Exploring the roles of compassion and post-traumatic stress disorder on global distress after sexual trauma

OBJECTIVES

Recovery from sexual trauma can be complex and multi-faceted. Most current psychological treatment protocols for trauma use a cognitive model of post-traumatic stress disorder (PTSD). However, sexual trauma may include specific complexities beyond that of a cognitive model of PTSD, such as relational factors. The distress experienced after sexual abuse may involve variables not exclusive to a PTSD model. Compassion focused therapy (CFT) is an approach that incorporates evolutionary, relational and social perspectives. This study explored the relationships between variables associated with CFT, PTSD and distress in survivors of sexual abuse to determine the role of CFT-related variables.

METHODS

155 adults who had experienced sexual abuse or any unwanted sexual experience at any point in their lives completed online questionnaires pertaining to various CFT variables (self-compassion, receiving compassion from others, having a fear of compassion from others, having a fear of compassion from the self, shame and self-criticism) and questionnaires measuring global distress as the outcome of sexual abuse and PTSD symptoms.

RESULTS

An exploratory model involving CFT-related variables explained significantly more of the variance (4.4%) in global distress than PTSD symptomology alone. Self-criticism was found to be the variable with significant contribution.

CONCLUSIONS

That CFT treatments, targeting self-criticism, should be developed alongside the standard cognitive model of PTSD based treatments for survivors of sexual abuse was supported. Future research may explore experimental designs utilizing CFT in this population, as well as further investigations on the roles of these specific CFT variables.

Evaluating a brief online compassion-focused intervention for intensive care nurses

BACKGROUND

High levels of stress have been found within health care staff, particularly in the nursing population, which is somewhat attributed to the Covid-19 pandemic. The development of self-compassion, a protective psychological construct, may promote well-being in the health care staff population. As part of a service development project, the authors delivered and evaluated a brief online compassion-focused intervention with nurses working within Intensive Care Units (ICUs).

AIMS

Aims were to explore feasibility within the ICU nursing population and consider potential benefits to psychological well-being.

METHODS

ICU nurses registered for an online, 4 week, compassion-focused intervention as part of a service development project. Measures of compassion, burnout, trauma, and the emotional climate of their work environment were analysed in two groups; those who completed the intervention and those who did not. Baseline and post-intervention measures were analysed to infer the potential benefits of the intervention.

RESULTS

Compared with their baseline scores, those who completed the intervention showed improvements on measures of compassion, soothing in emotional climate, and reductions in burnout, trauma and threat in emotional climate. At baseline, those who did not complete the intervention scored lower on measures of compassion and soothing within their emotional climate, as well as higher levels of trauma and threat within the emotional climate, compared with those who engaged with the intervention.

CONCLUSIONS

Brief online compassion-focused interventions may be a useful platform to promote well-being in ICU nurses, but possibly only for those who have a pre-established level of self-compassion.

RELEVANCE TO CLINICAL PRACTICE

This study demonstrates the value of offering online interventions to improve the mental health of nursing staff. The findings suggest that nurses may benefit from being offered online interventions as welll as traditional psychological interventions. This may shape further service provision by offering nurses who require support a wider range of treatment options.

The role of compassion in moral injury among military veterans: Implications for treatment

OBJECTIVES

The study investigated the relationship between psychological distress, alcohol use, the three fears of compassion (i.e., to self, from others, and to others), facilitators and inhibitors of compassion (self-reassurance, shame, and self-criticizing), and the three flows of compassion (to self, to others, and from others) on moral injury (MI) in military veterans.

METHOD

A total of 127 participants (81.9% male, Mage = 51.24, SD = 13.98) completed measures of MI, psychological distress, alcohol use, shame, fears of compassion, self-criticizing and self-reassurance, and the three flows of compassion. Bivariate correlations and a hierarchical multiple regression were conducted to determine relationships between psychological distress, alcohol use, and the facets of compassion and MI, and whether psychological distress, alcohol use, and the facets of compassion predicted MI among veterans.

