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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“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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Acceptance and Commitment Therapy for Substance Use Disorders
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“Cognitive fusion (the inability to detach from certain thoughts; Hayes 2019) has been proposed to be a key component of psychological inflexibility, which in turn may be central for a range of mental health conditions of transdiagnostic relevance (Levin et al. 2014).”
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“Associations between psychological inflexibility and eating disorder symptoms have been well documented across studies of clinical and non-clinical samples (Levin et al., 2014; Merwin et al., 2010).”
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“The results of a study conducted by Levin et al. (2014) suggest that psychological inflexibility is associated with several disorders such as anxiety and depression.”
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“Empirical research has consistently shown that individuals with high psychological inflexibility may alternate between these two tendencies: they may avoid distressing emotions in some contexts while becoming overly entangled with their thoughts in others [31,32].”
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“The Hexaflex/Inflexahex Model offers a transdiagnostic model that could be applied to a range of disorders which share functional processes despite their topographic differ - ences (Levin et al., 2014 ; Ruiz, 2010 ).”
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“Numerous studies have claimed that symptoms of anxiety and depression are indicators of psychological distress (Kranzler et al., 2016; Lace et al., 2019; Levin et al., 2014; Norton & Paulus, 2017).”
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“…with adult samples have demonstrated that psychological inflexibility strongly predicts stress, psychopathology, poor mental health, and quality of life (Bond et al., 2011; Gloster et al., 2011; Hernández - López et al., 2021; Kashdan & Rottenberg, 2010; Levin et al., 2014; Tynd all et al., 2020).”
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“EA is one such construct that may serve as a risk factor for a wide range of anxiety-related psychopathology as well as substance abuse and depression (Levin et al., 2014).”
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“All of this evidence has demonstrated the usefulness of the PI construct as a transdiagnostic variable of mental symptomatology (Levin et al., 2014).”
BackgroundMilanak, M. E., Witcraft, S. M., Park, J. Y., Hassell, K., McMahon, T. P., & Wilkerson, A. K. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1160001 · Cited by 4
Gorday, J. Y., Bardeen, J. R., Rogers, T. A., & Benfer, N. (2023) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2023.102725 · Cited by 5
Moosivand, M., Kulemarzi, M. J. B., Shirazi, M. S., & Zaremohzzabieh, Z. (2024) · BMC Psychology · doi:10.1186/s40359-024-01531-0 · Cited by 4
“A study by Levin et al. [10] revealed significant correlations between PI and a variety of psychological and behavioral problems, including depressive symptoms, anxiety, and eating disorders.”
BackgroundNeto, D. D., Mouadeb, D., Lemos, N., da Silva, A. N., Gloster, A. T., & Perez, W. F. (2024) · Current Psychology · doi:10.1007/s12144-024-06241-9 · Cited by 7
“…conversely, PI has been consistently associated with elevated rates of psychopathology (Fairburn et al., 2003; Gilbert, 2019; Gloster et al., 2017; Goldstone et al., 2011; Hayes et al., 2006; Levin et al., 2014; Meyer et al., 2019; Rawal et al., 2010; Tavakoli et al., 2019; Venta et al., 2012).”
Application of the Cognitive-Behavior Therapy principles in the development of e-mental health tools
Fonseca, A., Branquinho, M., & Canavarro, M. C. (2020) · Psychologica · doi:10.14195/1647-8606_63-2_6 · Cited by 5
“On the other hand, psychological inf lexibility, which is a core concept in the Acceptance and Commitment Therapy (ACT) model, has been considered as an important transdiagnostic process associated with psychopathology, including depression (Levin et al., 2014).”
BackgroundAcceptance and Commitment Therapy (ACT) for Problematic Anger: A Case Study
Tifft, E. D., Roberts, M. Z., Underwood, S. B., & Forsyth, J. P. (2022) · Clinical Case Studies · doi:10.1177/15346501221080931 · Cited by 3
“Psychological inflexibility is a transdiagnostic process, meaning it is associated with numerous psychological problems and dysfunctional behaviors including anxiety and mood disorders, disordered eating, substance and alcohol use (Grom et al., 2021; Levin et al., 2014), problematic anger, and aggression (Berkout et a…”
BackgroundBrandolin, F., Lappalainen, P., Gorinelli, S., Muotka, J., Räsänen, P., & Lappalainen, R. (2023) · British Journal of Guidance & Counselling · doi:10.1080/03069885.2023.2165636 · Cited by 3
“Following the example of Levin et al. (2014), we used the AFQ-Y for the student population in this study.”
