Compassion Mediates Poor Sleep Quality and Mental Health Outcomes

Abstract

Objectives

Poor sleep quality has been associated with suboptimal physical and mental health outcomes. Self-compassion has been shown to protect against the effects of poor sleep quality and promote positive mental health benefits. However, the attenuating role of fears of compassion on these relationships is less well known. Herein we examine the mediating role of self-compassion and fears of compassion on the relationship between poor sleep quality and mental health and wellbeing outcomes.

Methods

Two independent community and student samples within either a university setting or online research setting participated in the research. This was a 2-sample cross-sectional survey design (N = 196, sample 1; N = 151, sample 2) which was conducted March–July 2019. In both samples, we examined self-compassion and fears of compassion as focal mediators of poor sleep quality and mental health outcomes.

Results

Mediation analyses with non-parametric bootstrapping identified that self-compassion partially mediated the relationship between poor sleep quality and mental health outcomes (p < .001, R2 = .20). Fears of self-compassion partially mediated the relationship between poor sleep quality and mental health wellbeing (p < .001, R2 = .09) and fully mediated the relationship between poor sleep quality and psychological distress (p < .001, R2 = .09).

Conclusions

We provide empirical evidence for how both self-compassion and fears of compassion can mediate the relationship between poor sleep quality, psychological distress, and mental health wellbeing. Our results provide important suggestions for future work in therapy, clinical studies of sleep, and the utility of the fears of compassion scale as a key psychometric instrument for use within the field.

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References

  1. Baethge, A., Vahle-Hinz, T., & Rigotti, T. (2019). Coworker support and its relationship to allostasis during a workday: A diary study on trajectories of heart rate variability during work. Journal of Applied Psychology, 105(5), 506–526. https://doi.org/10.1037/apl0000445.

    Article  Google Scholar 

  2. Barnard, L. K., & Curry, J. F. (2011). Self-compassion: Conceptualizations, correlates, & interventions. Review of General Psychology, 15(4), 289–303. https://doi.org/10.1037/a0025754.

    Article  Google Scholar 

  3. Brüning, F., Noya, S. B., Bange, T., Koutsouli, S., Rudolph, J. D., Tyagarajan, S., Cox, J., Mann, M., Brown, S. A., & Robles, M. S. (2019). Sleep-wake cycles drive daily dynamics of synaptic phosphorylation sleep-wake cycles drive daily dynamics of synaptic phosphorylation. Science, 366, eaav3617. https://doi.org/10.1126/science.aav3617.

    Article  PubMed  Google Scholar 

  4. Burton, A. R., Rahman, K., Kadota, Y., Lloyd, A., & Vollmer-Conna, U. (2010). Reduced heart rate variability predicts poor sleep quality in a case-control study of chronic fatigue syndrome. Experimental Brain Research, 204(1), 71–78. https://doi.org/10.1007/s00221-010-2296-1.

    Article  PubMed  Google Scholar 

  5. Butz, S., & Stahlberg, D. (2018). Can self-compassion improve sleep quality via reduced rumination? Self and Identity, 17(6), 666–686. https://doi.org/10.1080/15298868.2018.1456482.

    Article  Google Scholar 

  6. Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Research, 28, 193–213.

    Article  Google Scholar 

  7. Catarino, F., Gilbert, P., McEwan, K., & Baião, R. (2014). Compassion motivations: Distinguishing submissive compassion from genuine compassion and its association with shame, submissive behavior, depression, anxiety and stress. Journal of Social and Clinical Psychology, 33(5), 399–412. https://doi.org/10.1521/jscp.2014.33.5.399.

    Article  Google Scholar 

  8. Cirelli, C., & Tononi, G. (2019). Linking the need to sleep with synaptic function. Science, 366(6462), 189–190. https://doi.org/10.1126/science.aay5304.

