The role of self-criticism and self-compassion in the development of PTSD among midwives.

OBJECTIVE: Healthcare providers might develop emotional distress following direct and indirect exposure to traumatic events. Evidence shows that midwives, who care for women in complicated situations, are often exposed to circumstances that have a potential to lead to a variety of psychological reactions, including symptoms identified with post-traumatic stress disorder (PTSD). Nevertheless, the positive-healthy context in which childbirth is mainly perceived raises questions regarding the protective role of personality traits, which are related to processing methods of stress and pain, in the development of PTSD among this unique population. This study aimed to explore the associations between traits such as self-compassion, self-criticism, resilience, cognitive thinking, and pain catastrophizing and PTSD symptoms among Israeli midwives. SETTING: Using a quantitative cross-sectional study,123 midwives from ten hospitals in Israel anonymously reported their characteristics and severity of stress and/or PTSD symptoms by filling out the Psychopathy Checklist questionnaire. Analysis of personality traits was performed via the following questionnaires: Self-Compassion Scale - Short Form, Depressive Experiences Questionnaire - Self Criticism, and the Connor-Davidson Resilience Scale. Additionally, we measured the level of catastrophizing pain by employing the Pain Catastrophizing Scale questionnaire. FINDINGS: Most of the midwives reported existing post-trauma symptoms, among them 11.38% had been diagnosed with PTSD. Severity of the PTSD correlated with their self-criticism and the pain catastrophizing rates. Additional examination of the involvement of personality traits showed that midwives with high self-criticism, low mental resilience, besides a high rate of pain catastrophizing, were more vulnerable to developing PTSD. CONCLUSIONS: The findings can help to refine the understanding regarding the involvement of midwives' personality characteristics in the process of PTSD onset. Vulnerable midwives have been identified as those at risk to develop PTSD symptoms. IMPLICATIONS FOR PRACTICE: The clinical significance of these insights is to promote the ability to identify midwives who are at risk to develop PTSD. Furthermore, this information might help to produce training programs and a support network to empower self-compassion and mental resilience, and to minimize self-criticism in order establish a support network, which would help to deal with the difficult experiences they face at work.

Ayahuasca may help to improve self-compassion and self-criticism capacities.

OBJECTIVE: Ayahuasca is a psychedelic brew that originated in the Amazon basin. The psychological effects of this drug are becoming better understood due to the growing research interest in identifying new potential therapeutic agents for the treatment of emotion dysregulation and other disorders. Previous studies suggest that ayahuasca enhances mindfulness-related capacities (decentering, non-judging, non-reacting and acceptance) and emotion regulation. The aim of the present exploratory study was to determine the effects of ayahuasca on self-compassion in a community sample. METHODS: We administered validated questionnaires (the Self-Compassion Scale-Short Form and Forms of Self-Criticism and Self-Reassurance) to evaluate pre-post changes in self-compassion and self-criticism/self-reassurance in 45 volunteers (27 women; 60%) before and after (≤24 h) an ayahuasca ceremony. Most participants (n = 29; 67.4%) had previously used ayahuasca. RESULTS: Ayahuasca resulted in significant improvements, with medium to large effect sizes (η2  = 0.184-0.276), in measures of self-compassion (p < 0.05), self-criticism (p < 0.01) and self-reassurance (p < 0.01). CONCLUSIONS: The findings of this study suggest that ayahuasca promotes well-being and self-compassion, which could have a therapeutic effect on individuals with negative affect and other psychopathological conditions. Large, controlled studies are needed to confirm these findings.

Psychological and Physiological Effects of the Mindful Lovingkindness Compassion Program on Highly Self-Critical University Students in South Korea.

OBJECTIVES: Self-critical behavior is especially relevant for university students who face academic and non-academic stressors, leading to negative outcomes such as mental distress and psychopathologies. To address this behavior, mindfulness and compassion are important factors to decrease self-criticism and ensure positive outcomes. This study examined the psychological and physiological effects of an intervention, the Mindful Lovingkindness Compassion Program (MLCP), on highly self-critical university students in South Korea. METHODS: Thirty-eight university students with a high level of self-criticism were assigned to an MLCP group (n = 18) or waitlist (WL) group (n = 20). Self-report measures of self-criticism, self-reassurance, psychological distress, and other mental health variables were completed, and the physiological measure of heart rate variability (HRV) was conducted before and after the intervention with both groups. In addition, 1- and 3-month follow-up assessments were conducted using self-report measurements. RESULTS: Compared to the WL group, participants in the MLCP group experienced significantly greater reductions in self-criticism and psychological distress, and a greater increase in self-reassurance, mental health, and HRV. The improvements in the self-report measures were maintained when assessed 1 and 3 months later. CONCLUSIONS: MLCP could be a promising intervention for alleviating self-criticism and increasing self-reassurance among self-critical individuals.

