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Self-criticism and Self-reassurance in Individuals with Recurrent Depression: Effects of Mindfulness Based Cognitive Therapy and Relationship to Relapse
Abstract
Background
Self‐criticism is associated with an elevated risk of developing recurrent depressive episodes. Self‐criticism can have different forms, functions and underpinning emotions. An investigation into variations of self‐criticism and its antidotes is therefore warranted. The aim of this study, embedded within a randomised efficacy trial of mindfulness‐based cognitive therapy (MBCT), was to explore the effect of MBCT on self‐to‐self relating within three domains: self‐inadequacy, self‐hate and the ability to self‐reassure. We also investigated whether these forms of self‐to‐self relating predicted depressive relapse for the MBCT participants within a time frame of two years after the intervention.
Methods
Sixty‐eight individuals with recurrent depressive disorder were randomised to MBCT or a waiting list condition (WLC). Participants in the MBCT intervention were assessed for depressive relapse at follow‐up after 6, 12 and 24 months.
Results
Compared with WLC (N = 30), completers of MBCT (N = 26) showed a significant improvement in Reassure self (d = 0.69, p = .016) and a significant reduction in Inadequate self (d = 0.51, p = .021), measured with the Forms of Self‐Criticizing and Reassuring Scale. There were no significant changes in Hated self. Improvements in the Reassure self during the intervention predicted non‐occurrence of depressive relapse within a period of two years after the MBCT intervention.
Conclusions
Findings from the present study support evidence that MBCT can affect how individuals relate to themselves in difficult situations in ways that may act as protection against depressive relapse.
... We were again interested in whether the form of self-criticism would affect the impact of teaching detached mindfulness. In a systematic review, Werner and colleagues (2019) found that several psychotherapies, including mindfulness-based interventions, were effective in reducing IS but not HS forms of self-criticism, a finding repeated more recently (Schanche et al., 2021). Halamova and colleagues (2018b) observed that mindfulness-based intervention had a more immediate effect on IS but a delayed effect on HS self-criticism. ...
... However, these changes were not correlated with changes in SCR. Perhaps longer periods of practice are necessary before decentering can account for the reduction in SCR, such as provided in mindfulness-based cognitive therapy (Schanche et al., 2021). In the present acute study, the results were consistent with decentering (as promoted by the detached mindfulness intervention) facilitating reductions in negative metabeliefs, which in turn, were associated with reductions in SCR. ...
Two studies explored whether Hated Self and Inadequate Self forms of self-criticism demonstrate different relationships to self-critical rumination (SCR), metacognitive beliefs, decentering and psychopathology. In study 1, 137 community participants experiencing SCR completed an online questionnaire battery. Self-hate was associated with higher SCR, stronger positive and negative metabeliefs about SCR, higher psychopathology and nonreactivity to internal experiences. Effects of Inadequate Self on psychopathology were fully mediated by SCR whereas Hated Self exerted direct effects on psychopathology alongside indirect effects via SCR. Study 2 explored whether higher self-hate attenuated the ability to detach from SCR triggers. Twenty-three participants received a single-session detached mindfulness intervention; pre-post changes in study 1 questionnaires and daily diary ratings of study 1 constructs in the week before and after the intervention were compared. Most measures improved; higher self-hate was not associated with reduced response. Although self-hate confers risk for psychopathology outside SCR, metacognitive interventions both undermine uncontrollability beliefs and facilitate decentering, so should continue to be investigated as interventions for SCR.
... Temuan dalam penelitian ini menambah dukungan pada klaim bahwa intervensil MBCT efektif untuk meningkatkan self esteem pada remaja. (Schanche et al., 2021) Dalam penelitiannya mengungkapkan bahwa Ketika terjadi kesalahan atau sesuatu berjalan tidak semestinya, orang-orang yang mengikuti MBCT tampak lebih mampu mentolerir kesalahan, mampu untuk mengendalikan kecenderungan untuk mengkritik diri sendiri, tidak terlalu memikirkan kekurangan diri sendiri, serta merasa tidak teralalu pantas untuk dikritik, (Huang et al., 2019) terjadi penurunan skor secara signifikan pada kesedihan (TRIG), emosi negatif (GAD-7 dan Depresi), dan kesulitan pengaturan emosi (DERS) sedangkan tingkat kesadaran (total skor FFMQ) meningkat secara signifikan. (Bang et al., 2023) MBCT secara signifikan penurunan skor pada gejala panik (Probst et al., 2020) memberikan manfaat bagi pasien depresi kronis yang lebih pendendam/ berpusat pada diri sendiri untuk belajar fokus membuat pengalaman baru dengan proses kognitif dan melaksanakan praktek mindfulness. ...
Self Esteem merupakan bentuk sikap menerima diri yang ditunjukan dengan besarnya kepercayaan terhadap kemampuan, keberartian, kesuksesan dan keberhargaan. Disisi lain, self esteem yang rendah mengakibatkan adanya kecenderungan depresi, mudah putus asa dan rentan mengalami perilaku menyimpang. Intervensi MBCT terbukti secara efektif meningkatkan self esteem, mengurangi depresi dan disregulasi suasana hati, emosi negatif serta berbagai dampak negative lain yang ditimbulkan dari rendahnya self esteem. MBCT terbuktu memberikan manfaat bagi remaja yang menjalankan therapy ini diantaranya adalah ketrampilang untuk focus pada masa kini, melakukan penerimaan, membingkai ulang kognitif, meningkatkan kemampuan pengelolaan stress dan emosi yang sulit (kemarahan dan kecemasan).
... Mindfulness encourages individuals to perceive their thoughts and experiences without harsh self-criticism. Meditation and mindfulness training have been shown to elevate levels of mindfulness (Yuan et al., 2020), offering individuals the tools to navigate the emotional turmoil typically associated with cyberbullying (Schanche et al., 2021). Recent research on non-clinical mindfulness training has also indicated its potential to enhance positive emotions and reduce negative emotions, such as depression and anxiety (Wang, 2020). ...
In the rapidly evolving digital society, people’s daily lives have become intricately woven with online activities, driven by an ever-increasing demand for digital interconnectedness. The internet has bestowed upon them the gift of instantaneous communication with their loved ones, while simultaneously opening doors to global connections. This transformative power of the internet has also spawned a disconcerting issue—cyberbullying. Within the vast expanse of the online world, they witness the proliferation of various forms of harassment and abuse. This not only psychologically but also physically harms on a distressing number of individuals. This study thoroughly explores this disconcerting phenomenon, drawing upon established theories such as the spiral of silence theory and social cognitive theory to unveil the underlying causes of cyberbullying. It embarks on a detailed study into mindfulness, recognizing it as a potential tool to regulate the pernicious effects of cyberbullying. However, a significant knowledge gap persists concerning the cultivation of mindfulness and the intricate factors influencing its effectiveness within the context of cyberbullying. The paper conducts a questionnaire survey encompassing 529 participants to bridge this chasm of understanding. This survey not only provides valuable insights into the repercussions of cyberbullying on internet users but also unveils the potential moderating role of mindfulness in this complex dynamic. The findings unearthed through this study carry profound implications, serving as a clarion call for heightened societal awareness and informed governmental interventions to combat the scourge of cyberbullying.
