Psychological inflexibility and intolerance of uncertainty moderate the relationship between social isolation and mental health outcomes during COVID-19

Smith, Brooke M.; Twohy, Alexander J.; Smith, Gregory S.

doi:10.1016/j.jcbs.2020.09.005

Cited by 194COVID-19 and Mental HealthMindfulness and Compassion InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Psychological inflexibility and intolerance of uncertainty moderate the relationship between social isolation and mental health outcomes during COVID-19

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Smith, Brooke M., Twohy, Alexander J., Smith, Gregory S.·2020·Journal of Contextual Behavioral Science

DOI 10.1016/j.jcbs.2020.09.005PMC PMC7489247

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Abstract

The COVID-19 pandemic has had an enormous impact on human activity worldwide, in part due to many governments issuing stay-at-home orders and limiting the types of social interactions in which citizens can engage. Previous research has shown that social isolation can contribute to psychological distress. The impact of increased social isolation on mental health functioning during the COVID-19 crisis, as well as potential mechanisms to buffer this impact, have yet to be investigated. The current study explored the moderating role of psychological flexibility and related constructs on the relationships between social isolation and mental health outcomes during the COVID-19 pandemic. Cross-sectional data from 278 participants, the majority residing in the United States, were collected during a 3-week period from mid-April to early May 2020 via online survey. A series of hierarchical linear regression analyses indicated statistically significant relationships between social isolation and psychological distress (depression, anxiety, and stress), well-being, and valued living. Psychological inflexibility, intolerance of uncertainty, and emotional suppression significantly moderated these relationships in a number of instances. Greater psychological flexibility and acceptance of difficult experiences appeared to act as a buffer against the negative effects of increased social isolation, while amplifying the benefits of social connectedness. Implications for promoting mental health and buffering against the harmful effects of social isolation during the COVID-19 pandemic and beyond are discussed.

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Smith et al. conceptualised intolerance of uncertainty as a specific manifestation of psychological flexibility.
“Smith et al. (2020) conceptualised IU as a specific manifestation of PF (difficulty accepting thoughts and feelings related to uncertainty and a behavioral orientation towards emotional control).”
From Behind the masks: A cross-sectional study on intolerance of uncertainty, perceived vulnerability to disease and psychological flexibility in relation to state anxiety and wellbeing during the COVID-19 pandemic (2021) · cites this paper as Smith et al. (2020)
The passage labeled Abstract conceptualizes intolerance of uncertainty as a specific instance of psychological *inflexibility*, not flexibility. It associates difficulty accepting uncertainty-related thoughts and feelings with intolerance of uncertainty, but assigns rigid emotional control to emotional suppression. (LLM, conf=0.88)
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Experimental — accuracy not yet measured
Social isolation and self-quarantine are associated with psychological distress.
“Social isolation and self-quarantine have been associated with psychological distress (Boyraz et al., 2020; Brooks, 2020; Smith et al., 2020).”
From Behind the masks: A cross-sectional study on intolerance of uncertainty, perceived vulnerability to disease and psychological flexibility in relation to state anxiety and wellbeing during the COVID-19 pandemic (2021) · cites this paper as Smith et al., 2020
The Abstract and Discussion report an association between social isolation and psychological distress during COVID-19. The paper discusses quarantine periods and stay-at-home orders, but the passages do not establish a separate association between self-quarantine and distress. (LLM, conf=0.84)
Experimental — accuracy not yet measured
Intolerance of uncertainty can moderate the impact of social isolation and stressors on anxiety.
“This is consistent with findings that IU is both directly related to anxiety (Rettie & Daniels, 2020) and can moderate the impact of social isolation and stressors on anxiety (Chen & Hong, 2010; Ciarrochi et al., 2005; Smith et al., 2020).”
From Behind the masks: A cross-sectional study on intolerance of uncertainty, perceived vulnerability to disease and psychological flexibility in relation to state anxiety and wellbeing during the COVID-19 pandemic (2021) · cites this paper as Smith et al., 2020
The Results (Moderation analyses; page not provided) report that intolerance of uncertainty moderated the relationship between social isolation and anxiety. The cited passages do not establish that it also moderates the effect of other stressors on anxiety. (LLM, conf=0.85)
Experimental — accuracy not yet measured
In the context of COVID-19, intolerance of uncertainty moderates the relationships between social isolation and anxiety and mental wellbeing.
