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RUNNING HEAD: Self-compassion and Coping
Please cite as:
Sirois, F. M., Molnar, D. S., & Hirsch, J. K. (in press). Self-compassion, stress and coping in the
context of chronic Illness. Self and Identity.
Self-compassion, Stress, and Coping in the Context of Chronic Illness
Fuschia M. Sirois, BSc, PhD
1,2
Danielle S. Molnar, Ph.D.
3
Jameson K. Hirsch, PhD
4
1
Health and Well-being Laboratory, Department of Psychology, Bishop’s University, 2600
College St., Sherbrooke, Quebec, Canada
2
Centre de recherche sur le vieillissement, Sherbrooke, Quebec, Canada
3
Department of Psychology, Brock University, St. Catharines, Ontario, Canada
4
Laboratory of Rural Psychological and Physical Health, Department of Psychology, East
Tennessee State University, USA
Correspondence concerning this article should be addressed to Fuschia M. Sirois, PhD,
Department of Psychology, Bishop’s University, 2600 College St., Sherbrooke, Quebec, Canada
J1M 1Z7, Email: fsirois@ubishops.ca
Preparation of this manuscript was supported by a Canada Research Chair awarded to the
first author.
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Abstract
A recent review suggested that self-compassion promotes use of adaptive rather than
maladaptive coping. Less is known about how self-compassion is linked to stress and coping in
the context of a chronic stressor. Across two primarily female chronic illness samples,
inflammatory bowel disease (N = 155) and arthritis (N = 164), a model linking self-compassion
to lower stress through coping styles and coping efficacy was tested. Path analyses revealed
significant indirect effects for adaptive coping styles (active, positive reframing, and acceptance),
and negatively for maladaptive coping styles (behavioral disengagement and self-blame) in both
samples. Findings suggest that the relative balance of adaptive and maladaptive coping strategies
used by self-compassionate people is associated with better coping outcomes in the context of
chronic illness.
Key words: self-compassion; coping; stress; coping efficacy; chronic illness
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Introduction
Whether considered a momentary mindset or an enduring tendency, self-compassion is
increasingly being recognized as an important quality for reducing stress. Self-compassion has
been defined as a positive self-view that involves relating to oneself with kindness and
acceptance in times of failure and difficulty (Neff, 2003b). A growing body of research has
documented that self-compassion is linked to lower levels of perceived stress (Neely, Schallert,
Mohammed, Roberts, & Chen, 2009; Sirois, 2014), and increased resilience in the face of
stressful situations (Neff, Kirkpatrick, & Rude, 2007), including chronic illness (Brion, Leary, &
Drabkin, 2014). In a recent theoretical review, Allen and Leary (2010) posited that self-
compassionate people may experience lower stress because of their use of effective coping
strategies, but found limited and mixed support for the hypothesis that people high in self-
compassion prefer and use more adaptive, problem-focused coping styles and less maladaptive
coping styles. Yet, there is little research on self-compassion, stress and coping in the context of
an ongoing chronic stressor such as chronic disease. Thus, it is unknown if the coping styles
identified by Allen and Leary (2010) relate to self-compassion in this context. Understanding the
potential of self-compassion for adaptive coping and therefore reducing stress in individuals with
chronic disease, and especially chronic inflammatory disease, is an important goal in light of
recent evidence highlighting the role of stress in the progression and exacerbation of
inflammatory conditions (Cohen et al., 2012). In this study we aimed to address these issues and
gaps in the research by testing the relations among self-compassion, adaptive and maladaptive
coping styles, coping efficacy, and stress across two chronic illness groups.
Self-compassion, Coping and Stress
Self-compassion, as conceptualized by Neff (2003b), is comprised of three key features
Self-compassion and Coping 3
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that may account for why self-compassionate people are able to successfully cope with stressful
life circumstances. Self-kindness refers to a capacity to treat oneself with kindness and
compassion rather than criticism or harsh self-judgment during challenging circumstances.
Common humanity involves recognizing that painful and difficult experiences are part of the
human condition rather than feeling isolated in one’s suffering. Mindfulness involves taking a
balanced perspective of one’s emotions, particularly negative emotional states, rather than
becoming over-identified and embroiled within these negative states (e.g., sadness, guilt, anger).
Together, these three qualities are proposed to reduce stress by helping individuals self-regulate
the negative emotions that can arise from unexpected and/or uncontrollable events (Neff et al.,
2007). In such instances, blaming events on one’s own actions or failings can cyclically
contribute to additional stress and impede healthy adjustment (Sirois, Davis, & Morgan, 2006).
