Psychological Flexibility With Prejudices Increases Empathy and Decreases Distress Among Adolescents: A Spanish Validation of the Acceptance and Action Questionnaire–Stigma

psyg-11-565638 Janua y 18, 2021 Time: 17:36 # 1 BRIEF RESEARCH REPORT published: 22 Janua y 2021 doi: 10.3389/ psyg.2020.565638 Edi ed by: Lau i A. Jensen-Campbell, Uni e si y o Texas a A ling on, Uni ed S a es Re iewed by: Belen Lopez-Pe ez, Li e pool Hope Uni e si y, Uni ed Kingdom Ma ía C is ina Richaud, Consejo Nacional de In es igaciones Cien í icas y Técnicas (CONICET), A gen ina *Co espondence: Sonsoles Valdi ia-Salas sonso al@uniza .es Special y sec ion: This a icle was submi ed o Pe sonali y and Social Psychology, a sec ion o he jou nal F on ie s in Psychology Recei ed: 25 May 2020 Accep ed: 15 Decembe 2020 Published: 22 Janua y 2021 Ci a ion: Valdi ia-Salas S, Ma ín-Albo J, C uz A, Villanue a-Blasco VJ and Jiménez TI (2021) Psychological Flexibili y Wi h P ejudices Inc eases Empa hy and Dec eases Dis ess Among Adolescen s: A Spanish Valida ion o he Accep ance and Ac ion Ques ionnai e–S igma. F on . Psychol. 11:565638. doi: 10.3389/ psyg.2020.565638 Psychological Flexibili y Wi h P ejudices Inc eases Empa hy and Dec eases Dis ess Among Adolescen s: A Spanish Valida ion o he Accep ance and Ac ion Ques ionnai e–S igma Sonsoles Valdi ia-Salas1*, José Ma ín-Albo1, A aceli C uz1, Víc o J. Villanue a-Blasco2 and Te esa I. Jiménez1 1Depa men o Psychology and Sociology, Uni e si y o Za agoza, Te uel, Spain, 2Depa men o Psychology, Valencian In e na ional Uni e si y, Valencia, Spain Empa hy is an emo ional esponse ha may acili a e p osocial beha io and inhibi agg ession by inc easing empa hic conce n o o he s. Bu he ica ious expe ience o o he ’s eelings may also u n in o pe sonal dis ess when he pe son has poo egula ion skills and holds s igma izing belie s. In hinking abou he p ocesses ha may igge he expe ience o pe sonal dis ess o empa hic conce n, esea ch on he in luence o psychological lexibili y and in lexibili y on s igma is showing p omising esul s. Bo h p ocesses a e assessed wi h he Accep ance and Ac ion Ques ionnai e– S igma (AAQ-S). The cu en s udy sough o ca y ou a alidi y s udy o a Spanish e sion o he AAQ-S wi h a sample o adolescen s aged 11–17 yea s. The s udy included an expanded es o i s p edic i e alidi y wi h measu es a h ee imes o e alua e he ole o psychological lexibili y and in lexibili y as isk o p o ec i e a iables o he de elopmen o pe sonal dis ess and/o empa hic conce n in he s igma ize . S a is ical analyses con i med a wo-co ela ed- ac o solu ion, he adequa e eliabili y o bo h ac o s, and hei cons uc and p edic i e alidi y in he expec ed di ec ion. The s igma ize ’s in lexible eac ion o hei s igma izing hough s p edic ed he occu ence o pe sonal dis ess, whe eas he s igma ize ’s lexible eac ion o hei s igma izing hough s p edic ed he occu ence o empa hic conce n o o he s. These indings con i m he impo ance o conside ing he ole o egula o y skills in he expe ience o empa hic conce n o pe sonal dis ess in he p esence o s igma izing hough s, wi h possible implica ions o he p omo ion o p osocial beha io and he educ ion o agg essi e beha io among adolescen s. Keywo ds: psychological in lexibili y, psychological lexibili y, s igma, empa hic conce n, pe sonal dis ess, Spanish adolescen s F on ie s in Psychology | www. on ie sin.o g 1Janua y 2021 | Volume 11 | A icle 565638 psyg-11-565638 Janua y 18, 2021 Time: 17:36 # 2 Valdi ia-Salas e al. S igma izing Though s, Empa hy, and Dis ess INTRODUCTION I is gene ally assumed ha empa hy is an emo ional esponse ha may acili a e p osocial beha io and inhibi agg ession, hus leading o a be e pe sonal and social adjus men om childhood (e.g., S a inides e al., 2010;Wang e al., 2011;Mikolajewski e al., 2014;Ca lo e al., 2015;Telle and P is e , 2016;Deschamps e al., 2018;Tampke e al., 2020). The lack o consensus on he bene i s o empa hy (e.g., Vachon e al., 2014), howe e , has p omo ed he eme gence o nume ous models and heo ies abou wha empa hy is and i s ela ion wi h o he cons uc s and ou comes ( o a e iew, see Cu e al., 2014). The mul idimensional model o empa hy by Da is (1983), o ins ance, dis inguishes be ween cogni i e and a ec i e empa hy. Cogni i e empa hy is he abili y o unde s and how o he s eel, whe eas a ec i e empa hy en ails he ica ious expe ience o o he s’ eelings (Vachon and Lynam, 2016). As no ed by Eisenbe g e al. (2010), i abo e some minimal h eshold, such ica ious expe ience o o he ’s eelings may u n in o empa hic conce n (EmpCon), pe sonal dis ess (Pe D), o bo h (see also Habashi e al., 2016). While EmpCon consis s o eelings o so ow o conce n o he o he , Pe D is a sel - ocused, a e si e–a ec i e eac ion o ano he ’s emo ion associa ed wi h he desi e o alle ia e one’s own, bu no he o he ’s dis ess. Acco dingly, EmpCon ends o be posi i ely ela ed o helping o he s, whe eas Pe D ends o be nega i ely o un ela ed