Self-reported acceptance of social anxiety symptoms: Development and validation of the Social Anxiety—Acceptance and Action Questionnaire.
Open accessAbstract
Social anxiety disorder (SAD) is characterized as a persistent fear of negative evaluation in social situations. This chronic condition is the fourth most common psychiatric disorder (Kessler, Berglund, Demler, Jin, & Walters, 2005), and is most often treated using cognitive behavior therapy (CBT). Although CBT has been widely demonstrated as efficacious for treating social anxiety, many individuals with social anxiety do not benefit from this treatment modality or only experience minimal improvement (Hofmann & Bogels, 2006). Therefore, clinicians and researchers have been drawn to other approaches to treatment, including mindfulness and acceptance-based interventions. Briefly, mindfulness can be described as intentional present moment awareness and a sense of nonjudgmental acceptance towards life's events (Kabat-Zinn, 1994). Mindfulness is a concept derived from eastern spiritual traditions, and has increasingly been incorporated by clinical researchers into interventions that are applied in medical and mental health settings. The acceptance component is of particular importance to the current study, and is often conceptualized along a continuum. The scope of acceptance ranges from experiential avoidance (or a lack of acceptance), where an individual is unwilling to remain in contact with internal experiences (such as thoughts and feelings), to acceptance, where an individual actively experiences his/her internal events (Hayes, Strosahl, & Wilson, 1999). Mindfulness and acceptance-based treatments, including acceptance and commitment therapy (ACT; Hayes et al., 1999), have emerged as efficacious for a wide spectrum of clinical disorders (Baer, 2003). ACT evolved from CBT and has retained some of its fundamentals, such as exposure (albeit following a different rationale), and builds upon them. Specifically, ACT aims to help clients increase acceptance of thoughts and feelings, choose valued directions for their lives, and commit to actions which are consistent with those values (Hayes et al., 1999). Within the ACT model, mindfulness and acceptance are related and distinct strategies used to increase psychological flexibility, or the ability to be aware of the present moment, in the pursuit of valued goals (Lillis, Hayes, Bunting, & Masuda, 2009). The goal of acceptance may be particularly significant for psychologists because disruptions in the acceptance component appear to be relevant in psychopathology (Hayes, Wilson, Gifford, Follette, & Stosahl, 1996). A growing body of research has provided evidence for the usefulness of mindfulness and acceptance-based interventions specifically in the context of social anxiety (Bogels, Sijbers, & Voncken, 2006; Dalrymple & Herbert, 2007; Herbert & Cardaciotto, 2005; Kocovski, Fleming, & Rector, 2009; Koszycki, Benger, Shlik, & Bradwejn, 2007; Ossman, Wilson, Storaasli, & McNeill, 2006). These findings in support of mindfulness and acceptance-based treatments for social anxiety are encouraging; however, further examinations of such interventions are necessary to build support for their use and also to address how these treatments work. Valid and reliable indices assessing mindfulness and/or acceptance are integral for understanding the mechanisms by which mindfulness and acceptance-based therapies result in beneficial changes. In recent years, a number of general self-report measures of mindfulness and acceptance have been developed and validated (Baer, Smith, & Allen, 2004; Brown & Ryan, 2003; Buchheld, Grossman, & Walach, 2001; Feldman, Hayes, Kumar, & Greeson, 2004). One such instrument is the Acceptance and Action Questionnaire (AAQ; Hayes et al., 2004). The AAQ is a measure commonly used by ACT researchers to assess experiential avoidance, or a lack of acceptance of negative private events (e.g., thoughts, feelings, physical sensations). The AAQ has been validated across a wide variety of populations and shown to be relatively psychometrically sound, and several complaint-specific measures have been adapted from this scale. …
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In its original adult version, the SA-AAQ revealed a unidimensional structure and presented excellent internal consistency (α = 0.94).
“In its original adult version, the SA-AAQ revealed a unidimensional structure and presented an excellent internal consistency (i.e., α = 0.94).”
From Psychological inflexibility explains social anxiety over time: a mediation analyses with a clinical adolescent sample (2024) · cites this paper as MacKenzie & Kocovski, 2010
The SA-AAQ has demonstrated positive correlations with other mindfulness and acceptance related measures, and negative correlations with social anxiety measures, depressive symptoms and thought suppression.
