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Development of the Valuing Questionnaire

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Title: Development of the Valuing Questionnaire


1
Development of the Valuing Questionnaire
  • Dr Matthew Davies
  • Dr Matthew Smout
  • School of Psychology
  • University of Adelaide

2
ACTs emphasis on values
  • creative hopelessness, defusion, connecting
    with self, acceptance, contact with the present
    moment, and valuing must lead to actual concrete
    differences in the clients behaviour that
    service those valued ends
  • (Strosahl et al., 2004)
  • While ACT allows for symptom alleviation, it is
    not a main target or the therapeutic goal.
    Rather the focus is on what we call broadband
    outcomes. Such outcomes are about helping the
    client move in life directions that they truly
    care about
  • (Eifert Forsyth, 2005)
  • All ACT techniques are eventually subordinated
    to helping the client live in accord with his or
    her chosen values.
  • (Hayes et al.,1999, p.205)

3
Values assessment in ACT research to date
  • Values measures not used as primary outcome
    measures in most ACT studies
  • Not all studies include values measures
  • Those that do usually operationalise as quality
    of life/satisfaction with life state not
    behaviour

4
Existing values measures
  • Outside ACT
  • Rokeach Values Questionnaire
  • Schwartz Values Survey
  • Values In Action (VIA)
  • Inside ACT
  • VLQ
  • Bulls Eye
  • Chronic Pain Values Inventory (CPVI)
  • Survey of Life Principles
  • Personal Values Questionnaire (PVQ)

5
Difficulties with individual domains methods
  • Having domains considered individually do not
    represent how values work i.e., out of context
    of choice, promote intellectualised / idealised
    choosing ranking would be more realistic but
    creates psychometric limitations
  • Therefore, empirically all domains get high
    importance ratings little differentiation
    (McCracken Yang, 2006)
  • Also high social desirability
  • Difficult to weight/combine across domains
    meaningfully.
  • Time is limited valuing as a verbal-linguistic
    activity is relatively unlimited. e.g.,Low
    consistency in one domain due to high consistency
    in another domain may still reflect living
    relatively ideal valued living
  • One behaviour may serve more than one value one
    valued domain may be served by many behaviours
  • Assessing by domain increases number of items
    makes it difficult to capture other ACT-specific
    qualities of values in a brief measure

6
Methodology Item generation
  • Searched key ACT texts for value references to
    comprehensively cover the concept from an ACT
    perspective
  • Hayes et al (1999) Acceptance and Commitment
    Therapy An experiential approach to behavior
    change. New York Guilford
  • Hayes Strosahl (2004). A practical guide to
    acceptance and commitment therapy. New York
    Springer.
  • Wilson Dufrene (2009). Mindfulness for two An
    acceptance and commitment therapy approach to
    mindfulness in psychotherapy. Oakland New
    Harbinger.
  • Dahl et (2009) The Art and Science of Valuing in
    Psychotherapy Helping Clients Discover, Explore,
    and Commit to Valued Action Using Acceptance and
    Commitment Therapy. Oakland New Harbinger.
  • Eifert Forsyth (2005). Acceptance and
    commitment therapy of anxiety disorders. A
    Practitioner's Treatment Guide to Using
    Mindfulness, Acceptance, and Value-Guide Behavior
    Change Strategies. Oakland CA New Harbinger.
  • Luoma et al (2007). Learning Act An Acceptance
    Commitment Therapy Skills-Training Manual for
    Therapists (Context / Nhp Context / Nhp).
  • Ciarrochi Bailey (2008). A CBT-Practitioner's
    Guide to ACT How to Bridge the Gap Between
    Cognitive Behavioral Therapy and Acceptance and
    Commitment Therapy. Oakland New Harbinger.
  • Zettle (2007). Act for Depression A Clinician's
    Guide to Using Acceptance and Commitment Therapy
    in Treating Depression. Oakland CA New
    Harbinger.
  • Plus self help books by Hayes Smith (2005),
    Forsyth Eifert (2008), Strosahl Robinson
    (2008)

