Volume 2025, Issue 1 8533257
Research Article
Open Access

The Relationship Between Difficulties in Emotion Regulation, Self-Compassion, and Somatization in Nursing Students

Sevinç Mersin

Corresponding Author

Sevinç Mersin

Psychiatric Nursing Department , Bilecik Şeyh Edebali University , Bilecik , Turkey , bilecik.edu.tr

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İrem Kuş

İrem Kuş

Psychiatric Nursing Department , Bilecik Şeyh Edebali University , Bilecik , Turkey , bilecik.edu.tr

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Neşe Mercan

Neşe Mercan

Psychiatric Nursing Department , Bilecik Şeyh Edebali University , Bilecik , Turkey , bilecik.edu.tr

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First published: 02 July 2025
Academic Editor: Xinqiao Liu

Abstract

This study aimed to examine the relationship between difficulties in emotion regulation, self-compassion, and somatization in nursing students. It was conducted with 351 nursing students in Turkey in the spring semester of 2024-2025. Data were collected using the Information Form, Difficulties in Emotion Regulation Scale–Brief Form, Self-Compassion Scale, and Somatization Scale. In the study, a negative relationship was found between self-compassion and difficulties in emotion regulation and somatization, and a positive relationship was found between difficulties in emotion regulation and somatization. The finding of a positive relationship between difficulties in emotion regulation and somatization in this study indicates that the emotional challenges faced by nursing students can also manifest as physical symptoms. The negative relationship between self-compassion and both difficulties in emotion regulation and somatization suggests that students with higher levels of self-compassion manage emotional difficulties better and, as a result, experience fewer stress-related physical symptoms. Thus, fostering self-compassion is a key to improving emotion regulation, reducing somatization, and supporting students’ overall well-being and success in nursing education.

1. Introduction

Emotion regulation skills are the skills that enable individuals to be aware of their emotions, identify what they feel, distinguish which emotions they experience in situations they encounter, and manage this emotional process​ [1, 2]. Gratz and Roemer [3] stated that emotion regulation skills consist of four dimensions: recognizing and understanding one’s emotions, accepting one’s emotions, maintaining impulse control and acting goal-directedly while experiencing negative emotions, and utilizing emotion regulation skills to facilitate changes that also respond to others’ goals. The components of emotion regulation skills include awareness, identification, understanding, labeling, acceptance, tolerance, modification, preparation for confrontation, and effective self-support [4]. It has shown that individuals who can regulate their emotions using these skills are mentally healthier compared to others [1, 2]. In the absence of these abilities, individuals experience difficulty in emotion regulation [3]. Difficulty in emotion regulation is defined as an insufficiency in an individual’s ability to control and manage emotional responses [3, 5]. Individuals who lack emotion regulation skills and are unable to recognize and express their emotions may resort to somatization as a way to express their feelings [3, 6]. Especially under intense stress conditions, somatic symptoms such as headaches, nausea, and muscle tension may emerge [7, 8]. Somatization functions as an unconscious defense mechanism to alleviate emotional distress [9] and is associated with structural changes in brain regions related to emotion regulation and bodily awareness [10].

