by the extent to which intended actions are mirrored by actual outcomes or feedback [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. These subjective experiences, which are anchored within the sensorimotor system and the body, are referred to as the \u0026ldquo;Embodied Sense of Self\u0026rdquo; (ESS) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAn alteration of one\u0026rsquo;s ESS implies a detachment of the person from themselves and their actions/experiences. It may involve global changes in the intersubjective and environmental experience of the external world, including anomalies of object perception and self-object relations, as well as an inability to reach an emotional attunement with others [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Therefore, there is evidence to support that the ESS may be altered in several psychiatric conditions, such as depression [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], borderline personality disorder [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], and psychosis [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. For instance, the self-experience is found to be fundamentally affected in individuals diagnosed with schizophrenia, often since the prodromal stages of the disease [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. It has also been suggested that a more robust sense of self may be regarded as an important restoration factor and internal resource that confers less vulnerability to psychopathology [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGiven the clear and important role of ESS in psychopathology [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], there have been efforts directed towards measuring the ESS construct based on subjective reports [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Sample measures include the Sense of Agency Scale [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], which is a measure of the subjective aspects of a sense of agency, and the Sense of Agency Rating Scale [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], which is a measure of agency disruption in hypnosis. Another measure is the Examination of Anomalous Self-Experience [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], which is a semi structured symptom checklist designed to assess subjective or experiential anomalies of basic self-awareness. However, the subjective SSE can be challenging to explore, as it constitutes an idiosyncratic and variable concept, that might be subject to subjectivity and misinterpretation. Besides, a wide range of functions including body and action are automatically regulated by the brain - unless an \u0026ldquo;error\u0026rdquo; processing is detected - [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], making the person often unaware of the feeling of self [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. To address these issues, and enable an accurate measurement of the ESS construct, Asai et al. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] proposed to rather focus on the \u0026ldquo;errors\u0026rdquo;, or the daily experiences resulting from an abnormal ESS, which may, in turn, raise the awareness for the self [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo this end, the authors developed the Embodied Sense of Self Scale (ESSS), a 25-item self-report questionnaire that measures an anomalous ESS through three dimensions, namely Ownership, Narrative, and Agency [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The \u0026ldquo;Ownership\u0026rdquo; dimension is composed of nine items (e.g., \u0026ldquo;Sometimes I sense that my body is very light\u0026rdquo; or \u0026ldquo;When I am doing something, it seems like I am observing myself from a distance\u0026rdquo;) which reflect the sense of the reality or existence of oneself (i.e., selfness) and the sense of ownership over one\u0026rsquo;s own body. The \u0026ldquo;Narrative self\u0026rdquo; dimension contains eight items (e.g., \u0026ldquo;I feel like sometimes people misunderstand my personality\u0026rdquo;, \u0026ldquo;I cannot remember what I did during that period because my memory was fuzzy\u0026rdquo;) which assesses the uniformity (i.e., uniqueness through personality, identity, and behavioural traits) and continuity (i.e., temporal extension through autobiographical memory) of the self. The \u0026ldquo;Agency\u0026rdquo; dimension involves eight items (e.g., \u0026ldquo;Something may attach itself to me without me realizing it\u0026rdquo;, \u0026ldquo;It is difficult to grope around for something without being able to see it\u0026rdquo;) to measure the sense of controllability of targets, such as the intentionality of one\u0026rsquo;s own actions and one\u0026rsquo;s own body [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The ESSS was originally validated through psychometric analyses based on five successive surveys in a large sample of Japanese university student, community adults and patients with schizophrenia (n\u0026thinsp;=\u0026thinsp;1167). The scale yielded good psychometric properties in terms of factorial structure, clinical validity, and test-retest reliability [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In addition, convergent validity and divergent validity were established through significant correlations between ESSS scores and positive schizotypy symptoms, empathy, self-esteem and self-efficacy [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The ESSS was then translated and validated into the Italian language, and its psychometric properties were tested in a sample of 269 community adults [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The Italian version showed a new 19-item three-factor structure (i.e., self-recognition, self-consistence, and self-awareness), with high internal consistency reliability and good validity (as reflected by positive correlations with schizotypy and aberrant salience, and negative correlations with empathy, generalized self-efficacy, and social self-efficacy) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. However, no psychometrically validated Arabic version of the ESSS is yet available.