Acceptance And Action Questionnaire-II Research Articles

Integrating the Relational Matrix: Attachment Style, Differentiation of Self, Triangulation, and Experiential Avoidance

In light of the recent call for greater efforts toward integration in psychotherapy theory, research, and practice (Gaete and Gaete in J Psychother Integr 25(2):158–174, 2015; Ziv-Beiman in J Psychother Integr 24(3):251–257, 2014), this study aimed to evaluate the relationships among attachment style, differentiation of self (DoS), triangulation, and experiential avoidance in an integrated model. Although attachment theory (Bowlby in Attachment and loss. Attachment, vol 1. Basic Books, New York, 1969; Cassidy and Shaver in Handbook of attachment: Theory, research, and clinical applications, 3rd edn. Guilford Press, New York, 2010) typically views relationships in terms of dyads, Bowen theory and other systemic theories focus on human relationships in terms of triangles, indicating that attachment theory may be overlooking the role of a second parent in psychological well-being. Furthermore, links between attachment theory and DoS (Kerr and Bowen in Family evaluation. W. W. Norton and Company, New York, 1988) may be characterized by the avoidance of painful private experience, termed experiential avoidance. A sample of 167 U.S. students enrolled at an urban Midwestern University filled out electronic surveys containing a demographic questionnaire and the Differentiation of Self Inventory-Short Form, the Triangular Relationship Inventory, the Experiences in Close Relationships Scale, and the Acceptance and Action Questionnaire—II (AAQ-II). We found that experiential avoidance partially mediated the relationships between avoidant attachment and emotional cut-off, as well as between anxious attachment and I-position. In addition, both anxious and avoidant attachment were associated with higher levels of triangulation and fully mediated the relationship between triangulation and DoS, suggesting that dyadic relationship patterns originate in triadic family processes and eventually effect DoS. Overall, these results connect the dyadic parent–child relationship, the central construct of attachment theory, to the triadic field of Bowen and other systemic theories.

Psychometric Properties of the Acceptance and Action Questionnaire–II in Colombia

The Acceptance and Action Questionnaire-II (AAQ-II) is a widely used measure of experiential avoidance and psychological inflexibility, two key constructs of acceptance and commitment therapy (ACT). The main aim of this study was to analyze the psychometric properties and factor structure of the Spanish version of the AAQ-II in Colombia. A secondary aim was to analyze measurement invariance of the AAQ-II across nonclinical and clinical samples considering that previous research has yielded mixed results. The AAQ-II was administered to a total of 1759 participants, including a sample of undergraduates, one of general population, and a clinical sample. Data were very similar to the ones obtained in the original AAQ-II version. The internal consistency across the different samples was good (Cronbach’s alpha between 0.88 and 0.91). The one-factor model found in the original scale showed a good fit to the data. Measurement invariance was also found across sample (clinical and nonclinical) and gender. The mean score of the clinical sample on the AAQ-II was significantly higher than the scores of the nonclinical samples. The AAQ-II was sensitive to the effects of a one-session ACT intervention, and AAQ-II scores were significantly related to emotional symptoms, mindfulness, satisfaction with life, and dysfunctional attitudes. The Spanish version of the AAQ-II shows good psychometric properties in Colombia.

Cultural considerations in the measurement of psychological flexibility: Initial validation of the Acceptance and Action Questionnaire–II among Hispanic individuals.

The aim of this study was to examine the psychometric properties of the Acceptance and Action Questionnaire–II (AAQ-II) among Hispanic college students (N = 104). Consistent with previous studies, the AAQ-II enjoyed excellent internal consistency in this sample and fit a 1-factor solution. However,

Change in Experiential Avoidance is Associated with Reduced Suicidal Ideation over the Course of Psychiatric Hospitalization

Growing empirical literature in recent years indicates that experiential avoidance plays a role in a wide variety of psychological disorders and psychotherapeutic interventions. This study explored the view of suicidal ideation as a form of experiential avoidance by examining the association between suicidal ideation and therapeutic change in a sample of 189 adult psychiatric inpatients. Results were consistent with predictions, showing a statistically significant association between scores on the Beck Scale for Suicidal Ideation and the Acceptance and Action Questionnaire-II (AAQ-II). It was further shown that change in AAQ-II scores over the course of hospitalization was associated with change in suicidality, independent of changes in depression severity and hopelessness. Moreover, treatment responders (patients whose suicidal ideation scores dropped significantly over the course of treatment) showed greater drops in experiential avoidance relative to nonresponders. These results are consistent with a view of suicidal ideation (and, by extension, suicide) as a form of experiential avoidance and potentially a therapeutic approach that specifically seeks to reduce experiential avoidance.

