Psychometric properties of the Cognitive Fusion Questionnaire in Colombia

Effect of applying nursing-based cognitive defusion techniques on mindful awareness, cognitive fusion, and believability of delusions among clients with schizophrenia: a randomized control trial

Background

Applying cognitive defusion techniques to enduring psychotic symptoms, such as delusions, presents both a challenge and a promising opportunity for psychiatric nurses to manage delusions among schizophrenia clients.

Objective

This study aimed to examine the impact of cognitive defusion techniques on psychological flexibility, mindful awareness, cognitive fusion, and the believability of delusions in schizophrenia clients.

Methodology

This study used a single-blind, parallel-arm Randomized Controlled Trial design. Over five weeks, 70 clients with schizophrenia were randomized to either the cognitive defusion intervention group (n = 35) or the control group (n = 35).

Findings

The participants showed significant reductions in the believability of delusions, cognitive fusion, and psychological inflexibility immediately after the intervention and at follow-up. Notable enhancements were observed in cognitive defusion and mindfulness awareness abilities.

Conclusion

Cognitive defusion techniques positively affect schizophrenia clients who struggle with persistent delusional beliefs. This underscores the importance of further investigating this approach to decrease the intensity of delusions as part of a comprehensive therapeutic intervention. Psychiatric nurses must receive training in "cognitive defusion skills" to aid schizophrenia clients in becoming more aware of their emotions and modifying their coping strategies for delusional beliefs. On August 3, 2023, the research was retrospectively registered under the reference number NCT05759091 as a randomized clinical trial.

Clinical trial registration

https://classic.clinicaltrials.gov/ct2/show/NCT05759091, identifier NCT05759091.

Acceptance and commitment therapy for autistic adults: A randomized controlled pilot study in a psychiatric outpatient setting

LAY ABSTRACT

Autistic adults are often stressed and feel depressed or anxious. However, mental health programs that are suited for autistic adults are few. Acceptance and commitment therapy is a psychotherapy method that seems to help people feel better, although not thoroughly evaluated in autistic individuals. In this study, 20 autistic adults had 14 weeks of acceptance and commitment therapy group treatment suited for autism (NeuroACT), while 19 autistic adults had ordinary care. The acceptance and commitment therapy group treatment program seemed logical and reasonable to the participants. Also, when comparing the participants in the NeuroACT group with those in the ordinary care group, the NeuroACT participants reported less stress and higher quality of life. Compared to the ordinary care group, they could also manage distressing thoughts better, perceived themselves as more flexible, and did not avoid stressful situations as much as before. However, there was no significant difference between the groups in depression, anxiety, sleep problems, social aspects of autism, everyday functioning, or executive challenges. Slightly more NeuroACT participants did not finish the treatment than ordinary care participants. In conclusion, the NeuroACT program may be a treatment for autistic adults who feel stressed and have reduced quality of life. More studies are needed to see how helpful the NeuroACT program is for autistic adults.

Psychometric properties of the Valuing Questionnaire in a Spaniard sample and factorial equivalence with a Colombian sample

BACKGROUND

The Valuing Questionnaire (VQ) is considered as one of the most psychometrically robust instruments to measure valued living according to the acceptance and commitment therapy model. It consists of 10 items that are responded to on a 7-point Likert-type scale and has two factors: Progression and Obstruction. The Spanish version of the VQ showed good psychometric properties in Colombian samples. However, there is no evidence of the psychometric properties of the VQ in Spaniard samples. This study aims to analyze the validity of the VQ in a large Spaniard sample and analyze the measurement invariance with a similar Colombian sample.

METHOD

The VQ was administered to a Spaniard sample of 846 adult participants from general online population. Cronbach's alpha and McDonald's omega were computed to analyze the internal consistency of the VQ. The fit of the VQ's two-factor model was tested through a confirmatory factor analysis with a robust maximum likelihood (MLR) estimation method. Afterward, we analyzed the measurement invariance across countries and gender. Convergent construct validity was analyzed with a package of questionnaires that evaluated experiential avoidance (Acceptance and Action Questionnaire-II, AAQ-II), emotional symptoms (Depression Anxiety and Stress Scale-21, DASS-21), life satisfaction (Satisfaction with Life Scale, SWLS), and cognitive fusion (Cognitive Fusion Questionnaire, CFQ).

RESULTS

The internal consistency across samples was adequate (alphas and omegas were .85 for VQ-Progress and .84 for VQ-Obstruction). The two-factor model obtained a good fit to the data (RMSEA = 0.073, 90% CI [0.063, 0.083], CFI = 0.98, NNFI = 0.97, and SRMR = 0.053). The VQ showed strict invariance across countries and gender and showed theoretically coherent correlations with emotional symptoms, life satisfaction, experiential avoidance, and cognitive fusion. In conclusion, the Spanish version of the VQ demonstrated good psychometric properties in a large Spaniard sample.

