A Qualitative Exploration of the Concept of Self-Compassion amongst Individuals with a History of Interpersonal Traumatic Events

A Qualitative Exploration of the Concept of Self-Compassion amongst Individuals with a History of Interpersonal Traumatic Events | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Qualitative Exploration of the Concept of Self-Compassion amongst Individuals with a History of Interpersonal Traumatic Events Pranati Misurya, Avril Mewse, Anke Karl This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6306510/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objectives: Self-compassion has been associated with better mental well-being, recovery from psychological trauma, and lower levels of post-traumatic stress. However, it has been studied primarily using quantitative research design(s), and there is a limited understanding of the concept of self-compassion amongst those who have experienced early and interpersonal trauma, which has been shown to impact a person’s view of self and others. This study aimed to develop an understanding of the concept of self-compassion, including its barriers, facilitators, and cultural influences, amongst individuals with a history of interpersonal trauma. Methods: The study used a semi-structured interview method with 16 participants (eleven females and five males) from diverse ethnic backgrounds with a history of interpersonal trauma. Data were analysed through Reflexive Thematic Analysis (Braun & Clarke, 2019). Results: The analysis revealed five themes: 1) Compassionate Coping: Leveraging Self-Compassion After Trauma; 2) Deliberate Self-Compassion: Embracing Challenges with Determination; 3) Navigating Self-Compassion with Support and Challenges from Loved Ones, 4) Paradox of Self-Compassion in Western Societies, and 5) Cultural Hindrances to Self-Compassion in the East. Conclusions: The findings clarify barriers, facilitators and cultural influences on self-compassion in trauma recovery and can inform the development of effective, culturally sensitive compassion interventions for complex PTSD and other conditions following interpersonal trauma. Keywords: self-compassion, interpersonal trauma, semi-structured interview, reflexive thematic analysis Figures Figure 1 Figure 2 Introduction Exposure to traumatic events can have far-reaching consequences on psychological functioning and public health (Magruder et al., 2017).Prolonged interpersonal trauma, such as physical or sexual abuse, is associated with even more severe symptoms than non-interpersonal trauma (Forbes et al., 2011) and serves as a risk factor for Post-Traumatic Stress Disorder (PTSD) (American Psychological Association [APA], 2013) and Complex Post-Traumatic Stress Disorder ( CPTSD) (World Health Organization [WHO], 2018). The Dimensional Model of Adversity and Psychopathology (DMAP) (McLaughlin & Sheridan, 2016) explains how early adversity impacts mental health by categorising experiences into threat and deprivation. Threat encompasses harm (e.g., physical abuse), while deprivation indicates a lack of social and cognitive stimulation (e.g., neglect). Threat modifies neural networks responsible for danger detection, leading to poor emotional regulation. Deprivation influences executive functioning, cognition, and language (McLaughlin & Sheridan, 2016; Sadikova et al., 2024). Consequently, early interpersonal trauma cultivates distrust and feelings of being unloved or unsafe (Bell et al., 2019), as well as shame (Kim et al., 2009), which hinders self-compassion (SC)-the ability to self-soothe in times of adversity (Zhang et al., 2023). Furthermore, this heightened sense of shame and self-criticism amplifies threat perception, exacerbating PTSD symptoms (Ehlers & Clark, 2000; Harman & Lee, 2010). Nevertheless, trauma survivors often exhibit resilience (Bonanno & Mancini, 2008). Positive mental health plays a pivotal role in recovery (Trompetter et al., 2017), with self-compassion (SC) identified as a protective factor against psychopathology (Scoglio et al., 2018; Trompetter et al., 2017). Thus, examining SC as a trauma intervention is essential. Self-Compassion as a Protective Factor SC comprises three components (Neff, 2016): self-kindness (being kind to oneself during setbacks), common humanity (seeing suffering as universal), and mindfulness (observing suffering without over-identification) (Neff, 2003). These components influence how individuals understand and manage challenges (Neff & Davidson, 2016). Gilbert’s (2009) evolutionary model links SC to three affect regulation systems: threat-protection system (detecting threats and negative emotions like shame, anger, and disgust), drive-excitement-seeking system (monitors resource seeking behaviour), and contentment-safety system (activating attachment, caregiving and self-soothing) (Depue & Morrone-Strupinsky, 2005). Dysfunctional early caregiving environments can increase sensitivity to rejection and self-criticism, heightening psychological distress and weakening internal stability (Gilbert, 2009; Mikulincer & Shaver, 2012). Thus, individuals who have experienced early trauma tend to have an overly developed threat system and an underdeveloped safety and contentment system (Gilbert, 2009), hindering their capacity for SC (Zhang et al., 2023) and contributing to traumatic stress (Humphreys & Zeanah, 2015). In contrast, secure attachment, characterised by positive and reliable caregiving experiences, promotes adaptive emotional regulation and SC (Bowlby, 1973; Gilbert, 2009; Mikulincer & Shaver, 2012). Even in the absence of secure early attachment, it is suggested that supportive relationships later in life can foster 'earned secure attachment' (Fear, 2018), promoting self-acceptance and an 'inner haven' for trauma recovery (Braehler & Neff, 2020). Developing a soothing system by enhancing feelings of safety, warmth, and reassurance can mitigate self-criticism and shame (Gilbert, 2009; Harman & Lee, 2010), reduce maladaptive coping such as avoidance (Thompson & Waltz, 2008), and enhance adaptive processing, which is critical for PTSD prevention and recovery (Ehlers & Clark, 2000). Compassion-focused therapy, which aims to balance the three affect regulation systems and increase greater access to soothing contentment systems, exemplifies this process (Au et al., 2017; Gilbert, 2009), highlighting the role of self-compassion, shaped by both early and later relationships, in trauma recovery. Research consistently demonstrates SC's inverse relationship with PTSD severity across various populations, including interpersonal trauma-exposed women (Scoglio et al., 2018), university students (Seligowski et al., 2015; Thompson & Waltz, 2008), and community groups (Maheux & Price, 2016). A systematic review by Winders et al. (2020) found higher SC correlated with lower PTSD symptoms and intervention studies also showed PTSD symptom improvement, suggesting SC’s potential role in treatment. Furthermore, evidence also supports the role of compassion-focused interventions in CPTSD (Brähler, 2023; Huang et al., 2024). However, misconceptions and fears about SC, such as self-criticism, can hinder treatment (Bayir & Lomas, 2016; Egan et al., 2022). For those with childhood maltreatment or highly critical backgrounds, SC can be fear-inducing (Gilbert et al., 2011; Boykin et al., 2018)) Fear of Self-Compassion Despite its benefits, fears and resistance to SC persist (Gilbert et al., 2011; Miron et al., 2016). Gilbert et al. (2011) outlined three fears of compassion (FOC): (a) compassion toward others, (b) compassion from others, or (c) fear of SC. For trauma survivors, especially those with insecure attachment histories, SC may trigger memories of past neglect in early dysfunctional relationships (Gilbert et al., 2011). Many with childhood maltreatment, abuse, or interpersonal trauma believe they do not deserve compassion and feel compelled to self-criticize (Boykin et al., 2018; Bistricky et al., 2017; Miron et al., 2016). These beliefs interfere with SC (Gilbert et al., 2011), reduce its protective effects (Messman-Moore & Bhuptani, 2020), and impede treatment and recovery (Miron et al., 2016). Additionally, FOC strongly correlates with self-criticism, shame, and depression (Kirby et al., 2019). Multiple childhood abuse episodes increase fear and resistance towards SC (Miron et al., 2016). One explanation is that inconsistent caregiving creates confusion and distress around SC. Self-critical thinking, rooted in adverse childhood experiences, reinforces PTSD and depressive symptoms, particularly in cases of childhood sexual abuse (Miron et al., 2016). This presents a paradox: those who most need SC for trauma recovery often struggle to access it. Attachment theory clarifies this paradox. Early experiences with caregivers shape internal working models, which are understood as the cognitive and emotional representations of the self and others (Bowlby, 1973), influencing emotional regulation and stress management (Mikulincer & Shaver, 2019). Secure attachment promotes healthy emotional regulation strategies (e.g., reappraisal, problem-solving). Conversely, insecure attachment correlates with maladaptive emotional regulation and a lack of internal resources to manage distress (Mikulincer & Shaver, 2019). This reinforces negative self-perceptions (Shaver et al., 2016), over-activating the threat system and hindering self-soothing and self-compassion (Gilbert & Procter, 2006). Internal working models shape perceptions of self and others: a negative self-view fosters feelings of inadequacy, while a positive self-view nurtures feelings of worthiness. Similarly, a negative view of others breeds distrust, whereas a positive view cultivates perceptions of support and trust (Gaskin-Wasson et al., 2017). While quantitative research has examined the effects of FOC, qualitative studies remain limited, leaving gaps in understanding (Lawrence & Lee, 2014; Roseman, 2024). Given the psychological benefits of self-compassion, resistance to it should be addressed in therapeutic interventions (Gilbert et al., 2011). Studies have investigated the shift from self-criticism to self-compassion in compassion-focused therapy (CFT) for PTSD (Lawrence & Lee, 2014) and the mechanisms of change in group CFT for complex PTSD (Ashfield et al., 2021). Roseman (2024) explored experiences of self-compassion, including barriers, in individuals with complex PTSD and low self-compassion, utilising the Mindful Self-Compassion program (Germer & Neff, 2019). Despite its insights, the study had limitations, such as a small sample size and a lack of diversity. Unlike previous studies that examined SC within the context of interventions, this study directly asked participants about their SC experiences outside of a structured program, providing a richer, more nuanced understanding of FOC. The findings contribute to a growing body of literature suggesting that SC interventions must address FOC before fostering its development (Kirby et al., 2019). This type of qualitative research can offer deeper insights into how FOC impacts the success of SC-focused interventions. Culture and Self-Compassion Cultural context shapes perceptions of self, others, and the world (Bernardi et al., 2019). Self-construal theory (Markus & Kitayama, 1991) suggests that self-construal—independent or interdependent—affects thoughts, actions, emotions and relationships. Individualistic cultures emphasise uniqueness and autonomy, while collectivist cultures prioritise social connectedness and harmony with others. These cultural differences influence SC's role in trauma recovery in three ways. Firstly, cultural self-construals shape trauma processing and support-seeking behaviours (Engelbrecht &Jobson, 2014; Jobson & O’Kearney, 2008). In collectivist cultures, trauma is appraised based on its impact on the group, leading survivors to feel guilt, responsibility, or alienation. In contrast, individualistic cultures frame trauma as personal weakness or failure, often leading to isolation, distrust, or external blame (Engelbrecht & Jobson, 2014; Jobson & O’Kearney, 2009). Secondly, self-construal influences SC and its role in emotional regulation. Western cultures emphasise self-expression and goal achievement, viewing relationships as a means of self-comparison. In contrast, collectivist cultures view relationships as self-defining, which may explain why Indian participants report greater compassion for others than for themselves (Sengupta & Saxena, 2024). Eastern cultures emphasise concern for others and self-sacrifice, potentially explaining higher compassion toward others which often precedes SC (Steindl et al., 2020; Triandis et al., 1993). Additionally, self-criticism is necessary for self-improvement and social harmony (Yamaguchi et al., 2014). Individuals often attribute shortcomings to themselves, reinforcing social identity (Heine et al., 1999). For instance, Northeast Indian participants showed heightened shame and self-criticism in compassion-focused therapy, reflecting cultural norms of emotional suppression and the belief that shame fosters social cohesion (Sengupta & Saxena, 2024). Thirdly, philosophical and religious traditions may shape SC and trauma recovery. Varying dialectical thinking levels influence SC abilities (Chio et al., 2021). Regarding China’s collectivist culture, students reported dialectical views on SC, balancing positive and negative dimensions and emphasising ‘benign self-criticism’ (Zhao et al., 2021) On the other hand, , Kariyawasam et al. (2022), using the Compassionate Engagement and Action Scales (CEAS; Gilbert et al., 2017), found that Sri Lankan participants reported higher SC than UK participants, likely due to Buddhist traditions emphasising self-kindness. Conversely, Steindl et al. (2020) found that Singaporeans (collectivist culture) had greater SC but less compassion for others than Australians (individualist culture). Globalisation has blurred cultural distinctions, increasing individualism worldwide (Katzarska-Miller & Faucher, 2022). Consequently, evidence on SC across cultures remains inconsistent, highlighting the need for further research. Beyond cultural differences, individual beliefs about productivity can also influence SC. Some associate self-criticism with success and resist self-kindness (Robinson et al., 2016). While this is not exclusive to Western cultures, research suggests capitalist, individualistic societies often discourage SC (Campion & Glover, 2017; Steindl et al., 2020). Given these cultural influences, psychological trauma processing and recovery differ significantly based on self-construal and societal values. Limited literature on the link between SC and self-construal highlights the need for qualitative studies on cultural influence in trauma recovery (Zhao et al., 2021). Further research can refine culturally sensitive interventions that address variations in emotional expression, self-perception, and social harmony (Sengupta & Saxena, 2024). Gender Differences in Self-Compassion and Trauma Recovery Men are more likely to experience traumatic events (Christiansen & Elklit, 2008), while women have a higher risk of PTSD (Lukaschek et al., 2013), with more chronic symptom (Seedat et al., 2005) and increased depression and anxiety (Spinhoven et al., 2014). Women face a greater risk of sexual trauma, while men typically encounter trauma from accidents, combat, and non-sexual assaults (Lukaschek et al., 2013). There are also gender differences in self–compassion that affect trauma recovery, as women typically exhibit lower SC, higher self-criticism, and more negative self-talk (Yarnell et al., 2015) . These challenges intensify in cultures with rigid gender roles, legal gender inequality (Makama, 2013), and female oppression (Wongnuch et al., 2023), where domestic violence may be legally sanctioned (Minwalla, 2019), as seen in Afghanistan (Greiff, 2010). Women also receive poorer healthcare (Nadakuditi, 2024), carry heavier caregiving burdens, and often lack adequate support from male partners or family (Carbó & Orellán, 2020). Despite well-documented gender differences in SC and trauma recovery, qualitative research on gender’s role in developing SC which can provide more insights (Yarnell et al., 2015) is limited, particularly after interpersonal trauma and across cultures. Although this study does not explicitly examine gender differences, its qualitative approach offers valuable perspectives on SC among trauma survivors, informing future research. Given the predominantly female sample, the findings may also highlight the unique challenges women face in cultivating SC post-trauma. Rationale and Aims of the Present Study Despite evidence of SC’s positive impact on mental health (Ferrari et al., 2019; Wakelin et al., 2022), little is known about trauma survivors’ experiences and challenges with the concept. Trauma history is linked to fears and resistance to SC (Miron et al., 2016), underscoring the need for qualitative research on its meanings, barriers, and facilitators (Bayir & Lomas, 2016; Roseman, 2024). The rise of compassion-based therapies (Kirby, 2017) reflects SC's role in well-being (Neff & Germer, 2017) and trauma recovery (see, e.g., Winders et al., 2020; Brahler, 2023). Given the detrimental consequences of FOC, Kirby et al. (2019) advised therapists to explore patients’ perceptions of compassion before therapy. Cultural differences in SC remain a priority (Steindl et al., 2020). To the author’s knowledge, no studies have considered interpersonal trauma survivors’ SC experiences, despite early trauma shaping self-concept (Kouvelis & Kangas, 2021), coping strategies (Pfluger et al., 2022), and one’s ability to seek and benefit from social support (Maercker & Horn, 2013). Limited understanding of implementing compassion interventions for those struggling with SC potentially impedes treatment efficacy (Roseman, 2024). Further research is needed to explore SC's meaning, barriers, facilitators, and cultural influences. This qualitative study aims to understand diverse trauma survivors’ SC experiences, including barriers, facilitators, and cultural influences. Improved qualitative understanding of the experiential components of compassion-giving and receiving may inform efficacious trauma interventions for complex symptom