Psychological Flexibility: What Theory and Which Predictions?

In their review, McCracken and Morley elegantly present a new theoretical model that aims to integrate current knowledge of the psychology of pain and to expand where existing theoretical models reach their boundaries. The authors introduce a fresh new concept, “psychological flexibility,” which they define not so much in terms of content but more in terms of processes and behaviors that can be qualified as “open, aware and active,” in which language and thought are key mechanisms. Psychological inflexibility is said to occur when an individual generates and strictly adheres to dysfunctional rules about himself or herself or the environment, thereby creating personal struggles that in turn prevent engagement in behavior that serves long-term valued goals. The psychological flexibility model includes 6 core processes that symmetrically increase or reduce problems: defusion from current thoughts, willingness to accept, considering self as observer, taking committed action, identifying values, and making contact with the present moment. The authors also review the current empirical status of acceptance and commitment therapy that is specifically developed to increase psychological flexibility. The result is an impressive and rapid accumulation of empirical studies, including pilot, (un)controlled outcome, and instrument development studies. To highlight the unique features of the psychological flexibility model, the authors compare the main existing theoretical models of pain within the cognitive-behavioral treatment (CBT) tradition along their organizing concepts: key outcomes, primary treatment process, and characteristic treatment methods.