Online Compassion Focused Therapy for overeating: Feasibility and acceptability pilot study.

OBJECTIVE: This pilot study aims to investigate the feasibility, acceptability, and potential effectiveness of online Compassion Focused Therapy for overeating (CFT-OE). METHOD: Eighteen Portuguese women seeking treatment for overeating were enrolled in this study, and 15 participants completed the CFT-OE. This was a single-arm study. Participants were assessed at pre- and post-intervention and 3-month follow-up. All participants completed measures assessing binge eating, cognitive restraint, uncontrolled eating, emotional eating, general eating psychopathology, general and body shame, self-criticism, self-compassion, and fears of self-compassion. RESULTS: The treatment attrition rate was 16.7%, which is relatively low compared to other similar online interventions. Participants gave positive feedback on the program and indicated they would recommend it to people with similar difficulties. CFT-OE improved self-compassion and reduced eating psychopathology symptoms, general and body shame, self-criticism, and fears of self-compassion. Clinical significance analysis showed that the majority of participants were classified as in recovery in all measures at post-intervention and 3-month follow-up. DISCUSSION: Preliminary results suggest that the online CFT-OE program is an acceptable and feasible intervention. Results also suggest that CFT-OE is beneficial for the treatment of women with difficulties with overeating. A future randomized controlled trial is necessary to establish the effectiveness of the CFT-OE. PUBLIC SIGNIFICANCE: This study indicates that online CFT-OE is a feasible and adequate intervention for women who struggle with overeating. This therapy showed promising results in reducing eating disorder symptoms, shame, and self-criticism and improving self-compassion. As an online intervention, CFT-OE may be more accessible and offer an alternative to in-person therapy.

Ruminative response scale for eating disorders: bifactor model and measurement invariance in a Portuguese community sample.

The Ruminative Response Scale for Eating Disorders (RRS-ED) measures ruminative thought content specifically related to eating disordered themes, assessing two domains of rumination, brooding and reflection. This study aims to examine the factor structure of the RRS-ED in a Portuguese community sample, using correlated two-factor models, unifactorial and bifactor models and test for invariance across sex. A sample of 535 adults (179 male; 356 female) filled out the RRS-ED. A subsample (n=347) answered additional measures of repetitive negative thinking and eating psychopathology. The bifactor model of the RRS-ED provided the best fit, demonstrating a reliable general rumination factor. Also, the bifactor model of the RRS-ED was invariant across sex. RRS-ED showed moderate to strong correlations with negative perseverative thinking and eating psychopathology. Both domain-specific factors of RRS-ED were associated with higher levels of eating psychopathology. Findings indicate that RRS-ED is a reliable and valid measure to assess the ruminative response from the general population in Portugal, showing initial evidence that supports the use of a total score of RRS-ED as an overall measure of rumination, while specific factor scores should be reported with caution. Future studies are needed to replicate the findings and further corroborate the unidimensionality of the RRS-ED.

Does self-compassion protect adolescents with non-suicidal self-injury from developing borderline features? A two-wave longitudinal study.

Background: Adolescence is a vulnerable developmental stage for the onset of non-suicidal self-injury (NSSI) and borderline features, which are related psychological phenomena. Self-compassion reflects a sensitivity to own suffering and a motivation to relieve it, consisting of a more positive and beneficial self-to-self relationship. The aim of the present study was to test the effect of self-compassion between borderline features at baseline and six months with a sample of adolescents with a history of NSSI.Methods: At assessment wave one, participants were 139 Portuguese adolescents with an NSSI history (mean age = 15.52 years, SD = 0.87). Of these, 87 were re-assessed six months later (mean age = 15.46 years, SD = 0.86). Data were analysed through SPSS and PROCESS Macro.Results: The moderation model explained 56% of borderline features six months later, and the interaction between initial borderline features and the low and medium levels of self-compassion was significant. Youth with lower initial borderline features presented higher borderline features six months later if they had low self-compassion.Conclusions: These findings suggest that among adolescents with a history of NSSI, those with lower levels of self-compassion tend to exhibit higher borderline features in six-month when compared to their peers with higher levels of self-compassion. This observation emphasises the potential beneficial effect of self-compassion within this population.

