Psychological flexibility in mild traumatic brain injury: an evaluation of measures
Abstract
Primary objective In this study, we examined the psychometric properties of measures of psychological flexibility in a mild traumatic brain injury (mTBI) sample.Method and Procedures Adults who sustained a mTBI (n = 112) completed the Acceptance and Action Questionnaire – Acquired Brain Injury reactive avoidance subscale (AAQ-ABI (RA). Exploratory factor analysis and Rasch analysis were conducted to evaluate the facture structure, dimensionality, and differential item functioning. Construct validity was determined by correlating the AAQ-ABI (RA) with the Acceptance and Action Questionnaire-Revised (AAQ-II) and Fear Avoidance after Traumatic Brain Injury (FAB-TBI).Main outcome and Results The AAQ-ABI (RA) was found to have strong internal consistency (Cronbach’s α = 0.87). Consistent with previous findings, the AAQ-ABI (RA) had one distinct factor. Fit to the unidimensional Rasch model was adequate (χ2 (18) = 22.5, p = .21) with no evidence of differential item functioning across person factors examined. The AAQ-ABI (RA) also had expected relationships with theoretically relevant constructs.Conclusions The AAQ-ABI (RA) appears to be a psychometrically sound measure of psychological flexibility in mTBI.
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Faulkner and colleagues found that the AAQ-ABI (RA) has one distinct underlying factor in mTBI and strong internal consistency (Cronbach's α=0.87).
“Faulkner and colleagues70 found that the AAQ-ABI (RA) has one distinct underlying factor in mTBI and strong internal consistency (Cronbach’s α=0.87).”
From Acceptance and commitment therapy for mild traumatic brain injury (ACTion-mTBI): a quasiexperimental feasibility study (2025) · cites this paper as [70]
Cites
Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2008.08.010 · Cited by 51,384 · see citing works
Lovibond, P. F., & Lovibond, S. H. (1995) · Behaviour Research and Therapy · doi:10.1016/0005-7967(94)00075-u · Cited by 14,523 · see citing works
Constructing validity: Basic issues in objective scale development.
Clark, L. A., & Watson, D. (1995) · Psychological Assessment · doi:10.1037/1040-3590.7.3.309 · Cited by 6,567 · see citing works
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R. D. (2011) · Behavior Therapy · doi:10.1016/j.beth.2011.03.007 · Cited by 3,950 · see citing works
Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.64.6.1152 · Cited by 3,595 · see citing works
Psychological flexibility as a fundamental aspect of health
Kashdan, T. B., & Rottenberg, J. (2010) · Clinical Psychology Review · doi:10.1016/j.cpr.2010.03.001 · Cited by 3,054 · see citing works
Measuring experiential avoidance: A preliminary test of a working model
Hayes, S. C., Strosahl, K., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., Polusny, M. A., Dykstra, T. A., Batten, S. V., Bergan, J., et al. (2004) · The Psychological Record · doi:10.1007/bf03395492 · Cited by 2,140 · see citing works
A-Tjak, J. G. L., Davis, M. L., Morina, N., Powers, M. B., Smits, J. A. J., & Emmelkamp, P. M. G. (2015) · Psychotherapy and Psychosomatics · doi:10.1159/000365764 · Cited by 921 · see citing works
Experiential avoidance as a functional dimensional approach to psychopathology: An empirical review
Chawla, N., & Ostafin, B. (2007) · Journal of Clinical Psychology · doi:10.1002/jclp.20400 · Cited by 805 · see citing works
Gregg, J. A., Callaghan, G. M., Hayes, S. C., & Glenn-Lawson, J. L. (2007) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.75.2.336 · Cited by 695 · see citing works
Mild Traumatic Brain Injury (mTBI) and chronic cognitive impairment: A scoping review
McInnes, K., Friesen, C. L., MacKenzie, D. E., Westwood, D. A., & Boe, S. G. (2017) · PLOS ONE · doi:10.1371/journal.pone.0174847 · Cited by 531 · see citing works
McMahon, P. J., Hricik, A. J., Yue, J. K., Puccio, A. M., Inoue, T., Lingsma, H. F., Beers, S. R., Gordon, W. A., Valadka, A. B., Manley, G. T., et al. (2013) · Journal of Neurotrauma · doi:10.1089/neu.2013.2984 · Cited by 516 · see citing works
