The Indirect Effect of Social Support on Post-Trauma Psychopathology Via Self-Compassion

Personality and Individual Differences 88 (2016) 102–107

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Personality and Individual Differences

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The indirect effect of social support on post-trauma psychopathology via self-compassion

Annie Maheux, Matthew Price ⁎

Department of Psychological Science, University of Vermont, Burlington, VT, USA article info abstract

Article history: Following a traumatic event, external resources such as social support facilitate recovery. The mechanism under- Received 24 June 2015 lying this relation is not well understood, however. Self-compassion is a positive coping strategy that has been Received in revised form 26 August 2015 negatively related to post-trauma psychopathology in prior work. It was hypothesized that the external resource Accepted 30 August 2015 of social support increased the internal resource of self-compassion, which resulted in decreased psychopathol- Available online 12 September 2015 ogy. The current study tested the hypothesis that the association between social support and posttraumatic stress

Keywords: disorder (PTSD), generalized anxiety disorder (GAD), and depression symptoms had an indirect pathway via self- Self-compassion compassion. Using a community sample of individuals exposed to potentially traumatic events, social support Trauma was positively related to self-compassion. Self-compassion was negatively related to PTSD, GAD, and depression PTSD symptoms. Self-compassion mediated the relation between social support and PTSD, GAD, and depression symp- Depression toms. These results suggest that social support may reduce symptoms of PTSD, GAD, and depression through in- Mediation creased self-compassion in those who experienced a trauma. © 2015 Elsevier Ltd. All rights reserved.

1. Introduction and care by others (Ullman & Filipas, 2001), social support was negatively related to PTSD symptoms in combat veterans (Pietrzak, Exposure to potentially traumatic events (PTEs) is associated with Johnson, Goldstein, Malley, & Southwick, 2009), natural disaster survi- increased risk for psychopathology including posttraumatic stress vors (Feder et al., 2013), and women with histories of childhood abuse disorder (PTSD; Zatzick et al., 2007), depression (Elhai, Contractor, and intimate partner abuse (Schumm, Briggs-Phillips, & Hobfoll, Palmieri, Forbes, & Richardson, 2011), and generalized anxiety disorder 2006). Elevated social support was associated with reduced symptoms (GAD; Grant, Beck, Marques, Palyo, & Clapp, 2008). Not all individuals of PTSD, GAD, and depression for civilians in warzones (Mugisha, exposed to a PTE develop psychopathology, however. Several models Muyinda, Malamba, & Kinyanda, 2015; Neria et al., 2010)andin provide a theoretical framework for the different post-trauma out- samples of individuals exposed to a range of PTEs (Kwako, Szanton, comes. The emotion processing theory proposes that limited processing Saligan, & Gill, 2011; Lian et al., 2014). of the PTE results in elevated psychopathology (Foa & Kozak, 1986). The precise mechanism by which social support protects against Cognitive models suggest that maladaptive interpretations of PTEs re- pathology, however, is unknown. The quality of social support is sults in a persistent belief that one is under threat. This sustained belief presumed to influence internal perceptions of the individual, which in results in negative outcomes (Ehlers & Clark, 2000).The conservation of turn reduces psychopathology. That is, negative social interactions in- resources model proposes that psychological health is a function of the crease negative self-perceptions whereas positive support increases retention of resources, broadly defined as variables that an individual positive self-perceptions. Victims of interpersonal traumas who experi- values, such as mastery of a skillset, self-esteem, and professional roles enced negative social reactions (e.g. blaming the victim) reported great- (Hobfoll, 1989). PTEs deplete resources, which results in psychopathol- er shame and PTSD symptoms than those who had positive social ogy. Each of these models proposes that exposure to PTEs alters internal interactions (Turner, Bernard, Birchwood, Jackson, & Jones, 2013; processes that increase vulnerability to psychopathology. Ullman, Townsend, Filipas, & Starzynski, 2007). Thus, poor social Considerable evidence supports social support, an external process, support may promote maladaptive internal perceptions about the as a protective factor against post-PTE psychopathology (Brewin, event, which results in psychopathology. It is posited that improved so- Andrews, & Valentine, 2000; Neria, Besser, Kiper, & Westphal, 2010; cial support would improve internal perceptions, which then reduces Ozer, Best, Lipsey, & Weiss, 2003). Defined as the provision of empathy psychopathology. An internal resource that is a protective factor against psychopathology is self-compassion. Self-compassion is conceptualized as the ⁎ Corresponding author at: Dept of Psychological Science, University of Vermont, 2 fi Colchester Ave, Burlington, VT 05405, USA. experience of supporting oneself during dif cult times, which closely E-mail address: [email protected] (M. Price). mirrors the benefit of social support. Self-compassion involves three