Thus, self-compassion may ameliorate stress by reducing coping that fosters negative emotional
responses to stressors, and by promoting coping via adaptive behavioral or appraisal-based
responses to stressors.
This view is consistent with appraisal-based models of coping and stress which
emphasize the transactional nature of stress. Lazarus and Folkman’s (1984) cognitive transaction
model of stress highlights the central role of the individuals’ cognitive and behavioral responses
in exacerbating or attenuating the stress response. Adaptive coping responses are those which
successfully remove or reduce the stressor by cognitively changing its appraisal, or by making
direct behavioral changes (Lazarus & Folkman, 1984). Thus, self-compassionate people may
appraise stressors in a way that frames them as less negative and threatening, allowing them to
engage in effective behavioral responses to reduce the stressor because their self-regulatory
resources are not monopolized by the negative self-evaluations and mood that often arise in
Self-compassion and Coping 4
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response to a stressful event (Sirois, Kitner, & Hirsch, in press; Terry & Leary, 2011).
Allen and Leary's (2010) review of the evidence linking self-compassion to coping
support this view. Using Skinner et al's (2003) taxonomy of coping as a conceptual lens they
examined whether self-compassionate people were more likely to use adaptive coping strategies
and less likely to use maladaptive coping strategies. Specific adaptive coping strategies
reviewed were positive cognitive restructuring (e.g., reframing stressful events in a positive
light), problem-solving (e.g., planning and taking active steps to deal with a stressor), support-
seeking (e.g., turning to others for support), distraction (e.g., reading or engaging in other
distracting activities), whereas escape-avoidance coping strategies (e.g., cognitively or
behaviorally disengaging from the stressor) were the less adaptive coping strategies reviewed.
Overall, self-compassionate people were more likely to use positive cognitive restructuring, and
less likely to use escape-avoidance coping strategies. Evidence for links to problem-solving was
mixed. Some studies found links between self-compassion and active coping, planning and
seeking instrumental support, and others did not; further, there was little evidence for links with
seeking emotional support and distraction coping (Allen & Leary, 2010). They concluded that
more research was needed to better understand how self-compassionate people handle stressors.
Self-compassion and Coping with Chronic Illness
An important consideration missing from this preliminary theory and research on self-
compassion and coping is whether these associations are relevant for dealing with chronic daily
stressors, such as a chronic and functionally limiting illness. There is mounting evidence that
ineffective management of stress in this context can negatively impact psychological and
physical well-being (Evers et al., 2013; Maunder & Levenstein, 2008). This may be especially
true for chronic inflammatory health conditions such as arthritis and inflammatory bowel disease
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(IBD) as stress can exacerbate inflammatory processes (Cohen et al., 2012).
The coping styles linked to self-compassion, as suggested by Allen and Leary (2010),
may differentially impact the stress perceived by individuals with IBD and arthritis. Among
patients with IBD, problem-focused and active coping strategies such as planning and
instrumental support seeking are associated with better psychological outcomes (Graff et al.,
2009; McCombie, Mulder, & Gearry, 2013), whereas use of passive coping strategies are linked
to worse outcomes (Jones, Wessinger, & Crowell, 2006). In patients with arthritis approach
coping is linked to better psychological outcomes such as life satisfaction and lower
psychological distress and depression (Treharne, Lyons, Booth, & Kitas, 2007; Vriezekolk, van
Lankveld, Geenen, & van den Ende, 2011). In contrast, escape-avoidance coping is associated
with poor outcomes including psychiatric distress (Jones et al., 2006), helplessness and less
illness acceptance (Voth & Sirois, 2009) in patients with IBD, and psychological distress in
patients with arthritis (Ramjeet, Smith, & Adams, 2008; Vriezekolk et al., 2011). Evidence is
limited for positive reappraisals. Optimistic beliefs are linked to better adjustment outcomes in
people with arthritis (Fournier, de Ridder, & Bensing, 2002). Similarly, acceptance, predicts
better adjustment in both IBD (Voth & Sirois, 2009) and arthritis (Pinto-Gouveia, Costa, &
Marôco, 2013). But, in the context of chronic illness distraction coping is not maladaptive as
Allen and Leary (2010) suggest, but adaptive (Compas, Jaser, Dunn, & Rodriguez, 2012). For
this reason it was not examined. Because evidence is mixed regarding whether emotion-focused
coping strategies, including emotional support seeking, are associated with better or poorer
adjustment in individuals with chronic illness (McCombie et al., 2013; Pellissier, Dantzer,
Canini, Mathieu, & Bonaz, 2010; Schussler, 1992), we did not examine these strategies.
