Decentering, rumination, cognitive defusion, and psychological flexibility in people with chronic pain
Abstract
The psychological flexibility model appears to be useful for organizing research into chronic pain. One component of the model is called "cognitive defusion." A process referred to as decentering, measured by the Experiences Questionnaire (EQ), appears similar to cognitive defusion. The purpose of this study is to extend previous investigations of the EQ, to evaluate its factor structure, and examine both indirect and direct roles for decentering in relation to key clinical outcomes. 352 people seeking pain treatment participated in this study. All completed the EQ and standard measures of daily functioning, including emotional functioning. Confirmatory factor analysis (CFA) and structural equation models (SEMs) were utilized to examine the factor structure of the EQ and evaluate the role of decentering in relation to outcomes. In CFA the overall fit of the EQ items to a two-factor model, specifying decentering and rumination factors, was poor. Separate models of decentering (a higher order model consisting of two sub-factors; cognitive defusion and self-a-context) and rumination, including reduced item sets, yielded good statistical fits. Analyses of these factors showed expected relations with emotional and social functioning but not with physical functioning. SEM revealed that both decentering and rumination have direct effects on functioning and indirect effects through measures of acceptance. A shortened 12-item measure of decentering warrants further study. Combined models of acceptance and the type of cognitive-defusion-related process reflected in decentering may improve our understanding social and emotional functioning in relation to chronic pain.
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A reanalysis of the EQ in adults experiencing pain-related distress revealed two factors: Self-as-Context and Cognitive Fusion.
“A reanalysis of the EQ in adult experiencing pain-related distress revealed two factors (47.3 ± 11.69 years)34. These were labeled Self-as-Context and Cognitive Fusion (cognitive fusion is simply the inverse of cognitive defusion).”
From Decentering as a core component in the psychological treatment and prevention of youth anxiety and depression: a narrative review and insight report (2021) · cites this paper as [34]
Cross-sectional studies indicate that the positive association between psychological stressors and distress is lessened as decentering-related abilities increase.
“Second, cross-sectional studies indicate that the positive association between psychological stressors and distress is lessened as decentering-related abilities increase.”
From Decentering as a core component in the psychological treatment and prevention of youth anxiety and depression: a narrative review and insight report (2021) · cites this paper as [34]
Significant positive association between rumination and depression, as well as negative association between cognitive fusion and decentring and depression have been observed.
“This finding also appears in line with previous research, where significant positive association between rumination and depression,62–65 as well as negative association between cognitive fusion and decentring (a process like cognitive defusion) and depression have been observed.58,62,66,67”
From Preliminary investigation of the associations between psychological flexibility, symptoms and daily functioning in people with chronic abdominal pain (2021) · cites this paper as [62]
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- Authors
- McCracken, L. M., Barker, E., & Chilcot, J.
- Affiliations
- St Thomas' Hospital (GB)
- King's College London (GB)
- Corresponding author
- McCracken, Lance M.
- Venue
- Journal of Behavioral Medicine
- Published
- 2014-05-17
- Volume
- 37
- Issue
- 6
- Pages
- 1215-1225
- ISSN
- 0160-7715 (ISSN-L)
- 1573-3521
- OpenAlex
- W2064165049
- Cited by
- 103
- References
- 51
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 8 · 2023: 13 · 2022: 8 · 2021: 13 · 2020: 12 · 2019: 5 · 2018: 9 · 2017: 6 · 2016: 12 · 2015: 6 · 2014: 1
- FWCI
- 9.84
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of Behavioral Medicine (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- chronic pain, decentering, rumination, cognitive defusion, psychological flexibility, acceptance, emotional functioning, social functioning, factor structure
- MeSH terms
- Adaptation, Psychological, Cognition, Female, Humans, Male, Middle Aged, Models, Psychological, Surveys and Questionnaires, Chronic Pain
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