Skip to main content
Top
Gepubliceerd in: Journal of Behavioral Medicine 6/2014

01-12-2014

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

Auteurs: Lance M. McCracken, Estelle Barker, Joseph Chilcot

Gepubliceerd in: Journal of Behavioral Medicine | Uitgave 6/2014

Log in om toegang te krijgen
share
DELEN

Deel dit onderdeel of sectie (kopieer de link)

  • Optie A:
    Klik op de rechtermuisknop op de link en selecteer de optie “linkadres kopiëren”
  • Optie B:
    Deel de link per e-mail

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.
Literatuur
go back to reference Bendayan, R., Esteve, R., & Blanca, M. J. (2012). New empirical evidence of the validity of the Chronic Pain Acceptance Questionnaire: The differential influence of activity engagement and pain willingness on adjustment to chronic pain. British Journal of Health Psychology, 17, 314–326.PubMedCrossRef Bendayan, R., Esteve, R., & Blanca, M. J. (2012). New empirical evidence of the validity of the Chronic Pain Acceptance Questionnaire: The differential influence of activity engagement and pain willingness on adjustment to chronic pain. British Journal of Health Psychology, 17, 314–326.PubMedCrossRef
go back to reference Bernini, O., Pennato, T., Cosci, F., & Berrocal, C. (2010). The psychometric properties of the Chronic Pain Acceptance Questionnaire in Italian patients with chronic pain. Journal of Health Psychology, 15, 1236–1245.PubMedCrossRef Bernini, O., Pennato, T., Cosci, F., & Berrocal, C. (2010). The psychometric properties of the Chronic Pain Acceptance Questionnaire in Italian patients with chronic pain. Journal of Health Psychology, 15, 1236–1245.PubMedCrossRef
go back to reference Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., et al. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42, 676–688.PubMedCrossRef Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., et al. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42, 676–688.PubMedCrossRef
go back to reference Browne, M. W., & Cudeck, R. (1993). Alternative ways of assessing model fit. In K. A. Bollen & J. S. Long (Eds.), Testing structural equation models (pp. 35–57). Newbury Park, CA: Sage. Browne, M. W., & Cudeck, R. (1993). Alternative ways of assessing model fit. In K. A. Bollen & J. S. Long (Eds.), Testing structural equation models (pp. 35–57). Newbury Park, CA: Sage.
go back to reference Buenaver, L. F., Quartana, P. J., Grace, E. G., Sarlani, E., Simango, M., et al. (2012). Evidence for indirect effects of pain catastrophizing on clinical pain among myofascial temporomandibular disorder participants: The mediating role of sleep disturbance. Pain, 153, 1159–1166.PubMedCrossRef Buenaver, L. F., Quartana, P. J., Grace, E. G., Sarlani, E., Simango, M., et al. (2012). Evidence for indirect effects of pain catastrophizing on clinical pain among myofascial temporomandibular disorder participants: The mediating role of sleep disturbance. Pain, 153, 1159–1166.PubMedCrossRef
go back to reference Fish, R. A., McGuire, B., Hogan, M., Morrison, T. G., & Stewart, I. (2010). Validation of the Chronic Pain Acceptance Questionnaire (CPAQ) in an Internet sample and development and preliminary validation of the CPAQ-8. Pain, 149, 435–443.PubMedCrossRef Fish, R. A., McGuire, B., Hogan, M., Morrison, T. G., & Stewart, I. (2010). Validation of the Chronic Pain Acceptance Questionnaire (CPAQ) in an Internet sample and development and preliminary validation of the CPAQ-8. Pain, 149, 435–443.PubMedCrossRef
