Evaluation of psychometric properties of the Persian version of Avoidance and Fusion Questionnaire for Youth (AFQ-Y)

Document Type : Research Paper


1 Department of clinical psychology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran

2 Department of psychiatry,, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran


Introduction: The concept of psychological inflexibility (PI) was proposed by the acceptance and commitment therapy (ACT). Avoidance and Fusion Questionnaire for Youth (AFQ-Y) is one of the tools for measuring this factor in youth. The aim of this study is to assess the factor structure and psychometric features of the Persian version of AFQ-Y.
Materials and Methods: The cases of this study included 303 school students of Kashan, Iran who were selected through cluster sampling method during 2017. The tools used were AFQ-Y and Revised Children's Manifest Anxiety Scale (RCMAS). The factor structure of AFQ-Y was studied by exploratory and confirmatory factor analyses. Also, the convergent validity, test-retest reliability (4-week interval) and internal consistency of AFQ-Y were assessed. The statistical analysis was performed using SPSS version 19 and AMOS-22.
Results: The results of exploratory factor analysis (EFA) indicated two factors: “cognitive fusion” and “experiential avoidance”. Confirmatory factor analysis (CFA) confirmed the 2-factor model (RMSEA 90% CI= 0.04-0.06). Furthermore, the convergent validity(r= 0.60, P< 0.001), Cronbach's alpha coefficient (α= 0.80) and test-retest reliability coefficient (r= 0.73) of this scale were also acceptable.
Conclusion: Based on the results, the Avoidance and Fusion Questionnaire for Youth is an appropriate tool with acceptable psychometric features for measuring psychological inflexibility in the youth population of Iran.