http://dx.doi.org/10.1016/j.paid.2015.08.051 0191-8869/© 2015 Elsevier Ltd. All rights reserved. A. Maheux, M. Price / Personality and Individual Differences 88 (2016) 102–107 103 distinct elements: being kind and understanding towards oneself in Participants were required to have experienced a Criterion A trau- times of difficulty, being mindfully aware of painful thoughts and feel- matic event to be included in the study. Demographic information is ings to prevent over-identification with problematic emotions, and see- reported in Table 1. ing one's struggles as part of a broader human experience (Neff, 2004). Self-compassion is positively associated with life satisfaction, emotional intelligence, and social connectedness in healthy adults (Neff, 2004). 2.2. Measures Self-compassion was negatively related to depressive symptoms and anxiety symptoms in community (Neff, 2003) and clinical samples 2.2.1. Life Events Checklist-5 (LEC-5; Weathers, Blake, Schnurr, Kaloupe, (Krieger, Altenstein, Baettig, Doerig, & Holtforth, 2013). Higher self- Marx, & Keane, 2013) compassion is also associated with less social anxiety (Werner et al., The LEC-5 is a 17-item self-report measure that assesses exposure to 2012). 16 potentially traumatic events across the lifespan. For each event, par- Self-compassion may protect against post-PTE psychopathology. In ticipants indicated if they experienced the event personally, witnessed a sample of children who witnessed a fire, those with high self- it, learned about it, experienced it as part of their job, were unsure if compassion showed lower depressive, suicidal, PTSD, and panic symp- they experienced the event, or felt the event did not apply. A count of toms relative to those with low self-compassion (Zeller, Yuval, Nitzan- the number of types of traumas that each individual had direct exposure Assayag, & Bernstein, 2014). In a similar study, adults with a history of to or witnessed in person was calculated (Table 2). The extended form child maltreatment and low self-compassion had greater psychological was used in which participants provided additional details about the distress, problematic alcohol use, and increased suicidality compared to most difficult trauma. The LEC was keyed to the DSM 5 and the worst those with high self-compassion (Tanaka, Wekerle, Schmuck, & Paglia- event, as chosen by the participant, was described if multiple events Boak, 2011). Disorder specific psychopathology was not assessed in this were endorsed. study, however. Self-compassion was negatively related to symptoms of avoidance but not re-experiencing, hyperarousal, or overall PTSD scores in a large sample of undergraduates with a history of PTE exposure 2.2.2. PTSD Checklist-5 (PCL-5; Weathers, Litz, Keane, Palmieri, Marx, & (Thompson & Waltz, 2008). Finally, self-compassion was negatively re- Schnurr, 2013) lated to PTSD symptoms after controlling for psychological inflexibility The PCL-5 is a 20-item self-report measure that assesses PTSD symp- in a large undergraduate sample (Seligowski, Miron, & Orcutt, 2014). toms in the last month according to the DSM 5 criteria. Items assess The kindness offered in positive social interactions mirrors the kind- symptoms across the 4 clusters of PTSD (re-experiencing, numbing, ness offered to oneself in self-compassionate individuals. The emphasis avoidance, and hyperarousal) on a 0 to 4 Likert scale. For participants of self-compassion on experiencing suffering as part of humanity relates who experienced multiple PTEs, the PCL-5 questionnaire was complet- to the feelings of inclusion and community imparted from social ed for the most significant PTE. Total scores range from 0 to 80. Internal support. Using the emotion processing theory, social support may consistency for the for the present sample was excellent with α = 0.95. allow for processing of the event in a manner that promotes self- compassion and thus symptom reduction. Within the cognitive model, Table 1 social support may present the individual with alternate interpretations Sample demographic statistics. of the event that promote self-compassion and reduce symptoms. Consistent with the conservation of resources model, social support is n% an external resource that may increase the internal resource of self- Race and ethnicity compassion to protect against psychopathology after a PTE. Thus, social African American 40 6.7 support and self-compassion are hypothesized to be part of a broader American Indian or Native Alaskan 12 2.0 resilience process. Asian 69 11.5 Hispanic 45 7.5 The present study examined self-compassion as a pathway by which Pacific Islander 3 0.5 social support is associated with psychopathology in a community White 418 69.8 sample of individuals exposed to a PTE. It was hypothesized that self- Other 12 2.0 compassion was negatively related to PTSD, GAD, and depression symp- Female 301 50.3 toms in adults with a history of PTEs. Self-compassion was hypothesized Income to be positively associated with social support. Finally, it was hypothe- b$25,000 161 26.9 sized that self-compassion would account for a significant portion of $25,001–$50,000 204 34.1 $50,001–$75,000 117 19.5 the relation between social support and PTSD, GAD, and depression $75,001–100,000 62 10.4 symptoms. Relevant covariates such as gender, age, racial/ethnic status, N$100,001 48 8.0 income level, and exposure to multiple types of trauma were included Did not disclose 7 1.2 in the analysis. Additional relations concerning PTSD symptom clusters Education were explored as indicated by relevant prior literature. High school diploma or GED 69 11.5 1–2 years of college 184 30.7 2. Methods Completed college 232 38.7 Some graduate school 36 6.0 Masters degree 59 9.8 2.1. Participants Advanced degree 10 1.7 Did not disclose 9 1.5 Participants (N = 599) were recruited through an online crowd- Employment sourcing platform (Amazon's Mechanical Turk). This methodology Fulltime 330 5.1 offers several advantages over other survey recruitment methods Parttime 71 11.9 including access to an ethnically diverse sample, efficient use of finan- Student 52 8.7 cial compensation, and added confidentiality (Paolacci, Chandler, & Unemployed 60 10.0 Retired/disabled 10 1.6 Ipeirotis, 2010). Recent work has demonstrated that samples with sig- Other 47 7.8 fi ni cant levels of psychopathology can be recruited via this method Did not disclose 29 4.8 (Shapiro, Chandler, & Mueller, 2013). Participants were compensated Age (M, SD) 34.08 10.99 for their time. 104 A. Maheux, M. Price / Personality and Individual Differences 88 (2016) 102–107

