Exploring the role of self-compassion in self-harm and suicidal ideation

Cleare, Seonaid (2019) Exploring the role of self-compassion in self-harm and suicidal ideation. PhD thesis, University of Glasgow.

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Background: To date suicide research has mostly focussed on the presence of risk factors for suicide, and as a result, we have a good understanding of how these factors interact and contribute to risk. However, despite major advances in understanding the psychology of suicide and self-harm there are many gaps in our knowledge. In particular, the evidence for factors that may protect against suicide risk is limited.
Self‐compassion has been implicated in the aetiology and course of mental health with evidence suggesting an association between greater self‐compassion and lower emotional distress. Adopting a compassionate stance to the self may help individuals tolerate difficult emotions, and as self-compassion can be developed through meditation type exercises, it may present a potentially modifiable protective factor for psychological distress and perhaps protect against suicide risk.
However, research into self-compassion, suicide and self-harm is a relatively new field and our understanding of how self-compassion relates to risk-factors and self-harm as a whole is limited. This thesis presents five studies designed to address the following research questions: 1. What is the nature of self-compassion?; 2. What is the relationship between self-compassion and suicidal ideation or self-harm?; 3. Is a brief self-compassion exercise acceptable to individuals with a history of self-harm?
Methods: A range of self-report and experimental measures were utilised to address the above research questions.
To investigate the first research question, the factor structure of the Self-Compassion Scale (SCS; Neff, 2003 a,b) was assessed in study 2. Exploratory and confirmatory factor analytical techniques were used (Time 1, n=526; Time 2, n= 332). Construct divergence of the SCS and a measure of self-criticism was assessed in studies 3 and 5.
To address the second research question, a systematic review of the literature (study 1) was conducted to establish the extent of the extant knowledge on this relationship.
In studies 3 and 5 self-compassion was investigated within the context of risk factors selected from the Integrated Motivational-Volitional model of suicidal behaviour (IMV; O’Connor & Kirtley, 2018; O’Connor, 2011).
Study 3: a longitudinal (Time 1, n=514; Time 2, n= 269) online self-report survey was conducted to explore self-compassion’s role within the motivational phase of the IMV model. The SCS was included along with the core constructs (defeat and entrapment) of the motivational phase of the IMV model and suicidal ideation history.
Studies 4 and 5 were laboratory studies which used experimental and qualitative components to develop and pilot a self-compassion exercise (SCM). Study 4 (n= 8) assessed the acceptability of the SCM to individuals with a history of self-harm (Question 3). Specifically study 4 contained a qualitative component to elicit feedback on the SCM and explore participant’s experiences of compassion. Study 5 (n= 61) was a randomised controlled comparison of the SCM versus relaxation exercise on autobiographical memory; an established risk factor for suicidality from the IMV model (Question 2).
Results: Addressing the first research question, the factor analysis confirmed a bifactorial model of the SCS indicating that both total score or and subscale scores are valid. Additionally, the SCS demonstrated significant divergence from self-criticism indicating that these measures assess different constructs. In respect of research question 2, consistent with the systematic review, all the studies herein found that higher self-compassion was associated with no history of suicidal ideation or self-harm and lower levels of psychological distress.
In studies 3 and 5, components of the SCS were found to mediate the different pathways between selected risk factors and suicidal ideation and self-harm. Individual mediation models indicated that defeat and entrapment were mediated by SCS total score and isolation; the entrapment-suicidal ideation relationship was mediated by isolation, self-kindness and self-judgement. In study 5 the relationship between overgeneral autobiographical memory and suicidal ideation was mediated by all the negative SCS subscales, mindfulness and the SCS total score. Also in study 5, non-significant opposing trends were evident for the SCM and relaxation exercises. Specifically, following the exercises, a main effect was observed in recall latency to negative cues; latency decreased following the SCM whereas latency increased following the relaxation exercise (both non-significant). Non-significant increases in specific memories were observed following the SCM while no change was observed following the relaxation exercise. This may suggest that SCM and relaxation exercises operate differentially within autobiographical memory.
There was clear evidence that a brief self-compassion exercise acceptable in individuals with a history of self-harm with only some minor changes in administration highlighted. Following the SCM increases in self-compassion were reported by participants.
Conclusions: The range of methods used in these studies allowed an in-depth evaluation of self-compassion’s role in suicidal ideation and self-harm. In line with previous research, the findings suggest that high levels of self-compassion are associated with lower suicidal ideation and self-harm. The results also indicate that components of self-compassion may play a role throughout the motivational phase of the IMV model. Findings from the laboratory studies indicated that individuals with a history of self-harm found the brief self-compassion exercise acceptable. Our findings demonstrate that a brief self-compassion meditation is acceptable and produces changes in levels of compassion. Signals in the data from study 5 suggest that brief self-compassion exercises may be useful to investigate the relationship between self-compassion and autobiographical memory. Overall, these findings suggest that self-compassion may be an important clinical target as, given the interconnected nature of its components, targeting self-compassion may have diffuse effects on various risk factors for suicidal ideation and self-harm. Further research should investigate feasibility and outcome signals of compassion-focussed interventions for suicidal behaviour. Ultimately further research is needed to better understand the role of self-compassion in suicidal ideation and self-harm.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Subjects: B Philosophy. Psychology. Religion > BF Psychology
R Medicine > R Medicine (General)
Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing
Supervisor's Name: O'Connor, Professor Rory C. and Gumley, Professor Andrew
Date of Award: 2019
Depositing User: Dr S Cleare
Unique ID: glathesis:2019-81292
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 21 May 2020 06:30
Last Modified: 21 May 2020 06:56
URI: https://theses.gla.ac.uk/id/eprint/81292
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