Post-Traumatic Growth and Psychological Inflexibility in High School Students Affected by the Kahramanmaraş Earthquake: The Mediating Role of Intolerance of Uncertainty

Post-Traumatic Growth and Psychological Inflexibility in High School Students Affected by the Kahramanmaraş Earthquake: The Mediating Role of Intolerance of Uncertainty | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Post-Traumatic Growth and Psychological Inflexibility in High School Students Affected by the Kahramanmaraş Earthquake: The Mediating Role of Intolerance of Uncertainty Melike Sarıkoç, Erol Uğur This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6735579/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 15 Oct, 2025 Read the published version in Scientific Reports → Version 1 posted 12 You are reading this latest preprint version Abstract In this study examines the mediating role of intolerance of uncertainty in the relationship between post-traumatic growth and psychological inflexibility among high school students who experienced the Kahramanmaraş earthquake on February 6, 2023. The study group consists of 399 participants, including 225 females and 174 males. Data were collected using the Post-Traumatic Growth Inventory, the Intolerance of Uncertainty Scale, and the Acceptance and Action Questionnaire-II. Pearson Correlation Analysis was used to analyze the data in line with the research questions. Additionally, a mediation model was employed to analyze the mediating role of intolerance of uncertainty in the relationship between post-traumatic growth and psychological inflexibility. The tested mediation model revealed that intolerance of uncertainty has a partial mediating role in this relationship. Biological sciences/Psychology Biological sciences/Psychology/Human behaviour Post-Traumatic Growth Intolerance of Uncertainty Kahramanmaraş Earthquake Psychological Inflexibility Figures Figure 1 Introduction Individuals encounter both positive and negative situations throughout their lives that shape their experiences. Natural disasters such as earthquakes, floods and storms can pose threats to individuals' mental health as well as their physical health It can lead to traumatic experiences that endanger individuals' psychological balance and general integrity of life. As a result of a traumatic experience, individuals' assumptions about life may be disrupted (Biram et al., 2024 ; Reser, 2004 ). Individuals exposed to earthquakes often experience psychological trauma, significantly impairing their quality of life (Özkan & Kutun, 2021 ). People of all ages, particularly children and adolescents, are adversely affected by earthquakes (Sharma & Kar, 2019 ). Common traumatic responses observed in earthquake survivors include shock, persistent fear and anxiety, difficulty concentrating, sleep disturbances, grief, anger, panic, and hopelessness (Brewin et al., 2025 ; Erdur-Baker, 2014 ). Among children, emotional and behavioral reactions include reluctance to separate from their parents, fear of death, frequent questioning about earthquakes, unwillingness to return home, irritability, difficulty controlling anger, sleep disturbances, and loss of appetite (Darga, 2023 ). However, not all people exposed to traumatic events exhibit the same stress responses. Most people evidence varying levels of adjustment when exposed to traumatic events. The positive personal changes elicited by trauma-related stressors, a phenomenon known as post-traumatic growth (PTG) (Landi et al., 2022 ). PTG refers to the experience of positive personal change as a result of coping with a major life crisis. PTG emerges as an outcome after traumatic events rather than a coping mechanism (Tedeschi & Calhoun, 2004 ; Türk, 2024 ). Related research shows that individuals who experience post-traumatic growth experience positive changes such as existential growth, lessons learned from illness, new opportunities, and social growth finding that they have a greater appreciation for survival, set new goals, improve their relationships, and have greater awareness of their personal development and health (Gökalp et al., 2022 ; Landi et al., 2022 ; Türk, 2024 ; Sun et al., 2021 ). Psychological inflexibility describes the inability to interact harmoniously with the present moment (Uğur et al., 2021 ). Individuals with high levels of psychological inflexibility have difficulty confronting internal experiences such as emotions, thoughts, and bodily sensations without judgment or defense, and taking actions that are consistent with personal values (Bond, Hayes, & Barnes-Holmes, 2013 ). Increasing psychological flexibility can make the way an individual responds to a traumatic event healthier when exposed to it. It is important to reduce or prevent negative psychological effects that may occur after a traumatic event. Understanding the role of psychological flexibility in trauma stress and PTG levels can help improve mental well-being (Türk, 2024 ). Intolerance of uncertainty refers to negative thoughts developed towards uncertain situations, as well as beliefs that the situation in question will have negative results and that the consequences cannot be dealt with. It has been observed that the common points that stand out in the definitions of intolerance of uncertainty are the perception of uncertainty as negative and unacceptable (Harmancı, 2023 ). Individuals with low levels of intolerance of uncertainty perceive uncertain situations as threats and have stated that they can react negatively to such situations (Nizamoğlu, 2024 ). Individuals with high levels of intolerance of uncertainty perceive uncertainty as a distressing, intensely stressful process and develop a belief that they should avoid uncertain situations (Buhr & Dugas, 2006 ), and struggle with feelings of helplessness (Miranda, Fontes, & Marroquin, 2008). Additionally, given that adolescence is a period of significant biological and psychological changes, sensitivity to traumatic experiences must be considered. Traumatic experiences encountered during adolescence may lead to developmental differences related to post-traumatic growth (Tedeschi & Calhoun, 2004 ). Accordingly, trauma-focused studies on adolescents can provide critical insights into the developmental impacts of trauma. Furthermore, research by Frazier, Conlon, and Glaser ( 2001 ) highlights adolescents' potential to develop psychological resilience, emphasizing that they may be more adept at finding new meanings in life, strengthening themselves, and adopting new perspectives in the aftermath of trauma. Similarly, given that adolescence is a critical period for identity formation, traumatic experiences can play a significant role in shaping adolescents' identity development processes. Therefore, the traumatic experiences of adolescents may serve as a key factor in their post-traumatic growth, influencing their ability to restructure their identity through changes in perspective, the establishment of new beliefs, or the formulation of personal goals (Joseph & Linley, 2006 ). A review of the literature indicates that research on post-traumatic growth among adolescents remains limited. In particular, studies investigating variables such as psychological inflexibility and intolerance of uncertainty among adolescents are scarce. In this context, the lack of research integrating these variables with earthquake-related trauma underscores the need for further studies in this field. This study aims to enhance awareness regarding effective psychosocial interventions and contributing factors in the post-traumatic growth process of individuals affected by earthquakes. Furthermore, this research has the potential to facilitate the creation of interventions that promote both individual and societal recovery following disasters. Additionally, the study aspires to provide valuable insights that can guide psychological counseling practices and clinical interventions targeting adolescent populations. The Relationship Between Psychological Inflexibility and Intolerance of Uncertainty It has been indicated in the literature that there is a significant relationship between psychological inflexibility and intolerance of uncertainty. Studies have shown that individuals with high levels of psychological inflexibility tend to exhibit lower levels of tolerance for uncertainty (Oran, 2023 ). The underlying reason for this is that individuals who do not