Meditation + warmth + fluffiness : the equation to more compassion? : the moderating effect of attachment-related avoidance on effects of self-compassion meditation

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SENSORY PRIMING IN SELF-COMPASSION ENHANCEMENT 0

Meditation + Warmth + Fluffiness: The Equation to More Compassion?

The Moderating Effect of Attachment-Related Avoidance

on Effects of Self-Compassion Meditation

Master thesis Child Development and Education (Orthopedagogiek) Author: BSc. R.E. van Bentum, 10179437 Supervisors: Mw. Prof. Dr. S.M. Bögels Mw. M. E. Wrzesien PhD Amsterdam, July 2017

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SENSORY PRIMING IN SELF-COMPASSION ENHANCEMENT

Faculty of Social and Behavioral Sciences

Graduate School of Child Development and Education

Meditation + Warmth + Fluffiness: The Equation to more

Compassion?

The Moderating Effect of Attachment-Related Avoidance

on Effects of Self-Compassion Meditation

Master thesis Child Development and Education (Orthopedagogiek) Author: BSc. R.E van Bentum, 10179437 Supervisors: Mw. Prof. Dr. S. M. Bögels Mw. M. E. Wrzesien PhD Amsterdam, July 2017

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SENSORY PRIMING IN SELF-COMPASSION ENHANCEMENT 1 Table of Contents Self-criticism ... 5 Attachment ... 5 Self-compassion ... 6 Defining self-compassion ... 6 Self-compassion interventions ... 7 Priming ... 8 Sensory priming ... 9 Aim ... 9 Methods ... 10 Participants ... 10

Design and procedure ... 10

Measures ... 11

Statistical analysis. ... 13

Results... 14

Demographics ... 14

Effects of priming and compassionate meditation on self-compassion ... 14

Effects of priming and compassionate meditation on self-self-criticism ... 15

Moderating role of attachment-related avoidance on self-compassion ... 16

Moderating role of attachment-related avoidance on self-criticism ... 16

Discussion ... 19

Effects of sensory priming on self-compassion ... 19

Effects of sensory priming on self-criticism ... 19

Moderating effect of attachment-related avoidance ... 20

Limitations... 20

Clinical implications... 21

Conclusions ... 22

References ... 22

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Acknowledgements

The past six months have been an intensive and educational period for me on a professional level as well as a personal level. I would like to thank my supervisors Prof. Dr. Susan Bögels and PhD Maja Wrzesien for letting me participate in their research, as well as for giving me meaningful insights and helpful guidance in writing my master thesis.

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Abstract

criticism is a depressive experience that can lead to psychological difficulty. Self-compassion has shown promise in targeting self-criticism. Those high in attachment-related avoidance have shown barriers to experiencing compassion, therefore new tools in self-compassion are needed. Kamboj et al. (2016) have used

3,4-methylenedioxy-N-methylamphetamine (MDMA) to enhance self-compassion. A compassionate mindset can also be produced by cognitive training such as meditation. Self-compassion related concepts such as interpersonal warmth have been successfully primed (Williams and Bargh, 2008). Given the similarity between these concepts, sensory priming is proposed as a tool to enhance self-compassion. This pilot study explored the effects of sensory priming in to enhance compassionate meditation and therefore self-compassion. Participants were randomly assigned to the sensory priming condition in which they held a warm, fluffy pillow or the control condition. Both conditions performed compassionate meditation. Self-report measures of attachment style, and self-criticism and self-compassion were measured before (T1) and after experimental condition (T2) and after compassionate meditation (T3). A moderating role of avoidant attachment was examined. Few results reached significance, but trends showed promising results of sensory priming in both self-criticism and self-compassion as well as a moderating role of avoidant attachment. Implications for future studies are discussed. Key words: Priming, Self-Compassion, Self-Criticism, Meditation, Attachment

Samenvatting

Zelfkritiek is een depressieve ervaring die kan leiden tot psychologische problemen.

Zelfcompassie is veelbelovend in de aanpak van zelfkritiek. Kamboj et al. (2016) gebruikte eerder 3,4-methyleendioxymethamfetamine (MDMA) om effecten van zelfcompassie meditatie te versterken. Een meedogenlijke gedachtegang kan ook verkregen worden met cognitieve training zoals meditatie. Mensen die hoog scoren op hechtingsgerelateerde vermijding hebben eerder barrières aangetoond in het ervaren van zelfcompassie, waarvoor nieuwe methoden voor zelfcompassie van groot belang zijn. Gerelateerde concepten zoals interpersoonlijke warmte zijn eerder succesvol geprimed (Williams and Bargh, 2009). Gezien de gelijkenissen tussen deze concepten, wordt zintuigelijke priming voorgesteld als methode om zelfcompassie meditatie te versterken. Dit pilot onderzoek exploreerde effecten van zintuigelijke priming ter aanvulling van compassie meditatie om zelfcompassie te versterken. Participanten werden willekeurig toegekend aan de zintuigelijke priming conditie, waarin zij een warm, zacht kussen vasthielden of de controle conditie. Beide condities voerden

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zelfcompassie werden gemeten voor (T1) en na de experimentele conditie (T2) en na

compassie meditatie (T3). Een modererend effect van vermijdende hechting werd onderzocht. Weinig significante effecten werden gevonden, maar trends toonden veelbelovende resultaten van zintuigelijke priming op zelfkritiek, zelfcompassie en hechtingsgerelateerde vermijding. Implicaties voor toekomstig onderzoek worden besproken.