... Increased trait mindfulness has been associated with decreased shame, increased self-esteem, and increased well-being (Bajaj, Gupta, et al., 2016;Bajaj, Robins, et al., 2016;Chan & Leung, 2021). Multiple studies have noted benefits of mindfulness-based interventions on shame and psychological phenomena relating to shame such as self-criticism and self-compassion (Malouf et al., 2017;Morley & Fulton, 2020;Schanche et al., 2021;Woods & Proeve, 2014), and the present study showed that MBRP, as well as a cognitive-behavioral RP intervention, were both associated with reductions in internalized shame. Importantly, women in the residential treatment program in the RP condition also had access to daily mindfulness meditation sessions that occurred as part of the broader treatment program. ...
Shame is one of the leading barriers to successful recovery in substance use treatment settings. This secondary analysis study examined measurement invariance of the Internalized Shame Scale (ISS) and explored changes in shame during treatment. Participants (N = 105) in the parent study were recruited from a nonprofit residential treatment center for justice-involved women and were randomized to receive mindfulness-based relapse prevention or relapse prevention treatment. A series of confirmatory factor analyses were used to assess measurement invariance in a one-factor measurement model of the ISS. Latent growth curve modeling was used to examine change in shame over time. Our findings support the assumption of measurement invariance across multiple time points and across treatment conditions, supporting comparisons of stigma scores across groups and over time. Although we observed significant reductions in shame from pre- to posttreatment, there were no differences across treatment conditions. Additional research is needed to determine how distinct treatment components relate to reductions in shame among individuals receiving treatment for a substance use disorder.
... The current study used baseline data collected as part of a larger randomized controlled trial of change mechanisms in MBCT for adults with recurrent MDD (see also Schanche et al. (2020Schanche et al. ( , 2021; and the entry of the study in the ISRCT registry: Trial no. ISRCTN18001392). ...
Background: Recurrent Major Depressive Disorder (MDD) is one of the most disabling mental disorders in modern society. Prior research has shown that self-compassion protects against ruminative tendencies, a key feature of recurrent MDD. In addition, self-compassion has been found to be positively related to higher psychophysiological flexibility (indexed by a higher vagally mediated heart rate variability; vmHRV) in young, healthy adults. To our knowledge, there is a lack of studies on how self-compassion relates to vmHRV in patients with recurrent MDD. The aim of the current study was to investigate whether higher self-compassion would associate with 1) lower ruminative tendencies and 2) higher vmHRV in a sample of adults with recurrent MDD.
Methods: We included a sample of patients (46 females) between 20 and 71 years old (M = 40.24, SD = 12.8) with a history of three or more depressive episodes. They filled out the Self-Compassion Scale (SCS), Beck Depression Inventory (BDI), and Rumination Rating Scale (RRS). ECG (used to derive vmHRV) was acquired while resting and the square root of the mean squared differences of successive RR interval values (RMSSD) was calculated as measure of vmHRV.
Results: As hypothesized, self-compassion was associated with lower ruminative tendencies. However, self-compassion was not associated with level of vmHRV. Several confounding variables were controlled for in the statistical analyses, and higher age predicted lower vmHRV across all statistical analyses.
Conclusion: The results confirmed our hypothesis that higher self-compassion would be associated with lower ruminative tendencies in recurrent MDD. Contrary to our expectation, we did not find that the tendency to be more self-compassionate was associated with higher vmHRV. As such, higher self-compassion seems to relate with a lower tendency to ruminate about past mistakes and events, but does not seem to relate to a flexible autonomic stress response (as indexed by higher vmHRV). Other potential explanatory factors for lower vmHRV in recurrent MDD is suggested as focus for exploration in future studies.
This study evaluated mindfulness-based cognitive therapy (MBCT), a group intervention designed to train recovered recurrently depressed patients to disengage from dysphoria-activated depressogenic thinking that may mediate relapse/recurrence. Recovered recurrently depressed patients (n = 145) were randomized to continue with treatment as usual or, in addition, to receive MBCT. Relapse/recurrence to major depression was assessed over a 60-week study period. For patients with 3 or more previous episodes of depression (77% of the sample), MBCT significantly reduced risk of relapse/recurrence. For patients with only 2 previous episodes, MBCT did not reduce relapse/recurrence. MBCT offers a promising cost-efficient psychological approach to preventing relapse/recurrence in recovered recurrently depressed patients.
Brief measures of depression and of dependency and self-criticism, personality factors believed to convey vulnerability to depression, were administered to 318 medical students. Depression was subsequently measured 2 years later (in the highly stressful 1st postgraduate year) and 10 years later when careers were established. When initial symptom levels and concurrent workload were controlled, dependency and, more particularly, self-criticism were significant predictors of depression for male doctors in the 1st postgraduate year. For female doctors, self-criticism was the only significant predictor. Ten years later, the predictive effects for male doctors were similar, but rather weaker, whereas none of the variables predicted depression in female doctors. Implications for preventive interventions are discussed.
Background:
The aim of this randomized wait-list controlled trial was to explore the effects of Mindfulness-Based Cognitive Therapy (MBCT) on risk and protective factors for depressive relapse within the domains of cognition, emotion and self-relatedness.
Methods:
Sixty-eight individuals with recurrent depressive disorder were randomized to MBCT or a wait-list control condition (WLC).
Results:
Completers of MBCT (N = 26) improved significantly on measures assessing risk and protective factors of recurrent depression compared to WLC (N = 30) on measures of rumination (d = 0.59, p = .015), emotion regulation (d = 0.50, p = .028), emotional reactivity to stress (d = 0.32, p = .048), self-compassion (d = 1.02, p < .001), mindfulness (d = 0.59, p = .010), and depression (d = 0.40, p = .018). In the Intention To Treat sample, findings were attenuated, but there were still significant results on measures of rumination, self-compassion and depression.
Conclusions:
Findings from the present trial contribute to evidence that MBCT can lead to reduction in risk factors of depressive relapse, and strengthening of factors known to be protective of depressive relapse. The largest changes were found in the domain of self-relatedness, in the form of large effects on the participants' ability to be less self-judgmental and more self-compassionate.
