The role of shame, self-criticism and self-compassion in persistent, treatment resistant depression

Background In 2017 the World Health Organisation (WHO), declared depression to be the leading cause of disability adjusted life years lost due to ill-health. Further, it is well established in the research literature that depression is a relapsing illness. In using Cognitive -Behavioural Therapy (CBT) with patients diagnosed with persistent, treatment resistant depression two clinical observations underpin this thesis. Firstly, that shame and self-criticism are key features of depression and secondly that standard Beckian CBT interventions have limited impact in tackling shame and self-criticism in this patient group. Integrating Compassion Focused Therapy (CFT) with CBT interventions results in some amelioration of shame and self-criticism, but this is limited empirically. Aim To examine shame, self-criticism and self-compassion in persistent, treatment resistant depression using the framework of Gilbert’s evolutionary psycho-biosocial formulation of emotional disorders. Methods Using a convergent parallel mixed methods design, the present study investigated the psychometric properties of three measures: the Other as Shamer Scale (OAS), Forms of Self-Criticism and Self-Reassurance Scale (FSCSR) and the Self-Compassion Scale (SCS) in a sample recruited from a large National Institute for Health Research (NIHR) funded Randomised Controlled Trial (RCT). Internal consistency and test-retest reliability were assessed, and construct validity examined with Confirmatory Factor Analysis (CFA). Univariate and multivariate statistical analysis was conducted to test the degree to which levels of shame, self-criticism and self-compassion varied according to level of depression as measured on three well validated measures of depression. In addition, using semi-structured interviews, a subset of participants (n=10) from the Treatment as Usual Arm (TAU) of the RCT cohort were interviewed to explore their lived experience of depression, shame, self-criticism and self-compassion. Interview data was analysed using Interpretative Phenomenological Analysis (IPA). Findings The OAS and FSCSR were found to be both reliable and valid measures when administered to this cohort. The descriptive goodness of fit indices and CFA supported the three-factor model (inferior, emptiness, mistakes) of external shame in the OAS and the three-factor (inadequate self, hated self, reassured self) model of internal shame in the FSCSR. The qualitative data provided evidence to support this conclusion. However, in the OAS the sub-scale emptiness did not perform as well as the inferior and mistakes sub-scales. This was also reflected in the qualitative data with no respondent speaking about emptiness as formulated within the OAS, but rather speaking about worthlessness as an aspect of external shame. Meanwhile, whilst the SCS demonstrated reliability it did not prove to be a valid measure in the cohort under study. The descriptive goodness of fit indices supported the six-factor model proposed by the SCS but the measure showed poor discriminant validity, due to issues of multicollinearity. In addition, the qualitative data analysis suggested the negative sub-scales of the SCS (self-judgement, isolation and overidentification) appeared to tap directly into the psychopathology of depression. An unexpected finding in the quantitative data analysis was that levels of shame and self-criticism did not appear to be a function of severity of depression but appear to be more stable psychological constructs. However, the qualitative data contradicted this. Both forms of data collected in this thesis highlight the importance of attribution in depression and shame. The qualitative analysis yielded interesting data regarding the relationship between different childhood environments and the different forms of external and internal shame. Conclusion The OAS (a measure of external shame) and the FSCSR (a measure of internal shame) are reliable and valid measures when tested on a cohort with persistent, treatment resistant depression. Further, both the quantitative and qualitative results provided evidence to support the formulation of shame tested in this thesis, and the presence of an interrelated, but differentiated relationship between external and internal shame in this population. A model is proposed which integrates attributional theories of depression and shame, and an evolutionary psychobiosocial perspective, which takes into consideration the cognitive science of depression, specifically, the presence of intrusive, autobiographical, shame based emotional memories in depression and the role of rumination, thought suppression and dissociation, as affect regulation strategies. These memories, linked to childhood trauma, are important in the maintenance of persistent, treatment resistant depression. This study extends clinical knowledge of the phenomenology of shame, self-criticism and self-compassion in the population studied

Police-Community Engagement and the Affordances and Constraints of Social Media

This article provides an analysis of the ‘affordances’ and ‘constraints’ of technology-mediated police-community engagement in the United Kingdom (UK). Whilst there has been optimism that social media may transform police communicative practice and help democratise policing, studies suggest that this potential has yet to be realised. Drawing on in-depth interviews with communications professionals, the article demonstrates that social media may afford constabularies visibility, editability, and association. However, organisational, individual and technological factors influence whether these affordances are achieved. This article adds to the literature by demonstrating how citizen engagement with mediated communication is not inevitable. It is instead a product of what the technology affords, the relationship between the technology and its users, and the context within which it is used