\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eRationale of the present study\u003c/h2\u003e \u003cp\u003eFrom a cross-cultural perspective, it has been argued that the self is characterized by being \u0026ldquo;non-individualistic\u0026rdquo; (or collective), \u0026ldquo;interdependent\u0026rdquo;, and \u0026ldquo;relationship dependent\u0026rdquo; in non-Western as compared to Western cultures [\u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. For instance, the role of others in the Arab-Muslim culture plays a crucial role in the formation of the self and in the way one defines themselves [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Lately, the MENA region and many Arab societies have been going through one of the most substantial transformations in history; and some believe that these changes can both be signs of self-change and have important implications to self of Arab people in the foreseen future [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. However, there is no (or only scarce) empirical research on the self and the ESS among people of Arab culture. To aid in closing this gap, this study aimed to adapt and validate the ESSS to the Arabic context and language by examining its factor structure, reliability, validity, and measurement invariance across sex. It is hypothesized that the confirmatory factor analysis will support the proposed three-factor solution, and show a good model fit. It is also expected that the Arabic translation of the scale will show good reliability and validity in a sample of Arabic-speaking adults from the general population of Tunisia.\u003c/p\u003e \u003c/div\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eProcedures\u003c/h2\u003e \u003cp\u003eData for this cross-sectional study was collected via a Google Form link, between March and May 2024. The sample was recruited conveniently; the research team approached people and asked them to fill the survey; those who accepted were asked to forward the link to other people they might know. Inclusion criteria for participation included being of a resident and citizen of Tunisia, aged over 18 years. Excluded were those who refused to fill out the questionnaire. After providing digital informed consent, participants were asked to complete the anonymous survey. Participants completed the survey voluntarily and without remuneration. Participants\u0026rsquo; anonymity and confidentiality were preserved. The study protocol was approved by the ethics committee of Razi Hospital.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eMeasures\u003c/h2\u003e \u003cp\u003eParticipants were asked to provide their demographic details consisting of age, and sex in addition to the following scales:\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eThe Embodied Sense of Self Scale (ESSS)\u003c/h2\u003e \u003cp\u003eThe ESSS is composed of 25 items, each is rated on a five-point scale as follows: 1\u0026thinsp;=\u0026thinsp;Strongly disagree, 2\u0026thinsp;=\u0026thinsp;Disagree somewhat, 3\u0026thinsp;=\u0026thinsp;Neither disagree nor agree, 4\u0026thinsp;=\u0026thinsp;Agree somewhat, and 5\u0026thinsp;=\u0026thinsp;Strongly agree [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Higher scores indicate more anomalous ESS. The ESSS scale was translated and adapted to the Arabic language and context. To this end, it was translated to the Arabic language with the purpose of achieving semantic equivalence between measures in their original and Arabic versions following international norms and recommendations [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. For this, the forward and backward translation method was applied. The English version was translated to Arabic by a bilingual expert who was completely unrelated to the study. Afterwards, a Tunisian psychiatrist with a full working proficiency in English, translated the Arabic version back to English. The translation team ensured that any specific and/or literal translation was balanced. The initial (English) and translated (Arabic) versions were compared by a committee of experts to guarantee the accuracy of the translation and eliminate any inconsistencies [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. An adaptation of the measure to our specific context was performed; it sought to verify the ease of items interpretation and determine any misunderstanding of the items wording. This allows to ensure the conceptual equivalence of the original and Arabic versions of the ESSS in both contexts [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. After the translation and adaptation of the measure, a pilot study was done on 30 adults to ensure all items were well understood; no changes were applied after the pilot study.