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Meditation + Warmth + Fluffiness: The Equation to more Compassion? The Moderating Effect of Attachment-Related Avoidance

on Effects of Self-Compassion Meditation

Self-criticism

Self-criticism is a depressive experience that develops in childhood (Blatt, Quinlan, Chevron, Mcdonald & Zuroff, 1982), which in high levels, can lead to many different forms of psychological difficulty (Gilbert & Irons, 2004). In particular, self-criticism leads to risk of disorders related to shame, such as mood disorders (Blatt & Zuroff, 1992), alcoholism (Potter-Efron, 2002), affect regulation- and personality disorders (Linehan, 1993), PTSD (Brewin, 2003) and suicide (Blatt, 1995). Self-criticism can be viewed as a form of internal harassment that is stressful and undermining of the self (Gilbert, 2005), which may stem from the

perceived inability to meet or control imposed standards (Dunkley & Blankstein, 2000). Self-critical people strive for high achievement, are typically harshly Self-critical and demanding of themselves (Hewitt & Flett, 1991) and as a result, feel alienated from others (Irons & Gilbert, 2005). The negative effects of self-criticism have been well defined as a transdiagnostic factor (Cox et al., 2000), not only playing a major role in the development, but also in maintenance of many different forms of psychopathology, such as depression (Cheng & Furnham, 2004) and social phobia (Cox et al., 2000).

A lesser explored aspect of shame-based self-condemning such as self-criticism, is the degree of inability to generate self-soothing thoughts, feelings and images (Gilbert, 2000). Gilbert (2000) argues that the pathogenic qualities of self-criticism to extend into two processes. The degree of self-directed hostility, contempt and self-loathing that permeates self-criticism and the relative inability to generate feelings of self-reassurance. Indeed, later research by Gilbert and Irons (2004) found that self-critics have more ready access to hostile self-to-self thoughts than self-soothing ones and even tend to exhibit a fear of compassion (Gilbert, McEwan, Matos & Rivis, 2011).

Attachment

A key problem for self-critical people to generate self-compassionate feelings may reside in that they have no access to memories of affectionate, soothing care, understimulating their care abilities, leading to underdeveloped and underelaborated capacities for self-compassion. This is particularly true for those with insecure attachment styles (Mikulincer, Shaver, Gillath, & Nitzberg, 2005). Gilbert & Irons (2004) found that self-soothing abilities

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are significantly associated with recall of whether parents were warm/affectionate and low on rejection. This can be explained by attachment theory, which argues that early experiences with caregivers are translated into internal working models (Bowlby, 1969). Securely attached children acquire internal models of others as safe, providing a source of self-soothing

(Baldwin, 1997). However, children with insecure attachment styles, namely those high in attachment-related avoidance (Pietromonaco & Barrett, 2000), learn to see others as a source of threat (Gilbert, 2005). Therefore, these children do not develop positive working models of themselves and others, leading to higher levels of self-criticism and barriers to experiencing self-compassion (Fraley, Davis & Shaver, 1998).

Self-compassion

While self-criticism does develop early in childhood, it remains open to revision (Waters, Merrick, Treboux, Crowell & Albersheim, 2000). This is an important finding, seeing as Zuroff (1994) has found that self-criticism predicts later vulnerability to

psychopathology as early as age 12. In addition, adolescents begin to compare themselves to others, creating vulnerability to more sources of self-criticism (Irons & Gilbert, 2005). In light of risk of later psychopathology, preventing and reducing self-criticism in childhood is of great importance. With the knowledge that self-criticism relates to difficulty of generating self-compassion, targeting self-compassion is a logical next step (Irons & Gilbert, 2005). Self-compassion is a good predictor of happiness, positive affect, and coping in the face of failure and stress (Neely, Schallert, Mohammed, Roberts & Chen, 2009), as well as being associated with more enduring feelings of self-worth (Neff & Vonk, 2009). Recently, self-compassion has been the focus for psychotherapeutic procedures (Kamboj et al., 2016), which have shown promise in targeting self-criticism as well as treatment of a range of disorders (Gilbert, 2014).

