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Behavior Therapy xx (2014) xxx xxx
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What Does the Acceptance and Action Questionnaire (AAQ-II)

Really Measure?
Martin Wolgast
Lund University

The present study seeks to investigate the extent to which the

Acceptance and Action Questionnaire (AAQ-II) is successful in
discriminating between experiential avoidance/psychological
flexibility on the one hand and the supposed outcomes in terms
of psychological well-being of having this trait on the other.
This was done using exploratory factor analysis on an item
pool containing the AAQ-II items, and items designed for
the present study to measure distress and acceptance/
non-acceptance, to see what factors are identified and on
which factor(s) the AAQ-II items had the highest factor
loadings. Interestingly, the analysis found the items of the
AAQ-II to be more strongly related to items designed to
measure distress than items designed to measure acceptance/
nonacceptance with minimal references to functional
outcomes. The results of the study are interpreted and
discussed in relation to the widespread use of the AAQ in
both clinical and scientific contexts and given the centrality of
the measure in empirically validating the ACT model of
psychopathology and treatment.

Keywords: AAQ-II; acceptance; ACT; experiential avoidance;

psychological flexibility

DUE TO THE IMPACT OFAND the widespread interest

inthe so-called third wave of behavior therapies in
general and in Acceptance and Commitment Therapy
(ACT) in particular, the constructs acceptance,
experiential avoidance, psychological flexibility,
and psychological inflexibility have received a lot of

Address correspondence to Martin Wolgast, Lund University,

Department of Psychology, Box 213, 221 00 Lund, Sweden; e-mail:
Martin.Wolgast@psy.lu.se.
0005-7894/ 2014 Association for Behavioral and Cognitive Therapies.
Published by Elsevier Ltd. All rights reserved.

scientific and clinical attention during recent years

(see, for example, Aldo, Nolen-Hoeksema, &
Schweizer, 2009; Hayes, Luoma, Bond, Masuda,
& Lillis, 2006; Kashdan & Rottenberg, 2010; st,
2008). In ACT, experiential avoidance was
originally put forth as a construct referring to the
unwillingness to remain in contact with aversive
private experiences and taking action to avoid and/
or alter them (Hayes, Wilson, Gifford, Follette, &
Strosahl, 1996), and is conceptualized as critical in
the development and maintenance of psychopathology (Hayes et al., 1999). In contrast, acceptance is
often referred to as the willingness to experience
aversive or unwanted private events while pursuing
ones values and goals (Hayes et al., 1999).
In recent years, the emphasis on acceptance and
experiential avoidance has shifted somewhat towards
the broader concepts of psychological flexibility and
psychological inflexibility (Bond et al., 2011). The
definitions of psychological flexibility and psychological inflexibility, however, are quite similar to
those of experiential avoidance and acceptance.
Psychological flexibility is defined as the ability to
fully contact the present moment and the thoughts
and feelings it contains without needless defense, and,
depending on what the situation affords, persisting in
or changing behavior in the pursuit of goals and
values (Hayes et al., 2006). Psychological inflexibility, on the other hand, refers to a rigid dominance
of psychological reactions over chosen values
and contingencies in guiding actions (Bond et al.),
which often occurs when people attempt to avoid
experiencing private events. In this view, acceptance
and experiential avoidance are seen as examples of
psychological flexibility and inflexibility, which are
still appropriate to use in clinical contexts, where
the present moment contains thoughts and feelings
that people might not wish to be in contact with
(Bond et al.). The concepts of psychological flexibility/

Please cite this article as: Martin Wolgast, What Does the Acceptance and Action Questionnaire (AAQ-II) Really Measure?, Behavior
Therapy (2014), http://dx.doi.org/10.1016/j.beth.2014.07.002

