July 25, 2015

SSCP Journal Club - Week 5: Psychological flexibility as a fundamental aspect of health

This week's article was entitled Psychological flexibility as a fundamental aspect of health (Kashdan & Rottenberg, 2010). The authors state that the aim of their review is to integrate work on emotion regulation, mindfulness/acceptance, social and personality psychology, and neuropsychology in order to better understand the concept of psychological flexibility and identify avenues for future research.   This week's article can be found here.

Psychological flexibility is the ability to: “recognize and adapt to various situational demands; shift mindsets or behavioral repertoires when these strategies compromise personal or social functioning; maintain balance among important life domains; and be aware, open, and committed to behaviors that are congruent with deeply held values.” (p. 865)

1. Evidence for the health benefits of psychological flexibility
  • Research demonstrates the benefits of being able to shift one’s mental and behavioral responses
    • Self-regulation of emotions (i.e., the ability to flexibly modify emotional responses to best match the situation) is more important for psychological well-being than simply striving to increase “positive” emotions and decrease “negative” ones
      • “Negative” emotions like anger can be productive toward desirable goals in certain contexts (e.g., confronting someone about a wrongdoing)
      • Also, devoting resources to regulate emotional experiences (decreasing the negative or increasing the positive) diverts time and effort from other goals
      • This idea is in line with Acceptance and Commitment Therapy (ACT)
    • The ability to regulate behavior (e.g., coping strategies) based on the situation is similarly predictive of real-world adjustment above and beyond any one particular regulatory strategy
      • Rigid adherence to a coping strategy may become problematic, and it may not be that case that certain regulatory strategies (e.g., cognitive reappraisal) are always better than others (e.g., thought suppression)
  • Balance among important life domains (e.g., work, school, relationships) is also beneficial
    • Important to have little discrepancy between one’s actual day-to-day activities and one’s ideal balance
    • It is also effective to be able to shift focus between different time perspectives (past/present/future); at times it is ideal to be immersed in the present moment, and other times to be focused on the future (e.g., clarifying future goals), and other times to recall the past (e.g., extracting lessons from previous experiences)

2. Psychopathology and (in)flexibility
  • Inflexibility (e.g., avoidance of negative emotions, lack of contextual sensitivity, rigid behavioral responses etc.) often leads to psychopathology
    • Examples in depression: pervasive low mood, rumination (i.e., perseverative, circular thinking), and inflexible attributional style (internal, stable, global attributions)
    • Examples in anxiety disorders: experiential avoidance (rigidly judging certain experiences – like anxiety – as unacceptable), behavioral avoidance of anxiety-provoking stimuli/situations becomes the default behavioral response, repetitive behaviors (e.g., worry in GAD, compulsions in OCD)
  • It has been challenging to integrate the manifestations of inflexibility across research areas
    • One opportunity for integration is by studying cardiac vagal control (CVC), which is tied to parasympathetic nervous system functioning (measured by beat-to-beat variability in HR) and may facilitate adjustment to changing environmental conditions
    • Correlational data suggests that CVC may be related to other elements of flexibility (e.g., overcoming attentional interference in the Stroop task)
    • Research is being conducted on manipulating resting CVC levels (e.g., using exercise routines) in order to observe effects on psychological functioning
    • Currently, it is still unclear whether inflexibility is an antecedent or a consequence of psychopathology

3. The building blocks of psychological flexibility
  • 3 factors that influence the likelihood of being psychologically flexible
    • Executive functioning or the ability to re-focus or rapidly shift cognitive sets and attention, which is important for self-control and goal-directed behaviors
      • Someone who is psychologically flexible is more able to (a) determine what a situation requires, and (b) organize and prioritize strategies that “fit” the situation (vs. reverting to default strategies)
      • Also a flexible individual is more able to: (a) tolerate distress, and be open and receptive toward inevitable negative emotions, thoughts, and sensations, and (b) detach from thoughts and feelings as temporary internal experiences (vs. objective reality or something that needs to be regulated), which is important because attempts to avoid, alter, or remove “negative” internal experiences paradoxically only ties a person closer to them
      • Working memory and recall are also important for selecting situationally-appropriate responses and facilitates learning
    • Default states: delicate balance between investing effort in surroundings vs. conserving mental energy for the future
      • Heuristics and stereotypes allow us to make efficient decisions
      • But they are resistant to reconsideration and change which can be problematic
      • Goal of psychological flexibility is to be able to override habits and biases when needed, incorporate other relevant information, and consider personal/situational variability
    • Personality configurations
      • Neuroticism (i.e., tendencies to experience negative emotions more frequently, intensely, and readily and for longer periods of time) makes it challenging to behave flexibly
      • Experience of positive affect allows us to access a wider array of thoughts and behaviors and facilitates flexibility (e.g., considering multiple aspects of a situation and selecting the most effective solution)
      • Openness to experiences (e.g., considering multiple perspectives, finding alternate routes to obstacles) demonstrates a willingness to make room for positive and negative feelings that often arise when confronting new, complex, and uncertain stimuli
        • Opposites = intolerance of uncertainty and need for closure; prioritize certainty instead of coping with the complexity of reality (and at the expense of learning/growth)
      • Self-control (related to conscientiousness): we need to be able to delay gratification and resist impulses/urges in order to be flexible with behavioral routines

4. Recommendations for future research
  • Need for prospective studies examining inflexibility as a predictor of onset in high risk populations in order to better determine direction of causality
  • Can we intervene to enhance flexibility (or even prevent the development of psychopathology)?
    • ACT approaches are promising, but also even more traditional approaches (e.g., cognitive therapy) involve thinking/behaving flexibly and could be examined
  • Importance of ecological momentary assessment (EMA) data which allows researchers to examine the dynamic aspects of flexibility in real-world contexts vs. simply relying on global static measures like the Acceptance and Action Questionnaire (AAQ)

Discussion questions
  1. Some lessons from this literature review were surprisingly at odds with things I have learned previously (e.g., the problems with thought suppression as discussed in exposure and response prevention and the benefits to being in the present moment as discussed in mindfulness modules of DBT). Instead, the authors state that one’s ability to be flexible both with one’s coping strategies and one’s focus on the past/present/future is the key – which I think is a really interesting and appealing lesson. Does this idea surprise anyone else?
  2. The authors state that some of the symptoms of depression and anxiety (e.g., rumination, compulsions, worry) are problems with inflexibility, which I thought was an interesting and novel conceptualization. Does this idea resonate with others based on clients you have worked with?
  3. After discussing extensive adaptive benefits of flexibility, the authors also raise the question of whether flexibility may ever be problematic (e.g., does it ever lead to instability and impulsiveness). They also suggest that there may be moderators that predict whether or not flexibility is impairing - any ideas of moderating factors that may lead to flexibility being maladaptive?

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