Psychometric properties of the Cognitive Fusion Questionnaire in Colombia

Psychometric properties of the Cognitive Fusion Questionnaire in Colombia

Full reference: Ruiz, F. J., Suárez-Falcón, J. C., Riaño-Hernández, D., & Gillanders, D. (2017). Psychometric properties of the Cognitive Fusion Questionnaire in Colombia. Revista Latinoamericana de Psicología, 49, 80-87. http://dx.doi.org/10.1016/j.rlp.2016.09.006

Study type: Cross-cultural validation and adaptation study

Background and objectives

The Cognitive Fusion Questionnaire (CFQ) is a recently published measure of cognitive fusion, a central construct in the Acceptance and Commitment Therapy (ACT) model of psychopathology. Cognitive fusion is defined as a verbal process whereby individuals become entangled in their thinking, evaluations, judgments, and memories, and behave according to the derived functions of these private experiences. In other words, private experiences dominate subsequent behavior, thereby preventing other sources of stimulus control from influencing behavior. When private experiences are aversive, fusion typically leads to experiential avoidance strategies (e.g., suppression, distraction, worry, rumination) that, although providing short-term relief, negatively reinforce these strategies and can lead to entrapment in the experiential avoidance loops characteristic of psychological disorders.

The theoretical framework situates cognitive fusion within a contextual behavioral model, where cognitive defusion (the process of taking a detached perspective on private experiences and unhooking behavior from them) constitutes a central intervention target in ACT. The CFQ was originally developed in English and demonstrated solid psychometric properties, including a one-factor structure, good internal consistency, convergent and discriminant validity, and sensitivity to treatment effects. Although a Spanish version of the CFQ already existed, validated in Spain by Romero-Moreno et al. (2014), it had been evaluated only in a relatively small sample of dementia caregivers. The authors argue that testing measures in culturally diverse samples and in other Spanish-speaking countries enhances both confidence in the measure and the cross-cultural relevance of the underlying theory being measured. The primary objective of the study was to analyze the psychometric properties and factor structure of a Spanish version of the CFQ adapted for Colombia.

Method

Participants

The study included four separate samples. Sample 1: 762 university undergraduates (age range 18-63 years, M = 21.16, SD = 3.76) from seven universities in Bogotá. Forty-six percent were studying Psychology; the remainder studied Law, Engineering, Philosophy, Communication, Business, Medicine, and Theology. Sixty-two percent were women. Of the total, 26% had received psychological or psychiatric treatment at some time, but only 4.3% were currently in treatment. 2.9% reported using psychotropic medication.

Sample 2: 724 Colombian participants (74.4% females) aged 18-88 years (M = 26.11, SD = 8.93), recruited through an anonymous online survey distributed via social media. 17.8% had primary or secondary education, 63.8% had undergraduate or college education, and 18.4% had graduate education. Forty-five percent had received psychological or psychiatric treatment at some time, but only 8.4% were currently in treatment. 5.4% reported using psychotropic medication.

Sample 3: 277 patients (64.6% females) aged 18-67 years (M = 28.50, SD = 11.22) diagnosed with emotional disorders (88.4%) or sexual disorders (11.6%) according to information provided by their therapists. All were evaluated at a private psychological consultation center. Only 6.3% reported using psychotropic medication.

Sample 4: 11 participants (2 males, mean age = 22.18, SD = 4.40, age range 18-32) who participated in a randomized multiple-baseline study analyzing the effect of a one-session ACT intervention. One participant had secondary education, six were undergraduate students, and four were college graduates. Participants were recruited through social media advertisements and reported having been entangled in thoughts, memories, and/or worries for at least 6 months with significant interference in at least two life areas. They were not receiving psychological or psychiatric treatment.

Instruments under study

Cognitive Fusion Questionnaire (CFQ): A 7-item scale with a 7-point Likert response format (7 = always; 1 = never true) that measures general cognitive fusion. Higher scores reflect a higher degree of cognitive fusion. The original English version demonstrated a one-factor structure, good reliability, temporal stability, convergent, discriminant, and criterion validity, and sensitivity to treatment effects. The Spanish version used was from Romero-Moreno et al. (2014), with a small pilot study (N = 10 Colombian university students) to enhance cultural sensitivity. Participants rated item clarity and simplicity, suggesting minor changes primarily related to gender. Item 7 was slightly modified to more accurately capture the sense of being caught up by thoughts.

Other outcome measures

Acceptance and Action Questionnaire-II (AAQ-II): A 7-item, 7-point Likert scale (7 = always; 1 = never true) that measures general experiential avoidance or psychological inflexibility. Items reflect unwillingness to experience unwanted emotions and thoughts and inability to be in the present moment and behave according to value-directed actions when experiencing unwanted psychological events. Very strong positive correlations between AAQ-II and CFQ were expected.

