The relationship between self-compassion and chronic depression: a cross-sectional clinical study

José Eduardo da Silva, Sónia Catarina Simões

Abstract

Background: At present, depression is the world’s most common psychopathology. Self-compassion is a psychological concept that has shown promise regarding its impact on psychopathology. Despite a vast literature studying the relationship between depression and self-compassion, few studies about this association were done in clinical samples.

Goals: This study sought to analyze the associations between self-compassion, its dimensions and symptomatology of depression, during and after a therapeutic intervention.

Methods: A non-probabilistic sampling method was used. All participants had been diagnosed with persistent depression disorder (dysthymia) and were treated in a residential therapeutic community for a period of six to eight months. The original sample was divided into two groups: during (In-Treatment) and after treatment (one-year Post-Treatment). The assessment protocol was composed of Beck Depression Inventory (BDI II), Self-Compassion Scale (SELFCS) and sociodemographic characterization.

Results: The sample was composed of 63 participants, 28 females and 35 males (age: M = 32.84, SD = 10.24). Women presented lower levels of self-kindness and self-compassion (total score), and higher levels of all the negative dimensions of SELFCS. Patients with moderate or severe symptoms of depression indicated a lower total score of self-compassion as well as higher scores in all the negative dimensions; patients having undergone previous treatments showed higher levels of symptomatology of depression. The group assessed after the intervention presented higher levels of self-compassion and lower levels of over-identification, when compared to the group that was assessed still undergoing treatment. Finally, the self-judgment dimension of the SELFCS stands out as a predictor of depression for the total sample and the SELFCS’s isolation dimension is a predictor of BDI’s scores for the group undergoing treatment.

Discussion: Although most of the results are in line with similar findings of the existing literature about the relationship between the studied variables, some were unexpected, and may guide the direction of future studies and the application of these concepts within the clinical context.

Keywords

Chronic Depression, Dysthymic disorder, Self-Compassion, Self-Judgment

Full Text:

PDF

References

American Psychiatric Association (APA). 1994. Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

American Psychiatric Association (APA). 2013. Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Barnard, L. K., & Curry, J. F. (2011). Self-compassion: conceptualizations, correlates, and interventions. Review of General Psychology, 15, 289-303. https://doi.org/10.1037/a0025754.

Bebbington, P. E. (1996). The origins of sex differences in depressive disorder: bridging the gap. International Review of Psychiatry, 8, 295 – 332. https://doi.org/10.3109/09540269 609 051547.

Bebbington, P. E. (1998). Sex and depression. Psychological Medicine, 28, 1 - 8. https://doi.org/10.1017/s003329179700 6065.

Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4(6), 561-571. http://doi.org/10.1001/ archpsyc.1961.01710120031004

Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation. https://doi.org/10.1037/t00742-000.

Bifulco, A., Brown, G. W., Moran, P., & Ball, C. (1998). Predicting depression in women: the role of past and present vulnerability. Psychological Medicine, 28, 39-50. https://doi.org/ 10.1017/s0033291797005953.

Castilho, P., & Gouveia, J. P. (2011). Auto-Compaixão: Estudo da validação da versão portuguesa da Escala da Auto-Compaixão e da sua relação com as experiências adversas na infância, a comparação social e a psicopatologia. Psychologica. 1(54), 203–230. https://doi.org/10.14195/1647-8606_54_8.

Coutinho, M. P. L., Gontiès, B., Araújo, L. F., & Sá, R. C. N. (2003). Depressão, um sofrimento sem fronteira: representações sociais entre crianças e idosos. Psico-USF, 8(2), 183–192. https://doi.org/10.1590/S1413-82712003000200010.

Galante, J., Galante, I., Bekkers, M. J., & Gallacher, J. (2014). Effect of kindness-based meditation on health and well-being: a systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 82, 1101-1114. https://doi.org/ 10.1037/a0037249.

Gilbert, P. (2009). Introducing compassion-focused therapy. Advances in psychiatric treatment, 15(3), 199-208. https://doi.org/10.1192/apt.bp.107.005264.

