The relationship between acceptance and commitment therapy processes and the well-being of adults with acquired facial palsy

Acceptance and commitment therapy (ACT), based in the psychological flexibility model, may benefit people with chronic abdominal pain. The current study preliminarily investigates associations between psychological flexibility processes and daily general, social and emotional functioning in chronic abdominal pain. An online survey comprising measures of psychological flexibility processes and daily functioning was distributed through social media. In total, 89 participants with chronic abdominal pain were included in the analyses. All investigated psychological flexibility processes significantly correlated with pain interference, work and social adjustment, and depression, in the expected directions (|r| = .35-.68). Only pain acceptance significantly correlated with gastrointestinal (GI) symptoms, r = -.25. After adjusting for pain in the analyses, pain acceptance remained significantly associated with all outcomes, |β| = .28-.56, but depression. After adjusting for pain and pain acceptance, only cognitive fusion remained significantly associated with anxiety, β = -.27, and depression, β = .43. When contrasting GI-specific anxiety with psychological flexibility processes, pain acceptance was uniquely associated with pain-related interference and work and social adjustment, and cognitive fusion and committed action were uniquely associated with depression. Psychological flexibility processes were positively associated with daily functioning in people with chronic abdominal pain. ACT may provide benefit for these people. Further studies with experimental designs are needed to examine the utility of ACT for people with abdominal pain.

Fatigue is commonly reported by people with chronic pain. The purpose of the current study was to examine Acceptance and Commitment Therapy (ACT), based on the Psychological Flexibility (PF) model, for fatigue in chronic pain. This study included 354 adults attending an interdisciplinary ACT-oriented treatment for chronic pain. T-tests and analyses of clinically meaningful change were used to investigate participant improvements in fatigue interference after the treatment. Pearson's correlations and hierarchical regressions were conducted to investigate associations between improvement in fatigue interference and improvements in PF processes. Finally, mixed effects models were used to explore associations between baseline fatigue interference and changes in treatment outcome measures. Participants improved in fatigue interference (d = 0.37), pain, some PF processes and daily functioning (d = 0.18-1.08). 39.7% of participants demonstrated clinically meaningfully improvements in fatigue interference. Changes in fatigue interference was associated with changes in pain, PF processes and daily functioning, |r| = 0.20-0.46. Change in fatigue interference was associated with change in pain acceptance independent of change in pain, β = -0.36, p < .001. However, baseline fatigue interference did not predict any treatment outcome. Overall, people with fatigue appeared to benefit from the ACT-oriented interdisciplinary treatment for chronic pain, and relatively higher levels of fatigue did not appear to impede this benefit. ACT-based treatments may benefit people with chronic pain and fatigue. Future studies including experimental designs, and studies investigating other PF processes, are needed to better understand the utility of ACT for comorbid fatigue and pain. This study investigates the association between fatigue interference and psychological flexibility processes in chronic pain, and the first one investigating fatigue interference as a predictor of functioning in chronic pain following Acceptance and Commitment Therapy (ACT)-based treatment. Findings of the study provide preliminary evidence for the association between ACT and fatigue in people with chronic pain and support the potential benefit of ACT for people with comorbid chronic pain and fatigue.

The purpose of this study was to examine the effectiveness of acceptance and commitment therapy (ACT) for older adults with chronic pain. Secondarily, we examined the associations between changes on processes of psychological flexibility and treatment outcome variables. Participants were 60 adults with chronic pain age 65 and older selected from a larger consecutive sample of 928 adults of any age. All participants had longstanding pain that was associated with significant distress and disability. Participants completed measures of pain, functioning, and depression, and processes of psychological flexibility at baseline, immediately post-treatment, and at a 9-month follow-up. Treatment consisted of a 2- or 4-week residential program based on principles of ACT delivered by an interdisciplinary team. Treatment was designed to increase daily functioning by enhancing key processes of psychological flexibility, including openness, awareness, and committed action. Participants showed significant improvements in functioning and mental health at posttreatment. Participants also showed significant increases in pain acceptance and committed action from pre- to post-treatment. Small effect sizes were observed for most treatment outcome and process variables in the pre-treatment to follow-up intervals; however, these improvements were not statistically significant. In secondary analyses, changes in facets of psychological flexibility were significantly associated with improvements in social functioning and mental health. This study supports the potential effectiveness of ACT for chronic pain among older adults. Future research is needed to determine how to maximize the impact of this treatment, particularly through greater impact on psychological flexibility.