Table 2 was posted seeking participants to complete questionnaires assessing Identified potentially traumatic events according to the Life Events Checklist. the impact of stressful events. Participants self-selected to participate Event experienced directly or witnessed in person n % based on this description, completed all measures, and disclosed their trauma history. Inclusion criteria for the study involved having directly Natural disaster 314 52.5 Fire or explosion 207 34.6 experienced or witnessed in-person a traumatic event described on the Transportation accident 432 72.5 LEC 5. The descriptions of the participant-identified most distressing Serious accident 222 35.6 trauma as reported on the LEC 5 were reviewed by a licensed clinical Exposure to toxic substances 46 7.6 psychologist and three trained bachelor's level research assistants to de- Physical assault without weapon 289 48.3 Physical assault with weapon 119 19.9 termine if they met Criterion A for the DSM 5 diagnosis of PTSD. Agree- Sexual assault 125 20.9 ment across the raters was 100%. Valid responses were identified with Other unwanted sexual experience 178 29.7 responses to 5 validity questions embedded throughout the measures. Combat 33 5.5 Participants were required to provide a specific response to each ques- Held in captivity 17 2.8 tion (e.g., for this item, please select “extremely”). Those who answered Having a life threatening illness or injury1 100 16.7 Exposed to severe suffering 120 20.1 4 or more items correctly and took longer than 5 min to answer all ques- Sudden violent death2 65 10.9 tions were deemed to have valid responses and were included in the Sudden accidental death2 73 12.2 sample. These procedures are consistent with recommendations to im- Cause serious harm or injury 58 9.7 prove the validity of responses collected through mTurk (Chandler, 1 Only includes participants who experienced this event direct. Mueller, & Paolacci, 2014). An institutional review board approved all 2 Only includes participants who witnessed the event directly. procedures.

