Examining the role of cognitive fusion and experiential avoidance in predicting anxiety and depression

The mediating role of meaning in life between experiential avoidance and death anxiety among cancer patients: a cross-sectional study

BACKGROUND

Death anxiety is thought to cause a range of mental disorders among cancer patients, which may affect their mental health and even quality of life. This study sought to investigate experiential avoidance, meaning in life, and death anxiety among Chinese cancer patients and then explore the relationship between these 3 variables.

METHODS

A total of 300 cancer patients recruited from a tertiary cancer hospital participated in this study from October to December 2021. A cross-sectional survey was conducted using a demographic and clinical characteristics questionnaire, the Acceptance and Action Questionnaire II, the Meaning in Life Questionnaire, and Templer's Death Anxiety Scale. Correlation analysis, hierarchical regression analysis, and mediating effect analysis were used to analyze the relationship among experiential avoidance, meaning in life (including 2 dimensions: presence of meaning and search for meaning), and death anxiety.

RESULTS

A total of 315 questionnaires were distributed, and 300 valid questionnaires were returned, resulting in a valid response rate of 95.2%. Experiential avoidance (r = 0.552, p < 0.01) was moderately positively correlated with death anxiety. Presence of meaning (r = - 0.400, p < 0.01) was moderately negatively correlated with death anxiety, while search for meaning (r = - 0.151, p < 0.01) was weakly negatively correlated with death anxiety. Regression analysis showed that experiential avoidance (β = 0.464) and presence of meaning (β = -0.228) were predictors of death anxiety. Mediating effect analysis revealed that presence of meaning either completely or partially mediated the effect of experiential avoidance and death anxiety, and the indirect effect accounted for 14.52% of the total effect.

CONCLUSION

Overall, experiential avoidance predicts death anxiety in cancer patients, and meaning in life can mediate this effect. The results of this study provide a new path for studying the mechanism of death anxiety and suggest a more positive and promising strategy for its management.

Session Reactions Scale-3: Initial psychometric evidence

Objective: This study aimed to develop an updated brief self-report post-session measure, suitable for collecting systematic feedback on clients' session reactions in the context of measurement-based care (MBC). Method: The Session Reactions Scale-3 (SRS-3; 33 items) was developed by extending and adjusting the Revised Session Reactions Scale. In Study 1, the psychometric properties of the SRS-3 were tested on N = 242 clients. In Study 2, a brief version of the SRS-3 (SRS-3-B; 15 items) was developed using a combination of conceptual, empirical, and pragmatic criteria. In Study 3, the psychometric properties of the SRS-3-B were tested on a new sample of N = 265 clients. Results: Exploratory factor analysis supported the use of the SRS-3-B as a two-factor (helpful reactions, hindering reactions) or unidimensional (overall session evaluation) instrument. The SRS-3-B was meaningfully related to another process measure (Individual Therapy Process Questionnaire) both on the item and factor levels. Conclusions: The SRS-3-B is a reliable process measure to elicit rich and clinically meaningful feedback from clients within the MBC context and as a research instrument to assess the helpful and hindering aspects of therapy sessions.

Personalised graded psychological intervention on negative emotion and quality of life in patients with breast cancer

BACKGROUND

Psychological factors are a risk factor for the incidence of breast cancer and have a significant impact on patient prognosis.

OBJECTIVE

The present study aims to investigate the effects of personalised graded psychological intervention on negative emotion and quality of life in patients with breast cancer.

METHODS

A total of 200 patients with breast cancer were randomly divided into two groups: an experimental group (n= 100) and control group (n= 100). Both groups received routine nursing care. The experimental group received personalised graded psychological intervention care, and the control group received routine nursing measures. After 2 months of standard treatment, the patients' quality of life and negative emotions were evaluated using the self-rating depression scale (SDS), self-rating anxiety scale (SAS), social support rating scale (SSRS) and quality of life measurement scale (FACT-B) scoring criteria.

