Relations Among Self-Compassion, PTSD Symptoms, and

Mindfulness
DOI 10.1007/s12671-014-0351-x
ORIGINAL PAPER
Relations Among Self-Compassion, PTSD Symptoms,
and Psychological Health in a Trauma-Exposed Sample
Antonia V. Seligowski & Lynsey R. Miron &
Holly K. Orcutt
# Springer Science+Business Media New York 2014
Abstract Emerging literature on self-compassion suggests
that establishing and maintaining a compassionate perspective
toward oneself and one’s experiences may help buffer against
the negative effects of trauma exposure, such as psychopathology and reduced quality of life. The goal of the current
study was to examine relations among self-compassion, posttraumatic stress disorder (PTSD) symptom severity, and overall psychological health in a sample of trauma-exposed university students. Further, the current study explored these
associations while controlling for a theoretically related construct, psychological inflexibility. Participants were 453 undergraduate students enrolled in an introductory psychology
course at a large Midwestern University (M age=19.75, SD=
3.07). A structural equation model (SEM) approach was used.
Results indicated that a two-factor solution for the SelfCompassion Scale defined by subscale valence (i.e., positive
and negative components) demonstrated improved fit over a
single-factor model. The overall model demonstrated good fit:
comparative fit index (CFI) = 0.96, Tucker-Lewis index
(TLI) = 0.93, root-mean-square residual (RMSEA) = 0.08
(90 % confidence interval (CI) 0.07 to 0.09). The two observed factors of self-compassion emerged as strong predictors of variation in overall psychological health, even in the
context of PTSD symptoms and psychological inflexibility.
Additionally, the two self-compassion factors accounted for
significant variance in psychological inflexibility, but not
PTSD symptoms. Results demonstrate that increasing levels
of self-compassion may represent an important area of intervention for trauma-exposed individuals.
A. V. Seligowski (*) : L. R. Miron : H. K. Orcutt
Department of Psychology, Northern Illinois University,
Psychology-Computer Science Building, Room 400, DeKalb,
IL 60115, USA
e-mail: [email protected]
Keywords Self-compassion . Trauma . PTSD .
Psychological inflexibility . Well-being . Psychological health
Introduction
Exposure to traumatic experiences has repeatedly been associated with poorer life satisfaction, decreased well-being, and
reduced quality of life (Afifi et al. 2007; Anda et al. 2006;
Herrenkohl et al. 2012; Royse et al. 1991). In addition, a
subset of individuals exposed to trauma (approximately 8 %
of the general population; Kessler et al. 1995) develop posttraumatic stress disorder (PTSD). Symptoms of PTSD (i.e.,
intrusive re-experiencing of trauma-related memories, avoidance of trauma-related stimuli, and hyperarousal; American
Psychiatric Association 2000) have been consistently linked
to lower quality of life and poorer psychological functioning
(Clark and Kirisci 1996; Doctor et al. 2011; Goenjian et al.
2011; Warshaw et al. 1993). Therefore, it is worthwhile to
examine additional factors that may contribute to psychological health in trauma-exposed individuals, in addition to further exploring its relation with PTSD symptoms.
When considering the relation between PTSD symptoms
and psychological health, it is important to note that while
reduced symptoms of PTSD have been shown to engender
positive changes in quality of life (e.g., Taylor et al. 2006), this
relation may be bidirectional (Giacco et al. 2013). More
specifically, Giacco et al. (2013) found that a reduction of
PTSD symptoms was associated with improved quality of life
over time and that improvements in quality of life were
associated with reduced PTSD symptoms in a war-exposed
sample. Despite these findings, reduced symptomatology and
increased quality of life do not always go hand in hand (e.g.,
Schnurr et al. 2003). For example, some individuals may have
reduced PTSD symptoms following treatment, yet continue to
experience disruptions in quality of life (e.g., low life
Mindfulness
satisfaction or relationship difficulties). Therefore, exploring
factors that may increase individuals’ life satisfaction and
subjective well-being, in addition to symptom reduction, is
worthwhile. Such an approach is in line with the Recovery
Model of mental health care (see Charney and Marx 2012),
which aims to address the psychological as well as psychosocial needs of individuals through the use of psychosocial
rehabilitation services (e.g., supported employment, self-care
skills training). One factor that has been consistently linked to
improved quality of life and reduced psychopathology, selfcompassion, has been proposed as a potentially adaptive
method of relating to oneself and one’s experiences following
exposure to difficulties and hardship (Barnard and Curry
2011; Neff and McGehee 2010). That is, establishing and
maintaining a compassionate perspective may help buffer
against the negative effects of trauma exposure, as well as
provide an effective therapeutic target for those seeking treatment for PTSD symptoms.
