Increase in Self-Compassion as a Common Mediator of Change in The Treatment of Cluster C Personality Disorders: Results From a Randomized Controlled Trial
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According to the short-term dynamic psychotherapy model "Affect Phobia Treatment" an increase in the experience of affects and a decrease in inhibitory affects during treatment are associated with an increase in self-compassion and clinical improvement. The present study aimed to explore to what extent an increase in self-compassion acts as a mediator between changes in activating and inhibitory affects during treatment and treatment outcome. Data were drawn from a randomized controlled trial comparing the effectiveness of cognitive therapy and short-term dynamic therapy for Cluster C personality disorders (Svartberg, Stiles & Seltzer, 2004). The Achievement of Therapeutic Objectives Scale (ATOS; McCullough, 2004) was used to code videotaped treatment sessions and to measure activating and inhibitory affects, as well as the proposed mediator self-compassion. One early (monthly session 6) and one late session (monthly session 36) were coded. Outcome measures included assessment of psychiatric symptoms (SCL-90-R; Derogatis, 1983), interpersonal problems (IIP; Horowitz, Rosenberg, Baer, Ureño & Villaseñor, 1988) and personality pathology (MCMI; Millon, 1984). Mediation was assessed using the Baron and Kenny (1986) causal steps procedure. The results indicated that an increase in self-compassion acted as a mediator between increase in activating affects during treatment and psychiatric symptoms, interpersonal problems and personality pathology, and between a decrease in inhibitory affects during treatment and psychiatric symptoms. An increase in self-compassion did not mediate the effect of a decrease in inhibitory affects on interpersonal problems and personality pathology. Based on these results, an increase in self-compassion appears to play a crucial role in successful treatment of Cluster C personality disorders.