A psychometric comparison of psychological inflexibility measures: Discriminant validity and item performance

A multi-centre prospective cohort study investigating the roles of psychological flexibility and self-compassion in appearance concerns after burn injuries

OBJECTIVES

Appearance concerns following burn injuries are common. Psychological factors are important in maintaining such concerns. However, there is a lack of longitudinal or prospective research investigating their development. This study investigated whether psychological flexibility and self-compassion at hospital admission predicted subsequent appearance concerns.

DESIGN

A multi-centre prospective cohort study across six burn services.

METHODS

Adults (n = 175; 67% male) in hospital following burn injuries were recruited. Questionnaires measuring appearance concerns, psychological flexibility, self-compassion, post-traumatic stress disorder symptoms and perceived noticeability were completed during hospital admission and two- and six-months later. Demographic and burn injury information was collected.

RESULTS

Correlational analyses showed that increased psychological flexibility and self-compassion at admission were associated with decreased appearance concerns cross-sectionally and prospectively at two- and six-month follow-up. These associations remained significant when controlling for key covariates (i.e. gender, age, ethnicity, percentage total body surface area burnt, perceived noticeability, PTSD symptoms). Multiple linear regression analyses revealed that psychological flexibility and self-compassion predicted appearance concerns during hospital admission. Although psychological flexibility significantly predicted appearance concerns over time, it became non-significant when controlling for baseline appearance concerns.

CONCLUSIONS

Psychological flexibility has a protective role against appearance concerns soon after burn injuries, although this protective role is reduced when accounting for baseline appearance concerns. Early interventions targeting psychological flexibility (i.e. acceptance and commitment therapy) may be beneficial after burns if adapted to address appearance-related concerns.

Acceptance and commitment therapy versus progressive relaxation training for misophonia: Randomized controlled trial protocol, interventions, and audiological assessments

BACKGROUND

Misophonia is a disorder characterized by an intense emotional reaction to specific sounds, often leading to significant distress and impairment in daily functioning. Acceptance and commitment therapy (ACT) is a promising psychotherapy for treating misophonia, but has only been previously tested in case studies. This paper presents a protocol for the first randomized controlled trial (RCT) assessing the efficacy and feasibility of ACT supplemented by audiological interventions for misophonia versus progressive relaxation training (PRT).

METHODS

The outlined protocol is a RCT with 60 adults with misophonia. After undergoing a comprehensive psychological and audiological evaluation, participants were randomly assigned to ACT (n = 30) or PRT (n = 30). All participants completed clinician-administered and self-report assessments at baseline, post-intervention, 3-month follow-up, and 6-month follow-up. The primary outcome was misophonia severity and impairment measured via clinical interview. Secondary outcomes included disgust, anger, sensory sensitivities, well-being, distress, and psychological flexibility.

DISCUSSION

This paper outlines the rationale of using ACT supplemented by audiological methods for misophonia with the novel therapeutic target of enhancing psychological flexibility. The results of this randomized controlled trial will help determine if ACT is an efficacious and acceptable treatment for misophonia. This trial will also help clarify active psychological mechanisms of misophonia, and assess whether this combination of psychological and audiological services can effectively help individuals with misophonia.

Profiles of psychological flexibility and caregiving experience in dementia family caregivers: A latent profile analysis

OBJECTIVES

To explore the profiles of psychological flexibility among dementia family caregivers and examine their associations with psychological well-being and caregiving factors.

METHODS

Participants were 521 dementia family caregivers in Japan. Latent profile analysis was conducted to explore the profiles of psychological flexibility. The analyses examined differences in depression, anxiety, life satisfaction, and work-family conflict/enrichment between the profiles, and whether sociodemographic variables and caregiving stressors predict the profile.

RESULTS

Four distinct profiles were identified: high psychological flexibility (14.2%), moderate psychological flexibility with high commitment (24.7%), moderate psychological flexibility with low commitment (48.0%), and low psychological flexibility (13.1%). The low psychological flexibility profile exhibited the highest scores of depression, anxiety and work-family conflict, followed by the moderate psychological flexibility with low/high commitment profiles, and the high psychological flexibility profile. The high psychological flexibility and moderate psychological flexibility with high commitment profiles exhibited higher life satisfaction than the moderate psychological flexibility with low commitment profile. Caregiving stressors, marital status, and caregiver status predicted the profile.