Reviews

Brian Clegg, Mining The Internet — Information Gathering and Research on the Net, Kogan Page: London, 1999. ISBN: 0–7494–3025–7. Paperback, 147 pages, £9.99

The role of shame, self-criticism and self-compassion in persistent, treatment resistant depression

Background In 2017 the World Health Organisation (WHO), declared depression to be the leading cause of disability adjusted life years lost due to ill-health. Further, it is well established in the research literature that depression is a relapsing illness. In using Cognitive -Behavioural Therapy (CBT) with patients diagnosed with persistent, treatment resistant depression two clinical observations underpin this thesis. Firstly, that shame and self-criticism are key features of depression and secondly that standard Beckian CBT interventions have limited impact in tackling shame and self-criticism in this patient group. Integrating Compassion Focused Therapy (CFT) with CBT interventions results in some amelioration of shame and self-criticism, but this is limited empirically. Aim To examine shame, self-criticism and self-compassion in persistent, treatment resistant depression using the framework of Gilbert’s evolutionary psycho-biosocial formulation of emotional disorders. Methods Using a convergent parallel mixed methods design, the present study investigated the psychometric properties of three measures: the Other as Shamer Scale (OAS), Forms of Self-Criticism and Self-Reassurance Scale (FSCSR) and the Self-Compassion Scale (SCS) in a sample recruited from a large National Institute for Health Research (NIHR) funded Randomised Controlled Trial (RCT). Internal consistency and test-retest reliability were assessed, and construct validity examined with Confirmatory Factor Analysis (CFA). Univariate and multivariate statistical analysis was conducted to test the degree to which levels of shame, self-criticism and self-compassion varied according to level of depression as measured on three well validated measures of depression. In addition, using semi-structured interviews, a subset of participants (n=10) from the Treatment as Usual Arm (TAU) of the RCT cohort were interviewed to explore their lived experience of depression, shame, self-criticism and self-compassion. Interview data was analysed using Interpretative Phenomenological Analysis (IPA). Findings The OAS and FSCSR were found to be both reliable and valid measures when administered to this cohort. The descriptive goodness of fit indices and CFA supported the three-factor model (inferior, emptiness, mistakes) of external shame in the OAS and the three-factor (inadequate self, hated self, reassured self) model of internal shame in the FSCSR. The qualitative data provided evidence to support this conclusion. However, in the OAS the sub-scale emptiness did not perform as well as the inferior and mistakes sub-scales. This was also reflected in the qualitative data with no respondent speaking about emptiness as formulated within the OAS, but rather speaking about worthlessness as an aspect of external shame. Meanwhile, whilst the SCS demonstrated reliability it did not prove to be a valid measure in the cohort under study. The descriptive goodness of fit indices supported the six-factor model proposed by the SCS but the measure showed poor discriminant validity, due to issues of multicollinearity. In addition, the qualitative data analysis suggested the negative sub-scales of the SCS (self-judgement, isolation and overidentification) appeared to tap directly into the psychopathology of depression. An unexpected finding in the quantitative data analysis was that levels of shame and self-criticism did not appear to be a function of severity of depression but appear to be more stable psychological constructs. However, the qualitative data contradicted this. Both forms of data collected in this thesis highlight the importance of attribution in depression and shame. The qualitative analysis yielded interesting data regarding the relationship between different childhood environments and the different forms of external and internal shame. Conclusion The OAS (a measure of external shame) and the FSCSR (a measure of internal shame) are reliable and valid measures when tested on a cohort with persistent, treatment resistant depression. Further, both the quantitative and qualitative results provided evidence to support the formulation of shame tested in this thesis, and the presence of an interrelated, but differentiated relationship between external and internal shame in this population. A model is proposed which integrates attributional theories of depression and shame, and an evolutionary psychobiosocial perspective, which takes into consideration the cognitive science of depression, specifically, the presence of intrusive, autobiographical, shame based emotional memories in depression and the role of rumination, thought suppression and dissociation, as affect regulation strategies. These memories, linked to childhood trauma, are important in the maintenance of persistent, treatment resistant depression. This study extends clinical knowledge of the phenomenology of shame, self-criticism and self-compassion in the population studied

The bi-factor structure of the 17-item Hamilton Depression Rating Scale in persistent major depression; dimensional measurement of outcome

