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Peltz J. Out of their control: College students' beliefs in sleep myths, sleep problems, and psychological flexibility. Sleep Health 2024; 10:478-484. [PMID: 38879397 DOI: 10.1016/j.sleh.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/30/2024] [Accepted: 05/04/2024] [Indexed: 08/10/2024]
Abstract
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.
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Affiliation(s)
- Jack Peltz
- Department of Psychology, State University of New York (SUNY) at Brockport, Brockport, New York, USA.
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2
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Navarrete J, Rodríguez-Freire C, Sanabria-Mazo JP, Martínez-Rubio D, McCracken LM, Gallego A, Sundstrom FTA, Serrat M, Alonso J, Feliu-Soler A, Nieto R, Luciano JV. Psychometric examination of the Multidimensional Psychological Flexibility Inventory Short Form (MPFI-24) and the Psy-Flex Spanish versions in individuals with chronic pain. Eur J Pain 2024. [PMID: 39031492 DOI: 10.1002/ejp.4704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 07/03/2024] [Accepted: 07/09/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND Acceptance and Commitment Therapy (ACT) has been found to be beneficial for individuals dealing with chronic pain. The theoretical mechanisms of change proposed by ACT are based on the Hexaflex model. To comprehensively reflect this model, the Multidimensional Psychological Flexibility Inventory (MPFI) and Psy-Flex have been developed. The study aimed to adapt the MPFI-24 and the Psy-Flex for Spanish-speaking populations with chronic pain and to examine their dimensionality, internal consistency, convergent validity and incremental validity. METHODS This cross-sectional study involved 309 Spanish-speaking adults with chronic pain who completed an online survey. The majority of the participants were women (88.3%). The ages ranged from 18 to 79 years. RESULTS Factor analysis showed that the Spanish version of the MPFI-24 has 12 factors, consisting of six flexibility and six inflexibility factors, similar to the original version, but lacking second-order general factors. The Psy-Flex demonstrated a single-factor structure, maintaining the general factor of psychological flexibility seen in the original version. The MPFI-24 showed good internal consistency and adequate convergent validity, with the exception of the Acceptance and Experiential Avoidance subscales. The Psy-Flex showed good internal consistency and convergent validity. Notably, both the MPFI-24 and Psy-Flex scores significantly explained additional variance in psychological distress beyond other ACT-related measures of Hexaflex processes; however, only the Psy-Flex explained pain interference. CONCLUSIONS The Spanish adaptations of the MPFI-24 and Psy-Flex are valid and reliable instruments for assessing the Hexaflex model processes in Spanish-speaking adults with chronic pain. SIGNIFICANCE STATEMENT Practitioners and researchers in chronic pain will find the Spanish versions of the MPFI-24 and the Psy-Flex here, along with recommendations for their use and scoring based on a robust psychometric rationale. It should be noted that these measures surpass the Chronic Pain Acceptance Questionnaire (CPAQ) and the Psychological Inflexibility in Pain Scale (PIPS), which are considered gold standards in chronic pain assessment.
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Affiliation(s)
- Jaime Navarrete
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan De Déu, Sant Boi De Llobregat, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Carla Rodríguez-Freire
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan De Déu, Sant Boi De Llobregat, Spain
| | - Juan P Sanabria-Mazo
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan De Déu, Sant Boi De Llobregat, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Basic, Developmental and Educational Psychology, Faculty of Psychology, Autonomous University of Barcelona, Bellaterra, Spain
| | - David Martínez-Rubio
- Faculty of Health Sciences, Department of Psychology, Universidad Europea de Valencia, Valencia, Spain
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
| | | | - Ana Gallego
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, Jyväskylä, Finland
- School of Wellbeing, JYU.Well, University of Jyväskylä, Jyväskylä, Finland
| | | | - Mayte Serrat
- Unitat d'Expertesa en Síndromes de Sensibilització Central, Servei de Reumatologia, Vall d'Hebron Hospital, Barcelona, Spain
| | - Jordi Alonso
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Health Services Research Unit, Hospital del Mar Research Institute Barcelona (IMIM), Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Albert Feliu-Soler
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Clinical and Health Psychology, Faculty of Psychology, Autonomous University of Barcelona, Bellaterra, Spain
| | - Rubén Nieto
- eHealth Lab Research Group, Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Juan V Luciano
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan De Déu, Sant Boi De Llobregat, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Clinical and Health Psychology, Faculty of Psychology, Autonomous University of Barcelona, Bellaterra, Spain
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Macri JA, Rogge RD. Examining domains of psychological flexibility and inflexibility as treatment mechanisms in acceptance and commitment therapy: A comprehensive systematic and meta-analytic review. Clin Psychol Rev 2024; 110:102432. [PMID: 38615492 DOI: 10.1016/j.cpr.2024.102432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 12/15/2023] [Accepted: 04/09/2024] [Indexed: 04/16/2024]
Abstract
The current systematic and meta-analytic review sought to integrate a growing number of studies examining dimensions of psychological flexibility as treatment mechanisms for Acceptance and Commitment Therapy (ACT). Analyses of 77 records (67 unique studies; Ntotal = 9123 participants) from comprehensive searches of multiple databases suggested that ACT interventions led to reduced inflexibility (i.e., lowered global inflexibility, lack of present moment awareness, cognitive fusion, experiential avoidance, self-as-content, & inaction) and increased flexibility (i.e., committed action/contact with values, global flexibility/acceptance, & defusion). Those changes remained significant when ACT was compared with waitlist or active treatments and were significantly linked to corresponding drops in psychological distress, supporting their roles as ACT treatment mechanisms. Moderation analyses revealed that the use of student samples, exclusion of clinically symptomatic individuals, and comparisons of ACT with other active treatments weakened these effects whereas offering ACT as an individual therapy and excluding individuals in extreme crisis (i.e., with suicidal ideation) strengthened them. The meta-analytic findings and systematic review suggested specific recommendations for future clinical work and research on ACT mechanisms: (1) Evaluate both psychological flexibility and inflexibility as distinct treatment mechanisms, (2) Evaluate specific dimensions of psychological flexibility/inflexibility as mechanisms with multidimensional scales (CompACT, MPFI), (3) Broaden treatment outcomes to include forms of wellbeing (peace of mind, vitality, connectedness), (4) Assess mechanisms and outcomes repeatedly throughout treatment to model the process of therapeutic change, (5) Investigate non-specific factors (therapeutic alliance, treatment adherence) as mechanisms, and (6) Explore treatment mechanisms in effectiveness studies.
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Affiliation(s)
- Jenna A Macri
- Department of Psychology, University of Rochester, USA
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Koppert TY, van Hoek R, Geenen R. Dimensions of psychological flexibility and their significance in people with somatic symptoms: The 18-item Flexibility Index Test (FIT-18). J Health Psychol 2024:13591053241239129. [PMID: 38566361 DOI: 10.1177/13591053241239129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Psychological flexibility has been hypothesized to preserve health in bad times. We examined whether psychological flexibility as assessed with an abbreviated questionnaire, was indicated to preserve mental and physical health when having somatic symptoms. Principal axis factoring indicated that two dimensions best represented the 60-item Flexibility Index Test (FIT-60) questionnaire: "mindfulness and acceptance" (M&A) and "commitment and behavior change" (C&BC). We selected 18 items that best denoted these dimensions (FIT-18 questionnaire). Regression analyses in 2060 Dutch people with and without persistent somatic symptoms, indicated that the M&A dimension (β = 0.33, p < 0.001) and C&BC dimension (β = 0.09, p < 0.001) were additively associated with mental well-being, but not with physical functioning. Moreover, the M&A dimension was indicated to protect mental well-being when having more severe somatic symptoms (β = 0.11, p < 0.001). The observed differential associations with health suggest the significance for health of the two dimensions of psychological flexibility as assessed with the FIT-18 questionnaire.
