This paper reports on an ongoing ARC Discovery Project that is conducting design research into learning in collaborative virtual worlds (CVW).The paper will describe three design components of the project: (a) pedagogical design, (b)technical and graphics design, and (c) learning research design. The perspectives of each design team will be discussed and how the three teams worked together to produce the CVW. The development of productive failure learning activities for the CVW will be discussed and there will be an interactive (...) demonstration of the project's CVW. (shrink)

Problematic substance use (PSU) among nurses has wide‐ranging adverse implications. A critical integrative literature review was conducted with an emphasis on building knowledge regarding the influence of structural factors within nurses' professional environments on nurses with PSU. Five thematic categories emerged: (i) access, (ii) stress, and (iii) attitudes as contributory factors, (iv) treatment policies for nurses with PSU, and (v) the culture of the nursing profession. Conclusions were that an overemphasis on individual culpability and failing predominates in the literature and (...) that crucial knowledge gaps exist regarding the influence of structural factors on driving and shaping nurses' substance use. (shrink)

While vaccination rates in the United States are high — generally over 90 percent — rates of exemptions have been going up, and preventable diseases coming back. Aside from their human cost and the financial cost of treatment imposed on those who become ill, outbreaks impose financial costs on an already burdened public health system, diverting resources from other areas. This article examines the financial costs of non-vaccination, showing how high they can be and what they include. It makes a (...) case for requiring those who do not vaccinate to cover the costs of outbreak caused by their choice. Such recouping is justified because the choice not to vaccinate can easily be seen as negligent. But even if it is not, that choice involves imposing costs on others, and there are good reasons to require the actors to internalize those costs. The article proposes alternative statutory and regulatory schemes to cover the costs imposed on the public purse, focusing on no-fault mechanisms. We consider both ex ante mechanisms like a tax or a fee that will go into a no-fault fund to cover the costs and ex post mechanisms like a statutory authorization for recoupment of those costs by health officials. (shrink)

Garrett Cullity contends that fairness is appropriate impartiality (See Cullity (2004) Chapters 8 and 10 and Cullity (2008)). Cullity deploys his account of fairness as a means of limiting the extreme moral demand to make sacrifices in order to aid others that was posed by Peter Singer in his seminal article ‘Famine, Affluence and Morality’. My paper is founded upon the combination of (1) the observation that the idea that fairness consists in appropriate impartiality is very vague and (2) the (...) fact that psychological studies show the self-serving bias is especially likely to infect one’s judgements when the ideas involved are vague. I argue that Cullity’s solution to extreme moral demandingness is threatened by these findings. I then comment on whether some other theories of fairness are vulnerable to the same objection. (shrink)

This paper argues that close personal relationships play an important role in our judgments about what is fair. I start with an explanation of leading theories of fairness, highlighting the potential for further work on the grounds of fairness. Next, I offer an account of close personal relationships as having the ability to generate legitimate and reasonable expectations of one or other party to a judgment about fairness, or both. I show how and when close personal relationships can ground fairness.

Nurses’ experiences in, and the overall effectiveness of, widely used alternative‐to‐discipline programs to manage nurses’ substance‐use problems have not been adequately scrutinized. We uncovered the conflicted official and experiential ways of knowing one such alternative‐to‐discipline program in a Canadian province. We explicated this conflict through an institutional ethnography analysis. Ethnographic data from interviews with 12 nurses who were enrolled in an alternative‐to‐discipline treatment program and three program administrators, as well as institutional texts, were analyzed to explore how institutional practices and (...) power relations co‐ordinated and managed nurses’ experiences. Analysis revealed the acritical acceptance of a standardized program not based on current norms of practice. Potential and actual conflicts of interest, power imbalances, and prevailing corporate interests were rife. Nurses were not afforded the same rights to quality ethical health care as other citizens. ‘Expert’ physicians’ knowledge was privileged while nurses’ knowledge was subordinated. Conclusions were that regulatory bodies cannot rely on the taken‐for‐granted standardized treatment model in widespread use. Individualized treatment alternatives reflecting current, scientific evidence must be offered to nurses, and nurses’ knowledge, expertise, and experiences need to be included in decision‐making processes in these programs. (shrink)

