Acceptance and Action Questionnaire – Stigma (AAQ-S)

Abstract

The Acceptance and Action Questionnaire – Stigma (AAQ-S) is a specialized psychometric instrument designed to measure psychological flexibility in relation to internal experiences of stigma, biases, and prejudices toward others. Developed within the framework of Acceptance and Commitment Therapy (ACT) and Contextual Behavior Science, the AAQ-S assesses the degree to which individuals are fused with or avoidant of their negative evaluative thoughts about people from different backgrounds. High scores on the primary subscale indicate greater psychological inflexibility, suggesting that one’s biases significantly interfere with value-driven social interactions and culturally sensitive behavior.

Keywords

AAQ-S, Psychological Flexibility, Stigma, Prejudice, Bias, Acceptance and Commitment Therapy, Inflexibility, Social Cognition, Contextual Behavior Science.

Authors

Michael E. Levin, Jason B. Luoma, Jason Lillis, Steven C. Hayes, Roger Vilardaga.

Purpose

The primary purpose of the AAQ-S is to provide researchers and clinicians with a reliable and valid measure for quantifying the construct of psychological flexibility specifically when confronting internal stigmatizing thoughts. While general AAQ measures exist, the AAQ-S focuses on the functional relationship between a person and their negative social evaluations. This allows for the precise measurement of how efforts to control or avoid prejudicial thoughts (psychological inflexibility) lead to impaired social functioning and a lack of valued action, particularly in situations demanding cultural sensitivity and inclusion.

The scale is crucial for evaluating interventions based on ACT principles aimed at reducing the impact of implicit and explicit prejudice by fostering acceptance and defusion from biased cognitions, rather than simply suppressing the thoughts themselves. It helps identify individuals whose biases and judgments function as barriers to meaningful interpersonal engagement.

Construct

The AAQ-S measures the core ACT construct of psychological flexibility, defined as the ability to contact the present moment fully as a conscious human being, and based on what the situation affords, change or persist in behavior in the service of chosen values. In the context of stigma, this means being aware of one’s own prejudicial thoughts and feelings without being dominated by them, allowing for behavior aligned with values like respect or inclusion.

The scale is divided into two primary subscales that reflect the two poles of this construct:

• Psychological Inflexibility Subscale: Items in this subscale measure cognitive fusion (believing negative thoughts about others are objective facts) and experiential avoidance (withdrawing from people or situations to avoid having negative thoughts or judgments).
• Psychological Flexibility Subscale: Items measure the opposite, focusing on acceptance (allowing unpleasant thoughts about others to exist without acting on them) and defusion (seeing judgments as mere reactions rather than absolute truths).

Validity

Initial psychometric studies conducted by Levin et al. (2014) established robust evidence for the AAQ-S’s validity. The scale demonstrated strong convergent validity by correlating positively with established measures of general psychological inflexibility and measures of explicit prejudice and bias. Crucially, it showed discriminant validity, indicating that while related to general distress, it measures a unique variance component specifically tied to the functional impact of stigmatizing thoughts.

The AAQ-S scores were found to predict relevant outcomes, such as reduced cultural sensitivity and impaired social interactions, even after controlling for general measures of psychopathology. This predictive power confirms that the instrument effectively captures the functional impairment associated with inflexible responses to internal biases.

Reliability

The internal consistency of the AAQ-S has been demonstrated to be high, generally showing Cronbach’s alpha coefficients in the acceptable to excellent range (typically above .85 for the overall scale and the Psychological Inflexibility subscale). The test-retest reliability was also confirmed across short intervals, suggesting that the measure provides stable scores over time, making it suitable for both clinical assessment and longitudinal research designs focused on changes in flexibility regarding stigma.

Factor Analysis

The development of the AAQ-S utilized exploratory and confirmatory factor analysis (CFA) to establish its underlying structure. The results supported a clear two-factor model, corresponding to the theoretical dimensions of Psychological Flexibility and Psychological Inflexibility, although researchers often use a single total score reflecting overall inflexibility (as is common with many AAQ instruments). The CFA results confirmed that the items loaded appropriately onto their respective factors, providing strong support for the theoretical conceptualization derived from Acceptance and Commitment Therapy.

Instrument

Test Type: Self-report questionnaire, Likert scale.

