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.