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TEMPORARY REMOVAL: The relationship between mindfulness, self-compassion and body appreciation
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The relationship between mindfulness, self-compassion and body appreciation Clotilde Lienhart PII: DOI: Reference:
S1550-8307(19)30469-0 https://doi.org/10.1016/j.explore.2019.09.003 JSCH 2423
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EXPLORE
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15 November 2018 18 September 2019 28 September 2019
Please cite this article as: Clotilde Lienhart , The relationship between mindfulness, self-compassion and body appreciation, EXPLORE (2019), doi: https://doi.org/10.1016/j.explore.2019.09.003
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Highlights
Fostering positive self-compassion in clients is essential to developing a positive body image. Mindfulness is associated with body appreciation. The current study contributes to the theoretical and research base on positive body image.
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The relationship between mindfulness, self-compassion and body appreciation
Clotilde Lienhart Associate Professor Marie Caltabiano
James Cook University, Cairns, Australia
Corresponding Author: Associate Professor Marie Caltabiano, PhD FAPS, FCHP Psychology, College of Healthcare Sciences, James Cook University, Cairns, Qld 4870 Australia. Phone: +61 7 42321183 E-mail: [email protected]
Abstract Background and objective: The present study examined the association between mindfulness, self-compassion and body appreciation. It was expected that
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mindfulness would be related to higher self-compassion and more body appreciation. Three models were tested: one investigating self-compassion as a mediator between mindfulness and body appreciation, another examining mindfulness as the mediator between self-compassion and body appreciation, and a proposed alternative model exploring both positive and negative self-compassion subscales as parallel mediators of the relationship between mindfulness and body appreciation. Methods: In an online survey, 482 participants (368 females, 112 males) answered questions relating to mindfulness, self-compassion and body appreciation. Mindfulness was measured with the Comprehensive inventory of mindfulness experiences (CHIME). The Body appreciation scale (BAS-2) was used to assess body appreciation. Self-compassion was measured by the Self-compassion scale – Short form (SCS-SF). Results: Hierarchical regression analysis, and SPSS PROCESS was used to conduct path analysis between the variables mindfulness, self-compassion and body appreciation. Mindfulness was positively related to self-compassion and body appreciation, whereas self-compassion as a whole was found to negatively relate to body appreciation in both simple mediation models. The proposed alternate parallel model partially mediated the relationship between mindfulness and body appreciation, where positive self-compassion subscales related strongly with body appreciation and mindfulness. Conclusions: The present study has established the strength of the predictive relationship between positive dimensions of self-compassion (self-kindness, common humanity) and body appreciation. The implications for clinical health practice are that fostering positive self-compassion in clients is essential to developing a positive body image.
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Keywords: positive body image, mindfulness, self-compassion, body appreciation
INTRODUCTION Body image has been widely defined as a multidimensional construct, relating to the perceptions and attitudes concerning one’s own physical appearance and function.1 Existing body image literature remains primarily rooted in pathology,1 with its focus on body dissatisfaction and the role of thin-ideal internalization and appearance comparison processes. It has been argued by Tylka and Wood-Barcalow2 that neglecting the factors which promote a positive body image has led to an incomplete understanding of body image. The present study aims to understand the protective mechanisms that promote accepting awareness and self-compassion towards the body. Negative body image has been extensively researched but research into Positive Body Image (PBI) is more recent.2 The study of PBI has focussed predominantly on body appreciation, which is also the focus of this research. The majority of the research uses the Body Appreciation Scale (BAS).3 The core characteristics of PBI are (1) inner positivity, (2) body appreciation, (3) body acceptance and love, (4) a broad conceptualisation of beauty and (5) an ability to filter information in a body protective manner.4 The presence of these core qualities forms a schema that permits individuals to appreciate their bodies regardless of idealistic media portrayals.5 4
Striegel-Moore and Cachelin6 theorised that PBI was not simply the opposite of negative body image. This theory was supported by research7 whose findings suggest that positive and negative body image can be experienced simultaneously, where low levels of dissatisfaction were expressed as neutral experiences. Further supporting the argument that positive and negative body image exist on a distinct continuum, Bailey et al.7 argue that all body image(s) overlap. This is potentially due to positive, negative and neutral body image being experienced within the one individual. PBI is a derivative of the school of positive psychology which is interested in the promotion of health rather than pathology. 8 Underlying this ethos is the framework of ‘flourishing’. According to Lopez8 flourishing is conceptualised as a range of behaviours that promote optimal functioning. Critical elements are the need to engage in the care of one’s mind, body and soul.4 When facing adverse events, individuals who flourish tend to develop resilience rather than simply coping. They have a grounded, felt acceptance of others and self.8 Features of flourishing often align with the ancient practice of mindfulness and self-compassion.9 Garland, Gaylord and Jongbae10 argue that approaches such as these aid in the reappraisal of painful experiences, allowing adaptive coping mechanisms to form. These findings offer an alternative framework to the existing pathology-driven model of understanding body image. A well-established procedure for reducing stress and fostering healthy coping mechanisms is mindfulness meditation.11 Rooted in Buddhist origins, mindfulness is commonly understood as the process of ‘turning toward’ or engaging in awareness of our most immediate reality through the senses, without engaging in cognitive or emotional reactions, but simply observing and acknowledging the experience itself. 5
Kabat-Zinn theorised that the non-judgmental nature of this awareness of presentmoment emotions, feelings and surroundings permits an acceptance of present events.11 Brown, Ryan and Creswell 12 suggest that mindfulness allows for sensory objects and events to be perceived impartially and how they truly are rather than filtered by self-centred thought and prior conditioning. Engaging in mindfulness has been theorised to help cultivate unconditional self-acceptance and move away from placing emphasis on self-esteem as a measure of worth.13 Mindfulness interventions have been found to significantly decrease body dissatisfaction, suggesting the practice of mindfulness may be an effective way of limiting adverse effects.14-16 Present Western conceptualisations of mindfulness draw from many different conflicting theoretical perspectives. As a result, numerous measures have been developed.17 Bergomi, Tschacher and Kupper18 developed the Comprehensive Inventory Of Mindful Experiences (CHIME) which aims to capture both dispositional (trait) and state mindfulness using the term quasi-trait as an indicator of the multifacetedness of mindfulness. Unlike previous measures, CHIME aims to encompass the full range of mindful experiences established in the literature.18 Another mechanism that is showing promise is self-compassion. Distinct from self-esteem and self-pity, it refers to the practice of holding one’s suffering and pain with connection, concern and warmth. In other words, turning compassion inward, toward oneself.19 Neff 20 describes self-compassion as being made up of (1) selfkindness: the act of extending kindness to self in difficult circumstances rather than being harsh and self-critical; (2) common humanity: perceiving one’s experiences as part of the greater human experience rather than isolating oneself; and (3) mindfulness: the act of holding painful thoughts and feelings in a balanced awareness rather than over-identifying with them. It is said to be a positive self-attitude that 6
protects against self-judgment, isolation and rumination.20 Unlike self-esteem, selfcompassion is a teachable skill set that has significant psychological health benefits.19 Bluth et al.19 propose a reciprocal association between mindfulness and selfcompassion. Their proposed model suggests that having a greater acceptance of oneself (mindfulness) leads to a recognition of self as a part of a common humanity (self-compassion). As a result of this recognition individuals have a greater awareness of thoughts (mindfulness), which leads to a recognition of the extent of self-judgment and rumination (mindfulness), corresponding to greater self-kindness and selfcompassion.19 A combination of mindfulness and self-compassion has been found to reduce stress and improve psychological health21 and lower body dissatisfaction and body comparison.22 Where recent studies have investigated the enhancement of wellbeing through mindfulness and self-compassion, results show significant gains in wellbeing.23 However, very little research24 has been carried out in relation to understanding how mindfulness and self-compassion work to facilitate body appreciation, or how the two constructs work separately. The aim of the present study was to understand protective mechanisms such as accepting awareness (mindfulness) and self-compassion towards the body which may promote body appreciation, a component of positive body image. Theory 22 currently suggests that mindfulness and self-compassion separately aid in reducing negative body image. Current literature 16,24 suggests that mindfulness incorporates acceptance and self-compassion to attain a present awareness. Research also implies that features of self-compassion such as self-kindness and common humanity often accompany the presence of mindfulness throughout painful experiences.25 Whilst self-compassion can automatically co-arise with mindfulness, past research indicates that the presence of one does not always necessitate the other.25 Therefore the hypotheses were: 7
1. Mindfulness would predict self-compassion and body appreciation, with selfcompassion being the mediator of the relationship between mindfulness and body appreciation (Model 1). 2. Mindfulness may mediate the relationship between self-compassion and body appreciation (Model 2). 3. Positive and negative aspects of Self-compassion would predict body appreciation differently, acting as parallel mediators of the relationship between mindfulness and body appreciation (Model 3).
