Religion and spirituality are vital aspects of many people’s lives both in the United States and across the globe. Although many constructs and measures exist to describe and assess the experience of pursuing the sacred, the complexity of religious and spiritual experience leads to mixed results in relation to well-being and psychopathological traits. However, in broad terms, the relationship appears positive. Over the past 30 years the need for more refined and useful approaches to the study of religious and spiritual behavior has been repeatedly acknowledged. Although authors wisely caution development of further measures without due cause, extant constructs and measures do not provide clear and consistent results for understanding the influence of one’s relationships to religion and spirituality upon behaviors of clinical interest. The present project drew from the functional contextual concept of psychological flexibility, which provides clarity to understanding the encouragement and maintenance of psychological well-being. A new construct of religious and psychological flexibility is explicated as a functional approach to understanding religious and spiritual behavior in a manner that is useful in research and clinical settings alike. The development and evaluation of the Measure of Religious and Spiritual Flexibility (MRSF) is described. The MRSF evidenced adequate internal consistency and test-retest reliability. Confirmatory factor analysis results were positive, but indicate further refinement. Analyses suggested good construct validity of the MRSF in relation to psychological well-being and psychopathology; construct validity in relation to extant constructs in the psychology of religion was varied. Implications and future directions are discussed.

Background: With advances in medical treatments, the numbers of cancer survivors have grown considerably over recent years. Following completion of cancer treatment, patients can experience a range of physical and psychological difficulties, particularly around critical transition phases such as adjustment to survivorship. One of the most common difficulties cited by cancer survivors is that of fear of cancer recurrence (FOR). Existing treatments for improving psychological wellbeing in this population appear to offer limited efficacy, and there are very few interventions directly targeting FOR. Acceptance-based approaches, with an underlying aim of improving psychological flexibility, offer one novel alternative approach to addressing these difficulties. Methods: This thesis presents a systematic review and meta-analysis of the literature in relation to the effectiveness of acceptance-based interventions for post treatment cancer survivors, with a particular focus on Mindfulness-Based Interventions (MBI). A cross sectional questionnaire study is then reported which explores the potential role of psychological flexibility in mediating the relationship between FOR and distress and quality of life (QoL)outcomes. Results: The findings of the review offer tentative support for the effectiveness of MBI in reducing stress and depressive symptoms, while less convincing results emerged for anxiety. Results from the empirical study suggest that while psychological flexibility does not appear to significantly mediate the impact of FOR on distress and QoL, value based living and cognitive fusion did emerge as significant mediating variables within these relationships. Conclusions: Findings suggest that acceptance-based approaches, may be of benefit in reducing the burden of distress and improving the lives of cancer survivors. Supporting cancer survivors to become less entangled with their thoughts and live in accordance with their values may be particularly beneficial. Further studies using larger samples and longitudinal designs are warranted.

Objectives: To explore how adjustment to type 2 diabetes mellitus (T2DM) can be understood using psychological (in)flexibility, the theoretical model underlying acceptance and commitment therapy (ACT). The specific research questions are: (a) what are participant experiences of adjustment and coping in T2DM? and (b) how can participant experiences be understood in terms of the processes underlying the model of psychological (in)flexibility? Design: This interview study utilised a cross-case qualitative methodology. Methods: Semi-structured interviews were conducted with 11 purposively recruited individuals with a diagnosis of T2DM. Interview transcripts were subjected to an interpretative phenomenological analysis (IPA) methodology. Results: Three primary themes were identified from the IPA: (a) ‘Eating myself into diabetes’: Managing the self in relation to perceived diabetes stigma; (b) My other illness is the real problem: diabetes minimised in the context of co-morbid diagnoses; and (c) Knowledge reduces attachment to the patient-role self-story. Conclusion The interpretation of the qualitative data generated suggests that adjustment to a diagnosis of T2DM is a complex process incorporating intra-individual and systemic factors. Whilst psychological flexibility may be a useful model for understanding and supporting adjustment, interventions are required that also address wider systemic issues such as the integration of care, health-related stigma and relationships with health professionals.

The present study extends previous research on acceptance and commitment therapy (ACT) by using a new ACT protocol, the Fusion Management System (Dixon, 2013 in press) with a new population. Participants were 2 high functioning children with autism: an 8-year old boy and a 12 year-old girl. Using a multiple baseline design, 2 participants were exposed to 15 hours of therapy over the span of 12 weeks. Behavioral data was taken for each participant by their parent(s) on a problematic behavior that was of concern to them. Prior to and following the ACT intervention, both participants took three psychometric measures that were designed to measure ACT related processes: the Child and Adolescent Mindfulness Measure (CAMM), the Acceptance and Action Questionnaire-II (AAQ-II), and the Avoidance and Fusion Questionnaire for Youth (AFQ-Y). Following the intervention one participant improved on all measures of the ACT related processes and the other participant's score improved on the AFQ-Y and slightly deteriorated on the CAMM and AAQ-II. During the intervention phase of this study both participants' problematic behavior significantly improved. Implications of the study and future research are also discussed.

