Effectiveness of compassion-focused therapy on self-criticism of the women applying for divorce.

INTRODUCTION: Making decision for separation from the spouse is one of the crises which are followed by unpleasant feelings such as self-criticism in the people. The purpose of the present study was to investigate the effectiveness of compassion-focused therapy (CFT) on self-criticism of the women applying for divorce.
MATERIALS AND METHODS: The research design was quasi-experimental with pretest, posttest, and control group type. The population included all the women applying for divorce who referred to an intervention-in-crisis center under the supervision of the organization of well-being in the city of Tehran in 2019. It had the convenient sampling method where the subjects were accommodated into two groups of fifteen women both in the experimental and control groups. The present study had the convenient nonrandom sampling method and the statistical population included 30 women from whom 15 women were accommodated into experimental group and so were 15 in the control group. Sampling method was in available, nonrandom type wherein 15 women were accommodated in the experimental group and so were 15 women in the control group. The experimental group participated in eight 90-min sessions of CFT and the control group did not receive any intervention. Before and after practical experimental administration, both the groups were assessed through self-criticism questionnaire by Smart et al. (2016). The statistical method used in the data analysis was ANCOVA.
RESULTS: The results showed that at the error level of 0.5, after controlling the effect of pretest scores as a covariance factor, the mean of the experimental group was significantly lower than the mean of the control group, which shows that CFT approach has been effective in reducing self-criticism.
CONCLUSION: As a result, CFT approach can help the people who face the crisis of making decision for divorce and self-criticism to be able to confront this issue effectively and achieve mental health. Copyright:

Introduction

Marital conflicts and the consequent breakdown of marital relationships are a major social problem that has many negative effects on individuals, families, and society.[1] Decision to finish marital life is among the events which cause problems. In-family maladjustments cause disturbance in family function and the relationships of family members and endangering family members' integrity, and finally, it leads to the family dissolution. Furthermore, marital maladjustment causes the increase of psychological disorders such as mental health,[2] anxiety,[3] depression,[24] and addiction to the Internet.[5] Psychological disorders can affect people's quality of life.[6] Researchers believe that these disorders are always associated with self-criticism.[7] Self-criticism is a process of self-assessment where the people judge themselves hard.[8] Self-criticism is followed by low self-esteem[9] and negative feelings,[10] and it approaches self-criticism perfectionism.[11] Self-criticism has been recognized more than other aspects of perfectionism as an important predictor of clinical signs, and it shows that it is the main factor in relationship with clinical problems;[12] in other words, self-criticism is a form of rumination and repetitive negative thought, the objective of which is making oneself valueless, and the researchers believe that it is related to psychological problems such as depression, anxiety, and anger.[13]

As it was pointed out before, making decision to get separated from the spouse is one of the crises which are followed by anxiety and, as a result, self-criticism. In this condition, the people need psychological and social supports and interventions more than any other time. One of these interventions is compassion-focused therapy (CFT). CFT includes developing and extending the individual's affection, love, and understanding toward his/her pains and sufferings. Therefore, the effectiveness of compassion-focused interventions is a tool to promote mental health.[141516] CFT is effective on the degree of self-confidence, self-criticism decrease, positive and negative emotions, stress decrease, depression and anxiety. CFT is effective on the self-confidence, the decrease of self-criticism, showing positive and negative emotions, the decrease of stress, depression and the signs of anxiety. CFT is effective on self-confidence,[1718] decreasing self-criticism, showing positive and negative emotions[19] decreasing stress, depression, and the signs of anxiety.[202122] CFT is composed of three components including self-affection rather than self-judgment, sharing all the human beings in isolation (all the people get engaged in problems and pain and sufferings are a natural part of the human's condition), and awareness of the present time.[23] The basic principles in CFT refer to the fact that the external soothing thoughts, factors, images, and behaviors should be internalized, and in this case, as the human's mind reacts to the external factors, it will get relaxed in confrontation with these soothing internalized states.[24] The effect of CFT has been confirmed in decreasing negative variables such as anxiety,[25262728293031] stress,[27293132] shame,[32] and depression[25] and also increasing positive variables such as resilience,[26] life quality,[27] mental health,[3334] well-being,[33] giving meaning to life,[34] marital commitment,[35] feeling happy and fortunate,[36] and positive affections.[33] Based on the results of the above research, it was found that compassion-focused therapy treatment is effective in treating a large number of psychological disorders and improves the variables related to mental health. On the other hand, because the variable of self-criticism is a psychological variable and its rate is high among women who are involved in family conflicts, it is necessary to conduct a scientific study on the factors affecting it. In conclusion, taking the history of effectiveness of CFT, it can be predicted that this type of therapy can be effective in decreasing self-criticism on the people facing divorce. Hence, the purpose of the present study is to investigate the effectiveness of CFT on self-criticism of the women applying for divorce in the city of Tehran. The hypothesis of this study is “CFT is effective on self-criticism of the women applying for divorce in the city of Tehran.”