As articulated by Neff (2003a), self-compassion is a way of
kindly and nonjudgmentally relating to oneself and one’s
emotional experiences. Neff (2003a) described selfcompassion as a single-factor construct consisting of six
unique but interacting components: self-kindness versus selfjudgment, common humanity versus isolation, and mindfulness versus overidentification. Self-kindness is considered the
tendency to be warm and understanding toward oneself rather
than judgmental or self-critical. Common humanity involves
viewing one’s suffering as part of the general human experience rather than viewing one’s experiences as separate or
isolated from the experiences of others. Mindfulness consists
of taking an open and accepting stance toward internal experiences and is contrasted with a tendency to fixate on and
overidentify with negative experiences. Through their interaction, these components are thought to combine and amplify
one another (Neff 2003a). For example, one may become
more kind toward themselves once they realize that other
people suffer in the same ways that they do.
Research on self-compassion has demonstrated consistent
associations with greater well-being, life satisfaction, and
feelings of social connectedness (Barnard and Curry 2011;
Neely et al. 2009; Neff et al. 2005, 2007; Neff and Vonk
2009). Self-compassion also appears to promote resilience
and may serve as a protective factor against the development
of psychopathology (Cohn et al. 2009; MacBeth and Gumley
2012). Although research has suggested that self-compassion
is associated with greater well-being, less is known about
whether this relation remains significant in the context of
PTSD symptoms.
In addition to the relation between self-compassion and
overall well-being, researchers have recently begun exploring
self-compassion in relation to PTSD symptoms. In one of the
only studies that has reported on this relation, Thompson and
Waltz (2008) examined PTSD symptom clusters and self-
compassion in a sample of 210 undergraduate students.
They found that self-compassion was significantly related to
PTSD and that it was negatively correlated with avoidance
strategies (Thompson and Waltz 2008). Given that PTSD
symptoms appear to be related to one’s level of self-compassion, it is important to determine how these variables are
related to overall well-being. In addition, it is of interest to
examine whether self-compassion is significantly related to
well-being in the context of related phenomena, such as
psychological inflexibility (the tendency to be self-judgmental, to avoid internal experiences, and to give more power to
psychological reactions than to values or meaningful activities; Bond et al. 2011). Although the term “experiential avoidance” has previously been used to describe this phenomena,
psychological inflexibility is a broader term that is more
consistent with the theoretical model underlying Acceptance
and Commitment Therapy (Bond et al. 2011; Hayes et al.
1999). Psychological inflexibility tends to be maladaptive,
has been linked to lower quality of life, and has been implicated in the onset and maintenance of PTSD (Hayes et al.
2004; Fledderus et al. 2010; Kashdan et al. 2006; Kumpula
et al. 2011; Marx and Sloan 2005).
Given that self-compassion has been described as a nonjudgmental openness to internal experiences (Neff 2003a) and
that self-compassionate individuals are less likely to suppress
unwanted thoughts and emotions (Leary et al. 2007), one
would expect a negative association between selfcompassion and psychological inflexibility. However, research in this area is emerging, and conclusions remain
speculative. For example, Woodruff et al. (2013) found that,
while self-compassion and psychological inflexibility
accounted for similar unique variance in positive outcomes,
psychological inflexibility generally out-predicted self-compassion in terms of negative outcomes (e.g., anxiety, negative
affect). In contrast, Costa and Pinto-Gouveia (2013) found
that self-compassion scores did not significantly predict depression when psychological inflexibility was included as a
predictor. Thus, because psychological inflexibility and selfcompassion appear related to one another, as well as to PTSD
symptoms and well-being, it is pertinent to examine whether
self-compassion makes an independent contribution to variance in well-being, beyond that of PTSD symptoms and
psychological inflexibility.
