Examining psychological inflexibility as a transdiagnostic process across psychological disorders
Open accessAbstract
The current cross-sectional study examined psychological inflexibility, a process in which behavior is rigidly guided by psychological reactions rather than direct contingencies or personal values, as a transdiagnostic process relevant to a range of depressive, anxiety, substance use and eating disorders. A sample of 972 first-year college students between 17 and 20 years of age completed self-report measures of psychological inflexibility and psychological distress as well as a structured diagnostic interview. Psychological inflexibility was significantly higher across a range of current and lifetime depressive and anxiety disorders as well as lifetime history of eating disorders, relative to students with no disorder, even after controlling for general psychological distress. Findings were mixed for substance use disorders, with a more consistent pattern for lifetime history than for current disorders. Psychological inflexibility was also related to having comorbid depressive, anxiety, and substance use disorders relative to only having one of these diagnoses. Results are discussed in relation to research on psychological inflexibility as a transdiagnostic pathological process and target for interventions. © 2014 Association for Contextual Behavioral Science.
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- Method
The AAQ-II was used as a 7-item measure of psychological inflexibility and experiential avoidance.
“The AAQ-II is a 7 item measure of psychological inflexibility and experiential avoidance.”
Quote in the paperNot yet classified1 of 1 sources checked- cites Bond et al., 2011 source
- Finding
The AAQ-II was not significantly related to current substance use disorders or to alcohol abuse, drug abuse, or drug dependence.
“The AAQ-II was not significantly related to having any current substance use disorder or specifically alcohol abuse, drug abuse, or drug dependence.”
Quote in the paperNot yet classified - Finding
For current depressive and anxiety disorders, comorbid cases were more psychologically inflexible than cases with only one of the two disorder classes.
“participants with comorbid current depressive and anxiety disorders were significantly more psychologically inflexible than participants with only a current anxiety disorder”
Quote in the paperNot yet classified - Finding
After controlling for general psychological distress, current depressive-anxiety comorbidity was no longer significantly associated with AAQ-II scores.
“There was no significant effect for current comorbidity status after controlling for general psychological distress as a covariate (p = .37).”
Quote in the paperNot yet classified - Finding
The authors argue that the findings provide preliminary support for psychological inflexibility as a transdiagnostic theoretical model, especially for depression and anxiety disorders.
“The results from the current study provide preliminary support for this transdiagnostic theoretical model, particularly in the domain of depression and anxiety disorders, by demonstrating that individuals with a variety of specific psychological disorders report similarly elevated levels of psychological inflexibility.”
Quote in the paperNot yet classified
- Finding
For lifetime diagnostic groups, participants with any lifetime depressive, anxiety, substance use, or eating disorder were more psychologically inflexible than the no-lifetime-disorder group.
“When examining lifetime history of disorders (any current or past disorder), participants were significantly more psychologically inflexible relative to the no lifetime disorder control group for any lifetime depressive, anxiety, substance use or eating disorder”
Quote in the paperNot yet classified - Finding
When controlling for general psychological distress, the current substance-use-only group still had lower AAQ-II scores than the depression/anxiety-only group.
“After controlling for the GHQ, participants with a current substance use disorder only continued to report significantly lower psychological inflexibility relative to participants with a depression/anxiety disorder only”
Quote in the paperNot yet classified - Finding
After controlling for general psychological distress, the same lifetime disorders remained associated with higher AAQ-II scores except drug abuse and alcohol abuse.
“ANCOVA indicated significantly higher AAQ-II scores, after controlling for the GHQ, for the same psychological disorders except drug abuse and alcohol abuse.”
Quote in the paperNot yet classified - Finding
The study found that psychological inflexibility was significantly higher in students with a range of current and lifetime depressive and anxiety disorders than in students with no disorder, even after controlling for general psychological distress.
“Psychological inflexibility was significantly higher across a range of current and lifetime depressive and anxiety disorders as well as lifetime history of eating disorders, relative to students with no disorder, even after controlling for general psychological distress.”
Quote in the paperNot yet classified - Finding
For current substance use disorders, people with substance use only reported lower psychological inflexibility than people with comorbid substance use and depressive/anxiety disorders.
“Participants with a current substance use disorder only reported significantly lower psychological inflexibility relative to participants with a comorbid current substance use and depressive/anxiety disorder”
Quote in the paperNot yet classified - Finding
Psychological inflexibility was related to comorbid depressive, anxiety, and substance use disorders relative to having only one of those diagnoses.
“Psychological inflexibility was also related to having comorbid depressive, anxiety, and substance use disorders relative to only having one of these diagnoses.”
Quote in the paperNot yet classified - Finding
The study found mixed evidence for substance use disorders, with a more consistent association for lifetime history than for current disorders.
“Findings were mixed for substance use disorders, with a more consistent pattern for lifetime history than for current disorders.”
Quote in the paperNot yet classified - Finding
After controlling for general psychological distress, lifetime depressive-anxiety comorbidity remained associated with higher AAQ-II scores.
“After controlling for the GHQ, participants with comorbid lifetime depressive and anxiety disorders continued to be significantly more psychologically inflexible relative to participants with only a lifetime anxiety disorder history alone”
Quote in the paperNot yet classified - Finding
The authors conclude that psychological inflexibility appears to be relevant to a variety of specific disorders and to comorbidity across disorders.
“The current study adds to the literature suggesting that psychological inflexibility is an important transdiagnostic process for a range of psychological disorders as well as comorbidity across disorders.”
Quote in the paperNot yet classified - Finding
For lifetime depressive and anxiety disorders, comorbid cases were more psychologically inflexible than cases with only one disorder class.
“participants with comorbid lifetime depressive and anxiety disorders were significantly more psychologically inflexible relative to participants with only a lifetime anxiety disorder history alone”
Quote in the paperNot yet classified - Method
The study used ANOVA to test whether AAQ-II scores were higher in current and lifetime disorder groups than in no-disorder control groups.
“Analysis of variance (ANOVA) was used to test whether psychological inflexibility (AAQ-II scores) were higher, relative to a no disorder control group, among students with a current (defined as occurring in the past month) or lifetime (defined as any current or past diagnosis) depressive, anxiety, substance use and eating disorder diagnosis.”
Quote in the paperNot yet classified - Method
The study used a cross-sectional design in a sample of 972 first-year college students aged 17 to 20 years.
“The current cross-sectional study examined psychological inflexibility, a process in which behavior is rigidly guided by psychological reactions rather than direct contingencies or personal values, as a transdiagnostic process relevant to a range of depressive, anxiety, substance use and eating disorders.”
Quote in the paperNot yet classified - Method
Follow-up ANCOVAs tested whether differences in AAQ-II scores remained after controlling for general psychological distress.
“Follow up analysis of covariance (ANCOVA) tests examined differences on the AAQ-II between those with and without a disorder, controlling for general psychological distress (GHQ) as a covariate.”
