Collman, S., Heriot‐Maitland, C., Peters, E., & Mason, O. (2023). Investigating associations between self‐compassion, self‐criticism and psychotic‐like experiences. Psychology and Psychotherapy: Theory, Research and Practice. https://doi.org/10.1111/papt.12500
Key Points
- This cross-sectional study found that the self-hatred subtype of self-criticism, but not the self-inadequacy subtype, was associated with the endorsement of psychotic-like experiences (PLEs) in a nonclinical sample.
- No association was found between self-compassion and endorsement of PLEs.
- Educational attainment was negatively associated with PLE endorsement.
- The findings suggest self-criticism and self-compassion may be separate factors with differential relationships to PLEs.
- More research is needed to confirm the directionality of these relationships and implications for psychological interventions.
Rationale
Previous research indicates that self-criticism may contribute to psychotic symptom maintenance, frequency, and distress (Louise et al., 2018).
In contrast, self-compassion may have a protective effect (Braehler et al., 2013). However, less research has examined associations between self-criticism, self-compassion, and psychotic-like experiences (PLEs), specifically in nonclinical populations.
As PLEs may signify a risk for developing clinical psychosis or other mental health issues, further investigating factors associated with them has value for informing early interventions (Kelleher et al., 2014; Unterrassner, 2018).
This cross-sectional study aimed to address this gap by analyzing relationships between self-criticism, self-compassion, and PLEs in a general population sample.
Method
Materials/Instruments:
- Self-Compassion Scale–Short Form (SCS-SF): 12 items assessing self-kindness, self-judgment, common humanity, isolation, mindfulness, over-identification (Raes et al., 2011)
- Forms of Self-Criticizing/Attacking and Self-Reassuring Scale (FSCRS): 22 items measuring self-hatred, self-inadequacy, and self-reassurance subscales (Gilbert et al., 2004)
- Transpersonal Experiences Questionnaire (TEQ): 33 items assessing psychotic-like experiences in nonclinical populations (Friedman, 1983)
Design:
Quantitative, cross-sectional, correlational.
Procedure:
Participants completed an online survey with the above measures.
Sample:
531 adults (79.1% female) aged 18-78 years (M=26.40, SD=10.47) were recruited via Prolific Academic in the UK.
Most were White British (84.0%) and identified as heterosexual (88.5%). Just over half (54.2%) had an undergraduate degree or higher. Individuals with a current or lifetime psychosis spectrum diagnosis were excluded.
Statistical Measures:
Linear regression models accounting for age, gender, ethnicity, sexual orientation, and educational level. Standardized beta weights (β) were reported.
Results
The self-hatred subtype of self-criticism positively predicted PLEs when accounting for demographics (β = .24, p < .001). In contrast, the self-inadequacy subtype did not significantly predict PLEs (β = .07, p = .067).
Self-compassion was not a significant predictor in the model (β = -.02, p = .632). Of the demographics, only educational attainment negatively predicted PLEs (β = -.13, p = .001).
Insight
This study provides initial evidence that self-criticism and self-compassion may be differentially associated with PLEs in nonclinical populations.
Specifically, feeling inadequate about one’s self may not relate to PLEs, while strongly disliking or hating oneself does.
In contrast, being self-compassionate appears unrelated. This nuance is informative for models of PLEs and related psychopathology.
The study also highlights the need for further research on these psychological processes in at-risk groups.
Strengths
- Used validated, reliable measures of all key constructs, including self-criticism (FSCRS), self-compassion (SCS-SF), and psychotic-like experiences (TEQ). This supports the validity of the findings.
- Controlled for several relevant demographic factors (age, gender, ethnicity, sexual orientation, relationship status, employment status, student status, and education level) as potential confounding variables. This allows for greater isolation of the relationships between the psychological variables.
- A relatively large sample size (N=531) provides good statistical power to detect effects. Finds significant relationships are unlikely to be spurious.
- Non-WEIRD (Western, Educated, Industrialized, Rich, Democratic) sample from the general population in the UK, improving generalizability beyond student samples.
- Provides a basis for testable hypotheses about self-criticism as a risk factor for psychotic phenomena. Can inform clinical recommendations.
Limitations
- Cross-sectional correlation design prevents conclusions about causality or directionality of relationships found. Cannot confirm if self-criticism precedes/causes psychotic experiences.
- Self-report measures prone to known biases like social desirability bias, retrospective recall biases, etc. Potential for inaccuracy.
