Young adult sexual minority men are at heightened risk for psychological distress (i.e., depression and anxiety). Mounting evidence suggests the adverse consequences of distal stigma, and existing frameworks (the Minority Stress Theory and Psychological Mediation Framework) posit that distal minority stress may impact psychological distress through minority stress-specific processes, such as internalized homonegativity, as well as general psychological vulnerability factors, such as emotion dysregulation. There is a lack of research examining this process integrating both frameworks and understanding potential resilience factors such as mindfulness and self-compassion and where they may assert impact. Using structural equation modeling, the current study investigated the relationship between distal minority stress, measured by heterosexist discrimination, and psychological distress (i.e., depression and anxiety) through a serial indirect effect via internalized homonegativity and emotion dysregulation, while including internalized homonegativity and emotion dysregulation for their unique indirect effects separately, among young adult sexual minority men ( = 307). Further, the study explored mindfulness and self-compassion as potential moderators in subsequent models. Results indicate that two significant paths explain the association between heterosexist discrimination and psychological distress, including through internalized homonegativity and emotion dysregulation as a serial indirect path, as well as through internalized homonegativity alone. Both mindfulness and self-compassion emerged as protective factors in the "upstream" part of the model, particularly in the effect of heterosexist discrimination on internalized homonegativity. Contrary to expectation, both mindfulness and self-compassion had a strengthening impact on the positive association between internalized homonegativity and emotion dysregulation. Findings support the conceptualization of emotion dysregulation as a "downstream" effect of minority stress, as well as adapting and utilizing mindfulness and self-compassion to alleviate the impact of distal minority stress. Additional longitudinal research, particularly rigorously designed clinical trials, is needed to further evaluate such intervention programs.

This article is part of a special issue in the devoted to process-based therapy (PBT) or a process-based approach to therapy and the role it plays in harmonizing existing evidence-based treatments. In the present discussion, we focus on acceptance and commitment therapy (ACT) and how it fits into the PBT framework. We describe how viewing ACT through a PBT framework and its organizing rubric-the extended evolutionary meta-model (EEMM)-provides fertile ground to expand the ACT and psychological flexibility models, transforming ACT into a more inclusive and flexible version of itself and giving clinicians wider berth with respect to delivering ACT. The PBT approach allows ACT to incorporate therapeutic elements that are not traditionally part of the framework, including include cognitive reappraisal, interpersonal therapy dynamics, physiological downregulation, and the principle of nonattachment. Importantly, ACT maintains its foundational principles throughout this integration. We provide a case example of how to use PBT methods to conceptualize an ACT case, to illustrate PBT-infused ACT in practice. Finally, we outline possible future directions for ACT as it continues to evolve inside of PBT.

Rising rates of mental health problems in undergraduate students is a critical public health issue. There is evidence supporting the efficacy of acceptance and commitment therapy (ACT) in decreasing psychological symptoms in undergraduates, which is thought to be facilitated through increases in psychological flexibility (PF) and decreases in psychological inflexibility (PIF). However, little is known about the effect of ACT on these processes in undergraduates. We conducted a systematic review and three-level meta-analysis examining this effect in 20 studies, which provided 56 effect sizes. A combined sample of 1,750 undergraduates yielded a small-to-medium overall effect ( = .38, = .09, < .001, 95% CI: [0.20, 0.56]). This effect did not depend on control group type, intervention modality, number of sessions, the questionnaire used, whether PF or PIF was measured, or participant age. However, there was a significant mean effect only in studies with a specific clinical target, but not in those without one. Furthermore, the higher the percentage of female participants, the lower the reported effect size. Results suggested that ACT may increase PF and decrease PIF in undergraduates and highlighted various conceptual and measurement issues. Study protocol and materials were preregistered (https://osf.io/un6ce/).