“It has also demonstrated positive correlations with other mindfulness and acceptance related measures, and negative correlations with social anxiety measures, depressive symptoms and thought suppression (MacKenzie & Kocovski, 2010).”
From Psychological inflexibility explains social anxiety over time: a mediation analyses with a clinical adolescent sample (2024) · cites this paper as MacKenzie & Kocovski, 2010
The SA-AAQ was considered to have a unidimensional structure.
“led the authors to opt for a unidimensional structure.”
From Assessing psychological flexibility in test situations: The test anxiety acceptance and action questionnaire for adolescents (2020) · cites this paper as MacKenzie & Kocovski, 2010
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Cognitive and behavioural treatments of fear of blushing, sweating or trembling
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Autonomic correlates of social anxiety and embarrassment in shy and non-shy individuals
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The role of experiential avoidance in acute pain tolerance: A laboratory test
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Mindfulness and task concentration training for social phobia: a pilot study
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Anticipatory processing plays a role in maintaining social anxiety
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Anticipatory processing in social anxiety
Vassilopoulos, S. P. (2004) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465804001377 · Cited by 85 · see citing works
Clinical features affecting treatment outcome in social phobia.
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Field, A., Psychol, C., & Morgan, J. (2004) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2003.08.004 · Cited by 77 · see citing works
Self-concept certainty in social phobia
Wilson, J. K., & Rapee, R. M. (2005) · Behaviour Research and Therapy · doi:10.1016/j.brat.2005.01.006 · Cited by 76 · see citing works
Psychological Treatments for Social Phobia
Rowa, K., & Antony, M. M. (2005) · The Canadian Journal of Psychiatry · doi:10.1177/070674370505000603 · Cited by 65 · see citing works
Recent Advances in the Treatment of Social Phobia: Introduction to the Special Issue
Hofmann, S. G., & Bögels, S. M. (2006) · Journal of Cognitive Psychotherapy · doi:10.1891/jcop.20.1.3 · Cited by 59 · see citing works
An Acceptance and Mindfulness-Based Perspective on Social Anxiety Disorder
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Issues related to social anxiety among controls in social phobia research
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Treatment of Fear of Blushing, Sweating, or lrembling
Scholing, A., & Emmelkamp, P. M. G. (1996) · Behavior Modification · doi:10.1177/01454455960203006 · Cited by 49 · see citing works
A comparison of the effects of thought suppression, distraction and concentration
Lin, Y.-J., & Wicker, F. W. (2007) · Behaviour Research and Therapy · doi:10.1016/j.brat.2007.08.004 · Cited by 47 · see citing works
Voluntary involuntariness: Thought suppression and the regulation of the experience of will
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Does Anticipation Help or Hinder Performance in a Subsequent Speech?
Brown, M. D., & Stopa, L. L. (2007) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465806003481 · Cited by 35 · see citing works
Mental representation of observable attributes in people with social phobia
Rapee, R. M., & Abbott, M. J. (2005) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2005.01.001 · Cited by 34 · see citing works
Voncken, M. J., & Bögels, S. M. (2006) · Journal of Cognitive Psychotherapy · doi:10.1891/jcop.20.1.59 · Cited by 30 · see citing works
Clinical applications of cardiovascular assessment.
