Depression

Facing Fears of Compassion in Anxiety and Depression

New research identifies obstacles to therapeutic engagement.

Posted May 17, 2020

“Do the best you can until you know better. Then when you know better, do better.” —Maya Angelou

By Grant H. Brenner

Research on depression and anxiety disorders highlights the connection between compassion and well-being. There is good evidence that training up compassion can improve well-being, alleviating symptoms and redressing underlying vulnerabilities.

Photo by Hian Oliveira on Unsplash
Source: Photo by Hian Oliveira on Unsplash

Fear of Compassion

Little research, however, has asked whether fear of compassion is associated with clinically significant depression and anxiety.

Fear of compassion may make people more likely to reject help—even failing to see the need for help in the first place. Fears of compassion often take the form of stoicism, a tendency to act “strong” because vulnerability is seen as weakness, or to believe that showing vulnerability will inevitably lead to being taken advantage of by others, among other things.

Fearing compassion, particularly receiving compassion, can make it especially hard for people who are isolated to reach toward others, leading to the absence of “social safeness,” a basic emotional state alongside positivity and negativity.

Understanding the Role of Fears of Compassion in Clinical Conditions

In order to better understand how people may avoid compassion, researchers developed the Fears of Compassion Scale. It covers three broad ways people can be afraid of compassion.

Fear of:

  1. Expressing compassion for others
  2. Receiving compassion from others
  3. Expressing kindness and compassion towards yourself

They relate to common underlying issues, such as concern about being seen as weak or being taken advantage of, fears of intimacy, betrayal or embarrassment, and issues with dependency. 

Fear of compassion has been correlated with difficulty recognizing one’s own emotions, beliefs that opening up about emotions is risky, and lower overall self-reflective function.

Studying Fears of Compassion in Anxiety Disorders and Depression

Because of the lack of research on the subject, psychologists Olivia A. Merritt and Christine L. Purdon conducted a study looking at fear of compassion in depression, generalized anxiety disorder, social anxiety, and obsessive-compulsive disorder compared to people with no diagnosed clinical conditions. 

Of 407 research participants, 34 were diagnosed with clinical depression, 27 with obsessive-compulsive disorder (OCD), 91 with social anxiety disorder (SAD) or “social phobia,” 43 with generalized anxiety disorder (GAD). The remainder or "control" participants (212) did not have diagnosed clinical issues.

Participants completed measures including the Fears of Compassion Scale (FOCS), the Depression Anxiety Stress Scale (DASS), the Dimensional Obsessive-Compulsive Scale (DOCS), and the Social Phobia Inventory (SPIN). Clinical scales used in the study were used to track various aspects of symptom severity for participants already diagnosed.

Findings

For the overall measure of fears of compassion, the clinical groups reported significantly higher scores than the control group. For fears of expressing compassion to others, there were no differences among any of the groups. But for fear of receiving compassion from others, the control group had significantly lower scores than all clinical groups. Participants in the depression and SAD groups had greater fear of receiving compassion than those in the GAD group. The OCD group had similar fears of receiving compassion as the other clinical groups.

In terms of fears of self-compassion, all the clinical groups scored higher than the control group, and the depression group showed greater fears of self-compassion than the GAD group, specifically.

Anxiety Disorders Independent of Depression

To look at how anxiety disorders and fears of compassion correlated when controlling for depression, researchers first calculated the relationship between depression and FOCS. They found that depressive symptoms were connected with both fears of receiving compassion and fears of self-compassion.

After factoring out the contribution from depression, anxiety disorders still showed significant correlations.

The SAD, GAD, and OCD groups all showed greater fear of receiving compassion and fear of self-compassion than the control groups.

The SAD group showed greater fear of receiving compassion than the GAD group, which makes sense given that people with social anxiety are afraid of both criticism and praise from others, generally preferring to avoid focus regardless of the nature of the attention.

The GAD group showed lower fear of receiving compassion and self-compassion than the depression group, fitting with psychological models suggesting that negative ideas about the self are a core feature of both depression and social anxiety. Negative ideas about the world are characteristic of generalized anxiety, with greater worry about external circumstances and events rather than feeling personally flawed.

Depression and social anxiety reflect greater difficulty with self-relationship, as people with these conditions often feel less deserving of compassion, making it hard to get needed help and provide for oneself.

In the OCD group, after controlling for depressive symptoms, fear of expressing compassion for others predicted symptom severity only for those with high fears of self-compassion. While the effect was weak and needs exploration, study authors note that people with OCD often report harsh, critical parenting growing up, which may lead them to internalize a less compassionate stance toward self and others.

This may play out in adult difficulties with compassion. Analysis showed that two FOCS items stood out with OCD: “people will take advantage of me if they see me as too compassionate” and “being compassionate towards people who have done bad things is letting them off the hook." Both present barriers to expressing compassion for others and may reflect a degree of moral rigidity often present in OCD.

Further Considerations

This is the first study to take a close look at how fears of compassion—and not compassion itself—correlate with depression and anxiety in patients compared with a control group.

While depression creates an underlying barrier to self-compassion and receptivity to help, fears of compassion seem to be present in different anxiety disorders uniquely, and independent of depression.

The limited role for fears of expressing compassion toward others, perhaps a greater factor where intimacy and relationship issues are present, may make it easier for some to move away from their problems in service to others—for example, finding purpose and meaning through altruistic work.

Looking in more detail at the role of developmental and adult trauma is important in understanding fears of compassion. Research suggests that, along with psychological inflexibility, fear of self-compassion is associated with higher PTSD symptom severity. As trauma is a common underlying factor, often missed when considering anxiety and depression, including this factor is critical for understanding the clinical relevance of fears of compassion.

Targeting specific aspects of fears of compassion is likely an important tool in improving treatment outcomes. For instance, research on therapy indicates that therapy-as-usual may lack a focus on building compassion. Where might fears of compassion fit in?

The work reviewed here supports that focusing on fears of compassion may be a necessary and overlooked element requiring early attention. For people who find that the idea of receiving help is challenging, and for those who have difficulty with their basic attitude toward self-care, evaluating fears of compassion may be high-yield. Because avoidance is a common, if ultimately ineffective way of coping with phobias, and fears of compassion from others and self-compassion present challenges to full therapeutic engagement, identifying such fears is but a first step. Addressing them effectively may take time, persistence, collaboration, and creativity.

See here for information on compassion-based practice and additional resources.

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