Cognitive Defusion as Strategy to Reduce the Intensity of Craving Episodes and Improve Eating Behavior

The elaborated intrusion theory of desire proposes that craving is a cognitive motivational process involving intrusive thoughts. Changing the way we react to them, cognitive defusion (CD), should limit thought elaboration and craving. We induced chocolate craving in female chocolate cravers before CD (Study 1). A decrease in craving measured by a single-item scale, Visual Analogical Scale (VAS; p < .001, ηp2 = .449) and as a state, State Food Craving Questionnaire (FCQ-S; p = .029, ηp2 = .106) were found in the experimental group, while similar results were also found in group control. The reduction in craving (VAS) in group CD correlated negatively with chocolate consumption on a bogus taste test (r = –.439, p = .036), while the correlation was positive in the case of group control (r = .429, p = .047). Food craving as a trait, measured by the Trait Food Craving Questionnaire (FCQ-T), showed negative correlations with measures of CD and mindfulness skills (lowest r = –.313, p = .018). In Study 2 participants made use of a smartphone application implementing the CD procedure in real contexts whenever they experienced food craving. A corresponding decline in self-reported craving was found, as well as in consumption of the craved food (indulgence) compared with the control condition. Our findings indicate that CD may be a promising intervention for tackling the elaboration of intrusive thoughts and eating behavior in young female food cravers, both in a controlled laboratory environment after a cue-food exposure craving induction procedure, as well as responding to naturally occurring food cravings in real-life settings.

Psychometric properties of the spanish version of the Valuing Questionnaire in Colombian clinical and nonclinical samples

OBJECTIVE

To examine the psychometric properties of the Spanish version of the Valuing Questionnaire (VQ) in Colombian clinical and nonclinical samples.

METHOD

The VQ was administered to a total sample of 1820 participants, which included undergraduates (N = 762), general population (N = 724), and a clinical sample (N = 334). The questionnaire packages included measures of experiential avoidance, cognitive fusion, mindfulness, life satisfaction, and psychological difficulties.

RESULTS

Across the different samples, internal consistency was good (global Cronbach's alpha of 0.83 for Progress and 0.82 for obstruction). Measurement invariance was found across samples and gender, and the two-factor model obtained a good fit to the data. The latent means of progress and obstruction of the clinical sample were lower and higher, respectively, than the latent means of the nonclinical samples. Correlations with other variables were in the expected direction.

CONCLUSION

The Spanish version of the VQ showed good psychometric properties.

Psychometric Properties of the Generalized Pliance Questionnaire in Spain

Abstract. Rule-governed behavior is a central concept to explain complex human behavior from a functional-analytic standpoint. Recently, a self-report measure of a functional type of rule-following called generalized pliance has been developed – the Generalized Pliance Questionnaire (GPQ). The GPQ has two versions with 18 and 9 items, respectively. This study aimed to analyze the factor structure and psychometric properties of both GPQ versions in a Spanish online sample ( N = 846). Confirmatory factor analyses showed that the one-factor model obtained an acceptable fit in the GPQ-18, but an inadequate fit in the GPQ-9. The GPQ-18 showed measurement invariance across gender, excellent internal consistency, and convergent construct validity. According to the results, the GPQ-18 showed good psychometric properties in Spanish samples.

Psychometric properties of the Automatic Thoughts Questionnaire-8 in two Spanish nonclinical samples

Background

The ATQ is a widely used instrument consisting of 30 items that assess the frequency of negative automatic thoughts. However, the extensive length of the ATQ could compromise its measurement efficiency in survey research. Consequently, an 8-item shortened version of the ATQ has been developed. This study aims to analyze the validity of the ATQ-8 in two Spanish samples.

Method

The ATQ-8 was administered to a total sample of 1,148 participants (302 undergraduates and 846 general online population). To analyze convergent construct validity, the questionnaire package also included the Dysfunctional Attitude Scale-Revised (DAS-R), Depression Anxiety and Stress Scale-21 (DASS-21), Acceptance Action Questionnaire-II (AAQ-II), Cognitive Fusion Questionnaire (CFQ), Generalized Pliance Questionnaire (GPQ), and Satisfaction with Life Scale (SWLS). To analyze internal consistency, we computed Cronbach’s alpha and McDonald’s omega. A confirmatory factor analysis was conducted to test the one-factor structure of the ATQ-8. In so doing, a robust diagonally weighted least square estimation method (Robust DWLS) was adopted using polychoric correlations. Afterward, we analyzed measurement invariance across samples, gender, groupage, and education level. Lastly, we evaluated convergent construct validity by computing Pearson correlations between the ATQ-8 and the remaining instruments.

