Access to evidence-based psychotherapy remains limited worldwide, with long waitlists even in high-income regions. Recent advances in large language models (LLMs) offer potential for scalable mental health support when designed with clinical oversight and safety mechanisms. We present Mind Companion, an LLM-based embodied conversational agent integrating multi-layered psychological analysis with process-based therapy principles. The system performs real-time analysis of client statements across fact extraction, psychological flexibility process detection, emotion recognition, and safety monitoring. Analysis results are stored for supervising clinicians to inform therapeutic planning. Response generation incorporates retrieval-augmented generation from evidence-based therapeutic literature and context-aware prompting. Responses are delivered through an embodied avatar with synchronized speech synthesis and animation. We evaluated three LLM configurations (GPT-4.1-mini, GPT-5.2, Claude Sonnet 4.5) against therapist responses from real therapy sessions using automated LLM-judge assessment and expert evaluation with 11 professional psychotherapists. GPT-5.2 achieved higher ratings than human therapist responses across understanding, interpersonal effectiveness, collaboration, and therapeutic alignment in both evaluations, demonstrating the feasibility of LLM-based conversational agents as tools to complement clinical care.

Understanding the drivers of COVID-19 vaccination intentions remains relevant as public health systems prepare for future pandemics. This study examined how emotional and social-cognitive factors influence COVID-19 vaccination intentions during two key phases of the COVID-19 pandemic: before (April-June 2020) and after (January-February 2021) vaccination rollout. A total of 586 adults completed an online survey assessing beliefs about COVID-19, self-efficacy to adhere to protective behaviours, perceived stress, affect, psychological flexibility, and prosociality. Self-efficacy, prosociality, psychological flexibility and positive affect significantly declined after vaccination rollout. Higher self-efficacy and perceived severity of the disease consistently predicted stronger vaccination intentions across time points. Perceived susceptibility was negatively associated with vaccination intention before, but not after rollout. The psychological variables were not significant predictors of intentions. These findings underscore the importance of social-cognitive factors, especially self-efficacy and perceived severity, in shaping vaccination-related decisions, with implications for designing effective communication strategies in future health emergencies.

Background/Objectives: The COVID-19 pandemic has adversely impacted the mental health of nurses worldwide. Nurse burnout results from chronic workplace stress and is characterized by exhaustion, negative or cynical feelings about work, and a diminished sense of accomplishment. This can lead to turnover intention. Therefore, psychological capacities, such as psychological flexibility, that could help nurses regulate and minimize the impact should be studied. This study aimed to compare burnout, insomnia and turnover intention among nurses from an Eastern and Western cultural context and to investigate the role of psychological flexibility as a protective factor against mental health and related problems such as insomnia and turnover intention. Methods: Nurses from Hong Kong (n = 158) and Switzerland (n = 294) involved in patient care during the COVID-19 pandemic participated in an online mental health survey. Results: We observed high levels of burnout, subthreshold insomnia and turnover intention in nurses from both Switzerland and Hong Kong, with higher burnout rates among Hong Kong nurses and higher turnover intentions among nurses from Switzerland, and that psychological flexibility is a crucial factor that may protect nurses from burnout and insomnia. Conclusions: The nurses from both regions involved in patient care one year after the onset of the pandemic suffered from poor mental health. Psychological flexibility was identified as a critical factor in improving nurses’ mental health. The results of this study should be incorporated into health promotions for nursing professionals and help develop specific and effective interventions for practical nursing application.

To examine the relationship between valued action and mood, this study analyzed Ecological Momentary Assessment data from a transdiagnostic in-and out-patient sample (EMA; N = 134; 62 female, 72 male; 62 inpatient, 72 outpatient; Mage = 36.6 years, SD = 11.6). Individual time series models were constructed to capture each participant's unique relationship between valued action and mood. The models were then meta-analyzed, revealing substantial variability, with two subgroups; Stoics (n = 64) and Non-Stoics (n = 70). The Stoics subgroup showed null or negative links between valued action and mood, replicating past findings from a nonclinical sample. The Non-Stoic group engaged significantly more in valued actions characterized by enjoyment and relaxation. Subsequent multilevel VAR networks were created to examine differences between Stoics and Non-Stoics. Within-person analyses indicated that, unlike Non-Stoics, Stoics showed no significant association between valued action and mood in contemporaneous networks. Temporal networks revealed that, for Non-Stoics, mood positively influenced future engagement in valued action. These findings challenge assumptions of a universally positive relationship between valued action and mood, suggesting divergent paths to wellbeing based on individual differences in mood-action dynamics.