o p osocial beha io s (e.g., G aziano and Habashi, 2010;Habashi e al., 2016;Win e e al., 2017), also in adolescen s (Eisenbe g e al., 2010), and in Spanish adolescen s (Gu ié ez e al., 2011; Tu -Po ca e al., 2016;Valdi ia-Salas e al., 2021). In hinking abou he p ocesses by which he ica ious expe ience o o he ’s eelings may e ol e in o ei he EmpCon o Pe D, he men al lexibili y and sel - egula ion componen o empa hy (Dece y and Jackson, 2004) may shed some ligh . This componen allows inhibi ing one’s own pe spec i e and engaging in pe spec i e aking so as o e alua e he o he s’ poin o iew. These egula ion skills p e en ica ious emo ional hype a ousal om u ning in o Pe D (Eisenbe g, 2000; see also Valdi ia-Salas e al., 2009;Ikezawa e al., 2012;Habashi e al., 2016;G ynbe g and López-Pé ez, 2018). The Pe D expe ienced wi hin in e pe sonal domains may also esul om holding s igma izing belie s abou o he s (Masuda e al., 2009). S igma is he endency o e alua e and disc imina e agains o he s based on hei g oup membe ship (Le in e al., 2014). S igma izing hough s a e usually ega ded as igid and sel -p o ec i e because hey acili a e he a oidance o pe cei ed dange (Masuda e al., 2007; see also Kokkinos and Kip i si, 2018). While he e is ex ensi e e idence o he ha m ul consequences o s igma o he s igma ized g oup ( o a e iew, see K a e al., 2018), esea ch conduc ed on he causes and consequences o s igma o he s igma ize is a he sca ce (Masuda e al., 2009). One line o such esea ch sugges s ha psychological in lexibili y (PsyIn lex) may pose a isk o he de elopmen o Pe D in he s igma ize , which, in u n, may lead o he s igma iza ion o o he s (Masuda e al., 2009). PsyIn lex occu s when ac ions a e igidly guided by psychological eac ions (e.g., pe cei ed dange , nega i e a ec , s igma izing hough s), a he han chosen alues, and a e p ima ily aimed a down- egula ing such psychological eac ions (e.g., Hayes e al., 1996;Tö neke e al., 2008;Valdi ia-Salas e al., 2010). PsyIn lex is associa ed wi h a b oad ange o psychological and beha io al heal h p oblems, Pe D among o he s (Mones ès e al., 2018). On he con a y, i s coun e pa psychological lexibili y (PsyFlex) e e s o he p ocess o engaging wi h psychological eac ions wi hou ying o down- egula e hem, while ac ing in alued di ec ions, and has been ela ed o heal h and quali y o li e and li e sa is ac ion (Mones ès e al., 2018). The empi ical e idence on he ela ion be ween PsyIn lex and s igma is sca ce bu shows consis en esul s. The de elopmen and alida ion o he ques ionnai e o assess PsyIn lex and PsyFlex wi h p ejudice hough s, i.e., Accep ance and Ac ion Ques ionnai e–S igma (AAQ-S; Le in e al., 2014), we e conduc ed wi h unde g adua e s uden s in a c oss-sec ional s udy and showed con e gen alidi y wi h e hnocul u al empa hy, EmpCon, and pe spec i e aking. A la e s udy e ealed ha he combina ion o high PsyIn lex, low PsyFlex, low EmpCon, and low pe spec i e aking accoun ed o app oxima ely 36% o he a iance in gene alized p ejudice and ha he combina ion o PsyIn lex and PsyFlex alone p edic ed gene alized p ejudice o e igh wing au ho i a ianism and social dominance (Le in e al., 2016). A ecen e iew and me a-analysis (K a e al., 2018) has e ealed signi ican co ela ions be ween PsyIn lex and di e en ypes o s igma, wi h an o e all e ec size s a is ically signi ican and medium o la ge (see also Masuda e al., 2009). All s udies on he ela ion be ween PsyIn lex and s igma ha e been conduc ed wi h No h Ame ican adul s, and hei c oss-sec ional na u e does no allow concluding abou he mechanisms explaining his ela ion o he di ec ion o he ela ions obse ed. In Spain, s igma has been explo ed p ima ily owa d he men ally ill (e.g., Cangas e al., 2017), and only ecen ly, he e is a g owing in e es in explo ing he po en ial o PsyIn lex and PsyFlex wi h p ejudice hough s o he unde s anding o youngs e s’ s igma owa d he men ally ill (T igue os e al., 2020). The e is also e idence ha gene al PsyIn lex in luences nega i ely Spanish child en and adolescen s’ psychological well-being (Valdi ia-Salas e al., 2017;Ga cía- Gómez e al., 2019;Mes e e al., 2019;Ga cía-Rubio e al., 2020). Bu he ela ion among PsyFlex, PsyIn lex, Pe D, and EmpCon emains unexplo ed. In his di ec ion, he cu en s udy sough o ca y ou a alidi y s udy o a Spanish e sion o he AAQ-S wi h a sample o adolescen s aged 11–17 yea s. The s udy includes an expanded es o i s p edic i e alidi y wi h measu es a h ee imes o e alua e he ole o PsyIn lex and PsyFlex as isk o p o ec i e a iables o he de elopmen o Pe D and EmpCon in he s igma ize . METHODS Pa icipan s We employed andomized clus e sampling o selec pa icipan s. The uni (clus e ) was he school. The sampling ame was all he public schools in he a ge egion. Each school on he lis was F on ie s in Psychology | www. on ie sin.o g 2Janua y 2021 | Volume 11 | A icle 565638 psyg-11-565638 Janua y 18, 2021 Time: 17:36 # 3 Valdi ia-Salas e al. S igma