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Developing the Unconditional Acceptance Questionnaire 445

Journal of Cognitive and Behavioral Psychotherapies,

Vol. 13, No. 2a, November 2013, 445-464.

PHILOSOPHICAL VERSUS PSYCHOLOGICAL

UNCONDITIONAL ACCEPTANCE:

IMPLICATIONS FOR CONSTRUCTING THE

UNCONDITIONAL ACCEPTANCE QUESTIONNAIRE Daniel DAVID

*1,2, Carmen D. COTEȚ1

, Aurora SZENTAGOTAI1,

James McMAHON3, Raymond DIGIUSEPPE

4

1Babeş–Bolyai University, Cluj-Napoca, Romania

2Icahn School of Medicine at Mount Sinai, New York, USA

3Albert Ellis Institute, New York, USA

4St. John’s University, New York, USA

Abstract

Unconditional acceptance (i.e., of self, others, and/or life) represents the

rational counterpart of the irrational belief of global evaluation, a key

construct of rational emotive behavior therapy (REBT). As relating the

“self”, the concept of self-esteem can refer to global self-esteem (i.e., global

evaluation of the self-like “I am a worthless person.”) and/or to specific

self-esteem relating specific domain evaluation of the self (e.g., “I am a bad

mother.”). In this study, we propose a new delineation between

philosophical unconditional acceptance and psychological unconditional

acceptance. While philosophical self-acceptance represents a counterpart to

global self-esteem, psychological self-acceptance represents the rational

variant of specific self-esteem. However, up to now this distinction has not

been made explicit and studied accordingly. We addressed this problem by

reporting the initial development and psychometric properties of the

Unconditional Acceptance Questionnaire (UAQ), a scale measuring

unconditional acceptance of the self, others, and life and differentiating

between psychological acceptance and philosophical acceptance. The UAQ

emerged as a valid candidate for measuring unconditional acceptance as a

rational secondary appraisal mechanism. Theoretical and practical

implications are discussed along with suggestions for future studies to

develop and test the new proposed constructs and the new questionnaire.

Keywords: self, unconditional acceptance, mental health, rational emotive

behavior therapy, questionnaire, philosophical unconditional acceptance,

psychological unconditional acceptance

*Correspondence concerning this article should be addressed to:

E-mail: [email protected]

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D. David, C. D. Coteţ, A. Szentagotai, J. McMahon, R. DiGiuseppe 446

Introduction

The concept of “self” generally refers to a collection of explicit

knowledge concerning one’s identity, as something separate from other selves

and/or the environment. It is a multi-dimensional concept, strongly related to

mental health and psychological disorders (e.g., Costa & McCrae, 1996). The

following (sub) concepts are typically related to the more general concept of

“self”: self-esteem, which refers to the general belief of self-worth and/or self-

value; self-efficacy, which refers to the belief in one’s capacity to perform various

tasks; self-confidence referring to beliefs in one’s personal worth and probability

to succeed; and self-concept referring to the organized structure of knowledge

about one’s self (see for details Bandura, 1997; Franken, 1994; Purkey, 1988).

Thus, no matter how we conceptualize the self, it often involves an

evaluative/rating component. This evaluative-rating component of the self is a key

part of the self–esteem (Rosenberg, Schooler, Schoenbach, & Rosenberg, 1995).

The concept of self-esteem represents a multidimensional construct, one of the

most investigated in the mental health field. Indeed, it can refer to global self-

esteem (i.e., global evaluation of the self like “I am a worthless person.”) – more

related to mental health – and/or specific self-esteem related to domain-specific

evaluation of the self (e.g., “I am a bad mother.”) – more related to behaviors

(Rosenberg et al., 1995). A well-known measure of global self-esteem is

Rosenberg’s Self-Esteem Scale, although different measures of specific

self-esteem also exist (see Rosenberg, 1965; Rosenberg et al., 1995).

If the evaluation of the self, whether it is in the form of global self-esteem

and/or specific self-esteem, falls in the low range (e.g., low self-esteem), it is

likely we will experience various psychological problems (see Chamberlain &

Haaga, 2001; 2001a; Rosenberg et al., 1995). These findings apparently support

the development of programs aiming to enhance various self-related components

(e.g., see the case for self-esteem enhancement programs in Dawes, 1994).

However, a high level of self-esteem is also associated with various psychological

problems (e.g., mania, perfectionism, vulnerability to criticisms, high

aggressiveness etc.) and/or could even generate cognitive vulnerability (see

Chamberlain & Haaga, 2001; 2001a; Dawes, 1994; Ellis, 1994). Indeed, both

global (e.g., “I am a wonderful person.”) and specific self-esteem (e.g., “I am a

wonderful mother.”) involve a rating component based on overgeneralization.

Due to the irrational overgeneralization process involved in global and/or specific

self-esteem, we learn to evaluate ourselves positively (i.e., positive self-esteem) in

positive situations (e.g., when we are succeeding) and negatively (i.e., negative

self-esteem) in negative situations (e.g., when we perform badly). Therefore, even

if we have a positive rating of our self or our specific role that leads to positive

global and/or specific self-esteem that supports positive feelings, this positive

rating presents a cognitive vulnerability factor when we face negative situations.

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First, in this paradigm, both global and specific self-esteem are cognitive

vulnerability factors because of the overgeneralization process they involve.

