{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T10:57:11Z","timestamp":1770893831239,"version":"3.50.1"},"reference-count":53,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2020,6,6]],"date-time":"2020-06-06T00:00:00Z","timestamp":1591401600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PI17\/00858"],"award-info":[{"award-number":["PI17\/00858"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Differences in fibromyalgia impact on functioning exist and appear to be influenced by numerous factors, including symptomatology severity, as well as the cognitive profile of the individual. The contribution of these elements, however, tends to be explored in a fragmented manner. To address this issue, we tested a comprehensive structural equation model in which associations of cognitive fusion and pain catastrophizing with function limitations are investigated through fibromyalgia symptomatology (i.e., fatigue, pain severity, and depression) in 231 women with fibromyalgia. In the model, cognitive fusion and two catastrophizing components (magnification and helplessness) were associated with poorer functioning indirectly through fibromyalgia symptomatology. Only the rumination component of catastrophizing had a direct association with functional limitations. All fibromyalgia symptoms were linked to increased functional limitations. A parsimonious model with significant associations only obtained an excellent fit (S-B \u03c72 = 774.191, df = 543, p &lt; 0.001; CFI = 0.943; RMSEA = 0.043; CAIC = \u22122724.04) and accounted for 50% of the variance of functional limitations. These results suggest that the relationship between psychological cognitive processes, fibromyalgia symptomatology, and functional limitations is complex and support the need for comprehensive models such as the present. The findings are discussed in the context of personalized psychological treatments (i.e., the need to address certain cognitive processes according to the problematic symptomatology or outcome).<\/jats:p>","DOI":"10.3390\/jcm9061763","type":"journal-article","created":{"date-parts":[[2020,6,9]],"date-time":"2020-06-09T06:34:16Z","timestamp":1591684456000},"page":"1763","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["Associations of Cognitive Fusion and Pain Catastrophizing with Fibromyalgia Impact through Fatigue, Pain Severity, and Depression: An Exploratory Study Using Structural Equation Modeling"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2687-6732","authenticated-orcid":false,"given":"Carmen","family":"\u00c9cija","sequence":"first","affiliation":[{"name":"Department of Psychology, Rey Juan Carlos University, 28922 Alcorc\u00f3n, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Octavio","family":"Luque-Reca","sequence":"additional","affiliation":[{"name":"Department of Psychology, Rey Juan Carlos University, 28922 Alcorc\u00f3n, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2655-1017","authenticated-orcid":false,"given":"Carlos","family":"Suso-Ribera","sequence":"additional","affiliation":[{"name":"Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, 12071 Castell\u00f3 de la Plana, Castell\u00f3, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia","family":"Catala","sequence":"additional","affiliation":[{"name":"Department of Psychology, Rey Juan Carlos University, 28922 Alcorc\u00f3n, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6307-5921","authenticated-orcid":false,"given":"Cecilia","family":"Pe\u00f1acoba","sequence":"additional","affiliation":[{"name":"Department of Psychology, Rey Juan Carlos University, 28922 Alcorc\u00f3n, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,6,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1186\/s12969-019-0375-9","article-title":"Pain, functional disability, and their Association in Juvenile Fibromyalgia Compared to other pediatric rheumatic diseases","volume":"17","author":"Connelly","year":"2019","journal-title":"Pediatr. Rheumatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1007\/s10880-018-9543-1","article-title":"Catastrophizing, Acceptance, and Coping as Mediators Between Pain and Emotional Distress and Disability in Fibromyalgia","volume":"25","author":"Lami","year":"2018","journal-title":"J. Clin. Psychol. Med. Settings"},{"key":"ref_3","first-page":"25","article-title":"Etiopathogenetic mechanisms of fibromyalgia syndrome","volume":"60","author":"Stisi","year":"2008","journal-title":"Reumatismo"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1097\/j.pain.0000000000001468","article-title":"Clustering a large Spanish sample of patients with fibromyalgia using the Fibromyalgia Impact Questionnaire\u2013Revised","volume":"160","author":"Calandre","year":"2019","journal-title":"Pain"},{"key":"ref_5","first-page":"90","article-title":"Fibromyalgia","volume":"37","author":"Fitzcharles","year":"2019","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"357","DOI":"10.2217\/pmt-2016-0003","article-title":"Using a biopsychosocial perspective in the treatment of fibromyalgia patients","volume":"6","author":"Turk","year":"2016","journal-title":"Pain Manag."