Measures Of Psychological Flexibility Research Articles

Online acceptance and commitment therapy (iACT) for adults with persistent physical symptoms – 3-month follow-up study of a randomized controlled trial

ObjectivePersistent physical symptoms (PPS) represent a major health problem affecting daily functioning. This RCT aimed to examine whether a guided Internet-based treatment based on acceptance and commitment therapy (ACT) provided additional benefits compared to Treatment as Usual (TAU) in reducing somatic complaints and psychological distress in adults with PPS. MethodsA total of 103 adults with PPS related to indoor environments, chronic fatigue or both conditions were assigned to receive either either a 14-week intervention (video-based case conceptualization + Internet-based ACT) combined with TAU (iACT + TAU; n = 50) or TAU alone (n = 53). Somatic symptoms, depression, anxiety, insomnia, and psychological flexibility were assessed from pre-intervention to a 3-month follow-up. Additionally, the association between changes in psychological flexibility from pre- to post-intervention and changes in symptoms from pre to 3-month follow-up was explored. Analyses were conducted using a multigroup method with full information maximum likelihood estimator. ResultsThe results revealed a significant interaction effect, indicating reductions in somatic symptoms and symptoms of depression and anxiety with moderate to large between-group effects (d = 0.71–1.09). No significant interaction effect was observed in insomnia and measures of psychological flexibility. ConclusionInternet-based ACT, when combined with Treatment as Usual, demonstrated efficacy for individuals with PPS associated with indoor environments and chronic fatigue. These findings are pertinent for primary healthcare providers, suggesting that the current treatment model could serve as a low-threshold first-line treatment option.The clinical trial registration number: NCT04532827

Psychological Flexibility Profiles and Mental Health Among University Students with Left-Behind Experience: A Latent Profile Analysis.

The left-behind experience as an adverse childhood experience has a negative impact on the mental health of university students. Psychological inflexibility mediated the relationship between adverse childhood experiences and mental disorders, but no similar findings were drawn in psychological flexibility (PF). More research is needed to understand the relationship between PF and mental health of university students with left-behind experience. To investigate the relationship between PF profiles and mental health and sleep quality of university students with left-behind experience based on latent profile analysis. A sample of 1988 Chinese university students with left-behind experience were recruited to complete an online survey. Participants provided demographic information and completed validated measures of PF and mental health. Latent profile analysis was used to identify patterns of PF, and logistic regression analysis was used to examine the relationships among these variables. We found four PF profiles among participants, with the largest number being the moderately flexible profile (n = 808, 40.6%). The level of PF was positively correlated with mental health and sleep quality (all P < 0.001). Females, being left behind at a young age and for a long time, and having little contact with parents were associated with low PF (all P < 0.05). Our study highlights the importance of focusing on the PF of university students with left-behind experience and left-behind children, and the need for interventions to improve their PF and thus their mental health.

Associations between psychological flexibility and daily functioning in endometriosis-related pain.

Processes of psychological flexibility (PF) are positively associated with health and wellbeing in several chronic pain disorders. However, these processes have not been investigated in endometriosis, a chronic pain disorder affecting 5-10 % of women worldwide. This study is a preliminary investigation of the associations between PF or psychological inflexibility (PI) and daily functioning in people with a primary diagnosis of endometriosis. This study is based on a secondary analysis of survey data from Swedish-speaking adult participants with chronic pain recruited online. The current study included only those reporting a diagnosis of endometriosis and significant long-term pain. All participants completed the Multidimensional Psychological Flexibility Inventory (MPFI), a measure of PF and PI, as well as other measures of PF, and measures of pain and daily functioning. Correlation and multiple regression analyses were performed to examine relations of PF and PI with measures of pain and daily functioning. In general, PF facet scores from the MPFI did not correlate with pain interference but did correlate with depression, with the exception of acceptance. The overall facets of PI appeared to perform better as correlates and in regression. Established measures of PF performed in correlation and regression analyses generally as has been observed in other chronic pain populations, with significant positive associations. In this preliminary analysis of PF and PI in participants with endometriosis-related pain, these processes appear relevant, especially in understanding depression, but results varied along with the measures used. Specifically, when employing the MPFI, the PI facets emerged as stronger correlates. The findings underscore the potential benefit of incorporating assessments of PF and PI as process variables in endometriosis-research, butalso that careful consideration should be given when selecting instruments.

