Pain and Depressive Symptoms: Exploring Cognitive Fusion and Self-Compassion in a Moderated Mediation Model

Exploring Pain-Severity and Psychological-Flexibility Trajectories During Group-Based Psychotherapy for Chronic Pain

This study aimed to identify subgroups of patients sharing similar outcome trajectories during group-based psychotherapy for chronic pain, to explore baseline predictors of trajectories, and to describe clinical outcomes as a function of these trajectories. Participants (n = 71) underwent eight weekly sessions of group psychotherapy for chronic pain at a tertiary care multidisciplinary pain treatment center. Pain outcomes, psychological distress, sleep, pain acceptance, and psychological inflexibility were assessed before, during, directly after, and 3 months after the intervention. Using growth mixture modeling, three to four trajectories were identified for pain-severity and psychological-flexibility symptoms during treatment; baseline levels of depression, pain severity, and psychological flexibility predicted trajectory membership. More research is needed to better understand the mechanisms underlying patients' variability in trajectories of symptom change across treatment.

Exploring the role of shame and self-compassion on the link between fibromyalgia symptoms and depression: Insights from mediation and moderation analyses

The intricacies of the fibromyalgia-depression link accentuate the need to further explore underlying psychosocial mechanisms. External shame resulting from fibromyalgia's nature and associated impairment may increase the risk for depression. We explored whether being supportive and compassionate toward one's perceived shortcomings would potentially weaken this association. This cross-sectional study comprised 138 women with fibromyalgia. Participants were recruited via patient associations and invited to complete an online survey. Descriptive, correlational, mediation and moderation analyses were performed to test the driving hypotheses. Both mediation and moderation analyses accounted for approximately 40% of the variance in depressive symptoms. Fibromyalgia severity was directly and indirectly- through external shame- associated with depressive symptoms. The shame-depressive symptoms link was weaker in participants with greater self-compassion skills. Findings point to the importance of shame and self-compassion and the need to address them in research and clinical contexts.

Euthymic despite pain: the role of cognitive reappraisal and experiential avoidance in autoimmune inflammatory rheumatic diseases-a cross-sectional study

Pain is a central feature of inflammatory rheumatic diseases and is associated with psychological distress. Pain is widely recognized not as a mere physical sensation, but as a complex, multidimensional phenomenon with an affective component. A plethora of research has conceptualized adaptation to pain by focusing on minimizing the pain experience. However, pain in autoimmune inflammatory rheumatic diseases is often neither avoidable nor curable. This cross-sectional study aimed to investigate the processes explaining how pain intensity may be associated with low well-being and why some patients may live well despite pain. Drawing upon the psychological (in)flexibility model and the process model of emotion regulation, we propose that cognitive reappraisal moderates the association between pain and euthymia through experiential avoidance. Ninety-seven patients with rheumatoid arthritis, psoriatic arthritis, or axial spondyloarthritis were included for analyses (mean age = 53.4; mean time since diagnosis = 9.2 years). Most patients were women (75%), married/cohabitant (71%), and attended high school (47%). Results indicate that experiential avoidance may explain how severe pain is associated with lowered euthymia. This indirect negative effect of pain intensity on euthymia became non-significant at high levels of cognitive reappraisal, suggesting that cognitive reappraisal may serve as a protective factor for patients with autoimmune inflammatory rheumatic diseases. This study paves the way for future research in this promising context by providing an initial step towards integrating emotion regulation and psychological inflexibility in pain conditions.

A Single-Session Process-Based Cognitive-Behavioral Intervention Combined with Multimodal Rehabilitation Treatment for Chronic Pain Associated with Emotional Disorders

BACKGROUND AND OBJECTIVES

Defined by chronic pain, rheumatic diseases are often co-occurring with anxiety and depression. Among the available psychological interventions, cognitive-behavioral therapies have an already-proven efficiency in these cases. However, the need to adjust their structure became ubiquitous during the post-pandemic period. Hence, the objective of this study was to investigate the impact of a single-session, process-based cognitive-behavioral intervention for patients with rheumatic conditions within an in-patient setting.

MATERIALS AND METHODS

A total of 31 participants (mean age 58.9 years) completed the single-session intervention. Assessments were conducted prior to the intervention, post-intervention and after one month.

RESULTS

Pearson's correlations, paired samples T tests and a covariance analysis based on the Linear Mixed Model were performed for exploring the relations between baseline variables and evaluating the impact of the SSI intervention. Immediately after the intervention, a significant reduction in cognitive fusion (p = 0.001, d = 1.78), experiential avoidance (p = 0.001, d = 1.4) and dysfunctional behavioral processes was observed. At the one-month evaluation, participants reported decreased pain (p = 0.001, d = 1.11), anxiety (p = 0.004, d = 0.55) and depression (p = 0.001, d = 0.72).

