Psychological Flexibility in South Sudanese Female Refugees in Uganda as a Mechanism for Change Within a Guided Self-Help Intervention

Daniel P. Lakin, Samuel E. Cooper, Lena Andersen, Felicity L. Brown, Jura L.S. Augustinavicius, Kenneth Carswell, Marx Leku, Alex Adaku, Teresa Au, Richard Bryant, Claudia Garcia Moreno, Ross G. White, Wietse A. Tol

Research output: Contribution to journalArticlepeer-review


Objective: To examine the role of psychological flexibility as a potential mediator in the relationship between involvement in a guided self-help intervention, Self-Help Plus, and psychological distress in a sample of South Sudanese refugee women living in northern Uganda. Method: We conducted secondary analysis of data from a cluster randomized controlled trial conducted in 2018. We used multilevel mediation modeling to explore the relationship of psychological flexibility, as measured by the Acceptance and Action Questionnaire (AAQ-II), as a mediating factor in the relationship between Self-Help Plus involvement and general psychological distress as measured by the Kessler Psychological Distress Scale–6 (K6). Results: We found strong multilevel mediation of decreasedK6 scores in the treatment group byAAQ-II scores (multilevel b=−3.28).Amore pronouncedmediation effect was discovered immediately post intervention (b = −1.09) compared to 3-month follow-up (b = −0.84). This is in line with the current literature that demonstrates the role of psychological flexibility as a primarymechanism of change in ACT-based interventions. Conclusions: Psychological flexibility is a contributing component in the theory of change for this ACT-based intervention. Identifying the core components of interventions allows formore effective adaptation and implementation of relevant services, especially in low-resource contexts.

Original languageEnglish (US)
Pages (from-to)6-13
Number of pages8
JournalJournal of Consulting and Clinical Psychology
Issue number1
StatePublished - 2023


  • global mental health
  • guided self help
  • psychological flexibility
  • trauma
  • treatment mediators

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology


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