Confirmatory measurement modeling and longitudinal invariance of the CompACT-15: A short-form assessment of psychological flexibility.

The Comprehensive Assessment of Acceptance and Commitment Therapy Processes (CompACT; Francis et al., 2016) is a recently developed measure of psychological flexibility (PF) possessing several advantages over other measures of PF, including multidimensional assessment and relative brevity. Unfortunately, previous psychometric evaluations of the CompACT have been limited by their use of exploratory factor analysis to assess dimensionality, coefficient α to assess reliability, and a lack of attention to measurement equivalence in assessing change over time. The present study used confirmatory factor analysis (CFA) and item factor analysis (IFA) to examine the dimensionality, factor-specific reliability, longitudinal measurement invariance, and construct validity of the CompACT items in a longitudinal online sample of U.S. adults (N = 523). Converging evidence across CFA and IFA confirmatory latent variable measurement models provides support for the reduction of the 23-item CompACT to a 15-item short form with a more stable factor structure, acceptable reliability over large ranges of its three latent factors, and measurement equivalence of its items in assessing latent change over time. Results also support the construct validity of the CompACT-15 items based on its relations with theoretically relevant measures. Overall, the CompACT-15 appears to be a psychometrically sound instrument with the potential to contribute to research and intervention efforts. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Negative emotional eating patterns among American university students: A replication study

Emotional eating (EE) has been consistently associated with obesity, weight gain, and certain eating disorders (EDs). Given the cultural influence on food consumption and eating styles, comparison of EE patterns of individuals in culturally distinct nations (e.g., USA and China) could yield interesting differences in findings. However, given the increasing convergence in eating practices between the above-mentioned nations (e.g., higher reliance on outdoor eating at restaurants among Chinese adolescents), EE patterns might share significant similarities. The present study examined EE patterns of American college students and is a replication of the study done by He, Chen, Wu, Niu, and Fan (2020) on Chinese college students. Responses of 533 participants (60.4% women, 70.1% White, aged 18–52 (mean age = 18.75, SD = 1.35), mean self-reported body mass index = 24.22 kg/m2 and SD = 4.77) on the Adult Eating Behavior Questionnaire (Emotional overeating and emotional undereating subscales) were examined using Latent Class Analysis to identify specific patterns of EE. Participants also completed questionnaire measures of disordered eating and associated psychosocial impairment, depression, stress, and anxiety symptoms, and a measure of psychological flexibility. A solution with four classes emerged, i.e., emotional over- and undereating (18.3%), emotional overeating (18.2%), emotional undereating (27.8%), and non-emotional eating (35.7%). Current findings replicated and extended findings from He, Chen, et al. (2020) in that the emotional over- and undereating class exhibited the highest risks for depression, anxiety, stress, and psychosocial impairment due to disordered eating symptoms as well as lower psychological flexibility. Individuals who have difficulty with awareness and acceptance of their emotions appear to engage in the most problematic form of EE and could benefit from Dialectical behavior therapy and Acceptance and commitment therapy skills training.

Psychological flexibility as a predictor of professional quality of life in newly qualified psychological therapy practitioners

