Marcela Matos

Fears of compassion: Development of three self-report measures

OBJECTIVES There is increasing evidence that helping people develop compassion for themselves and others has powerful impacts on negative affect and promotes positive affect. However, clinical observations suggest that some individuals, particularly those high in self-criticism, can find self-compassion and receiving compassion difficult and can be fearful of it. This study therefore developed measures of fear of: compassion for others, compassion from others, and compassion for self. We also explored the relationship of these fears with established compassion for self and compassion for others measures, self-criticism, attachment styles, and depression, anxiety, and stress. METHOD Students (N= 222) and therapists (N= 53) completed measures of fears of compassion, self-compassion, compassion for others, self-criticism, adult attachment, and psychopathology. RESULTS Fear of compassion for self was linked to fear of compassion from others, and both were associated with self-coldness, self-criticism, insecure attachment, and depression, anxiety, and stress. In a multiple regression, self-criticism was the only significant predictor of depression. CONCLUSION This study suggests the importance of exploring how and why some people may actively resist engaging in compassionate experiences or behaviours and be fearful of affiliative emotions in general. This has important implications for therapeutic interventions and the therapeutic relationship because affiliative emotions are major regulators of threat-based emotions.

Fears of compassion and happiness in relation to alexithymia, mindfulness, and self-criticism.

BACKGROUND There is increasing research to suggest that fears of, and resistances to, affiliative and positive emotions are linked to self-criticism and a range of psychopathologies. It is unclear how these fears and resistances are linked to each other and how these in turn are linked to psychological processes, such as abilities to be mindful and recognize and describe emotions. OBJECTIVES This research explores the relationship between fears of compassion and happiness in general, with capacities for emotional processing (alexithymia), capacities for mindfulness, and empathic abilities. To advance this research, a new scale was developed to measure general fears of positive feelings - the Fear of Happiness Scale. RESULTS The results showed that fears of compassion for self, from others and in particular fear of happiness, were highly linked to different aspects of alexithymia, mindfulness, empathy, self-criticism and depression, anxiety and stress. Especially noteworthy was the very high correlation between fear of happiness and depression (r= .70). CONCLUSION While the development of positive emotions, especially those linked to affiliation and connectedness are increasingly seen as important therapeutic targets, little research has focused on the blocks and fears to positive emotions. This study used newly developed fears of positive affect scales (e.g., compassion and happiness) to explore these aspects and found they were significantly linked to psychopathology variables self-criticism and difficulties such as alexithymia.

Understanding the Importance of Attachment in Shame Traumatic Memory Relation to Depression: The Impact of Emotion Regulation Processes

BACKGROUND Early relationships are crucial to human brain maturation, well-being, affect regulation and self-other schema. Shame traumatic memories are related to psychopathology, and recent research has shown that the quality and type of attachment relationships may be crucial in shame traumatic memories in relation to psychopathology. The current study explores a mediator model of emotion regulation processes (rumination, thought suppression and dissociation) on the association between shame traumatic memory, with attachment figures and with others, and depressive symptoms. METHOD Ninety subjects from the general community population completed the Shame Experiences Interview (SEI), assessing shame experiences from childhood and adolescence, and a battery of self-report scales measuring shame traumatic memory, rumination, thought suppression, dissociation and depression. RESULTS Mediator analyses show that emotion regulation processes, such as brooding, thought suppression and dissociation, mediate the association between shame traumatic memory with others and depression. In contrast, shame traumatic memory with attachment figures has a direct effect on depression, not mediated by emotion regulation processes, with only brooding partially mediating this relation. CONCLUSION The current findings shed light on the importance of attachment figures on the structuring of shame traumatic memories and on their impact on psychopathological symptoms, adding to recent neuroscience research and Gilberts approach on shame and compassion. In addition, our results emphasize the relevance of addressing shame memories, mainly those that involve attachment figures, particularly when working with patients suffering from depressive symptoms and/or that find compassion difficult or scary. KEY PRACTITIONER MESSAGE The quality of attachment relationships is important in how shame memories are structured and in their relation to psychopathology. The relationship between shame traumatic memory with attachment figures and depressive symptoms is not mediated by emotion regulation processes (rumination, thought suppression and dissociation). In contrast, these processes emerge as mediators on the association between shame traumatic memory with others and depression. For people suffering from depressive symptoms, having been shamed by an attachment figure may be a major block to develop self-compassion and receive compassion from others and may constitute an important obstacle to recovery. When working with patients suffering from depressive symptoms and/or that find compassion difficult or scary, it is important to target shame memories, especially those that involve attachment figures. In therapy with individuals with depressive symptoms and who reveal shame traumatic memories involving others, it may not only be pertinent to target these memories but also to evaluate and intervene on emotion regulation processes, particularly rumination, thought suppression and dissociation.

