COULD PSYCHOLOGICAL FLEXIBILITY PLAY A BUFFERING ROLE AGAINST THE NEGATIVE EFFECTS OF DEPRESSION, STRESS, AND ANXIETY IN GENERAL POPULATION: A CANONICAL CORRELATION ANALYSIS

Yıl 2024, Cilt: 23 Sayı: 90, 525 - 538, 16.04.2024

Mehmet Ali Padır , Mehmet S. Vangölü , Şahabettin Mutlu

https://doi.org/10.17755/esosder.1359777

Cited By: 1

Öz

The main purpose of the current study was to explore possible unique links between overall psychological flexibility (PF), its six processes (acceptance, defusion, present moment awareness, self as context, values and committed action) and psychological distress (depression, anxiety and stress). The data were collected from 331 participants from various universities in Turkey and canonical correlation analysis was utilized to test interrelationships between the variable sets. According to the findings psychological flexibility and psychological distress variable sets share a moderate variance of 40% and 15% of variance PF variate was explained by psychological distress variables, while 30% of variance in psychological distress variate was explained by PF variables. Findings also showed the negative connectivity of defusion, present moment awareness, and values, and committed action and total PF with all psychological distress variables. But, although at the bivariate level acceptance and self-as-context were inversely related with anxiety and stress, not with depression, these links were not observed in canonical correlation analysis. As a result our findings collectively reaffirms the importance and protective role of overall PF and its processes for understanding the onset and maintenance of depression, anxiety, and stress.

Anahtar Kelimeler

Psychological flexibility, psychological distress, Canonical correlation analysis

GENEL POPÜLASYONDA DEPRESYON, STRES VE KAYGININ OLUMSUZ ETKİLERİNE KARŞI PSİKOLOJİK ESNEKLİK KORUYUCU BİR ROL OYNAYABİLİR Mİ: BİR KANONİK KORELASYON ANALİZİ

Öz

Bu çalışmanın temel amacı, toplam psikolojik esneklik (PE) ve alt süreçleri (kabul, bilişsel ayrışma, an ile esnek temas, bağlamsal benlik, değerler ve değer odaklı eylemlerde kararlılık) ile psikolojik sıkıntılar (depresyon, kaygı ve stres) değişken kümeleri arasındaki olası özgün ilişkileri ortaya çıkarmaktır. Bu ilişkileri ortaya çıkarmak için Türkiye'deki çeşitli üniversitelerden 331 katılımcıdan toplanan veriler ile kanonik korelasyon analizi yapılmıştır. Elde edilen bulgulara göre, psikolojik esneklik ve psikolojik sıkıntı değişken kümelerinin %40'lık orta düzeyde bir varyansı paylaştığı ve psikolojik esneklik değişken kümesindeki varyansın %15'inin psikolojik sıkıntılar değişken kümesi tarafından açıklandığı, psikolojik sıkıntılar değişken kümesindeki varyansın %30'unun da psikolojik esneklik değişken kümesi tarafından açıklandığı görülmüştür. Bulgular ayrıca bilişsel ayrışma, an ile esnek temas, değerler, değer odaklı eylemlerde kararlılık ve toplam psikolojik esnekliğin tüm psikolojik sıkıntılar değişken kümesi ile negatif yönde ilişkili olduğunu göstermektedir. Her ne kadar ikili ilişkilerde kabul ve bağlamsal benlik değişkenlerinin kaygı ve stres değişkenleri ile negatif ilişkili oldukları, depresyon değişkeni ile anlamlı ilişkilerinin bulunmadığı tespit edilmiş olsa da bu bulguların kanonik korelasyon analizi ile doğrulanmadığı görülmektedir. Sonuç olarak bulgularımız, depresyon, anksiyete ve stresin başlangıcını ve devamını anlamada toplam psikolojik esneklik ve süreçlerinin önemini ve koruyucu rolünü toplu olarak doğrulamaktadır.

