Psychological Distress in Women with Fibromyalgia: The Roles of Body Appreciation, Self-Compassion, and Self-Criticism.

Body appreciation Fibromyalgia Psychological distress Self-compassion Self-criticism

Journal

International journal of behavioral medicine
ISSN: 1532-7558
Titre abrégé: Int J Behav Med
Pays: England
ID NLM: 9421097

Informations de publication

Date de publication:
17 Jun 2024
Historique:
accepted: 28 05 2024
medline: 18 6 2024
pubmed: 18 6 2024
entrez: 17 6 2024
Statut: aheadofprint

Résumé

While past research detected a direct link between symptoms of fibromyalgia (FM) and psychological distress, body appreciation was suggested as a viable mediator of this link. The aim of the present study was to further develop an explanatory model for the effect of FM on women's psychological distress and identify possible protective and risk factors. Specifically, it was hypothesized that self-compassion would moderate the indirect effect of body appreciation and self-criticism on psychological distress in women with FM. This study comprised a total of 293 women, aged 20-68 (M = 34.8, SD = 12.3), of whom 146 were women with FM and 147 were heathy controls. All the women completed questionnaires regarding demographic characteristics, depression (PHQ-9), anxiety (GAD-7), self-criticism (DEQ-SC), body appreciation (BAS2), and the self-compassion scale (SCS). A moderated serial mediation model demonstrated lower body appreciation in participants with FM compared to controls. These lower levels of body appreciation, together with lower levels of self-compassion, were associated with greater self-criticism and, consequently, higher levels of psychological distress. The results emphasize the role of self-compassion as a protective mechanism against psychological distress among women with FM. Future studies should further investigate the effect of self-compassion-focused interventions on patients with FM.

Sections du résumé

BACKGROUND BACKGROUND
While past research detected a direct link between symptoms of fibromyalgia (FM) and psychological distress, body appreciation was suggested as a viable mediator of this link. The aim of the present study was to further develop an explanatory model for the effect of FM on women's psychological distress and identify possible protective and risk factors. Specifically, it was hypothesized that self-compassion would moderate the indirect effect of body appreciation and self-criticism on psychological distress in women with FM.
METHOD METHODS
This study comprised a total of 293 women, aged 20-68 (M = 34.8, SD = 12.3), of whom 146 were women with FM and 147 were heathy controls. All the women completed questionnaires regarding demographic characteristics, depression (PHQ-9), anxiety (GAD-7), self-criticism (DEQ-SC), body appreciation (BAS2), and the self-compassion scale (SCS).
RESULTS RESULTS
A moderated serial mediation model demonstrated lower body appreciation in participants with FM compared to controls. These lower levels of body appreciation, together with lower levels of self-compassion, were associated with greater self-criticism and, consequently, higher levels of psychological distress.
CONCLUSIONS CONCLUSIONS
The results emphasize the role of self-compassion as a protective mechanism against psychological distress among women with FM. Future studies should further investigate the effect of self-compassion-focused interventions on patients with FM.

Identifiants

pubmed: 38886330
doi: 10.1007/s12529-024-10302-5
pii: 10.1007/s12529-024-10302-5
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2024. The Author(s).

