Exploring the Influence of Psychological Inflexibility on Depression, Anxiety, Self-Efficacy, and Gender Disparities among Individuals with Chronic Illnesses


  • Ms Aisha Shakeel University of Sialkot
  • Meera Irshad
  • Eman Ameer




Psychological Inflexibility, Self-Efficacy, Chronic Illness, Anxiety.


This research's goal was to explore the Influence of Psychological Inflexibility on Depression, Anxiety, Self-Efficacy, and Gender Disparities among Individuals with Chronic Illnesses." Sialkot, Pakistan. Chronically ill patients may prioritize the management of physical pain. It is important to also address mental health issues that may arise from psychological inflexibility. This psychological trait can have a negative impact on patients' mental health, leading to conditions such as anxiety and depression, and can also lower their self-efficacy. This study examined the mental health disorders like anxiety and depression developed due to psychological inflexibility in patients suffering from chronic pain. The research participants comprised one hundred and twenty (120) patients suffering from chronic illnesses, ranging from twenty to fifty (20-50) years old individuals, and opted through purposive sampling. The information was gathered using the three questionnaires along with demographic and onset forms. The data analysis was done through SPSS and it was revealed through correlation analysis that Psychological Inflexibility, Anxiety, Depression, and Self-efficacy have a significant relationship with each other. Moreover, the evidence of the t-test suggested, that there is a substantial variation between men and women concerning the level of self-efficacy and anxiety. Evaluation of Linear Regression revealed that anxiety and self-efficacy are high predictors of psychological inflexibility. Results are discussed to explain the findings about Pakistan culture and previous empirical evidence.


A, Tanhan (2019). Acceptance and Commitment Therapy with Ecological Systems Theory: Addressing Muslim Mental Health Issues and Wellbeing. DOI: 10.47602/jpsp.v3i2.172

Acceptance and Commitment Therapy for Chronic Pain | Society of Clinical Psychology. (2017, March 6). Div12.org. https://div12.org/treatment/acceptance-and-commitment-therapy-for-chronic-pain/https://integrativepainscienceinstitute.com/ acceptance-and-commitment-therapy-act-for-chronic-pain/

American Psychological Association. (n.d.). APA Dictionary of Psychology. Dictionary.apa.org. https://dictionary.apa.org/self-efficacy

Annagür, B. B., Uguz, F., Apiliogullari, S., Kara, İ., & Gunduz, S. (2014). Psychiatric Disorders and Association with Quality of Sleep and Quality of Life in Patients with Chronic Pain: A SCID-Based Study. Pain Medicine, 15(5), 772–781. https://pubmed.ncbi.nlm.nih.gov/24612225/

Arbinaga, F (June 2023). Pain Catastrophizing Related to Psychological Inflexibility, Self-Reported Injuries and Perfectionism in Soccer Referees. J. of SCI. IN SPORT AND EXERCISE (2023). https://doi.org/10.1007/s42978-023-00234-z

Ashraf, M. Sahar, N. Muhammad, K. Alam, J. (2023). Impact of Self-Efficacy and Perfectionism on Academic Procrastination among University Students in Pakistan. Behav. Sci. 2023, 13(7), 537;https://doi.org/10.3390/bs13070537

Bair, M. J., Robinson, R. L., Katon, W., & Kroenke, K. (2003). Depression and pain comorbidity: a literature review. Archives of Internal Medicine, 163(20), 2433–2445. https://pubmed.ncbi.nlm.nih.gov/14609780/

Benkel, I. Maria, A. Ulla, M. (April 2020). Living with a chronic disease: A quantitative study of the views of patients with a chronic disease on the change in their life situation. doi: 10.1177/2050312120910350

Cohen, S., P, Vase, L., & Hooten, W. M. (2021). Chronic pain: an update on burden, best practices, and new advances. Researchgate, 397(10289), 2082–2097. https://www.researchgate.net/publication/351973500_Chronic_pain_an_update_on_burden_best_practices_and_new_advances

Dindo, L., Brandt, C. P., & Fiedorowicz, J. G. (2019). Cross-sectional relations between psychological inflexibility and symptoms of depression and anxiety among adults reporting migraines or risk factors for cardiovascular disease. Journal of Contextual Behavioral Science, 13, 1–6. https://doi.org/10.1016/j.jcbs.2019.06.001

Farooq, S. T, Khan. S, Zaheer. K, Shafique (2019). Prevalence of anxiety and depressive symptoms and their association with multimorbidity and demographic factors: a community-based, cross-sectional survey in Karachi, Pakistan. Doi: 10.1136/bmjopen-2019-029315

Francisco, J., R (2014). Psychological inflexibility mediates the effects of self-efficacy and anxiety sensitivity on worry. DOI: 10.1017/sjp.2014.3

Gambin, M., Sękowski, M., Woźniak-Prus, M., Wnuk, A., Oleksy, T., Cudo, A., Hansen, K., Huflejt-Łukasik, M., Kubicka, K., Łyś, A. E., Gorgol, J., Holas, P., Kmita, G., Łojek, E., & Maison, D. (2021). Generalized anxiety and depressive symptoms in various age groups during the COVID-19 lockdown in Poland. Specific predictors and differences in symptoms severity. Comprehensive Psychiatry, 105(volume 105), 152222. https://doi.org/10.1016/j.comppsych.2020.

Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and Commitment Therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1–25. https://pubmed.ncbi.nlm.nih.gov/16300724/

Hayes, S. C., Wilson, K. G., Gifford, E. V., & Follette, V. M. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64(6), 1152–1168. https://doi.org/10.1037//0022-006x.64.6.1152


Jeffords, J. R., Bayly, B. L., Bumpus, M. F., & Hill, L. G. (2018). Investigating the Relationship between University Students’ Psychological Flexibility and College Self-Efficacy. Journal of College Student Retention: Research, Theory & Practice, 22(2), 152102511775107. https://doi.org/10.1177/1521025117751071

Kato, T. (2016). Impact of psychological inflexibility on depressive symptoms and sleep difficulty in a Japanese sample. Springer Plus, 5(1). https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC4908084/

Kato, T. (2020). Effect of Psychological Inflexibility on Depressive Symptoms and Sleep Disturbance among Japanese Young Women with Chronic Pain. International Journal of Environmental Research and Public Health, 17(20), 7426. https://pubmed.ncbi.nlm.nih.gov/33053863/

Magni, G., Marchetti, M., Moreschi, C., Merskey, H., & Luchini, S. R. (1993). Chronic musculoskeletal pain and depressive symptoms in the national health and nutrition examination I. Epidemiologic follow-up study. Pain, 53(2), 163–168. https://pubmed.ncbi.nlm.nih.gov/8336986/

Manning, K., Redmond, B. Y., Garey, L., & Zvolensky, M. J. (2022). Associations of Psychological Inflexibility with Exercise Self-Efficacy and Fatigue Severity among Individuals Seeking Treatment for Weight-Related Behaviors. Health Behavior Research, 5(4).

McWilliams, L. A., Cox, B. J., & Enns, M. W. (2003). Mood and anxiety disorders associated with chronic pain: an examination in a nationally representative sample. Pain, 106(1), 127–133. https://pubmed.ncbi.nlm.nih.gov/14581119/

Mehmood, M, M. J, Rehman. M, T, Saeed. B, Arif (2022). Knowledge, attitudes and practices of patients with chronic illnesses during the COVID-19 pandemic: A cross-sectional survey from Pakistan. Doi: 10.1177/17423953211023961

Mumford, D. B., Tareen, I. A. K., Bajwa, M. A. Z., Bhatti, M. R., & Karim, R. (1991). The translation and evaluation of an Urdu version of the Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 83(2), 81–85. https://doi.org/10.1111/j.1600-0447.1991.tb07370.x

Nagasawa, Y., Shibata, A., Ishii, K., & Oka, K. (2022). Psychological inflexibility and physical disability in older patients with chronic low back pain and knee pain. Pain Management, 12(7), 829–835. https://doi.org/10.2217/pmt-2022-0011

Nishtar, S. K, M, Bile. A, Ahmed. S, Shera. A, Ghaffar (2006). Process, Rationale, and Interventions of Pakistan’s National Action Plan on Chronic Diseases. http://www.cdc.gov/pcd/issues/2006/

Patricia, B, S. Alexis, M, G. Paula, H, A. (2021). Psychological Inflexibility and Loneliness Mediate the Impact of Stress on Anxiety and Depression Symptoms in Healthcare Students and Early-Career Professionals During COVID-19. https://doi.org/10.3389/fpsyg.2021.729171

Pizzo, P. A., & Clark, N. M. (2012). Alleviating Suffering 101 — Pain Relief in the United States. New England Journal of Medicine, 366(3), 197–199. https://pubmed.ncbi.nlm.nih.gov/22256802/

Rizzo, J. M., & Schwartz, R. C. (2020). The Effect of Mindfulness, Psychological Flexibility, and Emotional Intelligence on Self-Efficacy and Functional Outcomes among Chronic Pain Clients. Journal of Contemporary Psychotherapy, 51. https://doi.org/10.1007/s10879-020-09481-5

Ruiz, F. J. (2014). Psychological Inflexibility Mediates the Effects of Self-Efficacy and Anxiety Sensitivity on Worry. The Spanish Journal of Psychology, 17.