wolgast

inflexibility are mainly intended to broaden the

applicability of the model to also include contexts
where the avoidance of unwanted internal events are
not the main focus (Bond et al.), for example, in
sporting skills and job performance (Bond, Flaxman,
& Bunce, 2008).
As previously stated, the constructs of experiential
avoidance/psychological inflexibility and acceptance/
psychological flexibility have received significant
attention within clinical psychology during the last
15 years. In an empirical review made in 2007,
Chawla and Ostafin identified 28 studies published
between 1999 and 2006, specifically examining the
role of experiential avoidance in the etiology,
maintenance, and treatment of maladaptive behavior
and psychopathology. The general conclusion was
that experiential avoidance was significantly associated with a wide array of behavioral problems as well
as psychopathology. Additionally, Hayes et al.
conducted a meta-analysis in 2006 involving 32
studies and 6,628 participants, investigating the
relationship between experiential avoidance and
various measures of psychological well-being,
psychopathology, and quality of life and concluded
that experiential avoidance as measured by the
Acceptance and Action Questionnaire (AAQ; Hayes
et al., 2004) accounted for 16% to 28% of the
variance in health-related outcome measures. Other
studies of individual differences in levels of experiential avoidance have found that it is related to
likelihood of relapse in substance abuse (Stewart,
Zvolensky, & Eifert, 2002), has a strong relationship
to anxiety-related symptoms and mediates the
relationship between other regulatory strategies
(including cognitive reappraisal) and these symptoms
(Kashdan, Barrios, Forsyth, & Steger, 2006), predicts
severity of symptoms in specific psychiatric disorders
such as GAD (Roemer, Salters, Raffa, & Orsillo,
2005), and mediates the relation between traumatic
events and general psychological distress (Batten,
Follette, & Aban, 2001; Marx & Sloan, 2002).
Furthermore, in studies of psychological treatments
and interventions, changes in experiential avoidance
have been shown to mediate the effect of treatments
explicitly aimed at reducing it (e.g., Bond & Bunce,
2000; Gregg, Callaghan, Hayes, & Glenn-Lawson,
2007; Lillis, Hayes, Bunting, & Masuda, 2009).
Additionally, in a recent review by Kashdan and
Rottenberg (2010), it is shown that psychological
flexibilitybroadly definedis a prominent factor
in understanding psychological health.
Hence, there seems to be empirical support
for the suggestion that experiential avoidance/
psychological inflexibility is of significant importance in relation to the development, maintenance,
and treatment of psychopathology. Before drawing

this conclusion, however, one needs to establish that

the construct in question has been operationalized
in a way that makes the conclusion valid. This is
of particular importance in the present case: Many
of the studies referred to above, and the vast majority
of studies examining psychological flexibility/
experiential avoidance, have relied upon the AAQ
as a valid operationalization of the construct. Thus,
given the centrality of this specific measure in
determining the results, it is important to critically
reflect upon the measure and whether factors other
than the psychological phenomena it is supposed to
measure might explain parts of the findings from the
studies. One such potential source of confounded
measurement is if the items that are supposed to
measure experiential avoidance/psychological flexibility, contain formulations related to adaptive or
maladaptive outcomes in terms of psychological
distress, well-being, or functioning. Indeed, in a few
previous studies, the AAQ has been briefly criticized
for not making a clear enough distinction between
process and outcome (Chawla & Ostafin, 2007), and
for not having sufficient discriminant validity in
relation to negative affectivity or neuroticism
(Gmez, Chmielewski, Kotov, Ruggero, & Watson,
2011). More often, however, the AAQ was criticized
for having some shortcomings regarding comprehensibility and reliability (Bond et al., 2011), and
when revising the measure and constructing a new
version of the AAQ (AAQ-II; Bond et al.), the focus
was mainly on addressing these last two issues.
The relative lack of discussion regarding the
construct validity of the AAQ appears remarkable
given the centrality of the measure in validating central
theoretical assumptions from an ACT perspective and
the fact that many of the items are problematic in
regard to the discussion above. For example, the
nine-item version of AAQ-I contains the item, When
I compare myself with other people, it seems most of
them are handling their lives better than I do (Item 7),
which clearly incorporates formulations related to
outcome, thus risking circularity in measurements.
Items 4, 5, and 9 can also be subjected to this kind of
criticism. For example, Item 5 (I am not afraid of my
feelings) might receive a high score either if the
respondent has strong aversive feelings but is not
afraid of them or if the respondent in general has low
levels of negative emotionality and therefore does not
experience feelings as a problem. Additionally, Item 4
(I rarely worry about getting my anxieties, worries,
and feelings under control) might receive similar
scoring based on significantly different processes: one
might score high on the item if (a) one does not try to
control ones feelings; (b) if one regularly tries to
control ones feelings, is successful in doing so, and
therefore does not worry about it; or (c) if one has very

