Psychological flexibility and stress, depression and anxiety interventions: a systematic review

Abstract

Acceptance and commitment therapy (ACT) has gained notoriety in recent years. One of the main mechanisms of change in this therapy is psychological flexibility (PF), which concerns the ability to be in contact with the present moment, including internal experiences, and behave according to personal values. PF can be improved through interventions focused on accepting unpleasant internal states, such as stress, anxiety and depression. Interventions of this type can produce clinical improvements. The present study aimed to carry out a systematic review on PF and psychological interventions for stress, depression and anxiety. 22 studies were analyzed. Evidence in favor of the superiority of ACT interventions was found in 12 studies that used randomized clinical trials, among which 10 showed maintenance of effects in follow-ups. Among the interventions evaluated, there are short-form, online and self-guided formats, in addition to traditional ones (group and face-to-face). Although five studies evaluate how PF acts in producing results based on statistical analysis of regression, mediation and moderation, none of the studies evaluated basic behavioral processes involved in PF. We suggest that future research addresses these deficiencies.