Cognitive Fusion and Obstacles to Valued Living: Beyond Pain-Specific Events in Chronic Pain

Authors: Sergio A. Carvalho, Jose Pinto-Gouveia, David Gillanders, Paula Castilho

Abstract:

The role of psychological processes has long been recognized as crucial factors in depressive symptoms in chronic pain (CP). Although some studies have explored the negative impact of being entangled with internal experiences (e.g., thoughts, emotions, physical sensations) – cognitive fusion, it is not extensively explored 1) whether these are pain-related or rather general difficult experiences, and 2) how they relate to experiencing obstacles in committing to valued actions. The current study followed a cross-sectional design in a sample of 231 participants with CP, in which a mediational model was tested through path analyses in AMOS software. The model presented a very good model fit (Χ²/DF = 1.161; CFI = .999; TLI = .996; RMSEA = .026, PCLOSE = .550.), and results showed that pain intensity was not directly related to depressive symptoms (β = .055; p = .239) but was mediated by cognitive fusion with both general and pain-related internal experiences (β = .181, 95%CI [.097; .271]; p = .015). Additionally, results showed that only general cognitive fusion (but not pain-specific fusion) was associated with experiencing obstacles to living a meaningful life, which mediated its impact on depressive symptoms (β = .197, 95%CI [.102; .307]; p = .001). Overall, this study adds on current literature by suggesting that psychological interventions to pain management should not be focused only on management of pain-related experiences, but also on developing more effective ways of relating to overall internal experiences.

Keywords: cognitive fusion, chronic pain, depressive symptoms, valued living