The intertwined path of perfectionism and self-criticism in a client with obsessive-compulsive personality disorder.

Psychotherapy for obsessive-compulsive personality disorder (OCPD), where perfectionism is a defining criterion, is understudied. Despite a high prevalence few evidence-based treatments are available for the presentation. Here we describe the course of a 6-month program of metacognitive interpersonal therapy with an OCPD patient with prominent perfectionism and self-criticism, which were considered primary outcomes of the case study. Therapy aimed initially at increasing awareness of maladaptive interpersonal schemas and promoting a healthy self. First, behavioral experiments were used to try and counteract perfectionism. Second, experiential techniques, such as guided imagery and rescripting, were used to help the client in connect with different, healthier aspects of the self, thus increasing personal and interpersonal wellbeing. Qualitative and quantitative outcomes at the intervention end and at 1-month follow-up are summarized. Finally, we reflect on how this case study can inform treatment of perfectionism in OCPD.

Feasibility of the Internet Attachment-Based Compassion Therapy in the General Population: Protocol for an Open-Label Uncontrolled Pilot Trial.

BACKGROUND: Compassion-based interventions delivered over the internet are showing promising results for the promotion of psychological health and well-being. Several studies have highlighted their feasibility, acceptance, and preliminary efficacy. However, this is an incipient field of research, and to the best of our knowledge, there are no data available from Spanish-speaking countries. OBJECTIVE: The aim of this study is to investigate the feasibility, acceptance, and preliminary efficacy of the Internet Attachment-Based Compassion Therapy (iABCT), a web-based version of the Attachment-Based Compassion Therapy, in Spanish speakers from the general population. METHODS: This feasibility study features a single-arm, uncontrolled, within-group design with an embedded qualitative and quantitative process evaluation at baseline, immediately after the intervention and at the 3-month follow-up. A minimum of 35 participants from the general population will be allocated to iABCT. Feasibility measures will include attrition rate, patterns of use of the web-based system, and participants' acceptability, usability, and opinion. The primary outcome was measured using the Pemberton Happiness Index. Secondary outcomes were measured using the Compassion Scale, Self-Compassion Scale, Forms of Self-Criticizing/Attacking and Self-Reassuring Scale-Short form, Five Facets of Mindfulness Questionnaire, Relationships Questionnaire, General Health Questionnaire, Non-Attachment Scale, International Positive and Negative Affect Schedule Short Form, Purpose-In-Life Test, and difficulties regarding the practice of compassion (Compassion Practice Quality Questionnaire). Mixed models will be used to evaluate primary and secondary outcome measures. A qualitative content analysis of the participants' qualitative responses will also be performed. RESULTS: Enrollment started in February 2020 and will be finished in April 2020. Data analysis will start in October 2020. CONCLUSIONS: To our knowledge, this study will, for the first time, show data on the feasibility, acceptability, and preliminary efficacy of web-based compassion (and self-compassion) training-that is, the adapted iABCT-in Spanish speakers from the general population. Further aspects of their implementation (ie, facilitators, barriers, and unwanted effects) and mechanisms of change will be investigated. This study will allow the revision and fine-tuning of the developed intervention, study design, and planning procedures, as well as the initiation of a future randomized controlled trial. TRIAL REGISTRATION: Clinicaltrials.gov: NCT03918746. Registered on April 17, 2019. Protocol version 1, 6 March 2019. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/16717.

Maternal perinatal mental health: Associations with bonding, mindfulness, and self-criticism at 18 months' postpartum.

The perinatal period is a time of significant transition for women, with changes in maternal mental health from pregnancy to 18 months' postpartum. This study specifically analyzes maternal self-criticism and mindfulness during pregnancy and at 18 months' postpartum, and their associations with bonding. A longitudinal study (30 weeks' gestation-18 months' postpartum) assessed 32 mother-infant dyads, examining changes in maternal depression, anxiety, self-criticism, and mindfulness. In addition, associations between maternal variables during pregnancy and bonding were investigated. Maternal depression and self-criticism significantly increased from pregnancy to postpartum. Maternal anxiety, self-criticism, and facets of mindfulness during pregnancy were also associated with mother-infant bonding at 18 months. Maternal mental health during pregnancy is subject to change postchildbirth. The lack of control and autonomy accompanying motherhood may result in an increase in self-criticism during this period. Such feelings may elevate a woman's vulnerability to postpartum depression and have consequences for later maternal bonding. Early identification of at-risk mothers is important to increase likelihood of positive outcomes.

