Psychological Flexibility Model Research Articles

Acceptance and Commitment Teletherapy for Mixed Anxiety and Depressive Symptoms During the COVID-19 Pandemic: A case Study

The present case details a successful treatment response to 21 sessions of Acceptance and Commitment Therapy (ACT) delivered via teletherapy for mixed anxiety and depressive symptomology during the COVID-19 pandemic. The client (“Natalie”), a 19-year-old, White, cisgender female, presented to a university training clinic reporting primary problematic anxiety consistent with a diagnosis of Generalized Anxiety Disorder. The therapist conceptualized Natalie’s anxiety through the ACT psychological flexibility model, wherein Natalie’s challenges appeared to be maintained by experiential avoidance and lack of committed action. This case highlights (a) the unique challenges of treating someone with pervasive anxiety amid the uncertain context of the COVID-19 pandemic, (b) repeated assessment of transdiagnostic processes to inform intervention focus, and (c) the process of ACT teletherapy. Symptom, process, and outcome measures taken bi-weekly throughout therapy suggested theoretically consistent and reliable treatment responses. Clinical implications of the case are discussed.

Examining psychological flexibility in unaccompanied refugee minors: A network analysis

BackgroundRefugees, particularly unaccompanied refugee minors (URM), often report poor mental health. Psychological Flexibility (PF), derived from Acceptance and Commitment Therapy (ACT), appears to positively impact mental health in various populations, including adolescents and refugees. ObjectivesThis study aimed to examine the structure of the PF model and the connections among its core processes, as well as the structure and connections between mental health constructs (i.e., post-traumatic stress, depression, anxiety, stress, quality of life) and PF in URM. Methods100 URM aged 13–18 years living in shelters in the Republic of Cyprus completed four self-reports, assessing depression, anxiety, and stress (DASS-21), PF (Psy-Flex), PTSD (CRIES-13), and HRQL (KIDSCREEN-10). Network Analysis was used to examine the structure and connections of the constructs. ResultsMost core PF processes showed positive connections amongst each other, with the strongest edge between committed action and values. Together with self as context, these core processes exhibited the highest expected influence. The strongest positive connections in the mental health network were found among stress, anxiety, and depression. Stress had the highest expected influence, whereas PF had the lowest. A post hoc Johnson-Neyman analysis suggested a buffering effect of PF on the impact of PTSD on anxiety and stress. ConclusionsProposed areas of focus for clinicians working with URM include incorporating strategies that address stress symptoms and facilitate individuals in pursuing value-based behavior. It is equally important to encourage critical reflection on values and the conceptualized self in the context of culture.

The impact of a “clinical adaptation psychoeducation program” grounded in the psychological flexibility model on perceived stress and coping behaviors among nursing students: A randomized controlled experimental study

BackgroundThe clinical adaptation psychoeducation program grounded psychological flexibility model (PFMCAP) is consisting of six areas, fills a large gap in the literature regarding the effect of nursing students on perceived stress and coping behaviors in the clinical process. ObjectivesTo determine the effect of PFMCAP on perceived stress and coping behaviors of nursing students. DesignThis was a simple randomized controlled experimental pre-posttest design. SettingThis study was conducted with 66 first-year students studying in the nursing department of a university in Türkiye. MethodsA simple randomization method (computer-generated random number table) was used. Data were collected with “Sociodemographic Data Form”, “Perceived Stress Scale for Nursing Students (PSSNS)” and “Stress-Coping Behaviors Scale for Nursing Students (SCBNS)”. PFMCAP was conducted online with first-year nursing students, consisting of a total of six sessions, each lasting 90 min. Data were analyzed using percentiles and frequency distributions, and two-way mixed ANOVA one week after the completion of the PFMCAP. ResultsThere was no significant difference between the groups of descriptive characteristics (p > 0.05). Post-test measurements of students in the experimental group's PSSNS total and sub-dimension scores had a significant decrease compared to the control group (p < 0.001). There was no significant difference between the groups in the post-test SCBNS total scores of the students (p > 0.05). However, there was a significant increase in the post-test SCBNS-Staying Optimistic sub-dimension scores in the experimental group (p < 0.001). ConclusionThe impact of PFMCAP on nursing students' perceived stress levels was not limited to only reducing stress levels; it also contributed to an increase in the students' levels of optimism. These findings demonstrate the potential of PFMCAP in supporting nursing students during the clinical adaptation process. It is observed that the integration of PFMCAP into nursing education could assist nursing students in better adapting to clinical practices and effectively managing stress.

