دانلود مقاله ISI انگلیسی شماره 38910
عنوان فارسی مقاله

خود دلسوزی در افسردگی: ارتباط با نشانه های افسردگی، نشخوار فکری و اجتناب در بیماران سرپایی افسرده

کد مقاله سال انتشار مقاله انگلیسی ترجمه فارسی تعداد کلمات
38910 2013 13 صفحه PDF سفارش دهید محاسبه نشده
خرید مقاله
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عنوان انگلیسی
Self-Compassion in Depression: Associations With Depressive Symptoms, Rumination, and Avoidance in Depressed Outpatients ☆
منبع

Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)

Journal : Behavior Therapy, Volume 44, Issue 3, September 2013, Pages 501–513

کلمات کلیدی
خود دلسوزی - نشخوار - اجتناب - افسردگی - بیماران سرپایی
پیش نمایش مقاله
پیش نمایش مقاله خود دلسوزی در افسردگی: ارتباط با نشانه های افسردگی، نشخوار فکری و اجتناب در بیماران سرپایی افسرده

چکیده انگلیسی

Abstract Self-compassion involves being kind to oneself when challenged with personal weaknesses or hardship and has been claimed to be associated with resilience in various areas. So far, there are only a handful of studies that investigate self-compassion and its relation to clinical depression. Therefore, the principal goals of the present study were (a) to compare self-compassion in clinically depressed patients and never-depressed subjects, (b) to investigate self-compassion and its relation to cognitive-behavioral avoidance and rumination in depressed outpatients, and (c) to investigate rumination and avoidance as mediators of the relationship between self-compassion and depressive symptoms. One hundred and forty-two depressed outpatients and 120 never-depressed individuals from a community sample completed a self-report measure of self-compassion along with other measures. Results indicate that depressed patients showed lower levels of self-compassion than never-depressed individuals, even when controlled for depressive symptoms. In depressed outpatients, self-compassion was negatively related to depressive symptoms, symptom-focused rumination, as well as cognitive and behavioral avoidance. Additionally, symptom-focused rumination and cognitive and behavioral avoidance mediated the relationship between self-compassion and depressive symptoms. These findings extend previous research on self-compassion, its relation to depression, as well as processes mediating this relationship, and highlight the importance of self-compassion in clinically depressed patients. Since depressed patients seem to have difficulties adopting a self-compassionate attitude, psychotherapists are well advised to explore and address how depressed patients treat themselves.

