Educational Psychology Commons^™

Acceptance And Commitment Therapy For Obsessive Compulsive Disorder In A Brazilian Context: Treatment Of Three Cases, Luana D. Laurito, Carla Pereira Loureiro, Livi Faro, Rafaela Venâncio Dias, Bianca Torres, Maria Eduarda Moreira-De-Oliveira, Samara Dos Santos-Ribeiro, Gabriela B. De Menezes, Leonardo F. Fontenelle, Carter H. Davis, Michael P. Twohig

Psychology Faculty Publications

Previous research indicates that a combination of Acceptance and Commitment Therapy (ACT) and Exposure and Response Prevention (ERP) is an effective treatment for obsessive-compulsive disorder (OCD). However, there are no studies to date of ACT for OCD in Latin American populations. Because socio-cultural context influences OCD symptomatology, it is worth adapting and testing ACT for OCD in such cultures. Three patients seeking treatment for OCD at a public health center in Rio De Janeiro, Brazil were treated with 16 sessions of ACT and ERP. All participants showed decreased OCD scores from baseline to post-treatment that remained lower at follow-up, suggesting …

The “How” Of Exposures: Examining The Relationship Between Exposure Parameters And Outcomes In Obsessive-Compulsive Disorder, Clarissa W. Ong, Julie M. Peterson, Carina L. Terry, Jennifer Krafft, Jennifer L. Barney, Jonathan S. Abramowitz, Michael P. Twohig

Psychology Faculty Publications

Exposure and response prevention (ERP) is the most empirically supported treatment for obsessive-compulsive disorder (OCD). However, details on how to effectively conduct ERP are lacking. The current study aimed to identify exposure parameters associated with better subsequent outcomes in ERP for OCD. We analyzed data from 271 therapy sessions across 46 participants in a randomized controlled trial comparing traditional ERP and ERP conducted from an acceptance and commitment therapy framework (ACT + ERP). Multilevel model results indicated that experiential delivery of acceptance/tolerance practice was associated with higher exposure homework adherence, lower psychological inflexibility, and less OCD symptom severity (except contamination) …

Experiential Avoidance In Depression, Anxiety, Obsessive-Compulsive Related, And Posttraumatic Stress Disorders: A Comprehensive Systematic Review And Meta-Analysis, Mehdi Akbari, Mohammad Seydavi, Zahra S. Hosseini, Jennifer Krafft, Michael E. Levin

Psychology Faculty Publications

Although numerous studies on experiential avoidance and its relationship to psychopathology have been conducted, systematic summaries of this research are lacking. The current systematic review and meta-analysis evaluated the transdiagnostic role of experiential avoidance across depression, anxiety and related disorders (obsessive-compulsive and related disorders [OCRDs] and post-traumatic stress disorder [PTSD]) as well as potential moderators of these relations. A total of 441 eligible studies including 135,347 participants (66.16% female, mean age = 31.53) and 899 effect-sizes were summarized. Results indicated a moderate-to-large association of experiential avoidance with anxiety (r = .506) and depressive symptoms (r = .562), major …

An Open Trial Of Acceptance And Commitment Therapy With Exposure And Response Prevention In An Intensive Outpatient Setting For Adults With Ocd, L. K. Capel, P. Zurita-Ona, C. Muller, Michael P. Twohig

Psychology Faculty Publications

Intensive outpatient (IOP) treatment settings for adults with obsessive-compulsive disorder (OCD) are common, but data on their effectiveness is limited. The effectiveness of IOP treatment for adults with OCD using combined Acceptance and Commitment Therapy (ACT) and Exposure and Response Prevention (ERP) was studied with eight adults. The intervention was 15 hours per week for three weeks. Measures were collected at pre-treatment, one-week, two-weeks, post-treatment, and at one-month follow-up. At the end of treatment, all participants were in the mild range of OCD symptom severity with a mean symptom decrease of 58%. Psychological inflexibility, depression, anxiety and stress significantly decreased …

Enabling Resilient Educational Support Network During Covid-19 Pandemic For Undergraduate And Second Career Seeking Students, Phillip Dillulio, Oleksandr Kravchenko, Konstantin Cigularov