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Affiliation(s)
| | - Renée van Hoek
- Altrecht Psychosomatic Medicine, The Netherlands
- Utrecht University, The Netherlands
| | - Rinie Geenen
- Altrecht Psychosomatic Medicine, The Netherlands
- Utrecht University, The Netherlands
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Davis CH, Donahue ML, Gaudiano BA, Uebelacker LA, Twohig MP, Levin ME. Adding online storytelling-based acceptance and commitment therapy to antidepressant treatment for primary care patients: a randomized clinical trial. Cogn Behav Ther 2024; 53:48-69. [PMID: 37855277 PMCID: PMC10841889 DOI: 10.1080/16506073.2023.2265560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/26/2023] [Indexed: 10/20/2023]
Abstract
Depression is most often treated in primary care, where the prevailing treatment is antidepressant medication. Primary care patients with depression are less likely to be exposed to psychosocial interventions, despite evidence suggesting many of these treatments are effective. An example is acceptance and commitment therapy (ACT), a behavioral treatment for depression with a growing evidence base. A self-guided ACT intervention with a peer narrative (i.e. storytelling) format was developed with the intention of creating a treatment option for primary care patients that was more accessible than traditional psychotherapy. Titled LifeStories, the online program features videos of real individuals sharing coping skills for depression based on lived experiences and key ACT principles. A total of 93 primary care patients taking antidepressants were randomized to either continued antidepressant treatment alone or antidepressant treatment plus LifeStories for 4 weeks. There were no differences over time on depression severity and psychological inflexibility. However, LifeStories led to greater improvements in quality of life and increased patients' interest in additional treatment compared to antidepressant medication alone.Clinical trial pre-registration: ClinicalTrials.gov (NCT04757961).
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Affiliation(s)
| | | | - Brandon A. Gaudiano
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI
- Butler Hospital, Providence, RI
| | - Lisa A. Uebelacker
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI
- Butler Hospital, Providence, RI
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Lin SSH, Jacobs ML, Halli-Tierney A, Carroll DG, Allen RS. Psychometric Properties of the Acceptance and Action Questionnaire-II (AAQ-II) in Older Adult Primary Care Patients. Clin Gerontol 2023:1-14. [PMID: 37898917 DOI: 10.1080/07317115.2023.2276291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
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.
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Affiliation(s)
- Shayne S-H Lin
- Department of Psychology, College of Arts and Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
- Alabama Research Institute on Aging, College of Arts and Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Mary Lindsey Jacobs
- Department of Psychology, College of Arts and Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
- Alabama Research Institute on Aging, College of Arts and Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
- Research & Development Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama, USA
| | - Anne Halli-Tierney
- Alabama Research Institute on Aging, College of Arts and Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
- Family, Internal and Rural Medicine, College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Dana G Carroll
- Alabama Research Institute on Aging, College of Arts and Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
- Family, Internal and Rural Medicine, College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Rebecca S Allen
- Department of Psychology, College of Arts and Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
- Alabama Research Institute on Aging, College of Arts and Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
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Peltz JS, Bodenlos JS, Kingery JN, Abar C. Psychological processes linking problematic smartphone use to sleep disturbance in young adults. Sleep Health 2023; 9:524-531. [PMID: 37460376 DOI: 10.1016/j.sleh.2023.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVES With such high rates of sleep and mental health problems among undergraduate students, understanding potential antecedents of these interrelated problems has emerged as a critical area of examination. One potential factor underlying these problems is problematic smartphone use, which is defined as excessive phone use, impulse control problems related to the use, and negative consequences stemming from these behaviors. Accordingly, the current study sought to examine how relative changes in problematic smartphone use might impact college students' sleep disturbance via their psychological functioning (ie, psychological inflexibility and anxiety symptoms). METHODS The 2-wave (baseline and 2-month follow-up) online sample consisted of 385 undergraduates (81% female; M = 20.0, SD = 1.6), who reported problematic smartphone use, psychological flexibility, anxiety symptoms, and sleep disturbance. RESULTS Controlling for baseline levels of sleep hygiene, age, and gender, our model demonstrated a significant indirect effect from problematic smartphone use to sleep disturbance. Specifically, relative increases from baseline to the 2-month follow-up in students' problematic smartphone use predicted subsequent increases in psychological inflexibility, which predicted increases in anxiety symptoms, which, in turn, predicted increases in sleep disturbance. CONCLUSIONS Given the ubiquity of college students' smartphone use, the potential for problematic use remains high. Results suggest that the negative consequences of problematic smartphone use not only can include college students' mental health but also their sleep. With such high levels of college students suffering from mental health and sleep problems, clinicians and college administrators should consider the potential sequelae of the problematic use of smartphones.
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Affiliation(s)
- Jack S Peltz
- Department of Psychology, SUNY Brockport, Brockport, New York, USA.
| | - Jamie S Bodenlos
- Psychological Science Department, Hobart and William Smith Colleges, Geneva, New York, USA.
| | - Julie Newman Kingery
- Psychological Science Department, Hobart and William Smith Colleges, Geneva, New York, USA.
| | - Caitlin Abar
- Department of Psychology, SUNY Brockport, Brockport, New York, USA.
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8
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Gould RL, Rawlinson C, Thompson B, Weeks K, Gossage-Worrall R, Cantrill H, Serfaty MA, Graham CD, McCracken LM, White D, Howard RJ, Bursnall M, Bradburn M, Al-Chalabi A, Orrell R, Chhetri SK, Noad R, Radunovic A, Williams T, Young CA, Dick D, Lawrence V, Goldstein LH, Young T, Ealing J, McLeod H, Williams N, Weatherly H, Cave R, Chiwera T, Pagnini F, Cooper C, Shaw PJ, McDermott CJ. Acceptance and Commitment Therapy for people living with motor neuron disease: an uncontrolled feasibility study. Pilot Feasibility Stud 2023; 9:116. [PMID: 37420261 DOI: 10.1186/s40814-023-01354-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/27/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Motor neuron disease (MND) is a fatal, progressive neurodegenerative disease that causes progressive weakening and wasting of limb, bulbar, thoracic and abdominal muscles. Clear evidence-based guidance on how psychological distress should be managed in people living with MND (plwMND) is lacking. Acceptance and Commitment Therapy (ACT) is a form of psychological therapy that may be particularly suitable for this population. However, to the authors' knowledge, no study to date has evaluated ACT for plwMND. Consequently, the primary aim of this uncontrolled feasibility study was to examine the feasibility and acceptability of ACT for improving the psychological health of plwMND. METHODS PlwMND aged ≥ 18 years were recruited from 10 UK MND Care Centres/Clinics. Participants received up to 8 one-to-one ACT sessions, developed specifically for plwMND, plus usual care. Co-primary feasibility and acceptability outcomes were uptake (≥ 80% of the target sample [N = 28] recruited) and initial engagement with the intervention (≥ 70% completing ≥ 2 sessions). Secondary outcomes included measures of quality of life, anxiety, depression, disease-related functioning, health status and psychological flexibility in plwMND and quality of life and burden in caregivers. Outcomes were assessed at baseline and 6 months. RESULTS Both a priori indicators of success were met: 29 plwMND (104%) were recruited and 76% (22/29) attended ≥ 2 sessions. Attrition at 6-months was higher than anticipated (8/29, 28%), but only two dropouts were due to lack of acceptability of the intervention. Acceptability was further supported by good satisfaction with therapy and session attendance. Data were possibly suggestive of small improvements in anxiety and psychological quality of life from baseline to 6 months in plwMND, despite a small but expected deterioration in disease-related functioning and health status. CONCLUSIONS There was good evidence of acceptability and feasibility. Limitations included the lack of a control group and small sample size, which complicate interpretation of findings. A fully powered RCT to evaluate the clinical and cost-effectiveness of ACT for plwMND is underway. TRIAL REGISTRATION The study was pre-registered with the ISRCTN Registry (ISRCTN12655391).
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Affiliation(s)
- Rebecca L Gould
- Division of Psychiatry, University College London, Wing B, 6th Floor Maple House, 149 Tottenham Court Rd, London, W1T 7NF, UK.
| | - Charlotte Rawlinson
- Division of Psychiatry, University College London, Wing B, 6th Floor Maple House, 149 Tottenham Court Rd, London, W1T 7NF, UK
| | - Ben Thompson
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Kirsty Weeks
- Division of Psychiatry, University College London, Wing B, 6th Floor Maple House, 149 Tottenham Court Rd, London, W1T 7NF, UK
| | - Rebecca Gossage-Worrall
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Hannah Cantrill
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Marc A Serfaty
- Division of Psychiatry, University College London, Wing B, 6th Floor Maple House, 149 Tottenham Court Rd, London, W1T 7NF, UK
- Priory Hospital North London, London, UK
| | - Christopher D Graham
- Strathclyde Psychology, Department of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | | | - David White
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Robert J Howard
- Division of Psychiatry, University College London, Wing B, 6th Floor Maple House, 149 Tottenham Court Rd, London, W1T 7NF, UK
| | - Matt Bursnall
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Mike Bradburn
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ammar Al-Chalabi
- Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - Richard Orrell
- Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, London, UK
| | - Suresh K Chhetri
- Lancashire Teaching Hospitals NHS Foundation Trust, Lancashire, UK
| | - Rupert Noad
- Department of Neuropsychology, Derriford Hospital, Plymouth, UK
| | | | - Tim Williams
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | | | - David Dick
- Norfolk and Norwich University Hospital, Norwich, UK
| | - Vanessa Lawrence
- Health Services & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Laura H Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Tracey Young
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - John Ealing
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
| | - Hamish McLeod
- Mental Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Nicola Williams
- Primary Care Clinical Trials Unit, Oxford University, Oxford, UK
| | | | - Richard Cave
- Language and Cognition, University College London, London, UK
| | - Theresa Chiwera
- Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - Francesco Pagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Cindy Cooper
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Pamela J Shaw
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
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Flowers J, Eddy A, McCullough N, Christopher M, Kennedy CH. Acceptance and Commitment Therapy Processes Differentially Predict Aspects of Mental Health. Psychol Rep 2023:332941231169673. [PMID: 37052148 DOI: 10.1177/00332941231169673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
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.
