A Confirmatory Factor Analysis of Facets of Psychological Flexibility in a Sample of People Seeking Treatment for Chronic Pain

Whitney Scott, Lance M McCracken, Sam Norton, Whitney Scott, Lance M McCracken, Sam Norton

Abstract

Background: Evidence supports the validity of individual components of the psychological flexibility model in the context of chronic pain. However, there is a need to test the inter-relationships amongst measures of individual components of psychological flexibility in a more integrative manner. In particular, research is needed to examine whether a model with discrete facets as proposed is indeed reflected in data from currently used assessment measures in people with chronic pain.

Purpose: This cross-sectional study investigated the underlying structure of measures of processes of psychological flexibility amongst individuals with chronic pain and the associations between this measurement model and patient functioning.

Methods: Five-hundred and seventy-three adults with chronic pain completed measures of pain, physical and social functioning, mental health, depression and processes of psychological flexibility, including acceptance, cognitive defusion, decentering and committed action. Confirmatory factor analyses tested lower-order, higher-order and bifactor models to examine the structure of psychological flexibility process measures.

Results: A single general factor reflecting openness explained variability in items across all of the psychological flexibility process measures. In addition to this general factor, distinct decentering and committed action group factors emerged in the data. As expected, the general factor was strongly correlated with measures of social functioning, mental health and depression.

Conclusions: Future research is needed to determine the most useful means by which the presence of the general factor can be reflected in the measurement and theory of psychological flexibility.

Keywords: Chronic pain; Confirmatory factor analysis; Psychological flexibility.

Figures

Fig. 1
Fig. 1
Schematic of confirmatory factor analysis models tested. Note AAQ Acceptance and Action Questionnaire, CFQ Cognitive Fusion Questionnaire, EQ Experience Questionnaire and CAQ Committed Action Questionnaire. AAQ, CFQ, and CAQ-factor 2 items were reverse scored. Item numbers reported for the CFQ and EQ are in relation to their respective full-length measures

