University of Iowa

Iowa Research Online

Theses and Dissertations

Summer 2014

ACT process measures : specificity and incremental value

Joshua Holubec Gootzeit
University of Iowa

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Part of the Psychology Commons

Copyright 2014 Joshua Holubec Gootzeit

This dissertation is available at Iowa Research Online: https://ir.uiowa.edu/etd/1325

Recommended Citation
Gootzeit, Joshua Holubec. "ACT process measures : specificity and incremental value." PhD (Doctor of
Philosophy) thesis, University of Iowa, 2014.
https://doi.org/10.17077/etd.grjd6zw4

Follow this and additional works at: https://ir.uiowa.edu/etd

Part of the Psychology Commons
ACT PROCESS MEASURES: SPECIFICITY AND INCREMENTAL VALUE

by
Joshua Holubec Gootzeit

A thesis submitted in partial fulfillment

of the requirements for the Doctor of
Philosophy degree in Psychology
in the Graduate College of
The University of Iowa

August 2014

Thesis Supervisor: Associate Professor Kristian Markon

 Graduate College
The University of Iowa
Iowa City, Iowa

CERTIFICATE OF APPROVAL

_______________________

PH.D. THESIS
_______________

This is to certify that the Ph.D. thesis of

Joshua Holubec Gootzeit

has been approved by the Examining Committee

for the thesis requirement for the Doctor of Philosophy
degree in Psychology at the August 2014 graduation.

Thesis Committee: ___________________________________

Kristian Markon, Thesis Supervisor

___________________________________
Lilian Dindo

___________________________________
James Marchman

___________________________________
Molly Nikolas

___________________________________
Michael O'Hara
To Beth

ii
 ACKNOWLEDGMENTS

I would like to thank my advisor, Kristian Markon, for his help and support over

my graduate career. His guidance and his expertise in statistics and psychometrics, and

his patient willingness to sit down and have long discussions about the finer points of

structural equation modeling despite his busy schedule, have made this project possible. I

thank my dissertation committee members, Lilian Dindo, James Marchman, Molly

Nikolas, and Mike O’Hara for their feedback and guidance. I would like to particularly

thank James Marchman, whose invaluable mentorship and clinical training continues to

influence and inspire me, both professionally and personally. I thank my parents for their

unconditional support over the years. Finally, I thank my wife, Beth, for her constant

patience, love, and understanding.

iii
 ABSTRACT

A number of objective personality questionnaires have been published which aim

to measure the six processes related to Acceptance and Commitment Therapy’s model of

treatment (acceptance, defusion, present moment awareness, self-as-context, values, and

committed action). These measures operationally define these hypothesized processes in

research settings. However, little research has been done to investigate whether these

processes, as measured by these questionnaires, are differentiable from each other or

from other, seemingly similar constructs such as distress tolerance and coping styles.

Additionally, it is unclear whether these questionnaire measures have differing

relationships with other potentially relevant constructs, such as psychopathology,

functioning, and personality. The structure of these process measures was investigated

across two participant samples. A multi-trait structure of ACT processes was found, with

three higher order dimensions consisting of psychological inflexibility/cognitive fusion,

mindfulness, and avoidance, as well as a number of distinguishable lower order traits.

This structure was found across multiple samples, and measures of these factor

analytically-derived traits were found to have incremental validity and to be

distinguishable from other, superficially similar psychological processes. These results

provide guidance for measurement selection and suggest future directions for scale

development. Relevance to treatment outcome research is also discussed.

iv
 TABLE OF CONTENTS

LIST OF TABLES ............................................................................................................ vii

LIST OF FIGURES .............................................................................................................x

CHAPTER I. INTRODUCTION .........................................................................................1

Acceptance and Commitment Therapy ............................................................1

Acceptance Versus Experiential Avoidance .............................................2
Present Moment Awareness ......................................................................7
Defusion ....................................................................................................9
Self-as-Context ........................................................................................10
Values ......................................................................................................11
Committed Action ...................................................................................15
Potentially Related Constructs and Measures.................................................16
Anxiety Sensitivity ..................................................................................16
Distress Tolerance ...................................................................................17
Discomfort Intolerance ............................................................................19
Coping Styles...........................................................................................20
General Discussion of Study-Relevant Constructs and Processes .................22
Psychometrics and Functional Contextualism ................................................27
Rationale for Current Study ............................................................................32
Specific Aims of Study ............................................................................34

CHAPTER II. METHODS ................................................................................................36

Participants and Procedures ............................................................................36

Study Measures ...............................................................................................38
Data Analysis ..................................................................................................53

CHAPTER III. RESULTS .................................................................................................55

Univariate Statistics ........................................................................................55

Group Comparisons ........................................................................................55
Correlations.....................................................................................................56
Scale Level Exploratory Factor Analyses .......................................................58
Item Level Exploratory Factor Analyses ........................................................59
Factor Sum Scores ..........................................................................................62
Confirmatory Factor Analyses ........................................................................64
Predictions Across Time .................................................................................65
Incremental Validity .......................................................................................66

CHAPTER IV. DISCUSSION...........................................................................................69

Scale Relationships .........................................................................................70

The Structure of ACT Processes.....................................................................72
Characteristics of ACT Process Sum Scales ..................................................75
General Discussion .........................................................................................78
Conclusion ......................................................................................................83

v
REFERENCES ..................................................................................................................85

APPENDIX A. TABLES ...................................................................................................97

APPENDIX B. FIGURES ...............................................................................................232

APPENDIX C. STUDY MEASURES ............................................................................237

vi
 LIST OF TABLES

A1. Mechanical Turk Univariate Statistics ......................................................................98

A2. Student Univariate Statistics ...................................................................................100

A3. Cohen's d Statistics .................................................................................................103

A4. Correlations among ACT scales--Mechanical Turk. ..............................................105

A5. Correlations among ACT scales--Student Time 1 ..................................................108

A6. Correlations among ACT scales--Student Time 2 ..................................................111

A7. Correlations among non-ACT scales--Mechanical Turk ........................................114

A8. Correlations among non-ACT scales--Student Time 1...........................................118

A9. Correlations Among Non-ACT Scales--Student Time 2 ........................................122

A10. Correlations Among ACT and Non-ACT Scales--Mechanical Turk .....................126

A11. Correlations Among ACT and Non-ACT Scales—Student Time 1 .......................133

A12. Correlations Among ACT and Non-ACT Scales--Student Time 2. .......................140

A13. . Student T1-T2 Correlations Among ACT scales ..................................................147

A14. Table A14. Student T1-T2 Correlations Among Non-ACT Scales ........................151

A15. Parallel Analyses for Scale-Level Factor Analysis of ACT Measures ...................156

A16. Three-Factor ACT Model Promax Exploratory Factor Analysis. ..........................159

A17. Factor Correlations for Three-Factor ACT Model .................................................161

A18. Four-Factor ACT Model Promax Exploratory Factor Analysis .............................162

A19. Factor Correlations for Four-Factor ACT Model ...................................................165

A20. Item-Level Parallel Analyses for ACT Factor 1 (Fusion/Inflexibility). .................166

A21. Correlations Between Subfactor Loadings for 1st Scale-Level EFA factor ...........169

A22. Mechanical Turk Subfactors of ACT Factor 1 (Fusion/Inflexibility), Using

Promax Rotation .....................................................................................................170

A23. A23. Student Time 1 Subfactors of ACT Factor 1 (Fusion/Inflexibility),

Using Promax Rotation...........................................................................................175

A24. Student Time 2 Subfactors of ACT Factor 1 (Fusion/Inflexibility), Using

Promax Rotation. ....................................................................................................180

vii
A25. Item-Level Parallel Analyses for ACT Factor 2 (Awareness) ................................185

A26. Correlations Between Subfactor Loadings for 2nd Scale-Level EFA Factor .........188

A27. Mechanical Turk Subfactors of ACT Factor 2 (Awareness), Using Promax

Rotation...................................................................................................................189

A28. Student Time 1 Subfactors of ACT Factor 2 (Awareness), Using Promax

Rotation...................................................................................................................193

A29. Student Time 2 Subfactors of ACT Factor 2 (Awareness), Using Promax

Rotation...................................................................................................................197

A30. Item-Level Parallel Analyses for ACT Factor 3 (Avoidance) ................................201

A31. Correlations Between Subfactor Loadings for 3rd Scale-Level EFA Factor .........204
A32. Mechanical Turk Subfactors of ACT Factor 3 (Avoidance), Using Promax
Rotation...................................................................................................................205

A33. Student Time 1 Subfactors of ACT Factor 3 (Avoidance), Using Promax

Rotation...................................................................................................................208

A34. Student Time 2 Subfactors of ACT Factor 3 (Avoidance), Using Promax

Rotation...................................................................................................................211

A35. Correlations Among Subfactor Sum Scores for Mechanical Turk Sample ............214

A36. Correlations Among Subfactor Sum Scores for the Student Sample. ....................215

A37. Factor Analysis of Lower-Order Factor Sum Scores Using Promax Rotation .......217

A38. Mechanical Turk Correlations Between Subfactor Sum Scores and Other
Study Variables .......................................................................................................218

A39. Student Time 1 Correlations Between Subfactor Sum Scores and Other Study
Variables .................................................................................................................220

A40. Student Time 2 Correlations Between Subfactor Sum Scores and Other Study
Variables. ................................................................................................................222

A41. Fit Indices for Hierarchical and Correlated ACT Models ......................................224

A42. Student Correlations Between ACT Subfactors and Psychopathology

Measures Across Timepoints ..................................................................................225

A43. Mechanical Turk Partial Correlations Between ACT Subfactors and External
Measures Controlling for Subscales of the ASI, DIS, DTS, and COPE ................226

A44. . Student Time 1 Partial Correlations Between ACT Subfactors and External
Measures Controlling for Subscales of the ASI, DIS, DTS, and COPE. ...............227

A45. Student Time 2 Partial Correlations Between ACT Subfactors and External
Measures Controlling for Subscales of the ASI, DIS, DTS, and COPE ................228

viii
A46. Mechanical Turk R2 Values for Measures of Psychopathology, Personality,
and Functioning ......................................................................................................229

A47. Student Time 1 R2 Values for Measures of Psychopathology, Personality, and

Functioning .............................................................................................................230

A48. Student Time 2 R2 Values for Measures of Psychopathology, Personality, and

Functioning. ............................................................................................................231

ix
 LIST OF FIGURES

Figure

B1. The ACT Hexaflex..................................................................................................233

B2. Simple Hierarchical ACT Model ............................................................................234

B3. Hierarchical ACT Model with Cross Loadings ......................................................235

B4. Correlated ACT Model. ..........................................................................................236

x
 1

CHAPTER I.

INTRODUCTION

Acceptance and Commitment Therapy

Acceptance and Commitment Therapy (ACT) is a third wave cognitive behavioral

therapy. It distinguishes itself from other approaches to therapy by positing that

psychological distress is normative rather than a sign of abnormality, and that efforts to

control or eliminate such distress can paradoxically lead to psychological problems.

Rather than attempting to eliminate feelings of distress, ACT emphasizes achieving

psychological flexibility, or the ability to mindfully and flexibly maintain or change

behavior in order to achieve valued ends, as the primary goal of therapy (Hayes, Strosahl,

& Wilson, 2011).

The ACT model posits six relevant processes that are targets for change in

therapy. These six processes are all posited to be critical components of psychological

flexibility, and are therefore highly interconnected. This six-part model is known as the

ACT Hexaflex (Hayes et al, 2011; see Figure B1). Many objective personality

questionnaires have been created to measure these proposed ACT processes. Some of

these measures have been extensively used in both clinical and research settings. Indeed,

because the goal of ACT is to effect change in these areas, rather than to reduce

psychopathology, it has been suggested that ACT-specific measures be used in clinical

trials due to their hypothesized mediating effect on therapy outcomes (Hayes, Luoma,

Bond, Masuda, & Lillis, 2006). However, little research has been done on how these

process measures differ from each other, or from measures of similar psychological

constructs, such as distress tolerance, anxiety sensitivity, and emotion-focused coping.

 2

Acceptance Versus Experiential Avoidance

ACT proposes that willingness to experience unwanted internal experiences is an

important part of psychological flexibility. This process is conceptually related to the

concept of mindfulness, as described by practitioners of mindfulness-based stress

reduction, in that it advocates releasing one’s struggles with unwanted thoughts, feelings,

emotions, memories, and bodily sensations. Acceptance is a process in direct opposition

to experiential avoidance, or the unwillingness to remain in contact with unwanted

internal experiences.

Hayes, Wilson, Gifford, Follette, and Strosahl (1996) argue that experiential

avoidance is a key functional process in behavior problems in a way that transcends

traditional syndromal classifications of mental disorders. Most syndromes focus on the

topographical characteristics of the behavior, and offer limited etiological guidance; even

when treatments have been found to be disorder-specific, the atheoretical nature of the

DSM’s categories make theory-based improvements to treatment difficult. Conversely,

these authors argue that experiential avoidance offers a functional approach to

classification of behavior problems, allowing psychologists to tailor their treatments to

the functional process that has maintained the problem.

Experiential avoidance is a process implicated in a wide variety of psychological

disorders and behavior problems. In a study investigating vulnerability to substance use

disorders, Cooper, Russell, Skinner, Frone, and Mudar (1992) investigated a large sample

(n = 1,316) to test the hypothesis that problem drinking is an avoidant response to

feelings of distress. They found that the use of avoidant coping strategies predicted

problem drinking behaviors, particularly for men (β weights range from 0.10 to 0.18).
 3

Overall, they found that individual-specific characteristics such as the tendency to avoid

are better predictors than stressor-specific characteristics.

Experiential avoidance has also been implicated in models of self-harm behaviors

such as cutting, which are particularly prevalent in individuals with borderline personality

disorder (Chapman, Gratz, & Brown, 2006). In a study of individuals with a diagnosis of

borderline personality disorder, Chapman, Specht, and Cellucci (2005) found that, in a

study of 117 female inmates, self-harm frequency and borderline symptoms were

correlated with measures of experiential avoidance (self-harm: r = 0.15; borderline

symptoms: r = 0.53), thought suppression (self-harm: r = 0.27; borderline symptoms: r =

0.50), and avoidant coping (self-harm: r = 0.16; borderline symptoms: r = 0.45).

Additionally, individuals who engage in self-harm behaviors report an avoidant function;

in a survey of 75 individuals who engage in deliberate self-harm, 96% report that they do

so, at least in part, for emotional relief (Brown, Comtois, & Linehan, 2002). Similarly,

experiential avoidance may also be associated with full suicide attempts (Baumeister,

1990).

Anxiety disorders are also thought to be related to experiential avoidance. In a

study of panic disorder and emotional avoidance, Tull and Roemer (2007) investigated

individuals with (n = 91) and without (n = 91) a history of uncued panic attacks. They

found that individuals with a history of panic attacks scored statistically significantly

higher on measures of experiential avoidance (η2p = 0.06) and lack of emotional

acceptance (η2p = 0.04). Individuals with histories of panic attacks also reported using

more experientially avoidant strategies when assigned to watch an emotionally

distressing movie. Similarly, in a study of individuals with generalized anxiety disorder,

 4

Borkovec and Roemer (1995) examined 514 individuals to determine self-reported

functions of worrying. They found that individuals meeting DSM-III-R criteria for GAD

were more likely to report that worry would prevent undesired outcomes, would lead to

better problem solving, and served to distract them from “even more emotional things.”

These researchers suggest that the results indicate an avoidant function of worry for

individuals with GAD because such worry may suppress negative emotions and suppress

the affective consequences of stressful situations.

Finally, it has been suggested that experiential avoidance is related to the

development of depression. In a study of 109 research participants, Cribb, Moulds, and

Carter (2006) found that a measure of depression was correlated with measures of

experiential avoidance (r = 0.53), behavioral social avoidance (r = 0.50), behavioral

nonsocial avoidance (r = 0.42), cognitive social avoidance (r = 0.44), and cognitive

nonsocial avoidance (r = 0.37). They also found that a measure of rumination was highly

associated with these measures of avoidance (experiential avoidance: r = 0.62; behavioral

social avoidance: r = 0.42; behavioral nonsocial avoidance: r = 0.49; cognitive social

avoidance: r = 0.49; cognitive nonsocial avoidance: r = 0.42). These researchers argued

that depressive rumination, like generalized worry, may serve an avoidant function,

allowing depressed individuals to ruminate rather than to engage behaviors that are

potentially distressing in the short term.

In addition to these correlational studies, experimental research also suggests that

experiential avoidance is maladaptive (Hayes et al., 1996). Experimental studies of

thought suppression indicate that attempts to suppress particular thoughts have several

unintended effects. In their classic study, Wegner, Schneider, Carter, and White (1987)
 5

asked participants to either think about white bears (control group) or to suppress

thoughts about white bears for five minutes (thought suppression group); the researchers

found that the thought suppression group had more thoughts about white bears after the

five minutes were up compared with the control group, indicating a rebound effect after

individuals ended their focus on suppression. Additionally, participants can have great

difficulty maintaining suppression when placed under a cognitive load; Wegner and

Erber (1992) found that suppressed thoughts paradoxically become more accessible when

participants were asked to complete a time-pressured task or a color-word interference

task. Finally, some research suggests attempts to maintain thought suppression increase

the frequency of that thought even in the absence of a cognitive load (e.g., Lavy & Van

den Hout, 1990).

These experimental findings have been linked to clinical phenomena. For

example, Wenzlaff and Bates (1998) found that, when placed under a cognitive load,

depressed individuals produce more negative statements and fewer positive statements

compared to non-depressed individuals. In contrast with Lavy and Van den Hout’s (1990)

findings, this difference only occurred when placed under a cognitive load. The

researchers argue that these results suggest a tendency among depressed individuals to

use thought suppression in an effort to eliminate unwanted thoughts. In sum, thought

suppression has been found to relate to substance cravings, pain, trauma memories,

obsessive compulsive disorder, and depression (Wenzlaff & Wegner, 2000).

Although acceptance is a central process in Acceptance and Commitment

Therapy, it is not unique to this model. Other modern behavioral therapies, such as

Dialectical Behavior Therapy (Linehan, 1993) and Integrative Behavioral Couple

 6

Therapy (Jacobson & Christensen, 1996) also strongly emphasize the importance of

balancing acceptance with change. Additionally, many humanistic therapists also have

promoted self-acceptance and acceptance of emotional experiences as key therapeutic

processes (e.g., Greenberg & Safran, 1989; Rogers, 1955).

Studies have shown that acceptance is a key component of therapeutic change in

Acceptance and Commitment Therapy. Changes in acceptance have been found to

mediate outcomes in the treatment of workplace stress (Bond & Bunce, 2000), diabetes

management behaviors (Gregg, Callaghan, Hayes, & Glann-Lawson, 2007), smoking

cessation (Gifford et al., 2004), the reduction of prejudice (Lillis & Hayes, 2007), quality

of life in seizure patients (Lundgren, Dahl, & Hayes, 2008), weight loss (Lillis, Hayes,

Bunting, & Masuda, 2009), and in a mixed-diagnosis effectiveness study (Lappalainen et

al., 2007). These results suggest that changes in acceptance do indeed play a role in

changes in clinical outcome, and that increased acceptance at least partially drives

therapeutic change.

Measures of acceptance have been found to be associated with a variety of

clinically relevant measures. Hayes et al. (2006) conducted a meta-analysis on 32 studies,

including 6628 participants, to investigate the relations between a particular measure of

acceptance (the Acceptance and Action Questionnaire) and other measures of clinical

interest. They found that this measure of acceptance is correlated with measures of

depression (r = 0.50), anxiety (r = 0.54), general mental ill-health (r = 0.53), and the

probability of having a psychiatric disorder (r = 0.40). These results indicate that

acceptance is highly relevant when conceptualizing and treating a variety of psychiatric

problems. Additionally, in a study of its construct validity, acceptance was found to be

 7

distinct from the more established processes of reappraisal and perceived emotional

control, indicating that the process of accepting is distinct from the process of changing

one’s thoughts (Kollman, Brown, & Barlow, 2009).

Present Moment Awareness

ACT proposes that present moment awareness is an important part of

psychological flexibility, and that many therapy clients become so fixated on past or

future narratives that they pay little attention to present moment processes. Like

acceptance, present moment awareness shares some conceptual similarities with the

concept of mindfulness.

Mindfulness meditation is the practice of using focused, detached observation to

gain purposeful, present moment awareness and to prevent the mind from drifting. While

engaging in mindfulness meditation, both physical and mental experiences are noticed

without judgment or struggle, and no internal experience is afforded particular

importance over any other (Kabat-Zinn, 1982). This practice originated in the Mahayana

Buddhist Zen tradition, and was initially used by providers of Western medicine to

reduce stress (Goleman & Schwartz, 1976) and chronic pain (Kabat-Zinn, 1982).

Mindfulness-Based Stress Reduction (MBSR) has been developed as a structured

group intervention that uses principles of mindfulness to reduce stress (Kabat-Zinn,

2009); a meta-analysis by Grossman, Niemann, Schmidt, and Walach (2004) has been

found that this approach is effective in improving both mental wellbeing (e.g.,

depression, anxiety, and coping styles) and physical wellbeing (e.g., medical symptoms,

physical pain, physical impairment, and quality of life). In all, this meta-analysis found

an overall d value of 0.54 (N = 771) for controlled studies examining mental health
 8

variables and a d value of 0.53 (N = 203) for controlled studies examining physical health

variables. When examining pre-post (uncontrolled) studies, they found a d value of 0.50

(N = 894) for mental health variables and a d value of 0.42 (N = 466) for physical health

variables.

Mindfulness practice has also been used to enhance cognitive therapy for

depression, integrated into Mindfulness-Based Cognitive Therapy (MBCT). The creators

of MBCT argue that mindfulness practice can prevent relapse of depression following

cognitive therapy by giving clients additional tools to notice negative thoughts and to

bring themselves back to the present moment (Teasdale, Segal, & Williams, 1995). In a

meta-analysis of the efficacy of MBCT, Chiesa and Serretti (2011) found that the

addition of mindfulness meditation practice to standard cognitive approaches reduces the

rate of relapse in individuals suffering from depression compared with treatment as usual

(OR = 0.36, N= 326). In another meta-analysis, Piet and Houggaard (2011) similarly

found that, in a combined sample size of 593, there was a risk reduction of 43% when

using MBCT for individuals with at least three depressive episodes. This finding,

however, was not obtained for individuals with a history of one or two depressive

episodes, suggesting that MBCT is particularly useful for individuals with a more

extensive history of depression.

There is some preliminary evidence that mindfulness processes mediate treatment

outcomes in ACT interventions. Forman, Herbert, Moitra, Yeomans, and Geller (2007)

found that a measure of “acting with awareness” mediated outcomes for an ACT

intervention for depression and anxiety, whereas measures of “observing” and

“describing” mediated outcomes for Cognitive Therapy. These results suggest that
 9

mindfulness is important for both ACT and CT, but that different facets of mindfulness

might be more important for each.

Measures of mindfulness have been found to be related to external variables. In a

meta-analysis, Giluk (2009) investigated the relation between mindfulness, Big Five

personality traits, and affect. She found that mindfulness was particularly related to

neuroticism (ρ = -0.58), negative affect (ρ = -0.51), positive affect (ρ = 0.41), and

conscientiousness (ρ = 0.44), with moderate, but still significant relationships with

agreeableness (ρ = 0.30), openness (ρ = 0.20), and extraversion (ρ = 0.15). These results

indicate that levels of mindfulness are linked to clinically and functionally relevant

processes.

Defusion

The originators of ACT coined the term “defusion” to refer to the ability to

recognize an unwanted thought as an ongoing mental and verbal process. Unlike

traditional cognitive behavioral therapy, ACT does not attempt to change or to refute

unwanted thoughts; rather, the goal is to recognize the thought as an example of mental

language that has no intrinsic truth or falsity, and that may be observed without being

taken literally. Thus, an individual becomes “fused” with a thought if he or she believes

that it is a literal representation of the world; in ACT, the therapeutic goal is therefore to

reduce the believability of unhelpful thoughts, rather than to reduce the frequency or to

change the content.

Fusion/defusion has been found to be a mediator of change in some ACT studies.

For example, the believability (but not the frequency) of depressive thoughts was found

to mediate outcome for ACT, but not for CBT, in a study of depressed patients (Zettle &
 10

Hayes, 1986; reanalyzed by Hayes et al., 2006). Similarly Varra, Hayes, Roget, and

Fisher (2008) found that an ACT intervention to effect behavior change in substance

abuse counselors was mediated by believability of barriers. Similarly, Hayes, Bissett et

al. (2004) found that believability of thoughts mediated an ACT intervention targeting

stigma and burnout in counselors. Finally, Guadiano and Herbert (2006) found that, when

providing an ACT intervention to patients with psychosis, hallucination believability,

rather than frequency, mediated outcomes. These studies suggest that change in

believability of thoughts, rather than change in frequency or content, play an important

role in mediating the outcomes of ACT interventions.

Little research currently exists investigating the relation between cognitive fusion

and measures of psychopathology and functioning. However, Gillanders et al. (2013)

found that a measure of cognitive fusion was correlated with the Beck Depression

Inventory (r = 0.69), the Center for Epidemiological Studies Depression Scale (r = 0.85),

the Symptom Checklist 90 General Severity Index (r = 0.62), and the WHO Brief Quality

of Life Scale (r = -0.45). These results are preliminary, but suggest that cognitive fusion

is related to measures of distress and function.

Self-as-Context

ACT emphasizes the ability to flexibly change perspectives, forming a sense of

self that goes beyond one’s familiar thoughts, feelings, emotions, and memories.

Becoming aware of the “I” that observes such mental experiences, rather than defining

oneself in terms of them, is an important clinical goal. This self is the self-as-context, or

the observing self. Because this observing self exists independently from mental content,

it is constant and unchanging. Because it is the observer rather than the observed, self-as-
 11

context “is difficult to describe or contact verbally…it cannot be experienced as an object

because describing it would necessitate adopting a perspective on it that was not one’s

own perspective, which is impossible” (Stewart, Villatte, & McHugh, 2012).

ACT interventions attempt to strengthen this sense of self through the use of

experiential exercises. For example, Harris (2008) uses a series of mindfulness exercises

to distinguish self-as-context from ongoing experiences (e.g., “notice what you’re

thinking…[then] be aware that you’re noticing them.”). Metaphors can also be used to

make self-as-context more accessible to the client. For examples, Hayes et al. (2012) uses

a “chessboard metaphor” to illustrate facets of self, in which thoughts, feelings emotions,

and memories are the pieces fighting one another on the chessboard, whereas the noticing

self is the board itself.

Although few ACT studies examine self-as-context directly, at least one study

suggests that ACT interventions that include self-as-context exercises such as those

described above outperform ACT interventions that do not include such exercises

(Williams, 2006). There are currently no measures explicitly designed to assess patients’

abilities to take a self-as-context perspective. In addition, compared with other ACT

processes, there is little research on self-as-context.

Values

ACT emphasizes helping clients move towards valued areas of life. “Values,” in

ACT terms, refer to verbally constructed, freely chosen life domains, such as family,

friendship, work, leisure, and education that clients find personally meaningful.

Identifying a client’s values is an important part of the ACT therapeutic process.

 12

Within an ACT framework, interventions designed to enhance clients’ contact

with values have been found to have positive clinical effects. For example, ACT values

interventions have been found to be effective in increasing pain tolerance. Páez-Blarrina

et al (2008) divided 30 participants into three conditions: the first group received an

ACT-consistent values intervention, the second group received an intervention that

emphasized the importance of avoiding pain, and the third received no intervention.

These researchers found that seven of ten participants in the values group could tolerate

maximum pain, whereas only one of ten participants in the avoidance intervention group

and two of ten in the control group could do the same. Similarly, in a study of 171 pain

patients, Vowles and McCracken (2008) investigated the efficacy of values interventions

for chronic pain. They found that changes in values-based action during follow-up is

correlated with changes in pain intensity (r = -0.30), depression (r = -0.41), physical

disability (r = -0.39), and psychosocial disability (r = -0.40).

Additionally, values articulation exercises have been found to have a variety of

positive effects. In a study of 243 African American and Caucasian middle school

students, Cohen, Garcia, Apfel, and Master (2006) investigated the use of an exercise to

elicit values from students. They found that minority students who were prompted to

articulate their values had better academic performance compared with minority students

who wrote about and articulated values that they did not rate highly. In a similar study,

Miyake et al. (2010) investigated a values clarification intervention in 399 undergraduate

physics students. They found a narrowed gender gap for students who received the

intervention, and that female students who received the intervention increased from a C

average in the class to a B average.

 13

In another study of values affirmation exercises, Logel and Cohen (2012)

conducted a study on 26 overweight and 19 normal weight individuals who expressed

dissatisfaction with their weight. Half participated in a values affirmation exercise, in

which they wrote about personally-relevant values unrelated to weight loss. Control

participants wrote about values that they did not rate highly. Individuals who participated

in this exercise lost significantly more weight (d = 0.90) at 2.5 month follow-up

compared with participants in the control condition.

Cresswell et al. (2005) studied the effect of values affirmation exercises on stress

responses in 85 research participants. Participants were asked to write about either an

important or an unimportant value to them. Participants were then exposed to a stressful

situation by being asked to give a speech. It was found that individuals in the active

condition had significantly lower levels of cortisol (η2 = 0.07) compared with participants

in the control condition. This study suggests that physiological stress markers can be

reduced with a values articulation exercise.

Finally, Lomore, Spencer, and Holmes (2007) investigated the effects of a values

exercise on romantic relationships. In their study on 45 partnered women, they found

that, among the participants with low self-esteem, an intervention clarifying shared

values with one’s partner increased feelings of love and regard for one’s partner. Values

interventions may therefore be useful in couple interventions.

An emphasis on values is not unique to ACT. The existential therapist Viktor

Frankl strongly emphasized “meaning,” or purpose, in his psychotherapeutic approach.

Frankl’s logotherapy implicates existential anxiety, or lack of meaning, as a major cause

of neurotic disorders, and suggests that filling the client’s existential vacuum, helping
 14

him or her find meaning, is an important part of treatment (Frankl, 1985). Frankl’s

emphasis on searching for personal, individualized meaning is comparable to ACT’s

emphasis on valuing (Sharp, Schulenberg, Wilson, & Murrell, 2004). Likewise, Carl

Rogers suggested that choosing one’s personal values freely, rather than valuing due to

the influence of others, is the mark of a psychologically “mature” individual (Rogers,

1964). This emphasis on freely chosen values closely mirrors ACT’s conceptualization.

Motivational Interviewing also makes use of valuing by using a client’s individual values

to foster motivation and behavior change (Hettema, Steele, & Miller, 2005). Finally, in

addition to ACT, other modern CBT approaches have emphasized the importance of

values. Some Behavioral Activation (BA) protocols, for instance, share with ACT an

emphasis on values, using values assessment to create and guide activation assignments

in depressed individuals (Kanter et al., 2010).

Preliminary investigation of a measure of valued living indicates that valued

living is negatively correlated with measures of experiential avoidance (r = -0.14),

depression (r = -0.26), anxiety (r = -0.14), hostility (r = -0.20), and somatization (-0.19);

it is positively correlated with measures of functioning (r = 0.13) and mental health (r =

0.23) (Wilson, Sandoz, Kitchens, & Roberts, 2010). Similarly, a study of individuals with

chronic pain showed that measures of values discrepancies and values success were

significantly correlated with measures of pain-related depression (success: r = -0.45;

discrepancy: r = 0.38), anxiety (success: r = -0.29; discrepancy: r = 0.33), physical

disability (success: r = -0.30; discrepancy: r = 0.26), and psychosocial disability (success:

r = -0.47; discrepancy: r = 0.39) (McCracken & Yang, 2006).

 15

Committed Action

The ultimate goal of ACT is to help clients take value-directed actions.

Committed Action refers to the client’s ability to commit to valued change and to take

actions towards it. The other ACT processes, such as acceptance and mindfulness, serve

to help them maintain this movement when mental barriers, such as anxiety, arise.

Committed Action interventions borrow heavily from traditional behavior therapy

approaches such as exposure and behavioral activation, as ACT encourages values-based,

non-avoidant action by fostering greater acceptance, defusion, and mindfulness. Hayes et

al. (2013) argue that, although studies have shown that ACT interventions that do not

include behavioral activation or exposure interventions do show some efficacy (e.g.,

Twohig, Hayes, & Masuda, 2006; Twohig et al., 2010), such an approach tends to “peel

ACT away from its own model.” Rather, they argue that comparisons between standard

behavioral interventions and full ACT interventions provide a more useful comparison.

For instance, researchers have found a greater tendency for individuals to

behaviorally engage in a fear-inducing situation if they had been trained in acceptance

and mindfulness techniques rather than in relaxation techniques. For example, in a study

of 60 individuals with panic disorder, Levitt, Brown, Orsillo, and Barlow (2004) divided

participants into three groups; the first group received a brief ACT-based intervention,

the second group received an intervention encouraging them to try to gain control over

uncomfortable feelings by changing their thoughts, and the third group received no

intervention. All participants then participated in a CO2 breathing challenge in order to

induce panic-like symptoms. Participants who received the brief ACT intervention

reported less subjective distress when controlling for resting levels of distress (ƒ2 = 0.16)
 16

and a greater willingness to engage in another, similar task (η2 = 0.12). In a very similar

study, Eifert and Heffner (2003) investigated a sample of 60 participants with high levels

of anxiety sensitivity. One third of the participants were given instruction on mindfulness

and willingness, one third received instruction in relaxation and controlled breathing, and

one third received no clinical intervention. All were then given a series of CO2 breathing

tasks. It was found that the participants who received the ACT-consistent intervention

began each CO2 breathing task more quickly compared with the other groups (η2 = 0.26)

and were more likely to return for additional sessions (η2 = 0.20). These results indicate

greater behavioral engagement for individuals who received ACT interventions,

indicating that other ACT-relevant processes are important in fostering non-avoidant

coping and committed action.

Potentially Related Constructs and Measures

In addition to the processes discussed above, a number of psychological

constructs have been proposed that relate to how individuals respond or react to their

suffering. Because ACT emphasizes changing one’s response to suffering, rather than the

suffering itself, these constructs may be related to the ACT Hexaflex processes, although

they do not come from the ACT tradition.

Anxiety Sensitivity

Anxiety Sensitivity refers to an individual’s belief that anxiety has negative

consequences (Reiss, Peterson, Gursky, and McNally, 1986). This “fear of fear” was

proposed to be important to the development of panic disorder and other anxiety

disorders. Because this construct focuses on an individual’s beliefs about his or her

symptoms, it may be hypothesized that it relates to the ACT process of cognitive

 17

defusion, which broadly has to do with individuals’ interpretation of unwanted mental

experiences. On the other hand, anxiety sensitivity may be a narrower construct than

defusion, as it focuses entirely on fear processes.

In a meta-analysis, Naragon-Gainey (2010) found that anxiety sensitivity is most

strongly related to Panic Disorder (ρ = 0.60), Generalized Anxiety Disorder (ρ = 0.58),

and Posttraumatic Stress Disorder (ρ = 0.54), and is also highly related to other

internalizing disorders, such as Social Phobia (ρ = 0.49), Obsessive Compulsive Disorder

(ρ = 0.49), Depression (ρ = 0.46), Agoraphobia (ρ = 0.45), and Specific Phobia (ρ =

0.40). This researcher also found that anxiety sensitivity has incremental validity in

predicting most of these disorders (with the exception of OCD) above and beyond the

predictive power of trait neuroticism. Anxiety sensitivity may therefore be an important

contributor to the comorbidity between these internalizing disorders, as well as an

important risk factor for the development of these disorders. Furthermore, anxiety

sensitivity can be reduced via cognitive behavioral therapy (Smits, Berry, Tart, &

Powers, 2008), suggesting the possibility that the reduction of anxiety sensitivity may

mediate the treatment of these disorders.

Distress Tolerance

Distress Tolerance refers to one’s ability to tolerate negative emotional states;

Simons and Gaher (2005) suggest that this construct includes the ability to tolerate

aversiveness, inability to accept distress, avoidant behaviors in response to distress, and

inability to mentally disengage from feelings of distress. This construct appears to have

commonalities with the ACT process of acceptance, as both relate to one’s ability to

function while experiencing unwanted emotional and mental experiences. However, it

 18

may be argued (e.g., Wilson & Dufrene, 2010) that acceptance involves a more open,

willing stance compared with distress tolerance.

It has been found that intolerance of distress is a risk factor or a maintenance

factor for a various symptoms of psychopathology because such an intolerance would

cause individuals to use avoidant, maladaptive coping strategies to reduce feelings of

distress (Leyro, Zvolensky, & Bernstein, 2010). Distress tolerance has been found to be

an important process in the ability of individuals with substance use disorders to abstain,

as sobriety in this population requires an ability to tolerate feelings of distress. For

instance, in a study of 89 individuals with a history of drug use, Daughters, Lejuez,

Kahler, Strong, and Brown (2005) found a correlation of 0.27 between abstinence

duration and the ability to sit for a lengthy and stressful computer task.

Additionally, Linehan’s (1993) model of borderline personality disorder

hypothesizes that low distress tolerance is key to the development of this disorder, as it

has been found that individuals with a diagnosis of borderline exhibit lower levels of

distress tolerance compared to the general population. In a study comparing individuals

with a diagnosis of borderline (n = 17) with normal controls (n = 18), Gratz, Rosenthal,

Tull, Lejuez, and Gunderson (2006) found that, when asked to complete a stressful

computer-based task, individuals with a borderline diagnosis were significantly more

likely to terminate the task early (24% versus 0%), and were less likely to report a

willingness to engage in another, similar task (59% versus 89%). They also spent

significantly less time on the task before terminating (ηp2 = 0.14).

The enhancement of distress tolerance is a key goal of many therapies. Dialectical

Behavior Therapy (Linehan, 1993) identifies increasing distress tolerance as an important

 19

part of treatment. Additionally, it has been suggested (e.g., Leyro et al., 2010) that many

other third wave behavioral treatments, including ACT, Mindfulness-Based Cognitive

Therapy, Functional Analytic Psychotherapy, and Integrative Behavioral Couple

Therapy, directly or indirectly target distress tolerance.

Discomfort Intolerance

Discomfort Intolerance refers to one’s ability to tolerate uncomfortable bodily

sensations; the originators of this construct hypothesize that it is relevant to the

development of panic disorder, other anxiety disorders, and psychosomatic problems

(Schmidt, Richey, & Fitzpatrick, 2006). This intolerance of unpleasant physical

sensations may be related to defusion, as both constructs relate to one’s interpretation of

unwanted internal events.

Discomfort intolerance is thought to be particularly related to panic disorder.

Schmidt et al. (2006) found that individuals with a diagnosis of panic disorder had higher

levels of discomfort intolerance compared with both normal and anxious controls. The

authors hypothesize that intolerance of physical discomfort leads to interoceptive

avoidance and to a fear of the physical sensations of fear. These authors also found that

nonclinical individuals reporting higher levels of distress intolerance (n = 44) were more

reactive and reported more symptoms of panic in a high CO2 environment after

controlling for baseline levels of anxiety (SUDs: R2 = 0.10; Agoraphobic Cognitions: R2

= 0.14) (Schmidt, Richey, Cromer, & Buckner, 2007). Discomfort intolerance may also

be related to substance use. In a study of 265 participants, Buckner, Keough, and Schmidt

(2007) found that discomfort intolerance moderates the relationship between depression
 20

and substance coping, with depressed individuals with high discomfort intolerance being

more likely to have substance-related problems (β = -0.15).

Coping Styles

Coping styles refer to strategies used by individuals when responding to stress.

The exact number of coping strategies that are available tend to be measure specific. For

example, some research has divided coping into two broad categories: problem-focused

coping, which focuses on changing the environment, and emotion-focused coping, which

focus on regulating or avoiding stressful emotions (e.g., Folkman & Lazarus, 1980).

Other studies posit a larger variety of more narrowly defined coping styles; for example,

Folkman, Lazarus, Gruen, and DeLongis (1986) measure eight coping styles, consisting

of confrontive coping, distancing, self-controlling, seeking social support, accepting

responsibility, escape-avoidance, planful problem solving, and positive reappraisal.

A great deal of research exists on the correlates of different coping strategies. In a

meta-analysis examining the relations between coping styles and the Big Five personality

traits, Connor-Smith and Flachsbart (2007) found that active, engaged coping is weakly

correlated with extraversion (r = 0.15) and openness (r = 0.10), whereas avoidant,

disengaged coping is correlated with neuroticism (r = 0.27) and agreeableness (r = -

0.13). Conscientiousness was associated with both engaged (r = 0.11) and disengaged (r

= -0.15) coping.

Research shows that maladaptive coping styles are also related to measures of

psychopathology. In a meta-analysis, Aldao, Nolen-Hoeksema, and Schweizer (2010)

found that overall psychopathology was associated with rumination (r = 0.49), avoidance

(r = 0.38), suppression (r = 0.34), problem solving (r = -0.31), and reappraisal (r = -0.14).

 21

These results were found across a variety of specific psychopathologies. For example,

avoidant coping was correlated with anxiety (r = 0.37), depression (r = 0.48), eating

disorders (r = 0.18), and substance use disorders (r = 0.26), whereas rumination was

correlated with anxiety (r = 0.42), depression (r = 0.55), eating disorders (r = 0.26), and

substance use disorders (r = 0.21). In a follow-up study, these researchers (Aldao &

Nolen-Hoeksema, 2012) assessed coping in a sample of 1,317 research participants, and

re-assessed them at a one-year follow-up (n = 1,132). They found that maladaptive

coping strategies during Time 1 significantly predicted a psychopathology composite at

Time 2 (r = 0.41). Maladaptive coping strategies remained a significant predictor of Time

2 psychopathology even when accounting for Time 1 psychopathology (β = 0.10).

Overall, these studies demonstrate that coping styles are significantly related to

psychopathology, and may have causal predictive power.

In another meta-analysis examining the effectiveness of avoidant and non-

avoidant coping, Suls and Fletcher (1985) found important differences between short-

term and long-term outcomes. Avoidant coping tended to be more effective for short-

term outcomes, whereas non-avoidant coping tended to be more effective in the long

term. When non-avoidant coping was broken down into sensory monitoring versus

emotional monitoring, sensory monitoring was clearly superior to avoidance. These

results are consistent with ACT theory, which indicates that avoidance works in the short

term but is ineffective in the long term, and posits a difference between mindfulness

(similar to this study’s sensory monitoring) and emotional rumination.

 22

General Discussion of Study-Relevant Constructs and

Processes

In general, limited research has been done examining the relations among many

of the aforementioned processes. Although some of the non-ACT related processes (e.g.,

distress tolerance and anxiety sensitivity) have a good deal of research examining

specificity and incremental validity, most measures of ACT processes have almost no

such research.

Gloster, Klotsche, Chaker, Hummel, and Hoyer (2011) tested whether a measure

of acceptance/experiential avoidance has incremental power over measures of depression,

anxiety sensitivity, and neuroticism in explaining measures of functioning and

impairment. Across four samples (total n = 1167), they found that the acceptance did

indeed explain unique variance in impairment and functioning above and beyond the

other measures, with ΔR2 values ranging from 0.024 to 0.108. These results suggest that

acceptance/avoidance might help to explain some kinds of dysfunction above and beyond

other, more established measures.

Conversely, Wheaton, Berman, and Abramowitz (2010) administered measures of

acceptance/experiential avoidance and anxiety sensitivity to a sample of 636 research

participants in order to determine whether these process measures are associated with a

measure of health anxiety. They found that health anxiety is correlated with both

experiential avoidance (r = -0.28) and facets of anxiety sensitivity (physical anxiety

sensitivity: r = 0.45; social anxiety sensitivity: 0.32; cognitive anxiety sensitivity: r =

0.25). However, the experiential avoidance measure added no statistically significant

explanatory power after accounting for anxiety sensitivity (ΔR2 = 0.02; P > 0.05).
 23

Conversely, anxiety sensitivity had significant explanatory power after accounting for

experiential avoidance (ΔR2 = 0.16). These researchers suggest that these results provide

evidence for the role of maladaptive beliefs, rather than experiential avoidance, in the

development of health anxiety.

Most published ACT measures are at least somewhat related to each other; of

particular note, Gillanders et al. (2013) found that their Cognitive Fusion Questionnaire

(CFQ), a measure of defusion, had a correlation of 0.80 with the Acceptance and Action

Questionnaire-II (AAQ-II), a measure of experiential avoidance. The authors suggested

that this may be due either to item overlap or to the fact that both questionnaires are

meant to measure different facets of psychological flexibility. These results suggest that

some of the processes under discussion may be difficult to differentiate using self-report

questionnaires.

Patients and research participants may also have a difficult time in practice

distinguishing between measures of avoidance and measures of distress. In a study of 385

healthy research participants and 288 psychiatric outpatients, Gámez, Kotov, and Watson

(2010) found that participants make no distinction between avoidance and distress, even

when being interviewed. Correlations between self-reported distress and avoidance were

0.79 for healthy participants and 0.91 for outpatients, and did not significantly differ from

1.0. They also found that symptoms of avoidance had no incremental value in explaining

psychopathology after accounting for self-reported distress. These results suggest that

measures of avoidance will likely have a great deal of overlap with measures of distress,

and that they may be difficult to differentiate.

 24

McCracken and Keogh (2009) conducted a study on 125 pain patients to

investigate the relation between anxiety sensitivity, emotional distress, dysfunction, and

the ACT processes of acceptance, mindfulness, and values. They found that, after

accounting for pain, anxiety sensitivity was a significantly associated with depression

(ΔR2 = 0.33), pain-related anxiety (ΔR2 = 0.26), physical disability (ΔR2 = 0.13),

psychosocial disability (ΔR2 = 0.34), and number of doctor visits (ΔR2 = 0.14). In a

second regression analysis, these researchers first added pain, then measures of ACT-

related processes (acceptance, mindfulness, and values), followed by anxiety sensitivity.

The ACT-related measures added significant explanatory value over pain intensity

(depression: ΔR2 = 0.51; pain-related anxiety: ΔR2 = 0.45; physical disability: ΔR2 =

0.23; psychosocial disability: ΔR2 = 0.49; doctor visits: ΔR2 = 0.13). After accounting for

the ACT measures, anxiety sensitivity was no longer significantly associated with

physical disability, but had a small incremental value for the other variables (depression:

ΔR2 = 0.05; anxiety: ΔR2 = 0.04; psychosocial disability: ΔR2 = 0.05; doctor visits: ΔR2 =

0.08). These results indicate significant overlap in the explanatory power of these

processes.

