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Title: The relationship between self-compassion and psychological distress in chronic physical health conditions : review of the literature and testing mediation by worry and rumination in breast cancer patients
Author: Hughes, M.
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2018
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This thesis examines the role of self-compassion (SC) as a potential protective agent against emotional distress in chronic physical health conditions. This thesis takes the form of two papers; a systematic review of patients with a range of chronic conditions and an empirical study of breast cancer patients. Chronic physical health conditions are enduring and non-remitting conditions that can present significant challenges across functional (DiMatteo, Lepper & Croghan, 2000; Felker et al., 2010; Molosankwe, Patel, Gagliardino, Knapp & McDaid, 2012), social (Das-Munshi et al., 2007; Felker et al., 2010) and emotional domains (Mousavvi et al., 2007; National Institute for Health and Care Excellence (NICE), 2009). For many, emotional distress (i.e. anxiety and depression) presents a barrier to living well with a chronic diagnosis, with elevated rates of psychological comorbidity evident across chronic health diagnoses, as compared to the general population (Clarke & Currie, 2009). Cognitive behaviour therapy (CBT) is the NICE (2009; 2011) recommended treatment for anxiety and depression in chronic health conditions. However, it is argued that CBT achieves only modest effects in these populations (Farrand & Woodford, 2015; Jeyanantham, Kotecha, Thanki, Dekker & Lane, 2017; Xiao et al., 2017). Unlike traditional cognitive behavioural models, which aim to modify specific irrational thoughts about self and illness, third-wave interventions have been shown to be effective remediators of anxiety and depression in mental health populations through changing more global aspects of thinking (A-tjak et al., 2015; Normann, Emmerik, & Morina, 2014). A prominent third-wave approach, Compassion-Focused Therapy (CFT) centres upon SC (Gilbert, 2009). Self-compassion is the ability to afford kindness and care to oneself in the face of internal and external threat (Neff, 2003), and is associated with reduced emotional distress in mental health populations (MacBeth & Gumley, 2012). Arguably, a SC approach could offer the same emotional benefit to people living with chronic physical health conditions as demonstrated for mental health populations. To investigate this hypothesis, chapter one narratively synthesised the quantitative literature focusing on the relationship between SC and anxiety and depression for people living with chronic physical health conditions. Significant negative associations were noted across a range of chronic physical health presentations. Irrespective of the health diagnosis, greater SC was associated with lower levels of depression and/or anxiety, suggesting that SC may be a trans-diagnostic theory for understanding psychological distress. In light of the above, chapter two explored the relationship between SC and psychological distress in self-selecting sample of women affected by breast cancer and tested the hypothesis that any association was mediated by reduced rumination and worry. Mirroring the findings of previous literature, greater SC was associated with lower levels of depression and anxiety. Worry, reflection and depression-related rumination mediated the relationship between SC and anxiety. Brooding, reflection and depression-related rumination mediated the relationship between SC and depression.
Supervisor: Cherry, Mary Gemma ; Brown, Stephen ; Campbell, Sophie Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral