Psychological inflexibility components as trans-diagnostic predictors of emotional symptomatology and suicide risk among young adults

Marge Alejandra Sierra, Eliana Ortiz

Abstract


Trans-diagnostic approaches assume that most mental health disorders are behavioral manifestations of few functional units that represent a psychological risk towards the development of symptomatology. Psychological inflexibility is one of these trans-diagnostic units and evidence suggest that its components are risk factors that can predict emotional symptomatology and suicide risk levels. The present study aims to establish two classification models that predict the probability of having clinical levels of emotional symptomatology and higher suicide risk based on psychological inflexibility components. 513 people consented and completed an online survey as the only evaluation moment including Depression Anxiety and Stress Scales-21, Acceptance and Action Questionnaire - II, Cognitive Fusion Questionnaire, Perseverative Thinking Questionnaire, Valuing Questionnaire and Generalized Pliance Questionnaire as instruments. Participants had a mean age of approximately 27 years, the majority of them were cisgender, heterosexual and identified as women. Two dichotomous variables were created to classify clinical and high-risk cases, these variables were used as dependent on a backwards conditional binary logistic regression for each. Results show that psychological inflexibility is a trans-diagnostic risk factor for both emotional symptomatology and suicide risk. However, not every component was confirmed as a significant predictor. Experiential avoidance, cognitive fusion and repetitive negative thinking are supported as trans-diagnostic risk factors for emotional symptomatology, while only experiential avoidance and generalized pliance were predictive of a higher risk of committing suicide. In conclusion, the proposed models could be useful to identify clinical symptomatology or a higher risk of suicide, which is essential for the design and implementation of preventive interventions.

Keywords


Psychological Inflexibility; Emotional Symptomatology; Suicide Risk Contextual Behavioral Science; Risk Factors.

Full Text:

PDF

References


Adrian, M., Zeman, J., Erdley, C., Lisa, L., & Sim, L. (2010). Emotional Dysregulation and Interpersonal Difficulties as Risk Factors for Nonsuicidal Self-Injury in Adolescent Girls. Journal of Abnormal Child Psychology, 39(3), 389–400. https://doi.org/10.1007/s10802-010-9465-3

Aldea, M. A., & Rice, K. G. (2006). The role of emotional dysregulation in perfectionism and psychological distress. Journal of Counseling Psychology, 53(4), 498–510. https://doi.org/10.1037/0022-0167.53.4.498

Antony, M.M., Bieling, P.J., Cox, B.J., Enns, M.W., & Swinson, R.P. (1998). Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales (DASS) in clinical groups and a community sample. Psychological Assessment, 10, 176-181. https://doi.org/10.1037/1040-3590.10.2.176

Aparicio-García, M., Díaz-Ramiro, E., Rubio-Valdehita, S., López-Núñez, M., & García-Nieto, I. (2018). Health and Well-Being of Cisgender, Transgender and Non-Binary Young People. International Journal of Environmental Research and Public Health, 15(10), 2133. https://doi.org/10.3390/ijerph15102133

Aranmolate, R., Bogan, D.R., Hoard, T., Mawson, A.R. (2017) Suicide Risk Factors among LGBTQ Youth: Review. JSM Schizophr 2(2): 1011.

Ato, M., López-García, J. J., & Benavente, A. (2013). Un sistema de clasificación de los diseños de investigación en psicología. Anales de Psicología, 29(3). https://doi.org/10.6018/analesps.29.3.178511

Bardeen, J. R., & Fergus, T. A. (2016). The interactive effect of cognitive fusion and experiential avoidance on anxiety, depression, stress and posttraumatic stress symptoms. Journal of Contextual Behavioral Science, 5, 1–6. https://doi.org/10.1016/j.jcbs.2016.02.002

Barlow, D. H., Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Allen, L. B., & Ehrenreich-May, J. (2017). Unified protocol for transdiagnostic treatment of emotional disorders: Therapist guide (2nd edn). Oxford University Press.

Barlow, D. H., Sauer‐Zavala, S., Carl, J. R., Bullis, J. R., & Ellard, K. K. (2014). The nature, diagnosis, and treatment of neuroticism: Back to the future. Clinical Psychological Science, 2(3), 344–365. https://doi.org/10.1177/2167702613505532

Barrett, L. F., Robin, L., Pietromonaco, P. R., & Eyssell, K. M. (1998). Are Women the “More Emotional” Sex? Evidence From Emotional Experiences in Social Context. Cognition & Emotion, 12(4), 555–578. https://doi.org/10.1080/026999398379565

Bauer, G. R., Scheim, A. I., Pyne, J., Travers, R., & Hammond, R. (2015). Intervenable factors associated with suicide risk in transgender persons: a respondent driven sampling study in Ontario, Canada. BMC Public Health, 15(1). https://doi.org/10.1186/s12889-015-1867-2

Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., … Zettle, R. D. (2011). Preliminary Psychometric Properties of the Acceptance and Action Questionnaire–II: A Revised Measure of Psychological Inflexibility and Experiential Avoidance. Behavior Therapy, 42(4), 676–688. https://doi.org/10.1016/j.beth.2011.03.007

Bostwick, J. M., & Pankratz, V. S. (2000). Affective Disorders and Suicide Risk: A Reexamination. American Journal of Psychiatry, 157(12), 1925–1932. https://doi.org/10.1176/appi.ajp.157.12.1925

Bryan, C. J. (2016). Treating PTSD Within the Context of Heightened Suicide Risk. Current Psychiatry Reports, 18(8). https://doi.org/10.1007/s11920-016-0708-z