Similarly, Karekla and Panayiotou (2011) tested whether a measure of

acceptance/experiential avoidance has incremental power over the subscales of the brief

COPE (Carver, 1997), a measure of coping styles, in explaining psychological distress

and wellbeing. Using a sample of 197 research participants, these researchers conducted

an exploratory factor analysis of the items from the AAQ-II and the COPE. They found

that most of the AAQ-II items loaded with the COPE items measuring maladaptive

coping, indicating that these two processes may not be distinguishable. They found,
 25

however, that experiential avoidance did provide some significant incremental value

when explaining measures of perceived stress (ΔR2 = 0.11), physical quality of life (ΔR2

= 0.07), psychological quality of life (ΔR2 = 0.18), social quality of life (ΔR2 = 0.14), and

environmental quality of life (ΔR2 = 0.11), indicating that, while experiential avoidance

is highly related to maladaptive coping, it may offer some incremental value.

The relation between anxiety sensitivity and psychopathology may be moderated

by ACT-relevant processes. In a study of 248 research participants, Vujanovic,

Zvolensky, Bernstein, Feldner, and McLeish (2007) found that anxiety sensitivity is

strongly associated with a variety of external variables; some of these relationships were

moderated by a measure of mindfulness (anxious arousal: β = -0.64; agoraphobic

cognitions: β = -0.61). Significant moderating effects were not found for anhedonic

depression or for body vigilance. These results indicate that low levels of mindfulness

strengthen the relationship between anxiety sensitivity and certain measures of

psychopathology. In a follow-up study using the same sample, Kashdan, Zvolensky, and

McLeish (2008) investigated the relationship between anxiety sensitivity and a measure

of emotional non-acceptance. They found that non-acceptance moderated the

relationships between anxiety sensitivity and anxious arousal (β = 0.19) and worry (β =

0.13), but not for agoraphobic cognitions. These researchers suggest that mindfulness and

emotional acceptance may have a partial inoculation effect for individuals with high

anxiety sensitivity.

The relationship between discomfort intolerance and anxiety sensitivity has also

been investigated. Schmidt et al. (2007) found that, in a study of 44 research participants,

discomfort intolerance provides incremental value in explaining fear in a lab-based task

 26

after taking anxiety sensitivity into account (β = 0.39). Similarly, in a study of 216

participants, Bonn-Miller, Zvolensky, and Bernstein (2009) found that discomfort

intolerance has small but statistically significant incremental value over anxiety

sensitivity (β = 0.15) in explaining SUDs and physical panic in a fear-inducing lab-based

task. However, a follow-up study of the same sample (Kutz, Marshall, Bernstein, &

Zvolensky, 2010) found that neither discomfort intolerance nor distress tolerance had

incremental power over anxiety sensitivity in explaining symptoms of panic. These

studies show mixed results in their investigations of the utility of discomfort intolerance

over anxiety sensitivity as a risk factor for panic.

In another study, Bernstein, Zvolensky, Vujanovic, and Moos (2009) conducted

an item level exploratory factor analysis on measures of distress tolerance, discomfort

intolerance, and anxiety sensitivity (n = 229). They found a three-factor model emerged,

indicating that these three processes are distinguishable. Anxiety sensitivity and distress

tolerance were found to be related to each other as lower-order factors of a single, higher-

order tolerance/sensitivity factor. They did not find that discomfort intolerance was

highly related to this construct. A measure of negative affectivity was highly related to

this higher-order factor (r = -0.47) as well as to the lower-order distress tolerance factor (r

= -0.43) and anxiety sensitivity factor (r = 0.37). It was not significantly correlated with

the discomfort intolerance factor. Overall, these results suggest that anxiety sensitivity

and distress tolerance may not represent entirely distinct processes.

In another study, Keough, Riccardi, Timpano, Mitchell, and Schmidt (2010)

examined the relationship between anxiety symptoms, anxiety sensitivity, and distress

tolerance in a sample of 418 participants. They found that distress tolerance had small but
 27

significant incremental power above and beyond anxiety sensitivity when explaining

symptoms of OCD (β = -0.11), panic (β = -0.11), worry (β = -0.31), and social anxiety (β

= -0.15). In a similar study, Timpano, Buckner, Richey, Murphy, and Schmidt (2009)

examined the relationship between anxiety sensitivity, distress tolerance, and hoarding in

three samples (total n = 745). All were interrelated, but distress tolerance seemed to play

a less important role in hoarding in individuals with low anxiety sensitivity, but increases

vulnerability to hoarding in individuals with high anxiety sensitivity (interaction β = -

0.16), indicating that low distress tolerance is associated with hoarding only when anxiety

sensitivity is high and that the interpretation of anxiety symptoms as dangerous is

important to the development of hoarding behaviors. These results further suggest that

anxiety sensitivity and distress tolerance and distinguishable, despite being highly related.

Psychometrics and Functional Contextualism

The creation and study of ACT-specific questionnaire measures has been

hampered by the different philosophies of science that are said to underlie ACT and

psychometric theory; in particular, it has been argued that psychometric theory is

ultimately a mechanistic approach to understanding human behavior, whereas ACT is a

functional contextualist approach (Hayes, Barnes-Holmes, & Wilson, 2012). In order to

be able to agree upon the interpretation of ACT measures, a discussion of this

philosophical difference is necessary.

Stephen Pepper has suggested that science is rooted in one of several world

hypotheses or world views, which guide scientific research and scientific development

(Pepper, 1942; Hayes, Hayes, & Reese, 1988). These world views are implicit in any

scientific investigation, although they are rarely mentioned or explicitly considered.

 28

Pepper discussed several world hypotheses that commonly guide science; for the

purposes of this discussion, the two most important are mechanism and contextualism.

Each of these can be said that be guided by a “root metaphor” that guides our

understanding of the world (Hayes et al., 1988).

Mechanism’s root metaphor is the machine. A scientist guided by a mechanistic

world view seeks to describe a phenomenon of interest by investigating how the

relationships between its parts contribute to a unified whole. Although the parts may

interact, these interactions do not change the nature of the parts. Mechanists strive to

create models of a phenomenon of interest, and much of their work involves testing and

refining these models based on how well they correspond with reality. A mechanistic

scientific theory is “true” if this correspondence continues to exist as new facts emerge in

the world. Mechanistic theories are therefore evaluated using an ontological framework.

A mechanistic theory’s truth criterion is ontological; a theory is said to be “true” if it

accurately models or represents reality.

In psychology, mechanistic theories are used to model psychological constructs.

Although most psychologists do not explicitly discuss or consider the philosophy of

science underlying their work, much of psychological research is mechanistic. Biglan and

Hayes (1996) discuss a number of areas of psychological research that has an underlying

mechanistic framework. For example, they use Bandura’s (1977) self-efficacy theory as a

representative mechanistic psychological theory. Self-efficacy theory suggests that

changes in self-efficacy underlie individual differences in treatment outcomes, and it has

in fact been found that responses to self-efficacy measures predict the effects of various

treatments. Biglan and Hayes (1996) argue, however, that the theory is poorly suited to
 29

guide the creation of new treatments, and is therefore mechanistic, descriptive, and

ontological.

Contextualism’s root metaphor is the ongoing act in context. A scientist guided by

a functionalist perspective seeks to understand processes by understanding past and

present contextual factors. Contextualists strive to create models that are functional, and

that allow them to predict or influence the phenomena under investigation. A

contextualist theory is “true” if it is functionally useful in this way. For this reason,

contextualism is an a-ontological philosophy of science.

An example of a contextual theory is Isaac Newton’s theory of universal

gravitation. Newton did not hypothesize that gravity is a hypothetical construct that

mechanistically “exists;” rather, he sought to model how physical bodies influence each

other in order to be able to predict the motion of planets and other heavenly bodies. From

an ontological, mechanistic perspective, Newton’s theory was false, as Einstein later

proved with his theory of relativity. From an a-ontological, contextualist perspective,

Newton’s theory was true, as it functionally allowed the scientists of the day to predict

the movement of heavenly bodies. Newton’s theory can be contrasted with the

mechanistic theories of Ptolemy and Copernicus, which were purely descriptive, rather

than predictive.

Biglan and Hayes (1996) suggest that behavior analysis is an example of a

contextual psychological theory. Behavior analysis is ultimately the study of how

contextual factors—particularly histories of reinforcement and punishment—influence

behavior. This theory’s goal is not to model psychological constructs, but to better
 30

understand how to predict and influence behavior. Acceptance and Commitment Therapy

has grown out of this older behavior analytic tradition (Hayes et al., 2011).

The originators of ACT argue that classic psychometric test theory assumes the

ontological existence of the latent variable being measured. For example, Hayes et al.

(2012) cite the work of Borsboom, Mellenbergh, and van Heerden (2003), who argue that

the use and measurement of latent variables is difficult to justify without an ontological

philosophical approach. Borsboom et al. (2003) offer three possible ways to interpret a

latent variable. The first is to interpret such a variable as being a “numerical trick,”

essentially a sum score that has no larger reality and that is merely a simple way to

simplify data. The authors reject this interpretation because it requires the assumption

that different item sets cannot measure the same latent variable, rendering psychological

tests ungeneralizable. The authors’ second approach is to treat latent variables as human

constructions; in this view, latent variables are essentially a fiction with no independent

existence other than our perception. They object to this interpretation as well, arguing

that, if there is no independent truth to a theory, any conclusion drawn from a latent

variable must be as true as any other, and that therefore no hypothesis can be falsified.

They therefore argue for a “realist” perspective, which assumes both that the underlying

latent variable is a real construct and that our measure of the latent variable is an

imperfect measure of a real phenomenon.

It may be, however, that hypothetical constructs do not necessitate the existence

of a thing or an entity. MacCorquodale and Meehl (1948) define a hypothetical construct

as a variable hypothesizing the existence of “an entity, process, or event which is not

itself observed.” These hypothetical constructs are distinguished from abstractive

 31

constructs, or intervening variables, which “merely abstract the empirical relationships

[between variables]…[which] have no factual content surplus to the empirical functions

they serve to summarize.” These definitions would seem to suggest that a test or measure

could be indirectly assessing a process or event rather than an entity, and that this process

or event could still be considered a hypothetical construct (rather than an intervening

variable) if that process encompasses more examples than the test itself.

Hayes et al. (2012) suggest that some psychometric tests can be understood using

a functional contextualist framework; for example, a measure with high internal

consistency suggests that the different behaviors are under the same contextual control.

These authors take as examples two items: “I feel sad” and “I withdraw from people.”

From a contextualist perspective, these two behaviors correlate not because of the

existence of an underlying hypothetical construct (depression) but because they are under

the same contextual control (perhaps a combination of history, genetic vulnerability, and

current life circumstances). If, due to therapy, these contextual controls weaken, the

correlation between these two test items might decrease, causing a drop in coefficient

alpha.

This formulation by itself, however, provides little guidance in the interpretation

of why these particular processes are contextually related, and why they co-vary across

individuals in a predictable manner. The answers to such questions would seem to be

functionally important. Using the MacCorquodale and Meehl (1948) formulation

described above, it seems clear that depression is a hypothetical construct rather than an

intervening variable, as some portion of it exists beyond the processes directly measured

by the questionnaire (e.g., other, unassessed behaviors, biological processes, etiological

 32

factors, etc.). The contextual factors that cause individual differences in depression are

part of this construct, even if they are not directly measured. A hypothetical construct, in

functional contextualist terms, could then be said to be both a series of processes or

events and the contextual or etiological factors that link them, and not necessarily a thing

or entity. Referring to the construct of “depression” is therefore useful and consistent

with the principles of contextualism, as it allows us to model these shared contextual

relationships. The “construct” therefore represents real-life relationships between

processes, and is not a human invention. A measure of internal consistency would

therefore be interpreted as the extent to which the behaviors sampled by a questionnaire

measure share common contextual factors at that moment.

Throughout this paper, standard psychometric approaches will be used, and

language that is typically used in a mechanistic manner (e.g., “psychological constructs”)

may be used. It should be understood that such approaches and terms are used for the

sake of function, and that the scales and dimensions under discussion should best be

understood as processes sharing contextual factors, rather than as entities or objects.

Rationale for Current Study

Many of the aforementioned processes and constructs have been found to be

highly related to each other. However, no study has yet tried to create a full structural

model of ACT-related constructs. In the proposed study, a large number of questionnaires

investigating these processes were administered in order to investigate the structure of

these ACT constructs. This allowed the investigation into whether these constructs are

distinguishable from one another, whether the actual factor structure corresponds with the

Hexaflex model described above, and whether a hierarchical structure exists for these
 33

constructs. The relationships among these constructs, and the relationships between these

constructs and measures of psychopathology, personality, and functioning, were also

investigated.

Further, some research exists that investigates the differential relationships

between some of the aforementioned processes and other variables, such as

psychopathology and functioning. However, no comprehensive study exists that includes

all such processes in determining whether these measures have differential specificity or

incremental validity over and above such constructs as anxiety sensitivity, distress

tolerance, discomfort intolerance, or coping styles. The current study investigated the

incremental value of the ACT process measures under investigation. This research will

have treatment implications, as it is important to know which therapeutic process is most

related to each type of problem or concern.

The results of this research will be valuable in both clinical and research settings

for a number of reasons. First, it will help with scale selection. Clinicians and researchers

often have limited time to administer assessment measures; it is likely, given the state of

the literature, that psychologists are administering multiple ACT-relevant instruments

that are essentially measuring the same process, while ignoring other measures that may

sample relevant behaviors and processes. The current study’s findings will provide

guidance for instrument selection in such situations. Second, it will provide important

information for future scale development. The development of new instruments in these

domains has been hampered by imprecise knowledge of the exact nature of the processes

and constructs underlying these measures. For this reason, it is probable that new process

measures have been developed that have essentially duplicated previous measures. An
 34

instrument or set of instruments that fully samples all ACT-relevant processes may be

developed based on the structure uncovered in this research. Finally, this research may

assist clinicians in selecting ACT-relevant measures that are most related to the processes

under consideration.

Specific Aims of Study

Specific Aim 1. I aimed to find the overall structure of the questionnaire measures

that purport to measure the processes and constructs discussed above. I hypothesized that

the scales and subscales measuring ACT processes will be part of a hierarchical structure,

with a higher-order psychological flexibility factor and lower-order factors consisting of

acceptance vs. avoidance, values, committed action, defusion, and present moment

awareness. This hypothesis was consistent with the ACT model proposed by Hayes et al.

(2011). I also hypothesized that values and committed action may not separate into

distinct factors due to the small number of scales available to model these processes.

Specific Aim 2. I also aimed to determine whether the scales under consideration

have differential relationships with other clinically relevant constructs, such as

internalizing and externalizing psychopathology, personality traits, and functioning. I

hypothesized that experiential avoidance/acceptance and cognitive fusion will relate to

internalizing psychopathology, externalizing psychopathology, and neuroticism, as many

of these constructs and processes have individually been found to be related to

psychopathology. Consistent with the ACT hypothesis that a successful therapeutic

outcome is related to valued living rather than a reduction of symptoms (Hayes et al.,

2011), I hypothesized that values and committed action will show specificity to

functioning.
 35

Specific Aim 3. Third, I aimed to investigate the short-term test-retest reliability of

the included measures. There has been little-to-no research on the short-term stability of

ACT process measures. Because these measures often operationally define these

processes in research settings, it would be fruitful to examine reliability over time. This

allowed me to further measure to what extent these measures are differentiable; if the

test-retest reliabilities are significantly lower than the correlations among the scales, this

would indicate little scale specificity. This also allowed me to examine whether these

ACT constructs are trait-like or state-like.

Specific Aim 4. I aimed to use item-level factor analysis on a subset of items to

determine whether the six-factor ACT Hexaflex model of psychological flexibility can be

recreated structurally, and whether ACT processes are differentiable in this way. Few

questionnaires exist to measure values and committed action, and none exist to

specifically measure self-as-context. I hypothesized that a five or six-factor model of

psychological flexibility will emerge, with self-as-context possibly not emerging, given

the difficulty measuring such a process using objective personality measures.

Specific Aim 5. I aimed to determine whether measures of ACT processes have

incremental value in explaining psychopathology and functioning over and above

measures of anxiety sensitivity, distress tolerance, discomfort intolerance, and coping

styles. Little research has been done to test whether ACT processes are distinguishable

from these other psychological processes. I hypothesized that ACT process measures will

be distinguishable from these other, non-ACT processes, and will provide significant

incremental value.
 36

CHAPTER II

METHODS

Participants and Procedures

Participants in this study consisted of two samples: a sample of college students

from the University of Iowa (T1 student sample; N = 485) and a community sample

recruited through Amazon.com’s Mechanical Turk system (MT sample; N = 345). A

subset of the T1 student sample returned two weeks after completing the initial study to

provide Time 2 data (T2 student sample, N = 342) in order to provide retest information.

All participants completed online self-report measures.

University of Iowa Elementary Psychology students were recruited through the

research pool website. Subjects were required to be 18 years of age or older to

participate. Students who signed up for this study were directed to a set of online

questionnaires on the REDCap survey system website hosted by the University of Iowa

(Harris et al., 2009). Students who completed the online survey received one research

credit towards a course requirement. The T1 student sample was 71% female with a mean

and median age of 19. The self-reported racial makeup of this sample was as follows: 2

American Indian/Native American, 77 Asian, 19 Black or African American, 362 White

or Caucasian, 0 Hawaiian or Pacific Islander, 15 multiracial, 10 did not report.

Additionally, 29 participants self-identified as Hispanic or Latino of any race. 41

participants (8.5% of the total) reported a history of mental health or substance abuse

treatment. The breakdown was as follows: 33 treated for depression, 5 for bipolar

disorder, 14 for generalized anxiety disorder, 2 for posttraumatic stress disorder, 4 for

obsessive compulsive disorder, 2 for panic disorder, 1 for social phobia, 7 for other
 37

problems with fear or anxiety, 1 for alcohol use problems, 2 for drug use problems, 1 for

borderline personality disorder, and 2 for some other disorder or psychiatric problem.

Two weeks after completing the Time 1 administration of the study, all student

participants received an email asking them to participate in a second administration of the

study for a second research credit towards their course requirement. Of these student

participants, about 71% elected to participate in this Time 2 administration. This smaller

subset of the student sample had a mean and median age of 19, and was 74% female. The

self-reported racial makeup of the T2 sample was as follows: 1 American Indian/Native

American, 47 Asian, 12 Black or African American, 267 White or Caucasian, 0 Hawaiian

or Pacific Islander, 7 multiracial, 8 did not report. Additionally, 19 participants self-

identified as Hispanic or Latino of any race. 29 participants (8.5% of the total) reported a

history of mental health or substance abuse treatment. The breakdown was as follows: 24

treated for depression, 2 for bipolar disorder, 11 for generalized anxiety disorder, 1 for

posttraumatic stress disorder, 3 for obsessive compulsive disorder, 4 for other problems

with fear or anxiety, 1 for alcohol use problems, 2 for drug use problems, 1 for borderline

personality disorder, and 1 for some other disorder or psychiatric problem.

Additionally, a community sample was recruited through Amazon.com’s

Mechanical Turk System. Mechanical Turk is a service that allows its members to choose

among thousands of paid "microtasks." This service has been found by previous

researchers to be an excellent source of high-quality data that is comparable to data

collected from other community sources (see Paolacci, Chandler, & Ipeirotis 2010;

Mason & Suri, 2011; Buhrmester, Kwang, & Gosling, 2011).

 38

A total of 345 individuals completed at least part of the survey, and 301

individuals completed the entire survey. The sample was 52% male, and had a mean age

of 33 and a median age of 30. The self-reported racial makeup of the MT sample was as

follows: 9 American Indian/Native American, 189 Asian, 14 Black or African American,

122 White or Caucasian, 1 Hawaiian or Pacific Islander, 7 multiracial, 3 did not report.

Additionally, 23 participants self-identified as Hispanic or Latino of any race. 22

participants (6.4% of the total) reported a history of mental health or substance abuse

treatment. The breakdown was as follows: 17 treated for depression, 1 for bipolar

disorder, 1 for schizophrenia, 3 for generalized anxiety disorder, 1 for obsessive

compulsive disorder, 2 for social phobia, 6 for other problems with fear or anxiety, 4 for

alcohol use problems, 2 for drug use problems, 2 for some other disorder or psychiatric

problem.

Study Measures

The Acceptance and Action Questionnaire, version II (AAQ-II) is a common ACT

measure that was created primarily as a measure of avoidance versus acceptance (Hayes,

et al., 2004), although it is ultimately meant to encompass different aspects of

psychological flexibility (Hayes et al., 2006). The AAQ has been found to be related to a

number of psychopathology-relevant constructs. In their review of the literature, Hayes et

al. (2006) found that the AAQ is moderately-to-strongly related to psychopathology

measures, including measures of depression, trauma, fear, and generalized anxiety. In all

cases, low levels of acceptance (high levels of avoidance) were related to higher levels of

psychopathology.
 39

Bond et al. (2011) developed a revised version of the AAQ. The AAQ-II is a

seven-item, one factor measure of experiential avoidance/psychological inflexibility that

uses a seven-point Likert response scale. (Example item: “It seems like most people are

handling their lives better than I am.”) These researchers found that the AAQ-II has

improved reliability compared with the original AAQ; across six samples with a total

sample size of 2,816, the average coefficient alpha was found to be 0.84, the average 3-

month and 12-month test-retest reliabilities (investigated in a sample size of 583) were

found to be 0.81 and 0.79, respectively (Bond et al., 2011). The relationship between the

AAQ-II and other, external measures, such as depression and anxiety, remained

essentially unchanged compared with the AAQ, with average correlations of 0.70 with

the Beck Depression Inventory (N = 487), 0.61 with the Beck Anxiety Inventory (N =

206), 0.59 with the White Bear Suppression Inventory (N = 1,661), 0.61 with the DASS

Depression Scale (N = 432), 0.49 with the DASS Anxiety Scale (N=432), 0.57 with the

DASS Stress Scale (N = 432), 0.43 with the General Health Questionnaire-12 (N =

1,661), and 0.70 with the Symptom Checklist-90 Revised (N = 206), indicating good

convergent validity; the measure was also able to predict future absences from work (r =

0.25; N = 583), indicating the measure can predict behaviors longitudinally (Bond et al.,

2011).

The White Bear Suppression Inventory (WBSI) is a 15-item measure of thought

suppression that using a five-point Likert response scale (Wegner & Zanakos, 1994).

(Example item: “I wish I could stop thinking of certain things.”) It was designed as a

measure of thought suppression, which the authors hypothesized was related to obsessive

thinking. Across five samples consisting of a total of 2,746 participants, the coefficient
 40

alpha ranged from 0.87 to 0.89. In a follow-up study (N = 162), these researchers found

test-retest reliabilities of 0.69, with time intervals ranging from three weeks to three

months. They also found that the WBSI was moderately correlated with the Beck

Depression Inventory (rs range from 0.44 to 0.52), the Maudsley Obsessive Compulsive

Inventory (rs range from 0.38 to 0.40), the State-Trait Anxiety Inventory (r = 0.53), and

the Anxiety Sensitivity Inventory (r = 0.49).

The WBSI has been used by ACT researchers as an additional measure of

avoidance. The reduction of thought suppression is thought to mediate some of the gains

from mindfulness-based therapy interventions (Bowen, Witkiewitz, Dillworth, & Marlatt,

2007), and is related to other measures of acceptance versus avoidance (Hayes et al.,

2004; Bond et al., 2011; Gámez, Chmielewski, Kotov, Ruggero, & Watson, 2011). Bond

et al. (2011) suggests that thought suppression is a specific kind of experiential

avoidance, and that the WBSI is therefore measuring a narrower construct than the AAQ-

II.

The Multidimensional Experiential Avoidance Questionnaire (MEAQ) is a 62-

item measure of experiential avoidance that was designed as a measure of experiential

avoidance that uses a six-point Likert response scale (Gámez et al., 2011). (Example

item: “When a negative thought comes up, I immediately try to think of something else.”)

It was designed to be a more comprehensive measure of avoidance than the AAQ or the

AAQ-II. Whereas that AAQ is a unidimensional measure, the MEAQ is a six-factor

measure consisting of behavioral avoidance, distress aversion, procrastination,

distraction/suppression, repression/denial, and distress endurance. Across five samples

 41

with a total sample size of 1,358, the scale-level coefficient alphas averaged 0.83, ranging

from 0.76 to 0.90 (Gámez et al., 2011).

The authors found that these six scales are differentially related to various

psychopathology measures, and that, as a whole, the MEAQ had better correlations with

external variables than did the AAQ or the AAQ-II, and the partial correlations between

the MEAQ scales and external variables, when controlling for the AAQ-II, were higher

than the partial correlations between the AAQ-II and external variables when controlling

for the MEAQ. Across two samples with Ns of 314 and 201, the total MEAQ has

correlations of 0.66 and 0.74 with the AAQ-II and 0.54 and 0.56 with the WBSI,

indicating good convergent validity. The authors suggest that, although the MEAQ is a

more comprehensive measure of avoidance compared with the AAQ, the AAQ has come

to be seen as a broader measure of psychological inflexibility in general, and that the two

measures may be tapping into subtly different processes. Because it is a new measure,

little follow-up research has yet been done with the MEAQ.

The Mindful Attention Awareness Scale (MAAS) is a unidimensional, 15-item

scale measuring mindfulness, using a six-point Likert response scale (Brown & Ryan,

2003). (Example item: “I find myself doing things without paying attention.”) Across

seven samples with a total sample size of 1,492, the coefficient alphas ranged from 0.80

to 0.87. The four-week test-retest reliability coefficient, conducted with a sample of 60

participants, was 0.81.

The authors suggest that mindfulness is an important and unique component of

wellbeing; they found that their measure of mindfulness had moderate negative

correlations with depression (rs range from -0.37 to -0.42), anxiety (rs range from -0.26
 42

to -0.42), and neuroticism (r = -0.56), and had moderate positive correlations with self-

esteem (rs range from 0.36 to 0.50), emotional wellbeing (rs range from 0.16 to 0.39),

and physical wellbeing (rs range from 0.25 to 0.51) (Brown & Ryan, 2003). Further

research shows that the MAAS has moderate negative correlations with the AAQ (r = -

0.32) and the WBSI (-0.32) in a sample of 88 individuals, indicating a relationship with

measures of experiential avoidance and thought suppression (Baer, Smith, Hopkins,

Krietemeyer, & Toney, 2006). It is negatively associated with anxiety sensitivity (r = -

0.46; N = 122), indicating a possible relationship between the processes of mindfulness

and anxiety sensitivity (McCracken & Keogh, 2009).

The Philadelphia Mindfulness Scale (PHLMS) is a 20-item measure of

mindfulness which uses a five-point Likert response scale (Cardaciotto, Herbert, Forman,

Moitra, and Farrow, 2008). (Example item: “Whenever my emotions change, I am

conscious of them immediately.”) Unlike the MAAS, the PHLMS posits a two-factor

model of mindfulness, consisting of present-moment awareness and acceptance. Across

five samples totaling 923 participants, coefficient alphas ranged from 0.75 to 0.86 for the

awareness subscale and from 0.75 to 0.91 for the acceptance subscale.

These researchers found that the PHLMS acceptance scale was significantly

associated with measures of acceptance/avoidance such as the AAQ (rs range from 0.31

to 0.54) and the WBSI (rs range from -0.35 to -0.52), as well as with the Beck Depression

Inventory (rs range from -0.28 to -0.51) and the Beck Anxiety Inventory (rs range from -

0.29 to -0.39). Both the PHLMS awareness scale and the PHLMS acceptance scale

showed an association with the MAAS (acceptance subscale: rs range from 0.17 to 0.32;

awareness subscale: rs range from 0.21 to 0.40).

 43

The Five Facet Mindfulness Questionnaire (FFMQ) is a 39-item measure of

mindfulness, using a five-point Likert response scale (Baer et al., 2008). (Example item:

“I watch my feelings without getting lost in them.”) It is the result of previous research

showing that a factor analysis of a large number of self-report items suggests a five-factor

structure of mindfulness (Baer et al., 2006). The FFMQ facets consist of observing,

describing, acting with awareness, nonjudging of inner experience, and nonreactivity to

inner experience. Across four samples that include 1017 participants, Baer et al. (2008)

reported that all subscale coefficient alphas were in the good range (ranging from 0.72 to

0.92), which the exception of the nonreactivity to inner experience scale, whose alphas

ranged from 0.67 to 0.86.

The facets have differential relationships with other measures; in another study of

the FFMQ’s psychometric properties, Bohlmeijer, ten Klooster, Fledderus, Veehof, and

Baer (2011) investigated a sample of 376 participants. They found that the different

scales had different correlates. In particular, the nonjudging scale has the strongest

relationship with the AAQ-II (r = -0.54) and the NEO Neuroticism scale (r = -0.46), as

well as significant correlations with measures of anxiety (r = -0.24), depression (r = -

0.25), and positive mental health (r = 0.20). The observe subscale has strong relationships

with the NEO Openness scale (r = 0.44) and positive mental health (r = 0.30). The

describing subscale has significant relationships with the AAQ-II (r = 0.31), openness (r

= 0.30), neuroticism (r = -0.21), and positive mental health (r = 0.37). The act with

awareness subscale has significant correlations with the AAQ (r = 0.30), neuroticism (r =

-0.28), anxiety (r = -0.22), depression (r = -0.20), and positive mental health (r = 0.20).

Nonreactivity to inner experiences is significantly correlated with the AAQ (r = 0.37),

 44

neuroticism, (r = -0.39), anxiety (r = -0.20), depression (r = -0.16), and positive mental

health (r = 0.23). These results suggest that, while the facet subscales have significant

overlap, they also have unique variance.

The Automatic Thoughts Questionnaire (ATQ) was first developed by Hollon and

Kendall (1980) as a measure of the frequency of problematic thoughts. It consisted of 30

self-statements. (Example item: “I’m no good.”) The questionnaire was modified by

Zettle and Hayes (1986), who added a believability scale as a measure of cognitive

fusion, creating the ATQ-B. Each statement in the ATQ-B is rated on a five-point Likert

scale for both frequency and believability. The ATQ-B believability scale has been used

as an outcome measure for ACT clinical trials (e.g., Zettle, Rains, & Hayes, 2011); these

researchers report that, in two samples consisting of 177 mental health patients and 249

non-clinical individuals, the ATQ-B has a coefficient alpha of 0.95 and 0.97,

respectively, and has correlations with the BDI equal to 0.53 and 0.58, respectively. For

the nonclinical sample, the three month test-retest reliability is 0.85. Little additional

research exists on this measure’s psychometric properties.

The Cognitive Fusion Questionnaire (CFQ) is a 13-item measure of cognitive

fusion, using a seven-point Likert response scale (Gillanders et al., 2013). (Example item:

“I get upset with myself for having certain thoughts.”) In five samples totaling 1,849

individuals, coefficient alphas ranged from 0.88 to 0.93. The authors of the scale have

found that the scale is highly correlated with the AAQ-II (rs range from 0.72 to 0.87),

various measures of mindfulness (rs range from -0.50 to -0.70), and the ATQ-B (r =

0.61). In addition, it is highly correlated with measures of depression (rs range from 0.45
 45

to 0.85), and moderately negatively correlated with measures of life satisfaction (rs range

from -0.39 to -0.45) and quality of life (r = -0.45).

The CFQ is highly correlated with the AAQ-II. However, the authors found that

the CFQ had incremental validity in explaining a measure of distress (ΔR2 = 0.05). The

authors suggest that this high overlap is due to the fact that the AAQ-II is a general

measure of psychological inflexibility, whereas the CFQ measures a facet of inflexibility

(cognitive fusion). In an item-level factor analysis of the items from the AAQ-II and the

CFQ, the authors found that the items formed two factors in three of their five samples,

and formed one factor in the remaining two samples.

The Experiences Questionnaire (EQ) is a 20-item measure of decentering and

ruminating which uses a five-point Likert response scale (Fresco et al., 2007). (Example

item: “I can observe unpleasant feelings without being drawn into them.”). Its authors

define decentering as “the ability to observe one’s thoughts and feelings as temporary,

objective events in the mind, as opposed to reflections of the self that are necessarily

true,” (Fresco et al., 2007), a concept that appears conceptually related to defusion,

mindfulness, and self-as-context. In a validation sample of 1,669 individuals, the

decentering scale (11 items) had a coefficient alpha of 0.83, and the rumination scale (9

items) had a coefficient alpha of 0.70.

The authors found that their measure of decentering was correlated the AAQ-II (r

= -0.49) and the Beck Depression Inventory (r = -0.40) (Fresco et al., 2007).

Furthermore, McCracken, Gutiérrez-Martínez, and Smyth (2012), found that, in a sample

of 150 chronic pain patients, the EQ Decentering scale is correlated with measures of

pain-related distress (r = -0.33), depression (r = -0.47), pain-related anxiety (r = -0.46),

 46

and psychosocial disability (r = -0.47), suggesting that decentering may play a role in the

development of good functioning in this population.

The Valued Living Questionnaire (VLQ) is 10-item list of areas of life that might

be valued. Participants rate each area of life in terms both importance and consistency of

behavior using 10-pont Likert response scales (Wilson et al., 2010). (Example domain:

“Friendships/Social Relations.”) In two samples totaling 310 individuals, coefficient

alpha for the importance scale ranged from 0.77 to 0.83, and the coefficient alpha for the

consistency scale ranged from 0.58 to 0.75. In a subset of 57 participants for whom one

to two week test-retest data were collected, the importance scale had a test-retest

reliability of 0.90, and the consistency scale had a test-retest reliability of 0.58. These

results suggest that chosen valued domains are relatively stable, but that efforts to move

towards these domains vary over time. Correlations between the difficulties with valued

living and other measures tend to be relatively low. The VLQ has a correlation of -0.14

with the AAQ, -0.26 with a measure of depression, -0.14 with a measure of anxiety, -0.20

with a measure of hostility, 0.13 with a measure of relationship functioning, and 0.23

with a measure of mental health. These modest correlations suggest that variability in

valuing behaviors is not primarily accounted for by symptoms of psychopathology.

The Anxiety Sensitivity Index (ASI) is a sixteen-item measure of an individual’s

belief that anxiety has negative consequences rated using a five-point Likert response

scale (Reiss et al., 1986). (Example item: “It scares me when my heart beats rapidly.”) In

an initial validation sample of 127 individuals, it was found that this scale had a test-

retest reliability of 0.75 at two week follow-up. Internal consistency was not reported in
 47

this initial study, but other studies have suggested good internal consistency (e.g., α =

0.88; Zinbarg, Barlow, & Brown, 1997).

The ASI has been found to be a multidimensional scale; Zinbarg et al. (1997)

investigated a sample of 432 participants in order to investigate its structure. They found

the best fit for a hierarchical structure consisting of a higher-order general factor and the

three specific factors of physical concerns, mental incapacitation concerns, and social

concerns. Rodriguez, Bruce, Pagano, Spencer, and Keller (2004) also found support for

this structure in a sample of 206 individuals with anxiety disorder diagnoses. Correlations

among these three lower-order factors ranged from 0.44 to 0.49. They also found

acceptable test-retest correlations (ranging from 0.64 to 0.78 for the subscales and 0.72

for the total score) in a subset of 89 individuals who were re-assessed at a one-year

follow-up.

It has been found that the ASI is associated with the presence of all internalizing

disorders, especially posttraumatic stress disorder and generalized anxiety disorder

(Naragon-Gainey, 2010). This meta-analysis also showed that the three lower-order

scales have differential specificity. For example agoraphobia is more strongly associated

with the physical (ρ = 0.51) compared with the social (ρ = 0.40) and cognitive (ρ = 0.37)

subfactor. Similarly, depression is more strongly associated with the cognitive subfactor

(ρ = 0.53) compared with the physical (ρ = 0.40) and social (ρ = 0.28) subfactors.

Additionally, social anxiety is more associated with social anxiety sensitivity (ρ = 0.70)

compared with the cognitive (ρ = 0.45) and physical (ρ = 0.31) subfactors.

The Distress Tolerance Scale (DTS) is a 15-item measure of one’s ability to

tolerate negative emotional states rated using a five-point Likert scale (Simons & Gaher,
 48

2005). (Example item: “I can’t handle being distressed or upset.”) This scale is defined

hierarchically, with a general distress tolerance factor and four lower-order factors,

consisting of tolerance, appraisal, absorption, and regulation. Distress intolerance is

associated with negative affectivity (Simons & Gaher, 2005). In a validation sample of

823 participants, the coefficient alpha of the overall scale was 0.82, and alphas for the

lower-order factors ranged from 0.70 to 0.82. Six-month test-retest reliability was 0.61,

and men reported higher distress tolerance than women (d = 0.32). Overall distress

tolerance was negatively correlated with negative affectivity (r = -0.57) and substance use

problems (r = -0.23). Thus far, there is limited research on distress tolerance’s

relationship with psychopathology measures (Zvolensky, Vujanovic, Bernstein, & Leyro,

2010), and it has been suggested that more work needs to be done to investigate the

relationship between distress tolerance and other, related constructs (Leyro et al., 2010).

The Discomfort Intolerance Scale (DIS) is a 5-item measure of one’s ability to

tolerate unwanted physical sensations, rated using a seven-point Likert scale (Schmidt et

al., 2006). (Example item: “I have a high pain threshold.”) These researchers found a

two-factor model of the construct, consisting of discomfort avoidance and discomfort

intolerance. In a sample of 1,296 participants, coefficient alpha for the measure was 0.70,

with an alpha of 0.78 for the discomfort intolerance subfactor and an alpha of 0.92 for the

discomfort avoidance subfactor. Across a nonclinical (N = 1,296) and a clinical (N =

193) samples, correlations between the DIS and the ASI ranged from 0.33 to 0.38,

correlations between the DIS and the Beck Anxiety Inventory ranged from 0.18 to 0.31,

and correlations between the DIS and the Beck Depression Inventory ranged from 0.05 to

0.24.
 49

The COPE is a widely used measure of coping (Carver, Scheier, & Weintraub,

1989) that broadly measures various coping styles. It is the mostly widely used measure

of coping styles in the literature (Kato, 2013). It is a 53-item scale that is rated using a

four-point Likert scale. It was published with fourteen subscales, consisting of the

following: active coping, planning, suppression of competing activities, restraint coping,

seeking social support for instrumental reasons, seeking social support for emotional

reasons, positive reinterpretation and growth, acceptance, turning to religion, focusing

on/venting emotions, denial, behavioral disengagement, mental disengagement, and

alcohol/drug disengagement. In Carver et al.’s (1989) validation sample of 978

participants, coefficient alphas for these scales ranged from 0.45 (mental disengagement)

to 0.92 (turning to religion). Six week test-retest reliabilities, calculated for a subset of

116 participants, ranged from 0.42 (behavioral disengagement) to 0.89 (turning to

religion). In a meta-analysis, Kato (2013) found that the coefficient alphas of the scales

range from 0.53 (mental disengagement) to 0.91 (turning to religion). This meta-analysis

also examined the external correlates of the COPE scales, and found particularly high

correlations between behavioral disengagement and negative affect (r = 0.40), self-blame

and depression (r = 0.43), and self-blame and physical symptoms (r = 0.43).

The reliabilities of these fourteen rationally derived scales suggest that they are

not all robust measures, and subsequent factor-analytic studies have suggested that fewer

scales can be used. For example, Lyne and Roger (2000) investigated a sample of 539

individuals to investigate the factor structure of the COPE. They found that the original

scales could not easily be extracted using item-level analyses, and that a simpler three-

scale solution emerged. This new structure consists of rational/active coping (18 items, α
 50

= 0.89), emotion-focused coping (8 items, α = 0.83), and avoidance coping/hopelessness

(8 items, α = 0.69). These three scales are highly differentiable, with low intercorrelations

(ranging from 0 to 0.21) and differential specificity. In particular, they found that

avoidance coping is the most highly associated with distress (r = 0.35), with emotion

coping having a smaller but statistically significant correlation with distress (r = 0.13) and

active coping having no significant association.

The Kessler Psychological Distress Scale (K10). The K10 is a 10-item measure of

internalizing psychopathology symptoms, using a five-point Likert response scale

(Kessler et al., 2002). (Example item: “During the last 30 days, about how often did you

feel hopeless?”) This scale was included as a measure of depression in order to

investigate the relationship between internalizing psychopathology and ACT constructs.

In a validation sample of 1,574 participants, the K10 had a coefficient alpha of 0.92. In a

sample of 155 individuals with mental health problems, the K10 had good discrimination

between those with and without a diagnosis based on the Structured Clinical Interview

for DSM-IV (SCID), with a discrimination of 0.876. Additionally, in a study of 502

participants (Donker, van Straten, Marks, & Cuijpers, 2010), the K10 had a correlation of

0.84 with the CES-D. Additionally these researchers found that, in a subset of 157

individuals who received a DSM-IV Composite International Diagnostic Interview

(CIDI), the K10 and the CES-D were equally effective in predicting the diagnosis of a

depressive disorder.

Externalizing Spectrum Inventory, brief disinhibition scale (ESIdis). The

Externalizing Spectrum Inventory is a measure of problematic behavior, using a four-

point Likert response scale (Krueger, Markon, Patrick, Benning, & Kramer, 2007). A
 51

brief form of this measure, consisting of 20 items (example item: “Others have told me

they are concerned about my lack of self-control.”) was developed to measure

disinhibition (Patrick, Kramer, Krueger, & Markon, 2013). This measure was included to

investigate the relationship between externalizing psychopathology and ACT constructs.

In a sample of 599 participants, these researchers found that the ESIdis had a coefficient

alpha of 0.94, and, in a sample of 612 individuals, showed correlations with measures of

negative emotionality (r = 0.69), positive emotionality (r = -0.22), social closeness (r = -

0.36), alienation (r = 0.60), aggression (r = 0.58), and control (r = -0.59). Overall, the

ESIdis appears to be a robust measure of externalizing behavior.

The Mini-IPIP. The Mini-IPIP is a brief measure of the Big Five personality

traits, consisting of Neuroticism, Extraversion, Agreeableness, Conscientiousness, and

Openness (Donnellan, Oswald, Baird, & Lucas, 2006). It consists of 20 items that are

rated using a five-point Likert response scale. This measure was included to investigate

the relationship between personality traits and ACT constructs. In two initial validation

samples with a combined sample size of 2,992, coefficient alphas for the subscales

ranged from 0.65 to 0.82. The authors characterize these measures of internal consistency

as “acceptable, given their reduced length.” Additionally, in these two samples,

convergent correlations between the Mini-IPIP scales and the larger IPIP-FFM scales

were found to be good, ranging from 0.83 to 0.93, indicating that the shorter scales are

acceptable approximations of the larger scales. Short-term, three week test-retest

correlations of the Mini-IPIP subscales ranged from 0.72 to 0.89 in a sample of 216

individuals. Long-term, six to nine month test-retest correlations ranged from 0.68 to 0.86

in a sample of 148 participants. Additionally, for this sample, self-report corresponded

 52

with informant reports with correlations ranging from 0.26 to 0.53. Overall, the Mini-

IPIP was found to be an adequate brief measure of the Big Five personality traits.

Selected modules from the World Health Organization Disability Assessment

Schedule (WHODAS-II). Three modules from the 36-item self-report version of the

WHODAS-II will be used as measures of basic daily functioning (World Health

Organization, 2001). These scales were included to investigate the relationship between

levels of functioning and ACT constructs. These modules measure understanding and

communicating (six items; example item: “In the last 30 days, how much difficulty did

you have in remembering to do important things?”), getting along with other people (five

items; example item: “In the last 30 days, how much difficulty did you have in getting

along with people who are close to you?”), and life activities (eight items; example item:

“In the last 30 days, how much difficulty did you have in getting all the work done that

you need to do?”). All items use a five-point Likert response scale.

In a study of the psychometric properties of the WHODAS-II in several samples

of rehabilitation patients with a total sample size of 904, Pösl, Cieza, and Stucki (2007)

found coefficient alphas of 0.83 to 0.87 for understanding and communicating, 0.69 to

0.81 for getting along with others, and 0.94 to 0.97 for life activities. They also found

high correlations with measures of mental symptoms (rs range from -0.40 to -0.68) and

physical symptoms (rs range from -0.48 to -0.62).

Study-specific Variable Response Inventory (VRIN). In order to create a measure

of inconsistent responding, fourteen pairs of items with the highest correlations in the

student Time 1 sample were identified. Pair correlations ranged from 0.54 to 0.64.

(Example item pair: “I think some of my emotions are bad or inappropriate and I
 53

shouldn't feel them” and “I tell myself that I shouldn't have certain thoughts.”) Items were

standardized in order to account for different response scales, and the absolute value of

the difference between scores for each pair was calculated. These pair differences were

summed to create a total VRIN score. Individuals who scored highly on this scale can be

assumed to have responded to study questions in a more inconsistent or random manner

than someone who has a low score. Correlations between the VRIN item pairs were

somewhat higher than the pair correlations for the Minnesota Multiphasic Personality

Inventory-2, whose VRIN pairs have an average correlation of about 0.40 (Ketterer, Han,

Hur, & Moon, 2010).

Data Analysis

The data were analyzed using the Mplus and SAS statistical programs. Maximum

likelihood estimators were used for all structural equation modeling. Because most item-

level data used at least a five-point response scale, these data were treated as continuous,

as suggested by Rhemtulla, Brosseau-Liard, and Savalei (2012).

When calculating scale scores, missing item-level data were prorated using other

items in the same scale, such that each missing data point was assumed to be equal to the

average of the other items in that scale.

When examining the validity of scales and conducting factor analyses, a standard

rule of thumb is to investigate a sample size of at least 300 individuals (Clark & Watson,

1995). However, simulations conducted by MacCallum, Widaman, Zhang, and Hong

(1999) suggest that a sample size as low as 200 is adequate for factor analysis in most

situations, unless both the communalities between variables are low and there are few

variables defining each factor. Due to the high correlations between the constructs under
 54

consideration and to the over-determination of the factors investigated in this study, the

sample sizes in this study, which ranged from 342 to 485, were more than adequate for

the analyses that were run.

