Psychological Flexibility and Yoga

A new study has been published on psychological flexibility (PF) in the journal Psychological Trauma and I thought you might like to hear about it.  Psychological flexibility is the changing of one’s mental and behavioral repertoire in response to a given situation to live in accordance with one’s values (if you have been to the VYP Mindful Resilience Training you can probably hear Dr. Dan Libby in your head repeating variations of this phrase to drive the point home).  It is a set of responses antithetical to avoidance – avoidance being both a symptom of PTSD and a factor that maintains PTSD.  A person does not avoid undesirable internal bodily states such as muscle tension, the numbness of depression, or the sinking feeling of fear when he or she is psychologically flexible.  When a person permits these internal bodily states, the mind and body gradually learn that these states are not a threat and he or she can engage in meaningful activities whether or not those bodily states are present.  In other words, they do not have to be avoided. 

Studies over the past several years have demonstrated that low psychological flexibility is associated with PTSD.  Further, PTSD treatment outcomes are better when there are also increases in psychological flexibility.  Some psychotherapy treatments specifically aim to do just that.  The new study inspiring this blog post showed that PF predicted some of the variability in PTSD symptom severity one year into the future (Meyer et al., 2019).  This is above and beyond the variability associated with the PTSD avoidance symptoms – so psychological inflexibility is not merely avoidance but makes its own contribution to PTSD.  This prediction is also above and beyond personality factors associated with negative emotionality, another predictor of PTSD severity.  What’s more, that research team previously identified that low psychological flexibility predicted greater suicidal ideation one year later (DeBeer et al., 2018).  Multiple studies reinforce the idea that psychological flexibility is implicated in PTSD and related issues.

If greater psychological flexibility is associated with lower PTSD and suicidal ideation, and psychological flexibility is changeable, then what might someone with PTSD do besides psychotherapy (which should always be the first option for these concerns)?  I think you know where this is going.  A small randomized controlled trial found increases in psychological flexibility were related to improvements in PTSD in a group participating in yoga but that association was not present in the non-yoga control condition (Dick et al., 2014).  Curiously, the control group did have increases in PF but these were not associated with PTSD improvements.  Another small study of participants in a clinical yoga program, published by yours truly, showed that more yoga prior to the study was associated with greater psychological flexibility at baseline (Avery et al., 2018).  Further, the more yoga participants practiced during the study the greater their increases in PF.  It is not definitive that yoga improves PTSD through increasing psychological flexibility.  However, available information suggests there is a relationship and supporting theories are robust.  If you’re reading this, you probably didn’t need another reason to practice yoga.  If you did need another reason, keep an eye out for more research on the effects of yoga on psychological flexibility.


References

Avery, T., Blasey, C., Rosen, C., & Bayley, P. (2018). Psychological Flexibility and Set-Shifting Among Veterans Participating in a Yoga Program: A Pilot Study. Mil Med. doi:10.1093/milmed/usy045

DeBeer, B. B., Meyer, E. C., Kimbrel, N. A., Kittel, J. A., Gulliver, S. B., & Morissette, S. B. (2018). Psychological Inflexibility Predicts of Suicidal Ideation Over Time in Veterans of the Conflicts in Iraq and Afghanistan. Suicide Life Threat Behav, 48(6), 627-641. doi:10.1111/sltb.12388

Dick, A. M., Niles, B. L., Street, A. E., Dimartino, D. M., & Mitchell, K. S. (2014). Examining mechanisms of change in a yoga intervention for women: The influence of mindfulness, psychological flexibility, and emotion regulation on PTSD symptoms. Journal of Clinical Psychology, 70, 1170-1182. doi:10.1002/jclp.22104

Meyer, E. C., La Bash, H., DeBeer, B. B., Kimbrel, N. A., Gulliver, S. B., & Morissette, S. B. (2019). Psychological inflexibility predicts PTSD symptom severity in war veterans after accounting for established PTSD risk factors and personality. Psychol Trauma, 11(4), 383-390. doi:10.1037/tra0000358


Timothy Avery, PsyD, is a postdoctoral research fellow in complementary and alternative medicine for chronic health conditions and post traumatic stress affecting veterans. He is the director of program evaluation for Veterans Yoga Project.