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Clin J Pain. 2016 Jul;32(7):602-8. doi: 10.1097/AJP.0000000000000227.

Cognitive Fusion and Pain Experience in Young People.

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*Unit for the Study and Treatment of Pain-ALGOS †Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Tarragona ‡Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Tarragona, Catalonia, Spain §Lawson Health Research Institute ∥Beryl & Richard Ivey Rheumatology Day Programs, St. Joseph's Health Care ¶Clinical and Neurological Sciences Department, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada #Department of Rehabilitation Medicine, University of Washington, Seattle, WA.



Acceptance and Commitment Therapy (ACT) has been shown to be an effective treatment for chronic pain in young people. Cognitive fusion is a key concept of ACT that is hypothesized to contribute to distress and suffering. In this study, we sought to: (1) test hypothesized associations between cognitive fusion and pain intensity, disability, and catastrophizing; and (2) examine the function of cognitive fusion as a possible mediator between catastrophizing and disability.


A community sample of 281 young people (11 to 20 y) completed measures assessing cognitive fusion, pain intensity, disability, and pain catastrophizing.


Cognitive fusion was positively related to pain intensity (r=0.24, P<0.01), disability (r=0.32, P<0.001), and pain catastrophizing (r=0.47, P<0.001). Moreover, cognitive fusion was found to mediate the association between pain catastrophizing and disability (β=0.01, 95% confidence interval=0.002-0.024, 5000 bootstrap resamples).


The findings indicate that cognitive fusion is moderately to strongly associated with pain-related outcomes, which support the need for further research to (1) better understand the relationship between cognitive fusion and adjustment to chronic pain, and (2) determine whether the benefits of treatments such as ACT are mediated, at least in part, by reductions in cognitive fusion.

[Indexed for MEDLINE]

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