izing Though s, Empa hy, and Dis ess assigned a weigh equi alen o he numbe o s uden s a ending he school. Fou schools we e selec ed, and he p incipals o all o hem ag eed o pa icipa e. S uden s wi h ages anging be ween 11 and 17 yea s (mean = 13.66, SD = 1.34) and a ending he ou compulso y seconda y educa ion cou ses illed ou he ques ionnai es h ee imes wi hin a 12 mon hs in e al. The numbe o pa icipan s on each ime was as ollows: 847 (410 boys, 435 gi ls) a Time 1, 568 (271 boys, 297 gi ls) a Time 2, and 275 (131 boys, 144 gi ls) a Time 3. Measu es and Ins umen s PsyIn lex and PsyFlex Wi h P ejudice Though s We employed an ad hoc Spanish ansla ion o he AAQ-S (Le in e al., 2014). I includes 21 i ems ha measu e PsyFlex (“I am awa e when judgmen s abou o he s a e passing h ough my mind,” “When I e alua e someone nega i ely, I am able o ecognize ha his is jus a eac ion, no an objec i e ac ”) and PsyIn lex (“My biases and p ejudices a ec how I in e ac wi h people om di e en backg ounds,” “When I ha e judgmen s abou o he s, hey a e e y in ense”) wi h a b oad ange o nega i e hough s abou people belonging o di e en s igma ized g oups. Response op ions ange om 1 (ne e ue) o 7 (always ue), so ha highe sco es in he PsyIn lex subscale indica e g ea e in lexibili y, and highe sco es in he PsyFlex subscale indica e g ea e lexibili y. We ansla ed he ins umen in o Spanish wi h he pa allel back- ansla ion p ocedu e (B islin, 1986). The i ems we e i s ansla ed om English in o Spanish by expe ansla o s. The i ems we e hen back- ansla ed in o English and compa ed wi h he o iginal ones. Finally, h ee expe s and i e s uden s e alua ed he adequacy o he i ems o he cons uc being assessed. We ound no majo di icul ies wi h he seman ic equi alence o he i ems in Spanish. Psychological In lexibili y We employed he Spanish alida ion (Valdi ia-Salas e al., 2017) o he A oidance and Fusion Ques ionnai e o You h (AFQ-Y; G eco e al., 2008). The AFQ-Y con ains 17 i ems, measu ing wo in e ela ed p ocesses ha cha ac e ize PI, namely, cogni i e usion (CF; e.g., “My hough s and eelings mess up my li e”) and expe ien ial a oidance (EA; e.g., “I s op doing hings ha a e impo an o me whene e I eel bad”), and esponden s a e how ue each s a emen is o hem on a 5-poin scale anging om 0 (no a all ue) o 4 ( e y ue). Highe sco es indica e g ea e CF and EA. The Spanish alida ion showed good psychome ic p ope ies wi h Spanish adolescen s (Valdi ia-Salas e al., 2017). Empa hy We employed he Spanish alida ion (Pé ez-Albéniz e al., 2003) o he In e pe sonal Reac i i y Index (IRI; Da is, 1980). The IRI is a 28-i em sel - epo ques ionnai e ha comp ised ou subscales, namely, Fan asy, Pe spec i e Taking, EmpCon, and Pe D (se en i ems each). We employed only he EmpCon and Pe D subscales because o he li e a u e ha poses hem as a iables in ol ed in ei he p osocial o agg essi e beha io (Cu e al., 2014). The EmpCon e lec s he a ec i e/emo ional componen o empa hy and assesses he endency o expe ience wa m h, conce n, and compassion o o he s (e.g., “I o en ha e ende , conce ned eelings o people less o una e han me,” “I would desc ibe mysel as a p e y so -hea ed pe son”). The Pe D subscale assesses eelings o discom o and anxie y ha people may expe ience when hey wi ness nega i e expe iences in o he s (e.g., “I eel helpless when I am in an emo ionally cha ged si ua ion, “I sca es me o be in a ense emo ional si ua ion”). Responde s a e each i em on a scale anging om 0 (no a all like me) o 4 ( e y much like me), and i ems a e summed so ha highe sco es e lec g ea e EmpCon and g ea e Pe D. The e is e idence o he good psychome ic p ope ies o hese wo subscales in Spanish adolescen s (Ca asco O iz e al., 2011). P ocedu e We con ac ed he p incipals o he a ge schools o explain he pu pose o he esea ch and o eques hei pe mission o ca y ou he s udy. A e we had ob ained pe mission om he school p incipals, we eques ed he pa en s’/ u o s’ consen o hei child en o pa icipa e in he s udy. Once in he class oom, he esea che s desc ibed he goals o he s udy and in o med he s uden s ha hei pa icipa ion was olun a y and con iden ial and ha he e we e no good o bad answe s. A leas one esea che was p esen du ing he adminis a ion o he ins umen s o p o ide s uden s wi h he necessa y suppo o success ully comple e he ins umen s. Da a Analysis We i s calcula ed he desc ip i e s a is ics (mean, SD, and co ela ions) o he AAQ-S i ems and hei mean di e ences as a unc ion o gende by using he s a is ical package SPSS o Windows e sion 22 (IBM Co p, 2013). The ac o ial s uc u e o he scale was analyzed wi h he weigh ed leas squa es mean and a iance adjus ed es ima ion o 6.1 Mplus (Mu hén and Mu hén, (1998-2010)). The ac ha class oom was ou sample uni iola ed he assump ion o independence o obse a ions. This migh ha e in la ed he χ2 alue and unde es ima ed s anda d e o s (S aple on, 2006). Fo his eason, he “clus e ” op ion o class ooms and COMPLEX unc ion we e