Psychological Inflexibility Processes Research Articles

Investigating an Acceptance and Commitment Therapy-Based Exposure Therapy Intervention in Treatment-Refractory OCD and Related Disorders: Changes in Psychological Flexibility, Treatment Engagement, and Treatment Perceptions.

While exposure therapy is the most effective psychological treatment for obsessive-compulsive disorder (OCD), anxiety, and traumatic stress-related disorders, it is not universally effective, indicating a need for further treatment optimization. This study investigated a shift in approach to exposure therapy with 29 treatment-refractory adults in an OCD clinic not responding to standard treatment, comprising habituation-based exposure therapy. Participants completed standard exposure as a continuation of standard clinic treatment, followed by an acceptance and commitment therapy (ACT) consultation session to assess psychological inflexibility processes interfering with treatment progress, and then an ACT-based exposure targeting behavior change through increasing psychological flexibility. After each exposure, participants and independent raters reported levels of psychological flexibility, rituals, distress, treatment engagement, and treatment perceptions. We observed that the shift to ACT-based exposure was associated with greater psychological flexibility, treatment engagement, treatment acceptability, and treatment preference. These findings suggest that there may be situations where ACT-based exposure has particular utility.

Assessing psychological inflexibility in text: An examination of the inflexitext program

We generate a large amount of text through interactions with technology. Identifying digital markers of psychological constructs in this data may provide novel opportunities for research, assessment, and intervention. Psychological inflexibility has been broadly related to distress and poorer well-being and represents a promising target for such efforts. The present study examined the performance of Inflexitext, a program scoring psychological inflexibility in text, within essays about an important emotional issue by 630 undergraduates. Relationships between Inflexitext and self-report measures of psychological inflexibility processes, self-compassion, distress, and state positive and negative affect, use of words from positive and negative emotion categories, and human coder ratings were examined. Inflexitext scores demonstrated small theoretically consistent relationships with measures of cognitive fusion, challenges in pursuing values, self-compassion, distress, state positive and negative affect, and use of positive and negative emotion terms. Inflexitext also evidenced a moderate relationship with human coder ratings of inflexibility and was moderately predictive of coder classification of essays as containing any inflexibility in a Receiver Operating Characteristic (ROC) analysis. However, a comparison of areas under the curve (AUCs) associated with Inflexitext and use of negative emotion terms did not demonstrate a statistically significant difference in ability to classify essays as containing inflexibility. Inflexitext scores also did not evidence expected associations with self-reported progress towards values, experiential avoidance, and state experiential avoidance while writing the essay. Limitations of current findings and implications for future research are discussed.

Psychological flexibility and inflexibility in obsessive-compulsive symptom dimensions, disability, and quality of life: An online longitudinal study

Early intervention in obsessive-compulsive disorder has recently gained traction. However, to address obsessive-compulsive (OC) symptoms before they progress to clinical levels, it is important to investigate potential processes involved in driving OC symptoms, as well as the processes driving the lower quality of life, impairments in functioning, and increased comorbidities that are already present in the subthreshold phase of the disorder. This study aimed to investigate the role of 12 psychological flexibility and inflexibility processes in predicting quality of life, disability, and OC symptoms over six months while controlling for psychological distress. An online community sample of 766 individuals from Amazon Mechanical Turk was evaluated at baseline and again at 6-month follow-up with a survey battery assessing OC symptom dimensions, psychological in/flexibility processes, psychological distress, and sociodemographic information. Results revealed that greater self-as-content was associated with more severe mental contamination and unacceptable thoughts at baseline. No other psychological inflexibility processes were associated with OC symptom severity or disability cross-sectionally or longitudinally. The study did not provide support for psychological flexibility processes being associated with quality of life at any time point. These findings suggest that self-as-content may be related to OC symptom severity, and potentially more so than other inflexibility processes. With this knowledge, self-as-content requires more research attention in relation to OC symptoms, as well as research on processes that have the potential to improve important non-psychiatric outcomes.

Self-reported Fear, Psychological Inflexibility and Opioid Dose in Relation to Pain

Within the past two decades, research on the treatment of chronic pain with opioid medication has attempted to understand the complex relationship between psychological factors, subjective pain experience, and prescription opioid use. Specifically, fear and psychological inflexibility factors have been explored in relation to both pain sensation and opioid dose. The current study aims to explore and enhance the understandings of brief, subjective self-report measures of fear in relation to opioid dose, subjective fear, self-reported pain, and psychological inflexibility processes. This study examined whether (1) a quadratic relationship would exist between pain scores and opioid dose; (2) individuals with higher opioid dosages would have higher psychological inflexibility scores and subjective fear of pain scores; (3) subjective fear scores, in concert with psychological inflexibility pain measures, would be predictive of pain scores, and (4) subjective fear scores would positively correlate to psychological inflexibility pain measures. The final sample consisted of 202 respondents of an online survey for chronic pain. Survey measures included the Chronic Pain Grade questionnaire (CPG), the Psychological Inflexibility in Pain Scale (PIPS), Subjective Fear of Pain when in Low Pain (FlowP), and when in No Pain (FnoP). Opioid dosage for each participant was converted to the standardized Morphine Milligram Equivalent (MME). A significant quadratic relationship between the CPG and MME was found (p=0.016). MME scores were <i>ns</i> in relation to Subjective Fear of Pain scores or PIPS. FlowP and FnoP, however, did predict overall pain scores for participants (p<0.001). Overall pain scores also showed a positive moderate relationship with overall PIPS scores (r(200)=0.673, p<0.001). FlowP and PIPS together explained 45.7% of the variance of pain scores (F(2,199) = 83.640, p=0.003, R=0.676, R²=0.457) with FnoP and PIPS explaining slightly less at 44.8% (F(2,187)=76.002, p<0.001, R=0.670, R²=0.448). FlowP, however, showed slightly stronger correlations to overall PIPS scores (r(200)=0.648, p<0.001) when compared to FnoP (r(188)=0.589, p<0.001). These findings support previous research indicating a quadratic relationship between pain and opioid dose. Higher pain scores were correlated to higher scores on PIPS and subjective fear of pain questions. Of benefit, the subjective fear of pain questions showed some minor predictability when used as a two-question predictor of pain. Our results not only support previous research underlying the relationship between opioid dose and pain but expand on insight into the use of short-form, fear-related questions to predict psychometrics such as psychological inflexibility and pain sensation.

