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Background: Cognitive behavioural therapy (CBT) has, in the space of 50 years, evolved into the dominant modality in psychological therapy. Mechanism/s of change remain unclear, however. Aims: In this paper, we will describe key features of CBT that account for the pace of past and future developments, with a view to identifying candidates for mechanism of change. We also highlight the distinction between 'common elements' and 'mechanisms of change' in psychological treatment. Method: The history of how behaviour therapy and cognitive therapy developed are considered, culminating in the wide range of strategies which now fall under the heading of cognitive behavioural therapy (CBT). We consider how the empirical grounding of CBT has led to the massive proliferation of effective treatment strategies. We then consider the relationship between 'common factors' and 'mechanisms of change', and propose that a particular type of psychological flexibility is the mechanism of change not only in CBT but also effective psychological therapies in general. Conclusion: Good psychological therapies should ultimately involve supporting people experiencing psychological difficulties to understand where and how they have become 'stuck' in terms of factors involved in maintaining distress and impairment. A shared understanding is then evaluated and tested with the intention of empowering and enabling them to respond more flexibly and thereby reclaim their life. [ABSTRACT FROM AUTHOR]

Tobacco use disorder is a major public health concern. The aim of this study was to investigate the impact of a psychedelic experience in a natural context on tobacco use. A retrospective online survey was conducted on 173 individuals who reported having had a psychedelic experience while being smokers. Demographic information was collected, and characteristics of the psychedelic experience, tobacco addiction and psychological flexibility were assessed. Mean number of cigarettes smoked per day, and proportion of individuals with high tobacco dependency significantly decreased between the three time points (p <.001). Participants who reduced or quit smoking had more intense mystical experiences during the psychedelic session (p =.01) and lower psychological flexibility before the psychedelic experience (p =.018). The increase in psychological flexibility post psychedelic session, and the personal motives for the psychedelic experience were significant positive predictors of smoking reduction or cessation (p <.001). Our results confirmed that a psychedelic experience in smoker individuals can be associated with smoking and tobacco dependency reduction and that the personal motives for the psychedelic session, the intensity of the mystical experience, and the increase of psychological flexibility following the psychedelic experience, are associated with smoking cessation or reduction. [ABSTRACT FROM AUTHOR]

Objective: This study explores the presence of different profiles of video game players across five mindfulness facets (i.e., describing, observing, nonreacting, nonjudging, and acting with awareness) and nonattachment (i.e., the ability to relate to experiences without clinging onto them). Method: Adults who play video games (N = 629) were recruited from Amazon's Mechanical Turk. Participants completed an online survey, assessing their dispositional mindfulness and nonattachment, problem video gaming, emotion-based impulsivity, psychological inflexibility, and mental health. Results: The latent profile analysis identified four profiles, representing those who were highly mindful (n = 131; 20.8%), moderately mindful (n = 289; 46.0%), reactive and attached (n = 132; 21.0%), and judgmental and unaware (n = 77; 12.2%). Subsequent comparisons revealed that the judgmental and unaware profile reported the highest level of problem gaming, followed by the reactive and attached profile. The judgmental and unaware profile evidenced stronger general gaming motivations and higher emotion-based impulsivity; in contrast, the reactive and attached profile demonstrated greater psychological inflexibility and escapism motivation relative to the other profiles. Both the judgmental and unaware and the reactive and attached profiles had elevated levels of anxiety and depression. Conclusion: These findings provide a more nuanced assessment of the protective role of mindfulness. [ABSTRACT FROM AUTHOR]

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Objectives Methods Results Conclusions Clinical Implications Considering that the examination of psychological flexibility measures among older adults is scant, this study explores the psychometric properties of the Acceptance and Action Questionnaire-II (AAQ-II) among outpatient geriatrics primary care clinic patients in a university-affiliated medical center in the Deep South.On average, patients who consented to participate in research (N = 119) were 75.42 (SD = 9.14) years old. Approximately 74% were women, 91% were non-Hispanic white, and 86% lived in urban areas. Measures included psychological inflexibility, subjective health literacy, depression, anxiety, and global cognitive functioning.The AAQ-II demonstrated adequate internal reliability, Cronbach’s α = 0.79, and good test-retest reliability, r(28) = .84, p < .001. With the removal of item 4, confirmatory factor analysis demonstrated adequate construct validity for the use of AAQ-II with older adults. As predicted, the AAQ-II exhibited concurrent, predictive, discriminant, and incremental validity within this older adult sample.These results demonstrate meaningful scientific and clinical implications. This is the first study to examine the psychometric properties of the Acceptance and Action Questionnaire-II (AAQ-II) in an older adult sample.The AAQ-II is a psychometrically sound measurement that can be clinically used on older adults. [ABSTRACT FROM AUTHOR]

Parents of young children with eczema often experience adverse mental health consequences, including depression, anxiety, stress, and a reduced health-related quality of life (HRQoL), due to the unpredictable nature of flare-ups and exacerbations. This study investigated the roles of psychological flexibility, self-compassion, and self-efficacy in fostering parental mental health outcomes and HRQoL while caring for children diagnosed with eczema. Baseline data from an ongoing clinical trial examining the effects of a family acceptance-and-commitment-therapy-based eczema management program (FACT-EMP) on parent–child dyads affected by eczema (N = 110 dyads, 75.5% mothers; 66.4% boys) were analyzed using adjusted hierarchical regression analyses. The findings indicate that psychological inflexibility was significantly associated with symptoms of anxiety, depression, stress, and HRQoL. Self-compassion was significantly linked to all assessed mental health outcomes, whereas self-efficacy showed a significant association only with symptoms of depression. These results underscore the significance of promoting parental psychological flexibility and self-compassion through acceptance and commitment therapy and compassion-based approaches to enhance mental health and quality of life while managing children's eczema. [ABSTRACT FROM AUTHOR]

