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Self-Compassion and Psychological Distress in Adolescents—A Meta

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Self-Compassion and Psychological Distress in Adolescents—A Meta Mindfulness https://doi.org/10.1007/s12671-017-0850-7 REVIEW Self-compassion and Psychological Distress in Adolescents—aMeta-analysis 1 1 1 Imogen C. Marsh & Stella W. Y. Chan & Angus MacBeth # The Author(s) 2017. This article is an open access publication Abstract Research indicates that self-compassion is relevant Introduction to adolescents’ psychological well-being, and may inform the development of mental health and well-being interventions for Adolescence is a time of rapid biological, cognitive, and social youth. This meta-analysis synthesises the existing literature to change. These normative developmental changes may con- estimate the magnitude of effect for the association between tribute to some mental health issues, such as elevated stress self-compassion and psychological distress in adolescents. levels (Byrne et al. 2007). The global prevalence of mental Our search identified 19 relevant studies of adolescents (10– health problems in youth is estimated as 10–20% (Patel et al. 19 years; N = 7049) for inclusion. A large effect size was 2007); whilst mental health problems in youth predict poor found for an inverse relationship between self-compassion educational achievement, physical ill health, substance mis- and psychological distress indexed by anxiety, depression, use, and conduct problems in later life (Patel et al. 2007). It is and stress (r = − 0.55; 95% CI − 0.61 to − 0.47). The iden- estimated that 15–30% of disability-adjusted life years are lost tified studies were highly heterogeneous, however sensitivity to early mental health problems (Kieling et al. 2011), and thus analyses indicated that correction for publication bias did not present a significant burden to the global economy (Patel et al. significantly alter the pattern of results. These findings repli- 2007). The most common mental health issues experienced in cate those in adult samples, suggesting that lack of self- adolescence are stress, anxiety, and depression (Cummings compassion may play a significant role in causing and/or et al. 2014). maintaining emotional difficulties in adolescents. We con- Stress in adolescence is significantly related to anxiety, clude that self-compassion may be an important factor to tar- depression, and suicide (Byrne et al. 2007;Grant2013). get in psychological distress and well-being interventions for Females are more vulnerable to stress (Parker and Brotchie youth. 2010), which may be related to the increased prevalence of anxiety and depression observed in this group. Similarly, it has been reported that older adolescents are more vulnerable to Keywords Self-compassion . Adolescence . Anxiety . stress, although it has been suggested that this is more related Depression . Stress . Meta-analysis to the increasing demands on the individual and improving intellectual capacity to consider an uncertain future, than to age itself (Byrne et al. 2007). Anxiety disorders are common in youth, with a lifetime prevalence of 15–20% (Beesdo et al. 2009). They hinder psy- chosocial development and are associated with serious comor- bid difficulties including depression and suicidality * Angus MacBeth (Cummings et al. 2014). Female adolescents have been report- [email protected] ed to be two to three times more likely to experience anxiety (Beesdo et al. 2009). 1 Department of Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Rm 3.06A, Doorway 6, The lifetime prevalence of depression in 13- to 18-year- Medical Quad, Teviot Place, Edinburgh EH8 9AG, UK olds has been reported as 11% (Hankin 2015). It is the third Mindfulness most significant factor related to suicide completion in the well-being, and is predictive of lower symptom severity in adolescent population, and is highly predictive of further psy- anxiety and depression, as well as higher quality of life chological difficulties in adulthood, such as anxiety disorders, (Neff et al. 2007; Van Dam et al. 2011). Self-compassion substance misuse, and bipolar disorder (Thapar et al. 2012). and psychopathology have also been shown to be significantly Furthermore, it has been hypothesised that the substantial in- negatively correlated, with a large effect size, in adult clinical crease in depression during adolescence is related to a range of and non-clinical populations (MacBeth and Gumley 2012; physical and psychosocial changes (Spear 2000). As with Zessin and Garbade 2015). Whilst the research base regarding findings regarding anxiety, female adolescents are twice as self-compassion in the adolescent population is still emerging likely to experience depression as their male peers (Thapar (Xavier et al. 2016b), findings to date appear to mirror those