“In the context of COVID-19, IU has been found to moderate the relationships between social isolation and anxiety and mental wellbeing (Smith et al., 2020), to positively correlate with depression, anxiety and stress (Seco Ferreira et al., 2020), and to have both direct and mediated relationships with anxiety and wellbeing (Rettie & Daniels, 2020; Satici et al., 2020).”
From Behind the masks: A cross-sectional study on intolerance of uncertainty, perceived vulnerability to disease and psychological flexibility in relation to state anxiety and wellbeing during the COVID-19 pandemic (2021) · cites this paper as Smith et al., 2020
During the pandemic, psychological flexibility moderated the relationship between social isolation and depression and anxiety.
“During the pandemic PF has also been found to moderate the relationships between social isolation and depression and anxiety (Smith et al., 2020), COVID-19 risk factors and mental health difficulties (Pakenham et al., 2020), COVID-19 stressors and suicide risk (Crasta et al., 2020) and psychological distress within family systems (Daks et al., 2020).”
From Behind the masks: A cross-sectional study on intolerance of uncertainty, perceived vulnerability to disease and psychological flexibility in relation to state anxiety and wellbeing during the COVID-19 pandemic (2021) · cites this paper as Smith et al., 2020

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“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].”
Background
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The relationships between valued living and depression and anxiety: A systematic review, meta-analysis, and meta-regression
Tunç, H., Morris, P. G., Kyranides, M. N., McArdle, A., McConachie, D., & Williams, J. (2023) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2023.02.004 · Cited by 40 · see citing works
Do social isolation and neighborhood walkability influence relationships between COVID-19 experiences and wellbeing in predominantly Black urban areas?
Finucane, M. L., Beckman, R., Ghosh‐Dastidar, M., Dubowitz, T., Collins, R. L., & Troxel, W. (2021) · Landscape and Urban Planning · doi:10.1016/j.landurbplan.2021.104264 · Cited by 42 · see citing works
The role of psychological flexibility in the relationships between burnout, job satisfaction, and mental health among nurses in combatting <scp>COVID</scp> ‐19: A two‐region survey
Chong, Y. Y., Frey, E., Chien, W. T., Cheng, H. Y., & Gloster, A. T. (2023) · Journal of Nursing Scholarship · doi:10.1111/jnu.12874 · Cited by 42 · see citing works
Between Action and Emotional Survival During the COVID-19 era: Sensorimotor Pathways as Control Systems of Transdiagnostic Anxiety-Related Intolerance to Uncertainty
Goldstein Ferber, S., Shoval, G., Zalsman, G., Mikulincer, M., & Weller, A. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.680403 · Cited by 40 · see citing works
In the shadow of COVID-19: A randomized controlled online ACT trial promoting adolescent psychological flexibility and self-compassion
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
Associations between psychological inflexibility and mental health problems during the COVID-19 pandemic: A three-level meta-analytic review
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
Investigating differential effects of socio-emotional and mindfulness-based online interventions on mental health, resilience and social capacities during the COVID-19 pandemic: The study protocol
Godara, M., Silveira, S., Matthäus, H., Heim, C., Voelkle, M., Hecht, M., Binder, E. B., & Singer, T. (2021) · PLOS ONE · doi:10.1371/journal.pone.0256323 · Cited by 38 · see citing works
Work from Home Success: Agile work characteristics and the Mediating Effect of supportive HRM
Heidt, L., Gauger, F., & Pfnür, A. (2022) · Review of Managerial Science · doi:10.1007/s11846-022-00545-5 · Cited by 40 · see citing works
Psychometric Properties and Factor Structure of the Spanish Version of the Acceptance and Action Questionnaire-II (AAQ-II) in Ecuador
Paladines-Costa, B., López-Guerra, V., Ruisoto, P., Vaca-Gallegos, S., & Cacho, R. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18062944 · Cited by 37 · see citing works
“PI has also mediated the association between emotion regulation and loneliness [29].”