The Work-Related Acceptance and Action Questionnaire (WAAQ) is a self-report instrument that measures psychological flexibility at work. Although this scale has been validated in some languages, its psychometric properties in Colombia are unknown, making it challenging to assess work-related psychological flexibility in this country. The present study analyzed the psychometric properties and factor structure of the WAAQ in a sample of 985 Colombian workers. The internal consistency of the WAAQ measured through coefficient alpha was .88. The one-factor model with correlated error terms between items 4 and 7 showed a very good fit to the data (RMSEA= 0.033, CFI= .998, NNFI= .997, SRMR= 0.018). The WAAQ showed metric and scalar invariance across gender, age group, socioeconomic stratum, and hierarchical level. Furthermore, it correlated negatively with psychological inflexibility, psychological distress, emotional exhaustion, and cynicism and positively with professional efficacy, work engagement, and job satisfaction. In conclusion, the WAAQ seems to be a valid self-report of work-related psychological flexibility in Colombian samples. [ABSTRACT FROM AUTHOR]

The aim of this research was to determine the predictive strength of job satisfaction and job-related emotional exhaustion on dyadic marital adjustment, and the mediating role of psychological flexibility in this predictive relationship. In line with this, the hypothetical structural model was tested 246 married participants by using correlational design. The fit indices of the tested model were found in the range of an acceptable level. The findings showed that both job satisfaction and job-related emotional exhaustion positively predicted dyadic marital adjustment. While psychological flexibility also positively predicted dyadic marital adjustment, it functioned as a mediator variable only in the path between job satisfaction and dyadic marital adjustment. The findings were discussed within the framework of the relevant literature. [ABSTRACT FROM AUTHOR]

Background: The first coronavirus disease 2019 (COVID‐19) wave and lockdown adversely affected the lives of people in diverse ways. Aims: This study used a person‐centered approach to identify patterns of engagement in the 12 psychological flexibility (PF) and inflexibility (PI) processes to manage the first COVID‐19 wave and lockdown hardships. Materials & Methods: A total of 1035 Italian adults completed an online survey. Results: Latent profile analyses conducted on the 12 PI/PF processes measured by the Multidimensional Psychological Flexibility Inventory identified five profiles; three reflected gradations of high to low PF with corresponding inverse levels of PI, while two represented more complex relationships between PI and PF. After controlling for relevant socio‐demographic and COVID‐19/lockdown factors, the five profiles differed in mental health (depression, anxiety, and COVID‐19 distress). Essentially a gradient of progressive decreases in all PI processes (except experiential avoidance) corresponded with increments in mental health across all profiles. Two profiles, which evidenced the highest levels of mental health (highly flexible and moderately flexible profiles), also had the greatest proportion of the sample 56.42% (n = 584), and the highest levels of PF and experiential avoidance. Discussion: Findings from this and similar studies suggest intersecting complex relationships among the PI/PF processes that are likely to shift in response to changing contexts. We suggest this network of relationships is better represented by a three‐dimensional PF/PI hexaflex than a simplistic two‐dimensional depiction of the model. Conclusion: Distinguishing different PF/PI profiles identified groups most at risk for the adverse mental health impacts of the pandemic and exposed variations in the mental health protective and risk roles of PF and PI processes, respectively, that can inform ACT‐based mental health promotion interventions. [ABSTRACT FROM AUTHOR]

Understanding the impact of the COVID-19 pandemic on mental health and the psychological factors associated can help inform subsequent interventions to protect psychological health. In particular, psychological flexibility has been shown to be an important target for intervention. The current study aimed to investigate associations between protective factors (state mindfulness, values and self-compassion) and risk factors (COVID-19 stress, worry and rumination) for mental health during the early stages of the COVID-19 pandemic. 439 participants completed three online surveys during the 1st wave of the pandemic in the UK: Time 1 (April 1–5th 2020), Time 2 (April 15–19th April), Time 3 (May 13–17th 2020). Measures of wellbeing, burnout and life satisfaction. Psychological health outcome measures were found to be lower (worse) than normative comparison data during the early stages of the UK lockdown, while COVID-19 stress and worry reduced over time. Multilevel models found that higher levels of trait and state measures of psychological flexibility and self-compassion were associated with better psychological health across time points. Higher levels of COVID-19 stress, worry and rumination were also associated with poorer psychological health. The results showed that mindfulness, values and self-compassion are potential targets for intervention. [ABSTRACT FROM AUTHOR]

Emotional intelligence emphasizes the ability to attend to, understand and process one's own and others' emotions, while psychological flexibility focuses on connecting with the present moment and the ability to react to changing situations appropriately. The main objective of this research was to determine the relationship between emotional intelligence and psychological flexibility in university students. The study was carried out by means of a non-experimental, cross-sectional, quantitative, descriptive-correlational design. With an initial population of 881 students to which a non-probabilistic convenience sampling was applied with a final sample of 235 participants (72 men and 163 women), with an age range of 18 to 30 years. The scale for the evaluation of the expression, management and recognition of emotions (TMMS-24) was used to evaluate emotional intelligence and the Acceptance Action Questionnaire II (AAQ-II) was used to evaluate psychological flexibility. The results showed a slight positive relationship (Rho=0.378, p<.001) between the emotional attention dimension and psychological flexibility. The conclusion was that the greater the emotional intelligence, the greater the psychological flexibility. [ABSTRACT FROM AUTHOR]