Relations among emotion regulation and DSM-5 symptom clusters of PTSD

Emotion regulation has been implicated as a risk and maintaining factor for posttraumatic stress disorder (PTSD). Three aspects of emotion regulation have demonstrated the strongest relations with PTSD symptoms: experiential avoidance, rumination, and thought suppression. Given that emotion regulation has demonstrated differential relations with DSM-IV PTSD symptom clusters, the current study sought to examine these relations with the DSM-5 symptom clusters of PTSD. Participants were recruited via Amazon's Mechanical Turk (N=403). All participants endorsed trauma exposure. Measures included the PTSD Checklist for DSM-5 (PCL-5), the Acceptance and Action Questionnaire-II (AAQ-II), the negative affect scale of the Positive and Negative Affect Schedule (PANAS-NA; included as a control variable), the Ruminative Responses Scale (RRS), and the White Bear Suppression Inventory (WBSI). A path analysis model in Mplus indicated that the AAQ-II demonstrated large effects with all four PTSD symptom clusters. Of those relations, the largest was observed for the AAQ-II and the Negative Alterations in Cognition and Mood cluster of PTSD. Results suggest that individual variation in PTSD symptoms may have implications for the salience of particular emotion regulation strategies.

Psychological effects of meditation at a Buddhist monastery in Myanmar

Background: Meditation is widely used as a therapeutic measure because it can effectively reduce stress, pain, and improve the mental health, but there are many unclear points about the psychological effects of meditation.Aims: The purpose of this study is to verify the psychological effects of meditation.Method: The short version of Profile of Mood States (POMS-SF) and the Acceptance and Action Questionnaire-II (AAQ-II) were conducted to compare 97 Myanmar people practicing Vipassana contemplation training with 81 Myanmar nurses who did not have any experience with meditation.Results: The results of our study revealed that meditation mitigated depressive mood, anger, hostility, and fatigue and increased vigor. The enhancement of psychological flexibility occurred only after practicing meditation for more than a year.Conclusions: It can be considered that meditation mitigates anger, hostility and fatigue and increases vigor at a relatively early stage after starting meditation practice, and if meditation practice is continued for more than a year, enhancement of psychological flexibility can also be expected.

Psychometric Properties of the Acceptance and Action Questionnaire – II for Taiwanese College Students and Elite Athletes

The aim of this study was to validate the Taiwanese version of the Acceptance and Action Questionnaire-II (AAQ-II) using a population that consisted of college students and athletes. The authors conducted three independent studies to examine the psychometric properties of the AAQ-II. Study 1 examined the validity of the AAQ-II in a sample of undergraduate students. Study 2 examined the group invariance of the AAQ-II between undergraduate students and athletes. Study 3 examined nomological validity by testing the mediating role of experiential avoidance in the relationship between perceived autonomy support and well−/ill-being indicators. Overall, the results of the confirmatory factor analyses conducted in Study 1 demonstrated the existence of a unidimensional AAQ-II. AAQ-II was positively correlated with depression. The internal consistency of the scale was 0.81. In Study 2, factorial invariance of the AAQ-II was demonstrated across undergraduate students and adolescent athletes. Study 3 showed that perceived autonomy support was related to both depression and negative emotion through experiential avoidance. However, experiential avoidance did not mediate the relationship between perceived autonomy support and positive emotion and life satisfaction. In summary, this study provided preliminary evidence to support the validity and reliability of the AAQ-II and opened a new avenue for cross-cultural researchers.