 55

CHAPTER III

RESULTS

Univariate Statistics

Univariate statistics and group comparisons for all scales are shown in Tables A1

and A2. Coefficient alphas for most scales were in the moderate-to-high range, indicating

good internal consistency. The IPIP scales had slightly lower alphas, ranging from 0.65 to

0.82 across samples. Given the brief nature of these scales, their lower reliabilities were

not surprising. The ASI Social subscale showed notably low internal consistency, with

coefficient alphas ranging from 0.42 to 0.54 across the three samples. These results

indicate that this subscale might not be unidimensional, or it may simply be due to the

scale being relatively short (three items). All ACT-relevant scales had acceptable internal

consistencies.

Group Comparisons

Group comparisons are shown in Table A3. Overall, there were almost no

differences in student responses between Time 1 (T1) and Time 2 (T2); students showed

significantly higher social anxiety sensitivity during Time 1 than they did during Time 2,

but no other significant differences existed. Given the number of comparisons and the

lack of a theoretical rationale for this difference, it is quite possible that this represents a

type I error. Some significant group differences were found between student T1

responses and Mechanical Turk (MT) responses. Overall, the student population reported

significantly lower mental anxiety sensitivity, higher tolerance for physical discomfort,

fewer attempts to self-regulate feelings of distress, higher distress tolerance, higher

extraversion, higher functioning in social situations, and higher functioning in work or

 56

school. These results indicate a somewhat higher functioning student sample. There was

no significant difference between the two populations in rates of variable responding;

these results indicate that the Mechanical Turk sample was not significantly more

careless in their responding, despite the nature of their online recruitment.

Correlations

Tables A4, A5, and A6 show the correlations among the ACT-related scales for

the Mechanical Turk sample, the Student Time 1 sample, and the Student Time 2 sample

respectively. The Acceptance and Action Questionnaire, the Cognitive Fusion

Questionnaire, and the Automatic Thoughts Questionnaire-Believability are significantly

correlated across the three samples, with correlations ranging from 0.62 to 0.76. Other

correlations were more moderate, even when one would expect a theoretical link. For

example, the Mindful Attention Awareness Scale and the Philadelphia Mindfulness Scale

Awareness scales showed little relationship, ranging from 0.06 to 0.37. The Valued

Living Questionnaire scales showed little relationship with other ACT scales, with no

correlations consistently above 0.25 across the three samples. These results indicate some

gaps in our theoretical understanding of how these processes interact.

Tables A7, A8 and A9 show the correlations among the non-ACT-related scales

across the three samples. Overall, most of the correlations are in the low-to-moderate

range. Notably high correlations include that between the ASI Physical scale and the ASI

Mental scale (rs range from 0.63 to 0.72), those between the DTS scales (rs range from

0.44 to 0.79), that between the K10 depression scale and the Automatic Thoughts

Questionnaire-Frequency (rs range from 0.71 to 0.79), and those between the WHODAS

functioning scales (rs range from 0.49 to 0.78). Overall, these higher correlations are
 57

unsurprising given the nature of these scales; indeed most of the high correlations exist

between subscales of the same scale.

Tables A10, A11, and A12 show correlations between ACT-related scales and

non-ACT-related scales across the three samples. Most correlations fall within the low-

to-moderate range. However, some notably high correlations exist. The Automatic

Thoughts Questionnaire-Frequency has high correlations with the Acceptance and Action

Questionnaire, Cognitive Fusion Questionnaire, and Automatic Thoughts Questionnaire-

Believability (rs range from 0.63 to 0.89). The high correlations between the Automatic

Thoughts Questionnaire-Frequency and the Automatic Thoughts Questionnaire-

Believability (rs range from 0.88 to 0.89) are particularly striking, and suggest that,

despite the ostensible difference between the scales, participants have difficulty

distinguishing between the frequency and believability of depressive thoughts. It is

possible that experience with an ACT intervention would increase the ability of

individuals to discriminate between these things, but this is speculative. Likewise, the

K10 depression scale has high correlations with the Acceptance and Action

Questionnaire, Automatic Thoughts Questionnaire-Believability, and Cognitive Fusion

Questionnaire (rs range from 0.60 to 0.74). Again, these results may suggest that

untrained participants might have difficulty distinguishing between suffering on one hand

and the ACT conceptualizations of cognitive fusion and psychological inflexibility on the

other hand, or that the two constructs are simply indistinguishable in a self-report

measure due to the overlap of causal factors.

Tables A13 and A14 show correlations between student T1 scores and student T2

scores for ACT and non-ACT measures, respectively. Test-retest correlations are strong
 58

for most scales. As was the case when looking at coefficient alpha, the ASI Social

subscale shows low reliability, with a test-retest correlation of only 0.49, perhaps due in

part to the shortness of the scale (three items).

Scale Level Exploratory Factor Analyses

In order to better understand the relationships among the ACT-related scales, an

exploratory factor analysis was conducted. In order to determine the number of factors to

extract, parallel analysis was used using SAS code published by O’Connor (2002). For

each of the three samples, 500 simulations were run using a confidence interval of 95%.

Permutation datasets were generated for each simulation to match the empirical

distribution of the samples, and principal components analysis was used. For each factor,

eigenvalues from the raw data were compared to the average eigenvalues in the simulated

datasets. If the raw eigenvalue was higher than the 95% of the eigenvalues from the

simulated datasets, then the raw eigenvalue was higher than one would expect given

chance. The results of these analyses are shown in Table A15. For the MT and T1

datasets, the first four factors extracted explained significantly more of the variance than

one would expect given chance. For the T2 dataset, the first three factors extracted

explained significantly more of the variance than one would expect given chance.

In order to determine whether a three-factor model or a four-factor model of the

ACT scales was superior, factor loadings were calculated for each model for each of the

three samples in order the see how well each factor replicated across the three samples.

Table A16 shows the three-factor structure across the three samples. These factors

replicated well, with factor loading correlations ranging from 0.84 to 0.97 (see Table

A17). Table A18 shows the four-factor structure across the three samples. Not every
 59

factor in this solution replicated across samples, indicating that this structure is not

reliable (see Table A19). These results indicate that the three-factor solution (shown in

Table A16) is more reliable across samples.

In general, the first factor is most strongly defined by the Acceptance and Action

Questionnaire, the Automatic Thoughts Questionnaire-Believability, and the Cognitive

Fusion Questionnaire, with the Mindful Attention Awareness Scale, the FFMQ Act with

Awareness scale, and the FFMQ Nonjudge scale also loading primarily on this factor.

Given the dominance of psychological inflexibility, cognitive fusion, and believability of

depressive thoughts, this first factor appears to represent Fusion/Inflexibility.

The second factor is defined primarily by the EQ Decentering scale, the FFMQ

Describe scale, the FFMQ Nonreact scale, the FFMQ Observe scale, the MEAQ Distress

Endurance scale, and the PHLMS Awareness scale. Because of the dominance of mindful

awareness measures, this second factor appears to represent Awareness.

The third factor is defined primarily by the MEAQ Behavioral Avoidance scale,

the MEAQ Distraction/Suppression scale, the MEAQ Distress Aversion scale, and the

PHLMS Acceptance scale. This third factor appears to represent Avoidance.

Item Level Exploratory Factor Analyses

In order to examine the lower-order structure of these processes, item level

analyses were performed on the items of scales loading most highly on each of these

three factors. This was operationalized as scales loading >=0.35 on a factor for all three

samples (see Table A16). Using these criteria, the Acceptance and Action Questionnaire,

Automatic Thoughts Questionnaire-Believability, Cognitive Fusion Questionnaire,

FFMQ Act with Awareness, and the FFMQ Nonjudge, and the Mindful Attention
 60

Awareness Scale were found to be the best markers of Factor 1 (Fusion/Inflexibility). The

EQ Decentering, the FFMQ Observe, the FFMQ Describe, the FFMQ Nonresponse, the

MEAQ Distress Endurance, and the PHLMS Awareness scales were found to be the best

markers of Factor 2 (Awareness). Finally, the MEAQ Behavior Avoidance, the MEAQ

Distress Aversion, the MEAQ Distraction/Suppression, and the PHLMS Acceptance

scales were found to be the best markers of Factor 3 (Avoidance). The MEAQ

Procrastination, MEAQ Repression/Denial, White Bear Suppression Inventory, VLQ

Importance, and VLQ Consistency scales did not clearly load on one of these factors

across all samples, and were not included in item-level analysis.

Item-level factor analyses were conducted for each of these three clusters of

scales across samples. In order to determine how many lower-order factors to extract for

each factor, correlations between factor loadings were calculated for each solution across

samples in order to see which lower-order factors tended to replicate.

For Factor 1 (Fusion/Inflexibility), parallel analysis found that up to five or six

lower-order factors could be extracted that have significantly higher eigenvalues than

expected due to chance (Table A20). However, when correlations between factor

loadings across samples were calculated, only solutions extracting three or four factors

were found to be robust, with high correlations between the loadings across samples

(Table A21). The fourth subfactor extracted was difficult to rationally interpret, and

appeared to be a combination of self-judgment (e.g., “I tell myself that I shouldn’t be

feeling the way I’m feeling”) and a facet of cognitive fusion (e.g., “I struggle with my

thoughts”). These items were difficult to rationally distinguish from markers of the purer

cognitive fusion/inflexibility factor (e.g., “My thoughts cause me distress or emotional

 61

pain.”) Additionally, some items cross-loaded between this self-judgment/fusion factor

and the inflexibility/fusion factor (e.g., “I need to control the thoughts that come into my

head” had strong loadings for both factors, despite the oblique rotation used). For the

sake of parsimony, a three-subfactor model was therefore used. This three-subfactor

solution consisted of an Inflexibility subfactor (best defined by AAQ items, CFQ items,

and FFMQ nonjudge items; example item: “I tend to get very entangled in my thoughts”),

an Internalizing Belief subfactor (defined by ATQ-B items; example item: “I’m

worthless”), and a Detachment subfactor (defined by MAAS items and FFMQ Act with

Awareness items; example item: “I do jobs or tasks automatically, without being aware of

what I’m doing”) (see Tables A22, A23, and A24).

For Factor 2 (Awareness), parallel analysis found that up to five or six lower-

order factors could be extracted whose eigenvalues were significantly higher than would

be expected due to chance (Table A25). However, when factor loading correlations

between samples were calculated, it was found that only the first four factors were the

same across samples (Table A26). This four-subfactor solution consisted of a Perspective

Taking subfactor (defined by EQ Decentering items and FFMQ Nonreact items; example

item: “I can observe unpleasant feelings without being drawn into them”), a Committed

Action subfactor (defined by MEAQ Distress Endurance items; example item: “I don’t let

pain and discomfort stop me from getting what I want”), an Expressive Awareness

subfactor (defined by FFMQ Describe items; example item: “It’s hard for me to find the

words to describe what I’m thinking”), and a Physical Awareness subfactor (defined by a

few EQ decentering items, FFMQ Observe items, and PHLMS Awareness items;
 62

example item: “I pay attention to sensations, such as the wind in my hair or sun on my

face”) (Tables A27, A28, and A29).

For Factor 3 (Avoidance), parallel analysis found that four lower-order factors

could be extracted that have eigenvalues significantly greater than would be expected due

to chance (Table A30). When factor loading correlations were calculated across samples,

it was found that these four factors were robust and interpretable across all three samples

(Table A31). These four subfactors consisted of Physical Avoidance (defined by MEAQ

Behavioral Avoidance items and some MEAQ Distress Aversion items; example item:

“I’m quick to leave any situation that makes me feel uneasy”), Pain Aversion (defined by

MEAQ Distress Aversion items; example item: “The key to a good life is never feeling

any pain”), Distraction (defined by MEAQ Distraction/Suppression items; example item:

“When upsetting memories come up, I try to focus on other things”), and Mental

Avoidance (defined by PHLMS Acceptance items; example item: “There are aspects of

myself I don’t want to think about”) (Tables A32, A33, and A34).

Factor Sum Scores

Sum scores were then calculated for each of the eleven subfactors listed above.

The score for each item was standardized before being added to the sum score in order to

make items using different response formats comparable. For each subfactor, items were

chosen that that had a loading of >=0.35 for all samples, and whose next highest loading

was at least 0.15 lower than the primary loading for all samples (see Tables A22-A24,

A27-A29, and A32-A34).

Tables A35 and A36 show the correlations among these sum scores for all three

samples, as well as test-retest correlations for the sum scores for the student sample. The
 63

test-retest reliabilities for the sum scores tended to be high in the student sample. Overall,

the correlation between Inflexibility and Internalizing Beliefs appears to be particularly

high (rs range from 0.62 to 0.73), with most other correlations among the sum scores

falling in the low-to-moderate range. It is noteworthy that the Mental Avoidance sum

score is highly correlated with Inflexibility (rs range from 0.65 to 0.73), despite being

derived from a different higher-order factor. These results suggest that these sub-factors

may not fall into a simple hierarchical structure.

An exploratory factor analysis was then performed on these sum scores in order to

recreate the higher-order factor structure (Table A37). In general, the higher-order

structure was recreated. Mental Avoidance appeared to cross load between

Fusion/Inflexibility and Avoidance, with higher loadings on Fusion/Inflexibility. This is

surprising, given its initial derivation from the Avoidance higher-order factor. Similarly,

Distraction cross loaded between Avoidance and Awareness, although it tended to load

more highly on its “parent” factor of Avoidance.

Correlations between these sum scores and other scales of interest (all scales

whose items were not used for any sum scales, including ACT scales) were calculated

across the three samples (Tables A38-A40). The Inflexibility and Internalizing Belief

sum scores were highly correlated with a wide variety of scales, including measures of

anxiety sensitivity (rs range from 0.48 to 0.63), distress tolerance (rs range from -0.26 to -

0.65), depression (rs range from 0.63 to 0.74), neuroticism (rs range from 0.36 to 0.57),

and functioning (rs range from 0.28 to 0.55). Mental avoidance also correlated highly

with a number of scales, including measures of anxiety sensitivity (rs range from 0.40 to

0.46) and distress tolerance (rs range from -0.33 to -0.59). It was also noteworthy that
 64

discomfort intolerance, extraversion, agreeableness, openness/imagination, and values

were not highly correlated with any of the ACT sum scores. The lack of relationship

between measures of values and valuing on one hand and the ACT sum scales on the

other is particularly striking, given the hypothesized interrelationships between values

and other ACT processes in the Hexaflex model.

Confirmatory Factor Analyses

For each sample, three item-level CFAs were conducted in order to determine the

best overall structure for the constructs under consideration. The first structure (model 1)

tested was a hierarchical model, consisting of three higher-order factors consisting of

Fusion/Inflexibility, Awareness, and Avoidance, eleven lower-order factors consisting of

Inflexibility, Internalizing Belief, Detachment, Perspective Taking, Expressive

Awareness, Committed Action, Physical Awareness, Physical Avoidance, Pain Aversion,

Distraction, and Mental Avoidance, and the 126 items that were used to create the

subfactor sum scales. For model 1, the lower-order factors loaded only on the “parent”

factors from which they were derived (see Figure B2). Given the structure shown in

Table A34, a second hierarchical model (model 2) was tested in which Mental Avoidance

was allowed to load on both Avoidance and Fusion/Inflexibility and Distraction was

allowed to load on both Avoidance and Awareness (see Figure B3 for an illustration of

this structure). The third model tested (model 3) was a correlated factor model, in which

the higher-order factors were not included and the mid-level factors were allowed to

correlate freely (see Figure B4). Because item level data for most scales included at least

a five-point Likert scale, the data were treated as continuous, as suggested by Rhemtulla

et al. (2012). In order to compare the two models, the Akaike's Information Criterion
 65

(AIC) and the Bayesian Information Criterion (BIC) were calculated for each model. The

AIC and the BIC are used to compare the goodness of fit for different models. For both

indices, a smaller calculated value indicates a better fit.

Across all three samples, the correlated model (model 3) showed a better fit

compared with either hierarchical model across all three samples, using both the AIC and

the BIC (see Table A41). These results indicate that these ACT factors are better

understood as simple interrelated processes rather than as part of a greater hierarchical

structure. Across the three samples, the Root Mean Square Error of Approximation

(RMSEA) for this best-fitting model ranged from 0.045 to 0.052, and the Standardized

Root Mean Square Residual (SRMR) ranged from 0.067 to 0.078. These values are

within the commonly used acceptable limits set by Hu and Bentler (1999), which

establishes a cutoff of 0.06 for the RMSEA statistic and 0.08 for the SRMR statistic.

These results indicate an acceptable fit for this model.

Predictions Across Time

The ACT model predicts that Hexaflex processes such as experiential avoidance

and psychological inflexibility lead to symptoms of psychopathology. Therefore,

correlations between psychopathology measures and ACT sum scores were calculated

across timepoints in the student sample (see Table A42). It was hypothesized that, if ACT

processes play a causal role in the development of psychopathology, the correlation

between the Time 1 sum score and the Time 2 psychopathology score would be higher

than the correlation between the Time 1 psychopathology score and the Time 2 sum

score. As can be seen in Table A42, this was not universally the case. Across eleven sum

scores and two psychopathology scores (a total of 22 comparisons), the expected

 66

relationship was found in sixteen cases, and the reverse was found in six cases. However,

the difference tended to be quite small. For the sixteen comparisons that were found to be

in the expected direction, the average difference between the correlations was only 0.04,

with a standard deviation of 0.025. For all 22 comparisons, including the six in which the

relationship was opposite of what was hypothesized, the difference between the

correlations was 0.02 in the hypothesized direction, with a standard deviation of 0.042.

The only relationship in which the difference was more than 0.06 in the expected

direction was that between Expressive Awareness and Depression. For this relationship,

the correlation between Time 1 Expressive Awareness and Time 2 Depression was 0.10

higher than the relationship between Time 2 Expressive Awareness and Time 1

Depression. However, even this difference was not statistically significant (p = 0.14).

Therefore, no significant relationships in the hypothesized direction were found.

Incremental Validity

In order to investigate whether these ACT processes had incremental value in

explaining psychopathology, personality, and functioning, partial correlations between

the ACT sum scores and these external measures were calculated, partialing out variance

explained by anxiety sensitivity, distress tolerance, discomfort intolerance, and coping

styles (see Tables A43-A45). Most of the partial correlations were in the low range, but

some noteworthy partial correlations emerged. The Inflexibility sum score had moderate-

to-high correlations with Depression (rs range from 0.29 to 0.40) and Neuroticism (rs

range from 0.21 to 0.39). Likewise, the Internalizing Belief sum score had notably high

partial correlations with Depression (rs range from 0.38 to 0.51). Additionally, Mental

Avoidance had moderate correlations with Depression (rs range from 0.19 to 0.26) and
 67

Neuroticism (rs range from 0.25 to 0.29). Perspective Taking had moderate partial

correlations with Neuroticism (rs range from -0.20 to -0.34). Expressive Awareness had

moderate partial correlations with Openness/Imagination (rs range from 0.15 to 0.29).

Finally, Physical Avoidance had moderate partial correlations with Extraversion (rs range

from -0.22 to -0.27). These results indicate some incremental value among the ACT Sum

Scores.

In order to further investigate the incremental validity of these ACT process

measures, squared multiple correlations were calculated between explanatory variables

and measures of psychopathology, personality, and functioning (see Tables A46-A48).

For all criterion variables, squared multiple correlations first calculated for measures of

anxiety sensitivity, distress tolerance, discomfort intolerance, and coping, then for the

eleven ACT sum scores, and then for all of the explanatory variables combined. It was

found that the ACT sum scores were nearly universally better than the combined ASI,

DTS, DIS, and COPE scores in explaining these criterion variables. On average, the ACT

sum scores explained ΔR2 = 0.056 more of the variance than the non-ACT measures for

the Mechanical Turk sample (SD = 0.070), ΔR2 = 0.059 for the Student Time 1 sample

(SD = 0.039), and ΔR2 = 0.042 for the Student Time 2 sample (SD = 0.058).

Furthermore, in addition to being slightly better explanatory variables by themselves, the

ACT sum scores added incremental power above and beyond measures of anxiety

sensitivity, distress tolerance, discomfort intolerance, and coping. On average, the

incremental value for the ACT sum scores was ΔR2 = 0.114 for the Mechanical Turk

sample (SD = 0.064), ΔR2 = 0.106 for the Student Time 1 sample (SD = 0.024), and ΔR2

= 0.102 for the Student Time 2 sample (SD = 0.034). These results indicate that the ACT
 68

processes are robust explanatory variables for personality, psychopathology, and

functioning.
 69

CHAPTER IV

DISCUSSION

The aim of this study was to investigate the interrelationships among ACT

process measures in order to determine whether the ACT Hexaflex model emerges when

using questionnaire measures, to determine the differential relationships between ACT

processes and other, similar constructs such as distress tolerance, anxiety sensitivity, and

coping styles, and to investigate whether ACT processes can be differentiated in self-

report format. Additionally, the psychometric properties of the measures, including test-

retest reliability and incremental validity, were to be investigated.

It was predicted that scales measuring ACT processes would be part of a

hierarchical structure, with a higher-order psychological flexibility factor and lower-order

factors consisting of Hexaflex processes such as acceptance vs. avoidance, values,

committed action, defusion, and present moment awareness. It was found that most of

these Hexaflex processes were distinguishable using factor analysis; however it was also

found that a simple correlated model fit the data better than a hierarchical model, and that

a questionnaire measure of values was only minimally related to measures of other ACT

processes. It was also hypothesized that the ACT process measures would have

differential relationships with measures of psychopathology, personality, and functioning.

In particular, it was hypothesized that avoidance/acceptance and cognitive fusion would

be highly associated with measures of internalizing and externalizing psychopathology

and neuroticism. It was found that factors related to inflexibility/cognitive fusion in

particular had high correlations with internalizing psychopathology, externalizing

psychopathology, and neuroticism. However, it is unclear to what extent these processes

were distinguishable from the frequency of suffering by participants. Mental avoidance

 70

was highly associated with internalizing psychopathology and neuroticism, but only

moderately associated with externalizing psychopathology. It was also predicted that

ACT process measures would have be distinguishable from and have incremental

explanatory power over processes such as anxiety sensitivity, distress tolerance,

discomfort intolerance, and coping styles. It was found that ACT process measures do

indeed have incremental validity over and above these measures when explaining

psychopathology, personality, and functioning.

Scale Relationships

This study examined correlations between scales in order to preliminarily

investigate the relationships between the processes under consideration. In particular,

these results can be used to begin to determine the overall structure and interrelationships

between the ACT process measures and other measures of interest.

High correlations were found between the AAQ (a measure of psychological

inflexibility), the CFQ (a measure of cognitive fusion), and the ATQ-B (another measure

of cognitive fusion and the believability of depressive thoughts). All three measures were

highly associated with measures of depression and frequency of depressive thoughts.

These results suggest that it might be difficult, if not impossible, to psychometrically

separate psychological inflexibility from cognitive fusion. Gillanders et al. (2013) suggest

that this is due to the structure of the Hexaflex model, as cognitive fusion is a facet of

psychological flexibility. However, it is noteworthy that other facets of inflexibility in the

Hexaflex model, such as measures of mindfulness and avoidance, have much more

modest associations with the AAQ. These results also suggest that participants have great

difficulty separating these processes from the frequency and intensity of suffering, or that
 71

current measures lack the specificity to make such a distinction. These results are

consistent with the findings of Gámez et al. (2010), who found that participants do not

make a distinction between experiential avoidance and psychological distress on self-

report measures.

The strong associations between these processes may indicate that these scales are

measuring the same hypothetical constructs. This would indicate that ACT measures may

not “exist” separately from psychopathology, but rather are simply facets of or alternative

names for more established constructs. Alternatively using a functional contextual

perspective, it is possible that these processes are distinct, but correlate highly because

they are under the control of the same contextual factors, or because one causes the other

(Hayes et al., 2012). For instance, an individual may report high cognitive fusion and

high depression because both are caused by the same genetic and social vulnerabilities, or

because the fusion has caused the depression. Because an explicit goal of ACT is to

weaken this contextual control, these relationships might weaken in individuals who have

received ACT interventions. More research is necessary to test this hypothesis.

Additionally, it is noteworthy that the associations between the AAQ and the

MEAQ subscales are moderate rather than strong. In the literature, the AAQ is sometimes

called a measure of experiential avoidance and sometimes a measure of psychological

inflexibility. The associations between the AAQ and the MEAQ are consistent with those

found by Gámez et al. (2011). These results suggest that the AAQ measure a broader

process than avoidance, and that it may better be conceptualized as a measure of

inflexibility rather than avoidance.

 72

Another striking finding when looking at simple scale correlations is that the

Valued Living Questionnaire scales have low correlations with process measures that are

thought to be theoretically connected in the Hexaflex model. This may be due to

psychometric weaknesses in the scale itself; the VLQ is often used as a clinical

instrument to help the ACT therapist and the client collaboratively explore the client’s

values. The VLQ may not be a good measure of client values without this collaboration.

Alternatively, the low associations may suggest a looser relationship between values and

other Hexaflex processes, such as acceptance and defusion. A third possibility is that the

relationship between chosen values and other processes of interest might be expected to

strengthen among individuals who have received an ACT intervention.

The Structure of ACT Processes

Another aim of the study was to investigate the structure of the ACT processes

under investigation in order to determine whether the Hexaflex model could be derived

structurally, and to investigate whether these processes were distinguishable. To this end,

exploratory factor analyses of ACT process measures were conducted at the scale level.

Items from scales defining each higher-order factor were further factor analyzed in order

to investigate possible hierarchical structure.

A stable, three-factor model found at the scale level across three samples suggests

that many of these processes are indeed distinguishable. This is a particularly important

finding because the three factors appear to correspond to Hexaflex processes; cognitive

fusion, present awareness, and avoidance were found to be distinguishable at the scale

level. The AAQ, which is typically said to be a measure of psychological inflexibility or

experiential avoidance, loaded on the fusion factor rather than the avoidance factor,
 73

suggesting that the scale is better conceptualized as a measure of psychological

inflexibility, and that this process cannot be distinguished from cognitive fusion when

using questionnaire measures. Overall, the Hexaflex model holds up quite well in this

initial factor analysis; three of the six ACT processes (fusion, awareness, and avoidance)

are represented. The VLQ scales, representing values, were not strongly associated with

other scales, and were therefore not well modeled by any factor. Self-as-context and

committed action likely did not emerge because they were underrepresented at the scale

level.

When the items in the scales representing each of these three factors are

themselves subjected to factor analysis, eleven stable lower-order factors emerge that can

be observed across the three study samples. The Inflexibility/Fusion factor can be broken

into an Inflexibility subfactor (defined by items from the AAQ, CFQ, and FFMQ

Nonjudge), an Internalizing Belief subfactor (defined by items from the ATQ-B), and a

detachment subfactor (defined mostly by items from the MAAS). These results further

suggest that the AAQ and the CFQ are either measuring the same process or measuring

two processes that are under such similar contextual control as to be indistinguishable

when assessed using questionnaire measures. Overall, these subfactors all seem

conceptually related to the ACT process of cognitive fusion.

The Awareness factor can be broken into four lower-order factors at the item

level, consisting of Perspective Taking (mostly defined by items from the EQ

Decentering scale), Expressive Awareness (defined by items from the FFMQ Describe

scale), Committed Action (defined by items from the MEAQ Distress Endurance scale),

and Physical Awareness (defined by items from the FFMQ Observe scale). These
 74

subfactors are important, as they may represent additional Hexaflex processes. The

Perspective Taking subfactor (defined by items such as “I can separate myself from my

thoughts and feelings” and “I can observe unpleasant feelings without being drawn into

them”) may be conceptually related to ACT’s self-as-context, or the self that exists

beyond ever-changing mental content. This facet is self is thought to be related to the

ability to flexibly shift perspectives (Foody, Barnes-Holmes, & Barnes-Holmes, 2012).

Additionally, the Committed Action subfactor, defined by some of the items from the

MEAQ Distress Endurance scale (example item: “When working on something

important, I won’t quit even if things get difficult”) appears to be measuring the ACT

Hexaflex process of committed action. Expressive Awareness and Physical Awareness

both appear to be facets of present moment awareness. Thus, these subfactors appear to

represent the Hexaflex processes of present moment awareness, self as context, and

committed action. It is unclear why committed action is most closely associated with

awareness and self-as-context, but it may be that the ability to be mindful and to

dissociate one’s sense of self from one’s unpleasant mental content is an important

prerequisite for engaging in committed action while feeling distress. If this is the case, it

would make conceptual sense for these three points of the Hexaflex to be strongly

related.

Finally, the Avoidance factor was found to consistently be composed of four

lower-order factors consisting of Physical Avoidance, Pain Aversion, Distraction, and

Mental Avoidance. Physical Avoidance, defined by some items from the MEAQ

Behavioral Avoidance scale, and Pain Aversion, defined by some items from the MEAQ

Distress Aversion scale, and Mental Avoidance, defined by items from the PHLMS
 75

Acceptance scale, seem to conceptually relate to the ACT Hexaflex process of

avoidance/acceptance. Distraction, defined by items from the MEAQ

Distraction/Suppression scale (sample item: “When upsetting memories come up, I try to

focus on other things”) also appears conceptually related to the Hexaflex process of

avoidance/acceptance, but may also be conceptually related to a lack of present

awareness.

Of the six points of the ACT Hexaflex, as many as five emerge in these item-level

factor analyses. Inflexibility/cognitive fusion, avoidance, mindful awareness, and

committed action all appear to be distinguishable at an item level. Additionally, self-as-

context may be related to the perspective taking factor that is defined by some items from

the EQ. Values did not emerge in the initial factor analysis due to the VLQ’s inability to

strongly correlate with other measures. It is possible that this is due to the process of

valuing being under the control of fundamentally different contextual factors compared

with the other ACT Hexaflex processes. Alternatively, it may be that the VLQ has low

construct validity, and is not properly measuring the process of valuing.

Characteristics of ACT Process Sum Scales

Another aim of the study was to investigate the nature of these ACT processes. To

this end, sum scores of the eleven lower-order scales were calculated, and their

interrelationships, external relationships, and longitudinal relationships were investigated.

In order to investigate the interrelationships between these process sum scores to

determine if a three-factor structure emerges, the scores were re-factor analyzed. Despite

emerging from the Avoidance higher-order factor, the Mental Avoidance sum score cross

loaded on Avoidance and Inflexibility/Fusion across all three samples. Likewise,

 76

Distraction appeared to cross-load with both the Awareness and the Avoidance higher-

order factors. Item-level confirmatory factor analysis suggests that a simple correlated

factor model better accounts for the data compared with a hierarchical model, even when

taking these cross loadings into account. These results suggest that these processes are all

highly interrelated. Whereas a hierarchical model might have suggested different

contextual factors controlling different groups of processes, these results suggest that the

contextual factors underlying these processes have significant overlap across the different

processes.

When examining the relationships between these ACT-related processes and

external variables, Inflexibility, Internalizing Beliefs, Detachment, and Mental Avoidance

are most strongly related to psychopathology and poor functioning. Again, it is likely that

common contextual factors account for these findings. Given that the study participants

have not undergone ACT interventions, the strong relationship between fusion-related

processes and measures of suffering and functioning makes conceptual sense in light of

the ACT model. The very nature of cognitive fusion is that individuals have difficulty

separating thoughts, symptoms, and personal identity. It is possible that these

relationships would be weaker among individuals who have experience with ACT

interventions (Hayes et al., 2012).

Notably, Perspective Taking, Expressive Awareness, and Committed Action were

only moderately associated with measures of psychopathology and functioning. These

associations were in the expected direction (greater awareness and committed action were

associated with less psychopathology and greater functioning), but the relationships were

not particularly strong compared with the Cognitive Fusion and Mental Avoidance’s
 77

relationships with these variables. Physical Awareness and Distraction fared even more

poorly, with essentially no association with psychopathology and functioning. These

results may indicate that Acceptance and Defusion are particularly important Hexaflex

processes for increasing levels of functioning. It also suggests that mindfulness exercises

may be particularly useful when they help clients to increase their ability to verbally

describe their ongoing experiences, as this facet of present awareness appears to be the

most highly associated with functioning.

Because the ACT model suggests that unnecessary suffering is caused by

experiential avoidance, cognitive fusion, and a conceptualized, non-mindful viewpoint,

longitudinal analyses were conducted in order to determine whether the ACT processes at

Time 1 predict psychopathology at Time 2. Although, on average, this pattern was

observed, the results were neither statistically nor clinically significant. These results may

be because the two week test-retest period is too short to detect cause and effect

relationships. Alternatively, it is possible that the ACT processes do not play the

hypothesized causal role, but rather vary along with psychopathology. To truly shed light

on the causal relationships between these processes, longer-term longitudinal studies

would be necessary.

Despite the test-retest interval likely being too short to examine cause and effect

relationships, the simple longitudinal course of the ACT processes under consideration is

informative. The ACT process sum scores were quite reliable over time compared with

many of the study scales. These results offer preliminary evidence that these processes

are “traitlike” in the sense of being relatively stable over time. The reliabilities compare

favorably to that of the Mini IPIP scales; however, it is possible that longer and more
 78

robust measures of the Big Five personality traits would show higher reliability

(Donnellan et al., 2006). The stability of these processes over time suggests that they

might function as a diathesis for the development of psychopathology. Longer-term

longitudinal research would be useful to investigate this question further.

This study also aimed to determine whether ACT process measures have

incremental validity for measures of psychopathology, personality, and functioning over

and above superficially similar measures such as distress tolerance, discomfort

intolerance, anxiety sensitivity, and coping styles. It was found that ACT process

measures do indeed have incremental value, particularly processes related to

Inflexibility/Cognitive Fusion (Inflexibility, Internalizing Beliefs, Detachment, and

Mental Avoidance). These results suggest that cognitive fusion may be particularly

differentiable from non-ACT processes. Overall, the eleven ACT sum scores had

significant incremental value when added to the combined ASI, DTS, DIS, and COPE (a

total of twelve scales) in explaining most of the external study variables, including

measures of internalizing and externalizing psychopathology, personality traits, and

functioning. These results indicate that these process measures are not merely slight

variations of these other constructs, but rather add unique information about individual

differences.

General Discussion

This study set out to determine the validity and utility of ACT process measures,

to determine whether these processes can be distinguished from one another when self-

report measures are used, and to investigate whether there is evidence for the ACT

Hexaflex model in the structure of these self-report measures. Strengths of this study
 79

include the use of two large samples, collection of two week longitudinal data, and the

inclusion of a number of assessment measures, including measures never before collected

together. Because of these strengths, this study was very well suited to answer questions

about the utility and validity of these ACT process measures.

Overall, the results were positive for these process measures. Measures of ACT

processes have incremental value above and beyond measures of seemingly similar

psychological processes such as anxiety sensitivity, distress tolerance, discomfort

intolerance, and coping styles. Further, it was found that the ACT measures were

assessing a number of distinguishable processes, including nearly all of the Hexaflex

processes. Cognitive fusion, acceptance/avoidance, present awareness, committed action,

and possibly self-as-context were all psychometrically distinguishable. Values, as

operationalized by the VLQ, were not strongly related to any other study measure,

including measures of ACT processes. The other ACT processes were related to some

degree. Many of these Hexaflex processes, such as avoidance, awareness, and fusion,

could be broken into several interrelated processes. Committed action and self-as-context

could not. This may be due to there being fewer items that were explicitly measuring

these two processes.

At the measure level, there was some conceptual overlap. Most notably, the AAQ

and the CFQ could not be distinguished from one another, either at the scale level or at

the item level. These two scales were therefore either measuring the same process or

were measuring two different processes (psychological inflexibility and cognitive fusion)

that were under such similar contextual control as to be indistinguishable.

 80

Because it is a measure of “psychological inflexibility,” which is placed at the

center of the Hexaflex, the AAQ is often used as a standalone measure of ACT-related

processes. Although this measure is likely important to include when conducting

outcomes research for ACT interventions, this study’s structural analyses suggest that it

does not fully measure a number of Hexaflex processes, including present moment

awareness, self-as-context, committed action, and acceptance/avoidance. This is

particularly interesting because the AAQ is often called a measure of experiential

avoidance; however, the results of this study suggest that it is much more closely related

to the ACT process of cognitive fusion, as it is nearly indistinguishable from the CFQ and

highly related to the ATQ-B. Additionally, these measures are strongly related to a

measure of depression. These results suggest that naïve test takers may not be able to

distinguish cognitive fusion from symptoms of depression.

Overall, in order to fully assess and track these Hexaflex processes, several

measures must be used. Some measures can be used to assess multiple Hexaflex

processes. The FFMQ can be used to measure both mindful awareness and

inflexibility/fusion; the MEAQ can be used to measure both acceptance/avoidance and

committed action; the PHLMS can be used to measure both mindful awareness and

acceptance/avoidance. However, no measure exists to fully assess all Hexaflex

constructs. Such a comprehensive ACT measure could be developed relatively easily, and

the current study suggests that the ACT Hexaflex processes can be readily differentiated

at the scale level. The current study offers clear guidance to distinguish four Hexaflex

processes. Acceptance (related to the current study’s Mental Avoidance subfactor),

Defusion (related to the Inflexibility subfactor), Committed Action (related to the

 81

Committed Action subfactor), and Present Moment Awareness (related to the Expressive

Awareness subfactor) are clearly modeled in this study. The current study may also offer

guidance for measuring Perspective Taking using a self-report measure; however, more

research is needed to confirm the hypothesis that such a measure is associated with the

Hexaflex process of self-as-context. Likewise, more research is needed to determine

whether Values can be fully modeled using self-report measures, and, if so, how this can

best be done.

The results of this study are relevant to future research. From a purely

measurement perspective, it demonstrates that ACT Hexaflex processes can be

distinguished at the scale level, and the most ACT outcome studies that only use the

AAQ to measure changes in participants are not assessing all relevant processes. It is

recommended that future outcome studies begin to take these findings into account by

more broadly assessing changes in Hexaflex processes.

The study also suggests a high association between psychological

inflexibility/cognitive fusion and depression, offering some confirmation to the findings

of Gámez et al. (2010) that naïve participants have difficulty distinguishing between ACT

processes and symptoms of psychopathology. Hayes et al. (2012) suggest that, since an

explicit goal of ACT is to loosen the associations between these processes, these relations

would change due to ACT interventions. Future research should test this hypothesis by

including a sample that has undergone ACT interventions. ACT interventions may also

change the relationships found in this study in other ways, such as by strengthening the

associations between self-reported values and other Hexaflex processes. A study in which
 82

the structure of these process measures was examined before and after an ACT

intervention would address many of these issues.

This study also included a two week longitudinal component in order to test

relationships over time. Although this demonstrated that the test-retest correlations for

ACT processes were robust, suggesting that they are more trait-like than state-like, causal

relationships between the ACT processes and measures of psychopathology could not be

established. This may be due to the short timeframe between the test and the retest.

Future research should examine whether ACT processes affect future psychopathology

by examining longer timeframes.

This study also did not examine behavioral measures of the Hexaflex processes.

Therefore, although incremental validity, convergent validity, and discriminant validity

could be examined, full construct validity for these process measures has not been

established. Although it has been established that these processes are distinguishable and

that self-report measures of these processes have incremental validity, in future research

it would be fruitful to examine differential correlates between ACT process measures and

behavioral measures. Some such research has already been done. For example, Gratz et

al. (2006) found that a behavioral measure of willingness to experience distress correlated

r = -0.76 with the AAQ. Testing whether this relationship is stronger than that between

the behavioral measure and a measure of depression or internalizing psychopathology

would investigate whether psychological inflexibility is psychometrically distinguishable

from psychopathology measures in this context. Mindfulness analogue behavioral

measures have also been tested; Frewen, Evans, Maraj, Dozois, and Partridge (2008)

examined a mindfulness behavioral measure in which participants’ level of mindfulness

 83

was periodically queried during a mindful meditation exercise. This behavioral measure

had only a modest (r = 0.34) association with the MAAS. Overall, there has been limited

research to compare whether such measures are more valid or reliable than self-report

measures.

Conclusion

The current study had multiple strengths, including two large independent

samples, a longitudinal component, and a large number of scales to fully investigate the

structure, incremental validity, stability over time, and clinical utility of ACT process

measures. It was found that the ACT Hexaflex model could largely be recreated

structurally, with acceptance/avoidance, cognitive fusion, mindful awareness, committed

action, and self-as-context all being differentiable at an item level. Values, as

operationalized by the VLQ, were not related to the other processes. These processes

were differentiable and had incremental validity when explaining measures of

psychopathology, personality, and functioning. It was also found that these processes

were stable and had high reliabilities over time. It was also found that measures of

psychological inflexibility and cognitive fusion had very strong relationships with a

measure of depression, leading to questions of whether naïve participants could

distinguish between this ACT process and psychological distress in a self-report format.

It is possible that this relationship would be weakened in participants who have

undergone an ACT intervention due to the weakening of cognitive fusion’s contextual

control on symptoms of depression. Additionally, it was found that most ACT outcome

studies only poorly measure these ACT processes; most such studies use the AAQ-II,

which, of the ACT Hexaflex processes, is most closely related to cognitive fusion. Other
 84

measures may be used to more completely track the changes caused by these

interventions. Future research should also investigate how well these process measures

correspond with behavioral measures.