BackgroundMethodResultSaito, J., Kumano, H., Ghazizadeh, M., Shimokawa, C., & Tanemura, H. (2024) · JMIR Formative Research · doi:10.2196/45998 · Cited by 3
“Psychological inflexibility is a core concept of ACT, which is a comprehensive, transdiagnostic interpretation of mental health symptoms [7].”
BackgroundVu, T. V., Nguyen-Duong, B.-T., Le, H. T. T., Nguyen, T. V., & Le, V. T. (2025) · Discover Mental Health · doi:10.1007/s44192-025-00293-4 · Cited by 4
“PF is a central concept in ACT, has been recognized as a transdiagnostic approach that explains many mental health problems and promotes human functioning [7–9].”
Lin, R., Bartels, S. L., & Su, J. J. (2026) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2026.105349 · Cited by 3
Yusufov, M., McHugh, R. K., Greer, J. A., Dalrymple, K. L., Sannes, T. S., Braun, I. M., Tulsky, J. A., & Pirl, W. F. (2023) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2023.04.006 · Cited by 3
Differential explanations of psychological well-being according to clinical personality patterns
Ciofu, V., Marian, A.-L., Apostol, M.-M., & Chiriac, L.-E. (2024) · Current Psychology · doi:10.1007/s12144-024-06897-3 · Cited by 5
“More than that, in other studies, psychological inflexibility was closely linked to the manifestation of psychological disorders such as anxiety (Venta et al., 2012), substance use (Levin et al., 2014), eating disorders (Rawal et al., 2010), or psychotic disorders (Goldstone et al., 2011).”
Gardini, V., Grandi, S., & Tomba, E. (2025) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.70040 · Cited by 6
Bektaş-Aydın, C., & Yüksel-Şahin, F. (2025) · Journal of Interpersonal Violence · doi:10.1177/08862605251318283 · Cited by 6
“Consistent with the theory, psychological inflexibility is associated with mental health issues, such as depression, anxiety, eating disorders, substance use disorders, and PTSD (Levin et al., 2014).”
InfluentialNeuroplasticity and Technology
Reddy, K. J. (2025) · Springer eBooks · doi:10.1007/978-3-031-88117-6_8 · Cited by 3
Martínez‐García, L., Mendizabal, J. B., Santos-Goñi, M. A., Miralles, I., & Osma, J. (2025) · Digital Health · doi:10.1177/20552076251334442 · Cited by 3
McCoy, K., Reed, F. M., Conn, K., & Foldi, C. J. (2025) · Physiology & Behavior · doi:10.1016/j.physbeh.2025.114957 · Cited by 3
“…disparate mental health conditions, these conditions are linked all by impairments in executive functions, including cognitive flexibility [13,70] and altered reward processing [6,53,127,142], which are proposed to be common underlying mechanisms through which psilocybin exerts therapeutic…”
Screening Depression and Anxiety via Brief Measures of Psychological Inflexibility
Weeks, S. N., Renshaw, T. L., & Roberson, A. J. (2021) · Journal of Psychoeducational Assessment · doi:10.1177/07342829211050739 · Cited by 3
“The aim of improving psychological flexibility is applicable for all clients, regardless of presentation (Hayes et al., 2006; Levin et al., 2014).”
