The DOI matches its Crossref record; 46 of the 49 references it cites were found in a registry or an index; 1 of the 2 sources its claims cite were checked for support.
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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In the paper
“The AAQ-II is a 7 item measure of psychological inflexibility and experiential avoidance.”
§ Examining psychological inflexibility as a transdiagnostic process across psychological disorders > Method > Measures
What the sources say
- Supportedcites Bond et al., 2011 source
The General Discussion says the authors retained the seven-item AAQ-II and describes it as a measure of psychological inflexibility. The Abstract identifies experiential avoidance and psychological inflexibility as names for the construct it assesses. Page numbers were not supplied in our copy. (LLM, conf=0.94)
- Supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The AAQ-II was not significantly related to having any current substance use disorder or specifically alcohol abuse, drug abuse, or drug dependence.”
§ Examining psychological inflexibility as a transdiagnostic process across psychological disorders > Results > Relationship of AAQ-II to Depressive, Anxiety, Substance Use and Eating Disorders
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“participants with comorbid current depressive and anxiety disorders were significantly more psychologically inflexible than participants with only a current anxiety disorder”
§ Examining psychological inflexibility as a transdiagnostic process across psychological disorders > Results > Relationship of the AAQ-II to Comorbid Depressive and Anxiety Disorders
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was no significant effect for current comorbidity status after controlling for general psychological distress as a covariate (p = .37).”
§ Examining psychological inflexibility as a transdiagnostic process across psychological disorders > Results > Relationship of the AAQ-II to Comorbid Depressive and Anxiety Disorders
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Examining psychological inflexibility as a transdiagnostic process across psychological disorders > Discussion
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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”
§ Examining psychological inflexibility as a transdiagnostic process across psychological disorders > Results > Relationship of AAQ-II to Depressive, Anxiety, Substance Use and Eating Disorders
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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”
§ Examining psychological inflexibility as a transdiagnostic process across psychological disorders > Results > Relationship of the AAQ-II to Comorbid Substance Use and Depressive/Anxiety Disorders
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“ANCOVA indicated significantly higher AAQ-II scores, after controlling for the GHQ, for the same psychological disorders except drug abuse and alcohol abuse.”
§ Examining psychological inflexibility as a transdiagnostic process across psychological disorders > Results > Relationship of AAQ-II to Depressive, Anxiety, Substance Use and Eating Disorders
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Examining psychological inflexibility as a transdiagnostic process across psychological disorders > Abstract
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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”
§ Examining psychological inflexibility as a transdiagnostic process across psychological disorders > Results > Relationship of the AAQ-II to Comorbid Substance Use and Depressive/Anxiety Disorders
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?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measured
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“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
The cited source says what the claim attributes to it.
In the citing paper
“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
The cited source says what the claim attributes to it.
In the citing paper
“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 cited source says what the claim attributes to it.
In the citing paper
“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
The cited source says what the claim attributes to it.
In the citing paper
“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 cited source says what the claim attributes to it.
In the citing paper
“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
The cited source says what the claim attributes to it.
In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“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)
The cited source says what the claim attributes to it.
In the citing paper
“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
The cited source says what the claim attributes to it.
In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“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
The cited source says what the claim attributes to it.
In the citing paper
“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 check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“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
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.”
Citations
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“Considering that comorbid presentations tend to be linked to more severe impairment (Kessler et al., 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…”
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“Considering that comorbid presentations tend to be linked to more severe impairment (Kessler et al., 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…”
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“The mean AAQ-II score was 18.71 (SD¼7.70) out of a possible range from 7 to 49 (higher scores indicating greater inflexibility), which is comparable to AAQ-II scores found in other non-clinical and college student samples (Bond et al., 2011).”
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“Although the form of problematic behaviors differs across disorders, many of these can be conceptualized as sharing common psychological functions (Hayes et al., 1996).”
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“Much of this research has focused on particular subsets of disorders, however, such as eating disorders (Fairburn et al., 2003) or anxiety disorders (Norton & Philipp, 2008).”
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Flagged first, then by citations
3 of the 49 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
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
“…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
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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).”
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“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).”
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“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).”
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“A study also demonstrated an association of PI/EA with deliberate self-harm behavior [23,44] and suicidality [45].”
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“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).”
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“Likewise, in FNE, PI also contains excessive and rigid psychological reactions which stem from dysfunctional control efforts (Levin et al. 2014).”
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“Levin et al. (2014) describe psychological inflexibility as a transdiagnostic pathological process and a target for interventions in anxiety, depression and substance use disorders.”
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“…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).”
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“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).”
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Adaptability and psychological flexibility: Overlapping constructs?
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“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
“…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
“, 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
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
“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
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
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
“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 48
“…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 48
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
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 50
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
Faustino, B., Vasco, A. B., Farinha-Fernandes, A., & Delgado, J. (2023) · Current Psychology · doi:10.1007/s12144-021-01943-w · Cited by 37
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 37
“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 40
“, 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
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
“…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
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
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
“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
“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 34
“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 33
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 40
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
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
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 32
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
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
“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 32
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 28
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
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 28
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
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
“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
“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 29
Graham, C. D., O'Hara, D. J., & Kemp, S. (2018) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2174 · Cited by 24
“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
Zhang, J., & Wang, E. (2022) · Behavioral Sciences · doi:10.3390/bs12120485 · Cited by 25
“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
Starr, L. R., Huang, M., & Scarpulla, E. (2021) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2021.07.004 · Cited by 24
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
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
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 23
Rosenblau, G., Frolichs, K., & Korn, C. W. (2023) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2023.105181 · Cited by 20
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 24
“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 23
“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
“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
“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
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
“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 26
Mangini, P., Averill, L. A., & Davis, A. K. (2022) · Journal of Psychedelic Studies · doi:10.1556/2054.2021.00176 · Cited by 19
“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
Åkerblom, S., Perrin, S., Fischer, M. R., & McCracken, L. M. (2020) · European Journal of Pain · doi:10.1002/ejp.1530 · Cited by 19
“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
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 23
“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
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
Waldeck, D., Banerjee, M., Jenks, R. A., & Tyndall, I. T. (2020) · Stress and Health · doi:10.1002/smi.2946 · Cited by 21
“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
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
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
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
“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 19
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 22
Metadata
- 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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