Self-criticism and dependency in depressed patients treated with cognitive therapy or pharmacotherapy
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CBT may not benefit all people, especially those who are highly self-critical, where relapses in mental health problems are common.
“However, CBT may not benefit all people, especially those who are highly self-critical, where relapses in mental health problems are common (Rector et al., 2000).”
From An online acceptance, commitment, and self-compassion based treatment to decrease psychological distress in people with type 2 diabetes: A feasibility randomised-controlled trial (2023) · cites this paper as Rector et al., 2000
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“Self-critics may also do less well with standard therapies (Rector et al., 2000).”
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“Self-critical individuals are more likely to become depressed (Blatt and Zuroff 1992), less likely to respond to treatments ( Rector et al. 2000 ) and more likely to relapse when they do respond (Teasdale and Cox 2001).”
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“Individuals with higher levels of self-criticism tend to have poorer outcomes in traditional therapies, such as cognitive therapy and cognitive behavioural therapy (CBT) (Enns et al., 2002; Rector et al., 2000).”
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“As selfcriticism has been associated with negative outcomes in the psychotherapy literature reviewed (e.g., Marshall, Zuroff, McBride, & Bagby, 2008; Rector et al., 2000), it is important to consider ways to deal with self-criticism when it emerges in therapy.”
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“Also, in a recent review, Kannan and Levitt (2013) pointed out that self-criticism might act to impair the therapeutic alliance, which can determine poorer treatment outcomes (Marshall, Zuroff, McBride, & Bagby, 2008; Rector et al., 2000).”
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“Furthermore, several studies have shown that self-criticism negatively impacts the course and outcome of treatment for depression (Blatt, Quinlan, Pilkonis, & Shea, 1995; Rector et al., 2000; Shahar, Blatt, Zuroff, & Pilkonis, 2003) and that *Correspondence to: Ben Shahar, School of Psychology, Interdisciplinary Cente…”
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“Rector et al(59) reported that neither pretreatment self-criticism nor dependency scores were predictors of response to pharmacotherapy, but self-criticism scores were predictive of response to cognitive therapy.(59) These findings demonstrate that personality assessment may be useful to help predict the clinical cour…”
ResultSelf-citationThe Role of Perfectionism in Daily Self‐Esteem, Attachment, and Negative Affect
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Self‐criticism predicts differential response to treatment for major depression
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Self-citationEvolutionary Approaches to Psychopathology and Cognitive Therapy
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“This definition suggests that an individual’s personality is stable over time; however, it has been found that under certain circumstances, such as when an individual undergoes successful MD treatment, personality change, at least insofar as personality is currently measured, can occur (DeRubeis & Feeley, 1990; Rector…”
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“Self-critical individuals often struggle with standard therapies [64,65] and have become a focus for compassion focused therapy [13,14].”
BackgroundBagby, R. M., Gilchrist, E. J., Rector, N. A., Dickens, S. E., Joffe, R. T., LEVITT, A. J., Levitan, R. D., & Kennedy, S. H. (2001) · Cognitive Therapy and Research · doi:10.1023/a:1012975524455 · Cited by 60 · see citing works
“Recently, Rector et al. (2000) assessed the role of self-criticism and dependency, constructs similar to but not identical with sociotropy and autonomy, in response to cognitive therapy or pharmacotherapy.”
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“Rector et al. (2000) emphasized that self-criticism should be assessed prior to treatment and for some individuals it might be more intensively targeted and addressed than is the”
BackgroundA review of PTSD and shame in military veterans
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“As has been indicated in previous research, decreasing self-criticism can act as a protective buffer between distressing situations/conditions/thoughts and the development/maintenance of anxiety and depressive disorders by reducing repetitive and maladaptive thinking about these events (Cox et al. 2002; Gilbert and Pr…”
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Self-citationSelf‐criticism self‐report measures: Systematic review
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“Since self-critical individuals have poorer outcomes after depression treatment (Marshall et al., 2008; Rector et al., 2000), research has begun to focus on treatments specifically targeting self-criticism (see Kannan & Levitt, 2013 for a review, as well as Shahar et al., 2012; 2015a for example…”
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“…(Shahar et al., 2004) and is associated with interper- 115Eur J Pain 16 (2012) 115–122 © 2011 European Federation of International Association for the Study of Pain Chapters sonal difficulties (Santor and Zuroff, 1998) and poor response to psychotherapeutic treatment (Rector et al., 2000).”