Second, even when self-esteem is positive we could not establish a point up to

which we can increase self-esteem and expect no negative consequences. For

example, grandiosity, even when it supports global positive self-esteem is often

associated to negative consequences. However, people hold no such critical point

to identify when they are globally or specifically good, and it is difficult, if not

impossible, to establish such a cut-off point. Summarizing, the concept of self-

esteem and the self-esteem enhancing programs should be critically analyzed by

the mental health field (see Dawes, 1994; Ellis, 1994).

A potential alternative solution

Rational Emotive Behavior Therapy (REBT; Ellis, 1962; 1994), which is

the original foundational approach of cognitive-behavioral therapy (CBT), states

that an individuals’ emotions related to certain activating life events are largely

mediated by the beliefs that one holds about these events. If their beliefs are

rational, their emotions will be functional or adaptive. On the other hand if their

beliefs are irrational, their emotions will be dysfunctional or maladaptive.

Irrational beliefs pertain to one of four irrational/rational categories: (1)

demandingness/rigid thinking, (2) awfulizing/catastrophizing, (3) frustration

intolerance, and (4) global evaluation (of self, others, or life). Demandingness is a

primary irrational process, but not a proximal one; indeed, demandingness is

followed by the secondary irrational beliefs of awfulizing/catastrophizing,

frustration intolerance, and global evaluation, which are more proximal causes of

dysfunctional feelings and psychopathology (see also David, 2003). The

alternative rational beliefs are: (1) flexible and motivational preferences; (2)

nuanced evaluation of badness; (3) frustration tolerance; and (4) unconditional

acceptance (of self, others, life) (see for details David, 2003; David, Lynn, &

Ellis, 2010; Dryden, David, & Ellis, 2010). Thus, a key axis of the

irrational/rational area is represented by the global evaluation versus

unconditional acceptance distinction.

In this context, the REBT solution to the problem of self-rating in self-

esteem is a pragmatic one, namely to work towards unconditional self-acceptance

(USA), meaning that “…the individual fully and unconditionally accepts himself

whether or not he behaves intelligently, correctly, or competently and whether or

not other people approve, respect, or love him…” (Ellis, 1977, p. 101). Thus,

REBT proposes an “intellectual mutation” in the way we understand the role of

the “self” in health and illness. Based on the REBT argument we should avoid the

evaluation of self. The main concern is related to the global evaluation of the self.

As concerning specific self-esteem (i.e., specific domain/role-relating evaluations

of the self), things are less clear theoretically, methodologically, and practically.

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Indeed, the hypothesis that USA is associated with mental health has been

a central aspect of REBT theory for decades (Ellis, 1994), and related views have

long been espoused by, among others including Carl Rogers. Yet this idea has

rarely been tested empirically. Many outcome studies of the efficacy of REBT as

a treatment have been conducted (see Engels, Garnefski, & Diekstra, 1993), but

they have not tested whether increased self-acceptance mediates any favorable

impact of REBT (Haaga & Davison, 1993).

Despite the centrality of USA in the REBT theory, to date we have

identified only two studies that investigated this conceptual mutation/change

(Chamberlain & Haaga, 2001; 2001a) by comparing unconditional self-

acceptance (USAQ) to self-esteem in mental health. However, these two studies

have the following limitations: (1) the instruments used to measure USA were

contaminated with self-esteem items, and thus (2) the construct of unconditional

acceptance was not theoretically consistent with the REBT theory.

We believe the unconditional self-acceptance that has been proposed as

an alternative to the problem of self-esteem can be understood in both a

philosophical or psychological version (see also David et al., 2010).

The philosophical (self) acceptance approach (e.g., “I do not evaluate

myself and I accept myself unconditionally and try to improve my bad

behaviors.”) is an antidote to global self-esteem (e.g., “I am worthless.”). It posits

that people are better off if they make no evaluation of the self whatsoever (i.e.,

based on our performance and/or what others say and think about us).

Philosophical self-acceptance involves more generalized global beliefs that all

self-evaluations are over generalizations. Indeed, any evaluation of the self, be it

global (e.g., "I am worthless.”) and/or specific (e.g., “I am a bad mother.”),

involves an irrational process of overgeneralization that is best avoided. To be

logically consistent and avoid overgeneralization, we evaluate only our behaviors

(see also the above citation in Ellis, 1977). This type of unconditional acceptance

is believed to be the elegant or philosophical solution to global evaluation in the

REBT literature (DiGiuseppe, Doyle, Dryden & Backx, 2014; Ellis, 2013). It

remains uncertain, however, whether this approach can be as easily understood,

and indeed accepted by the public and psychotherapy. Indeed, avoiding

evaluations relating to the self could come unnatural to most people because of

the natural human tendency to categorize things, including categorization based

on the evaluation of the self, be it global or specific. This human tendency could

make the psychotherapy process difficult.

Psychological (self) acceptance (e.g., “Although I am a bad mother, I do

not evaluate myself and I accept my whole self unconditionally and even work

toward improving my role as a mother.”) is conceptualized here as an antidote to

specific self-esteem (e.g., “I am a bad mother.”). Psychological self-acceptance is

defined as an affirmation of human worth despite a deficit in character or failure

to perform a desired role. It posits that we are better off avoiding all evaluations

of the global self, based on the role/domain performance; however, we can use

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evaluations of specific behaviors, and specific aspects of the self (e.g., specific

domains/roles relating moral/character traits, intellectual traits, and/or physical

traits). Thus, as compared to philosophical acceptance, psychological acceptance

is more permissive and inclusive. It acknowledges faults in one’s character (or,

like philosophical acceptance, errors in behavior), but asserts that such are not the

criteria for self–worth. For example, evaluating your self-domain specifically

(e.g., “bad mother”), typically involves an irrational evaluative component of the

self (i.e., overgeneralization) and thus, it would be incompatible with

philosophical acceptance, in its elegant sense. However, for psychological

acceptance this domain-specific evaluative component is more permissive and by

starting to accept it, we will learn to avoid the general evaluation of the self (e.g.,

“Therefore, I am a totally bad person.”).

