Abstract
Objectives
More self-compassion has been related to a better psychological functioning in cancer patients, but little is known about the course of self-compassion over time in the trajectory of illness and cancer treatment. This longitudinal study aimed to examine subgroups of cancer patients with differential trajectories of self-compassion and associations of these trajectories with the course of psychological symptoms.
Methods
A total of 153 cancer patients participated in this longitudinal study. Self-reported questionnaires were used to measure self-compassion (i.e., overall self-compassion and, separately, positive self-compassion, and negative self-compassion), and depressive and anxiety symptoms. These assessments were taken directly after cancer diagnosis (T1), and at the start (T2) and the end (T3) of medical treatment. Latent class growth modelling and repeated measures ANOVA were applied to examine the research questions.
Results
We identified three trajectories of overall self-compassion (“stable low” 82.2%, “late increase” 11.8%, and “late decrease” 6.0%), four trajectories of positive self-compassion (“late decline” 57.2%, “early decline” 22.4%, “large increase” 15.1%, and “large decline” 5.3%), and four trajectories of negative self-compassion (“late decline” 42.1%, “stable negative self-compassion” 40.8%, “large fluctuation” 9.9%, and “large increase” 7.2%). Only the negative self-compassion trajectories were significantly related to the course of depressive and anxiety symptoms.
Conclusions
Our findings suggest that subgroups of cancer patients exist that show distinct trajectories of self-compassion over time. We identified a small group of patients at a higher risk of losing self-compassion throughout the cancer trajectory and experiencing psychological symptoms.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data Availability
The data of the current study is available from the corresponding author upon reasonable request.
References
Austin, J., Drossaert, C. H. C., Schroevers, M. J., Sanderman, R., Kirby, J. N., & Bohlmeijer, E. T. (2021). Compassion-based interventions for people with long-term physical conditions: A mixed methods systematic review. Psychology & Health, 36(1), 16–42. https://doi.org/10.1080/08870446.2019.1699090
Brenner, R. E., Heath, P. J., Vogel, D. L., & Credé, M. (2017). Two is more valid than one: Examining the factor structure of the Self-Compassion Scale (SCS). Journal of Counseling Psychology, 64(6), 696–707. https://doi.org/10.1037/cou0000211
Campo, R. A., Bluth, K., Santacroce, S. J., Knapik, S., Tan, J., Gold, S., Philips, K., Gaylord, S., & Asher, G. N. (2017). A mindful self-compassion videoconference intervention for nationally recruited posttreatment young adult cancer survivors: Feasibility, acceptability, and psychosocial outcomes. Supportive Care in Cancer, 25(6), 1759–1768. https://doi.org/10.1007/s00520-017-3586-y
Chen, H., Cohen, P., & Chen, S. (2010). How big is a big odds ratio? Interpreting the magnitudes of odds ratios in epidemiological studies. Communications in Statistics: Simulation and Computation, 39(4), 860–864. https://doi.org/10.1080/03610911003650383
Costa, J., Marôco, J., Pinto-Gouveia, J., Ferreira, C., & Castilho, P. (2016). Validation of the psychometric properties of the Self-Compassion Scale. Testing the factorial validity and factorial invariance of the measure among borderline personality disorder, anxiety disorder, eating disorder and general populations. Clinical Psychology and Psychotherapy, 23(5), 460–468. https://doi.org/10.1002/cpp.1974
Danucalov, M. A. D., Kozasa, E. H., Afonso, R. F., Galduroz, J. C. F., & Leite, J. R. (2017). Yoga and compassion meditation program improve quality of life and self-compassion in family caregivers of Alzheimer’s disease patients: A randomized controlled trial. Geriatrics and Gerontology International, 17(1), 85–91. https://doi.org/10.1111/ggi.12675
Eriksson, T., Germundsjö, L., Åström, E., & Rönnlund, M. (2018). Mindful self-compassion training reduces stress and burnout symptoms among practicing psychologists: A randomized controlled trial of a brief web-based intervention. Frontiers in Psychology, 9(11), 1–10. https://doi.org/10.3389/fpsyg.2018.02340
Ewert, C., Vater, A., & Schröder-Abé, M. (2021). Self-compassion and coping: A meta-analysis. Mindfulness, 12(5), 1063–1077. https://doi.org/10.1007/s12671-020-01563-8
Friis, A. M., Johnson, M. H., Cutfield, R. G., & Consedine, N. S. (2016). Kindness matters: A randomized controlled trial of a mindful self-compassion intervention improves depression, distress, and HbA 1c among patients with diabetes. Diabetes Care, 39(11), 1963–1971. https://doi.org/10.2337/dc16-0416
Gilbert, P. (2005). Compassion: Conceptualisations, research and use in psychotherapy. Routledge.
