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Modes of Processing Trauma: Self-Compassion Buffers Affective Guilt

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Modes of Processing Trauma: Self-Compassion Buffers Affective Guilt Mindfulness (2019) 10:824–832 https://doi.org/10.1007/s12671-018-1035-8 ORIGINAL PAPER Modes of Processing Trauma: Self-Compassion Buffers Affective Guilt Christine E. Valdez1 & Michelle M. Lilly2 Published online: 26 October 2018 # Springer Science+Business Media, LLC, part of Springer Nature 2018 Abstract Self-compassion (SC) entails being kind toward oneself when in pain and holding painful experiences in mindful awareness, and has been associated with lower levels of posttraumatic stress severity. Recent research suggests SC may be more relevant to the current conceptualization of PTSD that is based on the DSM-5 definition, which includes a new symptom cluster focused on alterations of cognitions and mood such as guilt. We examined effects of SC on affective guilt as a function of treatment-relevant processing modes. One week after completing the SC Scale, 63 victimized women were randomly assigned to one of three processing mode induction conditions: Banalytic^ (brooding), Bexperiential^ (mindful experiencing), or control. Following induction, women completed a trauma-specific perseverative thinking interview to process their trauma. Before induction (T1) and after the interview (T2), women completed a measure of affective guilt. Guilt increased from T1 to T2, and SC was negatively related to increases in guilt. Processing mode conditions moderated the relation between SC and changes in guilt; simple slopes revealed a negative relation among the analytic condition. Components of SC, including greater self-kindness and mindfulness, were related to diminished increases in guilt. Results suggest SC can buffer feelings of guilt, especially in those who process their trauma analytically. Implications for research are discussed. Keywords Self-compassion . Trauma processing . Trauma guilt . Analytic processing A growing body of research on self-compassion (SC) has PE treatment predicted decreases in posttraumatic stress found higher SC is associated with less posttraumatic stress (Hoffart et al. 2015). severity (Thompson and Waltz 2008) among combat veterans Moreover, research examining SC-based practices in treat- (Hiraoka et al. 2015), childhood abuse survivors (Barlow et al. ment for trauma-related distress has revealed positive find- 2017), and other interpersonal trauma survivors (Bistricky ings. In a pilot study of a 12-week course of Loving- et al. 2017). Even more, a study by Hoffart et al. (2015)found Kindness Meditation, a practice designed to enhance feelings components of SC predict within-person changes in posttrau- of kindness and compassion for self and others, PTSD symp- matic stress severity over the course of Prolonged Exposure toms decreased at 3-month follow-up (Kearney et al. 2013). Therapy (PE; Foa et al. 2007). PE is a trauma-focused cogni- The reduction in symptoms from baseline was mediated by tive behavioral treatment considered a first line intervention enhanced SC (Kearney et al. 2013). Mindfulness-Based Stress for posttraumatic stress disorder (PTSD; Karlin et al. 2010). Reduction (MBSR) has also been studied in trauma survivors. PE does not directly target SC, but can address it during post- MBSR is a treatment program that focuses on the progressive imagery dialogs in session. Greater self-kindness and less self- acquisition of mindful awareness, a core component of SC, judgment, isolation, and over-identification over the course of and loving-kindness is introduced during an all-day medita- tion (Kabat-Zinn 1990). Two studies examined the effective- ness of group MBSR in trauma survivors: one in a sample of adult community childhood sexual abuse survivors * Christine E. Valdez (Kimbrough et al. 2010) and another in veterans seeking treat- [email protected] ment at a Veterans Affairs hospital (Kearney et al. 2012). PTSD symptoms decreased after the MBSR course and were 1 Department of Psychology, California State University Monterey maintained after 6 months in both studies (Kearney et al. Bay, 100 Campus Center, Seaside, CA 93955, USA 2012; Kimbrough et al. 2010). A longitudinal follow-up study 2 Northern Illinois University, DeKalb, USA in the community sample of childhood sexual abuse survivors Mindfulness (2019) 10:824–832 825 found improvements in depression, PTSD, anxiety symptoms, (Owens et al. 2008) and may prevent trauma survivors from and mindfulness scores were shown two-and-a-half years lat- being able to fully recover (Kubany and Watson 2003). One er, with magnitude of intervention effects ranging from medi- study found that changes in guilt predicted subsequent chang- um to large (Earley et al. 2014). es in PTSD symptoms over the course of Prolonged Exposure Most research