Effects of mindfulness-based cognitive therapy for Chinese adults with PTSD symptoms: protocol for a randomised controlled trial

INTRODUCTION

Emerging evidence supports mindfulness as a potential psychotherapy for post-traumatic stress disorder (PTSD). Individuals with subthreshold PTSD experience significant impairment in their daily life and functioning due to PTSD symptoms, despite not meeting the full diagnostic criteria for PTSD in DSM-5. Mindfulness skills, including non-judgmental acceptance, attentional control and openness to experiences may help alleviate PTSD symptoms by targeting characteristics such as intensified memory processing, dysregulated hyperarousal, avoidance, and thought suppression. This trial aims to test the effects of mindfulness-based cognitive therapy (MBCT) when compared to an active control.

METHOD AND ANALYSIS

This 1:1 randomised controlled trial will enroll 160 participants with PTSD symptoms in 2 arms (MBCT vs. Seeking Safety), with both interventions consisting of 8 weekly sessions lasting 2 h each week and led by certified instructors. Assessments will be conducted at baseline (T0), post-intervention (T1), and 3 months post-intervention (T2), with the primary outcome being PTSD symptoms measured by the PTSD checklist for DSM-5 (PCL-5) at T1. Secondary outcomes include depression, anxiety, attention, experimental avoidance, rumination, mindfulness, and coping skills. Both intention-to-treat and per-protocol analyses will be performed. Mediation analysis will investigate whether attention, experimental avoidance, and rumination mediate the effect of mindfulness on PTSD symptoms.

DISCUSSION

The proposed study will assess the effectiveness of MBCT in improving PTSD symptoms. The findings are anticipated to have implications for various areas of healthcare and contribute to the enhancement of existing intervention guidelines for PTSD.

TRIAL REGISTRATION NUMBER

ChiCTR2200061863.

Mindfulness and acceptance-based training for elite adolescent athletes: a mixed-method exploratory study

Objectives

This study aimed to examine the effectiveness of a specifically designed mindfulness-acceptance-insight-commitment (MAIC) training program on relevant psychological factors (i.e., mindfulness, acceptance, performance-related satisfaction) as well as sport training performance for elite adolescent athletes from Hong Kong. And it also aimed to explore the athletes' real experiences (i.e., receptiveness and perceptions) of completing the MAIC program.

Methods and design

The mixed-method was used in this study, including a randomized controlled trial (RCT) and a qualitative exploration. The RCT employed a 2 (groups) x 3 (data collection points) design involving 40 elite adolescent athletes from the Hong Kong Sports Institute (HKSI). These athletes were randomly assigned to either the MAIC training group (MT; n = 20, Mage = 15.65) or the control group (CG; n = 20, Mage = 15.85) to further test the effectiveness of the MAIC intervention on mindfulness, acceptance, performance-related satisfaction, and sport training performance. Subsequent to the RCT, the qualitative exploration was used to explore the athletes' real experiences towards the MAIC program. In the qualitative exploration, all athletes who participated in the MAIC program were invited to participate in voluntary semi-structured interviews. Of these, 14 athletes chose to take part in the interviews. The RCT employed a 2×3 mixed-design ANOVA, while thematic analysis was applied to the qualitative exploration.

Results

The results revealed that the MAIC training program significantly enhanced athletes' mindfulness, acceptance, satisfaction with performance, and sport training performance. However, these effects diminished at the follow-up assessment compared to post-training. Notably, the acceptance level of MT athletes did not significantly differ from CG athletes at the follow-up assessment. Additionally, the qualitative analysis identified four key dimensions: (a) Attitude towards MAIC training, (b) Reflection on the MAIC learning process, (c) Outcomes of MAIC training, and (d) Recommendations for future MAIC training. Overall, the qualitative findings complemented and reinforced the quantitative results, offering deeper insights into athletes' experiences and valuable suggestions for further enhancing the MAIC program.

Conclusion

The findings suggested that the specifically designed MAIC training program in this study effectively enhanced sport training performance and various psychological factors among elite adolescent athletes from Hong Kong. Nevertheless, further investigations are still required to comprehensively evaluate and further develop the MAIC training program.

Investigating the acceptability of a culturally adapted acceptance and commitment therapy group for UK Vietnamese communities: A practice-based feasibility study

Acceptance and Commitment Therapy (ACT) is an empirically supported psychotherapy that offers promise for the mental health of minoritised ethnic populations. Given the diversity of those presenting to inner-city services and barriers to accessing appropriate mental healthcare, we sought to develop a culturally syntonic ACT intervention for UK Vietnamese refugee communities in a practice-based partnership project between a National Health Service and local third-sector service in East London. The aim was to explore the feasibility, acceptability and impact of the adapted intervention to inform culturally inclusive clinical practice and future research. We outline key aspects of Vietnamese belief systems and culture, and consider how these might influence the optimisation of group-based ACT. We then present a mixed-method evaluation of the seven-session adapted ACT group for 11 participants (9 male and 5 female, aged between 44 and 73 years). Individual-level change analyses indicated clinically significant improvements in psychological flexibility for the minority of participants and a mixed pattern for impact on well-being. A thematic analysis and descriptive approach examined acceptability, feasibility and narratives of impact. Participants reported positive feedback on group experience, relevance and usefulness, and emergent themes indicate that the group facilitated key acceptance, commitment and behaviour-change processes, promoted social connections and increased engagement in meaningful life activities in relation to new perspectives and values-based action. Limitations are outlined, but overall, findings suggest preliminary support for the potential beneficial effect of the adapted ACT group as a feasible, culturally acceptable therapeutic approach for UK Vietnamese communities that is worthy of further investigation.