Psychology Faculty Publications

During times of local and national quarantine due to the COVID-19 pandemic, universities had to close campuses and expediently convert operations and services from face-to-face to virtual learning environments, including virtual classrooms, learning communities, offices, and meeting/advising rooms. Many engineering faculty and students experienced personal, technical, and psychosocial challenges associated with this dramatically altered reality, which may have significant and unprecedented effects on their personal and academic lives. The current study presents results from a needs assessment survey examining the perceptions of 157 engineering students majoring in mechanical and aerospace engineering about the strengths and challenges exhibited by their professors/instructors …

Online Process-Based Training For Perfectionism: A Randomized Trial, Clarissa W. Ong, Eric B. Lee, Michael E. Levin, Michael P. Twohig

Psychology Faculty Publications

Process-based therapy (PBT) is model of psychotherapy designed to improve people’s ability to use a variety of skills from evidence-based treatments to match environmental needs and personal goals in the moment. This randomized trial tested the effect of an online self-help intervention modeled after PBT principles for participants with perfectionism (N = 77). The intervention comprised two four-session trainings teaching skills from different evidence-based treatments (e.g., cognitive-behavioral therapy, acceptance and commitment therapy) and targeting cognitive and motivational processes: (1) cognitive training and (2) motivational training respectively. Participants completed 17 assessments throughout the intervention and at 3- and 6-month follow-up. …

Intervention Research To Increase Pediatric Hearing Device Use: A Scoping Review, Karen F. Munoz, Diana Ortiz, Cameron Bolinger, Michael P. Twohig

Psychology Faculty Publications

Purpose: This study is a scoping review examining interventions to increase hearing device use for children.

Method: Online databases were used to identify peer-reviewed journal articles published prior to November 1, 2021, yielding 1,288 after duplications were removed. Four articles met the inclusion criteria after articles were screened by title name and abstract and subsequent full-text screening of six articles. A qualitative analysis was conducted to identify features of the intervention studies related to the participants, design, intervention, key findings, and limitations.

Results: The included studies were published between 1982 and 2021, and in all four studies, the children used …

Religiousness And Minority Stress In Conservatively Religious Sexual Minorities: Lessons From Latter-Day Saints, G. Tyler Lefevor, Samuel J. Skidmore, James S. Mcgraw, Edward B. Davis, Ty R. Mansfield

Psychology Faculty Publications

Sexual minorities who engage in conservative religions may experience both stress and support from their engagement with their faith. However, it is unclear how religion/spirituality and minority stress may simultaneously affect mental health. To address this gap, we recruited 1,083 U.S. adults reporting varied engagement with a conservative religious tradition, the Church of Jesus Christ of Latter-day Saints (Mormon; LDS), belonging to one of four groups: (a) heterosexual, LDS; (b) sexual minority, LDS; (c) heterosexual, nonLDS; and (d) sexual minority, nonLDS. We found that LDS sexual minorities reported more religiousness/spirituality and described experiencing more minority stressors, relative to nonLDS sexual …

The Association Of Assault Military Sexual Trauma And Sexual Function Among Partnered Female Service Members And Veterans: The Mediating Roles Of Depression And Sexual Self-Schemas, Rebecca K. Blais, Whitney S. Livingston

Psychology Faculty Publications

Background: Military sexual trauma (MST) that involves assault is associated with poorer sexual function in U. S. women service members/veterans (SM/Vs). Theory of sexual function suggests that the presence of higher depression severity and more negative sexual self-schemas may contribute to sexual dysfunction. This has yet to be examined in partnered women SM/Vs who are survivors of MST.

Objective: Using path analysis, the current study examined the associations of MST type, depression, sexual self-schemas, and sexual function in 818 partnered women SM/Vs.

Method: Three separate mediation models were tested, all testing indirect effects of depression and sexual self-schemas on the …

Sexual Prejudice, Sexism, And Religion, Chana Etengoff, G. Tyler Lefevor

Psychology Faculty Publications

Multi-national and meta-analytic studies suggest that the pathways between religiousness and sexism/sexual prejudice are partially mediated by sociopersonality factors such as conservatism. In this article, we describe the contributing factors to this relationship, such as authoritarianism and fundamentalism. These factors interact at the dynamic nexus of individual and social development. As such, religiously situated sexism and sexual prejudice are not viewed as inevitable outcomes to religious practice and faith. Individual differences (e.g. conservatism), congregational (e.g. doctrine/policies, limited contact), and cultural factors (e.g. power hierarchies) mutually contribute to this landscape, and individuals ultimately make choices regarding their behavior and views. Further …

Reducing Occupational Distress In Veterinary Medicine Personnel With Acceptance And Commitment Training: A Pilot Study, M. B. Spitznagel, A. S. G. Updegraff, Michael P. Twohig, M. D. Carlson, C. M. Fulkerson

Psychology Faculty Publications

Aims

To determine whether an educational programme targeting the reaction of veterinary personnel to difficult client interactions reduced burden transfer, stress and burnout in veterinary staff.