MATERIALS AND METHODS Participants Participants in the present study (N = 486) were recruited from James Cook University Psychology Students (54.9 %) and members of the general public from social media campaigns on Facebook and Instagram (40.3 %), word of mouth (n = 19, 3.9%) and other sources (n = 4, 0.8%). The mean age was 27.17 (SD = 11.37). Of the sample 75.72 % were women (n = 368), 23.04 % were men (n = 112) and 1.23 % identified as non-binary (n = 6). G Power conducted for Regression analysis for an effect size of .15 and an alpha level of .05 significance indicated a sample size of 107 was required. The present sample size indicates the power requirements were met. Measures
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The questionnaire was made up of three parts: (1) CHIME, (2) SCS-SF, and (3) BAS-2. Demographic data were also requested (age, gender and where questionnaire was accessed from). The questionnaire was hosted on Qualtrics. Comprehensive inventory of mindfulness experiences (CHIME). Mindfulness was assessed with the recently developed CHIME. 18 CHIME is a multi-dimensional assessment of the construct of mindfulness. CHIME investigates eight aspects of mindfulness : inner awareness (awareness towards internal experiences), acting with awareness, openness (openness to experiences), acceptance (accepting and nonjudgmental orientation), decentring and non-reactivity, insight (insightful understanding) and relativity (relativity of thoughts). The 37 item self-report scale uses a 6-point Likert scale format ranging from never or almost never = 1 to always or almost always = 6 to measure levels of mindfulness, where negatively-worded items (7, 10, 17, 19, 22, 26, 30, 33, 36) are reversed scored before calculating subscale scores. Individual subscale scores are added to calculate the total score, where higher scores relate to higher levels of mindfulness. An example of a CHIME item is “I notice details in nature, such as colours, shapes and textures”. The Cronbach’s alpha for CHIME in the current study is .87. Self-compassion scale – Short form (SCS-SF). Self-compassion was measured by the 12 item SCS-SF developped by Kristin D. Neff.26 The scale assessses the extent to which an individual is kind and understanding towards themself in occurrences of failure or pain.20 The SCS-SF uses a 5-point Likert scale ranging from almost never = 1 to almost always = 5 to measure levels of self-compassion. Made up of 6 subscales, the SCS-SF consists of (1) self- kindness (SK), (2) self-judgment (SJ), (3) common humanity (CH), (4) isolation (I), (5) mindfulness (M) and (6) overidentification (OI). SCS-SF is comprised of three positive subscales (SK, CH, M) and 9
three negative subscales (SJ, I, OI). Negative subscale items (1, 4, 8, 9, 11, 12) are reverse scored before calculating the total. An example of a SCS-SF item is “I try to be understanding and patient towards those aspects of my personality I don’t like.27 The Cronbach’s alpha for SCS-SF in the current study is .51, with subscale Cronbach alphas rating at (1) SK = .65, (2) SJ = .71, (3) CH = .66, (4) I = 60, (5) M = .63 and (6) OI = .69. Body appreciation scale – Short form (BAS-2). PBI was measured by the BAS2.28 An example of a BAS-2 item is “I am attentive to my body’s needs”. The BAS-2 uses a 5-point Likert scale ranging from never = 1 to always = 5 to assess to what extent individuals hold accepting, respectful and favourable opinions towards their bodies. Body appreciation is calculated by summing participants’ responses to items 1 to 10, where higher scores are suggested to depict a greater body appreciation and lower scores are an indication of a less pronounced body appreciation.28 The BAS-2 has been consistently validated, holding strong internal consistency, test – retest reliability and construct validity.28 The Chronbach’s alpha in the current study is .95. Procedures The study was approved by the Human Research Ethics Committee at James Cook University (JCU Approval No H7369). Participants of the general public and JCU students were invited to take part in an online questionnaire, via an anonymous website link. After completing an electronic informed consent sheet, participants completed CHIME followed by the SCS-SF and the BAS-2.
Statistical Analysis 10
SPSS Statistics Software (Version 23) was used to analyse the data. The assumptions of parametric statistics namely normally distributed data, linearity and homogeneity of variance were met. Mean scores for age, mindfulness, selfcompassion, body appreciation and positive and negative SCS-SF dimension subscales were computed and are displayed in Table 1. Pearson’s correlations and their significance were calculated between the dependant variable (body appreciation; BAS-2) and all continuous variables in the study and are reported in Table 2. Two hierarchical regressions were used to identify the strength of each variable in predicting body appreciation. The analysis met Baron and Kenny’s 29 statistical criteria for establishing mediation. As a result, SPSS PROCESS was used to conduct path analysis between the variables; mindfulness, self-compassion and body appreciation. Once initial analyses were investigated, total SCS-SF was removed as a variable and re-entered into the analysis by splitting the original SCS-SF into positive and negative subscales. Given the analysis already included mindfulness (CHIME) as a primary predictor variable and that one of the three positive dimensions of selfcompassion was mindfulness, mindfulness was removed from the combination of positive SCS-SF subscales. As a result, the positive SCS-SF dimensions selfkindness (SK) and common humanity (CH) were made into one variable, Positive SCS-SF (P-SCS-SF-S). Negative dimensions of the SCS-SF; self-judgment (SJ), isolation (I) and over-identification (OI) were all added together creating the Negative SCS-SF Subscales (N-SCS-SF-S). All data were included in the analysis, using listwise comparisons and SPSS PROCESS bootstrapping procedure. Bootstrapping generates an empirical representation of the sampling distribution through resampling.30 This process estimates indirect effects through a percentile based bootstrap confidence interval. 11
This procedure is said to have the highest power and the best Type I error control, in comparison to the Sobel test. 30 RESULTS Correlation analysis Significant positive relationships were found between mindfulness, selfcompassion and body appreciation (Table 2). Contrary to our hypothesis, selfcompassion did not have a significant correlation with total body appreciation scores. Age was only found to have a significant negative relationship with body appreciation. To further investigate the relationship between self-compassion and body appreciation, the SCS-SF was split into separate positive and negative dimension subscales in a post hoc correlation analysis with the other variables in the study. This correlation analysis revealed a positive relationship between positive SCS-SF subscales and body appreciation, mindfulness and self-compassion. Negative SCS-SF subscales were negatively correlated with mindfulness and body appreciation. It was then hypothesised that a combination of positive self-compassion subscales (common humanity and self-kindness) will be a better predictor of body appreciation.
Multiple Hierarchical Regression Analyses Two hierarchical regressions were conducted to investigate the overall best predictor of body appreciation (Refer to Table 3). Total body appreciation was regressed on total mindfulness (CHIME), total self-compassion scores (SCS-SF) and age. Overall the first regression model was statistically significant, the three 12
predictors accounted for 21.7 % of the variability in body appreciation (R2 = .217 F (3,478)
= 44.18, p <.001). In this model, mindfulness accounted for 19% of the
variability in body appreciation scores (R2 = .190, F (1,480) = 112.55, p <.001), total self-compassion scores accounted for an additional 2% of the variability in body appreciation (R2 = .020, F (1,479) =12.08, p <.001) and age accounted for an additional 0.6% of the variability in body appreciation (R2 = .007, F (1,476) = 4.40, p <.05). This was further investigated by conducting a second regression with SCS-SF split into the positive and negative subscales and removing total self-compassion as a predictor. Overall, the second regression model was statistically significant (See Table 3). Together mindfulness, positive SCS-SF subscales, negative SCS-SF subscales and age accounted for 40.6% of the variability in body appreciation (R2 = .40.7 F (2,477) = 83.58, p <.001). In this model, mindfulness accounted for 19.7% of the variability in body appreciation (R2 = .190, F (1,478) = 112.55, p <.001); positive SCSSF subscales accounted for an additional 15.8% variance in body appreciation scores (R2 = .15.8, F (1,478) = 116.07, p <.001). In addition, negative SCS-SF subscales accounted for an additional 5.8% of the variability in body appreciation scores (R2 = .058, F (1,478) = 46.98, p <.001). Lastly age accounted for an additional 0.6% of the variability in body appreciation (R2 = .007, F (1,476) = 4.40, p <.05).