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Factor structure of the Barratt impulsiveness scale
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The structure of common emotion regulation strategies: A meta-analytic examination
Naragon-Gainey, K., McMahon, T. P., & Chacko, T. P. (2017) · Psychological Bulletin · doi:10.1037/bul0000093 · Cited by 588 · see citing works
Kocovski, N. L., Fleming, J. E., Hawley, L. L., Huta, V., & Antony, M. M. (2013) · Behaviour Research and Therapy · doi:10.1016/j.brat.2013.10.007 · Cited by 188 · see citing works
Self-citationAkbari, M., Seydavi, M., Hosseini, Z. S., Krafft, J., & Levin, M. E. (2022) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2022.03.007 · Cited by 155 · see citing works
Yavuz, F., Ulusoy, S., Iskin, M., Esen, F. B., Burhan, H. S., Karadere, M. E., & Yavuz, N. (2016) · Klinik Psikofarmakoloji Bülteni-Bulletin of Clinical Psychopharmacology · doi:10.5455/bcp.20160223124107 · Cited by 152 · see citing works
A review of AAQ variants and other context-specific measures of psychological flexibility
Ong, C. W., Lee, E. B., Levin, M. E., & Twohig, M. P. (2019) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2019.02.007 · Cited by 142 · see citing works
Arch, J. J., & Mitchell, J. L. (2016) · Psycho-Oncology · doi:10.1002/pon.3890 · Cited by 103 · see citing works
Measuring the role of psychological inflexibility in trichotillomania
Houghton, D. C., Compton, S. N., Twohig, M. P., Saunders, S. M., Franklin, M. E., Neal-Barnett, A. M., Ely, L., Capriotti, M. R., & Woods, D. W. (2014) · Psychiatry Research · doi:10.1016/j.psychres.2014.08.003 · Cited by 84 · see citing works
Kocovski, N. L., Fleming, J. E., Hawley, L. L., Ho, M.-H. R., & Antony, M. M. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.04.005 · Cited by 78 · see citing works
Self-citationThe role of psychological flexibility in the relationship between parent and adolescent distress
Moyer, D. N., & Sandoz, E. K. (2015) · Journal of Child and Family Studies · doi:10.1007/s10826-014-9947-y · Cited by 67 · see citing works
Validating measures of psychological flexibility in a population with acquired brain injury
Whiting, D. L., Deane, F. P., Ciarrochi, J., McLeod, H. J., & Simpson, G. K. (2015) · Psychological Assessment · doi:10.1037/pas0000050 · Cited by 45 · see citing works
The Relative Contributions of Experiential Avoidance and Distress Tolerance to OC Symptoms
Blakey, S. M., Jacoby, R. J., Reuman, L., & Abramowitz, J. S. (2016) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465815000703 · Cited by 38 · see citing works
Flujas-Contreras, J. M., Recio-Berlanga, Á., Andrés, M. P., Fernández-Torres, M., Sánchez-López, P., & Gómez, I. (2023) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2023.07.006 · Cited by 27 · see citing works
Kocovski, N. L., Fleming, J. E., Blackie, R. A., MacKenzie, M. B., & Rose, A. L. (2019) · Behavior Therapy · doi:10.1016/j.beth.2018.10.007 · Cited by 25 · see citing works
Self-citationKrafft, J., Ong, C. W., Twohig, M. P., & Levin, M. E. (2019) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2018.08.003 · Cited by 18 · see citing works
Flynn, M. K., Bordieri, M. J., & Berkout, O. V. (2019) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2018.12.002 · Cited by 19 · see citing works
Psychometric evaluation of the Swedish Multidimensional Psychological Flexibility Inventory (MPFI)
Tabrizi, F. F., Larsson, A. B., Grönvall, H., Söderstrand, L., Hallén, E., Champoux-Larsson, M.-F., Lundgren, T., Sundström, F., Lavefjord, A., Buhrman, M., et al. (2023) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2022.2153077 · Cited by 18 · see citing works
Bluett, E. J., Landy, L. L., Twohig, M. P., & Arch, J. J. (2016) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.30.2.77 · Cited by 13 · see citing works
Figueiredo, D. V., Alves, F., & Vagos, P. (2024) · Current Psychology · doi:10.1007/s12144-023-04650-w · Cited by 13 · see citing works
“It has also demonstrated positive correlations with other mindfulness and acceptance related measures, and negative correlations with social anxiety measures, depressive symptoms and thought suppression (MacKenzie & Kocovski, 2010).”
Soltani, E., Bahrainian, S. A., Masjedi Arani, A., Farhoudian, A., & Gachkar, L. (2016) · Iranian Journal of Psychiatry and Behavioral Sciences · doi:10.17795/ijpbs.3753 · Cited by 12 · see citing works
Soltani, E., Hosseini, Z., & Naghizadeh, P. (2018) · Shiraz E-Medical Journal · doi:10.5812/semj.62496 · Cited by 11 · see citing works
Pinto-Gouveia, J., Carvalho, T., Cunha, M., Duarte, J., & Walser, R. D. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.06.023 · Cited by 10 · see citing works
Research Center for Psychiatry and Behavioral Sciences, S. U. O. M. S., Soltani, E., Bahrainian, S. A., Department of Clinical Psychology, S. O. M., Farhoudian, A., Department of Psychiatry, S. O. M., Masjedi Arani, A., Department of Clinical Psychology, S. O. M., Gachkar, L., & Infectious Diseases and Tropical Medicine Research Center, S. B. U. O. M. S. (2023) · Basic and Clinical Neuroscience Journal · doi:10.32598/bcn.2021.2785.1 · Cited by 10 · see citing works
“This questionnaire was created by MacKenzie and Kocovski (2010) to assess acceptance specific to social anxiety symptoms and the extent to which the person is aware of his/her thoughts and feelings about his/her own social anxiety without trying to change them.”