CONCLUSIONS

The single-session, process-based approach represents a promising intervention in healthcare contexts, as an integrative part of a multimodal rehabilitation treatment in patients with rheumatic conditions.

An investigation of the associations between stigma, self-compassion, and pain outcomes during treatment based on Acceptance and Commitment Therapy for chronic pain

Introduction

Stigma adversely affects people with chronic pain. The qualities within self-compassion may be particularly useful for buffering the impact of stigma on people with pain. In the context of an Acceptance and Commitment Therapy-based (ACT) treatment for chronic pain, this study investigated the association between changes in stigma and self-compassion and pain outcomes, and the potential moderating role of self-compassion on the association between stigma and pain outcomes.

Materials and methods

Five-hundred and nineteen patients completed standardized self-report questionnaires of stigma, self-compassion, psychological flexibility, pain intensity and interference, work and social adjustment, and depression symptoms at the start of an interdisciplinary ACT-based treatment for chronic pain. The same measures were completed at post-treatment (n = 431).

Results

The results indicated that key pain outcomes and self-compassion significantly improved during treatment, but stigma did not. Changes in stigma and self-compassion were significantly negatively correlated and changes in these variables were associated with improvements in treatment outcomes. There were significant main effects of stigma and self-compassion for many of the pre- and post-treatment regression models when psychological flexibility was not controlled for, but self-compassion did not moderate the association between stigma and pain outcomes. Stigma remained significant when psychological flexibility variables were controlled for, while self-compassion did not.

Discussion

The findings add to our conceptual understanding of the inter-relationships between stigma, self-compassion, and psychological flexibility and can contribute to treatment advancements to optimally target these variables.

The paradox of wellbeing: what happens among women with fibromyalgia? The effect of cognitive fusion

OBJECTIVE

Our study examined the 'paradox of wellbeing' among women with fibromyalgia and the role of cognitive fusion on wellbeing in relation to age.

METHODS

A total of 228 women diagnosed with fibromyalgia according to the American College of Rheumatology criteria were included. In order to explore the conditional effects of age in the moderation analyzes, as recommended in the PROCESS Macro, the 16th, 50th, and 84th percentiles were calculated. These percentiles define three age groups that we will call younger (from 30 to 53 years), middle-aged (from 54 to 60 years) and older women (from 61 to 78 years).

RESULTS

We found a 'paradox of wellbeing' among fibromyalgia patients which has not yet been reported: the older the patients, the higher scores on hedonic (positive affect) and eudaimonic (activities engagement) wellbeing. A moderation effect of age was found in the relationship between cognitive fusion and wellbeing (cognitive fusion showed negative associations with positive affect and activities engagement but not among older patients).

CONCLUSION

Our study underscores the need of personalized interventions for fibromyalgia patients to improve their wellbeing. Especially in younger and middle-aged patients, it would be of interest interventions in cognitive defusion through Acceptance and Commitment Therapy (ACT).

Psychological inflexibility and physical disability in older patients with chronic low back pain and knee pain

Aim: This study examined the associations between psychological inflexibility (PI) and physical disability (PD) among older patients with chronic low back and knee pain. Methods: Pain avoidance and cognitive fusion were assessed in outpatients as components of PI and PD, and sociodemographic and pain-related variables were used as covariates. Hierarchical multiple linear regression was used. The covariates were first entered, followed by PI. Results: Age and pain intensity had significant positive associations with PD. After adding PI, only pain avoidance was significantly and positively associated with PD. Conclusion: Focusing on pain avoidance may be effective for physical disability when acceptance and commitment therapy is administered to older patients with chronic low back and knee pain.

Self-stigma and cognitive fusion in parents of children with autism spectrum disorder. The moderating role of self-compassion

Background

Research shows that people with autism spectrum disorder and their families often experience social stigma. The internalization of social stigma can lead to the occurrence of self-stigma, understood as an internalized cognitive-affective self-directed and rigid process that results in individuals agreeing with stigmatizing opinions and applying them to themselves. Experiencing self-stigma can lead to a cognitive fusion with negative thoughts–especially those about oneself. Previous studies show that self-compassion reduces feelings of suffering, shame and self-stigma in a group of parents of children with autism spectrum disorder. The aim of this study was to test the relationship between self-stigma and cognitive fusion among parents of children with ASD. The moderating role of self-compassion as a protective factor was also verified.

