Examining Committed Action in Chronic Pain: Further Validation and Clinical Utility of the Committed Action Questionnaire


      • We investigated the Committed Action Questionnaire in patients with chronic pain.
      • We included 149 patients with pain in the analyses.
      • Results of the analyses showed support for the 2-factor model.
      • The 2 factors were significantly associated with psychosocial functioning.


      Psychosocial treatments for chronic pain conditions, such as Acceptance and Commitment Therapy, have highlighted minimizing pain avoidance behaviors and increasing engagement in valued activities as key treatment targets. In terms of salient processes within Acceptance and Commitment Therapy, committed action is considered essential to the pursuit of a meaningful life, as it entails a flexible persistence over time in living consistently with one's values. To date, however, only 1 study has examined the association between measures of committed action and important aspects of pain-related functioning. The purpose of the present study was to analyze the reliability of the Committed Action Questionnaire (CAQ) in a sample of 149 chronic pain patients, perform a confirmatory analysis of its factor structure, and examine how CAQ scores uniquely account for variance in functioning. Confirmatory factor analyses provided support for a 2-factor model, and regression analyses, which examined the cross-sectional direct effects of the 2 subscales on health-related functioning, indicated that the CAQ accounted for significant variance in functioning after controlling for relevant covariates. Overall, these findings provide further support for the CAQ as a measure of adaptive functioning in those with longstanding pain.


      This article presents additional evidence for the reliability and validity of the CAQ with chronic pain patients. Confirmatory factor analyses provided support for the 2-factor model, with both subscales demonstrating significant associations with multiple facets of health- and pain-related functioning.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Pain
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • American Psychiatric Association
        Diagnostic and Statistical Manual of Mental Disorders, Text Revision: Diagnostic and Statistical Manual of Mental Disorders-TR.
        American Psychiatric Association, Washington, DC2000
      1. American Psychological Association’s Society of Clinical Psychology: Research-supported psychological treatments: Chronic or persistent pain. Available at:

        • Baraldi A.N.
        • Enders C.K.
        An introduction to modern missing data analyses.
        J School Psychol. 2010; 48: 5-37
        • Bergner M.
        • Bobbitt R.A.
        • Carter W.B.
        • Gilson B.S.
        The Sickness Impact Profile: Development and final revision of a health status measure.
        Med Care. 1981; 19: 787-805
        • Browne M.W.
        • Cudeck R.
        Alternative ways of assessing model fit.
        in: Bollen K.A. Long J.S. Testing Structural Models. Sage Publications, Newbury Park, CA1993: 136-162
        • Cheung G.W.
        • Rensvold R.B.
        Evaluating goodness-of-fit indexes for testing measurement invariance.
        Struct Equ Modeling. 2002; 9: 233-255
        • Cohen J.
        A power primer.
        Psychol Bulletin. 1992; 112: 155-159
        • DeVellis R.F.
        Scale Development: Theory and Applications.
        SAGE publications, Thousand Oaks, CA2012
        • Erdfelder E.
        • Faul F.
        • Buchner A.
        G*Power: A general power analysis program.
        Behav Res Methods. 1996; 28: 175-191
        • Everitt B.
        • Skrondal A.
        The Cambridge Dictionary of Statistics.
        4th ed. Cambridge University Press, Cambridge, UK2010
        • Fish R.A.
        • Hogan M.J.
        • Morrison T.G.
        • Stewart I.
        • McGuire B.E.
        Willing and able: A closer look at pain willingness and activity engagement on the Chronic Pain Acceptance Questionnaire (CPAQ-8).
        J Pain. 2013; 14: 233-245
        • Fordyce W.E.
        Behavioral Methods for Chronic Pain And Illness.
        Mosby, St. Louis1976
        • Gatchel R.J.
        Comorbidity of chronic pain and mental health disorders: The biopsychosocial perspective.
        Am Psychol. 2004; 59: 795-805
        • Gatchel R.J.
        • McGeary D.D.
        • McGeary C.A.
        • Lippe B.
        Interdisciplinary chronic pain management: Past, present, and future.
        Am Psychol. 2014; 69: 119-130
        • Hallgren K.A.
        • Witkiewitz K.
        Missing data in alcohol clinical trials: A comparison of methods.
        Alcohol Clin Exp Res. 2013; 37: 2152-2160
        • Hayes S.C.
        • Strosahl K.
        • Wilson K.G.
        Acceptance and Commitment Therapy: The Process and Practice of Mindful Change.
        2nd ed. Guilford Press, New York2012
        • Hu L.T.
        • Bentler P.M.
        Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives.
        Struct Equ Modeling. 1999; 6: 1-55
        • Iverson G.L.
        • Remick R.
        Diagnostic accuracy of the British Columbia Major Depression Inventory.
        Psychol Rep. 2004; 95: 1241-1247
        • Jackson D.L.
        • Gillaspy J.A.
        • Purc-Stephenson R.
        Reporting practices in confirmatory factor analysis: An overview and some recommendations.
        Psychol Methods. 2009; 14: 6
        • Jensen M.P.
        • Johnson L.E.
        • Gertz K.J.
        • Vowles K.E.
        Living well with pain: Development and preliminary evaluation of the valued living scale.
        Pain Med. 2015; 16: 2109-2120
        • Kline R.B.
        Principles and Practice of Structural Equation Modeling.
        3rd ed. Guilford Press, New York2011
        • Leeuw M.
        • Houben R.M.
        • Severeijns R.
        • Picavet H.S.
        • Schouten E.G.
        • Vlaeyen J.W.
        Pain-related fear in low back pain: A prospective study in the general population.
        Eur J Pain. 2007; 11: 256-266
        • Lethem J.
        • Slade P.
        • Troup J.
        • Bentley G.
        Outline of a fear-avoidance model of exaggerated pain perception.
        Behav Res Ther. 1983; 21: 401-408
        • Luoma J.B.
        • Hayes S.C.
        • Walser R.D.
        • Learning A.C.T.
        An acceptance and commitment therapy skills-training manual for therapists.
        New Harbinger Publications, Oakland, CA2007
        • McCracken L.M.
        Committed action: An application of the psychological flexibility model to activity patterns in chronic pain.
        J Pain. 2013; 14: 828-835
        • McCracken L.M.
        • Dhingra L.
        A short version of the Pain Anxiety Symptoms Scale (PASS–20): Preliminary development and validity.
        Pain Res Manag. 2002; 7: 45-50
        • McCracken L.M.
        • Vowles K.E.
        A prospective analysis of acceptance of pain and values-based action in patients with chronic pain.
        Health Psychol. 2008; 27: 215-220
        • McCracken L.M.
        • Yang S.Y.
        The role of values in a contextual cognitive-behavioral approach to chronic pain.
        Pain. 2006; 123: 137-145
        • Moseley G.L.
        • Vlaeyen J.W.
        Beyond nociception: The imprecision hypothesis of chronic pain.
        Pain. 2015; 156: 35-38
      2. Muthén LK, Muthén BO. Mplus User's Guide. Seventh Edition. Los Angeles, CA, Muthén & Muthén, 1998-2015

