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2019

Examining the Relationship Between Self-Compassion and

Emotion Regulation Strategies Using Ambulatory assessment
Methods
Lindsay Mae Miller
[email protected]

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Strategies Using Ambulatory assessment Methods" (2019). Graduate Research Theses & Dissertations.
7445.
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 ABSTRACT

EXAMINING THE RELATIONSHIP BETWEEN SELF-COMPASSION AND EMOTION

REGULATION STRATEGIES USING AMBULATORY ASSESSMENT METHODS

Lindsay Mae Miller, Ph.D.

Department of Psychology
Northern Illinois University, 2020
Holly K. Orcutt, Director

Self-compassion focuses on how individuals treat themselves during periods of suffering.

Overall, self-compassion is positively associated with adaptive mental health outcomes and

negatively associated with psychopathology. One potential mechanism by which self-

compassion may influence other constructs is emotion regulation. Unfortunately, most research

about emotion regulation is conducted using retrospective reporting, meaning that the data are

subject to memory biases. Ambulatory assessment methods allow for more frequent sampling,

thus decreasing the reliance on recall. Using this methodology, the present study examined how

differences in self-compassion were related to emotion regulation in daily life. Contrary to

predictions, few ambulatory measures (depression, anxiety, problem solving of depression,

avoidance of all three types of distress) were significantly predicted by the corresponding

retrospective measures. Baseline self-compassion predicted ambulatory anxiety and stress, but

not depression. Although individuals varied in their ambulatory ratings of distress, self-

compassion did not significantly predict these ratings. Individuals also varied in the log odds of

choosing each emotion regulation strategy; however, self-compassion did not predict these odds.

Other exploratory hypotheses were examined regarding intensity of distress and emotion

regulation choice, intensity of distress and number of regulatory strategies endorsed, and self-

esteem and emotion regulation choice. Intensity of distress predicted selection of most or all of
the regulation strategies, and intensity of anxiety and stress (but not depression) significantly

predicted the number of strategies used. Finally, self-esteem negatively predicted avoidance of

depression, rumination of all three types of distress, and suppression of depression. Implications

and limitations are discussed.

 NORTHERN ILLINOIS UNIVERSITY
DE KALB, ILLINOIS

MAY 2020

EXAMINING THE RELATIONSHIP BETWEEN SELF-COMPASSION AND EMOTION

REGULATION STRATEGIES USING AMBULATORY ASSESSMENT METHODS

BY

LINDSAY MAE MILLER

©2019 Lindsay Mae Miller

A DISSERTATION SUBMITTED TO THE GRADUATE SCHOOL

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS

FOR THE DEGREE

DOCTOR OF PHILOSOPHY

DEPARTMENT OF PSYCHOLOGY

Doctoral Director:
Holly K. Orcutt
 ACKNOWLEDGEMENTS

Many individuals have contributed their expertise, time, and resources to various areas of

this project, and to them I am most grateful. I would first like to thank my primary thesis

advisor, Holly Orcutt, from whom I have learned so much and who has helped me shape and

focus every aspect of this project. Next, I am indebted to the rest of my committee members,

Michelle Lilly, Thomas Smith, and Kevin Wu. Their early conceptual feedback improved the

research design, and their later feedback helped me consider the constructs and the data more

thoroughly. The committee helped to broaden my perspectives and ultimately produce a stronger

and more thorough investigation.

 TABLE OF CONTENTS

Page

LIST OF TABLES ................................................................................................................. xii

LIST OF APPENDICES ........................................................................................................ xiii

Chapter

1. INTRODUCTION ................................................................................................ 1

Defining Self-Compassion ............................................................................. 2

Individual Differences in Self-Compassion ....................................... 3

Correlates of Self-Compassion .......................................................... 4

Longitudinally Examining Self-Compassion ..................................... 8

The Effects of Long- and Short-Term Self-Compassion

Interventions ...................................................................................... 9

Emotion Regulation ....................................................................................... 14

Acceptance ......................................................................................... 15

Avoidance .......................................................................................... 16

Problem Solving................................................................................. 18

Reappraisal ......................................................................................... 19

Rumination......................................................................................... 19
 iv
Chapter Page

Suppression ........................................................................................ 21

Self-Compassion as an Emotion Regulation Strategy ....................... 22

Ambulatory Assessment ................................................................................ 24

Ambulatory Assessment Methods in the Study of

Emotion Regulation ........................................................................... 25

Ambulatory Assessment Methods in the Study of

Self-Compassion ................................................................................ 28

Statement of the Problem ............................................................................... 29

Hypotheses ..................................................................................................... 32

Measure Check Hypothesis................................................................ 32

Hypothesis 0........................................................................... 32

A Priori Hypotheses ........................................................................... 33

Hypothesis 1........................................................................... 33

Hypothesis 2........................................................................... 33

Hypothesis 3........................................................................... 33

Hypotheses 4-6....................................................................... 33

Hypotheses 7-12..................................................................... 33

Exploratory Hypotheses ..................................................................... 34

Hypotheses 13-15................................................................... 34

Hypothesis 16......................................................................... 34

Hypothesis 17......................................................................... 35

Hypotheses 18-23................................................................... 35

2. METHODS ........................................................................................................... 36
 v
Chapter Page

Participants ................................................................................................ 36

Measures ................................................................................................ 37

Initial Laboratory Visit ...................................................................... 37

Potential Demographic Covariates ........................................ 37

Self-Compassion Scale (SCS; Neff, 2003a) .......................... 37

Rosenberg Self-Esteem Scale (RSE; Rosenberg, 1965) ........ 38

Depression, Anxiety, and Stress Scales 21 (DASS-21;

Henry & Crawford, 2005) ...................................................... 39

Five Facet Mindfulness Questionnaire, Nonjudgmental

Acceptance Subscale (FFMQ; Baer, Smith, Hopkins,
Krietemeyer, & Toney, 2006) ................................................ 39

Acceptance and Action Questionnaire-II (AAQ-II;

Bond et al., 2011) ................................................................... 40

Coping Strategies Inventory, Problem Solving Scale

(CSI; Tobin, Holroyd, & Reynolds, 2001) ............................ 41

Emotion Regulation Questionnaire (ERQ; Gross &

John, 2003)............................................................................. 42

Rumination-Reflection Questionnaire, Rumination

Factor (RRQ; Trapnell & Campbell, 1999) ........................... 42

Ambulatory Assessment Signals ....................................................... 43

Depression, Anxiety, and Stress ............................................ 43

Emotion Regulation Strategies .............................................. 43

Procedure ....................................................................................................... 44

3. RESULTS ............................................................................................................. 45

Missing Data, Testing of Potential Covariates, and Tests of Normality ....... 45

 vi
Chapter Page

Measure Check, A Priori, and Exploratory Hypotheses ................................ 47

Measure Check Hypothesis 0............................................................. 47

Hypothesis 0.1........................................................................ 49

Hypothesis 0.2........................................................................ 49

Hypothesis 0.3........................................................................ 50

Hypothesis 0.4........................................................................ 50

Hypothesis 0.5........................................................................ 50

Hypothesis 0.6........................................................................ 50

Hypothesis 0.7........................................................................ 51

Hypothesis 0.8........................................................................ 51

Hypothesis 0.9........................................................................ 51

Hypothesis 0.10...................................................................... 51

Hypothesis 0.11...................................................................... 51

Hypothesis 0.12...................................................................... 52

Hypothesis 0.13...................................................................... 52

Hypothesis 0.14...................................................................... 52

Hypothesis 0.15...................................................................... 52

Hypothesis 0.16...................................................................... 52

Hypothesis 0.17...................................................................... 53

Hypothesis 0.18...................................................................... 53

Hypothesis 0.19...................................................................... 53

Hypothesis 0.20...................................................................... 53
 vii
Chapter Page

Hypothesis 0.21...................................................................... 53

A Priori Hypothesis 1......................................................................... 54

Hypothesis 1.1........................................................................ 54

Hypothesis 1.2........................................................................ 54

Hypothesis 1.3........................................................................ 54

A Priori Hypothesis 2......................................................................... 55

Hypothesis 2.1........................................................................ 55

Hypothesis 2.2........................................................................ 55

Hypothesis 2.3........................................................................ 55

A Priori Hypothesis 3......................................................................... 55

Hypothesis 3.1........................................................................ 56

Hypothesis 3.2........................................................................ 56

Hypothesis 3.3........................................................................ 56

A Priori Hypotheses 4-6..................................................................... 57

Hypothesis 4.1........................................................................ 57

Hypothesis 4.2........................................................................ 57

Hypothesis 4.3........................................................................ 58

Hypothesis 4.4........................................................................ 58

Hypothesis 4.5........................................................................ 58

Hypothesis 4.6........................................................................ 58

Hypothesis 5.1........................................................................ 59

Hypothesis 5.2........................................................................ 59
 viii
Chapter Page

Hypothesis 5.3........................................................................ 59

Hypothesis 5.4........................................................................ 59

Hypothesis 5.5........................................................................ 60

Hypothesis 5.6........................................................................ 60

Hypothesis 6.1........................................................................ 60

Hypothesis 6.2........................................................................ 60

Hypothesis 6.3........................................................................ 61

Hypothesis 6.4........................................................................ 61

Hypothesis 6.5........................................................................ 61

Hypothesis 6.6........................................................................ 61

A Priori Hypotheses 7-12................................................................... 62

Hypothesis 7.1........................................................................ 62

Hypothesis 7.2........................................................................ 62

Hypothesis 7.3........................................................................ 62

Hypothesis 8.1........................................................................ 63

Hypothesis 8.2........................................................................ 63

Hypothesis 8.3........................................................................ 63

Hypothesis 9.1........................................................................ 63

Hypothesis 9.2........................................................................ 63

Hypothesis 9.3........................................................................ 63

Hypothesis 10.1...................................................................... 64

Hypothesis 10.2...................................................................... 64
 ix
Chapter Page

Hypothesis 10.3...................................................................... 64

Hypothesis 11.1...................................................................... 64

Hypothesis 11.2...................................................................... 64

Hypothesis 11.3...................................................................... 65

Hypothesis 12.1...................................................................... 65

Hypothesis 12.2...................................................................... 65

Hypothesis 12.3...................................................................... 65

Exploratory Hypotheses 13-15 .......................................................... 65

Hypothesis 13.1...................................................................... 66

Hypothesis 13.2...................................................................... 66

Hypothesis 13.3...................................................................... 66

Hypothesis 13.4...................................................................... 66

Hypothesis 13.5...................................................................... 66

Hypothesis 13.6...................................................................... 67

Hypothesis 14.1...................................................................... 67

Hypothesis 14.2...................................................................... 67

Hypothesis 14.3...................................................................... 67

Hypothesis 14.4...................................................................... 67

Hypothesis 14.5...................................................................... 68

Hypothesis 14.6...................................................................... 68

Hypothesis 15.1...................................................................... 68

Hypothesis 15.2...................................................................... 68
 x
Chapter Page

Hypothesis 15.3...................................................................... 68

Hypothesis 15.4...................................................................... 69

Hypothesis 15.5...................................................................... 69

Hypothesis 15.6...................................................................... 69

Exploratory Hypothesis 16 ................................................................ 69

Hypothesis 16.1...................................................................... 69

Hypothesis 16.2...................................................................... 70

Hypothesis 16.3...................................................................... 70

Exploratory Hypothesis 17 ................................................................ 70

Hypothesis 17.1...................................................................... 70

Hypothesis 17.2...................................................................... 71

Hypothesis 17.3...................................................................... 71

Exploratory Hypotheses 18-23 .......................................................... 71

Hypothesis 18.1...................................................................... 72

Hypothesis 18.2...................................................................... 72

Hypothesis 18.3...................................................................... 72

Hypothesis 19.1...................................................................... 72

Hypothesis 19.2...................................................................... 74

Hypothesis 19.3...................................................................... 74

Hypothesis 20.1...................................................................... 74

Hypothesis 20.2...................................................................... 74

Hypothesis 20.3...................................................................... 74
 xi
Chapter Page

Hypothesis 21.1...................................................................... 75

Hypothesis 21.2...................................................................... 75

Hypothesis 21.3...................................................................... 75

Hypothesis 22.1...................................................................... 75

Hypothesis 22.2...................................................................... 75

Hypothesis 22.3...................................................................... 76

Hypothesis 23.1...................................................................... 76

Hypothesis 23.2...................................................................... 76

Hypothesis 23.3...................................................................... 76

4. DISCUSSION ....................................................................................................... 77

Problems with Measurement.......................................................................... 80

Problems with Theory .................................................................................... 81

Problems with Experimental Design ............................................................. 83

Limitations ..................................................................................................... 84

Implications and Future Directions ................................................................ 85

REFERENCES ...................................................................................................................... 89

APPENDICES ....................................................................................................................... 109

 LIST OF TABLES

Table Page

1. Means, Standard Deviations, Cronbach’s Alphas, and Bivariate Correlations

of Initial Laboratory Visit Measures .......................................................................... 46

2. Means and Standard Deviations of Ambulatory Assessment Measures .................... 48

3. Summary of Hypotheses 7-12 and 18-23................................................................... 73

 LIST OF APPENDICES

Appendix Page

A. EQUATIONS ............................................................................................................. 109

B. DEMOGRAPHICS QUESTIONNAIRE ................................................................... 130

C. SELF-COMPASSION SCALE (NEFF, 2003b) ........................................................ 133

D. ROSENBERG SELF-ESTEEM SCALE (ROSENBERG, 1965) ............................. 136

E. DEPRESSION, ANXIETY, AND STRESS SCALES 21 (HENRY

& CRAWFORD, 2005) ............................................................................................. 138

F. FIVE FACET MINDFULNESS QUESTIONNAIRE,

NONJUDGMENTAL ACCEPTANCE SUBSCALE (BAER ET AL., 2006) .......... 141

G. ACCEPTANCE AND ACTION QUESTIONNAIRE-II (BOND ET AL.,

2011) .......................................................................................................................... 143

H. COPING STRATEGIES INVENTORY, PROBLEM SOLVING SCALE

(TOBIN ET AL., 2001) ............................................................................................. 145

I. EMOTION REGULATION QUESTIONNAIRE (GROSS & JOHN, 2003) ........... 147

J. RUMINATION-REFLECTION QUESTIONNAIRE, RUMINATION

FACTOR (TRAPNELL & CAMPBELL, 1999) ....................................................... 150

K. AMBULATORY ASSESSMENT SIGNAL ............................................................. 152

L. PSYCHOEDUCATION SCRIPT .............................................................................. 155

 CHAPTER 1

INTRODUCTION

Self-compassion is the attitude of treating oneself with kindness and understanding in the

face of difficult circumstances (Neff, 2003a, 2003b). Very generally, self-compassion is

positively associated with desirable mental health outcomes, such as well-being (e.g., Barnard &

Curry, 2011), and negatively associated with symptomatology, such as depression and anxiety

(e.g., MacBeth & Gumley, 2012). Intervention-based research indicates that self-compassion is

malleable and that participation in an intervention leads to changes in the aforementioned

outcomes (e.g., Finlay-Jones, Kane, & Rees, 2017). Thus, self-compassion may be an effective

target for intervention. Although the present study’s methodology does not employ an

intervention, the results of such research are summarized to demonstrate the malleability of self-

compassion and its potential as a target for intervention. One potential mechanism by which

self-compassion may lead to differences in symptomatology is through emotion regulation, a

term for attempts to influence one’s emotional responses (Koole, 2009). However, little is

known about the relationship between self-compassion and emotion regulation strategies. To

understand this relationship, research about self-compassion and emotion regulation will be

examined. First, self-compassion is defined, and empirical findings are summarized. Then

common emotion regulation strategies and their relationships (theorized and empirically

examined, when available) with self-compassion will be discussed. This is followed by a brief
 2
discussion of ambulatory assessment methods, a data collection procedure which does not rely

on retrospective reporting (Trull & Ebner-Priemer, 2013). Research on self-compassion and

emotion regulation using ambulatory assessment will be described. The purpose of this review is

to outline the need for a better understanding of the relationship between self-compassion and

emotion regulation in preparation for the current study examining this question using ambulatory

assessment methods.

Defining Self-Compassion

Self-compassion is an emerging construct in Western psychological research and has

been defined and operationalized by Neff (2003a, 2003b). It is rooted in Buddhist philosophy

(Neff, 2003a, 2003b) and is one example of clinical psychology’s recent emphasis on Buddhist

traditions and well-being (Wallace & Shapiro, 2006). Self-compassion is a metacognitive way

of relating to the self that was developed as an alternative to self-esteem (Neff, 2003a, 2003b).

Although it is correlated with self-esteem (e.g., Breines, Toole, Tu, & Chen, 2014; Kelly,

Vimalakanthan, & Miller, 2014; Magnus, Kowalski, & McHugh, 2010; Wasylkiw, MacKinnon,

& MacLellan, 2012), which is defined as one’s attitude toward or evaluation of the self

(Pyszczynski, Greenberg, Solomon, Arndt, & Schimel, 2004), it is distinct in that it requires

neither evaluations nor comparisons (Neff, 2003b, 2009, 2011). Indeed, it has been considered a

protective factor against low self-esteem (Marshall et al., 2015). Self-compassion consists of

three distinct yet interrelated components, each with its own contrast—self-kindness and self-

judgment, common humanity and isolation, and mindfulness and over-identification. The

components are strongly correlated with the total score (r = |.62-.91|, p < .05) and with each other

(r = |.46-.91|, p < .05; Neff, 2003a, 2016). Self-kindness is the extension of kindness and
 3
understanding to the self, which engenders a desire to lessen one’s suffering (Neff, 2003a,

2003b). In contrast, self-judgment is characterized by berating oneself and can be considered the

“just grin and bear it” approach (Neff, 2003b, 2011). Common humanity refers to the

perspective that suffering, failure, and difficult circumstances are part of the human condition

(Neff, 2003a, 2003b, 2011). Feelings of isolation occur when an individual feels disconnected

from others due to mistakes and struggles (Neff, 2003a, 2003b, 2011). The mindfulness

component of self-compassion, which is distinct from general mindfulness (Bluth & Blanton,

2014), is the awareness of painful thoughts and feelings, which allows for increased objectivity

and perspectivetaking (Neff, 2003a, 2003b, 2011). Over-identification denotes the magnification

and exaggeration of negative self-related internal experiences (Neff, 2003b, 2011). Together,

these components offer an alternate way of conceptualizing negative experiences and what they

mean about the self. Indeed, most research examines total self-compassion rather each

component individually. To understand self-compassion, researchers have examined individual

differences in self-compassion, correlates, and causal factors.

Individual Differences in Self-Compassion

One way to understand self-compassion is to examine how it varies between groups.

Some individual difference variables have been associated with higher levels of self-compassion.

A meta-analysis found that men reported higher self-compassion than women (Yarnell et al.,

2015). This difference was moderated by ethnicity, such that the difference between genders

was greater among non-Whites than Whites. The authors suggested that this gender gap may be

due to traditional gender roles or stress associated with minority status. Age also moderated this

gender difference, which decreased with age (Yarnell et al., 2015). In addition, age was
 4
correlated with self-compassion, showing that older individuals are more self-compassionate

than those who are younger (Neff & Pommier, 2013; Neff & Vonk, 2009; Przezdziecki et al.,

2013; Werner et al., 2012). This suggests developmental changes in how individuals respond to

their own suffering over time. Limited research has also examined cultural differences. An

American sample reported lower self-compassion than participants from Thailand but more than

those from Taiwan (Neff, Pisitsungkagarn, & Hsieh, 2008). Factors such as cultural norms and

values may play a role in how one relates to the self.

Other differences in self-compassion are related to one’s experiences. Meditators

reported more self-compassion than non-meditators, a finding that is sensitive to years of

meditation experience (Alda et al., 2016; Baer, Lykins, & Peters, 2012; Neff, 2003a; Neff &

Pommier, 2013). This finding is to be expected given that meditation and self-compassion both

originate in Buddhist traditions that focus on cultivating balanced psychological well-being

(Wallace & Shapiro, 2006). Survivors of childhood abuse reported lower levels of self-

compassion (Tanaka, Wekerle, Schmuck, Paglia-Boak, & MAP Research Team, 2011), a finding

which is sensitive to severity of emotional abuse (Miron, Orcutt, Hannan, & Thompson, 2014).

Some experiences, such as regular meditation, appear to bolster the development of self-

compassion, whereas others, such as childhood abuse, seem to hamper its development.

Correlates of Self-Compassion

Self-compassion has been studied in relation to multiple constructs in clinical

psychology, primarily using correlational and cross-sectional designs and employing samples

from various populations, such as undergraduate students, graduate students, mental health

treatment providers, clergy members, treatment-seeking individuals, and nonclinical community

 5
members (e.g., Barnard & Curry, 2011; MacBeth & Gumley, 2012). Perhaps the most replicated

findings are the positive relationships between self-compassion and mindfulness and between

self-compassion and well-being (for a review, see Barnard & Curry, 2011). A review identified

several additional correlates, including positive and negative affect, life satisfaction, happiness,

and emotional intelligence (Barnard & Curry, 2011). A meta-analysis found a large effect size (r

= -0.54) for the inverse relationships between self-compassion and depression, anxiety, and

stress when examining publications employing clinical and nonclinical samples (MacBeth &

Gumley, 2012). These results suggest that self-compassion is positively associated with general

well-being and negatively with psychopathology. Further, self-compassion mediated the

relationships between attachment anxiety and well-being (Wei, Liao, Ku, & Shaffer, 2011),

mindfulness and well-being (Hollis-Walker & Colosimo, 2011), and mindfulness and happiness

(Hollis-Walker & Colosimo, 2011). Although these studies do not reflect causation, they suggest

that self-compassion may explain why other constructs are related to well-being and happiness.

In addition, self-compassion was positively associated with quality of life (Duarte, Ferreira,

Trindade, & Pinto-Gouveia, 2015), as well as negatively associated with mood disturbance

(Birnie, Speca, & Carlson, 2010), anger (Neff & Vonk, 2009), suicide attempts (Tanaka et al.,

2011), and physiological symptoms of stress (Birnie et al., 2010). Overall, self-compassion

appears to be positively related to adaptive constructs and negatively related to maladaptive ones.