Marcus Arvan’s Rightness as Fairness is a highly ambitious book. In fewer than 230 pages, Arvan hopes to demonstrate that we ought to evaluate moral theories in a similar manner to the sciences, that existing moral theories fall short on that evaluation, that moral normativity reduces to instrumental rationality, and that a new theory of rightness as fairness meets the scientific evaluative standards better than any of the alternatives. I’m afraid I was unconvinced that we should abandon our preferred moral (...) theories in favor of rightness as fairness. (shrink)

Marcus Arvan’s Rightness as Fairness is a highly ambitious book. In fewer than 230 pages, hopes to demonstrate that we ought to evaluate moral theories in a similar manner to sciences, that existing moral theories fall short on that evaluation, that moral normativity reduces to instrumental rationality, and that a new theory of ‘rightness as fairness’ meets the scientific evaluative standards better than any of the alternatives.

The punchy central claim of Torbjörn Tännsjö's book is that act-utilitarianism best explains our considered intuitions about the moral status of different kinds of killing. An interesting aspect of this book is Tännsjö's revisionary methodology, which he names 'Applied Ethics (Turned Upside Down)'. So, why does Tännsjö choose applied ethics (turned upside down) to argue for act-utilitarianism's role in explaining our considered intuitions about killing and what, exactly, is his innovative method of moral investigation?

For several decades, researchers have debated whether attention is required for consciousness or not. Throughout this time, three particular paradigms — inattentional blindness, change blindness, and the attentional blink — have been extensively used to examine this relationship. In this chapter, we highlight many of the key findings that have been discovered using these paradigms, and discuss what these findings have taught us about the role attention plays in perceptual consciousness.

Previous research suggests that exposure to nature may reduce delay discounting and thereby facilitate healthier dietary intake. This pre-registered study examined the impact of online exposure to images of natural scenes on delay discounting and food preferences. It was predicted that exposure to images of natural scenes would be associated with: lower delay discounting; higher desirability for fruits and vegetables ; and delay discounting would mediate the effect of nature-image exposure on food desirability. Adult participants were recruited to an online (...) between-subjects experiment in which they viewed a timed sequence of six images either showing natural landscape scenes or urban scenes. They then completed measures of mood, delay discounting and rated their momentary desire to eat four fruits and vegetables, and four energy-dense foods. There was no statistically significant effect of experimental condition on delay discounting or food desirability. Bayes factors supported the null hypothesis for discounting, and energy-dense food desirability, but provided no strong evidence for either hypothesis for F&V desirability. These findings indicate that brief online exposure to images of nature does not affect momentary impulsivity or energy-dense food preference, whereas for preference for less-energy dense foods, the evidence was inconclusive. (shrink)

African American adolescents have become more active users of digital media, which may increasingly expose them to direct online discrimination based on their racial and gender identities. Despite well-documented impacts of offline discrimination, our understanding of if and how direct online discrimination affects African American adolescents similarly remains limited. Guided by intersectional and ecological frameworks, we examined the association between direct online discrimination and internalized computing stereotypes in African American adolescents. Further, we explored the moderating effects of systemic and individual (...) factors – vicarious online discrimination, parental technological attitudes, and racial identity centrality – on this association by adolescent gender. Utilizing data from 1041 African American parent-adolescent dyads, we found a positive association between adolescents’ direct online discrimination and internalized computing stereotypes. Surprisingly, greater vicarious online discrimination mitigated this association for both male and female adolescents. Further, parental technological attitudes and racial identity centrality mitigated this association only for female but not male adolescents. Our findings highlight the importance of understanding the impact of media on adolescents’ online experiences from intersectional and systemic perspectives. We discuss the implications for prospective research and educational programs focused on African American adolescents’ digital media use and online experiences. (shrink)

This paper provides an explanation for Gadamer’s inconsistent ideas of the symbol in his works, arguing that his concept of the symbol has evolved from a less-authentic experience to an authentic experience. In Truth and Method, the symbol is defined as having an instituted meaning and substitution function, and is devalued as a pure appearance of the real, which is less authentic than the artistic presentation that occasions the coming-into-existence events of the real. Later, in “The Relevance of the Beautiful”, (...) Gadamer elevates the symbol to the same status as the work of art, and uses it to defend the work of art’s inexhaustibility and irreplaceability in communicating meanings and revealing truth. Gadamer’s changed concept of the symbol also serves to justify the universality of philosophical hermeneutics in addressing modern art-related issues, particularly those involving the speechlessness, definition, and technological reproductions of art. (shrink)