Using polyphenols as a relevant therapy to diabetes and its complications, a review.

Diabetes is currently a worldwide health concern. Hyperglycemia, hypertension, obesity, and oxidative stress are the major risk factors that inevitably lead to all the complications from diabetes. These complications severely impact the quality of life of patients, and they can be managed, reduced, or even reverted by several polyphenols, plant extracts and foods rich in these compounds. The goal of this review is to approach diabetes not as a single condition but rather an interconnected combination of risk factors and complications. This work shows that polyphenols have multi target action and effects and they have been systematically proven to be relevant in the reduction of each risk factor and improvement of associated complication.

Recent advances in ß-galactosidase and fructosyltransferase immobilization technology.

The highly demanding conditions of industrial processes may lower the stability and affect the activity of enzymes used as biocatalysts. Enzyme immobilization emerged as an approach to promote stabilization and easy removal of enzymes for their reusability. The aim of this review is to go through the principal immobilization strategies addressed to achieve optimal industrial processes with special care on those reported for two types of enzymes: ß-galactosidases and fructosyltransferases. The main methods used to immobilize these two enzymes are adsorption, entrapment, covalent coupling and cross-linking or aggregation (no support is used), all of them having pros and cons. Regarding the support, it should be cost-effective, assure the reusability and an easy recovery of the enzyme, increasing its stability and durability. The discussion provided showed that the type of enzyme, its origin, its purity, together with the type of immobilization method and the support will affect the performance during the enzymatic synthesis. Enzymes' immobilization involves interdisciplinary knowledge including enzymology, nanotechnology, molecular dynamics, cellular physiology and process design. The increasing availability of facilities has opened a variety of possibilities to define strategies to optimize the activity and re-usability of ß-galactosidases and fructosyltransferases, but there is still great place for innovative developments.

Assessing the In Vitro Inhibitory Effects on Key Enzymes Linked to Type-2 Diabetes and Obesity and Protein Glycation by Phenolic Compounds of Lauraceae Plant Species Endemic to the Laurisilva Forest.

Methanolic leaf extracts of four Lauraceae species endemic to Laurisilva forest (Apollonias barbujana, Laurus novocanariensis, Ocotea foetens and Persea indica) were investigated for the first time for their potential to inhibit key enzymes linked to type-2 diabetes (α-amylase, α-glucosidase, aldose reductase) and obesity (pancreatic lipase), and protein glycation. Lauraceae extracts revealed significant inhibitory activities in all assays, altough with different ability between species. In general, P. indica showed the most promissing results. In the protein glycation assay, all analysed extracts displayed a stronger effect than a reference compound: aminoguanidine (AMG). The in vitro anti-diabetic, anti-obesity and anti-glycation activities of analysed extracts showed correlation with their flavonols and flavan-3-ols (in particular, proanthocyanins) contents. These Lauraceae species have the capacity to assist in adjuvant therapy of type-2 diabetes and associated complications, through modulation of the activity of key metabolic enzymes and prevention of advanced glycation end-products (AGEs) formation.

Self-disgust and urge to be thin in eating disorders: how can self-compassion help?

PURPOSE: This study aimed to examine the moderator role of self-compassion in the relationship between self-disgust and drive for thinness, controlling for external shame, in eating disorder patients and in a community sample. METHODS: Sixty-two female participants with an eating disorder diagnose and 119 female participants from the community, were asked to fill instruments that assess self-disgust, self-compassion, drive for thinness, and external shame. RESULTS: We found a moderator effect of self-compassion on the association between self-disgust and drive for thinness in the clinical sample when adjusting for shame. The association between self-disgust and drive for thinness was buffered among those who reported medium and lower levels of self-compassion. Replicating the findings in the community sample we found no moderator effect of self-compassion. CONCLUSION: These results provide evidence that people with eating disorders who perceive the self as highly disgusting may benefit from promoting a self-compassionate response to diminish drive for thinness. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Targeting NF-κB signaling pathway in cancer by dietary polyphenols.