Trasfondo: el período perinatal es un momento de significativa transición para las mujeres, con cambios en la salud mental materna a partir del embarazo hasta los 18 meses después del parto. Este estudio específicamente analiza la auto-crítica y la plena atención maternas durante el embarazo y a los 18 meses después del parto y sus asociaciones con la vinculación afectiva. Método: un estudio longitudinal (gestación de 30 semanas a 18 meses después del parto) evaluó a 32 díadas madre-infante por medio de examinar cambios en cuanto a depresión materna, ansiedad, auto-crítica y plena atención. Adicionalmente, se investigaron las asociaciones entre las variables maternas durante el embarazo y la vinculación afectiva. Resultados: la depresión materna y la auto-crítica aumentaron significativamente desde el embarazo hasta después del parto. También se asociaron la ansiedad materna, la auto-crítica y facetas de la plena atención durante el embarazo con la vinculación afectiva entre madre e infante a los 18 meses. Discusión: la salud mental materna durante el embarazo está sujeta a cambiar después del nacimiento del niño. La falta de control y autonomía que acompaña a la maternidad pudiera resultar en un aumento en la auto-crítica durante este período. Tales sentimientos pudieran incrementar la vulnerabilidad de una mujer con respecto a la depresión posterior al parto y tener consecuencias más tarde en la vinculación afectiva materna. Es importante la temprana identificación de madres bajo riesgo para aumentar la probabilidad de resultados positivos.

Contexte: La période périnatale est un moment de transition importante pour les femmes, avec des changements dans la santé mentale maternelle de la grossesse à 18 mois après la naissance. Cette étude analyse plus spécifiquement l'autocritique maternelle et la pleine conscience durant la grossesse et à 18 mois après la naissance, ainsi que leur lien avec la connexion. Méthode: Une étude longitudinale (30 semaine de grosses à 18 mois après la naissance) a évalué 32 dyades mère-nourrisson, en examinant les changements dans la dépression maternelle, l'anxiété, l'autocritique et la pleine conscience. De plus les liens entre les variables maternelles durant la grossesse et la connexion ont fait l'objet de la recherche. Résultats : La dépression maternelle et l'autocritique ont fortement augmenté de la grossesse à la période postpartum. L'anxiété maternelle, l'autocritique et les facettes de pleine conscience durant la grossesse étaient également liées à la connexion mère-nourrisson à 18 mois. Discussion: La santé mentale maternelle durant la grossesse peut changer après la naissance de l'enfant. Le manque de contrôle et d'autonomie qui accompagne la maternité peut résulter en une augmentation de l'autocritique durant cette période. De tels sentiments peuvent élever la vulnérabilité d'une femme à la dépression postpartum et avoir des conséquences sur la connexion maternelle ultérieure. Une identification précoce des mères à risque est importante afin d'augmenter les chances de résultats positifs.

Compassion-focused imagery reduces shame and is moderated by shame, self-reassurance and multisensory imagery vividness.

Compassion-focused imagery (CFI) is an emotion-regulation technique involving visualization of a person, animal or object offering one compassion, to generate feelings of safeness. It is proven to increase self-compassion and reduce negative affect. This study explores two hypotheses not previously investigated: i) which sensory modalities can stimulate compassionate affect; and ii) whether presentation of pictorial stimuli can enhance CFI. Additionally, we examine iii) whether CFI can reduce shame and iv) whether self-criticism inhibits CFI, since previous studies have involved small samples or methodological limitations. After completing measures of self-criticism, selfreassurance and imagery abilities in five sensory modalities, participants (n=160) were randomly assigned to look at compassionate images during CFI (visual input), compassionate images before CFI (priming), or abstract images (control). Participants trialled CFI then rated compassionate affect and completed open-response questions. Before and after CFI, participants recalled a shame-based memory and rated state shame. Correlational analyses explored whether self-criticism, self-reassurance, and multisensory imagery abilities moderated outcomes. CFI significantly reduced shame regarding a recalled memory, particularly for those high in shame. Compassionate affect was predicted by imagery vividness in visual and bodily-sensation modalities. Self-criticism predicted poorer CFI In multiple regressions, self-reassurance predicted poorer CFI outcomes but self-criticism did not. Between-group effects did not emerge. Qualitative data suggested that pictures helped some participants but hindered others. CFI is a promising technique for shame-prone clients, but may be challenging for those with low imagery abilities or unfamiliar with self-reassurance. Multiple senses should be engaged.

