The DOI matches its Crossref record; 48 of the 51 references it cites were found in a registry or an index.
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.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
Citations
Cites
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
(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(1999) · Cited by 5,934
Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008) · Perspectives on Psychological Science · doi:10.1111/j.1745-6924.2008.00088.x · Cited by 5,172
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R. D. (2011) · Behavior Therapy · doi:10.1016/j.beth.2011.03.007 · Cited by 3,950
Psychological flexibility as a fundamental aspect of health
Kashdan, T. B., & Rottenberg, J. (2010) · Clinical Psychology Review · doi:10.1016/j.cpr.2010.03.001 · Cited by 3,054 · cited 2×
“…significant negative relationship between decentering and general psychological avoidance, and a negative relationship between decentering and depression, in a student sample, and previous research showing that rumination is associated with psychological inflexibility (Kashdan & Rottenberg, 2010).”
BackgroundResultMediators and Mechanisms of Change in Psychotherapy Research
Kazdin, A. E. (2007) · Annual Review of Clinical Psychology · doi:10.1146/annurev.clinpsy.3.022806.091432 · Cited by 2,504 · cited 2×
“to focus more deliberately on specific treatment mechanisms based on carefully designed theoretical models (Kazdin, 2007; McCracken, 2011; McCracken & Morley, 2014; Morley & Keefe, 2007).”
BackgroundMeasuring experiential avoidance: A preliminary test of a working model
Hayes, S. C., Strosahl, K., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., Polusny, M. A., Dykstra, T. A., Batten, S. V., Bergan, J., et al. (2004) · The Psychological Record · doi:10.1007/bf03395492 · Cited by 2,140
Cochrane Database of Systematic Reviews
Lyons, R. (2006) · Progress in Neurology and Psychiatry · doi:10.1002/pnp.208 · Cited by 1,907
Psychological therapies for the management of chronic pain (excluding headache) in adults
Williams, A. C. D. C., Eccleston, C., & Morley, S. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007407.pub3 · Cited by 1,634
Acceptance of chronic pain: component analysis and a revised assessment method
McCracken, L. M., Vowles, K. E., & Eccleston, C. (2004) · Pain · doi:10.1016/j.pain.2003.10.012 · Cited by 1,101
Self-citation(1990) · Medical Entomology and Zoology · Cited by 842
The development and initial validation of the cognitive fusion questionnaire
Gillanders, D. T., Bolderston, H., Bond, F. W., Dempster, M., Flaxman, P. E., Campbell, L., Kerr, S., Tansey, L., Noel, P., Ferenbach, C., et al. (2014) · Behavior Therapy · doi:10.1016/j.beth.2013.09.001 · Cited by 837
Fresco, D. M., Moore, M. T., van Dulmen, M. H. M., Segal, Z. V., Ma, S. H., Teasdale, J. D., & Williams, J. M. G. (2007) · Behavior Therapy · doi:10.1016/j.beth.2006.08.003 · Cited by 810 · cited 4×
“It is also consistent with findings from Fresco et al. (2007) who found a significant negative relationship between decentering and general psychological avoidance, and a negative relationship between decentering and depression, in a student sample, and previous research showing that rumination is…”
BackgroundResultInfluentialLearning to live with the pain: acceptance of pain predicts adjustment in persons with chronic pain
McCracken, L. M. (1998) · Pain · doi:10.1016/s0304-3959(97)00146-2 · Cited by 685
Self-citationAcceptance and Commitment Therapy
Strosahl, K. D. (2002) · Elsevier eBooks · doi:10.1016/b0-12-343010-0/00001-5 · Cited by 647
Catastrophizing, pain, and disability in patients with soft-tissue injuries
Sullivan, M. J. L., Stanish, W., Waite, H., Sullivan, M., & Tripp, D. A. (1998) · Pain · doi:10.1016/s0304-3959(98)00097-9 · Cited by 593
McCracken, L. M., & Morley, S. (2014) · The Journal of Pain · doi:10.1016/j.jpain.2013.10.014 · Cited by 464
Self-citationFish, R. A., McGuire, B., Hogan, M., Morrison, T. G., & Stewart, I. (2010) · Pain · doi:10.1016/j.pain.2009.12.016 · Cited by 306
McCracken, L. M., Gauntlett-Gilbert, J., & Vowles, K. E. (2007) · Pain · doi:10.1016/j.pain.2006.12.013 · Cited by 290 · cited 2×
“, 2009), present moment awareness (McCracken & Thompson, 2009; McCracken et al., 2007), values (Bernini et al.”
