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Abstract

Psychological flexibility is the tendency to respond to situations in ways that facilitate valued goal pursuit. Psychological flexibility is particularly useful when challenges arise during goal pursuit that produce distress. In acceptance and commitment therapy, psychological flexibility is considered the pinnacle of emotional health and well-being. A growing body of research demonstrates that psychological flexibility leads to psychological benefits and adaptive behavior change. Yet, much of what we know, or think we know, about psychological flexibility hinges on a single measurement approach using the Acceptance and Action Questionnaire (AAQ and AAQ-II). Research suggests the AAQ-II is highly correlated with distress itself rather than flexible responses to distress. Existing approaches that assess psychological flexibility ignore the context in which flexibility matters most: the pursuit of valued goals. Below, we review theory and research on psychological flexibility, including its associations with healthy functioning, its measurement, and its overlap with related constructs. We discuss how gaps between theory and measurement impede our understanding and review promising evidence for a new measure of psychological flexibility. We provide new research directions in an effort to create a more generalizable foundation of knowledge. Soc Personal Psychol Compass. 2020;e12566. wileyonlinelibrary.com/journal/spc3
Received: 8 June 2020
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Revised: 23 August 2020
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Accepted: 4 September 2020
DOI: 10.1111/spc3.12566
RESEARCH ARTICLE
Psychological flexibility: What we know, what
we do not know, and what we think we know
James D. Doorley
1
|Fallon R. Goodman
2
|Kerry C. Kelso
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Todd B. Kashdan
1
1
Department of Psychology, George Mason
University, Fairfax, Virginia, USA
2
Department of Psychology, University of
South Florida, Tampa, Florida, USA
Correspondence
James D. Doorley, Department of
Psychology, George Mason University, Mail
Stop 3F5, Fairfax, VA 22030, USA.
Email: jdoorley@gmu.edu
Abstract
Psychological flexibility is the tendency to respond to
situations in ways that facilitate valued goal pursuit.
Psychological flexibility is particularly useful when chal-
lenges arise during goal pursuit that produce distress. In
acceptance and commitment therapy, psychological flexi-
bility is considered the pinnacle of emotional health and
wellbeing. A growing body of research demonstrates that
psychological flexibility leads to psychological benefits and
adaptive behavior change. Yet, much of what we know, or
think we know, about psychological flexibility hinges on a
single measurement approach using the Acceptance and
Action Questionnaire (AAQ and AAQII). Research sug-
gests the AAQII is highly correlated with distress itself
rather than flexible responses to distress. Existing ap-
proaches that assess psychological flexibility ignore the
context in which flexibility matters most: the pursuit of
valued goals. Below, we review theory and research on
psychological flexibility, including its associations with
healthy functioning, its measurement, and its overlap with
related constructs. We discuss how gaps between theory
and measurement impede our understanding and review
promising evidence for a new measure of psychological
flexibility. We provide new research directions in an effort
to create a more generalizable foundation of knowledge.
Soc Personal Psychol Compass. 2020;e12566. wileyonlinelibrary.com/journal/spc3 © 2020 John Wiley & Sons Ltd.
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https://doi.org/10.1111/spc3.12566
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INTRODUCTION
Psychological science, at its best, gives us a roadmap for responding to life's challenges: navigating relationships,
organizing ourselves in groups, learning and working effectively, and combating injustice. After decades and bil-
lions of dollars spent, perhaps our best answer is, “it depends.” Effective responses to life's challenges vary
depending on fluctuating situational contingencies, including our goals, and can be easily thwarted by distress.
Recently, theorists have attempted to synthesize existing literature on optimal stress responses to build contextual
models of emotion regulation. Instead of identifying a single optimal regulatory strategy across space and time,
these new frameworks—primarily rooted in social psychological research on emotion regulation and clinical
psychological research on acceptance and commitment therapy (ACT)—outline optimal responses to distress in the
context of meaningful goal pursuit.
Within these frameworks, life's challenges and resulting distress are not the primary obstacles to wellbeing;
instead, a focus on escaping these experiences prohibits valuesbased activity and diminishes wellbeing over time.
When we feel anxious about starting an important project, we scroll through social media. When we feel sad or
lonely, we comfort ourselves with excessive food, alcohol, or other substances. When we feel regret, we spend
hours mulling over the past, failing to connect with the world around us. Too often, our strategies to cope with life's
challenges, while providing momentary relief, bring us further away from the life we want. Flexible responses to
these challenges are essential for promoting longterm wellbeing.
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UNDERSTANDING PSYCHOLOGICAL FLEXIBILITY AND ITS ROLE IN
HEALTHY FUNCTIONING
We operationalize psychological flexibility as the tendency to respond to situations in ways that facilitate valued goal
pursuit, and we argue that psychological flexibility is most important in situations that are challenging and provoke
distress. This definition captures Hayes et al. (2004a) and Hayes, Strosahl, Bunting, Twohig, & Wilson (2004b, p. 15)
original conceptualization of psychological flexibility as “the ability to change or persist with functional behavioral
classes when doing so serves valued ends” while focusing on the specific contexts in which being flexible is crucial for
healthy functioning: challenging situations that would otherwise disrupt valued living. Consistent with psychological
flexibility theory (Hayes et al., 2004a,2004b), this framework does not assume that reducing distress is the desired
outcome of a regulatory response. Reducing distress is only functional to the extent that doing so facilitates the pursuit
of selfendorsed, meaningful, valued goals. Research on psychological flexibility and related constructs has increased
exponentially in recent years, pointing to the central role of psychological flexibility in healthy functioning.
To date, most research on psychological flexibility has been conducted in the context of ACT. Although psy-
chological flexibility is at the core of ACT theory and psychotherapeutic interventions, the majority of this research
explores the opposite of psychological flexibility: psychological inflexibility. Psychological inflexibility is associated
with a staggering number of constructs including, but not limited to, depression, anxiety, stress, substance abuse,
negative body image, disordered eating, pain catastrophizing, thought suppression, job burnout, and work absen-
teeism (e.g., Bluett et al., 2016; Bond et al., 2011; de Boer, Steinhagen, Versteegen, Struys, & Sanderman, 2014;
Lloyd, Bond, & Flaxman, 2013; Luoma, Drake, Kohlenberg, & Hayes, 2011). This focus on inflexibility rather than
flexibility is perhaps not surprising—clinical psychology has a long history of research on symptoms, syndromes, and
deficits, and most psychotherapies are designed to alleviate distress. While studies on the benefits of high psy-
chological flexibility are less abundant, data point to positive associations between psychological flexibility and self
compassion, job performance and satisfaction, and overall wellbeing (e.g., Bond, Hayes, & BarnesHolmes, 2006;
Kashdan & Rottenberg, 2010; Yadavaia, Hayes, & Vilardaga, 2014).