Effectiveness of Acceptance and Commitment Therapy in treating depression and suicidal ideation in Veterans

ObjectiveThis paper examines the effects of Acceptance and Commitment Therapy for depression (ACT-D), and the specific effects of experiential acceptance and mindfulness, in reducing suicidal ideation (SI) and depression among Veterans. MethodPatients included 981 Veterans, 76% male, mean age 50.5 years. Depression severity and SI were assessed using the BDI-II. Experiential acceptance and mindfulness were measured with the Acceptance and Action Questionnaire-II (AAQ-II) and the Five Facet Mindfulness Questionnaire, respectively. ResultsOf the 981 patients, 647 (66.0%) completed 10 or more sessions or finished early due to symptom relief. For Veterans with SI at baseline, mean BDI-II score decreased from 33.5 to 22.9. For Veterans with no SI at baseline, mean BDI-II score decreased from 26.3 to 15.9. Mixed models with repeated measurement indicated a significant reduction in depression severity from baseline to final assessment (b = −10.52, p < .001). After adjusting for experiential acceptance and mindfulness, patients with SI at baseline demonstrated significantly greater improvement in depression severity during ACT-D treatment, relative to patients with no SI at baseline (b = −2.81, p = .001). Furthermore, increases in experiential acceptance and mindfulness scores across time were associated with a reduction in depression severity across time (b = −0.44, p < .001 and b = −0.09, p < .001, respectfully), and the attenuating effect of mindfulness on depression severity increased across time (b = −0.05, p = .042). Increases in experiential acceptance scores across time were associated with lower odds of SI across time (odds ratio = 0.97, 95% CI [0.95, 0.99], p = .016) and the attenuating effect of experiential acceptance on SI increased across time (odds ratio = 0.96, 95% CI [0.92, 0.99], p = .023). Overall the number of patients with no SI increased from 44.5% at baseline to 65% at follow-up. ConclusionsVeterans receiving ACT-D demonstrated decreased depression severity and decreased odds of SI during treatment. Increases in experiential acceptance and mindfulness scores were associated with reduction in depression severity across time and increases in experiential acceptance scores were associated with reductions in SI across time.

Validating measures of psychological flexibility in a population with acquired brain injury.

This study presents preliminary validation data on both the Acceptance and Action Questionnaire-Acquired Brain Injury (AAQ-ABI) and the Acceptance and Action Questionnaire-II (AAQ-II). Data from 150 participants with ABI was subject to exploratory factor analysis on the AAQ-ABI (15 items). A subset of 75 participants with ABI completed a larger battery of measures to test construct validity for the AAQ-ABI and to undertake a confirmatory factor analysis (CFA) on the AAQ-II (7 items). Three meaningful factors were identified on the AAQ-ABI: Reactive Avoidance, Denial, and Active Acceptance. Reactive Avoidance demonstrated good internal and test-retest consistency (α = .89) and correlated in expected directions with other related measures including the AAQ-II. CFA of the AAQ-II did not provide a good fit but did have similar correlations with measures of psychological distress as found in prior non-ABI samples. The results suggest both measures can be used with individuals following an ABI but they index different facets of psychological flexibility. The AAQ-ABI appears to measure psychological flexibility about the thoughts and feelings relating to the brain injury itself while the AAQ-II measures psychological flexibility around general psychological distress. Future research could explore the additional 2 factors of the AAQ-ABI and use these measures in outcome studies that promote psychological flexibility in individuals with an ABI.

An Integrative Approach Using Third-Generation Cognitive-Behavioral Therapies for Avoidant Personality Disorder

Evidence-based practice emphasizes the integration of empirically supported treatments with clinical expertise and unique client characteristics. The present study describes an integrative approach using Acceptance and Commitment Therapy (ACT) and skills training adapted from Dialectical Behavior Therapy (DBT) to treat a client with avoidant personality disorder (AvPD), comorbid adjustment disorder, and self-injurious behavior. The process of matching the therapies to the client and specific techniques to symptoms and problem behaviors is described. Ongoing clinical measures indicated reductions in depression, hopelessness, and anxiety. Behavioral measures indicated remission of cutting behavior and increases in social and physical activities. Results from a 1-month follow-up suggested maintenance of gains and continued reduction in symptoms. The Minnesota Multiphasic Personality Inventory–2 (MMPI-2) profile at follow-up as compared with pre-treatment indicated significant decreases in the client’s experience and perception of her symptoms. Endorsements on the Acceptance and Action Questionnaire–II (AAQ-II) at mid-treatment and follow-up suggested that the client achieved greater psychological flexibility. This case serves as evidence that individuals with AvPD and significant symptoms of anxiety and depression can be receptive to, and can benefit from, the integration of third-generation cognitive-behavioral therapies.

