Dependency and self-criticism in treatments for depression

Impact of personality style changes on CBT and PDT treatment responses in major depression

This study examines the influence of depressive personality styles on treatment responses in patients with major depression receiving cognitive behavioural therapy and psychodynamic therapy. We assessed changes in personality styles, including dependency, self-criticism, sociotropy, and autonomy, and their association with treatment response. Both treatment modalities led to significant reductions in self-criticism and sociotropy scores. Depressive symptom severity decreased overall, with a more pronounced reduction observed in the cognitive behavioural therapy group. Notably, reduced self-criticism and sociotropy were associated with better treatment outcomes in the cognitive behavioural therapy group. Our findings highlight the role of personality styles in influencing treatment outcomes for major depression. The study suggests an association between changes in personality styles and the reduction of symptoms. Our results support the idea that unique pathways of change are activated depending on the therapeutic intervention. These insights are critical in tailoring treatments to individual needs, addressing the central question of 'what works for whom'.

Reliability and Validity of the Self-Rating Scale as a Measure of Self-Criticism

The Self-Rating Scale (SRS; Hooley et al., 2010), a widely used measure of self-criticism in self-injury research, did not utilize conventional test development methods and has limited psychometric data. We examined the internal consistency, test-retest reliability, and convergent and discriminant validity of the SRS. Participants were 295 psychology undergraduate students. The SRS demonstrated good internal consistency (α = .93), adequate test-retest reliability (r = .76), and satisfactory convergent validity with other measures of self-criticism. Convergent validity was also adequate for expected dimensions of perfectionism (socially prescribed, self-oriented, concerns about mistakes, and doubts about actions), depressive symptoms, and negative and positive affect. The SRS demonstrated adequate discriminant validity with expected constructs of perfectionism (other-oriented, personal standards, and organizational perfectionism). Although the SRS appears to be a psychometrically sound measure of self-criticism, high correlations with depression and perfectionism raise questions regarding the overlap of these constructs.

Self-criticism and psychotherapy outcome: A systematic review and meta-analysis

Self-criticism involves constant and harsh self-scrutiny, overly critical evaluations of one's own behavior, and negative reactions to perceived failures in terms of active self-bashing. Self-criticism is associated with various mental disorders and psychotherapy outcome. This paper provides (1) a meta-analysis of the association between pre-treatment self-criticism and multiple treatment outcomes, and (2) a systematic review of the association between change in self-criticism and therapy outcome. Based on a systematic literature search, 49 longitudinal studies (56 independent effect sizes; 3277 patients) were included in the meta-analysis and 7 studies were identified for the additional systematic review. A random-effects meta-analysis was performed to assess the magnitude of the association between self-criticism and outcome, also considering potential moderators. The overall association between pre-treatment self-criticism and psychotherapy outcome was r = -.20 (95% CI = -.25 - -.16, p < .0001), suggesting that higher levels of self-criticism are related to poorer outcome. Although effect sizes showed little heterogeneity, the association varied by type of mental health problem and indicated stronger associations with certain disorders (e.g., eating disorders). The review based on change scores yielded inconsistent results. Our findings support the relevance of self-criticism for psychotherapy outcome.

Responding to self-criticism in psychotherapy

OBJECTIVE

We explored the interactive process in which therapists respond to client self-critical positions.

METHODS

Drawing from the resources of conversation analysis (CA), we examined a corpus of in-session self-critical sequences of talk occurring in different kinds of treatments: Client Centered Therapy, (CCT), Emotion Focused Therapy (EFT), Psychoanalytic Psychotherapy (PP) and in different cultural contexts.

RESULTS

It was found that client self-critical talk performed various functions pertaining to diminished control, accountability (e.g., failed obligations leading to self-blame) and disparaging evaluations of self (contempt or disgust). Further, therapists were found to respond in ways that targeted the client's report of having diminished control or of being accountable for their negative attributes by providing a more optimistic reading of the client's experience, one that is more open to positive outcomes and the possibility of change. Our sequential analysis not only shows how clients may resist these optimistic readings, but also how therapists work towards successfully achieving moments of re-affiliation.

CONCLUSION

We anticipate that the fine-grained sequential analysis of therapy interaction can provide therapists with a more detailed understanding of the options and challenges therapists face when working with clinical challenges of clients' self-critical positions.

The clinical trait self-criticism and its relation to psychopathology: A systematic review - Update

BACKGROUND

Self-criticism represents a central phenomenon in a variety of mental disorders. The review looks at the recent body of literature (2012-2018) to summarize the relation of self-criticism and psychopathology beyond depression and aims at detecting how different conceptualizations of self-criticism with psychoanalytical, psychodynamic, or cognitive-evolutionary background are related to psychopathology. Furthermore, latest treatment approaches for dysfunctional forms of self-criticism are reviewed.

METHODS

The literature research of five databases (PsycINFO, PSYNDEX, PubMed, Medline, and Cochrane Library) took place in August 2018. Inclusion criteria for studies to enter the review narrative were an adult sample, non-clinical samples as well as clinical samples, and an empirical approach, which resulted in quantitative data.

