Content uploaded by Tobias Lundgren
Author content
All content in this area was uploaded by Tobias Lundgren on Oct 24, 2017
Content may be subject to copyright.
This article appeared in a journal published by Elsevier. The attached
copy is furnished to the author for internal non-commercial research
and education use, including for instruction at the authors institution
and sharing with colleagues.
Other uses, including reproduction and distribution, or selling or
licensing copies, or posting to personal, institutional or third party
websites are prohibited.
In most cases authors are permitted to post their version of the
article (e.g. in Word or Tex form) to their personal website or
institutional repository. Authors requiring further information
regarding Elsevier’s archiving and manuscript policies are
encouraged to visit:
http://www.elsevier.com/copyright
Author's personal copy
The Bull's-Eye Values Survey: A Psychometric Evaluation
Tobias Lundgren, University of Stockholm
Jason B. Luoma, Portland Psychotherapy Clinic, Research, & Training Center
JoAnne Dahl, University of Uppsala
Kirk Strosahl, Mountainview Consulting Group, Zillah, Washington
Lennart Melin, University of Uppsala
Two studies were conducted to develop and evaluate an instrument intended to identify and measure personal values, values
attainment, and persistence in the face of barriers. Study 1 describes a content validity approach to the construction and preliminary
validation of the Bull's Eye Values Survey (BEVS), using a sample of institutionalized patients suffering from epilepsy. Study 2
investigated the psychometric properties of the BEVS with a sample of Swedish university students. Results suggest that the BEVS is
sensitive to treatment effects and can differentiate between clients who receive values-based interventions and those who do not. The
BEVS subscales and total score appear to measure an independent dimension of psychological functioning that is negatively correlated
with measures of depression, anxiety, and stress, and positively correlated with a measure of psychological flexibility. The BEVS also
exhibits acceptable temporal stability and internal consistency. The study provides preliminary support for the BEVS as both a research
and clinical tool for measuring values, values-action discrepancies, and barriers to value-based living.
RESEARCH on cognitive behavioral therapies has
historically tended to emphasize symptom reduc-
tion as the primary outcome of interest. However, recent
papers have called for placing a greater emphasis on the
measurement of functional outcomes in domains such
as work, school, relationships (McKnight & Kashdan,
2009a), and positive dimensions of human functioning
(Duckworth, Steen, & Seligman, 2005). One newer cog-
nitive behavioral model that emphasizes positive life
functioning over symptom reduction is Acceptance and
Commitment Therapy (ACT; Hayes, Stroshal, & Wilson,
1999). ACT seeks to enhance psychological flexibility—
the ability to mindfully and actively accept unpleasant
thoughts, feelings, and other private experiences while
also maintaining flexible and effective action that is
consistent with a person's chosen values. To date, several
studies have supported the importance of mindfulness
and acceptance processes in promoting psychological
flexibility (for a review, see Hayes, Luoma, Bond, Masuda,
& Lillis, 2006); however, research on the values and
commitment processes has lagged behind. One factor
impeding research may be the lack of reliable and valid
measures for assessing values and commitment processes.
This paper outlines one attempt to develop such a measure.
This measure development project was guided by
a technical definition of values that emerges from a
psychological flexibility model: “values are freely chosen,
verbally constructed consequences of ongoing, dynamic,
evolving patterns of activity, which establish predominant
reinforcers for that activity that are intrinsic in engagement
in the valued behavioral pattern itself”(Wilson et al., 2010,
p. 65). For readers interested in a thorough description of
this technical definition that incorporates elements of
behavior analysis and Relational Frame Theory (Hayes,
Barnes-Holmes, & Roche, 2001), we refer readers to Dahl
et al. (2009). Speaking more colloquially, values are not
goals or ends in themselves, but can be thought of as
principles for living that organize and direct current action.
Values also are theorized to provide part of the motiva-
tion for acceptance and persistence in the face of barriers to
living according to these principles for living, as supported
in one analogue study that showed that adding a values-
focused component to an acceptance intervention en-
hanced participant tolerance of cold-pressor induced pain
(Branstetter-Rost, Cushing, & Douleh, 2009). While our
Keywords: values; values attainment; psychometric properties; psycho-
logical flexibility; measure development
1077-7229/11/518-526$1.00/0
© 2012 Association for Behavioral and Cognitive Therapies.
Published by Elsevier Ltd. All rights reserved.
www.elsevier.com/locate/cabp
A
vailable online at www.sciencedirect.com
Cognitive and Behavioral Practice 19 (2012) 518 -526
Author's personal copy
definition of values is specific to the psychological flexibility
model that guides this line of research, related lines of
research on concepts such as personal strivings (Emmons,
1991) or meaning in life (McKnight & Kashdan, 2009b)
also corroborate the idea that values-consistent behavior
is important for psychological health. Generally, research
in this area suggests that goal-related activity oriented to-
ward pursuing and accomplishing intrinsically meaningful
goals, such as those congruent with important life values,
contributes more to well-being than other forms of
goal-related activity, such as activity oriented toward
changing mood states (Steger, Kashdan, & Oishi, 2008).
