Psychological flexibility as a fundamental aspect of health

Emotion regulation flexibility: EEG/EMG predictors and consequences of switching between reappraisal and distraction strategies

Flexible use of emotion regulation (ER) strategies is central to mental health. To advance our understanding of what drives adaptive strategy-switching decisions, in this preregistered study, we used event-related potentials (late positive potential, LPP and stimulus preceding negativity, SPN) and facial electromyography (EMG corrugator activity) to test the antecedents and consequences of switching to an alternative ER strategy. Participants (N = 63, Mage = 24.8 years, all female) passively watched and then implemented an instructed ER strategy (reappraisal or distraction) in response to high-intensity negative pictures that were either easy or difficult to reinterpret (high or low reappraisal affordance, respectively). Next, they decided to "switch from" or "maintain" the instructed strategy and subsequently implemented the chosen strategy. Reappraisal affordance manipulations successfully induced switching. Regarding antecedents, switching was predicted by the reduced ER efficacy of the current strategy (corrugator, but not LPP). Switching to distraction was additionally predicted by increased responses to the stimulus during passive viewing (corrugator and LPP) and increased anticipatory effort in implementing reappraisal (SPN). Concerning consequences, switching to distraction improved, whereas switching to reappraisal impaired post-choice ER effects (LPP). However, starting with reappraisal was overall more effective than starting with distraction, irrespective of the subsequent decision (corrugator). Our results suggest that switching between ER strategies occurs in accordance with situational demands (stimulus affordances) and is predicted by reduced peripheral physiological ER efficacy. However, only switching to distraction leads to improved regulatory effects. These insights provide neurocognitively grounded starting points for developing interventions targeting ER flexibility.

Translating theoretical insights into an emotion regulation flexibility intervention: assessing effectiveness

ABSTRACTObjective: Traditional research often categorizes emotion regulation strategies as adaptive or maladaptive, overlooking crucial situational and individual differences that dictate their efficacy. The literature highlights the need for a more nuanced approach, like the role of emotion regulation flexibility. Despite its importance, research on developing and testing interventions that promote this flexibility is scarce. Addressing this gap, our study designed and tested an "Emotion Regulation Flexibility Booster Program" (ERFBP). We aimed to assess its efficacy in improving emotion regulation flexibility (ERF) and its impact on various mental health indicators. Method: We recruited 153 participants with low emotion regulation flexibility, randomly assigning them to experimental, control, and no-treatment groups. The experimental group was provided with an intervention based on an ERF model. The control group received sessions on study habits, whereas no-treatment group received no training. Results: The analysis indicated that participants in the ERFBP group exhibited significant changes in ERF, subjective wellbeing, and emotion regulation goals and psychological distress compared to baseline measurements and post-intervention scores of other two groups. Conclusion: These findings support the effectiveness of the ERFBP in enhancing ERF and wellbeing. However, further research must confirm these findings across diverse contexts and populations.

Perceived changes in mental health and social engagement attributed to a single psychedelic experience in autistic adults: results from an online survey

RATIONALE

Anecdotal reports suggest that psychedelic drugs can improve psychological wellbeing and social engagement in autistic people. However, there are few contemporary studies on this topic.

OBJECTIVES

To examine autistic participants' experiences with psychedelic drugs and the extent to which they attributed changes in mental health and social engagement to their most 'impactful' psychedelic experience. We also explored associations between these changes and mechanistically important variables (e.g., aspects of the acute psychedelic experience and changes in 'psychological flexibility').

METHODS

Self-selecting autistic participants (n = 233) with high autism quotient scores completed an online survey relating to their most impactful psychedelic experience. Questionnaires assessed the acute psychedelic experience and perceived psychedelic-induced changes in distress, social engagement and psychological flexibility, among other relevant variables.

RESULTS

The majority of participants attributed reductions in psychological distress (82%) and social anxiety (78%) and increases in social engagement (70%) to their most 'impactful' psychedelic experience. A substantial minority (20%) also reported undesirable effects such as increases in anxiety with some describing their psychedelic experience as among the most negatively impactful experiences of their lives. The only substantial predictor of reductions in psychological distress was increased psychological flexibility.

CONCLUSION

Autistic people attributed changes in mental health and social engagement to a single highly impactful psychedelic experience. The results and their implications are discussed with caution considering the use of a non-experimental design and biased sampling.

The mediating role of psychological flexibility in the relationship between psychotic symptom severity and depression in individuals diagnosed with schizophrenia

WHAT IS KNOWN ABOUT THE SUBJECT?: Psychotic symptoms and depression are common problems in people diagnosed with schizophrenia. Psychological flexibility is a skill that facilitates coping with difficulties. There is limited research on the role of psychological flexibility in the relationship between psychotic symptoms and depression in people diagnosed with schizophrenia. WHAT DOES THE ARTICLE ADD TO EXISTING KNOWLEDGE?: This article investigates the role of psychological flexibility in the link between psychotic symptom severity and depression in people diagnosed with schizophrenia. The article shows that psychological flexibility partially mediates the relationship between psychotic symptom severity and depression. The article suggests that interventions aimed at improving psychological flexibility may be beneficial in reducing depressive symptoms in people diagnosed with schizophrenia. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses should consider psychotic symptom severity and psychological flexibility when assessing and intervening for depressive symptoms in people diagnosed with schizophrenia. Mental health nurses should receive training to improve psychological flexibility and pass this skill on to their patients. Mental health nurses should continue to research the effectiveness and outcomes of interventions aimed at improving psychological flexibility.

ABSTRACT

INTRODUCTION: Psychological flexibility may help people diagnosed with schizophrenia (PWS) cope with their psychotic symptoms and reduce their depressive symptoms, but the mechanism of this effect is unclear.

AIM

To investigate whether psychological flexibility mediates the relationship between psychotic symptom severity and depression in PWS.

METHOD

A cross-sectional study was conducted, in which a total of 111 PWS were assessed with DSM-5 Clinician-Rated Dimensions of Psychosis Symptom Severity, Calgary Depression Scale for Schizophrenia and Acceptance and Action Questionnaire. Data analysis was performed using SPSS 25 and PROCESS macro.

RESULTS

Significant correlations were found between psychotic symptoms, depression and psychological flexibility. Psychological flexibility partially mediated the relationship between psychotic symptom severity and depression.

DISCUSSION

Psychological flexibility could weaken the impact of psychotic symptom severity on depression in PWS. Higher psychotic symptoms were associated with lower psychological flexibility and higher depression.

IMPLICATIONS FOR PRACTICE

Interventions to improve psychological flexibility may prevent depressive symptoms in PWS. Psychiatric nurses can use psychological flexibility as a goal for evaluation and intervention.

The three axioms of resilience

This article summarizes the growing literature on resilience in the face of aversive and potentially traumatic events (PTEs) in three basic axioms: (a) resilience is a common outcome, 2) there are no "key" traits to resilience (resilience is not a type), and (c) resilient outcomes occur through flexible self-regulation. The first axiom highlights the limitation of a traditional, binary view of trauma in terms of the presence-absence of posttraumatic stress disorder, emphasizing instead the heterogeneity of trauma outcomes. Four prototypical trajectories are reviewed: chronic symptoms; delayed symptoms; recovery; and the most common trajectory, resilience. The second axiom reviews the paradoxical inability of known correlates of resilience to adequately predict resilient outcomes. Resilience is instead described as a multifaceted phenomenon with no singular set of key traits, as various factors contribute to resilient outcomes in complex ways. The third axiom provides an explanation of how resilience can emerge from this complex array by introducing the concept of flexible self-regulation. The flexibility mindset is described as providing the motivation for flexible responding. The flexibility sequence is described as explaining the mechanisms underlying flexibility in terms of three serial stages: context sensitivity, strategy repertoire, and feedback adjustment. The final section briefly considers clinical implications.