Comparing Cognitive, Metacognitive, and Acceptance and Commitment Therapy Models of Depression: a Longitudinal Study Survey.

This study analyzed the interrelationships between key constructs of cognitive therapy (CT; depressogenic schemas), metacognitive therapy (MCT; dysfunctional metacognitive beliefs), and acceptance and commitment therapy (ACT; psychological inflexibility) in the prediction of depressive symptoms. With a lapse of nine months, 106 nonclinical participants responded twice to an anonymous online survey containing the following questionnaires: the Depression subscale of the Depression Anxiety and Stress Scales (DASS), the Dysfunctional Attitude Scale Revised (DAS-R), the Positive beliefs, Negative beliefs and Need to control subscales of the Metacognitions Questionnaire-30 (MCQ-30), and the Acceptance and Action Questionnaire - II (AAQ-II). Results showed that when controlling for baseline levels of depressive symptoms and demographic variables, psychological inflexibility longitudinally mediated the effect of depressogenic schemas (path ab = .023, SE = .010; 95% BC CI [.008, .048]) and dysfunctional metacognitive beliefs on depressive symptoms (positive metacognitive beliefs: path ab = .052, SE = .031; 95% BC CI [.005, .134]; negative metacognitive beliefs: path ab = .087, SE = .049; 95% BC CI [.016, .214]; need to control: path ab = .087, SE = .051; 95% BC CI [.013, .220]). Results are discussed emphasizing the role of psychological inflexibility in the CT and MCT models of depression.

Psychometric Properties of the Acceptance and Action Questionnaire–II for Chinese College Students and Elite Chinese Athletes

The purpose of the present study was to examine the psychometric properties of the Chinese version of the Acceptance and Action Questionnaire–II (AAQ-II) across two samples of Chinese college students (n = 183 and n = 366) and a sample of elite Chinese athletes (n = 330). Exploratory and confirmatory factor analyses supported the existence of a unidimensional AAQ-II. Adequate internal consistency reliability, test–retest reliability (one-month interval), factorial validity, and nomological validity with mindfulness, well-being, positive and negative affect/mood for both students and athletic samples were demonstrated. The AAQ-II also showed incremental validity in college students in explaining variances of well-being, positive and negative affect, anxiety, and depression, beyond the mindfulness measure. Most important, factorial invariance of the AAQ-II was demonstrated across male and female college students as well as across male and female athletes. Partial factorial invariance was also demonstrated across adolescent and adult athletes. Overall, results of this study suggest that the Chinese version of the AAQ-II may be a useful self-report measure of experiential avoidance in Chinese college students and elite Chinese athletes.

The relationship between low levels of mindfulness skills and pathological worry: The mediating role of psychological inflexibility. [La relación entre habilidades de mindfulness y preocupación patológica: El rol mediador de la inflexibilidad psicológica

Mindfulness-based interventions have recently been proposed for the treatment of generalized anxiety disorder (GAD). However, the specific nature of the relationship between mindfulness skills and pathological worry is still not very well known. This study analyzes the mediating role of psychological inflexibility, a central construct in the acceptance and commitment therapy (ACT) model of psychopathology, in the effect of mindfulness skills on pathological worry. A total of 132 nonclinical participants completed questionnaires assessing the constructs of interest: the Penn State Worry Questionnaire (PSWQ), the Acceptance and Action Questionnaire – II (AAQ-II), and the Kentucky Inventory of Mindfulness Skills (KIMS). Because the Spanish translation of the KIMS used lacked of a formal validation, its psychometric properties and factor structure were previously evaluated. This process led to a reduced version of the KIMS that showed good internal consistency and factor structure. Mediation analyses revealed that psychological inflexibility fully mediated the effects of mindfulness skills as a set on pathological worry. Regarding specific mindfulness skills, psychological inflexibility was shown to be a mediator and suppressor, respectively, of the relationship between acceptance without judgment and act with awareness on worry. Results are discussed emphasizing the need of using mindfulness exercises to promote psychological flexibility.