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eThe depression, Anxiety and Stress Scales (DASS-8)\u003c/h2\u003e \u003cp\u003eThe DASS-8 is an 8-item measure which evaluates levels of psychological distress via three subscales: depression (3 items), anxiety (3 items), and stress (2 items). Items can be rated from 0 (\u0026ldquo;does not apply to me\u0026rdquo;) to 3 (\u0026ldquo;always applies to me\u0026rdquo;). Higher scores indicate greater depression, anxiety and stress. The scale is validated in the Arabic language [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eThe Arabic Single Item Trait Empathy Scale (SITES)\u003c/h2\u003e \u003cp\u003eThe SITES is a measure of trait empathy, which consists of the following item: \u0026ldquo;I am an empathetic person\u0026rdquo;. Each participant is asked to score the extent to which the statement describes them in a five-point Likert-type scale ranging from 1 (\u0026ldquo;Not very true of me\u0026rdquo;) to 5 (\u0026ldquo;Very true of me\u0026rdquo;) [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. The Arabic version of the SITES was used [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eThe Arabic Single-Item Self-Esteem Scale (A-SISE)\u003c/h2\u003e \u003cp\u003eThe A-SISE consists of a single item (i.e. \u0026ldquo;I have high self-esteem\u0026rdquo;) that should be rated by each respondent from 1 (\u0026ldquo;not at all true of me\u0026rdquo;) to 5 (\u0026ldquo;very true of me\u0026rdquo;) [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. The Arabic validated version was used [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003eAnalytic Strategy\u003c/h2\u003e \u003cp\u003eThere were no missing responses in the dataset. We used data from the total sample to conduct a confirmatory factor analysis (CFA) using the SPSS AMOS v.29 software. The minimum sample size needed was 75\u0026ndash;500 participants based on the recommendations of 3\u0026ndash;20 times the number of the scale\u0026rsquo;s items [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Parameter estimates were obtained using the maximum likelihood method. The normed model chi-square (χ\u0026sup2;/df; \u0026le;5), the Steiger-Lind root mean square error of approximation (RMSEA; \u0026le; .08), the standardized root mean square residual (SRMR; \u0026le; .05), the Tucker-Lewis Index (TLI) and the comparative fit index (CFI) (\u0026ge;\u0026thinsp;.90 for both) [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Multivariate normality was not verified at first (Bollen-Stine bootstrap p\u0026thinsp;=\u0026thinsp;.002); therefore, we performed non-parametric bootstrapping procedure.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSex invariance.\u003c/b\u003e To examine sex invariance of ESSS scores, we conducted multi-group CFA [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e] using the total sample. Measurement invariance was assessed at the configural, metric, and scalar levels [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e] and verified if ΔCFI\u0026thinsp;\u0026le;\u0026thinsp;.010 and ΔRMSEA\u0026thinsp;\u0026le;\u0026thinsp;.015 or ΔSRMR\u0026thinsp;\u0026le;\u0026thinsp;.010 [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eComposite reliability was assessed using McDonald\u0026rsquo;s ω and Cronbach\u0026rsquo;s α, with values greater than .70 reflecting adequate composite reliability [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Normality was verified since the skewness and kurtosis values for each item of the scale varied between \u0026minus;\u0026thinsp;1 and +\u0026thinsp;1 [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Pearson test was used to correlate the ESSS scores with other scores. Student t test was used to compare two means. According to Cohen, values\u0026thinsp;\u0026le;\u0026thinsp;.10 were considered weak, ~ .30 were considered moderate, and ~\u0026thinsp;.50 were considered strong correlations.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eFive hundred two participants completed the survey, with a mean age of 21.74\u0026thinsp;\u0026plusmn;\u0026thinsp;2.65 years, 64.9% females and 98.4% single.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eConfirmatory Factor Analysis of the ESSS scale\u003c/h2\u003e \u003cp\u003eThe fit of the three-factor model was acceptable: χ\u003csup\u003e2\u003c/sup\u003e/df\u0026thinsp;=\u0026thinsp;683.95/272\u0026thinsp;=\u0026thinsp;2.52, RMSEA\u0026thinsp;=\u0026thinsp;.055 (90% CI .050, .060), SRMR\u0026thinsp;=\u0026thinsp;.054, CFI\u0026thinsp;=\u0026thinsp;.859, TLI\u0026thinsp;=\u0026thinsp;.845. The second-order CFA showed the same values for the fit indices. The standardised estimates of factor loadings were all adequate (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The reliability analysis was good for the total score (ω\u0026thinsp;=\u0026thinsp;.88 / α\u0026thinsp;=\u0026thinsp;.88) and for the three factors [Factor 1 (ω\u0026thinsp;=\u0026thinsp;.77 / α\u0026thinsp;=\u0026thinsp;.76), Factor 2 (ω\u0026thinsp;=\u0026thinsp;.80 / α\u0026thinsp;=\u0026thinsp;.80) and Factor 3 (ω\u0026thinsp;=\u0026thinsp;.74 / α\u0026thinsp;=\u0026thinsp;.74)].\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSex invariance\u003c/h2\u003e \u003cp\u003eWe were able to show the invariance across sex at the configural, metric, and scalar levels (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). No significant difference was seen between males and females in terms of ESSS total scores (73.66\u0026thinsp;\u0026plusmn;\u0026thinsp;17.70 vs 71.85\u0026thinsp;\u0026plusmn;\u0026thinsp;17.51; \u003cem\u003et\u003c/em\u003e (500)\u0026thinsp;=\u0026thinsp;1.10; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.272).