The mediating role of self-compassion in the relationship between internalized stigma and psychological resilience in bipolar disorder

INTRODUCTION

Internalized stigma is known to be high in bipolar disorder (BD). Concepts such as self-compassion and psychological resilience have recently begun to be studied as protective factors for BD. The aim of the current study was to examine the relationships between internalized stigma, self-compassion and resilience among individuals with BD.

METHOD

One hundred and thirty-two male and female (18-65 years of age) participants with a DSM 5 diagnosis of BD (BD- I & BD- II) were included. The remission criteria (YMRS< 5 and HDRS< 7) was evaluated using clinician-administered measures and all participants were found to be remitted. Correlation and mediation analyses were performed. Participants completed the Internalized Stigma in Mental Illness Scale (ISMI), the Self-Compassion Scale (SCS) and the Resilience Scale for Adults (RSA).

RESULTS

Significant correlations were found between internalized stigma, sub-dimensions of self-compassion (self-kindness, self-judgement, common humanity, isolation, mindfulness, and over-identification), and resilience in the expected directions like negative correlations between internalized stigma and positive dimensions of self-compassion (self-kindness, common humanity and mindfulness). Self-judgement and self-kindness mediated the relationship between internalized stigma and psychological resilience.

CONCLUSIONS

The findings of the study shed light on which dimensions of self-compassion might be more beneficial to work with in order to increase resilience when working with internalized stigma in BD. This strengths-based investigation would be valuable to enrich psycho-social interventions for the prevention of relapse in BD.

(No) Effects of a Self-Kindness Intervention on Self-Esteem and Visual Self-Perception: An Eye-Tracking Investigation on the Time-Course of Self-Face Viewing

Previous research has suggested a favorable impact of self-kindness on subjective well-being. The present experiment investigated the effects of an app-assisted self-kindness intervention for increasing self-esteem and self-face gaze, and for decreasing depression. We explored self-face processing via a time-course analysis of eye-tracking data. Eighty participants (56 female, 24 male; mean age: 23.2 years) were randomly allocated to one of two intervention groups, each receiving daily instructions to enhance either self-kindness or relaxation (active control). Following a one-week intervention period, both groups reported improved self-esteem (p = .035, ηpart2 = .068) and reduced depression (p < .001, ηpart2 = .17). The duration of self-face gaze increased in both groups (p < .001, ηpart2 = .21). Self-face processing was characterized by an early automatic attention bias toward the self-face, with a subsequent reduction in self-face bias, followed in turn by an attentional self-face reapproach, and then a stable self-face bias. We thus identified a complex temporal pattern of self-face inspection, which was not specifically altered by the intervention. This research sheds light on the potential for app-assisted interventions to positively impact psychological well-being, while also highlighting the complexity of self-face processing dynamics in this context. In the future, we propose the inclusion of personalized self-kindness statements, which may amplify the benefits of these interventions.

Validation and Psychometric Properties of the Italian Version of the Unconditional Self-Kindness Scale (USKS)

Western psychology and social sciences have long emphasized the value of a positive attitude toward oneself. Previous research had developed psychometric tools assessing self-compassion, defined as being open to and moved by one's own suffering. However, self-compassion did not describe whether people actually applied such protective factors when acutely faced with threats. The Unconditional Self-Kindness Scale (USKS) was developed as a tool to measure the behavioral response of self-kindness during an acute presence of threat to the self and not just as a general attitude when threat is absent. Since it can be experienced even in the most challenging situations and may promote resilience, this kindness may be defined as unconditional. We validated the Italian version of the USKS and found that the scale retained a one-factor structure. The USKS showed sound psychometric properties and good convergent validity since it was found to show very strong correlations with the Self-Compassion Scale-Short-Form and the Reassure Self subscale of the Forms of Self-criticizing/Attacking and Self-Reassuring Scale (FSCRS). In addition, the USKS showed good discriminant validity since it was found to show a negative moderate correlation and a negative strong correlation with the HS subscale and with the IS subscale of the FSCRS, respectively. Finally, the USKS showed good test-retest reliability and its use is encouraged in clinical and research settings in which the assessment of a positive attitude toward oneself during an acute presence of threat to the self is of interest.

