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Objective: Applying mindfulness training across cultures can be challenging because its internal motivation depends on values, but there are differences between Western and Eastern contexts. This meta-analysis examines the comparative impacts of the Western Mindfulness-Acceptance-Commitment (MAC) approach and the culturally-adapted Chinese Mindfulness-Acceptance-Insight-Commitment (MAIC) mindfulness training for athletes, to explore the importance of cultural adaptation in cross-cultural psychology to psychological skills training. Methods: This meta-analysis was registered with Prospero (ID: CRD42023474474) and adhered to the PRISMA principles. The PICO search methodology was employed to identify pertinent Chinese and English literature across six databases (Web of Science, PubMed, Scopus, CNKI, Wanfang, and VIP) from 2003 to 2023. The evidence originated from randomized controlled trials. Effect sizes were evaluated across three primary domains: athletic performance, mindfulness, and psychological flexibility, and heterogeneity and publication bias. Results: Both MAC and MAIC demonstrated positive effects across all outcome categories in 18 studies. MAIC exhibited substantially larger effect sizes compared to MAC. In mindfulness (MAIC: g = 1.273, p < 0.001; MAC: g = 0.521, p = 0.001), sports performance (MAIC: g = 0.945, p = 0.015; MAC: g = 0.550, p < 0.001), MAC did not provide evidence of improved psychological flexibility (g = 0.076, p = 0.747), while MAIC demonstrated significant benefits (g = 0.964, p < 0.001). Discussion: While MAIC is based on MAC, it yields more significant outcomes. This may be the "Insight" component introduced by MAIC, which skillfully integrates Eastern context. The MAIC strategy not only becomes more appropriate for local athletes but also indirectly enhances their mindfulness, athletic performance, and psychological flexibility, resulting from cultural adaptation. The new idea not only solves the culture shock caused by the direct application of Western MAC approach on Chinese athletes, but also provides a new solution to the problem that there is insufficient evidence to support the effect of the MAC approach on "psychological flexibility." Investigating differential effects between MAC and MAIC contributes to understanding the significance of culturally adapting mindfulness training and transnational movement of practices. The findings will assist practitioners in selecting evidence-based protocols tailored to athlete needs and cultural contexts. Systematic review registration: Prospero (ID: CRD42023474474). [ABSTRACT FROM AUTHOR]

Background: The benefits of positive psychology interventions (PPIs) have become increasingly popular. While there is an emerging evidence base on the effectiveness of applying positive psychology in curriculum as preventive, early mental health intervention for higher education students, little is known about the content and pedagogy in these promising courses. Objective: This article describes (a) the rationale for and development of a positive psychology course embedded into the curriculum that aims to foster posttraumatic growth, psychological flexibility, and socio-emotional competencies for higher education students; and (b) a mixed-method non-randomised pre-post study to evaluate the effectiveness of the positive psychology course in achieving positive participant outcomes. Methods: Higher education students from different disciplines will be enrolled to a general education course, "Positive Psychology and Personal Growth", where they will learn progressive topics and complete summative assessments related to key areas in positive psychology. In addition to lectures, participants will engage in constructivist-based experiential activities that are guided by research on PPIs, life-design interventions and constructivist learning principles. The primary outcome is posttraumatic growth, and the secondary outcomes are psychological flexibility, and socio-emotional competencies. Expected results: We hypothesised that after the curriculum-embedded PPI, participants will have significantly higher levels of posttraumatic growth, psychological flexibility, and socio-emotional competencies. Results derived from the questionnaire survey will be supported by corroborating evidence identified from qualitative analysis of participants' summative assessments and follow-up semi-structured interviews on their perceptions of the present course. Discussion: The current study will fill in a gap in existing intervention research and practise in curriculum-embedded PPIs and promote research transparency and pedagogical advancement. The intervention provides guidance and recommendations for educators to consider embedding positive psychology into the formal curriculum as cost-effective, low-intensity, structured, and sustainable educational interventions for higher education students. [ABSTRACT FROM AUTHOR]

Pain is a central feature of inflammatory rheumatic diseases and is associated with psychological distress. Pain is widely recognized not as a mere physical sensation, but as a complex, multidimensional phenomenon with an affective component. A plethora of research has conceptualized adaptation to pain by focusing on minimizing the pain experience. However, pain in autoimmune inflammatory rheumatic diseases is often neither avoidable nor curable. This cross-sectional study aimed to investigate the processes explaining how pain intensity may be associated with low well-being and why some patients may live well despite pain. Drawing upon the psychological (in)flexibility model and the process model of emotion regulation, we propose that cognitive reappraisal moderates the association between pain and euthymia through experiential avoidance. Ninety-seven patients with rheumatoid arthritis, psoriatic arthritis, or axial spondyloarthritis were included for analyses (mean age = 53.4; mean time since diagnosis = 9.2 years). Most patients were women (75%), married/cohabitant (71%), and attended high school (47%). Results indicate that experiential avoidance may explain how severe pain is associated with lowered euthymia. This indirect negative effect of pain intensity on euthymia became non-significant at high levels of cognitive reappraisal, suggesting that cognitive reappraisal may serve as a protective factor for patients with autoimmune inflammatory rheumatic diseases. This study paves the way for future research in this promising context by providing an initial step towards integrating emotion regulation and psychological inflexibility in pain conditions. [ABSTRACT FROM AUTHOR]

Purpose: Intensive Care Unit (ICU) staff report that a large part of the workrelated distress they experience is related to communication situations with colleagues, patients, and relatives. Based on these findings, the aim of the present study was to preliminary evaluate the effects of a novel Communication Skills Training (CST) program on mental health among ICU staff. Methods: The CST program was delivered to the entire work force of an ICU at a Swedish hospital and was evaluated as an uncontrolled clinical trial with three repeated measures. 100 participants were eligible and included in the analyses. The theoretical framework for the program was learning theory and cognitive behavioral therapy. The program was delivered by two psychologists and included one full-day lecture and three subsequent two-hour supervision sessions. Changes in mental health was evaluated with self-report questionnaires measuring perceived stress, general mental health, work engagement, and psychological flexibility. Results: Analyses of three repeated measures showed significant improvements with 1.3 points lower perceived stress and 2.0 points lower general mental health after the intervention. No differences were seen in measures of work engagement or psychological flexibility. Conclusion: Findings of the study supports the utility of the CST program as an intervention to target perceived stress and general mental health within intensive care. These findings should be further validated in trials with improved design. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic held considerable health-related outcomes worldwide, including mental health challenges, with elevated risk of psychiatric sequelae. Methods: This study aimed to test the longitudinal (1 year) predictive role of psychosocial factors on post-traumatic stress disorder (PTSD), anxiety, and depressive symptoms in SARS-CoV-2 survivors (N = 209 at T1; N = 61; attrition rate 70.83%), through Pearson's correlation analyses and longitudinal multiple regression analyses. Participants (age M = 35.4, SD = 10.1) completed online selfreport questionnaires of psychosocial variables, PTSD, anxiety, and depression. Results: Depression and anxiety symptoms were increased, and 42% of survivors presented clinically meaningful PTSD symptoms. PTSD symptoms were longitudinally predicted by having children (β = 0.32, p < 0.01), number of recent major life events (β = 0.34, p < 0.01), and psychological flexibility (β = -0.36, p < 0.01). Number of major life events (β = 0.29, p < 0.05) and psychological flexibility (β = -0.29, p < 0.05) predicted anxiety. Number of recent major life events (β = 0.32, p < 0.01) was the sole predictor of depressive symptoms. Discussion: Psychosocial variables contribute to the long-term harmful effects of the COVID-19 pandemic on psychopathological symptoms. These results suggest that, during the pandemic, mental health was impacted by both sociocontextual factors and individual self-regulatory skills, namely the ability to respond flexibily to contextual cues and guide behavior according to the direct experience. Specifically, results point out the importance of societal incentives to reduce parental burden and socioeconomic losses, as well as to promote adaptive psychological skills such as psychological flexibility. [ABSTRACT FROM AUTHOR]

Objectives: Increasing psychological flexibility is considered an important mechanism of change in psychotherapy across diagnoses. In particular, Acceptance and Commitment Therapy (ACT) primarily aims at increasing psychological flexibility in order to live a more fulfilling and meaningful life. The purpose of this study is to examine 1) how psychological flexibility changes during an ACT-based treatment in a transdiagnostic day hospital and 2) how this change is related to changes in symptomatology, quality of life, and general level of functioning. Methods: 90 patients of a psychiatric day hospital participated in the study. Psychological flexibility, symptomatology, and quality of life were assessed at three measurement time points (admission, discharge, and 3-month follow-up). The level of functioning was assessed at admission and discharge. Differences in psychological flexibility were tested via two-sided paired samples t-tests. Correlations of residualized change scores were calculated to detect associations between changes in psychological flexibility and other outcomes. Results: Psychological flexibility increased significantly from pre-treatment to posttreatment (d = .43, p <.001) and from pre-treatment to follow-up (d = .54, p <.001). This change was significantly correlated to a decrease in symptomatology (r = .60 --.83, p <.001) and an increase in most dimensions of quality of life (r = -.43 -- -.75, p <.001) and general level of functioning (r =-.34, p = .003). Discussion: This study adds further evidence for psychological flexibility as a transdiagnostic process variable of successful psychotherapy. Limitations are discussed. [ABSTRACT FROM AUTHOR]

