Caring for someone with an acquired brain injury: The role of psychological flexibility

Caregivers of individuals with dementia experience care-related burden and stressful reactions to behavioral and psychological symptoms of dementia (BPSD) which can negatively impact multiple domains of life, including decreased global quality of life (QoL). Transdiagnostic interventions, such as those using Acceptance and Commitment Therapy (ACT) benefit dementia caregivers by addressing underlying mechanisms that impact depression, anxiety, QoL, and more. The transdiagnostic mechanism in ACT is psychological flexibility. The current study used pre-intervention (T1), post-intervention (T2) and 6-week followup (T3) data from a study of caregivers using a 6-session online, self-guided ACT program, tailored to dementia caregiving. Stepwise regression analyses (N=79) tested longitudinal mediation, examining if T2 psychological flexibility (CompACT; Francis et al., 2016), explained associations between T1 caregiver burden (Bédard et al., 2001) and T3 QoL (de Boer et al., 2004). A similar model used T1 stress reactivity of BPSD (Teri et al., 1992) as the independent variable, instead of burden. Based on correlations, both models controlled for whether the caregiver lived with the care receiver. Results indicate that psychological flexibility partially mediated the impact of burden on QoL, and fully mediated the impact of stress reactivity on QoL. Findings suggests that psychological flexibility may be an important mechanism in mitigating the impact that care-specific stress experiences have on global QoL. Caregivers often cannot leave this role, requiring them to learn to live with care-related stress in ways that do not damage their long-term wellbeing. Psychological flexibility is amenable to intervention and ACT offers promising solutions in dementia caregivers.

Purpose: Within the framework of Acceptance and Commitment Therapy, the study aimed to examine the extent to which psychological flexibility predicted future anxiety among university students and whether core components of psychological flexibility, which are mindfulness, valuing (progress and obstruction), and cognitive defusion, explained additional variance in future anxiety beyond the psychological flexibility. Method: A correlational research design was used in this study. The sample consisted of 336 undergraduate students (213 females, 119 males, and four who did not disclose their gender) enrolled at universities in Ankara, Türkiye, with ages ranging from 18 to 29 years. Hierarchical regression analysis was conducted to test the proposed model. Findings: The results indicated that the final model accounted for 32% of the variance in future anxiety. Individuals with higher levels of psychological flexibility, mindfulness, and cognitive defusion reported lower levels of future anxiety, whereas those with greater value-related obstruction reported higher levels of future anxiety. Progress in values did not significantly predict future anxiety. Conclusion: The findings underscore the critical role of Acceptance and Commitment Therapy in understanding and addressing future anxiety among emerging adults.

Cancer significantly impacts overall satisfaction with life (SWL). Psychological flexibility (PF) involves adapting to situational demands, balancing life demands, and committing to value-aligned behaviours, which can help survivors manage cancer-related distress. Given the lack of research examining how PF affects relationship and sexual satisfaction, our purpose was to elucidate the relationship between variables associated with partner intimacy, pillars of PF, and variables related to psychological wellness. We explored relationships between SWL and the pillars of PF (Valued Action, Behavioural Awareness, Openness to Experience) as mediating factors in the association between relationship and sexual satisfaction and SWL. Participants (113 male, 106 female) completed questionnaires measuring sexual function, intimacy, relationship and sexual satisfaction, PF, SWL, anxiety, and depression. Results indicated an equal percentage (57.5%) of males and females reported sexual dysfunction; however, varied patterns of relationships emerged between the sexes. There were significant relationships between SWL and relationship and sexual satisfaction. The mediation analyses showed that valued action and openness to experience partially mediated the relationship between relationship satisfaction and SWL. Interestingly, Valued Action was the only pillar of PF that emerged as a partial mediator between sexual satisfaction and SWL. Thus, value-aligned behaviours may be a key focus for intervention in cancer survivors.

Personality is known to be a reliable predictor of well-being. However, it is rather difficult to influence the personality of individuals in order to improve their well-being. Therefore, it is important to examine possible underlying mechanisms or indirect effects. Consequently, the aim of the current study was to investigate whether psychological flexibility is a mechanism explaining the relationship between personality and well-being. Given the evidence that age-related differences exist in personality, flexibility, and well-being, we also investigated whether our indirect effects model differed in both older and younger adults. We used a cross-sectional design. Participants were asked to fill in questionnaires at home. We recruited 138 younger (25-50 years) and 120 older (65+) adults from a community-dwelling population. Self-report questionnaires were used to assess (mal)adaptive personality traits (Big Five), psychological flexibility, and affective and general subjective well-being. Similar indirect effects were found in older and younger adults: Psychological flexibility is a mechanism explaining the link between personality and well-being. In nearly half of the models, psychological flexibility even fully accounted for the effect of personality on well-being. These results have important implications for clinical practice, since psychological flexibility, contrary to personality traits, is malleable. Interventions to increase psychological flexibility already exist and are validated in both older and younger samples. They may hold promise to improve well-being.