Being a transcription factor, NF-κB regulates gene expressions involving cell survival and proliferation, drug resistance, metastasis, and angiogenesis. The activation of NF-κB plays a central role in the development of inflammation and cancer. Thus, the down-regulation of NF-κB may be an exciting target in prevention and treatment of cancer. NF-κB could act as a tumor activator or tumor suppressant decided by the site of action (organ). Polyphenols are widely distributed in plant species, consumption of which have been documented to negatively regulate the NF-κB signaling pathway. They depress the phosphorylation of kinases, inhibit NF-κB translocate into the nucleus as well as interfere interactions between NF-κB and DNA. Through inhibition of NF-κB, polyphenols downregulate inflammatory cascade, induce apoptosis and decrease cell proliferation and metastasis. This review highlights the anticancer effects of polyphenols on the basis of NF-κB signaling pathway regulation.

Construct validity, sensitivity and specificity of the USCD Performance-based Skill Assessment 2 in a mixed Portuguese sample.

Assessment batteries of functional capacity provide robust indicators of real-world functioning in major psychiatric illnesses and important information on an individual's ability to live autonomously and pursue relevant psychosocial goals. OBJECTIVES: This study explores the psychometric properties of the Portuguese USCD Performance-based Skill Assessment 2 (UPSA-2-PT) in a mixed sample of Portuguese participants. METHOD: A sample of 110 participants, 37 patients diagnosed with schizophrenia, 27 first-degree relatives of patients and 46 controls were administered the UPSA-2-PT and self-report questionnaires. The UPSA-2-PT reliability was assessed through inter-rater reliability and internal consistency, convergent validity with community integration and a receiver operating curve analysis was conducted to establish scores' sensitivity and specificity. Youden's Index was used to determine an optimal UPSA-2-PT cutoff score. RESULTS: Findings show an excellent inter-rater reliability, good internal consistency and construct validity, consistent with previous studies in Western countries. The UPSA-2-PT also showed a good discriminant ability between patients and controls, and an overall percentage of correct classification of 86.7% based on the 81.59 cutoff. DISCUSSION: Findings are congruous with previous versions, strengthening the body of evidence supporting the construct validity and providing a useful tool for research and clinical purposes to practitioners.

Are shame and self-criticism the path to the pervasive effect of social stress reactivity on social functioning in psychosis?

It is widely known that stress reactivity and social functioning impairment are important difficulties in people with psychosis. However, the specific impact of stress reactivity on social functioning and its underlying mechanisms are still less explored. Social rank variables, such as shame and self-criticism, have been pointed out as relevant in the development, maintenance of several types of psychosocial suffering and, specifically, in psychotic disorders. This study's aim was to explore the associations between external shame, self-criticism, social stress reactivity, and social functioning difficulties and understand the mediator role of shame and self-criticism in the relationship between social stress reactivity and social functioning. Seventy-seven participants with a psychotic disorder filled in self-reported measures of stress reactivity, shame, and self-criticism and were clinically evaluated for social functioning. To study the associations between variables in the study, Spearman correlation coefficients were used. The PROCESS macro was used to test the sequential mediation analyses. All variables under study were associated with each other, and social stress reactivity predicted social functioning difficulties through external shame, whereas self-criticism was not a significant mediator. The present study highlights the role of external shame in the pathway from stress reactivity to social impairment. These results inform recovery-oriented interventions and reinforce the relevance of considering social competitive mentality when working with people with psychosis. Further research is needed to clarify the role of self-to-self relationship in social impairment and to identify other mechanisms aimed at dealing with shame used by people with psychosis.

Release of health-related compounds during in vitro gastro-intestinal digestion of okara and okara fermented with Lactobacillus plantarum.