Bullis, J. R., Boettcher, H., Sauer‐Zavala, S., Farchione, T. J., & Barlow, D. H. (2019). What is an emotional disorder? A transdiagnostic mechanistic definition with implications for assessment, treatment, and prevention. Clinical Psychology: Science and Practice, 26(2), e12278. https://doi.org/10.1111/cpsp.12278

Burke, T. A., Hamilton, J. L., Cohen, J. N., Stange, J. P., & Alloy, L. B. (2016). Identifying a physical indicator of suicide risk: Non-suicidal self-injury scars predict suicidal ideation and suicide attempts. Comprehensive Psychiatry, 65, 79–87. https://doi.org/10.1016/j.comppsych.2015.10.008

Cantão, L., & Botti, N. C. L. (2016). Comportamento suicida entre dependentes químicos. Revista Brasileira de Enfermagem, 69(2), 389–396. https://doi.org/10.1590/0034-7167.2016690224i

Carlson, E. B., Palmieri, P. A., Field, N. P., Dalenberg, C. J., Macia, K. S., & Spain, D. A. (2016). Contributions of risk and protective factors to prediction of psychological symptoms after traumatic experiences. Comprehensive Psychiatry, 69, 106–115. https://doi.org/10.1016/j.comppsych.2016.04.022

Chang, E. C., Yu, T., Chang, O. D., & Hirsch, J. K. (2016). Hope and trauma: Examining a diathesis-stress model in predicting depressive and anxious symptoms in college students. Personality and Individual Differences, 96, 52–54. https://doi.org/10.1016/j.paid.2016.02.060

Chawla, N., & Ostafin, B. (2007). Experiential avoidance as a functional dimensional approach to psychopathology: An empirical review. Journal of Clinical Psychology, 63(9), 871–890. https://doi.org/10.1002/jclp.20400

Cheng, Z. H., Lozier, C. C., Lewis, M. M., O’Neil, M. E., Luoma, J. B., & Morasco, B. J. (2021). Investigating the role of psychological inflexibility, mindfulness, and self-compassion in PTSD. Journal of Contextual Behavioral Science, 22, 102–107. https://doi.org/10.1016/j.jcbs.2021.10.004

Chiappini, S., Mosca, A., Miuli, A., Santovito, M. C., Orsolini, L., Corkery, J. M., … Schifano, F. (2021). New Psychoactive Substances and Suicidality: A Systematic Review of the Current Literature. Medicina, 57(6), 580. https://doi.org/10.3390/medicina57060580

Chou, W. P., Yen, C. F., & Liu, T. L. (2018). Predicting Effects of Psychological Inflexibility/Experiential Avoidance and Stress Coping Strategies for Internet Addiction, Significant Depression, and Suicidality in College Students: A Prospective Study. International journal of environmental research and public health, 15(4), 788. https://doi.org/10.3390/ijerph15040788

Cookson, C., Luzon, O., Newland, J., & Kingston, J. (2019). Examining the role of cognitive fusion and experiential avoidance in predicting anxiety and depression. Psychology and Psychotherapy: Theory, Research and Practice. https://doi.org/10.1111/papt.12233

Dalgleish, T., Black, M., Johnston, D., & Bevan, A. (2020). Transdiagnostic approaches to mental health problems: Current status and future directions. Journal of Consulting and Clinical Psychology, 88(3), 179–195. https://doi.org/10.1037/ccp0000482

Davis, E. K. (2017). A Systematic Review of Posttraumatic Growth in Firefighters and an Investigation into Post-Traumatic Stress Symptoms in Ambulance Clinicians: Severity and Associations with Self Compassion, Psychological Inflexibility and Wellbeing [PhD Dissertation]. University of Edinburgh.

DeBeer, B. B., Kimbrel, N. A., Meyer, E. C., Gulliver, S. B., & Morissette, S. B. (2014). Combined PTSD and depressive symptoms interact with post-deployment social support to predict suicidal ideation in Operation Enduring Freedom and Operation Iraqi Freedom veterans. Psychiatry Research, 216(3), 357–362. https://doi.org/10.1016/j.psychres.2014.02.010

DeBeer, B. B., Meyer, E. C., Kimbrel, N. A., Kittel, J. A., Gulliver, S. B., & Morissette, S. B. (2018). Psychological Inflexibility Predicts of Suicidal Ideation Over Time in Veterans of the Conflicts in Iraq and Afghanistan. Suicide & life-threatening behavior, 48(6), 627–641. https://doi.org/10.1111/sltb.12388

Denning, D. M., Perry, T. R., Reilly, E. E., Berner, L. A., Velkoff, E. A., Kaye, W. H., Wierenga, C. E., & Brown, T. A. (2022). Associations of suicide risk with emotional reactivity, dysregulation, and eating disorder treatment outcomes. Suicide and Life-Threatening Behavior, 00, 1-14. https://doi.org/10.1111/sltb.12907

Departamento Administrativo Nacional de Estadística (DANE) (2022) Preguntas frecuentes estratificación. https://www.dane.gov.co/files/geoestadistica/Preguntas_frecuentes_estratificacion.pdf

Dereix-Calonge, I., Ruiz, F.J., Betancourt, V., & Flórez, C. L. (2020). Repetitive negative thinking longitudinally predicts the psychological adjustment of clinical psychology trainees. Behavioral Psychology. 28. 227-243.