Trial registration:
ISRCTN, ISRCTN18001392. Registered 29 June 2018.
Objective:
There has been substantial research and public interest in mindfulness interventions, biological pathways, and health over the past two decades. This article reviews recent developments in understanding relationships between mindfulness interventions and physical health.
Methods:
A selective review was conducted with the goal of synthesizing conceptual and empirical relationships between mindfulness interventions and physical health outcomes.
Results:
Initial randomized controlled trials (RCTs) in this area suggest that mindfulness interventions can improve pain management outcomes among chronic pain populations, and there is preliminary evidence for mindfulness interventions improving specific stress-related disease outcomes in some patient populations (i.e., clinical colds, psoriasis, IBS, PTSD, diabetes, HIV). We offer a stress buffering framework for the observed beneficial effects of mindfulness interventions and summarize supporting biobehavioral and neuroimaging studies that provide plausible mechanistic pathways linking mindfulness interventions with positive physical health outcomes.
Conclusion:
We conclude with new opportunities for research and clinical implementations to consider in the next two decades.
Mindfulness-based cognitive therapy (MBCT) was developed to prevent relapse in individuals with depressive disorders. This widely used intervention has garnered considerable attention and a comprehensive review of current trends is warranted. As such, this review provides an overview of efficacy, mechanisms of action, and concludes with a discussion of dissemination. Results provided strong support for the efficacy of MBCT despite some methodological shortcomings in the reviewed literature. With respect to mechanisms of action, specific elements, such as mindfulness, repetitive negative thinking, self-compassion and affect, and cognitive reactivity have emerged as important mechanisms of change. Finally, despite a lack of widespread MBCT availability outside urban areas, research has shown that self-help variations are promising. Combined with findings that teacher competence may not be a significant predictor of treatment outcome, there are important implications for dissemination. Taken together, this review shows that while MBCT is an effective treatment for depression, continued research in the areas of efficacy, mechanisms of action, and dissemination are recommended.
The development of the compassionate self, associated with practices such as slow and deeper breathing, compassionate voice tones and facial expressions and compassionate focusing, is central to Compassion-Focused Therapy. This study explores the impact of a 2-week compassionate mind training (CMT) program on emotional, self-evaluative and psychopathology measures and on heart rate variability (HRV). Participants (general population and college students) were randomly assigned to one of two conditions: CMT (n = 56) and wait-list control (n = 37). Participants in the CMT condition were instructed to practice CMT exercises during 2 weeks. Self-report measures of compassion, positive affect, fears of compassion, self-criticism, shame, depression, anxiety and stress and HRV were collected at pre- and post-interventions in both conditions. Compared to the control group, the experimental group showed significant increases in positive emotions, associated with feeling relaxed and also safe and content, but not activated, and in self-compassion, compassion for others and compassion from others. There were significant reductions in shame, self-criticism, fears of compassion and stress. Only the experimental group reported significant improvement in HRV. Developing awareness of the evolved nature and inherent difficulties of our minds allied with practicing CMT exercises has beneficial effects on participants’ psychological and physiological well-being.
Importance:
Relapse prevention in recurrent depression is a significant public health problem, and antidepressants are the current first-line treatment approach. Identifying an equally efficacious nonpharmacological intervention would be an important development.
Objective:
To conduct a meta-analysis on individual patient data to examine the efficacy of mindfulness-based cognitive therapy (MBCT) compared with usual care and other active treatments, including antidepressants, in treating those with recurrent depression.
Data sources:
English-language studies published or accepted for publication in peer-reviewed journals identified from EMBASE, PubMed/Medline, PsycINFO, Web of Science, Scopus, and the Cochrane Controlled Trials Register from the first available year to November 22, 2014. Searches were conducted from November 2010 to November 2014.
Study selection:
Randomized trials of manualized MBCT for relapse prevention in recurrent depression in full or partial remission that compared MBCT with at least 1 non-MBCT treatment, including usual care.
Data extraction and synthesis:
This was an update to a previous meta-analysis. We screened 2555 new records after removing duplicates. Abstracts were screened for full-text extraction (S.S.) and checked by another researcher (T.D.). There were no disagreements. Of the original 2555 studies, 766 were evaluated against full study inclusion criteria, and we acquired full text for 8. Of these, 4 studies were excluded, and the remaining 4 were combined with the 6 studies identified from the previous meta-analysis, yielding 10 studies for qualitative synthesis. Full patient data were not available for 1 of these studies, resulting in 9 studies with individual patient data, which were included in the quantitative synthesis.
Results:
Of the 1258 patients included, the mean (SD) age was 47.1 (11.9) years, and 944 (75.0%) were female. A 2-stage random effects approach showed that patients receiving MBCT had a reduced risk of depressive relapse within a 60-week follow-up period compared with those who did not receive MBCT (hazard ratio, 0.69; 95% CI, 0.58-0.82). Furthermore, comparisons with active treatments suggest a reduced risk of depressive relapse within a 60-week follow-up period (hazard ratio, 0.79; 95% CI, 0.64-0.97). Using a 1-stage approach, sociodemographic (ie, age, sex, education, and relationship status) and psychiatric (ie, age at onset and number of previous episodes of depression) variables showed no statistically significant interaction with MBCT treatment. However, there was some evidence to suggest that a greater severity of depressive symptoms prior to treatment was associated with a larger effect of MBCT compared with other treatments.
Conclusions and relevance:
Mindfulness-based cognitive therapy appears efficacious as a treatment for relapse prevention for those with recurrent depression, particularly those with more pronounced residual symptoms. Recommendations are made concerning how future trials can address remaining uncertainties and improve the rigor of the field.
Background. The Forms of Self-Criticising/Attacking & Self-Reassuring Scale (FSCRS, Gilbert,Clarke,Hempel, Miles, & Irons, 2004, Br. J.Clin. Psychology, 43, 31) is a self-report instrument that measures self-criticism and self-reassurance. It has shown good reliability and has been used in several different studies and in a range of different populations. The aim of this study was to explore its psychometric proprieties in a large clinical and non-clinical sample, to establish its reliability. In addition, to our knowledge, this is the first study to provide normative data to FSCRS. Differences in population scores will also be addressed.
Method. Data were collated from 12 different studies, resulting in 887 non-clinical participants and 167 mixed diagnosis patients who completed the FSCRS.
Results. A confirmatory factor analysis shows that both in non-clinical and clinical samples, the three-factor model of FSCRS is a well-adjusted measure for assessing the two forms of self-criticism and a form of self-reassurance. Normative data for the scale are presented. Comparing the two populations, the non-clinical was more self-reassuring and less self-critical than the clinical one. Comparing genders, in the non-clinical population men were more self-reassuring and less self-critical than women. No significant gender differences were found in the clinical population.
