Self-compassion influences PTSD symptoms in the process of change in trauma-focused cognitive-behavioral therapies: a study of within-person processes

Abstract

Although self-compassion is considered a promising change agent in the treatment of posttraumatic stress disorder (PTSD), no studies of this hypothesis exist. This study examined the within-person relationship of self-compassion components (self-kindness, common humanity, mindfulness, self-judgment, isolation, over-identification) and subsequent PTSD symptoms over the course of therapy.Method: PTSD patients (n = 65) were randomized to either standard prolonged exposure, which includes imaginal exposure (IE) to the traumatic memory, or modified prolonged exposure, where imagery re-scripting (IR) of the memory replaced IE as the imagery component of prolonged exposure in a 10 weeks residential program. They were assessed weekly on self-compassion and PTSD symptom measures. The centering method of detrending was used to separate the variance related to the within-person process of change over the course of treatment from between-person variance.Results: The self-compassion components self-kindness, self-judgment, isolation, and over-identification had a within-person effect on subsequent PTSD symptoms. These relationships were independent of therapy form. The within-person relationship between self-judgment and subsequent PTSD symptoms was stronger in patients with higher initial self-judgment. By contrast, there were few indications that within-person variations in PTSD symptoms predict subsequent self-compassion components.Conclusion: The results support the role of self-compassion components in maintaining PTSD and imply the recommendation to facilitate decrease of self-judgment, isolation, and over-identification and increase of self-kindness in the treatment of PTSD patients. The reduction of self-judgment appears to be most important, especially for patients with a high initial level of self-judgment.

Ashamed and Afraid: A Scoping Review of the Role of Shame in Post-Traumatic Stress Disorder (PTSD)

“…This is in line with the emerging support for compassion-oriented interventions [87] and self-compassion as a potent mechanism of change within psychotherapy for PTSD [88]. The current review found evidence that psychotherapy may help contain the toxic effects of shame, creating a buffer between experiences of shame and trauma-related distress [39].…”

Self–Compassion is Best Measured as a Global Construct and is Overlapping with but Distinct from Neuroticism: A Response to Pfattheicher, Geiger, Hartung, Weiss, and Schindler (2017)

“…For instance, after 8 weeks of mindful self‐compassion training (Neff & Germer, ) participants reported a 30% increase in compassionate and a 33% decrease in uncompassionate responding toward the self (Neff, , ). This pattern has been observed for a wide variety of methodologies such as self‐compassion meditation training (Albertson et al, ; Toole & Craighead, ; Wallmark, Safarzadeh, Daukantaitė, & Maddux, ); online psycho‐education (Finlay‐Jones, Kane, & Rees, ; Krieger, Martig, van den Brink, & Berger, ); affect training (Hildebrandt, McCall, & Singer, ); imaginal exposure therapy (Hoffart, Øktedalen, & Langkaas, ); self‐compassion field training (Khorami, Moeini, & Ghamarani, ); compassion‐based Kg‐Free weight reduction training (Pinto‐Gouveia et al, ); compassion‐focused therapy (Beaumont, Irons, Rayner, & Dagnall, ; Kelly & Carter, ); compassionate mind training (Arimitsu, ; Beaumont, Rayner, Durkin, & Bowling, ); and mindful self‐compassion (Finlay‐Jones, Xie, Huang, Ma, & Guo, , Friis et al, , see Footnote 2; Neff, ). Mindfulness‐based interventions also yield a simultaneous increase in compassionate SCS subscale scores and a decrease in uncompassionate SCS subscale scores: for example, mindfulness‐based stress reduction (Birnie, Speca, & Carlson, ; Raab, Sogge, Parker, & Flament, ); mindfulness‐based cognitive therapy (Kuyken et al, , see Footnote 2); and Koru (Greeson, Juberg, Maytan, James, & Rogers, ).…”

The development of compassionate engagement and action scales for self and others

“…using bipolar constructs: kindness vs self-judgement; mindfulness vs self-absorption/over identification, and common humanity vs isolation. Low scores, indicating low self-compassion, are highly correlated with experiences of paranoia, shame and self-criticism [88]; post traumatic stress disorder [60]; depression [95] and mental health problems in general [15,83,97].…”