Could worry and rumination mediate relationships between self‐compassion and psychological distress in breast cancer survivors?

Relationship between rumination, self-compassion, and psychological health among Japanese university students: A cross-sectional study

OBJECTIVES

Rumination is suggested to exacerbate psychological health, but there is room for investigating the potential protecting factors for individuals with high ruminative tendencies against psychological symptoms. The present cross-sectional study aimed to uncover the associations between rumination as a maladaptive dimension of self-focus, self-compassion, and psychological health, and whether and how components of self-compassion may moderate the associations between rumination and psychological health in Japanese undergraduate students.

METHODS

A questionnaire survey was conducted by using both an online platform and a paper-based questionnaire. The survey included established Japanese versions of psychological scales on rumination, self-compassion, perceived stress, trait anxiety, and depression.

RESULTS

The results revealed statistically significant positive correlations between rumination and negative dimensions of self-compassion, and rumination and psychological symptoms. Positive dimensions of self-compassion were significantly negatively correlated with both rumination and psychological symptoms. Reflection as a positive dimension of self-focus did not show significant correlations with most psychological variables. Furthermore, hierarchical multiple regression analyses involving subscales of self-compassion and their interactions with rumination as predictors revealed that the interactions between rumination and components of self-compassion, i.e., over-identification and mindfulness, significantly predicted trait anxiety. Higher rumination predicted higher anxiety when over-identification was high, but not when over-identification was low. Also, lower rumination predicted lower anxiety when mindfulness was high, but not when mindfulness was low.

CONCLUSIONS

The results suggest significant associations between rumination, components of self-compassion, and psychological health in a population of Japanese undergraduate students. The data also suggest that components of self-compassion play moderating roles in the relationship between rumination and psychological health, potentially serving as aggravating/protective factors for psychological health. Longitudinal studies and comparisons between different cultures should be conducted in the future quest.

Physical Limitations, Health Rumination/Worry, and Depressive Symptoms: Gender Differences among African Americans

Although studies have documented the relationships between physical health, health rumination/worry, and mental health, few investigations have assessed these linkages within African American communities. Using a community-based sample of residents in historically lower-income, African American communities (N = 306), this study assesses the mediating role of health rumination/worry in the physical limitation-depressive symptom relationship, and the moderating effect of gender on the relationship between health rumination/worry-depressive symptoms. Findings demonstrate that health rumination/worry explains half of the physical limitation-depressive symptom relationship, and the relationship between health rumination/worry and depressive symptoms is stronger for African American men than women. The findings underscore the importance of intersectional research for policy efforts aimed at reducing mental health morbidities within African American communities.

Examining the associations between self and body compassion and health related quality of life in people diagnosed with endometriosis

OBJECTIVE

An understanding of the role that self and body compassion may play as protective mechanisms in the context of psychological and physical health conditions is steadily increasing. The availability of research pertaining to their role in mitigating the health-related quality of life (HRQoL) impacts associated with endometriosis is limited. The current study examined the influence of self and body compassion on HRQoL in people diagnosed with endometriosis.

METHODS

Individuals aged 18+ years (n = 318), assigned female at birth, with a self-reported diagnosis of symptomatic endometriosis completed an online cross-sectional survey. Participant demographics and endometriosis-related data was collected in addition to self and body compassion and HRQoL. Standard multiple regression analyses (MRA) were conducted to estimate the proportion of variance in HRQoL that can be accounted for by self and body compassion in endometriosis.

RESULTS

Self and body compassion were both associated with higher HRQoL across all domains. However, when both self and body compassion were entered into a regression, only body compassion was significantly associated with HRQoL domains of physical wellbeing, bodily pain, vitality, social engagement and general HRQoL; self-compassion explained no unique variance. In the domain of emotional wellbeing, when both self and body compassion were entered into a regression, both were significantly associated, and explained unique variance.

CONCLUSIONS

It is suggested that future psychological interventions for individuals living with endometriosis should emphasise building general self-compassionate abilities with a subsequent specific focus on strategies designed to improve body compassion.