Methods

Employees of three small-animal veterinary hospitals in the south-western United States of America were recruited and randomised to intervention (educational programme; n = 16) or control (no intervention; n = 18) groups. Participants of this randomised, parallel arms trial completed pre-programme assessment including the Burden Transfer Inventory (BTI), Perceived Stress Scale, and Copenhagen Burnout Inventory. Assessment was followed by two, group-format educational sessions, based on acceptance and commitment training, tailored to reducing reactivity …

Self-Reported Ptsd Symptoms And Social Support In U.S. Military Service Members And Veterans: A Meta-Analysis, Rebecca K. Blais, Vanessa Tirone, Daria Orlowska, Ashton Lofgreen, Brian Klassen, Philip Held, Natalie Stevens, Alyson K. Zalta

Psychology Faculty Publications

Background: The mental health burden of posttraumatic stress disorder (PTSD) is high in U.S. military samples. Social support is one of the most robust protective factors against PTSD and a recent meta-analysis indicates that this relationship is even stronger in military samples compared to civilian samples. Yet no meta-analyses have explored factors impacting this association in veterans and military service members (VSMs).

Objective: The current meta-analysis examined demographic, social support, and military characteristics that may moderate the relationship of PTSD severity and social support among U.S. VSMs.

Method: A search identified 37 cross-sectional studies, representing 38 unique samples with a …

A Randomized Trial Of Brief Online Interventions To Facilitate Treatment Seeking For Social Anxiety, Margaret R. Tobias, Lauren N. Landy, Michael E. Levin, Joanna J. Arch

Psychology Faculty Publications

Objective: This study developed and evaluated a brief, single-session online intervention designed to facilitate treatment seeking among adults with clinically significant social anxiety (SA) symptoms, who generally seek treatment at exceptionally low rates.

Method: Adults (N= 267) reporting significant SA symptoms were recruited online and randomized to a brief, single-session online intervention: Education consisted of brief psychoeducation and treatment resources, or Education+Motivation which added treatment seeking-focused motivational content adapted from Motivational Interviewing and Acceptance and Commitment Therapy. Attitudes, intentions, perceived control, and treatment seeking were assessed at Pre, Post, and one-month follow-up (FU).

Results: Both interventions were feasible …

Study Protocol For A Randomized Controlled Trial Comparing Two Low-Intensity Weight Loss Maintenance Interventions Based On Acceptance And Commitment Therapy Or Self-Regulation, Jason Lillis, Leah Schumacher, J. Graham Thomas, Michael E. Levin, Shira Dunsiger, Jessica L. Unick, Erin Evans, Jacqueline F. Hayes, Rena R. Wing

Psychology Faculty Publications

Background: Weight regain is common following behavioral obesity treatment and attenuates many of the benefits of initial weight loss. This paper describes a randomized controlled trial that will evaluate the efficacy of two low-contact weight loss maintenance interventions based on Acceptance and Commitment Therapy (ACT) and self-regulation (SR). Potential mechanisms of action and moderators of treatment effects will also be evaluated.

Methods: Adults (anticipated N=480)with overweight or obesity will complete an initial 3-monthonline weight loss program (Phase 1). Participants who achieve ≥4 kg weight loss (anticipated N=288) will then be randomized to an ACT or SR weight loss maintenance intervention. …

Stimulus Complexity And Chunk Tightness Interact To Impede Perceptual Restructuring During Problem Solving, Zhonglu Zhang, Christopher M. Warren, Yi Lei, Qiang Xing, Hong Li

Psychology Faculty Publications

The mutual influence of stimulus complexity and chunk tightness on perceptual restructuring was examined using a chunk decomposition task (CDT). Participants attempted to remove components of Chinese characters in order to produce new, valid characters. Participants had their electroencephalogram recorded while completing a CDT in conditions of low or high stimulus complexity, crossed with two levels of chunk tightness. Tight chunks overlapped spatially whereas loose chunks did not. Both increasing chunk tightness and increasing stimulus complexity impaired performance (lower accuracy, longer reaction times), and these factors interacted such that highly complex, tight chunks produced the worst performance. These factors also …

