The Relationship Between Psychological Inflexibility and Well-Being in Adults: A Meta-Analysis of the Acceptance and Action Questionnaire.

Psychological inflexibility is defined as the rigid responding to stimuli (e.g., unpleasant thoughts and feelings) that interferes with well-being and valued actions. It is the treatment target in acceptance and commitment therapy (ACT). Despite the centrality of the link between inflexibility and well-being to ACT theory, an empirical review clarifying the nature of this relationship has not been conducted. As such, the current meta-analysis examined the meta-correlation between psychological inflexibility, measured by the Acceptance and Action Questionnaire (AAQ) and its variants, and well-being. A systematic review yielded 151 studies, including 25 versions of the AAQ and 43 well-being measures. Consistent with ACT theory, higher psychological inflexibility was associated with worse well-being (r = -.47, 95% CI[-.49, -.45]). In addition, sample diagnosis, type of AAQ, and type of well-being measure significantly moderated this relationship. Overall, our findings support the hypothesized link between psychological inflexibility and worse well-being. Limitations include reliance on cross-sectional data, precluding causal interpretation.

Psychometric properties and measurement invariance of the Work-Related Acceptance and Action Questionnaire (WAAQ) in a Colombian sample

The Work-Related Acceptance and Action Questionnaire (WAAQ) is a self-report instrument that measures psychological flexibility at work. Although this scale has been validated in some languages, its psychometric properties in Colombia are unknown, making it challenging to assess work-related psychological flexibility in this country. The present study analyzed the psychometric properties and factor structure of the WAAQ in a sample of 985 Colombian workers. The internal consistency of the WAAQ measured through coefficient alpha was .88. The one-factor model with correlated error terms between items 4 and 7 showed a very good fit to the data (RMSEA= 0.033, CFI= .998, NNFI= .997, SRMR= 0.018). The WAAQ showed metric and scalar invariance across gender, age group, socioeconomic stratum, and hierarchical level. Furthermore, it correlated negatively with psychological inflexibility, psychological distress, emotional exhaustion, and cynicism and positively with professional efficacy, work engagement, and job satisfaction. In conclusion, the WAAQ seems to be a valid self-report of work-related psychological flexibility in Colombian samples (AU)

Validity and Reliability of the Korean Version of the Acceptance and Action Questionnaire-Stigma (AAQ-S-K).

This study investigated the validity and reliability of the Korean version of the Acceptance and Action Questionnaire-Stigma (AAQ-S-K) in people with diabetes. A total of 208 patients with diabetes participated in the study. After performing forward and backward translation of the original version of the AAQ-S into Korean, its validity (construct and concurrent validity) and reliability were assessed. Construct validity measured using confirmatory factor analysis showed a good fit. Concurrent validity was confirmed through the significant correlation between the AAQ-S-K, acceptance and action, diabetes self-stigma and diabetes distress. The AAQ-S-K was positively correlated with acceptance and action and had a negative correlation with diabetes self-stigma and diabetes distress. The reliability of the AAQ-S-K ranged from 0.82 to 0.88. The AAQ-S-K can be applied to assess stigma acceptance and action in Korean patients with diabetes and to compare the level of psychological flexibility of patients with diabetes internationally.

Validation of the Chinese Version of the Body Image Acceptance and Action Questionnaire and the Mediating Role of Body Image Flexibility in the Relationship Between Body Dissatisfaction and Psychological Distress.

The psychometric properties of the Chinese version of the Body Image Acceptance and Action Questionnaire (C-BI-AAQ) and its short form (C-BI-AAQ-5) were examined with a sample of Chinese undergraduates (n =1,068, 52.6% female). The factor structure, measurement reliability, measurement invariance across gender, and latent gender mean difference of the two scales were explored. Confirmatory factor analysis was used to examine the factor structure of the C-BI-AAQ and the C-BI-AAQ-5. The original one-factor structure was replicated for both the C-BI-AAQ and the C-BI-AAQ-5. Both the C-BI-AAQ and C-BI-AAQ-5 showed good internal consistency, test-retest reliability, and convergent and discriminant validity (e.g., relationship patterns in the expected directions with theoretically similar psychological flexibility, and with theoretically dissimilar body dissatisfaction, and psychological distress). The C-BI-AAQ-5 was shown to be equivalent to the C-BI-AAQ. Furthermore, strict measurement invariance across gender was confirmed for both the C-BI-AAQ and C-BI-AAQ-5, and latent mean difference tests showed that men had higher levels of body image flexibility than women. Thus, both the C-BI-AAQ and C-BI-AAQ-5 appear to be psychometrically sound instruments for use in the Chinese young adult population. In addition, body image flexibility measured by both the C-BI-AAQ and the C-BI-AAQ-5 fully mediated the relationship between body dissatisfaction and psychological distress.