Defining self-compassion

While the importance of self-compassion has been widely recognized, a lack of consensus remains on how it should be defined (Strauss et al., 2016). Gilbert (2010)

conceptualizes compassion for others as being aware of and moved by suffering and wanting to help, as well as the ability to adopt a non-judgmental stance toward others and to tolerate one’s own distress when faced with others’ suffering. A more commonly used definition, however, is by Neff (2003), who turned a definition of compassion for others into a model of self-compassion, arguing that self-compassion is compassion directed inward toward the self. Neff concludes that self-compassion is expressed in three components: kindness (being kind

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and non-judgmental toward self and others, rather than self-critical), mindfulness (holding painful feelings in mindful awareness rather than over-identifying with them) and common humanity (seeing one’s suffering as part of human life rather than isolating). A third view is Buddhist thinking, that argues differentiating compassion for others and self-compassion means drawing a false distinction between the self and others, and that self-compassion is a prerequisite for showing true compassion toward others (Gilbert, 2010). Strauss et al. (2016) state however, that seeing compassion for others and self-compassion as part of the same overarching construct is debatable. In fact, in recent research associations between self-compassion and other-focused self-compassion have been found to be weak or even non-existent for some populations (Strauss et al., 2016).

Based on these results and the continuing discussion about the construct and definition of self-compassion, in this research the view of self-compassion will be based on the

definition constructed by Strauss et al. (2016), in which previous definitions and views are brought together. In this definition, self-compassion is a cognitive, affective and behavioral process consisting of five elements: recognizing suffering, understanding the universality of suffering in human experience, feeling empathy for the person suffering and connecting with the distress, tolerating uncomfortable feelings aroused in response to the suffering person and motivation to alleviate suffering.

Self-compassion interventions

Under the definition (by Strauss et al., 2016) used in this research, enhancing self-compassion would be beneficial for enhancing underdeveloped capacities for self-soothing as well as reducing self-criticism. This is exactly what several researchers have attempted to do by variations of interventions. Recently, novel psychotherapeutic procedures have been developed, inspired by Eastern meditative practices, in which compassion is channeled

through meditation (Gilbert, 2014). Therapeutic approaches have emphasized the evolutionary psychology of attachment and the capacity to influence negative self-referential thinking through a variety of compassion-focused exercises such as compassionate imagery (Kamboj et al., 2016). This has been done by use of Compassion-Focused Therapy (CFT) (Gilbert, 2014), in which people are invited to imagine their ideal of caring and compassion, to direct benevolent, warmly regarding and compassionate feelings toward the self (Gilbert, 2014). Self-directed compassion has shown promising results in reducing shame and guilt in psychopathology, as well as promoting wellbeing and resilience in the absence of psychological disorders (Wallace and Shapiro, 2006). Indeed, expert meditators show

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evidence of achieving states of ecstasy and transcendence, however, these effects are generally achieved only after intensive and prolonged practice. Therefore, it is of clinical interest to achieve these effects more efficiently.

To enhance effects of compassion in meditation, Rockliff et al. (2011) explored effects of oxytocin on Compassion Focused Imagery (CFI), and found that oxytocin reduced self-critical thoughts and increased the ease of imagining compassionate qualities. In addition, these effects were moderated by attachment-related avoidance, with oxytocin leading to more negative effects of CFI in those with avoidant attachment styles. Kamboj et al. (2016) have attempted to replicate these results by use of ecstasy, rather than oxytocin. In their study, similar results were found (as in Rockliff et al., 2011), with 3,4-Methylenedioxy-N-hydroxy-N-methylamphetamine (MDMA) producing increased compassion and reduced self-criticism, however, no moderation of attachment-related avoidance was found. Individuals in these researches experienced compassion as a frightening and alien experience, as such, improved methods of overcoming barriers to self-soothing are still of great need.

Priming

With intentions of finding successful treatments for children, methods of enhancing the effects of self-compassion interventions are needed that are ethical and non-invasive. Recently, a new method has been attempted to enhance effects of self-compassion interventions, by the use of priming. Currently, priming effects are ubiquitous in social psychological literature, as nearly all forms of social representation can be primed (Bargh, 2006). Priming can be defined as nonconscious activation of social knowledge structures, to influence what comes next without the person’s awareness of this influence (Bargh, 2006). Rowe et al. (2016) used semantic priming prior to mindfulness meditation training to increase the likelihood of continuing the mindfulness training. Attachment security was primed by visualising and writing about a person one has or had a close relationship with, activating feelings and thoughts. Self-compassion was activated by (adapted from Rockliff et al., 2011), visualising and writing about being completely compassionate and warm toward oneself. Results showed that both primes increased willingness to engage in further mindfulness training, thus improving chances of enhancing self-compassion through this form of meditation. While many meditational interventions include self-compassion training as an integral part of their programs (Hoffmann et al., 2011), self-compassion priming is

comparatively new in research (Rowe et al., 2016). Rowe et al. (2016) show that compassion can be reliably primed, suggesting that a combination of meditation and

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self-SENSORY PRIMING IN SELF-COMPASSION ENHANCEMENT 9

compassion enhancement may make self-compassion more accessible. These results make way for new research to find other forms of priming that can benefit the enhancement of self-compassion.