Psychological Flexibility as Shared Process of Change in Acceptance and Commitment Therapy and Exposure and Response Prevention for Obsessive-Compulsive Disorder: A Single Case Design Study

Acceptance and commitment therapy (ACT) for chronic pain aims to improve patient functioning by fostering greater psychological flexibility. While promising, ACT treatment process research in the context of chronic pain so far has only focused on a few of the processes of psychological flexibility. Therefore, this study aimed to more comprehensively examine changes in processes of psychological flexibility following an ACT-based treatment for chronic pain, and to examine change in these processes in relation to improvements in patient functioning. Individuals with chronic pain attending an interdisciplinary ACT-based rehabilitation program completed measures of pain, functioning, depression, pain acceptance, cognitive fusion, decentering, and committed action at pre- and post-treatment and during a nine-month follow-up. Significant improvements were observed from pre- to post-treatment and pre-treatment to follow-up on each of the treatment outcome and process variables. Regression analyses indicated that change in psychological flexibility processes cumulatively explained 6–27 % of the variance in changes in functioning and depression over both assessment periods, even after controlling for changes in pain intensity. Further research is needed to maximize the effectiveness of ACT for chronic pain, and to determine whether larger improvements in the processes of psychological flexibility under study will produce better patient outcomes, as predicted by the psychological flexibility model.

BackgroundGrowing evidence demonstrates the benefit of acceptance and commitment therapy (ACT) for people with chronic pain. However, there remain people with chronic pain who do not benefit from ACT, and predicting treatment response is difficult.AimsThis aim of this study was to investigate if baseline psychological flexibility (PF) profiles predict responses to an ACT‐based pain management programme.MethodsData from 415 participants attending an interdisciplinary pain management programme were included. Participants completed measures of PF processes and outcomes pre‐ and post‐treatment. Latent profile analysis was used to identify subgroups of participants based on their baseline PF scores. ANOVAs were conducted to compare subgroups of participants on outcome variables at baseline, and changes from pre‐ to post‐treatment.ResultsThree subgroups of participants were identified: (a) low PF, (b) low openness and (c) high awareness and action. The three subgroups significantly differed on all outcome measures at pre‐treatment, supporting the clinical relevance of these PF profiles. However, participants with different baseline PF profiles did not appear to differ in terms of changes in outcome variables.ConclusionsPeople with chronic pain demonstrate different PF profiles, but appear to respond to ACT similarly regardless of these profiles. Future studies with a more individualized focus are needed to further understand which components of ACT work for whom on which outcome and how.SignificanceThere remain people with chronic pain who do not benefit from acceptance and commitment therapy (ACT), and predicting treatment response is difficult. This is the first study to identify psychological flexibility (PF) profiles along multiple PF processes using latent class analysis, and the first longitudinal study to investigate PF profiles in relation to outcomes in ACT for chronic pain. The findings contribute to the understanding of theoretically consistent predictors of outcomes in ACT, which in turn can inform treatment development.

The U.S. Department of Defense continues to have a significant interest in the development and evaluation of evidence-based programs for enhancing resilience in military personnel. However, few studies have documented evidence-based interventions to maintain or boost performance and enhance resilience among service members. A robust body of literature describes the positive association between psychological flexibility and resilience as well as outcomes including performance, mental health, and social functioning in both healthy and clinical populations. Acceptance and Commitment Therapy (ACT) is an evidence-based intervention that directly targets the enhancement of psychological flexibility. In the current paper, we first describe the association between psychological flexibility and resilience. Then we briefly note the limitations of existing military resilience training programs and outline the relevant evidence in support of an ACT-based resilience training program. Finally, we describe the six psychological flexibility processes that comprise ACT interventions along with the relevance of each process for resilience enhancement in military personnel. We conclude with information about an in-progress study of a novel ACT-based training program targeting resilience enhancement and readiness optimization in active duty service members.