Psychometric Properties and Factor Structure of the Spanish Version of the Acceptance and Action Questionnaire-II (AAQ-II) in Ecuador.

(1) Background: The Acceptance and Action Questionnaire-II (AAQ-II) is the most well-known self-report measure to assess psychological inflexibility, a transdiagnostic pathological process, and targets for interventions. Objective: The aim of this study was to analyze the psychometric properties and factorial structure of the Ecuadorian Spanish version of the AAQ-II in a large sample of college students in Ecuador. (2) Methods: A total of 7905 students, 46.26% male and 53.75% female, from 11 Ecuadorian universities were surveyed. The AAQ-II was tested for factorial structure, reliability, and correlations with other health-related measures. (3) Results: The AAQ-II showed an unidimensional factorial structure, accounting for 66.87% to 70% of the total variance and showing a good fit of the data to the model (comparative adjustment index (CFI) = 0.995; goodness of fit index (GFI) = 0.992; Standardized Root Mean Squared Residual (SRMR) = 0.037; mean square approximation error (RMSEA) = 0.047, CI90% = 0.038-0.056). Reliability was optimal (Cronbach's α = 0.919; ω = 0.928), and AAQ-II scores significantly correlated with multiple health indicators. Psychological inflexibility was significantly higher in women than men. (4) Conclusions: The Spanish version of the AAQ-II showed good psychometric properties, which further supports psychological inflexibility, not just as a transdiagnostic process.

Psychological Flexibility and Depression in Advanced CKD and Dialysis.

RATIONALE & OBJECTIVE: Depression is prevalent and highly associated with mortality among patients with chronic kidney disease (CKD). Psychological flexibility can be captured as acceptance in psychology, and its improvement by behavioral therapy is associated with reduced depression in some clinical settings. However, no study has been reported on patients with CKD. This study aimed to examine the association between psychological flexibility and depression in patients with CKD. STUDY DESIGN: Cohort study. SETTING & PARTICIPANTS: This multicenter study of 5 hospitals in Japan included patients with nondialysis stage 3-5 CKD or stage 5D CKD receiving hemodialysis or peritoneal dialysis. PREDICTOR: Psychological flexibility measured using the 7-item Acceptance and Action Questionnaire (AAQ-II). OUTCOMES: The prevalence and incidence of depression after 1 year, which was defined by a score ≥ 16 points on the Center for Epidemiologic Studies Depression (CES-D) questionnaire. ANALYTICAL APPROACH: Gamma regression was used in the examination of correlates of the psychological flexibility value. Modified Poisson regression models were fit for the prevalence and incidence of depression. RESULTS: The cross-sectional and longitudinal analyses included 433 and 191 patients, respectively. Lower (ie, worse) psychological flexibility levels were associated with hemodialysis and peritoneal dialysis. Higher (ie, better) psychological flexibility levels were associated with lower prevalence of depression (per 5-point increase; adjusted prevalence ratio, 0.75; 95% CI, 0.70-0.80) and lower incidence of depression (per 5-point increase; adjusted risk ratio, 0.72; 95% CI, 0.61-0.85). LIMITATIONS: Depression was assessed using the CES-D questionnaire. Cultural differences may exist in the interpretation of AAQ-II scores. CONCLUSIONS: Better psychological flexibility was associated with lower prevalence and incidence of depression in patients with CKD. Further studies are warranted to determine the possible prevention and treatment of depression by the development of behavioral interventions to improve psychological flexibility.

Confirmatory Factor Analysis of the Acceptance and Action Questionnaire for Weight-Related Difficulties-Revised (AAQW-R) in a United States Sample of Adults with Overweight and Obesity.

OBJECTIVE: To examine the psychometric properties of the English language version of the 10-item Acceptance and Action Questionnaire for Weight-Related Difficulties-Revised (AAQW-R) in a United States (U.S.) sample of women and men with overweight/obesity (OW/OB). METHOD: Adults with OW/OB seeking weight loss (N = 283; 59% women) completed the AAQW-R and other weight-related and psychosocial measures. Confirmatory factor analysis was used to examine single-factor, three-factor, and second-order factor structures of the AAQW-R, which were previously examined in a sample of Portuguese women. A chi-square difference test was used to compare the fit of a single-factor structure with three-factor and second-order factor structures. Internal reliability and convergent validity were examined for the total and three-factor subscale scores. RESULTS: The single-factor structure evidenced poor fit to the data whereas the three-factor structure evidenced acceptable fit. The second-order structure was assessed qualitatively due to limitations to statistical model specification. The internal reliability of the AAQW-R total score and each of the three subscales were in the good and acceptable ranges, respectively. Total and subscale scores demonstrated good convergent validity. DISCUSSION: Findings suggest that the English language version of the AAQW-R can be used to assess weight-related experiential avoidance in U.S. adult samples with OW/OB as a three-factor construct (food as control, weight as a barrier to living, weight stigma), with or without a total score. Additional research should confirm measurement invariance among various sociodemographic groups.