ACT outcome studies and clinical trials also point to the benefits of psychological flexibility. These studies
suggest that ACT is an effective treatment for numerous presenting problems, including depression, chronic pain,
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anxiety, posttraumatic stress disorder, obsessivecompulsive disorder, trichotillomania, psychosis, and substance
use (e.g., Arch et al., 2012; Gaudiano & Herbert, 2006; Hann & McCracken, 2014; Lee, An, Levin, & Twohig, 2015;
Lee et al., 2020; Twohig et al., 2010; Zettle, Rains, & Hayes, 2011). Several metaanalyses suggest that, across
dozens of studies and hundreds of patients, ACT is more effective than waitlist and placebo conditions and at least
as effective as goldstandard cognitive behavioral interventions (e.g., Atjak et al., 2015; Jiménez, 2012; Levin,
Hildebrandt, Lillis, & Hayes, 2012; Powers, Vörding, & Emmelkamp, 2009). Importantly, ACT and similar mindful-
ness and acceptancebased interventions produce therapeutic change through psychological flexibility, their
theoretically proposed mechanism of action (Jiménez, 2012; Levin et al., 2012).
The data are promising. Yet there is a notsohidden problem in this large body of work. Nearly the entire
literature on the effectiveness of ACT interventions and the causes and consequences of psychological flexibility
hinge on the use of a single measure, the Acceptance and Action Questionnaire (AAQI and II), which has significant
limitations (e.g., Rochefort, Baldwin, & Chmielewski, 2018; Tyndall et al., 2019; Wolgast, 2014). In addition to
reliance on one measure, a lack of conceptual clarity furthers muddy our understanding of psychological flexibility.
We must define what psychological flexibility is and is not in order to accurately assess its role in our lives. To do so,
we must move beyond a narrow focus on clinical psychological literature (primarily ACTbased intervention work)
and examine the broader landscape of social psychology and personality theory to integrate constructs similar to
yet distinct from psychological flexibility.
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DISENTANGLING PSYCHOLOGICAL FLEXIBILITY FROM RELATED CONSTRUCTS
While the term “psychological flexibility” is relatively new (Hayes et al., 2004a,2004b), its origins are not (Block, 1961).
Multiple constructs describe how a person adapts their thoughts, feelings, and behaviors to a given situation and
whether their actions align with what is important to them (Aldao, Sheppes, & Gross, 2015; Duckworth, Peterson,
Matthews, & Kelly, 2007; Kashdan & Rottenberg, 2010; Snyder et al., 1991a). Executive functioning, for example,
entails mental processes involved in selfmanagement (Goldstein & Naglieri, 2014), including the capacity to shift back
and forth between mental sets, to inhibit impulsive responses, and to maintain and update relevant contextual in-
formation. These processes are considered essential to selfcontrol (i.e., inhibiting impulsive responses) and self
regulation (i.e., reducing discrepancies between actual and desired thoughts, feelings, and behaviors; Hofmann,
Schmeichel, & Baddeley, 2012), which are the building blocks of psychological flexibility (Kashdan & Rottenberg, 2010).
Hope is similar to psychological flexibility, capturing the belief that one can initiate effort toward goals (the agency
dimension) and if obstacles arise, consider and pursue alternatives (the pathways dimension; Snyder, Irving, &
Anderson, 1991b). Unlike psychological flexibility, hope theory does not specifically focus on uncomfortable emotions
and other forms of distress as barriers to valued goal pursuit. Grit entails passionate interest in and persistence to-
wards longterm goals (Duckworth et al., 2007), but time spent working towards a goal is not necessarily correlated
with its perceived importance. The Grit Scale prompts respondents to think about “a goal that took years of work”
(Duckworth et al., 2007). While longterm goals are often important, unimportant goals often take a long time. A
person may spend years working towards a goal, such as paying off exorbitant student loans, but “being debt free” may
not deeply matter to them. Grit is sometimes described as entailing “passion” for goals, although the original and
shortened grit scales appear to measure longterm consistency of interests in a goal (e.g., “New ideas and projects
sometimes distract me from previous ones” [reversedscored]) rather than passion (Duckworth et al., 2007; Duckworth &
Quinn, 2009). Taken together, the above constructs are related but distinct from psychological flexibility because they
do not describe how a person flexibly responds to emotional experiences in service of valued goals.
Psychological flexibility draws from social psychological research on emotion regulation. A prevailing
assumption in this work is that people are motivated to feel less negative and more positive emotions (e.g., Tice,
Baumeister, & Zhang, 2004). While this is often true (e.g., Riediger, Schmiedek, Wagner, & Lindenberger, 2009),
there are certain contexts in which people might have stronger preferences for negative emotions (e.g., anger
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before a negotiation: Tamir, Ford, & Ryan, 2013). Moreover, people may not regulate their emotions only to obtain
a particular emotional state (i.e., hedonic motives); they may pursue this emotional state in service of another
superordinate goal (i.e., instrumental motives; Tamir, 2016). For example, an athlete may upregulate feelings of anger
or an uncomfortable desire to seek revenge in order to enhance motivation and arousal prior to competition. In this
situation, her primary goal is not to feel particular emotions; her primary goal is to harness whatever emotions she
believes are necessary to achieve her goal. The logic underlying psychological flexibility is similar: emotion regu-
lation strategies are adaptive to the extent that they facilitate pursuit of valued goals. Unfortunately, existing
psychological flexibility measures fail to map onto this rich theory, as they do not capture the instrumental use of
psychological distress for valued goal achievement (i.e., harnessing). They also ignore the specific, valued goals of
respondents, which provide the very context for why people are willing to be flexible in the face of distress (Hayes,
Strosahl, & Wilson, 2011a; Hayes, Villatte, Levin, & Hildebrandt, 2011b).