Quote in the paperNot yet classified - Method
The GHQ-12 was used as a self-report measure of general psychological distress and included as a covariate to test whether associations with specific disorders were explained by general distress.
“The 12-item version of the GHQ was used in the current study as a self-report measure of general psychological distress. This measure was included as a covariate to test whether the relationship between psychological inflexibility and specific disorders is accounted for by more general elevated distress across diagnostic groups.”
Quote in the paperNot yet classified0 of 1 sources checked- cites Goldberg, 1972
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Method
Participants completed self-report measures of psychological inflexibility and psychological distress and a structured diagnostic interview.
“A sample of 972 first-year college students between 17 and 20 years of age completed self-report measures of psychological inflexibility and psychological distress as well as a structured diagnostic interview.”
Quote in the paperNot yet classified
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
EA predicts a range of specific anxiety disorders over and above general distress measures.
“EA has been found to predict anxiety disorders up to two years later (Spinhoven et al., 2014), to predict a range of specific anxiety disorders over and above general distress measures (e.g., Levin, MacLane, et al., 2014) and over and above other known predictors such as anxiety sensitivity (e.g., Gloster et al., 2013).”
From Examining the Role of Implicit Emotional Judgments in Social Anxiety and Experiential Avoidance (2017) · cites this paper as Levin, MacLane, et al., 2014
The Results (Relationship of AAQ-II to Depressive, Anxiety, Substance Use and Eating Disorders; page unavailable) report associations between psychological inflexibility and several specific anxiety disorders after controlling for general distress (GHQ). The Discussion calls the study cross-sectional and describes these as relationships, not evidence that experiential avoidance predicts subsequent diagnoses. (LLM, conf=0.84)
Experimental — accuracy not yet measuredPI is related to a range of current and lifetime depressive and anxiety disorders in a clinical sample of young adults (17-20 years old).
“PI was also found to relate to a range of both current and lifetime depressive and anxiety disorders in a clinical sample of young adults (17–20 years old; Levin et al., 2014).”
From Psychological inflexibility explains social anxiety over time: a mediation analyses with a clinical adolescent sample (2024) · cites this paper as Levin et al., 2014
The Discussion reports that psychological inflexibility was related to a range of current and lifetime depressive and anxiety disorders, and the paper identifies participants as 17–20-year-old first-year college students. But the Discussion explicitly calls this a non-clinical sample and says it is unclear whether the findings generalize to treatment-seeking clinical populations. Page numbers were not supplied in the passages. (LLM, conf=0.94)
Experimental — accuracy not yet measuredThe negative influence of psychological inflexibility, such as avoidance and cognitive fusion, was verified, further supporting the adaptive aspect of psychological flexibility.
“the negative influence of psychological inflexibility, such as avoidance and cognitive fusion, was verified, further supporting the adaptive aspect of psychological flexibility”
From Acceptance and commitment therapy reduces psychological distress in patients with cancer: a systematic review and meta-analysis of randomized controlled trials (2024) · cites this paper as Levin et al., 2014
The Discussion reports elevated psychological inflexibility among people with several disorders, supporting an association with poorer psychological functioning. But it describes the findings as preliminary and says the cross-sectional design cannot establish whether inflexibility contributed to psychopathology. It also notes that the measure emphasized experiential avoidance rather than cognitive fusion; the study did not separately verify cognitive fusion’s negative influence or directly test the adaptive effects of flexibility. (LLM, conf=0.88)
Experimental — accuracy not yet measuredPsychological inflexibility is a transdiagnostic dimension associated with psychological distress and poor mental health and quality of life.
“Psychological inflexibility is a transdiagnostic dimension associated to psychological distress and poor mental health and quality of life.”
From Spanish adaptation of the experiential approach scale (Eas) (2021) · cites this paper as [11]
The Discussion describes psychological inflexibility as a dimensional, transdiagnostic process associated with a variety of psychological disorders, even after controlling for general psychological distress. The Methods identify distress as a measured covariate. The passages do not report an association with quality of life, so that part of the claim is unsupported. (LLM, conf=0.85)
Experimental — accuracy not yet measuredPsychological inflexibility underlies a range of psychopathologies, including anxiety and mood disorders.
“PI underlies a range of psychopathologies, including anxiety and mood disorders (Bluett et al., 2014; Levin et al., 2014)”
From Associations between psychological inflexibility processes, pre‐sleep arousal and sleep quality. (2025) · cites this paper as Levin et al., 2014
The Discussion reports preliminary support for psychological inflexibility as a process relevant to multiple disorders, particularly depression and anxiety. But it says the cross-sectional study cannot establish whether inflexibility contributes to psychopathology or results from it, so “underlies” is stronger than the findings establish. (LLM, conf=0.85)
Experimental — accuracy not yet measured
Among university students, psychological inflexibility is linked to academic procrastination and negative emotional states such as stress, depression, and anxiety.
“Among university students, inflexibility has been found to be linked to academic procrastination and negative emotional states, such as stress, depression, and anxiety (Levin et al., 2014;Ruiz, 2014;Tavakoli, Broyles, Reid, Sandoval, & Correa-Fernández, 2019).”
From The effectiveness of a five-session workshop on the distress of international students in Finland – a pilot study. (2023) · cites this paper as Levin et al., 2014
The study of first-year college students reports that psychological inflexibility was higher among students with depressive and anxiety disorders (Abstract, page not provided). It does not report a link with academic procrastination or establish a separate link with stress; the Discussion says the disorder associations persisted after controlling for general psychological distress. (LLM, conf=0.88)
Experimental — accuracy not yet measuredLower psychological flexibility is associated with poorer coping and increased psychopathology.
“while lower psychological flexibility is well-documented to be associated with poorer coping and increased psychopathology (Kashdan et al., 2006; Levin et al., 2014; Woodruff et al., 2014).”
From ACTing towards better living during COVID-19: The effects of Acceptance and Commitment therapy for individuals affected by COVID-19 (2022) · cites this paper as Levin et al., 2014
Psychological inflexibility as a transdiagnostic process has been described as a continuum or dimension that could contribute to most psychological disorders, with a growing body of research increasingly supporting this parsimonious approach.
“psychological inflexibility as a transdiagnostic process has been described as a continuum or dimension that could contribute to most psychological disorders (Hayes et al., 2011), with a growing body of research increasingly supporting this parsimonious approach (Levin et al., 2014;Brown & Barlow, 2009).”
From Better living with illness: A transdiagnostic acceptance and commitment therapy group intervention for chronic physical illness (2016) · cites this paper as Levin et al., 2014
Psychological inflexibility is a relevant transdiagnostic process linked to the onset and maintenance of an extensive variety of psychological problems.
“Psychological inflexibility has been described as a relevant transdiagnostic process linked to the onset and maintenance of an extensive variety of psychological problems (Levin et al., 2014; Masuda et al., 2014.”