Introduction: Children and adolescents with diabetes face challenges that can significantly impact their quality of life. Investigating psychological interventions for stress management can equip them with the skills needed to cope with type 1 diabetes. This study investigated the impact of a brief Acceptance and Commitment Therapy (ACT) intervention on stress management, diabetes acceptance, psychological flexibility, and patient-doctor relationships among this population. Methods: A total of 55 children, and adolescents from Romania participated in a four-session ACT intervention for type 1 diabetes. The evaluation instruments used were the Perceived Stress Scale for Children (PSS-C), Acceptance and Action Diabetes Questionnaire (AADQ), Children's Psychological Flexibility Questionnaire (CPFQ), and Patient-Doctor Relationship Questionnaire (PDRQ-9). Results: The participants (mean age = 14.14, SD = 2.26; 67% girls) reported lower stress levels, increased acceptance of diabetes, and greater psychological flexibility after the intervention. Additionally, the patient-doctor relationship was enhanced, potentially improving patient adherence to treatment. Positive qualitative feedback mirrored previous ACT research in the paediatric population, highlighting the beneficial role of experiential activities and metaphors when working with this target group. Discussion: This study adds to the growing body of evidence supporting the effectiveness of ACT in enhancing healthy coping strategies among children and adolescents with chronic illnesses. [ABSTRACT FROM AUTHOR]

Background: Despite promising emerging evidence on the protective properties and interrelationships of posttraumatic growth, career adaptability and psychological flexibility, no studies have reported interventions that promote these positive personal resources among higher education students. Nurturing these positive personal resources in future interventions is recommended to holistically address students' developmental, academic and career-related challenges associated with major transitions. This paper describes (a) the rationale for and development of a tailored growth-based career construction psychosocial intervention, 'Sailing through Life and My Career Path' (SLCP) for higher education students; and (b) a mixed-method non-randomised pre-post study to evaluate the effectiveness of the proposed psychosocial intervention in achieving positive participant outcomes. Methods and analysis: Over a 12-week period, higher education students will be recruited to take part in group and independent learning activities that are tailored to nurture positive personal resources to overcome challenges related to developmental, academic and career-related transitions. Quantitative data will be collected before and after the intervention and will be analysed using SPSS v26. Follow-up semi-structured interviews with participants (students), interventionists (group facilitators), and administrators will be conducted to explore perceptions of the intervention, to understand its process of change, and to determine its feasibility and acceptability in the higher education setting. All interviews will be transcribed and analysed using thematic analysis. Discussion: By filling in a gap in existing intervention research and practice, the proposed study serves to generate new knowledge and insights by evaluating the effectiveness of a tailored psychosocial intervention that responds to the complex needs associated with major life transitions of higher education students. [ABSTRACT FROM AUTHOR]

ObjectiveApplying mindfulness training across cultures can be challenging because its internal motivation depends on values, but there are differences between Western and Eastern contexts. This meta-analysis examines the comparative impacts of the Western Mindfulness-Acceptance-Commitment (MAC) approach and the culturally-adapted Chinese Mindfulness-Acceptance-Insight-Commitment (MAIC) mindfulness training for athletes, to explore the importance of cultural adaptation in cross-cultural psychology to psychological skills training.MethodsThis meta-analysis was registered with Prospero (ID: CRD42023474474) and adhered to the PRISMA principles. The PICO search methodology was employed to identify pertinent Chinese and English literature across six databases (Web of Science, PubMed, Scopus, CNKI, Wanfang, and VIP) from 2003 to 2023. The evidence originated from randomized controlled trials. Effect sizes were evaluated across three primary domains: athletic performance, mindfulness, and psychological flexibility, and heterogeneity and publication bias.ResultsBoth MAC and MAIC demonstrated positive effects across all outcome categories in 18 studies. MAIC exhibited substantially larger effect sizes compared to MAC. In mindfulness (MAIC: g = 1.273, p

Pain is a central feature of inflammatory rheumatic diseases and is associated with psychological distress. Pain is widely recognized not as a mere physical sensation, but as a complex, multidimensional phenomenon with an affective component. A plethora of research has conceptualized adaptation to pain by focusing on minimizing the pain experience. However, pain in autoimmune inflammatory rheumatic diseases is often neither avoidable nor curable. This cross-sectional study aimed to investigate the processes explaining how pain intensity may be associated with low well-being and why some patients may live well despite pain. Drawing upon the psychological (in)flexibility model and the process model of emotion regulation, we propose that cognitive reappraisal moderates the association between pain and euthymia through experiential avoidance. Ninety-seven patients with rheumatoid arthritis, psoriatic arthritis, or axial spondyloarthritis were included for analyses (mean age = 53.4; mean time since diagnosis = 9.2 years). Most patients were women (75%), married/cohabitant (71%), and attended high school (47%). Results indicate that experiential avoidance may explain how severe pain is associated with lowered euthymia. This indirect negative effect of pain intensity on euthymia became non-significant at high levels of cognitive reappraisal, suggesting that cognitive reappraisal may serve as a protective factor for patients with autoimmune inflammatory rheumatic diseases. This study paves the way for future research in this promising context by providing an initial step towards integrating emotion regulation and psychological inflexibility in pain conditions.

Employees may experience stress in the workplace for various reasons. Psychological strengths may help them to cope with emerging challenges and foster mental health and work productivity. This study examined the mediating roles of meaning in life and psychological flexibility in the relationships between perceived occupational stress and job satisfaction, job performance and psychological distress. This cross-section study included 554 teachers (56.0% males; Mage = 36.99 ± 7.88 years) at all school levels in Türkiye. The research data was collected through a convenience sampling method using an online survey. Participants completed self-report measures of meaning in life, psychological flexibility, perceived occupational stress, job satisfaction, job performance, and psychological distress. Pearson product--moment correlation and parallel mediation model using PROCESS macro (Model 4) were utilized to analyze the data. The results showed that perceived occupational stress had a significant effect on meaning in life, psychological flexibility, job satisfaction, job performance, and psychological distress. Also, meaning in life and psychological flexibility had significant effects on job satisfaction, job performance, and psychological distress. Furthermore, meaning in life and psychological flexibility partially mediated the relationships between occupational stress and job satisfaction, job performance, and psychological distress. These findings highlight the significance of considering meaning in life and psychological flexibility as crucial factors in mitigating the impact of occupational stress on employee mental health and work productivity. By focusing on enhancing employees' sense of meaning and their ability to adapt flexibly to workplace challenges, organizations can potentially create a better environment that fosters positive outcomes for both employees and the organization. However, the impact of occupational stress on job performance, job satisfaction and psychological distress may change over time. To address this concern, future research should test the model through a longitudinal study design. [ABSTRACT FROM AUTHOR]

Introduction: The aim of our study is to explore the relationship between procrastination, time management skills and psychological flexibility and the changes in them during an Acceptance and Commitment therapy (ACT)-based course that included time management training. We also explored the effects of time management skills and psychological flexibility on procrastination. The study used an experimental design in an ACT-based well-being course that included time management training. Methods: The participants were 109 students taking the course and 27 waiting list students. Analyses were conducted with Pearson correlation, mixed ANOVA and causal mediation analysis. Results and discussion: Our results show that time management skills, psychological flexibility and procrastination were related to each other, and all changed during the course. In addition, change in both time management and psychological flexibility had an impact on the change in procrastination during the course. The results show that both time management and psychological flexibility influence the change in procrastination during an ACT-based course. [ABSTRACT FROM AUTHOR]

Psychological constructs related to health outcomes and well-being, such as metacognitive beliefs, have been linked to executive functions in general, and cognitive flexibility more specifically. However, such effects have previously only been discussed on a theoretical level and behavioral flexibility has most often been measured through self-report, only approximating information processing capacities. Objectively measured executive functions may be a more potent predictor of health outcomes. We set out to test whether cognitive flexibility capacity was associated with sick leave in a medium sized company. We included 111 subjects of widely different occupations and assessed their executive functions using Delis-Kaplan Executive Function System test battery (D-KEFS). To assess cognitive flexibility capacity, we included Design Fluency (DF) and Verbal Fluency (VF) and computed these into an index of cognitive flexibility (DFVF). Detailed information on sick leave for the last 5 years was gathered from the company. Our results showed that there was a significant negative correlation between DFVF and sick leave [rs(109) = -0.23, p = 0.015] in the full group as well as in the group that had at least 1 day of sick leave [rs(72) = -0.25, p = 0.03]. The results withstood adjustment for sex, age, occupation, and several core executive functions as well as autistic and ADHD-traits. The results remained for separate analyses using DF or VF. Our main findings were conceptually replicated in a group of bipolar disorder patients. This study shows that objectively measured capacity of cognitive flexibility is associated with key health outcomes such as sick leave. [ABSTRACT FROM AUTHOR]

