Flexibility (personality)

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Flexibility is a personality trait that describes the extent to which a person can cope with changes in circumstances and think about problems and tasks in novel, creative ways. [1] This trait comes into play when stressors or unexpected events occur, requiring that a person change their stance, outlook, or commitment.

Contents

Flexibility, or psychological flexibility, as it is sometimes called, is the ability to adapt to situational demands, balance life demands, and commit to behaviors.

Flexible personality should not be confused with cognitive flexibility, which is the ability to switch between two concepts, and to simultaneously think about multiple concepts. Researchers of cognitive flexibility describe it as the ability to switch one's thinking and attention between tasks. [2]

Measures/assessments

Due to the different facets of the definition of psychological flexibility, it is difficult to measure. There are multiple questionnaires that attempt to do so.

Acceptance and Action Questionnaire

The Acceptance and Action Questionnaire (AAQ) was designed to measure experiential avoidance. This test found that higher levels of avoidance are linked to higher levels of general psychopathology, depression, anxiety, fears, and a lower quality of life. AAQ also measures avoidant coping and self-deceptive positivity. [3] It was later decided that the AAQ actually measured psychological flexibility, not experiential avoidance. [4] It was used until the AAQ-II was created.

Acceptance and Action Questionnaire II

The AAQ-II was developed in order to improve upon the faults of the AAQ, which included scale brevity, item wording, and item selection procedures that caused insufficient alpha levels to be obtained in measurements. [4] AAQ-II scores predict many outcomes, including mental health and work absence rates. AAQ-II also was more psychometrically consistent than the original AAQ. [5]

Laboratory measures of flexibility are consistent with how flexible people are in their actual lives. [6] The validity of the AAQ has again been brought into question, primarily by inconsistent results. Studies have shown that both versions of the AAQ appear to measure the same thing, which is neuroticism/negative affect rather than experiential avoidance. [7]

Impacts on life

Parent–child relationships

Research shows that parenting psychological flexibility may influence the relationship between parent distress and child distress. [8] When parents are psychologically inflexible they cause more stress in their families.

A similar study looked at the longitudinal relationship between perceived parenting style and psychological flexibility among students over six years (7th–12th grade). Psychological flexibility decreased with age: as children grow older they become more set in their thoughts and habits, being less likely to change them due to circumstances. Results also indicated that authoritarian parenting styles predicted low psychological flexibility in children. Parents who over-control their children tend to restrict how well their children cope with stressors. Also, children with more psychological flexibility in 9th grade were more likely to have decreases in authoritarian and increases in authoritative parenting style later on. [9]

Authoritative parenting styles seem to be associated with psychological flexibility in children. Authoritative parents tend to be more warm, fair, and encouraging than those with other parenting styles, which may be why children raised by this style have more psychological flexibility. Such children are encouraged to be independent and are supported, so they are able to adjust to situations that do not go as predicted.

Work environment

Psychological flexibility improves mental health and absence rates[ clarification needed ]. [10] A mediating variable is job control, which suggests that people have more psychological flexibility when they have more control over their jobs. [11] This is likely due to workers feeling less restricted in what they can do and more empowered to solve problems. [11] A longitudinal study on psychological flexibility and job control showed that these variables predicted workers' mental health, job performance, and even their ability to learn new software. [10] The study demonstrates the power of psychological flexibility in the workplace: psychologically flexible workers have better mental health and job performance. [10] Allowing workers more job control could increase work productivity by increasing the workers' psychological flexibility. [10] In leadership studies, flexibility, defined as "the ability to get along with different groups and adapt to the demands of many organizations," is one aspect of portability, or the ability to acquire skills and move from one company to the next. [12]

Health

The ability to cope and be flexible is positively associated with psychological health. Flexibility reduces depression, anxiety, and stress. [13] An experiment analyzed the relationship between difficulty identifying and describing feelings (DIDF) and psychological flexibility in men undergoing cancer screenings. Results showed that DIDF and psychological flexibility were reliable predictors of mental health. However, psychological flexibility only predicted mental health when DIDF was involved[ clarification needed ]. Psychological flexibility allowed participants to have a better understanding of the subtleties of pleasant and unpleasant emotions. This understanding allowed participants to identify and describe their feelings better, thus enhancing their mental health. [14]