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eMeasurement Invariance of the Embodied Sense of Self Scale across Gender.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCFI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRMSEA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSRMR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModel Comparison\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eΔCFI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eΔRMSEA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eΔSRMR\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConfigural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.849\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.040\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMetric\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.854\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.069\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eConfigural vs metric\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScalar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.854\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.038\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.069\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMetric vs scalar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cem\u003eNote.\u003c/em\u003e CFI\u0026thinsp;=\u0026thinsp;Comparative fit index; RMSEA\u0026thinsp;=\u0026thinsp;Steiger-Lind root mean square error of approximation; SRMR\u0026thinsp;=\u0026thinsp;Standardised root mean square residual.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eConvergent and divergent validity\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e illustrates the Pearson correlation matrix. Higher ESSS scores were significantly and weakly associated with higher empathy (r\u0026thinsp;=\u0026thinsp;.18; p\u0026thinsp;\u0026lt;\u0026thinsp;.001), and moderately associated with higher depression (r\u0026thinsp;=\u0026thinsp;.45; p\u0026thinsp;\u0026lt;\u0026thinsp;.001), anxiety (r\u0026thinsp;=\u0026thinsp;.55; p\u0026thinsp;\u0026lt;\u0026thinsp;.001) and stress (r\u0026thinsp;=\u0026thinsp;.47; p\u0026thinsp;\u0026lt;\u0026thinsp;.001), but not with self-esteem (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.01; p\u0026thinsp;=\u0026thinsp;.905).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePearson correlation matrix.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. ESSS total score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. ESSS - Ownership\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.84***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. ESSS - Narrative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.84***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.56***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. ESSS - Agency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.82***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.53***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.56***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Depression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.45***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.41***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.42***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.31***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. Anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.55***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.49***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.43***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.46***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.63***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. Stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.47***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.40***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.43***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.35***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.61***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.59***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8. Empathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.18***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.12**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.18***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.14**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.10*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.23***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.23***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9. Self-esteem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.19***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.19***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e**p\u0026thinsp;\u0026lt;\u0026thinsp;.01; ***p\u0026thinsp;\u0026lt;\u0026thinsp;.001. ESSS: The Embodied Sense of Self Scale.\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eAlthough the concept of the ESS has attracted considerable interest from researchers around the world over the past years, research in this field is yet to be initiated in Arab countries. To address this gap, and owing to the important role the ESS construct plays in psychopathology, this study proposes to provide, for the first time, an Arabic validated measure of ESS for use among Arabic-speaking adults. Findings showed that the validity and reliability of the Arabic ESSS were at a good level, suggesting its suitability for use among Arabic-speaking adults to assess daily experiences induced by an anomalous ESS.