The goal of the current study was to examine relations
among self-compassion, PTSD symptoms, and overall psychological health in a sample of trauma-exposed young adults.
We anticipated that self-compassion would be negatively associated with PTSD symptoms and positively associated with
overall psychological health. Conversely, we expected that
psychological inflexibility would be positively associated
with PTSD symptoms and negatively associated with overall
psychological health. Given the mixed findings in the literature regarding self-compassion and psychological
Mindfulness
inflexibility, the current study did not include specific
predictions about whether self-compassion would contribute significant variance in PTSD symptoms and
overall psychological health after controlling for psychological inflexibility.
Method
Participants
Data were obtained from a pool of 604 undergraduate students
enrolled in an introductory psychology course at a large
Midwestern university. To be included in the current study,
participants were required to be at least 18 years of age, fluent
in English, and to have endorsed at least one prior criterion A
traumatic event (APA 2000). The resulting sample for the
current study was 453 (65.7 % female). The mean age of
participants was 19.75 years old (SD=3.07). Regarding racial
background, 60.7 % of participants identified as White,
21.9 % as Black, 7.3 % as Other, 5.1 % as Asian or SouthAsian, 0.9 % as Native Hawaiian or Pacific Islander, and
0.9 % as American Indian or Alaskan Native; 3.3 % chose
not to respond. With regard to ethnicity, 10.6 % of participants
endorsed a separate item self-identifying as Hispanic/Latino/a.
Procedure
The current study was approved by the university’s
Institutional Review Board. All participants were recruited
through a computerized enrollment system and asked to respond to several questionnaires. Participants then received
partial course credit for their participation.
Measures
Traumatic Life Events Questionnaire The Traumatic Life
Events Questionnaire (TLEQ; Kubany et al. 2000) is a brief
measure of trauma exposure that has demonstrated good psychometric properties in prior research (Kubany 2004).
Respondents indicate the frequency of experiencing 22 potentially traumatic events (e.g., physical abuse, sexual assault,
natural disaster). The TLEQ was used in the present study as
an initial trauma history screening. Individuals who reported
experiencing at least one criterion A traumatic event (APA
2000) in their lifetime were asked to provide additional information regarding potential PTSD symptoms.
PTSD Screening and Diagnostic Scale The PTSD Screening
and Diagnostic Scale (PSDS; Kubany et al. 2000) is a selfreport measure of 17 PTSD symptoms according to DSM-IVTR criteria (APA 2000). These 17 symptoms map onto the
three DSM-IV symptom clusters of PTSD: re-experiencing
(cluster B), avoidance/numbing (cluster C), and hyperarousal
(cluster D). Example items include “Unwanted thoughts or
mental pictures of the event(s) when nothing was happening
to remind you?” and “Feeling detached or cut off from others
around you.” Responses are given on a Likert-type scale from
0=absent or did not occur to 4=present to an extreme or
severe degree, with higher scores indicating greater PTSD
symptoms. The PSDS has demonstrated strong psychometric
properties (Kubany et al. 2000). Cronbach’s alpha in the
current sample was 0.94 for the total scale. Alpha’s for the
re-experiencing, avoidance/numbing, and hyperarousal symptom clusters were 0.89, 0.87, and 0.87, respectively. Using a
recommended cutoff of 18 for the PSDS total score, 36 % of
the current sample met criteria for probable PTSD (Kubany
et al. 2000).
