The relationship between changes in mindfulness and self-compassion, and changes on the IES and BDI-II:

In light of the close relationship between mindfulness and self-compassion (Birnie, Speca, & Carlson, 2010; Neff, 2003a; Smeets et al., 2014), a significant positive correlation between increases in mindfulness and increases in self-compassion is

expected. Additionally, as the benefits of mindfulness and self-compassion on intrusive memory experience are hypothesised to come from specific aspects of mindfulness and self-compassion, there is predicted to be a significant positive correlation between changes on the MAAS and SCS, and changes on the IES, in the mindfulness/self-compassion group only. No such correlation is expected in the relaxation group. There is also predicted to be a significant negative correlation between changes on the MAAS/SCS and BDI-II in the mindfulness/self-compassion group. Again, no such correlation is expected in the relaxation group, because these concepts are not addressed in relaxation training.

Methods: Participants:

The study was granted ethical approval from the University Teaching and Research Ethics Committee (UTREC). Participants were all students from the University of St Andrews, recruited via noticeboards in the department and through the University weekly memo system. Participants volunteered on the basis of having recently experienced intrusive memories with concurrent low mood. In total, 21 participants responded to an advert to participate in a study about mindfulness, self-compassion and intrusive memories and 20 participants responded to an advert to participate in a study about relaxation and intrusive memories. Therefore, it is important to note that participants self-selected for the type of intervention they participated in, a limitation that will be addressed in the discussion. Three participants withdrew from the

mindfulness and self-compassion condition and two withdrew from the relaxation condition. Data were only analysed for those participants who completed the study. As a result, the final sample consisted of 19 participants for the mindfulness and self-

compassion condition (15 female, 4 male) and 18 participants for the relaxation condition (16 female, 2 male). Distribution of the questionnaire data was checked by ensuring all questionnaire data fell within 3 SDs of the mean. No data were

consequently excluded.Power analysis revealed that a total sample size of 36 would be required to detect a medium effect size at a 95% confidence interval using the .05 criterion of statistical significance. Therefore the sample size was sufficient.

Participants received either £10 or a book for their participation.

Training:

Mindfulness and self-compassion sessions:

The mindfulness and self-compassion training took part in groups of 3-5 participants per group, and consisted of 3 weekly sessions. The first session began with a short overview of the benefits of mindfulness on mental well-being before introducing participants to the concept of mindfulness by talking about mindlessness and

highlighting occasions where we rush through activities or get carried away worrying about the future etc. Participants were next taken through the raisin exercise. This exercise encourages participants to really pay attention to the process of eating a raisin, in order to emphasize how mindlessly we sometimes eat. After this and each subsequent exercise in the training procedure, participants were encouraged to take part in a group discussion about their experiences. During this first session,

participants were also guided through a sitting meditation, where participants are encouraged to focus on their breath and bring their attention back to the breath should their mind wander. Over the coming week, participants were encouraged to bring mindfulness to an everyday activity (e.g. walking to class or washing the dishes) and were emailed an mp3 copy of the sitting meditation to practice at home once a day (or as often as they were comfortable doing so). The second session began with another

sitting meditation, and then introduced the 3-minute breathing space. This is a shorter mediation exercise, which participants are encouraged to turn to when they feel they are not being mindful, and helps to bring them back to a mindful focus. Participants were then given some red dot stickers to place in locations of their choice (e.g. on a bedroom mirror or a laptop) to serve as a reminder to be mindful throughout their daily lives. During the third week, participants took part in the self-compassion based exercises. The format of the session was adapted from Compassionate Mind Training (CMT) designed by Gilbert and Procter (2006) and outlined in Gilbert (2009), as well as the MSC program designed by Neff and Germer (2013). The first exercise involved generating a personalized compassionate image that participants could work with during the session, with qualities including wisdom, strength, warmth and non- judgmental acceptance. Participants were encouraged to think about images and feelings that arise when thinking of compassion they have for somebody else (e.g. a family member or a friend) to help them generate their compassionate images. The next task involved writing a letter from their compassionate self about the way they feel when they experience an intrusive memory. The final exercise involved creating five compassionate statements to the self to be practiced over the next week (e.g. ‘I would be sympathetic towards a friend in my situation. I’d like to feel this way about myself’). Over the next week participants were instructed to spend approximately one minute visualizing their kind, accepting image and to read the statements with warmth while holding their compassionate image in mind. As another homework element, participants were encouraged to try and generate their compassionate image when faced with their intrusive memories.

