The relationship between activating affects, inhibitory affects, and self-compassion in patients with Cluster C personality disorders.

Abstract

In the short-term dynamic psychotherapy model termed "Affect Phobia Treatment," it is assumed that increase in patients' defense recognition, decrease in inhibitory affects (e.g., anxiety, shame, guilt), and increase in the experience of activating affects (e.g., sadness, anger, closeness) are related to enhanced self-compassion across therapeutic approaches. The present study aimed to test this assumption on the basis of data from a randomized controlled trial, which compared a 40-session short-term dynamic psychotherapy (N = 25) with 40-session cognitive treatment (N = 25) for outpatients with Cluster C personality disorders. Patients' defense recognition, inhibitory affects, activating affects, and self-compassion were rated with the Achievement of Therapeutic Objectives Scale (McCullough et al., 2003b) in Sessions 6 and 36. Results showed that increase in self-compassion from early to late in therapy significantly predicted pre- to post-decrease in psychiatric symptoms, interpersonal problems, and personality pathology. Decrease in levels of inhibitory affects and increase in levels of activating affects during therapy were significantly associated with higher self-compassion toward the end of treatment. Increased levels of defense recognition did not predict higher self-compassion when changes in inhibitory and activating affects were statistically controlled for. There were no significant interaction effects with type of treatment. These findings support self-compassion as an important goal of psychotherapy and indicate that increase in the experience of activating affects and decrease in inhibitory affects seem to be worthwhile therapeutic targets when working to enhance self-compassion in patients with Cluster C personality disorders.

Is affect experiencing therapeutic in major depressive disorder? Examining associations between affect experiencing and changes to the alliance and outcome in intensive short-term dynamic psychotherapy.

“…Previous research using the ATOS found that increased levels of affect experiencing was related to a more compassionate and realistic sense of self and others (Berggraf, Ulvenes, Øktedalen, et al, 2014;Schanche, Stiles, McCullough, Svartberg, & Nielsen, 2011). In line with these findings and those of Fisher and colleagues (2016), we aimed to examine evidence of within-client associations between affect experiencing and changes in self-reported distress ratings on a session-by-session basis.…”

Ten Principles to Guide Psychodynamic Technique with Defense Mechanisms: An Examination of Theory, Research, and Clinical Implications

“…This study relied on the Achievement of Therapeutic Objectives Scale (ATOS) developed by McCullough et al [60] which allows researchers to examine different therapeutic processes and the extent to which a patient is able to assimilate within the course of a session. Further process studies on larger samples using scales such as the ATOS are needed [65] to determine how defensive functioning modulates the patient's abilities to adaptively process and experience affect.…”

“…Wolberg [10] indicates that current sources of stress (outside the therapy), and their interaction with personality needs and defenses be addressed before therapy can unfold in a productive fashion. These authors imply that what unfolds outside of therapy is of value and understanding the defensive processes that patients recount from their "outside" lives could be an equally valuable pursuit in-session [55][56][57][58][59][60][61][62][63][64][65][66][67][68]. This is in line with Vaillant's work [18] that suggests that events from outside the therapeutic hour should not only be acknowledged but also dealt with before systematic intervention focusing on defenses in-session is undertaken.…”

Validation of the Self-Compassion Scale: Correlations with the Beck Depression Inventory-II

“…Research inquiry into treating personality disorders with self-compassion has also ensued. Schanche, Stiles, McCullough, Svartberg, and Nielsen (2011) reported the development of self-compassion in individuals diagnosed with Cluster C personality disorders significantly predicted reductions of psychiatric symptoms, personality pathology, and relational challenges after therapy. Although the specific use of self-compassion in clinical applications is still being explored, results are promising thus far.…”