How do ACT core processes underlie loneliness and psychological health? A study among people with and without physical chronic disease

ABSTRACT

Aims: To explore the differences between individuals with and without chronic physical disease regarding cognitive fusion, experiential avoidance, uncommitted action, loneliness, and psychological health. A model that hypothesized that cognitive fusion has an effect on loneliness and psychological health, through higher experiential avoidance and less committed actions was also tested.

Method: The sample comprised 765 participants (304 with chronic physical disease, 461 without a chronic physical disease) and completed an online survey.

Results: Participants with chronic physical diseases reported higher levels of cognitive fusion, experiential avoidance and loneliness, and lower levels of psychological health, when compared to participants without chronic physical disease. In both groups, cognitive fusion was positively linked with experiential avoidance and loneliness and negatively linked with committed action and psychological health. The model explained 36% of loneliness and 57% of the psychological health’s variances. Cognitive fusion is associated with loneliness and decreased psychological health, through higher levels of experiential avoidance and lower levels of committed action, even controlling for the effect of age.

Discussion: Findings offer important suggestions on how the ACT core processes underlie loneliness and psychological health and support the development of interventions that target cognitive defusion, acceptance skills and committed actions to reduce loneliness and increase psychological health.

KEY POINTS

What is already known about this topic:

1. Chronic physical diseases have an overall impact on individuals’ health and quality of life, and psychological inflexibility processes may lead to psychological suffering.

2. Loneliness can underlie different negative psychological and social outcomes, as well as lower levels of physical health.

3. Despite the relevance of previous research, no studies have explored the relationship between ACT core processes with loneliness and psychological health.

What this topic adds:

1. This study has important implications for practice and research related to preventive intervention.

2. The assessment of the experience of loneliness in people with chronic physical disease and its link with psychological health should be prioritized.

3. Cognitive defusion, acceptance skills and committed actions may be useful to overcome the experience of loneliness and subsequently to promote psychological health.

KEYWORDS:

• Cognitive fusion
• committed action
• experiential avoidance
• loneliness
• physical chronic disease
• psychological health

Acknowledgments

We would like to thank Tânia Ramalho for her help in collecting the sample, Sara Oliveira for her help in analysing the results and Ânia Ferreira and Inês Melo for their help with linguistic correction. We are also grateful to the participants who answered to the research protocol.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author, Joana Pereira, upon reasonable request.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.