Mediation analysis A set of two simple mediations were analysed. In the first model selfcompassion was tested as the mediator between mindfulness (X) and body appreciation (Y). The second model consisted of mindfulness as the mediator variable 13
between self-compassion (X) and body appreciation (Y). Both models did not include covariates. Model 1: Simple mediation: Self-compassion as mediator Using the simple mediation model in Figure 1, it was found that mindfulness did have an indirect effect on body appreciation through the mediating effect of selfcompassion (ab = -0. 02), where the confidence intervals were found to be below zero (-.048 to -.01). As it can be seen in Table 4 and Figure 1, the relationship between mindfulness and self-compassion was significant (a = .11). Whilst holding mindfulness constant, the effect of self-compassion on body appreciation was also significant (b = -.27). When holding self-compassion constant, mindfulness had a positive significant direct effect on body appreciation. The model suggests that mindfulness does appear to predict an increase in self-compassion. However, increases in self-compassion predict a decrease in body appreciation.
Model 2: Simple mediation: Mindfulness as mediator Using the simple mediation model as depicted in Figure 2, it was found that self-compassion did have an indirect effect on body appreciation through the mediating effect of mindfulness (ab = .34), where confidence intervals were found to be outside zero (.24 to .45). Evidenced in Figure 2 and Table 5, the relationship between self-compassion and mindfulness was significant (a = 1.49). Holding selfcompassion constant, the effect of mindfulness on body appreciation was also found to be significant (b = .23). Whilst holding mindfulness constant, self-compassion had a significant negative direct effect on body appreciation (c’ = -.27). The model suggests that self-compassion predicts an increase in mindfulness. Consequently, an 14
increase in mindfulness also predicted an increase in body appreciation. However, the total model was not found to be significant.
Model 3: Parallel Multiple Mediator Model Lastly, a post hoc analysis of the two dimensions of self-compassion was conducted through a parallel multiple mediator path analysis, depicted in Figure 3. It was found that two cases that differ by one unit on mindfulness are estimated to increase by .091 units in their body appreciation scores through positive selfcompassion subscales (self-kindness and common humanity) (a1b1 = .076; 95% CI = .0473 to .1079). A second indirect effect of mindfulness on body appreciation was modelled through negative self-compassion subscales (self-judgment, isolation and over-identification), where two cases were estimated to decrease by 0.016 (a2b2 ; 95% CI = .0017 to .0329). Holding both positive and negative self-compassion subscales constant, there was a significant direct effect of mindfulness on body appreciation (c’ = .109, 95% CI = .0704 to .1480). The model confirms that the positive dimensions of self-compassion are strong positive predictors of body appreciation, bringing further support for self-compassion as a predictor of PBI. As seen in Table 6, total, direct and indirect pathways were found to be statistically significant. Holding all other variables at zero, the strongest relationship was found between positive SCS-SF subscales and body appreciation.
DISCUSSION The objective of the current study was to contribute to the positive body image literature to better inform interventions to decrease body dissatisfaction. The first 15
hypothesis that mindfulness would predict self-compassion and body appreciation was supported. Mindfulness was moderately associated with self-compassion, consistent with research31 which has used a different measure of dispositional mindfulness namely the Five Facet Mindfulness Questionnaire. In the current study Path analysis revealed mindfulness was a significant but weak predictor of selfcompassion (see Table 4) and a moderately strong predictor of body appreciation in all accounts, directly and indirectly. The present findings in relation to body appreciation, as a facet of PBI are consistent with findings22 examining the effectiveness of dispositional mindfulness on body comparison and body satisfaction. The second hypothesis—self-compassion will be a predictor of mindfulness— was supported. It was established that as self-compassion increased, mindfulness increased significantly. This pathway was found to be stronger than any other relationship in the study (see Table 5). These results may suggest that engaging in self-compassion promotes more effective mindfulness practices, confirming differences found between mindfulness meditation and loving kindness meditation.31 In addition, these findings may bring clarification to the distinction between a general mindfulness (the ability to pay attention in any circumstance, positive, negative and neutral) and the wider scope of mindfulness within self-compassion (a balanced awareness of negative thoughts and feelings).25 The third hypothesis—self-compassion will be a positive predictor of body appreciation—was not supported. Although literature consistently finds selfcompassion as an effective tool in reducing body dissatisfaction,32 the present findings suggest that self-compassion negatively predicts PBI. This confirms the view that self-compassion is made up of positive and negative features.20 It also confirms the standing of PBI as its own construct. It cannot be associated with negative features 16
of self-compassion such as self-judgment, isolation and over-identification because it is a positive construct. The substantiation of these findings has been further evidenced through Figure 3. Lastly, a post hoc hypothesis was added after preliminary analyses—a combination of the positively formulated items in the SCS-SF (common humanity and self -kindness) would be a better predictor of body appreciation than total SCS-SF. Neff26 established three aspects of self-compassion measured by SCS-SF which are conceptually distinct yet are found to mutually enhance and promote one another.20 In each of the self-compassion mechanisms, as one increases the other decreases, i.e. as self-kindness increases, self-judgement decreases. This appears to be consistent with the present study’s findings. The current research has established that self-compassion is a stronger predictor of mindfulness. It also demonstrates that the positive dimensions of selfcompassion are better suited in predicting PBI. The models tested form a basis for understanding the relationship between mindfulness and self-compassion, where Model 1 and 2 both indicate a relationship between the two practices. Model 2 was best suited for endorsing the indirect relationship between self-compassion and body appreciation through mindfulness. These findings illustrate that self-compassion is a central aspect in promoting both mindfulness and body appreciation. This was further emphasised in the separation of positive and negative dimensions of self-compassion. Model 3 proposed a framework for potentially understanding factors that play into both positive and negative body image. The present study demonstrates the relationship between mindfulness and the positive dimensions of self-compassion (the presences of self-kindness and common humanity) which predict PBI. Negative
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dimensions of self-compassion (the presence of self-judgment, isolation and overidentification) were found to negatively predict body appreciation. However, as PBI and body dissatisfaction are different conceptually, it is believed that the absence of body appreciation does not equate to negative body image.7 Limitations and further research Due to some of the limitations associated with the study, inferences drawn from it must be interpreted with caution. In an attempt to limit respondent fatigue, the study used the SCS-SF which has been shown to be less reliable than the full SCS. Generalisations from the present study might not extend to more diverse populations due to the skewed age and gender distributions. Lastly, although precautions were taken to reduce carry-over effects, it could be argued that answering the mindfulness measure (CHIME) first may have enhanced introspection and subsequently selfcompassion and body appreciation. Further use of these measures should be completely randomised. This study was the first to investigate the relationship between mindfulness, self-compassion and body appreciation. Preceding body appreciation literature has investigated the various dimensions of body appreciation and their roles within PBI. However, very little is known about the practices that promote body appreciation and PBI as a whole. The present study demonstrates a clear predictive relationship between self-compassion and mindfulness. In addition, the present study has established the strength of the predictive relationship between positive dimensions of self-compassion (self-kindness and common humanity) and body appreciation. Therefore, the current study contributes to the theoretical and research base on positive body image.
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Clinical implications of these findings should focus on fostering mindfulness, self-kindness and common humanity through loving kindness and mindfulness meditation. These skills are teachable. Fostering both mindfulness and selfcompassion may change body dissatisfaction treatment as a whole. REFERENCES 1. Cash TF, Smolak L. Body image: A handbook of science, practice, and prevention (2nd ed.). New York: Guilford Press; 2011. 2. Tylka TL, Wood-Barcalow NL. What is and what is not positive body image? Conceptual foundations and construct definition; Body Image. 2015;14:118129. doi:https://doi.org/10.1016/j.bodyim.2015.04.001 3. Tylka T, Wood-Barcalow N. The Body appreciation scale-2: Item refinement and psychometric evaluation; Body Image. 2015;12:53-67. doi:10.1016/j.bodyim.2014.09.006 4. Tylka TL. Positive psychology perspectives on body image. In TF Cash (Ed.), Encyclopedia of body image and human appearance (pp. 657-663). San Diego, CA: Elsevier Academic Press; 2012. doi:10.1016/B978-0-12-3849250.00104-8 5. Tylka TL. Positive psychology perspectives on body image. In TF Cash, L Smolak (Eds.) Body image: a handbook of science, practice, and prevention (pp.55 - 64). (2nd ed.). New York: Guilford Press; 2011. 6. Striegel-Moore RH, Cachelin FM. Body image concerns and disordered eating in adolescent girls - Risk and protective factors. In NG Johnson, MC Roberts (Eds.), Beyond appearance: A new look at adolescent girls (pp. 85-108). Washington DC: American Psychological Association; 1999.