A two-year longitudinal study found that psychological flexibility helps with long-term emotional adjustment. People who are better able to enhance and suppress their expression of emotions are less likely to be stressed over time. [15] People with more psychological flexibility also have greater endurance, higher pain tolerance, and a quicker recovery rate to baseline levels when experiencing physical pain. [16]

How to improve

People can improve their psychological flexibility by training, such as by engaging in various forms of psychotherapy. [17]

Acceptance and commitment therapy

The main goal of acceptance and commitment therapy (ACT) is to increase psychological flexibility. It helps people accept unavoidable events, identify actions that will lead to goals, and acknowledge thoughts rather than accepting or disregarding them. [18] When psychological flexibility was targeted[ clarification needed ] in one study of ACT, there was a stronger reduction in psychological distress. [19] There are six core processes in ACT interventions: acceptance, cognitive defusion, self as context, being present, values, and committed action. [20]

Acceptance
teaches people to embrace their emotions, rather than trying to get rid of them. [20] An example of acceptance would be when people feel angry and then choose to focus on the anger and accept that they are angry, rather than trying to unleash their anger to get rid of it.
Cognitive defusion
teaches people to not take their thoughts as literally true in order to decrease the believability of negative thoughts and increase flexibility to behave as they want. [20] An example of cognitive defusion would be when someone thinks "I am the worst," and then notices the thought for what it is—mere words—perhaps by saying to themselves "I am having the thought that I am the worst". This is in contrast to a cognitive therapy approach where the person might challenge the thought by thinking of things in which he or she excels.
Self-as-context
attempts to have people become aware of their own experiences without being attached to them. [20] This process helps people let go of specific content and experience themselves[ clarification needed ]. [20]
Being present
teaches people to directly experience the world by paying attention to the moment and being aware. [20] An example of being present would be meditation and mindfulness. [20]
Values
teaches people to take actions in deliberate furtherance of qualities they choose. [20] An example is somebody who chooses to continue to improve on being a father (chosen quality) by reliving painful childhood memories about how his own father parented him (action). The purpose is not to encourage pain, but rather to allow people to deal with pain for a valued choice, such as being a good father. [20]
Committed action
teaches people to make changes in behavior in deliberate furtherance of qualities they choose. [20] Committed action involves identifying psychological barriers that will interfere with short, medium, and longer-term goals and then working through those barriers in order to reach the goals. [20]

See also

Related Research Articles

<span class="mw-page-title-main">Cognitive behavioral therapy</span> Type of therapy to improve mental health

Cognitive behavioral therapy (CBT) is a form of psychotherapy that aims to reduce symptoms of various mental health conditions, primarily depression, PTSD and anxiety disorders. Cognitive behavioral therapy focuses on challenging and changing cognitive distortions and their associated behaviors to improve emotional regulation and develop personal coping strategies that target solving current problems. Though it was originally designed to treat depression, its uses have been expanded to include many issues and the treatment of many mental health and other conditions, including anxiety, substance use disorders, marital problems, ADHD, and eating disorders. CBT includes a number of cognitive or behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

Psychotherapy is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome problems. Psychotherapy aims to improve an individual's well-being and mental health, to resolve or mitigate troublesome behaviors, beliefs, compulsions, thoughts, or emotions, and to improve relationships and social skills. Numerous types of psychotherapy have been designed either for individual adults, families, or children and adolescents. Certain types of psychotherapy are considered evidence-based for treating some diagnosed mental disorders; other types have been criticized as pseudoscience.

Psychology is an academic and applied discipline involving the scientific study of human mental functions and behavior. Occasionally, in addition or opposition to employing the scientific method, it also relies on symbolic interpretation and critical analysis, although these traditions have tended to be less pronounced than in other social sciences, such as sociology. Psychologists study phenomena such as perception, cognition, emotion, personality, behavior, and interpersonal relationships. Some, especially depth psychologists, also study the unconscious mind.

<span class="mw-page-title-main">Dialectical behavior therapy</span> Psychotherapy for emotional dysregulation

Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that began with efforts to treat personality disorders and interpersonal conflicts. Evidence suggests that DBT can be useful in treating mood disorders and suicidal ideation as well as for changing behavioral patterns such as self-harm and substance use. DBT evolved into a process in which the therapist and client work with acceptance and change-oriented strategies and ultimately balance and synthesize them—comparable to the philosophical dialectical process of thesis and antithesis, followed by synthesis.

