Investigating the Influence and a Potential Mechanism of Self-Compassion on Experimental Pain: Evidence From a Compassionate Self-Talk Protocol and Heart Rate Variability

Investigating the effects and efficacy of self-compassion intervention on generalized anxiety disorders

BACKGROUND

Generalized anxiety disorder (GAD) is the least successfully treated anxiety disorder. This clinical trial investigated the effects and efficacy of a novel self-compassion intervention in GAD.

METHODS

A total of 75 GAD patients were assigned to a self-compassion intervention group (n = 25), a mindfulness intervention group (n = 25), or a treat-as-usual group (n = 25). Patients in the two active groups received eight intervention sessions in two weeks in addition to usual treatment i.e., pharmacotherapy. Primary outcomes were anxiety and worry, assessed at pre-intervention, post-intervention, and three-month follow-up. Secondary outcomes included depression, sleep, as well as self-compassion and mindfulness.

RESULTS

Both the self-compassion and mindfulness intervention induced a more rapid decrease in anxiety and depression than pharmacological treatment alone with excellent response and remission rate. Self-compassion intervention also induced a more rapid improvement in sleep quality compared to mindfulness intervention and pharmacological treatment alone. We also presented a mechanism for the self-compassion intervention in which decreased anxiety led to improvement in sleep quality. There was also a higher pleasure, acceptance, and willingness to re-attend in the self-compassion compared to the mindfulness intervention.

LIMITATIONS

This study was single blinded and nonrandomized which may bring risks of bias.

CONCLUSIONS

Overall, we provided novel evidence that self-compassion intervention is an alternative psychotherapy for GAD with excellent response and acceptability.

What are the benefits of cultivating self-compassion in adults with low back pain? A systematic review

Introduction

Low back pain is one of the most prevalent public health problems in the world, generating psychosocial impacts on quality of life and a high demand for medical care. Self-compassion may be beneficial for low back pain control, however, studies in the area are scarce. Therefore, this systematic review aimed to investigate the benefits of self-compassion-related interventions on low back pain and mental health in adults.

Methods

The review protocol was registered in PROSPERO and the method was performed according to the PRISMA guidelines. Searches were conducted using the keywords "self-compassion" and "low back pain" in Portuguese, English, and Spanish in the following databases: PubMed, LILACS, SciELO, PePSIC, PsycInfo, Embase, Scopus, Web of Science, and Cochrane. Additional searches were also conducted through the references of the included studies.

Results

Thirty-three articles were identified and analyzed by two independent reviewers using Rayyan. Four of these studies were included. RoB 2 was used to assess the risk of bias of each study. The main findings suggest that self-compassion-related interventions demonstrate benefits in the treatment of low back pain, as well as reduction in pain intensity, psychological stress, and improvement of pain acceptance.

Discussion

However, these positive data must be analyzed carefully, as only two studies presented a low risk of bias. Despite growing interest in this field, more research self-compassion-related interventions for low back pain are suggested, since biopsychosocial aspects associated with low back pain can impact the outcome of treatment.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier (CRD42022376341).

Distinct Emotional and Cardiac Responses to Audio Erotica between Genders

Emotional and cardiac responses to audio erotica and their gender differences are relatively unclear in the study of the human sexual response. The current study was designed to investigate gender differences regarding positive and negative emotional responses to erotica, as well as its association with cardiac response. A total of 40 healthy participants (20 women) were exposed to erotic, neutral, and happy audio segments during which emotions and heart rate changes were evaluated. Our data showed distinct emotional responses to erotica between genders, in which women reported a higher level of shame than men and rated erotic audios as less pleasant than happy audios. Meanwhile, men reported erotic and happy audios as equally pleasant. These results were independent of cardiac changes, as both sexes demonstrated comparable heart rate deceleration when exposed to erotica relative to neutral and happy stimuli. Our results highlight the role of sociocultural modulation in the emotional response to erotica.

Heart rate variability is not suitable as surrogate marker for pain intensity in patients with chronic pain

ABSTRACT

The search towards more objective outcome measurements and consequently surrogate markers for pain started decades ago; however, no generally accepted biomarker for pain has qualified yet. The goal is to explore the value of heart rate variability (HRV) as surrogate marker for pain intensity chronic pain setting. Pain intensity scores and HRV were collected in 366 patients with chronic pain, through a cross-sectional multicenter study. Pain intensity was measured with both the Visual Analogue Scale and Numeric Rating Scale, while 16 statistical HRV parameters were derived. Canonical correlation analysis was performed to evaluate the correlation between the dependent pain variables and the HRV parameters. Surrogacy was determined for each HRV parameter with point estimates between 0 and 1 whereby values close to 1 indicate a strong association between the surrogate and the true endpoint at the patient level. Weak correlations were revealed between HRV parameters and pain intensity scores. The highest surrogacy point estimate was found for mean heart rate as marker for average pain intensity on the Numeric Rating Scale with point estimates of 0.0961 (95% CI from 0.0384 to 0.1537) and 0.0209 (95% CI from 0 to 0.05) for patients without medication use, and medication use respectively. This study indicated that HRV parameters as separate entities are no suitable surrogacy candidates for pain intensity, in a population of chronic pain patients. Further potential surrogate candidates and clinical robust true endpoints should be explored, in order to find a surrogate measure for the highly individual pain experience.