Mindfulness for the self-management of negative coping, rumination and fears of compassion in people with cancer: An exploratory study

BACKGROUND

Cancer and its treatments have the potential to significantly impact mental health, provoking feelings of anxiety, depression, and distress, which can last long after treatment is over. One of the most rapidly emerging influences in the healthcare field is mindfulness-based interventions (MBIs), which are designed to cultivate present moment awareness, attentional flexibility, compassion and acceptance, to reduce physical and psychological distress. However, there is limited research into the efficacy of MBIs or disease specific MBIs in shifting negative coping, ruminative thinking and fears of compassion as primary outcomes in individuals with cancer.

AIMS

This exploratory study was designed to evaluate inter- and intra-individual change in the management of negative coping, rumination and fears of compassion, following a cancer-specific mindfulness-based intervention.

METHODS AND RESULTS

A single group, non-experimental, repeated measures study of 22 participants across six cancer care centres explored the efficacy of an 8-week Mindfulness-Based Cognitive Therapy for Cancer (MBCT-Ca) course. The Reliable Change Index (RCI) examined reliable clinical improvement, deterioration, or no change in individuals on the Mental Adjustment to Cancer Scale (MACS), the Ruminative Responses Scale (RRS) and the Fears of Compassion Scale (FCS). About 82% of participants (n = 18) saw an improvement in at least one measure. A significant decrease in primary outcome scores was observed in negative coping, ruminating and fears of self-compassion. There were significant correlations between the fear of self-compassion and depressive ruminating, fear of accepting compassion from others and showing it to others pre and post intervention.

CONCLUSION

Our findings indicate that the MBCT-Ca programme may significantly reduce negative coping, ruminating and fears of self-compassion improving psychological health and wellbeing in cancer survivors.

Is rumination associated with psychological distress after a cancer diagnosis? A systematic review

Objective: The aim of this work was to review evidence on the association between psychological rumination and distress in those diagnosed with cancer. Methods: Six databases were searched for studies exploring rumination alongside overall assessments of psychological distress, depression, anxiety, or stress. Results: Sixteen studies were identified. Rumination was associated with distress cross-sectionally and longitudinally. However, once baseline depression was controlled for, the association was no longer seen. The emotional valence of ruminative thoughts and the style in which they were processed, rather than their topic, was associated with distress. Brooding and intrusive rumination were associated with increased distress, deliberate rumination had no association, and reflection/instrumentality had mixed findings. Conclusions: This review highlights that it is not necessarily the topic of content, but the style and valence of rumination that is important when considering its association with distress. The style of rumination should be the target of clinical intervention, including brooding and intrusion.

Development and preliminary validation of the Brief Self-Compassion Inventory

Research and clinical interest in self-compassion has grown due to its associations with physical and mental health benefits. Widely used measures of self-compassion have conceptual and psychometric limitations that warrant attention. The purpose of this project was to develop a new self-compassion measure, the Brief Self-Compassion Inventory (BSCI), and test its psychometric properties. We developed items for the BSCI based on theory, prior research, and expert and cancer patient feedback. The BSCI was then tested with adults diagnosed with breast, gastrointestinal, lung, or prostate cancer (N = 404). Confirmatory factor analysis suggested a unidimensional structure, and internal consistency reliability was excellent. Construct validity of the BSCI was established through its correlations with psychological variables hypothesized to be related to self-compassion, such as mindfulness, acceptance of cancer, and other coping strategies. Furthermore, measurement invariance testing of the BSCI indicated that it could be used across patients of varying genders, cancer types, and stages of illness. In conclusion, the 5-item BSCI was determined to be psychometrically sound and suitable for use with adults of varying genders, cancer types, and stages of disease. The measure warrants testing with other medical and nonclinical populations.

