Associations between psychological flexibility and mental health problems during the Covid-19 pandemic: a three-level meta-analytic review

Yao, Xiaoyu; Chan, Ko Ling; Chen, Shimin; Gao, Shuling

doi:10.1007/s12144-024-05628-y

Cited by 7COVID-19 and Mental HealthMindfulness and Compassion InterventionsMaternal Mental Health During Pregnancy and Postpartum

Associations between psychological flexibility and mental health problems during the Covid-19 pandemic: a three-level meta-analytic review

Yao, Xiaoyu, Chan, Ko Ling, Chen, Shimin, Gao, Shuling·2024·Current Psychology

DOI 10.1007/s12144-024-05628-y

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Psychological flexibility is negatively associated with shame and stigma, as well as with psychological distress.
“Psychological flexibility is a psychological process that has been found to be negatively associated with shame and stigma, as well as with psychological distress (Krafft et al. 2018;Yao et al. 2024).”
From Illness Stigma and Shame in People With Chronic Illnesses vs. SARS‐CoV‐2 Survivors: Associations With Psychological Distress Through Psychological Flexibility and Self‐Compassion. (2024) · cites this paper as Yao et al. 2024
There are moderate negative associations between psychological flexibility and both depression and anxiety symptoms during the pandemic.
“A recent metaanalysis exploring the associations between psychological flexibility and mental health problems during the pandemic reported moderate negative associations between psychological flexibility and both depression and anxiety symptoms (Yao et al. 2024)”
From Illness Stigma and Shame in People With Chronic Illnesses vs. SARS‐CoV‐2 Survivors: Associations With Psychological Distress Through Psychological Flexibility and Self‐Compassion. (2024) · cites this paper as Yao et al. 2024