Artification occupies a specific place between art and non-art and is determined by giving a subjectively aesthetic meaning to the objects that previously had no such properties. We refer here explicitly to the studies and findings of Ellen Dissanayake and Ossi Naukkarinen. The study aimed to focus on the potential of artification at the end of one's life, exemplified by reports of the qualitative study conducted in one of the hospices in Katowice, Poland. The psychological flexibility categories, extracted from artification activities, were used in this research. [ABSTRACT FROM AUTHOR]

Psychological flexibility in the context of parenting (i.e., parenting flexibility) is associated with positive outcomes for parents and children, and it is a target of psychological interventions. Psychological flexibility as a construct has been historically difficult to define and measure, and parenting flexibility is subject to the same challenges. This scoping review aims to map and summarize the literature on development and validation of measures of parenting flexibility, and to provide recommendations for measurement selection to inform research and clinical practice. OVID MEDLINE, PsycINFO, SocINFO, and google scholar were searched for articles pertaining to the development and/or validation of a measure of parenting flexibility, supplemented with solicitation from professionals in the field. Two independent reviewers screened 820 titles and abstracts and assessed 32 full-text articles for inclusion criteria: peer reviewed, published in English, empirical studies using parent samples, assessed a construct related to parenting flexibility, and involved the development and/or validation of a measurement tool. Translated measures were included in the final article synthesis if a full-text English version was available. A total of 18 studies were included in the final scoping review. Charting was used to map demographic and sample characteristics, relevant results, and indications for measurement selection. Seven measures were identified, four for general parenting flexibility and three for specific parenting contexts. Validity and reliability across measures was variable, but generally demonstrated utility of use. There is overlap and divergence with regard to item wording, aspects of psychological flexibility being measured, and relevancy to different aspects of parenting. Limited evidence exists to determine which measure best applies to specific purposes. Recommendations are made for measurement selection and areas of future research. • Psychological flexibility is relevant to parenting and family functioning. • Measuring psychological flexibility in the context of parenting can be useful. • Several measures of parenting flexibility have been developed and validated. • Reliability and validity across measures of parenting flexibility is variable. • Evidence for selecting a measure of parenting flexibility is lacking. [ABSTRACT FROM AUTHOR]

Rising rates of mental health problems in undergraduate students is a critical public health issue. There is evidence supporting the efficacy of acceptance and commitment therapy (ACT) in decreasing psychological symptoms in undergraduates, which is thought to be facilitated through increases in psychological flexibility (PF) and decreases in psychological inflexibility (PIF). However, little is known about the effect of ACT on these processes in undergraduates. We conducted a systematic review and three-level meta-analysis examining this effect in 20 studies, which provided 56 effect sizes. A combined sample of 1750 undergraduates yielded a small-to-medium overall effect (g = 0.38, SE = 0.09, p <.001, 95% CI: [0.20, 0.56]). This effect did not depend on control group type, intervention modality, number of sessions, the questionnaire used, whether PF or PIF was measured, or participant age. However, there was a significant mean effect only in studies with a specific clinical target, but not in those without one. Furthermore, the higher the percentage of female participants, the lower the reported effect size. Results suggested that ACT may increase PF and decrease PIF in undergraduates and highlighted various conceptual and measurement issues. Study protocol and materials were preregistered (https://osf.io/un6ce/). • We examined the effect of ACT on undergraduates' psychological flexibility and inflexibility. • A three-level meta-analysis indicated that ACT had a small-to-medium effect on PF/PIF. • Clinical indication and participant sex were significant moderators. • Measurement issues limited knowledge regarding ACT's effect on PF/PIF components. • Results may aid efforts to refine the operationalization of PF/PIF. [ABSTRACT FROM AUTHOR]

Serious concerns have been raised regarding the validity of popular experiential avoidance measures. We developed a new "experiential avoidance rating scale" (EARS) to address some of the psychometric concerns with existing measures. Candidate items were generated according to the original functional contextual definition of experiential avoidance and reviewed by experts and public members for content validity and readability. Items then underwent validation involving n = 3628 participants. Exploratory factor analyses (n = 1069) identified six items with good underlying common variance. Confirmatory factor analyses from college student (n = 1068) and community samples (n = 1413) demonstrated excellent fit. In all samples, the EARS demonstrated evidence of content, factorial, concurrent, convergent, and discriminant validity. The EARS also demonstrated evidence of incremental validity by predicting significant additional variance above-and-beyond neuroticism and extant experiential avoidance measures in depression, anxiety, post-traumatic stress, alcohol use problems, and general mental health measures. Measurement invariance analyses indicated that the EARS demonstrated residual (strict) invariance between cisgender men and women; clinical and non-clinical participants; White Non-Hispanic, White Hispanic, Black, and Asian participants; and heterosexual and bisexual individuals. We suggest that the EARS be further investigated as a brief measure of experiential avoidance in additional studies, particularly with clinical populations. We also discuss areas of future psychometric study and implications. • We validated a new scale termed the experiential avoidance rating scale (EARS). • The EARS was validated on a large sample involving n = 3628 U.S.A. participants. • The EARS demonstrated excellent factor structure in multiple samples. • The EARS demonstrated concurrent, convergent, and discriminant validity. • The EARS demonstrated incremental validity above-and-beyond extant measures. [ABSTRACT FROM AUTHOR]