Please cite this article as: Martin Wolgast, What Does the Acceptance and Action Questionnaire (AAQ-II) Really Measure?, Behavior
Therapy (2014), http://dx.doi.org/10.1016/j.beth.2014.07.002

what does the aaq-ii really measure?

low levels of anxiety and worries so that controlling
them seldom seems to be an issue to worry about.
Similarly, Item 9 (If I could magically remove all
painful experiences Ive had in my life, I would do so)
might discriminate between subjects solely on the
basis of how many painful experiences they have
had in their lives, not only on the basis of how they
relate to these experiences.
As previously stated, a new version of the AAQ
(AAQ-II) was published in 2011, consisting of seven
items measuring psychological inflexibility or experiential avoidance (Bond et al., 2011), and it has since
been translated into several languages (e.g., Cao, Ji,
& Zou, 2013; Pennato, Berrocal, Bernini, & Rivas,
2013) and used in clinical studies (e.g., Meyer,
Morissette, Kimbrel, Kruse, & Gulliver, 2013). The
items of the AAQ-II are presented in Table 1.
Unfortunately, the items in this new version can,
based on their content, be subjected to the same
criticism of confounding process or trait with
outcome: for many of the items it is hard to
distinguish if a specific response is grounded in levels
of psychological inflexibility/experiential avoidance
or, for example, in levels of experienced aversive
emotions, memories, and worries.
The authors of the AAQ-II briefly addresses the
issue of discriminant validity by conducting a
confirmatory factor analysis to test if the AAQ-II
and the Beck Depression Inventory (BDI-II; Beck,
Steer, & Brown, 1996) are best represented by a oneor two-factor model. In this analysis a two-factor
model (with BDI-II and AAQ-II as separate factors)
provided a significantly better fit than a one-factor
model (Bond et al., 2011), indicating that the scales
do not measure the same construct. To claim that the
AAQ-II does not measure the same construct as the
BDI-II, however, addresses only parts of the problem

discussed above. It still remains unclear how well the

scale distinguishes between experiential avoidance or
psychological inflexibility as an approach or attitude
toward private events on the one hand and the
supposed outcome of this approach in terms of
emotional problems and experienced life satisfaction
on the other. Furthermore, the difference in item style
and wording between the BDI-II and the AAQ-II
renders a one-factor solution less likely for other
reasons than that they refer to distinct underlying
psychological traits or processes.
In developing their broader, multidimensional
measure of experiential avoidance (the Multidimensional Experiential Avoidance Questionnaire;
MEAQ), however, Gmez et al. (2011) raised the
problem with the discriminant validity of the AAQ
and the AAQ-II in relation to neuroticism. They also
compared the correlations between the MEAQ and
the AAQ with measures of negative affectivity and
neuroticism, and indeed consistently found the AAQ
(both I and II) to be more strongly associated with
neuroticism (Gmez et al.). Additionally, in a recently
published article, where a brief version of the MEAQ
is presented, this issue of confounded measurements
is raised even more clearly, and the items selected for
the brief version tries to further reduce this problem
(Gmez et al., 2014).
In part, the problem discussed above might be
seen as a natural consequence of the explicitly
functional framework in which the ACT model is
situated. In this context it is logical that the focus is
shifted from emotion regulation as traditionally
defined toward effective living (Blackledge & Hayes,
2001). Nonetheless, when the acceptance or psychological flexibility is measured and operationalized as
a psychological trait (e.g., Hayes et al., 2006) that can
be compared to, or even explain the effects of, other

