Enhancing Psychological Flexibility and Inhibitory Control in Chronic Kidney Disease Patients with Acceptance and Commitment Program
Keywords:
Acceptance and commitment program, Psychological flexibility, Inhibitory control, Chronic kidney diseaseAbstract
The objective of this research is to study the effects of the acceptance and commitment program on psychological flexibility and inhibitory control. The participants were 24 patients diagnosed with stage 3 chronic kidney disease. Participants were randomly assigned to experimental group (n = 12) participated in the acceptance and commitment program for chronic kidney disease, consisted of 8 sessions (50 minutes each) and control group (n = 12) was provided with the hospital’s standard treatment. Assessed by the psychological flexibility scale, CKD Go/No-Go task and In-depth interviews. Assessments were conducted at pre-test, post-test, and follow-up in 2 weeks. Statistical analyses were performed using repeated-measures analysis of variance with one between-subjects variable and one within-subjects variable. The Bonferroni method was applied for multiple comparisons.
The results showed that the experimental group had a significantly higher psychological flexibility than control group in post-test and follow-up (p < .05). And, in the experimental group, the post-test and follow-up had a significantly higher inhibitory control than pre-test (p < .05).
In conclusion, the acceptance and commitment program was effective in improving both psychological flexibility and inhibitory control. This program may be applied to promote behavioral modification as a guideline for delaying kidney failure and as a model for other patient groups.
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Thanakitcharu P. Hemodialysis and nursing care. Bangkok: Bangkok Vejasan Publishing; 2024. (in Thai)
Department of Disease Control (Thailand). Epidemiology and review of preventive measures for chronic kidney disease [report]. Thailand: Department of Disease Control;
(in Thai)
Wilson A, Carswell C, McKeaveney C, Atkinson K, Burton S, McVeigh C, et al. Examining the acceptability and feasibility of the Compassionate Mindful Resilience (CMR) programme in adults living with chronic kidney disease: the COSMIC study findings. BioMed Central Nephrology. 2024;25(1):1-12.
Spinale J, Cohen SD, Khetpal P, Peterson RA, Clougherty B, Puchalski CM, et al. Spirituality, social support, and survival in hemodialysis patients. Clinical Journal of the American Society of Nephrology. 2008;3(6):1620-7.
Kashdan TB, & Rottenberg J. Psychological flexibility as a fundamental aspect of health. Clinical Psychology Review. 2010;30(7):865-78.
Sadeghi AH, Ghodrati-Torbati A, & Ahmadi SA. The effectiveness of acceptance and commitment therapy on pain control and adherence to treatment in dialysis patients. Journal of Research & Health. 2023;13(5): 381-8.
Hazavei F, & Robatmeili S. The effect of acceptance and commitment therapy on psychological flexibility and behavioral inhibition of adolescents with social anxiety disorder. Journal of Health Promotion Management. 2019;8(6):18-29.
Ismoyowati TW. Pengaruh acceptance and commitment therapy terhadap perubahan kecemasan dan self-efficacy pada pasien dengan hemodialisa di RS Sint Carolus Jakarta. Jurnal Kesehatan. 2018;5(2)44–58.
Diéguez S, García-Llana H, Lobato D, Marín MT, Arenas MD, Dapena F, et al. Acceptance and commitment therapy for depression in chronic kidney patients: a pilot study. Frontiers in Psychology. 2025;16(1)1-10.
Facon-Barillot Q, Romo L, de Dios LG, & Morvan Y. Psychological flexibility and psychological distress among students: a temporal network approach. Journal of Contextual Behavioral Science. 2025;38(1):1-12.
Haenjohn J. Cognitive psychology. 3rded. Bangkok: Grand Point; 2021. (in Thai)
Salehinejad MA, Nejati V, & Derakhshan M. Neural correlates of trait resiliency: evidence from electrical stimulation of the dorsolateral prefrontal cortex (dLPFC) and orbitofrontal cortex (OFC). Personality and Individual Differences. 2017;106(1):209-16
Sanitpol W, Jaratham N, & Prayong C. Effects of the Self-efficacy Enhancement Program on Disease Control Behaviors among Chronic Kidney Disease with stage 3 and 4 at kidney Department, Lamphun Hospital. Lanna Public Health Journal. 2017;13(2):48-63.