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31. Baer RA, Lykins ELB, Peters JR. Mindfulness and self-compassion as predictors of psychological wellbeing in long-term meditators and matched nonmeditators; J Posit Psychol. 2012;7(3): 230-238. doi:10.1080/17439760.2012.674548 32. Wasylkiw L, MacKinnon AL, MacLellan AM. Exploring the link between self-compassion and body image in university women; Body Image. 2012;9(2):236-245. doi: https://doi.org/10.1016/j.bodyim.2012.01.007
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a = 0.11***
Self-Compassion (M)
Mindfulness (X)
b = -0.27**
Body Appreciation (Y) c’= 0.23***
Figure 1. Relationship between total mindfulness scores and total body appreciation scores accounting for self-compassion total scores (Model 1). All scores are beta coefficients.
24
a = 1.49***
Mindfulness (M)
Self - Compassion (X)
b = 0.23***
Body Appreciation (Y) c’= -0.27**
Figure 2. Relationship between total self-compassion scores and total body appreciation scores, accounting for total mindfulness scores (Model 2). All scores are beta coefficients.
25
Positive SCS-SF Subscales
a1= 0.075***
Mindfulness (X)
a2 = -0.03**
(M1)
b1 = 1.01***
Body Appreciation
c’ = 0.11*** Negative SCS-SF Subscales
(M2)
(Y)
b2 = -0.55***
Figure 3. Relationship between total mindfulness scores and total body appreciation scores, accounting for positive and negative dimensions of self-compassion (Model 3).
All scores are beta coefficients.
26
Table 1
Descriptive data for all continuous variables
Varia
M
SD
N
Min
Max
11.3
486
16
70
18.7
483
79
207
38.0
5.00
482
18
57
33.0
8.65
482
10
50
9.62
2.61
482
3.25
16.2
ble Age
27.1 7
Total Mindfulness
146. 32
Total SelfCompassion
7 3
6
Total Body 6 Appreciation PSCS-SF-S NSCS-SF-S
5 16.8 1
4.37
482
5.17
25.8 3
Note: P-SCS-SF = Positive Self-Compassion-Short Form Subscales, N-SCS-SF = Negative Self-Compassion Short Form Subscales, Min. = Minimum, Max. = Maximum.
27
Table 2 Pearson’s correlations between all continuous variables Variable
Age
Age
Total CHIME
Total SCS-SF
Total BAS-2
P- SCSSF-S
N-SCSSF-S
-
Total CHIME
-.042
-
Total SCS-SF
-.020
.398**
-
Total BAS-2
-.103*
.436**
.044
P-SCS-SF-S
-.047
.540**
.345**
.564**
-
N-SCS-SF-S
.019
-.125**
.615**
-.452***
-.474**
-
Note. Listwise N = 482. CHIME = Comprehensive Inventory of Mindful Experiences, SCS-SF = Self-Compassion-Short Form, P-SCS-SF = Positive Self-CompassionShort Form Subscales, N-SCS-SF = Negative Self-Compassion Short Form Subscales, *p <.05, two tailed. ** p <.01, two tailed. *** p <.001, two tailed.
28
Table 3
Hierarchical regression analyses showing prediction of body appreciation
Analysis 1
Intercept / Predictors
95% CI for B Lower Upper Bound Bound
B
SEb
Intercept
11.61
3.38
4.96
18.26
Age
-.065*
.031
-.125
-.004
Total Mindfulness
.228***
.020
.188
Total Self-Compassion
-.267***
.076
-.416
t
p
.465
.642
-.085
-2.10
.036
.268
.494
11.18
<.001
-.117
-.154
-3.49
<.001
6.11
<.001
R2 2
β
R2 = .217 18.72***
2.97
12.89
24.56
-.056*
.027
-.110
-.005
-.073
-2.08
.038
Total Mindfulness
.108***
.020
.053
.133
.235
5.51
<.001
P-SCS-SF-S
1.00***
.159
.517
.944
.302
6.29
<.001
N-SCS-SF-S
-.550***
.081
-.702
-.390
-.278
-6.83
<.001
Intercept Age
R2
R2 = .407
Note: P-SCS-SF = Positive Self-Compassion-Short Form Subscales, N-SCS-SF = Negative Self-Compassion Short Form Subscales, CI = Confidence Interval, *p <.05, two tailed. ** p <.01, two tailed. *** p <.001, two tailed.
29
Table 4 Effects of mindfulness on body appreciation through self-compassion (Model 1) Consequent Variable
B
LLCI
ULCI
B
LLCI
ULCI
Constant
22.50***
19.26
25.75
9.60*
3.20
16.01
.11***
.08
.13
c’ .23***
.19
.27
-
-
-
b
-.42
-.12
Mindfulness Self-Compassion
a
-.27**
R2
.16
.21
F
90.33***
N
482
112.55** * 482
Note: Listwise N = 482. LLCI = lower limit confidence interval, ULCI = upper limit confidence interval. Confidence level = 95%, *p < .05, two-tailed. **p < .01, twotailed. ***p <.001, two-tailed.
30
Table 5 Effects of self-compassion on body appreciation through mindfulness (Model 2) Consequent Variable
B
LLCI
ULCI
B
LLCI
Constant
89.61***
77.78
101.43
9.60*
3.20
16.01
-
-
-
b
.23***
.19
.27
1.49***
1.89
1.80
c’
-.27**
-.42
-.12
Mindfulness Self-Compassion
a
R2
.16
.21
F
90.33***
63.61***
N
482
482
ULCI
Note: Listwise N =482. LLCI = lower limit confidence interval, ULCI = upper limit confidence interval. Confidence level = 95%, *p < .05, two-tailed. **p < .01, twotailed. ***p <.001, two-tailed.
31
Table 6 Effects of mindfulness on body appreciation through parallel multiple mediation model depicted in Figure 3 (Model 3)
Consequent M1
M2
Pos SCS-SF Variable X
a1
Neg SCS-SF
B
SE
p
.075
.00
.001
(CHIME)
Y
a2
B
SE
p
-.03
.01
.001
-
-
-
-
-
-
(P-SCS-SF)
SE
p
.11
.02
.001
b
1.01
.16
.001
-.55
.08
.001
16.6
2.90 .001
1
M2
-
-
-
-
-
-
(N-SCS-SF) Constant
c
B ’
5
M1
BAS-2
b iM
-1.41
.79
.076
iM2
21.06
1.56
.01
2
1
iY R2 = .292
R2 = .015
R2
= .4005 F (1, 480) = 197.98, p <.001 F (1, 480) = 7.56, p = .006
F (3, 478) = 106.46, p
<.001 Note: CHIME = Comprehensive Inventory of Mindful Experiences, P-SCS-SF = Positive Self-Compassion-Short Form Subscales, N-SCS-SF = Negative SelfCompassion Short Form Subscales, BAS-2 = Body Appreciation Scale.
32
The relationship between mindfulness, self-compassion and body appreciation Clotilde Lienhart PII: DOI: Reference:
S1550-8307(19)30469-0 https://doi.org/10.1016/j.explore.2019.09.003 JSCH 2423
To appear in:
EXPLORE
Received date: Revised date: Accepted date:
15 November 2018 18 September 2019 28 September 2019
Please cite this article as: Clotilde Lienhart , The relationship between mindfulness, self-compassion and body appreciation, EXPLORE (2019), doi: https://doi.org/10.1016/j.explore.2019.09.003
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 Published by Elsevier Inc.
Highlights
Fostering positive self-compassion in clients is essential to developing a positive body image. Mindfulness is associated with body appreciation. The current study contributes to the theoretical and research base on positive body image.
