{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T02:15:50Z","timestamp":1793326550196,"version":"4.5.0"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T00:00:00Z","timestamp":1746576000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Continuous renal replacement therapy (CRRT) is the primary treatment for severe sepsis and has been shown to reduce patient mortality. Patients with severe sepsis who receive CRRT frequently experience significant physical and psychological distress, manifesting as shame, social withdrawal, and abnormal cognitive moods. This study aimed to explore the relationship between psychological resilience, cognitive flexibility, and post-traumatic growth (PTG) levels in patients with severe sepsis treated with CRRT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>From January to October 2024, patients with severe sepsis who were treated with CRRT in our hospital were selected by convenience sampling as the research object. The Connor-Davidson Resilience Scale (CDRISC), Cognitive Flexibility Scale, and Post-Traumatic Growth Inventory (PTGI) were used to evaluate patients\u2019 psychological resilience, cognitive flexibility, and PTG levels. Statistical methods included the independent sample t test, Pearson analysis, and linear regression analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The total scores of CDRISC, cognitive flexibility scale and PTGI in 205 patients was (42.98\u202f\u00b1\u202f6.13), (95.04\u202f\u00b1\u202f17.98) and (49.77\u202f\u00b1\u202f9.92), respectively. There was a significant positive correlation between psychological resilience, cognitive flexibility, and PTG levels in patients with severe sepsis treated with CRRT (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.05). Psychological resilience and cognitive flexibility had positive predictive effects on PTG, and there were significant positive predictive effects between psychological resilience and cognitive flexibility (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.05). Psychological resilience directly and positively predicted PTG (<jats:italic>\u03b2<\/jats:italic>\u202f=\u202f0.538, <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.05). The indirect effect of psychological resilience on cognitive flexibility was significant (<jats:italic>\u03b2<\/jats:italic>\u202f=\u202f0.677, <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.05), and the indirect effect of cognitive flexibility on PTG was significant (<jats:italic>\u03b2<\/jats:italic>\u202f=\u202f0.165, <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.05). The chain-mediating effect between psychological resilience, cognitive flexibility, and PTG was significant (<jats:italic>\u03b2<\/jats:italic>\u202f=\u202f0.112, <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Psychological resilience can affect the PTG level of patients with severe sepsis treated with CRRT and can also indirectly affect PTG levels through direct chain mediation of cognitive flexibility. Targeted intervention strategies should be formulated to improve mental health and promote clinical prognosis.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1589223","type":"journal-article","created":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T05:13:23Z","timestamp":1746594803000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Relationship between psychological resilience, cognitive flexibility and post-traumatic growth level in patients with severe sepsis treated by continuous renal replacement therapy"],"prefix":"10.3389","volume":"13","author":[{"given":"Changzheng","family":"Zhao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lancai","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haixia","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongzan","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MiaoMiao","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,5,7]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"67","DOI":"10.20471\/acc.2022.61.s1.11","article-title":"Sepsis definition: what's new in the treatment guidelines","volume":"61","author":"Srzi\u0107","year":"2022","journal-title":"Acta Clin Croat"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1967","DOI":"10.1001\/jama.2023.7560","article-title":"Fluid therapy for critically ill adults with Sepsis: a review","volume":"329","author":"Zampieri","year":"2023","journal-title":"JAMA"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1093\/ajhp\/zxab380","article-title":"The pathophysiology of sepsis-2021 update: part 1, immunology and coagulopathy leading to endothelial injury","volume":"79","author":"Jacobi","year":"2022","journal-title":"Am J Health Syst Pharm"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1146\/annurev-psych-020122-041854","article-title":"Psychological resilience: an affect-regulation framework","volume":"74","author":"Troy","year":"2023","journal-title":"Annu Rev Psychol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1186\/s12888-024-05526-4","article-title":"Social support, family resilience and psychological resilience among maintenance hemodialysis patients: a longitudinal study","volume":"24","author":"Wang","year":"2024","journal-title":"BMC Psychiatry"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1590","DOI":"10.34067\/KID.0008152021","article-title":"Post-traumatic stress disorder and post-traumatic growth following kidney transplantation","volume":"3","author":"Nash","year":"2022","journal-title":"Kidney360"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"390","DOI":"10.36131\/cnfioritieditore20220606","article-title":"Post traumatic growth (Ptg) in the frame of traumatic experiences","volume":"19","author":"Dell'Osso","year":"2022","journal-title":"Clin Neuropsychiatry"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"763","DOI":"10.3390\/ijerph21060763","article-title":"Relationship between thought style, emotional response, post-traumatic growth (Ptg), and biomarkers in Cancer patients","volume":"21","author":"Sierra-Murgu\u00eda","year":"2024","journal-title":"Int J Environ Res Public Health"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"688","DOI":"10.1017\/S1092852923002237","article-title":"Impaired cognitive flexibility across