Sensory processing sensitivity and health-related quality of life: the mediational role of coping strategies

Sensory processing sensitivity and health-related quality of life: the mediational role of coping strategies Mercedes Borda-Mas a , Magdalena S´ anchez-Fern´ andez a,* , Nerea Almeda a , Manuela P´ erez-Chac´ on b , Jose M. Mestre c a Department of Personality, Assessment and Psychological Treatment, University of Seville (Universidad de Sevilla), Seville, Spain b Spanish Association of High Sensitivity Professionals and Psychologists (PAS Espa˜ na, Asociaci´ on de Psic´ ologos y Profesionales de la Alta Sensibilidad), Madrid, Spain c Neuropsychology and Experimental Psychology Lab, University of Cadiz (Universidad de C´ adiz), Cadiz, Spain ARTICLE INFO Keywords: Sensory processing sensitivity Health-related quality of life Mental health Vitality Coping strategies ABSTRACT Coping strategies have been related to health-related quality of life (QoL) in highly sensitive individuals. Further research is needed on the possible mediating role of coping style in the relationship between Sensory Processing Sensitivity (SPS) and health-related QoL. The present study aimed to establish a model that explains the association between SPS and three health-related QoL variables (i.e., mental health, vitality, and social function) through coping strategies using structural equation modelling. Participants (N =10,520) completed the High Sensitivity Person Scale, Short Form Health Survey, and Coping Strategies Inventory. Two structural equation models were created. The results showed that SPS was directly associated with the three health-related QoL variables. The relationship between SPS and mental health was partially mediated by wishful thinking, selfcriticism, and social withdrawal. The relationships between SPS and vitality and between SPS and social function were partially mediated by emotional expression, wishful thinking, self-criticism, and social withdrawal strategies. These findings suggest that coping strategies may, in part, explain the association between SPS and health-related QoL and have practical implications for the development of prevention and intervention programs for highly sensitive individuals. 1. Introduction Sensory Processing Sensitivity (SPS) refers to an innate, stable, and inherited personality trait linked to individual differences in reactivity to internal and external stimuli (Aron & Aron, 1997). SPS is a facet of environmental sensitivity, an umbrella term that refers to theories that explain individual differences in the processing of environmental stimuli (Pluess, 2015). Individuals with high SPS are characterised by deep information processing, increased perception of environmental subtleties, increased emotional expression and empathy, and susceptibility to central nervous system overstimulation (Aron et al., 2012). It has been estimated that approximately 15–20 % of the general population exhibit high levels of this trait (Greven et al., 2019). SPS is related to other personality traits (Hentges et al., 2015). Therefore, high SPS levels have been associated with introversion, neuroticism, and openness to experience (Hellwig & Roth, 2021). Additionally, SPS components have been associated with vulnerable narcissism (Gubler et al., 2025), which is characterised by hypersensitivity, emotional vulnerability, and a sense of entitlement (Miller et al., 2018). Although SPS has been conceptualised as a temperamental trait and not a disorder (Greven et al., 2019), high reactivity to different stimuli with sufficient intensity can produce disturbances in daily life (Sobocko & Zelenski, 2015). Therefore, SPS appears to be associated with poor psychological and physical health (Kenemore et al., 2023). SPS has a negative impact on social, physical, cognitive, and emotional areas of quality of life (QoL), thus facilitating fluctuations in well-being, daily functioning, and health (Costa-L´ opez et al., 2021). Iimura (2022) showed that SPS was positively correlated with stress and negatively with resilience. P´ erez-Chac´ on et al. (2023) found negative correlations between SPS levels and three health-related QoL variables (i.e. mental health, vitality, and emotional role). However, previous studies have found that the effect of SPS on negative psychological states is mediated by other variables, such as a lack of adaptive emotional regulation strategies (Es¸kisu et al., 2022) or maladaptive cognitions (Wyller et al., 2017). Acevedo (2020) stated that the SPS trait can be adaptive. However, * Corresponding author at: C. Camilo Jos´ e Cela, s/n, 41018 Sevilla, Spain. E-mail address: [email protected] (M. S´ anchez-Fern´ andez). Contents lists available at ScienceDirect Personality and Individual Differences journal homepage: www.elsevier.com/locate/paid https://doi.org/10.1016/j.paid.2025.113242 Received 25 January 2025; Received in revised form 3 April 2025; Accepted 1 May 2025 Personality and Individual Dierences 243 (2025) 113242 Available online 7 May 2025 0191-8869/© 2025 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ ). SPS became maladaptive when people with high SPS do not have adequate coping strategies to respond to environmental needs. Therefore, it is likely that other psychological variables related to the ability to cope adequately with environmental stimuli mediate the relationship between SPS and QoL. Coping is defined as a set of emotional, cognitive, and behavioral responses employed by individuals to manage or tolerate stress (Skinner et al., 2003). Authors distinguished between adaptive