CONCLUSION

Enhancing defusion and acceptance, rather than increasing commitment to personal values, may be beneficial in supporting distressed caregivers. Having more caregiving stressors, being single/divorced/bereaved, and being a primary caregiver may be useful indicators of decreased psychological flexibility among dementia family caregivers.

Psychological flexibility and global health in young adults with and without a self-reported functional somatic syndrome: a preliminary investigation

Functional somatic syndromes (FSS) are associated with functional impairments and distress. FSSs are common among young adults, and psychological flexibility may be a transdiagnostic process appropriate for treatment of FSS in this population. The objective of the current study was to compare physical and mental health in young adults with and without a self-reported FSS and examine which psychological flexibility processes are associated with better physical and mental health in the FSS subset. A total of 447 young adults participated in the current study. Individuals who reported an FSS diagnosis were coded as having a self-reported FSS. Physical and mental health and psychological flexibility were measured via self-report. FSS and non-FSS groups were compared regarding demographic characteristics and on the primary outcomes. Hierarchical regression analyses were conducted to examine the role of the psychological flexibility processes in physical and mental health in the FSS subset. Findings revealed that the FSS group scored significantly lower on measures of physical health and demonstrated less behavioral awareness than the non-FSS group. No differences regarding mental health were found. All three psychological flexibility processes were associated with physical and mental health, accounting for 26-49% of the variance in these outcomes. In conclusion, young adults with FSS experience more physical health difficulties than those without FSS. Psychological flexibility processes were related to better physical and mental health in those with FSS. These findings add to the literature and provide preliminary support for psychological flexibility as a future target for intervention development and implementation aimed at young adults with FSS.

Expecting the uncertain: The applicability of the intolerance of uncertainty model on fear of childbirth

A considerable number of pregnant women experience fear of childbirth (FOC), characterized by worries and fear of the unpredictable. Despite this, the psychological processes in FOC have received notably little attention. The aim of this study was to advance the understanding by exploring the applicability of the Intolerance of Uncertainty (IU) model on FOC. Anonymous data was collected in a sample of pregnant women (N = 357) with varying levels of FOC. Analyses supported the associations between FOC and all proposed psychological processes: IU, negative problem orientation, positive beliefs about worry and avoidance of inner experiences. The exploration of potential mediators of the relation between IU and FOC revealed that, of the three processes from the model, only positive beliefs about worry were a mediator, and more specifically, a partial mediator between IU and FOC. These findings add to the theoretical understanding of FOC, by indicating that the role of IU may be similar to other conditions inflicted by worry and anxiety, which may inform treatment development.

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

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

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.

Influence of psychological inflexibility and mindfulness on hypersexuality and sexual satisfaction in a Spanish sample

Sexual satisfaction is tremendously relevant to wellbeing and quality of life. Inversely, hypersexuality may increase the risk of psychological distress, unprotected sex, and marital problems. This study attempts to explore the sociodemographic variables related to hypersexuality and the relationship between hypersexuality and sexual dissatisfaction with psychological inflexibility, cognitive fusion, body awareness, bodily dissociation, and mindfulness skills in the Spanish population. The sample was made up of 530 participants between 18 and 67 years of age. In total, 5.5% displayed hypersexuality, more likely in males, lesbians and gay men, singles, and students. An online survey was conducted including standardized questionnaires as follows: AAQ-II, CFQ, SBC, MAAS, NSSS-S, and HBI. Significant moderate positive correlations were found between hypersexuality and psychological inflexibility, cognitive fusion, and bodily dissociation, and an inverse moderate correlation with mindfulness skills. Moderate negative correlations were found between sexual satisfaction and bodily dissociation. Linear regression showed psychological inflexibility was the variable with the most weight on hypersexuality, while bodily dissociation was the variable with the most influence on sexual dissatisfaction. This study suggests lesbians and gay men, males, and singles may show an increased vulnerability toward engaging in hypersexual behavior and provides justification for interventions focused on psychological inflexibility and mindfulness skills to treat hypersexuality and improve sexual satisfaction.