Background
Intolerance of Uncertainty, Looming Cognitive Style, and Avoidant Coping as Predictors of Anxiety and Depression During COVID-19: a Longitudinal Study
Carnahan, N. D., Carter, M. M., & Sbrocco, T. (2021) · International Journal of Cognitive Therapy · doi:10.1007/s41811-021-00123-9 · Cited by 39 · see citing works
Psychological effects of green experiences in a virtual environment: a systematic review
Lee, M., Kim, E., Choe, J., Choi, S., Ha, S., & Kim, G. (2022) · Forests · doi:10.3390/f13101625 · Cited by 36 · see citing works
Transcending Adversity: Trauma-Informed Educational Development
Imad, M. (2021) · To improve the academy · doi:10.3998/tia.17063888.0039.301 · Cited by 36 · see citing works
Dealing with uncertain situations
Alquist, J., & Baumeister, R. F. (2023) · Journal of Positive Psychology · doi:10.1080/17439760.2023.2282781 · Cited by 21 · see citing works
The Psychological Functioning in the COVID-19 Pandemic and Its Association With Psychological Flexibility and Broader Functioning in People With Chronic Pain
Yu, L., Kioskli, K., & McCracken, L. (2021) · Journal of Pain · doi:10.1016/j.jpain.2021.02.011 · Cited by 36 · see citing works
The association between intolerance of uncertainty and academic burnout among university students: the role of self-regulatory fatigue and self-compassion
Qiang, J., He, X., Xia, Z., Huang, J., & Xu, C. L. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1441465 · Cited by 49 · see citing works
Safety behaviors and job satisfaction during the pandemic: The mediating roles of uncertainty and managerial commitment
Li, K., & Griffin, M. A. (2022) · Journal of Safety Research · doi:10.1016/j.jsr.2022.05.008 · Cited by 34 · see citing works
Increased Risk Perception, Distress Intolerance and Health Anxiety in Stricter Lockdowns: Self-Control as a Key Protective Factor in Early Response to the COVID-19 Pandemic
Lindner, C., Kotta, I., Marschalkó, E. E., Szabó, K., Kálcza-Jánosi, K., & Retelsdorf, J. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19095098 · Cited by 29 · see citing works
Effects of Coronavirus-19 Induced Loneliness on Mental Health: Sleep Quality and Intolerance for Uncertainty as Mediators
Gu, S., He, Z.-M., Sun, L., Jiang, Y., Xu, M.-H., Feng, G.-K., Ma, X., Wang, F.-S., & Huang, J. H. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.738003 · Cited by 26 · see citing works
Meaningfulness protects from and crisis of meaning exacerbates general mental distress longitudinally
Schnell, T., & Krampe, H. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-03921-3 · Cited by 33 · see citing works
Student well-being: the impact of belonging, COVID-19 pandemic related student stress, loneliness, and academic anxiety
Dost, G. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1481328 · Cited by 39 · see citing works
Health, well-being, and persisting symptoms in the pandemic: What is the role of psychological flexibility?
McCracken, L. M., Buhrman, M., Badinlou, F., & Brocki, K. C. (2022) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2022.10.003 · Cited by 24 · see citing works
“, 2006) as an important target in the treatment and recovery of those adversely affected (see Crasta et al., 2020; Daks et al., 2020; Dawson & Golijani-Moghaddam, 2020; Gloster et al., 2017; Kroska et al., 2020; McCracken et al., 2021; Pakenham et al., 2020; Smith et al., 2020).”
BackgroundMethodResult
Antidepressants and COVID-19: Increased use, occurrence in water and effects and consequences on aquatic environment. A review
Puga, A., Moreira, M. M., Sanromán, M. Á., Pazos, M. M., & Delerue-Matos, C. M. (2024) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2024.175993 · Cited by 22 · see citing works
Does cognitive flexibility change the nature of the relationship between intolerance of uncertainty and psychological symptoms during the COVID-19 outbreak in Turkey?