Format: 21 items.

Language Available: English (Primary publication language).

Population Group: General adult population (tested primarily on university students and community samples).

Age Group: Adolescents and Adults.

Population Details: Used to assess the functional relationship with internal biases across diverse social contexts.

Test Methodology: Respondents rate their agreement with each statement using a 7-point Likert scale. The scoring instructions are: 1= never true, 2= very seldom true, 3= seldom true, 4= sometimes true, 5= frequently true, 6= almost always true, 7= always true. Items marked with an asterisk (*) are reverse-scored. Higher cumulative scores generally indicate greater psychological inflexibility related to stigmatizing thoughts.

Keywords

Psychometric scale, Measurement, ACT, Prejudice, Bias, Cultural Sensitivity, Experiential Avoidance, Cognitive Fusion, Social Judgment, Contextual Behavior Science.

Authors

Author ORCID Identifier: Not specified in source material.

Affiliation Email addresses: Not specified in source material.

Correspondence Address: Correspondence generally directed to the lead author, Michael E. Levin, affiliated with Utah State University at the time of publication.

Permissions & Fee and Test Year

The AAQ-S was initially published in 2014. As an instrument developed by academics frequently associated with open science practices in Acceptance and Commitment Therapy, the scale is typically available for non-commercial research and clinical use without a fee, though users should consult the original publication or the authors’ lab website for specific usage guidelines.

The original PDF of the instrument and related materials can be accessed via the Utah State University repository: http://digitalcommons.usu.edu/cgi/viewcontent.cgi?article=2097&context=psych_facpub

Reference’s

• Levin, Michael E., Luoma, Jason B., Lillis, Jason., Hayes, Steven C., and Vilardaga, Roger. (2014). “The Acceptance and Action Questionnaire – Stigma (AAQ-S): Developing a Measure of Psychological Flexibility with Stigmatizing Thoughts”. Psychology Faculty Publications. Paper 1096. Available at: http://digitalcommons.usu.edu/psych_facpub/1096
• Levin, Michael E., Luoma, Jason B., Lillis, Jason., Hayes, Steven C., and Vilardaga, Roger. (2014). The Acceptance and Action Questionnaire – Stigma (AAQ-S): Developing a measure of psychological flexibility with stigmatizing thoughts. Journal of Contextual Behavior Science. 2014 Jan; 3(1), 21–26. doi: 10.1016/j.jcbs.2013.11.003

Items of the Acceptance and Action Questionnaire – Stigma (AAQ-S)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

1. My biases and prejudices affect how I interact with people from different backgrounds.

2. I feel that I am aware of my own biases.*

3. My negative thoughts about others are never a problem in my life.*

4. I need to reduce my negative thoughts about others in order to have good social interactions.

5. When I evaluate someone negatively, I am able to recognize that this is just a reaction, not an objective fact.*

6. I stop doing things that are important to me when it involves someone I don’t like.

7. I have trouble letting go of my judgments of others.

8. I feel that my prejudicial thoughts are a significant barrier to me being culturally sensitive.

9. I have trouble not acting on my negative thoughts about others.

10. I am aware when judgments about others are passing through my mind.*

11. It’s OK to have friends that I have negative thoughts about from time to time.*

12. I don’t struggle with controlling my evaluations about others.*

13. When I am having negative thoughts about others, I withdraw from people.

14. When I’m talking with someone I don’t like, I’m aware of my evaluations of them.*

15. When I have judgments about others, they are very intense.

16. When talking with someone I believe I should act according to how I feel about him/her, even if its negative.

17. I’m good at noticing when I have a judgment of another person.*

18. I rarely worry about getting my evaluations towards others under control.*

19. I accept that I will sometimes have unpleasant thoughts about other people.*

20. I often get caught up in my evaluations of what others are doing wrong.

21. The bad things I think about others must be true.

* Reverse scored items

Scoring Key: 1= never true, 2= very seldom true, 3= seldom true, 4= sometimes true, 5= frequently true, 6= almost always true, 7= always true.

Subscales:

• Psychological Inflexibility Subscale (1, 4, 6, 7, 8, 9, 13, 15, 16, 20, 21)
• Psychological Flexibility Subscale (2, 3, 5, 10, 11, 12, 14, 17, 18, 19)