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Stages of Change Theory Applied to Self-Critical Thinking and Fear of Compassion: a Brief Psycho- Educational Intervention University of Montana ScholarWorks at University of Montana Graduate Student Theses, Dissertations, & Professional Papers Graduate School 2015 STAGES OF CHANGE THEORY APPLIED TO SELF-CRITICAL THINKING AND FEAR OF COMPASSION: A BRIEF PSYCHO- EDUCATIONAL INTERVENTION Meghan Theresa Gill The University of Montana Follow this and additional works at: https://scholarworks.umt.edu/etd Let us know how access to this document benefits ou.y Recommended Citation Gill, Meghan Theresa, "STAGES OF CHANGE THEORY APPLIED TO SELF-CRITICAL THINKING AND FEAR OF COMPASSION: A BRIEF PSYCHO-EDUCATIONAL INTERVENTION" (2015). Graduate Student Theses, Dissertations, & Professional Papers. 4611. https://scholarworks.umt.edu/etd/4611 This Dissertation is brought to you for free and open access by the Graduate School at ScholarWorks at University of Montana. It has been accepted for inclusion in Graduate Student Theses, Dissertations, & Professional Papers by an authorized administrator of ScholarWorks at University of Montana. For more information, please contact [email protected]. i STAGES OF CHANGE THEORY APPLIED TO SELF-CRITICAL THINKING AND FEAR OF COMPASSION: A BRIEF PSYCHO-EDUCATIONAL INTERVENTION By MEGHAN THERESA GILL BA, University of Colorado, Boulder, CO 1999 MA University of Montana, Missoula, MT 2012 Dissertation presented in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Clinical Psychology The University of Montana Missoula, MT August, 2015 Approved by: Sandy Ross, Dean of The Graduate School Graduate School Jennifer Waltz, Chair Department of Psychology Kevin Dohr Department of Psychology Jennifer Robohm Department of Psychology Daisy Rooks Department of Sociology Gyda Swaney Department of Psychology ii © COPYRIGHT by Meghan Theresa Gill 2015 All Rights Reserved iii Gill, Meghan, PhD, August 2015 Clinical Psychology Stages of Change Theory Applied to Self-critical Thinking and Fear of Compassion: A Brief Psycho-educational Intervention Chairperson: Jennifer Waltz Abstract Content Self-critical thinking has been identified as a trans-diagnostic feature of several forms of psychopathology, including depression, and anxiety. Recent research has found that developing self-compassion skills reduces symptoms of distress and correlates with beneficial outcomes. Unfortunately, it also appears that some who experience high levels of self-criticism also experience a fear of compassion (i.e., a resistance to soothing and care when directed toward the self or when received from others). Fear of compassion has been identified as a barrier to engagement in, and efficacy of psychological treatment. The current study tested a brief psycho- educational intervention that integrated a stage of change conceptualization to address self- criticism and fear of compassion. Introductory Psychology students who were (a) high in self-critical thinking and fear of compassion and (b) low in openness to working on self-criticism participated in this project. A single group, pre-post study was conducted with 26 participants. The study examined the effects of a single, two-hour, individual, psycho-educational intervention. The objectives of the intervention were to impart information, build insight, allow for emotional expression, present behavioral choices and their consequences, and bolster self-efficacy, as is consistent with recommended processes of change for early stages of change. Results revealed significant reductions in self-criticism, fear of compassion for self, and distress, and an increase in willingness to take steps toward changing self-criticism. Self-reassurance and recognition of self-criticism as a problem did not change Three additional research questions were addressed. Firstly, results of this study suggest that there are likely many factors that interfere with changing self-criticism, and fear of compassion is just one of them, rather than an overlapping construct with early stage of change characteristics (precontemplation and contemplation). Secondly, findings from this research supported theory and previous findings that early childhood experiences of hardship (e.g., feeling threatened and submissive) are strongly correlated with self-criticism and fear of compassion in adulthood. Thirdly, results showed that degree of these childhood hardship experiences did not appear to have an effect on response to the intervention. Findings and implications for clinical and research contexts are discussed. iv Table of Contents Introduction to the Literature Review…………………………………………………….........1 Literature Review………………………………………………………………………………..2 Self-criticism Defined……….…….………………………………………………….…..2 Self-criticism Sub-types…….…………………………………………………….