Does Cognitive Fusion show up similarly across two behavioral health samples? Psychometric properties and invariance of the Greek–Cognitive Fusion Questionnaire (G-CFQ)

https://doi.org/10.1016/j.jcbs.2021.01.003Get rights and content

Highlights

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    G-CFQ presents with good psychometric properties.

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    G-CFQ was invariant across young adult smokers and chronic pain patients.

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    Early identification of cognitive fusion can facilitate psychopathology prevention.

Abstract

The Cognitive Fusion Questionnaire (CFQ) is a measure of cognitive fusion, a fundamental component of the psychological flexibility model, underlying Acceptance and Commitment Therapy (ACT). Numerous studies present cognitive fusion as a core pathological process contributing to psychological suffering, but none to date have examined phenomenological differences of this construct or assessed the CFQs' measuring performance across a clinical chronic pain sample vs. a sample of daily smoker university students. The purpose of this study was to examine the CFQ's psychometric properties in two Greek-speaking behavioral health samples (Sample 1: university student daily smokers, Sample 2: chronic pain patients) and assess its measurement model. Consistent with previous studies and the original English version, Exploratory and Confirmatory Factor Analysis, conducted separately per group, showed a unitary-factor solution for the Greek CFQ (G-CFQ). G-CFQ exhibited high internal reliability (Sample 1: Cronbach's α = 0.96, Sample 2: Cronbach's α = 0.95), good convergent validity with a theoretically related construct (Child and Adolescent Mindfulness Measure), good concurrent validity with the depression subscale of the Hospital Anxiety and Depression Scale and the Smoking Self-Efficacy Questionnaire and good discriminant validity with the Fagerström Test of Nicotine Dependence. Overall, the construct of cognitive fusion consists of items which are interpreted similarly across young adult smokers and chronic pain patients. The two groups differed in terms of the loadings on item 1, suggesting that they seem to understand this item differently. Also, these two populations were not significantly different in terms of their levels of cognitive fusion. Practical usability of the CFQ and future directions are discussed.

Section snippets

Procedure

This is a secondary data analysis study of two samples from university students who are daily smokers (Sample 1; Karekla et al., 2020) and patients with chronic pain (Sample 2; Karekla et al., 2017). Sample 1 was recruited from three universities and included daily smokers (>1 cigarette per day) who completed online questionnaires. Sample 2 participants were adults (older than 18 years old) diagnosed with a chronic pain condition (non-malignant, present for a minimum of 6 months), recruited

Data screening procedures and assumptions

Prior to running EFA in Sample 1 (daily smokers' group), data screening procedures were performed to examine whether assumptions were met. Kolmogorov-Smirnov (K–S) indicated non-normality, D(105) = 0.136-0.187, p < .001. An inspection of the histograms, the Q-Q and the P–P Plots revealed that the scores were only slightly different from a normal distribution. Skewness and kurtosis were converted to z-scores for all seven items, with all items falling within the range of −3 to 3 ratio. Box plot

Discussion

Studies investigating phenomenological differences across populations are of crucial theoretical and clinical importance as they increase knowledge regarding the degree to which deleterious processes contribute to psychopathology across different contexts. Towards this effort, the present study was the first to examine the psychometric properties and factorial structure of the G-CFQ, employing latent process modeling in a young adult daily smokers' sample and a chronic pain sample. Also, the

Declaration of competing interest

All authors state that they have no conflict of interest.

Acknowledgment

Data for this study originated from two studies funded: 1) for Sample 1, by a University of Cyprus “Start-up grant” awarded to Maria Karekla and 2) for Sample 2, by the European Union Structural funds and local funds via the collaborative program between Greece and the Republic of Cyprus, awarded to Maria Karekla (K3_01_06).

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