Psychological inflexibility and stigma: A meta-analytic review

Abstract

Stigma is known to have major impacts on the physical and psychological health of many groups. Psychological inflexibility is a psychological process that may help explain the impact of stigma on both self and others. Accordingly, acceptance and commitment therapy (ACT), which targets psychological inflexibility, has been researched as a potential treatment for stigma. In order to provide a comprehensive overview of these issues, this paper offers a systematic review and meta-analysis of the association between psychological inflexibility and stigma, as well as a systematic review of ACT interventions for stigma. The results of the meta-analysis showed a positive, medium-to-large association between psychological inflexibility and stigma measures aggregating across 16 studies. The systematic review of interventions identified 15 studies on ACT interventions for stigma. Initial findings indicate consistent reductions in stigma following ACT interventions, as well as improved outcomes relative to active controls. Data on mediation and moderation, as well as long-term outcomes, are also presented. Implications for conceptualizing and treating stigma, and limitations of the research, are discussed.

Measuring Stigma in Chronic Pain: Preliminary Investigation of Instrument Psychometrics, Correlates, and Magnitude of Change in a Prospective Cohort Attending Interdisciplinary Treatment

“…Theoretically, the core therapeutic processes of ACT are intended to enable people with pain to contact negative judgements and interactions with openness and wider awareness, and to not take them to heart, so to speak. 34 Given the demonstrated benefits of ACT for emotional, physical, and social functioning, one might predict that this could reduce instances of stigmatizing behaviour from others. This is based on the reasoning that better, healthier, functioning might make others unable to detect reflections of pain, distress, and disability on which they can impose negative judgements and interactions.…”

“…62 Another hypothesis is that ACT might not directly affect cognitive or emotional content related to stigma as measured by the SSCI-8, but rather it improves engagement in more adaptive behaviours in the presence of these experiences. 34 Finally, it may be that a general approach within ACT for chronic pain is not specifically targeted enough to impact stigma, and perhaps more specific customizing of ACT for stigma is needed.…”

Assessing psychological inflexibility in hoarding: The Acceptance and Action Questionnaire for Hoarding (AAQH)

“…Although the original AAQ (Hayes et al, 2004) and AAQ-II (Bond et al, 2011) are very commonly used in ACT research (e.g., Bluett, Homan, Morrison, Levin, & Twohig, 2014;Krafft, Ferrell, Levin, & Twohig, 2018), recent studies have suggested that the AAQ-II has excessive overlap with distress (e.g., Francis et al, 2016;Rochefort, Baldwin, & Chmielewski, 2018). As the AAQH was developed based on the AAQ-II and uses similar items, it is possible that it also has excessive overlap with general distress or with hoarding symptoms specifically.…”

Can Behavior Analysis Help Us Understand and Reduce Racism? A review of the Current Literature

“…ACTr procedures have been shown to reduce prejudice across different domains, with varying populations and practices (Krafft, Ferrell, Levin, & Twohig, 2018). A few promising behavior-analytic interventions may also reduce racial bias or attenuate the effects of bias.…”