A review of AAQ variants and other context-specific measures of psychological flexibility

Standardization of the Korean Version of the Acceptance and Action Questionnaire for Obsessions and Compulsions in University Students and Patients With Obsessive-Compulsive Disorder

OBJECTIVE

The Acceptance and Action Questionnaire for Obsessions and Compulsions (AAQ-OC) is a version of the Acceptance and Action Questionnaire (AAQ) that specifically measures unwanted intrusive thoughts and responses (e.g., experiential avoidance) to them. This study aimed to investigate the reliability and validity of the Korean version of the AAQ-OC in clinical and nonclinical Korean samples.

METHODS

In this study, 561 university students and 121 patients with obsessive-compulsive disorder (OCD) completed the AAQ-OC and several other psychological scales. Descriptive, correlation, and exploratory and confirmatory factor analyses as well as group comparisons were conducted.

RESULTS

The results of the exploratory and confirmatory factor analyses indicated a two-factor structure that best fits the data in the university sample: Factors 1 and 2 matched the original Valued Action and Willingness subscales, respectively. The reliability analyses revealed that the AAQ-OC and its factors had excellent internal consistencies. As regards the concurrent validity, the AAQ-OC and its factors had a positive correlation with the AAQ-II and Cognitive Fusion Questionnaire. Compared with the university students, the OCD patients had higher AAQ-OC scores, and their obsessive-compulsive symptoms, particularly the two symptom dimensions of responsibility for harm and mistakes and unacceptable thoughts, were significantly associated with the AAQ-OC and two subscales.

CONCLUSION

The findings of this study confirm the reliability and validity of the Korean version of the AAQ-OC.

Differences in Psychological Inflexibility Among Men With Erectile Dysfunction Younger and Older Than 40 Years: Web-Based Cross-Sectional Study

BACKGROUND

Psychological inflexibility is a core concept of acceptance and commitment therapy (ACT), which is a comprehensive, transdiagnostic interpretation of mental health symptoms. Erectile dysfunction (ED) is a condition that affects male sexual performance, involving the inability to achieve and maintain a penile erection sufficient for satisfactory sexual activity. Psychosocial factors primarily influence ED in men younger than 40 years, whereas biological factors are more likely to be the underlying cause in older men.

OBJECTIVE

This web-based cross-sectional study examined differences in depression, anxiety, and psychological inflexibility among men with ED younger and older than 40 years in a Japanese population.

METHODS

We used a web-based survey to gather data from various community samples. ED was assessed by the International Index of Erectile Function-5 (IIEF-5) questionnaire, while depression, anxiety, and psychological inflexibility were evaluated by the Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), Acceptance and Action Questionnaire-II (AAQ-II), Cognitive Fusion Questionnaire (CFQ), and Valuing Questionnaire-Obstacle Subscale (VQ-OB) questionnaires. The chi-square test estimated the scores of PHQ-9 and GAD-7 among men with ED, comparing those younger than 40 years and those older than 40 years. Additionally, a two-way ANOVA was conducted with ED severity and age group as independent variables, assessing psychological inflexibility.

RESULTS

Valid responses from 643 individuals (mean age 36.19, SD 7.54 years) were obtained. Of these, 422 were younger than 40 years (mean age 31.76, SD 5.00 years), and 221 were older than 40 years (mean age 44.67, SD 2.88 years). There was a statistical difference in the prevalence of depression as judged by PHQ≥10 between men with ED younger and older than 40 years (P<.001). On the other hand, there was no difference in the prevalence of anxiety as judged by GAD≥10 (P=.12). The two-way ANOVA revealed that the interactions for CFQ (P=.04) and VQ-OB (P=.01) were significant. The simple main effect was that men with ED younger than 40 years had significantly higher CFQ (P=.01; d=0.62) and VQ-OB (P<.001; d=0.87) scores compared to those older than 40 years in moderate ED and severe ED. Additionally, it was found that men younger than 40 years with moderate to severe ED had significantly higher CFQ (P=.01; d=0.42) and VQ-OB (P=.02; d=0.38) scores compared to men younger than 40 years without ED. On the other hand, no interaction was found for AAQ-II (P=.16) scores.

CONCLUSIONS

To the best of our knowledge, this web-based cross-sectional study is the first to examine the relationship between psychological inflexibility and ED. We conclude that men with moderate and severe ED younger than 40 years have higher psychological inflexibility and might be eligible for ACT.

The Relationship Between Psychological Inflexibility and Well-Being in Adults: A Meta-Analysis of the Acceptance and Action Questionnaire

Psychological inflexibility is defined as the rigid responding to stimuli (e.g., unpleasant thoughts and feelings) that interferes with well-being and valued actions. It is the treatment target in acceptance and commitment therapy (ACT). Despite the centrality of the link between inflexibility and well-being to ACT theory, an empirical review clarifying the nature of this relationship has not been conducted. As such, the current meta-analysis examined the meta-correlation between psychological inflexibility, measured by the Acceptance and Action Questionnaire (AAQ) and its variants, and well-being. A systematic review yielded 151 studies, including 25 versions of the AAQ and 43 well-being measures. Consistent with ACT theory, higher psychological inflexibility was associated with worse well-being (r = -.47, 95% CI[-.49, -.45]). In addition, sample diagnosis, type of AAQ, and type of well-being measure significantly moderated this relationship. Overall, our findings support the hypothesized link between psychological inflexibility and worse well-being. Limitations include reliance on cross-sectional data, precluding causal interpretation.

Acceptance and Commitment Therapy Processes and Mediation: Challenges and How to Address Them

Acceptance and commitment therapy (ACT) emphasizes a focus on theory-driven processes and mediating variables, a laudable approach. The implementation of this approach would be advanced by addressing five challenges, including (a) distinguishing ACT processes in measurement contexts, (b) developing and rigorously validating measures of ACT processes, (c) the wide use of psychometrically weaker ACT process measures and the more limited use of stronger measures in earlier work, (d) the inconsistency of past evidence that ACT processes are sensitive or specific to ACT or mediate ACT outcomes specifically, and (e) improving statistical power and transparency. Drawing on the existing literature, we characterize and provide evidence for each of these challenges. We then offer detailed recommendations for how to address each challenge in ongoing and future work. Given ACT's core focus on theorized processes, improving the measurement and evaluation of these processes would significantly advance the field's understanding of ACT.

ACT: A Process-Based Therapy in Search of a Process

A large array of randomized controlled trials and meta-analyses have determined the efficacy of Acceptance and Commitment Therapy (ACT). However, determining that ACT works does not tell us how it works. This is especially important to understand given the current emphasis on Process-Based Therapy, the promise of which is to identify manipulable causal mediators of change in psychotherapy, and how their effectiveness is moderated by individual contexts. This paper outlines four key areas of concern regarding ACT's status as a Process-Based Therapy. First, the relationship between ACT and Relational Frame Theory has been widely asserted but not yet properly substantiated. Second, most of the studies on ACT's core process of change, psychological flexibility, have used invalid measures. Third, while lots of research indicates means by which individuals can be helped to behave consistently with their values, there is virtually no research on how to help people effectively clarify their values in the first instance, or indeed, on an iterative basis. Finally, the philosophy underlying ACT permits a-moral instrumentalism, presenting several ethical challenges. We end by making several recommendations for coherent methodological, conceptual, and practical progress within ACT research and therapy.