RESULTS

Demographic variables of younger age and lower rank alongside psychological distress, alcohol use, and the facets of compassion were all significantly related to MI in veterans. Age, rank, psychological distress, alcohol use, and the facets of compassion did not predict MI in veterans. However, shame was found to be the biggest predictor of MI in veterans, followed by lower rank.

CONCLUSION

The study supports prior research indicating MI as a shame-based presentation with younger age and lower rank posing as risk factors for MI in veterans. Additionally, the findings indicate strong relationships between the facets of compassion and MI in veterans, highlighting the potential clinical utility of including compassion within MI-based interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A case series study of compassion-focused therapy for distressing experiences in psychosis

OBJECTIVES

Compassion-focused therapy (CFT) is an evolution-informed biopsychosocial approach that seeks to cultivate attachment and care motivational systems and their psychophysiological regulators. These can counteract some of the harmful effects of social threat, inferiority, shame, self-criticism and depression, which are common in people with psychosis and undermine their well-being, social trust and ability to feel safe. This study aimed to test the acceptability of a novel manualized individual CFT intervention for psychosis (CFTp).

DESIGN

A non-concurrent, multiple-baseline, case series design, with three phases: baseline, intervention and follow-up.

METHODS

The 26-session CFTp intervention was provided for a sample of eight people with distressing psychotic experiences and a psychosis-related diagnosis. The study aimed to assess acceptability of CFTp and to test clinically reliable improvements while receiving the intervention, compared to a baseline period.

RESULTS

Seven of eight participants completed the therapy, and clinically reliable improvements were found at both the single-case and group level of analysis. At the single-case level, over half the participants showed improvements in depression (5/7), stress (5/7), distress (5/7), anxiety (4/7) and voices (3/5). One participant showed a deterioration in anxiety (1/7) and dissociation (1/7). At the group level (n = 7), there were significant improvements in depression, stress, distress, voices and delusions. The improvements in voices, delusions and distress were sustained at 6- to 8-week follow-up, but depression and stress dropped slightly to trend-level improvements.

CONCLUSIONS

CFTp is a feasible and acceptable intervention for psychosis, and further investigation is warranted with a randomized controlled trial.

Compassion-based interventions in Asian communities: A meta-analysis of randomised controlled trials

PURPOSE

Practising compassion increases well-being and reduces depression, anxiety, and psychological distress among clinical and non-clinical populations. There is a rapid increase in compassion-based interventions within the past two decades. However, the reviews are limited to predominantly Western cultures. Therefore, this meta-analysis aimed to evaluate the literature attempting to promote and increase compassion in Asian communities.

METHOD

Eight randomised controlled trials (RCTs) conducted between 2016 to 2021 were included in the meta-analysis with data from 1012 participants across Thailand, Japan, China and Hong Kong. Effect sizes were calculated to test the efficacy of the compassion-based interventions on the self-compassion outcome. Intervention efficacy was tested by comparing the intervention groups against control groups (wait-list control and active control groups) at pre- and post-interventions.

RESULTS

Significant between-group differences in change scores were found on self-report measures of self-compassion with large effect sizes in interventions with wait-list control groups (d = .86) and small effect sizes in interventions with active-control groups (d = .19).

CONCLUSIONS

Although compassion-based interventions are heterogeneous in nature and limited in scope, there is promising evidence of improving self-compassion in Asian communities. This supports for the cross-cultural applicability of compassion-based interventions. However, research within the Asian context is limited and at an infancy stage, signifying the importance of conducting further compassion-based interventions in clinical and non-clinical groups living in the Asian communities.

Never underestimate fears, blocks, and resistances: The interplay between experiential practices, self-conscious emotions, and the therapeutic relationship in compassion focused therapy

Experiential practices are a core component of compassion focused therapy (CFT). Throughout the treatment process, the client's engagement with these practices may become blocked, resulting in a rupture in the therapeutic relationship. In these instances, the interplay between these experiential practices and the therapeutic relationship becomes an essential focus of therapy to repair the rupture, re-engage the client in the therapeutic process, and proceed with the CFT treatment plan. This paper presents the case of a man diagnosed with social anxiety disorder, with the presence of shame-based self-criticism, treated via 12 sessions of CFT. CFT was proceeding well until certain embodiment practices and chair work were introduced, at which point the client refused to continue and became disengaged in the session. The process of repair and re-engagement will be discussed from the perspective of this interplay between experiential exercises and therapeutic relationships. Implications for CFT practice and clinical recommendations will be provided.