Anahtar Kelimeler

Psikolojik esneklik, psikolojik sıkıntılar, kanonik korelasyon analizi

Kaynakça

• Almarzooqi, S., Chilcot, J., & McCracken, L. M. (2017). The role of psychological flexibility in migraine headache impact and depression. Journal of Contextual Behavioral Science, 6(2), 239-243. https://doi.org/10.1016/j.jcbs.2017.04.004
• Al-Naggar, R. A., & Al-Naggar, D. H. (2012). Prevalence and associated factors of emotional disorder among Malaysian University students. Int J Collab Res Intern Med Public Health, 4, 1401-11.
• Arslan, G., & Allen, K. A. (2022). Exploring the association between coronavirus stress, meaning in life, psychological flexibility, and subjective well-being. Psychology, Health & Medicine, 27(4), 803-814. https://doi.org/10.1080/13548506.2021.1876892
• Bai, Z., Luo, S., Zhang, L., Wu, S., & Chi, I. (2020). Acceptance and commitment therapy (ACT) to reduce depression: A systematic review and meta-analysis. Journal of Affective Disorders, 260, 728-737. https://doi.org/10.1016/j.jad.2019.09.040
• Baker, L. D., & Berghoff, C. R. (2022). Embracing complex models: Exploratory network analyses of psychological (In) Flexibility processes and unique associations with psychiatric symptomology and quality of life. Journal of Contextual Behavioral Science, 23, 64-74.https://doi.org/10.1016/j.jcbs.2021.12.002
• Bardeen, J. R., & Fergus, T. A. (2016). The interactive effect of cognitive fusion and experiential avoidance on anxiety, depression, stress and posttraumatic stress symptoms. Journal of Contextual Behavioral Science, 5(1), 1-6. https://doi.org/10.1016/j.jcbs.2016.02.002
• Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., ... & Zettle, R. D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire–II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42(4), 676-688. https://doi.org/10.1016/j.beth.2011.03.007
• Büyüköztürk, Ş. (2017). Sosyal bilimler için veri analizi el kitabı. Pegem Akademi Yayıncılık.
• Christodoulou, J., Le Roux, K., Tomlinson, M., Le Roux, I. M., Katzen, L. S., & Rotheram-Borus, M. J. (2019). Perinatal maternal depression in rural South Africa: Child outcomes over the first two years. Journal of Affective Disorders, 247, 168-174. https://doi.org/10.1016/j.jad.2019.01.019
• Çokluk, Ö., Güçlü, Ş., & Büyüköztürk, Ş. (2012). Sosyal bilimler için çok değişkenli istatistik SPSS ve Lirsel uygulamaları. Pegem Akademi.
• Davis, A. K., Barrett, F. S., & Griffiths, R. R. (2020). Psychological flexibility mediates the relations between acute psychedelic effects and subjective decreases in depression and anxiety. Journal of Contextual Behavioral Science, 15, 39-45. https://doi.org/10.1016/j.jcbs.2019.11.004
• Ernst, M. M., & Mellon, M. W. (2016). Acceptance and commitment therapy (ACT) to foster resilience in pediatric chronic illness. Child and adolescent resilience within medical contexts: Integrating Research and Practice, 193-207. https://psycnet.apa.org/doi/10.1007/978-3-319-32223-0_11
• Falah-Hassani, K., Shiri, R., & Dennis, C. L. (2017). The prevalence of antenatal and postnatal co-morbid anxiety and depression: a meta-analysis. Psychological medicine, 47(12), 2041-2053. https://doi.org/10.1017/S0033291717000617
• Field, A. (2005). Discovering statistics using SPSS, 2nd ed. In Discovering statistics using SPSS, 2nd ed. Sage Publications, Inc.
• Fledderus, M., Bohlmeijer, E. T., Fox, J. P., Schreurs, K. M., & Spinhoven, P. (2013). The role of psychological flexibility in a self-help acceptance and commitment therapy intervention for psychological distress in a randomized controlled trial. Behaviour research and therapy, 51(3), 142-151. https://doi.org/10.1016/j.brat.2012.11.007