İnözü, M., Gök, B. G., Tüzün, D., & Hacıömeroğlu, A. B. (2022) · Current Psychology · doi:10.1007/s12144-021-02450-8 · Cited by 25 · see citing works
Interplay between uncertainty intolerance, emotion regulation, cognitive flexibility, and psychopathology during the COVID-19 pandemic: a multi-wave study
Godara, M., Everaert, J., Sánchez-López, Á., Joormann, J., & Raedt, R. D. (2023) · Scientific Reports · doi:10.1038/s41598-023-36211-3 · Cited by 30 · see citing works
One-year into COVID-19 pandemic: Decision-making and mental-health outcomes and their risk factors
Fiorenzato, E., & Cona, G. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.04.144 · Cited by 21 · see citing works
Intolerance of uncertainty and psychological symptoms among people with a missing loved one: Emotion regulation difficulties and psychological inflexibility as mediators
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
Keep me updated! Social support as a coping strategy to reduce the perceived threat caused by the cognitive availability of COVID-19 relevant information
Klümper, L., & Sürth, S. (2021) · Current Psychology · doi:10.1007/s12144-021-01951-w · Cited by 20 · see citing works
Intolerance of uncertainty, anxiety sensitivity, and health anxiety during the COVID-19 pandemic: Exploring temporal relationships using cross-lag analysis
Bredemeier, K., Church, L. D., Bounoua, N., Feler, B., & Spielberg, J. M. (2023) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2022.102660 · Cited by 18 · see citing works
College students' cyberloafing and the sense of meaning of life: The mediating role of state anxiety and the moderating role of psychological flexibility
Li, Q., Xia, B., Zhang, H., Wang, W., & Wang, X. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.905699 · Cited by 29 · see citing works
Emotion regulation moderates the association between COVID-19 stress and mental distress: findings on buffering, exacerbation, and gender differences in a cross-sectional study from Norway
Haver, A., Krampe, H., Danbolt, L. J., Stålsett, G., & Schnell, T. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1121986 · Cited by 21 · see citing works
Harnessing the Neurobiology of Resilience to Protect the Mental Well-Being of Healthcare Workers During the COVID-19 Pandemic
Rajkumar, R. P. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.621853 · Cited by 18 · see citing works
Relationships between stress appraisals and intolerance of uncertainty with psychological health during early COVID-19 in the USA
McCarty, R. J., Downing, S. T., Daley, M. L., McNamara, J. P. H., & Guastello, A. D. (2023) · Anxiety, Stress, & Coping · doi:10.1080/10615806.2022.2075855 · Cited by 16 · see citing works
The impact of the first wave of the Covid‐19 pandemic on parents of children with externalising difficulties in ireland: A longitudinal cohort study
Berry, A., Burke, T., & Carr, A. (2021) · International Journal of Clinical Practice · doi:10.1111/ijcp.14941 · Cited by 16 · see citing works
The relationship between tolerance for uncertainty and academic adjustment: the mediating role of students’ psychological flexibility during COVID-19
Daşcı, E., Salihoğlu, K., & Daşcı, E. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1272205 · Cited by 16 · see citing works
Lonely meaning–seekers: The moderating role of search for meaning in the relationship between loneliness and presence of meaning
Borawski, D., Nowak, A., & Zakrzewska, A. (2022) · Personality and Individual Differences · doi:10.1016/j.paid.2022.111550 · Cited by 17 · see citing works
Post-traumatic stress symptoms and war-related concerns among pregnant women: The contribution of self-mastery and intolerance of uncertainty
Ring, L., Mijalevich‐Soker, E., Joffe, E., Awad-Yasin, M., & Ben‐Ari, O. T. –. (2024) · Journal of Reproductive and Infant Psychology · doi:10.1080/02646838.2024.2442471 · Cited by 15 · see citing works
The effects of loneliness and psychological flexibility on veterans’ substance use and physical and mental health functioning during the COVID-19 pandemic
Kelly, M. M., DeBeer, B. B., Chamberlin, E. S., Claudio, T., Duarte, B. A., Harris, J. I., Kennedy, M. A., Shirk, S. D., & Reilly, E. D. (2022) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2022.10.004 · Cited by 14 · see citing works
Intolerance of Uncertainty, Job Satisfaction and Work Performance in Turkish Healthcare Professionals: Mediating Role of Psychological Capital
Yıldırım, M., Çağış, Z. G., & Gómez-Salgado, J. C. (2024) · International Journal of Public Health · doi:10.3389/ijph.2024.1607127 · Cited by 14 · see citing works
Problem gambling during Covid-19
Frisone, F., Alibrandi, A., & Settineri, S. (2020) · Mediterranean Journal of Clinical Psychology · doi:10.6092/2282-1619/mjcp-2457 · Cited by 15 · see citing works