Self-blame is a coping strategy that may be very salient for understanding how self-
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compassion relates to adjustment in people with chronic illness. In the context of chronic illness,
self-blame is associated with poor adjustment to chronic tinnitus (Sirois et al., 2006), and is
linked to poor psychological well-being in patients with IBD (Voth & Sirois, 2009). Given that
self-compassionate individuals treat themselves with kindness rather than harsh self-judgment in
the face of a stressor, we expect that self-compassion will be negatively related to self-blame
coping.
Individuals with chronic illness face a variety of daily and ongoing stressors, including
pain and functional limitations, which can require using different coping strategies depending on
the demand (Gignac, Cott, & Badley, 2000). Successful management of stress therefore relies
less on the use of a single coping strategy, and more on the effectiveness of a set of coping
strategies. Coping efficacy, appraisals of how successfully one is coping with an illness-related
stressor (Gignac et al., 2000), is one way to capture the degree to which a set of coping strategies
are effective for managing stress in the context of chronic illness. For example, in a study of
older adults with arthritis, higher coping efficacy was associated with less feelings of
helplessness, dependence, and emotional reactivity (Gignac et al., 2000). In individuals with
IBD, greater use of denial and behavioral disengagement coping is associated with lower coping
efficacy (Voth & Sirois, 2009). Given the proposed links between self-compassion and the use of
adaptive coping strategies outlined by Terry and Leary (2010), it is reasonable to expect that self-
compassionate people with chronic illness would use a diverse set of coping strategies that would
promote feeling that they are coping successfully with their illness, and in turn perceive less
stress.
The Present Study
The current study aimed to test and extend theory and research on self-compassion,
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coping and stress by examining their associations in individuals with IBD and arthritis.
Consistent with previous research with healthy samples (Allen & Leary, 2010; Sirois, 2014), we
hypothesized that self-compassion would relate to using effective coping strategies and lower
perceived stress. We also expected that self-compassion would be positively linked to the
adaptive coping strategies, and negatively linked to the maladaptive coping strategies noted by
Allen and Leary (2010). We therefore examined a select set of coping strategies theorized to be
linked to self-compassion, and that research indicated a potential benefit for those with chronic
illness: problem solving coping (planning, instrumental support seeking, and active coping) and
positive cognitive restructuring (positive reframing and acceptance), and maladaptive coping
styles including escape avoidance coping (denial and behavioral disengagement) and self-blame.
Previous research has not directly examined the role of coping strategies with respect to
stress among self-compassionate people. We therefore tested the efficacy of the coping strategies
used by self-compassionate individuals and their associations with lower stress by examining the
relative balance of adaptive and maladaptive coping strategies across the two illness groups
using path analysis (see Figure 1). We posited that self-compassionate individuals in both
samples would use a more adaptive set of coping strategies, which in turn would be associated
with higher coping efficacy and, subsequently, would be associated with lower levels of stress.
Method
Participants and Procedure
The data analyzed for this study was collected as a six-month follow-up to a study on
self-perceptions and adjustment to illness among two chronic illness samples – individuals with
any form of arthritis, and individuals with inflammatory bowel disease (IBD). Individuals who
self-reported being medically diagnosed with either arthritis or IBD were eligible to participate;
individuals with a IBS, a related but distinct condition, were not eligible. Following clearance
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from the university research ethics board, participants were recruited via study notices placed in
the community, on electronic support groups for people with arthritis and IBD, on the Arthritis
Society research web page, and in the newsletter of the Crohn’s and Colitis Foundation of
Canada. The web page for each illness group directed participants to the corresponding online
survey, housed on a secure university server. The Time 1 participation involved completing an
online survey; there was no intervention involved. Participants consented to participate by
clicking an “I agree” button on the online consent form, and were given the option to enter a
drawing for a gift certificate to an online bookstore.