Cross-cultural adaptation, reliability, and validity of the Chinese version of the Acceptance and Action Questionnaire-Management of Child Hearing Loss

OBJECTIVE

The current study aims to translate and cross-culturally adapt the Acceptance and Action Questionnaire-Management of Child Hearing Loss (AAQ-MCHL) scale to Chinese caregivers of children with hearing loss (CHL) and verify its psychometric characteristics.

DESIGN

This is a cross-sectional design of psychometric validation study.

STUDY SAMPLE

In total, 135 caregivers of CHL were invited to participate in the study, and complete data from 125 participants were used to analyse internal consistency, test-retest reliability, content validity, structural validity, criterion validity, and the optimal cut-off score of AAQ-MCHL.

RESULTS

Through careful and complete translation and adaptation, the Chinese version of AAQ-MCHL was successfully created. The Chinse version of the AAQ-MCHL had good internal consistency, test-retest reliability, content validity, structural validity, and criterion validity. Our results also showed that poorer speech performance in CHL was a strong predictor of parental psychological inflexibility.

CONCLUSIONS

The Chinese version of the AAQ-MCHL could be used as an outcome indicator to evaluate the psychological inflexibility of caregivers of CHL in mainland China, and we suggest that early interventionists should be aware of signs of elevated psychological inflexibility in caregivers of CHL.

Perceived Social Support and Experiential Avoidance in Adolescents: A Moderated Mediation Model of Individual Relative Deprivation and Subjective Social Class

Based on the integration of ecological systems theory and the risk and protective factor model, the current study tested whether individual relative deprivation mediated the association between perceived social support and adolescents' experiential avoidance and whether this mediation model was moderated by subjective social class. A sample of 582 senior high school students in China participated in the current survey. The results indicated that perceived social support was negatively related to the students' experiential avoidance. Mediation analysis showed a significant indirect effect of perceived social support on experiential avoidance, via individual relative deprivation. Moreover, the mediation effect of individual relative deprivation was moderated by subjective social class. Specifically, the negative relationship between perceived social support and individual relative deprivation, and the direct relationship between perceived social support and experiential avoidance were stronger for adolescents with low subjective social class. In contrast, the positive relationship between individual relative deprivation and experiential avoidance was stronger for adolescents with high subjective social class.

Roles of Parental Psychological Flexibility, Self-Compassion, and Self-Efficacy in Affecting Mental Health and Quality of Life in Parents of Children with Eczema

Parents of young children with eczema often experience adverse mental health consequences, including depression, anxiety, stress, and a reduced health-related quality of life (HRQoL), due to the unpredictable nature of flare-ups and exacerbations. This study investigated the roles of psychological flexibility, self-compassion, and self-efficacy in fostering parental mental health outcomes and HRQoL while caring for children diagnosed with eczema. Baseline data from an ongoing clinical trial examining the effects of a family acceptance-and-commitment-therapy-based eczema management program (FACT-EMP) on parent-child dyads affected by eczema (N = 110 dyads, 75.5% mothers; 66.4% boys) were analyzed using adjusted hierarchical regression analyses. The findings indicate that psychological inflexibility was significantly associated with symptoms of anxiety, depression, stress, and HRQoL. Self-compassion was significantly linked to all assessed mental health outcomes, whereas self-efficacy showed a significant association only with symptoms of depression. These results underscore the significance of promoting parental psychological flexibility and self-compassion through acceptance and commitment therapy and compassion-based approaches to enhance mental health and quality of life while managing children's eczema.

Non-suicidal self-injury in Chinese college students with elevated autistic traits: Associations with anxiety, rumination and experiential avoidance

Although existing studies have proved that autistic traits (AT) may have relations to non-suicidal self-injury (NSSI) behaviors, its associations with anxiety, rumination and experiential avoidance (EA) are still unclear. The current study, based on a sample of 1317 Chinese college students, explored the associations between AT, anxiety and NSSI, and the possible modulating roles of rumination and EA in these associations. The results shows that 1) a total of 334 (25.36%) students reported a history of NSSI and 30 (2.28%) students were categorized as high AT; 2) Students with high AT reported higher rates of NSSI than those with low AT (36.67% vs. 25.10%); 3) AT, anxiety, rumination and EA have positive relations with NSSI; 4) AT predicted NSSI indirectly through anxiety; 5) Rumination and EA significantly moderated the effects of AT on NSSI via anxiety. In conclusion, this study confirms the indirect effect of AT on NSSI through anxiety in Chinese college students, and further clarifies the reinforcing effects of rumination and EA on the associations between AT, anxiety and NSSI. These findings suggest that developing adaptive emotion-regulating strategies and positive coping styles might promote the prevention and treatment of NSSI behaviors among autistic individuals.

Non-suicidal self-injury and suicidal ideation among Chinese college students of childhood emotional abuse: associations with rumination, experiential avoidance, and depression

Background

Prior studies have proved the relationships between childhood emotional abuse (CEA) histories and suicidal thoughts or behaviors in adulthood, however, how emotion regulation strategies work as the mediating mechanism is necessary to be investigated. This study aimed to further verify the impacts of rumination, experiential avoidance (EA) and depression on the associations between CEA and non-suicidal self-injury (NSSI) and suicidal ideation (SI) on a sample of Chinese college students.

Methods

The Childhood Emotional Abuse Questionnaire, the Non-Suicidal Self-Injury Questionnaire, the Symptom Checklist, the Ruminative Response Scale, the Acceptance and Action Questionnaire-II and the Zung Self-Rating Depression Scale were completed by 1,317 college students.

Results

The rates of NSSI and SI of students with CEA experiences were 31.70 and 7.90% respectively, both higher than those without such experiences. The mediating roles of rumination, EA and depression between CEA and NSSI and SI were significant (p < 0.01).