Depression, Anxiety, and Stress Scales-21 (DASS-21): A 21-item, 4-point Likert scale (3 = applied to me very much or most of the time; 0 = did not apply to me at all) with three subscales (Depression, Anxiety, and Stress) measuring negative emotional states. Strong positive correlations between CFQ and all DASS-21 subscales were expected.

Satisfaction with Life Survey (SWLS): A 5-item, 7-point Likert scale (7 = strongly agree; 1 = strongly disagree) measuring self-perceived well-being. Medium to strong negative correlations between SWLS and CFQ were expected.

Mindful Attention Awareness Scale (MAAS): A 15-item, 6-point Likert scale (6 = almost never; 1 = almost never) designed to measure the extent to which individuals pay attention during various tasks or behave on "autopilot" mode. Moderate to strong negative correlations between CFQ and MAAS were expected.

Dysfunctional Attitude Scale-Revised (DAS-R): A 17-item, 7-point Likert scale (7 = fully agree; 1 = fully disagree) grouped into two factors (Perfectionism/Performance evaluation and Dependency) measuring dysfunctional schemas. Moderate to strong positive correlations between CFQ and DAS-R were expected.

Procedure

Samples 1-3 provided informed consent and received questionnaire packets. Sample 1 completed questionnaires in classrooms during regular classes. Sample 2 responded to an anonymous online survey. Sample 3 completed questionnaires during one of the clinical assessment interviews at the beginning of treatment. Sample 4 completed a baseline period of 2-10 weeks, then received a one-session ACT intervention (approximately 75 minutes) focused on disrupting problematic worry and rumination through: (a) identifying triggers and experiential avoidance strategies, (b) promoting creative hopelessness regarding the counterproductive effects of worry/rumination, (c) promoting values clarification and commitment to valued actions, and (d) introducing defusion training.

Data analysis

Prior to factor analyses, data from Samples 1-3 were screened for missing values. Only two CFQ values were missing (one each for items 1 and 6), imputed using LISREL's matching response pattern method. For confirmatory factor analysis (CFA), weighted least squares (WLS) estimation with polychoric correlations was used due to the ordinal nature of the Likert scale. Chi-square tests and the following goodness-of-fit indices were computed for the one-factor model: RMSEA (Root Mean Square Error of Approximation), CFI (Comparative Fit Index), and NNFI (Non-Normed Fit Index). Acceptable fit was considered as RMSEA < .10 and very good fit as RMSEA < .05; CFI and NNFI > .90 indicated acceptable-fitting models, and > .95 represented good fit. Multiple-group CFAs were performed to test measurement invariance across samples and gender. Cronbach's alphas with 95% confidence intervals were computed to explore internal consistency. Corrected item-total correlations were obtained. Gender differences were examined using Student's t-tests. For criterion validity, CFQ scores were compared between nonclinical participants (Samples 1 and 2) and clinical participants (Sample 3). Pearson correlations were calculated to assess convergent validity. For Sample 4, dependent-samples t-tests were conducted between the last baseline CFQ score and the 6-week follow-up, with Cohen's d also computed.

Results

Factor structure

The fit of the one-factor model was adequate across all samples with good goodness-of-fit indices. Sample 1 (N = 762): χ² = 53.17, df = 14, p < .01; RMSEA = .061, 90% CI [.044, .078]; CFI = .98; NNFI = .97. Sample 2 (N = 724): χ² = 72.40, df = 14, p < .01; RMSEA = .076, 90% CI [.059, .094]; CFI = .99; NNFI = .98. Sample 3 (N = 277): χ² = 30.44, df = 14, p < .01; RMSEA = .065, 90% CI [.033, .097]; CFI = .99; NNFI = .99. For the total sample (N = 1,763), indices were also good: χ² = 135.56, df = 14, p < .01; RMSEA = .070, 90% CI [.060, .081]; CFI = .98; NNFI = .98. Standardized factor loadings ranged from .83 to 1.00, with all items substantially related to the latent cognitive fusion factor.

Measurement invariance

Measurement invariance was examined through multiple-group models. The multiple-group baseline model fit the data well with all goodness-of-fit indices suggesting well-fitting solutions. When equality constraints were placed on factor loadings, there was no significant decrement in goodness of fit, suggesting that the measures were invariant across samples and gender. Regarding measurement invariance across samples, all recommended criteria were met: the chi-square difference test was not statistically significant (χ²(12) = 26.06, p > .01), differences in RMSEA were lower than .01, and differences in CFI and NNFI were greater than -.01. All criteria were also met regarding measurement invariance across gender (χ²(6) = 7.99, p > .01).

Internal consistency and descriptive data

Cronbach's alpha for the CFQ ranged from .89 (Sample 1) to .93 (Samples 2 and 3), with an overall alpha of .93 (95% CI [.92, .93]). Corrected item-total correlations ranged from .67 to .72 in Sample 1, .76 to .80 in Sample 2, and .73 to .85 in Sample 3. The seven items were: (1) "My thoughts cause me distress or emotional pain" (item-total r = .76), (2) "I get so caught up in my thoughts that I am unable to do the things that I most want to do" (r = .79), (3) "I over-analyze situations to the point where it's unhelpful to me" (r = .73), (4) "I struggle with my thoughts" (r = .77), (5) "I get upset with myself for having certain thoughts" (r = .78), (6) "I tend to get very entangled in my thoughts" (r = .82), (7) "It's such a struggle to let go of upsetting thoughts even when I know that letting go would be helpful" (r = .77).

