Identification of psychological flexibility and inflexibility profiles during the COVID-19 pandemic.

BACKGROUND: The first coronavirus disease 2019 (COVID-19) wave and lockdown adversely affected the lives of people in diverse ways. AIMS: This study used a person-centered approach to identify patterns of engagement in the 12 psychological flexibility (PF) and inflexibility (PI) processes to manage the first COVID-19 wave and lockdown hardships. MATERIALS & METHODS: A total of 1035 Italian adults completed an online survey. RESULTS: Latent profile analyses conducted on the 12 PI/PF processes measured by the Multidimensional Psychological Flexibility Inventory identified five profiles; three reflected gradations of high to low PF with corresponding inverse levels of PI, while two represented more complex relationships between PI and PF. After controlling for relevant socio-demographic and COVID-19/lockdown factors, the five profiles differed in mental health (depression, anxiety, and COVID-19 distress). Essentially a gradient of progressive decreases in all PI processes (except experiential avoidance) corresponded with increments in mental health across all profiles. Two profiles, which evidenced the highest levels of mental health (highly flexible and moderately flexible profiles), also had the greatest proportion of the sample 56.42% (n = 584), and the highest levels of PF and experiential avoidance. DISCUSSION: Findings from this and similar studies suggest intersecting complex relationships among the PI/PF processes that are likely to shift in response to changing contexts. We suggest this network of relationships is better represented by a three-dimensional PF/PI hexaflex than a simplistic two-dimensional depiction of the model. CONCLUSION: Distinguishing different PF/PI profiles identified groups most at risk for the adverse mental health impacts of the pandemic and exposed variations in the mental health protective and risk roles of PF and PI processes, respectively, that can inform ACT-based mental health promotion interventions.

Predictors of mental health in aid workers: meaning, resilience, and psychological flexibility as personal resources for increased well-being and reduced distress.

Aid workers operate in stressful environments and tend to experience high psychological distress, yet not enough is known about their well-being and how to improve their mental health. This research project surveyed 243 aid workers in 77 countries undertaking humanitarian and development work who reported lower well-being and higher psychological distress than the general population. Well-being and distress emerged as two related but distinct mental health outcomes, encouraging further research on well-being in the sector. Better mental health outcomes were predicted by the presence of meaning, psychological flexibility, and resilience. Presence of meaning was the strongest predictor, whereas resilience was the weakest. Meaning was a stronger predictor of good mental health among national workers, whereas psychological flexibility was a stronger predictor among female, older, and international workers. These results can support evidence-based approaches to staff care and mental health interventions for aid workers, expanding the current focus on resilience to include meaning and psychological flexibility.

Quality of life and fear of cancer recurrence in patients and survivors of non-Hodgkin lymphoma.

Non-Hodgkin lymphoma (NHL) is a common haematological cancer that is comprised of approximately 30 subtypes, of which Waldenström Macroglobulinemia (WM) is a rare incurable form. It is typically managed using a watch-and-wait strategy that can contribute to illness uncertainty which may result in fear of cancer recurrence (FCR) and poor health-related quality of life (QOL). However, few studies have examined the correlates of FCR and QOL in NHL patients, including WM patients. One-hundred males and 92 females with a mean age of 62.7 years who were an average of 6.8 years from diagnosis completed the online questionnaire which asked about demographics, medical history, QOL, FCR, stress, anxiety and depression. Few NHL patients reported significant stress or affective distress, most had moderate-high QOL and 41% experienced recent FCR, relative to published cut-off scores. Poorer QOL was related to depression symptoms, FCR, higher illness burden (i.e. comorbidity) and fewer personal resources (i.e. unemployed), whereas FCR was related to shorter time since diagnosis and more depressive symptoms. Results suggest that FCR and depressive symptoms may adversely impact QOL, whereas a recent cancer diagnosis and depression-related pessimism may contribute to FCR.

The mental health of aid workers: risk and protective factors in relation to job context, working conditions, and demographics.

