Background: Breast cancer (BC), the most common cancer affecting women, has consequences on physical and psychological health. Recent studies highlighted selfcompassions’-, and fear of receiving compassion's protective respectively detrimental effects on psychological health. This study explored the moderating role of fear of receiving compassion from others on the associations between self-compassion and psychological distress. Methods: Participants were 78 Portuguese women with non-metastatic BC. Participants completed self-report measures of self-compassion, fear of receiving compassion from others, and psychological distress. Moderation analyzes through PROCESS Macro in SPSS was conducted. Results: Fear of receiving compassion from others moderated the association between self-compassion and depressive symptoms. At moderate and high levels of the moderator, the association was significant, at low levels the association was nonsignificant. The associations of self-compassion with anxiety, and with stress were not moderated by fear of receiving compassion from others. Conclusions: To our knowledge this study is solitary in examining fear of receiving compassion from others as moderator of the associations between self-compassion and psychological distress. This study contributes to increased understanding of psychological distress among women with BC. The findings should direct future research towards longitudinal, intervention-based studies, targeting fear of receiving compassion, and self-compassion, through compassion-focused therapies. / Bakgrund: Bröstcancer (BC), den vanligaste cancerformen hos kvinnor, har konsekvenser för fysisk och psykologisk hälsa. Tidigare studier har belyst självmedkänsla och rädsla för att ta emot medkänslas skyddande, respektive skadliga effekter på psykologisk hälsa. Den här studien undersökte den modererande rollen av rädsla för att ta emot medkänsla från andra på sambandet mellan självmedkänsla och psykologiska besvär. Metod: Deltagarna var 78 portugisiska kvinnor med icke-metastaserad BC. Deltagarna genomförde självskattningar avseende självmedkänsla, rädsla för att ta emot medkänsla från andra och psykologiska besvär. Moderationsanalyser genomfördes i PROCESS Macro i SPSS. Resultat: Rädsla för att ta emot medkänsla från andra modererade sambandet mellan självmedkänsla och depressiva symtom. Vid moderata och höga nivåer av moderatorn var associationen signifikant, vid låga nivåer var associationen inte signifikant. Associationerna mellan självmedkänsla och ångest eller stress modererades inte av rädsla för att ta emot medkänsla från andra. Slutsatser: Såvitt vi vet är denna studie ensam att undersöka rädsla för att ta emot medkänsla från andra som moderator på sambandet mellan självmedkänsla och psykologiska besvär. Denna studie bidrar till ökad förståelse för psykologiska besvär hos kvinnor med BC. Resultaten bör rikta framtida forskning mot longitudinella, interventionsbaserade studier, inriktade på rädsla för att ta emot medkänsla och självmedkänsla genom compassionfokuserade terapier.

Rapid escalation of Subclinical Eating Disorders (SED) in the form of high levels of body–dissatisfaction (BD) and drive for thinness (DT) globally and locally, and the at–risk status of university females are underscored by recent studies. As yet there exists no South African program tailored to the needs of afflicted female students and which includes a risk–protective focus grounded in Positive Psychology theory. In this chapter a theoretical overview on the nature and definition of SED, its prevalence and the rationale for a risk–protective focus grounded in Positive Psychology theory are provided. Thereafter three preliminary South African studies, namely two correlation studies (De Pãz Fransisco, 2007; Kirsten, Du Plessis & Swanepoel, 2010) and the Weight Over–concern and Well–being program of Kirsten, Du Plessis and Du Toit (2007) are discussed. Findings of these preliminary studies highlight the promise of utilizing Positive Psychology theoretical approaches to practically significantly reduce risk factors and promote protective factors. As such, Well–being therapy (Fava & Ruini, 2003) that promotes the six dimensions of psychological well–being (Ryff & Keyes, 1995), and Self–Determination Theory (Ryan & Deci, 2000) that can promote true self–esteem in the form of self–determination and mindfulness (Kabat–Zinn, 1998), with its inherent self–compassion, kindness and self–forgiving manner, show promise. More in–depth studies with larger samples are however needed. / Thesis (M.A. (Clinical Psychology))--North-West University, Potchefstroom Campus, 2012.

Rapid escalation of Subclinical Eating Disorders (SED) in the form of high levels of body–dissatisfaction (BD) and drive for thinness (DT) globally and locally, and the at–risk status of university females are underscored by recent studies. As yet there exists no South African program tailored to the needs of afflicted female students and which includes a risk–protective focus grounded in Positive Psychology theory. In this chapter a theoretical overview on the nature and definition of SED, its prevalence and the rationale for a risk–protective focus grounded in Positive Psychology theory are provided. Thereafter three preliminary South African studies, namely two correlation studies (De Pãz Fransisco, 2007; Kirsten, Du Plessis & Swanepoel, 2010) and the Weight Over–concern and Well–being program of Kirsten, Du Plessis and Du Toit (2007) are discussed. Findings of these preliminary studies highlight the promise of utilizing Positive Psychology theoretical approaches to practically significantly reduce risk factors and promote protective factors. As such, Well–being therapy (Fava & Ruini, 2003) that promotes the six dimensions of psychological well–being (Ryff & Keyes, 1995), and Self–Determination Theory (Ryan & Deci, 2000) that can promote true self–esteem in the form of self–determination and mindfulness (Kabat–Zinn, 1998), with its inherent self–compassion, kindness and self–forgiving manner, show promise. More in–depth studies with larger samples are however needed. / Thesis (M.A. (Clinical Psychology))--North-West University, Potchefstroom Campus, 2012.