Conclusions. Taken together, results corroborate previous findings about the link between self-criticism and clinical population, which stresses the need to both assess and address it in therapy. Results also confirm that FSCRS is a robust and reliable instrument, which now can aid clinicians and researchers to have a better understanding of the results, taking into account the norms presented.
The Five Facet Mindfulness Questionnaire (FFMQ; Baer, Smith, Hopkins, Krietemeyer, & Toney, 2006) and the Self-Compassion Scale (SCS; Neff, 2003) are widely used measures of mindfulness and self-compassion in mindfulness-based intervention research. The psychometric properties of the FFMQ and the SCS need to be independently replicated in community samples and relevant clinical samples to support their use. Our primary aim was to establish the factor structures of the FFMQ and SCS in individuals with recurrent depression in remission, since Mindfulness-Based Cognitive Therapy (MBCT) was developed as a treatment for preventing depressive relapse. In order to determine the consistency across populations, we examined the factor structures of the FFMQ and SCS in 3 samples: (1) a convenience sample of adults, (2) a sample of adults who practice meditation, and (3) a sample of adults who suffer from recurrent depression and were recruited to take part in a trial of MBCT. Confirmatory factor analyses (CFAs) showed that a 4-factor hierarchical model of the FFMQ best fits the community sample and the clinical sample but that a 5-factor hierarchical model of the FFMQ best fits the meditator sample. CFA did not endorse the SCS 6-factor hierarchical structure in any of the 3 samples. Clinicians and researchers should be aware of the psychometric properties of the FFMQ to measure mindfulness when comparing meditators and nonmeditators. Further research is needed to develop a more psychometrically robust measure of self-compassion. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Background:
People with personality disorders, especially those who also experience high self-criticism and shame, are known to be a therapeutic challenge and there is a high dropout rate from therapy. Compassion-focused therapy (CFT) was designed to address shame and self-criticism specifically, and to develop people's ability to be self-reassuring and more compassionate to themselves and others.
Aims:
This study explored how CFT affected self-criticism and self-attacking thoughts, feelings, and behaviours, as well as the general symptoms of anxiety, stress, and depression of a personality disordered group within an outpatient group setting, and evaluated the extent of maintenance at a 1-year follow-up. A secondary objective was to identify some of the key characteristics that such an intervention would require. This was a pilot study exploring the feasibility, acceptability, and potential value of CFT in treating this difficult population and, as such, was designed as a pre-randomized controlled trial (RCT) to provide evidence to support applications for funding for an RCT.
Methods and design:
This study utilized a mixed method combining qualitative and quantitative methods to support a programme evaluation. Eight participants were introduced to the evolutionary-based CFT model and taken through explorations of the nature of self-criticism and shame. In subsequent sessions, participants were taught the main compassion-focused exercises, and any difficulties were addressed. The group was asked to share their personal stories and experiences of practicing self-compassion and to develop compassionate encouragement for each other. Self-report measures were administered at the beginning, end, and at a 1-year follow-up.
Results:
This 16-week group therapy was associated with significant reductions in shame measured by the Others as Shamer Scale (OAS), social comparison on the Social Comparison Scale (SCS) feelings of hating oneself, and an increase in abilities to be self-reassuring on the Self-Attacking and Self-Reassuring Scale (FSCRS), depression and stress measured by the Depression Anxiety and Stress Scale (DASS). There were significant changes on all CORE variables, well-being, risk, functioning, and problems. Also interesting was that all variables showed a trend for continued improvement at 1-year follow-up, albeit statistically non-significant. A content analysis revealed that patients had found it a moving and very significant process in their efforts to develop emotional regulation and self-understanding.
Conclusion:
CFT, delivered in a routine psychotherapy department for personality disorders, revealed a beneficial impact on a range of outcome measures. These improvements were maintained and further changes noted at 1-year follow-up. Further research is needed to explore the benefits of CFT using more detailed analysis and RCTs.
Evaluation researchers frequently obtain self-reports of behaviors, asking program participants to report on process and outcome-relevant behaviors. Unfortunately, reporting on one’s behavior poses a difficult cognitive task, and participants’ reports can be profoundly influenced by question wording, format, and context. We review the steps involved in answering a question about one’s behavior and highlight the underlying cognitive and communicative processes. We alert researchers to what can go wrong and provide theoretically grounded recommendations for pilot testing and questionnaire construction.
Background:
The assessment of intervention integrity is essential in psychotherapeutic intervention outcome research and psychotherapist training. There has been little attention given to it in mindfulness-based interventions research, training programs, and practice.
Aims:
To address this, the Mindfulness-Based Interventions: Teaching Assessment Criteria (MBI:TAC) was developed. This article describes the MBI:TAC and its development and presents initial data on reliability and validity.
Method:
Sixteen assessors from three centers evaluated teaching integrity of 43 teachers using the MBI:TAC.
Results:
Internal consistency (α = .94) and interrater reliability (overall intraclass correlation coefficient = .81; range = .60-.81) were high. Face and content validity were established through the MBI:TAC development process. Data on construct validity were acceptable.
Conclusions:
Initial data indicate that the MBI:TAC is a reliable and valid tool. It can be used in Mindfulness-Based Stress Reduction/Mindfulness-Based Cognitive Therapy outcome evaluation research, training and pragmatic practice settings, and in research to assess the impact of teaching integrity on participant outcome.
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.
Recent work in the neuroscience of positive affect has suggested that there may be two different types of positive affect. One is linked to a drive/seeking system (and may be dopaminergic mediated) and the other is a soothing-contentment system (and may be opiate/oxytocin mediated). This study sought to develop a self-report scale that could tap these positive affects in regard to characteristic feelings individuals may have. Results from 203 students suggested three (rather than two) underlying factors: activated positive affect, relaxed positive affect, and safe/content positive affect. It was the safe/content positive affect that had the highest negative correlations with depression, anxiety and stress, self-criticism, and insecure attachment. Hence, greater clarity on the different types and functions of positive affect may demystify the relationship between positive emotions and well-being.
The Buddhist construct of mindfulness is a central element of mindfulness-based interventions and derives from a systematic phenomenological programme developed over several millennia to investigate subjective experience. Enthusiasm for ‘mindfulness’ in Western psychological and other science has resulted in proliferation of definitions, operationalizations and self-report inventories that purport to measure mindful awareness as a trait. This paper addresses a number of seemingly intractable issues regarding current attempts to characterize mindfulness and also highlights a number of vulnerabilities in this domain that may lead to denaturing, distortion, dilution or reification of Buddhist constructs related to mindfulness. Enriching positivist Western psychological paradigms with a detailed and complex Buddhist phenomenology of the mind may require greater study and long-term direct practice of insight meditation than is currently common among psychologists and other scientists. Pursuit of such an approach would seem a necessary precondition for attempts to characterize and quantify mindfulness.
