Psychological Flexibility, Chronic Pain, and Health.

Psychological flexibility is a model of human performance and well-being. It essentially entails an approach to life circumstances that includes openness, awareness, and engagement. It has roots in behavior analysis, and it is linked to a philosophy of science called functional contextualism and to a specific therapy approach called Acceptance and Commitment Therapy. One of the earliest and most developed research areas in which this model and therapy have been applied is chronic pain. This review describes psychological flexibility and its facets in more detail, sets them in a context of relevant psychological models, and examines related assessment and treatment methods. It also examines evidence, current challenges, and future directions. It is proposed that psychological flexibility, or an expanded model very much like it, could provide a basis for integrating current research and treatment approaches in chronic pain and health generally. This, in turn, could produce improved treatments for people with chronic pain and other conditions.

Psychological inflexibility as a predictor associated with insomnia.

Psychological flexibility has recently attracted the attention of researchers in the field of sleep disorders; therefore, in the study, psychological flexibility was evaluated as a predictor or factor related to the presence/severity of insomnia. We included 2218 individuals selected from the randomized-control trial for behavioural therapy for insomnia and cross-sectional studies, including 1797 individuals with insomnia and 421 controls without insomnia. All participants completed the DSM-5-based insomnia diagnosis interview, Insomnia Severity Index, Hospital Anxiety and Depression Scale, and Acceptance Action Questionnaire-II. Linear regression and multinomial logistic regression models were used. Sex, education, occupation, marital status, anxiety, depression and psychological inflexibility were possible predictors or factors associated with the severity of insomnia. Multivariate linear regression analysis demonstrated that sex (𝛽 = 0.88; t = 2.80; p = 0.005), depression (𝛽 = 0.41; t = 10.7; p < 0.001), anxiety (𝛽 = 0.58; t = 14.1; p < 0.001) and psychological inflexibility (𝛽 = 0.09; t = 5.07; p < 0.001) were predictors of insomnia. The results of the multinomial logistic regression demonstrate that, in comparison to the absence of insomnia, insomnia at all levels (mild, moderate and severe) was associated with sex, anxiety and depression. Psychological inflexibility was only associated with severe insomnia (odds ratio = 1.04). These findings are important from a public health perspective because behavioural strategies designed to treat insomnia with a focus on psychological flexibility are low-cost and may help improve sleep quality in adults with insomnia, which also influences mental health.

Examining the impact of androgen deprivation therapy, masculine self-esteem, and psychological flexibility on distress and quality of life in men with prostate cancer.

OBJECTIVE: Studies suggest that androgen deprivation therapy (ADT) exacerbates psychological and quality of life (QoL) issues associated with prostate cancer (PCa). However, quantitative research examining underlying psychosocial mechanisms for this is limited. We examined the association of PCa symptoms with distress and QoL in ADT-treated and ADT-naïve patients, and the influence of masculine self-esteem and psychological flexibility (PF) on these relationships. METHODS: Secondary analysis of a quantitative, cross-sectional survey of 286 PCa patients. Independent samples t-tests, moderation, and conditional process analysis were used to assess relationships between predictor, mediator, moderator, and outcome variables. RESULTS: ADT was associated with greater PCa symptomology, lower masculine self-esteem, and lower QoL. Moderation analysis showed that ADT potentiated adverse impacts of PCa symptomology on distress and QoL. High PF attenuated these relationships, though less so for ADT-treated participants. Conditional process analysis showed that masculine self-esteem mediated the predictive effect of symptoms on distress across treatments. However, ADT did not moderate this indirect effect, nor was moderation conditional on PF. CONCLUSION: PF appears to: (1) attenuate psychological distress in ADT patients; and (2) improve distress, QoL, and masculine self-esteem in ADT-naïve patients. Interventions targeting PF may thus be a viable adjunct to established approaches. However, their effects may be comparatively limited in ADT patients, who may benefit from more intensive and tailored treatment.

A pilot randomised controlled trial of acceptance and commitment therapy for medication decision-making and quality of life in women with breast cancer: The ACTION trial.

