The efficacy of group-based acceptance and commitment therapy on psychological capital and school engagement: A pilot study among Chinese adolescents

An online peer support program to improve mental health among university students: A randomized controlled trial

Despite recent calls for more peer support initiatives aimed at promoting mental health in postsecondary institutions, those initiatives remain scarce. In this study, a multisite randomized controlled trial was designed to assess the effect of an online peer support intervention based on acceptance and commitment therapy using mental health and school indicators. Undergraduate students were recruited in three Canadian universities and randomly assigned to an intervention (n = 54) or a wait-list control group (n = 53). Compared to control participants, those who took part in the program self-reported reduced psychological inflexibility, stress, anxiety and depression, and increased psychological flexibility and well-being. The intervention had no effect on academic satisfaction and engagement. These results were found both in completer and intent-to-treat samples. The findings provide evidence that peer support may be a beneficial adjunct to mental health interventions offered to college and university students.

Chinese nursing students' academic self-concept and deep learning in online courses: Does psychological capital play a moderating role?

The advent of online education has become indispensable for nursing students seeking to acquire knowledge. However, the efficacy of online education often falls short of initial expectations. Deep learning (DL) can assist learners tackle complex problems and make innovative decisions. Despite its potential, there has been limited exploration into the underlying mechanisms of DL among nursing students, both domestically and globally. This study examined the potential moderating effect of psychological capital (PC) on the association between academic self-concept (AS-c) and DL among nursing students from China enrolled in online courses. Conducted from October 2022 to January 2023, the survey involved 635 nursing students from four public universities in eastern China, utilizing convenience sampling. Data was collected using the AS-c scale, psychological capital scale, and DL scale in online courses. Correlation analyses, univariate analyses, multiple linear regression analyses, and the PROCESS macro were employed for a comprehensive examination. The results revealed a strong positive relationship between nursing students' DL and both their AS-c (r = 0.766, P < 0.01) and PC (r = 0.714, P < 0.01), respectively. Additionally, the effect of AS-c on DL was stronger among individuals with high PC (β = 0.34, SE = 0.03, P < 0.001) compared to those with low (β = 0.29, SE = 0.02, P < 0.001) or medium (β = 0.24, SE = 0.02, P < 0.001) levels of PC, indicating that PC exerts moderating effects and promotes DL among nursing students enrolled in online courses. Based on these findings, several implications are suggested for the theory and practice of facilitating DL.

Preliminary Effectiveness of a Brief School-Based HERO Intervention: Improving the Wellbeing of Final Year Adolescent Female Students

Young people face multiple challenges, including appearance dissatisfaction, academic stressors, anxiety and depression. These challenges may increase during the final year of high school and may have become further exacerbated by the COVID-19 pandemic. This study examines the preliminary effectiveness of a brief, uncontrolled school-based intervention aimed at enhancing Psychological Capital (PsyCap), consisting of positive resources of hope, self-efficacy, resilience and optimism (HERO), and reducing mental health symptoms among female year 12 students (n = 95, Mage = 16.78, SD = 0.45). Outcomes on measures of HERO and secondary outcomes of flourishing, appearance dissatisfaction, anxiety and depression were measured at pre and post-intervention. In the overall cohort, no significant changes were found on the HERO outcomes or flourishing post-intervention, while symptoms of depression, anxiety and appearance dissatisfaction decreased significantly. For students with higher baseline anxiety, optimism and anxiety symptoms improved significantly at post-intervention. However, students with lower baseline anxiety experienced significant decreases in self-efficacy and optimism, as well as a significant increase in anxiety symptoms post-intervention. Baseline depression levels did not impact intervention outcomes. The findings, although mixed and limited by the lack of control group, suggest that a brief intervention grounded in PsyCap theory may improve student wellbeing under challenging circumstances.