The COVID-19 pandemic involved a complex set of stressors affecting the health and well-being of the population. The understanding of the psychological processes that influence well-being in response to the pandemic and their interrelation is vital. A promising process in understanding the emotional impacts of these stressors is psychological flexibility. This study investigated the effect of psychological flexibility on well-being, both directly and indirectly, via mindfulness and coping strategies. A total of 334 Portuguese adults participated in this cross-sectional study. Participants were asked to complete an online questionnaire, including measures of psychological flexibility, well-being, mindfulness, and coping strategies. A multiple mediation model studied whether there are conditional indirect effects of mindfulness and coping strategies on well-being. The results showed statistically significant correlations between psychological flexibility, well-being, mindfulness, and coping strategies. Furthermore, we found that mindfulness and coping strategies partly mediate the relationship between psychological flexibility and well-being. Understanding the processes through which psychological flexibility influences well-being in a stressful context is important in comprehending the processes involved in an emotional reaction to a pandemic-like societal event. Mindfulness and coping are shown to be important processes to consider in understanding this phenomenon and designing future responses.

This article critiques the "protocol-for-syndrome" model in mental health research, highlighting two primary concerns: the complexity of protocols that include change processes irrelevant to many individuals, and the inadequacy of Diagnostic and Statistical Manual of Mental Disorders syndromes to capture the nuances of individual well-being and suffering. Advocating a shift to a process-based therapy (PBT) approach, the article proposes a coherent integration of diverse change processes and interventions to enrich therapy practices. It introduces a slightly revised extended evolutionary metamodel (EEMM) as a comprehensive framework that provides a consistent language for discussing change processes, focusing on the key drivers of variation, selection, and retention, and categorizing these into dimensions (such as cognition, emotion, self, motivation) and levels (from biology/physiology to psychology and social relationships/culture). The article details the application of EEMM in classifying therapeutic processes, validated through both human and artificial intelligence (AI) ratings. Furthermore, we developed an AI tool built on Distilled Bidirectional Encoder Representations from Transformers (distilBERT) models for categorizing therapeutic content, proving effective and accessible for community engagement and ongoing enhancement. The article also explores network theory and new analytics as tools for therapists to customize therapy to individual client needs. In summary, PBT supports therapeutic diversity while establishing common ground among different methods and approaches. This enhances communication, cooperation, and comparison, fostering the development of tailored and effective therapy strategies. It also opens the door to the potential unification of psychotherapy.

Psychological Flexibility is an essential concept in Contextual Behavioural Sciences. The development of instruments is vital for its study, and it is an opportunity to reflect on this concept. Among the measures of this construct, Psy-Flex shows promise due to comprehensiveness in assessing the six facets of psychological flexibility and its pragmatic value. In the present study, we sought to translate Psy-Flex to Portuguese and adapt it transculturally for use in Portugal and Brazil. The translation was done independently by Brazilian and Portuguese researchers, and a consensus procedure was done to identify a synthesis. A total of 873 adults from Portugal and Brazil were involved in this study. The participants completed several questionnaires with ACT-related measures (e.g., cognitive fusion, mindful attention) and instruments measuring conceptually related variables (e.g., positive mental health). The results show good psychometric properties of PsyFlex. The one-factor structure of the original instrument was confirmed in both the Portuguese and Brazilian samples. Confirmatory factor analysis revealed a good fit of the model to the data (CFI = 0.985, RMSEA = 0.055) of both countries. Furthermore, the Psy-Flex showed convergent validity with related measures in a conceptually expected way. As a transcultural instrument, we argue that both the similarities and differences across samples suggest the broad human nature of psychological flexibility while retaining its context sensitivity.

This research aimed to translate the original English version of the Psy-Flex, a scale of psychological flexibility, into Chinese and to test its psychometric properties among parents of children with autism spectrum disorder (ASD). Two phases were conducted: (1) translation from English to Chinese (Psy-Flex-C), followed by a semantic equivalence evaluation between two versions, a pre-test, and an evaluation of the Psy-Flex-C in terms of face validity with 20 parents of autistic children, and content validity of the Psy-Flex-C with eight experts. (2) A cross-sectional study with 248 parents of autistic children was conducted for validation, and a subgroup of 50 participants was randomly selected to assess the test–retest reliability at a 2-week interval. The Psy-Flex-C showed satisfactory semantic equivalence with the original version and demonstrated adequate internal consistency (Cronbach’s α = 0.84) and test–retest stability (weighted kappa statistic = 0.88). Concurrent validity was supported by a moderate correlation between the Psy-Flex-C and the Comprehensive Assessment of Acceptance and Commitment Therapy Processes (Pearson’s r = 0.54, p < 0.01). The Psy-Flex-C showed a significant mean score difference between parents with high and low parenting stress (t = 5.43, p < 0.001). Similar to the original scale, confirmatory factor analysis showed the best fitting one-factor structure of the Psy-Flex-C (X2/df = 1.62, p = 0.13, RMSEA = 0.05, GFI = 0.99, CFI = 0.99, TLI = 0.98, SRMR = 0.023). The Psy-Flex-C can be a reliable and valid instrument to self-report psychological flexibility in parents of children with ASD. Future research is recommended to test the Psy-Flex-C using diverse samples from different cultures and contexts to enhance its generalizability.