This study examined the roles of psychological flexibility and socioeconomic status (SES) in adolescents' identity development during the transition from lower secondary school to upper secondary education. Psychological flexibility was measured using the Avoidance and Fusion Questionnaire (AFQ-8; Greco et al., 2008) and identity processes were measured with the Dimensions of Identity Development Scale (DIDS; Luyckx et al., 2008). SES was assessed using the educational level of the highest-educated parent. The sample comprised 885 adolescents who answered surveys in Grade 9, as well as in the first and third year of upper secondary education. The results showed, first, that psychological flexibility was both concurrently and prospectively related to adolescents' identity formation (exploration in breadth and commitment making) as well as to their identity evaluation (exploration in depth, identification with commitment, ruminative exploration) processes. Second, the higher SES adolescents had, the more they had exploration in breadth and exploration in depth in the first year of upper secondary education. Thirdly, associations of psychological flexibility with commitment making and identification with commitments were stronger for adolescents with a higher SES than for adolescents with lower SES. The results suggest that psychological flexibility may play a key role in adolescents' identity development during critical educational transitions. • This study examined the roles of psychological inflexibility and socioeconomic status (SES) in adolescents' identity development. • Psychological flexibility was both concurrently and prospectively related to identity processes. • SES was positively related with exploration in breadth and exploration in depth. • SES moderated some of the associations between psychological flexibility and identity development. [ABSTRACT FROM AUTHOR]

This study examined the psychometric properties of the recently developed six-item Psy-Flex among community samples in Korea. Using a cross-sectional design, data were collected from 1059 participants. Three bilingual experts translated the scale to ensure content validity. Factor analysis was employed to confirm the factor structure, and a polytomous item response theory model was used to examine the individual items and entire scale. The theory-based single-factor structure was confirmed using a Korean community sample, and measurement invariances were found across sex and age groups. In addition, the scale showed a moderate relationship with established measures of interest. Furthermore, item and categorical functioning were investigated using the polytomous Item Response Theory (IRT) model (i.e., the Generalized Partial Credit Model [GPCM]), identifying well-functioning (e.g., items 4, 5, and 6) and suboptimal (e.g., item 2) items. Additionally, the results suggest that the participants might not be able to meaningfully differentiate the original five-response categories. To the best of our knowledge, this is the first attempt to validate the Psy-Flex in Korea. We believe that the findings are of considerable value in facilitating our understanding of the scale and, more broadly, the construct of psychological flexibility. • The Korean Psy-Flex scale supports the theory-based single-factor structure of psychological flexibility. • Measurement invariance was observed across age and sex groups. • The Psy-Flex may more accurately identify individual differences in below-average levels of psychological flexibility. [ABSTRACT FROM AUTHOR]

Physicians are likely to experience burnout early in their medical education, and it only accelerates as their clinical and academic responsibilities expand and they begin clinical practice. However, effective burnout interventions for clinical-year medical students are lacking. Avoidance of unpleasant internal experiences and decreased engagement in value-based behaviors are associated with burnout. This study, an open-label pilot research with a single-center, before-and-after comparative study design and without a control group, aimed to examine the feasibility and effectiveness of brief acceptance and commitment training (ACT) in reducing burnout during psychiatric clinical clerkships at a medical school. The feasibility proved to be good, with all the participants (n = 56) completing the training. There were no significant differences in the emotional exhaustion (EE) and depersonalization (DP) scores of burnout as measured by the Maslach Burnout Inventory (MBI) at the end of the ACT and two months following the intervention. A comparison was made with scores recorded before the intervention, and significant differences were observed. A subsample of medical students with moderate or greater burnout at T0 manifested significant burnout score reductions. The same subsample revealed a significant increase in psychological flexibility as indicated by the progress factor score on the Valuing Questionnaire (VQ) at T1 compared to T0 and a significant reduction in reaction latency to negative words as indicated by the D IRAP score of the Implicit Relational Assessment Procedure (IRAP) for anxiety. We argue that short-term ACT during clinical clerkships of medical students in psychiatry and palliative care is feasible and potentially effective, and a multi-site comparative study using more direct behavioral measures is warranted to further investigate its effectiveness. • Short-term ACT is feasible during clinical clerkship program of medical students • ACT could be effective for clinical-year medical students with burnout • Burnout improvement sustained for two months after ACT completion • Our findings suggest overt and covert changes in psychological flexibility [ABSTRACT FROM AUTHOR]

Body image flexibility shows promise for understanding positive body image in young people. However, its adaptive functions remain unclear due to the lack of youth-oriented models and existing focus on inflexibility in unidimensional measures. This study developed a measure of body image flexibility and inflexibility for youth by adapting the Multidimensional Psychological Flexibility Inventory (MPFI) with 724 male and female Australian high school and university students aged 11 to 30 years. The Body Image Flexibility and Inflexibility Scale (BIFIS) replicated the higher-order MPFI structure (flexibility and inflexibility), with modifications required to lower-order factors to achieve acceptable fit. The final model (24 items; two higher-order and eight lower-order factors) was invariant across gender and age cohorts. The higher-order body image flexibility and inflexibility factors were internally consistent, stable over one month, correlated in expected directions with adaptive and maladaptive body image and eating constructs and well-being, and explained adaptive outcomes beyond measures of body satisfaction and unidimensional body image flexibility. The BIFIS provides a way to measure how young people respond to body image threats and expands existing conceptual models by including adaptive and maladaptive processes. Future work could refine the items, further validate the factor structure, and consider more experiential measurement formats. • A measure of body image flexibility and inflexibility in youth was developed • A hierarchical structure (two higher-order, eight lower-order factors) was supported • The 24-item model was invariant across gender and age cohorts • Body image flexibility and inflexibility explained adaptive outcomes [ABSTRACT FROM AUTHOR]

We outline the sport psychology service delivery provided to a 23-year-old elite figure skater who reported unhelpful thoughts about her body image that hindered her performance and concentration in training. An acceptance and commitment therapy intervention was implemented over 12 sessions across a 6-month period. The acceptance and commitment therapy matrix was used to conceptualize the client's "stuckness" and provide a foundation for the techniques implemented. The aim of our work was to increase psychological flexibility, helping the client sit with, rather than change or remove, her unhelpful thoughts, moving her toward the athlete she wanted to be. This case reports how psychological flexibility was achieved through exercises to help the client "unhook" from her unhelpful thoughts about body image. Reflections from the client were obtained to monitor and evaluate the service delivery process. The trainee's reflections on practice highlight the unpredictability of presenting problems disclosed during service delivery, the isolating and challenging nature of working with elite athletes in private practice, and the need for practitioners to understand the theoretical orientations of their approach. [ABSTRACT FROM AUTHOR]

