ObjectiveTo examine the validity and reliability of the Chinese version of the Self-as-Context Scale (SACS) in college students.MethodWe used convenience sampling to recruit 708 Chinese college students. All participants completed the SACS and 343 of them were asked to complete the validation questionnaires (Satisfaction with Life Scale, Peace of Mind Scale, Acceptance and Action Questionnaire-II, Mindful Attention Awareness Scale, Cognitive Fusion Questionnaire-Fusion, and Depression Anxiety Stress Scale-21) at the same time. We conducted items analysis, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), measurement invariance test, correlation analysis, regression analysis, and internal consistency reliability analysis. After 3 weeks, 217 participants filled out the SACS again to assess the test–retest reliability.ResultsThe exploratory factor analysis showed that the SACS consisted of two factors (Centering and Transcending), with a total of 9 items. The confirmatory factor analysis demonstrated that the two-factor structure fit well (χ2 = 55.40, df = 22, CFI = 0.977, TLI = 0.963, RMSEA = 0.065, SRMR = 0.032). According to the results of the measurement invariance tests, configural invariance, metric invariance, scalar invariance, and strict invariance of the 2-factor model, the C-SACS scores were comparable across genders. Additionally, the C-SACS total score and its subscale scores were significantly positively correlated with positive indicators of mental health (life satisfaction, affective well-being), significantly negatively correlated with negative emotions (depression, anxiety, stress), significantly negatively correlated with experiential avoidance and cognitive fusion (except for the Transcending factor), and significantly positively correlated with mindful attention and awareness. Regression analysis results revealed that the C-SACS surpasses the incremental effectiveness of AAQ-II and CFQ-F in predicting different psychological health indicators. The Cronbach’s α coefficients of the C-SACS and two subscales were 0.88 [0.71, 0.90], 0.80 [0.87, 0.90] and 0.85 [0.83, 0.88] and McDonald’s ω = 0.88 [0.87, 0.90], ω = 0.80 [0.78, 0.83], ω = 0.85[0.83, 0.88]. The test–retest reliability (ICC) was 0.73 and 0.72, respectively.ConclusionThe results of our study suggest that the Chinese version of SACS has good reliability and validity in Chinese college students.
The psychological flexibility model can be seen as a basis for an integrated and progressive psychological approach to chronic pain management. Some researchers suggest that psychological flexibility and inflexibility represent distinct processes and constructs. This meta-analysis is the first to provide a summary estimate of the overall effect size for the relationship between psychological (in)flexibility and common outcomes among chronic pain patients. The research protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO, https://www.crd.york.ac.uk/PROSPERO/), registration number CRD42021285705. Four databases were searched (PsycINFO; PubMed; Web of Science, CINAHL) along with reference lists. Thirty-six cross-sectional studies were included (7,779 participants). Meta-analyses (random effects model) indicated a significant medium negative association between psychological flexibility and pain intensity or functional impairment. The present study also indicated a significant small to medium association between psychological inflexibility and pain intensity, a nearly large association between psychological inflexibility and functional impairment as well as the quality of life, and a large association between psychological inflexibility and anxiety/depression. Due to the limited number of included studies, the relationship between risk behavior and psychological inflexibility may not be significant. Types of countries and instruments measuring psychological inflexibility may explain part of the heterogeneity. These findings may carry significant implications for chronic pain patients regarding the potential relationship between psychological inflexibility or flexibility and these outcomes. It may consequently form the basis for more robust testing of causal and manipulable relationships.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021285705.
Hoarding is a common problem behavior worldwide and is detrimental to the physical and mental health of individuals and groups. Currently, effective interventions for hoarding are cognitive-behavioral therapies, but their post-intervention efficacy is questionable, and the available research does not examine the mediating variables of the effects of interventions on clinical outcomes. Moreover, current research on hoarding has focused on Western countries. Therefore, there is a need to investigate the efficacy of other forms of cognitive behavioral therapy on hoarding as well as other psychological outcomes related to hoarding and mediating variables that contribute to its effectiveness in different cultural contexts. One hundred thirty-nine college students with higher hoarding behaviors were randomly divided into three groups: 45 in the Acceptance and Commitment Therapy (ACT) group, 47 in the Rational Emotive Behavior Therapy (REBT) group, and 47 in the control group. They completed the Saving Inventory-Revised (SI-R), Obsessive-Compulsive Symptom Scale (OCSS), Difficulties in Emotion Regulation Scale (DERS), Experiences in Close Relationships Inventory-Attachment Anxiety Subscale (ECR), Depression Anxiety Stress Scales (DASS-21), Acceptance and Action Questionnaire II (AAQ-II), and Cognitive Fusion Questionnaire (CFQ) before and immediately after the intervention. The results showed that ACT and REBT improved individuals' psychological flexibility, cognitive fusion, acquisition-difficulty discarding, clutter, negative affect (anxiety, depression, stress), attachment anxiety, obsessive-compulsive disorder, and difficulty in emotion regulation compared to the control group. In addition, ACT was more effective than REBT in improving psychological flexibility and reducing hoarding, cognitive fusion, depression, stress, and obsessive-compulsive disorder; there were no significant differences between the two in anxiety and emotion regulation difficulties. Furthermore, psychological flexibility is a mediator of the effect of ACT and REBT on some behavioral and psychological outcomes (hoarding, negative affect, attachment anxiety). Limitations were discussed.
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