Rolffs, J. L., Rogge, R. D., & Wilson, K. G. (2018) · Assessment · doi:10.1177/1073191116645905 · Cited by 504 · see citing works
Acceptance and Values-Based Action in Chronic Pain: A Study of Treatment Effectiveness and Process
Vowles, K. E., & McCracken, L. M. (2008) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.76.3.397 · Cited by 500 · see citing works
The efficacy of Acceptance and Commitment Therapy: An updated systematic review and meta-analysis
Öst, L.-G. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.07.018 · Cited by 476 · see citing works
Summary of the WHO collaborating centre for neurotrauma task force on mild traumatic brain injury
Holm, L. W., Cassidy, J. D., Carroll, L., & Borg, J. (2005) · Journal of Rehabilitation Medicine · doi:10.1080/16501970510027321 · Cited by 467 · see citing works
Nelson, L. D., Temkin, N. R., Dikmen, S., Barber, J., Giacino, J. T., Yuh, E., Levin, H. S., McCrea, M. A., Stein, M. B., Mukherjee, P., et al. (2019) · JAMA Neurology · doi:10.1001/jamaneurol.2019.1313 · Cited by 451 · see citing works
What Does the Acceptance and Action Questionnaire (AAQ-II) Really Measure?
Wolgast, M. (2014) · Behavior Therapy · doi:10.1016/j.beth.2014.07.002 · Cited by 421 · see citing works
McCrea, M., Iverson, G. L., McAllister, T. W., Hammeke, T. A., Powell, M. R., Barr, W., & Kelly, J. P. (2009) · The Clinical Neuropsychologist · doi:10.1080/13854040903074652 · Cited by 417 · see citing works
Systematic Review of Multivariable Prognostic Models for Mild Traumatic Brain Injury
Silverberg, N. D., Gardner, A. J., Brubacher, J. R., Panenka, W. J., Li, J. J., & Iverson, G. L. (2015) · Journal of Neurotrauma · doi:10.1089/neu.2014.3600 · Cited by 393 · see citing works
Hou, R. H., Moss-Morris, R. E., Peveler, R., Mogg, K., Bradley, B. P., & Belli, A. (2011) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp-2011-300767 · Cited by 381 · see citing works
Carroll, L., Cassidy, J., Cancelliere, C., Côté, P., Hincapié, C., Kristman, V., Holm, L., Borg, J., Boussard, C. N.-D., & Hartvigsen, J. (2014) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2013.08.300 · Cited by 356 · see citing works
Tyndall, I., Waldeck, D., Pancani, L., Whelan, R., Roche, B., & Dawson, D. L. (2019) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2018.09.005 · Cited by 303 · see citing works
The role of the individual in the coming era of process-based therapy
Hayes, S. C., Hofmann, S. G., Stanton, C. E., Carpenter, J. K., Sanford, B. T., Curtiss, J. E., & Ciarrochi, J. (2019) · Behaviour Research and Therapy · doi:10.1016/j.brat.2018.10.005 · Cited by 295 · see citing works
Theadom, A., Parag, V., Dowell, T., McPherson, K. M., Starkey, N. J., Barker-Collo, S. L., Jones, K., Ameratunga, S. N., & Feigin, V. L. (2015) · British Journal of General Practice · doi:10.3399/bjgp16x683161 · Cited by 273 · see citing works
Self-citationMasuda, A., & Tully, E. C. (2012) · Journal of Evidence-Based Complementary & Alternative Medicine · doi:10.1177/2156587211423400 · Cited by 250 · see citing works
Experiential Avoidance: An Examination of the Construct Validity of the AAQ-II and MEAQ
Rochefort, C., Baldwin, A. S., & Chmielewski, M. (2018) · Behavior Therapy · doi:10.1016/j.beth.2017.08.008 · Cited by 247 · see citing works
Kashdan, T. B., Disabato, D. J., Goodman, F. R., Doorley, J. D., & McKnight, P. E. (2020) · Psychological Assessment · doi:10.1037/pas0000834 · Cited by 240 · see citing works
Bohlmeijer, E. T., Fledderus, M., Rokx, T. A. J. J., & Pieterse, M. E. (2011) · Behaviour Research and Therapy · doi:10.1016/j.brat.2010.10.003 · Cited by 232 · see citing works
Etiology of the post-concussion syndrome: Physiogenesis and psychogenesis revisited
Silverberg, N. D., & Iverson, G. L. (2011) · Neurorehabilitation · doi:10.3233/nre-2011-0708 · Cited by 232 · see citing works
Assessing Psychological Flexibility: What Does It Add Above and Beyond Existing Constructs?