1
The relationship between mindfulness, self-compassion and body appreciation
Clotilde Lienhart Associate Professor Marie Caltabiano
James Cook University, Cairns, Australia
Corresponding Author: Associate Professor Marie Caltabiano, PhD FAPS, FCHP Psychology, College of Healthcare Sciences, James Cook University, Cairns, Qld 4870 Australia. Phone: +61 7 42321183 E-mail: [email protected]
Abstract Background and objective: The present study examined the association between mindfulness, self-compassion and body appreciation. It was expected that
2
mindfulness would be related to higher self-compassion and more body appreciation. Three models were tested: one investigating self-compassion as a mediator between mindfulness and body appreciation, another examining mindfulness as the mediator between self-compassion and body appreciation, and a proposed alternative model exploring both positive and negative self-compassion subscales as parallel mediators of the relationship between mindfulness and body appreciation. Methods: In an online survey, 482 participants (368 females, 112 males) answered questions relating to mindfulness, self-compassion and body appreciation. Mindfulness was measured with the Comprehensive inventory of mindfulness experiences (CHIME). The Body appreciation scale (BAS-2) was used to assess body appreciation. Self-compassion was measured by the Self-compassion scale – Short form (SCS-SF). Results: Hierarchical regression analysis, and SPSS PROCESS was used to conduct path analysis between the variables mindfulness, self-compassion and body appreciation. Mindfulness was positively related to self-compassion and body appreciation, whereas self-compassion as a whole was found to negatively relate to body appreciation in both simple mediation models. The proposed alternate parallel model partially mediated the relationship between mindfulness and body appreciation, where positive self-compassion subscales related strongly with body appreciation and mindfulness. Conclusions: The present study has established the strength of the predictive relationship between positive dimensions of self-compassion (self-kindness, common humanity) and body appreciation. The implications for clinical health practice are that fostering positive self-compassion in clients is essential to developing a positive body image.
3
Keywords: positive body image, mindfulness, self-compassion, body appreciation
INTRODUCTION Body image has been widely defined as a multidimensional construct, relating to the perceptions and attitudes concerning one’s own physical appearance and function.1 Existing body image literature remains primarily rooted in pathology,1 with its focus on body dissatisfaction and the role of thin-ideal internalization and appearance comparison processes. It has been argued by Tylka and Wood-Barcalow2 that neglecting the factors which promote a positive body image has led to an incomplete understanding of body image. The present study aims to understand the protective mechanisms that promote accepting awareness and self-compassion towards the body. Negative body image has been extensively researched but research into Positive Body Image (PBI) is more recent.2 The study of PBI has focussed predominantly on body appreciation, which is also the focus of this research. The majority of the research uses the Body Appreciation Scale (BAS).3 The core characteristics of PBI are (1) inner positivity, (2) body appreciation, (3) body acceptance and love, (4) a broad conceptualisation of beauty and (5) an ability to filter information in a body protective manner.4 The presence of these core qualities forms a schema that permits individuals to appreciate their bodies regardless of idealistic media portrayals.5 4
Striegel-Moore and Cachelin6 theorised that PBI was not simply the opposite of negative body image. This theory was supported by research7 whose findings suggest that positive and negative body image can be experienced simultaneously, where low levels of dissatisfaction were expressed as neutral experiences. Further supporting the argument that positive and negative body image exist on a distinct continuum, Bailey et al.7 argue that all body image(s) overlap. This is potentially due to positive, negative and neutral body image being experienced within the one individual. PBI is a derivative of the school of positive psychology which is interested in the promotion of health rather than pathology. 8 Underlying this ethos is the framework of ‘flourishing’. According to Lopez8 flourishing is conceptualised as a range of behaviours that promote optimal functioning. Critical elements are the need to engage in the care of one’s mind, body and soul.4 When facing adverse events, individuals who flourish tend to develop resilience rather than simply coping. They have a grounded, felt acceptance of others and self.8 Features of flourishing often align with the ancient practice of mindfulness and self-compassion.9 Garland, Gaylord and Jongbae10 argue that approaches such as these aid in the reappraisal of painful experiences, allowing adaptive coping mechanisms to form. These findings offer an alternative framework to the existing pathology-driven model of understanding body image. A well-established procedure for reducing stress and fostering healthy coping mechanisms is mindfulness meditation.11 Rooted in Buddhist origins, mindfulness is commonly understood as the process of ‘turning toward’ or engaging in awareness of our most immediate reality through the senses, without engaging in cognitive or emotional reactions, but simply observing and acknowledging the experience itself. 5
Kabat-Zinn theorised that the non-judgmental nature of this awareness of presentmoment emotions, feelings and surroundings permits an acceptance of present events.11 Brown, Ryan and Creswell 12 suggest that mindfulness allows for sensory objects and events to be perceived impartially and how they truly are rather than filtered by self-centred thought and prior conditioning. Engaging in mindfulness has been theorised to help cultivate unconditional self-acceptance and move away from placing emphasis on self-esteem as a measure of worth.13 Mindfulness interventions have been found to significantly decrease body dissatisfaction, suggesting the practice of mindfulness may be an effective way of limiting adverse effects.14-16 Present Western conceptualisations of mindfulness draw from many different conflicting theoretical perspectives. As a result, numerous measures have been developed.17 Bergomi, Tschacher and Kupper18 developed the Comprehensive Inventory Of Mindful Experiences (CHIME) which aims to capture both dispositional (trait) and state mindfulness using the term quasi-trait as an indicator of the multifacetedness of mindfulness. Unlike previous measures, CHIME aims to encompass the full range of mindful experiences established in the literature.18 Another mechanism that is showing promise is self-compassion. Distinct from self-esteem and self-pity, it refers to the practice of holding one’s suffering and pain with connection, concern and warmth. In other words, turning compassion inward, toward oneself.19 Neff 20 describes self-compassion as being made up of (1) selfkindness: the act of extending kindness to self in difficult circumstances rather than being harsh and self-critical; (2) common humanity: perceiving one’s experiences as part of the greater human experience rather than isolating oneself; and (3) mindfulness: the act of holding painful thoughts and feelings in a balanced awareness rather than over-identifying with them. It is said to be a positive self-attitude that 6
protects against self-judgment, isolation and rumination.20 Unlike self-esteem, selfcompassion is a teachable skill set that has significant psychological health benefits.19 Bluth et al.19 propose a reciprocal association between mindfulness and selfcompassion. Their proposed model suggests that having a greater acceptance of oneself (mindfulness) leads to a recognition of self as a part of a common humanity (self-compassion). As a result of this recognition individuals have a greater awareness of thoughts (mindfulness), which leads to a recognition of the extent of self-judgment and rumination (mindfulness), corresponding to greater self-kindness and selfcompassion.19 A combination of mindfulness and self-compassion has been found to reduce stress and improve psychological health21 and lower body dissatisfaction and body comparison.22 Where recent studies have investigated the enhancement of wellbeing through mindfulness and self-compassion, results show significant gains in wellbeing.23 However, very little research24 has been carried out in relation to understanding how mindfulness and self-compassion work to facilitate body appreciation, or how the two constructs work separately. The aim of the present study was to understand protective mechanisms such as accepting awareness (mindfulness) and self-compassion towards the body which may promote body appreciation, a component of positive body image. Theory 22 currently suggests that mindfulness and self-compassion separately aid in reducing negative body image. Current literature 16,24 suggests that mindfulness incorporates acceptance and self-compassion to attain a present awareness. Research also implies that features of self-compassion such as self-kindness and common humanity often accompany the presence of mindfulness throughout painful experiences.25 Whilst self-compassion can automatically co-arise with mindfulness, past research indicates that the presence of one does not always necessitate the other.25 Therefore the hypotheses were: 7
1. Mindfulness would predict self-compassion and body appreciation, with selfcompassion being the mediator of the relationship between mindfulness and body appreciation (Model 1). 2. Mindfulness may mediate the relationship between self-compassion and body appreciation (Model 2). 3. Positive and negative aspects of Self-compassion would predict body appreciation differently, acting as parallel mediators of the relationship between mindfulness and body appreciation (Model 3).