There has been substantial interest in mindfulness as an approach to reduce cognitive vulnerability to stress and emotional distress in recent years. However, thus far mindfulness has not been defined operationally. This paper describes the results of recent meetings held to establish a consensus on mindfulness and to develop conjointly a testable operational definition. We propose a two-component model of mindfulness and specify each component in terms of specific behaviors, experiential manifestations, and implicated psychological processes. We then address issues regarding temporal stability and situational specificity and speculate on the conceptual and operational distinctiveness of mindfulness. We conclude this paper by discussing implications for instrument development and briefly describing our own approach to measurement.
For people at risk of depressive relapse, mindfulness-based cognitive therapy (MBCT) has an additive benefit to usual care (H. F. Coelho, P. H. Canter, & E. Ernst, 2007). This study asked if, among patients with recurrent depression who are treated with antidepressant medication (ADM), MBCT is comparable to treatment with maintenance ADM (m-ADM) in (a) depressive relapse prevention, (b) key secondary outcomes, and (c) cost effectiveness. The study design was a parallel 2-group randomized controlled trial comparing those on m-ADM (N = 62) with those receiving MBCT plus support to taper/discontinue antidepressants (N = 61). Relapse/recurrence rates over 15-month follow-ups in MBCT were 47%, compared with 60% in the m-ADM group (hazard ratio = 0.63; 95% confidence interval: 0.39 to 1.04). MBCT was more effective than m-ADM in reducing residual depressive symptoms and psychiatric comorbidity and in improving quality of life in the physical and psychological domains. There was no difference in average annual cost between the 2 groups. Rates of ADM usage in the MBCT group was significantly reduced, and 46 patients (75%) completely discontinued their ADM. For patients treated with ADM, MBCT may provide an alternative approach for relapse prevention.
Recovered recurrently depressed patients were randomized to treatment as usual (TAU) or TAU plus mindfulness-based cognitive therapy (MBCT). Replicating previous findings, MBCT reduced relapse from 78% to 36% in 55 patients with 3 or more previous episodes; but in 18 patients with only 2 (recent) episodes corresponding figures were 20% and 50%. MBCT was most effective in preventing relapses not preceded by life events. Relapses were more often associated with significant life events in the 2-episode group. This group also reported less childhood adversity and later first depression onset than the 3-or-more-episode group, suggesting that these groups represented distinct populations. MBCT is an effective and efficient way to prevent relapse/recurrence in recovered depressed patients with 3 or more previous episodes.
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.
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.
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.
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.
Processing difficult emotions is assumed to be of importance in therapeutic change. In this study, we examine whether a two-chair dialogue in Emotion-focused Therapy (EFT) is associated with a change in emotional processing, measured as changes in emotional arousal and emotional experiencing. In a multiple baseline design, 20 clients in treatment for depression or anxiety first received five, seven or nine weekly sessions of baseline treatment providing Rogerian conditions and affect attunement. In the second phase, two-chair intervention was added for the five consecutive sessions. All sessions were subdivided into 2 min segments which were rated using the Client Emotional Arousal Scale III and the Experiencing Scale. Analyses indicated a significantly higher number of high-arousal segment in the latter phase. Individual clients’ change trajectories were not significantly steeper in the second phase. Experiencing increased throughout both phases of treatment. However, after introducing the two-chair dialogue the Experiencing change trajectory was not significantly steeper than in the baseline phase. Findings suggest that both the two-chair dialogue and the Rogerian conditions with affect attunement focus are effective in facilitating emotional processing. Results are consistent with previous research, suggesting that the two-chair dialogue is an emotionally evocative intervention. Implications and limitations are discussed.
Self-compassion is increasingly explored as a protective factor in relation to psychopathology. The Self-Compassion Scale (SCS) and its Short Form variant (SCS-SF) are the most widely used instruments for measuring this psychological construct, and previous studies have indeed shown that the total score of this scale is negatively associated with psychopathology. In this article, we point out that half of the items of the SCS and SCS-SF are positive indicators of self-compassion and directly refer to the three key components of self-kindness, common humanity and mindfulness, while the other half of the items are negative indicators of the construct and reflect the precise opposite of the key components, namely self-judgment, isolation and over-identification. A meta-analysis was conducted including 18 studies that reported on the positive and negative indicators of self-compassion as indexed by the SCS/SCS-SF and their relations to various types of psychopathology. Results showed that positive indicators of self-compassion were negatively associated with psychopathology, which confirms their hypothesized protective influence. However, the negative indicators were positively linked to psychopathology, suggesting that these scales tap increased vulnerability to mental health problems. Moreover, tests comparing the strength of the relations between various SCS/SCS-SF counterparts (i.e., self-kindness versus self-judgment, common humanity versus isolation and mindfulness versus over-identification) and psychopathology showed that the negative indicators were significantly stronger linked to mental health problems than the positive indicators. This provides support for the idea that the use of a total self-compassion score of the SCS or SCS-SF, which typically includes the reversely scored negative subscales, will probably result in an inflated relationship with symptoms of psychopathology. Copyright © 2016 John Wiley & Sons, Ltd.
Self-compassion describes a positive and caring attitude of a person toward her- or himself in the face of failures and individual shortcomings. As a result of this caring attitude, individuals high in self-compassion are assumed to experience higher individual well-being. The present meta-analysis examines the relationship between self-compassion and different forms of well-being.
The authors combined k = 79 samples, with an overall sample size of N = 16,416, and analyzed the central tendencies of effect sizes (Pearson correlation coefficients) with a random-effect model.
We found an overall magnitude of the relationship between self-compassion and well-being of r = .47. The relationship was stronger for cognitive and psychological well-being compared to affective well-being. Sample characteristics and self-esteem were tested as potential moderators. In addition, a subsample of studies indicated a causal effect of self-compassion on well-being.
The results clearly highlight the importance of self-compassion for individuals' well-being. Future research should further investigate the relationship between self-compassion and the different forms of well-being, and focus on the examination of possible additional moderators.
© 2015 The International Association of Applied Psychology.