 85

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 97

APPENDIX A

TABLES
 98

Table A1. Mechanical Turk Univariate Statistics

Variable N Mean SD Alpha

AAQ 344 22.11 9.07 0.89
ASI Mental 342 4.62 3.94 0.84
ASI Physical 342 11.60 7.11 0.87
ASI Social 342 6.35 2.44 0.48
ASI total 342 24.06 12.52 0.91
ATQ Believability 333 66.69 26.70 0.97
ATQ Frequency 333 61.59 24.68 0.97
CFQ 330 46.00 11.44 0.79
COPE Active Coping 323 51.29 9.64 0.88
COPE Avoidant Coping 324 23.10 6.88 0.86
COPE Emotion Focused Coping 324 19.41 5.37 0.83
DIS Discomfort Avoidance 323 9.20 3.90 0.68
DIS Discomfort Tolerance 323 6.25 3.17 0.82
DTS Absorbtion 320 9.45 3.18 0.79
DTS Appraisal 320 19.83 5.36 0.80
DTS Regulation 320 8.59 3.13 0.79
DTS Tolerance 320 9.44 2.95 0.71
Experiences Decentering 321 36.46 6.78 0.82
Externalizing 318 39.16 9.81 0.88
FFMQ Act with Awareness 315 27.94 6.76 0.89
FFMQ Describe 315 27.29 6.34 0.85
FFMQ Nonjudge 315 26.01 6.31 0.85
FFMQ Nonreact 315 21.56 4.72 0.79
FFMQ Observe 315 26.37 6.19 0.82
IPIP Agreeableness 309 14.63 3.72 0.77
IPIP Conscientiousness 309 14.52 3.29 0.64
IPIP Extraversion 309 11.39 3.74 0.72
IPIP Openness 309 14.89 3.39 0.69
IPIP Neuroticism 309 11.25 3.48 0.62
K10 313 23.21 8.43 0.92
MAAS 309 62.70 13.61 0.90
MEAQ Behavior Avoidance 312 41.58 10.60 0.88
MEAQ Distraction/Suppression 312 28.60 6.85 0.84
MEAQ Distress Aversion 312 50.63 12.22 0.87
MEAQ Distress Endurance 311 46.46 9.90 0.87
MEAQ Procrastination 311 23.70 6.85 0.80
MEAQ Repression/Denial 312 37.75 12.73 0.88
 99

Table A1. Continued

Variable N Mean SD Alpha

PHLMS Acceptance 306 31.21 7.36 0.85
PHLMS Awareness 307 36.20 6.69 0.85
VLQ Consistence 303 71.12 17.29 0.87
VLQ Importance 303 75.67 16.06 0.85
WBSI 306 49.56 11.11 0.91
WHODAS Understand/Comm 305 13.17 5.75 0.91
WHODAS Getting Along 305 11.10 4.87 0.84
WHODAS Life Activities 305 9.27 4.17 0.93
WHODAS Work/School 274 9.29 4.16 0.92
VRIN 334 10.04 3.65 0.48
Note. AAQ = Acceptance and Action Questionnaire; ASI = Anxiety
Sensitivity Index; ATQ = Automatic Thoughts Questionnaire; CFQ =
Cognitive Fusion Questionnaire; DIS = Discomfort Intolerance Scale;
DTS = Distress Tolerance Scale; FFMQ = Five Facet Mindfulness
Questionnaire; IPIP = International Personality Item Pool; K10 = Kessler
Psychological Distress Scale; MAAS = Mindful Attention Awareness
Scale; MEAQ = Multidimensional Experiential Avoidance
Questionnaire; PHLMS = Philadelphia Mindfulness Scale; VLQ =
Valued Living Questionnaire; WBSI = White Bear Suppression
Inventory; WHODAS = World Health Organization Disability
Assessment; VRIN = Variable Response Inventory
Table A2. Student Univariate Statistics

Student Time 1 Student Time 2

Variable N Mean SD Alpha N Mean SD Alpha
AAQ 482 18.49 8.30 0.91 339 17.51 8.26 0.92
ASI Mental 482 3.00 3.18 0.81 338 3.01 3.29 0.85
ASI Physical 482 9.06 6.39 0.86 339 8.45 6.44 0.89
ASI Social 482 5.69 2.20 0.42 339 4.91 2.36 0.54
ASI total 482 19.11 10.54 0.88 339 17.60 11.22 0.91
ATQ believability 481 54.63 22.27 0.97 339 52.88 23.65 0.98
ATQ frequency 481 51.88 20.67 0.97 339 51.47 22.69 0.98
CFQ 482 44.64 10.75 0.80 340 43.08 11.07 0.80
COPE Active Coping 483 50.88 8.63 0.87 336 49.49 9.34 0.89
COPE Avoidant Coping 483 20.78 5.41 0.83 338 20.80 5.45 0.82
COPE Emotion Focused Coping 483 20.48 5.71 0.88 336 20.21 5.69 0.88
DIS Discomfort Avoidance 483 8.33 3.51 0.72 339 8.16 3.40 0.73
DIS Discomfort Tolerance 483 7.10 3.00 0.88 339 6.82 3.06 0.91
DTS Absorbtion 482 10.20 2.96 0.80 339 10.37 3.00 0.83
DTS Appraisal 482 21.73 5.12 0.85 339 21.69 5.19 0.86
DTS Regulation 482 9.68 2.79 0.79 338 9.99 2.58 0.75
DTS Tolerance 482 10.30 2.87 0.79 339 10.61 3.01 0.85
Experiences Decentering 482 36.94 6.06 0.84 339 36.38 5.95 0.83

100
Externalizing 482 35.23 7.23 0.81 339 34.78 7.67 0.85
Table A2. Continued

Student Time 1 Student Time 2

Variable N Mean SD Alpha N Mean SD Alpha
FFMQ Act with Awareness 481 26.47 5.37 0.87 338 26.22 5.61 0.89
FFMQ Describe 480 26.69 4.88 0.81 338 26.45 5.31 0.86
FFMQ Nonjudge 480 27.05 6.59 0.91 338 27.97 6.28 0.92
FFMQ Nonreact 480 20.94 3.79 0.73 338 20.87 4.02 0.79
FFMQ Observe 481 24.93 5.12 0.79 338 24.64 5.68 0.85
IPIP Agreeableness 482 15.45 2.90 0.69 340 15.20 3.06 0.76
IPIP Conscientiousness 482 14.41 3.15 0.69 340 14.48 3.14 0.74
IPIP Extraversion 482 12.96 3.60 0.80 340 13.02 3.56 0.82
IPIP Openness 482 14.20 2.86 0.66 340 13.93 2.91 0.70
IPIP Neuroticism 482 11.02 3.19 0.66 340 11.00 2.99 0.65
K10 482 20.83 6.92 0.89 340 20.29 7.20 0.92
MAAS 482 59.61 11.60 0.89 340 59.36 12.16 0.90
MEAQ Behavior Avoidance 482 36.43 8.62 0.84 340 35.29 8.82 0.88
MEAQ Distraction/Suppression 481 26.12 6.38 0.87 340 25.19 6.35 0.89
MEAQ Distress Aversion 482 43.77 10.64 0.85 340 40.85 10.40 0.87
MEAQ Distress Endurance 481 48.09 8.17 0.84 340 46.68 9.49 0.90
MEAQ Procrastination 481 23.70 6.42 0.83 340 22.80 6.30 0.83
MEAQ Repression/Denial 481 33.61 10.41 0.87 340 34.32 10.74 0.88
PHLMS Acceptance 482 29.48 7.01 0.88 340 28.54 7.05 0.90
PHLMS Awareness 482 34.63 5.82 0.81 340 33.74 6.61 0.87
VLQ Consistence 482 69.02 14.51 0.77 340 71.18 15.01 0.83

101
VLQ Importance 482 79.92 12.57 0.83 340 78.55 13.97 0.87
Table A2. Continued

Student Time 1 Student Time 2

Variable N Mean SD Alpha N Mean SD Alpha
WBSI 482 47.32 12.36 0.93 340 44.67 12.37 0.94
WHODAS Understand/Comm 482 10.90 3.81 0.82 340 10.87 4.08 0.87
WHODAS Getting Along 482 8.52 3.50 0.79 340 8.69 3.68 0.82
WHODAS Life Activities 482 6.93 3.16 0.89 340 7.02 3.19 0.92
WHODAS Work/School 458 8.55 3.30 0.88 323 8.14 3.38 0.90
VRIN 485 9.55 3.42 0.57 342 9.54 3.80 0.65
Note. AAQ = Acceptance and Action Questionnaire; ASI = Anxiety Sensitivity Index; ATQ =
Automatic Thoughts Questionnaire; CFQ = Cognitive Fusion Questionnaire; DIS = Discomfort
Intolerance Scale; DTS = Distress Tolerance Scale; FFMQ = Five Facet Mindfulness Questionnaire;
IPIP = International Personality Item Pool; K10 = Kessler Psychological Distress Scale; MAAS =
Mindful Attention Awareness Scale; MEAQ = Multidimensional Experiential Avoidance
Questionnaire; PHLMS = Philadelphia Mindfulness Scale; VLQ = Valued Living Questionnaire;
WBSI = White Bear Suppression Inventory; WHODAS = World Health Organization Disability
Assessment; VRIN = Variable Response Inventory

102
 103

Table A3. Cohen's d Statistics

T1-T2 Differences T1-MT Differences

Variable d (95% CI) d (95% CI)
AAQ 0.12 (-0.62, 1.00) -0.42 (-1.16, 0.54)
ASI Mental 0.00 (-0.29, 0.35) -0.46 (-0.75, -0.05)*
ASI Physical 0.09 (-0.48, 0.78) -0.38 (-0.95, 0.37)
ASI Social 0.34 (0.15, 0.60)* -0.29 (-0.48, -0.03)
ASI total 0.14 (-0.80, 1.33) -0.43 (-1.37, 0.89)
ATQ believability 0.08 (-1.91, 2.59) -0.50 (-2.49, 2.37)
ATQ frequency 0.02 (-1.83, 2.43) -0.43 (-2.28, 2.22)
CFQ 0.14 (-0.82, 1.32) -0.12 (-1.08, 1.11)
COPE Active Coping 0.16 (-0.61, 1.15) -0.05 (-0.82, 1.01)
COPE Avoidant Coping 0.00 (-0.49, 0.58) -0.38 (-0.87, 0.36)
COPE Em Focused Coping 0.05 (-0.46, 0.65) 0.19 (-0.32, 0.78)
DIS Discomfort Avoidance 0.05 (-0.26, 0.41) -0.24 (-0.55, 0.19)
DIS Discomfort Tolerance 0.09 (-0.18, 0.42) 0.28 (0.01, 0.62)*
DTS Absorbtion -0.06 (-0.32, 0.26) 0.25 (-0.02, 0.59)
DTS Appraisal 0.01 (-0.45, 0.56) 0.37 (-0.09, 0.95)
DTS Regulation -0.11 (-0.36, 0.16) 0.37 (0.13, 0.72)*
DTS Tolerance -0.10 (-0.36, 0.22) 0.30 (0.04, 0.62)*
Experiences Decentering 0.09 (-0.45, 0.73) 0.08 (-0.47, 0.82)
Externalizing 0.06 (-0.58, 0.88) -0.47 (-1.12, 0.61)
FFMQ Act with Awareness 0.05 (-0.43, 0.64) -0.25 (-0.73, 0.50)
FFMQ Describe 0.05 (-0.39, 0.61) -0.11 (-0.55, 0.59)
FFMQ Nonjudge -0.14 (-0.73, 0.53) 0.16 (-0.43, 0.86)
FFMQ Nonreact 0.02 (-0.32, 0.45) -0.15 (-0.49, 0.37)
FFMQ Observe 0.05 (-0.40, 0.66) -0.26 (-0.72, 0.42)
IPIP Agreeableness 0.08 (-0.18, 0.41) 0.25 (-0.01, 0.67)
IPIP Conscientiousness -0.02 (-0.30, 0.31) -0.03 (-0.31, 0.33)
IPIP Extraversion -0.02 (-0.34, 0.36) 0.43 (0.11, 0.85)*
IPIP Openness 0.09 (-0.16, 0.40) -0.23 (-0.48, 0.15)
IPIP Neuroticism 0.01 (-0.28, 0.32) -0.07 (-0.35, 0.32)
K10 0.08 (-0.54, 0.84) -0.32 (-0.93, 0.62)
MAAS 0.02 (-1.01, 1.31) -0.25 (-1.28, 1.27)
 104

Table A3. Continued

T1-T2 Differences T1-MT Differences

Variable d (95% CI) d (95% CI)
MEAQ Behavior
Avoidance 0.13 (-0.64, 1.07) -0.55 (-1.32, 0.63)
MEAQ
Distraction/Suppression 0.15 (-0.42, 0.82) -0.38 (-0.95, 0.38)
MEAQ Distress Aversion 0.28 (-0.67, 1.38) -0.61 (-1.56, 0.75)
MEAQ Distress Endurance 0.16 (-0.57, 1.17) 0.18 (-0.55, 1.28)
MEAQ Procrastination 0.14 (-0.43, 0.81) 0.00 (-0.57, 0.76)
MEAQ Repression/Denial -0.07 (-1.00, 1.07) -0.36 (-1.29, 1.05)
PHLMS Acceptance 0.13 (-0.49, 0.88) -0.24 (-0.87, 0.58)
PHLMS Awareness 0.14 (-0.37, 0.85) -0.25 (-0.77, 0.49)
VLQ Consistence -0.15 (-1.44, 1.45) -0.13 (-1.43, 1.81)
VLQ Importance 0.10 (-1.02, 1.59) 0.30 (-0.82, 2.11)
WBSI 0.21 (-0.89, 1.53) -0.19 (-1.29, 1.06)
WHODAS
Understand/Commun 0.01 (-0.33, 0.44) -0.49 (-0.83, 0.16)
WHODAS Getting Along -0.05 (-0.36, 0.34) -0.63 (-0.95, -0.09)*
WHODAS Life Activities -0.03 (-0.31, 0.31) -0.65 (-0.94, -0.19)*
WHODAS Work/School 0.12 (-0.18, 0.49) -0.20 (-0.51, 0.29)
VRIN 0.00 (-0.30, 0.41) -0.14 (-0.44, 0.25)
Note. * denotes statistically significant d values. T1 and T2 = Students Time 1 and
Time 2; MT = Mechanical Turk. AAQ = Acceptance and Action Questionnaire; ASI =
Anxiety Sensitivity Index; ATQ = Automatic Thoughts Questionnaire; CFQ =
Cognitive Fusion Questionnaire; DIS = Discomfort Intolerance Scale; DTS = Distress
Tolerance Scale; FFMQ = Five Facet Mindfulness Questionnaire; IPIP = International
Personality Item Pool; K10 = Kessler Psychological Distress Scale; MAAS = Mindful
Attention Awareness Scale; MEAQ = Multidimensional Experiential Avoidance
Questionnaire; PHLMS = Philadelphia Mindfulness Scale; VLQ = Valued Living
Questionnaire; WBSI = White Bear Suppression Inventory; WHODAS = World Health
Organization Disability Assessment; VRIN = Variable Response Inventory
Table A4. Correlations among ACT scales--Mechanical Turk

1 2 3 4 5 6 7 8
1. AAQ --
2. ATQ Believability 0.73 --
3. CFQ 0.73 0.68 --
4. EQ decentering -0.29 -0.24 -0.44 --
5. FFMQ Observe 0.05 0.12 0.10 0.38 --
6. FFMQ Describe -0.35 -0.25 -0.27 0.36 0.30 --
7. FFMQ Act with Awareness -0.61 -0.56 -0.61 0.27 -0.02 0.37 --
8. FFMQ Nonjudge -0.52 -0.53 -0.55 0.08 -0.35 0.18 0.52 --
9. FFMQ Nonreact -0.11 -0.02 -0.28 0.61 0.32 0.23 -0.01 -0.08
10. MEAQ Behavior Avoidance 0.32 0.24 0.35 -0.03 0.16 -0.12 -0.25 -0.43
11. MEAQ Distress Aversion 0.26 0.23 0.32 -0.01 0.22 0.03 -0.16 -0.44
12. MEAQ Procrastination 0.48 0.39 0.48 -0.25 -0.04 -0.36 -0.53 -0.40
13. MEAQ Distraction/Suppression 0.00 0.00 -0.02 0.31 0.29 0.06 0.04 -0.29
14. MEAQ Repression/Denial 0.46 0.44 0.39 -0.06 -0.07 -0.44 -0.52 -0.45
15. MEAQ Distress Endurance -0.26 -0.21 -0.30 0.52 0.33 0.31 0.20 0.02
16. MAAS -0.49 -0.44 -0.52 0.47 0.27 0.40 0.61 0.25
17. PHLMS Awareness -0.04 0.01 -0.01 0.44 0.68 0.40 0.14 -0.20
18. PHLMS Acceptance 0.38 0.34 0.36 0.07 0.27 -0.13 -0.33 -0.60
19. WBSI 0.55 0.46 0.59 -0.20 0.18 -0.25 -0.46 -0.57
20. VLQ Importance -0.21 -0.16 -0.17 0.31 0.21 0.16 0.20 -0.08
21. VLQ Consistence -0.14 -0.15 -0.21 0.33 0.15 0.22 0.21 0.03

105
Table A4. Continued

9 10 11 12 13 14 15 16
9. FFMQ Nonreact --
10. MEAQ Behavior Avoidance 0.06 --
11. MEAQ Distress Aversion 0.02 0.70 --
12. MEAQ Procrastination -0.12 0.50 0.34 --
13. MEAQ Distraction/Suppression 0.30 0.56 0.58 0.18 --
14. MEAQ Repression/Denial 0.10 0.37 0.27 0.52 0.14 --
15. MEAQ Distress Endurance 0.53 0.03 0.09 -0.29 0.44 -0.11 --
16. MAAS 0.23 -0.07 0.04 -0.37 0.19 -0.44 0.35 --
17. PHLMS Awareness 0.37 0.22 0.25 -0.10 0.40 -0.20 0.50 0.37
18. PHLMS Acceptance 0.13 0.55 0.56 0.39 0.63 0.36 0.15 -0.09
19. WBSI -0.05 0.54 0.54 0.48 0.44 0.42 0.02 -0.30
20. VLQ Importance 0.13 0.06 0.19 -0.06 0.32 0.03 0.18 0.23
21. VLQ Consistence 0.15 0.08 0.11 -0.09 0.17 0.04 0.13 0.19

106
Table A4. Continued

17 18 19 20 21
17. PHLMS Awareness --
18. PHLMS Acceptance 0.38 --
19. WBSI 0.20 0.72 --
20. VLQ Importance 0.23 0.13 0.01 --
21. VLQ Consistence 0.17 0.00 -0.06 0.63 --
Note. Ns range from 302 to 333. AAQ = Acceptance and Action Questionnaire; ATQ =
Automatic Thoughts Questionnaire; CFQ = Cognitive Fusion Questionnaire; FFMQ =
Five Facet Mindfulness Questionnaire; MAAS = Mindful Attention Awareness Scale;
MEAQ = Multidimensional Experiential Avoidance Questionnaire; PHLMS =
Philadelphia Mindfulness Scale; VLQ = Valued Living Questionnaire; WBSI = White
Bear Suppression Inventory

107
Table A5. Correlations among ACT scales--Student Time 1

1 2 3 4 5 6 7 8
1. AAQ --
2. ATQ Believability 0.70 --
3. CFQ 0.72 0.62 --
4. EQ decentering -0.41 -0.31 -0.50 --
5. FFMQ Observe 0.14 0.18 0.14 0.16 --
6. FFMQ Describe -0.30 -0.22 -0.29 0.36 0.19 --
7. FFMQ Act with Awareness -0.44 -0.40 -0.42 0.20 -0.24 0.24 --
8. FFMQ Nonjudge -0.58 -0.53 -0.64 0.32 -0.30 0.24 0.46 --
9. FFMQ Nonreact -0.10 -0.07 -0.27 0.46 0.33 0.26 -0.06 0.06
10. MEAQ Behavior Avoidance 0.32 0.25 0.32 -0.16 0.05 -0.21 -0.33 -0.33
11. MEAQ Distress Aversion 0.43 0.34 0.44 -0.19 0.13 -0.18 -0.33 -0.44
12. MEAQ Procrastination 0.36 0.29 0.26 -0.22 0.08 -0.26 -0.52 -0.27
13. MEAQ Distraction/Suppression 0.22 0.11 0.22 -0.05 0.09 -0.09 -0.26 -0.34
14. MEAQ Repression/Denial 0.37 0.32 0.33 -0.16 -0.05 -0.55 -0.44 -0.40
15. MEAQ Distress Endurance -0.14 -0.13 -0.20 0.36 0.29 0.29 0.14 0.06
16. MAAS -0.39 -0.36 -0.44 0.28 -0.11 0.29 0.67 0.40
17. PHLMS Awareness 0.04 0.06 0.05 0.24 0.59 0.29 -0.11 -0.12
18. PHLMS Acceptance 0.51 0.45 0.60 -0.25 0.22 -0.22 -0.45 -0.65
19. WBSI 0.54 0.45 0.60 -0.34 0.24 -0.22 -0.49 -0.59
20. VLQ Importance -0.12 -0.13 -0.07 0.20 0.07 0.16 0.06 0.09
21. VLQ Consistence -0.23 -0.20 -0.21 0.34 0.04 0.21 0.16 0.14

108
Table A5. Continued

9 10 11 12 13 14 15 16
9. FFMQ Nonreact --
10. MEAQ Behavior Avoidance -0.10 --
11. MEAQ Distress Aversion -0.13 0.57 --
12. MEAQ Procrastination -0.04 0.51 0.34 --
13. MEAQ Distraction/Suppression -0.02 0.46 0.56 0.20 --
14. MEAQ Repression/Denial -0.09 0.41 0.40 0.41 0.27 --
15. MEAQ Distress Endurance 0.33 -0.23 -0.09 -0.25 0.15 -0.29 --
16. MAAS -0.01 -0.20 -0.24 -0.39 -0.19 -0.40 0.14 --
17. PHLMS Awareness 0.24 0.05 0.08 0.03 0.09 -0.21 0.30 0.06
18. PHLMS Acceptance -0.13 0.37 0.54 0.31 0.58 0.40 -0.01 -0.40
19. WBSI -0.11 0.28 0.41 0.33 0.41 0.29 0.03 -0.53
20. VLQ Importance -0.03 -0.07 0.10 -0.16 0.17 -0.19 0.26 0.16
21. VLQ Consistence 0.12 -0.05 -0.05 -0.21 0.06 -0.13 0.19 0.25

109
Table A5. Continued

17 18 19 20 21
17. PHLMS Awareness --
18. PHLMS Acceptance 0.28 --
19. WBSI 0.21 0.71 --
20. VLQ Importance 0.13 0.02 0.00 --
21. VLQ Consistence 0.09 -0.10 -0.18 0.47 --
Note. Ns range from 478 to 481. AAQ = Acceptance and Action Questionnaire; ATQ =
Automatic Thoughts Questionnaire; CFQ = Cognitive Fusion Questionnaire; FFMQ = Five
Facet Mindfulness Questionnaire; MAAS = Mindful Attention Awareness Scale; MEAQ =
Multidimensional Experiential Avoidance Questionnaire; PHLMS = Philadelphia Mindfulness
Scale; VLQ = Valued Living Questionnaire; WBSI = White Bear Suppression Inventory

110
Table A6. Correlations among ACT scales--Student Time 2

1 2 3 4 5 6 7 8
1. AAQ --
2. ATQ Believability 0.68 --
3. CFQ 0.76 0.67 --
4. EQ decentering -0.44 -0.38 -0.49 --
5. FFMQ Observe 0.12 0.18 0.12 0.33 --
6. FFMQ Describe -0.36 -0.32 -0.37 0.45 0.32 --
7. FFMQ Act with Awareness -0.45 -0.38 -0.50 0.21 -0.26 0.26 --
8. FFMQ Nonjudge -0.57 -0.46 -0.69 0.26 -0.25 0.25 0.49 --
9. FFMQ Nonreact -0.15 -0.14 -0.33 0.56 0.42 0.32 -0.06 0.02
10. MEAQ Behavior Avoidance 0.45 0.29 0.42 -0.21 0.11 -0.28 -0.37 -0.40
11. MEAQ Distress Aversion 0.47 0.30 0.42 -0.23 0.09 -0.20 -0.32 -0.43
12. MEAQ Procrastination 0.49 0.40 0.44 -0.25 0.12 -0.34 -0.56 -0.37
13. MEAQ Distraction/Suppression 0.36 0.17 0.36 -0.12 0.15 -0.09 -0.27 -0.42
14. MEAQ Repression/Denial 0.46 0.43 0.44 -0.30 -0.10 -0.56 -0.38 -0.39
15. MEAQ Distress Endurance -0.18 -0.22 -0.25 0.39 0.26 0.42 0.16 0.13
16. MAAS -0.46 -0.39 -0.49 0.32 -0.05 0.37 0.67 0.39
17. PHLMS Awareness -0.01 0.00 -0.03 0.39 0.69 0.41 -0.09 -0.11
18. PHLMS Acceptance 0.56 0.40 0.60 -0.23 0.23 -0.21 -0.45 -0.68
19. WBSI 0.57 0.41 0.62 -0.27 0.16 -0.22 -0.47 -0.60
20. VLQ Importance -0.18 -0.29 -0.16 0.20 0.01 0.19 0.12 0.09
21. VLQ Consistence -0.27 -0.27 -0.22 0.18 -0.02 0.25 0.23 0.15

111
Table A6. Continued

9 10 11 12 13 14 15 16
9. FFMQ Nonreact --
10. MEAQ Behavior Avoidance -0.08 --
11. MEAQ Distress Aversion -0.13 0.66 --
12. MEAQ Procrastination -0.05 0.57 0.46 --
13. MEAQ Distraction/Suppression 0.01 0.57 0.65 0.41 --
14. MEAQ Repression/Denial -0.09 0.47 0.44 0.53 0.27 --
15. MEAQ Distress Endurance 0.35 -0.14 -0.08 -0.16 0.23 -0.32 --
16. MAAS 0.08 -0.27 -0.23 -0.44 -0.18 -0.45 0.24 --
17. PHLMS Awareness 0.37 0.03 0.06 -0.02 0.15 -0.27 0.40 0.16
18. PHLMS Acceptance -0.06 0.48 0.54 0.45 0.62 0.39 -0.02 -0.35
19. WBSI -0.10 0.45 0.47 0.46 0.57 0.37 0.07 -0.45
20. VLQ Importance -0.01 0.01 0.11 -0.10 0.15 -0.15 0.15 0.28
21. VLQ Consistence 0.00 -0.05 0.01 -0.20 0.06 -0.16 0.12 0.33

112
Table A6. Continued

17 18 19 20 21
17. PHLMS Awareness --
18. PHLMS Acceptance 0.29 --
19. WBSI 0.13 0.73 --
20. VLQ Importance 0.17 -0.01 -0.06 --
21. VLQ Consistence 0.12 -0.13 -0.16 0.61 --
Note. Ns range from 337 to 340. AAQ = Acceptance and Action Questionnaire; ATQ =
Automatic Thoughts Questionnaire; CFQ = Cognitive Fusion Questionnaire; FFMQ = Five
Facet Mindfulness Questionnaire; MAAS = Mindful Attention Awareness Scale; MEAQ =
Multidimensional Experiential Avoidance Questionnaire; PHLMS = Philadelphia Mindfulness
Scale; VLQ = Valued Living Questionnaire; WBSI = White Bear Suppression Inventory

113
 114

Table A7. Correlations among non-ACT scales--Mechanical Turk

1 2 3 4 5
1. ASI Physical --
2. ASI Mental 0.72 --
3. ASI Social 0.48 0.43 --
4. ATQ Frequency 0.50 0.56 0.24 --
5. COPE Active Coping -0.08 -0.04 0.09 -0.21 --
6. COPE Emotion-Focused Coping 0.28 0.34 0.17 0.25 0.32
7. COPE Avoidant Coping 0.43 0.53 0.22 0.50 0.08
8. DIS Tolerance -0.04 0.01 0.02 0.03 0.20
9. DIS Avoidance 0.24 0.29 0.16 0.03 0.13
10. DTS Tolerance -0.23 -0.25 -0.19 -0.18 0.21
11. DTS Appraisal -0.40 -0.41 -0.22 -0.44 0.30
12. DTS Absorbtion -0.32 -0.33 -0.19 -0.31 0.25
13. DTS Regulation -0.19 -0.22 -0.30 -0.06 0.01
14. Externalizing 0.42 0.46 0.21 0.55 -0.15
15. K10 0.49 0.55 0.23 0.79 -0.23
16. IPIP Extraversion -0.07 -0.01 -0.03 -0.22 0.24
17. IPIP Agreeableness -0.05 -0.13 0.04 -0.15 0.25
18. IPIP Conscientiousness -0.30 -0.34 -0.08 -0.42 0.24
19. IPIP Neuroticism 0.33 0.37 0.12 0.52 -0.39
20. IPIP Openness -0.24 -0.28 -0.05 -0.24 0.18
21. WHODAS Understand/Comm 0.42 0.57 0.22 0.56 -0.13
22. WHODAS Getting Along 0.38 0.46 0.20 0.51 -0.16
23. WHODAS Life Activities 0.31 0.41 0.13 0.46 -0.15
24. WHODAS Work/School 0.30 0.45 0.16 0.46 -0.12
25. VRIN 0.18 0.22 0.25 0.19 -0.15
Table A7. Continued

6 7 8 9 10 11 12 13
6. COPE Emotion-Focused Coping --
7. COPE Avoidant Coping 0.49 --
8. DIS Tolerance 0.00 0.03 --
9. DIS Avoidance 0.09 0.12 -0.08 --
10. DTS Tolerance -0.12 -0.15 0.24 -0.03 --
11. DTS Appraisal -0.17 -0.36 0.16 0.01 0.64 --
12. DTS Absorbtion -0.19 -0.30 0.18 -0.05 0.70 0.78 --
13. DTS Regulation -0.10 -0.06 0.11 -0.10 0.44 0.44 0.48 --
14. Externalizing 0.20 0.47 0.02 0.01 -0.12 -0.35 -0.27 -0.05
15. K10 0.31 0.57 0.06 0.01 -0.24 -0.51 -0.43 -0.09
16. IPIP Extraversion 0.17 -0.06 0.07 0.07 0.11 0.17 0.20 0.00
17. IPIP Agreeableness 0.24 -0.13 0.08 0.09 0.15 0.14 0.13 -0.01
18. IPIP Conscientiousness -0.11 -0.40 0.04 0.05 0.22 0.29 0.30 0.04
19. IPIP Neuroticism 0.16 0.28 -0.06 -0.04 -0.38 -0.52 -0.48 -0.20
20. IPIP Openness -0.12 -0.26 0.11 0.00 0.13 0.19 0.14 0.01
21. WHODAS Understand/Comm 0.33 0.62 0.03 0.05 -0.17 -0.39 -0.25 -0.10
22. WHODAS Getting Along 0.22 0.55 0.05 0.03 -0.16 -0.37 -0.29 -0.11
23. WHODAS Life Activities 0.25 0.46 0.00 0.05 -0.17 -0.30 -0.25 -0.10
24. WHODAS Work/School 0.24 0.52 0.01 0.07 -0.15 -0.33 -0.24 -0.08
25. VRIN 0.08 0.31 -0.06 -0.02 -0.13 -0.24 -0.22 -0.18

115
Table A7. Continued

14 15 16 17 18 19 20 21
14. Externalizing --
15. K10 0.60 --
16. IPIP Extraversion -0.01 -0.18 --
17. IPIP Agreeableness -0.31 -0.17 0.27 --
18. IPIP Conscientiousness -0.47 -0.45 0.13 0.28 --
19. IPIP Neuroticism 0.27 0.62 -0.32 -0.14 -0.34 --
20. IPIP Openness -0.39 -0.29 0.08 0.36 0.27 -0.19 --
21. WHODAS Understand/Comm 0.56 0.63 0.08 -0.21 -0.43 0.34 -0.36 --
22. WHODAS Getting Along 0.49 0.59 -0.05 -0.26 -0.39 0.35 -0.32 0.78
23. WHODAS Life Activities 0.45 0.51 0.08 -0.22 -0.48 0.30 -0.34 0.76
24. WHODAS Work/School 0.45 0.52 0.04 -0.15 -0.41 0.28 -0.31 0.78
25. VRIN 0.33 0.26 0.03 -0.18 -0.19 0.15 -0.22 0.31

116
Table A7. Continued

22 23 24 25
22. WHODAS Getting Along --
23. WHODAS Life Activities 0.72 --
24. WHODAS Work/School 0.67 0.73 --
25. VRIN 0.28 0.24 0.27 --
Note. Ns range from 272 to 342. ASI = Anxiety Sensitivity Index; ATQ = Automatic
Thoughts Questionnaire; DIS = Discomfort Intolerance Scale; DTS = Distress
Tolerance Scale; IPIP = International Personality Item Pool; K10 = Kessler
Psychological Distress Scale; WHODAS = World Health Organization Disability
Assessment; VRIN = Variable Response Inventory

117
 118

Table A8. Correlations among non-ACT scales--Student Time 1

1 2 3 4 5
1. ASI Physical --
2. ASI Mental 0.63 --
3. ASI Social 0.41 0.38 --
4. ATQ Frequency 0.42 0.62 0.27 --
5. COPE Active Coping 0.01 -0.05 0.08 -0.17 --
6. COPE Emotion-Focused Coping 0.19 0.11 0.03 0.05 0.36
7. COPE Avoidant Coping 0.35 0.50 0.16 0.50 0.07
8. DIS Tolerance -0.07 0.02 0.12 0.03 0.16
9. DIS Avoidance 0.27 0.22 0.15 0.14 0.09
10. DTS Tolerance -0.32 -0.36 -0.19 -0.37 0.15
11. DTS Appraisal -0.41 -0.53 -0.27 -0.50 0.16
12. DTS Absorbtion -0.37 -0.43 -0.20 -0.48 0.13
13. DTS Regulation -0.32 -0.30 -0.25 -0.28 -0.02
14. Externalizing 0.22 0.32 0.20 0.47 -0.11
15. K10 0.39 0.53 0.28 0.71 -0.17
16. IPIP Extraversion -0.10 -0.08 -0.03 -0.15 0.15
17. IPIP Agreeableness 0.00 -0.17 0.04 -0.13 0.24
18. IPIP Conscientiousness -0.11 -0.20 0.04 -0.26 0.18
19. IPIP Neuroticism 0.28 0.35 0.13 0.39 -0.13
20. IPIP Openness -0.09 -0.02 0.04 0.03 0.21
21. WHODAS Understand/Comm 0.28 0.41 0.20 0.45 -0.15
22. WHODAS Getting Along 0.25 0.39 0.16 0.46 -0.05
23. WHODAS Life Activities 0.22 0.34 0.10 0.36 -0.10
24. WHODAS Work/School 0.26 0.35 0.18 0.46 -0.05
25. VRIN 0.28 0.37 0.22 0.41 -0.08
Table A8. Continued

6 7 8 9 10 11 12 13
6. COPE Emotion-Focused Coping --
7. COPE Avoidant Coping 0.27 --
8. DIS Tolerance -0.21 -0.07 --
9. DIS Avoidance 0.17 0.16 -0.25 --
10. DTS Tolerance -0.18 -0.25 0.21 -0.28 --
11. DTS Appraisal -0.24 -0.42 0.17 -0.22 0.68 --
12. DTS Absorbtion -0.26 -0.35 0.15 -0.20 0.77 0.74 --
13. DTS Regulation -0.22 -0.26 0.12 -0.28 0.57 0.59 0.55 --
14. Externalizing 0.11 0.40 -0.06 0.16 -0.30 -0.35 -0.38 -0.24
15. K10 0.10 0.44 -0.03 0.17 -0.44 -0.57 -0.53 -0.32
16. IPIP Extraversion 0.16 0.00 0.00 0.04 0.05 0.06 0.02 -0.05
17. IPIP Agreeableness 0.24 -0.19 0.01 -0.01 0.04 0.08 0.05 0.00
18. IPIP Conscientiousness 0.00 -0.32 0.08 -0.11 0.11 0.23 0.16 0.06
19. IPIP Neuroticism 0.28 0.28 -0.21 0.06 -0.39 -0.55 -0.51 -0.26
20. IPIP Openness 0.04 -0.06 0.12 -0.01 0.14 0.11 0.04 0.12
21. WHODAS Understand/Comm 0.04 0.39 -0.12 0.20 -0.26 -0.38 -0.31 -0.25
22. WHODAS Getting Along 0.02 0.33 -0.07 0.12 -0.22 -0.30 -0.24 -0.14
23. WHODAS Life Activities 0.06 0.35 -0.11 0.14 -0.20 -0.28 -0.27 -0.16
24. WHODAS Work/School 0.11 0.32 0.02 0.18 -0.24 -0.31 -0.30 -0.21
25. VRIN 0.08 0.35 -0.09 0.16 -0.26 -0.31 -0.26 -0.17

119
Table A8. Continued

14 15 16 17 18 19 20 21
14. Externalizing --
15. K10 0.42 --
16. IPIP Extraversion 0.02 -0.12 --
17. IPIP Agreeableness -0.10 -0.11 0.25 --
18. IPIP Conscientiousness -0.36 -0.25 0.10 0.20 --
19. IPIP Neuroticism 0.21 0.51 -0.12 -0.03 -0.14 --
20. IPIP Openness 0.06 0.00 0.10 0.22 0.04 0.04 --
21. WHODAS Understand/Comm 0.42 0.56 -0.17 -0.25 -0.37 0.31 -0.09 --
22. WHODAS Getting Along 0.40 0.44 -0.32 -0.26 -0.24 0.27 -0.01 0.68
23. WHODAS Life Activities 0.39 0.39 -0.07 -0.14 -0.38 0.24 -0.06 0.60
24. WHODAS Work/School 0.35 0.48 -0.07 -0.06 -0.26 0.24 0.00 0.61
25. VRIN 0.24 0.44 -0.08 -0.13 -0.16 0.31 -0.03 0.30

120
Table A8 Continued

22 23 24 25
22. WHODAS Getting Along --
23. WHODAS Life Activities 0.56 --
24. WHODAS Work/School 0.49 0.55 --
25. VRIN 0.27 0.22 0.26 --
Note. Ns range from 454 to 483. ASI = Anxiety Sensitivity Index; ATQ =
Automatic Thoughts Questionnaire; DIS = Discomfort Intolerance Scale;
DTS = Distress Tolerance Scale; IPIP = International Personality Item Pool;
K10 = Kessler Psychological Distress Scale; WHODAS = World Health
Organization Disability Assessment; VRIN = Variable Response Inventory

121
 122

Table A9. Correlations Among Non-ACT Scales--Student Time 2

1 2 3 4 5
1. ASI Physical --
2. ASI Mental 0.69 --
3. ASI Social 0.52 0.48 --
4. ATQ Frequency 0.46 0.54 0.39 --
5. COPE Active Coping -0.10 -0.15 0.07 -0.26 --
6. COPE Emotion-Focused Coping 0.15 0.06 0.06 0.02 0.38
7. COPE Avoidant Coping 0.31 0.45 0.25 0.49 0.00
8. DIS Tolerance -0.12 -0.08 0.10 -0.01 0.19
9. DIS Avoidance 0.24 0.21 0.14 0.11 0.05
10. DTS Tolerance -0.37 -0.39 -0.21 -0.55 0.19
11. DTS Appraisal -0.44 -0.54 -0.31 -0.56 0.20
12. DTS Absorbtion -0.41 -0.42 -0.29 -0.59 0.18
13. DTS Regulation -0.31 -0.37 -0.30 -0.39 0.00
14. Externalizing 0.29 0.35 0.32 0.50 -0.21
15. K10 0.48 0.54 0.32 0.73 -0.26
16. IPIP Extraversion -0.19 -0.12 -0.15 -0.27 0.23
17. IPIP Agreeableness -0.09 -0.21 -0.03 -0.22 0.38
18. IPIP Conscientiousness -0.24 -0.27 -0.16 -0.37 0.35
19. IPIP Neuroticism 0.30 0.29 0.18 0.39 -0.22
20. IPIP Openness -0.18 -0.18 -0.01 -0.06 0.20
21. WHODAS Understand/Comm 0.38 0.54 0.28 0.57 -0.27
22. WHODAS Getting Along 0.34 0.46 0.23 0.56 -0.23
23. WHODAS Life Activities 0.38 0.45 0.29 0.58 -0.26
24. WHODAS Work/School 0.28 0.41 0.28 0.52 -0.21
25. VRIN 0.23 0.29 0.18 0.34 -0.19
Table A9. Continued

6 7 8 9 10 11 12 13
6. COPE Emotion-Focused Coping --
7. COPE Avoidant Coping 0.17 --
8. DIS Tolerance -0.19 -0.05 --
9. DIS Avoidance 0.14 0.06 -0.24 --
10. DTS Tolerance -0.14 -0.35 0.16 -0.27 --
11. DTS Appraisal -0.21 -0.46 0.17 -0.22 0.75 --
12. DTS Absorbtion -0.22 -0.39 0.14 -0.23 0.79 0.78 --
13. DTS Regulation -0.18 -0.27 0.08 -0.26 0.69 0.65 0.67 --
14. Externalizing 0.02 0.31 -0.03 0.05 -0.31 -0.34 -0.35 -0.29
15. K10 0.07 0.43 -0.10 0.19 -0.47 -0.54 -0.54 -0.33
16. IPIP Extraversion 0.17 -0.10 0.01 0.04 0.12 0.14 0.12 0.01
17. IPIP Agreeableness 0.32 -0.21 0.01 0.02 0.09 0.11 0.08 0.03
18. IPIP Conscientiousness 0.06 -0.33 0.09 -0.12 0.28 0.34 0.34 0.16
19. IPIP Neuroticism 0.27 0.17 -0.23 0.15 -0.37 -0.49 -0.48 -0.28
20. IPIP Openness 0.06 -0.14 0.07 0.05 0.10 0.14 0.06 0.08
21. WHODAS Understand/Comm -0.06 0.42 -0.14 0.12 -0.39 -0.45 -0.40 -0.30
22. WHODAS Getting Along -0.08 0.35 -0.10 0.08 -0.35 -0.41 -0.35 -0.23
23. WHODAS Life Activities -0.02 0.35 -0.19 0.13 -0.41 -0.44 -0.42 -0.30
24. WHODAS Work/School -0.04 0.31 -0.08 0.16 -0.30 -0.34 -0.35 -0.27
25. VRIN -0.02 0.26 0.00 -0.03 -0.23 -0.28 -0.26 -0.21

123
Table A9. Continued

14 15 16 17 18 19 20 21
14. Externalizing --
15. K10 0.41 --
16. IPIP Extraversion -0.05 -0.24 --
17. IPIP Agreeableness -0.15 -0.24 0.32 --
18. IPIP Conscientiousness -0.40 -0.38 0.24 0.36 --
19. IPIP Neuroticism 0.23 0.50 -0.15 -0.02 -0.22 --
20. IPIP Openness -0.01 -0.13 0.06 0.24 0.09 -0.01 --
21. WHODAS Understand/Comm 0.46 0.58 -0.26 -0.29 -0.47 0.33 -0.15 --
22. WHODAS Getting Along 0.41 0.53 -0.37 -0.34 -0.37 0.30 -0.07 0.77
23. WHODAS Life Activities 0.46 0.51 -0.25 -0.29 -0.48 0.30 -0.08 0.78
24. WHODAS Work/School 0.39 0.48 -0.16 -0.17 -0.40 0.28 -0.08 0.72
25. VRIN 0.28 0.40 -0.07 -0.19 -0.24 0.17 -0.07 0.23

124
Table A9. Continued

22 23 24 25
22. WHODAS Getting Along --
23. WHODAS Life Activities 0.71 --
24. WHODAS Work/School 0.60 0.68 --
25. VRIN 0.23 0.26 0.22 --
Note. Ns range from 318 to 340. ASI = Anxiety Sensitivity Index; ATQ =
Automatic Thoughts Questionnaire; DIS = Discomfort Intolerance Scale;
DTS = Distress Tolerance Scale; IPIP = International Personality Item Pool;
K10 = Kessler Psychological Distress Scale; WHODAS = World Health
Organization Disability Assessment; VRIN = Variable Response Inventory

125
 126

Table A10. Correlations Among ACT and Non-ACT Scales—Mechanical Turk

AAQ ATQ-b CFQ EQ

ASI Physical 0.53 0.48 0.50 -0.11
ASI Mental 0.59 0.58 0.58 -0.12
ASI Social 0.26 0.24 0.27 0.07
ATQ Frequency 0.73 0.89 0.69 -0.31
COPE Active Coping -0.20 -0.13 -0.26 0.59
COPE Emotion-Focused
Coping 0.26 0.27 0.26 0.07
COPE Avoidant Coping 0.52 0.56 0.47 -0.04
DIS Tolerance 0.04 0.07 -0.07 0.22
DIS Avoidance 0.05 0.09 0.07 0.23
DTS Tolerance -0.25 -0.18 -0.28 0.31
DTS Appraisal -0.50 -0.43 -0.52 0.40
DTS Absorbtion -0.43 -0.33 -0.49 0.38
DTS Regulation -0.12 -0.13 -0.19 0.11
Externalizing 0.51 0.50 0.43 -0.15
K10 0.68 0.74 0.68 -0.33
IPIP Extraversion -0.26 -0.14 -0.24 0.30
IPIP Agreeableness -0.17 -0.09 -0.16 0.28
IPIP Conscientiousness -0.40 -0.40 -0.36 0.32
IPIP Neuroticism 0.55 0.49 0.62 -0.51
IPIP Openness -0.21 -0.17 -0.11 0.21
WHODAS
Understand/Comm 0.51 0.54 0.47 -0.15
WHODAS Getting Along 0.49 0.51 0.44 -0.20
WHODAS Life Activities 0.42 0.43 0.38 -0.20
WHODAS Work/School 0.42 0.46 0.44 -0.12
VRIN 0.18 0.23 0.19 -0.08
 127

Table A10. Continued

FFMQ
FFMQ Obs FFMQ Des FFMQ Act Nonj
ASI Physical 0.15 -0.18 -0.38 -0.45
ASI Mental 0.08 -0.23 -0.46 -0.53
ASI Social 0.15 -0.03 -0.12 -0.35
ATQ Frequency 0.09 -0.29 -0.61 -0.50
COPE Active Coping 0.29 0.29 0.16 -0.02
COPE Emotion-Focused
Coping 0.13 -0.02 -0.24 -0.28
COPE Avoidant Coping 0.06 -0.32 -0.53 -0.44
DIS Tolerance 0.23 0.09 -0.10 -0.10
DIS Avoidance 0.19 0.15 0.01 -0.15
DTS Tolerance 0.11 0.23 0.17 0.20
DTS Appraisal 0.01 0.33 0.41 0.42
DTS Absorbtion 0.03 0.24 0.33 0.32
DTS Regulation -0.05 0.06 0.01 0.27
Externalizing 0.01 -0.26 -0.58 -0.37
K10 0.10 -0.29 -0.68 -0.53
IPIP Extraversion 0.08 0.28 0.22 0.13
IPIP Agreeableness 0.35 0.40 0.25 -0.03
IPIP Conscientiousness 0.17 0.38 0.51 0.21
IPIP Neuroticism -0.01 -0.30 -0.46 -0.39
IPIP Openness 0.34 0.39 0.29 0.11
WHODAS
Understand/Comm -0.02 -0.33 -0.54 -0.40
WHODAS Getting Along -0.02 -0.34 -0.46 -0.41
WHODAS Life
Activities -0.09 -0.30 -0.42 -0.29
WHODAS Work/School -0.07 -0.26 -0.45 -0.30
VRIN -0.11 -0.23 -0.12 -0.15
 128

Table A10. Continued

FFMQ MEAQ
Nonr MEAQ BA DAv MEAQ Pr
ASI Physical 0.02 0.34 0.25 0.32
ASI Mental -0.01 0.37 0.34 0.37
ASI Social 0.10 0.37 0.34 0.19
ATQ Frequency -0.06 0.19 0.19 0.38
COPE Active Coping 0.53 0.10 0.08 -0.16
COPE Emotion-Focused
Coping 0.07 0.23 0.18 0.24
COPE Avoidant Coping 0.11 0.33 0.17 0.52
DIS Tolerance 0.21 -0.10 -0.10 -0.05
DIS Avoidance 0.12 0.29 0.30 0.09
DTS Tolerance 0.25 -0.34 -0.36 -0.24
DTS Appraisal 0.26 -0.35 -0.33 -0.33
DTS Absorbtion 0.26 -0.40 -0.34 -0.32
DTS Regulation 0.02 -0.38 -0.45 -0.12
Externalizing 0.06 0.18 0.09 0.37
K10 -0.12 0.28 0.23 0.41
IPIP Extraversion 0.16 -0.22 -0.08 -0.26
IPIP Agreeableness 0.14 0.00 0.11 -0.12
IPIP Conscientiousness 0.14 -0.08 0.04 -0.48
IPIP Neuroticism -0.39 0.25 0.22 0.31
IPIP Openness 0.05 -0.13 0.02 -0.19
WHODAS
Understand/Comm -0.07 0.25 0.16 0.38
WHODAS Getting Along -0.08 0.26 0.13 0.35
WHODAS Life
Activities -0.10 0.23 0.10 0.34
WHODAS Work/School -0.11 0.27 0.16 0.34
VRIN -0.06 0.09 -0.01 0.11
 129

Table A10. Continued

MEAQ D/S MEAQ R/D MEAQ DE MAAS

ASI Physical 0.17 0.35 -0.16 -0.29
ASI Mental 0.14 0.51 -0.17 -0.36
ASI Social 0.28 0.21 0.02 0.00
ATQ Frequency -0.06 0.40 -0.26 -0.47
COPE Active Coping 0.39 -0.01 0.55 0.27
COPE Emotion-Focused
Coping 0.25 0.25 0.00 -0.20
COPE Avoidant Coping 0.07 0.60 -0.23 -0.44
DIS Tolerance 0.07 0.06 0.25 0.06
DIS Avoidance 0.22 0.07 0.03 0.17
DTS Tolerance -0.13 -0.19 0.30 0.25
DTS Appraisal -0.05 -0.36 0.32 0.43
DTS Absorbtion -0.10 -0.29 0.25 0.36
DTS Regulation -0.35 -0.15 -0.02 0.11
Externalizing -0.02 0.55 -0.15 -0.42
K10 -0.02 0.51 -0.25 -0.52
IPIP Extraversion 0.03 0.02 0.05 0.15
IPIP Agreeableness 0.25 -0.34 0.23 0.36
IPIP Conscientiousness 0.12 -0.37 0.38 0.50
IPIP Neuroticism -0.06 0.22 -0.39 -0.44
IPIP Openness 0.03 -0.41 0.24 0.27
WHODAS
Understand/Comm 0.00 0.57 -0.28 -0.48
WHODAS Getting Along -0.03 0.49 -0.25 -0.40
WHODAS Life Activities -0.04 0.44 -0.29 -0.40
WHODAS Work/School -0.04 0.41 -0.28 -0.36
VRIN -0.01 0.31 -0.25 -0.22
 130

