The Role of Emotion Regulation and Psychological Flexibility in the Development of Positive Health Behaviors
Keywords:
Emotion regulation, psychological flexibility, positive health behaviors, thematic analysis, semi-structured interviews, healthy lifestyleAbstract
This study aimed to explain how emotion regulation and psychological flexibility contribute to the initiation, maintenance, and recovery of positive health behaviors among adults living in Tehran. This qualitative study was conducted using thematic analysis. The participants were 24 adults residing in Tehran who were selected through purposive maximum-variation sampling. Eligibility required sustained experience with at least three positive health behaviors, including regular physical activity, balanced nutrition, adequate sleep, stress management, or engagement in preventive health care. Data were collected exclusively through in-depth semi-structured interviews. Sampling continued until theoretical saturation was reached; preliminary saturation occurred after the twenty-first interview, and three additional interviews were conducted to confirm the stability and comprehensiveness of the emerging categories. The interviews were transcribed verbatim and analyzed using the six-phase thematic analysis process with the assistance of NVivo 14 software. Credibility and trustworthiness were enhanced through participant checking, peer review, reflexive memoing, maintenance of an audit trail, maximum-variation sampling, and detailed documentation of analytical decisions. Five main categories were identified: “emotional awareness and a regulatory pause,” “adaptive emotion management and interruption of unhealthy compensatory cycles,” “value orientation and committed action,” “flexible planning and nonjudgmental recovery from lapses,” and “social regulation and the creation of a health-supportive environment.” Participants described emotional recognition, acceptance of unpleasant internal experiences, cognitive distancing from discouraging thoughts, linkage of daily actions to personally meaningful values, flexible adjustment of behavioral plans, and compassionate responses to setbacks as central mechanisms supporting positive health behaviors. In contrast, emotional avoidance, all-or-nothing thinking, excessive self-criticism, and rigid behavioral standards were associated with emotional eating, sleep disruption, reduced physical activity, and abandonment of self-care routines. Emotion regulation and psychological flexibility appear to function as complementary mechanisms that help transform health-related intentions into sustained action. Emotion regulation reduces impulsive and compensatory reactions, whereas psychological flexibility enables individuals to continue value-consistent behaviors despite distressing emotions, discouraging thoughts, fatigue, and environmental barriers. Health-promotion programs should therefore move beyond the provision of information and behavioral prescriptions. They should incorporate emotional awareness, acceptance, cognitive defusion, self-compassion, values clarification, flexible action planning, and relapse-recovery skills to strengthen the long-term maintenance of healthy lifestyles.
Downloads
References
Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179–211. https://doi.org/10.1016/0749-5978(91)90020-T
Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30(2), 217–237. https://doi.org/10.1016/j.cpr.2009.11.004
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa
Deslippe, A. L., Soanes, A., Bouchaud, C. C., Beckenstein, H., Slim, M., Plourde, H., & Cohen, T. R. (2023). Barriers and facilitators to diet, physical activity and lifestyle behavior intervention adherence: A qualitative systematic review of the literature. International Journal of Behavioral Nutrition and Physical Activity, 20, Article 14. https://doi.org/10.1186/s12966-023-01424-2
Gross, J. J. (2015). Emotion regulation: Current status and future prospects. Psychological Inquiry, 26(1), 1–26. https://doi.org/10.1080/1047840X.2014.940781
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1–25. https://doi.org/10.1016/j.brat.2005.06.006
John, O. P., & Gross, J. J. (2004). Healthy and unhealthy emotion regulation: Personality processes, individual differences, and life span development. Journal of Personality, 72(6), 1301–1334. https://doi.org/10.1111/j.1467-6494.2004.00298.x
Kashdan, T. B., & Rottenberg, J. (2010). Psychological flexibility as a fundamental aspect of health. Clinical Psychology Review, 30(7), 865–878. https://doi.org/10.1016/j.cpr.2010.03.001
Kelly, S. M., & Updegraff, J. A. (2017). Substituting activities mediates the effect of cognitive flexibility on physical activity: A daily diary study. Journal of Behavioral Medicine, 40(4), 669–674. https://doi.org/10.1007/s10865-017-9839-x
Malterud, K., Siersma, V. D., & Guassora, A. D. (2016). Sample size in qualitative interview studies: Guided by information power. Qualitative Health Research, 26(13), 1753–1760. https://doi.org/10.1177/1049732315617444
McRae, K., & Gross, J. J. (2020). Emotion regulation. Emotion, 20(1), 1–9. https://doi.org/10.1037/emo0000703
Nowell, L. S., Norris, J. M., White, D. E., & Moules, N. J. (2017). Thematic analysis: Striving to meet the trustworthiness criteria. International Journal of Qualitative Methods, 16, 1–13. https://doi.org/10.1177/1609406917733847
Pears, S., & Sutton, S. (2021). Effectiveness of acceptance and commitment therapy interventions for promoting physical activity: A systematic review and meta-analysis. Health Psychology Review, 15(1), 159–184. https://doi.org/10.1080/17437199.2020.1727759
Sairanen, E., Tolvanen, A., Karhunen, L., Kolehmainen, M., Järvelä-Reijonen, E., Lindroos, S., Peuhkuri, K., Korpela, R., Ermes, M., Mattila, E., & Lappalainen, R. (2017). Psychological flexibility mediates change in intuitive eating regulation in acceptance and commitment therapy interventions. Public Health Nutrition, 20(9), 1681–1691. https://doi.org/10.1017/S1368980017000441
Sirois, F. M. (2015). A self-regulation resource model of self-compassion and health behavior intentions in emerging adults. Preventive Medicine Reports, 2, 218–222. https://doi.org/10.1016/j.pmedr.2015.03.006
Sirois, F. M., Kitner, R., & Hirsch, J. K. (2015). Self-compassion, affect, and health-promoting behaviors. Health Psychology, 34(6), 661–669. https://doi.org/10.1037/hea0000158
Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research: A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357. https://doi.org/10.1093/intqhc/mzm042
Van Cappellen, P., Rice, E. L., Catalino, L. I., & Fredrickson, B. L. (2018). Positive affective processes underlie positive health behaviour change. Psychology & Health, 33(1), 77–97. https://doi.org/10.1080/08870446.2017.1320798
