Abstract
Given that Fibromyalgia Syndrome (FMS) is associated with problems in emotion regulation, the importance of assessing this construct is widely acknowledged by clinical psychologists and pain specialists. Although the Cognitive Emotion Regulation Questionnaire (CERQ) is a self-report measure used worldwide, there are no data on its psychometric properties in patients with FMS. This study analyzed the dimensionality, reliability, and validity of the CERQ in a sample of 231 patients with FMS. Given that “fibrofog” is one of the most disabling FMS symptoms, in the present study, items in the CERQ were grouped by dimension. This change in item presentation was conceived as an efficient way of facilitating responses as a result of a clear understanding of what the items related to each dimension are attempting to measure. The following battery of measures was administered: the CERQ, the Revised Fibromyalgia Impact Questionnaire, the Pain Catastrophizing Scale, the Center for Epidemiologic Studies Depression Scale, and the State-Trait Anxiety Inventory. Four models of the CERQ structure were examined and confirmatory factor analyses supported the original factor model, consisting of nine factors—Self-blame, Acceptance, Rumination, Positive refocusing, Refocus on planning, Positive reappraisal, Putting into perspective, Catastrophizing, and Other-blame. There was minimal overlap between CERQ subscales and their internal consistency was adequate. Correlational and regression analyses supported the construct validity of the CERQ. Our findings indicate that the CERQ (items-grouped version) is a sound instrument for assessing cognitive emotion regulation in patients with FMS.
Highlights
Chronic pain conditions, such as fibromyalgia syndrome (FMS), are amongst the most common health problems managed by general practitioners, rheumatologists, and clinical psychologists (Häuser et al, 2015)
In the confirmatory factor analysis (CFA) involving the one-factor model, we found that it provided a very poor fit to the sample data: χ2(594, N = 229) = 5,564.958, p < 0.001, CFI = 0.527, TLI = 0.498, and RMSEA = 0.191
The hierarchical factor model revealed that the inclusion of two second-order factors produced a worse fit to the data compared to the nine-factor model, χ2(584, N = 229) = 1,519.054, p < 0.001, CFI = 0.911, TLI = 0.904, and RMSEA = 0.084
Summary
Chronic pain conditions, such as fibromyalgia syndrome (FMS), are amongst the most common health problems managed by general practitioners, rheumatologists, and clinical psychologists (Häuser et al, 2015). FMS is characterized by multifocal pain, fatigue, non-restorative sleep, cognitive complaints ( known as fibrofog: lack of attention-concentration, decrease in memory, and loss of vocabulary, which are exacerbated in stressful situations), high levels of distress, and is associated with greater affect intensity, which in turn correlates with more pain and fatigue in those patients with deficient emotion processing skills (van Middendorp et al, 2008; Geenen et al, 2012). According to van Middendorp et al (2008), the strategies to regulate unpleasant emotions such as sadness or anger play an important role in the maintenance or exacerbation of FMS symptoms. Catastrophizing is a critically important risk factor for adverse pain-related outcomes and is directly associated with amplification of pain processing in the brain, whereas Reappraisal has a beneficial impact on an individual’s emotional state. In the long-term, it reduces chronic arousal of the hypothalamic-pituitary-adrenal axis (Edwards et al, 2009; Malfliet et al, 2017)
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