Difficulties in Emotion Regulation and Stress in Intensive Care Unit Nurses During COVID-19: Exploring the Mediating Role of Psychological Inflexibility and the Moderating Effect of Work Experience
Gesto, C. D., Policardo, G. R., Benucci, S. B., Çela, E., & Grano, C. (2025) · Healthcare · doi:10.3390/healthcare13131575 · Cited by 14 · see citing works
The Relationship Between Stress and Well-being: The Mediating Roles of Students’ Psychological Flexibility and Loneliness During the Coronavirus Pandemic
Indra, G. H., Radyani, A. M., & Oriza, I. I. D. (2021) · Psychological Research on Urban Society · doi:10.7454/proust.v4i2.100 · Cited by 14 · see citing works
Social Disconnection and Psychological Distress in Canadian Men During the COVID-19 Pandemic
Simpson, N., Oliffe, J., Rice, S., Kealy, D., Seidler, Z., & Ogrodniczuk, J. S. (2022) · American Journal of Men's Health · doi:10.1177/15579883221078145 · Cited by 13 · see citing works
Anxiety sensitivity and intolerance of uncertainty are unique and interactive risk factors for COVID-19 safety behaviors and worries
Saulnier, K. G., Koscinski, B., Volarov, M., Accorso, C., Austin, M. J., Suhr, J. A., Allan, D. M., & Allan, N. P. (2021) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2021.1976819 · Cited by 13 · see citing works
The Effect of Intolerance of Uncertainty on State Anxiety in the Regular Epidemic Prevention and Control Phase in the Context of Informatization: A Moderated Chain Mediation Model
Fu, J., Xu, C. L., Yan, W., & Li, L. (2023) · Applied Research in Quality of Life · doi:10.1007/s11482-023-10165-0 · Cited by 14 · see citing works
The interplay among burnout, and symptoms of depression, anxiety, and stress in Chinese clinical therapists
Gu, M., Wang, S., Zhang, S., Song, S., Gu, J., Shi, Y., Li, W., Chen, L., Liang, Y., Yang, Y., et al. (2024) · Scientific Reports · doi:10.1038/s41598-024-75550-7 · Cited by 12 · see citing works
Why communication matters? The roles of patient-provider communication and social media use in cancer survivors’ meaning in life
Wu, Q. J., Ngien, A., Jiang, S., & Dong, Y. (2024) · Computers in Human Behavior · doi:10.1016/j.chb.2024.108218 · Cited by 12 · see citing works
Stop to smell the virtual roses: a mixed-methods pilot study on the impact of multisensory virtual reality nature experiences on feelings of relaxation
Lopes, M. K. S., Jesus, B. J. D., Rosanne, O., Pardini, S., Appel, L., Smith, C. E., & Falk, T. H. (2024) · Frontiers in Virtual Reality · doi:10.3389/frvir.2024.1451704 · Cited by 10 · see citing works
Uncertainty and Well-Being in Turkish Adults: Exploring the Role of Religiosity and Psychological Symptoms
Türk, N., Arslan, G., Kaya, A., & YILDIRIM, O. (2025) · Journal of Religion and Health · doi:10.1007/s10943-025-02279-6 · Cited by 10 · see citing works
Individual risky and protective factors influencing university new graduates’ career adaptability during COVID-19: A moderated mediation model
He, M., & Yu, Y. (2021) · Journal of Health Psychology · doi:10.1177/13591053211064980 · Cited by 10 · see citing works
Self-Compassion as a Moderator of the Association Between COVID-19 Stressors and Psychological Symptoms: A Longitudinal Study
Keng, S., & Hwang, E. Z. N. (2022) · Behaviour Change · doi:10.1017/bec.2022.2 · Cited by 10 · see citing works
The moderating effects of intolerance of uncertainty and social connectedness on college students’ addictive behaviors and mental health symptoms during the COVID-19 pandemic
Wojtaszek, J. A., & Saules, K. K. (2024) · Journal of American College Health · doi:10.1080/07448481.2022.2082848 · Cited by 9 · see citing works
Friendship attachment style, intolerance of uncertainty, and psychological distress among unaccompanied immigrant minors in times of COVID‐19
Ceccon, C., & Moscardino, U. M. M. (2023) · Journal of Adolescence · doi:10.1002/jad.12254 · Cited by 9 · see citing works
The role of covid‐19 anxiety and intolerance of uncertainty in predicting resilience
Duru, Y. B., Gunal, V., Agaoglu, C. Y., & Tatlı, C. E. (2022) · Scandinavian Journal of Psychology · doi:10.1111/sjop.12820 · Cited by 9 · see citing works
Comparative Analysis of Academic, Behavioral, and Psychophysiological Variables in Male and Female Vocational Training Students
Clemente-Suárez, V. J., Beltrán-Velasco, A. I., Mendoza-Castejón, D., Rodríguez-Besteiro, S., López-Varas, F., & Martín-Rodríguez, A. (2024) · Children · doi:10.3390/children11070851 · Cited by 7 · see citing works
“The development, maintenance, and exacerbation of a diverse array of psychological issues have been hypothesized to be influenced by psychological inflexibility and experiential avoidance [35,36].”