Parent-adolescent discrepancies in educational expectations, relationship quality, and study engagement: a multi-informant study using response surface analysis

Whether parental educational expectations for adolescents serve as a source of motivation or stress depends on the extent to which adolescents hold expectations for themselves. Previous research on the discrepancies between parental and adolescent educational expectations and their impact on learning engagement has been limited by traditional statistical tests, and lacking an examination of the internal mediating mechanism of parent-child relational quality from both parental and adolescent perspectives. This cross-sectional study, utilizing a multi-informant design, examined the association between discrepancies in parents' and adolescents' reports of expectations, and adolescents' study engagement, as well as the mediating role of parent-child relational qualities perceived by both parties. The sample for this study consisted of 455 adolescents and their parents from 10 classes in a junior high school in Wuhan, Hubei Province, China. The adolescents had an average age of 12.8 years, and 51.6% of them were boys. Both parents and adolescents reported on their expectations and perceived relational quality, while adolescents also filled out questionnaires assessing their learning engagement. Data were analyzed using polynomial regressions with response surface analysis. The results revealed that when adolescents reported high expectations, regardless of whether their parents reported high or low expectations, adolescents reported satisfied relationships and high learning engagement. In contrast, parents reported satisfied relationships when both parties reported high expectations, or when parents reported higher expectations than adolescents. Lastly, the association between discrepancies in expectations and learning engagement was significantly mediated by adolescent-reported relationships but not parent-reported ones. These findings highlight the importance of considering multiple perspectives when studying the association between expectations and adolescent study engagement. This research advances our comprehension of the dynamics between parent-adolescent educational expectation discrepancies and adolescent learning engagement, offering insights for more nuanced and effective parenting strategies tailored to foster optimal educational outcomes.

Trait Anxiety, Emotion Regulation, and Metacognitive Beliefs: An Observational Study Incorporating Separate Network and Correlation Analyses to Examine Associations with Executive Functions and Academic Achievement

Trait anxiety, emotion regulation strategies, and metacognitive beliefs influence executive functions (EFs) and academic achievement. This study examines their interplay and impact on academic success. In total, 275 adolescents (10-17 years) and parents completed an online questionnaire assessing trait anxiety, emotion regulation strategies, metacognition, parent-reported behaviors related to executive functioning, and overall school average. Preliminary analyses confirmed consistency with the existing literature for each variable and their interaction. Furthermore, we conducted a network analysis among the main variables. This analysis supports the need to pay more attention to reflective variables-maladaptive emotion regulation strategies and metacognitive beliefs about worry-when studying trait anxiety. These variables were linked to problematic executive functioning in adolescents, and the latter was negatively linked to academic achievement. This study offers innovative insights by investigating relationships less explored in the scientific literature. It reveals high and significant correlations between metacognitive beliefs, maladaptive emotion regulation strategies, and trait anxiety (r > 0.500, p < 0.001) but also between these variables and both executive functioning and academic achievement. These findings offer new perspectives for research and underscore the importance of holistically examining the psychological factors related to academic success.

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

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

The core self-evaluations, psychological capital, and academic engagement: a cross-national mediation model

Introduction

An academic environment with continuously more demanding tasks requires students to capitalize on their strengths to meet the challenges and engage in learning experiences. Engaged students are deeply involved in their work, are strongly connected with their studies, and are more successful in academic tasks. The present study aimed to test a model in that core self-evaluations (CSE) predicts academic engagement (AE) directly and indirectly by increasing personal resources (i.e., psychological capital; PsyCap) in the case of two different samples, Romanian and Serbian.

Methods

Data were collected through three online questionnaires from 672 undergraduate students (Romania - 458; Serbia - 214).

Results

The findings confirmed that CSE was positively related to PsyCap, which was positively associated with AE, and PsyCap mediates the relationship between the two variables in both samples. A positive evaluation of one's characteristics (high CSE) mainly affects the cognitive and emotional mechanism of appraising the academic-related tasks one encounters (high PsyCap), ultimately shaping their motivation and engagement.

Discussion

These results pointed out the importance of the CSE and PsyCap that support each other and increase students' AE, explaining the mediating mechanism of PsyCap. Also, they provide insight into the students' engagement from two different cultural and educational contexts, being helpful to universities in their effort to increase students' engagement.