go back to reference Forman, E. M., Herbert, J. D., Juarascio, A. S., Yeomans, P. D., Zebell, J. A., et al. (2012). The Drexel Defusion Scale: A new measure of experiential distancing. Journal of Contextual Behavioral Science, 1, 55–65.CrossRef Forman, E. M., Herbert, J. D., Juarascio, A. S., Yeomans, P. D., Zebell, J. A., et al. (2012). The Drexel Defusion Scale: A new measure of experiential distancing. Journal of Contextual Behavioral Science, 1, 55–65.CrossRef
go back to reference Fresco, D. M., Moore, M. T., van Dulmen, M. H., Segal, Z. V., Ma, S. H., et al. (2007). Initial psychometric properties of the experiences questionnaire: Validation of a self-report measure of decentering. Behavior Therapy, 38, 234–246.PubMedCrossRef Fresco, D. M., Moore, M. T., van Dulmen, M. H., Segal, Z. V., Ma, S. H., et al. (2007). Initial psychometric properties of the experiences questionnaire: Validation of a self-report measure of decentering. Behavior Therapy, 38, 234–246.PubMedCrossRef
go back to reference Gillanders, D. T., Bolderston, H., Bond, F. W., Dempster, M., Flaxman, P. E., et al. (2014). The development and initial validation of the Cognitive Fusion Questionnaire. Behavior Therapy, 45, 83–101.PubMedCrossRef Gillanders, D. T., Bolderston, H., Bond, F. W., Dempster, M., Flaxman, P. E., et al. (2014). The development and initial validation of the Cognitive Fusion Questionnaire. Behavior Therapy, 45, 83–101.PubMedCrossRef
go back to reference Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44, 1–25.PubMedCrossRef Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44, 1–25.PubMedCrossRef
go back to reference Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York: Guildford Press. Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York: Guildford Press.
go back to reference Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2013). Acceptance and commitment therapy: The process and practice of mindful change. New York: Guildford Press. Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2013). Acceptance and commitment therapy: The process and practice of mindful change. New York: Guildford Press.
go back to reference Hayes, S. C., Strosahl, K. D., Wilson, K. G., Bissett, R. T., Pistorello, J., et al. (2004). Measuring experiential avoidance: A preliminary test of a working model. Psychological Record, 54, 553–578. Hayes, S. C., Strosahl, K. D., Wilson, K. G., Bissett, R. T., Pistorello, J., et al. (2004). Measuring experiential avoidance: A preliminary test of a working model. Psychological Record, 54, 553–578.
go back to reference Hu, L., & Bentler, P. M. (1999). Cuttoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55.CrossRef Hu, L., & Bentler, P. M. (1999). Cuttoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55.CrossRef
go back to reference Kazdin, A. E. (2007). Mediators and mechanisms of change in psychotherapy research. Annual Review of Clinical Psychology, 3, 1–27.PubMedCrossRef Kazdin, A. E. (2007). Mediators and mechanisms of change in psychotherapy research. Annual Review of Clinical Psychology, 3, 1–27.PubMedCrossRef
go back to reference Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.PubMedCentralPubMedCrossRef Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.PubMedCentralPubMedCrossRef
go back to reference McCracken, L. M. (1998). Learning to live with the pain: Acceptance of pain predicts adjustment in persons with chronic pain. Pain, 74, 21–27.PubMedCrossRef McCracken, L. M. (1998). Learning to live with the pain: Acceptance of pain predicts adjustment in persons with chronic pain. Pain, 74, 21–27.PubMedCrossRef
go back to reference McCracken, L. M. (2011). Fad, fashion and forward progress in psychological approaches to chronic pain management. Pain Management, 1, 491–493.PubMedCrossRef McCracken, L. M. (2011). Fad, fashion and forward progress in psychological approaches to chronic pain management. Pain Management, 1, 491–493.PubMedCrossRef
