In plain language
The word “flexibility” means different things to different psychologists. Neuropsychologists talk about cognitive flexibility — the mental ability to switch between tasks and shift strategies, part of what is called executive function. Clinical psychologists who practice acceptance and commitment therapy (ACT) talk about psychological flexibility — the ability to stay open to difficult thoughts and feelings while still acting in line with one's values. This conceptual review asks how these two constructs relate, and what that means for treating psychological distress after a traumatic brain injury (TBI).
People who survive a traumatic brain injury often have damaged executive processes, which can impair cognitive flexibility, yet they frequently respond well to acceptance-based therapies that build psychological flexibility. The authors review the overlaps between the two constructs across their definitions, their neural underpinnings, their links to psychopathology, and the measures used to assess them.
The review concludes that psychological flexibility is the broader, more overarching construct, with cognitive flexibility possibly a subcomponent — but not a prerequisite. In practical terms, this means someone can still benefit from ACT even if standard neuropsychological tests show their cognitive flexibility is impaired. The authors argue that task-based cognitive tests may be poor predictors of who can engage in therapy, and they call for more research testing ACT directly in people with TBI, along with therapy modifications (such as memory aids and involving family) to accommodate cognitive impairments.
Key findings
- Cognitive flexibility (an executive function) and psychological flexibility (an ACT treatment target) overlap substantially in definition, neural substrate, and mental processes.
- Psychological flexibility appears to be the more overarching construct, with cognitive flexibility possibly a subcomponent — but not necessarily a prerequisite for it.
- Impairments in both constructs are strongly associated with psychopathology.
- People with TBI often have impaired cognitive flexibility from executive damage yet still respond positively to acceptance-based therapies, suggesting cognitive flexibility is not required to build psychological flexibility.
- Task-based neuropsychological tests of cognitive flexibility may have poor ecological validity and may not predict who can successfully engage in therapy.
- The authors call for research testing ACT directly in TBI populations and recommend therapy modifications (memory aids, repetition, family involvement) to accommodate cognitive impairments.
How to cite
APA
Whiting, D. L., Deane, F. P., Simpson, G. K., McLeod, H. J., & Ciarrochi, J. (2015). Cognitive and psychological flexibility after a traumatic brain injury and the implications for treatment in acceptance-based therapies: A conceptual review. Neuropsychological Rehabilitation, 27(2), 263–299. https://doi.org/10.1080/09602011.2015.1062115
BibTeX
@article{whiting2015cognitive,
author = {Whiting, Diane L. and Deane, Frank P. and Simpson, Grahame K. and McLeod, Hamish J. and Ciarrochi, Joseph},
title = {Cognitive and psychological flexibility after a traumatic brain injury and the implications for treatment in acceptance-based therapies: A conceptual review},
journal = {Neuropsychological Rehabilitation},
year = {2015},
volume = {27},
number = {2},
pages = {263--299},
doi = {10.1080/09602011.2015.1062115}
}
Related work
- All publications by Joseph Ciarrochi (searchable, with free PDFs)
- Process-Based Therapy & Idionomic Analysis
Author: Joseph Ciarrochi (ORCID 0000-0003-0471-8100). Free copy hosted with permission for scholarly use. Please cite the published version via the DOI above.