From Psychological inflexibility in university students: the european portuguese version of the acceptance and action questionnaire—university students (2023) · cites this paper as Levin et al., 2014
The strong correlation between the two factors corroborates the theoretical model of psychological inflexibility.
“which corroborates the theoretical model of psychological inflexibility (Levin et al., 2014)”
From Psychological inflexibility in university students: the european portuguese version of the acceptance and action questionnaire—university students (2023) · cites this paper as Levin et al., 2014
Psychological inflexibility and experiential avoidance are theorized to contribute to the development, maintenance and exacerbation of a broad range of psychological problems, including insomnia.
“Psychological inflexibility and experiential avoidance are theorized to contribute to the development, maintenance and exacerbation of a broad range of psychological problems (Levin et al., 2014), including insomnia.”
From Psychological inflexibility as a predictor associated with insomnia (2024) · cites this paper as Levin et al., 2014
The co-occurrence of psychiatric symptoms (anxiety and depression) and insomnia in this study supports the premise that inflexibility is a transdiagnostic process that can occur in different disorders.
“The co-occurrence of psychiatric symptoms (anxiety and depression) and insomnia in this study supports the premise that inflexibility is a transdiagnostic process that can occur in different disorders (Levin et al., 2014).”
From Psychological inflexibility as a predictor associated with insomnia (2024) · cites this paper as Levin et al., 2014
ACT assumes that just as psychological inflexibility leads to suffering regardless of diagnosis, so the promotion of psychological flexibility leads to improvement regardless of diagnosis.
“ACT assumes that just as psychological inflexibility leads to suffering, regardless of diagnosis, so the promotion of psychological flexibility leads to improvement, regardless of diagnosis.”
From Increasing psychological flexibility is associated with positive therapy outcomes following a transdiagnostic ACT treatment (2024) · cites this paper as [16]
In Levin et al. (2014), psychological inflexibility is associated with several disorders such as anxiety and depression.
“The results of a study conducted by Levin etal. (2014) suggest that psychological inflexibility is associated with several disorders such as anxiety and depression.”
From Mapping acceptance and commitment therapy outcomes in the context of infertility: a systematic review (2024) · cites this paper as Levin et al. (2014)
PI has been associated with multiple mental health disorders.
“Accordingly, PI has been associated with multiple mental health disorders (Levin et al., 2014).”
From Psychological inflexibility explains social anxiety over time: a mediation analyses with a clinical adolescent sample (2024) · cites this paper as Levin et al., 2014
Psychological inflexibility is regarded as a transdiagnostic process common to numerous psychopathological states.
“while psychological inflexibility is regarded a transdiagnostic process common to numerous psychopathological states.15”
From Feasibility randomised controlled trial of online group Acceptance and Commitment Therapy for Functional Cognitive Disorder (ACT4FCD) (2023) · cites this paper as [15]
Psychological inflexibility is considered an important transdiagnostic factor of mental illness.
“Therefore, psychological inflexibility is considered an important transdiagnostic factor of mental illness (8).”
From Acceptance and commitment therapy in a psychiatric day hospital—A longitudinal naturalistic effectiveness trial (2023) · cites this paper as [8]
Psychological inflexibility is a transdiagnostic concept explaining numerous psychopathological processes.
“Psychological inflexibility is a transdiagnostic concept explaining numerous psychopathological processes 26 .”
From The effect of psychological inflexibility on health-related quality of life, depression, and anxiety in patients with chronic tinnitus without hearing loss (2023) · cites this paper as [26]
Psychological inflexibility leads people to avoid negative internal thoughts, feelings, and physical sensations by controlling their behavior, at the expense of more meaningful actions.
“Psychological inflexibility leads people to avoid negative internal thoughts, feelings, and physical sensations by controlling their behavior, at the expense of more meaningful actions.”
From The Mediating Role of Psychological Inflexibility in the Relationship Between Anxiety, Depression, and Emotional Eating in Adult Individuals With Obesity (2022) · cites this paper as Levin et al., 2013
Acceptance and Commitment Therapy is a widely researched and empirically sustained transdiagnostic approach to behavior change.
“Acceptance and Commitment Therapy (ACT) is a widely researched and empirically sustained transdiagnostic approach to behavior change (e.g., [18, 34–36])”
From Acceptance and commitment therapy as a transdiagnostic approach to adolescents with different anxiety disorders: study protocol. (2025) · cites this paper as [18]
The results are congruent with earlier ACT-based studies reporting positive outcomes in general student and international student populations.
“On the other hand, our results are congruent with earlier ACT-based studies reporting positive outcomes in general student (e.g.Grégoire et al., 2018;Levin et al., 2014Levin et al., , 2016Levin et al., , 2020;;Räsänen et al., 2016) as well as in international student populations (Muto et al., 2011;Xu et al., 2020).”
From The effectiveness of a five-session workshop on the distress of international students in Finland – a pilot study. (2023) · cites this paper as Levin et al., 2014
The Method (Participants and Procedure; page not provided) says this study analyzed pre-intervention baseline data from first-year college students. The Discussion describes cross-sectional findings about psychological inflexibility, not positive outcomes from an ACT intervention. Searches for ACT intervention and treatment outcomes found no such result in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measured
Statistics recomputed
Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.
- ConsistentF(2, 153) = 5.95reported p = .003 · recomputed p = .003
“F(2, 153) = 5.95, p = .003”
- ConsistentF(2, 382) = 8.15reported p < .001 · recomputed p < .001
“F(2, 382) = 8.15, p < .001”
- ConsistentF(2, 379) = 7.54reported p = .001 · recomputed p < .001
“F(2, 379) = 7.54, p = .001”
- ConsistentF(2, 193) = 8.62reported p < .001 · recomputed p < .001
“F(2, 193) = 8.62, p < .001”
- ConsistentF(2, 191) = 8.26reported p < .001 · recomputed p < .001
“F(2, 191) = 8.26, p < .001”
- ConsistentF(2, 437) = 7.43reported p = .001 · recomputed p < .001
“F(2, 437) = 7.43, p = .001”
- ConsistentF(2, 434) = 5.94reported p = .003 · recomputed p = .003
“F(2, 434) = 5.94, p = .003”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
An effect size of .08 is labeled small despite the paper's stated threshold
MinorThe paper defines partial η2 of .06 as a medium effect, but later describes a range extending to .08 as small.
“Small effect sizes for diagnostic status effects ranged from partial η2 values of .01 and .08 when controlling for the GHQ.”
“Partial η2 effect sizes from ANOVA and ANCOVA analyses were interpreted using conventions from Cohen (1988): small effect for η2p = .01, medium effect = .06, large effect = .14.”
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“Contextual Cognitive Behavioral Therapies including ACT, Dialectical Behavior Therapy, mindfulness-based therapies, and certain types of exposure-based therapies have been found to impact a variety of clinical problems by reducing psychological inflexibility (Berking et al., 2009; Bowen et al., 2007; Hayes, Villatte e…”
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“Consistent with this, research suggests that acceptance and mindfulness approaches, which target psychological inflexibility processes, may be particularly efficacious in treating patients with comorbid mood and anxiety disorders (Arch et al., 2013; Wolitzky-Taylor et al., 2012).”