Références

Borchers AT, Gershwin ME. Fibromyalgia: a critical and comprehensive review. Clin Rev Allergy Immunol. 2015;49:100–51. https://doi.org/10.1007/s12016-015-8509-4 .
doi: 10.1007/s12016-015-8509-4 pubmed: 26445775
Branco JC, Bannwarth B, Failde I, et al. Prevalence of fibromyalgia: a survey in five European countries. Semin Arthritis Rheum. 2010;39:448–53. https://doi.org/10.1016/j.semarthrit.2008.12.003 .
doi: 10.1016/j.semarthrit.2008.12.003 pubmed: 19250656
Thieme K, Turk DC, Flor H. Comorbid depression and anxiety in fibromyalgia syndrome: relationship to somatic and psychosocial variables. Psychosom Med. 2004;66. https://doi.org/10.1097/01.psy.0000146329.63158.40 .
Gormsen L, Rosenberg R, Bach FW, Jensen TS. Depression, anxiety, health-related quality of life and pain in patients with chronic fibromyalgia and neuropathic pain. Eur J Pain. 2010;14:127.e1-127.e8. https://doi.org/10.1016/j.ejpain.2009.03.010 .
doi: 10.1016/j.ejpain.2009.03.010 pubmed: 19473857
Weir PT, Harlan GA, Nkoy FL, et al. The incidence of fibromyalgia and its associated comorbidities: a population-based retrospective cohort study based on International Classification of Diseases, 9th Revision Codes. JCR J Clin Rheumatol. 2006;12. https://doi.org/10.1097/01.rhu.0000221817.46231.18 .
Galvez-Sánchez CM, Duschek S, Reyes Del Paso GA. Psychological impact of fibromyalgia: current perspectives. Psychol Res Behav Manag. 2019;12:117–27. https://doi.org/10.2147/PRBM.S178240 .
doi: 10.2147/PRBM.S178240 pubmed: 30858740 pmcid: 6386210
Woo AK. Depression and anxiety in pain. Rev Pain. 2010;4:8–12. https://doi.org/10.1177/204946371000400103 .
doi: 10.1177/204946371000400103 pubmed: 26527193 pmcid: 4590059
Cash TF, Jakatdar TA, Williams EF. The body image quality of life inventory: further validation with college men and women. Body Image. 2004;1:279–87. https://doi.org/10.1016/S1740-1445(03)00023-8 .
doi: 10.1016/S1740-1445(03)00023-8 pubmed: 18089159
Avalos L, Tylka TL, Wood-Barcalow N. The body appreciation scale: development and psychometric evaluation. Body Image. 2005;2:285–97. https://doi.org/10.1016/j.bodyim.2005.06.002 .
doi: 10.1016/j.bodyim.2005.06.002 pubmed: 18089195
Przezdziecki A, Sherman KA, Baillie A, et al. My changed body: breast cancer, body image, distress and self-compassion. Psychooncology. 2013;22:1872–9. https://doi.org/10.1002/pon.3230 .
doi: 10.1002/pon.3230 pubmed: 23203842
Geller S, Levy S, Ashkeloni S, et al. Predictors of psychological distress in women with endometriosis: the role of multimorbidity, body image, and self-criticism. Int J Environ. Res: Public Heal; 2021. p. 18.
Akkaya N, Akkaya S, Atalay NS, et al. Relationship between the body image and level of pain, functional status, severity of depression, and quality of life in patients with fibromyalgia syndrome. Clin Rheumatol. 2012;31:983–8. https://doi.org/10.1007/s10067-012-1965-9 .
doi: 10.1007/s10067-012-1965-9 pubmed: 22395855
Menten LA, Franco KFM, Franco YRS, et al. Do patients with fibromyalgia have body image and tactile acuity distortion? Pain Pract. 2022;22:678–87. https://doi.org/10.1111/papr.13153 .
doi: 10.1111/papr.13153 pubmed: 36345889
Boyington JE, Schoster B, Callahan LF. Comparisons of body image perceptions of a sample of black and white women with rheumatoid arthritis and fibromyalgia in the US. Open Rheumatol J. 2015;9:1–7. https://doi.org/10.2174/1874312901409010001 .
doi: 10.2174/1874312901409010001 pubmed: 25674181 pmcid: 4319189
Ettridge K, Scharling-Gamba K, Miller C, et al. Body image and quality of life in women with breast cancer: appreciating the body and its functionality. Body Image. 2022;40:92–102. https://doi.org/10.1016/j.bodyim.2021.11.001 .
doi: 10.1016/j.bodyim.2021.11.001 pubmed: 34902783
Geller S, Levy S, Mann Y, et al. Body appreciation as a protective factor in women with fibromyalgia an examination of associations between pain perception social comparison and psychological distress. Clin Exp Rheumatol. 2022;40:1166–74. https://doi.org/10.55563/clinexprheumatol/2otrk6 .
doi: 10.55563/clinexprheumatol/2otrk6 pubmed: 35579091
Gilbert P. Body shame in Gilbert, P., & Miles, J. (Eds.). Body Shame: Conceptualisation, Research and Treatment (1st ed.). Routledge; 2002. https://doi.org/10.4324/9781315820255 .
