Self-criticism has been shown to be a vulnerability factor that can lead to and maintain depressi... more Self-criticism has been shown to be a vulnerability factor that can lead to and maintain depression. We examined the moderating effect of fear of receiving compassion from others on the positive association between self-criticism and depression. Self-report measures were administered to four separate samples (total N = 701) varying in age (students and community adults) and cultural context (Canada, England, and Portugal). Two different measures of self-criticism and of depression were administered to investigate the generalizability of results. Self-criticism, depression, and fear of compassion from others were positively related to one another in all samples. As predicted, fear of compassion from others exerted a moderating effect on the relationship between self-criticism and depression. Low fear of compassion from others weakened the depressogenic effect of self-criticism, while high fear of compassion from others exacerbated the effect. Thus, a self-critic's ability to be open and responsive to care and support from others protected against depression. The aggregate moderating effect across the four studies was of medium size (d + = .53) and highly significant, indicating a robust phenomenon. Implications for working with self-critical depressed patients are discussed.
The extent to which patients experience their therapists as providing empathy, positive regard an... more The extent to which patients experience their therapists as providing empathy, positive regard and genuineness (the Rogerian Conditions) is an important predictor of outcome in the psychotherapy of depression (Zuroff & Blatt, 2006). Using data from 157 depressed outpatients treated by 27 therapists in the cognitive-behavior therapy, interpersonal therapy, or clinical management with placebo conditions of the Treatment of Depression Collaborative Research Program (Elkin et al., 1989), Zuroff, Kelly, Leybman, Blatt, and Wampold (2010) showed that between-therapists and within-therapist differences in Rogerian Conditions at the second treatment session predicted more rapid reductions in overall malad-justment. We conducted novel analyses intended to identify: 1) predictors of between-therapists and within-therapist differences in Rogerian Conditions and 2) moderators of the effects on maladjustment of between-therapists and within-therapist differences in Rogerian Conditions. Patients with lower levels of self-critical perfectionism, higher levels of an adaptive form of dependency or higher expectations of warmth from their therapists experienced higher levels of Rogerian Conditions than their therapist's average patient. High baseline self-critical perfectionism diminished the between-therapists effect of Rogerian Conditions on maladjustment, whereas baseline adaptive dependency enhanced the within-therapist effect of Rogerian Conditions. Results shed additional light on the centrality of patient characteristics, the Rogerian Conditions, and their transactions and interactions on outcome in brief outpatient therapy for depression.
The current study sought to assess the acceptability and feasibility of a compassion-focused ther... more The current study sought to assess the acceptability and feasibility of a compassion-focused therapy (CFT) group as an adjunct to evidence-based outpatient treatment for eating disorders, and to examine its preliminary efficacy relative to treatment as usual (TAU). Twenty-two outpatients with various types of eating disorders were randomly assigned to 12 weeks of TAU (n = 11) or TAU plus weekly CFT groups adapted for an eating disorder population (CFT + TAU; n = 11). Participants in both conditions completed measures of self-compassion, fears of compassion, shame and eating disorder pathology at baseline, week 4, week 8 and week 12. Additionally, participants receiving the CFT group completed measures assessing acceptability and feasibility of the group. Results indicated that the CFT group demonstrated strong acceptability; attendance was high and the group retained over 80% of participants. Participants rated the group positively and indicated they would be very likely to recommend it to peers with similar symptoms. Intention-to-treat analyses revealed that compared to the TAU condition, the CFT + TAU condition yielded greater improvements in self-compassion, fears of self-compassion, fears of receiving compassion, shame and eating disorder pathology over the 12 weeks. Results suggest that group-based CFT, offered in conjunction with evidence-based outpatient TAU for eating disorders, may be an acceptable, feasible and efficacious intervention. Furthermore, eating disorder patients appear to see benefit in, and observe gains from, working on the CFT goals of overcoming fears of compassion, developing more self-compassion and accessing more compassion from others.