BackgroundThe benefits of positive psychology interventions (PPIs) have become increasingly popular. While there is an emerging evidence base on the effectiveness of applying positive psychology in curriculum as preventive, early mental health intervention for higher education students, little is known about the content and pedagogy in these promising courses.ObjectiveThis article describes (a) the rationale for and development of a positive psychology course embedded into the curriculum that aims to foster posttraumatic growth, psychological flexibility, and socio-emotional competencies for higher education students; and (b) a mixed-method non-randomised pre-post study to evaluate the effectiveness of the positive psychology course in achieving positive participant outcomes.MethodsHigher education students from different disciplines will be enrolled to a general education course, “Positive Psychology and Personal Growth”, where they will learn progressive topics and complete summative assessments related to key areas in positive psychology. In addition to lectures, participants will engage in constructivist-based experiential activities that are guided by research on PPIs, life-design interventions and constructivist learning principles. The primary outcome is posttraumatic growth, and the secondary outcomes are psychological flexibility, and socio-emotional competencies.Expected resultsWe hypothesised that after the curriculum-embedded PPI, participants will have significantly higher levels of posttraumatic growth, psychological flexibility, and socio-emotional competencies. Results derived from the questionnaire survey will be supported by corroborating evidence identified from qualitative analysis of participants' summative assessments and follow-up semi-structured interviews on their perceptions of the present course.DiscussionThe current study will fill in a gap in existing intervention research and practise in curriculum-embedded PPIs and promote research transparency and pedagogical advancement. The intervention provides guidance and recommendations for educators to consider embedding positive psychology into the formal curriculum as cost-effective, low-intensity, structured, and sustainable educational interventions for higher education students.

IntroductionThe COVID-19 pandemic held considerable health-related outcomes worldwide, including mental health challenges, with elevated risk of psychiatric sequelae.MethodsThis study aimed to test the longitudinal (1 year) predictive role of psychosocial factors on post-traumatic stress disorder (PTSD), anxiety, and depressive symptoms in SARS-CoV-2 survivors (N = 209 at T1; N = 61; attrition rate 70.83%), through Pearson’s correlation analyses and longitudinal multiple regression analyses. Participants (age M = 35.4, SD = 10.1) completed online self-report questionnaires of psychosocial variables, PTSD, anxiety, and depression.ResultsDepression and anxiety symptoms were increased, and 42% of survivors presented clinically meaningful PTSD symptoms. PTSD symptoms were longitudinally predicted by having children (β = 0.32, p

ObjectivesIncreasing psychological flexibility is considered an important mechanism of change in psychotherapy across diagnoses. In particular, Acceptance and Commitment Therapy (ACT) primarily aims at increasing psychological flexibility in order to live a more fulfilling and meaningful life. The purpose of this study is to examine 1) how psychological flexibility changes during an ACT-based treatment in a transdiagnostic day hospital and 2) how this change is related to changes in symptomatology, quality of life, and general level of functioning.Methods90 patients of a psychiatric day hospital participated in the study. Psychological flexibility, symptomatology, and quality of life were assessed at three measurement time points (admission, discharge, and 3-month follow-up). The level of functioning was assessed at admission and discharge. Differences in psychological flexibility were tested via two-sided paired samples t-tests. Correlations of residualized change scores were calculated to detect associations between changes in psychological flexibility and other outcomes.ResultsPsychological flexibility increased significantly from pre-treatment to post-treatment (d = .43, p

Introduction: Stigma adversely affects people with chronic pain. The qualities within self-compassion may be particularly useful for buffering the impact of stigma on people with pain. In the context of an Acceptance and Commitment Therapy-based (ACT) treatment for chronic pain, this study investigated the association between changes in stigma and self-compassion and pain outcomes, and the potential moderating role of self-compassion on the association between stigma and pain outcomes. Materials and methods: Five-hundred and nineteen patients completed standardized self-report questionnaires of stigma, self-compassion, psychological flexibility, pain intensity and interference, work and social adjustment, and depression symptoms at the start of an interdisciplinary ACT-based treatment for chronic pain. The same measures were completed at post-treatment (n = 431). Results: The results indicated that key pain outcomes and self-compassion significantly improved during treatment, but stigma did not. Changes in stigma and self-compassion were significantly negatively correlated and changes in these variables were associated with improvements in treatment outcomes. There were significant main effects of stigma and self-compassion for many of the pre and post-treatment regression models when psychological flexibility was not controlled for, but self-compassion did not moderate the association between stigma and pain outcomes. Stigma remained significant when psychological flexibility variables were controlled for, while self-compassion did not. Discussion: The findings add to our conceptual understanding of the inter-relationships between stigma, self-compassion, and psychological flexibility and can contribute to treatment advancements to optimally target these variables. [ABSTRACT FROM AUTHOR]

Background: Enhancing resiliency and optimizing readiness in military personnel is a high priority for the U.S. Department of Defense. Most military resiliency-enhancement programs are evidence-informed interventions. However, few randomized studies have demonstrated efficacy of any intervention or training program to enhance resiliency and prevent the development of psychological health symptoms in military personnel when exposed to operational stressors. This manuscript provides an overview of the theoretical foundation, research design, and research methods of a preventive intervention trial designed to evaluate the efficacy of a training program to enhance resiliency and prevent psychological health symptoms in military personnel. The resiliency training intervention is based on Acceptance and Commitment Therapy (ACT), an evidence-based intervention with broad empirical support for improving functioning in those living with psychological and medical conditions. Method/design: This study will evaluate the efficacy of a two-day training program based on ACT for fostering psychological flexibility, the central target in ACT, for enhancing resiliency, and for preventing the development of psychological health symptoms. The research participants will be a nonclinical population of active duty military personnel (N = 600). The ACT-based training program (n = 300) will be compared to a military resiliency training as usual, known as Master Resilience Training (n = 300). Assessment measures will be administered at the baseline assessment, after training, prior to a military deployment, and after returning from a deployment. Qualitative interviews will be conducted to provide feedback on the training program. [ABSTRACT FROM AUTHOR]

IntroductionChildren and adolescents with diabetes face challenges that can significantly impact their quality of life. Investigating psychological interventions for stress management can equip them with the skills needed to cope with type 1 diabetes. This study investigated the impact of a brief Acceptance and Commitment Therapy (ACT) intervention on stress management, diabetes acceptance, psychological flexibility, and patient-doctor relationships among this population.MethodsA total of 55 children, and adolescents from Romania participated in a four-session ACT intervention for type 1 diabetes. The evaluation instruments used were the Perceived Stress Scale for Children (PSS-C), Acceptance and Action Diabetes Questionnaire (AADQ), Children’s Psychological Flexibility Questionnaire (CPFQ), and Patient-Doctor Relationship Questionnaire (PDRQ-9).ResultsThe participants (mean age = 14.14, SD = 2.26; 67% girls) reported lower stress levels, increased acceptance of diabetes, and greater psychological flexibility after the intervention. Additionally, the patient-doctor relationship was enhanced, potentially improving patient adherence to treatment. Positive qualitative feedback mirrored previous ACT research in the paediatric population, highlighting the beneficial role of experiential activities and metaphors when working with this target group.DiscussionThis study adds to the growing body of evidence supporting the effectiveness of ACT in enhancing healthy coping strategies among children and adolescents with chronic illnesses.

BackgroundDespite promising emerging evidence on the protective properties and interrelationships of posttraumatic growth, career adaptability and psychological flexibility, no studies have reported interventions that promote these positive personal resources among higher education students. Nurturing these positive personal resources in future interventions is recommended to holistically address students’ developmental, academic and career-related challenges associated with major transitions. This paper describes (a) the rationale for and development of a tailored growth-based career construction psychosocial intervention, ‘Sailing through Life and My Career Path’ (SLCP) for higher education students; and (b) a mixed-method non-randomised pre-post study to evaluate the effectiveness of the proposed psychosocial intervention in achieving positive participant outcomes.Methods and analysisOver a 12-week period, higher education students will be recruited to take part in group and independent learning activities that are tailored to nurture positive personal resources to overcome challenges related to developmental, academic and career-related transitions. Quantitative data will be collected before and after the intervention and will be analysed using SPSS v26. Follow-up semi-structured interviews with participants (students), interventionists (group facilitators), and administrators will be conducted to explore perceptions of the intervention, to understand its process of change, and to determine its feasibility and acceptability in the higher education setting. All interviews will be transcribed and analysed using thematic analysis.DiscussionBy filling in a gap in existing intervention research and practice, the proposed study serves to generate new knowledge and insights by evaluating the effectiveness of a tailored psychosocial intervention that responds to the complex needs associated with major life transitions of higher education students.