presentations. Methods Research Questions What do interpersonal trauma survivors understand by the concept of SC? What are the facilitators of SC for participants’ recovery from trauma? What are the barriers to SC for trauma survivors? What are trauma survivors' understandings of how their culture has allowed or hindered their practice of SC? (Comparison between Eastern and Western cultures). Participants Sixteen adults with a history of interpersonal trauma(s) participated. They identified ‘disturbances in self-organisation’ (DSO-related symptoms) from a list. Ethnically, six identified as English/Welsh/Scottish/Northern Irish, four as another White background, two as White and Asian, and four as Asian. Eleven were female and five were male (see Table 1). Participants were recruited through campus advertisements at the University of Exeter’s Streatham campus and the ‘Call for Participants’ website(https://www.callforparticipants.com/). Eligibility was based on self-reported experiences of interpersonal traumatic, such as physical, sexual, or emotional abuse/neglect. Specifically, the study sought participants who reported difficulties with emotional dysregulation, worthlessness, or social withdrawal affecting work and relationships. Exclusion criteria included a PHQ-8 score above ten, very high psychological distress, or being under 18. Table 1 Participant Demographic Characteristics (N = 16) Pseudonyms Age Gender Religion Ethnicity Employment status Relationship Status Disturbance in self-organisation symptoms (DSO) symptoms P1. AP_21 23 F Atheist British/Welsh/Scottish/Northern Irish Student Single Difficulties regulating negative or upsetting emotions, a sense of worthlessness, shame, or guilt, a sense of distance or feeling cut off from others P2 . LN_10 30 F Hindu Indian Student Single Difficulties regulating negative or upsetting emotions, a sense of worthlessness, shame, or guilt P3 . JD_32 41 F No religion or otherwise Any other white background Unable to work Divorced A sense of worthlessness, shame, or guilt P4 . BG_69 29 M No religion or otherwise British/Welsh/Scottish/Northern Irish Unable to work Single, Never Married Difficulties regulating negative or upsetting emotions, a sense of worthlessness, shame, or guilt, a sense of distance or feeling cut off from others P5 . GPG_90 22 F No religion or otherwise British/Welsh/Scottish/Northern Irish Employed for wages Married Difficulties regulating negative or upsetting emotions, a sense of worthlessness, shame, or guilt, a sense of distance or feeling cut off from others P6. CP_48 27 F Atheist White and Asian Student Single, Never Married Difficulties regulating negative or upsetting emotions, a sense of worthlessness, shame, or guilt, a sense of distance or feeling cut off from others P7 . AA_46 20 M Agnostic White and Asian Student Single, never married Difficulties regulating negative or upsetting emotions P8 . JJ_50 24 M Hindu Indian Employed for wages Single, never married A sense of worthlessness, shame, or guilt P9. N_67 28 F Atheist Indian Student Single, Never married Difficulties regulating negative or upsetting emotions, a sense of worthlessness, shame, or guilt, a sense of distance or feeling cut off from others P10 . NS_43 30 F Agnostic Any other white background Self-employed Single, never married A sense of distance or feeling cut off from others P11 . MG_50 29 F Buddhist Another white background Self-employed Single, never married Difficulties regulating negative or upsetting emotions, a sense of worthlessness, shame, or guilt, a sense of distance or feeling cut off from others P12. NM_65 43 M Christian African Self-employed Single, never married A sense of worthlessness, shame, or guilt P13. BD _91 25 F Atheist British/Welsh/Scottish/Northern Irish Student Married Difficulties regulating negative or upsetting emotions, a sense of worthlessness, shame, or guilt, a sense of distance or feeling cut off from others P14. KJ_60 55 F Christian British/Welsh/Scottish/Northern Irish Unable to work Divorced Difficulties regulating negative or upsetting emotions, a sense of worthlessness, shame, or guilt, a sense of distance or feeling cut off from others P15 . .NT_35 21 F Atheist Chinese Student Single, never married Difficulties regulating negative or upsetting emotions, a sense of worthlessness, shame, or guilt, a sense of distance or feeling cut off from others P16 . DB_42 32 M Agnostic British/Welsh/Scottish/Northern Irish Out of work but not looking for work Single, never married A sense of worthlessness, shame, or guilt Materials Screening Questions The screening included a demographic questionnaire (age, gender, ethnicity, employment, marital status, religion, and participant ID) and a Qualtrics questionnaire assessing eligibility. Participants confirmed if they were above 18, fluent in English, had any psychiatric diagnosis other than PTSD, were experiencing low mood or high distress, and had experienced interpersonal trauma. Participants also indicated symptoms of ‘Disturbance in Self-Organisation’ (DSO). Interview Schedule The interview topic guide was developed after thoroughly reviewing existing qualitative studies on SC (Campion & Glover, 2017; Kelley et al., 2021; Pauley & McPherson, 2010). The first author read these studies for gaps and compared them against the existing qualitative literature on SC and trauma (Lawrence & Lee, 2014; Ashfield et al., 2021). The interview schedule was informed by gaps from both areas of study, specifically, that only limited studies had explored SC qualitatively, particularly among trauma survivors. Thus, the interview topic guide was framed based on the research questions for the present study, which focused on concept, barriers, facilitators and cultural influence on SC, through discussions and iterations guided by both project supervisors. It was piloted with three participants, after which questions were reworded and modified. The study was preregistered on the Open Science Framework (OSF) platform (a link will be provided after the peer-review process to avoid revealing the identity of the authors). Psychoeducation Video on SC To introduce and orient the participants to SC, they were shown the first minute and a half of a video presentation on SC on YouTube by the School of Life (Self Compassion) on SC. School of Life is a UK-based group that shares knowledge about philosophical, psychological, and literary concepts to cultivate healing, growth, and understanding. Procedure Participants were provided with a participant information sheet and consent form before the study began. Participants were then asked to complete the screening questionnaire, comprising demographic information, including age, gender, religion, employment status, and marital status, they then had to select from a list of DSO symptoms on the Qualtrics platform. Interviews were held online using Microsoft Teams. Before the interview questions were presented, participants were shown a brief one-minute clip-on SC (see details above) and asked if they had any questions before being asked questions based on the interview guide. The average length of each interview was 30 minutes. Data Analysis and Quality Checking The data analysis was based on reflexive thematic analysis (Braun & Clarke, 2019), a method for identifying, analysing, and reporting patterns or themes in a given dataset from a reflective approach, emphasising the importance of researcher reflexivity in data generation and knowledge production. Epistemological considerations for the given data were based on constructionist epistemology; the interpretation of meaning and experience was seen as socially generated and sustained through a combination of subjective and inter-subjective construction. Further, an experiential orientation to data analysis was incorporated, focusing on the meaning ascribed to participants’ subjective personal viewpoints. Both inductive and deductive coding were employed, with a more significant predominance towards the latter, and both the semantic and latent meanings of responses were considered, with a greater emphasis on the former. Based on Braun and Clarke’s (2019) recommendation, the concept of ‘information power’ (Malterud et al., 2016) was used to determine sample size decisions. This involved considering the following factors: the richness of the data, study aims, sample specificity, use of established theory, quality of dialogue, and analysis strategy. Analytical Process The six-step analytical process for thematic analysis (Braun & Clarke, 2022) was followed. Data familiarisation involved interviews and taking notes. A reflective journal was used to document notes, thoughts, and reflections. Interviews were transcribed, and coded labels were applied using NVivo 14. After the first list of codes was developed, the original transcripts were consistently referenced to review established codes and analyse the interpretation of new codes with increasing data familiarisation. The codes were iterated for improved specificity and to ensure alignment with the research questions, and then they were discussed with the second and third authors. The first author reviewed interview files and evaluated the existing coded data’s codes (revising, modifying, and omitting). A meeting followed where all authors finalised codes for initial theme generation. Codes were compiled and clustered into themes, focusing on identifying meaningful patterns across the dataset. Emerging themes were reviewed with the coded data and the existing dataset. A thematic map of initial themes was created and critically reviewed via questions from Braun and Clarke (2012, p. 65). Following Braun & Clarke’s (2006) suggestion to use Patton’s (1990) ‘ dual criteria for judging categories’ , the themes, codes, and data extracts were reviewed at two levels. In the final stage, themes were refined to ensure a comprehensive dataset interpretation. The chosen data extracts were presented illustratively rather than analytically. Theme names were revised for clarity and precision (Braun & Clarke, 2021). Reflexive Statement from All Authors My interest in SC began when my therapist introduced me to it as a master’s student, resonating with my experience. Years later, discovering it as an emerging research area deepened my desire to make it the focus of my thesis. During my doctoral studies, I was particularly interested in how trauma survivors perceive SC. In this study, I sought to understand participants’ views on and why it was challenging to implement SC despite research highlighting its benefits. The author team comprises postgraduate-educated researchers fluent in English. The second author, a senior lecturer in psychology at the University of Exeter, researches the social context of health and risk-taking behaviour and has decades of experience in qualitative research. The third and senior author, a professor in psychology at the University of Exeter, is an expert in PTSD and psychophysiology and has completed extensive work on SC. Results Participants in this study experienced interpersonal traumatic events, including physical, sexual, or emotional abuse or neglect. The study sought to deepen participants’ perceptions of barriers and facilitators to SC and the influence of culture (specifically Eastern and Western) on SC. Participants shared their understandings, practices, facilitators, and obstacles to SC and how their cultures shaped its development. Figure 2 presents the five themes identified. Theme 1: Compassionate Coping: Leveraging Self-Compassion After Trauma This theme captures compassion as a coping resource—used cognitively to handle difficulties and suffering in daily life and behaviourally through enjoyable activities. The theme reflects participants’ understanding of compassion as a valuable coping mechanism: “ Self-compassion is, um, the strategies that you would employ to get yourself through a day. Because a lot of the time, I think people have to take it one day at a time or even one hour at a time ” (P1) Participants understood and soothed themselves by acknowledging the inherent complexities of the human experience and navigating everyday challenges. They recognised that SC involved an active cognitive process of struggle validation, kindness to oneself, and recognition of their shared humanity with others in adversity. This approach enabled participants to respond to their distress with empathy and care rather than judgment. Embracing Humanity: Self-Compassion through Acceptance and Understanding This sub-theme depicts participants’ progression towards SC, characterised by acknowledging their imperfections and moving towards treating themselves with kindness, as opposed to the earlier harsh self-criticism. P6 highlighted “… not being angry at myself for not being able to live up to my usual standards when I was struggling. I would have been hard on myself ”. Echoing this, P2 stated, “I think many problems come from self-blame… and guilt… So if we are a little self-compassionate and understand that I am also a human being, I do make mistakes”. Self-Reassurance as a Compassionate Coping Strategy SC is a coping resource involving reassuring, compassionate statements responding to suffering. Negative appraisals, including shame, guilt, self-blame, and complicated emotions, often accompany trauma. SC and self-reassurance offer means of managing setbacks with concern and care for oneself, with self-reassurance enabling soothing through encouragement and support in adversity (Petrocchi et al., 2019). P1 commented, “It was not instant, but I could gently count on myself and say, well, that is not what you are... something was done to you .” Similarly, P9 shared their experiences with soothing: “I always say, this was not your fault… like, ‘it is okay, it is okay’”. This subtheme illustrates how participants used self-reassurance to express SC, comfort themselves and their challenging emotions, and self-soothe, allowing them to feel they were extending compassion toward themselves. Self-Compassion through Comforting Activities Participants commonly associated compassion with pleasurable or comforting activities, including pursuing hobbies or finding momentary comfort through a relaxing shower, a nice meal, or crocheting. For instance, P14 shared her struggles with SC, which crocheting helped: “I tend to spend some time each day where I just do something... and well, I like just to sit, and I like just to do some crocheting”. Meanwhile, P7 enjoyed “allowing myself each day to do something that I want to do. For example, I enjoy sports. So I will go to the gym X times a week”. P1 also shared their approach: “I advise people to focus on small things that bring them pleasure or comfort, like their favourite food, watching a film, cleaning bedsheets, or brushing their teeth. These tiny acts of self-care are also associated with it ”. Other participants used compassion to address challenging emotions directly. SC was associated with activities that made them feel better, such as spending time with a pet or feeling clean. For instance, P13 practised SC by “ taking time to watch things that I enjoy... Sometimes, I need to get showered to make myself feel better... and trying to do things with my pet… will make me feel better” . P3 shared their practice of SC in daily life when experiencing challenging emotions: “My partner has a tiny space where he plays music and puts on some LED lights that are just this blue colour. There is a little cat there, so when I feel particularly down about myself or stressed, I will ask him to borrow his space, and he will leave it open. Just relax, breathe, and be mindful”. The theme suggests that participants practice SC through pleasurable or comforting activities. It also indicates that participants view SC as a coping mechanism, both cognitively and actively engaging in such activities to cultivate happiness, peacefulness, and relaxation. Theme 2: Deliberate Self-Compassion: Embracing Challenges with Determination This theme highlights that although participants generally recognised the value of SC, even those who regularly practiced SC required a conscious and deliberate effort to do so. P14 reflected on her inability for SC: “I am not one for showing kindness to myself, and I am pretty bad at that... I tend to show kindness towards others and not really towards myself”. Similarly, P3 discussed her difficulties with receiving and extending compassion towards herself: “I think it is easy to treat other people that way. I think it is tough to conceptualise treating me that way. I am not very good at that. That is probably my worst skill.” P6 reflected on the understanding that SC requires effort and gradually improves: “… I think that starting to struggle with mental health issues over COVID. I had to learn some of these techniques to be kind to myself and not beat myself up about not getting done what I thought I should… I do not think that was a very innate thing”. Responses illustrated that SC is a challenging concept to relate to and implement. Those who engaged in SC recognised that it required self-directed effort to improve, stemming from understanding its benefits. They acknowledged that consciously working to enhance SC abilities ultimately facilitated their experiences. This indicates that SC does not occur naturally for many, necessitating a deliberate commitment to developing this ability. P7 offered insights into the gradual progression of compassion: “Making a conscious effort to nurture yourself is what I would say is self-compassion. It seemed menial, but I do think that over time, it has manifested itself and cemented my routine. A conscious effort, awareness, and time are what you would need. I have made an active effort to look into it ”. Many individuals mistakenly believe that SC leads to laziness, feeling that self-criticism is necessary for motivation (Germer & Neff, 2015 ). However, SC can be a fierce and motivating force (Neff, 2011), as echoed by one participant (P11): “I went through that abusive relationship. I am an angrier person now, so sometimes, my self-compassion—maybe when I was younger, I understood compassion to be very gentle—is a bit sterner. Sometimes, I have to force myself to do something, but I am still trying to be compassionate. So I feel like I have incorporated some sternness into myself, compassion, but otherwise, it is gentle, loving, and friendly, just allowing yourself to exist”. Theme 3: Navigating Self-Compassion with Support and Challenges from Loved Ones Participants commonly acknowledged their family and friends’ significant role in practising SC. The presence and support of friends were crucial for some: “I think a big one is if other people are being nice to me… definitely when others are compassionate towards me, like my boyfriend or my dad” (P5). P15 also highlighted the supportive role of others in being able to practice SC: “I will give you an example within the context of emotional, abusive relationships. So, when I was trying to move past that experience, I was not very self-compassionate; however, my friends were. They would send me voice messages and sort of… be the voice in my head as compassionate, and eventually, it was there.” Conversely, some participants felt their friends and family negatively influenced their ability for SC and described how this negative influence hindered SC. For instance, P7 noted that SC could be affected when others failed to consider it essential, impacting their level of SC: “… people that either do not want or cannot, or are not able to practice self-compassion don’t allow you either ”. Similarly, P12 identified that negative people could undermine one’s compassion levels: “I think that there are so many barriers towards you giving yourself what you want… compassion… and one of them… toxic people, toxic friends”. Helpful social support from family and friends can facilitate the development and practice of SC; simultaneously, the detrimental impact of negative social influences can impede one’s ability for SC. The presence or absence of a supportive social network appears to be a crucial factor in shaping one’s capacity for SC. Additionally, family upbringing, religion, and community significantly influenced participants’ ability to cultivate SC. For some, family environments either facilitated or hindered SC. P13 commented, “Does family refer to my culture? Yeah, so my family are massive on, you know, practising self-compassion...”