Jordan Journal of Nursing Research
The ​Role of ​Psychological ​Flexibility in ​Heart ​Failure: Structural ​Equation ​Model ​Analysis


Mohammed Munther Al-Hammouri; Jehad A. Rababah;



With psychological flexibility as a central concept, the Acceptance and Commitment Therapy Model has gained empirical support with a broad range of behavioral and emotional issues across various populations. The role of psychological flexibility in health-related behavioral and emotional problems in heart failure is still limited. 


 To examine the role of psychological flexibility in persons with heart failure.


Observational, cross‐sectional study. A total of 172 persons with heart failure aged 31 to 87 years from three major referral hospitals. To achieve the current study goal, a proposed model guide by the acceptance and commitment therapy model was tested using structural equation modeling using AMOS.


The results showed that the path between psychological flexibility and emotional outcomes is statistically significant. The R2 value of the emotional outcomes construct was .52, meaning that psychological flexibility explains 52% of the predicted variance. On the other hand, the path between psychological flexibility and behavioral outcomes was not significant. Psychological flexibility explained half of the variance of stress and depression combined. 


This study suggests that psychological flexibility plays a significant role in determining emotional outcomes (i.e., stress and depression levels) in persons with heart failure. It also suggests that emotional outcomes may be improved by targeting psychological flexibility. 

Implications to Nursing

Nurses need to assess persons with compromised psychological flexibility as a predictor of adverse emotional outcomes, which inturn has been associated with various negative health outcomes. Nurses need to target these persons through specific interventions to promote psychological flexibility.


Psychological flexibility, heart failure, Acceptance and Commitment Therapy, depression, stress.