Although self-compassion is associated with healthier body image and eating behavior, these findi... more Although self-compassion is associated with healthier body image and eating behavior, these findings have generally emerged at the between-persons level only. The present study investigated the unique contributions of within-person variability in self-compassion, and between-persons differences in self-compassion, to body image and eating behavior. Over seven days, 92 female college students completed nightly measures of self-compassion, self-esteem, dietary restraint, intuitive eating, body appreciation, body satisfaction, and state body image. Multilevel modeling revealed that within-persons, day-today fluctuations in self-compassion contributed to day-today fluctuations in body image and eating. Between-persons, participants' average levels of self-compassion across days contributed to their average levels of body image and eating over the week. Results generally held when controlling for within-and between-persons self-esteem. Evidently, the eating and body image benefits of self-compassion may come not only from being a generally self-compassionate person, but also from treating oneself more self-compassionately than usual on a given day.
Researchers have theorized that experiences of emotional warmth in early life influence the devel... more Researchers have theorized that experiences of emotional warmth in early life influence the development of the soothing system, an affect regulation system thought to underpin individuals' capacity for self-compassion and receiving compassion. The current study tested the theory that feelings of social safeness, also considered an output of the soothing system, might be a key mechanism through which parental warmth and capacities for compassion are linked. One-hundred and fifty-three female college students completed online measures of parental rearing behaviors, social safeness, positive and negative affect, self-compassion, received social support, and fears of compassion. Bootstrapping analyses supported our hypothesized mediational model. Controlling for overprotective and rejecting parenting behaviors, recalled parental warmth was linked to a greater capacity for self-compassion (high self-compassion, low fear of self-compassion) and receiving compassion (high received social support, low fear of receiving compassion) indirectly through affective experiences in general, and feelings of social safeness in particular. These findings suggest that differences in feelings of connectedness, reassurance, and contentment in social relationships might help to explain why children who recall fewer experiences of emotional warmth with parents are less capable and more afraid of self-compassion and receiving compassion. Theoretical and practical implications are discussed.
Objectives. The present pilot study sought to compare a compassion-focused therapy (CFT)-based se... more Objectives. The present pilot study sought to compare a compassion-focused therapy (CFT)-based self-help intervention for binge eating disorder (BED) to a behaviourally based intervention. Design. Forty-one individuals with BED were randomly assigned to 3 weeks of food planning plus self-compassion exercises; food planning plus behavioural strategies; or a wait-list control condition. Methods. Participants completed weekly measures of binge eating and self-compassion; pre-and post-intervention measures of eating disorder pathology and depressive symptoms; and a baseline measure assessing fear of self-compassion. Results. Results showed that: (1) perceived credibility, expectancy, and compliance did not differ between the two interventions; (2) both interventions reduced weekly binge days more than the control condition; (3) the self-compassion intervention reduced global eating disorder pathology, eating concerns, and weight concerns more than the other conditions; (4) the self-compassion intervention increased self-compassion more than the other conditions; and (5) participants low in fear of self-compassion derived significantly more benefits from the self-compassion intervention than those high in fear of self-compassion. Conclusions. Findings offer preliminary support for the usefulness of CFT-based interventions for BED sufferers. Results also suggest that for individuals to benefit from self-compassion training, assessing and lowering fear of self-compassion will be crucial. Practitioner points Individuals with BED perceive self-compassion training self-help interventions, derived from CFT, to be as credible and as likely to help as behaviourally based interventions. The cultivation of self-compassion may be an effective approach for reducing binge eating, and eating, and weight concerns in individuals with BED. Teaching individuals with BED CFT-based self-help exercises may increase their self-compassion levels over a short period of time. It may be important for clinicians to assess and target clients' fear of self-compassion for clients to benefit from self-compassion training interventions.
