{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:35:17Z","timestamp":1792805717667,"version":"4.5.0"},"reference-count":75,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T00:00:00Z","timestamp":1792281600000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Pain"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Psychological treatments for chronic pain are effective, but the processes associated with therapeutic change, and whether these are shared across treatments or treatment\u2010specific, remain unclear. This exploratory secondary analysis examined whether changes in pain acceptance, pain catastrophizing facets and self\u2010compassion were associated with clinical outcomes in Mindful Self\u2010Compassion (MSC) versus Cognitive\u2010Behavioural Therapy (CBT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Data were drawn from a randomized trial comparing MSC (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200961) and CBT (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200959) in adults with chronic pain and elevated emotional distress. Processes and outcomes were assessed at baseline and post\u2010treatment. Single and theoretically ordered multiple\u2010mediator models examined whether changes in pain acceptance, rumination, magnification, helplessness and self\u2010compassion were associated with changes in anxiety, depression, quality of life, pain interference and pain intensity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Compared with CBT, MSC produced larger increases in pain acceptance and reductions in helplessness. These processes statistically accounted for improvements in self\u2010compassion, depression, mental quality of life and pain interference; acceptance additionally accounted for reduced pain intensity, and helplessness for reduced anxiety. Rumination and magnification predicted improvements across treatments but did not explain between\u2010group differences. Multiple\u2010mediator models indicated that acceptance\/self\u2010compassion and helplessness\/self\u2010compassion pathways favoured MSC for depression, anxiety and mental quality of life, explaining up to 51% of change. No mediator accounted for physical quality of life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MSC and CBT appeared to engage overlapping processes, with differential associations mainly involving pain acceptance and helplessness. Acceptance may be more relevant to functional and pain\u2010related outcomes, whereas helplessness\/self\u2010compassion pathways may be more relevant to emotional recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance Statement<\/jats:title>\n                    <jats:p>This study identifies pain acceptance and reduced helplessness as candidate processes associated with treatment response in MSC and CBT, with acceptance more closely linked to pain\u2010related and functional change and helplessness to emotional outcomes. These findings support more precise, process\u2010based psychological treatment for chronic pain.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejp.70427","type":"journal-article","created":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T05:49:42Z","timestamp":1792388982000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Shared and Differential Psychological Processes Associated With Treatment Response in Mindful Self\u2010Compassion and Cognitive\u2010Behavioural Therapy for Chronic Pain: An Exploratory Secondary Analysis of a Randomized Controlled Trial"],"prefix":"10.1002","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1570-0918","authenticated-orcid":false,"given":"Marta","family":"Torrijos\u2010Zarcero","sequence":"first","affiliation":[{"name":"Hospital Universitario Pr\u00edncipe de Asturias  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9815-4902","authenticated-orcid":false,"given":"Pablo","family":"Roca","sequence":"additional","affiliation":[{"name":"Precision Mind Lab (Premind) Universidad Villanueva  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9916-1378","authenticated-orcid":false,"given":"Cristina","family":"Rocamora\u2010Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Universidad Pontificia de Comillas  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1708-906X","authenticated-orcid":false,"given":"Mar\u00eda","family":"Del R\u00edo\u2010Di\u00e9guez","sequence":"additional","affiliation":[{"name":"Universidad Aut\u00f3noma de Madrid  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2717-5807","authenticated-orcid":false,"given":"\u00c1ngela","family":"Palao\u2010Tarrero","sequence":"additional","affiliation":[{"name":"Hospital La Paz Institute for Health Research (IdiPAZ)  Madrid Spain"},{"name":"Department of Psychiatry, Clinical Psychology and Mental Health La Paz University Hospital  Madrid Spain"},{"name":"Department of Psychiatry Universidad Aut\u00f3noma de Madrid (UAM)  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,18]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.0268"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2015.03.007"},{"key":"e_1_2_9_4_1","first-page":"771","article-title":"La versi\u00f3n espa\u00f1ola del SF\u201036 Health Survey (Cuestionario de Salud SF\u201036): Un instrumento para la medida de los resultados cl\u00ednicos","volume":"104","author":"Alonso J.","year":"1995","journal-title":"Medicina Cl\u00ednica"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.5402"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0025\u20107753(03)73601\u2010x"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13142\u2010011\u20100086\u20103"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000002357"},{"issue":"2","key":"e_1_2_9_9_1","first-page":"129","article-title":"Pain Assessment: Global Use of the Brief Pain Inventory","volume":"23","author":"Cleeland C. 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