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Affiliation(s)
- Jenna Flowers
- School of Graduate Psychology, Phacific University Health Professions Campus, Hillsboro, OR, USA
| | - Ashley Eddy
- School of Graduate Psychology, Phacific University Health Professions Campus, Hillsboro, OR, USA
| | - Nicole McCullough
- School of Graduate Psychology, Phacific University Health Professions Campus, Hillsboro, OR, USA
| | - Michael Christopher
- School of Graduate Psychology, Phacific University Health Professions Campus, Hillsboro, OR, USA
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Fang S, Huang M, Wang Y. Reliability and validity of the Chinese version of personalized psychological flexibility index (C-PPFI) in college students. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023. [DOI: 10.1016/j.jcbs.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
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Ditton E, Knott B, Hodyl N, Horton G, Oldmeadow C, Walker FR, Nilsson M. Evaluation of an App-Delivered Psychological Flexibility Skill Training Intervention for Medical Student Burnout and Well-being: Randomized Controlled Trial. JMIR Ment Health 2023; 10:e42566. [PMID: 36745486 PMCID: PMC9941904 DOI: 10.2196/42566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/06/2022] [Accepted: 12/24/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Physician burnout is a common problem, with onset frequently occurring during undergraduate education. Early intervention strategies that train medical students in psychological flexibility skills could support well-being and mitigate burnout risks associated with unmodifiable career stressors. There is a need for randomized controlled trials to assess effectiveness. As psychological flexibility varies contextually and among individuals, tailoring interventions may improve outcomes. Smartphone apps can facilitate individualization and accessibility, and the evaluation of this approach is an identified research priority. OBJECTIVE This study aimed to evaluate the effectiveness of a stand-alone app-delivered Acceptance and Commitment Training intervention for improving medical students' self-reported burnout, well-being, psychological flexibility, and psychological distress outcomes. We aimed to explore whether an individualized app would demonstrate benefits over a nonindividualized version. METHODS This parallel randomized controlled trial was conducted with a sample of medical students from 2 Australian universities (N=143). Participants were randomly allocated to 1 of 3 intervention arms (individualized, nonindividualized, and waitlist) using a 1:1:1 allocation ratio. Individualized and nonindividualized participants were blinded to group allocation. The 5-week intervention included an introductory module (stage 1) and on-demand access to short skill training activities (stage 2), which students accessed at their own pace. Stage 2 was either nonindividualized or individualized to meet students' identified psychological flexibility training needs. RESULTS The mean differences in change from baseline between the intervention groups and the waitlist group were not statistically significant for burnout outcomes: exhaustion (primary; individualized: -0.52, 95% CI -3.70 to 2.65, P=.75; nonindividualized: 1.60, 95% CI -1.84 to 5.03, P=.37), cynicism (individualized: -1.26, 95% CI -4.46 to 1.94, P=.44; nonindividualized: 1.00, 95% CI -2.45 to 4.46, P=.57), and academic efficacy (individualized: 0.94, 95% CI -0.90 to 2.79, P=.32; nonindividualized: 2.02, 95% CI 0.02-4.03, P=.05). Following the intervention, the individualized group demonstrated improved psychological flexibility (0.50, 95% CI 0.12-0.89; P=.01), reduced inflexibility (0.48, 95% CI -0.92 to -0.04; P=.04), and reduced stress (-6.89, 95% CI -12.01 to 5.99; P=.01), and the nonindividualized group demonstrated improved well-being (6.46, 95% CI 0.49-12.42; P=.04) and stress (-6.36, 95% CI -11.90 to -0.83; P=.03) compared with waitlist participants. Between-group differences for the individualized and nonindividualized arms were not statistically significant. High attrition (75/143, 52.4%) was observed. CONCLUSIONS This trial provides early support for the potential benefits of Acceptance and Commitment Training for medical student well-being and psychological outcomes and demonstrates that psychological flexibility and inflexibility can be trained using a smartphone app. Although postintervention burnout outcomes were not statistically significant, improvements in secondary outcomes could indicate early risk mitigation. Replication studies with larger samples and longer-term follow-up are required, and future research should focus on improving implementation frameworks to increase engagement and optimize individualization methods. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry 12621000911897; https://tinyurl.com/2p92cwrw. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/32992.
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Affiliation(s)
- Elizabeth Ditton
- Centre for Rehab Innovations, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | | | - Nicolette Hodyl
- Centre for Rehab Innovations, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,New South Wales Regional Health Partners, Newcastle, Australia
| | - Graeme Horton
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Christopher Oldmeadow
- Hunter Medical Research Institute, New Lambton Heights, Australia.,College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Frederick Rohan Walker
- Centre for Rehab Innovations, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Michael Nilsson
- Centre for Rehab Innovations, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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12
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Morimoto H, Kishita N, Kondo H, Tanaka N, Abe Y, Muto T. Reliability and validity of the Japanese version of the experiential avoidance in caregiving questionnaire (EACQ). JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023. [DOI: 10.1016/j.jcbs.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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13
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Mavragani A, Knott B, Hodyl N, Horton G, Walker FR, Nilsson M. Medical Student Experiences of Engaging in a Psychological Flexibility Skill Training App for Burnout and Well-being: Pilot Feasibility Study. JMIR Form Res 2023; 7:e43263. [PMID: 36626191 PMCID: PMC9874998 DOI: 10.2196/43263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Medical students are at higher risk of burnout than the general population. Interventions that facilitate adaptive coping behaviors (eg, Psychological Flexibility) in the context of inherent stressors associated with medical training could mitigate burnout risk and improve well-being. Delivering these interventions using smartphone apps offers advantages such as accessibility, scalability, mitigation of time and stigma barriers, and facilitation of individual tailoring (individualization). There is a need for feasibility trials with medical students in this emerging field. Formal evaluations of user experiences of app-based psychological skill training are required to identify barriers to and facilitators of engagement and optimize intervention development before implementation in efficacy trials and real-world settings. OBJECTIVE This study aimed to assess the feasibility of delivering an individualized Psychological Flexibility skill training intervention (Acceptance and Commitment Training [ACTraining]) to medical students using an app-based delivery format. We further aimed to explore how formal evaluation of user experiences might inform and guide the development of this app before implementation in an efficacy trial and future research involving app-delivered psychological skill training for medical students. METHODS This single-arm study was an early-phase feasibility trial of a stand-alone ACTraining app conducted with a sample of Australian medical students (n=11). We collected app usability and user experience data across a broad range of domains (eg, perceived helpfulness and relevance, learning experiences, and self-efficacy) using self-report questionnaires (quantitative and qualitative) and behavioral engagement outcomes. RESULTS Behavioral engagement data demonstrated that the app delivered the assessment procedures and individualized ACTraining intervention to medical students as intended. The subjective feedback provided by students who actively engaged with the app was generally positive across several indicators, including usability, perceived relevance and helpfulness, accessibility, maintenance of privacy, and opportunity for self-reflection. Disengagement from the app was an identified challenge throughout the trial. Participant feedback identified several factors that may have affected engagement, such as time, expectations regarding app interface functioning, and individual differences in confidence and self-efficacy when implementing skills. CONCLUSIONS This study reports user experience data that have been largely absent from the literature on digital psychological interventions for medical students. Our findings demonstrate the preliminary feasibility of an app-delivered ACTraining intervention for medical student well-being and burnout and support the value of future assessment of the efficacy of this approach with larger samples. We consider subjective feedback from medical students in relation to observed engagement and propose how this information might be used to inform the development of this app and future research in this nascent field.
