The role of psychological flexibility in recovery following mild traumatic brain injury
Abstract
Purpose and Objective: Psychological distress is known to contribute to recovery following mild traumatic brain injury (mTBI) and there is a need to understand the mechanisms that contribute to this relationship. The present study examined psychological flexibility, as a hypothesized psychological mechanism, in 169 treatment-seeking adults with mTBI. Research Method/Design: Participants completed self-report measures of postconcussion symptoms, psychological distress (anxiety, stress, and depression) and functional status within four weeks of entry to an mTBI outpatient clinic. A general measure (Acceptance and Action Questionnaire), as well as a context-specific (Acceptance and Action Questionnaire-Acquired Brain Injury) measure of psychological flexibility were administered. Results: Simple linear regression analysis showed that psychological flexibility made a significant contribution to the prediction of postconcussion symptoms and functional status. A series of multiple mediation analyses also found that psychological flexibility had a significant indirect effect on the relationships between psychological distress and postconcussion symptoms, and functional status. The context-specific, rather than the general measure of psychological flexibility, was consistently shown to contribute to these findings. Conclusions/Implications: These results suggest that psychological flexibility is a psychological mechanism that contributes to recovery outcomes in individuals with mTBI and could therefore be an important treatment target in mTBI interventions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Given evidence that psychological flexibility influences mTBI outcomes and recovery, targeting this process in the ACTion-mTBI intervention may also account for the reduction in PPCS and improvement in functional status observed in this study.
“Furthermore, given evidence that psychological flexibility influences mTBI outcomes and recovery,90 targeting this process in the ACTion-mTBI intervention may also account for the reduction in PPCS and improvement in functional status observed in this study.”
From Acceptance and commitment therapy for mild traumatic brain injury (ACTion-mTBI): a quasiexperimental feasibility study (2025) · cites this paper as [90]
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Lambert, M., Sheldrake, E., Deneault, A.-A., Wheeler, A., Burke, M., & Scratch, S. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.48453 · Cited by 51 · see citing works
Fear avoidance and return to work after mild traumatic brain injury
Snell, D. L., Faulkner, J. W., Williman, J. A., Silverberg, N. D., Theadom, A., Surgenor, L. J., Hackney, J. J., & Siegert, R. J. (2023) · Brain Injury · doi:10.1080/02699052.2023.2180663 · Cited by 18 · see citing works
“This may reflect the complexity of relationships between fear avoidance and return to work outcomes, underscoring the importance of exploring other factors such as, for example, psychological flexibility (17).”
BackgroundInfluentialSelf-citationNetwork analysis applied to post-concussion symptoms in two mild traumatic brain injury samples
Faulkner, J. W., Theadom, A., Snell, D. L., & Williams, M. N. (2023) · Frontiers in Neurology · doi:10.3389/fneur.2023.1226367 · Cited by 13 · see citing works
“org similar recruitment methods and inclusion criteria (39, 40).”
MethodSelf-citationFaulkner, J. W., Snell, D. L., & Siegert, R. J. (2024) · Brain Injury · doi:10.1080/02699052.2024.2411297 · Cited by 9 · see citing works
“This is a secondary analysis of data collected from participants attending outpatient concussion services in New Zealand who were enrolled in two separate studies that aimed to examine the role of psychological factors in mTBI recovery (41,42).”
Self-citationFaulkner, J. W., Snell, D. L., & Theadom, A. (2022) · Brain Injury · doi:10.1080/02699052.2022.2109747 · Cited by 9 · see citing works
“Our findings, alongside additional evidence (39,64), provides justification for this to occur.”
BackgroundResultInfluentialSelf-citationSmith, P. J., Whitson, H. E., Merwin, R. M., O’Hayer, C. V., & Strauman, T. J. (2023) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2023.1256430 · Cited by 8 · see citing works
“…continue to examine psychological flexibility as a key mechanism linking psychological and cognitive factors to behavioral outcomes, given its emerging importance within both chronic disease and neurological patient populations (Faulkner et al., 2020; Aytur et al., 2021; Faulkner et al., 2021).”
BackgroundMiller, L. R., Divers, R. M., Reed, C., Cherry, J., Patrick, A., & Calamia, M. R. (2023) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2023.2256964 · Cited by 9 · see citing works
“All subscales are known to re fl ect psychological fl exibility; however, the primary factor (Reactive Avoid-ance) is used more frequently due to better psychometric properties (Faulkner et al., 2021).”