References

    1. Vlaeyen JWS, Linton SJ. Fear-avoidance model of chronic musculoskeletal pain: 12 years on. Pain. 2012;153:1144–1147. doi: 10.1016/j.pain.2011.12.009.
    1. Jensen MP. Psychosocial approaches to pain management: An organizational framework. Pain. 2011;152:717–725. doi: 10.1016/j.pain.2010.09.002.
    1. Williams A, Eccleston C, Morley S. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev. 2012;11
    1. McCracken LM, Morley S. The psychological flexibility model: A basis for integration and progress in psychological approaches to chronic pain management. J Pain. 2014;15:221–234. doi: 10.1016/j.jpain.2013.10.014.
    1. McCracken LM, Vowles KE. Acceptance and Commitment Therapy and mindfulness for chronic pain: Model, process, and progress. Am Psychol. 2014;69:178–187. doi: 10.1037/a0035623.
    1. Hayes SC, Strosahl KD, Wilson KG. Acceptance and Commitment Therapy: An experiential approach to behavior change. New York: Guilford Press; 1999.
    1. Veehof MM, Oskam MJ, Schreurs KM, Bohlmeijer ET. Acceptance-based interventions for the treatment of chronic pain: A systematic review and meta-analysis. Pain. 2011;152:533–542. doi: 10.1016/j.pain.2010.11.002.
    1. Hann KE, McCracken LM. A systematic review of randomized controlled trials of Acceptance and Commitment Therapy for adults with chronic pain: Outcome domains, design quality, and efficacy. J Contextual Behav Sci. 2014;3:217–227. doi: 10.1016/j.jcbs.2014.10.001.
    1. Hayes SC, Levin ME, Plumb-Vilardaga J, Villatte JL, Pistorello J. Acceptance and Commitment Therapy and contextual behavioral science: Examining the progress of a distinctive model of behavioral and cognitive therapy. Behav Ther. 2013;44:180–198. doi: 10.1016/j.beth.2009.08.002.
    1. Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and Commitment Therapy: Model, processes and outcomes. Behav Res Ther. 2006;44:1–25. doi: 10.1016/j.brat.2005.06.006.
    1. Hayes SC, Villatte M, Levin M, Hildebrandt M. Open, aware, and active: Contextual approaches as an emerging trend in the behavioral and cognitive therapies. Annu Rev Clin Psychol. 2011;7:141–168. doi: 10.1146/annurev-clinpsy-032210-104449.
    1. Scott W, McCracken LM: Psychological flexibility, Acceptance and Commitment Therapy, and chronic pain. Curr Opin Psychol. 2014.
    1. Reneman MF, Dijkstra A, Geertzen JH, Dijkstra PU. Psychometric properties of Chronic Pain Acceptance Questionnaires: A systematic review. Eur J Pain. 2010;14:457–465. doi: 10.1016/j.ejpain.2009.08.003.
    1. McCracken LM, Velleman SC. Psychological flexibility in adults with chronic pain: A study of acceptance, mindfulness, and values-based action in primary care. Pain. 2010;148:141–147. doi: 10.1016/j.pain.2009.10.034.
    1. McCracken LM, Gutiérrez-Martínez O. Processes of change in psychological flexibility in an interdisciplinary group-based treatment for chronic pain based on Acceptance and Commitment Therapy. Behav Res Ther. 2011;49:267–274. doi: 10.1016/j.brat.2011.02.004.
    1. Vowles KE, Witkiewitz K, Sowden G, Ashworth J. Acceptance and Commitment Therapy for chronic pain: Evidence of mediation and clinically significant change following an abbreviated interdisciplinary program of rehabilitation. J Pain. 2014;15:101–113. doi: 10.1016/j.jpain.2013.10.002.
    1. Wicksell RK, Olsson GL, Hayes SC. Psychological flexibility as a mediator of improvement in Acceptance and Commitment Therapy for patients with chronic pain following whiplash. Eur J Pain. 2010;14:1059.e1051–1059.e1011.
    1. McCracken LM, DaSilva P, Skillicorn B, Doherty R. The Cognitive Fusion Questionnaire: A preliminary study of psychometric properties and prediction of functioning in chronic pain. Clin J Pain. 2013;30:894–901. doi: 10.1097/AJP.0000000000000047.
    1. McCracken LM. Committed action: An application of the psychological flexibility model to activity patterns in chronic pain. J Pain. 2013;14:828–835. doi: 10.1016/j.jpain.2013.02.009.
    1. McCracken L, Chilcot J, Norton S. Further development in the assessment of psychological flexibility: A shortened Committed Action Questionnaire (CAQ‐8) Eur J Pain. 2014;14:828–835. doi: 10.1016/j.jpain.2013.02.009.
    1. McCracken LM, Barker E, Chilcot J. Decentering, rumination, cognitive defusion, and psychological flexibility in people with chronic pain. J Behav Med. 2014;37:1215–1225. doi: 10.1007/s10865-014-9570-9.
    1. Vowles KE, Sowden G, Ashworth J. A comprehensive examination of the model underlying Acceptance and Commitment Therapy for chronic pain. Behav Ther. 2014;45:390–401. doi: 10.1016/j.beth.2013.12.009.
    1. Reise SP, Moore TM, Haviland MG. Bifactor models and rotations: Exploring the extent to which multidimensional data yield univocal scale scores. J Pers Assess. 2010;92:544–559. doi: 10.1080/00223891.2010.496477.
    1. Reise SP. The rediscovery of bifactor measurement models. Multivar Behav Res. 2012;47:667–696. doi: 10.1080/00273171.2012.715555.
    1. Wiesner M, Schanding GT. Exploratory structural equation modeling, bifactor models, and standard confirmatory factor analysis models: Application to the BASC-2 behavioral and emotional screening system teacher form. J Sch Psychol. 2013;51:751–763. doi: 10.1016/j.jsp.2013.09.001.
    1. Ware Jr JE, Sherbourne CD: The MOS 36-Item Short-Form Health Survey (SF-36): I. Conceptual framework and item selection. Med Care. 1992:473–483.
    1. Bergman S, Jacobsson LT, Herrström P, Petersson IF. Health status as measured by SF-36 reflects changes and predicts outcome in chronic musculoskeletal pain: A 3-year follow up study in the general population. Pain. 2004;108:115–123. doi: 10.1016/j.pain.2003.12.013.
    1. Kroenke K, Spitzer RL, Williams JB. The PHQ‐9. J Gen Intern Med. 2001;16:606–613. doi: 10.1046/j.1525-1497.2001.016009606.x.
    1. Bond FW, Hayes SC, Baer RA, et al. Preliminary psychometric properties of the Acceptance and Action Questionnaire–II: A revised measure of psychological inflexibility and experiential avoidance. Behav Ther. 2011;42:676–688. doi: 10.1016/j.beth.2011.03.007.
    1. McCracken LM, Zhao‐O’Brien J. General psychological acceptance and chronic pain: There is more to accept than the pain itself. Eur J Pain. 2010;14:170–175. doi: 10.1016/j.ejpain.2009.03.004.
    1. Gillanders DT, Bolderston H, Bond FW, et al. The development and initial validation of the Cognitive Fusion Questionnaire. Behav Ther. 2014;45:83–101. doi: 10.1016/j.beth.2013.09.001.
    1. Safran J, Segal ZV. Interpersonal process in cognitive therapy. Maryland: Roman & Littlefield Publishers, Inc; 1996.
    1. Fresco DM, Moore MT, van Dulmen MH, et al. Initial psychometric properties of the Experiences Questionnaire: Validation of a self-report measure of decentering. Behav Ther. 2007;38:234–246. doi: 10.1016/j.beth.2006.08.003.
    1. Muthén B, Muthén L. Mplus 7.1. 7. Los Angeles: Muthen & Muthen; 2013.
    1. Hu L, Peter M. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct Equ Model. 1999;6:1–55. doi: 10.1080/10705519909540118.
    1. McCracken LM, Davies M, Scott W, et al. Can a psychologically based treatment help people to live with chronic pain when they are seeking a procedure to reduce it? Pain Med. 2015;16:451–459. doi: 10.1111/pme.12623.
    1. Viane I, Crombez G, Eccleston C, et al. Acceptance of pain is an independent predictor of mental well-being in patients with chronic pain: Empirical evidence and reappraisal. Pain. 2003;106:65–72. doi: 10.1016/S0304-3959(03)00291-4.
    1. Vowles KE, McCracken LM, Eccleston C. Processes of change in treatment for chronic pain: The contributions of pain, acceptance, and catastrophizing. Eur J Pain. 2007;11:779–787. doi: 10.1016/j.ejpain.2006.12.007.
    1. Norton S, Cosco T, Doyle F, Done J, Sacker A. The hospital anxiety and depression scale: A meta confirmatory factor analysis. J Psychosom Res. 2013;74:74–81. doi: 10.1016/j.jpsychores.2012.10.010.
    1. McCracken LM, Yang SY. The role of values in a contextual cognitive-behavioral approach to chronic pain. Pain. 2006;123:137–145. doi: 10.1016/j.pain.2006.02.021.
    1. Barnes-Holmes D, Barnes-Holmes Y, Stewart I, Boles S. A sketch of the Implicit Relational Assessment Procedure (IRAP) and the Relational Elaboration and Coherence (REC) model. Psychol Rec. 2011;60:10.

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