he Revolutionary Art of Acceptance

Anxiety disorders are on the rise all around the world. Every year, 6.8 million people in the United States are diagnosed with GAD (Dugas et al., 1998). This development necessitates additional research to determine the problems underlying the threat. Self-compassion has been found to increase well-being and several psychoanalytical programs designed to treat anxiety disorders (Neff & Germer, 2013). This study used a literature review to identify, assess, and report on 10 papers. Self-compassion and mindfulness have been shown to improve human well-being. Furthermore, it was crucial in enhancing the efficacy of numerous therapy interventions. In regards to efficacy comparison, there was inadequate study addressing the topic. However, MSC was revealed to increase self-compassion and mindfulness.

Self-Compassionate- The Revolutionary Art of Acceptance

Introduction

This academic work will explore GAD and provide a conceptual account of how self-compassion and mindfulness can be predictors of disability as many people within our society find themselves unable to turn understanding, acceptance, and love inward. While the treatment studies and various research projects concerning mindfulness and self-compassion are fairly new within the psychology realm, I have decided to further review the efficacy between medication (SSRI) therapies to the ever-growing popularity of Mindful Self-Compassion (MSC) training. I hope to show that the variables of trait mindfulness and self-compassion, while not the traditional focus of research, at least match or support the effectiveness of alternative methods of treatment over what I consider to be the clinical “fall back” of prescribing a medication.

GAD (generalized Anxiety Disorder) often referred as ‘free floating’ anxiety condition or ‘’chronic worrying ‘’ is one of the most occurring anxiety disorders in the globe and is approximated to have 5-6 % lifetime prevalence according to past research and records (Dugas et al., 1998).. GAD can be defined as an anxiety disorder characterized by uncontrollable, excessive and constantly irrational worry (Dugas et al., 1998). People suffering from this disorder generally anticipate catastrophe and are overly worried of every aspect of life including health concerns, death, family problems, money, work difficulties, interpersonal relationships challenges and friendship problems (Baer, Lykins, & Peters, 2012). 6.8 million people (3.1% of total population) in United States are diagnosed with GAD every year.

Self-compassion is a newly established domain in the discipline of positive psychology. According to various studies conducted, self-compassion enables individuals to suffer less and live satisfactory live (Breines & Chen, 2012). Self-compassion refers to compassion guided inward, relating to individuals as the object of concern and care when encountered with the experience of suffereing. It is composed of three common elements namely; mindfulness, kindness and common humanity (Breines & Chen, 2012). However, since this paper focuses on mindfulness, only mindfulness will be defined. Mindfulness is an element of self-compassion that encompasses mindful awareness of one’s negative emotions and thoughts in order to approach them with equanimity and balance (Baer, Lykins, & Peters, 2012).

Method

The study utilized empirical literature review. Various websites and other internet sites with key words listed below were searched. A total of 10 peer review journals were identified and selected for the study. Articles which lacked the listed keywords were automatically excluded.

Key words: Posttraumatic, compassion, mindfulness, MSC, MBCT, trauma stress disorder

Results

Compassion-Based Therapy for Trauma-Related Shame and Posttraumatic Stress: Initial Evaluation Using a Multiple Baseline Design

Au TM, Sauer-Zavala S, King MW, Petrocchi N, Barlow DH, Litz BT.

Au et al., (2017) conducted a study to create a short compassion-grounded therapy and investigate its efficacy for minimizing PTSD symptoms and trauma-related shame. A community sample of 10 trauma-exposed adults with prolonged PTSD symptoms and trauma –related shame was selected to participate in the study (Au et al., 2017). The researchers employed a multiple baseline experimental design to evaluate the intervention. The identified participants finished weekly evaluations during a 2-, 4-, or 6-week baseline cycle as well as 6-week treatment cycle and at 2 and 4 weeks following intervention (Au et al., 2017).

9 out of 10 participants showed reliable decline in PTSD symptom severity and 8 out of 10 participants demonstrated significant decrease in shame at the end of the therapy. The researchers maintained the achieved improvements at 2- and 4-week follow-up. Other improvements associated with the therapy included self-blame and self-compassion (Au et al., 2017). Furthermore, high levels of satisfaction with the intervention were reported among participants. According to the findings, the intervention either singly or in combination with other studies is beneficial in reducing PTSD symptoms and trauma-related shame (Au et al., 2017).