used in all analyses. We used C onbach α o es he eliabili y o he AAQ-S and he esul s o he con i ma o y ac o analysis (CFA) o calcula e he composi e eliabili y index (CRI). In o de o es o he cons uc alidi y o he AAQ- S, we conduc ed a new CFA model inco po a ing he wo ac o s o he AFQ-Y. In o de o es ablish he AAQ-S p edic i e alidi y, we es ed he model shown in Figu e 1 wi h longi udinal pa h analysis me hodology and he maximum- likelihood obus es ima ion. The ollowing goodness-o - i indices we e epo ed: χ2 o model i , oo mean squa e e o o app oxima ion (RMSEA), compa a i e i index (CFI), and Tucke –Lewis Index (TLI). Following B owne and Cudeck (1993) indica ions, RMSEA alues close o 0.05, close o 0.08, and highe han 0.10 indica e good, easonable, and bad i , espec i ely. CFI alues should be highe han 0.90 (Ma sh e al., 2004). TLI alues be ween 0.90 and 0.95 a e conside ed accep able. Finally, missing da a we e eplaced by he me hod o linea in e pola ion usually employed by Mplus. F on ie s in Psychology | www. on ie sin.o g 3Janua y 2021 | Volume 11 | A icle 565638 psyg-11-565638 Janua y 18, 2021 Time: 17:36 # 4 Valdi ia-Salas e al. S igma izing Though s, Empa hy, and Dis ess FIGURE 1 | Longi udinal pa h. RESULTS Desc ip i e Analyses As Table 1 shows, mean PsyIn lex sco es (i ems 1, 4, 6, 7, 8, 9, 13, 15, 16, 20, 21) we e, o e all, lowe han mean PsyFlex sco es (i ems 2, 3, 5, 10, 11, 12, 14, 17, 18, 19). All PsyIn lex i ems sco ed lowe han 2.5, whe eas all PsyFlex i ems, excep o i ems 12 and 18, sco ed highe han 2.5. As o he co ela ions, hey we e s ong among same ac o i ems, wi h some excep ions: i em 4 co ela ed posi i ely wi h i em 5 ( xy = 0.37; p<0.05) and i em 19 ( xy = 0.27; p<0.05); as well, i em 16 co ela ed posi i ely wi h i em 17 ( xy = 0.32; p<0.05). Ku osis and asymme y indices we e lowe han 2, which p o e uni a ia e no mali y. Con i ma o y Fac o Analysis and Reliabili y Following he o iginal s uc u e, we es ed he wo-co ela ed- ac o solu ion, which showed good i indices in he o al sample [χ2= 500.36, deg ees o eedom (DF) = 188, RMSEA (low, high) = 0.04 (0.04, 0.05), CFI = 0.91, TLI = 0.91] and in bo h boys [χ2= 514.36, DF = 188, RMSEA (low, high) = 0.06 (0.06, 0.07), CFI = 0.92, TLI = 0.91] and gi ls [χ2= 355.69, DF = 188, RMSEA (low, high) = 0.05 (0.04, 0.05), CFI = 0.92, TLI = 0.91]. As shown in Table 2, all s anda dized pa ame e s we e posi i e and signi ican (p<0.05) and g ea e han 0.40 excep o i em 6 (β= 0.39). Reliabili y, as measu ed wi h C onbach α, was adequa e o bo h PsyFlex (α= 0.80) and PsyIn lex (α= 0.77). Conside ing ha α alues may unde es ima e he eal popula ion alue, we calcula ed he CRI (G aham, 2006), which esul ed in eliabili y alues o 0.83 o bo h PsyFlex and PsyIn lex. Cons uc Validi y C onbach α o he wo ac o s o he AFQ-Y was 0.82 o CF and 0.78 o EA. Resul s o he ou co ela ed ac o model we e good [χ2= 1,001.93, DF = 622, RMSEA (low, high) = 0.03 (0.02,0.03), CFI = 0.92, TLI = 0.92]. As expec ed, he wo ac o s o he AFQ-Y showed mo e s ong and posi i e ela ions wi h PsyIn lex ( xy = 0.64 o CF; and xy = 0.57 o EA) han wi h PsyFlex ( xy = 0.30 o CF; and xy = 0.24 o EA). P edic i e Validi y We i s conduc ed CFA and eliabili y calcula ions o Pe D and EmpCon subscales. The model showed adequa e i indices [χ2= 342.22, DF = 76, RMSEA (low, high) = 0.06 (0.05, 0.07), CFI = 0.94, TLI = 0.93]. C onbach αwas 0.70 o EmpCon and 0.67 o Pe D, and CRI was 0.86 o EmpCon and 0.78 o Pe D. The pa h model showed good i indices [χ2= 55.71, DF = 16, RMSEA (low, high) = 0.05 (0.04, 0.07), CFI = 0.97, TLI = 0.91]. Di ec E ec s As shown in Table 3, all au o eg essi e pa ame e s we e posi i e and signi ican , which showed he empo al s abili y o he ou ac o s. Rega ding he p edic i e ela ion be ween PsyFlex, PsyIn lex, and bo h Pe D and EmpCon, he esul s showed ha , om Time 3 o Time 2, Pe D was posi i ely ela ed o PsyIn lex (β= 0.15, p<0.05), and EmpCon was posi i ely ela ed o PsyFlex (β= 0.11, p<0.05) and nega i ely ela ed o PsyIn lex (β=−0.09, p<0.05). Simila pa e ns o ela ions occu ed om Time 2 o Time 1 (Table 3). In e es ingly, while he ela ion be ween Pe D and PsyIn lex was unidi ec ional, wi h PsyIn lex p edic ing Pe D, he ela ion be ween EmpCon and PsyFlex was bidi ec ional (Table 3). The explained a iance o he model was 34% o EmpCon, 36% o Pe D, 30% o PsyFlex, and 26% o PsyIn lex. Indi ec E ec s The analyses con i med wo ou es leading o Pe D in Time 3: on he one hand, he PsyIn lex ou e, s a ing a Time 1 F on ie s in Psychology | www. on ie sin.o g 4Janua y 2021 | Volume 11 | A icle 565638 psyg-11-565638 Janua y 18, 2021 Time: 17:36 # 5 Valdi ia-Salas e al. S igma izing Though s, Empa hy, and Dis ess and going h ough Time 2, which yielded a posi i e ela ion [β= 0.08, SE = 0.03 (s anda dized = 0.07; 0.02); p<0.01]; on he o he hand, he mixed ou e, s a ing wi h PsyFlex a Time 1 and going h ough PsyIn lex a Time 2, which yielded a nega i e ela ion o he occu ence o Pe D [β=−0.02; SE = 0.006; (s anda dized = −0.02; 0.006) p<0.01]. In bo h TABLE 1 | Desc ip i e analyses, co ela ions, a iances, and co a iances. I ems* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1. 