Self-compassion in Acceptance and Commitment Therapy for chronic pain: A pilot study
Open accessAbstract
Objectives: Evidence shows that Acceptance and Commitment Therapy (ACT) is an empirically supported psychological approach for chronic pain (CP) management. Although self-compassion is not explicitly a target of ACT, it seems to be one mechanism of change in ACT for CP. However, research is lacking on the benefits of including explicit self-compassionate exercises in ACT for CP. The current study pilot tested a Compassionate ACT 8-session group program (COMP.ACT; n=9), as well as an ACT-only 8-session group program (ACT; n=7), in a sample of women with CP. Methods: The current study follows a quasi-experimental design, and conducts Reliable and Significant Change analyses comparing pre- to post-intervention scores of self-report measures. Results: No differences were found between conditions at baseline, nor between completers and drop-outs. Although preliminary, results showed COMP.ACT led to greater clinical improvements in depression and anxiety, while ACT led to greater improvements in stress and uncompassionate self-responding. Reliable and Significant Change analysis showed that some participants improved significantly (in psychopathological symptoms, valued living and uncompassionate self-responding) in both conditions, while the majority did not change significantly. Conclusions: More research is needed to conclude whether explicit self-compassion exercises are useful in ACT for CP. Limitations and implications are further discussed. © 2021 Walter de Gruyter GmbH, Berlin/Boston.
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Cites
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Claims the paper makes
4 of 14 cited sources checked · 3 supported · 0 flagged · accuracy not yet measured
- Premisecitation
Acceptance and Commitment Therapy is an empirically supported psychological treatment for chronic pain management.
“Evidence shows that Acceptance and Commitment Therapy (ACT) is an empirically supported psychological approach for chronic pain (CP) management.”
- Also stated in: § Introduction · boosted
“There is strong evidence of the efficacy of ACT on improving quality of life, well-being, reducing pain limitation and psychopathological symptoms, and in promoting psychological flexibility in individuals with CP [3,4]”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [3] Feliu-Soler, A, Montesinos, F, Gutiérrez-Martínez, O, Scott, W, McCracken, LM, Luciano, JV. Current status of acceptance and commitment therapy for chronic pain: a narrative review. J Pain Res 2018;11:2145–59. https://doi.org/10.2147%2FJPR.S144631. source
- cites [4] Hughes, LS, Clark, J, Colclough, JA, Dale, E, McMillan, D. Acceptance and commitment therapy (ACT) for chronic pain. Clin J Pain 2017;33:552–68. https://doi.org/10.1097/AJP.0000000000000425. source
- Also stated in: § Introduction · boosted
- Premisecitation
Acceptance and Commitment Therapy promotes self-compassion.
“research suggests that ACT does promote self-compassion [16]”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [16] Yadavaia, JE, Hayes, SC, Vilardaga, R. Using acceptance and commitment therapy to increase self-compassion: a randomized controlled trial. J Contextual Behav Sci 2014;3:248–57. https://doi.org/10.1016/j.jcbs.2014.09.002. source
- Premisecitation
Self-compassion is one mechanism of therapeutic change underlying Acceptance and Commitment Therapy for chronic pain.
“is one mechanism of therapeutic change underlying ACT for CP [18]”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [18] Vowles, KE, Witkiewitz, K, Sowden, G, Ashworth, J. Acceptance and commitment therapy for chronic pain: evidence of mediation and clinically significant change following an abbreviated interdisciplinary program of rehabilitation. J Pain 2014;15:101–13. https://doi.org/10.1016/j.jpain.2013.10.002. source
- Premisecitation
Self-compassion overlaps with psychological processes that Acceptance and Commitment Therapy promotes.
“self-compassion overlap with psychological processes promoted through ACT [17]”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [17] Vowles, KE, Sowden, G, Ashworth, J. A comprehensive examination of the model underlying acceptance and commitment therapy for chronic pain. Behav Ther 2014;45:390–401. https://doi.org/10.1016/j.beth.2013.12.009. source
The available indexed passages are bibliographic information (the title and Abstract-labeled metadata), not discussion of the paper’s findings. Searches for “self-compassion” and for ACT psychological processes found no passage addressing whether they overlap. (LLM, conf=0.73)
Experimental — accuracy not yet measured
- Findingown data
No change was found in either condition in mindfulness and compassionate self-responding.
“No change was found in both conditions in terms of mindfulness and compassionate self-responding.”
Quote in the paperNot a substantial claim- Rests on an assumption: The pre-post changes observed in each condition are attributable to the respective interventions rather than to uncontrolled factors such as natural recovery, regression to the mean, or non-specific therapy effects.