Dionne, F., Ngô, T.-L., & Blais, M.-C. (2014). Le modèle de la flexibilité psychologique : une approche nouvelle de la santé mentale. Numéro Thématique, 38(2), 111–130. https://doi.org/10.7202/1023992ar

Ducasse, D., René, E., Béziat, S., Guillaume, S., Courtet, P., & Olié, E. (2014). Acceptance and Commitment Therapy for management of suicidal patients: A pilot study. Psychotherapy and Psychosomatics, 83, 374-376. https://doi.org/10.1159/000365974

Dvir, Y., Ford, J. D., Hill, M., & Frazier, J. A. (2014). Childhood Maltreatment, Emotional Dysregulation, and Psychiatric Comorbidities. Harvard Review of Psychiatry, 22(3), 149–161. https://doi.org/10.1097/hrp.0000000000000014

Eaton, N. R., Rodriguez-Seijas, C., Carragher, N., & Krueger, R. F. (2015). Transdiagnostic factors of psychopathology and substance use disorders: a review. Social Psychiatry and Psychiatric Epidemiology, 50(2), 171–182. https://doi.org/10.1007/s00127-014-1001-2

Ehring, T., Zetsche, U., Weidacker, K., Wahl, K., Schönfeld, S., & Ehlers, A. (2011). The Perseverative Thinking Questionnaire (PTQ): Validation of a content-independent measure of repetitive negative thinking. Journal of Behavior Therapy and Experimental Psychiatry, 42(2), 225–232. https://doi.org/10.1016/j.jbtep.2010.12.003

Ehring, T., & Watkins, E. R. (2008). Repetitive Negative Thinking as a Transdiagnostic Process. International Journal of Cognitive Therapy, 1(3), 192–205. https://doi.org/10.1521/ijct.2008.1.3.192

Ellis, T. E., & Rufino, K. A. (2016). Change in experiential avoidance is associated with reduced suicidal ideation over the course of psychiatric hospitalization. Archives of Suicide Research, 20, 426-437. https://doi.org/10.1080/13811118.2015.1093983

Eshun, E. A. (2020). Moderating role of psychological flexibility on the relationship between post traumatic stress disorder (PTSD) and health functioning of victims of defilement [MA Thesis]. University of Cape Coast.

Faustino, B. (2020). Transdiagnostic perspective on psychological inflexibility and emotional dysregulation. Behavioural and Cognitive Psychotherapy, 49(2), 233–246. https://doi.org/10.1017/s1352465820000600

Faustino, B., Vasco, A. B., Farinha-Fernandes, A., & Delgado, J. (2021). Psychological inflexibility as a transdiagnostic construct: relationships between cognitive fusion, psychological well-being and symptomatology. Current Psychology. https://doi.org/10.1007/s12144-021-01943-w

Field, A. P. (2009). Discovering statistics using SPSS: and sex and drugs and rock 'n' roll (3rd edn). SAGE Publications.

Fischer, A. H. (1993). Sex Differences in Emotionality: Fact or Stereotype? Feminism & Psychology, 3(3), 303–318. https://doi.org/10.1177/0959353593033002

Fiske, S. T., & Taylor, S. E. (1991). Social cognition (2nd ed.). McGraw-Hill

Gil-Luciano, B., Calderón-Hurtado, T., Tovar, D., Sebastián, B., & Ruiz, F. J. (2019). How are triggers for repetitive negative thinking organized? A relational frame analysis. Psicothema, 31(1), 53-59. https://doi.org/10.7334/psicothema2018.133.

Gillanders, D. T., Bolderston, H., Bond, F. W., Dempster, M., Flaxman, P. E., Campbell, L., … Remington, B. (2014). The Development and Initial Validation of the Cognitive Fusion Questionnaire. Behavior Therapy, 45(1), 83–101. https://doi.org/10.1016/j.beth.2013.09.001

Gómez, A.S. (2020). Psychosocial Factors and Clinical Predictors of Suicide Risk in College Students. Mediterranean Journal of Clinical Psychology, 8(3). https://doi.org/10.6092/2282-1619/mjcp-2602

González-Menéndez, A., Arboleya Faedo, T., González-Pando, D., Ordoñez-Camblor, N., García-Vega, E., & Paino, M. (2021). Psychological Inflexibility in People with Chronic Psychosis: The Mediating Role of Self-Stigma and Social Functioning. International Journal of Environmental Research and Public Health, 18(23), 12376. https://doi.org/10.3390/ijerph182312376

Guz, S., Kattari, S. K., Atteberry-Ash, B., Klemmer, C. L., Call, J., & Kattari, L. (2021). Depression and Suicide Risk at the Cross-Section of Sexual Orientation and Gender Identity for Youth. Journal of Adolescent Health, 68(2), 317–323. https://doi.org/10.1016/j.jadohealth.2020.06.008

Haas, A. P., Eliason, M., Mays, V. M., Mathy, R. M., Cochran, S. D., D’Augelli, A. R., … Clayton, P. J. (2010). Suicide and Suicide Risk in Lesbian, Gay, Bisexual, and Transgender Populations: Review and Recommendations. Journal of Homosexuality, 58(1), 10–51. https://doi.org/10.1080/00918369.2011.534038

Haliczer, L. A., Harnedy, L. E., Oakley, M., & Dixon-Gordon, K. L. (2021). Clarifying the Role of Multiple Self-Damaging Behaviors in the Association Between Emotion Dysregulation and Suicide Risk Among College Students. The Journal of Primary Prevention, 42(5), 473–492. https://doi.org/10.1007/s10935-021-00639-y

Hawton, K., Casañas, I., Comabella, C., Haw, C., & Saunders, K. (2013). Risk factors for suicide in individuals with depression: A systematic review. Journal of Affective Disorders, 147(1-3), 17–28. https://doi.org/10.1016/j.jad.2013.01.004

Hayes, S. C., Barnes-Holmes, D., & Roche, B. (2001). Relational frame theory: A post-Skinnerian account of human language and cognition. Kluwer Academic/Plenum.