The only published measure of values that has psycho-
metric data derived from a clinical sample is the Chronic
Pain Values Inventory (CPVI; McCracken & Yang, 2006),
which is used with chronic pain patients. The CPVI
includes an assessment of six domains of valued living,
rated according to how important clients consider their
values to be, along with a measure of the consistency
between importance and actual activity level. This mea-
sure has demonstrated correlations with a variety of
pain-related outcomes and functioning (McCracken &
Keogh, 2009; McCracken & Velleman, 2009; McCracken
& Yang, 2006) while changes in this measure as a result of
intervention correlate with improvement in pain-related
outcomes (Vowles & McCracken, 2008). While this
provides evidence for the importance of values in
promoting psychological health, the CPVI has limited
generalizability as it has been constructed to measure
values specifically for those experiencing chronic pain. A
second measure of valued living was developed by another
team of researchers concurrently with this measure, the
Valued Living Questionnaire (VLQ), and has been
evaluated in a nonclinical population (Wilson, Sandoz,
Kitchens, & Roberts, 2010). This measure assesses 10
domains of valued living, rated according to how important
clients consider their values to be, along with the
consistency between importance and actual activity level.
In developing a new measure of valued living, we
were particularly interested in developing a measure that
would be both psychometrically sound for use in research,
but also have high clinical utility for therapists. When
values are addressed in ACT, therapists help clients to
better identify their personal values and the psychological
barriers (e.g., thoughts, feelings, memories, or urges) that
impede their ability to live according to their values. In
ACT, mindfulness and acceptance techniques are used to
help clients take action in a manner that is consistent with
these life principles, while learning to make room for (i.e.,
accept) unpleasant emotions, thoughts, memories, and
bodily sensations that are triggered along the way. Our
measure was designed to guide a process of identifying
chosen principles for living in important life domains and
assessing for specific barriers that could be later targeted
in treatment. Thus, we asked participants to identify what
they value within important life domains, representing an
addition to the CPVI or VLQ, which simply ask respondents
to rate the importance of that area of living. We also asked
participants to identify perceived barriers to following
those values, again an addition to the CPVI/VLQ strategy
of asking about the discrepancy between behavior and
values. We felt that this idiographic assessment of values
and barriers would be useful to clinicians to use in treat-
ment planning and progress monitoring. Finally, we strove
to create a measure that could be completed rapidly and
that could be easily used and understood by individuals of
varying levels of education and intellectual functioning.
The result of this process was the Bull's-Eye Values Survey
(BEVS).
This paper describes the results of two studies that
examined the construct validity of the BEVS. Study 1
describes the initial development of the BEVS, provides
information on content validity, and describes its sen-
sitivity to intervention. Study 2 relates our measures of
values attainment and persistence in the face of barriers
to various measures of psychological distress, overall
well-being, and psychological flexibility, in order to
examine construct validity. In addition, Study 2 provides
information on temporal stability.
Study 1: Development of the BEVS
Study 1 outlines the initial piloting of the BEVS as part
of a larger clinical trial on the treatment of epilepsy (for
more complete information on this trial, see Lundgren,
Dahl, Melin, Kies, 2006). The goals of Study 1 were to pilot
the assessment procedure, evaluate the content validity of
responses, and examine the sensitivity of the measure to
intervention. The measure was developed in response to a
perceived need for a clinically useful and psychometri-
cally valid measure of values-focused processes of change
that were targeted in the intervention.
Participants
Participants were 27 South African adults (13 male, 14
female), ranging between 21 to 55 years old (mean
age=40.7), with 13 married and 14 single. All had an
electroencephalography-verified diagnosis of epilepsy and
were being treated with antiepileptic medication through
a center for epilepsy in South Africa. All participants were
living in poverty. Inclusion criteria for the larger study
included experiencing uncontrolled frequent epileptic
seizures and being willing to participate in the treatment
study. Through conversation between research and study
staff, participants judged as unable to actively participate
in the study due to cognitive impairment were excluded
from the study. Participants who were unable to actively
participate in the program or who changed their medica-
tion during the study period were excluded from the study.
519Bulls-eye of Valued Living
Author's personal copy
There were no significant differences between the groups
in terms of age, gender, seizing time, or type of epileptic
seizure. All participants were taking antiepileptic drugs.
