Intervening with State Self-Criticism: Comparing the Effects of Single-Session Cognitive Restructuring and Compassion-Focused Approaches as a Function of Individuals’ Trait Self-Criticism

Abstract

Self-criticism is a personality trait characterized by harsh self-judgement (Blatt, 1995) and a transdiagnostic risk factor for numerous psychological disorders (Werner et al., 2019). Individuals high in this trait experience varied, persistent, and harmful forms of psychological distress that are often resistant to improvement with commonly-used psychotherapeutic approaches like cognitive behaviour therapy (CBT) (e.g., Bulmash et al., 2009; Loew et al., 2020; Rector et al., 2000). Cognitive restructuring, a key intervention within CBT, assumes that individuals experience distress when their thinking is negatively biased and so helps individuals develop more logical and balanced thoughts. Despite being able to generate more logical and balanced thoughts, Gilbert (2005) observed that self-critical individuals struggle to feel soothed by these thoughts and may in fact experience them in a hostile, impatient voice. He integrated this observation with research on evolutionary psychology and neuroaffective science, which suggest that in response to giving and receiving care, the parasympathetic system (i.e., the vagus nerve) gives rise to soothed physiological feelings which reduces the threatened physiological response underpinned by the sympathetic nervous system (Gilbert, 2014; Porges, 2007). Gilbert therefore argued that to become less distressed, highly self-critical individuals need to develop a more compassionate, warmer way of relating to themselves because affiliation, not logic, evolved to be a key facilitator of soothed affect and physiology which in turn reduces sensitivity to threats (Gilbert, 2009). Although Gilbert’s theory is compelling, and there is growing evidence for the effectiveness of compassion-focused therapy, no studies have directly tested this theory by comparing the momentary effects of cognitive restructuring and compassion-focused interventions aimed at targeting self-criticism. The present study addressed this important clinical and theoretical gap in the literature in a pre-registered single-session randomized clinical trial. We hypothesized that in the face of heightened momentary shame and self-criticism, individuals higher in the trait of self-criticism would experience lower threat-based states (i.e., self-criticism, shame, negative affect, arousal) and higher affiliative-based states (i.e., soothing affect, state self-compassion, self-reassurance) following a compassion-based intervention involving directing warmth and care inward, than from a cognitive restructuring intervention involving developing more logical thinking about self. We also predicted that, in line with the theory behind compassion-focused therapy, these relative gains would be mediated by soothing affect, a positive affective state characterized by feelings of safeness and contentment (Gilbert et al., 2008). In addition to testing this overall theory, we sought to determine whether both compassion-based and cognitive restructuring interventions would outperform a distraction control condition at reducing threat-based states, and whether the compassion-based intervention would facilitate more affiliative-based states than a cognitive intervention. Participants were 577 undergraduate students (74.7% women) who participated in an audio-guided interactive virtual session during which they recalled a situation evoking self-criticism and shame. They were then randomly assigned to a virtually delivered compassion-based intervention, cognitive restructuring intervention, or distraction-based placebo control condition. Hierarchical regressions revealed partial support for our hypotheses. We found that the compassion intervention generally led to more soothing affect than the cognitive intervention at higher levels of trait self-criticism, whereas the cognitive intervention led to more soothing affect than the compassion condition at lower levels of trait self-criticism. While higher soothing affect after the intervention was generally associated with reduced threat-based states (i.e., state shame, state negative affect, and state self-criticism) and increased affiliative states (i.e., state self-compassion and state self-reassurance), compassion did not significantly mediate the relative effect of the compassion intervention on these outcomes among highly self-critical individuals. Other findings revealed that across the range of trait self-criticism scores in the sample, both the compassion and cognitive interventions had a more beneficial impact on outcomes than the distraction-based control condition; however, these active interventions did not differ from one another. Taken together, this research suggests that when college students are experiencing momentary shame and self-criticism, engaging in cognitive-restructuring or compassionate responding should be more beneficial than distraction, but that for highly self-critical individuals, compassionate responding might promote more soothed feelings. Although this latter finding is consistent with the theory behind compassion-focused therapy, future studies should build on this work in more diverse samples and by examining the relative effects of the cognitive restructuring and compassion-based intervention approaches among individuals with clinically high levels of trait self-criticism.