and maladaptive coping strategies based on expected outcomes (Tobin et al., 1989). Thus, the use of adaptive or maladaptive coping strategies may determine whether individuals with high SPS can effectively manage their intense perception of environmental stimuli. Consequently, this may have a greater or lesser impact on overall QoL. Research has shown that individuals with high SPS levels tend to use avoidance or withdrawal strategies when faced with threatening stimuli or situations to protect their mental health (P´ erez-Chac´ on et al., 2023). There is also evidence of an association between SPS and maladaptive coping strategies (Branjerdporn et al., 2019). Coping strategies have been consistently linked to health-related QoL. Several studies have shown that the use of positive coping strategies, such as active problem-solving and positive reappraisal, is associated with improvements in health-related QoL (Alanazi et al., 2022; Kupcewicz et al., 2020). In contrast, the adoption of maladaptive coping strategies, such as avoidance or denial, has been found to correlate with deterioration in health-related QoL (Alanazi et al., 2022). Thus, it can be suggested that coping strategies may play a mediating role in the relationship between high SPS levels and poor health-related QoL. However, although some studies have linked high SPS levels to a lower quality of life and the use of maladaptive coping strategies, no study has examined the potential mediating role of coping strategies in the relationship between SPS and health-related QoL. Identifying such a mechanism could be crucial for developing evidence-based prevention programs aimed at improving the health and quality of life of highly sensitive individuals. This study aimed to examine the associations between SPS, healthrelated QoL, and coping with stressful situations, with the ultimate goal of advancing knowledge in the field of individual differences in sensory sensitivity and generating insights that can help prevent the negative consequences of SPS. To achieve this, a comprehensive analysis will be conducted using structural equation modelling (SEM) to explore the relationships between SPS, coping strategies, and health-related QoL. SEM is a powerful statistical technique that allows for testing complex relationships between observed and latent variables and is particularly well-suited for analysing mediation models (Kline, 2015). Previous studies have employed SEM to investigate similar mediation models using cross-sectional designs in the fields of personality psychology and health research (e.g. G¨ okda˘ g, 2021), and SPS research (e.g. Costa-L´ opez et al., 2024). 1.1. The present study This study aimed to examine the associations between SPS, healthrelated QoL, and coping strategies. Specifically, it aimed to establish a model that explains the relationship between SPS and health-related QoL through coping strategies. The following two hypotheses (Hs) were proposed (Fig. 1): 1. SPS is negatively associated with health-related QoL through an increase in maladaptive coping strategies (H 1 ). 2. SPS is negatively associated with health-related QoL through a decrease in adaptive coping strategies (H 2 ). 2. Materials and methods 2.1. Participants The sample consisted of 10,520 adults (M age =33.61, SD =11.39, range 18–79 years). It was recruited from a Spanish community context. Convenience sampling was chosen. Participants had to meet the following inclusion criteria: (1) being at least 18 years old, (2) providing complete and appropriate data and completing the battery of tests, and (3) explicitly accepting the informed consent. The majority of the sample was female (83.5 %), single (50.0 %), and college-educated (59.0 %). 2.2. Procedure This was a cross-sectional study. The researchers were faculty members with recognised research experience and professionals who were experts in the understanding of highly sensitive individuals. For a better understanding of this procedure, please refer to P´ erez-Chac´ on et al. (2023) and Chac´ on et al. (2023). Participation in this study was voluntary and anonymous. All participants provided informed consent and were free to withdraw from the study. Data were collected according to Spanish Law 3/2018 to ensure data protection and confidentiality of digital rights. Additionally, this research was conducted following the code of ethics of the World Medical Association and was approved by the Doctoral Studies Program Academic Committee of the International Doctoral School of the University of Seville (EIDUS, from Spanish, ’Escuela Internacional de Doctorado de la Universidad de Sevilla’). 2.3. Measures In addition to the Ad Hoc Questionnaire of Sociodemographic Information, three scales were used. The High Sensitivity Person Scale (HSPS) (Aron & Aron, 1997; Spanish version: Chac´ on et al., 2021) was used to identify highly sensitive person sensitivity through five dimensions: overstimulation, aesthetic sensitivity, low sensory threshold, fine psychophysiological discrimination, and harm avoidance. This self-report scale consists of 27 items with Likert-type scale response options (1 =strongly disagree/7 = strongly agree). In this study, the total HSPS-S score demonstrated good internal consistency ( α =0.92). The Short Form Health Survey (SF-36) (Ware & Sherbourne, 1992; Spanish version: Vilagut et al., 2005) was used to assess health-related QoL in the general population. This scale consists of 36 items organised into eight categories: general health, mental health, physical role, emotional role, physical function, social