Employees may experience stress in the workplace for various reasons. Psychological strengths may help them to cope with emerging challenges and foster mental health and work productivity. This study examined the mediating roles of meaning in life and psychological flexibility in the relationships between perceived occupational stress and job satisfaction, job performance and psychological distress. This cross-section study included 554 teachers (56.0% males; Mage = 36.99 ± 7.88 years) at all school levels in Türkiye. The research data was collected through a convenience sampling method using an online survey. Participants completed self-report measures of meaning in life, psychological flexibility, perceived occupational stress, job satisfaction, job performance, and psychological distress. Pearson product–moment correlation and parallel mediation model using PROCESS macro (Model 4) were utilized to analyze the data. The results showed that perceived occupational stress had a significant effect on meaning in life, psychological flexibility, job satisfaction, job performance, and psychological distress. Also, meaning in life and psychological flexibility had significant effects on job satisfaction, job performance, and psychological distress. Furthermore, meaning in life and psychological flexibility partially mediated the relationships between occupational stress and job satisfaction, job performance, and psychological distress. These findings highlight the significance of considering meaning in life and psychological flexibility as crucial factors in mitigating the impact of occupational stress on employee mental health and work productivity. By focusing on enhancing employees’ sense of meaning and their ability to adapt flexibly to workplace challenges, organizations can potentially create a better environment that fosters positive outcomes for both employees and the organization. However, the impact of occupational stress on job performance, job satisfaction and psychological distress may change over time. To address this concern, future research should test the model through a longitudinal study design.

IntroductionThe aim of our study is to explore the relationship between procrastination, time management skills and psychological flexibility and the changes in them during an Acceptance and Commitment therapy (ACT)-based course that included time management training. We also explored the effects of time management skills and psychological flexibility on procrastination. The study used an experimental design in an ACT-based well-being course that included time management training.MethodsThe participants were 109 students taking the course and 27 waiting list students. Analyses were conducted with Pearson correlation, mixed ANOVA and causal mediation analysis.Results and discussionOur results show that time management skills, psychological flexibility and procrastination were related to each other, and all changed during the course. In addition, change in both time management and psychological flexibility had an impact on the change in procrastination during the course. The results show that both time management and psychological flexibility influence the change in procrastination during an ACT-based course.

Recognizing the pivotal role of psychosocial factors in triggering and maintaining Type 1 Diabetes Mellitus (T1DM), the integration of psychoeducational and psychotherapeutic interventions is associated with comprehensive management of the disease. This study aimed to evaluate the impact of a four-week online individual Acceptance and Commitment Therapy (ACT) intervention in mitigating diabetes-associated stress, fostering diabetes acceptance, enhancing the patient-doctor relationship, and promoting psychological flexibility in adults diagnosed with T1DM. Employing a single-arm trial design with mixed methodology, thirteen participants (Mage = 39.04, SDage =13.74) engaged in the intervention and completed self-report measures before and after the intervention. Quantitative analysis with the Wilcoxon signed-rank test indicated a statistically significant difference in diabetes-associated stress, diabetes acceptance, and psychological flexibility pre- and post-intervention. Notably, stress levels and psychological inflexibility diminished, while psychological flexibility and diabetes acceptance improved. However, the patient-doctor relationship did not exhibit a significant change. Furthermore, narrative feedback obtained from participants reflected overall satisfaction with the intervention. These preliminary findings contribute to the expanding body of literature supporting the affirmative influence of ACT interventions on individuals with T1DM.

IntroductionStigma adversely affects people with chronic pain. The qualities within self-compassion may be particularly useful for buffering the impact of stigma on people with pain. In the context of an Acceptance and Commitment Therapy-based (ACT) treatment for chronic pain, this study investigated the association between changes in stigma and self-compassion and pain outcomes, and the potential moderating role of self-compassion on the association between stigma and pain outcomes.Materials and methodsFive-hundred and nineteen patients completed standardized self-report questionnaires of stigma, self-compassion, psychological flexibility, pain intensity and interference, work and social adjustment, and depression symptoms at the start of an interdisciplinary ACT-based treatment for chronic pain. The same measures were completed at post-treatment (n = 431).ResultsThe results indicated that key pain outcomes and self-compassion significantly improved during treatment, but stigma did not. Changes in stigma and self-compassion were significantly negatively correlated and changes in these variables were associated with improvements in treatment outcomes. There were significant main effects of stigma and self-compassion for many of the pre- and post-treatment regression models when psychological flexibility was not controlled for, but self-compassion did not moderate the association between stigma and pain outcomes. Stigma remained significant when psychological flexibility variables were controlled for, while self-compassion did not.DiscussionThe findings add to our conceptual understanding of the inter-relationships between stigma, self-compassion, and psychological flexibility and can contribute to treatment advancements to optimally target these variables.

BackgroundEnhancing resiliency and optimizing readiness in military personnel is a high priority for the U.S. Department of Defense. Most military resiliency-enhancement programs are evidence-informed interventions. However, few randomized studies have demonstrated efficacy of any intervention or training program to enhance resiliency and prevent the development of psychological health symptoms in military personnel when exposed to operational stressors. This manuscript provides an overview of the theoretical foundation, research design, and research methods of a preventive intervention trial designed to evaluate the efficacy of a training program to enhance resiliency and prevent psychological health symptoms in military personnel. The resiliency training intervention is based on Acceptance and Commitment Therapy (ACT), an evidence-based intervention with broad empirical support for improving functioning in those living with psychological and medical conditions.Method/designThis study will evaluate the efficacy of a two-day training program based on ACT for fostering psychological flexibility, the central target in ACT, for enhancing resiliency, and for preventing the development of psychological health symptoms. The research participants will be a non-clinical population of active duty military personnel (N = 600). The ACT-based training program (n = 300) will be compared to a military resiliency training as usual, known as Master Resilience Training (n = 300). Assessment measures will be administered at the baseline assessment, after training, prior to a military deployment, and after returning from a deployment. Qualitative interviews will be conducted to provide feedback on the training program.Clinical Trial Registration: NCT05094115.

Interventions to preserve functional independence in older adults are critically needed to optimize ‘successful aging’ among the large and increasing population of older adults in the United States. For most aging adults, the management of chronic diseases is the most common and impactful risk factor for loss of functional independence. Chronic disease management inherently involves the learning and adaptation of new behaviors, such as adopting or modifying physical activity habits and managing weight. Despite the importance of chronic disease management in older adults, vanishingly few individuals optimally manage their health behavior in the service of chronic disease stabilization to preserve functional independence. Contemporary conceptual models of chronic disease management and health habit theory suggest that this lack of optimal management may result from an underappreciated distinction within the health behavior literature: the behavioral domains critical for initiation of new behaviors (Initiation Phase) are largely distinct from those that facilitate their maintenance (Maintenance Phase). Psychological factors, particularly experiential acceptance and trait levels of openness are critical to engagement with new health behaviors, willingness to make difficult lifestyle changes, and the ability to tolerate aversive affective responses in the process. Cognitive factors, particularly executive function, are critical to learning new skills, using them effectively across different areas of life and contextual demands, and updating of skills to facilitate behavioral maintenance. Emerging data therefore suggests that individuals with greater executive function are better able to sustain behavior changes, which in turn protects against cognitive decline. In addition, social and structural supports of behavior change serve a critical buffering role across phases of behavior change. The present review attempts to address these gaps by proposing a novel biobehavioral intervention framework that incorporates both individual-level and social support system-level variables for the purpose of treatment tailoring. Our intervention framework triangulates on the central importance of self-regulatory functioning, proposing that both cognitive and psychological mechanisms ultimately influence an individuals’ ability to engage in different aspects of self-management (individual level) in the service of maintaining independence. Importantly, the proposed linkages of cognitive and affective functioning align with emerging individual difference frameworks, suggesting that lower levels of cognitive and/or psychological flexibility represent an intermediate phenotype of risk. Individuals exhibiting selfregulatory lapses either due to the inability to regulate their emotional responses or due to the presence of executive functioning impairments are therefore the most likely to require assistance to preserve functional independence. In addition, these vulnerabilities will be more easily observable for individuals requiring greater complexity of self-management behavioral demands (e.g. complexity of medication regimen) and/or with lesser social support. Our proposed framework also intuits several distinct intervention pathways based on the profile of selfregulatory behaviors: we propose that individuals with intact affect regulation and impaired executive function will preferentially respond to ‘top-down’ training approaches (e.g., strategy and process work). Individuals with intact executive function and impaired affect regulation will respond to ‘bottom-up’ approaches (e.g., graded exposure). And individuals with impairments in both may require treatments targeting caregiving or structural supports, particularly in the context of elevated behavioral demands. [ABSTRACT FROM AUTHOR]

