Cognitive fusion as a mediator between pain interference and depressive and anxiety symptoms among adults with spinal cord injury

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.