2.2.3. Patient Health Questionnaire-8 (PHQ-8; Kroenke et al., 2009) 2.4. Data analytic plan The PHQ-8 is an 8-item self-report measure of depression symptoms during the last two weeks. Items were rated on a 0 to 3 Likert scale rang- Analyses for indirect effects were conducted using procedures ing from “not at all” to “nearly every day.” Total scores range from 0 to described in Preacher and Hayes (2004). Linear regressions were used 24. The PHQ-8 is adapted from the PHQ-9 in which the item on suicidal to establish the relation between social support and self-compassion ideation was removed because of the inability for the research team to (A-path), self-compassion and PTSD, GAD, and depression (B-path), provide appropriate intervention in the event a participant was at and social support and PTSD, GAD, and depression (C-Path). The indi- high risk. Internal consistency for the current sample was excellent rect effect (AB path) was calculated using a 99% CI from a 5000 with α =0.91. bootstrapped sampling distribution. Signiﬁcance for the AB path was determined if the 99% CI did not include 0. Sobel tests were also con- 2.2.4. Generalized Anxiety Disorder-7 (GAD-7; Spitzer, Kroenke, Williams, ducted to determine if the change in the total effect (C) and the direct ′ ﬁ &Lowe,2006) effect (C )weresigni cant. Given that there were three outcomes of in- The GAD-7 is a 7-item self-report measure that assesses GAD symp- terest, a Bonferroni correction was applied such that alpha was set at toms during the past two weeks. Items were rated on a 0 to 3 Likert .016. The covariates of gender, age, income, and number of types of scale ranging from “not at all” to “nearly every day.” Total scores range events to which the individual was exposed were included. There from 0 to 21. The scale has excellent psychometric properties (Spitzer were no cases with missing data on the administered measures. Analy- et al., 2006). Internal consistency for the current sample was excellent, ses were conducted with SPSS version 22. α = 0.92. 3. Results

