Allison C. Kelly

Soothing Oneself and Resisting Self-Attacks: The Treatment of Two Intrapersonal Deficits in Depression Vulnerability

Self-critical individuals are more likely to become and remain depressed (Blatt, Experiences of depression: Theoretical, research and clinical perspectives, American Psychological Association Press, Washington, DC, 2004). This vulnerability to depression may reflect the association of trait self-criticism with difficulties self-soothing and resisting self-attacks. The current study tested the impact of two self-help interventions designed to reduce depression by improving these two intrapersonal deficits. The first was designed to foster compassionate self-relating whereas the second was designed to foster resilient self-relating. Seventy-five distressed acne sufferers were assigned to one of three conditions: a self-soothing intervention, an attack-resisting intervention, or a control condition. The interventions consisted of daily imagery-based self-talk exercises inspired by Gilbert’s (Genes on the couch: Explorations in evolutionary psychotherapy, Brenner-Routledge, Hove, 2000) social mentatlities theory and compassionate mind training (Gilbert and Irons, Compassion: Conceptualisations, research and use in psychotherapy, Brunner-Routledge, London, 2005). In two weeks, the self-soothing intervention lowered shame and skin complaints. The attack-resisting intervention lowered depression, shame, and skin complaints, and was especially effective at lowering depression for self-critics. Implications for the treatment of self-criticism and depression are discussed.

Between‐therapist and within‐therapist differences in the quality of the therapeutic relationship: effects on maladjustment and self‐critical perfectionism

The relationship between therapeutic outcome and a patient-reported measure of the Rogerian conditions of positive regard, empathy, and genuineness was decomposed into between-therapist effects and within-therapist effects using multilevel modeling. Data were available for 157 depressed outpatients treated by 27 therapists in the cognitive-behavioral therapy, interpersonal therapy, or placebo with clinical management conditions of the Treatment of Depression Collaborative Research Program (Elkin, 1994). Consistent with prior findings of significant between-therapist variability in outcome (e.g., Baldwin, Wampold, & Imel, 2007), patients whose therapists provided high average levels of the perceived Rogerian conditions across the patients in their caseloads experienced more rapid reductions in both overall maladjustment and depressive vulnerability (self-critical perfectionism). Within each therapists caseload, differences between patients in perceived Rogerian conditions had weaker effects. The results underline the importance of differences between therapists as determinants of outcome in the treatment of depression.

Self-compassion and fear of self-compassion interact to predict response to eating disorders treatment: A preliminary investigation

Abstract Gilbert (2005) proposed that the capacity for self-compassion is integral to overcoming shame and psychopathology. We tested this model among 74 individuals with an eating disorder admitted to specialized treatment. Participants completed measures assessing self-compassion, fear of self-compassion, shame, and eating disorder symptoms at admission and every 3 weeks during treatment. At baseline, lower self-compassion and higher fear of self-compassion were associated with more shame and eating disorder pathology. Multilevel modeling also revealed that patients with combinations of low self-compassion and high fear of self-compassion at baseline had significantly poorer treatment responses, showing no significant change in shame or eating disorder symptoms over 12 weeks. Results highlight a new subset of treatment-resistant eating disorder patients.

Social Safeness, Received Social Support, and Maladjustment: Testing a Tripartite Model of Affect Regulation

Drawing on recent neuroscience research, Gilbert (2005, 2009a) suggested that vulnerability and psychopathology could be conceptualized and treated using a tripartite model of affect regulation which postulates three evolved systems oriented toward threats, resources, and affiliation, and respectively triggering negative affect (NA), activated positive affect (PA), and social safeness. He additionally proposed that social safeness, characterized by feelings of warmth and connectedness, plays an especially important role in psychosocial functioning. We tested various aspects of this theory through a 7-day daily diary study in which 51 male and 51 female students completed measures of social safeness, NA, PA, perceived social support (PSS), and received social support (RSS) every evening. First, social safeness emerged as operationally distinct from low NA, PA, and PSS. Second, participants who endorsed higher mean levels of RSS over the week had higher mean levels of safeness, and social safeness was higher on days when participants reported higher RSS than their mean. Third, social safeness was more strongly related to numerous indicators of vulnerability and psychopathology than NA, PA, and PSS, and it predicted these variables controlling for NA, PA, and PSS. Results support the theory that social safeness is a distinct affective experience that responds to affiliation and offers unique protection from psychosocial suffering.

Self-compassion moderates the relationship between body mass index and both eating disorder pathology and body image flexibility

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 ones 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 womens 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 ones BMI.

Understanding the roles of self-esteem, self-compassion, and fear of self-compassion in eating disorder pathology: An examination of female students and eating disorder patients

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.

Autonomous and controlled motivation for eating disorders treatment: Baseline predictors and relationship to treatment outcome

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. Another limitation is that this was a correlational study and it is therefore important to be cautious about making causal conclusions when interpreting the results.

Group‐Based Compassion‐Focused Therapy as an Adjunct to Outpatient Treatment for Eating Disorders: A Pilot Randomized Controlled Trial

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. Copyright

Within-persons predictors of change during eating disorders treatment: An examination of self-compassion, self-criticism, shame, and eating disorder symptoms

OBJECTIVE Attempts to identify the predictors of change during eating disorders treatment have focused almost exclusively on identifying between-persons factors (i.e., differences between patients). Research on within-person predictors of change (i.e., variations within patients over time) may provide novel and clinically useful information. To illustrate, we test the theory that within patients, self-compassion, self-criticism, shame, and eating disorder symptoms reciprocally influence one another over time. METHOD Seventy-eight patients with an eating disorder completed the Self-Compassion Scale, Experience of Shame Scale, and Eating Disorder Examination Questionnaire every three weeks across 12 weeks of treatment. RESULTS Multilevel modeling revealed that following periods of increased shame, a patients eating pathology was more severe than usual. Following periods of increased self-compassion or decreased eating pathology, a patients level of shame was lower than usual. Between-person differences in the relationships among study variables also emerged. DISCUSSION Results support the theory that shame and eating pathology influence one another cyclically within patients over time, and suggest that time-dependent increases in self-compassion may interrupt this cycle. If replicated, these results might suggest that assessing and intervening with increases in a patients level of shame may help to reduce her eating pathology, and improving a patients level of self-compassion or eating disorder symptomology may lower her subsequent experiences of shame. Findings highlight the value of administering and examining repeatedly measured within-person predictors of change during eating disorders treatment, and suggest that it may be clinically important to attend to the changes that occur within a given patient over time.

Social exchange styles: Measurement, validation, and application

Drawing on evolutionary psychology, social exchange styles were conceptualized in terms of two dimensions of individual differences in approaching exchange relationships: Benefit–seeking and cost–vigilance. In Study 1, a principal components analysis of the Social Exchange Styles Questionnaire (SESQ) in 156 undergraduates confirmed the presence of two dimensions that were very similar to the expected dimensions: Equitable alliance building (EAB) and vigilant alliance management (VAM). The SESQ scales showed good internal consistency and construct validity. Multiple regressions confirmed that social exchange styles were distinct from other personality variables. In Study 2, multilevel modelling conducted on 45 small work groups demonstrated that EAB positively predicted members’ subjective performance, while VAM positively predicted objective performance. Theoretical questions and future research directions are discussed. Copyright