The professional quality of life of psychological therapy practitioners can be conceptualised within a compassion satisfaction and compassion fatigue framework. Compassion fatigue has detrimental impacts on practitioners, organisations and patient care, whereas compassion satisfaction leads to positive outcomes. Psychological flexibility is purportedly a key resilience process associated with greater compassion satisfaction and lower compassion fatigue for healthcare professionals. However, no existing research has explored this association over a longitudinal trajectory for healthcare workers and specifically newly qualified psychological therapy practitioners. This study aimed to examine whether psychological flexibility prospectively predicts levels of compassion fatigue (inclusive of burnout and secondary traumatic stress) and compassion satisfaction in newly qualified psychological therapy practitioners. Using a prospective cohort longitudinal design, fifty-six trainee psychological therapy practitioners were recruited to complete an online survey at three timepoints pre- and post-qualification over eight-months. Forty-two and thirty-eight participants completed the survey at timepoints two and three respectively. The survey comprised a demographic questionnaire and measures of psychological flexibility, professional quality of life and workplace factors. Multilevel modelling revealed that higher prospective levels of psychological flexibility predicted higher levels of compassion satisfaction and lower levels of burnout and secondary traumatic stress at all timepoints. This study offers evidence suggesting a predictive association between psychological flexibility and professional quality of life outcomes for psychological therapy practitioners.In the context of broader empirical and conceptual literature, current findings invite further robust research examining whether psychological flexibility can predict and influence professional quality of life.

The contribution of psychological flexibility to functioning in people living with cancer-related pain.

Studies of individuals with non-cancer-related chronic pain find that higher levels of psychological flexibility (PF) are associated with less distress, better functioning, and a better response to treatment. People diagnosed with cancer are at a significantly increased risk of developing chronic cancer-related pain, the presence of which is associated with poorer health outcomes. Little is known about whether PF is applicable to cancer pain. The current study investigates the relationship between chronic cancer-related pain, distress and functioning, and three theoretical processes proposed by the PF model: pain acceptance, present-moment focus, and committed action. Adults (n=246) with a cancer diagnosis (current or previous), and living in Sweden, completed an online survey involving standardized measures of cancer-related pain (intensity and impairment), depression, fatigue, PF and social stigma. Moderate to strong correlations were found between PF and all variables. In regression analyses, PF, and particularly pain acceptance, accounted for a large and significant proportion of the observed variance in depression, pain-related and overall functioning, after controlling for cancer status, pain intensity and social stigma. Consistent with studies of non-cancer-related pain, higher levels of PF were strongly associated with lower levels of distress and better functioning in individuals with cancer-related pain. Further studies are needed to further explore these relationships and to determine whether psychosocial treatments targeting PF may be of benefit to people with chronic cancer-related pain. This study explores the relationship between cancer-related pain (intensity and impairment), depression, fatigue, overall functioning, social stigma and PF. The findings suggest that higher levels of PF are associated with lower levels of distress and improved functioning in chronic cancer-related pain, after controlling for cancer status (current, in remission), pain intensity and social stigma.

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

Finding psychological factors that can reduce the substantial impact of COVID-19 on mental and physical health is important. Here we replicate and expand a previous study regarding the role of psychological flexibility (PF) in this context. We employed a comprehensive and well validated measure of PF and examined its role in relation to health outcomes and persistent post COVID-19 symptoms. 1174 participants completed standardized measures of depression, anxiety, insomnia and the Multidimensional Psychological Flexibility Inventory (MPFI), and reported the presence of persistent symptoms associated with “long COVID.” All PF and psychological inflexibility (PI) facets, except for acceptance, correlated with the three mental health outcomes and with persistent symptoms. PF and PI accounted for significant variance in depression, anxiety, and insomnia after adjusting for background and health status variables. A notable finding was the particularly stronger correlations obtained for the PI facets. Our findings emphasize the potentially mitigating effects of PF on mental ill health, as well as the particularly aggravating effects of PI, in the pandemic context. A novel finding is the significant association of PI with persisting symptoms of COVID.

Confirmatory factor analysis of the Comprehensive Assessment of acceptance and Commitment Therapy (CompACT) in active-duty military personnel

