Self‐compassion and PTSD symptom severity

“Research on the Self-Compassion Scale has found that higher self-compassion is associated with greater psychological well-being: less depression, anxiety, rumination, and thought suppression, and with greater life satisfaction and social relatedness ( Neff, 2003b ).”

“More recently, Gilbert and Proctor (2006) developed a program aimed at fostering compassion and decreasing shame and self-criticism in patients with personality and/or mood disorders attending a hospital day treatment program.”

“Furthermore, a paper reporting associations between PTSD symptoms and compassion (Thompson & Waltz, 2008) was excluded as effect size data were reported for PTSD subscales only.”

“The state of self-compassion involves generating the desire to alleviate one's suffering, healing oneself with kindness, recognizing one's shared humanity, and being mindful when considering negative aspects of oneself (Neff, 2003; Neff & Vonk, 2009; Thompson & Waltz, 2008).”

“It has been hypothesized that self-compassion is positively associated with mindfulness and negatively associated with rumination, thought suppression, and avoidance (Neff et al., 2005; Neff, Kirkpatrick, & Rude, 2007; Neff & Vonk, 2009; Raes, 2010; Thompson & Waltz, 2008).”

“Furthermore, in examining the link between Post-traumatic Stress Disorder (PTSD) and self-compassion, Thompson and Waltz (2008) found that self-compassion was negatively related to experiential avoidance, a symptom of PTSD.”

“…development of self-compassion may be beneficial in alleviating depression and other psychological conditions (Leary, Tate, Allen, Adams, & Hancock, 2007; K. Neff, 2003; K. D. Neff, Kirkpatrick, & Rude, 2007; K. D. Neff, Rude, & Kirkpatrick, 2007; K. D. Neff & Vonk, 2009; Thompson & Waltz, 2008).”

“Consistent with this Buddhist approach, studies involving trauma patients have shown that higher levels of self-compassion and mindfulness lead to reductions in post-traumatic avoidance strategies (e.g., Follette et al. 2006; Thompson and Waltz 2008).”

“In a study of PTSD symptoms in university students, greater self-compassion significantly correlated with lower rates of avoidance symptoms, but not reexperiencing or hyperarousal (Thompson & Waltz, 2008).”

“Consistent with this approach, higher levels of selfcompassion (Thompson & Waltz, 2008) and mindfulness (Follette, Palm, & Pearson, 2006) have both been shown to reduce maladaptive posttraumatic avoidance strategies.”

“For instance, the level of self-compassion displayed by combat veterans returning from Iraq or Afghanistan was a better predictor of PTSD symptomology than level of combat exposure itself (Hiraoka et al., 2015).”

“…(Gregg, Callaghan, Hayes, & Glenn-Lawson, 2007)—an important element in the treatment of trauma (Courtois & Ford, 2009)—while also increasing self-compassion (Shapiro, Astin, Bishop, & Cordova, 2005), which is related to the severity of avoidance symptoms in PTSD (Thompson & Waltz, 2008).”

“…research documenting the salutary role of SC for stress-related disorders such as mood and anxiety disorders (Neff 2003a; Neff et al. 2007; Raes 2011), as well as preliminary evidence of its protective role with respect to trauma-related psychopathology more specifically (Thompson and Waltz 2008).”

“Conversely, research suggests that selfcompassion correlates negatively with anxiety and depression (Raes, 2010), negative affect (Leary et al., 2007), rumination, emotional suppression, and avoidance (Neff et al., 2005; Thompson & Waltz, 2008).”

“…6 Good Pinciotti et al., 2017 5 Fair Reffi et al., 2018 5 Fair Scoglio et al., 2018 7 Good Seligowski et al., 2015 5 Fair Tarber et al., 2016 4 Poor Thompson & Waltz, 2008 4 Poor Wu et al., 2018 3 Poor TABLE A2 Methodological quality rating scores for intervention studies according to the Downs…”

“Interestingly, self-compassion is negatively associated with avoidant coping (Allen & Leary, 2010; Neff, Hsieh, & Dejitterat, 2005) and experiential avoidance (Thompson & Waltz, 2008), both of which are key features of attachment avoidance (Mikulincer & Shaver, 2007a).”

“Conversely, self-compassion has been negatively associated with maladaptive states and psychiatric symptoms, including catastrophizing, anxiety, depression, self-criticism, avoidance, and PTSD symptoms (Neff et al., 2005; Thompson & Waltz, 2008).”

“Among traumaexposed individuals, greater self-compassion has been found to be associated with less avoidance and lower PTSD severity (Kearney et al., 2013; Thompson & Waltz, 2008).”

“2013), posttraumatic stress disorder (Thompson and Waltz 2008), aging (Allen et al.”

“In contrast, lower levels of self-compassion were associated with mental health problems such as posttraumatic stress disorder (Thompson & Waltz, 2008) and depression (Kuyken et al., 2015).”

“Building on prior research that demonstrated that selfcompassion was primarily associated with the avoidance symptoms of PTSD among a civilian sample with trauma exposure (Thompson & Waltz, 2008), we examined the relations between self-compassion and the DSM-IV PTSD symptom clusters.”

“The findings from the study support the work of various theorists, including Ehlers and Clark 2000; Gilbert and Proctor, 2006; Harman and Lee, 2010; Neff, Kirkpatrick and Rude, 2007; and Thompson and Waltz, 2008.”

“…associated with less posttraumatic stress symptoms among veterans (Dahm et al. 2015) and other trauma-exposed samples (e.g., individuals who experienced physical abuse, sexual assault, and natural disasters) (Dahm et al. 2015; Seligowski et al. 2015; Thompson and Waltz 2008; Zeller et al. 2015).”

“Self-compassion has been investigated as a resilience factor in situations of traumatic stress [15] or psychological vulnerability [16].”

“Research with students has found that self-compassion was negatively associated with avoidance but not re-experiencing or hyperarousal (Thompson and Waltz, 2008).”

“In particular, experiential avoidance exacerbates and prolongs posttraumatic stress in providers, whereas ‘‘self compassion is associated with greater willingness to engage painful thoughts’’ and memories of trauma (Thompson & Waltz, 2006, p. 558).”

“They concluded that it might be an inability to develop self-kindness and self-reassurance, as much as self-criticism, that may contribute to the maintenance of PTSD. Self-compassion has not been a central target in traumafocused cognitive-behavioral therapies, which are the ones that so far have been documented to be…”

“The COVID-19 pandemic has had severe multifaceted consequences for people’s psychosocial wellbeing and mental health [2, 3, 67], and hence a better understanding of the underlying protective and risk factors of both the negative and positive psychological effects of the pandemic is warranted [1, 74].”

“…types of psychopathology, such as depression, mixed anxiety-depressive disorder, eating disorder, or post-traumatic stress disorder, serving as a protective factor (Kelly, Vimalakanthan, & Miller, 2014; Odou & Brinker, 2014; Thompson & Waltz, 2008; Van Dam, Sheppard, Forsyth, & Earleywine, 2011).”

“…been increasing interest in self-compassion as a therapeutic target for PTSD treatment (Dahm et al., 2015 Hiraoka et al., 2015 Kearney et al., 2013; Thompson & Waltz, 2008; Zeller, Yuval, Nitzan-Assayag, & Bernstein, 2015) and preliminary results from clinical trials are promising (Au et al.,…”

“A study of PTSD symptoms among university students found a correlation between greater self-compassion and lower rates of avoidance symptoms.(16) An intervention called “compassionate mind training” designed to teach self-compassion, was beneficial for individuals who had experienced trauma in a small pilot study.”

“Prior research has shown that self-compassion is a promising construct in trauma-exposed individuals (Thompson & Waltz, 2008).”

“Thompson and Waltz (2008) found that in a sample of college students self-compassion was negatively correlated with symptoms of avoidance, but not re-experiencing or hyperarousal.”

“Such feelings have the potential to impede recovery following traumatic events (Thompson & Waltz, 2008).”

“…findings also seem to support previous research denoting that self-compassion may be viewed as a way of exposure to internal threats (Krieger et al., 2013; Thompson & Waltz, 2008) and rumination as a way of avoidance of painful aspects of the loss (Eisma, Schut et al., 2014; Stroebe et al., 2007).”

“The unique attachment and relationship with one’s dog may facilitate increases in self-compassion, which is constructive because selfcompassion is a protective factor against PTSD among military veterans.(45,46) Increased self-compassion is important because higher levels of self-compassion are characterized by object…”

“Thus, self-compassion might reduce the selection of isolative or avoidant behavioral repertoires (Thompson & Waltz, 2008).”

“Further, Thompson and Waltz (2008) found a significant negative correlation between selfcompassion and avoidance in students who had experienced a traumatic event.”

“Developing a self-compassionate perspective has been regarded as a valuable treatment target (MacBeth & Gumley, 2012), and may be adaptive in the context of trauma exposure (Kearney et al., 2013; Thompson & Waltz, 2008).”

“The present findings are consistent with the results of Thompson & Waltz (2008), who suggest that incorporating techniques into therapy that help create affiliative feelings, may benefit individuals suffering with symptoms of trauma, develop self-compassion.”