Self-Compassion: Conceptualizations, Correlates, & Interventions by Laura, B, C and John, F, C.

This study assessed the effectiveness of self-compassion training intervention on positive and negative affect, self-compassionate, life satisfaction, subjective happiness, depression, stress and anxiety (Barnard & Curry, 2011). Another aim of the study was to contribute to knowledge by evaluating whether alterations in self-compassion can forecast alterations in elements of well-being. A total of 74 students of social science were identified legible to participate in the study (Barnard & Curry, 2011). 33 students were randomly placed in the intervention group while another 41 participants were randomly assigned to a control group. The participants in intervention group were provided with psycho-educational training program whose intention was to teach them how to be more self-compassionate in conflicting circumstances (Barnard & Curry, 2011). No training was offered to control group.

Increases in life satisfaction, positive affect, self-compassion and subjective happiness, and reductions in depression, anxiety, stress and negative affect were reported in intervention group with reference to study results (Barnard & Curry, 2011). No changes were noted on control group. According to the findings self-compassion plays significant role on effectiveness of determined intervention programs and psychological well-being.

A randomized controlled trial of Mindfulness-Based Cognitive Therapy (MBCT) versus treatment-as-usual (TAU) for chronic, treatment-resistant depression: study protocol.

Mira B. Cladder-Micus, Janna N Vrijsen, Eni S. Becker, Rogier Donders, Jan Spijker, Anne E. M. Speckens

Speckens et al., (2015) conducted a randomized controlled experiment to compare MBCT (Mindfulness-Based Cognitive Therapy) with TAU (treatment-as-usual). Participants included patients with acute, treatment-resistant depression who had received cognitive behavioral therapy and antidepressant medication or interpersonal therapy (Speckens et al., 2015). Depressive symptoms were the primary outcomes whereas rumination, mindfulness skills, self-compassion, remission rates and quality of life were secondary outcomes. After the post TAU period evaluation, participants in TAU condition were engaged in MBCT. Follow-up assessments were carried out at 3 and 6 months for all patients who completed MBCT.

The researchers expected that the result of the trial will provide valuable information in regards to the effectiveness of MBCT in acute, treatment-resistant depressed patients who in past received psychological treatment as well as antidepressant medication (Speckens et al., 2015).

The challenge of this study is that it leans on expectations rather than actual findings. It could be prudent enough if the researchers reported the real findings. Nonetheless, the researchers are cognizant of other studies that have shown MBCT to be effective in decreasing relapse in recurrent depression and minimizing symptom levels in chronic depression (Speckens et al., 2015).

Self-compassion is more effective than acceptance and reappraisal in decreasing depressed mood in currently and formerly depressed individuals.

Ehret AM, Joormann J, Berking M

The researchers carried out a research to compare the efficacy of self-compassion with higher developed methods of reappraisal and acceptance. Individuals (n=40) who formerly, currently or never depressed were selected to participate in the study (Ehret, Joormann & Berking, 2018). Depressed mood was instigated in all participants at 4 varying time-points. Following each mood instigation, participants were directed to control their emotions through either employing self-compassion, accepting their emotions, waiting or reappraising the condition (Ehret, Joormann & Berking, 2018). The level of depressed mood was measured prior and after each mood instigation as well as control phase.

Self-compassion was reported to greatly reduce depressed mood than acceptance and waiting situations across all participants. Furthermore, self-compassion was found to be more effective in never depressed and recovered participants than reappraisal. However, since the study depended on self-report data, the results cannot be fully reliable due to influence of bias from respondents. In conclusion, Ehret, Joormann and Berking (2018) argued that since their findings revealed that self-compassion is superior to acceptance and more effective or equal to reappraisal, they offer motivation for undertaking future research on how self-compassionate can promote the stability and efficacy of current depression.

Embodying Compassion: A Virtual Reality Paradigm for Overcoming Excessive Self-Criticism

Caroline J. Falconer, Mel Slater, Aitor Rovira, John A. King, Paul Gilbert, Angus Antley, Chris R. Brewin

An experimental design to compare between 1PP (a first person perspective) and3PP third person perspective was conducted (Falconer et al., 2014). 43 females with average age of 22 years were recruited to participate in the study. 22 participants were placed in1PP group while the other 21 participants were assigned 3PP group. The two groups of participants were subjected to four phases of VR session.