A total of 325 people (170 with arthritis and 155 with IBD) completed the online survey
at Time 2. Only 39.8% of the Time 1 participants with arthritis, and 36.2% of the Time 1
participants with IBD completed the Time 2 survey. Although participants were from a variety of
locations around the world, the majority in both illness groups were from North America. Table
1 presents the complete demographic characteristics of the two illness samples. Both samples
were predominantly female and White. Among those with a self-reported diagnosis of any type
of arthritis, rheumatoid arthritis (42.9%) and osteoarthritis (27.6%) were the most frequently
reported subtypes, with fibromyalgia (7.1%), ankylosing spondylitis (5.9%), psoriatic arthritis
(4.1%) and other subtypes (lupus, gout, and other arthritis types) also included. In the IBD group,
50.6% had Crohn’s disease, 42.9% had ulcerative colitis, and 6.5% had unspecified colitis.
Measures
With the exception of disease-specific questions, participants completed identical surveys
which included questions about demographic information, disease severity and duration, coping
efficacy, coping, general perceived stress, and self-compassion. Scale means and reliabilities are
presented in Table 2. Although the coping measures were completed at Time 1 and 2, the self-
Self-compassion and Coping 9
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compassion scale was only completed at Time 2. Accordingly, the analyses focus on the Time 2
measures only.
Self-compassion. Both samples completed the 26-item Self-Compassion Scale (SCS;
Neff, 2003a). The SCS assesses the three main components of self-compassion and their
negative counterparts, Self-Kindness (Self-judgment), Common Humanity (Isolation), and
Mindfulness (Over-identification). It includes both positively (“I try to be loving toward myself
when I’m feeling emotional pain”) and negatively (“I’m disapproving and judgmental about my
own flaws and inadequacies“) worded items reflecting the six components of self-compassion.
Research indicates that the subscales are best explained by a single higher order factor of self-
compassion as they are highly inter-correlated (Neff, 2003a). All items are prefaced with the
statement “how I typically act towards myself during difficult times” and respondents indicate
how often they behave in the described way using response options ranging from 1 (Almost
Never) to 5 (Almost Always). Averaging the mean subscale scores after reverse coding the
negative items yields a total self-compassion score. This scale has been successfully used in both
student and community samples, demonstrating good validity, both convergent and discriminate,
and excellent test-retest reliability previously (α = .93) (Neff, 2003a; Neff & Pommier, 2013).
Disease-related variables. Participants indicated when they had been diagnosed with
their IBD or arthritis. These dates were then transformed into years to create a time-since-
diagnosis variable that was covaried in the main analyses. To assess the impact of their disease
on daily living, participants rated the question “To what extent has arthritis affected your daily
activities?” on a 4-point scale from 1 (not at all) to 4 (a lot). This item was chosen as a proxy for
disease severity in both samples so that disease impact could be measured on a comparable scale.
Coping strategies. The Brief COPE (Carver, 1997) is a well-validated, 30-item measure
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of the full COPE scale, that assesses how frequently functional and dysfunctional coping
strategies are used. Each subscales is comprised of two items rated on a 4-point scale ranging
from 1 (I usually don't do this at all) to 4 (I usually do this a lot). We examined eight subscales
that previous theory and research suggest may be linked to both self-compassion and adjustment
to chronic illness, including five adaptive coping strategies (instrumental support seeking, active
coping, planning, positive reframing, and acceptance) and three maladaptive coping strategies
(denial, behavioral disengagement, and self-blame)(Allen & Leary, 2010; Voth & Sirois, 2009).
Participants reported their use of the coping strategies for dealing with their illness-related stress.
Coping-efficacy. The three-item coping efficacy scale developed by Gignac and
colleagues (Gignac et al., 2000) assessed appraisals of efficacy in coping with the chronic
stressors associated with chronic illness. The scale focuses on three common challenges
associated with chronic illness: symptoms, emotional aspects, and day-to-day problems. Items
such as “I am successfully coping with the symptoms of my arthritis” are scored on a 5-point
Likert type scale with responses ranging from 1 (strongly disagree) to 5 (strongly agree); higher
scores reflect greater coping efficacy. For the IBD sample, the word “arthritis” in all items was
replaced with “IBD.”
Perceived stress. Each sample completed the 10-item version of the Perceived Stress
Scale (PSS; Cohen & Williamson, 1988), a widely used, empirically established index of general
stress. The perceived stressfulness of events experienced within the past month is assessed with
items such as “In the last month, how often have you felt nervous and stressed" rated on a 5-
point scale with response options ranging from “never” to very “often.” The PSS has
demonstrated good internal consistency in previous studies (Cohen & Williamson, 1988), and in
the current samples (see Table 2).