Conclusion

The current study shed light on the linking roles of rumination, EA and depression in the relations between CEA and NSSI and SI. It is suggested that developing adaptive emotion-regulating strategies may be helpful to the intervention of suicidal thoughts or behaviors among individuals with CEA experiences.

Psychological flexibility, cognitive emotion regulation and mental health outcomes among patients with asthma in Pakistan

Background/Objective

Adults with asthma who experience difficulties in emotion regulation are prone to developing psychopathological symptoms that may affect their self-management activities and symptom control. The current research investigated the role of psychological flexibility and cognitive emotion regulation strategies in relation to mental health outcomes (psychological distress and quality of life) among patients with asthma in Pakistan.

Method

A sample of 200 adults, diagnosed with asthma (32% men, 68% women; M_age = 42.32, SD_age = 16.99), completed the acceptance and action questionnaire (AAQ-II) cognitive emotion regulation questionnaire (CERQ), depression, anxiety, stress scale-21 (DASS-21), asthma-related quality of life questionnaire (AQLQ) and a self-structured demographic sheet.

Results

Results of Pearson product moment correlation showed that most of the adaptive cognitive emotion regulation strategies (positive refocusing, refocus on planning, and positive reappraisal) were positively correlated with psychological flexibility and quality of life, whereas negatively correlated with psychological distress. All the maladaptive strategies of cognitive emotion regulation had a significant inverse relationship with psychological flexibility and quality of life, while positively correlated with psychological distress. Results of serial mediation analysis through PROCESS MACRO showed that catastrophising and anxiety fully mediated the relationship between psychological flexibility and asthma-related quality of life.

Conclusion

Evidence-based interventions should focus on developing psychological flexibility and identifying maladaptive patterns of cognitive emotion regulation strategies for improved mental health and quality of life outcomes for adults with asthma.

Depression mediates the relationship of experiential avoidance and internet addiction: a cross-lagged mediation analysis

Previous research has identified the contemporaneous association between experiential avoidance, depression, and Internet addiction. However, the mechanisms underlying this association are not well acknowledged. The present study aimed to use cross-lagged panel modeling to examine whether depression mediates the relation between experiential avoidance and Internet addiction and whether gender plays a role in the relation. A total of 2731 participants (934 male, Meanage=18.03) were recruited from a university at the baseline study (December 2019). Data was collected at all 3 time points across one year (2019?2020), using 6-month intervals. Experiential avoidance, depression and Internet addiction were assessed using the Acceptance and Action Questionnaire-II (AAQ-II), the Beck Depression Inventory-II (BDI-II) questionnaire, and Young?s Internet Addiction Test (IAT), respectively. Cross-lagged panel models were used to evaluate the longitudinal association and the mediating effect. Multigroup analyses were conducted to examine gender differences in the models.Cross-lagged models indicated that experiential avoidance significantly predicted subsequent depression, and depression significantly predicted subsequent Internet addiction. Furthermore, mediation analyses showed that depression has a mediating effect in the relation between experiential avoidance and Internet addiction (? = 0.010, 95%CI[0.003, 0.018], p>0.001). Multigroup analyses demonstrated that the pattern of structural relations stayed consistent across gender. The findings indicated that experiential avoidance is indirectly related to Internet addiction through depression, suggesting that treatments targeted at reducing experiential avoidance could help relieve depression and thus decrease the risk of Internet addiction.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-023-04511-6.

How does stigma influence depressive symptoms among women who underwent termination of pregnancy for foetal anomaly: A path analysis

AIM AND OBJECTIVES

The purpose of this study was to explore the effect and paths of stigma on depressive symptoms in women who underwent termination of pregnancy for foetal anomaly (TOPFA).

BACKGROUND

Stigma may cause distress and depressive symptoms for women with TOPFA. However, few studies have examined the relationship between stigma and depression in women with TOPFA.

DESIGN

This study followed the STROBE checklist. A cross-sectional survey was conducted among 469 women with TOPFA. The path analysis used hierarchical multiple regression and structural equation model to examine the mediating role of social support and psychological flexibility on the relationship between stigma and depressive symptoms.

RESULTS

Hierarchical multiple regression analysis revealed the mediation effect of psychological flexibility between stigma and depressive symptoms. By contrast, social support did not present such effect. The structural equation model confirmed that stigma, directly and indirectly, affected depressive symptoms.

DISCUSSION

Many women with TOPFA have severe depressive symptoms and that stigma is an important influencing factor. Psychological flexibility plays an essential role in mitigating the effects of stigma on depressive symptoms.

RELEVANCE TO CLINICAL PRACTICE

Healthcare professionals should focus on measuring and intervening on stigma and psychological flexibility for alleviating the depressive symptoms of women with TOPFA. No Patient or Public Contribution.

Cyber Dating Abuse Victimization and Experiential Avoidance Among Chinese Female Adolescents: The Roles of Self-Compassion and Interpersonal Flexibility

Cyber dating abuse victimization (CDAV) among female adolescents is common and harmful; however, little is known regarding how CDAV relates to victims' experiential avoidance in the Chinese context. Drawing from general strain theory, this cross-sectional study investigated possible differences in the relationships among CDAV, experiential avoidance, and self-compassion according to female adolescents' levels of interpersonal flexibility (low vs. high). A sample of 420 female adolescents aged 13 to 17 years (mean age = 15.78 years) who had been in intimate relationships during the past year participated in a voluntary and anonymous paper-and-pencil survey. Participants completed four self-reported measures on CDAV experience, self-compassion, experiential avoidance, and interpersonal flexibility. The findings indicated that nearly 49% of participants had experienced CDAV in the last year; CDAV exposure was directly linked with experiential avoidance and indirectly related to experiential avoidance through self-compassion. Moderation analyses showed that the negative associations between CDAV and experiential avoidance and self-compassion were only significant among participants with low interpersonal flexibility. These findings deepen the understanding of CDAV as a risk factor for reduced self-compassion and increased experiential avoidance in female adolescents. However, high interpersonal flexibility is a potential protector. This study has implications for the prevention of experiential avoidance among female adolescents exposed to CDAV and supports incorporating self-compassion and interpersonal flexibility skills to combat the negative outcomes of CDAV.