MethodValues intervention as an establishing operation for approach in the presence of aversive stimuli
Hebert, E. R., Flynn, M. K., Wilson, K. G., & Kellum, K. K. (2021) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2021.04.001 · Cited by 10 · see citing works
Development of a Brief Version of the Social Anxiety – Acceptance and Action Questionnaire
MacKenzie, M. B., Kocovski, N. L., Blackie, R. A., Carrique, L. C., Fleming, J. E., & Antony, M. M. (2017) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-016-9585-3 · Cited by 9 · see citing works
Self-citationSoltani, E., Ghanizadeh, A., Dastgheib, S. A., Wong, Q. J. J., & Jaafari, N. (2020) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2020.100582 · Cited by 7 · see citing works
Pires, C. P., Putwain, D. W., Hofmann, S. G., Martins, D. S., MacKenzie, M. B., Kocovski, N. L., & Salvador, M. D. C. (2020) · Revista de Psicopatologia y Psicologia Clinica · doi:10.5944/rppc.29014 · Cited by 6 · see citing works
“There has been a growing development of assessment tools to appraise psychological flexibility, applied to several conditions, such as social anxiety (Social Anxiety – Acceptance and Action Questionnaire; SAAAQ; MacKenzie & Kocovski, 2010).”
BackgroundMethodResultInfluentialSelf-citationThe effect of acceptance and commitment therapy on the reduction of anxious thoughts in students
Dousti, P., Mohagheghi, H., & Jafari, D. (2015) · Environment Conservation Journal · doi:10.36953/ecj.2015.se1638 · Cited by 5 · see citing works
The development of the ‘Forms of Responding to Self-Critical Thoughts Scale’ (FoReST)
White, R. G., Larkin, P., McCluskey, J., Lloyd, J., & McLeod, H. J. (2020) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2019.11.003 · Cited by 4 · see citing works
Woodruff, S. C., Arnkoff, D. B., Glass, C. R., & Hindman, R. K. (2014) · The Wiley Blackwell Handbook of Mindfulness · doi:10.1002/9781118294895.ch37 · Cited by 3 · see citing works
Alves, F., Figueiredo, D. V., & Vagos, P. (2023) · Clinical Case Studies · doi:10.1177/15346501221144069 · Cited by 3 · see citing works
“…avoidance (i.e., lack of acceptance of thoughts and feelings) and unworkable action (i.e., actions that are inconsistent with core values), the Social Anxiety – Acceptance and Action Questionnaire (SA-AAQ; MacKenzie & Kocovski, 2010; Portuguese version by Martins et al., 2011) was used.”
BackgroundMethodInfluentialDevelopment and validation of a Japanese version of the Teachers Acceptance and Action Questionnaire
Koh, Y., Iwasawa, N., Inoue, K., & Ohtsuki, T. (2024) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2024.100726 · Cited by 1 · see citing works
- Authors
- MacKenzie, M. B., & Kocovski, N. L.
- Affiliations
- Memorial University of Newfoundland (CA)
- Wilfrid Laurier University (CA)
- Venue
- International Journal of Behavioral Consultation and Therapy
- Published
- 2010
- Volume
- 6
- Issue
- 3
- Pages
- 214-232
- ISSN
- 1555-7855 (ISSN-L)
- OpenAlex
- W2051723857
- Cited by
- 58
- References
- 125
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 4 · 2022: 5 · 2021: 5 · 2020: 4 · 2019: 3 · 2018: 9 · 2017: 3 · 2016: 5 · 2015: 8 · 2014: 5 · 2013: 1 · 2012: 2
- FWCI
- 1.67
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- International Journal of Behavioral Consultation and Therapy (publishedVersion, other-oa)
- Funders
- Social Sciences and Humanities Research Council of Canada
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- social anxiety disorder, mindfulness, acceptance-based interventions, acceptance and commitment therapy, experiential avoidance, psychological flexibility, self-report questionnaire development, questionnaire validation, cognitive behavioral therapy, treatment-resistant anxiety, acceptance
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