Self-Compassion Scale The Self-Compassion Scale (SCS;
Neff 2003b) is a 26-item self-report measure of the degree to
which individuals exhibit a kind and accepting attitude toward
themselves. Subscales of the SCS include the following: selfkindness (e.g., “I try to be loving towards myself when I’m
feeling emotional pain”), self-judgment (e.g., “When times are
really difficult, I tend to be tough on myself”), isolation (e.g.,
“When I fail at something that’s important to me I tend to feel
alone in my failure”), common humanity (e.g., “When I feel
inadequate in some way, I try to remind myself that feelings of
inadequacy are shared by most people”), mindfulness (e.g.,
“When something upsets me I try to keep my emotions in
balance”), and overidentified (e.g., “When I’m feeling down I
tend to obsess and fixate on everything that’s wrong”).
Responses are given on a Likert-type scale from 1=almost
never to 5=almost always, with higher scores indicating
greater self-compassion. The SCS has demonstrated good
internal consistency (α=0.92), as well as good test-retest
reliability (α=0.93; Neff 2003b) over a 3-week interval.
Cronbach’s alpha in the current sample was 0.92 for the total
scale. For subscales of the SCS, Cronbach’s alphas were as
follows: 0.81 (self-kindness), 0.86 (self-judgment), 0.83 (isolation), 0.82 (common humanity), 0.78 (mindfulness), and
0.82 (overidentified).
Acceptance and Action Questionnaire-II The Acceptance and
Action Questionnaire-II (AAQ-II; Bond et al. 2011) is a 7item self-report measure of psychological inflexibility.
Example items include “My painful memories prevent me
from having a fulfilling life” and “Worries get in the way of
my success.” Responses are given on a Likert-type scale from
1=never true to 7=always true, with higher scores indicating
greater psychological inflexibility. The AAQ-II has demonstrated strong internal consistency, test-retest reliability, and
validity (Bond et al. 2011). AAQ-II total scores were used in
the present analyses; Cronbach’s alpha in the current sample
was 0.94.
Mindfulness
Rand Health Quality of Life The Rand Health Quality of Life
scale (SF-12; Ware et al. 1996) is a 12-item self-report measure of overall physical and mental health. The Mental
Component Summary of the SF-12 (7 items; SF12-MCS)
was used in the current study. Example items include “In
general, would you say your health is:” (responses range from
1=poor to 5=excellent) and “How much of the time during
the past 4 weeks have you felt downhearted and blue?”
(responses range from 1=all of the time to 5=none of the
time). In the current study, items were coded such that higher
scores indicate greater mental health. Cronbach’s alpha was
0.55.
Subjective Happiness Scale The Subjective Happiness Scale
(SHS; Lyubomirsky and Lepper 1999) is a 4-item self-report
measure of the degree to which individuals feel happy in their
lives. Example items include “Compared to most of my peers, I
consider myself: (responses range from 1=not a very happy
person to 7=a very happy person)” and “Some people are
generally very happy. They enjoy life regardless of what is going
on, getting the most out of everything. To what extent does this
characterization describe you?” (responses range from 1=not
at all to 7=a great deal). SHS total scores were used in the
present analyses, and Cronbach’s alpha was 0.85.
Short Warwick-Edinburgh Mental Well-Being Scale The Short
Warwick-Edinburgh Mental Well-Being Scale (WBS; StewartBrown et al. 2009; Tennant et al. 2007) is a 7-item self-report
measure of overall well-being. Example items include “I’ve been
feeling optimistic about the future” and “I’ve been dealing with
problems well.” Responses are given on a Likert-type scale from
1=none of the time to 5=all of the time, with higher scores
indicating greater well-being. WBS total scores were used, and
Cronbach’s alpha in the current study was 0.88.
Data Analyses
All data were first screened for quality (i.e., responses within
range). The multivariate normality assumption was tested by
ensuring that all variables were normally distributed (i.e.,
checking skewness and kurtosis). No variables were found
to be outside of the recommended range for skewness or
kurtosis, given a sample size greater than 200 (range=−2 to
2). Second, the absence of outliers assumption was tested by
screening for outliers in the data (i.e., checking ranges and
leverage indices). No significant outliers were found.