This study utilised a cross-sectional survey of 369 participants in 77 countries to examine 15 possible risk and protective factors pertaining to the mental health of aid workers-many of which have not been assessed before-in the categories of job context, working conditions, and demographics. Risk factors associated with job context include emergency postings and being an international worker. No significant differences were found between humanitarian and development workers and none between organisation type; the number of past traumas was not associated with negative mental health outcomes. Protective factors with regard to working conditions include higher income, long-term contracts, previous psychosocial training, and voluntary postings. With respect to demographics, protective factors include older age, more work experience, and greater religiosity and spirituality, while female gender was a risk factor. Ultimately, this study provides a more nuanced understanding of the aid worker sector, which can inform the development of more targeted mental health support.

Pilot evaluation of a web-based acceptance and commitment therapy program to promote mental health skills in university students.

OBJECTIVE: This study evaluated a 4-week web-based acceptance and commitment therapy (ACT) mental health promotion program called YOLO (You Only Live Once) for university students. METHOD: A total of 130 participants were randomized to one of three intervention groups investigating varied program delivery methods. Primary outcomes assessed: depression, anxiety, stress, well-being, self-compassion, alcohol use, and life satisfaction. ACT processes assessed: acceptance, cognitive fusion, education values, valued living, and mindfulness. RESULTS: Improvement on the primary outcomes and ACT processes did not differ among the three intervention groups. Analyses showed significant improvements on all primary outcomes (except alcohol use), and on all ACT processes. All ACT processes mediated changes on one or more primary outcomes in the intent-to-treat sample. Intervention effects were consistent on most primary outcomes and ACT processes across three sample groupings. CONCLUSIONS: These preliminary findings provide support for a web-based ACT mental health promotion program for university students.

A dyadic and longitudinal investigation of adjustment in couples coping with multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) can affect adjustment at both the individual and couple level. PURPOSE: This study examined differences and associations between MS patient and spouse adjustment, and whether one partner's adjustment predicts the other partner's adjustment over time. METHODS: A total of 160 couples at Time 1 and 98 couples at Time 2 completed questionnaires. RESULTS: Mixed-model ANOVAs found that patients reported poorer adjustment than their spouse on a range of adjustment indicators and that positive affect and relationship satisfaction declined over time for both patients and spouses. Intraclass correlations found that patient and spouse scores on all adjustment indicators were related at Time 1. Multilevel modelling showed that one's partner's relationship satisfaction at Time 1 positively predicted one's own relationship satisfaction at Time 2. CONCLUSIONS: The findings indicate that a focus on the interpersonal nature of adjustment to MS may be beneficial for future research and practice.

Effects of Acceptance and Commitment Therapy (ACT) Training on Clinical Psychology Trainee Stress, Therapist Skills and Attributes, and ACT Processes.

UNLABELLED: Despite the increasing uptake of Acceptance and Commitment Therapy (ACT) by mental health practitioners, few studies have investigated the effects of ACT training on trainees. Clinical psychology trainees (CPTs) are susceptible to high stress such that their training represents a teachable moment for personal application of the therapy skills they learn for clinical practice. This study investigates the effects of ACT training on stress, therapist skills and attributes, and the personal acquisition of ACT strategies in CPTs. Thirty-two CPTs completed questionnaires before and after university-based ACT training that consisted of 12 2-h weekly workshops. Pairwise t-tests showed that CPTs reported improvements from before to after training on measures of counselling self-efficacy, client-therapist alliance, self-kindness, acceptance, defusion, mindfulness and values, and a marginally significant improvement on somatic symptoms, despite a trend towards increased work-related stress. As predicted, each of the ACT process variables was related to one or more of the therapist stress, skill and attribute variables, such that greater levels of mindfulness, values and acceptance, and less thought suppression were related to better trainee outcomes. This study provides preliminary data on therapist skill development and personal benefits for CPTs related to receiving ACT training that interweaves instruction in competencies acquisition with self-care. KEY PRACTITIONER MESSAGE: This study provides preliminary data on therapist skill development and personal benefits for clinical psychology trainees related to receiving ACT training that integrates training in competencies acquisition with self-care. The ACT training offers a framework for integrating the acquisition of clinical competencies and self-care skills and positive therapist attributes in trainees. Findings support a strong positive union between the ACT processes and better trainee personal and professional outcomes.

Effects of a multiple health behavior change intervention for colorectal cancer survivors on psychosocial outcomes and quality of life: a randomized controlled trial.