BackgroundEffects of psychotherapy on comorbid conditions in generalized anxiety disorder.
Borkovec, T. D., Abel, J. L., & Newman, H. (1995) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.63.3.479 · Cited by 165 · see citing works
Effects of psychotherapy on comorbid conditions in generalized anxiety disorder.
Borkovec, T. D., Abel, J. L., & Newman, H. (1995) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.63.3.479 · Cited by 165 · see citing works
Sauer-Zavala, S., Boswell, J. F., Gallagher, M. W., Bentley, K. H., Ametaj, A., & Barlow, D. H. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.05.005 · Cited by 163 · see citing works
Kumpula, M. J., Orcutt, H. K., Bardeen, J. R., & Varkovitzky, R. L. (2011) · Journal of Abnormal Psychology · doi:10.1037/a0023927 · Cited by 162 · see citing works
Transdiagnostic approaches to the treatment of anxiety disorders: A quantitative review.
Norton, P. J., & Philipp, L. M. (2008) · Psychotherapy: Theory, Research, Practice, Training · doi:10.1037/0033-3204.45.2.214 · Cited by 159 · cited 2× · see citing works
“Perhaps as a result, a number of explicitly transdiagnostic approaches have emerged that seek to explain and treat multiple disorders within a single approach (e.g., Barlow et al., 2010; Fairburn, Cooper, & Shafran, 2003; Hayes, Strosahl, & Wilson, 2011; Norton & Philipp, 2008).”
BackgroundExperiential avoidance and problem behavior: A mediational analysis
Kingston, J., Clarke, S., & Remington, B. (2010) · Behavior Modification · doi:10.1177/0145445510362575 · Cited by 154 · see citing works
Tsao, J. C. I., Mystkowski, J. L., Zucker, B. G., & Craske, M. G. (2002) · Behavior Therapy · doi:10.1016/s0005-7894(02)80013-2 · Cited by 128 · see citing works
Berking, M., Neacsiu, A., Comtois, K. A., & Linehan, M. M. (2009) · Behaviour Research and Therapy · doi:10.1016/j.brat.2009.04.011 · Cited by 124 · cited 1× · see citing works
“Contextual Cognitive Behavioral Therapies including ACT, Dialectical Behavior Therapy, mindfulness-based therapies, and certain types of exposure-based therapies have been found to impact a variety of clinical problems by reducing psychological inflexibility (Berking et al., 2009; Bowen et al., 2007; Hayes, Villatte e…”
BackgroundExperiential avoidance and emotion regulation difficulties in hoarding disorder
Fernández de la Cruz, L., Landau, D., Iervolino, A. C., Santo, S., Pertusa, A., Singh, S., & Mataix-Cols, D. (2013) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2013.01.004 · Cited by 124 · cited 2× · see citing works
“Another key gap in the literature seeking to test psychological inflexibility as a transdiagnostic process is that only a few studies have examined comorbidity (de la Cruz et al., 2013; Kingston, Clarke, & Remington, 2010).”
BackgroundLevin, M. E., Lillis, J., Seeley, J., Hayes, S. C., Pistorello, J., & Biglan, A. (2012) · Journal of American College Health · doi:10.1080/07448481.2012.673522 · Cited by 113 · cited 3× · see citing works
“…indicated that psychological inflexibility and experiential avoidance relate to problematic substance use (e.g., Bricker, Schiff, & Comstock, 2011; Levin et al., 2012) as well as a variety of other addictive behaviors (e.g., Kingston et al., 2010), but few studies have specifically examined…”
BackgroundInfluentialSelf-citationCollege of the Overwhelmed: The Campus Mental Health Crisis and What to Do About It
(2005) · Annals of Pharmacotherapy · doi:10.1345/aph.1g058 · Cited by 104 · see citing works
The relation between anxiety disorder and experiential avoidance in inpatient adolescents
Venta, A., Sharp, C., & Hart, J. (2012) · Psychological Assessment · doi:10.1037/a0025362 · Cited by 100 · see citing works
A transdiagnostic approach to understanding eating disorders.
Wade, T. D., Bergin, J. L., Martin, N. G., Gillespie, N. A., & Fairburn, C. G. (2006) · Journal of Nervous & Mental Disease · doi:10.1097/01.nmd.0000225067.42191.b0 · Cited by 75 · see citing works
Life hassles, experiential avoidance and distressing delusional experiences
Goldstone, E., Farhall, J., & Ong, B. (2011) · Behaviour Research and Therapy · doi:10.1016/j.brat.2011.02.002 · Cited by 60 · cited 1× · see citing works
“Research has shown that psychological inflexibility is relevant to an even broader range of problem areas beyond depressive, anxiety, eating and substance use disorders, including psychosis (Goldstone et al., 2011) and borderline personality disorder (Chapman, Specht, & Cellucci, 2005).”
BackgroundHooper, N., Villatte, M., Neofotistou, E., & McHugh, L. (2010) · International Journal of Behavioral Consultation and Therapy · doi:10.1037/h0100910 · Cited by 47 · cited 1× · see citing works
“, 2014) as well as exploring the development of behavioral and implicit measures of psychological inflexibility (Hooper et al., 2010).”
BackgroundBeaulieu, S., Saury, S., Sareen, J., Tremblay, J., Schütz, C. G., McIntyre, R. S., & Schaffer, A. (2012) · Annals of Clinical Psychiatry · doi:10.1177/104012371202400105 · Cited by 38 · cited 4× · see citing works
“, 2005) and are more difficult to treat (Beaulieu et al., 2012), this has potential implications for treatment development and suggests targeting psychological inflexibility may be particularly important for those who are experiencing comorbid problems.”
BackgroundInfluentialDoes avoidant coping influence young adults׳ smoking? A ten-year longitudinal study
Bricker, J. B., Schiff, L., & Comstock, B. A. (2011) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntr074 · Cited by 21 · see citing works
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Sloan, E., Hall, K., Moulding, R., Bryce, S., Mildred, H., & Staiger, P. K. (2017) · Clinical Psychology Review · doi:10.1016/j.cpr.2017.09.002 · Cited by 1,052 · see citing works
“…potential transdiagnostic candidates have been proposed within the literature (Mansell, 2011), including attentional biases (Mathews &MacLeod, 2005), anxiety sensitivity (Naragon-Gainey, 2010), perfectionism (Egan, Wade, & Shafran, 2011) and psychological flexibility (Levin et al., 2014).”