Gilbert, P., & Procter, S. (2006). Compassionate mind training for people with high shame and self-criticism: overview and pilot study of a group therapy approach. Clinical Psychology & Psychotherapy, 13(6), 353–379. https://doi.org/10.1002/ cpp.507.

Gusmão, R.M., Xavier, M., Heitor, M.J., Bento, A., & Almeida, J.M. (2005). O peso das perturbações depressivas: aspectos epidemiológicos globais e necessidades de informação em Portugal. Acta Médica Portuguesa, 18(2), 129-46.

Hofmann, S. G., Grossman, P., & Hinton, D. E. (2011). Loving-kindness and compassion meditation: Potential for psychological interventions. Clinical Psychology Review, 31, 1126-1132. https://doi.org/10.1016/j.cpr.2011.07.003.

Horn, G. L. (2012). An investigation into the effects of cognitive behavioural therapy on patients with chronic depression: a small case series. Psychology Research and Behavior Management, 5, 123-129. https://doi.org/10.2147/prbm.s31774.

Iskender, M. (2009). The relationship between self-compassion, self-efficacy, and control belief about learning in Turkish university students. Social Behavior and Personality, 37, 711-720. https://doi.org/10.2224/sbp.2009.37.5.711.

Kaplan, H. I., & Sadock, B. J. (1997). Tratado de psiquiatria. Porto Alegre: Artmed.

Kelly, M., Tyrka, A., Price, L., & Carpenter, L. (2008). Sex differences in the use of coping strategies: predictors of anxiety and depressive symptoms. Depression and Anxiety, 25(10), 839-846. https://doi.org/10.1002/da.20341.

Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593-602. https://doi.org/10.1001/archpsyc.62.6.593.

Keyes, C. L. M. (2005). Mental illness and/or mental health? Investigating axioms of the complete state model of health. Journal of Consulting and Clinical Psychology, 73(3), 539–548. https://doi.org/10.1037/0022-006x.73.3.539.

Kline, R. (2005). Principles and practice of structural equations modeling (2nd ed.). London: Guilford Press.

Korner, A., Coroiu, A., Copeland, L., Gomez-Garibello, C., Albani, C., & Zenger, M. (2015). The role of self-compassion in buffering symptoms of depression in the general population. PLoS One, 10(10). https://doi.org/10.1371/journal.pone.0136598.

Krieger, T., Altenstein, D., Baettig, I., Doerig, N., & Holtforth, M.G. (2013). Self-compassion in depression: Associations with depressive symptoms, rumination, and avoidance in depressed outpatients. Behavior Therapy, 44, 501-513. https://doi.org/10.1016/j.beth.2013.04.004.

Krieger, T., Berger, T., & Holtforth, M.G. (2016). The relationship of self-compassion and depression: Cross-lagged panel analyses in depressed patients after outpatient therapy. Journal of Affective Disorders, 202, 39-45. https://doi.org/10.1016/j.jad.2016.05.032.

Lamers, S. M. A., Westerhof, G. J., Bohlmeijer, E. T., ten Klooster, P. M., & Keyes, C. L. M. (2011). Evaluating the psychometric properties of the Mental Health Continuum-Short Form (MHC-SF). Journal of Clinical Psychology, 67(1), 99–110. https://doi.org/10.1002/jclp.20741.

Leaviss, J., & Uttley, L. (2014). Psychotherapeutic benefits of compassion-focused therapy: an early systematic review. Psychological Medicine, 45(5), 927-945. https://doi.org/ 10.1017/s0033291714002141.

Lutz, A., Greischar, L., Rawlings, N., Ricard, M., & Davidson, R. (2004). Long-term meditators self-induce high-amplitude gamma synchrony during mental practice. Proceedings of the National Academy of Sciences of the United States of America, 101(46). https://www.pnas.org/content/101/46/16369.

MacBeth, A., & Gumley, A. (2012). Exploring compassion: A meta-analysis of the association between self-compassion and psychopathology. Clinical Psychology Review, 32(6), 545–552. https://doi.org/10.1016/j.cpr.2012.06.003.