Some researchers have also considered self-compassion’s relationship to biological

variables. Individuals with higher self-compassion exhibited lower physiological responses to

stress than those with lower levels of self-compassion (Bluth et al., 2016; Breines et al., 2015;

Breines, Thoma, et al., 2014). For self-compassionate individuals, but not self-critical

individuals, compassion-focused imagery was associated with an increase in heart rate variability
 6
and a decrease in cortisol, suggesting that engaging in self-compassion is self-soothing (Rockliff,

Gilbert, McEwan, Lightman, & Glover, 2008). These findings are consistent with results from

self-report measures that associated higher levels of self-compassion with lower levels of stress.

Beyond mindfulness, general well-being, and depression and anxiety, research on self-

compassion has also focused on body concerns and disordered eating. In samples of women

with body concerns, self-compassion was positively correlated with body appreciation

(Wasylkiw et al., 2012) but negatively correlated with disordered eating (Breines, Toole, et al.,

2014; Ferreira, Pinto-Gouveia, & Duarte, 2013; Kelly, Carter, Zuroff, & Borairi, 2013; Kelly,

Vimalakanthan, et al., 2014; Webb & Forman, 2013), dietary restraint (Kelly, Vimalakanthan, et

al., 2014), weight/shape concerns (Wasylkiw et al., 2012), body dissatisfaction (C. Duarte et al.,

2015; Ferreira et al., 2013), body shame (Breines, Toole, et al., 2014; Kelly et al., 2013), desire

for thinness (Ferreira et al., 2013), and weight gain concern (Breines, Toole, et al., 2014; Kelly,

Vimalakanthan, et al., 2014). Overall, self-compassion is negatively associated with body

concerns and disordered eating, suggesting that these constructs may be characterized by self-

criticism. Self-compassion also mediated the relationship between body preoccupation and

depressive symptoms (Wasylkiw et al., 2012), body dissatisfaction and psychological quality of

life (C. Duarte et al., 2015), body dissatisfaction and drive for thinness (Ferreira et al., 2013), and

external shame and drive for thinness (Ferreira et al., 2013). These findings suggest that self-

compassion may account in part for the relationship between body concerns and other mental

health outcomes (e.g., depressive symptoms). In a population of patients with eating disorders,

only those with high self-compassion and low fear of self-compassion (i.e., not viewing self-

compassion as threatening) showed changes in disordered eating and body shame following 12

weeks of specialized treatment, suggesting that self-compassion plays an important role in

 7
recovery (Kelly et al., 2013). Although most research on self-compassion and body concerns

was conducted with samples endorsing eating pathology, one study examined a sample of breast

cancer survivors. They found that self-compassion was negatively associated with body image

difficulties (Przezdziecki et al., 2013). These findings suggest that self-compassion may be an

important component in self-related evaluations and associated beliefs and behaviors,

particularly among those with bodily concerns.

Research on self-compassion has also expanded to other areas. Among individuals with

chronic pain, patients with more self-compassion reported greater activity engagement and

acceptance of their pain than those with less self-compassion (Costa & Pinto-Gouveia, 2011).

Studies focused on personality traits have found that conscientiousness, extroversion, and

agreeableness were positively associated with self-compassion (Baker & McNulty, 2011; Neff,

Rude, & Kirkpatrick, 2007). Neuroticism was negatively correlated with self-compassion (Neff,

Rude, et al., 2007). These findings suggest that some personality traits may be more compatible

with the natural development of self-compassion than others. For example, individuals with high

trait levels of neuroticism may be more likely to have the tendency to be critical of themselves

than those with low levels of the same personality characteristic. This is not to suggest that these

individuals are incapable of treating themselves with compassion, but rather that they may

require additional support or guidance to do so consistently.

Correlational methods have also been used to examine self-compassion in samples of

helping professionals, such as clergy, nurses, and psychologists. In these samples, self-

compassion was positively correlated with emotional intelligence (Heffernan, Quinn Griffin,

McNulty, & Fitzpatrick, 2010) as well as negatively correlated with anxiety (Finlay-Jones, Rees,

& Kane, 2015) and burnout (Barnard & Curry, 2012; Dev, Fernando, Lim, & Consedine, 2018).
 8
One review recommended self-compassion and mindfulness-based stress reduction trainings for

health care professionals in order to decrease perceived stress and burnout, as well as to increase

self-compassion and empathy for clients (Raab, 2014). Self-compassion is positively correlated

with adaptive constructs across various populations, including nonclinical individuals, patients

with eating disorders and chronic pain, and helping professionals. However, these results merely

capture relationships between self-compassion and other variables at one point in time and do not

provide evidence for its effects over time.

Longitudinally Examining Self-Compassion

Few studies have examined the longitudinal effects of self-compassion. One study of

nonpatient undergraduates (N = 347) found that self-compassion predicted changes in depressive

symptoms five months later (Raes, 2011). Specifically, higher initial self-compassion

longitudinally predicted greater decreases and/or smaller increases in depression. In addition,

self-compassion remained stable across observations. Another study of nonpatient

undergraduates (N = 462) found that self-compassion moderated the relationship between

perceived stress at baseline and depression and anxiety six months later (Stutts, Leary, Zeveney,

& Hufnagle, 2018). The stability of self-compassion was not examined. Among adolescent

survivors of a natural disaster, self-compassion (measured within four weeks of the event)

predicted fewer depressive, suicidality, posttraumatic stress, and panic symptoms at the three-

month follow-up, and self-compassion measured at the three-month follow-up predicted these

symptoms six months following the event (Zeller, Yuval, Nitzan-Assayag, & Bernstein, 2015).

However, the stability of self-compassion was not tested. These findings suggest that self-
 9
compassion may play a role in the development and maintenance of psychological distress

following a traumatic event.

Among divorcing individuals (N = 109), higher initial self-compassion (M = 3.8 months

after marital separation, SD = 2.1 months) was associated with less emotional intrusion of the

divorce, somatic hyperarousal following the divorce, and avoidance behaviors in the following

nine months (Sbarra, Smith, & Mehl, 2012). Thus, self-compassion may affect how individuals

recover from stressful life events. It should be noted that a modified version of a self-report

measure of self-compassion was used. Specifically, raters scored a 4-minute stream-of-

consciousness audio recording during which participants described their relationships and

subsequent separations. Rather than assessing global, trait-level self-compassion, this method

appears to have measured self-compassion specific to the current marital separation. In addition,

self-compassion was not measured at nine-month follow-up, so stability could not be evaluated.

Lastly because self-compassion was first assessed following the stressful events (i.e., the natural

disaster and marital separations), these studies were unable to examine the effects of trauma

exposure on self-compassion or the extent to which pre-event self-compassion predicts post-

event symptomatology. Although there is limited longitudinal research, it suggests that self-

compassion’s causal role should be further examined using

experimental designs.

The Effects of Short- and Long-Term Self-Compassion Interventions

Some researchers have experimentally induced self-compassion as a state or mood. For

example, self-compassion was induced by admonishing dieters to treat themselves with

compassion after eating a doughnut (Adams & Leary, 2007). This temporary self-compassion
 10
induction was associated with more self-compassionate eating attitudes in response to diet

breaking (Adams & Leary, 2007). The authors hypothesized that the effects were due to the

intervention rather than experiment demand because participants who received the intervention

also ate less candy than those who did not, meaning that they did not engage in the restriction-

binge cycle that they hypothesized was caused by self-criticism (Adams & Leary, 2007). It

appears that temporarily increasing self-compassion may be easily accomplished by merely

instructing people to adopt this stance. Other researchers induced self-compassion by asking

participants to identify thoughts that would lead them to agree with each of the three components

of self-compassion (i.e., self-kindness, mindfulness, common humanity) or approach a situation

from a compassionate perspective (Baker & McNulty, 2011; Breines & Chen, 2012; Johnson &

O’Brien, 2013; Leary, Tate, Adams, Allen, & Hancock, 2007; Odou & Brinker, 2014).

Compared to a group that completed a self-esteem reflection, those who received this induction

reported greater motivation to change a weakness and to make amends following a moral

transgression (Breines & Chen, 2012). These results were not due to differences in positive

affect following the interventions. They also reported lower negative affect, state shame, and

mood following negative and/or shame-focused mood inductions (Johnson & O’Brien, 2013;

Leary et al., 2007; Odou & Brinker, 2014). Participants in the intervention group more strongly

believed that the negative event they described was caused by the kind of person they are and

that they were similar to others (Leary et al., 2007). Two weeks after the self-compassion

induction, participants reported increased self-compassion and decreased depression (Johnson &

O’Brien, 2013).

In one study of undergraduates in romantic relationships (M = 15.41 months, SD = 14.53

months), self-compassion and conscientiousness interacted such that higher levels of both traits
 11
were associated with greater motivation to correct interpersonal mistakes and willingness to

engage in accommodation behaviors (Baker & McNulty, 2011). This interaction was only

significant for male participants. Overall, this brief intervention appeared to change how

participants felt about themselves and difficult situations. Self-compassion appears to be

malleable and may play a causal role in how individuals view themselves and painful

experiences. Most of these experiments focused on immediate changes in self-compassion and

its effects. When considering self-compassion as a potential causal factor in the development

and maintenance of symptomatology, it is important to know if it is possible for an intervention

to lead to a sustainable increase in self-compassion.

To answer this question, further research has been conducted with additional samples to

understand whether interventions can lead to changes in self-compassion that endure beyond the

laboratory session. Trait-level (i.e., long-term) changes to self-compassion have been induced

through self-compassion exercises and training (Albertson, Neff, & Dill-Shackleford, 2015; Arch

et al., 2014; Finlay-Jones et al., 2017; Mosewich, Crocker, Kowalski, & DeLongis, 2013;

Shapira & Mongrain, 2010; Smeets, Neff, Alberts, & Peters, 2014; Wong & Mak, 2016),

mindful self-compassion programs (Germer & Neff, 2013; Neff & Germer, 2013), compassion-

focused therapy (Gilbert, 2014; Kelly, Carter, & Borairi, 2014; Kelly, Zuroff, Foa, & Gilbert,

2010; Lucre & Corten, 2013; Sommers-Spijkerman, Trompetter, Schreurs, & Bohlmeijer, 2018),

mindfulness-based stress reduction programs (Birnie et al., 2010; Edwards, Adams, Waldo,

Hadfield, & Biegel, 2014; Newsome, Waldo, & Gruszka, 2012), mindfulness-based cognitive

therapy (Proeve, Anton, & Kenny, 2018), the Gestalt two-chair exercise (Neff, Kirkpatrick, &

Rude, 2007), and even smartphone application-based self-compassion programs (Mak, Wong,

Chan, & Lau, 2019; Rodgers et al., 2018). Interventions ranged from four days (Arch et al.,
 12
2014) to twelve weeks (Kelly, Carter, et al., 2014). Participation in an intervention led to

increases in self-compassion at post-intervention (Albertson et al., 2015; Arch et al., 2014; Birnie

et al., 2010; Edwards et al., 2014; Finlay-Jones et al., 2017; Mosewich et al., 2013; Neff &

Germer, 2013; Proeve et al., 2018; Smeets et al., 2014; Sommers-Spijkerman et al., 2018), one-

month follow-up (Mak et al., 2019; Mosewich et al., 2013; Newsome et al., 2012), three-month

follow-up (Albertson et al., 2015; Mak et al., 2019; Sommers-Spijkerman et al., 2018), four-

month follow-up (Rodgers et al., 2018), six-month follow-up (Neff & Germer, 2013), and

twelve-month follow-up (Neff & Germer, 2013). Overall, effect sizes were medium to large and

ranged from d = 0.65-1.67 at post-intervention (Albertson et al., 2015; Birnie et al., 2010; Finlay-

Jones et al., 2017; Mosewich et al., 2013; Neff & Germer, 2013; Smeets et al., 2014) and d =

0.82-1.15 at follow-up (Finlay-Jones et al., 2017; Mosewich et al., 2013). This indicates that

self-compassion is malleable and that these increases are sustained after the intervention has

ended.

Mindfulness-based interventions also lead to increases in mindfulness, which has a well-

documented relationship with self-compassion (Birnie et al., 2010; Edwards et al., 2014; Neff &

Germer, 2013; Newsome et al., 2012; Smeets et al., 2014). Self-compassion and mindfulness are

considered to be mechanisms of change of mindfulness-based interventions (Keng, Smoski,

Robins, Ekblad, & Brantley, 2012). Completing a self-compassion intervention has led to

increases in life satisfaction (Neff & Germer, 2013), happiness (Finlay-Jones et al., 2017;

Shapira & Mongrain, 2010), and smoking cessation (Kelly et al., 2010), as well as decreases in

depression (Edwards et al., 2014; Finlay-Jones et al., 2017; Lucre & Corten, 2013; Neff &

Germer, 2013; Shapira & Mongrain, 2010; Sommers-Spijkerman et al., 2018), anxiety (Finlay-

Jones et al., 2015; Neff, Kirkpatrick, et al., 2007; Sommers-Spijkerman et al., 2018), stress
 13
(Edwards et al., 2014; Finlay-Jones et al., 2017; Lucre & Corten, 2013; Neff & Germer, 2013;

Newsome et al., 2012; Sommers-Spijkerman et al., 2018), and general psychological distress

(Mak et al., 2019).

Self-compassion’s positive relationships with adaptive constructs and negative

relationships with maladaptive constructs appear to be causal. In other words, increases in self-

compassion lead to improved daily functioning and decreased symptoms of common

psychopathology. Changes in mindfulness and stress were maintained or improved at one-month

follow-up, indicating that the effects of increased self-compassion persisted after the intervention

was concluded (Newsome et al., 2012). The self-compassion meditations also increased self-

compassion in response to social stressors and decreased biological and subjective anxiety

responses (Arch et al., 2014). This is consistent with the aforementioned correlational findings.

Compared to those in the control or waitlist groups, eating disorder patients who completed a

self-compassion meditation intervention reported greater increases in body appreciation as well

as greater reductions in body dissatisfaction, body shame, and appearance-based self-worth

(Albertson et al., 2015). Patients who evidenced greater increases in self-compassion early in

compassion-focused therapy saw greater overall decreases in shame (Kelly, Carter, et al., 2014).

As indicated by longitudinal research, self-compassion appears to play a key role in

psychotherapy for eating disorders. In addition, a review of the efficacy of mindfulness- and

loving-kindness-based interventions in mental health professionals reported that they increased

self-compassion in this population (Boellinghaus, Jones, & Hutton, 2014). Self-compassion

appears to be malleable in nonpatients, eating disorder patients, and helping professionals alike.

Self-compassion has been shown to be sensitive to short- and long-term intervention. The results

of these intervention-based studies indicate that self-compassion is malleable and plays a causal
 14
role in daily functioning and the development and maintenance of key mental health-related

constructs, such as symptoms of common psychopathology. Although the present study did not

include an intervention component, evidence that self-compassion can be increased bolsters the

clinical implications of the current study. One possible mechanism by which self-compassion

influences these outcomes is through emotion regulation.

Emotion Regulation

Emotion regulation refers to “the activation of a goal to up- or down-regulate either the

magnitude or duration of the emotional response” (Gross, 2013, p. 359). In other words, it is a

deliberate effort to overrule or change one’s naturally occurring emotional response (Koole,

2009). Gross's (1998) process model of emotion regulation asserts that there are five

opportunities in the emotion generative process for an individual to self-regulate. These five

points are situation selection (i.e., approaching or avoiding a situation due to its anticipated

emotional impact), situation modification (i.e., changing a situation to modify its emotional

impact), attentional deployment (i.e., directing one’s attention within a situation to alter one’s

emotions), cognitive change (i.e., reevaluating the situation to alter one’s emotions), and

response modulation (i.e., altering emotional response tendencies after the emotion has been

elicited; Gross, 1998, 1999, 2002, 2013). Because no one strategy is universally optimal, the

flexible use of emotion regulation strategies is considered integral to adaptive psychological

functioning, which is referred to as regulatory flexibility (Aldao, 2013; Bonanno & Burton,

2013; Gross, 2015). Regulatory flexibility is significantly related to outcomes such as

psychological adjustment (r = .24, p < .05; for a meta-analysis, see Cheng, Lau, & Chan, 2014)

and is thought to be a prominent feature of many psychological diagnoses (e.g., depression,

 15
anxiety; for a review, see Sheppes, Suri, & Gross, 2015). Emotion regulation is associated with

many psychological disorders, such as anxiety, depression, eating disorders, substance use

disorders, and borderline personality disorder (Aldao & Nolen-Hoeksema, 2010; Aldao, Nolen-

Hoeksema, & Schweizer, 2010; Amstadter, 2008; Berking, Wirtz, Svaldi, & Hofmann, 2014;

Berking & Wupperman, 2012; Berman, Wheaton, McGrath, & Abramowitz, 2010; Cisler,

Olatunji, Feldner, & Forsyth, 2010; Duarte, Matos, & Marques, 2015; Hofmann, Sawyer, Fang,

& Asnaani, 2012). There are at least 400 identified strategies, and it would be impossible for any

one study to assess all of them at once (Skinner, Edge, Altman, & Sherwood, 2003). However,

meta-analytic and factor-analytic designs tend to focus on the same six strategies—acceptance,

avoidance, problem solving, reappraisal, rumination, and suppression (e.g., Adrian, Zeman, &

Veits, 2011; Aldao, 2013; Aldao et al., 2010; Augustine & Hemenover, 2009; Koole, 2009;

Seligowski & Orcutt, 2015). Each of these strategies has similarities to one or more components

of self-compassion. However, the research examining the relationships between

self-compassion and these emotion regulation strategies is limited.

Acceptance

Acceptance is more than mere tolerance, but rather the “active nonjudgmental embracing

of experience in the here and now” as it is rather than as one perceives it or wishes it to be

(Hayes, 2004, p. 656). The common humanity and mindfulness components of self-compassion

appear to be particularly relevant to this emotion regulation strategy. First, the mindfulness

component involves acknowledging one’s thoughts and feelings without judgment, experiencing

them as they are (Neff, 2003a, 2003b, 2011). This appears to be similar to the aspect of

acceptance in that one must be aware of one’s inner experiences before they can be embraced.
 16
Second, the common humanity component recognizes that suffering is part of the human

condition rather than isolating (Neff, 2003a, 2003b, 2011). In other words, struggling is

universal. Although this is not the same as embracing one’s experience, it may make doing so

easier by making suffering less threatening. Theoretically, self-compassion and acceptance

should be positively related.

Research in this area consistently supports this hypothesis. Immediately after learning

that they had failed their midterm exams (N = 110 university students), self-compassion

predicted the use of acceptance to cope with failure (Neff, Hsieh, & Dejitterat, 2005). In a

sample of treatment-seeking couples diagnosed with infertility (N = 100 heterosexual couples),

self-compassion was positively correlated with acceptance (Pinto-Gouveia, Galhardo, Cunha, &

Matos, 2012). Among clinically depressed outpatients (N = 69), self-compassion was positively

correlated with acceptance (Diedrich, Burger, Kirchner, & Berking, 2017). Acceptance mediated

the relationship between self-compassion and depressive symptoms in a sample of community

adults with a history of recurrent depression (Bakker, Cox, Hubley, & Owens, 2018). Compared

to a traditional cognitive behavioral intervention, an affect regulation treatment (i.e., a

transdiagnostic intervention that focuses on adaptive emotion regulation), which included

components of self-compassion interventions, led to greater increases in acceptance among

inpatients with depression (N = 432; Berking, Ebert, Cuijpers, & Hofmann, 2013; Berking et al.,

2008). A similar intervention had a medium, positive effect on acceptance (d = .63) in a sample

of police officers (Berking, Meier, & Wupperman, 2010). Overall, self-compassion appears to

be positively associated with acceptance.

 17
Avoidance

Avoidance is an emotion regulation strategy that refers to escaping, or moving away

from, an undesirable situation or emotion (Skinner et al., 2003). Avoidance may be behavioral

(Ottenbreit & Dobson, 2004) or experiential (Bond et al., 2011) in nature. The mindfulness

component of self-compassion involves being aware of one’s own thoughts and emotions (Neff,

2003a, 2003b, 2011). One cannot move away from one’s experiences while also holding them in

conscious awareness (Allen & Leary, 2010). Thus, self-compassion and avoidance are

incompatible.

Research indicates that self-compassion and avoidance are negatively related. In a

sample of treatment-seeking couples diagnosed with infertility (same as above), self-compassion

was negatively correlated with avoidance for the men (r = -.33, p < .01) but not the women

(Pinto-Gouveia et al., 2012). Among university students who just learned that they had failed a

midterm exam (same as above), self-compassion was negatively associated with avoidance (Neff

et al., 2005). In a treatment-seeking sample of survivors of interpersonal violence (N = 27), self-

compassion was significantly correlated with avoidance (r = .78, p < .01; McLean, Fiorillo, &

Follette, 2018). Among outpatients with depression (N = 142), self-compassion was negatively

correlated with avoidance (r = -.30, p < .01), and avoidance significantly mediated the

relationship between self-compassion and depressive symptoms (Krieger, Altenstein, Baettig,

Doerig, & Holtforth, 2013). Avoidance also mediated the relationship between self-compassion

and depressive symptoms in a sample of community adults with a history of recurrent depression

(Bakker et al., 2018). In a sample of undergraduates who endorsed a trauma history (N = 100),

self-compassion was uniquely related to avoidance symptoms (r = -.24, p ≤ .05) but not
 18
reexperiencing (r = -.16, p = ns) or hyperarousal symptoms (Thompson & Waltz, 2008). One

intervention-based study found that community nonpatients reported decreased avoidance (d =

.50) after completing a mindful self-compassion program (Neff & Germer, 2013). Indeed, self-

compassion and avoidance appear to be inversely related.