Exploring the Cross-cultural Applicability of a Brief Compassionate Mind Training: a Study Comparing Sri Lankan and UK People

Objectives

Compassionate Mind Training (CMT) is a therapeutic approach proven to be effective for reducing distress and increasing well-being in clinical and non-clinical populations. This study aimed to explore the efficacy of a short-term, online version of the CMT on compassion, distress, and well-being in a cross-cultural, non-clinical sample of Sri Lankan and UK people.

Method

A randomized controlled trial with pre-, post-measurements, and a 2-week follow-up was conducted using CMT (n = 21 Sri Lankan, n = 73 UK) and wait-list control (n = 17 Sri Lankan, n = 54 UK) groups. The intervention effects were investigated using a series of repeated-measures ANOVAs using intention-to-treat and per-protocol analyses.

Results

The 2-week CMT was effective in increasing all aspects of compassion in both Sri Lankan and UK people. In addition, some cross-cultural similarities and differences (in the factors affecting compassion) were present in the improvements following CMT between the two countries, which were maintained at a 2-week follow-up.

Conclusion

This study provides promising evidence for the efficacy and cross-cultural applicability of CMT for reducing distress and increasing well-being.

Benefits of group compassion-focused therapy for treatment-resistant depression: A pilot randomized controlled trial

Major depression is one of the most common mental health problems worldwide. More than one-third of patients suffer from treatment-resistant depression (TRD). In this study, we explored the feasibility of group compassion-focused therapy (CFT) for TRD using a randomized controlled trial with two parallel groups. Eighteen participants were randomly allocated to the intervention group (CFT and usual care) and control group (usual care alone) and a participant in each group withdrew. Participants in the intervention group received a 1.5-h session every week for 12 weeks. The effects of the intervention on the participants' scores were calculated using a linear mixed model. There was a larger reduction in their depressive symptoms and fears of compassion for self and a greater increase in their compassion for self compared to the control group participants. The reliable clinical indices showed that in the CFT (intervention) group, three of nine participants recovered (33%), two improved (22%), two recovered but non-reliably (22%), and the condition of two remained unchanged (22%). These findings indicate adequate feasibility of group CFT for TRD in Japanese clinical settings.

Clinical trial registration

[https://clinicaltrials.gov/], identifier [UMIN 000028698].

Early shaming experiences and psychological distress: The role of experiential avoidance and self-compassion

OBJECTIVES

Early shaming experiences have been suggested to be associated with later psychopathological symptoms. Understanding this relationship is complex, due to a number of psychological processes potentially influencing this. Therefore, the aim of the current study was to further explore the nature of the mediating effect of experiential avoidance in the association between early shame experiences and psychological distress, and whether self-compassion moderates this relationship by mitigating the effects of this.

DESIGN

A cross-sectional design was conducted using self-report measures of early shaming experiences, experiential avoidance, self-compassion, and psychological distress.

METHOD

An online study of 556 participants, comprised of participants from the general population and university students participated within this online study.

RESULTS

The moderated mediation model explained 51% of variance within depressive symptoms. Experiential avoidance was found to mediate the association between early shaming experiences and depressive symptoms. This mediating relationship was shown to be moderated by self-compassion, with higher levels of self-compassion being associated with lower levels of depressive symptoms across all levels of experiential avoidance levels (low, medium, and high).

CONCLUSION

These findings suggest that self-compassion may play a significant buffering role within attenuating the effects of experiential avoidance associated with depressive symptoms. Such findings present important clinical and theoretical implications in further understanding the protective role of self-compassion within early shaming experiences and the relationship between depressive symptoms.

