Experiential avoidance and self‐compassion in chronic pain
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Abstract The present study investigates the role of coping, experiential avoidance, and self‐compassion on psychological distress prediction (i.e., depression, anxiety, and stress symptoms). A battery of self‐report questionnaires was used to assess coping, experiential avoidance, self‐compassion, and psychological distress in 103 adults with chronic pain from Portuguese primary health care units. Hierarchical regression analyses were performed and showed that experiential avoidance and self‐compassion are the factors that mostly explain psychological distress. Our results suggest that when people with chronic pain are willing to remain in contact with particular private experiences without attempting to control them, they reported less depression, anxiety, and stress. Implications for clinical practice were discussed, suggesting the importance of helping people with chronic pain to increase their willingness to pain rather than avoiding it.
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When patients attempt to accept pain, their pain intensity decreases.
“Conversely, when patients attempt to accept pain, their pain intensity decreases, and their mental health improves, which is one of the aims of Acceptance and Commitment Therapy (ACT) [19, 20].”
From Acceptance and commitment therapy for patients with chronic pain: A systematic review and meta-analysis on psychological outcomes and quality of life (2024) · cites this paper as [19]
When patients attempt to accept pain, their mental health improves.
“Conversely, when patients attempt to accept pain, their pain intensity decreases, and their mental health improves, which is one of the aims of Acceptance and Commitment Therapy (ACT) [19, 20].”
From Acceptance and commitment therapy for patients with chronic pain: A systematic review and meta-analysis on psychological outcomes and quality of life (2024) · cites this paper as [19]
Acceptance of pain is linked to better pain and mental health outcomes.
“This process is linked to better pain and mental health outcomes”
From Efficacy of Online-Based Acceptance and Commitment Therapy for Chronic Pain: A Systematic Review and Meta-Analysis (2021) · cites this paper as [10]
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“…with more intrapersonal resources such as self-efficacy, autonomy, sense of coherence, cognitive flexibility, and adaptive coping (Akin 2008; Costa and Pinto-Gouveia 2013; Iskender 2009; Martin et al. 2011; Neff et al. 2005; Sirois et al. 2015; Ying 2009), as well as more interpersonal…”
BackgroundYela, J. R., Crego, A., Buz, J., Sánchez‐Zaballos, E., & Gómez‐Martínez, M. Á. (2022) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12375 · Cited by 56 · see citing works
Personal strengths reported by people with chronic illness: A qualitative study
Kristjánsdóttir, Ó. B., Stenberg, U., Mirković, J., Krogseth, T., Ljosaa, T. M., Stange, K. C., & Ruland, C. M. (2018) · Health Expectations · doi:10.1111/hex.12674 · Cited by 58 · see citing works
“44 In people with chronic conditions, self-compassion has been linked to lower stress levels 45–47 suggesting its role in self-management.”
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“The recent study by Costa and Pinto-Gouveia [19] suggests that chronic pain patients who show lower levels of experiential avoidance report less depression, anxiety and stress.”
BackgroundThe relation of self‐compassion to functioning among adults with chronic pain
Edwards, K. A., Pielech, M., Hickman, J., Ashworth, J., Sowden, G., & Vowles, K. E. (2019) · European Journal of Pain · doi:10.1002/ejp.1429 · Cited by 56 · see citing works
Self-Compassion Induction Reduces Anticipatory Anxiety Among Socially Anxious Students
Harwood, E. M., & Kocovski, N. L. (2017) · Mindfulness · doi:10.1007/s12671-017-0721-2 · Cited by 56 · see citing works
“2005), adaptive coping, as opposed to avoidance (Costa and Pinto-Gouveia 2013), and use of first person plural pronouns (Bwe^; Barnard and Curry 2011).”
BackgroundSanterre-Baillargeon, M., Rosen, N., Steben, M., Pâquet, M., Perez, R. M., & Bergeron, S. (2017) · The Clinical Journal of Pain · doi:10.1097/ajp.0000000000000579 · Cited by 43 · see citing works
Mindfulness, selfcompassion, and depressive symptoms in chronic pain: the role of pain acceptance
Carvalho, S. A., Gillanders, D., Palmeira, L., Pinto‐Gouveia, J., & Castilho, P. (2018) · Journal of Clinical Psychology · doi:10.1002/jclp.22689 · Cited by 49 · see citing works
Self-citationYu, L., & McCracken, L. M. (2016) · Current Pain and Headache Reports · doi:10.1007/s11916-016-0541-4 · Cited by 45 · see citing works
Trindade, I. A., Duarte, J., Ferreira, C., Coutinho, M., & Pinto‐Gouveia, J. (2018) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2175 · Cited by 49 · see citing works
Self-citationYe, L., Li, Y., Deng, Q., Zhao, X., Zhong, L., & Yang, L. (2024) · PLoS ONE · doi:10.1371/journal.pone.0301226 · Cited by 43 · see citing works
Gilpin, H. R., Stahl, D. R., & McCracken, L. M. (2018) · European Journal of Pain · doi:10.1002/ejp.1310 · Cited by 36 · see citing works
Psychological flexibility, self-compassion and daily functioning in chronic pain
Davey, A., Chilcot, J., Driscoll, E., & McCracken, L. M. (2020) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2020.06.005 · Cited by 38 · see citing works
Mistretta, E. G., & Davis, M. C. (2021) · Mindfulness · doi:10.1007/s12671-021-01766-7 · Cited by 35 · see citing works
“More often, research finds that self-compassion benefits affective processing of pain, finding negative associations between self-compassion and pain catastrophizing, and positive associations between self-compassion and pain acceptance (Costa & Pinto-Gouveia, 2011, 2013; Wren et al., 2012).”