Self-compassion and Coping 11
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Statistical Analyses
Differences between the two samples were evaluated using t-tests. With correlation
analyses, we tested the proposed links between self-compassion, coping strategies, self-efficacy
and stress. In multivariate analyses, we also tested the hypothesis that self-compassion was
associated with a relative balance of more adaptive coping strategies and less maladaptive coping
strategies and, in turn, to better coping efficacy and lower stress across both chronic illness
samples (Figure 1), using path analysis via Mplus 7.11 (Muthen & Muthen, 2013). First, we
examined the overall model combining both the arthritis and IBD samples (see Table 2 top panel
for summary). Full-information maximum likelihood (FIML; Arbuckle, 1996) estimation
procedures were employed and standardized estimates are presented. Model fit was assessed
using the comparative fit index (CFI), the root-mean-square error of approximation (RMSEA),
and the standardized root mean square residual (SRMR). Indirect effects were tested using the
biased-corrected bootstrap method with 1,000 resamples and the 95% bias-corrected confidence
intervals (CIs). This method provides a more accurate balance between Type 1 and Type 2
errors compared to other methods used to test indirect effects (MacKinnon, Lockwood, &
Williams, 2004). Finally, the consistency of the path model results across sample (arthritis versus
IBD) was assessed using multiple group analysis: model fit indices were compared between a
path model in which all predictive paths were freely estimated within the two samples, and a
constrained model, in which corresponding predictive paths were set equal across samples.
Small, non-significant changes in the model fit indices indicate that the assumption of equality in
corresponding predictive paths across samples was tenable (Kline, 2005).
Results
Descriptive Information
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Descriptive information along with correlations between all study variables, for each
sample, is presented in Table 2. All variables were normally distributed except for denial
(skewness = 1.96, SE = .14), and behavioural disengagement coping (skewness = 1.47, SE =
.14), which were positively skewed. Across both samples, self-compassion was positively
associated with all adaptive coping styles and coping efficacy, and negatively associated with the
maladaptive coping styles and perceived stress. Results from independent sample t-tests revealed
that there were no sample-related differences in scores on model variables, except with respect to
age t(315) = 6.41, p <.001; individuals with arthritis were significantly older than those with IBD
(see Table 1). Consequently, age was included in the analyses as a covariate. Given the
heterogeneity of symptoms across the two samples, we used effects coding and included a set of
seven variables in the analyses to account for differences in symptoms across samples. This
allowed us to determine the effect of being in a particular subgroup (i.e., rheumatoid arthritis,
osteoarthritis, fibromyalgia, ankylosing spondylitis, other arthritic conditions, Crohn’s disease,
and ulcerative colitis) relative to the remaining sample with respect to the model variables.
Path Analyses
The conceptual model depicted in Figure 1, accounting for age and heterogeneity of
symptoms across samples, was tested. Goodness of fit indices revealed that the structure of the
hypothesized model did not provide an acceptable explanation of the data (i.χ
2(10)
= 68.35, p <
.001, CFI = .95, RMSEA = .14, p
close
<.001, SRMR = .03). Modification indices indicated that
adding a direct path from self-compassion to stress would significantly improve model fit. The
addition of this path greatly improved model fit (χ
2diff(1)
= 56.05, p < .001, ∆CFI = .05, ∆RMSEA
= .11) and resulted in a model that fit the data well (χ
2(9)
= 12.30, p = .20, CFI = 1.00, RMSEA =
.03, p
close
= .68, SRMR = .01). The results from the final model, accounting for 43% of the
Self-compassion and Coping 13
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variance in stress, are presented in Figure 2. As expected, coping self-efficacy was negatively
associated with stress. Active coping, positive reframing, and acceptance were positively
associated with coping self-efficacy, while behavioral disengagement and self-blame were
negatively associated with coping self-efficacy. Self-compassion was positively associated with
instrumental coping, active coping, planning, positive reframing, and acceptance, and negatively
associated with denial, behavioral disengagement, and self-blame. The illness subtype
comparisons revealed that fibromyalgia was associated with less coping self-efficacy, while
ulcerative colitis and Crohn’s disease were associated with higher levels of coping self-efficacy
relative to others. Individuals with ankylosing spondylitis used less planning relative to others.
Those with fibromyalgia were more likely to use positive re-framing, and those with ulcerative
colitis were less likely to use behavioral disengagement compared to the rest of the sample.