demonstrating the negative relation between Therapy, suggesting trauma-related guilt may be an important SC and posttraumatic stress uses the conceptualization of PTSD mechanism of change in PTSD treatment (Øktedalen et al. based on the Diagnostic and Statistical Manual of Mental 2014b). Disorders-Fourth Edition-Text Revision (DSM-IV-TR; In a recent pilot study, examining the effects of a 4-week- American Psychiatric Association [APA] 2000). In the DSM- long self-administered SC training on trauma-related guilt IV, PTSD is defined by three symptom clusters: (1) among a sample of highly traumatized homeless male veterans, reexperiencing, (2) avoidance/numbing, and (3) hyperarousal. SC increased over the treatment period and trauma-related guilt ResearchhasdemonstratedinasamplewhoendorsedDSM-IV decreased (Held and Owens 2015). Interestingly, trauma- Criterion A traumas that greater SC was associated with less related guilt cognitions increased slightly from pre- to mid- avoidance/numbing symptoms, but neither reexperiencing nor intervention assessment and dropped dramatically after. This hyperarousal symptom clusters (Thompson and Waltz 2008). brief incline in guilt may be explained by the treatment proce- However, the opposite was found in another sample who en- dure requiring participants to become more aware of their emo- dorsed DSM-IV Criterion A traumas; greater SC (defined by tions and negative self-talk, leading to a potential increased positively valanced items) was associated with less awareness of their cognitions and affective guilt in the begin- reexperiencing and hyperarousal symptom clusters, but not ning stages of treatment. However, when compared to the avoidance/numbing symptoms (Seligowski et al. 2015). In the stress-inoculation training control group, participants in both DSM-Fifth Edition (DSM-5;APA2013), slight alterations were interventions reported increased levels of SC and equal reduc- made to the reexperiencing and hyperarousal symptom clusters. tions in trauma-related guilt (Held and Owens 2015). Thus, A new symptom cluster was added (i.e., alterations in cogni- more research is needed to examine under what treatment con- tions and mood associated with trauma exposure), which had a ditions SC can exert effects on trauma-related affective guilt. significant impact on reconfiguring the avoidance/numbing Valdez and Lilly (2016) examined the effects of SC on symptom cluster. Specifically, the avoidance/numbing cluster analogue traumatic stress symptoms after a trauma processing was separated into two: one cluster to specify avoidant behav- interview during an experimental paradigm among a sample iors and the other cluster to specify dysphoric arousal that rep- of interpersonal trauma survivors. Results revealed those with resented affective responses to trauma. In a study examining the higher levels of mindfulness and self-kindness who were in relation between SC and PTSD symptoms using DSM-IV and the control group or who were induced to process their index DSM-5 criteria in two trauma-exposed samples, SC was nega- interpersonal trauma analytically (i.e., ruminate, brood) had tively associated with aggregated PTSD symptoms for DSM-IV less negative affect after their trauma processing interview. and DSM-5 (Maheux and Price 2015). However, SC was cor- Those who were induced to process their trauma experiential- related only with DSM-IV avoidance/numbing symptoms, but ly (i.e., engage in present moment awareness) did not show a was correlated with all DSM-5 symptom clusters (Maheux and relation between SC at baseline and negative affectivity after Price 2015). These findings suggest SC may be more relevant their trauma processing interview. These results suggest that for the current PTSD diagnostic criteria, which has significant processing modes exert differential effects of SC components implications for current treatments. on trauma-related negative affectivity. Specifically, SC mind- In fact, Hoffart et al. (2015) conjecture that increases in SC fulness and self-kindness may be most beneficial during ana- during treatment may reflect changes in negative cognitions lytic processing, potentially by working in conjunction to re- and subsequent mood, such that greater SC reduces shame, duce the tendency to perseverate on negative internal experi- guilt, and loneliness associated with a traumatic memory. This ences, including cognitions and emotions. Thus, treatments reduction in shame and guilt may relieve the potential for designed to enhance SC may be effective in targeting specific intrusive reexperiencing and avoidance of reminders. PTSD symptoms such as negative affectivity and affective Similarly, increases in SC may counteract the negative emo- guilt, especially among clients who engage in analytic modes tions associated with the trauma memory and the correspond- of processing. ing
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