Materials and Methods

The research method was quasi-experimental with pretest, posttest, and control group design. The population of the present study included all the women applying for divorce who referred to an intervention-in-crisis center under the supervision of the organization of well-being in the city of Tehran in 2019. The research sample was selected using the convenient. The women who had the inclusion criteria were selected through convenient method from those who are to getting divorced and referred to an intervention-in-crisis center under the supervision of the organization of well-being in the city of Tehran, and they were randomly accommodated into experimental and control groups (17 women in the experimental and 17 in the control group). The inclusion criteria for the participants included: diagnosing the anxiety (the score higher than 26 according to cutoff point of the questionnaire), the age range of 25–45 years old, minimum educational level of high school diploma, at least 2 years of marital life, and full agreement to participate in therapeutic sessions. The exclusion criteria included: taking psychiatric drugs, absence for more than 3 sessions, not doing the tasks, unpredicted events (disease, demise, etc.), and showing unwillingness to participate. In order to implement the experimental process, first, the necessary coordination was made with the welfare organization and a certain place for holding the classes was determined. Furthermore, the necessary coordination for how to inform the participants and how to hold meetings was determined. It should be noted that in the absence of any of the members, another meeting would be held immediately so that the participants would not fall behind. Then, the experimental group participated in eight 90-min sessions of CFT and the control group did not receive any intervention. Finally, after administering CFT sessions, both the groups took the posttest. In the end, two participants from each group were excluded for reasons such as not attending meetings or being too absent, and the scores of 15 participants in each group were confirmed.

The questionnaire of self-criticism rumination (2016) was used in the present study. Smart et al. developed this questionnaire to investigate self-report to evaluate negative self-assessment rumination. The questionnaire of self-criticism rumination has 10 questions with five alternatives ranging from 5 = I am completely the same, 4 = I am almost the same, 3 = I am the same to some extent, 2 = I am a little the same, and 1 = I am not the same at all. This questionnaire has a total score. Smart et al. reported 0.74 the concurrent validity coefficient of the questionnaire and 0.89 its reliability coefficient in comparison to the questionnaires about self-criticism rumination.[13] Furthermore, the reliability of the data taken from the questionnaire was calculated through Cronbach's alpha coefficient, and the general reliability coefficients were calculated 0.82 and 0.88, respectively, at pretest and posttest stages.

The instruction of the sessions and techniques trained in eight therapy sessions was taken from the sessions' description by Mabodi.[35] The summary of CFT sessions is offered in Table 1.

Table 1

Summary of compassion-focused therapy sessions

Session	Session description
First	Making primary relationship with the clients and having a review on the structure of the sessions
	Awareness of automatic guidance using body checking task (awareness of part by part of the body)
	Awareness of automatic guidance 4. Giving home task
Second	Training using body checking when facing saddening feelings or mental wandering
	Training five skills of knowledge accrual in order to define indifference toward the situations
Third	Training awareness of the relationship between mood, thoughts, feelings and events
	Group discussion about the effects of self-kindness rather than self-judgment
	Giving home task
Fourth	Exercising respiration
	Discussing about the common base among all human beings in life problems and the fact that all human beings get engaged in problem and pain and sufferings are a natural part of the human condition
	Training immediacy in respiration (sitting meditation) and body (alertness task)
Fifth	Discussing about the effects of awareness of the present time and behaving according to fact
	Accepting life facts
Sixth	Discussing about the effects of interpretive errors and negative attitude toward the self and others
	Discussing about necessary skills to avoid unjust interpretations
	Discussing about present problems and accepting without judgment and identifying negative automatic thoughts are trained
	Training about cognitive distortions, outcomes, and the methods to cope with it
Seventh	Offering strategies to decrease anxiety and self-criticism in life and avoiding imperious and critical behaviors (daring women through group conversations)
	Home task
Eighth	Offering the opinions of the participants about self-attack besides attention, thought, and sympathetic behavior
	Training the manner of creating sympathetic images through offering necessary meditations