RESULTS

There were no significant differences in the general data between the two groups (p> 0.05). Furthermore, there were no significant differences in the SDS, SAS, SSRS and FACT-B scores between the two groups before personalised graded psychological intervention (p> 0.05). After the intervention, the experimental group exhibited an improved nursing effect compared with the control group. The SDS and SAS scores were lower in the experimental group than in the control group (p< 0.05); after the intervention, the SDS and SAS scores were significantly lower in the experimental group than in the control group (p< 0.05). The SSRS and FACT-B scores were higher in the experimental group than in the control group (p< 0.05), and the experimental group's post-intervention SSRS and FACT-B scores were significantly higher than before the intervention (p< 0.05).

CONCLUSIONS

The use of personalised graded psychological intervention for the nursing of patients with breast cancer in clinical practice can significantly reduce patients' negative emotions as well as improve positive emotions and quality of life; thus, this method can be popularised in the nursing process.

Deviations from the balanced time perspective, cognitive fusion, and self-compassion in individuals with or without a depression diagnosis: different mean profiles but common links to depressive symptoms

Introduction

Prior research indicates that depressive symptoms in unselected or sub-clinical samples are associated with time perspective biases, including a more negative view of the past and a more fatalistic attitude toward the present. In the current study, we compared time perspective profiles for a clinical sample, with a depression diagnosis with that of a control group. Additionally, we considered a measure known as deviations from the balanced time perspective (DBTP) that capture deviations across time frames, not considered in previous studies. A second obejctive was to test a model involving DPTP as a mediator of the links between cognitive fusion and self-compassion with depressive symptoms.

Method

In total, 300 individuals participated in the study, 150 participants with a depression diagnosis and 150 without a depression diagnoses. All participants filled in questions regarding background variables together with Polish adaptations of ZTPI, CFQ, SCS-S, and DASS-21 using a web-survey.

Results

The results showed significantly higher scores on Past Negative and Present Fatalistic in the clinical sample. In line with the hypothesis the clinical group also displayed elevated DBTP scores (d = 0.75), a difference that remained significant when current symptoms were adjusted for. The results of structural equation modeling moreover indicate a major role of cognitive fusion (which, as expected, was strongly associated with DBTP) in predicting symptom burden, regardless of the clinical/non-clinical distinction, but. Still, DBTP accounted for significant (unique) variance in depressive symptoms. By contrast, the inclusion of cognitive fusion and DBTP eliminated the association of self-compassion and depressive symptoms.

Conclusion

Taken together, the results indicate that levels of DBTP/fusion for persons with depression diagnosis is present regardless of current symptom burden. Thus, DBTP could be regarded as a risk factor of developing depression. Prospective research designs are needed to further evaluate the associations of the main constructs in this study and the extent to which they are predictive of future diagnosis and changes in symptom level.

Effectiveness and mediators of change of an online CBT intervention for students with adjustment disorder-study protocol for a randomized controlled trial

BACKGROUND

Adjustment problems and disorders are highly prevalent among university students worldwide. These problems can cause significant interference in academic and social functioning and increase vulnerability to other mental health disorders. Unfortunately, only half of students in need receive psychological help. Furthermore, few studies have evaluated psychological interventions for adjustment disorders in students. New, more scalable forms of treatment for students with an adjustment disorder need to be developed, evaluated, and implemented. The study aims to determine the effectiveness of an online transdiagnostic cognitive behavioural intervention for students experiencing adjustment disorder and to assess mediators of change.

METHOD/DESIGN

In this three-arm randomized controlled trial, we plan to recruit 214 Polish students diagnosed with an adjustment disorder. Participants who meet initial eligibility criteria will be randomly assigned to one of three 6-week conditions: (1) online cognitive behavioural therapy intervention based on an existing, empirically supported transdiagnostic protocol, the unified protocol; (2) online progressive muscle relaxation training as an active control group; or (3) waiting-list control group. Both interventions are asynchronous, interactive, and include minimal amount of therapist support. Assessments will consist of self-report questionnaires, daily diary measures, and neurocognitive tasks for evaluating cognitive functioning. These will be conducted at baseline, post-treatment, and 1-month follow-up. Daily diary measures will be taken during the first and last week of treatment (or waitlist period). Primary outcome measures will include adjustment disorder severity; secondary outcome measures will consist of other negative (psychopathology: depression, anxiety, and stress) and positive (life satisfaction) indexes of mental health as well as process measures (e.g. mindfulness, experiential avoidance, cognitive fusion).