Introduction: University students are among the groups most adversely affected by COVID-19 in terms of their psychological and academic wellbeing, particularly given the pandemic's uncertainty. However, little is known about their psychological flexibility to deal with this uncertain nature of pandemic. This study aimed to examine the mediating role of psychological flexibility (PF) in the relationship between university students' intolerance of uncertainty (IU) and their academic adjustment to the online learning process during COVID-19. Methods: Data was collected from 388 university students from Türkiye (18-34 (Mage = 21.43, SD = 2.04) who completed five questionnaires - Intolerance of Uncertainty Scale, Acceptance and Action Questionnaire II, Academic Self Efficacy Scale, Educational Stress Scale, and Online Self-Regulatory Learning Scale. Additionally, as indicators of students' academic adjustment, perceived academic performance - ranging 1 to 10, and their last academic grade point average before and during the pandemic were also collected. Results: The results indicated that PF and IU had a significant effect on the academic adjustment of students during the pandemic. PF had a complete mediating role between the IU and academic adjustment. Results also revealed that online self-regulation, a sub-dimension of academic adjustment, did not show a significant relationship with any other variable in the model. Discussion: Research findings showed that psychological flexibility is a very important strength for university students to maintain their academic adjustment in stressful times. The results were discussed in light of the relevant research, and recommendations for further research and implications were provided. [ABSTRACT FROM AUTHOR]

IntroductionHIV and mental health problems are a global syndemic. One key issue is that the significant mental health problems among people vulnerable to acquiring or living with HIV have not been fully addressed. Access to social support has been one of the biggest challenges for HIV-positive men who have sex with men (HIV+ MSM). Lower social support has been linked to more severe depression symptoms. However, the mechanisms underlying the association between social support and depression in HIV+ MSM are unclear. Two possible mediators include hope and psychological flexibility. This study aimed to examine the relationship between social support and depression in HIV+ MSM and to explore the single mediating effects of hope and psychological flexibility and the chain mediating effect of these two variables on this relationship.MethodsA convenience sample was used to recruit participants from the designated HIV/AIDS hospital in Changsha city, Hunan Province of China. A total of 290 HIV+ MSM completed questionnaires.ResultsOur findings showed that hope mediated the relationship between social support and depression in HIV+ MSM. Furthermore, the chain mediation model confirmed a direct negative association between social support and depression, but this relationship was largely mediated by the chain effects of hope and psychological flexibility.ConclusionsIntegrating hope and psychological flexibility into interventions may provide better mental health support for HIV+ MSM and improve their wellbeing and quality of life.

Interventions to preserve functional independence in older adults are critically needed to optimize ‘successful aging’ among the large and increasing population of older adults in the United States. For most aging adults, the management of chronic diseases is the most common and impactful risk factor for loss of functional independence. Chronic disease management inherently involves the learning and adaptation of new behaviors, such as adopting or modifying physical activity habits and managing weight. Despite the importance of chronic disease management in older adults, vanishingly few individuals optimally manage their health behavior in the service of chronic disease stabilization to preserve functional independence. Contemporary conceptual models of chronic disease management and health habit theory suggest that this lack of optimal management may result from an underappreciated distinction within the health behavior literature: the behavioral domains critical for initiation of new behaviors (Initiation Phase) are largely distinct from those that facilitate their maintenance (Maintenance Phase). Psychological factors, particularly experiential acceptance and trait levels of openness are critical to engagement with new health behaviors, willingness to make difficult lifestyle changes, and the ability to tolerate aversive affective responses in the process. Cognitive factors, particularly executive function, are critical to learning new skills, using them effectively across different areas of life and contextual demands, and updating of skills to facilitate behavioral maintenance. Emerging data therefore suggests that individuals with greater executive function are better able to sustain behavior changes, which in turn protects against cognitive decline. In addition, social and structural supports of behavior change serve a critical buffering role across phases of behavior change. The present review attempts to address these gaps by proposing a novel biobehavioral intervention framework that incorporates both individual-level and social support system-level variables for the purpose of treatment tailoring. Our intervention framework triangulates on the central importance of self-regulatory functioning, proposing that both cognitive and psychological mechanisms ultimately influence an individuals’ ability to engage in different aspects of self-management (individual level) in the service of maintaining independence. Importantly, the proposed linkages of cognitive and affective functioning align with emerging individual difference frameworks, suggesting that lower levels of cognitive and/or psychological flexibility represent an intermediate phenotype of risk. Individuals exhibiting self-regulatory lapses either due to the inability to regulate their emotional responses or due to the presence of executive functioning impairments are therefore the most likely to require assistance to preserve functional independence. In addition, these vulnerabilities will be more easily observable for individuals requiring greater complexity of self-management behavioral demands (e.g. complexity of medication regimen) and/or with lesser social support. Our proposed framework also intuits several distinct intervention pathways based on the profile of self-regulatory behaviors: we propose that individuals with intact affect regulation and impaired executive function will preferentially respond to ‘top-down’ training approaches (e.g., strategy and process work). Individuals with intact executive function and impaired affect regulation will respond to ‘bottom-up’ approaches (e.g., graded exposure). And individuals with impairments in both may require treatments targeting caregiving or structural supports, particularly in the context of elevated behavioral demands.

IntroductionUniversity students are among the groups most adversely affected by COVID-19 in terms of their psychological and academic wellbeing, particularly given the pandemic’s uncertainty. However, little is known about their psychological flexibility to deal with this uncertain nature of pandemic. This study aimed to examine the mediating role of psychological flexibility (PF) in the relationship between university students’ intolerance of uncertainty (IU) and their academic adjustment to the online learning process during COVID-19.MethodsData was collected from 388 university students from Türkiye (18–34 (Mage = 21.43, SD = 2.04) who completed five questionnaires – Intolerance of Uncertainty Scale, Acceptance and Action Questionnaire II, Academic Self Efficacy Scale, Educational Stress Scale, and Online Self-Regulatory Learning Scale. Additionally, as indicators of students’ academic adjustment, perceived academic performance – ranging 1 to 10, and their last academic grade point average before and during the pandemic were also collected.ResultsThe results indicated that PF and IU had a significant effect on the academic adjustment of students during the pandemic. PF had a complete mediating role between the IU and academic adjustment. Results also revealed that online self-regulation, a sub-dimension of academic adjustment, did not show a significant relationship with any other variable in the model.DiscussionResearch findings showed that psychological flexibility is a very important strength for university students to maintain their academic adjustment in stressful times. The results were discussed in light of the relevant research, and recommendations for further research and implications were provided.

Sexual satisfaction is tremendously relevant to wellbeing and quality of life. Inversely, hypersexuality may increase the risk of psychological distress, unprotected sex, and marital problems. This study attempts to explore the sociodemographic variables related to hypersexuality and the relationship between hypersexuality and sexual dissatisfaction with psychological inflexibility, cognitive fusion, body awareness, bodily dissociation, and mindfulness skills in the Spanish population. The sample was made up of 530 participants between 18 and 67 years of age. In total, 5.5% displayed hypersexuality, more likely in males, lesbians and gay men, singles, and students. An online survey was conducted including standardized questionnaires as follows: AAQ-II, CFQ, SBC, MAAS, NSSS-S, and HBI. Significant moderate positive correlations were found between hypersexuality and psychological inflexibility, cognitive fusion, and bodily dissociation, and an inverse moderate correlation with mindfulness skills. Moderate negative correlations were found between sexual satisfaction and bodily dissociation. Linear regression showed psychological inflexibility was the variable with the most weight on hypersexuality, while bodily dissociation was the variable with the most influence on sexual dissatisfaction. This study suggests lesbians and gay men, males, and singles may show an increased vulnerability toward engaging in hypersexual behavior and provides justification for interventions focused on psychological inflexibility and mindfulness skills to treat hypersexuality and improve sexual satisfaction. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated the validity and reliability of the Chinese version of the Core Extrusion Schema-Revised (CES-R) for assessing high school students and measures invariance across gender and grade parameters. Methods: A sample of 1,334 high school students in Wuhan, China, participated in the study for item analysis, internal consistency tests, and measurement invariance tests of the CES-R. Additionally, 1745 high school students in Zhejiang Province, China. provided data for questionnaire validation. Results: The results of the confirmatory factor analysis showed that the two-dimensional model fit the data well [chi-squared discrepancy = 113.989; degrees of freedom = 26; Tucker-Lewis index (TLI) = 0.949; comparative fit index (CFI) = 0.963; standardized root mean square residual = 0.072]. The Chinese CES-R scores were positively correlated with both the Adolescent Avoidance and Integration Questionnaire scores (r = 0.63, p < 0.01) and the Adolescent Social Anxiety Questionnaire scores (r = 0.70, p < 0.01). The internal consistency coefficient of the questionnaire was 0.94, and the split-half reliability was 0.90. The factor structure invariance, factor loading invariance, and intercept invariance of the Chinese CES-R across gender and grade groups (ΔCFI <0.01, ΔTLI <0.01, ΔRMSEA <0.01) indicated equivalence across gender and grade groups. Conclusion: The Chinese version of CES-R has good validity and reliability for evaluating high school students and acceptable measurement invariance across genders and grades. [ABSTRACT FROM AUTHOR]

Sexual satisfaction is tremendously relevant to wellbeing and quality of life. Inversely, hypersexuality may increase the risk of psychological distress, unprotected sex, and marital problems. This study attempts to explore the sociodemographic variables related to hypersexuality and the relationship between hypersexuality and sexual dissatisfaction with psychological inflexibility, cognitive fusion, body awareness, bodily dissociation, and mindfulness skills in the Spanish population. The sample was made up of 530 participants between 18 and 67 years of age. In total, 5.5% displayed hypersexuality, more likely in males, lesbians and gay men, singles, and students. An online survey was conducted including standardized questionnaires as follows: AAQ-II, CFQ, SBC, MAAS, NSSS-S, and HBI. Significant moderate positive correlations were found between hypersexuality and psychological inflexibility, cognitive fusion, and bodily dissociation, and an inverse moderate correlation with mindfulness skills. Moderate negative correlations were found between sexual satisfaction and bodily dissociation. Linear regression showed psychological inflexibility was the variable with the most weight on hypersexuality, while bodily dissociation was the variable with the most influence on sexual dissatisfaction. This study suggests lesbians and gay men, males, and singles may show an increased vulnerability toward engaging in hypersexual behavior and provides justification for interventions focused on psychological inflexibility and mindfulness skills to treat hypersexuality and improve sexual satisfaction.

