Fibromyalgia has a significant impact on the lives of patients; symptoms are influenced by psychological factors, such as psychological flexibility and catastrophizing. The objective of this study was to determine the importance of these variables in moderating the association between the severity and impact of fibromyalgia symptoms. A total of 187 patients from a general hospital population were evaluated using the Combined Index of Severity of Fibromyalgia (ICAF), the Fibromyalgia Impact Questionnaire (FIQ), the Acceptance and Action Questionnaire-II (AAQ-II), and the Pain Catastrophizing Scale (PCS). A series of multiple regression analyses were carried out using the PROCESS macro and decision tree analysis. The results show that psychological flexibility modulates the relation between severity and the impact of fibromyalgia symptoms. Catastrophism has residual importance and depends on the interaction with psychological flexibility. Interaction occurs if the severity of the disease is in transition from a mild to a moderate level and accounts for 40.1% of the variance in the sample. These aspects should be considered for evaluation and early intervention in fibromyalgia patients.

Eating disorders have a dramatic effect on the lives of people who struggle with them, including cardiovascular and gastrointestinal problems, and death. Individuals with these diagnoses are also often struggling with comorbid diagnoses such as depression, anxiety, and substance abuse/dependence. Building on a conceptualization of eating disorders as a means to dysfunctionally regulate negative affect and escape unwanted thoughts, psychological flexibility, the ability of a person to contact unwanted thoughts or feelings and behave without escape or avoidance, is investigated as a tool for treatment. Additionally, because quantitative analysis of the construct of psychological flexibility has often employed the use of college samples, this study employed a sample of participants drawn from a residential treatment facility dedicated to the treatment of eating disorders. Through regression and modeling, psychological flexibility demonstrates its utility in the treatment of eating disorders through its relationship with body dissatisfaction and quality of life.

The present study implemented quantitative (Phase I) and qualitative (Phase II) analyses to investigate the relationships that the constructs of psychological flexibility (PF) and psychological inflexibility (PI) had with helping profession trainees’ experience of conflict in clinical supervision, conflict management styles, and ratings of the quality of the supervisoryrelationship. Phase-I results (n = 290) revealed no relationship between conflict prevalence, frequency, or distress with overall levels of PF and PI. However, secondary analyses suggested individual components of PF and PI as measured by the Multidimensional Psychological Flexibility Inventory (MPFI; Rolffs et al., 2016) may be related to these constructs, including Defusion, Self as Context, Values, Fusion, Lack of Contact with Values, and Inaction. Participants’ levels of PF and PI predicted most conflict management styles. PF was especially related to the Integrating style and PI was especially related to the Avoiding style. Participants’ levels of PF were also positively correlated with the quality of the supervisory relationship. Phase II results from semi-structured interviews interpreted via the Listening Guide method revealed relationships between four participants’ experiences of conflict in supervision and components of PF and PI. Three themes emerged across the interviews: negative affect, inexperience, and accepting responsibility. Qualitative findings were also related to various components of PF and PI, especially Self as Context, Experiential Avoidance, and Fusion.

ABA has demonstrated utility with a number of populations. One population that has had limited research devoted toward them is neurotypical adults. While there is much research on job satisfaction and what causes employees to be unhappy (mostly miscommunication), there is little research that explores what can be done to change the lack of satisfaction in the workplace. Through surveys designed to assess a variety of participants’ levels of expressive language and psychological flexibility, this study aims to determine if there are statistically signification relationships between expressive language abilities, psychological flexibility, and job satisfaction. This study found that there are statistically significant, positive correlations between job satisfaction, relational responding rates, and psychological flexibility. Additionally, this study explores potential treatment and trainings to combat employee dissatisfaction in the workplace.