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Affiliation(s)
| | | | - Nicolette Hodyl
- Centre for Rehab Innovations, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,New South Wales Regional Health Partners, Newcastle, Australia
| | - Graeme Horton
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Frederick Rohan Walker
- Centre for Rehab Innovations, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Michael Nilsson
- Centre for Rehab Innovations, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singaport, Singapore
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14
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Klimczak KS, Twohig MP, Peacock GG, Levin ME. Using peer-support coaching to improve adherence to online ACT self-help for college mental health: A randomized controlled trial. Behav Res Ther 2023; 160:104228. [PMID: 36455430 DOI: 10.1016/j.brat.2022.104228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/23/2022] [Accepted: 11/08/2022] [Indexed: 11/15/2022]
Abstract
Online self-help programs such as the Acceptance and Commitment Therapy (ACT) Guide address significant barriers to receiving therapy but suffer from low adherence rates. Peer-delivered coaching, using undergraduate students as coaches, is an innovative alternative to traditional coaching methods which may improve adherence in a more scalable format. To test the efficacy of peer-support coaching for college students using ACT Guide in a naturalistic setting, we conducted a pragmatic randomized controlled trial with three conditions (phone coaching, text message coaching, and a no support control group; N = 230). Participants were block randomized, and program adherence (i.e., number of modules completed) was the primary outcome. Participants completed significantly more ACT Guide modules in phone (M = 7.1, SD = 4.9) and text (M = 5.7, SD = 5) coaching than the no support control condition (M = 1.6, SD = 3.3, p < .001). Participants who received phone coaching experienced significant improvements across almost all measured outcomes as compared to the control group, while participants who received text coaching improved only on some outcomes compared to control (ps < .05). These results support peer-support coaching, particularly when delivered through phone calls, as an efficacious method for improving adherence to and outcomes from online self-help programs.
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Affiliation(s)
- Korena S Klimczak
- Utah State University, Department of Psychology, 2810 Old Main Hill, Logan, UT, 84322, USA.
| | - Michael P Twohig
- Utah State University, Department of Psychology, 2810 Old Main Hill, Logan, UT, 84322, USA
| | - Gretchen G Peacock
- Utah State University, Department of Psychology, 2810 Old Main Hill, Logan, UT, 84322, USA
| | - Michael E Levin
- Utah State University, Department of Psychology, 2810 Old Main Hill, Logan, UT, 84322, USA
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15
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McCracken LM, Buhrman M, Badinlou F, Brocki KC. Health, well-being, and persisting symptoms in the pandemic: What is the role of psychological flexibility? JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022; 26:187-192. [PMID: 36247216 PMCID: PMC9554036 DOI: 10.1016/j.jcbs.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022]
Abstract
Finding psychological factors that can reduce the substantial impact of COVID-19 on mental and physical health is important. Here we replicate and expand a previous study regarding the role of psychological flexibility (PF) in this context. We employed a comprehensive and well validated measure of PF and examined its role in relation to health outcomes and persistent post COVID-19 symptoms. 1174 participants completed standardized measures of depression, anxiety, insomnia and the Multidimensional Psychological Flexibility Inventory (MPFI), and reported the presence of persistent symptoms associated with "long COVID." All PF and psychological inflexibility (PI) facets, except for acceptance, correlated with the three mental health outcomes and with persistent symptoms. PF and PI accounted for significant variance in depression, anxiety, and insomnia after adjusting for background and health status variables. A notable finding was the particularly stronger correlations obtained for the PI facets. Our findings emphasize the potentially mitigating effects of PF on mental ill health, as well as the particularly aggravating effects of PI, in the pandemic context. A novel finding is the significant association of PI with persisting symptoms of COVID.
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Affiliation(s)
- Lance M. McCracken
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Monica Buhrman
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Farzaneh Badinlou
- Division of Emotion Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Karin C. Brocki
- Division of Emotion Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden,Corresponding author. Department of Psychology, Uppsala University, Box 1225, 751 42, Uppsala, Sweden
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16
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Measuring psychological flexibility in autistic adults: Examining the validity and reliability of the AAQ-II, BEAQ, and VQ. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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17
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Ankney AS, Baker RT, Pickering MA, Carr-Chellman DJ, Holyoke LB, Larkins LW. Psychometric evaluation of the acceptance and Action Questionnaire-II (AAQ-II) with Special Operations Forces soldiers. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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18
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Azadfar Z, Abdollahi A, Patra I, Chang YP, Alghazali T, Talib SG. The Iranian form of psychometric properties of the Multidimensional Psychological Flexibility Inventory. PSICOLOGIA, REFLEXAO E CRITICA : REVISTA SEMESTRAL DO DEPARTAMENTO DE PSICOLOGIA DA UFRGS 2022; 35:32. [PMID: 36171467 PMCID: PMC9519821 DOI: 10.1186/s41155-022-00236-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022]
Abstract
The Multidimensional Psychological Flexibility Inventory (MPFI) is a new 60-item self-report scale developed to assess the specific components of psychological flexibility and inflexibility proposed in the Hexaflex model of Acceptance and Commitment Therapy (ACT). The present study sought to examine the psychometric properties of the Persian version of the MPFI-60 in a community sample of 307 Iranian adults. The original study supported a 12-factor second-order structure consisting of 6 dimensions for psychological flexibility and 6 dimensions for psychological inflexibility. The Persian MPFI-60 demonstrated acceptable semantic and test content, internal structure, correlations with other variables, and internal consistency. It also evidenced in relation to anxiety, stress, depression, and self-compassion. Overall, the results indicate that the Persian MPFI-60 is a psychometrically sound measure in the Iranian context that enables researchers and clinicians to comprehensively assess the components of psychological flexibility and inflexibility within the Hexaflex model.
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Affiliation(s)
- Zahra Azadfar
- Department of Psychology, Faculty of Educational Sciences and Psychology, Alzahra University, Tehran, Iran
| | - Abbas Abdollahi
- Department of Counseling, Faculty of Education and Psychology, Alzahra University, Tehran, Iran.
| | | | - Ya-Ping Chang
- Department and Graduate School of Tourism Management, Chinese Culture University, 55, Hwa-Kang Road, Yang Ming Shan, Taipei, Taiwan, 11114
| | - Tawfeeq Alghazali
- Department of Journalism, College of Media, The Islamic University in Najaf, Najaf, Iraq
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19
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Meek C, das Nair R, Evangelou N, Middleton R, Tuite-Dalton K, Moghaddam N. Psychological Flexibility, Distress, and Quality of Life in Secondary Progressive Multiple Sclerosis: A Cross-sectional Study. Mult Scler Relat Disord 2022; 67:104154. [DOI: 10.1016/j.msard.2022.104154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 08/28/2022] [Indexed: 12/01/2022]
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20
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Tynan M, Afari N, Dochat C, Gasperi M, Roesch S, Herbert MS. Confirmatory Factor Analysis of the Comprehensive Assessment of Acceptance and Commitment Therapy (CompACT) in Active-Duty Military Personnel. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022; 25:115-121. [PMID: 36504674 PMCID: PMC9731269 DOI: 10.1016/j.jcbs.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Acceptance and Commitment Therapy (ACT) is a third-wave cognitive-behavioral treatment that targets psychological flexibility (PF), or the ability to persist in behavior consistent with values regardless of unwanted private experiences. The growing use of ACT necessitates an accurate assessment of PF. The Comprehensive Assessment of Acceptance and Commitment Therapy (CompACT) is a three-factor measure of PF (Openness to Experience, Valued Action, and Behavioral Awareness) whose psychometric properties have been examined in limited populations. The current study examined the factor structure and psychometric properties of the CompACT in U.S. military personnel who enrolled in a weight management randomized controlled trial. Military personnel who either failed or were at risk of failing the Navy's physical fitness assessment or had overweight/obese body mass index (BMI; N = 178, Mage = 29.15 years; MBMI = 33.13 kg/m2; 61.8% female) completed the CompACT and other questionnaires. Confirmatory factor analysis was used to evaluate the three-factor structure of the original 23-item CompACT (CompACT-23) as well as an 18-item version identified in a Portuguese sample (CompACT-18). Internal consistency and convergent validity with measures of weight-related experiential avoidance, perceived stress, anxiety, depression, PTSD symptoms, and life satisfaction were examined. The three-factor structure of the CompACT-23 showed poor fit to the data while the fit of the CompACT-18 was acceptable, as indicated by three descriptive indices (χ2/df = 1.73, RMSEA = 0.069, SRMR = 0.074). All descriptive fit indices in addition to two comparative fit indices (AIC and BIC) indicated improved model fit over the CompACT-23. The CompACT-18 and its subscales exhibited adequate internal consistency (α = 0.768 to 0.861) and convergent validity in expected directions with measures of weight-related experiential avoidance, perceived stress, anxiety, depression, PTSD symptoms, and satisfaction with life. Results support using the refined, English language CompACT-18 as a three-factor measure of PF in populations such as U.S. military personnel who may benefit from weight management intervention. Future research should explore the content validity of the full measure and the removed items. Lost content could mean the CompACT-23 and the CompACT-18 differentially assess PF. Additional studies should examine psychometric properties in large and more diverse samples to further evaluate the appropriateness of the measure across populations. Longitudinal studies are needed to examine test-retest reliability and sensitivity to change.