Total Pain and Fear of Recurrence in Post-Treatment Cancer Patients: Serial Mediation of Psychological Flexibility and Mentalization and Gender Moderation.

Background: The research indicates that painful experiences can significantly affect the fear of cancer recurrence among cancer survivors, which is a distressing concern that influences both physiological and psychological recovery. This cross-sectional study aims to advance our comprehension of the associations between total pain and the fear of recurrence in post-treatment cancer patients by examining two potential mediators: psychological flexibility and mentalization. Methods: Three hundred and thirty-five participants (aged 22 to 88, 49.1% female) who had finished their cancer treatment completed self-report assessments of total pain, their fear of recurrence, psychological flexibility, and mentalization. Results: The serial mediation analysis showed that all dimensions of total pain were positively and indirectly related to the fear of recurrence through psychological flexibility and mentalization in serial. Additionally, gender was found to moderate these serial mediational effects. Conclusions: In line with the psychological flexibility model, personal capacities to face difficult internal/external problems and interpret one's behavior in motivational terms can counterbalance a patient's negative emotions and feelings related to the illness. Gender factors also determine the way in which post-treatment cancer patients manage potential future anxiety and fears.

A fresh lens on psychological flexibility: Using network analysis and the Unified Flexibility and Mindfulness Model to uncover paths to wellbeing and distress

The current study sought to ground exploratory network analyses on 12 dimensions of psychological flexibility (PF) within the conceptual framework of the Unified Flexibility and Mindfulness (UFM) Model, organizing aspects of psychological flexibility into distinct stepwise stages of responding to difficult thoughts, feelings, and experiences. Toward that end, psychological network analyses were conducted within a sample of 276 undergraduate students (62% White, 61% female, Mage = 19) with a wide range of psychological distress and wellbeing in order to comprehensively explore the relationships between psychological flexibility and inflexibility processes as well as their unique links to various individual outcomes. The results offered new insights to the PF model. Whereas dimensions of flexibility demonstrated robust links to wellbeing, dimensions of inflexibility demonstrated more robust links to forms of distress. The models also highlighted cognitive fusion, inaction, contact with values, and self-as-context as notably central processes demonstrating strong links to many other forms of PF and to both psychological distress and wellbeing. Visualizing the results within the UFM conceptual framework offered tentative support for that model, as the results suggested that maintaining mindful present moment awareness was proximally linked to greater use of decentering strategies (i.e., acceptance, self-as-context, defusion) in response to difficult experiences, which were in turn proximally linked to more value-driven behavior (i.e., maintaining contact with values and engaging in committed action despite any setbacks or difficulties), which were proximally linked to various forms of wellbeing (i.e., psychological, social, environmental, and physical health wellbeing, flourishing). Additional links emerged (albeit relatively weaker) suggesting an even higher level of interconnectivity among mindful flexibility processes than suggested by the stages of the UFM. In fact, although most of the links were in the expected directions, experiential avoidance was linked to greater self-as-context, suggesting possible adaptive forms of that behavior. Implications are discussed.

The relationship between postpartum negative life events and postpartum depression: a moderated mediation model of neuroticism and psychological flexibility

BackgroundPostpartum depression (PPD) is a major public health problem worldwide. Previous studies have shown that postpartum negative life events and neuroticism are both important risk factors for PPD. However, few studies have considered the role of protective factors in the influence of postpartum negative life events and neuroticism on PPD. Based on the diathesis–stress model and Acceptance and Commitment Therapy (ACT), a moderated mediating model was established to examine the mediating role of neuroticism between postpartum negative life events and PPD, as well as the moderating role of psychological flexibility in this mediating effect.MethodsA sample of 776 parturients from three different Grade A hospitals in China were assessed using the Edinburgh Postpartum Depression Scale, the Postpartum Negative Life Events Scale, the Neuroticism Subscale of the Big Five Personality Scale, and the Acceptance and Action Questionnaire– II.ResultsPPD, postpartum negative life events, neuroticism, and experiential avoidance were significantly positively correlated with one another. Neuroticism partially mediated the relationship between postpartum negative life events and PPD. In this mediation model, the direct path and the second half of the mediation path were moderated by psychological flexibility. Specifically, the links between postpartum negative life events and PPD, as well as between neuroticism and PPD, were stronger when psychological flexibility was low, but weaker when psychological flexibility was high.ConclusionsThe results show that psychological flexibility plays an important role in buffering the negative effects of postpartum negative life events and neuroticism on PPD. These findings provide implications for the prevention and intervention of PPD using an ACT approach.

