The Body Is Not the Enemy: Befriending the Body through Mindfulness Reduces Self-Harm Ideation in Chronic Pain Patients

Background and Purpose:Chronic pain patients on long-term opioid therapy often present with mental health concerns in addition to their general medical conditions. Prevalence studies suggest that 25% of chronic pain patients exhibit self-harming and suicidal behaviors; however, little is known about what drives these life-threatening behaviors in this population. When considered from a functional perspective, self-harm serves myriad purposes, including relieving negative affect and punishing one’s self. The salience of these functions for chronic pain patients may relate to feeling betrayed by their bodies or believing they deserve pain given its inevitability in their lives. Alternatively, the desire to escape suffering may lead chronic pain patients to have thoughts of self-harm and suicide, but this may be less about the intensity of pain they are experiencing and more about whether patients feel their bodies are safe, predictable, trustworthy, and acceptable. Dispositional mindfulness, or the tendency or disposition to be mindful in everyday life, is associated with greater acceptance of thoughts, feelings, sensations, and experiences—even those typically deemed “negative.” The present study sought to examine the relationship between dispositional mindfulness and self-harm ideation in a sample of chronic pain patients. We hypothesized that patients reporting higher levels of mindfulness would be more accepting and trusting of their body sensations irrespective of pain, which would subsequently explain decreased self-harm ideation.

Methods: We collected self-report data from 111 chronic pain patients. Self-harm ideation was measured with an item on the Current Opioid Misuse Measure (COMM). Participants responded on a scale of 0 to 4 (“Never” to “Very often”) to the prompt, “In the past 30 days, how often have you seriously thought about hurting yourself?” Dispositional mindfulness was measured with the Five Facet Mindfulness Questionnaire (FFMQ). Experiencing one’s body as safe and trustworthy was measured with the “Trusting” subscale of the Multidimensional Assessment of Interoceptive Awareness (MAIA) scale.

Results: We found that experiencing the body as safe and trustworthy mediates the association between trait mindfulness and self-harm ideation (b = -.004, SE= .002, 95% CI [-.008, -.001]), such that relative to patients with lower levels of mindfulness, patients with higher levels of mindfulness reported greater acceptance and feelings of safety in their bodies, which partially accounted for their comparatively lower levels of self-harm ideation. This mediation effect remained significant after covarying pain intensity and pain interference.

Conclusions and Implications: Findings suggest that social work interventions focused on increasing dispositional mindfulness may reduce self-harm ideation among chronic pain patients by increasing their capacity to experience their bodies as safe and acceptable despite their pain. Social workers are well-suited for treating the integrative needs of chronic pain patients given the importance of treating individuals from a biopsychosocial perspective. Mindfulness may buffer self-harm risk by increasing acceptance of one’s cognitive, emotional, and sensory experiences.