Acceptance and Commitment Therapy (ACT) is a third-wave cognitive-behavioral treatment that targets psychological flexibility (PF), or the ability to persist in behavior consistent with values regardless of unwanted private experiences. The growing use of ACT necessitates an accurate assessment of PF. The Comprehensive Assessment of Acceptance and Commitment Therapy (CompACT) is a three-factor measure of PF (Openness to Experience, Valued Action, and Behavioral Awareness) whose psychometric properties have been examined in limited populations. The current study examined the factor structure and psychometric properties of the CompACT in U.S. military personnel who enrolled in a weight management randomized controlled trial.Military personnel who either failed or were at risk of failing the Navy's physical fitness assessment or had overweight/obese body mass index (BMI; N = 178, Mage = 29.15 years; MBMI = 33.13 kg/m2; 61.8% female) completed the CompACT and other questionnaires. Confirmatory factor analysis was used to evaluate the three-factor structure of the original 23-item CompACT (CompACT-23) as well as an 18-item version identified in a Portuguese sample (CompACT-18). Internal consistency and convergent validity with measures of weight-related experiential avoidance, perceived stress, anxiety, depression, PTSD symptoms, and life satisfaction were examined.The three-factor structure of the CompACT-23 showed poor fit to the data while the fit of the CompACT-18 was acceptable, as indicated by three descriptive indices (χ2/df = 1.73, RMSEA = 0.069, SRMR = 0.074). All descriptive fit indices in addition to two comparative fit indices (AIC and BIC) indicated improved model fit over the CompACT-23. The CompACT-18 and its subscales exhibited adequate internal consistency (α = 0.768 to 0.861) and convergent validity in expected directions with measures of weight-related experiential avoidance, perceived stress, anxiety, depression, PTSD symptoms, and satisfaction with life.Results support using the refined, English language CompACT-18 as a three-factor measure of PF in populations such as U.S. military personnel who may benefit from weight management intervention. Future research should explore the content validity of the full measure and the removed items. Lost content could mean the CompACT-23 and the CompACT-18 differentially assess PF. Additional studies should examine psychometric properties in large and more diverse samples to further evaluate the appropriateness of the measure across populations. Longitudinal studies are needed to examine test-retest reliability and sensitivity to change.

Exploring the relationship between psychological flexibility and self-report and task-based measures of cognitive flexibility

Acceptance and Commitment Therapy (ACT) interventions aim to increase psychological flexibility (PF) leading to positive treatment outcomes. It has been suggested that successful development of PF may depend on cognitive flexibility (CF). There is however a lack of clear empirical evidence accounting for the relationship between the two constructs. The current study investigated the relationship between PF and CF in a large nonclinical sample of younger adults (N = 246). Participants completed self-report measures of PF, and both self-report and task-based measures of CF. Results indicated that self-report, but not task-based, CF correlated with and predicted PF (r = −0.49, 95% BCa CI [−0.58, −0.38], R2 = 0.236). The results are discussed with reference to rule-governed behaviour, approaches to measurement, and ACT, with suggestions for future research.

The Persian Personalized Psychological Flexibility Index (P-PPFI): Psychometric properties in a general population sample of Iranians

Popular measures of psychological flexibility (PF), such as the Acceptance and Action Questionnaire (AAQ-II) and Brief Experiential Avoidance Questionnaire (BEAQ) have been criticized for questionable psychometric properties. The critiques include poor divergent validity with negative emotionality and disregarding PF's theoretical definition of flexible contact with the present moment while acting in the service of chosen values. Recently, the Personalized Psychological Flexibility Index (PPFI) has been proposed as an alternative self-report measure of PF that attempts to address these issues above. The current study sought to test the psychometric properties of the PPFI in a large sample of Iranians from the general population who completed a cross-sectional survey. Back translation and cognitive interviews were used to translate the PPFI into Persian. Exploratory factor analysis indicated that the Persian version of the PPFI, like the English version, has a three-factor structure mapping onto the avoidance, acceptance, and harnessing subscales. Confirmatory factor analyses supported a three-factor solution, showed a good model fit, and good internal consistencies. Correlational analyses supported the construct validity of the Persian PPFI with relations to well-being, goal-directedness, and life orientations in expected directions. Furthermore, the Persian PPFI demonstrated excellent divergent validity from negative emotionality (r = −0.38). Test of incremental validity indicated the Persian PPFI explained more variance in 10 of 15 outcomes than the BEAQ or AAQ-II. The current findings provide psychometric evidence for use of the PPFI in Persian-speaking populations as well as further support for evaluating PF ideographically and in line with theoretical definitions.