Until now, these nuances and distinctions have not been clear in the

REBT theory and research. In some publications/scales, philosophical acceptance

has been emphasized, in other publications/scales psychological acceptance has

been emphasized, and in still other publications/scales an undifferentiated

combination of them has appeared. We would say that even if the REBT theory,

research, and practice have not generally ignored and/or blocked the

psychological acceptance concept (even if not called this way), REBT portrayed

mainly the philosophical acceptance concept. Therefore, theoretically speaking, in

REBT theory psychological acceptance is often inferred implicitly (see the

definition of unconditional self-acceptance of Ellis, 1977), and rarely presented

explicitly. Indeed, the best support for this argument is that fact that the classical

scales measuring unconditional acceptance, whether they are subscales of more

general rational and irrational beliefs scales (see the ABS-II- DiGiuseppe, Robin,

Leaf, & Gormon, 1989; the GABS-SV-Lidner, Kirkby, Wertheim, & Birch, 1999)

or independent scales of unconditional self-acceptance (see the USAQ-

Chamberlain & Haaga, 2001; 2001a), are based only on philosophical acceptance

items! Because the theoretical distinctions have not been consistent and clear, it

has been difficult to explore their methodological and practical implications.

As we mentioned above, from a practical point of view, philosophical

acceptance might be more difficult to implement in the therapy process, because

of the natural human tendency to categorize things, including categorization based

on the evaluation of the self, be it globally (e.g., “I am a bad person.”) and/or

specific (e.g., “I am a bad mother.”). Thus, if elegant REBT would be difficult to

apply, then a psychological acceptance strategy might be the better clinical

strategy to implement (i.e., inelegant REBT).

From a methodological research point of view, we have no scale to date

that separately measures both philosophical and psychological acceptance.

Therefore, we do not know whether people can discriminate between them or if

they have a similar or a different impact on various clinical outcomes. Thus, even

if people can distinguish them, we have no research basis to recommend one

strategy over the other to be used first in clinical practice. Moreover, we cannot

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relate these antidotes (i.e., philosophical and/or psychological acceptance)

proposed by REBT to the more elaborated constructs of global versus specific

self-esteem.

Up until now, we have focused on the theoretical discussion of self-

esteem and self-acceptance. However, as we mentioned above, Ellis’ theory also

identifies the relationship of the acceptance of others and the acceptance of the

world. According to the REBT theory, global evaluations of other people would

lead to the disturbed emotions of clinical anger and contempt (DiGiuseppe &

Tafrate, 2007) and global evaluations of life (i.e., word/universe) could lead to a

wide range of disturbed emotions. The counter rational thoughts concerning

acceptance of others and the universe would also apply to accepting other people

and accepting the state of the universe and the conditions of our lives. REBT

theory posits that accepting others and the state of the universe when each is

suboptimal and against one’s wises leads to negative albeit healthy, adaptive

negative emotions.

Acceptance of others can also be divided between philosophical

acceptance of others and the psychological acceptance of others. Philosophical

acceptance of others is defined as a generalized global belief that all human

evaluations are over generalizations and that all humans have equal worth.

Psychological other-acceptance is defined as an affirmation of the human worth

of another person despite a deficit in his or her character or a failure by him/her to

perform a desired behavior or role.

Life acceptance involves rational statements concerning the way the

world is despite our desire that it be different. Life acceptance also can be divided

between philosophical life acceptance and the psychological life acceptance.

Philosophical life acceptance is defined as a generalized global belief that life, the

world, and the universe aren’t and do not have to be constructed in line with our

desires. Psychological life acceptance is defined as an affirmation that the

universe is as it is regardless of our wishes that it be reconstructed to include

aspect that fit one’s desires and recognizes that a deficit or a failure to meet one’s

desires exist.

Overview of this study

This study reports the initial development and psychometric properties of

the Unconditional Acceptance Questionnaire (UAQ), a scale intended to measure

unconditional acceptance of self, others, and life, encompassing the two types of

acceptance previously discussed: psychological acceptance and philosophical

acceptance. More precisely, the scale consists of 35 items organized on various

axes: (1) psychological vs. philosophical axis; (2) moral/character traits vs.

intellectual traits vs. physical characteristics; (3) self vs. others vs. life; and (4)

acceptance vs. non-acceptance. There are 15 self-related items, assessing

acceptance of: personality traits (5 items), intellectual abilities (5 items), and

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physical appearance (5 items). Another 15 items are other-related, evaluating

acceptance of others’: personality traits (5 items) intellectual abilities (5 items),

and physical appearance (5 items). The remaining 5 items of the scale refer to life

acceptance.

The first axis as discussed above includes the psychological or

philosophical nature of the item. The second axis tries to capture the most typical

and important evaluations people make, namely about their and others’ moral

traits, intellectual traits, and physical traits; these domains were suggested by the

review of the literature (see Rosenberg et al., 2005) and by a group of clinical

specialists, supervisors in REBT. The third axis is formulated based on the REBT

theory (see Ellis, 1994), namely that unconditional acceptance can refer to self

(i.e., unconditional self-acceptance), others (i.e., unconditional other acceptance),

and/or life (i.e., unconditional life acceptance). The forth axis is related to a

methodological distinction; to be sure that we capture the profound meaning of

the constructs, we use both direct and reversed items measuring the same

construct.

