Psychological flexibility and anxiety—A systematic review and meta‐analysis

OBJECTIVES: The association of psychological flexibility (PF) with anxiety has been widely studied. However, concerns about the measurement of PF raise questions regarding the validity and comparability of existing findings. This meta-analysis examined the association between PF and anxiety using a stringent set of validated PF measures and explored potential moderators of this relationship. DESIGN: This study employed a systematic review and meta-analysis design. METHODS: A literature search was conducted across five databases: CINAHL, Embase, MEDLINE, PsycINFO and Web of Science. RESULTS: A total of 29 studies, yielding 31 effect sizes, were included. Random-effects meta-analysis revealed a significant, moderate negative association between PF and anxiety (r = -.466, 95% CI [-0.52, -0.41]). Subgroup and meta-regression analyses showed that the PF instrument, anxiety construct and sample size significantly moderated the relationship between PF and anxiety. CONCLUSIONS: Overall, findings suggest that greater PF is associated with lower anxiety symptoms, although the magnitude of this relationship varies depending on how PF is operationalized. These results highlight the importance of measurement choice in PF research and support PF as a clinically relevant transdiagnostic target in interventions for anxiety.