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A Systematic Review of Self-Compassion in Chronic Pain: From Correlation to Efficacy

Published online by Cambridge University Press:  12 April 2021

Camile Lanzaro Open the ORCID record for Camile Lanzaro [Opens in a new window] ,
Sérgio A. Carvalho Open the ORCID record for Sérgio A. Carvalho [Opens in a new window] ,
Teresa A. Lapa Open the ORCID record for Teresa A. Lapa [Opens in a new window] ,
Ana Valentim Open the ORCID record for Ana Valentim [Opens in a new window]  and
Bruno Gago Open the ORCID record for Bruno Gago [Opens in a new window]
Camile Lanzaro*
Affiliation:
Centro Hospitalar e Universitário de Coimbra (Portugal)
Sérgio A. Carvalho
Affiliation:
Universidade de Coimbra (Portugal)
Teresa A. Lapa
Affiliation:
Centro Hospitalar e Universitário de Coimbra (Portugal) Universidade da Beira Interior (Portugal)
Ana Valentim
Affiliation:
Centro Hospitalar e Universitário de Coimbra (Portugal)
Bruno Gago
Affiliation:
Universidade de Aveiro (Portugal)
*
Correspondence concerning this article should be addressed to Camile Lanzaro. Centro Hospitalar e Universitario de Coimbra. Serviço de Anestesiologia. Praceta Prof. Mota Pinto. 3000-075Coimbra (Portugal). E-mail: clanzaro13@gmail.com
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Abstract

Chronic pain (CP) is a common condition affecting millions of people worldwide. Compassion-related interventions are proving to be advantageous in CP, and self-compassion (SC) is hypothesized to be related with pain regulation physiological processes, as well as with psychological benefits in CP. We aimed to review scientific literature on: 1) Compassion-based psychological interventions and their changes in pain outcomes; and 2) associations between SC and pain-related outcomes. We performed a systematic research in four electronic databases: MEDLINE, EMBASE, PsycINFO and the Cochrane Library from inception until April 2020. In Question 1, we included studies involving adult patients with CP who participated in compassion-based psychological interventions. In Question 2, we included studies that examined the associations between SC and pain outcomes in adults with CP. We identified 16 studies. For Question 1, we included seven studies focused on different compassion-based interventions that assessed at least one pain outcome, in a total of 253 participants with CP associated with multiple conditions. For Question 2, we included nine studies, in a total of 1,430 participants, with eight different pain outcomes: Intensity, acceptance, catastrophizing, self-efficacy, disability, distress, pain related coping and anxiety. Considering the high heterogeneity between studies and the poor-quality assessment, we could not draw definitive conclusions on the efficacy of compassion-based interventions nor on the association between SC and pain outcomes. Studies are further discussed in detail. This review can be a starting point for large-scale and high-quality trials in this area as it provides an organized overview of the current literature on this topic.

Keywords

compassionchronic painpersistent painself-compassion
Type
Review Article
Information
The Spanish Journal of Psychology , Volume 24 , 2021 , e26
Copyright
© Universidad Complutense de Madrid and Colegio Oficial de Psicólogos de Madrid 2021

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Footnotes

We would like to thank all authors of the articles included in this review, who contributed to complete data or clarify questions throughout this research.

Conflicts of Interest: None.

Funding statements: This research received no specific grant from any funding agency, commercial or not-for-profit sectors.