Gilbert, P., & Bailey, K. G. (2014). Genes on the couch: Explorations in evolutionary psychotherapy. Routledge.
Gilbert, P., McEwan, K., Matos, M., & Rivis, A. (2011). Fears of compassion: Development of three self-report measures. Psychology and Psychotherapy: Theory, Research and Practice, 84(3), 239–255. https://doi.org/10.1348/147608310X526511
Gillanders, D. T., Sinclair, A. K., MacLean, M., & Jardine, K. (2015). Illness cognitions, cognitive fusion, avoidance and self-compassion as predictors of distress and quality of life in a heterogeneous sample of adults, after cancer. Journal of Contextual Behavioral Science, 4(4), 300–311. https://doi.org/10.1016/j.jcbs.2015.07.003
Hayes, A. F., & Coutts, J. J. (2020). Use omega rather than Cronbach’s Alpha for estimating reliability. But Communication Methods and Measures, 14(1), 1–24. https://doi.org/10.1080/19312458.2020.1718629
Hinz, A., Mehnert, A., Kocalevent, R.-D., Brähler, E., Forkmann, T., Singer, S., & Schulte, T. (2016). Assessment of depression severity with the PHQ-9 in cancer patients and in the general population. BMC Psychiatry, 16(1), 22. https://doi.org/10.1186/s12888-016-0728-6
Izci, F., Ilgun, A. S., Findikli, E., & Ozmen, V. (2016). Psychiatric symptoms and psychosocial problems in patients with breast cancer. Journal of Breast Health, 12(3), 94–101. https://doi.org/10.5152/tjbh.2016.3041
Kangas, M., Henry, J. L., & Bryant, R. A. (2002). Posttraumatic stress disorder following cancer: A conceptual and empirical review. Clinical Psychology Review, 22(4), 499–524. https://doi.org/10.1016/S0272-7358(01)00118-0
Khoury, B. (2019). Compassion: Embodied and embedded. Mindfulness, 10(11), 2363–2374. https://doi.org/10.1007/s12671-019-01211-w
Klimecki, O. M., & Singer, T. (2017). The compassionate brain. In E. M. Seppälä, E. Simon-Thomas, S. L. Brown, M. C. Worline, C. D. Cameron, & J. R. Doty (Eds.), The Oxford handbook of compassion science (pp. 109–120). Oxford University Press.
Körner, A., Coroiu, A., Copeland, L., Gomez-Garibello, C., Albani, C., Zenger, M., & Brähler, E. (2015). The role of self-compassion in buffering symptoms of depression in the general population. PLoS ONE, 10(10), 1–14. https://doi.org/10.1371/journal.pone.0136598
Krieger, T., Berger, T., Holtforth, M., grosse. (2016). The relationship of self-compassion and depression: Cross-lagged panel analyses in depressed patients after outpatient therapy. Journal of Affective Disorders, 202, 39–45. https://doi.org/10.1016/j.jad.2016.05.032
Kumlander, S., Lahtinen, O., Turunen, T., & Salmivalli, C. (2018). Two is more valid than one, but is six even better? The factor structure of the Self-Compassion Scale (SCS). PLoS ONE, 13(12), 1–22. https://doi.org/10.1371/journal.pone.0207706
Lathren, C. R., Rao, S. S., Park, J., & Bluth, K. (2021). Self-compassion and current close interpersonal relationships: A scoping literature review. Mindfulness, 12(5), 1078–1093. https://doi.org/10.1007/s12671-020-01566-5
Liao, K. Y. H., Stead, G. B., & Liao, C. Y. (2021). A meta-analysis of the relation between self-compassion and self-efficacy. Mindfulness, 12(8), 1878–1891. https://doi.org/10.1007/s12671-021-01626-4
Lo, Y., Mendell, N. R., & Rubin, D. B. (2001). Testing the number of components in a normal mixture. Biometrika, 88(3), 767–778. https://doi.org/10.1093/biomet/88.3.767
