When working with grief in ACT, it can be helpful to consider use of a measure / scale in order to help yourself, and the client, understand their experience of grief and how this might change in motion, and over time.
We have found the Adult Attitude to Grief Scale (AAG) a helpful scale to understand an individual’s understanding of their grief. It is particularly useful in guiding conversations in therapy as well as helping clients to understand their own emotions. This understanding can, in turn, promote client’s psychological flexibility and help them to focus on their values.
The AAG scale was originally developed to validate concepts within the Range of Response to Loss (RRL) model. The scale identifies three key grief response categories: overwhelmed, controlled, and resilient (Machin, 2001). The AAG is a 9-item Likert scale, using responses from strongly agree to strongly disagree. It assesses bereaved clients’ characteristics and is a helpful guide for wider conversations in therapy around clients’ experience of grief.
Psychometric validation of the AAG confirmed its effectiveness in identifying vulnerability (Sim, Machin, and Bartlam, 2014). However, a 2024 study highlighted a weakness in item 8, which did not align well with the controlled domain. In response, a follow-up study in 2023 revised item 8 to better reflect the controlled aspect of grief. The revised item, “For me, it’s best to avoid thinking about my loss,” was tested with 407 bereaved clients and showed improved internal consistency and strong face validity.
Scores range from 0 to 36, where less than 20 shows low vulnerability, 21-23 is high vulnerability and 24 and above is severe vulnerability. This website is a really helpful place to look at use of the AAG in practice, along with a scoring guide as well as more detail on the underlying model.
You can download the measure here:
Download AAG