DISCUSSION

To our knowledge, the current study is the first to evaluate the effectiveness of a psychological intervention for students with adjustment disorder. Therefore, it may have important practical implications for students with this disorder. It can potentially guide the development of a scalable, validated treatment option.

TRIAL REGISTRATION

Clinical Trials, NCT05768308, registered 14 March 2023, https://www.

CLINICALTRIALS

gov/ct2/show/NCT05768308.

Emotion dysregulation and Internet gaming disorder in young people: Mediating effects of negative affect and metacognitions

BACKGROUND

Recent studies have found that emotion dysregulation, negative affect, and metacognitions about online gaming are risk factors for Internet gaming disorder (IGD). However, few studies investigated the mechanisms underlying these interactions. The present study aimed to explore the relationships between emotion dysregulation and IGD, and the mediating effects of negative affect and metacognitions about online gaming.

METHODS

An online survey was conducted with young people (aged 10-24 years) who played video games. 1768 participants were included in this study. Observed variables, including emotion dysregulation, IGD, depression, anxiety, and metacognitions, were measured with self-report scales. Structural equation modeling (SEM) was used to analyze the relationships among the variables.

RESULTS

The results showed that emotion dysregulation positively predicted IGD through a fully mediated model which included the independent mediating effects of negative affect and metacognitions about online gaming and their sequential mediating effect. The model explained 76.1 % of the variance in IGD.

LIMITATIONS

This was a cross-sectional study which could not infer causality.

CONCLUSIONS

This study emphasizes that negative affect and metacognitions about online gaming mediate the effect of emotion dysregulation on IGD; moreover, metacognition may be a proximal factor of IGD. Thus, improving emotional regulation and modifying maladaptive metacognitions in young people may improve the prevention and treatment of IGD.

Does Avoiding Distressing Thoughts and Feelings Influence the Relationship between Carer Subjective Burden and Anxiety Symptoms in Family Carers of People with Dementia?

Anxiety remains understudied in family carers of people with dementia. Understanding factors that moderate the relationship between stressors and anxiety symptoms in this population is critical to inform interventions. This study examined whether generic experiential avoidance (AAQ-II) and experiential avoidance specific to caregiving-related thoughts and feelings (EACQ) moderate the relationship between subjective burden (ZBI-12) and anxiety symptoms (GAD-7) in carers of people with dementia. The first model (R2 = .66, ∆R2 = .03) exploring the moderating effect of AAQ-II demonstrated a significant interaction term between AAQ-II and subjective burden. The second model (R2 = .53, ∆R2 = .03), exploring the moderating effect of EACQ, demonstrated a significant interaction term between EACQ and subjective burden. These results provide evidence that carers with higher levels of experiential avoidance may be particularly prone to the negative effect of subjective burden on anxiety symptoms. Clinical implications for assessment of experiential avoidance and its treatment in carers of people with dementia are discussed.

Psychological inflexibility explains social anxiety over time: a mediation analyses with a clinical adolescent sample

Social Anxiety Disorder (SAD) has its usual onset during adolescence when it is a highly prevalent and debilitating condition. Evidence regarding the processes that underline social anxiety and SAD is not compelling, especially in adolescents. Within an Acceptance and Commitment Therapy (ACT) framework, the causal role of ACT processes on adolescents' social anxiety and how these processes contribute to sustain social anxiety over time is still unknown. Hence, this study explored the role of psychological inflexibility (PI) and acceptance and committed action (as psychological flexibility processes) on social anxiety over time, in a clinical sample of adolescents. Twenty-one adolescents (Mage = 16.19, SD = 0.750) with a primary diagnosis of SAD completed a set of self-report measures assessing PI, acceptance (i.e., willingness to experience social anxiety symptoms), action (i.e., moving towards valued life directions despite social anxiety symptoms) and social anxiety. Path analysis was used to investigate a mediation model linking acceptance, committed action, and PI to social anxiety, directly and indirectly. Findings revealed that acceptance and action were negatively and directly associated with PI after 10-weeks. In turn, PI yielded a positive and direct effect on social anxiety after another 12-weeks. PI totally mediated the relation between acceptance and action and social anxiety, with significant indirect effects. Overall, findings offer evidence for the applicability of the ACT model to adolescent SAD and support the use of clinical interventions targeting PI to understand and alleviate adolescents' social anxiety.