1.07 0.23** 0.19** 0.19** 0.10** 0.31** 0.33** 0.27** 0.30** 0.20** 0.17** 0.23** 0.22** 0.16** 0.23** 0.19** 0.09** 0.18** 0.24** 0.25** 0.15** 2. 0.31 1.61 0.29** 0.26** 0.30** 0.10** 0.21** 0.14** 0.19** 0.40** 0.26** 0.15** 0.12** 0.27** 0.13** 0.27** 0.36** 0.11** 0.29** 0.18** 0.15** 3. 0.27 0.50 1.92 0.15** 0.30** 0.08** 0.11** 0.04** 0.10** 0.34** 0.26** 0.14** 0.05 0.23** 0.16** 0.16** 0.30** 0.08*0.29** 0.10** 0.05 4. 0.27 0.46 0.30 1.97 0.37** 0.15** 0.33** 0.13** 0.30** 0.22** 0.20** 0.13** 0.09*0.16** 0.16** 0.14** 0.21** 0.08** 0.27** 0.24** 0.14** 5. 0.15 0.53 0.58 0.72 1.98 0.01 0.18** −0.03** 0.09** 0.38** 0.27** 0.08*−0.00 0.29** 0.08*0.19** 0.36** 0.04 0.27** 0.17** 0.03 6. 0.33 0.13 0.11 0.21 0.01 1.08 0.30** 0.30** 0.32** 0.10** 0.08*0.20** 0.37** 0.17** 0.26** 0.11** 0.02 0.25** 0.09** 0.17** 0.19** 7. 0.37 0.30 0.17 0.50 0.27 0.34 1.20 0.23** 0.44** 0.20** 0.19** 0.22** 0.26** 0.18** 0.27** 0.15** 0.15** 0.21** 0.23** 0.25** 0.15** 8. 0.29 0.18 0.05 0.18 −0.04 0.32 0.26 1.04 0.38** 0.11** 0.07 0.21** 0.21** 0.07*0.30** 0.16** 0.02 0.26** 0.12** 0.17** 0.19** 9. 0.35 0.28 0.16 0.47 0.15 0.38 0.55 0.44 1.28 0.18** 0.14** 0.22** 0.27** 0.20** 0.30** 0.21** 0.12** 0.29** 0.29** 0.17** 0.20** 10. 0.28 0.68 0.63 0.42 0.72 0.13 0.30 0.16 0.27 1.81 0.33** 0.18** 0.06 0.38** 0.19** 0.29** 0.52** 0.15** 0.40** 0.24** 0.17** 11. 0.24 0.46 0.50 0.38 0.53 0.11 0.29 0.09 0.22 0.62 1.91 0.19** 0.07∗0.25** 0.20** 0.18** 0.31** 0.08*0.38** 0.24** 0.16** 12. 0.29 0.24 0.24 0.22 0.15 0.25 0.30 0.27 0.31 0.30 0.33 1.54 0.24** 0.21** 0.27** 0.15** 0.12** 0.29** 0.27** 0.21** 0.14** 13. 0.22 0.14 0.07 0.12 −0.00 0.36 0.27 0.21 0.28 0.07 0.10 0.28 0.90 0.19** 0.28** 0.14** 0.05 0.23** 0.08*0.17** 0.17** 14. 0.23 0.46 0.43 0.30 0.55 0.24 0.26 0.10 0.30 0.69 0.47 0.36 0.24 1.80 0.30** 0.29** 0.37** 0.16** 0.34** 0.19** 0.18** 15. 0.26 0.18 0.25 0.25 0.12 0.30 0.33 0.34 0.38 0.28 0.31 0.37 0.29 0.45 1.23 0.23** 0.22** 0.29** 0.23** 0.24** 0.29** 16. 0.25 0.44 0.29 0.27 0.36 0.14 0.22 0.22 0.31 0.51 0.32 0.24 0.17 0.50 0.33 1.72 0.32** 0.23** 0.29** 0.27** 0.20** 17. 0.13 0.61 0.55 0.39 0.67 0.03 0.21 0.03 0.18 0.93 0.58 0.20 0.06 0.66 0.33 0.56 1.78 0.16** 0.46** 0.24** 0.18** 18. 0.22 0.17 0.14 0.13 0.07 0.30 0.27 0.32 0.38 0.24 0.14 0.43 0.26 0.26 0.39 0.36 0.25 1.43 0.22** 0.21** 0.23** 19. 0.33 0.50 0.54 0.53 0.53 0.13 0.35 0.17 0.45 0.74 0.72 0.45 0.10 0.62 0.36 0.53 0.83 0.35 1.87 0.29** 0.25** 20. 0.32 29 0.17 0.42 0.29 0.22 0.33 0.22 0.24 0.40 0.42 0.33 0.20 0.32 0.34 0.44 0.40 0.31 0.50 1.54 0.31** 21. 0.17 0.21 0.07 0.21 0.05 0.21 0.18 0.21 0.24 0.25 0.25 0.20 0.18 0.28 0.35 0.29 0.28 0.30 0.38 0.42 1.23 Mean: 1.91 3.06 2.57 2.48 2.85 1.76 1.96 1.64 1.92 2.93 2.72 2.20 1.62 5.56 1.93 2.47 2.80 2.03 2.80 2.25 2.04 SD: 1.03 1.27 1.38 1.40 1.41 1.04 1.10 1.02 1.13 1.34 1.38 1.24 0.95 1.34 1.11 1.31 1.33 1.20 1.37 1.24 1.11 Skewness: 1.13 −0.06 0.43 0.49 0.14 1.37 1.06 1.69 1.15 0.05 0.31 0.77 1.65 0.45 1.15 0.56 0.18 1.00 0.21 0.75 0.95 Ku osis: 0.84 −0.99 −1.09 −1.07 −1.26 1.21 0.48 2.27 0.49 −1.15 −1.13 −0.46 2.34 −0.95 0.61 −0.78 −1.12 0.04 −1.16 −0.44 0.23 SD, S anda d De ia ion. *p <0.05. **p <0.01. ∗I ems (Spanish adap a ion) 1. My biases and p ejudices a ec how I in e ac wi h people om di e en backg ounds (Mis p ejuicios in luyen en mi mane a de elaciona me con pe sonas que son di e en es a mí). 2. I eel ha I am awa e o my own biases (Sien o que soy conscien e de mis p opios p ejuicios). 3. My nega i e hough s abou o he s a e ne e a p oblem in my li e (Mis pensamien os nega i os sob e o as pe sonas no me gene an p oblemas en mi ida). 4. I need o educe my nega i e hough s abou o he s in o de o ha e good social in e ac ions (Necesi o educi los pensamien os nega i os hacia los demás pa a pode ene buenas elaciones con ellos). 5. When I e alua e someone nega i ely, I am able o ecognize ha his is jus a eac ion, no an objec i e ac (Cuando pienso mal sob e alguien, soy capaz de econoce que es o es solo lo que yo pienso, y no necesa iamen e algo eal sob e esa pe sona). 6. I s op doing hings ha a e impo an o me when i in ol es someone I don’ like (Dejo de hace las cosas que son impo an es pa a mí cuando pa icipa alguien que no me gus a). 7. I ha e ouble le ing go o my judgmen s o o he s (Me esul a di ícil consegui que mis juicios sob e los demás no me in luyan). 8. I eel ha my p ejudicial hough s a e a signi ican ba ie o me being cul u ally sensi i e (Sien o que mis p ejuicios me di icul an espe a a pe sonas de o as cul u as). 9. I ha e ouble no ac ing on my nega i e hough s abou o he s (Me esul a complicado que mis pensamien os nega i os sob e los demás no me in luyan en cómo ac úo). 