IntroductionThe COVID-19 pandemic caused a decline in students’ well-being, but on the other hand, students’ experiences of online learning and studying vary widely. The aim of this study is to examine the relationship between psychological flexibility and study-related burnout and to explore whether students with different levels of psychological flexibility have experienced burnout and online studying during COVID-19 differently.MethodsThe data was collected from first-year life-science students (N = 296) in spring 2021. The relationship between psychological flexibility and study-related burnout was explored with Pearson’s correlation and linear regression. Students’ open-ended responses about their experiences of online learning were analyzed with inductive content analysis and the categories were quantified. Three different groups (high, middle, and low) were made based on respondents’ psychological flexibility, and the differences in their study-related burnout were analysed with ANOVA and Tukey’s test, and differences in online learning experiences were analysed with a Chi-square test.ResultsThe results showed that there was a negative relationship between psychological flexibility and study-related burnout. In addition, experiences of study-related burnout and online studying differed statistically significantly between the different groups.DiscussionThe results show that psychological flexibility is an important factor in enhancing students’ well-being and learning during the pandemic.

IntroductionDespite the negative effects of stigma in individuals with skin conditions, interventions to address its effects are rare. This might be in part due to a continued lack of understanding as to how individuals respond to stigma.MethodsIn this study, we employed a step-case analytic method, using traditional regression, moderation, and network analyses, to examine the role of psychological flexibility (PF) with stigmatized experiences, and stigma-related outcomes. We run a cross-sectional study (n = 105 individuals with various skin conditions) and analyzed stigma-related variables. We included variables examining perceived stigmatization (PSQ), anxiety (GAD-7), depression (PHQ-9), well-being (EQ5D5L), and variables stemming from the PF model (CompACT), presented as three coping with stigma responses, namely “open,” “aware,” and “active.”.ResultsUsing network analysis, the most influential or central variables that contributed to stigma were generalized anxiety, perceived stigmatization, and valued actions. In relation to PF, being open to the experience of stigma (as opposed to avoidance), keeping a distance from stigmatized thoughts (as opposed to self-stigmatizing), and bringing attention to value-based committed actions (as opposed to passivity) were all found to contribute to less stigmatized experiences.DiscussionThe results indicate that two of the three skills of the PF model (“open” and “active”) may be important targets for interventions targeting stigma in people living with skin conditions.

The Cancer-related Psychological Flexibility Questionnaire (CPFQ) was developed and validated for assessing cancer patients' psychological flexibility, including attitudes and behavior toward cancer. In a systematic process, the CPFQ identified four factors through principal component analysis and confirmatory factor analysis: Cancer Acceptance, Cancer Avoidance, Activity Engagement, and Valued Action. The results of this study reveal that the CPFQ has a clear factor structure and good psychometric properties. The specific nature of cancer and the need for a specific measure of cancer patient psychological flexibility make this questionnaire valuable for research on psychological flexibility in cancer patients. [ABSTRACT FROM AUTHOR]

Hoarding is a common problem behavior worldwide and is detrimental to the physical and mental health of individuals and groups. Currently, effective interventions for hoarding are cognitive-behavioral therapies, but their post-intervention efficacy is questionable, and the available research does not examine the mediating variables of the effects of interventions on clinical outcomes. Moreover, current research on hoarding has focused on Western countries. Therefore, there is a need to investigate the efficacy of other forms of cognitive behavioral therapy on hoarding as well as other psychological outcomes related to hoarding and mediating variables that contribute to its effectiveness in different cultural contexts. One hundred thirty-nine college students with higher hoarding behaviors were randomly divided into three groups: 45 in the Acceptance and Commitment Therapy (ACT) group, 47 in the Rational Emotive Behavior Therapy (REBT) group, and 47 in the control group. They completed the Saving Inventory-Revised (SI-R), Obsessive-Compulsive Symptom Scale (OCSS), Difficulties in Emotion Regulation Scale (DERS), Experiences in Close Relationships Inventory-Attachment Anxiety Subscale (ECR), Depression Anxiety Stress Scales (DASS-21), Acceptance and Action Questionnaire II (AAQ-II), and Cognitive Fusion Questionnaire (CFQ) before and immediately after the intervention. The results showed that ACT and REBT improved individuals' psychological flexibility, cognitive fusion, acquisition-difficulty discarding, clutter, negative affect (anxiety, depression, stress), attachment anxiety, obsessive-compulsive disorder, and difficulty in emotion regulation compared to the control group. In addition, ACT was more effective than REBT in improving psychological flexibility and reducing hoarding, cognitive fusion, depression, stress, and obsessive-compulsive disorder; there were no significant differences between the two in anxiety and emotion regulation difficulties. Furthermore, psychological flexibility is a mediator of the effect of ACT and REBT on some behavioral and psychological outcomes (hoarding, negative affect, attachment anxiety). Limitations were discussed.

The psychological flexibility model can be seen as a basis for an integrated and progressive psychological approach to chronic pain management. Some researchers suggest that psychological flexibility and inflexibility represent distinct processes and constructs. This meta-analysis is the first to provide a summary estimate of the overall effect size for the relationship between psychological (in)flexibility and common outcomes among chronic pain patients. The research protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO, https://www.crd.york.ac.uk/PROSPERO/), registration number CRD42021285705. Four databases were searched (PsycINFO; PubMed; Web of Science, CINAHL) along with reference lists. Thirty-six cross-sectional studies were included (7,779 participants). Meta-analyses (random effects model) indicated a significant medium negative association between psychological flexibility and pain intensity or functional impairment. The present study also indicated a significant small to medium association between psychological inflexibility and pain intensity, a nearly large association between psychological inflexibility and functional impairment as well as the quality of life, and a large association between psychological inflexibility and anxiety/depression. Due to the limited number of included studies, the relationship between risk behavior and psychological inflexibility may not be significant. Types of countries and instruments measuring psychological inflexibility may explain part of the heterogeneity. These findings may carry significant implications for chronic pain patients regarding the potential relationship between psychological inflexibility or flexibility and these outcomes. It may consequently form the basis for more robust testing of causal and manipulable relationships.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021285705.

ObjectiveTo examine the validity and reliability of the Chinese version of the Self-as-Context Scale (SACS) in college students.MethodWe used convenience sampling to recruit 708 Chinese college students. All participants completed the SACS and 343 of them were asked to complete the validation questionnaires (Satisfaction with Life Scale, Peace of Mind Scale, Acceptance and Action Questionnaire-II, Mindful Attention Awareness Scale, Cognitive Fusion Questionnaire-Fusion, and Depression Anxiety Stress Scale-21) at the same time. We conducted items analysis, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), measurement invariance test, correlation analysis, regression analysis, and internal consistency reliability analysis. After 3 weeks, 217 participants filled out the SACS again to assess the test–retest reliability.ResultsThe exploratory factor analysis showed that the SACS consisted of two factors (Centering and Transcending), with a total of 9 items. The confirmatory factor analysis demonstrated that the two-factor structure fit well (χ2 = 55.40, df = 22, CFI = 0.977, TLI = 0.963, RMSEA = 0.065, SRMR = 0.032). According to the results of the measurement invariance tests, configural invariance, metric invariance, scalar invariance, and strict invariance of the 2-factor model, the C-SACS scores were comparable across genders. Additionally, the C-SACS total score and its subscale scores were significantly positively correlated with positive indicators of mental health (life satisfaction, affective well-being), significantly negatively correlated with negative emotions (depression, anxiety, stress), significantly negatively correlated with experiential avoidance and cognitive fusion (except for the Transcending factor), and significantly positively correlated with mindful attention and awareness. Regression analysis results revealed that the C-SACS surpasses the incremental effectiveness of AAQ-II and CFQ-F in predicting different psychological health indicators. The Cronbach’s α coefficients of the C-SACS and two subscales were 0.88 [0.71, 0.90], 0.80 [0.87, 0.90] and 0.85 [0.83, 0.88] and McDonald’s ω = 0.88 [0.87, 0.90], ω = 0.80 [0.78, 0.83], ω = 0.85[0.83, 0.88]. The test–retest reliability (ICC) was 0.73 and 0.72, respectively.ConclusionThe results of our study suggest that the Chinese version of SACS has good reliability and validity in Chinese college students.