References

Anderson, K. O., Dowds, B. N., Pelletz, R. E., Edwards, T. W., & Peeters-Asdourian, C. (1995). Development and initial validation of a scale to measure self-efficacy beliefs in patients with chronic pain. Pain, 63(1), 77–83. https://doi.org/10.1016/0304-3959(95)00021-JCrossRefGoogle ScholarPubMed
Bandura, A. (1997). Self-efficacy: The exercise of control (1st Ed.). W H Freeman/Times Books/ Henry Holt & Co.Google Scholar
Biber, D. D., & Ellis, R. (2019). The effect of self-compassion on the self-regulation of health behaviors: A systematic review. Journal of Health Psychology, 24(14), 2060–2071. https://doi.org/10.1177/1359105317713361CrossRefGoogle ScholarPubMed
Boselie, J. J. L. M., Vancleef, L. M. G., & Peters, M. L. (2018). Filling the glass: Effects of a positive psychology intervention on executive task performance in chronic pain patients. European Journal of Pain, 22(7), 1268–1280. https://doi.org/10.1002/ejp.1214CrossRefGoogle ScholarPubMed
Breivik, H., Collett, B., Ventafridda, V., Cohen, R., & Gallacher, D. (2006). Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment Harald. European Journal of Pain, 10(4), 287–333. http://doi.org/10.1016/j.ejpain.2005.06.009CrossRefGoogle Scholar
Breivik, H., Eisenberg, E., & O’Brien, T. (2013). The individual and societal burden of chronic pain in Europe: The case for strategic prioritisation and action to improve knowledge and availability of appropriate care. BMC Public Health, 13, Article 1229. https://doi.org/10.1186/1471-2458-13-1229CrossRefGoogle ScholarPubMed
Brotto, L. A., Bergeron, S., Zdaniuk, B., & Basson, R. (2020). Mindfulness and cognitive behavior therapy for provoked vestibulodynia: Mediators of treatment outcome and long-term effects. Journal of Consulting and Clinical Psychology, 88(1), 48–64. https://doi.org/10.1037/ccp0000473CrossRefGoogle ScholarPubMed
Campayo, M. G., & Demarzo, J. (2015). Mindfulness y compasión: La nueva revolución [Mindfulness and compassion: The new revolution] (1st Ed.) Ilus Books.Google Scholar
Carson, J. W., Keefe, F. J., Lynch, T. R., Carson, K. M., Goli, V., Fras, A. M., & Thorp, S. R. (2005). Loving-kindness meditation for chronic low back pain: Results from a pilot trial. Journal of Holistic Nursing, 23(3), 287–304. https://doi.org/10.1177/0898010105277651CrossRefGoogle ScholarPubMed
Carvalho, S. A., Gillanders, D., Palmeira, L., Pinto-Gouveia, J., & Castilho, P. (2018). Mindfulness, selfcompassion, and depressive symptoms in chronic pain: The role of pain acceptance. Journal of Clinical Psychology, 74(12), 2094–2106. https://doi.org/10.1002/jclp.22689CrossRefGoogle ScholarPubMed
Chapin, H. L., Darnall, B. D., Seppala, E. M., Doty, J. R., Hah, J. M., & Mackey, S. C. (2014). Pilot study of a compassion meditation intervention in chronic pain. Journal of Compassionate Health Care, 1(1), Article 4. https://doi.org/10.1186/s40639-014-0004-xCrossRefGoogle ScholarPubMed
Costa, J., & Pinto-Gouveia, J. (2011). Acceptance of pain, self-compassion and psychopathology: Using the Chronic Pain Acceptance Questionnaire to identify patients’ subgroups. Clinical Psychology and Psychotherapy, 18(4), 292–302. https://doi.org/10.1002/cpp.718CrossRefGoogle ScholarPubMed
Costa, J., & Pinto-Gouveia, J. (2013). Experiential avoidance and self-compassion in chronic pain. Journal of Applied Social Psychology, 43(8), 1578–1591. https://doi.org/10.1111/jasp.12107CrossRefGoogle Scholar
Edwards, K. A., Pielech, M., Hickman, J., Ashworth, J., Sowden, G., & Vowles, K. E. (2019). The relation of self-compassion to functioning among adults with chronic pain. European Journal of Pain, 23(8), 1538–1547. https://doi.org/10.1002/ejp.1429CrossRefGoogle ScholarPubMed