Transient receptor potential vanilloid 4 (TRPV4), a member of the TRP superfamily, is a broadly expressed, cell surface‐localized cation channel that is activated by a variety of environmental stimuli. Importantly, TRPV4 has been increasingly implicated in the regulation of cellular morphology. Here we propose that TRPV4 and the cytoskeletal remodeling small GTPase RhoA together constitute an environmentally sensitive signaling complex that contributes to pathological cell cytoskeletal alterations during neurological injury and disease. Supporting this hypothesis is our recent work demonstrating direct (...) physical and bidirectional functional interactions of TRPV4 with RhoA, which can lead to activation of RhoA and reorganization of the actin cytoskeleton. Furthermore, a confluence of evidence implicates TRPV4 and/or RhoA in pathological responses triggered by a range of acute neurological insults ranging from stroke to traumatic injury. While initiated by a variety of insults, TRPV4–RhoA signaling may represent a common pathway that disrupts axonal regeneration and blood–brain barrier integrity. These insights also suggest that TRPV4 inhibition may represent a safe, feasible, and precise therapeutic strategy for limiting pathological TRPV4–RhoA activation in a range of neurological diseases. (shrink)

Evidence from a growing number of studies suggests leader character as a means to advance leadership knowledge and practice. Based on this evidence, we propose a process model depicting how leader character manifests in ethical leadership that has positive psychological and performance outcomes for leaders, along with the moderating effect of leaders’ self-control on the character strength–ethical leadership–outcomes relationships. We tested this model using multisource data from 218 U.S. Air Force officers and their subordinates and superiors. Findings provide initial support (...) for leader character as a mechanism triggering positive outcomes such that only when officers reported a high level of self-control did their honesty/humility, empathy, and moral courage manifest in ethical leadership, associated with higher levels of psychological flourishing and in-role performance. We discuss the implications of these results for future theory development, research, and practice. (shrink)

Background Increasing social pluralism adds to the already existing variety of heterogeneous moral perspectives on good care, health, and quality of life. Pluralism in social identities is also connected to health and care disparities for minoritized patient (i.e. care receiver) populations, and to specific diversity-related moral challenges of healthcare professionals and organizations that aim to deliver diversity-responsive care in an inclusive work environment. Clinical ethics support (CES) services and instruments may help with adequately responding to these diversity-related moral challenges. However, (...) although various CES instruments exist to support healthcare professionals with dealing well with morally challenging situations in healthcare, current tools do not address challenges specifically related to moral pluralism and intersectional aspects of diversity and social justice issues. This article describes the content and developmental process of a novel CES instrument called the Diversity Compass. This instrument was designed with and for healthcare professionals to dialogically address and reflect on moral challenges related to intersectional aspects of diversity and social justice issues that they experience in daily practice. Methods We used a participatory development design to develop the Diversity Compass at a large long-term care organization in a major city in the Netherlands. Over a period of thirteen months, we conducted seven focus groups with healthcare professionals and peer-experts, carried out five expert interviews, and facilitated four meetings with a community of practice consisting of various healthcare professionals who developed and tested preliminary versions of the instrument throughout three cycles of iterative co-creation. Results The Diversity Compass is a practical, dialogical CES instrument that is designed as a small booklet and includes an eight-step deliberation method, as well as a guideline with seven recommendations to support professionals with engaging in dialogue when they are confronted with diversity-related moral challenges. The seven recommendations are key components in working toward creating an inclusive and safe space for dialogue to occur. Conclusions The Diversity Compass seeks to support healthcare professionals and organizations in their efforts to facilitate awareness, moral learning and joint reflection on moral challenges related to diversity and social justice issues. It is the first dialogical CES instrument that specifically acknowledges the role of social location in shaping moral perspectives or experiences with systemic injustices. However, to make healthcare more just, an instrument like the Diversity Compass is not enough on its own. In addition to the Diversity Compass, a systemic and structural approach to social justice issues in healthcare organizations is needed in order to foster a more inclusive, safe and diversity-responsive care and work environment in health care organizations. (shrink)