Objective. This study aimed to identify baseline predictors of autonomous and controlled motivati... more Objective. This study aimed to identify baseline predictors of autonomous and controlled motivation for treatment (ACMT) in a transdiagnostic eating disorder sample, and to examine whether ACMT at baseline predicted change in eating disorder psychopathology during treatment. Method. Participants were 97 individuals who met DSM-IV-TR criteria for an eating disorder and were admitted to a specialized intensive treatment programme. Self-report measures of eating disorder psychopathology, ACMT, and various psychosocial variables were completed at the start of treatment. A subset of these measures was completed again after 3, 6, 9, and 12 weeks of treatment. Results. Multiple regression analyses showed that baseline autonomous motivation was higher among patients who reported more self-compassion and more received social support, whereas the only baseline predictor of controlled motivation was shame. Multilevel modelling revealed that higher baseline autonomous motivation predicted faster decreases in global eating disorder psychopathology, whereas the level of controlled motivation at baseline did not. Conclusion. The current findings suggest that developing interventions designed to foster autonomous motivation specifically and employing autonomy supportive strategies may be important to improving eating disorders treatment outcome. Practitioner points The findings of this study suggest that developing motivational interventions that focus specifically on enhancing autonomous motivation for change may be important for promoting eating disorder recovery. Our results lend support for the use of autonomy supportive strategies to strengthen personally meaningful reasons to achieve freely chosen change goals in order to enhance treatment for eating disorders. One study limitation is that there were no follow-up assessments beyond the 12-week study and we therefore do not know whether the relationships that we observed persisted after treatment.
The present study examined the relative contributions of self-compassion, fear of self-compassion... more The present study examined the relative contributions of self-compassion, fear of self-compassion, and self-esteem in eating disorder pathology. One-hundred and fifty-five female undergraduate students and 97 females entering eating disorder treatment completed the Self-Compassion Scale, Fears of Compassion Scale, Rosenberg Self-Esteem Inventory, and Eating Disorder Examination Questionnaire. T-tests revealed that the patient group had lower mean self-compassion and higher mean fear of self-compassion than the student group. When controlling for self-esteem, high fear of self-compassion emerged as the strongest predictor of eating disorder pathology in the patient group, whereas low self-compassion was the strongest predictor in the student group. These preliminary results suggest that targeting fear of self-compassion may be important when intervening with individuals suffering from an eating disorder, whereas building self-compassion may be a valuable approach for eating disorder prevention.
The current study examined whether self-compassion, the tendency to treat oneself kindly during d... more The current study examined whether self-compassion, the tendency to treat oneself kindly during distress and disappointments, would attenuate the positive relationship between body mass index (BMI) and eating disorder pathology, and the negative relationship between BMI and body image flexibility. One-hundred and fifty-three female undergraduate students completed measures of self-compassion, self-esteem, eating disorder pathology, and body image flexibility, which refers to one's acceptance of negative body image experiences. Controlling for self-esteem, hierarchical regressions revealed that self-compassion moderated the relationships between BMI and the criteria. Specifically, the positive relationship between BMI and eating disorder pathology and the negative relationship between BMI and body image flexibility were weaker the higher women's levels of self-compassion. Among young women, self-compassion may help to protect against the greater eating disturbances that coincide with a higher BMI, and may facilitate the positive body image experiences that tend to be lower the higher one's BMI.
Background: Individuals with Anorexia Nervosa (AN) are renowned for their poor short-and long-ter... more Background: Individuals with Anorexia Nervosa (AN) are renowned for their poor short-and long-term treatment outcomes. To gain more insight into the reasons for these poor outcomes, the present study compared patients with AN-R (restrictive subtype), AN-BP (binge-purge subtype), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS) over 12 weeks of specialized eating disorders treatment. Eighty-nine patients completed the Eating Disorder Examination-Questionnaire (EDE-Q) and various measures of psychosocial functioning at baseline, and again after weeks 3, 6, 9, and 12 of treatment. Results: Multilevel modeling revealed that, over the 12 weeks, patients with AN-BP and AN-R had slower improvements in global eating disorder pathology, shape concerns, and self-compassion than those with EDNOS and BN. Patients with AN-BP had slower improvements in shame, social safeness (i.e., feelings of warmth in one's relationships), and received social support compared to those with AN-R, BN, and EDNOS. Conclusions: These findings support the need for more effective and comprehensive clinical interventions for patients with AN and especially AN-BP. Results also highlight not-yet studied processes that might contribute to the poor outcomes AN patients often face during and after treatment.