    Article  PubMed  Google Scholar 

  9. Danielsson, N. S., Harvey, A. G., MacDonald, S., Jansson-Fröjmark, M., & Linton, S. J. (2013). Sleep disturbance and depressive symptoms in adolescence: The role of catastrophic worry. Journal of Youth and Adolescence, 42(8), 1223–1233. https://doi.org/10.1007/s10964-012-9811-6.

    Article  PubMed  Google Scholar 

  10. Diefenbach, G. J., Rabany, L., Hallion, L. S., Tolin, D. F., Goethe, J. W., Gueorguieva, R., Zertuche, L., & Assaf, M. (2019). Sleep improvements and associations with default mode network functional connectivity following rTMS for generalized anxiety disorder. Brain Stimulation, 12(1), 184–186. https://doi.org/10.1016/j.brs.2018.09.004.

    Article  PubMed  Google Scholar 

  11. Diekelmann, S., Büchel, C., Born, J., & Rasch, B. (2011). Labile or stable: Opposing consequences for memory when reactivated during waking and sleep. Nature Neuroscience, 14(3), 381–386. https://doi.org/10.1038/nn.2744.

    Article  PubMed  Google Scholar 

  12. Friedrich, A., & Schlarb, A. A. (2018). Let’s talk about sleep: A systematic review of psychological interventions to improve sleep in college students. Journal of Sleep Research, 27(1), 4–22. https://doi.org/10.1111/jsr.12568.

    Article  PubMed  Google Scholar 

  13. Gilbert, P. (2014). The origins and nature of compassion focused therapy. British Journal of Clinical Psychology, 53(1), 6–41. https://doi.org/10.1111/bjc.12043.

  14. 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.

    Article  Google Scholar 

  15. Gilbert, P., McEwan, K., Gibbons, L., Chotai, S., Duarte, J., & Matos, M. (2012). Fears of compassion and happiness in relation to alexithymia, mindfulness, and self-criticism. Psychology and Psychotherapy: Theory, Research and Practice, 85(4), 374–390. https://doi.org/10.1111/j.2044-8341.2011.02046.x.

    Article  Google Scholar 

  16. Gilbert, P., Catarino, F., Duarte, C., Matos, M., Kolts, R., Stubbs, J., & Basran, J. (2017). The development of compassionate engagement and action scales for self and others. Journal of Compassionate Health Care, 4(1), 1–24. https://doi.org/10.1186/s40639-017-0033-3.

    Article  Google Scholar 

  17. Harvey, A. G., Murray, G., Chandler, R. A., & Soehner, A. (2011). Sleep disturbance as transdiagnostic: Consideration of neurobiological mechanisms. Clinical Psychology Review, 31(2), 225–235. https://doi.org/10.1016/j.cpr.2010.04.003.

    Article  PubMed  Google Scholar 

  18. Hayes, A. F. (2017). Introduction to mediation, moderation, and conditional process analysis (Second ed.). New York: Guilford Press.

    Google Scholar 

  19. Hu, Y., Wang, Y., Sun, Y., Arteta-Garcia, J., & Purol, S. (2018). Diary study: The protective role of self-compassion on stress-related poor sleep quality. Mindfulness, 9(6), 1931–1940. https://doi.org/10.1007/s12671-018-0939-7.

    Article  Google Scholar 

  20. Irwin, M. R. (2019). Sleep and inflammation: Partners in sickness and in health. Nature Reviews Immunology, 19, 702–715. https://doi.org/10.1038/s41577-019-0190-z.

    Article  PubMed  Google Scholar 

  21. Jackowska, M., Dockray, S., Endrighi, R., Hendrickx, H., & Steptoe, A. (2012). Sleep problems and heart rate variability over the working day. Journal of Sleep Research, 21(4), 434–440. https://doi.org/10.1111/j.1365-2869.2012.00996.x.

    Article  PubMed  Google Scholar 

  22. Kelly, A. C., Carter, J. C., Zuroff, D. C., & Borairi, S. (2013). Self-compassion and fear of self-compassion interact to predict response to eating disorders treatment: A preliminary investigation. Psychotherapy Research, 23(3), 252–264. https://doi.org/10.1080/10503307.2012.717310.