Problem Solving

Problem solving involves actively changing the situation or stressor to produce a more

desirable outcome (Skinner et al., 2003). The most relevant self-compassion component is self-

kindness, which leads to a desire to decrease one’s suffering (Neff, 2003a, 2003b). Suffering

may be decreased through various methods, including problem solving. However, because there

are other, emotion-focused techniques, one may decrease suffering without engaging in problem

solving. Theoretically, the relationship between self-compassion and problem solving is unclear.

Yet previous studies (see below) suggest that they are positively related or unrelated.

Research on the relationship between self-compassion and problem solving is mixed.

In a sample of treatment-seeking couples diagnosed with infertility (same as above), self-

compassion was positively correlated with problem solving for the women (r = .51, p < .01) but

not the men (Pinto-Gouveia et al., 2012). Among undergraduate students (N = 117, self-

compassion was not significantly related to a one-item measure of “[taking] steps to fix the

problem” (Leary et al., 2007). Similarly, another study of university students (same as above)

found that there was no correlation between self-compassion and the use of problem solving to

cope with academic failure (r = -.10-.05, p = ns; Neff et al., 2005). These mixed findings may be

due to the role of context (Aldao, 2013). Various situations may place distinct emotional

demands, thus leading the same individual to employ regulatory flexibility and selectively
 19
choose different regulatory strategies while continuing to be motivated by self-kindness.

Reappraisal

Reappraisal is an emotion regulation strategy that involves changing one’s perception or

interpretation of a situation (Allen & Leary, 2010). It seems most related to common humanity,

the recognition that one’s painful experiences are part of the human condition rather than

isolating (Neff, 2003a, 2003b, 2009). Rejecting self-criticism and isolation in favor of self-

kindness and common humanity could be considered reappraisal. As such, self-compassion

should be positively related to reappraisal.

Research is limited and has mixed findings. In a sample of nonclinical community

members (N = 424), the common humanity component of self-compassion was positively

correlated with reappraisal (Petrocchi, Ottaviani, & Couyoumdjian, 2014). Following the failure

of their midterm exams, self-compassion was positively correlated with the use of reappraisal to

cope with their grades (r = .24, p ≤ .01) in a group of undergraduates (Neff et al., 2005).

However, in a sample of community members (N = 100), participation in a compassion-focused

therapy intervention did not lead to a significant increase in reappraisal (Jazaieri et al., 2014).

Reappraisal did not mediate the relationship between self-compassion and depressive symptoms

in a sample of community adults with a history of recurrent depression (Bakker et al., 2018).

More research is needed to understand the relationship between self-compassion and reappraisal.

Rumination

Rumination is a “a repetitive and passive focus on one’s negative emotions” (Treynor,

Gonzalez, & Nolen-Hoeksema, 2003, p. 247). Over-identification, the magnification and

 20
exaggeration of negative experiences, is similar to rumination in that both focus on negativity

(Neff, 2003b, 2011). The distinction is that over-identification focuses on the experiences, rather

than the emotional responses to those experiences. The contrasting component is mindfulness,

holding painful thoughts and feelings in awareness without repetitive focus characteristic of

rumination (Neff, 2003a, 2003b, 2011). Thus, self-compassion should be negatively related to

rumination.

In the context of self-compassion, rumination is perhaps the most frequently studied

emotion regulation strategy. Self-compassion was significantly negatively correlated with

rumination in samples of undergraduate students (Hasking, Boyes, Finlay-Jones, McEvoy, &

Rees, 2018; Odou & Brinker, 2014; Raes, 2010; Samaie & Farahani, 2011; Smeets et al., 2014),

nonpatient community members (r = -.51, p < .01; C. J. Robins, Keng, Ekblad, & Brantley,

2012), and outpatients diagnosed with depression (Krieger et al., 2013). Rumination mediated

the relationship between self-compassion and anxiety and depression in samples of nonclinical

undergraduates, outpatients with depression, and nonpatient community members (Bakker et al.,

2018; Krieger et al., 2013; Raes, 2010). Rumination also mediated the relationship between self-

compassion and sleep quality among nonclinical undergraduates (Butz & Stahlberg, 2018). In a

sample of nonpatient community members (same as above), those who completed a mindfulness-

based stress reduction reported greater decreases in rumination at two-month follow-up

compared to the waitlist control group (Robins et al., 2012). Another study with a sample of

patients with social anxiety disorder (N = 14) reported similar results (Goldin & Gross, 2010). In

another experiment, undergraduate students (N = 40) who completed the Gestalt two-chair

exercise reported increases in self-compassion, which were negatively correlated with

rumination at one-month follow-up (Neff, Kirkpatrick, et al., 2007). Female student athletes
 21
who participated in a self-compassion intervention (N = 29) reported decreases in rumination

immediately following the intervention and at one-month follow-up (Mosewich et al., 2013). A

similar significant change was found in a sample of undergraduate women (Smeets et al., 2014).

A mindfulness-based intervention that included a loving-kindness meditation led to a significant

decrease in rumination for a sample of undergraduate women (Caldwell & Shaver, 2015) and in

a sample of patients with bipolar disorder (Deckersbach et al., 2012). Overall, self-compassion

appears to be consistently negatively associated with rumination.

Suppression

Suppression involves repressing one’s emotion-expressive behavior or thoughts, which

are termed expressive suppression and thought suppression, respectively (Gross & John, 2003;

Wegner & Zanakos, 1994). In other words, an individual engages in suppression when he or she

makes an effort not to display one’s emotions or to think about something that is eliciting an

undesirable emotion. The most relevant component of self-compassion appears to be

mindfulness, awareness of one’s painful thoughts or feelings (Neff, 2003a, 2003b, 2011). When

considering this component, self-compassion and suppression appear to be incompatible.

Research in this area is limited and inconsistent. In a sample of community members

(same as above), compassion-focused therapy led to a significant reduction in suppression

(Jazaieri et al., 2014). The Gestalt two-chair exercise led to increases in self-compassion, which

were negatively correlated with suppression at one-month follow-up (r = -55, p < .01) in a

sample of university students (Neff, Kirkpatrick, et al., 2007). However, in a sample of

nonpatients (same as above), self-compassion was unrelated to suppression (Petrocchi et al.,

2014), and a mindfulness-based intervention that included a loving-kindness meditation did not
 22

affect suppression (Caldwell & Shaver, 2015). More research is needed to clarify the

relationship between self-compassion and suppression.

Self-Compassion as an Emotion Regulation Strategy

Self-compassion has been conceptualized as an emotion regulation strategy (Diedrich,

Grant, Hofmann, Hiller, & Berking, 2014; Diedrich, Hofmann, Cuijpers, & Berking, 2016; Neff,

2003a, 2003b). Neff (2003a, 2003b) defined self-compassion as an emotional-approach coping

strategy because it involves the mindful awareness of negative emotions with self-kindness and

shared humanity. Self-compassion permits “the clearer apprehension of one’s immediate

situation and the adoption of actions that change oneself and/or the environment in appropriate

and effective ways” (Neff, 2003b, p. 92). Although self-compassion was characterized as an

emotion regulation strategy, further explanation seems to imply that it influences emotions

indirectly through the use of adaptive regulatory strategies (i.e., “appropriate and effective

ways”).

Little research has examined self-compassion’s potential role as an emotion regulation

strategy. In a study by Diedrich and colleagues (2014), participants completed a low mood

induction and were instructed to regulate feelings of depression with self-compassion,

reappraisal, or acceptance. In the self-compassion condition, the instructions provided were

similar to Neff’s Self-Compassion Break and Taking Care of the Caregiver exercises

(https://self-compassion.org) and directed participants to become aware of and acknowledge

suffering, engage in self-soothing, and repeat supportive phrases. The self-compassion condition

was more effective at decreasing feelings of depression following the low mood induction than
 23
waiting, and it was equally as effective as the reappraisal or acceptance conditions (Diedrich et

al., 2014).

In another study with similar methodology employing a sample of individuals with

depression, the self-compassion condition was more effective than the acceptance condition

following the same low mood induction (Diedrich et al., 2016). Although self-compassion was

treated as an emotion regulation strategy, it was discussed as an attitude that encourages

individuals to engage in “adaptive” emotion regulation strategies (Diedrich et al., 2016). For

example, the authors asserted that a self-compassionate response increases motivation to engage

in “self-help strategies” (Diedrich et al., 2016). The efficacy of the self-compassion condition in

decreasing induced feelings of depression may be because a self-compassionate response evokes

the use of adaptive emotion regulation strategies or encourages the flexible use of multiple

strategies rather than a single, predetermined strategy. Individuals with greater self-compassion

may also be more willing to engage with their negative emotions, which could allow for more

adaptive regulation. However, it should be noted that the adaptiveness of a regulatory strategy is

dependent upon the situation.

Further research found that adaptive emotion regulation skills (a composite of awareness,

sensations, clarity, understanding, tolerance, readiness to confront distressing situations, and

modification) mediated the relationship between initial self-compassion and depressive

symptoms one week later in a sample of treatment-seeking individuals with depression (Diedrich

et al., 2017). A reverse mediation was nonsignificant; in other words, self-compassion did not

mediate the relationship between adaptive emotion regulation skills and depressive symptoms

(Diedrich et al., 2017). These findings suggest that self-compassion decreases depressive

symptoms through changes in emotion regulation. Emotion regulation may be a mechanism

 24
through which self-compassion decreases depressive symptomatology. This is theoretically

consistent with the definition of self-compassion (Neff, 2003a, 2003b) and the role of self-

compassion in emotion regulation (Diedrich et al., 2017, 2014, 2016). Self-compassionate

individuals appear to regulate their emotions differently than those with low trait self-

compassion, and emotion regulation choice may be a mechanism through which self-compassion

affects other constructs, such as psychopathology and general well-being.

Ambulatory Assessment

One limitation of much research examining emotion regulation is that retrospective

reporting is subject to memory and other biases (e.g., Shiffman, Stone, & Hufford, 2008; Stone

et al., 1998). Ambulatory assessment (which is also referred to as ecological momentary

assessment and experience sampling, among others) addresses this limitation by collecting

multiple data points over time rather than one retrospective report (for reviews, see Carpenter,

Wycoff, & Trull, 2016; Ebner-Priemer & Trull, 2009; Fahrenberg, Myrtek, Pawlik, & Perrez,

2007; Shiffman et al., 2008; Trull & Ebner-Priemer, 2013; Wilhelm & Grossman, 2010).

Advances in technology, such as the high prevalence of smartphone ownership, have made it

easier to collect this data (Carpenter et al., 2016; Kuntsche & Labhart, 2013). Researchers have

used this method to assess mood fluctuations in daily life (Wilhelm & Schoebi, 2007), including

among cancer patients (Wu, Johnson, Schepp, & Berry, 2011) and patients prescribed

psychotropic medications (Bos, Schoevers, & aan het Rot, 2015; Conner & Barrett, 2012), as

well as emotions in multiple contexts, such as mindfulness (Keng & Tong, 2016).

These methods are extremely versatile and have been used to better understand the

natural course of anxiety (Alpers, 2009; Pfaltz, Michael, Grossman, Margraf, & Wilhelm, 2010;
 25
Thielsch et al., 2015; Walz, Nauta, & aan het Rot, 2014), depression (Ebner-Priemer & Trull,

2009; Sowislo, Orth, & Meier, 2014; Wichers, Lothmann, Simons, Nicolson, & Peeters, 2012;

Wichers et al., 2010, 2011), borderline personality disorder (Ebner-Priemer, Kuo, et al., 2007;

Ebner-Priemer et al., 2008; Ebner-Priemer & Sawitzki, 2007; Ebner-Priemer, Welch, et al.,

2007; Reisch, Ebner-Priemer, Tschacher, Bohus, & Linehan, 2008; Trull et al., 2008), other

personality disorder symptoms (Wright & Simms, 2016), substance use disorders (for a review,

see Shiffman, 2009), attention-deficit/hyperactivity disorder (Skirrow et al., 2014), and psychotic

symptoms (Schlier, Moritz, & Lincoln, 2016; van Os, Lataster, Delespaul, Wichers, & Myin-

Germeys, 2014). Ambulatory assessment has also been used to examine the real-time

relationships between emotions and emotional appraisals (Tong et al., 2007), stress and fatigue

(Doerr et al., 2015), negative affect and cortisol levels (Jacobs et al., 2007), mood and being on-

call for work (Dettmers, Vahle-Hinz, Bamberg, Friedrich, & Keller, 2016), mood and memory

(Fahrenberg, Brügner, Foerster, & Käppler, 1999), emotions and mindfulness (Hill & Updegraff,

2012), positive and negative affect and a history of nonsuicidal self-injury (Bresin, 2014), and

negative affect and binge eating behavior (for a meta-analysis, see Haedt-Matt & Keel, 2011).

Ambulatory assessment allows researchers to address a variety of hypotheses in realtime as they

naturally occur without the limitations associated with memory biases and other biases (e.g.,

availability heuristic).

Ambulatory Assessment Methods in the Study of Emotion Regulation

Studies examining emotion regulation strategies (e.g., avoidance, problem solving) in

daily life using ambulatory assessment are fairly uncommon. Stone, Kennedy-Moore, and Neale

(1995) assessed the use of eight coping categories (distraction, situation redefinition
 26
[reappraisal], direct action [problem solving], catharsis, acceptance, seeking social support,

relaxation, and religion) regarding “the most bothersome event or issue of the day” in a group of

adolescents. They found that negative affect was positively associated with catharsis and

seeking social support and negatively associated with acceptance. Positive affect was positively

associated with distraction, acceptance, and relaxation. Stone and colleagues (1998) collected

information from participants every 20 – 60 minutes for 48 hours about stressors at work, in their

marriage, or in other contexts. If a participant endorsed a stressor since the previous reporting,

he or she indicated the extent to which each of 33 coping strategies was used. Researchers

compared the ambulatory assessment data to retrospective reporting of the same information.

There were considerable discrepancies between the regulatory strategies endorsed with

ambulatory assessment methods and with retrospective self-report (e.g., failing to report

stressors, over- and under-reporting how frequently regulatory strategies were used).

Silk, Steinberg, and Morris (2003) signaled adolescents six or seven times per day for one

week to identify an emotionally salient event that occurred in the 60 minutes prior to the signal.

Emotion regulation strategies were assessed when a participant reported an affect rating of 3 or

greater on a 5-point scale. They assessed the use of 13 strategies, which comprised four

subscales (primary control, secondary control, disengagement, and involuntary engagement).

They found that disengagement and involuntary engagement were ineffective at decreasing

negative affect. Tan and colleagues (2012) employed a method similar to the previous two

studies with adolescents with and without an anxiety disorder diagnosis. Researchers called

participants twice per day for one week and asked them to report their affect and its intensity.

The use of six categories of emotion regulation strategies (distraction, cognitive restructuring,

problem solving, acceptance, avoidance, and rumination) were assessed when a participant
 27
reported an affect rating of 3 or greater on a 5-point scale. They found that anxious and

nonanxious adolescents used the coping strategies with equal frequency. Problem solving and

distraction were effective for both groups. Acceptance was less effective and rumination was

more detrimental to those with an anxiety disorder than those without in predicting decreases in

emotional intensity (e.g., anxiety).

Short, Boffa, Clancy, and Schmidt (2018) examined emotion regulation in the context of

posttraumatic stress disorder. Participants with this diagnosis reported whether they experienced

a stressor since the last signal four times per day for eight days. Those who indicated that they

experienced “anything upsetting or stressful” reported whether they used each of seven emotion

regulation strategies (reappraisal, acceptance, problem solving, suppression, rumination,

impulsive behaviors, avoidance) and responded to ten items assessing posttraumatic stress

symptoms. Results indicated that the use of maladaptive emotion regulation strategies

(suppression, rumination, impulsive behaviors, avoidance) predicted greater posttraumatic stress

symptoms later in the day. Visser, Esfahlani, Sayama, and Strauss (2018) examined differences

in emotion regulation choice between individuals with schizophrenia or schizoaffective disorder

and control participants. All participants were signaled to report their emotional intensity (anger,

fear, sadness, shame, anxiety), emotion regulation use (suppression, reappraisal, relaxation,

distraction, talking about feelings with others, avoidance), and contextual information four times

per day for six days. Results found that those with schizophrenia or schizoaffective disorder

reported stronger negative emotions, and less effective use of emotion regulation strategies and

used more strategies in a given context than those in the control group. These findings suggest

that quality of regulatory strategies is more effective at decreasing distress than quantity of

strategies.
 28
Ambulatory assessment methods have also been used to examine the effects of the

induction of rumination, an emotion regulation strategy (Huffziger et al., 2013; Huffziger, Ebner-

Priemer, Koudela, Reinhard, & Kuehner, 2012). The inductions increased rumination and

decreased positive mood and calmness, and greater increases in rumination were associated with

greater decreases in positive mood (Huffziger et al., 2013, 2012). Using similar methods, the

potential regulatory effects of other behaviors have been studied. For example, listening to

music decreased subjective stress ratings (Linnemann, Ditzen, Strahler, Doerr, & Nater, 2015),

physical activity led to increased positive affect (for a review, see Liao, Shonkoff, & Dunton,

2015), nonsuicidal self-injury decreased negative affect (Armey, Crowther, & Miller, 2011), and

binge eating increased negative affect (for a meta-analysis, see Haedt-Matt & Keel, 2011).

Ambulatory assessment methods are an effective way to examine emotion regulation in daily

life.

Ambulatory Assessment Methods in the Study of Self-Compassion

The use of ambulatory assessment methods in the study of self-compassion is even less

common. In one study, researchers asked participants (N = 9) to record their self-critical

thoughts each day for two weeks while participating in a group-based self-compassion

intervention (Gilbert & Irons, 2004). Over treatment, there were no changes in self-criticism, but

there was a significant increase in the use of self-compassion to soothe self-critical thoughts.

However, it could be argued that this methodology still relies on retrospective reporting (i.e.,

indicating what happened previously rather than the current experience). In addition, the

extremely small sample size limits the generalizability of these findings. A similar study asked

participants (N = 95 female undergraduates) to complete a survey every evening for four days
 29
(Breines, Toole, et al., 2014). The survey assessed appearance-related self-compassion, self-

esteem, and disordered eating behaviors. Researchers found that self-compassion, but not self-

esteem, significantly predicted disordered eating. In a more recent study, participants (N = 100)

reported their affective states and their desire to change or maintain these states twice per day

throughout a nine-week compassion training intervention (Jazaieri et al., 2017). They also

completed weekly assessments of how frequently they used five emotion regulation strategies

(e.g., acceptance, suppression). There was a significant decrease in anxiety and a significant

increase in calm over the course of the intervention. There was also a decrease in the use of

suppression and an increase in the use of acceptance as emotion regulation strategies.

Another study using ambulatory assessment and self-compassion was conducted by

Krieger, Hermann, Zimmermann, and grosse Holtforth (2015). They assessed self-compassion

and global self-esteem in the laboratory as trait-level variables and then asked participants (N =

101 nonclinical community members) to report positive affect, negative affect, and perceived

stress twice daily for two weeks. Higher self-compassion was associated with greater positive

affect and less negative affect and perceived stress. When controlling for global self-esteem,

higher self-compassion was associated with more positive affect and less negative affect during

periods of higher levels of perceived stress. Self-compassion, but not global self-esteem, was

found to buffer the effects of perceived stress on negative affect. Further research is needed to

understand self-compassion’s role in daily functioning.

Statement of the Problem

Self-compassion is an emerging construct that was defined and operationalized by Neff

(2003a, 2003b). It is distinct from self-esteem and was developed as an alternate way of relating
 30
to the self (Neff, 2003a, 2003b). Self-compassion consists of three distinct yet interrelated pairs,

each with its own self-compassionate and self-critical component—self-kindness and self-

judgment, common humanity and isolation, and mindfulness and over-identification.

Self-compassion has been studied in relation to multiple constructs. A review of self-

compassion identified several correlates of self-compassion, including positive and negative

affect, well-being, life satisfaction, happiness, emotional intelligence, coping strategies, and

mindfulness (Barnard & Curry, 2011). The review also identified multiple studies showing that

self-compassion is negatively associated with depression and anxiety (Barnard & Curry, 2011).

A meta-analysis reported a large effect size for the inverse relationships between total self-

compassion and depression, anxiety, and stress (MacBeth & Gumley, 2012). Results of further

studies have been consistent with these findings. Intervention-based research indicates that self-

compassion can be increased (e.g., Kuyken et al., 2010; Mosewich et al., 2013; Robins et al.,

2012) and that its relationship with many of these psychopathology and well-being outcomes

may be causal (e.g., Neff & Germer, 2013; Shapira & Mongrain, 2010; Smeets et al., 2014).

Because self-compassion is sensitive to intervention and causally affects therapeutic outcomes of

interest, the results of the present study may have clinical implications.

One mechanism by which self-compassion may lead to lower levels of psychopathology

and greater well-being is emotion regulation. Self-compassion is positively associated with

acceptance (Diedrich et al., 2017; Neff et al., 2005; Pinto-Gouveia et al., 2012) and negatively

associated with avoidance (Krieger et al., 2013; Neff et al., 2005; Pinto-Gouveia et al., 2012) and

rumination (Odou & Brinker, 2014; Raes, 2010; Samaie & Farahani, 2011; Smeets et al., 2014).

There are mixed findings regarding the relationships between self-compassion and problem

solving (Leary et al., 2007; Pinto-Gouveia et al., 2012), reappraisal (Jazaieri et al., 2014; Neff et
 31
al., 2005; Petrocchi et al., 2014), and suppression (Jazaieri et al., 2014; Neff, Kirkpatrick, et al.,

2007; Petrocchi et al., 2014). Although self-compassion has been characterized as an emotion

regulation strategy, it appears to be a factor that influences emotion regulation choice and

enables individuals to adaptively regulate their emotions (Diedrich et al., 2017, 2014, 2016; Neff,

2003a, 2003b). Although little research has examined this distinction, one study found that

adaptive emotion regulation mediated the relationship between self-compassion and depressive

symptoms, but a reverse mediation was insignificant (Diedrich et al., 2017). Emotion regulation

appears to be a mechanism by which self-compassion leads to decreases in symptomatology and

increases in functioning. However, before such research can be conducted, it is important to

know if emotion regulation choice varies by trait self-compassion and, if so, the nature of these

differences.