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Affiliation(s)
- Mara Tynan
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, USA
| | - Niloofar Afari
- VA San Diego Healthcare System, 3350 La Jolla Village Drive., San Diego, CA 92161, USA,University of California San Diego, Department of Psychiatry, 9500 Gilman Drive, La Jolla, CA, 92093, USA,VA San Diego Center of Excellent for Stress and Mental Health, 3350 La Jolla Village Drive., San Diego, CA 92161, USA
| | - Cara Dochat
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, USA
| | - Marianna Gasperi
- VA San Diego Healthcare System, 3350 La Jolla Village Drive., San Diego, CA 92161, USA,University of California San Diego, Department of Psychiatry, 9500 Gilman Drive, La Jolla, CA, 92093, USA,VA San Diego Center of Excellent for Stress and Mental Health, 3350 La Jolla Village Drive., San Diego, CA 92161, USA
| | - Scott Roesch
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Matthew S. Herbert
- VA San Diego Healthcare System, 3350 La Jolla Village Drive., San Diego, CA 92161, USA,University of California San Diego, Department of Psychiatry, 9500 Gilman Drive, La Jolla, CA, 92093, USA,VA San Diego Center of Excellent for Stress and Mental Health, 3350 La Jolla Village Drive., San Diego, CA 92161, USA
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21
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Trindade IA, Vagos P, Moreira H, Fernandes DV, Tyndall I. Further validation of the 18-item Portuguese CompACT scale using a multi-sample design: Confirmatory factor analysis and correlates of psychological flexibility. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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22
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Yela JR, Crego A, Buz J, Sánchez-Zaballos E, Gómez-Martínez MÁ. Reductions in experiential avoidance explain changes in anxiety, depression and well-being after a mindfulness and self-compassion (MSC) training. Psychol Psychother 2022; 95:402-422. [PMID: 34904363 DOI: 10.1111/papt.12375] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/15/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The mindfulness and self-compassion (MSC) protocol has shown efficacy in reducing mental illness symptoms and increasing well-being. However, little is known on how the positive outcomes are produced. This study explores how reductions in experiential avoidance following MSC training may explain changes in the participants' levels of anxiety, depression, and well-being. METHODS The 8-week protocol-based MSC training was delivered to 50 participants, and pre- to post- intervention changes in anxiety, depression, and well-being were measured. A series of mediation models were conducted, with changes in self-compassion as predictor, changes in experiential avoidance as mediator, and changes in mental health and well-being as outcome variables. Point estimates and bootstrap-corrected 95% confidence intervals were calculated to analyse indirect effects through experiential avoidance, by means of structural equation modeling (SEM). RESULTS Following MSC training, participants increased their levels of self-compassion, reduced experiential avoidance, and enhanced mental health (i.e., anxiety and depression symptoms) and well-being scores. Increases in self-compassion were associated with decreases in experiential avoidance, which in turn were connected with changes in anxiety, depression, and well-being from pre- to post-training. The indirect path through changes in experiential avoidance represented moderate to large proportions of the total effects of self-compassion change-scores on anxiety, depression, and well-being change-scores. CONCLUSIONS Reducing experiential avoidance and increasing psychological flexibility may be a key effect of MSC training linked to improvements of the participants' mental health and well-being scores. Self-compassion practices could exert effects on anxiety, depression and well-being mainly through promoting reductions in experiential avoidance.
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Affiliation(s)
- José Ramón Yela
- Department of Psychology, Pontifical University of Salamanca, Salamanca, Spain
| | - Antonio Crego
- Department of Psychology, Pontifical University of Salamanca, Salamanca, Spain
| | - José Buz
- Department of Education, University of Salamanca, Salamanca, Spain
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Giovannetti AM, Pakenham KI, Presti G, Quartuccio ME, Confalonieri P, Bergamaschi R, Grobberio M, Di Filippo M, Micheli M, Brichetto G, Patti F, Copetti M, Kruger P, Solari A. A group resilience training program for people with multiple sclerosis: Study protocol of a multi-centre cluster-randomized controlled trial (multi-READY for MS). PLoS One 2022; 17:e0267245. [PMID: 35500015 PMCID: PMC9060330 DOI: 10.1371/journal.pone.0267245] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/01/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction REsilience and Activities for every DaY (READY) is an Acceptance and Commitment Therapy-based group resilience-training program that has preliminary empirical support in promoting quality of life and other psychosocial outcomes in people with multiple sclerosis (PwMS). Consistent with the Medical Research Council framework for developing and evaluating complex interventions, we conducted a pilot randomized controlled trial (RCT), followed by a phase III RCT. The present paper describes the phase III RCT protocol. Methods and analysis This is a multi-centre cluster RCT comparing READY with a group relaxation program (1:1 ratio) in 240 PwMS from eight centres in Italy (trial registration: isrctn.org Identifier: ISRCTN67194859). Both interventions are composed of 7 weekly sessions plus a booster session five weeks later. Resilience (primary outcome), mood, health-related quality of life, well-being and psychological flexibility will be assessed at baseline, after the booster session, and at three and six month follow-ups. If face-to-face group meetings are interrupted because of COVID-19 related-issues, participants will be invited to complete their intervention via teleconferencing. Relevant COVID-19 information will be collected and the COVID-19 Peritraumatic Distress scale will be administered (ancillary study) at baseline and 3-month follow-up. Analysis will be by intention-to-treat to show superiority of READY over relaxation. Longitudinal changes will be compared between the two arms using repeated-measures, hierarchical generalized linear mixed models. Conclusion It is expected that his study will contribute to the body of evidence on the efficacy and effectiveness of READY by comparing it with an active group intervention in frontline MS rehabilitation and clinical settings. Results will be disseminated in peer-reviewed journals and at other relevant conferences.