A Preliminary Investigation into the Factor Structure of Two Psychological Flexibility Measures in a Sample of Community-Dwelling Older Adults

OBJECTIVES

Acceptance and Commitment Therapy (ACT) targets psychological flexibility and the ability to identify behavioral function in context. Properly measuring these constructs is imperative to understanding whether these processes are mechanisms of change in treatment. The current study examined the factor structure of the Comprehensive Assessment of ACT processes (CompACT) and Tacting of Function scale (TOF) in community-dwelling older adults.

METHODS

Factor structure was examined with CFA. Eighty community-dwelling older adults completed questionnaires prior to an intervention.

RESULTS

While the original 23-item, 3-factor structure of the CompACT demonstrated inadequate fit, a modified 15-item, 3-factor structure demonstrated adequate fit. The original 1-factor structure of the TOF demonstrated inadequate fit. A modified 2-factor structure of the TOF fit significantly better than the original 1-factor structure; however, this model also demonstrated inadequate fit.

CONCLUSIONS

Examining the factor structure of the CompACT and TOF in an older adult sample contributes to the field's understanding of the constructs of psychological flexibility and tacting ability and to the clinical utility of these measures in an understudied sample.

CLINICAL IMPLICATIONS

These findings provide preliminary support for the use of a short-form version of the CompACT to measure therapeutic processes of change in community-dwelling older adults.

Acceptance and Commitment Therapy Processes Differentially Predict Aspects of Mental Health

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

Using network analysis to examine connections between Acceptance and Commitment Therapy (ACT) processes, internalizing symptoms, and well-being in a sample of undergraduates

BACKGROUND

Acceptance and Commitment Therapy (ACT) has been shown to be effective in treating internalizing symptoms. Understanding which ACT processes are most closely linked to certain symptoms may help develop targeted treatments. Network analysis an approach to gain insight into the interconnection between processes and the downstream benefits of targeting a particular process. However, limited work to date has explored networks involving ACT processes specifically.

METHODS

Undergraduate students (N = 447; 76.5 % female; 89.5 % White/Non-Hispanic) completed online questionnaires. The ACT processes assessed included experiential avoidance (AAQ-II), openness, awareness, and engagement (CompACT), and tacting ability (TOF), and internalizing symptoms/well-being (IDAS-II). Zero-order and partial correlation networks were examined as well as resulting communities.

RESULTS

In the association network, dysphoria and experiential avoidance, and suicidality (in the concentration network only) were central nodes. In community analyses, experiential avoidance had the strongest influence in the association network, whereas well-being had the strongest influence in the concentration network. Auto-detected communities were also evaluated.

LIMITATIONS

The present study was cross-sectional and included a largely White, female, undergraduate sample. This limits generalizability to more diverse, clinical, or general community populations. Potential concerns about data are also noted including low reliability on the TOF and two skewed domains on the IDAS-II which may impact stability of centrality metrics.

CONCLUSIONS

Well-being, dysphoria, and suicidality may be important process-based treatment targets. Further work is needed with diverse samples and using longitudinal designs to examine within person change of the associations between ACT processes and internalizing symptoms.

Using peer-support coaching to improve adherence to online ACT self-help for college mental health: A randomized controlled trial

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.

Psychometric evaluation of the Swedish Multidimensional Psychological Flexibility Inventory (MPFI)

Psychiatric disorders are common, and reliable measures are crucial for research and clinical practice. A cross-diagnostic construct that can be used to index treatment outcomes as well as prevalence of psychological ill health is psychological flexibility. The aim of this study was to validate a Swedish version of the Multidimensional Psychological Flexibility Inventory (MPFI). The MPFI has 12 subscales, six of which measure flexibility, and six that measure inflexibility. Using confirmatory factor analysis in a community sample of 670 participants, we found that a model with two higher order factors had satisfactory fit (CFI = .933) and a 12-factor model had the best fit to the data (CFI = .955). All 12 subscales showed adequate reliability (CRs = .803-.933) and the factor structure was similar across age groups and gender. Findings suggest that the Swedish version of the MPFI is a reliable instrument that can be used to index psychological flexibility. Potential areas for improvement of the instrument are discussed.

Health, well-being, and persisting symptoms in the pandemic: What is the role of psychological flexibility?

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.