Table A10. Continued

PHLMS
Aw PHLMS Ac WBSI VLQ I
ASI Physical 0.08 0.34 0.38 -0.02
ASI Mental 0.01 0.37 0.41 0.07
ASI Social 0.22 0.38 0.29 0.02
ATQ Frequency -0.03 0.31 0.43 -0.22
COPE Active Coping 0.40 0.18 -0.01 0.28
COPE Emotion-Focused
Coping 0.16 0.36 0.22 0.30
COPE Avoidant Coping -0.01 0.36 0.38 0.03
DIS Tolerance 0.25 0.10 0.06 0.00
DIS Avoidance 0.16 0.18 0.10 0.17
DTS Tolerance 0.13 -0.19 -0.24 0.04
DTS Appraisal 0.09 -0.29 -0.38 0.13
DTS Absorbtion 0.02 -0.28 -0.41 0.17
DTS Regulation -0.10 -0.33 -0.32 -0.02
Externalizing -0.09 0.19 0.31 -0.15
K10 -0.02 0.38 0.50 -0.19
IPIP Extraversion 0.06 -0.11 -0.20 0.31
IPIP Agreeableness 0.48 0.13 -0.05 0.36
IPIP Conscientiousness 0.27 -0.10 -0.23 0.21
IPIP Neuroticism -0.11 0.29 0.45 -0.16
IPIP Openness 0.32 -0.14 -0.10 0.10
WHODAS
Understand/Comm -0.16 0.24 0.34 0.02
WHODAS Getting Along -0.10 0.27 0.34 -0.11
WHODAS Life Activities -0.16 0.19 0.27 -0.03
WHODAS Work/School -0.08 0.21 0.29 -0.03
VRIN -0.09 0.07 0.11 -0.12
 131

Table A10. Continued

VLQ C
ASI Physical 0.00
ASI Mental 0.09
ASI Social -0.02
ATQ Frequency -0.23
COPE Active Coping 0.24
COPE Emotion-Focused
Coping 0.17
COPE Avoidant Coping 0.10
DIS Tolerance 0.01
DIS Avoidance 0.14
DTS Tolerance 0.03
DTS Appraisal 0.11
DTS Absorbtion 0.15
DTS Regulation 0.04
Externalizing -0.13
K10 -0.20
IPIP Extraversion 0.25
IPIP Agreeableness 0.19
IPIP Conscientiousness 0.20
IPIP Neuroticism -0.20
IPIP Openness 0.12
WHODAS Understand/Comm 0.00
WHODAS Getting Along -0.13
WHODAS Life Activities -0.07
WHODAS Work/School -0.06
VRIN -0.08
 132

Table A10. Continued

Note. Ns range from 273 to 342; Note. Ns range from 273 to 342; AAQ = Accepance and
Action Questionnaire 2; ATQ-b = Automatic Thought Questionnaire believability; CFQ
= Cognitive Fusion Questionnaire; EQ = Experiences Questionnaire decentering scale;
FFMQ Obs = Five Factor Mindfulness Questionnaire Observe; FFMQ des = Five Factor
Mindfulness Questionnaire Describe; FFMQ Act = Five Factor Mindfulness
Questionnaire Act with Awareness; FFMQ Nonj = Five Factor Mindfulness
Questionnaire Nonjudge; FFMQ Nonr = Five Factor Mindfulness Questionnaire
Nonreact; MEAQ BA = Multidimensional Experiential Avoidance Scale Behavioral
Avoidance; MEAQ DAv = Multidimensional Experiential Avoidance Scale Distress
Aversion; MEAQ Pr = Multidimensional Experiential Avoidance Scale Procrastination;
MEAQ D/S = Multidimensional Experiential Avoidance Scale Distraction/Suppression;
MEAQ R/D = Multidimensional Experiential Avoidance Scale Repression/Denial;
MEAQ DE = Multidimensional Experiential Avoidance Scale Distress Endurance;
MAAS = Mindful Attention Awareness Scale; PHLMS Aw = Phildelphia Mindfulness
Scale Awareness; PHLMS Ac = Philadelphia Mindfulness Scale Acceptance; WBSI =
White Bear Suppression Inventory; VLQ I = Valued Living Questionnaire Imporance;
VLQ C = Valued Living Questionnaire Consistency
 133

Table A11. Correlations Among ACT and Non-ACT Scales—Student Time 1

AAQ ATQ-b CFQ EQ

ASI Physical 0.47 0.45 0.41 -0.14
ASI Mental 0.60 0.61 0.54 -0.25
ASI Social 0.37 0.32 0.30 -0.05
ATQ Frequency 0.72 0.88 0.63 -0.36
COPE Active Coping -0.16 -0.12 -0.17 0.39
COPE Emotion-Focused
Coping 0.09 0.10 0.18 -0.05
COPE Avoidant Coping 0.44 0.46 0.40 -0.19
DIS Tolerance 0.04 0.05 -0.03 0.18
DIS Avoidance 0.17 0.11 0.16 -0.03
DTS Tolerance -0.43 -0.34 -0.51 0.36
DTS Appraisal -0.56 -0.49 -0.66 0.46
DTS Absorbtion -0.50 -0.46 -0.60 0.43
DTS Regulation -0.34 -0.27 -0.36 0.15
Externalizing 0.39 0.43 0.34 -0.25
K10 0.60 0.65 0.60 -0.35
IPIP Extraversion -0.18 -0.18 -0.13 0.18
IPIP Agreeableness -0.12 -0.10 -0.07 0.13
IPIP Conscientiousness -0.16 -0.24 -0.17 0.16
IPIP Neuroticism 0.44 0.38 0.58 -0.38
IPIP Openness -0.02 0.06 0.02 0.13
WHODAS
Understand/Comm 0.39 0.38 0.40 -0.23
WHODAS Getting Along 0.39 0.40 0.37 -0.24
WHODAS Life Activities 0.31 0.35 0.28 -0.16
WHODAS Work/School 0.40 0.44 0.36 -0.19
VRIN 0.36 0.42 0.35 -0.11
 134

Table A11. Continued

FFMQ
FFMQ Obs FFMQ Des FFMQ Act Nonj
ASI Physical 0.20 -0.06 -0.24 -0.38
ASI Mental 0.16 -0.20 -0.38 -0.51
ASI Social 0.19 -0.04 -0.23 -0.34
ATQ Frequency 0.16 -0.28 -0.44 -0.53
COPE Active Coping 0.23 0.32 0.17 0.02
COPE Emotion-Focused
Coping 0.11 0.23 -0.05 -0.15
COPE Avoidant Coping 0.10 -0.23 -0.38 -0.42
DIS Tolerance 0.24 0.04 -0.08 -0.03
DIS Avoidance 0.10 0.06 -0.16 -0.15
DTS Tolerance -0.08 0.21 0.32 0.40
DTS Appraisal -0.12 0.28 0.40 0.59
DTS Absorbtion -0.12 0.22 0.41 0.46
DTS Regulation -0.11 0.09 0.27 0.35
Externalizing 0.10 -0.12 -0.43 -0.30
K10 0.18 -0.24 -0.49 -0.53
IPIP Extraversion 0.08 0.22 0.01 0.09
IPIP Agreeableness 0.21 0.30 0.03 0.03
IPIP Conscientiousness 0.05 0.22 0.39 0.15
IPIP Neuroticism 0.11 -0.20 -0.28 -0.45
IPIP Openness 0.25 0.19 0.00 0.00
WHODAS
Understand/Comm 0.03 -0.31 -0.41 -0.32
WHODAS Getting Along 0.04 -0.25 -0.21 -0.32
WHODAS Life Activities -0.01 -0.20 -0.31 -0.23
WHODAS Work/School 0.10 -0.20 -0.36 -0.30
VRIN 0.13 -0.17 -0.26 -0.35
 135

Table A11. Continued

FFMQ MEAQ
Nonr MEAQ BA DAv MEAQ Pr
ASI Physical 0.02 0.33 0.37 0.22
ASI Mental -0.04 0.23 0.35 0.21
ASI Social 0.05 0.17 0.18 0.12
ATQ Frequency -0.06 0.26 0.34 0.29
COPE Active Coping 0.26 -0.14 -0.08 -0.21
COPE Emotion-Focused
Coping -0.07 0.08 0.15 0.04
COPE Avoidant Coping -0.04 0.27 0.29 0.34
DIS Tolerance 0.23 -0.19 -0.11 -0.06
DIS Avoidance 0.05 0.22 0.24 0.16
DTS Tolerance 0.23 -0.33 -0.47 -0.24
DTS Appraisal 0.28 -0.35 -0.51 -0.28
DTS Absorbtion 0.27 -0.31 -0.47 -0.30
DTS Regulation 0.08 -0.32 -0.52 -0.17
Externalizing -0.06 0.17 0.17 0.33
K10 -0.11 0.25 0.37 0.29
IPIP Extraversion 0.08 -0.25 0.01 -0.19
IPIP Agreeableness 0.07 -0.08 -0.11 -0.09
IPIP Conscientiousness 0.09 -0.18 -0.14 -0.44
IPIP Neuroticism -0.35 0.23 0.36 0.22
IPIP Openness 0.13 -0.23 -0.20 -0.07
WHODAS
Understand/Comm -0.09 0.26 0.23 0.28
WHODAS Getting Along -0.07 0.17 0.12 0.19
WHODAS Life Activities -0.03 0.18 0.12 0.27
WHODAS Work/School -0.06 0.16 0.20 0.33
VRIN -0.07 0.24 0.29 0.20
 136

Table A11. Continued

MEAQ D/S MEAQ R/D MEAQ DE MAAS

ASI Physical 0.24 0.22 -0.02 -0.29
ASI Mental 0.12 0.35 -0.13 -0.37
ASI Social 0.16 0.15 0.11 -0.27
ATQ Frequency 0.10 0.36 -0.20 -0.37
COPE Active Coping 0.10 -0.22 0.40 0.10
COPE Emotion-Focused
Coping 0.19 -0.17 0.08 -0.04
COPE Avoidant Coping 0.15 0.42 -0.25 -0.31
DIS Tolerance -0.11 0.01 0.25 -0.04
DIS Avoidance 0.15 0.10 -0.14 -0.15
DTS Tolerance -0.24 -0.21 0.21 0.33
DTS Appraisal -0.25 -0.34 0.27 0.42
DTS Absorbtion -0.23 -0.24 0.22 0.43
DTS Regulation -0.40 -0.21 0.05 0.33
Externalizing 0.08 0.26 -0.18 -0.39
K10 0.16 0.40 -0.20 -0.50
IPIP Extraversion 0.04 -0.17 0.08 0.06
IPIP Agreeableness 0.05 -0.35 0.27 0.08
IPIP Conscientiousness -0.01 -0.33 0.28 0.33
IPIP Neuroticism 0.18 0.21 -0.14 -0.27
IPIP Openness -0.14 -0.21 0.24 0.01
WHODAS
Understand/Comm 0.11 0.42 -0.29 -0.45
WHODAS Getting Along 0.02 0.29 -0.21 -0.32
WHODAS Life Activities 0.00 0.28 -0.24 -0.35
WHODAS Work/School 0.02 0.24 -0.21 -0.41
VRIN 0.13 0.32 -0.15 -0.25
 137

Table A11. Continued

PHLMS Aw PHLMS Ac WBSI VLQ I

ASI Physical 0.08 0.34 0.28 0.01
ASI Mental 0.04 0.38 0.33 -0.10
ASI Social 0.15 0.27 0.29 -0.04
ATQ Frequency 0.03 0.44 0.45 -0.15
COPE Active Coping 0.21 -0.01 -0.03 0.19
COPE Emotion-Focused
Coping 0.17 0.23 0.16 0.19
COPE Avoidant Coping -0.01 0.36 0.30 -0.10
DIS Tolerance 0.15 0.03 0.04 0.01
DIS Avoidance 0.09 0.14 0.14 0.06
DTS Tolerance -0.06 -0.40 -0.40 0.02
DTS Appraisal -0.03 -0.53 -0.49 0.08
DTS Absorbtion -0.05 -0.45 -0.51 0.03
DTS Regulation -0.09 -0.45 -0.39 -0.06
Externalizing 0.00 0.26 0.30 -0.19
K10 0.02 0.49 0.52 -0.14
IPIP Extraversion 0.12 -0.05 -0.04 0.19
IPIP Agreeableness 0.24 -0.01 0.04 0.24
IPIP Conscientiousness 0.09 -0.18 -0.19 0.15
IPIP Neuroticism 0.06 0.43 0.41 0.01
IPIP Openness 0.24 -0.04 0.07 0.02
WHODAS
Understand/Comm -0.13 0.31 0.36 -0.16
WHODAS Getting Along -0.12 0.26 0.27 -0.23
WHODAS Life
Activities -0.12 0.18 0.23 -0.20
WHODAS Work/School -0.02 0.28 0.37 -0.10
VRIN 0.15 0.31 0.24 -0.13
 138

Table A11. Continued

VLQ C
ASI Physical -0.11
ASI Mental -0.17
ASI Social -0.02
ATQ Frequency -0.24
COPE Active Coping 0.25
COPE Emotion-Focused
Coping 0.06
COPE Avoidant Coping -0.07
DIS Tolerance 0.06
DIS Avoidance -0.04
DTS Tolerance 0.18
DTS Appraisal 0.17
DTS Absorbtion 0.19
DTS Regulation 0.03
Externalizing -0.17
K10 -0.25
IPIP Extraversion 0.15
IPIP Agreeableness 0.08
IPIP Conscientiousness 0.11
IPIP Neuroticism -0.19
IPIP Openness 0.02
WHODAS Understand/Comm -0.16
WHODAS Getting Along -0.19
WHODAS Life Activities -0.20
WHODAS Work/School -0.23
VRIN -0.13
 139

Table A11. Continued

Note. Ns range from 454 to 482; AAQ = Accepance and Action Questionnaire 2; ATQ-b
= Automatic Thought Questionnaire believability; CFQ = Cognitive Fusion
Questionnaire; EQ = Experiences Questionnaire decentering scale; FFMQ Obs = Five
Factor Mindfulness Questionnaire Observe; FFMQ des = Five Factor Mindfulness
Questionnaire Describe; FFMQ Act = Five Factor Mindfulness Questionnaire Act with
Awareness; FFMQ Nonj = Five Factor Mindfulness Questionnaire Nonjudge; FFMQ
Nonr = Five Factor Mindfulness Questionnaire Nonreact; MEAQ BA =
Multidimensional Experiential Avoidance Scale Behavioral Avoidance; MEAQ DAv =
Multidimensional Experiential Avoidance Scale Distress Aversion; MEAQ Pr =
Multidimensional Experiential Avoidance Scale Procrastination; MEAQ D/S =
Multidimensional Experiential Avoidance Scale Distraction/Suppression; MEAQ R/D =
Multidimensional Experiential Avoidance Scale Repression/Denial; MEAQ DE =
Multidimensional Experiential Avoidance Scale Distress Endurance; MAAS = Mindful
Attention Awareness Scale; PHLMS Aw = Phildelphia Mindfulness Scale Awareness;
PHLMS Ac = Philadelphia Mindfulness Scale Acceptance; WBSI = White Bear
Suppression Inventory; VLQ I = Valued Living Questionnaire Imporance; VLQ C =
Valued Living Questionnaire Consistency
 140

Table A12. Correlations Among ACT and Non-ACT Scales--Student Time 2

AAQ ATQ-b CFQ EQ

ASI Physical 0.53 0.42 0.47 -0.24
ASI Mental 0.59 0.47 0.54 -0.29
ASI Social 0.51 0.35 0.41 -0.12
ATQ Frequency 0.76 0.88 0.71 -0.40
COPE Active Coping -0.24 -0.24 -0.28 0.46
COPE Emotion-Focused
Coping 0.03 -0.02 0.11 0.00
COPE Avoidant Coping 0.44 0.44 0.43 -0.28
DIS Tolerance -0.07 -0.05 -0.05 0.22
DIS Avoidance 0.19 0.06 0.16 0.01
DTS Tolerance -0.49 -0.50 -0.54 0.36
DTS Appraisal -0.59 -0.53 -0.64 0.45
DTS Absorbtion -0.57 -0.55 -0.66 0.42
DTS Regulation -0.39 -0.35 -0.40 0.22
Externalizing 0.43 0.46 0.44 -0.23
K10 0.66 0.68 0.65 -0.37
IPIP Extraversion -0.27 -0.29 -0.20 0.27
IPIP Agreeableness -0.16 -0.22 -0.12 0.15
IPIP Conscientiousness -0.34 -0.40 -0.33 0.29
IPIP Neuroticism 0.45 0.36 0.52 -0.40
IPIP Openness -0.09 -0.04 -0.08 0.16
WHODAS
Understand/Comm 0.56 0.52 0.50 -0.40
WHODAS Getting Along 0.49 0.53 0.47 -0.33
WHODAS Life Activities 0.53 0.55 0.47 -0.36
WHODAS Work/School 0.51 0.52 0.42 -0.30
VRIN 0.28 0.41 0.34 -0.17
 141

Table A12. Continued

FFMQ
FFMQ Obs FFMQ Des FFMQ Act Nonj
ASI Physical 0.12 -0.19 -0.31 -0.42
ASI Mental 0.08 -0.27 -0.37 -0.50
ASI Social 0.21 -0.10 -0.32 -0.34
ATQ Frequency 0.17 -0.35 -0.43 -0.52
COPE Active Coping 0.23 0.37 0.16 0.13
COPE Emotion-Focused
Coping 0.13 0.28 -0.06 -0.12
COPE Avoidant Coping 0.01 -0.29 -0.33 -0.37
DIS Tolerance 0.19 0.04 0.00 0.10
DIS Avoidance 0.20 0.02 -0.21 -0.22
DTS Tolerance -0.10 0.28 0.33 0.46
DTS Appraisal -0.08 0.34 0.39 0.57
DTS Absorbtion -0.16 0.24 0.41 0.52
DTS Regulation -0.15 0.18 0.31 0.39
Externalizing 0.16 -0.18 -0.42 -0.24
K10 0.12 -0.39 -0.51 -0.54
IPIP Extraversion 0.14 0.32 0.07 0.13
IPIP Agreeableness 0.14 0.28 0.10 0.07
IPIP Conscientiousness 0.03 0.31 0.39 0.24
IPIP Neuroticism 0.02 -0.22 -0.32 -0.39
IPIP Openness 0.19 0.30 0.01 0.06
WHODAS
Understand/Comm -0.01 -0.36 -0.42 -0.34
WHODAS Getting Along 0.01 -0.34 -0.30 -0.36
WHODAS Life
Activities 0.04 -0.27 -0.40 -0.34
WHODAS Work/School 0.15 -0.23 -0.41 -0.31
VRIN 0.11 -0.20 -0.23 -0.31
 142

Table A12. Continued

FFMQ MEAQ
Nonr MEAQ BA DAv MEAQ Pr
ASI Physical -0.05 0.40 0.37 0.34
ASI Mental -0.08 0.37 0.41 0.29
ASI Social 0.09 0.26 0.30 0.29
ATQ Frequency -0.12 0.34 0.32 0.42
COPE Active Coping 0.32 -0.18 -0.14 -0.26
COPE Emotion-Focused
Coping -0.12 0.08 0.17 -0.03
COPE Avoidant Coping -0.14 0.30 0.33 0.33
DIS Tolerance 0.18 -0.23 -0.22 -0.10
DIS Avoidance 0.08 0.25 0.27 0.22
DTS Tolerance 0.22 -0.30 -0.41 -0.32
DTS Appraisal 0.28 -0.37 -0.44 -0.32
DTS Absorbtion 0.25 -0.33 -0.41 -0.34
DTS Regulation 0.10 -0.32 -0.45 -0.28
Externalizing -0.01 0.21 0.17 0.36
K10 -0.12 0.34 0.37 0.40
IPIP Extraversion 0.07 -0.25 -0.04 -0.26
IPIP Agreeableness 0.03 -0.16 -0.09 -0.15
IPIP Conscientiousness 0.10 -0.20 -0.22 -0.49
IPIP Neuroticism -0.32 0.23 0.31 0.24
IPIP Openness 0.13 -0.17 -0.19 -0.02
WHODAS
Understand/Comm -0.15 0.33 0.30 0.40
WHODAS Getting Along -0.11 0.29 0.19 0.30
WHODAS Life Activities -0.14 0.28 0.23 0.41
WHODAS Work/School -0.11 0.23 0.27 0.44
VRIN -0.10 0.18 0.14 0.18
 143

Table A12. Continued

MEAQ D/S MEAQ R/D MEAQ DE MAAS

ASI Physical 0.29 0.33 -0.13 -0.35
ASI Mental 0.20 0.42 -0.30 -0.38
ASI Social 0.31 0.23 0.12 -0.32
ATQ Frequency 0.20 0.46 -0.26 -0.42
COPE Active Coping 0.04 -0.34 0.43 0.21
COPE Emotion-Focused
Coping 0.21 -0.26 0.16 0.02
COPE Avoidant Coping 0.21 0.47 -0.31 -0.39
DIS Tolerance -0.11 -0.05 0.19 0.03
DIS Avoidance 0.20 0.02 -0.08 -0.15
DTS Tolerance -0.20 -0.30 0.32 0.34
DTS Appraisal -0.25 -0.41 0.38 0.42
DTS Absorbtion -0.25 -0.30 0.28 0.39
DTS Regulation -0.34 -0.25 0.19 0.35
Externalizing 0.11 0.30 -0.11 -0.39
K10 0.16 0.49 -0.30 -0.49
IPIP Extraversion -0.03 -0.22 0.14 0.11
IPIP Agreeableness 0.09 -0.40 0.29 0.17
IPIP Conscientiousness -0.05 -0.42 0.26 0.38
IPIP Neuroticism 0.18 0.19 -0.17 -0.28
IPIP Openness -0.01 -0.23 0.27 0.10
WHODAS
Understand/Comm 0.12 0.50 -0.33 -0.41
WHODAS Getting Along 0.05 0.43 -0.27 -0.32
WHODAS Life Activities 0.08 0.41 -0.28 -0.41
WHODAS Work/School 0.12 0.31 -0.19 -0.35
VRIN 0.08 0.32 -0.26 -0.30
 144

Table A12. Continued

PHLMS
Aw PHLMS Ac WBSI VLQ I
ASI Physical 0.00 0.38 0.36 -0.13
ASI Mental -0.07 0.40 0.36 -0.13
ASI Social 0.16 0.38 0.36 -0.10
ATQ Frequency 0.00 0.47 0.44 -0.23
COPE Active Coping 0.26 -0.14 -0.09 0.24
COPE Emotion-Focused
Coping 0.14 0.13 0.11 0.19
COPE Avoidant Coping -0.14 0.27 0.29 -0.06
DIS Tolerance 0.12 -0.07 -0.08 0.09
DIS Avoidance 0.14 0.26 0.22 0.07
DTS Tolerance 0.01 -0.40 -0.39 0.18
DTS Appraisal 0.08 -0.47 -0.40 0.19
DTS Absorbtion -0.02 -0.47 -0.45 0.15
DTS Regulation -0.02 -0.40 -0.34 0.08
Externalizing -0.03 0.22 0.26 -0.33
K10 -0.06 0.46 0.45 -0.17
IPIP Extraversion 0.12 -0.12 -0.20 0.20
IPIP Agreeableness 0.27 0.03 0.01 0.23
IPIP Conscientiousness 0.17 -0.21 -0.24 0.22
IPIP Neuroticism -0.01 0.43 0.38 -0.04
IPIP Openness 0.23 0.02 0.06 0.06
WHODAS
Understand/Comm -0.20 0.33 0.38 -0.24
WHODAS Getting Along -0.19 0.28 0.30 -0.31
WHODAS Life Activities -0.14 0.29 0.36 -0.27
WHODAS Work/School -0.02 0.32 0.39 -0.14
VRIN 0.02 0.28 0.21 -0.12
 145

Table A12. Continued

VLQ C
ASI Physical -0.17
ASI Mental -0.19
ASI Social -0.15
ATQ Frequency -0.24
COPE Active Coping 0.22
COPE Emotion-Focused
Coping 0.14
COPE Avoidant Coping -0.12
DIS Tolerance 0.03
DIS Avoidance 0.05
DTS Tolerance 0.17
DTS Appraisal 0.20
DTS Absorbtion 0.17
DTS Regulation 0.12
Externalizing -0.28
K10 -0.26
IPIP Extraversion 0.20
IPIP Agreeableness 0.14
IPIP Conscientiousness 0.19
IPIP Neuroticism -0.10
IPIP Openness 0.16
WHODAS Understand/Comm -0.28
WHODAS Getting Along -0.27
WHODAS Life Activities -0.25
WHODAS Work/School -0.25
VRIN -0.12
 146

Table A12. Continued

Note. Ns range from 318 to 340; AAQ = Accepance and Action Questionnaire 2; ATQ-b
= Automatic Thought Questionnaire believability; CFQ = Cognitive Fusion
Questionnaire; EQ = Experiences Questionnaire decentering scale; FFMQ Obs = Five
Factor Mindfulness Questionnaire Observe; FFMQ des = Five Factor Mindfulness
Questionnaire Describe; FFMQ Act = Five Factor Mindfulness Questionnaire Act with
Awareness; FFMQ Nonj = Five Factor Mindfulness Questionnaire Nonjudge; FFMQ
Nonr = Five Factor Mindfulness Questionnaire Nonreact; MEAQ BA =
Multidimensional Experiential Avoidance Scale Behavioral Avoidance; MEAQ DAv =
Multidimensional Experiential Avoidance Scale Distress Aversion; MEAQ Pr =
Multidimensional Experiential Avoidance Scale Procrastination; MEAQ D/S =
Multidimensional Experiential Avoidance Scale Distraction/Suppression; MEAQ R/D =
Multidimensional Experiential Avoidance Scale Repression/Denial; MEAQ DE =
Multidimensional Experiential Avoidance Scale Distress Endurance; MAAS = Mindful
Attention Awareness Scale; PHLMS Aw = Phildelphia Mindfulness Scale Awareness;
PHLMS Ac = Philadelphia Mindfulness Scale Acceptance; WBSI = White Bear
Suppression Inventory; VLQ I = Valued Living Questionnaire Imporance; VLQ C =
Valued Living Questionnaire Consistency
Table A13. Student T1-T2 Correlations Among ACT scales

1. T1 2. T1 3. T1 4. T1 5. T1 6. T1 7. T1 8. T1 9. T1
1. T2 AAQ 0.74 0.61 0.65 -0.41 0.09 -0.34 -0.41 -0.57 -0.12
2. T2 ATQ Believability 0.58 0.71 0.50 -0.29 0.18 -0.30 -0.38 -0.45 -0.05
3. T2 CFQ 0.67 0.59 0.75 -0.43 0.14 -0.32 -0.45 -0.63 -0.22
4. T2 EQ decentering -0.33 -0.32 -0.42 0.63 0.20 0.38 0.21 0.27 0.42
5. T2 FFMQ Observe 0.15 0.17 0.14 0.17 0.69 0.20 -0.23 -0.19 0.28
6. T2 FFMQ Describe -0.27 -0.23 -0.24 0.29 0.19 0.71 0.21 0.19 0.26
7. T2 FFMQ Act with Awareness -0.43 -0.39 -0.43 0.21 -0.16 0.24 0.74 0.38 0.03
8. T2 FFMQ Nonjudge -0.49 -0.47 -0.57 0.24 -0.21 0.18 0.39 0.76 0.03
9. T2 FFMQ Nonreact -0.12 -0.10 -0.29 0.39 0.27 0.20 0.00 0.09 0.67
10. T2 MEAQ Behavior Avoidance 0.30 0.22 0.28 -0.15 0.08 -0.24 -0.32 -0.33 -0.15
11. T2 MEAQ Distress Aversion 0.36 0.31 0.35 -0.15 0.06 -0.17 -0.29 -0.33 -0.15
12. T2 MEAQ Procrastination 0.41 0.33 0.33 -0.18 0.11 -0.28 -0.51 -0.30 -0.05
13. T2 MEAQ Distraction/Suppression 0.28 0.20 0.32 -0.12 0.13 -0.09 -0.27 -0.34 -0.08
14. T2 MEAQ Repression/Denial 0.36 0.34 0.31 -0.17 -0.07 -0.48 -0.35 -0.33 -0.10
15. T2 MEAQ Distress Endurance -0.11 -0.13 -0.13 0.14 0.21 0.27 0.14 0.06 0.19
16. T2 MAAS -0.41 -0.34 -0.44 0.26 -0.07 0.32 0.59 0.40 0.03
17. T2 PHLMS Awareness 0.05 0.09 0.04 0.25 0.58 0.30 -0.09 -0.09 0.28
18. T2 PHLMS Acceptance 0.50 0.43 0.56 -0.16 0.26 -0.20 -0.42 -0.57 -0.06
19. T2 WBSI 0.52 0.42 0.58 -0.32 0.18 -0.21 -0.41 -0.54 -0.10
20. T2 VLQ Importance -0.17 -0.13 -0.09 0.19 0.02 0.14 0.11 0.13 -0.06
21. T2 VLQ Consistence -0.24 -0.16 -0.14 0.20 0.03 0.20 0.20 0.13 -0.01

147
Table A13. Continued

10. T1 11. T1 12. T1 13. T1 14. T1 15. T1 16. T1 17. T1 18. T1

1. T2 AAQ 0.35 0.40 0.34 0.19 0.40 -0.19 -0.39 0.00 0.48
2. T2 ATQ Believability 0.21 0.26 0.32 0.05 0.35 -0.20 -0.34 0.04 0.33
3. T2 CFQ 0.30 0.40 0.33 0.22 0.35 -0.19 -0.42 0.05 0.52
4. T2 EQ decentering -0.22 -0.21 -0.28 -0.04 -0.27 0.33 0.28 0.29 -0.22
5. T2 FFMQ Observe 0.00 0.09 0.09 0.09 -0.08 0.22 -0.12 0.54 0.20
6. T2 FFMQ Describe -0.21 -0.13 -0.23 -0.02 -0.48 0.33 0.24 0.32 -0.15
7. T2 FFMQ Act with Awareness -0.23 -0.26 -0.42 -0.19 -0.34 0.13 0.62 -0.06 -0.40
8. T2 FFMQ Nonjudge -0.27 -0.38 -0.21 -0.31 -0.33 0.06 0.37 -0.09 -0.55
9. T2 FFMQ Nonreact -0.07 -0.10 -0.05 0.05 -0.06 0.32 0.03 0.23 -0.08
10. T2 MEAQ Behavior Avoidance 0.66 0.39 0.39 0.37 0.35 -0.19 -0.22 0.07 0.36
11. T2 MEAQ Distress Aversion 0.48 0.68 0.27 0.48 0.35 -0.13 -0.22 0.09 0.46
12. T2 MEAQ Procrastination 0.40 0.26 0.70 0.25 0.41 -0.23 -0.40 0.01 0.33
13. T2 MEAQ Distraction/Suppression 0.44 0.47 0.23 0.66 0.24 0.11 -0.17 0.12 0.49
14. T2 MEAQ Repression/Denial 0.28 0.26 0.34 0.15 0.74 -0.26 -0.33 -0.15 0.31
15. T2 MEAQ Distress Endurance -0.15 -0.09 -0.16 0.10 -0.24 0.59 0.11 0.26 0.01
16. T2 MAAS -0.21 -0.18 -0.37 -0.12 -0.43 0.18 0.66 0.11 -0.31
17. T2 PHLMS Awareness 0.05 0.07 -0.01 0.14 -0.25 0.37 0.03 0.70 0.22
18. T2 PHLMS Acceptance 0.41 0.47 0.29 0.56 0.32 0.05 -0.31 0.24 0.76
19. T2 WBSI 0.31 0.37 0.25 0.39 0.27 0.05 -0.38 0.13 0.59
20. T2 VLQ Importance -0.01 0.11 -0.14 0.11 -0.17 0.22 0.15 0.08 -0.02
21. T2 VLQ Consistence -0.04 0.04 -0.17 0.07 -0.17 0.19 0.23 0.09 -0.07

148
 149

Table A13. Continued

19. T1 20. T1 21. T1

1. T2 AAQ 0.51 -0.06 -0.21
2. T2 ATQ Believability 0.38 -0.16 -0.15
3. T2 CFQ 0.58 -0.06 -0.26
4. T2 EQ decentering -0.26 0.20 0.29
5. T2 FFMQ Observe 0.19 0.06 0.01
6. T2 FFMQ Describe -0.15 0.18 0.21
7. T2 FFMQ Act with Awareness -0.47 0.07 0.20
8. T2 FFMQ Nonjudge -0.53 0.04 0.16
9. T2 FFMQ Nonreact -0.08 0.02 0.12
10. T2 MEAQ Behavior Avoidance 0.33 0.01 -0.08
11. T2 MEAQ Distress Aversion 0.37 0.18 -0.01
12. T2 MEAQ Procrastination 0.36 -0.08 -0.21
13. T2 MEAQ Distraction/Suppression 0.41 0.20 0.01
14. T2 MEAQ Repression/Denial 0.30 -0.13 -0.11
15. T2 MEAQ Distress Endurance 0.05 0.15 0.12
16. T2 MAAS -0.42 0.20 0.28
17. T2 PHLMS Awareness 0.15 0.19 0.11
18. T2 PHLMS Acceptance 0.64 0.05 -0.12
19. T2 WBSI 0.75 -0.03 -0.17
20. T2 VLQ Importance -0.06 0.72 0.36
21. T2 VLQ Consistence -0.16 0.43 0.57
 150

Table A13 Continued

Note. Ns range from 337 to 340. Test-retest reliability coefficients are bolded.
AAQ = Accepance and Action Questionnaire 2; ATQ-b = Automatic Thought
Questionnaire believability; CFQ = Cognitive Fusion Questionnaire; EQ =
Experiences Questionnaire decentering scale; FFMQ Obs = Five Factor
Mindfulness Questionnaire Observe; FFMQ des = Five Factor Mindfulness
Questionnaire Describe; FFMQ Act = Five Factor Mindfulness Questionnaire
Act with Awareness; FFMQ Nonj = Five Factor Mindfulness Questionnaire
Nonjudge; FFMQ Nonr = Five Factor Mindfulness Questionnaire Nonreact;
MEAQ BA = Multidimensional Experiential Avoidance Scale Behavioral
Avoidance; MEAQ DAv = Multidimensional Experiential Avoidance Scale
Distress Aversion; MEAQ Pr = Multidimensional Experiential Avoidance Scale
Procrastination; MEAQ D/S = Multidimensional Experiential Avoidance Scale
Distraction/Suppression; MEAQ R/D = Multidimensional Experiential
Avoidance Scale Repression/Denial; MEAQ DE = Multidimensional
Experiential Avoidance Scale Distress Endurance; MAAS = Mindful Attention
Awareness Scale; PHLMS Aw = Phildelphia Mindfulness Scale Awareness;
PHLMS Ac = Philadelphia Mindfulness Scale Acceptance; WBSI = White Bear
Suppression Inventory; VLQ I = Valued Living Questionnaire Imporance; VLQ
C = Valued Living Questionnaire Consistency
 151

Table A14. Student T1-T2 Correlations Among Non-ACT Scales

1. T1 2. T1 3. T1 4. T1 5. T1
1. T2 ASI Physical 0.70 0.52 0.27 0.38 0.00
2. T2 ASI Mental 0.47 0.70 0.28 0.50 0.01
3. T2 ASI Social 0.36 0.43 0.49 0.41 0.01
4. T2 ATQ Frequency 0.33 0.50 0.20 0.76 -0.12
5. T2 COPE Active Coping -0.01 -0.08 0.05 -0.16 0.56
6. T2 COPE Emotion-Focused
Coping 0.22 0.07 0.04 0.06 0.26
7. T2 COPE Avoidant Coping 0.20 0.37 0.08 0.44 0.05
8. T2 DIS Tolerance -0.10 -0.05 0.03 -0.01 0.11
9. T2 DIS Avoidance 0.32 0.20 0.09 0.11 0.12
10. T2 DTS Tolerance -0.33 -0.34 -0.15 -0.39 0.06
11. T2 DTS Appraisal -0.35 -0.45 -0.17 -0.44 0.09
12. T2 DTS Absorbtion -0.32 -0.37 -0.18 -0.44 0.05
13. T2 DTS Regulation -0.28 -0.32 -0.23 -0.29 -0.04
14. T2 Externalizing 0.12 0.24 0.11 0.41 -0.15
15. T2 K10 0.38 0.45 0.20 0.63 -0.16
16. T2 IPIP Extraversion -0.13 -0.09 -0.03 -0.21 0.16
17. T2 IPIP Agreeableness -0.01 -0.15 0.01 -0.15 0.21
18. T2 IPIP Conscientiousness -0.15 -0.22 0.03 -0.27 0.20
19. T2 IPIP Neuroticism 0.27 0.30 0.07 0.35 -0.18
20. T2 IPIP Openness -0.07 -0.05 0.01 -0.02 0.13
21. T2 WHODAS
Understand/Comm 0.25 0.44 0.15 0.47 -0.17
22. T2 WHODAS Getting Along 0.21 0.41 0.11 0.49 -0.12
23. T2 WHODAS Life Activities 0.28 0.45 0.14 0.50 -0.15
24. T2 WHODAS Work/School 0.17 0.33 0.15 0.46 -0.12
25. T2 VRIN 0.17 0.21 0.17 0.22 -0.08
 152

Table A14. Continued

6. T1 7. T1 8. T1 9. T1 10. T1
1. T2 ASI Physical 0.16 0.40 -0.03 0.30 -0.29
2. T2 ASI Mental 0.10 0.45 0.01 0.24 -0.30
3. T2 ASI Social 0.00 0.33 0.12 0.18 -0.24
4. T2 ATQ Frequency 0.04 0.51 0.10 0.17 -0.32
5. T2 COPE Active Coping 0.22 -0.10 0.10 0.01 0.11
6. T2 COPE Emotion-Focused
Coping 0.69 0.15 -0.22 0.15 -0.18
7. T2 COPE Avoidant Coping 0.11 0.59 0.02 0.11 -0.17
8. T2 DIS Tolerance -0.25 -0.16 0.76 -0.30 0.13
9. T2 DIS Avoidance 0.14 0.10 -0.27 0.54 -0.28
10. T2 DTS Tolerance -0.17 -0.34 0.06 -0.26 0.54
11. T2 DTS Appraisal -0.21 -0.38 0.09 -0.22 0.45
12. T2 DTS Absorbtion -0.24 -0.36 0.03 -0.20 0.50
13. T2 DTS Regulation -0.19 -0.29 0.02 -0.31 0.43
14. T2 Externalizing 0.00 0.29 0.06 0.12 -0.25
15. T2 K10 0.07 0.45 -0.01 0.25 -0.38
16. T2 IPIP Extraversion 0.18 -0.05 -0.02 0.02 0.03
17. T2 IPIP Agreeableness 0.28 -0.21 -0.06 -0.07 0.02
18. T2 IPIP Conscientiousness 0.03 -0.33 0.00 -0.14 0.10
19. T2 IPIP Neuroticism 0.23 0.17 -0.21 0.09 -0.36
20. T2 IPIP Openness 0.01 -0.08 0.07 -0.05 0.08
21. T2 WHODAS
Understand/Comm 0.00 0.42 -0.12 0.20 -0.26
22. T2 WHODAS Getting Along -0.02 0.40 -0.05 0.14 -0.19
23. T2 WHODAS Life Activities 0.01 0.44 -0.10 0.20 -0.28
24. T2 WHODAS Work/School 0.02 0.40 -0.07 0.18 -0.20
25. T2 VRIN -0.02 0.23 0.10 0.14 -0.17
 153

Table A14. Continued

11. T1 12. T1 13. T1 14. T1 15. T1

1. T2 ASI Physical -0.41 -0.37 -0.26 0.26 0.39
2. T2 ASI Mental -0.47 -0.35 -0.28 0.29 0.47
3. T2 ASI Social -0.35 -0.28 -0.28 0.26 0.35
4. T2 ATQ Frequency -0.47 -0.41 -0.24 0.38 0.63
5. T2 COPE Active Coping 0.14 0.12 0.02 -0.19 -0.16
6. T2 COPE Emotion-Focused
Coping -0.24 -0.24 -0.16 0.09 0.16
7. T2 COPE Avoidant Coping -0.33 -0.26 -0.13 0.29 0.35
8. T2 DIS Tolerance 0.15 0.14 0.07 -0.10 -0.10
9. T2 DIS Avoidance -0.23 -0.21 -0.33 0.04 0.14
10. T2 DTS Tolerance 0.56 0.54 0.47 -0.24 -0.45
11. T2 DTS Appraisal 0.70 0.52 0.44 -0.28 -0.49
12. T2 DTS Absorbtion 0.59 0.61 0.42 -0.29 -0.48
13. T2 DTS Regulation 0.46 0.47 0.55 -0.23 -0.36
14. T2 Externalizing -0.28 -0.32 -0.20 0.64 0.32
15. T2 K10 -0.47 -0.42 -0.27 0.34 0.70
16. T2 IPIP Extraversion 0.08 0.02 -0.03 -0.03 -0.16
17. T2 IPIP Agreeableness 0.06 0.02 -0.01 -0.09 -0.13
18. T2 IPIP Conscientiousness 0.24 0.17 0.11 -0.32 -0.26
19. T2 IPIP Neuroticism -0.47 -0.46 -0.26 0.18 0.43
20. T2 IPIP Openness 0.05 0.01 0.05 0.04 -0.08
21. T2 WHODAS
Understand/Comm -0.39 -0.32 -0.17 0.46 0.52
22. T2 WHODAS Getting Along -0.31 -0.25 -0.11 0.38 0.46
23. T2 WHODAS Life Activities -0.41 -0.35 -0.18 0.48 0.50
24. T2 WHODAS Work/School -0.32 -0.32 -0.18 0.38 0.47
25. T2 VRIN -0.20 -0.19 -0.15 0.14 0.31
 154

Table A14. Continued

16. T1 17. T1 18. T1 19. T1 20. T1

1. T2 ASI Physical -0.12 -0.05 -0.18 0.23 -0.11
2. T2 ASI Mental -0.08 -0.18 -0.20 0.27 -0.07
3. T2 ASI Social -0.10 -0.04 -0.09 0.17 -0.04
4. T2 ATQ Frequency -0.18 -0.13 -0.31 0.33 0.02
5. T2 COPE Active Coping 0.13 0.30 0.23 -0.14 0.13
6. T2 COPE Emotion-Focused
Coping 0.09 0.33 0.01 0.28 0.05
7. T2 COPE Avoidant Coping -0.02 -0.13 -0.36 0.18 -0.07
8. T2 DIS Tolerance 0.02 0.01 0.07 -0.23 0.07
9. T2 DIS Avoidance 0.07 0.06 -0.06 0.11 -0.01
10. T2 DTS Tolerance 0.04 -0.01 0.19 -0.35 0.05
11. T2 DTS Appraisal 0.08 0.07 0.25 -0.43 0.10
12. T2 DTS Absorbtion 0.08 0.01 0.27 -0.44 0.01
13. T2 DTS Regulation -0.01 0.03 0.07 -0.27 0.12
14. T2 Externalizing 0.01 -0.11 -0.30 0.13 -0.01
15. T2 K10 -0.19 -0.12 -0.27 0.37 -0.04
16. T2 IPIP Extraversion 0.80 0.20 0.12 -0.07 -0.02
17. T2 IPIP Agreeableness 0.26 0.63 0.26 0.03 0.16
18. T2 IPIP Conscientiousness 0.13 0.18 0.76 -0.13 0.01
19. T2 IPIP Neuroticism -0.14 -0.04 -0.12 0.71 0.07
20. T2 IPIP Openness 0.06 0.11 0.02 0.02 0.69
21. T2 WHODAS
Understand/Comm -0.15 -0.23 -0.40 0.30 -0.03
22. T2 WHODAS Getting Along -0.23 -0.28 -0.28 0.27 0.05
23. T2 WHODAS Life Activities -0.12 -0.23 -0.42 0.28 0.01
24. T2 WHODAS Work/School -0.09 -0.15 -0.34 0.27 -0.03
25. T2 VRIN -0.06 -0.10 -0.10 0.17 -0.03
 155

Table A14. Continued

21. T1 22. T1 23. T1 24. T1 25. T1

1. T2 ASI Physical 0.30 0.27 0.30 0.30 0.26
2. T2 ASI Mental 0.36 0.37 0.35 0.34 0.33
3. T2 ASI Social 0.23 0.30 0.25 0.27 0.24
4. T2 ATQ Frequency 0.45 0.41 0.34 0.42 0.34
5. T2 COPE Active Coping -0.20 -0.14 -0.21 -0.08 -0.13
6. T2 COPE Emotion-Focused
Coping -0.02 -0.05 -0.03 0.10 0.07
7. T2 COPE Avoidant Coping 0.23 0.21 0.25 0.25 0.34
8. T2 DIS Tolerance -0.12 -0.06 -0.14 0.00 -0.16
9. T2 DIS Avoidance 0.14 0.06 0.06 0.12 0.12
10. T2 DTS Tolerance -0.34 -0.17 -0.25 -0.33 -0.27
11. T2 DTS Appraisal -0.34 -0.25 -0.26 -0.31 -0.31
12. T2 DTS Absorbtion -0.31 -0.21 -0.25 -0.34 -0.27
13. T2 DTS Regulation -0.28 -0.13 -0.19 -0.30 -0.20
14. T2 Externalizing 0.34 0.34 0.36 0.33 0.25
15. T2 K10 0.45 0.40 0.34 0.38 0.35
16. T2 IPIP Extraversion -0.26 -0.36 -0.15 -0.13 -0.07
17. T2 IPIP Agreeableness -0.27 -0.21 -0.19 -0.09 -0.17
18. T2 IPIP Conscientiousness -0.38 -0.26 -0.36 -0.27 -0.21
19. T2 IPIP Neuroticism 0.25 0.20 0.14 0.23 0.18
20. T2 IPIP Openness -0.08 0.02 -0.12 -0.04 -0.07
21. T2 WHODAS
Understand/Comm 0.61 0.52 0.53 0.47 0.24
22. T2 WHODAS Getting Along 0.59 0.62 0.47 0.43 0.28
23. T2 WHODAS Life Activities 0.53 0.50 0.59 0.44 0.27
24. T2 WHODAS Work/School 0.48 0.45 0.47 0.56 0.21
25. T2 VRIN 0.20 0.15 0.17 0.24 0.48
Note. Ns range from 314 to 342. Test-retest reliability coefficients are bolded. ASI =
Anxiety Sensitivity Index; ATQ = Automatic Thoughts Questionnaire; DIS =
Discomfort Intolerance Scale; DTS = Distress Tolerance Scale; IPIP = International
Personality Item Pool; K10 = Kessler Psychological Distress Scale; WHODAS =
World Health Organization Disability Assessment; VRIN = Variable Response
Inventory
 156

Table A15. Parallel Analyses for Scale-Level Factor Analysis of

ACT Measures

Mechanical Turk

95% Upper
Factor Mean Random Bound
Raw Eigenvalue
number Eigenvalue Random
Eigenvalue

1 6.51 1.47 1.55

2 4.49 1.38 1.44
3 1.63 1.32 1.37
4 1.40 1.27 1.32
5 1.24 1.22 1.26
6 0.71 1.18 1.21
7 0.65 1.13 1.17
8 0.55 1.09 1.13
9 0.50 1.06 1.09
10 0.44 1.02 1.05
11 0.37 0.98 1.01
12 0.36 0.95 0.98
13 0.33 0.91 0.94
14 0.31 0.88 0.91
15 0.29 0.84 0.87
16 0.27 0.81 0.84
17 0.24 0.78 0.81
18 0.21 0.74 0.77
19 0.20 0.70 0.74
20 0.17 0.66 0.70
21 0.13 0.61 0.65
 157

Table A15 Continued

Student Time 1

95% Upper
Raw Mean Random
Factor number Bound Random
Eigenvalue Eigenvalue
Eigenvalue

1 6.66 1.39 1.46

2 2.83 1.32 1.37
3 1.72 1.27 1.31
4 1.50 1.23 1.26
5 1.06 1.19 1.22
6 0.94 1.15 1.18
7 0.90 1.11 1.14
8 0.74 1.08 1.11
9 0.60 1.05 1.08
10 0.52 1.02 1.04
11 0.50 0.99 1.01
12 0.43 0.96 0.99
13 0.40 0.93 0.95
14 0.35 0.90 0.92
15 0.34 0.87 0.90
16 0.31 0.84 0.87
17 0.29 0.81 0.84
18 0.27 0.78 0.80
19 0.23 0.75 0.77
20 0.22 0.71 0.74
21 0.17 0.66 0.70
 158

Table A15 Continued

Student Time 2

95% Upper
Factor Raw Mean Random Bound
number Eigenvalue Eigenvalue Random
Eigenvalue

1 7.25 1.47 1.55

2 3.24 1.39 1.44
3 1.95 1.32 1.37
4 1.26 1.27 1.31
5 1.02 1.22 1.26
6 0.85 1.18 1.21
7 0.71 1.13 1.17
8 0.63 1.09 1.13
9 0.53 1.06 1.09
10 0.42 1.02 1.05
11 0.41 0.98 1.01
12 0.4 0.95 0.98
13 0.36 0.91 0.94
14 0.33 0.88 0.91
15 0.3 0.84 0.88
16 0.28 0.81 0.84
17 0.26 0.78 0.81
18 0.25 0.74 0.77
19 0.23 0.7 0.73
20 0.17 0.66 0.7
21 0.14 0.61 0.65
Note. 500 simulations using a significance level of 95%.
Non-normal random datasets used (based on raw data).
Principal components analysis used.
Table A16. Three-Factor ACT Model Promax Exploratory Factor Analysis

Mechanical Turk Student Time 1 Student Time 2

F1 F2 F3 F1 F2 F3 F1 F2 F3
AAQ 0.84 -0.06 0.06 0.82 -0.01 -0.03 0.60 -0.02 0.40
ATQ-Believability 0.87 -0.17 -0.04 0.81 -0.07 -0.14 0.71 -0.08 0.15
CFQ 0.87 -0.06 0.05 0.84 0.01 -0.01 0.65 0.00 0.39
EQ decentering -0.27 -0.52 0.07 -0.44 -0.39 0.10 -0.33 -0.48 -0.15
FFMQ Observe 0.41 -0.87 -0.05 0.46 -0.73 -0.08 0.30 -0.84 0.08
FFMQ Describe -0.14 -0.52 -0.19 -0.22 -0.47 -0.08 -0.30 -0.49 -0.15
FFMQ Act with Awareness -0.69 -0.07 -0.08 -0.56 0.06 -0.14 -0.49 0.16 -0.31
FFMQ Nonjudge -0.62 0.25 -0.31 -0.72 0.14 -0.16 -0.46 0.17 -0.47
FFMQ Nonreact -0.08 -0.45 0.09 -0.03 -0.46 -0.05 -0.07 -0.53 -0.06
MEAQ Behavioral
0.06 0.07 0.75 0.13 0.18 0.50 0.00 0.11 0.71
Avoidance
MEAQ Distress Aversion 0.05 -0.03 0.72 0.24 0.06 0.58 -0.09 0.11 0.80
MEAQ Procrastination 0.30 0.29 0.44 0.33 0.15 0.18 0.26 0.06 0.50
MEAQ
-0.31 -0.13 0.87 -0.09 -0.01 0.90 -0.27 -0.01 0.92
Distraction/Suppression
MEAQ Repression/Denial 0.27 0.29 0.39 0.27 0.35 0.30 0.28 0.30 0.38
MEAQ Distress Endurance -0.23 -0.50 0.19 -0.12 -0.54 0.13 -0.35 -0.42 0.15

159
Table A16 Continued

Mechanical Turk Student Time 1 Student Time 2

F1 F2 F3 F1 F2 F3 F1 F2 F3
MAAS -0.48 -0.38 0.02 -0.54 -0.06 -0.05 -0.54 -0.06 -0.18
PHLMS Awareness 0.24 -0.90 0.08 0.30 -0.76 0.00 0.04 -0.83 0.14
PHLMS Acceptance 0.25 -0.18 0.70 0.55 -0.17 0.47 0.25 -0.19 0.70
WBSI 0.45 -0.05 0.57 0.67 -0.18 0.24 0.28 -0.10 0.64
VLQ Importance -0.28 -0.15 0.29 -0.23 -0.21 0.27 -0.50 -0.02 0.27
VLQ Consistence -0.26 -0.12 0.16 -0.35 -0.19 0.21 -0.49 0.01 0.15

Note. Correlations >= 0.35 are highlighted. Scales used to define factor are underlined.