demonstrate flexibility toward experiences are unable to tolerate potential uncertainties that may arise in the future, which consequently leads to increased stress in such situations. Accordingly, an increase in psychological inflexibility also leads to a rise in intolerance of uncertainty. Higher levels of psychological inflexibility and intolerance to uncertainty have been found to be associated with lower levels of psychological well-being (Uludağ, 2023). It has been stated that the psychological well-being of individuals with high levels of intolerance to uncertainty will be negatively affected (Erguvan, 2015). Interventions that focus on psychological flexibility and tolerance of uncertainty are especially valuable for adolescents who are in a transitional period and in the process of identity development. In addition, a study conducted by Frazier, Conlon, and Glaser ( 2001 ) examined the potential of adolescents to develop psychological flexibility and stated that they are more advantageous groups in terms of acquiring new meanings about life, becoming stronger, and developing new perspectives in the face of traumatic experiences. The Mediating Role of Intolerance of Uncertainty Intolerance of uncertainty is defined as an individual's tendency to exhibit negative emotional, cognitive, and behavioral reactions to uncertain situations. Individuals who have experienced traumatic events tend to show increased levels of intolerance of uncertainty. Consequently, the likelihood of experiencing anxiety, stress, and psychological inflexibility also increases. A review of the literature indicates that intolerance of uncertainty is positively associated with psychological inflexibility and negatively associated with post-traumatic growth (Buhr & Dugas, 2006 ; Miranda et al., 2008 ). Therefore, intolerance of uncertainty may serve as a mediating variable that influences the strength and direction of the relationship between psychological inflexibility and post-traumatic growth. Aims The present study examines the mediation role of intolerance of uncertainty in the relationship between psychological inflexibility and post-traumatic growth. The following hypotheses (H s ) were examined: H 1 : Psychological inflexibility has a positive relationship with intolerance of uncertainty H 2 : Psychological inflexibility has a positive relationship with post-traumatic growth H 3 : Intolerance of uncertainty has a mediating role in the relationship between psychological inflexibility and post-traumatic growth. Method Research Design In this study, the relational research model was utilized. The relational research model is employed to determine whether a relationship exists between two or more variables or to assess the level of such a relationship (Karasar, 2017 ). Based on this approach, the present study investigates the levels of post-traumatic growth among high school students who experienced the 7.8 and 7.5 magnitude earthquakes that struck Kahramanmaraş on February 6, 2023. Specifically, the study examines post-traumatic growth in relation to intolerance of uncertainty, psychological inflexibility, gender, and the experience of losing a close relative in the earthquake. Participants The study sample consists of a total of 399 individuals, with ages ranging from 14 to 18. 225 (56.4%) of the participants were female and 174 (43.6%) were male. The number of individuals who lost a close relative in the earthquake is recorded as 146 (36.6%), while those who did not lose a close relative account for 253 (63.4%). Measures Post-Traumatic Growth Inventory (PTGI) The Post-Traumatic Growth Inventory (PTGI) was used to measure the level of positive change and transformation in participants’ lives following their exposure to earthquake trauma. Developed by Tedeschi and Calhoun ( 1996 ), the PTGI consists of 21 items and is a Likert-type scale, scored on a 0 to 5 scale, with a total score range of 0 to 105. Higher scores indicate greater levels of post-traumatic growth. Tedeschi and Calhoun ( 1996 ) reported the internal consistency of the original scale as α = .90, with subscale internal consistency coefficients ranging from α = .67 to α = .85. The test-retest reliability coefficient was reported as .71. The Turkish adaptation of the scale was conducted by Dürü ( 2006 ), who found a Cronbach’s alpha coefficient of α = .93 for the entire scale. Construct validity was tested through factor analysis, which identified a five-factor structure as the most appropriate. In this five-factor model, 15 out of 21 items were found to load onto the same factors as in the original scale, and the model explained 67% of the total variance. Intolerance of Uncertainty Scale (IUS-12) The Intolerance of Uncertainty Scale (IUS-12) was used to assess participants’ levels of intolerance toward uncertainty. The IUS-12 was developed by Carleton, Norton, and Asmundson ( 2007 ) and adapted into Turkish by Sarıçam et al. ( 2014 ). The scale consists of 12 items, is Likert-type with five response options, and includes two subdimensions. The overall internal consistency coefficient of the scale was reported as .88, while the internal consistency coefficients for the prospective anxiety subdimension and inhibitory anxiety subdimension were .84 and .77, respectively. Sarıçam et al. ( 2014 ) found the Cronbach’s alpha reliability coefficient for the entire scale to be .84, with subscale reliability coefficients of .83 for inhibitory anxiety and .75 for prospective anxiety. Acceptance and Action Questionnaire-II (AAQ-II) The Acceptance and Action Questionnaire-II (AAQ-II) was used in this study to measure participants’ levels of psychological inflexibility. The AAQ-II was originally developed by Hayes et al. ( 2004 ) to assess individuals' psychological flexibility. The original version of the scale consisted of 16 items, where higher scores indicated lower psychological flexibility and higher psychological inflexibility. Due to its high internal consistency, the scale was revised into a 7-item version, scored on a 7-point Likert scale, and named Acceptance and Action Questionnaire-II. The test-retest reliability of the scale over a 60-day interval was reported as .81. The Turkish adaptation of the scale was conducted by Yavuz et al. ( 2016 ). The scale is unidimensional, and the Cronbach’s alpha internal consistency coefficient was calculated as .84 The Personal Information Form This form, prepared by the researcher, includes items regarding the participants' status of being in the earthquake zone during the earthquake, whether they lost a close relative in the earthquake, as well as their age and gender information. Procedure The data were collected from participants using the convenience sampling method, one of the non-probability sampling techniques. Convenience sampling is primarily employed to minimize cost, time, and labor loss (Büyüköztürk et al., 2019 ). The instruments used in the study were administered to high school students studying in the Onikişubat district of Kahramanmaraş during the 2023–2024 academic year. Prior to data collection, all necessary administrative and ethical approvals were obtained. The participants were informed in detail about the scope, purpose, and significance of the study, with particular emphasis placed on confidentiality and voluntary participation.The data were collected face-to-face from participants. The data will be stored by the researcher for five years. Additionally, the SPSS files containing the study data will be preserved both digitally and by the researcher in physical form for the same duration. Data Analysis The data were analyzed using the SPSS 29.0 statistical software package. The findings were evaluated based on a 95% confidence interval and a .05 significance level. Initially, the dataset was reviewed to assess its statistical suitability. Since the data were collected face-to-face, a missing data analysis was conducted. Subsequently, outlier detection was performed using the Mahalanobis distance method, and as a result of these analyses, 19 outliers were removed from the dataset. The correlation analysis was conducted to assess the relationship between the variables of the study. Additionally, the Levene test was performed to check the homogeneity of variances across the groups. To examine the mediating role of intolerance of uncertainty in the relationship between post-traumatic growth and