The Effect of Mindfulness Intervention on the Psychological Skills and Shooting Performances in Male Collegiate Basketball Athletes in Macau: A Quasi-Experimental Study

BACKGROUND

This study adopted a quasi-experimental design to examine the effect of a 7-week mindfulness intervention on the psychological coping ability and shooting performance of college-level male basketball athletes in Macau.

METHODS

A total of 43 male college basketball athletes in Macau were selected as the participants. Besides the regular basketball training, the intervention group (n = 23) received a 7-week mindfulness training; the weekly mindfulness intervention session lasted around one hour according to the mindfulness training manual for athletes, while the control group (n = 20) did not receive any mindfulness training. Before and immediately after the 7-week intervention, all players performed the following tests: the "Five-Facet Mindfulness Questionnaire", the "Acceptance and Action Questionnaire", the "Sport Competition Anxiety Test", the "Mindfulness Attention Awareness Scale", and three shooting tests. An independent-sample t-test and a paired-sample t-test were used to analyze the between- and within-group differences. Moreover, a repeated measures ANOVA was used to assess the group, time, and group-by-time effects on psychological skills and shooting performances.

RESULTS

The intervention resulted in both significant between-group and within-group differences in mindfulness level, acceptance level, attention level, three-point, and free-throw shooting performances (all p < 0.05, Cohen's d ranging from 0.565 to 1.117).

CONCLUSION

While further study is necessary, the present study suggests that the 7-week mindfulness training program can significantly improve psychological outcomes and shooting performance in Macau college basketball athletes. Future studies involving competition settings and objective metrics will aid in verifying mindfulness as the prevalent practice among basketball practitioners and athletes.

Study protocol of ConquerFear-HK: a randomised controlled trial of a metacognition-based, manualised intervention for fear of cancer recurrence among Chinese cancer survivors

INTRODUCTION

Fear of cancer recurrence (FCR) is a prevalent and frequently debilitating response to a cancer diagnosis, affecting a substantial proportion of cancer survivors. Approximately 30% of local Hong Kong Chinese cancer survivors in a recent survey reportedly experienced persistent high FCR over the first-year post-surgery. This was associated with lower levels of psychological well-being and quality of life. A manualised intervention (ConquerFear) developed primarily based on the Self-Regulatory Executive Function Model and the Rational Frame Theory, has been found to reduce FCR effectively among Caucasian cancer survivors. The intervention now has been adapted to a Chinese context; ConquerFear-HK. The primary aim of this study is to evaluate its efficacy vs a standard-survivorship-care control (BasicCancerCare) in FCR improvement in a randomised control trial (RCT).

METHODS AND ANALYSIS

In this RCT, using the sealed envelope method, 174 eligible Chinese cancer survivors will be randomised to either the ConquerFear-HK or BasicCancerCare intervention. Both interventions include six sessions over 10 weeks, which will be delivered via face to face or online by trained therapists. The ConquerFear-HK intervention incorporates value classification, metacognitive therapy, attentional training, detached mindfulness and psychoeducation; BasicCancerCare includes relaxation training, dietary and physical activity consultations. Participants will be assessed at prior randomisation (baseline; T0), immediately postintervention (T1), 3 months (T2) and 6 months postintervention (T3) on the measures of FCR (Fear of Cancer Recurrence Inventory) as a primary outcome; metacognition (30-item Metacognitions Quesionnaire) and cognitive attentional syndrome (Cognitive-attentional Syndrome Questionnaire) as process outcomes; psychological distress (Hospital Anxiety and Depression Scale), cancer-related distress (Chinese Impact of Events Scale), quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire) and treatment satisfaction are secondary outcomes.

ETHICS AND DISSEMINATION

Ethics approval has been obtained from HKU/HA HKW Institutional Review Board (ref: UW19-183). The patients/participants provide their written informed consent to participate in this study. The study results will be disseminated through international peer-review publications and conference presentations.

TRIAL REGISTRATION NUMBER

NCT04568226.

Examining the roles of experiential avoidance and cognitive fusion on the effects from mindfulness to athlete burnout: A longitudinal study

OBJECTIVES

Athlete burnout is a maladaptive outcome that is potentially detrimental for performance and wellbeing. Cross-sectional evidence suggests that mindfulness might be associated with athlete burnout via experiential avoidance and cognitive fusion. In the current study, we extend knowledge of these hypothesized mediational pathways using a longitudinal design.

METHODS

Data was collected at three occasions with a three-month interval. A final sample of 280 elite Chinese athletes aged 15-32 years (Mage = 19.13; SD = 2.92; Female = 130) reported their mindfulness at Time 1, experiential avoidance and cognitive fusion at Time 2, and athlete burnout at Time 3. Structural equation modelling was adopted to examine the mediating roles of experiential avoidance and cognitive fusion on the effects from mindfulness to athlete burnout.

RESULTS

We found statistically meaningful directs effects from mindfulness (Time 1) to experiential avoidance and cognitive fusion (Time 2), which in turn influenced athlete burnout (Time 3). However, the direct effect from mindfulness at Time 1 to athlete burnout at Time 3 was non-significant. The indirect effects of experiential avoidance and cognitive fusion on the effects from mindfulness to athlete burnout were significant, providing longitudinal evidence that these two variables contribute meaningfully to the mindfulness-burnout pathway.