BackgroundMendes-Santos, C. (2021) · Linköping studies in arts and science · doi:10.3384/9789179291143 · Cited by 3
Manning, K. F., Kauffman, B. Y., Garey, L., & Zvolensky, M. J. (2022) · Health Behavior Research · doi:10.4148/2572-1836.1155 · Cited by 3
“Past work suggests that psychological inflexibility is related to poor mental health outcomes (Levin et al., 2014; Morton et al., 2020), as well as worse outcomes for individuals with chronic health conditions (i.e. greater levels of pain, worse disease maintenance, poorer treatment adherence;…”
BackgroundSierra, M. A., & Ortíz, E. (2023) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2023.03.010 · Cited by 10
Alptekin, F. B., Burhan, H. Ş., & Kuru, T. (2023) · Cam and Sakura Medical Journal · doi:10.4274/csmedj.galenos.2023.2022-12-2 · Cited by 4
“Both psychological inflexibility and experiential avoidance are thought to contribute to a wide range of mental health problems (8).”
Adamowicz, J. L., Sirotiak, Z., & Thomas, E. B. K. (2023) · Psychology Health & Medicine · doi:10.1080/13548506.2023.2216940 · Cited by 3
“Individuals experiencing depressive and anxiety symptoms have significantly lower psychological flexibility while controlling for distress (Levin et al., 2014).”
BackgroundPavlacic, J. M., Ruggiero, K. J., Andrews, A. R., Price, M., & Rheingold, A. A. (2023) · Journal of Clinical Psychology · doi:10.1002/jclp.23610 · Cited by 3
Inflexibilidad psicológica y perfil psicopatológico en adictos a sustancias: Diferencias de sexo
Marín-Romero, B., & Garcı́a-Lecumberri, C. (2023) · Revista de Psicopatología y Psicología Clínica · doi:10.5944/rppc.37221 · Cited by 4
Psychometric Evaluation of the Swedish Multidimensional Psychological Flexibility Inventory (MPFI)Preprint
Tabrizi, F. F., Larsson, A. B., Grönvall, H., et al. (2022) · doi:10.31234/osf.io/dtbj8 · Cited by 3
Tao, Z., Wang, Z., Lan, Y., Zhang, W., & Qiu, B. (2025) · BMC Public Health · doi:10.1186/s12889-025-22628-0 · Cited by 3
“Cognitive fusion may also lead people to obstinately act in accordance with their intrusive thoughts [45], Individuals whose behaviors are closely tied to thoughts about environmental and interpersonal risks may opt out of activities to avoid potential unmanageable risks and the possibility of…”
Figueiredo, D. V., Salvador, M. D. C., Rijo, D., & Vagos, P. (2025) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-024-02608-2 · Cited by 2
“Acceptance and Commitment Therapy (ACT) is a widely researched and empirically sustained transdiagnostic approach to behavior change (e.g., [18, 34–36]) addressing both psychopathology (suffering) and psychological health.”
Juszczyk-Kalina, A., Holas, P., Bachem, R., & Roczon, P. (2026) · Journal of American College Health · doi:10.1080/07448481.2025.2593313 · Cited by 2
“18,34,35 Our study aligns with existing research, particularly the work of Rodgers and Tennison, 17 which found significant negative associations between AjD and students’ academic adjustment.”
Spanish adaptation of the experiential approach scale (Eas)
Reyes-Martín, S., Hernández-López, M., & Rodríguez-Valverde, M. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182412873 · Cited by 2
Jiang, Y., Tian, T., Li, F., Sun, J., Guo, Q., Wang, D., Li, X., & Yang, L. (2024) · BMC Psychology · doi:10.1186/s40359-024-02121-w · Cited by 2
“Conversely, psychological inflexibility (PI) is described as a pattern in which behaviour is controlled by one’s thoughts, feelings and other internal experiences, or to avoid these experiences at the expense of more effective and meaningful actions [8].”
BackgroundFarley, C. D., & Renshaw, T. L. (2025) · Behavioral Sciences · doi:10.3390/bs15020197 · Cited by 4
“A forced six-factor solution was then conducted to test the presence of a structure represented by open, aware, engaged, non-open, non-aware, and non-engaged factors (Levin et al., 2014).”
Psychometric investigation of the avoidance and inflexibility scale (AIS) for cocaine use
Jo, D., Leonard, S. J., Bodalski, E. A., Schmitz, J. M., & Stotts, A. L. (2025) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2025.100902 · Cited by 2
Arbinaga, F., Pedro, E. M. S., & Sierra, M. I. M. (2025) · PeerJ · doi:10.7717/peerj.19790 · Cited by 6
“Levin et al. (2014) examined psychological inflexibility as a transdiagnostic process across various psychological disorders.”