OBJECTIVE: Non-adherence to adjuvant endocrine therapy (AET) in women with breast cancer is common and associated with medication side-effects and distress. We co-designed an Acceptance and Commitment Therapy intervention (ACTION) to enhance medication decision-making and quality of life (QoL). We undertook a pilot trial of ACTION to inform the feasibility of a phase III trial, and to examine intervention acceptability. METHODS: This was a multi-site, exploratory, two-arm, individually randomised external pilot trial. Women with early breast cancer prescribed AET were randomised (1:1) to receive usual care (UC) or UC + ACTION. The ACTION intervention comprised a remotely delivered one-to-one ACT session followed by three group sessions delivered by clinical psychologists, alongside a website containing ideas for the self-management of side effects. RESULTS: Of the 480 women screened for eligibility, 260 (54.2%) were approached and 79 (30.4%) randomised. 71 (89.9%) women provided data at 3-month and 70 (88.6%) at 6-month 40 women were randomised to receive UC + ACTION and 32 (80.0%) completed the intervention. Most (75.0%) accessed the website at least once. ACTION was acceptable to participants (Borkovec & Nau Scale: mean = 7.8 [SD = 2.7] out of 10). Signals of effectiveness in favour of the UC + ACTION arm were observed for medication adherence (Adherence Starts with Knowledge questionnaire-12), QoL (work and social adjustment scale), health-related QoL (functional assessment of cancer therapy[FACT] general and FACT-ES-19/23), distress (generalised anxiety disorder -7, patient health questionnaire-9) and psychological flexibility (valuing questionnaire). CONCLUSIONS: The ACTION intervention was acceptable to patients. There were promising signals for effectiveness on primary and secondary outcomes. A phase III randomised controlled trial is feasible. TRIAL REGISTRATION: ISRCTN12027752.

Personal Resources and Total Pain: Exploring the Multiple Mediation of Fear of Recurrence, Meaning-Making, and Coping in Posttreatment Cancer Patients.

BACKGROUND: People with cancer who have completed treatment still experience negative effects, such as an increased risk of experiencing cancer-related pain. Psychological factors tend to influence cancer patients' ability to cope with pain in various dimensions. Although personal resources are an important factor in buffering total pain, still little is known about the intervening variables and underlying mechanisms. PURPOSE: The current study examined the relationship between psychological flexibility, self-esteem, and total pain, while considering fear of recurrence, meaning-making, and coping as potential mediating factors. METHODS: Adults (N = 304) who completed medical treatment (radiotherapy, chemotherapy, and combined therapy) participated in this study. They completed questionnaires measuring the aforementioned variables. Structural equation models were used to examine mediation effects. RESULTS: Psychological flexibility, and partly self-esteem, were negatively related to the dimensions of total pain. However, to a large extent, these relationships were serially and parallelly mediated by fear of recurrence, meaning-making, and emotion-oriented coping. CONCLUSIONS: Consistent with the meaning-making model, cognitive (meaning-making), and affective (fear of recurrence and emotional coping) factors may be potential mechanisms underlying the association between psychological flexibility, self-esteem, and total pain in posttreatment cancer patients. In this study, they tended to interact in the area of physiological and psychosocial experiences of cancer-related pain.

A significant number of cancer patients who undergo medical treatment tend to experience pain as a consequence of medical and psychological factors. Personal resources such as psychological flexibility and self-esteem can play important roles in the pain experiences of cancer patients, including their physical, psychological, social, and spiritual symptoms. However, other factors related to anxiety and coping can also affect the relationships mentioned above. Therefore, we examined whether fear of recurrence, meaning-making, and coping serially mediated the relationships between psychological flexibility, self-esteem, and total pain in posttreatment cancer patients. A total of 304 cancer patients (159 women, 145 men) who had completed medical treatment participated in our study. Patients with higher psychological flexibility experienced lower physical, psychological, social, and spiritual pain, whereas patients with higher self-esteem felt only lower physical pain. Furthermore, posttreatment cancer patients characterized by well-defined goals and self-worth experienced lower fear of recurrence and were able to find meaning and emotionally cope with their daily predicament. As a consequence, they felt less total pain in physical, psychological, social, and spiritual dimensions. Experiencing lower fear of cancer recurrence combined with finding meaning and goals predisposes patients to more effectively deal with pain symptoms.