Made available in DSpace on 2018-06-04T19:14:33Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-11-03 / Introdução: A flexibilidade psicológica tem sido considerada um preditor importante de qualidade de vida. A esquiva de experiência, por sua vez, está relacionada à diversas doenças. Indicadores de saúde sobre trabalhadores dos serviços de Atenção Primária (APS) apontam elevados índices de esgotamento profissional e de transtornos mentais na categoria. Objetivos: O presente estudo avalia a precisão e validade de construto dos fatores da versão brasileira da escala AAQ-2 (Escala de Aceitação e Ação II), investigando possíveis relações com medidas de ansiedade, mindfulness e autocompaixão nesta população. Métodos: O estudo, do tipo transversal correlacional, com medidas obtidas com a técnica de autorrelato, foi constituído de uma amostra de 407 profissionais da APS e utilizou questionário sociodemográfico e escalas AAQ-2, HADS, FFMQ e SCS como instrumentos. Os dados demográficos foram analisados por meio de estatística descritiva padrão. A análise fatorial confirmatória foi realizada para analisar a dimensionalidade do AAQ-2 e a consistência interna foi examinada com base no coeficiente α Cronbach. Coeficientes r de Pearson foram calculados entre os fatores da AAQ-II e as escalas HADS e SCS para avaliar as correlações. Resultados: A média de idade desses profissionais foi de 41, 12 (10,10) anos, 84,5% são do sexo feminino, 70,3% vivem com companheiro. No que se refere à ocupação profissional, 17,7% são médicos, 25,1% enfermeiras e 57,2% outros (agentes comunitários, dentistas etc). A categoria em estudo apresentou altos índices de ansiedade e depressão correlacionados à inflexibilidade psicológica, medida pela AAQ-II. Conclusões: Os resultados encontrados apontam o AAQ-2 como um instrumento válido para a população de profissionais da Atenção Primária à Saúde no Brasil, apresentando boa consistência interna. Há forte correlação positiva entre escores de ansiedade/depressão e inflexibilidade psicológica, bem como em autocompaixão e mindfulness. / Introduction: The psychological flexibility has been considered an important predictor of quality of life. Experiential avoidance, in turn, is related to various diseases. Health indicators on workers of Primary Care Services indicate high levels of burnout and mental disorders in the category. Objectives: This study evaluates the internal consistency and construct validity of the factors of the Brazilian version of AAQ-2 scale (Acceptance and Action Questionnaire), correlating them with measures of anxiety, mindfulness and self-compassion in this population. Method: The study, correlational cross-sectional, with measurements obtained by self-report technique consisted of a sample universe of 407 PHC professionals and used sociodemographic questionnaire and the AAQ-II scales, HADS, FFMQ and SCS as instruments. Demographic data were analyzed using descriptive statistics. Confirmatory Factor analysis were used to analyze the dimensionality of AAQ-II and the internal consistency was examined based on the Cronbach α coefficient. Correlations Pearson's r were made between the AAQ-II factors and the HADS scales and SCS to assess the correlations. Results: The mean age of these workers is 41, 12 (10,10) years, 84.5% were female, 70.3% live with a partner. With regard to occupation, 17.7% are physicians, nurses 25.1% and 57.2% other (community workers, dentists etc). The category study reported high levels of anxiety and depression related to psychological inflexibility, as measured by AAQ-II. Conclusions: The AAQ-II seems to be a valid instrument in the population of Primary Care Providers in Brazil, with good internal consistency.There is a strong positive correlation between scores of anxiety / depression and psychological inflexibility, as well as in self-compassion and mindfulness. / BV UNIFESP: Teses e dissertações