MATERIALS AND METHODS Participants Participants in the present study (N = 486) were recruited from James Cook University Psychology Students (54.9 %) and members of the general public from social media campaigns on Facebook and Instagram (40.3 %), word of mouth (n = 19, 3.9%) and other sources (n = 4, 0.8%). The mean age was 27.17 (SD = 11.37). Of the sample 75.72 % were women (n = 368), 23.04 % were men (n = 112) and 1.23 % identified as non-binary (n = 6). G Power conducted for Regression analysis for an effect size of .15 and an alpha level of .05 significance indicated a sample size of 107 was required. The present sample size indicates the power requirements were met. Measures
8
The questionnaire was made up of three parts: (1) CHIME, (2) SCS-SF, and (3) BAS-2. Demographic data were also requested (age, gender and where questionnaire was accessed from). The questionnaire was hosted on Qualtrics. Comprehensive inventory of mindfulness experiences (CHIME). Mindfulness was assessed with the recently developed CHIME. 18 CHIME is a multi-dimensional assessment of the construct of mindfulness. CHIME investigates eight aspects of mindfulness : inner awareness (awareness towards internal experiences), acting with awareness, openness (openness to experiences), acceptance (accepting and nonjudgmental orientation), decentring and non-reactivity, insight (insightful understanding) and relativity (relativity of thoughts). The 37 item self-report scale uses a 6-point Likert scale format ranging from never or almost never = 1 to always or almost always = 6 to measure levels of mindfulness, where negatively-worded items (7, 10, 17, 19, 22, 26, 30, 33, 36) are reversed scored before calculating subscale scores. Individual subscale scores are added to calculate the total score, where higher scores relate to higher levels of mindfulness. An example of a CHIME item is “I notice details in nature, such as colours, shapes and textures”. The Cronbach’s alpha for CHIME in the current study is .87. Self-compassion scale – Short form (SCS-SF). Self-compassion was measured by the 12 item SCS-SF developped by Kristin D. Neff.26 The scale assessses the extent to which an individual is kind and understanding towards themself in occurrences of failure or pain.20 The SCS-SF uses a 5-point Likert scale ranging from almost never = 1 to almost always = 5 to measure levels of self-compassion. Made up of 6 subscales, the SCS-SF consists of (1) self- kindness (SK), (2) self-judgment (SJ), (3) common humanity (CH), (4) isolation (I), (5) mindfulness (M) and (6) overidentification (OI). SCS-SF is comprised of three positive subscales (SK, CH, M) and 9
three negative subscales (SJ, I, OI). Negative subscale items (1, 4, 8, 9, 11, 12) are reverse scored before calculating the total. An example of a SCS-SF item is “I try to be understanding and patient towards those aspects of my personality I don’t like.27 The Cronbach’s alpha for SCS-SF in the current study is .51, with subscale Cronbach alphas rating at (1) SK = .65, (2) SJ = .71, (3) CH = .66, (4) I = 60, (5) M = .63 and (6) OI = .69. Body appreciation scale – Short form (BAS-2). PBI was measured by the BAS2.28 An example of a BAS-2 item is “I am attentive to my body’s needs”. The BAS-2 uses a 5-point Likert scale ranging from never = 1 to always = 5 to assess to what extent individuals hold accepting, respectful and favourable opinions towards their bodies. Body appreciation is calculated by summing participants’ responses to items 1 to 10, where higher scores are suggested to depict a greater body appreciation and lower scores are an indication of a less pronounced body appreciation.28 The BAS-2 has been consistently validated, holding strong internal consistency, test – retest reliability and construct validity.28 The Chronbach’s alpha in the current study is .95. Procedures The study was approved by the Human Research Ethics Committee at James Cook University (JCU Approval No H7369). Participants of the general public and JCU students were invited to take part in an online questionnaire, via an anonymous website link. After completing an electronic informed consent sheet, participants completed CHIME followed by the SCS-SF and the BAS-2.
Statistical Analysis 10
SPSS Statistics Software (Version 23) was used to analyse the data. The assumptions of parametric statistics namely normally distributed data, linearity and homogeneity of variance were met. Mean scores for age, mindfulness, selfcompassion, body appreciation and positive and negative SCS-SF dimension subscales were computed and are displayed in Table 1. Pearson’s correlations and their significance were calculated between the dependant variable (body appreciation; BAS-2) and all continuous variables in the study and are reported in Table 2. Two hierarchical regressions were used to identify the strength of each variable in predicting body appreciation. The analysis met Baron and Kenny’s 29 statistical criteria for establishing mediation. As a result, SPSS PROCESS was used to conduct path analysis between the variables; mindfulness, self-compassion and body appreciation. Once initial analyses were investigated, total SCS-SF was removed as a variable and re-entered into the analysis by splitting the original SCS-SF into positive and negative subscales. Given the analysis already included mindfulness (CHIME) as a primary predictor variable and that one of the three positive dimensions of selfcompassion was mindfulness, mindfulness was removed from the combination of positive SCS-SF subscales. As a result, the positive SCS-SF dimensions selfkindness (SK) and common humanity (CH) were made into one variable, Positive SCS-SF (P-SCS-SF-S). Negative dimensions of the SCS-SF; self-judgment (SJ), isolation (I) and over-identification (OI) were all added together creating the Negative SCS-SF Subscales (N-SCS-SF-S). All data were included in the analysis, using listwise comparisons and SPSS PROCESS bootstrapping procedure. Bootstrapping generates an empirical representation of the sampling distribution through resampling.30 This process estimates indirect effects through a percentile based bootstrap confidence interval. 11
This procedure is said to have the highest power and the best Type I error control, in comparison to the Sobel test. 30 RESULTS Correlation analysis Significant positive relationships were found between mindfulness, selfcompassion and body appreciation (Table 2). Contrary to our hypothesis, selfcompassion did not have a significant correlation with total body appreciation scores. Age was only found to have a significant negative relationship with body appreciation. To further investigate the relationship between self-compassion and body appreciation, the SCS-SF was split into separate positive and negative dimension subscales in a post hoc correlation analysis with the other variables in the study. This correlation analysis revealed a positive relationship between positive SCS-SF subscales and body appreciation, mindfulness and self-compassion. Negative SCS-SF subscales were negatively correlated with mindfulness and body appreciation. It was then hypothesised that a combination of positive self-compassion subscales (common humanity and self-kindness) will be a better predictor of body appreciation.
Multiple Hierarchical Regression Analyses Two hierarchical regressions were conducted to investigate the overall best predictor of body appreciation (Refer to Table 3). Total body appreciation was regressed on total mindfulness (CHIME), total self-compassion scores (SCS-SF) and age. Overall the first regression model was statistically significant, the three 12
predictors accounted for 21.7 % of the variability in body appreciation (R2 = .217 F (3,478)
= 44.18, p <.001). In this model, mindfulness accounted for 19% of the
variability in body appreciation scores (R2 = .190, F (1,480) = 112.55, p <.001), total self-compassion scores accounted for an additional 2% of the variability in body appreciation (R2 = .020, F (1,479) =12.08, p <.001) and age accounted for an additional 0.6% of the variability in body appreciation (R2 = .007, F (1,476) = 4.40, p <.05). This was further investigated by conducting a second regression with SCS-SF split into the positive and negative subscales and removing total self-compassion as a predictor. Overall, the second regression model was statistically significant (See Table 3). Together mindfulness, positive SCS-SF subscales, negative SCS-SF subscales and age accounted for 40.6% of the variability in body appreciation (R2 = .40.7 F (2,477) = 83.58, p <.001). In this model, mindfulness accounted for 19.7% of the variability in body appreciation (R2 = .190, F (1,478) = 112.55, p <.001); positive SCSSF subscales accounted for an additional 15.8% variance in body appreciation scores (R2 = .15.8, F (1,478) = 116.07, p <.001). In addition, negative SCS-SF subscales accounted for an additional 5.8% of the variability in body appreciation scores (R2 = .058, F (1,478) = 46.98, p <.001). Lastly age accounted for an additional 0.6% of the variability in body appreciation (R2 = .007, F (1,476) = 4.40, p <.05).
Mediation analysis A set of two simple mediations were analysed. In the first model selfcompassion was tested as the mediator between mindfulness (X) and body appreciation (Y). The second model consisted of mindfulness as the mediator variable 13
between self-compassion (X) and body appreciation (Y). Both models did not include covariates. Model 1: Simple mediation: Self-compassion as mediator Using the simple mediation model in Figure 1, it was found that mindfulness did have an indirect effect on body appreciation through the mediating effect of selfcompassion (ab = -0. 02), where the confidence intervals were found to be below zero (-.048 to -.01). As it can be seen in Table 4 and Figure 1, the relationship between mindfulness and self-compassion was significant (a = .11). Whilst holding mindfulness constant, the effect of self-compassion on body appreciation was also significant (b = -.27). When holding self-compassion constant, mindfulness had a positive significant direct effect on body appreciation. The model suggests that mindfulness does appear to predict an increase in self-compassion. However, increases in self-compassion predict a decrease in body appreciation.
Model 2: Simple mediation: Mindfulness as mediator Using the simple mediation model as depicted in Figure 2, it was found that self-compassion did have an indirect effect on body appreciation through the mediating effect of mindfulness (ab = .34), where confidence intervals were found to be outside zero (.24 to .45). Evidenced in Figure 2 and Table 5, the relationship between self-compassion and mindfulness was significant (a = 1.49). Holding selfcompassion constant, the effect of mindfulness on body appreciation was also found to be significant (b = .23). Whilst holding mindfulness constant, self-compassion had a significant negative direct effect on body appreciation (c’ = -.27). The model suggests that self-compassion predicts an increase in mindfulness. Consequently, an 14
increase in mindfulness also predicted an increase in body appreciation. However, the total model was not found to be significant.