BackgroundInfluentialSociotropy, Autonomy and Personality Disorder Criteria in Psychiatric Patients
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Centrality of Shame Memories and Psychopathology: The Mediator Effect of Self‐Criticism
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Assessing Self-Critical Perfectionism in Clinical Depression
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“, Enns, Cox, & Pidlubny, 2002; Zuroff et al., 2000) and for anxiety (Flett, Greene, & Hewitt, 2004). Advancements in perfectionism research have been due in large part to theoretical and measurement developments in this field. Two groups of authors—Frost, Marten, Lahart, and Rosenblate (1990) and Hewitt and Flett (199…”
BackgroundThe compassionate kitbag: a creative and integrative approach to compassion-focused therapy
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Transference-Countertransference: Where the (Political) Action Is.
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“The use of change scores as a means of evaluating posttreatment changes on dependent measures have been used in numerous treatment outcome studies (e.g., Green et al., 2001; Rector, Bagby, Segal, Joffe, & Levitt, 2000 ).”
MethodGroup Cognitive Behaviour Therapy for Residual Depression: Effectiveness and Predictors of Response
Enns, M. W., Cox, B. J., & Pidlubny, S. R. (2002) · Cognitive Behaviour Therapy · doi:10.1080/16506070252823643 · Cited by 35 · see citing works
“Furthermore, an earlier study of CBT for depression found that self-criticism but not dependency was associated with treatment outcome (Rector et al., 2000).”
BackgroundResultInfluentialZeeck, A., von Wietersheim, J., Weiß, H., Scheidt, C. E., Völker, A., Helesic, A., Eckhardt‐Henn, A., Beutel, M. E., Endorf, K., Treiber, F., et al. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.03.039 · Cited by 33 · see citing works
“In a study of Rector et al. (2000), selfcriticism was related to poor outcome in outpatients treated with CT, but not in the pharmacotherapy condition.”
Mistretta, E. G., & Davis, M. C. (2021) · Mindfulness · doi:10.1007/s12671-021-01766-7 · Cited by 35 · see citing works
“Unfortunately, therapies like CBT appear to yield fewer benefits in individuals high in self-criticism and/or negative emotional biases, and in situations of high stress (Ford and Troy, 2019; Rector et al., 2000; Siemer & Reisenzein, 2007).”
Yao, S., Fang, J., Zhu, X., & Zuroff, D. C. (2008) · Depression and Anxiety · doi:10.1002/da.20465 · Cited by 33 · see citing works
“’s([9]) literature review found that inter-scale correlations were generally low in student and community samples, but somewhat higher in clinical populations.([19,27,39]) The correlations between each factor in this study indicated good factorial validity of the DEQ-C.”
ResultDeveloping a Compassionate Internal Supervisor: Compassion-Focused Therapy for Trainee Therapists.
Bell, T., Dixon, A., & Kolts, R. (2017) · Clinical Psychology and Psychotherapy · doi:10.1002/cpp.2031 · Cited by 26 · see citing works
Dhokia, M., Elander, J., Clements, K., & Gilbert, P. (2020) · Psychology of Addictive Behaviors · doi:10.1037/adb0000579 · Cited by 26 · see citing works
“…effective for people who are high in self-criticism or have low motivation to change (Kelly et al., 2010; Leaviss & Uttley, 2015; Matos et al., 2017), whereas high self-criticism predicted poorer responses to CBT or psychotherapy for depression (Rector et al., 2000; Marshall et al., 2008).”