Promoting Healthy Decision-Making Via Natural Environment Exposure: Initial Evidence And Future Directions, Meredith S. Berry, Meredith A. Repke, Alexander L. Metcalf, Kerry Jordan

Psychology Faculty Publications

Research within psychology and other disciplines has shown that exposure to natural environments holds extensive physiological and psychological benefits. Adding to the health and cognitive benefits of natural environments, evidence suggests that exposure to nature also promotes healthy human decision-making. Unhealthy decision-making (e.g., smoking, non-medical prescription opioid misuse) and disorders associated with lack of impulse control [e.g., tobacco use, opioid use disorder (OUD)], contribute to millions of preventable deaths annually (i.e., 6 million people die each year of tobacco-related illness worldwide, deaths from opioids from 2002 to 2017 have more than quadrupled in the United States alone). Impulsive and unhealthy …

Natural Categorization: Electrophysiological Responses To Viewing Natural Versus Built Environments, Salif Mahamane, Nick Wan, Alexis Porter, Allison S. Hancock, Justin Campbell, M. S. Lyons, Kerry Jordan

Psychology Faculty Publications

Environments are unique in terms of structural composition and evoked human experience. Previous studies suggest that natural compared to built environments may increase positive emotions. Humans in natural environments also demonstrate greater performance on attention-based tasks. Few studies have investigated cortical mechanisms underlying these phenomena or probed these differences from a neural perspective. Using a temporally sensitive electrophysiological approach, we employ an event-related, implicit passive viewing task to demonstrate that in humans, a greater late positive potential (LPP) occurs with exposure to built than natural environments, resulting in a faster return of activation to pre-stimulus baseline levels when viewing natural …

A Religious Paradox: Can Priming Ideas Of God Reduce Rape Victim Blame?, Emma G. Heath, Kathryn Sperry

Psychology Faculty Publications

Rape victim blame contributes to unreported incidents of sexual assault and failure to support victims (Ahrens in American Journal of Community Psychology, 38(3-4), 263-274, 2006). The present study investigated the relationship between religiosity, religious priming, and rape victim blame. Using an online Qualtrics panel, 247 U.S. participants were randomly assigned to either a neutral prime or a religious prime. They then read a short vignette of an acquaintance rape scenario and answered questions regarding perceptions of victim blame, victim credibility, benevolent and hostile sexism, religiosity, religious fundamentalism, and Rape Myth Acceptance (RMA). Results revealed that the religious prime …

Comparing Effects Of Acceptance Training And Psychoeducation On Hoarding Symptoms, Clarissa W. Ong, Jennifer Krafft, Michael E. Levin, Michael P. Twohig

Psychology Faculty Publications

Hoarding symptoms include difficulty letting go of possessions, excessive acquisition, and clutter that precludes use of active living spaces. The current study compared the effects of acceptance training to psychoeducation on hoarding severity in a sample of college students with elevated hoarding symptoms. Participants (N = 47) completed self-report measures at baseline, posttest, and one-week follow-up and an in vivo discarding behavioral task at posttest. There were no differences in self-reported outcomes between conditions over time, suggesting acceptance training was not more effective than psychoeducation. Significant and large effect sizes for hoarding severity and maladaptive hoarding cognitions were found …

Lgbtq+ Emerging Adults Perceptions Of Discrimination And Exclusion Within The Lgbtq+ Community, Joshua Glenn Parmenter, Renee Vickerman Galliher, Adam D. A. Maughan

Psychology Faculty Publications

Research on LGBTQ+ emerging adult populations has primarily focused on discrimination that is experienced within the heterodominant culture. Due to systems of oppression and the forces of power and privilege, some sexual and gender minorities experience isolation and discrimination not only within the heterodominant culture, but within the LGBTQ+ community as well. Fourteen lesbian, gay, bisexual, transgender, or queer/questioning (LGBTQ+) young adults (20-25 years) with a diverse array of intersecting identities (e.g., gender, racial, ethnic, religious, cultural) participated in semi-structured individual interviews and focus groups. Participants reported on experiences of biphobia, acephobia, transphobia, gatekeeping the community, LGBTQ+ people of colour’s …

Acceptability, Feasibility, And Efficacy Potential Of A Multimodal Acceptance And Commitment Therapy Intervention To Address Psychosocial And Advance Care Planning Needs Among Anxious And Depressed Adults With Metastatic Cancer, Joanna J. Arch, Joel N. Fishbein, Michelle C. Ferris, Jill L. Mitchell, Michael E. Levin, Elizabeth T. Slivjak, David J. Andorsky, Jean S. Kutner

Psychology Faculty Publications

Background: Adults with metastatic cancer frequently report anxiety and depression symptoms, which may impact health behaviors such as advance care planning (ACP).