Hypotheses/predictions

First, we expected unconditional self-acceptance to correlate with

previous, well-established measures of self-acceptance. As self-acceptance

represents a part of unconditional acceptance, as defined throughout this article,

we expect the same relationship in the case of unconditional acceptance.

Second, we expected unconditional self-acceptance to have an inverse

correlation with self-esteem, as it is a distinct and an opposed concept to

unconditional self-acceptance; indeed, self-esteem, whether high or low, provides

an irrational global evaluation of the self (i.e., overgeneralization), while

unconditional self-acceptance provides a rational counterpart (Ellis, 1977). As

self-acceptance represents a part of unconditional acceptance, as defined

throughout this article, we expect the same relationship in the case of

unconditional acceptance.

Third, unconditional acceptance should have an inverse correlation with

distress, as REBT states that a rational style of thinking fosters healthy emotions

and not distress (Ellis & Harper, 1997); indeed, unconditional self-acceptance – as

part of unconditional acceptance - has been shown to be a protective factor

against emotional distress (Chamberlain & Haaga, 2001; 2001a).

Forth, there should be an inverse correlation between unconditional

acceptance and other irrational types of thinking (e.g., automatic thoughts,

irrational beliefs).

Finally, we will investigate the relationship between unconditional

acceptance and positive affect; we have no specific predictions here, as

unconditional acceptance aims to generate functional feelings, rather than positive

feelings.

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Method

Participants

The participants (N = 591, out of which 542 were women) were healthy

student volunteers who completed the measures in order to receive course credit.

Their mean age was M = 27.17, SD = 7.26. We found no differences between

men and women in any of the analyses of this study (see below).

Design and Procedure

We have used a correlational, cross-sectional design, to determine the

reliability and validity of the present scale. Participants initially consented to the

online study and provided demographic information. Afterwards, they completed

the online measures, starting with the newly developed Unconditional Acceptance

Questionnaire (UAQ) scale and followed by a set of 5 other questionnaires,

described below.

Measures

Unconditional Acceptance Questionnaire (UAQ). The scale we have

developed is a measure of unconditional acceptance. Participants were asked to

indicate the frequency to which they agree with a total of 35 statements regarding

acceptance of self (including moral traits, intellectual traits, and physical traits),

others (including moral traits, intellectual traits, and physical traits) and life, on a

7-point Likert. A total of 21 items are scored directly, targeting psychological

unconditional acceptance (e.g., “I know I have some negative personality traits,

but I accept myself just the way I am.”) and philosophical unconditional

acceptance (e.g. “I do not evaluate myself based on the way I look, but

unconditionally accept myself as a worthwhile human being.”), while another 14

items are reverse-scored, comprising psychological non-acceptance statements

(e.g., “I cannot accept people who are less smart than I am.”) and philosophical

non-acceptance (e.g., “When life is not the way I want it to be, I think life is

unfair.”). The scale provides a general unconditional acceptance (rationality)

score. The items appear in Appendix 1.

Unconditional Self-Acceptance Questionnaire (USAQ – Chamberlain &

Haaga, 2001). The USAQ measures unconditional acceptance of the self. The

scale was constructed based on Ellis’s idea of unconditional self-acceptance

(Ellis, 1977). It comprises 20 items measured on a 7-point Likert scale with

participants being asked how often they agree with statements describing either

conditional (reverse scored) or unconditional self-acceptance. A global

unconditional acceptance score can be computed from these items. Research on

the questionnaire indicates that it has good psychometric properties (Chamberlain

& Haaga, 2001, 2001a). Internal consistency for this sample was good, α = .86.

The Rosenberg Self-Esteem Scale (RSES – Rosenberg, 1965). The RSES

consists of 10 statements measuring self-esteem. Participants indicate the degree

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to which they believe the items represent them. Answers are given on a 4-point

Likert scale, and their sum represents a global measure of self-esteem. The RSES

has been shown to be reliable in terms of internal consistency and excellent

concurrent validity (Schmitt & Allik, 2005), as well as construct validity (Robins,

Hendin, & Trzesniewski, 2001). The RSES was validated on the Romanian

population (David, 2007).

Profile of Mood States (POMS; McNair, Lorr, & Droppleman, 1971). The

POMS is a measure of transient mood states, and consists of 47 items grouped

into 6 subscales (Tension-Anxiety, Vigor-Activity, Depression-Dejection,

Fatigue-Inertia, Anger-Hostility and Confusion-Bewilderment), and provides a

total distress score. Participants rate on a 5-point Likert scale the intensity of their

experience of emotion represented in each items in the present (ranging from “not

at all” to “very much”). The scale has high test-retest fidelity, has been used on a

variety of clinical and non-clinical populations, and has demonstrated good

criterion validity (DiLorenzo, Bovbjerg, Montgomery, Valdimarsdottir, &

Jacobsen, 1999; McNair, Lorr, & Droppleman, 1989). Internal consistency is

good for this sample, ranging from .82 to .95 on the 6 above-mentioned subscales.

We used both the total score for distress and the score of vigor-activity score as a

score for positive affect.

The Automatic Thoughts Questionnaire (ATQ – Hollon & Kendall, 1980).

