The incremental validity of cognitive defusion and flexible present-focused attention in predicting adjustment to chronic pain

Background: Research in the context of the Acceptance and Commitment Therapy (ACT) consistently showed that pain acceptance is associated to high emotional well-being and daily functioning in patients with chronic pain. Fewer studies have explored the contribution of other core processes of ACT to pain adjustment. This study explored the incremental validity of cognitive defusion and flexible present-focused attention over pain acceptance in predicting depression and life satisfaction in patients with chronic pain. Methods: Participants were 86 patients with chronic pain (66.3% females; mean age = 54y, SD = 12.8) recruited from the Unit of Anesthesiology and Pain Therapy at the Santa Chiara Hospital of Pisa (Italy). Participants completed self-report measures of pain acceptance, cognitive defusion, flexible attention, depression, and life satisfaction. Results: Pain acceptance, cognitive defusion and flexible attention were significantly related to less depression and higher life satisfaction. Cognitive defusion added unique and significant variance in the prediction of both less depression (18%) and higher life satisfaction (10%). Flexible present-focused attention added unique and significant variance in the prediction of life satisfaction (5%), but it failed to significantly predict depression. Cognitive defusion was the strongest predictor of depression, whilst pain acceptance was the strongest predictor of life satisfaction. Conclusions: Both cognitive defusion and flexible attention processes proved incremental validity over pain acceptance in predicting depression and/or life satisfaction. Findings highlight the importance of taking into account not only acceptance-related processes but also cognitive defusion and attentional abilities in explaining and promoting adjustment to chronic pain.