2.2.5. Short Form of the Self-Compassion Scale (SCS-SF; Raes, Pommier, Descriptive statistics and correlations are presented in Table 3. Using Neff, & Van Gucht, 2011) the recommended diagnostic cutoff of 38 for the PCL-5, 19.9% of the The SCS-SF assesses self-compassion, defined as self-kindness, com- sample likely met criteria for current PTSD. Using the recommended mon humanity, and mindfulness across 12 items. Psychometric studies cutoff of 10 on the GAD-7 and the PHQ-8, 26.2% of the sample met have supported the SCS-SF factor structure and provided evidence for a criteria for GAD and 32.9% met criteria for a major depressive episode. higher order construct of self-compassion (Raes et al., 2011). The total These estimates are consistent with other population estimates of psy- scale reflects the dimensionality of this higher order construct, has chopathology in those with exposure to multiple PTEs (Zatzick et al., been used in prior studies (Seligowski et al., 2014), and was used in 2007), yet are higher than what is observed in the general population the present study. Participants rate each item using a 1 (“almost (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995; Kilpatrick et al., never”)to5(“almost always”) Likert scale. Internal consistency for 2013). Comorbidity was common with 11.7% of the sample likely having the current sample was good, α = 0.88. a single disorder, 13.9% of the sample likely having two disorders, and 13.2% of the sample likely having three disorders. Analyses were con- 2.2.6. The Multidimensional Scale of Perceived Social Support (MSPSS; ducted with the total sample and then replicated with two randomly se- Zimet, Dahlem, Zimet, & Farley, 1988) lected sub-samples to determine the reliability of the observed The MSPSS measures perceived social support from three support relations. The findings were replicated in each sample and thus the re- fi sources: family, friends, and signi cant other. The measure includes sults from the total sample are presented. “ ” 12 items on a 7 point Likert scale from 1 ( very strongly disagree )to Controlling for age, gender, income, and exposure to multiple types “ ” 7( very strongly agree ). The MSPSS is negatively correlated with mea- of traumas, self-compassion was negatively related to PTSD symptoms sures of anxiety and depression (Zimet et al., 1988) and provides good (b = −0.65, p b .001). Controlling for the same covariates, social sup- internal consistency for the total measure. Internal consistency for the port was positively related to self-compassion (b = 0.22, p b .001) α current sample was excellent, =0.95. and negatively related to PTSD symptoms (b = −0.34, p b .001). Using a bootstrapped 99% confidence interval based on 5000 samples, 2.3. Procedure there was a significant indirect effect of social support on PTSD symptoms via self-compassion (indirect effect = −0.12; 99% CI: −0.17 to Participants were recruited through Amazon's Mechanical Turk −0.09; Table 4). A Sobel test also supported the indirect effect of social (mTurk), a crowdsourcing website. A Human Intelligence Task (HIT) support on PTSD symptoms via self-compassion (z = −5.87, p b .001). A. Maheux, M. Price / Personality and Individual Differences 88 (2016) 102–107 105

Table 3 Descriptive statistics and bivariate correlations for study variables.

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1. SC – ⁎⁎ 2. PTSD −.37 – ⁎⁎ ⁎⁎ 3. GAD −.54 .66 – ⁎⁎ ⁎⁎ ⁎⁎ 4. Depression −.57 .68 .84 – ⁎⁎ ⁎⁎ ⁎⁎ ⁎⁎ 5. SS .36 −.30 −.32 .56 – ⁎⁎ ⁎⁎ ⁎⁎ ⁎⁎ ⁎⁎ 6. PTSD-B −.27 .91 .57 .46 −.22 – ⁎⁎ ⁎⁎ ⁎⁎ ⁎⁎ ⁎⁎ ⁎⁎ 7. PTSD-C −.25 .79 .46 .45 −.16 .75 – ⁎⁎ ⁎⁎ ⁎⁎ ⁎⁎ ⁎⁎ ⁎⁎ ⁎⁎ 8. PTSD-D −.39 .94 .61 .66 −.33 .78 .66 – ⁎⁎ ⁎⁎ ⁎⁎ ⁎⁎ ⁎⁎ ⁎⁎ ⁎⁎ ⁎⁎ 9. PTSD-E −.38 .91 .67 .67 −.29 .74 .61 .82 – M 37.14 21.24 6.36 7.10 62.09 5.27 2.89 6.80 5.71 SD (9.99) (8.91) (5.54) (5.88) (16.42) (5.08) (2.58) (7.15) (5.80)

Note: SC = self-compassion as measured by the self-compassion scale. PTSD = PTSD symptoms as measured by the PCL-5. GAD = generalized anxiety disorder symptoms as measured by the GAD-7. Depression = major depressive disorder symptoms as measured by the PHQ-8. SS = Social support as measured by the MSPSS. PTSD-B = PTSD re-experiencing symptoms. PTSD-C = PTSD avoidance symptoms. PTSD-D = PTSD numbing symptoms. PTSD-E = PTSD hyperarousal symptoms. ⁎ p b .05. ⁎⁎ p b .01.