While the adaptation of evidence-based psychosocial support tailors the intervention components to the targeted context, minimizing the associated costs of developing new interventions for low-income contexts, the acceptability of such adapted interventions is important for augmenting successful implementation and sustainability. Given that psychosocial support to persons living with HIV is mostly rendered by healthcare providers, their acceptance of adapted interventions before implementation is crucial. This study explored healthcare providers' acceptance of an adapted mindfulness and acceptance-based intervention supporting adolescents with HIV. Ten healthcare providers at two urban clinics in Kampala, Uganda attended a three-day training on using the adapted intervention and gave feedback on its appropriateness during in-depth interviews conducted thereafter. Semi-structured interviews were based on the Theoretical Framework of Acceptability and findings were analyzed abductively within the seven components of the framework. Overall, the adapted intervention was perceived to be acceptable and appropriate for use with adolescents. Benefits included the intervention offering support beyond a focus on adherence to drugs, refocusing adolescents on aspects in their lives that matter most, and being easy to integrate into providers' work processes. Providers however expressed concern about the time the intervention requires and the possibility of increasing their workload. These findings will support further adaptation and implementation.

Misophonia is characterized by decreased tolerance of ordinary human-generated trigger sounds and associated visual stimuli (e.g., chewing, sniffing, lip smacking), coupled with intense affective reactions. The disorder often begins during childhood or adolescence and is associated with impairment and distress in numerous life domains. Research has begun to examine the underlying psychological mechanisms of misophonia in adults, but studies in youth are limited. Trait mindfulness (i.e., nonjudgmental and nonavoidant present-moment awareness) and cognitive emotion regulation (i.e., cognitive processing, or responding to, emotionally arousing situations) are two proposed mechanisms that may underpin pediatric misophonia and associated functional impairment. In the present exploratory cross-sectional study, we examined trait mindfulness and cognitive emotion regulation and their relations with misophonia features and adaptive functioning in 102 youth with misophonia ( = 13.7; = 2.5; range = 8-17). More severe misophonia was significantly associated with decreased levels of both trait mindfulness and adaptive functioning across domains, in addition to deficits in certain facets of cognitive emotion regulation, particularly self-blame. Neither trait mindfulness nor facets of cognitive emotion regulation moderated the association between misophonia severity and adaptive functioning across domains, with the notable exception that difficulties with adaptive functioning in peer relationships was attenuated in those high in mindfulness. Findings suggest that trait mindfulness- and to a lesser extent cognitive emotion regulation- may be potentially relevant processes in pediatric misophonia. However, more research is needed to uncover the precise nature of these processes to aid future characterization and intervention efforts, especially in light of equivocal findings in the present study.

Mindfulness skills are a component of many modern cognitive-behavioral therapies that are used to treat a wide range of disorders, including psychotic disorders. While habitual (i.e., trait) mindfulness is associated with clinical outcomes, the effects of momentary (i.e., state) mindfulness are unclear. This is due in part to previous studies using cross-sectional designs relying on trait self-report questionnaires. Although such approaches are invaluable, they lack temporal specificity to evaluate momentary changes and effects of mindfulness. To address these limitations, the current study used ecological momentary assessment (EMA) to evaluate state levels of two mindfulness skills, acceptance and monitoring, and their association with state fluctuations in symptoms. Participants included individuals with affective and non-affective psychotic disorders (PD; = 49) and healthy controls (CN; = 53) who completed six days of EMA. Results indicated that the PD group endorsed lower state acceptance than CN; however, the groups did not significantly differ in monitoring. Further, greater state mindfulness skills in both acceptance and monitoring were associated with greater positive affect, reduced negative affect, and reduced negative symptoms. However, participants with a predominantly affective psychosis presentation showed differential effects compared to those with non-affective presentations. These findings suggest that mindfulness training for people with psychotic disorders may benefit from focusing on improving acceptance in order to improve emotional experience and build on existing monitoring skills. Further, mindfulness based psychosocial interventions may offer a novel means of treating negative symptoms in people with PD, which are currently stalled and largely unresponsive to other treatments.

HIV disproportionately affects young Black men who have sex with men (YBMSM) in the Southern United States. Pre-exposure prophylaxis (PrEP) is an efficacious, biomedical approach to prevent HIV. While Mississippi (MS) has among the highest rates of new HIV infections, it also ranks among the top three states for unmet PrEP need. Thus, increasing engagement in PrEP care for YBMSM in MS is imperative. A potential method to improve psychological flexibility and promote PrEP uptake, explored by this study, is the incorporation of Acceptance and Commitment Therapy (ACT) into PrEP interventions. ACT is an evidence-based intervention used to treat a wide range of mental and physical illnesses.