BackgroundSelf-citationMcCracken, L. M., & Gutiérrez-Martínez, O. (2011) · Behaviour Research and Therapy · doi:10.1016/j.brat.2011.02.004 · Cited by 283
Self-citationThe role of values in a contextual cognitive-behavioral approach to chronic pain
McCracken, L. M., & Yang, S.-Y. (2006) · Pain · doi:10.1016/j.pain.2006.02.021 · Cited by 260 · cited 1×
“…2011; Reneman et al., 2010; Rodero et al., 2011; Vowles et al., 2008; Wicksell et al., 2009) and values (McCracken & Vowles, 2008; McCracken & Yang, 2006; Trompetter et al., 2013), and some less known and infrequently studied, such as committed action (McCracken, 2013) and…”
BackgroundSelf-citationVowles, K. E., McCracken, L. M., McLeod, C., & Eccleston, C. (2008) · Pain · doi:10.1016/j.pain.2008.08.012 · Cited by 226
Self-citationTrompetter, H. R., ten Klooster, P. M., Schreurs, K. M. G., Fledderus, M., Westerhof, G. J., & Bohlmeijer, E. T. (2013) · Psychological Assessment · doi:10.1037/a0033813 · Cited by 184 · cited 2×
“…Reneman et al., 2010; Rodero et al., 2011; Vowles et al., 2008; Wicksell et al., 2009) and values (McCracken & Vowles, 2008; McCracken & Yang, 2006; Trompetter et al., 2013), and some less known and infrequently studied, such as committed action (McCracken, 2013) and cognitive defusion (McCracken…”
BackgroundMcCracken, L. M. (2013) · The Journal of Pain · doi:10.1016/j.jpain.2013.02.009 · Cited by 172
Self-citationA prospective analysis of acceptance of pain and values-based action in patients with chronic pain.
McCracken, L. M., & Vowles, K. E. (2008) · Health Psychology · doi:10.1037/0278-6133.27.2.215 · Cited by 168 · cited 2×
“…2010; Rodero et al., 2011; Vowles et al., 2008; Wicksell et al., 2009), present moment awareness (McCracken & Thompson, 2009; McCracken et al., 2007), values (Bernini et al., 2010; McCracken & Vowles, 2008), committed action (McCracken, 2013), and cognitive defusion (McCracken et al., 2013a, b).”
BackgroundSelf-citationWicksell, R. K., Olsson, G. L., & Melin, L. (2009) · European Journal of Pain · doi:10.1016/j.ejpain.2008.09.003 · Cited by 135 · cited 4×
“…Bernini et al., 2010; Fish et al., 2010; McCracken, 1998; McCracken et al., 2004; Reneman et al., 2010; Rodero et al., 2011; Vowles et al., 2008; Wicksell et al., 2009), present moment awareness (McCracken & Thompson, 2009; McCracken et al., 2007), values (Bernini et al., 2010; McCracken &…”
BackgroundResultInfluentialPsychometric properties of chronic pain acceptance questionnaires: a systematic review
Reneman, M. F., Dijkstra, A., Geertzen, J. H. B., & Dijkstra, P. U. (2010) · European Journal of Pain · doi:10.1016/j.ejpain.2009.08.003 · Cited by 135
The Drexel defusion scale: a new measure of experiential distancing
Forman, E. M., Herbert, J. D., Juarascio, A. S., Yeomans, P. D., Zebell, J. A., Goetter, E. M., & Moitra, E. (2012) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2012.09.001 · Cited by 117
Acceptance and Commitment Therapy
Twohig, M. P. (2012) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2012.04.003 · Cited by 115 · cited 2×
“cific conceptualization of cognition and cognitive influence (Twohig, 2012).”