Table 1

Items of the AAQ-II, Distress and Acceptance Scales

AAQ-II

Distress

Acceptance

1. My painful experiences and memories 1. I often feel depressed, worried 1. I often try to control or change my thoughts and
make it difficult for me to live a life that I or anxious.
feelings.
would value.
2. Im afraid of my feelings.
2. I worry a lot.
2. When I feel depressed, worried or anxious, I do
not try to influence or change these feelings.
3. I worry about not being able to control 3. I have many problems in my life. 3. I let my thoughts and feelings come and go,
my worries and feelings.
without trying to control or avoid them.
4. My painful memories prevent me from 4. I have lots of painful memories. 4. I do the things I want to do, even if it makes me
having a fulfilling life.
feel nervous or anxious.
5. Emotions cause problems in my life. 5. I am not happy with the way my 5. When I feel anxious, worried or depressed, I note
life is.
these feelings but live my life the way I want to.
6. It seems like most people are handling
6. When I feel depressed, worried or anxious, I do
their lives better than I am.
not try to avoid these feelings.
7. Worries get in the way of my success.
7. When I feel depressed, worried or anxious, I try to
influence or change these feelings.
Please cite this article as: Martin Wolgast, What Does the Acceptance and Action Questionnaire (AAQ-II) Really Measure?, Behavior
Therapy (2014), http://dx.doi.org/10.1016/j.beth.2014.07.002

wolgast

approaches to private events (Boulanger, Hayes, &

Pistorello, 2010), it seems of central importance to
clarify the distinction between the trait on the one
hand and the outcome of having this trait or the
extent to which one has, for example, emotional
problems on the other. The purpose of the present
study was to provide an empirical investigation of the
extent to which the AAQ-II succeeds in making this
distinction that goes beyond what can be achieved by
correlating the scale with measures of similar and
different constructs. In this context, it should be
noticed that the study did not aim to develop a new
and improved measure of experiential avoidance/
psychological inflexibility (indeed, the originators of
the MEAQ have taken promising steps in that
direction; Gamz et al. 2011; Gamez et al., 2014).
Rather, the purpose was to provide an in-depth
empirical analysis of the most widely employed
measure of experiential avoidance/psychological
inflexibility, namely, the AAQ.

The Present Study: Purpose and Hypotheses

As previously stated, the main purpose of the
present study was to empirically investigate the
extent to which the AAQ-II differentiates between
psychological inflexibility/experiential avoidance as
a psychological trait and the supposed outcome of
having high or low levels of this trait in terms of
psychological well-being and functioning.
This was done using exploratory factor analysis
(EFA) on an item pool containing the AAQ-II items,
and items designed for the present study to measure
distress and acceptance/nonacceptance, to see what
factors are identified and on which factor(/s) the
AAQ-II items had the highest factor loadings. Given
the problematic design of the AAQ-II items
described above, the hypothesis was that the items
of the AAQ-II to a large extent would fall onto the
same factor as items designed to measure distress
rather than acceptance/nonacceptance. The choice
to use exploratory rather than confirmatory factor
analysis (CFA) in this part of the study was based
upon findings indicating that CFA is overly restrictive when conducting item level analyses (e.g., Marsh
et al., 2010).

Method
participants
Sample 1: ACT Therapists
To validate the items constructed to measure
acceptance and distress (see below), the items were
presented in an online questionnaire to a sample of
therapists working with ACT. Participants were
recruited via a group on Facebook for therapists
working with ACT and answers were obtained from
30 participants. Of these, 80% were licensed

psychologists, 10% were medical doctors, and 10%

stated other as their profession. Thirty percent of
the participants had worked with ACT between 1 and
5 years, 50% between 5 and 10 years, and 20% more
than 10 years. Eighty percent stated that they had
received training and education in ACT and 20%
stated that they had educated and trained others in
working with ACT.
Sample 2: Sample for the Main Study
For the analysis of the AAQ-II items in relation to the
items constructed to measure distress and acceptance,
convenience sampling was used for participants
recruited on campus and other public places. To be
eligible for the study, participants had to be fluent in
Swedish and at least 18 years old. Four hundred and
six individuals participated in the study by completing all of the questionnaires. Of these, 53% were
women and 47% were men. The average age was
24.6 years, with a span from 18 to 63 (SD = 7.5).
Seventy-nine percent stated student as their main
occupation, 16% stated employed, 3% stated
unemployed, and 2% stated other.