- The sample is still limited in diversity and representativeness. Most participants were young, educated, White British females. Findings may not generalize to other groups.
- Did not assess clinical symptoms, diagnoses, or functioning alongside psychotic-like experiences, limiting clinical interpretation. Unsure if related to need for care.
- Possible relevant third variables (e.g., trauma, attachment style) were not measured, which could influence the relationships found between key variables.
Implications
- Results support assessing and targeting self-hatred, specifically in interventions for distressing PLEs
- Findings may not generalize to clinical populations with diagnosed disorders
- Need for longitudinal and experimental studies to test causal risk models
- Potential value in studies sampling more diverse demographic groups
Conclusions
This study found initial evidence that the self-hatred subtype of self-criticism, but not self-inadequacy or low self-compassion, is associated with psychotic-like experiences in a nonclinical sample.
The findings highlight that self-hatred (Gilbert et al., 2004) may be an important psychological factor distinct from self-compassion in the context of subclinical psychotic phenomena.
Additional research establishing directionality and generalizability is warranted. Ultimately, confirming self-hatred as a risk or maintenance factor could have implications for preventative interventions aiming to reduce distress and improve functioning for those struggling with anomalous beliefs and perceptions.
References
Braehler, C., Gumley, A., Harper, J., Wallace, S., Norrie, J., & Gilbert, P. (2013). Exploring change processes in compassion focused therapy in psychosis: Results of a feasibility randomized controlled trial. British Journal of Clinical Psychology, 52(2), 199–214. https://doi.org/10.1111/bjc.12009
Friedman, H. L. (1983). The self-expansive level form: A conceptualization and measurement of a transpersonal construct. The Journal of Transpersonal Psychology, 15(1), 37.
Gilbert, P., Clarke, M., Hempel, S., Miles, J. N. V., & Irons, C. (2004). Criticizing and reassuring oneself: An exploration of forms, styles and reasons in female students. British Journal of Clinical Psychology, 43(1), 31–50. https://doi.org/10.1348/014466504772812959
Kelleher, I., & Cannon, M. (2011). Psychotic-like experiences in the general population: Characterizing a high-risk group for psychosis. Psychological Medicine, 41(1), 1–6. https://doi.org/10.1017/S0033291710001005
Kelleher, I., Devlin, N., Wigman, J. T. W., Kehoe, A., Murtagh, A., Fitzpatrick, C., & Cannon, M. (2014). Psychotic experiences in a mental health clinic sample: Implications for suicidality, multimorbidity and functioning. Psychological Medicine, 44(8), 1615–1624. https://doi.org/10.1017/S0033291713002122
Louise, S., Fitzpatrick, M., Strauss, C., Rossell, S. L., & Thomas, N. (2018). Mindfulness- and acceptance-based interventions for psychosis: Our current understanding and a meta-analysis. Schizophrenia Research, 192, 57–63. https://doi.org/10.1016/j.schres.2017.05.023
Nuevo, R., Chatterji, S., Verdes, E., Naidoo, N., Arango, C., & Ayuso-Mateos, J. L. (2012). The continuum of psychotic symptoms in the general population: A cross-national study. Schizophrenia Bulletin, 38(3), 475–485. https://doi.org/10.1093/schbul/sbq099
Raes, F., Pommier, E., Neff, K. D., & Van Gucht, D. (2011). Construction and factorial validation of a short form of the self-compassion scale. Clinical Psychology and Psychotherapy, 18(3), 250–255. https://doi.org/10.1002/cpp.702
Unterrassner, L. (2018). Subtypes of psychotic-like experiences and their significance for mental health. In F. Irtelli (Ed.), Psychosis-biopsychosocial and relational perspectives (pp. 52–65). IntechOpen. https://doi.org/10.5772/intechopen.78691
Learning check
- How might cultural factors relate to self-criticism, self-compassion, and psychotic phenomena? Would we expect to see different relationships across cultures?
- What are some possible mechanisms or explanations for the link found between self-hatred specifically and psychotic-like experiences?
- If future experimental studies manipulate self-criticism and find causal effects on psychotic experiences, what specific clinical recommendations would follow?
- What alternative explanations or third variables could potentially account for the associations found in this study? How might future research rule out these alternatives?
- Do the current findings generalize to clinical populations meeting thresholds for a psychotic disorder diagnosis? What similarities and differences might we expect?
