The development of the ‘Forms of Responding to Self-Critical Thoughts Scale’ (FoReST)

https://doi.org/10.1016/j.jcbs.2019.11.003Get rights and content

Highlights

  • Self-critical thoughts are associated with a range of mental health difficulties.

  • High levels of psychological inflexibility are associated with increased distress.

  • A measure of psychological inflexibility related to self-critical thoughts is needed.

  • The factor structure and validity of a new measure called the FoReST are explored.

  • The FoReST is a valid measure of inflexible responding to self-critical thoughts.

Abstract

Background

Self–critical thoughts are a feature of many mental health problems. Adopting a psychologically flexible response to thoughts has been highlighted as a key determinant of wellbeing. But, the measurement of psychological flexibility (PF) in relation to self-critical thoughts is under-developed. This paper reports on the development of the Forms of Responding to Self-Critical Thoughts Scale (FoReST).

Method

Study One involved the development and exploratory factor analysis of the FoReST in a convenience sample of 253 non-clinical adults. Study Two was a confirmatory factor analysis study of the FoReST in a sample of 110 University students. Study 3 explored the convergent and concurrent validity of the FoReST by examining associations with measures of similar constructs (PF, self-compassion, self-criticism) and relevant mental health measures (anxiety, depression, distress). Study 3 also explored the FoReST's incremental validity for predicting depression and anxiety levels beyond an established measure of self-critical thinking.

Results

In Study One, exploratory factor analysis produced a 9-item/2-factor solution (unworkable action and mindful acceptance). The measure demonstrated good internal consistency. In Study 2, the confirmatory factor analysis also indicated a 2-factor model (unworkable action and mindful acceptance) and overall internal consistency that was excellent. In Study Three, the FoReST demonstrated high convergent validity with similar measures, and good concurrent validity with mental health outcomes. Analyses also indicted good incremental validity for the FoReST for predicting HADS depression and anxiety scores.

Conclusions

The FoReST appears to be a psychometrically sound measure suitable for measuring change processes in third wave therapies such as Acceptance and Commitment Therapy, Mindfulness-based Interventions and Compassion Focused therapy.

Introduction

Excess self-criticism can be understood as a form of stressful self-harassment, which undermines healthy self-acceptance (Gilbert, 2004). Elevated levels of self-critical thoughts occur in depression (Yamaguchi & Kim, 2013); eating disorders (Goodwin, Arcelus, Geach, & Meyer, 2014); social anxiety (Kopala-Sibley, Zuroff, Russell, & Moskowitz, 2013) and psychosis. As such, self-critical thoughts have been identified as an important treatment target in Cognitive-Behavioral Therapy (CBT) (Fennell, 2006; McManus, Waite, & Shafran, 2009) and in more recent ‘third-wave therapies’ that build on the CBT tradition such as Mindfulness-based interventions (MBI) (e.g. Mindfulness-based Stress Reduction; Mindfulness Based Cognitive Therapy), Acceptance and Commitment Therapy (ACT), and Compassion Focused Therapy (CFT) (Hayes & Hofmann, 2017). These third-wave therapies aim to help people to pay attention ‘on purpose, in the present moment, and non-judgmentally’ (Kaiser, 1960, p. 4). Although research suggests that third-wave therapies are an effective treatment for multiple psychological disorders (e.g., recurrent depressive disorder; Piet & Hougaard, 2011), consensus has not been reached on what the key change processes in these therapies are (Van der Gucht, Takano, Raes, & Kuppens, 2017). As third-wave treatments have become more popular there have been increasing efforts to move beyond standard CBT measures that identify the presence of unhelpful or maladaptive cognitions and supplement them with measures that quantify the way that people relate and respond to internal experiences, including their thoughts.