- Premisecitation
Compassion-based psychological interventions have been found useful for promoting chronic pain management.
“Indeed, compassion-based psychological interventions were found useful in effectively promoting CP management (see [13]).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [13] Lanzaro, C, Carvalho, SA, Lapa, TA, Valentim, A, Gago, B. A systematic review of self-compassion in chronic pain: from correlation to efficacy. Span. J Psychol 2021;24:e26. https://doi.org/10.1017/SJP.2021.22. source
- Premisecitation
A theoretical link between Acceptance and Commitment Therapy and compassion-based approaches has been established.
“the bridge between ACT and compassion-based approaches has been theoretically built [14,15]”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [14] Neff, K, Tirch, D. Self-compassion and ACT. In: Kashdan, TB, Ciarrochi, J, editors. The Context Press mindfulness and acceptance practica series. Mindfulness, acceptance, and positive psychology: the seven foundations of well-being. Oakland, CA: New Harbinger Publications; 2013:78–106 pp.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [15] Neff, KD, Dahm, KA. Self-compassion: what it is, what it does, and how it relates to mindfulness. In: Ostafin, B, Robinson, MD, Meier, BP, editors. Handbook of mindfulness and self-regulation. New York: Springer; 2015:121–37 pp. source
- Interpretationreasoning
It is premature to establish a pattern of individual clinical benefits of COMP.ACT compared to ACT-only because the small sample does not allow in-depth examination of factors associated with individual response.
“However, it is premature to establish confidently a pattern of individual clinical benefits of COMP.ACT comparatively to ACT-only, given that the current small sample does not allow a more in-depth examination of which factors are associated to individual response to the program.”
Quote in the paperSubstantial claim- Rests on an assumption: The pre-post changes observed in each condition are attributable to the respective interventions rather than to uncontrolled factors such as natural recovery, regression to the mean, or non-specific therapy effects.
- Interpretationreasoning
The low education level in the sample may have contributed to the problematic internal consistency of some subscales.
“Indeed, the problematic internal consistency (α<0.70) of some subscales may have been a result from the low education level in our sample.”
Quote in the paperNot a substantial claim - Premisecitation
The added value of including explicit compassionate exercises in an Acceptance and Commitment Therapy protocol has not yet been established.
“the added value of including explicit compassionate exercises in an ACT protocol has yet to be established.”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [19] Hill, ML, Schaefer, LW, Spencer, SD, Masuda, A. Compassion-focused acceptance and commitment therapy for women with restrictive eating and problematic body-checking: a multiple baseline across participants study. J Contextual Behav Sci 2020;16:144–52. https://doi.org/10.1016/j.jcbs.2020.04.006. source
- cites [20] Trindade, IA, Ferreira, C, Pinto-Gouveia, J. Acceptability and preliminary test of efficacy of the Mind programme in women with breast cancer: an acceptance, mindfulness, and compassion-based intervention. J Contextual Behav Sci 2020;15:162–71. https://doi.org/10.1016/j.jcbs.2019.12.005. source
- Study design and conductown data
Some subscales had problematic internal consistency (α<0.70).
“the problematic internal consistency (α<0.70) of some subscales”
Quote in the paperNot a substantial claim - Interpretationown data
The small sample size does not allow more conclusive results.
“The sample was small, thus not allowing for more conclusive results.”
Quote in the paperSubstantial claim
- May combine two claims. 10
- The quote only partly states this claim. 5
- Classified as probably not a substantial claim. 9
May combine two claims. The quote only partly states this claim.
Findingown dataIn COMP.ACT, one participant (12.50%) recovered in pain intensity, while three participants (33.33%) deteriorated in pain disability.
“One participant was”
Quote in the paperNot a substantial claim- Rests on an assumption: The pre-post changes observed in each condition are attributable to the respective interventions rather than to uncontrolled factors such as natural recovery, regression to the mean, or non-specific therapy effects.
May combine two claims.
Findingown dataNo significant baseline differences were found between the COMP.ACT and ACT-only conditions on age, marital status, education, number of chronic pain diagnoses, duration of chronic pain, or presence of other chronic illnesses.
“No significant differences were found between conditions in terms of age (t (14) =1.216; p=0.244), marital status ( χ 2 (3, n=16) =2.12, p=0.549), education ( χ 2 (5, n=16) =2.79, p=0.732), number of CP diagnoses (t (14) =-1.038; p=0.317), duration of CP ( χ 2 (3, n=16) =5.67, p=0.129), and presence of other chronic illnesses ( χ 2 (1, n=16) =0.91, p=0.341).”
- Also stated in: § Abstract · plain
“No differences were found between conditions at baseline, nor between completers and drop-outs.”
