Relationships between self-compassion, attachment and interpersonal problems in patients with mixed anxiety and depression
Abstract
Background: There has been growing interest and research into the construct of self-compassion.
Self-compassion has been positively associated with psychological well-being,
and negatively associated with a range of psychological difficulties. The origins of self-compassion
have been linked to early attachment experiences, with poor attachment
relationships proposed to result in an inability to self-soothe and take a compassionate stance
towards the self. Whilst research in nonclinical populations provides some initial support for
these hypotheses, there is a lack of research conducted in clinical populations.
Given a large effect size has been found for the association between self-compassion and
psychological difficulties, this suggests it may be an important target for therapeutic change.
There is a growing evidence-base for the use of compassion-focused therapies, with research
suggesting they are effective in reducing mood symptomology. However, less is known
about the impact of these therapies on levels of self-compassion, or whether reductions in
mood symptomology occur as a causal effect of increased self-compassion. In addition, other
‘third wave’ therapies may also indirectly increase self-compassion.
Aims: The research aims were two-fold. The first aim was to conduct a systematic literature
review to evaluate the effectiveness of compassion-focused and mindfulness-based
interventions in increasing levels of self-compassion. The second aim was to examine the
role of self-compassion and its relationships with attachment and interpersonal problems in
adults attending a primary care psychological therapies service. Specifically, self-compassion
and interpersonal problems were hypothesised as potential mediators between
insecure attachment and anxiety and depression.
Method: To address the first research aim, a systematic search was conducted to identify
studies that utilised a compassion and/or mindfulness-based intervention with a clinical
population, and included self-compassion as an outcome measure. To address the second
research aim, a cross-sectional, quantitative study was conducted. Participants (N=74; 60%
female, mean age = 40 years) attending a primary care psychological therapies service
completed four self-report questionnaires assessing self-compassion, attachment,
interpersonal problems and anxiety and depression.
Results: The findings of the systematic review suggested that self-compassion can be
increased through both compassion-focused and mindfulness-based interventions. However,
methodological weaknesses across studies highlighted that further research is needed and
definitive conclusions cannot be drawn. The results of the empirical study indicated that low
self-compassion, attachment avoidance and high levels of interpersonal problems were all
associated with increased emotional distress. Furthermore, self-compassion mediated the
relationship between attachment avoidance and emotional distress and anxiety. Interpersonal
problems was not a significant mediator.
Conclusions: Taken collectively, the findings here suggest that self-compassion may be an
important target in psychological therapy. In addition, results of the mediation analysis
indicated that low self-compassion can be a pathway to overall emotional distress and
anxiety for individuals with attachment avoidance. This provides support for the theory that
self-compassion is linked to early attachment experiences.