Strategies of University Students to Cope with COVID-19 and the Role of Psychological Flexibility

The COVID-19 outbreak is an important stress factor that threatens the health of individuals both physically and psychologically. Within the scope of struggling the outbreak, many precautions, such as quarantine practices, social distance rules, distance education, flexible working hours have been taken and the lives of individuals have changed greatly. One of the groups that have been significantly influenced by this process is university students. The primary purpose of this study is to determine the ways in which university students cope with the outbreak and to understand the role of psychological flexibility. There were 457 university students in the study. Participants completed an online questionnaire form comprising items relevant to their coping strategies and psychological flexibility levels. Results revealed that participants used transcendental coping the most while relational coping the least. Additionally, psychological inflexibility negatively predicted transcendental, behavioral, and relational coping behaviors. These results revealed the fact that psychological flexibility is an important mechanism that channels students’ coping behaviors in such a critical process.

The Effect of Loneliness in Psychological and Behavioral Profile among High School Students in Spain

Loneliness is a distressing feeling that can be a barrier to a student’s development and affect their mental health. This research aimed to analyse the effects of loneliness on psychological and behavioral factors among students aged 12–19 years in Spain. Loneliness, experiential avoidance, psychological inflexibility, physical activity, mobile phone use, and smoke habits were analysed in a sample of 110 men and 122 women assigned into two groups depending on their loneliness levels: higher loneliness group (HLG) and lower loneliness group (LLG). Results showed that experimental avoidance and psychological inflexibility were related with loneliness (r = 0.471; p = 0.000). Experiential avoidance and psychological inflexibility were higher in HLG than LLG. Regarding the use of mobile phones and smoking habits, LLG presented significantly higher values than HLG. Higher age correlated with lower loneliness values (r = −0.155; p = 0.017). The present research found how students with higher loneliness presented higher experiential avoidance and psychological inflexibility and lower age, use of mobile phone, and smoking habits. These findings reveal the importance of considering multiple social behaviours when examining adolescent mental health factors.

Internet-Delivered Acceptance and Commitment Therapy Added to Multimodal Pain Rehabilitation: A Cluster Randomized Controlled Trial

Internet-delivered interventions hold the possibility to make pain rehabilitation more accessible and adaptable by providing qualified individualized psychological care to chronic pain patients in their homes. Acceptance and commitment therapy (ACT) has shown promising results on psychological functioning and pain acceptance. Internet-delivered ACT (IACT) added to multimodal pain rehabilitation program (MMRP) in primary care has, so far, not shown better results than MMRP alone. The aim of this cluster randomized controlled study was to investigate the effects of adding IACT during and after MMRP in specialist care on psychological outcomes. In total, 122 patients who enrolled in a specialist pain clinic were cluster randomized groupwise to either MMRP (n = 12 groups) or to MMRP with added IACT (n = 12 groups). The IACT addition included 6 weeks of treatment during MMRP and 11 weeks of aftercare following MMRP. Online and paper-and-pencil self-report measures of pain acceptance, psychological inflexibility, self-efficacy, and psychosocial consequences of pain, were collected at four occasions: prior to and post MMRP, post aftercare intervention and at 1 year follow-up. Dropout was extensive with 25% dropping out at post treatment, an additional 35% at post aftercare, and 29% at 1 year follow-up. Medium treatment between-group effects were found on pain acceptance in favor of the group who received IACT added to MMRP, at post treatment and at post aftercare. Large effects were seen on psychological inflexibility and self-efficacy at post aftercare. A medium effect size was seen on affective distress at post aftercare. Moreover, a medium effect on self-efficacy was found at 1 year follow-up. The results indicate that IACT added during MMRP may enhance the treatment effects on pain-related psychological outcomes. Results also suggest that IACT as aftercare may strengthen the long-term effect of MMRP. However, adding a second pain treatment, IACT, to an already extensive pain treatment, MMRP, could be perceived as too comprehensive and might hence influence completion negatively. Further research on adverse events and negative effects could be helpful to improve adherence. Next step of implementation trials could focus on adding IACT before MMRP to improve psychological functioning and after MMRP to prolong its effect.

PSIHOLOŠKA NEFLEKSIBILNOST KAO MEDIJATOR ODNOSA IZMEĐU RANIH MALADAPTIVNIH SHEMA I MANIFESTACIJA DEPRESIVNOSTI, ANKSIOZNOSTI I STRESA

