Abdominal Pain Beliefs Questionnaire (APBQ)

Abstract

The Abdominal Pain Beliefs Questionnaire (APBQ) is a specialized psychometric instrument designed to assess the cognitive appraisals and beliefs held by children regarding their recurrent or chronic abdominal pain. Developed based on the transactional model of stress and coping by Lazarus and Folkman (1984), the APBQ captures how children perceive the nature of their pain (e.g., seriousness, duration, frequency) and their perceived ability to cope with it. The scale exists in both a long form (32 items) and a validated short form (18 items), primarily utilized in clinical and research settings involving pediatric patients experiencing chronic abdominal symptoms. The APBQ provides critical insights into maladaptive cognitions that may contribute to pain-related disability and distress.

Keywords

Abdominal Pain Beliefs Questionnaire, APBQ, Chronic Abdominal Pain, Coping Appraisals, Pain Beliefs, Pediatric Pain, Psychometrics, Recurrent Pain, Functional Gastrointestinal Disorders.

Authors

Van Slyke, D. A., Walker, L. S., Stone, A. L., Smith, C. A., Garber, J., Claar, R. L.

Purpose

The primary purpose of the APBQ is to quantify the specific cognitive schemas and subjective beliefs that children hold concerning their abdominal pain experiences. These beliefs are crucial determinants of pain-related distress and functional disability in pediatric populations. The instrument allows clinicians and researchers to assess maladaptive beliefs, such as catastrophic thinking or perceived helplessness, which can then inform targeted psychological interventions, particularly those rooted in cognitive behavioral therapy (CBT).

Specifically, the APBQ helps differentiate between primary appraisals (beliefs about the condition itself) and secondary appraisals (beliefs about one’s ability to manage the condition), providing a detailed profile of the child’s pain coping potential. Early identification of these cognitive patterns is essential for improving long-term outcomes for children with chronic abdominal symptoms.

Construct

The APBQ is theoretically grounded in the Stress, Appraisal, and Coping model (Lazarus & Folkman, 1984). It measures two major domains of appraisal related to chronic pain:

• Primary Appraisals: Relate to the child’s evaluation of the pain condition itself, encompassing dimensions like seriousness, frequency, duration, and intensity of the episodes. These appraisals determine the degree of threat perceived by the child regarding their pain.
• Secondary Appraisals: Focus on the child’s perceived coping efficacy—their belief in their ability to manage the pain using both problem-focused (PFC) and emotion-focused (EFC) strategies. High scores on maladaptive subscales reflect a greater sense of pain threat and lower perceived coping potential.

Validity

The APBQ has demonstrated strong construct validity, aligning conceptually with the established transactional model of stress and coping. Studies (e.g., Walker et al., 2005; Stone et al., 2016) have shown that the scales correlate logically with measures of pain intensity, functional disability, and psychological distress, confirming its ability to measure pain-related cognitive factors relevant to clinical outcomes in children with chronic abdominal pain (CAP).

The validation of the short form (APBQ-SF) further confirmed the underlying factor structure and utility across clinical samples, demonstrating that the reduced item set maintains strong convergent and divergent validity with related measures of pain catastrophizing and anxiety.

Reliability

Research examining the psychometric properties of both the long and short forms of the APBQ indicates acceptable to strong internal consistency. The subscales typically exhibit robust Cronbach’s alpha coefficients, suggesting that the items within each factor reliably measure the intended underlying construct.

Test-retest reliability has also been supported in pediatric populations, indicating stability of pain beliefs over time, which is essential for measuring baseline characteristics and tracking changes resulting from treatment interventions.

Factor Analysis

The APBQ structure has been refined across several studies, resulting in both a 32-item long form and an 18-item short form, each possessing distinct factor structures derived from exploratory and confirmatory factor analysis.

The original 32-item Long Form is organized into seven subscales:

• Primary Coping Appraisals:
  • Condition-duration (CD): Items 2, 8, 15, 32 (Reverse code: 32)
  • Condition–frequency (CF): Items 5, 12, 22, 30 (Reverse code: 22)
  • Condition-Seriousness (CS): Items 1, 10, 16, 24 (Reverse code: 10 & 24)
  • Episode–duration (ED): Items 4, 17, 20, 26 (Reverse code: 17 & 26)
  • Episode–intensity (EI): Items 7, 13, 18, 28 (Reverse code: 13)
• Secondary Coping Appraisals:
  • Problem-focused coping potential (PFCP): Items 3, 11, 19, 21, 27, and 31 (Reverse code: 21, 27, & 31)
  • Emotion focused coping potential (EFCP): Items 6, 9, 14, 23, 25, and 29 (Reverse code: 6, 14, 25, & 29)

The 18-item Short Form (Stone & Walker et al., 2016) utilizes a streamlined three-factor model, offering clinical efficiency:

• Problem-Focused Coping Efficacy: Belief in the ability to actively stop or reduce the pain episode (Items 1, 7, 11, 13, 16, 18).
• Emotion-Focused Coping Efficacy: The ability to handle the pain and maintain emotional well-being despite its presence (Items 3, 6, 8, 14, 15, 17).
• Pain Threat: Combines elements of perceived seriousness, frequency, and chronicity of the pain condition (Items 2, 4, 5, 9, 10, 12).

Instrument

Test Type: Self-report questionnaire / Psychometric scale

Format: Likert scale scoring, typically ranging from 0 to 4.

Language Available: Primarily English (as developed in the US).

Population Group: Pediatric patients with chronic or recurrent pain.

Age Group: Typically utilized for children and adolescents (age range often 8 to 17 years old).

Population Details: Children diagnosed with functional or organic recurrent abdominal pain (RAP) or Irritable Bowel Syndrome (IBS). This measure is crucial for understanding the cognitive mechanisms underpinning functional gastrointestinal disorders.