Self-compassion and fear of cancer recurrence in Chinese breast cancer patients: The mediating role of maladaptive cognitive styles

OBJECTIVES

Previous studies have examined the benefits of self-compassion for psychological symptoms in breast cancer patients; however, little is known about the role of self-compassion for patients' fear of cancer recurrence (FCR) as well as the underlying mediating mechanisms. This study aimed to examine the effect of self-compassion on FCR, and whether maladaptive cognitive styles mediate this relationship.

METHODS

This cross-sectional study included 304 females with breast cancer. A self-report questionnaire was used to assess patients' self-compassion, maladaptive cognitive styles (i.e., rumination and catastrophising), and FCR. Parallel mediation analyses were conducted to examine the research questions.

RESULTS

Approximately half of the patients with breast cancer reported elevated levels of FCR. Self-compassion was negatively related to FCR, and the relationship between self-compassion and FCR was mediated by catastrophising, whereas rumination did not significantly mediate the relationship between self-compassion and FCR.

CONCLUSIONS

Our findings suggest that self-compassion and catastrophising are closely associated with FCR in patients with breast cancer, and catastrophising is a mediator between self-compassion and FCR. Clinicians could reduce breast cancer patients' FCR by enhancing their self-compassion and improving their maladaptive cognitive styles.

Examining the interrelationships between mindfulness-based interventions, depression, inflammation, and cancer survival

Depression is highly prevalent in those diagnosed with cancer and is also associated with poorer prognostic outcomes. Mindfulness-based interventions are effective in reducing depressive symptoms and improving quality of life in patients with cancer. The objective of this review was to investigate whether mindfulness practices can improve survival and, if so, what mechanisms of action may contribute to these outcomes. Although no long-term studies have investigated this hypothesis, the current literature supports an inflammatory basis for depression, implicating proinflammatory cytokines and hypothalamic-pituitary-adrenal axis dysfunction as contributing factors. Markers of inflammation, such as interleukin-6, tumor necrosis factor-α, and cortisol, are all found at elevated concentrations in many depressed individuals. These exact mechanisms are associated with higher mortality in patients with cancer. Mindfulness has been studied for its effects on cytokine and cortisol levels, and there are promising data to support that the intervention can measurably decrease inflammation. Therefore, it is conceivable that mindfulness programs can affect survival in this population. There are limited data on the long-term effects of mindfulness on depression and inflammatory markers in patients with cancer, and there are potential barriers to the implementation of mindfulness-based interventions as part of a comprehensive treatment plan. Therefore, it is necessary to further explore these questions through longitudinal studies to establish a survival correlation. CA Cancer J Clin. 2022;72:490-502.

Path analysis of the association between self-compassion and depressive symptoms among nursing and medical students: a cross-sectional survey

Background

Nursing and medical students are suffering from high rates of depressive symptoms. Mental health benefits students’ learning, growth and professional development. Exploring psychological resources to prevent depression is emphasized recently, and self-compassion is shown to be inversely associated with depressive symptoms. However, the mechanism through which self-compassion contributes to decreased depressive symptoms is limited. Therefore, this study aimed to explore and examine a model detailing the potential paths between self-compassion and depressive symptoms.

Methods

A cross-sectional study was conducted and convenient sampling was used. Among the 1800 nursing and medical students targeted from two universities in East and North China, 1341 completed the questionnaires, and 1127 valid questionnaires were analyzed comprising 566 and 561 from medical and nursing students, respectively. Data in May 2020 and July 2020 were collected through Patient Health Questionnaire, self-compassion scale, resilience scale, Life Orientation Test and Perceived Stress Scale. Then, path model analysis was conducted to analyze the data.

Results

Finally, this study included 1125 valid questionnaires after excluding two extremes of study variables. Participants consisted of 50.2% medical students and 49.8% nursing students. The model showed an acceptable fit to the data. After controlling for the demographics, self-compassion was directly and indirectly associated with decreased depressive symptoms by increasing resilience and optimism and reducing perceived stress among nursing and medical students. Resilience and optimism were directly and indirectly associated with decreased depressive symptoms by reducing perceived stress among nursing students and indirectly associated with decreased depressive symptoms among medical students.