BACKGROUND: Multiple health behavior change can ameliorate adverse effects of cancer. PURPOSE: The purpose of this study was to determine the effects of a multiple health behavior change intervention (CanChange) for colorectal cancer survivors on psychosocial outcomes and quality of life. METHODS: A total of 410 colorectal cancer survivors were randomized to a 6-month telephone-based health coaching intervention (11 sessions using acceptance and commitment therapy strategies focusing on physical activity, weight management, diet, alcohol, and smoking) or usual care. Posttraumatic growth, spirituality, acceptance, mindfulness, distress, and quality of life were assessed at baseline, 6 and 12 months. RESULTS: Significant intervention effects were observed for posttraumatic growth at 6 (7.5, p < 0.001) and 12 months (4.1, p = 0.033), spirituality at 6 months (1.8, p = 0.011), acceptance at 6 months (0.2, p = 0.005), and quality of life at 6 (0.8, p = 0.049) and 12 months (0.9, p = 0.037). CONCLUSIONS: The intervention improved psychosocial outcomes and quality of life (physical well-being) at 6 months with most effects still present at 12 months. ( TRIAL REGISTRATION NUMBER: ACTRN12608000399392).

The stress-buffering effects of hope on adjustment to multiple sclerosis.

BACKGROUND: Hope is an important resource for coping with chronic illness; however, the role of hope in adjusting to multiple sclerosis (MS) has been neglected, and the mechanisms by which hope exerts beneficial impacts are not well understood. PURPOSE: This study aims to examine the direct and stress-moderating effects of dispositional hope and its components (agency and pathways) on adjustment to MS. METHOD: A total of 296 people with MS completed questionnaires at time 1 at 12 months later and time 2. Focal predictors were stress, hope, agency and pathways, and the adjustment outcomes were anxiety, depression, positive affect, positive states of mind and life satisfaction. RESULTS: Results of regression analyses showed that as predicted, greater hope was associated with better adjustment after controlling for the effects of time 1 adjustment and relevant demographics and illness variables. However, these direct effects of hope were subsumed by stress-buffering effects. Regarding the hope components, the beneficial impacts of agency emerged via a direct effects mechanism, whereas the effects of pathways were evidenced via a moderating mechanism. CONCLUSION: Findings highlight hope as an important protective coping resource for coping with MS and accentuate the roles of both agency and pathways thinking and their different modes of influence in this process.

The mediating role of psychological flexibility in the relationship between resilience and distress and quality of life in people with multiple sclerosis.

The purpose of this study is to investigate the role of psychological flexibility in mediating the beneficial effects of resilience on distress and quality of life (QoL) in people with MS (PwMS). The psychological flexibility framework underpinning acceptance and commitment therapy (ACT) was used to conceptualise psychological flexibility. A total of 56 PwMS completed an online survey that assessed global psychological flexibility and each of its six core sub-processes, resilience, distress, mental and physical health QoL, socio-demographics, and illness variables. Mediation analyses showed that, as hypothesised, higher levels of global psychological flexibility and its sub-processes were associated with increases in the positive impacts of resilience on distress and mental and physical health QoL via a mediational mechanism. These findings suggest that psychological flexibility skills build resilience capacities in PwMS. The psychological flexibility framework offers an ACT-based intervention pathway to build resilience and enhance mental health and QoL in PwMS.

Internet-based acceptance and commitment therapy for obsessive-compulsive symptoms: A randomized controlled trial.

Subthreshold obsessive-compulsive symptoms (OCS) are associated with increased distress, help seeking behaviours, and functional problems, and may predict progression into further mental health problems. This study investigated the effectiveness of a four-module internet-based acceptance and commitment therapy (iACT) for adults with OCS compared to internet-based progressive relaxation training (iPRT). Eighty-nine adults with OCS participated in a single-blinded randomised controlled trial of iACT or iPRT. Self-report assessments of OCS, psychological flexibility, and quality of life, among others, were measured at baseline, post-treatment, and at three-month follow-up. Both iACT and iPRT showed large pre-post improvements in OCS (b = 6.32, p < 0.001, d = 0.8) and medium improvements in psychological flexibility (b = -0.38, p = 0.011, d = 0.47) and quality of life (b = -5.26, p = 0.008, d = 0.58), with no significant differences in effects between groups. All improvements were maintained at follow-up. There were no differences in attrition or adherence between groups. iACT was rated more favourably by participants at post-treatment, and there were some differences in qualitative feedback across groups. These findings suggest both iPRT and iACT may be helpful in improving mental health in adults with OCS, but that iACT may be more acceptable.