Warm and Harsh Parenting, Self-Kindness and Self-Judgment, and Well-Being: An Examination of Developmental Differences in a Large Sample of Adolescents

Objectives: This study aimed to examine the associations between warm and harsh parenting and adolescent well-being, and the mediating effects of self-kindness and self-judgment, in relationships. Moreover, this study investigated developmental differences across three adolescence stages (early, middle, and late). Methods: In total, 14,776 Chinese adolescents (mean age = 13.53 ± 2.08, 52.3% males), including individuals in early (10-12 years old, N = 5055), middle (13-15 years old, N = 6714), and late adolescence (16-18 years old, N = 3007) participated in this study. All the adolescents rated their levels of warm and harsh parenting, self-kindness and self-judgment, and well-being. Structural equation modeling (SEM) was adopted to examine the mediation model. Multi-group analysis was conducted to investigate differences in the mediation model across the different developmental stages. Results: Both warm and harsh parenting were related to adolescent well-being through the mediating effects of self-kindness and self-judgment. However, warm parenting exerted a more substantial impact on adolescent well-being. Self-kindness had a more robust mediating effect than self-judgment in relationships. Moreover, harsh parenting had a weaker impact on adolescent well-being in late adolescence than in early and middle adolescence. Warm parenting had a more significant impact on adolescent well-being in early adolescence than in middle and late adolescence. Conclusions: Overall, warm parenting had a more substantial effect than harsh parenting on adolescent well-being. The findings also highlighted the crucial mediating effect of self-kindness in the relationships between parenting and well-being. Moreover, this study also indicated the importance of warm parenting in early adolescence. Intervention programs should focus on enhancing the level of warm parenting to promote self-kindness in adolescents, in order to improve their well-being.

Compassion focused therapy for pain management: '3 systems approach' to understanding why striving and self-criticism are key psychological barriers to regulating activity and improving self-care for people living with persistent pain

Background

This paper describes the development of an eight-week Compassion Focused Therapy for Pain Management (CFT-PM) group. This group was specifically designed for 'strivers' a sub-group of people with persistent pain who tend to engage in over-activity and resist making reasonable adjustments to their activity levels to accommodate their persistent pain. 'Strivers' tend to cope by ignoring their pain and pushing on through, in the shorter term leading to 'boom and bust' activity-related exacerbations of their pain. They also risk the development of additional persistent fatigue and burnout in the longer term.

Method

117 people completed the CFT-PM group; The group was delivered in person (n = 84) but in online format from July 2020 (n = 33). 162 people started the CFT-PM group but 45 dropped-out (27.43%).

Results

There was a significant effect for time across all measures: significant improvement was found for depression, self-compassion, pain-related disability, pain-related anxiety and pain self-efficacy. Pain numeric rating scores were approaching significance. There was a significant main effect of diagnosis; post-hoc t-test analysis found significant improvement for all diagnoses on all measures with the exception of spinal. There was also a significant interaction between time and format: post-hoc t-test analysis found greater improvement for virtual format on self-compassion and pain-related anxiety.

Discussion

Findings suggests that CFT-PM may be a clinically effective group intervention with virtual format showing superior improvement. This approach might be less suitable for certain diagnoses; the spinal group may benefit more from traditional CBT-based PMPs. Limitations include the lack of random selection or allocation to treatment group. Future studies should adopt an experimental design to be able to draw firm conclusions regarding causation and efficacy. Despite these limitations, present findings suggest that CFT-PM may be an effective group intervention worthy of further investigation and clinical application.

Self-compassion and sleep quality: Examining the mediating role of taking a proactive health focus and cognitive emotional regulation strategies

Sleep quality (SQ) impacts health yet many university students get poor sleep. Self-compassion (SC)—care for oneself during challenging times—is associated with SQ yet how SC has these effects is unclear. This study cross-sectionally examined whether SC is negatively related to poor SQ and whether proactive health focus and cognitive emotional regulation strategies (CERS) mediate this relationship. University students (N = 193) self-reported SC, proactive health focus, CERS, and SQ. SC negatively associated with poor SQ (r = −0.34) and self-blame mediated this (b = 0.08, 95% CI [0.01, 0.16]). SC may improve SQ through reducing self-blame.

Influence of Self-Compassion on the Health of Midwives and Nurses: Protocol for a Scoping Review

BACKGROUND

Self-compassion is recognized to have a positive effect upon a person's health. However, the influence of self-compassion on the health of midwives and nurses is less well understood. Midwives and nurses often work in highly demanding environments and situations, and are exposed to multiple work-based stressors simultaneously. Stressors such as a demanding clinical workload, high acuity, missing breaks, working more than their contracted hours, insufficient resources and staff, and poor patient outcomes can lead to midwives and nurses feeling physically exhausted and at increased risk of poor mental health. Self-compassion may act as a protective factor, assisting midwives and nurses to remain healthy.

OBJECTIVE

This scoping review will provide an overview of the evidence base relating to the influence of self-compassion on the health of midwives and nurses.

METHODS

The purpose of a scoping review is to comprehensively and systematically review the literature and identify key evidence or gaps. The search strategy for this protocol includes electronic databases such as Medline, Embase, Emcare, PsycInfo, Joanna Briggs Institute, Cochrane Library, and Scopus. Grey literature sources will be also searched, including ProQuest Central, internet search engines (Google Scholar), and manually searched key journals and reference lists of relevant articles. This scoping review will be undertaken in seven stages, guided by established scoping review methods and reporting guidelines: (1) identifying the research questions; (2) identifying relevant studies; (3) selecting the studies; (4) charting the data; (5) collating, summarizing, and reporting the results; (6) consulting; and (7) dissemination of knowledge. Data will be abstracted and presented using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist and explanation by three independent researchers.

