The psychological flexibility model: A basis for integration and progress in psychological approaches to chronic pain management

Scientific models are like tools, and like any tool they can be evaluated according to how well they achieve the chosen goals of the task at hand. In the science of treatment development for chronic pain, we might say that a good model ought to achieve at least 3 goals: 1) integrate current knowledge, 2) organize research and treatment development activities, and 3) create progress. In the current review, we examine models underlying current cognitive behavioral approaches to chronic pain with respect to these criteria. A relatively new model is also presented as an option, and some of its features examined. This model is called the psychological flexibility model. This model fully integrates cognitive and behavioral principles and includes a process-oriented approach of treatment development. So far it appears capable of generating treatment applications that range widely with regard to conditions targeted and modes of delivery and that are increasingly supported by evidence. It has led to the generation of innovative experiential, relationship-based, and intensive treatment methods. The scientific strategy associated with this model seeks to find limitations in current models and to update them. It is assumed within this strategy that all current treatment approaches will one day appear lacking and will change. PERSPECTIVE: This Focus Article addresses the place of theory and models in psychological research and treatment development in chronic pain. It is argued that such models are not merely an academic issue but are highly practical. One potential model, the psychological flexibility model, is examined in further detail

The Dual Effects of Critical Thinking Disposition on Worry

This study investigated the relationship between disposition (people’s consistent motivation) toward critical thinking (CT) and worrying. In spite of its connection to psychopathology, worry is thought to represent an effort at problem-solving. Moreover, worry has been found to be underpinned by cognitive development, leading us to predict a positive relationship between worry and CT disposition. On the other hand, cognitive behavioral therapy, which involves techniques similar to CT, has been shown to be effective in reducing worrying, suggesting that increasing CT disposition decreases worrying. This study attempted to reconcile these seemingly contrasting predictions about the relationship between CT disposition and worrying by using multiple mediator analysis. A model was proposed wherein the mediators, responsibility to continue thinking and detached awareness of negative thinking, were related to two opposing predictions. The former is thought to lead to enhanced worrying and the latter to reduced worrying, with both positively related to CT disposition. A questionnaire study with university students (N = 760) revealed that CT disposition enhanced worrying by obliging people to continue thinking about a problem, but that it also reduced worrying by enhancing the detached and objective awareness of their negative thoughts. This study thus demonstrated the dual effects of CT disposition on worrying through different mediators. Thus, when enhancing CT disposition, it is important for educators to be aware of possible disadvantages apart from its worry-reducing effect. Future studies should therefore examine the underlying mechanisms of these two effects of CT disposition