psychological inflexibility, a mediation model was employed. The mediation analysis was conducted using Process Macro, a statistical tool developed by Andrew F. Hayes that enables testing of multiple sequential mediation models and conditional effects based on regression analysis (Hayes, 2017 ). Furthermore, the Bootstrap technique was applied to ensure the reliability and validity of the mediation model (Preacher & Hayes, 2008 ). Using this technique, the indirect effect of intolerance of uncertainty on post-traumatic growth was examined within the proposed mediation model. Results Descriptive Statistics The Pearson Correlation Analysis was conducted to examine the relationship between post-traumatic growth, intolerance of uncertainty, experiential avoidance, and psychological inflexibility variables in the study, and the findings are presented in Table 3. To assess the normality of the dataset, skewness and kurtosis values were examined, and the findings are presented in Table 1. Tablo 1. Descriptive statistics and test results for the normality assumption N Minimum Maximum 𝑥̅ Sd Skewness Kurtosis Post-Traumatic Growth 399 6 105 55.93 15.82 − .140 .557 Intolerance of Uncertainty 399 17 59 37.26 7.67 .129 − .265 Psychological Inflexibility 399 7 49 26.33 10.33 .189 − .724 Age 399 14 18 16 1.11 .203 − .949 As shown in Table 1, the skewness values of the variables range between − .281 and .189, while the kurtosis values vary between − .724 and .557. Given that all variables have skewness and kurtosis coefficients within the acceptable range of -1 to + 1, the dataset meets the normal distribution assumption. According to Büyüköztürk ( 2015 ), for social sciences, skewness and kurtosis values falling between − 1 and + 1 at a .05 significance level indicate an acceptable normal distribution. Therefore, the skewness and kurtosis coefficients in this study confirm the normality assumption. Correlation Analysis To examine the relationships among post-traumatic growth, intolerance of uncertainty, and psychological inflexibility, a Pearson Correlation Analysis was conducted, and the findings are presented in Table 2. Tablo 2. Correlation Analysis Results 1 2 3 4 Post-Traumatic Growth 1 Intolerance of Uncertainty − .468** 1 Psychological Inflexibility − .415** .552** 1 Age .004 .024 .001 1 𝑥̅ 55.93 37.26 26.33 16.00 SS 15.82 7.67 10.33 1.11 ** p < .001 According to the results of the Pearson Correlation Analysis, a moderate negative correlation was found between post-traumatic growth and intolerance of uncertainty (r = − .468). Another significant finding revealed a moderate negative correlation between post-traumatic growth and psychological inflexibility (r = − .415). Furthermore, a moderate positive correlation was observed between intolerance of uncertainty and psychological inflexibility (r = .552). No statistically significant relationship was found between the age variable and the other variables. Mediation Analysis The Process Macro developed by Andrew F. Hayes was utilized to analyze the mediating role of intolerance of uncertainty in the relationship between psychological inflexibility and post-traumatic growth, employing Model 4. In the regression analysis, the Bootstrap method was applied. In this context, psychological inflexibility (X) was defined as the independent variable, post-traumatic growth (Y) as the dependent variable, and intolerance of uncertainty (M) as the mediating variable. The findings of the analysis are presented in Fig. 1 and Table 3. Tablo 3. Findings on the Mediating Role of Intolerance of Uncertainty in the Relationship Between Post-Traumatic Growth and Psychological Inflexibility Predictors Intolerance of Uncertainty (M) Post-Traumatic Growth (Y) β SE t β SE t Psychological Inflexibility (X) .410 .031 13. 197 c′ =-.344 .070 -9.079 M - - - − .710 .107 -6.61 Constant 26.460 .879 30.096 91.443 3.404 26.860 R² =.305, F (1,397) = 174.168, p < .01 R² =.254, F (2,396) = 67.556, p < .01 Bootstrap Results for Indirect Effects β Boot SE BootLLCI BootULCI Indirect Effect Intolerance of Uncertainty − .291 .056 − .402 − .183 When Table 3 is examined, the results of the regression analysis demonstrating the effect of intolerance of uncertainty (M) as a mediating variable in the relationship between psychological inflexibility (X) and post-traumatic growth (Y) are observed. According to the table, psychological inflexibility positively predicted intolerance of uncertainty (β = .410; t = 13.197; p < .05). Moreover, psychological inflexibility negatively predicted post-traumatic growth (β = − .344; t = -9.079; p < .05). Additionally, intolerance of uncertainty was found to negatively predict post-traumatic growth (β = − .710; t = -6.61; p < .05). Accordingly, when the indirect effect of the mediating variable (M) within the 95% confidence interval was evaluated, the results for intolerance of uncertainty were BootLLCI intolerance of uncertainty = − .402 and BootULCI intolerance of uncertainty = − .183. Considering that the lower (BootLLCI) and upper (BootULCI) bounds of the bootstrap results fall within the 95% confidence interval and both are below zero, it can be concluded that intolerance of uncertainty has a statistically significant mediating role in the proposed model. When the fully standardized effect size of the mediation role is examined (K 2 intolerance of uncertainty = − .291), intolerance of uncertainty was found to have a partial mediating role. The schematic representation of Model 4 is presented in Fig. 1 . Discussion and Recommendations In this study, the relationships among psychological inflexibility, intolerance of uncertainty, and post-traumatic growth were examined. Significant associations were found among these variables. The first hypothesis of the study (H 1 ) posited a positive relationship between psychological inflexibility and intolerance of uncertainty. According to the findings, as individuals’ levels of psychological inflexibility increased, their intolerance of uncertainty also rose. Therefore, the first hypothesis (H 1 ) was supported. This finding is consistent with previous studies such as those by Geçgin and Sahranç ( 2017 ). Furthermore, intolerance of uncertainty has been shown to be associated with various psychological problems and difficulties in adaptation. The second hypothesis of the study (H 2 ) predicted a positive relationship between psychological inflexibility and post-traumatic growth. However, the findings did not support this hypothesis. Instead, a negative relationship was observed between psychological inflexibility and post-traumatic growth. Accordingly, as psychological inflexibility increased, individuals’ levels of post-traumatic growth decreased. This finding aligns with studies such as those by Bruno (2022) and Linley & Joseph ( 2004 ), which emphasized that post-traumatic growth is positively associated with effective coping skills, psychological resilience, sources of social support, and a positive attitude. The third hypothesis of the study (H 3 ) suggested that intolerance of uncertainty mediates the relationship between psychological inflexibility and post-traumatic growth. The findings indicated that intolerance of uncertainty had a partial mediating effect in this relationship. According to the definition by Baron and Kenny ( 1986 ), a mediator variable plays a role in explaining the effect of an independent variable on a dependent variable. In this context, intolerance of uncertainty partially explains the negative impact of psychological inflexibility on post-traumatic growth and contributes to a more nuanced understanding of this relationship. Psychological inflexibility is defined in the literature as the opposite of psychological flexibility (Harris, 2019 ), and studies supporting the negative relationship between psychological flexibility and intolerance of uncertainty (Oran, 2023 ) are consistent with the present findings. Additionally, previous research has shown that post-traumatic growth is negatively associated with factors such as neuroticism, depression, and anxiety (Linley & Joseph, 2004 ). Therefore, it is plausible that such psychopathological variables may also serve as potential mediators in the relationship between psychological inflexibility and post-traumatic growth. In light of these findings, reducing individuals’ levels of intolerance of uncertainty and psychological inflexibility is essential for