Background
Factors associated with psychological distress among college students under COVID-19 pandemic: the moderating role of coping styles and social support
Mao, Z., Qin, T., Fan, L., Li, N., & Wang, Y. (2023) · Current Psychology · doi:10.1007/s12144-023-05156-1 · Cited by 7 · see citing works
Brief online ACT intervention to improve adolescents' well-being: Effectiveness among adolescents with depressive symptoms during COVID-19.
Keinonen, K., Lappalainen, P., Puolakanaho, A., Kaipainen, K., Lappalainen, R., & Kiuru, N. (2024) · Children and Youth Services Review · doi:10.1016/j.childyouth.2024.107671 · Cited by 6 · see citing works
Intolerance of Uncertainty and Psychological Flexibility Predict Worry in Young Adults
Kalaycı, M. Y., & Aydın, Y. (2025) · Bartın University Journal of Faculty of Education · doi:10.14686/buefad.1368769 · Cited by 8 · see citing works
The interplay between perceived stress, psychological flexibility, and interpretation biases in undergraduate mental health
Machulska, A., & Klucken, T. (2025) · Scientific Reports · doi:10.1038/s41598-025-26492-1 · Cited by 7 · see citing works
The association between COVID-19-related stressors and mental health outcomes for survivors of past interpersonal and non-interpersonal trauma
Maharaj, R., Tineo, K., Flores-Ortega, M., Cordova, D. A., Iskhakova, A., Linn, R., & Nikulina, V. (2022) · European Journal of Trauma & Dissociation · doi:10.1016/j.ejtd.2022.100300 · Cited by 6 · see citing works
Loneliness and mental health during the COVID-19 pandemic in the Dutch general population: The moderating role of psychological flexibility
Tilburg, J., Simons, M., Batink, T., Janssens, M., Peeters, S. C. T., Lataster, J., Jacobs, N., & Reijnders, J. S. A. M. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e37172 · Cited by 7 · see citing works
Translasi, Adaptasi dan Validasi Skala Intolerance of Uncertainty Short Version 12-item (IUS-12) ke Bahasa Indonesia
Istiqomah, A. N., Helmi, A. F., & Widhiarso, W. (2022) · Psikologika Jurnal Pemikiran dan Penelitian Psikologi · doi:10.20885/psikologika.vol27.iss1.art8 · Cited by 6 · see citing works
Associations of psychological inflexibility with posttraumatic stress disorder and adherence to COVID-19 control measures among refugees in Uganda: The moderating role of coping strategies
Baluku, M. M., Nansubuga, F., Kibanja, G., Ouma, S., Balikoowa, R., Nansamba, J., Ruto, G. C., Kawooya, K., & Musanje, K. (2023) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2023.05.002 · Cited by 6 · see citing works
The roles of intolerance of uncertainty and mindfulness in psychological distress: a two-wave longitudinal study
Atalay, A. A., Abdulcebbar, A., Kantarcı, L., & Yılmaz, E. (2024) · Current Psychology · doi:10.1007/s12144-024-06243-7 · Cited by 6 · see citing works
Examining the effectiveness and acceptability of a group-based ACT intervention delivered by videoconference to international university students during the COVID-19 pandemic.