Self-criticism has been shown to be a vulnerability factor that can lead to and maintain depressi... more Self-criticism has been shown to be a vulnerability factor that can lead to and maintain depression. We examined the moderating effect of fear of receiving compassion from others on the positive association between self-criticism and depression. Self-report measures were administered to four separate samples (total N = 701) varying in age (students and community adults) and cultural context (Canada, England, and Portugal). Two different measures of self-criticism and of depression were administered to investigate the generalizability of results. Self-criticism, depression, and fear of compassion from others were positively related to one another in all samples. As predicted, fear of compassion from others exerted a moderating effect on the relationship between self-criticism and depression. Low fear of compassion from others weakened the depressogenic effect of self-criticism, while high fear of compassion from others exacerbated the effect. Thus, a self-critic's ability to be open and responsive to care and support from others protected against depression. The aggregate moderating effect across the four studies was of medium size (d + = .53) and highly significant, indicating a robust phenomenon. Implications for working with self-critical depressed patients are discussed.
The extent to which patients experience their therapists as providing empathy, positive regard an... more The extent to which patients experience their therapists as providing empathy, positive regard and genuineness (the Rogerian Conditions) is an important predictor of outcome in the psychotherapy of depression (Zuroff & Blatt, 2006). Using data from 157 depressed outpatients treated by 27 therapists in the cognitive-behavior therapy, interpersonal therapy, or clinical management with placebo conditions of the Treatment of Depression Collaborative Research Program (Elkin et al., 1989), Zuroff, Kelly, Leybman, Blatt, and Wampold (2010) showed that between-therapists and within-therapist differences in Rogerian Conditions at the second treatment session predicted more rapid reductions in overall malad-justment. We conducted novel analyses intended to identify: 1) predictors of between-therapists and within-therapist differences in Rogerian Conditions and 2) moderators of the effects on maladjustment of between-therapists and within-therapist differences in Rogerian Conditions. Patients with lower levels of self-critical perfectionism, higher levels of an adaptive form of dependency or higher expectations of warmth from their therapists experienced higher levels of Rogerian Conditions than their therapist's average patient. High baseline self-critical perfectionism diminished the between-therapists effect of Rogerian Conditions on maladjustment, whereas baseline adaptive dependency enhanced the within-therapist effect of Rogerian Conditions. Results shed additional light on the centrality of patient characteristics, the Rogerian Conditions, and their transactions and interactions on outcome in brief outpatient therapy for depression.
The current study sought to assess the acceptability and feasibility of a compassion-focused ther... more The current study sought to assess the acceptability and feasibility of a compassion-focused therapy (CFT) group as an adjunct to evidence-based outpatient treatment for eating disorders, and to examine its preliminary efficacy relative to treatment as usual (TAU). Twenty-two outpatients with various types of eating disorders were randomly assigned to 12 weeks of TAU (n = 11) or TAU plus weekly CFT groups adapted for an eating disorder population (CFT + TAU; n = 11). Participants in both conditions completed measures of self-compassion, fears of compassion, shame and eating disorder pathology at baseline, week 4, week 8 and week 12. Additionally, participants receiving the CFT group completed measures assessing acceptability and feasibility of the group. Results indicated that the CFT group demonstrated strong acceptability; attendance was high and the group retained over 80% of participants. Participants rated the group positively and indicated they would be very likely to recommend it to peers with similar symptoms. Intention-to-treat analyses revealed that compared to the TAU condition, the CFT + TAU condition yielded greater improvements in self-compassion, fears of self-compassion, fears of receiving compassion, shame and eating disorder pathology over the 12 weeks. Results suggest that group-based CFT, offered in conjunction with evidence-based outpatient TAU for eating disorders, may be an acceptable, feasible and efficacious intervention. Furthermore, eating disorder patients appear to see benefit in, and observe gains from, working on the CFT goals of overcoming fears of compassion, developing more self-compassion and accessing more compassion from others.
