Cited by 104Mindfulness and Compassion InterventionsMusculoskeletal pain and rehabilitationAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

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Decentering, rumination, cognitive defusion, and psychological flexibility in people with chronic pain

McCracken, Lance M., Barker, Estelle, Chilcot, Joseph·2014·Journal of Behavioral Medicine

DOI 10.1007/s10865-014-9570-9

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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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Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives
Hu, L., & Bentler, P. M. (1999) · Structural Equation Modeling A Multidisciplinary Journal · doi:10.1080/10705519909540118 · Cited by 108,788
The PHQ-9: Validity of a brief depression severity measure
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2001.016009606.x · Cited by 44,910
Untitled work
(1992) · PubMed · Cited by 33,716
The MOS 36-ltem Short-Form Health Survey (SF-36): I. Conceptual Framework and Item Selection
Ware, J. E., & Sherbourne, C. D. (1992) · Medical Care · doi:10.1097/00005650-199206000-00002 · Cited by 30,033
Alternative Ways of Assessing Model Fit
Browne, M. W., & Cudeck, R. (1992) · Sociological Methods & Research · doi:10.1177/0049124192021002005 · Cited by 27,200
Testing Structural Equation Models.
Mueller, C. W., Bollen, K. A., & Long, J. S. (1994) · Contemporary Sociology A Journal of Reviews · doi:10.2307/2074955 · Cited by 14,211
SF-36 health survey: Manual and interpretation guide
Ware, J. (2003) · Medical Entomology and Zoology · Cited by 11,424
Testing Structural Equation Models.
Clogg, C. C., Bollen, K. A., & Long, J. S. (1995) · Social Forces · doi:10.2307/2580595 · Cited by 8,246
The Pain Catastrophizing Scale: Development and validation.
Sullivan, M. J. L., Bishop, S. R., & Pivik, J. (1995) · Psychological Assessment · doi:10.1037//1040-3590.7.4.524 · Cited by 8,227
Acceptance and commitment therapy: model, processes and outcomes
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006) · Behaviour Research and Therapy · doi:10.1016/j.brat.2005.06.006 · Cited by 6,587 · cited 1×
“It is defined as the capacity to persist or change behavior guided by one’s goals and values, and attuned to what situations afford, in a context of interacting cognitive processes and direct experiences (Hayes et al., 2006).”
Background

Show all 51 references

Research works printed but not linked: 1

Muthén, L. K., & Muthén, B. O. (2012). Mplus version 7. Los Angeles: Muthén & Muthén.

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Background
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Background
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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.
ORCID: McCracken, Lance M.
Chilcot, Joseph
Venue: Journal of Behavioral Medicine
Publisher: Springer Science and Business Media LLC
Published: 2014-05-17
Volume: 37
Issue: 6
Pages: 1215-1225
ISSN: 0160-7715 (ISSN-L)
1573-3521
DOI: 10.1007/s10865-014-9570-9
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 › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › 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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Decentering, rumination, cognitive defusion, and psychological flexibility in people with chronic pain

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