Experiential Avoidance and Post-traumatic Stress Symptoms Among Child Abuse Counselors and Service Workers: A Brief Report.

Professionals who counsel and serve survivors of childhood abuse may be at risk of experiencing symptoms of post-traumatic stress disorder (PTSD), which can be exacerbated by cognitive and emotional processes. It is hypothesized that (1) a significant proportion of professionals who primarily serve child abuse survivors experience elevated levels of PTSD symptoms and (2) elevated PTSD symptoms are associated with psychological inflexibility processes, specifically increased experiential avoidance, cognitive fusion, and emotion regulation difficulties. Child abuse counselors and service workers (N = 31) in a major metropolitan area were recruited for a small pilot study. Participants completed self-report measures of PTSD symptoms and levels of psychological flexibility processes. A significant proportion of counselors endorsed clinically significant PTSD symptoms (n = 13, 41.9%). PTSD symptoms were significantly associated with experiential avoidance (r = .54, p < .01) and emotion regulation difficulties (r = .51, p < .01). These associations remained significant after controlling for the personality trait of emotional stability/neuroticism. These findings suggest that PTSD symptoms may be common among child abuse counselors and service workers, and these symptoms tend to be of greater intensity when responded to in avoidant and inflexible ways.

Psychological inflexibility processes and nonsuicidal self-injury: Concurrent and prospective associations.

The aim of this study was to examine concurrent and 3-month prospective associations between a multidimensional measure of psychological inflexibility and nonsuicidal self-injury (NSSI) among participants with a self-harm history. Participants completed measures of NSSI, psychological inflexibility, negative urgency, and depression at baseline (N = 106, Mage = 34.70, SD = 9.43, 66% women), and were again assessed at follow-up (N = 86). Participants currently engaging in NSSI reported significantly higher psychological inflexibility as compared to those who have ceased NSSI. After controlling for covariates, psychological inflexibility was concurrently associated with NSSI recency and longitudinally predicted perceived likelihood of future NSSI. Psychological inflexibility was not associated with new NSSI acts after including baseline covariates. Finally, psychological inflexibility subscales demonstrated differential relationships with various NSSI functions. Results highlight the psychological inflexibility model's utility in understanding NSSI and have implications for future research that may inform clinical practice.

Utilizing ACT daily as a self-guided app for clients waiting for services at a college counseling center: A pilot study

Objective Considering increasing demands for mental health services at college counseling centers (CCCs), there is a need for cost-effective solutions that avoid depleting stressed CCC resources. This study examined if ACT Daily, a mobile application based on acceptance and commitment therapy (ACT), could serve as an effective self-guided intervention. Participants: 11 individuals on a CCC waitlist suffering from anxiety/depression participated in the study over 2 weeks. Methods: This study implemented a pre-post, open trial design of ACT Daily. Assessments were completed at baseline and 2-week post assessment. Results: Results indicated that ACT Daily was acceptable and that participants improved on depression and anxiety symptoms as well as psychological inflexibility processes over the 2 weeks. App data further indicated significant in-the-moment improvements on depression, anxiety and psychological inflexibility immediately following skill coaching, with these effects becoming larger over time. Conclusions: Mobile apps like ACT Daily could serve as an effective, pre-therapy tool for depressed/anxious students.

Examining processes of change in an online acceptance and commitment therapy dismantling trial with distressed college students

This secondary analysis examined the processes of change from a randomized dismantling trial evaluating the Open (i.e., cognitive defusion, acceptance) and Engaged (i.e., values, committed action) components of acceptance and commitment therapy (ACT). Analyses were conducted with 161 distressed college students randomly assigned to a full online ACT program (Full n = 40), online ACT targeting the Open components (Open n = 41) or targeting the Engaged components (Engaged n = 39), or a waitlist condition (Waitlist n = 41). The intervention occurred over six weeks followed by a post-treatment assessment with mental health symptoms as the primary outcome. Consistent with predictions, pre-to post-treatment improvements in global psychological inflexibility, cognitive fusion, acceptance, values, and committed action all predicted pre-to post-treatment improvements in mental health, with most processes continuing to independently predict improvements when included in a single model. The relations between changes in psychological flexibility and mental health were generally equivalent between conditions. Each psychological flexibility process separately mediated improvements in mental health for Engaged versus waitlist and Full versus waitlist conditions. However, global inflexibility, committed action, and values progress did not mediate effects for Open versus waitlist. Overall, results indicate a range of acceptance, defusion, values, and committed action processes are functionally relevant for outcomes with the Engaged components of ACT and Full ACT, but values, committed action, and global psychological inflexibility processes may be more weakly related to the effects of the Open components of ACT alone.