RESULTS

A preliminary search conducted in Medline (OVID) retrieved 194 results. Completion of the review is expected in December 2020 and will be published in early 2021.

CONCLUSIONS

To our knowledge, this will be the first scoping review of evidence-based literature relating to the influence of self-compassion on the health of midwives and nurses. It is anticipated that this analysis of the literature will contribute to understanding how midwives and nurses may use self-compassion in a proactive way to reduce work-based stressors such as burnout, stress, and compassion fatigue. Furthermore, the findings may inform educational needs with implications for clinical practice.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/21917.

The effects of self-compassion components on shame-proneness in individuals with depression: An exploratory study

To date, there is no evidence regarding how self-compassion's components, self-kindness, common humanity and mindfulness could work as distinct interventions. Thus, the main objective of the present study was exploring the effects that the three separate components of self-compassion would have on shame-proneness levels in individuals with clinical depression. All the participants (n = 122) with a diagnostic of Major Depressive Disorder were randomized in four experimental groups: the self-kindness exercises group, the mindfulness exercises group, the common humanity one and the control group. Results indicated that levels of depression and shame-proneness, as measured by BDI-II, TOSCA-3 and ESS decreased from baseline to post-intervention, but no significant differences were observed between groups. Therefore, we cannot conclude that one self-compassion component is more efficient than the others, but the present study does offer, though, a strong starting point for more complex, future studies.

The relationship between childhood adversities and complex posttraumatic stress symptoms: a multiple mediation model

Background: There is a growing research literature on complex posttraumatic stress disorder (CPTSD), yet studies that focused on Chinese populations are still limited. Accumulating evidence showed that adverse childhood experiences (ACEs) are associated with a higher likelihood of CPTSD symptoms, but potential mediating roles of self-kindness and self-judgement on the ACEs-CPTSD relationship remain understudied. Objective: The purpose of this study was to first examine the relationship between ACEs and CPTSD among Chinese college students, and then to test the mediating role of self-kindness and self-judgement on the ACEs-CPTSD relationship. Method: The study included 1361 college students for an online survey in May 2020. Demographic variables (e.g. age, gender, having sibling[s] or not, residence, family structure, and subjective socioeconomic status), ACEs, self-compassion (self-kindness and self-judgement subscales), and CPTSD symptoms were assessed. After controlling for demographic variables, a series of structural equation models tested the mediation hypothesis: indirect effects of self-kindness and self-judgement on the relationship between ACEs and CPTSD symptom. Results: ACEs of College students were positively associated with more severe CPTSD symptoms (posttraumatic stress disorder and disturbances in self-organization symptoms). Furthermore, these direct pathways were mediated by decreased self-kindness and increased self-judgement. Conclusions: Findings have substantial theoretical and treatment implications, including the two critical targets (i.e. lowering self-judgement and raising self-kindness) when treating complex PTSD.

Meaning in Life Following Intimate Partner Psychological Aggression: The Roles of Self-Kindness, Positive Reframing, and Growth

Psychological aggression is experienced by a large proportion of people in intimate relationships, and the negative impact of this experience has the potential to weaken one's sense of meaning in life. This study aimed to understand a mechanism through which the experience of psychological aggression in a past intimate relationship relates to less meaning in life. By applying self-compassion and meaning-making theory, we proposed that the experience of psychological aggression decreases one's ability to be kind toward oneself in times of suffering (i.e., self-kindness), which decreases positive reframing of the experience, which sequentially decreases growth from the experience, which in turn decreases meaning in life. Participants were 253 people who experienced psychological aggression in a past intimate relationship. Participants completed measures of psychological aggression, self-kindness, positive reframing, growth, and meaning in life. Results found that psychological aggression experienced in a past intimate relationship related to less meaning in life and that the serial mediation model proposed was supported. As such, the results indicate that greater psychological aggression experienced relates to less self-kindness, which in turn relates to less positive reframing, which is sequentially associated with less growth, which is associated with less meaning in life. The findings indicate the need for counseling and psychotherapies to bolster self-kindness in people who have experienced psychological aggression in a past intimate relationship. This is because levels of self-kindness might be depleted after experiencing psychological aggression and because self-kindness appears to support adaptive meaning-making processes.

A Qualitative Exploration of Self-Kindness and "Treating Oneself" in Contexts of Eating, Weight Regulation and Other Health Behaviors: Implications for Mindfulness-Based Eating Programs

Background: Caring for oneself through mindfulness and compassion to improve or enhance health behaviors, and specifically eating behaviors has come to the forefront of scientific inquiry. The experiences and challenges for people in decision making around food within the context of self-kindness for body and mind care have not been previously explored.

