Exploring Working Memory,Self-Criticism,and Rumination as Factors Related to Self-Harm

Abstract

The prevalence of self-harm and the relative emotional influences are well understood, but certain cognitive factors such as working memory, rumination, and self-criticism are not fully explored. The aim of the current study is to examine specific aspects of cognition to explore their influence on self-harming behaviors. Participants included 101 undergraduates from a British University. Factors were measured using the Center for Epidemiological Studies Depression Scale, the Depressive Experiences Questionnaire, Ruminative Response Scale, and the Automated Working Memory Assessment. Findings indicated a greater incidence of self-harming behaviors among those who demonstrated higher depressive symptoms, but depression scores were not significantly related to self-harm. Additionally, a binary logistic regression indicated that self-criticism was associated with the presence of self-harming behavior, and a Classification and Regression Trees found that the single strongest predictor of self-harming behavior was a belief that love needs to be continually earned from others. Incorporating treatments that reduce self-criticism, such as improving self-compassion with Compassionate Mind Training, may address underlying mechanisms that trigger self-harm behavior.

Keywords

rumination depression self-criticism working memory self-harm

Self-Harm

Self-harm (SH) defined as directly and intentionally inflicting damage to one’s own body tissue with or without intention of suicide (Brereton & McGlinchey, 2020) is relatively prevalent, with an estimated 4% of adults in the United States having self-harmed (Monto et al., 2018; Rockett et al., 2021). The rates are higher among adolescents, with approximately 15% of teens reporting some form of SH (Gilles et al., 2018), and an even higher risk for SH among college students, with rates ranging from 17%–35% (Selby et al., 2012). Indeed, several other countries demonstrate similar rates including Scotland (16.2%; O’Connor et al., 2018), while the UK demonstrates self-reported lifetime SH ranging from 2.4% to 6.4% (McManus et al., 2019).

By engaging in SH, the person may intend to obtain relief from a negative feeling or mental state or induce a positive feeling state (Sheehy et al., 2019). Most report that the behavior regulates high levels of emotional distress and negative emotions, caused by anxiety or depression. Self-harming behaviors redirect attention away from the distressing thoughts and emotions toward the act itself (Klonsky, 2011; Tait et al., 2014) and is related to maladaptive coping strategies (Christian & McCabe, 2011). To a lesser extent, SH may also be used as a form of self-punishment to reconnect with the self or “feel something” in response to somatic dissociation, or to communicate a sense of pain and desire for relief from others (Baumgarden, 2017). In young adults, common factors contributing to emotional distress are family arguments, problems with romantic partners, or academic difficulties. Some of these common factors may represent chronic difficulties in emotion regulation (see Brereton & McGlinchey, 2020 for a review) and/or behavior (Harrington, 2001).

While the previously mentioned motivations of SH have been thoroughly examined, there are less explored cognitive factors that may precipitate and maintain self-harming behaviors. The goal of the present study is to explore additional factors such as rumination, depression, self-criticism, and the role of working memory in their relation to SH.

Rumination

Rumination, defined as a method of coping with negative mood that involves self-focused attention and self-reflection (Treynor et al., 2003) influences the rate of SH (Khedmati, 2020). There are several types of rumination including positive (reflection), negative (brooding), and anger rumination. Positive rumination may increase the understanding of one’s behaviors, their effectiveness, and consider alternative behaviors for future similar circumstances. Conversely, negative rumination (i.e., brooding) is associated with increased negative emotions by decreasing mood stability and increases the intensity and length of depressive symptoms (Brinker & Dozois, 2009). Brooding is also correlated with the onset of major depressive disorder (MDD; Nolen-Hoeksema, 2000), and decreased positive mood (Ciarrochi, Scott, Dean, & Heaven, 2003). Those who engage in negative rumination when depressed or dysphoric have longer and more severe periods of depression that those who do not (Nolen-Hoeksema et al., 2008).

Several studies indicate that individuals who self-harm are more likely to actively ruminate before and after self-harming (Borrill et al., 2009; Nicolai et al., 2016). Rumination may be an independent predictor of SH because it is an excessive self-focus that results in an increased salience of negative evaluations of one’s own thoughts and actions. According to Response Styles Theory (Nolen-Hoeksema et al., 2008), rumination prolongs distress by prompting negative thoughts to interpret ones’ surroundings, encouraging fatalistic thinking and feelings of powerlessness, and decreases the likelihood of situation oriented instrumental behavior necessary to change one’s circumstances. This increase in negative feelings may be an impetus for the feelings of helplessness that often lead to SH.

Self-Criticism

Self-criticism is defined as the tendency to react strongly against the self when there is a discrepancy perceived between the actual and ideal self. A number of studies have linked self-criticism to self-harm, depression and psychopathology (Gilbert et al., 2010; Richter et al., 2009; Zelkowitz & Cole, 2019) and problems with disrupted emotion regulation (Warren, 2015). Individuals who engage in SH tend to have higher levels of trait self-criticism than those who have never self-harmed (Nagy et al., 2021; You et al., 2015), and trait self-criticism may increase one’s desire for self-punishment (Hooley & St. Germain, 2014) in which individuals may be attempting to cope with self-critical thoughts.