Psychometric Properties of the Acceptance and Action Questionnaire-II (AAQ-II) in Older Adult Primary Care Patients

OBJECTIVES

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

CLINICAL IMPLICATIONS

The AAQ-II is a psychometrically sound measurement that can be clinically used on older adults.

Measurement of psychological inflexibility: an examination of the psychometric properties of the AAQ-3 compared to AAQ-II

Due to the limitations of the existing measurements of experiential avoidance, we would like to check the validity of the improved version of Acceptance and Action Questionnaire-II (AAQ-II), i.e., Acceptance and Action Questionnaire-3 (AAQ-3), in Chinese content. The present study was aim to examine the construct and validity of the Chinese version of AAQ-3 in college students and provide an initial validation of this instrument to promote future cross-cultural examination of the psychological flexibility. Totally 1,572 college students were invited to complete the Chinese AAQ-3 and the related questionnaires at the same time. After one month, 380 participates were assessed with same questionnaires to examine the test-retest reliability. The results indicated a similar one-factor solution in the Chinese AAQ-3 to the original version by exploratory factor analysis, parallel analysis and confirmatory factor analysis. Internal consistency and test-retest reliability were good. According to the testing of the measurement invariance, the one-factor model was acceptable across gender (Man = 875, Girl = 697). Additionally, Chinese AAQ-3 was significantly negatively correlated with positive mental health (life satisfaction, mindful attention awareness), significantly positively correlated with negative emotions (depression, anxiety, stress), and significantly positively correlated with AAQ-II and Brief Experiential Avoidance Questionnaire (BEAQ). Besides, Chinese AAQ-3 was the strongest predictor of depression, anxiety, stress and life satisfaction compared to the AAQ-II and BEAQ. However, according to the exploratory structural equation model, the Chinese AAQ-3 demonstrated excellent discriminate validity from negative emotions. Overall, the AAQ-3 modified the limitations of the existing measurements of experiential avoidance (i.e., AAQ-II and BEAQ) as it showed better convergent validity with positive mental health indicators, better discriminant validity with negative emotions, and higher incremental validity. Therefore, the Chinese AAQ-3 is a valid measurement tool for assessing the level of experiential avoidance or psychological flexibility in Chinese college students.

Does Avoiding Distressing Thoughts and Feelings Influence the Relationship between Carer Subjective Burden and Anxiety Symptoms in Family Carers of People with Dementia?

Anxiety remains understudied in family carers of people with dementia. Understanding factors that moderate the relationship between stressors and anxiety symptoms in this population is critical to inform interventions. This study examined whether generic experiential avoidance (AAQ-II) and experiential avoidance specific to caregiving-related thoughts and feelings (EACQ) moderate the relationship between subjective burden (ZBI-12) and anxiety symptoms (GAD-7) in carers of people with dementia. The first model (R2 = .66, ∆R2 = .03) exploring the moderating effect of AAQ-II demonstrated a significant interaction term between AAQ-II and subjective burden. The second model (R2 = .53, ∆R2 = .03), exploring the moderating effect of EACQ, demonstrated a significant interaction term between EACQ and subjective burden. These results provide evidence that carers with higher levels of experiential avoidance may be particularly prone to the negative effect of subjective burden on anxiety symptoms. Clinical implications for assessment of experiential avoidance and its treatment in carers of people with dementia are discussed.

Acceptance and Commitment Therapy Processes Differentially Predict Aspects of Mental Health

Psychological flexibility relates to various aspects of mental health, including psychological distress and adaptive mental health. The CompACT has been developed to assess psychological flexibility by quantifying psychological flexibility as a multidimensional whole, and by three processes of psychological flexibility including, Openness to Experience (OE), Behavioral Awareness (BA), and Valued Action (VA). The current study examined the unique predictive property of each three process of the CompACT with aspects of mental health. Participants (N = 593) were a diverse sample of United States adults. Our results found OE and BA significantly predicted depression, anxiety, and stress. OE and VA significantly predicted satisfaction with life, and all three processes significantly predicted resilience. Our results support multidimensional assessment of psychological flexibility when examining aspects of mental health.

The influence of psychological flexibility on persistent post concussion symptoms and functional status after mild traumatic brain injury

PURPOSE

This study investigated the predictive role of psychological flexibility on long-term mTBI outcomes.

METHOD

Adults with mTBI (N = 147) completed a context specific measure of psychological flexibility, (AAQ-ABI), psychological distress, and mTBI outcomes at less than three months post injury (M = 6.02 weeks after injury) and 6 months later (N = 102). Structural equation modelling examined the mediating effects of psychological flexibility on psychological distress and mTBI outcomes at six months. The direct effect of psychological flexibility at less than three months on mTBI outcomes at six months was entered into the model, plus pre-injury and injury risk factors.

RESULTS

The theoretically derived model had good overall fit (χ2 = 1.42; p = 0.09; NFI = 0.95; TLI = 0.95; CFI = 0.98 and RMSEA = 0.06). Psychological flexibility at less than 3 months was directly significantly related to psychological distress and post-concussion symptoms at six months. Psychological flexibility at 6 months significantly mediated the relationship between psychological distress and functional disability but not post-concussion symptoms at six months post injury.

CONCLUSION

The exploratory findings suggest that a context specific measure of psychological flexibility assessed acutely and in the chronic phase of recovery may predict longer-term mTBI outcomes.Implications for RehabilitationPersistent post-concussion symptoms (PPCS) after mild traumatic brain injury (mTBI) can have a significant impact on wellbeing, functional status, and quality of life.In this study, psychological flexibility early in recovery, was associated with higher levels of psychological distress and more severe post-concussion symptoms six months later.Psychological flexibility at six months post-injury also mediated the relationship between psychological distress and functional disability.A context specific measure of psychological flexibility may predict poorer long-term outcomes following mTBI.

Psychological flexibility in older adulthood: a scoping review

OBJECTIVES

Psychological flexibility/inflexibility (PF/PI) is a core component of the acceptance and commitment therapy (ACT) model, which is gaining more attention in the geropsychological literature. This scoping review examines the size and scope of the research on PF/PI in older adulthood related to age differences between older adult and younger samples, correlates relevant to psychological health, and changes with ACT.

METHODS

A systematic literature search was conducted using PubMed, CINAHL, and PsycINFO. Peer-reviewed articles available in English were included that: had a mean age ≥65 and a minimum age ≥60; and reported self-report measures of PF/PI. We categorized PF/PI into three domains: open, aware, and engaged.