Sensory priming

For example, Williams and Bargh (2008) have used sensory priming to assess different but related concepts, such as interpersonal warmth and prosocial behavior toward self and others. Interpersonal warmth was primed by physical warmth by holding a hot (versus cold) therapeutic pad. Results showed that those holding the hot pad were more likely to show interpersonal warmth and prosocial behavior toward others. Another way to

experience physical and psychological warmth, is through the use of animals, like in Animal Assisted Therapy (AAT). AAT has been receiving growing attention as a legitimate means of influencing a large number of health-related problems (Martin & Farnum, 2002). Research indicates that interaction with animals may have the ability to enhance both physiological and psychological well-being, reducing anxiety (Barker & Dawson, 1998), increasing self-esteem (Walsh & Mertin, 1994) and alleviating stress in children (Hansen, Messinger, Baun & Megel, 1999).

Aim

The aim of this research, is to find new ways of enhancing the effects of

self-compassion interventions, thus, to enhance self-self-compassion. It is hypothesized that the results of earlier self-compassion interventions can be combined in sensory priming, to achieve results in self-compassion enhancement. In this experimental pilot study, sensory priming will be compared to a control condition. To replicate previous research, adults will be used in this study. The further aim is to implement results in later research with children. Based on earlier results, it is hypothesized that self-compassion will increase significantly more after

meditation for those in the sensory priming condition, than those in the control condition. In turn, self-criticism is expected to decrease more after meditation for those in the sensory priming condition, than in the control condition. The final hypothesis is exploratory. A moderating effect of attachment-related avoidance in self-compassion and self-criticism is expected for those in the sensory priming condition, but due to conflicting results in earlier research, the direction of this effect is currently unknown.

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Methods

Participants

Participants were recruited from the local community through word of mouth, through flyers that were handed out at locations such as local universities and stores and by posts on social media websites such as Facebook, Instagram and LinkedIn. Participants were screened via e-mail and/or phone to exclude those with prior self-compassion meditation experience, non-sufficient English language level and/or outside the range of ages 18 through 45. Participants generally did not practice meditation (n = 49), although some had other meditation experience (n = 9). The number of years that participants had used the English language (speaking, writing, listening and reading) was generally high, over 6 to 10 years (n = 39), while for most participants English was not their native language (n = 43). 50 participants began and completed the study. However, one was excluded on the grounds that the

participant seemed to understand the purpose of the research, resulting in a sample size of n = 49 (thirty-seven women and 12 men, mean age 25.06 years).

All participants gave written, informed consent forms at the start of the experiment, during which they were made aware that they could withdraw from the study at any time without needing to give reason, as well as ask any questions they might have during the experiment if problems occurred. The study was approved by the University’s School of Psychology Ethics Committee (2016-CDE-7472).

Design and procedure

The experimental design corresponds to a within between-subject factorial design, in which two conditions, sensory priming and control, were compared during three time points (baseline, after priming and after meditation). Participants were randomly assigned to a lab room, by allowing each participant to choose a slip with a room number inside and instructing them to individually read the number and find the room. Both conditions followed identical protocol, held in identical lab rooms, located in the same psychology lab at the University of Amsterdam, The Netherlands. In addition, the experiment was blinded, therefore both the participant as well as the researcher were blind to the condition. Therefore, reliability of results was maximized by ensuring a minimum amount of interaction between researcher and participant.

Experiments were held in three daily sessions, starting at 08.00, 09.00 or 10.00 AM, with a maximum of nine participants per session. Once the lab room was found, the

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participants completed several questionnaires on a desktop computer, including a

demographic questionnaire, the Revised Adult Attachment Scale (RAAS) (Collins, 1990) for measuring attachment dimensions and the Self-Compassion and Self-Criticism Scales (SCCS) (Falconer, King & Brewin, 2015) for measuring self-criticism and self-compassion. Next, participants were instructed on the computer screen to grab the box on the floor beneath their desk and read the instructions in the box. In the sensory priming condition, these instructions implied holding a warm, fluffy pillow on their lap, which was filled with an activated

therapeutic pad, for three minutes and in the control condition, performing five simple hand tendons of twenty seconds each (Darebee workouts, 2017). After the condition, participants completed the SCCS once more, then were asked to stay comfortably seated while listening to a 15-minute meditation recording of the compassionate friend meditation by Christopher Germer, through their headsets. Following the meditation exercise, the SCCS was completed one last time. After finishing the experiment, each participant was given €5 for their time and were entered in a prize draw for a €50 voucher. At night, participants were debriefed and thanked for their time.

Measures

Priming.

Sensory priming by use of a warm, fluffy pillow the size of a small animal, was inspired by animal assisted therapy (AAT) and sensory priming used in Williams and Bargh (2008). A therapeutic pad was activated before the experiment and put inside a soft, fluffy pillow. Therapeutic pads were used rather than animals, as it was logistically easier to use inside the psychology lab, in addition to being more animal friendly.

Attachment-related avoidance.