Conclusions

The study provides evidence that self-compassion significantly influences the decrease in depressive symptoms by increasing resilience and optimism and reducing perceived stress. These findings suggested that programs enhancing students’ self-compassion, resilience, and optimism simultaneously can help decrease depressive symptoms and improve mental health in education and healthcare institutes. These findings may facilitate the designing of educational programs for preventing depressive symptoms and promoting mental health among nursing and medical students.

Psychological well-being and death anxiety among breast cancer survivors during the Covid-19 pandemic: the mediating role of self-compassion

Background

Despite the abundance of clinical data available for Coronavirus Disease 2019 (COVID-19), little research on the psychological well-being of breast cancer survivors has been published. We investigate the extent to which self-compassion accounted for the association between psychological well-being (depression, anxiety) and death anxiety in breast cancer survivors.

Methods

A cross-sectional study design was applied. Participants were recruited from three departments of oncology in Zanjan, Iran. Data were collected from 210 breast cancer patients. Participants completed self-report measures. Pearson correlation coefficient was used to assess the relationship among the study variables. Bootstrapping analyses were used to test the significance of indirect effects.

Results

Correlational analyses revealed that depression and anxiety were significantly and positively related to death anxiety (r = 0.77, p < 0.01; r = 0.85, p < 0.01, respectively) and negatively to self-compassion (r = − 0.48, p < 0.01; r = − 0.53, p < 0.01, respectively). Bootstrapping analyses revealed significant indirect effects of depression (β = 0.065, SE = 0.35, p < 0.03, 95% CI [LL = − 0.0083, UL: − 0.1654]) and anxiety (β = 0.089, SE = 0.09, p < 0.04, 95% CI [LL = − 0.0247, UL: − 0.1987]) on death anxiety through self-compassion.

Conclusions

Findings from this study indicate that self-compassion may be considered as one treatment strategy to improve psychological well-being of cancer patients in the new context of the COVID-19 pandemic.

Association Between Daily Worry, Pathological Worry, and Fear of Progression in Patients With Cancer

Background: Fear of progression (FoP), or fear of cancer recurrence (FCR), is characterized by worries or concerns about negative illness-related future events. Actually, to worry is a common cognitive process that, in its non-pathological form, belongs to daily life. However, worry can also become pathological appearing as a symptom of mental disorders. This study aimed at investigating the associations among daily worry, pathological worry, and FoP in patients with cancer.

Methods: This is a cross-sectional study that includes 328 hospitalized patients with cancer. Patients filled out the FoP Questionnaire (FoP-Q), the Worry Domains Questionnaire (WDQ) for the assessment of daily worry, and the Penn State Worry Questionnaire (PSWQ) for the assessment of pathological worry. Depressive, anxiety, and somatic symptoms were measured with modules of the Patient Health Questionnaire [Patient Health Questionnaire-Depressive Symptoms (PHQ-2), Generalized Anxiety Disorder-2 (GAD-2), and Patient Health Questionnaire-Somatic Symptoms (PHQ-15)]. Furthermore, a structured clinical interview was conducted for the assessment of anxiety disorders. The hierarchical multiple linear regression analysis was used to identify factors independently associated with FoP.

Results: Mean age of the participants was M = 58.5 years (SD = 12.8), and 64.6% were men. FoP and worry were significantly intercorrelated (r = 0.58–0.78). The level of FoP was most strongly associated with daily worry (β = 0.514, p < 0.001), followed by pathological worry (β = 0.221, p < 0.001). Further significant determinants were younger age and depressive and anxiety symptoms. Clinical variables were not independently associated with FoP. The final model explained 74% of the variance.

Discussion: Fear of progression is strongly associated with daily worry and pathological worry. These results bring up the question of whether FoP is an expression of a general tendency to worry. Whether a general tendency to worry, in fact, represents an independent vulnerability factor for experiencing FCR/FoP needs to be investigated in a longitudinal research design.

