Self-compassion, automatic thoughts, and mental pain in depression: Mediating effects and clinical implications

Depression is a leading global health concern with high suicide rates and recurrence. Cognitive models suggest that mental pain and automatic thoughts are central to depression's impact. The hypothesis is that self-compassion will be negatively associated with mental pain, mediated by automatic thoughts.

To determine the mediating role of automatic thoughts in the relationship between self-compassion and mental pain in individuals with depression.

This cross-sectional study included 389 inpatients with depression from Tianjin Anding Hospital. Participants completed the Self-Compassion Scale-Chinese Version (SCS-C), Automatic Thought Questionnaire (ATQ), and Orbach & Mikulincer Mental Pain Scale-Chinese Version (OMMP). Data were analyzed using Pearson correlations, multiple linear regressions, and mediation analysis.

The SCS-C total score was 68.95 ± 14.89, ATQ was 87.02 ± 28.91, and OMMP was 129.01 ± 36.74. Correlation analysis showed mental pain was positively associated with automatic thoughts (r = 0.802, P < 0.001) and negatively with self-compassion (r = -0.636, P < 0.001). Regression analysis indicated automatic thoughts (β = 0.623, P < 0.001) and self-compassion (β = -0.301, P < 0.001) significantly predicted mental pain. Mediation analysis confirmed automatic thoughts partially mediated the relationship between self-compassion and mental pain (ab = -0.269, 95%CI: -0.363 to -0.212).

Self-compassion is inversely related to mental pain in depression, with automatic thoughts playing a mediating role. These findings suggest potential therapeutic targets for alleviating mental pain in depressed patients.