Background: Many Australians experience mental health challenges, but only a third access face-to-face psychological services, due to multiple barriers including long waitlists. Additional strategies to prevent or help people de-escalate distress at an early stage are needed. Web-based mental health interventions are becoming increasingly acceptable to consumers and referring General Practitioners (GPs), but most are designed for specific disorders/populations. This study explores consumers' and health professionals' preferences and recommendations for the design of a transdiagnostic, Acceptance and Commitment Therapy (ACT)-based, online intervention for Australian adults. Methods: Thirty-five people (consumers, carers, GPs, mental health professionals) participated in one or more co-design stages. Stage 1: semi-structured interviews to establish what is wanted from such websites (n = 22). Stage 2: feedback emailed on branding options (n = 20). Stage 3: feedback provided via Zoom or an online survey after testing a website prototype (n = 19). Data were analysed using Thematic Framework Analysis and descriptive statistics. Results: Stage 1 highlighted nine key design principles (plus 25 subthemes) that participants emphasised as important to ensure the website would have broad appeal and meet their needs: (1) user choice is valued highly; (2) ACT-based content is acceptable as it is focused on helping people be proactive and 'get unstuck'; (3) non-pathologising, direct, empowering, lay language is endorsed; (4) a positive look and feel is appreciated; (5) images and videos are important to break up text and maintain engagement; (6) short text messages to aid engagement are valued; (7) provision of tailored psychoeducation for highly distressed and suicidal users is endorsed; (8) personal and proactive brand name is preferred (icanactnow); (9) diverse marketing and training activities are recommended. In Stage 2, icanactnow branding preferences were elicited (simplicity, colours to represent growth and a call to action). Stage 3 resulted in the inclusion of a safety plan template and a tailored entry portal for people referred to icanactnow by health professionals. High levels of satisfaction with the prototype were reported. Conclusions: These findings informed icanactnow and provide insights for the development of other online mental health interventions, in ways that appeal to both consumers and professionals recommending them. [ABSTRACT FROM AUTHOR]

Background: Experiencing racial microaggressions has clear effects on physical and psychological health, including obsessive-compulsive disorder symptoms (OCS). More research is needed to examine this link. Psychological flexibility is an important process to examine in this work. Aims: This study aimed to examine if, while controlling for depression and anxiety, experiences of microaggressions and psychological flexibility helped explain OCD symptoms within a university-affiliated sample (undergraduate, graduate and law students). This was a pilot exploration of the relationships across themes. Method: Initial baseline data from a longitudinal study of psychological flexibility, OCD symptoms, depression, anxiety and experience of microaggressions was utilized. Correlations and regressions were utilized to examine which OCD symptom dimensions were associated with experiencing racial microaggressions in addition to anxiety and depression, and the added role of psychological flexibility was examined. Results: OCD symptoms, experiences of microaggressions and psychological flexibility were correlated. Experiences of racial microaggressions explained responsibility for harm and contamination OCD symptoms above and beyond psychological distress. Exploratory results support the relevance of psychological flexibility. Conclusion: Results support other work that experiences of racial microaggressions help explain OCS and they add some support for psychological flexibility as a relevant risk or protective factor for mental health in marginalized populations. These topics should be studied longitudinally with continued consideration of all OCD themes, larger sample sizes, intersecting identities, clinical samples, and continued exploration of psychological flexibility and mindfulness and values-based treatments. [ABSTRACT FROM AUTHOR]

The goal of the study is to find out how many female educational guides in preparatory schools have self-compassion and how much psychological resilience they have. It also wants to find out how self-compassion and psychological resilience are related. The sample for the research was made up of (50) educational counsellors. To achieve these goals, the researcher made a scale of self-compassion with (22) items and three possible answers for each. The study's sample The data was put through a statistical analysis, and the results showed that self-compassion and psychological resilience go together well. Based on the results, the researcher suggests that educational institutions and school administrations stress the importance of psychological resilience and compassion in the face of life pressures, trauma, and emotions. One of the ideas is to study the professors at the University of Mosul in the same way. [ABSTRACT FROM AUTHOR]

Grounded in self-regulation theory, this research assesses the relationship between employees' experiences of workplace ostracism and organizational deviance, further exploring the mediating function of procrastination and the buffering role of psychological flexibility. Results based on longitudinal (three-wave) data collected from employees in North American organizations illustrate that workplace ostracism elicits organizational deviance because employees suffer from impaired self-regulation, shown through procrastination. Accordingly, this study identifies procrastination as a way by which workplace ostracism facilitates organizational deviance but highlights that the association between procrastination and deviant behavior is mitigated when employees can actively engage in psychological flexibility. Examining the interplay between these variables may present an opportunity to potentially understand how to curb adverse workplace outcomes by encouraging employees to adapt their behaviors in the pursuit of organizational goals, despite the distracting thoughts and emotions associated with the experience of workplace ostracism. [ABSTRACT FROM AUTHOR]