The Iranian form of psychometric properties of the Multidimensional Psychological Flexibility Inventory

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.

Confirmatory Factor Analysis of the Comprehensive Assessment of Acceptance and Commitment Therapy (CompACT) in Active-Duty Military Personnel

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, M_age = 29.15 years; M_BMI = 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.

Is Activation the Active Ingredient of Transdiagnostic Therapies? A Randomized Clinical Trial of Behavioral Activation, Acceptance and Commitment Therapy, and Transdiagnostic Cognitive-Behavioral Therapy for Emotional Disorders

Studying the usefulness of contextual and cognitive transdiagnostic therapies calls for an analysis of both their differential efficacy and their specificity when acting on the transdiagnostic conditions on which they focus. This controlled trial compares the post-treatment and 3- and 6-month follow-up effects of Behavioral Activation (BA), Acceptance and Commitment Therapy (ACT) and Cognitive-Behavioral Transdiagnostic Therapy (TD-CBT) on emotional symptomatology, and analyses the role played by Experiential Avoidance, Cognitive Fusion, Activation and Emotion Regulation in the clinical change. One hundred twenty-eight patients who fulfilled diagnostic criteria for anxiety and/or depression (intention-to-treat sample) were randomly assigned to three experimental group-treatment conditions (BA, n = 34; ACT, n = 27; TD-CBT n = 33) and one control group (WL, n = 34). Ninety-nine (77.34%) completed the treatment (per-protocol sample). In the post-treatment, all therapies reduced anxiety and depression symptomatology. In the follow-ups, the reduction in emotional symptomatology was greater in the condition which produced greater and more prolonged effects on Activation. Activation appears to be the principal condition in modifying all the transdiagnostic patterns and BA was the most efficacious and specific treatment. The trial was registered at ClinicalTrials.gov NCT04117464. Raw data are available online http://dx.doi.org/10.17632/krj3w2hfsj.1 .

An Acceptance and Commitment Therapy Prototype Mobile Program for Individuals With a Visible Difference: Mixed Methods Feasibility Study

Background

Mobile apps may offer a valuable platform for delivering evidence-based psychological interventions for individuals with atypical appearances, or visible differences, who experience psychosocial appearance concerns such as appearance-based social anxiety and body dissatisfaction. Before this study, researchers and stakeholders collaboratively designed an app prototype based on acceptance and commitment therapy (ACT), an evidence-based form of cognitive behavioral therapy that uses strategies such as mindfulness, clarification of personal values, and value-based goal setting. The intervention also included social skills training, an established approach for increasing individuals’ confidence in managing social interactions, which evoke appearance-based anxiety for many.

Objective

In this study, the authors aim to evaluate the feasibility of an ACT-based app prototype via the primary objectives of user engagement and acceptability and the secondary feasibility objective of clinical safety and preliminary effectiveness.

Methods

To address the feasibility objectives, the authors used a single-group intervention design with mixed methods in a group of 36 participants who have a range of visible differences. The authors collected quantitative data via measures of program use, satisfaction ratings, and changes over 3 time points spanning 12 weeks in outcomes, including selected ACT process measures (experiential avoidance, cognitive defusion, and valued action), scales of appearance concerns (appearance-based life disengagement, appearance-fixing behaviors, appearance self-evaluation, and fear of negative appearance evaluation), and clinical well-being (depression and anxiety). Semistructured exit interviews with a subsample of 12 participants provided qualitative data to give a more in-depth understanding of participants’ views and experiences of the program.

Results

In terms of user engagement, adherence rates over 6 sessions aligned with the upper boundary of those reported across mobile mental health apps, with over one-third of participants completing all sessions over 12 weeks, during which a steady decline in adherence was observed. Time spent on sessions matched design intentions, and engagement frequencies highlighted semiregular mindfulness practice, mixed use of value-based goal setting, and high engagement with social skills training. The findings indicate a good overall level of program acceptability via satisfaction ratings, and qualitative interview findings offer positive feedback as well as valuable directions for revisions. Overall, testing for clinical safety and potential effectiveness showed encouraging changes over time, including favorable changes in appearance-related life disengagement, appearance-fixing behaviors, and selected ACT measures. No iatrogenic effects were indicated for depression or anxiety.