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WHAT WE KNOW ABOUT PSYCHOLOGICAL FLEXIBILITY HINGES ON
FAULTY MEASUREMENT
Psychological flexibility is plagued by faulty measurement (e.g., Chawla & Ostafin, 2007; Rochefort et al., 2018;
Tyndall, et al., 2019; Wolgast, 2014). The original AAQI (Hayes et al., 2004a,2004b) was designed to measure
experiential avoidance (EA), defined as an unwillingness to remain in contact with aversive internal experiences
(e.g., thoughts, memories, bodily sensations). The AAQI items capture several constructs similar to and distinct
from this definition of EA, including thought suppression (e.g., “I try to suppress thoughts and feelings that I don't like by
just not thinking about them”), broad functional impairment instead of impaired values pursuit (e.g., “When I feel
depressed or anxious, I am unable to take care of my responsibilities”), and beliefs about emotions (e.g., “anxiety is bad”).
Each of these constructs has been operationalized with their own validated measures (e.g., Tsai & Knutson, 2006;
Ware, Kosinski, & Keller, 2001; Wegner & Zanakos, 1994). Despite its many facets, the AAQ1 is scored with a
single total score, which may account for its modest internal consistency (e.g., αs<0.50; Zvolensky, Feldner, Leen
Feldner, & Yartz, 2005). Further, data suggest that the AAQI measures a construct more similar to negative
emotionality than a person's response to negative emotionality (Chawla & Ostafin, 2007; Zvolensky et al., 2005).
The revised AAQII emerged in response to these criticisms but has similar problems. Item content is still
conflated with broad functional impairment (e.g., “Emotions cause problems in my life,” “It seems like most people are
handling their lives better than I am”). The AAQII has demonstrated validity problems, including high correlations
with measures of psychological distress (e.g., 0.70–0.71 correlations between the AAQII and the Beck Depression
Inventory (BDI); Bond et al., 2011; Rochefort et al., 2018; Tyndall et al., 2019; Wolgast, 2014). It is no wonder that
the AAQII correlates with nearly every manifestation of psychopathology (Bond et al., 2011).
Valued goals are integral to the definition of psychological flexibility. Hayes et al. (2011a,2011b) define
psychological flexibility as flexible contact with the present moment while acting in the service of chosen values.
Existing psychological flexibility measures may mention values abstractly but do not assess responses to distress in
the context of valued goal pursuit. For instance, two AAQII items reference valued living either in a hypothetical,
futureoriented manner (“my painful experiences and memories make it difficult for me to live a life that I would value”) or
broadly construe it as a “meaningful life” (“my painful memories prevent me from having a meaningful life”; Bond et al.,
2011), which includes other components in addition to values (Krause & Hayward, 2014). Values are treated with
similar abstraction in new measures of psychological flexibility, including the comprehensive assessment of
acceptance and commitment therapy (e.g., “My values are really reflected in my behavior”; Francis, Dawson, & Golijani
Moghaddam, 2016) and the Multidimensional Psychological Flexibility Inventory (e.g., “Negative experiences derailed
me from what's really important;” Roffs, Rogge, & Wilson, 2018).
It is worth contemplating the mental burden placed on participants to calculate the contribution of past painful
memories to a hypothetical future (as with the AAQII). We know from existing field and laboratory studies that
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humans are exceptionally poor at predicting the valence, quality, and duration of upcoming psychological experi-
ences (e.g., Wilson & Gilbert, 2005). These types of items decrease the probability that measures are capturing the
intended construct. Further, none of these scales incorporate aspects of instrumental emotion regulation (Tamir,
2016; Tamir et al., 2013), representing the use of emotions as tools for obtaining desired ends.
Researchers have attempted to broaden the scope of psychological flexibility measures by creating population/
disorder specific versions of the AAQII, of which there are now at least 20 (e.g., for the workplace, tinnitus, irritable
bowel syndrome, exercise, and epilepsy). While a review of disorderspecific AAQII variants points to favorable
incremental validity beyond the general AAQII in their designated focus areas (Ong, Lee, Levin, & Twohig, 2019),
authors also note that the often inadequate attempts at scale validation. As a range of nonclinicians recognize the
importance of psychological flexibility (e.g., businesspeople, educators, athletes, medical professionals, and the
general public), creating a different measure of psychological flexibility for every relevant group is not only
unsustainable, but further hinders conceptual clarity and generalizability across disciplines. Consistent with the
construct itself, psychological flexibility measures must be designed with flexibility in mind in order to facilitate
reliable use across a diverse set of contexts and populations.
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THE PERSONALIZED PSYCHOLOGICAL FLEXIBILITY INDEX
Attempting to address these gaps, we created the Personalized Psychological Flexibility Index (PPFI; Kashdan,
Disabato, Goodman, Doorley, & McKnight, 2020). Rather than measuring distress itself or vague consequences of
negative emotions (e.g., “Emotions cause problems in my life;” Bond et al., 2011), the PPFI asks respondents to think
about a presently important goal and answer questions about how they respond to the distress that arises while
pursuing this goal (cf. Feldman, Rand, & KahleWrobleski, 2009). When creating the PPFI items, we sought to
capture flexible responses to distress that are central to early psychological flexibility conceptualizations: avoid-
ance and acceptance of distress. We also drew from emotion regulation literature to capture active engagement
with distress as a means to facilitate goal pursuit: harnessing. We conceptualize harnessing as using distress
instrumentally to stay focused, motivated, and energized while pursuing important life aims.
Consider the value of harnessing in the following scenario. A job applicant feels anxious three weeks prior to an
interview for his dream position. He can avoid this anxiety, and in doing so, ignore necessary preparation and
decrease his chances of success. He can accept this anxiety and, remembering how much he wants the job, trudge
ahead with preparation despite discomfort (in line with traditional psychological flexibility conceptualizations;
Hayes et al., 2011a,2011b). But better still, he can use this anxiety to amplify his goal pursuit. Moderate levels of
anxiety might help him attend to important details in researching the new position, combat inactivity, and stay
mentally engaged during a taxing day of interviews. After all, moderate emotional/physiological arousal (compared
to none) facilitates task performance in a range of contexts (e.g., Anderson, 1994; Waters et al., 1997). If we cannot
control the presence of negative emotions and other potential barriers to goal pursuit, perhaps the best we can do
is creatively use them to our advantage.
Preliminary evidence shows that the PPFI total and subscale scores (avoidance, acceptance, and harnessing)
predict conscientiousness, grit, distress tolerance, subjective happiness, life satisfaction, purpose and meaning in
life, psychological needs satisfaction, depression, generalized anxiety, and social anxiety (Kashdan et al., 2020).