measures
Acceptance and Action QuestionnaireII (AAQ-II)
The AAQ-II (Bond et al., 2011) is a 7-item measure of
psychological inflexibility/experiential avoidance.
Answers are given on a 7-point scale ranging from
1 = never true to 7 = always true. The Swedish
version of the scale used in the present study has been
translated using a translation and back translation
procedure and showed good internal consistency
( = .90) in the present study.
Positive and Negative Affect Scale (PANAS)
To assess dispositional positive and negative emotionality, participants completed the trait version of
the PANAS (Watson, Clark, & Tellegen, 1988). The
PANAS is a 20-item mood adjective checklist
designed to measure the Positive Affect (PA) and
Negative Affect (NA) factors and has shown satisfactory psychometric properties in previous research (Watson et al., 1988). To complete the
PANAS, participants were instructed to use a
5-point scale (1 = very slightly or not at all; 5 =
extremely) to indicate to what extent you generally feel this way, that is, how you feel on the
average for each adjective. The Swedish version of
the scale showed adequate internal consistency for
both PA and NA in the present study (PA: = .78;
NA: = .86).
Distress
Five items measuring psychological distress were
rationally constructed using the items from the
AAQ-II as templates in order to construct items

Please cite this article as: Martin Wolgast, What Does the Acceptance and Action Questionnaire (AAQ-II) Really Measure?, Behavior
Therapy (2014), http://dx.doi.org/10.1016/j.beth.2014.07.002

what does the aaq-ii really measure?

similar in wording and style and possible to answer
on the same 7-point scale (with the same verbal
anchors as used in the AAQ-II), though clearly
measuring aspects of psychological distress. The
items are presented in Table 1. Analyzing the items
as a separate scale indicated good internal consistency ( = .85), which the deletion of any of the
included items would reduce. The average score
was 3.1 (scale mean divided by number of items)
with a standard deviation of 1.4, and the average
item score ranged from 2.6 to 3.8.
Acceptance
For the present study, 7 items were rationally
constructed to assess acceptance/nonacceptance in a
way that explicitly tried to separate strategy/trait from
outcome or relative presence of distress. This was
done in different ways depending on item content, but
the main strategy was to include explicit formulations
referring to the presence or absence of active control
efforts and clear reference to actions performed in the
actual presence of aversive inner states. As with the
items measuring psychological distress, the items
were constructed using the items from the AAQ-II as
templates in order to produce items that were similar
in wording and style and possible to answer on the
same 7-point scale as the items from the AAQ-II,
using identical verbal anchors. The items are
presented in Table 1. Analyzing the items as a
separate scale (with Items 1 and 7 reverse scored)
indicated adequate internal consistency ( = .75),
which the exclusion of any of the included items
would reduce. The average score was 3.9 (scale mean
divided by number of items) with a standard
deviation of .93, and the average item score ranged
from 3.2 to 4.7.
Questionnaire to ACT Therapists
In order to provide a test of the construct validity of
the items in the Acceptance and Distress scales, a
questionnaire was administered to therapists working
with ACT (see above for sample description). The
questionnaire listed all 12 items and the participants
were asked to assess to what degree they judged that
each item was measuring acceptance/nonacceptance
(as standardly conceived in ACT) and psychological
distress. Answers were given on a 5-point scale
(1 = not at all; 5 = to a very large extent).

data analysis
Data analysis proceeded through several steps.
First, to test the construct validity of the constructed
scales and item, the data from the questionnaire
administered to ACT therapists were analyzed by
comparing average scores on item and scale level to
see whether there were significant differences in the
extent to which the different items were judged as

measuring acceptance and distress. To further test

the validity of the constructed scales, scale scores
(Distress and Acceptance) were correlated with the
PANAS-N and PANAS-P scales as a partial test of
their conceptual validity. In these analyses the
predicted outcome pattern was that the Distress
scale would be positively correlated with the
PANAS-N and negatively correlated with PANAS-P,
whereas the opposite pattern was predicted for the
Acceptance scale. In addition, given that the Distress
scale was supposed to measure emotionality and
experiential content whereas the Acceptance scale
was designed to measure psychological and behavioral strategies in separation from emotionality, it
was predicted that the conceptual overlap between
the Distress scale and the PANAS would be greater
than that between the PANAS and the Acceptance
scale. Hence, the correlations between the Distress
scale and the PANAS subscales were predicted to be
significantly stronger than the correlations between
the Acceptance scale and the PANAS subscales.
In the second step of the data analysis, an
exploratory factor analysis using principal axis
factoring and promax rotation was performed on
an item pool consisting of the items from the AAQ-II
and the items from the Distress and Acceptance scales
(in total 19 items). Promax rotation was used since
the factors were expected to be correlated. Prior to
running the analysis, parallel analysis (Thompson,
2004) was performed to determine the number of
factors to extract.