López, A., Sanderman, R., & Schroevers, M. J. (2018). A close examination of the relationship between self-compassion and depressive symptoms. Mindfulness, 9(5), 1470–1478. https://doi.org/10.1007/s12671-018-0891-6
López, A., Sanderman, R., Smink, A., Zhang, Y., Eric, V. S., Ranchor, A., & Schroevers, M. J. (2015). A reconsideration of the Self-Compassion Scale’s total score: Self-compassion versus self-criticism. PLoS ONE, 10(7), 1–12. https://doi.org/10.1371/journal.pone.0132940
Luttik, M. L. A., Jaarsma, T., Sanderman, R., & Fleer, J. (2011). The advisory brought to practice routine screening on depression (and anxiety) in Coronary Heart Disease; Consequences and implications. European Journal of Cardiovascular Nursing, 10(4), 228–233. https://doi.org/10.1016/j.ejcnurse.2010.08.005
MacBeth, A., & Gumley, A. (2012). Exploring compassion: A meta-analysis of the association between self-compassion and psychopathology. Clinical Psychology Review, 32(6), 545–552. https://doi.org/10.1016/j.cpr.2012.06.003
Manea, L., Gilbody, S., & McMillan, D. (2012). Optimal cut-off score for diagnosing depression with the Patient Health Questionnaire (PHQ-9): A meta-analysis. Canadian Medical Association Journal, 184(3), E191–E196. https://doi.org/10.1503/cmaj.110829
Marsh, I. C., Chan, S. W. Y., & MacBeth, A. (2018). Self-compassion and psychological distress in adolescents—A meta-analysis. Mindfulness, 9(4), 1011–1027. https://doi.org/10.1007/s12671-017-0850-7
Marziliano, A., Tuman, M., & Moyer, A. (2020). The relationship between post-traumatic stress and post-traumatic growth in cancer patients and survivors: A systematic review and meta-analysis. Psycho-Oncology, 29(4), 604–616. https://doi.org/10.1002/pon.5314
McLachlan, G. J., Lee, S. X., & Rathnayake, S. I. (2019). Finite mixture models. Annual Review of Statistics and Its Application, 6(1), 355–378. https://doi.org/10.1146/annurev-statistics-031017-100325
Muris, P., & Otgaar, H. (2020). The process of science: A critical evaluation of more than 15 years of research on self-compassion with the Self-Compassion Scale. Mindfulness, 11(6), 1469–1482. https://doi.org/10.1007/s12671-020-01363-0
Muris, P., Otgaar, H., López, A., Kurtic, I., & van de Laar, I. (2021). The (non)protective role of self-compassion in internalizing symptoms: Two empirical studies in adolescents demonstrating unwanted effects of using the Self-Compassion Scale total score. Mindfulness, 12(1), 240–252. https://doi.org/10.1007/s12671-020-01514-3
Muris, P., Otgaar, H., & Pfattheicher, S. (2019). Stripping the forest from the rotten trees: Compassionate self-responding is a way of coping, but reduced uncompassionate self-responding mainly reflects psychopathology. Mindfulness, 10(1), 196–199. https://doi.org/10.1007/s12671-018-1030-0
Muris, P., & Petrocchi, N. (2017). Protection or vulnerability? A meta-analysis of the relations between the positive and negative components of self-compassion and psychopathology. Clinical Psychology & Psychotherapy, 24(2), 373–383. https://doi.org/10.1002/cpp.2005
Muris, P., van den Broek, M., Otgaar, H., Oudenhoven, I., & Lennartz, J. (2018). Good and bad sides of self-compassion: A face validity check of the Self-Compassion Scale and an investigation of its relations to coping and emotional symptoms in non-clinical adolescents. Journal of Child and Family Studies, 27(8), 2411–2421. https://doi.org/10.1007/s10826-018-1099-z
Muthén, L. K., & Muthén, B. O. (2012). Mplus : Statistical analysis with latent variables : user’s guide. Muthén & Muthén.