Hayes, S. C., Barnes-Holmes, D., & Wilson, K. G. (2012). Contextual Behavioral Science: Creating a science more adequate to the challenge of the human condition. Journal of Contextual Behavioral Science, 1(1-2), 1–16. https://doi.org/10.1016/j.jcbs.2012.09.004

Hayes, S. C., Brownstein, A. J., Zettle, R. D., Rosenfarb, I., & Korn, Z. (1986). Rule-Governed Behavior and Sensitivity to Changing Consequences of Responding. Journal of the Experimental Analysis of Behavior, 45(3), 237–256. https://doi.org/10.1901/Jeab.1986.45-237

Hayes, S. C., Merwin, R. M., McHugh, L., Sandoz, E. K., A-Tjak, J. G. L., Ruiz, F. J., … McCracken, L. M. (2021). Report of the ACBS Task Force on the strategies and tactics of contextual behavioral science research. Journal of Contextual Behavioral Science, 20, 172–183. https://doi.org/10.1016/j.jcbs.2021.03.007

Hayes, S. C., Pistorello, J., & Levin, M. E. (2012). Acceptance and Commitment Therapy as a Unified Model of Behavior Change. The Counseling Psychologist, 40(7), 976–1002. https://doi.org/10.1177/0011000012460836

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change (2nd edn). The Guilford Press

Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64(6), 1152–1168. https://doi.org/10.1037/0022-006x.64.6.1152

Hedley, D., Hayward, S. M., Clarke, A., Uljarević, M., & Stokes, M. A. (2022). Suicide and Autism: A Lifespan Perspective. End of Life and People with Intellectual and Developmental Disability, 59–94. https://doi.org/10.1007/978-3-030-98697-1_3

Hedley, D., Uljarević, M., Foley, K.-R., Richdale, A., & Trollor, J. (2018). Risk and protective factors underlying depression and suicidal ideation in Autism Spectrum Disorder. Depression and Anxiety, 35(7), 648–657. https://doi.org/10.1002/da.22759

Hernández-López, M., Cepeda-Benito, A., Díaz-Pavón, P., & Rodríguez-Valverde, M. (2021). Psychological inflexibility and mental health symptoms during the COVID-19 lockdown in Spain: A longitudinal study. Journal of contextual behavioral science, 19, 42–49. https://doi.org/10.1016/j.jcbs.2020.12.002

Hernández-Sampieri, R., Fernández-Collado, C., & Baptista-Lucio, P. (2014). Metodología de la investigación: (6a. ed.). McGraw-Hill.

Herres, J., Shearer, A., Kodish, T., Kim, B., Wang, S. B., & Diamond, G. S. (2019). Differences in Suicide Risk Severity Among Suicidal Youth With Anxiety Disorders. Crisis, 40(5), 333–339. https://doi.org/10.1027/0227-5910/a000571

Hyman, J., Ireland, R., Frost, L., & Cottrell, L. (2012). Suicide Incidence and Risk Factors in an Active Duty US Military Population. American Journal of Public Health, 102(S1), S138–S146. https://doi.org/10.2105/ajph.2011.300484

Kanwar, A., Malik, S., Prokop, L. J., Sim, L. A., Feldstein, D., Wang, Z., & Murad, M. H. (2013). The association between anxiety disorders and suicidal behaviors: a systematic review and meta-analysis. Depression and Anxiety, 30: 917–929. https://doi.org/10.1002/da.22074

Kashdan, T. B., & Rottenberg, J. (2010). Psychological flexibility as a fundamental aspect of health. Clinical Psychology Review, 30(7), 865–878. https://doi.org/10.1016/j.cpr.2010.03.001

Khan, A., Leventhal, R. M., Khan, S., & Brown, W. A. (2002). Suicide risk in patients with anxiety disorders: a meta-analysis of the FDA database. Journal of Affective Disorders, 68(2-3), 183–190. https://doi.org/10.1016/s0165-0327(01)00354-8

Kessler, R. C., Ormel, J., Petukhova, M., McLaughlin, K. A., Green, J. G., Russo, L. J., Stein, D. J., Zaslavsky, A. M., Aguilar-Gaxiola, S., Alonso, J., Andrade, L., Benjet, C., de Girolamo, G., de Graaf, R., Demyttenaere, K., Fayyad, J., Haro, J. M., Hu, C. y., Karam, A., Lee, S., … Ustün, T. B. (2011). Development of lifetime comorbidity in the World Health Organization world mental health surveys. Archives of general psychiatry, 68(1), 90–100. https://doi.org/10.1001/archgenpsychiatry.2010.180

Koushiou, M., Kapatais, A., Iasonidou, E., Adonis, M., Ferreira, N. (2021). The moderating role of body image inflexibility in the relation between weight concerns and symptoms of eating disorders in Cypriot University students. Mediterranean Journal of Clinical Psychology, 9(2). https://doi.org/10.13129/2282-1619/mjcp-2977

Koushiou, M., Loutsiou, A., & Karekla, M. (2020). Eating disorders among middle-school students: The role of psychological inflexibility and self-esteem. International Journal of School & Educational Psychology, 9(sup1), S58–S68. https://doi.org/10.1080/21683603.2020.1742259

Krafft, J., Hicks, E.T., Mack, S.A. and Levin, M. (2019), Psychological Inflexibility Predicts Suicidality Over Time in College Students. Suicide Life Threat Behav, 49: 1488-1496. https://doi.org/10.1111/sltb.12533

