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

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.