Results
construct validity of the distress and
acceptance scales
The data from the questionnaire administered to ACT
therapists were analyzed to investigate the construct
validity of the constructed items and scales. Results are
presented in Table 2. On scale level, the Acceptance
scale was assessed as measuring acceptance to a
significantly larger extent than what the Distress scale
did, t(29) = 14.37, p b .01, and the Distress scale was
assessed as measuring distress to a significantly larger
extent than what the Acceptance scale did, t(29) =
6.90, p b .01. In addition, the Acceptance scale was
judged as measuring acceptance significantly better
than distress, t(29) = 9.83, p b .01, whereas the
opposite was true for the Distress scale, t (29) =
9.68, p b .01. When analyzing data on item level, the
results from Bonferonni-corrected paired sample
t-tests revealed significant differences between the
mean on the acceptance and distress ratings for all
items (all p-values b .001). Hence, the performed
analyses indicated adequate construct validity for
the constructed items as well as for the aggregated
scales.

Please cite this article as: Martin Wolgast, What Does the Acceptance and Action Questionnaire (AAQ-II) Really Measure?, Behavior
Therapy (2014), http://dx.doi.org/10.1016/j.beth.2014.07.002

wolgast

Table 2

Ratings of Content by ACT Therapists, Scale and Item Means

MAcceptance (SD) MDistress (SD)
(N = 30)
(N = 30)

Acceptance scale
1. I often try to control or change my thoughts and feelings.
2. When I feel depressed, worried or anxious, I do not try to influence or change these feelings.
3. I let my thoughts and feelings come and go, without trying to control or avoid them.
4. I do the things I want to do, even if it makes me feel nervous or anxious.
5. When I feel anxious, worried or depressed, I note these feelings but live my life the way I want to.
6. When I feel depressed, worried or anxious, I do not try to avoid these feelings.
7. When I feel depressed, worried or anxious, I try to influence or change these feelings.
Scale average

4.2
4.1
4.9
4.8
4.9
4.5
3.7
4.4

(1.0)
(1.1)
(.3)
(.4)
(.3)
(.7)
(1.4)
(.6)

2.1
1.6
2.0
1.9
2.7
1.7
1.7
1.9

(1.2)
(.8)
(1.4)
(1.2)
(1.4)
(.9)
(.9)
(1.0)

Distress scale
1. I often feel depressed, worried or anxious.
2. I worry a lot.
3. I have many problems in my life.
4. I have lots of painful memories.
5. I am not happy with the way my life is.
Scale average

1.6
1.9
1.8
1.6
2.2
1.8

(.7)
(1.2)
(.8)
(.8)
(.8)
(.6)

4.1
4.0
3.9
3.5
3.9
3.9

(1.0)
(1.1)
(.7)
(1.3)
(1.0)
(.9)

relationships between the constructed

scales, the aaq-ii and the panas
The constructed Distress and Acceptance scales
were correlated with the PANAS-N and PANAS-P
(see above under the data analysis section). Results
are presented in Table 3 and are consistent with the
predicted outcome pattern. To test the prediction
that the correlations would be stronger between the
Distress scale and the PANAS scales than between
the Acceptance scale and the PANAS scales, Fishers
r-to-z test was used to test whether the correlation
coefficients differed significantly from each other in
the predicted direction. The results supported the
prediction (PANAS-P: z = 5.45, p b .01; PANAS-N:
z = 7.26, p b .01), indicating that the Distress scale,
as expected, contained a stronger component of
emotionality and experiential content when compared to the Acceptance scale.
When correlating the AAQ-II with the PANAS
subscales, the results indicate correlations as strong
as for the constructed Distress scales and significantly
stronger than what was found for the constructed
Acceptance scale (PANAS-P: z = 6.59, p b .01;
PANAS-N: z = 8.18, p b .01).
Table 3

Bivariate Correlations Between the Distress Scale, the

Acceptance Scale, AAQ-II, PANAS-N and PANAS-P (N = 406)

PANAS-N
PANAS-P
p b .01.