FSCRS (Forms of Self-Criticizing/Attacking and Self-Reassuring Scale) was adopted to assess self-reassurance and trait self-criticism. I-PANAS-SF (International Positive and Negative Affect Schedule, Short Form) and SCCS (Self-Compassion and Self-Criticism Scale) were used to measure positive affect and negative affect, and self-compassion and self-criticism respectively (Falconer et al., 2014).

No differences in initial trait levels of self-criticism were observed in the two groups as recorded by FSCRS. Greater body agency and ownership was noted in 1PP in comparison to 3PP. Irrespective of viewing dimension, results revealed that participants experienced reduced self-criticism level after re-experiencing their compassionate. There were no observable changes in positive and negative affect (Falconer et al., 2014). The study was capable of producing valid and reliable results owing to various strategies it employed to control unfavorable incidences like bias, ethical problems and poor data analysis.

The Revolting Self: Perspectives on the Psychological, Social, and Clinical Implications of Self-Directed Disgust 

Philip A. Powell, ‎ Paul G. Overton, ‎ Jane Simpson

This book broadly explores the idea of self-disgusting using informed theorizing, novel empirical research, social commentary and academic review. It offers readers with comprehensive summary of present state of research and theory on self-disgust. Self-disgust is an area of big importance for psychopathology that has just start to provoke great research interest (Powell, Overton & Simpson, 2014).

The authors provide audience a transdiagnostic guideline for comprehending how self-disgust may be viewed across different disorders. There are various ways through which experiencing disgust may lead to psychiatric disorders. Emotional dispositions for human beings require social programming (Powell, Overton & Simpson, 2014). In fact, people have to calibrate and acquire schemas that allow for intelligible and culturally acceptable strategies of building and emotional self. In conclusion, Powell, Overton and Simpson (2014) promote disgust towards the self to its correct position together with other though different self-conscious and evaluative emotions including guilt, anger and shame (Powell, Overton & Simpson, 2014).

The Transdiagnostic Phenomenon of Self-Criticism by Elisabeth Schanche (2013)

The objective of this article is to specify and demonstrate three common interventions (Affect Experience via gradual exposure to Previous Avoided Affects, Establishing and Rehearsing an Inner Compassionate Image and Dialogue, and Regulation of High Levels of Anxiety, Guilty, Shame and pain Associated with Negative Affects and Compassionate Imagery)) that can be utilized when dealing with highly self-critical patients (Schanche, 2013). A case of a female patient diagnosed with avoidant personality disorder was employed to illustrate the interventions (Schanche, 2013). The patient had a pervasive propensity to cure herself in a critical self-defeating way. The interventions were aimed at promoting the patient’s ability to associate herself with higher self-compassionate. The interventions were derived from two distinct therapeutic approaches namely; social mentality theory and short-term psychodynamic model (Schanche, 2013).

The patient managed to slowly develop a greater tolerance for and awareness of her feeling of anger, developed a heightened ability to cure herself with higher self-compassion and tolerance for her own negative affects, and while using compassionate imagery she was amazed by her own capability to visualize (Schanche, 2013).

A Wait-List Randomized Controlled Trial of Loving-Kindness Meditation Programme for Self-Criticism

Ben Shahar, Ohad Szepsenwol, Sigal Zilcha-Mano, Netalee Haim, Orly Zamir, Simi Levi-Yeshuvi, Nava Levit-Binnun

Shahar et al., (2015) carried out a study to investigate the efficacy of LKM (loving-kindness mediation) program created to heighten self-compassionate in a population of self-critical persons. 38 participants with high scores on self-critical perfectionism were recruited for the study and divided into two equal groups (n=19). One group was randomized to LKM and the other one to WL (wait-list) situation. Evaluations of self-compassionate, self-criticism and psychological distress were taken prior and immediately after the program (LW or LKM). The intervention was administered to WL group immediately following waiting period. 3 months after intervention both groups were evaluated (Shahar et al., 2015).

Per-protocol analyses (n=32) as well as intent-treat (n=38) revealed substantial decreases in depressive symptoms and self-criticism, and great increases in positive emotions and self-compassionate in LKM situation compared to WL situation (Shahar et al., 2015). Three months after the intervention, follow-up per-protocol analysis in the 2 groups (n=20) revealed that the benefits were maintained (Shahar et al., 2015). The researchers deduced that on basis of results, LKM may be suitable in eliminating self-criticism, heightening self-compassionate and improving depressive symptoms in self-critical persons (Shahar et al., 2015).