RESULTS

Forty-six articles were included. Most studies measured open or aware domains; few measured the engaged domain. Older adults evidenced greater awareness compared to younger adults (9 of 13 analyses were significant). Openness and awareness consistently yielded medium to large correlations with anxiety and depression. PF/PI did not relate with positive affect and inconsistently correlated with quality of life measures.

CONCLUSION

Despite emerging trends, variability and limitations were evident in the literature. Specifically, measurement issues, lack of conceptual clarity, and the omission of values and behavioral measures require future attention.

Examining psychological inflexibility as a mediator of postpartum depressive symptoms: A longitudinal observational study of perinatal depression

Background

Depression is a common, serious complication during the postpartum period. Predictors of postpartum depression characterize who is at-risk for persistent symptoms. This study explored how psychological inflexibility affects depressive symptoms at 4 and 12 weeks postpartum.

Methods

Participants receiving prenatal care at a medical center were recruited during the second trimester. Participants (n = 180) completed online assessments and diagnostic interviews during the third trimester (≥ 28 weeks gestation), and at 4-, 8-, and 12-weeks postpartum. Online assessments measured psychological inflexibility (PI) and depressive symptoms, while diagnostic interviews measured lifetime history of depression.

Results

Mediation analysis examined pathways between 4-weeks postpartum depression, 8-weeks postpartum PI, and 12-weeks postpartum depression. Depressive symptoms at 4-weeks postpartum predicted PI at 8-weeks postpartum (β = 0.31, SE = 0.06, t(177) = 6.06, p < .001). Depressive symptoms at 4-weeks postpartum (β = 0.42, SE = 0.06, t(176) = 7.12, p < .001) and PI at 8-weeks postpartum (β = 0.32, SE = .08, t(176) = 4.09, p < .001) predicted depressive symptoms at 12-weeks postpartum. Depressive symptoms at 4-weeks, 8-week PI, and lifetime history of depression accounted for 42% of the variance in 12-week depressive symptoms (R2 = 0.42). The confidence interval of the indirect effect (0.04, 0.18) did not include zero, indicating significant mediation by PI.

Conclusions

PI mediated the relation between 4- and 12-weeks postpartum depressive symptoms when controlling for lifetime history of depression. Psychological inflexibility is a transdiagnostic target for future prevention and intervention research during the postpartum period.

Psychological inflexibility in university students: the european portuguese version of the acceptance and action questionnaire-university students

Psychological inflexibility is defined as a transdiagnostic mechanism characterized by rigid efforts to control psychological reactions to painful, undesirable, unpleasant internal experiences. The Acceptance and Action Questionnaire-University Students (AAQ-US) was designed to assess students' academic context-related psychological inflexibility. This study adapted the AAQ-US to Portuguese and examined its factor structure, validity, and reliability in a college student sample (sample 1: N = 262). Exploratory factor analysis and parallel analysis suggested a two-factor structure. A confirmatory factor analysis was conducted in a second sample to cross-validate the AAQ-US factor structure (sample 2: N = 260). One higher-order factor (psychological inflexibility) with two lower-order factors (cognitive fusion and experiential avoidance) revealed a very good fit to the data. The AAQ-US total and dimensions showed good reliability, convergent and incremental validity. Overall, the Portuguese version of the AAQ-US is a reliable and valid instrument for assessing context-specific psychological inflexibility in university students.

A scoping review to identify process and outcome measures used in acceptance and commitment therapy research, with adults with acquired neurological conditions

Background

Acceptance and Commitment Therapy interventions are increasing in use in neurological populations. There is a lack of information on the measures available.

Purpose

To identify and classify the measures used in Acceptance and Commitment Therapy research studies with adults with acquired neurological conditions.

Methods

PRISMA-ScR guided scoping review. MEDLINE, PsycInfo and CINAHL databases searched (up to date 29/06/2022) with forward and backward searching. All study types included. Extraction of Acceptance and Commitment Therapy process-of-change and health-related outcome measures. Outcomes coded using the Core Outcome Measures in Effectiveness Trials (COMET) taxonomy.

Results

Three hundred and thirty three papers found on searching. Fifty four studies included and 136 measurement tools extracted. Conditions included multiple sclerosis, traumatic brain injury and stroke. Thirty-eight studies measured processes of change, with 32 measures extracted. The process measure most often used was the Acceptance and Action Questionnaire ( n = 21 studies). One hundred and four health-related outcome measures extracted. Measures exploring quality of life, health status, anxiety and depression occurred most frequently, and were used in all included neurological conditions. COMET domains most frequently coded were emotional functioning/well-being ( n = 50), physical functioning ( n = 32), role functioning ( n = 22) and psychiatric ( n = 22).

Conclusions

This study provides a resource to support future identification of candidate measures. This could aid development of a Core Outcome Set to support both research and clinical practice. Further research to identify the most appropriate and relevant targets and tools for use in these populations should include expert consensus, patient, carer and public involvement and psychometric examination of measures.

The Persian version of the psychological flexibility in sport scale: a psychometric study

Background

There is a growing body of research suggesting that psychological flexibility (PF) is an important psychological construct related to psychological health and human performance. The Psychological Flexibility in Sport Scale (PFSS) is the first general scale to assess sport-related PF. So far, the PFSS has not yet been validated in other contexts than Sweden. Therefore, the current study sought to investigate a Persian version of the PFSS (P-PFSS) and extend the investigation of the psychometric properties of the PFSS in Iranian athletes.

Methods

A total of 302 athletes from both team and individual sports (average age of 20.7 years, SD ± 7.5, 62.3% were female) were involved in the current study. Statistical analysis was performed on the data to test validity and reliability. The validity of the P-PFSS was tested through face and content validity, construct validity, criterion validity, and known-groups validity. The reliability of P-PFSS was verified through internal consistency and temporal stability of the scale.

Results

Results revealed that validity of the P-PFSS was satisfactory. The instrument was determined to have strong face and content validity. With modifications, the confirmatory factor analysis confirmed the scale’s unidimensionality. The convergent validity of the P-PFSS was found to be acceptable (average variance extracted = 0.66) and satisfactory results were also found in the correlation matrix for the assessment of construct validity. The P-PFSS showed good criterion validity related to generic psychological flexibility and athletic-related variables. Also, the P-PFSS was able to differentiate PF between known groups. The P-PFSS was found to be reliable, with good internal consistency (Cronbach’s alpha = 0.92; composite reliability = 0.92) and temporal stability on retest (intraclass correlation coefficient = 0.95).

Conclusions

Overall, the Persian version of the PFSS showed good psychometric qualities in Iranian athletes. The current study provides additional support for the PFSS and extends the context-specific utility for practitioners and researchers in assessing sport-related PF.