Additionally, all bivariate correlations were inspected and
found to be in the expected directions.
A structural equation model (SEM) approach was used
with SPSS Amos Version 21 (IBM SPSS AMOS 2012). The
three DSM-IV symptom clusters for PTSD (B, reexperiencing; C, avoidance/numbing; and D, hyperarousal)
were each modeled as manifest indicators of a latent factor
for PTSD symptoms. For self-compassion, all six subscales of
the SCS (i.e., self-kindness, self-judgment, common humanity, isolation, mindfulness, and overidentification) were used as
manifest indicators. Three manifest indicators of overall psychological health were used: the SF12-MCS, the SHS, and the
WBS. For psychological inflexibility, all seven items from the
AAQ-II were first tested in a measurement model and found to
adequately demonstrate a one-factor solution. Therefore, it
was subsequently parceled into three observed variables (item
parceling is an atheoretical technique in which a measure is
broken up into a smaller number of groups, or parcels, by
combining two or more individual items; Bandalos 2008; Sass
and Smith 2006). Parcel 1 included AAQ-II items 5 and 7,
parcel 2 included items 1 and 2, and parcel 3 included items 3, 4,
and 6 (items in each parcel were determined via random number
generator). A maximum likelihood estimation model was used
with the following fit indices: comparative fit index (CFI),
Tucker-Lewis index (TLI), and root-mean-square residual
(RMSEA; Browne and Cudeck 1992; Hu and Bentler 1999).
Given that there were more known than unknown parameters,
the model was overidentified. A nonsignificant Chi-square test
was not required because a large sample size is likely to produce
a significant Chi-square regardless of model fit.
Results
See Table 1 for descriptive statistics and bivariate correlations.
All study variables were significantly correlated with one
another in expected directions.
A measurement model was first estimated in order to
examine the fit for each latent factor (for parsimony, one
correlated model was used). In terms of PTSD symptoms,
variables for symptom clusters B, C, and D loaded highly
(0.81, 0.95, and 0.81, respectively). In terms of overall psychological health, the WBS, SHS, and SF-12-MCS all loaded
well (0.81, 0.81, and 0.70, respectively). In terms of psychological inflexibility, all three parcels loaded highly (0.86, 0.88,
and 0.97). In terms of self-compassion, three subscales had
factor loadings that were less than 0.40: self-kindness, common humanity, and mindfulness. Given that these subscales
are thought to represent counterparts to self-judgment, isolation, and overidentification (Neff 2003a), separate analyses
were conducted in order to compare a correlated two-factor
model to the one-factor model, as well as to a six-factor model,
which has also been previously examined in the literature
(Neff 2003b; Williams et al. 2014). The first factor, called
positive self-compassion components (PSC), consisted of
self-kindness, common humanity, and mindfulness. The second factor, called negative self-compassion components
(NSC), consisted of self-judgment, isolation, and overidentification. Traditionally, these three subscales are reverse coded
Mindfulness
Table 1 Descriptive statistics and bivariate correlations for all study variables
1. SCS total
2. PSC factor
3. NSC factor
4. SF12-MCS
5. SHS
6. WBS
7. AAQ-II
8. PSDS-B
9. PSDS-C
10. PSDS-D
1
2
–
0.73**
0.84**
0.44**
0.54**
0.53**
−0.63**
−0.25**
0.36**
−0.34**
–
0.23**
0.20**
0.38**
0.38**
−0.21**
−0.08
−0.17**
−0.11*
3
–
0.46**
0.47**
0.45**
−0.72**
−0.28**
−0.38**
−0.39**
4
–
0.54**
0.56**
−0.52**
−0.22**
−0.31**
−0.34**
5
–
0.67**
−0.55**
−0.25**
−0.37**
−0.37**
6
7
–
−0.55**
−0.20**
−0.32**
−0.33**
–
0.43**
0.52**
0.51**
8
–
0.77**
0.65**
9
M (SD)
Range
–
0.77**
79.61 (16.99)
39.69 (9.59)
39.87 (11.98)
57.33 (16.73)
20.56 (5.09)
24.86 (5.24)
20.95 (9.96)
4.47 (4.62)
5.72 (5.98)
4.56 (4.84)
27.00–127.00