Associations between social media addiction, psychological distress, and food addiction among Taiwanese university students

BACKGROUND

Worldwide, 60% of people use social media. Excessive and/or addictive use of social media termed "problematic social media use", has been reported to negatively influence psychological and physiological health. Therefore, we proposed an illustrated model to investigate the associations between social media addiction, psychological distress and food addiction among Taiwanese university students.

METHODS

A total of 598 participants (mean age = 22.8 years) completed an online survey comprising the Bergen Social Media Addiction Scale (BSMAS) assessing social media addiction, the Depression Anxiety and Stress Scale (DASS-21) assessing psychological distress, and the Yale Food Addiction Scale 2.0 (YFAS 2.0) assessing food addiction.

RESULTS

Structural equation modeling showed the significant associations between BSMAS and DASS-21 (standardized coefficient [β] = 0.45; p < 0.01) and between DASS-21 and YFAS 2.0 (β = 0.43; p < 0.01). In addition, mediation effect with 100 bootstrapping samples showed the indirect effect of DASS-21 in the association between BSMAS and YFAS 2.0 CONCLUSIONS: The present study details the relationships between social media addiction and psychological distress as well as food addiction. The results suggest the need for interventions aimed at reducing these negative outcomes. Coping strategies for improving self-control or reducing weight-related stigma, such as food consumption monitoring or mindfulness, could be adopted for at-risk individuals to address these problems.

Cognitive Fusion, Ruminative Response Style and Depressive Spectrum Symptoms in a Sample of University Students

Psychological inflexibility is related to depressive symptoms through the ‘ruminative response style’ (RR) and ‘cognitive fusion’ (CF). We aimed at exploring whether university students were more exposed to CF, RR and depressive symptoms because of their intellectual performance than non-university students of the same age. We compared university students (US) (n = 105) vs. non-university students (NUS) (n = 76) through online administration of the ‘Cognitive Fusion Questionnaire’ (CFQ-7), the ‘Depression-Zung Self-Assessment Scale’ (ZSDS) and the ‘Perseverative Thinking Questionnaire’ (PTQ) (study protocol #0077818/2022, approved by the Ethical Committee of the University of Pisa, Italy). University students scored significantly higher than non-university students in the CFQ-7 Total Score (27.5 ± 9.4 vs. 24.4 ± 9.5; p = 0.040), ZSDS Total Score (41.1 ± 7.7 vs. 39.0 ± 7.3; p = 0.031), PTQ Total Score (26.1 ± 13.1 vs. 21.8 ± 13.9; p = 0.029), PTQ ‘Repetitiveness’ (5.3 ± 2.8 vs. 4.5 ± 2.9; p = 0.034), ‘Intrusiveness’ (5.8 ± 3.0 vs. 4.8 ± 3.1; p = 0.046) and ‘Repetitive Negative Thinking capturing mental resources’ (5.0 ± 3.1 vs. 4.0 ± 3.0; p = 0.013) (MANOVA analysis). In a binary logistic regression analysis of US (with ZSDS scores < 44 vs. ≥44 as the dependent variable, and PTQ Total Score and dimensions, CFQ-7 Total Score, age and gender as the covariates), PTQ Total Score predicted the more severe depressive symptomatology (OR = 1.44, 95% CI: 1.017–2.039; p = 0.040). We believe that RR and CF should be specifically targeted through psychoeducational/psychotherapeutic interventions in university students.

The Effects of Cognitive Fusion on Depression in Primary School Principals During the COVID-19 Pandemic: The Mediating Role of Psychological Vulnerability and the Moderating Role of Self-Esteem

Purpose

The COVID-19 pandemic had triggered a serious crisis that had brought stress and challenges to primary school principals, as well as having a dramatic impact on their mental health. This study explored the relationship between cognitive fusion and depression among primary school principals during COVID-19, as well as the mediating role of psychological vulnerability and the moderation role of self-esteem in this process.

Patients and Methods

Cognitive Fusion Questionnaire (CFQ), Center for Epidemiological Studies Depression Scale (CES-D), psychological vulnerability scale, and self-esteem scale were used to measure 279 rural primary school principals. The data were analyzed by adopting Pearson's correlations and moderated mediation analysis.