Faulkner, J. W., Snell, D. L., Theadom, A., Mahon, S., & Barker-Collo, S. L. (2022) · Disability and Rehabilitation · doi:10.1080/09638288.2022.2055167 · Cited by 8 · see citing works
Self-citationFaulkner, J., Prouty, D., Devlin, L., Appleton, D., Roche, M., Below, K., Moffat, J., Snell, D., Williams, M. N., Barker-Collo, S., et al. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-089727 · Cited by 7 · see citing works
Self-citationRytter, H. M., Attauabi, S., Hansen, L. S., & Borch, M. W. (2025) · Disability and Rehabilitation · doi:10.1080/09638288.2025.2578994 · Cited by 3 · see citing works
“…experiences during their work resumption process [26]. acceptance is therefore a core concept in the psychological processing of trauma [27,28]. acceptance is not merely an intra-psychological phenomenon but is simultaneously shaped by the social and environmental context in which the…”
Valued living after mild traumatic brain injury: Characteristics and relationship with outcomes
Faulkner, J. W., Whiting, D. L., Theadom, A., Snell, D. L., Roche, M., & Barker-Collo, S. L. (2024) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2024.2328876 · Cited by 3 · see citing works
“Psychological flexibility has been found to play a key role in recovery following mTBI (Faulkner et al., 2021), however, the extent to which valued living (VL) has an impact on recovery following mTBI has received much less attention.”
Self-citationPsychological Transdiagnostic Processes in Mild Traumatic Brain Injury Recovery: A Scoping Review
Courchesne, C., Nair, M. A., Gelineau, M., McCloskey, L., Faulkner, J. W., & Cairncross, M. (2025) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2025.07.014 · Cited by 3 · see citing works
Self-citationPark, C., Song, H., Lee, J. Y., Lee, E., Yang, G., Kim, J., & Lee, J. H. (2025) · CHI Conference Extended Abstracts on Human Factors in Computing Systems (CHI EA) · doi:10.1145/3706599.3720071 · Cited by 2 · see citing works
“Self-distancing, which lets people view emotions objectively, helps manage anxiety effectively [17, 20].”
Bonn, M. M., Dickey, J. P., Moran, B., McGuire, S., & Graham, L. J. (2024) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2024.2397089 · Cited by 2 · see citing works
“…associated with persistent symptoms following an mTBI, including history of mental health conditions (Silverberg et al, 2015), coping strategies (Cassetta et al, 2021), psychological flexibility (Faulkner et al, 2021), and somatization of symptoms (Stubbs et al, 2020) should be investigated.”
Link between post-stroke psychopathology and scope-of-action awareness
Stahl, B., Becker, K., Kocyigit, K., Denzler, P., & Röder, P. (2024) · Therapeutic Advances in Neurological Disorders · doi:10.1177/17562864241282633 · Cited by 2 · see citing works
“These studies point to a link between severity of depression and reduced psychological flexibility in individuals with mild traumatic brain injury, 19,20 spinal cord injury 21 as well as in mixed samples with stroke survivors and their relatives 22 or a wide spectrum of neurological syndromes such…”
BackgroundResultBradshaw, J., Best, M., Jones, K. F., Schultz, R., & Pryor, J. (2026) · Disability and Rehabilitation · doi:10.1080/09638288.2026.2616374 · Cited by 2 · see citing works
An Update on Premorbid Personality Traits and Brain Recovery: Another Aspect of Resilience
Laricchiuta, D., Picerni, E., Markett, S. A., Reuter, M., & Montag, C. (2023) · Contemporary clinical neuroscience · doi:10.1007/978-3-031-24930-3_16
Psychological Consequences of Concussion
Daley, M., Shoop, J., & Meehan, W. P., III (2023) · Contemporary pediatric and adolescent sports medicine · doi:10.1007/978-3-031-25126-9_6
Farzad, V., & Mardani, F. (2024) · Journal of Personality and Psychosomatic Research · doi:10.61838/kman.jppr.2.1.3
Faulkner, J. W., & Cairncross, M. (2026) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803395.2026.2707991
Self-citationSnell, D. L., Williman, J. A., Faulkner, J. W., Silverberg, N. D., Theadom, A., Surgenor, L. J., & Siegert, R. J. (2026) · Brain Impairment · doi:10.1071/ib26011
Self-citation
- Authors
- Faulkner, J. W., Snell, D. L., Theadom, A., Mahon, S., & Barker-Collo, S.
- Affiliations
- Auckland University of Technology (NZ)
- Venue
- Rehabilitation Psychology
- Published
- 2021-11
- Volume
- 66
- Issue
- 4
- Pages
- 479-490
- ISSN
- 0090-5550 (ISSN-L)
- 1939-1544
- OpenAlex
- W3204316569
- Cited by
- 21
- References
- 0
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 5 · 2023: 6 · 2022: 3
- FWCI
- 2.52
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Rehabilitation Psychology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Health Research Council of New Zealand (20/041)
- Topics
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Cognitive Functions and Memory
- Keywords
- psychological flexibility, mild traumatic brain injury, post-concussion symptoms, psychological distress, anxiety, depression, stress, functional status, Acceptance and Action Questionnaire, mediation, recovery mechanisms, treatment goals
- MeSH terms
- Adult, Anxiety, Anxiety Disorders, Brain Concussion, Brain Injuries, Humans, Post-Concussion Syndrome
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