Brandolin, F., Lappalainen, P., Gorinelli, S., Muotka, J., & Lappalainen, R. (2024) · Counselling Psychology Quarterly · doi:10.1080/09515070.2023.2254726 · Cited by 5 · see citing works
“…psychological flexibility has been proven to be a moderating factor in the relationships between social isolation and depression and anxiety (Smith, Twohy, & Smith, 2020), COVID-19 risk factors and mental health difficulties (Pakenham et al., 2020), and COVID-19 stressors and suicide risk…”
Using a novel multiple-source indicator to investigate the effect of scale format on careless and insufficient effort responding in a large-scale survey experiment
Ulitzsch, E., Buchholz, J., Shin, H. J., Bertling, J., & Lüdtke, O. (2024) · Large-scale Assessments in Education · doi:10.1186/s40536-024-00205-y · Cited by 5 · see citing works
Dynamic neighborhood isolation and resilience during the pandemic in America's 50 largest cities
Zhai, W., Liu, M., & Han, Y. (2024) · Cities · doi:10.1016/j.cities.2024.105260 · Cited by 6 · see citing works
A Research on Interpersonal Emotion Regulation Strategies and Intolerance of Uncertainty in The COVID-19 Process
KARDUZ, F. F. A., & KELEŞOĞLU, F. (2022) · Cumhuriyet International Journal of Education · doi:10.30703/cije.1003610 · Cited by 6 · see citing works
The Moderating Role of Intolerance of Uncertainty in the Relationship Between Health Anxiety and Pandemic-Related Stress
Sorid, S. D., Yap, D. L., Bravo, A. J., & Behar, E. (2023) · Cognitive Therapy and Research · doi:10.1007/s10608-023-10365-w · Cited by 5 · see citing works
Mental Burden of Hospital Workers During the COVID-19 Crisis: A Quanti-Qualitative Analysis
Luquiens, A., Morales, J., Bonneville, M., Potier, H., Perney, P., Faure, G., & Canaguier, A. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.622098 · Cited by 5 · see citing works
Prediction of Fear of COVID-19: Meaning in Life and Psychological Resilience
Baltacı, Ö. (2021) · Educational policy analysis and strategic research · doi:10.29329/epasr.2020.345.3 · Cited by 5 · see citing works
Intolerance of uncertainty predicts fear of healthcare settings but not desire for testing during the novel coronavirus pandemic
Radell, M. L., & McGuire, B. M. (2021) · Discover Psychology · doi:10.1007/s44202-021-00010-6 · Cited by 5 · see citing works
Post-traumatic growth, psychological inflexibility, and the mediating role of intolerance of uncertainty in adolescents affected by the Kahramanmaraş earthquake
Sarıkoç, M., & Uğur, E. (2025) · Scientific Reports · doi:10.1038/s41598-025-19935-2 · Cited by 7 · see citing works
The relationship between online class environments and economic burden and mental health among university students during the COVID-19 pandemic
Iida, A., Mizuno, K., Irie, T., Kawasaki, N., Saito, M., & Nishimura, T. (2021) · The Japanese journal of psychology · doi:10.4992/jjpsy.92.20339 · Cited by 4 · see citing works
Psychological profile in women undergoing minimally invasive cosmetic procedures: A pilot–survey-based–retrospective study
Misici, I., Micarelli, B., Venturino, P., Alessandrini, N., Basso, L., Gallo, G., Alessandrini, M., & Micarelli, A. (2025) · Medicine · doi:10.1097/md.0000000000042255 · Cited by 4 · see citing works
The Moderation Effect of Generation on the Relationship between Psychological Flexibility and Covid-19 Preventive Behaviour among Females
Kotta, I. (2020) · The Proceedings of the International Conference on Humanities, Psychology and Social Sciences. · doi:10.33422/11th.hpsconf.2020.12.94 · Cited by 4 · see citing works
Face Covered and Six Feet Apart: Behavioral Awareness Predicts Greater Adherence to Public Health Guidelines during the COVID-19 Pandemic
Schneider, A., & Kroska, E. B. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18168247 · Cited by 4 · see citing works
Effect of Coronavirus-19 Restrictions in Male Handball Players: Physical Activity, Sedentary Behavior, and Satisfaction with Life
Hermassi, S., Hayes, L. D., Sanal‐Hayes, N. E. M., & Schwesig, R. (2021) · Applied Sciences · doi:10.3390/app112311373 · Cited by 4 · see citing works
The psychometric properties and gender invariance of the Italian version of the Perceived Vulnerability to Disease Questionnaire (I-PVDQ) during the COVID-19 pandemic
Chiesi, F., Marunic, G., Tagliaferro, C., & Lau, C. (2022) · BMC Psychology · doi:10.1186/s40359-022-01023-z · Cited by 3 · see citing works
General trust and intolerance of uncertainty: Disentangling within- and between-person associations