Test Methodology: Respondents rate the extent to which each statement is true for them using a 5-point scale:

1. 0 = Not at all true
2. 1 = A little true
3. 2 = Some true
4. 3 = Mostly true
5. 4 = Very true

Specific items require reverse coding depending on the factor structure being utilized (long or short form) to ensure higher scores consistently reflect higher levels of the measured construct (e.g., greater threat or lower efficacy).

Keywords

Pediatric psychology, Health psychology, Somatic symptoms, Cognitive behavioral therapy (CBT), Pain coping, Functional gastrointestinal disorders, Pain appraisal, Pain catastrophizing.

Authors

Author ORCID Identifier: N/A (Information not provided in source material)

Affiliation Email addresses: N/A (Information not provided in source material)

Correspondence Address: N/A (Information not provided in source material)

Permissions & Fee and Test Year

The initial concept and development of the APBQ by Van Slyke (2001) and subsequent refinement by Walker et al. (2005) date the instrument to the early 2000s, with the 18-item short form validated in 2016. The scale is often utilized freely in academic research settings, particularly those affiliated with the developers at Vanderbilt University. Researchers should consult the primary authors, Dr. Lynn Walker, or the institution where the research originated for formal permission and details regarding usage fees, although the scale is generally considered accessible for research purposes.

Reference’s

The original PDF information sheet for the questionnaire can be downloaded here: https://www.childrenshospital.vanderbilt.org/uploads/documents/PBQ_Info_Sheet.pdf

• Lazarus, R.S., Folkman, S. (1984). Stress, Appraisal, and Coping. Springer Publishing Company; New York.
• Stone, Amanda L., Walker, Lynn S., Laird, Kelsey T., Shirkey, Kezia C., and Smith, Craig A., (2016). Pediatric Pain Beliefs Questionnaire: Psychometric Properties of the Short Form. J Pain, 17(9): 1036–1044. doi:10.1016/j.jpain.2016.06.006. (Further details regarding the short form are available here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5032835/)
• Van Slyke, D.A. (2001). Maternal influences on children’s pain behavior. Doctoral dissertation, Dissertation Abstracts International, 63-2B, 1103.
• Van Slyke, D. A., & Walker, L. S. (2006). Mothers’ responses to children’s pain. Clinical Journal of Pain, 22, 387-391.
• Walker, L. S., Baber, K.F., Garber, J., Smith, C. A. (2008). A typology of pain coping strategies in pediatric patients with chronic abdominal pain. Pain, 137, 266–275.
• Walker, L. S., Garber, J., & Greene, J. W. (1993). Psychosocial correlates of recurrent childhood pain: A comparison of pediatric patients with recurrent abdominal pain, organic illness, and psychiatric disorders. Journal of Abnormal Psychology, 102, 248–258.
• Walker, L. S., Smith, C. A., Garber, J., & Claar, R. L. (2005). Testing a model of pain appraisal and coping in children with chronic abdominal pain. Health Psychology, 24, 364 – 374.

Items of the Abdominal Pain Beliefs Questionnaire (APBQ)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

Long Form (32 Items)

1. My stomach aches mean I have a serious illness
2. I’ll always have stomach aches
3. When I have a bad stomach ache, I can find ways to feel better
4. When I have a bad stomach ache, it usually lasts a long time
5. I get stomach aches all the time
6. When I have a bad stomach ache, I just can’t take it*
7. My stomach aches hurt a whole lot
8. I’m going to have stomach aches for the rest of my life
9. I know I can handle it no matter how bad my stomach hurts
10. Even though I get stomach aches, there’s nothing seriously wrong with me*
11. When I have a bad stomach ache, I can feel better if I decide to
12. I almost always have a stomach ache
13. My stomach aches don’t hurt very much*
14. I don’t think I’ll be able to stand it if I keep having stomach aches*
15. I’ll still have stomach aches when I’m older
16. My stomach aches mean that I’m very sick
17. My stomach aches only last a few minutes
18. My stomach aches hurt worse than anything*
19. When I have a bad stomach ache, there are ways I can get it to stop
20. My stomach aches go on forever
21. When I have a bad stomach ache, nothing I try seems to help*
22. I only get stomach aches once in a while*
23. Things will be OK for me even if I keep having stomach aches
24. My stomach aches are no big deal*
25. If I keep having stomach aches, my life will be terrible*
26. My stomach aches go away quickly*
27. When I have a bad stomach ache, there’s not much I can do to feel better*
28. My stomach aches hurt really bad PF-EI
29. I can’t deal with it when I have a stomach ache*
30. I always get stomach aches
31. When I have a bad stomach ache, I can’t seem to make it better*
32. I’ll stop having stomach aches soon*

Short Form (18 Items)

1. When I have a bad stomach ache, I can find ways to feel better
2. I get stomach aches all the time
3. When I have a bad stomach ache, I just can’t take it
4. My stomach aches hurt a whole lot
5. I’m going to have stomach aches for the rest of my life
6. I know I can handle it no matter how bad my stomach hurts
7. When I have a bad stomach ache, I can feel better if I decide to
8. I don’t think I’ll be able to stand it if I keep having stomach aches
9. My stomach aches mean that I’m very sick
10. My stomach aches hurt worse than anything
11. When I have a bad stomach ache, there are ways I can get it to stop
12. My stomach aches go on forever
13. When I have a bad stomach ache, nothing I try seems to help
14. Things will be OK for me even if I keep having stomach aches
15. If I keep having stomach aches, my life will be terrible
16. When I have a bad stomach ache, there’s not much I can do to feel better
17. I can’t deal with it when I have a stomach ache
18. When I have a bad stomach ache, I can’t seem to make it better