Edwards, R. R., Dworkin, R. H., Sullivan, M. D., Turk, D., & Wasan, A. D. (2016). The role of psychosocial processes in the development and maintenance of chronic pain. The Journal of Pain, 17(9), T70–792. https://doi.org/doi:10.1016/j.jpain.2016.01.001CrossRefGoogle ScholarPubMed
Fayaz, A., Croft, P., Langford, R. M., Donaldson, L. J., & Jones, G. T. (2016). Prevalence of chronic pain in the UK: A systematic review and meta-analysis of population studies. BMJ Open, 6, Article e010364. https://doi.org/10.1136/bmjopen-2015-010364CrossRefGoogle Scholar
Fish, R. A., McGuire, B., Hogan, M., Morrison, T. G., & Stewart, I. (2010). Validation of the Chronic Pain Acceptance Questionnaire (CPAQ) in an Internet sample and development and preliminary validation of the CPAQ–8. Pain, 149(3), 435–443. https://doi.org/10.1016/j.pain.2009.12.016CrossRefGoogle Scholar
Flink, I. K., Smeets, E., Bergbom, S., & Peters, M. L. (2015). Happy despite pain: Pilot study of a positive psychology intervention for patients with chronic pain. Scandinavian Journal of Pain, 7(1), 71–79. https://doi.org/10.1016/j.sjpain.2015.01.005CrossRefGoogle ScholarPubMed
Gilbert, P. (2005). Compassion: Conceptualizations, research and use in psychotherapy (1st Ed.). Routledge.CrossRefGoogle Scholar
Gilbert, P. (2010). Compassion focused therapy: Distinctive features (1st Ed.). Routledge/Taylor & Francis Group. http://doi.org/10.4324/9780203851197CrossRefGoogle Scholar
Gilbert, P. (2014). The origins and nature of compassion focused therapy. British Journal of Clinical Psychology, 53(1), 6–41. https://doi.org/10.1111/bjc.12043CrossRefGoogle ScholarPubMed
Gooding, H., Stedmon, J., & Crix, D. (2020). ‘All these things don’t take the pain away but they do help you to accept it’: Making the case for compassion-focused therapy in the management of persistent pain. British Journal of Pain, 14(1), 31–41. https://doi.org/10.1177/2049463719857099CrossRefGoogle ScholarPubMed
Higgins, J. P. T., Altman, D. G., Gøtzsche, P. C., Jüni, P., Moher, D., Oxman, A. D., Savović, J., Schulz, K. F., Weeks, L., & Sterne, J. A. C. (2011). The Cochrane Collaboration’s tool for assessing risk of bias in randomized trials. British Medical Journal (Online), 343, Article d5928. https://doi.org/10.1136/bmj.d5928CrossRefGoogle Scholar
Hofmann, S. G., Grossman, P., & Hilton, D. E. (2011). Loving-kindness and compassion meditation: Potential for psychological interventions. Clinical Psychology Review, 31(7), 1126–1132. https://doi.org/doi:10.1016/j.cpr.2011.07.003CrossRefGoogle ScholarPubMed
Iskender, M. (2009). The relationship between self-compassion, self-efficacy, and control belief about learning in Turkish university students. Social Behavior and Personality: An International Journal, 37(5), 711–720. https://doi.org/10.2224/sbp.2009.37.5.711CrossRefGoogle Scholar
Jazaieri, H., McGonigal, K., Jinpa, T., Doty, J. R., Gross, J. J., & Goldin, P. R. (2014). A randomized controlled trial of compassion cultivation training: Effects on mindfulness, affect, and emotion regulation. Motivation and Emotion, 38(1), 23–35. https://doi.org/10.1007/s11031-013-9368-zCrossRefGoogle Scholar
Jensen, M. P., Keefe, F. J., Lefebvre, J. C., Romano, J. M., & Turner, J. A. (2003). One- and two-item measures of pain beliefs and coping strategies. Pain, 104(3), 453–469. https://doi.org/10.1016/S0304-3959(03)00076-9CrossRefGoogle ScholarPubMed
Johannsen, M., O’Connor, M., O’Toole, M. S., Jensen, A. B., & Zachariae, R. (2018). Mindfulness-based cognitive therapy and persistent pain in women treated for primary breast cancer. Clinical Journal of Pain, 34(1), 59–67. https://doi.org/10.1097/AJP.0000000000000510CrossRefGoogle ScholarPubMed