Gloster, A. T., Klotsche, J., Chaker, S., Hummel, K. V., & Hoyer, J. (2011) · Psychological Assessment · doi:10.1037/a0024135 · Cited by 206 · see citing works
DIKMEN, S. S., Machamer, J., & Temkin, N. R. (2016) · Journal of Neurotrauma · doi:10.1089/neu.2016.4618 · Cited by 196 · 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
Substance abuse and psychological flexibility: the development of a new measure
Luoma, J., Drake, C. E., Kohlenberg, B. S., & Hayes, S. C. (2011) · Addiction Research & Theory · doi:10.3109/16066359.2010.524956 · Cited by 131 · see citing works
Acceptance and Commitment Therapy
Flaxman, P. E., Blackledge, J. T., & Bond, F. W. (2010) · doi:10.4324/9780203834688 · Cited by 122 · see citing works
Real and Artificial Differential Item Functioning in Polytomous Items
Andrich, D., & Hagquist, C. (2014) · Educational and Psychological Measurement · doi:10.1177/0013164414534258 · Cited by 109 · see citing works
Fear Avoidance and Clinical Outcomes from Mild Traumatic Brain Injury
Silverberg, N. D., Panenka, W. J., & Iverson, G. L. (2018) · Journal of Neurotrauma · doi:10.1089/neu.2018.5662 · Cited by 98 · see citing works
The post-concussional syndrome: Physiogenesis, psychogenesis and malingering. An integrative model
Jacobson, R. R. (1995) · Journal of Psychosomatic Research · doi:10.1016/0022-3999(95)00006-5 · Cited by 97 · see citing works
Does the fear avoidance model explain persistent symptoms after traumatic brain injury?
Wijenberg, M. L. M., Stapert, S. Z., Verbunt, J. A., Ponsford, J. L., & Van Heugten, C. M. (2017) · Brain Injury · doi:10.1080/02699052.2017.1366551 · Cited by 89 · 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
Randall, D., Thomas, M., Whiting, D., & McGrath, A. (2017) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000000250 · Cited by 80 · see citing works
Ownsworth, T., Little, T., Turner, B., Hawkes, A., & Shum, D. (2008) · Brain Injury · doi:10.1080/02699050802446697 · Cited by 78 · see citing works
Leonidou, C., Panayiotou, G., Bati, A., & Karekla, M. (2016) · Journal of Health Psychology · doi:10.1177/1359105316666657 · Cited by 72 · see citing works
Greenberg, J., Mace, R. A., Funes, C. J., Silverberg, N. D., Iverson, G. L., Caplan, D. N., & Vranceanu, A. (2019) · Psychosomatics · doi:10.1016/j.psym.2019.09.004 · Cited by 50 · see citing works
Treatment for depression following mild traumatic brain injury in adults: A meta-analysis
Barker-Collo, S. L., Starkey, N. J., & Theadom, A. (2013) · Brain Injury · doi:10.3109/02699052.2013.801513 · Cited by 46 · see citing works
Self-citationSnell, D. L., Surgenor, L. J., Hay-Smith, J. E., Williman, J. A., & Siegert, R. J. (2014) · Brain Injury · doi:10.3109/02699052.2014.976594 · Cited by 46 · see citing works
Self-citationValidating 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
Perceptions of mild traumatic brain injury in adults: a scoping review
Mah, K., Hickling, A., & Reed, N. (2018) · Disability and Rehabilitation · doi:10.1080/09638288.2016.1277402 · Cited by 39 · see citing works
Polich, G. R., Iaccarino, M. A., Kaptchuk, T. J., Morales-Quezada, L., & ZAFONTE, R. D. (2019) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0000000000001290 · Cited by 38 · see citing works
Evaluation of the Fear Avoidance Behavior after Traumatic Brain Injury Questionnaire
Snell, D., Siegert, R., Debert, C., Cairncross, M., & Silverberg, N. (2020) · Journal of Neurotrauma · doi:10.1089/neu.2019.6729 · Cited by 32 · see citing works