Although the link between Early Maladaptive Schemas and many psychopathological manifestations has been confirmed, there is still not enough research examining the mechanism by which this link is realized. The aim of this study was to examine whether psychological inflexibility could be a mediator of the relationship between early maladaptive schemas grouped in schema domains and problems in current functioning, manifested through depression, anxiety and stress symptoms. Among the instruments used were the Young’s Schema Questionnaire, the Acceptance and Action Questionnaire and Depression, Anxiety, and Stress Scales. The sample included 320 subjects (Nfemales = 215; M = 33.5; SD = 9.6). The results indicate significant connections of psychological inflexibility with all scheme domains and all criterion variables, with this connection being the strongest in relation to depression (r = .74, p < .01) and autonomy impairment domain (r = .74, p < .01). Schema domains are important predictors of criterion variables, provided that the highest percentage of explained variance is in relation to depression. Psychological inflexibility has been shown to be a partial mediator of all relations between all schema domains and manifestations of depression, anxiety and stress. Although schema domains still have a significant direct effect on psychopathological manifestations, in the case of impaired limits when it comes to anxiety (b = .045; p<.05, 95% BCa CI [.03, .05]) and depression (b = .06, p<.05, 95% BCa CI [.04, .07]) the difference between the indirect and direct effect is most evident, while in the case of stress the greatest difference between the effects is in relation to the domain of autonomy impairment (b = .07, p < .05, 95% BCa CI [.05, .08]). The implications for the integration of schema therapy and third wave cognitive-behavioral therapy are discussed. Keywords: early maladaptive schemas, schema domains, psychological flexibility, depression, stress, anxiety

Spanish Adaptation of the Experiential Approach Scale (EAS)

Psychological inflexibility is a transdiagnostic dimension associated to psychological distress and poor mental health and quality of life. While multiple instruments have been developed for the assessment of patterns of inflexible responding to aversive private events (e.g., unwanted cognitions and emotions), the Experiential Approach Scale (EAS) is the first instrument specifically designed to assess inflexible responding to appetitive private events (e.g., desired affective states). In this study, we explored the factor structure, internal consistency, and convergent validity of a Spanish adaptation of the EAS with a convenience sample of college students from Spain (n = 206; 79% female). A two-factor solution demonstrated very good fit to the data and was similar to the original two-subscale EAS structure: Anxious Clinging and Experience Prolonging. The scale showed adequate overall (α = 0.85) and subscale (αs: 0.90 and 0.89) internal consistency. Unlike the original instrument, both subscales were uncorrelated. Anxious Clinging correlated positively with experiential avoidance and with measures of negative affect and psychopathology, and negatively with positive affect, subjective happiness, and life satisfaction. In turn, Experience Prolonging correlated negatively with psychopathology and positively with positive affect, subjective happiness, and life satisfaction. Our results point to Anxious Clinging as the only EAS subscale contributing to psychological inflexibility.

Psychological Inflexibility and Geriatric Primary Care: Transforming Peri-Urban and Rural Aging

Based on the acceptance and commitment therapy (ACT) framework, human suffering is thought to be caused by psychological inflexibility. Psychological inflexibility is characterized by rigid avoidance of unpleasant experiences, fusion with unhelpful thoughts, lack of contact with the present moment, fusion with a narrow self-narrative, and lack of clarity and contact with one’s core values in life. Psychological inflexibility captures the unhelpful or unworkable ways in which individuals respond to emotional discomfort. Research using samples of adults under age 65 indicate that psychological inflexibility is associated with poorer quality of life and mental well-being; however, the literature on psychological inflexibility in older adults is limited. Patients (N=129) ages 65 and older presenting to a Geriatric Primary Care clinic in the Deep South completed measures of depression, anxiety, subjective health literacy, and psychological inflexibility. Our team used the Acceptance and Action Questionnaire-II (AAQ-II), which is the most commonly used measure of psychological inflexibility. Anxiety (r = 0.66, p &lt; .001) and depression (r = 0.70, p &lt; .001) were moderately correlated with psychological inflexibility, which is consistent with the existing literature on psychological inflexibility in adults under the age of 65. Subjective health literacy significantly predicted psychological inflexibility, b = –.058, t(127) = -4.07, p &lt; .001. This finding provides additional support for the importance of increasing health literacy among older adults in the Deep South, as it has implications in level of psychological flexibility and, thus, quality of life and mental well-being.

O papel da inflexibilidade psicológica na relação entre o stress relacionado com a infertilidade e os sintomas depressivos em mulheres com um diagnóstico de infertilidade

Background and Aim: Introduction: Infertility is a medical and social condition that impacts people’s lives at the marital, family, social and financial levels. Several studies point to comorbidity between psychopathology and infertility, and people facing the demands of infertility may use maladaptive mechanisms of emotion regulation translated into psychological inflexibility. Objectives: This current study aimed to explore the mediating role of infertility-related psychological inflexibility in the relationship between infertility-related stress and depressive symptoms in women presenting an infertility diagnosis and pursuing infertility medical treatment. In addition, as a secondary aim, the associations between the time since diagnosis and the study variables were examined. Methods: A cross-sectional study was conducted on a sample of 96 women recruited with the support of the Portuguese Fertility Association. Participants filled in online a set of self-report instruments. Sociodemographic and clinical data were collected, and standardized measures of infertility-related stress, depressive symptoms, and infertility-related psychological inflexibility were used. Results: The results demonstrated that the effect of infertility-related stress on depressive symptoms was .46, being totally mediated by infertility-related psychological inflexibility. Discussion: Difficulty in achieving a pregnancy is a painful life event that interferes with the goals and plans for building a family, which can lead to stress and depressive symptoms. The relationship between these symptoms seems to be influenced by the mechanism of infertility-related psychological inflexibility. Therefore, interventions such as Acceptance and Commitment Therapy and the Mindfulness-Based Program for Infertility may be particularly suitable for this population by integrating psychological inflexibility as a therapeutic target.