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Antalet sjukskrivningar till följd av stressrelaterade sjukdomar har ökat kraftigt för vårdpersonal. Därtill saknas det evidens för internetbaserade interventioner mot stressrelaterad ohälsa för vårdpersonal. Syftet var att undersöka och utvärdera en internetbaserad kognitiv beteendeterapi-intervention (iKBT) avseende graden av samvetsstress, arbetsrelaterad stress samt självmedkänsla hos vårdpersonal. Enkäter bestående av Stress of Conscience Questionnaire (SCQ), Copenhagen Psychosocial Questionnaire version II (COPSOQ II) och Self-Compassion Scale (SCS) besvarades av deltagarna (N = 8), samtliga var kvinnor mellan 27 – 53 år. Resultaten analyserades med PEM och RCI på individnivå och T-test på gruppnivå. RCI-analysen visade begränsade resultat för SCQ, blandade resultat för COPSOQ II och övervägande positiva resultat för SCS. Analysen på gruppnivå visade en signifikant minskning i Sömnbesvär (p = .032) och Self-Judgment (p = .021) samt signifikant ökning i Self-Kindness (p = .016). Studien behöver replikeras i framtida studier med ett större antal deltagare och en studiedesign som är metodologiskt robust. / The amount of sick leave due to stress-related illnesses has increased significantly for healthcare staff. In addition, there is a lack of evidence for internet-based interventions for stress-related illness for healthcare staff. The aim was to examine and evaluate an internet-based Cognitive Behavioral Therapy (iCBT) intervention regarding the degree of stress of conscience, work-related stress and self-compassion among healthcare staff. Questionnaires consisting of Stress of Conscience Questionnaire (SCQ), Copenhagen Psychosocial Questionnaire version II (COPSOQ II) and Self-Compassion Scale (SCS) were answered by the participants (N = 8), all were women between 27 - 53 years. The results were analyzed with PEM and RCI at the individual level and T-tests at group level. The RCI analysis showed limited results for SCQ, mixed results for COPSOQ II and predominantly positive results for SCS. The analysis at group level showed a significant decrease in Sleep Disorders (p = .032) and Self-Judgment (p = .021) as well as a significant increase in Self-Kindness (p = .016). The study needs to be replicated in future studies with a larger number of participants and a study design that is more methodologically robust.

Pain during sexual intercourse, now classified under the single term of genito-pelvic pain/penetration disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), would affect up to 34% of young women and 45% of older women. Provoked vestibulodynia, a chronic pain elicited via pressure to the vulvar vestibule or attempted vaginal penetration, is the most common form of pain during intercourse. Controlled studies have shown that provoked vestibulodynia has multiple deleterious physical, psychological, sexual and relational impacts and thus greatly affects women’s quality of life, as well as their partners’. Provoked vestibulodynia occurs in the very intimate context of sexual intercourse. In that context, women’s self-concept could be negatively affected. Moreover, research among couples with provoked vestibulodynia has demonstrated the role of interpersonal factors in the modulation of women’s pain and associated consequences for both partners. Considering the documented efficacy of cognitive-behavioural therapy for chronic pain, including provoked vestibulodynia, and the importance of the relational context for this condition, a new cognitive-behavioural couple therapy has been developed by our team. It is the first treatment to take into account the interpersonal context of provoked vestibulodynia. Furthermore, we lack empirical evidence on mediators of change of cognitive-behavioural therapy for provoked vestibulodynia and on positive psychological factors that could foster better adjustment for women and their partners. The objective of this thesis was to use a dyadic perspective to examine the role of self-compassion in the adjustment of couples coping with provoked vestibulodynia, as well as the roles of both partners’ pain self-efficacy and pain catastrophizing as mediators of change in cognitive-behavioural couple therapy. The first study examined the associations between self-compassion of women with provoked vestibulodynia and their partners and their depression, anxiety, sexual distress and relational satisfaction as well as women’s pain intensity during intercourse. Forty-eight couples with provoked vestibulodynia completed self-report questionnaires. For both women and their partners, higher levels of self-compassion were associated with their own lower anxiety and depression. When partners reported higher levels of self-compassion, they were more satisfied with their relationship, and both partners and women reported lower sexual distress. No significant association was found for pain during intercourse. The second article examined pain self-efficacy and catastrophizing as mediators of therapeutic change regarding pain, sexual distress and sexual function in