PRACTITIONER POINTS

Early shaming experiences have been linked to later psychological distress. Experiential avoidance identified a core underlying psychological process in the relationship between early shaming experiences and psychological distress. Self-compassion offers a range of protective features that may alleviate the effects of experiential avoidance and depressive symptoms. Self-compassion-based interventions that target experiential avoidance may offer greater reductions within depressive symptoms.

Views and experiences of compassion in Sri Lankan students: An exploratory qualitative study

Practicing compassion has shown to reduce distress and increase emotional well-being in clinical and non-clinical populations. The existing research is primarily focused on Western populations although the concepts of compassion are heavily influenced by Asian Buddhist views. There is a dearth of compassion research conducted particularly in the Asian context. Therefore, this study aimed to explore the views and lived experiences of compassion in Sri Lankan students, to understand whether compassion is a socially embraced construct in Sri Lanka, considering that Sri Lanka is a Buddhist influenced society. Participants' views and lived experiences of compassion towards themselves and to/from others were also investigated, with a specific focus on their perceived inhibitors and facilitators of compassion. Aims were set to identify whether Western compassion-based practices could be successfully applied to Asian societies such as Sri Lanka. An Interpretative Phenomenological Analysis approach was used to obtain and analyse qualitative data from a convenience sample of 10 Sri Lankan students, recruited from a Psychology course. The phenomenological analysis of the semi-structured face-to-face interviews elicited three predominant themes: What compassion means to me, what I make of it, and compassion through facilitators and inhibitors. The findings suggested that participants shared a similar understanding of the concept of compassion as reflected in the Western definitions. Experiences and views of compassion were shaped by several factors including religion, culture, society, and upbringing. In general, this study revealed that participants were well aware of the concept of compassion as well as its impact on their psychological well-being. Despite this, inhibitors existed in experiencing compassion. The religious and collectivistic-cultural influences need to be further explored and taken into account when implementing Western compassion-based practices to non-Western contexts such as Sri Lanka.

Compassionate Mind Training: An 8-week group for the general public

OBJECTIVES

There is an increasing interest in how compassion training, and in particular, the cultivation of self-compassion may be an important component in the reduction of distress and promotion of well-being. Compassion Focused Therapy (CFT) has shown promising results in this area, with positive outcome studies in a wide range of mental health problems. However, following the successful development of short mindfulness-based programmes (e.g., Mindfulness-based Stress Reduction and Mindfulness-based Cognitive Therapy) and compassion/self-compassion programmes (e.g., Mindful Self-Compassion) that can be accessed by the general public, we were keen to develop and research an 8-week Compassionate Mind Training (CMT) course, based on the CFT model.

DESIGN

Within-subjects pre-to-post-group comparison.

METHODS

Following an 8-week CMT groups, participants in the general population (n = 55) completed pre- and post-measures (with 22 of these also providing 3-month follow-up data) on self-compassion, compassion for others, compassion from others, attachment, self-criticism, positive emotion, well-being, and distress.

RESULTS

Significant increases in compassion, self-reassurance, social rank, positive emotions, and well-being were found, alongside reductions in self-criticism, attachment anxiety, and distress. Changes were maintained at 3-month follow-up. Change scores indicated the importance of increases in self-compassion and reductions in self-criticism in overall improvements in well-being and psychological distress.

CONCLUSIONS

Findings offer preliminary support for the usefulness of group CMT in community samples.

PRACTITIONER POINTS

Compassionate Mind Training (CMT) groups appear to be applicable and beneficial in community samples. CMT psychoeducation and practices appear to bring positive changes to a variety of psychological processes, including attachment, self-criticism, self-compassion, well-being, and distress. Further studies are required to investigate whether the mechanisms through which CMT is beneficial.