Quote in the paperSubstantial claim- Also stated in: § Abstract · plain
May combine two claims. The quote only partly states this claim.
Findingown dataIn ACT-only, three participants improved, two of whom recovered in uncompassionate self-responding; in COMP.ACT, one participant (11.11%) recovered. One participant in ACT-only (14.29%) and two in COMP.ACT (22.22%) deteriorated in uncompassionate self-responding.
“Three participants in ACT-only improved, two of which”
Quote in the paperNot a substantial claim- Rests on an assumption: The pre-post changes observed in each condition are attributable to the respective interventions rather than to uncontrolled factors such as natural recovery, regression to the mean, or non-specific therapy effects.
May combine two claims. The quote only partly states this claim.
Findingown dataIn ACT-only, one participant recovered and two deteriorated in obstruction to valued living; in COMP.ACT, one participant recovered in progress in valued living.
“One participant in ACT-only”
Quote in the paperNot a substantial claim- Rests on an assumption: The pre-post changes observed in each condition are attributable to the respective interventions rather than to uncontrolled factors such as natural recovery, regression to the mean, or non-specific therapy effects.
May combine two claims.
Findingown dataThe majority of participants in both conditions did not show reliable and clinically significant changes, while some improved significantly in psychopathological symptoms, valued living, and uncompassionate self-responding.
“Reliable and Significant Change analysis showed that some participants improved significantly (in psychopathological symptoms, valued living and uncompassionate self-responding) in both conditions, while the majority did not change significantly.”
- Also stated in: § Discussion · plain
“Results showed that while the majority of participants in both conditions did not present reliable and clinically significant changes, some did significantly improve in key outcomes (e.g., psychopathological symptoms, valued living and uncompassionate self-responding).”
Quote in the paperSubstantial claim- Rests on an assumption: The pre-post changes observed in each condition are attributable to the respective interventions rather than to uncontrolled factors such as natural recovery, regression to the mean, or non-specific therapy effects.
- Also stated in: § Discussion · plain
May combine two claims.
Findingown dataIn COMP.ACT, two participants (25.00%) recovered in depressive symptoms and two (25.00%) in anxiety symptoms, and these were the same two participants; in ACT-only, three participants (42.86%) recovered in stress symptoms.
“Results show that two participants were”
Quote in the paperNot a substantial claim- Rests on an assumption: The pre-post changes observed in each condition are attributable to the respective interventions rather than to uncontrolled factors such as natural recovery, regression to the mean, or non-specific therapy effects.
Classified as probably not a substantial claim.
Interpretationown dataWhether explicit self-compassion exercises in an ACT program for chronic pain are useful remains to be determined.
“More research is needed to conclude whether explicit self-compassion exercises in an ACT program for CP (COMP.ACT) is a useful strategy to complement medical treatment as usual for women with CP.”
Quote in the paperSubstantial claim- Rests on an assumption: The pre-post changes observed in each condition are attributable to the respective interventions rather than to uncontrolled factors such as natural recovery, regression to the mean, or non-specific therapy effects.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims. The quote only partly states this claim.
Study design and conductreasoningThe study deviated from its registered protocol: the sample was 16 instead of the planned 20, the 6-month follow-up was not conducted, an additional exclusion criterion was added, and the quality of life measure was excluded.
“the sample size is n=16, instead of the aimed n=20”
- Also stated in: § Procedure · plain
“we ended up excluding the quality of life measure from the protocol.”
Quote in the paperNot a substantial claim- Also stated in: § Procedure · plain
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataThe intervention was delivered by two clinical psychologists trained in ACT and compassion approaches with previous experience in acceptance, mindfulness, and compassion-based interventions.
“The intervention was conducted in a co-therapy setting by two clinical psychologists with training in ACT and compassion approaches, and previous experience in delivering acceptance, mindfulness and compassion-based interventions.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationThe current study is built on previous research that established the efficacy of ACT for chronic pain and the efficacy of incorporating compassion in mindfulness-and acceptance-based interventions.
“The current study is built on previous research that established the efficacy of ACT for CP [4], as well as on the efficacy of incorporating compassion in mindfulness-and acceptance-based interventions [19,20]”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [4] Hughes, LS, Clark, J, Colclough, JA, Dale, E, McMillan, D. Acceptance and commitment therapy (ACT) for chronic pain. Clin J Pain 2017;33:552–68. https://doi.org/10.1097/AJP.0000000000000425. source
- cites [19] Hill, ML, Schaefer, LW, Spencer, SD, Masuda, A. Compassion-focused acceptance and commitment therapy for women with restrictive eating and problematic body-checking: a multiple baseline across participants study. J Contextual Behav Sci 2020;16:144–52. https://doi.org/10.1016/j.jcbs.2020.04.006. source
- cites [20] Trindade, IA, Ferreira, C, Pinto-Gouveia, J. Acceptability and preliminary test of efficacy of the Mind programme in women with breast cancer: an acceptance, mindfulness, and compassion-based intervention. J Contextual Behav Sci 2020;15:162–71. https://doi.org/10.1016/j.jcbs.2019.12.005. source
Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.
