The development & initial validation of the cognitive fusion questionnaire or, “How I learned not...

The development & initial validation of the cognitive fusion questionnaire

or, “How I learned not to be afraid of factor analysis

and did what I had to do to be published in Behavior Therapy”

Dr. David Gillanders Dr. Helen Bolderston

University of Edinburgh Bournemouth University

Prof. Frank W. BondUniversity of London, Goldsmiths

The University of Edinburgh is a charitable body, registered in Scotland, with registration number SC005336 www.ed.ac.uk

Cognitive Fusion & Defusion

• Thoughts themselves are not seen as problematic

• The function of thoughts to lead to action is problematic

• Content plus contextual cueing


Proxy measures

• Despite the centrality of fusion prior to our measure it was measured using the proxy of ‘believability of thoughts’

• This is a narrow definition of what we mean by defusion / fusion

• So we saw a gap…..


Item development

• Maria Dempster (2007)

• Prof Frank Bond (University of London, Goldsmiths) & Helen Bolderston (University of Southampton)

• Items generated based on knowledge of the literature, clinical experience and personal experience


Item development

• Breadth of definition:

dominance of cognitive events in a person’s experience, inability to view cognitive events from a different perspective, reacting emotionally to thoughts, behavior being highly regulated by cognitive events, attempts to control thinking, over analysis of situations, evaluating and judging thought content, as well as aspects of literality and believability.


Initial item pool

• 42 items from Edinburgh and 27 items from Dorset

• Fusion and defusion wordings

• Positively and negatively keyed


Initial item pool


I get very focussed on distressing thoughts

I feel like my thoughts need to change before I can have a good life

I over-analyse situations to the point where it’s unhelpful to me

My thoughts cause me distress or emotional pain

I get so caught up in my thoughts that I forget what I’m actually doing

I get upset with myself for having certain thoughts

I tend to get very entangled in my thoughtsI need to control the thoughts that come into my head

I tell myself that I shouldn’t be thinking the way I’m thinking

I make judgements about whether my thoughts are good or bad

I find it easy to view my thoughts from a different perspective

I can be aware of my thoughts without necessarily reacting to them

Expert Panel Review

• Initial list of items rated by ACT experts

• Items rated as moderately or highly representative 42 items selected

• Some wording tweaks


Instruction set and response scale

• General rather than specific• Chose not to offer a time scale• 7 point Likert scale


Philosophical and conceptual aspects

• Our background in behaviourism

• The odd language of psychometrics – “latent variables”“traits”

• Playing both games or talking two languages?


Exploratory factor analysis and item reduction using a student sample


418; 71%

174;

29%

Female Male

381

173

21 8 9 17 - 24 years25 - 34 years35 - 44 years45 - 55 yearsover 55 years

• UoE students & associates of Maria and David • n = 592

Factor extraction / Item reduction

• Parallel Analysis (Horn, 1965) – suggested 3 factors

• Increasingly stringent factor loadings


Item reduction

• 2 factors explaining 59.8% of the variance

• 7 fusion scored items and 3 defusion items


The interim period: 28 and 13 item versions

• What the article doesn't’t say….

• For several years we collected data with the above versions

• The 10 item version came through the re analysis of data at the end as we wrote up for publication


Gathering data on diverse samples

• Community adult sample including a sample of prison officers (n = 447)

Lindsey Campbell (NHS Grampian)Louise Tansey (NHS Lothian / NHS

Lanarkshire)Joda Lloyd & Lauraine May (University of

London, Goldsmiths)



• Work site stress management sample (n = 242)

Paul Flaxman (City University)

Economic and Social Research Council (ESRC grant no: RES-061-0232)

• Multiple sclerosis sample (n = 133)Clive Ferenbach (NHS Fife)



• Mixed mental health sample (n = 215)Helen Bolderston (University of Southampton)

Penelope Noel (NHS Tayside)Samantha Masely (NHS Grampian)Sian Kerr (NHS Grampian)

• Dementia caregivers (n = 447)Louise Roach (NHS Lothian)


Investigating the factor structure

• We spent a lot of time exploring if this really was a 2 factor scale

• Theoretically these are two sides of the same coin

• Method Effect or Method Variance (Marsh, 1986)


The back and forth with reviewers…

• There were 3 ‘revise and resubmit’ decisions before acceptance on the 4th submission.

• In the end the reviewers asked us to show that the 3 reversed items actually improved the scale.