Acceptance and Commitment Therapy for a Child With Misophonia: A Case Study

Misophonia, a condition involving hypersensitivity, anger, and/or disgust in response to specific noises (e.g., chewing, tapping), is highly underresearched in children. Several case studies point towards the utility of cognitive behavioral therapy and related treatments (e.g., acceptance and commitment therapy [ACT]). ACT presents a particularly promising option, as it focuses on building psychological flexibility in response to difficult internal experiences, rather than trying to remove or change them (e.g., responding effectively to irritation provoked by chewing). The present case study describes “Kelly” (pseudonym), a 12-year-old girl with moderately severe misophonia symptoms, who received a 16-session course of ACT for misophonia. At post-treatment, Kelly reported a decline to the mild range of misophonia, as well as re-engagement in activities that were important to her and clinically significant reductions in depressive symptoms. These results suggest that ACT may be an appropriate treatment for children with misophonia; however, much more research is warranted.

A negative body image contextualization of the self-compassion scale

Self-compassion, a style of responding to oneself in times of suffering, is typically measured as a general tendency for how one normally responds using the Self-Compassion Scale (SCS; Neff, 2003). A contextualized adaptation to the SCS could provide a new understanding of how one responds to suffering by providing a standard frame of reference, is more likely to be more predictive of context outcomes, and reduces intraindividual variance (Baird & Lucas, 2011). How a contextualized assessment of self-compassion compares to the original assessment using parallel measures is unknown. The purpose of this study was to explore the use of a modified SCS adapted for the context of responding to the experience of negative body image (BI-SCS). There were 468 participants who completed the SCS and then wrote about a specific negative body image experience (to prime a negative body image experience) before they completed a modified SCS and related constructs. Confirmatory Factor Analysis supported a bi-factor structure consistent with SCS. Correlations with body image outcomes were stronger for the majority of BI-SCS scores compared to the SCS. Unique explained variance of the BI-SCS supported incremental validity. Results show promising initial evidence supporting the use of the BI-SCS for body-related outcomes.

Online ACT intervention for fibromyalgia: An exploratory study of feasibility and preliminary effectiveness with smartphone-delivered experiential sampling assessment

INTRODUCTION

Acceptance and commitment therapy (ACT) is an effective treatment for chronic pain conditions. ACT seeks to produce clinical change by enhancing Psychological Flexibility (PF). This exploratory (feasibility and preliminary effectiveness) study presents a pilot application of an online ACT group intervention for fibromyalgia (FM) with an extensive Experiential Sampling (ES) assessment of outcome and process variables via smartphone.

METHOD

5-weekly ACT online group sessions were applied to 9 female FM patients. Questionnaire-based assessments of several clinical outcomes and PF processes were conducted pre- and post-intervention, and at 6-month follow-up. Extensive (6 weeks pre- and 6 weeks post-intervention) smartphone-delivered ES was implemented to gather process and outcome data in the patients' usual contexts. Clinically significant change was evaluated both at the group level and individually.

RESULTS

This treatment format appears to be feasible and acceptable to participants, with good adoption and completion rates (75 %) and excellent rates of treatment completion and clinical adherence (100 %). Participants showed significant reductions in affective pain, distress and biopsychosocial impact of FM both post-intervention and at 6-month follow-up (as measured with questionnaires), as well as significant improvements in satisfaction with actions and emotional discomfort (as measured through ES). Multilevel regression analyses indicated that PF-related processes assessed through ES had a significant impact on clinical outcomes and predicted the impact of FM at the 6-month follow-up.

CONCLUSIONS

A brief online group ACT intervention for FM was both feasible and acceptable to participants. Also, there was preliminary evidence of effectiveness in enhancing pain-related PF and producing clinical benefits in FM.

The Role of Psychological Inflexibility and Experiential Approach on Mental Health in Children and Adolescents: An Exploratory Study

The prevalence of mental health problems during childhood and adolescence is on the rise. There is a growing interest in the examination of personal variables that may function as risk factors and that may be targeted for effective intervention. This study explores the relationships amongst different aspects of psychological inflexibility (one, typically studied, focusing on the individual’s responding to unwanted emotions and cognitions, and another, more recently explored, focusing on the individual’s responding to desired thoughts and affective states), emotional intelligence, and mental health symptoms. A total of 129 school-going children (mean age: 11.16 years old) completed a battery of instruments comprising the Avoidance and Fusion Questionnaire-Youth (AFQ-Y17), the Experiential Approach Scale (EAS), the Emotional Intelligence Quotient Inventory (EQi-YV), and the Revised Child Anxiety and Depression Scale (RCADS-30). Results showed that both the AFQ-Y17 score and an EAS subscale score (Anxious Clinging) were significant independent predictors of mental health symptoms in general. Emotional intelligence was predictive only for depression, and both the AFQ-Y17 and the Anxious Clinging EAS subscale significantly incremented the predictive power of a hierarchical linear regression model including all three variables. These results underscore the relevance of psychological inflexibility for child/adolescent mental health, and the need to further explore a specific aspect of inflexibility regarding positive emotions and other appetitive private events.

Brief and Telehealth Acceptance and Commitment Therapy (ACT) Interventions for Stress in Inflammatory Bowel Disease (IBD): A Series of Single Case Experimental Design (SCED) Studies

Psychological intervention targeting distress is now considered an integral component of inflammatory bowel disease (IBD) management. However, significant barriers to access exist which necessitate the development of effective, economic, and accessible brief and remote interventions. Acceptance and commitment therapy (ACT) is a therapy with demonstrated acceptability and a growing evidence base for the treatment of distress in IBD populations. The present paper trialled two brief ACT interventions via randomized multiple baseline designs. Study 1 trialled a single-session ACT intervention (delivered face-to-face and lasting approximately two hours) targeting stress and experiential avoidance, respectively. Participants were seven people with an IBD diagnosis who presented with moderate to extremely severe stress (five females, two males; M age = 39.57, SD = 5.74). The findings of study 1 indicate that a single-session ACT intervention represented an insufficient dosage to reduce stress and experiential avoidance. Study 2 investigated a brief telehealth ACT intervention (delivered via a video conferencing platform and lasting approximately four hours) targeting stress and increased psychological flexibility. Participants (N = 12 people with an IBD diagnosis and mild to extremely severe stress) completed baselines lasting from 21 to 66 days before receiving a two-session ACT telehealth intervention supplemented by a workbook and phone consultation. Approximately half of participants experienced reduced stress, increased engagement in valued action, and increased functioning. Despite shortcomings such as missing data and the context of COVID-19, the present findings suggest that brief ACT interventions in this population may be effective and economic, though further research and replications are necessary.