Compared to the AAQII and Brief Experiential Avoidance Questionnaire (BEAQ), the PPFI is a stronger predictor
of outcomes central to psychological flexibility theory. This includes effective daily goal pursuit (e.g., effort and
success, pursuing daily goals closely aligned with one's purpose in life), effective pursuit of broader personal
strivings (e.g., feelings of competence, joy, and meaning while pursuing strivings; e.g., Emmons, 1986; Little, 1989),
and wideranging emotion regulation strategy use in response to daily stressors (e.g., reappraisal, perspective
taking, problem solving, and benefit finding).
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In contrast to the AAQII, several analyses demonstrate that the PPFI is not conflated with negative
emotionality. First, correlations between the PPFI and psychopathology were moderate. Second, multilevel models
containing both the AAQII and PPFI revealed only the AAQII predicted unique variance in daily negative emo-
tions. Third, an exploratory factor analysis demonstrated that the PPFI subscales load onto their own factor,
separate from a second factor that contained negative emotionality (e.g., neuroticism, negative affect, and
depression), the AAQII, and the BEAQ (Kashdan et al., 2020).
Preliminary results for the PPFI are promising, but potential limitations are worth noting. Since psychological
flexibility scores are tied to idiographic goals, researchers must be careful about generalizing across populations
and goal content. The nature and prioritization of a person's goals may change over time, leading to more unstable
psychological flexibility scores over longer time frames (which will differ from the test–retest correlations and
trajectories of traditional personality assessments). Goals can be expected to vary substantially between people as
well, and this variance may contribute to observed differences in PPFI scores. Goal fluidity and heterogeneity may
provide promising new avenues for research, however. With idiographic measures like the PPFI, new questions can
be asked about the value of goal consistency over time and in specific life circumstances or transitions (e.g., Sheldon
& Kasser, 1995,2001) and whether the nature/quality of goals can facilitate or hinder psychological flexibility
(specific vs. vague, long vs. shortterm, and self vs. otheroriented). More research is needed to fully understand the
value of integrating qualitative and quantitative approaches into measurement, areas for refinement, and appli-
cations to clinical, social, occupational, developmental, crosscultural, and other contexts.
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FUTURE DIRECTIONS FOR THE STUDY OF PSYCHOLOGICAL FLEXIBILITY
We believe the PPFI represents a promising step forward, but there is plenty of work to do. We are creating a
revised PPFI that goes beyond linking each item to a person's idiographic goals. In this next iteration, participants
endorse their most important values and rate their idiographic goal in terms of these values. We are testing
algorithms to determine how much a person is being flexible in response to distress in the pursuit of deeply valued
goals (i.e., weighting total scores based on valuegoal congruence). Perhaps psychological flexibility is more
beneficial when there is greater harmony between values and chosen goals. The content of values may also be
important (e.g., What are the consequences of flexibly responding to goalrelated distress in the service of power or
achievementbased values compared to values related to equality or security?).
Only recently has research examined the utility of emotions to facilitate goal pursuit. The PPFI harnessing sub-
scale predicted greater daily goal difficulty, goal effort, and a wider range of daily emotion regulation strategies than
avoidance and acceptance subscales (Kashdan et al., 2020). Perhaps high harnessing scorers are more skilled at
choosing functional regulatory strategies based on dynamic situational contingencies. Indeed, research shows that
expressive suppression, often considered a “maladaptive” strategy, is beneficial in certain contexts (e.g., Burton &
Bonanno, 2016). While a small literature supports the benefits of harnessing (e.g., Tamir, Mitchell, & Gross, 2008;
Tamir & Ford, 2009), we know little about individual differences that explain why people are more or less inclined to
harness. People do not simply experience emotions; they have personality traits (e.g., Eldesouky & English, 2019),
certain beliefs about emotions (e.g., Kneeland, Goodman, & Dovidio, 2020), and emotional sensitivities (e.g., McHugh,
Reynolds, Leyro, & Otto, 2013) that influence how they respond to different emotional experiences. More research is
needed on the antecedents, interpersonal consequences, and momentary use of harnessing during goal pursuit.
Psychological flexibility involves choosing appropriate selfregulatory strategies for a given context. The
implications of psychological flexibility for functioning in social interactions, however, remain poorly understood.
This is disconcerting given that social interactions are omnipresent for humans. Theory suggests people high on
emotion regulation flexibility are wellattuned to social cues in choosing regulatory strategies (e.g., Bonanno &
Burton, 2013). In contrast, people with high social anxiety, who are often socially impaired (e.g., Kashdan & Wenzel,
2005; Rodebaugh et al., 2014), show signs of inflexible emotion regulation—overrelying and placing considerable
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value on controlling, avoidance, and concealing their emotions regardless of situational cues (Daniel et al., in press;
Dryman & Heimberg, 2018; Goodman, Kashdan, & İmamoğlu, in press; Goodman, Kashdan, Stiksma, & Blalock,
2019; O'Toole, Zachariae, & Mennin, 2017). There is reason to believe psychological flexibility and social func-
tioning covary, but causal links are unclear. Perhaps psychological flexibility and social skills are both influenced by
other variables such as cognitive and attentional flexibility or reward and punishment sensitivities. In theory,
psychologically flexible people should skillfully manage the intricacies, uncertainties, and emotional challenges of
socializing. Researchers can explore links among psychological flexibility, emotional/social intelligence, wisdom, as
well as how psychologically flexible people perform through the lens of other people and objective metrics.
Intrapersonal phenomena, including psychological flexibility, are insufficiently explored interpersonally. What is
it like to be in a romantic relationship with a psychologically flexible partner? Work for a psychologically inflexible
employer? What happens when your best friend's psychological flexibility levels are one standard deviation below
your own? What do the social networks of highly psychologically flexible people look like and how do they differ
from the average person? We are beginning to learn more about the interpersonal consequences of psychological
phenomena that explicitly involve other people, such as social anxiety (e.g., Kashdan, Volkmann, Breen, & Han,
2007; Stevens & Morris, 2007; Van Zalk, Van Zalk, Kerr, & Stattin, 2011), but more work must be done to un-
derstand the social implications of psychological flexibility. Psychological flexibility can build off and extend new
models in affective science that detail how and why emotion regulation is an interpersonal process that must be
studied accordingly (Zaki & Williams, 2013). Beyond studying psychological flexibility within an interpersonal
framework, future research can examine how psychological flexibility influences distress in the context of re-
lationships and discrete social interactions (e.g., Hofmann, 2014). Researchers must explore these questions if we
wish to expand the nomological network of psychological flexibility into the social realm.