………3 Functions of Self-criticism…………………………...…………………………………...5 Self-criticism and Psychopathology………………………………………………………6 Theorized Etiology…………………………………………………………………………...7 Psychodynamic conceptualization………………………………………………………7 Cognitive behavioral theory……………………………………………………………..8 Developmental and biopsychosocial perspective……………………………………….9 ACE’s and self-criticism……………………………………………………………10 ACE’s, stress and self-criticism…………………………………………………….11 Integrated theory: Three systems of Regulation…………………………………………12 Self-criticism as a submissive defensive coping strategy …………………………14 Social Injustice and Oppression…………………………………………………………16 Self-criticism and Related Constructs………………………………………………………...18 Compassion, Self-compassion and Self-reassurance…………………………………………21 Correlates of self-compassion……………………………………………………………23 Receiving compassion from others………………………………………………………25 Compassion-based interventions………………………………………………………...26 Fear of Compassion…………………………………………………………………………...31 Theories of etiology……………………………………………………………………...32 Fear of compassion and physiology……………………………………………………..34 Interpersonal results of fear of compassion……………………………………………...36 Transtheoretical Model and Stages of Change………………………………………………. 38 Processes of change, relational stances and stage-matched interventions……………….39 Stages of change and psychopathology………………………………………………….43 Intervention considerations for early stages of change…………………………………..44 Application of Stages of Change Model to Self-Criticism……………………………………46 Purpose of Study……………………………………………………………………………...48 Research Questions…………………………………………………………………………...50 Methods………………………………………………………………………………………….51 Recruitment…………………………………………………………………………………...51 Participants……………………………………………………………………………………52 Procedure….…………………………………………………………………………………..55 Intervention…………………………………………………………………………………...57 Measures………………………………………………………………………………………62 Data Analysis…………………………………………………………………………………65 Results…………………………………………………………………………………………...67 Discussion……………………………………………………………………………………….83 Impact of Intervention………………………………………………………………………...83 Intervention Limitations………………………………………………………………………89 Additional Research Questions……………………………………………………………….92 Overall Study Limitations……………………………………………………………...……95 v Implications for Clinical Practice…………………………………………………………….96 Assessment…………….…………………………………………………………………98 Treatment………………………………………………………………………………...99 Prevention……………………………………………………………………………....101 Implications for Research……………………………………………………………………102 Conclusion………………….………………………………………………………………..103 References………………….……………………………………………………………..……115 Appendix A……………………………………………………………………………….……121 Appendix B…………………………………………………………………………………….158 Appendix C…………………………………………………………………………………….187 vi List of Tables Table 1: Demographics of Study 1: Screening Sample of 200 …………..52 Table 2: Demographics of Study 1: Intervention Sample of 26 …………..53 Table 3: Demographics of Participants That Scored Above the Mean on Self- …………..54 criticism: Sampler of 88 Table 4: Demographics of Study 2: Sample of 167 …………..55 Table 5: Means and Standard Deviations for all Measures for Study 1, Screen Sample (N =199) …………..67 Table 6: Pre-intervention Means and Standard Deviations for All Measures for Study 1, Intervention Sample (N=26) …………..68 Table 7: Intervention Sample Participants Scores on Inclusion Criteria Variable …………..69 Table 8: Means and Standard Deviations for the Intervention Sample at Pre and Post Intervention on Outcome Measures …………..70 Table 9: Study 1 Intervention Sample Pre and Post Intervention Paired Sample, One Tailed T-Test Results on All Outcome Measures. …………..71 Table 10: Stage of Change Level Endorsed by Intervention Sample Participants at Pre and Post Assessment and Pearson Chi-Square Analysis of Stage of Change Discrete Variable Measure …………..72 Table 11: Means and Standard Deviations for Study 2, on measures of Self- Criticism, Self Reassurance, Fear of Compassion and Childhood …………..73 Hardship Table 12: Pearson Correlations for Measures of Self-Criticism, Self- Reassurance, and Fear of Compassion with Childhood Hardship in a Sample of 162. …………..73 Table 13: Hierarchical Regression with Dependent Variable of Post- Intervention Self-Criticism Total with Predictors of Pre-intervention Self- Criticism and Childhood Hardship (ELES) …………..75 Table 14: Hierarchical Regression with Dependent variable of Post-Intervention Fear of Compassion for Self with Predictors of Pre-intervention Fear of Compassion for Self and Childhood Hardship ELES. …………..75 Table 15: Means and Standard Deviations of the Sample of Participants Who …………..76 Scored Above the Mean on Self-Criticism (N=88) Table 16: Pearson Correlations for Measures of Fear of Compassion with Three …………..77 Dimensions of Stages of Change for Addressing Self-Criticism in the Sample of Participants
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