Objective: The study leveraged acceptance and commitment therapy (ACT), an evidence-based approach for reducing distress and improving health behaviors, and adapted it into a multimodal intervention (M-ACT) designed to address the psychosocial and ACP needs of anxious and depressed adults with metastatic cancer. The study evaluated M-ACT's acceptability, feasibility, and efficacy potential.

Design: The study was designed as a single-arm intervention development and pilot trial.

Setting/Subjects: The trial enrolled 35 anxious or depressed adults with stage IV cancer …

A Randomized Trial Of Acceptance And Commitment Therapy And Traditional Cognitive-Behavioral Therapy Self-Help Books For Social Anxiety, Jennifer Krafft, Michael P. Twohig, Michael E. Levin

Psychology Faculty Publications

Background: Self-help resources such as books may help meet critical mental health needs in college students, but there is insufficient evidence on whether and how such books work. This randomized trial compared acceptance and commitment therapy (ACT) and traditional cognitive behavior therapy (tCBT) self-help books for social anxiety, a common concern with notable barriers to treatment seeking.

Methods: A sample of college students (n = 102) with social anxiety was randomly assigned to use one of the two self-help books over eight weeks.

Results: Improvements were observed in both conditions across all outcomes (social anxiety, general well-being, and social …

Experiential Avoidance And Negative Affect As Predictors Of Daily Drinking, Jason B. Luoma, Benjamin G. Pierce, Michael E. Levin

Psychology Faculty Publications

People who drink alcohol to cope with negative affect tend to drink more and experience more frequent negative alcohol-related consequences. Experiential avoidance, the tendency to avoid, suppress, or otherwise attempt to control unwanted inner experiences, is a largely pathological process that may help account for how negative affect is linked to increased alcohol consumption. However, research to-date has typically used global, trait-like measures, which limit our understanding of the conditions under which experiential avoidance is problematic. The current study tested both between-person (trait) and within-person (daily) variation in experiential avoidance and negative affect as predictors of solitary and social drinking …

Evaluating Acceptance And Commitment Therapy And Mindfulness-Based Stress Reduction Self-Help Books For College Student Mental Health, Michael E. Levin, Woolee An, Carter H. Davis, Michael P. Twohig

Psychology Faculty Publications

Objectives: Self-help has the potential to improve access to mental health resources for college students. However, solutions are needed to improve sustainable delivery, cost- effectiveness, and to know which resources are most useful. Methods: A sample of 109 college students were randomly assigned to read either an Acceptance and Commitment Therapy (ACT) or Mindfulness-Based Stress Reduction (MBSR) self-help book through the University library website over 8 weeks with assessments at baseline, midtreatment (4-weeks), and posttreatment (8-weeks). Results: The majority of participants reported reading over half of their assigned book and high satisfaction ratings were given for both books. Both conditions …

Comparing The Efficacy Of Defusion, Self-As-Context, And Distraction Strategies For Getting Rid Of Possessions, Clarissa W. Ong, Carina L. Terry, Michael P. Twohig

Psychology Faculty Publications

Interventions for hoarding disorder need to target difficulty letting go of items to reduce clutter and improve functioning. The present studies were designed to test the efficacy of brief cognitive interventions for letting go of possessions and self-report outcomes. Participants (N = 67 in Study 1; N = 110 in Study 2) received training on defusion or distraction in Study 1 and defusion, self-as-context, or distraction in Study 2 and completed measures at pre- and postintervention. Study 1 found no differences between defusion and distraction on saving, self-rated discomfort with discarding, or perceived importance of the target belonging. In …

Examining Processes Of Change In An Online Acceptance And Commitment Therapy Dismantling Trial With Distressed College Students, Michael E. Levin, Jennifer Krafft, Michael P. Twohig