Distress

Acceptance

AAQ-II

.64
-.55

-.24
.23

.67
-.61

factor analysis
A principal axis factoring parallel analysis
(Thompson, 2004) indicated that only the first
three factors in the actual data exceeded the
corresponding eigenvalues in a normally distributed
random score matrix of the same rank. Hence, three
factors were extracted in the subsequent EFA. The
three factors had eigenvalues of 6.6, 2.5, and 1.6 and
accounted for 36.8%, 14.1%, and 8.9% of the
variance, respectively. Overall, the extracted factors
accounted for 59.8% of the variance. Table 4
displays the pattern matrix of the three promaxrotated factors. Items that loaded at least .40 on one
factor were assigned to a specific factor based on
their highest loading. All of the items included in the
analysis were assigned to a factor.
As can be seen in Table 4, all of the items from the
AAQ-II loaded on the same factor as the items
designed to measure distress (Factor 1), whereas
Factor 2 consists of items related to the control or
avoidance of thoughts and emotions and Factor 3
consists of two items relating to behavioral
flexibility and goal-directed behavior in the presence of aversive emotions.
correlation between factors
Given that the resulting factors were expected to be
correlated, between factor bivariate correlations were
computed to investigate the relationships between the
identified factors (Table 5). Factor scores were created
by summing the scores on the items assigned to
each factor. The results reveal significant correlations
between all three factors, where the strongest

Please cite this article as: Martin Wolgast, What Does the Acceptance and Action Questionnaire (AAQ-II) Really Measure?, Behavior
Therapy (2014), http://dx.doi.org/10.1016/j.beth.2014.07.002

what does the aaq-ii really measure?

Table 4

Factor Loadings for Each Item on the Three Factors

Item

Factor
1
b

I often feel depressed, worried or anxious

.83
.81
Worries get in the way of my success a
My painful memories prevent me from having .81
a fulfilling life a
My painful experiences and memories make .79
it difficult for me to live a life that I would
value a
It seems like most people are handling their .77
lives better than I am a
.72
I worry a lot b
I have many problems in my life b
.72
.68
Emotions cause problems in my life a
.69
I have lots of painful memories b
I worry about not being able to control my .61
worries and feelings a
.57
Im afraid of my feelings a
.48
I am not happy with the way my life is b
When I feel depressed, worried or anxious, I .01
do not try to influence or change those
feelings c
When I feel depressed, worried or anxious, I .08
try to influence or change those feelings c
I often try to control or change my thoughts .23
and feelings c
I let my thoughts and feelings come and go, .00
without trying to control or avoid them c
When I feel depressed, worried or anxious, I .10
do not try to avoid those feelings c
I do the things I want to do, even if it makes .07
me feel nervous or anxious c
When I feel anxious, worried or depressed, I -.16
note those feelings but live my life the way I
want to c

.02 -.05
-.00 -.03
-.06 .20
-.08

.18

-.03 -.13
.16 .05
-.00 -.11
.06 -.13
-.44 .10
.18 .08
.24 .05
-.11 -.34
-.73 -.18

.60

.34

.61 -.06
-.52

.36

-.55

.25

.09

.79

-.07

.44

a = Item from the AAQ-II; b = Item originally constructed to

measure distress; c = Item originally constructed to measure
acceptance/nonacceptance. Numbers in boldface indicate factor
loading on the factor the item was assigned to.

correlation is found between Factor 2 (Control/

avoidance) and Factor 3 (Behavioral flexibility).

Discussion
The present study sought to investigate the extent to
which the AAQ-II is successful in discriminating