Krueger, R. F., & Eaton, N. R. (2015). Transdiagnostic factors of mental disorders. World Psychiatry, 14(1), 27–29. https://doi.org/10.1002/wps.20175

Kyung-Sook, W., SangSoo, S., Sangjin, S., & Young-Jeon, S. (2018). Marital status integration and suicide: A meta-analysis and meta-regression. Social Science & Medicine, 197, 116–126. https://doi.org/10.1016/j.socscimed.2017.11.053

Landi, G., Pakenham, K. I., Crocetti, E., Tossani, E., & Grandi, S. (2022). The trajectories of anxiety and depression during the COVID-19 pandemic and the protective role of psychological flexibility: A four-wave longitudinal study. Journal of affective disorders, 307, 69–78. https://doi.org/10.1016/j.jad.2022.03.067

Latkin, C. A., Edwards, C., Davey-Rothwell, M. A., & Tobin, K. E. (2017). The relationship between social desirability bias and self-reports of health, substance use, and social network factors among urban substance users in Baltimore, Maryland. Addictive Behaviors, 73, 133–136. https://doi.org/10.1016/j.addbeh.2017.05.005

Law 1090 of 2006: Whereby the practice of the profession of Psychology is regulated, the Code of Ethics and Bioethics and other provisions are issued. September 6, 2006. D.O. No. 46.383.

Law, K. C., Khazem, L. R., & Anestis, M. D. (2015). The role of emotion dysregulation in suicide as considered through the ideation to action framework. Current Opinion in Psychology, 3, 30–35. https://doi.org/10.1016/j.copsyc.2015.01.014

Law, K. C., & Tucker, R. P. (2018). Repetitive negative thinking and suicide: a burgeoning literature with need for further exploration. Current Opinion in Psychology, 22, 68–72. https://doi.org/10.1016/j.copsyc.2017.08.027

Levin, M. E., MacLane, C., Daflos, S., Seeley, J. R., Hayes, S. C., Biglan, A., & Pistorello, J. (2014). Examining psychological inflexibility as a transdiagnostic process across psychological disorders. Journal of Contextual Behavioral Science, 3(3), 155–163. https://doi.org/10.1016/j.jcbs.2014.06.003

Levin, M. E., Twohig, M. P., & Smith, B. M. (2016). Contextual Behavioral Science: An overview. In R. D. Zettle, S. C. Hayes, D. Barnes-Holmes & A. Biglan (Eds.), The Wiley Handbook of Contextual Behavioral Science (pp. 17-36).New York: Wiley-Blackwell. https://doi.org/10.1002/9781118489857.ch3

Love, H. A., Nalbone, D. P., Hecker, L. L., Sweeney, K. A., & Dharnidharka, P. (2018). Suicidal Risk Following the Termination of Romantic Relationships. Crisis, 39(3), 166–174. https://doi.org/10.1027/0227-5910/a000484

Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33(3), 335–343. https://doi.org/10.1016/0005-7967(94)00075-u

Luciano, C. (2017). The self and responding to the own’s behavior. Implications of coherence and hierarchical framing. International Journal of Psychology and Psychological Therapy, 17, 267-275.

Lynch, S. J., Sunderland, M., Newton, N. C., & Chapman, C. (2021). A systematic review of transdiagnostic risk and protective factors for general and specific psychopathology in young people. Clinical Psychology Review, 87, 102036. https://doi.org/10.1016/j.cpr.2021.102036

Madden, T. E., Barrett, L. F., & Pietromonaco, P. R. (2000). Sex differences in anxiety and depression: Empirical evidence and methodological questions. In A. Fischer (Ed.), Gender and emotion: Social psychological perspectives (pp. 277–298). Cambridge University Press.

Mallot, R. W. (1989). The Achievement of Evasive Goals: Control by Rules Describing Contingencies That Are Not Direct Acting. In S. C. Hayes. (Ed). Rule-Governed Behavior Cognition, Contingencies, and Instructional Control (pp. 269-324) Plenum Press. https://doi.org/10.1007/978-1-4757-0447-1_8

Martinotti, G., Schiavone, S., Negri, A., Vannini, C., Trabace, L., De Berardis, D., … Di Giannantonio, M. (2021). Suicidal Behavior and Club Drugs in Young Adults. Brain Sciences, 11(4), 490. https://doi.org/10.3390/brainsci11040490

McEvoy, P. M., Watson, H., Watkins, E. R., & Nathan, P. (2013). The relationship between worry, rumination, and comorbidity: Evidence for repetitive negative thinking as a transdiagnostic construct. Journal of Affective Disorders, 151(1), 313–320. https://doi.org/10.1016/j.jad.2013.06.014

McLaughlin, K. A., & Nolen-Hoeksema, S. (2011). Rumination as a transdiagnostic factor in depression and anxiety. Behaviour Research and Therapy, 49(3), 186–193. https://doi.org/10.1016/j.brat.2010.12.006

Merwin, R. M., Timko, C. A., Moskovich, A. A., Ingle, K. K., Bulik, C. M., & Zucker, N. L. (2010). Psychological Inflexibility and Symptom Expression in Anorexia Nervosa. Eating Disorders, 19(1), 62–82. https://doi.org/10.1080/10640266.2011.533606

Miron, L. R., Sherrill, A. M., & Orcutt, H. K. (2015). Fear of self-compassion and psychological inflexibility interact to predict PTSD symptom severity. Journal of Contextual Behavioral Science, 4(1), 37–41. https://doi.org/10.1016/j.jcbs.2014.10.003