Results

The internal consistency across samples was adequate (alpha and omega = .89). The one-factor model demonstrated a good fit to the data (RMSEA = 0.10, 90% CI [0.089, 0.112], CFI = 0.98, NNFI = 0.97, and SRMR = 0.048). The ATQ-8 showed scalar metric invariance across samples, gender, groupage, and education level. The ATQ-8 scores were significantly associated with emotional symptoms (DASS-21), satisfaction with life (SWLS), dysfunctional schemas (DAS-R), cognitive fusion (CFQ), experiential avoidance (AAQ-II), and generalized pliance (GPQ). In conclusion, the Spanish version of the ATQ-8 demonstrated adequate psychometric properties in Spanish samples.

Exploring the potential of acceptance and commitment therapy model in self-care behaviour in persons with heart failure

Aim

This study examined the interaction among cognitive fusion, mindfulness and committed action on the self-care behaviour in person with heart failure as guided by the acceptance and commitment therapy model.

Design

An exploratory cross-sectional design was used.

Method

Participants with heart failure from in-patients setting (N = 165) were recruited from two major regional hospitals. Data were collected using self-report questionnaires of the study variables and demographic characteristics. Data were analysed using Hayes SPSS process macros.

Results

Based on the acceptance and commitment therapy model propositions, all main and interaction effects, except for cognitive fusion, were significant. The current study showed that the main effect of the study variables on self-care behaviour was insufficient and adding complex interactions between these variables improved the model fit, as it was suggested by the acceptance and commitment therapy model.

Development and initial validation of the Generalized Tracking Questionnaire

The concept of rule-governed behavior (RGB) has been used in the behavior-analytic literature as a way to analyze complex human behavior, including thinking and problem-solving. Relational frame theory suggests the existence of two main functional types of RGB termed pliance and tracking. In this paper, we describe the development of the Generalized Tracking Questionnaire (GTQ) and the preliminary evaluation of its psychometric properties and validity through three studies, with a total of 1155 participants. In Study 1, a pool of items describing the main characteristics of generalized tracking was designed and evaluated by experts on the RFT account of RGB. The resulting 11 items were administered to 460 undergraduates to examine the understandability and psychometric quality of the items. The exploratory factor analysis indicated that the GTQ can be seen as a unidimensional scale, with all items exhibiting high factor loadings and corrected item-total correlations. In Study 2, the GTQ was administered online to a sample of 464 non-clinical participants and a clinical sample of 125 participants. The one-factor model of the GTQ obtained a good fit in the conducted confirmatory factor analysis. The GTQ showed measurement invariance across gender and clinical and nonclinical participants. It also obtained excellent internal consistency and correlated in theoretically coherent ways with other constructs. In Study 3, the GTQ and a neuropsychological battery of executive functions were administered to 105 participants. The GTQ showed statistically significant, medium-size correlations with working memory tests, verbal fluency, planning, and behavioral inhibition. In conclusion, the GTQ seems to be a promising measure to advance in the empirical analysis of functional classes of RGB.

A Multiple-Baseline Evaluation of Acceptance and Commitment Therapy Focused on Repetitive Negative Thinking for Comorbid Generalized Anxiety Disorder and Depression

Repetitive negative thinking (RNT) is a core feature of generalized anxiety disorder (GAD) and depression. Recently, some studies have shown promising results with brief protocols of acceptance and commitment therapy (ACT) focused on RNT in the treatment of emotional disorders in adults. The current study analyzes the effect of an individual, 3-session, RNT-focused ACT protocol in the treatment of severe and comorbid GAD and depression. Six adults meeting criteria for both disorders and showing severe symptoms of at least one of them participated in the study. A delayed multiple-baseline design was implemented. All participants completed a 5-week baseline without showing improvement trends in emotional symptoms (Depression Anxiety and Stress Scale - 21; DASS-21) and pathological worry (Penn State Worry Questionnaire; PSWQ). The ACT protocol was then implemented, and a 3-month follow-up was conducted. Five of the six participants showed clinically significant changes in the DASS-21 and the PSWQ. The standardized mean difference effect sizes for single-case experimental design were very large for emotional symptoms (d = 3.34), pathological worry (d = 4.52), experiential avoidance (d = 3.46), cognitive fusion (d = 3.90), repetitive thinking (d = 4.52), and valued living (d = 0.92 and d = 1.98). No adverse events were observed. Brief, RNT-focused ACT protocols for treating comorbid GAD and depression deserve further empirical tests.