IntroductionThe overarching goal of ACT is to increase psychological flexibility, which can be enhanced through mechanisms such as acceptance, valued-driven actions, or mindfulness. Several meta-analyses confirm the effectiveness of Acceptance and Commitment Therapy (ACT) in the treatment of clinical and subclinical populations, including patients diagnosed with depressive disorder and insomnia, largely within outpatient settings. However, there is no scientific research evaluating the efficacy of ACT as an adjunct treatment for psychiatric inpatients with depression. This study aimed to evaluate the efficacy of a manualized ACT treatment in addition to treatment as usual (TAU), within an inpatient setting for patients diagnosed with depressive disorder and comorbid insomnia.MethodEight psychiatric inpatients received eight ACT sessions (two per week), in addition to TAU, which involved cognitive behavioral therapy (CBT) and psychiatric medication. A single case series design with an A-B replication across inpatients was implemented. Patients were assessed one week (T1) and one day (T2) before ACT treatment (while already receiving TAU), as well as one week (T3) and three months (T4) after treatment termination. Symptom improvement was assessed using self-report questionnaires: Beck Depression Inventory-II (BDI-II), Regensburger Insomnia Scale (RIS), Acceptance and Action Questionnaire-II (AAQ-II), Sleep Problem Acceptance Questionnaire (SPAQ), and quality of life (WHOQOL-BREF).ResultsNo significant change was observed from T1 to T2 (p >.05). However, significant improvement from T2 to T3 and T2 to T4 was found for depressive symptoms, insomnia, psychological flexibility, acceptance of insomnia symptomatology, and quality of life related to physical and psychological symptoms.DiscussionThe findings suggest that ACT is a promising adjunct intervention, applicable transdiagnostically for individuals suffering from depression and comorbid insomnia in inpatient settings. By enhancing psychological flexibility and symptom acceptance, ACT may offer unique benefits beyond traditional CBT, particularly for patients with residual symptoms, chronic distress, or recurrent depressive episodes. Despite these promising findings, results must be interpreted with caution due to the small sample size and lack of a control group. Future research should replicate and extend these findings in larger randomized controlled trials to further evaluate ACT’s potential in inpatient psychiatric care.

The COVID-19 pandemic has contributed to an increase in psychological distress. However, protective factors such as social support, psychological flexibility, and coping mechanisms can help individuals cope with the effects of psychological distress. This study aimed to test a recent hypothesis suggesting that psychological flexibility is not necessarily a coping strategy but a mechanism that can influence the coping strategies an individual employs during stressful events. We tested a mediation model that COVID-19 concerns would contribute to higher levels of perceived social support, which would directly increase psychological flexibility, and finally test if the effect of psychological flexibility on distress was mediated by approach and avoidant coping strategies. The results show that social support facilitates higher levels of psychological flexibility. Further, that psychological flexibility indirectly reduces psychological distress by reducing avoidant coping and increasing approach coping strategies. Within the context of COVID-19, we have shown the importance of social support and psychological flexibility for reducing distress. We have provided further evidence that psychological flexibility might not be a coping mechanism but a strategy that leads individuals to engage in more approach coping strategies and fewer avoidant coping strategies.

The implementation of lockdowns and the Covid-19 pandemic situation have negatively impacted mental health (anxiety, depression). However, little is known about individual differences in the longitudinal reactions to lockdown. We designed a longitudinal study (a) to identify the various trajectories of symptoms of depression and anxiety in the general population during and after lockdown; (b) to determine which positive psychological resources prevent individuals from falling into groups with the most severe trajectories; (c) to test the mediating role of psychological flexibility. We collected and analysed longitudinal data on a sample of French participants (N = 1399, Mage = 43.4; SDage = 12; 87.8% women) during the end of the first lockdown. Participants were asked to report their psychological resources and (in)flexibility at baseline and symptoms of anxiety and depression at each measurment occasion (five weekly observations from 17 March to 11 May 2020, including baseline). Using growth mixture modelling, seven dynamic profiles of symptoms were identified: four for depression and three for anxiety. Resilience emerged as the most frequent trajectory. Wisdom, optimism, hope, self-efficacy and peaceful disengagement significantly prevented individuals from belonging to the symptomatic groups. Moreover, psychological flexibility emerged as a significant mediator of these effects. This study highlights the importance of cultivating protective factors and psychological flexibility to prevent mental health damage during potentially traumatic events (PTE) and to favour resilience trajectories.

Acceptance and Commitment Therapy (ACT) is an approach that is increasingly found to be very helpful for adjustment following acquired brain injury. The ACT Matrix is a perspective taking tool that can help support cognitive difficulties in the adjustment process and lead to greater ‘psychological flexibility’ and vitality. The utility of the ACT Matrix is demonstrated with a client with a severe brain injury.