Neff, K. D. (2003a). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2(2), 85–101. https://doi.org/10.1080/15298860309032
Neff, K. D. (2003b). The development and validation of a scale to measure self-compassion. Self and Identity, 2(3), 223–250. https://doi.org/10.1080/15298860309027
Neff, K. D., Hsieh, Y.-P., & Dejitterat, K. (2005). Self-compassion, achievement goals, and coping with academic failure. Self and Identity, 4(3), 263–287. https://doi.org/10.1080/13576500444000317
Neff, K. D., Kirkpatrick, K. L., & Rude, S. S. (2007). Self-compassion and adaptive psychological functioning. Journal of Research in Personality, 41(1), 139–154. https://doi.org/10.1016/j.jrp.2006.03.004
Neff, K. D., Long, P., Knox, M. C., Davidson, O., Kuchar, A., Costigan, A., Williamson, Z., Rohleder, N., Tóth-Király, I., & Breines, J. G. (2018). The forest and the trees: Examining the association of self-compassion and its positive and negative components with psychological functioning. Self and Identity, 17(6), 627–645. https://doi.org/10.1080/15298868.2018.1436587
Neff, K. D., Tóth-Király, I., Yarnell, L. M., Arimitsu, K., Castilho, P., Ghorbani, N., Guo, H. X., Hirsch, J. K., Hupfeld, J., Hutz, C. S., Kotsou, I., Lee, W. K., Montero-Marin, J., Sirois, F. M., De Souza, L. K., Svendsen, J. L., Wilkinson, R. B., & Mantzios, M. (2019). Examining the factor structure of the Self-Compassion Scale in 20 diverse samples: Support for use of a total score and six subscale scores. Psychological Assessment, 31(1), 27–45. https://doi.org/10.1037/pas0000629
Nielsen, N. R., & Grønbæk, M. (2006). Stress and breast cancer: A systematic update on the current knowledge. Nature Clinical Practice Oncology, 3(11), 612–620. https://doi.org/10.1038/ncponc0652
Nylund, K. L., Asparouhov, T., & Muthén, B. O. (2007). Deciding on the number of classes in latent class analysis and growth mixture modeling: A Monte Carlo simulation study. Structural Equation Modeling: A Multidisciplinary Journal, 14(4), 535–569. https://doi.org/10.1080/10705510701575396
Peters, G. (2014). The alpha and the omega of scale reliability and validity: Why and how to abandon Cronbach’s alpha and the route towards more comprehensive assessment of scale quality. The European Health Psychologist, 16(2), 56–69. https://doi.org/10.31234/osf.io/h47fv
Pinto-Gouveia, J., Duarte, C., Matos, M., & Fráguas, S. (2014). The protective role of self-compassion in relation to psychopathology symptoms and quality of life in chronic and in cancer patients. Clinical Psychology & Psychotherapy, 21(4), 311–323. https://doi.org/10.1002/cpp.1838
Podsakoff, P. M., MacKenzie, S. B., & Podsakoff, N. P. (2012). Sources of method bias in social science research and recommendations on how to control it. Annual Review of Psychology, 63, 539–569. https://doi.org/10.1146/annurev-psych-120710-100452
Przezdziecki, A., Sherman, K. A., Baillie, A., Taylor, A., Foley, E., & Stalgis-Bilinski, K. (2013). My changed body: Breast cancer, body image, distress and self-compassion. Psycho-Oncology, 22(8), 1872–1879. https://doi.org/10.1002/pon.3230
Raes, F., Pommier, E., Neff, K. D., & Van Gucht, D. (2011). Construction and factorial validation of a short form of the Self-Compassion Scale. Clinical Psychology and Psychotherapy, 18(3), 250–255. https://doi.org/10.1002/cpp.702
Schellekens, M. P. J., Karremans, J. C., van der Drift, M. A., Molema, J., van den Hurk, D. G. M., Prins, J. B., & Speckens, A. E. M. (2017). Are mindfulness and self-compassion related to psychological distress and communication in couples facing lung cancer? A Dyadic Approach. Mindfulness, 8(2), 325–336. https://doi.org/10.1007/s12671-016-0602-0
Shand, L. K., Cowlishaw, S., Brooker, J. E., Burney, S., & Ricciardelli, L. A. (2015). Correlates of post-traumatic stress symptoms and growth in cancer patients: A systematic review and meta-analysis. Psycho-Oncology, 24(6), 624–634. https://doi.org/10.1002/pon.3719
Shirtcliff, E. A., Vitacco, M. J., Graf, A. R., Gostisha, A. J., Merz, J. L., & Zahn-Waxler, C. (2009). Neurobiology of empathy and callousness: Implications for the development of antisocial behavior. Behavioral Sciences & the Law, 27(2), 137–171. https://doi.org/10.1002/bsl.862
Strauss, C., Lever Taylor, B., Gu, J., Kuyken, W., Baer, R., Jones, F., & Cavanagh, K. (2016). What is compassion and how can we measure it? A review of definitions and measures. Clinical Psychology Review, 47, 15–27. https://doi.org/10.1016/j.cpr.2016.05.004
Stutts, L. A., Leary, M. R., Zeveney, A. S., & Hufnagle, A. S. (2018). A longitudinal analysis of the relationship between self-compassion and the psychological effects of perceived stress. Self and Identity, 17(6), 609–626. https://doi.org/10.1080/15298868.2017.1422537