BackgroundBuenaver, L. F., Quartana, P. J., Grace, E. G., Sarlani, E., Simango, M., Edwards, R. R., Haythornthwaite, J. A., & Smith, M. T. (2012) · Pain · doi:10.1016/j.pain.2012.01.023 · Cited by 110
McCracken, L. M., Gutiérrez-Martínez, O., & Smyth, C. (2013) · Health Psychology · doi:10.1037/a0028093 · Cited by 87 · cited 4×
“…Rodero et al., 2011; Vowles et al., 2008; Wicksell et al., 2009) and values (McCracken & Vowles, 2008; McCracken & Yang, 2006; Trompetter et al., 2013), and some less known and infrequently studied, such as committed action (McCracken, 2013) and cognitive defusion (McCracken et al., 2013a, b).”
BackgroundMethodResultInfluentialSelf-citationMcCracken, L. M., DaSilva, P., Skillicorn, B., & Doherty, R. (2014) · The Clinical Journal of Pain · doi:10.1097/ajp.0000000000000047 · Cited by 75
Self-citationComponents of Mindfulness in Patients with Chronic Pain
McCracken, L. M., & Thompson, M. (2009) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-008-9099-8 · Cited by 59
Self-citationBendayan, R., Esteve, R., & Blanca, M. J. (2012) · British Journal of Health Psychology · doi:10.1111/j.2044-8287.2011.02039.x · Cited by 54
Rodero, B., Casanueva, B., Luciano, J. V., Gili, M., Serrano-Blanco, A., & García-Campayo, J. (2011) · BMC Musculoskeletal Disorders · doi:10.1186/1471-2474-12-143 · Cited by 54
Getting a handle on process and change in CBT for chronic pain
Morley, S., & Keefe, F. J. (2006) · Pain · doi:10.1016/j.pain.2006.10.025 · Cited by 37
Bernini, O., Pennato, T., Cosci, F., & Montiel, C. B. (2010) · Journal of Health Psychology · doi:10.1177/1359105310365576 · Cited by 33
Pincus, T., Anwar, S., McCracken, L. M., McGregor, A. H., Graham, L., Collinson, M., Farrin, A. J., & on behalf of the OBI Trial Management Team (2013) · Trials · doi:10.1186/1745-6215-14-172 · Cited by 15
Self-citationFad, Fashion and Forward Progress in Psychological Approaches to Chronic Pain Management
McCracken, L. M. (2011) · Pain Management · doi:10.2217/pmt.11.58 · Cited by 1
Self-citation
Research works printed but not linked: 1
- Muthén, L. K., & Muthén, B. O. (2012). Mplus version 7. Los Angeles: Muthén & Muthén.
Cited by
Sorted by citations
Reconstructing and deconstructing the self: cognitive mechanisms in meditation practice
Dahl, C. J., Lutz, A., & Davidson, R. J. (2015) · Trends in Cognitive Sciences · doi:10.1016/j.tics.2015.07.001 · Cited by 809
The structure of common emotion regulation strategies: A meta-analytic examination
Naragon-Gainey, K., McMahon, T. P., & Chacko, T. P. (2017) · Psychological Bulletin · doi:10.1037/bul0000093 · Cited by 588
Hann, K. E. J., & McCracken, L. M. (2014) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2014.10.001 · Cited by 259
Self-citationAcceptance and Commitment Therapy for Chronic Pain
(2012) · PsycEXTRA Dataset · doi:10.1037/e674542012-001 · Cited by 147
Scott, W., Hann, K. E. J., & McCracken, L. M. (2016) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-016-9328-5 · Cited by 111
“In a previous study, the CAQ showed excellent internal reliability (Chronbach’s a = 0.91), and uniquely predicted functioning and mental health outcomes even when controlling for chronic pain acceptance in a sample of people with chronic pain (McCracken et al. 2014a).”
BackgroundInfluentialSelf-citation
Metadata
- 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 › 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