. Conversely, P7 noted that living away from home facilitated SC: “I think I, so I currently live away from home, so I am at university, and I find it much easier to be more compassionate away from like my parents”. The community was also influential. Discussing living in Harlem, P11 found that its community and belonging facilitated their SC journey: “Most of all the places I live I am most comfortable right now… There is like a big community. I find it easier to be compassionate with myself here than other places”. These insights underscore how family, religion, and community dynamics influence participants’ approaches to SC within their respective cultural contexts. Theme 4: The Paradox of Self-Compassion in Western Societies Th i s theme captures participants’ diverse perspectives; some found SC easier in Western cultures and believed that their culture fostered its development, while others felt its progress was limited despite existing and being discussed. Cultural Facilitators of Self-Compassion: Perspectives on Individualism Cultural values prioritising individualism can foster the practice of SC. Some participants believed their culture facilitated SC. “I would say that my culture (Western)… probably facilitated more self-compassion… I was fortunate to be growing up when the mental health movement started, and more awareness in schools and families was being encouraged” (P1). Some participants compared Eastern and Western cultures, understanding that Western culture affords greater SC. P5 offered insights into this: “ I think this is a weird one for me because my stepdad was South African, which always made me think that British culture was comparatively very compassionate”. Limits of Self-Compassion in Western Culture: Factors and Perceptions Participants believed that, although compassion existed in Western culture, it was characterised by certain limits attributed to different factors. Discussing the UK, P7 felt that “it is a taboo in the UK as well, or it is still not as progressed as perhaps it could be, which I find quite interesting. .. although it seems to be mentioned in the mainstream headlines...”. P13 attributed these difficulties in practice to increased cultural focus in the UK on academic pressure: “… high schools and colleges are so driven by people achieving, going to university and that sort of thing that often… they do not care for self-compassion, and they will do the odd session on it… think British society as a whole… does not lend time for self-compassion”. P3 attributed this to Western culture’s focus on independence: “ The epitome of this American ideal is someone strong enough to stand on their own… it alienates you from a protective space of people who might care and have compassion and teach you compassion for yourself .” In summary, some found that their culture accepted and enabled SC. Others shared that despite the concept being present in their culture, it was restricted from being fully practised. The general agreement seemed to be that Western culture acknowledges the benefits of SC, which aided some in their ability to practice competently and align with their views. For others, this meant that cultural constraints made SC difficult despite cultural discussion. Theme 5: Cultural Hindrances to Self-Compassion in the East Participants felt their Eastern cultural environment was not conducive to cultivating SC. They attributed this to societal norms, family dynamics, and individual experiences that hindered engagement in SC practices within their cultural context. Cultural Collectivism: Impacts on Self-Compassion Development in Eastern Contexts According to P2, “I feel that I come from a society which concentrates more on collective behaviours and living rather than individual... if anybody focuses a little more on themselves, in terms of mental health, we immediately tend to label them as selfish .” Similarly, P7 shared that his culture did not deem SC important: “So I am half Chinese... and my dad is from the UK, but I think culturally, me and my sister have come and brought up much more along Chinese culture… from that influence on upbringing, mental health is not a thing. Self-compassion is a luxurious extra ..that is not necessary”. Similarly, P8 commented: “Self-compassion is spending time on my realising stuff, being, having a personal space, but I think they will not allow me to do that... they will not allow me to stay alone… that is the restriction I have in the culture here”. This sub-theme reflects how collectivist values emphasise collective well-being and societal norms and prioritise familial duties over individual emotional needs like SC. Filial Piety and Self-Compassion: Cultural Challenges in Eastern Contexts Filial piety (the strong sense of duty and respect towards one’s parents and elders) impeded participants’ cultivation of SC within Eastern cultural contexts. Participants felt that cultural emphasis on prioritising the needs of family and elders over one’s own hindered SC and was viewed as selfish or disrespectful. P15 shared that “ growing up in Asia… I think they have very unrealistic expectations… would be the barrier because sometimes I think I am doing well, but then I am like… my parents would disapprove” . Similarly, P6 reflected on this incongruence in expectations: “ They disapprove of the fact that I am incredibly masculine, that I want a career, and that I do not want to get married and have children. I actively do not want to have any children. When I did biology, I did not then do medicine, and I think that it is evident that their priority is not my happiness—their priority is me fitting into their mould”. Participants’ responses revealed a strong sense of filial piety influencing self-perceptions, including their choices and ability to engage with SC. Cultural Stigma in Eastern Contexts: Hindrances to Self-Compassion Among Sexual Trauma Survivors This theme reflected participants’ understanding of how their society’s perception and treatment of trauma hindered the development of SC. Participants felt that their society’s norms and expectations often failed to provide a supportive environment for processing and healing from traumatic experiences. This lack of societal understanding towards trauma impeded participants from cultivating SC due to internalising the idea that difficult emotions and struggles were not valid or deserving of care and kindness. P1, who identified as belonging to Western culture, emphasised how societal views of trauma made a positive difference: “ I think it was crucial that environment and it probably would have turned out very badly if it had not been for that constant support because I think some mistakes, such as if a culture treats it like a taboo and the person cannot bring it up at all. You might feel constricted, but I didn’t… that made a big difference. I think so”. Conversely, P6 explained how society’s view of her sexual abuse negatively impacted her: “… it is sort of a journey with self-reflection moving forward to retrain my brain out of what I think society thinks of me; I experienced sexual assault when I was very young, and for a long time, I blamed myself... and I think that a lot of that mindset came from the society’s sort of opinion at the time... that victims were at fault for sexual assaults happening”. Similarly, P9 discussed the context of India, stating that: “… everything is blamed back to a girl if anything happens. It is difficult to get out of those situations. ..you are a girl, it is your fault... that anything happened, any abuse happened, nobody thinks about the scenario. Nobody would say, ‘It is okay, it is okay. It does not matter.’”. Participants from Eastern cultural backgrounds often felt their cultural environments did not encourage SC. Several explanatory sub-themes emerged, including a low cultural emphasis on SC, a collectivist culture prioritising collective needs over individual concerns, filial piety and duty, a cultural avoidance of discussing mental health and personal struggles, and negative perceptions towards trauma and self-care in Eastern cultural contexts. Overall, societal norms and family dynamics in many Eastern cultures posed significant barriers to developing and practising SC. In summary, participants described that while SC was discussed in Western cultures, its practice was often limited by societal values emphasising competition and achievement, which conflicted with SC principles. In contrast, participants from Eastern cultures described environments that undervalued SC, shaped by collectivism, filial piety, and cultural stigma surrounding mental health and sexual abuse. The findings also highlight the interaction between cultural and gender-based barriers. Women, who made up a large proportion of the sample, frequently reported experiences of sexual and physical violence, consistent with literature showing that women are disproportionately affected by such experiences. Traditional gender roles further exacerbate these challenges, as women are often expected to be nurturers and carers, showing greater compassion toward others than themselves. In Western cultures, these expectations intersect with competitive and achievement-oriented values, while in Eastern contexts, collectivism, filial piety and stigma place additional burdens on women’s ability to practice SC. Discussion This qualitative study employed semi-structured interviews to understand SC and its barriers, facilitators, and cultural influences for sixteen ethnically/culturally diverse individuals who had experienced interpersonal trauma. Reflexive Thematic Anaysis enabled the identification and development of five themes. Theme 1: Compassionate Coping: Leveraging Self-Compassion After Trauma Consistent with existing research establishing SC as a valuable coping resource (Ewert et al., 2021 ; Wong & Yeung, 2017), participants described how they used SC as a coping resource. They distinguished it as a cognitive and behavioural practice in the present study; cognitively, participants practised SC through acceptance ( sub-theme: ‘Accepting and understanding that I am human’) and reframing the situation ( sub-theme: ‘Providing reassuring statements to self) . These findings are significant, as SC may foster post-traumatic growth (PTG), a positive psychological change following adversity, by enhancing crisis acceptance, constructive reframing, and meaning-making (Wong & Yeung, 2017). Klingle and van Vliet’s ( 2019 ) qualitative study linked self-compassion (SC) to enjoyable activities. Similarly, participants in the present study viewed engaging in enjoyable activities as a strategy for managing negative emotions. This reinforces existing literature on self-directed actions that reflect self-compassionate behaviour (Gilbert, 2009 ). In support of this, the current findings suggest that while a long-term avoidance of complex emotions contradicts SC, temporarily redirecting attention through alternative actions may be a valid SC approach. Theme 2: Deliberate Self-Compassion: Embracing Challenges with Determination Participants reported challenges in cultivating SC, often finding it unfamiliar or unattainable. Early life adversity predisposes individuals to heightened self-criticism and shame due to inadequate nurturing, impairing self-soothing and emotional regulation (Gilbert & Procter, 2006 ; Russo et al., 2023). Poor emotional regulation is linked to behavioural problems (Choi & Oh, 2014) and increased PTSD symptoms, as childhood trauma correlates with ineffective regulation strategies and lower distress tolerance (Russo et al., 2023). These findings align with existing literature on fear of SC, which is associated with repeated childhood abuse (Boykin et al., 2018 ; Miron et al., 2016). Despite these challenges, participants recognised SC’s benefits and tried to implement it, consistent with previous findings (Bayir & Lomas, 2016 ; Campion & Glover, 2017 ; Pauley & McPherson, 2010). Individuals who struggle with FOC may benefit from psychological interventions that address two primary objectives: first, assisting individuals in acknowledging their potential for SC, and second, providing support for cultivating SC skills, considering the practical challenges associated with it (Pauley & McPherson, 2010). Steindl et al. (2018) suggest that motivational interviewing enhances motivation and commitment before compassion-based interventions, increasing the likelihood of participants benefiting from Compassion-focused interventions. Theme 3: Navigating Self-Compassion with Support and Challenges from Loved Ones This study found that social relationships significantly shaped individuals’ engagement with SC and their ability to benefit from it. Participants noted that family and friends influenced their ability to practice SC—some fostering positive attitudes, while others reinforced negative dynamics and societal messages devaluing SC. This study’s findings underscore the role of social context in shaping SC and the importance of social support in facilitating it (Maheux & Price, 2016 ; Markus & Kitayama, 1991 ). This is consistent with existing literature which suggests that supportive relationships promote SC through acceptance and empathy, while negative relationships undermine SC through criticism or neglect (Lathren et al., 2021 ). Further, the findings from the present study align with Bayir and Lomas ( 2016 ) who found that close relationships can reinforce self-criticism, and Campion and Glover ( 2017 ) who highlighted the influence of societal norms on SC. Theme 4: The Paradox of Self-Compassion in Western Societies The present study builds on prior research (Campion & Glover, 2017 ; Steindl et al., 2020), highlighting the paradox of SC in Western cultures. While SC is valued as personal empowerment and self-care (Stevenson & Allen, 2017), it is simultaneously undermined by societal factors such as competition, social comparison, and heightened self-criticism (Montero-Marin et al., 2018). Thus, while SC is acknowledged in Western cultures, its practice is limited by societal norms valuing self-reliance and individualism (Campion & Glover, 2017 ). Participants in the present study noted that SC was promoted in schools and institutions but constrained by Western values prioritising independence and achievement (Assmann & Ehrl, 2021 ). These findings align with existing research suggesting individuals may hesitate to practise SC due to fears of perceived laziness or failure (Robinson et al., 2016). Participants in the present study reported intense cultural pressure in the UK and USA to be successful and independent conflicting with SC. One’s perceptions about whether SC or self-criticism better promotes emotional well-being, productivity and desired outcomes may explain observed results (Robinson et al., 2016). Theme 5: Cultural Hindrances to Self-Compassion in the East In this study, participants felt that their Eastern collectivist norms, including a lack of emphasis on self, stigma surrounding sexual trauma and mental health, and filial piety, discouraged SC. Like Sengupta & Saxena (2024), participants in this study struggled to apply SC, finding it more socially desirable to extend it to others. Gender roles also shape this, as women are generally expected to be more compassionate towards others than men (Selvaraja & Baskaran, 2023; Yarnell et al., 2015). These findings contrast with research suggesting that SC may be more prevalent in Eastern contexts due to Buddhist traditions (Fung et al., 2021 ; Kariwayasam et al., 2022), which blur the self-other distinction, encouraging universal compassion (Promchin et al., 2024). Greater SC has been observed among Sri Lankan and Singapore participants (Kariyawasam et al., 2022 ; Steindl et al., 2020), with Kariyawasam et al. ( 2022 ) linking this in Sri Lankans to Buddhist practices like loving-kindness and meditation. However, this requires careful interpretation, as Buddhism values shame as moral conduct (Sun, 2021), potentially conflicting with SC. The dialectical nature of SC, where SC and self-criticism coexist, has also been observed in Eastern cultures, including among Chinese (Zhao et al., 2021) and Hong Kong participants (Fung et al., 2021 ). Eastern societies often prioritise collective harmony over individual emotional needs, emphasising self-sacrifice and humility (Triandis, 2001). Consequently, self-criticism may be more prevalent, as individuals fear being seen as selfish for prioritising self-care (Heine et al., 1999 ). Filial piety also hindered SC in this study’s participants as it influenced self-perception, limited autonomy, and discouraged self-kindness. Participants reported suppressing personal interest due to imposed expectations, such as academic pressures affecting self-worth and rigid social norms leading to criticism. Steindl et al. (2020) argue that collectivist cultures promote an other-focused orientation driven more by duty or submission rather than genuine compassion. Drawing from findings in a western context, Catarino et al., (2014) differentiate between genuine and submissive compassion, the latter defined as caring to gain approval or avoid rejection, a phenomenon observed in collectivistic cultures. Cultural barriers to SC in the East can be understood through cognitive consistency. According to Hoshino-Browne ( 2012 ), cognitive consistency refers to the alignment of one’s thoughts, beliefs, attitudes, and behaviours, with its importance varying across cultural orientations. Individualistic cultures emphasise autonomy, integrity and authenticity, prioritizing consistency between attitudes, thoughts, and behaviours. In contrast, collectivistic cultures value social harmony and interdependence, often at the expense of cognitive consistency, reinforcing conformity (Hoshino-Browne, 2012 ). Previous research has debated whether Eastern or Western cultures might have more SC (Steindl et al., 2020; Fung et al., 2021 ). For example, Steindl et al., (2020) highlight how individualistic, capitalistic societies limit SC due to competition and self-criticism, corroborating other studies (Campion & Glover, 2017 ; Montero-Martin et al., 2018). While Singaporeans in the study demonstrated higher SC than expected, the authors suggested it may reflect “submissive compassion” in collectivist cultures. Similarly, Fung et al. ( 2021 ) found that Hong Kong participants displayed high SC and heightened self-criticism, supporting the dialectical nature of SC (Zhao et al., 2021). However, research on Northeast India suggests greater compassion toward others than oneself, with heightened self-criticism and shame reinforcing emotional suppression to maintain social harmony (Sengupta & Saxena, 2024). Thus, the existing research is mixed on the prevalence of SC in Eastern cultures. This present study indicates that both East and West present barriers and facilitators to SC. Western values such as competition and success may conflict with SC. Eastern cultures may also conflict with SC by discouraging acknowledgment of trauma. Gender Differences in Recovery from Trauma and the Role of Self-Compassion This study’s sample consisted primarily of female participants. Previous research suggests that women typically experience higher rates of physical and sexual traumatic experiences (Lukaschek et al., 2013 ), and they also have more negative outcomes following traumatic experiences (Spinhoven et al., 2014), which likely explains their greater participation in research that examines these topics. Secondly, women also exhibit lower levels of SC than men (Yarnell et al., 2015), as noted in the earlier section. On the other hand, due to gender norms, men are likely to demonstrate an unwillingness to disclose such experiences, particularly regarding sexual abuse (Alaggia, 2005). Although not explicitly explored in the topic guide, some participants disclosed extensive experiences of sexual assault during the interviews. This aligns with existing research indicating that women experience higher rates of sexual trauma (Lukaschek et al., 2013 ) Implications Clinical Implications for Assessment and Formulation As highlighted earlier, our results corroborate the work of Kirby et al. ( 2019 ), suggesting that therapists should explore patients’ perceptions of compassion before therapy. This involves understanding their conceptualisations, perceived barriers and facilitators in incorporating compassion. Further, our findings align with Maercker and Horn ( 2013 ), emphasising the need to consider interpersonal and cultural influences shaping trauma responses during treatment assessment and formulation. Clinical Implications for Intervention and Prevention Our findings corroborate existing evidence to suggest that interventions focused on cultivating SC could be crucial in trauma recovery (Winders et al., 2020; Rushforth et al., 2024). Participants used SC in diverse ways, offering insights into refining interventions to be more adaptive and practical (Pauley & McPherson, 2010). Further, the study highlights the need for culturally sensitive approaches to fostering SC (Arimitsu, 2023 ). Implications for Practitioner Training Our research follows existing literature on SC's counterintuitive nature, stressing the need for practitioners to model SC based on clients’ perceptions by receiving culturally sensitive training and carefully considering gender differences. Limitations and Future Research This qualitative study offered insights into SC among individuals with interpersonal trauma, though it had limitations. The sample was predominantly female, potentially limiting generalisability. Some participants had prior therapy, which may have influenced SC levels and responses. The study did not confirm a formal diagnosis of PTSD or CPTSD, and cultural factors were simplified into a Western-Eastern dichotomy. Additionally, our study did not have specific gender-related questions in the topic guide, and the interaction between gender and culture was not explicitly explored. Future research should examine SC across diverse populations, particularly gender, cultural background, and therapeutic history. It should also explore influences like family upbringing, the role of religion, and community, which emerged as key themes as described in the results section. Additionally, qualitative research investigating SC through motivational interviewing and diary studies could provide deeper insights into how individuals enact, conceptualise, and apply SC. Future research should also further explore gender differences, specifically on SC in male trauma survivors across cultures. Conclusion These themes highlight the influence of interpersonal relationships and internal psychological processes in shaping individuals’ experiences of SC and its role in psychological trauma recovery. They also emphasise the significant impact of cultural contexts on cultivating and expressing SC. Furthermore, the themes underscore the practical utility of SC as a coping mechanism, particularly following traumatic experiences. These insights offer a comprehensive understanding of SC in trauma recovery as influenced by intrapersonal, social, and cultural processes. Declarations No funding was received for conducting this study. The authors have no competing interests to declare relevant to this article's content Ethics approval Approval was obtained from the ethics committee of the University of Exeter (Ethics application number: 489051). The procedures used in this study adhere to the tenets of the Declaration of Helsinki. Consent to participate Informed consent was obtained from all individual participants included in the study The use of AI The first author (PM) acknowledges the use of the GenAI tool: Grammarly and link to https://www.grammarly.com/grammar-check) to proofread and correct grammar or spelling errors. Author Contribution PM, AK, and AM contributed to the conceptualization of the study. PM, AM, and AK collaborated on the methodology. Formal analysis and investigation were conducted by PM. PM drafted the original manuscript. PM, AK, and AM contributed to the review and editing of the manuscript. AK and AM provided supervision for the study. This study forms part of PM’s PhD thesis. Acknowledgement I would like to thank Leah Salley for her professional proofreading support as a native English speaker, and for her kindness through the revision process. 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Self-compassion in Chinese young adults: Specific features of the construct from a cultural perspective. Mindfulness , 12 , 2718-2728. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6306510","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":439780617,"identity":"2480630d-4708-42c8-b30d-7811fb021b15","order_by":0,"name":"Pranati Misurya","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA00lEQVRIiWNgGAWjYFAC/scPJCqQBXgIauFhM7A4A6TZSNDCIFHZRooWc7GzBwxuzrNJ7JdvPvaBocaOweDMAfxaLGfnJTycuS3NWLKNLXkGw7FkBoOzDfi1GNxOMDCW3HZYzuAYjzHQdQcYDM4TcBhIi/TfOf957I/xf2Zg+EeUlhwDCcmGA3IGbDzMDIxtBwg7zHJ2WpqBxLFkY4ljacYMiX3JPJKEvG8unXz4gUSNXWJ/8+HHDB++2cnxnUkg4DAUXgIxEWlAUMUoGAWjYBSMAgDVJD9GnadFYQAAAABJRU5ErkJggg==","orcid":"","institution":"University of Exeter","correspondingAuthor":true,"prefix":"","firstName":"Pranati","middleName":"","lastName":"Misurya","suffix":""},{"id":439780618,"identity":"4ee467a6-06d5-4a0a-a087-005f7e58f470","order_by":1,"name":"Avril Mewse","email":"","orcid":"","institution":"University of Exeter","correspondingAuthor":false,"prefix":"","firstName":"Avril","middleName":"","lastName":"Mewse","suffix":""},{"id":439780619,"identity":"95cdf364-9e67-4bf8-9762-a7438f355d6d","order_by":2,"name":"Anke Karl","email":"","orcid":"","institution":"University of Exeter","correspondingAuthor":false,"prefix":"","firstName":"Anke","middleName":"","lastName":"Karl","suffix":""}],"badges":[],"createdAt":"2025-03-25 19:38:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6306510/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6306510/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":80813843,"identity":"94920623-c34c-402a-bd99-97abe3af4700","added_by":"auto","created_at":"2025-04-17 10:44:34","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":47033,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eParticipant Flow\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6306510/v1/c889972001c6b7f8c843b2b5.jpg"},{"id":80814588,"identity":"5e4889d8-e09b-42ce-9685-a8d4d37ad6f5","added_by":"auto","created_at":"2025-04-17 10:52:35","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":99016,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eThematic Map Illustrating Generated Themes\u003c/em\u003e\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6306510/v1/873267dd20cb8578537287a6.jpg"},{"id":80815449,"identity":"70afdcb5-2fa6-42e1-b6a1-27ac76120505","added_by":"auto","created_at":"2025-04-17 11:00:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1758965,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6306510/v1/d00e94e7-5e2e-4aee-a022-89de81a49bae.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Qualitative Exploration of the Concept of Self-Compassion amongst Individuals with a History of Interpersonal Traumatic Events","fulltext":[{"header":"Introduction","content":"\u003cp\u003eExposure to traumatic events can have far-reaching consequences on psychological functioning and public health (Magruder et al., 2017).Prolonged interpersonal trauma, such as physical or sexual abuse, is associated with even more severe symptoms than non-interpersonal trauma (Forbes et al., 2011) and serves as a risk factor for Post-Traumatic Stress Disorder (PTSD) (American Psychological Association [APA], 2013) and Complex Post-Traumatic Stress Disorder\u003cstrong\u003e\u0026nbsp;(\u003c/strong\u003eCPTSD) (World Health Organization [WHO], 2018).\u003c/p\u003e\n\u003cp\u003eThe Dimensional Model of Adversity and Psychopathology (DMAP) (McLaughlin \u0026amp; Sheridan, 2016) explains how early adversity impacts mental health by categorising experiences into threat and deprivation. Threat encompasses harm (e.g., physical abuse), while deprivation indicates a lack of social and cognitive stimulation (e.g., neglect). Threat modifies neural networks responsible for danger detection, leading to poor emotional regulation. Deprivation influences executive functioning, cognition, and language (McLaughlin \u0026amp; Sheridan, 2016; Sadikova et al., 2024). Consequently, early interpersonal trauma cultivates distrust and feelings of being unloved or unsafe (Bell et al., 2019), as well as shame (Kim et al., 2009), which hinders self-compassion (SC)-the ability to self-soothe in times of adversity (Zhang et al., 2023). Furthermore, this heightened sense of shame and self-criticism amplifies threat perception, exacerbating PTSD symptoms (Ehlers \u0026amp; Clark, 2000; Harman \u0026amp; Lee, 2010).\u003c/p\u003e\n\u003cp\u003eNevertheless, trauma survivors often exhibit resilience (Bonanno \u0026amp; Mancini, 2008). Positive mental health plays a pivotal role in recovery (Trompetter et al., 2017), with self-compassion (SC) identified as a protective factor against psychopathology (Scoglio et al., 2018; Trompetter et al., 2017). Thus, examining SC as a trauma intervention is essential.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSelf-Compassion as a Protective Factor\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSC comprises three components (Neff, 2016): self-kindness (being kind to oneself during setbacks), common humanity (seeing suffering as universal), and mindfulness (observing suffering without over-identification) (Neff, 2003). These components influence how individuals understand and manage challenges (Neff \u0026amp; Davidson, 2016).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGilbert’s (2009) evolutionary model links SC to three affect regulation systems: threat-protection system (detecting threats and negative emotions like shame, anger, and disgust), drive-excitement-seeking system (monitors resource seeking behaviour), and contentment-safety system\u0026nbsp;(activating attachment, caregiving and self-soothing)\u0026nbsp;(Depue \u0026amp; Morrone-Strupinsky, 2005).\u0026nbsp;Dysfunctional early caregiving environments can increase sensitivity to rejection and self-criticism, heightening psychological distress and weakening internal stability\u0026nbsp;(Gilbert, 2009; Mikulincer \u0026amp; Shaver, 2012).\u0026nbsp;Thus,\u0026nbsp;individuals who have experienced early trauma tend to have an overly developed threat system and an underdeveloped safety and contentment system (Gilbert, 2009), hindering their capacity for SC (Zhang et al., 2023) and contributing to traumatic stress (Humphreys \u0026amp; Zeanah, 2015).\u003c/p\u003e\n\u003cp\u003eIn contrast, secure attachment, characterised by positive and reliable caregiving experiences, promotes adaptive emotional regulation and SC\u0026nbsp;(Bowlby, 1973; Gilbert, 2009; Mikulincer \u0026amp; Shaver, 2012).\u0026nbsp;Even in the absence of secure early attachment, it is suggested that supportive relationships later in life can foster 'earned secure attachment' (Fear, 2018), promoting self-acceptance and an 'inner haven' for trauma recovery (Braehler \u0026amp; Neff, 2020). Developing a soothing system by enhancing feelings of safety, warmth, and reassurance can mitigate self-criticism and shame (Gilbert, 2009; Harman \u0026amp; Lee, 2010), reduce maladaptive coping such as avoidance (Thompson \u0026amp; Waltz, 2008), and enhance adaptive processing, which is critical for PTSD prevention and recovery (Ehlers \u0026amp; Clark, 2000). Compassion-focused therapy, which aims to balance the three affect regulation systems and increase greater access to soothing contentment systems, exemplifies this process (Au et al., 2017; Gilbert, 2009), highlighting the role of self-compassion, shaped by both early and later relationships, in trauma recovery.\u003c/p\u003e\n\u003cp\u003eResearch consistently demonstrates SC's inverse relationship with PTSD severity across various populations, including interpersonal trauma-exposed women (Scoglio et al., 2018), university students (Seligowski et al., 2015; Thompson \u0026amp; Waltz, 2008), and community groups (Maheux \u0026amp; Price, 2016). A systematic review by Winders et al. (2020) found higher SC correlated with lower PTSD symptoms and intervention studies also showed PTSD symptom improvement, suggesting SC’s potential role in treatment. Furthermore, evidence also supports the role of compassion-focused interventions in CPTSD (Brähler, 2023; Huang et al., 2024). However, misconceptions and fears about SC, such as self-criticism, can hinder treatment (Bayir \u0026amp; Lomas, 2016; Egan et al., 2022). For those with childhood maltreatment or highly critical backgrounds, SC can be fear-inducing (Gilbert et al., 2011; Boykin et al., 2018))\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFear of Self-Compassion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDespite its benefits, fears and resistance to SC persist (Gilbert et al., 2011; Miron et al., 2016). Gilbert et al. (2011) outlined three fears of compassion (FOC): (a) compassion toward others, (b) compassion from others, or (c) fear of SC. For trauma survivors, especially those with insecure attachment histories, SC may trigger memories of past neglect in early dysfunctional relationships (Gilbert et al., 2011). Many with childhood maltreatment, abuse, or interpersonal trauma believe they do not deserve compassion and feel compelled to self-criticize (Boykin et al., 2018; Bistricky et al., 2017; Miron et al., 2016). These beliefs interfere with SC (Gilbert et al., 2011), reduce its protective effects (Messman-Moore \u0026amp; Bhuptani, 2020), and impede treatment and recovery (Miron et al., 2016). Additionally, FOC strongly correlates with self-criticism, shame, and depression (Kirby et al., 2019).\u003c/p\u003e\n\u003cp\u003eMultiple childhood abuse episodes increase fear and resistance towards SC (Miron et al., 2016). One explanation is that inconsistent caregiving creates confusion and distress around SC. Self-critical thinking, rooted in adverse childhood experiences, reinforces PTSD and depressive symptoms, particularly in cases of childhood sexual abuse (Miron et al., 2016). This presents a paradox: those who most need SC for trauma recovery often struggle to access it.