Resilience@Work Mindfulness Program: Results From a Cluster Randomized Controlled Trial With First Responders

Background

A growing body of research suggests that resilience training can play a pivotal role in creating mentally healthy workplaces, particularly with regard to protecting the long-term well-being of workers. Emerging research describes positive outcomes from various types of resilience training programs (RTPs) among different occupational groups. One specific group of workers that may benefit from this form of proactive resilience training is first responders. Given the nature of their work, first responders are frequently exposed to stressful circumstances and potentially traumatic events, which may impact their overall resilience and well-being over time.

Objective

This study aimed to examine whether a mindfulness-based RTP (the Resilience@Work [RAW] Mindfulness Program) delivered via the internet can effectively enhance resilience among a group of high-risk workers.

Methods

We conducted a cluster randomized controlled trial (RCT) comprising 24 Primary Fire and Rescue and Hazmat stations within New South Wales. Overall, 12 stations were assigned to the 6-session RAW Mindfulness Program and 12 stations were assigned to the control condition. A total of 143 active full-time firefighters enrolled in the study. Questionnaires were administered at baseline, immediately post training, and at 6-month follow-up. Measurements examined change in both adaptive and bounce-back resilience as well as several secondary outcomes examining resilience resources and acceptance and mindfulness skills.

Results

Mixed-model repeated measures analysis found that the overall test of group-by-time interaction was significant (P=.008), with the intervention group increasing in adaptive resilience over time. However, no significant differences were found between the intervention group and the control group in terms of change in bounce-back resilience (P=.09). At 6-month follow-up, the group receiving the RAW intervention had an average increase in their resilience score of 1.3, equating to a moderate-to-large effect size compared with the control group of 0.73 (95% CI 0.38-1.06). Per-protocol analysis found that compared with the control group, the greatest improvements in adaptive resilience were observed among those who completed most of the RAW program, that is, 5 to 6 sessions (P=.002).

Conclusions

The results of this RCT suggest that mindfulness-based resilience training delivered in an internet format can create improvements in adaptive resilience and related resources among high-risk workers, such as first responders. Despite a number of limitations, the results of this study suggest that the RAW Mindfulness Program is an effective, scalable, and practical means of delivering online resilience training in high-risk workplace settings. To the best of our knowledge, this is the first time a mindfulness-based RTP delivered entirely via the internet has been tested in the workplace.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12615000574549; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368296 (Archived by WebCite at http://www.webcitation.org/75w4xtrpw).

Mindfulness-Based Resilience Training in the Workplace: Pilot Study of the Internet-Based Resilience@Work (RAW) Mindfulness Program

Background

The impact of mental illness on society is far reaching and has been identified as the leading cause of sickness absence and work disability in most developed countries. By developing evidence-based solutions that are practical, affordable, and accessible, there is potential to deliver substantial economic benefits while improving the lives of individual workers. Academic and industry groups are now responding to this public health issue. A key focus is on developing practical solutions that enhance the mental health and psychological resilience of workers. A growing body of research suggests resilience training may play a pivotal role in the realm of public health and prevention, particularly with regards to protecting the long-term well-being of workers.

Objective

Our aim is to examine whether a mindfulness-based resilience-training program delivered via the internet is feasible and engaging to a group of high-risk workers. Additionally, we aim to measure the effect of the Resilience@Work Resilience@Work Mindfulness program on measures of resilience and related skills.

Methods

The current pilot study recruited 29 full-time firefighters. Participants were enrolled in the 6-session internet-based resilience-training program and were administered questionnaires prior to training and directly after the program ended. Measurements examined program feasibility, psychological resilience, experiential avoidance, and thought entanglement.

Results

Participants reported greater levels of resilience after Resilience@Work training compared to baseline, with a mean increase in their overall resilience score of 1.5 (95% CI -0.25 to 3.18, t₁₄=1.84, P=.09). Compared to baseline, participants also reported lower levels of psychological inflexibility and experiential avoidance following training, with a mean decrease of -1.8 (95% CI -3.78 to 0.20, t₁₃=-1.94, P=.07). With regards to cognitive fusion (thought entanglement), paired-samples t tests revealed a trend towards reduction in mean scores post training (P=.12).

Conclusions

This pilot study of the Resilience@Work program suggests that a mindfulness-based resilience program delivered via the Internet is feasible in a high-risk workplace setting. In addition, the firefighters using the program showed a trend toward increased resilience and psychological flexibility. Despite a number of limitations, the results of this pilot study provide some valuable insights into what form of resilience training may be viable in occupational settings particularly among those considered high risk, such as emergency workers. To the best of our knowledge, this is the first time a mindfulness-based resilience-training program delivered wholly via the internet has been tested in the workplace.