The Psychological Flexibility in Epilepsy Questionnaire (PFEQ): Psychometric properties of the Persian version

The present study aimed to evaluate the psychometric properties of a Persian version of the Psychological Flexibility Epilepsy Questionnaire (P-PFEQ). Transcultural adaptation and validation of the Persian version of the PFEQ were performed using translation and back-translation with pilot testing (on 17 patients) and expert evaluation. Participants in the current study involved 100 patients with an EEG-verified epilepsy diagnosis and an average age of 30.96 years (SD ± 6.46) (63% were female). Data collection included a sociodemographic questionnaire, epilepsy-specific questionnaire, the Depression-Anxiety-stress scale (DASS-21), the Insomnia Severity Index (ISI), the 31-item Quality-of-Life questionnaire in Epilepsy (QOLIE-31), the Acceptance and Action Questionnaire (AAQ), the Committed Action Questionnaire (CAQ), and the short form of the Freiburg Mindfulness Inventory (FMI). Descriptive and inferential analyses were conducted by SPSS software V.26. The P-PFEQ demonstrated semantic, conceptual, and content validity in equivalence with the Swedish version. Based on Exploratory Factor Analysis (EFA), five items were eliminated and unidimensional scale of PFEQ with 12 items, explaining 50.38% of the total variance, was accepted. The scale showed good reliability through internal consistency (Cronbach's α of 0.9) and temporal stability on retest (n = 85, Intraclass correlation = 0.92). Convergent and divergent validity findings were acceptable for the P-PFEQ. The findings show that the P-PFEQ is a reliable and valid scale for assessing psychological flexibility in the Iranian patients with epilepsy. Also, it can be confidently recommended as a useful instrument in clinical practice.

Is ACT-Informed Exposure a Viable Treatment for Excoriation Disorder? A Multiple Baseline Study

This study piloted the use of ACT-informed exposure as an adjunct to habit reversal training (HRT) for excoriation disorder (ExD). Using a nonconcurrent multiple baseline single case design, four participants completed sessions of exposure and HRT. Repeated measures and self-report data were collected on skin picking and psychological flexibility. Two participants completed HRT followed by exposure, and two participants completed exposure followed by HRT. Results support the effectiveness of HRT in reducing picking. Results suggest exposure may have some impact in reducing picking, but effects were weaker compared to HRT. Contrary to predictions, repeated measures and self-report data did not indicate consistent improvement in psychological flexibility during exposure phases. As any reduction in picking may be clinically meaningful and all participants maintained gains at follow-up, there is some indication that exposure may be a second-line treatment worth further study. Limitations and future areas of research are discussed.

Acceptance and commitment therapy for individuals with depressive and anxiety symptoms following acquired brain injury: A non-concurrent multiple baseline design across four cases

Patients with acquired brain injury (ABI) often experience symptoms of anxiety and depression. Until now, evidence-based treatment is scarce. This study aimed to investigate the effectiveness of Acceptance and Commitment Therapy (ACT) for patients with ABI. To evaluate the effect of ACT for people with ABI, a non-concurrent multiple baseline design across four cases was used. Participants were randomly assigned to a baseline period, followed by treatment and then follow-up phases. Anxiety and depressive symptoms were repeatedly measured. During six measurement moments over a year, participants filled in questionnaires measuring anxiety, depression, stress, participation, quality of life, and ACT-related processes. Randomization tests and NAP scores were used to calculate the level of change across phases. Clinically significant change was defined with the Reliable Change Index. Three out of four participants showed medium to large decreases in anxiety and depressive symptoms (NAP = 0.85 till 0.99). Furthermore, participants showed improvements regarding stress, cognitive fusion, and quality of life. There were no improvements regarding psychological flexibility, value-driven behaviour, or social participation. This study shows that ACT is possibly an effective treatment option for people experiencing ABI-related anxiety and depression symptoms. Replication with single case or large scale group studies is needed to confirm these findings.

Spanish Adaptation of the Experiential Approach Scale (EAS)

Psychological inflexibility is a transdiagnostic dimension associated to psychological distress and poor mental health and quality of life. While multiple instruments have been developed for the assessment of patterns of inflexible responding to aversive private events (e.g., unwanted cognitions and emotions), the Experiential Approach Scale (EAS) is the first instrument specifically designed to assess inflexible responding to appetitive private events (e.g., desired affective states). In this study, we explored the factor structure, internal consistency, and convergent validity of a Spanish adaptation of the EAS with a convenience sample of college students from Spain (n = 206; 79% female). A two-factor solution demonstrated very good fit to the data and was similar to the original two-subscale EAS structure: Anxious Clinging and Experience Prolonging. The scale showed adequate overall (α = 0.85) and subscale (αs: 0.90 and 0.89) internal consistency. Unlike the original instrument, both subscales were uncorrelated. Anxious Clinging correlated positively with experiential avoidance and with measures of negative affect and psychopathology, and negatively with positive affect, subjective happiness, and life satisfaction. In turn, Experience Prolonging correlated negatively with psychopathology and positively with positive affect, subjective happiness, and life satisfaction. Our results point to Anxious Clinging as the only EAS subscale contributing to psychological inflexibility.

Quality of life in coeliac disease: relationship between psychosocial processes and quality of life in a sample of 1697 adults living with coeliac disease

BACKGROUND

Coeliac disease is a chronic gastrointestinal condition associated with an increased risk of psychiatric comorbidity, and diminished quality of life. Ongoing gastrointestinal symptomatology is frequently reported post-diagnosis, despite undertaking a gluten-free diet.

PURPOSE

To examine the role of psychosocial factors in mediating the relationship between gastrointestinal symptoms and quality of life, using a cross-sectional structural equation modelling mediation analysis guided by the Common-Sense Model.

METHODS

1697 adults with coeliac disease (83.1% female, mean age = 55.79, SD = 14.98 years) completed an online questionnaire. Measures included gluten-free diet adherence, gastrointestinal symptoms, illness perceptions, coping, gastrointestinal-specific anxiety, pain catastrophising, psychological flexibility, psychological distress, and quality of life.

RESULTS

A structural equation model was developed explaining 50.6% of the variation in quality of life and demonstrating good fit (χ2 (2) = 8.54, p = .014, χ2/N = 4.27, RMSEA = 0.04, SRMR = 0.01, CFI = 0.999, TLI = 0.98, GFI = 0.999). Gastrointestinal symptoms directly affected quality of life, and indirectly, via negative illness perceptions, maladaptive coping, pain catastrophising, and psychological distress.

CONCLUSION

Psychosocial processes may affect adjustment in coeliac disease by mediating the relationship between gastrointestinal symptoms and quality of life. Individuals living with coeliac disease may benefit from interventions targeting maladaptive psychosocial factors.