The ‘Close Relationships’ Version of the Revised Adult Attachment Scale was used (Collins, 1990), which consists of 18 statements and three subscales (‘Close’, ‘Depend’ and ‘Anxiety’). Each statement is rated on a five-point Likert scale, expressing the extent to which is characteristic of how the participant generally feels in important close relationships in their life (1 = not at all characteristic of me, 5 = very characteristic of me). Subscale ‘Close’ measures how comfortable an individual is with closeness, tapping attachment-related avoidance. The normative value of this subscale, based on a large-scale cluster analysis of different attachment styles is 3.20 (Collins, 1990). The ‘Close’ subscale was of particular interest in this study due to earlier research results, which found a moderating effect of

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attachment-related avoidance in effects of self-compassion intervention (Rockliff et al., 2011). Results on the ‘Close’ subscale were recoded as directed in Collins (1990). As performed in Kamboj et al. (2016), participants were classified as relatively low (mean score ± SD: 2.99 ± 0.58) or high on attachment related avoidance (mean score ± SD: 4.24 ± 0.40) on attachment-related avoidance, based on a median split of their scores, which were statistically different (t (47) = -8.65, p < 0.001).

State self-compassion and self-criticism.

The SCCS (Falconer, King & Brewin, 2015) was used to measure situational self-compassion and self-criticism. Items from this measure were used to assess to what extent participants felt soothing, reassuring, compassionate (self-compassion items), harsh,

contemptuous or critical (self-criticism items) on seven-point Likert scales (1 = not at all to 7 = highly). The SCCS is psychometrically separated into two orthogonal scales (self-criticism and self-compassion), which have excellent or good reliability with Cronbach’s alphas of 0.91 and 0.87 respectively (Falconer, King & Brewin, 2015). Recent research suggests that the SCCS is a useful tool in repeated measures designs that examine the effects of experimental compassion-focused interventions (Falconer et al., 2014).

Compassionate mediation.

Participants completed a guided meditation exercise by listening to an MP3 recording of the Compassionate Friend Meditation by Christopher Germer through a headset. In the recording, nurturing, warmly regarding and compassionate feelings were channeled toward a compassionate friend, similar to the CI exercise in Kamboj et al (2016). Here, a brief outline is provided (the exercise is available on Germer’s website:

https://chrisgermer.com/meditations/). The first five minutes consisted of visualizing a safe, comfortable place and a compassionate being, such as a friend or teacher. The next five minutes consisted of stepping out of the visualized safe place to meet or invite in your compassionate friend. In the last five minutes, it is made clear that the visualized

compassionate being is actually part of the self, that all the compassionate feelings are always within and can be called upon whenever one might need to. The description was permissive, allowing participants to generate any type of compassionate figure, per their preference. Participants were not given any specific instructions to bring the compassionate images and feelings to mind when completing the other measures.

Demographic questionnaire.

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country of birth, level of English (if not native, how many years and fluency of English language in speaking, writing, reading and listening), level of education,

employment status and previous (compassion) meditation experience.

Statistical analysis.

Prior to analyzing data, preliminary analyses were conducted, including a randomization check (comparison of groups at baseline (T1)), a check for outliers and correlations between variables (see Table 1) and assessment of assumptions important for conducting repeated measures analysis of variance (ANOVA). Six assumptions for repeated measures ANOVA were assessed. The assumptions that the dependent variable(s) (self-criticism and self-compassion) is measured at the continuous level and that the independent variable(s) should consist of at least two related groups, were met. The assumptions that the related groups show no significant outliers and that the dependent variable(s) should be normally distributed were violated. Self-criticism data was non-normally distributed and outliers above three times the box length were found for all three measurements of self-criticism in the sensory condition at baseline (T1 self-self-criticism skewness = 0.67 (SE = 0.47) and kurtosis = 0.12 (SE = 0.92), after priming (T2 self-criticism skewness = 0.28 (SE = 0.46) and kurtosis = -0.56 (SE = 0.90) and after meditation (T3 self-criticism skewness = 1.79 (SE = 0.47) and kurtosis = 2.91 (SE = 0.92) and in the control condition after priming (T2 self-criticism skewness = 1.00 (SE = 0.46) and kurtosis = 0.92 (SE = 0.90). Therefore, the data was transformed with a logarithmic transformation. The data showed no significant outliers above three times box length after transformation and the distribution of self-criticism was near normal in both the sensory condition (T1 self-criticism skewness = -0.13 (SE = 0.47) and kurtosis = -0.80 (SE = 0.92, T2 self-criticism skewness = 1.25 (SE = 0.47) and kurtosis = 0.86 (SE = 0.92), T3 self-criticism skewness = 1.16 (SE = 0.47) and kurtosis = 0.24 (SE = 0.92) and the control condition (T1 self-criticism skewness = -0.42 (SE = 0.46) and kurtosis = -0.47 (SE = 0.90), T2 self-criticism skewness = 0.11 (SE = 0.92) and kurtosis = -1.09 (SE = 0.90), T3 self-criticism skewness = 0.446 (SE = 0.46) and kurtosis = -1.24 (SE = 0.92). Self-compassion met all the formerly discussed assumptions. The sphericity assumption was met for both self-criticism and self-compassion. Finally, the assumption of homogeneity of variances for each combination of the groups of factors was violated at T3 (after meditation) for self-criticism. Levene’s test for equality of variances indicated that at T3, (M = 0.68, SD = 0.23), (F (1, 47) = 4.49, p = .04) self-criticism had significant non-homogeneous variances.

