Preliminary investigation of self-as-context in people with fibromyalgia
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Acceptance and commitment therapy (ACT), based on the Psychological Flexibility (PF) model, has been recently applied to fibromyalgia (FM), and appeared effective in improving functioning. However, evidence for some of the processes within the PF model, self-as-context (SAC) in particular, is lacking within this population. The current study validates a measure of SAC, the Self Experiences Questionnaire (SEQ), and preliminarily investigates the role of SAC in relation to functioning in FM. Participants (N = 298, 93.3% women) self-reporting a diagnosis of FM were recruited via the Internet and completed an online survey. Measures included pain, pain acceptance and SAC, as processes, and pain interference, work and social adjustment, depression and depression-related interference, as outcomes. Confirmatory factor analysis of the SEQ suggested a bi-factor structure, with a general factor underlying all items and two sub-factors, self-as-distinction and self-as-observer (χ2 = 46.55, p = .06, comparative fit index (CFI) = .99, Tucker-Lewis Index (TLI) = .99, root mean square error of approximation (RMSEA) = .04). Component factors showed good reliability, Cronbach's α = .90, and construct validity, supported by significant Pearson's correlations between SEQ scores, acceptance and outcomes (r = -.14 to -.33). In multiple regression analyses, SEQ scores significantly predicted pain-related interference (β = -.17, p < .05), work and social adjustment (β = -.14, p < .05) and depression (β = -.21, p < .01), but not depression-related interference, after controlling for pain, but only significantly predicted depression after controlling pain acceptance. These preliminary results show potentially important associations between SAC and functioning in people with FM.
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Pain acceptance emerged as an independent predictor of depression in several other studies of ACT for chronic pain, even when competing with other PF processes.
“pain acceptance emerged as an independent predictor of depression in several other studies of ACT for chronic pain,44,50,60 even when competing with other PF processes.”
From Preliminary investigation of the associations between psychological flexibility, symptoms and daily functioning in people with chronic abdominal pain (2021) · cites this paper as [50]
The Results (page not provided) report that pain acceptance significantly predicted depression in a regression that also included self-as-context, another psychological-flexibility process. But this was an observational survey of people with fibromyalgia, not a study of ACT treatment for chronic pain. The paper therefore supports the independent-predictor finding, but not the description of this study as an ACT study. (LLM, conf=0.87)
Experimental — accuracy not yet measuredCorrelations 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 [50]
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Self-citation
- Authors
- Yu, L., Norton, S., Almarzooqi, S., & McCracken, L. M.
- Affiliations
- King's College London (GB)
- Corresponding author
- McCracken, Lance M
- Venue
- British Journal of Pain
- Publisher
- SAGE Publications
- Published
- 2017-05-08
- Volume
- 11
- Issue
- 3
- Pages
- 134-143
- ISSN
- 2049-4637 (ISSN-L)
- 2049-4645
- PMC
- PMC5521349
- OpenAlex
- W2613328240
- Cited by
- 35
- References
- 44
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 4 · 2022: 3 · 2021: 8 · 2020: 4 · 2019: 6 · 2018: 3
- FWCI
- 4.41
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- British Journal of Pain (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Middlesex University Research Repository (Middlesex University Of London) (acceptedVersion)
- Research Portal (King's College London) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- self-as-context, fibromyalgia, acceptance and commitment therapy, psychological flexibility, pain interference, depression, work and social adjustment, pain acceptance
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