Chen, Y., Li, C., Jing, L., & Dong, Y. H. (2025) · Personality and Individual Differences · doi:10.1016/j.paid.2025.113582 · Cited by 3 · see citing works
Learning outcomes for participants in citizen science mosquito surveillance
Sousa, L. B., Fricker, S. R., Webb, C. E., Baldock, K. L., & Williams, C. R. (2024) · Journal of Medical Entomology · doi:10.1093/jme/tjae117 · Cited by 3 · see citing works
The Impact of Employee Satisfaction With Care on the Performance of Employees in the Food Industry in the Republic of Serbia
Radivojević, N., Jovanović, R., Pimić, M., Cvjetković, M., & Cvjetković, M. (2025) · Journal of East European Management Studies · doi:10.31083/jeems41067 · Cited by 3 · see citing works
Early impact of COVID-19 social distancing on social determinants of health and their effects on mental health and quality of life of Korean undergraduate students
Lee, K., Han, S., & Suh, H. S. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1197143 · Cited by 3 · see citing works
Fear, Perceived Threat, and Anxiety During COVID-19 Pandemic: The Mediating Role of Cognitive Control/Flexibility and Intolerance of Uncertainty
Akgül, Ö., Uzgan, B. Ö., Tetik, M., & Aykaç, C. (2023) · Turkish Journal of Psychiatry · doi:10.5080/u27017 · Cited by 3 · see citing works
Psychological impact of COVID-19 and determinants among Spanish university students
Cebrino, J., & de la Cruz, S. P. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1252849 · Cited by 3 · see citing works
Associations Among Online Social Reactions to Disclosure of Sexual Victimization, Coping and Social Isolation
Bhuptani, P. H., López, G., Peterson, R. S., & Orchowski, L. M. (2024) · Journal of Child Sexual Abuse · doi:10.1080/10538712.2024.2314287 · Cited by 4 · see citing works

The moderating roles of psychological flexibility and inflexibility on the mental health impacts of COVID-19 pandemic and lockdown in Italy
Pakenham, K. I., Landi, G., Boccolini, G., Furlani, A., Grandi, S., & Tossani, E. (2020) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2020.07.003 · Cited by 210 · see citing works
Psychological distress, social support, and psychological flexibility during COVID-19
Tindle, R., & Moustafa, A. A. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-824289-6.00012-x · Cited by 19 · see citing works
Loneliness and mental health during the COVID-19 pandemic in the Dutch general population: The moderating role of psychological flexibility
Tilburg, J., Simons, M., Batink, T., Janssens, M., Peeters, S. C. T., Lataster, J., Jacobs, N., & Reijnders, J. S. A. M. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e37172 · Cited by 7 · see citing works
The association between psychological inflexibility and mental health during the third wave of COVID-19 pandemic
Barzut, V., Blanuša, J., Knežević, J., & Marinković, G. (2023) · Zbornik radova Filozofskog fakulteta u Pristini · doi:10.5937/zrffp53-43010 · Cited by 1 · see citing works
The Relationship Between COVID-19 Stress, Psychological Inflexibility, and Psycholoical Well-Being
Duckering, A. (2022) · CSUSB ScholarWorks (California State University, San Bernardino)

Authors: Smith, B. M., Twohy, A. J., & Smith, G. S.
Affiliations: Western Michigan University (US)
The Chicago School (US)
Corresponding author: Smith, Brooke M.
ORCID: Smith, Brooke M.
Twohy, Alexander J.
Smith, Gregory S.
Venue: Journal of Contextual Behavioral Science
Publisher: Elsevier BV
Published: 2020-10
Volume: 18
Pages: 162-174
ISSN: 2212-1447 (ISSN-L)
DOI: 10.1016/j.jcbs.2020.09.005
PMC: PMC7489247
OpenAlex: W3086356361
Cited by: 194
References: 67
Citations by year: 2026: 13 · 2025: 16 · 2024: 30 · 2023: 50 · 2022: 37 · 2021: 44 · 2020: 3 · 2015: 1
FWCI: 13.41
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Journal of Contextual Behavioral Science (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords: psychological inflexibility, intolerance of uncertainty, social isolation, COVID-19 pandemic, psychological flexibility, acceptance and commitment therapy, emotional suppression, psychological distress, depression, anxiety, stress, well-being, valued living, social connectedness, buffering effect

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Psychological inflexibility and intolerance of uncertainty moderate the relationship between social isolation and mental health outcomes during COVID-19

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