In addition to the direct negative association between self-compassion and stress, self-
compassion also shared significant and negative indirect associations with stress via active
coping and coping self-efficacy [b = -.030; 95% CI = (-.060; -.005)], positive reframing and
coping self-efficacy [b = -.033; 95% CI = (-.062; -.016)], acceptance and coping self-efficacy [b
= -.020; 95% CI = (-.041; -.006)], behavioral disengagement and coping self-efficacy [b = -.038;
95% CI = (-.077; -.018)], and through self-blame and coping self-efficacy [b = -.048; 95% CI =
(-.084; -.025)]. Concerning the consistency of results across samples, the assumption of equality
across illness groups was tenable (∆χ
2
= 55.11, df = 56, p = .50; ∆CFI = .001; ∆RMSEA = .019).
Discussion
Across two chronic illness samples we found that self-compassion was associated with
greater use of adaptive coping and less use of maladaptive coping which, in turn, were linked to
coping efficacy and subsequently less stress. After accounting for indirect relationships, the
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direct relationship between self-compassion and stress remained significant, indicating that self-
compassion is linked to lower stress through routes beyond coping. The model did not differ
across the two illness samples, suggesting that self-compassion is a quality associated with
adjustment to stressors in the context of IBD and arthritis.
Our findings replicate and extend previous research on self-compassion and coping in
several important ways. Whereas past research has demonstrated mixed findings with respect to
self-compassion and problem-solving coping styles (Allen & Leary, 2010), we found
associations with three coping styles in this category at the bivariate level: instrumental support-
seeking, active coping and planning, all of which are cognitive or behavioral in nature. However,
only active coping linked self-compassion to coping efficacy, indicating that this problem-
focused coping strategy may be more effective for coping with IBD and arthritis. Findings
regarding the use of positive cognitive restructuring strategies (positive reframing and
acceptance) were consistent with previous research (Allen & Leary, 2010); however, we found
that these strategies linked self-compassion to better coping efficacy and, in turn, to less stress. In
the context of chronic inflammatory illness, research suggests that acceptance – a cognitive
appraisal process - may be especially important for managing day-to-day stress and promoting
adjustment (Pinto-Gouveia et al., 2013; Ramjeet, Koutantji, Barrett, & Scott, 2005; Voth &
Sirois, 2009). Thus, self-compassionate people may have a coping advantage that promotes
adjustment to illness because they reframe how they view illness-related challenges and,
therefore, engage in appropriate, rather than unrealistic, problem-solving strategies to minimize
stress.
As expected, self-compassion was negatively related to each of the escape avoidant
coping strategies, denial and behavioral disengagement. Previous research has noted a negative
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association between self-compassion and trait procrastination, a form of behavioral
disengagement and avoidant coping (Sirois, 2014). Consistent with this, we found that less use of
behavioral disengagement was linked to successful coping and less stress. The negative
association with self-blame coping is unique to this study and highlights the importance of the
self-kindness dimension of self-compassion (Neff, 2003b) for minimizing harsh and self-critical
thoughts when dealing with illness-related stressors. In low control circumstances such as
chronic illness, it is not uncommon for individuals to try to regain control by retrospectively
attributing uncontrollable illness-related changes to their own behavior (Thompson, Sobolew-
Shubin, Galbraith, Schwankovsky, & Cruzen, 1993) and view these changes as personal failures.
This self-blaming response is linked to poor adjustment in other chronic conditions (Sirois et al.,
2006; Thompson, Cheek, & Graham, 1988), and poor coping efficacy in IBD (Voth & Sirois,
2009). Our findings provide preliminary and suggestive evidence that self-compassion may be a
protective factor against this form of maladaptive coping.
The current findings also demonstrate, for the first time, that it is the relative balance of
the greater use of adaptive and less use of maladaptive coping strategies that links self-
compassion to better coping outcomes. In their review of current research, Allen and Leary
(2010) posited that this may be the case. By using a path analysis model that allowed for
simultaneous testing of the associations of self-compassion with several adaptive and
maladaptive coping strategies, we were able to provide more direct empirical support for this
proposition and were also able to examine how the coping styles were linked to coping efficacy
and lower stress in our health-compromised samples. Although cross-sectional, our analyses
suggest that self-compassionate individuals with chronic illness may have a repertoire of
adaptive coping styles that they call upon to deal with different stressors associated with their
Self-compassion and Coping 16
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illness. This view of self-compassionate individuals is consistent with theory and research on
coping flexibility which highlights the benefits of being able to shift among different coping
strategies to find the most effective response for psychological health and well-being (Kato,
2012). Examining how self-compassion relates to flexible coping may, therefore, be a fruitful
area for future research.