Tiggemann M. Sociocultural perspectives on human appearance and body image. In: Guilford T, editor. Body image: a handbook of science, practice, and prevention, 2nd. New York, NY, US: Press; 2011. p. 12–9.
Quick V. Social theory applied to body image and chronic illness in youth. Am J Lifestyle Med. 2013;8:15–20. https://doi.org/10.1177/1559827613505408 .
doi: 10.1177/1559827613505408
Rice KG, Suh H, Davis DE. Perfectionism and emotion regulation. In: The psychology of perfectionism: theory, research, applications. Routledge/Taylor & Francis Group, New York, NY, US, 2018; pp 243–262.
Duarte C, Pinto-Gouveia J, Ferreira C, Batista D. Body image as a source of shame: a new measure for the assessment of the multifaceted nature of body image shame. Clin Psychol Psychother. 2015;22:656–66. https://doi.org/10.1002/cpp.1925 .
doi: 10.1002/cpp.1925 pubmed: 25316416
Holm-Denoma JM, Otamendi A, Joiner TE Jr. On self-criticism as interpersonally maladaptive. In: Self-criticism and self-enhancement: theory, research, and clinical implications. Washington, DC, US: American Psychological Association; 2008. p. 73–86.
doi: 10.1037/11624-005
Lerman SF, Shahar G, Rudich Z. Self-criticism interacts with the affective component of pain to predict depressive symptoms in female patients. Eur J Pain. 2012;16:115–22. https://doi.org/10.1016/j.ejpain.2011.05.007 .
doi: 10.1016/j.ejpain.2011.05.007 pubmed: 21664158
Gutierrez L, Velasco L, Blanco S, et al. Perfectionism, maladaptive beliefs and anxiety in women with fibromyalgia. An explanatory model from the conflict of goals. Pers Individ Dif. 2022;184:111165. https://doi.org/10.1016/j.paid.2021.111165 .
Luyten P, Kempke S, Van Wambeke P, et al. Self-critical perfectionism, stress generation, and stress sensitivity in patients with chronic fatigue syndrome: relationship with severity of depression. Psychiatry. 2011;74:21–30. https://doi.org/10.1521/psyc.2011.74.1.21 .
doi: 10.1521/psyc.2011.74.1.21 pubmed: 21463167
Neff KD. Self-compassion: an alternative conceptualization of a healthy attitude toward oneself. Self Identity. 2003;2:85–101. https://doi.org/10.1080/15298860309032 .
doi: 10.1080/15298860309032
Falconer CJ, Slater M, Rovira A, et al. Embodying compassion: a virtual reality paradigm for overcoming excessive self-criticism. PLoS ONE. 2014;9: e111933.
doi: 10.1371/journal.pone.0111933 pubmed: 25389766 pmcid: 4229123
Turk F, Waller G. Is self-compassion relevant to the pathology and treatment of eating and body image concerns A systematic review and meta-analysis. Clin Psychol Rev. 2020;79:101852.   https://doi.org/10.1016/j.cpr.2020.101856 .
doi: 10.1016/j.cpr.2020.101856 pubmed: 32438284
Yamaguchi A, Kim M-S, Akutsu S. The effects of self-construals, self-criticism, and self-compassion on depressive symptoms. Pers Individ Dif. 2014;68:65–70. https://doi.org/10.1016/j.paid.2014.03.013 .
doi: 10.1016/j.paid.2014.03.013
Diedrich A, Grant M, Hofmann SG, et al. Self-compassion as an emotion regulation strategy in major depressive disorder. Behav Res Ther. 2014;58:43–51. https://doi.org/10.1016/j.brat.2014.05.006 .
doi: 10.1016/j.brat.2014.05.006 pubmed: 24929927
Kauser S, Keyte R, Regan A, et al. Exploring associations between self-compassion, self-criticism, mental health, and quality of life in adults with cystic fibrosis: informing future interventions. J Clin Psychol Med Settings. 2022;29:332–43. https://doi.org/10.1007/s10880-021-09831-y .
doi: 10.1007/s10880-021-09831-y pubmed: 34750694
Montero-Marin J, Van Gordon W, Shonin E, et al. Attachment-based compassion therapy for ameliorating fibromyalgia: mediating role of mindfulness and self-compassion. Mindfulness (N Y). 2020;11:816–28. https://doi.org/10.1007/s12671-019-01302-8 .
doi: 10.1007/s12671-019-01302-8
Brooks BD, Kaniuka AR, Rabon JK, et al. Social support and subjective health in fibromyalgia: self-compassion as a mediator. J Clin Psychol Med Settings. 2022;29:375–83. https://doi.org/10.1007/s10880-021-09832-x .
doi: 10.1007/s10880-021-09832-x pubmed: 35001253
Turk F, Kellett S, Waller G. Determining the potential links of self-compassion with eating pathology and body image among women and men: a cross-sectional mediational study. Body Image. 2021;37:28–37. https://doi.org/10.1016/j.bodyim.2021.01.007 .