“Self-directed compassion generates a desire to alleviate one’s own suffering, to heal oneself with kindness, to recognize one’s shared humanity, and to be mindful when considering negative aspects of oneself (Neff 2003; Neff and Vonk 2009; Thompson and Waltz 2008).”

“Trauma-related cues may arouse fear in traumatized individuals and may lead to the elicitation of a judgmental reaction and avoidance behaviors (Thompson & Waltz, 2008).”

“…a negative association between selfcompassion and rumination, thought suppression, avoidance (Neff et al., 2007; Neff & Vonk, 2009; Raes, 2010; Thompson & Waltz, 2008), depression, anxiety (Neff et al., 2007; Richardson et al., 2020), and perfectionism (D’Souza et al., 2011; Neff, 2003b)…”

“…be important, as low levels of self-compassion are associated with increased severity of trauma symptoms in community-based samples (Maheux & Price, 2015; Thompson & Waltz, 2008) as well as emotion regulation difficulties in young people with an abuse history (Vettese, Dyer, Li, & Wekerle, 2011).”

“Adolescents with higher levels of dispositional mindfulness are more likely to present more acceptance toward themselves, and hold a non-judgmental attitude toward the present experience (Kabat-Zinn, 2003; Thompson & Waltz, 2008).”

“In trauma-exposed samples of college students, higher self-compassion was associated with lower PTSD avoidance symptoms (Thompson & Waltz, 2008), and was a strong predictor of psychological health (Seligowski, Miron, & Orcutt, 2015).”

“One study found that self-compassion was associated with only the avoidance symptom cluster of PTSD, and not with other symptom clusters (Thompson & Waltz, 2008).”

“, 2015) and behavioural avoidance (Thompson and Waltz, 2008).”

“The experience of shame and self-criticism is transdiagnostic, prevalent in disorders such as depression, social anxiety disorder, psychotic disorders, PTSD, eating disorders, and per‐ sonality disorders (Gilbert, Pehl, & Allan, 1994; Thompson & Waltz, 2008).”

“Lastly, mindfulness has also been found to negatively predict cognitive avoidance (Thompson & Waltz, 2008, 2010), cognitive fusion, and cognitive suppression (Nitzanassayag et al., 2015).”

“Forgiveness is characterized with positive attitudes of individuals towards themselves especially when they experience negative life events (Worthington, Witvliet, Pietrini, & Miller, 2007) like self-compassion (Leary et al., 2007; Neff, 2003b; Thompson & Waltz, 2008).”

“2013), psychological functioning (Thompson and Waltz 2008; Zeller et al. 2015) and physical health (Hall et al.”

“Not all people develop PTSD following exposure to trauma while still showing post-traumatic stress (PTS) symptoms such as anxiety, irritability, and sleep disturbances 33,41 .”

“This is problematic as low self-compassion is negatively associated with trauma symptoms (Karatzias et al., 2019; Maheux & Price, 2015; Thompson & Waltz, 2008), and fear of self-compassion can contribute to symptoms of post-traumatic stress disorder (PTSD) and depression in CSA survivors (Miron…”

“Empowering individuals who experience sexual assault to practice self-compassion and to love and view themselves positively may be bene fi cial in the recovery process following sexual assault (Dunn, 2005; Thompson & Waltz, 2008).”

“Moreover, adolescents with PSC are more inclined to view suffering as something everyone can experience and thus deal with traumatic events calmly and peacefully (Thompson & Waltz, 2008).”

“These were close to the prevalence rate of 31.8% in the third study with American young adults (aged from 18 to 30) during COVID-19 (62).”

“An increasing number of investigations propose self-compassion as a worthwhile therapeutic target (Germer and Neff 2013; MacBeth and Gumley 2012) which can play a protective role against pathological reactions to trauma such as PTSD (Thompson and Waltz 2008; Kearney et al. 2013).”

“Also, drawing on past research on experience-based variability in other cognitions such as self-concept, attitudes, or global motivation ([34–37]), we reasoned that people are likely to vary in their compassionate self-responding across different contexts, depending on their past experiences [38].”

“These results were in line with previous research on the relationship between PTSD and self-compassion [20, 25, 39].”

“Selfcompassion can be a helpful self-care skill for coping with the guilt and shame that many veterans report as well as other symptoms of PTSD (Thompson & Waltz, 2008).”

“Although there is robust cross-sectional support for the influence of mindfulness on the re-experience of trauma symptoms in PTSD (e.g., Seligowski et al., 2015), some studies did not find significant associations (Karatzias et al., 2018; Maheux & Price, 2015; Thompson & Waltz, 2008).”