This article defines the construct of self-compassion and describes the development of the Self-Compassion Scale. Self-compassion entails being kind and understanding toward oneself in instances of pain or failure rather than being harshly self-critical; perceiving one's experiences as part of the larger human experience rather than seeing them as isolating; and holding painful thoughts and feelings in mindful awareness rather than over-identifying with them. Evidence for the validity and reliability of the scale is presented in a series of studies. Results indicate that self-compassion is significantly correlated with positive mental health outcomes such as less depression and anxiety and greater life satisfaction. Evidence is also provided for the discriminant validity of the scale, including with regard to self-esteem measures.
Evaluation researchers frequently obtain self-reports of behaviors, asking program participants to report on process and outcome-relevant behaviors. Unfortunately, reporting on one’s behavior poses a difficult cognitive task, and participants’ reports can be profoundly influenced by question wording, format, and context. We review the steps involved in answering a question about one’s behavior and highlight the underlying cognitive and communicative processes. We alert researchers to what can go wrong and provide theoretically grounded recommendations for pilot testing and questionnaire construction.
Whereas self-criticism has been proposed as an important risk factor for major depressive disorder (MDD), self-compassion has been suggested as a resilience factor that protects against the development and maintenance of depressive episodes. This study aimed to test the hypothesis that frequent self-criticism and low habitual self-compassion are related to concurrent depression and to vulnerability to depression by comparing groups of currently, remitted and never depressed individuals. As expected, both currently and remitted depressed individuals reported higher levels of self-criticism and lower self-compassion than never depressed controls. Individual differences in self-criticism and self-compassion were related to depression status above and beyond additional potential correlates of MDD (i.e., perfectionistic beliefs and cognitions, rumination and overall adaptive emotion regulation). The findings provide support for the idea that increased self-criticism and decreased self-compassion place certain individuals at increased risk for experiencing depression repeatedly or chronically over the course of their lives.
Although cognitive behavioral therapy (CBT) is an effective treatment for depression, a substantial number of individuals experience relapse following treatment. It is possible that these individuals remain vulnerable due to personality characteristics such as self-critical perfectionism. This study examined the longitudinal association of depressive symptoms, stressful events, and self-critical perfectionism using post-treatment data from the Component Analysis of Cognitive-Behavioral Treatment for Depression study. The temporal relationship between depressive symptoms and stressful events (assessed at treatment termination and at 6-, 12-, 18-, and 24-month follow-ups) was evaluated using the Latent Difference Score (LDS) structural modelling framework. Four theoretical models (no association, stress generation, stress reactivity, transactional) were compared. Results supported the stress reactivity model, in which stressful events led to subsequent depression symptom change. Multigroup LDS analysis demonstrated that longitudinal stress reactivity occurred only for individuals experiencing high levels of self-critical perfectionism. The results suggest that maintenance of treatment gains following CBT is related to an individual's personality style and stress reactivity.
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Self-criticism is a vulnerability risk factor for a number of psychological disorders, and it predicts poor response to psychological and pharmacological treatments. In the current study, we evaluated the efficacy of a loving-kindness meditation (LKM) programme designed to increase self-compassion in a sample of self-critical individuals. Thirty-eight individuals with high scores on the self-critical perfectionism subscale of the Dysfunctional Attitude Scale were randomized to an LKM condition (n = 19) or a wait-list (WL) condition (n = 19). Measures of self-criticism, self-compassion and psychological distress were administered before and immediately following the intervention (LKM or WL). WL participants received the intervention immediately after the waiting period. Both groups were assessed 3 months post-intervention. Intent-to-treat (n = 38) and per-protocol analyses (n = 32) showed significant reductions in self-criticism and depressive symptoms as well as significant increases in self-compassion and positive emotions in the LKM condition compared with the WL condition. A follow-up per-protocol analysis in both groups together (n = 20) showed that these gains were maintained 3 months after the intervention. These preliminary results suggest that LKM may be efficacious in alleviating self-criticism, increasing self-compassion and improving depressive symptoms among self-critical individuals. Copyright © 2014 John Wiley & Sons, Ltd.
Key practitioner message:
Self-criticism plays a major role in many psychological disorders and predicts poor response to brief psychological and pharmacological treatments for depression. The current study shows that loving-kindness meditation, designed to foster self-compassion, is efficacious in helping self-critical individuals become less self-critical and more self-compassionate. The study also suggests that practising loving-kindness may reduce depressive symptoms and increase positive emotions.
The Forms of Self‐criticizing/Attacking and Self‐reassuring Scale (FSCRS) is a self‐report questionnaire that assesses the forms of self‐criticism and self‐reassurance. The aim of this study was to explore the latent structure of the FSCRS in nonclinical and clinical samples. Data from 381 participants from the general population and from 304 participants from clinical settings were subjected to confirmatory factor analyses to explore several structural models reflecting alternative representations of the FSCRS dimensionality. Overall, the model with the best fit to the data, in both samples, was the three‐factor model (inadequate self, hated self and reassured self subscales) replicating the FSCRS original structure. The scale showed good psychometric characteristics, and the three factors discriminated between the clinical and nonclinical samples. To our knowledge, this is the first study to confirm the factor structure of the FSCRS in a purely clinical sample, and to test alternative models. This study adds to the existent literature that has been supporting the conceptualization of self‐criticism as a multidimensional construct. Given the good psychometric properties of the Portuguese version of the FSCRS, its use is encouraged and recommended for the assessment of self‐criticism in both clinical and research settings. Copyright © 2013 John Wiley & Sons, Ltd.
Key Practitioner Message
Our results suggest that self‐criticism is associated with psychopathology indicators and, for this reason, should be addressed in clinical settings. Also, self‐criticism is not a single process, and thus therapists may need to explore in more detail its different forms (i.e., feeling inadequate and hateful feelings for the self).
The FSCRS questionnaire may be an important tool in aiding therapists in assessing their patients, given its ability to discriminate individuals from the normal population and individuals from clinical settings. Thus, self‐criticism is s not only theoretically but also clinically meaningful.
Given the idea that self‐reassuring operates through a different affect system, helping people develop inner warmth and compassion for the self may be important to counteract feelings of self‐hatred and self‐attack.
A common concern when faced with multivariate data with missing values is whether the missing data are missing completely at random (MCAR); that is, whether missingness depends on the variables in the data set. One way of assessing this is to compare the means of recorded values of each variable between groups defined by whether other variables in the data set are missing or not. Although informative, this procedure yields potentially many correlated statistics for testing MCAR, resulting in multiple-comparison problems. This article proposes a single global test statistic for MCAR that uses all of the available data. The asymptotic null distribution is given, and the small-sample null distribution is derived for multivariate normal data with a monotone pattern of missing data. The test reduces to a standard t test when the data are bivariate with missing data confined to a single variable. A limited simulation study of empirical sizes for the test applied to normal and nonnormal data suggests that the test is conservative for small samples.