Regarding gender differences, in Sample 1 males (M = 19.90, SD = 8.21) had slightly lower scores than females (M = 21.49, SD = 8.94), with a statistically significant difference (t = -2.46, p = .014). In Sample 2, no statistically significant differences were found between males (M = 25.05, SD = 10.30) and females (M = 23.36, SD = 10.35; t = 1.86, p = .06). Similarly, in Sample 3 no significant gender differences were found (males: M = 30.43, SD = 11.87; females: M = 32.20, SD = 10.24; t = -1.23, p = .22). The mean score of the clinical sample (Sample 3, M = 31.53, SD = 10.86) was significantly higher than that of Sample 1 (M = 20.87, SD = 8.70; t = -14.71, p < .001) and Sample 2 (M = 23.80, SD = 10.36; t = -10.42, p < .001), providing evidence of criterion validity.

Correlations with related constructs

The CFQ showed correlations with all assessed constructs in theoretically coherent ways. Specifically, it showed significant positive correlations with psychological inflexibility (AAQ-II): Sample 1, r = .76; Sample 2, r = .84; Sample 3, r = .81 (all p < .001). Correlations with depressive symptoms (DASS-21) were: Sample 1, r = .57; Sample 2, r = .70; Sample 3, r = .66 (all p < .001). With anxiety symptoms (DASS-21): Sample 1, r = .49; Sample 2, r = .60; Sample 3, r = .58 (all p < .001). With stress symptoms (DASS-21): Sample 1, r = .53; Sample 2, r = .63; Sample 3, r = .68 (all p < .001). With dysfunctional attitudes (DAS-R): Sample 1, r = .40 (p < .001).

The CFQ showed significant negative correlations with attentional awareness (MAAS): Sample 1, r = -.34 (p < .001). With life satisfaction (SWLS): Sample 1, r = -.36; Sample 2, r = -.52; Sample 3, r = -.53 (all p < .001). These correlation patterns support the expected convergent and discriminant validity of the instrument.

Sensitivity to treatment

In Sample 4, the mean score at the last baseline assessment was 30.27 (SD = 7.56), whereas at the 6-week follow-up it was 19.36 (SD = 7.63). The difference was statistically significant with a very large effect size (t = 6.23, p < .001, d = 1.89), demonstrating that the CFQ was sensitive to the effects of the one-session ACT intervention focused on disrupting problematic worry and rumination.

Discussion and conclusions

The data obtained demonstrated that the Spanish version of the CFQ possesses good psychometric properties in Colombia. Specifically, the CFQ showed construct validity in that confirmatory factor analysis confirmed the same one-factor solution found in the original English scale. Measurement invariance criteria were completely met across samples (undergraduate, general population online, and clinical sample) and across genders. Internal consistency of the CFQ was very good with an overall alpha of .93, and it showed criterion validity by discriminating between clinical and nonclinical samples. The instrument also evidenced convergent validity through the positive correlations found with psychological inflexibility and emotional symptoms, and negative correlations with attentional awareness and life satisfaction. Finally, the CFQ was sensitive to the effect of a one-session ACT intervention in people with problematic worry and rumination.

The authors acknowledge several limitations. First, no systematic information was obtained regarding specific diagnoses in clinical participants, who were categorized in broad categories such as emotional and sexual disorders. Second, some of the instruments used to explore convergent and divergent validity of the CFQ lacked formal validation in Colombian samples (DASS-21 and SWLS), although their internal consistencies were adequate and similar to the original validation studies. Third, the percentage of females was higher across all samples; however, statistical measurement invariance analyses confirmed that the CFQ was invariant across gender. Despite these limitations, the data presented demonstrate the adequacy of CFQ measurement in the Colombian population and contribute to the growing body of research showing the cross-cultural relevance of the concept of cognitive fusion.

Significance and contribution

This study significantly contributes to the cross-cultural validation of theory and measurement of cognitive fusion within the Acceptance and Commitment Therapy framework. The CFQ has now demonstrated good psychometric properties in multiple languages (English, Spanish, Catalan, Chinese, French, Italian, Dutch, Farsi, Turkish, Polish, and Greek) and cultural contexts, providing solid evidence that cognitive fusion is a transculturally relevant construct related to psychological disorders and behavioral inflexibility. For researchers and clinicians in Colombia and other Spanish-speaking contexts, this study validates the use of the CFQ as a measurement instrument for cognitive fusion, facilitating both research on basic ACT processes and clinical assessment in treatments oriented toward defusion.

---