Although self-compassion is associated with healthier body image and eating behavior, these findi... more Although self-compassion is associated with healthier body image and eating behavior, these findings have generally emerged at the between-persons level only. The present study investigated the unique contributions of within-person variability in self-compassion, and between-persons differences in self-compassion, to body image and eating behavior. Over seven days, 92 female college students completed nightly measures of self-compassion, self-esteem, dietary restraint, intuitive eating, body appreciation, body satisfaction, and state body image. Multilevel modeling revealed that within-persons, day-today fluctuations in self-compassion contributed to day-today fluctuations in body image and eating. Between-persons, participants' average levels of self-compassion across days contributed to their average levels of body image and eating over the week. Results generally held when controlling for within-and between-persons self-esteem. Evidently, the eating and body image benefits of self-compassion may come not only from being a generally self-compassionate person, but also from treating oneself more self-compassionately than usual on a given day.
Researchers have theorized that experiences of emotional warmth in early life influence the devel... more Researchers have theorized that experiences of emotional warmth in early life influence the development of the soothing system, an affect regulation system thought to underpin individuals' capacity for self-compassion and receiving compassion. The current study tested the theory that feelings of social safeness, also considered an output of the soothing system, might be a key mechanism through which parental warmth and capacities for compassion are linked. One-hundred and fifty-three female college students completed online measures of parental rearing behaviors, social safeness, positive and negative affect, self-compassion, received social support, and fears of compassion. Bootstrapping analyses supported our hypothesized mediational model. Controlling for overprotective and rejecting parenting behaviors, recalled parental warmth was linked to a greater capacity for self-compassion (high self-compassion, low fear of self-compassion) and receiving compassion (high received social support, low fear of receiving compassion) indirectly through affective experiences in general, and feelings of social safeness in particular. These findings suggest that differences in feelings of connectedness, reassurance, and contentment in social relationships might help to explain why children who recall fewer experiences of emotional warmth with parents are less capable and more afraid of self-compassion and receiving compassion. Theoretical and practical implications are discussed.
Objectives. The present pilot study sought to compare a compassion-focused therapy (CFT)-based se... more Objectives. The present pilot study sought to compare a compassion-focused therapy (CFT)-based self-help intervention for binge eating disorder (BED) to a behaviourally based intervention. Design. Forty-one individuals with BED were randomly assigned to 3 weeks of food planning plus self-compassion exercises; food planning plus behavioural strategies; or a wait-list control condition. Methods. Participants completed weekly measures of binge eating and self-compassion; pre-and post-intervention measures of eating disorder pathology and depressive symptoms; and a baseline measure assessing fear of self-compassion. Results. Results showed that: (1) perceived credibility, expectancy, and compliance did not differ between the two interventions; (2) both interventions reduced weekly binge days more than the control condition; (3) the self-compassion intervention reduced global eating disorder pathology, eating concerns, and weight concerns more than the other conditions; (4) the self-compassion intervention increased self-compassion more than the other conditions; and (5) participants low in fear of self-compassion derived significantly more benefits from the self-compassion intervention than those high in fear of self-compassion. Conclusions. Findings offer preliminary support for the usefulness of CFT-based interventions for BED sufferers. Results also suggest that for individuals to benefit from self-compassion training, assessing and lowering fear of self-compassion will be crucial. Practitioner points Individuals with BED perceive self-compassion training self-help interventions, derived from CFT, to be as credible and as likely to help as behaviourally based interventions. The cultivation of self-compassion may be an effective approach for reducing binge eating, and eating, and weight concerns in individuals with BED. Teaching individuals with BED CFT-based self-help exercises may increase their self-compassion levels over a short period of time. It may be important for clinicians to assess and target clients' fear of self-compassion for clients to benefit from self-compassion training interventions.