نتیجه گیری انگلیسی

Results Preliminary Analyses The DS and the NDS differed significantly regarding depressive symptoms (DS: M = 25.61, SD = 9.04; NDS: M = 3.95, SD = 3.88; t[198, 93] = 25.86, p < .001). Further, the samples differed significantly regarding age, (t[258, 84] = 7.05, p < .001) and marital status (χ2[2] = 10.99, p < .01), and there was an insignificant trend with regard to education (χ2[3] = 9.31, p = .051). Samples did not differ regarding gender distribution (χ2[1] = 0.28, p = .87). Due to the results of these analyses, we decided to include age, marital status, and education as covariates in subsequent analyses comparing the two samples. Self-Compassion in Clinically Depressed Patients and Never-Depressed Subjects As Table 1 indicates, clinically depressed patients were significantly less self-compassionate than never-depressed subjects. Furthermore, the two samples differed regarding all subscales of self-compassion.1 In order to investigate whether levels of depressive symptoms may account for this difference, we reconducted the analyses of depressed and never-depressed subjects regarding levels of self-compassion with depressive symptoms as an additional covariate. Results indicated that the two samples still differed significantly regarding the self-compassion total score, as well as the self-kindness, self-judgment, isolation, and overidentification subscale. Table 1. Self-Compassion in Never-Depressed Subjects and Clinically Depressed Patients Never-Depressed SubjectsM (SD) Depressed PatientsM (SD) F Partial η2 F Partial η2 (Controlling for depressive symptoms) SCS 3.31 (.36) 2.75 (.41) 126.70** .34 12.39** .05 SCS-sk 3.31 (.78) 2.47 (.78) 59.49** .19 4.82* .02 SCS-ch 2.97 (.76) 2.55 (.71) 15.00** .06 0.67 .00 SCS-m 3.32 (.70) 2.82 (.70) 37.23** .13 0.84 .00 SCS-sj 2.34 (.70) 3.55 (.62) 230.65** .48 30.73** .11 SCS-i 1.93 (.84) 3.40 (.81) 220.52** .47 26.76** .10 SCS-oi 2.51 (.80) 3.62 (.66) 146.21** .37 12.40** .05 Notes. Due to missing values in covariates, sample size was n = 119 for the never-depressed sample and n = 134 for the depressed sample. SCS = Self-Compassion total score, -sk = Self-Kindness subscale, -ch = Common Humanity subscale, -m = Mindfulness subscale, -sj = Self-Judgment subscale, -i = Isolation subscale, -oi = Over-Identification subscale. Age, marital status and education were entered as covariates in all analyses. * p < .05. ** p < .01. Table options Self-Compassion, Its Components, and Depressive Symptoms Next, we performed correlational analyses for self-compassion as measured by the SCS, its subscales, and depressive symptoms in both samples. As can be seen in Table 2, self-compassion was significantly negatively correlated with depressive symptoms in the DS (r = -.23, p < .01) as well as in the NDS (r = -.37, p < .01). These correlation coefficients did not differ significantly from each other (Zdiff = 1.23, p = .22). All subscales of the SCS correlated in the expected direction with the total self-compassion score in the depressed sample as well as in the never-depressed sample. Furthermore, correlational analyses indicated that in both samples all subscales except common humanity correlated with depressive symptoms in the expected direction. Table 2. Intercorrelations of Self-Compassion, Its Components, and Depressive Symptoms in Depressed Outpatients and Never-Depressed Subjects 1 2 3 4 5 6 7 8 1. SCS - .79** .65** .68** -.43** -.52** -.22* -.37** 2. SCS-sk .87** - .46** .44** -.22* -.23* -.11 -.19* 3. SCS-ch .74** .61** - .50** .14 .02 .04 -.11 4. SCS-m .79** .68** .55** - -.17 -.25** -.38** -.31** 5. SCS-sj -.70** -.61** -.28** -.37** - .61** .61** .37** 6. SCS-i -.58** -.37** -.20** -.39** .52** - .62** .48** 7. SCS-oi -.35** -.37** -.21** -.36** .44** .68** - .40** 8. BDI-II -.23** -.21** -.15 -.18* .23** .22** .24** - Notes. SCS = Self-Compassion total score, -sk = Self-Kindness subscale, -ch = Common Humanity subscale, -m = Mindfulness subscale, -sj = Self-Judgment subscale, -i = Isolation subscale, -oi = Over-Identification subscale, BDI-II = Beck Depression Inventory II. Correlation coefficients for the depressed sample (n = 142) are shown in the lower-left part of the table and for the never-depressed sample (n = 120) in the upper-right part of the table. * p < .05, ** p < .01. Table options Self-Compassion, Rumination, and Avoidance in Depressed Patients Table 3 gives an overview of how self-compassion is related to the different facets of rumination and avoidance in the DS. As expected, self-compassion was significantly negatively associated with symptom-focused rumination, but not with self-focused rumination. Furthermore, self-compassion was significantly negatively associated with all avoidance scales except for cognitive social avoidance. Table 3. Descriptives and Intercorrelations of Self-Compassion, Rumination, Avoidance and Depressive Symptoms in Depressed Outpatients 1 2 3 4 5 6 7 8 M (SD) 1. SCS - 2.76 (.41) 2. RSQ-SYM -.19* - 2.70 (.54) 3. RSQ-SELF -.16 .52** - 2.42 (.49) 4. CBAS-T -.30** .38** .25** - 2.86 (.63) 5. CBAS-BS -.27** .25** .28** .84** - 2.70 (.84) 6. CBAS-BN -.32** .39** .35** .84** .62** - 3.12 (.71) 7. CBAS-CS -.16 .22** .01 .80** .57** .52** - 2.68 (.77) 8. CBAS-CN -.23** .38** .20* .80** .51** .63** .53** - 2.95 (.73) 9. BDI-II -.23** .40** .17* .36** .37** .28** .20** .34** 25.61 (9.04) Notes. n = 140-142. SCS = Self-Compassion total score, RSQ-SYM = Symptom-focused rumination, RSQ-SELF = Self-focused rumination, CBAS-T = Cognitive-Behavioral Avoidance total score, -BS = CBAS, Behavioral Social subscale, -BN = CBAS, Behavioral Nonsocial subscale, -CS = CBAS, Cognitive Social subscale, -CN = CBAS, Cognitive Nonsocial subscale, BDI-II = Beck Depression Inventory-II. * p < .05. ** p < .01. Table options Mediation Analyses: Rumination and Avoidance as Mediators of the Relation Between Self-Compassion and Depressive Symptoms The results of the mediation analyses are presented in Table 4. The indirect effect of self-compassion on depressive symptoms through symptom-focused rumination was ab = -.06 (SE = .03) with a 95% bootstrap confidence interval (CI95%) of -.12 to -.002. Because zero is not in the 95% confidence interval for symptom-focused rumination, it can be concluded that this indirect effect is significantly different from zero at p < .05, and that symptom-focused rumination mediates the relationship between self-compassion and depressive symptoms. With respect to self-focused rumination, this was not the case (ab = -.02, SE = .02, CI95% = -.07 to .002). Table 4. Summary of Mediational Analyses (1000 Bootstrap Samples) Independent variable (IV) Mediating variable (M) Dependent variable (DV) Effect of IV on M (a) Effect of M on DV (b) Direct effect (c’) Indirect effect (ab) Total effect (c) 1. SCS RSQ-SYM BDI-II -.22* .28** -.12 -.07a -.18** 2. SCS RSQ-SELF BDI-II -.19 .10 -.17* -.02 -.18** 3. SCS CBAS-T BDI-II -.34** .24** -.11 -.08a -.19** 4. SCS CBAS-BS BDI-II -.31** .24** -.12 -.07a -.19** 5. SCS CBAS-BN BDI-II -.36** .16** -.13 -.06a -.19** 6. SCS CBAS-CS BDI-II -.18 .12* -.17* -.02 -.19** 7. SCS CBAS-CN BDI-II -.27** .22** -.13 -.06a -.19** Notes. n = 140-142. SCS = Self-Compassion total score, RSQ-SYM = Symptom-focused rumination, RSQ-SELF = Self-focused rumination, CBAS-T = Cognitive-Behavioral Avoidance total score, -BS = CBAS, Behavioral Social subscale, -BN = CBAS, Behavioral Nonsocial subscale, -CS = CBAS, Cognitive Social subscale, -CN = CBAS, Cognitive Nonsocial subscale, BDI-II = Beck Depression Inventory-II. a Significant point estimate (p < .05). * p < .05. ** p < .01. Table options Next, we tested whether total avoidance and the subscales of avoidance mediate the relationship between self-compassion and depressive symptoms. Results of these analyses suggest that total avoidance completely mediated the relation between self-compassion and depression. The indirect effect of self-compassion on depressive symptoms through avoidance was ab = -0.08 (SE = .03) with a 95% bootstrap confidence interval of -.17 to -.02. Subsequent analyses for the subscales of avoidance showed that all subscales of the CBAS (CBAS-BN: ab = -.06, SE = .03, CI95% = -.13 to -.01; CBAS-BS: ab = -.07, SE = .03, CI95% = -.15 to -.02; CBAS-CN: ab = -.06, SE = .03, CI95% = -.13 to -.01), except for cognitive social avoidance (ab = -.02, SE = .02, CI95% = -.08 to .002), mediated the relation between self-compassion and depressive symptoms. In a last step, we tested the hypothesis that the relation between self-compassion and depressive symptoms is mediated through a latent variable “avoidant functioning”, which was composed of the avoidance total score and symptom-focused rumination. A model of the association between participants’ self-compassion and their current depressive symptoms was specified. Low levels of self-compassion were significantly associated with increased depressive symptoms (β = -.23, z = -2.91, p < .01). Subsequently, a model including the direct association between self-compassion and current depressive symptoms as well as the indirect association of self-compassion through its association with avoidant functioning (defined as a latent factor and including avoidance total score and symptom-focused rumination) on depressive symptoms was specified and estimated. This model was found to fit the observed data adequately: χ2(1) = 1.53, p = .22, CFI = 0.99, TLI = 0.95, RMSEA = .06, SRMR = .02. As shown in Fig. 1, low levels of self-compassion were significantly associated with high levels of avoidant functioning (β = -.39, z = -3.03, p < .01). Avoidant functioning, in turn, was significantly associated with high levels of depressive symptoms (β = .63, z = 3.49, p < .01). Furthermore, the significant association between participants’ self-compassion and their depressive symptoms decreased when avoidant functioning was included in the model (β = .03, z = .23, p = .82). Finally, a bootstrapping procedure with 1000 resamples indicated that the indirect effect of self-compassion on depressive symptoms through avoidant functioning was significant (p = .04). Direct and indirect standardized association between self-compassion, avoidant ... Figure 1. Direct and indirect standardized association between self-compassion, avoidant functioning and levels of depressive symptoms in depressed patients (n = 140). Rectangles indicate measured variables and the circle represents a latent construct. * p < .05. ** p < .01.

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