Results

The results revealed that: (1) There were significant relationships among cognitive fusion, depression, psychological vulnerability and self-esteem. (2) The results showed that psychological vulnerability mediated the link between cognitive fusion and depression. (3) Self-esteem moderated the associations between cognitive fusion and depression, and also moderated the associations between cognitive fusion and psychological vulnerability. The relationship between cognitive fusion and depression was weaker for primary school principals with high levels of self-esteem. In contrast, the relationship between cognitive fusion and psychological vulnerability was stronger for primary school principals with low levels of self-esteem.

Conclusion

Psychological vulnerability played a mediating role in the relationship between cognitive fusion and depression. Moreover, self-esteem moderated the effect of cognitive fusion on depression, and also the effect of cognitive fusion on psychological vulnerability.

Trait Acceptance Buffers Aggressive Tendency by the Regulation of Anger during Social Exclusion

Social exclusion has led to increased negative emotions and aggressive behaviors, two outcomes that are correlated with each other. Thus, the down-regulation of negative emotions appears to play a crucial role in reducing the tendency for aggressive behavior. However, this assumption has not yet been tested. To this end, a total of 397 undergraduates reported their aggressive tendencies, state emotions and trait acceptance by completing corresponding questionnaires, and a recall paradigm was used to induce experiences of social exclusion. The results showed that in the context of social exclusion, (1) trait acceptance was negatively correlated with negative emotions and aggressive tendency but was positively correlated with positive emotions; (2) negative emotions, rather than positive emotions, were positively correlated with aggressive tendency; (3) increased trait acceptance buffered the experience of anger, which is, in turn, related to reduced aggressive tendency; (4) trait acceptance also downregulated the feeling of sadness, which is, however, related to increased aggression; (5) the mediator of sadness was smaller in effect size than that of anger. Taken together, these results suggest that negative emotions are associated with aggression in the context of social exclusion, and the habitual use of an acceptance strategy was conductive to decreasing aggressive tendencies by decreasing anger.

Family Carers of People with Dementia in Japan, Spain, and the UK: A Cross-Cultural Comparison of the Relationships between Experiential Avoidance, Cognitive Fusion, and Carer Depression

Objective and research design This study investigated whether the relationship between experiential avoidance and carer depression is mediated by cognitive fusion using path analysis and whether this model differs between family carers from Japan, Spain, and the UK using multi-group path analysis. Results The whole sample model (N = 745) showed a good fit to the data. The direct effect of experiential avoidance on carer depression (β = .10) and its indirect effect on carer depression through cognitive fusion (β = .15) were significant. Examined variables accounted for 45% of the variance of depression. Multi-group path analysis confirmed the same pattern of indirect path across 3 countries, while the direct path was no longer significant in Spanish and UK samples.Conclusion These findings suggest that targeting cognitive fusion may be particularly critical in culturally diverse carers and pre-emptive efforts to reduce experiential avoidance using psychological techniques may be beneficial among family carers prone to cognitive fusion regardless of cultural differences.

Cognitive fusion and personality traits in the context of mindfulness: A cross-sectional study

Objectives

Meditation and mindfulness, though rooted in eastern traditions, have been increasingly embraced in western psychology. However, questions remain regarding the mechanisms through which the beneficial effects of mindfulness occur. The present study aimed to address cognitive fusion as a potential mediator between mindfulness and negative affect and whether the mindfulness-cognitive fusion link is moderated by personality factors in an international sample of frequent meditators.

Methods

An international sample of 739 frequent meditators completed measures of mindfulness (Southampton Mindfulness Questionnaire), cognitive fusion (Cognitive Fusion Questionnaire), negative affect (Brief Symptom Checklist), and personality (Big Five Inventory) in an online survey. Using SPSS Process Macro, cognitive fusion was examined as a mediator between mindfulness and negative affect. Furthermore, Extraversion, Conscientiousness, and Neuroticism were investigated as moderators in the mediation model.

Results

Cognitive fusion was found to be a partial mediator between mindfulness and negative affect (b = -0.249; 95% CI, [-0.289, -0.203]), whereas the examined personality factors were not found to moderate the present model (E: t(734) = 0.951, p = .342); C: t(734) = -0.042, p = .967; N: t(734) = -2.271, p = .023).