Cross-cultural validity and reliability of the comprehensive assessment of acceptance and commitment therapy processes (CompACT) in people with multiple sclerosis.

PURPOSE: The Comprehensive assessment of Acceptance and Commitment Therapy (CompACT) is a 23-item questionnaire measuring psychological flexibility, a quality of life protective factor. An 18-item version was recently produced. We assessed validity and reliability of CompACT, and equivalence of paper and electronic (eCompACT) versions in people with multiple sclerosis (PwMS) in Italy, Germany and Spain. METHODS: We used confirmatory factor analysis and assessed CompACT-23 and CompACT-18 measurement invariance between the three language versions. We assessed construct validity (Spearman's correlations) and internal consistency (Cronbach's alpha). Test-retest reliability (intraclass correlation coefficient, ICC) and equivalence of paper and eCompACT (ICC and linear regression model for repeated measures) were assessed in subsamples of PwMS. RESULTS: A total of 725 PwMS completed the study. The three-factor structure of the CompACT-23 showed poor fit (RMSEA 0.07; CFI 0.82; SRMR 0.08), while the fit of the CompACT-18 was good (RMSEA 0.05; CFI 0.93; SRMR 0.05). Configural and partial metric invariance were confirmed, as well as partial scalar invariance (reached when five items were allowed to vary freely). The CompACT-18 showed good internal consistency (all alpha ≥ 0.78); and test-retest reliability (all ICCs ≥ 0.86). Equivalence between paper and eCompACT was excellent (all ICCs ≥ 0.86), with no mode, order, or interaction effects. CONCLUSION: Results support using the refined CompACT-18 as a three-factor measure of psychological flexibility in PwMS. Paper and eCompACT-18 versions are equivalent. CompACT-18 can be used cross-culturally, but sub-optimal scalar invariance suggests that direct comparison between the three language versions should be interpreted with caution.

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

BACKGROUND: Postpartum 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. METHODS: A 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. RESULTS: PPD, 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. CONCLUSIONS: The 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.

Reduction of alcohol use and increase in psychological flexibility after a naturalistic psychedelic experience: a retrospective survey.

INTRODUCTION: Alcohol use can be significantly associated with negative social, professional, and health outcomes. Even more so, alcohol use disorder (AUD) is a critical public health issue and major avoidable risk factor. This study aimed to examine the effect of a naturalistic psychedelic experience on alcohol use and related measures. METHODS: A retrospective online survey was conducted on 160 individuals who reported a psychedelic experience and a concomitant drinking habit but did not necessarily have an AUD. Demographic data, characteristics of the psychedelic experience, and changes in alcohol consumption and psychological flexibility were surveyed. Results: The mean number of drinking days per week and AUDIT scores significantly decreased after the psychedelic experience (P < .001). Subjects who quit or reduced drinking had a more severe AUD (P < .01) and lower psychological flexibility (P = .003) before the psychedelic session. Alcohol use reduction was significantly associated with the intensity of the mystical experience (P = .03). Psychological flexibility increased more in participants who reduced their alcohol use (P < .001), and the change in psychological flexibility was one of the predictors of alcohol use improvement (P = .003). Conclusion: Our findings suggest that a naturalistic psychedelic experience could be associated with a reduction in alcohol use and dependency. Such positive health outcomes can be associated with the intensity of the mystical experience as well as an increase in psychological flexibility.

Intolerance of uncertainty and psychological flexibility as predictors of mental health from adolescence to old age.