The impact of shame and self-judgment on psychopathology in infertile patients.

BACKGROUND Little is known about psychological processes of infertile couples pursuing medical treatment in comparison with fertile couples and adoption candidates who also suffer from infertility but are not seeking medical help. This study aims to contribute to a better understanding of these individuals in terms of psychological processes (such as external shame, internal shame and self-judgment) and their association with psychopathology, also attending to gender differences. METHODS One hundred control couples without known fertility problems [fertile group (FG)], 100 couples with an infertility diagnosis and pursuing medical treatment [infertile group (IG)], and 40 couples with an infertility diagnosis who are applying for adoption [adoption group (AG)] completed the instruments: Beck Depression Inventory, Spielberger State-Trait Anxiety Inventory, Others as Shamer, Experience of Shame Scale and the Self-compassion Scale. One-way analysis of variances were used to compare the three groups demographic and study variables. Pearson correlations and linear multiple regression analysis were performed to investigate the associations between shame, self-judgment, depression and anxiety. To explore gender differences, T-tests were used. RESULTS The IG group scored higher than FG and AG in measures of depression, anxiety, external shame, internal shame and self-judgment. In infertile couples, self-judgment, external shame and internal shame emerged as significant predictors of depressive symptomatology. Women with an infertility diagnosis tend to present higher levels of depressive and anxiety symptoms in comparison with fertile controls and adoption candidates. CONCLUSIONS This study highlights the importance of emotional regulation processes such as internal and external shame, and self-judgment, to the understanding of psychopathological symptomatology associated with infertility. Our results suggest that these issues should be addressed in a therapeutic context with these couples. Nevertheless, the heterogeneity of the infertile group, in what concerns different stages of medical diagnosis and treatment, might represent a limitation in the interpretation of our findings.

Shame Memories and Eating Psychopathology: The Buffering Effect of Self-Compassion

OBJECTIVE Research suggests that self-compassion may protect against shame in eating disorders. This study examines the association between shame memories, self-compassion, self-judgment and eating psychopathology severity and tests the moderator effect of self-compassion on the relationships between shame memories and eating psychopathology. METHOD Participants were 34 patients with the diagnosis of an eating disorder, who were assessed using Eating Disorder Examination and the Shame Experiences Interview and self-report instruments measuring the traumatic and centrality to identity features of shame memories, self-compassion and self-judgment. RESULTS Self-compassion was negatively correlated to shame memory features and eating psychopathology, and self-judgment was positively associated with such variables. Self-compassion had a moderator effect on the association between shame traumatic and central memories and eating psychopathology severity. CONCLUSION This is the first study to explore the buffering effect of self-compassion against the pathogenic effects of shame memories on eating psychopathology severity in eating disorders, with relevant clinical and research implications.

Differences between Depression and Paranoia: The Role of Emotional Memories, Shame and Subordination

UNLABELLED The present study explores how emotional memories, shame and submissive behaviour in adulthood are differently related to depression and paranoia, in a sample of 255 subjects from the general community population. Results show that emotional memories (especially, shame traumatic memory) are significantly correlated with external and internal shame. Emotional memories are significantly associated with submissive behaviour. Both types of shame are correlated with submissive behaviour, particularly internal shame. Emotional memories, external and internal shame are linked to depressive symptoms. Emotional memories, external and internal shame, and submissive behaviour are significantly related to paranoia. Path analysis results suggested that (1) shame traumatic memory and recall of threat and submissiveness in childhood predicted depressive symptoms through external and internal shame; (2) early emotional memories of shame, threat and submissiveness predicted paranoid ideation both directly and indirectly, through external shame; and (3) emotional memories impact on paranoid ideation both through their effect upon external shame and also through their indirect effect upon submission, which in turn fully mediates the effect of internal shame upon paranoid ideation. These findings highlight the differences between depression and paranoia. In depression, it is the internalization of early experiences of shame, threat and submissiveness that heighten the vulnerability to depressive states. In paranoia, not only shame traumas and recollections of threat and submissiveness directly influence paranoid beliefs but also these memories promote external and internal shame thoughts and feelings and submissive defenses, which in turn increase paranoid ideation. KEY PRACTITIONER MESSAGE Individuals with shame traumas, threat and submissiveness experiences in childhood and high levels of external and internal shame report more depressive symptoms. High levels of paranoid beliefs are associated with high negative emotional memories, external and internal shame thoughts and feelings, and submissive behaviour defenses. Therapy for depression needs to incorporate strategies that help individuals develop skills to deal with shame experiences and its outputs. Treatment for paranoid ideation must address external and internal shame, as well as emotional memories of shame, threat and submissiveness in childhood and development of assertive skills.

