The Parent Psychological Flexibility Questionnaire (PPFQ): Item Reduction and Validation in a Clinical Sample of Swedish Parents of Children with Chronic Pain

Abstract

In pediatric chronic pain, research indicates a positive relation between parental psychological flexibility (i.e., the parent’s willingness to experience distress related to the child’s pain in the service of valued behavior) and level of functioning in the child. This points to the utility of targeting parental psychological flexibility in pediatric chronic pain. The Parent Psychological Flexibility Questionnaire (PPFQ) is currently the only instrument developed for this purpose, and two previous studies have indicated its reliability and validity. The current study sought to validate the Swedish version of the 17-item PPFQ (PPFQ-17) in a sample of parents (n = 263) of children with chronic pain. Factor structure and internal reliability were evaluated by means of principal component analysis (PCA) and Cronbach’s alpha. Concurrent criterion validity was examined by hierarchical multiple regression analyses with parental anxiety and depression as outcomes. The PCA supported a three-factor solution with 10 items explaining 69.5% of the total variance. Cronbach’s alpha (0.86) indicated good internal consistency. The 10-item PPFQ (PPFQ-10) further explained a significant amount of variance in anxiety (29%), and depression (35.6%), confirming concurrent validity. In conclusion, results support the reliability and validity of the PPFQ-10, and suggest its usefulness in assessing psychological flexibility in parents of children with chronic pain.

Something Else Going On? Diagnostic Uncertainty in Children with Chronic Pain and Their Parents

“…Parent Psychological Flexibility. Parent psychological flexibility regarding their child’s pain was assessed using the Parent Psychological Flexibility Questionnaire, 10-item version (PPFQ-10) [ 16 , 17 ]. Items are rated on a 7-point Likert scale, from 0 for “Never” to 6 for “Always”.…”

“…In addition to the total score, the measure includes three subscales: value based action (3 items), emotional acceptance (4 items), and pain willingness (3 items). Items were reverse scored where indicated [ 16 , 17 ] and summed to calculate the total score and three subscales, with higher scores indicating greater psychological flexibility. Internal consistency for the total score within this sample was good (α = 0.83) and ranged from acceptable to good for subscales (value based action α = 0.75, emotional acceptance α = 0.88, pain willingness α = 0.72).…”

“…Of particular relevance to diagnostic uncertainty is a study that found that parents who told a distress (versus resilience) narrative, characterized by more negative affect and an unresolved orientation toward the child’s diagnosis of chronic pain, reported higher levels of catastrophizing about their child’s pain (helplessness subscale) [ 15 ]. Relatedly, parents’ willingness to experience distress in the presence of their child’s pain in the service of valued behavior, termed ‘psychological flexibility’, is linked with both parent protective behavior and child functioning [ 16 , 17 ] and may be influenced by parents’ diagnostic uncertainty. Particularly, parents who feel confident in the accuracy of their child’s diagnosis may be more willing to tolerate the distress associated with their child’s pain.…”

A Clinical Pilot Study of Individual and Group Treatment for Adolescents with Chronic Pain and Their Parents: Effects of Acceptance and Commitment Therapy on Functioning

“…Items are rated on a scale from 0 (never true) to 6 (always true), and examples of items are: “Even though my child has pain we can continue to do things that are important and enjoyable” and “My child’s pain makes it impossible to focus on anything else” (reversed scoring). In this study, we used a 10-item version of the instrument, with seven reversed items and a maximum score of 60, on the basis of a psychometric evaluation and factor analysis of a Swedish version of the instrument [34]. At pre-treatment assessment, Cronbach’s alpha for PPFQ in this sample was 0.82.…”

The Effectiveness of Acceptance and Commitment Therapy on Insomnia Patients (A Single-arm Trial Plan)

“…Psychological flexibility has a positive impact on mental health (9). In fact, psychological flexibility is the core treatment target in ACT (10). Various studies have focused on the effects of ACT on mental disorders; the results of a meta-analysis have shown that ACT impacts anxiety (11); the results of another study show that ACT is a promising treatment for depression (12).…”