Objective:
Several studies have used the Forms of Self-Criticism/Reassurance Scale (FSCRS; Gilbert, Clarke, Hempel, Miles, & Irons, 2004) when exploring the role of emotion regulation in psychopathology. However, psychometric evaluation of the FSCRS is limited. The present study sought to confirm the factor structure of the FSCRS based on theoretical and empirical grounds in a large sample of the general population.
Method:
The FSCRS was completed by a large sample of men and women (N= 1,570) as part of an online survey. The data were randomly split in order to perform both independent exploratory (EFA) and confirmatory factor analyses (CFA). One-, two- and three-factor solutions were examined.
Results:
A three-factor model of reassured-self (RS) and the two types of self-criticism, inadequate-self (IS), and hated-self (HS), proved to be the best-fitting measurement model in this sample (χ(2) = 800.3, df= 148, p < .001; CFI [comparative fit index]= .966, TLI [Tucker Lewis index]= .961, RMSEA [root mean square error of the approximation]= .074). Although very similar to the original questionnaire, there were some differences in terms of the items that were retained. Validity was confirmed with the shortened FSCRS showing the same associations with mood and sex as the original version of the FSCRS.
Conclusion:
A three-factor model (RS, IS and HS) provided the best-fitting structure and confirmed the separation of different types of self-criticism. Future research should explore the degree to which these separable aspects of self-criticism are theoretically and clinically meaningful and to identify the role of self-reassurance in ameliorating their effects.
In this paper we investigate compassion and its place within mindfulness-based approaches. Compassion is an orientation of mind that recognizes pain and the universality of pain in human experience and the capacity to meet that pain with kindness, empathy, equanimity and patience. We outline how learning to meet pain with compassion is part of how people come to live with chronic conditions like recurrent depression. While most mindfulness-based approaches do not explicitly teach compassion, we describe how the structure of the programme and teachers' embodiment enable participants to cultivate compassion in the landscape of suffering. We describe a case example of how this process unfolded for someone through mindfulness-based cognitive therapy.
Compassionate mind training (CMT) was developed for people with high shame and self-criticism, whose problems tend to be chronic, and who find self-warmth and self-acceptance difficult and/or frightening. This paper offers a short overview of the role of shame and self-criticism in psychological difficulties, the importance of considering different types of affect system (activating versus soothing) and the theory and therapy process of CMT. The paper explores patient acceptability, understanding, abilities to utilize and practice compassion focused processes and the effectiveness of CMT from an uncontrolled trial. Six patients attending a cognitive–behavioural-based day centre for chronic difficulties completed 12 two-hour sessions in compassionate mind training. They were advised that this was part of a research programme to look at the process and effectiveness of CMT and to become active collaborators, advising the researchers on what was helpful and what was not. Results showed significant reductions in depression, anxiety, self-criticism, shame, inferiority and submissive behaviour. There was also a significant increase in the participants' ability to be self-soothing and focus on feelings of warmth and reassurance for the self. Compassionate mind training may be a useful addition for some patients with chronic difficulties, especially those from traumatic backgrounds, who may lack a sense of inner warmth or abilities to be self-soothing. Copyright © 2006 John Wiley & Sons, Ltd.
A sample of college students was selected as high or low in self-criticism using the Depressive Experiences Questionnaire. These students were videotaped criticizing themselves and responding to the criticism after an imagination exercise which recalled an experience of failure. Observer codings of emotion showed that Self-Critics displayed more contempt and disgust for the self in their self-criticism than did Controls. Observer codings also revealed that Self-Critics were less self-resilient than Controls in response to the criticism: They were less assertive, more submissive and more sad and ashamed than Controls. These results support the importance of emotion as well as negative cognition in the genesis of depressive states, particularly the emotions of contempt and disgust for the self. Furthermore, these findings suggest the need for a model of depressive vulnerability which more adequately accounts for emotional processes and which can account for self-resilience in the generation of vulnerable or invulnerable self-states.
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Cognitive behaviour therapy (CBT) is an effective treatment for chronic fatigue syndrome (CFS; sometimes known as myalgic encephalomyelitis). However, only a minority of patients fully recover after CBT; thus, methods for improving treatment outcomes are required. This pilot study concerned a mindfulness-based cognitive therapy (MBCT) intervention adapted for people with CFS who were still experiencing excessive fatigue after CBT. The study aimed to investigate the acceptability of this new intervention and the feasibility of conducting a larger-scale randomized trial in the future. Preliminary efficacy analyses were also undertaken. Participants were randomly allocated to MBCT or waiting list. Sixteen MBCT participants and 19 waiting-list participants completed the study, with the intervention being delivered in two separate groups. Acceptability, engagement and participant-rated helpfulness of the intervention were high. Analysis of covariance controlling for pre-treatment scores indicated that, at post-treatment, MBCT participants reported lower levels of fatigue (the primary clinical outcome) than the waiting-list group. Similarly, there were significant group differences in fatigue at 2-month follow-up, and when the MBCT group was followed up to 6 months post-treatment, these improvements were maintained. The MBCT group also had superior outcomes on measures of impairment, depressed mood, catastrophic thinking about fatigue, all-or-nothing behavioural responses, unhelpful beliefs about emotions, mindfulness and self-compassion. In conclusion, MBCT is a promising and acceptable additional intervention for people still experiencing excessive fatigue after CBT for CFS, which should be investigated in a larger randomized controlled trial.
Key practitioner message:
Only about 30% of people with chronic fatigue syndrome (CFS) recover after cognitive behaviour therapy (CBT); thus, methods for improving treatment outcomes are needed. This is the first pilot randomized study to demonstrate that a mindfulness-based intervention was associated with reduced fatigue and other benefits for people with CFS who were still experiencing excessive fatigue after a course of CBT. Levels of acceptability, engagement in the intervention and rated helpfulness were high. A larger-scale randomized controlled trial is required.
Mindfulness-based cognitive therapy (MBCT) is an efficacious psychosocial intervention for recurrent depression (Kuyken et al., 2008, Ma and Teasdale, 2004 and Teasdale et al., 2000). To date, no compelling research addresses MBCT’s mechanisms of change. This study determines whether MBCT’s treatment effects are mediated by enhancement of mindfulness and self-compassion across treatment, and/or by alterations in post-treatment cognitive reactivity. The study was embedded in a randomized controlled trial comparing MBCT with maintenance antidepressants (mADM) with 15-month follow-up (Kuyken et al., 2008). Mindfulness and self-compassion were assessed before and after MBCT treatment (or at equivalent time points in the mADM group). Post-treatment reactivity was assessed one month after the MBCT group sessions or at the equivalent time point in the mADM group. One hundred and twenty-three patients with ≥3 prior depressive episodes, and successfully treated with antidepressants, were randomized either to mADM or MBCT. The MBCT arm involved participation in MBCT, a group-based psychosocial intervention that teaches mindfulness skills, and discontinuation of ADM. The mADM arm involved maintenance on a therapeutic ADM dose for the duration of follow-up. Interviewer-administered outcome measures assessed depressive symptoms and relapse/recurrence across 15-month follow-up. Mindfulness and self-compassion were measured using self-report questionnaire. Cognitive reactivity was operationalized as change in depressive thinking during a laboratory mood induction.