CONCLUSION

With initial evidence for the mediating effects of experiential avoidance and cognitive fusion, future studies could consider using experimental designs to examine the potential changing mechanisms of mindfulness on reducing athlete burnout.

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

Background

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

Methods

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

Results

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

Conclusions

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

The Development and Validation of the Comprehensive Assessment of Acceptance and Commitment Therapy Processes (CompACT)—Malay Version

Objectives: psychological flexibility is a crucial construct highly correlated with psychological wellness. There is a need for a tool to measure psychological flexibility in order to accurately ascertain the effects of treatment. The existing industry standard, the Acceptance and Action Questionnaire-II (AAQ-II), has issues with conflating psychological flexibility with distress; moreover, it does not cover the hexaflexes. The 23-item CompACT was designed to surmount these limitations. Methods: the classical test theory (CTT) and Rasch measurement theory (RMT) were used to check the validity and reliability of the Malay version of the CompACT Scale. Cronbach’s α, McDonald’s Ω, and greatest lower bound were used to measure internal consistency. A Pearson’s correlation test was used to measure test–retest reliability of the Malay versus the original English version. For validity, convergent validity was established by using the Malay AAQ-7 Scale. The dimensionality of the Malay version of the CompACT Scale was explored using exploratory factor analysis. For the RMT, weighted fit statistics (infit) and outlier sensitive fit statistic (outfit) mean square (MnSq) values were used at the item level, while item and person separation reliability values and item and person separation indices were applied at the scale level. Results: the internal consistency measures, including Cronbach α and McDonald’s Ω, passed the suggested cutoff points. Convergent validity with the AAQ-II was 0.693. The quality of the Malay version of the CompACT Scale was also satisfactory, as all item and person reliability values and indices exceeded the suggested cut-off points. Conclusions: the Malay CompACT is a psychometrically sound instrument to assess psychological flexibility in both clinical and research settings.

The Impact of Baseline Mindfulness Scores on Mindfulness-Based Intervention Outcomes: Toward Personalized Mental Health Interventions

A growing body of evidence has portrayed mindfulness as a useful tool for dealing with a broad range of psychological problems and disorders. This has created the impression that mindfulness-based interventions (MBIs) can be used to treat nearly all psychological difficulties, in all cases. Nonetheless, little research has been done on how individual differences may contribute to intervention outcomes. The goal of this study was to evaluate the role of baseline mindfulness on participants’ outcomes by examining three prior Randomized Controlled Trials that addressed the impact of MBIs on mental health and mindfulness measures. The participants were 164 people, aged between 12 and 45, from both clinical and non-clinical samples. Our findings indicate that at least two thirds of the change produced by these interventions in terms of mindfulness scores can be predicted by the baseline scores of the same variables. We also found that many trajectories are not only strongly influenced by the initial status of the participants, but also by the intervention performed, as attested to by the significant interactions found. These results stress the need to continue doing research in a way that considers the diversity of participants’ trajectories, increasing the room for intervention improvements aligned with a more personalized health care model.

Is it magic? An exploratory randomized controlled trial comparing imagery rescripting and cognitive restructuring in the treatment of depression

BACKGROUND AND OBJECTIVES

To investigate whether working with intrusive images and the use of imagery processes would be beneficial to treating depression, an imagery-based intervention (imagery rescripting, IR) was compared with a more commonly used verbal-based technique (cognitive restructuring, CR). The study aimed not only to test the efficacy of IR as a brief modular treatment for depression, but to explore whether such experiential use of imagery would alleviate the abstract-evaluative, verbal processes of rumination and worry.

METHODS

Forty-one participants diagnosed with clinical depression and who also reported intrusive images underwent one assessment session of imagery properties before they were randomly assigned to an IR group or to an active control group of CR. They then received three weekly sessions of treatment, and outcomes were measured before and after treatment, as well as at two-month follow-up.

RESULTS

The results showed that IR was equally if not more effective than CR in alleviating depression. Significant differential reductions in rumination, worry and experiential avoidance between treatments added support to the technique's experiential nature, and possibly, a defusing out of an abstract-evaluative mode of processing.

LIMITATIONS

Only self-report measures were used, with a small number of treatment sessions by one clinician.

CONCLUSIONS

The findings support the therapeutic potential of imagery modalities in the treatment of depression, which compared to cognitive restructuring, appear to bring about more significant emotional change with time (clinical trial registered at the Joint CUHK-NTEC CREC Ref. No. 2015.458).

Cross-cultural adaptation, reliability, and validity of the Chinese version of the Acceptance and Action Questionnaire-Adult Hearing Loss

OBJECTIVE

Few mental health assessment tools are available for people with hearing loss (HL) in China. The Acceptance and Action Questionnaire-Adult Hearing Loss (AAQ-AHL) has been specifically designed to assess psychological inflexibility in adults with HL and may help assess mental health status promptly for targeted psychological interventions. The study aimed to investigate the cross-cultural validity and reliability of the Chinese version of the AAQ-AHL to assess its applicability to teenagers and adults with HL in China.

DESIGN

A descriptive and correlational study of a convenience sample of students aged above 12 years. All participants were invited to complete an online questionnaire.

STUDY SAMPLES

Participants included 402 students with HL.

RESULTS

The Chinese version of the AAQ-AHL was shown to be an excellent, reliable, and valid instrument that can be used to assess psychological inflexibility in teenagers and adults with HL by clinicians working with Mandarin-speaking populations.

