Abstract
Objectives
The 39-item Five Facet Mindfulness Questionnaire (FFMQ) has been used extensively to evaluate mindfulness features that contribute to well-being but assessments of its factor structure and incremental validity have been limited across cultures and clinical populations. The present study was designed to (1) identify the optimal FFMQ factor structure for Chinese adults with chronic pain and (2) evaluate the incremental validity of the best-fitting FFMQ structure in predicting emotional distress, independent of key pain-related correlates of distress.
Methods
Participants were Chinese adults with chronic musculoskeletal pain (271 women, 68 men) who completed a back-translated self-report battery that included the FFMQ, measures of demographics, emotional distress, and pain experiences.
Results
Confirmatory factor analyses (CFA) indicated the three-factor 12-item version of the FFMQ (i.e., the MQ-12) was the only version to have uniformly acceptable model fits in the sample. Hierarchical multiple regression analyses indicated MQ-12 “describing one’s experience” and “acting with awareness” components contributed an additional R2 = .05 to R2 = .21 to the prediction of depression, perceived stress, and pain catastrophizing after controlling for other significant predictors. Across models, acting with awareness was the sole MQ-12 facet to have a unique, statistically significant impact.
Conclusions
Findings support use of the MQ-12 in future treatment studies of chronic pain in China and provide foundations for the hypothesis that changes toward improving the acting with awareness facet are especially critical for reducing emotional distress within this group.
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Data Availability
All data are available at the Open Science Framework (https://osf.io/upkdy/quickfiles).
References
Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13(1), 27–45. https://doi.org/10.1177/1073191105283504.
Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Sauer, S., Walsh, E., Duggan, E., & Williams, J. M. G. (2008). Construct validity of the five facet mindfulness questionnaire in meditating and non-meditating samples. Assessment, 15(3), 329–342. https://doi.org/10.1177/1073191107313003.
Baer, R., Gu, J., Cavanagh, K., & Strauss, C. (2019). Differential sensitivity of mindfulness questionnaires to change with treatment: a systematic review and meta-analysis. Psychological Assessment, 31, 1247–1263. https://doi.org/10.1037/pas0000777.
Bair, M. J., Robinson, R. L., Katon, W., & Kroenke, K. (2003). Depression and pain comorbidity: a literature review. Archives of Internal Medicine, 163(20), 2433–2445. https://doi.org/10.1001/archinte.163.20.2433.
Bohlmeijer, E., Ten Klooster, P. M., Fledderus, M., Veehof, M., & Baer, R. (2011). Psychometric properties of the five facet mindfulness questionnaire in depressed adults and development of a short form. Assessment, 18(3), 308–320. https://doi.org/10.1177/1073191111408231.
Brady, B., Kneebone, I. I., & Bailey, P. E. (2019). Validation of the five facet mindfulness questionnaire among community-dwelling older adults. Mindfulness, 10(3), 529–536. https://doi.org/10.1007/s12671-018-0994-0.
Brown, T. (2006). Confirmatory factor analysis for applied research. New York: Guilford.
Carpenter, J. K., Conroy, K., Gomez, A. F., Curren, L. C., & Hofmann, S. G. (2019). The relationship between trait mindfulness and affective symptoms: a meta-analysis of the Five Facet Mindfulness Questionnaire (FFMQ). Clinical Psychology Review, 74, 101785. https://doi.org/10.1016/j.cpr.2019.101785.
Chen, S., & Jackson, T. (2018). Pain beliefs mediate relations between general resilience and dysfunction from chronic back pain. Rehabilitation Psychology, 63(4), 604–611. https://doi.org/10.1037/rep0000244.
Chen, S., Pu, J., Ye, X., Wang, Y., & Jackson, T. (2020). Factor structure, correlates, and incremental validity of the Pain Appraisal Inventory-Short Form. Journal of Health Psychology, 25(9), 1292–1302. https://doi.org/10.1177/1359105317753716.