Refugees are vulnerable to developing mental health problems. The unprecedented appearance and rapid spread of COVID-19 exacerbated this vulnerability, especially in low-income countries where refugees survive on humanitarian aid and live in congested settlements. These appalling living conditions are a stressor, making adherence to COVID-19 control measures impractical and an additional psychological strain for refugees. The present study examined how psychological inflexibility is associated with adherence to COVID-19 control measures. A sample of 352 refugees from Kampala City and Bidibidi settlements were recruited. Refugees with high levels of psychological inflexibility reported higher PTSD symptom severity and low adherence to COVID-19 control measures. Moreover, PTSD severity mediated the association between psychological inflexibility and adherence, while avoidance coping moderated both direct and indirect effects. Interventions for reducing psychological inflexibility and avoidance coping may be essential in boosting adherence to measures relevant to the current and future status of the pandemic, along with other crises that refugees face.

This paper describes the iterative development of an evidence-based behavioral intervention for individuals with cancer at risk for opioid use disorder, using the National Institutes of Health Stage Model for Behavioral Intervention Development. Adult patients with cancer from an outpatient palliative care clinic at an academic cancer center, with moderate to high risk of opioid misuse, were enrolled in a treatment development study that aimed to increase psychological flexibility. In this intervention, psychological flexibility is the posited mechanism of change for reduction of opioid use disorder risk. Patients completed baseline (pre-intervention) assessments, a six-session behavioral intervention based in Acceptance and Commitment Therapy, post-intervention assessments, and a semi-structured exit interview. Ten patients with moderate to high risk of opioid misuse completed the intervention. Patients rated the intervention as highly acceptable and were generally highly satisfied. Patients reported finding the coping skills helpful (e.g., mindfulness, cognitive defusion) and reported a preference for more sessions. These treatment development efforts have implications for the development and design of acceptance- and mindfulness-based, targeted interventions for individuals with cancer, receiving palliative care and at risk for opioid use disorder. Specifically, this six-session behavioral intervention to increase psychological flexibility was acceptable to patients and ready to be studied in a pilot RCT.

Distress tolerance, or the ability to tolerate physically and emotionally aversive experiences, is a target of psychological intervention in contextual behavioral science. It has been conceptualized as a self-reported ability, as well as a behavioral tendency, and operationalized with a wide variability of questionnaires and behavioral tasks. The current study aimed to investigate whether behavioral tasks and self-report assessments of distress tolerance measure the same underlying dimension, two correlated dimensions, or whether method factors accounted for covariation above and beyond a general content dimension. A university student sample ( = 288) completed behavioral tasks associated with distress tolerance and self-report distress tolerance measures. Confirmatory factor analysis indicated that behavioral and self-report assessments of distress tolerance do not comprise a single dimension of distress tolerance, or two correlated dimensions of self-report or behavioral distress tolerance. Results also failed to support a bifactor conceptualization with a general distress tolerance dimension and domain-specific method dimensions for behavioral and self-report assessments. Findings suggest that more precision and attention to contextual factors are required in the operationalization and conceptualization of distress tolerance.

Patients with advanced gastrointestinal cancer often experience high symptom burden, which is associated with heightened distress in both patients and their family caregivers. Few interventions have been tested to jointly address patient and caregiver symptoms in advanced gastrointestinal cancer. In a randomized pilot trial, telephone-based, dyadic acceptance and commitment therapy (ACT) was found to be feasible in this population. The present secondary analyses examined the impact of this intervention on patient and caregiver physical and psychological symptoms. Patients and caregivers ( = 40 dyads) were recruited from clinics in Indianapolis, Indiana and randomized to either six weeks of telephone-based ACT or education/support, an attention control condition. Outcomes were assessed at baseline and at 2 weeks and 3 months post-intervention. Study group differences in outcomes were not statistically significant. However, when examining within-group change, only ACT patients experienced moderate reductions in pain severity and interference at 2 weeks post-intervention (effect size [ES]=-0.47; -0.51) as well as moderate reductions in depressive symptoms at 2 weeks (ES=-0.42) and 3 months (ES=-0.41) post-intervention. ACT caregivers experienced moderate reductions in sleep disturbance (ES=-0.56; -0.49) and cognitive concerns (ES=-0.61; -0.85) across follow-ups. Additionally, caregivers in both conditions experienced moderate reductions in fatigue (ES=-0.38 to -0.70) and anxiety (ES=-0.40 to -0.49) across follow-ups. Findings suggest that ACT may improve certain symptoms in dyads coping with advanced gastrointestinal cancer and warrant replication in a larger trial.