These results suggest that self-compassion accounted for 38% of the −0.04). A Sobel (1982) test also supported the indirect effect of social total effect of social support on PTSD symptoms. support on GAD symptoms via self-compassion (z = −7.68, p b .001). Controlling for age, gender, income, and exposure to multiple types These results suggest that self-compassion accounted for 54% of the of traumas, self-compassion was negatively related to GAD symptoms total effect of social support on GAD symptoms. (b = −0.29, p b .001). Controlling for the same covariates, social sup- Controlling for age, gender, income, and exposure to multiple types port was negatively related to GAD symptoms (b = −0.10, p b .001). of traumas self-compassion was negatively related to depression symp- The total effect of social support on GAD was b = −0.11, p b .001. toms (b = −0.33, p b .001). Controlling for the same covariates, social Using a bootstrapped 99% confidence interval based on 5000 samples, support was negatively related to depression symptoms (b = −0.13, there was a significant indirect effect of social support on GAD symp- p b .001). The total effect of social support on depression symptoms toms via self-compassion (indirect effect = −0.06; 99% CI: −.08 to was b = −0.14, p b .001. Using a bootstrapped 99% confidence interval based on 5000 samples, there was a significant indirect effect of social

Table 4 support on depression symptoms via self-compassion (indirect ef- − − − A, B, C′, and AB paths for models examining the association between social support, self- fect = 0.06; 99% CI: 0.08 to 0.05). A Sobel (1982) test also sup- compassion, and psychopathology. ported the indirect effect of social support on depression symptoms via self-compassion (z = −7.71, p b .001). These results suggest that Dependent variable 95% CI self-compassion accounted for 43% of the total effect of social support B SE LLCI ULCI on depression symptoms. ⁎⁎ Self-compassion SS (A-path) 0.22 0.02 0.17 0.27 The associations between DSM 5 PTSD clusters and self-compassion ⁎⁎ Age 0.16 0.4 0.07 0.25 were then examined controlling for age, gender, income, and exposure Gender −1.25 0.79 −3.28 0.78 to multiple types of traumas (Table 5). Self-compassion was significant- Income 0.11 0.33 −0.74 0.96 − b Trauma exposure −0.37 0.33 −1.21 0.48 ly negatively associated with re-experiencing (b = 0.13, p .001), ⁎⁎ PTSD SC (B-path) −0.57 0.07 −0.71 −0.42 avoidance (b = −0.06, p b .001), numbing (b = −0.27, p b .001), ⁎⁎ SS (C′-path) −0.22 0.05 −0.31 −0.13 and hyperarousal (b = −0.21, p b .001). Using a bootstrapped 99% con- AB path −0.12+ 0.02 −0.17 −0.09 ⁎⁎ fidence interval based on 5000 samples, self-compassion was tested as a Age −0.18 0.07 −0.35 −0.01 ⁎⁎ Gender 4.75 1.45 1.01 8.49 mediator between social support and each of the PTSD symptom clus- Income 0.27 0.61 −1.29 1.83 ters. There was a significant indirect effect of social support on Trauma exposure 0.27 0.61 −1.29 1.83 reexperiencing symptoms via self-compassion (indirect effect = −0.02; ⁎⁎ Depression SC (B-path) −0.29 0.02 −0.33 −0.25 − − − ⁎⁎ 0.02; 99% CI: 0.04 to 0.01), avoidance (indirect effect = 0.01; 99% SS (C′-path) −0.08 0.01 −0.11 −0.06 CI: −0.02 to −0.01), numbing (indirect effect = −0.05; 99% CI: −0.07 AB path −0.06+ 0.01 −0.08 −0.05 − − − Age −0.03 0.02 −0.07 0.02 to 0.03), and hyperarousal (indirect effect = 0.04; 99% CI: 0.05 to Gender 0.79 0.40 −0.24 1.82 −0.03). Income −0.39 0.17 −0.82 0.04 Trauma exposure 0.37 0.17 −0.53 0.80 ⁎⁎ 4. Discussion GAD SC (B-path) −0.27 0.02 −0.31 −0.23 ⁎⁎ SS (C′-path) −0.05 0.12 −0.07 −0.02 AB path −0.06+ 0.01 −0.08 −0.04 The current findings support the hypothesis that self-compassion Age −0.04 0.02 −0.09 0.01 accounts for a significant portion of the relation between social support Gender 0.75 0.39 −0.26 1.76 and post-trauma psychopathology, which suggests that self- Income −0.32 0.16 −0.74 0.10 ⁎⁎ compassion may play an important role in this relation. Consistent Trauma exposure 0.46 0.16 0.04 0.88 with previous research, PTSD symptom severity was negatively corre- Note: SC = self-compassion as measured by the self-compassion scale. PTSD = PTSD lated with self-compassion (Seligowski et al., 2014; Thompson & symptoms as measured by the PCL-5. GAD = generalized anxiety disorder symptoms as measured by the GAD-7. Depression = major depressive disorder symptoms as measured Waltz, 2008) and social support (Brewin et al., 2000; Ozer et al., by the PHQ-8. SS = Social support as measured by the MSPSS. PTSD-B = PTSD re- 2003). Self-compassion was also negatively correlated with symptoms experiencing symptoms. PTSD-C = PTSD avoidance symptoms. PTSD-D = PTSD numbing of GAD and depression (Goodman et al., 2014; Jain, Gitlin, & Lavretsky, symptoms. PTSD-E = PTSD hyperarousal symptoms. Trauma exposure refers to the num- 2012). These findings further show that external and internal factors ber of types of trauma to which an individual was exposed. Alpha level set at 0.016 for all work together to facilitate recovery from negative experiences and pro- analyses. + AB path significance determined by the exclusion of 0 in the 99% CI. vide preliminary support for a theoretical mechanism of this process in ⁎⁎ p b .01. which external support may translate to internal support. Longitudinal 106 A. Maheux, M. Price / Personality and Individual Differences 88 (2016) 102–107