Moreira, H., Dias, T., & Trindade, I. A. (2025) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2025.100950 · Cited by 2
Lampe, E. W., Velkoff, E. A., & Manasse, S. M. (2025) · International Journal of Eating Disorders · doi:10.1002/eat.24602 · Cited by 2
Jormanainen, A., Kalttila, K., Hämäläinen, T., Lappalainen, P., Tunkkari, M., & Kiuru, N. H. (2025) · Scandinavian Journal of Psychology · doi:10.1111/sjop.70053 · Cited by 2
“Psychological inflexibility is a transdiagnostic process that involves rigid ways of reacting to one's negative thoughts, feelings, and experiences (Hayes et al. 2006; Levin et al. 2014).”
Sarnola, K., Välitalo, H., Kraav, S., Therman, S., Kurkinen, K., Ruuska, S.-M., Kekkonen, V., Kivimäki, P., Lehto, S. M., & Tolmunen, T. (2026) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.70268 · Cited by 2
“Similarly, PI/EA appears to underlie many psychopathological conditions in youth (Levin et al. 2014).”
InfluentialFaustino, B., & da Fonseca, I. B. (2023) · Applied Neuropsychology Adult · doi:10.1080/23279095.2023.2204526 · Cited by 2
“Also, several transdiagnostic constructs have been suggested, such as neuroticism (Barlow et al., 2014), early maladaptive schemas (Faustino & Vasco, 2020), psychological inflexibility (Faustino, 2021; Levin et al., 2014) and executive functions (Freis et al., 2022).”
Sease, T. B., Andersland, M., Perkins, D. R., Sandoz, E. K., Jean, C., Sudduth, H., & Cox, C. R. (2024) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2024.100815 · Cited by 4
Hinss, M. F., Brock, A., & Roy, R. N. (2024) · PLoS ONE · doi:10.1371/journal.pone.0305675 · Cited by 2
Holas, P., Kamińska, J., & Zajenkowski, M. (2025) · Dialogues in Clinical Neuroscience · doi:10.1080/19585969.2025.2470426 · Cited by 2
“Psychological inflexibility may increase concerns due to resistance to challenging experiences (levin et al. 2014). lower meaning in life could also heighten concerns, as these traits relate to difficulty in finding personal relevance or accepting disorienting experiences (steger et al. 2006).”
Villanueva‐Blasco, V. J., Martínez, A. C., Eslava, D., & Valdivia‐Salas, S. (2018) · INFORMACIO PSICOLOGICA · doi:10.14635/ipsic.2018.115.7 · Cited by 2
Focusing on the Correct Level of Analysis in Process-Based Therapy
Hayes, S. C., & Hofmann, S. G. (2019) · Clinical Psychological Science · doi:10.1177/2167702618818433 · Cited by 3
“We know that given biopsychosocial processes can give rise to different problems (e.g., Levin et al., 2014), and that individuals with apparently similar problems can differ on the processes that led to them (e.g., Fisher, Medalgia, & Jeronimus, 2018).”