BackgroundImpact of COVID-19 pandemic on mental health: An international study
Gloster, A. T., Lamnisos, D., Lubenko, J., Presti, G., Squatrito, V., Constantinou, M., Nicolaou, C., Papacostas, S., Aydın, G., Chong, Y. Y., et al. (2020) · PLOS ONE · doi:10.1371/journal.pone.0244809 · Cited by 558 · see citing works
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“The theoretical underpinnings of this prediction are that stress may lead to greater psychological inflexibility and pessimism, and lower optimism which may in turn lead to greater psychological problems (Al Jarrah et al. 2019; Ingram and Luxton 2005; Levin et al. 2014; Yildirim and Alanazi 2018).”
BackgroundCherry, 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 · see citing works
Toward a unified treatment for emotional disorders: Update on the science and practice
Norton, P. J., & Paulus, D. J. (2016) · Behavior Therapy · doi:10.1016/j.beth.2015.07.002 · Cited by 180 · see citing works
Sloshower, J., Guss, J., Krause, R., Wallace, R. M., Williams, M. T., Reed, S., & Skinta, M. D. (2020) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2019.11.002 · Cited by 171 · see citing works
“In contrast, psychological inflexibility can be seen as functionally related to a range of psychological problems, including depressive, anxiety, substance disorders, and eating disorders (Levin et al., 2014).”
BackgroundAkbari, M., Seydavi, M., Hosseini, Z. S., Krafft, J., & Levin, M. E. (2022) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2022.03.007 · Cited by 155 · see citing works
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“, 2011), and has been empirically supported as an extremely important indicator for the prediction of mental health (Levin et al., 2014; Lucas and Moore, 2020).”
BackgroundBarnett, P., Arundell, L.-L., Saunders, R., Matthews, H., & Pilling, S. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.10.060 · Cited by 111 · see citing works
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Tyndall, I., Waldeck, D., Pancani, L., Whelan, R., Roche, B., & Pereira, A. (2020) · Behavior Modification · doi:10.1177/0145445518820036 · Cited by 104 · see citing works
Eisenbeck, N., Carreno, D. F., & Uclés‐Juárez, R. (2019) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2019.07.007 · Cited by 115 · see citing works
Levin, M. E., Hayes, S. C., Pistorello, J., & Seeley, J. R. (2016) · Journal of Clinical Psychology · doi:10.1002/jclp.22254 · Cited by 103 · see citing works
“This is made less plausible by past research showing the DASS to be sensitive to the effects of ACT with students (e.g., Levin et al., 2014).”
BackgroundMethodResultInfluentialSelf-citationLevin, M. E., Luoma, J. B., Vilardaga, R., Lillis, J., Nobles, R., & Hayes, S. C. (2015) · Journal of Applied Social Psychology · doi:10.1111/jasp.12355 · Cited by 100 · see citing works
Self-citationChou, W., Yen, C., & Liu, T. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15040788 · Cited by 102 · see citing works
“A study also demonstrated an association of PI/EA with deliberate self-harm behavior [23,44] and suicidality [45].”
BackgroundExperiential Avoidance and Technological Addictions in Adolescents
García‐Oliva, C., & Piqueras, J. A. (2016) · Journal of Behavioral Addictions · doi:10.1556/2006.5.2016.041 · Cited by 99 · see citing works
“In several studies with first-year college students, EA was related to lifetime history of alcohol use and other substance use disorders (Levin et al., 2012, 2014).”
BackgroundDoes Psychedelic Therapy Have a Transdiagnostic Action and Prophylactic Potential?
Kočárová, R., Horáček, J., & Carhart-Harris, R. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.661233 · Cited by 96 · see citing works
Guss, J. R., Krause, R., & Sloshower, J. (2020) · doi:10.31234/osf.io/u6v9y · Cited by 86 · see citing works
Uğur, E., Kaya, Ç., & Tanhan, A. (2021) · Current Psychology · doi:10.1007/s12144-020-01074-8 · Cited by 81 · see citing works
“Likewise, in FNE, PI also contains excessive and rigid psychological reactions which stem from dysfunctional control efforts (Levin et al. 2014).”
BackgroundEisenbeck, N., Carreno, D. F., & Pérez‐Escobar, J. A. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.648383 · Cited by 85 · see citing works
Tavakoli, N., Broyles, A., Reid, E. K., Sandoval, J. R., & Correa-Fernández, V. (2019) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2018.11.001 · Cited by 72 · see citing works
Renshaw, T. L., & Cook, C. R. (2016) · Psychology in the Schools · doi:10.1002/pits.21978 · Cited by 64 · see citing works
Transdiagnostic perspective on psychological inflexibility and emotional dysregulation
Faustino, B. (2021) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465820000600 · Cited by 62 · see citing works
“Levin et al. (2014) describe psychological inflexibility as a transdiagnostic pathological process and a target for interventions in anxiety, depression and substance use disorders.”
BackgroundResultBrassington, L., Ferreira, N. B., Yates, S., Fearn, J., Lanza, P., Kemp, K., & Gillanders, D. (2016) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2016.09.001 · Cited by 59 · see citing works
“…inflexibility as a transdiagnostic process has been described as a continuum or dimension that could contribute to most psychological disorders (Hayes et al., 2011), with a growing body of research increasingly supporting this parsimonious approach (Levin et al., 2014; Brown & Barlow, 2009).”
BackgroundOng, C. W., Barthel, A. L., & Hofmann, S. G. (2024) · Behavior Therapy · doi:10.1016/j.beth.2023.05.007 · Cited by 61 · see citing works
Zimmermann, M., Bledsoe, C., & Papa, A. (2020) · doi:10.31234/osf.io/2y7hu · Cited by 57 · see citing works
Bonanno, G. A., Maccallum, F., Malgaroli, M., & Hou, W. K. (2018) · Assessment · doi:10.1177/1073191118820131 · Cited by 57 · see citing works
“In contrast, the inflexible application of regulatory strategies, irrespective of the contextual demands is generally associated with poor mental health outcomes (Kashdan & Rottenberg, 2010; Levin et al., 2014).”
BackgroundKam, B., Mendoza, H., & Masuda, A. (2018) · International Journal for the Advancement of Counselling · doi:10.1007/s10447-018-9365-8 · Cited by 57 · see citing works
Close, J. B., Hajien, E. C., Watts, R., Roseman, L., & Carhart-Harris, R. L. (2020) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2020.01.005 · Cited by 54 · see citing works
Adaptability and psychological flexibility: Overlapping constructs?
Waldeck, D., Pancani, L., Holliman, A. J., Karekla, M., & Tyndall, I. T. (2021) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2021.01.002 · Cited by 58 · see citing works
Feather, G., & Williams, M. (2022) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2021.12.007 · Cited by 48 · see citing works
Bi, D., & Li, X. (2021) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2021.01.008 · Cited by 50 · see citing works
Hollocks, M. J., Charman, T., Baird, G., Lord, C., Pickles, A. R., & Simonoff, E. A. (2021) · Autism · doi:10.1177/13623613211046160 · Cited by 51 · see citing works
“In those without, autism inflexible thinking has been shown to be related to a range of difficulties including anxiety, depression, substance use, and eating disorders, as well as the presence of multiple co-occurring conditions (Levin et al., 2014; Tchanturia et al., 2011).”