Self-citationAtypical Somatic Symptoms in Adults With Prolonged Recovery From Mild Traumatic Brain Injury
Stubbs, J. L., Green, K. E., Silverberg, N. D., Howard, A. K., Dhariwal, A. K., Brubacher, J. R., Garraway, N., Heran, M. K. S., Sekhon, M. S., Aquino, A., et al. (2020) · Frontiers in Neurology · doi:10.3389/fneur.2020.00043 · Cited by 29 · see citing works
Rasch analysis of the Frost Multidimensional Perfectionism Scale
Mitchell‐parker, K., Medvedev, O. N., Krägeloh, C. U., & Siegert, R. J. (2017) · Australian Journal of Psychology · doi:10.1111/ajpy.12192 · Cited by 24 · see citing works
Merz, Z. C., Zane, K. L., Emmert, N. A., Lace, J. W., & Grant, A. F. (2019) · Brain Injury · doi:10.1080/02699052.2019.1581949 · Cited by 18 · see citing works
Faulkner, J. W., Theadom, A., Mahon, S., Snell, D. L., Barker-Collo, S., & Cunningham, K. (2020) · Medical Hypotheses · doi:10.1016/j.mehy.2020.110141 · Cited by 15 · see citing works
Self-citationSylvester, M. (2011) · Cited by 12 · see citing works
A Guide for the Statistically Perplexed
Streiner, D. L. (2012) · University of Toronto Press eBooks · doi:10.3138/9781442662827 · Cited by 12 · see citing works
Emotion habituation is accelerated in chronic mild traumatic brain injury
Mantua, J., & Ready, R. E. (2019) · Brain Injury · doi:10.1080/02699052.2019.1646434 · Cited by 8 · see citing works
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Faulkner, J. W., Snell, D. L., & Theadom, A. (2022) · Brain Injury · doi:10.1080/02699052.2022.2109747 · Cited by 9 · see citing works
Self-citationFaulkner, J. W., Snell, D. L., Theadom, A., Mahon, S., & Barker-Collo, S. L. (2022) · Disability and Rehabilitation · doi:10.1080/09638288.2022.2055167 · Cited by 8 · see citing works
Self-citationFaulkner, J., Prouty, D., Devlin, L., Appleton, D., Roche, M., Below, K., Moffat, J., Snell, D., Williams, M. N., Barker-Collo, S., et al. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-089727 · Cited by 7 · see citing works
Self-citationMikolić, A., Snell, D. L., Theadom, A., Faulkner, J. W., Zemek, R. L., & Silverberg, N. D. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-089471 · Cited by 3 · see citing works
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- Authors
- Faulkner, J. W., Snell, D. L., Theadom, A., Mahon, S., Barker-Collo, S., & Skirrow, P.
- Affiliations
- Massey University (NZ)
- University of Otago (NZ)
- Auckland University of Technology (NZ)
- University of Auckland (NZ)
- Corresponding author
- Faulkner, Josh W.
- Venue
- Brain Injury
- Publisher
- Informa UK Limited
- Published
- 2021-07-29
- Volume
- 35
- Issue
- 9
- Pages
- 1103-1111
- ISSN
- 0269-9052 (ISSN-L)
- 1362-301X
- OpenAlex
- W3189549088
- Cited by
- 4
- References
- 58
- Citations by year
- 2025: 2 · 2022: 2
- FWCI
- 0.36
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Brain Injury (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Health Research Council of New Zealand (Foxley Clinical Fellowship (20/041))
- Topics
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- mild traumatic brain injury, psychological flexibility, psychometric properties, construct validity, Rasch analysis, differential item functioning, fear avoidance
- MeSH terms
- Adult, Brain Concussion, Factor Analysis, Statistical, Humans, Psychometrics, Surveys and Questionnaires, Reproducibility of Results
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