Psychological flexibility and post-traumatic growth: A meta-analytic review

Öz

Some individuals report positive psychological changes following traumatic experiences, such as an increased appreciation of life, redefined personal values, and enhanced empathy. These changes are commonly referred to as post-traumatic growth. In recent years, the relationship between post-traumatic growth and psychological flexibility has received increasing attention. However, the findings remain inconclusive, highlighting the need for a systematic review or quantitative synthesis of the empirical literature examining this relationship. Therefore, the present study aimed to consolidate existing research findings through a meta-analysis. A systematic search of MEDLINE, Scopus, Web of Science, ERIC, APA PsycArticles, and ScienceDirect was conducted on January 5, 2026, and restricted to English-language publications. Eleven studies comprising 3,734 participants met the eligibility criteria. Correlation coefficients (r) were synthesized using a random-effects model. The pooled analysis indicated a small positive association between psychological flexibility and post-traumatic growth (r = .231, 95% CI [.120, .336], p < .001), accompanied by substantial between-study heterogeneity (I² = 91.42%). Given the correlational nature of the evidence, the variability across individual findings, and differences in trauma contexts and measurement approaches, no causal conclusions can be drawn. Psychological flexibility may be considered a potential correlate of PTG, but longitudinal research is needed to clarify the direction and conditions of this association.

Anahtar Kelimeler

• Psychological inflexibility
• experiential avoidance
• meaning-making
• acceptance and commitment therapy
• trauma-related outcomes

Psikolojik esneklik ve travma sonrası büyüme: Meta-analitik bir inceleme

Öz

Travmatik deneyimler sonrasında bazı bireyler, yaşama yönelik takdirin artması, kişisel değerlerin yeniden tanımlanması ve empatinin gelişmesi gibi olumlu psikolojik değişimler bildirmektedir. Bu değişimler genel olarak travma sonrası büyüme olarak adlandırılmaktadır. Son yıllarda travma sonrası büyüme ile psikolojik esneklik arasındaki ilişki giderek daha fazla ilgi görmektedir. Bununla birlikte, bulgular kesinlik kazanmamış olup bu ilişkiyi inceleyen ampirik alanyazının sistematik olarak gözden geçirilmesine veya nicel olarak sentezlenmesine ihtiyaç duyulmaktadır. Bu nedenle, mevcut çalışmada var olan araştırma bulgularının bir meta-analiz aracılığıyla bütünleştirilmesi amaçlanmıştır. MEDLINE, Scopus, Web of Science, ERIC, APA PsycArticles ve ScienceDirect veri tabanlarında 5 Ocak 2026 tarihinde gerçekleştirilen ve İngilizce yayımlarla sınırlandırılan sistematik tarama sonucunda, uygunluk ölçütlerini karşılayan ve toplam 3.734 katılımcıyı kapsayan 11 çalışma analize dâhil edilmiştir. Korelasyon katsayıları (r), rastgele etkiler modeli kullanılarak sentezlenmiştir. Birleştirilmiş analiz, psikolojik esneklik ile travma sonrası büyüme arasında küçük düzeyde pozitif bir ilişki olduğunu (r = .231, %95 GA [.120, .336], p < .001) göstermiştir. Bununla birlikte, çalışmalar arasında yüksek düzeyde heterojenlik belirlenmiştir (I² = %91.42). Kanıtların korelasyonel niteliği, bireysel çalışma bulguları arasındaki farklılıklar ve travma bağlamları ile ölçüm yaklaşımlarındaki çeşitlilik göz önünde bulundurulduğunda nedensel sonuçlara ulaşılamaz. Psikolojik esneklik, travma sonrası büyümenin olası bir ilişkili değişkeni olarak değerlendirilebilir; ancak bu ilişkinin yönünü ve hangi koşullarda ortaya çıktığını açıklığa kavuşturmak için boylamsal araştırmalara ihtiyaç vardır.

Anahtar Kelimeler

• Psikolojik katılık
• yaşantısal kaçınma
• anlam oluşturma
• kabul ve kararlılık terapisi
• travmayla ilişkili sonuçlar