Measuring psychological flexibility and cognitive defusion in individuals with acquired brain injury

ABSTRACT Purpose Acceptance and Commitment Therapy (ACT) is used increasingly for individuals with psychological distress following acquired brain injury (ABI) in different countries. However, questionnaires measuring ACT-processes are often not validated for this patient group and need cross-cultural validation. This study investigated the psychometric properties of the Acceptance and Action Questionnaire for Acquired Brain Injury (AAQ-ABI; measuring psychological flexibility related to thoughts and feelings about ABI) and the Cognitive Fusion Questionnaire (CFQ-7; measuring cognitive defusion). Materials and methods Score distribution, reliability, and convergent validity of the AAQ-ABI and the CFQ-7 were examined in Dutch individuals with ABI. Results Seventy-three patients with ABI were included. The AAQ-ABI showed good reliability (Cronbach’s α = 0.87) and the CFQ-7 excellent reliability (Cronbach’s α = 0.97). Both did not show a floor or ceiling effect, nor a skewed distribution. There were strong to moderate correlations between the questionnaires and measures of psychological flexibility, mood, quality of life, and value-driven behavior (AAQ-ABI: r = −0.70–0.81; CFQ-7 = −0.67–0.84). Inter-item total correlations indicate that the questions within each questionnaire measured the same construct (AAQ-ABI: r = 0.40–0.78; CFQ-7: r = 0.84–0.93). Conclusions The current study shows that the Dutch AAQ-ABI and CFQ-7 have acceptable to good psychometric properties when measuring psychological flexibility and cognitive defusion in patients with ABI.

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

The psychological flexibility model of behavior change underpins acceptance and commitment therapy (ACT). However, the measurement of psychological flexibility over the past 20 years has mostly hinged on the use of measures with poor discriminant validity and fuzzy boundaries with distress and negative emotionality. The current study analyzed the structure of psychological flexibility as assessed with the recently developed Multidimensional Psychological Flexibility Inventory (MPFI) and examined its link with distress. We used data from an online cross-sectional survey (N = 1542) which assessed psychological flexibility with the MPFI and the Acceptance and Action Questionnaire-II (AAQ-II), as well as anxiety, and depression. Exploratory and confirmatory factor analyses highlighted that the six psychological flexibility processes of the MPFI loaded on a psychological flexibility factor, while anxiety, depression and the AAQ-II loaded on a distress factor, supporting the discriminant validity of the MPFI in assessing psychological flexibility. Findings were consistent with those from prior studies which suggest that the AAQ-II is more of a measure of global distress than psychological inflexibility or by proxy, psychological flexibility. The 30-item MPFI psychological flexibility scale demonstrated good construct and discriminant validity. Overall, findings support psychological flexibility as a construct that is empirically distinct from distress.

The role of psychological flexibility in the context of COVID-19: Associations with depression, anxiety, and insomnia

Evidence for detrimental impacts of the COVID-19 pandemic on mental health and well-being around the world is now accumulating. As it does a next step is to understand how such effects can be mitigated, such as by studying psychological capacities that may afford people immunity against these impacts. In this study, we explore psychological flexibility (PF) and grit as potential resilience factors in the context of COVID-19. Standardized measures of depression, anxiety, and insomnia as well as measures of PF (committed action and inflexibility) and grit (perseverance of effort and consistency of interest) were administered through a large scale national online survey (N = 1102; mean age 36,9 years; 75% women). As predicted, the results show both PF and grit to be negatively associated with symptoms of depression, anxiety, and insomnia. Further, regression models including relevant background variables and both sets of resilience factors showed that total variance accounted for in symptoms of depression, anxiety, and insomnia was substantial, 50.5%, 49.5%, and 28.8%, respectively, with the PF components accounting for most of the explained variance in mental health. We conclude that PF and to a lesser extent grit may be important psychological resilience factors against mental health problems in the context of COVID-19. Our findings are practically important as they point to malleable public health targets during the ongoing pandemic of COVID-19 and in the event of similar widespread health threats in the future.