Model 3: Parallel Multiple Mediator Model Lastly, a post hoc analysis of the two dimensions of self-compassion was conducted through a parallel multiple mediator path analysis, depicted in Figure 3. It was found that two cases that differ by one unit on mindfulness are estimated to increase by .091 units in their body appreciation scores through positive selfcompassion subscales (self-kindness and common humanity) (a1b1 = .076; 95% CI = .0473 to .1079). A second indirect effect of mindfulness on body appreciation was modelled through negative self-compassion subscales (self-judgment, isolation and over-identification), where two cases were estimated to decrease by 0.016 (a2b2 ; 95% CI = .0017 to .0329). Holding both positive and negative self-compassion subscales constant, there was a significant direct effect of mindfulness on body appreciation (c’ = .109, 95% CI = .0704 to .1480). The model confirms that the positive dimensions of self-compassion are strong positive predictors of body appreciation, bringing further support for self-compassion as a predictor of PBI. As seen in Table 6, total, direct and indirect pathways were found to be statistically significant. Holding all other variables at zero, the strongest relationship was found between positive SCS-SF subscales and body appreciation.
DISCUSSION The objective of the current study was to contribute to the positive body image literature to better inform interventions to decrease body dissatisfaction. The first 15
hypothesis that mindfulness would predict self-compassion and body appreciation was supported. Mindfulness was moderately associated with self-compassion, consistent with research31 which has used a different measure of dispositional mindfulness namely the Five Facet Mindfulness Questionnaire. In the current study Path analysis revealed mindfulness was a significant but weak predictor of selfcompassion (see Table 4) and a moderately strong predictor of body appreciation in all accounts, directly and indirectly. The present findings in relation to body appreciation, as a facet of PBI are consistent with findings22 examining the effectiveness of dispositional mindfulness on body comparison and body satisfaction. The second hypothesis—self-compassion will be a predictor of mindfulness— was supported. It was established that as self-compassion increased, mindfulness increased significantly. This pathway was found to be stronger than any other relationship in the study (see Table 5). These results may suggest that engaging in self-compassion promotes more effective mindfulness practices, confirming differences found between mindfulness meditation and loving kindness meditation.31 In addition, these findings may bring clarification to the distinction between a general mindfulness (the ability to pay attention in any circumstance, positive, negative and neutral) and the wider scope of mindfulness within self-compassion (a balanced awareness of negative thoughts and feelings).25 The third hypothesis—self-compassion will be a positive predictor of body appreciation—was not supported. Although literature consistently finds selfcompassion as an effective tool in reducing body dissatisfaction,32 the present findings suggest that self-compassion negatively predicts PBI. This confirms the view that self-compassion is made up of positive and negative features.20 It also confirms the standing of PBI as its own construct. It cannot be associated with negative features 16
of self-compassion such as self-judgment, isolation and over-identification because it is a positive construct. The substantiation of these findings has been further evidenced through Figure 3. Lastly, a post hoc hypothesis was added after preliminary analyses—a combination of the positively formulated items in the SCS-SF (common humanity and self -kindness) would be a better predictor of body appreciation than total SCS-SF. Neff26 established three aspects of self-compassion measured by SCS-SF which are conceptually distinct yet are found to mutually enhance and promote one another.20 In each of the self-compassion mechanisms, as one increases the other decreases, i.e. as self-kindness increases, self-judgement decreases. This appears to be consistent with the present study’s findings. The current research has established that self-compassion is a stronger predictor of mindfulness. It also demonstrates that the positive dimensions of selfcompassion are better suited in predicting PBI. The models tested form a basis for understanding the relationship between mindfulness and self-compassion, where Model 1 and 2 both indicate a relationship between the two practices. Model 2 was best suited for endorsing the indirect relationship between self-compassion and body appreciation through mindfulness. These findings illustrate that self-compassion is a central aspect in promoting both mindfulness and body appreciation. This was further emphasised in the separation of positive and negative dimensions of self-compassion. Model 3 proposed a framework for potentially understanding factors that play into both positive and negative body image. The present study demonstrates the relationship between mindfulness and the positive dimensions of self-compassion (the presences of self-kindness and common humanity) which predict PBI. Negative
17
dimensions of self-compassion (the presence of self-judgment, isolation and overidentification) were found to negatively predict body appreciation. However, as PBI and body dissatisfaction are different conceptually, it is believed that the absence of body appreciation does not equate to negative body image.7 Limitations and further research Due to some of the limitations associated with the study, inferences drawn from it must be interpreted with caution. In an attempt to limit respondent fatigue, the study used the SCS-SF which has been shown to be less reliable than the full SCS. Generalisations from the present study might not extend to more diverse populations due to the skewed age and gender distributions. Lastly, although precautions were taken to reduce carry-over effects, it could be argued that answering the mindfulness measure (CHIME) first may have enhanced introspection and subsequently selfcompassion and body appreciation. Further use of these measures should be completely randomised. This study was the first to investigate the relationship between mindfulness, self-compassion and body appreciation. Preceding body appreciation literature has investigated the various dimensions of body appreciation and their roles within PBI. However, very little is known about the practices that promote body appreciation and PBI as a whole. The present study demonstrates a clear predictive relationship between self-compassion and mindfulness. In addition, the present study has established the strength of the predictive relationship between positive dimensions of self-compassion (self-kindness and common humanity) and body appreciation. Therefore, the current study contributes to the theoretical and research base on positive body image.
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Clinical implications of these findings should focus on fostering mindfulness, self-kindness and common humanity through loving kindness and mindfulness meditation. These skills are teachable. Fostering both mindfulness and selfcompassion may change body dissatisfaction treatment as a whole. REFERENCES 1. Cash TF, Smolak L. Body image: A handbook of science, practice, and prevention (2nd ed.). New York: Guilford Press; 2011. 2. Tylka TL, Wood-Barcalow NL. What is and what is not positive body image? Conceptual foundations and construct definition; Body Image. 2015;14:118129. doi:https://doi.org/10.1016/j.bodyim.2015.04.001 3. Tylka T, Wood-Barcalow N. The Body appreciation scale-2: Item refinement and psychometric evaluation; Body Image. 2015;12:53-67. doi:10.1016/j.bodyim.2014.09.006 4. Tylka TL. Positive psychology perspectives on body image. In TF Cash (Ed.), Encyclopedia of body image and human appearance (pp. 657-663). San Diego, CA: Elsevier Academic Press; 2012. doi:10.1016/B978-0-12-3849250.00104-8 5. Tylka TL. Positive psychology perspectives on body image. In TF Cash, L Smolak (Eds.) Body image: a handbook of science, practice, and prevention (pp.55 - 64). (2nd ed.). New York: Guilford Press; 2011. 6. Striegel-Moore RH, Cachelin FM. Body image concerns and disordered eating in adolescent girls - Risk and protective factors. In NG Johnson, MC Roberts (Eds.), Beyond appearance: A new look at adolescent girls (pp. 85-108). Washington DC: American Psychological Association; 1999.
