Cognitive distortions of somatic experiences: Revision and validation of a measure

doi:10.1016/S0022-3999(97)00020-2

Journal of Psychosomatic Research

Volume 43, Issue 3, September 1997, Pages 293-306

https://doi.org/10.1016/S0022-3999(97)00020-2 Get rights and content

Abstract

The article reports on the revision of the Cognitive Errors Questionnaire (CEQ). The CEQ which was originally developed to measure cognitive distortions specific to chronic pain, has been significantly shortened and made applicable to a wider range of somatic problems. The Cognitive Errors Questionnaire-Revised (CEQ-R) contains two subscales: Somatic—distortions specific to somatic experiences; and General—distortions to everyday life events. Validation of the scale with CFS, depressed, and chronic pain groups and healthy controls confirms the CEQ-R loads onto general and somatic factors. Both subscales have high internal consistency and good test-retest reliability. The pattern of subjects' responses to the CEQ-R scores showed that the depressed group scored significantly higher on the General CEQ-R scale than the other groups, whereas the CFS and chronic pain groups scored higher than healthy controls on the Somatic CEQ-R. Somatic CEQ-R scores showed a significant decrease over the course of a pain management program, with a concomitant decrease in disability and depression scores. Further analyses showed the Somatic CEQ-R to be significantly related to self and symptom focusing, whereas the General CEQ-R was found to be significantly correlated with higher depression, lower self-esteem, and self focusing. The CEQ-R may be a useful instrument to examine the relationship between cognitive distortions and disability in a variety of illnesses, and to differentiate primary depression from overlapping somatic disorders.

References (40)

MP Jensen et al.
Coping with chronic pain: a critical review of the literature
Pain
(1991)
CJ Main et al.
A comparison of cognitive measures in low back pain: statistical structure and clinical validity
Pain
(1991)
K Petrie et al.
The impact of catastrophic beliefs on functioning in chronic fatigue syndrome
J Psychom Res
(1995)
SK Johnson et al.
Depression in fatiguing illness: comparing patients with chronic fatigue syndrome, multiple sclerosis and depression
J Affect Disord
(1996)
R Powell et al.
Attributions and self esteem in depression and chronic fatigue syndromes
J Psychom Research
(1990)
J Russo et al.
Severity of somatization and its relationship to psychiatric disorders and personality
Psychosomatics
(1994)
C Ray et al.
Ways of coping with chronic fatigue syndrome: development of an illness management questionnaire
Soc Sci Med
(1993)
RC Tait et al.
The Pain Disability Index: psychometric properties
Pain
(1990)
R Moss-Morris
The role of illness cognitions and coping in the aetiology and maintenance of the chronic fatigue syndrome
DC Turk et al.
Assessment of cognitive factors in chronic pain: a worthwhile enterprise?
J Consult Clin Psychol
(1986)

DC Turk et al.

Cognitive factors and persistent pain: a glimpse into Pandora's box

Cognit Ther Res

(1992)

AT Beck

Depression: clinical, experimental and theoretical aspects

(1967)

AT Beck et al.

Cognitive therapy of depression: a treatment manual

(1978)

AK Rosenthiel et al.

The use of coping strategies in chronic low back pain patients: relationship to patients' characteristics and current adjustment

Pain

(1983)

JC Lefebvre et al.

Pain in young adults: the use and perceived effectiveness of pain-coping strategies

Clin J Pain

(1995)

GM Coughlan et al.

Attrition from a pain management programme

Br J Clin Psychol

(1995)

MP Jensen et al.

Correlates of improvement in multidisciplinary treatment of chronic pain

J Consult Clin Psychol

(1994)

MJL Sullivan et al.

Relation between catastrophizing and depression in chronic pain patients

J Abnorm Psychol

(1990)

JC Lefebvre

Cognitive distortion and cognitive errors in depressed psychiatric and low back pain patients

J Consult Clin Psychol

(1981)

TW Smith et al.

Cognitive distortion and depression in chronic pain: association with diagnosed disorders

J Consult Clin Psychol

(1994)

Cited by (33)

