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Journal of Affective Disorders 262 (2020) 43–48

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Journal of Affective Disorders 262 (2020) 43–48 Journal of Affective Disorders 262 (2020) 43–48 Contents lists available at ScienceDirect Journal of Affective Disorders journal homepage: www.elsevier.com/locate/jad Research paper An investigation of self-compassion and nonattachment to self in people T with bipolar disorder ⁎ Yan Yanga, , Kathryn Fletchera, Erin E. Michalakb, Greg Murraya a Centre for Mental Health, Swinburne University of Technology, PO Box 218, Hawthorn Victoria, 3122 Hawthorn, Australia b Department of Psychiatry, University of British Columbia, Vancouver, Canada ABSTRACT Background: There have been longstanding theories and research evidence into the important role of the person's vulnerability at the level of self-concept in bipolar disorder (BD). The current study investigated two emerging self-related constructs, self-compassion and nonattachment to self in BD. Specifically, we examined the levels of the two constructs in people with BD compared with those from the general population, and the associations between the constructs and bipolar symp- tomologies within the BD group. Methods: The BD group consisted of 302 individuals with a diagnosis of BD participating in an international randomised controlled trial. A general population sample (n = 372) was recruited from an Australian university as a comparison group. All participants completed measures of self-compassion and nonattachment to self. The BD group completed additional measures of depression and symptoms of hypo/mania. Results: Participants with BD showed significantly lower self-compassion and nonattachment to self than those from the comparison group after controlling for demographic variables (e.g., gender, age, education, occupation). In the BD group, lower self-compassion and nonattachment to self were associated with greater severity of depression on both self- and clinician-rated scales. Nonattachment to self but not self-compassion was negatively associated with hypo/mania sympto- mology. Limitations: The cross-sectional design cannot determine the direction of the relationships between study variables. Nonattachment to self is a novel psychological construct and further research is needed to replicate study findings. Conclusions: The study findings suggest that self-compassion and nonattachment to self may be meaningful targets in psychological interventions for peoplewithBD. 1. Introduction their own adversity as an isolated or shared human experience (Neff, 2003a). Existing research suggests that low self-compassion is Bipolar disorder (BD) is a serious mental illness, associated with common in mental disorders and may represent a modifiable ther- high comorbidity, marked psychological impairment, and elevated risk apeutic target in clinical practice (Braun et al., 2016; Krieger et al., of suicide (Goodwin and Jamison, 2007). One of the increasingly re- 2013; Krieger et al., 2016). Despite growing interest in the role of self- cognised issues in BD relates to the person's vulnerability at the level of compassion in the broad psychopathology, relatively few studies have self-concept (Leitan, 2016; Power, 2005). Major theoretical frameworks investigated this construct in BD. Døssing et al. (2015) reported lower including the classic manic defence model (Winters and Neale, 1985) levels of self-compassion in participants with BD compared to healthy and a contemporary cognitive model (Mansell et al., 2007) suggest that controls but found that self-compassion was not associated with the extremely positive and negative self-concept may drive a complex illness course and symptoms of BD. However, Yang et al. (2018) showed psychological process of behavioural in/activation and problematic that lower self-compassion was related to greater manic and depressive interpersonal dynamics, potentially leading to mood episodes in BD. severity, and served as a unique mediator between bipolar tendencies The aim of this study was to advance understanding of the self-concept and psychological distress in a non-clinical sample. Given the scarcity of in BD by examining whether people with diagnosed BD differ from the research in this area, many foundational questions addressing the role general population in relation to two putatively protective self-related of self-compassion in BD remain largely inconclusive. constructs: self-compassion and nonattachment to self. The study also Nonattachment to self is conceptualised as releasing fixation on sought to explore whether the self-related constructs were related to rigid self-perceptions (Shonin et al., 2016). In Buddhism, nonattach- bipolar symptomologies. ment to self is thought to mitigate emotional distress and improve Self-compassion encapsulates the extent of warmth