Couples coping with multiple sclerosis: a dyadic perspective on the roles of mindfulness and acceptance.

This study investigated the roles of mindfulness and acceptance on adjustment in couples coping with multiple sclerosis (MS) by examining the effects of an individual's mindfulness and acceptance on their own adjustment (actor effects) and the effects of their partner's mindfulness and acceptance on their adjustment (partner effects) using the Actor-Partner Interdependence Model. The study was a cross-sectional standard dyadic design that collected data from couples coping with MS. Sixty-nine couples completed measures of mindfulness, acceptance and adjustment (depression, anxiety, life satisfaction, positive affect and relationship satisfaction). As hypothesised there were actor effects of mindfulness and acceptance on better adjustment, however, the beneficial actor effects of mindfulness were only evident on depression and anxiety. The actor effects of both mindfulness and acceptance on relationship satisfaction were moderated by MS status. Regarding partner effects, there was support for the beneficial impact of acceptance on partner relationship satisfaction. In addition, the partner effect of acceptance moderated the actor effect of acceptance on depression, such that the actor effect on lower depression was weaker when the partner reported high acceptance. Findings support the roles of mindfulness and acceptance in shaping individual and dyadic adjustment in couples coping with chronic illness.

Associations between benefit finding and adjustment outcomes in thyroid cancer.

OBJECTIVE: Few studies have examined psychological adjustment in thyroid cancer (TC) patients and no published studies have investigated benefit finding (BF) in this population. This study examined the relationship between BF and adjustment in TC using an expanded conceptualisation of adjustment that incorporated higher order cognitive and motivational states (HOCMS) and health behaviour changes, and a BF measure that accounted for positive and negative changes. Partner ratings of patient's BF and health behaviour changes were examined as sources of external validity for these constructs. METHODS: 154 TC patients and 32 partners completed questionnaires. RESULTS: Findings supported the prediction that BF would be associated with greater positive affect and positive health behaviour change, and better outcomes on the HOCMS of adjustment. After controlling for demographics and cancer stress, BF evidenced associations with greater positive affect, wisdom, spiritual wellbeing, and lifestyle changes. CONCLUSIONS: Results suggest that BF is related to health behaviour change that is corroborated by significant others and is strongly related to the existentially oriented adjustment outcomes.

Caregiving tasks in caring for an adult with mental illness and associations with adjustment outcomes.

BACKGROUND: Carers of persons with mental illness engage in many caregiving tasks and spend considerable time on these activities. This caregiving is of immense social and economic value, but often at a high cost to carers. Investigation of the specific caregiving tasks these carers undertake and how these may affect their adjustment has been neglected. PURPOSE: This study examines: (1) the dimensional and psychometric structure of the Caregiving Tasks in Caring for an Adult with Mental Illness Scale (CTiCAMIS), (2) relations between caregiving tasks and various caregiving parameters, and (3) associations between caregiving tasks and adjustment cross-sectionally and over 12 months. METHOD: Participants were 114 carers of adults with a mental illness who completed questionnaires at time 1 and 12 months later (time 2). RESULTS: Factor analyses showed that the CTiCAMIS could be represented by a single dimension or three caregiving domains: instrumental care, activities of daily living care, psychosocial care. The CTiCAMIS factors were psychometrically sound and evidenced differential relations with most carer, care recipient and caregiving context variables, and were correlated with adjustment outcomes concurrently and over 12 months after controlling for initial adjustment. CONCLUSION: Findings delineate the key dimensions of mental health caregiving and show the differential links between caregiving activities and caregiving parameters and carer adjustment.

A stress and coping model of adjustment to caring for an adult with mental illness.

