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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. COTE1, Aurora SZENTAGOTAI1,
James McMAHON3, Raymond DIGIUSEPPE4
1

BabeBolyai University, Cluj-Napoca, Romania


Icahn School of Medicine at Mount Sinai, New York, USA
3
Albert Ellis Institute, New York, USA
4
St. Johns 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: daniel.david@ubbcluj.ro
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Introduction
The concept of self generally refers to a collection of explicit
knowledge concerning ones 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 selfvalue; self-efficacy, which refers to the belief in ones capacity to perform various
tasks; self-confidence referring to beliefs in ones personal worth and probability
to succeed; and self-concept referring to the organized structure of knowledge
about ones 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 selfesteem (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 selfesteem (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
Rosenbergs 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 selfesteem 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 selfesteem 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 selfacceptance (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 ones character (or,
like philosophical acceptance, errors in behavior), but asserts that such are not the
criteria for selfworth. 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 USAQChamberlain & 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 selfesteem 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 ones 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 arent 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 ones desires and recognizes that a deficit or a failure to meet ones
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 Elliss 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, = .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 ScaleShort Form (GABS-SF; Lindner,
Kirkby, Wertheim, & Birch, 1999). The GABS-sf is a measure of rational and
irrational attitudes and beliefs constructed based on Elliss notion of irrational
evaluative beliefs (Ellis, 1962). The scale consists of 26 items measured on a 5point 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
UAQ
USAQ Total
RSES
POMS Total
ATQ
GABS-SF Total

Minimum
75
42
17
8
15
22

Maximum
245
140
36
167
72
92

Mean
192.33
96.38
25.78
59.23
26.10
41.18

Std. Deviation
31.72
18.10
2.56
31.94
11.18
15.75

Notes: UAQ = Unconditional Acceptance Questionnaire, USAQ = Unconditional SelfAcceptance Scale, RSES = Rosenbergs 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 KaiserMeyerOlkin measure attested sampling
adequacy, KMO = .94. Bartletts sphericity (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
I do not evaluate myself based on the way I look, but unconditionally accept myself as a
worthwhile human being.
I do not evaluate myself as a person based on my performance, but unconditionally accept
myself as a worthwhile human being.
I do not evaluate others based on the good or bad things they do, but unconditionally accept
them as worthwhile human beings.
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.
I do not think I should evaluate my worth as a human being based on my performance.
I do not evaluate others based on their performance, but unconditionally accept them as
worthwhile human beings.
It is normal to evaluate others based on their performance.
It is normal that I evaluate myself based on the way I look.
I do not think I should evaluate others based on their performance.
I think it is normal that I evaluate myself as a person based on my performance.
Even if the others have negative personality traits, I can accept them the way they are.
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.
It is normal to evaluate others based on the way they look.
I do not evaluate others based on the way they look, but I unconditionally accept them as
worthwhile human beings.
I do not think I should evaluate others as worthwhile or worthless human beings based on the
good or bad things they do.
It is normal that I evaluate myself as a person based on the good or bad things that I do.
I know I am not as smart as others, but I accept myself, and feel good about myself just the
way I am.
I do not think I should evaluate myself based on the way I look.
Even if life is unfair, I can accept it just the way it is.
I cannot accept the fact that I am less attractive than others.
I cannot accept the fact that I am not as smart as others.
I do not think I should evaluate myself as a person based on the good or bad things that I do.
Even if someone is not attractive, I can accept him/her as worthwhile human being.
I do not think I should evaluate others based on the way they look.
When life is not the way I want it be, I think life is unfair.
Even if the others are less smart than I am, I accept them as worthwhile human beings.
I find it hard to accept that life is unfair.
I know I have some negative personality traits, but I accept myself just the way I am.
I know I am less attractive than others, but I accept myself and feel good about myself just the
way I am.
I cannot accept my negative personality traits.
I cannot accept people who are less smart than I am.
I cannot accept people who have negative personality traits.
Life cannot be rated as good/fair or bad/unfair; life is the way it is, and it should be accepted as
such.
I cannot accept people who are not attractive.
I do not rate life as good/fair or bad/unfair, but unconditionally accept it just the way it is.

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Component
1
.768
.767
.747
.720
.690
.688
.683
.666
.658
.653
.643
.605
.601
.599
.598
.597
.596
.596
.596
.587
.584
.580
.563
.559
.558
.551
.537
.525
.520
.517
.511
.510
.485
.464
.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
**
1. Unconditional Acceptance Questionnaire
1 -.72
2. General Attitudes and Beliefs Scale
1
3. Profile of Mood States
4. Automatic Thoughts Questionnaire
5. Rosenbergs Self-Esteem Scale
6. Vigour/activity (POMS)
**. Correlation is significant at the 0.01 level (1-tailed).