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(Meditation ± priming) and Time (T1, T2, T3) as within-subjects factors and state self-compassion and self-criticism as dependent variables. Repeated measures ANOVAs (2 x 3 x 2) were also used to assess the effects of sensory priming on compassion and

self-criticism, respectively, with attachment-related avoidance status (high and low) as a between-subjects factor. Based on Kamboj et al. (2016) a post-hoc power calculation was done with G*Power, with the assumption of medium effects (ƒ = 0.25) in a within-between interaction repeated measures analysis of variance (ANOVA) (Time x Condition), with β = .4, α = 0.05, assuming strong correlations between variables across time, suggested a medium power of 0.56 for a sample size of 49.

Results

Demographics

Participants were screened via e-mail and/or phone to exclude those with prior self-compassion meditation experience, non-sufficient English language level and/or outside the range of ages 18 through 45. Fifty participants began and completed the study. However, one was excluded on the grounds that the participant seemed to understand the purpose of the research, resulting in a sample size of n = 49 (thirty-seven women and twelve men, mean age 25.06 years (SD = 6.2), range = 18-45). On average, the highest level of education that most participants had completed was a bachelor degree (n = 22), followed by some college credit (n = 10) and high school (n = 8). While the majority of participants was not a native English speaker (87,8%) and most of them were born in The Netherlands (n = 36), nearly all participants had experience with the English language for more than 3 years (97.6%). In addition, all participants rated themselves no lower than 4 on 7-point Likert scales for speaking, writing, reading and listening, indicating that the level of English was sufficient to understand and perform the experiment.

Effects of priming and compassionate meditation on self-compassion

No significant main effects of Time (F (2, 90) = 1.31, p = 0.27, η2 = 0.03) or

Condition (F (1,45) = 1.17, p = 0.29, η2 = 0.03) were found on the self-compassion scale of the SCCS indicating that there was no significant difference in self-compassion scores throughout time points (T1-T3) or between experimental conditions. A non-significant trend was found for the interaction effect for Time × Condition (F (2, 90) = 3.01, p = .054, η2 = .06)

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on the self-compassion scale of the SCCS. As can be seen in Figure 1, a slight increase occurred in the sensory priming condition between time points (T1-T3), namely between T1 and T2, but this increase is not significantly different from the control condition. An overview of means and standard deviations of these effects can be found in Table 2.

Figure 1. Effect of Condition (sensory priming and control condition) on self-compassion

over time (T1, T2, T3). SCCS: Self-Compassion and Criticism Scale.

Effects of priming and compassionate meditation on self-criticism

A significant main effect was found for Time (F (2, 90) = 15.32, p = < .001, η2 = 0.25) on the self-criticism scale of the SCCS indicating that self-criticism scores differed between time points (T1-T3). As can be seen in Figure 2, this effect reflects the reduced self-criticism between baseline (T1 M = 0.79, SD = 0.19) and priming (T2 M = 0.64, SD = 0.20) and between priming (T2) and compassionate meditation (T3 M = 0.62, SD = 0.18) in the sensory condition. A similar reduction was found in the control condition between baseline (T1 M = 0.83, SD = 0.16), (neutral) priming (T2 M = 0.76, SD = 0.22) and compassionate meditation (T3 M = 0.74) (SD = 0.25). A non-significant trend was found for Condition (F (1, 45) = 3.28, p = 0.08, η2 = 0.07) but no significant interaction effect for Time × Condition (F (2, 90) = 2.41, p = 0.10, η2 = 0.05) was found. As can be seen in Figure 2, self-criticism shows a larger reduction in the sensory priming condition than the control condition.

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condition (M = 0.68, SD = 0.19) and the control condition (M = 0.78, SD = 0.21) in the experiment.

Figure 2. Effect of Condition (sensory priming and control condition) on self-compassion

over time (T1, T2, T3). SCCS: Self-Compassion and Criticism Scale.

Moderating role of attachment-related avoidance on self-compassion

A non-significant trend for the moderating role of attachment-related avoidance was found with respect to self-compassion (F (1, 45) = 3.31, p = 0.08, η2_{= .07). No interaction}

effects for Time × attachment-related avoidance (F (2, 90) = 1.36, p = 0.26, η2_{= .03) or Time}

× Condition × attachment-related avoidance (F (2,90) = 0.91, p = 0.41, η2_{= 0.02) were found.}

However, a significant interaction effect was found for Condition × attachment-related avoidance regarding self-compassion (F (1, 45) = 10.5, p = 0.002, η2 _{= 0.19), indicating a}

difference in self-compassion between conditions (sensory priming and control) and level of attachment-related avoidance. As can be seen in Figure 3, this effect reflects the improvement in self-compassion for those low in attachment-related avoidance in the sensory condition. A reduction of self-compassion was found for those in the control condition. For those high in attachment-related avoidance a similar but smaller improvement was found in the sensory condition and a slight reduction in self-compassion for those in the control condition.