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Bucourt, E., Martaill\u00e9, V., Goupille, P., Joncker-Vannier, I., Huttenberger, B., R\u00e9veill\u00e8re, C., Mulleman, D., and Courtois, A.R. (2019). A Comparative Study of Fibromyalgia, Rheumatoid Arthritis, Spondyloarthritis, and Sj\u00f6gren\u2019s Syndrome; Impact of the Disease on Quality of Life, Psychological Adjustment, and Use of Coping Strategies. Pain Med.","DOI":"10.1093\/pm\/pnz255"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1667","DOI":"10.1111\/j.1526-4637.2011.01239.x","article-title":"Pain and Functional Capacity in Female Fibromyalgia Patients","volume":"12","author":"Aparicio","year":"2011","journal-title":"Pain Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1002\/acr.20140","article-title":"The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity","volume":"62","author":"Wolfe","year":"2010","journal-title":"Arthritis Care Res. (Hoboken)"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1002\/ejp.1481","article-title":"How and for whom does a positive affect intervention work in fibromyalgia: An analysis of mediators and moderators","volume":"24","author":"Molinari","year":"2019","journal-title":"Eur. J. Pain"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1037\/0022-006X.70.3.678","article-title":"Psychological factors in chronic pain: Evolution and revolution","volume":"70","author":"Turk","year":"2002","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/s10865-006-9085-0","article-title":"The Fear-Avoidance Model of Musculoskeletal Pain: Current State of Scientific Evidence","volume":"30","author":"Leeuw","year":"2006","journal-title":"J. Behav. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"204","DOI":"10.4103\/0253-7176.106012","article-title":"Pain catastrophizing: An updated review","volume":"34","author":"Leung","year":"2012","journal-title":"Indian J. Psychol. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1097\/AJP.0000000000000425","article-title":"Acceptance and Commitment Therapy (ACT) for Chronic Pain","volume":"33","author":"Hughes","year":"2017","journal-title":"Clin. J. Pain."},{"key":"ref_15","unstructured":"Luoma, J.B., Hayes, S.C., and Walser, R.D. (2007). Learning ACT: An Acceptance & Commitment Therapy Skills-Training Manual for Therapists, New Harbinger Publications."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1007\/s12160-017-9877-1","article-title":"Associations Between Pain Catastrophizing and Cognitive Fusion in Relation to Pain and Upper Extremity Function Among Hand and Upper Extremity Surgery Patients","volume":"51","author":"Zale","year":"2017","journal-title":"Ann. Behav. Med."},{"key":"ref_17","first-page":"12847","article-title":"Patients With Fibromyalgia Reporting Severe Pain but Low Impact of the Syndrome: Clinical and Pain-Related Cognitive Features","volume":"20","author":"Slim","year":"2019","journal-title":"Pain Pract."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1097\/AJP.0000000000000227","article-title":"Cognitive Fusion and Pain Experience in Young People","volume":"32","author":"Racine","year":"2016","journal-title":"Clin. J. Pain"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1002\/art.1780330203","article-title":"The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee","volume":"33","author":"Wolfe","year":"1990","journal-title":"Arthritis Rheum."},{"key":"ref_20","first-page":"487","article-title":"Validation of the Spanish version of the Pain Catastrophizing Scale in fibromyalgia","volume":"131","author":"Rodero","year":"2008","journal-title":"Med. Clin. (Barc.)"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1037\/1040-3590.7.4.524","article-title":"The pain catastrophizing scale: Development and validation","volume":"7","author":"Sullivan","year":"1995","journal-title":"Psychol. Assess."