Psychological flexibility in South Sudanese female refugees in Uganda as a mechanism for change within a guided self-help intervention

Daniel P. Lakin, Samuel E. Cooper, Lena Andersen, Felicity L. Brown, Jura L.S. Augustinavicius, Kenneth Carswell, Marx Leku, Alex Adaku, Teresa Au, Richard Bryant, Claudia Garcia-Moreno, Ross G. White, Wietse A. Tol

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: To examine the role of psychological flexibility as a potential mediator in the relationship between involvement in a guided self-help intervention, Self-Help Plus, and psychological distress in a sample of South Sudanese refugee women living in northern Uganda. METHOD: We conducted secondary analysis of data from a cluster randomized controlled trial conducted in 2018. We used multilevel mediation modeling to explore the relationship of psychological flexibility, as measured by the Acceptance and Action Questionnaire (AAQ-II), as a mediating factor in the relationship between Self-Help Plus involvement and general psychological distress as measured by the Kessler Psychological Distress Scale-6 (K6). RESULTS: We found strong multilevel mediation of decreased K6 scores in the treatment group by AAQ-II scores (multilevel b = -3.28). A more pronounced mediation effect was discovered immediately post intervention (b = -1.09) compared to 3-month follow-up (b = -0.84). This is in line with the current literature that demonstrates the role of psychological flexibility as a primary mechanism of change in ACT-based interventions. CONCLUSIONS: Psychological flexibility is a contributing component in the theory of change for this ACT-based intervention. Identifying the core components of interventions allows for more effective adaptation and implementation of relevant services, especially in low-resource contexts. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Original languageEnglish (US)
Pages (from-to)6-13
Number of pages8
JournalJournal of Consulting and Clinical Psychology
Issue number1
StatePublished - Jan 1 2023

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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