BackgroundEtiology and Treatment of Cluster C Personality Disorders
Eskedal, G. A., & Demetri, J. M. (2006) · Journal of Mental Health Counseling · doi:10.17744/mehc.28.1.7yjq6tabcexb1a6j · Cited by 27 · see citing works
Self-Criticism, Anxious Attachment, and Avoidant Attachment as Predictors of Career Decision Making
Braunstein‐Bercovitz, H. (2013) · Journal of Career Assessment · doi:10.1177/1069072713492938 · Cited by 26 · see citing works
Exploiting the plasticity of compassion to improve psychotherapy
Förster, K., & Kanske, P. (2021) · Current Opinion in Behavioral Sciences · doi:10.1016/j.cobeha.2021.01.010 · Cited by 27 · see citing works
“Patients that respond poorly to cognitive therapy report that, although they practice and incorporate their new thoughts and beliefs in everyday life, they still feel that their negative, irrational thoughts and beliefs are true [2,3].”
BackgroundSolution-Focused Brief Therapy for Depression and Alcohol Dependence
Spilsbury, G. (2012) · Clinical Case Studies · doi:10.1177/1534650112450506 · Cited by 24 · see citing works
Dozois, D. J. A., & Beck, A. T. (2011) · Wiley eBooks · doi:10.1002/9781118001851.ch2 · Cited by 26 · see citing works
Kılıç, A., Hudson, J. L., Scott, W., McCracken, L. M., & Hughes, L. D. (2022) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2022.110728 · Cited by 27 · see citing works
Thew, G. R., Gregory, J. D., Roberts, K., & Rimes, K. A. (2017) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465817000327 · Cited by 23 · see citing works
“, 2007), show generally poorer treatment outcomes (Cox et al., 2002; Dent and Teasdale, 1988; Marshall et al., 2008; Rector et al., 2000) and have greater risk of relapse (Mongrain and Leather, 2006).”
BackgroundKariyawasam, L., Ononaiye, M. S. P., Irons, C., & Kirby, S. E. (2022) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2022.10 · Cited by 22 · see citing works
“Such experiences pose a vulnerability to selfcriticism, which hinders compassion cultivation (Rector et al., 2000), and acts as a pervasive element of shame and psychopathology (Gilbert and Irons, 2005).”
BackgroundTatham, M. (2011) · Clinical Psychology Review · doi:10.1016/j.cpr.2011.06.008 · Cited by 22 · see citing works
Lindfors, O., Knekt, P., Heinonen, E. O., & Virtala, E. T. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.09.011 · Cited by 22 · see citing works
“Furthermore, higher level of self-criticism has been shown to predict poorer symptomatic outcome in interpersonal therapy but not in cognitivebehavioural therapy (CBT) (Marshall et al., 2008), while in another study the effect was also found for CBT (Rector et al., 2000).”
BackgroundResultInfluentialMaratos, F. A., Duarte, J., Barnes, C. R., McEwan, K., Sheffield, D., & Gilbert, P. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.01.066 · Cited by 21 · see citing works
“Self-criticism is also associated with poorer recovery rates from depression (Bulmash et al., 2009) and is a barrier to treatment effectiveness (Rector et al., 2000).”
BackgroundDenckla, C. A., Consedine, N. S., & Bornstein, R. F. (2016) · Self and Identity · doi:10.1080/15298868.2016.1264464 · Cited by 22 · see citing works
Adapting compassion focused therapy for an adult with a learning disability—A case study
Cooper, R., & Frearson, J. (2017) · British Journal of Learning Disabilities · doi:10.1111/bld.12187 · Cited by 20 · see citing works
Dunlop, B. W., Cole, S. P., Nemeroff, C. B., Mayberg, H. S., & Craighead, W. E. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.12.035 · Cited by 20 · see citing works
“Our analysis indicates that both treatments address this group of symptoms, which is consistent with prior studies (Imber et al., 1990; Rector et al., 2000), but that the “bottom-up” engagement of limbic structures by medications acts more rapidly than the “top-down” enhancement of affective control purported to be en…”
ResultShahar, G., Blatt, S. J., & Zuroff, D. C. (2007) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.2007.26.5.540 · Cited by 20 · see citing works
Emotional Reactivity, Emotion Regulation, and Social Emotions in Affective Disorders
Förster, K., Kurtz, M., Konrad, A. C., & Kanske, P. (2022) · Zeitschrift für Klinische Psychologie und Psychotherapie · doi:10.1026/1616-3443/a000648 · Cited by 19 · see citing works
Effects of soothing images and soothing sounds on mood and well‐being
Witten, E., Ryynanen, J., Wisdom, S., Tipp, C., & Chan, S. W. Y. (2022) · British Journal of Clinical Psychology · doi:10.1111/bjc.12400 · Cited by 18 · see citing works
“…has been suggested that individuals with depression may find it harder to generate positive mental images (Blackwell et al, 2015) and therefore may not experience the benefits of mental imagery in interventions such as CFT or standard cognitive therapy (Rector, Bagby, Segal, Joffe & Levitt, 2000).”