Okara is a highly perishable by-product remaining after filtration of the smashed soybeans seeds in the production of soymilk. Due to its nutritional value, different approaches have been developed to use it as functional ingredient. Fermentation of okara appears as an interesting strategy to preclude spoilage, providing a more stable matrix to be incorporated in the formulation of functional foods. Okara has antioxidant compounds but the effect of fermentation, and their bioaccessibility still need to be investigated. To achieve this aim, the phenolic compounds (as determined by TPC and TFC assays) and the antioxidant properties (as determined by ABTS ·+, DPPH · , O2 ·- assays) of okara and okara fermented with Lactobacillus plantarum CIDCA 83114 were assessed both before and after exposure to simulated gastro-intestinal conditions. Before digestion, okara showed higher values of TPC and TFC than the fermented counterpart. Although a decrease of TPC and TFC was observed after exposing okara to gastric conditions, no significant differences between okara and fermented okara were detected. No further decrease of TPC were observed in intestinal conditions. Okara showed higher antioxidant activity than fermented okara. There was a considerable decrease in the antioxidant activity for both samples when exposed to gastric and intestinal conditions. A good correlation between TFC and antioxidant activities was detected, suggesting that flavonoids play an important role as antioxidants. As a whole, this work provides a solid support for the stability of phytochemicals along the digestive process of both okara and fermented okara.

Cognitive fusion and depressive symptoms in women with chronic pain: A longitudinal growth curve modelling study over 12 months.

This study aims to (a) explore individual differences in women with chronic pain (CP) in regard to pain intensity, functional impairment, cognitive fusion, and depressive symptoms and (b) longitudinally test whether cognitive fusion is a significant predictor of depression symptoms, while controlling for pain intensity and functional impairment, over a 12-month period. This study follows a longitudinal design and was conducted in a sample of 86 women with CP who responded to an online battery of questionnaires in three equally spaced assessment moments. In order to explore the growth trajectory of variables of interest, latent growth curve models were examined. Also, correlation analyses were conducted between demographic and illness-related variables and depressive symptoms, as well as between all variables in all assessment moments. Cognitive fusion and functional impairment (but not pain intensity) were significantly associated with baseline levels of depressive symptoms. Cognitive fusion significantly predicted the growth trajectory of depressive symptoms, whereas pain intensity and functional impairment did not. No demographic (age, marital status, education, socio-economic) nor illness-related variables (number of CP diagnoses, duration of CP, taking medication) were associated with depressive symptoms at any point. These results suggest that the trajectory of depressive symptoms in women with CP is not predicted by the intensity of pain nor pain-related functional impairment, but rather by the tendency to get entangled with internal experiences (e.g., thoughts, emotions, and physical sensations), which may or may not be related to pain-specific contents. Clinical implications are discussed.

Mindfulness, selfcompassion, and depressive symptoms in chronic pain: The role of pain acceptance.

OBJECTIVE(S): The aim of this study was to test a theory driven model in which pain acceptance (both pain willingness [PW] and activity engagement [AE]) mediates the relationships of mindfulness and selfcompassion with depressive symptoms, while controlling for pain intensity. METHODS: A path analysis was conducted using AMOS software to test a meditational model in a sample of women with chronic musculoskeletal pain (N = 231). RESULTS: Participants with higher levels of mindful awareness and selfcompassion presented lower levels of pain intensity and depressive symptoms, and higher levels of AE. PW did not significantly correlate with any variable in study. The mediation analysis showed that AE mediated the relationship between selfcompassion and depressive symptoms, independently from pain intensity. CONCLUSIONS: These findings seem to corroborate the hypothesis that selfcompassion is rooted in a motivational system, as it seems to correlate with less depressive symptoms through increasing the engagement with valued actions despite experiencing pain.

BEfree: A new psychological program for binge eating that integrates psychoeducation, mindfulness, and compassion.