Christopher, M. S., Neuser, N. J., Michael, P. G., & Baitmangalkar, A. (2012). Exploring the psychometric properties of the Five Facet Mindfulness Questionnaire. Mindfulness, 3, 124–131. https://doi.org/10.1007/s12671-011-0086-x.
Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385–396.
Deng, Y. Q., Liu, X. H., Rodriguez, M. A., & Xia, C. Y. (2011). The five facet mindfulness questionnaire: psychometric properties of the Chinese version. Mindfulness, 2(2), 123–128. https://doi.org/10.1007/s12671-011-0050-9.
Duan, W., & Li, J. (2016). Distinguishing dispositional and cultivated forms of mindfulness: item-level factor analysis of five-facet mindfulness questionnaire and construction of short inventory of mindfulness capability. Frontiers in Psychology, 7, 1348. https://doi.org/10.3389/fpsyg.2016.01348.
Fayaz, A., Croft, P., Langford, R. M., Donaldson, L. J., & Jones, G. T. (2016). Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies. BMJ Open, 6(6), e010364. https://doi.org/10.1136/bmjopen-2015-010364.
Fish, R. A., Hogan, M. J., Morrison, T. G., Stewart, I., & McGuire, B. E. (2013). Willing and able: a closer look at pain willingness and activity engagement on the Chronic Pain Acceptance Questionnaire (CPAQ-8). The Journal of Pain, 14(3), 233–245. https://doi.org/10.1016/j.jpain.2012.11.004.
Harland, N. J., & Georgieff, K. (2003). Development of the Coping Strategies Questionnaire 24, a clinically utilitarian version of the Coping Strategies Questionnaire. Rehabilitation Psychology, 48(4), 296–300. https://doi.org/10.1037/0090-5550.48.4.296.
Hilton, L., Hempel, S., Ewing, B. A., Apaydin, E., Xenakis, L., Newberry, S., Colaiaco, B., Maher, A. R., Shanman, R. M., Sorbero, M. E., & Maglione, M. A. (2017). Mindfulness meditation for chronic pain: aystematic review and meta-analysis. Annals of Behavioral Medicine, 51(2), 199–213. https://doi.org/10.1007/s12160-016-9844-2.
Hou, J., Wong, S. Y. S., Lo, H. H. M., Mak, W. W. S., & Ma, H. S. W. (2014). Validation of a Chinese version of the Five Facet Mindfulness Questionnaire in Hong Kong and development of a short form. Assessment, 21(3), 363–371. https://doi.org/10.1177/1073191113485121.
Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55.
Jackson, D. L., Gillaspy, J. A., & Purc-Stephenson, R. (2009). Reporting practices in confirmatory factor analysis: an overview and some recommendations. Psychological Methods, 6, 934–937. https://doi.org/10.1037/a0014694.
Jackson, T., Chen, H., Iezzi, T., Yee, M., & Chen, F. (2014). Prevalence and correlates of chronic pain in a random population study of adults in Chongqing, China. The Clinical Journal of Pain, 30(4), 346–352. https://doi.org/10.1097/AJP.0b013e31829ea1e3.
Jackson, T., Thomas, S., Stabile, V., Han, X., Shotwell, M., & McQueen, K. (2015). Prevalence of chronic pain in low-income and middle-income countries: a systematic review and meta-analysis. The Lancet, 385, S10. https://doi.org/10.1016/S0140-6736(15)60805-4.
Jackson, T., Yang, Z., & Su, L. (2019). Pain-related gaze biases and later functioning among adults with chronic pain: a longitudinal eye-tracking study. Pain, 160(10), 2221–2228. https://doi.org/10.1097/j.pain.0000000000001614.
Jensen, M. P., Thorn, B. E., Carmody, J., Keefe, F. J., & Burns, J. W. (2018). The role of cognitive content and cognitive processes in chronic pain: an important distinction? The Clinical Journal of Pain, 34(5), 391–401. https://doi.org/10.1097/AJP.0000000000000559.