Self-compassion is defined as the psychological strength that involves acknowledging one’s own suffering without avoidance, responding to it with kindness, and approaching oneself with understanding, compassion, and acceptance, thereby motivating individuals to reach their fullest potential [1113]. High levels of self-compassion are associated with better coping with stress and more effective use of emotional regulation skills [14]. Förster and Kanske [15] found that compassion-focused interventions enhance both external and internal positive emotions, supported by physiological markers such as heart rate variability. Their findings suggest that compassion promotes emotional well-being and is an effective tool for regulating positive effects. Others have also stated that high levels of self-compassion have been found to have positive effects on both physical and psychological health [16]. Additionally, the study conducted by Finlay-Jones et al. [17] revealed that interventions based on the development of self-compassion have positive effects on individuals’ coping with stress, thereby reducing potential physical health problems. These findings contribute to our understanding of the critical role self-compassion plays in individuals’ emotion regulation processes. Just as individuals strive to achieve balance during emotion regulation by increasing or decreasing their positive emotions [18, 19], self-compassion refers to the desire to reduce and heal suffering rather than avoid it [11]. Therefore, individuals’ difficulties in emotion regulation and low levels of self-compassion are seen to be positively correlated [2022]. According to the results of the study conducted by Aldao et al. [23], it was revealed that people who have problems with emotional regulation are more likely to experience mental disorders. At the same time, Sirois et al. [24] demonstrated that individuals with higher levels of self-compassion can alleviate emotional distress in stressful situations through a compassionate and supportive approach. This, in turn, contributes to a reduction in the severity of somatic symptoms and an overall improvement in health status. The nature of self-compassion in helping to cope with negative emotions has also been found to be effective in reducing psychological problems such as stress, anxiety, and depression [16, 25].

Nursing students and professionals face numerous academic, clinical, and psychological challenges—including heavy workload, fatigue, emotional demands, stressful working conditions, patient suffering, and quick decision-making responsibilities—that can impair emotion regulation and increase psychological distress such as exhaustion, anxiety, and depression [2631]. These emotional difficulties can manifest as physical symptoms through a process called somatization, where psychological stress appears as bodily complaints such as headaches, nausea, and muscle tension, negatively affecting academic and clinical performance [3234]. Self-compassion—defined as treating oneself kindly during hardship and recognizing shared human suffering—is linked to more effective stress coping, greater emotional flexibility, and fewer somatic symptoms [3538]. Therefore, investigating how self-compassion influences emotion regulation and somatization among nursing students is essential for developing protective interventions that support their psychological well-being and enable early preventive measures during their education. For this purpose, the following hypotheses were tested in this study.

Hypothesis 1. There is a negative relationship between self-compassion levels and difficulties in emotion regulation among nursing students.

Hypothesis 2. There is a negative relationship between self-compassion levels and somatization among nursing students.

Hypothesis 3. There is a positive relationship between difficulties in emotion regulation and somatization among nursing students.

2. Methods

2.1. Study Design and Participants

This study was descriptive, cross-sectional, and correlational. It was conducted at a nursing department in Turkey. A power analysis was performed to determine the sample size, which was calculated to be 224 students with a margin of error of 0.05, a confidence interval of 0.95, and a population representation power of 0.90. The sample was selected using disproportionate stratified sampling, and the study was conducted with a total of 351 students.

2.2. Data Collection

Before the study was initiated, the written approval of the university ethics committee (decision date: 2025.01.28; decision no: 1/13) was obtained. The data of the study were collected face-to-face using data collection tools during the spring semester of 2024-2025. The study was conducted in a classroom setting. Participation was based on voluntariness, and students who agreed to take part were informed about the purpose, content, and procedures of the research. It was clearly stated that each student had the right to decline participation or to withdraw from the study at any point after joining. This approach was adopted to create a pressure-free environment in which students could participate freely. The voluntary nature of participation ensures the ethical appropriateness of the study and the protection of participants’ individual rights.

2.3. Instruments

In the study, data were collected using the Information Form, Difficulties in Emotion Regulation Scale–Brief Form (DERS-16), Self-Compassion Scale (SCS), and the Somatization Scale (SS).

Information Form: This form assesses the individual’s demographic characteristics.

DERS-16: Developed by Gratz and Roemer [3] and updated by Bjureberg et al. [5], the scale is used to assess different subdimensions of emotion regulation difficulties. Its validity and reliability in Turkish were conducted by Yiğit and Guzey-Yiğit [39]. The scale consists of a total of 16 items. The subdimensions of the scale are openness, goals, drive, strategies, and nonacceptance. The items including the “Openness” subdimension are 1, 2; the items including the “Goals” subdimension are 3, 7, and 15; the items including the “Impulse” subdimension are 4, 8, and 11; the items including the “Strategies” subdimension are 5, 6, 12, 14, and 16; and the items including the “Nonacceptance” subdimension are 9, 10, and 13. There were no reverse coded items in the scale. High scores obtained from the scale indicate that emotion regulation difficulty is high. Cronbach’s alpha coefficient for this scale in this study was calculated to be 0.938.