The Relationship between Self-Compassion and the Experience of Memorial Symptoms in Patients with Gastrointestinal Cancer

Background:

Patients with Gastrointestinal (GI) cancer experience a range of physical and psychological memorial symptoms after developing cancer and beginning to receive medical care. The present study was conducted to investigate the relationship between self-compassion and the experience of memorial symptoms in patients with GI cancer.

Materials and Methods:

This descriptive-correlational study was conducted in July to August 2019. The study sample included 190 patients admitted to Seyed Al-Shohada Hospital, with GI cancer who entered the study by convenience sampling. Data were collected using a patient demographic information form, Neff's Self-Compassion Scale (SCS), and the Memorial Symptoms Assessment Scale (MSAS) and then analyzed by Pearson correlation coefficient in SPSS-20.

Results:

The mean (SD) total score of self-compassion was 86.67 (16.65) out of 130, and the mean (SD) total score of memorial symptoms was 1.40 (0.64) out of 4 in patients with GI cancer. The most frequently reported physical symptom was lack of energy, with an 86.84% prevalence, and the most frequently reported psychological symptoms included worrying and feeling nervous, with 70.52% prevalence rates. The total score of self-compassion was inversely correlated with the total score of memorial symptoms, the score of psychological symptoms, and the score of physical symptoms. Furthermore, the total score of the memorial symptoms was inversely correlated with the scores of all the self-compassion components (p < 0.001).

Conclusions:

Cancer patients had memorial symptoms in both physical and psychological domains. These symptoms decrease with an increase in self-compassion, so compassion-based educational interventions by nurses can be used to reduce these symptoms.

Self-compassion and nursing competency among Japanese psychiatric nurses

PURPOSE

This study examined the association of self-focus and self-compassion with nursing competency.

DESIGN AND METHODS

Data of 433 psychiatric nurses comprising demographics, other-consciousness, self-compassion, self-focus, and nursing competency were analyzed using the Other-Consciousness Scale (OCS), Self-Compassion Scale (SCS), Japanese version of the Rumination-Reflection Questionnaire (RRQ), and Oriented Problem Solving Behavior (OPSN).

FINDINGS

Higher internal aspect and lower fantastic aspect in OCS, higher reflection in RRQ, and lower SCS negative subscales predicted a higher OPSN score. The account rate of variance was 12.5%.

PRACTICE IMPLICATIONS

Psychiatric nursing education should facilitate other-consciousness and reflection enhancement, and assuage uncompassionate attitude towards self.

Coping Strategies and Their Impact on Emotional Distress and Fatigue Among Breast Cancer Survivors: A Cross-sectional Survey

OBJECTIVES

This study examined the relations between subjective stress and strategies for coping with stress (emotion control strategies and self-compassion), as well as the relations between emotional distress and fatigue.

METHODS

The study used a cross-sectional survey design. Participants were 170 women aged 24 to 82 years with diagnoses of breast cancer stages I to III who were 1 to 12 months postchemotherapy, with no current evidence of disease and no previous cancer diagnosis. Participants were recruited by consecutive sampling, and the overall response rate was 85%.

RESULTS

Higher subjective stress was associated with higher emotional control (r = 0.23, P < 0.01), and both were associated with higher emotional distress (r = 0.63, P < 0.001; r = 0.20, P < 0.05). Lower self-compassion was associated with higher emotional distress (r = -0.20, P < 0.05). Fatigue exhibited a high association with emotional distress (r = 0.67, P < 0.001), which increased as subjective stress increased. Older age was associated with emotional control (r = 0.16, P < 0.05), whereas younger age was associated with emotional distress. Time elapsed since chemotherapy was negatively associated with both emotional distress (r = -0.19, P < 0.05) and fatigue (r = -0.18, P < 0.05). A strong positive association emerged between fatigue and emotional distress (r = 0.67, P < 0.001).

CONCLUSIONS

The results of this study underline the importance of self-compassion as a coping strategy to decrease emotional distress among breast cancer survivors.

