The moderating roles of psychological flexibility and inflexibility on the mental health impacts of COVID-19 pandemic and lockdown in Italy

Abstract

The Moderating Roles of Psychological Flexibility and Inflexibility on the Mental Health Impacts of COVID-19 Pandemic and Lockdown in Italy. Preliminary data suggest the COVID-19 pandemic has adverse effects on mental health in approximately a quarter of the general population. Few prior studies have identified contextual risk factors and no published study has explored factors that might moderate their adverse effects on mental health. Psychological flexibility is the cornerstone of psychological health and resiliency. This study investigated the roles of psychological flexibility and inflexibility in moderating the effects of COVID-19 risk factors on three mental health outcomes: COVID-19 peritraumatic distress, anxiety, depression. We hypothesized that psychological flexibility would mitigate and psychological inflexibility would exacerbate the adverse effects of COVID-19 risk factors on mental health. During the Italian national lockdown ( M = 39.29 days, SD = 11.26), 1035 adults (79% female, M = 37.5 years, SD = 12.3) completed an online survey. Twelve COVID-19 risk factors were identified (e.g. lockdown duration, family infected by COVID-19, increase in domestic violence and in unhealthy lifestyle behaviours) and constituted a COVID-19 Lockdown Index. As predicted, results showed that after controlling for sociodemographic variables, global psychological flexibility and four of its sub-processes (self-as context, defusion, values, committed action), mitigated the detrimental impacts of COVID-19 risk factors on mental health. In contrast and as expected, global psychological inflexibility and four of its sub-processes (lack of contact with present moment, fusion, self-as-content, lack of contact with personal values) exacerbated the detrimental impacts of COVID-19 risk factors on mental health. Findings converge with those from the broader psychological flexibility literature providing robust support for the use of ACT-based interventions to promote psychological flexibility and mental health during the COVID-19 pandemic.

Health Anxiety and Mental Health Outcome During COVID-19 Lockdown in Italy: The Mediating and Moderating Roles of Psychological Flexibility

“…In view of the adverse mental health impacts of COVID-19 and associated lockdowns and of the lingering negative psychosocial effects of prior pandemics (e.g., SARS; Hawryluck et al, 2004 ; Taylor, 2019 ), it is essential that effective public health interventions are developed to bolster resilience and promote wellbeing during and in the aftermath of such health crises. Such interventions should target psychological flexibility given the findings from the present study and those from other research indicating that psychological flexibility moderates the adverse impacts of COVID-19 contextual risk factors ( Pakenham et al, 2020 ). Public health ACT-based interventions designed to strengthen psychological flexibility have been shown to promote mental health in a variety of populations using flexible modes of delivery in various contexts: university students via online delivery ( Viskovich and Pakenham, 2020 ), cancer patients via phone ( Hawkes et al, 2014 ), Sudanese refugees using audio-recorded stress-management workshops and a self-help book ( Tol et al, 2020 ), and health anxiety patients via group delivery ( Eilenberg et al, 2016 ).…”

“…Although values, self-as-context, and present moment awareness were significantly associated with better mental health at the bivariate level, these psychological flexibility processes did not emerge as significant mediators or moderators in the link between trait health anxiety and the mental health outcomes. However, in another study values and self-as-context significantly moderated the adverse effects of COVID-19 risk factors on mental health, and the inverse of present moment awareness exacerbated the negative impacts of these contextual factors ( Pakenham et al, 2020 ). It is likely that the prominence and roles of the six contextually sensitive and dynamic psychological flexibility processes will vary according to the nature of the corresponding independent variables and situational factors investigated within a given model.…”

“…We found no published theoretical or empirical data on either the mediating or moderating role of psychological flexibility in the link between health anxiety and mental health outcomes in general, or in the context of a pandemic. However, in the broader literature psychological flexibility has been examined as both a mediator and a moderator ( Masuda et al, 2011 ; Fischer et al, 2016 ; Novaes et al, 2018 ; Makriyianis et al, 2019 ; Ramaci et al, 2019 ; Pakenham et al, 2020 ). Studies that have examined psychological flexibility as a mediator have in the main tested models where the independent variable is typically a stable personality characteristic or a risk factor related to a personality trait (e.g., self-concealment, Masuda et al, 2011 ; early maladaptive schemas, Fischer et al, 2016 ; adverse childhood experiences, Makriyianis et al, 2019 ), and the dependent variable is a mental health outcome, most frequently depression or anxiety.…”

“…Alternatively, studies that have examined psychological flexibility as a moderator have mostly tested models where the independent variable is a contextual risk factor rather than a personality characteristic, including work stressors ( Ramaci et al, 2019 ), job demands ( Novaes et al, 2018 ), and COVID-19 risk factors ( Pakenham et al, 2020 ). Regarding the latter, psychological flexibility mitigated the adverse effects of COVID-19 pandemic and lockdown risk factors on mental health via a moderation pathway.…”

The Psychological Effect of COVID-19 and Lockdown on the Population: Evidence from Italy

“…Additional research identified moderating variables that have an impact on reported mental health during the lockdown (Pakenham et al, 2020). This study included a measure of psychological flexibility described as the ability to adapt to changing situation with a resilient attitude.…”