A pilot feasibility study exploring the practising of compassionate imagery exercises in a nonclinical population.

UNLABELLED: This study assessed the acceptability of practising compassionate imagery as an online task without clinician support. Participants completed questionnaires at baseline, after, and 6 months of follow-up. Participants engaged safely and successfully with the tasks. There were significant improvements in questionnaire scores which were largely maintained over 6 months. PRACTITIONER POINTS: People can practise compassionate imagery tasks in an unsupervised way from online recordings and not suffer adverse effects (even with higher baseline scores in self-criticism). Compassionate imagery recordings may be used as an adjunct to improve traditional psychotherapy.

A wait-list randomized controlled trial of loving-kindness meditation programme for self-criticism.

UNLABELLED: Self-criticism is a vulnerability risk factor for a number of psychological disorders, and it predicts poor response to psychological and pharmacological treatments. In the current study, we evaluated the efficacy of a loving-kindness meditation (LKM) programme designed to increase self-compassion in a sample of self-critical individuals. Thirty-eight individuals with high scores on the self-critical perfectionism subscale of the Dysfunctional Attitude Scale were randomized to an LKM condition (n = 19) or a wait-list (WL) condition (n = 19). Measures of self-criticism, self-compassion and psychological distress were administered before and immediately following the intervention (LKM or WL). WL participants received the intervention immediately after the waiting period. Both groups were assessed 3 months post-intervention. Intent-to-treat (n = 38) and per-protocol analyses (n = 32) showed significant reductions in self-criticism and depressive symptoms as well as significant increases in self-compassion and positive emotions in the LKM condition compared with the WL condition. A follow-up per-protocol analysis in both groups together (n = 20) showed that these gains were maintained 3 months after the intervention. These preliminary results suggest that LKM may be efficacious in alleviating self-criticism, increasing self-compassion and improving depressive symptoms among self-critical individuals. KEY PRACTITIONER MESSAGE: Self-criticism plays a major role in many psychological disorders and predicts poor response to brief psychological and pharmacological treatments for depression. The current study shows that loving-kindness meditation, designed to foster self-compassion, is efficacious in helping self-critical individuals become less self-critical and more self-compassionate. The study also suggests that practising loving-kindness may reduce depressive symptoms and increase positive emotions.

Do therapeutic imagery practices affect physiological and emotional indicators of threat in high self-critics?

OBJECTIVES: Imagery is known to be a powerful means of stimulating various physiological processes and is increasingly used within standard psychological therapies. Compassion-focused imagery (CFI) has been used to stimulate affiliative emotion in people with mental health problems. However, evidence suggests that self-critical individuals may have particular difficulties in this domain with single trials. The aim of the present study was to further investigate the role of self-criticism in responsiveness to CFI by specifically pre-selecting participants based on trait self-criticism. DESIGN: Using the Forms of Self-Criticism/Self-Reassuring Scale, 29 individuals from a total sample of 139 were pre-selected to determine how self-criticism impacts upon an initial instance of imagery. METHODS: All participants took part in three activities: a control imagery intervention (useable data N = 25), a standard CFI intervention (useable data N = 25), and a non-intervention control (useable data N = 24). Physiological measurements (alpha amylase) as well as questionnaire measures of emotional responding (i.e., the Positive and Negative Affect Schedule, the Types of Positive Affect Scale, and the State Adult Attachment Scale) were taken before and after the different interventions. RESULTS: Following both imagery interventions, repeated measures analyses revealed that alpha amylase increased significantly for high self-critics compared with low self-critics. High self-critics (HSC) also reported greater insecurity on entering the imagery session and more negative CFI experiences compared with low self-critics. CONCLUSIONS: Data demonstrate that HSC respond negatively to imagery interventions in a single trial. This highlights that imagery focused therapies (e.g., CFI) need interventions that manage fears, blocks, and resistances to the techniques, particularly in HSC. PRACTITIONER POINTS: An initial instance of imagery (e.g., CFI) can be frightening for people who have a tendency to be self-critical. This research provides examples of physiological and emotional responses to imagery type therapies in high and low self-critics, and associated clinical implications. Therapists may find it helpful to be mindful that when introducing imagery based therapies, highly self-critical patients need interventions that manage fears, blocks, and resistances to the techniques.