    Article  PubMed  Google Scholar 

  23. Kelly, A. C., Vimalakanthan, K., & Carter, J. C. (2014). Understanding the roles of self-esteem, self-compassion, and fear of self-compassion in eating disorder pathology: An examination of female students and eating disorder patients. Eating Behaviors, 15(3), 388–391. https://doi.org/10.1016/j.eatbeh.2014.04.008.

    Article  PubMed  Google Scholar 

  24. Keyes, C. L. M. (2002). The mental health continuum: From languishing to flourishing in life. Journal of Health and Social Research, 43, 207–222.

    Google Scholar 

  25. Kim, C., & Ko, H. (2018). The impact of self-compassion on mental health, sleep, quality of life and life satisfaction among older adults. Geriatric Nursing, 39(6), 623–628. https://doi.org/10.1016/j.gerinurse.2018.06.005.

    Article  PubMed  Google Scholar 

  26. Kim, J. J., Parker, S. L., Henderson, T., & Kirby, J. N. (2020a). Physiological fractals: Visual and statistical evidence across timescales and experimental states. Journal of the Royal Society Interface, 3(34), 20200334. https://doi.org/10.1098/rsif.2020.0334.

    Article  Google Scholar 

  27. Kim, J. J., Cunnington, R., & Kirby, J. N. (2020b). The neurophysiological basis of compassion: An fMRI meta-analysis of compassion and its related neural processes. Neuroscience and Biobehavioral Reviews, 108, 112–123. https://doi.org/10.1016/j.neubiorev.2019.10.023.

    Article  PubMed  Google Scholar 

  28. Kim, J., Gerrish, R., Gilbert, P., & Kirby, J. N. (2020c). Stressed, depressed, and rank obsessed: Individual differences in compassion and neuroticism predispose toward rank-based depressive symptomatology. Psychology and Psychotherapy: Theory, Research and Practice. https://doi.org/10.1111/papt.12270.

  29. Kim, J. J., Kent, K. M., Cunnington, R., Gilbert, P., & Kirby, J. N. (2020d). Attachment styles modulate neural markers of threat and imagery when engaging in self-criticism. Scientific Reports, 10(13776), 1–10. https://doi.org/10.1038/s41598-020-70772-x.

    Article  Google Scholar 

  30. Kim, J. J., Henderson, T., Best, T., Cunnington, R., & Kirby, J. N. (2020e). Neural and self-report markers of reassurance: A generalized additive modelling approach. Frontiers in Psychiatry, 11(September), 1–7. https://doi.org/10.3389/fpsyt.2020.566141.

    Article  Google Scholar 

  31. Kim, J., Parker, S., Doty, J., Cunnington, R., Gilbert, P., & Kirby, J. (2020f). Neurophysiological and behavioural markers of compassion. Scientific Reports, 10(1), 6789. https://doi.org/10.1038/s41598-020-63846-3.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Kirby, J. N., Doty, J. R., Petrocchi, N., & Gilbert, P. (2017a). The current and future role of heart rate variability for assessing and training compassion. Frontiers in Public Health, 5, 40. https://doi.org/10.3389/fpubh.2017.00040.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Kirby, J. N., Tellegen, C. L., & Steindl, S. R. (2017b). A meta-analysis of compassion-based interventions: Current state of knowledge and future directions. Behavior Therapy, 48(6), 778–792. https://doi.org/10.1016/j.beth.2017.06.003.

    Article  PubMed  Google Scholar 

  34. Kirby, J. N., Day, J., & Sagar, V. (2019). The ‘flow’ of compassion: A meta-analysis of the fears of compassion scales and psychological functioning. Clinical Psychology Review, 70, 26–39. https://doi.org/10.1016/j.cpr.2019.03.001.

    Article  PubMed  Google Scholar 

  35. Krystal, A. D. (2020). Sleep therapeutics and neuropsychiatric illness. Neuropsychopharmacology, 45, 166–175. https://doi.org/10.1038/s41386-019-0474-9.

