How Family Bonds Shape Anxiety: New Lebanese Research Points to Psychological Flexibility

Anxiety has become the most prevalent psychological condition in Lebanon, and researchers warn that the humanitarian crises the country has faced since 2019 are likely to push rates even higher. Against this backdrop, a new study published in Current Psychology offers a fresh perspective on where anxiety comes from and, crucially, where interventions might be aimed. A team led by Maya M. Bachir of Haigazian University, together with colleagues at the American University of Beirut, the University of New York in Prague, and Trinity College Dublin, examined how the functioning of the family unit relates to anxiety symptoms in Lebanese adults, and whether a psychological trait known as psychological flexibility helps explain that connection. The findings suggest that the path from family life to anxiety may run, in large part, through this single, trainable capacity.

The rationale for focusing on the family is deeply rooted in Lebanese society. The authors note that the family is the most central institution in Lebanon, a collectivist culture in which household dynamics carry unusual weight in shaping individual wellbeing. Family Systems Theory holds that a well-functioning family acts as a protective factor against anxiety, providing structure, communication, and emotional support that buffer members against stress. Conversely, families marked by conflict, poor communication, or chaotic roles are thought to sensitize members to threat. Prior research in other cultural settings, including studies of African American and European American young adults and work during the COVID-19 pandemic, has consistently linked poorer family functioning to higher anxiety, but the Lebanese context, with its layered economic, political, and social pressures, had been underexplored.

To connect family functioning with anxiety, the researchers drew on two additional theoretical strands. Attachment Theory and Social Learning Theory both imply that high-functioning families foster psychological flexibility in their members, the capacity to remain open to difficult thoughts and feelings while still pursuing valued actions. Psychological flexibility is the core construct behind Acceptance and Commitment Therapy, a transdiagnostic behavioral intervention, and the ACT model holds that flexibility protects against anxiety by reducing experiential avoidance, the rigid struggle to escape uncomfortable inner experiences. A six-year longitudinal study of adolescents, published in the Journal of Youth and Adolescence, had already shown that inflexible parents tend to raise inflexible children, hinting that flexibility may be transmitted through family processes rather than arising purely within the individual.

The study pursued two goals: first, to reexamine the relationship between family functioning and anxiety in Lebanon, and second, to test whether psychological flexibility mediates, or statistically explains, that relationship. The team collected data from two independent samples. The first comprised 220 adults recruited through social media, a group varied enough in educational attainment that the researchers statistically controlled for education. The second comprised 408 college students, for whom education was uniform and therefore not controlled. All participants completed an online survey covering family functioning, psychological flexibility, anxiety symptoms, and demographic information. The study received ethics approval from the Institutional Review Boards of Haigazian University and the American University of Beirut, and all participants gave informed consent.

Family functioning was measured with the Family Assessment Device, a widely used instrument based on the McMaster model that evaluates dimensions such as communication, problem-solving, roles, and behavioral control. One item from the Communication subscale, concerning difficulty talking about tender feelings, was inadvertently omitted from the online survey due to a setup error, a detail the authors transparently report. Psychological flexibility was assessed with the Acceptance and Action Questionnaire-II, the standard self-report measure in the ACT literature, though researchers have debated exactly what the instrument captures. Anxiety symptoms were measured with a validated clinical scale, and the data underwent careful screening, with the full screening results made publicly available through the Open Science Framework, an unusually high level of transparency for this field.

The mediation analyses, conducted using regression-based approaches to mediation developed by Andrew Hayes and colleagues, produced a pattern that is as intriguing for its nuance as for its consistency. In the adult sample, psychological flexibility partially mediated the relationship between family functioning and anxiety, meaning that flexibility accounted for a substantial share of the association, but a direct link between family functioning and anxiety remained even after flexibility was taken into account. In the college student sample, the pattern was stronger: psychological flexibility fully mediated the relationship, such that once flexibility was modeled, family functioning no longer showed a direct association with anxiety. In both samples, better family functioning predicted greater psychological flexibility, and greater flexibility predicted lower anxiety.

What might explain the difference between the two samples? The authors do not overinterpret the contrast, but the developmental context is suggestive. College students are typically younger, still embedded in family systems, and at a life stage when emotion-regulation habits are consolidating, so family functioning may shape their anxiety almost entirely through the flexibility it cultivates. Adults, whose family-of-origin influences have had decades to interact with work stress, financial strain, and independent living, may carry additional direct pathways from family experience to anxiety that flexibility alone cannot absorb. Research on emotion regulation in the family context, including influential work by Morris and colleagues, supports the idea that families teach children how to handle emotions, and that these lessons calcify over development into stable individual differences.

The theoretical chain the study tested, from family systems through attachment and social learning to the ACT model, now has empirical support in a Middle Eastern setting where such evidence has been scarce. Earlier Lebanese research had documented a substantial mental health burden, including lifetime prevalence data on mental disorders collected during periods of war exposure, rising suicide rates linked to financial stress, and a large treatment gap among adolescents. By identifying psychological flexibility as a possible mediating mechanism, the study gives clinicians and policymakers a concrete target. Flexibility is not a fixed trait; it is the explicit focus of Acceptance and Commitment Therapy and related mindfulness- and acceptance-based interventions, which have been shown to reduce anxiety across a wide range of medical and psychological conditions. If family environments build flexibility, and flexibility dampens anxiety, then strengthening both families and flexibility skills could form a two-pronged prevention strategy.

The authors are careful to frame their conclusions appropriately. The data are correlational, collected at a single point in time, so the findings tentatively show, rather than prove, that enhancing family functioning and psychological flexibility is associated with reductions in anxiety. Causality could, in principle, run in either direction: anxious individuals may perceive their families as functioning more poorly, or low flexibility may color both family relationships and anxiety reports. Still, the convergence of the two samples, the grounding in established theory, and the consistency with prior international findings give the results credibility. The researchers suggest their conclusions may extend to countries with cultural contexts similar to Lebanon, where family remains the primary social institution and where humanitarian or economic crises amplify psychological risk.

For a country confronting what some Lebanese researchers have called tomorrow’s silent epidemic, the study offers a quietly hopeful message. The family, often described as both a refuge and a source of strain, appears to be more than a backdrop to individual mental health; it may be an active ingredient in it. And the mechanism linking the two, psychological flexibility, is something that can be measured, taught, and practiced. As Lebanon’s crises continue, the research points toward interventions that work with, rather than around, the family system, cultivating households in which difficult feelings can be acknowledged and valued actions pursued. In a field often dominated by individual-level risk factors, this study is a reminder that the architecture of mental health may begin at the dinner table, and that the skills learned there can echo through a lifetime of coping with uncertainty.

Subject of Research: The mediating role of psychological flexibility in the relationship between family functioning and anxiety in Lebanon

Article Title: The mediating role of psychological flexibility in the relation between family functioning and anxiety in Lebanon

Article References: Bachir, M. M., Ayoub, M., Hout, H., Agopian, V., & Bosqui, T. (2026). The mediating role of psychological flexibility in the relation between family functioning and anxiety in Lebanon. Current Psychology, 45(17), Article 1454. https://doi.org/10.1007/s12144-026-09995-6

Image Credits: AI Generated

DOI: 10.1007/s12144-026-09995-6

Keywords: anxiety, family functioning, psychological flexibility, Lebanon, Family Systems Theory, Acceptance and Commitment Therapy, mediation analysis, attachment theory, mental health, collectivist culture, Current Psychology, humanitarian crisis