BackgroundSelf-citationCardoso, B., Galhardo, A. B., Massano‐Cardoso, I., & Cunha, M. I. V. A. (2021) · Revista Portuguesa de Investigação Comportamental e Social · doi:10.31211/rpics.2021.7.2.220 · Cited by 2
Machado, A. B. C., Zancan, R. K., & Oliveira, M. D. S. (2021) · Contextos Clínicos · doi:10.4013/ctc.2021.143.13 · Cited by 2
“…mental em universitários como transtornos alimentares, depressão, abuso de substâncias, ansiedade, somatização, vício em internet e ideação suicida (Levin et al. 2014; Hill, Masuda, Melcher, Morgan, & Twohig, 2015; Chou, Yen, & Liu, 2018; Tavakoli, Broyles, Reid, Sandoval, & Correa-Fernández,…”
BackgroundZeas-Sigüenza, A., Oliveira, S., Ferreira, C., Ganho, A., Vagos, P., & Ruisoto, P. (2021) · doi:10.31234/osf.io/eyxvn · Cited by 2
Examining Item Content Across Nine Psychological (In)flexibility Scales: What Do They Measure?Preprint
Ong, C. W., Skolnik, A., Johnson, H. M., et al. (2023) · doi:10.31234/osf.io/wur26 · Cited by 2
Karaağaç, Z. G., Deniz, M. E., Erişen, Y., Bırni, G., Satıcı, B., & Kaya, Y. (2024) · SSRN Electronic Journal · doi:10.2139/ssrn.4860288 · Cited by 2
Underwood, S. B., White, S. V., & Forsyth, J. P. (2024) · Clinical Case Studies · doi:10.1177/15346501241278297 · Cited by 1
“…see Hayes et al., 2012) and can be described as a pattern in which behavior is excessively in fl uenced by unwanted private events (e.g., thoughts, feelings, physical sensations) or avoidance of these experiences at the expense of more effective and value-guided actions (Levin et al., 2014).”
Strika-Bruneau, L., Fauvel, B., Dupuis, D., & Benyamina, A. (2023) · L Évolution Psychiatrique · doi:10.1016/j.evopsy.2023.01.003 · Cited by 1
The Valued Action and Satisfaction Questionnaire: Preliminary Validation and Psychometric Evaluation
Lyons, G. A., Stone, B. M., Primeaux, S., Wang, V., & Drake, C. E. (2023) · The Psychological Record · doi:10.1007/s40732-023-00548-y · Cited by 1
Shao, M., Luo, S., Qian, H., Li, X., Wei, Z., Hong, M., Wang, J., Li, X., & Meng, J. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e26082 · Cited by 2
“Psychological inflexibility involves individuals engaging in counterproductive attempts to manage or evade unpleasant internal or external events through their responses to bodily sensations, emotions, or thoughts [29,30].”
BackgroundFACT: A pilot study of process-based therapy to promote occupational well-being
Macías-Morón, J., & Valero-Aguayo, L. (2024) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2024.100761 · Cited by 2
Prowse, G., Conroy, E., & Mogensen, L. L. (2024) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2024.100821 · Cited by 2
Costa, C. E., Banaco, R. A., Becker, R. M., & Luiz, A. C. D. M. (2024) · Perspectivas em Análise do Comportamento · doi:10.18761/pac7827927 · Cited by 1
Roberts, M. Z., Tifft, E. D., Forsyth, J. P., & Boswell, J. F. (2024) · Clinical Case Studies · doi:10.1177/15346501241283059 · Cited by 2
“…also aligned with the conceptualization of Acceptance and Commitment Therapy as a uni fi ed approach to behavior change (e.g., Hayes, 2019; Hayes et al., 2012) and with empirical evidence demonstrating psychological in fl exibility underlies various mental health concerns (e.g., Levin et al., 2014).”
Examining item content across nine psychological (in)flexibility scales: What do they measure?
Ong, C. W., Skolnik, A. M., Johnson, H. M., & Lee, E. B. (2025) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2025.100872 · Cited by 5
Ho, J. K. Y., Williams, K., & Knight, G. (2025) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x24000461 · Cited by 1
“Over time, these patterns of behaving dictated by internal experiences take individuals away from living a life that is guided by their values (Levin et al ., 2014).”
Villa, Ó. M. G., Basurto, F. Z., & Ortega‐Campos, E. (2025) · Universitas Psychologica · doi:10.11144/javeriana.upsy22.dria · Cited by 1
Validation of the food craving acceptance and action questionnaire (FAAQ) in pregnancy
Hormes, J. M., & Timko, C. A. (2025) · Eating Behaviors · doi:10.1016/j.eatbeh.2025.101974 · Cited by 1
Shin, Y.-M., Jang, S.-H., & Ihm, J. (2025) · Current Psychology · doi:10.1007/s12144-025-07802-2 · Cited by 3
“Contemporary research identifies EA as a transdiagnostic process in psychopathology (Akbari et al., 2022 ; Levin et al., 2014 ).”