Sherman, K. A., Roper, T., & Kilby, C. J. (2019) · Health Psychology and Behavioral Medicine · doi:10.1080/21642850.2019.1587298 · Cited by 31 · see citing works
“…distress, such as rumination (Krieger, Altenstein, Baettig, Doerig, & Holtforth, 2013; Neff, 2003; Raes, 2010), thought suppression (Neff, 2003; Neff, Kirkpatrick, & Rude, 2007), and avoidance (Costa & Pinto-Gouveia, 2013; Finlay-Jones et al., 2017; Krieger et al., 2013; Roemer et al., 2009).”
Self-Compassion and Depressive Symptoms in Chronic Pain (CP): A 1-Year Longitudinal Study
Carvalho, S. A., Trindade, I. A., Gillanders, D. T., Pinto‐Gouveia, J., & Castilho, P. (2019) · Mindfulness · doi:10.1007/s12671-019-01292-7 · Cited by 31 · see citing works
Self-citationYu, L., Norton, S., Harrison, A. M., & McCracken, L. M. (2015) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2015.10.003 · Cited by 30 · see citing works
A Systematic Review of Self-Compassion in Chronic Pain: From Correlation to Efficacy
Lanzaro, C., Carvalho, S. A., Lapa, T. A., Valentim, A., & Gago, B. (2021) · The Spanish Journal of Psychology · doi:10.1017/sjp.2021.22 · Cited by 29 · see citing works
“…that SC is a relevant psychological process in CP (Vowles et al., 2014), which has been related to less emotional distress and depressive symptoms (Costa & Pinto-Gouveia, 2013), to greater pain acceptance, lower levels of depression, stress and anxiety (Carvalho et al., 2018), and lower levels of…”
BackgroundLuo, X., Liu, J., & Che, X. (2019) · Journal of Pain · doi:10.1016/j.jpain.2019.11.006 · Cited by 29 · see citing works
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“…self-compassion associates greater levels of self-compassion with less anxiety and depression, fewer reports of feeling isolated by one's problems, and greater emotional regulation (Costa & Pinto-Gouveia, 2013; Hill et al., 2017; Krieger, Altenstein, Baettig, Doerig, & Holtforth, 2013; Raes, 2011).”
Self-Compassion and Quality of Life in Adults Who Stutter
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“Self-compassion has also been shown to be significantly and negatively related to psychological distress in individuals with chronic pain (Costa & Pinto-Gouveia, 2013; Sirois et al., 2015; Wren et al., 2012), social anxiety (Blackie & Kocovski, 2018), major depressive disorder (Diedrich et al.,…”
BackgroundRole of Occupational Therapy in Pain Management
American Occupational Therapy Association (2021) · American Journal of Occupational Therapy · doi:10.5014/ajot.2021.75s3001 · Cited by 27 · see citing works
“…Self-Test to measure psychosocial and emotional factors including isolation versus common humanity, self-judgment versus self-kindness, and overidenti fi cation versus mindfulness (Costa & Pinto-Gouveia, 2013; Neff, 2003; Raes et al., 2011; Tian et al., 2020; Wren et al., 2012) ( Continued )”
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“For example, EA has been related to more symptoms of depression and anxiety in adults with chronic pain visiting primary health care units (Costa & Pinto-Gouveia, 2013), greater anxiety, depression, pain-related impairment, catastrophising and hypervigilance in patients with chronic spinal pain…”
BackgroundSelf-compassion in somatoform disorder
der Ven, C. D.-V., Kloth, S. A. M., Thorsell, S., SCHOLTEN, R. G., Gucht, V. D., & Geenen, R. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.12.013 · Cited by 20 · see citing works
“…affects the way people deal with pain and physical symptoms and is associated with lower negative affect, avoidance, catastrophizing, stress, and rumination (Costa and Pinto-Gouveia, 2011, 2013; Wren et al., 2012; Hayter and Dorstyn, 2014; Pinto-Gouveia et al., 2014; Purdie and Morley, 2015).”