        • Noble M.
        • Tregear S.J.
        • Treadwell J.R.
        • Schoelles K.
        Long-term opioid therapy for chronic noncancer pain: A systematic review and meta-analysis of efficacy and safety.
        J Pain Symptom Manage. 2008; 35: 214-228
        • Roelofs J.
        • McCracken L.
        • Peters M.L.
        • Crombez G.
        • van Breukelen G.
        • Vlaeyen J.W.
        Psychometric evaluation of the Pain Anxiety Symptoms Scale (PASS) in chronic pain patients.
        J Behav Med. 2004; 27: 167-183
        • Schriesheim C.A.
        • Eisenbach R.J.
        An exploratory and confirmatory factor-analytic investigation of item wording effects on the obtained factor structures of survey questionnaire measures.
        J Manage. 1995; 21: 1177-1193
        • Tabachnick B.G.
        • Fidell L.S.
        Chapter 13: Prinicipal components and factor analysis.
        in: Tabachnick B.G. Fidell L.S. Using Multivariate Statistics. Pearson, Boston, MA2001: 607-675
        • Ullman J.
        Chapter 14: Structural equation modeling.
        in: Tabachnick B.G. Fidell L.S. Using Multivariate Statistics. Pearson, Boston, MA2001: 715
        • Vlaeyen J.W.
        • Linton S.J.
        Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art.
        Pain. 2000; 85: 317-332
        • Vowles K.E.
        • Gross R.T.
        • McCracken L.M.
        Evaluating outcomes in the interdisciplinary treatment of chronic pain: A guide for practicing clinicians.
        in: Schatman M.E. Campbell A. Chronic Pain Management: Guidelines for Multidisciplinary Program Development. Informa, New York2007: 203-220
        • Vowles K.E.
        • McCracken L.M.
        • O’Brien J.Z.
        Acceptance and values-based action in chronic pain: A three-year follow-up analysis of treatment effectiveness and process.
        Behav Res Ther. 2011; 49: 748-755
        • Vowles K.E.
        • McCracken L.M.
        • Sowden G.
        • Ashworth J.
        Psychological flexibility in coping with chronic pain: Further examination of the Brief Pain Coping Inventory-2.
        Clin J Pain. 2014; 30: 324-330
        • Vowles K.E.
        • Sowden G.
        • Ashworth J.
        A comprehensive examination of the model underlying acceptance and commitment therapy for chronic pain.
        Behav Ther. 2014; 45: 390-401
        • Vowles K.E.
        • Witkiewitz K.
        • Sowden G.
        • Ashworth J.
        Acceptance and commitment therapy for chronic pain: Evidence of mediation and clinically significant change following an abbreviated interdisciplinary program of rehabilitation.
        J Pain. 2014; 15: 101-113