Binge eating disorder (BED) is associated with several psychological and medical problems, such as obesity. Approximately 30% of individuals seeking weight loss treatments present binge eating symptomatology. Moreover, current treatments for BED lack efficacy at follow-up assessments. Developing mindfulness and self-compassion seem to be beneficial in treating BED, although there is still room for improvement, which may include integrating these different but complimentary approaches. BEfree is the first program integrating psychoeducation-, mindfulness-, and compassion-based components for treating women with binge eating and obesity. OBJECTIVE: To test the acceptability and efficacy up to 6-month postintervention of a psychological program based on psychoeducation, mindfulness, and self-compassion for obese or overweight women with BED. DESIGN: A controlled longitudinal design was followed in order to compare results between BEfree (n = 19) and waiting list group (WL; n = 17) from preintervention to postintervention. Results from BEfree were compared from preintervention to 3- and 6-month follow-up. RESULTS: BEfree was effective in eliminating BED; in diminishing eating psychopathology, depression, shame and self-criticism, body-image psychological inflexibility, and body-image cognitive fusion; and in improving obesity-related quality of life and self-compassion when compared to a WL control group. Results were maintained at 3- and 6-month follow-up. Finally, participants rated BEfree helpful for dealing with impulses and negative internal experiences. CONCLUSIONS: These results seem to suggest the efficacy of BEfree and the benefit of integrating different components such as psychoeducation, mindfulness, and self-compassion when treating BED in obese or overweight women. KEY PRACTITIONER MESSAGE: The current study provides evidence of the acceptability of a psychoeducation, mindfulness, and compassion program for binge eating in obesity (BEfree); Developing mindfulness and self-compassionate skills is an effective way of diminishing binge eating, eating psychopathology and depression, and increasing quality of life in women with obesity; Integrating psychoeducation, mindfulness, and compassion seem to be effective in diminishing binge eating, with results maintained up to 6-month postintervention.

Phytochemical Profile, Chemotaxonomic Studies, and In Vitro Antioxidant Activities of Two Endemisms from Madeira Archipelago: Melanoselinum decipiens and Monizia edulis (Apiaceae).

Melanoselinum decipiens and Monizia edulis (Apiaceae) are two endemic plants from Madeira archipelago, phytochemical compositions of which remains little explored, despite their use in folk medicine. Using liquid chromatography with diode array and electrospray ionization/mass spectrometry analysis, their polyphenolic profile was established for the first time. Fifty-six compounds were identified with 5-O-caffeoylquinic acid, quercetin-O-(malonyl)hexoside, luteolin diacetyl, and quercetin-O-hexoside being the major constituents in the leaves of both plant species (≥ 0.76 mg/g of dry extract). Principal component analysis provided a suitable tool to differentiate targeted plants. Naringenin-6,8-di-C-glucoside, quercetin 3-O-pentosylhexoside, and 1,5-O-dicaffeoylquinic acid can be used as discriminatory taxonomic/geographical markers for M. edulis subspecies from Madeira and Porto Santo populations. This methodology of using polyphenols as chemotaxonomic markers proved to be useful for identification of plant species since the results are consistent with previous taxonomical data. The free-radical scavenging activities of the M. decipiens extracts proved to be higher than those of M. edulis, which correlated well with their phenolic content (R2  > 0.906).

Validation of the Psychometric Properties of the Self-Compassion Scale. Testing the Factorial Validity and Factorial Invariance of the Measure among Borderline Personality Disorder, Anxiety Disorder, Eating Disorder and General Populations.

BACKGROUND: During the last years, there has been a growing interest in self-compassion. Empirical evidences show that self-compassion is associated with psychological benefits among young adults and it might be considered a buffer factor in several mental disorders. AIMS: The aim of this study was to validate the psychometric properties of the Self-compassion Scale (SCS: Neff, 2003a) after the initial lack of replicating the original six-factor structure. METHOD: Data were collected from the overall database of a research centre (56 men and 305 women; mean age = 25.19) and comprised four groups: borderline personality disorder, anxiety disorder, eating disorder and general population. RESULTS: Confirmatory factor analysis supported a two-factor model (self-compassionate attitude versus self-critical attitude) with good internal consistencies, construct-related validity and external validity. Configural, weak measurement and structural invariance of the two-factor model of SCS were also shown. CONCLUSIONS: Findings support the generalizability of the two-factor model and show that both properties and interpretations of scores on self-compassion are equivalent across these population groups. Copyright © 2015 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: A two-factor structure of SCS with strong psychometric validity was supported in clinical and non-clinical samples. Helping individuals with limited experiences of compassion to develop positive internal processing systems seems to be related with better mental health, self-acceptance and self-nurturing abilities. The non-probabilistic sampling limits the generalization of our conclusions.