Psychological flexibility: What we know, what we do not know, and what we think we know

AbstractPsychological flexibility is the tendency to respond to situations in ways that facilitate valued goal pursuit. Psychological flexibility is particularly useful when challenges arise during goal pursuit that produce distress. In acceptance and commitment therapy, psychological flexibility is considered the pinnacle of emotional health and well‐being. A growing body of research demonstrates that psychological flexibility leads to psychological benefits and adaptive behavior change. Yet, much of what we know, or think we know, about psychological flexibility hinges on a single measurement approach using the Acceptance and Action Questionnaire (AAQ and AAQ‐II). Research suggests the AAQ‐II is highly correlated with distress itself rather than flexible responses to distress. Existing approaches that assess psychological flexibility ignore the context in which flexibility matters most: the pursuit of valued goals. Below, we review theory and research on psychological flexibility, including its associations with healthy functioning, its measurement, and its overlap with related constructs. We discuss how gaps between theory and measurement impede our understanding and review promising evidence for a new measure of psychological flexibility. We provide new research directions in an effort to create a more generalizable foundation of knowledge.

Understanding psychological flexibility: A multimethod exploration of pursuing valued goals despite the presence of distress.

Psychological flexibility (PF), defined as the ability to pursue valued life aims despite the presence of distress, is a fundamental contributor to health (Kashdan & Rottenberg, 2010). Existing measures of PF have failed to consider the valued goals that give context for why people are willing to manage distress. Using 4 independent samples and 3 follow-up samples, we examined the role of PF in well-being, emotional experience and regulation, resilience, goal pursuit, and daily functioning. We describe the development and psychometric properties of the Personalized Psychological Flexibility Index (PPFI), which captures tendencies to avoid, accept, and harness discomfort during valued goal pursuit. Correlational, laboratory, and experience-sampling methods show that the PPFI measures a trait-like individual difference dimension that is related to a variety of well-being and healthy personality constructs. Unlike existing measures of PF, the PPFI was shown to be distinct from negative emotionality. Beyond trait measures, the PPFI is associated with effective daily goals and life strivings pursuit and adaptive emotional and regulatory responses to stressful life events. By adopting our measurement index, PF may be better integrated into mainstream theory and research on adaptive human functioning. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Psychological flexibility, self-compassion and daily functioning in chronic pain

Psychological flexibility (PF) and self-compassion (SC) are both associated with positive outcomes for people living with chronic pain. Despite conceptual similarities they have mostly been studied independently. The present study aimed to determine the relationship between PF and SC, and investigate their roles in relation to pain interference, work and social adjustment, and depressive symptoms. 420 participants attending a speciality chronic pain service completed the Self-Compassion Scale Short Form along with measures of PF, pain, interference, functioning, and depression, prior to starting treatment. PF and SC variables were significantly correlated (r = 0.38 to 0.56) and demonstrated a degree of independence. Multiple regression models for all three pain outcomes explained 44% of the variance in pain interference, 36% in work and social adjustment, and 32% in depression. SC accounted for significant unique variance in each of the pain outcomes, however this was no longer significant when PF variables were added to the model for pain interference and work and social adjustment. In conclusion, PF and SC appear to include mostly related and some distinct elements in the context of chronic pain. PF processes may encompass the effects of SC on pain interference and work and social adjustment. However, SC appears to play an independent role in depression. Given the high comorbidity of depression, it may be beneficial to further study the potential for SC-based processes and methods to improve overall wellbeing for people with chronic pain.

The development of the ‘Forms of Responding to Self-Critical Thoughts Scale’ (FoReST)