Karl, J. A., Prado, S. M. M., Gracanin, A., Verhaeghen, P., Ramos, A., Mandal, S. P., Michalak, J., Zhang, C., Schmidt, C., Tran, U. S., Druica, E., Solem, S., Astani, A., Liu, X., Luciano, J. V., Tkalčić, M., Lilja, J. L., Dundas, I., Wong, S. Y. S., & Fischer, R. (2020). The cross-cultural validity of the Five-Facet Mindfulness Questionnaire across 16 countries. Mindfulness, 11, 1226–1237. https://doi.org/10.1007/s12671-020-01333-6.
Kitayama, S., Markus, H. R., Matsumoto, H., & Norasakkunkit, V. (1997). Individual and collective process in the construction of the self: self-enhancement in the United States and self-criticism in Japan. Journal of Personality and Social Psychology, 72, 1245–1267. https://doi.org/10.1037/0022-3514.72.6.1245.
Kline, R. B. (2015). Principles and practice of structural equation modeling (4th ed.). New York: Guilford.
Lee, A. C., Harvey, W. F., Price, L. L., Morgan, L. P., Morgan, N. L., & Wang, C. (2017). Mindfulness is associated with psychological health and moderates pain in knee osteoarthritis. Osteoarthritis and Cartilage, 25(6), 824–831. https://doi.org/10.1016/j.joca.2016.06.017.
Leung, D. Y., Lam, T. H., & Chan, S. S. (2010). Three versions of Perceived Stress Scale: validation in a sample of Chinese cardiac patients who smoke. BMC Public Health, 10(1), 513–519. https://doi.org/10.1186/1471-2458-10-513.
Liao, K. Y. H., Henceroth, M., Lu, Q., & LeRoy, A. (2016). Cultural differences in pain experience among four ethnic groups: a qualitative pilot study. Journal of Behavioral Health, 5(2), 75–81. https://doi.org/10.5455/jbh.20160204094059.
Liu, Y., Wang, L., Wei, Y., Wang, X., Xu, T., & Sun, J. (2016). Validation of a Chinese version of the Chronic Pain Acceptance Questionnaire (CAPQ) and CPAQ-8 in chronic pain patients. Medicine, 95(33), e4339. https://doi.org/10.1097/MD.0000000000004339.
Mansfield, K. E., Sim, J., Jordan, J. L., & Jordan, K. P. (2016). A systematic review and meta-analysis of the prevalence of chronic widespread pain in the general population. Pain, 157(1), 55–64. https://doi.org/10.1097/j.pain.0000000000000314.
Mattes, J. (2019). Systematic review and meta-analysis of correlates of FFMQ mindfulness facets. Frontiers in Psychology, 10, 2684. https://doi.org/10.3389/fpsyg.2019.02684.
Myers, N. D., Ahn, S., & Jin, Y. (2011). Sample size and power estimates for a confirmatory factor analytic model in exercise and sport: a Monte Carlo approach. Research Quarterly for Exercise and Sport, 82, 412–423. https://doi.org/10.1080/02701367.2011.10599773.
Ng, T. S. (2019). Racial differences in experimental pain sensitivity and conditioned pain modulation: a study of Chinese and Indians. Journal of Pain Research, 12, 2193–2200. https://doi.org/10.2147/JPR.S197803.
Podsakoff, P. M., MacKenzie, S. B., Lee, J. Y., & Podsakoff, N. P. (2003). Common method biases in behavioral research: a critical review of the literature and recommended remedies. Journal of Applied Psychology, 88(5), 879–903. https://doi.org/10.1037/0021-9010.88.5.879.
Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401. https://doi.org/10.1177/014662167700100306.
Rosenstiel, A. K., & Keefe, F. J. (1983). The use of coping strategies in chronic low back pain patients: relationship to patient characteristics and current adjustment. Pain, 17(1), 33–44. https://doi.org/10.1016/0304-3959(83)90125-2.
Schütze, R., Rees, C., Preece, M., & Schütze, M. (2010). Low mindfulness predicts pain catastrophizing in a fear-avoidance model of chronic pain. Pain, 148(1), 120–127. https://doi.org/10.1016/j.pain.2009.10.030.