Evaluating the Multifactor Structure of the Long and Short Versions of the Self-Compassion Scale in a Clinical Sample.

OBJECTIVE: There has been a growing interest in the concept of self-compassion in Eastern psychology. The aim of the present study was to explore the dimensionality of the widely used Self-Compassion Scale (SCS; long and short versions) in both clinical and nonclinical samples METHOD: Several confirmatory factor analyses (CFAs) were computed in a mixed clinical (n = 316) and a nonclinical sample (n = 1128) from the Portuguese population. Also, differences were tested between the groups in the SCS 6 factors. RESULTS: The CFA supported both a 6-factor model and a hierarchical model in both samples. The SCS also showed good psychometric properties, with good internal consistency, test-retest reliability, and convergent validity. Our study further suggests that individuals with several psychopathological disorders showed significantly lower self-compassionate abilities. CONCLUSIONS: The SCS (long and short versions) is thus a reliable instrument to assess self-compassion and is useful for research and, in particular, clinical practice.

Exploring self-criticism: confirmatory factor analysis of the FSCRS in clinical and nonclinical samples.

The Forms of Self-criticizing/Attacking and Self-reassuring Scale (FSCRS) is a self-report questionnaire that assesses the forms of self-criticism and self-reassurance. The aim of this study was to explore the latent structure of the FSCRS in nonclinical and clinical samples. Data from 381 participants from the general population and from 304 participants from clinical settings were subjected to confirmatory factor analyses to explore several structural models reflecting alternative representations of the FSCRS dimensionality. Overall, the model with the best fit to the data, in both samples, was the three-factor model (inadequate self, hated self and reassured self subscales) replicating the FSCRS original structure. The scale showed good psychometric characteristics, and the three factors discriminated between the clinical and nonclinical samples. To our knowledge, this is the first study to confirm the factor structure of the FSCRS in a purely clinical sample, and to test alternative models. This study adds to the existent literature that has been supporting the conceptualization of self-criticism as a multidimensional construct. Given the good psychometric properties of the Portuguese version of the FSCRS, its use is encouraged and recommended for the assessment of self-criticism in both clinical and research settings.

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.

Recall of threat and submissiveness in childhood and psychopathology: the mediator effect of self-criticism.

UNLABELLED: Research has robustly shown that early negative parenting experiences are associated with psychopathology and self-criticism in adulthood. This study investigates recall of personal feelings of perceived threat and subordination in childhood and its relation to psychopathology. In addition, we explore the mediator role of self-criticism in this association. A sample of 193 subjects from the general population completed self-report questionnaires measuring the study variables. The mediator analyses suggested that the impact of submissiveness experiences in childhood on depression and anxiety is mediated by self-criticism. Our findings highlight the route through which the recall of personal feelings of perceived involuntary subordination to parents contributes to depression and anxiety in adulthood. KEY PRACTITIONER MESSAGE: Although the relation between early experiences of abuse and later psychological problems is now well established, there has been less study on subtler forms of threat and subordinate behaviour in childhood. Given ours and previous findings, therapists should be aware of, and prone to explore, these early experiences. Most studies exploring early negative experiences mainly refer to attachment theory-related constructs (e.g., attachment style). We also highlight the importance of noting rank structure and rank style in the family. Self-criticism seems to be a key process in the relation between early aversive experiences of subordination and psychopathology. Given the idea that self-reassuring operates through a different affect system, helping people develop inner warmth and compassion for the self may be important to counteract feelings of self-hatred and self-attack.