Khalil, Z., Mason, T. B., & Smith, K. E. (2025) · Journal of American College Health · doi:10.1080/07448481.2025.2510687 · Cited by 1
“5–7 Conversely, higher resilience (i.e., the ability to adapt positively to adversity) is related to positive health outcomes and is negatively associated with EDs.”
Kallesøe, K. H., Ørnbøl, E., Wellnitz, K. B., & Rask, C. U. (2025) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2025.2521719 · Cited by 3
“…is a transdiagnostic core concept that encompasses six interconnected processes, involving cognitive and behavioural patterns in which the individual seeks to avoid, escape, or control distressing internal experiences at the expense of more effective and meaningful actions (Levin et al., 2014).”
Internalized Ageism and Other Barriers to Purpose in Later Life: Protocol for a Qualitative Study
Valdivia‐Salas, S., & Horrillo, A. C. (2025) · International Journal of Qualitative Methods · doi:10.1177/16094069251360319 · Cited by 1
“…and greater self-esteem and reported well-being (Kashdan & Rottenberg, 2010; for evidence on the negative associations of its counterpart, psychological in fl exibility, with adaptation and wellbeing, see Bond et al., 2011; Levin et al., 2014; Monestès et al., 2018; Valdivia-Salas et al., 2017).”
Fanciullacci, L., Pricoco, P., Malanima, M. A., Fornili, M., Baglietto, L., Smorti, M., & Montiel, C. B. (2025) · Children · doi:10.3390/children12081000 · Cited by 1
Fahroedin, D. K., & Morris, E. M. J. (2025) · Clinical Psychologist · doi:10.1080/13284207.2025.2533125 · Cited by 2
Batallas, D., Guerra, V., Jiménez, M., Hidalgo, V., & Salvador, A. (2026) · Psychological Reports · doi:10.1177/00332941251415326 · Cited by 1
Finding Hope in Creative Hopelessness: Hope and Flow as Mechanisms Leading to Wellbeing
Ignjatovic, C., Kern, M. L., Fave, A. D., & Allen, M. K. (2026) · Psychotherapy and Counselling Journal of Australia · doi:10.59158/001c.156091 · Cited by 2
A scoping review and research agenda: Psychological flexibility and wellbeing in organisations
Roche, M., Faulkner, J. W., & Callagher, E. (2026) · Applied Psychology Health and Well-Being · doi:10.1111/aphw.70139 · Cited by 2
“Although widely adopted, the AAQ-II primarily reflects tendencies to struggle with thoughts or emotions rather than the broader behavioural processes emphasised in conceptualisations of PF (Chawla & Ostafin, 2007; Levin et al., 2014).”
Validation of the Italian Multidimensional Psychological Flexibility Inventory Short Form (MPFI-24)
Landi, G., Bao, Z., Bruno, F., Pakenham, K. I., Chiesi, F., Tossani, E., & Grandi, S. (2026) · Behavioral Sciences · doi:10.3390/bs16040510 · Cited by 1
“…psychological flexibility is linked to improved mental health (Gloster et al., 2017; McCracken & Gutiérrez-Martínez, 2011; Young et al., 2022) and higher psychological inflexibility is linked to more psychopathology (Levin et al., 2014; Ong et al., 2024) across diverse populations and settings.”
Navarrete, J., Brandolin, F., Lappalainen, P., García‐Rubio, C., Ferreira, C., Luciano, J. V., Lappalainen, R. I., & Kiuru, N. H. (2026) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2026.101015 · Cited by 1
Examining clinical relevance of interpretation inflexibility in social contexts
Deng, W., Zabag, R., Narain, S., Cannon, T. D., & Joormann, J. (2026) · Annals of General Psychiatry · doi:10.1186/s12991-026-00683-0 · Cited by 1
“Research has linked inflexible interpretations of neutral (non-social; e.g., pictures of everyday objects) stimuli to the onset and maintenance of various psychiatric disorders, including depression, anxiety, PTSD, OCD, anorexia nervosa, psychosis and alcohol dependence [41–43].”
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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