promoting post-traumatic growth. Especially, mindfulness-based interventions and Acceptance and Commitment Therapy (ACT) may enhance psychological flexibility and thereby contribute to post-traumatic growth. Moreover, cognitive-behavioral therapies aimed at reducing intolerance of uncertainty and psychoeducational programs that develop emotion regulation skills may also prove effective. Future studies are recommended to examine the potential mediating roles of variables such as neuroticism, depression, and anxiety in these relationships. Declarations Ethics approval and consent to participate This article is based on the master's thesis conducted by Melike Sarıkoç at the Department of Psychological Counseling and Guidance, Institute of Educational Sciences, Duzce University. Melike Sarıkoç carried out the data collection, analysis, and drafting of the manuscript. Erol Uğur supervised the research process, provided critical revisions, and approved the final version of the manuscript. Both authors have read and approved the final manuscript. Consent for publication Ethical permission for this study was obtained from Duzce University Educational Sciences Institute (Approval No: 2024/4, Date: 25.01.2024). The study was conducted in accordance with the Declaration of Helsinki. All participants and their legal guardians provided written informed consent before participating. Competing interests Not applicable. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Clinical trial number Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Authors’ information Authors and Affiliations *Melike Sarıkoç MSc, Department of Educational Sciences, Psychological Counseling and Guidance, Duzce University, Duzce, Turkey [email protected] , ORCID: 0009-0001-2888-3031 **Erol Uğur, Assoc. Prof., Department of Psychology, Duzce University, Turkey, [email protected] , ORCID: 0000-0003-1974-2621 Corresponding author Correspondence to: Melike Sarıkoç, [email protected] Authors’ contributions This article is based on the master's thesis conducted by Melike Sarıkoç at the Department of Psychological Counseling and Guidance, Institute of Educational Sciences, Duzce University. Melike Sarıkoç carried out the data collection, analysis, and drafting of the manuscript. Erol Uğur supervised the research process, provided critical revisions, and approved the final version of the manuscript. Both authors have read and approved the final manuscript. References Baron, R. M., & Kenny, D. A. (1986). 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Cite Share Download PDF Status: Published Journal Publication published 15 Oct, 2025 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 04 Aug, 2025 Reviews received at journal 30 Jul, 2025 Reviewers agreed at journal 23 Jul, 2025 Reviews received at journal 20 Jul, 2025 Reviewers agreed at journal 20 Jul, 2025 Reviewers agreed at journal 18 Jul, 2025 Reviewers agreed at journal 18 Jul, 2025 Reviewers invited by journal 17 Jul, 2025 Editor assigned by journal 17 Jul, 2025 Editor invited by journal 03 Jun, 2025 Submission checks completed at journal 02 Jun, 2025 First submitted to journal 23 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6735579","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":488486818,"identity":"a0c3ca68-a932-42f8-9f43-9c04d757cc3c","order_by":0,"name":"Melike Sarıkoç","email":"data:image/png;base64,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","orcid":"","institution":"Duzce University","correspondingAuthor":true,"prefix":"","firstName":"Melike","middleName":"","lastName":"Sarıkoç","suffix":""},{"id":488486819,"identity":"162c351b-9476-4abe-8e14-494adb6ca56c","order_by":1,"name":"Erol Uğur","email":"","orcid":"","institution":"Duzce University","correspondingAuthor":false,"prefix":"","firstName":"Erol","middleName":"","lastName":"Uğur","suffix":""}],"badges":[],"createdAt":"2025-05-23 20:53:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6735579/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6735579/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-19935-2","type":"published","date":"2025-10-16T00:00:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":87381470,"identity":"6c9e2899-e5ba-44a7-8ab5-cc46470c24f1","added_by":"auto","created_at":"2025-07-23 08:38:07","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":40534,"visible":true,"origin":"","legend":"\u003cp\u003eThe Mediating Role of Intolerance of Uncertainty in the Relationship Between Post-Traumatic Growth and Psychological Inflexibility (Mediation Model 4)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6735579/v1/e2f56d4ce5e156f0d703dcff.png"},{"id":93949499,"identity":"18196103-0ad4-44db-a529-009b4fc2098c","added_by":"auto","created_at":"2025-10-20 14:46:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":831296,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6735579/v1/907dd712-a5cb-4f05-8ce2-4269ba1b36af.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Post-Traumatic Growth and Psychological Inflexibility in High School Students Affected by the Kahramanmaraş Earthquake: The Mediating Role of Intolerance of Uncertainty","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIndividuals encounter both positive and negative situations throughout their lives that shape their experiences. Natural disasters such as earthquakes, floods and storms can pose threats to individuals' mental health as well as their physical health It can lead to traumatic experiences that endanger individuals' psychological balance and general integrity of life. As a result of a traumatic experience, individuals' assumptions about life may be disrupted (Biram et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Reser, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). Individuals exposed to earthquakes often experience psychological trauma, significantly impairing their quality of life (\u0026Ouml;zkan \u0026amp; Kutun, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). People of all ages, particularly children and adolescents, are adversely affected by earthquakes (Sharma \u0026amp; Kar, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eCommon traumatic responses observed in earthquake survivors include shock, persistent fear and anxiety, difficulty concentrating, sleep disturbances, grief, anger, panic, and hopelessness (Brewin et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Erdur-Baker, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Among children, emotional and behavioral reactions include reluctance to separate from their parents, fear of death, frequent questioning about earthquakes, unwillingness to return home, irritability, difficulty controlling anger, sleep disturbances, and loss of appetite (Darga, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHowever, not all people exposed to traumatic events exhibit the same stress responses. Most people evidence varying levels of adjustment when exposed to traumatic events. The positive personal changes elicited by trauma-related stressors, a phenomenon known as post-traumatic growth (PTG) (Landi et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). PTG refers to the experience of positive personal change as a result of coping with a major life crisis. PTG emerges as an outcome after traumatic events rather than a coping mechanism (Tedeschi \u0026amp; Calhoun, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2004\u003c/span\u003e; T\u0026uuml;rk, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Related research shows that individuals who experience post-traumatic growth experience positive changes such as existential growth, lessons learned from illness, new opportunities, and social growth finding that they have a greater appreciation for survival, set new goals, improve their relationships, and have greater awareness of their personal development and health (G\u0026ouml;kalp et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Landi et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; T\u0026uuml;rk, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Sun et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePsychological inflexibility describes the inability to interact harmoniously with the present moment (Uğur et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Individuals with high levels of psychological inflexibility have difficulty confronting internal experiences such as