Monestès, J.-L., Karekla, M., Jacobs, N., Michaelides, M. P., Hooper, N., Kleen, M., Ruiz, F. J., Miselli, G., Presti, G., Luciano, C., Villatte, M., Bond, F. W., Kishita, N., & Hayes, S. C. (2018). Experiential avoidance as a common psychological process in European cultures. European Journal of Psychological Assessment, 34(4), 247–257. https://doi.org/10.1027/1015-5759/a000327

Morton, C., Mooney, T. A., Lozano, L. L., Adams, E. A., Makriyianis, H. M., & Liss, M. (2020). Psychological inflexibility moderates the relationship between thin-ideal internalization and disordered eating. Eating Behaviors, 36, 101345. https://doi.org/10.1016/j.eatbeh.2019.101345

Nolen-Hoeksema, S., Wisco, B.E., & Lyubomirsky, S. (2008). Rethinking Rumination. Perspectives in Psychological Science, 3(5), 400-424. https://doi.org/10.1111/j.1745-6924.2008.00088.x

Nordström, P., Åsberg, M., Åberg-Wistedt, A., & Nordin, C. (1995). Attempted suicide predicts suicide risk in mood disorders. Acta Psychiatrica Scandinavica, 92(5), 345–350. https://doi.org/10.1111/j.1600-0447.1995.tb09595.x

Ogbeide, S. A., Young, A., Houston, B., & Knight, C. (2020). Treating Post-traumatic Stress Disorder with a Prolonged Exposure Protocol Within Primary Care Behavioral Health: A Case Example. Journal of Clinical Psychology in Medical Settings, 28(3), 575–583. https://doi.org/10.1007/s10880-020-09747-z

O’Connor, M., Byrne, P., Ruiz, F. J., & McHugh, L. (2018). Generalized Pliance in Relation to Contingency Insensitivity and Mindfulness. Mindfulness, 10(5), 833–840. https://doi.org/10.1007/s12671-018-1046-5

Pawłowska, B., & Szymańska, J. (2021). Suicidal ideation, plans, and attempts and the use of psychoactive substances by adolescents. Current Problems of Psychiatry, 22(3), 217–224. https://doi.org/10.2478/cpp-2021-0016

Pereira-Morales, A. J., Adan, A., Camargo, A., & Forero, D. A. (2017). Substance use and suicide risk in a sample of young Colombian adults: An exploration of psychosocial factors. The American Journal on Addictions, 26(4), 388–394. https://doi.org/10.1111/ajad.12552

Plöderl, M., Wagenmakers, E.-J., Tremblay, P., Ramsay, R., Kralovec, K., Fartacek, C., & Fartacek, R. (2013). Suicide Risk and Sexual Orientation: A Critical Review. Archives of Sexual Behavior, 42(5), 715–727. https://doi.org/10.1007/s10508-012-0056-y

Popa, C. O., Rus, A. V., Lee, W. C., Cojocaru, C., Schenk, A., Văcăraș, V., Olah, P., Mureșan, S., Szasz, S., & Bredicean, C. (2022). The Relation between Negative Automatic Thoughts and Psychological Inflexibility in Schizophrenia. Journal of Clinical Medicine, 11(3), 871. https://doi.org/10.3390/jcm11030871

Richardson, A., Gurung, G., Samaranayaka, A., Gardner, D., deGraaf, B., Wyeth, E. H., Derrett, S., Shepherd, D., & McBride, D. (2020). Risk and protective factors for post-traumatic stress among New Zealand military personnel: A cross sectional study. PLOS ONE, 15(4), e0231460. https://doi.org/10.1371/journal.pone.0231460

Retz, W., Stieglitz, R.-D., Corbisiero, S., Retz-Junginger, P., & Rösler, M. (2012). Emotional dysregulation in adult ADHD: what is the empirical evidence? Expert Review of Neurotherapeutics, 12(10), 1241–1251. https://doi.org/10.1586/ern.12.109

Rimes, K. A., Goodship, N., Ussher, G., Baker, D., & West, E. (2019). Non-binary and binary transgender youth: Comparison of mental health, self-harm, suicidality, substance use and victimization experiences. International Journal of Transgenderism, 20(2-3), 230–240. https://doi.org/10.1080/15532739.2017.1370627

Ruiz, F. J., Flórez, C. L., García-Martín, M. B., Monroy-Cifuentes, A., Barreto-Montero, K., García-Beltrán, D. M., … Gil-Luciano, B. (2018). A multiple-baseline evaluation of a brief acceptance and commitment therapy protocol focused on repetitive negative thinking for moderate emotional disorders. Journal of Contextual Behavioral Science, 9, 1–14. https://doi.org/10.1016/j.jcbs.2018.04.004

Ruiz, F. J., García-Martín, M. B., Suárez-Falcón, J. C., & Odriozola-González, P. (2017). The hierarchical factor structure of the Spanish version of Depression Anxiety and Stress Scale - 21. International Journal of Psychology and Psychological Therapy, 17, 97-105.

Ruiz, F. J., Gil-Luciano, B., & Segura-Vargas, M.A. (2022). Cognitive Defusion. In P. Goldblum, D. L. Espelage, J. Chu & B. Bongar (Eds.), Youth Suicide and Bullying: Challenges and Strategies for Prevention and Intervention (pp. 121-133). Oxford University Press.