Concurrent TMS-EEG and EEG reveal neuroplastic and oscillatory changes associated with self-compassion and negative emotions

Background/Objective

Self-compassion has a consensual relevance for overall mental health, but its mechanisms remain unknown. Using intermittent theta burst stimulation (iTBS) and concurrent transcranial magnetic stimulation-electroencephalography (TMS-EEG), this study investigated the causal relationship of the dorsolateral prefrontal cortex (DLPFC) with self-compassion and explored the changes in neuroplasticity and neural dynamics.

Method

Thirty-two healthy participants received iTBS or sham stimulation over the DLPFC, before and after which they were instructed to either use self-compassionate strategies or to be rejected in the context of social rejection and to report the level of self-compassion or negative affect. TMS-evoked potentials were evaluated as novel neuroplastic techniques with N45, P60, N100, and P180.

Results

iTBS uniquely decreased P180 amplitude measured with TMS-EEG whereby sham stimulation had no effect on neuroplasticity. In line with neuroplasticity changes, iTBS enhanced a widespread gamma band power and coherence, which correlated consistently with increased engagement in self-compassion. Meanwhile, iTBS demonstrated opposite effects on theta activity dependent on the social contexts whereby self-compassion decreased and social rejection enhanced it respectively. This unique effect of iTBS on theta activity was also supplemented by the enhancement of theta band coherence following iTBS.

Conclusions

We found a causal relationship between DLPFC and self-compassion. We also provide evidence to indicate widespread gamma activity and connectivity to correlate with self-compassion as well as the critical role of the DLPFC in modulating theta activity and negative emotions.

Regulatory Emotional Self-Efficacy Buffers the Effect of Heart Rate Variability on Functional Capacity in Older Adults With Chronic Low Back Pain

Introduction

Chronic low back pain is one of the leading causes of disability globally among older adults. Prevailing research suggests that autonomic dysregulation places individuals at increased risk for chronic pain. This study examines the moderating role of emotional self-efficacy (ESE) on the relationship between heart rate variability (HRV) and pain related-outcomes, including movement-evoked pain (MEP) and physical functioning.

Methods

In a secondary analysis of the Adaptability and Resilience in Aging Adults (ARIAA) study, a total of 58 adults (aged 60 and older) with chronic low back pain (cLBP) completed the PROMIS self-efficacy for managing emotions questionnaire and the 6-minute walk test (6 MWT) to assess functional capacity and MEP. Heart rate variability, indexed by the frequency domain, was assessed for 5 min during rest.

Results

For pain-related outcomes, having a lower body mass index (p = 0.03) was associated with better functional capacity on the 6MWT, while higher education level (p = 0.01) and less pain duration (p = 0.00) were correlated with lower MEP. After controlling for sex, age, and body mass index, an increase in low-frequency HRV (LF-HRV) was associated with poorer physical functioning among individuals low in ESE (b = −0.12 p = 0.03). No significant moderation effects were observed for MEP.

Conclusion

Our results bring attention to the degree to which ESE influences the relationship between LF-HRV and physical functioning. Interventions that enhance adaptive psychological processes such as ESE may dampen ANS dysregulation and mitigate risk for adverse pain outcomes among older adults with cLBP.

Self-Compassion and Its Association With Ruminative Tendencies and Vagally Mediated Heart Rate Variability in Recurrent Major Depression

Background

Recurrent Major Depressive Disorder (MDD) is one of the most disabling mental disorders in modern society. Prior research has shown that self-compassion protects against ruminative tendencies, a key feature of recurrent MDD. In addition, self-compassion has been found to be positively related to higher psychophysiological flexibility (indexed by a higher vagally mediated heart rate variability; vmHRV) in young, healthy adults. To our knowledge, there is a lack of studies on how self-compassion relates to vmHRV in patients with recurrent MDD. The aim of the current study was to investigate whether higher self-compassion would associate with (1) lower ruminative tendencies and (2) higher vmHRV in a sample of adults with recurrent MDD.