Aims: The thesis aimed to contribute to the current understanding of how to improve comprehensive health outcomes for children and adolescents with type 1 diabetes. Methods: A systematic review was undertaken to identify existing interventions designed to improve health-related quality of life in a paediatric diabetes population. The quality of identified studies was assessed and the effectiveness of the interventions was evaluated. Parent-adolescent dyads were also recruited via paediatric diabetes teams to participate in an empirical study. Participants were asked to complete questionnaires measuring psychological flexibility, mindfulness, perception of parental care and control, adherence to treatment and quality of life. Relationships were explored using correlation and regression analysis. Results: Twenty seven articles were identified in the systematic review. More than half were rated as “acceptable” or “high quality”. Quality of life was a primary treatment target in only three studies. Eight studies reported significant beneficial effects on health-related quality of life. In the empirical study, regression analysis found that both parent and adolescent diabetes-specific psychological flexibility predicted treatment adherence while adolescent mindfulness and insulin administration predicted quality of life. Conclusion: There is some evidence for the effectiveness of intensive structured education and coping skills training in improving health-related quality. However consideration should be given to developing theoretically informed interventions to target quality of life alongside other treatment related outcomes. The empirical study suggested psychological flexibility and mindfulness are useful constructs for understanding health outcomes in adolescents with type 1 diabetes. Acceptance and commitment, and mindfulness-based therapies may prove beneficial for improving outcomes in this population.

Thesis Portfolio Abstract Background Whilst the role of Psychological Flexibility on psychosocial outcomes has been assessed in some chronic health conditions and cancers, its role in psychosocial outcomes in men with prostate cancer has not been established. Fear of cancer recurrence has been shown to be associated with poorer psychosocial outcomes. The relationship of Psychological Flexibility on the impact of fear of cancer recurrence has not be evaluated. Research into the measurement of Psychological Flexibility in individuals with chronic ill health has not revealed a definitive measure. Methods A systematic review of the reliability and validity of measures of Psychological Flexibility in individuals with chronic health conditions was conducted. A quality assessment of the included studies was conducted and relevant results were synthesised. A cross-sectional study utilising a survey methodology was conducted to establish the role of Psychological Flexibility and fear of cancer recurrence in psychological distress and quality of life in men with prostate cancer. Regression analyses were used to establish whether fear of cancer recurrence or Psychological Flexibility significantly predicted any variance in distress or quality of life. Whether Psychological Flexibility mediated or moderated the relationship between fear of cancer recurrence and psychosocial outcomes was assessed with conditional process analysis. Results The systematic review revealed no single definitive measure of Psychological Flexibility, and that many measures currently in use within research and clinical settings have not been fully validated in individuals with chronic ill health conditions. The cross-sectional study found that Psychological Flexibility and fear of cancer recurrence each significantly predict variance in psychological distress and quality of life. Psychological Flexibility mediated and moderated the relationship between fear of cancer recurrence and psychological distress and mediated the relationship between fear of cancer recurrence and quality of life. Conclusions In the absence of a definitive measure of Psychological Flexibility, information on the measures identified were provided to allow clinicians and researchers to choose the most appropriate measure for their use. Future research might focus on further validation of existing measures of Psychological Flexibility rather than the development of additional measures. The challenges underlying using a psychometric approach to measure contextual science concepts was discussed. Due to the role of Psychological Flexibility within psychosocial outcomes in prostate cancer, it was suggested as a potential treatment target. The relevance of treatments such as Acceptance and Commitment Therapy, which aim to increase Psychological Flexibility, for men with prostate cancer was discussed. Future research avenues to further assess the role of Psychological Flexibility in psychosocial outcomes was discussed.

This thesis is an exploration of two interconnected areas: Acceptance and Commitment Therapy (ACT) training for helping professionals (HPs) and psychological flexibility in helping professionals. The ACT model holds that HPs need to be psychologically flexible (or, herein, flexible) in order to be effective ACT practitioners, and thus a primary goal of ACT training is to enhance participant flexibility. The first chapter is a systematic review of studies that have evaluated the effectiveness of ACT training. It focused on ACT training practices and outcomes related to knowledge, skills, and psychological flexibility in HPs. The results of this review suggested that ACT training can be effective in providing HPs from a range of occupational background with the necessary knowledge and competency to deliver ACT interventions. Furthermore, ACT training can increase HP flexibility. However, confidence in these findings is limited due to methodological weaknesses, particularly variability in ACT training practices, inconsistent use of available measures, a lack of psychometrically robust measures to assess ACT knowledge, and the absence of a flexibility measure designed for use with HP populations. Recommendations were made regarding future research needs in this area, including the development of a HP-specific measure of flexibility. The second chapter reports on the development and initial validation of a measure designed to assess flexibility in the specific context of professional helping, called the Mindful Healthcare Scale (MHS). The results of two studies employing two separates samples of HPs provided good preliminary evidence of the MHS's factor structure and internal validity. The MHS was also found to converge in theoretically-consistent ways with other measures of flexibility and constructs related to the occupational functioning of HPs including burnout syndrome, self-compassion, and empathy. These findings suggest that the MHS may have considerable utility in relation to ACT training for HPs and may also advance our understanding of flexibility's role in HP occupational well-being and functioning.