Purpose and Objective: Psychological distress is known to contribute to recovery following mild traumatic brain injury (mTBI) and there is a need to understand the mechanisms that contribute to this relationship. The present study examined psychological flexibility, as a hypothesized psychological mechanism, in 169 treatment-seeking adults with mTBI. Research Method/Design: Participants completed self-report measures of postconcussion symptoms, psychological distress (anxiety, stress, and depression) and functional status within four weeks of entry to an mTBI outpatient clinic. A general measure (Acceptance and Action Questionnaire), as well as a context-specific (Acceptance and Action Questionnaire-Acquired Brain Injury) measure of psychological flexibility were administered. Results: Simple linear regression analysis showed that psychological flexibility made a significant contribution to the prediction of postconcussion symptoms and functional status. A series of multiple mediation analyses also found that psychological flexibility had a significant indirect effect on the relationships between psychological distress and postconcussion symptoms, and functional status. The context-specific, rather than the general measure of psychological flexibility, was consistently shown to contribute to these findings. Conclusions/Implications: These results suggest that psychological flexibility is a psychological mechanism that contributes to recovery outcomes in individuals with mTBI and could therefore be an important treatment target in mTBI interventions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

ABSTRACTBackgroundIntensive care unit (ICU) nurses frequently encounter ethical dilemmas, patient death and emotional distress, which can shape attitudes towards end‐of‐life care. Spiritual coping and psychological flexibility may support nurses' well‐being and caregiving behaviour, but the mechanisms by which these factors affect ICU nurses' attitudes towards end‐of‐life care remain underexplored, particularly in Eastern cultural contexts.AimsTo examine associations between spiritual coping, psychological flexibility and attitudes towards end‐of‐life care among ICU nurses, and to test whether psychological flexibility mediates the spiritual coping–attitude relationship.Study DesignA cross‐sectional study was conducted between November and December 2024 in a large teaching hospital in China. Participants were selected using convenience sampling, and data were collected using the Chinese versions of the Spiritual Coping Questionnaire, Comprehensive Assessment of Acceptance and Commitment Therapy Processes (CompACT) and the End‐of‐Life Care Attitude Scale for Medical Workers. Descriptive statistics, group comparisons, Pearson correlations, multiple linear regression and PROCESS (Model 4) bootstrap mediation were used.ResultsA total of 244 ICU nurses were included. Psychological flexibility and spiritual coping were positively correlated with attitudes towards end‐of‐life care (r = 0.635 and r = 0.282, both p < 0.001). In regression, psychological flexibility (p < 0.001), spiritual coping (p = 0.015), death education (p < 0.001), end‐of‐life care practice (p < 0.001) and educational level (p = 0.036) were significant predictors; the model explained 67.9% of the variance (R2 = 0.679). Bootstrap mediation showed a significant indirect effect of spiritual coping on attitudes via psychological flexibility (indirect effect = 0.118, 95% CI 0.064–0.193), accounting for 48.96% of the total effect.ConclusionsICU nurses with greater spiritual coping report more positive end‐of‐life care attitudes, partly through higher psychological flexibility. Interventions integrating Acceptance and Commitment Therapy–informed flexibility training with culturally sensitive spiritual support and structured death education may strengthen nurses' preparedness for end‐of‐life care.Relevance to Clinical PracticeIncorporating psychological flexibility and spiritual coping into continuing education could enhance ICU nurses' resilience and improve end‐of‐life care quality.

Maladie de Parkinson dans le service de neurologie du CHU Gabriel-Touré de Bamako : intérêt du test à la L-dopa dans le diagnostic de la maladie

BackgroundEuthymia is characterized by the lack of mood disorders, the presence of positive affects, psychological flexibility and well-being, a unifying outlook on life, and resistance to stress. The Euthymia Scale (ES) is a 10-item self-rating clinimetric index assessing euthymia.ObjectivesThe present study was conducted to examine the clinimetric sensitivity and concurrent validity of the Japanese version of the Euthymia Scale (ES-J).MethodsA cross-sectional online survey was conducted. The Mini-International Neuropsychiatric Interview was used to determine the presence of past or current major depressive episodes (MDE). The clinimetric sensitivity was evaluated using the Analysis of Variance (ANOVA). Pearson’s correlation coefficients were performed to examine the concurrent validity of the ES-J.ResultsA total of 1030 eligible participants completed the survey. The ES-J differentiated healthy subjects from complete remission (i.e., those with a past history of MDE without current MDE) (p < 0.001), from those with past or current history of MDE (p < 0.001), subjects with current MDE from those with sub-threshold symptoms of depression (p < 0.001), and healthy participants from subjects with moderate to severe symptoms of psychological distress (p < 0.001). The associations between the ES-J and measures of psychological well-being, resilience, life satisfaction, and social support were significantly positive (0.353 < r < 0.666, p < 0.001). A negative relationship between the ES-J and measures of psychological distress was also found (r = − 0.595, p < 0.001).ConclusionsThe findings of the present study indicated that the ES-J is a valid and highly sensitive clinimetric index, which can be used as a screening measure in the clinical process of assessment of recovery, particularly when symptoms are expected to be mild and/or when dealing with subclinical symptoms of psychological distress and depression. The findings of this study also support the use of the ES-J to detect vulnerability to depression and to identify subjects at higher risk of relapse.