PURPOSE: The COVID-19 pandemic brought with it significant social, economic and health uncertainties. These were proposed to impact young people more compared to adults, leading adolescents to report more mental health problems during the pandemic. The current study examined whether differences in cognitive risk (tolerance of uncertainty) and protective (psychological flexibility) factors accounted for age-related differences in depression and anxiety. METHODS: These associations were investigated in the COVID-19 Risks Across the Lifespan (CORAL) cohort (N = 2280, 11-89 years). RESULTS: The results showed that adolescents experienced greater intolerance of uncertainty and lower psychological flexibility compared to adults and older adults. Tolerance of uncertainty did not account for age-related differences in depression or anxiety. However, psychological flexibility conferred more protective advantage for anxiety in adults compared to adolescents. CONCLUSION: The observed age-related differences in risk and protective factors advance our understanding of developmental vulnerabilities to depression and anxiety. Implications for mental health interventions in the context of future pandemics are discussed.

Acceptance and Commitment Therapy for Major Depressive Disorder: Navigating Depression Treatment in Traditional and Digital Settings with Insights from Current Research.

Given the shortcomings of a mechanistic assumption of traditional cognitive behavioral therapy (CBT), a newer generation of CBT-grounded interventions focusing on process-orientated emotional and motivational aspects has emerged. These so-called third-wave CBTs emphasize function and context of inner experience over form and content, and have become evidence-based practice in the past four decades. Among these approaches, acceptance and commitment therapy (ACT) has both a large body of research for various (mental) health conditions, including major depressive disorder (MDD) in particular. ACT is a transdiagnostic approach that intends to increase psychological flexibility (PF) of clients as a universal mechanism of behavior change and a value-driven orientation in life. By focusing on present-moment awareness, acceptance, defusion, establishing a stable sense of self, clarifying personal valued life directions, and committing to behaviors consistent to these values, ACT targets the core processes of PF. Meta-analyses have indicated the efficacy and effectiveness of ACT in reducing depressive symptoms and increasing well-being, with mainly moderate effect sizes in clinical trials. ACT for MDD has been shown to be effective across different delivery modes (e.g., individual, group, digital). ACT can also be applied using self-help formats (e.g., mobile apps) and combined with features from compatible approaches like behavioral activation. There is also evidence for a high acceptability of ACT and adherence rates comparable to classic CBT. Moreover, process research has shown that ACT works specifically through the mediator of PF and by addressing its suggested core therapeutic processes. Given the essential role of offering a personalized therapeutic strategy in treatment outcomes and adherence, it is central to provide more effective options that match clients' needs and preferences. This chapter illustrates different applications of ACT for adults with MDD and the current evidence base to promote informed decisions on using ACT as additional or stand-alone therapeutic approach.

Psychological flexibility prospectively predicts COVID-19 PPE use across a two-month interval.

Perceived susceptibility, psychological flexibility and health behaviors (PPE use, social distancing) were measured at two time points spaced 2 months apart during the height of the COVID-19 pandemic and lockdown in the U.S.A (Time 1 April 2020; Time 2 June 2020). Demographic variables were also collected. Data from 151 Mturk workers indicated that Time 1 psychological flexibility significantly predicted PPE use and social distancing. The effect sizes were substantial. Perceived susceptibility was not a significant predictor. Psychological flexibility messaging and interventions could be an important way to increase the likelihood of people performing health protective behaviors to better constrain the continuing COVID-19 outbreak.

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.

Resilience in the face of pandemic: exploring the influence of psychological flexibility on turnover intentions and burnout among critical care nurses in COVID-19 hospitals.