Procedure
Participants were randomly assigned to 9 hours of
therapy over a 4-week period, either an ACT intervention
focused on epilepsy or supportive therapy. In both con-
ditions, treatment began with one 90-minute individual
session, followed by two 3-hourgroup sessions, and another
90-minute individual session. The BEVS was completed
at pretreatment, posttreatment, 6-month follow-up, and
1-year follow-up as part of a larger assessment battery. Nine
of the participants required an interpreter to interact with
study assessors and therapists. The interpreters were staff
members at the center who had undergone a 4-hour train-
ing in the BEVS prior to the start of the study. Results
showed that ACT resulted in significant reductions in sei-
zure frequency and improvements in subjective well-being
at posttreatment and that these changes were maintained
at 1-year follow-up (Lundgren et al., 2006). Mediational
analyses showed that BEVS values attainment scores, in
combination with other measures of psychological flexibil-
ity, mediated the relationship between the ACT interven-
tion and epileptic seizures, quality of life, and well-being
(Lundgren, Dahl, & Hayes, 2008).
Bull's Eye Assessment
In our efforts to build a measure that was accessible to a
wide range of individuals and usable across cultures, the
BEVS uses the visual analogy of a dart board or archery
target because most people are familiar with aiming at a
multi-ring target. In the BEVS, the target measures 4.5
centimeters from the center of the target to the edge of
the outer ring. Scores were measured using a ruler and
rounded to the nearest millimeter. The BEVS procedure
in Study 1 consisted of several steps:
1. The participant was given three pieces of paper,
each with a representation of a dart board on it.
They were instructed to "Choose three areas in your
life that you feel you want to develop or have in your
life which you don't have today.”A description of a
value as it pertained to each area was written under
the dartboard on each of the three pieces of paper.
An example values description is, “Iwanttobea
present dad,a model that both listens to mydaughter
and supports her when she needs it. I want to show
her that I love her very much.”
2. The respondent was then asked to place a mark
(e.g., an X) somewhere on the first dart board to
signify the extent to which the person was living in
a manner consistent with that value. The further
the mark was placed away from the bull's eye, the
greater the perceived value-action discrepancy. This
was repeated for the second and third dart board.
3. Following identification and definition of the valued
domains, participants were provided with a fourth
dart board where they were asked to write down
the psychological barriers to living in accord with
these values. Participants were asked to indicate with
another mark how much they persisted in the face of
these barriers. This was scored so that high persis-
tence was indicated by a mark in the center of the
target. An example description of barriers is, “My
epilepsy, and I have let my daughter down for many
years and now it is too late. It is better that I don't
disturb herand her mother. I am not a good dad and
I don't have enough confidence.”
Values attainment was calculated by averaging the
scores of the first three dart boards. Persistence in the face
of barriers was measured using the single score of the last
dart board. Scores ranged from 0 to 4.5, with lower scores
indicating greater values attainment and greater persis-
tence with barriers.
Results
Content Validity
Responses from the 27 participants (84 responses, 3 per
participant) were independently categorized by the first
author into an initial group of 10 life domains (see Table 1)
based on concurrent research conducted on a different
measure of valuing (Wilson et al., 2010). Disagreements in
classifications between the first and third author were dis-
cussed and a final category was determined through con-
sensus. Results indicated that the most frequent domains
related to work/education and social relationships (i.e.,
relationships, family, parenting, friendship). Other less
frequently endorsed domains were health, spirituality, and
community work.
Table 1
Number of Responses in Each Valued Domain (N= 84)
Chosen domains Number of responses
Work 19
Relationships 17
Family 13
Parenting 11
Education 7
Leisure time 6
Health 4
Friendship 3
Spirituality 2
Community work 2
Total Responses 84
520 Lundgren et al.
Author's personal copy
Discriminative Validity: Sensitivity to Intervention
As mentioned previously, this instrument develop-
ment project was part of a larger study of using ACT for
treatment-refractory epilepsy. Core ACT interventions
are to engage the client in a dialogue about personal
values, have the client evaluate the extent to which daily
behaviors are consistent with identified values, and to
identify and overcome external or internal factors that
function as obstacles to value-consistent living. In this
study, ACT was compared to a general supportive psy-
chotherapy intervention that lacked an explicit focus on
values clarification and value-action discrepancies. Thus,
we predicted that only the patients in the ACT condition
would exhibit a positive change in their values attainment
scores (i.e., a reduction in value-action discrepancies). This
permitted an evaluation of the extent to which the BEVS is
sensitive to clinical changes related to treatments that do
and do not explicitly target values. The data were analyzed
using repeated measures ANOVA. As reported in Table 2,
results provide preliminary support for the hypothesis
that the BEVS values attainment scale is sensitive to clin-
ical intervention. ACT clients reported highly significant
positive changes in their values attainment scores when
compared with clients in the supportive therapy treat-
ment. This was indicated by a significant interaction
effect between groups over time in favor of the ACT group.
Furthermore, Cohen's dshowed that the positive changes
in the ACT group were large and stable from post to
one-year follow up, while changes in the Supportive
Therapy group were minimal or nonexistent.
Study 2: Psychometric Properties of the BEVS
The goal of Study 2 was to evaluate the psychomet-
ric properties of the BEVS, particularly its test-retest
reliability, internal consistency, discriminant validity, and
concurrent validity with respect to established measures
of psychological flexibility, psychological distress, and life
satisfaction.