In the current paper, our aim is to explore the latent power dynamics surrounding corporate social responsibility in developing countries. To do this, we synthesize an analytic framework that borrows from both cross-cultural management literature as well as feminist considerations of power. We then use the framework to examine three streams of CSR literature. Our analysis uncovers the prevalence of arguments and discussions about indigenous and power-over themes rather than more generative, endogenous, and power-to themes. The paper concludes with the (...) suggestion for more space in the CSR literature for examining the realities and potentialities of local SME CSR expressions to counterbalance the overwhelming focus on MNCs. Such counterbalancing can better lead to the recognition that power and domination are not the only important dynamics to examine in CSR research. Just as important is the need for a more nuanced consideration of the role and contributions of different actors to the continuously unfolding CSR discourse. (shrink)

BackgroundConcerns about decision making related to resuscitation have led to two important challenges in the courts resulting in new legal precedents for decision-making practice. Systematic research investigating the experiences of doctors involved in decisions about resuscitation in light of the recent changes in law remains lacking.AimTo analyse the practice of resuscitation decision making on hospital wards from the perspectives of doctors.DesignThe data presented in this paper were collected as part of a wider research study of end-of-life care in an acute (...) hospital setting. Data collection comprised ethnographic non-participant observation on two acute hospital wards and individual interviews with patients, relatives and healthcare professionals caring for patients thought to be approaching the end of life. Data were analysed using a constructivist grounded theory approach.ResultsDiscussions and decision making about resuscitation present many challenges for those involved on acute medical wards. The data highlight the potential for multiple interpretations of legal precedents, creating misunderstandings that may impact patient care in less positive ways.ConclusionsThis paper provides unique insights into how doctors respond to the changing medico-legal culture and the subsequent effects on patient care. It demonstrates how the juridification of medical practice can occur. It highlights the potential benefit of a structure to support clinicians, patients and relatives in discussing and navigating decisions around care at the end of life in line with the patient’s wishes and preferences. Recommendations for future research are made and legal ramifications are discussed. (shrink)

This research examines the ethical orientations of students (ethical idealism, ethical relativism and Machiavellianism) towards their attitude to plagiarize. It also examines the moderating effect of religious orientation on the relationship of the independent variables toward students’ attitude towards plagiarism. Data was collected from 160 business diploma and undergraduate students from a local private college and a local public university in Malaysia. Results from the hierarchical regression analysis showed that ethical relativism and Machiavellianism had a positive relationship with students’ attitude (...) towards plagiarism whilst ethical idealism was negatively related to students’ attitude towards plagiarism. Religious orientation was found to have no moderating effect on the relationship between the three independent variables: ethical idealism, ethical relativism and Machiavellianism and the dependent variable, students’ attitude towards plagiarism. (shrink)

The aim of the article is to illustrate concrete problems in the asymmetrical nurse–patient power relationship. It is an ethical demand that the nurse is faced with the challenges that the power in the relation is administered so that the patient's room for action is expanded and trust maintained. It is an essential message in care philosophy, but in clinical practice, success is not always achievable. A hidden and more or less unconscious restriction of the patient's room for action may (...) result in the excesses of care. Three selected aspects: dependence, trust, and power described by the Danish philosopher K.E. Løgstrup and the Norwegian nursing philosopher Kari Martinsen's care philosophy has inspired this empirically based examination of some current barriers in the asymmetrical nurse–patient relationship. On the basis of qualitative interviews with six patients and six nurses, the research thus provides an identifying and problem‐exploratory examination of some current obstacles in which the handling of trust and power reflects the excesses of care. The findings develop three themes. ‘Being a burden’ acknowledges that the balance of power will always tip to the nurse's advantage. The second theme, ‘Doing only what's absolutely necessary’, shows how a fixation with ‘technicalism’ creates a distance between people that may constrain the patient's room for action. The last theme is concerning the nurse's ability to navigate between closeness and distance is essential in avoiding ‘the excesses of care’, paternalism, and overprotectiveness. A situation in which distance takes the upper hand and care turns into paternalism. A different situation would arise if the nurse's emotions became sentimental or intimate with the result that closeness gets the upper hand. To avoid a harmful exercise of power and the excesses of care, the findings have demonstrated that a relationship‐based caring is a demand for situation‐specific sensitive attention skills. (shrink)

ABSTRACT When does a state of affairs constitute a harm to someone? Comparative accounts say that being worse off constitutes harm. The temporal version of the comparative account is seldom taken seriously, due to apparently fatal counterexamples. I defend the temporal version against these counterexamples, and show that it is in fact more plausible than the prominent counterfactual version of the account. Non-comparative accounts say that being badly off constitutes harm. However, neither the temporal comparative account nor the non-comparative account (...) can correctly classify all harms. I argue that we should combine them into a hybrid account of harm. The hybrid account is extensionally adequate and presents a unified view on the nature of harm. (shrink)

