The nomological network of cognitive fusion among people living with HIV: Associations with rumination, shame, and depressive symptoms

There is little research examining the interrelationships between cognitive fusion and the conceptually related constructs of shame, rumination, and self-compassion, especially among people living with HIV (PLWH). Given that PLWH are at risk for depression and anxiety, it is important to understand the nomological network of cognitive fusion and related risk factors for these internalizing symptoms among PLWH. The purpose of this study is to examine the extent to which cognitive fusion is associated with these related constructs among a sample of PLWH presenting to an outpatient behavioral health clinic (N = 111). Cognitive fusion was associated with greater levels of general shame, HIV-related shame, and rumination, and with lower levels of self-compassion. In a network analysis, cognitive fusion was most strongly associated (negatively) with self-compassion. In addition, cognitive fusion was associated with both depressive and anxiety symptoms, and to a similar degree. The results highlight the interconnectedness of cognitive fusion with these conceptually related constructs. Future research is needed to clarify the extent to which cognitive fusion is a causal factor for internalizing symptoms, both uniquely and in conjunction with related constructs, among PLWH as well as the extent to which targeting cognitive fusion (e.g., with Acceptance and Commitment Therapy) can reduce internalizing symptoms.