One way to understand the interpersonal processes related to psychological flexibility is to diversify measure-
ment approaches. Ecologically valid methods, such as experiencesampling, facilitate the study of psychological
flexibility in social situations and other contexts. Psychological flexibility is most frequently explored as an outcome or
mechanism of action in clinical treatment (e.g., with the AAQ) rather than a component of daily life. Experience
sampling may be superior to trait measures because psychological flexibility is, by definition, dynamic (e.g., based on
what a given situation affords, either persisting or changing in behaviors in the service of chosen values; Hayes et al.,
2011a,2011b). For example, research using the day reconstruction method (Kahneman, Krueger, Schkade, Schwarz, &
Stone, 2004) suggests psychological flexibility is associated with a wider range of daily emotion regulation strategies
and greater daily goalrelated difficulty, progress, effort, joy, and meaning (Kashdan et al., 2020).
Future research can expand upon this work by exploring interactions between daily situations and chosen
regulatory strategies to test whether psychological flexibility entails better selfregulation in response to a
changing environment. Experiencesampling is ideal for exploring the degree to which daily behaviors, such as
coping strategies or communication patterns, facilitate valued living (often termed “workability”; Harris, 2019).
Creating validated momentary measures of psychological flexibility is a promising next step to facilitate this work.
While research suggests stable individual differences, psychological flexibility, like other traits, likely varies within
people from day to day or even moment to moment. Perhaps levels of momentary psychological flexibility depend
on the salience of chosen goals or values in a given situation. Maybe psychological flexibility is more predictive of
goal achievement and sense of meaning in life in certain daily contexts compared to others (e.g., when experiencing
low mood, surrounded by people with high psychological flexibility, or facing a goalrelated challenge).
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CONCLUSION
As interest in psychological flexibility grows, we must take stock of what is known, what is misunderstood, and how
to move forward. Psychological flexibility has roots in social psychology (e.g., selfcontrol, hope theory, and emotion
regulation), but since this term first appeared in the clinical literature (Hayes et al., 2004a,2004b), it has been
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researched predominantly therein. We know that treatments targeting psychological flexibility (ACT, primarily) are
effective in enhancing mental health and wellbeing. Although, unlike virtually any other psychological construct,
psychological flexibility is recognized almost exclusively within a single therapeutic intervention. The potential for
psychological flexibility is far greater. To demonstrate this potential to other fields, we must conceptualize and
measure psychological flexibility in ways that facilitate widespread adoption. This starts with valid measures that
assess a wide spectrum of flexible responses and capture flexibility in the context of values and valued goals. With
new measurement approaches, the time is ripe to extend and bolster research on psychological flexibility in social
and personality psychology and beyond.
CONFLICT OF INTEREST
We have no conflicts of interest to disclose.
ORCID
Kerry C. Kelso https://orcid.org/0000-0002-3286-2823
Todd B. Kashdan https://orcid.org/0000-0001-6438-0485
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AUTHOR BIOGRAPHIES
Jim Doorley is a doctoral candidate in Clinical Psychology at George Mason University. His research focuses on
psychological flexibility, wellbeing, resilience, and their application to athletes. Jim is also a clinical fellow in
psychology at Massachusetts General Hospital where he researches and applies mindbody interventions for
patients with neurological disorders, orthopedic injuries, and other chronic medical conditions. He received his
B.A. in Psychology from the University of Massachusetts Amherst.
Fallon Goodman is an Assistant Professor in the Department of Psychology and directs the Emotion and
Resilience Laboratory at the University of South Florida. Her research explores connections between anxiety
and wellbeing, including identifying barriers to social connection and strategies for mitigating loneliness and
rejection. She earned her B.S from the University of Maryland and Ph.D. from George Mason University, and
she completed her predoctoral clinical training at Harvard Medical School.
Kerry C. Kelso is a doctoral candidate in Clinical Psychology at George Mason University. Currently she is
interested in sources of risk and resilience in anxiety including experiential avoidance, psychological flexibility,
meaning in life, and purpose in life. She aims to understand the nuances of these relationships and how they
unfold over time with the ultimate goal of identifying targets for anxiety prevention and intervention. She
earned a B.A. in Psychology at University of North Carolina at Chapel Hill and M.A. in Clinical Psychology at
Appalachian State University.
Todd B. Kashdan is a Professor in the Department of Psychology at George Mason University. He has published
over 200 peerreviewed journal articles, mostly on the intersection of wellbeing and emotional disturbances,
including the nature of curiosity, meaning and purpose in life, psychological strengths, and resilience. His books
include The Upside of Your Dark Side (2014) and Curious? Discover the Missing Ingredient to a Fulfilling Life (2009).
He received a B.S in Human Service Studies from Cornell University, and a Ph.D. in Psychology from the
University of New York at Buffalo.
How to cite this article: Doorley JD, Goodman FR, Kelso KC, Kashdan TB. Psychological flexibility: What we
know, what we do not know, and what we think we know. Soc Personal Psychol Compass. 2020;e12566.
https://doi.org/10.1111/spc3.12566
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... The potential for psychological flexibility is far greater. Doorley et al., 2020 From an experimental point of view, few studies seem to have been interested in the possible links between different notions such as cognitive flexibility and psychological flexibility and whose tools also seem not to currently allow for a clear convergence of concepts and measuring building blocks of psychological flexibility (cognitive, behavioral, affective) (Palm & Follette, 2011;Johnco et al., 2014;Whiting et al., 2015aWhiting et al., , 2015b. ...
... Although the notion of psychological flexibility emerged recently (Alrefi, 2019;Doorley et al., 2020;Kashdan & Rottenberg, 2010) in the field of psychological research, it would seem that the question of a form of flexibility in mental processes may already be a theme under study since the 1940s (Berg, 1948). It would seem, however, that at present, a multiplication of notions relating to psychological flexibility exists, with a particularly close lack of convergence of notions, which helps to explain the lack of literature under the name of "psychological flexibility," while other notions such as cognitive flexibility seem to be more studied (Cherry et al., 2021). ...
... It is now time to reflect on how we can move forward in the research on psychological flexibility, building a bridge between approaches, from neuropsychology to clinical psychology and psychotherapy. However, we seem to know very little about the scope of the concept of psychological flexibility (Kashdan & Rottenberg, 2010;Doorley et al., 2020;Cherry et al., 2021). ...