One limitation of much research examining emotion regulation is that retrospective

reporting is subject to memory and other biases (Shiffman et al., 2008). Ambulatory assessment

addresses this limitation by collecting multiple data points over time rather than one

retrospective report (for reviews, see Carpenter, Wycoff, & Trull, 2016; Shiffman et al., 2008;

Trull & Ebner-Priemer, 2013). Although studies examining emotion regulation strategies (e.g.,

experiential avoidance, problem solving) in daily life using ambulatory assessment are

uncommon, findings suggest that regulation choice and the efficacy of these strategies varies

across individuals (Silk et al., 2003; Stone et al., 1995; Tan et al., 2012).

The use of ambulatory assessment methods in the study of self-compassion is even less

common. Participation in a self-compassion intervention led to a significant increase in the use

of self-compassion to soothe self-critical thoughts over treatment, and self-compassion

significantly predicted decreased anxiety, perceived stress, negative affect, and disordered eating,
 32
as well as increased calm and positive affect (Breines, Toole, et al., 2014; Gilbert & Irons, 2004;

Jazaieri et al., 2014; Krieger et al., 2015). Self-compassion also predicted a decrease in the use

of suppression and an increase in the use of acceptance as emotion regulation strategies (Jazaieri

et al., 2014). More research is needed to understand the effects of self-compassion on emotion

regulation choice in daily life.

The purpose of the present study was to use ambulatory assessment methodology to

examine how differences in self-compassion were associated with the use of emotion regulation

strategies in daily life through replicating and extending previous methodology to also assess

emotion regulation choice, depression, and anxiety (Krieger et al., 2015).

Hypotheses

See Appendix A for additional information and the statistical equations associated with

each of the hypotheses.

Measure Check Hypothesis

Hypothesis 0

Initial ratings of baseline distress (depression, anxiety, stress) will predict total average

ambulatory levels of distress (depression, anxiety, stress). Initial ratings of baseline emotion

regulation (acceptance, avoidance, problem solving, reappraisal, rumination, suppression) will

predict average ambulatory log odds of choosing each emotion regulation strategy (acceptance,

avoidance, problem solving, reappraisal, rumination, suppression).

 33
A Priori Hypotheses

Hypothesis 1

In replication of previous findings, baseline self-compassion will significantly negatively

relate to initial distress (depression, anxiety, stress).

Hypothesis 2

Individuals will vary significantly in their total average ambulatory levels of distress

(depression, anxiety, stress).

Hypothesis 3

In replication of previous findings, baseline self-compassion will predict total average

levels of ambulatory distress (depression, anxiety, stress).

Hypotheses 4-6

Individuals will differ in the log odds that they select each emotion regulation strategy

(acceptance, avoidance, problem solving, reappraisal, rumination, suppression) to regulate

distress (depression, anxiety, stress).

Hypotheses 7-12

When regulating ambulatory distress (depression, anxiety, stress), self-compassion will

predict the log odds that individuals choose each emotion regulation strategy (acceptance,

avoidance, problem solving, reappraisal, rumination, suppression). Self-compassion was

 34
expected to positively predict the log odds of using acceptance to regulate distress (depression,

anxiety, stress). Self-compassion was expected to negatively predict the log odds of using

avoidance to regulate distress (depression, anxiety, stress). No directionality was predicted in the

relationship between self-compassion and the log odds of using problem solving or reappraisal to

regulate distress (depression, anxiety, stress). Self-compassion was expected to negatively

predict the log odds of using rumination to regulate distress (depression, anxiety, stress). No

directionality was predicted in the relationship between self-compassion and the log odds of

using suppression to regulate distress (depression, anxiety, stress).

Exploratory Hypotheses

Hypotheses 13-15

Intensity of ambulatory distress (depression, anxiety, stress) may predict the log odds of

choosing to use each emotion regulation strategy (acceptance, avoidance, problem solving,

reappraisal, rumination, suppression). No predictions were made regarding directionality or

significance.

Hypothesis 16

There may be between-subjects variance in the number of emotion regulation strategies

chosen when coping with ambulatory distress (depression, anxiety, stress). No predictions were

made regarding directionality or significance.

 35
Hypothesis 17

Ambulatory distress severity (depression, anxiety, stress) may predict the number of

emotion regulation strategies chosen. No predictions were made regarding directionality or

significance.

Hypotheses 18-23

When regulating ambulatory distress (depression, anxiety, stress), self-esteem may

predict the log odds that individuals choose each emotion regulation strategy (acceptance,

avoidance, problem solving, reappraisal, rumination, suppression). No predictions were made

regarding directionality or significance.

 CHAPTER 2

METHODS

Participants

Participants were 40 undergraduate students enrolled in an introductory psychology

course, all of whom were recruited from the SONA website and received four research

participation credits. All participants were 18 years of age or older (Mage = 19.28 years, SDage =

1.52 years). Most participants were female (65.0%) and did not identify as Hispanic (87.5%).

The sample was also primarily White (62.5%; 27.5% Black, 7.5% Other [Hispanic], 2.5% Asian

or South Asian). The only inclusion criterion was smartphone ownership, and the majority of

participants used a device with an iOS operating system (70.0%). No participants dropped out of

the study, and all participants responded correctly to at least one of three catch questions (92.5%

responded correctly to all three questions). Thus, the entire sample of 40 participants was

included in the analyses.

 37
Measures

Initial Laboratory Visit

Potential Demographic Covariates

Age (in years), gender (1 = male, 2 = female), and race (1 = American Indian/Alaskan

Native, 2 = Asian or South-Asian, 3 = Black or African American, 4 = Native Hawaiian/Pacific

Islander, 5 = White or Caucasian, 6 = not listed) have been identified as demographic correlates

of self-compassion. As such, data about these variables were gathered using a self-report

questionnaire (see Appendix B).

Self-Compassion Scale (SCS; Neff, 2003a)

The SCS is a 26-item measure assessing self-compassion (e.g., “I try to be loving towards

myself when I’m feeling emotional pain”; see Appendix C). Participants indicated the extent to

which each statement is reflective of how they usually behave towards themselves by selecting

one of five Likert-type response options (1 = almost never to 5 = almost always). Although there

is some disagreement over the factor structure of the SCS (Costa, Marôco, Pinto-Gouveia,

Ferreira, & Castilho, 2016; López et al., 2015), up to 95% of the variance in self-compassion can

be explained by a general factor of self-compassion (Neff, 2016; Neff et al., 2019). Furthermore,

it has been concluded that the self-compassion and self-criticism components cannot be

separated into distinct subscales due to considerable overlap (Neff, 2019). As such, most

research using the SCS uses the one-factor model (López et al., 2015). Given these findings and

precedents set by previous researchers, the total score was used to quantify self-compassion in
 38
the present study. This score was determined by reverse scoring the self-critical items and

calculating the mean of all items. A higher score is indicative of greater self-compassion. The

SCS has been used in samples of undergraduates and has demonstrated excellent test-retest

reliability over a one-week period (r = .93, p < .05; Neff, 2003a) and internal consistency (α =

.83 – .95; e.g., Albertson et al., 2015; Arimitsu & Hofmann, 2015; Baer et al., 2012). In the

present study, the SCS demonstrated comparable internal consistency to previous research (α =

.91). Furthermore, the SCS total score has demonstrated convergent validity with the Social

Connectedness Scale (r = .41, p < .05) and the self-criticism scale of the Depressive Experiences

Questionnaire (r = -.65, p < .05) and discriminant validity with the Narcissistic Personality

Inventory (r = .11, p = ns; Neff, 2003a).

Rosenberg Self-Esteem Scale (RSE; Rosenberg, 1965)

The RSE is a ten-item measure of global self-esteem (e.g., “On the whole, I am satisfied

with myself”; see Appendix D). Participants indicated the extent to which they agree with each

statement by selecting one of four Likert-type response options (1 = Strongly Agree to 4 =

Strongly Disagree). The RSE was scored by reverse scoring the appropriate items and summing

the responses; a higher score is indicative of greater global self-esteem. The RSE is a well-

established measure of self-esteem and has been used frequently with samples of undergraduate

students (Aspinwall & Taylor, 1993; Gonzales & Hancock, 2011; Neff, 2003a). It has

demonstrated excellent internal consistency (α = .80 - .87), and scores from this instrument have

demonstrated convergent validity evidence when compared with well-known measures of the

Overall Life Satisfaction Scale (r = .54, p < .01) and discriminant validity evidence with
 39
perceived general intellectual ability (r = .20, p > .01; Aspinwall & Taylor, 1993; Gonzales &

Hancock, 2011; Krieger et al., 2015; Robins, Hendin, & Trzesniewski, 2001). The RSE

demonstrated comparable internal consistency in the present study (α = .894).

Depression, Anxiety, and Stress Scales 21 (DASS-21; Henry & Crawford, 2005)

The DASS-21 is a 21-item measure assessing three subscales, each consisting of seven

items (see Appendix E). The three subscales are depression (e.g., “I felt down-hearted and

blue”), anxiety (e.g., “I felt I was close to panic”), and stress (e.g., “I felt that I was using a lot of

nervous energy”). Responses were provided by selecting one of four ordinal response options (0

= did not apply to me at all to 3 = applied to me very much or most of the time). Subscale scores

are calculated by summing the items, and a higher score is indicative of greater symptoms. The

DASS-21 has been used in samples of undergraduates (e.g., Samaie & Farahani, 2011) and

scores from this instrument have demonstrated excellent internal consistency (α = .82 - .90) and

good convergent validity when the corresponding subscale was compared to the Beck

Depression Inventory-II (r = .80, p < .001), the Beck Anxiety Inventory (r = .69, p < .001), and

the Perceived Stress Scale (r = .73, p < .001; Henry & Crawford, 2005; Osman et al., 2012). The

DASS-21 demonstrated comparable internal consistency in the present study (α = .850 - .935).

Five Facet Mindfulness Questionnaire, Nonjudgmental Acceptance Subscale (FFMQ; Baer,

Smith, Hopkins, Krietemeyer, & Toney, 2006)

The Nonjudgmental Acceptance subscale of the FFMQ (see Appendix F) is an eight-item

subset of the 39-item measure and has been used independent of the remaining items (Seligowski

& Orcutt, 2015). This subscale measures acceptance (e.g., “I criticize myself for having
 40
irrational or inappropriate emotions,” reverse scored), and responses were indicated by selecting

one of five Likert-type response options (1 = never or very rarely true to 5 = very often or

always true). This subscale score was calculated by reverse scoring all items and calculating the

sum; a higher score is indicative of greater acceptance. The FFMQ was developed using a

sample of undergraduates (Baer et al., 2006) and has been used with similar samples since (Baer

et al., 2008). The Nonjudgmental Acceptance subscale has demonstrated excellent internal

consistency (α = .87-.93) and good convergent validity when compared to the Self-Compassion

Scale (r = .48, p < .001), the Difficulties with Emotion Regulation Questionnaire (r = -.52, p <

.001), and the Acceptance and Action Questionnaire (r = -.49, p < .001; Baer et al., 2006, 2008).

The Nonjudgmental Acceptance scale demonstrated divergent validity with the openness to

experience domain of the NEO-Five Factor Inventory (r = -.07, p = ns; Baer et al., 2006).

This subscale demonstrated similar internal consistency in the present study (α = .953).

Acceptance and Action Questionnaire-II (AAQ-II; Bond et al., 2011)

The AAQ-II is a seven-item measure assessing experiential avoidance (e.g., “I’m afraid

of my feelings”; see Appendix G). Participants indicated the extent to which each statement was

true for them by selecting one of seven Likert-type response options (1 = never true to 7 =

always true). The measure was scored by summing all items, and a higher score is indicative of

greater avoidance. The AAQ-II was developed using samples from various populations,

including undergraduate students (Bond et al., 2011). It has demonstrated good to excellent

internal consistency (α = .78-.88) and good convergent and discriminant validity when compared

to the Mental Health Continuum-Short Form (r = -.45; p < .01) and the Marlowe-Crowne Social
 41
Desirability Scale (r = -.09, p = ns), as well as the previous version of the AAQ-II (r = .97, p <

.001; Bond et al., 2011; Fledderus, Oude Voshaar, ten Klooster, & Bohlmeijer, 2012). In the

present study, the AAQ-II demonstrated a slightly higher level of internal consistency (α = .924).

Coping Strategies Inventory, Problem Solving Scale (CSI; Tobin, Holroyd, & Reynolds, 2001)

The Problem Solving scale of the CSI is a nine-item subset of the 72-item measure, and

previous research has administered only a subset of the scales (Hansel & Wittrock, 1997; Yoo &

Lee, 2005). This subscale measures problem solving (e.g., “I worked on solving problems in the

situation”; see Appendix H), and responses were indicated by selecting one of five Likert-type

response options (0 = not at all to 4 = very much). The scale score was calculated by summing

the items, and a higher score is indicative of greater use of problem solving. The original

measure instructs participants to identify and write about “an event or situation that has been

very stressful for you during the last month.” However, given the more generalized aims of the

present study, instructions were altered to direct participants to indicate how they “usually handle

troubling events.” Previous studies have made similar alterations to the measure’s instructions to

better align with the hypotheses (Su, Lee, & Vang, 2005; Yoo & Lee, 2005). The CSI was

developed using samples of undergraduates (Tobin, Holroyd, Reynolds, & Wigal, 1989). The

Problem Solving scale has demonstrated excellent internal consistency (α = .82), and the CSI has

predicted depressive symptoms in participants under high stress (Tobin et al., 2001,

1989). The scale demonstrated similar internal consistency in the present study (α = .833).
 42
Emotion Regulation Questionnaire (ERQ; Gross & John, 2003)

The ERQ (see Appendix I) is a ten-item measure designed to assess the use of two

emotion regulation strategies—the reappraisal facet (e.g., “When I’m faced with a stressful

situation, I make myself think about it in a way that helps me stay calm”) and the suppression

facet (e.g., “I control my emotions by not expressing them”). Participants indicated the extent to

which they agreed with each item by selecting one of seven Likert-type response options (1 =

strongly disagree to 7 = strongly agree). Facet scores were calculated by summing responses; a

higher score is indicative of greater use of the respective strategy. The ERQ was developed

using samples of undergraduate students (Gross & John, 2003). The scales have demonstrated

good to excellent internal consistency (α = .68-.82), good convergent validity when compared to

the reinterpretation (reappraisal; β = .43, p < .05) and venting (suppression; β = -.43, p < .05)

scales from the COPE, and divergent validity when compared to each other (r = -.06-.06, p = ns;

Gross & John, 2003). Both facets demonstrated similar levels of internal reliability

in the present study (α = .726-.782).

Rumination-Reflection Questionnaire, Rumination Factor (RRQ; Trapnell & Campbell, 1999)

The Rumination factor of the RRQ is a 12-item measure of rumination (e.g., “Long after

an argument or disagreement is over with, my thoughts keep going back to what happened”; see

Appendix J). Participants’ responses reflect the extent to which they agreed with each statement

by selecting one of five Likert-type response options (1 = Strongly Disagree to 5 = Strongly

Agree). The factor score was calculated by reverse coding the appropriate items and averaging

the responses; a higher score is indicative of greater rumination. The RRQ was developed using
 43
samples of undergraduate students (Trapnell & Campbell, 1999). The Rumination factor

demonstrated excellent internal consistency (α > .90), good convergent validity when compared

to the self-reflectiveness subscale of the Private Self-Consciousness Scale (r = .53, p < .05), and

discriminant validity when compared to the internal state awareness subscale of the Private Self-

Consciousness Scale (r = .05, p = ns; Trapnell & Campbell, 1999). This factor demonstrated

comparable internal reliability in the present study (α = .899).

Ambulatory Assessment Signals

See Appendix K for the measures provided at each signal.

Depression, Anxiety, and Stress

Methodology from previous studies was used to assess state depression, anxiety, and

stress. At each signal, participants were asked, “How depressed did you feel since the last

assessment?” (Krieger et al., 2015). Similar questions were used to assess anxiety and stress.

Participants responded using a 101-point scale (0 = not at all to 100 = completely). Higher

scores indicated greater distress.

Emotion Regulation Strategies

Methodology from previous studies was used to assess emotion regulation choice. After

each rating of depression, anxiety, and stress, participants were asked to report their responses to

these emotions from a list of six strategies (acceptance, avoidance, problem solving, reappraisal,

rumination, and suppression). This is similar to previous studies (Short et al., 2018; Silk et al.,

2003; Tan et al., 2012; Visser et al., 2018).

 44
Procedure

Participants enrolled in the study using an online study sign-up website (i.e., SONA),

where they were provided with a brief description of the study. During the initial laboratory

visit, each participant provided informed consent, completed the initial laboratory visit measures,

received psychoeducation about the emotions (i.e., depression, anxiety, and stress) and emotion

regulation strategies assessed in this study (i.e., acceptance, avoidance, problem solving,

reappraisal, rumination, and suppression; see Appendix L), downloaded the PACO application

(PACO, 2016) to his or her Apple- or Android-based smartphone, and received a brief tutorial on

how to use the application.

After the laboratory visit, participants were signaled by the PACO application to

complete the ambulatory assessment measures. Similar to previous methodology (Silk et al.,

2003; Stone et al., 1995), they were signaled approximately every two to three hours for the rest

of the day of the initial laboratory visit and six times daily for the next five days. Participants

had a one-hour window during which to complete the measures (Silk et al., 2003), after which

time the signal was classified as missed. The 40 participants completed an average of 78.10% of

scheduled signals (SD = 22.11%), resulting in an average of 27.5 completed signals each (SD =

9.8), meeting the 30/30 recommendation (i.e., 30 data samplings from 30 participants) to ensure

sufficient data for multilevel modeling (Maas & Hox, 2005; McNeish & Stapleton, 2016;

Scherbaum & Ferreter, 2009).

 CHAPTER 3

RESULTS

Missing Data, Testing of Potential Covariates, and Tests of Normality

At baseline, one participant chose “Prefer not to respond” in response to one item (item

11 of the SCS). There was no additional missing data or selection of the “Prefer not to respond”

option. Chi-square tests indicated that total self-compassion did not significantly vary by gender

(X2 (31, N = 40) = 31.94, p = ns) or race (X2 (93, N = 40) = 90.47, p = ns), and a bivariate

correlation determined that self-compassion and age were not significantly related (r = -.030, p =

ns). Because these covariates were not significant, they were not included as Level 2 variables in

any of the analyses. See Table 1 for means, standard deviations, Cronbach’s alphas, and

bivariate correlations of all measures completed during the initial laboratory visit. As would be

expected, self-compassion was positively correlated with self-esteem and negatively correlated

with depression (though nonsignificant), anxiety, and stress. Most of the relationships between

self-compassion and emotion regulation strategies were consistent with predictions made in

Hypotheses 7 – 12. As anticipated, self-compassion positively predicted acceptance, negatively

predicted avoidance and rumination, and was unrelated to problem solving and reappraisal.

Contrary to predictions, self-compassion was unrelated to suppression. Self-esteem was

similarly related to the other variables of interest, though its correlation with depression was

significant. Depression, anxiety, and stress were significantly correlated with each other. When
 Table 1

Means, Standard Deviations, Cronbach’s Alphas, and Bivariate Correlations of Initial Laboratory Visit Measures

Scales 1 2 3 4 5 6 7 8 9 10 11
1. SCS (.910) *
2. RSE .615* (.894)
3. DASS_D -.375* -.736* (.935)
4. DASS_A -.466* -.565* .649* (.850)
5. DASS_S -.580* -.579* .599* .734* (.858)
6. FFMQ_A .586* .645* -.514* -.667* -.614* (.953)
7. AAQ-II -.621* -.649* .704* .715* .709* -.734* (.924)
8. CSI_PRS .088* .243* .087* .078* .144* -.035* .073* (.833)
9. ERQ_R .340* .341* -.060* .107* -.028* -.069* -.039* .336* (.726)
10. ERQ_S -.090* -.011* .319* .348* .222* -.220* .340* .391* .068* (.782)
11. RRQ_Ru -.605* -.412* .378* .608* .644* -.495* .589* .075* .003* .241* (.899)
Mean 2.72 28.70 5.70 6.00 7.83 26.37 25.68 22.98 29.30 16.05 3.76
SD 0.67 6.06 6.11 5.38 5.35 9.45 11.24 6.26 5.91 5.72 0.77
Note: N = 40. Cronbach’s alphas are presented on the diagonal. *p < .01. SCS = Self-Compassion Scale. RSE = Rosenberg Self-
Esteem Scale. DASS_D = Depression, Anxiety, and Stress Scales 21, Depression Subscale. DASS_A = Depression, Anxiety, and
Stress Scales 21, Anxiety Subscale. DASS_S = Depression, Anxiety, and Stress Scales 21, Stress Subscale. FFMQ_A = Five Facet
Mindfulness Questionnaire, Nonjudgmental Acceptance Subscale. AAQ-II = Acceptance and Action Questionnaire-II. CSI_PRS =
Coping Strategies Inventory, Problem Solving Scale. ERQ_R = Emotion Regulation Questionnaire, Reappraisal Facet. ERQ_S =
Emotion Regulation Questionnaire, Suppression Facet. RRQ_Ru = Rumination-Reflection Questionnaire, Rumination Factor.

46
 47
distress and emotion regulation were significantly correlated, the relationships were as expected

(e.g., anxiety was positively correlated with rumination). When the regulatory strategies were

significantly correlated with each other, the relationships were as expected (e.g., acceptance was

negatively correlated with avoidance). See Table 2 for means and standard deviations of all

ambulatory assessment variables. After the models were fitted for the following hypotheses, the

multilevel modeling assumptions were tested. If any of these assumptions were not met, this was

noted, and robust standard errors were used when testing the hypotheses. A significance level of

α = .01 was used to determine significance for all tests.