Rational emotive behavior therapy (REBT), previously called rational therapy and rational emotive therapy, is an active-directive, philosophically and empirically based psychotherapy, the aim of which is to resolve emotional and behavioral problems and disturbances and to help people to lead happier and more fulfilling lives.

Psychological trauma is an emotional response caused by severe distressing events that are outside the normal range of human experiences. It must be understood by the affected person as directly threatening the affected person or their loved ones generally with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se. Examples of distressing events include violence, rape, or a terrorist attack.

Cognitive restructuring (CR) is a psychotherapeutic process of learning to identify and dispute irrational or maladaptive thoughts known as cognitive distortions, such as all-or-nothing thinking (splitting), magical thinking, overgeneralization, magnification, and emotional reasoning, which are commonly associated with many mental health disorders. CR employs many strategies, such as Socratic questioning, thought recording, and guided imagery, and is used in many types of therapies, including cognitive behavioral therapy (CBT) and rational emotive behaviour therapy (REBT). A number of studies demonstrate considerable efficacy in using CR-based therapies.

Acceptance and commitment therapy is a form of psychotherapy, as well as a branch of clinical behavior analysis. It is an empirically based psychological intervention that uses acceptance and mindfulness strategies along with commitment and behavior-change strategies to increase psychological flexibility.

Mindfulness-based cognitive therapy (MBCT) is an approach to psychotherapy that uses cognitive behavioral therapy (CBT) methods in conjunction with mindfulness meditative practices and similar psychological strategies. The origins to its conception and creation can be traced back to the traditional approaches from East Asian formative and functional medicine, philosophy and spirituality, birthed from the basic underlying tenets from classical Taoist, Buddhist and Traditional Chinese medical texts, doctrine and teachings.

Cognitive therapy (CT) is a type of psychotherapy developed by American psychiatrist Aaron T. Beck. CT is one therapeutic approach within the larger group of cognitive behavioral therapies (CBT) and was first expounded by Beck in the 1960s. Cognitive therapy is based on the cognitive model, which states that thoughts, feelings and behavior are all connected, and that individuals can move toward overcoming difficulties and meeting their goals by identifying and changing unhelpful or inaccurate thinking, problematic behavior, and distressing emotional responses. This involves the individual working with the therapist to develop skills for testing and changing beliefs, identifying distorted thinking, relating to others in different ways, and changing behaviors. A cognitive case conceptualization is developed by the cognitive therapist as a guide to understand the individual's internal reality, select appropriate interventions and identify areas of distress.

In psychology, self-compassion is extending compassion to one's self in instances of perceived inadequacy, failure, or general suffering. American psychologist Kristin Neff has defined self-compassion as being composed of three main elements – self-kindness, common humanity, and mindfulness.

Social anxiety is the anxiety and fear specifically linked to being in social settings. Some categories of disorders associated with social anxiety include anxiety disorders, mood disorders, autism spectrum disorders, eating disorders, and substance use disorders. Individuals with higher levels of social anxiety often avert their gazes, show fewer facial expressions, and show difficulty with initiating and maintaining a conversation. Social anxiety commonly manifests itself in the teenage years and can be persistent throughout life; however, people who experience problems in their daily functioning for an extended period of time can develop social anxiety disorder. Trait social anxiety, the stable tendency to experience this anxiety, can be distinguished from state anxiety, the momentary response to a particular social stimulus. Half of the individuals with any social fears meet the criteria for social anxiety disorder. Age, culture, and gender impact the severity of this disorder. The function of social anxiety is to increase arousal and attention to social interactions, inhibit unwanted social behavior, and motivate preparation for future social situations.

The self-regulation of emotion or emotion regulation is the ability to respond to the ongoing demands of experience with the range of emotions in a manner that is socially tolerable and sufficiently flexible to permit spontaneous reactions as well as the ability to delay spontaneous reactions as needed. It can also be defined as extrinsic and intrinsic processes responsible for monitoring, evaluating, and modifying emotional reactions. The self-regulation of emotion belongs to the broader set of emotion regulation processes, which includes both the regulation of one's own feelings and the regulation of other people's feelings.

