New research suggests that the development of a kind, caring, and warm attitude toward oneself might help those suffering from chronic pain. The study, published in the Journal of Clinical Psychology, found that people with higher levels self-compassion tended to be better able to “get on with the business of living” despite experiencing pain, which was itself linked to lower levels of depressive symptoms

“This study in particular is part of a larger one that aims to better understand the role of self-compassion and its interaction with other psychological processes in chronic pain,” explained study author Sérgio A. Carvalho of the University of Coimbra.

“The interest in self-compassion in the context of chronic pain has been recently grown in clinical and behavioral psychology. There are several reason for that. The more obvious, and actually not specific to chronic pain, is that there is mounting evidence that self-compassion (both as a trait, as well as the more formal practice of it) is associated with less psychological suffering (i.e. less anxiety, less depression) and more quality of life.”

“It’s hypothesized that both mindfulness and self-compassion result in acceptance, but self-compassion adds to it a motivation to action, a motivation to alleviate one’s suffering in a kind a soothing manner, which mindfulness does not necessarily do. This is very debatable, and definitely an ongoing conversation.”

“Although there is accumulating research suggesting that acceptance of pain is a relevant aspect in chronic pain management, acceptance of pain comprises both a cognitive aspect (willingness to experience it) as well as a behavioral one (keeping on acting as I intend to, despite experiencing pain). And this would be a very fitting opportunity to test the hypothesis that self-compassion, but not mindfulness, is behaviorally-oriented.”

The study of 231 Portuguese women with chronic musculoskeletal pain found that both mindful awareness and self-compassion were negatively associated with depressive symptoms. In other words, women higher in mindfulness and self-compassion tended to report lower levels of depressive symptoms.

“The results suggest that being able to be warm and kind towards oneself — instead of harsh, critical, shaming, etc — when facing difficulties is related to having less depressive symptoms in chronic pain. This suggests that a person suffering from chronic pain might very well benefit from practicing exercises that increase their ability to be kind and warm in order to navigate the difficulties of their chronic illness,” Carvalho told PsyPost.

Women who scored high on the measure of mindfulness disagreed with statements such as “I find it difficult to stay focused on what’s happening in the present” and “I find myself doing things without paying attention,” while those who scored high on the measure of self-compassion agreed with statements like “I try to be understanding and patient towards those aspects of my personality I don’t like” and “I try to see my failings as part of the human condition.”

The researchers found that self-compassion — but not mindfulness — was associated with being willing to engage in valued activities despite pain, which in turn was associated with less depressive symptoms.

“Also, it seems that the positive aspect of self-compassion that relates to one having less depression has to do with its orientation to action. In other words, it seems that being kind to oneself in troubled times may lead to a better capacity to continue moving forward and engaging in valued activities, despite the pain, which in turn is related to having less depressive symptoms. These relationships were not influenced by the participants levels’ of pain intensity, as this was statistically controlled,” Carvalho explained.

But the study — like all research — includes some limitations.

“It is very important to have in mind that these results are not definitive due to the methodology used. We have to understand that when conducting psychological research through self-report, our research is as good as our instruments. And there are still ongoing discussions regarding the measurement of mindfulness and self-compassion, in part (but not only) because the conceptualization of these phenomena is still in development,” Carvalho said.

“Regarding our study in particular, we have used an instrument to measure mindfulness that in fact measures a very specific aspect of mindfulness: mindful attention. However, mindfulness can be conceptualized in a much larger sense, including different domains that go beyond attentional processes (e.g. non-reactivity, non-judgment).”

“Also, this a standard cross-sectional design, so it is unwarranted to pick these results and draw causal relationships between variables. We have given a small contribution to understanding these relationships. But there are questions that still need to be answered. We need to better understand the physiological fundamentals of self-compassion. There seems to be a growing interest in the relationship between self-compassion and parasympathetic activity, specifically vagally mediated heart rate variability,” Carvalho continued.

“Also, there is still an absence of high quality research on compassion-based psychological interventions for chronic pain management, particularly randomized control trials. So, there is still to learn on self-compassion in chronic pain. But the accumulating research is encouraging.”

“This research is part of my PhD studies, and we will start our clinical trial of a mindfulness- and compassion-based group intervention for women with chronic pain next January 2019. If the readers are interested in this line of research, please have a look to our research unit website (https://cineicc.uc.pt), where you can find all the research carried out by our research team and colleagues,” Carvalho added.

The study, “Mindfulness, selfcompassion, and depressive symptoms in chronic pain: The role of pain acceptance“, was authored by Sérgio A. Carvalho, David Gillanders, Lara Palmeira, José Pinto‐Gouveia, and Paula Castilho.