BackgroundBurnout and depression among medical students is linked to serious problems that require appropriate solutions. Subthreshold autism traits or autistic-like traits (ALTs) may be possible factors associated with burnout and depression. The effectiveness of acceptance and commitment therapy (ACT) for burnout and depression has been widely reported. The treatment aims to improve psychological flexibility, a concept indicating engagement in personal value-based behaviors without avoiding uncomfortable private experiences. This study examined whether ALTs were associated with burnout or depression among medical students during clinical clerkships in Japan, and then investigated what psychological flexibility processes might mediate these associations.MethodsA cross-sectional survey was administered to 284 medical students at Nagoya City University School of Medical Sciences who had been in clinical clerkships for 10 months or longer. Linear multiple regressions were performed with each burnout factor or depression as the outcome variable using validated tools measuring burnout (Maslach Burnout Inventory), anxiety and depression (Hospital Anxiety and Depression Scale), ALT (Autism-Spectrum Quotient Japanese version-21), and psychological flexibility processes (Cognitive Fusion Questionnaire-7 and Valuing Questionnaire). Additionally, a mediation analysis was conducted using structural equation modeling.ResultsA linear multiple regression analysis that controlled for age and gender found that ALTs were significantly associated with lower personal accomplishment, a factor of burnout, and depression. Lower personal accomplishment was also associated with males and lower progress toward values of the psychological flexibility process. Depression was also associated with males and higher cognitive fusion, lower progress towards values, and higher obstruction to values of the psychological flexibility process. Surprisingly, emotional exhaustion and depersonalization were not significantly associated with ALTs. The mediation analysis revealed that the relationship between ALTs and personal accomplishment was partially mediated by a process of progress toward values, while the relationship between ALTs and depression was partially mediated by both processes of progress toward values and cognitive fusion.ConclusionsALTs were significantly associated with lower personal accomplishment of burnout and depression among medical students in clinical clerkships. Consideration should be given to the psychological flexibility processes that focus on interventions targeting psychological flexibility for medical students with ALTs to reduce burnout and depression.

This study evaluated the effectiveness of Acceptance and Commitment Therapy (ACT) interventions in changing psychological flexibility processes in young physically active adults aged 20 to 25 years (N = 30). It also examined the moderating role of personality traits, measured with the Big Five Questionnaire (BFQ). Participants self-selected into either an experimental group, which completed eight weekly ACT-based interventions, or a passive control group. All participants completed the BFQ and the Multidimensional Psychological Flexibility Inventory (MPFI) at baseline. The MPFI was administered again after 10 weeks, while personality was assessed only at baseline. The study showed that at baseline, psychological flexibility processes differed between the groups, with the experimental group reporting lower flexibility. After 10 weeks, no significant differences remained. The ACT interventions were associated with a reduction in inflexibility processes in the experimental group, while the control group also showed a decrease in flexibility processes. Within the experimental group, the personality trait of dominance negatively predicted changes in most psychological flexibility processes. While previous research supports the effectiveness of ACT interventions for mental health, this study expands current understanding by focusing on a physically active young adult sample and assessing both flexibility and inflexibility processes. Personality traits, particularly dominance, may moderate ACT intervention outcomes.