10. I’m good a no icing when I ha e a judgmen o ano he pe son (Cuando hago juicios sob e o as pe sonas, me doy cuen a de que los es oy haciendo). 11. I ’s OK o ha e iends ha I ha e nega i e hough s abou om ime o ime (No pasa nada po ene amigos sob e los que a eces engo pensamien os nega i os). 12. I don’ s uggle wi h con olling my e alua ions abou o he s (No me es ue zo po e i a hace alo aciones sob e los demás). 13. When I am ha ing nega i e hough s abou o he s, I wi hd aw om people (Cuando engo pensamien os nega i os sob e o as pe sonas, me aislo de la gen e). 14. When I’m alking wi h someone I don’ like, I’m awa e o my e alua ions o hem (Cuando es oy hablando con alguien que no me gus a, me doy cuen a de las alo aciones nega i as que hago de esa pe sona). 15. When I ha e judgmen s abou o he s, hey a e e y in ense (Cuando juzgo a los demás, suelo hace lo de mane a muy in ensa). 16. When alking wi h someone I belie e should ac acco ding o how I eel abou him/he , e en i i is nega i e (C eo que cuando hablo con una pe sona, yo debe ía ac ua de acue do a lo que sien o po ella, incluso cuando lo que sien o es nega i o). 17. I am awa e when judgmen s abou o he s a e passing h ough my mind (Se me da bien da me cuen a cuando hago juicios sob e o as pe sonas). 18. I a ely wo y abou ge ing my e alua ions owa d o he s unde con ol (No me p eocupo po man ene bajo con ol mis alo aciones nega i as sob e los demás). 19. I accep ha I will some imes ha e unpleasan hough s abou o he people (Acep o que a eces end é pensamien os desag adables sob e los demás). 20. I o en ge caugh up in my e alua ions o wha o he s a e doing w ong (A menudo me quedo pillado dándole uel as a las alo aciones que hago sob e lo que o os hacen mal). 21. The bad hings I hink abou o he s mus be ue (Deben de se e dad las cosas malas que pienso de los demás). F on ie s in Psychology | www. on ie sin.o g 5Janua y 2021 | Volume 11 | A icle 565638 psyg-11-565638 Janua y 18, 2021 Time: 17:36 # 6 Valdi ia-Salas e al. S igma izing Though s, Empa hy, and Dis ess TABLE 2 | Es ima ed pa ame e s in he con i ma o y ac o analysis. I em Es ima e SE S anda dized es ima e S anda dized SE In lex by T1PRE_1 1.000 0.000 0.605 0.014 T1PRE_4 0.876 0.056 0.530 0.026 T1PRE_6 0.638 0.028 0.386 0.021 T1PRE_7 1.101 0.060 0.666 0.028 T1PRE_8 0.795 0.090 0.481 0.046 T1PRE_9 1.085 0.059 0.657 0.021 T1PRE_13 0.680 0.020 0.412 0.009 T1PRE_15 1.090 0.054 0.660 0.020 T1PRE_16 1.091 0.063 0.660 0.032 T1PRE_20 0.926 0.032 0.560 0.011 T1PRE_21 0.905 0.068 0.548 0.030 Flex by T1PRE_2 1.000 0.000 0.531 0.015 T1PRE_3 0.900 0.079 0.478 0.030 T1PRE_5 0.976 0.039 0.518 0.013 T1PRE_10 1.393 0.064 0.739 0.028 T1PRE_11 0.967 0.046 0.514 0.020 T1PRE_12 0.947 0.026 0.503 0.006 T1PRE_14 1.113 0.068 0.591 0.021 T1PRE_17 1.300 0.059 0.690 0.021 T1PRE_18 0.774 0.028 0.411 0.020 T1PRE_19 1.342 0.044 0.713 0.018 Flex wi h in lex 0.224 0.007 0.697 0.008 All pa ame e s we e signi ican wi h p <0.01. cases, PsyIn lex played a signi ican media ing ole. Rega ding he occu ence o EmpCon a Time 3, analyses con i med h ee ou es: i s , he PsyIn lex ou e, s a ing a Time 1 and going h ough Time 2, which yielded a nega i e ela ion [β=−0.05; SE = 0.001; (s anda dized = −0.04; 0.004); p<0.01]; he second ou e s a ed wi h PsyFlex a Time 1 and con inued wi h EmpCon a Time 2, wi h posi i e e ec on EmpCon a Time 3 [β= 0.06; SE = 0.004; (s anda dized = 0.06;0.008); p<0.01]; las ly, he PsyFlex ou e, which also had a posi i e e ec on EmpCon a Time 3 and had PsyFlex as p edic i e a iable a bo h Times 1 and 2 [β= 0.04; SE = 0.004; (s anda dized = −0.04; 0.01); p<0.01]. These EmpCon ou es indica e he media ing ole o PsyFlex, al hough in his case, PsyFlex and EmpCon seem o show a non- ecu si e pa e n o in luence. DISCUSSION The pu pose o he cu en esea ch was o conduc a alidi y s udy o a Spanish e sion o he AAQ-S wi h a sample o adolescen s aged 11–17 yea s. S a is ical analyses con i med a wo-co ela ed- ac o solu ion (PsyFlex and PsyIn lex), he adequa e eliabili y o bo h ac o s and hei cons uc and p edic i e alidi y in he expec ed di ec ion. The CRI yielded he same eliabili y o bo h PsyFlex and PsyIn lex, a alue simila o ha shown in he ini ial alida ion o he ins umen (Le in e al., 2014). S ill, he PsyIn lex subscale showed only adequa e α alue, and he pe cen age TABLE 3 | Es ima ed pa ame e s in he longi udinal pa h model. Va iables Es ima e SE S anda dized es ima es SE p Pe DT3 ON Pe DT2 0.513 0.047 0.551 0.076 0.000 EmpConT2 −0.059 0.043 −0.063 0.051 0.213 PsyFlexT2 0.041 0.030 0.047 0.038 0.225 PsyIn lexT2 0.156 0.045 0.147 0.033 0.000 EmpConT3 ON Pe DT2 0.179 0.083 0.171 0.092 0.064 EmpConT2 0.456 0.056 0.433 0.006 0.000 PsyFlexT2 0.110 0.001 0.112 0.012 0.000 PsyIn lexT2 −0.105 0.004 −0.088 0.011 0.000 PsyFlexT3 ON Pe DT2 −0.066 0.052 −0.062 0.048 0.194 EmpConT2 0.222 0.085 0.206 0.089 0.020 PsyFlexT2 0.494 0.036 0.493 0.013 0.000 PsyIn lexT2 −0.097 0.099 −0.079 0.084 0.342 PsyIn lexT3 ON Pe DT2 0.011 0.066 0.014 0.080 