Ruiz, F. J. (2014). Psychological Inflexibility Mediates the Effects of Self-Efficacy and Anxiety Sensitivity on Worry. The Spanish Journal of Psychology, 17. https://doi.org/10.1017/sjp.2014.3

Shahed, S., Yasin, S., Mehmood, S., Batool, F., & Sarah, S. (2019). Role of Gender Differences in Self Efficacy and Health Beliefs of Heart Patients. FOUNDATION UNIVERSITY JOURNAL of PSYCHOLOGY, 3(2), 110–132. https://doi.org/10.33897/fujp3.2431082019

Sheng, J. Liu, Y. Cui, R. Zhang, X. (June 2017). The Link between Depression and Chronic Pain: Neural Mechanisms in the Brain. Neural Plast. 2017; 2017:9724371. doi: 10.1155/2017/9724371

Tabassum, U., Rehman, G., Schwarzer, R., & Jerusalem, M. (2003). urdu self-efficacy. Userpage.fu-Berlin.de. http://userpage.fu-berlin.de/~health/urdu.htm

Tavakoli, N., Broyles, A., Reid, E. K., Sandoval, J. R., & Correa-Fernández, V. (2019). Psychological inflexibility as it relates to stress, worry, generalized anxiety, and somatization in an ethnically diverse sample of college students. Journal of Contextual Behavioral Science, 11, 1–5. https://doi.org/10.1016/j.jcbs.2018.11.001

Touronis, V. (2021). Acceptance and Commitment Therapy for chronic pain: how can it help? My Online Therapy. https://myonlinetherapy.com/acceptance-and-commitment-therapy-for-chronic-pain/

Usubini, A. G., Varallo, G., Giusti, E. M., Cattivelli, R., Granese, V., Consoli, S., Bastoni, I., Volpi, C., & Castelnuovo, G. (2022). The Mediating Role of Psychological Inflexibility in the Relationship between Anxiety, Depression, and Emotional Eating in Adult Individuals with Obesity.

W, C, C, Sally (2021). Chronic Disease Management, Self-Efficacy and Quality of Life. The journal of Nursing Research 29(1):e129. DOI: 10.1097/JNR.0000000000000422

W, M, Sabry. A, Vohra (2013). Role of Islam in the management of Psychiatric disorders. doi: 10.4103/0019-5545.105534

White, R. G., Gumley, A. I., McTaggart, J., Rattrie, L., McConville, D., Cleare, S., & Mitchell, G. (2012). Depression and Anxiety Following Psychosis: Associations with Mindfulness and Psychological Flexibility. Behavioural and Cognitive Psychotherapy, 41(1), 34–51. https://doi.org/10.1017/s1352465812000239

Wicksell, R., Renöfält, J., Olsson, G., & Lennart, amp; (2006). Psychological Inflexibility in Pain Scale (PIPS). https://www.div12.org/wp-content/uploads/2015/06/ Psychological-Inflexibility-in-Pain-Scale.pdf

Woo, A. K. (2010). Depression and Anxiety in Pain. Reviews in Pain, 4(1), 8–12. https://doi.org/10.1177/204946371000400103

Wu, S, F. V., Huang, Y. C., Lee, M. C., Wang, T. J., Tung, H. H., & Wu, M. P. (2013). Self-efficacy, self-care behavior, anxiety, and depression in Taiwanese with type 2 diabetes: A cross-sectional survey. Nursing & Health Sciences, 15(2), 213–219. https://doi.org/10.1111/nhs.12022

Yao, X., Xu, X., Chan, K. L., Chen, S., Assink, M., & Gao, S. (2023). Associations between psychological inflexibility and mental health problems during the COVID-19 pandemic: A three-level meta-analytic review. Journal of Affective Disorders, 320, 148–160. https://doi.org/10.1016/j.jad.2022.09.116

Farhane-Medina, N. Z., Luque, B., Tabernero, C., & Castillo-Mayén, R. (2022). Factors associated with gender and sex differences in anxiety prevalence and comorbidity: A systematic review. Science Progress, 105(4), 003685042211354. https://doi.org/10.1177/00368504221135469

Farooqi, Y., & Habib, M. (2010). Gender differences in anxiety, depression and stress among survivors of suicide bombing. Pakistan Journal of Social and Clinical Psychology, 8(2), 145–153.

Gitay, M. N., Fatima, S., Arshad, S., Arshad, B., Ehtesham, A., Baig, M. A., Ilyas, M. F., Rizvi, S. F., Farooqui, Q., Masroor, M., & Haque, Z. (2018). Gender Differences and Prevalence of Mental Health Problems in Students of Healthcare Units. Community Mental Health Journal, 55(5), 849–853. https://doi.org/10.1007/s10597-018-0304-2




How to Cite

Shakeel, A., Irshad, M. ., & Ameer, E. (2023). Exploring the Influence of Psychological Inflexibility on Depression, Anxiety, Self-Efficacy, and Gender Disparities among Individuals with Chronic Illnesses. Pakistan Journal of Gender Studies, 23(2), 1–21. https://doi.org/10.46568/pjgs.v23i2.706