<span class="mw-page-title-main">Rumination (psychology)</span> Focused attention

Rumination is the focused attention on the symptoms of one's mental distress. In 1998, Nolen-Hoeksema proposed the Response Styles Theory, which is the most widely used conceptualization model of rumination. However, other theories have proposed different definitions for rumination. For example, in the Goal Progress Theory, rumination is conceptualized not as a reaction to a mood state, but as a "response to failure to progress satisfactorily towards a goal". According to multiple studies, rumination is a mechanism that develops and sustains psychopathology conditions such as anxiety, depression, and other negative mental disorders. There are some defined models of rumination, mostly interpreted by the measurement tools. Multiple tools exist to measure ruminative thoughts. Treatments specifically addressing ruminative thought patterns are still in the early stages of development.

In psychology, avoidance coping is a coping mechanism and form of experiential avoidance. It is characterized by a person's efforts, conscious or unconscious, to avoid dealing with a stressor in order to protect oneself from the difficulties the stressor presents. Avoidance coping can lead to substance abuse, social withdrawal, and other forms of escapism. High levels of avoidance behaviors may lead to a diagnosis of avoidant personality disorder, though not everyone who displays such behaviors meets the definition of having this disorder. Avoidance coping is also a symptom of post-traumatic stress disorder and related to symptoms of depression and anxiety. Additionally, avoidance coping is part of the approach-avoidance conflict theory introduced by psychologist Kurt Lewin.

Experiential avoidance (EA) has been broadly defined as attempts to avoid thoughts, feelings, memories, physical sensations, and other internal experiences — even when doing so creates harm in the long run. The process of EA is thought to be maintained through negative reinforcement — that is, short-term relief of discomfort is achieved through avoidance, thereby increasing the likelihood that the avoidance behavior will persist. Importantly, the current conceptualization of EA suggests that it is not negative thoughts, emotions, and sensations that are problematic, but how one responds to them that can cause difficulties. In particular, a habitual and persistent unwillingness to experience uncomfortable thoughts and feelings is thought to be linked to a wide range of problems, as opposed to deliberately choosing discomfort, which only results in discomfort.

Childbirth-related post-traumatic stress disorder is a psychological disorder that can develop in women who have recently given birth. This disorder can also affect men or partners who have observed a difficult birth. Its symptoms are not distinct from post-traumatic stress disorder (PTSD). It may also be called post-traumatic stress disorder following childbirth (PTSD-FC).

Cognitive emotional behavioral therapy (CEBT) is an extended version of cognitive behavioral therapy (CBT) aimed at helping individuals to evaluate the basis of their emotional distress and thus reduce the need for associated dysfunctional coping behaviors. This psychotherapeutic intervention draws on a range of models and techniques including dialectical behavior therapy (DBT), mindfulness meditation, acceptance and commitment therapy (ACT), and experiential exercises.

Self-as-context, one of the core principles in acceptance and commitment therapy (ACT), is the concept that people are not the content of their thoughts or feelings, but rather are the consciousness experiencing or observing the thoughts and feelings. Self-as-context is distinguished from self-as-content, defined in ACT as the social scripts people maintain about who they are and how they operate in the world. A related concept, decentering which is a central change strategy of mindfulness-based cognitive therapy, is defined as a process of stepping outside of one’s own mental events leading to an objective and non-judging stance towards the self.

A transdiagnostic process is a proposed psychological mechanism underlying and connecting a group of mental disorders.