Background: A growing body of evidence suggests that the COVID‐19 pandemic is adversely impacting the mental health and well‐being of frontline nurses worldwide. It is therefore important to understand how such impact can be mitigated, including by studying psychological capacities that could help the nurses regulate and minimize the impact. Aim: To examine the role of psychological flexibility in mitigating the adverse impacts of burnout and low job satisfaction on mental health problems (i.e., anxiety, depression, and stress) and well‐being among the frontline nurses in Hong Kong and Switzerland during the COVID‐19 pandemic. Design: Cross‐sectional, two‐region survey study. Method: Four hundred fifty‐two nurses from Hong Kong (n = 158) and Switzerland (n = 294) completed an online survey. An adjusted structured equation model was used to examine the interrelationship of the constructs. Results: Psychological flexibility was found to partially mediate the effects of job satisfaction on mental well‐being (β = 0.32, 95% CI [0.19, 0.57], p = 0.001) and mental health problems (β = −0.79, 95% CI [−1.57, −0.44], p = 0.001), respectively. Similarly, this partial mediation was found in the effects of burnout on mental well‐being (β = −0.35, 95% CI [−0.89, −0.15], p = 0.002) and mental health problems (β = 0.89, 95% CI [0.48, 3.65], p = 0.001). Conclusion: Psychological flexibility could be a crucial psychological resilience factor against the adverse impact of nurses' burnout on their mental health problems and well‐being during COVID‐19. Clinical Relevance: Organizational measures should focus on fostering psychological flexibility in nurses through highly accessible, brief psychotherapeutic interventions, such as Acceptance and Commitment Therapy, to reduce the impact on mental health. [ABSTRACT FROM AUTHOR]

The present study investigated the psychometric properties of the Personalized Psychological Flexibility Index (PPFI) in a racially diverse sample of college students. Seven hundred twenty-three undergraduate students were recruited from a four-year public university in Hawaiʻi, USA. Confirmatory factor analyses were initially conducted to examine whether the theory-driven three-factor structure (i.e., Avoidance, Acceptance, and Harnessing) found in previous studies was identified in the current sample. The Generalized Partial Credit Model (GPCM), an item response theory (IRT) model for polytomous responses, was then used to explore the adequacy and accuracy of items and their response categories. We found a three-dimensional structure of PPFI, with minor modification for a correlated error term allowed between two items to be best fit of the present data. The GPCM analysis also indicated that, while most items in the Avoidance and Acceptance factors reliably measured the intended constructs, several items in the Harnessing factor showed suboptimal item information. Furthermore, our findings suggested reducing the 7-point original response categories to 5-point ones given the probabilities endorsed by items. Using an IRT model, this was the first study that investigated the psychometric properties of PPFI with a racially diverse sample of college students. While the PPFI is a promising measure of psychological flexibility, we found the areas of improvement through examining it at the item level. [ABSTRACT FROM AUTHOR]

Perinatal anxiety and potential protective processes are often poorly understood compared to other types of perinatal distress. The present study investigated the relationship between perinatal anxiety and quality of life or life satisfaction in a pregnant sample. Psychological flexibility and self-compassion were examined as moderators of these associations. COVID-19 and other external factors were examined on an exploratory basis. Results indicate significant correlations between perinatal anxiety and satisfaction with life, as well as psychological flexibility and perinatal anxiety; proposed interaction effects were not significant. This study may enhance understanding of these processes and contribute to the growing field of reproductive psychology. [ABSTRACT FROM AUTHOR]

Introduction and Objectives The COVID-19 pandemic in 2020 and the use of quarantine to prevent it have increased psychological reactions like depression, anxiety, and stress in the general population. Hence, the need to identify variables that can affect these psychological reactions is felt more than ever. The aim of this study was to predict the rate of depression, stress, and anxiety during quarantine based on psychological flexibility, dysfunctional attitude, and coping styles. Method The research design was descriptive-correlational and the statistical population included all students who were active in social media. A total of 501 students accessed the call for completion of questionnaires on online media, including Instagram, and completed prepared questionnaires in the Google Form format. Measures included the Depression, Anxiety, and Stress Questionnaire (DASS-21, 1995), the Revised Dysfunctional Attitude Scale (DAS-26, 1978), the Acceptance and Practice Questionnaire (AAQ-II, 2005), and the Lazarus and Folkman Coping Strategies Questionnaire (CSQ, 1984). Results Psychological inflexibility, dysfunctional attitudes, and maladaptive coping strategies predicted depression, anxiety, and stress in a positive way, but problem-oriented coping strategies only showed an inverse relationship with depression. In regression analysis, the variable of psychological inflexibility had the greatest effect on explaining depression, anxiety, and stress. Discussion and Conclusion It can be concluded that teaching psychological flexibility and cognitive reconstruction can be useful in reducing depression, anxiety, and stress during the quarantine. Teaching problem-solving strategies can also have positive effects on reducing depression [ABSTRACT FROM AUTHOR]

Body image flexibility – defined as one's ability to accept positive and negative body-related experiences – is theorized to promote adaptive motivational and behavioural outcomes. To date, there is a dearth of literature examining how body image flexibility is related to exercise motivation, a key predictor of exercise behaviour. The purpose of this study was to examine prospective within- and between-person associations between body image flexibility and autonomous and controlled exercise motivation in two independent samples. In Study 1 (N = 204) and Study 2 (N = 165), university students completed online surveys once a week for three weeks. Findings were consistent across studies, whereby during weeks when participants experienced higher than usual body image flexibility, they reported lower levels of controlled motivation (b s = −0.13 to −0.09, p s <.001). Further, participants with higher average levels of body image flexibility reported lower average scores of controlled motivation (b s = −0.30 to −0.27, ps <.001). Body image flexibility was not associated with autonomous motivation in either study. The findings provide novel insights on the relationship between body image flexibility and exercise motivation and identify body image flexibility as a potential modifiable factor that may be associated with lower controlled exercise motivation in daily life. • The relationship between body image flexibility and exercise motivation was examined. • Higher body image flexibility was linked to lower controlled, but not autonomous, exercise motivation. • Body image flexibility may be a factor to avert maladaptive exercise motivations. [ABSTRACT FROM AUTHOR]