Developing the HERO within: Evaluation of a brief intervention for increasing Psychological Capital (PsyCap) in Australian female students during the final year of school in the first year of COVID-19

Academic stress is linked to adolescent distress and perfectionism during the final years at school, with girls being at greater risk. The onset of the COVID-19 pandemic was an additional stressor that impacted student learning on a global scale. The present study examines the effectiveness of an intervention targeting Psychological Capital (PsyCap), comprising hope, efficacy, resilience, and optimism (HERO) to increase these HERO resources and assess its impact on mental health symptoms and subjective wellbeing outcomes among a cohort of Year 12 students (n = 82, Mage = 17.09, SD = 0.28, 99% identifying as female) from a girls school during the first year of the pandemic. Primary outcomes of anxiety symptoms, depressive symptoms, and flourishing and secondary outcomes of HERO variables and perfectionism were examined. There were no significant changes in primary outcomes. Significant changes in efficacy, optimism, omnibus PsyCap (HERO combined) and perfectionism were found at post-intervention. Findings indicate the intervention targeting HERO constructs may be promising for developing HERO capabilities in youth and reducing common areas of concern for students (e.g., perfectionism). Future research directions addressing limitations are discussed.

Psychological mechanism of acceptance and commitment therapy and rational emotive behavior therapy for treating hoarding: Evidence from randomized controlled trials

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

Effectiveness of acceptance and commitment therapy on weight, eating behaviours and psychological outcomes: a systematic review and meta-analysis

PURPOSE

To examine the effectiveness of ACT on weight (body mass index and body mass), eating behaviours (binge eating, emotional eating, external eating and restraint eating), and psychological outcomes (quality of life [QoL], depression, psychological flexibility, and weight stigma) among adults with overweight and obesity.

METHODS

Seven electronic databases (CINAHL, EMBASE, PubMed, PsycInfo Scopus, The Cochrane Library, and Web of Science) were searched from inception through 17 June 2022. 13 studies and 48 unique effect sizes were analyzed using random-effects models. Pooled effect estimates were calculated using weighted mean differences (WMD) and standardized mean differences expressed in Hedges' g (g). Heterogeneity was assessed using Q-statistics and interpreted using I².

RESULTS

ACT was found to be effective in improving weight loss in terms of BMI (k = 6, WMD = - .50, 95% CI = - .90; - .11, t = - 3.25, p = .20, I² = .0%), psychological flexibility and weight-related stigma. However, non-significant changes were found for body mass (k = 4, WMD = - 0.33 95% CI = - 1.53; 0.87, t = - .88, p = .44, I² = .0%), binge eating (k = 4, g = - .34, 95% CI = - 1.31; 0.62, t = - 1.13, p = .34, I² = 71.1%), emotional eating (k = 6, g = - .20, 95% CI = - 0.54; 0.15, t = - 1.47, p = .20, I² = 45.0%), external eating (k = 5, g = - .40, 95% CI = 0.96; 0.16, t = - 1.99, p = .12, I² = 81.8%), restraint eating (k = 3, g = .22 95% CI = - 0.57; 1.01, t = 1.19, p = .36, I² = 69.1%), QoL (k = 3, g = .01, 95% CI = - 1.51; 1.52, t = .02, p = .99, I² = 90.2%) and depression (k = 3, g = - .55, 95% CI = - 1.78; 0.67, t = - 1.94, p = .19, I² = 79.9%).

CONCLUSION

ACT could be effective in improving weight loss but more studies are needed to ascertain its effectiveness and the underlying mechanism by which the various components influence weight-related outcomes.

LEVEL OF EVIDENCE

Evidence obtained from a systematic review and meta-analysis of existing empirical studies.

The relationship between stressful life events and school engagement for junior high school students in China: A serial mediation model

The purpose of this study is to examine the relationship between stressful life events (SLE) and school engagement and to determine if there are some likely mediating variables between them. A sample of 1517 Chinese junior high school students (51.5% female) completed the adolescent self-rating life events checklist (ASLEC), Utrecht Work Engagement Scale-student (UWES-s), cognitive fusion questionnaire (CFQ), and positive psychological capital questionnaire (PPQ). The model was calculated using the PROCESS macro in SPSS. The serial mediator model revealed a significant negative effect of SLE on school engagement through psychological flexibility and psychological capital (effect = −.08, 95% CI [−.10, −.06]). There was also a direct mediating effect through psychological capital (effect = −.17, 95% CI [−.21, −.13]). The results of the present study may help to clarify mechanisms that might explain the association between SLE and school engagement. Future research on improving school engagement should consider the critical roles of psychological flexibility and psychological capital.