\u003c/p\u003e\n\u003cp\u003eAttachment theory clarifies this paradox. Early experiences with caregivers shape internal working models, which are understood as the cognitive and emotional representations of the self and others (Bowlby, 1973), influencing emotional regulation and stress management (Mikulincer \u0026amp; Shaver, 2019). Secure attachment promotes healthy emotional regulation strategies (e.g., reappraisal, problem-solving). Conversely, insecure attachment correlates with maladaptive emotional regulation and a lack of internal resources to manage distress (Mikulincer \u0026amp; Shaver, 2019). This reinforces negative self-perceptions (Shaver et al., 2016), over-activating the threat system and hindering self-soothing and self-compassion (Gilbert \u0026amp; Procter, 2006). Internal working models shape perceptions of self and others: a negative self-view fosters feelings of inadequacy, while a positive self-view nurtures feelings of worthiness. Similarly, a negative view of others breeds distrust, whereas a positive view cultivates perceptions of support and trust (Gaskin-Wasson et al., 2017). While quantitative research has examined the effects of FOC, qualitative studies remain limited, leaving gaps in understanding (Lawrence \u0026amp; Lee, 2014; Roseman, 2024). Given the psychological benefits of self-compassion, resistance to it should be addressed in therapeutic interventions (Gilbert et al., 2011). Studies have investigated the shift from self-criticism to self-compassion in compassion-focused therapy (CFT) for PTSD (Lawrence \u0026amp; Lee, 2014) and the mechanisms of change in group CFT for complex PTSD (Ashfield et al., 2021). Roseman (2024) explored experiences of self-compassion, including barriers, in individuals with complex PTSD and low self-compassion, utilising the Mindful Self-Compassion program (Germer \u0026amp; Neff, 2019). Despite its insights, the study had limitations, such as a small sample size and a lack of diversity.\u003c/p\u003e\n\u003cp\u003eUnlike previous studies that examined SC within the context of interventions, this study directly asked participants about their SC experiences outside of a structured program, providing a richer, more nuanced understanding of FOC. The findings contribute to a growing body of literature suggesting that SC interventions must address FOC before fostering its development (Kirby et al., 2019). This type of qualitative research can offer deeper insights into how FOC impacts the success of SC-focused interventions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCulture and Self-Compassion\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCultural context shapes perceptions of self, others, and the world (Bernardi et al., 2019).\u003c/p\u003e\n\u003cp\u003eSelf-construal theory (Markus \u0026amp; Kitayama, 1991) suggests that self-construal—independent or interdependent—affects thoughts, actions, emotions and relationships. Individualistic cultures emphasise uniqueness and autonomy, while collectivist cultures prioritise social connectedness and harmony with others. These cultural differences influence SC's role in trauma recovery in three ways.\u003c/p\u003e\n\u003cp\u003eFirstly, cultural self-construals shape trauma processing and support-seeking behaviours (Engelbrecht \u0026amp;Jobson, 2014; Jobson \u0026amp; O’Kearney, 2008). In collectivist cultures, trauma is appraised based on its impact on the group, leading survivors to feel guilt, responsibility, or alienation. In contrast, individualistic cultures frame trauma as personal weakness or failure, often leading to isolation, distrust, or external blame (Engelbrecht \u0026amp; Jobson, 2014; Jobson \u0026amp; O’Kearney, 2009).\u003c/p\u003e\n\u003cp\u003eSecondly, self-construal influences SC and its role in emotional regulation. Western cultures emphasise self-expression and goal achievement, viewing relationships as a means of self-comparison. In contrast, collectivist cultures view relationships as self-defining, which may explain why Indian participants report greater compassion for others than for themselves (Sengupta \u0026amp; Saxena, 2024). Eastern cultures emphasise concern for others and self-sacrifice, potentially explaining higher compassion toward others which often precedes SC (Steindl et al., 2020; Triandis et al., 1993). Additionally, self-criticism is necessary for self-improvement and social harmony (Yamaguchi et al., 2014). Individuals often attribute shortcomings to themselves, reinforcing social identity (Heine et al., 1999). For instance, Northeast Indian participants showed heightened shame and self-criticism in compassion-focused therapy, reflecting cultural norms of emotional suppression and the belief that shame fosters social cohesion (Sengupta \u0026amp; Saxena, 2024).\u003c/p\u003e\n\u003cp\u003eThirdly, philosophical and religious traditions may shape SC and trauma recovery.\u0026nbsp;Varying dialectical thinking levels influence SC abilities (Chio et al., 2021). Regarding China’s collectivist culture, students reported dialectical views on SC, balancing positive and negative dimensions and emphasising ‘benign self-criticism’ (Zhao et al., 2021) On the other hand, , Kariyawasam et al. (2022), using the Compassionate Engagement and Action Scales (CEAS; Gilbert et al., 2017), found that Sri Lankan participants reported higher SC than UK participants, likely due to Buddhist traditions emphasising self-kindness. Conversely, Steindl et al. (2020) found that Singaporeans (collectivist culture) had greater SC but less compassion for others than Australians (individualist culture). Globalisation has blurred cultural distinctions, increasing individualism worldwide (Katzarska-Miller \u0026amp; Faucher, 2022). Consequently, evidence on SC across cultures remains inconsistent, highlighting the need for further research.\u003c/p\u003e\n\u003cp\u003eBeyond cultural differences, individual beliefs about productivity can also influence SC. Some associate self-criticism with success and resist self-kindness (Robinson et al., 2016). While this is not exclusive to Western cultures, research suggests capitalist, individualistic societies often discourage SC (Campion \u0026amp; Glover, 2017; Steindl et al., 2020). Given these cultural influences, psychological trauma processing and recovery differ significantly based on self-construal and societal values.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLimited literature on the link between SC and self-construal highlights the need for qualitative studies on cultural influence in trauma recovery (Zhao et al., 2021). Further research can refine culturally sensitive interventions that address variations in emotional expression, self-perception, and social harmony (Sengupta \u0026amp; Saxena, 2024).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGender Differences in Self-Compassion and Trauma Recovery\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMen are more likely to experience traumatic events (Christiansen \u0026amp; Elklit, 2008), while women have a higher risk of PTSD (Lukaschek et al., 2013), with more chronic symptom (Seedat et al., 2005) and increased depression and anxiety (Spinhoven et al., 2014). Women face a greater risk of sexual trauma, while men typically encounter trauma from accidents, combat, and non-sexual assaults (Lukaschek et al., 2013). There are also gender differences in self–compassion that affect trauma recovery, as women typically exhibit lower SC, higher self-criticism, and more negative self-talk (Yarnell et al., 2015)\u003cu\u003e.\u003c/u\u003e These challenges intensify in cultures with rigid gender roles, legal gender inequality (Makama, 2013), and female oppression (Wongnuch et al., 2023), where domestic violence may be legally sanctioned (Minwalla, 2019), as seen in Afghanistan (Greiff, 2010). Women also receive poorer healthcare (Nadakuditi, 2024), carry heavier caregiving burdens, and often lack adequate support from male partners or family (Carbó \u0026amp; Orellán, 2020). Despite well-documented gender differences in SC and trauma recovery, qualitative research on gender’s role in developing SC which can provide more insights (Yarnell et al., 2015) is limited, particularly after interpersonal trauma and across cultures. Although this study does not explicitly examine gender differences, its qualitative approach offers valuable perspectives on SC among trauma survivors, informing future research. Given the predominantly female sample, the findings may also highlight the unique challenges women face in cultivating SC post-trauma.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRationale and Aims of the Present Study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDespite evidence of SC’s positive impact on mental health (Ferrari et al., 2019; Wakelin et al., 2022), little is known about trauma survivors’ experiences and challenges with the concept.\u0026nbsp;Trauma history is linked to fears and resistance to SC (Miron et al., 2016), underscoring the need for qualitative research on its meanings, barriers, and facilitators (Bayir \u0026amp; Lomas, 2016; Roseman, 2024). The rise of compassion-based therapies (Kirby, 2017) reflects SC's role in well-being (Neff \u0026amp; Germer, 2017) and trauma recovery (see, e.g., Winders et al., 2020; Brahler, 2023). Given the detrimental consequences of FOC, Kirby et al. (2019) advised therapists to explore patients’ perceptions of compassion before therapy. Cultural differences in SC remain a priority (Steindl et al., 2020). To the author’s knowledge, no studies have considered interpersonal trauma survivors’ SC experiences, despite early trauma shaping self-concept (Kouvelis \u0026amp; Kangas, 2021), coping strategies (Pfluger et al., 2022), and one’s ability to seek and benefit from social support (Maercker \u0026amp; Horn, 2013). Limited understanding of implementing compassion interventions for those struggling with SC potentially impedes treatment efficacy (Roseman, 2024). Further research is needed to explore SC's meaning, barriers, facilitators, and cultural influences.\u003c/p\u003e\n\u003cp\u003eThis qualitative study aims to understand diverse trauma survivors’ SC experiences, including barriers, facilitators, and cultural influences. Improved qualitative understanding of the experiential components of compassion-giving and receiving may inform efficacious trauma interventions for complex symptom presentations.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eResearch Questions\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eWhat do interpersonal trauma survivors understand by the concept of SC?\u003c/li\u003e\n \u003cli\u003eWhat are the facilitators of SC for participants\u0026rsquo; recovery from trauma?\u003c/li\u003e\n \u003cli\u003eWhat are the barriers to SC for trauma survivors?\u003c/li\u003e\n \u003cli\u003eWhat are trauma survivors\u0026apos; understandings of how their culture has allowed or hindered their practice of SC? (Comparison between Eastern and Western cultures).\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSixteen adults with a history of interpersonal trauma(s) participated. They identified \u0026lsquo;disturbances in self-organisation\u0026rsquo; (DSO-related symptoms) from a list.\u0026nbsp;Ethnically, six identified as English/Welsh/Scottish/Northern Irish, four as another White background, two as White and Asian, and four as Asian. Eleven were female and five were male (see Table 1).\u003c/p\u003e\n\u003cp\u003eParticipants were recruited through campus advertisements at the University of Exeter\u0026rsquo;s Streatham campus and the \u0026lsquo;Call for Participants\u0026rsquo; website(https://www.callforparticipants.com/).\u003c/p\u003e\n\u003cp\u003eEligibility was based on self-reported experiences of interpersonal traumatic, such as physical, sexual, or emotional abuse/neglect. Specifically, the study sought participants who reported difficulties with emotional dysregulation, worthlessness, or social withdrawal affecting work and relationships. Exclusion criteria included a PHQ-8 score above ten, very high psychological distress, or being under 18.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e\u003cem\u003e\u0026nbsp;Participant Demographic Characteristics (N = 16)\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePseudonyms\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEthnicity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment status\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRelationship Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDisturbance in self-organisation symptoms (DSO) symptoms\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP1.\u003c/strong\u003e AP_21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003eAtheist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003eBritish/Welsh/Scottish/Northern Irish\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eDifficulties regulating negative or upsetting emotions, a sense of worthlessness, shame, or guilt, a sense of distance or feeling cut off from others\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP2\u003c/strong\u003e. LN_10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003eHindu\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003eIndian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eDifficulties regulating negative or upsetting emotions, a sense of worthlessness, shame, or guilt\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP3\u003c/strong\u003e. JD_32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003eNo religion or otherwise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003eAny other white background\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eUnable to work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eA sense of worthlessness, shame, or guilt\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP4\u003c/strong\u003e. BG_69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003eNo religion or otherwise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003eBritish/Welsh/Scottish/Northern Irish\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eUnable to work\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eSingle, Never Married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eDifficulties regulating negative or upsetting emotions, a sense of worthlessness, shame, or guilt, a sense of distance or feeling cut off from others\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP5\u003c/strong\u003e. GPG_90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003eNo religion or otherwise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003eBritish/Welsh/Scottish/Northern Irish\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eEmployed for wages\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eDifficulties regulating negative or upsetting emotions, a sense of worthlessness, shame, or guilt, a sense of distance or feeling cut off from others\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP6.\u0026nbsp;\u003c/strong\u003eCP_48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003eAtheist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003eWhite and Asian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eSingle, Never Married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eDifficulties regulating negative or upsetting emotions, a sense of worthlessness, shame, or guilt, a sense of distance or feeling cut off from others\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP7\u003c/strong\u003e. AA_46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003eAgnostic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003eWhite and Asian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eSingle, never married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eDifficulties regulating negative or upsetting emotions\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP8\u003c/strong\u003e. JJ_50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003eHindu\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003eIndian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eEmployed for wages\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eSingle, never married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eA sense of worthlessness, shame, or guilt\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP9.\u003c/strong\u003e N_67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003eAtheist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003eIndian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eSingle, Never married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eDifficulties regulating negative or upsetting emotions, a sense of worthlessness, shame, or guilt, a sense of distance or feeling cut off from others\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP10\u003c/strong\u003e. NS_43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003eAgnostic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003eAny other white background\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eSelf-employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eSingle, never married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eA sense of distance or feeling cut off from others\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP11\u003c/strong\u003e. MG_50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003eBuddhist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003eAnother white background\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eSelf-employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eSingle, never married\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eDifficulties regulating negative or upsetting emotions, a sense of worthlessness, shame, or guilt, a sense of distance or feeling cut off from others\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP12.\u003c/strong\u003e NM_65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003eChristian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003eAfrican\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eSelf-employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eSingle, never married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eA sense of worthlessness, shame, or guilt\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP13.