Abdominal Pain Beliefs Questionnaire (APBQ)

Abstract

The Abdominal Pain Beliefs Questionnaire (APBQ) is a specialized psychometric instrument designed to measure the cognitive appraisal and beliefs held by individuals, particularly children and adolescents, regarding their recurrent or chronic abdominal pain (CAP). Developed primarily by Lynn S. Walker and colleagues, the APBQ is theoretically grounded in the Lazarus and Folkman stress and coping framework, differentiating between primary appraisals (beliefs about the pain condition itself, such as seriousness, duration, and frequency) and secondary appraisals (beliefs about one’s ability to cope with the pain). The scale exists in both a 32-item Long Form and an 18-item Short Form, providing clinicians and researchers with efficient measures to understand the psychological factors that maintain pain distress and disability in pediatric pain populations.

Keywords

Abdominal Pain Beliefs Questionnaire, APBQ, chronic abdominal pain, pediatric pain, cognitive appraisal, coping efficacy, pain threat, functional disability, recurrent pain, psychosocial assessment.

Authors

Lynn S. Walker, Jennifer Garber, Craig A. Smith, Amanda L. Stone, Kezia C. Shirkey, Kelsey T. Laird.

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Purpose

The primary purpose of the APBQ is to quantify specific pain-related beliefs that influence a patient’s emotional response, coping strategies, and subsequent functional outcomes regarding abdominal pain. By assessing these beliefs, the instrument helps identify maladaptive cognitive patterns—such as catastrophizing or low self-efficacy—that are known to contribute to pain-related disability in youth.

The scale serves as a valuable tool in clinical settings for treatment planning, particularly for cognitive-behavioral interventions aimed at modifying negative pain cognitions. It allows researchers to investigate the pathways through which pain appraisals mediate the relationship between pain symptoms and psychosocial functioning.

Construct

The APBQ is fundamentally rooted in the transactional model of stress and coping proposed by Lazarus and Folkman (1984). This model posits that an individual’s response to a stressor (in this case, abdominal pain) is determined by two levels of cognitive appraisal:

• Primary Coping Appraisals: These relate to the perceived characteristics of the pain condition itself. The Long Form measures these across five subscales: Condition-duration (CD), Condition–frequency (CF), Condition-Seriousness (CS), Episode–duration (ED), and Episode–intensity (EI).
• Secondary Coping Appraisals: These relate to the individual’s perceived resources or ability to manage the pain. The Long Form assesses Problem-focused coping potential (PFCP) and Emotion focused coping potential (EFCP).

The Short Form (Stone et al., 2016) streamlines these constructs into three primary factors: Pain Threat (reflecting seriousness, frequency, and intensity beliefs), Problem-Focused Coping Efficacy, and Emotion-Focused Coping Efficacy.

Validity

Evidence supports the validity of the APBQ, demonstrating its ability to differentiate between children with chronic pain and healthy controls, and its strong correlation with relevant psychosocial measures. Studies have shown that scores on the APBQ subscales, particularly those related to pain threat and low coping efficacy, are significantly associated with increased pain-related functional disability, anxiety, and depressive symptoms in pediatric populations.

The Short Form (APBQ-SF) specifically demonstrated convergent validity through expected correlations with established measures of pain catastrophizing, pain intensity, and functional impairment, confirming that the scale accurately measures the intended cognitive dimensions related to chronic abdominal pain.

Reliability

The APBQ exhibits good internal consistency, particularly in its refined Short Form version. The original Long Form subscales generally demonstrate acceptable to good reliability, though the Short Form was developed partly to improve the reliability and efficiency of measurement.

The 18-item Short Form published by Stone and Walker et al. (2016) reported strong internal consistency across its three main factors: Pain Threat, Problem-Focused Coping Efficacy, and Emotion-Focused Coping Efficacy, suggesting that the items within each factor reliably measure the same underlying construct. Test-retest reliability has also been evaluated, indicating stability of pain beliefs over time, which is crucial for a measure intended for use in longitudinal studies or treatment outcome assessments.

