This journal recently published a paper by Torrijos‐Zarcero et al., (2021) entitled ‘Mindful Self‐Compassion Program for Chronic Pain Patients: A Randomized Controlled Trial’. In their study the authors compare a treatment including mindfulness and self‐compassion methods (MSC) with conventional cognitive behavioural therapy (CBT). They recruited people with long‐standing chronic pain plus significant anxiety or depression (N = 123). They achieve good treatment completion and retention in trial and document no adverse events. In the end, MSC appeared superior to CBT with respect to improvements in self‐compassion, pain‐acceptance, pain interference, and anxiety. None of the analyses of nine outcomes favoured CBT. The authors boldly go where previous approaches within CBT have only rarely gone before, into aspects of human behaviour such as self, kindness, caring, love, compassion, dignity, forgiveness, and gratitude. A few comments might help clarify what this means for the field, and where this might lead next.

The authors choose a head‐to‐head comparison between MSC and CBT. It is a high bar to surpass CBT, even setting aside the potential for overlapping methods and therapeutic mechanisms. One additional difficulty with this is that analysing treatment at a level of therapy type is a coarse level of analysis (McCracken, 2020). When one type surpasses the other, it does not answer for whom, under what circumstances or how. Within each treatment package there will be component parts that worked for some people and not for others, some that delivered impact for many and some that delivered impact for few. Future studies that include component analyses, or moderation and mediation analyses, will be needed to answer these additional questions.

A by‐product of the development of distinct therapy types for chronic pain, and for other conditions, is that it can cultivate allegiance, division and competition. It is basic to how we are as humans, we want to be included, appreciated, right, and superior. This can waste time and energy.

The authors here choose self‐compassion as their primary outcome. In a sense this worked out ok for them. From a wider point of view, their choice might not be ideal. It might be better to maintain a distinction between a common set of outcomes on the one hand, and a more varied, growing, set of processes of change variables on the other. Self‐compassion, or variables like it, may one day populate a list of empirically supported processes of change. At the same time, it is unlikely to become an outcome that treatment developers from varying theoretical backgrounds will endorse as a common currency. A list of empirically supported processes of change may one day help us to select empirically supported methods for driving these processes of change, and to apply these serially, in a highly individualized way, customized for each presenting person and occasion during the course of treatment (Hayes et al., 2019).

It is worth noting that the MSC treatment was delivered in a group setting, continuing a long tradition within interdisciplinary pain management. An extended discussion of relative merits of group versus individual treatment delivery is beyond the space limits of this commentary. It is just to say, however, that the vision of truly individualized treatment will not be something we can achieve with our current knowledge. In order to deliver best fitting sets of methods, potentially varying for each person, we will first need to employ research methods sensitive to the outcomes and processes of change in the individual cases. This means we will need to supplement what we know from aggregated group data, and groups treatment settings, with additional knowledge gained from finer grained, longitudinal, idiographic, data collection over time (Hayes et al., 2019).

Finally, there is something missing in the authors’ report that would have been easy to do and could have significantly increased the understanding of their results, and it is related to the previous points. This missing piece is an analysis at the level of individuals, an analysis of how many people on a given outcome surpassed a threshold for minimally important, reliable, or clinically significant change. Although standardized mean differences are useful, underneath them are people who improve a lot, improve a little, stay the same, or worsen to one degree or another. Looking at these data is important, and it is a step towards understanding the question of ‘for whom’.

To summarize, we ought to do more bold new things. Mindful self‐compassion deserves further study. At the same time we might want to proceed from here in a different way. This way could be more focused on (a) identifying processes of change, mediators and moderators of outcomes, (b) growing a set of empirically supported processes that cut across therapy types, (c) employing a uniform consensus view of key outcomes and (d) developing the knowledge and technical means to individualize treatment. A vision for the future is to set aside distinctions like MSC versus CBT and instead to develop the means to apply for each person the optimal processes and methods without regard to their origin, only based on evidence and fit.