BackgroundThe Acceptance and Action Questionnaire – II: an Item Response Theory Analysis
Ong, C. W., Pierce, B. G., Woods, D. W., Twohig, M. P., & Levin, M. E. (2018) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-018-9694-2 · Cited by 50 · see citing works
“…AAQ-II has been used across nonclinical and clinical samples in various study designs, including cross-sectional surveys in college students (e.g., Levin et al. 2014b), randomized controlled trials for specific psychological conditions (e.g., Juarascio et al. 2015; Lappalainen et al. 2014), and…”
BackgroundMethodSelf-citationLevin, M. E., Krafft, J., Pierce, B. G., & Potts, S. (2018) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2018.07.005 · Cited by 50 · see citing works
“, 2014) and above and beyond related variables such as general distress (Levin et al., 2014) and anxiety sensitivity (Gloster et al.”
BackgroundSelf-citationPaulos-Guarnieri, L., Linares, I. M. P., & El Rafihi-Ferreira, R. (2022) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2021.11.001 · Cited by 48 · see citing works
Benítez-Agudelo, J. C., Restrepo, D., Navarro-Jiménez, E., & Clemente‐Suárez, V. J. (2025) · BMC Psychology · doi:10.1186/s40359-025-03041-z · Cited by 100 · see citing works
“This contrasts with some studies that have found psychological flexibility to be inversely associated with symptoms of depression and anxiety [75].”
Angelakis, I., & Pseftogianni, F. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.03.062 · Cited by 47 · see citing works
Hernández-López, M., Cepeda-Benito, A., Díaz-Pavón, P., & Rodríguez-Valverde, M. (2021) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2020.12.002 · Cited by 45 · see citing works
Bermejo-Franco, A., Sánchez-Sánchez, J. L., Gaviña-Barroso, M. I., Atienza-Carbonell, B., Balanzá-Martínez, V., & Clemente-Suárez, V. J. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19020810 · Cited by 45 · see citing works
“Psychological inflexibility and experiential avoidance are theorized to contribute to the development, maintenance and exacerbation of a broad range of psychological problems such as mood and anxiety disorders, substance use disorders, eating disorders, and psychotic disorders [42,43].”
BackgroundCoifman, K. G., & Summers, C. B. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.00392 · Cited by 45 · see citing works
“…at high risk for PTSD demonstrated that regulatory-choice flexibility moderated the association between traumatic-event exposure and PTSD symptomatology such that individuals exhibiting greater flexibility were protected from risk associated with increased trauma exposure (Levy-Gigi et al., 2016).”
BackgroundAssessing psychological flexibility: Validation of the Open and Engaged State Questionnaire
Benoy, C., Knitter, B., Knellwolf, L., Doering, S., Klotsche, J., & Gloster, A. T. (2019) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2018.08.005 · Cited by 41 · see citing works
Jiang, X., Sun, J., Song, R., Wang, Y., Li, J., & Shi, R. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1253266 · Cited by 43 · see citing works
Yao, X., Xu, X., Chan, K. L., Chen, S., Assink, M., & Gao, S. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.09.116 · Cited by 43 · see citing works
Lappalainen, P., Lappalainen, R., Keinonen, K., Kaipainen, K., Puolakanaho, A., Muotka, J., & Kiuru, N. (2023) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2022.12.001 · Cited by 41 · see citing works
Faustino, B., Vasco, A. B., Farinha-Fernandes, A., & Delgado, J. (2023) · Current Psychology · doi:10.1007/s12144-021-01943-w · Cited by 37 · see citing works
Scaling up and scaling out: Consilience and the evolution of more nurturing societies
Biglan, A., Johansson, M., Ryzin, M. J. V., & Embry, D. D. (2020) · Clinical Psychology Review · doi:10.1016/j.cpr.2020.101893 · Cited by 36 · see citing works
“fective functioning, and lower levels of a wide variety of psychological and behavioral problems and diagnoses (Amlung et al., 2019; Bickel, Jarmolowicz, Mueller, Koffarnus, & Gatchalian, 2012; Gloster, Meyer, & Lieb, 2017; Kashdan & Rottenberg, 2010; Lempert, Steinglass, Pinto, Kable, & Simpson, 2019; Levin et al., 2…”
Self-citationTraumatic Stress in Overview: Definition, Context, Scope, and Long-Term Outcomes
Gerhart, J. I., Canetti, D., & Hobfoll, S. E. (2015) · Springer eBooks · doi:10.1007/978-3-319-18866-9_1 · Cited by 38 · see citing works
“, 2014; Maack, Tull, & Gratz, 2012; Shenk, Putnam, Rausch, Peugh, & Noll, 2014) and may lead to generalized vulnerability to psychopathology and interpersonal problems (Gerhart, Baker, Hoerger, & Ronan, 2014; Goldsmith, Gerhart, Chesney, et al., 2014; Levin et al., 2014; Shenk, Putnam, & Noll, 2014).”
Lappalainen, P., Keinonen, K., Pakkala, I., Lappalainen, R., & Nikander, R. (2021) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2021.04.005 · Cited by 34 · see citing works
Levin, M. E., Haeger, J., Ong, C. W., & Twohig, M. P. (2018) · The Psychological Record · doi:10.1007/s40732-018-0281-4 · Cited by 34 · see citing works
“…that the AAQ-II, which references mental health problems and is known to correlate highly with mental health (e.g., Bluett et al., 2014; Hayes et al., 2006; Levin et al., 2014), would statistically account for a large portion of variance in mental health, including the portion predicted by DD.”
InfluentialSelf-citationShepherd, K., Golijani-Moghaddam, N., & Dawson, D. L. (2022) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2021.12.003 · Cited by 31 · see citing works
Beyond acceptance and commitment therapy: Process-based therapy
Ong, C. W., Levin, M. E., & Twohig, M. P. (2020) · The Psychological Record · doi:10.1007/s40732-020-00397-z · Cited by 32 · see citing works
Jiménez, D. O., Ruisoto, P., Bretones, F. D., Zhindón, M. D. R. R., & Vaca, S. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18062992 · Cited by 35 · see citing works
“Previous studies have suggested that loneliness can be understood as a key human stressor that is based on our social nature and shared neurobiological response [33], and that psychological (in)flexibility may be related to more (dis)adaptative coping skills when dealing with adverse private events [29].”
BackgroundBonilla-Sierra, P., Manrique-G, A., Hidalgo-Andrade, P., & Ruisoto, P. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.729171 · Cited by 32 · see citing works
“Thus, psychological inflexibility represents a form of generalized psychological vulnerability (Kashdan et al., 2006; Kashdan and Rottenberg, 2010; Levin et al., 2014) associated with greater depressive symptoms (Kato, 2016), anxiety, psychopathological conditions, and an increased risk for the deterioration of mental…”
BackgroundResultInfluentialSantos‐Carrasco, D., & la Casa, L. G. D. (2023) · BMC Psychology · doi:10.1186/s40359-023-01253-9 · Cited by 29 · see citing works
“Thus, processes such as psychological inflexibility [14], insomnia [15], intolerance of uncertainty [16], hypervigilance [17], perfectionism [18], rumination [19], and dissociation [20] have been proposed as transdiagnostic factors.”