The scale comprises 15 items containing irrational automatic thoughts, mainly

related to depression and distress. Subjects are required to state the frequency to

which they have been having these thoughts on a 5-point Likert scale (from

“never” to “almost always”). The ATQ has demonstrated high reliability and high

construct and criterion-related validity, both in clinical and non-clinical

population (Harrell & Ryon, 1983; Hollon & Kendall, 1980). The scale has been

adapted for the Romanian population (David, 2007) and has good psychometric

properties.

The General Attitudes and Beliefs Scale–Short Form (GABS-SF; Lindner,

Kirkby, Wertheim, & Birch, 1999). The GABS-sf is a measure of rational and

irrational attitudes and beliefs constructed based on Ellis’s notion of irrational

evaluative beliefs (Ellis, 1962). The scale consists of 26 items measured on a 5-

point Likert scale, offering specific rational and irrational subscale scores, as well

as a general irrationality score. Good psychometric properties have been reported

for this scale, as regards test-retest reliability and construct validity (Lindner, et

al., 1999). The GABS-sf has been adapted for the Romanian population and

presents good psychometric properties (David, 2007).

Results

We have assessed the present scale with regards to its validity and

reliability and results are presented below.

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Descriptive data

Descriptive data (means and standard deviations) regarding the

investigated variables are presented in Table 1.

Table 1. Descriptive statistics for the self-report scales – means and standard deviations.

N = 591 Minimum Maximum Mean Std. Deviation

UAQ 75 245 192.33 31.72

USAQ Total 42 140 96.38 18.10

RSES 17 36 25.78 2.56

POMS Total 8 167 59.23 31.94

ATQ 15 72 26.10 11.18

GABS-SF Total 22 92 41.18 15.75

Notes: UAQ = Unconditional Acceptance Questionnaire, USAQ = Unconditional Self-

Acceptance Scale, RSES = Rosenberg’s Self-Esteem Scale, POMS = Profile of Mood

States, ATQ = Automatic Thoughts Questionnaire, GABS-SF = General Attitudes and

Beliefs Scale – Short Form.

Exploratory factor analysis

We conducted a principal component analysis (PCA) on the 35 items of

the questionnaire, with an initial constraint of eigenvalues > 1 and an oblique

rotation (direct oblimin), accounting for the fact that we expect the underlying

factors to be related. The Kaiser–Meyer–Olkin measure attested sampling

adequacy, KMO = .94. Bartlett’s sphericity χ² (595) = 11579.85 was significant, p

< .001, showing that inter-item correlations fit the standards for conducting PCA.

Initial analyses determined six components with eigenvalues > 1, which in

combination explained 61.57% of the variance. However, the determinant of the

correlation matrix was 1.96*10-9, smaller than the required value, suggesting

multicollinearity. The scree plot presented 3 points of inflexion suggesting that a

1-factor, a 3-factor, or a 6-factor model could be taken into consideration.

Considering both these factors, we decided to retain a 1-factor model of the UAQ.

Factor loadings were appropriate, provided in Table 2.

Content validity

The items were elaborated based on the REBT theory, starting also from

the previous available scales mentioned above. After the authors generated the

items, each item was independently rated by three psychologists who had

completed training in REBT to the supervisory level. Items were included in the

UAQ only when all three supervisors agreed 100% that the items represent good

operationalization of the constructs.

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Table 2. Component Matrix of the UAQ factor loadings.

UAQ- Items Component

1

I do not evaluate myself based on the way I look, but unconditionally accept myself as a

worthwhile human being.

.768

I do not evaluate myself as a person based on my performance, but unconditionally accept

myself as a worthwhile human being.

.767

I do not evaluate others based on the good or bad things they do, but unconditionally accept

them as worthwhile human beings.

.747

I do not evaluate myself as a person regardless of the good or bad things that I do, but I

unconditionally accept myself as a worthwhile human being.

.720

I do not think I should evaluate my worth as a human being based on my performance. .690

I do not evaluate others based on their performance, but unconditionally accept them as

worthwhile human beings.

.688

It is normal to evaluate others based on their performance. .683

It is normal that I evaluate myself based on the way I look. .666

I do not think I should evaluate others based on their performance. .658

I think it is normal that I evaluate myself as a person based on my performance. .653

Even if the others have negative personality traits, I can accept them the way they are. .643

I think it is normal to evaluate the others as worthwhile or worthless human beings based on

the good or bad things that they do.

.605

It is normal to evaluate others based on the way they look. .601

I do not evaluate others based on the way they look, but I unconditionally accept them as


.599

I do not think I should evaluate others as worthwhile or worthless human beings based on the

good or bad things they do.

.598

It is normal that I evaluate myself as a person based on the good or bad things that I do. .597

I know I am not as smart as others, but I accept myself, and feel good about myself just the

way I am.

.596

I do not think I should evaluate myself based on the way I look. .596

Even if life is unfair, I can accept it just the way it is. .596

I cannot accept the fact that I am less attractive than others. .587

I cannot accept the fact that I am not as smart as others. .584

I do not think I should evaluate myself as a person based on the good or bad things that I do. .580

Even if someone is not attractive, I can accept him/her as worthwhile human being. .563

I do not think I should evaluate others based on the way they look. .559

When life is not the way I want it be, I think life is unfair. .558

Even if the others are less smart than I am, I accept them as worthwhile human beings. .551

I find it hard to accept that life is unfair. .537

I know I have some negative personality traits, but I accept myself just the way I am. .525

I know I am less attractive than others, but I accept myself and feel good about myself just the

way I am.

.520

I cannot accept my negative personality traits. .517

I cannot accept people who are less smart than I am. .511

I cannot accept people who have negative personality traits. .510

Life cannot be rated as good/fair or bad/unfair; life is the way it is, and it should be accepted as

such.

