Assessing psychological flexibility and inflexibility in chronic pain using the multidimensional psychological flexibility inventory (MPFI)
Open accessAbstract
Psychological flexibility (PF) is a model of well-being and daily functioning that is applied to chronic pain, and is the model behind Acceptance and Commitment Therapy (ACT). However, studies of PF in chronic pain are limited by the lack of a single measure capturing all facets. The Multidimensional Psychological Flexibility Inventory (MPFI) assesses all facets of PF and psychological inflexibility (PI) and could remedy this problem. The current study employs this measure. Adult participants with chronic pain (N = 404) were recruited online and completed the MPFI, other validated measures of PF/PI, and measures of pain, work and social adjustment, and depression, at two time points. The reliability, factor structure, and validity of the MPFI were assessed. Confirmatory factor analysis results demonstrated a good model fit for the proposed factor-and subscale structure. Correlations between MPFI and theoretically similar measures were moderate to strong, and correlations with pain intensity, pain interference, work-and social adjustment, and depression, were small to large. In this first examination of the potential utility of the MPFI within a chronic pain population, we found it to be valid and reliable. It should be noted that the MPFI was less predictive of outcomes compared with more established measures in most cases. Despite this, results from the wide range of variables available from the MPFI highlights the potential importance of aspects of PF and PI not previously emphasized, including the greater predictive utility of the inflexibility facets. Further use and study of the MPFI is recommended. ClinicalTrials.gov ID: NCT05050565 PERSPECTIVE: This article presents a comprehensive examination of a self-report measure assessing all facets of psychological flexibility and inflexibility, in a chronic pain sample. The results support the role of facets not previously emphasized. Comprehensive assessment of PF and PI appears possible and is recommended depending on research questions being asked.
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Experiential avoidance, cognitive fusion, and behavioral variables are dynamic states, while physical and emotional functioning components are relatively stable.
“The selection of variables for the T1 and T2 assessment relies on the research indicating the classification of experiential avoidance, cognitive fusion and behavioral variables as dynamic states, while highlighting the relative stability of physical and emotional functioning components [87,88,89].”
From A Single-Session Process-Based Cognitive-Behavioral Intervention Combined with Multimodal Rehabilitation Treatment for Chronic Pain Associated with Emotional Disorders (2024) · cites this paper as [89]
The discussion passage (page not supplied) describes psychological flexibility and inflexibility facets, which include experiential avoidance, fusion and inaction, as changeable and context-sensitive. The Reliability passage (page not supplied) measures their stability over two weeks. The paper does not establish the claimed contrast with relatively stable physical and emotional functioning components. (LLM, conf=0.86)
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- Authors
- Sundström, F. T., Lavefjord, A., Buhrman, M., & McCracken, L. M.
- Affiliations
- Uppsala University (SE)
- Corresponding author
- Sundström, Felicia TA
- Venue
- The Journal of Pain
- Publisher
- Elsevier BV
- Published
- 2023-05
- Volume
- 24
- Issue
- 5
- Pages
- 770-781
- ISSN
- 1526-5900 (ISSN-L)
- OpenAlex
- W4310064098
- Cited by
- 40
- References
- 42
- Citations by year
- 2026: 10 · 2025: 11 · 2024: 7 · 2023: 11 · 2022: 1
- FWCI
- 6.86
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Pain (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Uppsala University Publications (Uppsala University) (submittedVersion, cc-by)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Social Sciences › Psychology › Social Psychology › Psychological Well-being and Life Satisfaction
- Keywords
- psychological flexibility, psychological inflexibility, chronic pain, acceptance and commitment therapy, psychometric validation, factor structure, reliability statistics, depression, work and social adjustment, pain interference, self-report measures
- MeSH terms
- Adaptation, Psychological, Adult, Humans, Surveys and Questionnaires, Reproducibility of Results, Self Report, Chronic Pain, Acceptance and Commitment Therapy
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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