The influence of self-criticism on depression symptoms among ambulatory patients with inflammatory bowel disease

Considering that self-criticism is an important process in the development and maintenance of depression, and taking into account the stigma associated with inflammatory bowel disease (IBD), the present study aimed to analyse whether self-criticism exacerbates the relationships of depression symptoms with IBD symptomatology and chronic illness-related shame. The sample included 53 ambulatory IBD patients (66% females) with ages from 18 to 65. Moderation analyses were conducted using structural equation modelling. Self-criticism exacerbated the associations of depression with IBD symptoms (b = 0.01; standard error [SE] = 0.00; Z = 3.73; P < .001) and illness shame (b = 0.02; SE = 0.01; Z = 2.40; P = .016). For the same level of IBD symptomatology or chronic illness-related shame, those individuals who present more feelings of inadequacy towards the self, experience more symptoms of depression. This exacerbation effect is stronger when IBD symptomatology and chronic illness-related shame are more intense. A high self-critical IBD patient may view the illness and/or symptomatology as a flaw or error that should be self-corrected. Physicians and other health professionals should be attentive to these pathological mechanisms and should attempt to alleviate them. It may be beneficial to refer high self-critical patients to psychological care.

Experienced stigma and its impacts in psychosis: The role of social rank and external shame

OBJECTIVES

Experienced stigma is detrimental to those who experience psychosis and can cause emotional distress and hinder recovery. This study aimed to explore the relationship between experienced stigma with emotional distress and recovery in people with psychosis. It explored the role of external shame and social rank as mediators in these relationships.

DESIGN

A cross-sectional design was implemented.

METHODS

Fifty-two service users were administered a battery of questionnaires examining experienced stigma, external shame, social rank, personal recovery, positive symptoms, depression, and anxiety. Correlation and multiple regression analysis were conducted on the data. Where appropriate, mediation analysis was employed to explore social rank and external shame as mediatory variables.

RESULTS

Experienced stigma was significantly related to shame (social rank and external shame), positive symptoms, emotional distress (depression and anxiety), and personal recovery. The impact of experienced stigma on depression was mediated by external shame. Social rank was a mediator between experienced stigma and personal recovery only.

CONCLUSION

People with psychosis who have experienced stigma are likely to experience emotional distress and be inhibited in their recovery. This was found to be partly mediated by external shame and low social rank. Clinical approaches to stigma need to target these as potential maintenance factors.

PRACTITIONER POINTS

Experienced stigma is significantly related to shame (social rank and external shame) emotional distress, and reduced personal recovery. External shame mediated the relationship between experienced stigma and depression in psychosis. Social rank mediated the relationship between experienced stigma and personal recovery. Clinical approaches to stigma should include the assessment of external shame and low social rank.

Does Compassion-Focused Therapy Training for Health Care Educators and Providers Increase Self-Compassion and Reduce Self-Persecution and Self-Criticism?

INTRODUCTION

There is a growing body of evidence within the health care community suggesting that developing feelings of compassion can profoundly affect physical and psychological health. This is an important area of work, and initial research with nonprofessional groups has found that practicing compassion through a variety of experiential practices and meditations can lead to higher levels of compassion for others, sensitivity to suffering, motivation to help, and altruism. This study examines outcome measures after a 3-day introductory workshop on compassion-focused therapy provided to health care providers and educators. The aim of the research is to explore whether the training would increase self-compassion and reduce self-criticism and self-persecution.

METHODS

A total of 28 participants who were classified into three groups "nurses and midwives," "counselors/psychotherapists," and "other health care providers" completed the Self-Compassion Scale and Functions of Self-Criticizing and Self-Attacking Scale before and after training.

RESULTS

Results reveal an overall statistically significant increase in self-compassion and statistically significant reduction in self-critical judgment after training. There was no statistically significant reduction in self-persecution or self-correction scores after training.

DISCUSSION

Developing self-compassion and compassionately responding to our own "self-critic" may lead the way forward in the development of more compassionate care among health care professionals. Training people in compassion-based exercises may bring changes in levels of self-compassion and self-critical judgment. The findings are exciting in that they suggest the potential benefits of training health care providers and educators in compassion-focused practices.