• Fonseca, S., Trindade, I. A., Mendes, A. L., & Ferreira, C. (2020). The buffer role of psychological flexibility against the impact of major life events on depression symptoms. Clinical Psychologist, 24(1), 82-90.https://doi.org/10.1111/cp.12194
• Fraenkel, J. R., Wallen, N. E., & Hyun, H. H. (2012). How to design and evaluate research in education (Vol. 7, p. 429). New York: McGraw-hill.
• Francis, A. W., Dawson, D. L., & Golijani-Moghaddam, N. (2016). The development and validation of the Comprehensive assessment of Acceptance and Commitment Therapy processes (CompACT). Journal of Contextual Behavioral Science, 5(3), 134-145. https://doi.org/10.1016/j.jcbs.2016.05.003
• Fredrickson, B. L., & Joiner, T. (2002). Positive emotions trigger upward spirals toward emotional well-being. Psychological science, 13(2), 172-175. https://doi.org/10.1111/1467-9280.00431
• Gloster, A. T., Meyer, A. H., & Lieb, R. (2017). Psychological flexibility as a malleable public health target: Evidence from a representative sample. Journal of Contextual Behavioral Science, 6(2), 166-171. http://dx.doi.org/10.1016/j.jcbs.2017.02.003
• Grégoire, S., Lachance, L., Bouffard, T. ve Dionne, F. (2018). The use of acceptance and commitment therapy to promote mental health and school engagement in university students: A multisite randomized controlled trial. Behavior Therapy, 49(3), 360–372. https://doi.org/10.1016/j.beth.2017.10.003
• Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2010). Multivariate data analysis (7th Edition). NJ: Prentice Hall.
• Han, A., Yuen, H. K., & Wilroy, J. D. (2022). Exploring associations of psychological inflexibility with depressive symptoms, anxiety, and stress in individuals living with a spinal cord injury: A cross-sectional study. Rehabilitation Psychology, 67(2), 170–178. https://doi.org/10.1037/rep0000444
• Harris, R. (2006). Embracing your demons: An overview of acceptance and commitment therapy. Psychotherapy in Australia, 12(4), 70-6. https://doi/10.3316/informit.545561433272993
• Hayes, S. C., & Strosahl, K. D. (Eds.). (2004). A practical guide to acceptance and commitment therapy. Springer Science & Business Media.
• Hayes, S. C., Barnes-Holmes, D. & Roche, B. (2001). Relational frame theory: A post-skinnerian account of human language and cognition. New York: Plenum Press.
• Hayes, S. C., Ciarrochi, J., Hofmann, S. G., Chin, F., & Sahdra, B. (2022). Evolving an idionomic approach to processes of change: Towards a unified personalized science of human improvement. Behaviour Research and Therapy, 104155. https://doi.org/10.1016/j.brat.2022.104155
• Hayes, S. C., Follette, V. M. & Linehan, M. (2004). Mindfulness and acceptance: Expanding the cognitive-behavioral tradition. Guilford Press.
• Hayes, S. C., Levin, M. E., Plumb-Vilardaga, J., Villatte, J. L., & Pistorello, J. (2013). Acceptance and commitment therapy and contextual behavioral science: Examining the progress of a distinctive model of behavioral and cognitive therapy. Behavior therapy, 44(2), 180-198. https://doi.org/10.1016/j.beth.2009.08.002
• Hayes, S. C., Strosahl, K. D. & Wilson, K. G. (2012). Acceptance and commitment therapy. In The process and practice of mindful change (2nd ed.). New York, NY, US: The Guilford Press.
• Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change. Guilford press.
• Holland, K. (2018). Anxiety: Causes, symptoms, treatment, and more. Retrieved from https://www.healthline.com/health/anxiety.
• Institute of Health Metrics and Evaluation. Global Health Data Exchange (GHDx). https://vizhub.healthdata.org/gbd-results/ (Accessed 4 March 2023).