0.865 EmpConT2 0.036 0.027 0.043 0.037 0.247 PsyFlexT2 −0.007 0.017 −0.008 0.023 0.713 PsyIn lexT2 0.479 0.111 0.501 0.064 0.000 Pe DT2 ON Pe DT1 0.490 0.051 0.470 0.048 0.000 EmpConT1 0.093 0.040 0.091 0.038 0.015 PsyFlexT1 0.023 0.045 0.024 0.047 0.603 PsyIn lexT1 0.083 0.039 0.069 0.036 0.053 EmpConT2 ON Pe DT1 0.048 0.045 0.046 0.044 0.294 EmpConT1 0.478 0.018 0.472 0.015 0.000 PsyFlexT1 0.134 0.023 0.141 0.020 0.000 PsyIn lexT1 −0.037 0.078 −0.031 0.065 0.633 PsyFlexT2 ON Pe DT1 0.033 0.035 0.030 0.031 0.338 EmpConT1 0.092 0.009 0.085 0.008 0.000 PsyFlexT1 0.373 0.020 0.366 0.013 0.000 PsyIn lexT1 0.038 0.072 0.030 0.057 0.603 PsyIn lexT2 ON Pe DT1 0.068 0.030 0.074 0.033 0.025 EmpConT1 0.028 0.041 0.031 0.046 0.491 PsyFlexT1 −0.131 0.008 −0.156 0.012 0.000 PsyIn lexT1 0.503 0.016 0.478 0.014 0.000 Pe D, pe sonal dis ess; EmpCon, empha ic conce n; PsyFlex, psychological lexibili y; PsyIn lex, psychological in lexibili y; T1, Time 1; T2, Time 2; T3, Time 3. o explained a iance o he p edic i e model was lowe han ha o PsyFlex. This may be he esul o he wo ding o he PsyIn lex i ems ha may ha e been di icul o ea ly adolescen s (in ou sample, a e age age was 13.66 yea s; age ange, 11–17 yea s). In ac , in he s udy by T igue os e al. (2020), which employed an olde sample (a e age age was 17.12 yea s; age ange, 15–19 yea s), eliabili y o he PsyIn lex subscale was highe . Should his ins umen be u he adap ed o ea ly adolescence, ewo ding o he PsyIn lex i ems is highly ecommended (G eco e al., 2008). Mos i ems loaded on o hei co esponding ac o , bu we also ound unexpec ed co ela ions among di e en - ac o i ems. Again, we a gue ha he adap a ion o his ins umen o ea ly adolescen s equi e u he e inemen in he wo ding o he i ems so as o clea ly di e en ia e be ween lexible and in lexible eac ions o s igma izing hough s. Fo ins ance, PsyFlex i em 17 eads: “I am good a no icing when I F on ie s in Psychology | www. on ie sin.o g 6Janua y 2021 | Volume 11 | A icle 565638 psyg-11-565638 Janua y 18, 2021 Time: 17:36 # 7 Valdi ia-Salas e al. S igma izing Though s, Empa hy, and Dis ess ha e a judgmen o ano he pe son,” and PsyIn lex i em 16 eads: “When alking wi h someone, I belie e I should ac acco ding o how I eel abou him/he , e en i i is nega i e.” Howe e , i is compa ible being awa e o you s igma izing hough s and s ill ac ing on hem. Un o una ely, in he o iginal alida ion o he scale (Le in e al., 2014), PsyFlex i ems we e e e se sco ed, so i is no possible o es ablish compa isons wi h ou indings. Fu he e inemen s o he ins umen adap ed o Spanish ea ly adolescen s ough o ake his in o conside a ion. The wo- ac o solu ion showed good i indices in he o al sample and when sepa a ed by gende . This goes in line wi h p e ious s udies ha ha e no ound di e ences in PsyIn lex and PsyFlex wi h s igma izing hough s as a unc ion o gende (T igue os e al., 2020). Rega dless o how he s igma izing hough s a e acqui ed and how hei con en may be di e en as a ma e o gende , ou esul s sugges ha bo h gende s ela e o such hough s bo h in lexible and in lexible ways. This p obably ela es o he ac ha PsyIn lex and PsyFlex a e gene al o e a ching egula o y skills ha , once lea ned, occu wi h hough s and eelings ha a e expe ienced as a e si e ega dless o hei con en (Mones ès e al., 2018). The cons uc alidi y s udy showed ha he in lexibili y ac o s o he AFQ-Y, namely, CF and EA, we e mo e s ongly ela ed o PsyIn lex han o PsyFlex, as expec ed. The p edic i e alidi y s udy yielded he mos in e es ing esul s. As expec ed, di ec e ec s showed ha PsyIn lex p edic ed he occu ence o Pe D and p e en ed he occu ence o EmpCon, and PsyFlex p edic ed he occu ence o EmpCon. PsyIn lex wi h s igma izing hough s leads o Pe D and blocks he expe ience o empa hy in he s igma ize . In e es ingly, while he ela ion be ween PsyIn lex and Pe D seems unidi ec ional, wi h PsyIn lex p edic ing Pe D, he ela ion be ween PsyFlex and EmpCon seems bidi ec ional. Tha is, ela ing wi h lexibili y o ou s igma izing hough s abou o he s makes us mo e empa he ic, and in u n, p ac icing he empa he ic conce n o o he s’ si ua ion makes us mo e empa he ic and mo e psychologically lexible wi h ou s igma izing hough s, in a kind o upwa d i uous cycle. The bidi ec ional ela ion be ween psychological in/ lexibili y and ou come a iables has been epo ed be o e (Valdi ia-Salas e al., 2017) and shows i s suscep ibili y o aining and change o e ime. This is especially ele an du ing adolescence, when egula o y skills a e no ye ully consolida ed, and hence p e en ion and socioeduca i e in e en ions a e c ucial (Glick and Hil , 2000). In he same line, he indi ec e ec s showed expec ed esul s such as he p edic i e ole o PsyIn lex o he de elopmen o Pe D and he p edic i e ole o PsyFlex o he de elopmen o EmpCon. This sugges s ha , when main ained o e ime as he p edominan coping s a egy, PsyIn lex will lead o Pe D, whe eas PsyFlex will lead o EmpCon. Indi ec