Tratamiento de la autocrítica a través de la terapia focalizada en la emoción

Résumé

The study of self-criticism has gained attention in recent years due to its marked influence on several psychopathological manifestations (Kannan and Levitt, 2013; Shahar et al., 2012; Werner, Tibubos, Rohrmann, & Reiss, 2018), as well as the worse response to treatment offered by people with high self-criticism (Marshall, Zuroff, McBride, & Bagby, 2008; Rector, Bagby, Segal, Joffe, & Levitt, 2000). Also, as far as we know, we have not found specific evidence to assess the intensity and forms of self-criticism in Spanish population. Due to these circumstances, our interest is in the adaptation to Spanish (study 1) of two scales of self-criticism (Forms of Self-Critificsm / Attacking and Self-Reassuring Scale, FSCRS, and Funcitions of Self-Criticism / Attacking Scale, FSCS; Gilbert, Clarke, Hempel, Miles, & Irons, 2004). The FSCRS scale is widely used for research purposes. The results obtained allow us to have a scale that measures both the intensity of the criticism and its forms, as well as a factor that evaluates the ability to be self-reassurance (FSCRS). The factor structure obtained in the scale of forms of self-criticism supports the results of the original study, as well as in other adaptations and later studies (Halamová et al., 2018). Likewise, our data replicates Gilbert, Clarke et al. (2004) factorial structure of functions’ scale (FSCS). Both scales have shown adequate internal consistency. In addition, the mediation study supports that the most pathogenic function of self-criticism (Self-persecution) impacts on depression through the three factors of self-criticism, while Self-correction generates changes in depressive symptomatology by a more specific route. The analysis of results reveals that the ability to be a self-reassurance makes a moderation of the impact of self-criticism on depression, while high scores on self-compassion can make higer magnitude moderation than self-reassurance. Also, we have evaluated the efficacy of a treatment within Emotion-Focused Therapy (EFT) framework. We performed a Randomized Control Trial (RCT) design. Individual therapy sessions (10-12 sessions) were made in order to soothe or solve problems with self-criticism, because of that special emphasis has been placed on the two-chair work. In addition to self-criticism, we measured depression (BDI-II), self-compassion (SCS), general symptomatology (CORE-OM) and interpersonal problems (IIP-32). Our results reveal that the EFT intervention is an effective treatment for self-critical patients, reducing the form of self-criticism that generates inadequacy emotions at 3 months of follow-up and producing a continuous improvement in self-compassion at the end of treatment and in the 3 months follow-up. In addition, the self-reassurance and depression scores are statistically significantly modified as a treatment effect, although this effect is not maintained at 3 months follow-up. The effect sizes are comparable to those reported by other humanistic-experiential studies (Angus, Watson, Elliott, Schneider, & Timulak, 2015; Ellitott, Watson, Greenberg, Timulak, & Freire, 2013). We have also analyzed the predictive capacity of the therapeutic alliance, informed by patient and therapist in the changes in the scores of the outcome measures.