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Affiliation(s)
- Ambra Mara Giovannetti
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
- School of Psychology, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, QLD, Australia
- * E-mail:
| | - Kenneth Ian Pakenham
- School of Psychology, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Giovambattista Presti
- Kore University Behavioral Lab, Faculty of Human and Social Sciences, Università degli Studi di Enna ’Kore’, Enna, Italy
| | | | - Paolo Confalonieri
- MS Centre, Unit of Neuroimmunology and Neuromuscular Diseases, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | | | - Monica Grobberio
- Laboratorio di neuropsicologia, UOSD psicologia clinica e UOC neurologia, ASST Lariana, Como, Italy
| | - Massimiliano Di Filippo
- Centro Malattie Demielinizzanti e Laboratori di Neurologia Sperimentale, Clinica Neurologica, Università degli Studi di Perugia, Perugia, Italy
| | - Mary Micheli
- Dipartimento Riabilitazione ASLUmbria2, Foligno, Italy
| | - Giampaolo Brichetto
- AISM Rehabilitation Service of Genoa, Italian Multiple Sclerosis Society, Genova, Italy
- Scientific Research Area, Italian MS Society Foundation, Genova, Italy
| | - Francesco Patti
- Neurology Clinic, Multiple Sclerosis Centre, University Hospital Policlinico Vittorio Emanuele, Catania, Italy
| | - Massimiliano Copetti
- Unit of Biostatistics, Fondazione IRCSS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Paola Kruger
- Patient Expert, EUPATI Fellow (European Patients Academy for Therapeutic Innovation) Italy, Roma, Italy
| | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
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24
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Ditton E, Knott B, Hodyl N, Horton G, Walker FR, Nilsson M. Assessing the Efficacy of an Individualized Psychological Flexibility Skills Training Intervention App for Medical Student Burnout and Well-being: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e32992. [PMID: 35119378 PMCID: PMC8857701 DOI: 10.2196/32992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/22/2021] [Accepted: 12/08/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Medical student burnout is a prevalent problem with adverse long-term outcomes. Incorporating psychological resource-building interventions into comprehensive burnout prevention approaches during medical training is an identified priority among educators. These interventions could reduce burnout risk by buffering students against nonmodifiable career stressors. However, there is a need for rigorous investigation into optimal intervention targets and methods. Psychological flexibility (PF) is an adaptive behavioral skill set that has demonstrated relationships with medical student burnout and well-being. More broadly, there is evidence that PF mediates burnout and well-being outcomes and may be a protective factor. Efficacy studies assessing the benefits of interventions targeting PF among medical students are needed. Research also supports the need to establish optimal methods for increasing intervention efficacy in the context of individual differences in burnout and PF by using individualized approaches. OBJECTIVE This study aims to assess whether an app-delivered PF intervention (Acceptance and Commitment Training) reduces burnout and improves well-being among medical students. We will examine whether changes in burnout and well-being are mediated by changes in PF. The potential benefits of an individualized version of the app versus those of a nonindividualized version will also be evaluated. METHODS In this 3-arm, parallel, randomized controlled study, a sample of medical students will be randomly allocated to 1 of 3 intervention arms (individualized, nonindividualized, and waiting list) by using a 1:1:1 allocation ratio. Participants in the individualized and nonindividualized intervention arms will have 5 weeks to access the app, which includes a PF concepts training session (stage 1) and access to short PF skill activities on demand (stage 2). Stage 2 will be either individualized to meet participants' identified PF training needs at each log-in or nonindividualized. RESULTS Burnout, well-being, and PF will be assessed at baseline and after the intervention. Quantitative analyses will include descriptive and inferential statistics. We hypothesize that the Acceptance and Commitment Training intervention app will be effective in improving burnout and well-being and that changes in these outcomes will be mediated by changes in PF. We further hypothesize that participants in the individualized intervention group will demonstrate greater improvements in burnout and well-being outcomes than those in the nonindividualized group. CONCLUSIONS The findings of this study could guide the development of burnout prevention and well-being initiatives for medical students. Identifying PF as a mediating process would provide support for the delivery of preventive intervention programs that train individuals to strengthen this psychological resource before burnout symptoms emerge. This would be an important step in addressing and potentially offsetting the significant costs of burnout among medical students and physicians. Demonstrating the superiority of an individualized version of the app over a nonindividualized version would have implications for enhancing intervention precision and efficacy by using scalable interventions. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ANZCTR 12621000911897; https://www.anzctr.org.au/ACTRN12621000911897.aspx. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/32992.
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Affiliation(s)
- Elizabeth Ditton
- Centre for Rehab Innovations, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | | | - Nicolette Hodyl
- Centre for Rehab Innovations, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Graeme Horton
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Frederick Rohan Walker
- Centre for Rehab Innovations, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Michael Nilsson
- Centre for Rehab Innovations, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Browning ME, Morena A, Gould ER, Lloyd-Richardson EE. Brief ACT for Undergraduates: A Mixed-Methods Pilot Investigation of Acceptance and Commitment Therapy Delivered over Zoom. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2022. [DOI: 10.1080/87568225.2022.2029659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Morgan E. Browning
- Department of Psychology, University of Massachusetts Dartmouth, North Dartmouth, MA, USA
| | - Alexandra Morena
- Department of Psychology, University of Massachusetts Dartmouth, North Dartmouth, MA, USA
| | - Evelyn R. Gould
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Feather G, Williams M. The moderating effects of psychological flexibility and psychological inflexibility on the relationship between climate concern and climate-related distress. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2021.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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27
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Paulos-Guarnieri L, Linares IMP, El Rafihi-Ferreira R. Evidence and characteristics of Acceptance and Commitment Therapy (ACT)-based interventions for insomnia: A systematic review of randomized and non-randomized trials. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Thompson EM, Brierley MEE, Destrée L, Albertella L, Fontenelle LF. Psychological flexibility and inflexibility in obsessive-compulsive symptom dimensions, disability, and quality of life: An online longitudinal study. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2021.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Călinici MS, Călinici T. "Comprehensive Assessment of ACT Processes CompACT.
Romanian Adaptation and Short Form Validation". JOURNAL OF EVIDENCE-BASED PSYCHOTHERAPIES 2021. [DOI: 10.24193/jebp.2021.2.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
"The current paper presents the translation and validation for Romanian
non-clinical population of Comprehensive Assessment of ACT Processes
– CompACT (Francis et al., 2016), an instrument that evaluates three
dimensions of psychological flexibility: openness to experience, present
moment awareness (mindfulness) and valued action. The psychometric
properties of the Romanian version of the instrument were investigated,
convergent validity in relation with AQQ-II and concurrent validity in
relation with DASS-21 (with comparable results with ones reported for the
original instrument). Considering modest model fit with theoretical factor
structure of the instrument, current paper proposes a shorter, more stable
Romanian Version, and tests its psychometric properties."
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Affiliation(s)
- Mirela Simona Călinici
- Babes-Bolyai University, Faculty of Psychology and Educational Sciences, Cluj-Napoca, Romania
| | - Tudor Călinici
- "Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Department of Medical Education, Cluj-Napoca, Romania"
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The Multidimensional Psychological Flexibility Inventory (MPFI): Discriminant validity of psychological flexibility with distress. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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31
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Punna M, Lappalainen R, Kettunen T, Lappalainen P, Muotka J, Kaipainen K, Villberg J, Kasila K. Can peer-tutored psychological flexibility training facilitate physical activity among adults with overweight? JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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32
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Starr LR, Huang M, Scarpulla E. Does it help to talk about it? Co-rumination, internalizing symptoms, and committed action during the COVID-19 global pandemic. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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33
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Landi G, Pakenham KI, Giovannetti AM, Presti G, Boccolini G, Cola A, Grandi S, Tossani E. Italian validation of the Italian multidimensional psychological flexibility inventory (MPFI). JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Kennedy C, Deane FP, Chan AY. Intolerance of uncertainty and psychological symptoms among people with a missing loved one: Emotion regulation difficulties and psychological inflexibility as mediators. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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35
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O'Brien WH, Wang S, Varga AV, Xu H, Sims T, Horan K, Lim CX. Predicting personal protective equipment use, trauma symptoms, and physical symptoms in the USA during the early weeks of the COVID-19 lockdown (April 9-18, 2020). JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021; 21:37-47. [PMID: 34031641 PMCID: PMC8133802 DOI: 10.1016/j.jcbs.2021.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 04/08/2021] [Accepted: 05/11/2021] [Indexed: 12/27/2022]
Abstract
The COVID-19 pandemic created a complex psychological environment for Americans. In this study, 450 MTurk workers completed measures of sociodemographic characteristics, perceived risk for COVID-19, general perceived vulnerability to disease, intolerance of uncertainty, and psychological flexibility. These variables were used to predict COVID-19 preventive health behaviors (PPE use), psychological distress, and physical symptoms. The surveys were completed between April 9, 2020 and April 18, 2020 which is a period that corresponded to the first 2-3 weeks of lockdown for most participants. A demographically diverse sample of participants was recruited. A substantial number of participants reported a reduction employment status and 69% were in self-isolation. Participants reported a high degree of perceived vulnerability to COVID-19. PPE mask wearing was variable: 16% "not at all," 20% "some of the time," 42% "a good part of the time," and 26 "most of the time." Using clinical cutoff on the post-trauma scale, 70% of the sample would be considered to have symptoms consistent with PTSD. Physical symptom reporting was also high. Intolerance of uncertainty and psychological inflexibility were significant predictors of psychological distress and physical symptoms. Psychological flexibility moderated the relationship between intolerance of uncertainty and psychological distress/physical symptoms. The relationship between intolerance of uncertainty and psychological distress/physical symptoms was stronger among participants with lower levels of psychological flexibility. These findings indicate psychological flexibility can reduce distress associated with COVID-19. Additionally, these results support the workability of the Unified Flexibility and Mindfulness Model as a framework for studying health behavior.
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Affiliation(s)
| | - Shan Wang
- Duke Kunshan University, Suzhou, China
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Ohse L, Burian R, Hahn E, Burian H, Ta TMT, Diefenbacher A, Böge K. Process-outcome associations in an interdisciplinary treatment for chronic pain and comorbid mental disorders based on Acceptance and Commitment Therapy. PAIN MEDICINE 2021; 22:2615-2626. [PMID: 33755159 DOI: 10.1093/pm/pnab102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
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.