Todd, B. L., Moskowitz, M. C., Ottati, A., & Feuerstein, M. (2014). Stressors, stress response, and cancer recurrence: A systematic review. Cancer Nursing, 37(2), 114–125. https://doi.org/10.1097/NCC.0b013e318289a6e2
Todorov, N., Sherman, K. A., & Kilby, C. J. (2019). Self-compassion and hope in the context of body image disturbance and distress in breast cancer survivors. Psycho-Oncology, 28(10), 2025–2032. https://doi.org/10.1002/pon.5187
Tóth-Király, I., & Neff, K. D. (2021). Is self-compassion universal? Support for the measurement invariance of the Self-Compassion Scale across populations. Assessment, 28(1), 169–185. https://doi.org/10.1177/1073191120926232
van der Donk, L. J., Fleer, J., Tovote, A., Ranchor, A. V., Smink, A., Mul, V. E. M., Sanderman, R., & Schroevers, M. J. (2020). The role of mindfulness and self-compassion in depressive symptoms and affect: A comparison between cancer patients and healthy controls. Mindfulness, 11(4), 883–894. https://doi.org/10.1007/s12671-019-01298-1
Venderbos, L. D. F., Van Den Bergh, R. C. N., Roobol, M. J., Schröder, F. H., Essink-Bot, M. L., Bangma, C. H., Steyerberg, E. W., & Korfage, I. J. (2015). A longitudinal study on the impact of active surveillance for prostate cancer on anxiety and distress levels. Psycho-Oncology, 24(3), 348–354. https://doi.org/10.1002/pon.3657
Wadsworth, L. P., Forgeard, M., Hsu, K. J., Kertz, S., Treadway, M., & Björgvinsson, T. (2018). Examining the role of repetitive negative thinking in relations between positive and negative aspects of self-compassion and symptom improvement during intensive treatment. Cognitive Therapy and Research, 42(3), 236–249. https://doi.org/10.1007/s10608-017-9887-0
Wilson, A. C., Mackintosh, K., Power, K., & Chan, S. W. Y. (2019). Effectiveness of self-compassion related therapies: A systematic review and meta-analysis. Mindfulness, 10(6), 979–995. https://doi.org/10.1007/s12671-018-1037-6
Wong-Kim, E. C., & Bloom, J. R. (2005). Depression experienced by young women newly diagnosed with breast cancer. Psycho-Oncology, 14(7), 564–573. https://doi.org/10.1002/pon.873
Wu, Q., Chen, C., Liang, Y., Zhou, N., Cao, H., Du, H., Lin, X., & Chi, P. (2020). Not only the forest and trees but also the ground they are rooted in: Identifying profiles of self-compassion from the perspective of dialecticism. Mindfulness, 11(8), 1967–1977. https://doi.org/10.1007/s12671-020-01406-6
Zeller, M., Yuval, K., Nitzan-Assayag, Y., & Bernstein, A. (2015). Self-compassion in recovery following potentially traumatic stress: Longitudinal study of at-risk youth. Journal of Abnormal Child Psychology, 43(4), 645–653. https://doi.org/10.1007/s10802-014-9937-y
Zhu, L., Wang, J., Liu, S., Xie, H., Hu, Y., Yao, J., Ranchor, A. V., Schroevers, M. J., & Fleer, J. (2020). Self-compassion and symptoms of depression and anxiety in Chinese cancer patients: The mediating role of illness perceptions. Mindfulness, 11(10), 2386–2396. https://doi.org/10.1007/s12671-020-01455-x
Zhu, L., Yao, J., Wang, J., Wu, L., Gao, Y., Xie, J., Liu, A., Ranchor, A. V., & Schroevers, M. J. (2019). The predictive role of self-compassion in cancer patients’ symptoms of depression, anxiety, and fatigue: A longitudinal study. Psycho-Oncology, 28(9), 1918–1925. https://doi.org/10.1002/pon.5174
Acknowledgements
The authors give sincere thanks to the research nurses for helping in data collection and cancer patients for participating in the present research.
Funding
The present study was financially supported by the National Natural Science Foundation of China (Grant Number: 32000773) and Project of Humanities and Social Sciences (Grant Number: 20YJA190013).
Author information
Authors and Affiliations
Contributions
J.W. analyzed the data and wrote the manuscript. Y.H., L.W. and A.L. were involved with the study execution and data collection. J.Y., M.J.S. and L.Z. collaborated in the study design and final editing of the manuscript. All authors approved the final version of the current manuscript.
Corresponding author
Ethics declarations
Ethics Approval
This study was approved by the medical ethical committee at the Shaanxi Provincial Tumor Hospital (approval number: 2017–2). All procedures were in accordance with the 1964 Helsinki Declaration and its later amendments.
Consent to Participate
The written informed consent form was obtained from all cancer patients included in the study.
Conflict of Interest
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Wang, J., Hu, Y., Wei, L. et al. Trajectories of Self-compassion and Psychological Symptoms in Newly Diagnosed Cancer Patients. Mindfulness 13, 484–499 (2022). https://doi.org/10.1007/s12671-021-01809-z
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12671-021-01809-z