In light of the adverse mental health impacts of the COVID-19 pandemic for parents of preschool-aged children, it is important to identify modifiable protective factors that can inform interventions for parents who continue to struggle. The present study examined prospective and concurrent associations of parental psychological flexibility (acceptance, defusion, and committed action) with measures of parental stress and depression symptoms in an international sample of parents of preschoolers assessed at three time points over the first two years of the COVID-19 pandemic: The start of the pandemic (T1) as well as the end of the first (T2) and second (T3) year of the pandemic. Consistent with hypotheses, the three measures of parent psychological flexibility (assessed at T2) prospectively predicted parenting stress levels one year later (T3) ( < .05). Defusion and Committed Action also prospectively predicted lower levels of depression symptoms one year later [ < .05]. Comparable concurrent analyses of data of parents who provided data at T1 and T2 (N = 79) are also presented with acceptance and defusion negatively associated with parental stress (p < .001) and defusion negatively associated with depression (p < .05). This study contributes longitudinal evidence for the value of psychological flexibility for parents and suggests that Acceptance and Commitment Therapy interventions may help to support parental mental health during sustained periods of stress such as the COVID-19 pandemic.

Although some adolescents managed to cope well with the challenges brought on by the COVID-19 pandemic, the well-being of many was adversely affected due to school closures, distance education, restrictions on gathering with friends, and limited access to mental health services. Many adolescents reported increased anxiety and depression as well as decreased psychological wellbeing due to the pandemic. Consequently, there is a need for psychological support that exceeds the strained resources available to schools to support young people during times of crisis and societal pressure.

Studies of the effects of the COVID-19 pandemic have shown that this health emergency has affected especially young people. Supporting the well-being of children is thus particularly urgent. However, the high prevalence of ill-being among children requires novel approaches to providing help. Health care resources are limited, and many children did not receive support even before the pandemic. The current study presents a novel approach to delivering brief interventions for school-aged children. A mobile game based on acceptance and commitment therapy was used to increase psychological flexibility and well-being among 10 to 12-year-old schoolchildren. A sample of 106 students played the game in four weekly sessions as part of normal teaching practice in school. The effectiveness of the brief game intervention was examined as a universal intervention among the whole sample and among subgroups created on the basis of baseline psychological flexibility (i.e., based on the need for an intervention). The results show that higher psychological flexibility was associated with less emotional and behavioral problems, higher health-related quality of life, mood, and school satisfaction, and less loneliness ( = 0.46-0.63). While a significant effect was not detected in the whole sample, the subsample of children with initially high psychological inflexibility benefitted from participating in the intervention (Cohen's  = 0.35). These preliminary findings suggest that the brief game-based intervention can increase psychological flexibility among children when the need for an intervention is considered. Further research is necessary to examine the stability of improvements in psychological flexibility.

Depression is a common, serious complication during the postpartum period. Predictors of postpartum depression characterize who is at-risk for persistent symptoms. This study explored how psychological inflexibility affects depressive symptoms at 4 and 12 weeks postpartum.

