AAQ-II — Acceptance and Action Questionnaire

The AAQ-II is the process measure most ACT work is tracked against. It asks about psychological inflexibility — the unwillingness to stay in contact with painful private experience, and what the client does to get rid of it. Seven items, and most clients are through it in about two minutes.

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What it measures

Psychological inflexibility, also described as experiential avoidance: the unwillingness to remain in contact with private experiences — thoughts, feelings, bodily sensations — and the action taken to alter their form or frequency. It is not a symptom measure. A client can post a moderate PHQ-9 and a high AAQ-II, and the second number is the one that tells you the depression is being managed by avoidance. Higher scores mean more inflexibility, which means worse functioning.

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When to use it

• Baseline before ACT work. Administer alongside the presenting-problem measure so you have the process alongside the symptom.
• Every 4–6 weeks through an ACT protocol. Inflexibility is the thing the protocol is aimed at, so it’s the thing worth re-measuring.
• When avoidance looks like the maintaining mechanism. Clients who organize their week around not feeling something, in any diagnostic category.
• Paired with the CFQ-7. Inflexibility and cognitive fusion are related but separable; the pair tells you whether the client is entangled with thoughts, avoiding experience, or both.
• Before and after values clarification. Item 1 is explicitly about painful experience getting in the way of a valued life, which is the same territory the worksheet works in.

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How clients fill it

Two minutes. The stem reads: “Below you will find a list of statements. Please rate how true each statement is for you. Use the scale below to make your choice. 1 = Never true, 2 = Very seldom true, 3 = Seldom true, 4 = Sometimes true, 5 = Frequently true, 6 = Almost always true, 7 = Always true.” All seven items share the same seven-option scale:

• Never true
• Very seldom true
• Seldom true
• Sometimes true
• Frequently true
• Almost always true
• Always true

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How Rivet scores it

Each option carries its own number — Never true scores 1, Always true scores 7, and the five options between them run 2 through 6 in order. The total is the sum of all seven items. Range: 7–49. There are no reverse-scored items and no subscales — the AAQ-II is a single unidimensional total. Higher means more inflexibility. The total and the current band appear live in your scoring pill as the client answers.

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Score bands

A score of 24 or higher is the cutoff for clinically relevant psychological inflexibility, taken from the clinical-sample mean reported in Bond 2011. Read the direction carefully when you’re reviewing a chart. On the AAQ-II, up is worse. On the SCS-SF, up is better. Two ACT-adjacent measures administered in the same session move in opposite directions.

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Clinical change

There is no published minimal clinically important difference for the AAQ-II in the source Rivet scores it from. Treat a movement across a band boundary as the meaningful event, and read it against the client’s symptom measure rather than on its own. Rivet shows the current total; it doesn’t compute the difference between two administrations.

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Using it in a Canadian practice

Your client’s answers stay in Canada. A completed AAQ-II is health information about a named person. The answers are stored encrypted in a Montreal data centre and land in that client’s chart against the session they belong to. Nothing goes to an outside service to be scored. Getting it into your file of record. The scored result copies out formatted for a progress note, so it pastes into Jane, Owl or whatever holds the record. You’re not retyping a total, and the interpretation travels with it. English only. The version here is English. If you practise in French, you’ll be working from your own copy for that client.

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When NOT to use it

• As a diagnostic instrument. Psychological inflexibility is not a diagnosis. There is nothing to diagnose with this number.
• As a symptom-outcome measure. If a referrer or an insurer wants outcome documentation, they want the PHQ-9 or the GAD-7. The AAQ-II is for the process you’re working on, not the symptom you’re reporting.
• Outside a model that treats avoidance as a mechanism. In a course of straight behavioural activation or CBT-I, the number is interesting and not actionable.

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AAQ-II vs CFQ-7

Two ACT process measures, seven items each, both scored 7–49, both with higher meaning worse. The difference is which process. The AAQ-II measures psychological inflexibility — broadly, unwillingness to stay in contact with difficult private experience and the things a person does to avoid it. The CFQ-7 measures cognitive fusion specifically: being tangled in thoughts and treating them as literal truth rather than as thoughts. If you’re running defusion work, the CFQ-7 is the measure closest to what you’re doing and the one most likely to move. If you want a general read on inflexibility across a course of ACT, the AAQ-II is the one with the longer track record. They complement rather than substitute — many ACT practitioners run both, plus values clarification for the committed-action side that neither questionnaire touches.

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Is it free to use?

Yes. Free clinical and research use, per the Association for Contextual Behavioral Science.

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Citation

Bond, Hayes, Baer, Carpenter, Guenole, Orcutt, Waltz & Zettle (2011). Behavior Therapy, 42: 676–688. Free for clinical and research use, per its ContextualScience distribution. Rivet preserves the canonical item wording verbatim — paraphrase would break instrument validity, because the published cutoff only applies to the published item wording.

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