The journal of spinal cord medicine · 2026
Cognitive fusion as a mediator between pain interference and depressive and anxiety symptoms among adults with spinal cord injury.
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Han Areum, Hong Ickpyo, Wilroy Jereme D, Oruche Ukamaka
Аннотация
CONTEXT/OBJECTIVE: This study examined whether cognitive fusion statistically mediated the cross-sectional associations of pain interference with depressive and anxiety symptoms among individuals with spinal cord injury (SCI).
DESIGN: Cross-sectional mediation models estimated using path analysis were used to test cognitive fusion as a mediator between pain interference and depressive or anxiety symptoms.
SETTING: Online survey completed by adults with SCI in the United States.
PARTICIPANTS: 156 adults (51.3% female; mean age = 42.1 years) with traumatic (78.2%) or non-traumatic (21.8%) SCI.
OUTCOME MEASURES: Pain interference was measured using the spinal cord injury - Quality of Life (SCI-QOL) Pain Interference Short Form. Cognitive fusion was assessed with the Cognitive Fusion Questionnaire-7. Depressive and anxiety symptoms were measured using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7, respectively. Grief due to SCI, measured using the SCI-QOL Grief and Loss Short form, was retained as a covariate.
RESULTS: Pain interference was significantly associated with higher cognitive fusion and greater depressive and anxiety symptoms. After controlling for SCI-related grief, cognitive fusion partially mediated these relationships, accounting for 45.4% of the total effect of pain interference on depressive symptoms and 42.3% of the total effect on anxiety.
CONCLUSION: Cross-sectional path analyses supported an indirect statistical association between pain interference and depressive/anxiety symptoms through cognitive fusion. These findings highlight cognitive fusion as a critical, modifiable psychological mechanism underlying this relationship. Targeting cognitive fusion in interventions such as acceptance and commitment therapy may help mitigate the psychological impact of pain interference and improve mental health.
DESIGN: Cross-sectional mediation models estimated using path analysis were used to test cognitive fusion as a mediator between pain interference and depressive or anxiety symptoms.
SETTING: Online survey completed by adults with SCI in the United States.
PARTICIPANTS: 156 adults (51.3% female; mean age = 42.1 years) with traumatic (78.2%) or non-traumatic (21.8%) SCI.
OUTCOME MEASURES: Pain interference was measured using the spinal cord injury - Quality of Life (SCI-QOL) Pain Interference Short Form. Cognitive fusion was assessed with the Cognitive Fusion Questionnaire-7. Depressive and anxiety symptoms were measured using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7, respectively. Grief due to SCI, measured using the SCI-QOL Grief and Loss Short form, was retained as a covariate.
RESULTS: Pain interference was significantly associated with higher cognitive fusion and greater depressive and anxiety symptoms. After controlling for SCI-related grief, cognitive fusion partially mediated these relationships, accounting for 45.4% of the total effect of pain interference on depressive symptoms and 42.3% of the total effect on anxiety.
CONCLUSION: Cross-sectional path analyses supported an indirect statistical association between pain interference and depressive/anxiety symptoms through cognitive fusion. These findings highlight cognitive fusion as a critical, modifiable psychological mechanism underlying this relationship. Targeting cognitive fusion in interventions such as acceptance and commitment therapy may help mitigate the psychological impact of pain interference and improve mental health.