• Institute of Health Metrics and Evaluation. Global Health Data Exchange (GHDx), (https://vizhub.healthdata.org/gbd-results/, accessed 14 May 2022).
• Kalaycı, Ş. (2004). SPSS uygulamalı çok değişkenli istatistik teknikleri. Asil Yayıncılık.
• Karakuş, S., & Akbay, S. E. (2020). Psychological flexibility scale: adaptation, validity and reliability study. Mersin University Journal of The Faculty of Education, 16(1), 32-43. https://doi.org/10.17860/mersinefd.665406
• Kashdan, T. B., & Rottenberg, J. (2010). Psychological flexibility as a fundamental aspect of health. Clinical Psychology Review, 30(7), 865-878. https://doi.org/10.1016/j.cpr.2010.03.001
• Kato, T. (2016). Impact of psychological inflexibility on depressive symptoms and sleep difficulty in a Japanese sample. Springer Plus, 5(1), 1-9. doi 10.1186/s40064-016-2393-0
• Kent, W., Hochard, K. D., & Hulbert-Williams, N. J. (2019). Perceived stress and professional quality of life in nursing staff: How important is psychological flexibility?. Journal of Contextual Behavioral Science, 14, 11-19. https://doi.org/10.1016/j.jcbs.2019.08.004
• Krafft, J., Haeger, J. A., & Levin, M. E. (2019). Comparing cognitive fusion and cognitive reappraisal as predictors of college student mental health. Cognitive Behaviour Therapy, 48(3), 241–252. https://doi.org/10.1080/16506073.2018.1513556
• Landi, G., Pakenham, K. I., Crocetti, E., Tossani, E., & Grandi, S. (2022). The trajectories of anxiety and depression during the COVID-19 pandemic and the protective role of psychological flexibility: A four-wave longitudinal study. Journal of Affective Disorders, 307, 69-78. https://doi.org/10.1016/j.jad.2022.03.067
• Leahy, R. L., Tirch, D. D., & Melwani, P. S. (2012). Processes underlying depression: Risk aversion, emotional schemas, and psychological flexibility. International Journal of Cognitive Therapy, 5(4), 362-379. https://doi.org/10.1521/ijct.2012.5.4.362
• Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33(3), 335-343. https://doi.org/10.1016/0005-7967(94)00075-U
• Masuda, A., & Tully, E. C. (2012). The role of mindfulness and psychological flexibility in somatization, depression, anxiety, and general psychological distress in a nonclinical college sample. Journal of Evidence-Based Complementary & Alternative Medicine, 17(1), 66-71. https://doi.org/10.1177/2156587211423400
• McCracken, L. M., Badinlou, F., Buhrman, M., & Brocki, K. C. (2021). The role of psychological flexibility in the context of COVID-19: Associations with depression, anxiety, and insomnia. Journal of Contextual Behavioral Science, 19, 28-35. https://doi.org/10.1016/j.jcbs.2020.11.003
• Moens, M., Jansen, J., De Smedt, A., Roulaud, M., Billot, M., Laton, J., ... & Goudman, L. (2022). Acceptance and commitment therapy to increase resilience in chronic pain patients: a clinical guideline. Medicina, 58(4), 499. https://doi.org/10.3390/medicina58040499
• Nalbant, A. & Yavuz, K. F. (2019). Getting out of language cocoon: cognitive defusion. Journal of Cognitive Behavioral Psychotherapy and Research, 8(1), 58–62. https://doi.org/10.5455/JCBPR.33709
• Østergaard, T., Lundgren, T., Zettle, R. D., Landrø, N. I., & Haaland, V. Ø. (2020). Psychological flexibility in depression relapse prevention: processes of change and positive mental health in group-based ACT for residual symptoms. Frontiers in psychology, 11, 528. https://doi.org/10.3389/fpsyg.2020.00528
• Pizzagalli, D. A., & Roberts, A. C. (2022). Prefrontal cortex and depression. Neuropsychopharmacology, 47(1), 225-246. https://doi.org/10.1038/s41386-021-01101-7
• Polizzi, C., Lynn, S. J., & Perry, A. (2020). Stress and coping in the time of COVID-19: Pathways to resilience and recovery. Clinical Neuropsychiatry, 17(2), 59. 10.36131/CN20200204