BackgroundAtefi, G. L., de Vugt, M. E., van Knippenberg, R. J. M., Levin, M. E., Verhey, F. R. J., & Bartels, S. L. (2023) · Clinical Psychology Review · doi:10.1016/j.cpr.2023.102341 · Cited by 30 · see citing works
Self-citationPsychological flexibility and cognitive-affective processes in young adults’ daily lives
Westhoff, M., Heshmati, S., Siepe, B. S., Vogelbacher, C., Ciarrochi, J., Hayes, S. C., & Hofmann, S. G. (2024) · Scientific Reports · doi:10.1038/s41598-024-58598-3 · Cited by 35 · see citing works
Self-citationLevin, M. E., Krafft, J., Pistorello, J., & Seeley, J. R. (2019) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2018.03.004 · Cited by 30 · see citing works
Self-citationFoldi, C. J., Morris, M. J., & Oldfield, B. J. (2021) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2021.110395 · Cited by 29 · see citing works
Fatigue severity and avoidance among individuals with chronic disease: A meta-analysis
Adamowicz, J. L., Velez-Bermudez, M. E., & Thomas, E. B. K. (2022) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2022.110951 · Cited by 30 · see citing works
Academic stress, mindfulness-related skills and mental health in international university students.
Koppenborg, K. A., Garnefski, N., Kraaij, V., & Ly, V. (2024) · Journal of American College Health · doi:10.1080/07448481.2022.2057193 · Cited by 28 · see citing works
Bruno, F., Vozzo, F., Arcuri, D., Maressa, R., La Cava, E., Malvaso, A., Lau, C., & Chiesi, F. (2024) · Current Psychology · doi:10.1007/s12144-022-03502-3 · Cited by 28 · see citing works
“According to Acceptance and Commitment Therapy (ACT; Hayes et al., 2011), psychological inflexibility represents a transdiagnostic process across psychological disorders (Levin et al., 2014).”
Bernal, A. M. O., Raison, C. L., Lancelotta, R., & Davis, A. K. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.1049643 · Cited by 26 · see citing works
González‐Roz, A., Secades‐Villa, R., Weidberg, S. E., Pérez, Á. G., & Reed, D. D. (2018) · Nicotine & Tobacco Research · doi:10.1093/ntr/nty236 · Cited by 27 · see citing works
Berghoff, C. R., Ritzert, T. R., & Forsyth, J. P. (2018) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2018.07.005 · Cited by 26 · see citing works
Rovner, G., Vowles, K. E., Gerdle, B. U. C., & Gillanders, D. T. (2015) · Journal of Pain · doi:10.1016/j.jpain.2015.07.007 · Cited by 27 · see citing works
Guerrini Usubini, A., Varallo, G., Giusti, E. M., Cattivelli, R., Granese, V., Consoli, S., Bastoni, I., Volpi, C., & Castelnuovo, G. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.861341 · Cited by 22 · see citing works
Influence of depression and anxiety on hemodialysis patients: The value of multidisciplinary care
Delgado-Domínguez, C. J., Sanz-Gómez, S., López-Herradón, A., Díaz Espejo, B., Lamas González, O., de los Santos Roig, M., Berdud Godoy, I., Rincón Bello, A., & Ramos Sánchez, R. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18073544 · Cited by 26 · see citing works
“Although the form of problem behaviors differs between disorders, many of them can be conceptualized as sharing common psychological functions [10].”
BackgroundRenshaw, T. L. (2016) · Journal of Psychoeducational Assessment · doi:10.1177/0734282916644096 · Cited by 25 · see citing works
“The psychological inflexibility model is a transdiagnostic approach for understanding the development, maintenance, and treatment of mental health problems (Levin et al., 2014).”
BackgroundInfluentialTan, X. F., Yang, Y., & Yu, M. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.07.069 · Cited by 28 · see citing works
Graham, C. D., O'Hara, D. J., & Kemp, S. (2018) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2174 · Cited by 24 · see citing works
“First, because ACT’s target, psychological flexibility, is a trans-diagnostic process (Levin et al., 2014) it may have impact across the psychological heterogeneity evident in FND (Graham et al., 2017).”
BackgroundOguz, G., Celikbas, Z., Batmaz, S., Cagli, S., & Sungur, M. Z. (2019) · International Journal of Cognitive Therapy · doi:10.1007/s41811-019-00047-5 · Cited by 23 · see citing works
Zhang, J., & Wang, E. (2022) · Behavioral Sciences · doi:10.3390/bs12120485 · Cited by 25 · see citing works
“Growing evidence supporting the contributing role of experiential avoidance in the domain of addictions has been found [34,35].”
BackgroundRutschmann, R., Romanczuk-Seiferth, N., Gloster, A., & Richter, C. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1403718 · Cited by 21 · see citing works
Starr, L., Huang, M., & Scarpulla, E. (2021) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2021.07.004 · Cited by 18 · see citing works
Hekmati, I., Abdollahpour Ranjbar, H., Eskin, M., Drake, C. E., & Jobson, L. (2023) · Current Psychology · doi:10.1007/s12144-021-01539-4 · Cited by 22 · see citing works
Kennedy, C., Deane, F. P., & Chan, A. Y. C. (2021) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2021.05.006 · Cited by 21 · see citing works
Weeks, S. N., Renshaw, T. L., Galliher, R. V., & Tehee, M. A. (2020) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2020.10.007 · Cited by 20 · see citing works
Rosenblau, G., Frolichs, K., & Korn, C. W. (2023) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2023.105181 · Cited by 20 · see citing works
Brem, M. J., Shorey, R. C., Anderson, S. T., & Stuart, G. L. (2017) · Sexual Addiction & Compulsivity The Journal of Treatment and Prevention · doi:10.1080/10720162.2017.1365315 · Cited by 20 · see citing works
“Experiential avoidance is linked to a number of poor health outcomes, most notably, substance-related disorders (Levin et al., 2014).”
BackgroundGender Differences in Problematic Alcohol Consumption in University Professors
Ruisoto, P., Vaca, S., López-Goñi, J. J., Cacho, R., & Suárez, I. F. (2017) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph14091069 · Cited by 20 · see citing works
“This finding is consistent with previous studies that highlight the negative health implications of psychological inflexibility, understood as the lack of ability to adapt to fluctuating situational demands and balancing competing needs in life [34,36], as well as job dissatisfaction [18,40–43].”