A compassionate-focused therapy group approach for acute inpatients: feasibility, initial pilot outcome data, and recommendations

OBJECTIVES

This study aimed to examine the feasibility of running and evaluating a compassion-focused therapy (CFT) group adapted for acute inpatient settings, characterized by unpredictable lengths of admission, presentations, and diagnoses.

DESIGN AND METHODS

This pilot project used a mixed methods design to assess the impact of offering CFT-informed group sessions on an acute inpatient unit. Pre- and post-session ratings of distress and calmness, and ratings of understanding and helpfulness, were gathered from participants over a 6-month period. Semi-structured interviews were conducted with four participants to gather their experience of the group.

RESULTS

Fifty-seven complete sets of rating measures were generated from 82 participants recruited for the study (attrition rate 30%), from a total pool of 93 inpatients attending group sessions. Pre- to post-CFT session data highlighted a significant decrease in distress ratings and a significant increase in calmness ratings. A thematic analysis of four interviews identified themes relating to understanding compassion, experience of positive affect, and the experience of common humanity.

CONCLUSIONS

This is the first attempt to explore the effects of a CFT-informed approach in acute mental health settings. These groups were well received by staff and patients, with some therapeutic impact despite being comparatively short and set against the background of a busy inpatient ward. These groups can be open and transdiagnostic, with stand-alone topics and practices having positive impacts on distress and calmness. Future studies need to focus on adapting content and pacing for this group of people based on ongoing feedback from participants.

Development of a striving to avoid inferiority scale

Social rank theory suggests that mood variation is linked to the security a person feels in his/her social domain and the extent to which they are sensitive to involuntary subordination (e.g. feeling defeated and feeling inferior). Previous studies looking at rank-related and competitive behaviour have often focused on striving for dominance, whereas social rank theory has focused on striving to avoid inferiority. This study set out to develop a measure of 'Striving to Avoid Inferiority' (SAIS) and assess its relationship to other rank and mood-related variables. We hypothesized two factors: one we called insecure striving, relating to fear of rejection/criticism for 'not keeping up', and the second we called secure non-striving, relating to feeling socially acceptable and valued regardless of whether one succeeds or not. This scale was given to 207 undergraduates. The SAIS had good psychometric properties, with the two factors of insecure striving and secure non-striving strongly supported by exploratory factor analysis. Both factors were significantly (though contrastingly) related to various fears of rejection, need for validation, hypercompetitive attitudes, feeling inferior to others, submissive behaviour and indicators of stress, anxiety and depression. Striving to avoid inferiority was a significant predictor of psychopathologies, especially where individuals perceived themselves to have low social rank.

Self-harm in a mixed clinical population: the roles of self-criticism, shame, and social rank

OBJECTIVES

This study explored the relationship of forms and functions of self-criticism, shame, and social rank variables to self-harm, depression, and anxiety.

DESIGN

The study used a questionnaire design.

METHOD

In-patients and day-patients (N=73) completed a series of questionnaires measuring self-harm, mood, self-criticism, shame, and social comparison.

RESULTS

Self-harm was significantly associated with forms and functions of self-criticism, shame, and feelings of inferiority (low social rank). The self-persecuting function of self-criticism was especially linked to self-harm, depression, and anxiety.

CONCLUSIONS

This study adds to a growing literature on the importance of recognizing the pathogenic effects of negative self-critical thoughts and feelings about the self and the value of distinguishing different types of self-criticism.

Parental recall, attachment relating and self-attacking/self-reassurance: their relationship with depression

OBJECTIVES

When things go wrong for people they can become self-critical or focus on positive, reassuring aspects of the self. This study explored the relationship between forms of self-criticism and self-reassurance, recall of parental experiences and attachment style in relation to depressed symptoms in students.

METHODS

A sample of 197 undergraduate students from the UK and Canada completed self-report questionnaires measuring recall of parental styles, attachment, forms of self-criticism, self-reassurance, and depression symptoms.

RESULTS

Recall of parents as rejecting and overprotecting was significantly related to both inadequacy and self-hating self-criticism. In contrast, parental warmth was negatively correlated with these forms of self-criticism. In addition, when things go wrong for the person, recall of parental warmth was associated with the ability to be self-reassuring. A mediator analysis suggested that (I) the impact of recall of negative parenting on depression is mediated through the forms of self-criticism and (2) the effect of parental warmth on depression was mediated by the ability to be self-reassuring.