\u003c/p\u003e \u003cp\u003eOur study replicated the three-factor model (i.e., Ownership, Narrative, and Agency) of the ESSS as proposed by Asai et al. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] and initially tested in a Japanese (non-Western, collectivist) population, with the same distribution of the items and without any modification or removal items. The original 25-item English-language version of the ESSS was developed based on an initial pool of 120 items [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], and its three factors were extracted following theoretical discussions on the core components of the ESS construct by prominent researchers in the field (i.e., [\u003cspan additionalcitationids=\"CR48\" citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]). In contrast, the original three-factor structure failed to be replicated in an Italian (Western, individualist) sample [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], where satisfactory goodness-of-fit and good internal consistency were achieved only after removal of six items. As a result, three new factors emerged. The first factor was labelled \u0026ldquo;self-recognition\u0026rdquo;; it consists of eight items which assess one\u0026rsquo;s capacity to recognize external or internal objects as real or belonging to the self, thus reflecting experiences of derealization and depersonalization. The second factor was labelled \u0026ldquo;self-consistence\u0026rdquo;; it consists of seven items which measure the uniformity and continuity of the embodied self, and reflect aspects of the temporal homogeneity of one\u0026rsquo;s thoughts, actions, and personality. The third factor was labelled \u0026ldquo;self-awareness\u0026rdquo;; it consists of four items which evaluate feelings of being consciously aware of one\u0026rsquo;s own body, thus reflecting the sense of proprioceptive coenesthetic and connection with the body [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Overall, findings reported in the current and previous studies suggest that the ESSS in the three-factorial solution is rather culture-dependent (not universal). This implies that the factor structure of the ESSS should be tested in a given cultural context before concluding which ESS dimensions could be measured and whether the scores obtained could be trusted, in order to guarantee a certain degree of confidence in the scale before using it.\u003c/p\u003e \u003cp\u003eThe Arabic ESSS showed good reliability (α\u0026thinsp;=\u0026thinsp;.88 for the total score, and α\u0026thinsp;=\u0026thinsp;.74 \u0026minus;\u0026thinsp;.80 for the three factors), offering additional support to Asai et al.\u0026rsquo;s findings that the ESSS was highly consistent in measuring the ESS concept through the constructs of Ownership, Narrative, and Agency [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The original version ESSS had good internal consistency reliability coefficients in a sample of 718 university students (α ranging from .74 to .84 for the three subscales) [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. As for the Italian version, reliability coefficients were also high for the total score (α\u0026thinsp;=\u0026thinsp;.889) and all three dimensions (α\u0026thinsp;=\u0026thinsp;.763-.827) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Furthermore, measurement invariance across sex was established in our sample at the configural, metric, and scalar levels. Establishing measurement invariance is essential to ensure that patterns of responding are similar between male and female respondents. Ensuring that the ESSS is valid across sex groups enables meaningful comparisons of ESSS total and subscale scores to be made between males and females. No significant difference in ESSS scores was observed between male and female adults, which concurs with the results of Asai et al. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] who also found no statistical sex difference in the ESSS total score in a sample of 718 Japanese university students. As our study is the first to establish sex invariance of the ESSS, future studies are called to test this important psychometric property before any conclusions can be made about potential sex differences.\u003c/p\u003e \u003cp\u003eOur study examined the relationship between the ESSS in its Arabic version and other relevant measures. As expected, we found that the SITES, a measure of trait empathy, positively and weakly correlated with the ESSS, thus attesting to divergent validity of the Arabic version of the ESSS. In the initial validation study by Asai et al. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], the ESSS scores superficially correlated with those of empathy, thus supporting that the scale adequately discriminates two somehow related concepts, i.e. the sense or awareness of others (or empathy) and the sense of self (as reflected by ESSS scores) [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Moreover, no significant correlation was observed between ESSS and self-esteem, which suggests criterion-related validity of the Arabic version of the ESSS. The ESS has a concept similar to, but still distinguishable from, self-esteem. Consistent with our results, the original validation findings in a Japanese adult community sample found no more than a weak negative correlation between ESSS and self-esteem [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], suggesting that anomalous ESS might cause lower self-esteem. From a theoretical perspective, self-esteem reflects high evaluation and self-respect [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e], and should therefore be more related to narrative self (personality and identity) than Agency or Ownership. The lack of a statistically significant correlation between self-esteem and ESS in our sample can be explained by cultural influences, as self-esteem is known to be constructed differently across cultures [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]; hence, it can relate to the ESS construct in a different manner from one culture to another. Finally, findings revealed significant correlations between higher ESSS scores and more severe psychological distress (i.e. depression, anxiety and stress). This is consistent with the growing body of literature indicating that the loss of self is a common experience encountered in people with depression [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e], and it has been associated with the loss of certain identities and roles [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. In addition, people with depression report the loss of their own bodies\u0026rsquo; control [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e], as well as disruptions of the relationship between the self, the body and subsequently the world, which affect, in turn, the way how they perceive themselves and interact with their social context [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e]. Moreover, it is well-established that anxiety and stress are both contributors to an array of psychopathology which entail breakdowns of the self [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]. Altogether, the results provide support for the validity of the Arabic version of the ESSS.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eStudy limitations\u003c/h2\u003e \u003cp\u003eThere are some limitations that may affect the interpretation and generalizability of the present findings, and that need to be acknowledged. First, the study did not examine some psychometric properties, such as test-retest reliability which is important to ensure the temporal stability of the Arabic ESSS. Second, only community adults were included, which prevented us from exploring clinical validity of the scale. This limitation should be addressed by considering the inclusion of a clinical sample (e.g., patients with schizophrenia) in future validation studies. Third, data were collected using an online questionnaire and the snowball sampling method, which might limit the generalizability of findings to the wider general population.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003ePractical and research implications\u003c/h2\u003e \u003cp\u003eGiven the increasing acknowledgement within the scientific community of the importance of the ESS construct and its impact on clinical and behavioural outcomes, its evaluation through a reliable, succinct, and cost-effective self-report tool such as the ESSS is imperative for clinical practice. Findings of the present study indicated that the psychometric properties of our Arabic version of the ESSS were good, suggesting that the scale is valid, reliable and ready for use in Arabic-speaking adults and Arab contexts. Making available an Arabic-language measure of the ESS will hopefully enable to investigate the structure of the subjectivity of the self in a new context and population, and advance knowledge on how each ESS factor is represented in one\u0026rsquo;s brain. This can help to remove some of the mystery that has been surrounding the origin of the self for decades now through the embodiment approach [\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e], which considers that that the body and action, but not the self, are embedded within the brain [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e]. The Arabic ESSS can also be useful for clinicians and researchers in clarifying the complex role of the ESS in the psychopathology of different mental conditions, such as schizophrenia and depression. Finally, and because only little psychometric information is currently available on the ESSS, future studies in different cultural contexts are needed to further analyse the structural validity the three-factor model proposed by the theory, in order to generalize its adequate psychometric properties and expand its use in clinical and research practices globally.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study is the first to explore the psychometric properties of an Arabic version of the ESSS, and the first, to date, to provide a validated self-report instrument to measure embodiment abnormalities in Arabic-speaking individuals and Arab settings, which are little-represented in the ESS research literature. Future studies addressing the present limitations and testing the validity and reliability of the ESSS in different languages, cultures, and countries device are warranted.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics Approval and Consent to Participate:\u003c/h2\u003e\n\u003cp\u003eEach participant provided a voluntary oral informed consent before beginning the survey. The research protocol was approved by the ethics committee of the Razi psychiatric hospital, Manouba, Tunisia. The study was performed following the standards for medical research involving human subjects recommended by the Declaration of Helsinki for human research.