Telehealth strategies have become essential for responding to the sanitary emergency due to the COVID-19 pandemic. In this context, developing online psychological interventions (OPIs) that can treat and prevent psychological difficulties is gaining more relevance. This article describes an acceptance and commitment therapy (ACT) based OPI focused on repetitive negative thinking (RNT). This OPI is called Disentangled, Aware, and Committed (DAC) and represents an attempt to adapt previous RNT-focused ACT protocols to this format type. Study 1 evaluated content validity through the assessment of four experts in ACT regarding clarity, utility, pertinence, conceptual adjustment, and therapeutic goal fulfillment for each component of the DAC program. In Study 2, forty-one undergraduate clinical psychology trainees rated the components of the DAC program according to its clarity and perceived utility. These participants were enrolled in a randomized controlled trial that analyzed the efficacy of the DAC to prevent the usually observed increase in emotional symptoms and RNT among this population. Expert reviewers in Study 1 rated all DAC components as clear and useful for potential users, following a logical order, theoretically coherent with the ACT model, and successfully fulfilling its stated goals. In Study 2, the participants also rated the DAC components as clear and potentially useful for their lives. In conclusion, the DAC appears to be a feasible transdiagnostic OPI for treating and preventing emotional symptoms, which warrants further studies analyzing its efficacy.

The COVID-19 pandemic evokes high levels of post-traumatic stress (PTS) in some people as well as positive personal changes, a phenomenon known as post-traumatic growth (PTG). Experiencing an adverse event as traumatic is crucial for triggering PTG, therefore higher PTS is often associated with higher PTG. This longitudinal study examined the protective role of psychological flexibility in fostering PTG in a group of people reporting high PTS related to COVID-19 as compared to those with low PTS. We hypothesized that higher psychological flexibility will be associated with higher PTG in those with high PTS and that psychological flexibility would be unrelated to PTG in those with low PTS. Secondary data analysis was conducted on data from a larger project investigating the psychological impacts of COVID-19. Adult Italians (N = 382) completed online surveys at Time 1 (three months after the first national lockdown, July 2020) and Time 2 (three months later when the number of COVID-19 cases increased, October 2020). Based on the Impact of Event Scale-Revised cut-off score, two PTS groups were identified at Time 2: low PTS (below cut-off) and high PTS (above cut-off). As predicted, moderation analyses showed that after controlling for Time 1 PTS and PTG and confounding variables, Time 1 psychological flexibility was associated with higher Time 2 PTG in the high PTS group, whereas psychological flexibility was unrelated to PTG in the low PTS group. Four psychological flexibility sub-processes (present moment awareness, defusion, values, committed action) at Time 1 were related to higher Time 2 PTG in only the high PTS group. Findings advance understanding of the role of psychological flexibility in trauma reactions and pandemic mental health adjustment. Evidence-based approaches that target psychological flexibility, like Acceptance and Commitment Therapy, are likely to foster PTG and ultimately adjustment in people with high PTS during and after the pandemic.

Health risks associated with contracting COVID-19, stay-at-home orders, and pandemic-related economic and social hardships created unique challenges for individuals throughout the pandemic, and in particular for families whose daily routines were disrupted at the start of the pandemic. This study applied a contextual behavioral science lens to Family Systems Theory to examine the impact of COVID-19 stressors on family and individual functioning.

People's psychological response to the COVID-19 pandemic is significantly affected by their psychological inflexibility. One possible mechanism explaining the association between psychological inflexibility and psychological functioning concerns coping styles. While avoidance and approach coping styles were previously found to mediate this association, the mediating role of meaning-centered coping has not yet been explored. However, meaning-centered coping it is likely to be crucial in circumstances as uncertain as those at the onset of the COVID -19 pandemic. This study explored the mediating role of the three coping styles in the relationship of psychological inflexibility with ill-being and well-being. Slovenian adults ( = 1365) aged 18-81 years provided self-reports on the Acceptance and Action Questionnaire, the Depression Anxiety Stress Scale, the PERMA Profiler, the Brief COPE Inventory, and the Meaning-Centered Coping Scale. In the context of the highly stressful beginning of the pandemic, psychological inflexibility contributed to higher ill-being and lower well-being directly and through increased use of avoidance coping, decreased use of meaning-centered coping, and, to a lesser extent, decreased use of approach coping. Avoidance coping predicted higher levels of ill-being, suggesting a maladaptive effect of this coping strategy. Approach coping positively but weakly predicted well-being, indicating a diminished value of this coping style in low-controllable circumstances of the pandemic. Finally, meaning-centered coping appeared to be the most beneficial in such circumstances, as it was associated with both lower levels of ill-being and higher levels of well-being. This finding suggests that meaning-centered coping should be studied as a stand-alone strategy, rather than as a combination of specific approach coping strategies. Consistent with previous research, this study demonstrates the importance of psychological inflexibility in effectively adapting to and actively coping with aversive situations. Furthermore, the results suggest that seeking or making meaning is vital, at least in a context characterized by low levels of control and high levels of uncertainty.