emotions, thoughts, and bodily sensations without judgment or defense, and taking actions that are consistent with personal values (Bond, Hayes, \u0026amp; Barnes-Holmes, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Increasing psychological flexibility can make the way an individual responds to a traumatic event healthier when exposed to it. It is important to reduce or prevent negative psychological effects that may occur after a traumatic event. Understanding the role of psychological flexibility in trauma stress and PTG levels can help improve mental well-being (T\u0026uuml;rk, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIntolerance of uncertainty refers to negative thoughts developed towards uncertain situations, as well as beliefs that the situation in question will have negative results and that the consequences cannot be dealt with. It has been observed that the common points that stand out in the definitions of intolerance of uncertainty are the perception of uncertainty as negative and unacceptable (Harmancı, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Individuals with low levels of intolerance of uncertainty perceive uncertain situations as threats and have stated that they can react negatively to such situations (Nizamoğlu, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Individuals with high levels of intolerance of uncertainty perceive uncertainty as a distressing, intensely stressful process and develop a belief that they should avoid uncertain situations (Buhr \u0026amp; Dugas, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2006\u003c/span\u003e), and struggle with feelings of helplessness (Miranda, Fontes, \u0026amp; Marroquin, 2008).\u003c/p\u003e\u003cp\u003eAdditionally, given that adolescence is a period of significant biological and psychological changes, sensitivity to traumatic experiences must be considered. Traumatic experiences encountered during adolescence may lead to developmental differences related to post-traumatic growth (Tedeschi \u0026amp; Calhoun, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). Accordingly, trauma-focused studies on adolescents can provide critical insights into the developmental impacts of trauma. Furthermore, research by Frazier, Conlon, and Glaser (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2001\u003c/span\u003e) highlights adolescents' potential to develop psychological resilience, emphasizing that they may be more adept at finding new meanings in life, strengthening themselves, and adopting new perspectives in the aftermath of trauma. Similarly, given that adolescence is a critical period for identity formation, traumatic experiences can play a significant role in shaping adolescents' identity development processes. Therefore, the traumatic experiences of adolescents may serve as a key factor in their post-traumatic growth, influencing their ability to restructure their identity through changes in perspective, the establishment of new beliefs, or the formulation of personal goals (Joseph \u0026amp; Linley, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2006\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eA review of the literature indicates that research on post-traumatic growth among adolescents remains limited. In particular, studies investigating variables such as psychological inflexibility and intolerance of uncertainty among adolescents are scarce. In this context, the lack of research integrating these variables with earthquake-related trauma underscores the need for further studies in this field. This study aims to enhance awareness regarding effective psychosocial interventions and contributing factors in the post-traumatic growth process of individuals affected by earthquakes. Furthermore, this research has the potential to facilitate the creation of interventions that promote both individual and societal recovery following disasters. Additionally, the study aspires to provide valuable insights that can guide psychological counseling practices and clinical interventions targeting adolescent populations.\u003c/p\u003e\n\u003ch3\u003eThe Relationship Between Psychological Inflexibility and Intolerance of Uncertainty\u003c/h3\u003e\n\u003cp\u003eIt has been indicated in the literature that there is a significant relationship between psychological inflexibility and intolerance of uncertainty. Studies have shown that individuals with high levels of psychological inflexibility tend to exhibit lower levels of tolerance for uncertainty (Oran, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). The underlying reason for this is that individuals who do not demonstrate flexibility toward experiences are unable to tolerate potential uncertainties that may arise in the future, which consequently leads to increased stress in such situations. Accordingly, an increase in psychological inflexibility also leads to a rise in intolerance of uncertainty.\u003c/p\u003e\u003cp\u003eHigher levels of psychological inflexibility and intolerance to uncertainty have been found to be associated with lower levels of psychological well-being (Uludağ, 2023). It has been stated that the psychological well-being of individuals with high levels of intolerance to uncertainty will be negatively affected (Erguvan, 2015). Interventions that focus on psychological flexibility and tolerance of uncertainty are especially valuable for adolescents who are in a transitional period and in the process of identity development. In addition, a study conducted by Frazier, Conlon, and Glaser (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2001\u003c/span\u003e) examined the potential of adolescents to develop psychological flexibility and stated that they are more advantageous groups in terms of acquiring new meanings about life, becoming stronger, and developing new perspectives in the face of traumatic experiences.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eThe Mediating Role of Intolerance of Uncertainty\u003c/h2\u003e\u003cp\u003eIntolerance of uncertainty is defined as an individual's tendency to exhibit negative emotional, cognitive, and behavioral reactions to uncertain situations. Individuals who have experienced traumatic events tend to show increased levels of intolerance of uncertainty. Consequently, the likelihood of experiencing anxiety, stress, and psychological inflexibility also increases. A review of the literature indicates that intolerance of uncertainty is positively associated with psychological inflexibility and negatively associated with post-traumatic growth (Buhr \u0026amp; Dugas, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Miranda et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Therefore, intolerance of uncertainty may serve as a mediating variable that influences the strength and direction of the relationship between psychological inflexibility and post-traumatic growth.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eAims\u003c/h3\u003e\n\u003cp\u003eThe present study examines the mediation role of intolerance of uncertainty in the relationship between psychological inflexibility and post-traumatic growth. The following hypotheses (H\u003csub\u003es\u003c/sub\u003e) were examined:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eH\u003csub\u003e1\u003c/sub\u003e: Psychological inflexibility has a positive relationship with intolerance of uncertainty\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eH\u003csub\u003e2\u003c/sub\u003e: Psychological inflexibility has a positive relationship with post-traumatic growth\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eH\u003csub\u003e3\u003c/sub\u003e: Intolerance of uncertainty has a mediating role in the relationship between psychological inflexibility and post-traumatic growth.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eResearch Design\u003c/h2\u003e\u003cp\u003eIn this study, the relational research model was utilized. The relational research model is employed to determine whether a relationship exists between two or more variables or to assess the level of such a relationship (Karasar, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Based on this approach, the present study investigates the levels of post-traumatic growth among high school students who experienced the 7.8 and 7.5 magnitude earthquakes that struck Kahramanmaraş on February 6, 2023. Specifically, the study examines post-traumatic growth in relation to intolerance of uncertainty, psychological inflexibility, gender, and the experience of losing a close relative in the earthquake.