Psychological Flexibility as a Buffer against Caregiver Distress in Families with Psychosis
Open accessAbstract
Background: Research has shown that caregivers of persons with psychosis play an invaluable role in recovery, but unfortunately, often report high levels of distress. While cognitive models of caregiver distress have been well supported, there is still limited knowledge of the psychological factors involved. Recent advances in cognitive behavioural therapy seem to converge on the importance of acceptance- and mindfulness based processes. Aims: To examine the impact of psychological flexibility on caregiver distress in the early phases of psychosis, while controlling for known predictors of caregiver distress. Method: Within a cross-sectional design, 101 caregivers of 38 persons with first-episode psychosis in a clinical epidemiological sample completed a series of self-report measures. Results: A linear mixed model analysis found that, after controlling for caregiver socio-demographic factors, service user symptoms, drug use and global functioning, psychological flexibility was a significant predictor of caregiver distress. Conclusion: Greater level of psychological flexibility in caregivers, seems to be related to lower levels of caregiver distress. This finding corresponds to studies within a broad range of emotional disorders. There may be important clinical implications in terms of facilitating the process of acceptance through interventions from the ‘third-wave’ or contextual cognitive behavioural therapies.
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Studies have found psychological flexibility to be a significant buffer against psychological distress (i.e., anxiety, depressive symptoms) in family caregivers.
“Studies have found psychological flexibility to be a significant buffer against psychological distress (i.e., anxiety, depressive symptoms) in family caregivers [55].”
From Feasibility and acceptability of an acceptance and commitment therapy intervention for caregivers of adults with Alzheimer’s disease and related dementias (2021) · cites this paper as [55]
The Abstract and Discussion report a significant association between greater psychological flexibility and lower distress among caregivers of people with first-episode psychosis. However, the Methods measured overall distress with the GHQ-30, not anxiety and depressive symptoms separately; the Discussion also cautions that the cross-sectional design cannot establish a causal buffering effect. (LLM, conf=0.86)
Experimental — accuracy not yet measuredTwo previous meta-analyses involving RCTs and quasi-experimental designs have indicated beneficial effects of ACT on psychological health and quality of life among informal caregivers.
“Two previous meta-analyses involving randomized clinical trials (RCTs) and quasi-experimental designs have indicated the beneficial effects of ACT on psychological health and quality of life among informal caregivers.24,25”
From Acceptance and Commitment Therapy Among Informal Caregivers of People With Chronic Health Conditions: A Systematic Review and Meta-Analysis (2023) · cites this paper as [25]
The Introduction (page unavailable) reports that ACT has been effective for conditions including depression, anxiety, and stress, and the Discussion (page unavailable) says acceptance- and mindfulness-based therapies can be used with caregivers. The paper does not report two meta-analyses of ACT among informal caregivers or their findings on psychological health and quality of life; its cited ACT meta-analysis is not described as caregiver-specific. (LLM, conf=0.78)
Experimental — accuracy not yet measuredCompared with conventional psychotherapy, ACT places greater emphasis on acceptance and mindfulness, rather than changing cognitive content, to enhance caregivers' capacity and flexibility to adapt to long-term committed actions.
“Compared with conventional psychotherapy, ACT places greater emphasis on acceptance and mindfulness, rather than changing the cognitive content, to enhance caregivers’ capacity and flexibility to adapt to long-term committed actions.24,25,26,27,28”
From Acceptance and Commitment Therapy Among Informal Caregivers of People With Chronic Health Conditions: A Systematic Review and Meta-Analysis (2023) · cites this paper as [25]
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Simsion, D. D., Jermey, A., & Morris, E. M. J. (2026) · Clinical Psychologist · doi:10.1080/13284207.2026.2713441
Moran, R., & Schok, M. (2026) · SSRN Electronic Journal · doi:10.2139/ssrn.7388390
Liu, Y., Zhong, S., & Yang, C. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1876251
- Authors
- Jansen, J. E., Haahr, U. H., Lyse, H.-G., Pedersen, M. B., Trauelsen, A. M., & Simonsen, E.
- Affiliations
- Mental Health Services (DK)
- Psychiatry Region Zealand (DK)
- Region Zealand (DK)
- University of Copenhagen (DK)
- Corresponding author
- Jansen, Jens E.
- Venue
- Frontiers in Psychology
- Publisher
- Frontiers Media SA
- Published
- 2017-10-04
- Volume
- 8
- Pages
- 1625-1625
- ISSN
- 1664-1078 (ISSN-L)
- PMC
- PMC5632725
- OpenAlex
- W2759881763
- Cited by
- 32
- References
- 67
- Citations by year
- 2026: 6 · 2025: 2 · 2024: 1 · 2023: 4 · 2022: 3 · 2021: 7 · 2020: 4 · 2019: 3 · 2018: 2
- FWCI
- 3.05
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Frontiers in Psychology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Region Sjælland
- Topics
- Social Sciences › Psychology › Clinical Psychology › Family Caregiving in Mental Illness
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Clinical Psychology › Family and Disability Support Research
- Keywords
- psychological flexibility, caregiver distress, psychosis, first-episode psychosis, family caregivers, early psychosis, caregiver burden
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