SCS: Developed by Neff [11] and adapted into Turkish by Deniz et al. [40], this scale measures an individual’s ability to view their own experiences as part of the shared human experience to develop balanced awareness of negative thoughts and emotions and to cope with these experiences without self-judgment or self-pity. It is a unidimensional scale consisting of 24 items. The SCS is a 5-point Likert scale, with ratings ranging from 1 (almost never) to 5 (almost always). Items 1, 3, 5, 7, 10, 12, 15, 17, 19, 22, and 23 are reverse scored. As the scores increase, it shows an increase in the level of self-compassion. The lowest possible score on the scale is 24, and the highest is 120. Cronbach’s alpha coefficient for this scale in this study was calculated to be 0.853.

SS: The Turkish validity and reliability study of the scale consisting of the items of the somatization subscale of the Minnesota Multidimensional Personality Inventory was conducted by Dülgerler [41]. The scale is a 33-item scale consisting of a true and false answer key. In the scoring method of the scale, Items 1, 4, 5, 6, 7, 10, 11, 19, 20, 21, 22, 23, 26, 27, 32, and 33 are scored straight and Items 2, 3, 8, 9, 12, 13, 14, 15, 16, 17, 18, 24, 25, 28, 29, 30, and 31 are reverse scored. The total score is between 0 and 33, and a high score indicates a high level of somatization [41]. Cronbach’s alpha coefficient for this scale in this study was calculated to be 0.830.

2.4. Data Analysis

The data were analyzed using the Statistical Package for the Social Sciences (SPSS) 25.0 program. In the data analysis, descriptive statistics, correlation, and regression analyses were calculated. The statistical significance level was accepted at 0.05.

3. Results

The average age of the students was 21.23 ± 2.80 (range 18–44), with 57.4% being female (n = 247). The students were distributed as follows: 25.6% (n = 90) were first-year students, 25.1% (n = 88) were second-year students, 20.2% (n = 71) were third-year students, and 29.1% (n = 102) were fourth-year students (Table 1).

Table 1. Demographic characteristics of the students.
N %
Gender
 Male 104 42.6
 Female 247 57.4
Age (X ± SD) 21.23 ± 2.80
Year of study
 First year 90 25.6
 Second year 88 25.1
 Third year 71 20.2
 Fourth year 102 29.1

The scores obtained by the students on the DERS-16, SCS, and SS were 37.95 ± 12.78, 74.13 ± 13.43, and 15.40 ± 6.11, respectively (Table 2).

Table 2. The scores of DERS-16, SCS, and SS of students.
Min. Max. Mean (X̄ ± SD)
Total DERS-16 score 16.00 80.00 37.95 ± 12.78
 Openness 2.00 10.00 4.78 ± 1.69
 Goals 3.00 10.00 8.62 ± 3.04
 Impulse 3.00 15.00 6.38 ± 2.87
 Strategies 5.00 25.00 11.58 ± 4.64
 Nonacceptance 3.00 15.00 6.59 ± 2.84
Total SCS score 35.00 113.00 74.13 ± 13.43
Total SS score 2.00 30.00 15.40 ± 6.11
  • Abbreviations: DERS-16, Difficulties in Emotion Regulation Scale–Brief Form; SCS, Self-Compassion Scale; SS, Somatization Scale.

In this study, a significant negative correlation was found between total DERS-16 and total SCS scores (r = −0.559, p < 0.01). Similarly, a statistically significant negative correlation was found between total SCS and total SS scores (r = −0.283, p < 0.01). Furthermore, a significant positive correlation was observed between total difficulty in emotion regulation and total somatization scores (r = 0.380, p < 0.01) (Table 3).