Measure Check, A Priori, and Exploratory Hypotheses

All models estimated are detailed in Appendix A. Except when specified, all hypotheses

were tested using multilevel modeling, where the repeated measures were clustered within

individuals. A significance level of α = .01 was used. Null models were fitted for each outcome

variable, and the intraclass correlation coefficient (ICC) and design effect (DEFF) were

computed to assess the importance of clustering.

Measure Check Hypothesis 0

To test whether baseline ratings of distress (depression, anxiety, stress) predicted total

average ambulatory levels of distress (depression, anxiety, stress), the ambulatory distress

measures were entered as the outcome variables. Initial ratings of distress were entered as the

Level 2 predictors in separate models. To test whether initial ratings of baseline emotion

regulation (acceptance, avoidance, problem solving, reappraisal, rumination, suppression)

predicted total average ambulatory log odds of choosing each emotion regulation strategy
 48
Table 2

Means and Standard Deviations of Ambulatory Assessment Measures

Standard
Variable Mean
Deviation
Depression 12.70 23.55
Acceptance 0.27 0.44
Avoidance 0.14 0.35
Problem Solving 0.14 0.35
Reappraisal 0.10 0.29
Rumination 0.10 0.30
Suppression 0.12 0.33
Number of Strategies 0.87 1.28
Anxiety 15.49 24.65
Acceptance 0.30 0.46
Avoidance 0.16 0.37
Problem Solving 0.17 0.38
Reappraisal 0.11 0.31
Rumination 0.10 0.30
Suppression 0.14 0.35
Number of Strategies 0.99 1.28
Stress 20.29 27.47
Acceptance 0.38 0.49
Avoidance 0.20 0.40
Problem Solving 0.28 0.45
Reappraisal 0.13 0.34
Rumination 0.14 0.35
Suppression 0.17 0.38
Number of Strategies 1.30 1.39
Note: N = 1099. Emotion regulation strategies
are coded 0 = did not use and 1 = did use. Scores
for all distress ratings ranged 0 – 100, scores for
all emotion regulation ranged 0 – 1, and scores
for number of strategies for all distress types
ranged 0 – 6.
 49
(acceptance, avoidance, problem solving, reappraisal, rumination, suppression) for each type of

distress (depression, anxiety, stress), the emotion regulation strategies were entered as the

outcome variables, and initial emotion regulation scores were entered as the Level 2 predictors.

If the data supported this hypothesis, the model term of interest was significantly different from

zero and positive (see Appendix A for all models and specified model terms of interest). In

addition, each of these models was compared to their corresponding null model, and R2 was

computed to determine the percent of variance explained by ambulatory distress and ambulatory

emotion regulation choice.

Hypothesis 0.1

Robust standard errors were used when testing this hypothesis because the Level 1

residuals were not normally distributed, the Level 2 residuals were not normally distributed, and

the Level 1 residuals were not homogeneous across the clusters. As predicted, initial ratings of

depression (DASS-21) predicted total average ambulatory depression (𝛽01 = 1.918, p < .001).

When compared to the corresponding null model, initial depression increased the model variance

by 0.01%.

Hypothesis 0.2

Robust standard errors were used when testing this hypothesis because the Level 1

residuals were not normally distributed, the Level 2 residuals were not normally distributed, and

the Level 1 residuals were not homogeneous across the clusters. As predicted, initial ratings of

anxiety (DASS-21) predicted total average ambulatory anxiety (𝛽01 = 2.185, p < .001). When
 50
compared to the corresponding null model, initial anxiety predicted 0% of the variance in

ambulatory anxiety.

Hypothesis 0.3

Robust standard errors were used when testing this hypothesis because the Level 1

residuals were not normally distributed, the Level 2 residuals were not normally distributed, and

the Level 1 residuals were not homogeneous across the clusters. Initials ratings of stress (DASS-

21) did not significantly predict total average ambulatory stress (𝛽01 = 1.468, p = .015).

Hypothesis 0.4

Initial ratings of acceptance (FFMQ) did not significantly predict the log odds of using

acceptance to cope with depression (𝛽01 = -0.064, p = .173).

Hypothesis 0.5

Initial ratings of acceptance (FFMQ) did not significantly predict the log odds of using

acceptance to cope with anxiety (𝛽01 = -0.055, p = .154).

Hypothesis 0.6

Initial ratings of acceptance (FFMQ) did not significantly predict the log odds of using

acceptance to cope with stress (𝛽01 = -0.052, p = .209).

 51
Hypothesis 0.7

As predicted, initial ratings of avoidance (AAQ-II) significantly predicted the log odds of

using avoidance to cope with depression (𝛽01 = 0.123, p = .001). The odds ratio was 1.130.

Hypothesis 0.8

As predicted, initial ratings of avoidance (AAQ-II) significantly predicted the log odds of

using avoidance to cope with anxiety (𝛽01 = 0.122, p < .001). The odds ratio was 1.129.

Hypothesis 0.9

As predicted, initial ratings of avoidance (AAQ-II) significantly predicted the log odds of

using avoidance to cope with stress (𝛽01 = 0.098, p < .001). The odds ratio was 1.102.

Hypothesis 0.10

Initial ratings of problem solving (CSI) did not significantly predict the log odds of using

problem solving to cope with depression (𝛽01 = 0.170, p = .046).

Hypothesis 0.11

Initial ratings of problem solving (CSI) did not significantly predict the log odds of using

problem solving to cope with anxiety (𝛽01 = 0.049, p = .354).

 52
Hypothesis 0.12

Initial ratings of problem solving (CSI) did not significantly predict the log odds of using

problem solving to cope with stress (𝛽01 = 0.038, p = .482).

Hypothesis 0.13

Initial ratings of reappraisal (ERQ) did not significantly predict the log odds of using

reappraisal to cope with depression (𝛽01 = 0.090, p = .309).

Hypothesis 0.14

Initial ratings of reappraisal (ERQ) did not significantly predict the log odds of using

reappraisal to cope with anxiety (𝛽01 = 0.069, p = .275).

Hypothesis 0.15

Initial ratings of reappraisal (ERQ) did not significantly predict the log odds of using

reappraisal to cope with stress (𝛽01 = 0.078, p = .211).

Hypothesis 0.16

Initial ratings of rumination (RRQ) did not significantly predict the log odds of using

rumination to cope with depression (𝛽01 = 0.699, p = .190).

 53
Hypothesis 0.17

Initial ratings of rumination (RRQ) did not significantly predict the log odds of using

rumination to cope with anxiety (𝛽01 = 0.676, p = .136).

Hypothesis 0.18

Initial ratings of rumination (RRQ) did not significantly predict the log odds of using

rumination to cope with stress (𝛽01 = 0.630, p = .154).

Hypothesis 0.19

Initial ratings of suppression (ERQ) did not significantly predict the log odds of using

suppression to cope with depression (𝛽01 = 0.064, p = .270).

Hypothesis 0.20

Initial ratings of suppression (ERQ) did not significantly predict the log odds of using

suppression to cope with anxiety (𝛽01 = 0.020, p = .720).

Hypothesis 0.21

Initial ratings of suppression (ERQ) did not significantly predict the log odds of using

suppression to cope with stress (𝛽01 = -0.022, p = .658).

 54
A Priori Hypothesis 1

To test whether baseline self-compassion was significantly negatively related to initial

distress (depression, anxiety, stress), linear regression analyses were used. The measures of

initial distress were the outcome variables, and the total self-compassion score was the predictor.

If the data supported this hypothesis, the model term of interest was significantly different from

zero and negative.

Hypothesis 1.1

Baseline self-compassion did not significantly predict baseline depression (β = -3.436, p

= .017).

Hypothesis 1.2

As predicted, baseline self-compassion significantly predicted baseline anxiety (β =

-3.763, p = .002). Self-compassion predicted 21.7% of the variance in baseline anxiety.

Hypothesis 1.3

As predicted, baseline self-compassion significantly predicted baseline stress (β = -4.654,

p < .001). Self-compassion predicted 33.6% of the variance in baseline stress.

 55
A Priori Hypothesis 2

To determine if individuals varied significantly in their total average ambulatory levels of

distress (depression, anxiety, stress), the ambulatory distress measures were entered as the

outcome variables in a multilevel model. If the data supported this hypothesis, the random effect

of interest was significantly different from zero.

Hypothesis 2.1

As predicted, individuals significantly varied in their average ambulatory depression

(Var(𝑟0𝑖 ) = 325.86, p < .001).

Hypothesis 2.2

As predicted, individuals significantly varied in their average ambulatory anxiety

(Var(𝑟0𝑖 ) = 356.21, p < .001).

Hypothesis 2.3

As predicted, individuals significantly varied in their average ambulatory stress (Var(𝑟0𝑖 )

= 458.43, p < .001).

A Priori Hypothesis 3

To determine if baseline self-compassion predicted average levels of ambulatory distress

(depression, anxiety, stress), the distress measures were entered as the outcome variables in a

multilevel model. The total self-compassion score was entered as the Level 2 predictor. If the
 56
data supported the hypothesis, the model term of interest was significantly different from zero.

In addition, each of these models was compared to their corresponding null model, and R2 was

computed to determine the percent of variance explained by self-compassion.

Hypothesis 3.1

Robust standard errors were used when testing this hypothesis because the Level 1

residuals were not normally distributed, the Level 2 residuals were not normally distributed, and

the Level 1 residuals were not homogeneous across the clusters. Baseline self-compassion did

not significantly predict average ambulatory depression (𝛽01 = -7.483, p = .046).

Hypothesis 3.2

Robust standard errors were used when testing this hypothesis because the Level 1

residuals were not normally distributed, the Level 2 residuals were not normally distributed, and

the Level 1 residuals were not homogeneous across the clusters. Baseline self-compassion did

not significantly predict average ambulatory anxiety (𝛽01 = -6.402, p = .127).

Hypothesis 3.3

Robust standard errors were used when testing this hypothesis because the Level 1

residuals were not normally distributed, the Level 2 residuals were not normally distributed, and

the Level 1 residuals were not homogeneous across the clusters. Baseline self-compassion did

not significantly predict average ambulatory stress (𝛽01 = -8.101, p = .047).

 57
A Priori Hypotheses 4-6

To determine if individuals varied in the log odds that they selected each emotion

regulation strategy (acceptance, avoidance, problem solving, reappraisal, rumination,

suppression) when coping with ambulatory distress (depression, anxiety, stress), the emotion

regulation strategies were entered as the outcome variables, and null multilevel models were

fitted. If the data supported the hypotheses, the model term of interest was significantly different

from zero. In addition, the ICC and DEFF were computed to assess the importance of the

clustering.

Hypothesis 4.1

As predicted, individuals significantly varied in the log odds of acceptance for depression

(Var(𝜋0𝑖 ) = 6.42, p < .001). The ICC (.661) and DEFF (18.51) indicate that clustering is

important.

Hypothesis 4.2

As predicted, individuals significantly varied in the log odds of avoidance for depression

(Var(𝜋0𝑖 ) = 5.31, p < .001). The ICC (.618) and DEFF (17.35) indicate that clustering is

important.
 58
Hypothesis 4.3

As predicted, individuals significantly varied in the log odds of problem solving for

depression (Var(𝜋0𝑖 ) = 7.18, p < .001). The ICC (.686) and DEFF (19.16) indicate that

clustering is important.

Hypothesis 4.4

As predicted, individuals significantly varied in the log odds of reappraisal for depression

(Var(𝜋0𝑖 ) = 5.82, p < .001). The ICC (.639) and DEFF (17.92) indicate that clustering is

important.

Hypothesis 4.5

As predicted, individuals significantly varied in the log odds of rumination for depression

(Var(𝜋0𝑖 ) = 4.02, p < .001). The ICC (.550) and DEFF (15.56) indicate that clustering is

important.

Hypothesis 4.6

As predicted, individuals significantly varied in the log odds of suppression for

depression (Var(𝜋0𝑖 ) = 3.42, p < .001). The ICC (.509) and DEFF (14.49) indicate that

clustering is important.
 59
Hypothesis 5.1

As predicted, individuals significantly varied in the log odds of acceptance for anxiety

(Var(𝜋0𝑖 ) = 4.42, p < .001). The ICC (.573) and DEFF (16.18) indicate that clustering is

important.

Hypothesis 5.2

As predicted, individuals significantly varied in the log odds of avoidance for anxiety

(Var(𝜋0𝑖 ) = 3.78, p < .001). The ICC (.535) and DEFF (15.16) indicate that clustering is

important.

Hypothesis 5.3

As predicted, individuals significantly varied in the log odds of problem solving for

anxiety (Var(𝜋0𝑖 ) = 3.38, p < .001). The ICC (.507) and DEFF (14.42) indicate that clustering is

important.

Hypothesis 5.4

As predicted, individuals significantly varied in the log odds of reappraisal for anxiety

(Var(𝜋0𝑖 ) = 3.84, p < .001). The ICC (.538) and DEFF (15.26) indicate that clustering is

important.
 60
Hypothesis 5.5

As predicted, individuals significantly varied in the log odds of rumination for anxiety

(Var(𝜋0𝑖 ) = 3.01, p < .001). The ICC (.477) and DEFF (13.64) indicate that clustering is

important.

Hypothesis 5.6

As predicted, individuals significantly varied in the log odds of suppression for anxiety

(Var(𝜋0𝑖 ) = 2.90, p < .001). The ICC (.468) and DEFF (13.40) indicate that clustering is

important.

Hypothesis 6.1

As predicted, individuals significantly varied in the log odds of acceptance for stress

(Var(𝜋0𝑖 ) = 5.10, p < .001). The ICC (.608) and DEFF (17.10) indicate that clustering is

important.

Hypothesis 6.2

As predicted, individuals significantly varied in the log odds of avoidance for stress

(Var(𝜋0𝑖 ) = 3.23, p < .001). The ICC (.495) and DEFF (14.12) indicate that clustering is

important.
 61
Hypothesis 6.3

As predicted, individuals significantly varied in the log odds of problem solving for stress

(Var(𝜋0𝑖 ) = 3.72, p < .001). The ICC (.530) and DEFF (15.05) indicate that clustering is

important.

Hypothesis 6.4

As predicted, individuals significantly varied in the log odds of reappraisal for stress

(Var(𝜋0𝑖 ) = 3.32, p < .001). The ICC (.502) and DEFF (14.30) indicate that clustering is

important.

Hypothesis 6.5

As predicted, individuals significantly varied in the log odds of rumination for stress

(Var(𝜋0𝑖 ) = 3.17, p < .001). The ICC (.490) and DEFF (13.99) indicate that clustering is

important.

Hypothesis 6.6

As predicted, individuals significantly varied in the log odds of suppression for stress

(Var(𝜋0𝑖 ) = 2.31, p < .001). The ICC (.412) and DEFF (11.91) indicate that clustering is

important.
 62
A Priori Hypotheses 7-12

To determine if baseline self-compassion predicted the log odds that individuals chose

each emotion regulation strategy (acceptance, avoidance, problem solving, reappraisal,

rumination, suppression) when regulating ambulatory distress (depression, anxiety, stress), the

emotion regulation strategies were entered as the outcome variables in generalized multilevel

models. The total self-compassion score was entered as the Level 2 predictor. If the data

supported the hypotheses, the model term of interest was significantly different from zero for

acceptance, avoidance, and rumination, and the coefficient was positive for acceptance and

negative for avoidance and rumination.

Hypothesis 7.1

Baseline self-compassion did not significantly predict the log odds that individuals chose

acceptance when regulating ambulatory depression (β = -0.143, p = .835).

Hypothesis 7.2

Baseline self-compassion did not significantly predict the log odds that individuals chose

acceptance when regulating ambulatory anxiety (β = -0.142, p = .801).

Hypothesis 7.3

Baseline self-compassion did not significantly predict the log odds that individuals chose

acceptance when regulating ambulatory stress (β = -0.164, p = .784).

 63
Hypothesis 8.1

Baseline self-compassion did not significantly predict the log odds that individuals chose

avoidance when regulating ambulatory depression (β = -1.273, p = .067).

Hypothesis 8.2

Baseline self-compassion did not significantly predict the log odds that individuals chose

avoidance when regulating ambulatory anxiety (β = -1.153, p = .038).

Hypothesis 8.3

Baseline self-compassion did not significantly predict the log odds that individuals chose

avoidance when regulating ambulatory stress (β = -0.908, p = .057).

Hypothesis 9.1

Baseline self-compassion did not significantly predict the log odds that individuals chose

problem solving when regulating ambulatory depression (β = 0.342, p = .641).

Hypothesis 9.2

Baseline self-compassion did not significantly predict the log odds that individuals chose

problem solving when regulating ambulatory anxiety (β = 0.262, p = .595).

Hypothesis 9.3

Baseline self-compassion did not significantly predict the log odds that individuals chose

problem solving when regulating ambulatory stress (β = -0.014, p = .978).

 64
Hypothesis 10.1

Baseline self-compassion did not significantly predict the log odds that individuals chose

reappraisal when regulating ambulatory depression (β = 0.288, p = .688).

Hypothesis 10.2

Baseline self-compassion did not significantly predict the log odds that individuals chose

reappraisal when regulating ambulatory anxiety (β = -0.273, p = .627).

Hypothesis 10.3

Baseline self-compassion did not significantly predict the log odds that individuals chose

reappraisal when regulating ambulatory stress (β = -0.099, p = .846).

Hypothesis 11.1

Baseline self-compassion did not significantly predict the log odds that individuals chose

rumination when regulating ambulatory depression (β = -0.554, p = .353).

Hypothesis 11.2

Baseline self-compassion did not significantly predict the log odds that individuals chose

rumination when regulating ambulatory anxiety (β = -0.685, p = .186).

 65
Hypothesis 11.3

Baseline self-compassion did not significantly predict the log odds that individuals chose

rumination when regulating ambulatory stress (β = -0.540, p = .287).

Hypothesis 12.1

Baseline self-compassion did not significantly predict the log odds that individuals chose

suppression when regulating ambulatory depression (β = -0.958, p = .074).

Hypothesis 12.2

Baseline self-compassion did not significantly predict the log odds that individuals chose

suppression when regulating ambulatory anxiety (β = -0.666, p = .176).

Hypothesis 12.3

Baseline self-compassion did not significantly predict the log odds that individuals chose

suppression when regulating ambulatory stress (β = -0.585, p = .160).

Exploratory Hypotheses 13-15

To determine if intensity of ambulatory distress (depression, anxiety, stress) predicted the

log odds of choosing to use each emotion regulation strategy (acceptance, avoidance, problem

solving, reappraisal, rumination, suppression), the emotion regulation strategies were entered as

outcome variables in generalized multilevel models. The ambulatory distress measures were
 66
entered as time-varying Level 1 predictors. If ambulatory distress predicted the log odds of

choosing an emotion regulation strategy, the model term of interest was significantly different

from zero, and the coefficient indicated if this relationship was positive or negative.

Hypothesis 13.1

Ambulatory depression significantly predicted the log odds of choosing acceptance (β =

0.016, p < .001). The odds ratio was 1.016.

Hypothesis 13.2

Ambulatory depression significantly predicted the log odds of choosing avoidance (β =

0.025, p < .001). The odds ratio was 1.025.

Hypothesis 13.3

Ambulatory depression did not significantly predict the log odds of choosing problem

solving (β = 0.006, p = .292).

Hypothesis 13.4

Ambulatory depression did not significantly predict the log odds of choosing reappraisal

(β = 0.003, p = .611).

Hypothesis 13.5

Ambulatory depression significantly predicted the log odds of choosing rumination (β =

0.051, p < .001). The odds ratio was 1.052.

 67
Hypothesis 13.6

Ambulatory depression significantly predicted the log odds of choosing suppression (β =

0.043, p < .001). The odds ratio was 1.044.

Hypothesis 14.1

Ambulatory anxiety did not significantly predict the log odds of choosing acceptance (β =

0.002, p = .605).

Hypothesis 14.2

Ambulatory anxiety significantly predicted the log odds of choosing avoidance (β =

0.026, p < .001). The odds ratio was 1.027.

Hypothesis 14.3

Ambulatory anxiety significantly predicted the log odds of choosing problem solving (β =

0.017, p < .001). The odds ratio was 1.017.

Hypothesis 14.4

Ambulatory anxiety significantly predicted the log odds of choosing reappraisal (β =

0.019, p < .001). The odds ratio was 1.019.

 68
Hypothesis 14.5

Ambulatory anxiety significantly predicted the log odds of choosing rumination (β =

0.039, p < .001). The odds ratio was 1.040.

Hypothesis 14.6

Ambulatory anxiety significantly predicted the log odds of choosing suppression (β =

0.039, p < .001). The odds ratio was 1.040.

Hypothesis 15.1

Ambulatory stress significantly predicted the log odds of choosing acceptance (β = 0.019,

p < .001). The odds ratio was 1.019.

Hypothesis 15.2

Ambulatory stress significantly predicted the log odds of choosing avoidance (β = 0.027,

p < .001). The odds ratio was 1.027.

Hypothesis 15.3

Ambulatory stress significantly predicted the log odds of choosing problem solving (β =

0.020, p < .001). The odds ratio was 1.020.

 69
Hypothesis 15.4

Ambulatory stress significantly predicted the log odds of choosing reappraisal (β = 0.020,

p < .001). The odds ratio was 1.020.

Hypothesis 15.5

Ambulatory stress significantly predicted the log odds of choosing rumination (β = 0.041,

p < .001). The odds ratio was 1.042.

Hypothesis 15.6

Ambulatory stress significantly predicted the log odds of choosing suppression (β =

0.027, p < .001). The odds ratio was 1.028.

Exploratory Hypothesis 16

To determine if there was between-subjects variance in the number of emotion regulation

strategies chosen when coping with ambulatory distress (depression, anxiety, stress), the number

of strategies were entered as the outcome variables in a multilevel model. If the data supported

the hypothesis, the model term of interest was significantly different from zero.

