Background & Aims

Based on available evidence, Acceptance and Commitment Therapy (ACT) provides benefits for people with chronic pain. Understanding the mechanisms of change underlying these benefits requires the ability to assess these mechanisms. In the case of ACT, the theoretically proposed mechanisms include facets of psychological flexibility, also referred to as the “Hexaflex” model. The Multidimensional Psychological Flexibility Inventory (MPFI) and Psy-Flex are newly developed instruments designed to comprehensively reflect this model. The purpose of this study was to adapt the short form of the MPFI (MPFI-24) and the complete Psy-Flex to Spanish and to examine their reliability and construct validity.

Methods

In this cross-sectional study, 309 Spanish-speaking adults with chronic pain completed an online survey administered via Qualtrics. The participants were mainly women (88.3%) with longstanding chronic pain (> 3 months) and moderate-to-high pain intensity and interference. Confirmatory Factor Analyses (CFAs) with a diagonally weighted least squares (WLSMV) estimation method were conducted to assess dimensionality. In addition to Cronbach’s ?, McDonald’s ? was used to investigate the reliability of the MPFI-24 and Psy-Flex. Convergent validity was estimated by calculating Pearson correlation coefficients between the MPFI-24, Psy-Flex, CPAQ (chronic pain acceptance), PIPS (psychological inflexibility in pain), BPI-SF (pain interference), PCS (pain catastrophizing), TSK (pain-related fear), HADS-A (anxiety), HADS-D (depression), and HADS-T (general distress). Finally, the incremental validity of the MPFI-24 and Psy-Flex scores relative to the CPAQ and PIPS was investigated.

Results

Factor analysis showed that the Spanish version of the MPFI-24 includes twelve factors (six factors of flexibility and six factors of inflexibility), similar to the original version, but without second-order general factors. Additionally, the Psy-Flex includes one factor (one general factor of psychological flexibility), as in the original version. Overall, both scales showed good reliability and adequate convergent validity, except for the MPFI-Acceptance, MPFI-Present Moment Awareness, and MPFI-Experiential Avoidance subscales. Finally, the MPFI-24 and Psy-Flex scores significantly explained additional variance in psychological distress and pain interference beyond other ACT-related tools for measuring Hexaflex processes.

Conclusions

In conclusion, the MPFI-24 and Psy-Flex appear to be reliable and valid instruments for assessing the Hexaflex model processes in Spanish-speaking adults with chronic pain.

References

Feliu-Soler, A., Montesinos, F., Gutiérrez-Martínez, O., Scott, W., McCracken, L. M., & Luciano, J. V. (2018). Current status of acceptance and commitment therapy for chronic pain: A narrative review. Journal of Pain Research, 2145-2159. https://doi.org/ 10.2147/JPR.S144631
Gloster, A. T., Block, V. J., Klotsche, J., Villanueva, J., Rinner, M. T., Benoy, C., Walter, M., Karekla, M., & Bader, K. (2021). Psy-Flex: A contextually sensitive measure of psychological flexibility. Journal of Contextual Behavioral Science, 22, 13-23. https://doi.org/10.5451/unibas-ep84813
Gregoire, S., Gagnon, J., Lachance, L., Shankland, R., Dionne, F., Kotsou, I., Monestès, J-L., Rolffs, J. L., & Rogge, R. D. (2020). Validation of the English and French versions of the multidimensional psychological flexibility inventory short form (MPFI-24). Journal of Contextual Behavioral Science, 18, 99-110. https://doi.org/10.1016/j.jcbs.2020.06.004
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1-25. https://doi.org/10.1016/j.brat.2005.06.006
Rolffs, J. L., Rogge, R. D., & Wilson, K. G. (2018). Disentangling Components of Flexibility via the Hexaflex Model: Development and Validation of the Multidimensional Psychological Flexibility Inventory (MPFI). Assessment, 25(4), 458–482. https://doi.org/10.1177/1073191116645905
Sundström, F. T., Lavefjord, A., Buhrman, M., & McCracken, L. M. (2023). Assessing psychological flexibility and inflexibility in chronic pain using the multidimensional psychological flexibility inventory (MPFI). The Journal of Pain, 24(5), 770-781. https://doi.org/10.1016/j.jpain.2022.11.010

Presenting Author

Jaime Navarrete

Poster Authors

Jaime Navarrete

PhD

Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan De Déu

Lead Author

Carla Rodríguez-Freire

MD

Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan De Déu

Lead Author

Juan P. Sanabria-Mazo

MD

Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan De Déu

Lead Author

Lance McCracken

Uppsala University

Lead Author

Jordi Alonso

Dr.

Health Services Research Unit, Hospital del Mar Research Institute Barcelona (IMIM)

Lead Author

Albert Feliu-Soler

PhD

Department of Clinical and Health Psychology, Autonomous University of Barcelona

Lead Author

Juan V Luciano

Department of Clinical and Health Psychology, Autonomous University of Barcelona

Lead Author

Topics

  • Assessment and Diagnosis