Kaynakça

1. *Akcan, G., Bakkal, B. H., & Elmas, Ö. (2024). The mediation role of coping with stress in the relationship between psychological flexibility and post-traumatic growth in cancer patients. OMEGA-Journal of Death and Dying, 93(4), 2685-2703.. https://doi.org/10.1177/00302228241292381
2. Bai, C., Ma, J., Bai, B., & Zhu, S. (2025). How does strength use relate to post-traumatic growth in health care workers during the COVID-19 pandemic? The mediating role of self-efficacy and optimism. Psychological Trauma: Theory, Research, Practice, and Policy, 14 (4), 758-765. https://doi.org/10.1037/tra0001626
3. Belen, H., Tunca, A. (2025). Strength-based parenting improves depression outcomes and promotes post-traumatic growth in earthquake survivors: a longitudinal study. BMC Psychology 13, 228. https://doi.org/10.1186/s40359-025-02512-7
4. Boreinstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2009). Introduction to meta-analysis. Wiley.
5. Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2022). Comprehensive meta-analysis (Version 4) [Computer software]. Biostat.
6. *Bruno, F., Vozzo, F., Arcuri, D., Maressa, R., La Cava, E., Malvaso, A., ... & Chiesi, F. (2024). The longitudinal association between Perceived Stress, PTSD Symptoms, and Post-Traumatic Growth during the COVID-19 Pandemic: the role of coping strategies and psychological inflexibility. Current Psychology, 43(15), 13871-13886. https://doi.org/10.1007/s12144-022-03502-3
7. 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
8. *Boykin, D. M., Anyanwu, J., Calvin, K., & Orcutt, H. K. (2020). The moderating effect of psychological flexibility on event centrality in determining trauma outcomes. Psychological Trauma: Theory, Research, Practice, and Policy, 12(2), 193. https://psycnet.apa.org/doi/10.1037/tra0000490

9. Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155–159. https://psycnet.apa.org/doi/10.1037/0033-2909.112.1.155
10. *Çon, H. Ö., & Osmanağaoğlu, N. (2025). Traumatic stress, social support, resilience, and posttraumatic growth: Comparison of LBGT+ and heterosexual individuals in a developing country. Psychological Trauma: Theory, Research, Practice, and Policy, 17(6), 1340. https://doi.org/10.1037/tra0001833
11. Dong, X., Li, G., Liu, C., Kong, L., Fang, Y., Kang, X., & Li, P. (2017). The mediating role of resilience in the relationship between social support and post-traumatic growth among colorectal cancer survivors with permanent intestinal ostomies: a structural equation model analysis. European Journal of Oncology Nursing, 29, 47-52. https://doi.org/10.1016/j.ejon.2017.04.007
12. 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
13. Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes, and outcomes. Behaviour Research and Therapy, 44(1), 1–25. https://doi.org/10.1016/j.brat.2005.06.006
14. Hayes, S.C., Strosahl, K.D., & Wilson, K.G. (2011). Acceptance and Commitment Therapy: The process and practice of mindful change. The Guilford Press.
15. Herzog, R., Álvarez-Pasquin, M. J., Díaz, C., Del Barrio, J. L., Estrada, J. M., & Gil, Á. (2013). Are healthcare workers’ intentions to vaccinate related to their knowledge, beliefs and attitudes? A systematic review. BMC Public Health, 13(1), 154. https://doi.org/10.1186/1471-2458-13-154
16. İkican, T. Ç., & Mor, E. (2025). Post-traumatic growth among health care professionals working during disasters: The mediating role of resilience. Journal of Psychosocial Nursing and Mental Health Services, 47-54. https://doi.org/10.3928/02793695-20250506-03
17. Kilmer, R. P., Gil‐Rivas, V., Tedeschi, R. G., Cann, A., Calhoun, L. G., Buchanan, T., & Taku, K. (2009). Use of the revised posttraumatic growth inventory for children. Journal of Traumatic Stress: Official Publication of The International Society for Traumatic Stress Studies, 22(3), 248-253. https://doi.org/10.1002/jts.20410
18. *Landi, G., Pakenham, K. I., Mattioli, E., Crocetti, E., Agostini, A., Grandi, S., & Tossani, E. (2022). Post-traumatic growth in people experiencing high post-traumatic stress during the COVID-19 pandemic: The protective role of psychological flexibility. Journal of Contextual Behavioral Science, 26, 44-55. https://doi.org/10.1016/j.jcbs.2022.08.008
19. Meyerson, D. A., Grant, K. E., Carter, J. S., & Kilmer, R. P. (2011). Posttraumatic growth among children and adolescents: A systematic review. Clinical Psychology Review, 31(6), 949-964. https://doi.org/10.1016/j.cpr.2011.06.003
20. Mullen, B., Muellerleile, P., & Bryant, B. (2001). Cumulative meta-analysis: a consideration of indicators of sufficiency and stability. Personality and Social Psychology Bulletin, 27(11), 1450-1462. https://doi.org/10.1177/01461672012711006
21. Modesti, P. A., Reboldi, G., Cappuccio, F. P., Agyemang, C., Remuzzi, G., Rapi, S., ... & ESH Working Group on CV Risk in Low Resource Settings. (2016). Panethnic differences in blood pressure in Europe: a systematic review and meta-analysis. PloS One, 11(1), e0147601. https://doi.org/10.1371/journal.pone.0147601
22. *Özönder Ünal, I., Ünal, C., Duymaz, T., & Ordu, C. (2023). The relationship between psychological flexibility, self-compassion, and post-traumatic growth in cancer patients in the COVID-19 pandemic. Supportive Care in Cancer, 31(7), 428. https://doi.org/10.1007/s00520-023-07891-4
23. Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., & Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. International Journal of Surgery, 88, Article 105906. https://doi.org/10.1016/j.ijsu.2021.105906
24. Pohar, R., & Argáez, C. (2017). Acceptance and commitment therapy for post-traumatic stress disorder, anxiety, and depression: A review of clinical effectiveness. Canadian Agency for Drugs and Technologies in Health. https://www.ncbi.nlm.nih.gov/books/NBK525684/
25. Rehman, S., Ghazali, S. R., & Elklit, A. (2026). A systematic and meta-analytical review of Acceptance and Commitment Therapy for PTSD. Journal of Loss and Trauma, 31(1), 90–119. https://doi.org/10.1080/15325024.2025.2565354
26. Rolffs, J. L., Rogge, R. D., & Wilson, K. G. (2018). Disentangling components of flexibility via the hexaflex model: Development and validation of the Multidimensional Psychological Flexibility Inventory (MPFI). Assessment, 25(4), 458-482. https://doi.org/10.1177/1073191116645905
27. Rowe-Johnson, M. K., Browning, B., & Scott, B. (2024). Effects of acceptance and commitment therapy on trauma-related symptoms: A systematic review and meta-analysis. Psychological Trauma: Theory, Research, Practice, and Policy, 17 (3), 668-675. https://doi.org/10.1037/tra0001785
28. *Sachdeva, J., & Shukla, R. (2024). Exploring the mediating influence of psychological flexibility and self-compassion on the relationship between adverse childhood experiences and post-traumatic growth among young adults in India. Psychological Reports, 00332941241302318. https://doi.org/10.1177/00332941241302318
29. *Sarıkoç, M., & Uğur, E. (2025). Post-traumatic growth, psychological inflexibility, and the mediating role of intolerance of uncertainty in adolescents affected by the Kahramanmaraş earthquake. Scientific Reports, 15(1), 36179. https://doi.org/10.1038/s41598-025-19935-2
30. *Seidler, D., Battle, M. C., & Drake, C. E. (2025). Examining relations among psychological flexibility, psychological inflexibility, and positive and negative outcomes of post-traumatic stress symptoms. The Psychological Record, 1-13. https://doi.org/10.1007/s40732-025-00661-0
31. Tedeschi, R. G., Shakespeare-Finch, J., Taku, K., & Calhoun, L. G. (2018). Post-traumatic growth. Routledge. https://doi.org/10.4324/9781315527451
32. Tedeschi, R. G., & Calhoun, L. G. (2004). Post-traumatic growth: conceptual foundations and empirical evidence. Psychological Inquiry, 15(1), 1–18. https://doi.org/10.1207/s15327965pli1501_01
33. Tedeschi, R. G., & Calhoun, L. G. (1996). The Post-traumatic Growth Inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress, 9(3), 455-471.https://doi.org/10.1007/BF02103658
34. *Türk, F. (2024). Traumatic stress and post-traumatic growth in individuals who have had Covid-19: The mediating effect of resilience and moderating effect of psychological flexibility. PloS One, 19(12), e0310495. https://doi.org/10.1371/journal.pone.0310495
35. Vukčević Marković, M., Šapić, D., Dimoski, J., & Ajduković, D. (2025). Post-traumatic growth among refugees in transit context. Psychological Trauma: Theory, Research, Practice, and Policy.
36. Xiaoli W., Kaminga, A. C., Dai, W., Deng, J., Wang, Z., Pan, X., & Liu, A. (2019). The prevalence of moderate-to-high post-traumatic growth: A systematic review and meta-analysis. Journal of Affective Disorders, 243, 408-415. https://doi.org/10.1016/j.jad.2018.09.023
37. Walser, R. D., & Westrup, D. (2007). Acceptance and commitment therapy. New Harbinger.
38. *Yıldız, E. (2021). Post-traumatic growth and positive determinants in nursing students after COVID‐19 alarm status: A descriptive cross‐sectional study. Perspectives in Psychiatric Care, 57(4), 1876-1887. https://doi.org/10.1111/ppc.12761