Methods

We included a sample of 63 patients (46 females) between 20 and 71 years old (M = 40.24, SD = 12.8) with a history of three or more depressive episodes. They filled out the Self-Compassion Scale (SCS), Beck Depression Inventory (BDI), and Rumination Rating Scale (RRS). ECG (used to derive vmHRV) was acquired while resting and the square root of the mean squared differences of successive RR interval values (RMSSD) was calculated as measure of vmHRV.

Results

As hypothesized, self-compassion was associated with lower ruminative tendencies. However, self-compassion was not associated with level of vmHRV. Several confounding variables were controlled for in the statistical analyses, and higher age predicted lower vmHRV across all statistical analyses.

Conclusion

The results confirmed our hypothesis that higher self-compassion would be associated with lower ruminative tendencies in recurrent MDD. Contrary to our expectation, we did not find that the tendency to be more self-compassionate was associated with higher vmHRV. As such, higher self-compassion seems to relate with a lower tendency to ruminate about past mistakes and events but does not seem to relate to a flexible autonomic stress response (as indexed by higher vmHRV). Other potential explanatory factors for lower vmHRV in recurrent MDD is suggested as focus for exploration in future studies.

Heart Rate Variability and Pain: A Systematic Review

Background and Objective: Heart rate variability (HRV) as an index of the autonomic nervous system appears to be related to reactivity to experimental pain stimuli. HRV could better explain the contributions of sympathetic and parasympathetic activity response to nociceptive stimulation. The aim of this study was to systematically review and synthesize the current evidence on HRV in relation to the experience of pain in experimental tasks. Databases and Data Treatment: Studies indexed in the PubMed, PsycINFO, MEDLINE, WebOfScience, and Scopus databases were reviewed for eligibility. Studies on the autonomic response (i.e., HRV) to experimentally induced pain in healthy adults were included. Different methods of pain induction were considered (e.g., thermal, pressure, and electrical). Data were synthesized considering the association between HRV and both pain induction and subjective measures of pain. Results: Seventy-one studies were included. The results underline significant change in both the sympathetic and parasympathetic autonomic nervous systems during the painful stimulation independent of the pain induction method. The autonomic reaction to pain could be affected by several factors, such as sex, age, body mass index, breathing patterns, the intensity of the stimulation, and the affective state. Moreover, an association between the autonomic nervous system and the subjective experience of pain was found. Higher parasympathetic activity was associated with better self-regulation capacities and, accordingly, a higher pain inhibition capacity. Conclusions: HRV appears to be a helpful marker to evaluate nociceptive response in experimentally induced pain. Future studies are also needed in clinical samples to understand better the interindividual changes of autonomic response due to pain stimuli.

Investigating the Influence of Self-Compassion-Focused Interventions on Posttraumatic Stress: A Systematic Review and Meta-Analysis

Objectives

Self-compassion-focused interventions may be able to decrease posttraumatic stress symptoms. However, previous studies demonstrated mixed effects in which a series of confounders were not systematically quantified. In this study, a systematic review with meta-analysis was conducted to quantify the effects of self-compassion-focused therapies on posttraumatic stress disorder.

Methods

Twelve eligible studies were included after a systematic search of databases. Outcome measures were extracted for posttraumatic stress disorder.

Results

Our data indicated a medium protective effect on posttraumatic stress symptoms (SMD =  − 0.65), with most of the studies (8/12) coming from clinical settings. More importantly, longer interventions were associated with better posttraumatic stress outcomes (p < 0.001). Baseline or changes in self-compassion scores were not associated with posttraumatic stress outcomes post-interventions.

Conclusions

Overall, findings from this meta-analysis quantified the complex influence of self-compassion-focused interventions on posttraumatic stress symptoms and may provide insights for optimizing intervention strategies. 

Systematic Review and Meta-analysis Registration: PROSPERO CRD42020208663.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12671-021-01732-3.

Corrigendum to "Self-Compassion Demonstrating a Dual Relationship with Pain Dependent on High-Frequency Heart Rate Variability"

[This corrects the article DOI: 10.1155/2020/3126036.].

Self-Compassion Demonstrating a Dual Relationship with Pain Dependent on High-Frequency Heart Rate Variability

One previous study indicated the significance of trait self-compassion in psychological well-being and adjustment in people with chronic pain. Higher-frequency heart rate variability (HF-HRV) was found to be closely associated with self-compassion and pain coping. The current study was therefore designed to investigate the relationship between self-compassion and experimental pain as well as the impact of HF-HRV. Sixty healthy participants provided self-reported self-compassion and underwent a cold pain protocol during which HF-HRV was evaluated. Results demonstrated a dual relationship between self-compassion and pain, dependent on the level of HF-HRV during pain exposure. Specifically, self-compassion was associated with lower pain in the condition of higher HF-HRV, while there was an inverse relationship between self-compassion and pain when HF-HRV was lower. Our data indicate the significance of HF-HRV in moderating the association between self-compassion and experimental pain.