A multi-sample investigation of psychological flexibility processes and reactive and proactive functions of aggression

Both theory and empirical research support the application of the psychological flexibility model to understanding aggressive behavior. However, methodological limitations persist, as studies have generally relied upon a single measure of psychological inflexibility, and measures of aggression typically fail to differentiate aggressive behavior based on function. This limits our ability to understand how specific dimensions of psychological (in)flexibility relate to functional differences in aggression. To extend this line of research, the primary aim of this study was to examine the associations between proactive and reactive aggression, and multiple measures of psychological (in)flexibility processes, across three samples: one undergraduate (N = 116) and two online community samples (N = 262 and N = 317). Further, we examined the unique contribution of psychological (in)flexibility processes in the prediction of aggression, over and above negative affect-related variables. Proactive and reactive aggression was assessed across all samples, with individual samples also responding to various measures of anger, negative affect, negative urgency, experiential avoidance, cognitive fusion, valued living, or a multidimensional measure of psychological flexibility. Correlational and regression analyses revealed that inflexibility processes were generally associated with reactive aggression, but more inconsistent associations were found with proactive aggression in multivariable models. Flexibility processes, on the other hand, exhibited inconsistent and sometimes unexpected associations with aggression. The psychological flexibility model appears useful in understanding different functions of aggressive behavior, however additional research is necessary to clarify the nature of discrepancies within and between samples.

Euthymic despite pain: the role of cognitive reappraisal and experiential avoidance in autoimmune inflammatory rheumatic diseases-a cross-sectional study.

Pain is a central feature of inflammatory rheumatic diseases and is associated with psychological distress. Pain is widely recognized not as a mere physical sensation, but as a complex, multidimensional phenomenon with an affective component. A plethora of research has conceptualized adaptation to pain by focusing on minimizing the pain experience. However, pain in autoimmune inflammatory rheumatic diseases is often neither avoidable nor curable. This cross-sectional study aimed to investigate the processes explaining how pain intensity may be associated with low well-being and why some patients may live well despite pain. Drawing upon the psychological (in)flexibility model and the process model of emotion regulation, we propose that cognitive reappraisal moderates the association between pain and euthymia through experiential avoidance. Ninety-seven patients with rheumatoid arthritis, psoriatic arthritis, or axial spondyloarthritis were included for analyses (mean age = 53.4; mean time since diagnosis = 9.2 years). Most patients were women (75%), married/cohabitant (71%), and attended high school (47%). Results indicate that experiential avoidance may explain how severe pain is associated with lowered euthymia. This indirect negative effect of pain intensity on euthymia became non-significant at high levels of cognitive reappraisal, suggesting that cognitive reappraisal may serve as a protective factor for patients with autoimmune inflammatory rheumatic diseases. This study paves the way for future research in this promising context by providing an initial step towards integrating emotion regulation and psychological inflexibility in pain conditions.

Psychological flexibility for the well-being of musicians: New possibilities for psychological counseling

Musicians face demands such as long-term practice, skill assessment, mental preparation difficulties, anxiety, depression, and study addiction. These challenges extend to their professional life with occupational demands influencing well-being, which underlines the necessity for psychological interventions and preventive programs. Acceptance and Commitment Therapy/training, based on the psychological flexibility model (acceptance, defusion, self as context, committed action, values, and contacting the present moment), has recently been implemented in work with musicians and appears to be effective in lowering performance anxiety and enhancing performance. This study aimed to conceptualize the psychological functioning of musicians using the psychological flexibility model and to qualitatively analyze possible differences between musicians with high and low experiential avoidance measured with the Measurement of Experiential Avoidance Questionnaire (MEAQ-30PL). The survey was administered twice, with slight modifications the second time, to two samples of 57 and 63 musicians, respectively. In both experiential avoidance groups, we observed flexibility processes such as values and engaged actions, and inflexibility processes such as fusion with thoughts and avoidance of unease. We also found differences between the ways in which committed actions, fusion, and inflexible attention were expressed by participants with high and low experiential avoidance. We discuss these results in light of preventive programs in music education, with an indication of improvements that could be made on the basis of the psychological flexibility model.

Application of Acceptance and Commitment Therapy (ACT) in Hospice and Palliative Care Settings.