Table 3. Correlation coefficients between the scales.
Total SCS Total DERS-16 Openness Goals Impulse Strategies Nonacceptance Total SS
Total SCS 1 −0.559∗∗ −0.330∗∗ −0.457∗∗ −0.438∗∗ −0.579∗∗ −0.441∗∗ −0.283∗∗
Total DERS-16 1 0.682∗∗ 0.844∗∗ 0.837∗∗ 0.930∗∗ 0.826∗∗ 0.380∗∗
 Openness 1 0.531∗∗ 0.507∗∗ 0.556∗∗ 0.485∗∗ 0.225∗∗
 Goals 1 0.632∗∗ 0.729∗∗ 0.578∗∗ 0.301∗∗
 Impulse 1 0.706∗∗ 0.622∗∗ 0.324∗∗
 Strategies 1 0.723∗∗ 0.403∗∗
 Nonacceptance 1 0.266∗∗
Total SS 1
  • Abbreviations: DERS-16, Difficulties in Emotion Regulation Scale–Brief Form; SCS, Self-Compassion Scale; SS, Somatization Scale.
  • ∗∗Correlation is significant at the 0.01 level.

The negative effects between self-compassion and difficulty in emotion regulation (R2 = 0.313; p ≤ 0.001), as well as between self-compassion and somatization (R2 = 0.080; p ≤ 0.001), were statistically significant. The positive effects between difficulty in emotion regulation and somatization were also determined (Table 4).

Table 4. Regression among scales.
Dependent variable Independent variable R2 F β t p
DERS-16 SCS 0.313 158.806 −0.588 −12.602 ≤ 0.001
SS SCS 0.080 30.495 −0.623 −5.522 ≤ 0.001
SS DERS-16 0.144 58.800 0.182 7.668 ≤ 0.001
  • Note: The statistical significance level was considered as p ≤ 0.001.
  • Abbreviations: DERS-16, Difficulties in Emotion Regulation Scale–Brief Form; SCS, Self-Compassion Scale; SS, Somatization Scale.

4. Discussion

According to this study, nursing students’ scores on difficulties in emotion regulation are at a moderate level, indicating that the students experience some challenges in regulating their emotions. There are various factors that lead to emotion regulation difficulties in nursing students [4244]. Intensive academic programs, exam stress, and course load can increase the emotional burden of students and make emotion regulation difficult [45, 46]. Challenging experiences such as emotional demands, emergencies, and patient losses encountered in clinical internships may also negatively affect students’ emotional balance [47]. In addition, interpersonal conflicts, intrateam conflicts, and hierarchical structures in the clinics and at school may increase stress levels and cause difficulties in emotion regulation skills [4851]. Fatigue factors such as long working hours and irregular sleep can increase physical and psychological fatigue, making emotional control difficult. Lack of social support can make it difficult for students to cope with stress [52], while personal perfectionism and high expectations can lead to emotional difficulties by increasing fear of failure [53]. In addition, a low sense of self-efficacy in managing one’s own emotions and coping with stress is an important factor triggering emotion dysregulation [28, 54]. Strengthening emotion regulation skills in nursing education can facilitate students’ ability to cope with negative experiences and enhance their professional competence. It is critical for educators to address students’ emotional needs and provide training and support in emotion regulation skills, as this is crucial for the sustainability of the nursing profession [18, 55].

According to another result obtained from this study, the students’ self-compassion scores were also at a moderate level, indicating that nursing students face some difficulties in developing a kind and understanding approach toward themselves. Self-compassion in nursing students is often reduced by factors such as high stress, perfectionism, compassion fatigue, harsh self-criticism, negative social interactions, and traumatic experiences [31, 5658]. These factors impair psychological well-being and may lead to inadequate self-care and increased risk of burnout during education and clinical practice [5961]. Self-compassion aids in healthier stress coping and improves physical and emotional health [62, 63]; however, the current study among nursing students shows that self-compassion is at a moderate level. This result indicates the need for more education and support. Strengthening self-compassion is crucial for long-term well-being and professional effectiveness, making educator guidance in this area essential [61, 64, 65].