psychiatric disorders","volume":"28","author":"Grant","year":"2023","journal-title":"CNS Spectr"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1016\/j.encep.2022.02.001","article-title":"Factors that hinder post-traumatic growth: a systematic review","volume":"48","author":"Henson","year":"2022","journal-title":"Enc\u00e9phale"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"5924","DOI":"10.3390\/ijms25115924","article-title":"Acute kidney injury in Sepsis","volume":"25","author":"Pais","year":"2024","journal-title":"Int J Mol Sci"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1080\/00325481.2024.2388021","article-title":"Review: sepsis guidelines and core measure bundles","volume":"136","author":"Desposito","year":"2024","journal-title":"Postgrad Med"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"564","DOI":"10.1186\/s12879-022-07543-8","article-title":"Frequency and mortality of sepsis and septic shock in China: a systematic review and meta-analysis","volume":"22","author":"Liu","year":"2022","journal-title":"BMC Infect Dis"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"3857","DOI":"10.1038\/s41380-024-02603-8","article-title":"Severe mental illness and mortality in sepsis and septic shock: a systematic review and meta-analysis","volume":"29","author":"Lakbar","year":"2024","journal-title":"Mol Psychiatry"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1016\/j.encep.2020.05.021","article-title":"Post-traumatic growth: some conceptual considerations","volume":"47","author":"Magne","year":"2021","journal-title":"Enc\u00e9phale"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"21m03230","DOI":"10.4088\/PCC.21m03230","article-title":"Psychological resilience, coping, and distress in admitted patients with Covid-19 infection","volume":"24","author":"Miglani","year":"2022","journal-title":"Prim Care Companion CNS Disord"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e13759","DOI":"10.1111\/ecc.13759","article-title":"Exploring psychological resilience and demoralisation in prostate cancer survivors","volume":"31","author":"Chien","year":"2022","journal-title":"Eur J Cancer Care"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1016\/j.jad.2023.08.060","article-title":"The moderating role of psychological resilience in the relationship between falls, anxiety and depressive symptoms","volume":"341","author":"Wang","year":"2023","journal-title":"J Affect Disord"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"963","DOI":"10.15537\/smj.2024.45.9.20240467","article-title":"Psychological resilience and well-being among a sample of Saudi","volume":"45","author":"Almutlaq","year":"2024","journal-title":"Saudi Med J"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1064494","DOI":"10.3389\/fpsyg.2022.1064494","article-title":"Cognitive flexibility as a protective factor for empathy","volume":"13","author":"Cai","year":"2022","journal-title":"Front Psychol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"740","DOI":"10.1002\/cpp.2838","article-title":"Posttraumatic growth in colorectal cancer survivors: a systematic review","volume":"30","author":"Wang","year":"2023","journal-title":"Clin Psychol Psychother"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"114594","DOI":"10.1016\/j.psychres.2022.114594","article-title":"Cognitive flexibility and suicide risk indicators among psychiatric inpatients","volume":"313","author":"Novak","year":"2022","journal-title":"Psychiatry Res"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1643","DOI":"10.1007\/s10802-022-00952-y","article-title":"Cognitive flexibility and impulsivity deficits in suicidal adolescents","volume":"50","author":"HA","year":"2022","journal-title":"Res Child Adolesc Psychopathol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"305","DOI":"10.3390\/brainsci13020305","article-title":"Biological correlates of post-traumatic growth (Ptg): a literature review","volume":"13","author":"Dell'Osso","year":"2023","journal-title":"Brain Sci"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1152823","DOI":"10.3389\/fpsyg.2023.1152823","article-title":"The effect of the social support on Ptsd and Ptg about university student volunteers in the prevention and controlling of coronavirus: with coping style as the intermediary","volume":"14","author":"Hao","year":"2023","journal-title":"Front Psychol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1016\/j.jad.2022.09.114","article-title":"Social support and posttraumatic growth: a meta-analysis","volume":"320","author":"Ning","year":"2023","journal-title":"J Affect Disord"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"e077896","DOI":"10.1136\/bmjopen-2023-077896","article-title":"Scoping review protocol of post-traumatic growth (Ptg) in Korean cancer survivors","volume":"14","author":"Park","year":"2024","journal-title":"BMJ Open"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"102159","DOI":"10.1016\/j.cpr.2022.102159","article-title":"Cognitive biases in perceptions of posttraumatic growth: a systematic review and meta-analysis","volume":"94","author":"Gower","year":"2022","journal-title":"Clin Psychol Rev"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"e20220524","DOI":"10.47626\/2237-6089-2022-0524","article-title":"Psychological resilience and mood disorders: a systematic review and meta-analysis","volume":"46","author":"Imran","year":"2024","journal-title":"Trends Psychiatry Psychother"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"e0292887","DOI":"10.1371\/journal.pone.0292887","article-title":"Psychological resilience mediates the association between sleep quality and anxiety symptoms: a repeated measures study in college students","volume":"18","author":"Cai","year":"2023","journal-title":"PLoS One"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1589223\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T05:13:24Z","timestamp":1746594804000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1589223\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,7]]},"references-count":30,"alternative-id":["10.3389\/fpubh.2025.1589223"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1589223","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,7]]},"article-number":"1589223"}}