Cyber victimization is a new phenomenon that keeps increasing with every year, and although the interest in research has grown, little is still known about ways to minimize the outcomes of cyber victimization on mental health. This thesis aimed to investigate whether psychological flexibility could act as a moderator on the relationship between cyber victimization and trait anxiety in Swedish youth. Gender was used as a control variable. Participants were recruited on Facebook, and data was collected via an online questionnaire that contained gender, age, Adolescent Cyber-Victimization Scale, Avoidance and Fusion Questionnaire for Youth, and Penn State Worry Questionnaire for Children. The sample consisted of 102 Swedish youths (females, N = 74, males, N = 28) aged 16 to 25 years (M = 20.34, SD = 2.88). A multiple linear regression showed that psychological flexibility and cyber victimization significantly predicted anxiety. The results for psychological flexibility as a moderator on the relationship between cyber victimization and anxiety, and for gender as a predictor for anxiety, were non-significant. The results provide a deeper understanding of the role of psychological flexibility in mental health in youth, but further research is needed on psychological flexibility as a moderator. Future research should focus on more clinical groups with increased sample size and add a wider gender perspective. / Att bli utsatt för nätmobbning är ett nytt fenomen som fortsätter att öka för varje år, och trots att intresset för forskning har växt, så vet man fortfarande lite om sätt att minska utfallet av nätmobbning på mental hälsa. Den här studien syftade till att undersöka huruvida psykologisk flexibilitet kan agera som en moderator på relationen mellan nätmobbning och ångest hos svenska ungdomar. Kön användes som kontrollvariabel. Deltagarna rekryterades på Facebook och data samlades in via ett onlineformulär som innehöll kön, ålder, Adolescent Cyber-Victimization Scale, Avoidance and Fusion Questionnaire for Youth, och Penn State Worry Questionnaire for Children. Antalet deltagare var 102 svenska ungdomar (kvinnor, N = 74, män, N = 28) i åldern 16 till 25 år (M = 20,34, SD = 2,88). En multipel linjär regression visade att psykologisk flexibilitet och nätmobbning signifikant predicerade ångest. Resultaten för psykologisk flexibilitet som en moderator på relationen mellan nätmobbning och ångest, och för kön som prediktor av ångest, var icke-signifikanta. Resultaten bidrar med en ökad förståelse för vilken roll psykologisk flexibilitet har i mental hälsa hos unga, men fortsatt forskning behövs på psykologisk flexibilitet som en moderator. Framtida forskning borde fokusera på mer kliniska grupper med ökad urvalsstorlek och lägga till ett bredare genusperspektiv.

Bullying has long-term negative effects on the mental health and wellbeing of everyone involved. School-wide interventions have been successful in some contexts, but they often require significant institutional and financial resources. Empathy is comprised of a cognitive component (perspective taking) and an affective component (empathic concern), both of which may be necessary for prosocial behavior. According to relational frame theory (RFT), empathy involves a transformation of stimulus functions across deictic relations (I-YOU, HERE-THERE, NOW-THEN), which also requires psychological willingness (i.e., psychological flexibility). The present study investigated this theoretical model of empathy based on RFT and the role of this model in middle school bullying. Results tentatively support this model by demonstrating two ways in which psychological flexibility moderates the relationship between deictic framing ability and empathy. The utility of deictic framing and psychological flexibility in predicting bullying behaviors was also examined. Deictic framing ability and psychological flexibility were expected to negatively predict bullying behaviors, and psychological flexibility was expected to moderate the relationship between deictic framing ability and relational bullying in particular. Additional research questions explored the roles of deictic framing and psychological flexibility in the relationship between relational bullying and other relevant psychological determinants: (a) parental discord, (b) social anxiety, and (c) social roles. The results of this study were insufficient to apply this model to bullying behaviors. Methodological and statistical limitations are discussed in depth, and future directions to improve on this study and clarify these relationships are emphasized.

PTSD is a mental health condition that affects many people over the course of their life (National Comorbidity Survey, 2005), including veterans (Litz & Schlenger, 2009). However, many do not experience clinical levels of distress and some experience posttraumatic growth (PTG) resulting from such an event (Tedeschi, Park, & Calhoun, 1998). The Psychological Flexibility Model, of which Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999) is based, may help explain these phenomena. The purpose of this study was to examine these relationships utilizing a measure simultaneously assessing psychological flexibility and inflexibility. It was hypothesized that psychologically inflexible behaviors would predict PTSD symptom severity, while flexible behaviors would predict PTG. Furthermore, each of psychological inflexibility and flexibility would account for unique variance in PTSD symptom severity and PTG, respectively. Finally, the domains of ACT were examined to assess the strength each component has in the maintenance of these experiences. Results indicated that both psychological inflexibility and flexibility predicted PTSD symptoms and PTG, respectively, and each predicted unique variance in these experiences. Of the individual components, cognitive fusion, experiential avoidance, inaction, and lack of contact with the present moment all contributed to PTSD symptom severity, while values clarity, lack of contact with the present moment, and present moment awareness contributed to PTG. These results suggest the psychological flexibility model overall is consistent with the experience of PTSD symptoms and the posttraumatic growth. Though further experimental methods are needed, the application of psychological flexibility through ACT could enhance PTSD treatments.

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