A Systematic Scoping Review of Psychological Capital Related to Mental Health in Youth

Psychological capital (PsyCap) is a term coined in organizational psychology and refers to a person's development of states that motivate behavior. Also known in the literature as PsyCap, this construct typically refers to positive states of hope, self-efficacy, resilience, and optimism that are amenable to intervention and that are related to subjective well-being and life satisfaction. The aims of this systematic scoping review were to explore how PsyCap is described in youth mental health literature and how PsyCap and mental health are related. Results from four databases were reported following PRISMA guidelines. A total of 772 studies were identified and 16 studies were fully reviewed, including an overall sample of 6,772 youth from six countries. PsyCap has a positive relationship with mental health in youth. Future studies should involve school nurses to validate the constructs that characterize PsyCap and validate an instrument for measuring PsyCap in youth mental health in English.

Negative School Gossip and Youth Adolescents' Mobile Phone Addiction: Mediating Roles of Anxiety and Experiential Avoidance

Being the target of negative school gossip, a form of relational aggression, has been shown to be associated with psychological and behavioral problems in youth adolescents. Based on the experience avoidance model, this study tested the association between negative school gossip and youth adolescents' mobile phone addiction, and the serial mediation roles of anxiety and experience avoidance in this relationship. Junior high school students (N = 837; ages 12-15; 50% girls) completed the Negative School Gossip Scale, Anxiety Scale, Acceptance and Action Questionnaire (AAQ-II), and Mobile Phone Addiction Scale in their classrooms. The results of regression-based analyses showed that after controlling for age and gender, (1) negative school gossip was significantly associated with mobile phone addiction; (2) anxiety and experience avoidance each significantly mediated this association; (3) anxiety and experience avoidance serially mediated this association. The results support the experience avoidance model and highlight emotional factors as an internal mechanism by which negative school gossip is associated with youth adolescents' mobile phone addiction. The results also have implications for preventing and reducing youth adolescents' mobile phone addiction.

Cognitive Defusion and Psychological Flexibility Predict Negative Body Image in the Chinese College Students: Evidence from Acceptance and Commitment Therapy

Body dissatisfaction is a global phenomenon. Despite the significant cultural difference, most research on negative body image was conducted in Western countries. How do cognitive fusion and psychological flexibility relate to negative body image in the Chinese population? In the present study, this question was investigated through the intervention technique, Acceptance and Commitment Therapy (ACT). Here, 86 young Chinese university students with high negative physical self were invited, in which 42 students received 10 sessions of group-based ACT intervention in a clinical setting while the remained acted as the control group with no intervention. Pretests showed no statistical differences in negative body image between these two groups, while both cognitive fusion and psychological flexibility predicted negative body image. Post-pre tests showed no change in the control group, while enhanced cognitive defusion and psychological flexibility in the ACT group. Individual differences in psychological flexibility and cognitive defusion enhancement predicted improved body image. A strong association of implicit body image with Fatness and Shortness changes suggested that although with individual differences, those components could be internalized during the intervention in the College students.

Which outcome variables are associated with psychological inflexibility/flexibility for chronic pain patients? A three level meta-analysis

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

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021285705.

Measuring self-as-context in Chinese college students: Validity and reliability of the Chinese version of self-as-context scale (C-SACS)

Objective

To examine the validity and reliability of the Chinese version of the Self-as-Context Scale (SACS) in college students.

Method

We used convenience sampling to recruit 708 Chinese college students. All participants completed the SACS and 343 of them were asked to complete the validation questionnaires (Satisfaction with Life Scale, Peace of Mind Scale, Acceptance and Action Questionnaire-II, Mindful Attention Awareness Scale, Cognitive Fusion Questionnaire-Fusion, and Depression Anxiety Stress Scale-21) at the same time. We conducted items analysis, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), measurement invariance test, correlation analysis, regression analysis, and internal consistency reliability analysis. After 3 weeks, 217 participants filled out the SACS again to assess the test-retest reliability.