Snyder, C. R. (1999). Coping: the psychology of what works. New York: Oxford University Press.
Sullivan, M. J., Bishop, S. R., & Pivik, J. (1995). The pain catastrophizing scale: development and validation. Psychological Assessment, 7(4), 524–532. https://doi.org/10.1037/1040-3590.7.4.524.
Sullivan, M. J., Lynch, M. E., & Clark, A. J. (2005). Dimensions of catastrophic thinking associated with pain experience and disability in patients with neuropathic pain conditions. Pain, 113(3), 310–315. https://doi.org/10.1016/j.pain.2004.11.003.
Turner, J. A., Anderson, M. L., Balderson, B. H., Cook, A. J., Sherman, K. J., & Cherkin, D. C. (2016). Mindfulness-based stress reduction and cognitive-behavioral therapy for chronic low back pain: similar effects on mindfulness, catastrophizing, self-efficacy, and acceptance in a randomized controlled trial. Pain, 157(11), 2434–2444. https://doi.org/10.1097/j.pain.0000000000000635.
Veehof, M. M., Peter, M., Taal, E., Westerhof, G. J., & Bohlmeijer, E. T. (2011). Psychometric properties of the Dutch Five Facet Mindfulness Questionnaire (FFMQ) in patients with fibromyalgia. Clinical Rheumatology, 30(8), 1045–1054. https://doi.org/10.1007/s10067-011-1690-9.
Veehof, M. M., Trompetter, H. R., Bohlmeijer, E. T., & Schreurs, K. M. (2016). Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review. Cognitive Behavior Therapy, 45, 5–31. https://doi.org/10.1080/16506073.2015.1098724.
Von Korff, M., Ormel, J., Keefe, F. J., & Dworkin, S. F. (1992). Grading the severity of chronic pain. Pain, 50, 133–149.
Watson-Singleton, N. N., Walker, J. H., LoParo, D., Mack, S. A., & Kaslow, N. J. (2018). Psychometric evaluation of the five facet mindfulness questionnaire in a clinical sample of African Americans. Mindfulness, 9(1), 312–324. https://doi.org/10.1007/s12671-017-0776-0.
Wong, W. S., & Fielding, R. (2011). Prevalence and characteristics of chronic pain in the general population of Hong Kong. The Journal of Pain, 12(2), 236–245. https://doi.org/10.1016/j.jpain.2010.07.004.
Wong, S., Chan, F., Wong, R. L. P., Chu, M. C., Lam, Y. Y. K., Mercer, S. W., & Ma, S. H. (2011). Comparing the effectiveness of mindfulness-based stress reduction and multidisciplinary intervention programs for chronic pain: a randomized comparative trial. The Clinical Journal of Pain, 27(8), 724–734. https://doi.org/10.1097/AJP.0b013e3182183c6e.
Yap, J. C., Lau, J., Chen, P. P., Gin, T., Wong, T., Chan, I., Chu, J., & Wong, E. (2008). Validation of the Chinese Pain Catastrophizing Scale (HK-PCS) in patients with chronic pain. Pain Medicine, 9(2), 186–195. https://doi.org/10.1111/j.1526-4637.2007.00307.x.
Funding
This research was supported by grants from the China National Natural Sciences Foundation (#31671142 and #31871141) and a Chongqing 100 Persons fellowship to the corresponding author as well as Chongqing Graduate Research and Innovation Project (CYB 19103) and China Scholarship Council (#201906990064) grants to the first author.
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SC: designed the study, performed all data analyses, and wrote initial drafts of many paper sections. BY: collected the data. TJ: contributed to the study design and wrote final versions of most paper sections. All authors approved the final manuscript version.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Human Research Ethics Committee of Southwest University, Chongqing.
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Chen, S., You, B. & Jackson, T. Facets of Mindfulness as Predictors of Emotional Distress Among Chinese Adults with Chronic Musculoskeletal Pain. Mindfulness 12, 775–783 (2021). https://doi.org/10.1007/s12671-020-01548-7
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DOI: https://doi.org/10.1007/s12671-020-01548-7