Objective: Patients suffering from psychological disorders report decreased quality of life and low mood. The relationship of these symptoms to daily upsetting events or environments, and in the context of active coping mechanisms is poorly understood. The present study thus investigates the association between mood, psychological flexibility, upsetting events, and environment in the daily life of outpatients.Method: We investigated 80 outpatients at the beginning of treatment, using event sampling methodology (ESM). Patients' mood, occurrence of upsetting events, current environment, and psychological flexibility were sampled six times per day during a one-week intensive longitudinal examination. Data were analyzed using linear mixed models (LMMs).Results: Participants reported worse mood the more upsetting events they experienced. Further, participants reported better mood when in private environments (e.g., with friends), and worse mood when at the hospital, compared to being at home. Higher levels of psychological flexibility, however, were associated with better mood, irrespective of the occurrence of upsetting events or current environment.Conclusion: Results suggest that mood is positively associated with psychological flexibility, not despite, but especially during the dynamic and context-specific challenges of daily life. Psychological flexibility may thus potentially act as a buffer against distress-provoking situations as patients go about their daily lives.Trial registration: ISRCTN.org identifier: ISRCTN11209732.

Our study examines the relationship between self-compassion, other-compassion, and romantic attraction in couples, and questions the psychological homogeneity assumption—the idea that psychological responses are uniform across individuals and couples. We analyzed data from 161 participants in 84 couples, with an average age 32 (SD = 12.02), using smartphones for event sampling six times daily over a week to measure self-compassion, other-compassion, and attraction. Through within-person and network analysis, we discovered significant variability in how self and other-compassion influence attraction, identifying two distinct couple types: "synergistic," where compassion significantly affects attraction, and "independent," where it does not. Further analysis revealed that, when other-compassion is accounted for, males with high self-compassion were less attracted to their female partners. The significant diversity in how individuals and couples experience compassion and attraction challenges the assumption that conclusions drawn from group averages can be universally applied to individual couples. Clinically this means that efforts to enhance compassion in couples therapy should be tailored to the couple's unique dynamics. Indeed, for some men, emphasizing self-compassion without considering other-compassion could even be detrimental to the relationship. Our findings highlight the need for nuanced case formulation and personalized treatment planning in couples therapy, underscoring the complexity of relationship dynamics and the importance of rejecting "one size fits all" assumptions.

ObjectivesIncreasing psychological flexibility is considered an important mechanism of change in psychotherapy across diagnoses. In particular, Acceptance and Commitment Therapy (ACT) primarily aims at increasing psychological flexibility in order to live a more fulfilling and meaningful life. The purpose of this study is to examine 1) how psychological flexibility changes during an ACT-based treatment in a transdiagnostic day hospital and 2) how this change is related to changes in symptomatology, quality of life, and general level of functioning.Methods90 patients of a psychiatric day hospital participated in the study. Psychological flexibility, symptomatology, and quality of life were assessed at three measurement time points (admission, discharge, and 3-month follow-up). The level of functioning was assessed at admission and discharge. Differences in psychological flexibility were tested via two-sided paired samples t-tests. Correlations of residualized change scores were calculated to detect associations between changes in psychological flexibility and other outcomes.ResultsPsychological flexibility increased significantly from pre-treatment to post-treatment (d = .43, p <.001) and from pre-treatment to follow-up (d = .54, p <.001). This change was significantly correlated to a decrease in symptomatology (r = .60 –.83, p <.001) and an increase in most dimensions of quality of life (r = -.43 – -.75, p <.001) and general level of functioning (r =-.34, p = .003).DiscussionThis study adds further evidence for psychological flexibility as a transdiagnostic process variable of successful psychotherapy. Limitations are discussed.