Participants
The baseline sample consisted of 181 Swedish univer-
sity students participating in a clinical psychology course.
The purposes of the study were explained at the end of
a class, and interested volunteers were contacted by phone
or e-mail and enlisted into the study. Of the original sam-
ple, 156 completed the second assessment, 147 completed
the third assessment, and 147 participants (48 male, 99
female) completed all assessments at all time points. Only
data from those participants who completed all assess-
ments are analyzed below. The mean age of participants
was 26.4 years (SD = 10.7), with relationship status
reported as 42% single, 26.5% dating, 19% cohabitating,
and 12% married. Twenty-six percent reported having
children.
Measures
To increase the efficiency of the BEVS, the authors
elected to condense the procedure for identifying
values-action discrepancies into one unified protocol,
rather than using separate sheets of paper for each life
domain (see Appendix). The revised protocol elicits all
value statements on a single page and, similarly, ratings of
value-action discrepancies are displayed on a single target.
The authors also chose to elicit ratings for a range of
potentially important domains, rather than allowing
participants to self-select which valued domains they
might choose to focus on. The domains selected were
based on clinical observations, as well as results from Study
1, where the most frequently observed domains of interest
were work/education, relationships, and leisure time. In
addition, the health and spirituality domains were clustered
into a fourth domain termed Health/Personal Growth.
Thus, the revised BEVS included four major life domains:
Work/Education, Relationships, Leisure, Health/Personal
Growth.
Two changes were made to the scoring of the BEVS
compared to Study 1. First, the scoring direction of the
Table 2
Average BEVS Values Attainment and Persistence With Barriers Scores for ACT and Supportive Therapy Patients
Pre Post 6 months 1year Interaction
effect
Within d
Pre to 1 year
MSD MSD MSD MSD
Values attainment
ACT 3.8 0.60 1.7 (0.74) 1.3 (0.76) 1.0 (0.40) F(1, 3) = 93.17 5.49
ST 4.2 0.58 3.6 (0.55) 4.3 (0.42) 4.0 (0.47) pb.001 0.07
Persistence with barriers
ACT 3.8 (0.64) 1.4 (0.87) 0.7 (0.69) 0.7 (0.79) F(1, 3) = 61.45 4.31
ST 3.8 (1.01) 3.3 (0.74) 4.1 (0.72) 3.9 (0.72) pb.001 -0.11
Note. In Study 1, lower scores indicated greater values attainment and greater persistence with barriers. Possible scores ranged from 0 to 4.5.
521Bulls-eye of Valued Living
Author's personal copy
BEVS scales was reversed so that higher scores corre-
sponded to greater attainment of valued living. Second,
the measure of physical distance from the bull's eye was
dropped in favor of a more user-friendly scoring system
in which a value of 7 was supplied if the respondent
placed a mark in the center of the bull's eye and 1 point
was removed for each of the remaining 6 rings on the
target. Thus, placing a mark in the outer most ring of
the target equaled a score of 1. Lower numerical scores
on the BEVS values attainment variable indicate a greater
discrepancy and lower attainment. Higher scores indi-
cate higher values attainment. These changes allowed us
to score the BEVS values attainment score as a continuous
variable while making the scoring process considerably
more user friendly.
The procedure for identifying persistence with barriers
was also modified. In the new version, participants were
first asked to write down the obstacles that "stand between
you and living your current life as you want to, from what
you have written in your areas of value." They were then
asked to provide a 1 (doesn't prevent me at all)to7(prevents
me completely) Likert rating of the extent to which "the
obstacle(s) you just described can prevent you from living
your life in a way that is in keeping with your values." This
item was reverse scored so that higher scores correspond
with higher levels of persistence with barriers. The dart
board was not used to supplement the Likert ratings of
persistence.
Life Satisfaction
The Satisfaction With Life Scale (SWLS) is a self-report
measure of global judgments of satisfaction with one's
life (Diener, Emmons, Larsen, & Griffin, 1985). The scale
consists of five statements (e.g., “In most ways my life is
close to ideal”and “I am satisfied with my life”). Responses
are rated on a 7-point scale from 1 (strongly disagree)to
7(strongly agree), with scale totals ranging from 5 to 35. The
SWLS has shown a strong internal reliability (α=.87) and
good temporal stability (Diener, Emmons, Larsen, & Griffin,
1985) and is one of the primary well-being measures
used in a large literature on the topic.
Psychological Flexibility
The Acceptance and Action Questionnaire II (AAQ-II)
is a 10-question measure of psychological flexibility (Hayes
et al., 2004). The AAQ-II is a widely used instrument in
ACT studies to assess the purported mechanism of change
in psychotherapeutic research (Hayes et al., 2006). The
scale consists of 10 statements rated on a 7-point scale
from 1 (never true of me)to7(always true of me). Higher scores
indicate higher psychological flexibility. The AAQ-II has
shown good reliability (test-retest reliability= .81-.87) and
validity (Bond et al., 2011).
