The Psychological Flexibility Model

Psychological flexibility refers to an individual’s ability to cope with, accept, and adjust to difficult situations by distancing from current mindsets and considering other possible mindsets, in a way that is congruent with personal values (Kashdan & Rottenberg, 2010).

Psychological dysfunction correlates with psychological inflexibility (Bond et al., 2011) and psychological flourishing correlates with high psychological flexibility (Kashdan & Rottenberg, 2010). There is growing empirical support for the role of psychological flexibility in psychedelic-assisted therapy outcomes (Davis et. al, 2020; Agin-Liebes, 2022). As a result, more therapists are turning to contemplative approaches, including third-wave behavioural approaches grounded in psychological flexibility, as a framework for structuring psychedelic-assisted therapy (Hayes et. al, 2019).

Given that exposure to psychedelics alone may increase psychological flexibility, and that this is associated with positive outcomes, it seems logical to nest psychedelic-assisted therapy within a therapeutic framework that is intentionally designed to increase psychological flexibility and promote potential synergies.

The ACT Hexaflex Model

A six-component “Hexaflex” model has been conceived to describe processes relevant to psychological flexibility and there are incorporated into the therapeutic application of Acceptance and Commitment Therapy.

Please ensure that you read through all items before proceeding by selecting each of the six components of the diagram.

Contact with the Present Moment

Closely related to mindfulness

Values

Contact with values

Committed Actions

Steps to take aligned with values

Self as Context

Flexible perspective taking

Defusion

Also known as meta-awareness, de-centering or disidentifying from thoughts

Acceptance

The inverse of experiential avoidance

The psychological flexibility model aligns with core processes of altered states of consciousness that are relevant to psychopathology.

Three common psychological processes underlie many, if not most, psychopathologies and dis-ease among those who do not have mental health diagnoses. Refer to each core process of ACT which may serve as a possible antidote.

Please ensure that you read through all items before proceeding by selecting each title.

Antidote

Defusion, de-centering, metacognitive awareness, flexible perspective taking (self as contex) Consider: Without your thoughts, would you be in distress?

Psychedelic experiences and other altered states of consciousness can powerfully introduce clients to awareness outside of words and narratives, allowing them to take a new perspective less bound by narratives, beliefs or other identifications. A compassion dimension that may evolve from such perspective is directly experiencing states of ‘interbeing’, ‘unitive awareness,’ or ‘common humanity’. Acceptance and commitment therapy encourages and supports shifting towards these perspectives; common mindfulness practices, such as mindfulness meditation (focused or open monitoring) and metta practices likewise support this shift.

Antidote

Exposure with experiential acceptance, affect tolerance

Most disorders involve difficulty opening to painful experience; avoidance makes painful experiences more disruptive and long lasting.

For example, with sadness, a poignant feeling comes and goes. In depression, sadness is repressed, and one is often blocked or stuck in avoidance. Altered states of consciousness, particularly those created by psychedelic medicines, serve to soften the repression barrier while simultaneously increasing one’s capacity to embrace or tolerate these experiences.

Antidote

Flexible perspective taking (self-as context), selflessness

Self-preoccupation takes a central role in most disorders, involving narratives about me (e.g. my inadequacies, my failures, ruminative thinking, etc.) usually involving over-activation of the default mode network. With a flexible perspective related to the self, we let go of seeing ourselves in the fixed way we are accustomed to. How might a flexible “unfixed” sense of self free up our behavioural repertoire?

Developing selflessness supports us to accept diverse parts of ourselves, become less defensive and connect more deeply with others. Psychedelic experiences are powerful catalysts for reference experiences of a broader self beyond an ego-constrained self or even non-dual ‘no-self’ states of selflessness and unity.

Acceptance and Commitment Therapy

Application of these processes through acceptance and commitment therapy is an evidence-informed approach that can serve as a useful structure for preparing and integrating psychedelic experiences.

An adaptation of ACT, ACE (described on the next page) may also serve as a valuable clinical tool for guiding clients in these processes relative to psychedelic-assisted therapy.