.485

I cannot accept people who are not attractive. .464

I do not rate life as good/fair or bad/unfair, but unconditionally accept it just the way it is. .361

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Criterion Validity

Concurrent validity

Concurrent validity was assessed by computing a correlation between the

scores obtained at the UAQ and an existing well-established measure of

unconditional self-acceptance, the USAQ. A high correlation was obtained,

r(589) = .78, p < .001. This means in other words that the higher the

unconditional acceptance across all axes of the UAQ, the higher the unconditional

self-acceptance of the individual on the USAQ, in accordance to our hypothesis.

Construct validity

Convergent and divergent validity

Assessment of convergent validity was conducted by computing

correlations between the unconditional acceptance measure and measures of other

related constructs: self-esteem, mood states, negative automatic thoughts, and

general irrational attitudes and beliefs (see Table 3).

Table 3. Correlations between unconditional acceptance and the other related constructs.

N = 591 1 2 3 4 5 6

1. Unconditional Acceptance Questionnaire 1 -.72**

-.48**

-.52**

-.18**

.26**

2. General Attitudes and Beliefs Scale 1 .54**

.65**

.26**

-.32**

3. Profile of Mood States 1 .78**

.23**

-.73**

4. Automatic Thoughts Questionnaire 1 .29**

-.53**

5. Rosenberg’s Self-Esteem Scale 1 -.02**

6. Vigour/activity (POMS) 1

**. Correlation is significant at the 0.01 level (1-tailed).

According to our findings, the UAQ scores demonstrated a negative

correlation to self-esteem, r(589) = -.18, p < .001. This goes in line with the

REBT theory, which states that self-esteem is not only a distinct concept from

self-acceptance, but they are in opposition. For example, while self-esteem

provides an evaluation of the self, unconditional self-acceptance promotes

acceptance without evaluation, irrespective of the person’s intelligence or

behavior (Ellis, 1977).

UAQ further presented a negative correlation with general emotional

distress as measured by the POMS, r(589) = -.48, p < .001. This means that the

higher unconditional acceptance one possesses, the lower their distress.

With regards to negative automatic thoughts, UAQ presents a moderate

inverse correlation, r(589) = -.52, p < .001. This translates into a lower frequency

of negative automatic thoughts as the frequency of unconditional acceptance

thoughts increases.

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Concerning general irrational attitudes and beliefs, UAQ shows a high

inverse correlation, r(589) = -.72, p < .001, as expected. As total irrationality

increases, rational and flexible unconditional acceptance beliefs decrease, and

vice versa.

Finally we found a positive correlation between unconditional acceptance

and positive affect, r(589) = .26, p < .001.

Reliability

Internal consistency

We have computed the internal consistency index (Cronbach’s α) in order

to assess the reliability of the scale. The index showed an excellent internal

consistency for the whole scale (α = .95).

Additional analyses

In an exploratory manner, we reran the PCA analysis with a constraint of

2 factors, in order to investigate whether unconditional philosophical and

psychological acceptance diverge as separate factors. After eliminating

ambiguous items, these two factors did emerge, comprising items 2, 3, 5, 6, 7, 14,

16, 17, 19, 20, 21, 33, 34 for the unconditional psychological acceptance factor

and items 10, 11, 12, 13, 15, 22, 23, 28, 30, 32, 35 for the unconditional

philosophical acceptance factor.

Upon closer inspection, we found a significant difference between the

associations of these two factors with general rational and irrational beliefs, z = -

3.37, p < .01 (Table 4). In other words, psychological unconditional acceptance

has a significantly higher inverse correlation than philosophical unconditional

acceptance with total score of irrational beliefs, as measured by GABS. This

might imply that the more psychologically acceptant one has, the less irrational,

and that philosophical acceptance is a little more difficult to grasp. This

conclusion warrants caution nonetheless, as factors themselves were still strongly

positively associated, r(598) = .63, p < .01 (1-tailed).

Table 4. Correlations between the two psychological unconditional acceptance factors

and general rational and irrational beliefs.

N = 591 Psychological

acceptance

Philosophical

acceptance

Z p

(2-tailed)

General Attitudes and

Beliefs Scale

-0.68** -0.56** -3.37 .00

** Correlation is significant at the 0.01 level (1-tailed)

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Discussion and conclusions

From a theoretical point of view, there is a clear distinction between

philosophical unconditional acceptance and psychological unconditional

acceptance. While philosophical unconditional acceptance is an antidote to the

global self-esteem, psychological acceptance should be seen as an antidote to the

specific self-esteem. This theoretical distinction has important practical

implications.

From a practical point of view, philosophical unconditional acceptance is

more difficult to implement. However, if it is more useful than psychological

unconditional acceptance, it should be the first line of intervention. In the case

that both philosophical and psychological unconditional acceptance are equally

useful, then a primary line of intervention should be more related to the more

accessible approach.

Until now, it has been impossible to establish clinical guidelines for

whether to use philosophical and/or psychological unconditional acceptance

because there were no scales measuring them, and therefore, we could not

investigate the issue empirically. By constructing the UAQ, we methodologically

addressed this problem, with important theoretical and practical implications.

First, results of the factor analysis showed that participants failed to

distinguish phenomenologically between philosophical and psychological

unconditional acceptance items, as they loaded on only one factor. This was the

case even though the judges familiar with REBT could distinguish the items.