Methods

The following questionnaires were used: Perceived Public Stigma Scale, Perceived Courtesy Stigma Scale, Self-Compassion Scale–Short Form, Cognitive Fusion Questionnaire, and Depression, Anxiety and Stress Scale. The study included 233 Polish parents of children with autism spectrum disorder (including 218 women).

Results

The results showed a positive correlation between fusion and both affiliate (r = 0.31, p < 0.001) and public stigma (r = 0.33, p < 0.001). Fusion and self-compassion were significant predictors of affiliate stigma. Self-compassion moderated the relationship between fusion and depression (β = −0.11, p < 0.05) and the relationship between fusion and stress (β = −0.11, p < 0.05). Cognitive fusion with negative beliefs about oneself can contribute to self-stigma. Defusion-oriented actions are an opportunity to distance oneself from emerging thoughts and eliminate their negative consequences. Self-compassion manifests itself in a compassionate and accepting attitude towards oneself and improves the individual’s well-being. Actions taken to strengthen the indicated factors could contribute to a better quality of life of parents of children with ASD.

Do Cognitive Abilities Influence Physical and Mental Fatigue in Patients with Chronic Pain after Walking According to a Clinical Guideline for Physical Exercise?

The objective of this study is to explore the mediator role of cognitive fusion and chronic pain acceptance on the effects that the walking pattern, following an established clinical guideline for physical exercise, can have on fatigue (physical and mental) in patients with chronic pain. The sample consisted of a total of 231 women with fibromyalgia with a mean age of 56.91 years (Standard Deviation SD = 9.58 years, range 30−78 years). The results show a significant indirect effect of the walking pattern on both physical and mental fatigue through cognitive fusion and chronic pain acceptance. Specifically, walking predicted less cognitive fusion, which predicted greater chronic pain acceptance, which, in turn, predicted less mental and physical fatigue (Beta-B- = −0.04, Standard Error SE = 0.02, 95% Confidence Interval 95% CI = [−0.09, −0.02]; B = −0.09, SE = 0.05, 95% CI = [−0.22, −0,15], respectively). It can be concluded that the walking pattern is linked to both physical and mental fatigue through cognitive defusion and chronic pain acceptance. These cognitive abilities would allow fibromyalgia patients to perceive an improvement in both physical and mental fatigue by carrying out the walking pattern. Emphasizing the training of cognitive defusion and pain acceptance would improve the adherence of these patients to walking.

Early shaming experiences and psychological distress: The role of experiential avoidance and self-compassion

OBJECTIVES

Early shaming experiences have been suggested to be associated with later psychopathological symptoms. Understanding this relationship is complex, due to a number of psychological processes potentially influencing this. Therefore, the aim of the current study was to further explore the nature of the mediating effect of experiential avoidance in the association between early shame experiences and psychological distress, and whether self-compassion moderates this relationship by mitigating the effects of this.

DESIGN

A cross-sectional design was conducted using self-report measures of early shaming experiences, experiential avoidance, self-compassion, and psychological distress.

METHOD

An online study of 556 participants, comprised of participants from the general population and university students participated within this online study.

RESULTS

The moderated mediation model explained 51% of variance within depressive symptoms. Experiential avoidance was found to mediate the association between early shaming experiences and depressive symptoms. This mediating relationship was shown to be moderated by self-compassion, with higher levels of self-compassion being associated with lower levels of depressive symptoms across all levels of experiential avoidance levels (low, medium, and high).

CONCLUSION

These findings suggest that self-compassion may play a significant buffering role within attenuating the effects of experiential avoidance associated with depressive symptoms. Such findings present important clinical and theoretical implications in further understanding the protective role of self-compassion within early shaming experiences and the relationship between depressive symptoms.

PRACTITIONER POINTS

Early shaming experiences have been linked to later psychological distress. Experiential avoidance identified a core underlying psychological process in the relationship between early shaming experiences and psychological distress. Self-compassion offers a range of protective features that may alleviate the effects of experiential avoidance and depressive symptoms. Self-compassion-based interventions that target experiential avoidance may offer greater reductions within depressive symptoms.