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Figure 3. Moderating effect of avoidant attachment on self-compassion at three measurement

points (T1, T2, T3) within the sensory priming + meditation condition and control + meditation condition. SCCS: Self-Compassion and Criticism Scale.

Moderating role of attachment-related avoidance on self-criticism

No significant moderating role of attachment-related avoidance was found with respect to self-criticism (F (1, 45) = 0.019, p = 0.89, η2_{= .000) indicating that}

attachment-related avoidance had no significant effect on self-criticism. In addition, no significant interaction effects were found for Time × attachment-related avoidance (F (2, 90) = 2.31, p = 0.11, η2_{= .05), Condition × attachment-related avoidance (F (1, 45) = 0.27, p = 0.61, η}2 ₌

0.01) or Time × Condition × attachment-related avoidance (F (2,90) = 0.71, p = 0.93, η2₌

.002). In Figure 4 a small reduction in self-criticism can be seen for those high in attachment-related avoidance in the sensory condition. A similar, but smaller reduction was found for those high in attachment-related avoidance in the control condition. In addition, a similar reduction in self-criticism was found for those low in attachment-related avoidance in the sensory condition between T1 and T3 as well as a slight reduction for the control condition. However, these effects were not statistically significant.

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Figure 4. Moderating effect of avoidant attachment on self-criticism at three measurement

points (T1, T2, T3) within the sensory priming + meditation condition and control + meditation condition. SCCS: Self-Compassion and Criticism Scale.

Table 2

Means and Standard Deviations of Self-Criticism and Self-Compassion for those Low and High in Attachment-Related Avoidance at Measurement Time Points T1 (Baseline), T2 (after Priming) and T3 (after Compassionate Meditation)

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Discussion

The present pilot study examined the effects of sensory priming, by use of a warm fluffy pillow, in addition to compassionate meditation, as new way to enhance the effect of self-compassion meditation. Anecdotal reports have been inconclusive and systematic studies on self-compassion enhancement have been lacking (Kamboj et al., 2016). The investigation of the use of sensory priming has been extended beyond the widely documented effects for concepts related to self-compassion such as interpersonal warmth and prosocial behavior (Williams & Bargh, 2008) to self-compassion. Trends were found in line with earlier predictions.

Effects of sensory priming on self-compassion

In terms of self-compassion the hypothesis was tested that self-compassion would increase significantly more after compassionate meditation (T3) in the sensory condition, than in the control condition. Different from earlier research (Kamboj et al., 2016),

self-compassion did not show a significant increase over time or between conditions. A non-significant trend was found for improvements of self-compassion in the sensory condition, showing a larger improvement in self-compassion directly after the priming phase (T2). While not statistically significant, this finding suggests a positive effect of sensory priming on self-compassion. However, these results cannot confirm this hypothesis, as self-compassion did not increase more significantly for the sensory condition after compassionate meditation (T3) than the control condition.

Effects of sensory priming on self-criticism

This study tested the hypothesis that self-criticism would decrease significantly more after compassionate meditation (T3) in the sensory priming condition than in the control condition. Self-criticism showed significant reduction over time and a nonsignificant trend was found for Condition, with larger reductions of self-criticism observed for those in the sensory condition. However, these reductions did not reach statistical significance. The direction of this trend is in line with recent research on which the hypothesis was based, in which enhancement of meditation effects such as self-criticism reduction was facilitated by the use of MDMA (Kamboj et al., 2016). Lastly, no interaction effects were found, which is not in line with results from Kamboj et al. (2016), but can be contributed to the lack of achieving statistical significance in main effects of Condition. The hypothesis cannot be

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confirmed, as no significant results were found for differences in self-criticism between conditions.

Moderating effect of attachment-related avoidance

In addition, attachment-related avoidance was expected to moderate the effects of sensory priming on self-criticism and self-compassion. No significant moderating role was found regarding self-criticism. For self-compassion, a non-significant trend was found for the moderating role of attachment-related avoidance. The direction of both findings was in line with earlier research by Kamboj et al. (2016). In addition, a significant interaction was found between Condition and attachment-related avoidance, indicating larger improvements in self-compassion for those low in attachment-related avoidance in the sensory priming condition. This finding is in line with research by Rockliff et al. (2011), in which oxytocin facilitated stronger compassionate meditation effects for those low in attachment-related avoidance. However, research by Kamboj et al. (2016) found opposite results, in which MDMA facilitated stronger effects of compassionate meditation and resulting self-compassion for those high in attachment-related avoidance.