My paper challenges an influential distinction between pain and suffering put forward by physician-ethicist, Eric Cassell. I argue that Cassell’s distinction is philosophically untenable because he contrasts suffering with an outdated theory of pain. In particular, Cassell focuses on one type of pain, the interpretation of nociception induced by noxious stimuli such as heat or sharp objects; yet since the late 1970s, pain scientists have rendered both nociception and noxious stimuli unnecessary for pain. I argue that this discrepancy between Cassell’s (...) distinction and pain science produces three philosophical problems for his distinction: first, he frames his distinction too generally, concentrating on only one type of pain to the neglect of others, such as neuropathy; second, it is possible that Cassell’s understanding of pain may include suffering; and third, Cassell gives examples of pain and suffering manifesting independently of each other, but it is possible that these cases may instead exemplify differences between nociceptive and non-nociceptive types of pain. Due to these problems, I conclude that Cassell’s distinction currently lacks a difference. I call for new efforts to articulate the differences, if any, between pain and suffering. (shrink)

In a criminal trial, a judge or jury needs to reason about what happened based on the available evidence, often including statistical evidence. While a probabilistic approach is suitable for analysing the statistical evidence, a judge or jury may be more inclined to use a narrative or argumentative approach when considering the case as a whole. In this paper we propose a combination of two approaches, combining Bayesian networks with scenarios. Whereas a Bayesian network is a popular tool for analysing (...) parts of a case, constructing and understanding a network for an entire case is not straightforward. We propose an explanation method for understanding a Bayesian network in terms of scenarios. This method builds on a previously proposed construction method, which we slightly adapt with the use of scenario schemes for the purpose of explaining. The resulting structure is explained in terms of scenarios, scenario quality and evidential support. A probabilistic interpretation of scenario quality is provided using the concept of scenario schemes. Finally, the method is evaluated by means of a case study. (shrink)

This paper is a short report about a series of picture books and manuals designed for P4C (especially Philosophy for Korean Young Children). There were not proper educational reading materials or books to help Korean young children to think by (or for) themselves and dialogue with. Dr. Sharp’s is a very helpful guidebook for young children to think by themselves, dialogue with friends, and discuss with others (peers, older or younger children, teacher and parents, etc.). However, there remain some needs (...) for consideration of Korean culture. I developed new eight picture books for young children and short manuals for parents and teachers to do ‘thinking experiments’ with children. The stories were created in the contexts of Korean young children’s daily lives and typical episodes. The community of inquiry, which Korean young children participate in, needs to consider general and special aspects, such as the relationship between peers, children-parents, and children-teachers, Confucius or new western customs, new and old generations, moral and cultural atmosphere of Korean kindergartens or childcare centers, etc. Various episodes and scenes in the picture books will revoke and encourage Korean children’s deeper or higher thinking, interesting and creative dialogues, vivid and harmonious discussions based on their own experiences and contexts of life in the community of inquiry. (shrink)

Charlotte Wolff was born in Riesenburg, West Prussia into a middle-class Jewish family. She studied philosophy and then medicine at several German universities, completing her doctorate in Berlin in 1926. Working in various institutions over the next few years, she was also interested in psychotherapy and had a small private medical and psychotherapeutic practice. In 1933 she was forced to leave Germany because of the Nazi regime, and settled for a few years in Paris. As a German refugee she (...) was unable to practice medicine, so she began her research into the correlation between hand traits and personality. In 1936 she went to London to continue her research work and lived there until her death. An active lesbian from an early age, her later research turned to sexology and her writing on lesbianism and bisexuality were influential early works in the field. This is a great opportunity to rediscover her early work, including her first autobiography. (shrink)