    Article  PubMed  Google Scholar 

  36. Li, Y., Wu, Y., Zhai, L., Wang, T., Sun, Y., & Zhang, D. (2017). Longitudinal association of sleep duration with depressive symptoms among middle-aged and older Chinese. Scientific Reports, 7(1), 1–7. https://doi.org/10.1038/s41598-017-12182-0.

    Article  Google Scholar 

  37. Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the depression anxiety stress scales (dass) with the beck depression and anxiety inventories. Behaviour Research and Therapy, 33(3), 335–343. https://doi.org/10.1016/0005-7967(94)00075-U.

    Article  PubMed  Google Scholar 

  38. Marshall, L., Helgadottir, H., Molle, M., & Born, J. (2006). Boosting slow oscillations during sleep potentiates memory. Nature, 444, 610–613. https://doi.org/10.1038/nature05278

  39. Matos, M., Duarte, C., Duarte, J., Pinto-gouveia, J., Petrocchi, N., Basran, J., & Gilbert, P. (2017). Psychological and physiological effects of compassionate mind training: A pilot randomised controlled study. Mindfulness, 8(6), 1699–1712. https://doi.org/10.1007/s12671-017-0745-7.

    Article  Google Scholar 

  40. McEwan, K., Gilbert, P., Dandeneau, S., Lipka, S., Maratos, F., Paterson, K. B., & Baldwin, M. (2014). Facial expressions depicting compassionate and critical emotions: The development and validation of a new emotional face stimulus set. PLoS One, 9(2), e88783. https://doi.org/10.1371/journal.pone.0088783.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Medic, G., Wille, M., & Hemels, M. E. H. (2017). Short- and long-term health consequences of sleep disruption. Nature and Science of Sleep, 9, 151–161. https://doi.org/10.2147/NSS.S134864.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Milojevich, H. M., & Lukowski, A. F. (2016). Sleep and mental health in undergraduate students with generally healthy sleep habits. PLoS One, 11(6), 1–14. https://doi.org/10.1371/journal.pone.0156372.

    Article  Google Scholar 

  43. Mutz, J., Edgcumbe, D. R., Brunoni, A. R., & Fu, C. H. Y. (2018). Efficacy and acceptability of non-invasive brain stimulation for the treatment of adult unipolar and bipolar depression: A systematic review and meta-analysis of randomised sham-controlled trials. Neuroscience and Biobehavioral Reviews, 92, 291–303. https://doi.org/10.1016/j.neubiorev.2018.05.015.

    Article  PubMed  Google Scholar 

  44. Neff, K. D. (2003). The development and validation of a scale to measure self-compassion. Self and Identity, 2, 223–250. https://doi.org/10.1080/15298860390209035.

    Article  Google Scholar 

  45. Noya, S. B., Colameo, D., Brüning, F., Spinnler, A., Mircsof, D., Opitz, L., & Brown, S. A. (2019). The forebrain synaptic transcriptome is organized by clocks but its proteome is driven by sleep. Science, 366(6462), eaav2646. https://doi.org/10.1126/SCIENCE.AAV2642.

    Article  Google Scholar 

  46. Okano, K., Kaczmarzyk, J. R., Dave, N., Gabrieli, J. D. E., & Grossman, J. C. (2019). Sleep quality, duration, and consistency are associated with better academic performance in college students. NPJ Science of Learning, 4(1), 16. https://doi.org/10.1038/s41539-019-0055-z.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Perugini, M. L. L., de la Iglesia, G., Castro Solano, A., & Keyes, C. L. M. (2017). The mental health continuum–short form (MHC–SF) in the Argentinean context: Confirmatory factor analysis and measurement invariance. Europe's Journal of Psychology, 13(1), 93–108. https://doi.org/10.5964/ejop.v13i1.1163.

