Acceptance and Action Questionnaire (AAQ-II)

Abstract

The Acceptance and Action Questionnaire-II (AAQ-II) is a widely utilized and psychometrically refined self-report instrument designed to measure the core process of change central to Acceptance and Commitment Therapy (ACT): psychological inflexibility. It represents a streamlined and improved version of its predecessors (such as the AAQ-I and AAQ-9).

The AAQ-II consists of seven items that capture the degree to which an individual is entangled with their private experiences (thoughts, feelings, and sensations) and consequently unable to engage in committed, values-driven action. High scores on the scale indicate greater levels of experiential avoidance and reduced psychological flexibility, which are strong predictors of general psychological distress and poor functioning.

Keywords

Acceptance and Action Questionnaire, AAQ-II, Psychological Inflexibility, Experiential Avoidance, Acceptance and Commitment Therapy, ACT, Psychological Assessment, Validity, Reliability, Self-report.

Authors

Steven C. Hayes, Kirk D. Strosahl, Kelly G. Wilson, Frederick W. Bond, et al. (The AAQ-II refinement was primarily led by Bond, Hayes, et al., 2011).

Purpose

The primary purpose of the AAQ-II is to quantify the degree to which an individual exhibits experiential avoidance—the tendency to avoid or suppress unwanted internal experiences such as thoughts, feelings, or memories. By measuring this construct, the instrument provides a direct index of a person’s level of psychological inflexibility.

The scale serves as a critical measure in research pertaining to Acceptance and Commitment Therapy (ACT), where it is used both to screen participants and to evaluate treatment efficacy. It aims to capture the transdiagnostic psychological processes underlying various forms of distress rather than specific diagnostic symptoms.

Construct

The AAQ-II measures psychological inflexibility, which is the core mechanism hypothesized to drive psychopathology within the ACT framework. Psychological inflexibility is characterized by two interlocking components: cognitive fusion (being overly entangled with one’s thoughts) and experiential avoidance (actively trying to suppress or control unwanted internal experiences).

The items on the AAQ-II specifically reflect the extent to which emotions, memories, and worries interfere with the ability to live a valued and fulfilling life. A high score signifies a lack of psychological acceptance, where the individual’s behavior is rigidly controlled by their internal private experiences rather than by their chosen life values.

Validity

The AAQ-II has demonstrated strong empirical support for its construct validity across diverse populations. Research consistently shows that the AAQ-II is significantly correlated with established measures of general psychological distress, including anxiety, depression, and poor quality of life, confirming its theoretical link to psychopathology.

Furthermore, the scale exhibits good predictive validity, often accounting for variance in outcomes related to mental health and behavioral functioning above and beyond traditional symptom measures. Its ability to serve as a reliable process measure makes it highly valuable for evaluating the underlying mechanisms of change in behavioral therapies.

Reliability

The refinement into the AAQ-II significantly improved the instrument’s psychometric reliability compared to earlier versions. Across multiple studies, the AAQ-II consistently demonstrates excellent internal consistency, with Cronbach’s alpha coefficients typically reported in the mid-to-high 0.80s, suggesting that the seven items measure a unified construct effectively.

In addition to internal consistency, the AAQ-II has shown good test-retest reliability, indicating that the measure provides stable assessment results over reasonable periods of time, supporting its use for tracking changes in psychological inflexibility pre- and post-intervention.

Factor Analysis

The factor structure of the Acceptance and Action Questionnaire has evolved significantly across its various iterations. While earlier, longer versions (like the AAQ-16) often suggested a two-factor model (Willingness/Acceptance and Action/Committed Behavior), the revised AAQ-II was developed specifically to function optimally as a robust, unidimensional measure.

Confirmatory factor analyses generally support the use of the AAQ-II as a single-factor instrument, reflecting the overarching construct of psychological inflexibility. Although some academic debate persists regarding the precise conceptual distinction between experiential avoidance and lack of committed action, the practical and dominant scoring method for the AAQ-II relies on summing all seven items to obtain a single total score.

Instrument

Test Type: Self-report questionnaire.

Format: 7 items, 7-point Likert scale (1= never true, 2= very seldom true, 3= seldom true, 4= sometimes true, 5= frequently true, 6= almost always true, 7= always true).

Language Available: English, with numerous validated translations available globally (e.g., Swedish, Spanish, Dutch, Italian, German).

Population Group: Clinical and non-clinical adult populations.

Age Group: Adolescents and Adults.

Population Details: Widely used across various psychiatric populations (e.g., depression, anxiety disorders), chronic physical conditions (e.g., pain), and general community samples to measure transdiagnostic processes.

Test Methodology: Respondents rate their agreement with each statement based on the 7-point frequency scale. Total scores range from 7 to 49. Higher scores indicate greater experiential avoidance and inflexibility.

Keywords

Psychometrics, Self-report, Experiential Avoidance, Acceptance, Committed Action, Acceptance and Commitment Therapy, Psychological Flexibility, Distress, Unidimensionality.

Authors

Author ORCID Identifier: N/A (Information not provided in source).

Affiliation Email addresses: N/A (Information not provided in source).

Correspondence Address: N/A (Information not provided in source).

Permissions & Fee and Test Year

The AAQ-II is generally considered a public domain instrument for use in non-commercial research and clinical practice, consistent with the spirit of behavioral science research. Researchers and clinicians are typically encouraged to use the scale without charge, though proper citation is required.

The original AAQ was published in 2004 by Hayes et al., and the psychometrically refined AAQ-II was formally published in 2011 by Bond, Hayes, et al.

The original PDF of the AAQ-II instrument and scoring can be downloaded here: http://www.goodmedicine.org.uk/files/assessment‚%20aaq-ii.pdf.

Reference’s

• Bond, F. W. & Bunce, D. (2003). The role of acceptance and job control in mental health, job satisfaction, and work performance. Journal of Applied Psychology, 88, 1057-1067.
• Hayes, S. C., Strosahl, K. D., Wilson, K. G., Bissett, R. T., Pistorello, J., et al. (2004). Measuring experiential avoidance: A preliminary test of a working model. The Psychological Record, 54, 553-578.
• Bond, F. W., Hayes, S. C., et al. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire–II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42(4): 676-688.
• Bond, F. W., Hayes, S. C., et al. (2011). Acceptance and Action Questionnaire Revised. In: Simmons C. A., Lehmann P. (eds). Tools for strengths-based assessment and evaluation, New York, NY: Springer, pp. 150-151. (2013).
• Wolgast, Martin. (2014). What Does the Acceptance and Action Questionnaire (AAQ-II) Really Measure? Behavior Therapy 45, 831–839.

Items of the Acceptance and Action Questionnaire (AAQ-II )

The AAQ-II uses a 7-point Likert scale (1= never true, 7= always true). Items 1, 2, 3, 4, 5, 6, and 7 are all scored in the direction of psychological inflexibility (higher scores indicate greater inflexibility). The following are the seven core items:

1. my painful experiences and memories make it difficult for me to live a life that I would value
2. I’m afraid of my feelings
3. I worry about not being able to control my worries and feelings
4. my painful memories prevent me from ha‎ving a fulfilling life
5. emotions cause problems in my life
6. it seems like most people are handling their lives better than I am
7. worries get in the way of my success