The effectiveness of the DNA-V program on reducing anxiety among Chinese adolescents: Outcomes of the face-to-face and web-based versions

Many studies have indicated an alarming prevalence of anxiety among Chinese adolescents, highlighting the critical need for prevention protocols. DNA-V (Discoverer, Noticer, Advisor-Values model) is an adapted version of Acceptance and Commitment Therapy designed to prevent mental health problems in adolescents. This study investigated the effects and underlying mechanisms of DNA-V. The DNA-V prevention program was culturally adapted and optimized in both content and form specifically for Chinese adolescents, with the aim of reducing anxiety levels. A total of 139 participants (59 females) from six eighth-grade classes at an average middle school in Beijing were randomly assigned to one of three groups consisting of the DNA-V face-to-face group (two classes), the DNA-V web-based group (two classes), or the active control group (two classes). Adolescents' anxiety and cognitive fusion were measured before (Time 1), immediately after (Time 2), and 2 months after (Time 3) the program using the Chinese Secondary School Students Anxiety Scale (CSSSAS) and Cognitive Fusion Questionnaire (CFQ). Results showed that in the DNA-V face-to-face group, the anxiety score at Time 3 was significantly lower than the scores at Time 1 (p < .001, Cohen's drm = 0.56) and Time 2 (p = .043, Cohen's drm = 0.24). The cognitive fusion score at Time 3 was significantly lower than the scores at Time 1 (p = .001, Cohen's drm = 0.51) and Time 2 (p = .003, Cohen's drm = 0.37). The results of the study suggest that the DNA-V prevention program could serve as an effective tool for reducing anxiety in adolescents.

Effectiveness of an interactive brain health campaign on motivation for dementia risk reduction: a pretest-posttest evaluation

Whilst dementia is a global health concern, recent research indicates that behaviour changes can reduce its risk. This study aimed to explore the impact of an interactive visual art exhibition on adults' motivation for dementia risk reduction. Participants (N = 165) completed the Motivation to Change Behaviour for Dementia Risk Reduction 10-item scale before and after the exhibition. Paired-sample t-tests compared changes in total motivation levels, and positive and negative cues to action scores. Multilinear regression was employed to identify predictors of increased motivation post exhibit. Participants showed a significant overall increase in motivation for brain-healthy lifestyles immediately post-exhibit (t(62) = - 2.70, p = 0.009), particularly with positive cues to action. Longer time spent engaging in the exhibit was associated with increased motivational change (R2 = 0.177, F(6,156) = 5.605, p < 0.001). Findings indicate that interactive visual art exhibitions hold significant potential as a means of enhancing adults' motivation for dementia risk reduction. By offering positive cues to action, these exhibitions could serve as an innovative component of public health strategies focused on promoting brain-healthy lifestyles. Our results contribute to the relatively limited body of research on the development of arts-based interventions that are both engaging and scalable, with the capacity to reach diverse populations. Further investigation into the long-term effects and underlying mechanisms is warranted to inform the design of more efficacious public health programs to support global efforts on mitigating the burden of dementia.

Psychologically Informed Physical Therapy Management of Chronic Musculoskeletal Pain in Culturally Diverse Populations: An Intervention Logic Model

Culturally and linguistically diverse (CALD) individuals are underrepresented in pain research, including studies of psychologically informed physical therapy (PIPT) for musculoskeletal pain. This perspective describes a conceptual framework for PIPT management of chronic musculoskeletal pain that identifies essential elements which can be culturally tailored to meet the needs of different CALD populations. Essential interventions, determinants of behavior change, and clinical outcomes were identified from studies of existing PIPT interventions for chronic pain. PIPT approaches shared the following essential interventions: (1) cognitive skill training, (2) general aerobic activity, (3) impairment-based therapeutic exercises, and (4) graded functional movement training. An intervention logic model was developed to conceptualize how these interventions might promote active coping behaviors and greater engagement in physical activity, therapeutic exercise, and functional mobility. The model included physical and cognitive-emotional processes that may contribute to behavioral changes which ultimately reduce pain-related disability. To illustrate cultural tailoring of model constructs, we describe how intervention delivery and assessments were customized for Latino persons with chronic spine pain at a health center located near the United States (US)-Mexico border. A literature review of sociocultural influences on the pain experience of Latino persons was conducted, and essential elements of the model were operationalized to ensure that therapeutic goals, language, content, and processes were compatible with Latino cultural beliefs, values, and behaviors. Future research using the proposed model to adapt and test PIPT interventions for other CALD populations may help identify shared and divergent mechanisms of treatment response for culturally tailored pain management programs. PERSPECTIVE: A novel conceptual framework may help inform cultural tailoring of psychologically informed physical therapy management approaches for chronic musculoskeletal pain by maintaining fidelity to essential treatment elements while also leveraging the unique sociocultural context of different culturally and linguistically diverse communities to improve health outcomes.

Addressing emotional distress to improve outcomes in adults with type 1 diabetes: Protocol for ACT1VATE randomized controlled trial

BACKGROUND

Diabetes distress (DD) is a prevalent concern among people with type 1 diabetes (T1D) and is linked to poor clinical outcomes. Instead of targeting the elimination of DD, we propose a novel approach that empowers individuals with strategies to manage their diabetes effectively in the context of DD: Acceptance and Commitment Therapy (ACT). The purpose of this in-progress trial is to compare an ACT group intervention (ACT1VATE) with usual care in improving HbA1c, DD, quality of life, and cost-effectiveness in adults with T1D.

METHODS

This is a two-arm, parallel group, randomized controlled superiority trial enrolling N = 250 adults with T1D, elevated HbA1c, and significant DD in a real-world community-based health system. Participants are randomized to receive ACT1VATE (a five-week ACT group telehealth intervention) or diabetes self-management education and support (usual care as the first-line recommended intervention for DD). The trial will examine comparative effectiveness in improving HbA1c, DD, quality of life, and cost-effectiveness over 12 months.

DISCUSSION

We predict that ACT1VATE will be superior given its (1) specific focus on DD, without any expectation that difficult diabetes-related thoughts and emotions must (or can) be completely eliminated; and (2) purposeful linkage of diabetes self-care behaviors to an individual's deeply held values, thus eliciting intrinsic, patient-centric motivation for meaningful and lasting health behavior changes. This trial will provide a valuable test of real-world effectiveness, drive sustainability and scalability, and inform the future of chronic disease care.

TRIAL REGISTRATION

NCT04933851 (https://clinicaltrials.gov/ct2/show/NCT04933851).

CLINICAL TRIAL

Clinicaltrials.govNCT04933851https://clinicaltrials.gov/study/NCT04933851.

Co-administration of midazolam and psilocybin: differential effects on subjective quality versus memory of the psychedelic experience

Aspects of the acute experience induced by the serotonergic psychedelic psilocybin predict symptomatic relief in multiple psychiatric disorders and improved well-being in healthy participants, but whether these therapeutic effects are immediate or are based on memories of the experience is unclear. To examine this, we co-administered psilocybin (25 mg) with the amnestic benzodiazepine midazolam in 8 healthy participants and assayed the subjective quality of, and memory for, the dosing-day experience. We identified a midazolam dose that allowed a conscious psychedelic experience to occur while partially impairing memory for the experience. Furthermore, midazolam dose and memory impairment tended to associate inversely with salience, insight, and well-being induced by psilocybin. These data suggest a role for memory in therapeutically relevant behavioral effects occasioned by psilocybin. Because midazolam blocks memory by blocking cortical neural plasticity, it may also be useful for evaluating the contribution of the pro-neuroplastic properties of psychedelics to their therapeutic activity.

Universal online self-help ACT interventions for youth: A systematic review

Previous reviews of online self-help have not exclusively focussed on universally delivered Acceptance and Commitment Therapy (ACT). This systematic review aimed to evaluate the effectiveness of universal online self-help ACT interventions for young people. Relevant databases were searched for studies examining ACT interventions that were delivered universally, online and as self-help (guided and unguided) to young people aged 10 to 25-years-old. Eleven studies met inclusion criteria. These were assessed for quality and findings summarised using a narrative synthesis. Outcomes on mental health, well-being and ACT processes were reviewed, and results across studies were mixed. Most studies found significant improvements in mental health and well-being outcomes following the ACT intervention; however less than half found improvements in ACT process measures. Subgroups, such as those with elevated mental health symptoms, had better outcomes. There were no changes in measures of psychological inflexibility. However, methodological issues limited the interpretation of findings. Heterogeneity between studies and methodological issues made it difficult for this review to draw conclusions regarding the effectiveness of universal online self-help ACT interventions for young people. Future research with consistent approaches is needed across these types of interventions to improve methodological rigour to determine whether these interventions are effective.