This study investigated the utility of a stress and coping framework for identifying factors associated with adjustment to informal caregiving to adults with mental illness. Relations between stress and coping predictors and negative (distress) and positive (positive affect, life satisfaction, benefit finding, health) carer adjustment outcomes were examined. A total of 114 caregivers completed questionnaires. Predictors included relevant background variables (carer and care recipient characteristics and caregiving context), coping resources (optimism, social support, carer-care recipient relationship quality), appraisal (threat, control, challenge) and coping strategies (problem-focused, avoidance, acceptance, meaning-focused). Results indicated that after controlling for relevant background variables (burden, caregiving frequency, care recipient symptom unpredictability), better caregiver adjustment was related to higher social support and optimism, better quality of carer-care recipient relationship, lower threat and higher challenge appraisals, and less reliance on avoidance coping, as hypothesised. Coping resources emerged as the most consistent predictor of adjustment. Findings support the utility of stress and coping theory in identifying risk and protective factors associated with adaptation to caring for an adult with mental illness.

The effectiveness of an ACT informed intervention for managing stress and improving therapist qualities in clinical psychology trainees.

OBJECTIVES: Clinical psychology trainees (CPTs) are vulnerable to high stress, which can adversely affect their personal and professional functioning. This study evaluated the effectiveness of a group acceptance and commitment therapy (ACT) informed stress management intervention for CPTs. DESIGN: Outcome measures were work-related stress, distress, life satisfaction, counseling self-efficacy, self-compassion, and therapeutic alliance. A cohort-controlled design, where an experimental group (n = 28) was compared with a waitlist control group (n = 28), was utilized, with a 10-week follow-up. RESULTS: Group comparisons showed statistically significant intervention effects for the main outcome measures, which were maintained at follow-up. Mediational analyses showed that changes on most outcomes were mediated by ACT mindfulness and acceptance processes. CONCLUSIONS: Findings support the effectiveness of a group ACT program for CPTs regarding stress reduction and improving therapist qualities.

Young Adult Carers during the Pandemic: The Effects of Parental Illness and Other Ill Family Members on COVID-19-Related and General Mental Health Outcomes.

The mental health impacts of the COVID-19 pandemic on young adult carers have been neglected. This study aimed to identify COVID-19 related risk factors for young adult carers and to investigate their mental health relative to non-carer peers. Of the 1823 Italians aged 18-29 who completed an online survey, 1458 reported no ill family member (non-carers). Young adult carers included 268 with an ill parent, and 97 with an ill non-parent family member. Two mental health outcome categories were measured: COVID-19-related (risky health behaviors, loneliness, home violence, fear of COVID-19) and general (anxiety, depression, wellbeing). Six COVID-19 related risk factors were significantly correlated with poorer mental health in young adult carers. These factors constituted a COVID-19 Context Index. Compared to non-carers, young adult carers reported poorer mental health across all outcomes, as expected. The prediction that young adult carers caring for an ill parent would report poorer mental health than those caring for ill non-parent family members was evident only for the COVID-19-related mental health outcomes. The elevated rates of clinically significant distress and pandemic-related mental health problems among young adult carers highlight this group as a priority for mental health promotion interventions and whole-of-family support across multiple sectors.

The trajectories of anxiety and depression during the COVID-19 pandemic and the protective role of psychological flexibility: A four-wave longitudinal study.

BACKGROUND: Published reports on the adverse mental health impacts of the initial phase of the COVID-19 pandemic suggest an emerging global mental health crisis. However, the trajectories of these mental health impacts over multiple COVID-19 peaks and corresponding lockdowns are unknown. This study explored the trajectories of anxiety and depression over two consecutive lockdowns during the first nine months of the pandemic in Europe (April 2020-January 2021) and examined whether they varied as a function of different psychological flexibility and inflexibility profiles. METHODS: A total of 569 Italians completed online surveys at four assessment points. Trajectories of anxiety and depression were examined with latent growth modeling and according to different psychological flexibility and inflexibility profiles. RESULTS: Anxiety increased linearly throughout the study period, whereas depression displayed a quadratic trajectory evidencing a decrease with the easing of the first lockdown followed by an increase during the second lockdown. Furthermore, two profiles were identified that displayed different anxiety and depression trajectories. Compared to the psychologically flexible profile, the psychologically inflexible profile reported significantly higher anxiety and depression which remained higher across the study period. LIMITATIONS: A reliance on self-report measures and convenience sampling constitute key study limitations. CONCLUSIONS: Results suggest that high psychological inflexibility is a risk factor for prolonged elevated anxiety and depression during the COVID-19 pandemic, whereas high psychological flexibility is a protective factor. Psychological flexibility and inflexibility should be targeted by preventive public health interventions that harness evidence-based strategies shown to effectively target these factors.