A systematic review of the roles of body image flexibility as correlate, moderator, mediator, and in intervention science (2011-2018).

The emergence of body image flexibility into the positive body image nomenclature has innovatively expanded the conceptualization of how individuals may adaptively respond to body image threats. Given the notable growth of interest in researching this construct over nearly the past decade, the present analysis provides a systematic and critical review of evidence examining the roles of body image flexibility as correlate, mediator, moderator, and in intervention research. Results indicated that body image flexibility tended to demonstrate a pattern of relationships with correlates in directions predicted by its conceptualization and showed promise in functioning as both effect modifier and as an explanatory variable in the associations evaluated. Multiple studies demonstrated susceptibility to change following intervention. Although the current state of the literature is bound by notable limitations, the results of this review point to pertinent future steps in advancing the theory and application of body image flexibility scholarship.

Psychological Flexibility of Nurses in a Cancer Hospital: Preliminary Validation of a Chinese Version of the Work-related Acceptance and Action Questionnaire.

OBJECTIVE: To translate the English work-related acceptance and action questionnaire (WAAQ), make cross-cultural adaptations, and examine its psychometric properties when used by Chinese oncology nurses. METHODS: After translation, the psychometric properties of the Chinese WAAQ were analyzed among 417 nurses, and content validity was determined by six experts. RESULTS: Item-level content validity index (CVI) values were between 0.83 and 1.00; scale-level CVI/universal agreement (S-CVI/UA) and S-CVI/average were 0.86 and 0.98, respectively, which implicated a good content validity. The correlation of the Chinese WAAQ with AAQ-II (rs = -0.247, P < 0.001) suggested criterion validity, and those with General Health Questionnaire-12 (-0.250, <0.001) and general self-efficacy scale (0.491, <0.001) and Utrecht work engagement scale (UWES) (0.439, <0.001) suggested convergent validity. Exploratory factor analysis identified a seven-item, one-factor structure of WAAQ. The Chinese version of WAAQ had high internal consistency (Cronbach's α = 0.920), with an item-total correlation coefficient of 0.702-0.828 (P < 0.05), split-half reliability of 0.933, and test-retest reliability of 0.772. CONCLUSIONS: The Chinese WAAQ is a reliable and valid tool for assessing psychological flexibility in Chinese oncology nurses.

Psychometric Properties of the Persian Version of the Social Anxiety - Acceptance and Action Questionnaire.

BACKGROUND: Social anxiety disorder is often related to specific impairment or distress in different areas of life, including occupational, social and family settings. OBJECTIVE: The purpose of the present study was to examine the psychometric properties of the persian version of the social anxiety-acceptance and action questionnaire (SA-AAQ) in university students. MATERIALS AND METHODS: In this descriptive cross-sectional study, 324 students from Shahid Beheshti University of Medical Sciences participated via the cluster sampling method during year 2015. Factor analysis by the principle component analysis method, internal consistency analysis, and convergent and divergent validity were conducted to examine the validity of the SA-AAQ. To calculate the reliability of the SA-AAQ, Cronbach's alpha and test-retest reliability were used. RESULTS: The results from factor analysis by principle component analysis method yielded three factors that were named acceptance, action and non-judging of experience. The three-factor solution explained 51.82% of the variance. Evidence for the internal consistency of SA-AAQ was obtained via calculating correlations between SA-AAQ and its subscales. Support for convergent and discriminant validity of the SA-AAQ via its correlations with the acceptance and action questionnaire - II, social interaction anxiety scale, cognitive fusion questionnaire, believability of anxious feelings and thoughts questionnaire, valued living questionnaire and WHOQOL- BREF was obtained. The reliability of the SA-AAQ via calculating Cronbach's alpha and test-retest coefficients yielded values of 0.84 and 0.84, respectively. CONCLUSIONS: The Iranian version of the SA-AAQ has acceptable levels of psychometric properties in university students. The SA-AAQ is a valid and reliable measure to be utilized in research investigations and therapeutic interventions.