Development and initial validity of the Exercise-Related Cognitive Errors Questionnaire
2016, Psychology of Sport and Exercise
Citation Excerpt :
Evidence within the study of health behaviour has demonstrated that biased or irrational beliefs might exacerbate the failure to follow good health practices. They have been related to behavioural failures such as: poor adherence to treatment regimens (Anderson & Emery, 2014; Meichenbaum & Turk, 1987), poor health practices (Christensen, Moran, & Wiebe, 1999), disability status (Smith, Follick, Ahern, & Adams, 1986), and excessive or inadequate rest leading to extreme cycles of activity (Moss-Morris & Petrie, 1997; Petrie, Moss-Morris, & Weinman, 1995; Spence, Moss-Morris, & Chalder, 2005). Psychologically, they have been related to lower confidence to self-manage one's chronic disease symptoms (Shnek et al., 1997), body dissatisfaction and weight pre-occupation (Jakatdar, Cash, & Engle, 2006), This evidence illustrates that biased or irrational beliefs may distort the processing and interpretation of health-relevant information and be related to subsequent poor health behaviours.
Cognitive errors (CEs) reflect individuals' biased evaluations of context-relevant information. In the exercise domain, a valid form of exercise CE assessment is needed. The Exercise-related Cognitive Errors Questionnaire (E-CEQ) was developed to determine to what extent adults make cognitive errors regarding exercise decisions. The purpose of this study was to develop and provide initial validity evidence for the E-CEQ.
The current study used an online self-report survey.
First, 24 initial vignettes representing 6 CEs were created and content validated. Second, data from 364 adults (M_age = 29.1, SD_age = 11.6; 81.3% female) was gathered to examine the E-CEQ's factor structure. Finally, data from the 364 participants was used to examine aspects of criterion-related validity.
A 16-item, three-factor model was retained as the final E-CEQ factor structure and had good psychometric properties (χ² = 164.35, df = 75, p < .001; RMSEA = .057; CFI = .947; TLI = .915). Evidence of the questionnaire's predictive utility is provided. For example, exercise CEs were negatively related to exercise and accounted for 4.9% of additional variance beyond the contribution of past exercise in predicting exercise intention.
The steps taken to examine different forms of validity helped provide a platform from which to continue (a) to study biases linked to cognitive errors and (b) the E-CEQ validation process through ongoing investigation.
The role of cognitive distortion in online game addiction among Chinese adolescents
2013, Children and Youth Services Review
Citation Excerpt :
Cognitive distortions have been described as errors of logic in interpreting situations, which include selective abstract-focusing, overgeneralization, personalization, catastrophic thinking, and all-or-nothing thinking (Beck, Rush, Shaw, & Emery, 1979). Given the important role of cognitive distortion in the development of serious medical conditions, such as major depression, anxiety, chronic pain, substance abuse, and pathological gambling, this area of interest has gained increased attention among psychologists and psychiatrists (MacKillop, Anderson, Castelda, Mattson, & Donovick, 2006; Moss-Morris & Petrie, 1997; Nasir, Zamani, Yusooff, & Khairudin, 2010). However, very few studies have explored the role of cognitive distortion in the development of online game addiction, nor prevention programs been developed that focus on adjusting cognitive distortions in order to reduce online game addiction among adolescents.
The aim of the present study was to examine the role of cognitive distortions in the development of on-line game addiction among Chinese adolescents. In Study 1, the sample comprised 495 adolescents aged 12 to 19 who recruited from two middle schools in Guangzhou, China. They were administered questionnaires relating background variables, the Internet Addiction Scale (IAS), Cognitive Distortions Scale (CDS) and Online Game Cognitive Addiction Scale (OGCAS). In Study 2, Twenty eight adolescents with excessive on-line game play recruited from a local mental hospital were randomly divided into to a CBT group (N = 14) and a clinical control group (N = 14). Measures of severity of on-line game playing, anxiety, depression, and cognitive distortions were assessed on baseline and after the 6 week intervention. Results of the present study showed that rumination and short-term thinking were the most predictors of online game addiction, and all-or-nothing thinking predict online game addiction at marginal significant levels. Males are at a greater risk of developing online game addiction than do females. CBT and basic counseling had different treatment effects on the all-or-nothing thinking scores, online comfort scores and short-term thinking scores, SDS scores and SAS scores. Interestingly, CBT and basic counseling had similar treatment effects on IAS scores and OGCAS scores. Applications of these findings to etiological research and clinical treatment programs are discussed.
The measurement of abnormal illness behavior: Toward a new research agenda for the Illness Behavior Questionnaire
2008, Journal of Psychosomatic Research
Citation Excerpt :
For example, higher IBQ scores may be associated with more health concern and a greater inclination to make somatic attributions for physical sensations and to misinterpret somatic information. Comparisons of scores obtained on the IBQ with those on existing instruments such as the Health Anxiety Inventory [82], Symptom Interpretation Questionnaire [40], Cognitive Errors Questionnaire–Revised [41], and Illness Attitudes Scale [83] may help to clarify the degree of empirical and conceptual overlap among these constructs. Moreover, theoretical frameworks such as the cognitive–behavioral model of health anxiety upon which the Health Anxiety Inventory is based may help to better characterize the dimensions of AIB, particularly in terms of overt illness behaviors.
Abnormal illness behavior (AIB) refers to a maladaptive manner of experiencing, evaluating, or acting in response to health and illness that is disproportionate to evident pathology. The construct was originally informed by the sociological notions of the sick role and illness behavior. The present article provides a comprehensive review of the conceptual and empirical development of AIB with a detailed insight into the variety of illness contexts to which it has been applied using the Illness Behavior Questionnaire (IBQ). While the relevance of AIB continues to be demonstrated within the prescribed contexts of the chronic pain and psychiatric literatures, criticisms of AIB and its measurement have arisen when researchers have attempted to move beyond these contexts. In recognition of these criticisms, this article presents a new research agenda to address key limitations that currently impede the broader development and application of AIB. Most importantly, it is proposed that greater consideration needs to be given to the definition of AIB according to type of illness and for general community members without a current illness. The article concludes with comment on the potential practical implications of any future reconceptualization of AIB, including the need to reconsider the manner in which IBQ scores are derived and interpreted, and the need for caution when applying the label “abnormal” in specific illness contexts.
Fatigue and social impairment in multiple sclerosis: The role of patients' cognitive and behavioral responses to their symptoms
2006, Journal of Psychosomatic Research
The aim of this study was to test whether the way in which multiple sclerosis (MS) patients interpret and respond to their symptoms may help to explain their experience of fatigue and social impairment.
In a cross-sectional study, 149 patients with a definite diagnosis of MS completed validated questionnaires that measured their symptom interpretation and behavioral response, fatigue, mood, and social adjustment. A neurologist assessed their level of neurological impairment.
Regression analyses revealed that patients' cognitive interpretations of their symptoms, such as a tendency to attribute a wide range of symptoms to their MS and feelings of embarrassment about symptoms, were significantly associated with fatigue and social adjustment over and above neurological impairment, remission status, and mood. The behavioral variables including an all-or-nothing response to symptoms and rest/avoidance behaviours were also strongly associated with fatigue and social impairment. The degree of neurological deficit was not associated with either physical or mental fatigue, although it was associated with social impairment. Depression, anxiety, and remission status were also related to fatigue, and depression to social impairment.
These findings suggest that treatment approaches that challenge unhelpful cognitive interpretations and behavioural responses to symptoms, and address anxiety and depression, may be important in improving the overall management of fatigue in MS.
The reluctance to generalize corrective experiences in chronic low back pain patients: A questionnaire study of dysfunctional cognitions
2005, Behaviour Research and Therapy
Citation Excerpt :
In our vignette study, personalization related to LBP was not included. Previous research has found that this dysfunctional cognition loaded onto the general CEQ factor rather than on the somatic CEQ factor (Moss-Morris & Petrie, 1997). It was replaced by a new dysfunctional cognition, namely the lack of generalization of corrective experiences.
The present study investigated whether pain catastrophizing and pain-related fear is related to a reluctance to generalize an experience of lesser pain than expected to other similar situations. Eighty-five patients with chronic low back pain (40 males; 45 females; age range=21–63 years) completed a series of vignettes assessing catastrophizing, overgeneralization, personalization and selective abstraction related to general life experiences and to low back pain (LBP) experiences. Three vignettes also assessed the lack of generalization of corrective experiences related to LBP. Our results showed that dysfunctional cognitions related to general life experiences were the strongest predictor of the self-denigration subscale of the Beck Depression Inventory (BDI), whereas only dysfunctional cognitions related to LBP had a unique contribution in the prediction of the somatic and physical function subscale of the BDI. Furthermore, dysfunctional cognitions related to LBP were significantly correlated with interference with daily life due to pain. As predicted, pain catastrophizing and pain-related fear had a unique contribution in predicting the lack of generalization of corrective experiences, over and above sociodemogaphic variables, pain severity and pain duration.
Functional somatic syndromes
2004, Psychology in the Physical and Manual Therapies