doi: 10.1016/j.bodyim.2021.01.007 pubmed: 33548664
Ferreira C, Dias B, Oliveira S. Behind women’s body image-focused shame: exploring the role of fears of compassion and self-criticism. Eat Behav. 2019;32:12–7. https://doi.org/10.1016/j.eatbeh.2018.11.002 .
doi: 10.1016/j.eatbeh.2018.11.002 pubmed: 30471481
Tylka TL, Wood-Barcalow NL. The body appreciation scale-2: Item refinement and psychometric evaluation. Body Image. 2015;12:53–67. https://doi.org/10.1016/j.bodyim.2014.09.006 .
doi: 10.1016/j.bodyim.2014.09.006 pubmed: 25462882
Geller S, Handelzalts JE, Levy S, et al. An examination of the factor structure and preliminary assessment of the psychometric properties of a Hebrew translation of the body appreciation scale-2 (BAS-2). Body Image. 2020;34:145–54. https://doi.org/10.1016/j.bodyim.2020.05.013 .
doi: 10.1016/j.bodyim.2020.05.013 pubmed: 32674037
Neff KD. The development and validation of a scale to measure self-compassion. Self Identity. 2003;2:223–50. https://doi.org/10.1080/15298860309027 .
doi: 10.1080/15298860309027
Gerber Z, Tolmacz R, Doron Y. Self-compassion and forms of concern for others. Pers Individ Dif. 2015;86:394–400. https://doi.org/10.1016/j.paid.2015.06.052 .
doi: 10.1016/j.paid.2015.06.052
Blatt SJ, D’Afflitti JP, Quinlan DM. Experiences of depression in normal young adults. J Abnorm Psychol. 1976;85:383–9.
doi: 10.1037/0021-843X.85.4.383 pubmed: 956505
Yona, T., Weisman, A., Gottlieb, U., Lin, E., & Masharawi, Y. (2021). The reliability and validity of the Hebrew patient health questionnaire (PHQ-9) in the general population. MedRxiv, 2021-07.
Kroenke K, Spitzer RL, Williams JBW. The PHQ-9. J Gen Intern Med. 2001;16:606–13. https://doi.org/10.1046/j.1525-1497.2001.016009606.x .
doi: 10.1046/j.1525-1497.2001.016009606.x pubmed: 11556941 pmcid: 1495268
Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166:1092–7. https://doi.org/10.1001/archinte.166.10.1092 .
doi: 10.1001/archinte.166.10.1092 pubmed: 16717171
IBM Corp. IBM SPSS Statistics for Windows, Version 28.0. 2021.
Hayes AF. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach (Methodology in the Social Sciences) (2nd ed.). New York, NY: The Guilford Press; 2018.
Jolly M. Body image issues in rheumatology. In: Guilford T, editor. Body image: A handbook of science, practice, and prevention, 2nd. New York, NY, US: Press; 2011. p. 350–7.
Kim C-H, Luedtke CA, Vincent A, et al. Association of body mass index with symptom severity and quality of life in patients with fibromyalgia. Arthritis Care Res (Hoboken). 2012;64:222–8. https://doi.org/10.1002/acr.20653 .
doi: 10.1002/acr.20653 pubmed: 21972124
Schmidt CK, Raque-Bogdan TL, Hollern EA. Self-compassion, affect, and body image in college women. J Coll Couns. 2019;22:152–63. https://doi.org/10.1002/jocc.12127 .
doi: 10.1002/jocc.12127
Kılıç A, Hudson J, McCracken LM, et al. A systematic review of the effectiveness of self-compassion-related interventions for individuals with chronic physical health conditions. Behav Ther. 2021;52:607–25. https://doi.org/10.1016/j.beth.2020.08.001 .
doi: 10.1016/j.beth.2020.08.001 pubmed: 33990237
Hamilton NA, Pressman M, Lillis T, et al. Evaluating evidence for the role of sleep in fibromyalgia: a test of the sleep and pain diathesis model. Cognit Ther Res. 2012;36:806–14. https://doi.org/10.1007/s10608-011-9421-8 .
doi: 10.1007/s10608-011-9421-8 pubmed: 24501433
Alleva JM, Tylka TL. Body functionality: a review of the literature. Body Image. 2021;36:149–71. https://doi.org/10.1016/j.bodyim.2020.11.006 .
doi: 10.1016/j.bodyim.2020.11.006 pubmed: 33321273

Auteurs

Sigal Levy (S)

Statistical Education Unit, The Academic College of Tel Aviv-Yaffo, Tel-Aviv, Israel.

Shay Ohayon (S)

School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, 14 Rabenu Yeruham St, 68182, Tel-Aviv, Israel.

Ronit Avitsur (R)

School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, 14 Rabenu Yeruham St, 68182, Tel-Aviv, Israel.

Shulamit Geller (S)

School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, 14 Rabenu Yeruham St, 68182, Tel-Aviv, Israel. shulamit@mta.ac.il.

Classifications MeSH