Exploring psychological flexibility processes in adults with spinal cord injury: a qualitative study

Psychological flexibility, the capacity to remain open to difficult internal experiences while engaging in values-based action, has been linked to better mental health after spinal cord injury (SCI). Yet how these processes are enacted in daily life is underexplored. This study qualitatively examined lived experiences of psychological flexibility and its processes among adults with SCI.

Sixteen adults with SCI were purposively sampled from a larger U.S. survey to maximize variation in psychological flexibility and mental health outcomes. Semi-structured videoconference interviews addressed acceptance, defusion, present-moment awareness, self-as-context, values, committed action, and perceived barriers/supports. Data were analyzed using interpretative phenomenological analysis.

Four themes emerged: (1) navigating emotional pain and complexity; (2) strategies for emotional regulation and mindful coping; (3) reconstructing identity and reconnecting with values; and (4) barriers and systemic constraints (inaccessibility, fragmented care, financial/insurance burdens). Psychological flexibility was described as active, effortful, and context-dependent rather than a fixed trait.

Adults with SCI recognize, cultivate, and apply psychological flexibility while navigating persistent physical, relational, and structural demands. Findings support integrating psychological flexibility-based approaches (e.g., acceptance and commitment therapy) across the rehabilitation continuum, paired with system-level changes to improve accessibility, continuity of psychosocial care, and insurance processes.