Factor Analysis

The structure of the APBQ was established through factor analytic techniques, leading to both the comprehensive Long Form and the parsimonious Short Form. The 32-item Long Form structure includes seven factors grouped under Primary and Secondary Appraisals, detailed as follows:

• Primary Appraisals (Condition Characteristics): Condition-duration (CD), Condition–frequency (CF), Condition-Seriousness (CS), Episode–duration (ED), and Episode–intensity (EI).
• Secondary Appraisals (Coping Potential): Problem-focused coping potential (PFCP) and Emotion focused coping potential (EFCP).

The 18-item Short Form was derived through further factor analysis to create a more efficient measure for clinical use. This analysis yielded a robust three-factor structure, which captures the most clinically relevant aspects of pain beliefs:

1. Pain Threat (measuring perceived seriousness, frequency, and intensity of pain).
2. Problem-Focused Coping Efficacy (the belief in one’s ability to actively manage or reduce the pain episode).
3. Emotion-Focused Coping Efficacy (the belief in one’s ability to manage negative emotions and maintain functionality despite pain).

Instrument

Test Type: Self-report questionnaire / Psychometric scale

Format: Likert scale responses. The scoring range is 0 to 4, where 0=Not at all true, 1=A little true, 2=Some true, 3=Mostly true, and 4=Very true.

Language Available: English (Primary validation language).

Population Group: Clinical and non-clinical youth presenting with recurrent or chronic abdominal pain.

Age Group: Typically utilized in children and adolescents (school-age through teenage years).

Population Details: Validated primarily on pediatric patients diagnosed with functional or recurrent abdominal pain (RAP).

Test Methodology: Administration is usually pencil-and-paper or digital self-report. Certain items require reverse scoring to maintain scale directionality (e.g., items reflecting low threat or high efficacy are reverse-scored when calculating threat or low-efficacy subscales).

Keywords

Pain beliefs, coping potential, emotion-focused coping, problem-focused coping, Lazarus and Folkman, recurrent abdominal pain, psychopathology, disability index, health psychology.

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Authors

Author ORCID Identifier: Information not provided in source content.

Affiliation Email addresses: Information not provided in source content.

Correspondence Address: Correspondence is typically directed toward Dr. Lynn S. Walker, Department of Pediatrics, Vanderbilt University School of Medicine (based on publication affiliations).

Permissions & Fee and Test Year

The APBQ is generally available for non-commercial research and clinical use. The primary validation of the Long Form was established in research throughout the 1990s and early 2000s (e.g., Walker et al., 2005). The refined 18-item Short Form was published in 2016 by Stone, Walker, et al. This instrument can be found at the following resources:

The instrument information sheet, which includes scoring details, can be downloaded here: PBQ_Info_Sheet.pdf. Further validation details are available in the academic literature, such as: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5032835/ (Stone et al., 2016).

Reference’s

• Lazarus, R.S., Folkman, S. (1984). Stress, Appraisal, and Coping. Springer Publishing Company; New York.
• 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.
• Van Slyke, D.A. (2001). Maternal influences on children’s pain behavior. Doctoral dissertation, Dissertation Abstracts International, 63-2B, 1103.
• 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.
• 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.
• 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.

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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 Items (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

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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*

Long Form Scoring Structure:

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

Short Form Items (18 Items)

Stone and Walker et al, 2016

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

Response Scale: 0=Not at all true, 1=A little true, 2=Some true, 3= Mostly true, 4= Very true

Short Form Scoring Structure:

• Reverse coded items: 3, 8, 13, 15, 16, 17, and 18.
• Problem-Focused Coping Efficacy (PFCE): 1, 7, 11, 13, 16, 18.
• Emotion-Focused Coping Efficacy (EFCE): 3, 6, 8, 14, 15, 17.
• Pain Threat (PT): 2, 4, 5, 9, 10, 12.