Psychological Inflexibility in Pain Scale

by Psychology Roots

Psychological Inflexibility in Pain Scale

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About Psychological Inflexibility in Pain Scale

Scale Name

Psychological Inflexibility in Pain Scale

Author Details

Rikard K. Wicksell, Jonas Renöfält, Gunnar L. Olsson, and Lennart Melin

Translation Availability

Not Sure


The Psychological Inflexibility in Pain Scale (PIPS) emerged from the need to assess a specific aspect of chronic pain: psychological inflexibility. This concept, rooted in Acceptance and Commitment Therapy (ACT), posits that individuals struggling with chronic pain often engage in unhelpful behaviors due to a lack of psychological flexibility.

Developed by a team of researchers led by Rikard K. Wicksell, the PIPS measures two key components of psychological inflexibility in chronic pain:

  • Avoidance of Pain: This subscale assesses the tendency to avoid thoughts, feelings, and situations associated with pain. This can manifest in various ways, like avoiding activities or social interactions due to fear of pain worsening.
  • Cognitive Fusion with Pain: This subscale investigates the extent to which individuals believe their thoughts, feelings, and bodily sensations associated with pain are inherently bad or dangerous. This “fusion” with pain can lead to catastrophizing scenarios and increased emotional distress.

By measuring these key aspects of psychological inflexibility, the PIPS serves multiple purposes. It helps assess treatment progress in ACT interventions, identify individuals who might benefit from ACT-based approaches, and monitor changes in psychological flexibility over time. Additionally, it supports research into the relationship between psychological inflexibility and various pain-related outcomes.

Administration, Scoring and Interpretation

  • Materials:
    • A copy of the PIPS questionnaire: This can be a physical paper form or a digital version presented on a computer screen.
    • A writing instrument (pen or stylus, depending on the format).
  • Instructions:
    • Provide clear and concise instructions: Explain to the individual the purpose of the PIPS and how their responses will be used. Ensure they understand the importance of responding honestly and accurately.
    • Review the instructions and items: Briefly walk them through the instructions on the PIPS, ensuring they understand the rating scale (usually 1-7, ranging from “never true” to “always true”).
    • Allow for questions and clarification: Encourage the individual to ask questions about any item they find unclear or ambiguous before they begin completing the scale.
    • Privacy and confidentiality: Ensure the individual understands their responses are confidential and will be used solely for the intended purpose (e.g., treatment planning, research).
    • Completion: Allow the individual sufficient time to thoughtfully complete the PIPS at their own pace.

Reliability and Validity

The PIPS has undergone various studies to assess its reliability and validity as a measure of psychological inflexibility in chronic pain populations. Here’s a summary of the findings:


  • Internal consistency: Measures how well the items within each subscale (avoidance and cognitive fusion) cohere. Studies have shown good internal consistency, with Cronbach’s alpha coefficients typically exceeding 0.70, indicating the items within each subscale measure a single underlying construct.
  • Test-retest reliability: Measures the consistency of scores over time when individuals take the PIPS on multiple occasions with a stable level of psychological inflexibility. Studies have shown moderate test-retest reliability coefficients, ranging from 0.48 to 0.58, suggesting the PIPS provides a relatively stable measure over short periods.


  • Content validity: Refers to the relevance and representativeness of the items to the intended construct (psychological inflexibility in chronic pain). The PIPS items were developed based on the principles of ACT and expert review, suggesting good content validity.
  • Criterion validity: Assesses how well the PIPS scores correlate with other established measures of related constructs. Studies have shown moderate correlations between PIPS subscales and other measures of pain avoidance and cognitive fusion, supporting its criterion validity.
  • Construct validity: Investigates whether the PIPS measures what it is intended to measure by examining its relationship with other theoretically relevant variables. Studies have shown PIPS scores to correlate with pain intensity, disability, and depression, supporting its construct validity.

Available Versions



Wicksell, R. K., Lekander, M., Sorjonen, K., & Olsson, G. L. (2010). The Psychological Inflexibility in Pain Scale (PIPS)–statistical properties and model fit of an instrument to assess change processes in pain related disability. European Journal of Pain14(7), 771-e1.

Important Link

Scale File:

Frequently Asked Questions

What is the PIPS?
The PIPS is a questionnaire that measures psychological inflexibility in individuals with chronic pain.

What does “psychological inflexibility” mean?
It refers to difficulty accepting pain and engaging in unhelpful behaviors to avoid it.

How does the PIPS work?
It asks individuals to rate statements about their thoughts, feelings, and behaviors related to pain on a 7-point scale.

What are the benefits of using the PIPS?
Helps assess treatment progress in ACT interventions.
Identifies individuals who may benefit from ACT approaches.
Monitors changes in psychological flexibility over time.
Supports research on pain and inflexibility.

Is the PIPS reliable and valid?
Yes, studies show it has acceptable reliability and validity for measuring psychological inflexibility in chronic pain populations.


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