Depression, Anxiety, and Stress
The Depression, Anxiety and Stress Scale (DASS-21;
Antony, Bieling, Cox, Enns, & Swinson, 1998) is a short
version of the DASS-42 (Lovibond & Lovibond, 1995) and
is a widely used measure of depression/anxiety/stress in
clinical research. The instrument consists of 21 statements
about stress, anxiety, and depression symptoms that have
been experienced in the past week. Statements are rated
on a 4-point scale from 1 (did not apply to me at all)to4
(applied to me very much, or most of the time). The DASS-21
and its subscales have been demonstrated to have good
internal consistency (Crawford & Henry, 2003), as well as
temporalstability and convergent validity (Brown, Chorpita,
Korotitsch & Barlow, 1997).
Procedure
Participants completed three separate assessments
with 2-week intervals separating each assessment. The
first assessment session lasted approximately 40 minutes
and required participants to complete the BEVS, SWLS,
AAQ-II, and DASS-21. Subsequent sessions involved only
completing the BEVS. Assessments were conducted in a
classroom in groups of 7 to 10 participants. A research
assistant was present to answer any questions about how
to complete each instrument. The assessment leader was
not allowed to add any new information or to suggest
any answers when fielding questions. This is important
because the first part of the BEVS, where participants
write statements describing their values, can be easily
influenced by the experimenter. The final two assessment
sessions took place in the same classroom as the initial
assessment and the same research assistant guided the
process. Each participant's values statements gathered at
Session 1 were preprinted on the unified BEVS protocol.
Participants interested in a more detailed description of
the study were offered a written description of the study
and a half-hour lecture on values work in ACT after the
third assessment occasion.
Results
There was no evidence of floor or ceiling effects on
the BEVS. Means for all subscales were in the middle range
of possible scores—Work/Education (M=3.7, SD =1.5),
Relationships (M= 4.2, SD=1.8), Leisure (M=3.7, SD =1.7),
Health/Personal Growth (M=3.5, SD = 1.4), and persistence
with barriers (M=4.1, SD =1.2).
Reliability
The test-retest correlations for the total BEVS values
attainment scores were significant between Times 1 and
2, r(180)= .85, pb.001; between Time 1 and 3, r(180) = .70,
pb.001; and between Times 2 and 3, r(180) = .71, pb.001.
The test-retest correlation for the persistence with barriers
522 Lundgren et al.
Author's personal copy
score was significant between Times 1 and 2, r(180) = .89,
pb.001; between Times 1 and 3, r(180)= .90, pb.001; and
between Times 2 and 3, r(180)=.71, pb.001.
Correlational Analyses
The four valuesattainment scores, average values attain-
ment scores, and persistence with values scores from the
BEVS were correlated with the SWLS, AAQ-II, and DASS-21
subscale scores (see Table 3). Overall, higher values attain-
ment scores were associated with lower psychological
distress, higher psychological flexibility, and higher sub-
jective well-being. The exception was the DASS-21 Anxiety
subscale, which was not significantly correlated with three
of the BEVS subscales. The persistence with barriers scores
showed a similar pattern, with higher persistence being
associated with lower psychological distress, higher psycho-
logical flexibility, and higher subjective well-being.
Factor Analyses
An exploratory factor analysis was conducted in an
effort to determine the underlying relationship between
the various measures examined in this study. Principal
components analysis was used for factor extraction, and
varimax (orthogonal) rotation was used for factor rota-
tion. Variables entered in the factor analyses were the five
scores that make up the BEVS and the total scores of the
instruments described above (see Table 4). Components
were retained if their eigenvalues exceeded 1.0. Factor
loadings for specific variables were retained if they were
greater than positive or negative .50. As can be seen in
Table 4, two factors collectively explained 52% of the
variance. The first factor appears to reflect a psychological
distress dimension characterized by high DASS scores, low
psychological flexibility, and low subjective well-being. The
second factor appears to reflect a life satisfaction dimen-
sion characterized by a positive association between value
attainment and subjective well-being. That these compo-
nents were nearly orthogonal supported the hypothesis
that the BEVS measures something distinct from most
of the other measures in the study. Of particular interest
is that psychological flexibility (AAQ-II) loaded on a dif-
ferent factor than the BEVS scales.
Discussion
The results of the present study provide preliminary
support for the BEVS as a useful tool for both process
(Lundgren et al., 2008) and outcome research for treat-
ments that employ values-based interventions. The BEVS
exhibited good temporal stability and showed many
properties supporting its construct validity. High scores
on the BEVS values attainment scale indicated a small
discrepancy between personal values and actions that were
consistent with those values. Lower values attainment was
related to heightened levels of depression, anxiety, and
stress, as well as lower levels of psychological flexibility and
reduced reports of subjective well-being. In addition, lower
levels of BEVS persistence in the face of barriers predicted
heightened levels of depression, anxiety, and reduced
levels of psychological flexibility and subjective well-being.