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eThe study sample consists of a total of 399 individuals, with ages ranging from 14 to 18. 225 (56.4%) of the participants were female and 174 (43.6%) were male. The number of individuals who lost a close relative in the earthquake is recorded as 146 (36.6%), while those who did not lose a close relative account for 253 (63.4%).\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eMeasures\u003c/h2\u003e\u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\u003ch2\u003ePost-Traumatic Growth Inventory (PTGI)\u003c/h2\u003e\u003cp\u003eThe Post-Traumatic Growth Inventory (PTGI) was used to measure the level of positive change and transformation in participants\u0026rsquo; lives following their exposure to earthquake trauma. Developed by Tedeschi and Calhoun (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e1996\u003c/span\u003e), the PTGI consists of 21 items and is a Likert-type scale, scored on a 0 to 5 scale, with a total score range of 0 to 105. Higher scores indicate greater levels of post-traumatic growth. Tedeschi and Calhoun (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e1996\u003c/span\u003e) reported the internal consistency of the original scale as α\u0026thinsp;=\u0026thinsp;.90, with subscale internal consistency coefficients ranging from α\u0026thinsp;=\u0026thinsp;.67 to α\u0026thinsp;=\u0026thinsp;.85. The test-retest reliability coefficient was reported as .71. The Turkish adaptation of the scale was conducted by D\u0026uuml;r\u0026uuml; (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2006\u003c/span\u003e), who found a Cronbach\u0026rsquo;s alpha coefficient of α\u0026thinsp;=\u0026thinsp;.93 for the entire scale. Construct validity was tested through factor analysis, which identified a five-factor structure as the most appropriate. In this five-factor model, 15 out of 21 items were found to load onto the same factors as in the original scale, and the model explained 67% of the total variance.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\n\u003ch3\u003eIntolerance of Uncertainty Scale (IUS-12)\u003c/h3\u003e\n\u003cp\u003eThe Intolerance of Uncertainty Scale (IUS-12) was used to assess participants\u0026rsquo; levels of intolerance toward uncertainty. The IUS-12 was developed by Carleton, Norton, and Asmundson (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2007\u003c/span\u003e) and adapted into Turkish by Sarı\u0026ccedil;am et al. (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). The scale consists of 12 items, is Likert-type with five response options, and includes two subdimensions. The overall internal consistency coefficient of the scale was reported as .88, while the internal consistency coefficients for the prospective anxiety subdimension and inhibitory anxiety subdimension were .84 and .77, respectively. Sarı\u0026ccedil;am et al. (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) found the Cronbach\u0026rsquo;s alpha reliability coefficient for the entire scale to be .84, with subscale reliability coefficients of .83 for inhibitory anxiety and .75 for prospective anxiety.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eAcceptance and Action Questionnaire-II (AAQ-II)\u003c/h2\u003e\u003cp\u003eThe Acceptance and Action Questionnaire-II (AAQ-II) was used in this study to measure participants\u0026rsquo; levels of psychological inflexibility. The AAQ-II was originally developed by Hayes et al. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2004\u003c/span\u003e) to assess individuals' psychological flexibility. The original version of the scale consisted of 16 items, where higher scores indicated lower psychological flexibility and higher psychological inflexibility. Due to its high internal consistency, the scale was revised into a 7-item version, scored on a 7-point Likert scale, and named Acceptance and Action Questionnaire-II. The test-retest reliability of the scale over a 60-day interval was reported as .81. The Turkish adaptation of the scale was conducted by Yavuz et al. (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). The scale is unidimensional, and the Cronbach\u0026rsquo;s alpha internal consistency coefficient was calculated as .84\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eThe Personal Information Form\u003c/h2\u003e\u003cp\u003eThis form, prepared by the researcher, includes items regarding the participants' status of being in the earthquake zone during the earthquake, whether they lost a close relative in the earthquake, as well as their age and gender information.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eProcedure\u003c/h2\u003e\u003cp\u003eThe data were collected from participants using the convenience sampling method, one of the non-probability sampling techniques. Convenience sampling is primarily employed to minimize cost, time, and labor loss (B\u0026uuml;y\u0026uuml;k\u0026ouml;zt\u0026uuml;rk et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). The instruments used in the study were administered to high school students studying in the Onikişubat district of Kahramanmaraş during the 2023\u0026ndash;2024 academic year.\u003c/p\u003e\u003cp\u003ePrior to data collection, all necessary administrative and ethical approvals were obtained. The participants were informed in detail about the scope, purpose, and significance of the study, with particular emphasis placed on confidentiality and voluntary participation.The data were collected face-to-face from participants.\u003c/p\u003e\u003cp\u003eThe data will be stored by the researcher for five years. Additionally, the SPSS files containing the study data will be preserved both digitally and by the researcher in physical form for the same duration.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eThe data were analyzed using the SPSS 29.0 statistical software package. The findings were evaluated based on a 95% confidence interval and a .05 significance level.\u003c/p\u003e\u003cp\u003eInitially, the dataset was reviewed to assess its statistical suitability. Since the data were collected face-to-face, a missing data analysis was conducted. Subsequently, outlier detection was performed using the Mahalanobis distance method, and as a result of these analyses, 19 outliers were removed from the dataset. The correlation analysis was conducted to assess the relationship between the variables of the study. Additionally, the Levene test was performed to check the homogeneity of variances across the groups.\u003c/p\u003e\u003cp\u003eTo examine the mediating role of intolerance of uncertainty in the relationship between post-traumatic growth and psychological inflexibility, a mediation model was employed. The mediation analysis was conducted using Process Macro, a statistical tool developed by Andrew F. Hayes that enables testing of multiple sequential mediation models and conditional effects based on regression analysis (Hayes, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Furthermore, the Bootstrap technique was applied to ensure the reliability and validity of the mediation model (Preacher \u0026amp; Hayes, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Using this technique, the indirect effect of intolerance of uncertainty on post-traumatic growth was examined within the proposed mediation model.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eDescriptive Statistics\u003c/h2\u003e\u003cp\u003eThe Pearson Correlation Analysis was conducted to examine the relationship between post-traumatic growth, intolerance of uncertainty, experiential avoidance, and psychological inflexibility variables in the study, and the findings are presented in Table\u0026nbsp;3.\u003c/p\u003e\u003cp\u003eTo assess the normality of the dataset, skewness and kurtosis values were examined, and the findings are presented in Table\u0026nbsp;1.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTablo 1.