13.00–65.00
11.00–65.00
17.86–94.29
4.00–28.00
9.00–35.00
7.00–49.00
0.00–20.00
0.00–28.00
0.00–20.00
SCS self-compassion scale, PSC positive self-compassion components, NSC negative self-compassion components, SF12-MCS Rand Health Quality of
Life Scale-Mental Component Summary, SHS Subjective Happiness Scale, WBS Short Warwick-Edinburgh Mental Well-Being Scale, AAQ-II
Acceptance and Action Questionnaire-II, PSDS PTSD Screening and Diagnostic Scale, PSDS-B re-experiencing cluster, PSDS-C avoidance/numbing
cluster, PSDS-D hyperarousal cluster
*p<0.05
**p<0.01
in order to obtain a total score that indicates one’s level of
overall self-compassion; however, given the separation of
these subscales from the others, items were not reverse coded,
such that greater scores indicate higher levels of the NSC
factor. The two-factor model fit the data reasonably well
(CFI=0.95, TLI=0.87, RMSEA=0.15 [90 % confidence interval (CI) 0.12 to 0.18]) and demonstrated a significant
improvement in fit over the one- and six-factor solutions.
For a summary of these models, see Table 2. To test the
generalizability of this solution, the correlated two-factor
model was also evaluated in a sample of individuals without
trauma exposure (N=151; 25 % of the original participant
pool of 604). In the no-trauma sample, the correlated twofactor model fit the data well (CFI = 0.99, TLI = 0.96,
RMSEA=0.09 [90 % CI 0.02 to 0.14]).
The structural model (Fig. 1) with the two-factor SCS
components was a good fit to the data: CFI=0.96, TLI=
0.94, RMSEA=0.07 (90 % CI 0.06 to 0.08). The PSC factor
of self-compassion was significantly related to overall psychological health, even in the context of PTSD symptoms.
Further, this relationship was significant after controlling for
psychological inflexibility. PTSD symptoms did not account
for significant variance in overall psychological health beyond
that explained by the self-compassion factors and psychological inflexibility. The self-compassion factors did not account
for significant variance in PTSD symptoms after controlling
for psychological inflexibility. Additionally, the relations
between the two self-compassion factors and psychological inflexibility were significant, with the relation between psychological inflexibility and the NSC factor
being much greater than that of psychological inflexibility and the PSC factor.
Discussion
The primary goal of the current study was to examine the
relations among self-compassion, PTSD symptoms, and overall psychological health in a sample of individuals with diverse forms of trauma exposure. As expected, selfcompassion and overall psychological health were strongly
related at the zero-order level and moderately related in the
structural model. In contrast to prior research (Thompson and
Waltz 2008), self-compassion did not evidence a significant
negative relation with PTSD symptomatology in the structural
model, though they were significantly related at the bivariate
level. This may be partially explained by the inclusion of
psychological inflexibility. Specifically, Thompson and
Waltz (2008) found that self-compassion scores were associated with the avoidance/numbing cluster of PTSD, but not
with the hyperarousal or re-experiencing clusters. Therefore, it
may be the case that self-compassion does not account for
additional variance in PTSD symptoms beyond that explained
by the tendency to avoid negative internal experiences.
Findings related to overall psychological health support
existing evidence in the literature suggesting that selfcompassion is an important construct related to psychological
health and well-being (Barnard and Curry 2011; Neely et al.
2009; Neff et al. 2005, 2007; Neff and Vonk 2009). Increasing
levels of self-compassion may contribute to greater life satisfaction and subjective well-being for trauma survivors, a
treatment aim consistent with the Recovery Model of mental
healthcare (e.g., Charney and Marx 2012).
