Associations Between Six Core Processes of Psychological Flexibility and Functioning for Chronic Pain Patients: A Three-Level Meta-Analysis

Abstract

The previous research showed contradictions in the relationships between psychological flexibility processes and functioning. This meta-analysis is the first to provide a comprehensive meta-analysis of the associations between six core processes of psychological flexibility and functioning among chronic pain patients. Four databases were searched (PsycINFO; PubMed; CINAHL; Web of Science) along with reference lists. Thirty-six cross-sectional studies were included (7,812 chronic pain patients). A three-level meta-analytic model was used to examine the associations. The publication bias was assessed with the Egger test, funnel plot, and p-curve analysis. Significant associations were found between functioning and six processes of psychological flexibility (i.e., acceptance, defusion, present moment, committed action, self as context, and values). Except for the relationship between defusion and functioning, the relationships between the other five psychological flexibility processes and functioning were all moderated by domains of functioning. No moderators were found regarding age, percentage of females, country, or type of instrument used to measure functioning. These findings may carry significant implications for chronic pain patients and clinical workers. It might be more effective to focus on functioning-related psychological flexibility processes rather than all therapy packages if the relationships between functioning and specific processes of psychological flexibility were better informed. Limitations were also discussed.

Which outcome variables are associated with psychological inflexibility/flexibility for chronic pain patients? A three level meta-analysis

“…This may be due to the fact that the present study did not distinguish between psychological and physiological functioning, and included the both two distinct subcomponents in the heading of functioning. A recent study has specifically explored the relationship between the six subcomponents of psychological flexibility and functioning (Ding and Zheng, 2022 ). This study identified the measurement instrument of functioning as a possible factor contributing to heterogeneity (Ding and Zheng, 2022 ).…”

“…A recent study has specifically explored the relationship between the six subcomponents of psychological flexibility and functioning (Ding and Zheng, 2022 ). This study identified the measurement instrument of functioning as a possible factor contributing to heterogeneity (Ding and Zheng, 2022 ). Perhaps this study can give deeper insight into the relationship between psychological flexibility and functioning.…”

“…We divided countries into Eastern and Western according to their geographical distribution. If the measurement was used only in one effect size, it would be coded as “other” to reduce the number of dummy variables (Ding and Zheng, 2022 ). The dummy variables were mutually exclusive.…”

“…A three-level meta-analytic model was used to synthesize effect sizes and conduct moderator analyses (Cheung, 2014 ). This model can explore three sources of variance: sampling variance of the observed effect sizes (Level 1), the variance between effect sizes from the same study (Level 2), and variance between studies (Cheung, 2014 ; Ding and Zheng, 2022 ). The significant variance of level 2 and level 3 indicated a heterogeneous effect size distribution.…”

“…Psychological flexibility is established through six core ACT processes, i.e., acceptance, defusion, present moment, self-as-content, committed action, and values. In contrast, the opposite six dimensions constitute psychological inflexibility: lack of present moment awareness, lack of contact with values, inaction, self-as-content, fusion, and experiential avoidance (Hayes et al, 2006 ; Ding and Zheng, 2022 ).…”