Gilbert (2009a) suggested that the adoption of harsh and self-critical thoughts in relation to oneself serves as a maladaptive way of defending against criticism from others (Gilbert & Irons, 2005). Like many cognitive experiences, problematic self-criticism will be determined by the context of the experience. The capacity for self-critical thoughts may have evolved as a self-regulatory ability that motivated behavior change in the face of failure or repetition of unhelpful behaviors. Hence, criticizing the self as a discrete action to activate motivation for change may be energizing in particular contexts, but repeated critical self-talk will be demoralizing and likely to undermine effective behavior change efforts. The suggestion here being that self-critical thoughts serve to limit a person engaging in behaviours that might expose him/her to potentially harmful evaluation from others. The cultivation of self-compassion can be seen as a more adaptive alternative to both self-criticism and low self-esteem (Neff, 2003b). It consists of three main components: self-kindness, common humanity and mindfulness (Neff, 2003b). Assessment instruments that measure self-compassion (e.g. Self-Compassion Scale: SCS, Neff, 2003a) and self-critical thoughts (e.g. Forms of Self-Criticizing/Attacking & Self-Reassuring Scale: FSCRS, Gilbert, Clarke, Hempel, Miles, & Irons, 2004) have been used to evaluate the efficacy of CFT.

But the mere presence of self-critical thoughts is not necessarily indicative of pathological processes. Self-critical thoughts are intrinsic to human experience and are widely reported in non-clinical samples (Baião, Gilbert, McEwan, & Carvalho, 2015). Indeed, as has been suggested, these may serve a regulatory function (Duarte, Matos et al., 2017). Hence, in addition to measuring the presence and level of self-critical thinking, there is a need to understand how responses to self-critical thoughts may impede engagement in behaviors consistent with personally held values.

Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999; 2012) specifically aims to cultivate what has been operationalized as psychological flexibility (PF) - “the ability to be in the present moment with full awareness and openness to experiences and to take guided action towards personally held values” (Harris, 2009, p. 12). Instead of utilising ‘first order’ strategies aimed at directly altering the content of thoughts, ACT seeks to explore the functional context in which these experiences occur and employ ‘second-order’ strategies such as mindfulness, acceptance, or cognitive defusion to enhance PF. Low PF is characterized by behavioral rigidity that stems from efforts to control and suppress difficult internal experiences (e.g. thoughts, feelings, sensations) and is implicated in the development and maintenance of a broad range of psychological problems (Bond & Bunce, 2003) including social anxiety (Dalrymple & Herbert, 2007); depression (Cash & Whittingham, 2010), psychosis (White, 2015, White et al., 2013) and borderline personality disorder (Rüsch et al., 2008). Moreover, studies have also demonstrated that greater PF is positively associated with subjective wellbeing (A-Tjak et al., 2015; McCracken, Gutierrez-Martinez, & Smyth, 2013; Bohlmeijer et al., 2017).

The most commonly used measure of PF is the Acceptance and Action Questionnaire (AAQ-II; Bond et al., 2011), which assesses the extent to which an individual's cognitions can prevent them from engaging in values-consistent actions (e.g. “I'm afraid of my feelings”, “My painful memories prevent me from having a fulfilling life”). Because the AAQ-II is very general in its focus, a range of context-specific measures of PF have been developed e.g. the Acceptance and Action Questionnaire – Substance Abuse (AAQ-SA; Luoma, Drake, Kohlenberg, & Hayes, 2011); Voices Acceptance and Action Questionnaire (V-AAQ; Shawyer et al., 2007); Acceptance and Action Questionnaire for Social Anxiety (AAQ-SA; MacKenzie and Kocovski, 2010; the Work-related Acceptance and Action Questionnaire (WAAQ; Bond, Lloyd, & Guenole, 2013); Acceptance and Action Questionnaire – Acquired Brain Injury (AAQ-ABI; Whiting, Deane, Ciarrochi, McLeod, & Simpson, 2015); and the Acceptance and Action Questionnaire – Stigma (AAQ-S; Levin et al., 2014).

To date, no measure of PF that focuses specifically on self-critical thoughts has been developed. Given the associations between self-critical thoughts and various forms of mental health difficulties (e.g. depression, social anxiety, eating disorders and psychosis), it is likely that the development of such a measure would have both clinical and research utility. This new measure would complement existing measures that assess the intensity/frequency of self-critical thoughts, but do not measure the extent to which the person becomes psychologically inflexible in response to these thoughts. A measure of this type would have widespread application for third-wave interventions such as MBI, ACT and CFT.

The current paper reports on the development of the Forms of Responding to Self-critical Thoughts Scale (FoReST), a novel measure of how psychologically flexible people are in responding to self-critical thoughts. This measure aims to assess willingness to experience self-critical thoughts whilst simultaneously committing to values-directed action.