7
Methodology Item generation
  • Apparent key features of values from ACT
    standpoint
  • Clarity
  • Priority
  • Chosen Pliance not main source of control
  • Justification of actions involves fitting them
    into existing culturally supported verbal
    networksin many ways this is the exact opposite
    of valuing (Hayes et al., 1999, p.208)
  • Enactment
  • To some degree, we engage in an act of valuing
    each time we do something that is purposive or
    instrumental (Luoma et al., 2007, p.131)
  • Persistence
  • If the client bases living entirely on the
    absence of emotional or cognitive obstacles, then
    valued directions cannot be pursued in a
    committed fashion (Hayes et al, 1999, p.210).
  • Engagement/vitality
  • living in accord with ones values lends an
    inherent sense of purpose and vitality that makes
    confronting monsters a legitimate and honourable
    undertaking (Hayes et al., 1999, p.209)
  • Consistency/stability
  • Values are more abstract and global than
    concrete verbal goals and thus provide a kind of
    verbal glue that makes sets of verbal goals more
    coherent (Hayes et al, 1999, p. 207) Basic
    values seldom change (Hayes et al., 1999, p.259)

8
Methodology Item generation
  • Brainstormed a list of items to tap each facet.
  • Initially gave list of 64 items to friends/family
    to rate readability (clear, not sure, unclear)
    provide comments
  • A list of the 64 items then given to one group
    (n4) of ACT experts to rate how well each item
    represents valuing on a scale of 0 to 4.
  • Items deleted/amended on feedback, new items
    generated, 79-item list provided to 3 other
    experts to rate for representativeness
  • (Thanks to Patty Bach, Rob Zettle, Robyn Walser,
    Russ Harris, Joe Ciarrochi, Kirk Strosahl,
    Jennifer Plumb)
  • Final list of 70 items.
  • Questionnaire starts with the statement
  • 1. Please read each statement carefully and then
    select the number which best describes how much
    the statement was true for you DURING THE PAST
    WEEK, INCLUDING TODAY.
  • Likert Scale from 0 (Not At All) to 6
    (Completely)

9
Methodology validation
  • Administered to n658 university students 50
    random split for exploratory/confirmatory
  • Validation measures
  • Depression Anxiety Stress Scales (DASS) (symptom
    measure)
  • Satisfaction With Life Scales (SWLS)
  • Valued Living Questionnaire (VLQ)
  • Positive and Negative Affect Scales (PANAS)
  • Mindfulness Attention Awareness Scale (MASS)
  • Acceptance and Action Questionnaire II (AAQ II)
  • Ryffs (1989) Wellbeing Scales
  • Autonomy
  • Environmental Mastery
  • Personal Growth
  • Positive relations with others
  • Purpose In Life
  • Self-acceptance

10
Demographics
Exploratory (n366) Confirmatory (n292)
Age 20.4 (sd 4.5) 20.2 (sd 3.9)
Gender 69 Female 69 Female
Ethnicity 68.3 White 21.6 Asian 71.6 white 19.5 Asian
Language at home 80.8 English 81.2 English
Employed 39 57 40 49
Course year level 87 First year 88 First year
Student status 92 Full time 94 Full time
Relationship status 61.5 34.3 59 36
11
How should a valuing questionnaire be validated?
Self-report measures
  • Strongest positive associations
  • other values measures VLQ
  • satisfaction with life
  • well-being
  • ?quality of life
  • Moderate positive associations
  • Measures of mindfulness
  • Measures of psychological flexibility
  • Low correlations
  • Affect states
  • Psychological and physical symptoms

12
Exploratory Factor Analysis
  • Deleted Multivariate outliers (n59)
  • Principal Axis Factoring
  • 11 Eigenvalues gt 1
  • 2 factors accounted for 51 variance
  • Promax (oblique) rotation

13
Factor 1 Successful valued living
  • Rotation Sums of Squares Loading 25.6 variance
  • 40/70 variables loaded gt .32 on this factor
  • 10 variables loaded .8 -.85 Cronbach a .95
  • I continued to get better at being the kind of
    person I want to be
  • I did things that brought me closer to what
    really matters to me in my life
  • I made progress in the areas of my life I care
    most about
  • Most of the things I did were very important to
    me
  • I was proud about how I lived my life
  • I lived my life in a manner I would be happy to
    be remembered for
  • Ive been able to stay focused on the things that
    are most important to me in life
  • I was active and focused on the goals I set for
    myself
  • I was in touch with what was important to me
  • My behaviour was a good example of what I stand
    for in life