• We did a series of correlational, regression, CFA analyses…

• We couldn’t provide evidence that the reverse scored items improved the scale


The final 7 item scale1. My thoughts cause me distress or emotional pain2. I get so caught up in my thoughts that I am unable

to do the things that I most want to do3. I over-analyse situations to the point where its

unhelpful to me4. I struggle with my thoughts5. I get upset with myself for having certain thoughts6. I tend to get very entangled in my thoughts7. It’s such a struggle to let go of upsetting thoughts

even when I know that letting go would be helpful


The final CFA of 7 items


CFQ1

CFQ2

CFQ3

CFQ4

CFQ5

CFQ6

CFQ7

e1

e2

e3

e4

e5

e6

e7

Fusion

Factor regression weights:CFQ1 1.000CFQ2 0.955CFQ3 1.224CFQ4 1.210CFQ5 1.151CFQ6 1.203CFQ7 1.394

The final CFA of 7 items


Sample χ2 df Χ2 ÷ df

CFI IFI RMSEA

Community (n=448)

40.857* 14 2.918 .986 .986 .065

Stress management(n= 242)

44.388* 14 3.171 .971 .971 .095

Mixed mental health(n = 215)

20.333 14 1.452 .991 .991 .046

Multiple Sclerosis(n = 133)

25.852 14 1.847 .983 .983 .101

Dementia Caregivers(n = 219)

45.024* 14 3.216 .962 .963 .101

Psychometric Properties

• F (4,1844) = 96.87, p <.0001

• 1 month test retest reliability: r = .80, p <.001

(Community sample n = 82)The University of Edinburgh is a charitable body, registered in Scotland, with registration number SC005336

www.ed.ac.uk

Student & Community(n = 1040)

Work stress(n = 242)

Mental Health(n = 215)

Multiple Sclerosis(n = 133)

Dementia caregivers(n = 219)

Mean (SD)22.28a

(8.30)25.84b

(8.52)

34.31c

(8.06)

21.22a

(10.36)

23.48a

(8.24)

Cronbach’s α

.90 .92 .88 .93 .90

Convergent validity


AAQII SMS FFMQ KIMS

CFQ .80 -.70 -.50 -.59

n 1020 167 47 78

Mindfulness and acceptance measures

Convergent validity


HADSa HADSd BDI-II SCL90-GSI

CFQ .69 .54 .69 .62

n 277 277 77 77

Measures of distress / emotional disturbance

Convergent validity


Deiner’s

WHOQoL Job satisfaction

VLQ - success

CFQ -.39 -.45 -.42 -.21

n 167 113 144 109

Measures of quality of life, living well, satisfaction

Incremental validity


Step

Variable β t p R2 R2 change

p

1 Helplessness beliefs (ICQ)

.426 5.384 <.001 .181 .181 <.001


.130 2.328 .021 .655 .474 <.001

AAQ-II .749 13.37 <.001


.116 2.098 .038 .670 .015 .017

AAQ-II .561 5.897 <.001

CFQ .229 2.416 .017

Prediction of distress in multiple sclerosis over and above

helplessness and psychological flexibility

Sensitivity to treatment effects


Pre

inte

rven

tion

Post

inte

rven

tion

3 m

onth

follo

w u

p0

10

20

30

ACTControl

For the whole sample

Group by time interaction: F(2,113) = 9.998, p <.001,

partial η 2 = .150 (large effect)

So what do we have?

• A brief, psychometrically robust measure that has a theoretically and empirically valid factor structure, across diverse samples, that correlates as it should with other constructs, and has incremental validity in comparison to them, that is stable across time, but sensitive to intervention and that such changes mediate the impact of that intervention.


So what do we have?

• A useful tool in the hands of clinicians and researchers

• A good publication in Behavior Therapy


Reflecting on the process of publication

• We departed from our initial behavioural stand point

• The introduction was totally re-written to talk the psychometric language more clearly

• The scale is very different to how we started

• Broad to narrow

• ‘The data is your friend’


Translations

• Currently translated into:Dutch, French, Spanish, German,

Portuguese (European and Brazilian), Japanese, Hebrew, Greek, Turkish, Catalan, Polish, Italian, Farsi, Chinese & Korean.


CFQ News

• >2400 views on Scopus

• Cited in 31 papers

• Ongoing studies in our lab in cancer, fear of recurrence, muscle disease, healthy ageing, self help treatment.

• Development of a state version by Helen Bolderston


A scientific development community

• All of this has been possible through the international ACBS community

• www.contextualscience.org

• CFQThe University of Edinburgh is a charitable body, registered in Scotland, with registration number SC005336

www.ed.ac.uk

http://www.contextualscience.org/

http://www.contextualscience.org/

http://www.contextualscience.org/CFQ

UoE Graduates:Dr Maria DempsterDr Lindsey CampbellDr Sian KerrDr Louise TanseyDr Penelope NoelDr Clive Ferenbach Dr Samantha MaselyDr Louise RoachDr Emma MillerDr Ashleigh SinclairDr Louise KeirCurrent UoE Trainees:Kate RandallShane FordeDr Christopher GrahamVictoria Thomson

External Partners:

Dr Helen Bolderston (Bournemouth University)Prof Frank Bond (U. of London, Goldsmiths)Dr Paul Flaxman (City University, London)Dr Joda Lloyd (U. of London, Goldsmiths)Ms Lauraine May (U. of London, Goldsmiths)Prof Susan Clarke (U. of Bournemouth)Prof Bob Remington (U. of Southampton)


The development & initial validation of the cognitive fusion questionnaire or, “How I learned not...

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