Aims: This study explored the experiences of eating behaviors in a community sample and examined the understanding of self-kindness and its relationship to eating behaviors and wellbeing of body and mind.

Methods: A phenomenological theoretical position was taken; data were collected using individual semi-structured interviews. The sample was twenty-five members of the wider community in the West Midlands in England. The data were analyzed using Braun and Clarke’s (2006) procedural steps for thematic analysis.

Results: Two overarching themes were inductively formulated: ‘Thinking about eating’ and ‘Caring for body and mind’. Five themes were constructed: (a) Treat food is exceptional eating, (b) The proof of the pudding is in the planning, (c) Dieting is a dirty word, which are subsumed under Thinking about eating, and (d) Self-kindness is a disavowed abstract noun, and (e) Self-kindness: A rose by any other name; under Caring for body and mind. Participants described a number of ways of treating themselves both with food and with other activities and pleasure in eating was discussed in terms of social aspects of eating rather than food. Two clear contradictions within narratives around eating and health behaviors were shown. Participants largely eschewed the concept of dieting, but described engaging in highly regulated and restrained eating. There was a lack of connection with the notion of self-kindness; although positive eating and exercise health behaviors were undertaken, they were described as necessary self-regulation, not construed as acts of self-kindness.

Conclusion: The results suggests a lack of ease in the interpretation of being kind to oneself as a means of improving mental wellbeing, and an inability to relate self-kindness to physical health behaviors. The association of self-kindness with self-indulgence, and the described disconnect between hunger, satiety and pleasure in eating has implications for interpretation of mindful eating scales, practices and interventions.

Improvements in emotion regulation following mindfulness meditation: Effects on depressive symptoms and perceived stress in younger breast cancer survivors

OBJECTIVE

Mindfulness meditation reduces psychological distress among individuals with cancer. However, mechanisms for intervention effects have not been fully determined. This study tested emotion regulation strategies as mediators of intervention effects in a sample of younger women treated for breast cancer, a group at risk for psychological distress. We focused on two distinct strategies targeted by the intervention-rumination and self-kindness-and further examined the broader construct of mindfulness as a potential mediator.

METHOD

Women (n = 71) with Stage 0-III breast cancer diagnosed at or before age 50 who had completed cancer treatment were randomly assigned to a 6-week mindfulness intervention or wait-list control group. Assessments occurred at study entry, postintervention, and a 3-month follow-up.

RESULTS

In single mediator analyses, increases in self-kindness (CIB [-7.83, -1.93]), decreases in rumination (CIB [-5.05, -.31]), and increases in mindfulness (CIB [-6.58, -.82]) each mediated reductions in depressive symptoms from pre- to postintervention. Increases in self-kindness also mediated reductions in perceived stress (CIB [-5.37, -.62]) from pre- to postintervention, and increases in self-kindness (CIB [-5.67, -.22]) and in mindfulness (CIB [-5.51, -.16]) each mediated intervention effects on perceived stress from preintervention to 3-month follow-up. In multiple mediator analysis, only self-kindness mediated intervention effects on depressive symptoms from pre- to postintervention (CIB [-6.41, -.61]), and self-kindness and mindfulness together mediated intervention effects on perceived stress from preintervention to follow-up (CIB [-6.77, -.35]).

CONCLUSIONS

Self-kindness played a consistent role in reducing distress in younger women with breast cancer. The efficacy of this understudied emotion regulation strategy should be evaluated in other clinical populations. (PsycINFO Database Record

Conversation analysis of the two-chair self-soothing task in emotion-focused therapy

OBJECTIVE

Despite an increasing recognition of the relevance and significance of self-compassion processes, little research has explored interventions that seek to enhance these in therapy. In this study, we examined the compassionate self-soothing task of emotion-focused therapy involving two-chair work, with seven clients.

METHOD

Conversation analysis was used to examine client-therapst interaction.

RESULTS

The analysis yielded a detailed description of interactional practices and processes involved in the accomplishment of self-soothing, drawing on Goffman's concept of the participation frame. We show how therapists and clients collaborate to move from the ordinary frame of therapeutic conversation to a self-soothing frame and back again by using various interactional practices: Therapists' instructions to clients, specific ways of sequencing actions in interaction, explanations and justification of the importance of the self-soothing task, pronouns as a way to distinguish among addressees (e.g., clients versus soothing agents), corrections of clients' talk, and response tokens (hm mm, yeah, good). These practices are used to help clients accomplish self-soothing in the form of self-praise, disclosing caring, and offering of helpful advice.

CONCLUSIONS

This study offers therapists a specific account of how to respond to clients at specific junctures in self-soothing dialogues and how to structure and accomplish the self-soothing task.