  1. Hayes SC, Barnes-Holmes D, Wilson KG. Contextual behavioral science: Creating a science more adequate to the challenge of the human condition. J Contextual Behav Sci 2012; 1(s1-2): 1-16.
  2. Hayes SC. Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behav Ther 2004; 35(4): 639-65.
  3. Twohig MP. Acceptance and commitment therapy: Introduction. Elsevier; 2012.
  4. Hayes SC, Strosahl KD, Wilson KG. Acceptance and commitment therapy: An experiential approach to behavior change. New York: Guilford; 1999.
  5. Forman EM, Chapman JE, Herbert JD, Goetter EM, Yuen EK, Moitra E. Using session-by-session measurement to compare mechanisms of action for acceptance and commitment therapy and cognitive therapy. Behav Ther 2012; 43(2): 341-54.
  6. Hayes SC, Strosahl KD. A practical guide to acceptance and commitment therapy. London: Springer Science and Business Media; 2004.
  7. Luoma JB, Hayes SC. Cognitive defusion. In: Donohue WT, Fisher JE, Hayes SC. (editors). Empirically supported techniques for cognitive behavior therapy: A step by step guide for clinicians. New York: Wiley; 2003.
  8. Hayes SC, Gifford E V. The trouble with language: Experiential avoidance, rules, and the nature of verbal events. Psychol Sci 1997; 8(3):170-3.
  9. Bond FW, Hayes SC, Barnes-Holmes D. Psychological flexibility, ACT, and organizational behavior. J Organ Behav Manage 2006; 26(1-2): 25-54.
  10. Bond FW, Bunce D. The role of acceptance and job control in mental health, job satisfaction, and work performance. J Appl Psychol 2003; 88(6): 1057.
  11. Butler J, Ciarrochi J. Psychological acceptance and quality of life in the elderly. Qual life Res 2007; 16(4): 607-15.
  12. Ciarrochi J, Bilich L, Godsell C. Psychological flexibility as a mechanism of change in acceptance and commitment therapy. In: Baer RA. (weditor). Assessing mindfulness and acceptance processes in clients: Illuminating the theory and practice of change. USA: New Harbinger; 2010: 51-76.
  13. Fledderus M, Bohlmeijer ET, Smit F, Westerhof GJ. Mental health promotion as a new goal in public mental health care: A randomized controlled trial of an intervention enhancing psychological flexibility. Am J Public Health 2010; 100(12): 2372.
  14. Fledderus M, Bohlmeijer ET, Fox J-P, Schreurs KMG, Spinhoven P. The role of psychological flexibility in a self-help acceptance and commitment therapy intervention for psychological distress in a randomized controlled trial. Behav Res Ther 2013; 51(3): 142-51.
  15. Bond FW, Bunce D. Mediators of change in emotion-focused and problem-focused worksite stress management interventions. J Occup Health Psychol 2000; 5(1): 156.
  16. Tull MT, Gratz KL, Salters K, Roemer L. The role of experiential avoidance in posttraumatic stress symptoms and symptoms of depression, anxiety, and somatization. J Nerv Ment Dis 2004; 192(11): 754-61.
  17. Lillis J, Hayes SC, Bunting K, Masuda A. Teaching acceptance and mindfulness to improve the lives of the obese: A preliminary test of a theoretical model. Ann Behav Med 2009;37(1): 58-69.
  18. Ruiz FJ. A review of Acceptance and Commitment Therapy (ACT) empirical evidence: Correlational, experimental psychopathology, component and outcome studies. Int J Psychol Psychol Ther 2010; 10(1): 125-62.
  19. Bond FW, Hayes SC, Baer RA, Carpenter KM, Guenole N, Orcutt HK, et al. Preliminary psychometric properties of the Acceptance and Action Questionnaire–II: A revised measure of psychological inflexibility and experiential avoidance. Behav Ther 2011; 42(4): 676-88.
  20. Gifford E V, Kohlenberg BS, Hayes SC, Antonuccio DO, Piasecki MM, Rasmussen-Hall ML, et al. Acceptance-based treatment for smoking cessation. Behav Ther 2004; 35(4): 689-705.
  21. Vowles KE, McCracken LM, McLeod C, Eccleston C. The chronic pain acceptance questionnaire: confirmatory factor analysis and identification of patient subgroups. Pain 2008; 140(2): 284-91.
  22. Lundgren T, Dahl J, Yardi N, Melin L. Acceptance and commitment therapy and yoga for drug-refractory epilepsy: a randomized controlled trial. Epilepsy Behav 2008; 13(1): 102-8.
  23. Halliburton AE, Cooper LD. Applications and adaptations of Acceptance and Commitment Therapy (ACT) for adolescents. J Context Behav Sci 2015; 4(1): 1-11.
  24. Greco LA, Lambert W, Baer RA. Psychological inflexibility in childhood and adolescence: Development and evaluation of the Avoidance and Fusion Questionnaire for Youth. Psychol Assess 2008; 20(2): 93.
  25. Schmalz JE, Murrell AR. Measuring experiential avoidance in adults: The Avoidance and Fusion Questionnaire. Int J Behav Consult Ther 2010; 6(3): 198.
  26. Fergus TA, Valentiner DP, Gillen MJ, Hiraoka R, Twohig MP, Abramowitz JS, et al. Assessing psychological inflexibility: The psychometric properties of the Avoidance and Fusion Questionnaire for Youth in two adult samples. Psychol Assess 2012; 24(2): 402.
  27. Hayes SC, Strosahl K, Wilson KG, Bissett RT, Pistorello J, Toarmino D, et al. Measuring experiential avoidance: A preliminary test of a working model. Psychol Rec 2004; 54(4): 553-78.
  28. Valdivia-Salas S, Martín-Albo J, Zaldivar P, Lombas AS, Jiménez TI. Spanish validation of the avoidance and fusion questionnaire for youth (AFQ-Y). Assessment 2017; 24(7): 919-31.
  29. Livheim F, Tengström A, Bond FW, Andersson G, Dahl J, Rosendahl I. Psychometric properties of the Avoidance and Fusion Questionnaire for Youth: A psychological measure of psychological inflexibility in youth. J Context Behav Sci 2016; 5(2): 103-10.
  30. Simon E, Verboon P. Psychological inflexibility and child anxiety. J Child Fam Stud 2016; 25(12): 3565-73.
  31. Comrey AL, Lee HB. A first course in factor analysis. USA: Psychology Press; 2013.
  32. Renshaw TL. Screening for psychological inflexibility: Initial validation of the Avoidance and Fusion Questionnaire for Youth as a school mental health screener. J Psychoeduc Assess 2017; 35(5): 482-93.
  33. Wisniewski JJ, Genshaft JL, Mulick JA, Coury DL. Test-retest reliability of the Revised Children’s Manifest Anxiety Scale. Percept Mot Skills 1987; 65(1): 67-70.
  34. Reynolds CR. Concurrent validity of What I Think and Feel: The Revised Children’s Manifest Anxiety Scale. J Consult Clin Psychol 1980; 48(6): 774.
  35. Taghavi MR, Alishahi MJ. [Study of validity and reliability of manifest anxiety scale for children]. Journall of psychology 2003; 4(7): 342-57. (Persian)
  36. Browne MW, Cudeck R. Alternative ways of assessing model fit. Sociol Methods Res 1992; 21(2): 230-58.
  37. Tabachnick B, Fidell L. Using multivariate statistics. 5th ed. Boston, MA: Allyn and Bacon; 2007.
  38. Kline RB. Principles and practice of structural equation modeling. Methodology in the social sciences. New York: Guilford; 2004.
  39. Muris P, Meesters C, Herings A, Jansen M, Vossen C, Kersten P. Inflexible youngsters: Psychological and Psychopathological Correlates of the Avoidance and Fusion Questionnaire for Youths in nonclinical Dutch adolescents. Mindfulness (N Y) 2017; 8(5): 1381-92.
  40. Venta A, Sharp C, Hart J. The relation between anxiety disorder and experiential avoidance in inpatient adolescents. Psychol Assess 2012; 24(1): 240.
  41. Christodoulou A, Michaelides MP, Karekla M. Greek version of the Avoidance and Fusion Questionnaire for Youth: Psychometric evaluation and gender multigroup invariance in adolescents. J Psychoeduc Assess 2018; 36(8): 844-9.
  42. Sairanen E, Lappalainen P, Hiltunen A. Psychological inflexibility explains distress in parents whose children have chronic conditions. PLoS One 2018; 13(7): e0201155-e0201155.
  43. Papachristou H, Theodorou M, Neophytou K, Panayiotou G. Community sample evidence on the relations among behavioural inhibition system, anxiety sensitivity, experiential avoidance, and social anxiety in adolescents. J Context Behav Sci 2018; 8: 36-43.