Many terminally ill cancer patients grapple with a range of physical, psychological, and social challenges. Therefore, it is critical to offer effective psychological interventions to assist them in managing these issues and enhancing their quality of life. This brief communication provides a concise overview of acceptance and commitment therapy (ACT), along with empirical evidence of its application for patients, caregivers, and healthcare professionals in hospice and palliative care settings and an overview of future directions of ACT interventions in South Korea. ACT, a third-wave type of cognitive behavioral therapy, is a model of psychological flexibility that promotes personal growth and empowerment across all life areas. Currently, there is substantial evidence from overseas supporting the effectiveness of ACT on health-related outcomes among patients with various diseases, caregivers, and healthcare professionals. The necessity and significance of conducting ACT-based empirical research in hospice and palliative care settings in South Korea are discussed.

Effectiveness of and processes related to internet-delivered acceptance and commitment therapy for adolescents with anxiety disorders: a randomized controlled trial.

Early access to evidence-based help is crucial for adolescents with anxiety disorders. Internet-delivered acceptance and commitment therapy (iACT) may offer adolescents increased access to care and more flexibility in engaging with treatment when and how they prefer. Process-based therapies, such as ACT, focus on theoretically derived and empirically tested key mechanisms in treatment that enable change. This study aimed to investigate the effectiveness of iACT for adolescents with anxiety disorders. The study also assessed the relationship between psychological flexibility and treatment outcomes and the relationship between participating adolescents' and therapists' perceived alliance and treatment outcomes. This was a randomized controlled trial comparing a 10-week intervention group with a wait-list control group. The 52 participants, aged 15 to 19, were recruited from all over Sweden. The treatment was effective in increasing quality of life and psychological flexibility, with moderate between-group effect sizes based on observed values. Changes in psychological flexibility was associated with changes in anxiety symptoms. The results further showed a statistically significant between-group difference in post-treatment diagnoses. No significant time per group interaction was found for anxiety symptoms, as both groups improved. Working alliance was rated as high by both participating adolescents and therapists but showed no significant relationship with treatment outcomes. Participants found the treatment an acceptable intervention. This study shows promising results for iACT in treating adolescents with anxiety disorders. The results suggest the model of psychological flexibility as an important process of change in treatment outcomes. Future research should validate these findings in larger samples and clinical contexts.

A network analysis of psychological flexibility, coping, and stigma in dermatology patients.

Despite the negative effects of stigma in individuals with skin conditions, interventions to address its effects are rare. This might be in part due to a continued lack of understanding as to how individuals respond to stigma. In this study, we employed a step-case analytic method, using traditional regression, moderation, and network analyses, to examine the role of psychological flexibility (PF) with stigmatized experiences, and stigma-related outcomes. We run a cross-sectional study (n = 105 individuals with various skin conditions) and analyzed stigma-related variables. We included variables examining perceived stigmatization (PSQ), anxiety (GAD-7), depression (PHQ-9), well-being (EQ5D5L), and variables stemming from the PF model (CompACT), presented as three coping with stigma responses, namely "open," "aware," and "active.". Using network analysis, the most influential or central variables that contributed to stigma were generalized anxiety, perceived stigmatization, and valued actions. In relation to PF, being open to the experience of stigma (as opposed to avoidance), keeping a distance from stigmatized thoughts (as opposed to self-stigmatizing), and bringing attention to value-based committed actions (as opposed to passivity) were all found to contribute to less stigmatized experiences. The results indicate that two of the three skills of the PF model ("open" and "active") may be important targets for interventions targeting stigma in people living with skin conditions.

Pain acceptance and psychological inflexibility predict pain interference outcomes for persons with chronic pain receiving pain psychology.

Awareness (being present), acceptance, and engagement (committed action) are three dimensions of psychological flexibility. Understanding these in the context of chronic pain may identify treatment targets to help refine individual treatment. Our objective was to test the predictive capacity of three dimensions within the psychological flexibility model on the longitudinal trajectory of pain interference. Patients receiving pain psychology treatment at a pain management center participated in this pragmatic clinical longitudinal study (n=86 with at least three assessments; Mean age=51 years; Gender=60 females, 26 males). Measures included the Five Facet Mindfulness Questionnaire (FFMQ-SF); Chronic Pain Acceptance Questionnaire (CPAQ-8); Psychological Inflexibility in Pain Scale (PIPS-12); and Committed Action Questionnaire (CAQ-8). The dependent variable was the Patient Reported Outcomes Information System (PROMIS) Pain Interference (PI). We used latent growth modelling to analyze scores assessed within 180days of patient care. Psychological inflexibility (PIPS-12) and pain acceptance (CPAQ-8) measured at baseline predicted PI outcomes (n=86). PIPS-12 showed a direct relationship with pain interference (PI), where higher PIPS-12 scores predicted significantly higher PI mean scores on average across the study period (ρ=0.422, r2=0.382) but also predicted significantly greater decreases in PI across time (ρ=-0.489, r2=0.123). Higher CPAQ-8 scores predicted significantly lower PI mean scores on average across the study period (ρ=-0.478, r2=0.453) but also significantly smaller decreases in PI across time (ρ=0.495, r2=0.076). Awareness (FFMQ-SF) and engagement (CAQ-8) were not predictive of PI outcomes. Patients who entered pain psychology treatment with lower pain acceptance and higher psychological inflexibility showed the largest reductions in pain interference across time. These results contribute towards a novel prognostic understanding of the predictive roles of an enhancing dimension and limiting dimension of psychological flexibility.