Table 5 The present study had several limitations of note. The data were A, B, C′, and AB paths examining the relation between PTSD symptom clusters, self-com- cross sectional, which limits the extent that conclusions regarding cau- passion, and social support. sality can be drawn from the indirect effects (MacKinnon & Pirlott, Dependent variable 99% CI 2015). Future studies in which self-compassion is experimentally ma- B SE LLCI ULCI nipulated are needed to determine the causal nature of these relations. ⁎⁎ The study also relied exclusively on self-report data. Future studies PTSD-B SC (B-path) −0.11 0.02 −0.15 −0.06 ⁎⁎ SS (C′-path) −0.05 0.01 −0.07 −0.02 should incorporate objective measures of symptoms to reduce the po- AB path −0.02+ 0.01 −0.04 −0.01 tential bias of self-report measures. The study focused exclusively on ⁎⁎ Age −0.06 0.02 −0.10 −.01 self-compassion, even though other internal resources are likely affect- ⁎⁎ Gender 1.65 0.41 0.58 2.71 ed by social support such as self-esteem. Additionally, the sample was Income 0.19 0.17 −0.26 0.63 recruited through a web-based crowdsourcing platform. Although Trauma exposure 0.34 0.17 −0.11 0.78 ⁎⁎ PTSD-C SC (B-path) −0.06 0.01 −0.08 −0.03 numerous studies have provided strong support for the validity of SS (C′-path) −0.01 −0.01 −0.03 0.01 crowdsourcing platforms as a means to recruit clinical samples AB path −0.01+ 0.002 −0.02 −0.01 (Kilpatrick et al., 2013; Shapiro et al., 2013), concerns remain as to the Age −0.01 0.01 −0.03 0.02 ⁎⁎ quality of the obtained responses. Several steps were taken to optimize Gender 0.88 0.21 0.34 1.43 Income 0.01 0.09 −0.23 0.23 the validity of the data, such as the inclusion of validity check questions, ⁎⁎ Trauma exposure 0.23 0.09 0.01 0.46 monitoring of the time spent on the measure packet by each participant, ⁎⁎ PTSD-D SC (B-path) −0.22 0.03 −0.28 −0.17 and a multi-rater review of the PTEs individuals reported. Another im- ⁎⁎ SS (C′-path) −0.10 0.02 −0.13 −0.06 portant limitation of the current study was the lack of a non-trauma AB Path −0.05+ 0.01 −0.07 −0.03 control condition. A comparison between those with a PTE history Age −0.06 0.03 −0.12 0.01 Gender 1.31 0.55 −0.11 2.74 and those without is necessary to determine the extent to which self- Income 0.07 0.23 −0.53 0.67 compassion is affected by exposure to PTEs and the resulting Trauma exposure 0.43 0.23 −0.16 1.02 ⁎⁎ symptomology. PTE exposure is related to a variety of psychopathol- PTSD-E SC (B-path) −0.18 0.02 −0.23 −0.14 ⁎⁎ ogies that were not assessed in the present study, such as substance SS (C′-path) −0.06 0.01 −0.09 −0.04 AB path −0.04+ 0.01 −0.05 −0.03 abuse disorders or other anxiety disorders. Future work should examine ⁎⁎ Age −0.06 0.02 −0.11 −0.03 the relationship between social support, self-compassion, and other Gender 0.80 0.45 −0.37 1.97 disorders in a PTE-exposed sample. The analyses in the study were con- Income −0.04 0.19 −0.52 0.45 ducted using the DSM 5 characterization of psychopathology, of