Self-Critical Perfectionism and Anxious and Depressive Symptoms Over 2 Years: Moderated Mediation Models of Anxiety Sensitivity and Experiential Avoidance

This three-wave longitudinal study of 297 community adults (mean age = 38.66 years, 67% female) examined how anxiety sensitivity and experiential avoidance work together to explain the relation between perfectionism and anxious and depressive symptoms over 2 years. Participants completed measures of self-critical (SC) and personal standards (PS) higher-order dimensions of perfectionism, anxiety sensitivity, experiential avoidance, and anxious and depressive symptoms at Time 1. Participants completed measures of anxiety sensitivity, experiential avoidance, and symptoms again at Time 2 one year later, and symptoms measures again at Time 3 two years after baseline. Moderated mediation analyses showed that for those with higher Time 1 experiential avoidance, Time 1 SC perfectionism was indirectly related to Time 3 anxious arousal symptoms through Time 2 anxiety sensitivity. For those with moderate to higher Time 1 anxiety sensitivity, Time 1 SC perfectionism was indirectly associated with Time 3 general distress and anxious arousal symptoms through Time 2 experiential avoidance. These moderated mediation effects were not found for PS perfectionism. These results support anxiety sensitivity and experiential avoidance as moderating and mediating processes that may be important treatment targets for reducing vulnerability to anxious and depressive symptoms over the longer-term in SC perfectionistic individuals.

The Adaptiveness of Emotion Regulation Variability and Interoceptive Attention in Daily Life

OBJECTIVE

In daily life, we must dynamically and flexibly deploy strategies to regulate our emotions, which depends on awareness of emotions and internal bodily signals. Variability in emotion-regulation strategy use may predict fewer negative emotions, especially when people pay more attention to their bodily states-or have greater "interoceptive attention" (IA). Using experience sampling, this study aimed to test whether IA predicts variability in strategy use and whether this variability and IA together predict negative affect.

METHODS

University student participants ( n = 203; 165 females; Mage = 20.68, SD age = 1.84) completed trait questionnaires and reported state levels of IA, emotional awareness, negative affect, and emotion-regulation strategies, seven times daily for 1 week.

RESULTS

State IA significantly predicted between-strategy variability, which was mediated by emotional awareness (indirect effect = 0.002, 95% confidence interval = <0.001-0.003). Between-strategy variability was associated with lower negative affect, particularly when individuals had higher state IA (simple slope = -0.83, t = -5.87, p < .001) versus lower IA (simple slope = -0.31, t = -2.62, p = .009).

CONCLUSIONS

IA appears to facilitate adaptative emotion regulation and help alleviate negative affect. Findings underscore the key roles of IA and emotion-regulation flexibility in mental health.

eLIFEwithIBD: study protocol for a randomized controlled trial of an online acceptance and commitment therapy and compassion-based intervention in inflammatory bowel disease

Background

Inflammatory bowel disease (IBD) entails physical, psychological, and social burden and holds a significant impact on quality of life. Experiential avoidance, cognitive fusion, shame, and self-criticism have been identified as possible therapeutic targets for improving mental health in people with IBD. Traditional face-to-face psychological therapy continues to provide obstacles for patients seeking assistance. Online psychological therapies centered on acceptance, mindfulness, and compassion have been shown to improve psychological distress in other populations.

Objective

This paper presents the study protocol of a two-arm Randomized Controlled Trial (RCT) of an ACT and compassion-based, online intervention - eLIFEwithIBD - on the improvement of psychological distress, quality of life, work and social functioning, IBD symptom perception, illness-related shame, psychological flexibility, and self-compassion.

Methods

The eLIFEwithIBD intervention is an adaptation of the LIFEwithIBD programme (delivered through an in-person group format) and entails an ACT, mindfulness, and compassion-based intervention designed to be delivered as an e-health tool for people with IBD. This protocol outlines the structure and contents of the eLIFEwithIBD intervention. Participants were recruited by an advertisement on the social media platforms of Portuguese Associations for IBD in January 2022. A psychologist conducted a brief interview with 80 patients who were interested in participating. Fifty-five participants were selected and randomly assigned to one of two conditions [experimental group (eLIFEwithIBD + medical TAU; n = 37) or control group (medical TAU; n = 18)]. Outcome measurement took place at baseline, post-intervention, and 4-month follow-up. All analyses are planned as intent-to-treat (ITT).

Results

The eLIFEwithIBD intervention is expected to empower people with IBD by fostering psychological strategies that promote illness adjustment and well-being and prevent subsequent distress. The eLIFEwithIBD aims to gain a novel and better understanding of the role of online contextual behavioral interventions on improving the quality of life and mental health of people with IBD.

Clinical Trial Registration

https://classic.clinicaltrials.gov/ct2/show/NCT05405855, NCT05405855.

Does the good life feel good? The role of positive emotion in competing conceptions of the good life

Flourishing refers to one kind of generalized wellbeing. Contemporary flourishing research often privileges positive emotion in the theorization and measurement of the construct, such that flourishing is frequently conceptualized as involving a predominance of positive over negative emotions. Positive emotions are thus, on some views of flourishing, seen as an essential component of "the good life." This paper explores the nuanced variations in conceptions of the good life, focusing on the interplay between positive emotion and flourishing. Through an analysis of contemporary perspectives on flourishing, we underscore the diversity in conceptualizations of flourishing and the implications of this diversity for flourishing theorists. Our review reveals significant disparities in perspectives regarding the significance of positive emotion in the pursuit of a good life. Furthermore, we delineate the theoretical distinctions between objective-list approaches and functional approaches to flourishing, highlighting their respective advantages and limitations. Theoretical dissensus persists regarding whether positive emotion is a necessary constituent of the good life, thus prompting a critical examination of the justification for its inclusion in flourishing models. Finally, we emphasize the need for greater theoretical clarity in defining wellbeing to inform both research endeavors and societal discourse. We suggest that an adequate appreciation of variation in the development and maintenance of flourishing requires admitting for more complex relationships between the construct and both positive and negative emotionality, while embracing the cultural and individual variety that are unavoidable in accurate models of human life.

The Indirect Influence of Cannabis Use Disorder Symptoms on PTSD Symptom Severity Through Psychological Inflexibility

Background: One in five college students (21%) report using cannabis in the past month, and approximately 10% develop cannabis use disorder (CUD). Further, college students have high rates of trauma exposure, and CUD is prospectively linked to posttraumatic stress disorder (PTSD). Given the high rate of co-occurrence, research is needed to understand transdiagnostic, modifiable factors that could account for the relationship between CUD and PTSD. Psychological inflexibility (PI) is one such factor and refers to difficulty adapting thoughts or behaviors to various situations that reflect of one's personal values. Objectives: PI predicts worse PTSD symptom severity and has been established as a maintaining factor between alcohol use and PTSD, albeit no studies have examined this relationship with CUD. Results: College students (N = 336) completed self-report measures of CUD, PI, and PTSD. A cross-sectional mediation model explained 54% of the variance in PTSD symptom severity, F(5, 330) = 78.86, p < .001. After controlling for age, gender, and probable alcohol use disorder, CUD was not directly associated with PTSD symptom severity, yet was indirectly associated with PTSD through higher PI. Specifically, CUD was associated with higher PI (b = 0.31, p < .05, 95% CI [0.07, 0.54]), and higher PI was associated with greater PTSD symptom severity (b = 1.07, p < .001, 95% CI [0.95, 1.19]). Conclusion: Although CUD has been previously linked with worse PTSD symptoms, results suggest that this occurs through PI. Importantly, PI is malleable, and may be an important treatment target for co-occurring CUD and PTSD in college students.

Out of their control: College students' beliefs in sleep myths, sleep problems, and psychological flexibility

OBJECTIVES

College students suffer from deficient sleep, and the pernicious factors that support this phenomenon are diverse. The aim of the current study was to better understand the role of sleep-related myths in college students' sleep disturbance. A second aim was to examine if college students' levels of sleep disturbance were similarly associated with their belief in sleep-related myths or if their capacity to be psychologically flexible might moderate this process.

METHODS

The online sample consisted of 638 undergraduates (82.4% female; Mage=21.3, SD=1.6years), who reported on their level of belief in sleep-related myths, sleep disturbance, sleep environment, sleep hygiene, and psychological flexibility.

RESULTS

Controlling for critical sleep-related correlates, including melatonin usage, work hours and perceived sleep-related self-efficacy, we found that for students with below-average (-1 SD) psychological flexibility, the greater their belief in the myth that their sleep schedules were out of their control was associated with greater levels of sleep disturbance.

CONCLUSIONS

These results not only highlight another important source of college students' sleep problems, but they also speak to the widespread belief that college students have little control over their sleep. Findings from the current study raise the possibility that by developing students' capacities to be more psychologically flexible and by empowering students to prioritize their sleep, they will be able to decrease the likelihood of experiencing sleep and sleep-related problems.

Euthymia, Psychological Well-Being, and Professional Quality of Life in Health Care Workers

Objective

Euthymia is a transdiagnostic construct characterized by the presence of positive mood states, psychological flexibility and resilience. These components contribute to psychological wellbeing and support mental functioning. Exposure to suffering and high levels of stress can lead to the onset of burnout and secondary traumatic stress, but also lack of compassion satisfaction. The study aimed to test the existing relationships between euthymia, psychological well-being, and factors associated with quality of life of healthy participants involved in medical settings.

