Psychological Pain and Staying in Treatment: What the Research Shows

By Steven Mee, MD · October 29, 2026

Ask people living with depression, or working through recovery from substance use, to describe the hardest part. Many describe something other than sadness. They describe an ache that is hard to name and harder to explain to others. Researchers call this psychological pain, which also goes by "mental pain" or "psychache."

For about two decades, Steven Mee, MD, and colleagues at UC Irvine and the VA Long Beach Healthcare System have studied two questions. Can psychological pain be measured reliably? And does measuring it tell clinicians anything useful? This article summarizes what that work has found, including a 2019 study on substance use treatment. It also covers how research teams outside the United States now use the same measurement tool.

What is psychological pain?

In a 2006 review in the Journal of Psychiatric Research, Dr. Mee and co-authors defined psychological pain as a distinct symptom that can be assessed systematically. The review noted that people with severe depression often describe this pain as worse than any physical pain they have had. It also summarized brain-imaging studies suggesting that psychological pain and physical pain activate overlapping patterns in the brain.

Psychological pain overlaps with depression, hopelessness and anxiety, but it is not the same thing as any of them. That distinction matters. Two people can have similar depression scores and very different levels of inner suffering. The research question is whether that difference carries clinical information.

Measuring it: the Mee-Bunney Psychological Pain Assessment Scale

To study psychological pain, the team developed a brief, 10-item self-rating questionnaire, the Mee-Bunney Psychological Pain Assessment Scale (MBP, also abbreviated MBPPAS).

The validation study appeared in the Journal of Psychiatric Research in 2011. It compared 73 people in a major depressive episode with 96 people without a psychiatric diagnosis. The scale showed good reliability and validity. People in a depressive episode who scored above a set threshold also had higher scores on a separate measure of suicidal behavior. Across the depressed group, higher psychological pain went along with higher suicidality scores.

A 2017 study in PLOS One extended this work to 57 U.S. veterans in a suicide prevention program. Among all the assessments used, psychological pain accounted for the largest share of overlap with suicidality ratings. Together with impulsiveness, it contributed more to suicidality than the other measures combined. The authors concluded that measuring psychological pain alongside standard suicide assessments could improve risk assessment and help direct clinical resources toward prevention.

Psychological pain and staying in substance use treatment

A 2019 study in PLOS One, led by Dr. Mee, asked a different question: does psychological pain at the start of treatment relate to whether people stay in treatment?

The researchers analyzed data from 289 patients at an outpatient community drug treatment clinic in Southern California. Each patient completed the MBP and other standard questionnaires before treatment began. The team then compared patients above and below a previously set psychological-pain threshold.

The findings:

• Patients in the higher-pain group also scored higher on anxiety, hopelessness and depression.
• Patients in the higher-pain group stayed in treatment for a shorter time.
• They had more than twice the odds of dropping out compared with patients with lower psychological pain.
• Of all the assessments, psychological pain had the strongest correlation with how long patients stayed in treatment.

The authors described this as the first study to show that psychological pain relates to meaningful outcomes in substance use disorder. They suggested that screening for psychological pain before treatment may help programs identify higher-risk patients early. Those patients could then get added support aimed at helping them stay in treatment and complete it.

The study has limits. It was retrospective and drew on a single clinic. It shows an association, not proof that psychological pain causes dropout. Even so, it points to a practical, low-cost step that programs could test.

Research beyond Southern California

One way to judge a measurement tool is whether independent researchers adopt it. The MBP has been translated and studied by teams in several countries:

• Germany and Switzerland. A 2025 study in Archives of Suicide Research tested a German translation with 580 participants. The German version showed excellent internal consistency. People with a recent suicide attempt reported more psychological pain than people with suicidal thoughts alone, and both groups reported more than clinical and non-clinical comparison groups.
• Switzerland. A 2026 study of psychiatric inpatients at the University of Bern used the MBP and found that psychological pain distinguished between groups in ways that diagnostic labels alone did not.
• Turkey. A Turkish translation was validated in 200 people, including patients with major depression and bipolar disorder, with excellent internal consistency (Current Psychology, 2020).

Dr. Mee was not an author on these studies. That independence is part of what makes the findings useful.

What this means in a clinical setting

A psychological pain score is not a diagnosis, and no single questionnaire predicts what any one person will do. In clinical care, it is one input alongside a careful interview, history and ongoing relationship.

At Aspera & Applied Innovative Psychiatry in Los Alamitos, the MBP is part of our signature approach: we measure psychological pain, work to identify its sources, and shape a treatment plan to relieve it. Depending on the person, that plan may include medication management, psychotherapy, or, for depression that has not responded to standard treatment, our Ketamine Augmented Treatment Program. Each option is discussed with the patient, including its evidence, risks and alternatives.

Questions worth bringing to your next appointment

Whether you see Dr. Mee or another clinician, these questions can open a useful conversation:

• Beyond my mood, how is my level of inner pain being assessed?
• What do you think is driving that pain right now?
• If my current treatment isn't reducing it, what are the next options?
• What support is available if I feel like stopping treatment?

To explore an evaluation, email or call our office. Virtual evaluations are available for patients anywhere in California.

If you are having thoughts of suicide, call or text 988 to reach the 988 Suicide & Crisis Lifeline, or call 911 in an emergency.