\u0026nbsp;\u003c/strong\u003eBD _91\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003eAtheist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003eBritish/Welsh/Scottish/Northern Irish\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eDifficulties regulating negative or upsetting emotions, a sense of worthlessness, shame, or guilt, a sense of distance or feeling cut off from others\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP14.\u003c/strong\u003e KJ_60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32px;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003eChristian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003eBritish/Welsh/Scottish/Northern Irish\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eUnable to work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eDifficulties regulating negative or upsetting emotions, a sense of worthlessness, shame, or guilt, a sense of distance or feeling cut off from others\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP15\u003c/strong\u003e. .NT_35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003eAtheist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003eChinese\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eSingle, never married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eDifficulties regulating negative or upsetting emotions, a sense of worthlessness, shame, or guilt, a sense of distance or feeling cut off from others\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP16\u003c/strong\u003e. DB_42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003eAgnostic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003eBritish/Welsh/Scottish/Northern Irish\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eOut of work but not looking for work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eSingle, never married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eA sense of worthlessness, shame, or guilt\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003cp\u003e\u003cstrong\u003eMaterials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eScreening Questions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe screening included a demographic questionnaire (age, gender, ethnicity, employment, marital status, religion, and participant ID) and a Qualtrics questionnaire assessing eligibility. Participants confirmed if they were above 18, fluent in English, had any psychiatric diagnosis other than PTSD, were experiencing low mood or high distress, and had experienced interpersonal trauma. Participants also indicated symptoms of \u0026lsquo;Disturbance in Self-Organisation\u0026rsquo; (DSO).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eInterview Schedule\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe interview topic guide was developed after thoroughly reviewing existing qualitative studies on SC (Campion \u0026amp; Glover, 2017; Kelley et al., 2021; Pauley \u0026amp; McPherson, 2010). The first author read these studies for gaps and compared them against the existing qualitative literature on SC and trauma (Lawrence \u0026amp; Lee, 2014; Ashfield et al., 2021). The interview schedule was informed by gaps from both areas of study, specifically, that only limited studies had explored SC qualitatively, particularly among trauma survivors. Thus, the interview topic guide was framed based on the research questions for the present study, which focused on concept, barriers, facilitators and cultural influence on SC, through discussions and iterations guided by both project supervisors. It was piloted with three participants, after which questions were reworded and modified. The study was preregistered on the Open Science Framework (OSF) platform (a link will be provided after the peer-review process to avoid revealing the identity of the authors).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePsychoeducation Video\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003eon SC\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo introduce and orient the participants to SC, they were shown the first minute and a half of a video presentation on SC on YouTube by the \u003cem\u003eSchool of Life\u003c/em\u003e (Self Compassion) on SC. \u003cem\u003eSchool of Life\u003c/em\u003e is a UK-based group that shares knowledge about philosophical, psychological, and literary concepts to cultivate healing, growth, and understanding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProcedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were provided with a participant information sheet and consent form before the study began. Participants were then asked to complete the screening questionnaire, comprising\u0026nbsp;demographic information, including age, gender, religion, employment status, and marital status, they then had to select from a list of DSO symptoms on the Qualtrics platform. Interviews were held online using Microsoft Teams. Before the interview questions were presented, participants were shown a brief one-minute clip-on SC (see details above) and asked if they had any questions before being asked questions based on the interview guide. The average length of each interview was 30 minutes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis and Quality Checking\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data analysis was based on reflexive thematic analysis (Braun \u0026amp; Clarke, 2019), a method for identifying, analysing, and reporting patterns or themes in a given dataset from a reflective approach, emphasising the importance of researcher reflexivity in data generation and knowledge production.\u003c/p\u003e\n\u003cp\u003eEpistemological considerations for the given data were based on constructionist epistemology; the interpretation of meaning and experience was seen as socially generated and sustained through a combination of subjective and inter-subjective construction. Further, an experiential orientation to data analysis was incorporated, focusing on the meaning ascribed to participants\u0026rsquo; subjective personal viewpoints. Both inductive and deductive coding were employed, with a more significant predominance towards the latter, and both the semantic and latent meanings of responses were considered, with a greater emphasis on the former.\u003c/p\u003e\n\u003cp\u003eBased on Braun and Clarke\u0026rsquo;s (2019) recommendation, the concept of \u0026lsquo;information power\u0026rsquo; (Malterud et al., 2016) was used to determine sample size decisions. This involved considering the following factors: the richness of the data, study aims, sample specificity, use of established theory, quality of dialogue, and analysis strategy.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnalytical Process\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe six-step analytical process for thematic analysis (Braun \u0026amp; Clarke, 2022) was followed. Data familiarisation involved interviews and taking notes. A reflective journal was used to document notes, thoughts, and reflections. Interviews were transcribed, and coded labels were applied using NVivo 14. After the first list of codes was developed, the original transcripts were consistently referenced to review established codes and analyse the interpretation of new codes with increasing data familiarisation. The codes were iterated for improved specificity and to ensure alignment with the research questions, and then they were discussed with the second and third authors. The first author reviewed interview files and evaluated the existing coded data\u0026rsquo;s codes (revising, modifying, and omitting). A meeting followed where all authors finalised codes for initial theme generation. Codes were compiled and clustered into themes, focusing on identifying meaningful patterns across the dataset. Emerging themes were reviewed with the coded data and the existing dataset. A thematic map of initial themes was created and critically reviewed via questions from Braun and Clarke (2012, p. 65).\u003c/p\u003e\n\u003cp\u003eFollowing Braun \u0026amp; Clarke\u0026rsquo;s (2006) suggestion to use Patton\u0026rsquo;s (1990) \u003cem\u003e\u0026lsquo;\u003c/em\u003e\u003cem\u003edual criteria for judging categories\u0026rsquo;\u003c/em\u003e, the themes, codes, and data extracts were reviewed at two levels. In the final stage, themes were refined to ensure a comprehensive dataset interpretation. The chosen data extracts were presented illustratively rather than analytically. Theme names were revised for clarity and precision (Braun \u0026amp; Clarke, 2021).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReflexive Statement from All Authors\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMy interest in SC began when my therapist introduced me to it as a master\u0026rsquo;s student, resonating with my experience. Years later, discovering it as an emerging research area deepened my desire to make it the focus of my thesis. During my doctoral studies, I was particularly interested in how trauma survivors perceive SC. In this study, I sought to understand participants\u0026rsquo; views on and why it was challenging to implement SC despite research highlighting its benefits.\u003c/p\u003e\n\u003cp\u003eThe author team comprises postgraduate-educated researchers fluent in English. The second author, a senior lecturer in psychology at the University of Exeter, researches the social context of health and risk-taking behaviour and has decades of experience in qualitative research. The third and senior author, a professor in psychology at the University of Exeter, is an expert in PTSD and psychophysiology and has completed extensive work on SC.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eParticipants in this study experienced interpersonal traumatic events, including physical, sexual, or emotional abuse or neglect. The study sought to deepen participants\u0026rsquo; perceptions of barriers and facilitators to SC and the influence of culture (specifically Eastern and Western) on SC. Participants shared their understandings, practices, facilitators, and obstacles to SC and how their cultures shaped its development. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the five themes identified.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eTheme 1: Compassionate Coping: Leveraging Self-Compassion After Trauma\u003c/h3\u003e\n\u003cp\u003eThis theme captures compassion as a coping resource\u0026mdash;used cognitively to handle difficulties and suffering in daily life and behaviourally through enjoyable activities. The theme reflects participants\u0026rsquo; understanding of compassion as a valuable coping mechanism:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eSelf-compassion is, um, the strategies that you would employ to get yourself through a day. Because a lot of the time, I think people have to take it one day at a time or even one hour at a time\u003c/em\u003e\u0026rdquo; (P1)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e Participants understood and soothed themselves by acknowledging the inherent complexities of the human experience and navigating everyday challenges. They recognised that SC involved an active cognitive process of struggle validation, kindness to oneself, and recognition of their shared humanity with others in adversity. This approach enabled participants to respond to their distress with empathy and care rather than judgment.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEmbracing Humanity: Self-Compassion through Acceptance and Understanding\u003c/h2\u003e \u003cp\u003eThis sub-theme depicts participants\u0026rsquo; progression towards SC, characterised by acknowledging their imperfections and moving towards treating themselves with kindness, as opposed to the earlier harsh self-criticism.\u003c/p\u003e \u003cp\u003eP6 highlighted \u003cem\u003e\u0026ldquo;\u0026hellip; not being angry at myself for not being able to live up to my usual standards when I was struggling. I would have been hard on myself\u003c/em\u003e\u0026rdquo;. Echoing this, P2 stated, \u003cem\u003e\u0026ldquo;I think many problems come from self-blame\u0026hellip; and guilt\u0026hellip; So if we are a little self-compassionate and understand that I am also a human being, I do make mistakes\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSelf-Reassurance as a Compassionate Coping Strategy\u003c/h3\u003e\n\u003cp\u003eSC is a coping resource involving reassuring, compassionate statements responding to suffering. Negative appraisals, including shame, guilt, self-blame, and complicated emotions, often accompany trauma. SC and self-reassurance offer means of managing setbacks with concern and care for oneself, with self-reassurance enabling soothing through encouragement and support in adversity (Petrocchi et al., 2019).\u003c/p\u003e \u003cp\u003eP1 commented, \u003cem\u003e\u0026ldquo;It was not instant, but I could gently count on myself and say, well, that is not what you are... something was done to you\u003c/em\u003e.\u0026rdquo; Similarly, P9 shared their experiences with soothing: \u003cem\u003e\u0026ldquo;I always say, this was not your fault\u0026hellip; like, \u0026lsquo;it is okay, it is okay\u0026rsquo;\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eThis subtheme illustrates how participants used self-reassurance to express SC, comfort themselves and their challenging emotions, and self-soothe, allowing them to feel they were extending compassion toward themselves.\u003c/p\u003e\n\u003ch3\u003eSelf-Compassion through Comforting Activities\u003c/h3\u003e\n\u003cp\u003e Participants commonly associated compassion with pleasurable or comforting activities, including pursuing hobbies or finding momentary comfort through a relaxing shower, a nice meal, or crocheting. For instance, P14 shared her struggles with SC, which crocheting helped: \u003cem\u003e\u0026ldquo;I tend to spend some time each day where I just do something... and well, I like just to sit, and I like just to do some crocheting\u0026rdquo;.\u003c/em\u003e Meanwhile, P7 enjoyed \u003cem\u003e\u0026ldquo;allowing myself each day to do something that I want to do. For example, I enjoy sports. So I will go to the gym X times a week\u0026rdquo;.\u003c/em\u003e P1 also shared their approach: \u003cem\u003e\u0026ldquo;I advise people to focus on small things that bring them pleasure or comfort, like their favourite food, watching a film, cleaning bedsheets, or brushing their teeth. These tiny acts of self-care are also associated with it\u003c/em\u003e\u0026rdquo;.\u003c/p\u003e \u003cp\u003e Other participants used compassion to address challenging emotions directly. SC was associated with activities that made them feel better, such as spending time with a pet or feeling clean. For instance, P13 practised SC by \u0026ldquo;\u003cem\u003etaking time to watch things that I enjoy... Sometimes, I need to get showered to make myself feel better... and trying to do things with my pet\u0026hellip; will make me feel better\u0026rdquo;\u003c/em\u003e. P3 shared their practice of SC in daily life when experiencing challenging emotions: \u003cem\u003e\u0026ldquo;My partner has a tiny space where he plays music and puts on some LED lights that are just this blue colour. There is a little cat there, so when I feel particularly down about myself or stressed, I will ask him to borrow his space, and he will leave it open. Just relax, breathe, and be mindful\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e The theme suggests that participants practice SC through pleasurable or comforting activities. It also indicates that participants view SC as a coping mechanism, both cognitively and actively engaging in such activities to cultivate happiness, peacefulness, and relaxation.\u003c/p\u003e\n\u003ch3\u003eTheme 2: Deliberate Self-Compassion: Embracing Challenges with Determination\u003c/h3\u003e\n\u003cp\u003eThis theme highlights that although participants generally recognised the value of SC, even those who regularly practiced SC required a conscious and deliberate effort to do so. P14 reflected on her inability for SC: \u003cem\u003e\u0026ldquo;I am not one for showing kindness to myself, and I am pretty bad at that... I tend to show kindness towards others and not really towards myself\u0026rdquo;.\u003c/em\u003e Similarly, P3 discussed her difficulties with receiving and extending compassion towards herself: \u003cem\u003e\u0026ldquo;I think it is easy to treat other people that way. I think it is tough to conceptualise treating me that way. I am not very good at that. That is probably my worst skill.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eP6 reflected on the understanding that SC requires effort and gradually improves: \u003cem\u003e\u0026ldquo;\u0026hellip; I think that starting to struggle with mental health issues over COVID. I had to learn some of these techniques to be kind to myself and not beat myself up about not getting done what I thought I should\u0026hellip; I do not think that was a very innate thing\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eResponses illustrated that SC is a challenging concept to relate to and implement. Those who engaged in SC recognised that it required self-directed effort to improve, stemming from understanding its benefits. They acknowledged that consciously working to enhance SC abilities ultimately facilitated their experiences. This indicates that SC does not occur naturally for many, necessitating a deliberate commitment to developing this ability. P7 offered insights into the gradual progression of compassion: \u003cem\u003e\u0026ldquo;Making a conscious effort to nurture yourself is what I would say is self-compassion. It seemed menial, but I do think that over time, it has manifested itself and cemented my routine. A conscious effort, awareness, and time are what you would need. I have made an active effort to look into it\u003c/em\u003e\u0026rdquo;.