Measuring the role of psychological inflexibility in Trichotillomania

Psychological Inflexibility (PI) is a construct that has gained recent attention as a critical theoretical component of Acceptance and Commitment Therapy (ACT). PI is typically measured by the Acceptance and Action Questionnaire-II (AAQ-II). However, the AAQ-II has shown questionable reliability in clinical populations with specific diagnoses, leading to the creation of content-specific versions of the AAQ-II that show stronger psychometric properties in their target populations. A growing body of the literature suggests that PI processes may contribute to hair pulling, and the current study sought to examine the psychometric properties and utility of a Trichotillomania-specific version of the AAQ-II, the AAQ-TTM. A referred sample of 90 individuals completed a battery of assessments as part of a randomized clinical trial of Acceptance-Enhanced Behavior Therapy for Trichotillomania. Results showed that the AAQ-TTM has two intercorrelated factors, adequate reliability, concurrent validity, and incremental validity over the AAQ-II. Furthermore, mediational analysis between emotional variables and hair pulling outcomes provides support for using the AAQ-TTM to measure the therapeutic process. Implications for the use of this measure will be discussed, including the need to further investigate the role of PI processes in Trichotillomania.

Behavioral and experiential avoidance in patients with hoarding disorder

Background and objectivesThis study examined the relationship between experiential and behavioral avoidance and hoarding symptom severity, controlling for anxiety and depression symptoms, in 66 adult individuals (M age = 61.41; SD = 9.03) with HD. MethodsHierarchical regression was used to test the associations between hoarding severity, as defined by the Savings Inventory-Revised (SI-R) total and its three subscales, and avoidance, as defined by the Acceptance and Action Questionnaire II (AAQ-II) and two scales from the Brief COPE (Self-Distraction and Behavioral Disengagement) when controlling for anxiety and depression symptoms. ResultsExperiential avoidance (AAQ-II) and behavioral avoidance (Brief COPE subscales Self-Distraction and Behavioral Disengagement) uniquely accounted for aspects of hoarding severity (SI-R) in regression models. Behavioral avoidance contributed significant additional variance to the SI-R Clutter subscale, whereas experiential avoidance was uniquely predictive of additional variance in the SI-R Difficulty Discarding and the SI-R Acquisition subscales. LimitationsFuture research should examine the effect of experiential avoidance on hoarding behaviors experimentally. ConclusionsGiven that the AAQ-II and Self-Distraction and Behavioral Disengagement subscales were not correlated, these findings suggest that experiential and behavioral avoidance are two distinct processes contributing to the severity of specific HD. Results support the utility of avoidance in the cognitive-behavioral model for HD.

Altering Impulsive Decision Making With an Acceptance-Based Procedure

Delay discounting is one facet of impulsive decision making and involves subjectively devaluing a delayed outcome. Steeply discounting delayed rewards is correlated with substance abuse and other problematic behaviors. To the extent that steep delay discounting underlies these clinical disorders, it would be advantageous to find psychosocial avenues for reducing delay discounting. Acceptance-based interventions may prove useful as they may help to decrease the distress that arises while waiting for a delayed outcome. The current study was conducted to determine if a 60–90minute acceptance-based training would change delay discounting rates among 30 undergraduate university students in comparison to a waitlist control. Measures given at pre- and posttraining included a hypothetical monetary delay discounting task, the Acceptance and Action Questionnaire-II (AAQ-II), and the Distress Tolerance Scale. Those assigned to the treatment group decreased their discounting of delayed money, but not distress intolerance or psychological inflexibility when compared to the waitlist control group. After the waiting period, the control group received the intervention. Combining all participants’ pre- to posttreatment data, the acceptance-based treatment significantly decreased discounting of monetary rewards and increased distress tolerance. The difference in AAQ-II approached significance. Acceptance-based treatments may be a worthwhile option for decreasing delay discounting rates and, consequently, affecting the choices that underlie addiction and other problematic behaviors.