Objective. This study aimed to identify baseline predictors of autonomous and controlled motivati... more Objective. This study aimed to identify baseline predictors of autonomous and controlled motivation for treatment (ACMT) in a transdiagnostic eating disorder sample, and to examine whether ACMT at baseline predicted change in eating disorder psychopathology during treatment. Method. Participants were 97 individuals who met DSM-IV-TR criteria for an eating disorder and were admitted to a specialized intensive treatment programme. Self-report measures of eating disorder psychopathology, ACMT, and various psychosocial variables were completed at the start of treatment. A subset of these measures was completed again after 3, 6, 9, and 12 weeks of treatment. Results. Multiple regression analyses showed that baseline autonomous motivation was higher among patients who reported more self-compassion and more received social support, whereas the only baseline predictor of controlled motivation was shame. Multilevel modelling revealed that higher baseline autonomous motivation predicted faster decreases in global eating disorder psychopathology, whereas the level of controlled motivation at baseline did not. Conclusion. The current findings suggest that developing interventions designed to foster autonomous motivation specifically and employing autonomy supportive strategies may be important to improving eating disorders treatment outcome. Practitioner points The findings of this study suggest that developing motivational interventions that focus specifically on enhancing autonomous motivation for change may be important for promoting eating disorder recovery. Our results lend support for the use of autonomy supportive strategies to strengthen personally meaningful reasons to achieve freely chosen change goals in order to enhance treatment for eating disorders. One study limitation is that there were no follow-up assessments beyond the 12-week study and we therefore do not know whether the relationships that we observed persisted after treatment.
The present study examined the relative contributions of self-compassion, fear of self-compassion... more The present study examined the relative contributions of self-compassion, fear of self-compassion, and self-esteem in eating disorder pathology. One-hundred and fifty-five female undergraduate students and 97 females entering eating disorder treatment completed the Self-Compassion Scale, Fears of Compassion Scale, Rosenberg Self-Esteem Inventory, and Eating Disorder Examination Questionnaire. T-tests revealed that the patient group had lower mean self-compassion and higher mean fear of self-compassion than the student group. When controlling for self-esteem, high fear of self-compassion emerged as the strongest predictor of eating disorder pathology in the patient group, whereas low self-compassion was the strongest predictor in the student group. These preliminary results suggest that targeting fear of self-compassion may be important when intervening with individuals suffering from an eating disorder, whereas building self-compassion may be a valuable approach for eating disorder prevention.
The current study examined whether self-compassion, the tendency to treat oneself kindly during d... more The current study examined whether self-compassion, the tendency to treat oneself kindly during distress and disappointments, would attenuate the positive relationship between body mass index (BMI) and eating disorder pathology, and the negative relationship between BMI and body image flexibility. One-hundred and fifty-three female undergraduate students completed measures of self-compassion, self-esteem, eating disorder pathology, and body image flexibility, which refers to one's acceptance of negative body image experiences. Controlling for self-esteem, hierarchical regressions revealed that self-compassion moderated the relationships between BMI and the criteria. Specifically, the positive relationship between BMI and eating disorder pathology and the negative relationship between BMI and body image flexibility were weaker the higher women's levels of self-compassion. Among young women, self-compassion may help to protect against the greater eating disturbances that coincide with a higher BMI, and may facilitate the positive body image experiences that tend to be lower the higher one's BMI.
Background: Individuals with Anorexia Nervosa (AN) are renowned for their poor short-and long-ter... more Background: Individuals with Anorexia Nervosa (AN) are renowned for their poor short-and long-term treatment outcomes. To gain more insight into the reasons for these poor outcomes, the present study compared patients with AN-R (restrictive subtype), AN-BP (binge-purge subtype), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS) over 12 weeks of specialized eating disorders treatment. Eighty-nine patients completed the Eating Disorder Examination-Questionnaire (EDE-Q) and various measures of psychosocial functioning at baseline, and again after weeks 3, 6, 9, and 12 of treatment. Results: Multilevel modeling revealed that, over the 12 weeks, patients with AN-BP and AN-R had slower improvements in global eating disorder pathology, shape concerns, and self-compassion than those with EDNOS and BN. Patients with AN-BP had slower improvements in shame, social safeness (i.e., feelings of warmth in one's relationships), and received social support compared to those with AN-R, BN, and EDNOS. Conclusions: These findings support the need for more effective and comprehensive clinical interventions for patients with AN and especially AN-BP. Results also highlight not-yet studied processes that might contribute to the poor outcomes AN patients often face during and after treatment.
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