Ruiz, F. J., Suárez-Falcón, J. C., Barbero-Rubio, A., & Flórez, C. L. (2018). Development and initial validation of the Generalized Pliance Questionnaire. Journal of Contextual Behavioral Science. https://doi.org/10.1016/j.jcbs.2018.03.003

Ruiz, F. J., Suárez-Falcón, J. C., Cárdenas-Sierra, S., Durán, Y., Guerrero, K., & Riaño-Hernández, D. (2016). Psychometric Properties of the Acceptance and Action Questionnaire–II in Colombia. The Psychological Record, 66(3), 429–437. https://doi.org/10.1007/s40732-016-0183-2

Ruiz, F. J., Suárez-Falcón, J. C., Riaño-Hernández, D., & Gillanders, D. (2017). Psychometric Properties of the Cognitive Fusion Questionnaire in Colombia. Revista Latinoamericana de Psicología, 49(1), 80–87. https://doi.org/10.1016/j.rlp.2016.09.006

Ruiz, F. J., & Odriozola-González, P. (2015). Comparing Cognitive, Metacognitive, and Acceptance and Commitment Therapy Models of Depression: a Longitudinal Study Survey. The Spanish journal of psychology, 18, E39. https://doi.org/10.1017/sjp.2015.31

Ruiz, F.J., Odriozola-González, P., Suárez-Falcón, J.C., Segura-Vargas, M.A. (2022) Psychometric properties of the Valuing Questionnaire in a Spaniard sample and factorial equivalence with a Colombian sample. PeerJ 10:e12670 https://doi.org/10.7717/peerj.12670

Ruiz, F. J., Peña-Vargas, A., Ramírez, E. S., Suárez-Falcón, J. C., García-Martín, M. B., García-Beltrán, D. M., Henao, Á. M., Monroy-Cifuentes, A., & Sánchez, P. D. (2020). Efficacy of a two-session repetitive negative thinking-focused acceptance and commitment therapy (ACT) protocol for depression and generalized anxiety disorder: A randomized waitlist control trial. Psychotherapy (Chicago, Ill.), 57(3), 444–456. https://doi.org/10.1037/pst0000273

Segerstrom, S. C., Tsao, J. C. I., Alden, L. E., & Craske, M. G. (2000). Worry and Rumination: Repetitive Thought as a Concomitant and Predictor of Negative Mood. Cognitive Therapy and Research, 24(6), 671–688. https://doi.org/10.1023/a:1005587311498

Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., … Dunbar, G. C. (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatry interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59 (20), 22-33.

Sigmon, S. T., Pells, J. J., Boulard, N. E., Whitcomb-Smith, S., Edenfield, T. M., Hermann, B. A., LaMattina, S. M., Schartel, J. G., & Kubik, E. (2005). Gender Differences in Self-Reports of Depression: The Response Bias Hypothesis Revisited. Sex Roles, 53(5–6), 401–411. https://doi.org/10.1007/s11199-005-6762-3

Smout, M., Davies, M., Burns, N., & Christie, A. (2014). Development of the Valuing Questionnaire (VQ). Journal of Contextual Behavioral Science, 3(3), 164–172. https://doi.org/10.1016/j.jcbs.2014.06.001

Sorg, S., Vögele, C., Furka, N., & Hans-Meyer, A. (2012). Perseverative thinking in depression and anxiety. Frontiers in Psychology, 3. https://doi.org/10.3389/fpsyg.2012.00020

Spinhoven, P., Drost, J., de Rooij, M., van Hemert, A. M., & Penninx, B. W. (2014). A Longitudinal Study of Experiential Avoidance in Emotional Disorders. Behavior Therapy, 45(6), 840–850. https://doi.org/10.1016/j.beth.2014.07.001

Suokas, J., Suominen, K., Isometsä, E., Ostamo, A., & Lönnqvist, J. (2001). Long-term risk factors for suicide mortality after attempted suicide - Findings of a 14-year follow-up study. Acta Psychiatrica Scandinavica, 104(2), 117–121. https://doi.org/10.1034/j.1600-0447.2001.00243.x

Stack, S., & Scourfield, J. (2013). Recency of Divorce, Depression, and Suicide Risk. Journal of Family Issues, 36(6), 695–715. https://doi.org/10.1177/0192513x13494824

Statutory Law 1266 of 2008: Whereby the general provisions of habeas data are issued and the handling of information contained in personal databases is regulated, especially financial, credit, commercial, services and information from third countries, and other provisions are issued. December 31, 2008. D.O. No. 47.219

Statutory Law 1581 of 2012: Whereby general provisions are issued for the protection of personal data. October 18, 2012. D.O. No. 48.587

Tebbe, E. A., & Moradi, B. (2016). Suicide risk in trans populations: An application of minority stress theory. Journal of Counseling Psychology, 63(5), 520–533. https://doi.org/10.1037/cou0000152

Testa, R. J., Hendricks, M. L. (2015). Suicide risk among transgender and gender-nonconforming youth. In P. Goldblum, D. L. Espelage, J. Chu & B. Bongar (Eds.), Youth Suicide and Bullying: Challenges and Strategies for Prevention and Intervention (pp. 121-133). Oxford University Press.

Thompson, E. M., Brierley, M.-E. E., Destrée, L., Albertella, L., & Fontenelle, L. F. (2022). Psychological flexibility and inflexibility in obsessive-compulsive symptom dimensions, disability, and quality of life: An online longitudinal study. Journal of Contextual Behavioral Science, 23, 38–47. https://doi.org/10.1016/j.jcbs.2021.11.004

Törneke, N., Luciano, C., & Valdivia-Salas, S. (2008). Rule-Governed Behavior and Psychological Problems. International Journal of Psychology and Psychological Therapy, 8(2), 141-156.

