The influence of self‐criticism on depression symptoms among ambulatory patients with inflammatory bowel disease

Abstract

Considering that self-criticism is an important process in the development and maintenance of depression, and taking into account the stigma associated with inflammatory bowel disease (IBD), the present study aimed to analyse whether self-criticism exacerbates the relationships of depression symptoms with IBD symptomatology and chronic illness-related shame.The sample included 53 ambulatory IBD patients (66% females) with ages from 18 to 65. Moderation analyses were conducted using structural equation modelling. Self-criticism exacerbated the associations of depression with IBD symptoms (b = 0.01; standard error [SE] = 0.00; Z = 3.73; P < .001) and illness shame (b = 0.02; SE = 0.01; Z = 2.40; P = .016). For the same level of IBD symptomatology or chronic illness-related shame, those individuals who present more feelings of inadequacy towards the self, experience more symptoms of depression. This exacerbation effect is stronger when IBD symptomatology and chronic illness-related shame are more intense.A high self-critical IBD patient may view the illness and/or symptomatology as a flaw or error that should be self-corrected. Physicians and other health professionals should be attentive to these pathological mechanisms and should attempt to alleviate them. It may be beneficial to refer high self-critical patients to psychological care.

The LIFEwithIBD Intervention: Study Protocol for a Randomized Controlled Trial of a Face-to-Face Acceptance and Commitment Therapy and Compassion-Based Intervention Tailored to People With Inflammatory Bowel Disease

“…Symptom perception was measured by the IBD symptoms scale ( 15 ), a 16-item self-report Portuguese scale which was developed to evaluate the frequency of IBD symptoms during the precedent month (e.g., fatigue, abdominal pain and bloating, flatulence, diarrhea, nausea or vomiting, fever, the urgency to evacuate). Each item is rated on a 7-point scale [ranging from “ Never” (0) to “ Always” (6) ].…”

“…Recently, a few studies have called for the pertinence of adding compassion-based components to such interventions based on the fact that people with IBD are impacted by stigma, shame, and self-criticism ( 12 , 15 , 31 ). Concerns of people with IBD can include being treated as different, being ostracized by society, or feeling a burden to others ( 32 , 33 ).…”

“…Illness-related shame in people with IBD also seems to negatively influence psychological health and quality of social relationships ( 31 ). People with IBD may be self-critical, perceiving themselves as inadequate, flawed, or defective, which seems to exacerbate the effects of IBD symptom perception and illness shame on depressive symptomatology ( 15 ).…”

“…Findings from recent studies examining which factors are linked to poor mental health outcomes in people with IBD have suggested that this population may benefit from psychological interventions focused on promoting acceptance and cultivating self-compassion (12)(13)(14)(15). Arguments for interventions based on psychological flexibility lie on studies showing the detrimental effects of experiential avoidance (i.e., unwillingness to have internal experiences such as thoughts, emotions, and physical sensations, consequently leading to attempts to avoid them) (16) and cognitive fusion (entanglement with thoughts which leads to taking them as literal truths) (17), on mental health and quality of life outcomes.…”

A pilot randomized controlled trial of online acceptance and commitment therapy versus compassion‐focused therapy for chronic illness

“…Rumination seems to be an underlying mechanism of the impact of chronic stress on hypertension (Gerin et al, 2012), not only amplifying distress and suicidality but also extending the stress physiological response (Grierson et al, 2016). In addition to rumination, self‐criticism detrimentally contributes to poor mental health in CI, for example, by intensifying the impact of pain on depression in chronic pain (Lerman et al, 2012), or the impact of depression on inflammatory bowel disease symptom severity and illness‐related shame (e.g., Trindade et al, 2019). Indeed, illness‐related shame seems to be a relevant affective process in CI (Dolezal & Lyons, 2017), with studies suggesting that it is associated with poor quality of life in college students with CI (Trindade, Duarte, et al, 2018), mediates the impact of body image dissatisfaction on depression in women with breast cancer (Trindade, Marta‐Simões, et al, 2018), and is associated to avoidance (as opposed to valued living) and poor psychological and social quality of life in people with inflammatory bowel disease (Trindade et al, 2020).…”