Examining domains of psychological flexibility and inflexibility as treatment mechanisms in acceptance and commitment therapy: A comprehensive systematic and meta-analytic review.

The current systematic and meta-analytic review sought to integrate a growing number of studies examining dimensions of psychological flexibility as treatment mechanisms for Acceptance and Commitment Therapy (ACT). Analyses of 77 records (67 unique studies; Ntotal = 9123 participants) from comprehensive searches of multiple databases suggested that ACT interventions led to reduced inflexibility (i.e., lowered global inflexibility, lack of present moment awareness, cognitive fusion, experiential avoidance, self-as-content, & inaction) and increased flexibility (i.e., committed action/contact with values, global flexibility/acceptance, & defusion). Those changes remained significant when ACT was compared with waitlist or active treatments and were significantly linked to corresponding drops in psychological distress, supporting their roles as ACT treatment mechanisms. Moderation analyses revealed that the use of student samples, exclusion of clinically symptomatic individuals, and comparisons of ACT with other active treatments weakened these effects whereas offering ACT as an individual therapy and excluding individuals in extreme crisis (i.e., with suicidal ideation) strengthened them. The meta-analytic findings and systematic review suggested specific recommendations for future clinical work and research on ACT mechanisms: (1) Evaluate both psychological flexibility and inflexibility as distinct treatment mechanisms, (2) Evaluate specific dimensions of psychological flexibility/inflexibility as mechanisms with multidimensional scales (CompACT, MPFI), (3) Broaden treatment outcomes to include forms of wellbeing (peace of mind, vitality, connectedness), (4) Assess mechanisms and outcomes repeatedly throughout treatment to model the process of therapeutic change, (5) Investigate non-specific factors (therapeutic alliance, treatment adherence) as mechanisms, and (6) Explore treatment mechanisms in effectiveness studies.

Connection at your fingertips: A first look at the Agapé app's contributions to healthy relationships.

Although a range of relationship enhancement interventions have shown benefits, programs involving trained facilitators are difficult to scale and self-directed programs tend to suffer from low rates of adherence (i.e., nonuse/disuse attrition). The present study evaluated Agapé, a relationship wellness smartphone app optimized for broad dissemination through 4 years of persuasive system design driven by user feedback. Agapé builds moments of connection by providing daily prompts to couples and then showing them one another's answers when both partners have responded. To evaluate Agapé, a single-arm, pilot study followed 405 couples (n = 810 partners; 68% non-Latinx White; 50% female; Mage = 29; 50% cohabiting; 31% married; 33% dissatisfied/distressed) through their first month of using the app. Agapé had high engagement (99%, completing M = 27 daily prompts dyadically) and 88% of couples provided follow-up data. The results among completers supported the acceptability, feasibility, and utility of Agapé, suggesting that partners found the app easy (74%) and enjoyable (93%) to use, particularly if they perceived their partners to be responsive. Most partners saw improvement in their relationships (80%) and in their individual well-being (70%). Repeated-measures analyses of variance (ANOVAs) revealed significant within-person improvement on relationship functioning (decreases in relationship negative qualities and increases in relationship satisfaction, relationship positive qualities, and dedication) and on individual functioning (increases in vitality and quality of life with decreases in psychological distress and depressive symptoms) among completers (Cohen's ds ranging from |.14 to .42|). Dosage effects demonstrated that gains in relationship quality were stronger for couples completing more daily prompts. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Biopsychosocial Model and Perinatal Health Care: Determinants of Perinatal Care in a Community Sample.

Insufficient care in the perinatal period is associated with poorer maternal health, poorer perinatal outcomes, infant mortality, and health inequalities. Identifying the sources of and reducing the rates of insufficient care is therefore a major clinical and public health objective. We propose a specific application of the biopsychosocial model that conceptualizes prenatal and postpartum care quality as health markers that are influenced by psychological factors and family and social context. Clinic attendance data were abstracted from the electronic medical records of N = 291 participants enrolled in a longitudinal pregnancy cohort study of healthy women who have been followed since the first trimester; the Kotelchuck Index (KI) was calculated as an index of perinatal care utilization. Detailed prenatal psychological, social, and sociodemographic data were collected from self-report questionnaire and interview. Bivariate analyses indicated socio-demographic (e.g., race), psychological (e.g., response to perceived racism, affective symptoms, trauma experience), and social and family context (e.g., social support, family size) significantly influenced pre- and post-natal care utilization. Multivariate logistic regression analyses, adjusting for medical complications, identified social and family context as robust predictors of perinatal care utilization. The findings underscore the need for biopsychosocial models of health care and highlight several potential strategies for improving health care utilization.