14
Factor 2 Disrupted valued living
  • Rotation Sums of Squares Loading 19.4 variance
  • 30/70 variables loaded gt .32 on this factor
  • 10 variables loaded .7 -.81, Cronbach a .93
  • I tried to work towards important goals, but
    something always got in the way
  • I had unpleasant thoughts and emotions that
    stopped me from achieving my goals
  • Difficult thoughts, feelings or memories got in
    the way of what I really wanted to do
  • It seemed like I was just going through the
    motions, rather than focusing on what was
    important to me
  • I spent a lot of time trying to please other
    people
  • I found it hard to follow through on important
    activities because of unpleasant thoughts and
    feelings
  • Most of what I did was to please other people,
    rather than doing whats important to me
  • I was basically on auto-pilot most of the time
  • When things didnt go according to plan, I gave
    up easily
  • I found it hard to stay focused and engaged with
    what I was doing

15
(No Transcript)
16
Confirmatory Factor Analysis
  • Fit Indices
  • CMIN/DF 1.914 (lt 3 OK)
  • NFI .945 (.9 - .95 OK, gt .95 ideal)
  • GFI .912 (should be gt .9)
  • AGFI .877 (should be gt .9)
  • CFI .973 (closer to 1 better)
  • RMSEA .058 (lt .06 good, closer to .05 better)
  • TLI .966 (close to 1 better, can exceed 1)

17
Validation with Existing Measures
18
Symptom Measures DASS-21 PANAS
Depression Anxiety Stress Pos. Affect Neg. Affect
VQ - Successful -.527 -.214 -.297 .716 -.270
VQ Disrupted .706 .560 .599 -.463 .645
19
Well-Being Life Satisfaction
VQ Success VQ - Disrupted
Ryffs Scales
Autonomy .393 -.483
Env. Mastery .646 -.718
Personal Growth .454 -.602
Pos. Relations .433 -.524
Purpose in Life .640 -.716
Self-Acceptance .681 -.649
Satisfaction With Life .639 -.513
20
Valued Living Questionnaire
VQ success VQ - disruption
VLQ Importance .314 -.147
VLQ Consistency .462 -.312
VLQ Composite .475 -.287
21
Mindfulness Acceptance
VQ Success VQ - Disruption
Mindful Awareness (MAAS) .449 -.482
Acceptance (AAQ2) -.400 .701
22
Alison Christie Honours thesis
  • N 555
  • Age M 32.9, sd 14.87
  • 69.5 Female
  • Country
  • Australia 78
  • North America 15.2
  • Europe 4
  • Education
  • lt12 years schooling 5
  • Year 12 39
  • University 44
  • Other professional 7
  • Income
  • lt 20,000 19
  • 20,000-69,999 29
  • 70,000-129,999 28
  • gt 130,000 24

23
Christie cont..
  • Tested a 35-item version (2 items dropped did
    not load). EFA 2 factors accounted for 52.2
    variance

(n553) VQ Success VQ - Disruption
CPVI (Mean Importance) .209 .355
CPVI (Mean success) .421 .597
CPVI (Mean diff Import-succ) -.283 -.352
All significant p lt .001
24
Christie cont..
  • Tested a 35-item version (2 items dropped did
    not load). EFA 2 factors accounted for 52.2
    variance

(n553) VQ Success VQ - Disruption
Core value 1 Importance (PVQ) .167 .285
Core value 1 Success PVQ) .342 .506
All significant p lt .001
25
Preliminary sensitivity to change - Dewar
  • N24 government department workers friends
    attending an ACT for the general public pilot
    5-session program
  • VQ was a 12-item verson (top 3 loading items of
    an early 4-factor PCA) summed (with reverse coded
    items reversed)

(n24) M Sd
VQ Baseline 43.75 8.17
VQ Post-test 46.79 6.42 t(23) -2.2, p .038
MAAS Baseline 59.00 9.68
MAAS Post-test 63.38 9.60 t(23) -2.15, p .042
26
Summary of Valuing Questionnaire Findings
  • General (rather than domain-specific) values
    measure
  • Captures two facets of valuing (r -.516)
  • Factors are internally reliable
  • Items generated in consultation with ACT experts
    and literature
  • Convergent Validity demonstrated with established
    ACT Non-ACT measures, although is VQ
    functioning as mood measure in current form or is
    it that existing ACT Values measures are
    problematic?