    Article  Google Scholar 

  48. Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments, & Computers, 36(4), 717–731. https://doi.org/10.1002/jcp.28952.

    Article  Google Scholar 

  49. Preacher, K. J., Rucker, D. D., & Hayes, A. F. (2007). Addressing moderated mediation hypotheses: Theory, methods, and prescriptions. Multivariate Behavioral Research, 42(1), 185–227. https://doi.org/10.1080/00273170701341316.

    Article  PubMed  Google Scholar 

  50. Scheer, F. A. J. L., Hilton, M. F., Mantzoros, C. S., & Shea, S. A. (2009). Adverse metabolic and cardiovascular consequences of circadian misalignment. Proceedings of the National Academy of Sciences of the United States of America, 106(11), 4453–4458. https://doi.org/10.1073/pnas.0808180106.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Spira, A. P., Beaudreau, S. A., Stone, K. L., Kezirian, E. J., Lui, L. Y., Redline, S., & Stewart, A. (2012). Reliability and validity of the Pittsburgh sleep quality index and the Epworth sleepiness scale in older men. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 67 A(4), 433–439. https://doi.org/10.1093/gerona/glr172.

    Article  Google Scholar 

  52. Stein, P. K., & Pu, Y. (2012). Heart rate variability, sleep and sleep disorders. Sleep Medicine Reviews, 16(1), 47–66. https://doi.org/10.1016/j.smrv.2011.02.005.

    Article  PubMed  Google Scholar 

  53. Stickley, A., Leinsalu, M., DeVylder, J. E., Inoue, Y., & Koyanagi, A. (2019). Sleep problems and depression among 237 023 community-dwelling adults in 46 low- and middle-income countries. Scientific Reports, 9(1), 1–10. https://doi.org/10.1038/s41598-019-48334-7.

    Article  Google Scholar 

  54. Svendsen, J. L., Osnes, B., Binder, P. E., Dundas, I., Visted, E., Nordby, H., & Sørensen, L. (2016). Trait self-compassion reflects emotional flexibility through an association with high vagally mediated heart rate variability. Mindfulness, 7(5), 1103–1113. https://doi.org/10.1007/s12671-016-0549-1.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Tononi, G., & Cirelli, C. (2013). Sleep and the price of plasticity: From synaptic and cellular homeostasis to memory consolidation and integration. Neuron, 81(1), 12–34. https://doi.org/10.1016/j.neuron.2013.12.025.

    Article  Google Scholar 

  56. Tran, T. D., Tran, T., & Fisher, J. (2013). Validation of the depression anxiety stress scales (DASS) 21 as a screening instrument for depression and anxiety in a rural community-based cohort of northern Vietnamese women. BMC Psychiatry, 13(1), 1. https://doi.org/10.1186/1471-244X-13-24.

    Article  Google Scholar 

  57. Urrila, A. S., Artiges, E., Massicotte, J., Miranda, R., Vulser, H., Bézivin-Frere, P., & Martinot, J. L. (2017). Sleep habits, academic performance, and the adolescent brain structure. Scientific Reports, 7(April 2016), 1–9. https://doi.org/10.1038/srep41678.

    Article  Google Scholar 

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JJK: collaborated with the design of the study, analysed the data, and wrote the paper. MO: collaborated with the design of the study, executed the study, collaborated with the writing of the study, and assisted with data analyses. ATF: collaborated with the design of the study. JNK: designed the study and collaborated in the writing and editing of the final manuscript.

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Correspondence to Jeffrey J. Kim.

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This research was supported by the University of Queensland Health and Behavioural Sciences Low & Negligible Risk Ethics subcommittee.

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Kim, J.J., Oldham, M., Fernando, A.T. et al. Compassion Mediates Poor Sleep Quality and Mental Health Outcomes. Mindfulness 12, 1252–1261 (2021). https://doi.org/10.1007/s12671-021-01595-8

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Keywords

  • Compassion
  • Sleep quality
  • Mental health
  • Distress
  • Wellbeing
  • Fears of compassion