The finding that PTSD symptoms were not significantly
related to overall psychological health is not consistent with
previous research that demonstrated a strong relation between
Mindfulness
Table 2 Factor loadings and fit indices for Self-Compassion Scale models
Self-kindness
Common humanity
Mindfulness
Self-judgment
Isolation
Overidentified
SCS one-factor model loadings
SCS two-factor model loadings
Factor 1
Factor 2
0.34**
0.11*
0.26**
0.88**
0.88**
0.88**
0.81**
–
0.68**
–
0.87**
–
–
0.88**
–
0.88**
–
0.88**
Fit indices
SCS one-factor model
SCS two-factor model
SCS six-factor model
One-factor vs two-factor
Six-factor vs two-factor
CFI
TLI
0.64
0.15
0.95
0.87
0.90
0.88
Δχ2 (1)=486.30, p<0.001
Δχ2 (276)=763.467, p<0.001
RMSEA
0.37
0.15
0.07
90 % CI
0.35–0.40
0.12–0.18
0.06–0.07
SCS self-compassion scale, CFI comparative fit index, TLI Tucker-Lewis index, RMSEA root-mean-square error of approximation, CI confidence
interval
*p<0.05
**p<0.01
quality of life and PTSD symptoms (Giacco et al. 2013).
However, this may be partially explained by the inclusion of
Self-kindness
.81**
Common
humanity
.68**
d1
self-compassion in the current study, such that selfcompassion could serve as a potential protective factor
Mindfulness
PSDS-B
.87**
.81**
PSC
PSDS-C
.95**
PSDS-D
.81**
PTSD
d4
Overall
psychological
health
d5
.31**
-.28**
.58**
d2
NSC
-.26 **
-.14**
.86**
.76**
Selfjudgment
.89**
Isolation
.89**
Overidentified
Psychological
Inflexibility
d3
.86**
AAQ-II P1
.88**
AAQ-II P2
-.51*
.97**
AAQ-II P3
Fig. 1 Final SEM model. Note. Dashed lines represent nonsignificant
paths; PSC positive self-compassion components, NSC negative selfcompassion components; AAQ-II Acceptance and Action Questionnaire-II, PSDS PTSD Screening and Diagnostic Scale, PSDS-B re-
.81**
WBS
.81**
SHS
.68**
SF-12MCS
experiencing cluster, PSDS-C avoidance/numbing Cluster, PSDS-D hyperarousal cluster, WBS Short Warwick-Edinburgh Mental Well-Being
Scale, SHS Subjective Happiness Scale, SF12-MCS Rand Health Quality
of Life Scale-Mental Component Summary. *p<0.05, **p<0.001
Mindfulness
following trauma exposure. Additional research is needed to
further explore these relations.
Regarding a second aim of this study, our findings related to
overall psychological health were significant even after for
controlling for the construct of psychological inflexibility, which
has demonstrated significant relations with psychological health
and PTSD symptoms in prior research (e.g., Hayes et al. 2004;
Marx and Sloan 2005). Since self-compassion and psychological inflexibility appear to be theoretically related, it is not surprising that both factors of self-compassion were significantly
associated with psychological inflexibility. Further, both selfcompassion factors contributed unique variance in overall psychological health beyond that explained by psychological inflexibility. In line with hypotheses, psychological inflexibility
also emerged as a significant predictor of variation in overall
psychological health and PTSD symptoms in the present model.
Overall, results may indicate that one’s nonjudgmental acceptance of his or herself may be just as important as one’s willingness to be in contact with internal experiences, such as thoughts
and emotions. For example, in a population exposed to traumatic experiences, an individual may be more likely to have better
psychological health if they are accepting and kind toward
themselves and their experiences, regardless of what thoughts
or emotions they have. This acceptance and kindness may also
play an important role in maintaining willingness to experience
distressing thoughts and emotions.