AIM: Assess the levels of psychological flexibility, burnout, and turnover intention among critical care nurses and assess the impact of psychological flexibility on burnout, and turnover intention among critical care nurses. BACKGROUND: Burnout and turnover intentions among critical care nurses are rapidly increasing because of the challenges of COVID-19. There is a need for evidence-based interventions like psychological flexibility to be addressed in research to overcome those challenges. METHODS: A descriptive correlational research. A convenient sample of 200 critical care nurses working in COVID-19 hospitals from two governorates in Egypt. The sociodemographic and clinical data sheet, the work-related acceptance and action questionnaire, the Copenhagen burnout inventory, and the adopted version of the staff nurses' intention to leave the nursing profession questionnaire were used. RESULTS: The majority of critical care nurses reported a moderate level of psychological flexibility (75.5%, Mean = 31.23), a moderate level of burnout (65.5%, Mean = 59.61), and low to moderate levels of intention to leave (73%, Mean = 5.95). Psychological flexibility has a statistically significant negative correlation with burnout (PC = -0.304, Sig = 0.000) and the intention to leave (PC = -0.258, Sig = 0.000). In addition, psychological flexibility has a predictable effect on decreasing burnout (R2 = 0.232) and intention to leave (R2 = 0.127) among critical care nurses. CONCLUSION: critical care nurses in COVID-19 hospitals reported varied levels of burnout and an intention to leave that must be considered. The effect of psychological flexibility on burnout and intention to turnover highlighted the importance of improving it among critical care nurses by applying acceptance and commitment therapy as a management intervention.

Bereavement guilt among young adults impacted by caregivers' cancer: Associations with attachment style, experiential avoidance, and psychological flexibility.

OBJECTIVES: This paper focuses on the experiences of bereavement guilt among young adults bereaved by a caregiver's cancer, examining associations with attachment style, experiential avoidance, and psychological flexibility with the aim of informing psychosocial interventions for this population. METHODS: Ninety-seven young adults (18-25 years) bereaved by a parent/guardian's cancer completed an online survey, including measures of bereavement guilt, attachment style, experiential avoidance, and psychological flexibility. Mediation analyses explored the associations between attachment style (anxious, avoidant) and bereavement guilt, and if these associations were mediated by experiential avoidance or psychological flexibility. RESULTS: Bereavement guilt was significantly positively associated with anxious, but not avoidant, attachment to the deceased; the relationship between anxious attachment and bereavement guilt was partially mediated by experiential avoidance. Bereavement guilt was also negatively associated with psychological flexibility and engagement with bereavement counseling. SIGNIFICANCE OF RESULTS: Given the limited literature on cancer-related bereavement in young adulthood, this study offers important theoretical and clinical insights into factors associated with more complex aspects of grief in this population. Specifically, this work identified that anxious attachment is associated with ongoing bereavement complications in the years following the death of a caregiver to cancer, with experiential avoidance partially mediating this relationship. While further research is needed to better understand the interaction between these factors and other related constructs, such as psychological flexibility, these findings may be helpful in selecting therapeutic approaches to use with this population.

How mood is affected by environment and upsetting events: The moderating role of psychological flexibility.

OBJECTIVE: Patients suffering from psychological disorders report decreased quality of life and low mood. The relationship of these symptoms to daily upsetting events or environments, and in the context of active coping mechanisms is poorly understood. The present study thus investigates the association between mood, psychological flexibility, upsetting events, and environment in the daily life of outpatients. METHOD: We investigated 80 outpatients at the beginning of treatment, using event sampling methodology (ESM). Patients' mood, occurrence of upsetting events, current environment, and psychological flexibility were sampled six times per day during a one-week intensive longitudinal examination. Data were analyzed using linear mixed models (LMMs). RESULTS: Participants reported worse mood the more upsetting events they experienced. Further, participants reported better mood when in private environments (e.g., with friends), and worse mood when at the hospital, compared to being at home. Higher levels of psychological flexibility, however, were associated with better mood, irrespective of the occurrence of upsetting events or current environment. CONCLUSION: Results suggest that mood is positively associated with psychological flexibility, not despite, but especially during the dynamic and context-specific challenges of daily life. Psychological flexibility may thus potentially act as a buffer against distress-provoking situations as patients go about their daily lives. TRIAL REGISTRATION: ISRCTN.org identifier: ISRCTN11209732.

Psychological flexibility, self-compassion, subjective well-being, and substance misuse in college students: a serial mediation model.