Psychometric properties of the Cognitive Fusion Questionnaire in females with fibromyalgia

Cognitive fusion, or the degree to which a person is entangled with their thoughts and takes them literally, is considered a normal yet detrimental cognitive process associated with diverse negative outcomes across healthy and disordered functioning, including in fibromyalgia. Given the relevance of this cognitive process, the aim of the present study is to generate empirical evidence on the reliability and validity of the Cognitive Fusion Questionnaire (CFQ) in a sample of Spanish females with fibromyalgia. In this cross-sectional study, 230 Spanish females diagnosed with fibromyalgia (mean age 56.89 years; SD = 8.96) were assessed on cognitive fusion, pain catastrophizing, personality traits, positive and negative affect, anxiety symptoms, depressive symptoms and disease severity. Confirmatory factor analysis, reliability and validity analyses were performed. The CFQ showed a unidimensional structure, adequate temporal stability and good internal consistency. In addition, convergent and discriminant validity were found with respect to dispositional, pain-related, affective, mood and anxious measures; as well as incremental and criterion validity in the prediction of psychological symptoms or the disease severity status. The CFQ has been revealed as a solid and valid measure in the evaluation of cognitive fusion in Spanish females suffering from fibromyalgia, and may also be useful in clinical contexts due to the relationships it has shown with important outcomes. Limitations and future directions are also discussed.

Effective Strategies for Contents Recommendation Based on Psychological Ownership of over the Top Services in Cyberspace

With the advanced development of IT, people are spending an increasing amount of time in the cyberspace and perceive psychological ownership of intangible objects (e.g., e-books, avatars, online movie streaming services), which they come to regard as “theirs”. This study focuses on users’ psychological ownership of OTT (over the top) services, which have recently received much attention, and investigates how service providers can present recommendation information more effectively when recommending content to users. This study, based on psychological ownership theory, specifically attempts to verify which method of recommending information is effective in correlation to the level of psychological ownership that a user feels about an online service. Additionally, this study presents this effect in terms of psychological distance, which we argue is the underlying mechanism of psychological ownership. Watcha, one of South Korea’s OTT services, was employed as the experimental subject in this study, and a scenario-based test was conducted. In conclusion, this study found that for users with high psychological ownership of online services, a recommendation information message based on objective and concrete information about a movie was more effective, whereas for users with low psychological ownership, abstractly expressed messages were more effective. Furthermore, by applying a moderated mediation model, this study confirmed that psychological distance mediated the results stated above.

Meta-analytic review on the differential effects of self-compassion components on well-being and psychological distress: The moderating role of dialecticism on self-compassion

Although self-compassion has been extensively studied in the recent decades, the representation of self-compassion as a unitary measure or the presence of self-warmth (i.e., presence of the positive components: self-kindness, common humanity, and mindfulness) and self-coldness (i.e., presence of the negative components: self-judgment, isolation, and mindfulness) remains controversial. Moreover, the differential effects of the six components of self-compassion on mental well-being and psychological distress have not been systematically investigated. To synthesize the differential effects of the six components of self-compassion and to examine how people in different cultures may associate the positive and negative components of self-compassion differentially, the present meta-analysis synthesized 183 effect sizes across 27 cultures. Results showed that the negative components of self-compassion (rs = 0.44 to 0.45) showed greater effect sizes with psychological distress than the positive counterparts (rs = -0.17 to -0.29) whereas the positive components of SCS (rs = 0.29 to.39) showed greater effect sizes with mental well-being than the negative counterparts (rs = -0.29 to -0.36), with the exception of common humanity and isolation (r = 0.29 and - 0.36). Cultural orientation of dialecticism moderated the association between the positive and the negative components of self-compassion, with dialectical cultures showing lower associations between the two opposing components. Findings have implications on the design and implementation of self-compassion interventions cross-culturally.

Cognitive fusion and depressive symptoms in women with chronic pain: A longitudinal growth curve modelling study over 12 months

This study aims to (a) explore individual differences in women with chronic pain (CP) in regard to pain intensity, functional impairment, cognitive fusion, and depressive symptoms and (b) longitudinally test whether cognitive fusion is a significant predictor of depression symptoms, while controlling for pain intensity and functional impairment, over a 12-month period. This study follows a longitudinal design and was conducted in a sample of 86 women with CP who responded to an online battery of questionnaires in three equally spaced assessment moments. In order to explore the growth trajectory of variables of interest, latent growth curve models were examined. Also, correlation analyses were conducted between demographic and illness-related variables and depressive symptoms, as well as between all variables in all assessment moments. Cognitive fusion and functional impairment (but not pain intensity) were significantly associated with baseline levels of depressive symptoms. Cognitive fusion significantly predicted the growth trajectory of depressive symptoms, whereas pain intensity and functional impairment did not. No demographic (age, marital status, education, socio-economic) nor illness-related variables (number of CP diagnoses, duration of CP, taking medication) were associated with depressive symptoms at any point. These results suggest that the trajectory of depressive symptoms in women with CP is not predicted by the intensity of pain nor pain-related functional impairment, but rather by the tendency to get entangled with internal experiences (e.g., thoughts, emotions, and physical sensations), which may or may not be related to pain-specific contents. Clinical implications are discussed.