Study 1 entailed the generation of items for the FoReST and an Exploratory Factor Analysis (EFA) of the measure in a convenience non-clinical sample of adults. Study 2 continued the development of the FoReST by conducting a Confirmatory Factor Analysis (CFA). Study 3 explored the construct validity of the FoReST by measuring convergent validity against measures of similar constructs (psychological inflexibility, self-compassion and self-criticism); concurrent validity of the FoReST in relation to theoretically relevant outcomes measures (depression, anxiety and distress), and incremental validity by examining the FoReST's ability to predict levels of depression and anxiety (two clinically important outcomes) beyond an established measure of self-critical thinking (inadequate-self-critical thoughts).

Section snippets

Item generation

The FoReST was developed to assess how psychologically flexible people are in responding to self-critical thoughts rather than the frequency or severity of the self-critical thoughts. It was decided that a single stem statement would be used for each assessment item: ‘When I have a critical thought about myself … ‘, with the items themselves taking the form of responses to this stem statement (e.g. “… I try to ignore it”).

An initial set of 46 items was generated by the research team by drawing

Analysis

We conducted an EFA in order to identify one or more latent factors underlying the observed data. We undertook a common factor analysis and used parallel analysis (Horn, 1965) to determine the number of factors to extract. All analyses were conducted on the SPSS statistics program version 22 (IBM Corp, 2013). In accordance with (Kaiser (1960)) recommendation, factors with Eigenvalues over 1 were included in the initial model. Existing measures have found unifactorial models of PF (Bond et al.,

Results

We first examined the appropriateness of our dataset for analysis. The Kaiser-Meyer-Olkin measure of sampling adequacy and Barlett's test of sphericity both indicated the suitability of the dataset for structure detection. An initial review of the 46 items indicated that seven had low inter-item correlations and eight did not have distributions that approximated normal. After these items were excluded, 31 items remained. At this stage, multicollinearity was found to be an issue as the

Procedure

Study 2 also used a cross-sectional design. Data collection for this study formed part of an undergraduate student project within the Department of Psychology at Goldsmiths, University of London, UK. Ethical approval was sought and granted from the Department's ethics committee. Participants were undergraduate students studying a range of disciplines from multiple colleges within the University of London. Participants from within Goldsmiths were offered course credit for their participation,

Analysis

In our second study, we carried out a CFA to test the fit of the two-factor FoReST model and examine the fit of this model in comparison to an alternative one-factor model where all items were allowed to load onto a single ‘Forms of Responding to Self-Critical Thoughts’ factor. We used Mplus version 8.2 (Muthén & Muthén, 1998–2017) for all data analysis. We fitted our measurement model using the Maximum likelihood [ML] estimator and evaluated goodness of fit using a combination of absolute and

Procedure

Study 3 was conducted to explore the convergent, concurrent and incremental validity of the FoReST. Data from Study 1 (i.e. Sample 1) and Study 2 (i.e. Sample 2) were used to assess the convergent validity of the FoReST by assessing correlations with the AAQ-II (Sample 1 and 2), the Self-Compassion Scale (SCS) (Sample 1 and 2) and the Forms of Self-Criticizing/Attacking & Self-Reassuring Scale (FSCRS) subscales (Sample 1). The concurrent validity of the FoReST was assessed by investigating

Discussion

In this series of studies, we systematically developed and examined the psychometric properties of a novel measure of how psychologically flexible people are in responding to self-critical thoughts (the FoReST) (see Fig. 1). A measure of this type should have applications with third-wave psychological interventions (e.g. ACT, MBI and CFT) for mental health difficulties where self-critical thoughts are purported to be a prominent causal or maintenance factor (e.g. depression, eating disorders,

Conclusion

Our data provides preliminary support for the coherence, validity, and internal consistency of the FoReST – an easy to administer measure that assesses people's tendency to act in a closed, inflexible, values-incongruent manner, in the presence of self-critical thoughts. The FoReST has potential clinical applications with people experiencing problematic levels of shame and guilt; which can include, but is not limited to, those with a lived experience of depression, eating disorders, social

Funding sources

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declaration of competing interest

None.

Acknowledgements

The authors would like to acknowledge the helpful support that Prof Paul Gilbert, Dr Dennis Tirch, Dr Nic Hooper, Dr Jason Luoma, Dr Paul Christiansen, Dr Alex Stenhoff provided in the development of the FoReST.

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