27
How should a valuing questionnaire be validated?
Future work
  • ?Test more behavioural item version
  • Comparing questionnaire responses to other means
    of capturing valued behaviour (e.g., diaries,
    EMA)
  • Correlation between Valuing Questionnaire
    responses and size of domain-specific
    values-behaviour correlations
  • Developing norms for clinical and high-achieving/
    successful populations
  • Sensitivity to change in general to
    values-focused interventions
  • AND OF COURSE FINALISING THE STATISTICAL ANALYSES
    ON THE CURRENT DATA SET

28
Qualities of values
  • Common across values definitions outside ACT
  • concepts or beliefs
  • guide selection or evaluation of behaviour,
    policies, people, and events
  • transcend specific actions and situations
  • are less numerous and more central to personality
    than are attitudes
  • ordered by importance relative to one another
  • (Schwartz and Bilsky (1987) cf. Verkasalo et.,
    2009, p.780).

29
Acts emphasis on values
  • All ACT techniques are eventually subordinated
    to helping the client live in accord with his or
    her chosen values.
  • (Hayes et al.,1999, p.205)

30
ACTs emphasis on values
  • In ACT, we are relatively uninterested in
    helping the client get in touch with feelings,
    for feelings sake. There is nothing life
    enhancing about wallowing in ones own emotional
    soup. The reason for teaching clients to detach
    from hot events, to experience such events from
    the self-as-context, to let go of the struggle
    for emotional control is that private experiences
    function as barriers to valued actions.
  • (Strosahl et al., 2004)

31
Primary outcome measures in ACT studies
17 studies 8 measure distress/symptoms 2
measure willingness, 4 measure problem
behaviours, 3 objective/indirect measures of
problem behaviour. 0 directly measure changes in
valued living.
32
Use of values measures in ACT studies since Hayes
et al (2006)
  • Bricker et al (2010) telephone-delivered ACT
    smoking Intent-to quit smoking cessation. No
    values measures
  • Hayes et al (2010) acceptance-based behaviour
    therapy for GAD VLQ, What percentage of the
    time did you feel you were spending time on the
    things that are important to you? (0-100)
  • time spent in things important 48.31 ? 71.55
    over therapy
  • Valued action was not a significant predictor of
    quality of life after acceptance controlled
  • Hernandez-Lopez et al (2009) ACT v CBT smoking.
    No values measures
  • Johnson et al (2010) ACT self-help for chronic
    pain (n14)
  • Chronic Pain Values Inventory discrepancy
    between importance and success across various
    life domains
  • Both ACT and control group reduced
    values-discrepancy scores over time, no
    differences
  • Lillis et al (2009) 1-day mindfulness
    acceptance workshop for obesity. Used
    weight-related quality of life measure (ORWELL).
    3-mo FU better QOL for intervention group.

33
Use of values measures in ACT studies since Hayes
et al (2006)
  • Lungdren et (2008) n18 RA ACT v yoga for
    drug-refractory epilepsy. Used SWLS WHO-QOL
    (both groups improved equally on these measures)
  • Wicksell et al (2009) ACT v TAU chronic pain
    whiplash. Improvements in SWLS
  • Dalrymple Herbert (2007) n19 uncontrolled ACT
    social anxiety. Used VLQ (importance-consistency
    discrepancies) QOLI, both improved over time.
  • Forman et (2007) 101 Randomly assigned ACT v CBT.
    Both groups improved on SWLS, QOLI
  • Forman et (2007) acceptance v control-based
    strategies coping with food cravings. No values
    measures
  • Gregg et (2007) RCT Education ACT v Education.
    No values measures
  • Lappalainen et (2007) CBT and ACT in trainees. No
    values measures
  • Lungdren et (2008) mediators of ACT on epilepsy
    in n28 South Africans. Values attainment and
    persistence in face of barriers (measured by
    BullsEye) correlated with seizures, SWLS,
    WHO-QOL, wellbeing (magnitude .61 - .73)
  • Luoma et (2008) 6-hour group workshop for
    reducing self-stigma for people in addiction Tx.
    Used Quality of Life Scale but no values specific
    measures.

