خوددلسوزی پایین در بیماران مبتلا به اختلال دوقطبی
|کد مقاله||سال انتشار||تعداد صفحات مقاله انگلیسی||ترجمه فارسی|
|38924||2015||6 صفحه PDF||سفارش دهید|
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Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Comprehensive Psychiatry, Volume 60, July 2015, Pages 53–58
Abstract Background Emerging research suggests that low self-compassion may be linked to psychopathology and in particular depressive symptoms. To further elucidate this topic, the present study investigated self-compassion in patients with Bipolar Disorder (BD). Method Thirty remitted BD patients were compared to thirty age- and sex matched controls on the Self-Compassion Scale (SCS). The BD patients also completed the Altman Self-Rating Mania Scale (ASRM), the Major Depression Inventory (MDI), the Work and Social Adjustment Scale (WSAS), the Satisfaction With Life Scale (SWLS) and the Internalized Stigma of Mental Illness Scale (ISMI-10) and further reported their illness history on a survey sheet. Results The BD patients were found to have significantly lower self-compassion than controls. In addition, self-compassion correlated positively and significantly with life-satisfaction but no significant correlations with functional impairment, internalized stigma or frequency of past affective episodes were found. Limitations The small sample size entailed reduced statistical power. Conclusions By suggesting that self-compassion is reduced and possibly linked to life-satisfaction in BD, the findings highlight a potential vulnerability meriting further investigations.
Introduction Bipolar disorder (BD) is a debilitating and often chronic affective disorder characterized by affective episodes such as mania and depression interceded by intervals with remission . BD often entails functional impairments  and reduced quality of life . A central characteristic of BD is the marked variations in self-perception during affective episodes, with low self-esteem during depression and high or inflated self-esteem during mania. Abnormalities in self-conception are, however, not confined to mood episodes in BD. Previous studies suggest that during periods of remission BD is associated with self-criticism  and , low self-esteem , maladaptive self-schemas  and  and a dichotomized self-organization . As a result of the cognitive focus within this research, less attention has been devoted to emotional aspects of self-conception. Acknowledging that BD is an affective disorder with major shifts in mood and emotion, emotional aspects of self-conception indeed appears relevant. Self-compassion, which entails certain emotional inclinations towards the self, is a relatively new psychological concept that has been conceptualized in different but overlapping theories by Neff  and  and Gilbert  and . High self-compassion involves being kind and understanding toward oneself in difficult times and perceiving difficulties as part of a larger human experience . More broadly, it involves an accepting and nonjudgmental attitude toward one’s experiences. Low self-compassion, on the other hand, involves being self-judgmental and inclined to over-identify with negative experiences as well as feeling isolated by suffering. Self-compassion has to our knowledge not previously been examined in BD patients. There are, nevertheless, a number of reasons for assuming a relevance of self-compassion in BD. One of these is empirical as previous studies indicate that self-compassion is related to psychopathology. A meta-analysis by Macbeth and Gumley  found that low self-compassion was associated with symptoms of depression and anxiety in both clinical and non-clinical populations. Also, in a study by Krieger et al.  patients with Major Depressive Disorder (MDD) exhibited lower self-compassion compared to a non-clinical control group, even when controlling for depressive symptoms. Thus, based on prior research it appears that low self-compassion may be linked to depression and depressive symptoms. However, it remains to be examined whether this association also applies to BD with its different affective symptomatology. The other reason for assuming a relevance of the concept in BD is the theorized connection between low self-compassion and affective dysregulation. According to Gilbert  and , self-compassion is a critical component in the human capacity to regulate emotions. In his theoretical model, three neurobiological systems influence affect regulation; the threat system related to fear and avoidance, the drive system related to motivation and rewards and the soothing system related to feelings of calmness and affiliation. It is particularly the soothing system that is involved in compassion towards self and others. The soothing system contributes to handling both ups and downs and resisting psychological stress. Drawing upon Gilbert’s theory and the Behavioral Activation System theory of BD , Lowens  proposes that affect dysregulation in BD involves an over- and underactivation of the drive system, an unstable threat system and a limited soothing system. From this perspective, BD could involve a restricted capacity for a self-compassionate attitude due to a limited soothing system. The abnormal oxytocin levels  and  and increased amygdala activity  found in BD patients support the idea of a limited soothing system at a neurobiological level. However, it remains to be examined whether such presents as low self-compassion at the phenomenological level. Based on the outlined empirical and theoretical reasons, self-compassion was investigated in a sample of BD patients. The purpose of the study was two-fold. Firstly, in order to examine the overall level of self-compassion, BD patients were compared to age- and sex matched controls. Secondly, to explore the potential impact of self-compassion in BD patients, associations between self-compassion and indicators of illness severity and psychological well-being were examined. In agreement with prior research, age of onset and frequency of past affective episodes were used as proxies for illness severity  and . As indicators of psychological well-being measures of functional impairment, internalized stigma and quality of life were employed. In order to control for the confounding effects of mood symptoms, a remission design was employed with absence of affective episodes as an inclusion criteria for study participation.