Problematic levels of eating disorder (ED) spectrum problems are becoming increasingly pervasive on college campuses, especially among female college students. Research suggests that ED cognitions and a lack of body image acceptance are linked to diminished psychological flexibility (PF), which is linked to ED and other negative health symptoms. Two hundred thirty-six undergraduates completed an online survey, and mediation analyses were conducted. PF fully mediated the relation between ED cognitions and non-specific psychiatric symptoms and partially mediated the link between ED cognitions and ED symptoms. PF also partially mediated the link between body image acceptance and non-specific psychiatric symptoms, but not the relation between body image acceptance and ED symptoms. Findings suggest that clinical symptoms and one’s coping style are both important factors to take into consideration in case conceptualization and treatment, and suggest that therapies such as ACT that target PF may be beneficial in treating ED spectrum problems.

The purpose of the present study is to examine the relationship among psychological flexibility, mindfulness, and goal-directed behaviors controlled by executive function, as measured by the Avoidance and Fusion Questionnaire for Youth (AFQ-Y), the Child and Adolescent Mindfulness Measure (CAMM), and the Comprehensive Executive Function Inventory (CEFI). Participants completed the AFQ-Y, CAMM, and CEFI as part of a Midwestern alternative school’s curriculum. Data was collected for 30 participants (male = 28, female = 2) with approval from the school. The results indicate a significant relationship between the AFQ-Y and CAMM (r = -0.7711, p < 0.0001), CAMM and CEFI (r = -0.3226; p = 0.0821), AFQ-Y and the emotion regulation subscale (r = -0.5018; p = 0.0047), as well as the working memory subscale of the CEFI (r = -0.3622; p = 0.0492), and the CAMM and the emotion regulation subscale (r = 0.494; p = 0.0055), organization subscale (r = 0.3723; p = 0.0427), and working memory subscale (r = 0.4725; p = 0.0084). The results are beneficial for clinicians who specialize in providing treatment to children and adolescents with development disabilities and various other disorders. Limitations and future research are also discussed within the current study.

Values are directly relevant in a number of theoretical orientations in psychology, including Acceptance and Commitment Therapy (ACT). In ACT, clarification of one’s personal values is paramount. The present study examined the ability to predict clinical symptoms and psychological flexibility using variables derived from one’s performance on the ACT Values Card Sort (ACT-VCS), a novel values clarification exercise. The independent variables, obtained from the ACT-VCS, included 1) the number of values endorsed as very important in the initial sort (i.e., valuing propensity), 2) the number of values domains represented in the final sort (i.e., values diversity), and 3) the extent to which one’s values were oriented toward uncontrollable experiences (i.e., control agenda endorsement). Three hierarchical regressions were conducted to examine the extent to which these three predictors accounted for the variance in scores of a) depression, anxiety, and stress, b) psychological flexibility, and c) psychological inflexibility. The psychological flexibility model was significant (∆R squared = .25 (F (3, 69) = 12.20, p < .001) with valuing propensity (squared semi-partial correlation r = .13, p < .001) and control agenda endorsement (squared semi-partial correlation r = .05, p < .01), but not values diversity, independently accounting for a significant portion of the variance. Prior therapy experience moderated some of these relationships. These findings provide preliminary evidence for using performance variables from the ACT-VCS to predict clinical variables.