Hypothesis 16.1

Individuals significantly varied in the number of emotion regulation strategies chosen

when coping with ambulatory depression (Var(𝜋0𝑖 ) = 4.03, p < .001).

 70
Hypothesis 16.2

Individuals significantly varied in the number of emotion regulation strategies chosen

when coping with ambulatory anxiety (Var(𝜋0𝑖 ) = 2.33, p < .001).

Hypothesis 16.3

Individuals significantly varied in the number of emotion regulation strategies chosen

when coping with ambulatory stress (Var(𝜋0𝑖 ) = 1.57, p < .001).

Exploratory Hypothesis 17

To determine if severity of ambulatory distress (depression, anxiety, stress) predicted the

number of emotion regulation strategies chosen, the number of endorsed strategies was entered

as the outcome variable in a multilevel model. The ambulatory distress measures were entered

as Level 1 predictors. If ambulatory distress predicted the number of strategies used, the model

term of interest was significantly different from zero, and the coefficient indicated if this

relationship was positive or negative. In addition, these models were compared to the null

models in Hypothesis 16, and R2 was computed to determine the percent of variance explained

by

ambulatory distress.

Hypothesis 17.1

Robust standard errors were used when testing this hypothesis because the Level 1

residuals were not normally distributed, the Level 1 predictor was not independent of the Level 1

residuals, and the Level 2 residuals were not normally distributed. Ambulatory depression did
 71
not significantly predict the number of strategies used (β = 0.010, p = .019). When compared to

the corresponding null model, ambulatory depression predicted 15.46% of the variance in the

number of strategies used.

Hypothesis 17.2

Robust standard errors were used when testing this hypothesis because the Level 1

residuals were not normally distributed, the Level 1 predictor was not independent of the Level 1

residuals, and the Level 2 residuals were not normally distributed. Ambulatory anxiety

significantly predicted the number of strategies used (β = 0.011, p = .004). When compared to

the corresponding null model, ambulatory anxiety predicted 22.31% of the variance in the

number of strategies used.

Hypothesis 17.3

Robust standard errors were used when testing this hypothesis because the Level 1

residuals were not normally distributed, the Level 1 predictor was not independent of the Level 1

residuals, and the level 2 residuals were not normally distributed. Ambulatory stress

significantly predicted the number of strategies used (β = 0.012, p < .001). When compared to

the corresponding null model, ambulatory stress predicted 29.08% of the variance in the number

of strategies used.

Exploratory Hypotheses 18-23

To determine if self-esteem predicted the log odds that individuals chose each emotion

regulation strategy (acceptance, avoidance, problem solving, reappraisal, rumination,

 72
suppression) when regulating ambulatory distress (depression, anxiety, stress), the emotion

regulation strategies were entered as the outcome variables in generalized multilevel models.

The total self-esteem score was entered as the Level 2 predictor. If self-esteem was a significant

predictor, the model term of interest was significantly different from zero, and the coefficient

indicated if this relationship was positive or negative. Table 3 summarizes the findings of these

hypotheses and of Hypotheses 7-12.

Hypothesis 18.1

Baseline self-esteem did not significantly predict the log odds that individuals chose

acceptance when regulating ambulatory depression (β = -0.123, p = .092).

Hypothesis 18.2

Baseline self-esteem did not significantly predict the log odds that individuals chose

acceptance when regulating ambulatory anxiety (β = -0.038, p = .535).

Hypothesis 18.3

Baseline self-esteem did not significantly predict the log odds that individuals chose

acceptance when regulating ambulatory stress (β = -0.063, p = .325).

Hypothesis 19.1

Baseline self-esteem significantly predicted the log odds that individuals chose avoidance

when regulating ambulatory depression (β = -0.192, p = .007). The odds ratio was 0.825.
 73
Table 3

Summary of Hypotheses 7-12 and 18-2

Dependent Variable Self-Compassion β Self-Esteem β

Depression
Acceptance ns ns
Avoidance ns -0.192
Problem Solving ns ns
Reappraisal ns ns
Rumination ns -0.185
Suppression ns -0.141
Anxiety
Acceptance ns ns
Avoidance ns ns
Problem Solving ns ns
Reappraisal ns ns
Rumination ns -0.164
Suppression ns ns
Stress
Acceptance ns ns
Avoidance ns ns
Problem Solving ns ns
Reappraisal ns ns
Rumination ns -0.140
Suppression ns Ns
Note: N = 1099. ns = nonsignificant. For all reported β, p ≤ .01.
 74
Hypothesis 19.2

Baseline self-esteem did not significantly predict the log odds that individuals chose

avoidance when regulating ambulatory anxiety (β = -0.094, p = .104).

Hypothesis 19.3

Baseline self-esteem did not significantly predict the log odds that individuals chose

avoidance when regulating ambulatory stress (β = -0.084, p = .103).

Hypothesis 20.1

Baseline self-esteem did not significantly predict the log odds that individuals chose

problem solving when regulating ambulatory depression (β = -0.043, p = .595).

Hypothesis 20.2

Baseline self-esteem did not significantly predict the log odds that individuals chose

problem solving when regulating ambulatory anxiety (β = -0.022, p = .691).

Hypothesis 20.3

Baseline self-esteem did not significantly predict the log odds that individuals chose

problem solving when regulating ambulatory stress (β = -0.067, p = .221).

 75
Hypothesis 21.1

Baseline self-esteem did not significantly predict the log odds that individuals chose

reappraisal when regulating ambulatory depression (β = -0.057, p = .467).

Hypothesis 21.2

Baseline self-esteem did not significantly predict the log odds that individuals chose

reappraisal when regulating ambulatory anxiety (β = -0.062, p = .315).

Hypothesis 21.3

Baseline self-esteem did not significantly predict the log odds that individuals chose

reappraisal when regulating ambulatory stress (β = -0.062, p = .255).

Hypothesis 22.1

Baseline self-esteem significantly predicted the log odds that individuals chose

rumination when regulating ambulatory depression (β = -0.185, p = .003). The odds ratio was

0.831.

Hypothesis 22.2

Baseline self-esteem significantly predicted the log odds that individuals chose

rumination when regulating ambulatory anxiety (β = -0.164, p = .002). The odds ratio was

0.849.
 76
Hypothesis 22.3

Baseline self-esteem significantly predicted the log odds that individuals chose

rumination when regulating ambulatory stress (β = -0.140, p = .007). The odds ratio was 0.869.

Hypothesis 23.1

Baseline self-esteem significantly predicted the log odds that individuals chose

suppression when regulating ambulatory depression (β = -0.141, p = .010). The odds ratio was

0.868.

Hypothesis 23.2

Baseline self-esteem did not significantly predict the log odds that individuals chose

suppression when regulating ambulatory anxiety (β = -0.105, p = .046).

Hypothesis 23.3

Baseline self-esteem did not significantly predict the log odds that individuals chose

suppression when regulating ambulatory stress (β = -0.101, p = .023).

 CHAPTER 4

DISCUSSION

The purpose of the present study was to use ambulatory assessment methodology to

examine how differences in self-compassion were associated with the use of emotion regulation

strategies in daily life. It was designed to extend previous methodology, which examined self-

compassion and stress, to also assess emotion regulation choice, depression, and anxiety (Krieger

et al., 2015).

Hypothesis 0 anticipated that baseline measures of distress (depression, anxiety, and

stress) and emotion regulation strategies (acceptance, avoidance, problem solving, reappraisal,

rumination, and suppression) would predict ambulatory measures of distress and emotion

regulation choice. Overall, the results of this hypothesis were mixed. Although baseline

measures of depression and anxiety predicted ambulatory ratings depression and anxiety,

baseline stress did not significantly predict ambulatory stress. Corresponding baseline measures

did not predict ambulatory acceptance, reappraisal, rumination, or suppression of depression,

anxiety, or stress. Baseline problem solving significantly predicted problem solving of

depression but not of anxiety or stress. Finally, baseline avoidance significantly predicted

ambulatory avoidance of depression, anxiety, and stress.

Hypothesis 1 sought to replicate previous findings, specifically that self-compassion

would predict distress (depression, anxiety, and stress) at baseline. This hypothesis was partially
 78
supported. Although self-compassion did not significantly predict depression, it did predict

anxiety and stress.

Hypothesis 2 anticipated that participants would vary in their total average ambulatory

levels of distress (depression, anxiety, and stress), which the data supported. This was a

necessary precondition for later hypotheses. Hypothesis 3 sought to extend previous findings,

specifically that baseline self-compassion would predict ambulatory distress (depression,

anxiety, and stress). However, the model terms of interest were not significantly different from

zero.

Hypotheses 4, 5, and 6 anticipated that participants would vary in the log odds that they

chose to employ each emotion regulation strategy (acceptance, avoidance, problem solving,

reappraisal, rumination, and suppression) to cope with ambulatory distress (depression, anxiety,

and stress). The data supported these hypotheses for each combination of emotion regulation

strategy and distress type. This was a necessary precondition for later hypotheses. Hypotheses

7, 8, 9, 10, 11, and 12 focused on the relationship between baseline self-compassion and

ambulatory emotion regulation choice (acceptance, avoidance, problem solving, reappraisal,

rumination, and suppression) of distress (depression, anxiety, and stress). Some specific

predictions were made regarding significance and directionality. For acceptance, the model term

of interest was expected to be significantly different from zero and positive. For avoidance and

rumination, the model terms of interest were expected to be significantly different from zero and

negative. However, self-compassion did not significantly predict the log odds that individuals

chose any emotion regulation strategy to regulate ambulatory depression, anxiety, or stress.

Hypotheses 13, 14, and 15 explored whether the severity of ambulatory distress

(depression, anxiety, and stress) predicted the log odds of choosing each emotion regulation
 79
strategy (acceptance, avoidance, problem solving, reappraisal, rumination, and suppression). No

predictions were made regarding significance or directionality. Many of the model terms of

interest were significant. Intensity of depression significantly and positively predicted the log

odds that individuals selected acceptance, avoidance, rumination, and suppression to cope.

Intensity of anxiety significantly and positively predicted the log odds of using avoidance,

problem solving, reappraisal, rumination, and suppression to cope. Lastly intensity of stress

significantly and positively predicted the log odds that individuals selected acceptance,

avoidance, problem solving, reappraisal, rumination, and suppression.

Hypothesis 16 examined whether individuals varied in the number of emotion regulation

strategies chosen to cope with ambulatory distress (depression, anxiety, and stress). The

variance was significant for all three model terms of interest. This was a necessary precondition

for later hypotheses. Hypothesis 17 explored whether the severity of ambulatory distress

(depression, anxiety, and stress) predicted the number of emotion regulation strategies

individuals used. No predictions were made regarding significance or directionality. Although

intensity of depression did not predict the number of strategies used, intensity of anxiety and

stress significantly and positively predicted the number of strategies used.

Finally, Hypotheses 18, 19, 20, 21, 22, and 23 explored whether baseline self-esteem

predicted ambulatory emotion regulation choice (acceptance, avoidance, problem solving,

reappraisal, rumination, and suppression) of distress (depression, anxiety, and stress). No

predictions were made regarding significance or directionality. Most of the model terms of

interest were nonsignificant. However, self-esteem significantly and negatively predicted

avoidance of depression, rumination of all three types of distress, and suppression of depression.
 80
Various potential factors may have contributed to the null results. As Cronbach and

Meehl (1955) suggest, the nonsignificant findings could indicate problems with measurement,

theory, and/or experimental design. Each of these potential causes will be explored.

Problems with Measurement

One possible explanation for the null findings is problems with measurement, specifically

that the assessment methods did not accurately measure the constructs of interest (Cronbach &

Meehl, 1955). All of the retrospective measures used were well established in the assessment of

their respective constructs. However, the laboratory measures did not always significantly

predict the corresponding ambulatory measures, as would be expected if each set of measures

were assessing the same construct. Because the retrospective measures have demonstrated their

validity and relationships with each other repeatedly, it is more likely that the problems lie with

the ambulatory assessment items. The laboratory measures each consist of multiple items that

are used collectively to calculate a total score; the ambulatory measures each consist of

individual items that stand alone. For example, the DASS-21’s depression subscale consists of

seven items (Henry & Crawford, 2005), whereas the ambulatory assessment of depression

involves one item. It is possible that the participants’ understanding of each construct (e.g.,

depression) was not equivalent to the field’s diagnostic criteria (e.g., symptoms of depression

included in the DASS-21). For example, participants may have focused exclusively on feelings

of sadness while rating their ambulatory depression without considering other symptoms of

depression that were measured in the laboratory (e.g., having nothing to look forward to). Thus,

the ambulatory measures may not be evaluating the same constructs as were assessed in the

laboratory.
 81
Another potential measurement issue is the use of the AAQ-II to assess avoidance. This

scale has been criticized for measuring negative affect and general distress rather than avoidance

(Ong, Pierce, Woods, Twohig, & Levin, 2019; Rochefort, Baldwin, & Chmielewski, 2018;

Tyndall et al., 2019; Wolgast, 2014). Factor analyses have found that the items of the AAQ-II

were more strongly related to items measuring negative affect and general distress than to items

measuring avoidance (Rochefort et al., 2018; Tyndall et al., 2019; Wolgast, 2014). One study

using item response theory framework found that none of the AAQ-II’s items perform well when

assessing avoidance (Ong et al., 2019). Given these criticisms regarding the AAQ-II’s poor

discriminant validity, a different measure of avoidance, such as the Brief Experiential Avoidance

Questionnaire (Gámez et al., 2014), may have been a better predictor of ambulatory avoidance.

Problems with Theory

Another potential explanation for the nonsignificant results is problems with theory,

specifically that the theoretical foundation of the hypotheses is flawed (Cronbach & Meehl,

1955). All the hypotheses assumed equivalency between retrospective reporting and ambulatory

assessment. Given the null findings of Hypothesis 0, this assumption appears to be flawed. It

has been established that memory is subject to recall and other biases (e.g., Shiffman, Stone, &

Hufford, 2008; Stone et al., 1998), and previous research has noted differences between

retrospective and ambulatory measures (e.g., Stone et al., 1995). However, there is insufficient

research to determine which constructs tend be less subjective to recall and other biases.

Furthermore, almost all the a priori research focused on replicating previous, well-established

findings using ambulatory assessment methodology under the aforementioned assumption. This

flawed expectation of equivalency may explain why most hypotheses were nonsignificant.
 82
The potential impact of the data collection methodology on the constructs of interest

should be considered as well. Research has shown that self-monitoring impacts behavior and

could be considered an intervention. For example, among individuals who smoke, monitoring

their smoking behavior led to changes in the number of cigarettes smoked and the amount of

time spent smoking each cigarette (McFall, 1970). A more recent study found that teachers who

monitored when they praised their students increased the frequency of praise (Kalis, Vannest, &

Parker, 2007). More relevant to the present study, nonclinical university students who monitored

their anxiety demonstrated decreases in anxiety over the course of a week (Hiebert & Fox, 1981).

Researchers have hypothesized that these changes, also termed “reactivity,” may be due to self-

evaluation, importance of evaluated behavior, or other consequences of increased awareness of

one’s behavior (Korotitsch & Nelson-Gray, 1999; Nelson & Hayes, 1981). Thus, it is possible

that merely reporting on their distress and emotion regulation choice led to decreases (or other

changes) in these variables of interest.

Another potential theoretical flaw is that in the present study self-compassion was neither

classified as an emotion regulation strategy nor treated as such. However, previous researchers

have conceptualized self-compassion as a regulatory strategy (Diedrich et al., 2014). In their

study, self-compassion was more effective at decreasing induced depressed mood than waiting,

and it was equally as effective as reappraisal and acceptance. Another study found that, while

adaptive emotion regulation mediated the relationship between self-compassion and depressive

symptoms, a reverse mediation was nonsignificant (Diedrich et al., 2017). Furthermore, self-

compassion is not confined to a single step in Gross’s process model (Gross, 1998), but instead it

could influence regulation at any point. Thus, it was argued in the introduction that self-

compassion influences emotion regulation choice but is not itself a strategy. This framework
 83
informed the hypotheses that self-compassion would predict which strategies individuals used to

cope with their distress. However, it is possible that self-compassion did not predict any

regulatory strategies because individuals with high self-compassion were responding to their

distress with self-compassion rather than by using one of the identified strategies. For example,

highly self-compassionate individuals may respond to feelings of anxiety with self-kindness,

awareness of their distress, and acknowledgement that suffering is universal. While it could be

argued that doing so corresponds to specific regulatory strategies (as was asserted in the

introduction), participants may instead view this response as part of their general attitude or

outlook on life. It is possible that self-compassion is a distinct method of coping with distress

using attitudes described in the SCS. However, no measure of

self-compassion was included in the app, so the present data cannot examine this possibility.

Problems with Experimental Design

A third possible explanation for the null findings is problems with experimental design,

specifically that the chosen methodology did not adequately test the hypotheses (Cronbach &

Meehl, 1955). First, given the large number of hypotheses, a more stringent threshold for

significance was used when interpreting the results. This meant that some results that would

have been considered significant at the typical threshold (p = .05) were interpreted as

nonsignificant. A potential solution would have been to collect additional data to increase

power. The ambulatory assessment portion of the study lasted less than six days and included up

to six prompts per day. While this decision was made in an effort to maximize careful

responding and prevent dropout, additional data in the form of more frequent prompts or

additional days would have increased the statistical power. However, it is possible that
 84
participants would not have complied or that reactivity to self-monitoring may have further

influenced the variables of interest.

Recall that the laboratory measures did not significantly predict the corresponding

ambulatory measures, which may have been due to participants’ inaccurate understanding of the

constructs of interest. Although the methodology was designed to combat this by providing

psychoeducation about each construct measured using the app, it may not have been effective.

Participants’ comprehension of the information was not assessed, and participants were not

provided with definitions of each construct to take with them or within the app itself. Either of

these additions to the methodology could have decreased concerns that participants did not

adequately understand all the items.

It is also possible that the participants were not consistently careful in their responding.

Although catch questions were included in the laboratory measures, no efforts were made to

ensure that participants completed the ambulatory measures with equal care. The laboratory

measures were also conducted under more controlled circumstances; participants were in a room

with few distractions and aware that their attention to the items was being evaluated. However,

the ambulatory measures were completed wherever the participant happened to be at the time of

the notifications, with all the inherent distractions. Participants were provided with no external

motivation for careful responding, which may have impacted the quality of the ambulatory data.

Limitations

Although potential flaws in the experimental design have already been discussed, it is

important to acknowledge other limitations of the present study. There are limitations inherent

in the sample used. Participants were nonclinical undergraduate students, so the results of the
 85
present study may not generalize to individuals with clinical diagnoses or nonstudents. The

mean scores of the depression, anxiety, and stress subscales of the DASS-21 were in the mild,

moderate, and normal-to-mild ranges, respectively (Henry & Crawford, 2005; Osman et al.,

2012). Although these scores are higher than those reported in some studies (Henry & Crawford,

2005; Osman et al., 2012), they are similar to means reported in other nonclinical samples

(Bayram & Bilgel, 2008; Sinclair et al., 2012). Furthermore, participants also reported low

levels of distress and little endorsement of emotion regulation strategies on average. Mean

distress scores ranged from 12.70 to 20.29 on a 0 – 100 scale. Participants also used few

strategies to cope with distress (M = 0.87 – 1.30), suggesting that there was little variability in

emotion regulation choice to predict.

Implications and Future Directions

The results of the present study suggest areas for future research and examination. First,

depression, anxiety, avoidance (depression, anxiety, and stress), and problem solving (depression

only) were the only constructs that demonstrated consistency across the laboratory assessment

and ambulatory assessments. Researchers should continue to employ ambulatory assessment

methodology. Most research on emotion regulation relies on retrospective reporting. Additional

research is needed to understand the extent to which recall and other memory biases influence

each of these constructs. Such methodology is subject to various biases that could impede

research in this area. Researchers should also explore concerns inherent with this methodology,

such as the use of single-item constructs and the extent to which they are predicted by

corresponding multi-item scales, ensuring careful responding when participants are outside of the

laboratory, and other unique aspects of ambulatory assessment methodology.

 86
A second area for future exploration is ambulatory emotion regulation choice. Because

all three types of distress predicted the selection of most or all of the emotion regulation

strategies, it is possible that regulatory strategies are nonspecific (i.e., used for all types of

distress) and generalize to other negative emotions, such as anger. In addition, it is unclear

whether self-compassion influences emotion regulation choice, if it is an emotion regulation

strategy, or if it plays both roles. Future research should examine these possibilities.

Third, an overlooked construct in this project was regulatory flexibility. It is possible that

regulatory flexibility is employed indiscriminately based on type of distress. This could explain

why intensity of distress predicted most or all of the regulatory strategies. Furthermore, number

of strategies chosen may be a proxy for regulatory flexibility. Those with greater flexibility

might employ more strategies than those with less flexibility because they may select additional

strategies when the initial ones prove ineffective. For example, an individual with greater

flexibility may find that suppression is ineffective at regulating stress and may try additional

strategies (e.g., avoidance, rumination, problem solving) until he or she has effectively regulated

the distress. It is possible that only high levels of distress are flexibly regulated (thus depression,

which was lower on average, was not a significant predictor) or that individuals only flexibly

regulate their emotions when they experience specific types of distress. Future research should

examine the role of regulatory flexibility in the selection of strategies and the number of

strategies used, which may vary by type and intensity of distress. This construct may provide

some clarity in why individuals choose specific strategies or the number of strategies chosen. In

other words, regulatory flexibility may lead to a better understanding of some of the exploratory

hypotheses included in this study.

 87
Given the similarities and distinctions between self-compassion and self-esteem, more

research should be conducted to understand how the two constructs influence emotion

regulation, thus exploring the questions raised by the final set of exploratory hypotheses. This

set of hypotheses (18-23) was included to compare the predictive power of self-compassion

(Hypotheses 7-12) and self-esteem. Self-compassion was anticipated to be the better predictor.