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Introduction: Introduction: This study aims to determine the effectiveness of compassion-focused acceptance and commitment therapy on psychological flexibility and self-efficacy in females with MS.Method: To carry out this research, 30 women at Kashani Hospital in Isfahan who were diagnosed with MS were selected. In two stages pre-test and post-test, they were measured through the cognitive flexibility inventory (CFI) and Sherer & Maddux general self-efficacy scale (GSSES) in 1 group of treatment and 1 control group. The experimental group was treated for 8 sessions based on compassion-focused acceptance and commitment therapy, but the control group did not receive any treatment. Research data were analyzed using multivariate analysis of covariance and one-way analysis of covariance and SPSS software were used.Result: The results showed that the treatment increased psychological flexibility and self-efficacy in the post-test compared to the pre-test. But this change was not observed in the control group.Discussion and conclusion: using compassion-focused acceptance and commitment therapy is effective in increasing psychological flexibility and self-efficacy of women with multiple sclerosis.

Abstract Background Burnout and depression among medical students is linked to serious problems that require appropriate solutions. Subthreshold autism traits or autistic-like traits (ALTs) may be possible factors associated with burnout and depression. The effectiveness of acceptance and commitment therapy (ACT) for burnout and depression has been widely reported. The treatment aims to improve psychological flexibility, a concept indicating engagement in personal value-based behaviors without avoiding uncomfortable private experiences. This study examined whether ALTs were associated with burnout or depression among medical students during clinical clerkships in Japan, and then investigated what psychological flexibility processes might mediate these associations. Methods A cross-sectional survey was administered to 284 medical students at Nagoya City University School of Medical Sciences who had been in clinical clerkships for 10 months or longer. Linear multiple regressions were performed with each burnout factor or depression as the outcome variable using validated tools measuring burnout (Maslach Burnout Inventory), anxiety and depression (Hospital Anxiety and Depression Scale), ALT (Autism-Spectrum Quotient Japanese version-21), and psychological flexibility processes (Cognitive Fusion Questionnaire-7 and Valuing Questionnaire). Additionally, a mediation analysis was conducted using structural equation modeling. Results A linear multiple regression analysis that controlled for age and gender found that ALTs were significantly associated with lower personal accomplishment, a factor of burnout, and depression. Lower personal accomplishment was also associated with males and lower progress toward values of the psychological flexibility process. Depression was also associated with males and higher cognitive fusion, lower progress towards values, and higher obstruction to values of the psychological flexibility process. Surprisingly, emotional exhaustion and depersonalization were not significantly associated with ALTs. The mediation analysis revealed that the relationship between ALTs and personal accomplishment was partially mediated by a process of progress toward values, while the relationship between ALTs and depression was partially mediated by both processes of progress toward values and cognitive fusion. Conclusions ALTs were significantly associated with lower personal accomplishment of burnout and depression among medical students in clinical clerkships. Consideration should be given to the psychological flexibility processes that focus on interventions targeting psychological flexibility for medical students with ALTs to reduce burnout and depression.

This study investigated the efficacy of a resilience-based curriculum on the impulsivity and psychological flexibility of adolescents with an addiction propensity. This study was quasi-experimental, with pre- and post-testing, a control group, and a two-month follow-up. In the 2019-2020 academic year, the statistical population included secondary high school pupils with a tendency toward addiction. Using a systematic sampling technique, 25 adolescents were selected and randomly assigned to experimental and control groups. Over the course of two and a half months, the experimental group received ten seventy-five minute sessions of a teaching program on resilience. Three students in the experimental group and two students in the control group dropped out of the study after its initiation. This study utilized the addiction tendency questionnaire (ATQ), the impulsivity questionnaire (IQ), and the psychological flexibility questionnaire (PFQ). The data were analyzed using statistical software version 23 and repeated-measurement ANOVA and Bonferroni follow-up tests. The results indicated that the resilience curriculum had a significant impact on the impulsivity and psychological flexibility of adolescents with a tendency toward addiction (p

This study aimed to examine the effectiveness of acceptance and commitment therapy (ACT) on suicidal ideation, emotional self-regulation, and psychological flexibility in adolescents with suicidal ideation who were referred to a social emergency center. The research method was a quasi-experimental pretest-posttest design with a control group. The population of the study included all adolescents with suicidal ideation who visited the counseling center of the social emergency in Astaneh-ye Ashrafiyeh city in 2021. Thirty participants (15 in the control group and 15 in the experimental group) were selected from this population by purposive sampling and randomly assigned to two groups. The experimental group received eight 90-minute sessions of group ACT, while the control group was put on a waiting list. Data were collected using the Acceptance and Action Questionnaire (AAQ-2), the Cognitive Emotion Regulation Questionnaire (CERQ), and the Beck Scale for Suicide Ideation (BSSI). Data were analyzed using the analysis of covariance (ANCOVA) test. The results showed that there was a significant difference between the experimental and control groups in the posttest mean scores of the reappraisal component of emotion regulation and suicidal ideation. However, there was no significant difference in the flexibility and suppression components of emotion regulation. Based on the results of this study, it is recommended that psychologists and psychotherapists working in social emergency centers or with adolescents use the results of this study to improve emotion regulation and reduce suicidal ideation in their adolescent clients