After collecting the information, the data were analyzed through descriptive statistics (mean and standard deviation) and inferential statistics (univariate ANCOVA) via SPSS22 software (SPSS 2007 for windows, Chicago, USA SPSS Company version 22). It is worth mentioning that before filling out the questionnaires, the ethical considerations were observed; for instance, the participants got informed about the subject and method of conducting the research and accepted the participation in the meetings with personal and conscious consent, the personal and private information of the volunteers was protected, the results were interpreted for them if desired, authority to cancel participation in meetings and hold free sessions for the participants.

For instance, the participants became aware of the purpose and the procedure of the study and agreed to participate in it, and their private information was preserved and interpreted after their affirmation.

Results

The present study was conducted on a sample of 30 women whose demographic information is as the following: the age of the participants in the experimental group (33.3% between 25 and 31, 46.7% between 32 and 38, and 20% more than 32 years old) and the age of the participants in the control group (26.74% between 25 and 31, 53.3% between 32 and 38, and 20% more than 32 years old), the educational level of the experimental group (40% high school diploma and 60% Ph.D.), and the educational level of the control group (40% high school diploma and 60% Ph.D.). Moreover, the marital duration in the experimental group was 46.7% between 2 and 7 years, 26.7% between 8 and 13 years, and 20% more than 13 years. The mean and standard deviation of the variable of self-criticism, respectively, in the pretest and posttest stages in the experimental group were 36.20 (7.47) and 30.07 (6.52) and they were 32.47 (6.96) and 33.35 (7.08) for the control group.

Using ANCOVA test entails observing some assumptions such as the manner of data distribution, equality of variance between the groups, and homogeneity of regression slopes. The Shapiro–Wilk index was used to investigate the form of data distribution. The Levin test was used to investigate the homogeneity of variances, and the interaction between the effect of pretest and independent variable (CFT-based training) was used to investigate the assumption of homogeneity of regression slopes. The Shapiro–Wilk index results whereof (W = 0.97, P = 0.16) imply the presence of the assumption of data normality. Amount of the test statistic in the Levin test and its significance (F = 0.09 and P = 0.92) confirm this assumption too. The amount and also the insignificance of the interaction between the effect of pretest and independent variable (F = 2.17 and P = 0.23) confirm the presence of the assumption of homogeneity of regression slopes. In general, investigating the required assumptions showed that there is no impediment in using univariate ANCOVA. The results of the test are offered in Table 2.

Table 2

Results of analysis of covariance to compare the scores of the two experimental and control groups

Change sources	df	ms	F	P	η2	Power
Pretest	1	1438.97	238.16	0.001	0.96	0.99
Group	1	151.27	88.11	0.001	0.76	0.97
Error	28	1.71

As it is observed in Table 2, there is a significant difference in the posttest scores of self-criticism (η2= 0.30, P = 0.004, F = 10.41) after deleting the effects of pretest scores between the experimental and control groups; in other words, it can be said that training CFT has significantly caused the decrease of self-criticism in the students at the posttest stage. The calculated effect size is 0.76 at the posttest stage; that is, 76% of posttest scores in the variable of self-criticism have been related to group membership (compassion therapy). Therefore, the assumption of the study implying the effectiveness of CFT on self-criticism of the women applying for divorce was confirmed.