Method

The sample was composed of 177 healthy participants involved in medical settings, 118 women (66.7%) and 59 men (33.3%) aged between 19 and 69 years old (mean = 27.16; SD = 8.47). Standardized psychodiagnostics instruments were used to assess euthymia (Euthymia Scale-ES), psychological well-being (The Well-Being Index scale-WHO-5) and the quality of life of the involved participants (Professional Quality of Life Measure-ProQOL-5).

Results

The results showed that gender, well-being and psychological well-being were predictors of compassion satisfaction and secondary traumatic stress. Specifically, female gender predicted higher levels of compassion satisfaction. Well-being and psychological flexibility predicted higher levels of compassion satisfaction and lower secondary traumatic stress. Psychological well-being predicted higher levels of compassion satisfaction.

Conclusions

Promoting euthymia and well-being helps individuals to preserve psychological well-being and increase tolerance to stressful life situations. Results highlighted the need for promoting health care professionals' euthymia and well-being. In line with evidence, encouraging interventions based on evidence appears relevant.

Affect variability and cortisol in context: The moderating roles of mean affect and stress

Positive and negative affect have been shown to have implications for hormones like cortisol but how moment to moment changes in affect (i.e., affect variability) influence cortisol secretion is less well understood. Additionally, context characteristics such as mean affect and stress may influence the association between affect variability and cortisol output. In the current study, we examined affect, stress, and cortisol data from 113 participants (age range = 25-63, M = 35.63, SD = 11.34; 29% male; 42% White/Caucasian, 37% Asian or Pacific Islander, 13% Hispanic/Latino, 4% Black/African American, 1% Native American, Eskimo, or Aleut, 4% selected "other" for their race/ethnicity). Participants completed ecological momentary assessments assessing positive and negative affect and stress four times per day for five days and provided saliva samples at each time point. Saliva was assayed for cortisol, and area under the curve with respect to ground was computed. In a three-way interaction, both positive affect mean level and stress moderated the association between positive affect variability and cortisol (b = -1.55, t(100) = -3.29, SE = 0.47, p <.01, β = -4.05). When breaking down this three-way interaction, in the context of low stress and high mean positive affect, variability was positively related to total cortisol output. In contrast, in the context of high stress and high mean positive affect, variability was negatively related to total cortisol output. While greater positive affect variability is generally worse for health-relevant outcomes (as prior research has shown and as we show here at low levels of stress), at high levels of stress, fluctuation in affect may be adaptive. For someone experiencing a high stress week, having fluctuations in positive affect may mean that they are adaptively changing to meet their environmental needs especially when they typically report high mean positive affect levels. There were no associations between negative affect variability and cortisol secretion nor did mean negative affect or stress play a moderating role for negative affect variability. This study provides evidence that positive affect variability's association with cortisol secretion throughout the day may vary based on stress and mean positive affect levels.

Bibliometric Mapping of Psychological Flexibility Research: Trends and Future Directions

In this article, we offer an exhaustive analysis of academic work on psychological flexibility using bibliometric techniques. We identify emerging trends in a dataset of 3535 scholarly articles from the Web of Science database. We highlight key publications, map out the field's intellectual framework, and anticipate future research avenues through co-citation and co-word analytics. The co-citation assessment revealed five distinct clusters, while the co-word analysis showed three. Although research regarding psychological flexibility has gained recent popularity, there remains a need for more scholarly initiatives to achieve a nuanced understanding of this subject.

A Qualitative Content Analysis of Perceived Individual and Relational Consequences of Sexual Compliance and Their Contributors

Sexual compliance (i.e., consensually engaging in sex despite a lack of desire for it) is common in committed intimate relationships, but the consequences of compliance for the well-being of the individual and the relationship are poorly understood. We investigated the perceived consequences of sexual compliance and perceptions of factors contributing to negative/positive consequences by applying qualitative content analysis to free-text retrospective survey responses from 107 (mostly) Finnish adults. We identified five themes of personal consequences (emotions and mood, sexual experience, sexual desire, pressure and violations, and physical pain), four of relational consequences (relationship satisfaction, partner's response, relationship interaction, and value alignment), and nine of possible factors contributing to negative/positive consequences (communication, self-esteem, motives for sex, relationship factors, agency and self-knowledge, mental health and stress, psychological flexibility, societal norms, and past negative experiences). Perceived consequences varied widely across individuals, both in terms of whether any positive or negative consequences were experienced and whether compliance was perceived as improving or worsening specific domains of well-being. We discuss the themes identified in relation to previous theories of sexuality and intimate relationships and offer hypotheses that can be tested in future quantitative studies.

How a general vulnerability for psychopathology during adolescence manifests in young adults' daily lives

BACKGROUND

There is widespread interest in the general factor of psychopathology or 'p factor', which has been proposed to reflect vulnerability to psychopathology. We examined to what extent this 'vulnerability' is associated with dysregulations in affect and behavior that occur in daily life. As such we hoped to provide an account of how this vulnerability may be maintained.

METHODS

We used data from the Tracking Adolescents' Individual Lives Survey (TRAILS; N = 2,772) collected at ages 11, 14, 16, 19, and 22 years to fit a bifactor model with a general psychopathology factor, alongside internalizing, externalizing (EXT), attention-deficit/hyperactivity, and autism spectrum problem domains. Following the fifth TRAILS assessment, a subsample of participants (n = 133, age = 22.6, 43% women) with heightened risk for psychopathology completed a 6-month daily diary protocol with one assessment each day. Using a dynamic structural equation approach, we examined to what extent mean intensity, variability, inertia, and within-day co-occurrence of EXT, anxious-tense, and depressed-withdrawn affects and behaviors were associated with general factor scores.

RESULTS

Unexpectedly, higher general factor scores were not associated with higher mean intensity of any of the three types of daily negative affects and behaviors, but were associated with higher variability and less carryover (inertia) EXT affects and behaviors.

CONCLUSIONS

We showed that individual differences in general factor scores do not manifest as differences in average levels of daily affects and behaviors, but instead were related to a type of EXT reactivity to the environment. Future research is necessary to investigate whether reactive irritable moods may be involved in or signal vulnerability sustained psychopathology.

Positive Childhood Experiences and Spiritual Well-Being: Psychological Flexibility and Meaning-Based Coping as Mediators in Turkish Sample

Spiritual well-being enhances life quality, acts as a stress reliever, and mitigates unfavorable feelings. It helps individuals find meaning and purpose, increasing inner peace and happiness while improving stress management and overall well-being. This study examined whether positive childhood experiences are linked to spiritual well-being and if psychological flexibility and meaning-based coping serve as mediators. The sample included 1061 participants (Mage = 39.38; SD = 8.82) from various Turkish cities. Structural equation modeling assessed relationships between spiritual well-being, positive childhood experiences, psychological flexibility, and meaning-based coping. Results showed that positive childhood experiences directly enhance spiritual well-being, mediated by psychological flexibility and meaning-based coping. This underscores the significance of fostering positive childhood experiences to promote spiritual well-being and coping mechanisms.

Neurocognitive functioning in adults with trichotillomania: Predictors of treatment response and symptom severity in a randomized control trial

Trichotillomania (TTM) is associated with impairments in response inhibition and cognitive flexibility, but it is unclear how such impairments relate to treatment outcome. The present study examined pre-treatment response inhibition and cognitive flexibility as predictors of treatment outcome, change in these domains from pre-to post-treatment, and associations with TTM severity. Participants were drawn from a randomized controlled trial comparing acceptance-enhanced behavior therapy (AEBT) to psychoeducation and supportive therapy (PST) for TTM. Adults completed assessments at pre-treatment (n = 88) and following 12 weeks of treatment (n = 68). Response inhibition and cognitive flexibility were assessed using the Stop Signal Task and Object Alternation Task, respectively. Participants completed the MGH-Hairpulling Scale. Independent evaluators administered the NIMH-Trichotillomania Severity Scale and Clinical Global Impressions-Improvement Scale. Higher pre-treatment TTM severity was associated with poorer pre-treatment cognitive flexibility, but not response inhibition. Better pre-treatment response inhibition performance predicted positive treatment response and lower post-treatment TTM symptom severity, irrespective of treatment assignment. Cognitive flexibility did not predict treatment response. After controlling for age, neither neurocognitive variable changed during treatment. Response inhibition and cognitive flexibility appear uniquely related to hair pulling severity and treatment response in adults with TTM. Implications for treatment delivery and development are discussed.