During the COVID-19 pandemic, social isolation was a common experience as people were trying to keep themselves and others safe from infection. Veterans with problematic substance use are at particular risk of the consequences of social isolation. This study evaluated the nature of social interactions during the COVID-19 pandemic and the effects of loneliness and psychological flexibility on self-reported substance use and physical and mental health functioning among U.S. veterans who reported problematic substance use. Data from 409 veterans with self-reported substance use concerns were obtained via a cross-sectional online survey. Results showed that many veterans who engaged in problematic substance use during the COVID-19 pandemic reported a number of social supports during this period and frequent communication with others, but still felt lonelier during the pandemic. In regression analyses, higher levels of loneliness were associated with more negative impacts of the pandemic, greater substance use, and poorer physical and mental health functioning. Psychological flexibility demonstrated significant unique variance in explaining mental health functioning during the pandemic after accounting for loneliness, but not for substance use or physical functioning. For veterans with high levels of loneliness, high levels of psychological flexibility were associated with a lower negative impact on quality of life due to the pandemic, but for veterans with low levels of loneliness, differing levels of psychological flexibility were not significantly associated with the negative impact of COVID-19. Overall, loneliness and psychological flexibility appear to be highly associated with the negative impact of COVID-19 on veterans with problematic substance use.

Gender, racial, and ethnic disparities persist in the scientific community despite increasing attention to research-related equity. Men publish in biomedical, scientific journals more frequently than women researchers and have more leadership roles (e.g., first authorship) in these submissions. Similar differences in scientific publishing appear among under-represented minority (URM) authors compared to White counterparts. These findings of authorship disparities are not consistent across all journals and may relate to mentorship variables. This study aimed to investigate gender and racial patterns of publishing and research mentorship within the Association for Contextual Behavioral Science (ACBS) community, including in the (JCBS). Two hundred and eighty-two ACT for Professionals listserv members responded to the anonymous 31-item survey. Men reported significantly more publications and more first author manuscripts than women, both in scientific journals generally and in JCBS specifically. White versus URM respondents more frequently reported publishing in JCBS, but not in other scientific journals. There were no differences in the total number of barriers noted between men and women or between White respondents and URM respondents. The top barriers to publishing among all respondents were lack of time, institutional support, and funding. Women more frequently reported lack of adequate research mentorship or collaboration as a barrier to publishing in scientific journals, as well as in JCBS specifically; men more frequently reported experiencing publishing barriers related to embargos and not having research that was appropriate for JCBS. Identifying as the same gender as one's primary research mentor did not relate to any areas of training. However, participants whose race differed from their mentor were significantly more likely to report training in running a study and receiving positive encouragement. Being matched in terms of gender or race with one's mentor did not relate to publishing variables. Findings highlight the continued gender and racial disparities in publishing within the ACBS community and in JCBS. Recommendations for decreasing these differences through research mentorship and structured training efforts are provided.

There are no known efficacious digital smoking cessation interventions for Hispanic/Latinx adults who smoke. This study is a secondary analysis using data from a randomized trial to evaluate whether Acceptance and Commitment Therapy (ACT) delivered via a smartphone app (iCanQuit) would be more efficacious for smoking cessation than the US Clinical Practice (USCPG)-based app (QuitGuide) in a sample of Hispanic/Latinx participants.