go back to reference McCracken, L. M. (2013). Committed action: An application of the psychological flexibility model to activity patterns in chronic pain. The Journal of Pain, 14, 828–835.PubMedCrossRef McCracken, L. M. (2013). Committed action: An application of the psychological flexibility model to activity patterns in chronic pain. The Journal of Pain, 14, 828–835.PubMedCrossRef
go back to reference McCracken, L. M., DaSilva, P., Skillicorn, B., & Doherty, R. (2013a). The Cognitive Fusion Questionnaire: A preliminary study of psychometric properties and prediction of functioning in chronic pain. The Clinical Journal of Pain,. doi:10.1097/AJP.0000000000000047 McCracken, L. M., DaSilva, P., Skillicorn, B., & Doherty, R. (2013a). The Cognitive Fusion Questionnaire: A preliminary study of psychometric properties and prediction of functioning in chronic pain. The Clinical Journal of Pain,. doi:10.​1097/​AJP.​0000000000000047​
go back to reference McCracken, L. M., Gauntlett-Gilbert, J., & Vowles, K. E. (2007). The role of mindfulness in a contextual cognitive-behavioral analysis of chronic pain-related suffering and disability. Pain, 131, 63–69.PubMedCrossRef McCracken, L. M., Gauntlett-Gilbert, J., & Vowles, K. E. (2007). The role of mindfulness in a contextual cognitive-behavioral analysis of chronic pain-related suffering and disability. Pain, 131, 63–69.PubMedCrossRef
go back to reference McCracken, L. M., & Gutierrez-Martinez, O. (2011). Processes of change in psychological flexibility in an interdisciplinary group-based treatment for chronic pain based on acceptance and commitment therapy. Behaviour Research and Therapy, 49, 267–274.PubMedCrossRef McCracken, L. M., & Gutierrez-Martinez, O. (2011). Processes of change in psychological flexibility in an interdisciplinary group-based treatment for chronic pain based on acceptance and commitment therapy. Behaviour Research and Therapy, 49, 267–274.PubMedCrossRef
go back to reference McCracken, L. M., Gutierrez-Martinez, O., & Smyth, C. (2013b). “Decentering” reflects psychological flexibility in people with chronic pain and correlates with their quality of functioning. Health Psychology, 32, 820–823.PubMedCrossRef McCracken, L. M., Gutierrez-Martinez, O., & Smyth, C. (2013b). “Decentering” reflects psychological flexibility in people with chronic pain and correlates with their quality of functioning. Health Psychology, 32, 820–823.PubMedCrossRef
go back to reference McCracken, L. M., & Morley, S. (2014). The psychological flexibility model: A basis for integration and progress in psychological approaches to chronic pain management. The Journal of Pain, 15, 221–234.PubMedCrossRef McCracken, L. M., & Morley, S. (2014). The psychological flexibility model: A basis for integration and progress in psychological approaches to chronic pain management. The Journal of Pain, 15, 221–234.PubMedCrossRef
go back to reference McCracken, L., & Thompson, M. (2009). Components of mindfulness in patients with chronic pain. Journal Psychopathology and Behavior Assessment, 31, 75–82.CrossRef McCracken, L., & Thompson, M. (2009). Components of mindfulness in patients with chronic pain. Journal Psychopathology and Behavior Assessment, 31, 75–82.CrossRef
go back to reference McCracken, L. M., & Vowles, K. E. (2008). A prospective analysis of acceptance of pain and values-based action in patients with chronic pain. Health Psychology, 27, 215–220.PubMedCrossRef McCracken, L. M., & Vowles, K. E. (2008). A prospective analysis of acceptance of pain and values-based action in patients with chronic pain. Health Psychology, 27, 215–220.PubMedCrossRef