Investigation of risk factors of psychological acceptance and burnout syndrome among nurses in China

The objectives of this study were to determine reliability of Chinese version of Acceptance and Action Questionnaire-II (AAQ-II), the relationship between psychological acceptance (PA), and burnout syndrome and their risk factors among nurses in China. The reliability of AAQ-II in Chinese was evaluated first by testing on 111 doctors and 108 nurses in China. On the number of 845 nurses selected from nine city hospitals by using stratified cluster sampling method, the Maslach Burnout Inventory-General Survey was administered to establish the presence of burnout, and the AAQ-II was used to measure their PA. Results showed that the AAQ-II in Chinese had a good test-retest reliability. PA was statistically significantly negatively correlated to the three dimensionalities of burnout among nurses in China. Male and female nurses had a significant difference in PA. Risk factors for burnout were age (25-44 years), marital status (married), gender (male), hospital department (emergency) and position (primary title) as well as PA. The findings provide insights into the risk factors of burnout in Chinese nurses and may have clinical implications in preventing burnout in Chinese nurses.

Italian Version of the Acceptance and Action Questionnaire-II (AAQ-II): Dimensionality, Reliability, Convergent and Criterion Validity

This study focused on the validation of the Italian version of the Acceptance and Action Questionnaire-II (AAQ-II, Bond et al. Behavior Therapy 42:676–688, 2011). This measure was developed to address the need for an improved measure of psychological inflexibility. The participants were 255 adults (77 males and 178 females, mean age of 31.9 years, SD = 13.7) from the general population. The results of Principal Axis Factor analyses supported a unidimensional structure of AAQ-II scores. The one-factor solution accounted for 42 % of the variance. Internal consistency was high (.83), and test-retest reliability over a 12-month period was modest (.61). Higher AAQ-II scores significantly related to anxiety and depression, and to lower psychological well-being, supporting the concurrent validity of the scale. Correlations with measures of conceptually related constructs also supported the convergent validity of the scale. Furthermore, psychological inflexibility significantly predicted important outcome measures beyond conceptually related constructs. The results of this study suggest that the Italian version of the AAQ-II is a reliable and valid measure of psychological inflexibility, and that the 7-item version of the scale features improved psychometric properties over previous versions of the questionnaire.

Measuring experiential avoidance and psychological inflexibility: The Spanish version of the Acceptance and Action Questionnaire - II

Experiential avoidance and psychological inflexibility have been recently found to be important constructs related to a wide range of psychological disorders and quality of life. The current study presents psychometric and factor structure data concerning the Spanish translation of a general measure of both constructs: the Acceptance and Action Questionnaire - II (AAQ-II). Six samples, with a total of 712 participants, from several independent studies were analyzed. Data were very similar to the ones obtained in the original AAQ-II version. The internal consistency across the different samples was good (between a= .75 and a= .93). The differences between clinical and nonclinical samples were statistically significant and the overall factor analysis yielded to a one-factor solution. The AAQ-II scores were significantly related to general psychopathology and quality of life measures. This Spanish translation of the AAQ-II emerges as a reliable and valid measure of experiential avoidance and psychological inflexibility.

Measuring psychological flexibility in medical students and residents: a psychometric analysis

PurposePsychological flexibility involves mindful awareness of our thoughts and feelings without allowing them to prohibit acting consistently with our values and may have important implications for patient-centered clinical care. Although psychological flexibility appears quite relevant to the training and development of health care providers, prior research has not evaluated measures of psychological flexibility in medical learners. Therefore, we investigated the validity of our learners’ responses to three measures related to psychological flexibility.MethodsFourth-year medical students and residents (n=275) completed three measures of overlapping aspects of psychological flexibility: (1) Acceptance and Action Questionnaire-II (AAQ-II); (2) Cognitive Fusion Questionnaire (CFQ); and (3) Mindful Attention and Awareness Questionnaire (MAAS). We evaluated five aspects of construct validity: content, response process, internal structure, relationship with other variables, and consequences.ResultsWe found good internal consistency for responses on the AAQ (α=0.93), MAAS (α=0.92), and CFQ (α=0.95). Factor analyses demonstrated a reasonable fit to previously published factor structures. As expected, scores on all three measures were moderately correlated with one another and with a measure of life satisfaction (p<0.01).ConclusionOur findings provide preliminary evidence supporting validity of the psychological flexibility construct in a medical education sample. As psychological flexibility is a central concept underlying self-awareness, this work may have important implications for clinical training and practice.