Kirby, J. N. (2017). Compassion interventions: The programmes, the evidence, and implications for research and practice. Psychology and Psychotherapy: Theory, Research and Practice, 90(3), 432–455. https://doi.org/10.1111/papt.12104CrossRefGoogle ScholarPubMed
MacBeth, A., & Gumley, A. (2012). Exploring compassion: A meta- analysis of the association between self-compassion and psychopathology. Clinical Psychology Review, 32(6), 545–552. http://doi.org/10.1016/j.cpr.2012.06.003CrossRefGoogle ScholarPubMed
Marsh, I. C., Chan, S. W. Y., & Macbeth, A. (2018). Self-compassion and psychological distress in adolescents — A meta-analysis. Mindfulness, 9(4), 1011–1027. http://doi.org/10.1007/s12671-017-0850-7CrossRefGoogle ScholarPubMed
McCracken, L. M., & Eccleston, C. (2003). Coping or acceptance: What to do about chronic pain? Pain, 105(1–2), 197–204. https://doi.org/10.1016/S0304-3959(03)00202-1CrossRefGoogle ScholarPubMed
McCracken, L. M., Eccleston, C., & Bell, L. (2005). Clinical assessment of behavioral coping responses: Preliminary results from a brief inventory. European Journal of Pain, 9(1), 69–78. https://doi.org/10.1016/j.ejpain.2004.04.005CrossRefGoogle ScholarPubMed
McCracken, L. M., & Vowles, K. E. (2014). Acceptance and commitment therapy and mindfulness for chronic pain: Model, process, and progress. American Psychologist, 69(2), 178–187. https://doi.org/10.1037/a0035623CrossRefGoogle ScholarPubMed
McCracken, L. M., Vowles, K. E., & Eccleston, C. (2004). Acceptance of chronic pain: Component analysis and a revised assessment method. Pain, 107(1), 159–166. http://doi.org/10.1016/j.pain.2003.10.012CrossRefGoogle Scholar
McCracken, L. M., Zayfert, C., & Gross, R. T. (1992). The Pain Anxiety Symptoms Scale: Development and validation of a scale to measure fear of pain. Pain, 50(1), 67–73. https://doi.org/10.1016/0304-3959(92)90113-PCrossRefGoogle ScholarPubMed
Merksey, H., & Bogduk, N. (Eds.). (1994). Classification of chronic pain. Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms (2nd Ed.). IASP Press.Google Scholar
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & The Prisma Group. (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLOS Medicine, 6(7), Article e1000097. https://doi.org/10.1371/journal.pmed.1000097CrossRefGoogle ScholarPubMed
Montero-Marin, J., van Gordon, W., Shonin, E., Navarro-Gil, M., Gasión, V., López-del-Hoyo, Y., Luciano, J. V., & Garcia-Campayo, J. (2020). Attachment-based compassion therapy for ameliorating fibromyalgia: Mediating role of mindfulness and self-compassion. Mindfulness, 11(3), 816–828. https://doi.org/10.1007/s12671-019-01302-8CrossRefGoogle Scholar
Muris, P., & Otgaar, H. (2020). The process of science: A critical evaluation of more than 15 years of research on self-compassion with the Self-Compassion Scale. Mindfulness, 11, 1469–1482. https://doi.org/10.1007/s12671-020-01363-0CrossRefGoogle Scholar
Muris, P., van den Broek, M., Otgaar, H., Oudenhoven, I., & Lennartz, J. (2018). Good and bad sides of self-compassion: A face validity check of the Self-Compassion Scale and an investigation of its relations to coping and emotional symptoms in non-clinical adolescents. Journal of Child and Family Studies, 27(8), 2411–2421. https://doi.org/10.1007/s10826-018-1099-zCrossRefGoogle Scholar
Neff, K. D. (2003). The development and validation of a scale to measure self-compassion. Self and Identity, 2, 223–250. https://doi.org/10.1080/15298860309027CrossRefGoogle Scholar
Neff, K. D. (2016). The Self-Compassion Scale is a valid and theoretically coherent measure of self-compassion. Mindfulness, 7(1), 264–274. https://doi.org/10.1007/s12671-015-0479-3CrossRefGoogle Scholar
Neff, K. D. (2019). Setting the record straight about the Self-Compassion Scale. Mindfulness, 10, 200–202. https://doi.org/10.1007/s12671-018-1061-6CrossRefGoogle Scholar