go back to reference McCracken, L. M., Vowles, K. E., & Eccleston, C. (2004). Acceptance of chronic pain: Component analysis and a revised assessment method. Pain, 107, 159–166.PubMedCrossRef McCracken, L. M., Vowles, K. E., & Eccleston, C. (2004). Acceptance of chronic pain: Component analysis and a revised assessment method. Pain, 107, 159–166.PubMedCrossRef
go back to reference McCracken, L. M., & Yang, S. Y. (2006). The role of values in a contextual cognitive-behavioral approach to chronic pain. Pain, 123, 137–145.PubMedCrossRef McCracken, L. M., & Yang, S. Y. (2006). The role of values in a contextual cognitive-behavioral approach to chronic pain. Pain, 123, 137–145.PubMedCrossRef
go back to reference Morley, S., & Keefe, F. J. (2007). Getting a handle on process and change in CBT for chronic pain. Pain, 127, 197–198.PubMedCrossRef Morley, S., & Keefe, F. J. (2007). Getting a handle on process and change in CBT for chronic pain. Pain, 127, 197–198.PubMedCrossRef
go back to reference Muthén, L. K., & Muthén, B. O. (2012). Mplus version 7. Los Angeles: Muthén & Muthén. Muthén, L. K., & Muthén, B. O. (2012). Mplus version 7. Los Angeles: Muthén & Muthén.
go back to reference Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking rumination. Perspectives on Psychological Science, 3, 400–424.CrossRef Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking rumination. Perspectives on Psychological Science, 3, 400–424.CrossRef
go back to reference Pincus, T., Anwar, S., McCracken, L., McGregor, A., Graham, L., et al. (2013). Testing the credibility, feasibility and acceptability of an optimised behavioural intervention (OBI) for avoidant chronic low back pain patients: Protocol for a randomised feasibility study. Trials, 14, 172.PubMedCentralPubMedCrossRef Pincus, T., Anwar, S., McCracken, L., McGregor, A., Graham, L., et al. (2013). Testing the credibility, feasibility and acceptability of an optimised behavioural intervention (OBI) for avoidant chronic low back pain patients: Protocol for a randomised feasibility study. Trials, 14, 172.PubMedCentralPubMedCrossRef
go back to reference Reneman, M. F., Dijkstra, A., Geertzen, J. H., & Dijkstra, P. U. (2010). Psychometric properties of Chronic Pain Acceptance Questionnaires: A systematic review. European Journal of Pain, 14, 457–465.PubMedCrossRef Reneman, M. F., Dijkstra, A., Geertzen, J. H., & Dijkstra, P. U. (2010). Psychometric properties of Chronic Pain Acceptance Questionnaires: A systematic review. European Journal of Pain, 14, 457–465.PubMedCrossRef
go back to reference Rodero, B., Casanueva, B., Luciano, J. V., Gili, M., Serrano-Blanco, A., & Garcia-Campayo, J. (2011). Relationship between behavioural coping strategies and acceptance in patients with fibromyalgia syndrome: Elucidating targets of interventions. BMC Musculoskeletal Disorders, 12, 143.PubMedCentralPubMedCrossRef Rodero, B., Casanueva, B., Luciano, J. V., Gili, M., Serrano-Blanco, A., & Garcia-Campayo, J. (2011). Relationship between behavioural coping strategies and acceptance in patients with fibromyalgia syndrome: Elucidating targets of interventions. BMC Musculoskeletal Disorders, 12, 143.PubMedCentralPubMedCrossRef
go back to reference Safran, J. D., & Segal, Z. V. (1990). Interpersonal process in cognitive therapy. New York: Basic Books. Safran, J. D., & Segal, Z. V. (1990). Interpersonal process in cognitive therapy. New York: Basic Books.
go back to reference Sullivan, M. J., Bishop, S. R., & Pivik, J. (1995). The Pain Catastrophizing Scale: Development and validation. Psychological Assessment, 7, 524–532.CrossRef Sullivan, M. J., Bishop, S. R., & Pivik, J. (1995). The Pain Catastrophizing Scale: Development and validation. Psychological Assessment, 7, 524–532.CrossRef