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15. Clancy SE. The effects of yoga on body dissatisfaction, self-objectification, and mindfulness of the body in college women. (Dissertation/Thesis), ProQuest LLC; 2010. 16. Seo CA. Mindfulness meditation and innate compassion training interventions and body image dissatisfaction in women. (Dissertation/Thesis), ProQuest Dissertations Publishing; 2015. 17. Russell JV. The effect of mindfulness-based stress reduction on quality of life: A meta-analysis. (Clinical and Health Psychology), The University of Edinburgh, Edinburgh; 2011. 18. Bergomi C, Tschacher W, Kupper Z. Measuring mindfulness: First steps towards the development of a comprehensive mindfulness scale; Mindfulness. 2012;4(1):18-32. doi:10.1007/s12671-012-0102-9 19. Bluth K, Roberson PNE, Gaylord SA. A pilot study of a mindfulness intervention for adolescents and the potential role of self-compassion in reducing stress; Explore-NY. 2015;11(4): 292-295. doi:10.1016/j.explore.2015.04.005 20. Neff KD. Self-Compassion: An alternative conceptualization of a healthy attitude toward oneself; Self Identity. 2003;2(2):85-101. doi:10.1080/15298860309032 21. Fong M, Loi NM. The mediating role of self-compassion in student psychological health; Aust Psychol. 2016;51(6):431-441. doi:10.1111/ap.12185 22. Dijkstra P, Barelds DPH. Examining a model of dispositional mindfulness, body comparison, and body satisfaction; Body Image. 2011;8(4):419-422. doi:10.1016/j.bodyim.2011.05.007
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23. Ivtzan I, Young, T, Lee HC, Lomas T, et al. Mindfulness based flourishing program: A cross-cultural study of Hong Kong Chinese and British participants; J Happiness Stud. 2017; doi:10.1007/s10902-017-9919-1 24. Albertson ER, Neff KD, Dill-Shackleford KE. Self-compassion and body dissatisfaction in women: A randomized controlled trial of a brief meditation intervention; Mindfulness. 2015;6(3):444-454.doi:10.1007/s12671-014-0277-3 25. Neff KD, Dahm KA. Self-compassion: What it is, what it does, and how it relates to mindfulness. In B Ostafin, M Robinson, B Meier (Eds.), Handbook of Mindfulness and Self-Regulation (pp. 121-137). New York: Springer; 2015. 26. Neff KD. The development and validation of a scale to measure selfcompassion; Self Identity. 2003;2(3):223-250. doi:10.1080/15298860309027 27. Raes F, Pommier E, Neff KD, Van Gucht D. Construction and factorial validation of a short form of the self-compassion scale; Clin Psychol Psychot. 2011;18(3):250-255. doi:10.1002/cpp.702 28. Avalos L, Tylka TL, Wood-Barcalow N. The Body Appreciation Scale: Development and psychometric evaluation; Body Image.2005;2(3):285-297. doi:https://doi.org/10.1016/j.bodyim.2005.06.002 29. Baron RM, Kenny DA. The Moderator-Mediator Variable Distinction in Social Psychological Research: Conceptual, Strategic, and Statistical Considerations; J Pers Soc Psychol. 1986;51(6):1173-1182. doi:10.1037/00223514.51.6.1173 30. Hayes AF. Beyond Baron and Kenny: Statistical Mediation Analysis in the New Millennium; Commun Monogr. 2009;76(4):408-420. doi:10.1080/03637750903310360
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31. Baer RA, Lykins ELB, Peters JR. Mindfulness and self-compassion as predictors of psychological wellbeing in long-term meditators and matched nonmeditators; J Posit Psychol. 2012;7(3): 230-238. doi:10.1080/17439760.2012.674548 32. Wasylkiw L, MacKinnon AL, MacLellan AM. Exploring the link between self-compassion and body image in university women; Body Image. 2012;9(2):236-245. doi: https://doi.org/10.1016/j.bodyim.2012.01.007
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a = 0.11***
Self-Compassion (M)
Mindfulness (X)
b = -0.27**
Body Appreciation (Y) c’= 0.23***
Figure 1. Relationship between total mindfulness scores and total body appreciation scores accounting for self-compassion total scores (Model 1). All scores are beta coefficients.
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a = 1.49***
Mindfulness (M)
Self - Compassion (X)
b = 0.23***
Body Appreciation (Y) c’= -0.27**
Figure 2. Relationship between total self-compassion scores and total body appreciation scores, accounting for total mindfulness scores (Model 2). All scores are beta coefficients.
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Positive SCS-SF Subscales
a1= 0.075***
Mindfulness (X)
a2 = -0.03**
(M1)
b1 = 1.01***
Body Appreciation
c’ = 0.11*** Negative SCS-SF Subscales
(M2)
(Y)
b2 = -0.55***
Figure 3. Relationship between total mindfulness scores and total body appreciation scores, accounting for positive and negative dimensions of self-compassion (Model 3).
All scores are beta coefficients.
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Table 1
Descriptive data for all continuous variables
Varia
M
SD
N
Min
Max
11.3
486
16
70
18.7
483
79
207
38.0
5.00
482
18
57
33.0
8.65
482
10
50
9.62
2.61
482
3.25
16.2
ble Age
27.1 7
Total Mindfulness
146. 32
Total SelfCompassion
7 3
6
Total Body 6 Appreciation PSCS-SF-S NSCS-SF-S
5 16.8 1
4.37
482
5.17
25.8 3
Note: P-SCS-SF = Positive Self-Compassion-Short Form Subscales, N-SCS-SF = Negative Self-Compassion Short Form Subscales, Min. = Minimum, Max. = Maximum.
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Table 2 Pearson’s correlations between all continuous variables Variable
Age
Age
Total CHIME
Total SCS-SF
Total BAS-2
P- SCSSF-S
N-SCSSF-S
-
Total CHIME
-.042
-
Total SCS-SF
-.020
.398**
-
Total BAS-2
-.103*
.436**
.044
P-SCS-SF-S
-.047
.540**
.345**
.564**
-
N-SCS-SF-S
.019
-.125**
.615**
-.452***
-.474**
-
Note. Listwise N = 482. CHIME = Comprehensive Inventory of Mindful Experiences, SCS-SF = Self-Compassion-Short Form, P-SCS-SF = Positive Self-CompassionShort Form Subscales, N-SCS-SF = Negative Self-Compassion Short Form Subscales, *p <.05, two tailed. ** p <.01, two tailed. *** p <.001, two tailed.
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Table 3
Hierarchical regression analyses showing prediction of body appreciation
Analysis 1
Intercept / Predictors
95% CI for B Lower Upper Bound Bound
B
SEb
Intercept
11.61
3.38
4.96
18.26
Age
-.065*
.031
-.125
-.004
Total Mindfulness
.228***
.020
.188
Total Self-Compassion
-.267***
.076
-.416
t
p
.465
.642
-.085
-2.10
.036
.268
.494
11.18
<.001
-.117
-.154
-3.49
<.001
6.11
<.001
R2 2
β
R2 = .217 18.72***
2.97
12.89
24.56
-.056*
.027
-.110
-.005
-.073
-2.08
.038
Total Mindfulness
.108***
.020
.053
.133
.235
5.51
<.001
P-SCS-SF-S
1.00***
.159
.517
.944
.302
6.29
<.001
N-SCS-SF-S
-.550***
.081
-.702
-.390
-.278
-6.83
<.001
Intercept Age
R2
R2 = .407
Note: P-SCS-SF = Positive Self-Compassion-Short Form Subscales, N-SCS-SF = Negative Self-Compassion Short Form Subscales, CI = Confidence Interval, *p <.05, two tailed. ** p <.01, two tailed. *** p <.001, two tailed.
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Table 4 Effects of mindfulness on body appreciation through self-compassion (Model 1) Consequent Variable
B
LLCI
ULCI
B
LLCI
ULCI
Constant
22.50***
19.26
25.75
9.60*
3.20
16.01
.11***
.08
.13
c’ .23***
.19
.27
-
-
-
b
-.42
-.12
Mindfulness Self-Compassion
a
-.27**
R2
.16
.21
F
90.33***
N
482
112.55** * 482
Note: Listwise N = 482. LLCI = lower limit confidence interval, ULCI = upper limit confidence interval. Confidence level = 95%, *p < .05, two-tailed. **p < .01, twotailed. ***p <.001, two-tailed.
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Table 5 Effects of self-compassion on body appreciation through mindfulness (Model 2) Consequent Variable
B
LLCI
ULCI
B
LLCI
Constant
89.61***
77.78
101.43
9.60*
3.20
16.01
-
-
-
b
.23***
.19
.27
1.49***
1.89
1.80
c’
-.27**
-.42
-.12
Mindfulness Self-Compassion
a
R2
.16
.21
F
90.33***
63.61***
N
482
482
ULCI
Note: Listwise N =482. LLCI = lower limit confidence interval, ULCI = upper limit confidence interval. Confidence level = 95%, *p < .05, two-tailed. **p < .01, twotailed. ***p <.001, two-tailed.
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Table 6 Effects of mindfulness on body appreciation through parallel multiple mediation model depicted in Figure 3 (Model 3)
Consequent M1
M2
Pos SCS-SF Variable X
a1
Neg SCS-SF
B
SE
p
.075
.00
.001
(CHIME)
Y
a2
B
SE
p
-.03
.01
.001
-
-
-
-
-
-
(P-SCS-SF)
SE
p
.11
.02
.001
b
1.01
.16
.001
-.55
.08
.001
16.6
2.90 .001
1
M2
-
-
-
-
-
-
(N-SCS-SF) Constant
c
B ’
5
M1
BAS-2
b iM
-1.41
.79
.076
iM2
21.06
1.56
.01
2
1
iY R2 = .292
R2 = .015
R2
= .4005 F (1, 480) = 197.98, p <.001 F (1, 480) = 7.56, p = .006
F (3, 478) = 106.46, p
<.001 Note: CHIME = Comprehensive Inventory of Mindful Experiences, P-SCS-SF = Positive Self-Compassion-Short Form Subscales, N-SCS-SF = Negative SelfCompassion Short Form Subscales, BAS-2 = Body Appreciation Scale.
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