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.

The role of psychological flexibility in the meaning-reconstruction process in cancer: The intensive longitudinal study protocol.

Meaning-making is an important element of adapting to disease. However, this process is still poorly understood and the theoretical model has not been comprehensively verified yet, particularly in terms of complexity, dynamics, and intraindividual variability. The aim of this study is a deeper understanding of the meaning-reconstruction process in cancer and empirical verification of the integrative meaning-making model of coping extended by the psychological flexibility model. We postulate that psychological flexibility can foster the meaning-making in cancer by building more flexible and workable meaning-making explanations of disease. A daily-diary study conducted for 14 days in patients following the first autologous or allogeneic hematopoietic cell transplantation (HCT). Participants (at least 150) will be requested to complete the daily-diary related to daily situational meaning, meaning-related distress, meaning-making, psychological flexibility, meanings made, and wellbeing for 14 days after hospital discharge following HCT. Also, baseline and follow-up assessment of global meaning, wellbeing, and meanings made will be performed. Statistical analysis of the data will be conducted using the multilevel and dynamic structural equation modeling. The study will fill in the gaps in health psychology in the understanding of the meaning-reconstruction process in cancer by within- and between-person verification of the integrative meaning-making model and its extension by the psychological flexibility model. The data obtained will be used in further research on the development of meaning-making by means of interventions based on psychological flexibility.

The Effects of Internet-Based Acceptance and Commitment Therapy on Process Measures: Systematic Review and Meta-analysis.

BackgroundAcceptance and commitment therapy (ACT) is based on a psychological flexibility model that encompasses 6 processes: acceptance, cognitive defusion, self-as-context, being present, values, and committed action.ObjectiveThis systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to examine the effects of internet-based ACT (iACT) on process measures.MethodsA comprehensive search was conducted using 4 databases. The quality of the included RCTs was assessed using the Cochrane Collaboration Risk of Bias Tool. A random-effects or fixed-effects model was used. Subgroup analyses for each outcome were conducted according to the type of control group, use of therapist guidance, delivery modes, and use of targeted participants, when applicable.ResultsA total of 34 RCTs met the inclusion criteria. This meta-analysis found that iACT had a medium effect on psychological flexibility and small effects on mindfulness, valued living, and cognitive defusion at the immediate posttest. In addition, iACT had a small effect on psychological flexibility at follow-up. The overall risk of bias across studies was unclear.ConclusionsRelatively few studies have compared the effects of iACT with active control groups and measured the effects on mindfulness, valued living, and cognitive defusion. These findings support the processes of change in iACT, which mental health practitioners can use to support the use of iACT.

Acceptance and Commitment Therapy (ACT) for Problematic Anger: A Case Study

Though anger is a common human emotion, the unfettered behavioral expression of anger is often costly, contributing to a range of functional impairments, poor quality of life, and both physical and mental health problems. The current case illustrates how a third-generation cognitive behavioral therapy, Acceptance and Commitment Therapy (ACT), may be effective in reducing suffering linked with problematic anger. The client (“Robert”), a treatment-naïve man of low socioeconomic status, presented to a university training clinic reporting problematic anger outbursts that interfered with his relationships at work and with his girlfriend. The therapist conceptualized Robert’s problematic anger through the ACT psychological flexibility model, wherein Robert’s anger appeared to function as experiential avoidance to distance him from underlying emotional hurt. The therapist used ACT over 27 sessions to reduce Robert’s psychological inflexibility while promoting more psychological flexibility. Early sessions highlighted the unworkability of Robert’s anger, whereas subsequent sessions focused on clarifying values, loosening cognitive fusion, facilitating present moment awareness, and cultivating mindful acceptance in the service of living a meaningful life. The therapist monitored treatment progress using quantitative measures and qualitative reports. Collectively, the client showed notable gains. The case study adds to the growing body of literature supporting ACT for problematic anger.