Another finding of this study was that the somatization scores of the students were at a moderate level. Moderate somatization scores suggest that students physically feel the difficulties they face, and that emotional distress is closely related to physical symptoms. Nursing students frequently face intense clinical situations such as pain and death, leading to psychological issues such as emotional exhaustion, anxiety, and depression [66, 67]. The transformation of all these psychological pressures into physical symptoms forms the core mechanism of somatization. Additionally, factors such as communication problems and interpersonal conflicts can reduce students’ capacity to cope with stress [27, 50, 68]. Therefore, educational programs should include psychological and physiological support, teaching stress management and promoting healthy environments [34, 68, 69].

In our study, a significant negative relationship was found between emotion regulation difficulties and self-compassion among nursing students, confirming H1 hypothesis. Further analysis revealed that a one-unit increase in self-compassion resulted in a 0.588-unit decrease in emotion regulation difficulties (β = −0.588, p ≤ 0.001). Self-compassion plays a crucial role in helping individuals cope with stress and emotional difficulties [70]. Studies show that difficulties in emotion regulation and low self-compassion negatively affect psychological health [21, 71]. Therefore, increasing self-compassion and emotion regulation skills can have positive results in terms of students’ individual well-being and their impact in clinical practice [19, 45, 72, 73]. Since nursing education involves frequent emotional challenges, developing emotion regulation is vital for students’ readiness and effectiveness in practice [54, 74]. Thus, educators should address students’ emotion regulation needs and focus on strategies such as self-compassion interventions to strengthen emotion regulation skills.

In our study, a significant negative relationship was found between somatization and self-compassion in nursing students, and H2 hypothesis was confirmed. When further analysis was performed, it was determined that one unit increase in self-compassion decreased the somatization level by 0.623 units (β = −0.623, p ≤ 0.001). The literature indicates that increased self-compassion enhances individuals’ ability to cope with stress and positively affects health [29, 75]. Self-compassion enables individuals to approach themselves with kindness and understanding when faced with challenging situations, which contributes to the reduction of stress and physical discomfort [76]. It also promotes the fulfillment of physical needs such as adequate sleep, healthy nutrition, regular exercise, and rest [36, 77] and supports the practice of relaxation techniques—including breathing exercises, meditation, and mindfulness—thereby helping to alleviate somatic symptoms [27]. It has been emphasized in the literature that stress in nursing students leads to symptoms such as sleep disorders, musculoskeletal problems, and gastrointestinal issues, and these symptoms reflect the impact of emotional burdens on physical health [7, 26, 78]. During nursing education, self-compassion enhances students’ emotional resilience and physical health, while low self-compassion may contribute to the emergence of somatic symptoms [18, 35, 70, 71]. Thus, self-compassion is a key factor in preventing emotional burnout and physical symptoms in students [79].

The findings of our study show that there is a positive relationship between difficulties in emotion regulation and somatization. Thus, hypothesis H3 was confirmed. In further analysis, it was determined that one-unit increase in emotion regulation difficulty increased somatization by 0.182 units (β = 0.182, p ≤ 0.001). This finding is consistent with the literature, showing that emotional difficulties and stress can increase physical symptoms [80]. Difficulties in emotion regulation can make it difficult for individuals to cope with emotional stress, leading to increased physical symptoms in the body [26, 32, 54, 81, 82]. Somatization is associated with disruptions in emotion regulation and may develop under the influence of risk factors such as insecure attachment and trauma history. It can lead to changes in endocrine and immune systems and pain regulation systems, negatively affecting health. Therefore, enhancing emotional awareness and understanding difficulties in emotion regulation play a key role in reducing somatization [83]. Nursing students who encounter many challenging situations in their academic and clinical experiences may experience difficulties in emotion regulation, which can lead to difficulties coping with stressful situations and an increase in somatic symptoms. For this reason, it is important to evaluate the somatic complaints of students with emotion regulation difficulties.

