{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T16:04:44Z","timestamp":1790265884607,"version":"4.1.0"},"reference-count":35,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T00:00:00Z","timestamp":1752192000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health\u2014Ricerca Corrente"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background. Several psychological processes can influence the adjustment of cardiac patients. Psychological flexibility has been linked to significant improvements in psychological well-being during cardiac rehabilitation (CR). It can be understood as the dynamic interaction of three key processes: openness to experience (OE), behavioral awareness (BA), and value-driven action (VA). This study aimed to (1) evaluate the distinct role of these processes in predicting anxiety, depression, and psychological well-being in cardiac patients, and (2) assess these associations over the course of CR. Methods. A total of 194 CR patients participated in this longitudinal study, with 156 completing follow-up assessments at T2. Anxiety and depression were measured using the Patient Health Questionnaire-4, psychological well-being with the Psychological Well-being Index-Short, and psychological flexibility using the Comprehensive Assessment of ACT Processes. Results. Cross-sectional regression analysis revealed that all three psychological flexibility dimensions were negatively associated with anxiety and depression and positively associated with psychological well-being at T1. However, longitudinal analyses showed that only VA was positively associated with a decrease in depressive symptoms following CR. A sensitivity analysis conducted on the subgroup of patients with mild to severe symptoms of anxiety and depression further confirmed the robustness of these findings. Conclusions. These results highlight the potential benefits of measuring specific psychological flexibility processes when examining the psychological status of cardiac patients and when planning psychological interventions during CR.<\/jats:p>","DOI":"10.3390\/jcm14144937","type":"journal-article","created":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T14:22:36Z","timestamp":1752243756000},"page":"4937","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Psychological Flexibility Processes Differentially Predict Anxiety, Depression, and Well-Being Throughout Cardiac Rehabilitation"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4807-9566","authenticated-orcid":false,"given":"Chiara A. M.","family":"Spatola","sequence":"first","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6457-2169","authenticated-orcid":false,"given":"Giada","family":"Rapelli","sequence":"additional","affiliation":[{"name":"Department of Psychology, Catholic University of the Sacred Heart, 20123 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5131-004X","authenticated-orcid":false,"given":"Christina L.","family":"Goodwin","sequence":"additional","affiliation":[{"name":"Department of Psychiatry & Behavioral Health, Cooper University Health Care, Camden, NJ 08103, USA"},{"name":"Department of Psychiatry, Cooper Medical School of Rowan University, Camden, NJ 08103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5995-5456","authenticated-orcid":false,"given":"Roberto","family":"Cattivelli","sequence":"additional","affiliation":[{"name":"Department of Psychology Renzo Canestrari, Alma Mater Studiorum University of Bologna, 40127 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5911-5748","authenticated-orcid":false,"given":"Giada","family":"Pietrabissa","sequence":"additional","affiliation":[{"name":"Department of Psychology, Catholic University of the Sacred Heart, 20123 Milano, Italy"},{"name":"IRCCS Istituto Auxologico Italiano, Clinical Psychology Research Laboratory, 20145 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9488-2021","authenticated-orcid":false,"given":"Gabriella","family":"Martino","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2633-9822","authenticated-orcid":false,"given":"Gianluca","family":"Castelnuovo","sequence":"additional","affiliation":[{"name":"Department of Psychology, Catholic University of the Sacred Heart, 20123 Milano, Italy"},{"name":"IRCCS Istituto Auxologico Italiano, Clinical Psychology Research Laboratory, 20145 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1037\/hea0001109","article-title":"Physical activity after cardiac rehabilitation: Explicit and implicit attitudinal components and ambivalence","volume":"40","author":"Bermudez","year":"2021","journal-title":"Health Psychol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1016\/j.jacc.2018.07.042","article-title":"Positive psychological well-being and cardiovascular disease: JACC health promotion series","volume":"72","author":"Kubzansky","year":"2018","journal-title":"J. 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