Neural activations during self-related processing in patients with chronic pain and effects of a brief self-compassion training - A pilot study

Psychiatry Res Neuroimaging. 2020 Oct 30;304:111155. doi: 10.1016/j.pscychresns.2020.111155. Epub 2020 Jul 30.


Chronic pain negatively affects psychological functioning including self-perception. Self-compassion may improve self-related functioning in patients with chronic pain but understanding of the neural mechanisms is limited. In this study, twenty patients with chronic low back pain read negative self-related situations and were instructed to be either self-reassuring or self-critical while undergoing fMRI. Patients rated their feelings of self-reassurance and self-criticism during each condition, and brain responses were contrasted with neutral instructions. Trait self-compassion measures (SCS) were also acquired. Brain activations during self-criticism and self-reassurance were localized to prefrontal, self- and emotion-processing areas, such as medial prefrontal cortex, dorsolateral prefrontal cortex (dlPFC), dorsal anterior cingulate cortex and posterior cingulate cortex. Self-reassurance resulted in more widespread and stronger activations relative to self-criticism. Patients then completed a brief self-compassion training (8 contact hours, 2 weeks home practice). Exploratory pre-post comparisons in thirteen patients found that feelings of self-criticism were significantly reduced and brain activations were greater in the anterior insula and prefrontal cortical regions such as dlPFC. Pre-post increases in dlPFC activation correlated with increased self-compassion (SCS), suggesting that early self-compassion skills might primarily target self-criticism via dlPFC upregulation. Future controlled studies on self-compassion training in chronic pain populations should extend these results.

Keywords: corticial midline regions; dorsolateral prefrontal cortex; emotion regulation; fMRI; insula; pain; prefrontal cortex; self-compassion; self-criticism; self-related processes.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Brain / physiopathology*
  • Brain Mapping
  • Cerebral Cortex / physiopathology
  • Chronic Pain / physiopathology*
  • Emotions / physiology
  • Empathy
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Patients
  • Pilot Projects
  • Prefrontal Cortex / physiopathology
  • Self Concept*