Depression is characterized by a large risk of relapse/recurrence. Mindfulness-based cognitive therapy (MBCT) is a recent non-drug psychotherapeutic intervention to prevent future depressive relapse/recurrence in remitted/recovered depressed patients. In this randomized controlled trial, the authors investigated the effects of MBCT on the relapse in depression and the time to first relapse since study participation, as well as on several mood states and the quality of life of the patients. 106 recovered depressed patients with a history of at least 3 depressive episodes continued either with their treatment as usual (TAU) or received MBCT in addition to TAU. The efficacy of MBCT was assessed over a study period of 56 weeks. At the end of the study period relapse/recurrence was significantly reduced and the time until first relapse increased in the MBCT plus TAU condition in comparison with TAU alone. The MBCT plus TAU group also showed a significant reduction in both short and longer-term depressive mood and better mood states and quality of the life. For patients with a history of at least three depressive episodes who are not acutely depressed, MBCT, added to TAU, may play an important role in the domain of relapse prevention in depression.
This study explored the relationship of forms and functions of self-criticism, shame, and social rank variables to self-harm, depression, and anxiety.
The study used a questionnaire design.
In-patients and day-patients (N=73) completed a series of questionnaires measuring self-harm, mood, self-criticism, shame, and social comparison.
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.
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.
Mindfulness-Based Cognitive Therapy (MBCT) is a group intervention that integrates elements of Cognitive Behavioural Therapy (CBT) with components of mindfulness training to prevent depressive relapse. The efficacy of MBCT compared to Treatment As Usual (TAU), shown in two randomized controlled trials indicates a significant decrease in 1-year relapse rates for patients with at least three past depressive episodes. The present study is the first independent replication trial comparing MBCT+TAU to TAU alone across both language and culture (Swiss health care system).
Sixty unmedicated patients in remission from recurrent depression (>or=3 episodes) were randomly assigned to MBCT+TAU or TAU. Relapse rate and time to relapse were measured over a 60 week observation period. The frequency of mindfulness practices during the study was also evaluated.
Over a 14-month prospective follow-up period, time to relapse was significantly longer with MBCT+TAU than TAU alone (median 204 and 69 days, respectively), although both groups relapsed at similar rates. Analyses of homework adherence revealed that following treatment termination, the frequency of brief and informal mindfulness practice remained unchanged over 14 months, whereas the use of longer formal meditation decreased over time.
Relapse monitoring was 14months in duration and prospective reporting of mindfulness practice would have yielded more precise frequency estimates compared to the retrospective methods we utilized.
Further studies are required to determine which patient characteristics, beyond the number of past depressive episodes, may predict differential benefits from this therapeutic approach.
Mental mechanisms have evolved to enable animals (and humans) to be able to function in various social roles. It is suggested that the nature and functions of the mental mechanisms that enable animals to act as a hostile-dominant or threatened-subordinate can be distinguished. It is further suggested these can be internally activated and 'play off' against each other, such that a person 'attacks' themselves and then responds to their own internal attacks with subordinate defences. Hence, a depressed person can submit, feel defeated, belittled, beaten down, or want to run away (escape) from their own self-attacking thoughts, while psychotic voice hearers can feel similarly to their hostile voices. Such internal interactions may relate to depression in both psychotic voice hearers and depressed people.
A group of 66 voice hearers with a diagnosis of schizophrenia and 50 depressed patients were compared on a series of self-report questionnaires measuring the power of hostile self-directed thoughts/voices and the activation of defensive responses, especially fight/flight.
We present evidence that schizophrenic, malevolent voice hearers and self-critical depressed people experience their hostile, internally generated voices/thoughts as powerful, dominating and controlling (i.e. have typical characteristics of a hostile dominant). Moreover, these voices/thoughts activate evolved subordinate defences such as fight/flight and these are associated with depression in both depression and schizophrenia.
Conceptualizing aspects of depressed and psychotic thinking as relating to evolved mental mechanisms, which are role serving, but can internally play off against each other, may open new ways of investigating certain aspects of severe pathologies.
The Interacting Cognitive Subsystems analysis of cognitive vulnerability to depression predicts that subjective experiences of dysphoria in recovered depressed patients will be qualitatively different from those of controls. This study tested this prediction using a new instrument, the Depressed States Checklist.
Twenty-three recovered recurrently depressed patients and 54 never depressed controls rated the affective and self-devaluative components of a dysphoric experience.
Groups reported similar levels of affective component but recovered depressed patients reported higher self-devaluative dysphoric experience. At zero affective component of dysphoria neither group reported any self-devaluative feelings. With increasing affective component of dysphoria, the self-devaluative component increased significantly more in recovered patients than in controls. The ratio of self-devaluative to affective components of dysphoria significantly differentiated recovered depressed patients from controls.
As predicted, dysphoria in recovered depressed patients is qualitatively different from controls in ways that increase vulnerability to major depression. The Depressed States Checklist is a new, brief, measure of cognitive vulnerability to depression that may be particularly useful in large, prospective, epidemiological studies.
A wait-list randomized controlled trial of loving-kindness meditation programme for self-criticism
- B Shahar
- O Szepsenwol
- S Zilcha-Mano
- N Haim
- O Zamir
- S Levi-Yeshuvi
- N Levit-Binnun
Shahar, B., Szepsenwol, O., Zilcha-Mano, S., Haim, N., Zamir, O., Levi-Yeshuvi, S., & Levit-Binnun, N. (2015). A wait-list randomized controlled trial of loving-kindness meditation programme for self-criticism. Clinical Psychology & Psychotherapy, 22, 346-356. https://doi.
org/10.1002/cpp.1893
Measuring mindfulness and self-compassion: a questionnaire and ERP study (Doctoral dissertation
- T Talpsep
Talpsep, T. (2015). Measuring mindfulness and self-compassion: a questionnaire and ERP study (Doctoral dissertation, Tartu Ülikool).
Measuring mindfulness and self‐compassion: a questionnaire and ERP study (Doctoral dissertation, Tartu Ülikool)
- T. Talpsep