BackgroundThe Factor Structure and External Validity of the COPE 60 Inventory in Slovak Translation
Halamová, J., Kanovský, M., Krizova, K., Greškovičová, K., Strnádelová, B., & Baránková, M. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.800166 · Cited by 16 · see citing works
“The individual elements of compassion and self-compassion appear to be helpful in the coping process (e.g., Van Vliet and Kalnins, 2011; Costa and Pinto-Gouveia, 2013; Yu et al., 2016).”
BackgroundÖz-Duyarlık: Psikolojik Belirtiler ile İlişkisi ve Psikoterapide Kullanımı
Korkmaz, B. (2018) · Psikiyatride Guncel Yaklasimlar · doi:10.18863/pgy.336489 · Cited by 12 · see citing works
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“…to decreased suicide risk and is inversely related to psychopathological correlates of suicide, such as stress and interpersonal disruption, and the factors examined in our study, including depression, anxiety, and hopelessness (Brion et al., 2014; Costa & Pinto-Gouveia, 2013; Neff, 2003a, 2003b).”
BackgroundMethodInfluentialDuarte, J., & Pinto‐Gouveia, J. (2016) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2016.12.002 · Cited by 17 · see citing works
Self-citationMiller-Matero, L. R., Chipungu, K. E., Martinez, S., Eshelman, A. K., & Eisenstein, D. (2016) · Psychology Health & Medicine · doi:10.1080/13548506.2016.1191659 · Cited by 15 · see citing works
Reconnecting the mind and body: A pilot study of developing compassion for persistent pain
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“Furthermore, previous research has suggested that self-compassion and persistent pain acceptance are significantly correlated 5 , which this study would further support as both pain acceptance in terms of pain willingness and activity engagement noticeably increased as did self-compassion and…”
BackgroundSpitzer, E., & Pakenham, K. I. (2016) · Clinical Psychologist · doi:10.1111/cp.12108 · Cited by 15 · see citing works
“Higher self-compassion is related to better adjustment to chronic pain (Costa & Pinto-Gouveia, 2013) and greater acceptance predicts better adjustment to MS (Pakenham & Fleming, 2011).”
BackgroundCarvalho, S. A., Pinto‐Gouveia, J., Gillanders, D. T., Lapa, T. A. S. C., Valentim, A., Santos, E., Paciência, J., & Castilho, P. (2020) · Scandinavian Journal of Pain · doi:10.1515/sjpain-2020-0082 · Cited by 14 · see citing works
“Indeed, self-compassion seems to be a crosssectional predictor of depressive symptoms [9], of negative affect and pain disability [10], and to prospectively predict depressive symptoms [11].”
BackgroundSelf-citationWong, M. Y. C., Fung, H. W., Wong, J. Y. H., & Lam, S. K. K. (2025) · Scientific Reports · doi:10.1038/s41598-025-95821-1 · Cited by 21 · see citing works
“The outcomes align with the existing literature, stating that individuals who are kinder to themselves are considered as protective from distressing experiences 47,48 .”
Mehta, S., Rice, D. B., Janzen, S. E., Serrato, J., Getty, H., Shapiro, A. P., Morley-Forster, P., Sequeira, K., & Teasell, R. W. (2016) · Pain Research and Management · doi:10.1155/2016/6954896 · Cited by 13 · see citing works
“Individuals that are less likely to be in contact with unwanted experiences and are more likely to try to control sensations have been shown to have decreased functioning and increased distress [7].”
BackgroundPsychological Theories of Pain
Penlington, C., Urbanek, M., & Barker, S. (2018) · Primary Dental Journal · doi:10.1177/205016841800700407 · Cited by 12 · see citing works
Obstacles to social safeness in women with chronic pain: The role of fears of compassion
Carvalho, S. A., Pinto‐Gouveia, J., Gillanders, D. T., & Castilho, P. (2019) · Current Psychology · doi:10.1007/s12144-019-00489-2 · Cited by 12 · see citing works
Self-citationCarvalho, S. A., Trindade, I. A., Duarte, J., Menezes, P. J., Patrão, B., Nogueira, M. R., Guiomar, R. N. R. M., Lapa, T. A. S. C., Pinto‐Gouveia, J., & Castilho, P. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.630766 · Cited by 11 · see citing works
“Interestingly, self-compassion appears be associated with important ACT processes (Costa and Pinto-Gouveia, 2013; Carvalho et al., 2018a; Edwards et al., 2019), and although ACT interventions do not specifically incorporate explicit selfcompassionate exercises, self-compassion was found to mediate the change in disabi…”
BackgroundSelf-citationBast, D. F., Linares, I. M. P., Gomes, C. T., Kovac, R., & Barnes‐Holmes, D. (2016) · The Psychological Record · doi:10.1007/s40732-016-0162-7 · Cited by 10 · see citing works
Generoso, L. P., Oliveira, G. P., Ferreira, L. L., Correia, L. M. F., da Silva, J. R. T., & da Silva, M. L. (2022) · Brazilian Journal Of Pain · doi:10.5935/2595-0118.20220009 · Cited by 10 · see citing works
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Role of Occupational Therapy in Pain Management
American Occupational Therapy Association (2021) · American Journal of Occupational Therapy · doi:10.5014/ajot.2020.75s3001 · Cited by 8 · see citing works
Compassion Focused Psychosexual Therapy for Women Who Experience Pain during Sex
Saunders, F., Vosper, J., Gibson, S., Jamieson, R., Zelin, J., & Barter, J. (2022) · OBM Integrative and Complementary Medicine · doi:10.21926/obm.icm.2202017 · Cited by 9 · see citing works
“It has been found that SC is associated with reduced mental health difficulties such as anxiety, depression, and stress for clients with various types of chronic pain [23].”