Background: There is much overlap among the symptomology of autistic spectrum disorders (ASDs), obsessive compulsive disorders (OCDs), and alexithymia, which all typically involve impaired social interactions, repetitive impulsive behaviors, problems with communication, and mental health. Aim: This study aimed to identify direct and indirect associations among alexithymia, OCD, cardiac interoception, psychological inflexibility, and self-as-context, with the DV ASD and depression, while controlling for vagal related aging. Methodology: The data involved electrocardiogram (ECG) heart rate variability (HRV) and questionnaire data. In total, 1,089 participant’s data of ECG recordings of healthy resting state HRV were recorded and grouped into age categories. In addition to this, another 224 participants completed an online survey that included the following questionnaires: Yale-Brown Obsessive Compulsive Scale (Y-BOCS); Toronto Alexithymia Scale 20 (TAS-20); Acceptance and Action Questionnaire (AAQII); Depression, Anxiety, and Stress Scale 21 (DAS21); Multi-dimensional Assessment of Interoceptive Awareness Scale (MAIA); and the Self-as-Context Scale (SAC). Results: Heart rate variability was shown to decrease with age when controlling for BMI and gender. In the two SEMs produced, it was found that OCD and alexithymia were causally associated with autism and depression indirectly through psychological inflexibility, SAC, and ISen interoception. Conclusion: The results are discussed in relation to the limitations of the DSM with its categorical focus of protocols for syndromes and provide support for more flexible ideographic approaches in diagnosing and treating mental health and autism within the Extended Evolutionary Meta-Model (EEMM). Graph theory approaches are discussed in their capacity to depict the processes of change potentially even at the level of the relational frame. [ABSTRACT FROM AUTHOR]

Background: Positive and negative focus in information processing associated with age has a diverse role in COVID-19 vaccine uptake. The aim of the study was the exploration of the generational diversity among psychological predictors of COVID-19 vaccine uptake. Methods: A cross-sectional research was conducted. The sample included 978 Hungarian women. Based on former literature findings, the COVID-19 vaccine uptake predictors were chosen from the health beliefs model, COVID-19 vaccine hesitancy, and psychological flexibility. Multivariate logistic regression analysis was conducted to investigate the predictors of COVID-19 vaccine uptake in women of Gen X, Gen Y, and Gen Z. Results: In Gen X women, the influence of significant predictors are more prone to the positivity in COVID-19 vaccine uptake behavior, perceived benefits being the most relevant, increasing the likelihood of vaccine uptake more than four times. In Gen Y women, perceived barriers, lack of confidence/skepticism and avoidance significantly reduce the probability of vaccine uptake, showing an accentuated negative focus in information processing related to COVID-19 vaccination. The vaccine uptake in Gen Z is predicted only by the perceived benefits, and the likelihood of COVID-19 vaccine uptake is heightened in chance more than 19 times. Conclusion: Women belonging to Gen X or Gen Y, the perceived benefits hold the key to vaccine uptake, while in women of Gen Z, low risks, lack of threats, and accessibility could motivate the decision of vaccine uptake. The findings are useful in generation-adapted vaccination campaigns and can also serve as inspiration for evolutionary psychology studies on health behavior and the broad area of study in cognitive biases in health information processing. [ABSTRACT FROM AUTHOR]

In the last decades, third wave approaches in cognitive-behavioral therapies (CBT) have shown eectiveness in treating several mental disorders, including schizophrenia spectrum disorders (SSD). Three crucial processes associated with clinical changes in patients include mindfulness, psychological flexibility (PF) and self-compassion (SC). PF is generally assessed by cognitive fusion (CF), a negative formulated key process of PF. The current study encompasses a cross-sectional design to examine the interplay of mindfulness, CF, SC and symptom severity in SSD. It was hypothesized that mindfulness is negatively correlated with symptom severity, CF mediates the negative relation between mindfulness and symptom severity, and SC moderates the link between mindfulness and CF. In total, 79 persons with SSD were recruited at the Department of Psychiatry and Neurosciences at the Charité - Universitätsmedizin Berlin. Correlations, as well as moderated mediation analyses, were performed using the analysis modeling tool PROCESS with total symptom severity and negative symptom severity as outcome variables, measured by the Positive and Negative Syndrome Scale (PANSS) and the Self-Evaluation of Negative Symptoms Scale (SNS). Results show that the moderated mediation hypothesis was confirmed for negative symptom severity assessed by SNS, however, not for total symptom severity assessed by PANSS. In general, the association between mindfulness and CF was stronger for participants with higher SC scores in our data. Future studies should investigate the relationship between mindfulness, SC, and PF regarding symptom severity in SSD in longitudinal designs while considering the impact on dierent outcomes and dirences regarding assessment tools. [ABSTRACT FROM AUTHOR]

BackgroundThere is much overlap among the symptomology of autistic spectrum disorders (ASDs), obsessive compulsive disorders (OCDs), and alexithymia, which all typically involve impaired social interactions, repetitive impulsive behaviors, problems with communication, and mental health.AimThis study aimed to identify direct and indirect associations among alexithymia, OCD, cardiac interoception, psychological inflexibility, and self-as-context, with the DV ASD and depression, while controlling for vagal related aging.MethodologyThe data involved electrocardiogram (ECG) heart rate variability (HRV) and questionnaire data. In total, 1,089 participant's data of ECG recordings of healthy resting state HRV were recorded and grouped into age categories. In addition to this, another 224 participants completed an online survey that included the following questionnaires: Yale-Brown Obsessive Compulsive Scale (Y-BOCS); Toronto Alexithymia Scale 20 (TAS-20); Acceptance and Action Questionnaire (AAQII); Depression, Anxiety, and Stress Scale 21 (DAS21); Multi-dimensional Assessment of Interoceptive Awareness Scale (MAIA); and the Self-as-Context Scale (SAC).ResultsHeart rate variability was shown to decrease with age when controlling for BMI and gender. In the two SEMs produced, it was found that OCD and alexithymia were causally associated with autism and depression indirectly through psychological inflexibility, SAC, and ISen interoception.ConclusionThe results are discussed in relation to the limitations of the DSM with its categorical focus of protocols for syndromes and provide support for more flexible ideographic approaches in diagnosing and treating mental health and autism within the Extended Evolutionary Meta-Model (EEMM). Graph theory approaches are discussed in their capacity to depict the processes of change potentially even at the level of the relational frame.

BackgroundPositive and negative focus in information processing associated with age has a diverse role in COVID-19 vaccine uptake. The aim of the study was the exploration of the generational diversity among psychological predictors of COVID-19 vaccine uptake.MethodsA cross-sectional research was conducted. The sample included 978 Hungarian women. Based on former literature findings, the COVID-19 vaccine uptake predictors were chosen from the health beliefs model, COVID-19 vaccine hesitancy, and psychological flexibility. Multivariate logistic regression analysis was conducted to investigate the predictors of COVID-19 vaccine uptake in women of Gen X, Gen Y, and Gen Z.ResultsIn Gen X women, the influence of significant predictors are more prone to the positivity in COVID-19 vaccine uptake behavior, perceived benefits being the most relevant, increasing the likelihood of vaccine uptake more than four times. In Gen Y women, perceived barriers, lack of confidence/skepticism and avoidance significantly reduce the probability of vaccine uptake, showing an accentuated negative focus in information processing related to COVID-19 vaccination. The vaccine uptake in Gen Z is predicted only by the perceived benefits, and the likelihood of COVID-19 vaccine uptake is heightened in chance more than 19 times.ConclusionWomen belonging to Gen X or Gen Y, the perceived benefits hold the key to vaccine uptake, while in women of Gen Z, low risks, lack of threats, and accessibility could motivate the decision of vaccine uptake. The findings are useful in generation-adapted vaccination campaigns and can also serve as inspiration for evolutionary psychology studies on health behavior and the broad area of study in cognitive biases in health information processing.