Conclusions

An ACT-based mobile program for individuals struggling with visible differences shows promising proof of concept in addressing appearance concerns, although further revisions and development are required before further development and more rigorous evaluation.

Examining depression symptoms within OCD: the role of experiential avoidance

BACKGROUND

Obsessive compulsive disorder (OCD) and depression commonly co-occur. Past research has evaluated underlying mechanisms of depression in the context of other diagnoses, but few to no studies have done this within OCD.

AIMS

This study examines the relationships between distress tolerance (DT), experiential avoidance (EA), depression, and OCD symptom severity across intensive/residential treatment (IRT) for OCD. It was hypothesized that all variables would be significantly moderately related and EA would emerge as a potential contributing factor to change in depression and OCD symptoms across IRT for OCD.

METHOD

The sample included 311 participants with a primary diagnosis of OCD seeking IRT. Correlations were performed between all variables at both admission and discharge. A two-step hierarchical regression with change in OCD symptoms and change in DT in the first block and change in EA in the second block examined if change in EA explained change in depression above and beyond change in OCD and DT ability.

RESULTS

At both admission and discharge, higher EA, lower DT, and higher OCD symptom severity were significantly associated with more depressive symptoms. Change in EA explained a significant amount of variance in change in depression above and beyond change in OCD symptom severity and change in DT.

CONCLUSIONS

This study expands past results within an OCD sample, emphasizing EA as an important treatment target in OCD. Future studies could utilize samples from other treatment contexts, use a measure of EA specific to OCD, and utilize a longitudinal model that takes temporal precedence into account.

The mediating role of personalized psychological flexibility in the association between distress intolerance and psychological distress: A national survey during the fourth waves of COVID-19 pandemic in Iran

The global COVID-19 outbreak has put the human race's distress tolerance abilities to the test. And, the distress experienced getting worse with each pandemic wave; however, the more flexible the person, the greater the chance of surviving. Thus, the current study aimed to examine the mediating role of personalized psychological flexibility (PPF) in the link between distress intolerance to psychological distress during the fourth wave of the pandemic in Iran. A total of 576 individuals (Meanage 34.80, ±10.9, females 55.6%) took part in the online survey. In this national sample, PPF partially played a role in mediating the association mentioned above. Interestingly, this mediation was independent of demographic factors (age, gender, marital status, and educational level) and fear of COVID-19, mindfulness, and satisfaction with life. So, despite the mentioned variables, accepting and using unpleasant emotions as fuel to achieve valued goals rather than avoiding them would mitigate the psychological distress during the pandemic. Consequently, public health services can aim to provide psychological flexibility enhancing interventions to decay COVID-19-related mental distress.

Increases in Psychological Flexibility Mediate Relationship Between Acute Psychedelic Effects and Decreases in Racial Trauma Symptoms Among People of Color

BACKGROUND

Previous research showed acute psychedelic effects were associated with decreases in racial trauma (RT) symptoms among black, indigenous, and people of color (BIPOC). Among samples comprised primarily of white participants, positive outcomes of psychedelic experiences have been mediated by increases in psychological flexibility. Therefore, we examined whether changes in psychological flexibility from before to after a psychedelic experience mediated the relationship between acute psychedelic effects and changes in RT symptoms among BIPOC.

METHODS

This cross-sectional online survey study included 313 BIPOC (mean age = 33.1; SD = 11.2; female = 57%). A multiple linear regression analysis was used to examine the association between acute psychedelic effects and decreases in RT symptoms in a nonclinical setting; a path analysis was used to explore whether changes in psychological flexibility mediated this relationship.

RESULTS

Acute insight and challenging effects were significantly (p < .001) associated with decreases in RT symptoms following a psychedelic experience. Increases in psychological flexibility partially mediated relationships between greater intensity of psychological insight and less intensity of challenging experiences and decreases in RT symptoms (ps<.001).

CONCLUSION

This research suggests psychedelics confer potential benefits in decreasing RT symptoms among BIPOC and psychological flexibility may be an important mediator of these effects. Future research should test this hypothesis in a longitudinal clinical trial among BIPOC.

Psychological inflexibility and mental health symptoms during the COVID-19 lockdown in Spain: A longitudinal study

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.