CONCLUSION

Although the AAQ-AHL showed very good psychometric properties in hearing-impaired students aged above 12 years, further testing is needed to validate the measure across other age groups and validate its feasibility and utility in clinical applications.

A Chain Mediation Model of Perceived Stress, Neuroticism, and Psychological Inflexibility on Depressive Symptoms of Chinese New Fathers

There is a growing concern about mental health issues in new fathers, such as postpartum depression (PPD). Factors associated with PPD in men include personality traits and perceived stress. This study examined a set of hypothesized paths using perceived stress, neuroticism, and psychological inflexibility to predict depressive symptoms. A total of 189 participants took part. The mean age of these first-time fathers was 36.12 years (SD = 2.39). Perceived stress, neuroticism, and psychological inflexibility positively predicted new fathers’ depressive symptoms (B = 0.13, 0.37, and 0.31, respectively). These predictors explained 48% (R² = 0.48) of the variance in the measured outcome of depressive symptoms in these new Chinese fathers. The total standardized direct effects of the three variables on depressive symptoms were 0.47 (95% CI [0.38, 0.53]). In conclusion, this study provides novel information about the chain mediating role played by neuroticism and psychological inflexibility in the relationship between perceived stress and PPD. Perceived stress significantly predicted neuroticism and psychological inflexibility, which in turn significantly predicted depressive symptoms in new Chinese fathers. The relationship between perceived stress and depressive symptoms was also mediated by each of psychological inflexibility or neuroticism alone.

Is psychological flexibility a mediator between perceived stress and general anxiety or depression among suspected patients of the 2019 coronavirus disease (COVID-19)?

This study is aimed to investigate the status of general anxiety and depression among suspected patients of COVID-19 and explore whether psychological flexibility can serve as a mediator between perceived stress and general anxiety or depression. Total of 180 participants completed the online questionnaire which comprised demographic information, the Perceived Stress Scale (PSS), the 7-item Generalized Anxiety Disorder scale (GAD-7), the 9-item Patients Health Questionnaire (PHQ-9), the Acceptance and Action Questionnaire-II (AAQ-II) and the Cognitive Fusion Questionnaire (CFQ). Statistical methods including correlation analysis, multiple linear regression analysis and structural equation model were used in this study. The scores of 23.9% (43/180) and 34.4% (62/180) of participants were higher than the cut points of GAD-7 and PHQ-9 respectively. Psychological flexibility was significantly correlated with perceived stress, general anxiety and depression. Multiple regression analyses showed the possible mediation effect of psychological flexibility between perceived stress and general anxiety or depression. The structural equation model confirmed that psychological flexibility partially mediated between perceived stress and general anxiety or depression. Our findings suggested the potential benefit of Acceptance and Commitment Therapy (ACT) as a psychological support approach in suspected patients of COVID-19 because ACT targets psychological flexibility.

Experiential avoidance mediates the association between paranoid ideation and depressive symptoms in a sample from the general population

Psychotic experiences are prevalent in the general population and are associated with negative outcomes, including depressive symptoms. The mechanisms underlying this relationship remain unclear, but new insights could be obtained by exploring the role of transdiagnostic processes such as experiential avoidance, defined as a person's attempts or desires to suppress unwanted internal experiences like thoughts, emotions, memories, or bodily sensations. Studies analyzing the link between negative emotional states and psychotic experiences are scant. We explored the association between a specific kind of psychotic experience (paranoid ideation), experiential avoidance, and depressive, anxiety, and stress symptoms in a sample from the general population. We found that experiential avoidance partially mediates the associations between paranoid ideation and stress and anxiety symptoms and that it fully mediates the association between paranoid ideation and depressive symptoms. Our results suggest that the presence of paranoid ideation and the usage of experiential avoidance to cope with it are vulnerability factors associated with psychological distress.

Examining the Effects of Brief Mindfulness Training on Athletes' Flow: The Mediating Role of Resilience

Background

Flow is characterized by the strong concentration in competitions, eliminating irrelevant thoughts and emotions, integrating all tasks, and continuing the competition smoothly even in challenging situations. The present study was into whether or not brief mindfulness training can improve athletes' flow and further explore the mediating effect of resilience in the intervention.

Methods

The 2 (experimental conditions) × 2 (time) mixed design was used in this study. Fifty-seven student-athletes were recruited and randomly assigned into either a brief mindfulness group (n = 29) or a control group (n = 28). Before and after the intervention, every participant completed a self-report measure including mindfulness, flow, and resilience.

Results

Participants in the brief mindfulness group showed increased mindfulness, flow, and resilience (p < 0.001) after brief mindfulness training; when putting resilience change (B = 0.30, 95% CI [0.031, 0.564]) into the equation, the direct (95% CI [3.156, 13.583]) and indirect (95% CI [0.470, 5.048]) effects of mindfulness training were both significant.

Conclusion

It was concluded that brief mindfulness training could significantly improve athletes' flow and resilience, and resilience partly mediated the effects of brief mindfulness training on flow.

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

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

Psychometric Properties and Factor Structure of the Spanish Version of the Acceptance and Action Questionnaire-II (AAQ-II) in Ecuador

(1) Background: The Acceptance and Action Questionnaire-II (AAQ-II) is the most well-known self-report measure to assess psychological inflexibility, a transdiagnostic pathological process, and targets for interventions. Objective: The aim of this study was to analyze the psychometric properties and factorial structure of the Ecuadorian Spanish version of the AAQ-II in a large sample of college students in Ecuador. (2) Methods: A total of 7905 students, 46.26% male and 53.75% female, from 11 Ecuadorian universities were surveyed. The AAQ-II was tested for factorial structure, reliability, and correlations with other health-related measures. (3) Results: The AAQ-II showed an unidimensional factorial structure, accounting for 66.87% to 70% of the total variance and showing a good fit of the data to the model (comparative adjustment index (CFI) = 0.995; goodness of fit index (GFI) = 0.992; Standardized Root Mean Squared Residual (SRMR) = 0.037; mean square approximation error (RMSEA) = 0.047, CI90% = 0.038-0.056). Reliability was optimal (Cronbach's α = 0.919; ω = 0.928), and AAQ-II scores significantly correlated with multiple health indicators. Psychological inflexibility was significantly higher in women than men. (4) Conclusions: The Spanish version of the AAQ-II showed good psychometric properties, which further supports psychological inflexibility, not just as a transdiagnostic process.