BackgroundBiopsychosocial assessment and management of persistent orofacial pain
Penlington, C., & Ohrbach, R. K. (2019) · Oral Surgery · doi:10.1111/ors.12470 · Cited by 8 · see citing works
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Bibliometric Mapping of Psychological Flexibility Research: Trends and Future Directions
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Self-Compassion and Mindfulness
Shapiro, S. L., & Fitch, A. (2023) · Mindfulness in behavioral health · doi:10.1007/978-3-031-22348-8_2 · Cited by 7 · see citing works
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“…and low self-compassion, which goes in line with the theoretical notion linking EA and the overall process of psychological flexibility (Hayes et al., 1999) and empirical evidence on the negative association between EA and selfcompassion (e.g., Costa & Pinto-Gouveia, 2013; Bakker et al., 2019).”
BackgroundKepelbagaian Pelajar dan Sekolah: Satu Kajian Kes di Negeri Pahang
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“…have demonstrated that patients with higher levels of selfcompassion showed lower levels of distress, pain-related disability and pain catastrophizing, decreased experiential avoidance, and increased pain acceptance (Costa and Pinto-Gouveia, 2011, 2013; Edwards et al., 2019; Wren et al., 2012).”
BackgroundCuerda‐Ballester, M., Bustos, A., Sancho-Cantus, D., Martínez‐Rubio, D., Privado, J., Alarcón-Jiménez, J., Villarón-Casales, C., de Bernardo, N., Navarro-Illana, E., & Ortí, J. E. D. L. R. (2024) · Bioengineering · doi:10.3390/bioengineering11010100 · Cited by 5 · see citing works
“These therapies could be complemented with nutritional interventions such as antioxidant-enriched ketogenic diets and moderate group exercise.”
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Psychological Theories of Pain
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Experiential Avoidance, Pain, and Suicide Risk in a National Sample of Gulf War Veterans
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“For instance, EA has been associated with depression and anxiety in patients with chronic pain in primary care settings (Costa & Pinto-Gouveia, 2013), greater pain-related impairment, catastrophizing and hypervigilance among patients with chronic spinal pain (Ram (cid”
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“These findings are consistent with works that consider experiential avoidance and self-compassion as variables associated with different mental health indicators, such as anxiety and depression (Yela et al. 2020), and physical health, such as chronic pain (Costa and Pinto-Gouveia 2013).”
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“Costa & PintoGouveia (2013) n = 103; mean age = 60.81 (males); 59.53 (females); 78% female Rheumatoid arthritis (n=40) and unspecified chronic pain (n=63) Psychopathology8 SCS2 SC was significantly correlated with depression (r = -.609; p ≤ .001), anxiety (r = -.373; p ≤ .001) and stress (r =…”
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Self-Compassion and Chronic Medical Conditions
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“Self-compassion was also related to lower anxiety and depression (Costa and Pinto-Gouveia, 2013).”
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- Authors
- Costa, J., & Pinto‐Gouveia, J.
- Affiliations
- University of Coimbra (PT)
- Corresponding author
- Costa, Joana
- Venue
- Journal of Applied Social Psychology
- Publisher
- Wiley
- Published
- 2013-07-08
- Volume
- 43
- Issue
- 8
- Pages
- 1578-1591
- ISSN
- 0021-9029 (ISSN-L)
- 1559-1816
- OpenAlex
- W2162048259
- Cited by
- 100
- References
- 85
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 7 · 2023: 6 · 2022: 8 · 2021: 15 · 2020: 7 · 2019: 11 · 2018: 9 · 2017: 8 · 2016: 8 · 2015: 7 · 2014: 3
- FWCI
- 6.67
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- Journal of Applied Social Psychology (publishedVersion)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, cc-by)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- chronic pain, experiential avoidance, self-compassion, coping, psychological distress, depression, anxiety, stress, primary care, pain acceptance
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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