Background: The objective of the current study was to further explore the mediating role of psychological flexibility and self-compassion in the relationship between traumatic memories of shame and the severity of depression and anxiety symptoms. The psychological processes that may have an impact on this connection make it difficult to understand. Methods: The research method was structural equation modeling. A sample of 296 university students from Tehran, Iran, was chosen through random cluster sampling for online research. The study data collection tools included the Early Life Experiences Scale (ELES), Impact of ‎Event Scale-Revised (IES-R), Depression Anxiety Stress Scales (DASS), Cognitive Fusion ‎Questionnaire (CFQ), Acceptance and Action Questionnaire-II (AAQ-II), Self ‎Experiences Questionnaire (SEQ‎), and Self-Compassion Scale (SCS).‎ Based on the partial least squares (PLS) approach, structural equation modeling, SPSS, and SmartPLS‎ software were used to evaluate the generated data. A statistical investigation revealed a clear correlation between the intensity of depression and anxiety symptoms and painful recollections of shame. Results: The results showed that traumatic memories of shame had a significantly favorable impact on anxiety (P < 0.001; β = 0.30) and depression (P < 0.001; β = 0.33), and a significantly negative impact on self-compassion (P < 0.001; β = 0.31) and psychological flexibility (P < 0.001; β = 0.47). Self-compassion significantly decreased sadness and anxiety (P < 0.001; = 0.25), and psychological flexibility significantly decreased sadness (P < 0.001; =0.54) and anxiety (P < 0.001; =0.37). Conclusion: These results suggest that the effects of experiential avoidance, cognitive fusion, and self-conceptualization, which together make up the overall construct of psychological resilience and are linked to the aggravation of depression and anxiety symptoms in people with traumatic shame memories, may be significantly reduced by self-compassion.

Jing Wang,1 Shuanghu Fang,1 Chunying Yang,2 Xiaobin Tang,3 Luosha Zhu,3 Yu Nie4 1School of Educational Science, Anhui Normal University, Wuhu, People’s Republic of China; 2School of Special Education, Zhengzhou Normal University, Zhengzhou, People’s Republic of China; 3School of Marxism, Anhui Normal University, Wuhu, People’s Republic of China; 4Office of Student Affairs, Anhui Normal University, Wuhu, People’s Republic of ChinaCorrespondence: Shuanghu Fang, Email fsh9075@163.comPurpose: To explore the potential classification of psychological flexibility (PF) among Chinese college students, analyze whether there is group heterogeneity in PF, and discuss the differences in the latent profile of PF in the negative emotions of depression, anxiety, and stress.Methods: A total of 1769 college students were investigated using the Psychological Flexibility Questionnaire and Depression-Anxiety-Stress Self-rating Scale, and heterogeneity was tested by latent profile analysis.Results: The PF of college students can be divided into three latent profiles: self-contradiction group (19.2%), high PF group (34.1%), and low PF group (46.7%). The scores of depression, anxiety, and stress are significantly different among the groups.Conclusion: There is obvious group heterogeneity in the PF of college students, and they can be divided into the self-contradiction group, the high PF group, and the low PF group. The self-contradiction and low PF groups score significantly higher on the negative emotions of depression, anxiety, and stress than the high PF group.Keywords: acceptance and commitment therapy, psychological flexibility, negative emotions, latent profile analysis

Abstract Aim The aim of the study was to investigate the effect of perceived social support (PSS) on sleep quality in arteriosclerotic obliterans patients in China and examined whether psychological flexibility (PF) has a mediating effect between PSS and sleep quality. Design A cross‐sectional survey. Methods A cross‐sectional study was conducted between September 2020 and December 2021 on 172 patients with atherosclerotic obliterans recruited from a hospital in China. Results PSS was negatively associated with sleep quality and PF, whereas PF was positively associated with sleep quality. This relationship between PSS and sleep quality was mediated by PF. Patient or public contribution Vascular surgery specialist nurses assisted the members of the research group in distributing the questionnaires after the patients gave oral informed consent, and the patients cooperated to complete the questionnaires. We thank both parties for their contributions to this survey.

Addressing global mental health is a major 21st-century challenge. Current treatments have recognized limitations; in this context, new ones that are prophylactic and effective across diagnostic boundaries would represent a major advance. The view that there exists a core of transdiagnostic overlap between psychiatric disorders has re-emerged in recent years, and evidence that psychedelic therapy holds promise for a range of psychiatric disorders supports the position that it may be transdiagnostically effective. Here, we propose that psychedelic therapy's core, transdiagnostically relevant action lies in its ability to increase neuronal and mental plasticity, thus enhancing the potential for change, which we consider to be a key to its therapeutic benefits. Moreover, we suggest that enhanced plasticity via psychedelics, combined with a psychotherapeutic approach, can aid healthy adaptability and resilience, which are protective factors for long-term well-being. We present candidate neurological and psychological markers of this plasticity and link them with a predictive processing model of the action of psychedelics. We propose that a model of psychedelic-induced plasticity combined with an adequate therapeutic context has prophylactic and transdiagnostic potential, implying that it could have a broad, positive impact on public health.

This study examined the relationships among cognitive acceptance, behavioral commitment, psychological need satisfaction, autonomous extrinsic motivation (EM) for physical activity (PA), and PA behavior. Participants (N = 456, Mage = 40.7 years) completed online measures of these variables, and data were analyzed using structural equation modeling. Results indicated a direct pathway from behavioral commitment to autonomous EM, plus indirect effects via autonomy, competence, and relatedness. There was no direct pathway from cognitive acceptance to autonomous EM, but there were indirect effects via competence and autonomy satisfaction. There was a direct pathway from cognitive acceptance to self-reported PA plus indirect effects via autonomous EM. There was no direct pathway from behavioral commitment to self-reported PA, but there were indirect effects via autonomous EM. Cognitive acceptance and behavioral commitment potentially support the development of autonomous EM for PA. Future research using longitudinal and intervention-based research designs is required to determine the causal relationships among these variables. [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.