The effects of alexithymia, experiential avoidance, and childhood sexual abuse on non-suicidal self-injury and suicidal ideation among Chinese college students with a history of childhood sexual abuse

BACKGROUND

Although previous studies have shown that childhood sexual abuse (CSA) experiences might be related to suicide-related thoughts and behaviours in later life, the effects of alexithymia and experiential avoidance (EA) on this relationship have remained unclear. The present study aimed to expand prior findings among Chinese college students with a history of CSA in order to further test the effects of alexithymia on the relationship between CSA and non-suicidal self-injury (NSSI) and suicidal ideation (SI), and its indirect effects on NSSI and SI through EA.

METHODS

The Childhood Sexual Abuse Questionnaire, the Toronto Alexithymia Scale-20, the Acceptance and Action Questionnaire-II, the Non-Suicidal Self-Injury Questionnaire, and the Symptom Checklist were completed by 6,834 college students (3,829 female).

RESULTS

Overall, 1404 (20.76%) Chinese college students reported experiences of CSA; students with CSA experiences reported higher rates of SI and NSSI than those without CSA (12.82% vs. 4.50%, 35.11% vs. 20.82%). CSA, alexithymia, and EA were positively related to NSSI and SI. The effect of alexithymia on the relationship between CSA and NSSI and SI were significant. The effects of EA on the relationship between alexithymia and NSSI and SI were significant, too.

LIMITATIONS

The major limitations of this study are its cross-sectional design and the use of self-report scales, especially retrospective self-reports (e.g., the Childhood Sexual Abuse Questionnaire).

CONCLUSIONS

This study cast light on the effects of alexithymia, EA, and CSA on NSSI and SI in Chinese college students with a history of CSA. These findings can contribute to the prevention and treatment of suicide-related thoughts and behaviours.

Psychological Flexibility Among Competitive Athletes: A Psychometric Investigation of a New Scale

There is increasing interest in applying acceptance and mindfulness interventions among athletes. However, there is a lack of sport-specific psychometrically evaluated scales to measure the impact of these interventions. The present study describes the development of a measure: the Psychological Flexibility in Sport Scale (PFSS). Its validity was tested in two studies. In the first study, with 152 elite athletes from various sports, explorative factor analysis was used to evaluate the scale's validity, and one factor emerged with seven items. Significant correlations between psychological flexibility, performance, and quality of life were found. Moreover, the PFSS was significantly negatively associated with age, number of years in sport, and number of years as an elite athlete. In the second study, the confirmatory factor analysis with a new population (252 athletes) supported the one-factor solution. Further, positive associations were found with anxiety (BAI) and depression (BDI-I), indicating construct validity. In conclusion, this study presents a scale for measuring psychological flexibility in a broad range of athletes, with satisfactory psychometric properties and the potential to be a useful instrument for both researchers and clinicians in the sport field.

Translating, modifying, and validating the Adult Picky Eating Questionnaire for use in China

OBJECTIVE

The aim of this study was to translate, modify, and validate the Adult Picky Eating Questionnaire (APEQ) for use in China.

METHODS

Based on standard procedures, the APEQ was translated into Chinese. Four items were added in the final Chinese version of the APEQ (C-APEQ). For testing the psychometric properties of the C-APEQ, a total of 1069 participants (17-24 years; 52.57% women) were recruited from two universities in mainland China.

RESULTS

Exploratory factor analysis and confirmatory factor analysis supported the previous four-factor structure of the APEQ. Findings also showed that the C-APEQ had adequate internal consistency (α = 0.874) and test-retest reliability (ICC = 0.778). The C-APEQ demonstrated strong measurement invariance across gender. Furthermore, the C-APEQ composite score presented positive and significant correlations with eating disturbance, psychological distress, and psychological inflexibility. It also showed a negative and significant correlation with food-related life satisfaction.

CONCLUSION

Findings suggested that the Chinese version of the APEQ demonstrated sound psychometric properties. Thus, the C-APEQ can be a useful tool in future studies to accurately assess picky eating among adult population and explore the relationships between picky eating and other physical and psychological outcomes in a Chinese context.

Psychometric properties of the acceptance and action questionnaire (AAQ II) Malay version in cancer patients

OBJECTIVES

Acceptance and action questionnaire (AAQ II) is a scale used to assess psychological inflexibility. The aim of this study is to translate AAQ II into Malay language and evaluate the psychometric properties of AAQ II Malay version.

METHODS

The AAQ II which has been translated into Malay language via back translation procedure was distributed to 101 cancer patients and 100 non-cancer patients. The evaluation of psychometric properties in this study included content validity index, internal consistency, parallel reliability, exploratory factor analysis, concurrent validity, sensitivity and specificity of AAQ II Malay version.

RESULTS

AAQ II Malay version has established good content validity index, acceptable internal consistency with Cronbach's alpha value of 0.91, excellent parallel reliability and adequate concurrent validity. Exploratory factor analysis (EFA) results demonstrated AAQ II Malay version is a unidimensional factor instrument. The result of sensitivity and specificity of AAQ II Malay version indicated cancer patients who scored more than 17.5 were having significant psychological inflexibility.