In general, results found in this study did not reach statistical significance, but the direction of the effects was in compliance to results found by Kamboj et al. (2016) and Rockliff et al. (2011). Self-criticism decreased significantly over time and a trend was found for a stronger decrease in the sensory condition than the control condition at T2, rather than the hypothesized T3. Self-compassion showed a non-significant trend for the moderating role of attachment-related avoidance and a significant interaction between condition and

attachment-related avoidance, showing that those low in attachment-related avoidance experienced significantly more self-compassion in the sensory condition than the control condition. As few effects reached statistical significance, more research is required in order to make conclusions about the effects of sensory priming in self-compassion enhancement as well as the moderating effect of attachment-related avoidance. The absence of significance for these results may reflect insufficient statistical power and therefore results may have been unable to detect effects in statistical analyses.

Limitations

Some noteworthy limitations existed in this research. This study relied on convenience sampling, so participants may be non-representative in terms of attachment-related avoidance. The study was primarily limited by a small sample size and therefore constricting

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generalizability. Despite of some results not being statistically significant (p < 0.05), medium effect sizes were observed in post-hoc analysis. Due to the small sample size, a lack of statistical power existed in this study. Therefore, it may have not been possible to detect differences in self-criticism and self-compassion between conditions, as well as the

moderating effect of attachment-related avoidance. Another limitation is due to non-normal distribution, transformation of self-criticism data was needed and analyses were not

conducted with original data. Therefore, the accuracy of the test results may be impaired. In spite of these limitations, this study had some noteworthy strengths as well. The risk of bias was reduced because the research was blinded and therefore both participant as well as researcher were blind to the research condition that the participant was in. In addition, the use of priming as means for self-compassion enhancement was an ethical and

non-invasive approach, especially in comparison to earlier research using pharmacological means. This approach may be useful in future research with children, which requires increased attention for ethical questions (Morrow & Richards, 1996). Therefore, this study was a successful pilot study in self-compassion enhancement by use of sensory priming.

Clinical implications

The results found in this study have implications for clinical practice. While the inability to find conclusive results requires further research, the general direction of the findings suggest that sensory priming is a promising and potentially effective component in clinical interventions for self-compassion enhancement. In addition to successful results in research using pharmacological methods, like in Kamboj et al. (2016) and Rockliff et al. (2011), a new way may have been found to enhance effects of compassion meditation and consequently enhance self-compassion and reduce self-criticism. Encouraging trends were found in this suggesting that adding a simple, non-invasive component like sensory priming could be beneficial to current self-criticism and self-compassion interventions. Although the findings presented here are promising, further research is still of the essence. Inconclusive results were found regarding both self-compassion and self-criticism, as well as for the moderating role of attachment-related avoidance. These results were in accordance to several researches rather than one. More comparative research with stronger statistical power is needed to expand results and make definitive conclusions about the use of sensory priming in self-compassion enhancement. Negative referential thinking, like self-criticism, continues to be an underlying factor in aetiology and maintenance of a variety psychopathologies and can be regarded as an important transdiagnostic factor (Irons & Gilbert, 2005). For those high in

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attachment-related avoidance in particular, whom experience barriers to self-compassion (Fraley, Davis & Shaver, 1998), finding effective ways of decreasing self-criticism remains a priority for psychiatry and clinical psychology. Non-invasive means of enhancing self-compassion such as sensory-priming are easy to implement and of great use, especially in children, for whom animal(like) therapy has shown to be very beneficial in enhancing well-being, increasing self-esteem (Walsh & Mertin, 1994) and alleviating stress (Hansen, Messinger, Baun & Megel, 1999).

Future research should strive to replicate this study with a larger and more diverse sample. In addition, the moderating effect of attachment should be further assessed through sensory priming to obtain more meaningful results. More meaningful results may allow for sensory priming to be implemented in self-compassion interventions, creating new tools for prevention and treatment of a range of disorders in children as well as adults.

Conclusions

In conclusion, this study has shown promise for sensory priming in the enhancement of compassionate meditation effects such as compassion. Improvements in

self-compassion and reduction in self-criticism were found, though due to several limitations constraining the study and only a few significant results, the findings must be interpreted with great care. While an improvement of self-compassion was found for those low in related avoidance, no significant results were found for the moderating role of attachment-related avoidance in either self-compassion or self-criticism. The moderating role of

attachment-related avoidance should therefore be further investigated. With more conclusive results, the effect of sensory priming on self-compassion and self-criticism and the role of attachment-related avoidance can be further defined. While more comparative research is needed, a first step has been made toward a new tool for self-compassion enhancement. Implementing sensory priming in clinical interventions could be an easy, non-invasive tool to enrich current self-criticism and self-compassion interventions for children as well as adults that experience barriers to self-compassion.

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Appendices Appendix A.

Table 1

Correlations between Self-Criticism and Self-Compassion at Measurement Time Points T1 (Baseline), T2 (after Priming condition) and T3 (after Compassionate Meditation)

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Appendix B.

The fluffy pillows used in the sensory condition in the experiment, which were later filled with therapeutic pads, shown below in Appendix E.

Appendix C.

Therapeutic hot pad which were activated and put inside the fluffy pillows shown in Appendix F as source of warmth for sensory priming in the experiment.