CONCLUSIONS

The impacts of negative parenting styles may translate into vulnerabilities to depression via the way children (and later adults) develop their self-to-self relating (e.g. as self-critical versus self-reassuring). Hence, there is a need for further research on the link between attachment experiences, recall of parental rejection/warmth and their relationship to internal, self-evaluative and affect systems in creating vulnerabilities to psychopathology.

Self-Criticism and Self-Warmth: An Imagery Study Exploring Their Relation to Depression

When things go wrong for people, those who are self-critical, compared to those who self-reassure, are at increased risk of psychopathology. However, little is known of the internal processes involved in self-criticism and self-reassurance, such as the ease of eliciting critical imagery, and the power, emotion and vividness of self-criticalness and self-reassurance. This study used a self-imagery task to investigate trait self-criticism and trait self-reassurance in relation to the ease and clarity of generating self-critical and self-reassuring images, and the felt power and emotion of self-critical and self-reassuring imagery. We also explored these in relation to depressive symptoms in students. Results suggested that trait self-criticism is associated with ease and clarity in generating hostile and powerful self-critical images, while trait self-reassurance is associated with ease and clarity of generating warm and supportive images of the self. Data analysis using structural equation models also suggests that difficulties in generating self-reassurance and compassionate images about the self with self-directed warmth, may also contribute to depressive symptoms. Thus self-critics may not only suffer for elevated negative feelings about the self but may also struggle to be able to generate self-supportive images and feelings for the self, and these difficulties could be a focus of therapeutic interventions.

Interpersonal sensitivities: their links to mood, anger and gender

This paper explores two interpersonal sensitivities (to rejection and to social put-down) in a group of 54 depressed men and 50 depressed women. Measures of anhedonia, anxiety, anger, social comparison, and submissive behaviour were also obtained. We found no differences in rejection sensitivity, anger, anhedonia, or anxiety between the sample of depressed men and women. Depressed women rated themselves as more submissive and more inferior than depressed men, and blamed themselves more for being criticized and put-down by other people. Principal components analysis (PCA) revealed three underlying factors: mood (including anxiety and depression), internalization (related to self-blame and feelings of low rank), and externalization (related to anger and blaming others for criticism). For both men and women internalization was significantly correlated with depression. However, externalization was negatively related to depression in women, but positively related to depression in men.

The relation of entrapment, shame and guilt to depression, in carers of people with dementia

There is increasing research exploring depression in carers of people with dementia. This study explored the relation of entrapment, shame and guilt to depression in a group of 70 carers of those with dementia. As in other studies the experience of entrapment in the role was highly related to depression. Moreover, experiences of shame relating to self-criticism, other people's expectations and the fear of their criticism were significantly related to depression, entrapment and guilt. Guilt however, as focused on the fears of harming others, letting others down and sense of responsibility, was not associated with depression or entrapment. Depression in carers may relate in part to feeling trapped in a role but also being vulnerable to criticism and feelings of inadequacy in that role. In this study, degree of behavioural disturbance/dependence was not found to be significantly associated with any of the research variables.

Evolved mechanisms in adolescent anxiety and depression symptoms: the role of the attachment and social rank systems

One hundred and forty adolescent students were assessed on measures of attachment, social rank (social comparison and submissive behaviour), and depression and anxiety symptoms. Secure attachment was significantly correlated with positive social comparison and inversely with submissive behaviour, depression and anxiety symptoms. In contrast, insecure attachment of both avoidance and ambivalence was associated with unfavourable comparison with others, and positively correlated with submissive behaviour, depression and anxiety symptoms. Exploring the relationship of attachment with depression and anxiety symptoms revealed that this link might have different routes through social rank perceptions. For secure attachment, social rank concerns (i.e. social comparison and submissive behaviour) did not mediate the linkage with anxiety or depression symptoms. However, for insecure attachment, social rank concerns showed either a partial or complete mediation of these relationships. This data may indicate that insecure attachment sensitizes individuals to become focused on the competitive dynamics of groups, the power of others to shame, hurt or reject, and the need to defend against these possibilities.