Relaxation sessions:

The relaxation sessions were also run in groups of 3-5 participants, and consisted of three weekly sessions. The first session began with a similar short overview about the benefits of relaxation on mental well-being. Participants were then guided through a deep breathing exercise and, as in the mindfulness/self-compassion condition, participants were encouraged to discuss their experiences in the group after each exercise they took part in. Also during the first session, participants were guided through a progressive muscle relaxation, an mp3 copy of which was emailed to them to practice at home once a day, or as often as they felt comfortable with. The second session began with another progressive muscle relaxation and then introduced a guided imagery exercise, followed by further group discussions. Participants were encouraged to practice the guided imagery over the next week, once or a day or as much as they felt comfortable with. In the third session participants again completed the progressive muscle relaxation introduced in session one and then took part in a second more extensive deep breathing exercise. Participants were encouraged to continue to practice relaxation exercises over the next week and also to try and practice the exercises when they experienced an intrusive memory.

Procedure:

Participants first came into the research lab for an individual interview session where they provided informed consent and were taken through the Intrusive Memory Interview to determine the presence of intrusive memories experienced over the past week (time 1). Participants then completed the battery of self-report questionnaires detailed above (IES, BDI-II, MAAS and SCS) in a randomized order. The three-week training in either mindfulness and self-compassion or relaxation followed. One week

after the final session, participants returned to the research lab for a final time (time 2) to recomplete the self-report questionnaires, to be debriefed and to be compensated for their time.

Results:

1) Baseline data:

In conjunction with previous research (Brewin et al., 1996, Newby & Moulds, 2012), the intrusive memories that participants reported included relationship/family

problems (e.g. when my girlfriend broke up with me, an argument with my friend at a University ball), work/school issues or personal failure (e.g. disagreement with a supervisor at work, an embarrassing job interview) and illness/death of another (e.g. being with Mum as she died in the hospital, receiving the news that a school teacher had died in a car accident) .The mean rating of intrusive memory distress in

mindfulness/self-compassion group was 66.32 (SD = 19.85) out of 100, and the mean rating of distress in relaxation group was 65.23 (SD = 20.25) out of 100. An

independent samples t-test revealed that this difference was not significant, t (35) = .16, p > .05. Distress ratings were similar between the two groups.

i) Group differences pre-training:

All questionnaire data fell within 3 SDs of the mean; therefore no data was excluded from analysis. There were no between-group differences on any of the measures at time 1. These results are displayed in Table 3.1 below. Levene’s test for Equality of Variances was non-significant for all measures apart from the SCS, F (1, 35) = 4.81, p < .05. Therefore a t-test not assuming homogeneity of variances was computed for the

SCS measure. There was however still no significant difference in SCS scores between the two groups at baseline.

Table 3.1

Descriptive statistics (means and standard deviations) at time 1 and t-tests comparing group characteristics at time 1. Measure Relaxation: Mean (SD) N = 18 Mindfulness/Self-Compassion: Mean (SD) N = 19 t-value sig. IES 42.61 (14.59) 43.42 (12.07) -0.18 n.s. IES - intrusive 19.11 (7.68) 22.58 (7.07) -1.43 n.s IES – avoidance 23.50 (8.66) 20.84 (6.37) 1.07 n.s BDI-II 20.44 (14.85) 19.37 (11.13) 0.25 n.s. SCS 2.71 (.93) 2.52 (0.68) 0.72 n.s MAAS 3.58 (.73) 3.18 (0.97) 1.42 n.s.

ii) Correlations between the measures at time 1:

Table 3.2 overleaf is a correlation matrix displaying the relationships between the measures at baseline, collapsed across training group. As predicted, both the measures of mindfulness and self-compassion were negatively correlated with BDI-II scores. Also as predicted, individuals reporting higher levels of mindfulness also reported higher self-compassion. In terms of intrusive memory experience, there was no significant correlation between overall IES score and mindfulness. However, looking at the subscales of the IES, higher levels of mindfulness were associated with less memory ‘intrusiveness’, although mindfulness was not related to memory

‘avoidance’. Higher self-compassion, conversely, was related to lower overall IES scores, and again higher self-compassion was related to lower levels of ‘intrusiveness’ but was not significantly related to avoidance.

Table 3.2

A correlation matrix displaying correlations between the self-report measures at baseline.

Measure 1. IES 2. IES-I 3. IES-A 4. BDI-II 5. MAAS 6. SCS