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

Abstract

The association between chronic pain (CP) and depression is complex, and influenced by several psychological processes. Cognitive fusion (i.e. being entangled with one´s internal experiences) and self-compassion (i.e. being touched by one´s suffering, with a motivation to alleviate it) have been hypothesized as relevant psychological processes in physical and mental health, but few studies have addressed them in CP, and none in a comprehensive model relating pain intensity and depressive symptoms. This study tests, in a moderated mediation model, the mediator role of cognitive fusion between pain intensity and depressive symptoms, and the moderator effect of self-compassion in this mediation. In a cross-sectional study, 231 female CP patients (Age: M = 48.51, SD = 10.89) responded online self-report measures. PROCESS, an SPSS macro for conducting path analysis modeling, was used to test the hypothesized model. The model explained 63% of depressive symptoms, and cognitive fusion mediates the association between pain intensity and depressive symptoms. Also, self-compassion moderates this mediation (regardless of self-compassion being low, moderate or high). Although pain intensity is a predictor of depressive symptoms, fusion with thinking in general mediates this association, this relationship is buffered when patients are able to respond to setbacks and perceived shortcomings with self-kindness and warmth. Clinical and theoretical implications are discussed.

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

“…Correlation analyses show that cognitive fusion at baseline is significantly associated with depressive symptoms at all time points. This seems to be in line with previous studies that suggest that cognitive fusion is associated with depressive symptoms in chronic illness (e.g., Gillanders et al, ) and in CP (Carvalho et al, ; McCracken et al, 2014b; Scott et al, 2016; Wiksell et al, 2010; Wicksell et al, ). Also, results show that neither pain intensity nor pain‐related functional impairment were significantly associated with depressive symptoms at baseline, at 6‐ and 12‐month assessments.…”

“…More interestingly, our results seem to suggest that neither duration nor number of CP diagnoses significantly correlate with depressive symptoms at any time point. This seems to be in line with the ongoing discussion regarding the complex interaction between pain and depression, perhaps suggesting that there may be other variables, such as psychological processes, operating the relationship between pain and depression (Carvalho et al, ; Gatchel et al, ; Turk et al, ).…”

“…It suggests that cognitive fusion is a much more relevant factor in the development and/or maintenance of depression in CP than pain‐specific symptoms such as pain intensity and pain‐related functional impairment. These findings are based on previous research that found that cognitive fusion is associated with depressive symptoms in CP (e.g., McCracken, DaSilva, et al, ; Scott, Hann, & McCracken, ; Wicksell et al, ; Wicksell et al, ) and that it fully mediates the relationship between pain intensity and depressive symptoms (Carvalho et al, ). Furthermore, it adds to previous findings by conducting a more robust statistical procedure in a longitudinally designed study.…”

“…On the basis of these results, as well as on previous studies that suggest that depressive symptoms in CP are greatly influenced by psychological processes (e.g., Gatchel et al, ; Turk et al, ), including cognitive fusion (e.g., Carvalho et al, ; McCracken et al, 2014b; Scott et al, 2016), we have tested two conditional models in order to examine the specific impact of pain intensity and cognitive fusion (Model 1) and functional impairment and cognitive fusion (Model 2) on depressive symptoms over 12 months. Results showed that cognitive fusion, but not pain intensity, significantly predicted both the baseline levels of depressive symptoms, as well as their changes over the 12 months.…”

“…Those that did found that cognitive fusion correlates with pain interference and quality of life (Wicksell, Renöfält, Olsson, Bond, & Melin, ) and with depression in CP (McCracken, DaSilva, et al, ). Recently, one study found that cognitive fusion uniquely predicts depressive symptoms, and it mediates the association between pain intensity and depressive symptoms in women with CP (Carvalho, Pinto‐Gouveia, Gillanders, & Castilho, ); however, the interpretation was limited by its cross‐sectional design. Nevertheless, although results seem to corroborate the proposition that cognitive fusion is a detrimental process associated to negative outcomes in CP (Wicksell et al, ; Wicksell, Lekander, Sorjonen, & Olsson, ), longitudinal studies are needed to establish temporal associations between variables.…”