Meta-analytic review on the differential effects of self-compassion components on well-being and psychological distress: The moderating role of dialecticism on self-compassion

Although self-compassion has been extensively studied in the recent decades, the representation of self-compassion as a unitary measure or the presence of self-warmth (i.e., presence of the positive components: self-kindness, common humanity, and mindfulness) and self-coldness (i.e., presence of the negative components: self-judgment, isolation, and mindfulness) remains controversial. Moreover, the differential effects of the six components of self-compassion on mental well-being and psychological distress have not been systematically investigated. To synthesize the differential effects of the six components of self-compassion and to examine how people in different cultures may associate the positive and negative components of self-compassion differentially, the present meta-analysis synthesized 183 effect sizes across 27 cultures. Results showed that the negative components of self-compassion (rs = 0.44 to 0.45) showed greater effect sizes with psychological distress than the positive counterparts (rs = -0.17 to -0.29) whereas the positive components of SCS (rs = 0.29 to.39) showed greater effect sizes with mental well-being than the negative counterparts (rs = -0.29 to -0.36), with the exception of common humanity and isolation (r = 0.29 and - 0.36). Cultural orientation of dialecticism moderated the association between the positive and the negative components of self-compassion, with dialectical cultures showing lower associations between the two opposing components. Findings have implications on the design and implementation of self-compassion interventions cross-culturally.

COVID-19 Outbreak Effects on Job Security and Emotional Functioning Amongst Women Living With Breast Cancer

The outbreak of Coronavirus disease 2019 (COVID-19) has negatively impacted global economies and employment. In the UK, it is predicted that approximately eight million jobs were furloughed as a result of the outbreak and the associated restriction of movement or shielding measures. This study aimed to investigate the impact of changes in employment status on cognitive and emotional health as well as perceptions of work. Furthermore, it examined the relationships between women’s job security and anxiety, depression and cognitive function. Women living with breast cancer (N = 234) completed online questionnaires to measure their cognitive function, general emotional well-being, COVID-19 related emotional vulnerability (COVID-EMV), work ability and COVID-19 related perceptions of work. Our results revealed that threat to job security was predictive of depression and cognitive function in the entire sample Such that those with higher levels of perceived job security had lower depression and better cognitive function. Further, women who were furloughed or unable to continue work reported higher job insecurity compared to those who had worked throughout the pandemic. Greater rumination was also associated with worse anxiety and depression as well as poorer cognitive function. Finally, moderation analysis highlighted that women who had better cognitive functioning were less likely to experience anxiety when their job security was high. Given our findings, we suggest that employers provide women with accessible interventions to enhance cognitive and emotional resilience and thus help protect against the detrimental effects of job insecurity created by the COVID-19 outbreak.

The Effect of Self-Compassion on Psychosocial and Clinical Outcomes in Patients With Medical Conditions: A Systematic Review

Studies about the role of self-compassion have focused primarily on psychological well-being, but there is solid evidence to suggest that self-compassion may have larger and more prominent implications in the medical world. Therefore, this systemic review aimed to investigate the effects of self-compassion on psychosocial and clinical outcomes in medically ill patients.

A comprehensive search of several databases from their inception to August 10, 2020, was conducted, which included Ovid MEDLINE(R) and Epub Ahead of Print, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Eligible studies needed to include psychosocial or clinical outcomes of self-compassion in medically ill patients.

Nineteen articles (n=2,713 patients; 73.3% females) met our eligibility criteria and were included in this systematic review. There was a negative correlation between self-compassion and psychosocial outcomes such as anxiety, depression, and stress. Moreover, based on self-compassion intervention, there was an improvement in clinical outcomes related to diabetes such as hemoglobin A1c (HbA1c) and blood glucose levels.

This systematic review highlights the effect of self-compassion on psychosocial and clinical outcomes. Further studies are needed to evaluate long-term outcomes of a self-compassion-based-intervention to highlight its importance in the role of disease management.