Indeed, although the scale was initially designed to have three scores (i.e.,

philosophical, psychological, and the global unconditional acceptance), based on

factorial analysis we retained only one factor. Thus a global unconditional

acceptance score resulting from summing philosophical and psychological

unconditional acceptance is computed. We had some additional analyses arguing

for a two factor solutions: psychological versus philosophical unconditional

acceptance. Although some interesting results emerged (i.e., total irrational score

of GABS was more strongly associated to psychological rather than philosophical

acceptance), future studies should explore this solution and its consequences.

Following the single factor solution, we found that in this form the scale

has very good psychometric properties. Let us analyze them as follows.

Previous measures of unconditional acceptance were either subscales in

more general measures of irrational/rational beliefs or independent measures. The

only available independent measure is USAQ (Chamberlain & Haaga, 2001;

2001a). The problems of the USAQ are that: (1) it focuses only on one component

of unconditional acceptance (i.e., self), ignoring the other two components (i.e.,

others, and life); and (2) it seems to be contaminated by self-esteem items (i.e., a

positive correlation between self-esteem measure and unconditional self-

acceptance was found), thus invalidating the theoretical consistency of the scale.

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The UAQ developed and tested here rectifies these limitations. Indeed, it

is focused on self, others, and life unconditional acceptance, independently of the

other irrational beliefs; this it is more comprehensive and focused compared to

other previous measures of unconditional acceptance. The results also showed

that although it correlated positively with USAQ (i.e. convergent validity), it

correlated negatively with the global measure of self-esteem, thus being

theoretical consistent and maybe the first measure of unconditional acceptance

that captured this important hypothesized REBT relationship. The fact that there

is a strong convergent validity (r = 0.78) argues that unconditional-self

acceptance (the only common component in both UAQ and USAQ) is an

important component in the overall construct of unconditional acceptance.

Moreover, its construct validity was supported, UAQ correlating negatively with

distress, automatic thoughts, and irrational beliefs. Finally, we found a positive

correlation between unconditional acceptance and positive affect. However, we

should remember that according to REBT, in negative situations rational beliefs

will generate functional negative feelings, while irrational beliefs will generate

dysfunctional negative feelings. In positive situation, rational beliefs will generate

functional positive feelings and irrational beliefs will generate dysfunctional

positive feelings (see David et al., 2010). Therefore, the relationship between

unconditional acceptance and positive affect should be immersed in this context

and thus, future studies should explore the relationship between functional and

dysfunctional feelings, be they positive and/or negative, and unconditional

acceptance, during positive and negative activating events.

Taking into account that the UAQ has good psychometric properties, it is

a short scale (35 items), and it is easy to complete, it could be the choice measure

of unconditional acceptance. If used in research, we think that a global score

would be the best choice. If used in the clinical practice, various subscales

resulting from combination the axes of (1) philosophical vs. psychological; (2)

self vs. other vs. life (3) moral/character traits vs. intellectual traits vs. physical

traits could become relevant for the clinical evaluation, intervention strategy, and

progress monitoring.

The study has several limitations. Although it used a very large sample,

the sample was not a clinical one. Moreover, the sample was young and women

dominated. Finally, the analyses were based on correlational design. Therefore,

the generalization of the results to general clinical population should be done with

caution. However, it should be mentioned that the level of distress was elevated,

thus a more correct description of the sample would be a subclinical distressed

sample (see for comparison Igna, 2012). Future studies should investigate the

stability and the generalizability of the results for various populations and

conditions, both in correlational/predictive and experimental designs. However,

before doing this programmatically, it was important to develop a rigorous scale

and this is what we have done here.

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Now that we have a more rigorous measure of the key REBT’s construct

of unconditional acceptance (e.g., that capture empirically for the first time the

inverse relationship to self-esteem), we can initiate more rigorous research and

discussions to understand the role of the concept of acceptance in REBT and other

third-wave CBTs. Let us briefly anticipate such potential developments.

First, acceptance is part of the primary mechanism of appraisal (see David

et al., 2010), as an alternative to demandingness/rigid thinking. For example, a

rigid inflexible thought could be formulated like this: “I must absolutely succeed

and cannot conceive otherwise.” A rational alternative could be formulated in

various ways. In the classical REBT style, this would become: “I would like to

succeed, but I not have to.” We suggested (see also David et al., 2010) that new

developments should be brought to classical REBT, based on cognitive science

and positive psychology. First, in the classical approach the acceptance is implicit

(i.e., “If I do not have to get it, then it means that I can accept it.”). Moreover, the

classical approach (i.e., “I do not have to”) may suggest a lack of clients’ values

consideration. Second, the classical approach might suggest a lack of motivation

(i.e., “I would like to succeed”). Third, the positive component is also implicit,

therapists working on it during the therapy process, once the client accepted the

rational counter part of the irrational belief. Therefore, in a multimodal and

integrative CBT we proposed (David et al., 2010) new versions of rational beliefs

including (1) flexible thinking, (2) motivational relevance, (3) explicit acceptance,

and (4) the explicit positive component (i.e., positive expectation/hope/optimism-

based component). In this new version, the rational belief would become: “I

would like to succeed, and I do my best to achieve it, but I accept that it might not

happen; if it does happen I can still find meaning/pleasure in life”. Future studies

should elaborate rigorous measures for this kind of acceptance to understand if its

impact is stronger than the classical one and how it is related to the acceptance

construct in other CBTs.

