Use of the Cognitive Fusion Questionnaire (CFQ) in Research with Informal Caregivers: A Scoping Review

Abstract

Cognitive fusion, a core concept in Acceptance and Commitment Therapy (ACT), refers to the rigid adherence to thoughts, contributing to psychological distress. The Cognitive Fusion Questionnaire (CFQ) is a psychometrically validated tool for measuring this process. This study conducted a scoping review, following PRISMA-ScR and Joanna Briggs Institute guidelines, to map the use of the CFQ in research involving informal caregivers. A search across eight databases yielded 16 studies published between 2014 and 2025, mainly from Spain and the United States. Participants were predominantly women, with a mean age of 62, caring for people with dementia. Most studies had cross-sectional designs, using the Spanish and CFQ-7 versions, with Cronbach’s alphas ranging from 0.79 to 0.97. The most frequent dependent variables were depressive symptoms, anxiety, caregiver burden, and values satisfaction; independent variables included psychological interventions and sociodemographic characteristics. Higher levels of fusion were associated with greater distress, while reduced fusion correlated with improved well-being. ACT-based interventions showed promising results. Limitations included cross-sectional designs and convenience samples. The findings suggest that the CFQ is a useful tool for assessing cognitive fusion in caregivers, but highlight the need for longitudinal and culturally diverse studies to strengthen the evidence base.