Compassion focused therapy for pain management: ‘3 systems approach’ to understanding why striving and self-criticism are key psychological barriers to regulating activity and improving self-care for people living with persistent pain

Abstract

Background This paper describes the development of an eight-week Compassion Focused Therapy for Pain Management (CFT-PM) group. This group was specifically designed for ‘strivers’ a sub-group of people with persistent pain who tend to engage in over-activity and resist making reasonable adjustments to their activity levels to accommodate their persistent pain. ‘Strivers’ tend to cope by ignoring their pain and pushing on through, in the shorter term leading to ‘boom and bust’ activity-related exacerbations of their pain. They also risk the development of additional persistent fatigue and burnout in the longer term. Method 117 people completed the CFT-PM group; The group was delivered in person ( n = 84) but in online format from July 2020 ( n = 33). 162 people started the CFT-PM group but 45 dropped-out (27.43%). Results There was a significant effect for time across all measures: significant improvement was found for depression, self-compassion, pain-related disability, pain-related anxiety and pain self-efficacy. Pain numeric rating scores were approaching significance. There was a significant main effect of diagnosis; post-hoc t-test analysis found significant improvement for all diagnoses on all measures with the exception of spinal. There was also a significant interaction between time and format: post-hoc t-test analysis found greater improvement for virtual format on self-compassion and pain-related anxiety. Discussion Findings suggests that CFT-PM may be a clinically effective group intervention with virtual format showing superior improvement. This approach might be less suitable for certain diagnoses; the spinal group may benefit more from traditional CBT-based PMPs. Limitations include the lack of random selection or allocation to treatment group. Future studies should adopt an experimental design to be able to draw firm conclusions regarding causation and efficacy. Despite these limitations, present findings suggest that CFT-PM may be an effective group intervention worthy of further investigation and clinical application.

Do patients in neurosurgical wards benefit from psychotherapy? A brief discussion on the application of cognitive-behavioural therapy in patients treated for spinal conditions

“…Similar outcomes were obtained in another meta-analysis with a systematic review: individualised physiotherapeutic interventions were shown to have a modest yet significant effect on pain reduction, with pain relief being more effective when combined with CBT (Fleckenstein et al, 2022). Some studies have analysed the effects of third-wave therapies on reducing the severity of chronic pain (Barrett et al, 2021;Ma et al, 2023;Malpus et al, 2023;Norman-Nott et al, 2023). The results indicate pain relief, improved acceptance of the experience of pain and its associated limitations, and greater flexibility in managing discomfort.…”

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

“…However, it is notable that, while significant, the magnitude of improvement was small. For comparison, a recent study reporting outcomes from an 8-week pain management treatment based on compassion-focused therapy reported a significant improvement in self-compassion with a large effect ( Malpus et al, 2023 ). That study specifically selected treatment participants who displayed a pattern of “striving,” such that they tended to push through activities or use activities to distract from pain resulting in a “boom and bust” pattern ( Malpus et al, 2023 ).…”

“…For comparison, a recent study reporting outcomes from an 8-week pain management treatment based on compassion-focused therapy reported a significant improvement in self-compassion with a large effect ( Malpus et al, 2023 ). That study specifically selected treatment participants who displayed a pattern of “striving,” such that they tended to push through activities or use activities to distract from pain resulting in a “boom and bust” pattern ( Malpus et al, 2023 ). Additionally, there can be many barriers to engaging in self-compassion, such as fears that doing so may lower personal standards or lead to failure, and beliefs that one might not be deserving of self-compassion ( Gilbert et al, 2011 ; Carvalho et al, 2021 ; Biskas et al, 2022 ).…”

Self-compassion and pain disability in adults with chronic pain: The mediating role of future self-identification and self-efficacy

“…There is research exploring the effects of self-compassion interventions for chronic pain. For example, Compassion Focused Therapy (CFT) increased self-compassion and reduced pain disability in a sample of adults with chronic pain who engage in over-activity (Malpus et al, 2023). Another randomized controlled trial found that Mindful Self-Compassion training (MSC) reduced pain interference to a greater extent than Cognitive Behavioral Therapy (CBT) in chronic pain patients (Torrijos-Zarcero et al, 2021).…”