A growing body of research has demonstrated the positive eff ects of Acceptance and Commitment Therapy (ACT) delivered in the workplace on employees' well-being and psychological fl exibility. Delivering ACT in the workplace aims to enhance employee performance and reduce stress levels by promoting psychological flexibility, a skill to consciously live in the present, observing thoughts and emotions, and engaging in value-driven actions. The short-term effects of a 5-week-long ACT-based psychological flexibility training program were tested. A total of 21 corporate employees (62 % women, Mage = 43.9 years, SD = 9.5) from a large company in the fi nancial sector completed study measures prior to and after the training sessions. The six core processes of psychological flexibility were examined. Psychological flexibility, Valued living, Thought suppression, and five facets of Mindfulness and Cognitive fusion were assessed. Results showed signifi cant diff erence in one core process of psychological flexibility (Contact with the present moment). Moreover, Acting with awareness, Describe and Nonjudge showed significant difference before and after the training. The present research has provided further empirical evidence for the effectiveness of ACT-based psychological flexibility training with regard to three aspects of Contact with the present moment, which is a core process of psychological fl exibility (Acting with awareness, Describe, and Nonjudge). The findings provide a basis for future research to investigate longer-term effects, including monitoring how participants in the research program practice the learnt techniques in their everyday lives. (Neuropsychopharmacol Hung 2025; 27(3): 157-168)

The Multidimensional Psychological Flexibility Inventory (MPFI): Discriminant validity of psychological flexibility with distress

The role of psychological flexibility in palliative care

Despite theoretical overlap between self-compassion and psychological flexibility, empirical links between these constructs is limited. This study examined the relationships between psychological flexibility, self-compassion, and emotional well-being to add to the literature on understanding the importance of self-compassion as a possible contributor to mental health, adding support to continuing development of compassion-based therapies. Relationships among these constructs were explored using survey data from a sample of 144 university psychology students (110 females and 34 males, aged 17-60 years). Self-compassion was significantly correlated with psychological flexibility processes, including mindful acceptance, defusion, and emotional well-being. Regression analyses indicated that self-compassion predicts significant unique variance above and beyond psychological flexibility across various indices of emotional well-being. These findings support the association between psychological flexibility, self-compassion, and emotional well-being, with implications for 3rd-wave models of therapy, including acceptance and commitment therapy (ACT) and compassion-based approaches. Therapies incorporating compassion processes may potentially lead to improved treatment outcomes.

Efficacy of Videoconference Group Acceptance and Commitment Therapy (ACT) and Behavioral Activation Therapy for Depression (BATD) for Chronic Low Back Pain (CLBP) Plus Comorbid Depressive Symptoms: A Randomized Controlled Trial (IMPACT Study)

Psychedelic-assisted therapy research for depression and PTSD has been fast tracked in the United States with the Food and Drugs Administration (FDA) granting breakthrough designations for MDMA (post-traumatic stress disorder) and psilocybin (major depressive disorder). The psychotherapeutic treatments accompanying these psychedelics have not been well-studied and remain controversial. This article reviews the challenges unique to psychedelic-assisted therapy and introduces a newly optimised psychological flexibility model that adapts Contextual Behavioural Science (CBS)/Acceptance and Commitment Therapy (ACT) to those multiple challenges, including ego inflation, traumatic memories, and the perceived presence of entities. A methodology aligned with biological mechanisms, psychological processes and therapeutic contexts may be advantageous for improving outcomes. This model expands ACT by integrating practices and data from psychedelic-assisted therapy research into a Contextual Behavioural Science framework, allowing both fields to inform each other. Psychological flexibility processes are questioned and adapted to a psychedelic context, and interventions that operationalise these processes are considered. The principle through-line of the paper is to consider varied constructs of Self, as understood by these fields, and integrates respective elements of varied self-models, interventions and data into a Spectrum of Selves model for psychedelic-assisted therapy. Secondly the paper examines how to select and retain new self-perspectives and their corresponding behaviours systemically, drawing from evolutionary science principles. A case example of such behavioural reinforcement is provided, as well as a psychedelic integration checklist to guide the practical implementation of such an approach. This method can enable a coherent therapeutic framework with clear operational relationships between (1) problematic behaviour patterns that an individual wishes to address (2) the guided psychedelic experiences of that individual, and (3) the barriers to maintaining any changes, thus increasing theoretical-practical coherence, broadening treatment benefits and reducing relapse in psychedelic-assisted therapy. Research questions for further developing a CBS-consistent psychedelic-assisted therapy are offered.