Discussion

The results regarding the effectiveness of CFT on self-criticism of the women applying for divorce showed that there was a significant difference in the posttest scores of self-criticism of the women applying for divorce between the experimental and control groups. Therefore, it can be said that the assumption of the study is confirmed, and CFT has been effective on self-criticism of the women applying for divorce; the findings of the present study are consistent with the results of some of the studies. Lucre and Corten[17] and Sommers-Spijkerman et al.[1819] emphasize the role of CFT treatment in building confidence in reducing self-criticism. Women with higher self-esteem are more confident in their rational decisions in the face of life's crises and are less likely to be affected by environmental conditions. Some researchers also point to the importance of the effectiveness of CFT in reducing anxiety.[25262728] Anxiety is the natural reaction of humans to stress.[27293132] If the level of anxiety is out of the ordinary, it will disrupt the person's daily functioning. High anxiety can disrupt the decision-making process, which can ultimately lead to self-blame. In addition, some researchers emphasize the importance of C-treatment in increasing positive psychological aspects.[143334] An old saying goes, “The best way to defend yourself is to attack.” Therefore, reinforcing positive behaviors can lead to reduced negative aspects of behavior. In explaining the findings of the study, it can be said that through applying the technique of “awareness of the present time and the behavior consistent with the fact,” the researcher succeeded in training the women applying for divorce in the experimental group to identify their negative thoughts and feelings to be able to avoid bias about life events and wrong judgments and, as such, identify and annul self-criticism thoughts. Moreover, it can be said that training CFT to the women applying for divorce causes reinforcing mindfulness, and this process causes them to experience cognitive and emotional events without judgment. Therefore, immediacy can promote the primary diagnosis of the signs of a problem in the women, and the application of these skills was effective in self-criticism. Therefore, they succeeded in decreasing their anxiety and self-criticism thoughts coming from marital life crises and lowering the marital conflicts. In this regard, some researchers believe that this therapy gave necessary assistance to the clients through creating or increasing an internal compassionate relationship with themselves instead of reprimanding, convicting, or self-criticizing.[33] Among the results of this type of therapy are: caring for well-being, understanding and empathy, lack of judgment and lack of blaming the others, bearing pain and suffering through attention, thought, behavior, imagery, and feeling compassionately. Hence, the women in the experimental group got more compassionate feelings through receiving necessary skills in being compassionate in the process of held sessions.

Due to different events and accidents, the people face self-criticism and anxiety disorders and they require being aware of effective therapeutic methods to use them in case of any mental damage as an efficient tool. As one of the effective methods, CFT, refers to the related beliefs to thinking and the strategies, the people use to regulate and control thought processes. CFT approach believes that the people get engaged in emotional sadness because their cognition leads to a specific model of responding to internal experiences which causes the continuity of negative emotions and reinforcing negative feelings. In experiencing unpleasant events (e.g., the divorce crisis), CFT helps the people to experience fewer negative feelings (the component of human commonalities) considering the fact that the human might balk and all the people make a mistake and make an erroneous decision and, as such, find more ability in managing negative feelings. Conducting any type of research faces some limitations in administration. The sampling method is a case in point which can influence the results. Furthermore, not doing follow-up test to investigate permanence of therapy effects on the women applying for divorce is another limitation.

Conclusion

Based on the results of this study, it can be claimed that CFT is effective on self-criticism of the women applying for divorce. CFT has been designed for the people whose mental health problem is related to self-criticism and self-humiliation. Therefore, CFT helps identifying and describing the emotions in interpersonal relationship, and it leads to the acceptance of the events, nonjudgmental and present-time-focused awareness; besides, it decreases using inefficient strategies such as suppression and rumination. As a result, it can be stated that CFT causes a decrease of self-criticism, so it can be profitable for the consultants and family psychologists. From the strong suits of this study is its being functional for the consultants and family psychologists. So it can be applicable by both the consultants and the family consultants. Hence, using the results of the present study in therapy session leads to the decrease of anxiety, self-criticism, and happier life in the women applying for divorce. Besides, consultation centers are suggested to use CFT to decrease anxiety, decrease self-criticism, promote mental hygiene, and improve meaning in life.

Financial support and sponsorship

This study was financially supported by Student and KhomeiniShahr Azad University, Iran.

Conflicts of interest

There are no conflicts of interest.