Conclusions

This study suggests that cognitive fusion plays a significant role in the association between mindfulness and negative affect. These findings indicate the importance of how individuals internally respond and relate to experiences and the instrumental value of mindfulness effects beyond and outside of mindfulness-based interventions.

The Association between Metacognitions and Worry: The Mediator Role of Experiential Avoidance Strategies

Although experiential avoidance is emphasized as an underlying factor for persevering worry, limited empirical attempt exists to integrate this concept with cognitive models explaining pathological worry. Therefore, the current study aims to investigate the mediator role of different experiential avoidance strategies in the relationship between metacognitions and worry-related symptoms. The study was conducted with a community sample consisting of 563 volunteer participants (405 females, 158 males) whose ages ranged between 18 and 40 (M = 25.56, SD = 4.72). Online data collection of self-report measures including demographic information form, Metacognitions Questionnaire-30, Multidimensional Experiential Avoidance Questionnaire, and Penn State Worry Questionnaire was applied. The results of the hierarchical regression analysis revealed that experiential avoidance predicted worry beyond metacognition. In addition, particular avoidant strategies, aversion/avoidance, procrastination, distraction, and distress endurance explained the associations between positive and negative metacognitive beliefs and worry. Current findings point to different avoidant strategies that might play a role in the intensification and maintenance of worry and suggest the benefits of incorporating acceptance and commitment-based interventions with metacognitive therapy for better therapeutic outcomes.

Is Activation the Active Ingredient of Transdiagnostic Therapies? A Randomized Clinical Trial of Behavioral Activation, Acceptance and Commitment Therapy, and Transdiagnostic Cognitive-Behavioral Therapy for Emotional Disorders

Studying the usefulness of contextual and cognitive transdiagnostic therapies calls for an analysis of both their differential efficacy and their specificity when acting on the transdiagnostic conditions on which they focus. This controlled trial compares the post-treatment and 3- and 6-month follow-up effects of Behavioral Activation (BA), Acceptance and Commitment Therapy (ACT) and Cognitive-Behavioral Transdiagnostic Therapy (TD-CBT) on emotional symptomatology, and analyses the role played by Experiential Avoidance, Cognitive Fusion, Activation and Emotion Regulation in the clinical change. One hundred twenty-eight patients who fulfilled diagnostic criteria for anxiety and/or depression (intention-to-treat sample) were randomly assigned to three experimental group-treatment conditions (BA, n = 34; ACT, n = 27; TD-CBT n = 33) and one control group (WL, n = 34). Ninety-nine (77.34%) completed the treatment (per-protocol sample). In the post-treatment, all therapies reduced anxiety and depression symptomatology. In the follow-ups, the reduction in emotional symptomatology was greater in the condition which produced greater and more prolonged effects on Activation. Activation appears to be the principal condition in modifying all the transdiagnostic patterns and BA was the most efficacious and specific treatment. The trial was registered at ClinicalTrials.gov NCT04117464. Raw data are available online http://dx.doi.org/10.17632/krj3w2hfsj.1 .

The Influence of Self-Esteem and Psychological Flexibility on Medical College Students' Mental Health: A Cross-Sectional Study

BACKGROUND

Mental health problems has become a major public health issue among medical students. Self-esteem and psychological flexibility were important associated factors for mental health, but their relations have not been discussed in medical students. The present study aimed to assess the status of mental health problems among medical students and identified whether psychological flexibility had a mediating role in the effects of self-esteem on the top three most common psychological symptoms.

METHODS

A total of 810 undergraduate students from 18 classes comprised in the sample. Nine dimensions of psychological symptoms was assessed by the Symptom Checklist-90-revised (SCL-90-R). Self-esteem was measured by the Self-esteem Scale (SES) and psychological flexibility was evaluated by the Acceptance and Action Questionnaire 2nd Edition (AAQ-II) and Cognitive Fusion Questionnaire (CFQ-F). Univariate analysis and logistic regression analysis were used to determine the relationship among the top three common psychological symptoms, self-esteem, psychological flexibility, and participants' characteristics. The mediating effect of psychological flexibility between self-esteem and psychological symptoms was detected by bootstrap method.