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Affiliation(s)
- Ludwig Ohse
- Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstraße 79, 10365, Berlin, Germany.,Psychologische Hochschule Berlin, Am Köllnischen Park 2, 10179, Berlin, Germany
| | - Ronald Burian
- Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstraße 79, 10365, Berlin, Germany
| | - Eric Hahn
- Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstraße 79, 10365, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Hannah Burian
- Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstraße 79, 10365, Berlin, Germany
| | - Thi Minh Tam Ta
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Albert Diefenbacher
- Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstraße 79, 10365, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Kerem Böge
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
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Internet-Based Acceptance and Commitment Therapy: A Transdiagnostic Systematic Review and Meta-Analysis for Mental Health Outcomes. Behav Ther 2021; 52:492-507. [PMID: 33622516 DOI: 10.1016/j.beth.2020.07.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 07/04/2020] [Accepted: 07/08/2020] [Indexed: 02/02/2023]
Abstract
Internet-based acceptance and commitment therapy (iACT) primarily targets the process of psychological flexibility. Its accessibility and low-intensity delivery are applicable across different treatment and prevention scenarios. This transdiagnostic meta-analysis reviews the effectiveness of iACT on anxiety, depression, quality of life, and psychological flexibility across individuals with different psychological and somatic conditions/complaints, or undiagnosed complaints. Seven databases were searched for randomized controlled trials that reported on anxiety, depression, quality of life, and psychological flexibility outcomes from iACT in any adult population. Engagement with iACT was summarized and methodological and population-related variables were investigated as potential moderators of effectiveness. Across 25 studies, small pooled effects were found for all outcomes at post-assessment and maintained at follow-up time-points. Interventions with therapist guidance demonstrated greater effectiveness in improving depression and psychological flexibility outcomes compared to nonguided iACT, and populations defined by a psychological condition or symptoms (e.g., depressed samples) demonstrated greater improvements in anxiety compared to nonclinical or somatic populations (e.g., chronic pain samples or students). Participants completed on average 75.77% of iACT treatments. While we found iACT to be effective in improving and maintaining mental health outcomes across diverse populations, there was limited evidence of reliable, clinically significant effects. PROSPERO registration number: CRD42020140086.
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38
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Self-as-context and depressive symptoms in the general population: A further analysis of the self experiences questionnaire. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01383-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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39
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The role of psychological flexibility in the context of COVID-19: Associations with depression, anxiety, and insomnia. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2020.11.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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40
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Hernández-López M, Cepeda-Benito A, Díaz-Pavón P, Rodríguez-Valverde M. Psychological inflexibility and mental health symptoms during the COVID-19 lockdown in Spain: A longitudinal study. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020; 19:42-49. [PMID: 33520642 PMCID: PMC7834284 DOI: 10.1016/j.jcbs.2020.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 12/04/2020] [Accepted: 12/06/2020] [Indexed: 01/02/2023]
Abstract
Spain, one of the European countries most affected by the COVID-19 pandemic, underwent a strict lockdown between March and May 2020. This study examines longitudinally the evolution of both psychological inflexibility and mental health symptoms in a sample of college students from the beginning and throughout the end of the mandated lockdown period. We present the results from 197 participants who responded to an online survey at least at two of three data-collection waves scheduled at the beginning (N = 226), halfway (N = 172), and end (N = 188) of the lockdown. The analyses revealed that psychological inflexibility and symptomatology increased over time, and that inflexibility at the beginning of the lockdown indirectly predicted self-reported symptoms at the end of the lockdown via autoregressive parallel paths that also connected cross-sectionally to reveal that changes in inflexibility were predictive of changes in mental health. These results present a dynamic and robust relationship between psychological inflexibility and mental health symptoms throughout a relatively long and presumably stressful period of time.
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Affiliation(s)
- Mónica Hernández-López
- Psychology Department, University of Jaén, Campus Las Lagunillas S/n, 23071, Jaén, Spain
| | | | - Pilar Díaz-Pavón
- Psychology Department, University of Jaén, Campus Las Lagunillas S/n, 23071, Jaén, Spain
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Brassey J, van Witteloostuijn A, Huszka C, Silberzahn T, van Dam N. Emotional flexibility and general self-efficacy: A pilot training intervention study with knowledge workers. PLoS One 2020; 15:e0237821. [PMID: 33052922 PMCID: PMC7556510 DOI: 10.1371/journal.pone.0237821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/03/2020] [Indexed: 11/19/2022] Open
Abstract
Emotional flexibility advancement has been found to be highly effective in clinical settings to treat, for example, depression, anxiety, and chronic pain. Developing these skills in the working context has also shown very encouraging results in public sector settings. Also, a few studies have revealed effectiveness in a private sector setting, but no studies have yet looked at the effectiveness of developing these skills amongst high-paced, high-demanding, and highly-educated knowledge workers. In this pilot training intervention study, we report evidence that emotional flexibility can be developed in this context. We conducted an experiment with treatment and control groups, with only the treatment group receiving an emotional flexibility training. Emotional flexibility improved significantly for the treatment group, whereas the improvements were minimal or negative for the control group. Furthermore, we reveal that General self-efficacy improved amongst treatment group participants (and not for control group participants), and that this is associated with emotional flexibility. Finally, we show that the improvements were higher for participants starting from a lower baseline.
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Affiliation(s)
- Jacqueline Brassey
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- IE University, Segovia, Spain
- Maastricht University, Maastricht, The Netherlands
| | - Arjen van Witteloostuijn
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Antwerp Management School / University of Antwerp, Antwerp, Belgium
| | - Csaba Huszka
- Maastricht University, Maastricht, The Netherlands
| | | | - Nick van Dam
- IE University, Segovia, Spain
- Nyenrode Business University, Breukelen, The Netherlands
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42
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Daks JS, Peltz JS, Rogge RD. Psychological flexibility and inflexibility as sources of resiliency and risk during a pandemic: Modeling the cascade of COVID-19 stress on family systems with a contextual behavioral science lens. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020; 18:16-27. [PMID: 32834972 PMCID: PMC7428754 DOI: 10.1016/j.jcbs.2020.08.003] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The coronavirus disease (COVID-19) pandemic and the historic economic shutdown and stay-at-home efforts to slow its spread have radically impacted the lives of families across the world, completely disrupting routines and challenging them to adjust to new health risks as well as to new work and family demands. The current study applied a contextual behavioral science lens to the spillover hypothesis of Family Systems Theory to develop a multi-stage mechanistic model for how COVID-19 stress could impact family and child functioning and how parents' psychological flexibility could shape those processes. METHODS A total of 742 coparents (71% female; 84% Caucasian, 85% married, M = 41 years old) of children (ages 5-18, M = 9.4 years old, 50% male) completed an online survey from March 27th to the end of April 2020. RESULTS Path analyses highlighted robust links from parent inflexibility to all components of the model, predicting: greater COVID-19 stress, greater coparenting discord and family discord, greater caustic parenting, and greater parent and child distress. Parent flexibility was associated with greater family cohesion, lower family discord and greater use of constructive parenting strategies (inductive, democratic/autonomy supportive, positive). Results further suggested that COVID-19 stressors predicted greater family and coparent discord, which in turn predicted greater use of caustic parenting (reactive, inconsistent, aggressive), which in turn predicted greater child and parent distress. CONCLUSIONS The current results highlight parental flexibility and inflexibility as key points of intervention for helping families navigate the current global health crisis, highlighting the crucial role they play in the lives of families.