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The results of the Russian-language adaptation of the questionnaire «Measuring experiential avoidance» with 32 and 16 questions (Hayes, 2004) and «Acceptance and Action Questionnaire» with 9 and 7 questions (Bond, 2011) are presented. This questionnaire s measures an individual tendency of avoiding experience and action. The sample consisted of 313 respondents, age ranged from 17 to 64 years, with average years 34.25, 70% are female. In 32-question version received Cronbach's Alpha 0.773, but low CFI parameters. In 16-question version Cronbach Alpha is 0.78, also low CFI parameters. In 9-question version received Cronbach Alpha 0.649, which is sufficient for this type of scales, and the required CFI scores. The 7-question version gave Cronbach's Alpha 0.659 and the required CFI parameters. The validity of the scales checked by comparison of clinical groups and the results were satisfactory. The retest reliability was carried out after 3 months, checked by the Pearson correlation method and gave the results r = 0.84, with p <0.001. Variants with 32 and 16 questions gave results comparable to those of the original English language, and the scales with 7 and 9 questions meet all modern statistical requirements and are highly valid.
... In contrast, psychological inflexibility involves "the rigid dominance of psychological reactions, over chosen values and contingencies, in guiding action" (35, p. 678). Psychological inflexibility is evident in a range of health conditions including depression, anxiety, eating disorders, chronic pain and insomnia (34,36,37). Psychological flexibility has also been found to be associated with psychological adjustment in severe TBI (38). ...
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Objectives: Psychological factors contribute to poorer long-term outcomes following mild traumatic brain injury (mTBI); however, the exact psychological mechanisms that underly this relationship are not well understood. This study examined the relationship between psychological flexibility, fear avoidance, and outcomes over the first 6 months after mTBI Method: Adults with mTBI-completed measures of psychological flexibility, fear avoidance, postconcussion symptoms, and functional status at baseline (<3 months post-injury; N = 152), and 3-month (N = 133) and 6-month follow-up (N = 102). A conceptually derived moderation-mediation analysis was used to test the mediating effect of fear avoidance on post-concussion symptoms and functional outcomes, and the moderating effects of psychological flexibility on fear avoidance. Results: Fear avoidance had a significant indirect effect on the relationship between post-concussion symptoms and functional status across all three time points. Psychological flexibility was found to significantly moderate these effects. Only low levels of psychological flexibility had a significant influence on the mediating effects of high fear avoidance on functional status at 6-month follow-up. Conclusions: Psychological flexibility may influence mTBI recovery by exerting an influence on fear avoidance. These initial findings provide a potential theoretical explanation of how fear avoidance can become maladaptive with time after mTBI.
... We eventually chose a unidimensional model with theoretically consistent residual correlations between items within specific factors of the original three-factor model as the best fit of the data. This final factor structure is unidimensional, but different from that of previous studies (e.g., Bond et al., 2011;Fledderus et al., 2012) in that it seems to provide evidence pointing to psychological inflexibility measured by the AAQ-II as a multifaceted construct, which comports with psychological inflexibility discussed in contextual CBT literature (Doorley et al., 2020;Hayes et al., 2012)-a construct that may be related to, yet distinct from, psychological flexibility (i.e., psychological inflexibility and flexibility may lie on separate continuums; Rolffs et al., 2018). ...
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The Five Facet Mindfulness Questionnaire (FFMQ), Engaged Living Scale (ELS), and Acceptance and Action Questionnaire-II (AAQ-II) are three commonly used contextual cognitive behavioral therapy (CBT)-informed self-report questionnaires. The present study aimed to psychometrically validate these three scales with racially and ethnically diverse adults in Hawaiʻi (N = 1102). Using a cross-validation strategy with an iterative process of exploratory and confirmatory factor analyses, findings revealed that factor structures of the FFMQ, ELS, and AAQ-II were theoretically consistent with extant literature. However, we also found slight factorial structure differences in the present sample, which may have practical implications when assessing these constructs within racially and ethnically diverse adults. Evidence of reliability, convergent validity, and measurement invariance of these scales are also provided. Implications and limitations of these findings are discussed.
... We eventually chose a unidimensional model with theoretically consistent residual correlations between items within specific factors of the original three-factor model as the best fit of the data. This final factor structure is unidimensional, but different from that of previous studies (e.g., Bond et al., 2011;Fledderus et al., 2012) in that it seems to provide evidence pointing to psychological inflexibility measured by the AAQ-II as a multifaceted construct, which comports with psychological inflexibility discussed in contextual CBT literature (Doorley et al., 2020;Hayes et al., 2012)-a construct that may be related to, yet distinct from, psychological flexibility (i.e., psychological inflexibility and flexibility may lie on separate continuums; Rolffs et al., 2018). ...
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The Five Facet Mindfulness Questionnaire (FFMQ), Engaged Living Scale (ELS), and Acceptance and Action Questionnaire-II (AAQ-II) are three commonly used contextual cognitive behavioral therapy (CBT)-informed self-report questionnaires. The present study aimed to psychometrically validate these three scales with racially and ethnically diverse adults in Hawaiʻi (N = 1102). Using a cross-validation strategy with an iterative process of exploratory and confirmatory factor analyses, findings revealed that factor structures of the FFMQ, ELS, and AAQ-II were theoretically consistent with extant literature. However, we also found slight factorial structure differences in the present sample, which may have practical implications when assessing these constructs within racially and ethnically diverse adults. Evidence of reliability, convergent validity, and measurement invariance of these scales are also provided. Implications and limitations of these findings are discussed.
... Psychological flexibility is one such psychological mechanism that may influence mTBI outcomes [22,23]. In a recent scoping review, Cherry et al., [24] proposed three essential components for a consensus definition of psychological flexibility: a) handling interference or distress (e.g., encountering new environmental information, experiencing emotional distress, facing set-backs); b) taking action to manage interference or distress (e.g., persevering, accepting, tolerating or engaging in emotional regulation strategies); and c) taking action occurs in a manner that is congruent with situational demands and facilitates the pursuit of personal goals or values [25,26]. The building blocks of psychological flexibility include executive function, self-regulation skills and personality configurations that support openness and expansion of one's experience [26]. ...