Consumers play an important role as one of the main actors in food safety social co-governance. To create a pattern of food safety social co-governance, the active and effective participation of consumers is critical. To encourage consumers to participate in food safety social co-governance voluntarily and positively, we attempted to develop and preliminarily validate a multidimensional questionnaire on consumer psychological capital that could be used to measure the degree of consumer participation in food safety social co-governance. The aim of the (...) initial sample and test sample 2 was to investigate the factor structure of a preliminary measure of consumer psychological capital. A 4-factor model with 23 items explained 61.05% of the total variance in item scores. The aim of test sample 3 was to measure the retest reliability. Test sample 4 was randomly allocated to the modeling sample and validation sample to verify questionnaire reliability and validity. Convergent validity, discriminant validity, and the internal inconsistency coefficients of the questionnaire were assessed in the modeling sample. While processing CFA, we deleted 9 items with small standardized factor loadings. The remaining 14 items in the final revised 4-factor model included self-efficacy, resilience, hope, and optimism. The fit indices of the revised four-factor model and second-order factor model in the modeling sample revealed an acceptable model fit. The convergent validity and discriminant validity of the revised model were good and acceptable, respectively. A cross-validation procedure confirmed the appropriateness of the revised four-factor model and second-order factor model in the validation sample. The cross-validation results confirmed that the fit indices of the revised four-factor model fitted the data well and the second-order factor model in the validation sample reached acceptable values. We concluded that the questionnaire developed in this study had good reliability and stable and acceptable construct validity. It could provide a theoretical basis for measuring psychological capital in food safety co-governance. (shrink)

Animals do a wide range of work in our society, but they are rarely recognized as workers or accorded any labour rights, and their working conditions are often oppressive and exploitative. Drawing on law, ethics, and labour studies, the essays in this volume explore the potential and dangers of animal labour.

ABSTRACT Testimony from victims of gendered violence is often wrongly disbelieved. This paper explores a way to address this problem by developing a phenomenological approach to testimony. Guided by the concept of ‘disclosedness’, a tripartite analysis of testimony as an affective, embodied, communicative act is developed. Affect indicates how scepticism may arise through the social moods that often attune agents to victims’ testimony. The embodiment of meaning suggests testimony should not be approached as an assertion, but as a process of (...) ‘articulating an understanding’. This account is deepened in the discussion of testimony as a communicative act. It is argued that testimony must be considered as a relational whole, and thus our aim in receiving victims’ testimony should be to honour the relational conditions under which the truth of testimony can be heard. Approaching testimony as the collaborative process of enabling an understanding to be articulated can enhance our conception of gendered violence, whilst also better serving the victims of gendered violence by helping to overcome the lack of trust and excessive scepticism with which victims’ testimony is often met. (shrink)

The importance of patient involvement is increasing in healthcare, and initiatives are constantly implemented to reach the ideal of involved and educated patients. This secondary analysis was initially embedded in a randomized controlled study where the aim was to gain insight into perceptions and experiences within a group of women undergoing fertility treatment through two focus group interviews. In this secondary analysis, we investigated how patient involvement was strived for in both clinical practice and research. During the analysis, it became (...) apparent that the women exercised and maintained a clear perspective on their hope for a child, Project Child, while the interviewer pursued a treatment perspective, Project Treatment. Despite different perspectives, the conversation during the interviews seemed effortless, and it became apparent how the interviewer and the participants were actually focusing partly on the same, but primarily on different issues but without addressing or acknowledging this. Knowledge and awareness of the difference in perspectives is important when healthcare professionals seek to involve patients both in clinical practice and in research. Patient involvement in both research and clinical practice has shown to be a challenge and entails that pathways are organized and decisions shared by healthcare professionals. (shrink)

Resilience factors have been suggested as key mechanisms in the relation between symptoms and disability among individuals with chronic pain. However, there is a need to better operationalize resilience and to empirically evaluate its role and function. The present study examined psychological flexibility as a resilience factor in relation to symptoms and functioning among 252 adults with chronic pain applying for participation in a digital ACT-based self-help treatment. Participants completed measures of symptoms (pain intensity, anxiety), functioning (pain interference, depression), as (...) well as the hypothesized resilience factor psychological flexibility (measured as avoidance, value obstruction, and value progress). As expected, symptoms, functioning and resilience factors were significantly associated. Hierarchical linear regression analyses showed that psychological flexibility significantly contributed to the prediction of pain interference and depression when adjusting for age, pain and anxiety. Also, participants with low levels of psychological flexibility were more likely to be on sick leave. Furthermore, a series of multiple mediation analyses showed that psychological flexibility (avoidance, value obstruction, value progress) had a significant indirect effect on the relationship between symptoms and functioning. Avoidance was consistently shown to contribute to the indirect effect. Results support previous findings and suggest the importance of psychological flexibility as a resilience factor among individuals with chronic pain and anxiety. (shrink)