It is an alternative to self-esteem (Neff, 2003a, 2003b) and a protective factor against low self-

esteem (Marshall et al., 2015). Furthermore, self-compassion is a stable construct (Raes, 2011),

whereas self-esteem fluctuates to varying degrees (Kernis, 2005). It is interesting that self-

esteem negatively predicted the log odds of choosing some emotion regulation strategies

(avoidance and suppression of depression, rumination of all types of distress) while self-

compassion was a nonsignificant predictor. Unlike self-compassion, self-esteem is dependent

upon comparison, and high self-esteem requires favorable comparisons in order to be maintained

(Neff, 2003b, 2009, 2011). This distinction may explain why some of the results of these

hypotheses were significant. Three of the emotion regulation strategies of depression were

significant, which could suggest that there is something unique about the relationship between

self-esteem and depression. The types of distress assessed in this study may be less threatening

to those with high self-esteem, particularly depression. Individuals with low self-esteem could

be avoiding and suppressing feelings of depression to protect their self-esteem. Rumination may

reflect further comparisons. For example, if an individual feels depressed about being rejected,

he or she may ruminate on the situation in an effort to discover comparisons that reflect

favorably on the self rather than the rejector.

The present study sought to examine how differences in self-compassion were associated

with the use of emotion regulation strategies in daily life over six days using ambulatory
 88
assessment methodology. Although the findings were largely nonsignificant, the project

generated a number of considerations for future research which could have important

implications, such as the lack of equivalency between baseline and ambulatory measures and the

possibility of gathering ambulatory ratings of self-compassion.

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APPENDIX A

EQUATIONS
 110
The variables in the following equations stand for SCS = self-compassion, RSE = self-

esteem, DEP = ambulatory depression, ANX = ambulatory anxiety, STR = stress, DEP_I, =

initial depression, ANX_I = initial anxiety, STR_I = initial stress, ACC = initial acceptance,

AVD = initial avoidance, PRS = initial problem solving, RAP = initial reappraisal, RUM = initial

rumination, SUP = initial suppression, ACC_D = ambulatory acceptance for depression (dummy

coded), AVD_D = ambulatory avoidance for depression (dummy coded), PRS_D = ambulatory

problem solving for depression (dummy coded), RAP_D = ambulatory reappraisal for depression

(dummy coded), RUM_D = ambulatory rumination for depression (dummy coded), SUP_D =

ambulatory suppression for depression (dummy coded), ACC_A = ambulatory acceptance for

anxiety (dummy coded), AVD_A = ambulatory avoidance for anxiety (dummy coded), PRS_A =

ambulatory problem solving for anxiety (dummy coded), RAP_A = ambulatory reappraisal for

anxiety (dummy coded), RUM_A = ambulatory rumination for anxiety (dummy coded), SUP_A

= ambulatory suppression for anxiety (dummy coded), ACC_S = ambulatory acceptance for

stress (dummy coded), AVD_S = ambulatory avoidance for stress (dummy coded), PRS_S =

ambulatory problem solving for stress (dummy coded), RAP_S = ambulatory reappraisal for

stress (dummy coded), RUM_S = ambulatory rumination for stress (dummy coded), SUP_S =

ambulatory suppression for stress (dummy coded), NER_D = number of ambulatory emotion

regulation strategies used for depression, NER_A = number of ambulatory emotion regulation

strategies used for anxiety, and NER_S = number of ambulatory emotion regulation strategies

used for stress.

Hypothesis 0. Initial ratings of distress will predict average ambulatory levels of

distress. Specifically, depression will predict average ambulatory levels of depression

(Hypothesis 0.1), initial ratings of anxiety will predict average ambulatory levels of anxiety
 111
(Hypothesis 0.2), and initial ratings of stress will predict average ambulatory levels of stress

(Hypothesis 0.3). Initial ratings of baseline emotion regulation (acceptance, avoidance, problem

solving, reappraisal, rumination, suppression) will predict average ambulatory log odds of

choosing each emotion regulation strategy (acceptance, avoidance, problem solving, reappraisal,

rumination, suppression) for each type of distress (depression, anxiety, stress; Hypotheses 0.4-

0.21). In other words, 𝛽01 should be significantly different from zero and positive for all

hypotheses. In addition, each of these models will be compared to their corresponding null

model, and R2 will be computed to determine the percent of variance explained by ambulatory

distress and ambulatory emotion regulation choice.

Note that emotion regulation strategies are binomial outcome variable in these

hypotheses. As such, when the variable is indicated as the outcome, it is actually a link function

𝜑𝑖𝑗
(ηij =log(1−𝜑𝑖𝑗)) referring to the log odds of using that strategy, although it is not specified as

such in each hypothesis. This is also true for all hypotheses with a binomial outcome variable.

Hypothesis 0.1:

Level 1: 𝐷𝐸𝑃𝑡𝑖 = 𝜋0𝑖 + 𝑒𝑡𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝐷𝐸𝑃_𝐼) + 𝑟0𝑖

Hypothesis 0.2:

Level 1: 𝐴𝑁𝑋𝑡𝑖 = 𝜋0𝑖 + 𝑒𝑡𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝐴𝑁𝑋_𝐼) + 𝑟0𝑖

Hypothesis 0.3:

Level 1: 𝑆𝑇𝑅𝑡𝑖 = 𝜋0𝑖 + 𝑒𝑡𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑆𝑇𝑅_𝐼) + 𝑟0𝑖

Hypothesis 0.4:
 112
Level 1: 𝐴𝐶𝐶_𝐷𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝐴𝐶𝐶) + 𝑟0𝑖

Hypothesis 0.5:

Level 1: 𝐴𝐶𝐶_𝐴𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝐴𝐶𝐶) + 𝑟0𝑖

Hypothesis 0.6:

Level 1: 𝐴𝐶𝐶_𝑆𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝐴𝐶𝐶) + 𝑟0𝑖

Hypothesis 0.7:

Level 1: 𝐴𝑉𝐷_𝐷𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝐴𝑉𝐷) + 𝑟0𝑖

Hypothesis 0.8:

Level 1: 𝐴𝑉𝐷_𝐴𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝐴𝑉𝐷) + 𝑟0𝑖

Hypothesis 0.9:

Level 1: 𝐴𝑉𝐷_𝑆𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝐴𝑉𝐷) + 𝑟0𝑖

Hypothesis 0.10:

Level 1: 𝑃𝑅𝑆_𝐷𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑃𝑅𝑆) + 𝑟0𝑖

Hypothesis 0.11:

Level 1: 𝑃𝑅𝑆_𝐴𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑃𝑅𝑆) + 𝑟0𝑖

 113
Hypothesis 0.12:

Level 1: 𝑃𝑅𝑆_𝑆𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑃𝑅𝑆) + 𝑟0𝑖

Hypothesis 0.13:

Level 1: 𝑅𝐴𝑃_𝐷𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑅𝐴𝑃) + 𝑟0𝑖

Hypothesis 0.14:

Level 1: 𝑅𝐴𝑃_𝐴𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑅𝐴𝑃) + 𝑟0𝑖

Hypothesis 0.15:

Level 1: 𝑅𝐴𝑃_𝑆𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑅𝐴𝑃) + 𝑟0𝑖

Hypothesis 0.16:

Level 1: 𝑅𝑈𝑀_𝐷𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑅𝑈𝑀) + 𝑟0𝑖

Hypothesis 0.17:

Level 1: 𝑅𝑈𝑀_𝐴𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑅𝑈𝑀) + 𝑟0𝑖

Hypothesis 0.18:

Level 1: 𝑅𝑈𝑀_𝑆𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑅𝑈𝑀) + 𝑟0𝑖

Hypothesis 0.19:

Level 1: 𝑆𝑈𝑃_𝐷𝑡𝑖 = 𝜋0𝑖

 114
Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑆𝑈𝑃) + 𝑟0𝑖

Hypothesis 0.20:

Level 1: 𝑆𝑈𝑃_𝐴𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑆𝑈𝑃) + 𝑟0𝑖

Hypothesis 0.21:

Level 1: 𝑆𝑈𝑃_𝑆𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑆𝑈𝑃) + 𝑟0𝑖

Hypothesis 1. In replication of previous findings, self-compassion at baseline will be

significantly negatively related to initial depression (Hypothesis 1.1), anxiety (Hypothesis 1.2),

and stress (Hypothesis 1.3). In other words, 𝛽1 should be significantly different from zero and

negative for all hypotheses.

Hypothesis 1.1:

𝐷𝐸𝑃𝑖 = 𝛽0 + 𝛽1 𝑆𝐶𝑆 + 𝑒𝑖

Hypothesis 1.2:

𝐴𝑁𝑋𝑖 = 𝛽0 + 𝛽1 𝑆𝐶𝑆 + 𝑒𝑖

Hypothesis 1.3:

𝑆𝑇𝑅𝑖 = 𝛽0 + 𝛽1 𝑆𝐶𝑆 + 𝑒𝑖

Hypothesis 2. Individuals will vary (between subjects variation) significantly in their

average levels of distress, namely depression (Hypothesis 2.1), anxiety (Hypothesis 2.2), and

stress (Hypothesis 2.3). In other words, Var(𝑟0𝑖 ) = 𝜏̂ 00 should be significantly different from

zero for depression, anxiety, and stress.

Hypothesis 2.1:

Level 1: 𝐷𝐸𝑃𝑡𝑖 = 𝜋0𝑖 + 𝑒𝑡𝑖

 115
Level 2: 𝜋0𝑖 = 𝛽00 + 𝑟0𝑖

Hypothesis 2.2:

Level 1: 𝐴𝑁𝑋𝑡𝑖 = 𝜋0𝑖 + 𝑒𝑡𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝑟0𝑖

Hypothesis 2.3:

Level 1: 𝑆𝑇𝑅𝑡𝑖 = 𝜋0𝑖 + 𝑒𝑡𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝑟0𝑖

Hypothesis 3. In replication of previous findings, self-compassion will predict average

levels of ambulatory distress, namely depression (Hypothesis 3.1), anxiety (Hypothesis 3.2), and

stress (Hypothesis 3.3). In other words, 𝛽01 should be significantly different from zero for

depression, anxiety, and stress. In addition, each of these models will be compared to their

corresponding null model, and R2 will be computed to determine the percent of variance

explained by self-compassion.

Hypothesis 3.1:

Level 1: 𝐷𝐸𝑃𝑡𝑖 = 𝜋0𝑖 + 𝑒𝑡𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑆𝐶𝑆) + 𝑟0𝑖

Hypothesis 3.2:

Level 1: 𝐴𝑁𝑋𝑡𝑖 = 𝜋0𝑖 + 𝑒𝑡𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑆𝐶𝑆) + 𝑟0𝑖

Hypothesis 3.3:

Level 1: 𝑆𝑇𝑅𝑡𝑖 = 𝜋0𝑖 + 𝑒𝑡𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑆𝐶𝑆) + 𝑟0𝑖

 116
Hypotheses 4-6. Individuals will vary in the log odds that they select each emotion

regulation strategy when regulating ambulatory distress, namely depression (Hypothesis 4),

anxiety (Hypothesis 5), and stress (Hypothesis 6). Specifically, the log odds that they select

acceptance (Hypothesis 4.1), avoidance (Hypothesis 4.2), problem solving (Hypothesis 4.3),

reappraisal (Hypothesis 4.4), rumination (Hypothesis 4.5), and suppression (Hypothesis 4.6) will

vary when regulating depression. Similar variation will be found in the log odds of selecting

acceptance (Hypothesis 5.1), avoidance (Hypothesis 5.2), problem solving (Hypothesis 5.3),

reappraisal (Hypothesis 5.4), rumination (Hypothesis 5.5), and suppression (Hypothesis 5.6)

when regulating anxiety. Individuals will also vary in the log odds that they select acceptance

(Hypothesis 6.1), avoidance (Hypothesis 6.2), problem solving (Hypothesis 6.3), reappraisal

(Hypothesis 6.4), rumination (Hypothesis 6.5), and suppression (Hypothesis 6.6) when

regulating stress. In other words, Var(𝜋0𝑖 ) = 𝜏̂ 00 should be significantly different from zero for

all hypotheses. In addition, the ICC and DEFF will be computed to assess the importance of the

clustering.

Hypothesis 4.1:

Level 1: 𝐴𝐶𝐶_𝐷𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝑟0𝑖

Hypothesis 4.2:

Level 1: 𝐴𝑉𝐷_𝐷𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝑟0𝑖

Hypothesis 4.3:

Level 1: 𝑃𝑅𝑆_𝐷𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝑟0𝑖

 117
Hypothesis 4.4:

Level 1: 𝑅𝐴𝑃_𝐷𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝑟0𝑖

Hypothesis 4.5:

Level 1: 𝑅𝑈𝑀_𝐷𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝑟0𝑖

Hypothesis 4.6:

Level 1: 𝑆𝑈𝑃_𝐷𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝑟0𝑖

Hypothesis 5.1:

Level 1: 𝐴𝐶𝐶_𝐴𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝑟0𝑖

Hypothesis 5.2:

Level 1: 𝐴𝑉𝐷_𝐴𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝑟0𝑖

Hypothesis 5.3:

Level 1: 𝑃𝑅𝑆_𝐴𝑡𝑖 = 𝜋0𝑖 + 𝑒𝑡𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝑟0𝑖

Hypothesis 5.4:

Level 1: 𝑅𝐴𝑃_𝐴𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝑟0𝑖

Hypothesis 5.5:

Level 1: 𝑅𝑈𝑀_𝐴𝑡𝑖 = 𝜋0𝑖

 118
Level 2: 𝜋0𝑖 = 𝛽00 + 𝑟0𝑖

Hypothesis 5.6:

Level 1: 𝑆𝑈𝑃_𝑆𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝑟0𝑖

Hypothesis 6.1:

Level 1: 𝐴𝐶𝐶_𝑆𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝑟0𝑖

Hypothesis 6.2:

Level 1: 𝐴𝑉𝐷_𝑆𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝑟0𝑖

Hypothesis 6.3:

Level 1: 𝑃𝑅𝑆_𝑆𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝑟0𝑖

Hypothesis 6.4:

Level 1: 𝑅𝐴𝑃_𝑆𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝑟0𝑖

Hypothesis 6.5:

Level 1: 𝑅𝑈𝑀_𝑆𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝑟0𝑖

Hypothesis 6.6:

Level 1: 𝑆𝑈𝑃_𝑆𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝑟0𝑖

 119
Hypothesis 7-12. Self-compassion is expected to positively predict the log odds of

acceptance when regulating depression (Hypothesis 7.1), anxiety (Hypothesis 7.2), and stress

(Hypothesis 7.3). Self-compassion is expected to negatively predict the log odds of avoidance in

when regulating depression (Hypothesis 8.1), anxiety (Hypothesis 8.2), and stress (Hypothesis

8.3). No directionality is predicted in the relationship between self-compassion and the log odds

of problem solving (Hypothesis 9) or reappraisal (Hypothesis 10) when regulating depression

(Hypothesis 9.1, Hypothesis 10.1), anxiety (Hypothesis 9.2, Hypothesis 10.2), and stress

(Hypothesis 9.3, Hypothesis 10.3). Self-compassion is expected to negatively predict the log

odds of rumination when regulating depression (Hypothesis 11.1), anxiety (Hypothesis 11.2),

and stress (Hypothesis 11.3). No directionality is predicted in the relationship between self-

compassion and the log odds of suppression (Hypothesis 12) when regulating depression

(Hypothesis 12.1), anxiety (Hypothesis 12.2), and stress (Hypothesis 12.3). In other words, 𝛽01

should be significantly different from zero for acceptance, avoidance, and rumination, and the

coefficient should be positive for acceptance and negative for avoidance and rumination.

Hypothesis 7.1:

Level 1: 𝐴𝐶𝐶_𝐷𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑆𝐶𝑆) + 𝑟0𝑖

Hypothesis 7.2:

Level 1: 𝐴𝐶𝐶_𝐴𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑆𝐶𝑆) + 𝑟0𝑖

Hypothesis 7.3:

Level 1: 𝐴𝐶𝐶_𝑆𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑆𝐶𝑆) + 𝑟0𝑖

 120
Hypothesis 8.1:

Level 1: 𝐴𝑉𝐷_𝐷𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑆𝐶𝑆) + 𝑟0𝑖

Hypothesis 8.2:

Level 1: 𝐴𝑉𝐷_𝐴𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑆𝐶𝑆) + 𝑟0𝑖

Hypothesis 8.3:

Level 1: 𝐴𝑉𝐷_𝑆𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑆𝐶𝑆) + 𝑟0𝑖

Hypothesis 9.1:

Level 1: 𝑃𝑅𝑆_𝐷𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑆𝐶𝑆) + 𝑟0𝑖

Hypothesis 9.2:

Level 1: 𝑃𝑅𝑆_𝐴𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑆𝐶𝑆) + 𝑟0𝑖

Hypothesis 9.3:

Level 1: 𝑃𝑅𝑆_𝑆𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑆𝐶𝑆) + 𝑟0𝑖

Hypothesis 10.1:

Level 1: 𝑅𝐴𝑃_𝐷𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑆𝐶𝑆) + 𝑟0𝑖

Hypothesis 10.2:

Level 1: 𝑅𝐴𝑃_𝐴𝑡𝑖 = 𝜋0𝑖

 121
Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑆𝐶𝑆) + 𝑟0𝑖

Hypothesis 10.3:

Level 1: 𝑅𝐴𝑃_𝑆𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑆𝐶𝑆) + 𝑟0𝑖

Hypothesis 11.1:

Level 1: 𝑅𝑈𝑀_𝐷𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑆𝐶𝑆) + 𝑟0𝑖

Hypothesis 11.2:

Level 1: 𝑅𝑈𝑀_𝐴𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑆𝐶𝑆) + 𝑟0𝑖

Hypothesis 11.3:

Level 1: 𝑅𝑈𝑀_𝑆𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑆𝐶𝑆) + 𝑟0𝑖

Hypothesis 12.1:

Level 1: 𝑆𝑈𝑃_𝐷𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑆𝐶𝑆) + 𝑟0𝑖

Hypothesis 12.2:

Level 1: 𝑆𝑈𝑃_𝐴𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑆𝐶𝑆) + 𝑟0𝑖

Hypothesis 12.3:

Level 1: 𝑆𝑈𝑃_𝑆𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑆𝐶𝑆) + 𝑟0𝑖

 122
Hypotheses 13-15. Intensity of ambulatory distress, specifically depression (Hypothesis

13), anxiety (Hypothesis 14), and stress (Hypothesis 15), may predict the log odds of choosing to

use acceptance (Hypothesis 13.1, Hypothesis 14.1, Hypothesis 15.1), avoidance (Hypothesis

13.2, Hypothesis 14.2, Hypothesis 15.2), problem solving (Hypothesis 13.3, Hypothesis 14.3,

Hypothesis 15.3), reappraisal (Hypothesis 13.4, Hypothesis 14.4, Hypothesis 15.4), rumination

(Hypothesis 13.5, Hypothesis 14.5, Hypothesis 15.5), and suppression (Hypothesis 13.6,

Hypothesis 14.6, Hypothesis 15.6). No predictions are made regarding directionality or

significance. In other words, 𝛽10 will be significantly different from zero if intensity of distress

predicts the proportion with which individuals choose an emotion regulation strategy, and the

coefficient will indicate if this relationship is positive or negative.