in et al. 2012). adult samples. Several studies have shown that female adoles- The global impact of youth psychological distress high- cents have lower levels of self-compassion than their male lights the need to identify mechanisms of change to inform counterparts (Bluth and Blanton 2014;Castilhoetal.2017; effective psychological health promotion and interventions for Sun et al. 2016). Age has also been shown to interact with this population. One potential mechanism of change that has gender, with older female adolescents (above 14 years) been indicated in adult and adolescent samples is self- reporting lower levels of self-compassion than younger fe- compassion (MacBeth and Gumley 2012;Xavieretal. males and male adolescents (Bluth and Blanton 2015;Bluth 2016b). The concept of self-compassion is rooted in et al. 2017; Muris et al. 2016). There are also indications that Buddhist philosophy (where self-compassion is considered self-compassion may have a different ‘action’ in males and to be identical to compassion towards others, merely turned females: Bluth and Blanton (2015) reported that in males self- inward to the self (Neff 2004). Neff’s(2003a)dimensional compassion only mediated the relationship between mindful- model of self-compassion proposes that self-compassion ex- ness and negative affect, whereas self-compassion also medi- ists on a spectrum from high to low (Neff 2016), and that self- ated the relationship between mindfulness and perceived compassion comprises three spectra (each with opposing stress in their female counterparts. poles): self-kindness vs. critical self-judgement, common hu- As in adult samples, self-compassion has been identified as manity vs. isolation, and mindfulness vs. over-identification. a predictor of well-being in adolescents. Low self-compassion The construct of self-kindness encapsulates an individual’s has been shown to be predictive of elevated depressive symp- ability to respond to their own suffering with warmth and toms (Trollope 2009; Williams 2013), elevated psychological the desire to alleviate their own pain (Neff and Dahm 2013). distress, problem alcohol use, and serious suicide attempts Common humanity reflects an individual’scapacitytorecog- (Tanaka et al. 2011). In a naturalistic longitudinal study, nise that all humans share similar internal experience and that Zeller et al. (2015)foundthatahigherlevelofself- their suffering is not unique. Mindfulness consists of the abil- compassion at baseline was predictive of lower levels of psy- ity to dispassionately consider aversive experience and main- chopathology (depression, post-traumatic stress, panic, and tain distance between the self and emotions (Neff and Dahm suicidality) following a traumatic event in a sample of 2013). The self-compassion scale (SCS; Neff 2003b)isthe adolescents. most prevalent standardized measure of self-compassion, Additionally, self-compassion has been identified as a and thus the majority of the literature examining self- Bbuffer^ against a range of negative psychological and compassion draws explicitly on Neff’s dimensional model. physical health outcomes in adolescent populations. Játiva Another model of (self) compassion has been developed by and Cerezo (2014) found that self-compassion acts as a buffer Gilbert (2009). Gilbert’s(2009) model frames compassion as between negative life experiences (such as victimisation) and the result of adaptive capacities shaped by evolution, and em- poor psychological outcomes in disadvantaged youths. phasizes the physiological and neurological correlates of men- Trollope (2009)andWilliams(2013) both identified a signif- tal and emotional states. The Gilbert model is constructed on icant inverse relationship between self-compassion and de- the premise that the Bcompassion system^ is separate to the pression, reporting preliminary indications that self- Bcritical system^ (Gilbert 2014), suggesting that these con- compassion mediates the relationship between stressful life- structs should be measured independently, in contrast to events and depressive symptoms (Trollope 2009) and social Neff’s(2003b) dimensional conceptualization. However, both rank and depression (Williams 2013). In relation to this, Neff and Gilbert’s models propose that self-compassion is a Marshall et al. (2015) found that high self-compassion buff- relational state characterized by kindness and empathy, and ered the detrimental effect of low self-esteem on mental health are complementary frameworks for understanding the concept in this population. Castilho et al. (Castilho et al. 2017)report of compassion towards the self and others (MacBeth and findings which suggest that self-compassion and emotional Gumley 2012). intelligence are key regulatory process in protecting against In adult samples, self-compassion has been shown to ac- depressive
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