Research Implications
Findings of this study suggest the potential presence of a twofactor model of self-compassion. This is in contrast to the
conceptualization and initial factor analysis conducted by
Neff (2003a, b), where self-compassion appeared to be an
overarching factor emerging out of the combination of six
subscale components (i.e., self-kindness, self-judgment, common humanity, isolation, mindfulness, and overidentification)
using two undergraduate samples. The present study utilized a
trauma-exposed student sample, though participants were not
selected on the basis of pathology (i.e., clinically significant
levels of PTSD symptoms), and similar factor structure was
observed in the no-trauma sample. In line with the present
findings, Williams et al. (2014) recently examined the factor
structure of the SCS in three adult samples (i.e., unspecified,
meditator, and clinical) and did not find support for one- or
six-factor structures. Neither Neff (2003b) nor Williams et al.
(2014) tested a two-factor solution collapsed across valence.
Given promising results observed for both the trauma and notrauma samples in the present study, further research utilizing
the SCS may benefit from utilizing the two-factor solution.
Interestingly, the structural model from the current study
suggests that the NSC factor is more strongly related to
psychological inflexibility than the PSC factor. This may
indicate that the NSC factor of the SCS is assessing a construct
similar to psychological inflexibility. Conversely, this finding
could also be an artifact of scoring direction. As such, further
examination of these variables is warranted in order to help
determine if the NSC factor observed in the present study is
truly unique from psychological inflexibility.
Clinical Implications
While the two self-compassion factors assessed did not demonstrate a direct association with PTSD symptoms in the structural
model, results from the bivariate correlations suggest that individuals exposed to traumatic events may benefit from interventions that incorporate self-compassion. Although no empirically
supported treatment has been developed to increase selfcompassion in trauma survivors specifically, Gilbert (2009,
2010) and Neff and Germer (2013) have designed therapeutic
protocols to teach and increase self-compassion skills in both
clinical and nonclinical populations (Compassion-Focused
Therapy and the Mindful Self-Compassion program, respectively). Results of the current study may provide support for the use
of these protocols in trauma-exposed samples. However, it is
important to note that psychological inflexibility may be a more
primary target for these interventions, given that it was strongly
related to PTSD symptoms in the structural model of the current
study. Indeed, research suggests that interventions aimed at
lowering psychological inflexibility may be quite beneficial for
individuals with symptoms of PTSD (King et al. 2013; Lang
et al. 2012; Orsillo and Batten 2005). An additional clinical
implication of the present results relates to the observed associations between the two self-compassion factors and overall
psychological health. As previously mentioned, research has
demonstrated that higher levels of self-compassion are related
to greater health and well-being (e.g., Barnard and Curry 2011;
Neff et al. 2007, 2009). Therefore, results of the current study
may provide support for the use of self-compassion training to
increase overall life satisfaction and well-being.
Limitations
There are some important limitations to the current study.
First, the study sample consisted of primarily White undergraduate students, which decreases generalizability to other
populations. Future research that tests relations among the
present variables in more diverse samples (e.g., nonstudents,
older adults, different racial/ethnic backgrounds) is needed. A
second limitation of the current study is that the data were
cross-sectional. Therefore, causality cannot be implied from
the results of the SEM model. Future research ought to address
the causal relationships among self-compassion, psychological inflexibility, PTSD symptoms, and overall psychological
health in longitudinal studies. Given the importance of developmental transitions and their interactive relationship with
psychopathology, prospective research is needed in order to
Mindfulness
determine the nature of these relationships across different
developmental periods and prior to the onset of certain
stressors, such as college. Third, the SF12-MCS demonstrated
fairly low internal consistency in the current study (α=0.55).
While it is possible that low internal consistency is due to the
SF12-MCS having only seven items, results should still be
interpreted with this low reliability in mind. Fourth, the current study included trauma-exposed individuals with varying
symptom levels of PTSD. Therefore, future research may
benefit from examining the relations among self-compassion,
PTSD symptoms, and psychological health in individuals who
meet diagnostic criteria for PTSD. Finally, the present study
relied exclusively on self-report data. In order to more accurately determine the presence of psychopathology, clinicianadministered assessments are needed. For example, the current study found that 36 % of participants met criteria for
probable PTSD; however, this number may be inflated given
the self-report nature of the PSDS. Future research may gain a
more accurate estimate of psychopathology by using a clinical
interview of PTSD symptoms.
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