BackgroundSelf–critical thoughts are a feature of many mental health problems. Adopting a psychologically flexible response to thoughts has been highlighted as a key determinant of wellbeing. But, the measurement of psychological flexibility (PF) in relation to self-critical thoughts is under-developed. This paper reports on the development of the Forms of Responding to Self-Critical Thoughts Scale (FoReST). MethodStudy One involved the development and exploratory factor analysis of the FoReST in a convenience sample of 253 non-clinical adults. Study Two was a confirmatory factor analysis study of the FoReST in a sample of 110 University students. Study 3 explored the convergent and concurrent validity of the FoReST by examining associations with measures of similar constructs (PF, self-compassion, self-criticism) and relevant mental health measures (anxiety, depression, distress). Study 3 also explored the FoReST's incremental validity for predicting depression and anxiety levels beyond an established measure of self-critical thinking. ResultsIn Study One, exploratory factor analysis produced a 9-item/2-factor solution (unworkable action and mindful acceptance). The measure demonstrated good internal consistency. In Study 2, the confirmatory factor analysis also indicated a 2-factor model (unworkable action and mindful acceptance) and overall internal consistency that was excellent. In Study Three, the FoReST demonstrated high convergent validity with similar measures, and good concurrent validity with mental health outcomes. Analyses also indicted good incremental validity for the FoReST for predicting HADS depression and anxiety scores. ConclusionsThe FoReST appears to be a psychometrically sound measure suitable for measuring change processes in third wave therapies such as Acceptance and Commitment Therapy, Mindfulness-based Interventions and Compassion Focused therapy.

Brief Engagement and Acceptance Coaching for Community and Hospice Settings (the BEACHeS Study): Protocol for the development and pilot testing of an evidence-based psychological intervention to enhance wellbeing and aid transition into palliative care

BackgroundCancer affects millions of individuals globally, with a mortality rate of over eight million people annually. Although palliative care is often provided outside of specialist services, many people require, at some point in their illness journey, support from specialist palliative care services, for example, those provided in hospice settings. This transition can be a time of uncertainty and fear, and there is a need for effective interventions to meet the psychological and supportive care needs of people with cancer that cannot be cured. Whilst Acceptance and Commitment Therapy (ACT) has been shown to be effective across diverse health problems, robust evidence for its effectiveness in palliative cancer populations is not extensive.MethodThis mixed-methods study uses a single-case experimental design with embedded qualitative interviews to pilot test a novel intervention for this patient group. Between 14 and 20 patients will be recruited from two hospices in England and Scotland. Participants will receive five face-to-face manualised sessions with a psychological therapist. Sessions are structured around teaching core ACT skills (openness, awareness and engagement) as a way to deal effectively with challenges of transition into specialist palliative care services. Outcome measures include cancer-specific quality of life (primary outcome) and distress (secondary outcome), which are assessed alongside measures of psychological flexibility. Daily diary outcome assessments will be taken for key measures, alongside more detailed weekly self-report, through baseline, intervention and 1-month follow-up phases. After follow-up, participants will be invited to take part in a qualitative interview to understand their experience of taking part and acceptability and perceived effectiveness of the intervention and its components.DiscussionThis study is the first investigation of using ACT with terminally ill patients at the beginning of their transition into palliative treatment. Using in-depth single-case approaches, we will refine and manualise intervention content by the close of the study for use in follow-up research trials. Our long-term goal is then to test the intervention as delivered by non-psychologist specialist palliative care practitioners thus broadening the potential relevance of the approach.Trial registrationOpen Science Framework, 46033. Registered 19 April 2018.

Treatment sensitivity: Its importance in the measurement of psychological flexibility

BackgroundPsychological flexibility (PF) is a central construct in Acceptance and Commitment Therapy (ACT). Many studies have operationalized PF using the self-report Acceptance and Actions Questionnaire (AAQ-II). Information on the treatment sensitivity of self-report assessments of PF is lacking, however. We investigated differences in the treatment sensitivity of the AAQ-II compared to other measures of PF across various samples. MethodsUsing three different clinical samples (N = 164), we compared the pretreatment–posttreatment change scores of the AAQ-II to those of three alternative self-report questionnaires measuring PF in a within-subject design. Sensitivity to change was assessed with effect sizes and Reliable Change Index (RC). ResultsWithout exception, effect sizes and rates of clinically significant change were larger in all three alternative questionnaires and across three populations compared to the standard formulation of the AAQ-II. ConclusionsThe results of the present study show greater treatment sensitivity of three alternative questionnaires measuring PF compared to the AAQ-II. The results suggest that treatment effects concerning PF may have been underestimated depending on the wording and measure used. Implications for research on PF and ACT processes and outcomes are discussed.