whose Trauma exposure 0.44 0.19 −0.05 0.92 utility has been called into question (Insel et al., 2010). Additional work Note: SC = self-compassion as measured by the self-compassion scale. PTSD = PTSD should continue to evaluate these relations using dimensional measures symptoms as measured by the PCL-5. SS = Social support as measured by the MSPSS. of psychopathology. PTSD-B = PTSD re-experiencing symptoms. PTSD-C = PTSD avoidance symptoms. PTSD-D = PTSD numbing symptoms. PTSD-E = PTSD hyperarousal symptoms. Trauma The present study supports previous research that self-compassion exposure refers to the number of types of trauma to which an individual was exposed. is negatively related to symptoms of post-PTE psychopathology. Results Alpha level set at 0.016 for all analyses. also indicate that self-compassion may be a mechanism by which social + AB path significance determined by the exclusion of 0 in the 99% CI. support improves PTSD, GAD, and depression symptoms. Future re- ⁎⁎ p b .01. search should investigate related covariates and alternative models of how associated internal and external resources alter reactions to stressful events. Longitudinal research would also help to understand if the and experimental work, however, are needed to further support this interaction between self-compassion and social support protects hypothesis. against the onset of symptoms or if a lack of these resources is a risk fac- The hypothesized model was supported across symptoms of PTSD, tor after a PTE. Such knowledge will allow for translation of this research depression, and GAD, which suggests that social support and self- to clinical application to enhance treatments for those exposed to a PTE. compassion may target shared factors of these disorders. PTSD, depression, and GAD share considerable overlap in symptoms (Durham et al., References 2015; Elhai et al., 2015; Gros, Price, Magruder, & Frueh, 2012; Price & van Stolk-Cooke, 2015) such that theorists suggest that these disorders Brewin, C.R., Andrews, B., & Valentine, J.D. (2000). Meta-analysis of risk factors for post- may reflect a common factor of general distress (Slade & Watson, 2006). traumatic stress disorder in trauma-exposed adults. Journal of Consulting and The results of the present study suggest that social support and self- Clinical Psychology, 68(5), 748–766. http://doi.org/10.1037/0022-006X.68.5.748 Chandler, J., Mueller, P., & Paolacci, G. (2014). Nonnaïveté among Amazon Mechanical compassion may target this shared factor and thus address a broad Turk workers: Consequences and solutions for behavioral researchers. Behavior range of post-trauma psychopathology. Future factor analytic work is Research Methods, 46(1), 112–130. http://doi.org/10.3758/s13428-013-0365-7 needed to identify the symptoms represented in this shared factor and Durham, T.A., Elhai, J.D., Fine, T.H., Tamburrino, M., Cohen, G., Shirley, E., ... Calabrese, J.R. (2015). 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