Dindo L, Van Liew JR, & Arch JJ. Acceptance and commitment therapy: a transdiagnostic behavioral intervention for mental health and medical conditions. Neurotherapeutics. 2017;14(3):546-53.
Haenjohn J. Acceptance and commitment therapy (ACT): Chonburi, Get Good Creation; 2014. (in Thai)
Spatola CA, Rapelli G, Giusti EM, Cattivelli R, Goodwin CL, Pietrabissa G, et al. Effects of a brief intervention based on acceptance and commitment therapy versus usual care for cardiac rehabilitation patients with coronary heart disease (ACTonHEART): a randomised controlled trial. The British Medical Journal open. 2024;14(6):1-11.
Ardiansyah F, Shinta S, & Amita D. Acceptance and commitment therapy (ACT) for patients with chronic renal failure. Malahayati International Journal of Nursing and Health Science. 2021; 26;4(1):51-6.
Iida H, Fujimoto S, Wakita T, Yanagi M, Suzuki T, Koitabashi K, et al. Psychological flexibility and depression in advanced CKD and dialysis. Kidney medicine. 2020;2(6):684-91.
Punpoem N, Haenjohn J, & Supwirapakorn W. Delay dementia in the elderly: a working memory training program based on acceptance and commitment therapy. Journal of The Royal Thai Army Nurses. 2022;23(3):428-37. (in Thai)
Järvelä-Reijonen E, Karhunen L, Sairanen E, Muotka J, Lindroos S, Laitinen J, et al. The effects of acceptance and commitment therapy on eating behavior and diet delivered through face-to-face contact and a mobile app: a randomized controlled trial. International Journal of Behavioral Nutrition and Physical Activity. 2018;15(1):1-14.
Rattanatamtong A, Haenjohn J, & Supwirapakorn W. Development of online acceptance and commitment program to enhance inhibitory control on cyberbullying in adolescents. Journal of The Royal Thai Army Nurses. 2022;24(1):80-90. (in Thai)
Haenjohn J, Supwirapakorn W, & Namyen J. Integrative cognitive neuropsychological program emphasizing brain response to enhance inhibitory control among substance abusers at the alternative rehabilitation communities in Eastern Thailand. Frontiers in Psychiatry. 2025;16(1):1-18.
Bond FW, Hayes SC, Baer RA, Carpenter KM, Guenole N, Orcutt HK, et al. Preliminary psychometric properties of the acceptance and action questionnaire–II: a revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy. 2011;42(4): 676-88.
Haenjohn J, Sapwirapakorn W, Noimanop K, & Chulvanitphong T. Outstanding basketry wisdom for integrated knowledge development: a study in the Eastern Economic Corridor area [research report]. Chonburi: Burapha University; 2023. (in Thai)
Elander J, Kapadi R, Coyne E, Taal MW, Selby NM, Stalker C, et al. Using patient feedback to adapt intervention materials based on acceptance and commitment therapy for people receiving renal dialysis. BioMed Central Urology. 2021;21(1):1-11.
Liu H, Liu N, Chong ST, Yau EKB, & Badayai ARA. Effects of acceptance and commitment therapy on cognitive function: a systematic review. Heliyon. 2023;9(3):1-12.
Öst LG. The efficacy of acceptance and commitment therapy: an updated systematic review and meta-analysis. Behaviour Research and Therapy. 2014;61(10):105-21.
A-Tjak J, & De Groot F. Acceptatie. In: A-Tjak J, De Groot F, editors. Acceptance & commitment therapy: theorie en praktijk. Houten: Bohn Stafleu van Loghum; 2015. p. 19-25.
Leblanc-Sirois Y, Braun CM, & Elie-Fortier J. Reaction time of erroneous responses in the Go/No-go paradigm. Experimental Psychology. 2018;65(5): 314–21.
Heitz RP. The speed-accuracy tradeoff: history, physiology, methodology, and behavior. Frontiers in Neuroscience. 2014;8(1):1-19.
Afek A, Ben-Avraham R, Davidov A, Berezin Cohen N, Ben Yehuda A, Gilboa Y, et al. Psychological resilience, mental health, and inhibitory control among youth and young adults under stress. Frontiers in Psychiatry. 2021;11(1):1-12.
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