A Pilot Study and Randomized Controlled Trial of The Mindful Self-Compassion Program

Neff KD, Germer CK.

In 2012, Neff and Germer carried out a randomized trial of MSC (Mindful Self-Compassion) intervention that compared efficacy of treatment group (n=25) to randomized WL control group (27). All participant recruited for the study were females (n= 52). Study findings showed that 76% of participants reported having prior experience with mindfulness intervention (Neff & Germer, 2013). The group subjected to MSC demonstrated substantial increase in self-compassion levels (43%) together with significant effect size.

Other significant improvements among participants were noted in increase in compassion for others (7%), mindfulness (19%) and life satisfaction (24%), and reductions in anxiety (20%), emotional avoidance (16%), depression (24%) and stress (10%). Follow-up at 6 months and one year was used to maintain all significant benefits in study outcomes. Nevertheless, life satisfaction significantly heightened from the period of intervention completion to the one year follow-up implying that the ongoing practice of self-compassionate improves the quality of life for an individual with time (Neff & Germer, 2013). Researchers concluded that MSC intervention tends to be effective at promoting mindfulness, self-compassion and well-being.

Discussion/Conclusion

Numerous studies report that treating oneself with compassion and mindfulness is a powerful strategy to promote interpersonal and intrapersonal well-being (Diedrich et al., 2014). All studies discussed above support this claim. When individuals are mindful of their pain or distress and respond with kindness bearing in mind that pain is part of the shared human condition, they are capable of coping with struggles of life with much ease (Breines & Chen, 2012). When human beings combine mindful acceptance of their current moment experience with the compassionate desire to be free from suffering and to be joyous they maximize their capability to heal as well as attain their full potential (Barnard & Curry, 2011).

It has been demonstrated beyond any doubtful reasons that self-compassion plays significant role on effectiveness of focused intervention programs and psychological well-being. For instance, Ehret et al., (2018) found that self-compassion greatly reduced depressed mood than acceptance and waiting situations across all studied participants. Negative affects, anxiety, stress, depression, self-defeating traits, negative emotions and self-criticism have negative impact on well-being and life satisfaction (Ehret, Joormann & Berking, 2018).

Although there is no much research done on comparing the efficacy between medication (SSRI) therapies to the ever-growing popularity of Mindful Self-Compassion (MSC) training, various studies measuring outcomes of each intervention independently argue that teaching self-compassion creates the difference. A study comparing LKM and WL intervention revealed that LKM was more effective (Shahar et al., 2015). Nevertheless, research shows that MSC programs tend to be effective at promoting mindfulness, self-compassion and well-being. For example, MBCT has been found to be effective in decreasing relapse in recurrent depression and minimizing symptom levels in chronic depression (Speckens et al., 2015).

The main limitation of this study is use of a few peer review journals. Future research should utilize more review articles to make the findings more valid and reliable. In addition, future research should focus on comparing various interventions of treating anxiety disorders

References

Au, T. M., Sauer-Zavala, S., King, M. W., Petrocchi, N., Barlow, D. H., & Litz, B. T. (2017). Compassion-based therapy for trauma-related shame and posttraumatic stress: Initial evaluation using a multiple baseline design. Behavior Therapy, 48(2), 207-221.

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Falconer, C. J., Slater, M., Rovira, A., King, J. A., Gilbert, P., Antley, A., & Brewin, C. R. (2014). Embodying compassion: a virtual reality paradigm for overcoming excessive self-criticism. PloS one, 9(11), e111933.

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Powell, P. A., Overton, P. G., & Simpson, J. (Eds.). (2014). The revolting self: Perspectives on

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Shahar, B., Szepsenwol, O., Zilcha‐Mano, S., Haim, N., Zamir, O., Levi‐Yeshuvi, S., & Levit‐Binnun, N. (2015). A wait‐list randomized controlled trial of loving‐kindness meditation programme for self‐criticism. Clinical psychology & psychotherapy, 22(4), 346-356.

Speckens, A. E., Becker, E. S., Spijker, J., Vrijsen, J. N., Cladder-Micus, M. B., & Donders, R. (2015). A randomized controlled trial of Mindfulness-Based Cognitive Therapy (MBCT) versus treatment-as-usual (TAU) for chronic, treatment-resistant depression: study protocol. BMC psychiatry, 15(1), 275.