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Purpose: This study investigated the predictive role of psychological flexibility on long-term mTBI outcomes. Method: Adults with mTBI (N =147) completed a context specific measure of psychological flexibility, (AAQ-ABI), psychological distress, and mTBI outcomes at less than three months post injury (M = 6.02 weeks after injury) and 6 months later (N=102). Structural equation modelling examined the mediating effects of psychological flexibility on psychological distress and mTBI outcomes at six months. The direct effect of psychological flexibility at less than three months on mTBI outcomes at six months was entered into the model, plus pre-injury and injury risk factors. Results: The theoretically derived model had good overall fit (χ2 = 1.42; p = 0.09; NFI = 0.95; TLI = 0.95; CFI = 0.98 and RMSEA = 0.06). Psychological flexibility at less than 3 months was directly significantly related to psychological distress and post-concussion symptoms at six months. Psychological flexibility at 6 months significantly mediated the relationship between psychological distress and functional disability but not post-concussion symptoms at six months post injury. Conclusion: The exploratory findings suggest that a context specific measure of psychological flexibility assessed acutely and in the chronic phase of recovery may predict longer-term mTBI outcomes.
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The literature describing psychological interventions for co-occurring obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) is limited. Acceptance and Commitment Therapy (ACT) is a transdiagnostic intervention that targets functionally avoidant behavior underlying both OCD and PTSD. The current case report describes how an ACT-informed approach to treatment was implemented over 14 sessions to treat co-occurring OCD and PTSD in a 9-months postpartum adult woman. The patient was initially referred to psychotherapy by her psychiatrist and showed high motivation to engage in treatment. This case presentation outlines how the intervention targeted core ACT processes while also incorporating components from both exposure and response prevention (ERP) and cognitive processing therapy (CPT) to address the patient’s presenting concerns. Measurements of OCD and PTSD symptom severity, as well as of depressive and anxiety symptoms, over the course of treatment are included. Health-related comorbidities, psychiatric medications, and implications are discussed.
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Elevated psychosocial distress, pain and existential dread are prevalent among those living with a palliative illness with consequential negative impacts on quality of life (QoL). Psychological flexibility (PF) is a protective factor related to better psychosocial outcomes in various adverse health contexts. This study tests the applicability of the PF framework in accounting for variability in four palliative patient outcomes (death attitudes, distress, pain and QoL) and the stability of these variables over one month. Fifty-four palliative patients and 21 of their carers completed a questionnaire at Time 1 and one month later (Time 2). Informal carers provided proxy ratings of the patient's QoL. Results indicated no change in PF or patient outcomes, and that higher Time 1 total PF significantly predicted better Time 2 outcomes across QoL, distress, and death attitudes. The acceptance PF dimension evidenced the strongest beneficial associations, whereas unexpectedly the values-based action PF dimension predicted higher death escape attitudes, and the mindfulness PF dimension failed to predict any outcome, although at the bivariate level it was related to better outcomes across QoL, death attitudes and distress. Unexpectedly, the values-based action PF dimension was correlated with worse pain outcomes. Overall, these findings support the role of PF in improving palliative patient outcomes, and prior calls for the evaluation of Acceptance and Commitment Therapy (ACT), which targets PF, in palliative care. The unexpected findings regarding the two PF dimensions of mindfulness and values-based action, suggest that these PF processes need further investigation and require fine tuning in ACT interventions to ensure sensitivity to the palliative care context. These findings are currently being utilised to inform the development and evaluation of a self-help ACT resource for palliative patients.
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Background The extent to which a person believes they can change or control their own emotions is associated with trait-level symptoms of mood and anxiety-related psychopathology.Method The present study examined how this belief relates to momentary and daily self-reports of affect, emotion regulation tendencies, and perceived effectiveness of emotion regulation attempts throughout a five-week experience sampling study conducted in N = 113 high socially anxious people (https://osf.io/eprwt/).ResultsResults suggest that people with relatively stronger beliefs that their emotions are malleable experienced more momentary and daily positive affect (relative to negative affect), even after controlling for social anxiety symptom severity (although only daily positive affect, and not momentary positive affect, remained significant after correcting for false discovery rate). However, emotion malleability beliefs were not uniquely associated with other emotion regulation-related outcomes in daily life, despite theory suggesting malleability beliefs influence motivation to engage in emotion regulation.Conclusion The paucity of significant associations observed between trait malleability beliefs and momentary and daily self-reports of emotion regulation (despite consistent findings of such relationships at trait levels) calls for additional research to better understand the complex dynamics of emotion beliefs in daily life.
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This study examines relationships between emotion beliefs and emotion regulation strategy use among people with social anxiety disorder (SAD) and a psychologically healthy control group. Using experience-sampling methodology, we tested group differences in 2 types of emotion beliefs (emotion control values and emotion malleability beliefs) and whether emotion beliefs predicted trait and daily use of cognitive reappraisal and emotion suppression. People with SAD endorsed higher emotion control values and lower emotion malleability beliefs than did healthy controls. Across groups, emotion control values were positively associated with suppression (but unrelated to reappraisal), and emotion malleability beliefs were negatively associated with suppression and positively associated with reappraisal. We also addressed 2 exploratory questions related to measurement. First, we examined whether trait and state measures of emotion regulation strategies were related to emotion control values in different ways and found similar associations across measures. Second, we examined whether explicit and implicit measures of emotion control values were related to daily emotion regulation strategy use in different ways-and found that an implicit measure was unrelated to strategy use. Results are discussed in the context of growing research on metaemotions and the measurement of complex features of emotion regulation. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Psychological flexibility refers to a way of interacting with internal experiences and the external environment that advances one toward chosen values whereas psychological inflexibility reflects rigid adherence to ineffective responses such that valued living is compromised. Psychological flexibility is a critical variable of interest in acceptance and commitment therapy, thus, accurate assessment of this construct is pertinent to professionals in the field. Numerous measures of psychological flexibility for specific conditions exist and the psychometric validation of each of these measures varies in breadth and depth. To orient professionals to the scope of available measures as well as their psychometric properties, the current review summarizes the existing literature on context-specific measures of psychological flexibility. Most measures demonstrated satisfactory basic psychometric properties, though their clinical utility (e.g., treatment sensitivity) has largely been underexplored. Generally, context-specific measures performed better than a generic measure of psychological flexibility with respect to incremental validity and treatment sensitivity. Still, further research is needed to validate these measures (e.g., discriminant validity) in order to justify their use across settings and study designs.
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People with anxiety disorders tend to make decisions on the basis of avoiding threat rather than obtaining rewards. Despite a robust literature examining approach-avoidance motivation, less is known about goal pursuit. The present study examined the content, motives, consequences, and daily correlates of strivings among adults diagnosed with social anxiety disorder and healthy controls. Participants generated six strivings along with the motives and consequences of their pursuit. Compared with controls, people with social anxiety disorder were less strongly driven by autonomous motives and reported greater difficulty pursuing strivings. Coders analyzed strivings for the presence of 10 themes: achievement, affiliation, avoidance, emotion regulation, generativity, interpersonal, intimacy, power, self-presentation, and self-sufficiency. People with social anxiety disorder constructed more emotion regulation strivings than did controls, but they did not differ across other themes. This research illustrates how studying personality at different levels of analysis (traits, strivings) can yield novel information for understanding anxiety disorders.