ResultDonati, M. A., Montiel, C. B., Bernini, O., Gori, C., & Primi, C. (2021) · PLoS ONE · doi:10.1371/journal.pone.0246434 · Cited by 20 · see citing works
“These and other related findings in clinical psychology have led to an increasing emphasis on developing transdiagnostic models, such as the ACT model, that can be applied to a range of mental health issues [4].”
BackgroundMenéndez, A. G., Arboleya, T., González‐Pando, D., Ordóñez-Camblor, N., García-Vega, E., & Paíno, M. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182312376 · Cited by 20 · see citing works
“Psychological flexibility allows individuals to experience private events in a way that is accepting, defused, and mindful, and allows individuals to act on personal goals regardless of private events [22].”
BackgroundGrant, A., & Cassidy, S. (2021) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2021.12.006 · Cited by 23 · see citing works
Krafft, J., Ong, C. W., Twohig, M. P., & Levin, M. E. (2019) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2018.08.003 · Cited by 18 · see citing works
“Psychological inflexibility has been associated with a range of mental health concerns and life outcomes, including anxiety, depression, and job performance (Bluett et al., 2014; Bond et al., 2011; Kashdan & Rottenberg, 2011; Levin, MacLane et al., 2014).”
Self-citationAkbari, M., Disabato, D. J., Seydavi, M., & Zamani, E. (2021) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2021.09.004 · Cited by 23 · see citing works
Mangini, P., Averill, L. A., & Davis, A. K. (2022) · Journal of Psychedelic Studies · doi:10.1556/2054.2021.00176 · Cited by 19 · see citing works
“Consistent with prior studies, psychological inflexibility has been implicated in a variety of pathologic mental states (Levin et al., 2014), in particular those suffering from PTSD and AUD (Grosso et al., 2014; Meyer, Morissette, Kimbrel, Kruse, & Gulliver, 2013), and therapies designed to enhance…”
ResultFlynn, M. K., Bordieri, M. J., & Berkout, O. V. (2019) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2018.12.002 · Cited by 19 · see citing works
Åkerblom, S., Perrin, S., Fischer, M. R., & McCracken, L. M. (2020) · European Journal of Pain · doi:10.1002/ejp.1530 · Cited by 19 · see citing works
“We note a recent study which found that individuals who were low in psychological flexibility tended to have multiple rather than single disorders (Levin et al., 2014).”
BackgroundDolcos, S. M., Hu, Y., Williams, C. L., Bogdan, P. C., Hohl, K., Berenbaum, H., & Dolcos, F. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.585536 · Cited by 19 · see citing works
Carreno, D. F., Eisenbeck, N., Greville, W. J., & Wong, P. T. P. (2023) · Journal of Happiness Studies · doi:10.1007/s10902-023-00633-7 · Cited by 19 · see citing works
“Not surprisingly, several studies have demonstrated the links between psychological inflexibility and mental health problems (Bond et al., 2011; Kashdan & Rottenberg, 2010; Levin et al., 2014).”
BackgroundTreating functional non-epileptic attacks – should we consider acceptance and commitment therapy?
Cope, S. R., Poole, N., & Agrawal, N. (2017) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2017.06.003 · Cited by 18 · see citing works
Validation of the Hungarian version of the Acceptance and Action Questionnaire-II (AAQ-II)
Eisenbeck, N., & Szabó-Bartha, A. (2018) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2018.07.007 · Cited by 18 · see citing works
Waldeck, D., Banerjee, M., Jenks, R. A., & Tyndall, I. T. (2020) · Stress and Health · doi:10.1002/smi.2946 · Cited by 19 · see citing works
“ACT is purported to help promote psychological flexibility (A-Tjak et al., 2015; Hacker, Stone, & MacBeth, 2016; Lee, An, Levin, & Twohig, 2015; Levin et al., 2014) and reduce reliance on experiential avoidance (i.e., increasing emotional self-regulation), to facilitate clients to work towards…”
BackgroundPsychometric evaluation of the Swedish Multidimensional Psychological Flexibility Inventory (MPFI)
Tabrizi, F. F., Larsson, A. B., Grönvall, H., Söderstrand, L., Hallén, E., Champoux-Larsson, M.-F., Lundgren, T., Sundström, F., Lavefjord, A., Buhrman, M., et al. (2023) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2022.2153077 · Cited by 18 · see citing works
Bırni, G., Erus, S. M., Satıcı, S. A., & Deniz, M. E. (2024) · Personality and Individual Differences · doi:10.1016/j.paid.2024.112861 · Cited by 20 · see citing works
Khanjani, M. S., Kazemi, J., Younesi, J., Dadkhah, A., Biglarian, A., & Ebrahimi Barmi, B. (2021) · Iranian Journal of Psychiatry and Behavioral Sciences · doi:10.5812/ijpbs.105378 · Cited by 17 · see citing works
El Rafihi-Ferreira, R., do Brasil do Carmo, M. M. I., Bassolli, L., Hasan, R., Aizawa, I. M. N., & Toscanini, A. C. (2022) · Psicologia: Reflexão e Crítica · doi:10.1186/s41155-022-00243-x · Cited by 17 · see citing works
“Psychological inflexibility is characterized by a rigid pattern of behaviors based on the avoidance of internal experiences (thoughts, feelings, sensations) to the detriment of value-based behaviors (Levin et al., 2014).”
BackgroundInfluentialCorrea-Fernández, V., McNeel, M. M., Sandoval, J. R., Tavakoli, N., Kahambwe, J. K., & Kim, H. (2020) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2020.04.002 · Cited by 17 · see citing works
Kachadourian, L. K., Lyons, R. C., Davis, B. C., Haller, M. M., & Norman, S. B. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.02.022 · Cited by 17 · see citing works
- Authors
- Levin, M. E., MacLane, C., Daflos, S., Seeley, J. R., Hayes, S. C., Biglan, A., & Pistorello, J.
- Affiliations
- Utah State University (US)
- University of Nevada, Reno (US)
- Oregon Research Institute (US)
- Corresponding author
- Levin, Michael E.
- Venue
- Journal of Contextual Behavioral Science
- Publisher
- Elsevier BV
- Published
- 2014-07
- Volume
- 3
- Issue
- 3
- Pages
- 155-163
- ISSN
- 2212-1447 (ISSN-L)
- PMC
- PMC5650239
- OpenAlex
- W2033922058
- Cited by
- 400
- References
- 49
- Citations by year
- 2026: 42 · 2025: 60 · 2024: 58 · 2023: 58 · 2022: 43 · 2021: 50 · 2020: 35 · 2019: 13 · 2018: 21 · 2017: 7 · 2016: 7 · 2015: 6
- FWCI
- 7.87
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Contextual Behavioral Science (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Digital Commons - USU (Utah State University) (submittedVersion)
- Funders
- National Institute of Mental Health
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- psychological inflexibility, transdiagnostic mechanisms, depression, anxiety disorders, substance use disorders, eating disorders, comorbidities, psychological distress, university students, behavioral inflexibility
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