Factor analyses of the scales in Study 2 showed that
our measure of general psychological flexibility, the
AAQ-II, loaded on an overall distress factor with measures
of depression, anxiety, stress, and well-being. In contrast,
BEVS scores loaded on a separate factor along with the
Table 3
Correlations Between BEVS and Other Measures (N= 147)
Bull's-Eye Domains DASS-t DASS-d DASS-a DASS-s AAQ II SWLS
Relationships -.16* -.16* -.09 -.15 .26** .46***
Work/Education -.20* -.23** -.13 -.17* .14 .27**
Leisure -.19* -.18* -.15 -.16* .23** .28**
Personal growth/Health -.28** -.17* -.28** -.26** .22** .39***
Overall values attainment -.24** -.23** -.17* -.20* .26** .47***
Persistence with barriers .30*** .20* .25** .30*** -.31*** -.38***
Note. DASS-t = Total score of Depression Anxiety and Stress Scale, DASS-d = Depression scale, DASS-a = Anxiety scale, DASS-s = Stress
scale, AAQ = Acceptance and Action Questioner, SWLS = Subjective Well Being Life Scale.
*pb.05, **pb.01, ***pb.001.
Table 4
Principal Component Factor Loadings for All Study Measures
Variables Factor One Factor Two
Work .12 -.51
Leisure .07 -.70
Relations .10 -.66
Health/personal growth .24 -.54
Persistence with barriers -.28 .57
Depression .76 .01
Anxiety .79 .04
Stress .86 .09
Psychological flexibility .73 .21
Subjective well-being -.61 -.52
Eigenvalue 2.93 2.25
Explained variance in percentage 29% 23%
523Bulls-eye of Valued Living
Author's personal copy
well-being scale. This pattern suggested that the BEVS
scales were not redundant with the more general measure
of psychological flexibility. Also, the results suggested that
well-being was not simply related to lower levels of distress,
but also to the presence of positive action toward valued
ends. Overall, our findings indicate that the BEVS may be
a useful measure for researchers who are interested in
studying valued living and related constructs.
In addition to its utility in research studies, the BEVS
may have clinical utility. First, the BEVS can be used to
identify values idiographically and thus can be used as
a treatment-planning tool in therapy. Compared with
traditional quality-of-life measures, which use standard
questions that are rated on a Likert scale, the BEVS also
obtains an idiographic measure of valuing that may have
clinical utility. For example, it may allow for a more targeted
clinical approach to behavior change in line with indi-
vidual client's particular values. Second, the BEVS quan-
tifies the discrepancy between personal values and actions
that are consistent with those values within a particular
domain, making it possible to examine the differential
impact of value-action discrepancies within different life
domains. If tracked over time, values attainment scores
could serve as a way to measure progress in treatment.
Third, the BEVS elicits an idiographic assessment of per-
ceived obstacles to improving value-action discrepancies.
The types of obstacles that serve as barriers and the degree
to which these obstacles are seen as insurmountable
are important pieces of information for clinical practice.
The psychological content presented by the client in the
assessment can be responded to with acceptance, mindful-
ness, and defusion processes. The BEVS can also serve as a
guide to choosing domains where valued actions might be
taken and identifying what valued actions might challenge
his or her obstacles. Taking active steps in valued directions
then serves to break rigid behavior patterns and broaden
the client's behavioral repertoire.
There were several limitations in the current study.
First, the initial development sample was small and this
might have skewed the life domains that were selected
for the BEVS. Another weakness was that the measure
was revised somewhat between Study 1 and 2, leaving the
question open as to how well the results from Study 1
apply to the measure used in Study 2, for example, the
bull's eye scoring was changed from a continuous physical
analogue measure to an ordinal measure, which may have
influenced responding. However, previous studies com-
paring visual analogue to interval measures have shown
that they tend to correlate highly with each other (Guyatt,
Townsend, Berman, & Keller, 1987; Laerhoven, Zaag
Loonen & Derkx, 2004). Finally, studies will be needed to
determine whether the psychometric properties observed
in the Swedish university sample will generalize to popula-
tions from other nationalities, or other racial, ethnic, or
clinical samples. On the other hand, the fact that results
obtained with the Swedish sample were consistent with
those obtained with the South African sample increases our
confidence that this measure may be reliable and valid
across different cultural contexts.
The purpose of this study was to develop clinically
useful and psychometrically valid assessment process for
personal values. Evidence was also provided that living life
in accord with one's values contributes to well-being above
and beyond negative mood states. Our hope is that the
availability of the new measure of valuing we developed
will aid in future studies on personal values and their role
in increasing quality of life.
Appendix. Bull's-Eye Values Survey
Age:________________________
Sex: (Circle): Woman Man
Civil status: (Circle) Married Living together Girl/-Boy
friend Single
Children: (yes or no) ________ If yes, how many:
_______________________________
Occupation:_______________________________________
Bull's-Eye
The Bull's Eye dart board on [next page] is divided into
four areas of living that are important in people's lives:
work/education, leisure, relationships and personal
growth/health.