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Ong CW, Pierce BG, Petersen JM, Barney JL, Fruge JE, Levin ME, Twohig MP. A psychometric comparison of psychological inflexibility measures: Discriminant validity and item performance. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.08.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Examining the correlates of psychological flexibility in romantic relationship and family dynamics: A meta-analysis. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.09.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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45
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Landi G, Pakenham KI, Boccolini G, Grandi S, Tossani E. Health Anxiety and Mental Health Outcome During COVID-19 Lockdown in Italy: The Mediating and Moderating Roles of Psychological Flexibility. Front Psychol 2020; 11:2195. [PMID: 32982888 PMCID: PMC7488226 DOI: 10.3389/fpsyg.2020.02195] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 08/05/2020] [Indexed: 12/22/2022] Open
Abstract
The COVID-19 emergency has severely affected the Italian population. During a pandemic, those with high health anxiety are at risk of adverse mental health outcomes, including peritraumatic distress and mood disturbance. No prior research has explored the role of psychological flexibility in protecting people at high risk of poorer mental health impacts due to health anxiety during a pandemic. Psychological flexibility is the cornerstone of psychological health and resiliency. According to acceptance and commitment therapy (ACT), it involves behaving consistently with one's chosen values even in the presence of emotional and mental discomfort. This study examined the mediating and moderating roles of psychological flexibility in the link between trait health anxiety and three mental health outcomes: COVID-19 peritraumatic distress, anxiety, and depression. We hypothesized that higher psychological flexibility would decrease the negative impacts of trait health anxiety on mental health outcomes. During the mandatory national lockdown (M = 35.70 days, SD = 8.41), 944 Italian adults (75.5% female, M = 38.86 years, SD = 13.20) completed an online survey consisting of standardized measures of psychological flexibility, trait health anxiety, COVID-19 distress, anxiety, and depression. Results indicated that psychological flexibility did not moderate the link between trait health anxiety and mental health outcomes. Rather, greater psychological flexibility mediated decreases in the adverse effects of trait health anxiety on COVID-19 distress, anxiety, and depression. In particular, two psychological flexibility processes, observing unhelpful thoughts rather than taking them literally (defusion) and values-based action (committed action), mediated decreases in the negative effects of trait health anxiety on all mental health outcomes. In contrast, the psychological flexibility process acceptance, which involves openness to inner discomfort, mediated increases in negative mental health outcomes. Overall, the combination of these processes mitigated the detrimental impacts of trait health anxiety on mental health during the emergency mandatory COVID-19 nationwide lockdown. Consistent with the ACT conceptualization of psychological flexibility, findings suggest embracing (rather than avoiding) inner discomfort and observing associated unhelpful thoughts, while also engaging in values-based action, increases resilience during adversity. Evidenced-based large-scale online public health interventions that target psychological flexibility in those experiencing health anxiety in the context of a pandemic are urgently needed. Many empirically-based ACT interventions are suited for this purpose.
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Affiliation(s)
- Giulia Landi
- Department of Psychology, University of Bologna, Bologna, Italy
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Cesena, Italy
| | - Kenneth I. Pakenham
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - Giada Boccolini
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Cesena, Italy
| | - Silvana Grandi
- Department of Psychology, University of Bologna, Bologna, Italy
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Cesena, Italy
| | - Eliana Tossani
- Department of Psychology, University of Bologna, Bologna, Italy
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Cesena, Italy
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Mediators of the association between COVID-19-related stressors and parents' psychological flexibility and inflexibility: The roles of perceived sleep quality and energy. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020; 17:168-176. [PMID: 32834971 PMCID: PMC7382960 DOI: 10.1016/j.jcbs.2020.07.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 12/23/2022]
Abstract
Background The COVID-19 pandemic has forced parents across the United States to quickly transition to a new way of living. These transitions present new stressors, including the stress associated with physical health, with the demands of social distancing placed on families, and with the possibility of losing a job or not being able to pay bills. Such stressors have the potential to disrupt basic functioning, such as sleep and daily energy levels. Furthermore, the impact of stress might have repercussions on parents' capacities to be psychologically flexible, thus putting their psychological functioning at risk. Drawing upon a contextual behavioral science perspective, the current study sought to examine links between COVID-19-related stressors and psychological flexibility/inflexibility through such basic processes as parents' perceived sleep quality and daily energy level. Methods A total of 1003 parents (97% from the US; 74% female; M = 40.9 years old, SD = 8.5) of children (ages 5-18) completed an online survey from the end of March to the end of April of 2020. Results Path analyses suggested that, after controlling health-related stress and the stress of work and parenting demands due to the pandemic directly predicting greater inflexibility and lower inflexibility, two mediation paths emerged. Specifically, higher levels of health-related stress were associated with lower levels of energy, which, in turn predicted lower levels of psychological flexibility. In addition, higher levels of health-related stress were associated with lower perceived sleep quality, which, in turn, was associated with higher levels of psychological inflexibility. In secondary analyses on the specific dimensions of flexibility and inflexibility, results suggested that lower energy levels indirectly linked health-related stress to lower levels of all 6 dimensions of flexibility and poorer sleep quality indirectly linked health-related stress to higher levels of self-as-content, fusion, and inaction. Conclusions The stressors associated with COVID-19 pandemic have the potential to disrupt parents' perceived sleep quality and daily energy levels, reducing their abilities to respond to difficult or challenging experiences in a flexible manner and instead promoting more reactive and inflexible responses.
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Baker LD, Berghoff CR, Kuo JL, Quevillon RP. Associations of Police Officer Health Behaviors and Subjective Well-Being. EUROPEAN JOURNAL OF HEALTH PSYCHOLOGY 2020. [DOI: 10.1027/2512-8442/a000055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Abstract. Background: Law enforcement officers (LEOs) are responsible for maintaining public order and safety within communities. As a consequence of this obligation, LEOs are repeatedly exposed to a myriad of unavoidable occupational stressors, known to affect health behaviors and well-being. Importantly, LEO well-being has public safety implications as those reporting higher well-being exhibit more equitable police behavior relative to those reporting lower well-being. Aims: The present study aimed to identify factors that may be leveraged to enhance LEO well-being by investigating the indirect relation of health behaviors to well-being through psychological flexibility. Method: Path-analytic regression models were used to analyze cross-sectional data provided by LEOs recruited from three geographically dispersed police agencies ( N = 459; Male = 84.7%, White = 64.2%). Results: Results indicated psychological flexibility accounted for the relations of chronic pain and quality sleep to well-being. Regular exercise accounted for the largest proportion of well-being variance, though the indirect effect through psychological flexibility was not significant. Limitations: Inclusion of more comprehensive measures of well-being and health behaviors may further clarify the strength of relations reported herein. Conclusion: Enhancing flexible response styles may support high well-being in LEO populations who report poor sleep quality and chronic pain.
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Affiliation(s)
- Lucas D. Baker
- Department of Psychology, University of South Dakota, Vermillion, SD, USA
| | | | - Jennifer L. Kuo
- Department of Psychology, University of South Dakota, Vermillion, SD, USA
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Pakenham KI, Landi G, Boccolini G, Furlani A, Grandi S, Tossani E. The moderating roles of psychological flexibility and inflexibility on the mental health impacts of COVID-19 pandemic and lockdown in Italy. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020; 17:109-118. [PMID: 32834969 PMCID: PMC7370913 DOI: 10.1016/j.jcbs.2020.07.003] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 12/22/2022]
Abstract
The Moderating Roles of Psychological Flexibility and Inflexibility on the Mental Health Impacts of COVID-19 Pandemic and Lockdown in Italy. Preliminary data suggest the COVID-19 pandemic has adverse effects on mental health in approximately a quarter of the general population. Few prior studies have identified contextual risk factors and no published study has explored factors that might moderate their adverse effects on mental health. Psychological flexibility is the cornerstone of psychological health and resiliency. This study investigated the roles of psychological flexibility and inflexibility in moderating the effects of COVID-19 risk factors on three mental health outcomes: COVID-19 peritraumatic distress, anxiety, depression. We hypothesized that psychological flexibility would mitigate and psychological inflexibility would exacerbate the adverse effects of COVID-19 risk factors on mental health. During the Italian national lockdown (M = 39.29 days, SD = 11.26), 1035 adults (79% female, M = 37.5 years, SD = 12.3) completed an online survey. Twelve COVID-19 risk factors were identified (e.g. lockdown duration, family infected by COVID-19, increase in domestic violence and in unhealthy lifestyle behaviours) and constituted a COVID-19 Lockdown Index. As predicted, results showed that after controlling for sociodemographic variables, global psychological flexibility and four of its sub-processes (self-as context, defusion, values, committed action), mitigated the detrimental impacts of COVID-19 risk factors on mental health. In contrast and as expected, global psychological inflexibility and four of its sub-processes (lack of contact with present moment, fusion, self-as-content, lack of contact with personal values) exacerbated the detrimental impacts of COVID-19 risk factors on mental health. Findings converge with those from the broader psychological flexibility literature providing robust support for the use of ACT-based interventions to promote psychological flexibility and mental health during the COVID-19 pandemic.
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Affiliation(s)
- Kenneth I. Pakenham
- The University of Queensland; School of Psychology, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Giulia Landi
- Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Viale Europa 115, 47023, Cesena, Italy
| | - Giada Boccolini
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Viale Europa 115, 47023, Cesena, Italy
| | - Annalisa Furlani
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Viale Europa 115, 47023, Cesena, Italy
| | - Silvana Grandi
- Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Viale Europa 115, 47023, Cesena, Italy
| | - Eliana Tossani
- Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Viale Europa 115, 47023, Cesena, Italy
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Levin ME, Krafft J, Twohig MP. Examining processes of change in an online acceptance and commitment therapy dismantling trial with distressed college students. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Changes in psychological inflexibility as a potential mediator of longitudinal links between college students’ sleep problems and depressive symptoms. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2019.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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