BackgroundApplication of a mindfulness and compassion‐based approach to the at‐risk mental state
Hickey, T., Nelson, B., & Meadows, G. N. (2017) · Clinical Psychologist · doi:10.1111/cp.12132 · Cited by 18 · see citing works
Žilinský, T., & Halamová, J. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20032592 · Cited by 16 · see citing works
“In addition, if there is a significant impact on clinical samples, it would be worth testing efficiency in non-clinical samples as well because the impact could be potentially even higher, as clinical samples may struggle more to overcome self-critical thoughts [71].”
BackgroundSelf-criticism and attachment: A systematic review and meta-analysis
Rogier, G., Muzi, S., Morganti, W., & Pace, C. S. (2023) · Personality and Individual Differences · doi:10.1016/j.paid.2023.112359 · Cited by 19 · see citing works
An Investigation of the Perfectionism/Self-criticism Domain of the Personal Style Inventory
Shahar, G. (2006) · Cognitive Therapy and Research · doi:10.1007/s10608-006-9032-y · Cited by 17 · see citing works
“... as measured by the Dysfunctional Attitudes Scale (DAS; Weissman & Beck, 1978), impedes response to brief psychotherapeutic, as well as pharmacological, treatment, and that such impediment occurred by means of the adverse effect of perfectionism/self-criticism on social relations within and outside treatment (Shaha…”
MethodState of the art of the literature on definitions of self-criticism: a meta-review
Zaccari, V., Mancini, F., & Rogier, G. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1239696 · Cited by 16 · see citing works
A Compassion Focused Approach to Anxiety Disorders
Welford, M. (2010) · International Journal of Cognitive Therapy · doi:10.1521/ijct.2010.3.2.124 · Cited by 17 · see citing works
Integrating Cognitive and Existential Treatment Strategies in Psychotherapy With Dependent Patients
Bornstein, R. F. (2004) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-004-2525-7 · Cited by 15 · see citing works
“Five studies assessed the effectiveness of cognitive or cognitive-behavioral treatment for dependency, with two producing positive results (Nelson-Gray, Johnson, Foyle, Daniel & Harmon, 1996; Rathus, Sanderson, Miller & Wetzler, 1995), and three producing nonsignificant results (Black et al., 1996; Moore & Blackburn,…”
ResultIntroducing compassion focused psychosexual therapy
Vosper, J., Irons, C., Mackenzie-White, K., Saunders, F., Lewis, R., & Gibson, S. (2021) · Sexual & Relationship Therapy · doi:10.1080/14681994.2021.1902495 · Cited by 15 · see citing works
“A variety of research findings have suggested that shame and self-criticism may inhibit the effectiveness of therapy (Gilbert, 2010, 2014; L€ ow et al., 2020; Rector et al., 2000).”
BackgroundPsychometric Properties of the German Version of the Fears of Compassion Scales.