\u003c/p\u003e \u003cp\u003eMany individuals mistakenly believe that SC leads to laziness, feeling that self-criticism is necessary for motivation (Germer \u0026amp; Neff, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). However, SC can be a fierce and motivating force (Neff, 2011), as echoed by one participant (P11):\u003cem\u003e\u0026ldquo;I went through that abusive relationship. I am an angrier person now, so sometimes, my self-compassion\u0026mdash;maybe when I was younger, I understood compassion to be very gentle\u0026mdash;is a bit sterner. Sometimes, I have to force myself to do something, but I am still trying to be compassionate. So I feel like I have incorporated some sternness into myself, compassion, but otherwise, it is gentle, loving, and friendly, just allowing yourself to exist\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e\n\u003ch3\u003eTheme 3: Navigating Self-Compassion with Support and Challenges from Loved Ones\u003c/h3\u003e\n\u003cp\u003e Participants commonly acknowledged their family and friends\u0026rsquo; significant role in practising SC. The presence and support of friends were crucial for some: \u003cem\u003e\u0026ldquo;I think a big one is if other people are being nice to me\u0026hellip; definitely when others are compassionate towards me, like my boyfriend or my dad\u0026rdquo; (P5).\u003c/em\u003e\u003c/p\u003e \u003cp\u003eP15 also highlighted the supportive role of others in being able to practice SC:\u003cem\u003e\u0026ldquo;I will give you an example within the context of emotional, abusive relationships. So, when I was trying to move past that experience, I was not very self-compassionate; however, my friends were. They would send me voice messages and sort of\u0026hellip; be the voice in my head as compassionate, and eventually, it was there.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eConversely, some participants felt their friends and family negatively influenced their ability for SC and described how this negative influence hindered SC. For instance, P7 noted that SC could be affected when others failed to consider it essential, impacting their level of SC: \u003cem\u003e\u0026ldquo;\u0026hellip; people that either do not want or cannot, or are not able to practice self-compassion don\u0026rsquo;t allow you either\u003c/em\u003e\u0026rdquo;. Similarly, P12 identified that negative people could undermine one\u0026rsquo;s compassion levels: \u003cem\u003e\u0026ldquo;I think that there are so many barriers towards you giving yourself what you want\u0026hellip; compassion\u0026hellip; and one of them\u0026hellip; toxic people, toxic friends\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eHelpful social support from family and friends can facilitate the development and practice of SC; simultaneously, the detrimental impact of negative social influences can impede one\u0026rsquo;s ability for SC. The presence or absence of a supportive social network appears to be a crucial factor in shaping one\u0026rsquo;s capacity for SC.\u003c/p\u003e \u003cp\u003eAdditionally, family upbringing, religion, and community significantly influenced participants\u0026rsquo; ability to cultivate SC. For some, family environments either facilitated or hindered SC. P13 commented, \u003cem\u003e\u0026ldquo;Does family refer to my culture? Yeah, so my family are massive on, you know, practising self-compassion...\u0026rdquo;.\u003c/em\u003e Conversely, P7 noted that living away from home facilitated SC: \u003cem\u003e\u0026ldquo;I think I, so I currently live away from home, so I am at university, and I find it much easier to be more compassionate away from like my parents\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eThe community was also influential. Discussing living in Harlem, P11 found that its community and belonging facilitated their SC journey: \u003cem\u003e\u0026ldquo;Most of all the places I live I am most comfortable right now\u0026hellip; There is like a big community. I find it easier to be compassionate with myself here than other places\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eThese insights underscore how family, religion, and community dynamics influence participants\u0026rsquo; approaches to SC within their respective cultural contexts.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eTheme 4: The Paradox of Self-Compassion in Western Societies\u003c/h2\u003e \u003cp\u003eTh\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ei\u003c/span\u003es theme captures participants\u0026rsquo; diverse perspectives; some found SC easier in Western cultures and believed that their culture fostered its development, while others felt its progress was limited despite existing and being discussed.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eCultural Facilitators of Self-Compassion: Perspectives on Individualism\u003c/h3\u003e\n\u003cp\u003eCultural values prioritising individualism can foster the practice of SC. Some participants believed their culture facilitated SC. \u003cem\u003e\u0026ldquo;I would say that my culture (Western)\u0026hellip; probably facilitated more self-compassion\u0026hellip; I was fortunate to be growing up when the mental health movement started, and more awareness in schools and families was being encouraged\u0026rdquo; (P1).\u003c/em\u003e\u003c/p\u003e \u003cp\u003eSome participants compared Eastern and Western cultures, understanding that Western culture affords greater SC. P5 offered insights into this: \u0026ldquo;\u003cem\u003eI think this is a weird one for me because my stepdad was South African, which always made me think that British culture was comparatively very compassionate\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e\n\u003ch3\u003eLimits of Self-Compassion in Western Culture: Factors and Perceptions\u003c/h3\u003e\n\u003cp\u003eParticipants believed that, although compassion existed in Western culture, it was characterised by certain limits attributed to different factors. Discussing the UK, P7 felt that \u003cem\u003e\u0026ldquo;it is a taboo in the UK as well, or it is still not as progressed as perhaps it could be, which I find quite interesting.\u003c/em\u003e..\u003cem\u003ealthough it seems to be mentioned in the mainstream headlines...\u0026rdquo;.\u003c/em\u003e P13 attributed these difficulties in practice to increased cultural focus in the UK on academic pressure: \u003cem\u003e\u0026ldquo;\u0026hellip; high schools and colleges are so driven by people achieving, going to university and that sort of thing that often\u0026hellip; they do not care for self-compassion, and they will do the odd session on it\u0026hellip; think British society as a whole\u0026hellip; does not lend time for self-compassion\u0026rdquo;.\u003c/em\u003e P3 attributed this to Western culture\u0026rsquo;s focus on independence: \u0026ldquo;\u003cem\u003eThe epitome of this American ideal is someone strong enough to stand on their own\u0026hellip; it alienates you from a protective space of people who might care and have compassion and teach you compassion for yourself\u003c/em\u003e.\u0026rdquo;\u003c/p\u003e \u003cp\u003eIn summary, some found that their culture accepted and enabled SC. Others shared that despite the concept being present in their culture, it was restricted from being fully practised. The general agreement seemed to be that Western culture acknowledges the benefits of SC, which aided some in their ability to practice competently and align with their views. For others, this meant that cultural constraints made SC difficult despite cultural discussion.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eTheme 5: Cultural Hindrances to Self-Compassion in the East\u003c/h2\u003e \u003cp\u003eParticipants felt their Eastern cultural environment was not conducive to cultivating SC. They attributed this to societal norms, family dynamics, and individual experiences that hindered engagement in SC practices within their cultural context.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eCultural Collectivism: Impacts on Self-Compassion Development in Eastern Contexts\u003c/h2\u003e \u003cp\u003eAccording to P2, \u003cem\u003e\u0026ldquo;I feel that I come from a society which concentrates more on collective behaviours and living rather than individual... if anybody focuses a little more on themselves, in terms of mental health, we immediately tend to label them as selfish\u003c/em\u003e.\u0026rdquo; Similarly, P7 shared that his culture did not deem SC important: \u003cem\u003e\u0026ldquo;So I am half Chinese... and my dad is from the UK, but I think culturally, me and my sister have come and brought up much more along Chinese culture\u0026hellip; from that influence on upbringing, mental health is not a thing. Self-compassion is a luxurious extra ..that is not necessary\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eSimilarly, P8 commented: \u003cem\u003e\u0026ldquo;Self-compassion is spending time on my realising stuff, being, having a personal space, but I think they will not allow me to do that... they will not allow me to stay alone\u0026hellip; that is the restriction I have in the culture here\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eThis sub-theme reflects how collectivist values emphasise collective well-being and societal norms and prioritise familial duties over individual emotional needs like SC.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eFilial Piety and Self-Compassion: Cultural Challenges in Eastern Contexts\u003c/h2\u003e \u003cp\u003eFilial piety (the strong sense of duty and respect towards one\u0026rsquo;s parents and elders) impeded participants\u0026rsquo; cultivation of SC within Eastern cultural contexts. Participants felt that cultural emphasis on prioritising the needs of family and elders over one\u0026rsquo;s own hindered SC and was viewed as selfish or disrespectful.\u003c/p\u003e \u003cp\u003eP15 shared that \u0026ldquo;\u003cem\u003egrowing up in Asia\u0026hellip; I think they have very unrealistic expectations\u0026hellip; would be the barrier because sometimes I think I am doing well, but then I am like\u0026hellip; my parents would disapprove\u0026rdquo;\u003c/em\u003e. Similarly, P6 reflected on this incongruence in expectations: \u0026ldquo;\u003cem\u003eThey disapprove of the fact that I am incredibly masculine, that I want a career, and that I do not want to get married and have children. I actively do not want to have any children. When I did biology, I did not then do medicine, and I think that it is evident that their priority is not my happiness\u0026mdash;their priority is me fitting into their mould\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e Participants\u0026rsquo; responses revealed a strong sense of filial piety influencing self-perceptions, including their choices and ability to engage with SC.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eCultural Stigma in Eastern Contexts: Hindrances to Self-Compassion Among Sexual Trauma Survivors\u003c/h2\u003e \u003cp\u003eThis theme reflected participants\u0026rsquo; understanding of how their society\u0026rsquo;s perception and treatment of trauma hindered the development of SC. Participants felt that their society\u0026rsquo;s norms and expectations often failed to provide a supportive environment for processing and healing from traumatic experiences. This lack of societal understanding towards trauma impeded participants from cultivating SC due to internalising the idea that difficult emotions and struggles were not valid or deserving of care and kindness.\u003c/p\u003e \u003cp\u003eP1, who identified as belonging to Western culture, emphasised how societal views of trauma made a positive difference: \u0026ldquo;\u003cem\u003eI think it was crucial that environment and it probably would have turned out very badly if it had not been for that constant support because I think some mistakes, such as if a culture treats it like a taboo and the person cannot bring it up at all. You might feel constricted, but I didn\u0026rsquo;t\u0026hellip; that made a big difference. I think so\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eConversely, P6 explained how society\u0026rsquo;s view of her sexual abuse negatively impacted her:\u003cem\u003e\u0026ldquo;\u0026hellip; it is sort of a journey with self-reflection moving forward to retrain my brain out of what I think society thinks of me; I experienced sexual assault when I was very young, and for a long time, I blamed myself... and I think that a lot of that mindset came from the society\u0026rsquo;s sort of opinion at the time... that victims were at fault for sexual assaults happening\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eSimilarly, P9 discussed the context of India, stating that: \u003cem\u003e\u0026ldquo;\u0026hellip; everything is blamed back to a girl if anything happens. It is difficult to get out of those situations. ..you are a girl, it is your fault... that anything happened, any abuse happened, nobody thinks about the scenario. Nobody would say, \u0026lsquo;It is okay, it is okay. It does not matter.\u0026rsquo;\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eParticipants from Eastern cultural backgrounds often felt their cultural environments did not encourage SC. Several explanatory sub-themes emerged, including a low cultural emphasis on SC, a collectivist culture prioritising collective needs over individual concerns, filial piety and duty, a cultural avoidance of discussing mental health and personal struggles, and negative perceptions towards trauma and self-care in Eastern cultural contexts. Overall, societal norms and family dynamics in many Eastern cultures posed significant barriers to developing and practising SC.\u003c/p\u003e \u003cp\u003eIn summary, participants described that while SC was discussed in Western cultures, its practice was often limited by societal values emphasising competition and achievement, which conflicted with SC principles. In contrast, participants from Eastern cultures described environments that undervalued SC, shaped by collectivism, filial piety, and cultural stigma surrounding mental health and sexual abuse. The findings also highlight the interaction between cultural and gender-based barriers. Women, who made up a large proportion of the sample, frequently reported experiences of sexual and physical violence, consistent with literature showing that women are disproportionately affected by such experiences. Traditional gender roles further exacerbate these challenges, as women are often expected to be nurturers and carers, showing greater compassion toward others than themselves. In Western cultures, these expectations intersect with competitive and achievement-oriented values, while in Eastern contexts, collectivism, filial piety and stigma place additional burdens on women\u0026rsquo;s ability to practice SC.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis qualitative study employed semi-structured interviews to understand SC and its barriers, facilitators, and cultural influences for sixteen ethnically/culturally diverse individuals who had experienced interpersonal trauma. Reflexive Thematic Anaysis enabled the identification and development of five themes.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eTheme 1: Compassionate Coping: Leveraging Self-Compassion After Trauma\u003c/h2\u003e \u003cp\u003eConsistent with existing research establishing SC as a valuable coping resource (Ewert et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Wong \u0026amp; Yeung, 2017), participants described how they used SC as a coping resource. They distinguished it as a cognitive and behavioural practice in the present study; cognitively, participants practised SC through acceptance (\u003cem\u003esub-theme: \u0026lsquo;Accepting and understanding that I am human\u0026rsquo;)\u003c/em\u003e and reframing the situation (\u003cem\u003esub-theme: \u0026lsquo;Providing reassuring statements to self)\u003c/em\u003e. These findings are significant, as SC may foster post-traumatic growth (PTG), a positive psychological change following adversity, by enhancing crisis acceptance, constructive reframing, and meaning-making (Wong \u0026amp; Yeung, 2017).\u003c/p\u003e \u003cp\u003eKlingle and van Vliet\u0026rsquo;s (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) qualitative study linked self-compassion (SC) to enjoyable activities. Similarly, participants in the present study viewed engaging in enjoyable activities as a strategy for managing negative emotions. This reinforces existing literature on self-directed actions that reflect self-compassionate behaviour (Gilbert, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). In support of this, the current findings suggest that while a long-term avoidance of complex emotions contradicts SC, temporarily redirecting attention through alternative actions may be a valid SC approach.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eTheme 2: Deliberate Self-Compassion: Embracing Challenges with Determination\u003c/h2\u003e \u003cp\u003eParticipants reported challenges in cultivating SC, often finding it unfamiliar or unattainable. Early life adversity predisposes individuals to heightened self-criticism and shame due to inadequate nurturing, impairing self-soothing and emotional regulation (Gilbert \u0026amp; Procter, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Russo et al., 2023). Poor emotional regulation is linked to behavioural problems (Choi \u0026amp; Oh, 2014) and increased PTSD symptoms, as childhood trauma correlates with ineffective regulation strategies and lower distress tolerance (Russo et al., 2023).\u003c/p\u003e \u003cp\u003eThese findings align with existing literature on fear of SC, which is associated with repeated childhood abuse (Boykin et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Miron et al., 2016). Despite these challenges, participants recognised SC\u0026rsquo;s benefits and tried to implement it, consistent with previous findings (Bayir \u0026amp; Lomas, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Campion \u0026amp; Glover, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Pauley \u0026amp; McPherson, 2010).