When depressed—be mindful of and kind to yourself: Self-compassion as mediator of change in a mindful depression treatment

Abstract

Objective

Self-compassion as an outcome and potential mediator in mindfulness-based interventions has gained increased attention in the last years. However, most mediation studies had several methodological shortcomings which precluded robust conclusions regarding its mediating role. This randomized controlled study aimed to address these issues by assessing self-compassion, as proposed mediator and outcome, in a temporal sequence.

Method

Eighty-one patients with current depression and work-related conflicts were randomly assigned to either an eight-week mindfulness-based day hospital treatment (MDT-DH; n = 47; including psychopharmacological treatment if necessary) or a waitlist control condition including a psychopharmacological consultation (PCC; n = 34). The outcome, depression severity, was assessed before, at mid-treatment and after the treatment while the proposed mediator, self-compassion, was measured at two week-intervals from before treatment until directly after treatment. Within-person and between-person mediation effects were analysed using multilevel structural equation modelling.

Results

The results from the mediation models show that self-compassion (as a general factor) and two of its components (mindfulness of personal suffering and common humanity) increased and mediated the change in depressive symptoms over time.

Conclusion

This study provides preliminary support for self-compassion as a mediator of treatment effects on depression in a mindful depression treatment.

Keywords:

• mediation
• self-compassion
• mindfulness
• depression

Data Availability

The data that support the findings of this study are openly available in the Open Science Framework at https://osf.io/sg243.

Declarations and Ethical Statements

Ethical Approval: The ethics committee of the University of Hildesheim approved the study and we obtained research governance approval from the local primary care health board, Ärztekammer Hamburg. All procedures were in accordance with the ethical standards of the institutional research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed Consent: All participants attended an information session and were given a written description of the procedure and content of the study as well as an estimation of time and effort required prior to participation. Informed consent was obtained from all participants included in the study.

Clinical Trial Registration: Deutsches Register Klinischer Studien (DRKS) Nr. 00006314.

Acknowledgements

Author Contributions: AB designed and executed the study and wrote the paper. CH analysed the data and collaborated with the writing and editing of the paper. CR collaborated in the design and execution of the study, and writing and editing of the final manuscript. JM collaborated with the design of the study, and writing and editing of the final manuscript. All authors approved the final version of the manuscript for submission.

Disclosure Statement

AB declares a potential conflict of interest as employee of ASKLEPIOS Kliniken Hamburg GmbH of which the funding company, ASKLEPIOS proresearch, is a subsidiary company. CR and CH declare that they have no conflicts of interest. JM is the director of the Achtsamkeitsinstitut Ruhr (an institute offering mindfulness training) and principal investigator on several DFG (German Science Foundation) research projects. He also receives royalties as the author of mindfulness books.

Supplemental data

Supplemental data for this article can be accessed doi:10.1080/10503307.2023.2179439.

Additional information

Funding

This research was supported by ASKLEPIOS proresearch, Klinische Forschung und Entwicklung, Lohmühlenstraße 5, Haus J, 20099 Hamburg, Deutschland. Fundind was received under the grant number 2933. The funder of the study had no role in the study design, data collection, data analysis, interpretation of data, or writing of the paper. The corresponding author had full access to the data and had final responsibility for the decision to submit for publication.