Matthews, T., Danese, A., Wertz, J., Odgers, C. L., Ambler, A., Moffitt, T. E., & Arseneault, L. (2016). Social isolation, loneliness and depression in young adulthood: a behavioural genetic analysis. Social Psychiatry and Psychiatric Epidemiology, 51, 339-348. https://doi.org/10.1007/s00127-016-1178-7.

Michalak, E. E., & Lam, R. W. (2002). Breaking the myths: new treatment approaches for chronic depression. Canadian Journal of Psychiatry, 47(7), 635-643. https://doi.org/10.1177/ 070674370204700705.

Mills, A., Gilbert, P., Bellew, R., McEwan, K., & Gale, C. (2007). Paranoid beliefs and self-criticism in students. Clinical Psychology & Psychotherapy, 14(5), 358–364. https://doi.org/10.1002/cpp.537.

Mueller, T. I., Leon, A. C., Keller, M. B., Solomon, D. A., Endicott, J., Coryell, W., … Maser, J. D. (1999). Recurrence after recovery from major depressive disorder during 15 years of observational follow-up. The American Journal of Psychiatry, 156(7), 1000–1006. doi: 10.1176/ajp.156.7.1000

Neff, K. (2003a). Self-Compassion: An Alternative Conceptualization of a Healthy Attitude Toward Oneself. Self and Identity, 2(2), 85–101. https://doi.org/10.1080/1529886030 9032.

Neff, K. (2003b). The development and validation of a scale to measure self-compassion. Self and Identity, 2(3), 223–250. https://doi.org/10.1080/15298860309027.

Neff, K. D. (2012). The science of self-compassion. In C. Germer & R. Siegel (Eds.), Compassion and Wisdom in Psychotherapy (pp. 79-92). New York: Guilford Press.

Neff, K. D. (2015). The self-compassion scale is a valid and theoretically coherent measure of self-compassion. Mindfulness, 7(1), 264-274. https://doi.org/10.1007/s12671-015-0479-3.

Neff, K. D. (2016). Does self-compassion entail reduced self-judgment, isolation, and over-identification? A response to Muris, Otgaar, and Petrocchi. Mindfulness, 7(3), 791-797. https://doi.org/10.1007/s12671-016-0531-y.

Neff, K. D., Hsieh, Y. -P., & Dejitterat, K. (2005). Self-compassion, achievement goals, and coping with academic failure. Self and Identity, 4, 263-287. https://doi.org/10.1080/13576 500444000317.

Neff, K. D., Kirkpatrick, K.L., & Rude, S. S. (2007). Self-compassion and adaptive psychological functioning. Journal of Research in Personality, 41, 139-154. https://doi.org/ 10.1016/j.jrp.2006.03.004.

Neff, K. D., & McGehee, P. (2010). Self-compassion and psychological resilience among adolescents and young adults. Self and Identity, 9, 225-240. https://doi.org/10.1080/15298860 902979307.

Neff, K. D., Pisitsungkagarn, K., & Hsieh, Y. (2008). Self-compassion and self-construal in the United States, Thailand, and Taiwan. Journal of Cross-Cultural Psychology, 39, 267-285. https://doi.org/10.1177/0022022108314544.

Neff, K. D., & Pommier, E. (2013). The relationship between self-compassion and other-focused concern among college undergraduates, community adults, and practicing meditators. Self and Identity, 12, 160-176. https://doi.org/10.1080/ 15298868.2011.649546.

Neff, K. D., Rude, S. S., & Kirkpatrick, K. L. (2007). An examination of self-compassion in relation to positive psychological functioning and personality traits. Journal of Research in Personality, 41(4), 908–916. https://doi.org/10.1016/j.jrp.2006. 08.002.

Neff, K. D., & Vonk, R. (2009). Self-Compassion Versus Global Self-Esteem: Two Different Ways of Relating to Oneself. Journal of Personality, 77(1), 23–50. https://doi.org/10.1111/ j.1467-6494.2008.00537.x.

Parker, G., Wilhelm, K., & Asghari, A. (1997). Early onset depression: the relevance of anxiety. Social Psychiatry and Psychiatric Epidemiology, 32, 30-37. https://doi.org/10.1007/ bf00800665.