Substance misuse is a pressing public health concern, especially among emerging adults, with implications for psychological health and overall well-being. This cross-sectional study investigates the mediating roles of self-compassion and subjective well-being in the relationship between psychological flexibility and substance misuse among Turkish college students. The study included 445 emerging adults enrolled at a state university in Türkiye. University participants were recruited via convenience sampling using snowball methods. Data were collected using self-report scales. The sample was 69% female (n = 307) and 31% male (n = 138) and ranged in age from 18 to 26 years (M = 20.85, SD = 1.35). In the study, Pearson product-moment correlation analysis was conducted to examine the relationships between the variables and then the serial mediation model was tested. The findings have revealed that psychological flexibility significantly predicts substance misuse, subjective well-being, and self-compassion. Additionally, the study identifies self-compassion as a mediator in the relationship between psychological flexibility and subjective well-being. While self-compassion contributes significantly to well-being, it does not explain the impact of psychological flexibility on substance misuse. Furthermore, subjective well-being also appears to be a mediator in the relationship between psychological flexibility and substance misuse, emphasizing its potential significance in reducing the likelihood of resorting substance misuse. Overall, the study contributes to understanding the pivotal role of self-compassion and psychological flexibility in fostering well-being and preventing substance misuse in the college setting.

Positive Childhood Experiences and Spiritual Well-Being: Psychological Flexibility and Meaning-Based Coping as Mediators in Turkish Sample.

Spiritual well-being enhances life quality, acts as a stress reliever, and mitigates unfavorable feelings. It helps individuals find meaning and purpose, increasing inner peace and happiness while improving stress management and overall well-being. This study examined whether positive childhood experiences are linked to spiritual well-being and if psychological flexibility and meaning-based coping serve as mediators. The sample included 1061 participants (Mage = 39.38; SD = 8.82) from various Turkish cities. Structural equation modeling assessed relationships between spiritual well-being, positive childhood experiences, psychological flexibility, and meaning-based coping. Results showed that positive childhood experiences directly enhance spiritual well-being, mediated by psychological flexibility and meaning-based coping. This underscores the significance of fostering positive childhood experiences to promote spiritual well-being and coping mechanisms.

Investigation of Predictors of Psychological Resilience in Occupational Therapy Students in Terms of Different Variables.

There is an increased number of publications concerning the mental health of occupational therapy students. The aim of this study is to investigate the predictors of psychological resilience in occupational therapy students in terms of different variables. Four scales measuring resilience, psychological flexibility, coping and coping attitudes were used in this study. Predictors of resilience were evaluated using multiple linear regression analysis with the backward elimination. It was determined that psychological resilience, psychological flexibility, and coping attitudes are interrelated concepts (p < 0.05). This is the first study to examine the predictors of the concept of resilience in occupational therapy students in terms of different variables. The results show that students' psychological flexibility and positive coping behaviors need to be improved to develop psychological resilience.

Reappraising personal values in cancer: Meaning-in-life adaptation, meaningfulness, and quality of life.

OBJECTIVE: This study explores the reappraisal of personal values among people with cancer post-diagnosis and its connections to meaningfulness, encompassing personal meaning and sense of meaning, and various dimensions of quality of life. METHODS: A total of 144 patients with diverse cancer types and a control group comprising 158 healthy adults with similar demographic characteristics completed the Valued Living Questionnaire-Perceived Change, the Personal Meaning Profile-Brief, the Portrait Values Questionnaire, and the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being. RESULTS: Cancer patients displayed a substantial values reappraisal compared to healthy adults. They reported an increased significance of social areas and self-transcendental values, including close relationships (family, partner, and friends), spirituality, citizenship, and universalism, as well as an increased importance of self-care and self in general. Conversely, cancer patients assigned less importance to work and self-enhancement values such as stimulation, power, and achievement. Cluster analysis revealed that patients who reappraised their values exhibited higher meaningfulness and better indicators of quality of life, including spiritual and physical well-being, compared to patients who did not modify their value system. CONCLUSIONS: These findings underscore the importance of assessing and promoting meaning-in-life adaptability among people with cancer, with potential applications in meaning-centered therapies and interventions aimed at enhancing psychological flexibility.

The mediating role of psychological flexibility in the association of autistic-like traits with burnout and depression in medical students during clinical clerkships in Japan: a university-based cross-sectional study.

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