Criticizing and reassuring oneself: An exploration of forms, styles and reasons in female students

OBJECTIVES

Self-critical people, compared with those who self-reassure, are at increased risk of psychopathology. However, there has been little work on the different forms and functions of these self-experiences. This study developed two self-report scales to measure forms and functions of self-criticism and self-reassurance and explore their relationship to depression.

METHODS

A self-report scale measuring forms of self-criticism and self-reassuring, and a scale measuring possible functions of self-criticism, together with a measure of depression and another self-criticism scale (LOSC), were given to 246 female students.

RESULTS

Self-criticizing vs. self-reassuring separated into two components. Forms of self-criticizing separated into two components related to: being self-critical, dwelling on mistakes and sense of inadequacy; and a second component of wanting to hurt the self and feeling self-disgust/hate. The reasons/functions for self-criticism separated into two components. One was related to desires to try to self-improve (called self-improving/correction), and the other to take revenge on, harm or hurt the self for failures (called self-harming/persecuting). Mediation analysis suggested that wanting to harm the self may be particularly pathogenic and is positively mediated by the effects of hating the self and negatively mediated by being able to self-reassure and focus on one's positives.

CONCLUSIONS

Self-criticism is not a single process but has different forms, functions, and underpinning emotions. This indicates a need for more detailed research into the variations of self-criticism and the mechanisms for developing self-reassurance.

A pilot exploration of the use of compassionate images in a group of self‐critical people

Self-criticism has long been associated with a variety of psychological problems and is often a key focus for intervention in psychotherapy. Recent work has suggested that self-critics have underelaborated and underdeveloped capacities for compassionate self-soothing and warmth. This pilot study developed a diary for monitoring self-attacking and self-soothing thoughts and images. It also explored the personal experiences of a group of volunteer self-critics from the local depression support group who were given training in self-soothing and self-compassion. Although using small numbers, this study suggests the potential value of developing more complex methodologies for studying the capacity for self-compassion, interventions to increase self-compassion (including imagery techniques), and their effects on mental health.

Life events, entrapments and arrested anger in depression

OBJECTIVES

A recent, evolution derived theory of depression has suggested that aroused but arrested defences of fight (arrested anger) and flight (entrapments) may be important components of depression. This study therefore set out to explore unexpressed anger and entrapment in depression. The focus was on the nature of severe life events and difficulties, the time course of arrested defences, fantasies of escaping, fantasies of expressing anger, and reasons for not acting on emotions/behaviours.

METHODS

Fifty diagnosed depressed people, being treated for depression, were interviewed using the Life Event and Difficulties Schedule (LEDS). They then completed five further questionnaires: the escape inhibition questionnaire; the reasons for not escaping questionnaire; the anger inhibition questionnaire; the reasons for not expressing anger questionnaire, and the Beck Depression Inventory.

RESULTS

In regard to arrested flight, 88% of the group acknowledged strong desires to escape difficulties in their life but many felt unable to. Transcript analysis from the LEDS also indicated strong themes of entrapment. 38.7% felt trapped before becoming depressed. Fantasies of escaping were common, but making actual plans to get away less common. A variety of reasons were given for not escaping: In regard to arrested anger, 82% felt they suppressed their anger and 56% felt this problem predated their depression. A number of different reasons were given for not expressing anger. Despite self-blame often being seen as important to depression, we found that for many severe life events and difficulties patients did not blame themselves. Rather they blamed external circumstances or other people and saw these as the source of their entrapment.

CONCLUSIONS

Disturbances in fight/flight mechanisms are common in depression. For some these may predate a depression and may play a causal role, whilst for others these experiences emerge with the depression. Depression is related to chronic stress states and clinical attention to disturbances in flight/flight may throw light on these states and offer novel approaches to intervention.