between experiential avoidance/psychological flexibility on the one hand and the outcomes in terms of
psychological well-being of having this trait or
behavioral pattern on the other. Based on a critical
examination of the items of the AAQ-II, the
assumption was that there exists a problem with
regard to the discriminant validity of the AAQ-II in
terms of an overlap between the way experiential
avoidance/psychological flexibility is operationalized and measures of psychological well-being, thus
risking circularity of measurements and an overestimation of the association between experiential
avoidance/psychological flexibility and different
health-related outcome measures. The findings of
the performed exploratory factor analysis indeed
showed that the items of the AAQ-II loaded on the
same factor as items designed to measure general
distress and did not load on the same factor as the
items that were designed to measure acceptance/
nonacceptance as an explicit attitude or response to
aversive psychological states. Furthermore, when
comparing the association between the scales and the
PANAS, the AAQ-II was found to have an identical
pattern of correlations to the measures of negative and
positive emotionality as the constructed Distress scale
had, whereas the correlation was significantly weaker
for the constructed Acceptance scale. In conjunction
with the above, this strengthens the suggestion that
the discriminant validity of the AAQ-II is highly
questionable.
There are important limitations to the present
study that should be noted. First, the study is based
on only one sample from a nonclinical population. In
future studies it is important to study more samples
and other populationsfor example, using clinical
samples to see if the results replicate or whether parts
of the identified factor structure is due to method
effects. In addition, the items constructed for the
item-pool on which the factor analysis was made
were rationally developed as a part of the present
study, and though efforts were taken to separate
process or strategy from distress and negative
affectivity (which the empirical tests performed
suggest that this effort was at least partially
successful), it is hard to completely achieve this

Table 5

Bivariate Correlations Between the Factors (N = 406)

Factor 1
Factor 2
Factor 3

Factor 1
(AAQ + Distress)

Factor 2
(Control/avoidance)

1.00
.24
-.27

1.00
-.41

Factor 3
(Behavioral
flexibility)

1.00

p b .01.
Please cite this article as: Martin Wolgast, What Does the Acceptance and Action Questionnaire (AAQ-II) Really Measure?, Behavior
Therapy (2014), http://dx.doi.org/10.1016/j.beth.2014.07.002

wolgast

distinction in a static and global self-report measure.

Hence, parts of the criticism directed at the AAQ-II
are probably valid for some of the items constructed
in this study as well. The validation procedure used
to handle this problem, where the content of the
items were assessed by ACT therapists, however,
strengthens the assumption that the constructed
items have adequate content validity.
Despite these limitations, the results of the study
are interesting and important in light of the
widespread use of the AAQ in both clinical and
scientific contexts (Bond et al., 2011), and given
the centrality of the measure in empirically validating
the ACT model of psychopathology and treatment
(e.g., Boulanger et al., 2010; Hayes et al., 2006).
Indeed, the present study builds upon previous
research (e.g., Chawla & Ostafin, 2007; Gmez
et al., 2011) and suggests that the extent to which the
relatively strong associations often found between
psychological inflexibility/experiential avoidance
particularly when operationalized with the AAQ or
AAQ-IIand measures related to psychological
well-being are due to the psychological processes
assumed in the theoretical models, or merely a
consequence of measurement and operationalization
(i.e., that they to a large extent measure the same
thing), remains to be determined. Hence, based upon
the findings of the study, one might question the
appropriateness of using the AAQ-II in clinical
research and stress the importance of the development of new measures of acceptance or psychological
flexibility. In this context, the MEAQ, developed by
Gmez et al. (2011), seems to be a more promising
measure of experiential avoidance/psychological
inflexibility than the AAQ-II, but might also suffer
from some of the same limitations, such as strong
correlations with neuroticism and an uncertainty as
to what some items really measure. In addition, the
risk of measuring confounding constructs has been
even further reduced in the brief version of the
MEAQ that was recently published (Gmez et al.,
2014). Indeed, when taking into account the results
of the present study, the brief version of the MEAQ
(Gmez et al., 2014) seems to be the most appropriate
measure for assessing experiential avoidance/
psychological flexibility, and clearly preferable to
the AAQ-II.
Finally, however, it is my opinion that a central
part of the problem discussed in this article is that one
tries to capture a dynamic and shifting psychological
process with a static and global self-report measure.
Instead, in light of the results from the present study,
and as suggested by Kashdan and Rottenberg (2010),
future studies should aim at developing alternative
and more dynamic and contextually situated
approaches to measuring psychological flexibility/

experiential avoidance and see how they relate to

psychological well-being and functioning.
Conflict of Interest Statement
The author declares that there are no conflicts of interest.

Acknowledgment
I would like to express my gratitude to professor
Lars-Gunnar Lundh for valuable comments on an
earlier version of this manuscript.
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