function, bodily pain, and vitality. Each item presents several response options based on a Likerttype scale, and each scale is punctuated independently. In this study, the domains used were mental health (MH; feelings of happiness, calmness, and tranquillity vs. feelings of anxiety and depression), vitality (V; feeling dynamic and energetic vs. feeling tired and/or exhausted), and social function (SF; engaging in normal social activities Fig. 1. Hypothesised structural model. M. Borda-Mas et al. Personality and Individual Dierences 243 (2025) 113242 2 vs. interference in social activities due to physical or emotional problems). In the present study, the three subscales showed acceptable levels of internal consistency (MH: α =0.87; V: α =0.84; SF: α =0.63). The Coping Strategies Inventory (CSI) (Tobin et al., 1989; Spanish version: Cano García et al., 2007) was used to assess the coping strategies used by individuals to deal with adverse situations in their daily lives. This 40-items instrument assesses coping strategies along two axes: engagement strategies (i.e., problem solving [PS], cognitive restructuring [CR], emotional expression [EE] and social support [SS]) and disengagement strategies (i.e., problem avoidance [PA], wishful thinking [WT], social withdrawal [SW] and self-criticism [SC]). It consists of five items for each strategy, with five response options on a Likert-type scale (1 =never/5 =almost always). In the present study, engagement strategies were considered adaptive coping strategies, and disengagement strategies were considered maladaptive coping strategies (Cano García et al., 2007). These eight subscales showed acceptable levels of internal consistency (CR: α =0.60; EE: α =0.82; WT: α =0.87; SC: α =0.88; PA: α =0.70; SW: α =0.77; PS: α =0.83; SS: α =0.87). 2.4. Data analyses Data were analyzed using JASP (JASP Team, 2024). Absolute skewness ranged from 0.06 to 1.93, and kurtosis from −0.27 to 6.44; therefore, the distributions were considered normal (Kim, 2013). Standard deviations, reliability coefficients, and Pearson’s correlations were calculated. Structural equation modelling (SEM) was used to examine the relationship between SPS and health-related QoL via coping strategies. Coping strategies were included if their correlation with the SPS exceeded 0.10. Confirmatory factor analysis was used to assess the measurement model, and discriminant validity was verified using the Fornell-Larcker criterion (Ab Hamid et al., 2017). Two structural models were developed: Model 1 (mental health) and Model 2 (vitality and social function), predicting health-related QoL via SPS and mediated by coping strategies. The ULS estimator was used to handle missing values via listwise deletion. Model fit was evaluated using CFI, IFI, NFI, TLI, and RMSEA, considering the sensitivity of χ 2 to sample size and RMSEA’s limitations with low degrees of freedom (Kenny et al., 2015). Standardized path coefficients tested the hypotheses, and indirect effects were analyzed via bootstrapping (5000 resamples). Minimum sample size was determined using Soper’s (2015) calculator for an effect size of 0.10, α =0.05, power =0.80, with eight latent and 12 observed variables (Model 1), and nine latent and 13 observed variables (Model 2). The required sample sizes (1889 for Model 1 and 1960 for Model 2) were easily met. 3. Results 3.1. Descriptive analyses Table 1 presents the correlations between SPS, health-related QoL, and coping strategies. Negative correlations were found between SPS and the three QoL variables and between SPS and problem avoidance. Wishful thinking, self-criticism, and social withdrawal were also negatively correlated with the three QoL variables. Mental health and social function were negatively correlated with emotional expression. Positive correlations were observed among the three QoL variables and between mental health, vitality, and cognitive restructuring. SPS correlated positively with cognitive restructuring, emotional expression, wishful thinking, self-criticism, social withdrawal, and problem-solving. Emotional expression was positively correlated with vitality, social function with cognitive restructuring, and the three QoL variables with problem avoidance, problem solving, and social support. The correlation between SPS and social support was not significant. 3.2. Structural equational model To test Hypotheses 1 and 2, structural equation modelling was conducted. The measurement model yielded an appropriate fit (CFI =0.97, IFI =0.97, NFI =0.97, TLI =0.93, RMSEA =0.12). Discriminant validity was adequate for vitality (√AVE =0.74) and social function (√AVE =0.71), but questionable for mental health (√AVE =0.61), given its high correlations with vitality (r =0.71) and social function (r =0.66). Therefore, structural equation models were computed separately for mental health (Model 1) and vitality and social function (Model 2). The two structural models showed an acceptable fit (CFI =0.90, IFI =0.90, NFI =0.90, TLI =0.80, RMSEA =0.11), with approximately explained variances (MH: R 2 =0.30, V: R 2 =0.20, SF: R 2 =0.23). These are shown in Fig. 2 (Model 1) and Fig. 3 (Model 2). Table 2 shows the direct and indirect effects after controlling for age Table 1 Pearson correlations of the study variables (N =10,520). Variables 1 2 3 4 5 6 7 8 9 10 11 12 1. SPS – 2. Mental health −0.23*** – 3. Vitality −0.22*** 0.71*** – 4. Social function −0.24*** 0.66*** 0.58*** – 5. Problem solving (PS) 0.07*** 0.24*** 0.24*** 0.16*** – 6. Cognitive restructuring (CR) 0.05*** 0.32*** 0.28*** 0.17*** 0.49*** – 7. Emotional expression (EE) 0.14*** −0.01 0.04*** −0.04*** 0.29*** 0.28*** – 8. Social support (SS) −0.00 0.16*** 0.17*** 0.16*** 0.25*** 0.32*** 0.54*** – 9. Wishful thinking (WT) 0.23*** −0.44*** −0.34*** −0.35*** −0.10*** −0.11*** 0.13*** 0.01 – 10. Self-criticism (SC) 0.22*** −0.48*** −0.35*** −0.38*** −0.06*** −0.12*** 0.08*** −0.07*** 0.61*** – 11. Problem avoidance (PA) −0.09*** 0.12*** 0.10*** 0.03** 0.03** 0.39*** −0.02** 0.00 0.01 −0.04*** – 12. Social withdrawal (SW) 0.16*** −0.33*** −0.28*** −0.33*** −0.12*** −0.10*** −0.35*** −0.48*** 0.33*** 0.39*** 0.22*** – M154.40 49.97 47.33 57.62 12.72 11.12 10.64 9.69 13.40 12.03 5.30 9.05 SD 22.42 16.72 17.91 26.55 4.12 3.89 4.75 4.89 4.91 5.00 3.58 4.38 Range 27–189 0–100 0–100 0–100 0–20 0–20 0–20 0–20 0–20 0–20 0–20 0–20 SPS: Sensory Processing Sensitivity, M: mean, SD: standard deviation. Adaptive coping strategies: PS, CR, EE, SS; Maladaptive coping strategies: WT, SC, PA, SW. ** p <0.01. *** p <0.001. M. Borda-Mas et al. Personality and Individual Dierences 243 (2025) 113242 3 and sex. In terms of direct effects, SPS had a significant negative effect on the three health-related QoL variables. The indirect effect of SPS on the three health-related QoL variables through coping strategies was negative and significant, except for the effect of SPS on vitality through emotional expression, which was positive. 4. Discussion According to previous evidence, high levels of sensory processing sensitivity (SPS) are associated with lower quality of life (QoL) (CostaL´ opez et al., 2021). Additionally, coping strategies have been found to be associated with health-related QoL in individuals with moderate to high SPS levels, such that adaptive strategies (i.e., cognitive restructuring) are linked to better health-related QoL, whereas maladaptive coping strategies (i.e., wishful thinking, self-criticism, social withdrawal, and problem avoidance) are associated with lower mental health-related QoL (P´ erez-Chac´ on et al., 2023). Moreover, other variables mediate the relationship between SPS and QoL (Es¸kisu et al., 2022; Wyller et al., 2017). This study aimed to examine the impact of SPS on health-related QoL, focusing on the mediating role of coping strategies in a large sample. Structural equation modelling was used to account for the partial overlap between the measurement constructs. Given the high correlation between the latent variable of mental health and the other two health-related QoL dimensions (vitality and social functioning), and considering the discriminant validity of the constructs, two separate models were specified: one with mental health as the outcome variable and another simultaneously incorporating vitality and social functioning as outcome variables. Regarding correlations, SPS was significantly negatively associated with all three health-related QoL variables. This finding aligns with previous research, which concluded that individuals with high SPS tend to report lower QoL (Costa-L´ opez et al., 2021) and poorer physical and mental health outcomes (Iimura, 2022; Kenemore et al., 2023; P´ erezChac´ on et al., 2023). In contrast, SPS levels were positively correlated with coping strategies for emotional expression, wishful thinking, selfcriticism, and social withdrawal. These findings partially diverge from expectations. While wishful thinking, self-criticism, and social withdrawal are considered maladaptive coping strategies and have been positively associated with SPS in previous studies (Alanazi et al., 2022; Kupcewicz et al., 2020), emotional expression has been conceptualised as an adaptive coping strategy, and adaptive strategies have been negatively associated with SPS levels in earlier research (Alanazi et al., 2022). This apparent contradiction may be attributed to the fact that Fig. 2. Structural model of the associations between SPS, coping strategies, and mental health. Standardized path coefficients are shown. Sex and age were controlled as covariates. ***p <0.001. For clarity, the observed indicators, residual covariances, and error covariance are not presented. Fig. 3. Structural model of the associations between SPS, coping strategies, vitality, and social function. Standardized path coefficients are shown. Sex and age were controlled as covariates. ***p <0.001. For clarity, the observed indicators, residual covariances, and error covariance are not presented. M. Borda-Mas et al. Personality and Individual Dierences 243 (2025) 113242 4 individuals with high SPS tend to exhibit heightened emotional reactivity to negative events in their daily lives. This increased sensitivity often results in more intense emotional responses to adverse situations, such as emotional expression (Brindle et al., 2015; Van Reyn et al., 2022). The multidimensional nature of SPS offers another explanation, as it enables the identification of distinct profiles within individuals with this trait and emphasises its potential positive aspects (Chac´ on et al., 2021). For example, research has demonstrated that the aesthetic sensitivity dimension of SPS is associated with positive affect (Sobocko & Zelenski, 2015), sensitivity to rewards and empathy (Acevedo et al., 2017), openness (De Gucht et al., 2022), and the use of adaptive coping strategies (Chac´ on et al., 2024). No significant correlation was found between SPS and social support, and the correlations between SPS and other coping strategies such as cognitive restructuring, problem avoidance, and problem solving were very small. Consequently, these variables were not included in either model. It was hypothesised that SPS was negatively