Study design and conductnone givenInformed consent was obtained from all participants.
“Informed consent was obtained from all individual adult participants included in the study.”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationown dataSome participants had primary-level education, which may have impacted item interpretation.
“although all participants could read and write, some had a primary-level education, which may have impacted on the interpretation of items.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Premisenone givenThis is the first pilot study exploring the role of self-compassion in ACT by comparing it to a standard ACT-only intervention.
“is the first pilot study exploring the role of self-compassion in ACT by comparing it to a standard ACT-only intervention.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe study was registered as a trial (NCT04210466) at ClinicalTrials.gov.
“This study is registered as a trial (NCT04210466) at ClinicalTrials.gov.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe British Pain Society recommends Acceptance and Commitment Therapy for chronic pain management.
“its efficacy for CP has been acknowledged by The British Pain Society recommendation of ACT for CP management [5].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [5] The British Pain Society. Guidelines for pain management programmes for adults an evidence-based review prepared on behalf of the British Pain Society; 2013. Available from: www.britishpainsociety.org.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenParticipants were allocated according to schedule preference.
“Finally, participants were allocated according to schedule preference.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe self-report measures used had already been validated for the Portuguese population.
“the protocol included self-report measures already validated for the Portuguese population.”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationown dataThe sample was composed of women, so the results cannot be generalized to other genders.
“Firstly, the sample was composed of women, which does not allow for further generalization of results to other genders.”
Quote in the paperNot a substantial claim
The paper relies on this without support.
The pre-post changes observed in each condition are attributable to the respective interventions rather than to uncontrolled factors such as natural recovery, regression to the mean, or non-specific therapy effects.
“Although preliminary, results showed COMP.ACT led to greater clinical improvements in depression and anxiety, while ACT led to greater improvements in stress and uncompassionate self-responding.”
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“Therefore, although self-compassion is interwoven throughout ACT in practice and training and seen as a potential mechanism of change, it is not adequately conceptualised within the model (Carvalho et al., 2022; Ne ff & Tirch, 2013).”
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“40,41 There is evidence that ACT is effective in increasing self-compassion.”
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“25 While some of the techniques used within ACT aim to enhance compassion, 26 in CFT self-compassion and self-criticism are targeted more directly, that is, compassion is more central and more elaborated.”
BackgroundMethodCarvalho, S. A., Menezes, P. J., Duarte, C., Skvarc, D., Silva, A. R., Valentim, A., Diogo, J. E., Sargento‐Freitas, J., Trindade, I. A., Castilho, P., et al. (2025) · JMIR Research Protocols · doi:10.2196/80611 · Cited by 2 · see citing works
“The VR-ACT intervention content will adapt ACT-based interventions for chronic pain that were previously developed and tested by the research team (eg, the face-to-face COMP.ACT program [33] and the online iACTwithPain platform [34]) into a VR format and tailored to CPSP.”
Self-citationDuarte, C. C. M., Spilker, R. L. F., Paiva, C., Ferreira, R. J. O., da Silva, J. A. P., & Pinto, A. M. (2023) · Trials · doi:10.1186/s13063-023-07692-4 · Cited by 2 · see citing works
“RA programme (i.e. mindfulness, acceptance, and compassion-based strategies), have been previously proposed and tested in people with binge eating disorder [47], cancer [48], chronic pain [49], and overweight and obesity [50].”
BackgroundMethodDepartment of Educational Sciences, F. O. E. S. A. P., Pourfarahani, M., Shareh, H., Department of Educational Sciences, F. O. L. A. H., Haji Arbabi, F., & Department of Educational Sciences, F. O. E. S. A. P. (2023) · Iranian Journal of Psychiatry and Clinical Psychology · doi:10.32598/ijpcp.29.1.225.13 · Cited by 2 · see citing works
Abdelrasheed, N. S. G., Petkov, I., Kaur, H., Sharma, A., Prasad, K., Nazarova, D., Gardanova, Z. R., Nikolenko, D. A., Ismail, S. M., & Zwamel, A. H. (2025) · Psychology Health & Medicine · doi:10.1080/13548506.2025.2478660 · Cited by 4 · see citing works
“We propose the following hypotheses: H1 the psychological �exibility processes are positively related to the components of psychological well-being.”