View all citing articles on Scopus

View full text

Original articleCognitive distortions of somatic experiences: Revision and validation of a measure

Abstract

Pain

Pain

J Psychom Res

J Affect Disord

J Psychom Research

Psychosomatics

Soc Sci Med

Pain

The role of illness cognitions and coping in the aetiology and maintenance of the chronic fatigue syndrome

Assessment of cognitive factors in chronic pain: a worthwhile enterprise?

J Consult Clin Psychol

Cognitive factors and persistent pain: a glimpse into Pandora's box

Cognit Ther Res

Depression: clinical, experimental and theoretical aspects

Cognitive therapy of depression: a treatment manual

The use of coping strategies in chronic low back pain patients: relationship to patients' characteristics and current adjustment

Pain

Pain in young adults: the use and perceived effectiveness of pain-coping strategies

Clin J Pain

Attrition from a pain management programme

Br J Clin Psychol

Correlates of improvement in multidisciplinary treatment of chronic pain

J Consult Clin Psychol

Relation between catastrophizing and depression in chronic pain patients

J Abnorm Psychol

Cognitive distortion and cognitive errors in depressed psychiatric and low back pain patients

J Consult Clin Psychol

Cognitive distortion and depression in chronic pain: association with diagnosed disorders

J Consult Clin Psychol

Original article
Cognitive distortions of somatic experiences: Revision and validation of a measure