该期刊最近发表了Torrijos-Zarcero等人的论文（2021年），题为“针对慢性疼痛患者的谨慎自我同情计划：一项随机对照试验”。在他们的研究中，作者将包括正念和自我同情方法（MSC）的治疗方法与常规认知行为疗法（CBT）进行了比较。他们招募了长期慢性疼痛加重严重焦虑或抑郁情绪的人（N = 123）。他们在试验中达到了良好的治疗完成率和保留率，并且未记录任何不良事件。最后，在自我同情，疼痛接受，疼痛干扰和焦虑方面的改善方面，MSC似乎优于CBT。对九种结果的分析均不支持CBT。作者大胆地探索了CBT中以前很少采用的方法，涉及人类行为的各个方面，例如自我，友善，关怀，爱，同情，尊严，宽恕和感激。几点评论可能有助于弄清楚这对于该领域意味着什么，以及下一步可能会导致什么。

作者选择了MSC和CBT之间的正面对比。超越CBT是一个很高的门槛，甚至不考虑重叠方法和治疗机制的潜力。这样做的另一个困难是，在某种治疗类型的水平上对治疗进行分析是一种粗略的分析（McCracken，  2020）。当一种类型超越另一种类型时，它不会回答谁，在什么情况下或如何发生。在每个治疗包中，将包含对某些人有用而不对其他人有用的组成部分，其中一些对许多人产生了影响，而另一些对少数人却产生了影响。将来需要包括成分分析或中度和中介分析在内的研究来回答这些其他问题。

开发针对慢性疼痛和其他疾病的独特疗法类型的副产品是，它可以培养效忠，分裂和竞争。这是我们作为人类的基础，我们希望被包容，欣赏，正确和优越。这会浪费时间和精力。

作者在这里选择自我同情作为他们的主要结果。从某种意义上说，这对他们来说行得通。从更广泛的角度来看，他们的选择可能不是理想的。最好一方面保持一组共同的结果，另一方面保持一组更多变化，不断增长的变化变量的过程之间的区别。自我同情或类似的变量可能有一天会填充一系列经验支持的变化过程。同时，来自不同理论背景的治疗开发者也不太可能将其认可为一种通用货币。一系列有经验支持的变革过程可能有一天可以帮助我们选择有经验支持的方法来驱动这些变革过程，并以高度个性化的方式依次应用这些方法， 2019）。

值得一提的是，MSC治疗是在团体中进行的，延续了跨学科疼痛管理的悠久传统。关于团体治疗与个人治疗的相对优点的扩展讨论超出了此评论的范围。只是说，用我们目前的知识无法实现真正​​个性化治疗的愿景。为了提供最合适的方法集（可能因人而异），我们首先需要采用对个别案例的变化结果和过程敏感的研究方法。这意味着我们需要补充从汇总的分组数据和分组处理设置中获得的信息，以及从更细粒度，纵向，独特， 2019）。

最后，作者的报告中缺少某些内容，这些内容很容易做到，并且可能会大大增加对其结果的理解，并且与先前的观点有关。遗漏的部分是对个人的分析，是对在给定结果上有多少人超过了最低限度重要，可靠或临床上显着变化的阈值的分析。尽管标准化的均值差异是有用的，但在它们下面的是能够进步很多，进步一点，保持不变或恶化到一个或另一个程度的人。查看这些数据很重要，这是朝着“为谁”的问题迈出的一步。

总而言之，我们应该做更多大胆的新事情。正念的自我同情值得进一步研究。同时，我们可能希望以其他方式从这里开始。这种方式可以更着重于（a）确定变化的过程，结果的中介者和调节者，（b）扩展一套经验支持的过程，这些过程跨越治疗类型，（c）对关键结果采用统一的共识观点，并且（ d）发展使个体化治疗的知识和技术手段。未来的愿景是撇开MSC和CBT之类的区别，取而代之的是开发一种方法，仅根据证据和适合性，为每个人提供最佳方法和方法，而不必考虑其来源。