cognitive-behavioural couple therapy for provoked vestibulodynia. Because cognitive-behavioural couple therapy did not improve significantly more pain self-efficacy relative to lidocaine treatment, this variable was not included in subsequent mediation models. In women with provoked vestibulodynia, greater decreases in pain catastrophizing in cognitive-behavioural couple therapy, as compared to the lidocaine control condition, mediated reductions in pain intensity and sexual distress as well as improvement of sexual function. In partners, greater decreases in pain catastrophizing in cognitive-behavioural couple therapy, as compared to the lidocaine control condition, mediated reductions in sexual distress and improvement of sexual function. Partners’ pain catastrophizing reductions also mediated women’s decrease in sexual distress. Implications of results, as well as theoretical, methodological and clinical contributions of the thesis are discussed. / Les problèmes de douleur durant les relations sexuelles, maintenant désignés par le terme « douleur génito-pelvienne » dans le Manuel diagnostique et statistique des troubles mentaux (DSM-5), toucheraient jusqu’à 34% des jeunes femmes et 45% des femmes plus âgées. La cause la plus fréquente de douleur génito-pelvienne serait la vestibulodynie provoquée (VP). Les études contrôlées indiquent que la VP a des conséquences négatives multiples, physiques, psychologiques, sexuelles et relationnelles, et hypothèque donc grandement la qualité de vie des femmes qui en souffrent, ainsi que celle de leurs partenaires. Une particularité de ce problème de douleur chronique est le contexte dans lequel il survient, soit celui des relations intimes. Dans ce contexte, l'image que les femmes souffrant de VP ont d'elles-mêmes en tant que partenaires sexuelles serait affectée. De plus, la recherche a démontré l’influence des facteurs interpersonnels sur l’intensité de la douleur et les conséquences psychologiques et sexuelles associées. Considérant l’efficacité documentée des thérapies cognitivo-comportementales (TCC) pour la douleur chronique, incluant la VP et l’importance du contexte relationnel de cette problématique, une nouvelle TCC de gestion de la douleur a été développée pour les couples. Ce traitement vient combler une lacune importante du domaine puisqu’aucun autre traitement à ce jour ne tient compte de l’influence des facteurs interpersonnels. Par ailleurs, le manque de connaissance des mécanismes de changement sous-tendant l’efficacité des traitements psychologiques pour la VP ainsi que le peu d’études sur les facteurs psychologiques qui joueraient un rôle protecteur chez les femmes souffrant de VP sont d’autres limites du domaine. Afin de pallier ces lacunes, l’objectif de la thèse était d’examiner dans une perspective dyadique le rôle de l’auto-compassion dans l’ajustement de couples faisant face à la VP, de même que le rôle du catastrophisme et l’auto-efficacité comme médiateurs de changement dans le cadre d’un essai clinique randomisé évaluant l’efficacité de la thérapie cognitive-comportementale de couple (TCCC). Le premier article de la thèse visait à examiner les liens entre l’auto-compassion et l’ajustement psychologique et sexuel des femmes souffrant de VP et de leurs partenaires. Quarante-huit couples ont complété des questionnaires auto-rapportés. Les analyses ont montré que plus d’auto-compassion chez les femmes souffrant de VP était associée à moins de symptômes dépressifs et anxieux chez celles-ci. Plus d’auto-compassion chez les partenaires était aussi associée à moins de symptômes dépressifs et anxieux de même que plus de satisfaction relationnelle chez ceux-ci. De plus, des niveaux plus élevés d’auto-compassion chez les partenaires étaient aussi associés à moins de détresse sexuelle pour eux et pour l’autre membre du couple, soit la femme souffrant de VP. Aucune association avec l’intensité de la douleur n’était significative. Dans le deuxième article de la thèse, l’auto-efficacité et le catastrophisme ont été examinés en tant que médiateurs de changement thérapeutique au cours de la TCCC, comparée à un traitement médical, la lidocaïne topique. Puisque la TCCC n’améliorait pas l’auto-efficacité significativement plus que le traitement de lidocaïne, cette variable n’a pas été incluse dans les modèles de médiation. La TCCC, en comparaison avec le groupe contrôle de lidocaïne, diminuait significativement la douleur, la détresse sexuelle et la fonction sexuelle des femmes via la plus grande diminution de leurs propres niveaux de catastrophisme, en comparaison au groupe contrôle de lidocaïne. La plus grande diminution du catastrophisme chez les partenaires, en comparaison au groupe contrôle, expliquait également les améliorations quant à leur propre détresse et fonction sexuelle. Enfin, la plus grande diminution du catastrophisme chez les partenaires expliquait la diminution de la détresse sexuelle des femmes dans le groupe TCCC, en comparaison au groupe contrôle. Les implications de ces résultats et les contributions théoriques, cliniques et méthodologiques de la thèse sont discutées.