In the last decades, third wave approaches in cognitive-behavioral therapies (CBT) have shown effectiveness in treating several mental disorders, including schizophrenia spectrum disorders (SSD). Three crucial processes associated with clinical changes in patients include mindfulness, psychological flexibility (PF) and self-compassion (SC). PF is generally assessed by cognitive fusion (CF), a negative formulated key process of PF. The current study encompasses a cross-sectional design to examine the interplay of mindfulness, CF, SC and symptom severity in SSD. It was hypothesized that mindfulness is negatively correlated with symptom severity, CF mediates the negative relation between mindfulness and symptom severity, and SC moderates the link between mindfulness and CF. In total, 79 persons with SSD were recruited at the Department of Psychiatry and Neurosciences at the Charité – Universitätsmedizin Berlin. Correlations, as well as moderated mediation analyses, were performed using the analysis modeling tool PROCESS with total symptom severity and negative symptom severity as outcome variables, measured by the Positive and Negative Syndrome Scale (PANSS) and the Self-Evaluation of Negative Symptoms Scale (SNS). Results show that the moderated mediation hypothesis was confirmed for negative symptom severity assessed by SNS, however, not for total symptom severity assessed by PANSS. In general, the association between mindfulness and CF was stronger for participants with higher SC scores in our data. Future studies should investigate the relationship between mindfulness, SC, and PF regarding symptom severity in SSD in longitudinal designs while considering the impact on different outcomes and differences regarding assessment tools.

Explore the influence mechanism of discrimination perception on higher vocational Students’ career exploration, it provides empirical evidence for promoting vocational college Students’ career exploration and career development. Using the questionnaire survey method, 893 higher vocational students from four higher vocational colleges in Jiangsu Province were investigated by using the Discrimination Perception Scale, the Core Self-Evaluation Scale (CSES), the Chinese version of the Acceptance and Action Questionnaire, the Chinese version of the Cognitive Fusion Questionnaire (CFQ) and the Career Exploration Scale (CES). The data were analyzed using SPSS26.0 and Amos23.0, and the results showed that discrimination perception was significantly negatively correlated with core self-evaluation, psychological flexibility and career exploration (r = −0.487, −0.497, −0.326, p < 0.01), core self-evaluation was significantly positively correlated with psychological flexibility and career exploration (r = 0.518, 0.352, p < 0.01), and psychological flexibility was significantly positively correlated with career exploration (r = 0.386, p < 0.01); Core self-evaluation and psychological flexibility mediated the effect between discrimination perception and career exploration with effect sizes of −0.054 and −0.061, respectively; Core self-evaluation and psychological flexibility mediated the chain effect between discrimination perception and career exploration of higher vocational students with effect sizes of −0.030. Therefore, discrimination perception not only directly influences career exploration of higher vocational students, but also indirectly influences career exploration of higher vocational students through the separate mediating effects of core self-evaluation and psychological flexibility and the chain mediating effects of core self-evaluation and psychological flexibility. Accordingly, the following suggestions are put forward, which should pay attention to the cultivation of core self-evaluation and psychological flexibility of higher vocational students, strengthen the teaching quality and improve the image of vocational colleges.

BackgroundWith the gradual penetration of network media into various fields of people's life, the relationship between network behavior and the sense of meaning of life is bound to be closer and closer. The purpose of this study is to explore the mediating role of state anxiety between cyber loafing and the sense of meaning of life, and the moderating role of psychological flexibility in this mediating relationship.MethodologyWith 964 undergraduates recruited as subjects three-wave-time-lagged quantitative research design was conducted in China. All participants were required to complete a self-reported electronic questionnaire. Then, the mediating mechanism and moderating effect were explored with utilization of SPSS25.0.ResultsThe results showed that cyberloafing had significant negative correlation with the sense of meaning of life. Our analysis testing the mediating effect showed that state anxiety partially mediated the relationship between cyberloafing and the sense of meaning of life (indirect effect = −0.05, p < 0.01,), while the mediating effect was 31.25% of the total effect. Our analysis testing the moderating effect showed that psychological flexibility significantly moderated the relationship between cyberloafing and state anxiety (interaction effect = −0.26, p < 0.01). And our analysis testing the moderated mediating effect showed that psychological flexibility played a moderating role in the mediating effect of state anxiety.ConclusionBased on the findings of this study, college students' cyberloafing negatively affects their sense of meaning of life. Therefore, appropriate measures should be taken to supervise and restrict college students' Internet use and provide them with corresponding guidance; certain psychological adjustment measures should also be taken when necessary to help college students with low psychological flexibility in reducing their state anxiety and improving their sense of meaning of life.

ObjectiveDuring the COVID-19 pandemic, the occupational stress of medical staff has been a major issue. This study aimed to suggest a new strategy to identify high-risk factor sets of occupational stress in medical staff using fuzzy-set qualitative comparative analysis (fs-QCA) and provide ideas for the prevention and intervention of occupational stress.MethodsA total of 1,928 medical staff members were surveyed and tested using the Acceptance and Action Questionnaire-II (AAQ-II), Occupational Stress Inventory-Revised edition (OSI-R), and Eysenck Personality Questionnaire-Revised Short Scale (EPQ-RSC). The fs-QCA was used to explore the high-risk factors for occupational stress among medical staff.ResultsThe psychological strain (PSY) score of the medical staff was 26.8 ± 7.13, and the physical strain (PHS) score was 24.3 ± 6.50. Low psychological flexibility score-introversion-high role overload, introversion-neuroticism-high role overload, and low psychological flexibility score-neuroticism were high-risk factor sets for PSY. Low psychological flexibility score-introversion-high role overload, low psychological flexibility score-introversion-neuroticism, low psychological flexibility score-neuroticism-high role overload, low psychological flexibility score-psychoticism-neuroticism, and psychoticism-neuroticism-high role overload were high-risk factor sets for PHS.ConclusionThere are different combinations of high-risk factors for occupational stress among the medical staff. For occupational stress intervention and psychological counseling, targeted and individualized health intervention measures should be implemented according to specific characteristic combinations of different individuals.

Psychological flexibility is a key concept of acceptation and commitment therapy (ACT). This factor has been linked with psychological wellbeing and associated factors, such as quality of life, in cancer patients. These and other positive results of acceptation and commitment therapy in cancer patients found in previous research could be enhanced by using mhealth tools. A three-arm randomized superiority clinical trial, with a pre-post-follow-up repeated measures intergroup design with a 1:1:1 allocation ratio is proposed. A hundred and twenty cancer patients will be randomly assigned to one of the following interventions: (1) face-to-face ACT + mobile application (app), (2) face-to-face ACT, and (3) Waitlist control group. The primary expected outcome is to observe significant improvements in psychological flexibility acceptance and action questionnaire- II (AAQ-II) in the face-to-face ACT + app group, after comparing baseline and post-treatment scores, and the scores will remain stable in the two assessment points, 3 and 6 months after the intervention. Secondary expected outcomes are significant increasing scores in quality of life (EORTC QLQ C-30) and post-traumatic-growth (PTGI-SF), and significant decreasing scores in anxiety and depression (HADS), insomnia (ISI) and fatigue (BFI) at the same assessment points. Also, it is expected that the scores of this group will be higher than the scores of the face-to-face ACT group and the waitlist control group. This study aims to assess the efficacy of a combined intervention (face-to face ACT + app) for psychological flexibility and associated symptoms in cancer patients. The results of this protocol may help to consider the use of acceptation and commitment therapy and mhealth applications in cancer settings as a valid therapeutic choice. Clinical Trial Registration: [www.ClinicalTrials.gov], identifier [NCT05126823]. [ABSTRACT FROM AUTHOR]

Background: Mental health problems has become a major public health issue among medical students. Self-esteem and psychological flexibility were important associated factors for mental health, but their relations have not been discussed in medical students. The present study aimed to assess the status of mental health problems among medical students and identified whether psychological flexibility had a mediating role in the effects of self-esteem on the top three most common psychological symptoms. Methods: A total of 810 undergraduate students from 18 classes comprised in the sample. Nine dimensions of psychological symptoms was assessed by the Symptom Checklist-90-revised (SCL-90-R). Self-esteem was measured by the Self-esteem Scale (SES) and psychological flexibility was evaluated by the Acceptance and Action Questionnaire 2nd Edition (AAQ-II) and Cognitive Fusion Questionnaire (CFQ-F). Univariate analysis and logistic regression analysis were used to determine the relationship among the top three common psychological symptoms, self-esteem, psychological flexibility, and participants' characteristics. The mediating effect of psychological flexibility between self-esteem and psychological symptoms was detected by bootstrap method. Results: 57.8% of the medical undergraduate students reported positive at least one of the nine psychological symptom dimensions assessed by the SCL-90-R and 13.8% of students had moderate or more severe symptoms. The symptoms of obsessive-compulsiveness, interpersonal sensitivity, and depression were the three most common psychological symptoms among the medical students. Meanwhile, self-esteem and psychological flexibility were negatively associated to the symptoms of obsessive-compulsiveness, interpersonal sensitivity, and depression. And, almost 50% effects of self-esteem on these three symptoms in medical students exert indirect effects through psychological flexibility. Conclusions: Psychological distress was quite common in the Chinese medical students. The three most common psychological symptoms were successively obsessive-compulsiveness, interpersonal sensitivity, and depression. Low self-esteem and psychological inflexibility might be the risk factors for these top three symptoms, and psychological flexibility might play a mediating role in the effects of self-esteem on these psychological symptoms. [ABSTRACT FROM AUTHOR]