Fear of childbirth (FOC) is a significant issue for many women. However, findings from studies of psychological interventions to reduce FOC are equivocal. Resource constraints highlight the need for brief interventions. Previous research demonstrated that a face-to-face single session acceptance and commitment therapy (ACT) intervention showed promise. The National Health Service (NHS) Long Term Plan for England highlights a wish to increase digitalization. There is a need to test online adaptations of interventions. This study aimed to assess the feasibility and acceptability, and preliminary indications of effectiveness of an online ACT group intervention for individuals who experience FOC in their first pregnancy. Participants were recruited via an NHS maternity service to attend an online two-session, small group, ACT intervention. Information on recruitment, retention, and qualitative and quantitative feedback on the sessions was gathered. Primary outcome measures (FOC and anxiety) and secondary measures (psychological flexibility and coping style) to identify potential mechanisms of change were completed pre-intervention and 2 weeks following the second session. Seven two-session groups ran with 25 individuals participating in both sessions, indicating good feasibility. All participants were retained and provided follow-up data. Feedback information suggested that the intervention was highly acceptable. Statistical and clinical reductions in FOC and anxiety were found. Statistically significant changes in psychological flexibility and coping style offer preliminary hypotheses regarding potential mechanisms of change. A two-session online ACT group intervention tailored for FOC appears feasible and acceptable and shows promise in terms of impact. A pilot randomized controlled trial is warranted.

Veteran traumatic experiences and negative mental health outcomes have long been a topic of discussion within the research community. It is well established that posttraumatic stress disorder (PTSD) symptoms are associated with aggression and intimate partner violence (IPV), though the mechanisms by which PTSD leads to these behaviors are not fully understood. Some research suggests that how an individual experiences their emotions or processes their thoughts contributes to aggression in individuals with a history of trauma. For example, both psychological flexibility (a person’s ability to remain in the present moment despite unpleasant feelings or experiences) and social information processing (how a person interprets social interactions and decides how to respond) are two possible processes that may explain exacerbated PTSD symptoms and a higher propensity of aggressive outcomes in veterans. In this current study, a sample of 949 veterans were surveyed to discover whether psychological flexibility and/or processing social information in a hostile way explained the relationship between PTSD symptomology and aggression/IPV. Each participant completed a self-report questionnaire detailing PTSD symptomology, psychological flexibility, whether he/she was more prone to hostile attribution bias, and the presence of aggression and/or IPV. PTSD symptoms were found to be predictive of psychological inflexibility, aggression, and IPV. It was also discovered that a veteran’s psychological inflexibility partially explained the relationship between PTSD symptoms and IPV. Finally, gender differences were examined to see if a moderating effect would take place between PTSD symptoms and aggression/IPV but was not found to be significant.

Introduction There is a high prevalence of depression and burnout in allied health students, emphasising the need to understand predictors of these outcomes. Examining perfectionism as a transdiagnostic process could extend understanding of these poor mental health outcomes, particularly understanding how rigidity and inflexibility in pursuing high standards impact depression and burnout in allied health students. Objectives This study investigates how psychological inflexibility may clarify understandings of perfectionism as a transdiagnostic process. A multidimensional approach to psychological flexibility was used to examine its mediating role in the relationships of perfectionism and depression, and perfectionism and burnout. Methods A cross-sectional correlational study design was used with 187 allied health students aged between 19 and 53 years old completing an online survey. Data were analysed using correlational and parallel mediation analysis. Results Higher levels of perfectionism were associated with greater depression (r = .38, p < .01) and burnout (r = .32, p < .01). Parallel mediation found cognitive fusion and experiential avoidance to mediate the perfectionism–depression relationship, whereas cognitive fusion and committed action meditated the perfectionism-burnout relationship. Conclusions These findings suggest psychological flexibility contributes to understanding of perfectionism as a transdiagnostic process.Individuals high in perfectionism tend to be strongly guided by rules about themselves, avoid distress, lack present moment awareness, and are inactive with valued goals. While, shared psychological flexibility processes account for the perfectionism–burnout relationship, cognitive fusion had a greater explanatory role in the perfectionism–depression relationship.