RESULTS

57.8% of the medical undergraduate students reported positive at least one of the nine psychological symptom dimensions assessed by the SCL-90-R and 13.8% of students had moderate or more severe symptoms. The symptoms of obsessive-compulsiveness, interpersonal sensitivity, and depression were the three most common psychological symptoms among the medical students. Meanwhile, self-esteem and psychological flexibility were negatively associated to the symptoms of obsessive-compulsiveness, interpersonal sensitivity, and depression. And, almost 50% effects of self-esteem on these three symptoms in medical students exert indirect effects through psychological flexibility.

CONCLUSIONS

Psychological distress was quite common in the Chinese medical students. The three most common psychological symptoms were successively obsessive-compulsiveness, interpersonal sensitivity, and depression. Low self-esteem and psychological inflexibility might be the risk factors for these top three symptoms, and psychological flexibility might play a mediating role in the effects of self-esteem on these psychological symptoms.

A network analysis of two conceptual approaches to the etiology of PTSD

Two prominent conceptual models of posttraumatic stress disorder (PTSD) are the cognitive model, associated with cognitive processing therapy (CPT; Resick & Schnicke, 1992), and the functional contextualist model, underlying acceptance and commitment therapy (ACT; Hayes et al., 1999). Network analysis was used to examine dynamic interactions among cognitive (relating to CPT) and functional contextualistic (relating to ACT) variables and PTSD symptoms in a sample of 722 trauma-exposed adults. Results from the cognitive networks highlighted the importance of maladaptive beliefs about threat in maintaining the co-occurrence of PTSD symptoms and cognitive variables. Additionally, PTSD symptoms were more likely to lead to cognitive variables, rather than the reverse direction. Results from the functional contextualist networks identified numerous associations amongst variables that contribute to the co-occurrence of PTSD symptoms and psychological inflexibility. Findings from this study may help generate causal hypotheses that can be tested further using a longitudinal study design.

Avoidant coping as mediator of the relationship between rumination and mental health among family caregivers of Chinese breast cancer patients

INTRODUCTION

Family caregivers of cancer patients were often referred to the 'forgotten patients', yet little researches have been conducted on their mental health. Rumination might put family caregivers at risk for psychological distress during the caregiving, such as stress and anxiety. The aim of the present study was to explore the relationship between rumination, stress and anxiety among family caregivers of breast cancer patients in China and examine the mediating role of avoidant coping in this relationship.

METHODS

Face-to-face questionnaire interviews were conducted with a sample of 99 caregivers from the public oncology hospital. They were assessed with stress, anxiety, rumination and avoidant coping by Chinese Perceived Stress Scale, Zung's Self-Rating Anxiety Scale, Ruminative Responses Scale and Coping Strategy Indicator. Structural equation modelling was applied to assess the mediation analysis.

RESULTS

The reporting scores of participants indicated the incidence of anxiety was 17.2%. Rumination could directly predict stress (β = 0.58, p < 0.01) and anxiety (β = 0.46, p < 0.01) and also predict stress and anxiety via the mediator of avoidant coping (stress: β = 0.087, p < 0.01; anxiety: β = 0.109, p < 0.01).

CONCLUSIONS

The important role played by family caregivers in supporting breast cancer patients is well recognised. The findings suggested that rumination and avoidant coping may be two critical risk factors for family caregivers of breast cancer developing stress and anxiety. This study highlights the importance of preventing avoidant coping, which plays a critical role for developing interventions for this vulnerable group.

Acceptance and Commitment Therapy for Children with Special Health Care Needs and Their Parents: A Systematic Review and Meta-Analysis