References

  1. ↑ Thurston, Becky J.; Runco, Mark A. (August 1999), "Flexibility", Encyclopedia of creativity, vol. 1, Academic Press, pp. 729–732, ISBN   9780122270758
  2. ↑ Miyake, A; Friedman, N.P.; Emerson, M.J.; Witzki, A.H.; Howerter, A.; Wagner, T. (2000). "The unity and diversity of executive functions and their contributions to complex "frontal lobe" tasks: A latent variable analysis". Cognitive Psychology. 41 (1): 49–100. CiteSeerX   10.1.1.485.1953 . doi:10.1006/cogp.1999.0734. PMID   10945922. S2CID   10096387.
  3. ↑ Hayes, Steven; Strosahl, Kirk; Wilson, Kelly; Bissett, Richard; Pistorello, Jacqueline; Toarmino, Dosheen; Polusny, Melissa; Dykstra, Thane; Batten, Sonja; Bergan, John; Stewart, Sherry; Zvolensky, Michael; Eifert, Georg; Bond, Frank; Forsyth, John; Karekla, Maria; McCurry, Susan (2004). "Measuring Experiential Avoidance: A Preliminary Test of a Working Model". The Psychological Record. 54 (4): 553–578. doi:10.1007/BF03395492. S2CID   53326452.
  4. 1 2 Hayes, Steven. "Acceptance & Action Questionnaire (AAQ) and AAQ-II". Association for Contextual Behavioral Science.
  5. ↑ Bond, F.W.; Hayes, S.C.; Baer, R.A.; Carpenter, K.M.; Guenole, N.; Orcutt, H.K.; Waltz, T.; Zettle, R.D. (2011). "Preliminary psychometric properties of the acceptance and action questionnaire-ii: A revised measure of psychological inflexibility and experiential avoidance" (PDF). Behavior Therapy. 42 (4): 676–688. doi:10.1016/j.beth.2011.03.007. PMID   22035996.
  6. ↑ Cheng, C. (2001). "Assessing Coping Flexibility in Real-life and Laboratory Settings: A Multimethod Approach". Journal of Personality and Social Psychology. 80 (5): 814–833. doi:10.1037/0022-3514.80.5.814. PMID   11374752.
  7. ↑ Rochefort, Catherine; Baldwin, Austin S.; Chmielewski, Michael (2017). "Experiential Avoidance: An Examination of the Construct Validity of the AAQ-II and MEAQ". Behavior Therapy. 49 (3): 435–449. doi:10.1016/j.beth.2017.08.008. PMID   29704971.
  8. ↑ Moyer, D.N.; Sandoz, E.K. (2014). "The role of psychological flexibility in the relationship between parent and adolescent distress". Journal of Child and Family Studies. 24 (5): 1406–1418. doi:10.1007/s10826-014-9947-y. S2CID   254603939.
  9. ↑ Williams, K.E.; Ciarrochi, J.; Heaven, P.C. (2012). "Inflexible Parents, Inflexible Kids: a 6-year Longitudinal Study of Parenting Style and the Development of Psychological Flexibility in Adolescents". Journal of Youth and Adolescence. 41 (8): 1053–1066. doi:10.1007/s10964-012-9744-0. PMID   22311519. S2CID   254739471.
  10. 1 2 3 4 Bond, F.W.; Flaxman, P.E. (2006). "The Ability of Psychological Flexibility and Job Control to Predict Learning, Job Performance, and Mental Health". Journal of Organizational Behavior Management. 26 (1–2): 113–130. doi:10.1300/J075v26n01_05. S2CID   145803470.
  11. 1 2 Bond, F.W.; Flaxman, P.E.; Bunce, D. (2008). "The Influence of Psychological Flexibility on Work Redesign: Mediated Moderation of a Work Reorganization Intervention" (PDF). Journal of Applied Psychology. 93 (3): 645–654. doi:10.1037/0021-9010.93.3.645. PMID   18457492.
  12. ↑ Petriglieri, Gianpiero (August 10, 2017). "The Portable Leader Is the New "Organization Man"". Harvard Business Review. Retrieved August 19, 2017.
  13. ↑ Kato, T. (2012). "Development of the Coping Flexibility Scale: Evidence for the Coping Flexibility Hypothesis". Journal of Counseling Psychology. 59 (2): 262–273. doi:10.1037/a0027770. PMID   22506909.
  14. ↑ Landstra, J.B.; Ciarrochi, J.; Deane, F.P.; Hillman, R.J. (2013). "Identifying and Describing Feelings and Psychological Flexibility Predict Mental Health in Men with HIV". British Journal of Health Psychology. 18 (4): 844–857. doi:10.1111/bjhp.12026. PMID   23368629.
  15. ↑ Bonanno, G.A.; Papa, A.; Lalande, K.; Westphal, M.; Coifman, K. (2004). "The Importance of Being Flexible: The Ability to Both Enhance and Suppress Emotional Expression Predicts Long-term Adjustment". Psychological Science. 15 (7): 482–487. doi:10.1111/j.0956-7976.2004.00705.x. PMID   15200633. S2CID   15289041.