When considered in light of the predominantly female sample, the links between self-
compassion and coping in the current study both parallel and contrast research on how women
cope with stress in comparison to men. For example, a meta-analysis of sex differences in coping
found that women in comparison to men tend to use positive self-talk to cope with stressors
(Tamres, Janicki, & Helgeson, 2002). As noted previously, this positive reappraisal style of
coping reflects the tendency of self-compassionate people to reframe stressors as less
threatening. However, this meta-analysis and other research found that women tend to use more
emotion-focused strategies, including rumination, as well as more avoidant coping strategies,
than men (Matud, 2004; Tamres et al., 2002). In the current study self-compassionate individuals
with IBD and arthritis tended to use less avoidant coping, and less self-blame coping, a strategy
akin to rumination in that it involves repetitive, unproductive thinking that is associated with
greater feelings of distress and less self-compassion (Filip, 2010). Taken together, the current
findings and research highlighting how women cope with stress provides suggestive evidence
that self-compassion may be especially beneficial for women coping with the stressors of chronic
illness because it promotes the use of adaptive coping strategies while minimizing the use of
maladaptive coping strategies.
Despite being novel, the results from this study should be considered in light of several
limitations. Although, the proposed links among self-compassion, coping, coping efficacy and
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stress are informed by theory and experimental research (Allen & Leary, 2010; Neff, 2003b), the
cross-sectional nature of our data precludes any strong conclusions about causality. To determine
the temporal precedence of the model it should be tested within the framework of a prospective
longitudinal study. We tested a limited number of coping styles as suggested by theory and
research; however, future research could provide a more comprehensive portrait of the repertoire
of coping styles used by self-compassionate individuals in the context of chronic illness. It
should also be noted that the direct association from self-compassion to stress remained
significant, highlighting the role of factors, coping-related or otherwise, not tested in the current
study that might explain why self-compassionate people perceive less stress. For example, the
mindfulness component of self-compassion, with its emphasis on not becoming embroiled in
negative mood states, may account for this link. Further research on understanding the direct link
between self-compassion and stress would bring clarity to this issue.
Although our findings are generally consistent with previous research in both healthy and
health-compromised individuals, the coping styles associated with self-compassion in the current
study may not apply to other samples. Indeed, the diversity of sub-types within each illness
group makes it difficult to determine if the results apply more or less to any one sub-type.
Moreover, IBD and arthritis, though both forms of chronic inflammatory disease, are also very
distinct in many ways, despite the results suggesting that the relations among the study variables
did not differ significantly between the two groups, or as a function of any one subtype. Both
samples were primarily White and female also limiting the applicability of the findings to more
diverse samples. The results may also be specific to chronic inflammatory conditions and may
not generalize to other chronic illness groups or to general medical populations. Collectively,
these limitations indicate that more work with other illness populations would clarify the extent
Self-compassion and Coping 18
18
to which the findings can be generalized to other samples. Nonetheless, the current study is the
first that we are aware of to examine self-compassion and coping with IBD and arthritis.
The current study replicated and extended previous theory and research, finding that in
women with IBD and arthritis, self-compassion is linked to greater use of adaptive coping and
less use of maladaptive coping for illness-related stressors, which, in turn, was linked to
successful coping and less stress. The healthy repertoire of coping styles associated with self-
compassion found in this study provides suggestive evidence that cultivating a tendency to relate
to oneself with kindness, compassion and acceptance in times of failure and difficulty may be
valuable for reducing stress for those coping with chronic inflammatory disease.
Self-compassion and Coping 19
19
Acknowledgements
Gratitude is expressed to all the participants who took the time to complete the surveys.
Self-compassion and Coping 20
20
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Table 1.
Demographic characteristics of each illness sample.
Illness group
Arthritis IBD
N 170
91.5
47.44 (11.6)
18-75
92.1
49.1
44.2
4.12
1.2
1.2
36.4
21.0
18.5
24.1
13.3
66.1
20.6
57.0
20.6
22.4
155
83.1
38.84 (12.8)
18-72
93.6
48.7
31.2
14.3
1.3
4.5
43.6
20.8
25.5
10.1
13.6
65.6
20.8
67.5
7.9
24.5
Sex (% female)
Age
Mean (SD)
Range
Ethnicity (% Caucasian)
Country (%)
Canada
United States
United Kingdom
Australia/New Zealand
Europe
Employment status (%)
Full-time
Part-time
Unemployed/retired
Disabled
Education (%)
High school or less
University or college
Graduate school
Relationship status (%)
Married
Separated/Divorced/Widowed
Never married
Note: IBD = Inflammatory bowel disease; SD = standard deviation;
Self-compassion and Coping 26
26
Table 2.