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Psychological inflexibility and experiential avoidance are key constructs in the Acceptance and Commitment Therapy (ACT) model of behavior change. Wolgast (2014) questioned the construct validity of the Acceptance and Action Questionnaire-II (AAQ-II), the most used self-report instrument to assess the efficacy of ACT interventions. Wolgast suggested that the AAQ-II measured psychological distress rather than psychological inflexibility and experiential avoidance. The current study further examined the construct validity of the AAQ-II by conducting an online cross-sectional survey (n = 524), including separate measures of experiential avoidance and psychological distress. Confirmatory factor analyses indicated that items from the AAQ-II correlated more highly with measures of depression, anxiety, and stress than the Brief Experiential Avoidance Questionnaire (BEAQ). Implications include that, as broad measures of experiential avoidance, the AAQ-II and BEAQ may not measure the same construct. In terms of psychological distress, the BEAQ has greater discriminant validity than the AAQ-II, and perhaps an alternative instrument of psychological inflexibility might be needed to assess core outcomes in ACT intervention research.
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The purpose of this study was to examine acceptance and commitment therapy (ACT) as a standalone treatment for trichotillomania in a randomized controlled trial of adults and adolescents. Participants consisted of a community sample of treatment seeking adults and adolescents with trichotillomania. Of the eligible 39 participants randomized into treatment and waitlist groups, 25 completed treatment and were included in the final analysis. Treatment consisted of a 10-session ACT protocol. Multiple mixed models repeated measures analyses were utilized to evaluate changes in trichotillomania symptom severity, daily number of hairs pulled and urges experienced, and experiential avoidance from pretreatment to posttreatment. Findings indicated significant changes in symptom severity and daily hairs pulled, but not daily urges experienced or psychological flexibility. However, psychological flexibility saw a 24.5% decrease in the treatment group and reduced from clinical to subclinical levels on average. This study suggests that ACT alone is an effective treatment for adults and adolescents with trichotillomania. Outcomes appear to be similar to trials that combined ACT and habit reversal training (HRT).
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Psychological flexibility (PF), defined as the ability to pursue valued life aims despite the presence of distress, is a fundamental contributor to health (Kashdan & Rottenberg, 2010). Existing measures of PF have failed to consider the valued goals that give context for why people are willing to manage distress. Using 4 independent samples and 3 follow-up samples, we examined the role of PF in well-being, emotional experience and regulation, resilience, goal pursuit, and daily functioning. We describe the development and psychometric properties of the Personalized Psychological Flexibility Index (PPFI), which captures tendencies to avoid, accept, and harness discomfort during valued goal pursuit. Correlational, laboratory, and experience-sampling methods show that the PPFI measures a trait-like individual difference dimension that is related to a variety of well-being and healthy personality constructs. Unlike existing measures of PF, the PPFI was shown to be distinct from negative emotionality. Beyond trait measures, the PPFI is associated with effective daily goals and life strivings pursuit and adaptive emotional and regulatory responses to stressful life events. By adopting our measurement index, PF may be better integrated into mainstream theory and research on adaptive human functioning.
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One potential factor that could influence how individuals with at least moderate symptoms of depression cope with upsetting events in their daily lives is the beliefs that these individuals hold about whether emotions are malleable or fixed. The current study adopted an experience sampling approach to examine how the beliefs about emotion’s malleability related to daily positive and negative affect and daily emotion regulation efforts among individuals with at least moderate symptoms of depression (N = 84). Results demonstrated that individuals having at least moderate symptoms of depression who held more malleable beliefs about emotions reported decreased negative affect both overall during the day and specifically in response to daily upsetting events. Additionally, these individuals who held more malleable beliefs about their emotions also reported more daily use of cognitive reappraisal to regulate their emotions in response to upsetting daily events. Results from the current study extend previous work examining the relationship between emotion malleability beliefs, emotional experiences, and emotion regulation to examine these relationships in people who are moderately depressed as they navigate the emotional landscape of their daily lives.
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Objective: We investigated how the Big Five traits predict individual differences in five theoretically important emotion regulation goals that are commonly pursued – pro-hedonic, contra-hedonic, performance, pro-social, and impression management. Method: We conducted two studies: (1) a large survey study consisting of undergraduates (N = 394; 18-25 years; 69% female; 56% European-American) and community adults (N = 302; 19-74 years; 50% female; 75% European-American) who completed a newly developed global measure of individual differences in emotion regulation goals and (2) a 9-day daily diary study with community adults (N = 272; 50% female; 84% European-American) who completed daily reports of emotion regulation goals. In both studies, participants completed a measure of the Big Five. Results: Across global and daily measures, pro-hedonic goals and pro-social goals were positively associated with agreeableness, performance goals were positively associated with openness, and impression management goals were positively associated with neuroticism. Globally, contra-hedonic goals were also negatively associated with agreeableness and conscientiousness. Conclusions: The Big Five systematically predict the emotion regulation goals people typically pursue. These findings have important implications for understanding why people engage in certain forms of regulatory behavior and why personality has consequences for well-being.
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Social anxiety disorder (SAD) and major depressive disorder (MDD) are highly comorbid, and together they result in greater functional impairment and a poorer prognosis than either condition alone. Theoretical models implicate impairments in emotion regulation in the development and maintenance of internalizing disorders, yet there has been no systematic comparison of emotion regulation in social anxiety and depression. The current review presents an in-depth examination of the literature on two widely-studied emotion regulation strategies, expressive suppression (ES) and cognitive reappraisal (CR), in SAD and MDD. Our review indicated that SAD is broadly characterized by an overreliance on ES, which is associated with negative social and emotional consequences. SAD is also characterized by ineffective utilization of CR, which inhibits the potential positive emotional benefits of this adaptive emotion regulation strategy. In contrast, MDD is broadly characterized by an underutilization of CR, which may be particularly detrimental in stressful or uncontrollable situations. For both SAD and MDD, treatment intervention appears to address deficits in CR but not ES. After reviewing the literature, we propose multiple pathways by which impairments in ES and CR may increase risk for the co-occurrence of SAD and MDD. Clinical implications and future research directions are also discussed.