Effects of Acceptance and Commitment Training Plus Behavior Parent Training on Parental Implementation of Autism Treatment

The objective of this study was to examine the effects of acceptance and commitment training (ACT) plus behavior parent training (BPT), when delivered via telehealth, on parental implementation of behavioral strategies, experiential avoidance (EA), and stress. The study also examined the subsequent effects on the parents’ autistic children’s behaviors. A multiple baseline design was implemented across four parent-child dyads who participated in the online training. The findings showed that ACT+BPT resulted in parental implementation reaching and maintaining high levels. The training also decreased EA and stress in three parents. Moreover, the parents’ ratings of their children’s challenging behaviors decreased. However, such a trend was not as clearly depicted by direct measures of the children’s behaviors. A social validity interview revealed parents found ACT beneficial in assisting them to learn and use the BPT strategies. Implications and suggestions for future research are discussed.

The Role of Acceptance in Eating Behaviors-Spanish Validation of Food Craving Acceptance and Action Questionnaire (FAAQ-S)

Background: The Food Craving Acceptance and Action Questionnaire (FAAQ) was developed to measure food craving acceptance, but has not yet been adapted to Spanish. The aim of this study was to validate the FAAQ to the Spanish population and to analyze its psychometric properties.

Method: Two studies were conducted. In the first study, the sample consisted of 224 undergraduate students who participated in the comprehension of the Spanish version and the Confirmatory Factor Analysis (CFA). The second sample consisted of 378 participants from a community sample who completed the refined version of the FAAQ and similar and dissimilar measures.

Results: Study (1) The CFA was conducted, showing an inadequate fit of the model (CFI = 0.74, RMSEA = 0.18). Therefore, FAAQ was refined and it was administered to the community sample. Study (2) After an exploratory factor analysis, two factors were obtained as in the original FAAQ, Acceptance (30.92% variance explained) and Willingness (36.05%). The internal consistency was adequate for both subscales (ω = 0.88 and ω = 0.87, respectively). Correlation between the factors was r = 0.07, which provides evidence that Acceptance and Willingness are different constructs. Correlations of Acceptance with similar variables (r between −0.30 and −0.52) were stronger than the dissimilar measures (r between −0.26 and 0.24). This did not occur for the Willingness subscale, since correlations were low in all cases (r between −0.22 and 0.25).

Conclusions: Spanish version of the FAAQ showed evidence of its reliability and validity, and may be a measure to provide a better understanding of how acceptance of thoughts and emotions concerning food and willingness impact eating management behaviors.

Measuring psychological flexibility and cognitive defusion in individuals with acquired brain injury

PURPOSE

Acceptance and Commitment Therapy (ACT) is used increasingly for individuals with psychological distress following acquired brain injury (ABI) in different countries. However, questionnaires measuring ACT-processes are often not validated for this patient group and need cross-cultural validation. This study investigated the psychometric properties of the Acceptance and Action Questionnaire for Acquired Brain Injury (AAQ-ABI; measuring psychological flexibility related to thoughts and feelings about ABI) and the Cognitive Fusion Questionnaire (CFQ-7; measuring cognitive defusion).

MATERIALS AND METHODS

Score distribution, reliability, and convergent validity of the AAQ-ABI and the CFQ-7 were examined in Dutch individuals with ABI.

RESULTS

Seventy-three patients with ABI were included. The AAQ-ABI showed good reliability (Cronbach's α = 0.87) and the CFQ-7 excellent reliability (Cronbach's α = 0.97). Both did not show a floor or ceiling effect, nor a skewed distribution. There were strong to moderate correlations between the questionnaires and measures of psychological flexibility, mood, quality of life, and value-driven behavior (AAQ-ABI: r = -0.70-0.81; CFQ-7 = -0.67-0.84). Inter-item total correlations indicate that the questions within each questionnaire measured the same construct (AAQ-ABI: r = 0.40-0.78; CFQ-7: r = 0.84-0.93).

CONCLUSIONS

The current study shows that the Dutch AAQ-ABI and CFQ-7 have acceptable to good psychometric properties when measuring psychological flexibility and cognitive defusion in patients with ABI.

Psychological flexibility in mild traumatic brain injury: an evaluation of measures

PRIMARY OBJECTIVE

In this study, we examined the psychometric properties of measures of psychological flexibility in a mild traumatic brain injury (mTBI) sample.

METHOD AND PROCEDURES

Adults who sustained a mTBI (n = 112) completed the Acceptance and Action Questionnaire - Acquired Brain Injury reactive avoidance subscale (AAQ-ABI (RA). Exploratory factor analysis and Rasch analysis were conducted to evaluate the facture structure, dimensionality, and differential item functioning. Construct validity was determined by correlating the AAQ-ABI (RA) with the Acceptance and Action Questionnaire-Revised (AAQ-II) and Fear Avoidance after Traumatic Brain Injury (FAB-TBI).

MAIN OUTCOME AND RESULTS

The AAQ-ABI (RA) was found to have strong internal consistency (Cronbach's α = 0.87). Consistent with previous findings, the AAQ-ABI (RA) had one distinct factor. Fit to the unidimensional Rasch model was adequate (χ² (18) = 22.5, p = .21) with no evidence of differential item functioning across person factors examined. The AAQ-ABI (RA) also had expected relationships with theoretically relevant constructs.

CONCLUSIONS

The AAQ-ABI (RA) appears to be a psychometrically sound measure of psychological flexibility in mTBI.

The Group Nurturance Inventory - initial psychometric evaluation using Rasch and factor analysis

BACKGROUND

This paper describes the development and psychometric evaluation of a behavioral assessment instrument primarily intended for use with workgroups in any type of organization. The instrument was developed based on the Nurturing Environments framework which describes four domains important for health, well-being, and productivity; minimizing toxic social interactions, teaching and reinforcing prosocial behaviors, limiting opportunities for problem behaviors, and promoting psychological flexibility. The instrument is freely available to use and adapt under a CC-BY license and intended as a tool that is easy for any group to use and interpret to identify key behaviors to improve their psychosocial work environment.

METHODS

Questionnaire data of perceived frequency of behaviors relevant to nurturance were collected from nine different organizations in Sweden. Data were analyzed using confirmatory factor analysis, Rasch analysis, and correlations to investigate relationships with relevant workplace measures.

RESULTS

The results indicate that the 23-item instrument is usefully divided in two factors, which can be described as risk and protective factors. Toxic social behaviors make up the risk factor, while the protective factor includes prosocial behavior, behaviors that limit problems, and psychological flexibility. Rasch analysis showed that the response categories work as intended for all items, item fit is satisfactory, and there was no significant differential item functioning across age or gender. Targeting indicates that measurement precision is skewed towards lower levels of both factors, while item thresholds are distributed over the range of participant abilities, particularly for the protective factor. A Rasch score table is available for ordinal to interval data transformation.

CONCLUSIONS

This initial analysis shows promising results, while more data is needed to investigate group-level measurement properties and validation against concrete longitudinal outcomes. We provide recommendations for how to work in practice with a group based on their assessment data, and how to optimize the measurement precision further. By using a two-dimensional assessment with ratings of both frequency and perceived importance of behaviors the instrument can help facilitate a participatory group development process. The Group Nurturance Inventory is freely available to use and adapt for both commercial and non-commercial use and could help promote transparent assessment practices in organizational and group development.