\u003c/p\u003e \u003cp\u003eIndividuals who struggle with FOC may benefit from psychological interventions that address two primary objectives: first, assisting individuals in acknowledging their potential for SC, and second, providing support for cultivating SC skills, considering the practical challenges associated with it (Pauley \u0026amp; McPherson, 2010). Steindl et al. (2018) suggest that motivational interviewing enhances motivation and commitment before compassion-based interventions, increasing the likelihood of participants benefiting from Compassion-focused interventions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eTheme 3: Navigating Self-Compassion with Support and Challenges from Loved Ones\u003c/h2\u003e \u003cp\u003eThis study found that social relationships significantly shaped individuals\u0026rsquo; engagement with SC and their ability to benefit from it. Participants noted that family and friends influenced their ability to practice SC\u0026mdash;some fostering positive attitudes, while others reinforced negative dynamics and societal messages devaluing SC. This study\u0026rsquo;s findings underscore the role of social context in shaping SC and the importance of social support in facilitating it (Maheux \u0026amp; Price, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Markus \u0026amp; Kitayama, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e1991\u003c/span\u003e). This is consistent with existing literature which suggests that supportive relationships promote SC through acceptance and empathy, while negative relationships undermine SC through criticism or neglect (Lathren et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Further, the findings from the present study align with Bayir and Lomas (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) who found that close relationships can reinforce self-criticism, and Campion and Glover (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) who highlighted the influence of societal norms on SC.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eTheme 4: The Paradox of Self-Compassion in Western Societies\u003c/h2\u003e \u003cp\u003eThe present study builds on prior research (Campion \u0026amp; Glover, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Steindl et al., 2020), highlighting the paradox of SC in Western cultures. While SC is valued as personal empowerment and self-care (Stevenson \u0026amp; Allen, 2017), it is simultaneously undermined by societal factors such as competition, social comparison, and heightened self-criticism (Montero-Marin et al., 2018).\u003c/p\u003e \u003cp\u003eThus, while SC is acknowledged in Western cultures, its practice is limited by societal norms valuing self-reliance and individualism (Campion \u0026amp; Glover, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Participants in the present study noted that SC was promoted in schools and institutions but constrained by Western values prioritising independence and achievement (Assmann \u0026amp; Ehrl, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThese findings align with existing research suggesting individuals may hesitate to practise SC due to fears of perceived laziness or failure (Robinson et al., 2016). Participants in the present study reported intense cultural pressure in the UK and USA to be successful and independent conflicting with SC. One\u0026rsquo;s perceptions about whether SC or self-criticism better promotes emotional well-being, productivity and desired outcomes may explain observed results (Robinson et al., 2016).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eTheme 5: Cultural Hindrances to Self-Compassion in the East\u003c/h2\u003e \u003cp\u003eIn this study, participants felt that their Eastern collectivist norms, including a lack of emphasis on self, stigma surrounding sexual trauma and mental health, and filial piety, discouraged SC. Like Sengupta \u0026amp; Saxena (2024), participants in this study struggled to apply SC, finding it more socially desirable to extend it to others. Gender roles also shape this, as women are generally expected to be more compassionate towards others than men (Selvaraja \u0026amp; Baskaran, 2023; Yarnell et al., 2015).\u003c/p\u003e \u003cp\u003eThese findings contrast with research suggesting that SC may be more prevalent in Eastern contexts due to Buddhist traditions (Fung et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Kariwayasam et al., 2022), which blur the self-other distinction, encouraging universal compassion (Promchin et al., 2024). Greater SC has been observed among Sri Lankan and Singapore participants (Kariyawasam et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Steindl et al., 2020), with Kariyawasam et al. (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) linking this in Sri Lankans to Buddhist practices like loving-kindness and meditation. However, this requires careful interpretation, as Buddhism values shame as moral conduct (Sun, 2021), potentially conflicting with SC.\u003c/p\u003e \u003cp\u003eThe dialectical nature of SC, where SC and self-criticism coexist, has also been observed in Eastern cultures, including among Chinese (Zhao et al., 2021) and Hong Kong participants (Fung et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Eastern societies often prioritise collective harmony over individual emotional needs, emphasising self-sacrifice and humility (Triandis, 2001). Consequently, self-criticism may be more prevalent, as individuals fear being seen as selfish for prioritising self-care (Heine et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e1999\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFilial piety also hindered SC in this study\u0026rsquo;s participants as it influenced self-perception, limited autonomy, and discouraged self-kindness. Participants reported suppressing personal interest due to imposed expectations, such as academic pressures affecting self-worth and rigid social norms leading to criticism. Steindl et al. (2020) argue that collectivist cultures promote an other-focused orientation driven more by duty or submission rather than genuine compassion. Drawing from findings in a western context, Catarino et al., (2014) differentiate between genuine and submissive compassion, the latter defined as caring to gain approval or avoid rejection, a phenomenon observed in collectivistic cultures.\u003c/p\u003e \u003cp\u003eCultural barriers to SC in the East can be understood through cognitive consistency. According to Hoshino-Browne (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2012\u003c/span\u003e), cognitive consistency refers to the alignment of one\u0026rsquo;s thoughts, beliefs, attitudes, and behaviours, with its importance varying across cultural orientations. Individualistic cultures emphasise autonomy, integrity and authenticity, prioritizing consistency between attitudes, thoughts, and behaviours. In contrast, collectivistic cultures value social harmony and interdependence, often at the expense of cognitive consistency, reinforcing conformity (Hoshino-Browne, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePrevious research has debated whether Eastern or Western cultures might have more SC (Steindl et al., 2020; Fung et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). For example, Steindl et al., (2020) highlight how individualistic, capitalistic societies limit SC due to competition and self-criticism, corroborating other studies (Campion \u0026amp; Glover, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Montero-Martin et al., 2018). While Singaporeans in the study demonstrated higher SC than expected, the authors suggested it may reflect \u0026ldquo;submissive compassion\u0026rdquo; in collectivist cultures. Similarly, Fung et al. (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) found that Hong Kong participants displayed high SC and heightened self-criticism, supporting the dialectical nature of SC (Zhao et al., 2021). However, research on Northeast India suggests greater compassion toward others than oneself, with heightened self-criticism and shame reinforcing emotional suppression to maintain social harmony (Sengupta \u0026amp; Saxena, 2024). Thus, the existing research is mixed on the prevalence of SC in Eastern cultures. This present study indicates that both East and West present barriers and facilitators to SC. Western values such as competition and success may conflict with SC. Eastern cultures may also conflict with SC by discouraging acknowledgment of trauma.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eGender Differences in Recovery from Trauma and the Role of Self-Compassion\u003c/h2\u003e \u003cp\u003eThis study\u0026rsquo;s sample consisted primarily of female participants. Previous research suggests that women typically experience higher rates of physical and sexual traumatic experiences (Lukaschek et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2013\u003c/span\u003e), and they also have more negative outcomes following traumatic experiences (Spinhoven et al., 2014), which likely explains their greater participation in research that examines these topics. Secondly, women also exhibit lower levels of SC than men (Yarnell et al., 2015), as noted in the earlier section. On the other hand, due to gender norms, men are likely to demonstrate an unwillingness to disclose such experiences, particularly regarding sexual abuse (Alaggia, 2005). Although not explicitly explored in the topic guide, some participants disclosed extensive experiences of sexual assault during the interviews. This aligns with existing research indicating that women experience higher rates of sexual trauma (Lukaschek et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2013\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eImplications\u003c/h2\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eClinical Implications for Assessment and Formulation\u003c/h2\u003e \u003cp\u003eAs highlighted earlier, our results corroborate the work of Kirby et al. (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), suggesting that therapists should explore patients\u0026rsquo; perceptions of compassion before therapy. This involves understanding their conceptualisations, perceived barriers and facilitators in incorporating compassion. Further, our findings align with Maercker and Horn (\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2013\u003c/span\u003e), emphasising the need to consider interpersonal and cultural influences shaping trauma responses during treatment assessment and formulation.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eClinical Implications for Intervention and Prevention\u003c/h2\u003e \u003cp\u003eOur findings corroborate existing evidence to suggest that interventions focused on cultivating SC could be crucial in trauma recovery (Winders et al., 2020; Rushforth et al., 2024). Participants used SC in diverse ways, offering insights into refining interventions to be more adaptive and practical (Pauley \u0026amp; McPherson, 2010). Further, the study highlights the need for culturally sensitive approaches to fostering SC (Arimitsu, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eImplications for Practitioner Training\u003c/h2\u003e \u003cp\u003eOur research follows existing literature on SC's counterintuitive nature, stressing the need for practitioners to model SC based on clients\u0026rsquo; perceptions by receiving culturally sensitive training and carefully considering gender differences.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eLimitations and Future Research\u003c/h2\u003e \u003cp\u003eThis qualitative study offered insights into SC among individuals with interpersonal trauma, though it had limitations. The sample was predominantly female, potentially limiting generalisability. Some participants had prior therapy, which may have influenced SC levels and responses. The study did not confirm a formal diagnosis of PTSD or CPTSD, and cultural factors were simplified into a Western-Eastern dichotomy. Additionally, our study did not have specific gender-related questions in the topic guide, and the interaction between gender and culture was not explicitly explored.\u003c/p\u003e \u003cp\u003eFuture research should examine SC across diverse populations, particularly gender, cultural background, and therapeutic history. It should also explore influences like family upbringing, the role of religion, and community, which emerged as key themes as described in the results section. Additionally, qualitative research investigating SC through motivational interviewing and diary studies could provide deeper insights into how individuals enact, conceptualise, and apply SC. Future research should also further explore gender differences, specifically on SC in male trauma survivors across cultures.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThese themes highlight the influence of interpersonal relationships and internal psychological processes in shaping individuals\u0026rsquo; experiences of SC and its role in psychological trauma recovery. They also emphasise the significant impact of cultural contexts on cultivating and expressing SC. Furthermore, the themes underscore the practical utility of SC as a coping mechanism, particularly following traumatic experiences. These insights offer a comprehensive understanding of SC in trauma recovery as influenced by intrapersonal, social, and cultural processes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eNo funding was received for conducting this study.\u003c/p\u003e\n\u003cp\u003eThe authors have no competing interests to declare relevant to this article's content\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApproval was obtained from the ethics committee of the University of Exeter (Ethics application number: 489051). The procedures used in this study adhere to the tenets of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe use of AI\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe first author (PM) acknowledges the use of the GenAI tool: Grammarly and link to https://www.grammarly.com/grammar-check) to proofread and correct grammar or spelling errors.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003ePM, AK, and AM contributed to the conceptualization of the study. \u0026nbsp;PM, AM, and AK collaborated on the methodology. \u0026nbsp;Formal analysis and investigation were conducted by PM. \u0026nbsp;PM drafted the original manuscript. \u0026nbsp;PM, AK, and AM contributed to the review and editing of the manuscript. \u0026nbsp;AK and AM provided supervision for the study. \u0026nbsp;This study forms part of PM’s PhD thesis.\u003c/p\u003e\n\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eI would like to thank Leah Salley for her professional proofreading support as a native English speaker, and for her kindness through the revision process.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe raw data from the interviews is not available for open sharing due to its confidential nature, as it may contain identifiable information. Researchers may request detailed, anonymised excerpts upon reasonable request from the first author(PM), subject to ethical consideration and institutional approval.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eArimitsu, K. (2023). Self-compassion across cultures. In A. Finlay-Jones, K. Bluth, \u0026amp; K. Neff (Eds.) \u003cem\u003eHandbook of Self-Compassion\u003c/em\u003e (pp. 129\u0026ndash;141). Springer.\u003c/li\u003e\n\u003cli\u003eAshfield, E., Chan, C., \u0026amp; Lee, D. (2021). Building \u0026lsquo;a compassionate armour\u0026rsquo;: The journey to develop strength and self‐compassion in a group treatment for complex post‐traumatic stress disorder. \u003cem\u003ePsychology and Psychotherapy: Theory, Research and Practice\u003c/em\u003e, \u003cem\u003e94\u003c/em\u003e, 286\u0026ndash;303.\u003c/li\u003e\n\u003cli\u003eAssmann, D., \u0026amp; Ehrl, P. (2021). 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Self-compassion in Chinese young adults: Specific features of the construct from a cultural perspective. \u003cem\u003eMindfulness\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e, 2718-2728.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6306510/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6306510/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eObjectives: Self-compassion has been associated with better mental well-being, recovery from psychological trauma, and lower levels of post-traumatic stress. However, it has been studied primarily using quantitative research design(s), and there is a limited understanding of the concept of self-compassion amongst those who have experienced early and interpersonal trauma, which has been shown to impact a person’s view of self and others. This study aimed to develop an understanding of the concept of self-compassion, including its barriers, facilitators, and cultural influences, amongst individuals with a history of interpersonal trauma.\u003c/p\u003e\n\u003cp\u003eMethods: The study used a semi-structured interview method with 16 participants (eleven females and five males) from diverse ethnic backgrounds with a history of interpersonal trauma. Data were analysed through Reflexive Thematic Analysis (Braun \u0026amp; Clarke, 2019).\u0026nbsp; Results: The analysis revealed five themes: 1) Compassionate Coping: Leveraging Self-Compassion After Trauma; 2) Deliberate Self-Compassion: Embracing Challenges with Determination; 3) Navigating Self-Compassion with Support and Challenges from Loved Ones, 4) Paradox of Self-Compassion in Western Societies, and 5) Cultural Hindrances to Self-Compassion in the East.\u003c/p\u003e\n\u003cp\u003eConclusions: The findings clarify barriers, facilitators and cultural influences on self-compassion in trauma recovery and can inform the development of effective, culturally sensitive compassion interventions for complex PTSD and other conditions following interpersonal trauma.\u0026nbsp; Keywords: self-compassion, interpersonal trauma, semi-structured interview, reflexive thematic analysis\u0026nbsp;\u003c/p\u003e","manuscriptTitle":"A Qualitative Exploration of the Concept of Self-Compassion amongst Individuals with a History of Interpersonal Traumatic Events","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-17 10:44:30","doi":"10.21203/rs.3.rs-6306510/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b436461a-29dd-49b4-bccc-2bfaa5d7922f","owner":[],"postedDate":"April 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-18T16:53:13+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-17 10:44:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6306510","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6306510","identity":"rs-6306510","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}