Psychology Faculty Publications

This secondary analysis examined the processes of change from a randomized dismantling trial evaluating the Open (i.e., cognitive defusion, acceptance) and Engaged (i.e., values, committed action) components of acceptance and commitment therapy (ACT). Analyses were conducted with 161 distressed college students randomly assigned to a full online ACT program (Full n=40), online ACT targeting the Open components (Open n=41) or targeting the Engaged components (Engaged n=39), or a waitlist condition (Waitlist n=41). The intervention occurred over six weeks followed by a post-treatment assessment with mental health symptoms as the primary outcome. Consistent with predictions, pre- to …

An Examination Of The Relationship Between Perfectionism And Neurological Functioning, Julie M. Petersen, Clarissa W. Ong, Allison S. Hancock, Ronald B. Gillam, Michael E. Levin, Michael P. Twohig

Psychology Faculty Publications

Clinical perfectionism is the rigid pursuit of high standards, interfering with functioning. Little research has explored neural patterns in clinical perfectionism. The present study explores neural correlates of clinical perfectionism, before and after receiving ten 50-minute, weekly sessions of acceptance and commitment therapy (ACT), as compared to low-perfectionist controls, in specific cortical structures: the dorsolateral prefrontal cortex (DLPFC), medial prefrontal cortex (MPFC), right inferior parietal lobule (IPL). Participants in the perfectionist condition (n = 43) were from a randomized controlled trial evaluating ACT for clinical perfectionism and low-perfectionist controls were undergraduate students (n = 12). Participants completed three tasks (editing …

A Preliminary Investigation Of The Effect Of Acceptance And Commitment Therapy On Neural Activation In Clinical Perfectionism, Clarissa W. Ong, Allison S. Hancock, Tyson S. Barrett, Eric B. Lee, Nicholas Wan, Ronald B. Gillam, Michael E. Levin, Michael P. Twohig

Psychology Faculty Publications

Clinical perfectionism is associated with various cognitive processes including performance monitoring and emotion regulation. This exploratory study analyzed neurological data from a randomized controlled trial for clinical perfectionism that compared acceptance and commitment therapy (ACT) to a waitlist control. The objective was to assess the effect of ACT on neural activation. Twenty-nine participants underwent a functional near-infrared spectroscopy assessment during which they completed behavioral tasks designed to elicit error detection and error generation at pre- and posttreatment. The hemodynamic response function (HRF) in the dorsolateral prefrontal cortex, dorsomedial prefrontal cortex, and right inferior parietal lobe was analyzed using mixed effects …

Moderators And Processes Of Change In Traditional Exposure And Response Prevention (Erp) Versus Acceptance And Commitment Therapy-Informed Erp For Obsessive-Compulsive Disorder, Clarissa W. Ong, Shannon M. Blakey, Brooke M. Smith, Kate L. Morrison, Ellen J. Bluett, Jonathan S. Abramowitz, Michael P. Twohig

Psychology Faculty Publications

The present study evaluated moderators and processes of change in a randomized controlled trial comparing exposure and response prevention (ERP) delivered from a traditional framework versus ERP from an acceptance and commitment therapy framework (ACT+ERP) for obsessive-compulsive disorder (OCD). This paper presents baseline, weekly session, posttreatment, and follow-up data from the study. We examined (a) moderation effects of anxiety, depression, psychological inflexibility, and interpretation of intrusions and (b) the role of psychological inflexibility and interpretation of intrusions respectively as processes of change. Participants with less dysfunctional appraisals at pretreatment performed consistently better in ERP relative to ACT+ERP. In process analyses, …

A Psychometric Comparison Of Psychological Inflexibility Measures: Discriminant Validity And Item Performance, Clarissa W. Ong, Benjamin G. Pierce, Julie M. Petersen, Jennifer L. Barney, Jeremiah E. Fruge, Michael E. Levin, Michael P. Twohig

Psychology Faculty Publications

Psychological inflexibility is a rigid behavioral pattern that interferes with engagement in personally meaningful activities; it is the hypothesized root of suffering in acceptance and commitment therapy (ACT). Thus, the quality of its measurement affects the research, theory, and practice of ACT. The current study aimed to evaluate the discriminant validity and item performance of four measures of psychological inflexibility: the Acceptance and Action Questionnaire—II (AAQ-II), a revised version of the AAC-II (AAQ-3), the Brief Experiential Avoidance Questionnaire (BEAQ), and the Comprehensive assessment of Acceptance and Commitment Therapy processes (CompACT). We analyzed data from community (n = 253), student …