Developing and validating of educational-therapeutic package based on psychological flexibility for nurses in the intensive care unit of COVID-19: Application of grounded theory

BACKGROUND

Caring for COVID-19 patients has caused high stress and burnses. Therefore, the current research aims to develop and validate an educational-therapeutic package based on psychological flexibility for COVID-19 nurses.

MATERIALS AND METHODS

The approach of this research was Exploratory Sequential Mixed Method, which was carried out in 2019 to 2021. In the qualitative phase, to identify the paradigm model of the research, the grounded theory of the Strauss and Corbin model, purposeful sampling, and in-depth semi-structured interviews with 12 nurses were used. Goba and Lincoln's criteria were used to ensure the accuracy and reliability of the data. In the quantitative phase, based on the Paradarim model, a training package according to psychological flexibility was developed with the approval of 10 experts from the fields of medical, psychology and nursing education.

RESULTS

The qualitative analysis of the data obtained from the interviews led to the identification of 29 primary concept codes, 8 subcategories, and 3 categories in the conceptual format of context, process, and consequence. The categories included "psychological insecurity in the workplace," "strategic immunization in facing special conditions," and "safe communication." "Psychologically safe exposure" was identified as the central category. In several stages, based on the findings of the qualitative stage, the educational-therapeutic package was compiled. The validity of the package was confirmed by calculating two relative coefficients of content validity ratio (CVR) and content validity index (CVI) equal to 0.91 and 0.85, respectively.

CONCLUSION

This research led to the development of an educational-therapeutic package of safe psychological exposure for nurses, which can be used by managers and nurse educators through in-service training courses. Therefore, it is suggested to use training and safe coping strategies to improve the quality of life in nurses.

Callous-Unemotional Traits and Conduct Problems in Children: The Role of Strength and Positive Characteristics

In recent decades, many researchers have focused on the development of Conduct Problems from childhood to adolescence. Understanding behavior problems also requires an understanding of well-regulated characteristics. Focusing our assessment on strengths makes it possible, on the one hand, to help children or adolescents with deficits in important areas (e.g., socio-emotional deficits) to develop emotional regulation skills and adapt their responses to different contexts. This study aims to understand the role of self-competence, self-regulation, empathy, and responsibility (strength variables) in the relationship between Callous Unemotional characteristics and Conduct Problems, with a sample of 236 children aged between 3 and 10 years (M = 7.51, SD = 1.63), through mediation analysis. In general, our findings suggest that self-regulation significantly explains the relationship between the callous dimension of the Inventory of Callous-Unemotional Traits and Conduct Problems, pointing out that this strength variable seems to act as a protective factor against the development of behavior problems. No other mediation effects were found, and these results are considered in light of some limitations.

Humor in parenting: Does it have a role?

BACKGROUND

Despite the widespread use of humor in social interactions and the considerable literature on humor in multiple fields of study, the use of humor in parenting has received very little formal study. The purpose of this pilot study was to gather preliminary data on the use of humor in the raising of children.

MATERIALS AND METHODS

We developed and administered a 10-item survey to measure people's experiences being raised with humor and their views regarding humor as a parenting tool. Responses were aggregated into Disagree, Indeterminate, and Agree, and analyzed using standard statistical methods.

RESULTS

Respondents (n = 312) predominantly identified as male (63.6%) and white (76.6%) and were (by selection) between the ages of 18-45 years old. The majority of participants reported that they: were raised by people who used humor in their parenting (55.2%); believe humor can be an effective parenting tool (71.8%) and in that capacity has more potential benefit than harm (63.3%); either use (or plan to use) humor in parenting their own children (61.8%); and would value a course on how to utilize humor in parenting (69.7%). Significant correlations were found between the use of humor and both i) the quality of respondents' relationships with their parents and ii) assessments of how good a job their parents had done.

CONCLUSIONS

In this pilot study, respondents of childbearing/rearing age reported positive views about humor as a parenting tool.

The use of multilevel emotion regulation strategies in the context of critical public events: the more the better?

Critical public events, like COVID-19, significantly impact individuals' emotional and mental health. People tend to use multi-level emotion regulation strategies (intrapersonal, interpersonal and hyper-personal) to cope with these events, resulting in various strategy profiles. However, few studies have examined ER strategies from a multilevel perspective. Therefore, this study examines the use of multi-level strategies during COVID-19, and evaluates the effectiveness of these strategies, with a particular interest in identifying strategy profiles promoting mental health. We conducted a two-wave study (an interval of 1 week) using online questionnaires during COVID-19, with an initial sample of 1,189 participants and 895 samples completing the surveys across the two waves. Cross-lagged analysis indicated that experiential avoidance was reciprocally positively related to negative emotions while perspective-taking and humorous-meme-saving were reciprocally positively related to life satisfaction or positive emotions over time. Cluster analysis suggested that there were 9 different profiles which scored differently on mental health indicators. Specifically, the use of multi-level strategies tended to be associated with greater positive emotions and life satisfaction while with lower negative emotions and loneliness. This study revealed that the use of multi-level strategies plays a protective role in mental health when facing critical public events. These findings expanded our understanding of how multilevel emotion regulation strategies impact mental health during critical public events and identify protective profiles for mental health.

Increasing psychological flexibility is associated with positive therapy outcomes following a transdiagnostic ACT treatment

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 post-treatment (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.

Emotion Regulation Flexibility in Adolescents: A Systematic Review from Conceptualization to Methodology

Considerable attention has been devoted to the concept of flexible emotion regulation, which de-emphasizes the importance of any specific regulatory strategy in favor of the flexible deployment of strategies in response to specific situational challenges. The bulk of research in this area has been conducted on adult samples. Research on emotion regulation flexibility (ERF) in youth has been documented in only a limited number of studies and using various definitions. This systematic review aims to gather and summarize different conceptualizations and methodological approaches of adolescent ERF. We incorporate these findings into a general framework to understand ERF and its role in adolescents' emotional, behavioral and social functioning. Adhering to the PRISMA guidelines, 11 studies were included in the review. While ERF has been defined in various and inconsistent ways, the included studies utilized conceptualizations from two overarching domains: the regulation of expressed emotion and the repertoire of emotion regulation strategies. Promising approaches and future directions will be highlighted.

Resilience in the face of pandemic: exploring the influence of psychological flexibility on turnover intentions and burnout among critical care nurses in COVID-19 hospitals

AIM

Assess the levels of psychological flexibility, burnout, and turnover intention among critical care nurses and assess the impact of psychological flexibility on burnout, and turnover intention among critical care nurses.

BACKGROUND

Burnout and turnover intentions among critical care nurses are rapidly increasing because of the challenges of COVID-19. There is a need for evidence-based interventions like psychological flexibility to be addressed in research to overcome those challenges.

METHODS

A descriptive correlational research. A convenient sample of 200 critical care nurses working in COVID-19 hospitals from two governorates in Egypt. The sociodemographic and clinical data sheet, the work-related acceptance and action questionnaire, the Copenhagen burnout inventory, and the adopted version of the staff nurses' intention to leave the nursing profession questionnaire were used.

RESULTS

The majority of critical care nurses reported a moderate level of psychological flexibility (75.5%, Mean = 31.23), a moderate level of burnout (65.5%, Mean = 59.61), and low to moderate levels of intention to leave (73%, Mean = 5.95). Psychological flexibility has a statistically significant negative correlation with burnout (PC = -0.304, Sig = 0.000) and the intention to leave (PC = -0.258, Sig = 0.000). In addition, psychological flexibility has a predictable effect on decreasing burnout (R2 = 0.232) and intention to leave (R2 = 0.127) among critical care nurses.

CONCLUSION

critical care nurses in COVID-19 hospitals reported varied levels of burnout and an intention to leave that must be considered. The effect of psychological flexibility on burnout and intention to turnover highlighted the importance of improving it among critical care nurses by applying acceptance and commitment therapy as a management intervention.