\u003c/p\u003e\n\u003ch2\u003eConsent for publication:\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eCompeting interests:\u003c/h2\u003e\n\u003cp\u003eThe authors have nothing to disclose.\u003c/p\u003e\n\u003ch2\u003eFunding:\u003c/h2\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eFFR designed the study; GA processed the data; FFR and SH drafted the manuscript; SH carried out the analysis and interpreted the results; AMA and MC reviewed the paper for intellectual content; all authors reviewed the final manuscript and gave their consent.\u003c/p\u003e\n\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eThe authors would like to thank all participants.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to restrictions from the ethics committee but are available from the corresponding author [SH] on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKlein SB: \u003cstrong\u003eThe self: As a construct in psychology and neuropsychological evidence for its multiplicity\u003c/strong\u003e. \u003cem\u003eWiley Interdisciplinary Reviews: Cognitive Science \u003c/em\u003e2010, \u003cstrong\u003e1\u003c/strong\u003e(2):172-183.\u003c/li\u003e\n\u003cli\u003eVarela FJ, Thompson E, Rosch E: \u003cstrong\u003eThe embodied mind\u003c/strong\u003e. \u003cem\u003e(No Title) \u003c/em\u003e2017.\u003c/li\u003e\n\u003cli\u003ePashko S: \u003cstrong\u003eShifting between our two self-identities can cause the placebo effect and response shift\u003c/strong\u003e. \u003cem\u003eJournal of Transpersonal Psychology \u003c/em\u003e2013, \u003cstrong\u003e45\u003c/strong\u003e(1).\u003c/li\u003e\n\u003cli\u003eBerkovich-Ohana A, Glicksohn J: \u003cstrong\u003eThe consciousness state space (CSS)\u0026mdash;a unifying model for consciousness and self\u003c/strong\u003e. \u003cem\u003eFrontiers in psychology \u003c/em\u003e2014, \u003cstrong\u003e5\u003c/strong\u003e:341.\u003c/li\u003e\n\u003cli\u003eKlein SB, Gangi CE: \u003cstrong\u003eThe multiplicity of self: neuropsychological evidence and its implications for the self as a construct in psychological research\u003c/strong\u003e. \u003cem\u003eAnn N Y Acad Sci \u003c/em\u003e2010, \u003cstrong\u003e1191\u003c/strong\u003e:1-15.\u003c/li\u003e\n\u003cli\u003eDe Vignemont F: \u003cstrong\u003eA self for the body\u003c/strong\u003e. \u003cem\u003eMetaphilosophy \u003c/em\u003e2011, \u003cstrong\u003e42\u003c/strong\u003e(3):230-247.\u003c/li\u003e\n\u003cli\u003eDavid N, Newen A, Vogeley K: \u003cstrong\u003eThe \u0026ldquo;sense of agency\u0026rdquo; 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To address this gap, and owing to the important role the ESS construct plays in psychopathology, this study proposes to adapt and validate the Embodied Sense of Self Scale (ESSS) to the Arabic context and language by examining its factor structure, reliability, validity, and measurement invariance across sex.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional study was performed between March and May 2024 using an online questionnaire and the snowball sampling technique. A total of 502 participants (mean age of 21.74 years, 64.9% females) were included. The ESSS was translated into Arabic using the forward-backward translation method.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOur study replicated the originally proposed three-factor model (i.e., Ownership, Narrative, and Agency) of the ESSS with an acceptable fit: χ\u003csup\u003e2\u003c/sup\u003e/df\u0026thinsp;=\u0026thinsp;683.95/272\u0026thinsp;=\u0026thinsp;2.52, RMSEA\u0026thinsp;=\u0026thinsp;.055 (90% CI .050, .060), SRMR\u0026thinsp;=\u0026thinsp;.054, CFI\u0026thinsp;=\u0026thinsp;.859, TLI\u0026thinsp;=\u0026thinsp;.845. The reliability analysis was good for the total score (α\u0026thinsp;=\u0026thinsp;.88) and for the three factors (α\u0026thinsp;=\u0026thinsp;.74 \u0026minus;\u0026thinsp;.80). In addition, measurement invariance across sex was established in our sample at the configural, metric, and scalar levels. Findings also showed that empathy positively and weakly correlated with ESSS scores, thus attesting to divergent validity of the Arabic version of the scale. Significant correlations were found between higher ESSS scores and more severe depression, anxiety and stress, whereas no significant correlation was observed between ESSS and self-esteem.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eFindings of the present study indicated that the psychometric properties of our Arabic version of the ESSS were good, suggesting that the scale is valid, reliable and ready for use in Arabic-speaking adults and Arab contexts. The Arabic ESSS can be useful for clinicians and researchers in clarifying the complex role of the ESS in the psychopathology of different mental conditions.\u003c/p\u003e","manuscriptTitle":"Validation of the Arabic version of the Embodied Sense of Self Scale (ESSS) in general population adults","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-23 21:22:39","doi":"10.21203/rs.3.rs-4762476/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e006af4a-4651-48be-92b3-f1f6e1660d47","owner":[],"postedDate":"August 23rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-09-19T02:11:03+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-23 21:22:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4762476","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4762476","identity":"rs-4762476","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}