Maladaptive eating patterns and behaviors are frequently documented in relation to obesity onset and management. To better understand these occurrences, it is important to examine psychological processes that may be guiding these patterns and behaviors. The current study examined the role of psychological inflexibility on emotional eating, food cravings, and disordered eating symptoms among 161 participants (60.9% female, = 31.58, = 10.71) who attended a baseline appointment for a larger randomized-controlled trial for individuals with elevated anxiety sensitivity and obesity. Three separate two-step hierarchal regressions were conducted. Results indicated that greater levels of psychological inflexibility were associated with greater levels of emotional eating, food cravings, and disordered eating symptoms. These findings suggest that promoting psychological flexibility may be a key factor in promoting positive changes in eating behaviors among individuals seeking treatment for comorbid affective vulnerabilities and weight-related behaviors.

Finding psychological factors that can reduce the substantial impact of COVID-19 on mental and physical health is important. Here we replicate and expand a previous study regarding the role of psychological flexibility (PF) in this context. We employed a comprehensive and well validated measure of PF and examined its role in relation to health outcomes and persistent post COVID-19 symptoms. 1174 participants completed standardized measures of depression, anxiety, insomnia and the Multidimensional Psychological Flexibility Inventory (MPFI), and reported the presence of persistent symptoms associated with "long COVID." All PF and psychological inflexibility (PI) facets, except for acceptance, correlated with the three mental health outcomes and with persistent symptoms. PF and PI accounted for significant variance in depression, anxiety, and insomnia after adjusting for background and health status variables. A notable finding was the particularly stronger correlations obtained for the PI facets. Our findings emphasize the potentially mitigating effects of PF on mental ill health, as well as the particularly aggravating effects of PI, in the pandemic context. A novel finding is the significant association of PI with persisting symptoms of COVID.

Research demonstrates that socially mediated consequences impact adherence to health mandates during pandemics. However, no published research has examined whether adherence varies based on the extent to which an individual relies on arbitrary social approval (i.e., displays generalized pliance). The present study explored the relationships between adherence to COVID-19 public health measures, two types of rule-following (pliance and tracking), and perceived peer behavior in a sample of adults (n = 288). Findings revealed that adherence was negatively correlated with generalized pliance and tracking was unrelated to adherence. Pliance did not moderate the relationship between peer adherence and individual adherence. Findings are discussed with reference to the need to develop easily adaptable and context sensitive measures of types of rule-following, in addition to a measure of social tracking.

The burden of the COVID-19 pandemic has been mainly carried by health care providers. Technology-Mediated Interventions (TMI) seem to be a feasible alternative to increase access to behavioral health resources in this population. However, scaling-up treatments into TMI requires developing user-friendly, accepted, and accessible formats. A two-stage study was conducted to assess scalability of an Acceptance and Commitment Therapy (ACT) based strategy (named FACE COVID) delivered using technology. First, a mix-method design connected qualitative and quantitative data from health providers and ACT experts by which changes were performed to enhance scalability. Second, a pretest-posttest study was conducted to preliminary evaluate the efficacy of FACE COVID intervention on well-being, psychological distress, and psychological flexibility. Results showed a positive impact on well-being, but not distress and psychological flexibility. While this intervention has promising results, changes in dose intensity, social support, and mental health literacy could improve retention as well as increase opportunities to target distress and psychological flexibility in future studies.