Neff, K. D., & Dahm, K. A. (2015). Self-compassion: What it is, what it does, and how it relates to mindfulness. In Ostafin, B. D., Robinson, M. D., & Meier, B. P. (Eds.), Handbook of mindfulness and self‐regulation (pp. 121–137). Springer. https://doi.org/10.1007/978-1-4939-2263-5_10CrossRefGoogle Scholar
Neff, K. D., & Germer, C. (2017). Self-compassion and psychological wellbeing. In Seppälä, E. M., Simon-Thomas, E., Brown, S. L., Worline, M. C., Cameron, C. D., & Doty, J. R. (Eds.), Oxford handbook of compassion science. Oxford University Press. http://doi.org/10.1093/oxfordhb/9780190464684.013.27Google Scholar
Neff, K. D., & Germer, C. K. (2013). A pilot study and randomized controlled trial of the mindful self-compassion program. Journal of Clinical Psychology, 69(1), 28–44. https://doi.org/10.1002/jclp.21923CrossRefGoogle ScholarPubMed
Neff, K., & Tirch, D. (2013). Self-compassion and ACT. In Kashdan, T. B. & Ciarrochi, J. (Eds.), Mindfulness, acceptance, and positive psychology: The seven foundations of well-being. (pp. 78–106). Context Press/New Harbinger Publications.Google Scholar
Neff, K. D., Whittaker, T. A., & Karl, A. (2017). Examining the factor structure of the Self-Compassion Scale in four distinct populations: Is the use of a total scale score justified? Journal of Personality Assessment, 99, 596–607. https://doi.org/10.1080/00223891.2016.1269334CrossRefGoogle ScholarPubMed
National Heart, Lung, and Blood Institute. (2020, February 7). Study quality assessment tools. https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-toolsGoogle Scholar
Parry, S. L., & Malpus, Z. (2017). Reconnecting the mind and body: A pilot study of developing compassion for persistent pain. Patient Experience Journal, 4(1), 145–153. https://doi.org/10.35680/2372-0247.1175CrossRefGoogle Scholar
Paulus, J. K., Dahabreh, I. J., Balk, E. M., Avendano, E. E., Lau, J., & Ip, S. (2014). Opportunities and challenges in using studies without a control group in comparative effectiveness reviews. Research Synthesis Methods, 5(2), 152–161. https://doi.org/10.1002/jrsm.1101CrossRefGoogle ScholarPubMed
Penlington, C. (2019). Exploring a compassion-focused intervention for persistent pain in a group setting. British Journal of Pain, 13(1), 59–66. https://doi.org/10.1177/2049463718772148CrossRefGoogle Scholar
Pergolizzi, J., Ahlbeck, K., Aldington, D., Alon, E., Coluzzi, F., Dahan, A., Huygen, F., Kocot-Kępska, M., Mangas, A. C., Mavrocordatos, P., Morlion, B., Müller-Schwefe, G., Nicolaou, A., Pérez Hernández, C., Sichère, P., Schäfer, M., & Varrassi, G. (2013). The development of chronic pain: Physiological CHANGE necessitates a multidisciplinary approach to treatment. Current Medical Research and Opinion, 29(9), 1127–1135. https://doi.org/10.1185/03007995.2013.810615CrossRefGoogle ScholarPubMed
Peters, M. L., Smeets, E., Feijge, M., van Breukelen, G., Andersson, G., Buhrman, M., & Linton, S. J. (2017). Happy despite pain: A randomized controlled trial of an 8-week Internet-delivered positive psychology intervention for enhancing well-being in patients with chronic pain. The Clinical Journal of Pain, 33(11), 962–975. https://doi.org/10.1097/AJP.0000000000000494CrossRefGoogle ScholarPubMed
Pielech, M., Bailey, R. W., McEntee, M. L., Ashworth, J., Levell, J., Sowden, G., & Vowles, K. E. (2016). Preliminary evaluation of the values tracker: A two-item measure of engagement in valued activities in those with chronic pain. Behavior Modification, 40(1–2), 239–256. https://doi.org/10.1177/0145445515616911CrossRefGoogle ScholarPubMed
Purdie, F., & Morley, S. (2015). Self-compassion, pain, and breaking a social contract. Pain, 156(11), 2354–2363. http://doi.org/10.1097/j.pain.0000000000000287CrossRefGoogle ScholarPubMed