160
 161

Table A17. Factor Correlations for Three-

Factor ACT Model

MT-T1 MT-T2 T1-T2

Factor 1 0.97 0.97 0.95
Factor 2 0.94 0.94 0.96
Factor 3 0.94 0.91 0.84
 162

Table A18. Four-Factor ACT Model Promax Exploratory Factor

Analysis

Mechanical Turk
Factor Factor Factor Factor
1 2 3 4
AAQ 0.83 0.06 0.09 0.02
ATQ-Believability 0.87 -0.02 0.15 -0.08
CFQ 0.78 0.34 0.22 0.11
EQ decentering -0.14 -0.69 0.18 -0.05
FFMQ Observe 0.29 -0.22 0.70 0.02
FFMQ Describe -0.25 -0.05 0.48 -0.09
FFMQ Act with Awareness -0.82 0.16 0.14 0.06
FFMQ Nonjudge -0.62 0.08 -0.17 -0.28
FFMQ Nonreact 0.16 -0.84 0.07 -0.13
MEAQ Behavioral
Avoidance 0.06 0.09 -0.06 0.77
MEAQ Distress Aversion -0.02 0.17 0.06 0.81
MEAQ Procrastination 0.37 0.08 -0.26 0.39
MEAQ
Distraction/Suppression -0.25 -0.19 0.00 0.84
MEAQ Repression/Denial 0.49 -0.31 -0.44 0.21
MEAQ Distress Endurance -0.14 -0.51 0.25 0.11
MAAS -0.58 -0.08 0.31 0.12
PHLMS Awareness 0.10 -0.18 0.77 0.17
PHLMS Acceptance 0.26 -0.07 0.11 0.68
WBSI 0.42 0.12 0.08 0.59
VLQ Importance -0.27 -0.13 0.04 0.30
VLQ Consistence -0.24 -0.17 0.02 0.16
 163

Table A18. Continued

Student Time 1
Factor Factor Factor Factor
1 2 3 4
AAQ 0.74 0.00 0.12 -0.01
ATQ-Believability 0.68 -0.07 0.14 -0.11
CFQ 0.90 0.07 -0.06 0.02
EQ decentering -0.55 -0.43 0.07 0.06
FFMQ Observe 0.24 -0.74 0.14 -0.08
FFMQ Describe -0.09 -0.41 -0.31 -0.06
FFMQ Act with Awareness -0.10 0.23 -0.75 -0.04
FFMQ Nonjudge -0.61 0.13 -0.13 -0.17
FFMQ Nonreact -0.32 -0.57 0.33 -0.11
MEAQ Behavioral
Avoidance -0.02 0.14 0.30 0.47
MEAQ Distress Aversion 0.22 0.08 0.08 0.58
MEAQ Procrastination -0.05 0.02 0.64 0.12
MEAQ
Distraction/Suppression -0.05 0.02 0.00 0.87
MEAQ Repression/Denial -0.04 0.24 0.56 0.25
MEAQ Distress Endurance -0.05 -0.48 -0.23 0.14
MAAS -0.17 0.09 -0.64 0.04
PHLMS Awareness 0.22 -0.70 -0.08 0.03
PHLMS Acceptance 0.52 -0.12 0.04 0.49
WBSI 0.57 -0.17 0.13 0.25
VLQ Importance -0.04 -0.13 -0.31 0.30
VLQ Consistence -0.22 -0.13 -0.22 0.22
 164

Table A18. Continued

Student Time 2
Factor Factor Factor Factor
1 2 3 4
AAQ 0.57 0.02 0.27 0.19
ATQ-Believability 0.56 -0.04 0.36 -0.04
CFQ 0.79 0.07 0.18 0.09
EQ decentering -0.42 -0.54 -0.07 -0.02
FFMQ Observe 0.21 -0.82 0.15 -0.04
FFMQ Describe -0.03 -0.46 -0.38 -0.18
FFMQ Act with Awareness -0.14 0.22 -0.56 -0.25
FFMQ Nonjudge -0.54 0.14 -0.16 -0.26
FFMQ Nonreact -0.39 -0.63 0.24 0.06
MEAQ Behavioral
Avoidance -0.02 0.07 0.12 0.73
MEAQ Distress Aversion 0.08 0.10 -0.07 0.76
MEAQ Procrastination -0.04 -0.01 0.44 0.53
MEAQ
Distraction/Suppression 0.08 -0.02 -0.24 0.84
MEAQ Repression/Denial -0.05 0.24 0.46 0.44
MEAQ Distress Endurance -0.09 -0.41 -0.33 0.13
MAAS -0.13 0.00 -0.61 -0.13
PHLMS Awareness 0.21 -0.78 -0.17 0.01
PHLMS Acceptance 0.45 -0.16 0.00 0.51
WBSI 0.43 -0.08 0.06 0.45
VLQ Importance -0.07 0.01 -0.51 0.28
VLQ Consistence -0.08 0.05 -0.51 0.17
Note. Correlations >= 0.35 are highlighted.
 165

Table A19. Factor Correlations for Four-

Factor ACT Model

MT-T1 MT-T2 T1-T2

Factor 1 0.76 0.74 0.99
Factor 2 0.61 0.61 0.97
Factor 3 -0.42 -0.31 0.90
Factor 4 0.92 0.92 0.89
 166

Table A20. Item-Level Parallel Analyses for ACT Factor 1

(Fusion/Inflexibility)

Mechanical Turk
Factor Raw Mean Random 95% Upper Bound
number Eigenvalue Eigenvalue Random Eigenvalue
1 27.94 2.20 2.30
2 5.48 2.11 2.18
3 3.77 2.04 2.10
4 2.76 1.98 2.03
5 2.22 1.93 1.98
6 1.80 1.88 1.93
7 1.55 1.83 1.87
8 1.47 1.79 1.83
9 1.25 1.75 1.79
10 1.17 1.71 1.75
11 1.12 1.67 1.71
12 1.06 1.64 1.68
13 1.01 1.61 1.64
14 0.97 1.57 1.61
15 0.93 1.54 1.57
 167

Table A20. Continued

Student Time 1
Factor Raw Mean Random 95% Upper Bound
number Eigenvalue Eigenvalue Random Eigenvalue
1 26.25 1.93 2.00
2 6.46 1.86 1.91
3 4.01 1.81 1.85
4 2.92 1.77 1.81
5 2.16 1.73 1.76
6 1.86 1.69 1.72
7 1.49 1.66 1.69
8 1.41 1.62 1.66
9 1.29 1.60 1.62
10 1.18 1.57 1.60
11 1.09 1.54 1.57
12 1.01 1.51 1.54
13 0.98 1.48 1.51
14 0.93 1.46 1.48
15 0.91 1.44 1.46
 168

Table A20. Continued

Table A20. Item-Level Parallel Analyses for ACT Factor 1

(Fusion/Inflexibility)
Student Time 2
95% Upper Bound
Raw Mean Random
Factor number Random
Eigenvalue Eigenvalue
Eigenvalue
1 28.82 2.14 2.23
2 7.58 2.05 2.12
3 4.80 1.99 2.04
4 3.28 1.93 1.98
5 2.20 1.88 1.93
6 1.89 1.84 1.88
7 1.45 1.79 1.83
8 1.40 1.75 1.79
9 1.16 1.71 1.75
10 1.14 1.68 1.71
11 0.98 1.65 1.68
12 0.93 1.61 1.64
13 0.88 1.58 1.61
14 0.86 1.55 1.58
15 0.83 1.52 1.55
Note. 500 simulations using a significance level of 95%. Non-normal random
datasets used (based on raw data). Principal components analysis used.
 169

Table A21. Correlations Between Subfactor Loadings for 1st Scale-Level EFA factor

1 factor solution 2 factor solution 3 factor solution

Internalizing Depressive
Belief/Inflexibility Belief/Inflexibility Internalizing Belief
T1-
MT-T1 MT-T2 T1-T2 MT-T1 MT-T2 T1-T2 MT-T1 MT-T2 T2
-0.99 0.99 -0.99 0.97 0.93 0.95 0.96 0.96 0.97
Detachment Inflexibility
T1-
MT-T1 MT-T2 T1-T2 MT-T1 MT-T2 T2
0.94 0.90 0.98 0.88 0.93 0.96
Detachment
T1-
MT-T1 MT-T2 T2
0.91 0.94 0.97
4 factor solution 5 factor solution
Internalizing Belief Internalizing Belief
MT-T1 MT-T2 T1-T2 MT-T1 MT-T2 T1-T2
0.96 0.97 0.97 0.96 0.95 0.97
Fusion Inflexibility
MT-T1 MT-T2 T1-T2 MT-T1 MT-T2 T1-T2
0.85 0.77 0.79 0.77 0.65 0.93
Detachment ???
MT-T1 MT-T2 T1-T2 MT-T1 MT-T2 T1-T2
0.92 0.94 0.98 0.89 0.88 0.96
??? Detachment
MT-T1 MT-T2 T1-T2 MT-T1 MT-T2 T1-T2
0.90 0.89 0.95 0.83 0.84 0.98
???
MT-T1 MT-T2 T1-T2
-0.09 -0.20 0.91
Table A22. Mechanical Turk Subfactors of ACT Factor 1 (Fusion/Inflexibility), Using Promax Rotation

Int
Item Scale Inflexibility Belief Detachment
My painful experiences and memories make it difficult for me to live a
life that I would value. AAQ 0.41 0.33 0.11
I’m afraid of my feelings. AAQ 0.41 0.28 0.11
I worry about not being able to control my worries and feelings. AAQ 0.60 0.15 0.08
My painful memories prevent me from having a fulfilling life. AAQ 0.43 0.26 0.14
Emotions cause problems in my life. AAQ 0.52 0.19 0.02
It seems like most people are handling their lives better than I am. AAQ 0.37 0.28 0.11
Worries get in the way of my success. AAQ 0.49 0.15 0.10
I feel like I’m up against the world. ATQ-b 0.17 0.39 0.02
I’m no good. ATQ-b 0.02 0.72 -0.05
Why can’t I ever succeed? ATQ-b 0.12 0.61 0.02
No one understands me. ATQ-b 0.07 0.59 0.05
I’ve let people down. ATQ-b 0.06 0.62 0.01
I don’t think I can go on. ATQ-b 0.05 0.62 0.05
I wish I were a better person. ATQ-b 0.16 0.47 -0.05
I’m so weak. ATQ-b 0.03 0.70 0.02
My life’s not going the way I want it to. ATQ-b 0.21 0.38 0.06
I’m so disappointed in myself. ATQ-b 0.15 0.64 0.08
Nothing feels good anymore. ATQ-b 0.06 0.72 0.05
I can’t stand this anymore. ATQ-b 0.04 0.70 0.06
I can’t get started. ATQ-b 0.10 0.62 0.06

170
Table A22. Continued

Int
Item Scale Inflexibility Belief Detachment
What’s wrong with me? ATQ-b 0.11 0.68 -0.04
I wish I were somewhere else. ATQ-b 0.12 0.55 -0.05
I can’t get things together. ATQ-b 0.14 0.69 0.02
I hate myself. ATQ-b -0.05 0.84 -0.03
I’m worthless. ATQ-b -0.03 0.89 -0.04
Wish I could just disappear. ATQ-b 0.02 0.75 -0.06
What’s the matter with me? ATQ-b 0.08 0.71 -0.03
I’m a loser. ATQ-b 0.01 0.78 0.03
My life is a mess. ATQ-b 0.07 0.63 0.09
I’m a failure. ATQ-b 0.05 0.79 0.00
I’ll never make it. ATQ-b -0.02 0.81 0.06
I feel so hopeless. ATQ-b 0.05 0.76 0.01
Something has to change. ATQ-b 0.41 0.38 -0.16
There must be something wrong with me. ATQ-b 0.11 0.75 -0.04
My future is bleak. ATQ-b -0.04 0.78 0.07
It’s just not worth it. ATQ-b -0.05 0.80 -0.05
I can’t finish anything. ATQ-b 0.07 0.67 0.01
My thoughts cause me distress or emotional pain CFQ 0.56 0.26 0.02
I get so caught up in my thoughts that I am unable to do the
things that I most want to do CFQ 0.65 0.16 0.07
Even when I am having distressing thoughts, I know that
they may become less important eventually CFQ 0.41 -0.23 -0.29

171
Table A22. Continued

Int
Item Scale Inflexibility Belief Detachment
I over-analyse situations to the point where it’s unhelpful to me CFQ 0.62 0.06 0.08
I struggle with my thoughts CFQ 0.67 0.06 0.15
Even when I’m having upsetting thoughts, I can see that those thoughts may
not be literally true CFQ 0.42 -0.19 -0.20
I get upset with myself for having certain thoughts CFQ 0.63 0.06 0.02
I need to control the thoughts that come into my head CFQ 0.69 -0.03 -0.11
I find it easy to view my thoughts from a different perspective CFQ 0.13 0.06 -0.33
I tend to get very entangled in my thoughts CFQ 0.70 0.00 0.09
I tend to react very strongly to my thoughts CFQ 0.50 0.16 -0.08
Its possible for me to have negative thoughts about myself and still know
that I am an OK person CFQ 0.43 -0.24 -0.02
It’s such a struggle to let go of upsetting thoughts even when I know that
letting go would be helpful CFQ 0.67 0.12 0.04
I could be experiencing some emotion and not be conscious of it until some
time later. MAAS 0.14 -0.15 -0.52
I break or spill things because of carelessness, not paying attention, or
thinking of something else. MAAS 0.18 -0.14 -0.64
I find it difficult to stay focused on what’s happening in the present. MAAS -0.12 -0.06 -0.62
I tend to walk quickly to get where I’m going without paying attention to
what I experience along the way. MAAS -0.13 0.13 -0.58
I tend not to notice feelings of physical tension or discomfort until they
really grab my attention. MAAS 0.18 -0.02 -0.50
I forget a person’s name almost as soon as I’ve been told it for the first time. MAAS -0.04 0.13 -0.45
It seems I am “running on automatic” without much awareness of what I’m
doing. MAAS -0.10 0.04 -0.74

172
Table A22. Continued

Int
Item Scale Inflexibility Belief Detachment
I rush through activities without being really attentive to them. MAAS -0.14 0.06 -0.76
I get so focused on the goal I want to achieve that I lose touch
with what I am doing right now to get there. MAAS -0.04 -0.03 -0.56
I do jobs or tasks automatically, without being aware of what I’m
doing. MAAS -0.08 -0.01 -0.76
I find myself listening to someone with one ear, doing something
else at the same time. MAAS -0.22 0.16 -0.49
I drive places on “automatic pilot” and then wonder why I went
there. MAAS 0.18 -0.20 -0.65
I find myself preoccupied with the future or the past. MAAS -0.32 0.04 -0.33
I find myself doing things without paying attention. MAAS -0.12 0.14 -0.76
I snack without being aware that I’m eating. MAAS 0.13 -0.24 -0.63
When I do things, my mind wanders off and I’m easily distracted. FFMQ AwA -0.49 0.01 -0.35
I don’t pay attention to what I’m doing because I’m daydreaming,
worrying, or otherwise distracted FFMQ AwA -0.39 0.02 -0.38
I am easily distracted. FFMQ AwA -0.39 -0.03 -0.38
I find it difficult to stay focused on what’s happening in the
present. FFMQ AwA -0.41 -0.07 -0.34
It seems I am “running on automatic” without much awareness of
what I’m doing. FFMQ AwA -0.35 -0.02 -0.39
I rush through activities without being really attentive to them. FFMQ AwA -0.34 0.02 -0.37
I do jobs or tasks automatically without being aware of what I’m
doing. FFMQ AwA -0.21 -0.08 -0.39
I find myself doing things without paying attention. FFMQ AwA -0.33 -0.03 -0.45

173
Table A22. Continued.

Int
Item Scale Inflexibility Belief Detachment
I criticize myself for having irrational or inappropriate emotions. FFMQ NJ -0.48 -0.06 0.00
I tell myself I shouldn’t be feeling the way I’m feeling. FFMQ NJ -0.40 -0.19 -0.01
I believe some of my thoughts are abnormal or bad and I shouldn’t think that
way. FFMQ NJ -0.45 -0.11 -0.07
I make judgments about whether my thoughts are good or bad. FFMQ NJ -0.34 -0.12 0.25
I tell myself that I shouldn’t be thinking the way I’m thinking. FFMQ NJ -0.51 -0.05 -0.03
I think some of my emotions are bad or inappropriate and I shouldn’t feel
them. FFMQ NJ -0.44 -0.17 0.01
When I have distressing thoughts or images, I judge myself as good or bad,
depending on what the thought/image is about FFMQ NJ -0.36 -0.16 0.17
I disapprove of myself when I have irrational ideas. FFMQ NJ -0.30 -0.18 0.01
Note. Underlined loadings indicate that the item is used to calculate the subfactor subscore.

174
Table A23. Student Time 1 Subfactors of ACT Factor 1 (Fusion/Inflexibility), Using Promax Rotation

Int
Item Scale Inflexibility Belief Detachment
My painful experiences and memories make it difficult for me to live a
life that I would value. AAQ 0.34 0.44 0.01
I’m afraid of my feelings. AAQ 0.60 0.19 -0.01
I worry about not being able to control my worries and feelings. AAQ 0.64 0.14 0.01
My painful memories prevent me from having a fulfilling life. AAQ 0.33 0.40 0.00
Emotions cause problems in my life. AAQ 0.56 0.25 -0.05
It seems like most people are handling their lives better than I am. AAQ 0.41 0.35 0.07
Worries get in the way of my success. AAQ 0.44 0.27 0.03
I feel like I’m up against the world. ATQ-b 0.20 0.50 0.02
I’m no good. ATQ-b 0.17 0.67 -0.05
Why can’t I ever succeed? ATQ-b 0.15 0.66 0.02
No one understands me. ATQ-b 0.33 0.43 0.01
I’ve let people down. ATQ-b 0.20 0.51 0.01
I don’t think I can go on. ATQ-b -0.13 0.79 0.03
I wish I were a better person. ATQ-b 0.16 0.57 0.04
I’m so weak. ATQ-b -0.01 0.66 0.07
My life’s not going the way I want it to. ATQ-b 0.06 0.63 0.02
I’m so disappointed in myself. ATQ-b 0.06 0.69 0.04
Nothing feels good anymore. ATQ-b 0.02 0.72 0.02
I can’t stand this anymore. ATQ-b 0.08 0.62 -0.01
I can’t get started. ATQ-b -0.09 0.63 0.15

175
Table A23. Continued

Int
Item Scale Inflexibility Belief Detachment
What’s wrong with me? ATQ-b 0.31 0.54 -0.06
I wish I were somewhere else. ATQ-b 0.19 0.46 -0.02
I can’t get things together. ATQ-b 0.08 0.65 0.07
I hate myself. ATQ-b -0.01 0.83 -0.06
I’m worthless. ATQ-b -0.08 0.86 -0.05
Wish I could just disappear. ATQ-b 0.02 0.75 -0.07
What’s the matter with me? ATQ-b 0.27 0.62 -0.10
I’m a loser. ATQ-b -0.09 0.72 0.01
My life is a mess. ATQ-b 0.05 0.65 0.03
I’m a failure. ATQ-b -0.10 0.86 -0.03
I’ll never make it. ATQ-b -0.20 0.82 0.07
I feel so hopeless. ATQ-b -0.04 0.79 0.04
Something has to change. ATQ-b 0.30 0.39 0.01
There must be something wrong with me. ATQ-b 0.22 0.67 -0.13
My future is bleak. ATQ-b -0.14 0.74 0.11
It’s just not worth it. ATQ-b -0.08 0.71 0.04
I can’t finish anything. ATQ-b -0.08 0.68 0.09
My thoughts cause me distress or emotional pain CFQ 0.60 0.25 -0.02
I get so caught up in my thoughts that I am unable to do the
things that I most want to do CFQ 0.41 0.32 0.15
Even when I am having distressing thoughts, I know that
they may become less important eventually CFQ 0.28 -0.11 -0.11

176
Table A23. Continued

Int
Item Scale Inflexibility Belief Detachment
I over-analyse situations to the point where it’s unhelpful to me CFQ 0.60 0.02 0.05
I struggle with my thoughts CFQ 0.73 0.14 -0.04
Even when I’m having upsetting thoughts, I can see that those thoughts may not
be literally true CFQ 0.21 -0.19 0.02
I get upset with myself for having certain thoughts CFQ 0.77 0.01 -0.01
I need to control the thoughts that come into my head CFQ 0.75 -0.01 -0.03
I find it easy to view my thoughts from a different perspective CFQ 0.07 -0.06 -0.02
I tend to get very entangled in my thoughts CFQ 0.61 0.06 0.06
I tend to react very strongly to my thoughts CFQ 0.56 0.08 -0.02
Its possible for me to have negative thoughts about myself and still know that I
am an OK person CFQ 0.20 -0.12 -0.07
It’s such a struggle to let go of upsetting thoughts even when I know that letting
go would be helpful CFQ 0.64 -0.03 0.04
I could be experiencing some emotion and not be conscious of it until some
time later. MAAS -0.05 0.01 -0.38
I break or spill things because of carelessness, not paying attention, or thinking
of something else. MAAS 0.02 0.02 -0.47
I find it difficult to stay focused on what’s happening in the present. MAAS -0.12 -0.01 -0.58
I tend to walk quickly to get where I’m going without paying attention to what I
experience along the way. MAAS -0.04 0.04 -0.49
I tend not to notice feelings of physical tension or discomfort until they really
grab my attention. MAAS 0.05 0.11 -0.52
I forget a person’s name almost as soon as I’ve been told it for the first time. MAAS 0.00 0.06 -0.34
It seems I am “running on automatic” without much awareness of what I’m
doing. MAAS 0.05 0.01 -0.73

177
Table A23. Continued

Int
Item Scale Inflexibility Belief Detachment
I rush through activities without being really attentive to them. MAAS 0.12 -0.01 -0.80
I get so focused on the goal I want to achieve that I lose touch
with what I am doing right now to get there. MAAS 0.02 -0.04 -0.66
I do jobs or tasks automatically, without being aware of what I’m
doing. MAAS 0.14 -0.05 -0.79
I find myself listening to someone with one ear, doing something
else at the same time. MAAS -0.19 0.08 -0.47
I drive places on “automatic pilot” and then wonder why I went
there. MAAS 0.09 -0.06 -0.58
I find myself preoccupied with the future or the past. MAAS -0.42 0.10 -0.36
I find myself doing things without paying attention. MAAS 0.00 0.08 -0.76
I snack without being aware that I’m eating. MAAS -0.06 0.04 -0.46
When I do things, my mind wanders off and I’m easily distracted. FFMQ AwA -0.09 0.01 -0.49
I don’t pay attention to what I’m doing because I’m daydreaming,
worrying, or otherwise distracted FFMQ AwA -0.02 -0.06 -0.55
I am easily distracted. FFMQ AwA -0.02 -0.01 -0.47
I find it difficult to stay focused on what’s happening in the
present. FFMQ AwA -0.14 -0.06 -0.54
It seems I am “running on automatic” without much awareness of
what I’m doing. FFMQ AwA -0.04 -0.14 -0.60
I rush through activities without being really attentive to them. FFMQ AwA -0.08 -0.04 -0.59
I do jobs or tasks automatically without being aware of what I’m
doing. FFMQ AwA 0.02 -0.02 -0.64
I find myself doing things without paying attention. FFMQ AwA -0.06 0.06 -0.69

178
Table A23. Continued.

Int
Item Scale Inflexibility Belief Detachment
I criticize myself for having irrational or inappropriate emotions. FFMQ NJ -0.59 -0.08 -0.02
I tell myself I shouldn’t be feeling the way I’m feeling. FFMQ NJ -0.64 -0.02 -0.01
I believe some of my thoughts are abnormal or bad and I shouldn’t think that
way. FFMQ NJ -0.62 -0.06 -0.07
I make judgments about whether my thoughts are good or bad. FFMQ NJ -0.59 0.07 -0.04
I tell myself that I shouldn’t be thinking the way I’m thinking. FFMQ NJ -0.68 0.02 -0.03
I think some of my emotions are bad or inappropriate and I shouldn’t feel
them. FFMQ NJ -0.63 -0.03 -0.09
When I have distressing thoughts or images, I judge myself as good or bad,
depending on what the thought/image is about FFMQ NJ -0.54 0.01 -0.13
I disapprove of myself when I have irrational ideas. FFMQ NJ -0.50 -0.04 -0.12
Note. Underlined loadings indicate that the item is used to calculate the subfactor subscore

179
Table A24. Student Time 2 Subfactors of ACT Factor 1 (Fusion/Inflexibility), Using Promax Rotation

Int
Item Scale Inflexibility Belief Detachment
My painful experiences and memories make it difficult for me to live a
life that I would value. AAQ 0.36 0.34 0.10
I’m afraid of my feelings. AAQ 0.44 0.23 0.16
I worry about not being able to control my worries and feelings. AAQ 0.62 0.17 0.03
My painful memories prevent me from having a fulfilling life. AAQ 0.36 0.40 0.06
Emotions cause problems in my life. AAQ 0.58 0.17 0.03
It seems like most people are handling their lives better than I am. AAQ 0.50 0.32 0.04
Worries get in the way of my success. AAQ 0.52 0.19 0.07
I feel like I’m up against the world. ATQ-b 0.06 0.62 0.05
I’m no good. ATQ-b 0.13 0.68 0.02
Why can’t I ever succeed? ATQ-b 0.21 0.58 0.03
No one understands me. ATQ-b 0.21 0.57 0.03
I’ve let people down. ATQ-b 0.22 0.59 -0.07
I don’t think I can go on. ATQ-b -0.23 0.89 0.01
I wish I were a better person. ATQ-b 0.17 0.60 0.00
I’m so weak. ATQ-b -0.01 0.76 0.03
My life’s not going the way I want it to. ATQ-b 0.11 0.64 0.02
I’m so disappointed in myself. ATQ-b 0.06 0.68 0.07
Nothing feels good anymore. ATQ-b -0.07 0.90 -0.05
I can’t stand this anymore. ATQ-b 0.06 0.77 0.00
I can’t get started. ATQ-b 0.05 0.71 0.06

180
Table A24. Continued

Int
Item Scale Inflexibility Belief Detachment
What’s wrong with me? ATQ-b 0.25 0.69 -0.04
I wish I were somewhere else. ATQ-b 0.17 0.49 0.09
I can’t get things together. ATQ-b 0.12 0.72 0.01
I hate myself. ATQ-b -0.07 0.89 -0.04
I’m worthless. ATQ-b -0.03 0.86 -0.04
Wish I could just disappear. ATQ-b -0.11 0.89 0.01
What’s the matter with me? ATQ-b 0.23 0.77 -0.11
I’m a loser. ATQ-b 0.01 0.77 -0.05
My life is a mess. ATQ-b 0.06 0.72 0.01
I’m a failure. ATQ-b 0.00 0.83 -0.03
I’ll never make it. ATQ-b 0.02 0.78 -0.01
I feel so hopeless. ATQ-b -0.01 0.86 -0.07
Something has to change. ATQ-b 0.38 0.47 -0.07
There must be something wrong with me. ATQ-b 0.15 0.78 -0.10
My future is bleak. ATQ-b -0.06 0.82 0.03
It’s just not worth it. ATQ-b -0.01 0.79 0.01
I can’t finish anything. ATQ-b -0.01 0.72 0.04
My thoughts cause me distress or emotional pain CFQ 0.73 0.21 -0.03
I get so caught up in my thoughts that I am unable to do the
things that I most want to do CFQ 0.60 0.26 0.06
Even when I am having distressing thoughts, I know that
they may become less important eventually CFQ 0.46 -0.23 -0.22

181
Table A24. Continued

Int
Item Scale Inflexibility Belief Detachment
I over-analyse situations to the point where it’s unhelpful to me CFQ 0.77 -0.09 0.08
I struggle with my thoughts CFQ 0.71 0.18 0.02
Even when I’m having upsetting thoughts, I can see that those thoughts may
not be literally true CFQ 0.44 -0.22 -0.21
I get upset with myself for having certain thoughts CFQ 0.73 0.11 -0.01
I need to control the thoughts that come into my head CFQ 0.71 0.09 -0.03
I find it easy to view my thoughts from a different perspective CFQ 0.32 -0.09 -0.20
I tend to get very entangled in my thoughts CFQ 0.71 0.07 0.05
I tend to react very strongly to my thoughts CFQ 0.58 0.11 0.02
Its possible for me to have negative thoughts about myself and still know
that I am an OK person CFQ 0.38 -0.31 -0.20
It’s such a struggle to let go of upsetting thoughts even when I know that
letting go would be helpful CFQ 0.68 0.06 0.02
I could be experiencing some emotion and not be conscious of it until some
time later. MAAS 0.07 -0.19 -0.38
I break or spill things because of carelessness, not paying attention, or
thinking of something else. MAAS 0.20 -0.15 -0.51
I find it difficult to stay focused on what’s happening in the present. MAAS 0.02 -0.12 -0.58
I tend to walk quickly to get where I’m going without paying attention to
what I experience along the way. MAAS -0.08 0.05 -0.61
I tend not to notice feelings of physical tension or discomfort until they
really grab my attention. MAAS 0.04 -0.02 -0.46
I forget a person’s name almost as soon as I’ve been told it for the first time. MAAS 0.02 -0.06 -0.37
It seems I am “running on automatic” without much awareness of what I’m
doing. MAAS 0.07 0.01 -0.81

182
Table A24. Continued

Int
Item Scale Inflexibility Belief Detachment
I rush through activities without being really attentive to them. MAAS 0.02 0.07 -0.85
I get so focused on the goal I want to achieve that I lose touch
with what I am doing right now to get there. MAAS -0.04 0.07 -0.72
I do jobs or tasks automatically, without being aware of what I’m
doing. MAAS 0.11 -0.01 -0.86
I find myself listening to someone with one ear, doing something
else at the same time. MAAS -0.13 0.12 -0.54
I drive places on “automatic pilot” and then wonder why I went
there. MAAS 0.13 -0.07 -0.65
I find myself preoccupied with the future or the past. MAAS -0.28 -0.02 -0.38
I find myself doing things without paying attention. MAAS -0.03 0.11 -0.84
I snack without being aware that I’m eating. MAAS -0.03 0.06 -0.54
When I do things, my mind wanders off and I’m easily distracted. FFMQ AwA -0.23 0.04 -0.43
I don’t pay attention to what I’m doing because I’m daydreaming,
worrying, or otherwise distracted FFMQ AwA -0.14 -0.08 -0.51
I am easily distracted. FFMQ AwA -0.09 0.06 -0.52
I find it difficult to stay focused on what’s happening in the
present. FFMQ AwA -0.15 -0.09 -0.47
It seems I am “running on automatic” without much awareness of
what I’m doing. FFMQ AwA -0.07 0.02 -0.67
I rush through activities without being really attentive to them. FFMQ AwA -0.20 0.08 -0.57
I do jobs or tasks automatically without being aware of what I’m
doing. FFMQ AwA -0.08 0.14 -0.68
I find myself doing things without paying attention. FFMQ AwA -0.12 0.10 -0.66

183
Table A24. Continued.

Int
Item Scale Inflexibility Belief Detachment
I criticize myself for having irrational or inappropriate emotions. FFMQ NJ -0.59 -0.09 -0.08
I tell myself I shouldn’t be feeling the way I’m feeling. FFMQ NJ -0.61 0.02 -0.10
I believe some of my thoughts are abnormal or bad and I shouldn’t think that
way. FFMQ NJ -0.63 -0.02 -0.09
I make judgments about whether my thoughts are good or bad. FFMQ NJ -0.59 0.13 0.01
I tell myself that I shouldn’t be thinking the way I’m thinking. FFMQ NJ -0.63 0.08 -0.11
I think some of my emotions are bad or inappropriate and I shouldn’t feel
them. FFMQ NJ -0.58 -0.01 -0.14
When I have distressing thoughts or images, I judge myself as good or bad,
depending on what the thought/image is about FFMQ NJ -0.51 -0.01 -0.17
I disapprove of myself when I have irrational ideas. FFMQ NJ -0.52 0.00 -0.13
Note. Underlined loadings indicate that the item is used to calculate the subfactor subscore

184
 185

Table A25. Item-Level Parallel Analyses for ACT Factor 2

(Awareness)

Mechanical Turk
Factor Raw Mean Random 95% Upper Bound
number Eigenvalue Eigenvalue Random Eigenvalue
1 12.88 1.94 2.03
2 4.35 1.85 1.92
3 3.65 1.78 1.84
4 2.59 1.72 1.77
5 2.04 1.67 1.72
6 1.62 1.62 1.66
7 1.40 1.58 1.63
8 1.23 1.54 1.58
9 1.19 1.50 1.54
10 1.09 1.46 1.50
11 1.06 1.43 1.46
12 0.98 1.39 1.42
13 0.96 1.36 1.39
14 0.92 1.32 1.36
15 0.91 1.29 1.32
 186

Table A25. Continued

Student Time 1
Factor Raw Mean Random 95% Upper Bound
number Eigenvalue Eigenvalue Random Eigenvalue
1 9.69 1.73 1.80
2 4.71 1.66 1.72
3 3.08 1.61 1.66
4 3.05 1.57 1.61
5 2.07 1.53 1.56
6 1.60 1.49 1.53
7 1.49 1.46 1.49
8 1.36 1.43 1.46
9 1.16 1.39 1.43
10 1.09 1.37 1.40
11 1.07 1.34 1.36
12 1.01 1.31 1.34
13 0.96 1.29 1.31
14 0.94 1.26 1.29
15 0.91 1.24 1.26
 187

Table A25. Continued

Student Time 2
Factor Raw Mean Random 95% Upper Bound
number Eigenvalue Eigenvalue Random Eigenvalue
1 13.53 1.89 1.98
2 5.11 1.80 1.86
3 3.45 1.74 1.79
4 3.04 1.68 1.73
5 1.95 1.64 1.68
6 1.58 1.59 1.64
7 1.40 1.55 1.59
8 1.21 1.51 1.55
9 1.16 1.47 1.51
10 1.01 1.44 1.47
11 0.97 1.40 1.43
12 0.93 1.37 1.40
13 0.88 1.34 1.37
14 0.86 1.31 1.34
15 0.81 1.28 1.31
Note. 500 simulations using a significance level of 95%. Non-normal
random datasets used (based on raw data). Principal components
analysis used.
 188

Table A26. Correlations Between Subfactor Loadings for 2nd Scale-Level EFA Factor

1 factor solution 2 factor solution 3 factor solution

Awareness Accepting Awareness Accepting Awareness
T1-
MT-T1 MT-T2 T1-T2 MT-T1 MT-T2 T1-T2 MT-T1 MT-T2 T2
0.76 0.78 0.74 0.72 0.71 0.83 0.83 0.69 0.66
Physical/Mindful Expressive/Mindful
Awareness Awareness
T1-
MT-T1 MT-T2 T1-T2 MT-T1 MT-T2 T2
-0.82 0.83 -0.90 0.89 0.86 0.89
Physical Awareness
T1-
MT-T1 MT-T2 T2
-0.92 0.90 -0.90
4 factor solution 5 factor solution
Perspective taking Perspective taking
MT-T1 MT-T2 T1-T2 MT-T1 MT-T2 T1-T2
0.90 0.92 0.92 0.62 0.80 0.89
Expressive Awareness Committed Action
MT-T1 MT-T2 T1-T2 MT-T1 MT-T2 T1-T2
0.90 0.93 0.94 0.86 0.90 0.94
Committed Action Physical Awareness
MT-T1 MT-T2 T1-T2 MT-T1 MT-T2 T1-T2
0.83 0.90 0.94 -0.85 -0.95 0.93
Physical Awareness Expressive Awareness
MT-T1 MT-T2 T1-T2 MT-T1 MT-T2 T1-T2
-0.92 -0.95 0.97 0.92 0.90 0.94
???
MT-T1 MT-T2 T1-T2
-0.35 0.42 -0.89
Table A27. Mechanical Turk Subfactors of ACT Factor 2 (Awareness), Using Promax Rotation

Perspective Expressive Committed Physical

Item Scale taking awareness Action awareness
I am better able to accept myself as I am. EQ 0.45 0.20 -0.08 0.05
I can slow my thinking at times of stress. EQ 0.56 -0.01 0.02 -0.02
I notice that I don’t take difficulties so personally. EQ 0.65 -0.17 0.01 -0.12
I can separate myself from my thoughts and feelings. EQ 0.61 0.06 0.00 -0.14
I can take time to respond to difficulties. EQ 0.44 0.18 -0.15 0.11
I can treat myself kindly. EQ 0.53 0.15 -0.04 -0.01
I can observe unpleasant feelings without being drawn
into them. EQ 0.63 0.01 0.02 -0.12
I have the sense that I am fully aware of what is going on
around me and inside me. EQ 0.27 0.26 -0.06 0.30
I can actually see that I am not my thoughts. EQ 0.45 -0.17 0.10 -0.05
I am consciously aware of a sense of my body as a whole. EQ 0.27 0.18 0.01 0.35
I view things from a wider perspective. EQ 0.26 0.28 0.07 0.22
I’m good at finding words to describe my feelings. FFMQ Des 0.11 0.60 -0.09 0.21
I can easily put my beliefs, opinions, and expectations into
words. FFMQ Des 0.03 0.64 0.02 0.12
Even when I’m feeling terribly upset, I can find a way to
put it into words. FFMQ Des 0.14 0.51 -0.02 0.18
My natural tendency is to put my experiences into words. FFMQ Des 0.13 0.45 -0.06 0.26

189
Table A27. Continued

Perspective Expressive Committed Physical

Item Scale taking awareness Action awareness
I can usually describe how I feel at the moment in
considerable detail. FFMQ Des 0.04 0.45 0.07 0.26
It’s hard for me to find the words to describe what I’m
thinking. FFMQ Des -0.15 0.82 -0.01 -0.29
I have trouble thinking of the right words to express how I
feel about things FFMQ Des -0.08 0.85 -0.01 -0.32
When I have a sensation in my body, it’s difficult for me to
describe it because I can’t find the right words. FFMQ Des -0.18 0.67 0.10 -0.25
I perceive my feelings and emotions without having to react
to them. FFMQ Nonr 0.49 -0.06 0.16 -0.01
I watch my feelings without getting lost in them. FFMQ Nonr 0.55 -0.08 0.22 -0.08
When I have distressing thoughts or images, I “step back”
and am aware of the thought or image without getting taken
over by it. FFMQ Nonr 0.32 -0.16 0.05 0.22
In difficult situations, I can pause without immediately
reacting. FFMQ Nonr 0.33 -0.08 0.22 0.07
When I have distressing thoughts or images, I feel calm soon
after. FFMQ Nonr 0.56 -0.01 0.04 -0.07
When I have distressing thoughts or images I am able just to
notice them without reacting FFMQ Nonr 0.61 -0.08 0.18 -0.10
When I have distressing thoughts or images, I just notice
them and let them go. FFMQ Nonr 0.61 -0.08 0.00 0.11

190
Table A27. Continued

Perspective Expressive Committed Physical

Item Scale taking awareness Action awareness
When I’m walking, I deliberately notice the sensations of
my body moving. FFMQ Obs 0.12 -0.10 -0.28 0.60
When I take a shower or bath, I stay alert to the sensations
of water on my body. FFMQ Obs 0.00 -0.16 -0.07 0.75
I notice how foods and drinks affect my thoughts, bodily
sensations, and emotions. FFMQ Obs 0.03 -0.08 -0.19 0.60
I pay attention to sensations, such as the wind in my hair
or sun on my face. FFMQ Obs 0.03 -0.12 -0.10 0.79
I pay attention to sounds, such as clocks ticking, birds
chirping, or cars passing. FFMQ Obs -0.11 -0.01 -0.02 0.69
I notice the smells and aromas of things. FFMQ Obs -0.06 0.14 0.10 0.48
I notice visual elements in art or nature, such as colors,
shapes, textures, or patterns of light and shadow. FFMQ Obs -0.01 0.05 0.12 0.54
I pay attention to how my emotions affect my thoughts
and behavior. FFMQ Obs 0.02 0.03 -0.03 0.59
People should face their fears MEAQ DE 0.16 0.10 0.26 0.09
Even when I feel uncomfortable, I don’t give up working
toward things I value MEAQ DE 0.16 0.01 0.57 -0.02
I am willing to put up with pain and discomfort to get
what I want MEAQ DE 0.01 -0.12 0.63 0.03
I am willing to suffer for the things that matter to me MEAQ DE 0.03 0.05 0.60 0.05
Fear or anxiety won’t stop me from doing something
important MEAQ DE 0.14 0.08 0.52 -0.06
When I am hurting, I still do what needs to be done MEAQ DE 0.06 -0.07 0.66 -0.03
I don’t let pain and discomfort stop me from getting what

191
I want MEAQ DE 0.02 0.07 0.73 -0.04
Table A27. Continued

Perspective Expressive Committed Physical

Item Scale taking awareness Action awareness
I am willing to put up with sadness to get what I want MEAQ DE 0.02 -0.17 0.43 0.14
I continue working toward my goals even if I have doubts MEAQ DE 0.20 0.07 0.54 -0.07
I don’t let gloomy thoughts stop me from doing what I want MEAQ DE 0.26 -0.05 0.50 -0.04
When working on something important, I won’t quit even if
things get difficult MEAQ DE 0.12 0.03 0.69 0.01
I am aware of what thoughts are passing through my mind. PHLMS Aw -0.01 0.35 0.10 0.29
When talking with other people, I am aware of their facial
and body expressions. PHLMS Aw 0.00 0.24 0.09 0.41
When I shower, I am aware of how the water is running over
my body. PHLMS Aw -0.06 -0.06 0.01 0.73
When I am startled, I notice what is going on inside my
body. PHLMS Aw -0.10 -0.13 0.03 0.64
When I walk outside, I am aware of smells or how the air
feels against my face. PHLMS Aw -0.12 0.01 0.25 0.61
When someone asks how I am feeling, I can identify my
emotions easily. PHLMS Aw 0.02 0.36 0.22 0.25
I am aware of thoughts I’m having when my mood changes. PHLMS Aw -0.09 0.05 0.30 0.35
I notice changes inside my body, like my heart beating faster
or my muscles getting tense. PHLMS Aw -0.19 -0.20 0.16 0.66
Whenever my emotions change, I am conscious of them
immediately. PHLMS Aw -0.07 0.13 0.22 0.41
When talking with other people, I am aware of the emotions I
am experiencing. PHLMS Aw -0.01 0.04 0.33 0.44
Note. Underlined loadings indicate that the item is used to calculate the subfactor subscore.