Validation of the Chinese Version of the Body Image Acceptance and Action Questionnaire and the Mediating Role of Body Image Flexibility in the Relationship Between Body Dissatisfaction and Psychological Distress

The psychometric properties of the Chinese version of the Body Image Acceptance and Action Questionnaire (C-BI-AAQ) and its short form (C-BI-AAQ-5) were examined with a sample of Chinese undergraduates (n =1,068, 52.6% female). The factor structure, measurement reliability, measurement invariance across gender, and latent gender mean difference of the two scales were explored. Confirmatory factor analysis was used to examine the factor structure of the C-BI-AAQ and the C-BI-AAQ-5. The original one-factor structure was replicated for both the C-BI-AAQ and the C-BI-AAQ-5. Both the C-BI-AAQ and C-BI-AAQ-5 showed good internal consistency, test-retest reliability, and convergent and discriminant validity (e.g., relationship patterns in the expected directions with theoretically similar psychological flexibility, and with theoretically dissimilar body dissatisfaction, and psychological distress). The C-BI-AAQ-5 was shown to be equivalent to the C-BI-AAQ. Furthermore, strict measurement invariance across gender was confirmed for both the C-BI-AAQ and C-BI-AAQ-5, and latent mean difference tests showed that men had higher levels of body image flexibility than women. Thus, both the C-BI-AAQ and C-BI-AAQ-5 appear to be psychometrically sound instruments for use in the Chinese young adult population. In addition, body image flexibility measured by both the C-BI-AAQ and the C-BI-AAQ-5 fully mediated the relationship between body dissatisfaction and psychological distress.

Single-Session Acceptance and Commitment Therapy (ACT) Interventions for Patients with Chronic Health Conditions: A Systematic Review and Meta-Analysis

RATIONALE

Chronic health conditions (CHCs) are costly and difficult to manage. Patients often struggle with behavioral adherence to complex treatment regimens and experience psychiatric distress. Acceptance and Commitment Therapy (ACT) is a transdiagnostic behavioral approach that aims to improve functioning and quality of life (QoL), which are important treatment outcomes for this population. Preliminary efficacy of multi-session ACT in patients with CHCs has been demonstrated, and single-session ACT interventions have since been developed to increase feasibility, acceptability, and accessibility. The purpose of this systematic review and meta-analysis was to describe the literature on single-session ACT intervention studies in CHC populations with regards to (1) study design and methodology, (2) patient characteristics and conditions targeted, and (3) efficacy for outcomes across various domains, using narrative and quantitative methods.

METHODS

PsycINFO, PubMed, and Web of Science were systematically searched in August 2020. Studies of single-session ACT interventions in adult patients with CHCs that reported quantitative outcomes in any of the following domains were included: (a) functioning and related domains (e.g., disability, QoL, well-being); (b) mental health; (c) physical health; (d) ACT processes. Both controlled and uncontrolled studies were included. Study quality was assessed using the Psychotherapy Outcome Study Methodology Rating Scale (POMRF). Between-group random effects meta-analysis was conducted on general functioning outcomes.

RESULTS

Fourteen manuscripts reporting outcomes from 13 studies (N = 793) met inclusion criteria. Ten studies were identified by their authors as pilot or feasibility trials. Eight studies used comparison or control groups. Twelve studies delivered the ACT content in workshop format. Studies recruited for a variety of conditions. Narrative review found that between- and within-group effect sizes showed generally positive results favoring single-session ACT overall (69%), especially for measures of functioning and related domains (88%), mental health (67%), and ACT processes (73%). Meta-analysis found that ACT did not significantly outperform comparison groups on measures of general functioning (Hedges' g: -0.51, 95% confidence interval: [-1.19, 0.16]; I 2 = 86%; K = 5) despite a medium-sized pooled effect.

DISCUSSION

Use of single-session ACT interventions in CHC populations is an emergent field. There is preliminary evidence for the acceptability, feasibility, and efficacy of these interventions, which provides support for further testing in fully-powered RCTs. Additional RCTs will enable larger meta-analyses and stronger conclusions about efficacy. Recommendations for future trials are provided.

Process-outcome associations in an interdisciplinary treatment for chronic pain and comorbid mental disorders based on Acceptance and Commitment Therapy

OBJECTIVE

Numerous studies support the effectiveness of Acceptance and Commitment Therapy (ACT) for chronic pain, yet little research has been conducted about its underlying mechanisms of change, especially regarding patients with comorbid mental disorders. The present investigation addressed this issue by examining associations of processes targeted by ACT (pain acceptance, mindfulness, psychological flexibility) and clinical outcomes (pain intensity, somatic symptoms, physical health, mental health, depression, general anxiety).

SUBJECTS

Participants were 109 patients who attended an ACT-based interdisciplinary treatment program for chronic pain and comorbid mental disorders in a routine care psychiatric day hospital.

METHODS

Pre- to post-treatment differences in processes and outcomes were examined with Wilcoxon signed-rank tests and effect size r. Associations between changes in processes and changes in outcomes were analyzed with correlation and multiple regression analyses.

RESULTS

Pre- to post-treatment effect sizes were mostly moderate to large (r between |0.21| and |0.62|). Associations between changes in processes and changes in outcomes were moderate to large for both, bivariate correlations (r between |0.30| and |0.54|) and shared variances accounting for all three processes combined (R2 between 0.21 and 0.29).

CONCLUSION

The present investigation suggests that changes in pain acceptance, mindfulness and psychological flexibility are meaningfully associated with changes in clinical outcomes. It provides evidence on particular process-outcome associations that had not been investigated in this way before. The focus on comorbid mental disorders informs clinicians about a population of chronic pain patients that often has a severe course of illness and has seldom been studied.

Defining and measuring "psychological flexibility": A narrative scoping review of diverse flexibility and rigidity constructs and perspectives

Psychological flexibility (PF) is a popular construct in clinical psychology. However, similar constructs have existed since the mid-20th century, resulting in different terms, definitions and measures of flexibility, hindering the advancement of the field. The main measure of PF - the Acceptance and Action Questionnaire (AAQ-II; Bond et al., 2011) - has also been heavily criticized. To move towards definitional consensus and improved measurement, we surveyed the literature to map PF and related-terms, examine definitional overlaps, and assessthe psychometric quality of prominent flexibility measures. A scoping review was conducted in two databases (PsycNET and SCOPUS). Twenty-three flexibility constructs appeared across 220 articles, and twelve measures were included and rated for quality. PF, psychological inflexibility (PI), and cognitive flexibility (CF) were most prominent. Definitional similarities among prominent flexibility constructs emerged, namely handling distress or interference, taking action, and meeting goals or values. The Personalized Psychological Flexibility Index (PPFI; Kashdan, Disabato, Goodman, Doorley, & McKnight, 2020) appears to be the best measure available to assess PF. Problems with the current use of the AAQ-II were apparent, hindering current knowledge of PF. Definitional consensus and measurement development are vital to advance the field. To this end, recommendations and next steps for researchers and practitioners are outlined.