To develop effective and personalized interventions, it is essential to identify the most critical processes or psychological drivers that impact an individual’s well-being. Some processes may be universally beneficial to well-being across many contexts and people, while others may only be beneficial to certain individuals in specific contexts. We conducted three intensive daily diary studies, each with more than 50 within-person measurement occasions, across three data sets (n1 = 44; n2 = 37; n3 = 141). We aimed to investigate individual differences in the strength of within-person associations between three distinct process measures and a variety of outcomes. We utilized a unique idiographic algorithm, known as i-ARIMAX (Autoregressive Integrated Moving Average), to determine the strength of the relationship (Beta) between each process and outcome within individuals (“i”). All of the computed betas were then subjected to meta-analyses, with individuals treated as the “study”. The results revealed that the process-outcome links varied significantly between individuals, surpassing the homogeneity typically seen in meta-analyses of studies. Although several processes showed group-level effects, no process was found to be universally beneficial when considered individually. For instance, processes involving social behavior, like being assertive, did not demonstrate any group-level links to loneliness but still had significant individual-level effects that varied from positive to negative. Using i-ARIMAX might help reduce the number of candidate variables for complex within-person analyses. Additionally, the size and pattern of i-ARIMAX betas could prove useful in guiding personalized interventions.

Background: Clinical data are usually analyzed with the assumption that knowledge gathered from group averages applies to the individual. Doing so potentially obscures patients with meaningfully different trajectories of therapeutic change. Needed are “idionomic” methods that first examine idiographic patterns before nomothetic generalizations are made. The objective of this paper is to test whether such an idionomic method leads to different clinical conclusions.Methods: 51 patients completed weekly process measures and symptom severity over a period of eight weeks. Change trajectories were analyzed using a nomothetic approach and an idiographic approach with bottom-up clustering of similar individuals. The outcome was patients’ well-being at post-treatment.Results: Individuals differed in the extent that underlying processes were linked to symptoms. Average trend lines did not represent the intraindividual changes well. The idionomic approach readily identified subgroups of patients that differentially predicted distal outcomes (well-being).Conclusions: Relying exclusively on average results may lead to an oversight of intraindividual pathways. Characterizing data first using idiographic approaches led to more refined conclusions, which is clinically useful, scientifically rigorous, and may help advance individualized psychotherapy approaches.

The present study compared multi-methodically and multi-dimensionally the effects of acceptance and avoidance coping with emotional pain, both between and within-group. Convenience sampling was used, with 88 participants included (81.8% females; Mage=21.75 years) and being randomly assigned to one of two instructed groups: (a) Acceptance followed by avoidance of pain sensations and thoughts, and (b) Avoidance followed by acceptance. All participants underwent an emotional pain induction procedure three times involving negative autobiographical recall and an emotional-pain standardized script. In the first emotion induction, no instructions were given whereas in the other two, participants were instructed to use the techniques they were trained in. On both autobiographical and emotional-pain script tasks, participants who used firstly avoidance and secondly acceptance exhibited significantly lower mean heart rate and higher mean heart rate variability RR index across time. Also, in the last emotional pain induction, on both tasks, acceptance resulted in lower physiological activation than avoidance. No significant differences were found for the self-report of negative affect. Overall, acceptance vs. avoidance differences were mostly found in the physiological outcomes, suggesting the importance of including objective measures when examining coping techniques. Our findings suggest that ACT's concept of creative hopelessness is supported, as participants may have to use firstly use ineffective coping strategies to better understand what methods are most effective for managing pain. To our knowledge, this study is the first study to compare acceptance vs. avoidance coping with emotional pain both between and within-group, using a multi-method and multi-dimensional approach.

Day-to-day social life and mental health are intertwined. Yet, no study to date has assessed how the quantity and quality of social interactions in daily life are associated with changes in depressive symptoms. This study examines these links using multiple-timescale data (iSHAIB data set; N = 133), where the level of depressive symptoms was measured before and after three 21-day periods of event-contingent experience sampling of individuals' interpersonal interactions (T = 64,112). We find weak between-person effects for interaction quantity and perceiving interpersonal warmth of others on changes in depressive symptoms over the 21-day period, but strong and robust evidence for overwarming-a novel construct representing the self-perceived difference between one's own and interaction partner's level of interpersonal warmth. The findings highlight the important role qualitative aspects of social interactions may play in the progression of individuals' depressive symptoms.