and kindness to psychosocial functioning through relinquishing clinginess to desirable which the individual relates to the self and the degree to which they see personal qualities and being content with those deemed undesirable ⁎ Corresponding author. E-mail address: [email protected] (Y. Yang). https://doi.org/10.1016/j.jad.2019.10.042 Received 27 May 2019; Received in revised form 4 September 2019; Accepted 28 October 2019 Available online 30 October 2019 0165-0327/ © 2019 Elsevier B.V. All rights reserved. Y. Yang, et al. Journal of Affective Disorders 262 (2020) 43–48 (Sahdra et al., 2010; Shonin et al., 2016). Indeed, growing research obtained from all participants. shows that a general mentality of nonattachment may buffer against psychological dysfunction (Arch et al., 2016; Bhambhani and 3. Measures Cabral, 2016; Wang et al., 2016). Yang et al. (2018) reported that lower levels of nonattachment to self were associated with greater manic and 3.1. Self-compassion depressive tendencies in a non-clinical sample. Yang et al. (2018) ad- ditionally found that nonattachment to self uniquely mediated the re- Self-compassion was assessed by the Self-Compassion Scale (SCS; lationship between BD tendencies and psychological distress over and Neff, 2003b). The SCS comprises 26 items rated on a five-point Likert above a well-established psychological construct (rumination). Non- scale (1 = almost never; 5 = almost always). Neff (2003b) established attachment to self has not been empirically investigated in people with sound psychometric properties including excellent internal reliability BD despite the potential utility of the construct in research and ther- (Cronbach's α = 0.92) and convergent validity. The SCS has been used apeutic settings. widely in psychological research, total SCS score as recently established The concepts of self-compassion and nonattachment to self both as a reliable measure of global self-compassion (Neff et al., 2017). In- emerge from Buddhism and hence overlap conceptually; nevertheless ternal consistency was adequate in the present samples (Cronbach's they are also meaningfully distinguishable (Yang et al., 2018). The α = 0.94 in both the BD and general population sample). former involves cultivating positive attitudes towards the self, whilst the latter aims to reduce preoccupation with self-concept regardless of 3.2. Nonattachment to self valence. The two are therefore psychologically distinguishable parti- cularly as potential therapeutic targets. The present study examined the Nonattachment to self was assessed by the recently developed levels of self-compassion and nonattachment to self in people with BD Nonattachment to Self Scale (NTS; Whitehead et al., 2018). The NTS relative to the general population. It was hypothesised that self-com- comprises 7 items rated on a seven-point Likert scale (1 = strongly passion and nonattachment to self would be significantly lower in disagree; 7 = strongly agree) measuring the degree to which the person people with BD compared with those from the general population after releases fixation on self-related thoughts and feelings. A standard pro- controlling for relevant demographic confounds and anxiety (con- tocol of scale development and validation was followed to generate the ducted as a subsidiary analysis controlling for state mood) (Hypothesis initial items (e.g., consultations with experts in the field) and validate 1). The study further investigated the associations between the two self- the scale (e.g., use of factor analysis) (Whitehead et al., 2018). Sound related constructs, and depression and hypo/mania symptomatology in psychometric properties were established including good reliability the BD group. It was hypothesised that self-compassion and non- (Cronbach's α = 0.84; test-retest reliability: r = 0.80), construct va- attachment to self would be negatively associated with depressive and lidity and criterion validity (Whitehead et al., 2018). Internal con- hypo/manic symptoms (Hypothesis 2). sistency was good in the present samples (Cronbach's α = 0.88 and 0.87 in the BD and general population sample respectively). 2. Methods 3.3. Anxiety 2.1. Participants Anxiety was assessed by the anxiety subscale of the Depression Participants in the BD group (n = 302) were recruited to participate Anxiety Stress Scale-21 items (DASS-21; Lovibond and in an international randomised controlled trial investigating an online Lovibond, 1995). The anxiety subscale, comprising seven items rated on self-management intervention for people with BD (the ORBIT project; a four-point Likert scale (0= did not apply to me at all; 3= applied to see Fletcher et al., 2018 for protocol details). The general population me very much, or most of the time), measures physiological arousal and sample (n = 372) was drawn from an Australian university
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