We’ve added measures that will be useful for clinicians that work with an Acceptance and Commitment Therapy (ACT) perspective to the NovoPsych test library. These scales measure key concepts important in ACT, such as cognitive fusion, cognitive flexibility, values-committed action, and acceptance of thoughts. I’ve often found that when introducing these ideas to clients, measuring the construct with a questionnaire helps make the idea more tangible for the client. We’ve put together a summary of these measures below, and hope you find them useful in developing a shared formulation with your clients.
- Automatic Thoughts Questionnaire – Believability
- Cognitive Flexibility Inventory
- Valuing Questionnaire
- Five Facet Mindfulness Questionnaire
Questionnaire – Believability (ATQ-B-15)
The Automatic Thoughts Questionnaire – Believability (ATQ-B-15; Netemeyer et al., 2002), is a 15-item self-report measure designed to assess the degree of believability of cognitions associated with depression. The scale does not measure the frequency of unhelpful thoughts, but rather measures the extent to which the client believes the thoughts to be true.
Consistent with the ACT concept of fusion, the ATQ-B asks how much the client believed a thought when they felt depressed/sad. Given that changes in believability of unhelpful thoughts occur independently of reductions in their frequency (Zettle & Hayes, 1986), the believability and fusion of thoughts is an important aspect to target in therapy (Zettle, Rains & Hayes, 2011). The ATQ has been found to be a reliable measure of cognitive change in depression in response to ACT and can therefore be a useful measure of progress in therapy (Zettle et al., 2011).
Learn more about the ATQ-B-15
Cognitive Flexibility Inventory
The Cognitive Flexibility Inventory (CFI; Dennis & Vander Wal, 2010), is a 20-item self-report measure to monitor cognitive flexibility, a cognitive skill that enables individuals to think adaptively when encountering stressful life events. It is a core skill that helps individuals avoid becoming stuck in maladaptive patterns of thinking. Administering the CFI during either ACT or CBT can be helpful to introduce the concept of cognitive flexibility to clients as part of a collaborate process to generate a shared formulation about their difficulties. The CFI measures two aspects of cognitive flexibility:
(1) Alternatives – the adaptive ability to perceive multiple alternative explanations for life occurrences and the ability to generate multiple alternative solutions to difficult situations.
(2) Control – having an internal locus of control, or the tendency to perceive difficult situations as somewhat controllable.
While ACT encourages patients to accept those things that are out of their control, it also encourages them to commit to actions designed to enrich their lives, hence why the control subscale is useful. Individuals with high cognitive flexibility are more likely to react adaptively in response to difficult life experiences, while cognitively inflexible individuals are more susceptible to experiencing pathological reactions.
The CFI has been shown to differentiate between a clinical group (anxiety and depression) and a non-clinical sample (Johnco, Wuthrich, & Rapee, 2014).
Learn more about the Cognitive Flexibility Inventory (CFI)
Valuing Questionnaire (VQ)
The Valuing Questionnaire (VQ: Smout et al. 2014), is a 10-item self-report scale designed to measure how consistently an individual has been living with their self-determined values or personal principles. Articulation of self-defined values is a core component of ACT-like therapies, and this scale is best used in conjunction with this process in therapy. The VQ measures “valuing”, which refers to actions one takes to live in accordance with values, rather than simply pleasant outcomes or satisfaction with life.
It has two subscales:
(1) Progress, defined as enactment of values, perseverance, and including clear awareness of what is personally important.
(2) Obstruction, which reflects the disruption of valued living due to avoidance of unwanted experience, distraction from values by inattention to values or undue attention to distress.
Learn more about the Valuing Questionnaire (VQ)
Five Facet Mindfulness Questionnaire
The Five Facet Mindfulness Questionnaire (FFMQ-15) is a 15 question self-report scale that measures mindfulness with regards to thoughts, experiences, and actions in daily life (Baer, Carmody, & Hunsinger, 2012). The FFMQ-15 measures 5 subscales of mindfulness:
- Acting with Awareness
Mindfulness is considered a core skill in ACT, and increased mindfulness is related to decreases in distress and other psychological symptoms. Studies on a large-scale population including students, professionals, and clinically depressed individuals showed that FFMQ-15 is a predictor for optimistic thinking, an overall uplifted mood, and subjective feelings of well-being (Baer et al., 2006; Bohlmeijer, Ten Klooster, Fledderus, Veehof, & Baer, 2011).
