Association for Contextual Behavioral Science

Acceptance and Action Questionnaire – II (AAQ-II)

The AAQ-II was developed in order to establish an internally consistent measure of ACT’s model of mental health and behavioral effectiveness. Although the original AAQ (Hayes, Strosahl, Wilson, Bissett, Pistorello et al., 2004) has proved broadly useful (see Hayes, Luoma, Bond, Masuda and Lillis, 2006), obtaining sufficient alpha levels for it has at times been a problem. It appears that there are several reasons for this (e.g., scale brevity, item wording, item selection procedures), and they were addressed in developing the AAQ-II. As a result, it is recommended that researchers and practitioners use this newer scale instead of the original AAQ (which from here forward will be termed the AAQ-I). The AAQ-II was designed to assess the same construct as the AAQ-I and, indeed, the two scales correlate at .82. Thus, the AAQ-I can still be used, and findings based on it are still relevant, but it is perhaps psychometrically safer to use the AAQ-II.

The reference for the AAQ-II is:

Bond, F.W., Hayes, S.C., Baer, R.A., Carpenter, K.M., Orcutt, H.K., Waltz, T. & Zettle, R.D. (Submitted). Preliminary psychometric properties of the Acceptance and Action Questionnaire – II: A revised measure of psychological flexibility and acceptance.

(Note that authorship order was alphabetically determined for Carpenter, Orcutt, Waltz, and Zettle.)

What do we call ACT’s model of mental health and behavioral effectiveness? (Or, what does the AAQ-I and -II measure?)

[Taken from Bond et al. (Submitted)]

When ACT was originally developed, the overarching term for its underlying model was experiential avoidance – the attempt to alter the form, frequency, or situational sensitivity of negative private events (e.g., thoughts, feelings, and physiological sensations), even when doing so leads to behavioral difficulties (Hayes, Wilson, Gifford, Follette, & Strosahl, 1996). Acceptance was the term used to positively describe this model; thus, it is defined as the willingness to experience (i.e., not alter the form, frequency, or sensitivity of) unwanted private events, in the pursuit of one’s values and goals.

The ACT model has matured over the years, with more emphasis on the dynamic and flexible fit between context, private experiences and valued action, which have always been inherent in the model. Such flexibility is seen when ACT therapists note that sometimes persisting in behavior is helpful, while at other times changing it is helpful: it depends upon the value- and goal-related opportunities that are available in a given context. Furthermore, as other parts of the ACT model are now given emphasis (e.g., cognitive defusion, contacting the present moment, mindfulness, and perspective-taking), experiential avoidance and, hence, acceptance are taking on a narrower meaning and are being used less often as terms for the overarching model (Hayes et al., 2006). Instead, the term psychological flexibility (or flexibility) is now being used to describe this model. It is defined as the ability to fully contact the present moment and the thoughts and feelings it contains without needless defense, and, depending upon what the situation affords, persisting or changing in behavior in the pursuit of goals and values (Hayes et al., 2006). While experiential avoidance and acceptance are still useful and acceptable ways to describe this construct, psychological flexibility is the more current and overarching term. In addition, it needs to be acknowledged that in some contexts (e.g., industrial-organizational psychology) it is important to speak of this domain positively (acceptance or flexibility) and in other contexts (e.g., psychopathology) it is easier to speak of it negatively (experiential avoidance or psychological inflexibility). These differences are terminological, not substantive.

The AAQ-II and key psychometric findings for the scale can be found here. Older versions of the AAQ (i.e., AAQ-9, AAQ-16 and AAQ-49) are also listed below.

There are more specific acceptance and defusion measures available. A good measure has been developed in the area of smoking (contact Elizabeth Gifford for more information: elizgifford@earthlink.net); a pain measure developed from the earliest versions of the AAQ called the Chronic Pain Acceptance Questionnaire (CPAQ; see attachments below) has been published and worked very well in this area (contact Lance McCracken for more information: Lance.McCracken@rnhrd-tr.swest.nhs.uk).

Several AAQ measures for specific problems and populations are posted under Disease and disorder specific AAQ variations.

There are also a variety of translated versions of the AAQ and AAQ-II posted under ACT measures in Languages Other than English.