\u003c/b\u003e Descriptive statistics and test results for the normality assumption\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"8\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMinimum\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMaximum\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e𝑥̅\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSd\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSkewness\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eKurtosis\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePost-Traumatic Growth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e399\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e105\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e55.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e15.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e− .140\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.557\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntolerance of Uncertainty\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e399\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e37.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e7.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.129\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e− .265\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychological Inflexibility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e399\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e10.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.189\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e− .724\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e399\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.203\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e− .949\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAs shown in Table\u0026nbsp;1, the skewness values of the variables range between − .281 and .189, while the kurtosis values vary between − .724 and .557. Given that all variables have skewness and kurtosis coefficients within the acceptable range of -1 to + 1, the dataset meets the normal distribution assumption. According to Büyüköztürk (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), for social sciences, skewness and kurtosis values falling between − 1 and + 1 at a .05 significance level indicate an acceptable normal distribution. Therefore, the skewness and kurtosis coefficients in this study confirm the normality assumption.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eCorrelation Analysis\u003c/h2\u003e\u003cp\u003eTo examine the relationships among post-traumatic growth, intolerance of uncertainty, and psychological inflexibility, a Pearson Correlation Analysis was conducted, and the findings are presented in Table\u0026nbsp;2.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTablo 2.\u003c/b\u003e Correlation Analysis Results\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e\u003ccolgroup cols=\"8\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePost-Traumatic Growth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntolerance of Uncertainty\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e− .468**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychological Inflexibility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e− .415**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u003cp\u003e.552**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e.004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u003cp\u003e.024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e𝑥̅\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e55.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u003cp\u003e37.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e26.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e16.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e15.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u003cp\u003e7.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e10.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" colname=\"c1\"\u003e\u003cp\u003e**\u003cem\u003ep\u003c/em\u003e \u0026lt; .001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAccording to the results of the Pearson Correlation Analysis, a moderate negative correlation was found between post-traumatic growth and intolerance of uncertainty (r = − .468). Another significant finding revealed a moderate negative correlation between post-traumatic growth and psychological inflexibility (r = − .415). Furthermore, a moderate positive correlation was observed between intolerance of uncertainty and psychological inflexibility (r = .552). No statistically significant relationship was found between the age variable and the other variables.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eMediation Analysis\u003c/h2\u003e\u003cp\u003eThe Process Macro developed by Andrew F. Hayes was utilized to analyze the mediating role of intolerance of uncertainty in the relationship between psychological inflexibility and post-traumatic growth, employing Model 4. In the regression analysis, the Bootstrap method was applied. In this context, psychological inflexibility (X) was defined as the independent variable, post-traumatic growth (Y) as the dependent variable, and intolerance of uncertainty (M) as the mediating variable. The findings of the analysis are presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Table\u0026nbsp;3.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTablo 3.\u003c/b\u003e Findings on the Mediating Role of Intolerance of Uncertainty in the Relationship Between Post-Traumatic Growth and Psychological Inflexibility\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e\u003ccolgroup cols=\"8\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePredictors\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eIntolerance of Uncertainty\u003c/p\u003e\u003cp\u003e(M)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003ePost-Traumatic Growth\u003c/p\u003e\u003cp\u003e(Y)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychological Inflexibility (X)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e.410\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.031\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13. 197\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003ec′\u003c/em\u003e=-.344\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.070\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-9.079\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e− .710\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-6.61\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConstant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e26.460\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.879\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e30.096\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e91.443\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.404\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e26.860\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003e\u003cem\u003eR²\u003c/em\u003e=.305, \u003cem\u003eF\u003c/em\u003e(1,397) = 174.168, \u003cem\u003ep\u003c/em\u003e \u0026lt; .01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e\u003cem\u003eR²\u003c/em\u003e=.254, \u003cem\u003eF\u003c/em\u003e(2,396) = 67.556, \u003cem\u003ep\u003c/em\u003e \u0026lt; .01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eBootstrap Results for Indirect Effects\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBoot SE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eBootLLCI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eBootULCI\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eIndirect Effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eIntolerance of Uncertainty\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e− .291\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.056\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e− .402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e− .183\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eWhen Table\u0026nbsp;3 is examined, the results of the regression analysis demonstrating the effect of intolerance of uncertainty (M) as a mediating variable in the relationship between psychological inflexibility (X) and post-traumatic growth (Y) are observed. According to the table, psychological inflexibility positively predicted intolerance of uncertainty (β = .410; t = 13.197; p \u0026lt; .05). Moreover, psychological inflexibility negatively predicted post-traumatic growth (β = − .344; t = -9.079; p \u0026lt; .05). Additionally, intolerance of uncertainty was found to negatively predict post-traumatic growth (β = − .710; t = -6.61; p \u0026lt; .05).