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Examining the Role of Repetitive Negative Thinking in Relations Between Positive and Negative Aspects of Self-compassion and Symptom Improvement During Intensive Treatment

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Abstract

Positive aspects of self-compassion (i.e., self-kindness and nonjudgmental acceptance of personal experiences) as well as negative aspects (i.e., high self-criticism and self-coldness) are strong predictors of anxiety, depression, worry, and quality of life. To date, however, relatively little is known about (a) how both aspects of self-compassion change during naturalistic treatment, (b) whether and how such changes relate to symptom improvement, and (c) which processes might explain the potential benefits of self-compassion. To address these gaps, the present study examined whether relations between changes in both aspects of self-compassion and treatment outcomes in a brief partial hospital setting for acute psychology could be explained by associated changes in repetitive negative thinking (RNT), an established maladaptive cognitive process involved in anxiety and depressive disorders. In a sample of 582 people receiving cognitive-behavioral (CBT) and dialectical behavior therapy over the course of 1–2 weeks, increases in positive aspects of self-compassion and decreases in negative aspects related to improvements in depression and anxiety. RNT mediated the relationship between decreases in negative aspects of self-compassion and improvements in anxiety and depression. However, a reverse model also showed that decreases in negative aspects of self-compassion could also explain relations between RNT and depressive symptom improvement only. These findings suggest that negative aspects of self-compassion and RNT may constitute important targets for treatment in acute settings. Future studies should investigate the impact of greater focus on self-compassion on RNT and symptom improvement using longitudinal experimental designs with multiple assessment points, examining causality and directionality.

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Notes

  1. Most participants also attended a group that provided a brief (45 min), single-session introduction to self-compassion based on the model proposed by Neff (2011). In this group, participants learned Neff’s (2011) definition and components of self-compassion (self-kindness, common humanity, mindfulness), reviewed misconceptions and obstacles to self-compassion, and discussed and practiced concrete ways to implement self-compassion (e.g., through a short, guided meditation exercise, or an adapted cognitive restructuring worksheet). For all participants for which group attendance data was available (n = 480; data was missing for 102 participants), 74.2% attended.

  2. Clinicians are asked to perform MINI assessments during the initial program therapy session. A total of 93 MINIs were not administered for clinical reasons (e.g., participant was severely distressed, or there were clinical concerns about participant safety or burden). In addition, four MINIs were excluded because the clinician indicated that results were likely < 50% valid.

  3. When we tested a four-factor solution, a second factor consisting of four PTQ items emerged (items 2, 6, 7, and 12, which appear to more specifically assess the presence of intrusive/obsessive thoughts); however, all four items also loaded on the main PTQ factor. Although items that load on two factors are sometimes deleted from scales, we decided not to do this given that the PTQ has already been validated in its 15-item form, and instead opted to retain the 3-factor solution.

  4. Attendance to the self-compassion group (yes/no) did not relate to changes in self-compassion in this sample (p > .05), which was not surprising given the brief nature of this introductory group.

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Authors and Affiliations

  1. Clinical Psychology, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA, 02125, USA

    Lauren P. Wadsworth

  2. Behavioral Health Partial Hospital Program, McLean Hospital/Department of Psychiatry, Harvard Medical School, Belmont, USA

    Marie Forgeard & Thröstur Björgvinsson

  3. Department of Psychology, University of California, Los Angeles, Los Angeles, USA

    Kean J. Hsu

  4. Department of Psychology, Southern Illinois University, Carbondale, USA

    Sarah Kertz

  5. Department of Psychology, Emory University, Atlanta, USA

    Michael Treadway

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  1. Lauren P. Wadsworth
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Correspondence to Lauren P. Wadsworth.

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Lauren P. Wadsworth, Marie Forgeard, Kean Hsu, Sarah Kertz, Michael Treadway and Thröstur Björgvinsson declare that they have no conflict of interest.

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Wadsworth, L.P., Forgeard, M., Hsu, K.J. et al. Examining the Role of Repetitive Negative Thinking in Relations Between Positive and Negative Aspects of Self-compassion and Symptom Improvement During Intensive Treatment. Cogn Ther Res 42, 236–249 (2018). https://doi.org/10.1007/s10608-017-9887-0

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