Caregiving Responsibilities and Mental Health Outcomes in Young Adult Carers during the COVID-19 Pandemic: A Longitudinal Study.

This study investigated caregiving responsibilities and associated mental health outcomes in young adult carers during the COVID-19 pandemic and had three aims: (1) to investigate differences in caregiving responsibilities across two groups of young adult carers (parental illness context vs. ill non-parent family member context) relative to non-carers, (2) to identify COVID-19/lockdown correlates of caregiving responsibilities, and (3) to examine the longitudinal associations between caregiving responsibilities and mental health outcomes. Of the 1048 Italians aged 18-29 (Mage = 24.48, SDage = 2.80; 74.33% female) who consented to complete online surveys at Time 1, 813 reported no ill family member (non-carers). Young adult carers included 162 with an ill parent and 73 with an ill non-parent family member. The study included 3 time points: 740 participants completed Time 2 assessment (Mage = 24.35, SDage = 2.81; 76.76% female), while 279 completed Time 3 assessment (Mage = 24.78, SDage = 2.72; 79.93% female). Key variables measured were 13 COVID-19/lockdown factors at Times 1 and 2, caregiving responsibilities at Time 2, and mental health outcomes at Time 3 (fear of COVID-19, anxiety, depression, wellbeing). Two COVID-19/lockdown factors were significantly correlated with higher caregiving responsibilities: insufficient home space, and greater time spent working and learning from home. As predicted, young adult carers reported higher caregiving responsibilities than non-carers, and this effect was greater in young adults caring for an ill parent compared to young adults caring for an ill non-parent family member. As expected, irrespective of family health status, caregiving responsibilities were longitudinally related to poorer mental health outcomes, operationalised as higher fear of COVID-19, anxiety, and depression, and lower wellbeing. Elevated young adult caregiving is an emerging significant public health issue that should be addressed through a multipronged approach that includes education about young adult carer needs for personnel across all relevant sectors and flexible care plans for ill family members that include a 'whole family' biopsychosocial approach.

Evaluation of a program for training psychologists in an acceptance and commitment therapy resilience intervention for people with multiple sclerosis: a single-arm longitudinal design with a nested qualitative study.

PURPOSE: This single-arm longitudinal study evaluated the effectiveness of a program for training psychologists in delivering an acceptance and commitment therapy-based program (REsilience and Activities for every DaY; READY) for people with multiple sclerosis (PwMS). MATERIALS AND METHODS: The training encompassed three phases: (1) training workshop; (2) READY participation; (3) READY delivery to PwMS. Self-report data were collected immediately before the workshop, before and after participation in READY, and at 3- and 15-month follow-ups. RESULTS: Forty psychologists successfully completed the training. The training was effective in fostering the acquisition of knowledge and skills for effective delivery of READY to PwMS. Participants improved over the course of training in resilience, positive affect, wellbeing, psychological flexibility, and associated processes. These improvements peaked during the participation in READY phase and continued to accrue at a slower rate three months later. Psychological flexibility mediated the improvements in resilience, positive affect, and wellbeing. Qualitative data confirmed the personal, professional, and multiple sclerosis (MS) psychologist community level positive training impacts. CONCLUSIONS: The training fostered positive professional and personal development in trainees and consolidated the integration of READY into a frontline service for PwMS. To date, more than 50 READY groups for PwMS have been conducted in Italy.Implications for rehabilitationTraining psychologists in delivering an acceptance and commitment therapy (ACT)-based resilience intervention for people with multiple sclerosis (MS) is associated with positive personal and professional impacts for the trainees.The training program strengthened the sense of community among members of the professional network who attended as trainees.In ACT training, psychological flexibility plays a key role in improving resilience, positive affect, and wellbeing in trainees, and is therefore an important intervention target.ACT training for practitioners fosters the integration of ACT-based interventions into frontline services.