Compassion-focused therapy eases thoughts about suicide, pain

Engaging in online sessions of compassion-focused therapy, which works toward getting people to become more compassionate about themselves, may help women with multiple sclerosis (MS) deal with suicidal thoughts, a small study suggests.

Compassion-focused therapy also may help these women overcome pain catastrophizing, which is a tendency to view pain as considerably worse than it actually is, and to feel worried and helpless as if there is no way to control the pain.

While the study included only women, its findings support “continuing the implementation of psychological interventions and paying attention to the dimension of mental health” in all people with MS, wrote its author, Fahimeh Mohamadpour, PhD, from Shiraz University, in Iran.

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The study, “Effectiveness of compassion-based online therapy on suicidal thoughts and pain catastrophizing in female patients with multiple sclerosis in the relapsing–remitting phase,” was published in Frontiers in Psychology.

In MS, the body’s own immune system attacks the brain and spinal cord, causing damage to nerve cells. As a result, people with MS can experience a wide range of symptoms, including fatigue and pain. Living with MS also takes a toll on mental health.

Both fatigue and mental health problems are linked to suicidal thoughts in people with MS and, sometimes, to suicidal intent. Despite being more common than in the general population, there is little support for people with MS who think about or attempt suicide.

Now, Mohamadpour investigated how well compassion-focused therapy, delivered virtually as a series of eight two-hour online sessions, may help women with MS deal with suicidal thoughts and overcome pain catastrophizing.

While compassion-focused therapy uses different techniques, some of which are drawn from other therapies, its backbone is compassionate mind training. This technique teaches the attributes of compassion, with the goal of helping people feel compassionate about others and about their own limitations.

Sharing a ‘sense of commonality’

“Experiencing a compassionate attitude helps people to feel a sense of commonality between themselves and others and thereby overcome their painful feelings,” Mohamadpour wrote.

Some of the exercises used throughout the eight online sessions were mindfulness and breathing exercises, talking and writing about compassion, and compassion-focused imagery exercises to help improve low self-worth.

The study included 30 women, mean age 26.6 years, with a diagnosis of relapsing-remitting MS, a form of the disease defined by periods of new or worsening symptoms, called relapses, followed by periods of remission (recovery) when symptoms ease.

Half of the women were assigned randomly to compassion-focused therapy. The other half served as controls and did not receive any intervention. However, they were placed on a waiting list for a chance to receive compassion-focused therapy after the study was completed.

Suicidal ideation was scored on a 19-item scale. The total score ranges from zero to 38 points, with a higher score indicating greater risk of suicidal thoughts. Data were collected at the start of the study and three months after the end of compassion-focused therapy.

In control participants, the mean suicidal ideation score remained about the same at the two time points (16.3 vs. 16.8 points). For women who engaged in compassion-focused therapy, however, the mean score dropped from 16.4 to 9.7 points, indicating a reduction in suicidal thoughts. 

“This suggests that the use of online compassion-based therapy has an effect on suicidal thoughts and the effectiveness of the treatment was 42.4%,” Mohamadpour wrote.

Pain catastrophizing scored

Mental rumination (constant thinking), magnification (exaggeration), and helplessness — three aspects of pain catastrophizing — were scored on a 13-item scale. The total score ranges from zero to 52 points, with a higher score indicating more pain catastrophizing.

In controls, the mean pain catastrophizing score did not change significantly over time. But in women who engaged in compassion-focused therapy, it dropped by about 10 points, indicating less tendency for pain catastrophizing.

“The effectiveness of the treatment on pain catastrophizing was 58.9%,” Mohamadpour wrote. For mental rumination, magnification, and helplessness, all of which eased after compassion-focused therapy, it was 57.3%, 19.3%, and 52.1%, respectively.

“Compassion-based therapy, due to the nature of the techniques used in it, which is mostly mental and conversation-oriented, can be one of the suitable options for online use,” Mohamadpour concluded.