The Cognitive Fusion Questionnaire: A Preliminary Study of Psychometric Properties and Prediction of Functioning in Chronic Pain
Abstract
BACKGROUND: Acceptance and Commitment Therapy and the psychological flexibility model on which it is based are growing interests for those researching and treating chronic pain. One part of this model is a therapeutic process called cognitive defusion. Cognitive defusion is a process of experiencing a distinction between thoughts and the events or people they describe. This process is intended to reduce the dominating psychological influence of thoughts without necessarily changing the content or frequency of the thoughts. There are recently developed measures of this process but little study of it in people with chronic pain. METHODS: This study explored the reliability and validity of the Cognitive Fusion Questionnaire (CFQ) within a chronic pain population. A total of 326 adults with chronic pain completed this measure and a set of other standard clinical measures at the start of treatment in a specialty chronic pain service in the United Kingdom. RESULTS: An exploratory factor analysis revealed an interpretable 2-factor structure within the items of the CFQ. Internal consistency reliability was good (α=0.87). In the analyses of validity the CFQ significantly correlated with general psychological acceptance and pain-related acceptance as expected. In multiple regression analyses, which included relevant patient background variables, pain, and acceptance of pain, cognitive fusion contributed significantly to the explained variance in the prediction of 5 of 6 dependent variables tested. DISCUSSION: The CFQ may be a useful measure for further research and treatment development.
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The Cognitive Fusion Questionnaire has good factor structure, validity, reliability, and stability over time, and has been validated in healthy individuals and in patients.
“Earlier research has shown that the CFQ has good factor structure, validity, reliability, and stability over time [42]. The questionnaire has been validated in healthy individuals and in patients [42, 43].”
The Cognitive Fusion Questionnaire (CFQ) has good factor structure, validity, reliability, and stability over time, and has been validated in healthy and medical populations.
“Earlier research has shown that the CFQ has good factor structure, validity, reliability, and stability over time [42].”
Cognitive fusion was found correlated with depression, r = .51, and patient functioning, |r| = .16-.39, in a cross-sectional study in chronic pain.
“Cognitive fusion was found correlated with depression, r = .51, and patient functioning, |r| = .16–.39, in a cross-sectional study in chronic pain.58”
From Preliminary investigation of the associations between psychological flexibility, symptoms and daily functioning in people with chronic abdominal pain (2021) · cites this paper as [58]
Correlations between pain acceptance and mood and functioning were also observed in cross-sectional studies in people with chronic pain.
“Correlations between pain acceptance and mood and functioning were also observed in cross-sectional studies in people with chronic pain.50,58”
From Preliminary investigation of the associations between psychological flexibility, symptoms and daily functioning in people with chronic abdominal pain (2021) · cites this paper as [58]
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 [58]
Cognitive fusion assessed with the CFQ has been related to anxious and depressed symptoms in cross-sectional and longitudinal studies.
“Cognitive fusion assessed with the CFQ has also been related to anxious and depressed symptoms (McCracken et al., 2014) in cross-sectional (Écija et al., 2020; Carvalho et al., 2018; McCracken et al., 2014) and longitudinal studies (Carvalho et al., 2019).”
From Psychometric properties of the Cognitive Fusion Questionnaire in females with fibromyalgia (2023) · cites this paper as McCracken et al., 2014
In patients with fibromyalgia or chronic pain conditions, cognitive fusion has been linked to lower vitality, increased physical fatigue, and poorer perceived general health.
“In patients experiencing FM or chronic pain conditions, cognitive fusion has also been linked to lower vitality (McCracken et al., 2014), increased physical fatigue (Écija et al., 2020) and poorer perceived general health (McCracken et al., 2014).”
From Psychometric properties of the Cognitive Fusion Questionnaire in females with fibromyalgia (2023) · cites this paper as McCracken et al., 2014
Cognitive fusion was significantly related to anxious and depressive symptoms in Spanish females with fibromyalgia.
“cognitive fusion was also significantly related to anxious and depressive symptoms in females with FM.”
From Psychometric properties of the Cognitive Fusion Questionnaire in females with fibromyalgia (2023) · cites this paper as McCracken et al., 2014
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- Authors
- McCracken, L. M., DaSilva, P., Skillicorn, B., & Doherty, R.
- Affiliations
- King's College London (GB)
- Guy's and St Thomas' NHS Foundation Trust (GB)
- Corresponding author
- McCracken, Lance M.
- DaSilva, Philomena
- Doherty, Richard
- ORCID
- McCracken, Lance M.
- Venue
- The Clinical Journal of Pain
- Published
- 2014-10
- Volume
- 30
- Issue
- 10
- Pages
- 894-901
- ISSN
- 0749-8047 (ISSN-L)
- OpenAlex
- W1971644871
- Cited by
- 75
- References
- 33
- Citations by year
- 2026: 2 · 2024: 3 · 2023: 6 · 2022: 6 · 2021: 12 · 2020: 6 · 2019: 10 · 2018: 9 · 2017: 5 · 2016: 6 · 2015: 8 · 2014: 2
- FWCI
- 5.93
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Journal of Pain (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
- Cognitive Fusion Questionnaire, cognitive fusion, cognitive defusion, acceptance and commitment therapy, psychological flexibility, chronic pain, psychological acceptance, pain acceptance, psychometric validation, factor structure, reliability statistics, chronic pain patients
- MeSH terms
- Adaptation, Psychological, Adult, Aged, Attitude to Health, Factor Analysis, Statistical, Female, United Kingdom, Humans, Male, Middle Aged, Pain Measurement, Psychometrics, Surveys and Questionnaires, Statistics as Topic, Thinking, Reproducibility of Results, Young Adult, Chronic Pain, Acceptance and Commitment Therapy
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