Background:The 17-item Hamilton Depression Rating Scale (HDRS17) is used world-wide as an observer-rated measure of depression in randomised controlled trials (RCTs) despite continued uncertainty regarding its factor structure. This study investigated the dimensionality of HDRS17 for patients undergoing treatment in UK mental health settings with moderate to severe persistent major depressive disorder (PMDD).Methods:Exploratory Structural Equational Modelling (ESEM) was performed to examine the HDRS17 factor structure for adult PMDD patients with HDRS17 score ≥16. Participants (n = 187) were drawn from a multicentre RCT conducted in UK community mental health settings evaluating the outcomes of a depression service comprising CBT and psychopharmacology within a collaborative care model, against treatment as usual (TAU). The construct stability across a 12-month follow-up was examined through a measurement equivalence/invariance (ME/I) procedure via ESEM.Results:ESEM showed HDRS17 had a bi-factor structure for PMDD patients (baseline mean (sd) HDRS17 22.6 (5.2); 87% PMDD >1 year) with an overall depression factor and two group factors: vegetative-worry and retardation-agitation, further complicated by negative item loading. This bi-factor structure was stable over 12 months follow up. Analysis of the HDRS6 showed it had a unidimensional structure, with positive item loading also stable over 12 months.Conclusions:In this cohort of moderate-severe PMDD the HDRS17 had a bi-factor structure stable across 12 months with negative item loading on domain specific factors, indicating that it may be more appropriate to multidimensional assessment of settled clinical states, with shorter unidimensional subscales such as the HDRS6 used as measures of change

A Practical Guide of the Southwest Oncology Group to Measure Malignant Pleural Mesothelioma Tumors by RECIST and Modified RECIST Criteria

Abstract:Malignant pleural mesothelioma (MPM) is difficult to measure radiographically due to the nonradial and variable pattern of growth and response to therapy. Inaccurate and inconsistent tumor measurements often compromise results from clinical trials that are dependent on identifying response rate and progression-free survival. In this article, we sought to provide a practical guide through the Southwest Oncology Group on how to measure MPM by the updated RECIST version 1.1 and by modified RECIST. We hope that these steps will provide a simple means by which computed tomography measurements can be consistently performed, minimizing intra- and interobserver variability. With this consistency, we may be able to better estimate the prognosis and response to therapy. With greater utilization, we will be able to better understand the biology of MPM

Schubert Polynomials for the affine Grassmannian of the symplectic group

We study the Schubert calculus of the affine Grassmannian Gr of the symplectic group. The integral homology and cohomology rings of Gr are identified with dual Hopf algebras of symmetric functions, defined in terms of Schur's P and Q-functions. An explicit combinatorial description is obtained for the Schubert basis of the cohomology of Gr, and this is extended to a definition of the affine type C Stanley symmetric functions. A homology Pieri rule is also given for the product of a special Schubert class with an arbitrary one.Comment: 45 page

HI Rich but Low Star Formation galaxies in MaNGA: Physical Properties and Comparison to Control Samples

Gas rich galaxies are typically star-forming. We make use of HI-MaNGA, a program of HI follow-up for the Mapping Nearby Galaxies at Apache Point Observatory (MaNGA) survey of the Sloan Digital Sky Surveys to construct a sample of unusual neutral hydrogen (HI, 21cm) rich galaxies which have low Star Formation Rates (SFRs); using infra-red color from the Wide-field Infrared Survey Explorer (WISE) as a proxy for specific SFR. Out of a set of 1575 MaNGA galaxies with HI-MaNGA detections, we find 83 (5%) meet our selection criteria to be HI rich with low SFR. We construct two stellar mass-matched control samples: HI rich galaxies with typical SFR (High SF Control) and HI poor galaxies with low SFR (Low HI Control). We investigate the properties of each of these samples, comparing physical parameters such as ionization state maps, stellar and ionized gas velocity and dispersion, environment measures, metallicity, and morphology to search for the reasons why these unusual HI rich galaxies are not forming stars. We find evidence for recent external accretion of gas in some galaxies (via high counter-rotating fractions), along with some evidence for AGN feedback (from a high cLIER and/or red geyser fraction), and bar quenching (via an enhanced strong bar fraction). Some galaxies in the sample are consistent with simply having their HI in a high angular momentum, large radius, low density disc. We conclude that no single physical process can explain all HI rich, low SFR galaxies.Comment: 15 pages, in press MNRAS. v2 following corrections noticed in proof