CONCLUSION

AAQ II Malay version is a reliable and valid instrument to measure psychological inflexibility among cancer patient in Malaysia.

The Values, Acceptance, and Mindfulness Scale for Ice Hockey: A Psychometric Evaluation

There is an increased interest in mindfulness, acceptance, and values based skills training interventions in sports but there is a lack of psychometrically evaluated instruments to investigate the processes adapted to sport populations. This paper describes the development and investigation of an instrument that measure acceptance, mindfulness, and values for ice hockey players. Ice hockey players at elite and sub elite level (n = 94) in Sweden participated in the study. The results reveal that the values, acceptance, and mindfulness (VAMS) shows acceptable internal consistency (α = 0.76) and satisfactory validity. Furthermore, scores on the VAMS predicts ice hockey performance as measured by assists and team points. Future research is suggested to evaluate the sensitivity of the instrument for longitudinal research design studies. In conclusion, VAMS is a useful instrument for practitioners and researchers to increase the knowledge in how psychological processes such as acceptance, mindfulness, and values influence performance among ice hockey players.

Assessing acceptance in mindfulness with direct-worded items: The development and initial validation of the Athlete Mindfulness Questionnaire

PURPOSE

The purpose of the current study was to develop and validate a sport-specific mindfulness measure, the Athlete Mindfulness Questionnaire (AMQ), through 5 related studies using 4 separate samples of Chinese athletes. The AMQ is a 3-factor measure designed to assess mindfulness that reflects present-moment attention, awareness, and acceptance in a sport context.

METHODS

In Study 1, an initial pool of items was generated based on previous literature, existing mindfulness scales, as well as interviews with and feedback from the athletes, coaches, and mindfulness experts. Initial support for the 3-factor structure of the AMQ was established via exploratory factor analysis in Study 2, and cross-validated through confirmatory factor analysis in Studies 3 and 4. In Study 5, a modified 3-factor AMQ with direct-worded acceptance items was examined in a fourth independent sample.

RESULTS

Convergent and concurrent validities of the acceptance subscale failed to be established in Studies 3 and 4 which may be due to the inattention and confusion of the athletes whilst interpreting the reverse-worded items. A modified 16-item AMQ in Study 5 displayed satisfactory model fit and acceptable internal consistencies. Most importantly, convergent and concurrent validities of the 16-item AMQ were supported. The 3 subscales showed significant positive associations with mindfulness, flow, well-being, and positive affect and significant negative associations with experiential avoidance, burnout, and negative affect.

CONCLUSION

The AMQ is a psychometrically sound measure of mindfulness in a sport context. The importance of using direct-worded acceptance items is discussed.

Impact of psychological inflexibility on depressive symptoms and sleep difficulty in a Japanese sample

Background

Psychological inflexibility is a core concept in the acceptance and commitment therapy (ACT) model. The current study hypothesized and tested two models in which psychological inflexibility was linked with higher levels of depressive symptoms and sleep difficulty.

Results

To attain data, Japanese university students (N = 633) completed questionnaires related to psychological inflexibility, depressive symptoms, and sleep difficulty. Psychological inflexibility was significantly correlated with higher levels of both depressive symptoms (r = 0.61) and sleep difficulty (r = 0.39). Structural equation modeling showed that psychological inflexibility was associated with higher levels of depressive symptoms after controlling for the effect of sleep difficulty. Additionally, psychological inflexibility was correlated with higher levels of sleep difficulty after controlling for the effect of depressive symptoms. These findings might assist with motivating clinicians to use ACT for insomnia.

Conclusions

The current study found that greater psychological inflexibility was linked with high levels of depressive symptoms and sleep difficulties. These findings might assist with motivating clinicians to use ACT for insomnia.

Psychological inflexibility and depressive symptoms among Asian English speakers: A study on Indian, Philippine, and Singaporean samples

Psychological inflexibility is a core concept in Acceptance and Commitment Therapy. The primary aim of this study was to examine psychological inflexibility and depressive symptoms among Asian English speakers. A total of 900 adults in India, the Philippines, and Singapore completed some measures related to psychological inflexibility and depressive symptoms through a Web-based survey. Multiple regression analyses revealed that higher psychological inflexibility was significantly associated with higher levels of depressive symptoms in all the samples, after controlling for the effects of gender, marital status, and interpersonal stress. In addition, the effect sizes of the changes in the R(2) values when only psychological flexibility scores were entered in the regression model were large for all the samples. Moreover, overall, the beta-weight of the psychological flexibility scores obtained by the Philippine sample was the lowest of all three samples.

Spanish Validation of the Avoidance and Fusion Questionnaire for Youth (AFQ-Y)

Psychological inflexibility (PI) refers to the overarching and nonadaptive avoidance of thoughts and feelings. PI is a transdiagnostic process that is present in numerous psychopathologies, such as anxiety and mood disorders, addictive behaviors, and chronic pain, as presented by American adults and adolescents. Despite the high rates of depression and depressed mood among Spanish and Latino adolescents and the observed relation between PI and adjustment problems at this age, an instrument assessing PI in Spanish-speaking adolescents is lacking. In this study, we assessed the psychometric properties of a Spanish adaptation of the Avoidance and Fusion Questionnaire for Youth with 483 students from Spain (mean age 13.89 years). The Spanish Avoidance and Fusion Questionnaire for Youth proved to be a two-factor psychometrically sound instrument. Total PI scores correlated positively with depression and negatively with satisfaction with life. The predictive validity results showed cognitive fusion and experiential avoidance to be two interrelated but distinct processes that characterize PI.