The PRISMA 2020 statement: an updated guideline for reporting systematic reviews
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., et al. (2021) · Systematic Reviews · doi:10.1186/s13643-021-01626-4 · Cited by 13,874 · see citing works
Acceptance and commitment therapy: model, processes and outcomes
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006) · Behaviour Research and Therapy · doi:10.1016/j.brat.2005.06.006 · Cited by 6,587 · cited 1× · see citing works
“PF is a transdiagnostic construct related to increased adaptation when facing challenging situations (Hayes et al., 2006; Pakenham et al., 2020).”
Preliminary Psychometric Properties of the Acceptance and Action Questionnaire–II: A Revised Measure of Psychological Inflexibility and Experiential Avoidance
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R. D. (2011) · Behavior Therapy · doi:10.1016/j.beth.2011.03.007 · Cited by 3,950 · see citing works
Bias and Efficiency of Meta-Analytic Variance Estimators in the Random-Effects Model
Viechtbauer, W. (2005) · Journal of Educational and Behavioral Statistics · doi:10.3102/10769986030003261 · Cited by 1,699 · cited 1× · see citing works
“All model parameters were calculated using the restricted maximum likelihood method (Viechtbauer, 2005), and a two-tailed p -value smaller than 0.05 was regarded as statistically significant.”
Influential
Acceptance and commitment therapy.
Hayes, S. C., & Lillis, J. (2012) · American Psychological Association eBooks · doi:10.1037/17335-000 · Cited by 1,543 · see citing works
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Hayes, S. C., Levin, M. E., Plumb-Vilardaga, J., Villatte, J. L., & Pistorello, J. (2013) · Behavior Therapy · doi:10.1016/j.beth.2009.08.002 · Cited by 1,120 · cited 2× · see citing works
“ACT is one of the most influential modes of clinical behavior analysis, and focuses on cognitive and behavioral intervention to interpret human action, increase well-being, and foster PF (Bond et al., 2006; Hayes et al., 2004, 2013).”
Disentangling Components of Flexibility via the Hexaflex Model: Development and Validation of the Multidimensional Psychological Flexibility Inventory (MPFI)
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Öst, L.-G. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.07.018 · Cited by 476 · cited 1× · see citing works
“Previous studies have documented the efficacy of ACT-based interventions for PTSD symptoms (Grau et al., 2020), drug abuse (Öst, 2014), and PF (Pakenham et al., 2020).”
COVID-19: Psychological flexibility, coping, mental health, and wellbeing in the UK during the pandemic
Dawson, D. L., & Golijani-Moghaddam, N. (2020) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2020.07.010 · Cited by 445 · see citing works
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“ACT is one of the most influential modes of clinical behavior analysis, and focuses on cognitive and behavioral intervention to interpret human action, increase well-being, and foster PF (Bond et al., 2006; Hayes et al., 2004, 2013).”
Acceptance and commitment therapy for anxiety and OCD spectrum disorders: An empirical review
Bluett, E. J., Homan, K. J., Morrison, K. L., Levin, M. E., & Twohig, M. P. (2014) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2014.06.008 · Cited by 306 · cited 1× · see citing works
“A different finding in a non-COVID context has been indicated by Bluett et al. (2014), who reported a significant moderate correlation between the PI and measures of anxiety ( r = 0.450) based on a meta-analysis including 63 studies.”
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Defining and measuring “psychological flexibility”: A narrative scoping review of diverse flexibility and rigidity constructs and perspectives
Cherry, K. M., Hoeven, E. V., Patterson, T. S., & Lumley, M. N. (2021) · Clinical Psychology Review · doi:10.1016/j.cpr.2021.101973 · Cited by 267 · cited 7× · see citing works
“Some scholars considered PF and PI as the opposite points in a single continuum (e.g., PI is the absence of PF; Bond et al., 2011; Plys et al., 2022), whereas others regarded them as separate-yet-related constructs (e.g., the improvement on one dimension of PI does not suggest the improvement on the corresponding dime…”
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The moderating roles of psychological flexibility and inflexibility on the mental health impacts of COVID-19 pandemic and lockdown in Italy
Pakenham, K. I., Landi, G., Boccolini, G., Furlani, A., Grandi, S., & Tossani, E. (2020) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2020.07.003 · Cited by 210 · cited 6× · see citing works
“…research in COVID-19 contexts showing that PF and five of its sub-processes (i.e., defusion, present moment awareness, self-as-context, values, and committed action) alleviated the adverse impacts of COVID-19 risk factors on adults’ depressive and anxiety symptoms in Italy (Pakenham et al., 2020).”
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Psychological flexibility and inflexibility as sources of resiliency and risk during a pandemic: Modeling the cascade of COVID-19 stress on family systems with a contextual behavioral science lens
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Psychological Flexibility, ACT, and Organizational Behavior
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Landi, G., Pakenham, K. I., Boccolini, G., Grandi, S., & Tossani, E. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.02195 · Cited by 146 · cited 6× · see citing works
“…research in COVID-19 contexts showing that PF and five of its sub-processes (i.e., defusion, present moment awareness, self-as-context, values, and committed action) alleviated the adverse impacts of COVID-19 risk factors on adults’ depressive and anxiety symptoms in Italy (Pakenham et al., 2020).”
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The role of psychological flexibility in the context of COVID-19: Associations with depression, anxiety, and insomnia
McCracken, L. M., Badinlou, F., Buhrman, M., & Brocki, K. C. (2021) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2020.11.003 · Cited by 146 · see citing works
Social support, psychological flexibility and coping mediate the association between COVID-19 related stress exposure and psychological distress
Tindle, R., Hemi, A., & Moustafa, A. A. (2022) · Scientific Reports · doi:10.1038/s41598-022-12262-w · Cited by 125 · see citing works
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The trajectories of anxiety and depression during the COVID-19 pandemic and the protective role of psychological flexibility: A four-wave longitudinal study
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Is psychological flexibility a mediator between perceived stress and general anxiety or depression among suspected patients of the 2019 coronavirus disease (COVID-19)?
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“…the specific context of the COVID-19 pandemic, evidence-based interventions using (online) ACT or ACT self-help books to foster PF could be used to alleviate psychological distress and improve resilience against prolonged stressors (Huang et al., 2021; Levin et al., 2020; Probst et al., 2019).”
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Dubey, N., Podder, P., & Pandey, D. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.589365 · Cited by 56 · cited 2× · see citing works
“For example, Dubey et al. (2020) used a community sample of 402 Indian adults and found that PF had significant medium and negative associations with psychological problems (i.e., depressive, anxiety, and stress symptoms), and for people in clinical settings, Margolies et al. (2021) documented a…”
Psychological flexibility and psychological inflexibility are independently associated with both hedonic and eudaimonic well-being
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Examining the associations between psychological flexibility, mindfulness, psychosomatic functioning, and anxiety during the covid-19 pandemic: A path analysis
Wielgus, B., Urban, W., Patriak, A., & Cichocki, Ł. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17238764 · Cited by 51 · cited 4× · see citing works
“…in many countries, such as Sweden (McCracken et al., 2021), America (Margolies et al., 2021), Cyprus (Papageorgiou et al., 2021), and Poland (Wielgus et al., 2020), have examined correlations between PF and multiple psychological problems (i.e., symptoms of depression, anxiety, and stress)…”
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Feather, G., & Williams, M. (2022) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2021.12.007 · Cited by 48 · cited 1× · see citing works
“…potential effects of mediating and moderating mechanisms that form the basis of the associations between PF and mental health problems; for example, Feather and Williams (2022) investigated the moderating roles of PF and PI on the association between climate concern and climate-related distress.”
Behind the masks: A cross-sectional study on intolerance of uncertainty, perceived vulnerability to disease and psychological flexibility in relation to state anxiety and wellbeing during the COVID-19 pandemic
Mallett, R., Coyle, C., Kuang, Y., & Gillanders, D. T. (2021) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2021.09.003 · Cited by 42 · see citing works
Baseline psychological inflexibility moderates the outcome pain interference in a randomized controlled trial on Internet-based Acceptance and Commitment Therapy for chronic pain
Probst, T., Baumeister, H., McCracken, L. M., & Lin, J. (2018) · Journal of Clinical Medicine · doi:10.3390/jcm8010024 · Cited by 38 · see citing works
The mediating role of personalized psychological flexibility in the association between distress intolerance and psychological distress: A national survey during the fourth waves of COVID-19 pandemic in Iran
Akbari, M., Seydavi, M., & Zamani, E. (2021) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2685 · Cited by 31 · see citing works
Psychological flexibility in older adulthood: a scoping review.
Plys, E., Jacobs, M. L., Allen, R. S., & Arch, J. J. (2023) · Aging & Mental Health · doi:10.1080/13607863.2022.2036948 · Cited by 29 · cited 2× · see citing works
“Since a prior study found that older adults generally present lower levels of PI than younger adults (Plys et al., 2022), the mean age of the samples in primary studies was examined as a moderator variable in the current study.”
Prevalence and predictors of mental health outcomes in UK doctors and final year medical students during the COVID-19 pandemic
Johns, G., Waddington, L., & Samuel, V. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.05.024 · Cited by 25 · see citing works
Fear of COVID‐19 and COVID‐19 stress and association with sociodemographic and psychological process factors in cases under surveillance in a frontline worker population in borneo
Pang, N. T. P., Nold Imon, G., Johoniki, E., Mohd Kassim, M. A., Omar, A., Syed Abdul Rahim, S. S., Hayati, F., Jeffree, M. S., & Ng, J. R. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18137210 · Cited by 23 · cited 1× · see citing works
“For example, despite AAQ-II being applied to measure PI as well as PF in the empirical literature during the pandemic (Arslan et al., 2021; Pang et al., 2021), when measuring PF the reverse score of AAQ-II was used.”