e ec also showed he p o ec i e e ec s o PsyFlex o he de elopmen o Pe D in ha high PsyIn lex sco es a Time 2 led o ei he Pe D o EmpCon, depending on he beha io egula ion skills a Time 1: when adolescen s sco ed high in PsyFlex a Time 1, he mos p obable ou come a Time 3 was EmpCon, whe eas when adolescen s sco ed high in PsyIn lex a Time 1, he mos p obable ou come a Time 3 was Pe D. Somehow, depa ing om lexible egula o y skills bu e ed he nega i e consequences o de eloping in lexible egula o y skills a some ime du ing de elopmen . This has g ea implica ions o he p omo ion o PsyFlex as ea ly as possible du ing childhood. And calls o u he esea ch on he ole exe ed by PsyFlex in he in e play among Pe D, EmpCon, and pe spec i e- aking, one o he componen s o cogni i e empa hy, which seems o deac i a e Pe D in a o o EmpCon (G aziano and Habashi, 2010;Habashi e al., 2016). I migh be he case ha PsyFlex, which in ol es pe spec i e om ou own hough s (Le in e al., 2014), somehow acili a ed aking ano he ’s pe spec i e and led o EmpCon a he han Pe D. These indings con i m he impo ance o conside ing he ole o egula o y skills in he expe ience o ei he EmpCon o Pe D when in he p esence o s igma izing hough s abou o he s (Dece y and Jackson, 2004). And also, hese indings go in line wi h he e idence ha ac ing on hough s and eelings o somehow al e hei con en o alle ia e hei p esence (i.e., PsyIn lex) leads o in e nalizing and ex e nalizing p oblems, also du ing adolescence. As e iewed in he in oduc o y sec ion, Pe D is ega ded as a sel - ocus a e si e–a ec i e eac ion o ano he ’s emo ion ha is associa ed wi h he desi e o alle ia e one’s own, bu no he o he ’s dis ess (e.g., Eisenbe g e al., 2010;Win e e al., 2017). Ou indings p o e ha Pe D de i es om iden i ying wi h s igma izing hough s and ac ing on hem (o “pushed” by hem) despi e he mid- and long- e m consequences his may ha e in bo h he s igma ize and he s igma ized. Ou s udy demons a es ha beha io egula ion skills in luence he deg ee o which an adolescen will expe ience mo e EmpCon o mo e Pe D when hey wi ness a nega i e expe ience o o he s. Bu we canno asse ha PsyFlex and PsyIn lex will in luence hei engagemen in ei he p osocial o agg essi e beha io . P e ious li e a u e would suppo his hypo hesis (see, o ins ance, Masuda e al., 2007, 2009); s ill u he esea ch is called o . Fu he esea ch should also include la ge samples so as o inc ease he gene alizabili y o ou indings, addi ional wa es ha allowed analyzing wi hin-subjec and be ween-subjec e ec s, and expe imen al designs. In Spain, p ejudices and s igma become e iden in he beha io o adolescen s om he ea ly age o 12 yea s (e.g., Fe agu e al., 2017). Ou s udy shows ha he way he adolescen s eac o hei s igma izing hough s may be one ea ly link o he chain o ei he p osocial o agg essi e/disc imina o y beha io . DATA AVAILABILITY STATEMENT The aw da a suppo ing he conclusions o his a icle will be made a ailable by he au ho s, wi hou undue ese a ion. F on ie s in Psychology | www. on ie sin.o g 7Janua y 2021 | Volume 11 | A icle 565638 psyg-11-565638 Janua y 18, 2021 Time: 17:36 # 8 Valdi ia-Salas e al. S igma izing Though s, Empa hy, and Dis ess ETHICS STATEMENT The s udies in ol ing human pa icipan s we e e iewed and app o ed by Comi é é ico de in es igación clínica de A agón. W i en in o med consen o pa icipa e in his s udy was p o ided by he pa icipan s’ legal gua dian/nex o kin. AUTHOR CONTRIBUTIONS SV-S and JM-A designed he s udy. VV-B managed da a collec ion and da abase upda e. AC assis ed du ing da a collec ion. JM-A conduc ed da a analyses. SV-S, JM-A, and AC w o e he manusc ip . VV-B and TJ e ised p e ious e sions o he manusc ip . All au ho s ead and app o ed he submi ed e sion. FUNDING This esea ch was pa ially suppo ed by g an s om Uni e si y o Za agoza and Ibe caja Founda ion ( e . JIUZ-2016-SOC-04) and om Go e nmen o A agon and FEDER Building Eu ope om A agon ( e . LMP40_18). ACKNOWLEDGMENTS We hank he p incipals o he pa icipa ing high schools as well as he s a membe s who collabo a ed wi h he esea ch eam du ing da a collec ion. As well, we hank he amilies who ga e hei in o med consen o hei child en o pa icipa e in he s udy. REFERENCES B islin, R. W. (1986). The wo ding and ansla ion o esea ch ins umen s. C oss Cul . Res. Me hodol. 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Copy igh © 2021 Valdi ia-Salas, Ma ín-Albo, C uz, Villanue a-Blasco and Jiménez. This is an open-access a icle dis ibu ed unde he e ms o he C ea i e Commons A ibu ion License (CC BY). The use, dis ibu ion o ep oduc ion in o he o ums is pe mi ed, p o ided he o iginal au ho (s) and he copy igh owne (s) a e c edi ed and ha he o iginal publica ion in his jou nal is ci ed, in acco dance wi h accep ed academic p ac ice. No use, dis ibu ion o ep oduc ion is pe mi ed which does no comply wi h hese e ms. F on ie s in Psychology | www. on ie sin.o g 9Janua y 2021 | Volume 11 | A icle 565638