Context: Acceptance and Commitment Therapy (ACT) is an emerging treatment for improving psychological well-being. Objective: To summarize research evaluating the effects of ACT on psychological well-being in children with special health care needs (SHCN) and their parents. Data Sources: An electronic literature search was conducted in PubMed, Web of Science, Ovid/EMBASE and PsycINFO (January 2000–April 2021). Study Selection: Included were studies that assessed ACT in children with SHCN (ages 0–17y) and/or parents of children with SHCN and had a comparator group. Data Extraction: Descriptive data were synthesized and presented in a tabular format, and data on relevant outcomes (e.g., depressive symptoms, stress, avoidance and fusion) were used in the meta-analyses to explore the effectiveness of ACT (administered independently with no other psychological therapy) compared to no treatment. Results: Ten studies were identified (child (7) and parent (3)). In children with SHCN, ACT was more effective than no treatment at helping depressive symptoms (standardized mean difference [SMD] = −4.27, 95% CI: −5.20, −3.34; p < 0.001) and avoidance and fusion (SMD = −1.64, 95% CI: −3.24, −0.03; p = 0.05), but not stress. In parents of children with SHCN, ACT may help psychological inflexibility (SMD = −0.77, 95% CI: −1.07, −0.47; p < 0.01). Limitations: There was considerable statistical heterogeneity in three of the six meta-analyses. Conclusions: There is some evidence that ACT may help with depressive symptoms in children with SHCN and psychological inflexibility in their parents. Research on the efficacy of ACT for a variety of children with SHCN and their parents is especially limited, and future research is needed.

Sequential multiple mediation of cognitive fusion and experiential avoidance in the relationship between rumination and social anxiety among Chinese adolescents

BACKGROUND AND OBJECTIVES

The potential mechanism by which rumination influences social anxiety through cognitive fusion and experiential avoidance proposed by the Acceptance and Commitment Therapy model has not been well-documented. This study, therefore, aimed to examine the sequential multiple mediation of the two processes.

DESIGN

A cross-sectional survey was conducted.

METHOD

A total of 233 Chinese adolescents (42.06% girls) completed a set of printed self-report questionnaires measuring rumination, cognitive fusion, experiential avoidance, and social anxiety. The SPSS macro PROCESS (model 6) was used to test a sequential mediating model. A 95% confidence interval (CI) was calculated with 5000 bootstrapping re-samples.

RESULTS

Bootstrap analyses indicated that there were indirect effects of rumination on social anxiety mediated by cognitive fusion together with experiential avoidance (B = 0.098, BootSE = 0.032, CI = 0.045 to 0.170), or solely by experiential avoidance (B = 0.048, BootSE = 0.020, CI = 0.014 to 0.093). The mediation of cognitive fusion alone was not significant (B = 0.065, BootSE = 0.038, CI = -0.006 to 0.144).

CONCLUSIONS

The results indicated the sequential mediating role of cognitive fusion and experiential avoidance, and the relative prominence of the latter in the association between rumination and social anxiety.

Effects of Acceptance and Commitment Therapy and Repetitive Transcranial Magnetic Stimulation on Obsessive-Compulsive Disorder

Objective: This study aims to explore the difference of clinical efficacy and psychological flexibility of sertraline hydrochloride combined with acceptance and commitment therapy (ACT) or repeated transcranial magnetic stimulation (rTMS) in patients with obsessive-compulsive disorder (OCD). Materials and Methods: Sixty-three inpatients diagnosed with OCD were randomly divided into ACT group (N = 32) and rTMS group (N = 31), both of which were combined with sertraline hydrochloride. The following assessments were completed by the Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Symptom Checklist 90 (SCL-90), Acceptance and Action Questionnaire (AAQ-II), and Cognitive Fusion Questionnaire (CFQ) during pretreatment, 4 weeks posttreatment, and 8-week follow-up. Results: After treatment: (1) the SCL-90 score of two groups significantly decreased from pretreatment to 8-week follow-up (P < 0.01 and P < 0.001); (2) The HAMA, HAMD, and Y-BOCS scores of the two groups significantly decreased from pretreatment to 8-week follow-up (P < 0.001 and P < 0.05); (3) No statistically significant difference of the SCL-90, HAMA, HAMD and Y-BOCS between two groups; (4) The AAQ-II and CFQ scores of the ACT group significantly decreased from 4 weeks posttreatment to 8-week follow-up (P < 0.01). However, no statistically significant difference was observed in the rTMS group (P > 0.05). Conclusions: Overall, our study suggested that sertraline hydrochloride combined with ACT or rTMS can improve the obsessive-compulsive symptoms, anxiety, and depression and has equivalent efficacy. Moreover, ACT can more effectively and durably improve the psychological flexibility of patients compared with rTMS.