1) Work/Education refers to your career aims, your
values about improving your education and knowl-
edge, and generally feeling of use to those close to
you or to your community (i.e., volunteering,
overseeing your household, etc.).
524 Lundgren et al.
Author's personal copy
2) Leisure refers to how you play in your life, how you
enjoy yourself, your hobbies or other activities that
you spend your free time doing (i.e., gardening,
sewing, coaching a children's soccer team, fishing,
playing sports).
3) Relationships refers to intimacy in your life, relation-
ships with your children, your family of origin, your
friends and social contacts in the community.
4) Personal growth/health refers to your spiritual life,
either in organized religion or personal expressions of
spirituality, exercise, nutrition, and addressing health
risk factors like drinking, drug use, smoking, weight.
In this exercise, you will be asked to look more closely
at your personal values in each of these areas and write
them out. Then, you will evaluate how close you are to
living your life in keeping with your values. You will also
take a closer look at the barriers or obstacles in your life
that stand between you and the kind of life you want to
live. Don't rush through this; just take your time.
Part 1. Identify Your Values
Start by describing your values within each of the four
values areas. Think about each area in terms of your
dreams, like you had the possibility to get your wishes
completely fulfilled. What are the qualities that you would
like to get out of each area and what are your expectations
from these areas of your life? Your value should not be a
specific goal but instead reflect a way you would like to live
your life over time. For example, getting marriedmight be a
goal you have in life, but it just reflects your value of being
an affectionate, honest and loving partner. To accompany
your son to a baseball game might be a goal; to be an
involved and interested parent might be the value. Note!
Write your value for each area on the lines provided below.
It is your personal values that are important in this exercise.
Work/education: __________________________________
________________________________________________
________________________________________________
Leisure: ________________________________________
________________________________________________
________________________________________________
Relationships: ___________________________________
______________________________________________
Personal growth/health: ____________________________
______________________________________________
Now, look again at the values you have written above.
Think of your value as "bull's eye" (the middle of the dart
board). “Bull's eye”is exactly how you want your life to be,
a direct hit, where you are living your life in a way that is
consistent with your value. Now, make an X on the dart
board in each area that best represents where you stand
today. An X in the bull's eye means that you are living
completely in keeping with your value for that area of
living. An X far from bull's eye means that your life is way
off the mark in terms of how you are living your life.
Since there are four areas of valued living, you should
mark four Xs on the dart board. Note! Use the dart board
on this page before you go to Part 2 of this exercise.
Part 2: Identify Your Obstacles
Now write down what stands between you and living
your current life as you want to, from what you have
written in your areas of value. When you think of the life
you want to live and the values that you would like to put
in play, what gets in the way of you living that kind of life?
Describe any obstacle (s) on the lines below.
____________________________________________
____________________________________________
____________________________________________
____________________________________________
Now estimate to what extent the obstacle (s) you just
described can prevent you from living your life in a way
that is in keeping with your values. Circle one number
below that best describes how powerful this obstacle (s) is
in your life.
1234567
Doesn't prevent me at all Prevents me completely
Part 3. My Valued Action Plan
Think about actions you can take in your daily life that
would tell you that you are zeroing in on the bull's-eye in
My life is just as I
want it to be My life is far from
how I want it to be
Work/
Education
Leisure
RelationshipsPersonal growth/
Health
525Bulls-eye of Valued Living
Author's personal copy
each important area of your life. These actions could be
small steps toward a particular goal or they could just be
actions that reflect what you want to be about as a person.
Usually, taking a valued step includes being willing to
encounter the obstacle(s) you identified earlier and to
take the action anyway. Try to identify at least one value-based
action you are willing to take in each of the four areas listed below.
Work/education: _________________________________
________________________________________________
________________________________________________
Leisure: ________________________________________
________________________________________________
________________________________________________
Relationships: ___________________________________
________________________________________________
________________________________________________
Personal growth/health: ____________________________
________________________________________________
________________________________________________
References
Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W., & Swinson, R. P.
(1998). Psychometric properties of the 42-item and 21-item
versions of the Depression Anxiety Stress Scales in clinical groups
and a community sample. Psychological Assessment,10, 176.
Bond,F.W.,Hayes,S.C.,Baer,R.A.,Carpenter,K.M.,Guenole,N.,Orcutt,
H. K., Waltz, T., & Zettle, R. D. (2011). Preliminary psychometric
properties of the Acceptance and Action Questionnaire –II: A revised
measure of psychological inflexibility and experiential avoidance.
Behavior Therapy,42, 676–688.
Branstetter-Rost, A., Cushing, C., & Douleh, T. (2009). Personal values
and pain tolerance: Does a values intervention add to acceptance?
The Journal of Pain,10(8), 887–892.