Exploring The Impact of Acceptance and Commitment Based Cultural Humility Training on Standardized Patient Interactions: Revisiting the Measurement Process

Recent findings in health sciences and medical education highlight the importance of training healthcare professionals to interact with their patients in a culturally humble manner (Nadal et al., in Journal of Counseling and Development 92: 57-66, 2014; Pascoe & Smart Richman, in Psychological Bulletin 135: 531, 2009; Sirois & Burg, in Behavior Modification 27: 83-102, 2003; Williams & Mohammed, in Journal of Behavioral Medicine 32: 20-47, 2009). An important piece in the progression of our ability to address training challenges is the assessment of cultural humility. As an extension of previous research (Lombardero et al., in Journal of Clinical Psychology in Medical Settings, 30: 261-273, 2023), this study implemented an evidence-based cultural humility intervention (based on Acceptance and Commitment Training) to improve medical students' interactions with standardized patients (SPs) which was assessed via direct behavioral observation. Specifically, the observational measurement system was focused on culturally humble responses to patients reporting microaggressions to the medical professional. A pre-post comparison of the results demonstrated statistically significant improvements pertaining to participants' culturally humble responses to SPs' reports of microaggressions for one of the measurement scales used (i.e., ARISE), but not the other (i.e., Responsiveness to Racial Challenges Scale). Further analyses, on the bottom quartile of performers, were conducted to assess a possible ceiling effect of the scale that did not demonstrate significant change. These results and implications for future research will be discussed.

The effectiveness of acceptance and commitment therapy on identity crisis and distress tolerance in mothers of children with cancer

BACKGROUND

Examining the psychological factors related to the disease and their treatment can be important. The present study was carried out with the aim of the effectiveness of acceptance and commitment therapy (ACT) on identity crisis and distress tolerance in the mothers of children with cancer.

MATERIALS AND METHODS

This research method was semi-experimental with a pre-test and post-test design. The statistical population included all mothers of children with cancer who were referred to Sheikh Mashhad Hospital in 2021. The sample consisted of 30 people who were selected by purposive sampling and were randomly replaced in two groups of experimental and control (equally 15 people in each group). The experimental group underwent ACT, and the control group did not receive any therapy. The identity crisis questionnaire of Rajaei et al. and the distress tolerance scale of Sevens and Gaher were used. Data were analyzed through SPSS 21 software and the analysis of covariance.

RESULTS

The results revealed that the effect of therapeutic intervention on identity crisis (F = 53.601, P < 0.05) as well as distress tolerance is significant (F = 181.34, P < 0.05). In addition, the effect was stable in the follow-up period (P < 0.05).

CONCLUSION

According to the results, it can be stated that ACT can reduce the identity crisis and increase the level of distress tolerance in the mothers of children with cancer.

Significant Psychedelic Experiences Evaluated for Mystical Characteristics Associated with Cannabis Use Reduction and Psychological Flexibility Improvement: A Naturalistic Cross-Sectional Retrospective Survey

Treating cannabis use disorder remains a significant challenge in the field of addiction medicine. Some recent studies point to psychedelic-assisted psychotherapy as a potential treatment option for substance use disorders. The objective of this study was therefore to explore the impact of naturalistic psychedelic experiences on cannabis use and psychological flexibility. An online retrospective survey was carried out on 152 cannabis users who also reported a significant experience induced by psychedelics in the past. Following a psychedelic experience, there was a significant and sustained reduction of average CUDIT score (p < .001), frequency of cannabis use (p < .001), and acute duration of daily intoxication (p < .001). Cannabis use reduction during the first month post-experience was significantly associated with the intensity of the mystical experience (p = .01). Participants reported a concomitant increased lasting improvement of psychological flexibility following the experience (p < .001), which was correlated to the intensity of the mystical experience during the first month post-experience (p = .04). This study demonstrates that naturalistic psychedelic experiences may be followed by a decrease in cannabis use. Positive health outcomes appear potentially connected to the intensity of the mystical experience, as well as an improvement in psychological flexibility.

Association of resilience and psychological flexibility with surgeons' mental wellbeing

BACKGROUND

Existing research highlights the link between certain personality traits and mental health in surgeons. However, little research has explored the important role of psychological skills and qualities in potentially explaining this link. A cross-sectional survey of UK-based surgeons was used to examine whether two such skills (psychological flexibility and resilience) helped to explain why certain personality traits might be linked to mental health in surgeons.

METHOD

An online survey comprising measures of personality (neuroticism, extraversion and conscientiousness), psychological skills/qualities (psychological flexibility and resilience) and mental health (depression, anxiety, stress and burnout) was sent to surgeons practising in the UK. Mediation analyses were used to examine the potential mediating role of psychological flexibility and resilience in explaining the relationship between personality factors and mental health.

RESULTS

A total of 348 surgeons completed the survey. In all 12 mediation models, psychological flexibility and/or resilience played a significant role in explaining the relationship between personality traits (neuroticism, extraversion and conscientiousness) and mental health (depression, anxiety and burnout).

CONCLUSION

Findings suggest that it is not only a surgeon's personality that is associated with their mental health, but the extent to which a surgeon demonstrates specific psychological qualities and skills (psychological flexibility and resilience). This has important implications for improving surgeons' mental wellbeing, because psychological flexibility and resilience are malleable, and can be successfully targeted with interventions in a way that personality traits cannot.

Facing Change: Using Automated Facial Expression Analysis to Examine Emotional Flexibility in the Treatment of Depression

OBJECTIVE

Depression involves deficits in emotional flexibility. To date, the varied and dynamic nature of emotional processes during therapy has mostly been measured at discrete time intervals using clients' subjective reports. Because emotions tend to fluctuate and change from moment to moment, the understanding of emotional processes in the treatment of depression depends to a great extent on the existence of sensitive, continuous, and objectively codified measures of emotional expression. In this observational study, we used computerized measures to analyze high-resolution time-series facial expression data as well as self-reports to examine the association between emotional flexibility and depressive symptoms at the client as well as at the session levels.

METHOD

Video recordings from 283 therapy sessions of 58 clients who underwent 16 sessions of manualized psychodynamic psychotherapy for depression were analyzed. Data was collected as part of routine practice in a university clinic that provides treatments to the community. Emotional flexibility was measured in each session using an automated facial expression emotion recognition system. The clients' depression level was assessed at the beginning of each session using the Beck Depression Inventory-II (Beck et al., 1996).

RESULTS

Higher emotional flexibility was associated with lower depressive symptoms at the treatment as well as at the session levels.

CONCLUSION

These findings highlight the centrality of emotional flexibility both as a trait-like as well as a state-like characteristic of depression. The results also demonstrate the usefulness of computerized measures to capture key emotional processes in the treatment of depression at a high scale and specificity.

A brief nonattachment intervention based on the three marks of existence: development, rationale, and initial evidence

BACKGROUND

The practices described in Buddhist philosophy are essentially a suite of non-theistic cognitive and behavioral interventions designed to induce nonattachment (N-A), which can be defined in terms of the absence of a need for one's personal reality to be other than it is. Although meditative practices have received attention in multiple literatures, the cognitive analogs to these behaviorally-oriented practices have not.

DESIGN

Two experiments involving undergraduate participants (total N = 239; M age = 19.04) investigated whether the provision of wisdom related to the Three Marks of Existence (i.e., some degree of suffering is inevitable, there is impermanence, and many events are not in our control) could result in (1) higher nonattachment attitudes, (2) lower threat appraisals, (3) lower stressor reactivity, and (4) shorter emotion reaction durations.

RESULTS

With moderate to large effect sizes, the Three Marks trainings (relative to placebo or control conditions) resulted in (1) higher nonattachment attitudes, (2) lower threat appraisals, (3) no differences in negative emotional intensity, but 4) shorter emotion durations.

CONCLUSIONS

These results provide preliminary evidence that enduring cognitive trainings such as the Three Marks can be an effective tool to increase acceptance-related attitudes while attenuating negative reactivity.

The emotional states and associated behavioral responses (flexible-adaptive behaviors vs. inflexible-maladaptive behaviors) of cancer patients during the SARS-CoV-2 outbreak: A multi-center cross-sectional study in Italy

OBJECTIVE

Distress during SARS-CoV-2 outbreak affected also cancer patients' well-being. Aim of this study was to investigate patient' reactions and behavior (flexible-adaptive vs. inflexible-maladaptive) during the SARS-CoV-2 outbreak.

METHODS

A cross-sectional survey was designed with a self-report questionnaire, "the ImpACT questionnaire," developed for the study. Regression analysis was performed on data.

RESULTS

Four hundred and forty five cancer patients from 17 Italian regions participated in the study. 79.8% of participants were female (mean age of 58 years). 92.6% of participants reported feeling vulnerable to COVID-19 contagion; 75.6% reported helpless, 62.7% sad, 60.4% anxious, and 52.0% anger. Avoidance of thinking about coronavirus is the principal maladaptive behavior that emerged. Participants who reported feeling anxious were more likely to have fear of staff being infected with COVID-19 (OR = 3.01; 95% CI = 1.49-6.30) and to have disrupted sleep due to worry (OR = 2.42; 95% CI = 1.23-4.83). Younger participants reported more anxiety (OR = 0.97; 95% CI = 0.94-1.00); men reported feeling calm more than women (OR = 2.60; 95% CI = 1.27-5.43).

