Psychological Flexibility in Rehabilitation

Chennai Super Kings’ Ruturaj Gaikwad receives medical attention after sustaining an injury REUTERS/Stringer

Introduction

Athletes may frame rehabilitation as a purely physical process focusing on strength, mobility, and tissue healing. However, there is increasing emphasis on the role of psychological flexibility (PF) in injury recovery. Psychological flexibility is rooted in Acceptance and Commitment Therapy (ACT), a third-wave cognitive behavioral approach^(1,2). It refers to the ability to adapt, remain engaged in meaningful actions, and persist despite discomfort. For clinicians, integrating PF into rehabilitation practice can enhance patient adherence, pain management, and emotional resilience. 

“Psychological flexibility can be a game-changer in rehabilitation.”

Psychological Flexibility

Psychological flexibility is the capacity to be open with thoughts, feelings, and emotions and for these not to influence the pursuit to change or persist with behavior that is guided by an athlete’s values and goals (see figure 1). It is the ability to remain open to experiences, including discomfort, while still taking actions aligned with one’s values. It involves six interrelated processes: acceptance, cognitive defusion, present-moment awareness, self-as-context, values, and committed action. These processes help injured athletes build resilience, improve adherence to rehabilitation programs, and enhance pain tolerance. For example, PF lowers pain-related distress and improves rehabilitation engagement and psychological readiness for return to sport. In contrast, psychological rigidity—characterized by avoidance, over-identification with negative thoughts, and disconnection from values—can significantly hinder the recovery process. Rigid athletes may avoid rehabilitation exercises due to fear of pain, catastrophize setbacks, and experience reduced motivation⁽³⁾. Recognizing these patterns early allows clinicians to intervene effectively and shift the focus toward more adaptive behaviors.