Acceptance and Commitment Therapy (ACT) is a third-wave cognitive-behavioral treatment that targets psychological flexibility (PF), or the ability to persist in behavior consistent with values regardless of unwanted private experiences. The growing use of ACT necessitates an accurate assessment of PF. The Comprehensive Assessment of Acceptance and Commitment Therapy (CompACT) is a three-factor measure of PF (Openness to Experience, Valued Action, and Behavioral Awareness) whose psychometric properties have been examined in limited populations. The current study examined the factor structure and psychometric properties of the CompACT in U.S. military personnel who enrolled in a weight management randomized controlled trial. Military personnel who either failed or were at risk of failing the Navy's physical fitness assessment or had overweight/obese body mass index (BMI; N = 178, M = 29.15 years; M = 33.13 kg/m; 61.8% female) completed the CompACT and other questionnaires. Confirmatory factor analysis was used to evaluate the three-factor structure of the original 23-item CompACT (CompACT-23) as well as an 18-item version identified in a Portuguese sample (CompACT-18). Internal consistency and convergent validity with measures of weight-related experiential avoidance, perceived stress, anxiety, depression, PTSD symptoms, and life satisfaction were examined. The three-factor structure of the CompACT-23 showed poor fit to the data while the fit of the CompACT-18 was acceptable, as indicated by three descriptive indices (χ/df = 1.73, RMSEA = 0.069, SRMR = 0.074). All descriptive fit indices in addition to two comparative fit indices (AIC and BIC) indicated improved model fit over the CompACT-23. The CompACT-18 and its subscales exhibited adequate internal consistency (α = 0.768 to 0.861) and convergent validity in expected directions with measures of weight-related experiential avoidance, perceived stress, anxiety, depression, PTSD symptoms, and satisfaction with life. Results support using the refined, English language CompACT-18 as a three-factor measure of PF in populations such as U.S. military personnel who may benefit from weight management intervention. Future research should explore the content validity of the full measure and the removed items. Lost content could mean the CompACT-23 and the CompACT-18 differentially assess PF. Additional studies should examine psychometric properties in large and more diverse samples to further evaluate the appropriateness of the measure across populations. Longitudinal studies are needed to examine test-retest reliability and sensitivity to change.

Biological, genetic, and environmental factors make weight loss very difficult. Acceptance-based behavioral treatment (ABT) supplements standard behavioral treatments (BT) for obesity by teaching skills to accept the discomfort inherent to weight control behaviors and prioritize long-term, values-based goals. Grit, the ability to persevere in goal pursuit, overlaps conceptually with ABT principles and may predict outcomes in ABT. During a randomized controlled trial comparing three weight loss interventions (BT, BT with an emphasis on physical activity [BT+PA], ABT with an emphasis on physical activity [ABT+PA]), this study examined if grit predicted weight loss, intervention engagement (session attendance and dietary self-monitoring), and perceived intervention effectiveness, and whether intervention condition moderated these relationships. Participants (=309) with overweight/obesity enrolled in an 18-month weight loss intervention completed the Short Grit Scale at baseline. Weight and PA were measured at baseline, during the intervention (12 and 18 months), and at follow-up (24 and 36 months). Session attendance and dietary self-monitoring were assessed throughout the intervention, and perceived intervention effectiveness at end-of-intervention. The relation of grit to several outcomes depended on condition. In ABT+PA, but not BT or BT+PA, grit related to weight loss at 12 and 24 months, session attendance, and perceived intervention effectiveness. Grit was not related to PA or dietary self-monitoring in any condition. ABT's focus on building skills to facilitate long-term goal pursuit may be unique and beneficial to those with lower grit. Those with higher grit may already possess ABT-consistent skills and benefit less from ABT. Research on trait-level characteristics like grit in relation to weight must be cautious not to reinforce weight bias; rather, this work suggests that an evidence-based intervention (ABT) may be well-suited to those with lower grit levels seeking weight loss.

Few studies have examined factors that might explain or affect the relationship between psychological flexibility and university students' COVID-19 burnout. The present study tested a moderated mediation model with perceived COVID-19 stress as the mediator and social support, a moderator, among 2377 Chinese college students. After controlling for gender, age, family location, and year of study (freshmen, sophomores, juniors, seniors), psychological flexibility was significantly associated with COVID-19 burnout, and this link was mediated by perceived COVID-19 stress. Social support buffered the adverse effects of perceived COVID-19 stress on psychological flexibility, as well as the correlation between perceived COVID-19 stress and burnout.

Acceptance and Commitment Therapy (ACT) is a third-wave behavioral and cognitive therapy that increases psychological flexibility through mindfulness, acceptance, and value-driven behavior change. ACT has been successfully used to inform a variety of health interventions. Using non-therapists to deliver ACT-based behavioral health interventions offers an opportunity to provide cost efficient and integrated care, particularly among underserved populations experiencing barriers to mental health care, such as inadequate insurance, mental health stigma, and provider shortages. This systematic review aims to: 1) identify ACT-informed behavioral health interventions delivered by laypeople and 2) review the specific characteristics of each intervention including number and duration of sessions, delivery modality, interventionist training, and intervention outcomes.