Treatment sensitivity: Its importance in the measurement of psychological flexibility

Abstract

Background: Psychological flexibility (PF) is a central construct in Acceptance and Commitment Therapy (ACT). Many studies have operationalized PF using the self-report Acceptance and Actions Questionnaire (AAQ-II). Information on the treatment sensitivity of self-report assessments of PF is lacking, however. We investigated differences in the treatment sensitivity of the AAQ-II compared to other measures of PF across various samples.Methods: Using three different clinical samples (N=164), we compared the pretreatmentposttreatment change scores of the AAQ-II to those of three alternative self-report questionnaires measuring PF in a within-subject design. Sensitivity to change was assessed with effect sizes and Reliable Change Index (RC).Results: Without exception, effect sizes and rates of clinically significant change were larger in all three alternative questionnaires and across three populations compared to the standard formulation of the AAQ-II. Conclusions:The results of the present study show greater treatment sensitivity of three alternative questionnaires measuring PF compared to the AAQ-II. The results suggest that treatment effects concerning PF may have been underestimated depending on the wording and measure used. Implications for research on PF and ACT processes and outcomes are discussed.

Intervention and Mediation Effects of Target Processes in a Randomized Controlled Trial of Acceptance and Commitment Therapy for Anxious Cancer Survivors in Community Oncology Clinics

“…First, the considerable missing data at Pre on the BEAQ in the present study may have led to a lack of power to detect intervention effects. In addition, the AAQ-II (which provided many of the item stems for the AAQc) has previously shown failure to capture intervention effects (Benoy et al, 2019). It is possible that the AAQc is inconsistently sensitive to treatment effects, and thus failed to capture actual experiential avoidance change in the Valued Living RCT.…”

“…Regarding extant methodological constraints, first, psychometric concerns have arisen about several of the most widely used measures of the core theorized ACT target processes including in the domains of experiential avoidance (Tyndall et al, 2019;Wolgast, 2014) and values-aligned behavior (Barrett et al, 2019;Reilly et al, 2019). It is possible that previous studies' failure to detect movement on these variables results from the use of insufficiently sensitive or construct-specific instruments (Benoy et al, 2019). Second, studies examining mechanisms of ACT have naturally focused on the six core theorized ACT target processes (Stockton et al, 2019).…”

Be a Mom, a Web-Based Intervention to Promote Positive Mental Health Among Postpartum Women With Low Risk for Postpartum Depression: Exploring Psychological Mechanisms of Change

“…It is possible that this failure in finding a significant improvement could in part be due to the instrument that was used to measure psychological flexibility. Although the AAQ-II is the most used self-report measure of psychology flexibility, it has been shown that, compared to other measures, the AAQ-II is less sensitive to treatment change (64). Indeed, previous intervention studies using an Acceptance and Commitment Therapy approach have not found significant results when considering AAQ-II scores (22,65).…”

The spatiotemporal movement of patients in and out of a psychiatric hospital: an observational GPS study

“…Each item assesses how often a statement was true during the past month, ranging from 0 (never) to 5 (almost every day). Psychological flexibility was measured using the Psyflex scale ([ 16 ]; Gloster AT, Block VJ, Klotsche J, Villanueva J, Rinner MTB, Benoy C, et al: Psy-Flex: A Contextually Sensitive Measure of Psychological Flexibility, In review) which measures core skills of psychological flexibility on a scale from 1 (very rarely) to 5 (very often). The Psyflex shows very high internal consistency (Raykov’s r = 0.91) and produces a single score with higher scores indicating better psychological flexibility qualities.…”