• Puolakanaho, A., Muotka, J. S., Lappalainen, R., Hirvonen, R., Lappalainen, P., & Kiuru, N. (2023). Temperament and symptoms of stress and depression among adolescents: The mediating role of psychological flexibility. Journal of Affective Disorders Reports, 12, 100493. https://doi.org/10.1016/j.jadr.2023.100493
• Rapaport, M. H., Clary, C., Fayyad, R., & Endicott, J. (2005). Quality-of-life impairment in depressive and anxiety disorders. American Journal of Psychiatry, 162(6), 1171-1178. https://doi.org/10.1176/appi.ajp.162.6.1171
• Sarıçam, H. (2018). The psychometric properties of Turkish version of Depression Anxiety Stress Scale-21 (DASS-21) in health control and clinical samples. Journal of Cognitive-Behavioral Psychotherapy and Research, 7(1), 19-30. https://doi.org/10.5455/JCBPR.274847
• Selye, H. (1956). The stress of life. New York: McGraw-Hill.
• Steel, Z., Marnane, C., Iranpour, C., Chey, T., Jackson, J. W., Patel, V., & Silove, D. (2014). The global prevalence of common mental disorders: a systematic review and meta-analysis 1980–2013. International Journal of Epidemiology, 43(2), 476-493. https://doi.org/10.1093/ije/dyu038
• Stotts, A. L., Green, C., Masuda, A., Grabowski, J., Wilson, K., Northrup, T. F., ... & Schmitz, J. M. (2012). A stage I pilot study of acceptance and commitment therapy for methadone detoxification. Drug and Alcohol Dependence, 125(3), 215-222. https://doi.org/10.1016/j.drugalcdep.2012.02.015
• Sundström, F. T., Lavefjord, A., Buhrman, M., & McCracken, L. M. (2023). Assessing psychological flexibility and inflexibility in chronic pain using the multidimensional psychological flexibility inventory (MPFI). The Journal of Pain, 24(5), 770-781. https://doi.org/10.1016/j.jpain.2022.11.010
• Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics, 5th ed. In Using multivariate statistics, 5th ed. Allyn & Bacon/Pearson Education.
• Thompson, B. L., Luoma, J. B., & LeJeune, J. T. (2013). Using acceptance and commitment therapy to guide exposure-based interventions for posttraumatic stress disorder. Journal of Contemporary Psychotherapy, 43(3), 133-140. 10.1007/s10879-013-9233-0
• Trindade, I. A., Mendes, A. L., & Ferreira, N. B. (2020). The moderating effect of psychological flexibility on the link between learned helplessness and depression symptomatology: A preliminary study. Journal of Contextual Behavioral Science, 15, 68-72. https://doi.org/10.1016/j.jcbs.2019.12.001
• Vangölü, M.S. (2022). The effect of acceptance and commitment therapy oriented psycho-education program on psychological flexibility, psychologıcal resilience and depressive symptom levels of adolescents[Doctoral dissertation, Van Yüzüncü Yıl University].
• Wang, J., Fang, S., Yang, C., Tang, X., Zhu, L., & Nie, Y. (2023). The relationship between psychological flexibility and depression, anxiety and stress: a latent profile analysis. Psychology Research and Behavior Management, 997-1007. 10.2147/PRBM.S400757
• Wąsowicz, G., Mizak, S., Krawiec, J., & Białaszek, W. (2021). Mental health, well-being, and psychological flexibility in the stressful times of the COVID-19 pandemic. Frontiers in Psychology, 12, 647975. https://doi.org/10.3389/fpsyg.2021.647975
• Wersebe, H., Lieb, R., Meyer, A. H., Hofer, P., & Gloster, A. T. (2018). The link between stress, well-being, and psychological flexibility during an Acceptance and Commitment Therapy self-help intervention. International Journal of Clinical and Health Psychology, 18((1)), 60–68. https://doi.org/10.1016/j.ijchp.2017.09.002
• W. H. O. (2017). Other common mental disorders: global health estimates. Geneva: World Health Organization, 24.