This study compared acceptance vs. avoidance coping with acute physical pain, in a pain-induction experiment and examined both between and within-group differences, multi-methodically and multi-dimensionally using behavioral, physiological and self-report measures. The sample consisted of 88 University students (76.1% females; Mage = 21.33 years). Participants were randomly assigned to four instructed groups and participated twice in the Cold Pressor Task: (a) Acceptance followed by avoidance; (b) Avoidance followed by acceptance; (c) No instructions (control) followed by acceptance, and (d) No instructions (control) followed by avoidance. All analyses were conducted using repeated-measures ANOVAs. Randomized techniques analyses showed that participants receiving no instructions followed by acceptance reported significantly greater changes in physiological and behavioral measures across time. Low adherence to acceptance instructions was found, especially during the first phase. Exploratory analyses on actual techniques used (as opposed to taught technique) showed that participants using avoidance followed by acceptance exhibited significantly greater changes in physiological and behavioral measures across time. No significant differences were found for the self-report of negative affect outcome. Overall, our findings provide support to ACT theory, as participants might have to use firstly ineffective coping to understand what works best to cope with pain. This is the first study examining acceptance vs. avoidance coping both between and within individuals in physical pain, multi-methodically and multi-dimensionally.

Resumo: Com o aparecimento da COVID-19 as pessoas tiveram que lidar e se adaptar à nova realidade tal como aos seus impactos a nível psicológico, em particular o stress.O suporte social percebido e a flexibilidade psicológica são componentes que podem influenciar positivamente o stress provocado pelo contexto da pandemia.Esta investigação foi realizada com uma subamostra portuguesa do estudo COVID-IMPACT (Gloster et al., 2020).Recorreu-se a um Questionário sociodemográfico, e às medidas Inventário Breve de Saúde Mental, Escala de Stress Percebido, Escala de Suporte Social de Oslo e Medida de Flexibilidade Psicológica (Psyflex).Os resultados indicam que o stress percebido se relaciona com a saúde mental, e o suporte social percebido e a flexibilidade psicológica apresentam uma boa capacidade preditiva sobre o mesmo.O suporte social percebido modera a relação entre stress percebido e saúde mental, e a flexibilidade psicológica medeia a relação entre stress percebido e saúde mental.A realização deste estudo permitiu aprofundar o conhecimento do contexto pandémico, assim como a relação existente entre as variáveis saúde

INTRODUCTION:We aim to understand the factors that drive citizens of different countries to adhere to recommended self-protective behaviors during the COVID-19 pandemic.METHODS:Survey data was obtained through the COVID-19 Impact project. We selected countries that presented a sufficiently complete time series and a statistically relevant sample for running the analysis: Cyprus, Germany, Greece, Ireland, Latvia, Spain, Switzerland, the United Kingdom, and the United States of America. To identify country-specific differences in self-protective behaviors, we used previous evidence and change-point detection analysis to establish variations across participating countries whose effect was then assessed by means of interrupted series analysis.RESULTS:A high level of compliance with health and governmental authorities' recommendations were generally observed in all included countries. The level of stress decreased near the period when countries such as Cyprus, Greece or the United Kingdom relaxed their prevention behavior recommendations. However, this relaxation of behaviors did not occur in countries such as Germany, Ireland, or the United States. As observed in the change-point detection analysis, when the daily number of recorded COVID-19 cases decreased, people relaxed their protective behaviors (Cyprus, Greece, Ireland), although the opposite trend was observed in Switzerland.DISCUSSION:COVID-19 self-protective behaviors were heterogeneous across countries examined. Our findings show that there is probably no single winning strategy for exiting future health crises, as similar interventions, aimed to promote self-protective behaviors, may be received differently depending on the specific population groups and on the particular geographical context in which they are implemented.

Identifying common factors that affect public adherence to COVID-19 containment measures can directly inform the development of official public health communication strategies. The present international longitudinal study aimed to examine whether prosociality, together with other theoretically derived motivating factors (self-efficacy, perceived susceptibility and severity of COVID-19, perceived social support) predict the change in adherence to COVID-19 containment strategies. In wave 1 of data collection, adults from eight geographical regions completed online surveys beginning in April 2020, and wave 2 began in June and ended in September 2020. Hypothesized predictors included prosociality, self-efficacy in following COVID-19 containment measures, perceived susceptibility to COVID-19, perceived severity of COVID-19 and perceived social support. Baseline covariates included age, sex, history of COVID-19 infection and geographical regions. Participants who reported adhering to specific containment measures, including physical distancing, avoidance of non-essential travel and hand hygiene, were classified as adherence. The dependent variable was the category of adherence, which was constructed based on changes in adherence across the survey period and included four categories: non-adherence, less adherence, greater adherence and sustained adherence (which was designated as the reference category). In total, 2189 adult participants (82