Results

The exploratory factor analysis showed that the SACS consisted of two factors (Centering and Transcending), with a total of 9 items. The confirmatory factor analysis demonstrated that the two-factor structure fit well (χ ² = 55.40, df = 22, CFI = 0.977, TLI = 0.963, RMSEA = 0.065, SRMR = 0.032). According to the results of the measurement invariance tests, configural invariance, metric invariance, scalar invariance, and strict invariance of the 2-factor model, the C-SACS scores were comparable across genders. Additionally, the C-SACS total score and its subscale scores were significantly positively correlated with positive indicators of mental health (life satisfaction, affective well-being), significantly negatively correlated with negative emotions (depression, anxiety, stress), significantly negatively correlated with experiential avoidance and cognitive fusion (except for the Transcending factor), and significantly positively correlated with mindful attention and awareness. Regression analysis results revealed that the C-SACS surpasses the incremental effectiveness of AAQ-II and CFQ-F in predicting different psychological health indicators. The Cronbach's α coefficients of the C-SACS and two subscales were 0.88 [0.71, 0.90], 0.80 [0.87, 0.90] and 0.85 [0.83, 0.88] and McDonald's ω = 0.88 [0.87, 0.90], ω = 0.80 [0.78, 0.83], ω = 0.85[0.83, 0.88]. The test-retest reliability (ICC) was 0.73 and 0.72, respectively.

Conclusion

The results of our study suggest that the Chinese version of SACS has good reliability and validity in Chinese college students.

The use of acceptance and commitment therapy in managing psychological symptoms in paediatric functional non-epileptic attacks: A clinical report

Functional non-epileptic attacks (FNEA) are seizure like activities that occur without any organic cause. Although a debilitating and costly disorder, there is much debate within the clinical literature on the causes and prognosis of FNEA, as well as possible effective psychological interventions. This is especially true for FNEA occurring in paediatric populations. Limited evidence to date suggests that acceptance and commitment therapy (ACT) shows promise and has pragmatic benefits in the context of functional disorders for adults. This case study provides information of a brief (8-session) ACT protocol targeting FNEA and associated emotional difficulties in a 12-year child. Treatment aimed to promote psychological flexibility and reduce functional interference of FNEA symptoms using ACT consistent techniques. Post-treatment, the child demonstrated reliable/clinical recovery in psychological flexibility, symptom interference and anxiety, as well as a marked reduction in the frequency of FNEA episodes. The majority of these gains were evidenced at 5-month follow-up. Such promising findings need to be tempered by methodological considerations.

Evaluating an ACT-Based Brief Intervention for Educators Treatment Package on Reported Well-Being and ACT-Consistent Language in the Classroom

Educators continue to experience stress and burnout, both of which have been negatively impacted by the COVID-19 pandemic, and there continues to be a need to develop interventions that support not only educators’ well-being, but a climate within school buildings that fosters psychological well-being for students and school staff alike. Acceptance and Commitment Therapy (ACT) is one promising approach to interventions for both educator and student psychological well-being. The present study sought to evaluate the effect of a low-dosage, online, and remotely delivered ACT intervention for educators on self-reported burnout, psychological flexibility, ACT knowledge, and frequency of use of ACT-consistent language while teaching in an alternative educational setting. The ACT-based intervention targeted the development of educator psychological flexibility, but the analysis provided an evaluation of non-targeted participants’ use of ACT-consistent language in the classroom, as well. Results suggest an overall improvement in participants’ self-reported burnout and psychological flexibility, an increase in participants’ ACT knowledge following each phase of the study, and an increase in the frequency of ACT-consistent language for all participants following the onset of a feedback component. We discuss potential implications of practical ACT-based interventions for educators in an applied setting and related increases in ACT-consistent verbal stimuli within the classroom setting.

Associations Between Six Core Processes of Psychological Flexibility and Functioning for Chronic Pain Patients: A Three-Level Meta-Analysis

The previous research showed contradictions in the relationships between psychological flexibility processes and functioning. This meta-analysis is the first to provide a comprehensive meta-analysis of the associations between six core processes of psychological flexibility and functioning among chronic pain patients. Four databases were searched (PsycINFO; PubMed; CINAHL; Web of Science) along with reference lists. Thirty-six cross-sectional studies were included (7,812 chronic pain patients). A three-level meta-analytic model was used to examine the associations. The publication bias was assessed with the Egger test, funnel plot, and p-curve analysis. Significant associations were found between functioning and six processes of psychological flexibility (i.e., acceptance, defusion, present moment, committed action, self as context, and values). Except for the relationship between defusion and functioning, the relationships between the other five psychological flexibility processes and functioning were all moderated by domains of functioning. No moderators were found regarding age, percentage of females, country, or type of instrument used to measure functioning. These findings may carry significant implications for chronic pain patients and clinical workers. It might be more effective to focus on functioning-related psychological flexibility processes rather than all therapy packages if the relationships between functioning and specific processes of psychological flexibility were better informed. Limitations were also discussed.