Hypothesis 13.1:

Level 1: 𝐴𝐶𝐶_𝐷 = 𝜋0𝑖 + 𝜋1𝑖 (𝐷𝐸𝑃)

Level 2: 𝜋0𝑖 = 𝛽00 +𝑟0𝑖

𝜋1𝑖 = 𝛽10

Hypothesis 13.2:

Level 1: 𝐴𝑉𝐷_𝐷 = 𝜋0𝑖 + 𝜋1𝑖 (𝐷𝐸𝑃)

Level 2: 𝜋0𝑖 = 𝛽00 +𝑟0𝑖

𝜋1𝑖 = 𝛽10

Hypothesis 13.3:

Level 1: 𝑃𝑅𝑆_𝐷 = 𝜋0𝑖 + 𝜋1𝑖 (𝐷𝐸𝑃)

Level 2: 𝜋0𝑖 = 𝛽00 +𝑟0𝑖

𝜋1𝑖 = 𝛽10

Hypothesis 13.4:
 123
Level 1: 𝑅𝐴𝑃_𝐷 = 𝜋0𝑖 + 𝜋1𝑖 (𝐷𝐸𝑃)

Level 2: 𝜋0𝑖 = 𝛽00 +𝑟0𝑖

𝜋1𝑖 = 𝛽10

Hypothesis 13.5:

Level 1: 𝑅𝑈𝑀_𝐷 = 𝜋0𝑖 + 𝜋1𝑖 (𝐷𝐸𝑃)

Level 2: 𝜋0𝑖 = 𝛽00 +𝑟0𝑖

𝜋1𝑖 = 𝛽10

Hypothesis 13.6:

Level 1: 𝑆𝑈𝑃_𝐷 = 𝜋0𝑖 + 𝜋1𝑖 (𝐷𝐸𝑃)

Level 2: 𝜋0𝑖 = 𝛽00 +𝑟0𝑖

𝜋1𝑖 = 𝛽10

Hypothesis 14.1:

Level 1: 𝐴𝐶𝐶_𝐴 = 𝜋0𝑖 + 𝜋1𝑖 (𝐴𝑁𝑋)

Level 2: 𝜋0𝑖 = 𝛽00 +𝑟0𝑖

𝜋1𝑖 = 𝛽10

Hypothesis 14.2:

Level 1: 𝐴𝑉𝐷_𝐴 = 𝜋0𝑖 + 𝜋1𝑖 (𝐴𝑁𝑋)

Level 2: 𝜋0𝑖 = 𝛽00 +𝑟0𝑖

𝜋1𝑖 = 𝛽10

Hypothesis 14.3:

Level 1: 𝑃𝑅𝑆_𝐴 = 𝜋0𝑖 + 𝜋1𝑖 (𝐴𝑁𝑋)

Level 2: 𝜋0𝑖 = 𝛽00 +𝑟0𝑖

𝜋1𝑖 = 𝛽10
 124
Hypothesis 14.4:

Level 1: 𝑅𝐴𝑃_𝐴 = 𝜋0𝑖 + 𝜋1𝑖 (𝐴𝑁𝑋)

Level 2: 𝜋0𝑖 = 𝛽00 +𝑟0𝑖

𝜋1𝑖 = 𝛽10

Hypothesis 14.5:

Level 1: 𝑅𝑈𝑀_𝐴 = 𝜋0𝑖 + 𝜋1𝑖 (𝐴𝑁𝑋)

Level 2: 𝜋0𝑖 = 𝛽00 +𝑟0𝑖

𝜋1𝑖 = 𝛽10

Hypothesis 14.6:

Level 1: 𝑆𝑈𝑃_𝐴 = 𝜋0𝑖 + 𝜋1𝑖 (𝐴𝑁𝑋)

Level 2: 𝜋0𝑖 = 𝛽00 +𝑟0𝑖

𝜋1𝑖 = 𝛽10

Hypothesis 15.1:

Level 1: 𝐴𝐶𝐶_𝑆 = 𝜋0𝑖 + 𝜋1𝑖 (𝑆𝑇𝑅)

Level 2: 𝜋0𝑖 = 𝛽00 +𝑟0𝑖

𝜋1𝑖 = 𝛽10

Hypothesis 15.2:

Level 1: 𝐴𝑉𝐷_𝑆 = 𝜋0𝑖 + 𝜋1𝑖 (𝑆𝑇𝑅)

Level 2: 𝜋0𝑖 = 𝛽00 +𝑟0𝑖

𝜋1𝑖 = 𝛽10

Hypothesis 15.3:

Level 1: 𝑃𝑅𝑆_𝑆 = 𝜋0𝑖 + 𝜋1𝑖 (𝑆𝑇𝑅)

Level 2: 𝜋0𝑖 = 𝛽00 +𝑟0𝑖

 125
𝜋1𝑖 = 𝛽10

Hypothesis 15.4:

Level 1: 𝑅𝐴𝑃_𝑆 = 𝜋0𝑖 + 𝜋1𝑖 (𝑆𝑇𝑅)

Level 2: 𝜋0𝑖 = 𝛽00 +𝑟0𝑖

𝜋1𝑖 = 𝛽10

Hypothesis 15.5:

Level 1: 𝑅𝑈𝑀_𝑆 = 𝜋0𝑖 + 𝜋1𝑖 (𝑆𝑇𝑅)

Level 2: 𝜋0𝑖 = 𝛽00 +𝑟0𝑖

𝜋1𝑖 = 𝛽10

Hypothesis 15.6:

Level 1: 𝑆𝑈𝑃_𝑆 = 𝜋0𝑖 + 𝜋1𝑖 (𝑆𝑇𝑅)

Level 2: 𝜋0𝑖 = 𝛽00 +𝑟0𝑖

𝜋1𝑖 = 𝛽10

Hypothesis 16. There may be between subject variance in the number of emotion

regulation strategies chosen when coping with ambulatory distress, specifically depression

(Hypothesis 16.1), anxiety (Hypothesis 16.2), and stress (Hypothesis 16.3). If the data support

the hypothesis, Var(𝜋0𝑖 ) = 𝜏̂ 00 will be significantly different from zero.

Hypothesis 16.1:

Level 1: 𝑁𝐸𝑅_𝐷𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝑟0𝑖

Hypothesis 16.2:

Level 1: 𝑁𝐸𝑅_𝐴𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝑟0𝑖

 126
Hypothesis 16.3:

Level 1: 𝑁𝐸𝑅_𝑆𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝑟0𝑖

Hypothesis 17. Ambulatory distress severity, specifically depression (Hypothesis 17.1),

anxiety (Hypothesis 17.2), and stress (Hypothesis 17.3), may predict the number of emotion

regulation strategies chosen. No predictions are made regarding directionality or significance.

In other words, 𝛽10 will be significantly different from zero if intensity of distress predicts the

proportion with which individuals choose an emotion regulation strategy, and the coefficient will

indicate if this relationship is positive or negative. In addition, these models will be compared to

the null models in Hypothesis 16, and R2 will be computed to determine the percent of variance

explained by ambulatory distress.

Hypothesis 17.1:

Level 1: NER_𝐷 = 𝜋0𝑖 + 𝜋1𝑖 (𝐷𝐸𝑃) + 𝑒𝑡𝑖

Level 2: 𝜋0𝑖 = 𝛽00 +𝑟0𝑖

𝜋1𝑖 = 𝛽10

Hypothesis 17.2:

Level 1: NER_𝐴 = 𝜋0𝑖 + 𝜋1𝑖 (𝐴𝑁𝑋) + 𝑒𝑡𝑖

Level 2: 𝜋0𝑖 = 𝛽00 +𝑟0𝑖

𝜋1𝑖 = 𝛽10

Hypothesis 17.3:

Level 1: NER_𝑆 = 𝜋0𝑖 + 𝜋1𝑖 (𝑆𝑇𝑅) + 𝑒𝑡𝑖

Level 2: 𝜋0𝑖 = 𝛽00 +𝑟0𝑖

𝜋1𝑖 = 𝛽10
 127
Hypothesis 18-23. Self-esteem may predict the log odds that individuals choose each

emotion regulation strategy, specifically acceptance (Hypothesis 18), avoidance (Hypothesis 19),

problem solving (Hypothesis 20), reappraisal (Hypothesis 21), rumination (Hypothesis 22), and

suppression (Hypothesis 23). No predictions are made regarding directionality or significance.

In other words, 𝛽01 will be significantly different from zero if self-esteem predicts use of the

emotion regulation strategy.

Hypothesis 18.1:

Level 1: 𝐴𝐶𝐶_𝐷𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑅𝑆𝐸) + 𝑟0𝑖

Hypothesis 18.2:

Level 1: 𝐴𝐶𝐶_𝐴𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑅𝑆𝐸) + 𝑟0𝑖

Hypothesis 18.3:

Level 1: 𝐴𝐶𝐶_𝑆𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑅𝑆𝐸) + 𝑟0𝑖

Hypothesis 19.1:

Level 1: 𝐴𝑉𝐷_𝐷𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑅𝑆𝐸) + 𝑟0𝑖

Hypothesis 19.2:

Level 1: 𝐴𝑉𝐷_𝐴𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑅𝑆𝐸) + 𝑟0𝑖

Hypothesis 19.3:

Level 1: 𝐴𝑉𝐷_𝑆𝑡𝑖 = 𝜋0𝑖

 128
Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑅𝑆𝐸) + 𝑟0𝑖

Hypothesis 20.1:

Level 1: 𝑃𝑅𝑆_𝐷𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑅𝑆𝐸) + 𝑟0𝑖

Hypothesis 20.2:

Level 1: 𝑃𝑅𝑆_𝐴𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑅𝑆𝐸) + 𝑟0𝑖

Hypothesis 20.3:

Level 1: 𝑃𝑅𝑆_𝑆𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑅𝑆𝐸) + 𝑟0𝑖

Hypothesis 21.1:

Level 1: 𝑅𝐴𝑃_𝐷𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑅𝑆𝐸) + 𝑟0𝑖

Hypothesis 21.2:

Level 1: 𝑅𝐴𝑃_𝐴𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑅𝑆𝐸) + 𝑟0𝑖

Hypothesis 21.3:

Level 1: 𝑅𝐴𝑃_𝑆𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑅𝑆𝐸) + 𝑟0𝑖

Hypothesis 22.1:

Level 1: 𝑅𝑈𝑀_𝐷𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑅𝑆𝐸) + 𝑟0𝑖

Hypothesis 22.2:
 129
Level 1: 𝑅𝑈𝑀_𝐴𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑅𝑆𝐸) + 𝑟0𝑖

Hypothesis 22.3:

Level 1: 𝑅𝑈𝑀_𝑆𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑅𝑆𝐸) + 𝑟0𝑖

Hypothesis 23.1:

Level 1: 𝑆𝑈𝑃_𝐷𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑅𝑆𝐸) + 𝑟0𝑖

Hypothesis 23.2:

Level 1: 𝑆𝑈𝑃_𝐴𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑅𝑆𝐸) + 𝑟0𝑖

Hypothesis 23.3:

Level 1: 𝑆𝑈𝑃_𝑆𝑡𝑖 = 𝜋0𝑖

Level 2: 𝜋0𝑖 = 𝛽00 + 𝛽01 (𝑅𝑆𝐸) + 𝑟0𝑖

 APPENDIX B

DEMOGRAPHICS QUESTIONNAIRE
 131
Please answer the following:

1. In what year were you born (please enter 4 digits – 19XX)? (YYYY)

2. In what month were you born?

a. January

b. February

c. March

d. April

e. May

f. June

g. July

h. August

i. September

j. October

k. November

l. December

3. On what date were you born (please enter a number between 1 and 31 – for example, if

you were born on March 30th, enter 30)? ___

4. What is your gender?

a. Male
 132
b. Female

c. Prefer not to respond

5. What is your race?

a. American Indian/Alaskan Native

b. Asian or South-Asian

c. Black or African American

d. Native Hawaiian/Pacific Islander

e. White or Caucasian

f. Not listed:

g. Prefer not to respond

6. Do you identify as Latino/a, Hispanic, or being of Spanish origin?

a. Yes

b. No

c. Prefer not to respond

 APPENDIX C

SELF-COMPASSION SCALE (NEFF, 2003B)

 134
HOW I TYPICALLY ACT TOWARDS MYSELF IN DIFFICULT TIMES

Please read each statement carefully before answering. To the left of each item, indicate how

often you behave in the stated manner, using the following scale:

1 Almost never

5 Almost always

_____ 1. I’m disapproving and judgmental about my own flaws and inadequacies.

_____ 2. When I’m feeling down I tend to obsess and fixate on everything that’s wrong.

_____ 3. When things are going badly for me, I see the difficulties as part of life that everyone

goes through.

_____ 4. When I think about my inadequacies, it tends to make me feel more separate and cut off

from the rest of the world.

_____ 5. I try to be loving towards myself when I’m feeling emotional pain.

_____ 6. When I fail at something important to me I become consumed by feelings of

inadequacy.

_____ 7. When I'm down and out, I remind myself that there are lots of other people in the world

feeling like I am.

_____ 8. When times are really difficult, I tend to be tough on myself.

_____ 9. When something upsets me I try to keep my emotions in balance.

_____ 10. When I feel inadequate in some way, I try to remind myself that feelings of

inadequacy are shared by most people.

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_____ 11. I’m intolerant and impatient towards those aspects of my personality I don't like.

_____ 12. When I’m going through a very hard time, I give myself the caring and tenderness I

need.

_____ 13. When I’m feeling down, I tend to feel like most other people are probably happier

than I am.

_____ 14. When something painful happens I try to take a balanced view of the situation.

_____ 15. I try to see my failings as part of the human condition.

_____ 16. When I see aspects of myself that I don’t like, I get down on myself.

_____ 17. When I fail at something important to me I try to keep things in perspective.

_____ 18. When I’m really struggling, I tend to feel like other people must be having an easier

time of it.

_____ 19. I’m kind to myself when I’m experiencing suffering.

_____ 20. When something upsets me I get carried away with my feelings.

_____ 21. I can be a bit cold-hearted towards myself when I'm experiencing suffering.

_____ 22. When I'm feeling down I try to approach my feelings with curiosity and openness.

_____ 23. I’m tolerant of my own flaws and inadequacies.

_____ 24. When something painful happens I tend to blow the incident out of proportion.

_____ 25. When I fail at something that's important to me, I tend to feel alone in my failure.

_____ 26. I try to be understanding and patient towards those aspects of my personality I don't

like.
 APPENDIX D

ROSENBERG SELF-ESTEEM SCALE (ROSENBERG, 1965)

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Below is a list of statements dealing with your feelings about yourself. Please indicate how

strongly you agree or disagree with each statement.

1 Strongly Agree

2 Agree

3 Disagree

4 Strongly Disagree

_____ 1. On the whole, I am satisfied with myself.

_____ 2. At times I think I am no good at all.

_____ 3. I feel that I have a number of good qualities

_____ 4. I am able to do things as well as most other people.

_____ 5. I feel I do not have much to be proud of.

_____ 6. I certainly feel useless at times.

_____ 7. I feel that I’m a person of worth, at least on an equal plan with others.

_____ 8. I wish I could have more respect for myself.

_____ 9. All in all, I am inclined to feel that I am a failure.

_____ 10. I take a positive attitude toward myself.

 APPENDIX E

DEPRESSION, ANXIETY, AND STRESS SCALES 21 (HENRY & CRAWFORD, 2005)

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Please read each statement and write the number 0, 1, 2 or 3 which indicates how much the

statement applied to you over the past week. There are no right or wrong answers. Do not spend

too much time on any statement.

The rating scale is as follows:

0 Did not apply to me at all

1 Applied to me to some degree, or some of the time

2 Applied to me to a considerable degree, or a good part of time

3 Applied to me very much, or most of the time

_____ 1. I found it hard to wind down

_____ 2. I was aware of dryness of my mouth

_____ 3. I couldn’t seem to experience any positive feeling at all

_____ 4. I experienced breathing difficulty (e.g., excessively rapid breathing, breathlessness in

the absence of physical exertion)

_____ 5. I found it difficult to work up the initiative to do things

_____ 6. I tended to over-react to situations

_____ 7. I experienced trembling (e.g., in the hands)

_____ 8. I felt that I was using a lot of nervous energy

_____ 9. I was worried about situations in which I might panic and make a fool of myself

_____ 10. I felt that I had nothing to look forward to

_____ 11. I found myself getting agitated

_____ 12. I found it difficult to relax

_____ 13. I felt down-hearted and blue

_____ 14. I was intolerant of anything that kept me from getting on with what I was doing
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_____ 15. I felt I was close to panic

_____ 16. I was unable to become enthusiastic about anything

_____ 17. I felt I wasn't worth much as a person

_____ 18. I felt that I was rather touchy

_____ 19. I was aware of the action of my heart in the absence of physical exertion (e.g., sense

of heart rate increase, heart missing a beat)

_____ 20. I felt scared without any good reason

_____ 21. I felt that life was meaningless

 APPENDIX F

FIVE FACET MINDFULNESS QUESTIONNAIRE, NONJUDGMENTAL ACCEPTANCE

SUBSCALE (BAER ET AL., 2006)

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Please rate each of the following statements using the scale provided. Write the number in the

blank that best describes your own opinion of what is generally true for you.

1 never or very rarely true

2 rarely true

3 sometimes true

4 often true

5 very often or always true

_____ 1. I criticize myself for having irrational or inappropriate emotions.

_____ 2. I tell myself I shouldn’t be feeling the way I’m feeling.

_____ 3. I believe some of my thoughts are abnormal or bad and I shouldn’t think that way.

_____ 4. I make judgements about whether my thoughts are good or bad.

_____ 5. I tell myself that I shouldn’t be thinking the way I’m thinking.

_____ 6. I think some of my emotions are bad or inappropriate and I shouldn’t feel them.

_____ 7. When I have distressing thoughts or images, I judge myself as good or bad, depending

what the thought/image is about.

_____ 8. I disapprove of myself when I have irrational ideas.

 APPENDIX G

ACCEPTANCE AND ACTION QUESTIONNAIRE-II (BOND ET AL., 2011)

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Below you will find a list of statements. Please rate how true each statement is for you by using

the scale below to fill in your choice.

1 never true

2 very seldom true

3 seldom true

4 sometimes true

5 frequently true

6 almost always true

7 always true

_____ 1. My painful experiences and memories make it difficult for me to live a life that I would

value.

_____ 2. I’m afraid of my feelings.

_____ 3. I worry about not being able to control my worries and feelings.

_____ 4. My painful memories prevent me from having a fulfilling life.

_____ 5. Emotions cause problems in my life.

_____ 6. It seems like most people are handling their lives better than I am.

_____ 7. Worries get in the way of my success.

 APPENDIX H

COPING STRATEGIES INVENTORY, PROBLEM SOLVING SCALE (TOBIN ET AL.,

2001)
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The purpose of this questionnaire is to find out how people deal with situations that trouble

people in their day-to-day lives. Please read each item and determine the extent to which you

used it in handling troubling events in general.

0 Not at all

1 A little

2 Somewhat

3 Much

4 Very much

_____ 1. I just concentrated on what I had to do next; the next step.

_____ 2. I changed something so that things would turn out all right.

_____ 3. I stood my ground and fought for what I wanted.

_____ 4. I made a plan of action and followed it.

_____ 5. I tackled the problem head-on.

_____ 6. I knew what had to be done, so I doubled my efforts and tried harder to make things

work.

_____ 7. It was a tricky problem, so I had to work around the edges to make things come out

OK.

_____ 8. I worked on solving problems in the situation.

_____ 9. I struggled to resolve the problem.

 APPENDIX I

EMOTION REGULATION QUESTIONNAIRE (GROSS & JOHN, 2003)

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We would like to ask you some questions about your emotional life, in particular, how you

control (that is, regulate and manage) your emotions. The questions below involve two distinct

aspects of your emotional life. One is your emotional experience, or what you feel like inside.

The other is your emotional expression, or how you show your emotions in the way you talk,

gesture, or behave. Although some of the following questions may seem similar to one another,

they differ in important ways. For each item, please answer using the following scale:

1 strongly disagree

4 neutral

7 strongly agree

_____ 1. When I want to feel more positive emotion (such as joy or amusement), I change what

I’m thinking about.

_____ 2. I keep my emotions to myself.

_____ 3. When I want to feel less negative emotion (such as sadness or anger), I change what

I’m thinking about.

_____ 4. When I am feeling positive emotions, I am careful not to express them.

_____ 5. When I’m faced with a stressful situation, I make myself think about it in a way that

helps me stay calm.

_____ 6. I control my emotions by not expressing them.

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_____ 7. When I want to feel more positive emotion, I change the way I’m thinking about the

situation.

_____ 8. I control my emotions by changing the way I think about the situation I’m in.

_____ 9. When I am feeling negative emotions, I make sure not to express them.

_____ 10. When I want to feel less negative emotion, I change the way I’m thinking about the

situation.
 APPENDIX J

RUMINATION-REFLECTION QUESTIONNAIRE, RUMINATION FACTOR (TRAPNELL

& CAMPBELL, 1999)

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For each of the statements located below, please indicate your level of agreement or

disagreement by indicating the appropriate response choice. Use the scale as shown below:

1 Strongly Disagree

2 Disagree

3 Neutral

4 Agree

5 Strongly Agree

_____ 1. My attention is often focused on aspects of myself I wish I’d stop thinking about.

_____ 2. I always seem to be “re-hashing” in my mind recent things I’ve said or done.

_____ 3. Sometimes it is hard for me to shut off thoughts about myself.

_____ 4. Long after an argument or disagreement is over with, my thoughts keep going back to

what happened.

_____ 5. I tend to “ruminate” or dwell over things that happen to me for a really long time

afterward.

_____ 6. I don’t waste time re-thinking things that are over and done with.

_____ 7. Often I’m playing back over in my mind how I acted in a past situation.

_____ 8. I often find myself re-evaluating something I’ve done.

_____ 9. I never ruminate or dwell on myself for very long.

_____ 10. It is easy for me to put unwanted thoughts out of my mind.

_____ 11. I often reflect on episodes in my life that I should no longer concern myself with.

_____ 12. I spend a great deal of time thinking back over my embarrassing or disappointing

moments.
 APPENDIX K

AMBULATORY ASSESSMENT SIGNAL

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How depressed did you feel since the last assessment?

not at all completely

0 100

Which strategies did you use to cope with feeling depressed?

Yes No

Acceptance

Avoidance

Problem solving

Reappraisal

Rumination

Suppression

How anxious did you feel since the last assessment?

not at all completely

0 100

Which strategies did you use to cope with feeling anxious? Select as many as you want.

Yes No

Acceptance

Avoidance

Problem solving

Reappraisal

Rumination
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Suppression

How stressed did you feel since the last assessment?

not at all completely

0 100

Which strategies did you use to cope with feeling stressed? Select as many as you want.

Yes No

Acceptance

Avoidance

Problem solving

Reappraisal

Rumination

Suppression
 APPENDIX L

PSYCHOEDUCATION SCRIPT
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Because people may use different words to describe the same thing, we want to make sure that

everyone is using the same definitions for what the app will ask. The three feelings that you will

be asked to rate are depression, anxiety, and stress. Here, “depression” means feeling blue, not

seeming to experience any positive feeling at all, or feeling that you have nothing to look

forward to. “Anxiety” means feeling close to panic or experiencing breathing difficulty or

noticing the action of your heart in the absence of physical exertion. These feelings might be

excessively rapid breathing, breathlessness, like your heart rate increased, or like your heart

missed a beat. “Stress” means finding it difficult to relax, finding it hard to wind down, or

feeling like you’re using a lot of nervous energy. Those are the feelings the app will ask you

about. Do you have any questions about these feelings?

The app will also ask you about how you handled those feelings. Six ways you might handle

these feelings are acceptance, avoidance, problem solving, reappraisal, rumination, or

suppression. Here, “acceptance” means being okay with how your feeling without labeling it as

“good” or “bad.” When you’re accepting your emotions, you might tell yourself, “I feel worried,

and that’s okay.” “Avoidance” means trying to escape or get away from the situation that caused

the feeling or the feeling itself. When you’re avoiding your emotions, you might try to distract

yourself or leave. “Problem solving” means changing the situation so that you get a better

outcome. When you’re problem solving, you might brainstorm ways to fix something.

“Reappraisal” means thinking differently about a situation so that you feel better about it. When

you’re reappraising, you might tell yourself, “It’s not that bad—maybe I made a wrong

assumption.” “Rumination” means focusing over and over again on negative emotions. When

you’re ruminating, you might keep thinking about how stressed you are. And keep thinking

about it. And keep thinking about it. “Suppression” means trying not to think about something
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or trying not to feel a certain way. When you’re suppressing your emotions, you might try really

hard not to think about that test you’re really worried about. These are the different ways of

handling feelings that the app will ask you about. You’ll be able to choose as many or as few as

you used for each feeling. Do you have any questions about these different ways of handing

feelings?