Self-criticism and self-compassion : measurements, roles and treatment effectiveness in maladaptive perfectionism

Abstract

In recent research studies, maladaptive perfectionism has been shown to be a trans-diagnostic factor that maintains and predicts different mental health problems. It has been shown self-criticism and self-compassion are both robust predictors in opposite direction of maladaptive perfectionism and psychological distress. However, the manner or mechanisms by which these factors relate to maladaptive perfectionism and psychological distress remain unclear. Psychological treatments that specialize in the treatment of maladaptive perfectionism are scarce and have limited focus on either self-criticism or self-compassion. The present research includes three studies. In study 1, the Chinese Self-Compassion Scale-HK (CSCS-HK) and Chinese Level of Self-Criticism-HK (LOSC-HK) were validated in a local clinical sample. In study 2, the roles of self-criticism and self-compassion as mediators of the relationships among maladaptive perfectionism and psychological distress were investigated. In study 3, the effectiveness of a 6-session intervention of weekly Emotion-Focused Therapy (EFT) with outcomes measured as alleviation of psychological distress, reduction of self-criticism and increase of self-compassion was examined. Process and client factors contributing to treatment outcomes were also explored. In studies 1 and 2, cross-sectional data of the main variables included maladaptive perfectionism, self-criticism, self-compassion and psychological distress were collected from patients with transdiagnostic mental health problems (n=307) through conducting a survey in three public psychiatric outpatient clinics. One-third of the participants (n=104) completed a test-retest procedure of completing the measurements of self-criticism and self-compassion again two weeks after the survey for the scale validation. Same samples were used in both Studies 1 and 2. In study 3, 10 participants who presented with depression and/or anxiety disorders as well as significant maladaptive perfectionism and self-criticism were recruited from community psychiatric clinics. Each participant attended a 6-session weekly EFT and completed a set of measurements in each session. The measurements included those used in studies 1 and 2 as well as some measurements related to process factor variables that were level of task-specific intervention, level of client experiencing, working alliance and perceived empathy. In study 1, the factor analysis replicated a six-factor model of CSCS-HK that found previously for the original scale. However, the original factor structure of CLOSC-HK was not supported. Results suggested a four-factor model rather than a two-factor model as the best fit model in the current sample. Both scales yielded good internal consistency, test-retest reliability, convergent and construct validity. In study 2, self-criticism and self-compassion were found mediating the relationships among maladaptive perfectionism and psychological distress. In study 3, the completion rate of participants was 100%. The results indicated that a brief EFT was a potential intervention to increase self-compassion and reduce self-criticism and psychological distress. Furthermore, the effects of EFT were maintained in one-month and three-month follow-ups. Deeper level of emotional experiences was suggested to help participants have a better treatment outcome in overall psychological distress and anxiety after the 6-session weekly EFT. Other process and client factors that potentially contributing to the outcome were discussed. Clinical implications from the results, limitations of the studies and directions for future studies were discussed.