associated with healthrelated QoL through an increase in maladaptive coping strategies (H 1 ). Thus, H1 was partially supported. The study showed that the total effects of SPS on the three QoL variables were partially mediated by the three maladaptive coping strategies introduced in each model (i.e., wishful thinking, self-criticism, and social withdrawal). Regarding mental health, the indirect effects of SPS through these three strategies explained 54.1 % of the total effect. This result is in line with the study by Brindle et al. (2015), who concluded that difficulties in emotional regulation mediate the relationship between SPS and mental health. Similarly, for vitality and social function, the percentages were 34.0 and 42.4 %, respectively. Thus, people with high SPS have a worse physical, mental, and social health-related quality of life, with maladaptive coping strategies as mediators. This suggests that interventions aimed at effectively managing self-criticism and wishful thinking, as well as objectively reassessing emotional expression and reactions to others’ opinions, could potentially improve this relationship. This result is consistent with a study by Kenemore et al. (2023), who found that perceived stress, which may be a consequence of maladaptive coping strategies, is related to health levels. It was hypothesised that SPS was negatively associated with healthrelated QoL through a decrease in adaptive coping strategies (H 2 ). This hypothesis was partially supported. The findings indicated that emotional expression partially mediated the relationship between SPS and vitality, as well as between SPS and social functioning, leading to improvements in these two dimensions of health-related QoL. Individuals with high SPS who employ adaptive coping strategies tend to report better health outcomes, as these strategies function as protective factors that enhance their overall QoL (Engel-Yeger et al., 2020; P´ erezChac´ on et al., 2023). In contrast, the mediating effect of emotional expression on the relationship between SPS and mental health was not significant. This result may be attributed to the heightened emotional reactivity typical of individuals with high SPS (Van Reyn et al., 2022), which can lead to a substantial emotional burden that adversely affects their mental health (Dollar et al., 2023; Ripper et al., 2018). In such cases, emotional expression alone may be insufficient to mediate this negative effect. However, in the context of vitality and social functioning, emotional expression may play a more prominent role in improving the management of social relationships and fostering a greater sense of energy through the release of accumulated emotional tension. Finally, the fact that the percentage of the indirect effect is higher for mental health (54.1 %) than for vitality (39.1 %) is consistent with Engel-Yeger et al. (2020), who reported that coping strategies play a greater role in predicting mental health-related QoL than physical health-related QoL. 4.1. Limitations This study had several limitations. First, the cross-sectional design limits the ability to infer causality between the variables. Consequently, future research should replicate these findings using a longitudinal design to establish the directionality of the relationships between the variables studied. Second, the study relied solely on self-report measures to evaluate the variables, which introduces limitations such as social desirability and recall biases. Future research should complement selfreported data with qualitative methods, such as focus groups and interviews, to gain a deeper understanding of these phenomena. Additionally, the instruments used to assess SPS and coping strategies may be unsuitable. For example, the SPS instrument employed in this study yielded high scores across the sample (M =154.40, SD = 22.42, range: 27–189), raising concerns regarding its appropriateness. Future studies should consider using alternative instruments to measure SPS, such as the Sensory and Behavioral Modulation Questionnaire (Engel-Yeger, 2024). This tool evaluates sensory responsiveness in everyday contexts using three subscales: sensitivity, habituation to Table 2 Bootstrap analyses of the significance of mediation (controlling for age and sex). Model pathways Estimated a (sig.) 95 % CI of B Percentage over total effect Lower Upper Model 1 Total effects SPS → Mental health −0.24*** −0.26 −0.22 – Direct effects SPS → Mental health −0.11*** −0.14 −0.09 45.9 Indirect effects SPS → Self-criticism → Mental health −0.06*** −0.07 −0.05 25.0 SPS → Emotional expression → Mental health 0.00 −0.01 0.01 – SPS → Social withdrawal → Mental health −0.02*** −0.03 −0.02 8.3 SPS → Wishful thinking → Mental health −0.05*** −0.05 −0.04 20.8 Total indirect effects SPS → Mental health −0.13*** −0.14 −0.12 54.1 Model 2 Total effects SPS → Vitality −0.23*** −0.24 −0.20 – SPS → Social function −0.26*** −0.28 −0.23 – Direct effects SPS → Vitality −0.13*** −0.16 −0.11 56.5 SPS → Social function −0.14*** −0.16 −0.12 53.8 Indirect effects SPS → Self-criticism → Vitality −0.04*** −0.05 −0.03 17.4 SPS → Self-criticism → Social function −0.04*** −0.05 −0.03 15.4 SPS → Emotional expression → Vitality 0.01*** 0.00 0.01 4.3 SPS → Emotional expression → Social function −0.01*** −0.01 −0.00 3.8 SPS → Social withdrawal → Vitality −0.02*** −0.03 −0.02 8.7 SPS → Social withdrawal → Social function −0.04*** −0.05 −0.03 15.4 SPS → Wishful thinking → Vitality −0.04*** −0.05 −0.03 17.4 SPS → Wishful thinking → Social function −0.03*** −0.04 −0.02 11.5 Total indirect effects SPS → Vitality −0.09*** −0.10 −0.08 39.1 SPS → Social function −0.12*** −0.12 −0.11 46.2 *** p <0.001. a Standardised coefficient. M. Borda-Mas et al. Personality and Individual Dierences 243 (2025) 113242 5 stimuli and avoidance. Additionally, the Sensory Processing Sensitivity Questionnaire (De Gucht et al., 2022) evaluates this construct across six scales: sensory sensitivity to subtle internal and external stimuli, emotional and physiological reactivity, sensory discomfort, sensory comfort, socioaffective sensitivity, and aesthetic sensitivity. Furthermore, future research should explore additional measures, such as the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004), to examine the mediating role of emotion regulation strategies in the relationship between SPS and health-related QoL. These tools can provide a more nuanced understanding of the mechanisms underlying these relationships. Third, data collection was conducted online, which excluded individuals without Internet access. To ensure equal opportunities for all segments of the target population, future studies should consider incorporating face-to-face data collection methods. Finally, the scarcity of prior research in the field of SPS presents another limitation, as it constrains the ability to compare the findings with those of existing studies. Expanding the literature on this topic is essential for contextualising and validating future research outcomes. 5. Conclusions This study makes a significant contribution to the SPS field. To our knowledge, this is the first study to examine the mediating role of coping strategies in the relationship between SPS and health-related QoL. The findings demonstrate that maladaptive coping strategies, such as wishful thinking, self-criticism, and social withdrawal, mediate the negative associations between SPS and three QoL indicators: mental health, vitality, and social function. Conversely, the adaptive strategy of emotional expression was identified as a protective factor that mitigated the negative effects of SPS on vitality and social functioning. These findings support Acevedo’s (2020) idea that the negative impact of this trait on well-being can be mitigated by reducing the use of maladaptive coping strategies or adequately addressing external and internal stimuli when dealing with stressors arising from heightened environmental sensitivity. These findings have practical implications for designing prevention and intervention strategies to address health-related challenges in highly sensitive individuals. Interventions aimed at improving healthrelated quality of life in this population should focus on adequately managing the characteristics of this personality trait, with special emphasis on cognitive and behavioral approaches to coping strategies, promoting either a reduced use of maladaptive strategies (P´ erez-Chac´ on et al., 2024). Accepting that the use of strategies such as self-criticism or wishful thinking entails suffering or that social withdrawal is employed to avoid emotional reactivity can facilitate the management of these strategies. Similarly, re-evaluating the interpretation of others’ actions or the sense of injustice that accompanies emotional expression in highly sensitive individuals is essential for increasing the use of this strategy, which is frequently employed in interpersonal relationships, while ensuring that it is adequately managed to prevent overwhelming emotional reactivity. Moreover, this study highlights the relevance of tailored psychological interventions, given that individuals with high SPS may exhibit greater responsiveness to treatment than those with lower SPS levels (Pluess & Boniwell, 2015). CRediT authorship contribution statement Mercedes Borda-Mas: Writing – review & editing, Supervision, Methodology, Investigation, Conceptualization. Magdalena S´ anchezFern´ andez: Writing – original draft, Methodology, Investigation, Formal analysis, Conceptualization. Nerea Almeda: Writing – original draft, Investigation, Conceptualization. Manuela P´ erez-Chac´ on: Supervision, Resources, Investigation. Jose M. Mestre: Writing – review & editing, Supervision, Methodology, Investigation, Conceptualization. Informed consent All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all participants for being included in the study. Declaration of Generative AI and AI-assisted technologies in the writing process To ensure the highest linguistic quality, some paragraphs of this manuscript were refined with the assistance of ChatGPT (GPT-4.5), Grammarly and Paperpal. These tools were used exclusively to enhance clarity and fluency in English, while the scientific content and interpretations remain entirely our own. Funding M. S´ anchez-Fern´ andez contributions were funded by the ‘VI Plan Propio de Investigaci´ on y Transferencia’ of the University of Seville. Declaration of competing interest The authors declare no conflict of interest. Acknowledgments The authors thank all the professionals who participated in this study for making it possible. We also thank the Spanish Association of High Sensitivity Professionals and Psychologists: www.pasespana.org. Data availability Data will be made available on request. References Ab Hamid, Sami, W., & Sidek, M. M. (2017). Discriminant validity assessment: Use of Fornell & Larcker criterion versus HTMT criterion. Journal of Physics, 890(1), Article 012163. https://doi.org/10.1088/1742-6596/890/1/012163 Acevedo, B. P. (2020). The basics of sensory processing sensitivity. In The highly sensitive brain (pp. 1–15). Academic