نتیجه گیری انگلیسی
Results 3.1. Baseline characteristics and self-compassion Descriptive characteristics of the 30 BD patients who participated in the study are provided in Table 1. The SCS total was not significantly correlated with affective symptoms, as measured by MDI (r = −.18, p = .351), ASRM (r = −.08, p = .672), length of remission (r = .29, p = .131), or polarity of most recent affective episode (r = −.25, p = .180). In the BD group (r = .40, p = .028), but not in the control group (r = .24, p = .194) the SCS total correlated significantly with age. Moreover, there was also a trend towards a higher SCS-total in males compared to females (t = 1.77, p = .088, d = .65) in the BD group while this was not the case in the control group (t = −.09, p = .929, d = .05). Table 1. Descriptive characteristics of the sample of BD patients (N=30). Mean/% SD/N Age of onset 18.1 5.34 Illness duration (years) 12.8 6.89 Annual frequency of past depressive episodes (AFDE) 0.8 0.55 Annual frequency of past manic or hypomanic episodes (AFME) 0.5 0.44 Length of remission (months) 13.2 16.28 Manic/hypomanic symptoms (ASRM) 1.5 1.63 Depressive symptoms (MDI) 8.6 6.17 Functional impairments (WSAS) 12.53 6.30 Internalized stigma (ISMI) 1.59 .38 Life-satisfaction (SWLS) 15.80 5.44 Polarity of most recent episode: Depressive episode 63.3% 19 Hypomanic/Manic/Mixed episode 36.6% 11 Treatment: Psychoeducation: 96.7% 29 Psychopharmacology: 100% 30 Antiepileptics 66.7% 20 Antipsychotics 53.3% 16 Antidepressants 50.0% 15 Lithium 26.7% 8 Anxiolytics 3.3% 1 Other 6.7% 2 ASRM: Altman Self-Rating Mania Scale, MDI: Major Depression Inventory, WSAS: Work and Social Adjustment Scale, ISMI: Internalized Stigma of Mental Illness Scale, SWLS: The Satisfaction With Life Scale. Table options 3.2. Between group differences in self-compassion The mean age was 30.9 years (SD = 7.31) for the BD patients and 30.8 years (SD = 7.55) for the participants in the control group. Each group contained 9 males and 21 females. There was no difference between the two groups in terms of educational level (χ2 = 6,935, df = 5, p = 0,226), however BD patients were more likely to be unemployed than the controls (χ2 = 11.46, df = 4, p < 0,05). Table 2 displays the group means and between group differences on the SCS total and subscales. The t-test ( Table 2) revealed that the BD group had significantly lower self-compassion than the control group on the SCS total (t = −4.39, p = .000, d = 1.13). On the subscales the BD patients had significantly lower scores on Self-Kindness (t = −.2.37, p = .021, d = .61), and Common Humanity (t = −5.70, p = .000, d = 1.50) and significantly higher scores on Self-Judgment (t = 2.10, p = .040, d = 0.54), Isolation (t = 3.76, p = .000, d = .98), and Over-Identification (t = 2.94, p = .005, d = .77). Table 2. Comparisons between BD patients and controls in terms of self-compassion. SCS subscales: BD patients Mean (SD) Controls Mean (SD) BD patients vs. controls t p d Self-compassion total 2.53 (.59) 3.21 (.61) −4.39 .000 1.13 Self-Judgment 3.37 (.80) 2.93 (.85) 2.10 .040 .54 Isolation 3.68 (.86) 2.73 (1.07) 3.76 .000 .98 Over-Identification 3.73 (.73) 3.08 (.96) 2.94 .005 .77 Self-Kindness 2.65 (.78) 3.12 (.77) −2.37 .021 .61 Common Humanity 2.32 (.64) 3.48 (.91) −5.70 .000 1.50 Mindfulness 3.01 (.87) 3.41 (.70) −1.97 .054 .51 Table options Non-significant Shapiro-Wilk tests (>.05) revealed that data for all of the SCS dimensions (i.e. subscales and total) were approximately normally distributed in the BD group. This was also the case in the control group with the exception of the SCS total (p = .044). Thus, additional tests were conducted on this variable. When two outliers detected by box-plot were removed in the control group, the group difference on the SCS total remained significant (t = 4.83, p = .000, d = 1.29). Also, a non-parametric Mann-Whitney U test obtained similar results as the t-test (U = .722, p = .000), hence confirming the lower self-compassion in the BD patients compared to controls. 3.3. Correlates of self-compassion in the BD patients The bivariate correlations between SCS scores and the illness course and outcomes are presented in Table 3. A number of significant correlations between the subscale scores and illness course emerged. For instance, younger age of onset correlated with the Isolation subscale (r = −.37, p = .045), while longer illness duration was correlated with Self-Kindness, (r = .47, p = .009), Common Humanity (r = .42, p = .022), and Mindfulness (r = .37, p = .044). The SCS total (r = .37, p = .047) and Self-Judgment (r = −.42, p = .022) correlated significantly with general life-satisfaction. Notably, the annual frequencies of depressive episodes (r = −.31, p = .121) and manic episodes (r = −.20, p = .341) tended to correlate with lower self-compassion, albeit not significantly. Table 3. Correlates of self-compassion in BD patients (N = 30). Age of onset Illness duration AFDE AFME WSAS ISMI SWLS r r r r r r r Self-compassion total .21 .27 −.31 −.20 −.09 −.28 .37* Self-judgment −.22 .10 .26 .15 .14 .33 −.42* Isolation −.37* .05 .20 .01 .00 .18 −.23 Over-identification −.13 −.14 .20 .10 −.10 .08 −.25 Self-kindness .06 .47** −.31 −.16 −.17 −.26 .26 Common humanity .06 .42* −.16 −.11 −.30 .36 .35 Mindfulness .07 .37* −.27 −.35 .05 .10 .18 *p < 0.05, **p < 0.01, AFDE: Annual Frequency of Past Depressive Episodes, AFME: Annual Frequency of Past Manic and Hypomanic Episodes. WSAS: Work and Social Adjustment Scale, ISMI: Internalized Stigma of Mental Illness Scale, SWLS: The Satisfaction With Life Scale.