192
Table A28. Student Time 1 Subfactors of ACT Factor 2 (Awareness), Using Promax Rotation

Perspective Expressive Committed Physical

Item Scale taking awareness Action awareness
I am better able to accept myself as I am. EQ 0.56 0.09 0.13 0.17
I can slow my thinking at times of stress. EQ 0.63 -0.02 -0.11 0.07
I notice that I don’t take difficulties so personally. EQ 0.63 -0.04 -0.10 0.11
I can separate myself from my thoughts and feelings. EQ 0.62 0.00 -0.11 0.09
I can take time to respond to difficulties. EQ 0.39 0.02 0.10 -0.06
I can treat myself kindly. EQ 0.47 0.14 0.18 0.25
I can observe unpleasant feelings without being drawn
into them. EQ 0.73 0.05 -0.05 0.13
I have the sense that I am fully aware of what is going on
around me and inside me. EQ 0.48 0.13 0.00 -0.12
I can actually see that I am not my thoughts. EQ 0.49 0.01 -0.03 -0.01
I am consciously aware of a sense of my body as a whole. EQ 0.51 0.01 -0.02 -0.25
I view things from a wider perspective. EQ 0.48 -0.01 0.11 -0.05
I’m good at finding words to describe my feelings. FFMQ Des 0.05 0.65 -0.05 -0.14
I can easily put my beliefs, opinions, and expectations into
words. FFMQ Des 0.05 0.54 0.15 -0.12
Even when I’m feeling terribly upset, I can find a way to
put it into words. FFMQ Des 0.10 0.30 0.07 -0.06
My natural tendency is to put my experiences into words. FFMQ Des 0.03 0.38 -0.01 -0.26

193
Table A28. Continued

Perspective Expressive Committed Physical

Item Scale taking awareness Action awareness
I can usually describe how I feel at the moment in
considerable detail. FFMQ Des 0.09 0.49 -0.04 -0.29
It’s hard for me to find the words to describe what I’m
thinking. FFMQ Des -0.06 0.82 -0.04 0.16
I have trouble thinking of the right words to express how I
feel about things FFMQ Des -0.01 0.78 -0.04 0.17
When I have a sensation in my body, it’s difficult for me to
describe it because I can’t find the right words. FFMQ Des 0.04 0.52 0.07 0.21
I perceive my feelings and emotions without having to react
to them. FFMQ Nonr 0.18 -0.01 0.05 -0.21
I watch my feelings without getting lost in them. FFMQ Nonr 0.38 0.06 0.08 -0.02
When I have distressing thoughts or images, I “step back”
and am aware of the thought or image without getting taken
over by it. FFMQ Nonr 0.23 -0.09 0.05 -0.31
In difficult situations, I can pause without immediately
reacting. FFMQ Nonr 0.37 -0.09 0.18 -0.04
When I have distressing thoughts or images, I feel calm soon
after. FFMQ Nonr 0.41 -0.11 -0.03 -0.14
When I have distressing thoughts or images I am able just to
notice them without reacting FFMQ Nonr 0.43 -0.06 -0.06 -0.17
When I have distressing thoughts or images, I just notice
them and let them go. FFMQ Nonr 0.48 -0.14 -0.02 -0.08

194
Table A28. Continued

Perspective Expressive Committed Physical

Item Scale taking awareness Action awareness
When I’m walking, I deliberately notice the sensations of
my body moving. FFMQ Obs 0.01 -0.13 -0.15 -0.64
When I take a shower or bath, I stay alert to the sensations
of water on my body. FFMQ Obs 0.05 -0.05 -0.15 -0.60
I notice how foods and drinks affect my thoughts, bodily
sensations, and emotions. FFMQ Obs 0.01 -0.10 0.01 -0.52
I pay attention to sensations, such as the wind in my hair
or sun on my face. FFMQ Obs -0.01 -0.05 0.08 -0.60
I pay attention to sounds, such as clocks ticking, birds
chirping, or cars passing. FFMQ Obs -0.08 -0.08 0.13 -0.48
I notice the smells and aromas of things. FFMQ Obs 0.00 0.05 0.20 -0.45
I notice visual elements in art or nature, such as colors,
shapes, textures, or patterns of light and shadow. FFMQ Obs -0.02 -0.07 0.05 -0.53
I pay attention to how my emotions affect my thoughts
and behavior. FFMQ Obs -0.06 0.07 0.16 -0.42
People should face their fears MEAQ DE 0.16 -0.05 0.36 -0.03
Even when I feel uncomfortable, I don’t give up working
toward things I value MEAQ DE 0.02 -0.01 0.63 -0.01
I am willing to put up with pain and discomfort to get
what I want MEAQ DE -0.02 -0.15 0.46 -0.22
I am willing to suffer for the things that matter to me MEAQ DE -0.09 -0.04 0.56 -0.12
Fear or anxiety won’t stop me from doing something
important MEAQ DE 0.05 0.01 0.60 0.11
When I am hurting, I still do what needs to be done MEAQ DE -0.06 0.04 0.68 0.06
I don’t let pain and discomfort stop me from getting what

195
I want MEAQ DE -0.02 -0.11 0.74 0.02
Table A28. Continued

Perspective Expressive Committed Physical

Item Scale taking awareness Action awareness
I am willing to put up with sadness to get what I want MEAQ DE -0.01 -0.21 0.39 -0.11
I continue working toward my goals even if I have doubts MEAQ DE -0.07 0.06 0.71 0.07
I don’t let gloomy thoughts stop me from doing what I want MEAQ DE 0.17 0.06 0.52 0.15
When working on something important, I won’t quit even if
things get difficult MEAQ DE 0.01 0.02 0.69 0.09
I am aware of what thoughts are passing through my mind. PHLMS Aw 0.04 0.22 0.17 -0.18
When talking with other people, I am aware of their facial
and body expressions. PHLMS Aw -0.02 0.06 0.31 -0.28
When I shower, I am aware of how the water is running over
my body. PHLMS Aw 0.02 -0.05 -0.17 -0.64
When I am startled, I notice what is going on inside my
body. PHLMS Aw -0.01 -0.07 -0.16 -0.63
When I walk outside, I am aware of smells or how the air
feels against my face. PHLMS Aw -0.12 0.10 0.01 -0.64
When someone asks how I am feeling, I can identify my
emotions easily. PHLMS Aw 0.09 0.59 -0.08 -0.20
I am aware of thoughts I’m having when my mood changes. PHLMS Aw -0.09 0.10 0.03 -0.55
I notice changes inside my body, like my heart beating faster
or my muscles getting tense. PHLMS Aw -0.12 0.02 -0.03 -0.60
Whenever my emotions change, I am conscious of them
immediately. PHLMS Aw 0.03 0.16 -0.03 -0.48
When talking with other people, I am aware of the emotions I
am experiencing. PHLMS Aw -0.07 0.19 0.08 -0.48
Note. Underlined loadings indicate that the item is used to calculate the subfactor subscore.

196
Table A29. Student Time 2 Subfactors of ACT Factor 2 (Awareness), Using Promax Rotation

Perspective Expressive Committed Physical

Item Scale taking awareness Action awareness
I am better able to accept myself as I am. EQ 0.36 0.23 0.15 0.18
I can slow my thinking at times of stress. EQ 0.62 -0.03 0.02 0.16
I notice that I don’t take difficulties so personally. EQ 0.58 -0.04 -0.07 0.13
I can separate myself from my thoughts and feelings. EQ 0.59 -0.01 -0.01 0.13
I can take time to respond to difficulties. EQ 0.43 0.13 0.18 -0.04
I can treat myself kindly. EQ 0.46 0.26 0.02 0.17
I can observe unpleasant feelings without being drawn
into them. EQ 0.70 0.04 -0.01 0.11
I have the sense that I am fully aware of what is going on
around me and inside me. EQ 0.34 0.15 -0.01 -0.32
I can actually see that I am not my thoughts. EQ 0.55 0.10 -0.13 -0.09
I am consciously aware of a sense of my body as a whole. EQ 0.28 0.12 -0.07 -0.43
I view things from a wider perspective. EQ 0.39 0.04 0.05 -0.13
I’m good at finding words to describe my feelings. FFMQ Des 0.03 0.55 0.06 -0.26
I can easily put my beliefs, opinions, and expectations into
words. FFMQ Des 0.11 0.49 0.18 -0.20
Even when I’m feeling terribly upset, I can find a way to
put it into words. FFMQ Des 0.19 0.48 0.07 -0.23
My natural tendency is to put my experiences into words. FFMQ Des 0.11 0.40 -0.08 -0.30

197
Table A29. Continued

Perspective Expressive Committed Physical

Item Scale taking awareness Action awareness
I can usually describe how I feel at the moment in
considerable detail. FFMQ Des 0.04 0.56 -0.01 -0.39
It’s hard for me to find the words to describe what I’m
thinking. FFMQ Des -0.02 0.79 -0.07 0.25
I have trouble thinking of the right words to express how I
feel about things FFMQ Des -0.08 0.86 -0.04 0.17
When I have a sensation in my body, it’s difficult for me to
describe it because I can’t find the right words. FFMQ Des -0.08 0.75 0.00 0.10
I perceive my feelings and emotions without having to react
to them. FFMQ Nonr 0.40 -0.10 0.18 -0.15
I watch my feelings without getting lost in them. FFMQ Nonr 0.57 0.01 0.07 -0.05
When I have distressing thoughts or images, I “step back”
and am aware of the thought or image without getting taken
over by it. FFMQ Nonr 0.41 -0.06 0.01 -0.21
In difficult situations, I can pause without immediately
reacting. FFMQ Nonr 0.54 -0.13 0.13 -0.07
When I have distressing thoughts or images, I feel calm soon
after. FFMQ Nonr 0.54 -0.23 -0.08 -0.14
When I have distressing thoughts or images I am able just to
notice them without reacting FFMQ Nonr 0.56 -0.16 0.08 -0.04
When I have distressing thoughts or images, I just notice
them and let them go. FFMQ Nonr 0.53 -0.06 -0.07 -0.04

198
Table A29. Continued

Perspective Expressive Committed Physical

Item Scale taking awareness Action awareness
When I’m walking, I deliberately notice the sensations of
my body moving. FFMQ Obs -0.03 -0.04 -0.28 -0.75
When I take a shower or bath, I stay alert to the sensations
of water on my body. FFMQ Obs 0.17 -0.10 -0.19 -0.69
I notice how foods and drinks affect my thoughts, bodily
sensations, and emotions. FFMQ Obs -0.05 -0.21 -0.05 -0.59
I pay attention to sensations, such as the wind in my hair
or sun on my face. FFMQ Obs 0.08 -0.08 -0.07 -0.71
I pay attention to sounds, such as clocks ticking, birds
chirping, or cars passing. FFMQ Obs 0.02 0.03 -0.01 -0.63
I notice the smells and aromas of things. FFMQ Obs 0.12 0.08 0.16 -0.51
I notice visual elements in art or nature, such as colors,
shapes, textures, or patterns of light and shadow. FFMQ Obs 0.09 -0.02 -0.02 -0.61
I pay attention to how my emotions affect my thoughts
and behavior. FFMQ Obs -0.05 0.03 0.09 -0.61
People should face their fears MEAQ DE 0.09 0.02 0.50 -0.03
Even when I feel uncomfortable, I don’t give up working
toward things I value MEAQ DE -0.03 0.08 0.62 -0.01
I am willing to put up with pain and discomfort to get
what I want MEAQ DE 0.10 -0.25 0.67 -0.01
I am willing to suffer for the things that matter to me MEAQ DE -0.05 -0.02 0.68 -0.09
Fear or anxiety won’t stop me from doing something
important MEAQ DE 0.04 0.01 0.66 0.11
When I am hurting, I still do what needs to be done MEAQ DE 0.01 0.00 0.74 0.04
I don’t let pain and discomfort stop me from getting what

199
I want MEAQ DE 0.06 -0.01 0.75 0.06
Table A29. Continued

Perspective Expressive Committed Physical

Item Scale taking awareness Action awareness
I am willing to put up with sadness to get what I want MEAQ DE -0.02 -0.24 0.59 -0.13
I continue working toward my goals even if I have doubts MEAQ DE -0.01 0.05 0.75 0.04
I don’t let gloomy thoughts stop me from doing what I want MEAQ DE 0.01 0.11 0.70 0.13
When working on something important, I won’t quit even if
things get difficult MEAQ DE 0.03 0.06 0.69 0.09
I am aware of what thoughts are passing through my mind. PHLMS Aw 0.06 0.17 0.15 -0.32
When talking with other people, I am aware of their facial
and body expressions. PHLMS Aw -0.10 0.12 0.26 -0.47
When I shower, I am aware of how the water is running over
my body. PHLMS Aw 0.09 -0.09 -0.17 -0.70
When I am startled, I notice what is going on inside my
body. PHLMS Aw -0.07 0.02 -0.10 -0.69
When I walk outside, I am aware of smells or how the air
feels against my face. PHLMS Aw -0.08 0.01 0.11 -0.73
When someone asks how I am feeling, I can identify my
emotions easily. PHLMS Aw 0.04 0.46 0.14 -0.25
I am aware of thoughts I’m having when my mood changes. PHLMS Aw -0.07 0.02 0.19 -0.59
I notice changes inside my body, like my heart beating faster
or my muscles getting tense. PHLMS Aw -0.20 -0.17 0.11 -0.68
Whenever my emotions change, I am conscious of them
immediately. PHLMS Aw -0.02 0.03 0.15 -0.52
When talking with other people, I am aware of the emotions I
am experiencing. PHLMS Aw -0.06 0.14 0.18 -0.54
Note. Underlined loadings indicate that the item is used to calculate the subfactor subscore.

200
 201

Table A30. Item-Level Parallel Analyses for ACT Factor 3 (Avoidance)

Mechanical Turk
Factor Raw Mean Random 95% Upper Bound
number Eigenvalue Eigenvalue Random Eigenvalue
1 12.94 1.77 1.86
2 3.29 1.69 1.75
3 2.01 1.62 1.67
4 1.84 1.56 1.61
5 1.33 1.51 1.55
6 1.02 1.46 1.50
7 1.00 1.42 1.46
8 0.97 1.38 1.41
9 0.93 1.34 1.37
10 0.90 1.30 1.33
11 0.85 1.27 1.30
12 0.83 1.23 1.26
13 0.78 1.20 1.23
14 0.73 1.17 1.19
15 0.69 1.13 1.16
 202

Table A30. Continued

Student Time 1
Factor Raw Mean Random 95% Upper Bound
number Eigenvalue Eigenvalue Random Eigenvalue
1 11.63 1.60 1.67
2 3.39 1.53 1.59
3 2.51 1.48 1.53
4 1.91 1.44 1.48
5 1.39 1.40 1.44
6 1.18 1.37 1.40
7 1.15 1.33 1.36
8 1.01 1.30 1.33
9 0.95 1.27 1.30
10 0.90 1.24 1.27
11 0.84 1.22 1.24
12 0.80 1.19 1.21
13 0.78 1.16 1.19
14 0.74 1.14 1.16
15 0.69 1.11 1.13
 203

Table A30. Continued

Student Time 2
Factor Raw Mean Random 95% Upper Bound
number Eigenvalue Eigenvalue Random Eigenvalue
1 13.76 1.73 1.82
2 3.34 1.65 1.71
3 2.33 1.58 1.64
4 1.88 1.53 1.57
5 1.15 1.48 1.52
6 1.10 1.44 1.48
7 1.01 1.40 1.44
8 0.97 1.36 1.39
9 0.85 1.32 1.36
10 0.81 1.29 1.33
11 0.76 1.25 1.28
12 0.75 1.22 1.25
13 0.72 1.19 1.22
14 0.72 1.16 1.19
15 0.66 1.13 1.16
Note. 500 simulations using a significance level of 95%. Non-normal
random datasets used (based on raw data). Principal components
analysis used.
 204

Table A31. Correlations Between Subfactor Loadings for 3rd Scale-Level EFA Factor

1 factor solution 2 factor solution 3 factor solution

Avoidance Mental Avoidance Distraction
MT-T1 MT-T2 T1-T2 MT-T1 MT-T2 T1-T2 MT-T1 MT-T2 T1-T2
0.38 0.51 0.90 0.92 0.82 0.92 0.94 0.88 0.91
Physical Avoidance Physical Avoidance
MT-T1 MT-T2 T1-T2 MT-T1 MT-T2 T1-T2
0.93 0.79 0.90 0.94 0.91 0.95
Mental Avoidance
MT-T1 MT-T2 T1-T2
0.89 0.93 0.91
4 factor solution 5 factor solution
Physical Avoidance Physical Avoidance
MT-T1 MT-T2 T1-T2 MT-T1 MT-T2 T1-T2
0.86 0.87 0.94 0.89 0.90 0.94
Pain Aversion Pain Aversion
MT-T1 MT-T2 T1-T2 MT-T1 MT-T2 T1-T2
0.87 0.93 0.83 0.85 0.83 0.89
Distraction Distraction
MT-T1 MT-T2 T1-T2 MT-T1 MT-T2 T1-T2
0.94 0.87 0.88 0.90 0.78 0.91
Mental Avoidance Mental Avoidance
MT-T1 MT-T2 T1-T2 MT-T1 MT-T2 T1-T2
0.92 0.92 0.97 0.69 0.62 0.81
???
MT-T1 MT-T2 T1-T2
-0.92 0.91 -0.96
Table A32. Mechanical Turk Subfactors of ACT Factor 3 (Avoidance), Using Promax Rotation

Physical Pain Mental

Item Scale avoidance aversion Distraction avoidance
I won’t do something if I think it will make me uncomfortable MEAQ BA 0.21 0.10 0.37 -0.10
I avoid activities if there is even a small possibility of getting
hurt MEAQ BA 0.57 0.17 -0.13 -0.06
I rarely do something if there is a chance that it will upset me MEAQ BA 0.44 0.09 0.09 0.06
I work hard to avoid situations that might bring up unpleasant
thoughts and feelings in me MEAQ BA 0.29 0.05 0.31 0.13
I prefer to stick to what I am comfortable with, rather than try
new activities MEAQ BA 0.79 -0.06 -0.11 0.01
If I have any doubts about doing something, I just won’t do it MEAQ BA 0.55 -0.05 0.06 0.04
If I am starting to feel trapped, I leave the situation immediately MEAQ BA 0.66 -0.21 0.13 0.09
I go out of my way to avoid uncomfortable situations MEAQ BA 0.58 0.10 0.05 0.02
If I am in a slightly uncomfortable situation, I try to leave right
away MEAQ BA 0.75 0.04 0.03 -0.05
I avoid situations if there is a chance that I’ll feel nervous MEAQ BA 0.65 0.11 -0.04 0.15
I’m quick to leave any situation that makes me feel uneasy MEAQ BA 0.75 -0.02 -0.02 -0.03
When something upsetting comes up, I try very hard to stop
thinking about it MEAQ D/S 0.06 0.04 0.55 0.08
When negative thoughts come up, I try to fill my head with
something else MEAQ D/S 0.02 0.00 0.73 -0.14
I usually try to distract myself when I feel something painful MEAQ D/S 0.07 -0.18 0.74 -0.17
When upsetting memories come up, I try to focus on other things MEAQ D/S -0.08 0.04 0.80 -0.08
I work hard to keep out upsetting feelings MEAQ D/S 0.31 0.13 0.28 0.10

205
Table A32. Continued

Physical Pain Mental

Item Scale avoidance aversion Distraction avoidance
When unpleasant memories come to me, I try to put them out of
my mind MEAQ D/S -0.01 -0.01 0.79 -0.07
When a negative thought comes up, I immediately try to think of
something else MEAQ D/S 0.07 0.02 0.72 -0.07
If I could magically remove all of my painful memories, I would MEAQ DA -0.03 0.38 0.28 -0.05
Happiness means never feeling any pain or disappointment MEAQ DA 0.08 0.72 -0.25 -0.03
When I am hurting, I would do anything to feel better MEAQ DA 0.32 0.12 0.21 0.04
Happiness involves getting rid of negative thoughts MEAQ DA -0.13 0.57 0.27 -0.12
One of my big goals is to be free from painful emotions MEAQ DA 0.17 0.44 0.20 0.08
I’d do anything to feel less stressed MEAQ DA 0.23 0.19 0.16 0.17
In this day and age people should not have to suffer MEAQ DA 0.05 0.35 0.13 -0.01
My life would be great if I never felt anxious MEAQ DA 0.10 0.19 0.20 0.14
I would give up a lot not to feel bad MEAQ DA 0.43 0.17 0.12 0.04
Pain always leads to suffering MEAQ DA 0.35 0.40 -0.09 0.02
I wish I could get rid of all of my negative emotions MEAQ DA -0.15 0.55 0.12 0.26
The key to a good life is never feeling any pain MEAQ DA 0.07 0.81 -0.21 0.00
I hope to live without any sadness and disappointment MEAQ DA 0.05 0.64 0.05 0.00

206
Table A32. Continued

Physical Pain Mental

Item Scale avoidance aversion Distraction avoidance
I try to distract myself when I feel unpleasant emotions. PHLMS Ac -0.13 -0.08 0.54 0.35
There are aspects of myself I don’t want to think about. PHLMS Ac 0.21 -0.07 -0.23 0.73
I try to stay busy to keep thoughts or feelings from coming to
mind. PHLMS Ac 0.00 -0.05 0.28 0.44
I wish I could control my emotions more easily. PHLMS Ac 0.12 0.16 -0.01 0.54
I tell myself that I shouldn’t have certain thoughts. PHLMS Ac 0.00 0.09 -0.14 0.64
There are things I try not to think about. PHLMS Ac 0.00 -0.02 0.01 0.72
I tell myself that I shouldn’t feel sad. PHLMS Ac -0.05 0.07 0.14 0.47
If there is something I don’t want to think about, I’ll try many
things to get it out of my mind. PHLMS Ac -0.12 -0.10 0.49 0.39
I try to put my problems out of mind. PHLMS Ac 0.05 -0.08 0.51 0.23
When I have a bad memory, I try to distract myself to make it go
away. PHLMS Ac -0.02 -0.06 0.55 0.26
Note. Underlined loadings indicate that the item is used to calculate the subfactor subscore.

207
Table A33. Student Time 1 Subfactors of ACT Factor 3 (Avoidance), Using Promax Rotation

Physical Pain Mental

Item Scale avoidance aversion Distraction avoidance
I won’t do something if I think it will make me uncomfortable MEAQ BA 0.29 0.04 0.25 -0.30
I avoid activities if there is even a small possibility of getting
hurt MEAQ BA 0.57 0.11 -0.07 -0.04
I rarely do something if there is a chance that it will upset me MEAQ BA 0.59 0.06 0.16 -0.09
I work hard to avoid situations that might bring up unpleasant
thoughts and feelings in me MEAQ BA 0.18 0.23 0.36 0.02
I prefer to stick to what I am comfortable with, rather than try
new activities MEAQ BA 0.63 -0.13 -0.09 0.09
If I have any doubts about doing something, I just won’t do it MEAQ BA 0.60 -0.10 -0.04 0.05
If I am starting to feel trapped, I leave the situation immediately MEAQ BA 0.34 0.08 0.19 0.09
I go out of my way to avoid uncomfortable situations MEAQ BA 0.52 0.13 0.03 0.11
If I am in a slightly uncomfortable situation, I try to leave right
away MEAQ BA 0.57 0.13 0.11 -0.04
I avoid situations if there is a chance that I’ll feel nervous MEAQ BA 0.62 0.09 -0.08 0.11
I’m quick to leave any situation that makes me feel uneasy MEAQ BA 0.68 0.05 0.03 -0.03
When something upsetting comes up, I try very hard to stop
thinking about it MEAQ D/S 0.00 0.10 0.64 -0.02
When negative thoughts come up, I try to fill my head with
something else MEAQ D/S 0.03 -0.10 0.80 -0.04
I usually try to distract myself when I feel something painful MEAQ D/S 0.00 0.03 0.66 0.00
When upsetting memories come up, I try to focus on other things MEAQ D/S -0.08 0.00 0.85 -0.03
I work hard to keep out upsetting feelings MEAQ D/S -0.01 0.33 0.25 0.21

208
Table A33. Continued

Physical Pain Mental

Item Scale avoidance aversion Distraction avoidance
When unpleasant memories come to me, I try to put them out of
my mind MEAQ D/S 0.07 -0.01 0.76 0.00
When a negative thought comes up, I immediately try to think of
something else MEAQ D/S 0.04 0.17 0.64 -0.01
If I could magically remove all of my painful memories, I would MEAQ DA 0.03 0.45 0.13 0.07
Happiness means never feeling any pain or disappointment MEAQ DA 0.16 0.48 -0.06 -0.06
When I am hurting, I would do anything to feel better MEAQ DA -0.10 0.36 0.29 0.02
Happiness involves getting rid of negative thoughts MEAQ DA -0.14 0.57 0.22 -0.10
One of my big goals is to be free from painful emotions MEAQ DA 0.04 0.57 -0.01 0.16
I’d do anything to feel less stressed MEAQ DA -0.05 0.37 0.14 0.21
In this day and age people should not have to suffer MEAQ DA 0.09 0.30 0.23 -0.22
My life would be great if I never felt anxious MEAQ DA -0.03 0.38 0.06 0.18
I would give up a lot not to feel bad MEAQ DA 0.13 0.46 -0.03 0.21
Pain always leads to suffering MEAQ DA 0.22 0.49 -0.22 0.11
I wish I could get rid of all of my negative emotions MEAQ DA -0.05 0.66 0.07 0.13
The key to a good life is never feeling any pain MEAQ DA 0.13 0.62 -0.17 -0.03
I hope to live without any sadness and disappointment MEAQ DA 0.06 0.68 -0.06 -0.10

209
Table A33. Continued

Physical Pain Mental

Item Scale avoidance aversion Distraction avoidance
I try to distract myself when I feel unpleasant emotions. PHLMS Ac 0.02 -0.09 0.41 0.37
There are aspects of myself I don’t want to think about. PHLMS Ac 0.01 0.14 -0.15 0.65
I try to stay busy to keep thoughts or feelings from coming to
mind. PHLMS Ac 0.10 -0.08 0.18 0.59
I wish I could control my emotions more easily. PHLMS Ac 0.04 0.18 -0.21 0.71
I tell myself that I shouldn’t have certain thoughts. PHLMS Ac 0.06 0.05 -0.13 0.75
There are things I try not to think about. PHLMS Ac -0.04 0.04 0.11 0.68
I tell myself that I shouldn’t feel sad. PHLMS Ac -0.15 0.17 0.11 0.53
If there is something I don’t want to think about, I’ll try many
things to get it out of my mind. PHLMS Ac 0.07 -0.15 0.34 0.50
I try to put my problems out of mind. PHLMS Ac -0.02 -0.08 0.40 0.38
When I have a bad memory, I try to distract myself to make it go
away. PHLMS Ac 0.02 -0.07 0.40 0.43
Note. Underlined loadings indicate that the item is used to calculate the subfactor subscore.

210
Table A34. Student Time 2 Subfactors of ACT Factor 3 (Avoidance), Using Promax Rotation

Physical Pain Mental

Item Scale avoidance aversion Distraction avoidance
I won’t do something if I think it will make me uncomfortable MEAQ BA 0.39 0.02 0.18 -0.17
I avoid activities if there is even a small possibility of getting
hurt MEAQ BA 0.53 0.27 -0.14 0.00
I rarely do something if there is a chance that it will upset me MEAQ BA 0.59 0.11 0.15 -0.17
I work hard to avoid situations that might bring up unpleasant
thoughts and feelings in me MEAQ BA 0.23 0.07 0.47 0.03
I prefer to stick to what I am comfortable with, rather than try
new activities MEAQ BA 0.65 -0.09 -0.03 0.03
If I have any doubts about doing something, I just won’t do it MEAQ BA 0.56 0.15 -0.10 0.03
If I am starting to feel trapped, I leave the situation immediately MEAQ BA 0.64 -0.16 0.22 0.00
I go out of my way to avoid uncomfortable situations MEAQ BA 0.54 0.05 0.09 0.17
If I am in a slightly uncomfortable situation, I try to leave right
away MEAQ BA 0.72 0.03 0.05 -0.02
I avoid situations if there is a chance that I’ll feel nervous MEAQ BA 0.61 0.13 -0.09 0.14
I’m quick to leave any situation that makes me feel uneasy MEAQ BA 0.71 0.03 0.04 -0.03
When something upsetting comes up, I try very hard to stop
thinking about it MEAQ D/S 0.00 0.05 0.72 0.03
When negative thoughts come up, I try to fill my head with
something else MEAQ D/S -0.06 -0.05 0.81 -0.02
I usually try to distract myself when I feel something painful MEAQ D/S 0.13 -0.19 0.73 0.00
When upsetting memories come up, I try to focus on other things MEAQ D/S -0.04 -0.05 0.81 -0.05
I work hard to keep out upsetting feelings MEAQ D/S 0.08 0.16 0.46 0.16

211
Table A34. Continued

Physical Pain Mental

Item Scale avoidance aversion Distraction avoidance
When unpleasant memories come to me, I try to put them out of
my mind MEAQ D/S 0.12 -0.13 0.74 0.03
When a negative thought comes up, I immediately try to think of
something else MEAQ D/S 0.10 0.01 0.69 0.06
If I could magically remove all of my painful memories, I would MEAQ DA -0.10 0.36 0.51 -0.08
Happiness means never feeling any pain or disappointment MEAQ DA 0.00 0.83 -0.09 -0.09
When I am hurting, I would do anything to feel better MEAQ DA -0.08 0.12 0.56 -0.04
Happiness involves getting rid of negative thoughts MEAQ DA -0.05 0.42 0.32 -0.03
One of my big goals is to be free from painful emotions MEAQ DA 0.07 0.48 0.16 0.16
I’d do anything to feel less stressed MEAQ DA -0.03 0.13 0.45 0.08
In this day and age people should not have to suffer MEAQ DA 0.14 0.34 0.07 -0.09
My life would be great if I never felt anxious MEAQ DA 0.06 0.20 0.24 0.20
I would give up a lot not to feel bad MEAQ DA 0.10 0.39 0.13 0.20
Pain always leads to suffering MEAQ DA 0.27 0.35 -0.12 0.16
I wish I could get rid of all of my negative emotions MEAQ DA -0.04 0.32 0.41 0.20
The key to a good life is never feeling any pain MEAQ DA 0.14 0.82 -0.21 -0.01
I hope to live without any sadness and disappointment MEAQ DA 0.04 0.54 0.18 -0.02

212
Table A34. Continued

Physical Pain Mental

Item Scale avoidance aversion Distraction avoidance
I try to distract myself when I feel unpleasant emotions. PHLMS Ac 0.00 -0.12 0.41 0.41
There are aspects of myself I don’t want to think about. PHLMS Ac -0.05 0.11 -0.05 0.74
I try to stay busy to keep thoughts or feelings from coming to
mind. PHLMS Ac -0.11 0.05 0.05 0.76
I wish I could control my emotions more easily. PHLMS Ac -0.01 0.03 -0.04 0.67
I tell myself that I shouldn’t have certain thoughts. PHLMS Ac 0.01 0.14 -0.17 0.78
There are things I try not to think about. PHLMS Ac 0.01 -0.06 0.01 0.82
I tell myself that I shouldn’t feel sad. PHLMS Ac 0.02 0.02 -0.02 0.65
If there is something I don’t want to think about, I’ll try many
things to get it out of my mind. PHLMS Ac 0.08 -0.11 0.27 0.52
I try to put my problems out of mind. PHLMS Ac 0.05 -0.08 0.23 0.50
When I have a bad memory, I try to distract myself to make it go
away. PHLMS Ac 0.14 -0.28 0.27 0.58
Note. Underlined loadings indicate that the item is used to calculate the subfactor subscore.

213
Table A35. Correlations Among Subfactor Sum Scores for Mechanical Turk Sample

1 2 3 4 5 6 7 8 9 10 11
1. Inflexibility --
2. Internalizing Belief 0.73 --
3. Detachment -0.51 -0.47 --
4. Perspective Taking -0.20 -0.16 0.27 --
5. Expressive Awareness -0.34 -0.32 0.42 0.18 --
6. Committed Action -0.13 -0.20 0.31 0.52 0.26 --
7. Physical Awareness 0.22 0.11 0.25 0.27 0.22 0.37 --
8. Physical Avoidance 0.43 0.25 -0.16 -0.08 -0.21 -0.02 0.12 --
9. Pain Aversion 0.30 0.19 -0.02 -0.08 -0.07 -0.09 0.08 0.59 --
10. Distraction 0.07 -0.07 0.16 0.34 0.01 0.45 0.29 0.40 0.31 --
11. Mental Avoidance 0.65 0.43 -0.25 -0.08 -0.26 0.01 0.28 0.50 0.42 0.37 --

214
Table A36. Correlations Among Subfactor Sum Scores for the Student Sample

1 2 3 4 5 6 7 8 9 10 11
1. T1 Inflexibility --
2. T1 Internalizing Belief 0.66 --
3. T1 Detachment -0.45 -0.34 --
4. T1 Perspective Taking -0.39 -0.25 0.16 --
5. T1 Expressive Awareness -0.33 -0.28 0.35 0.30 --
6. T1 Committed Action -0.06 -0.15 0.16 0.32 0.27 --
7. T1 Physical Awareness 0.27 0.16 -0.10 0.17 0.13 0.27 --
8. T1 Physical Avoidance 0.33 0.27 -0.25 -0.19 -0.28 -0.28 0.03 --
9. T1 Pain Aversion 0.34 0.28 -0.18 -0.15 -0.20 -0.18 0.08 0.51 --
10. T1 Distraction 0.24 0.07 -0.20 -0.07 -0.11 0.17 0.08 0.37 0.31 --
11. T1 Mental Avoidance 0.71 0.48 -0.40 -0.36 -0.31 -0.05 0.27 0.34 0.38 0.41 --
12. T2 Inflexibility 0.83 0.58 -0.47 -0.32 -0.33 -0.07 0.22 0.30 0.33 0.25 0.61
13. T2 Internalizing Belief 0.54 0.70 -0.36 -0.23 -0.35 -0.21 0.16 0.22 0.23 0.03 0.39
14. T2 Detachment -0.45 -0.32 0.72 0.21 0.38 0.20 -0.04 -0.23 -0.17 -0.11 -0.31
15. T2 Perspective Taking -0.28 -0.25 0.13 0.66 0.26 0.31 0.21 -0.21 -0.18 -0.01 -0.30
16. T2 Expressive Awareness -0.24 -0.27 0.29 0.26 0.70 0.33 0.15 -0.23 -0.14 0.00 -0.20
17. T2 Committed Action -0.03 -0.13 0.10 0.15 0.25 0.60 0.23 -0.19 -0.19 0.11 -0.03
18. T2 Physical Awareness 0.25 0.17 -0.14 0.19 0.15 0.25 0.75 0.00 0.05 0.10 0.21
19. T2 Physical Avoidance 0.32 0.23 -0.26 -0.18 -0.29 -0.24 0.06 0.63 0.34 0.29 0.33
20. T2 Pain Aversion 0.23 0.25 -0.15 -0.09 -0.19 -0.23 0.05 0.42 0.64 0.22 0.27
21. T2 Distraction 0.34 0.17 -0.18 -0.14 -0.13 0.11 0.13 0.36 0.29 0.63 0.37
22. T2 Mental Avoidance 0.70 0.49 -0.35 -0.25 -0.30 0.02 0.25 0.35 0.35 0.41 0.73

215
Table A36. Continued

12 13 14 15 16 17 18 19 20 21 22
12. T2 Inflexibility --
13. T2 Internalizing Belief 0.62 --
14. T2 Detachment -0.48 -0.35 --
15. T2 Perspective Taking -0.29 -0.29 0.19 --
16. T2 Expressive Awareness -0.30 -0.34 0.39 0.32 --
17. T2 Committed Action -0.05 -0.22 0.23 0.36 0.38 --
18. T2 Physical Awareness 0.26 0.15 -0.06 0.31 0.22 0.28 --
19. T2 Physical Avoidance 0.43 0.28 -0.27 -0.15 -0.27 -0.14 0.14 --
20. T2 Pain Aversion 0.29 0.25 -0.15 -0.14 -0.17 -0.20 0.06 0.56 --
21. T2 Distraction 0.42 0.12 -0.16 -0.04 -0.05 0.27 0.19 0.50 0.35 --
22. T2 Mental Avoidance 0.73 0.43 -0.35 -0.23 -0.23 -0.04 0.28 0.40 0.34 0.47 --
Note. Test-retest reliabilities are bolded.

216
Table A37. Factor Analysis of Lower-Order Factor Sum Scores Using Promax Rotation

Mechanical Turk Student Time 1 Student Time 2

Factor 1 Factor 2 Factor 3 Factor 1 Factor 2 Factor 3 Factor 1 Factor 2 Factor 3
Inflexibility 0.97 0.09 0.07 1.00 0.13 -0.02 1.00 0.11 0.00
Internalizing Belief 0.77 -0.03 -0.06 0.74 -0.05 -0.12 0.67 -0.16 -0.07
Detachment -0.50 0.32 0.06 -0.41 0.07 -0.12 -0.46 0.20 -0.04
Perspective taking -0.08 0.60 -0.07 -0.36 0.32 0.03 -0.25 0.40 -0.03
Expressive Awareness -0.25 0.29 -0.13 -0.24 0.30 -0.11 -0.19 0.48 -0.14
Committed Action 0.01 0.79 -0.06 0.05 0.83 0.08 0.02 0.79 0.02
Physical Awareness 0.33 0.62 -0.02 0.36 0.44 0.02 0.31 0.48 0.02
Physical Avoidance 0.06 -0.06 0.79 0.01 -0.25 0.58 -0.01 -0.08 0.80
Pain Aversion -0.06 -0.12 0.74 0.09 -0.13 0.50 -0.10 -0.17 0.69
Distraction -0.11 0.49 0.54 -0.10 0.29 0.82 0.12 0.38 0.66
Mental Avoidance 0.50 0.16 0.42 0.63 0.14 0.31 0.65 0.13 0.22

217
Table A38. Mechanical Turk Correlations Between Subfactor Sum Scores and Other Study Variables

Int Persp. Express Commit Phys. Phys. Pain Mental

Inflex Belief Detach taking Aware. Action Aware. Avoid. Avers. Distract Avoid.
ASI Total 0.62 0.52 -0.34 -0.04 -0.25 -0.15 0.16 0.40 0.29 0.14 0.43
ASI Physical 0.57 0.47 -0.33 -0.05 -0.24 -0.15 0.16 0.34 0.19 0.12 0.37
ASI Mental 0.63 0.57 -0.40 -0.07 -0.28 -0.17 0.09 0.37 0.31 0.07 0.40
ASI Social 0.34 0.23 -0.04 0.06 -0.05 0.01 0.20 0.33 0.27 0.23 0.36
ATQ Frequency 0.73 0.89 -0.51 -0.21 -0.34 -0.23 0.09 0.22 0.15 -0.10 0.44
COPE Active Coping -0.11 -0.13 0.26 0.57 0.25 0.53 0.31 0.05 0.00 0.39 0.05
COPE Emotion Focused
Coping 0.32 0.28 -0.22 0.09 -0.08 0.01 0.15 0.22 0.12 0.21 0.34
COPE Avoidant Coping 0.53 0.56 -0.48 0.08 -0.37 -0.21 0.06 0.36 0.15 0.03 0.41
DIS Tolerance 0.06 0.07 0.01 0.23 0.02 0.24 0.25 -0.11 -0.17 0.06 0.04
DIS Avoidance 0.09 0.08 0.14 0.18 0.13 0.01 0.17 0.26 0.27 0.17 0.13
DTS Tolerance -0.24 -0.17 0.23 0.32 0.22 0.29 0.09 -0.35 -0.33 -0.07 -0.25
DTS Appraisal -0.52 -0.43 0.44 0.37 0.35 0.31 0.00 -0.38 -0.29 0.03 -0.40
DTS Absorbtion -0.44 -0.33 0.35 0.38 0.24 0.23 0.00 -0.42 -0.27 -0.03 -0.37
DTS Regulation -0.21 -0.13 0.08 0.12 0.08 -0.02 -0.10 -0.34 -0.33 -0.30 -0.33
Externalizing 0.50 0.50 -0.47 -0.03 -0.32 -0.13 0.01 0.21 0.08 -0.02 0.26
MEAQ Procrastination 0.52 0.39 -0.41 -0.18 -0.40 -0.29 -0.04 0.53 0.29 0.15 0.43
MEAQ Denial/Repression 0.47 0.44 -0.49 0.08 -0.48 -0.10 -0.09 0.41 0.31 0.10 0.40
K10 0.71 0.74 -0.56 -0.23 -0.35 -0.22 0.10 0.32 0.18 -0.07 0.49

218
Table A38. Continued

Int Persp. Express Commit Phys. Phys. Pain Mental

Inflex Belief Detach taking Aware. Action Aware. Avoid. Avers. Distract Avoid.
IPIP E -0.26 -0.13 0.16 0.27 0.26 0.04 0.07 -0.25 0.00 0.04 -0.16
IPIP A -0.09 -0.09 0.36 0.15 0.38 0.21 0.39 -0.06 0.00 0.23 0.05
IPIP C -0.37 -0.40 0.52 0.20 0.37 0.36 0.20 -0.12 0.01 0.11 -0.17
IPIP N 0.57 0.48 -0.45 -0.51 -0.33 -0.37 0.00 0.29 0.17 -0.11 0.43
IPIP I -0.12 -0.18 0.30 0.07 0.39 0.22 0.33 -0.17 -0.04 0.04 -0.17
WBSI 0.70 0.46 -0.34 -0.17 -0.32 0.02 0.21 0.53 0.38 0.37 0.74
WHODAS
understand/commun 0.49 0.55 -0.53 -0.09 -0.38 -0.26 -0.03 0.28 0.20 -0.04 0.32
WHODAS getting along 0.48 0.51 -0.43 -0.12 -0.37 -0.24 -0.02 0.29 0.19 -0.07 0.34
WHODAS life activities 0.39 0.42 -0.42 -0.12 -0.34 -0.27 -0.09 0.26 0.15 -0.05 0.27
WHODAS work/school 0.40 0.46 -0.39 -0.10 -0.29 -0.26 -0.05 0.31 0.20 -0.07 0.30
VLQ Importance -0.11 -0.16 0.22 0.20 0.14 0.15 0.21 0.03 0.20 0.30 0.06
VLQ Consistency -0.14 -0.14 0.19 0.25 0.19 0.12 0.16 0.05 0.13 0.15 -0.06
VRIN 0.19 0.22 -0.26 -0.04 -0.23 -0.23 -0.10 0.11 0.02 0.01 0.11
Note. Correlations>=0.40 are highlighted.