Press. Acevedo, B. P., Jagiellowicz, J., Aron, E., Marhenke, R., & Aron, A. (2017). Sensory processing sensitivity and childhood quality’s effects on neural responses to emotional stimuli. Clinical Neuropsychiatry, 14(6), 359–373. Alanazi, M., Given, C., Deka, P., Lehto, R., & Wyatt, G. (2022). A literature review of coping strategies and health-related quality of life among patients with heart failure. European Journal of Cardiovascular Nursing, 22(3), 236–244. https://doi.org/ 10.1093/eurjcn/zvac042 Aron, E. N., & Aron, A. (1997). Sensory-processing sensitivity and its relation to introversion and emotionality. Journal of Personality and Social Psychology, 73(2), 345–368. https://doi.org/10.1037//0022-3514.73.2.345 Aron, E. N., Aron, A., & Jagiellowicz, J. (2012). Sensory processing sensitivity: A review in the light of the evolution of biological responsivity. Personality and Social Psychology Review, 16(3), 262–282. https://doi.org/10.1177/108886831143421 Branjerdporn, G., Meredith, P., Strong, J., & Green, M. (2019). Sensory sensitivity and its relationship with adult attachment and parenting styles. PloS ONE, 14(1), Article e0209555. https://doi.org/10.1371/journal.pone.0209555 Brindle, K., Moulding, R., Bakker, K., & Nedeljkovic, M. (2015). Is the relationship between sensory-processing sensitivity and negative affect mediated by emotional regulation? Australian Journal of Psychology, 67, 214–221. https://doi.org/10.1111/ AJPY.12084 Cano García, F. J., Rodríguez Franco, L., & García Martínez, J. (2007). Adaptaci´ on espa˜ nola del Inventario de Estrategias de Afrontamiento. Actas Espa˜ nolas de Psiquiatría, 35(1), 29–39. http://hdl.handle.net/11441/56854. Chac´ on, A., Avargues-Navarro, M. L., P´ erez-Chac´ on, M., & Borda-Mas, M. (2023). Occupational psychosocial risks and quality of professional life in service sector workers with sensory processing sensitivity. Behavioral Sciences, 13(6). https://doi. org/10.3390/bs13060496 Chac´ on, A., Borda-Mas, M., Rivera, F., P´ erez-Chac´ on, M., & Avargues-Navarro, M. L. (2024). Aesthetic sensitivity: Relationship with openness to experience and agreeableness, health-related quality of life and adaptive coping strategies in people M. Borda-Mas et al. Personality and Individual Dierences 243 (2025) 113242 6 with high sensory processing sensitivity. Frontiers in Psychology, 14, 1276124. https://doi.org/10.3389/fpsyg.2023.1276124 Chac´ on, A., P´ erez-Chac´ on, M., Borda-Mas, M., Avargues-Navarro, M. L., & L´ opezJim´ enez, A. M. (2021). Cross-cultural adaptation and validation of the Highly Sensitive Person Scale to the Adult Spanish Population (HSPS-S). Psychology Research and Behavior Management, 14, 1041–1052. https://doi.org/10.2147/PRBM.S321277 Costa-L´ opez, B., Ferrer-Cascales, R., Ruiz-Robledillo, N., Albaladejo-Blazquez, N., & Baryła-Matejczuk, M. (2021). Relationship between sensory processing and quality of life: A systematic review. Journal of Clinical Medicine, 10(17), 3961. https://doi. org/10.3390/jcm10173961 Costa-L´ opez, B., Ruiz-Robledillo, N., Moreno, O., Albaladejo-Bl´ azquez, N., Hernandez, C., Baryła-Matejczuk, M., & Ferrer-Cascales, R. (2024). Sensory processing sensitivity as a predictor of health-related quality of life outcomes via stress and sleep quality. Scientific Reports, 14(1), 22707. https://doi.org/10.1038/s41598-024-72657-9 De Gucht, V., Woestenburg, D. H., & Wilderjans, T. F. (2022). The different faces of (high) sensitivity, toward a more comprehensive measurement instrument. Development and validation of the sensory processing sensitivity questionnaire (SPSQ). Journal of Personality Assessment, 104(6), 784–799. https://doi.org/ 10.1080/00223891.2022.2032101 Dollar, J., Perry, N., Calkins, S., Shanahan, L., Keane, S., Shriver, L., & Wideman, L. (2023). Longitudinal associations between specific types of emotional reactivity and psychological, physical health, and school adjustment. Development and Psychopathology, 35(2), 509–523. https://doi.org/10.1017/S0954579421001619 Engel-Yeger, B. (2024). The development and validation of the “SENSE” −Sensory and Behavioral Modulation Questionnaire for adults. Research in Developmental Disabilities, 147, Article 104715. https://doi.org/10.1016/j.ridd.2024.104715 Engel-Yeger, B., Serafini, G., Gonda, X., Pompili, M., & Amore, M. (2020). Sensory processing patterns, coping strategies, and quality of life among patients with major affective disorders. European Psychiatry, 33(S1), S126. https://doi.org/10.1016/j. eurpsy.2016.01.172 Es¸kisu, M., A˘ gırkan, M., Çelik, O., Yalçın, R.Ü., & Haspolat, N. K. (2022). Do the highly sensitive people tend to have psychological problems because of low emotion regulation and dysfunctional attitudes? Journal of Rational-Emotive & CognitiveBehavior Therapy, 40(4), 683–706. https://doi.org/10.1007/s10942-021-00436-w G¨ okda˘ g, C. (2021). How does interpersonal emotion regulation explain psychological distress? The roles of attachment style and social support. Personality and Individual Differences, 176, Article 110763. Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26, 41–54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94 Greven, C. U., Lionetti, F., Booth, C., Aron, E. N., Fox, E., Schendan, H. E., … Homberg, J. (2019). Sensory processing sensitivity in the context of environmental sensitivity: A critical review and development of research agenda. Neuroscience & Biobehavioral Reviews, 98, 287–305. https://doi.org/10.1016/j.neubiorev.2019.01.009 Gubler, D., Janelt, T., Roth, M., & Troche, S. (2025). The hidden Narcissus in the orchid: The relationship between sensory processing sensitivity, narcissism, self-esteem, and the HEXACO personality traits. Personality and Individual Differences.. https://doi. org/10.1016/j.paid.2024.112891 Hellwig, S., & Roth, M. (2021). Conceptual ambiguities and measurement issues in sensory processing sensitivity. Journal of Research in Personality.. https://doi.org/ 10.1016/j.jrp.2021.104130 Hentges, R. F., Davies, P. T., & Cicchetti, D. (2015). Temperament and interparental conflict: The role of negative emotionality in predicting child behavioral problems. Child Development, 86(5), 1333–1350. https://doi.org/10.1111/cdev.12389 Iimura, S. (2022). Sensory-processing sensitivity and COVID-19 stress in a young population: The mediating role of resilience. Personality and Individual Differences, 184, Article 111183. https://doi.org/10.1016/j.paid.2021.111183 JASP Team. (2024). JASP (Version 0.19.1) [Computer software]. Retrieved on 14 November 2024 from: https://jasp-stats.org/. Kenemore, J., Chavez, J., & Benham, G. (2023). The pathway from sensory processing sensitivity to physical health: Stress as a mediator. Stress and Health, 39, 1148–1156. https://doi.org/10.1002/smi.3250 Kenny, D. A., Kaniskan, B., & McCoach, D. B. (2015). The performance of RMSEA in models with small degrees of freedom. Sociological Methods & Research, 44(3), 486–507. https://doi.org/10.1177/0049124114543236 Kim, H. Y. (2013). Statistical notes for clinical researchers: Assessing normal distribution (2) using skewness and kurtosis. Restorative Dentistry & Endodontics, 38(1), 52–54. https://doi.org/10.5395/rde.2013.38.1.52 Kline, R. B. (2015). Principles and practice of structural equation modeling. NYC, US: Guilford publications. Kupcewicz, E., Grochans, E., Kaduˇ c´ akov´ a, H., Mikla, M., & J´ o´ zwik, M. (2020). Analysis of the relationship between stress intensity and coping strategy and the quality of life of nursing students in Poland, Spain and Slovakia. International Journal of Environmental Research and Public Health, 17(12), 4536. https://doi.org/10.3390/ijerph17124536 Miller, J. D., Lynam, D. R., Vize, C., Crowe, M., Sleep, C., Maples-Keller, J. L., … Campbell, W. K. (2018). Vulnerable narcissism is (mostly) a disorder of neuroticism. Journal of Personality, 86(2), 186–199. https://doi.org/10.1111/jopy.12303 P´ erez-Chac´ on, M., Borda-Mas, M., Chac´ on, A., & Avargues-Navarro, M. L. (2023). Personality traits and coping strategies as psychological factors associated with health-related quality of life in highly sensitive persons. International Journal of Environmental Research and Public Health, 20(9). https://doi.org/10.3390/ ijerph20095644 P´ erez-Chac´ on, M., Borda-Mas, M., Rivera, F., Chac´ on, A., & Avargues-Navarro, M. L. (2024). Analysis of the moderator effect of overstimulation on the relationships between indicators of health-related quality of life, extraversion and maladaptive coping strategies in people with sensory processing sensitivity. Current Psychology, 43, 29143–29153. https://doi.org/10.1007/s12144-024-06507-2 Pluess, M. (2015). Individual differences in environmental sensitivity. Child Development Perspectives, 9(3), 138–143. https://doi.org/10.1111/cdep.12120 Pluess, M., & Boniwell, I. (2015). Sensory-processing sensitivity predicts treatment response to a school-based depression prevention program: Evidence of vantage sensitivity. Personality and Individual Differences, 82, 40–45. https://doi.org/ 10.1016/j.paid.2015.03.011 Ripper, C., Boyes, M., Clarke, P., & Hasking, P. (2018). Emotional reactivity, intensity, and perseveration: Independent dimensions of trait affect and associations with depression, anxiety, and stress symptoms. Personality and Individual Differences, 121, 93–99. https://doi.org/10.1016/J.PAID.2017.09.032 Skinner, E. A., Edge, K., Altman, J., & Sherwood, H. (2003). Searching for the structure of coping: A review and critique of category systems for classifying ways of coping. Psychological Bulletin, 129(2), 216–269. https://doi.org/10.1037/00332909.129.2.216 Sobocko, K., & Zelenski, J. M. (2015). Trait sensory-processing sensitivity and subjective well-being: Distinctive associations for different aspects of sensitivity. Personality and Individual Differences, 83, 44–49. https://doi.org/10.1016/j.paid.2015.03.045 Soper, D. (2015). A-priori sample size calculator for structural equation models. Computer Software www.danielsoper.com/statcalc. Tobin, D. L., Holroyd, K. A., Reynolds, R. V., & Wigal, J. K. (1989). The hierarchical factor structure of the Coping Strategies Inventory. Cognitive Therapy and Research, 13, 343–361. https://doi.org/10.1007/BF01173478 Van Reyn, C., Koval, P., & Bastian, B. (2022). Sensory processing sensitivity and reactivity to daily events. Social Psychological and Personality Science, 14, 772–783. https://doi.org/10.1177/19485506221119357 Vilagut, G., Ferrer, M., Rajmil, L., Rebollo, P., Permanyer-Miralda, G., Quintana, J. M., … Alonso, J. (2005). El Cuestionario de Salud SF-36 espa˜ nol: una d´ ecada de experiencia y nuevos desarrollos. Gaceta Sanitaria, 19, 135–150. http://scielo.isciii.es/scielo.ph p?script=sci_arttext&pid=S0213-91112005000200007&nrm=iso. Ware, J. E. J., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care, 30(6), 473–483. Wyller, H. B., Wyller, V. B. B., Crane, C., & Gjelsvik, B. (2017). The relationship between sensory processing sensitivity and psychological distress: A model of underpinning mechanisms and an analysis of therapeutic possibilities. Scandinavian Psychologist, 4, e15. https://doi.org/10.15714/scandpsychol.4.e15 M. Borda-Mas et al. Personality and Individual Dierences 243 (2025) 113242 7