CONCLUSIONS

Majority of cancer patients reported serious concerns regarding SARS-CoV-2 infection; reliable information and psychological support must be offers to respond to these needs.

Higher emotion regulation flexibility predicts more stable negative emotions and faster affective recovery in early psychosis: an experience sampling study

BACKGROUND

While evidence shows that people with early psychosis are flexible in using different emotion regulation (ER) strategies to manage the varying contextual demands, no studies have examined the effectiveness of such regulatory flexibility in this population. We addressed this issue by investigating whether and how ER flexibility relate to different dynamic aspects (variability, instability, inertia, and recovery) of negative affect (NA) in a combined early psychosis sample, consisting of both individuals at high clinical risk for psychosis and those diagnosed with first-episode psychosis.

METHODS

Participants were 148 individuals from the INTERACT project, a multi-center randomized controlled trial on the efficacy of acceptance and commitment therapy in early psychosis. We utilized data from the baseline assessment, during which all participants completed six days of experience sampling assessment of momentary NA, as well as end-of-day assessments of ER strategy use.

RESULTS

Multilevel models of within-person associations showed that greater ER flexibility was associated with more stable NA, and quicker recovery of NA from stressors during the day. Linear regression analyses of between-person associations showed that people who had more variable and unstable NA reported greater ER flexibility generally. No evidence was found for associations with NA inertia.

CONCLUSIONS

The current study identified unique within-person and between-person links between ER flexibility and dynamics of NA in early psychosis. These findings further provide evidence for ER flexibility in early psychosis, emphasizing the adaptive nature of regulatory flexibility in relation to reduced instability in NA and faster recovery from NA in everyday life.

Coprococcus eutactus screened from healthy adolescent attenuates chronic restraint stress-induced depression-like changes in adolescent mice: Potential roles in the microbiome and neurotransmitter modulation

The onset of depression commonly occurs in adolescence; therefore, depressive prevention and intervention are pivotal during this period. It is becoming evident that neurotransmitter imbalance and gut microbiota dysbiosis are prominent causes of depression. However, the underlying links and mechanisms remain poorly understood. In this study, with 16S ribosomal RNA gene sequencing, genus Coprococcus markedly differentiated between the healthy and unmedicated depressive adolescents. Based on this, transplantation of Coprococcus eutactus (C.e.) was found to dramatically ameliorate the chronic restraint stress (CRS) induced depression-like changes and prevent synaptic loss and glial-stimulated neuroinflammation in mice. The Ultra-high performance liquid chromatography tandem mass spectrometry analysis (UHPLC-MS/MS) further showed that neurotoxic neurotransmitters in kynurenine pathway (KP) such as 3-hydroxykynurenine (3-HK) and 3-hydroxyanthranilic acid (3-HAA) decreased in mouse brains, mechanistically deciphering the transfer of the tryptophan metabolic pathway to serotonin metabolic signaling in the brain after C.e. treatment, which was also verified in the colon. Molecularly, blockage of KP activities mediated by C.e. was ascribed to the restraint of the limit-step enzymes responsible for kynurenine, 3-HK, and quinolinic acid generation. In the colon, C.e. treatment significantly recovered goblet cells and mucus secretion in CRS mice which may ascribe to the rebalance of the disordered gut microbiota, especially Akkermansia, Roseburia, Rikenella, Blautia, and Alloprevotella. Taken together, the current study reveals for the first time the beneficial effects and potential mechanisms of C.e. in ameliorating CRS-induced depression, unraveling the direct links between C.e. treatment and neurotransmitter rebalance, which may provide efficacious therapeutic avenues for adolescent depressive intervention.

Relationships between cognitive flexibility performance and adaptive behavior outcomes in survivors of pediatric brain tumor

Objective: Survivors of pediatric brain tumors are at increased risk of executive function (EF) and adaptive behavior difficulties. While previous research suggests that executive dysfunction impacts suboptimal adaptive outcomes, the specific elements of EF influencing this relationship remain unexplored. This study examines the relationship between cognitive flexibility and adaptive behavior in survivors compared to healthy controls. Methods: 86 survivors (Mage(SD)=23.41(4.24), 44 females) and 86 controls (Mage(SD)=23.09(4.50), 44 females) completed the Delis-Kaplan Executive Function System Trail Making Test (TMT) and Verbal Fluency Test (VFT). The Letter-Number Sequencing (LNS) and Category Switching (CS) conditions were isolated as measures of cognitive flexibility. Informants provided responses to obtain adaptive behavior ratings using the Scales of Independent Behavior-Revised (SIB-R). Linear regressions explored relationships between cognitive flexibility and SIB-R scores in survivors compared to controls. Results: For both TMT and VFT, the relationship between cognitive flexibility and adaptive behavior was significantly different between survivors and controls for SIB-R scores in Social Communication, Community Living, and Personal Living Skills (p<.0125). Survivors' better LNS performance predicted greater SIB-R scores across the same 3 domains (all p= <.001, r2semipartial=.08). Similarly, survivors' better CS performance predicted greater SIB-R scores across the same 3 domains (p = 0.002 to .02, r2semipartial =.03 to .04). No significant relationships were found in controls (all p >.05). After adjusting for working memory and inhibitory control, most relationships remained significant in survivors (p= <.001 to .046, r2semipartial=.02 to .08). Conclusion: These findings reveal a robust, positive relationship between cognitive flexibility performance and adaptive behaviors specific to survivors.

The Effect of Psychological Flexibility on Well-Being during the COVID-19 Pandemic: The Multiple Mediation Role of Mindfulness and Coping

The COVID-19 pandemic involved a complex set of stressors affecting the health and well-being of the population. The understanding of the psychological processes that influence well-being in response to the pandemic and their interrelation is vital. A promising process in understanding the emotional impacts of these stressors is psychological flexibility. This study investigated the effect of psychological flexibility on well-being, both directly and indirectly, via mindfulness and coping strategies. A total of 334 Portuguese adults participated in this cross-sectional study. Participants were asked to complete an online questionnaire, including measures of psychological flexibility, well-being, mindfulness, and coping strategies. A multiple mediation model studied whether there are conditional indirect effects of mindfulness and coping strategies on well-being. The results showed statistically significant correlations between psychological flexibility, well-being, mindfulness, and coping strategies. Furthermore, we found that mindfulness and coping strategies partly mediate the relationship between psychological flexibility and well-being. Understanding the processes through which psychological flexibility influences well-being in a stressful context is important in comprehending the processes involved in an emotional reaction to a pandemic-like societal event. Mindfulness and coping are shown to be important processes to consider in understanding this phenomenon and designing future responses.

Psychological flexibility, self-compassion, subjective well-being, and substance misuse in college students: a serial mediation model

Substance misuse is a pressing public health concern, especially among emerging adults, with implications for psychological health and overall well-being. This cross-sectional study investigates the mediating roles of self-compassion and subjective well-being in the relationship between psychological flexibility and substance misuse among Turkish college students. The study included 445 emerging adults enrolled at a state university in Türkiye. University participants were recruited via convenience sampling using snowball methods. Data were collected using self-report scales. The sample was 69% female (n = 307) and 31% male (n = 138) and ranged in age from 18 to 26 years (M = 20.85, SD = 1.35). In the study, Pearson product-moment correlation analysis was conducted to examine the relationships between the variables and then the serial mediation model was tested. The findings have revealed that psychological flexibility significantly predicts substance misuse, subjective well-being, and self-compassion. Additionally, the study identifies self-compassion as a mediator in the relationship between psychological flexibility and subjective well-being. While self-compassion contributes significantly to well-being, it does not explain the impact of psychological flexibility on substance misuse. Furthermore, subjective well-being also appears to be a mediator in the relationship between psychological flexibility and substance misuse, emphasizing its potential significance in reducing the likelihood of resorting substance misuse. Overall, the study contributes to understanding the pivotal role of self-compassion and psychological flexibility in fostering well-being and preventing substance misuse in the college setting.

Individual factors as predictors of secondary traumatic stress and burnout in forensic inpatient staff

WHAT IS KNOWN ON THE SUBJECT

Secondary traumatic stress (STS) is the indirect traumatisation of a person through the stress of helping or knowing about other's trauma. Burnout is gradual exhaustion in response to long-term work-related stress. Both have negative psychological, physiological and/or organisational consequences; however, the existing research in forensic health care professionals (FHCPs) is limited. One study explored STS in FCHPs and found that lower psychological flexibility (ability to adapt) was a predictor of greater STS. Existing research on burnout in FHCPs suggests that individual differences, such as the ways in which we cope (talking to people vs. using substances), may predict burnout levels.

WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE

Prevalence findings add to the recent evidence base, which also found moderate levels of burnout. However, this study is the first to find high levels of secondary traumatic stress in FHCPs. Similar to existing literature, the study's findings suggest that FHCP's with lower levels of psychological flexibility and more maladaptive coping strategies may experience greater STS and burnout symptoms, while staff who use more adaptive coping strategies may experience less burn-out. Unexpectedly, staff who reported a more anxious attachment style were burnt-out; however, there are limitations to this finding.

WHAT ARE THE IMPLICATIONS FOR PRACTICE

Policies and practices in forensic settings should reflect the risk of STS and burnout. Practices or interventions should enhance adaptive coping strategies and psychological flexibility, such as Resilience Enhancement Programmes or Acceptance and Commitment Therapy (ACT).

ABSTRACT

INTRODUCTION: Secondary traumatic stress (STS) and burnout literature in inpatient forensic health care professionals (FHCPs) is limited, despite the psychological, physiological and organisational consequences.

AIMS

This study aimed to further this limited evidence base, investigating predictors of STS and burnout in FHCPs.

METHOD

98 healthcare professionals working in two UK forensic inpatient settings completed measures assessing: burnout, STS, psychological flexibility, coping style, attachment style and a demographic questionnaire recording length of service and the sex of staff.

RESULTS

Results indicated high STS and moderate burnout levels. The main predictors of STS and burnout were poorer psychological flexibility and greater maladaptive coping styles, whereas lower burnout was predicted by greater adaptive coping styles and an anxious attachment style.

DISCUSSION

This study has contributed towards a limited evidence base and indicates poorer psychological flexibility and greater maladaptive coping may be risk factors for STS and burnout in FHCPs, whereas greater maladaptive coping may be a protective factor.

IMPLICATION FOR PRACTICE

The findings suggest that interventions such as Acceptance and Commitment Therapy (ACT) and coping skills interventions, may offer protective benefits to inpatient forensic healthcare professionals.

Acceptance and commitment therapy for the treatment of irritable bowel syndrome and inflammatory bowel disease: a narrative review

Background and Objective

Cognitive behavioral therapy (CBT) is a common treatment modality for patients with irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). CBT may not be a good fit for all patients and some may instead benefit from an acceptance and commitment therapy (ACT) approach. This narrative review presents evidence for the use of ACT in adult patients with IBS or IBD. The authors also suggest instances in which patients with IBS or IBD may benefit from ACT and discuss future directions of research.

Methods

Between August 2023 and January 2024, databases such as Google Scholar, institutional libraries, and PubMed were used to review the literature on ACT in patients with IBS and IBD. A variety of search terms were included. Non-English, pediatric, and studies that did not employ a full ACT protocol were excluded.

Key Content and Findings

ACT for IBS studies typically utilized a self-help book or a one-day workshop intervention, with results indicating reductions in IBS and mood symptoms and improvements in quality of life. Within IBD, three randomized controlled trials (RCTs) tested the impact of ACT, two of which found reductions in stress, depression, and anxiety symptoms.

Conclusions

Despite the limited number of studies testing a full ACT protocol in patient populations with IBS or IBD, results indicate potential efficacy in managing not only symptoms, but also facets of quality of life. Future studies should utilize robust experimental designs and comprehensively test the effectiveness of ACT in IBS and IBD patient populations with both process and outcome measures.

Psychometric Evaluation of the Swedish Acceptance and Action Diabetes Questionnaire: A Rasch Analysis

Background and Purpose: The Acceptance and Action Diabetes Questionnaire (AADQ) is a tool for assessing the acceptance of thoughts and emotions related to diabetes in people living with the disease. This study aimed to examine the psychometric properties of the Swedish version of AADQ (Swe-AADQ) in a sample of adults with type 1 diabetes. Methods: To examine the psychometric properties of the Swe-AADQ, the Rasch model was used. Data for 120 individuals were included. Results: The Swe-AADQ showed an acceptable fit to the Rasch model. A sufficiently high value of the separation index indicated a capacity to distinguish between different levels of acceptance in the sample. The 7-point Likert scale was reduced to three categories suggesting an improvement in the ordering of the item thresholds. Conclusions: The Swe-AADQ possesses reasonable quality in terms of reliability and validity. However, there are some deficiencies regarding the categorization of the response rating that should be addressed.

10-Week Trajectories of Candidate Psychological Processes Differentially Predict Mental Health Gains from Online Dyadic versus Mindfulness Interventions: A Randomized Clinical Trial

Background: App-based contemplative interventions, such as mindfulness-based interventions, have gained popularity for the promotion of mental health; however, the understanding of underlying intervention-specific mechanisms remains limited, especially related to novel inter-relational dyadic practices. Methods: We tested (n = 253) seven putative mechanisms underlying two brief (daily 12-min) online mental interventions: attention-focused mindfulness and socio-emotional partner-based, both supported by weekly online coaching. Weekly self-reports of rumination, worry, psychological flexibility, affective control, social support, acceptance, and mindfulness were obtained over 10 weeks of intervention, and depression, anxiety, and resilience were assessed as pre- and post-intervention outcomes. Results: Significant week-to-week reductions in rumination and increases in psychological flexibility were observed in both interventions. Only attention-based practice led to temporal reductions in worry, and only socio-emotional dyadic practice led to temporal increases in affective control. Mediation analyses with slopes of weekly variables as mediators detected no significant indirect effects. However, exploratory moderation analyses revealed that intervention-related reductions in depressive symptomatology and anxiety vulnerability and increases in resilience were predicted by weekly increases in acceptance and affective control in the socio-emotional dyadic group, and by weekly reductions in rumination and worry in the mindfulness group. Limitations of the study include reliance on brief self-report measures, relatively small sample size, and absence of long-term follow-up assessments indicating the need for future well-powered longitudinal studies comparing intervention modalities. Conclusions: We present preliminary evidence for practice-specific active ingredients of contemplative interventions, which can be leveraged to enhance their efficiency for mental health.

Mean Affect Moderates the Association between Affect Variability and Mental Health

Increasing evidence suggests that within-person variation in affect is a dimension distinct from mean levels along which individuals can be characterized. This study investigated affect variability's association with concurrent and longitudinal mental health and how mean affect levels moderate these associations. The mental health outcomes of depression, panic disorder, self-rated mental health, and mental health professional visits from the second and third waves of the Midlife in the United States Study were used for cross-sectional (n = 1,676) and longitudinal outcomes (n = 1,271), respectively. These participants took part in the National Study of Daily Experiences (NSDE II), where they self-reported their affect once a day for 8 days, and this was used to compute affect mean and variability. Greater positive affect variability cross-sectionally predicted a higher likelihood of depression, panic disorder, mental health professional use, and poorer self-rated mental health. Greater negative affect variability predicted higher panic disorder probability. Longitudinally, elevated positive and negative affect variability predicted higher depression likelihood and worse self-rated mental health over time, while greater positive affect variability also predicted increased panic disorder probability. Additionally, mean affect moderated associations between variability and health such that variability-mental health associations primarily took place when mean positive affect was high (for concurrent mental health professional use and longitudinal depression) and when mean negative affect was low (for concurrent depression, panic disorder, self-rated mental health, and longitudinal self-rated mental health). Taken together, affect variability may have implications for both short- and long-term health and mean levels should be considered.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42761-024-00238-0.

Examining aspects of psychological flexibility within the integrated motivational-volitional model of suicidal behavior: A prospective investigation

BACKGROUND

According to the integrated motivational-volitional model of suicide, feelings of entrapment are related to the emergence of suicidal ideation (SI). However, this relation can be moderated by certain protective factors.

METHODS

This study examined whether aspects of psychological flexibility (i.e., experiential avoidance, experiential acceptance, harnessing) moderated the relation between aspects of entrapment and SI severity in college students experiencing SI (N = 553) both cross-sectionally and when SI severity was measured 1 week later (N = 247).

RESULTS

At baseline, experiential acceptance, but not experiential avoidance or harnessing, significantly moderated the relation between external entrapment and SI severity and internal entrapment and SI severity. No aspects of psychological flexibility prospectively moderated relations between entrapment and SI severity.

CONCLUSIONS

Aspects of psychological flexibility may influence immediate vulnerability to SI severity among young adults experiencing feelings of entrapment. Implications for clinical interventions influencing changes in psychological flexibility are discussed.