Törneke, N., Luciano, C., Barnes-Holmes, Y., & Bond, F. W. (2016). RFT for Clinical Practice: three core strategies in understanding and treating human suffering. In R. D. Zettle, S. C. Hayes, D. Barnes-Holmes, A. Biglan (Eds.), The Wiley Handbook of Contextual Behavioral Science (pp. 254-272). Wiley-Blackwell. https://doi.org/10.1002/9781118489857.ch12

Toro, R., Alfaro, D., Juyó, E., & Sandino, V. (2020). Rumiación cognitiva y afecto negativo como predictores diferenciales de los síntomas psicopatológicos internalizantes. Psychologia, 14(2), 27-36. https://doi.org/10.21500/19002386.4618

Twohig, M. P., Abramowitz, J. S., Smith, B. M., Fabricant, L. E., Jacoby, R. J., Morrison, K. L., Bluett, E. J., Reuman, L., Blakey, S. M., & Ledermann, T. (2018). Adding acceptance and commitment therapy to exposure and response prevention for obsessive-compulsive disorder: A randomized controlled trial. Behaviour Research and Therapy, 108, 1–9. https://doi.org/10.1016/j.brat.2018.06.005

Twohig, M., Morrison, K., & Bluet, E. (2014). Acceptance and Commitment Therapy for Obsessive Compulsive Disorder and Obsessive Compulsive Spectrum Disorders: A Review. Current Psychiatry Reviews, 10(4), 296–307. https://doi.org/10.2174/1573400510666140714172145

Twohig, M. P., Vilardaga, J. C. P., Levin, M. E., & Hayes, S. C. (2015). Changes in psychological flexibility during acceptance and commitment therapy for obsessive compulsive disorder. Journal of Contextual Behavioral Science, 4(3), 196–202. https://doi.org/10.1016/j.jcbs.2015.07.001

Tyndall, I., Waldeck, D., Pancani, L., Whelan, R., Roche, B., & Pereira, A. (2018). Profiles of Psychological Flexibility: A Latent Class Analysis of the Acceptance and Commitment Therapy Model. Behavior Modification, 44(3), 365–393. https://doi.org/10.1177/0145445518820036

Van Stralen, J. (2016). Emotional dysregulation in children with attention-deficit/hyperactivity disorder. ADHD Attention Deficit and Hyperactivity Disorders, 8(4), 175–187. https://doi.org/10.1007/s12402-016-0199-0

Wakefield, S., Roebuck, S., & Boyden, P. (2018). The evidence base of Acceptance and Commitment Therapy (ACT) in psychosis: A systematic review. Journal of Contextual Behavioral Science, 10, 1–13. https://doi.org/10.1016/j.jcbs.2018.07.001

Walser, R. D., Garvert, D. W., Karlin, B. E., Trockel, M., Ryu, D. M., & Taylor, C. B. (2015). Effectiveness of Acceptance and Commitment Therapy in treating depression and suicidal ideation in veterans. Behaviour Research and Therapy, 74, 25-31. https://doi.org/10.1016/j.brat.2015.08.012

Watkins, E. R. (2008). Constructive and Unconstructive Repetitive Thought. Psychological Bulletin, 134, 163-206. https://doi.org/10.1037/0033-2909.134.2.163

Watkins, E., Moulds, M., & Mackintosh, B. (2005). Comparisons between rumination and worry in a non-clinical population. Behaviour Research and Therapy, 43(12), 1577–1585. https://doi.org/10.1016/j.brat.2004.11.008

White, R. G., Gumley, A. I., McTaggart, J., Rattrie, L., McConville, D., Cleare, S., & Mitchell, G. (2012). Depression and Anxiety Following Psychosis: Associations with Mindfulness and Psychological Flexibility. Behavioural and Cognitive Psychotherapy, 41(1), 34–51. https://doi.org/10.1017/s1352465812000239

Wilson, K. G., & Luciano, C. (2002). Terapia de Aceptación y Compromiso: Un Tratamiento conductual orientado a los valores. Pirámide

Wilkinson, P. O. (2011). Nonsuicidal self-injury: A clear marker for suicide risk. Journal of the American Academy of Child & Adolescent Psychiatry, 50(8), 741–743. https://doi.org/10.1016/j.jaac.2011.04.008

Wolford-Clevenger, C., Cannon, C. J., Flores, L. Y., Smith, P. N., & Stuart, G. L. (2017). Suicide Risk Among Transgender People: A Prevalent Problem in Critical Need of Empirical and Theoretical Research. Violence and Gender, 4(3), 69–72. https://doi.org/10.1089/vio.2017.0006

World Health Organization. (2014). Preventing suicide: A global imperative. World Health Organization. https://apps.who.int/iris/bitstream/handle/10665/131056/9789241564779_eng.pdf

World Health Organization. (2019). Suicide in the world: Global Health Estimates. World Health Organization. https://apps.who.int/iris/bitstream/handle/10665/326948/WHO-MSD-MER-19.3-eng.pdf

World Medical Association (2013). World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA, 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053

Yip, P. S. F., Yousuf, S., Chan, C. H., Yung, T., & Wu, K. C.-C. (2015). The roles of culture and gender in the relationship between divorce and suicide risk: A meta-analysis. Social Science & Medicine, 128, 87–94. https://doi.org/10.1016/j.socscimed.2014.12.034

Zettle, R. D., & Hayes, S. C. (1982). Rule-Governed Behavior: A Potential Theoretical Framework For Cognitive–Behavioral Therapy. Advances In Cognitive - Behavioral Research And Therapy, 73–118. https://doi.org/10.1016/B978-0-12-010601-1.50008-5




DOI: https://doi.org/10.13129/2282-1619/mjcp-3565

Refbacks