Biermann, M., Bohus, M., Gilbert, P., Vonderlin, R., Cornelisse, S., Osen, B., Graser, J., Brüne, M., Ebert, A., Lyssenko, L., et al. (2020) · Clinical Psychology and Psychotherapy · doi:10.1002/cpp.2496 · Cited by 9 · see citing works
Kopala‐Sibley, D. C., Chartier, G., Bhanot, S., Cole, J., Chan, P. Y., Berlim, M. T., & McGirr, A. (2019) · The Canadian Journal of Psychiatry · doi:10.1177/0706743719839705 · Cited by 10 · see citing works
Martin, C. J. H., Patterson, J., Paterson, C., Welsh, N., Dougall, N. J., Karatzias, T., & Williams, B. (2021) · Midwifery · doi:10.1016/j.midw.2021.102947 · Cited by 10 · see citing works
“Gilbert observed that although these individuals were able to engage with cognitive and behavioural tasks, they often responded poorly to therapy (Rector et al. 2000, Bulmarsh et al., 2009).”
Wakelin, K., Perman, G., & Simonds, L. M. (2022) · Veterinary Record · doi:10.1002/vetr.2177 · Cited by 11 · see citing works
Amano, M., Katayama, N., Umeda, S., Terasawa, Y., Tabuchi, H., Kikuchi, T., Abe, T., Mimura, M., & Nakagawa, A. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.997154 · Cited by 9 · see citing works
“The DAS Need for Social Approval subscale is a measure of interpersonal personality vulnerability (47) and the belief that one’s happiness and self-worth are dependent on the receipt of approval, support, and love from others (48).”
BackgroundGu, X., Li, S.-S., & Hyun, M.-H. (2022) · SAGE Open · doi:10.1177/21582440221121596 · Cited by 7 · see citing works
“Rector et al. (2000) reported that the treatment effect of individuals with high self-criticism in cognitive behavioral therapy (CBT) was less than that of individuals with relatively low self-criticism.”
BackgroundSelf-Compassion and Social Anxiety: A Scoping Review
Slivjak, E. T., Majid, F. A., Wrigley, J., Russell, S., Zielony, L., & Arch, J. J. (2024) · Mindfulness · doi:10.1007/s12671-024-02450-2 · Cited by 9 · see citing works
“…training prior to exposure therapy improved state self-compassion and length of time engaging with a social stressor (Slivjak et al., 2022) and that more self-critical individuals with unipolar major depression do not benefit as much from traditional cognitive therapy (Rector et al., 2000).”
Bellur, Z., Alpay, E., & Aydın, A. (2021) · Current Psychology · doi:10.1007/s12144-021-01408-0 · Cited by 7 · see citing works
Kılıç, A., Hudson, J., Scott, W., McCracken, L. M., Hackett, R. A., & Hughes, L. D. (2023) · Internet Interventions · doi:10.1016/j.invent.2023.100658 · Cited by 6 · see citing works
“However, CBT may not benefit all people, especially those who are highly self-critical, where relapses in mental health problems are common (Rector et al., 2000).”
BackgroundGuo, M., Liu, A., Wang, X., & Liu, Y. (2024) · Mindfulness · doi:10.1007/s12671-024-02342-5 · Cited by 6 · see citing works
“Individuals with high self-criticism and shame may not fully benefit from CBT (Rector et al., 2000).”
- Authors
- Rector, N. A., Bagby, R. M., Segal, Z. V., Joffe, R. T., & Levitt, A.
- Affiliations
- Centre for Addiction and Mental Health (CA)
- McMaster University Medical Centre (CA)
- Sunnybrook Health Science Centre (CA)
- Corresponding author
- Rector, Neil A.
- Venue
- Cognitive Therapy and Research
- Published
- 2000-10
- Volume
- 24
- Issue
- 5
- Pages
- 571-584
- ISSN
- 0147-5916 (ISSN-L)
- 1573-2819
- OpenAlex
- W309627724
- Cited by
- 154
- References
- 38
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 11 · 2023: 7 · 2022: 10 · 2021: 10 · 2020: 6 · 2019: 6 · 2018: 7 · 2017: 9 · 2016: 6 · 2015: 6 · 2014: 9 · 2013: 10 · 2012: 9
- FWCI
- 4.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Cognitive Therapy and Research (publishedVersion)
- Funders
- National Institutes of Health
- National Institute of Mental Health
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- self-criticism, dependency, unipolar major depression, cognitive therapy, pharmacotherapy, treatment response, moderators of treatment outcome, predictors of treatment response
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