Pestana, M. H., & Gageiro, J. N. (2008). Análise de dados para ciências sociais: a complementaridade do SPSS (5th ed.). Lisboa: Edições Sílabo.

Piccinelli, M., & Wilkinson, G. (2000). Gender differences in depression. The British Journal of Psychiatry, 177(6), 486-492. https://doi.org/10.1192/bjp.177.6.486.

Ponciano, E., Cardoso, I., & Pereira, A. (2004). Adaptação de uma versão experimental em língua portuguesa do Beck Depression Inventory Second Edition (BDI-II) em estudantes do Ensino superior. In: Acção social e aconselhamento psicológico no ensino superior e intervenção (p. 329–337). Coimbra: SASUC.

Raes, F. (2010). Rumination and worry as mediators of the relationship between self-compassion and depression and anxiety. Personality and Individual Differences, 48(6), 757–761. https://doi.org/10.1016/j.paid.2010.01.023.

Raes, F. (2011). The effect of self-compassion on the development of depression symptoms in a non-clinical sample. Mindfulness, 2, 33-36. https://doi.org/10.1007/s12671-011-0040-y.

Raque-Bogdan, T., Ericson, S. K., Jackson, J., Martin, H. M., & Bryan, N. A. (2011). Attachment and mental and physical health: Self-compassion and mattering as mediators. Journal of Counseling Psychology, 58, 272-278. https://doi.org/ 10.1037/a0023041.

Rodgers, B. (1994). Pathways between parental divorce and adult depression. Journal of Child Psychology and Psychiatry, 35, 1289 -1308. https://doi.org/10.1111/j.1469-7610.1994. tb01235.x.

Trompetter, H., Kleine, E., & Bohlmeijer, E. T. (2016). Why does positive mental health buffer against psychopathology? An exploratory study on self-compassion as a resilience mechanism and adaptive emotion regulation strategy. Cognitive Therapy and Research, 41, 459-468. https://doi.org/10.1007/ s10608-016-9774-0.

Van Dam, N. T., Sheppard, S. C., Forsyth, J. P., & Earleywine, M. (2011). Self-compassion is a better predictor than mindfulness of symptom severity and quality of life in mixed anxiety and depression. Journal of Anxiety Disorders, 25(1), 123–30. https://doi.org/10.1016/j.janxdis.2010.08.011.

Veijola, J., Puukka, P., Letinen, V., Moring, J., Lindholm, T., & Vaisanen, E. (1998). Sex differences in the association between childhood experiences and adult depression. Psychological Medicine, 28, 21 -27. https://doi.org/10.1017/ s0033291797006089.

Weich, S., Brugha, T., King, M., McManus, S., Bebbington, P., Jenkins, R., … Stewart-Brown, S. (2011). Mental well-being and mental illness: Findings from the adult psychiatric morbidity survey for England 2007. British Journal of Psychiatry, 199(1), 23–28. https://doi.org/10.1192/bjp.bp.111.091496.

Wispe, L. (1991). The psychology of sympathy. New York: Plenum.

World Health Organization (WHO). 2017. Depression and Other Common Mental Disorders: Global Health Estimates. Geneva: Author.

Xavier, M., Baptista, H., Mendes, J. M., Magalhães, P., & Caldas-de-Almeida, J. M. (2013). Implementing the World Mental Health Survey Initiative in Portugal: rationale, design and fieldwork procedures. International Journal of Mental Health Systems, 7, 19. https://doi.org/10.1186/1752-4458-7-19.

Yarnell, L. M., & Neff, K. D. (2013). Self-compassion, interpersonal conflict resolutions, and well-being. Self and Identity, 12, 146-159. https://doi.org/10.1080/15298868.2011.6495 45.

Yarnell, L. M., Stafford, R., Neff, K. D., Reilly, E., Knox, M. C., & Mullarkey, M. (2015). Meta-Analysis of Gender Differences in Self-Compassion. Self and Identity, 14(5), 499-520. https://doi.org/10.1080/15298868.2015.1029966.

Refbacks

  • There are currently no refbacks.