The Mediator Role of Emotion Regulation Processes on Infertility-Related Stress

The objective of this study is to investigate gender differences regarding the mediator role of self-compassion and self-judgment on the effects of external shame, internal shame, dyadic adjustment, on infertility-related stress. One hundred and sixty-two women and 147 men with a primary infertility diagnosis completed the following set of self-report measures: Others as Shamer, Experience of Shame Scale, Dyadic Adjustment Scale, Self-Compassion Scale, and Fertility Problem Inventory. Path analyses results revealed that in women self-compassion fully mediated the effect of internal shame on infertility-related stress and partially mediated the effect of dyadic adjustment on this variable, while external shame had only a direct effect. In men self-judgment fully mediated the effect of external and internal shame on infertility-related stress. Dyadic adjustment had only a direct effect on infertility-related stress. In conclusion, there is a distinct role of self-compassion and self-judgment on the relationship between shame and infertility-related stress in men and women. Such differences should be taken into account in psychological interventions with these patients. Future research is warranted to further support our results.

O Impacto Traumático de Experiências de Vergonha: Estudo das propriedades psicométricas da versão portuguesa da Impact of Event Scale - Revised

Experiencias precoces de vergonha tem sido apontadas como possiveis experiencias traumaticas, constituindo-se como memorias traumaticas com implicacoes na vulnerabilidade para a psicopatologia. O presente estudo explora as propriedades psicometricas da versao portuguesa da Escala do Impacto do Acontecimento- Revista (Impact of Event Scale-Revised, IES-R; Weiss & Marmar, 1997) numa amostra de 811 sujeitos da populacao geral. Especificamente, examina a estrutura factorial, a consistencia interna, a validade convergente e divergente deste instrumento de auto-resposta. A escala original (IES-R) foi traduzida para portugues e a comparabilidade do conteudo foi verificada atraves de traducao-retroversao. A validade de constructo foi analisada atraves de uma Analise em Componentes Principais, cujos resultados apoiaram a estrutura de uma dimensao subjacente a IES-R, que explica 55.4% da variância. Foram encontradas correlacoes item-total moderadas a elevadas (>.56) e um alfa de Cronbach elevado (α=.96), indicadores de excelente consistencia interna. A validade convergente e divergente da escala foi comprovada atraves das correlacoes elevadas encontradas com a Escala de Centralidade do Acontecimento e das correlacoes moderadas encontradas com as subescalas Depressao, Ansiedade e Stress. A IES-R mostrou ser um instrumento fiavel e valido para avaliar reaccoes de stress traumatico, com caracteristicas de intrusao, evitamento e hiperactivacao, em relacao a experiencias de vergonha.

The Impact of Shame, Self-Criticism and Social Rank on Eating Behaviours in Overweight and Obese Women Participating in a Weight Management Programme

Recent research has suggested that obesity is a stigmatised condition. Concerns with personal inferiority (social rank), shame and self-criticism may impact on weight management behaviours. The current study examined associations between social comparison (shame, self-criticism), negative affect and eating behaviours in women attending a community based weight management programme focused on behaviour change. 2,236 participants of the programme completed an online survey using measures of shame, self-criticism, social comparison, and weight-related affect, which were adapted to specifically address eating behaviour, weight and body shape perceptions. Correlation analyses showed that shame, self-criticism and social comparison were associated with negative affect. All of these variables were related to eating regulation and weight control (p < 0.001). Path analysis revealed that the association of shame, hated-self, and low self-reassurance on disinhibition and susceptibility to hunger was fully mediated by weight-related negative affect, even when controlling for the effect of depressive symptoms (p < 0.050 to p < 0.010). In addition, feelings of inadequacy and unfavourable social comparisons were associated with higher disinhibition and susceptibility to hunger, partially mediated through weight-related negative affect (p = 0.001). These variables were negatively associated with extent of weight loss during programme attendance prior to the survey, while self-reassurance and positive social comparisons were positively associated with the extent of weight loss prior to the survey (p < .050). Shame, self-criticism, and perceptions of inferiority may play a significant role in self-regulation of eating behaviour in overweight people trying to manage their weight.

Incorporating psychoeducation, mindfulness and self-compassion in a new programme for binge eating (BEfree): Exploring processes of change

This study explores the efficacy of BEfree, a 12-session group intervention that integrates psychoeducation, mindfulness, compassion and value-based action, in a sample of overweight and obese women with binge eating disorder (N = 31). We used repeated measures analyses of variance and explored processes of change in binge eating and eating psychopathology. At post-intervention, participants decreased in binge eating severity, eating psychopathology, external shame, self-criticism, psychological inflexibility, body image cognitive fusion and increased self-compassion and engagement with valued actions. These results were maintained at 3- and 6-month follow-up. The changes in binge eating were mediated by the changes in the psychological processes promoted by BEfree.