Post-traumatic growth in people experiencing high post-traumatic stress during the COVID-19 pandemic: The protective role of psychological flexibility

Giulia Landi; Kenneth I Pakenham; Elisa Mattioli; Elisabetta Crocetti; Alessandro Agostini; Silvana Grandi; Eliana Tossani

doi:10.1016/j.jcbs.2022.08.008

Post-traumatic growth in people experiencing high post-traumatic stress during the COVID-19 pandemic: The protective role of psychological flexibility

J Contextual Behav Sci. 2022 Oct:26:44-55. doi: 10.1016/j.jcbs.2022.08.008. Epub 2022 Aug 28.

Authors

Giulia Landi^{1

2}, Kenneth I Pakenham³, Elisa Mattioli², Elisabetta Crocetti¹, Alessandro Agostini⁴, Silvana Grandi^{1

2}, Eliana Tossani^{1

2}

Affiliations

¹ Department of Psychology, University of Bologna, Bologna, Italy.
² Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Cesena, Italy.
³ School of Psychology, The University of Queensland, Brisbane QLD, Australia.
⁴ Department of Experimental, Diagnostic and Specialty Medicine DIMES St.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.

Abstract

The COVID-19 pandemic evokes high levels of post-traumatic stress (PTS) in some people as well as positive personal changes, a phenomenon known as post-traumatic growth (PTG). Experiencing an adverse event as traumatic is crucial for triggering PTG, therefore higher PTS is often associated with higher PTG. This longitudinal study examined the protective role of psychological flexibility in fostering PTG in a group of people reporting high PTS related to COVID-19 as compared to those with low PTS. We hypothesized that higher psychological flexibility will be associated with higher PTG in those with high PTS and that psychological flexibility would be unrelated to PTG in those with low PTS. Secondary data analysis was conducted on data from a larger project investigating the psychological impacts of COVID-19. Adult Italians (N = 382) completed online surveys at Time 1 (three months after the first national lockdown, July 2020) and Time 2 (three months later when the number of COVID-19 cases increased, October 2020). Based on the Impact of Event Scale-Revised cut-off score, two PTS groups were identified at Time 2: low PTS (below cut-off) and high PTS (above cut-off). As predicted, moderation analyses showed that after controlling for Time 1 PTS and PTG and confounding variables, Time 1 psychological flexibility was associated with higher Time 2 PTG in the high PTS group, whereas psychological flexibility was unrelated to PTG in the low PTS group. Four psychological flexibility sub-processes (present moment awareness, defusion, values, committed action) at Time 1 were related to higher Time 2 PTG in only the high PTS group. Findings advance understanding of the role of psychological flexibility in trauma reactions and pandemic mental health adjustment. Evidence-based approaches that target psychological flexibility, like Acceptance and Commitment Therapy, are likely to foster PTG and ultimately adjustment in people with high PTS during and after the pandemic.

Keywords: COVID-19 pandemic; Longitudinal study; Pandemic-related adjustment; Post-traumatic growth; Post-traumatic symptoms; Psychological flexibility.