Learn More about the Five Facet Mindfulness Questionnaire (FFMQ-15)
Acceptance and Commitment Therapy (ACT)
The core conception of Acceptance and Commitment Therapy (ACT) is that psychological suffering and a failure to prosper is usually caused by psychological inflexibility (Hayes, n.d.). Psychological inflexibility is argued to emerge from six basic processes. Stated in their most general fashion these are emotional inflexibility, cognitive inflexibility, attentional inflexibility, failures in perspective taking, lack of chosen values, and an inability to broaden and build habits of values-based action (Hayes, n.d.).
ACT is a cognitive-behavioural intervention that aims to foster psychological flexibility as a central means to human adaptation and wellbeing (Biglan et al., 2008). This means that in order to be psychologically flexible, clients must accept their own thoughts and emotions and act on long-term values rather than short-term impulses, thoughts, and feelings that are often linked to experiential avoidance (Hülsheger et al., 2013).
ACT aims to develop and expand psychological flexibility through six core processes:
- Acceptance: involves acknowledging and embracing the full range of your thoughts and emotions rather than trying to avoid or deny, or alter them. Measure Acceptance with the FFMQ.
- Cognitive Defusion: involves distancing yourself from and changing the way you react to distressing thoughts and feelings, which will mitigate their harmful effects. Measure Cognitive Defusion with the ATQ-B
- Being Present: involves being mindful in the present moment and observing your thoughts and feelings without judging them or trying to change them; experiencing events clearly and directly can help promote behaviour change. Being Present can be measured with the FFMQ.
- Self as Context: is an idea that expands the notion of self and identity; it purports that people are more than their thoughts, feelings, and experiences.
- Values: encompass choosing personal values in different domains and striving to live according to those principles. This stands in contrast to actions driven by the desire to avoid distress or adhere to other people’s expectations, for example. Measure Values with the VQ.
- Committed Action: involves taking concrete steps to incorporate changes that will align with your values and lead to positive change. This may involve goal setting, exposure to difficult thoughts or experiences, and skill development. Measure Committed Action with the VQ.
We hope the above measures will help you introduce key ACT based ideas to your clients and measure outcomes based on this shared formulation.
Acceptance and Commitment Therapy. (n.d.). Psychology Today. Retrieved April 8, 2022, from https://www.psychologytoday.com/au/therapy-types/acceptance-and-commitment-therapy
Biglan, A., Hayes, S. C., and Pistorello, J. (2008). Acceptance and commitment: implications for prevention science. Prev. Sci. 9, 139–152. doi: 10.1007/s11121-008-0099-4
Dennis, J. P., & Vander Wal, J. S. (2010). The cognitive flexibility inventory: Instrument development and estimates of reliability and validity. Cognitive Therapy and Research, 34(3), 241–253. https://doi.org/10.1007/s10608-009-9276-4
Hayes, S. (n.d.). About ACT: Psychological Inflexibility: An ACT View of Suffering and Failure to Thrive. Association for Contextual Behavioral Science. Retrieved April 8, 2022, from https://contextualscience.org/about_act
Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and Commitment Therapy: An experiential approach to behavior change. New York: Guilford Press.
Hollon, S. D., & Kendall, P. C. (1980). Cognitive self-statements in depression: Development of an Automatic Thoughts Questionnaire.Cognitive Therapy and Research,4, 383-395.
Hülsheger, U. R., Alberts, H. J., Feinholdt, A., and Lang, J. W. (2013). Benefits of mindfulness at work: The role of mindfulness in emotion regulation, emotional exhaustion, and job satisfaction. J. Appl. Psychol. 98:310. doi: 10.1037/a0031313
Johnco, C., Wuthrich, V. M., & Rapee, R. M. (2014). Reliability and validity of two self-report measures of cognitive flexibility. Psychological Assessment, 26(4), 1381–1387. https://doi.org/10.1037/a0038009
Netemeyer, R. G., Williamson, D. A., Burton, S., Biswas, D., Jindal, S., Landreth, S., Mills, G., & Primeaux, S. (2002). Psychometric properties of shortened versions of the automatic thoughts questionnaire. Educational and Psychological Measurement, 62(1), 111–129. https://doi.org/10.1177/0013164402062001008
Zettle, R. D., & Hayes, S. C. (1986). Dysfunctional control by client verbal behavior: The context of reason-giving. The Analysis of Verbal Behavior, 4, 30–38. https://doi.org/10.1007/BF03392813
Zettle, R. D., Rains, J. C., & Hayes, S. C. (2011). Processes of change in acceptance and commitment therapy and cognitive therapy for depression: a mediation reanalysis of Zettle and Rains. Behavior Modification, 35(3), 265–283. https://doi.org/10.1177/0145445511398344