34
Definitions of values
  • Inside ACT
  • special class of reinforcers that are verbally
    constructed, dynamic, ongoing patterns of
    activity for which the predominant reinforcer is
    intrinsic in the valued behavioural pattern
    itself (Wilson Sandoz, 2008, p. 92)
  • Outside ACT
  • trans-situational goals that serve as guiding
    principles in the life of a person or group (cf.
    Verkasalo et., 2009, p.780)

35
Existing values measures
  • Values In Action (VIA)
  • Designed to measures 24 character strengths
    (e.g., creativity, vitality, kindness)
  • Individual rates agreement with statements
    describing behaviour representative of strength
    (e.g., am able to come up with new and different
    ideas) A very much like me E very much
    unlike me
  • High item numbers (e.g., 213-item version used by
    MacDonald et al, 2008)
  • Trait-like in standard form encourages
    personality assessment

36
Existing values measures
  • Valued Living Questionnaire (VLQ)
  • (Wilson et al., 2010)
  • Individual rates each of 10 valued domains 1-10
    for Importance and how consistently has lived
    according to how much they value the domain
  • Family relations
  • Marriage/couples/intimate relations
  • Parenting
  • Friendships/social
  • Employment
  • Education/training
  • Recreation
  • Spirituality
  • Citizenship/Community Life
  • Physical Well-being

37
Existing values measures
  • Bulls eye (Lungdren et al, 2005)
  • Individual places x to represent how consistent
    his/her actions are to his/her valued direction
  • Distance from bulls eye discrepancy in valued
    living
  • Final Bullseye psychological barriers to valued
    living. Individual places X representing
    persistence in pursuing values in face of
    barriers
  • Test-retest reliability r .86
  • Mediation of follow-up changes in seizures,
    personal wellbeing from ACT for epilepsy
    (Lungdren et al., 2008)

38
VLQ
  • (Wilson et al., 2010)
  • Validation with n338 undergraduates and Butcher
    Treatment Planning Inventory
  • Importance range limited mean ratings from 7.43
    9.46
  • Importance-consistency product normally
    distributed
  • One factor accounts for 35 variance item-factor
    loadings ranged .39 - .65.
  • Internal consistency importance a .77 and
    consistency a .75 interpretation needs
    validation.

39
VLQ
  • (Wilson et al., 2010)
  • Consistency subscale correlation with time on
    things that are important to you .4 (Hayes et,
    2010)
  • Very low correlation with AAQ r -.14
  • Correlation with MCSD r .25
  • ?VLQ consistency wording confusing when
    individuals rate domain low importance

40
CPVI
  • McCracken Yang, 2006
  • 6 domains (family, intimate relations, friends,
    work, health, growth learning)
  • Rate importance 0 (not at all) - 5 (extremely
    important)
  • Rate success 0(not at all) 5 (extremely
    successful)
  • Importance-success discrepancies unrelated to
    pain intensity
  • a .82 (success, discrepancy)

41
CPVI
  • CPVI cont..
  • Discrepancy score is sensitive to change
    (Johnston et al., 2010)
  • Moderate relations to general health (SF-36)
    .36-.53 unique variance after Acceptance
    mindfulness in 7/8 SF-36 scales (McCracken
    Vellerman, 2010)
  • Prospectively predict pain-related anxiety and
    impairment (Vowles McCracken, 2008)

42
CPVI
  • McCracken Keogh (2009)

43
Survey of Life Principles
  • (see Ciarrochi Bailey, 2008)
  • 52 items representing 10 universal values cluster
    of Schwartz
  • Each rated 1-9 for importance, pressure to hold
    1-5 putting into practice success in
    implementing.
  • Norms for university students for Importance,
    Pressure, Success, Activity for each item.

44
Personal Values Questionnaire (PVQ)
  • (Blackledge et al)
  • 9 values domains (full version) 3 value domains
    (family, couple relationships, friendships)
  • Individual writes down their value statement in
    each domain and then rates on 1-5 scale
  • Importance
  • Commitment to living the value
  • Desire to improve progress
  • Success in living the value in last 10 weeks
  • Social pressure to hold value
  • Guilt/shame if value was not important
  • Importance free of social pressure
  • Extent the value makes life meaningful
  • Experience fun and enjoyment when living
    consistently with value
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