Second, acceptance is part of the secondary appraisal mechanism (see

David et al., 2010), meaning unconditional self, others, and life acceptance. The

relationships between this kind of acceptance and the previous one, also relating

the acceptance in other CBTs is now possible, based on this rigorous measure. For

example, unconditional self-acceptance seems to be the foundation for the “self-in

the context” concept in the Acceptance and Commitment Therapy (ACT – Hayes,

Strosahl, & Wilson, 1999), but there are no empirical investigations in this

direction.

Thus, acceptance in REBT can appear as a rational primary appraisal

mechanism, an alternative to demandingness (i.e., irrational primary appraisal

mechanism) and/or as a rational secondary appraisal mechanism, an alternative to

global evaluation (i.e., irrational secondary appraisal mechanism) (see David et

al., 2010). The relationship between them is important to be studied.

To conclude, the Unconditional Acceptance Questionnaire (UAQ)

showed robust psychometric properties and becomes a valid candidate for

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measuring unconditional acceptance as a secondary appraisal rational belief

promoting mental health. The scale however remains to be further tested and

refined. The nature of unconditional acceptance as a mechanism of change

remains as well to be investigated, and establishing its role as a protective factor

against distress warrants further inquiry, in relationship to various nuances

regarding the acceptance constructs in the REBT (i.e., flexible preferences) and/or

other CBTs.

ACKNOWLEDGEMENTS This research was supported by the Albert Ellis Institute (project awarded to David and

Szentagotai).

REFERENCES

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Appendix 1

Unconditional Acceptance Questionnaire

For each of the statements bellow, please indicate how often the statement is true in your case.

There are no right or wrong answers, so please respond honestly. Be sure to answer every item by

circling the appropriate number beside it.

Almost

always false

Usually

false

More often

false than

true

As often

true as

false

More often

true than

false

Usually

true

Almost

always true

1 2 3 4 5 6 7

1 When life is not the way I want it be, I think life is unfair. 1 2 3 4 5 6 7

2. I know I have some negative personality traits, but I accept

myself just the way I am.

1 2 3 4 5 6 7

3. I cannot accept people who are less smart than I am. 1 2 3 4 5 6 7

4. Life cannot be rated as good/fair or bad/unfair; life is the way

it is, and it should be accepted as such.

1 2 3 4 5 6 7

5. I cannot accept people who have negative personality traits. 1 2 3 4 5 6 7

6. I cannot accept my negative personality traits. 1 2 3 4 5 6 7

7. I cannot accept the fact that I am not as smart as others. 1 2 3 4 5 6 7

8 I do not evaluate others based on the way they look, but I

unconditionally accept them as worthwhile human beings.

1 2 3 4 5 6 7

9 I do not evaluate myself as a person regardless of the good or

bad things that I do, but I unconditionally accept myself as a


1 2 3 4 5 6 7

10. It is normal that I evaluate myself as a person based on the

good or bad things that I do.

1 2 3 4 5 6 7

11. I think it is normal that I evaluate myself as a person based on

my performance.

1 2 3 4 5 6 7

12. I do not think I should evaluate others as worthwhile or

worthless human beings based on the good or bad things they

do.

1 2 3 4 5 6 7

13. I think it is normal to evaluate the others as worthwhile or

worthless human beings based on the good or bad things that

they do.

1 2 3 4 5 6 7

14. I cannot accept people who are not attractive. 1 2 3 4 5 6 7

15. I do not think I should evaluate myself as a person based on

the good or bad things that I do.

1 2 3 4 5 6 7

16. I know I am less attractive than others, but I accept myself and

feel good about myself just the way I am.

1 2 3 4 5 6 7

17. Even if the others are less smart than I am, I accept them as


1 2 3 4 5 6 7

18. I do not evaluate others based on their performance, but

unconditionally accept them as worthwhile human beings.

1 2 3 4 5 6 7

19. Even if someone is not attractive, I can accept him/her as


1 2 3 4 5 6 7

20. It is normal to evaluate others based on the way they look. 1 2 3 4 5 6 7

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Almost

always false

Usually

false

More often

false than

true

As often

true as

false

More often

true that

false

Usually

true

Almost

always true

1 2 3 4 5 6 7

21. I know I am not as smart as others, but I accept myself, and

feel good about myself just the way I am.

1 2 3 4 5 6 7

22. I do not think I should evaluate others based on their

performance.

1 2 3 4 5 6 7

23. I do not think I should evaluate others based on the way they

look.

1 2 3 4 5 6 7

24. I do not evaluate myself based on the way I look, but

unconditionally accept myself as a worthwhile human being.

1 2 3 4 5 6 7

25. I do not evaluate myself as a person based on my

performance, but unconditionally accept myself as a


1 2 3 4 5 6 7

26. I do not evaluate others based on the good or bad things they

do, but unconditionally accept them as worthwhile human

beings.

1 2 3 4 5 6 7

27. I do not rate life as good/fair or bad/unfair, but

unconditionally accept it just the way it is.

1 2 3 4 5 6 7

28. It is normal that I evaluate myself based on the way I look. 1 2 3 4 5 6 7

29. I find it hard to accept that life is unfair. 1 2 3 4 5 6 7

30. It is normal to evaluate others based on their performance. 1 2 3 4 5 6 7

31. Even if life is unfair, I can accept it just the way it is. 1 2 3 4 5 6 7

32. I do not think I should evaluate my worth as a human being

based on my performance.

1 2 3 4 5 6 7

33. I cannot accept the fact that I am less attractive than others. 1 2 3 4 5 6 7

34. Even if the others have negative personality traits, I can accept

them the way they are.

1 2 3 4 5 6 7

35. I do not think I should evaluate myself based on the way I

look.

1 2 3 4 5 6 7

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