The predictive value of self-compassion for psychological adjustment in left ventricular assist device patients: an observational study.

AIMS: Implantation of a left ventricular assist device (LVAD) is an established treatment option for patients with advanced heart failure. However, apart from its challenging medical management, it comes with serious psychological implications. Empirical evidence suggests that self-compassion, a self-regulation strategy for countering negative self-directed emotions, might be a promising approach in facilitating psychological adjustment also in LVAD patients. The aims of the present study were to investigate self-compassion as a protective factor for anxiety and depressive symptoms, to test whether taking a decentred perspective mediates these effects, and to explore whether self-compassion predicts the clinically rated functional health status. METHOD AND RESULTS: A sample of N = 45 patients (36 male) with a mean age of 60.5 years (SD = 10.8) from the outpatient department for terminal heart failure at the University Medical Center in Kiel, Germany, participated in the study. Patients completed self-report measures for psychological adjustment (HADS), self-compassion (SCS), and decentring (EQ). Functional health status was determined by the NYHA classification. The more patients were self-compassionate, the less they reported anxiety (r = -0.28) and depressive symptoms (r = -0.34). Decentring mediated both effects. Moreover, self-compassion predicted the functional health status, even when controlling for anxiety (odds ratio [OR] = 0.09) and depressive symptoms (OR = 0.11). CONCLUSIONS: This study provides the first evidence for a significant interrelation between self-compassion and common adverse psychological conditions in LVAD patients. Longitudinal data and the evaluation of interventions to strengthen self-compassion are needed to further validate the beneficial effects of self-compassion in LVAD patients in the future.

[Self-Responsibility: Relationship with Depression and Anxiety and Relevance for the Treatment Outcome of Inpatients with Major Depression]. / Selbstverantwortung: Zusammenhänge mit Depression und Angst und Relevanz für das Behandlungsergebnis bei schwer depressiven Patient*innen in vollstationärer Behandlung.

OBJECTIVE: Though in most psychotherapy schools a high self-responsibility (SR) of patients is considered as the basis necessary for the success of psychological treatment, there is neither a uniform definition nor a psychometric operationalisation of SR. Hence, there is no empirical evidence for the actual importance of SR in psychotherapy. This work aims (1) to introduce a definition of SR as well as to develop a questionnaire for its measurement and (2) to evaluate SR in the treatment of depression. METHODS: In two studies with samples of healthy adults (n=233, n=301), the "Self-Responsibility Inventory" (German: "Selbstverantwortungs-Inventar", SV-I) was developed. In a third study, the SV-I was administered to n=231 psychiatric inpatients with major depression according to the ICD-10 diagnostic criteria. Patients were mainly treated with psychotherapy. RESULTS: The final SV-I version consisted of three scales with 10 items each: "Being determined by others", "Self-determination", "Orientation towards the expectations of others". In healthy adults, poor SR was accompanied by high levels of depression, and high trait anxiety. Inpatients with mental disorders show less SR than healthy individuals. During treatment, SR increased from admission to discharge. It was found that the higher the SR at discharge, the stronger the decrease of depression from admission to discharge. DISCUSSION: The SV-I appears to be suitable for use in healthy individuals and in clinical groups. Our findings suggest that low SR is related to the development of psychological symptoms and illnesses. CONCLUSIONS: SR may be a critical factor for outcome in the psychotherapy of major depression. The SV-I could be a useful tool for understanding psychotherapeutic processes.

Patients responses to diagnoses of mental disorders: Development and validation of a reliable self-report measure.

OBJECTIVES: Psychiatric patients are regularly informed about diagnoses. Treatment guidelines assume that informing patients fosters functional coping processes, but few research exists on how patients respond. Thus, the objective was to develop a standardized self-report measure to assess patients reactions to diagnoses. METHODS: Fifty nine items were generated based on a qualitative study. The process of item selection and determination of the factor structure were performed on a sample of 252 patients: Results of an explorative factor analysis with a randomly split sub-sample 1 were cross-validated by confirmatory factor analysis on sub-sample 2. The revised 26-item instrument was revaluated using data from an independent sample of 1.271 patients with different diagnoses. RESULTS: Three functional and three dysfunctional processing styles emerged from the analyses and provided good model fit in the revaluation study (TLI = 0.935; CFI = 0.943; RMSEA = 0.051; SRMR = 0.048). Variance-analytical calculations and post hoc analyses revealed significant differences among diagnoses with regard to coping styles, such as schizophrenia was associated with self-stigmatization and anorexia nervosa showed pronounced over-identification. Overall, various diagnosis-dependent specifics were found. CONCLUSIONS: As patients reactions to diagnoses vary substantially, their formation, impact on treatment and overall cause should be investigated in further studies.