\u003c/p\u003e\u003cp\u003eAccordingly, when the indirect effect of the mediating variable (M) within the 95% confidence interval was evaluated, the results for intolerance of uncertainty were BootLLCI intolerance of uncertainty = − .402 and BootULCI intolerance of uncertainty = − .183. Considering that the lower (BootLLCI) and upper (BootULCI) bounds of the bootstrap results fall within the 95% confidence interval and both are below zero, it can be concluded that intolerance of uncertainty has a statistically significant mediating role in the proposed model. When the fully standardized effect size of the mediation role is examined (K\u003csup\u003e2\u003c/sup\u003e intolerance of uncertainty = − .291), intolerance of uncertainty was found to have a partial mediating role. The schematic representation of Model 4 is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion and Recommendations","content":"\u003cp\u003eIn this study, the relationships among psychological inflexibility, intolerance of uncertainty, and post-traumatic growth were examined. Significant associations were found among these variables. The first hypothesis of the study (H\u003csub\u003e1\u003c/sub\u003e) posited a positive relationship between psychological inflexibility and intolerance of uncertainty. According to the findings, as individuals’ levels of psychological inflexibility increased, their intolerance of uncertainty also rose. Therefore, the first hypothesis (H\u003csub\u003e1\u003c/sub\u003e) was supported. This finding is consistent with previous studies such as those by Geçgin and Sahranç (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Furthermore, intolerance of uncertainty has been shown to be associated with various psychological problems and difficulties in adaptation.\u003c/p\u003e\u003cp\u003eThe second hypothesis of the study (H\u003csub\u003e2\u003c/sub\u003e) predicted a positive relationship between psychological inflexibility and post-traumatic growth. However, the findings did not support this hypothesis. Instead, a negative relationship was observed between psychological inflexibility and post-traumatic growth. Accordingly, as psychological inflexibility increased, individuals’ levels of post-traumatic growth decreased. This finding aligns with studies such as those by Bruno (2022) and Linley \u0026amp; Joseph (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2004\u003c/span\u003e), which emphasized that post-traumatic growth is positively associated with effective coping skills, psychological resilience, sources of social support, and a positive attitude.\u003c/p\u003e\u003cp\u003eThe third hypothesis of the study (H\u003csub\u003e3\u003c/sub\u003e) suggested that intolerance of uncertainty mediates the relationship between psychological inflexibility and post-traumatic growth. The findings indicated that intolerance of uncertainty had a partial mediating effect in this relationship. According to the definition by Baron and Kenny (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1986\u003c/span\u003e), a mediator variable plays a role in explaining the effect of an independent variable on a dependent variable. In this context, intolerance of uncertainty partially explains the negative impact of psychological inflexibility on post-traumatic growth and contributes to a more nuanced understanding of this relationship.\u003c/p\u003e\u003cp\u003ePsychological inflexibility is defined in the literature as the opposite of psychological flexibility (Harris, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), and studies supporting the negative relationship between psychological flexibility and intolerance of uncertainty (Oran, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) are consistent with the present findings. Additionally, previous research has shown that post-traumatic growth is negatively associated with factors such as neuroticism, depression, and anxiety (Linley \u0026amp; Joseph, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). Therefore, it is plausible that such psychopathological variables may also serve as potential mediators in the relationship between psychological inflexibility and post-traumatic growth.\u003c/p\u003e\u003cp\u003eIn light of these findings, reducing individuals’ levels of intolerance of uncertainty and psychological inflexibility is essential for promoting post-traumatic growth. Especially, mindfulness-based interventions and Acceptance and Commitment Therapy (ACT) may enhance psychological flexibility and thereby contribute to post-traumatic growth. Moreover, cognitive-behavioral therapies aimed at reducing intolerance of uncertainty and psychoeducational programs that develop emotion regulation skills may also prove effective. Future studies are recommended to examine the potential mediating roles of variables such as neuroticism, depression, and anxiety in these relationships.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis article is based on the master\u0026apos;s thesis conducted by Melike Sarıko\u0026ccedil; at the Department of Psychological Counseling and Guidance, Institute of Educational Sciences, Duzce University. Melike Sarıko\u0026ccedil; carried out the data collection, analysis, and drafting of the manuscript. Erol Uğur supervised the research process, provided critical revisions, and approved the final version of the manuscript. Both authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical permission for this study was obtained from Duzce University Educational Sciences Institute (Approval No: 2024/4, Date: 25.01.2024). The study was conducted in accordance with the Declaration of Helsinki. All participants and their legal guardians provided written informed consent before participating.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors and Affiliations\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e*Melike Sarıko\u0026ccedil; MSc, Department of Educational Sciences, Psychological Counseling and Guidance, Duzce University, Duzce, Turkey\u0026nbsp;\u003c/p\u003e\n\u003cp\[email protected], ORCID: \u0026nbsp;0009-0001-2888-3031\u003c/p\u003e\n\u003cp\u003e**Erol Uğur, Assoc. Prof., Department of Psychology, Duzce University, Turkey, [email protected], ORCID: 0000-0003-1974-2621\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCorresponding author\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence to: Melike Sarıko\u0026ccedil;, [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis article is based on the master\u0026apos;s thesis conducted by Melike Sarıko\u0026ccedil; at the Department of Psychological Counseling and Guidance, Institute of Educational Sciences, Duzce University. Melike Sarıko\u0026ccedil; carried out the data collection, analysis, and drafting of the manuscript. Erol Uğur supervised the research process, provided critical revisions, and approved the final version of the manuscript. Both authors have read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBaron, R. 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Turkish version of the Acceptance and Action Questionnaire-II (AAQ-II): A reliability and validity analysis in clinical and non-clinical samples. \u003cem\u003eBulletin of Clinical Psychopharmacology, 26\u003c/em\u003e(4), 329\u0026ndash;444. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Post-Traumatic Growth, Intolerance of Uncertainty, Kahramanmaraş Earthquake, Psychological Inflexibility","lastPublishedDoi":"10.21203/rs.3.rs-6735579/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6735579/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIn this study examines the mediating role of intolerance of uncertainty in the relationship between post-traumatic growth and psychological inflexibility among high school students who experienced the Kahramanmaraş earthquake on February 6, 2023. The study group consists of 399 participants, including 225 females and 174 males. Data were collected using the Post-Traumatic Growth Inventory, the Intolerance of Uncertainty Scale, and the Acceptance and Action Questionnaire-II. Pearson Correlation Analysis was used to analyze the data in line with the research questions. Additionally, a mediation model was employed to analyze the mediating role of intolerance of uncertainty in the relationship between post-traumatic growth and psychological inflexibility. 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