Purdie, F., & Morley, S. (2016). Compassion and chronic pain. Pain, 157(12), 2625–2627. https://doi.org/10.1097/j.pain.0000000000000638CrossRefGoogle ScholarPubMed
Raes, F., Pommier, E., Neff, K. D., & van Gucht, D. (2011). Construction and factorial validation of a short form of the Self-Compassion Scale. Clinical Psychology & Psychotherapy, 18(3), 250–255. https://doi.org/10.1002/cpp.702CrossRefGoogle Scholar
Rockliff, H., Gilbert, P., Mcewan, K., Lightman, S., & Glover, D. (2008). A pilot exploration of heart rate variability and salivary Cortisol responses to compassion-focused imagery. Clinical Neuropsychiatry: Journal of Treatment Evaluation, 5(3), 132–139.Google Scholar
Rockliff, H., Karl, A., Mcewan, K., Gilbert, J., Matos, M., & Gilbert, P. (2011). Effects of intranasal oxytocin on ‘compassion focused imagery’. Emotion, 11(6), 1388–1396. https://doi.org/10.1037/a0023861CrossRefGoogle ScholarPubMed
Santerre-Baillargeon, M., Rosen, N. O., Steben, M., Pâquet, M., Macabena Perez, R., & Bergeron, S. (2018). Does self-compassion benefit couples coping with vulvodynia? Associations with psychological, sexual, and relationship adjustment. The Clinical Journal of Pain, 34(7), 629–637. https://doi.org/10.1097/AJP.0000000000000579CrossRefGoogle ScholarPubMed
Scascighini, L., Toma, V., Dober-Spielmann, S., & Sprott, H. (2008). Multidisciplinary treatment for chronic pain: A systematic review of interventions and outcomes. Rheumatology, 47(5), 670–678. https://doi.org/10.1093/rheumatology/ken021CrossRefGoogle ScholarPubMed
Sullivan, M. J. L., Bishop, S. R., & Pivik, J. (1995). The Pain Catastrophizing Scale: Development and validation. Psychological Assessment, 7(4), 524–532. https://doi.org/10.1037/1040-3590.7.4.524CrossRefGoogle Scholar
Tait, R. C., Chibnall, J. T., & Krause, S. (1990). The Pain Disability Index: Psychometric properties. Pain, 40(2), 171–182. https://doi.org/10.1016/0304-3959(90)90068-OCrossRefGoogle ScholarPubMed
Viera, A., & Garrett, J. (2005). Understanding interobserver agreement: The kappa statistic. Family Medicine, 37(5), 360–363.Google ScholarPubMed
Vowles, K. E., Sowden, G., & Ashworth, J. (2014). A comprehensive examination of the model underlying acceptance and commitment therapy for chronic pain. Behavior Therapy, 45(3), 390–401. https://doi.org/10.1016/j.beth.2013.12.009CrossRefGoogle ScholarPubMed
Wang, C. K., Hah, J. M., & Carroll, I. (2009). Factors contributing to pain chronicity. Current Pain and Headache Reports, 13(1), 7–11. https://doi.org/10.1007/s11916-009-0003-3CrossRefGoogle ScholarPubMed
Williams, A., Eccleston, C., & Morley, S. (2012). Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database of Systematic Reviews, 11. https://doi.org/10.1002/14651858.CD007407.pub3Google ScholarPubMed
Wilson, A. C., Mackintosh, K., Power, K., & Chan, S. W. Y. (2019). Effectiveness of self-compassion related therapies: A systematic review and meta-analysis. Mindfulness, 10(6), 979–995. https://doi.org/10.1007/s12671-018-1037-6CrossRefGoogle Scholar
Wren, A. A., Somers, T. J., Wright, M. A., Goetz, M. C., Leary, M. R., Fras, A. M., Huh, B. K., Rogers, L. L., & Keefe, F. J. (2012). Self-compassion in patients with persistent musculoskeletal pain: Relationship of self-compassion to adjustment to persistent pain. Journal of Pain and Symptom Management, 43(4), 759–770. https://doi.org/10.1016/j.jpainsymman.2011.04.014CrossRefGoogle ScholarPubMed
Ziemer, K. S., Fuhrmann, A., & Hoffman, M. A. (2017). Effectiveness of a positive writing intervention for chronic pain: A randomized trial. MYOPAIN, 23, 143–154. https://doi.org/10.1080/24708593.2017.1307893CrossRefGoogle Scholar