},{"key":"ref_22","first-page":"117","article-title":"Cognitive fusion in dementia caregiving: Psychometric properties of the spanish version of the \u201ccognitive fusion questionnaire\u201d","volume":"22","author":"Losada","year":"2014","journal-title":"Behav. Psychol. Psicol. Conduct."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.beth.2013.09.001","article-title":"The development and initial validation of the Cognitive Fusion Questionnaire","volume":"45","author":"GilGillanders","year":"2014","journal-title":"Behav. Ther."},{"key":"ref_24","first-page":"129","article-title":"Pain assessment: Global use of the Brief Pain Inventory","volume":"23","author":"Cleeland","year":"1994","journal-title":"Ann. Acad. Med. Singap."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/0304-3959(96)03078-3","article-title":"The use of multiple-item scales for pain intensity measurement in chronic pain patients","volume":"67","author":"Jensen","year":"1996","journal-title":"Pain"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/S0163-8343(03)00043-4","article-title":"A validation study of the hospital anxiety and depression scale (HADS) in a Spanish population","volume":"25","author":"Herrero","year":"2003","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_27","first-page":"94","article-title":"Multidimensional fatigue inventory: Spanish adaptation and psychometric properties for fibromyalgia patients. The Al-andalus study","volume":"30","author":"Romero","year":"2012","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1186\/s13075-016-0954-9","article-title":"Perceived function and physical performance are associated with pain and fatigue in women with fibromyalgia","volume":"18","author":"Dailey","year":"2016","journal-title":"Arthritis Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"S86","DOI":"10.1002\/acr.20531","article-title":"Measures Applied to the Assessment of Fibromyalgia: Fibromyalgia Impact Questionnaire (FIQ), Brief Pain Inventory (BPI), the Multidimensional Fatigue Inventory (MFI-20), the MOS Sleep Scale, and the Multiple Ability Self-Report Questionnaire (MASQ; cognit","volume":"63","author":"Williams","year":"2011","journal-title":"Arthritis Care Res. (Hoboken)"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1665","DOI":"10.1080\/09638280601055782","article-title":"Assessment of fatigue in patients with fibromyalgia and chronic widespread pain. Reliability and validity of the Swedish version of the MFI-20","volume":"29","author":"Ericsson","year":"2007","journal-title":"Disabil. Rehabil."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1186\/1477-7525-11-132","article-title":"Validation of a Spanish version of the Revised Fibromyalgia Impact Questionnaire (FIQR)","volume":"11","author":"Salgueiro","year":"2013","journal-title":"Heal. Qual. Life Outcomes"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"R120","DOI":"10.1186\/ar2783","article-title":"The Revised Fibromyalgia Impact Questionnaire (FIQR): Validation and psychometric properties","volume":"11","author":"Bennett","year":"2009","journal-title":"Arthritis Res. Ther."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"000140","DOI":"10.1136\/rmdopen-2015-000140","article-title":"Psychometric properties of three single-item pain scales in patients with rheumatoid arthritis seen during routine clinical care: A comparative perspective on construct validity, reproducibility and internal responsiveness","volume":"1","author":"Sendlbeck","year":"2015","journal-title":"RMD Open"},{"key":"ref_34","unstructured":"IBM Corp (2013). IBM SPSS Statistics for Windows, Version 22.0, IBM Corp."},{"key":"ref_35","unstructured":"Bentler, P.M., and Wu, E.J.C. (2002). EQS 6 for Windows User\u2019s Guide, Multivariate Software."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1146\/annurev.psych.58.110405.085530","article-title":"Missing Data Analysis: Making It Work in the Real World","volume":"60","author":"Graham","year":"2009","journal-title":"Annu. Rev. Psychol."},{"key":"ref_37","unstructured":"Garson, G.D. (2012). Structural Equation Modeling, Statistical Associates Publishers."},{"key":"ref_38","unstructured":"Hair, J.F., Black, W.C., Babin, B.J., and Anderson, R.E. (2014). Multivariate Data Analysis, Pearson Education Limited. [7th ed.]."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1177\/002224378101800104","article-title":"Evaluating Structural Equation Models with Unobservable Variables and Measurement Error","volume":"18","author":"Fornell","year":"1981","journal-title":"J. Mark. Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1644","DOI":"10.1016\/j.athoracsur.2015.11.024","article-title":"Adjust for Multiple Comparisons? It\u2019s Not That Simple","volume":"5","author":"Althouse","year":"2016","journal-title":"Ann. Thorac. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1037\/0021-9010.88.5.879","article-title":"Common method biases in behavioral research: A critical review of the literature and recommended remedies","volume":"88","author":"Podsakoff","year":"2003","journal-title":"J. Appl. Psychol."},{"key":"ref_42","first-page":"195","article-title":"Psychological aspects of persistent pain: Current state of the science","volume":"5","author":"Keefe","year":"2004","journal-title":"J. Pain."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1586\/ern.09.34","article-title":"Pain catastrophizing: A critical review","volume":"9","author":"Quartana","year":"2009","journal-title":"Expert. Rev. Neurother."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.rehab.2019.06.017","article-title":"Physical and psychological paths toward less severe fibromyalgia: A structural equation model","volume":"63","author":"McVeigh","year":"2020","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_45","first-page":"9762864","article-title":"Pain Catastrophizing and Its Relationship with Health Outcomes: Does Pain Intensity Matter?","volume":"2017","author":"Arbona","year":"2017","journal-title":"Pain Res. Manag."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1038\/nrrheum.2011.2","article-title":"Pain, catastrophizing, and depression in the rheumatic diseases","volume":"7","author":"Edwards","year":"2011","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1002\/cpp.2386","article-title":"Cognitive fusion and depressive symptoms in women with chronic pain: A longitudinal growth curve modelling study over 12 months","volume":"26","author":"Carvalho","year":"2019","journal-title":"Clin. Psychol. Psychother."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"907","DOI":"10.3389\/fpsyg.2019.00907","article-title":"Reduction in Pain Intensity Is More Strongly Associated With Improved Physical Functioning in Frustration Tolerant Individuals: A Longitudinal Moderation Study in Chronic Pain Patients","volume":"10","author":"Osma","year":"2019","journal-title":"Front. Psychol."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Mungu\u00eda-Izquierdo, D., Pulido-Martos, M., Acosta, F.M., Acosta-Manzano, P., Gavil\u00e1n-Carrera, B., Rodriguez-Ayllon, M., Geenen, R., Delgado-Fern\u00e1ndez, M., \u00c1lvarez-Gallardo, I.C., and Segura-Jim\u00e9nez, V. (2019). Objective and subjective measures of physical functioning in women with fibromyalgia: What type of measure is associated most clearly with subjective well-being?. Disabil. Rehabil., 1\u20138.","DOI":"10.1080\/09638288.2019.1671503"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/j.jpain.2012.05.007","article-title":"Pain measurement and brain activity: Will neuroimages replace pain ratings?","volume":"14","author":"Robinson","year":"2013","journal-title":"J. Pain"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1097\/AJP.0000000000000670","article-title":"The Multimodal Assessment Model of Pain","volume":"35","author":"Wideman","year":"2019","journal-title":"Clin. J. Pain"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.mincom.2017.10.002","article-title":"Description and narrative review of well-established and promising psychological treatments for fibromyalgia","volume":"2","author":"Tuccillo","year":"2017","journal-title":"Mindfulness Compassion"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1146\/annurev-clinpsy-050718-095744","article-title":"Behavioral Conceptualization and Treatment of Chronic Pain","volume":"16","author":"Vlaeyen","year":"2020","journal-title":"Annu. Rev. Clin. Psychol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/6\/1763\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:36:14Z","timestamp":1760175374000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/6\/1763"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,6]]},"references-count":53,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2020,6]]}},"alternative-id":["jcm9061763"],"URL":"https:\/\/doi.org\/10.3390\/jcm9061763","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,6]]}}}