Preliminary validation of a Chinese version of the comprehensive assessment of acceptance and commitment therapy processes

Acceptance and Commitment Therapy (ACT) improves mental health by augmenting psychological flexibility. Studies showed that psychological flexibility affects mental health; however, although studies have examined individual aspects of psychological flexibility, few have comprehensively examined an entire psychological flexibility model, especially in China. The Comprehensive Assessment of Acceptance and Commitment Therapy Processes (CompACT) is a comprehensive evaluation method that reflects psychological flexibility. The objectives of this study were to develop a Chinese version of CompACT that fits with Chinese culture and examine its reliability and validity. We studied 4999 non-clinical Chinese civil servants and explored the characteristics of the Chinese version of CompACT. Exploratory factor analysis was used to measure Openness to Experience, Behavioral Awareness, and Valued Action that explained 54.3% of the total variance. Confirmatory factor analysis provided support for the three-factor model. The Cronbach’s α-coefficient of the scale was 0.87, suggesting that the Chinese version of the CompACT is reliable. The Chinese CompACT total score represents the overall level of psychological flexibility; it is significantly negatively correlated with negative emotions and positively associated with well-being. Our findings suggest that the Chinese version of the CompACT accurately assesses psychological flexibility in Chinese adults.

Effects of Acceptance and Commitment Therapy (ACT) on Mental Health and Resiliency of Migrant Live-in Caregivers in Canada: Pilot Randomized Wait List Controlled Trial.

BackgroundTemporary migrant live-in caregivers constitute a vulnerable stream of temporary foreign workers in Canada. This is because the majority are racialized women from the Global South, the gendered nature of caregiving work has historically been undervalued, and their working and living spheres are intertwined which makes application of labor laws and surveillance almost impossible. Their invisible position in the fabric of Canadian society along with their precarious employment and immigration status place their mental health at jeopardy. There is a paucity of research about psychological support for this population.ObjectiveOur pilot study Women Empowerment—Caregiver Acceptance and Resilience E-Learning (WE2CARE) aimed to assess the efficacy of a 6-week online delivery of a psychological intervention based on acceptance and commitment therapy (ACT) in reducing psychological distress and promoting resiliency among live-in care givers in the Greater Toronto Area.MethodsA pilot randomized wait list controlled design was used. Participants were recruited by two community peer champions working with community health organizations serving migrant live-in caregivers. A total of 36 participants were recruited and randomly assigned to the intervention and wait list control groups; 7 dropped out of the study due to competing life priorities. Standardized self-reported surveys were administered online pre-, post-, and 6-week postintervention to assess mental distress (DASS-21), psychological flexibility (AAQ-2), mindfulness (CAMS-R), and Multi-System Model of Resilience (MSMR-I). Independent and dependent t tests were used to compare study outcomes at pre, post, and 6-week follow-up across and within both arms of the study. Linear mixed effects models were created for each outcome of interest from baseline to postintervention among intervention and control participants. Self-reported impact of the WE2CARE intervention was examined using independent t tests across the study arms.ResultsAverage age of participants was 38 years. Many were born in the Philippines (23/29, 79%). The data on the impact of the psychological intervention showed a lower level of depression, anxiety, and stress among the intervention group compared with the control. However, the differences were not significant due to small sample size and COVID-19 crisis (6.94 vs 9.50, P=.54; 6.94 vs 10.83, P=.20; 7.76 vs 10.33, P=.44, respectively). There was a significant improvement in mindful qualities and external resilience, particularly in life satisfaction and accessible support among the intervention group (37.18 vs 32.92, t22=2.35, P=.03; 20.29 vs 16.5, t21=2.98, P=.007; 8.47 vs 6.75, t14=2.41, P=.03; 7.59 vs 5.33, t16=.008, respectively).ConclusionsWE2CARE is among the first studies exploring the efficacy of online delivery of ACT in addressing mental health challenges among live-in caregivers. While there are increased web-based ACT interventions, few use group videoconferencing to promote peer connection and mutual support. WE2CARE showed promising results in reducing psychological distress and promoting mindfulness and resiliency. The intervention highly motivated participants to engage collectively in building social support networks.International Registered Report Identifier (IRRID)RR2-10.2196/preprints.31211

A Spectrum of Selves Reinforced in Multilevel Coherence: A Contextual Behavioural Response to the Challenges of Psychedelic-Assisted Therapy Development.

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.