go back to reference Sullivan, M. J., Stanish, W., Waite, H., Sullivan, M., & Tripp, D. A. (1998). Catastrophizing, pain, and disability in patients with soft-tissue injuries. Pain, 77, 253–260.PubMedCrossRef Sullivan, M. J., Stanish, W., Waite, H., Sullivan, M., & Tripp, D. A. (1998). Catastrophizing, pain, and disability in patients with soft-tissue injuries. Pain, 77, 253–260.PubMedCrossRef
go back to reference Trompetter, H. R., Ten Klooster, P. M., Schreurs, K. M., Fledderus, M., Westerhof, G. J., & Bohlmeijer, E. T. (2013). Measuring values and committed action with the Engaged Living Scale (ELS): Psychometric evaluation in a nonclinical sample and a chronic pain sample. Psychological Assessment, 25, 1235–1246.PubMedCrossRef Trompetter, H. R., Ten Klooster, P. M., Schreurs, K. M., Fledderus, M., Westerhof, G. J., & Bohlmeijer, E. T. (2013). Measuring values and committed action with the Engaged Living Scale (ELS): Psychometric evaluation in a nonclinical sample and a chronic pain sample. Psychological Assessment, 25, 1235–1246.PubMedCrossRef
go back to reference Twohig, M. P. (2012). Acceptance and commitment therapy: Introduction. Cognitive and Behavioral Practice, 19, 499–507.CrossRef Twohig, M. P. (2012). Acceptance and commitment therapy: Introduction. Cognitive and Behavioral Practice, 19, 499–507.CrossRef
go back to reference Vowles, K. E., McCracken, L. M., McLeod, C., & Eccleston, C. (2008). The Chronic Pain Acceptance Questionnaire: Confirmatory factor analysis and identification of patient subgroups. Pain, 140, 284–291.PubMedCrossRef Vowles, K. E., McCracken, L. M., McLeod, C., & Eccleston, C. (2008). The Chronic Pain Acceptance Questionnaire: Confirmatory factor analysis and identification of patient subgroups. Pain, 140, 284–291.PubMedCrossRef
go back to reference Ware, J. E., Jr, & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care, 30, 473–483.PubMedCrossRef Ware, J. E., Jr, & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care, 30, 473–483.PubMedCrossRef
go back to reference Ware, J. E., Snow, K. K., Kosinski, M., & Gandeck, B. (1993). SF-32 health survey: Manual and interpretation guide. Boston, MA: Nimrod Press. Ware, J. E., Snow, K. K., Kosinski, M., & Gandeck, B. (1993). SF-32 health survey: Manual and interpretation guide. Boston, MA: Nimrod Press.
go back to reference Wicksell, R. K., Olsson, G. L., & Melin, L. (2009). The Chronic Pain Acceptance Questionnaire (CPAQ)—Further validation including a confirmatory factor analysis and a comparison with the Tampa Scale of Kinesiophobia. European Journal of Pain, 13, 760–768.PubMedCrossRef Wicksell, R. K., Olsson, G. L., & Melin, L. (2009). The Chronic Pain Acceptance Questionnaire (CPAQ)—Further validation including a confirmatory factor analysis and a comparison with the Tampa Scale of Kinesiophobia. European Journal of Pain, 13, 760–768.PubMedCrossRef
go back to reference Williams, A. C., Eccleston, C., & Morley, S. (2012). Psychological therapies for the management of chronic pain (excluding headache) in adults. The Cochrane Database of Systematic Reviews, 11, CD007407.PubMed Williams, A. C., Eccleston, C., & Morley, S. (2012). Psychological therapies for the management of chronic pain (excluding headache) in adults. The Cochrane Database of Systematic Reviews, 11, CD007407.PubMed
Metagegevens
Titel
Decentering, rumination, cognitive defusion, and psychological flexibility in people with chronic pain
Auteurs
Lance M. McCracken
Estelle Barker
Joseph Chilcot
Publicatiedatum
01-12-2014
Uitgeverij
Springer US
Gepubliceerd in
Journal of Behavioral Medicine / Uitgave 6/2014
Print ISSN: 0160-7715
Elektronisch ISSN: 1573-3521
DOI
https://doi.org/10.1007/s10865-014-9570-9

Andere artikelen Uitgave 6/2014

Journal of Behavioral Medicine 6/2014 Naar de uitgave