**

**

**

**

-.48 -.52
.54** .65**
1 .78**
1

-.18
.26**
.23**
.29**
1

.26
-.32**
-.73**
-.53**
-.02**
1

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 persons 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 (Cronbachs ) in order
to assess the reliability of the scale. The index showed an excellent internal
consistency for the whole scale ( = .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
-0.68**

Philosophical
acceptance
-0.56**

General Attitudes and


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

Developing the Unconditional Acceptance Questionnaire

Z
-3.37

p
(2-tailed)
.00

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Articles Section

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

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D. David, C. D. Cote, A. Szentagotai, J. McMahon, R. DiGiuseppe

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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.

Developing the Unconditional Acceptance Questionnaire

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Now that we have a more rigorous measure of the key REBTs 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/optimismbased 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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D. David, C. D. Cote, A. Szentagotai, J. McMahon, R. DiGiuseppe

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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).
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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

1
2.
3.
4.
5.
6.
7.
8
9

10.
11.
12.

13.

14.
15.
16.
17.
18.
19.
20.

More often
false than
true
3

As often
true as
false
4

More often
true than
false
5

When life is not the way I want it be, I think life is unfair.
I know I have some negative personality traits, but I accept
myself just the way I am.
I cannot accept people who are less smart than I am.
Life cannot be rated as good/fair or bad/unfair; life is the way
it is, and it should be accepted as such.
I cannot accept people who have negative personality traits.
I cannot accept my negative personality traits.
I cannot accept the fact that I am not as smart as others.
I do not evaluate others based on the way they look, but I
unconditionally accept them as worthwhile human beings.
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.
It is normal that I evaluate myself as a person based on the
good or bad things that I do.
I think it is normal that I evaluate myself as a person based on
my performance.
I do not think I should evaluate others as worthwhile or
worthless human beings based on the good or bad things they
do.
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.
I cannot accept people who are not attractive.
I do not think I should evaluate myself as a person based on
the good or bad things that I do.
I know I am less attractive than others, but I accept myself and
feel good about myself just the way I am.
Even if the others are less smart than I am, I accept them as
worthwhile human beings.
I do not evaluate others based on their performance, but
unconditionally accept them as worthwhile human beings.
Even if someone is not attractive, I can accept him/her as
worthwhile human being.
It is normal to evaluate others based on the way they look.

Developing the Unconditional Acceptance Questionnaire

Usually
true

Almost
always true

1
1

2
2

3 4
3 4

5 6
5 6

7
7

1
1

2
2

3 4
3 4

5 6
5 6

7
7

1
1
1
1

2
2
2
2

3
3
3
3

5
5
5
5

6
6
6
6

7
7
7
7

3 4

5 6

3 4

5 6

3 4

5 6

3 4

5 6

3 4

5 6

1
1

2
2

3 4
3 4

5 6
5 6

7
7

3 4

5 6

3 4

5 6

3 4

5 6

3 4

5 6

3 4

5 6

4
4
4
4

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Almost
always false

Usually
false

21.
22.
23.
24.
25.

26.

27.
28.
29.
30.
31.
32.
33.
34.
35.

464

More often
false than
true
3

As often
true as
false
4

More often
true that
false
5

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


feel good about myself just the way I am.
I do not think I should evaluate others based on their
performance.
I do not think I should evaluate others based on the way they
look.
I do not evaluate myself based on the way I look, but
unconditionally accept myself as a worthwhile human being.
I do not evaluate myself as a person based on my
performance, but unconditionally accept myself as a
worthwhile human being.
I do not evaluate others based on the good or bad things they
do, but unconditionally accept them as worthwhile human
beings.
I do not rate life as good/fair or bad/unfair, but
unconditionally accept it just the way it is.
It is normal that I evaluate myself based on the way I look.
I find it hard to accept that life is unfair.
It is normal to evaluate others based on their performance.
Even if life is unfair, I can accept it just the way it is.
I do not think I should evaluate my worth as a human being
based on my performance.
I cannot accept the fact that I am less attractive than others.
Even if the others have negative personality traits, I can accept
them the way they are.
I do not think I should evaluate myself based on the way I
look.

Usually
true

Almost
always true

3 4

5 6

3 4

5 6

3 4

5 6

3 4

5 6

3 4

5 6

3 4

5 6

3 4

5 6

1
1
1
1
1

2
2
2
2
2

3
3
3
3
3

5
5
5
5
5

6
6
6
6
6

7
7
7
7
7

1
1

2
2

3 4
3 4

5 6
5 6

7
7

3 4

5 6

4
4
4
4
4

D. David, C. D. Cote, A. Szentagotai, J. McMahon, R. DiGiuseppe

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