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Illness Stigma and Shame in People With Chronic Illnesses vs. SARS‐CoV‐2 Survivors: Associations With Psychological Distress Through Psychological Flexibility and Self‐Compassion.
Berglund, S., Danielsson, A., Jakobsson Støre, S., Carreiras, D., Carvalho, S. A., Blomqvist‐Storm, M., Pinto, H., Palmeira, L., Pereira, M., & Trindade, I. A. (2024) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.70009 · Cited by 6 · see citing works

Authors: Yao, X., Chan, K. L., Chen, S., & Gao, S.
Affiliations: Shanghai University (CN)
Hong Kong Polytechnic University (HK)
China University of Mining and Technology (CN)
Corresponding author: Gao, Shuling
ORCID: Chan, Ko Ling
Chen, Shimin
Gao, Shuling
Venue: Current Psychology
Publisher: Springer Science and Business Media LLC
Published: 2024-01-23
Volume: 43
Issue: 26
Pages: 22734-22753
ISSN: 1046-1310 (ISSN-L)
1936-4733
DOI: 10.1007/s12144-024-05628-y
OpenAlex: W4391141055
Cited by: 7
References: 36
Citations by year: 2026: 2 · 2025: 3 · 2024: 2
FWCI: 3.52
Type: journal article
Language: en
Open access: closed
Licence: www.springernature.com/gp/researchers/text-and-data-mining (tdm)
www.springernature.com/gp/researchers/text-and-data-mining (vor)
Locations: Current Psychology (publishedVersion)
Funders: Humanities and Social Sciences Youth Foundation, Ministry of Education of the People's Republic of China (20YJC840012)
Topics: Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
Keywords: psychological flexibility, mental illness, COVID-19 pandemic, depressive symptoms, anxiety symptoms, stress symptoms, protective factors, sex differences

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Associations between psychological flexibility and mental health problems during the Covid-19 pandemic: a three-level meta-analytic review

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