219
Table A39. Student Time 1 Correlations Between Subfactor Sum Scores and Other Study Variables

Int Persp. Express Commit Phys. Phys. Pain Mental

Inflex Belief Detach taking Aware. Action Aware. Avoid. Avers. Distract Avoid.
ASI Total 0.59 0.56 -0.37 -0.16 -0.18 -0.03 0.20 0.33 0.33 0.21 0.40
ASI Physical 0.48 0.45 -0.29 -0.10 -0.12 -0.02 0.18 0.32 0.29 0.22 0.32
ASI Mental 0.60 0.61 -0.38 -0.19 -0.24 -0.12 0.16 0.25 0.32 0.08 0.41
ASI Social 0.40 0.31 -0.26 -0.06 -0.08 0.11 0.19 0.16 0.12 0.14 0.26
ATQ Frequency 0.68 0.87 -0.37 -0.29 -0.33 -0.20 0.16 0.27 0.27 0.07 0.49
COPE Active Coping -0.04 -0.13 0.10 0.33 0.29 0.39 0.21 -0.17 -0.13 0.12 -0.06
COPE Emotion Focused
Coping 0.21 0.10 -0.05 -0.09 0.16 0.09 0.12 0.08 0.06 0.19 0.21
COPE Avoidant Coping 0.45 0.46 -0.33 -0.13 -0.28 -0.25 0.09 0.29 0.26 0.12 0.36
DIS Tolerance 0.04 0.05 -0.05 0.22 0.03 0.24 0.22 -0.20 -0.09 -0.11 0.01
DIS Avoidance 0.19 0.10 -0.17 -0.03 0.02 -0.13 0.11 0.22 0.17 0.16 0.13
DTS Tolerance -0.49 -0.34 0.32 0.38 0.23 0.21 -0.10 -0.33 -0.38 -0.19 -0.45
DTS Appraisal -0.65 -0.48 0.41 0.46 0.32 0.27 -0.13 -0.37 -0.44 -0.19 -0.59
DTS Absorbtion -0.57 -0.45 0.41 0.46 0.27 0.21 -0.13 -0.32 -0.37 -0.19 -0.51
DTS Regulation -0.40 -0.26 0.33 0.16 0.13 0.07 -0.13 -0.31 -0.42 -0.37 -0.44
Externalizing 0.37 0.43 -0.40 -0.21 -0.16 -0.17 0.10 0.20 0.11 0.09 0.31
MEAQ Procrastination 0.31 0.29 -0.41 -0.17 -0.31 -0.26 0.09 0.53 0.24 0.19 0.31
MEAQ Denial/Repression 0.35 0.32 -0.44 -0.11 -0.59 -0.30 -0.07 0.44 0.38 0.22 0.40
K10 0.63 0.65 -0.50 -0.32 -0.29 -0.20 0.17 0.27 0.30 0.12 0.55

220
Table A39. Continued

Int Persp. Express Commit Phys. Phys. Pain Mental

Inflex Belief Detach taking Aware. Action Aware. Avoid. Avers. Distract Avoid.
IPIP E -0.13 -0.18 0.04 0.13 0.20 0.07 0.08 -0.26 0.02 0.08 -0.08
IPIP A -0.03 -0.11 0.08 0.06 0.28 0.27 0.20 -0.13 -0.20 0.07 -0.03
IPIP C -0.15 -0.25 0.35 0.10 0.23 0.29 0.04 -0.22 -0.16 0.00 -0.18
IPIP N 0.54 0.36 -0.24 -0.45 -0.22 -0.13 0.13 0.23 0.26 0.14 0.50
IPIP I 0.05 0.04 0.03 0.10 0.20 0.23 0.25 -0.23 -0.20 -0.13 -0.02
WBSI 0.68 0.43 -0.52 -0.34 -0.28 0.02 0.27 0.28 0.25 0.38 0.72
WHODAS
understand/commun 0.38 0.38 -0.47 -0.18 -0.36 -0.29 0.01 0.28 0.18 0.08 0.34
WHODAS getting along 0.38 0.39 -0.31 -0.18 -0.29 -0.21 0.02 0.20 0.09 -0.01 0.29
WHODAS life activities 0.28 0.36 -0.36 -0.10 -0.25 -0.24 -0.02 0.21 0.13 0.00 0.23
WHODAS work/school 0.39 0.44 -0.42 -0.15 -0.26 -0.20 0.08 0.19 0.16 0.01 0.33
VLQ Importance -0.09 -0.13 0.15 0.11 0.15 0.25 0.08 -0.12 0.04 0.17 -0.02
VLQ Consistency -0.21 -0.20 0.23 0.27 0.21 0.19 0.04 -0.08 -0.04 0.09 -0.17
VRIN 0.40 0.43 -0.28 -0.12 -0.24 -0.16 0.17 0.24 0.24 0.09 0.33
Note. Correlations>=0.40 are highlighted.

221
Table A40. Student Time 2 Correlations Between Subfactor Sum Scores and Other Study Variables

Int Persp. Express Commit Phys. Phys. Pain Mental

Inflex Belief Detach taking Aware. Action Aware. Avoid. Avers. Distract Avoid.
ASI Total 0.63 0.48 -0.40 -0.21 -0.29 -0.15 0.14 0.43 0.35 0.30 0.46
ASI Physical 0.54 0.42 -0.34 -0.19 -0.25 -0.14 0.12 0.41 0.30 0.27 0.38
ASI Mental 0.58 0.47 -0.38 -0.22 -0.32 -0.30 0.07 0.38 0.41 0.16 0.44
ASI Social 0.50 0.35 -0.31 -0.06 -0.12 0.10 0.23 0.25 0.16 0.29 0.36
ATQ Frequency 0.71 0.87 -0.41 -0.31 -0.39 -0.26 0.15 0.35 0.29 0.18 0.51
COPE Active Coping -0.13 -0.25 0.22 0.41 0.35 0.41 0.22 -0.21 -0.21 0.05 -0.18
COPE Emotion Focused
Coping 0.15 -0.03 0.03 -0.09 0.25 0.16 0.12 0.05 0.07 0.20 0.12
COPE Avoidant Coping 0.43 0.45 -0.39 -0.20 -0.31 -0.30 -0.03 0.31 0.34 0.18 0.29
DIS Tolerance -0.05 -0.05 0.02 0.18 0.05 0.18 0.17 -0.23 -0.25 -0.09 -0.08
DIS Avoidance 0.23 0.05 -0.16 0.02 -0.04 -0.09 0.20 0.22 0.23 0.19 0.23
DTS Tolerance -0.50 -0.50 0.34 0.36 0.30 0.31 -0.10 -0.31 -0.37 -0.17 -0.41
DTS Appraisal -0.61 -0.53 0.42 0.43 0.36 0.37 -0.06 -0.38 -0.38 -0.20 -0.51
DTS Absorbtion -0.62 -0.55 0.40 0.42 0.27 0.27 -0.15 -0.34 -0.32 -0.21 -0.50
DTS Regulation -0.43 -0.35 0.35 0.23 0.20 0.19 -0.14 -0.33 -0.35 -0.30 -0.38
Externalizing 0.40 0.46 -0.39 -0.14 -0.23 -0.12 0.12 0.22 0.12 0.09 0.25
MEAQ Procrastination 0.47 0.39 -0.46 -0.20 -0.38 -0.16 0.11 0.58 0.36 0.40 0.42
MEAQ Denial/Repression 0.42 0.43 -0.46 -0.19 -0.57 -0.31 -0.12 0.51 0.45 0.24 0.40
K10 0.64 0.68 -0.49 -0.27 -0.44 -0.29 0.10 0.36 0.32 0.14 0.51

222
Table A40. Continued

Int Persp. Express Commit Phys. Phys. Pain Mental

Inflex Belief Detach taking Aware. Action Aware. Avoid. Avers. Distract Avoid.
IPIP E -0.19 -0.29 0.09 0.19 0.32 0.14 0.12 -0.28 -0.02 -0.04 -0.13
IPIP A -0.05 -0.23 0.17 0.03 0.27 0.29 0.16 -0.19 -0.18 0.10 0.01
IPIP C -0.30 -0.40 0.38 0.18 0.33 0.26 0.05 -0.22 -0.22 -0.03 -0.23
IPIP N 0.47 0.36 -0.27 -0.45 -0.24 -0.16 0.03 0.24 0.22 0.14 0.47
IPIP I -0.03 -0.05 0.10 0.07 0.29 0.26 0.20 -0.18 -0.26 0.01 0.03
WBSI 0.70 0.40 -0.45 -0.27 -0.26 0.08 0.19 0.44 0.26 0.53 0.73
WHODAS
understand/commun 0.47 0.52 -0.42 -0.27 -0.39 -0.32 -0.04 0.36 0.28 0.10 0.36
WHODAS getting along 0.45 0.53 -0.32 -0.23 -0.37 -0.26 -0.04 0.31 0.17 0.04 0.32
WHODAS life activities 0.46 0.55 -0.41 -0.27 -0.30 -0.28 0.00 0.30 0.22 0.06 0.34
WHODAS work/school 0.43 0.52 -0.34 -0.23 -0.26 -0.19 0.12 0.23 0.21 0.10 0.34
VLQ Importance -0.14 -0.29 0.27 0.10 0.21 0.15 0.05 0.00 0.07 0.16 -0.04
VLQ Consistency -0.22 -0.27 0.33 0.07 0.27 0.12 0.02 -0.07 0.02 0.06 -0.15
VRIN 0.38 0.45 -0.32 -0.16 -0.22 -0.25 0.13 0.21 0.15 0.08 0.33
Note. Correlations>=0.40 are highlighted.

223
Table A41. Fit Indices for Hierarchical and Correlated ACT Models

AIC BIC SRMR RMSEA

MT Simple Hierarchical Model 96492.475 97999.144 0.102 0.049
MT Multi-Path Hierarchical Model 96322.091 97836.447 0.095 0.049
MT Correlated Model 96157.183 97821.438 0.075 0.048
T1 Simple Hierarchical Model 147001.926 148642.112 0.077 0.046
T1 Multi-Path Hierarchical Model 146894.844 148543.399 0.078 0.046
T1 Correlated Model 146643.204 148454.940 0.067 0.045
T2 Simple Hierarchical Model 100348.917 101852.163 0.102 0.053
T2 Multi-Path Hierarchical Model 100227.465 101738.381 0.101 0.053
T2 Correlated Model 100037.749 101698.222 0.078 0.052

224
Table A42. Student Correlations Between ACT Subfactors and Psychopathology Measures Across Timepoints

Int Persp. Express Commit Phys. Phys. Pain Mental

Inflex Belief Detach taking Aware. Action Aware. Avoid. Avers. Distract Avoid.
T1 K10-T1 Factor 0.63 0.65 -0.50 -0.32 -0.30 -0.20 0.16 0.27 0.30 0.12 0.55
T2 K10-T1 Factor 0.56 0.63 -0.44 -0.25 -0.40 -0.23 0.08 0.29 0.28 0.06 0.47
T1 K10-T2 Factor 0.58 0.58 -0.48 -0.30 -0.30 -0.18 0.10 0.26 0.25 0.12 0.46
T1 ESI-T1 Factor 0.37 0.43 -0.40 -0.21 -0.16 -0.17 0.10 0.20 0.11 0.09 0.31
T2 ESI-T1 Factor 0.37 0.38 -0.42 -0.18 -0.21 -0.18 0.13 0.20 0.13 0.07 0.30
T1 ESI-T2 Factor 0.32 0.37 -0.35 -0.15 -0.19 -0.13 0.06 0.18 0.13 0.12 0.26
Note. N = 485 for T1. N = 340 for T2.

225
Table A43. Mechanical Turk Partial Correlations Between ACT Subfactors and External Measures Controlling for Subscales of the
ASI, DIS, DTS, and COPE

Int Persp. Express Commit Phys. Phys. Pain Mental

Inflex Belief Detach taking Aware. Action Aware. Avoid. Avers. Distract Avoid.
K10 0.40 0.51 -0.19 -0.09 -0.03 0.08 0.13 0.08 0.08 0.00 0.26
ESI 0.14 0.20 -0.18 0.10 -0.08 0.11 -0.03 0.00 -0.02 0.03 0.00
IPIP Extraversion -0.28 -0.10 0.07 0.15 0.19 -0.14 0.01 -0.27 0.00 -0.10 -0.17
IPIP Agreeableness 0.02 0.03 0.31 0.01 0.29 0.04 0.34 -0.03 0.04 0.12 0.08
IPIP Conscientiousness -0.09 -0.13 0.31 0.06 0.15 0.19 0.18 0.08 0.12 0.02 0.02
IPIP Neuroticism 0.39 0.29 -0.18 -0.34 -0.09 -0.13 0.08 0.13 0.04 -0.03 0.29
IPIP Openness 0.15 0.04 0.11 -0.08 0.29 0.04 0.33 -0.08 0.05 -0.04 -0.07
WHODAS II
Communication 0.03 0.15 -0.20 -0.02 -0.11 -0.07 -0.08 0.04 0.06 -0.02 0.00
WHODAS II Getting
Along 0.10 0.17 -0.09 -0.04 -0.11 -0.04 -0.05 0.08 0.10 -0.05 0.09
WHODAS II Life
Activities 0.05 0.13 -0.15 -0.03 -0.13 -0.11 -0.12 0.07 0.04 -0.02 0.04
WHODAS II Work and
School 0.05 0.13 -0.10 -0.04 -0.06 -0.08 -0.07 0.13 0.10 -0.06 0.07
Note. Ns range from 271 to 304.

226
Table A44. Student Time 1 Partial Correlations Between ACT Subfactors and External Measures Controlling for Subscales of the
ASI, DIS, DTS, and COPE

Int Persp. Express Commit Phys. Phys. Pain Mental

Inflex Belief Detach taking Aware. Action Aware. Avoid. Avers. Distract Avoid.
K10 0.29 0.38 -0.27 -0.06 -0.05 -0.01 0.09 0.00 0.02 0.04 0.27
ESI 0.07 0.21 -0.22 -0.04 0.03 -0.02 0.05 0.00 -0.12 0.00 0.06
IPIP Extraversion -0.14 -0.15 0.01 0.11 0.15 0.01 0.06 -0.25 0.07 0.04 -0.09
IPIP Agreeableness 0.07 0.03 -0.01 -0.01 0.15 0.13 0.17 -0.08 -0.17 0.03 0.02
IPIP Conscientiousness 0.03 -0.10 0.29 -0.04 0.09 0.12 0.04 -0.09 -0.04 0.00 -0.06
IPIP Neuroticism 0.30 0.07 -0.02 -0.20 -0.06 0.06 0.12 0.01 0.05 0.07 0.27
IPIP Openness 0.14 0.10 -0.02 0.03 0.15 0.16 0.24 -0.16 -0.14 -0.09 0.05
WHODAS II
Communication 0.10 0.12 -0.31 -0.01 -0.22 -0.16 -0.04 0.07 -0.05 0.00 0.12
WHODAS II Getting
Along 0.18 0.18 -0.16 -0.08 -0.16 -0.11 -0.04 0.05 -0.10 -0.06 0.12
WHODAS II Life
Activities 0.04 0.14 -0.24 0.05 -0.11 -0.12 -0.07 0.05 -0.04 -0.06 0.02
WHODAS II Work and
School 0.14 0.24 -0.27 -0.04 -0.16 -0.14 -0.01 0.03 -0.01 -0.06 0.13
Note. Ns range from 452 to 475.

227
Table A45. Student Time 2 Partial Correlations Between ACT Subfactors and External Measures Controlling for Subscales of the
ASI, DIS, DTS, and COPE

Int Persp. Express Commit Phys. Phys. Pain Mental

Inflex Belief Detach taking Aware. Action Aware. Avoid. Avers. Distract Avoid.
K10 0.31 0.44 -0.23 0.06 -0.24 -0.03 0.09 0.06 0.01 -0.02 0.19
ESI 0.12 0.23 -0.18 0.09 -0.03 0.08 0.11 0.00 -0.13 -0.05 -0.02
IPIP Extraversion -0.06 -0.18 -0.06 0.09 0.20 0.03 0.11 -0.22 0.06 -0.02 -0.02
IPIP Agreeableness 0.12 -0.07 0.00 -0.16 0.03 0.05 0.08 -0.06 -0.04 0.10 0.16
IPIP Conscientiousness -0.01 -0.16 0.17 -0.09 0.11 0.00 0.04 0.01 -0.01 0.06 0.01
IPIP Neuroticism 0.21 0.13 -0.10 -0.22 -0.14 0.02 0.01 0.01 -0.01 0.00 0.25
IPIP Openness 0.11 0.11 0.00 -0.06 0.20 0.14 0.15 -0.08 -0.18 0.05 0.15
WHODAS II
Communication 0.13 0.23 -0.15 -0.04 -0.13 -0.03 -0.05 0.09 -0.05 -0.02 0.07
WHODAS II Getting
Along 0.17 0.31 -0.07 -0.01 -0.14 -0.01 -0.04 0.10 -0.12 -0.06 0.08
WHODAS II Life
Activities 0.14 0.31 -0.18 -0.02 -0.04 -0.03 0.00 0.01 -0.10 -0.09 0.05
WHODAS II Work and
School 0.18 0.33 -0.12 -0.07 -0.06 0.03 0.13 0.00 -0.05 -0.02 0.11
Note. Ns range from 317 to 334.

228
 229

Table A46. Mechanical Turk R2 Values for Measures of Psychopathology, Personality,

and Functioning

ASI, COPE, DIS, 11 ACT

DTS subfactors All
K10 0.547 0.656 0.698
ESI 0.340 0.353 0.407
IPIP Extraversion 0.133 0.222 0.309
IPIP Agreeableness 0.208 0.313 0.391
IPIP Conscientiousness 0.273 0.354 0.389
IPIP Neuroticism 0.407 0.545 0.574
IPIP Openness 0.141 0.292 0.343
WHODAS II Communication 0.501 0.441 0.544
WHODAS II Getting Along 0.383 0.367 0.425
WHODAS II Life Activities 0.287 0.302 0.339
WHODAS II Work and School 0.357 0.351 0.407
 230

Table A47. Student Time 1 R2 Values for Measures of Psychopathology,

Personality, and Functioning

ASI, COPE, DIS, 11 ACT

DTS subfactors All
K10 0.454 0.570 0.588
ESI 0.252 0.286 0.339
IPIP Extraversion 0.066 0.171 0.212
IPIP Agreeableness 0.164 0.174 0.239
IPIP Conscientiousness 0.171 0.221 0.276
IPIP Neuroticism 0.388 0.382 0.472
IPIP Openness 0.104 0.173 0.223
WHODAS II Communication 0.273 0.343 0.384
WHODAS II Getting Along 0.196 0.247 0.285
WHODAS II Life Activities 0.193 0.239 0.278
WHODAS II Work and School 0.197 0.300 0.330
 231

Table A48. Student Time 2 R2 Values for Measures of Psychopathology, Personality,

and Functioning

ASI, COPE, DIS, 11 ACT

DTS subfactors All
K10 0.456 0.595 0.623
ESI 0.252 0.285 0.340
IPIP Extraversion 0.133 0.230 0.274
IPIP Agreeableness 0.261 0.207 0.332
IPIP Conscientiousness 0.283 0.261 0.342
IPIP Neuroticism 0.363 0.361 0.460
IPIP Openness 0.107 0.188 0.234
WHODAS II Communication 0.410 0.407 0.469
WHODAS II Getting Along 0.316 0.385 0.425
WHODAS II Life Activities 0.351 0.400 0.445
WHODAS II Work and School 0.252 0.326 0.359
 232

APPENDIX B

FIGURES
 233

Present Moment
Awareness

Acceptance Values

Psychological
Flexibility

Defusion Committed Action

Self as Context

Figure B1. The ACT Hexaflex

 Depressive
Awareness Avoidance
Inflexibility

Internalizing P erspective Expressive Committed P hysical P hysical P ain Mental

Inflexibility Detachment Distraction
Belief Taking Awareness Action Awareness Avoidance Aversion Avoidance

Figure B2. Simple Hierarchical ACT Model

234
 Depressive
Awareness Avoidance
Inflexibility

Internalizing P erspective Expressive Committed P hysical P hysical P ain Mental

Inflexibility Detachment Distraction
Belief Taking Awareness Action Awareness Avoidance Aversion Avoidance

Figure B3. Hierarchical ACT Model with Cross Loadings

235
 Internalizing P erspective Expressive Committed P hysical P hysical P ain Mental
Inflexibility Detachment Distraction
Belief Taking Awareness Action Awareness Avoidance Aversion Avoidance

Figure B4. Correlated ACT Model

236
 237

APPENDIX C

STUDY MEASURES
 238

Acceptance and Action Questionnaire-II (AAQ-II)

Below you will find a list of statements. Please rate how true each statement is for you.

1, never true | 2, very seldom true | 3, seldom true | 4, sometimes true | 5, frequently true | 6,
almost always true | 7, always true

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.

 239

Anxiety Sensitivity Index (ASI)

Use the scale below to determine the one phrase that best represents the extent to which you

agree with each item. If any of the items concern something that is not part of your experience

(e.g., "It scares me when I feel shaky" for someone who has never trembled or had the "shakes"),

answer on the basis of how you think you might feel if you had such an experience. Otherwise,

answer all items on the basis of your own experience.

0, very little | 1, a little | 2, some | 3, much | 4, very much

1) It is important to me not to appear nervous

2) When I cannot keep my mind on a task, I worry that I might be going crazy.

3) It scares me when I feel "shaky" (trembling).

4) It scares me when I feel faint.

5) It is important for me to stay in control of my emotions.

6) It scares me when my heart beats rapidly.

7) It embarrasses me when my stomach growls.

8) It scares me when I am nauseous.

9) When I notice my heart is beating rapidly, I worry that I might have a heart attack.

10) It scares me when I become short of breath.

11) When my stomach is upset, I worry that I might be seriously ill.

12) It scares me when I am unable to keep my mind on a task.

13) Other people notice when I feel shaky.

14) Unusual body sensations scare me.

15) When I am nervous, I worry that I might be mentally ill.

16) It scares me when I am nervous.

 240

ASI Continued

ASI Physical items:

3, 4, 6, 8, 9, 10, 11, 14

ASI Mental items:

2, 12, 15, 16

ASI Social items:

1, 5, 13
 241

Automatic Thoughts Questionnaire (ATQ)

Instructions: Listed below are a variety of thoughts that pop into people's heads. Please read each

thought and indicate how frequently, if at all, the thought occurred to you OVER THE LAST

WEEK. After rating each thought's frequency, please indicate how strongly, if at all, you tend

to believe that thought, when it occurs.

Please rate how frequently you experienced this thought over the last week.

1, not at all | 2, sometimes | 3, moderately often | 4, often | 5, all the time

Please indicate how strongly, if at all, you tend to believe that thought, when it occurs.

1, not at all | 2, somewhat | 3, moderately | 4, very much | 5, totally

1) I feel like I'm up against the world.

2) I'm no good.

3) Why can't I ever succeed?

4) No one understands me.

5) I've let people down.

6) I don't think I can go on.

7) I wish I were a better person.

8) I'm so weak.

9) My life's not going the way I want it to.

10) I'm so disappointed in myself.

11) Nothing feels good anymore.

12) I can't stand this anymore.

13) I can't get started.

14) What's wrong with me?

 242

ATQ Continued

15) I wish I were somewhere else.

16) I can't get things together.

17) I hate myself.

18) I'm worthless.

19) Wish I could just disappear.

20) What's the matter with me?

21) I'm a loser.

22) My life is a mess.

23) I'm a failure.

24) I'll never make it.

25) I feel so hopeless.

26) Something has to change.

27) There must be something wrong with me.

28) My future is bleak.

29) It's just not worth it.

30) I can't finish anything.

 243

Cognitive Fusion Questionnaire (CFQ)

Below you will find a list of statements. Please rate how true each statement is for you.

1, never true | 2, very seldom true | 3, seldom true | 4, sometimes true | 5, frequently true | 6,

almost always true | 7, always true

1) My thoughts cause me distress or emotional pain

2) I get so caught up in my thoughts that I am unable to do the things that I most want to do

3) Even when I am having distressing thoughts, I know that they may become less important

eventually

4) I over-analyze situations to the point where it's unhelpful to me

5) I struggle with my thoughts

6) Even when I'm having upsetting thoughts, I can see that those thoughts may not be literally

true

7) I get upset with myself for having certain thoughts

8) I need to control the thoughts that come into my head

9) I find it easy to view my thoughts from a different perspective

10) I tend to get very entangled in my thoughts

11) I tend to react very strongly to my thoughts

12) It's possible for me to have negative thoughts about myself and still know that I am an OK

person

13) It's such a struggle to let go of upsetting thoughts even when I know that letting go would be

helpful
 244

COPE

We are interested in how people respond when they confront difficult or stressful events in their

lives. There are lots of ways to try and deal with stress. This questionnaire asks you to indicate

what you generally do and feel, when YOU experience stressful events. Obviously different

events bring out somewhat different responses, but think about what you USUALLY do when

you are under a lot of stress. Please indicate the response that most reflects how you deal with

stressful events.

1, I usually don't do this at all | 2, I usually do this a little bit | 3, I usually do this a medium

amount | 4, I usually do this a lot

1) I take additional action to try to get rid of the problem

2) I concentrate my efforts on doing something about it

3) I do what has to be done, one step at a time

4) I take direct action to get around the problem

5) I try to come up with a strategy about what to do

6) I make a plan of action

7) I think hard about what steps to take

8) I think about how I might best handle the problem

9) I put aside other activities in order to concentrate on this

10) I focus on dealing with this problem, and if necessary let other things slide a little

11) I keep myself from getting distracted by other thoughts or activities

12) I try hard to prevent other things from interfering with my efforts at dealing with this

13) I force myself to wait for the right time to do something

14) I hold off doing anything about it until the situation permits

15) I make sure not to make matters worse by acting too soon
 245

COPE Continued

16) I restrain myself from doing anything too quickly

17) I ask people who have had similar experiences what they did

18) I try to get advice from someone about what to do

19) I talk to someone more about the situation

20) I talk to someone who could do something concrete about the problem

21) I talk to someone about how I feel

22) I try to get emotional support from friend or relatives

23) I discuss my feelings with someone

24) I get sympathy and understanding from someone

25) I look for something good in what is happening

26) I try to see it in a different light to make it seem more positive

27) I learn something from the experience

28) I try to grow as a person as a result of the experience

29) I learn to live with it

30) I accept that this has happened and that it can't be changed

31) I get used to the idea that it happened

32) I accept the reality of the fact that it happened

33) I seek God's help

34) I put my trust in God

35) I try to find comfort in my religion

36) I pray more than usual

37) I get upset and let my emotions out

38) I let my feelings out

39) I feel a lot of emotional distress and I find myself expressing those feelings a lot

40) I get upset, and am really aware of it

41) I refuse to believe that it has happened

 246

COPE Continued

42) I pretend that it hasn't really happened

43) I act as though it hasn't even happened

44) I say to myself, this isn't real

45) I give up the attempt to get what I want

46) I just give up trying to reach my goal

47) I admit to myself that I can't deal with it and quit trying

48) I reduce the amount of effort I'm putting into solving the problem

49) I turn to work or other substitute activities to take my mind off things

50) I go to movies or watch TV, to think about it less

51) I daydream about things other than this

52) I sleep more than usual

53) I drink alcohol or take drugs in order to think about it less

COPE Active Coping:

1, 2, 3, 4, 5, 6, 7, 8, 10, 12, 15, 16, 25, 26, 27, 28, 31, 32

COPE Emotion Focused Coping

18, 22, 23, 24, 37, 38, 39, 40

COPE Avoidant Coping

14, 29, 41, 43, 44, 45, 46, 48, 51, 52

 247

Discomfort Intolerance Scale (DIS)

Instructions: Below are statements about how some people feel and behave. For each statement

below, indicate the number which best describes the degree to which the statement applies to

you.

0 Not at All Like M

3 Moderately Like Me

6 Extremely Like Me

1) I can tolerate a great deal of physical discomfort.

2) I have a high pain threshold

3) I take extreme measures to avoid feeling physically uncomfortable

4) When I begin to feel physically uncomfortable, I quickly take steps to relieve the discomfort

5) I am more sensitive to feeling physical discomfort compared to most people

DIS Discomfort Tolerance:

1, 2

DIS Discomfort Avoidance:

3, 4, 5
 248

Distress Tolerance Scale (DTS)

Directions: Think of times that you feel distressed or upset. Select the response that best

describes your beliefs about feeling distressed or upset.

1, strongly agree | 2, mildly agree | 3, agree and disagree equally | 4, mildly disagree | 5, strongly

disagree

1) Feeling distressed or upset is unbearable to me.

2) When I feel distressed or upset, all I can think about is how bad I feel.

3) I can't handle feeling distressed or upset.

4) My feelings of distress are so intense that they completely take over.

5) There's nothing worse than feeling distressed or upset.

6) I can tolerate being distressed or upset as well as most people.

7) My feelings of distress or being upset are not acceptable.

8) I'll do anything to avoid feeling distressed or upset.

9) Other people seem to be able to tolerate feeling distressed or upset better than I can.

10) Being distressed or upset is always a major ordeal for me.

11) I am ashamed of myself when I feel distressed or upset.

12) My feelings of distress or being upset scare me.

13) I'll do anything to stop feeling distressed or upset.

14) When I feel distressed or upset, I must do something about it immediately.

15) When I feel distressed or upset, I cannot help but concentrate on how bad the distress

actually feels.
 249

DTS Continued

DTS Tolerance items:

1, 3, 5

DTS Appraisal items:

6R, 7, 9, 10, 11, 12

DTS Absorption items:

2, 4, 15

DTS Regulation items:

8, 13, 14
 250

Experiences Questionnaire (EQ)

Instructions: We are interested in your recent experiences. Below is a list of things that people

sometimes experience. Please indicate how much you currently have experiences similar to those

described.

1, Never | 2, Rarely | 3, Sometimes | 4, Often | 5, All the time

1) I think about what will happen in the future

2) I remind myself that thoughts aren't facts

3) I am better able to accept myself as I am

4) I notice all sorts of little things and details in the world around me.

5) I am kinder to myself when things go wrong

6) I can slow my thinking at times of stress

7) I wonder what kind of person I really am

8) I am not so easily carried away by my thoughts and feelings

9) I notice that I don't take difficulties so personally

10) I can separate myself from my thoughts and feelings

11) I analyze why things turn out the way they do

12) I can take time to respond to difficulties

13) I think over and over again about what others have said to me

14) I can treat myself kindly

15) I can observe unpleasant feelings without being drawn into them

16) I have the sense that I am fully aware of what is going on around me and inside me

17) I can actually see that I am not my thoughts

18) I am consciously aware of a sense of my body as a whole

19) I think about the ways in which I am different from other people

20) I view things from a wider perspective

 251

EQ continued

EQ decentering items:

3, 6, 9, 10, 12, 14, 15, 16, 17, 18, 20

 252

Externalizing Symptoms Inventory (ESI)

For each question, please select the response that best applies to you.

1, False | 2, Mostly False | 3, Mostly True | 4, True

1) I have had problems at work because I was irresponsible.

2) I have stolen something out of a vehicle.

3) I get in trouble for not considering the consequences of my actions.

4) I have missed work without bothering to call in.

5) People often abuse my trust.

6) Others have told me they are concerned about my lack of self-control.

7) I often get bored quickly and lose interest.

8) I have taken items from a store without paying for them.

9) I have robbed someone.

10) I've gotten in trouble because I missed too much school.

11) I have taken money from someone's purse or wallet without asking.

12) I keep appointments I make.

13) I have lost a friend because of irresponsible things I've done.

14) I have good control over myself.

15) I have a hard time waiting patiently for things I want.

16) My impulsive decisions have caused problems with loved ones.

17) I jump into things without thinking.

18) I've often missed things I promised to attend.

19) I have conned people to get money from them.

20) I often act on immediate needs.

 253

Five Factor Mindfulness Questionnaire (FFMQ)

Please rate each of the following statements using the scale provided. Indicate the response that

best describes your own opinion of what is generally true for you.

1, never or very rarely true | 2, rarely true | 3, sometimes true | 4, often true | 5, very often or

always true

1) When I'm walking, I deliberately notice the sensations of my body moving.

2) I'm good at finding words to describe my feelings.

3) I criticize myself for having irrational or inappropriate emotions.

4) I perceive my feelings and emotions without having to react to them.

5) When I do things, my mind wanders off and I'm easily distracted.

6) When I take a shower or bath, I stay alert to the sensations of water on my body.

7) I can easily put my beliefs, opinions, and expectations into words.

8) I don't pay attention to what I'm doing because I'm daydreaming, worrying, or otherwise

distracted

9) I watch my feelings without getting lost in them.

10) I tell myself I shouldn't be feeling the way I'm feeling.

11) I notice how foods and drinks affect my thoughts, bodily sensations, and emotions.

12) It's hard for me to find the words to describe what I'm thinking.

13) I am easily distracted.

14) I believe some of my thoughts are abnormal or bad and I shouldn't think that way.

15) I pay attention to sensations, such as the wind in my hair or sun on my face.

16) I have trouble thinking of the right words to express how I feel about things

17) I make judgments about whether my thoughts are good or bad.

18) I find it difficult to stay focused on what's happening in the present.

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FFMQ Continued

19) When I have distressing thoughts or images, I step back and am aware of the

20) I pay attention to sounds, such as clocks ticking, birds chirping, or cars passing.

21) In difficult situations, I can pause without immediately reacting.

22) When I have a sensation in my body, it's difficult for me to describe it because I can't find the

right words.

23) It seems I am running on automatic without much awareness of what I'm doing.

24) When I have distressing thoughts or images, I feel calm soon after.

25) I tell myself that I shouldn't be thinking the way I'm thinking.

26) I notice the smells and aromas of things.

27) Even when I'm feeling terribly upset, I can find a way to put it into words.

28) I rush through activities without being really attentive to them.

29) When I have distressing thoughts or images I am able just to notice them without reacting.

30) I think some of my emotions are bad or inappropriate and I shouldn't feel them.

31) I notice visual elements in art or nature, such as colors, shapes, textures, or patterns of light

and shadow.

32) My natural tendency is to put my experiences into words.

33) When I have distressing thoughts or images, I just notice them and let them go.

34) I do jobs or tasks automatically without being aware of what I'm doing.

35) When I have distressing thoughts or images, I judge myself as good or bad, depending what

the thought/image is about.

36) I pay attention to how my emotions affect my thoughts and behavior.

37) I can usually describe how I feel at the moment in considerable detail.

38) I find myself doing things without paying attention.

39) I disapprove of myself when I have irrational ideas.

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FFMQ Continued

FFMQ Observe items:

1, 6, 11, 15, 20, 26, 31, 36

FFMQ Describe items:

2, 7, 12R, 16R, 22R, 27, 32, 37

FFMQ Act with Awareness items:

5R, 8R, 13R, 18R, 23R, 28R, 34R, 38R

FFMQ Nonjudge items:

3R, 10R, 14R, 17R, 25R, 30R, 35R, 39R

FFMQ Nonreact items:

4, 9, 19, 21, 24, 29, 33

 256

Multidimensional Experiential Avoidance Questionnaire (MEAQ)

Please indicate the extent to which you agree with each of the following statements.

1, strongly disagree | 2, moderately disagree | 3, slightly disagree | 4, slightly agree | 5,

moderately agree | 6, strongly agree

1) I won't do something if I think it will make me uncomfortable

2) If I could magically remove all of my painful memories, I would

3) When something upsetting comes up, I try very hard to stop thinking about it

4) I sometimes have difficulty identifying how I feel

5) I tend to put off unpleasant things that need to get done

6) People should face their fears

7) Happiness means never feeling any pain or disappointment

8) I avoid activities if there is even a small possibility of getting hurt

9) When negative thoughts come up, I try to fill my head with something else

10) At times, people have told me I'm in denial

11) I sometimes procrastinate to avoid facing challenges

12) Even when I feel uncomfortable, I don't give up working toward things I value

13) When I am hurting, I would do anything to feel better

14) I rarely do something if there is a chance that it will upset me

15) I usually try to distract myself when I feel something painful

16) I am able to "turn off" my emotions when I don't want to feel

17) When I have something important to do I find myself doing a lot of other things instead

18) I am willing to put up with pain and discomfort to get what I want

19) Happiness involves getting rid of negative thoughts

20) I work hard to avoid situations that might bring up unpleasant thoughts and feelings in me
 257

MEAQ Continued

21) I don't realize I'm anxious until other people tell me

22) When upsetting memories come up, I try to focus on other things

23) I am in touch with my emotions

24) I am willing to suffer for the things that matter to me

25) One of my big goals is to be free from painful emotions

26) I prefer to stick to what I am comfortable with, rather than try new activities

27) I work hard to keep out upsetting feelings

28) People have said that I don't own up to my problems

29) Fear or anxiety won't stop me from doing something important

30) I try to deal with problems right away

31) I'd do anything to feel less stressed

32) If I have any doubts about doing something, I just won't do it

33) When unpleasant memories come to me, I try to put them out of my mind

34) In this day and age people should not have to suffer

35) Others have told me that I suppress my feelings

36) I try to put off unpleasant tasks for as long as possible

37) When I am hurting, I still do what needs to be done

38) My life would be great if I never felt anxious

39) If I am starting to feel trapped, I leave the situation immediately

40) When a negative thought comes up, I immediately try to think of something else

41) It's hard for me to know what I'm feeling

42) I won't do something until I absolutely have to

43) I don't let pain and discomfort stop me from getting what I want

44) I would give up a lot not to feel bad

45) I go out of my way to avoid uncomfortable situations

46) I can numb my feelings when they are too intense

 258

MEAQ Continued

47) Why do today what you can put off until tomorrow

48) I am willing to put up with sadness to get what I want

49) Some people have told me that I "hide my head in the sand"

50) Pain always leads to suffering

51) If I am in a slightly uncomfortable situation, I try to leave right away

52) It takes me awhile to realize when I'm feeling bad

53) I continue working toward my goals even if I have doubts

54) I wish I could get rid of all of my negative emotions

55) I avoid situations if there is a chance that I'll feel nervous

56) I feel disconnected from my emotions

57) I don't let gloomy thoughts stop me from doing what I want

58) The key to a good life is never feeling any pain

59) I'm quick to leave any situation that makes me feel uneasy

60) People have told me that I'm not aware of my problems

61) I hope to live without any sadness and disappointment

62) When working on something important, I won't quit even if things get difficult
 259

MEAQ Continued

MEAQ Behavioral Avoidance items:

1, 8, 14, 20, 26, 32, 39, 45, 51, 55, 59

MEAQ Distress Aversion items:

2, 7, 13, 19, 25, 31, 34, 38, 44, 50, 54, 58, 61

MEAQ Procrastination item:

5, 11, 17, 30R, 36, 42, 47

MEAQ Distraction & Suppression items:

3, 9, 15, 22, 27, 33, 40

MEAQ Repression & Denial items:

4, 10, 16, 21, 23R, 28, 35, 41, 46, 49, 52, 56, 60

MEAQ Distress Endurance items:

6, 12, 18, 24, 29, 37, 43, 48, 53, 57, 62

 260

Kessler Psychological Distress Scale (K10)

These questions concern how you have been feeling over the past 30 days. Indicate the response

to each question that best represents how you have been.

1, None of the time | 2, A little of the time | 3, Some of the time | 4, Most of the time | 5, All of

the time

1) During the last 30 days, about how often did you feel tired out for no good reason?

2) During the last 30 days, about how often did you feel nervous?

3) During the last 30 days, about how often did you feel so nervous that nothing could calm you

down?

4) During the last 30 days, about how often did you feel hopeless?

5) During the last 30 days, about how often did you feel restless or fidgety?

6) During the last 30 days, about how often did you feel so restless you could not sit still?

7) During the last 30 days, about how often did you feel depressed?

8) During the last 30 days, about how often did you feel that everything was an effort?

9) During the last 30 days, about how often did you feel so sad that nothing could cheer you up?

10) During the last 30 days, about how often did you feel worthless?
 261

Mindful Attention Awareness Scale (MAAS)

Below is a collection of statements about your everyday experience. Using the scale provided,

please indicate how frequently or infrequently you currently have each experience. Please

answer according to what really reflects your experience rather than what you think your

experience should be.

1, Almost always | 2, Very frequently | 3, Somewhat frequently | 4, Somewhat infrequently | 5,

Very infrequently | 6, Almost never

1) I could be experiencing some emotion and not be conscious of it until some time later.

2) I break or spill things because of carelessness, not paying attention, or thinking of something

else.

3) I find it difficult to stay focused on what's happening in the present.

4) I tend to walk quickly to get where I'm going without paying attention to what I experience

along the way.

5) I tend not to notice feelings of physical tension or discomfort until they really grab my

attention.

6) I forget a person's name almost as soon as I've been told it for the first time.

7) It seems I am running on automatic without much awareness of what I'm doing.

8) I rush through activities without being really attentive to them.

9) I get so focused on the goal I want to achieve that I lose touch with what I am doing right now

to get there.

10) I do jobs or tasks automatically, without being aware of what I'm doing.

11) I find myself listening to someone with one ear, doing something else at the same time.

12) I drive places on automatic pilot and then wonder why I went there.

13) I find myself preoccupied with the future or the past.

 262

MAAS Continued

14) I find myself doing things without paying attention.

15) I snack without being aware that I'm eating.

 263

International Personality Item Pool (IPIP)

Instructions: On the following pages, there are phrases describing people's behaviors. Please use

the provided rating scale to describe how accurately each statement describes you. Describe

yourself as you generally are now, not as you wish to be in the future. Describe yourself as you

honestly see yourself, in relation to other people you know of the same sex as you are, and

roughly your same age.

1, Very Inaccurate | 2, Moderately Inaccurate | 3, Neither Inaccurate nor Accurate | 4, Moderately

Accurate | 5, Very Accurate

1) Am the life of the party

2) Sympathize with others' feelings

3) Get chores done right away

4) Have frequent mood swings

5) Have a vivid imagination

6) Don't talk a lot

7) Am not interested in other people's problems

8) Often forget to put things back in their proper place

9) Am relaxed most of the time

10) Am not interested in abstract ideas

11) Talk to a lot of different people at parties

12) Feel others' emotions

13) Like order

14) Get upset easily

15) Have difficulty understanding abstract ideas

16) Keep in the background

 264

IPIP Continued

17) Am not really interested in others

18) Make a mess of things

19) Seldom feel blue

20) Do not have a good imagination

IPIP Extraversion items:

1, 6R, 11, 16R

IPIP Agreeableness items:

2, 7R, 12, 17R

IPIP Conscientiousness items:

3, 8R, 13, 18R

IPIP Neuroticism items:

4, 9R, 14, 19R

IPIP Openness/Imagination items:

5, 10R, 15R, 20R

 265

Philadelphia Mindfulness Scale (PHLMS)

Please indicate how often you experienced each of the following statements within the past

week.

1, Never | 2, Rarely | 3, Sometimes| 4, Often | 5, Very Often

1) I am aware of what thoughts are passing through my mind.

2) I try to distract myself when I feel unpleasant emotions.

3) When talking with other people, I am aware of their facial and body expressions.

4) There are aspects of myself I don't want to think about.

5) When I shower, I am aware of how the water is running over my body.

6) I try to stay busy to keep thoughts or feelings from coming to mind.

7) When I am startled, I notice what is going on inside my body.

8) I wish I could control my emotions more easily.

9) When I walk outside, I am aware of smells or how the air feels against my face.

10) I tell myself that I shouldn't have certain thoughts.

11) When someone asks how I am feeling, I can identify my emotions easily.

12) There are things I try not to think about.

13) I am aware of thoughts I'm having when my mood changes.

14) I tell myself that I shouldn't feel sad.

15) I notice changes inside my body, like my heart beating faster or my muscles getting tense.

16) If there is something I don't want to think about, I'll try many things to get it out of my mind.

17) Whenever my emotions change, I am conscious of them immediately.

18) I try to put my problems out of mind.

19) When talking with other people, I am aware of the emotions I am experiencing.

20) When I have a bad memory, I try to distract myself to make it go away.
 266

PHLMS Continued

PHLMS Awareness items:

1, 3, 5, 7, 9, 11, 13, 15, 17, 19

PHLMS Acceptance items:

2, 4, 6, 8, 10, 12, 14, 16, 18, 20

 267

White Bear Suppression Inventory (WBSI)

This survey is about thoughts. There are no right or wrong answers, so please respond honestly

to each of the items below. Be sure to answer every item by indicating the best response.

1, Stongly disagree | 2, Disagree | 3, Neutral or don't know | 4, Agree | 5, Strongly Agree

1) There are things I prefer not to think about.

2) Sometimes I wonder why I have the thoughts I do.

3) I have thoughts that I cannot stop.

4) There are images that come to mind that I cannot erase.

5) My thoughts frequently return to one idea.

6) I wish I could stop thinking of certain things.

7) Sometimes my mind races so fast I wish I could stop it.

8) I always try to put problems out of mind.

9) There are thoughts that keep jumping into my head.

10) There are things that I try not to think about.

11) Sometimes I really wish I could stop thinking.

12) I often do things to distract myself from my thoughts.

13) I have thoughts that I try to avoid.

14) There are many thoughts that I have that I don't tell anyone.

15) Sometimes I stay busy just to keep thoughts from intruding on my mind.
 268

World Health Organization Disability Assessment (WHODAS)

This questionnaire asks about difficulties due to health conditions. Health conditions include
diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or
emotional problems, and problems with alcohol or drugs. Think back over the last 30 days and
answer these questions thinking about how much difficulty you had doing the following
activities. In the last 30 days, how much difficulty did you have in:

1, None | 2, Mild | 3, Moderate | 4, Severe | 5, Extreme / Cannot Do

1) Concentrating on doing something for ten minutes?

2) Remembering to do important things?

3) Analyzing and finding solutions to problems in day to day life?

4) Learning a new task, for example, learning how to get to a new place?

5) Generally understanding what people say?

6) Starting and maintaining a conversation?

7) Dealing with people you do not know?

8) Maintaining a friendship?

9) Getting along with people who are close to you?

10) Making new friends?

11) Sexual activities?

12) Taking care of your household responsibilities?

13) Doing most important household tasks well?

14) Getting all the household work done that you needed to do?

15) Getting your household work done as quickly as needed?

16) Your day to day work/school?

17) Doing your most important work/school tasks well?

18) Getting all the work done that you need to do?

19) Getting your work done as quickly as needed?

 269

WHODAS Continued

WHODAS Communication items:

1, 2, 3, 4, 5, 6

WHODAS Getting Along with Others items:

7, 8, 9, 10, 11

WHODAS Life Activities items:

12, 13, 14, 15

WHODAS Work/School items:

16, 17, 18, 19

 270

Valued Living Questionnaire (VLQ)

Below are domains of life that are valued by some people. We are concerned with your

subjective experience of your quality of life in each of these domains. One aspect of quality of

life involves the importance one puts on the different domains of living. Rate the importance of

each domain (by indicating a number) on a scale of 1-10. 1 means that domain is not at all

important and 10 means that domain is very important. Not everyone will value all of these

domains, or value all domains the same. Rate each domain according to your own personal sense

of importance on a scale of 1-10.

1 not at all important

10 extremely important

1) Family relations (other than marriage or parenting)

2) Marriage/couples/intimate relations

3) Parenting

4) Friendships/social relations

5) Employment

6) Education/training

7) Recreation

8) Spirituality

9) Citizenship/Community Life

10) Physical well-being

 271

VLQ Continued

In this section, we would like you to give a rating of how consistent your actions are with each

value. Everyone does better in some domains than others. We are NOT asking about your ideal

in each domain. We want to know how you think you have been doing during the past week.

Rate each item (by indicating a number) on a scale of 1-10. 1 means that your actions have been

fully inconsistent with your value and 10 means that your actions have been fully consistent with

your value during the past week on a scale of 1-10.

1 not at all consistent

10 extremely consistent

1) Family relations (other than marriage or parenting)

2) Marriage/couples/intimate relations

3) Parenting

4) Friendships/social relations

5) Employment

6) Education/training

7) Recreation

8) Spirituality

9) Citizenship/Community Life

10) Physical well-being