Brown, T. A., Chorpita, B. F., Korotitsch, W., and Barlow, D. H. (1997).
Psychometric properties of the Depression Anxiety Stress Scales
(DASS-21) in clinical samples. Behavior Research and Therapy,35,
79–89.
Crawford, J. R., & Henry, J. D. (2003). The Depression Anxiety Stress
Scales (DASS-21): Normative data and latent structure in a larger
non-clinical sample. British Journal of Clinical Psychology,42,
111–131.
Dahl, J., Plumb, J., Stewart, I., & Lundgren, T. (2009). The art and science
of values in psychotherapy. Oakland, CA: New Harbinger.
Diener, E., Emmons, R. A., Larsen R. J., & Griffin S. (1985). The
Satisfaction With Life Scale. Journal of Personality and Social Psychology,
49,71–75.
Duckworth, A. L., Steen, T. A., & Seligman, M. E. (2005). Positive
psychology in clinical practice. Clinical Psychology,1, 629.
Emmons, R. A. (1991). Personal strivings, daily life events, and
psychological and physical well-being. Journal of Personality,59,
453–472.
Guyatt, G. H., Townsend, M., Berman, L. B., & Keller, J. L. (1987). A
comparison of Likert and visual analogue scales for measuring
change in function. Journal of Chronic Diseases,40, 1129–1133.
Hayes, S. C., Barnes-Holmes, D., & Roche, B. (2001). Relational frame
theory: A post-Skinnerian account of human language and cognition.
Springer: New York.
Hayes, S. C., Bissett, R., Roget, N., Padilla, M., Kohlenberg, B. S., Fisher,
G., . . . Niccolls, R. (2004). The impact of acceptance and
commitment training and multicultural training on the stigma-
tizing attitudes and professional burnout of substance abuse
counselors. Behavior Therapy,35, 821–835.
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006).
Acceptance and commitment therapy: Model, processes and
outcomes. Behaviour Research and Therapy,44,1–25.
Hayes, S. C., Stroshal, K., & Wilson, K. G. (1999) Acceptance and
Commitment Therapy: An experiential approach to behavior change. New
York: Guilford Press.
Laerhoven, H., Zaag Loonen, H. J., & Derkx, B. H. F. (2004). A
comparison of Likert scale and visual analogue scales as response
options in children's questionnaires. Acta Paediatrica,93, 830–835.
Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the Depression
Anxiety Stress Scales (2
nd
ed.). Sydney: Psychology Foundation.
Lundgren, T., Dahl, J., & Hayes, S. (2008). Evaluation of mediators of
change in the treatment of epilepsy with acceptance and
commitment therapy. Journal of Behavior Therapy,31, 225–235.
Lundgren, T., Dahl, J., Melin, L., & Kies, B. (2006). Evaluation of
Acceptance and Commitment Therapy for drug refractory
epilepsy: A randomized controlled trial in South Africa. Epilepsia,
47, 2173–2179.
McCracken, L. M., & Keogh, E. (2009). Acceptance, mindfulness, and
values-based action may counteract fear and avoidance of
emotions in chronic pain: An analysis of anxiety sensitivity. The
Journal of Pain,10, 408–415.
McCracken, L. M., & Velleman, S. C. (2009). Psychological flexibility in
adults with chronic pain: A study of acceptance, mindfulness, and
values-based action in primary care. Pain,148, 141–147.
McCracken,L. M., & Yang, S. Y. (2006). The role of values in a contextual
cognitive-behavioral approach to chronic pain. Pain,12,137–145.
McKnight, P. E., & Kashdan, T. B. (2009). The importance of
functional impairment to mental health outcomes: A case for
reassessing our goals in depression treatment research. Clinical
Psychology Review,29, 243–259.
McKnight, P. E., & Kashdan, T. B. (2009). Purpose in life as a system
that creates and sustains health and well-being: An integrative,
testable theory. Review of General Psychology,13, 242–251.
Steger, M. F., Kashdan, T. B., & Oishi, S. (2008). Being good by doing
good: Eudaimonic activity and daily well-being correlates,
mediators, and temporal relations. Journal of Research in Personality,
42,22–42.
Vowles, K. E., & McCracken, L. M. (2008). Acceptance and values-based
action in chronic pain: A study of treatment effectiveness and
process. Journal of Consulting and Clinical Psychology,76,397–407.
Wilson, K. G., Sandoz, E. K., Kitchens, J., & Roberts, M. (2010). The
Valued Living Questionnaire: Defining and measuring valued
action within a behavioral framework. The Psychological Record,60,
249–272.
Address correspondence to Tobias Lundgren, Psychology Department,
University of Stockholm Sweden, Frescati hagväg 8, 106 91 Stockholm,
Sweden; e-mail: Tobias.Lundgren@psychology.su.se.
Received: November 2, 2010
Accepted: January 6, 2012
Available online 9 March 2012
526 Lundgren et al.