4.1. Limitations

Among the limitations of this study, the fact that it was conducted using scales caused only subjective data to be collected and results based on students’ personal perceptions to be obtained. This may prevent a more comprehensive analysis of complex psychological and physiological conditions such as emotion dysregulation, self-compassion, and somatization. In addition, the study was conducted in a single center, which leads to the generalization of the findings to only students from a specific school or district. Data from different geographical regions and different educational institutions may increase the generalizability of the results to a broader population. Future studies with larger sample groups and students from different educational levels, using more diverse data collection methods and adopting longitudinal designs, would be useful to overcome these limitations.

5. Conclusion

The findings of our study emphasize the positive relationship between difficulties in emotion regulation and somatization and the negative relationship between difficulties in emotion regulation and somatization and self-compassion. These findings reveal the importance of increasing emotion regulation skills and self-compassion in nursing education and clinical practice. The intense academic load that is a natural part of nursing education and the stress that accompanies clinical practice experiences may increase the emotional burden of students. The ways of coping with these emotional difficulties may have a direct impact on both students’ well-being and their professional success. Therefore, it may be useful to address students’ emotion regulation skills and self-compassion levels as a part of nursing education. In this sense, suggestions that can help nursing students cope with issues such as emotion regulation difficulties, self-compassion, and somatization can be presented. During nursing education, workshops, seminars, or group therapies can be organized for students to strengthen their emotion regulation skills. These studies can provide students with training on topics such as coping with stress, relaxation techniques, and emotional awareness. In this way, students can be more effective in coping with emotionally challenging situations and avoid emotional burnout. To strengthen self-compassion, students can be offered training and activities that explain the importance of self-compassion. Educators can support students’ self-compassion development by encouraging them to adopt a self-compassionate approach, providing positive feedback, and providing resources such as written materials on self-compassion, meditation, or mindfulness activities. Educational programs on stress management and somatization prevention can be offered to nursing students to help them cope with stress and somatic symptoms. These programs should include techniques to help students cope with stress and provide guidance for the prevention of somatic symptoms. In addition, it should be emphasized that students should adopt healthy living habits, exercise regularly, eat a healthy diet, and get enough sleep. It is useful to provide individual support to nursing students on emotional regulation and coping with stress, and to establish counseling services or psychological support units in schools. These units should be organized to provide a safe space where students can easily apply when they encounter emotional or psychological difficulties, and mentoring and group support programs should be initiated. Mentorship programs consisting of experienced nurses can help students develop stress management skills and support them in coping with the challenges they face in their professional lives. Group support meetings that encourage experience sharing among students can enhance emotional solidarity and reduce feelings of loneliness and isolation. It is also very important to create an empathic and supportive educational environment. A supportive educational environment should be provided by considering the emotional and physical needs of students during the nursing education process. Educators should adopt an empathic approach to help students cope with emotional difficulties and encourage them. Such an environment can help students become emotionally stronger. These suggestions may enable nursing students to cope with the emotional difficulties they face in their professional and personal lives in a healthier way and improve their overall well-being. When all these situations are evaluated, it is clear that nursing education should be strengthened not only with technical knowledge but also with skills to support emotional and psychological health. Additionally, future studies should examine the effects of training programs aimed at improving nursing students’ self-compassion skills on reducing emotion regulation difficulties and somatic symptoms, as well as their impact on human physiology and biochemistry. Specifically, investigating changes in stress hormones (such as cortisol) and overall physiological responses could be beneficial.

Conflicts of Interest

The authors declare no conflicts of interest.

Funding

No funding was received for this manuscript.

Acknowledgments

The authors would like to express their gratitude to all students who participated in the research.

    Data Availability Statement

    The datasets analyzed during the current study are available from the authors on reasonable request.

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