Descriptive Information and Correlations of the Model Variables in the Arthritis and Inflammatory
Bowel disease (IBD) Samples.
Variable 1 2 3 4 5 6 7 8 9 10 11
1. SC - .19* .41* .33* -.28* .32* .37* -.35* -.46* .43* -.56*
2. IN .18* - .25* .40* .05 .28* .21* -.12 .15 .09 -.07
3. ACT .48* .33* - .71* -.16 .37* .45* -.34* -.07 .40* -.31*
4. PLAN .41* .35* .63* - -.12 .51* .60* -.29* .01 .36* -.24*
5. DEN -.17* .01 -.09 -.02 - -.06 -.39* .37* .43* -.35* .31*
6. PRF .52* .34* .45* .42* .01 - .36* -.25* .02 .35* -.20*
7. ACC .28* .12 .29* .38* -.26* .29* - -.32* -.21* .48* -.35*
8. BDIS -.42* .03 -.31* -.16* .32* -.20* -.17* - .37* -.46* .37*
9. SB -.50* .17* -.13 .03 .32* .00 -.14 .51* - -.47* .47*
10. CSE .47* -.06 .38* .23* -.22* .31* .29* -.56* -.39* - -.54*
11. PSS -.56* .02 -.35* -.23* .15 -.26* -.10 .48* .38* -.57* -
12. TDIAG .16* .04 .17* .14 -.09 .10 .22* -.24* -.13 .25* -.10
13. AGE .29* -.01 .06 .14 .06 .20* .17* -.13 -.15 .23* -.26*
Mean
(Arthritis)
2.98 2.26 2.75 2.66 1.31 2.28 3.08 1.55 3.66 3.58 2.83
SD
(Arthritis)
.69 .81 .75 .83 .55 .87 .78 .74 1.70 .94 .84
Mean
(IBD)
2.87 2.41 2.77 2.69 1.34 2.22 3.03 1.54 3.77 3.72 2.87
SD
(IBD)
.71 .95 .88 .89 .56 .92 .80 .75 1.61 .91 .74
α
(Arthritis)
.94 .79 .60 .69 .44 .77 .75 .70 .71 .92 .90
α
(IBD)
.94 .89 .81 .81 .53 .83 .80 .77 .67 .91 .91
Note. Bivariate associations for the Arthritis sample are presented in the lower diagonal and bivariate
associations for the IBD sample are presented in the upper diagonal of the table.
Note. SC = self-compassion; IN = instrumental support coping; ACT = active coping; PLAN =
planning coping; DEN = denial coping; PRF = positive reframing coping; ACC = acceptance coping;
BDIS = behavioral disengagement coping; SB = self-blame coping; CSE = coping efficacy; PSS =
perceived stress; TDIAG = time since diagnosis.
Note. * p < .05.
Self-compassion and Coping 27
27
Self-
Compassion
Coping Self-
Efficacy Stress Coping Styles
Figure 1. Conceptual model linking self-compassion to stress via coping styles and coping self-
efficacy.
Self-compassion and Coping 0
0
Figure 2. Final model linking self-compassion to stress via coping styles and coping self-efficacy.
.20*
Self-
Compassion
Instrumental
Coping
Active Coping
Planning
Denial
Positive
Reframing
Acceptance
Behavioural
Disengagement
Self-Blame
Coping self-
efficacy
Stress
-
.36*
-
.38*
.16*
.18*
.15*
-
.24*
-
.25*
.46*
.38*
-
.24*
.44*
.32*
-
.38*
-
.47*
-
.06
-
.01
-
.02
Self-compassion and Coping 1
1
Note. Statistically significant paths are shown via solid lines, while the dashed lines represent paths that were estimated in the model,
but were not statistically significant.
Note. A set of seven variables that were created using effects coding were included in the analyses to account for differences in
symptoms among the different samples, but not shown for ease of presentation. Respondent’s age was also accounted for in the
analyses, but not shown for ease of presentation.
Note. Covariances between disturbances associated with coping styles were estimated, but not shown for ease of presentation.
Note. Standardized path coefficients are displayed.
Note. * p <.05