RESULTS

48 studies entered the review. Besides depressive symptoms, self-criticism showed positive relations to symptoms of eating disorders, social anxiety disorder, and personality disorders as well as to psychotic symptoms or interpersonal problems through different conceptualizations of self-criticism. Regarding the treatment of self-criticism, compassion- or emotion-focused therapy interventions were investigated in most of the reviewed studies and both reduced self-criticism in clinical and non-clinical samples. However, harsh forms of self-criticism were more persistent and difficult to change.

LIMITATIONS

The review focused only on the latest empirical findings regarding self-criticism and psychopathology.

CONCLUSION

Potentially functional forms and functions of self-criticism need further consideration, as they represent a possible goal of psychotherapeutic treatment. Future research should address specific questions regarding antecedents and consequences of self-criticism.

Do student service members/veterans experience worse mental health stigma than their peers? A comparative study in a national sample

OBJECTIVES

Examine differences in mental health treatment-related stigma in student service members and veterans (SSM/Vs) and peers from 57 post-secondary institutions across the United States.

METHODS

In total, 909 SSM/Vs and 1818 demographically- and institutionally-matched non-SSM/Vs completed assessments of stigma-related barriers to mental health service utilization as part of the Healthy Minds Study between 2011 and 2015.

RESULTS

When compared to non-SSM/V peers, SSM/Vs reported more mental health treatment-related stigma toward help-seekers and less confidence in the helpfulness of therapy/counseling and psychotropic medications. However, effect sizes were small in magnitude (ds = .10 to .16), and depressed students in both groups reported greater stigma.

CONCLUSIONS

SSM/Vs experience greater treatment-related stigma than non-SSM/V peers, which may deter service use in many cases. However, differences in stigma were small and other under-studied barriers to help-seeking may apply to the substantive subset of SSM/Vs and non-SSM/Vs who may benefit from utilizing available services.

The role of change in self-criticism across young adulthood in explaining developmental outcomes and psychological wellbeing

OBJECTIVE

Past research has confirmed the role of self-criticism in numerous forms of psychopathology and negative interpersonal outcomes. However, the majority of these studies were cross-sectional and have not addressed the role of possible changes in self-criticism across time for future outcomes. The current study investigated the degree to which changes in self-criticism during young adulthood precede better psychological outcomes beyond the contribution of their baseline levels.

METHOD

A total of 168 Israeli emerging adults were followed for 12 years. Participants completed assessments of self-criticism at age 23, 24, 26.5, and 29, and of developmental tasks and psychological adaptation at age 35. Analyses assessed the extent to which the intercept and linear slope of self-criticism were associated with assessments of coping with age-related tasks and psychological well-being at age 35.

RESULTS

Findings indicated that decreases in self-criticism between the ages of 23 and 29 were associated with better coping with age-related task outcomes and psychological health at age 35.

CONCLUSIONS

These findings are among the first to show that decreases in self-criticism serve as important precursors of coping with age-related tasks and psychological outcomes and point to the positive contributions of changes in personality attributes for future development.

Maslow’s Unacknowledged Contributions to Developmental Psychology

Few readily identify Maslow as a developmental psychologist. On the other hand, Maslow’s call for holistic/systemic, phenomenological, and dynamic/relational developmental perspectives in psychology (all being alternatives to the limitations of the dominant natural science paradigm) anticipated what emerged both as and in the subdiscipline of developmental psychology. In this article, we propose that Maslow’s dynamic systems approach to healthy human development served as a forerunner for classic and contemporary theory and research on parallel constructs in developmental psychology that provide empirical support for his ideas—particularly those affiliated with characteristics of psychological health (i.e., self-actualization) and the conditions that promote or inhibit it. We also explore Maslow’s adaptation of Goldstein’s concept of self-actualization, in which he simultaneously: (a) explicated a theory of safety versus growth that accounts for the two-steps-forward-one-step-back contiguous dynamic that realistically characterizes the ongoing processes of being-in-becoming and psychological integration in human development/maturity and (b) emphasized being-in-the-world-with-others with the intent of facilitating the development of an ideal society by promoting protective factors that illustrate Maslow’s safety, belonging, and esteem needs. Finally, we dialogue with the extant literature to clarify common misgivings about Maslow’s ideas.

Changes in Self-Representations Following Psychoanalytic Psychotherapy for Young Adults: A Comparative Typology

Changes in dynamic psychological structures are often a treatment goal in psychotherapy. The present study aimed at creating a typology of self-representations among young women and men in psychoanalytic psychotherapy, to study longitudinal changes in self-representations, and to compare self-representations in the clinical sample with those of a nonclinical group. Twenty-five women and sixteen men were interviewed according to Blatt's Object Relations Inventory pretreatment, at termination, and at a 1.5-year follow-up. In the comparison group, eleven women and nine men were interviewed at baseline, 1.5 years, and three years later. Typologies of the 123 self-descriptions in the clinical group and 60 in the nonclinical group were constructed by means of ideal-type analysis for men and women separately. Clusters of self-representations could be depicted on a two-dimensional matrix with the axes Relatedness-Self-definition and Integration-Nonintegration. In most cases, the self-descriptions changed over time in terms of belonging to different ideal-type clusters. In the clinical group, there was a movement toward increased integration in self-representations, but above all toward a better balance between relatedness and self-definition. The changes continued after termination, paralleled by reduced symptoms, improved functioning, and higher developmental levels of representations. No corresponding tendency could be observed in the nonclinical group.