Psychological Flexibility as Shared Process of Change in Acceptance and Commitment Therapy and Exposure and Response Prevention for Obsessive-Compulsive Disorder: A Single Case Design Study

Changes in psychological flexibility were tracked in a combined protocol of exposure and response prevention (ERP) and acceptance and commitment therapy (ACT) for adults with OCD to assess if changes in psychological flexibility processes were unique to ACT intervention (e.g., not impacted by ERP). Using a nonconcurrent multiple baseline design, four participants received sessions of ERP and ACT while data was collected on psychological flexibility processes of change and OCD symptom severity. Results indicate treatment response for three of four participants based on OCD scores. Contrary to predictions, data suggest both ERP and ACT have positive effects on psychological flexibility. Implications of these findings are discussed in relation to recent research on ACT and ERP for OCD. This study also illustrates a type of research design that can be accomplished in clinical practice.

[Measurement of pain-related experiential avoidance: analysis of the Acceptance and Action Questionnaire-II-Pain in patients with chronic pain]

Einleitung und Fragestellung

Erlebensvermeidung („experiential avoidance“) stellt einen zentralen störungsrelevanten Prozess im Rahmen der Akzeptanz- und Commitment-Therapie (ACT) dar. Zur Erfassung wurde der Acceptance and Action Questionnaire II (AAQ-II) entwickelt und in den Niederlanden für eine Patientengruppe mit chronischem Schmerz adaptiert und validiert (AAQ-II‑P). Hohe Werte im AAQ-II‑P bedeuten hohe schmerzbezogene Erlebensvermeidung. Ziel unserer Untersuchung ist die Erfassung von schmerzbezogener Erlebensvermeidung mit einer deutschen Version des AAQ-II‑P bei chronischen Schmerzpatienten und die Prüfung psychometrischer Merkmale des Messverfahrens.

Methodik

Der AAQ-II wurde mittels eines Vorwärts-Rückwärts-Verfahrens ins Deutsche übersetzt, für chronischen Schmerz adaptiert (AAQ-II‑P) und von 168 Patienten einer universitären Schmerzambulanz beantwortet. Zusätzlich wurden Daten zu schmerzbedingter Beeinträchtigung (CPG: Schweregrad nach von Korff) und Schmerzkatastrophisieren (PCS) erhoben sowie zu gesundheitsbezogener Lebensqualität (SF-12), Angst und Depressivität (HADS-D). Ebenfalls erfasst wurden allgemeine Persönlichkeitsmerkmale (BFI‑K) und habituelle Achtsamkeit (KIMS-S). Ausgewertet wurden Reliabilität und faktorielle Validität des AAQ-II‑P sowie seine Beziehung zu den anderen psychometrischen Verfahren.

Ergebnisse

Der AAQ-II‑P erzielte eine hohe interne Konsistenz mit α = 0,89 sowie eine eindimensionale Faktorenstruktur mit 61 % aufgeklärter Varianz. Geringe Korrelationen ergaben sich zu Persönlichkeitsdimensionen (maximal r = 0,44 zu Neurotizismus) und Achtsamkeit (maximal r = −0,43 zu Akzeptanz). Ein hoher Zusammenhang fand sich zu Schmerzkatastrophisieren (r = 0,75), Depression (r = 0,73) und Angst (r = 0,66). Die Beziehung zu Lebensqualität war am stärksten ausgeprägt auf der Psychischen Summenskala (r = −0,58).

Diskussion und Schlussfolgerung

Die deutsche Version des AAQ-II‑P hat eine gute Reliabilität und weist hinsichtlich Zuverlässigkeit und Faktorenstruktur hohe Vergleichbarkeit mit der Originalversion auf. Die Beziehungen zu den Skalen der psychometrischen Verfahren sind zumeist in erwarteter Richtung und Höhe. Patienten mit chronischem Schmerz und hoher schmerzbezogener Erlebensvermeidung tendieren deutlich zum Schmerzkatastrophisieren und zeichnen sich durch schlechtere psychische Lebensqualität aus. Dies spricht für die Relevanz des Konstrukts hinsichtlich therapeutischer Zielvariablen.

A Pilot Randomized Controlled Trial of Acceptance and Commitment Therapy Guided Self-Help for Overweight and Obese Adults High in Weight Self-Stigma

Weight self-stigma, in which individuals internalize stigmatizing messages about weight, is a prevalent problem that contributes to poor quality of life and health. This pilot randomized controlled trial evaluated acceptance and commitment therapy (ACT) guided self-help using The Diet Trap for 55 overweight/obese adults high in weight self-stigma. Participants were randomized to the ACT self-help book plus phone coaching (GSH-P; n = 17), self-help book plus email prompts only (GSH-E; n = 20), or a waitlist condition (n = 18), with online self-report assessments at baseline and posttreatment (8 weeks later). Participants reported high satisfaction ratings and engagement with the ACT self-help book, with no differences between GSH-P and GSH-E. Both GSH-P and GSH-E improved weight self-stigma relative to waitlist with large effect sizes. There were mixed findings for health outcomes. The GSH-P condition improved more on healthy eating behaviors and general physical activity, but neither ACT condition improved more than waitlist on self-reported body mass index, emotional eating, and a second measure of physical activity. Results suggest an ACT self-help book with email prompts can reduce weight self-stigma and potentially improve some health behavior outcomes. Phone coaching may provide additional benefits for generalizing ACT to diet and physical activity.

Effect of Psychological Inflexibility on Depressive Symptoms and Sleep Disturbance among Japanese Young Women with Chronic Pain

Background: Psychological inflexibility based on an acceptance and commitment therapy model is theoretically well-established as a process to exacerbate psychological distress, such as depressive symptoms and sleep disturbance. This study aimed to examine the associations of psychological inflexibility with depressive symptoms and sleep distribution. We hypothesized that psychological inflexibility would be associated with higher levels of depressive symptoms and sleep disturbance in women with chronic pain. Methods: Female college students in Japan answered a questionnaire on pain status, treatment, and psychological inflexibility as measured by the Acceptance and Action Questionnaire-Ⅱ before answering questionnaires on depressive symptoms and sleep disturbance eight months after. Results: Women with chronic pain (n = 320) reported more severe depressive symptoms and sleep disturbances compared to women without chronic pain (n = 90). Hierarchical multiple regressions revealed that psychological inflexibility predicted higher levels of depressive symptoms and sleep disturbance, independent of the pain intensity, whether they consulted a doctor or used pain medication. Conclusion: Based on our findings self-management interventions aimed at reducing psychological inflexibility should be developed for individuals who are experiencing chronic pain.