Bernabé, J. R. Y., Buz, J., Crego, A., Gregoris, L., & Alonso, M. (2026) · Scientific Reports · doi:10.1038/s41598-026-46387-z · Cited by 1 · see citing works
“In addition, self-compassion is positively associated with psychological flexibility 41,42 and is considered a related transdiagnostic process 43–45 , supporting its role in adaptive emotional regulation.”
(2022) · Scandinavian Journal of Pain · doi:10.1515/sjpain-2022-frontmatter3
فعالية العلاج بالتقبل والالتزام في تنمية الرأفة بالذات لدى طلاب الجامعة
أبو, ر. ص. ع. ا. (2023) · مجلة كلية التربية جامعة بنها · doi:10.21608/jfeb.2023.323490
Davey, M., Fried, L., Rooney, R. M., Roberts, A., & Chih, H. (2025) · Mental Health and Digital Technologies · doi:10.1108/mhdt-03-2025-0021
Azadfar, Z., Baetens, I., Tsantzalou, K. S., Castiglione, L., Heel, M. V., & Theuns, P. (2025) · Current Psychology · doi:10.1007/s12144-025-08162-7 · Cited by 1 · see citing works
“Although self-compassion is not an explicit target of ACT, it appears to function as a mechanism of change in ACT-based interventions (Carvalho et al., 2022 ).”
Compassion-Focused Therapy in European Latin Cultures
Martínez-Rives, N. L., & Beaumont, J. (2026) · Advances in mental health and addiction · doi:10.1007/978-3-032-12438-8_7
Man, L. L., Dahary, H., Mishra, S., Magnacca, C., Steel, L., Lunsky, Y., Porthukaran, A., Siu, J., Bobbette, N., Redquest, B. K., et al. (2026) · JMIR Formative Research · doi:10.2196/86205
Ma, H., Yang, Y., Cariola, L. A., & Gillanders, D. (2026) · Supportive Care in Cancer · doi:10.1007/s00520-026-10985-4
Self-citationde Carvalho, M. M., & Henriques, A. (2026) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-026-09745-6
Design of a Virtual Reality–Based Framework for ACT Delivery in Chronic Post-Stroke Pain
Sousa, A. J., Carvalho, S. A., & Menezes, P. J. (2026) · IEEE International Conference on Intelligent Reality (ICIR) · doi:10.1109/icir70631.2026.11628245
“The intervention follows a systematic progression across three domains, based on previous pilot tests of group face-to-face [25] [15] and online Compassionate ACT in chronic pain [26]”
Self-citationCarvalho, S. A., Veloso, B., Pereira, A. S., Soares, A. M., Carreiras, D., Marta‐Simões, J., Moreira, H., & Trindade, I. A. (2026) · Journal of Psychosocial Oncology · doi:10.1080/07347332.2026.2729877
Self-citation
- Authors
- Carvalho, S. A., Gillanders, D., Forte, T., Trindade, I. A., Pinto-Gouveia, J., Lapa, T., Valentim, A., Santos, E., Paciência, J., Guiomar, R., & Castilho, P.
- Affiliations
- University of Coimbra (PT)
- University of Edinburgh (GB)
- University of Aveiro (PT)
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Education Sciences, University of Coimbra , Coimbra , Portugal
- University of Beira Interior (PT)
- Unidade Local de Saúde de Coimbra (PT)
- Corresponding author
- Carvalho, Sérgio A.
- ORCID
- Venue
- Scandinavian Journal of Pain
- Publisher
- Walter de Gruyter GmbH
- Published
- 2021-12-22
- Volume
- 22
- Issue
- 3
- Pages
- 631-638
- ISSN
- 1877-8860 (ISSN-L)
- 1877-8879
- OpenAlex
- W4200077992
- Semantic Scholar
- 893bf72c72644d880375c15df7e9d949c8e956f3
- Cited by
- 21
- References
- 33
- Citations by year
- 2026: 7 · 2025: 5 · 2023: 6 · 2022: 3
- FWCI
- 1.53
- Type
- journal article
- Language
- en
- Open access
- Licence
- other-oa
- Locations
- Scandinavian Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, other-oa)
- Funders
- FCT (SFRH/BD/112833/2015)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- self-compassion, acceptance and commitment therapy, chronic pain, group intervention, women, depression, anxiety, stress, valued living, mechanisms of change
- MeSH terms
- Self-Compassion, Anxiety, Female, Humans, Pilot Projects, Chronic Pain, Acceptance and Commitment Therapy
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