  16. ↑ Feldner, M.T.; Hekmat, H.; Zvolensky, M.J.; Vowles, K.E.; Secrist, Z.; Leen-Feldner, E.W. (2006). "The Role of Experiential Avoidance in Acute Pain Tolerance: A Laboratory Test". Journal of Behavior Therapy and Experimental Psychiatry. 37 (2): 146–158. doi:10.1016/j.jbtep.2005.03.002. PMID   15882839.
  17. ↑
    • Greenberg, Leslie S.; Rice, Laura North; Elliott, Robert (1993). Facilitating emotional change: the moment-by-moment process. New York: Guilford Press. p.  76. ISBN   978-0898629941. OCLC   27897484. Once we attend to our emotional feedback, our survival/growth tendency ensures that we are constantly attempting to make the decision most advantageous to our well-being in terms of how we currently perceive ourselves and the situation. Thus the growth tendency is constantly pushing the organism toward adaptive flexibility and need satisfaction in a specific context. As will be noted later, therapy is a process of helping the client access and strengthen this tendency.
    • Kashdan, Todd B.; Rottenberg, Jonathan (November 2010). "Psychological flexibility as a fundamental aspect of health". Clinical Psychology Review . 30 (7): 865–878. doi:10.1016/j.cpr.2010.03.001. PMC   2998793 . PMID   21151705. We have mentioned empirically based interventions that describe the cultivation of flexibility as a therapeutic aim... However even when psychological interventions do not explicitly discuss flexibility as an aim of treatment (e.g., behavioral activation, cognitive therapy, interpersonal psychotherapy), flexibility is such an integral part of psychological functioning that it is almost inevitable that it will in some way be impacted.
    • Fox, Kieran C.R.; Kang, Yoona; Lifshitz, Michael; Christoff, Kalina (2016). "Increasing cognitive-emotional flexibility with meditation and hypnosis: the cognitive neuroscience of de-automatization". In Raz, Amir; Lifshitz, Michael (eds.). Hypnosis and meditation: towards an integrative science of conscious planes. Oxford; New York: Oxford University Press. pp. 191–220. ISBN   9780198759102. OCLC   948262934. Are there ways in which we can increase the flexibility and diversity of the cognitive and emotional aspects of our spontaneous thought? Practices geared toward changing both the content and process of spontaneous thought are as ancient as their scientific study is new—such techniques have existed for millennia and continue to be developed in modern clinical contexts.
    • Hinton, Devon E.; Kirmayer, Laurence J. (March 2017). "The flexibility hypothesis of healing". Culture, Medicine and Psychiatry . 41 (1): 3–34. doi:10.1007/s11013-016-9493-8. PMID   27142641. S2CID   254793002. In this paper, we argue that many forms of healing and psychotherapy may work by inducing positive psychological states marked by flexibility or an enhanced ability to shift cognitive sets.
  18. ↑ Bach, P.; Hayes, S.C. (2002). "The Use of Acceptance and Commitment Therapy to Prevent the Rehospitalization of Psychotic Patients: A Randomized Controlled Trial". Journal of Consulting and Clinical Psychology. 70 (5): 1129–1139. CiteSeerX   10.1.1.529.9140 . doi:10.1037/0022-006x.70.5.1129. PMID   12362963.
  19. ↑ Fledderus, M.; Bohlmeijer, E.T.; Fox, J.; Schreurs, K.M.G.; Spinhoven, P. (2013). "The Role of Psychological Flexibility in a Self-help Acceptance and Commitment Therapy Intervention for Psychological Distress in a Randomized Controlled Trial" (PDF). Behaviour Research and Therapy. 51 (3): 142–151. doi:10.1016/j.brat.2012.11.007. PMID   23337183.
  20. 1 2 3 4 5 6 7 8 9 10 11 Boulanger, Jennifer L.; Hayes, Steven C.; Lillis, Jason (2009). "Acceptance and Commitment Therapy". In Fisher, Gary L.; Roget, Nancy A. (eds.). Encyclopedia of Substance Abuse Prevention, Treatment, & Recovery. Vol. 1. Thousand Oaks, CA: SAGE Publications. pp. 4–7. ISBN   9781412950848.
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