Self-criticism is also often described as a risk factor for depression, yet it is also a unique predictor of SH after controlling for depression (Glassman et al., 2007). According to Self-Discrepancy Theory (Higgins, 1987), when one’s actual self does not match their personal ideal self, a feeling of internal dejection may result, which may lead to self-injuring behavior. Carver and Ganellen (1983) found that self-criticism, along with unrealistically high standards and overgeneralization of failures, are the main factors that cultivate an overall self-punitive attitude. More recently, the Cognitive-Evolutionary Model (Gilbert, 2014) suggests that self-criticism is part of “threat protection system” which motivates the individual to avoid loss of social rank within their social group. When a possible threat is detected, an individual may try to reduce their emotional distress through self-harm (O’Neill et al., 2021).

Additionally, shame and guilt are significantly related with high rates of self-criticism (see Sheehy et al., 2019 for a review). Specifically, external shame, hated self and fear of self-compassion indirectly predicted non-suicidal self-harm in a population of adolescents (Xavier et al., 2016). While the role of self-criticism has been explored in the role of self-harm, other cognitive factors such as working memory are less well known.

Working Memory

Working memory is one’s ability to process and remember information. Working memory is part of a constellation of executive function skills, including updating and monitoring information, as well as shifting between mental tasks, inhibiting inactive tasks, reasoning, and problem solving (Miyake et al., 2000). It is linked to a range of cognitive activities from reasoning tasks to verbal comprehension (Kane & Engle, 2002).

Working memory is also associated with various mental health outcomes. Individuals with low working memory capacity struggle in regulating both their emotional experiences and expressions, which are essential elements of psychological well-being (Schmeichel et al., 2008). Working memory may be associated with secondary control coping, which is an effort to adapt to a source of stress by cognitive restructuring or distraction (Andreotti et al., 2013). Joormann and Gotlib (2008) found that depressed participants had greater intrusion effects of emotional stimuli into working memory, than a control group when memorizing lists of emotional words. Overall individuals with depression had a more difficult time removing negative emotional content from working memory.

Specific working memory deficits may exist in groups that self-injure because of a difficulty using cognitively demanding tasks to distract from a negative mood for emotional regulation (Van Dillen & Koole, 2007).

However, to date, there is little research investigating working memory and SH, and the existing findings are mixed. Miller et al. (2012) reported that working memory (backward digit recall) was not a significant predictor of SH, while Fikke et al., (2011) found that males who performed “high-risk SH” made significantly more errors on a test of spatial working memory than males in a control group. A recent study indicated that people with Borderline Personality Disorder (BPD) symptoms with and without non-suicidal self-injury showed attention bias to anger and pain stimuli and were slower at discarding angry and pain stimuli from working memory (Esmaeilian et al., 2020).

Looking generally at executive function skills and the link to SH, deficits in some aspects of executive function have been reported in those who engage in SH, depending on the frequency and severity of self-harming behavior. Miller et al. (2012) found that in a young adult population, a global measure of executive function significantly predicted SH over and above IQ, and a measure of inhibition (Continuous Performance test - errors of commissions) was also predictive of SH when controlling for IQ. This suggests that a range of cognitive skills, including working memory, inhibition, sustained attention, and overall executive function may be important in predicting SH. Additionally, adolescents who self-injure illustrate deficits on decision-making tasks (Oldershaw et al., 2009) and perform significantly worse compared to those in a control group on the Stop Signal Task, used to measure motor inhibition (Fikke et al., 2011). This pattern of deficits supports the emotional regulation hypothesis: SH is used to regulate emotions by decreasing the negative affective state of the user. Additionally, SH may be related to impulse control and how some individuals report habitual self-harming behaviors. A recent study indicated longer reaction times and more errors on a task control paradigm, and overall difficulties in behavioral control were observed in an SH group compared to a non-SH control group (Lee & Hyun, 2021).

However, other researchers have found no executive function or working memory deficits among those who engage in self-injuring behaviors. In a population of adolescent girls, there were no differences in measures of inhibition and planning (as measured by Stroop Task and Wisconsin Card Sorting Test) in those who self-injured and those that did not (Ohmann et al., 2008).

Current research has not fully evaluated the influences of rumination, self-criticism, and working memory of NSSI. While there is body of research exploring the larger neurocognitive factors related to self-harm including executive functioning broadly (see de Cates et al., 2017 for a review) little research has explored specific components of executive functioning such as working memory and self-harm. Exploring the cognitive antecedents of SH is critical to understanding the mechanisms responsible for SH and to develop proper assessment and more targeted interventions.

Current Study

The present study explored the following hypotheses:

Hypothesis 1

Working memory scores will be negatively correlated with depression, self-criticism, and rumination (independently).

Hypothesis 2

Higher scores in rumination and self-criticism and lower scores in working memory will be associated with self-harming behaviors.

Although not a major factor in our analysis, we expected a gender difference in the scores on the self-criticism, rumination, and depression mental health tests, based on the well-established gender differences in depression prevalence and symptom strength (Silverstein et al., 2013). Additionally, research indicates gender differences in SH in which men and women differ significantly on age of onset and degree of medical injury (Andover et al., 2010).

Method

Participants

Due to the high rates of self-harm on university campuses (Selby et al., 2012), undergraduate participants were recruited at a British University. Of the 101 participants, 35 were men and 66 were women, whose ages ranged from 17 to 52, with a mean age of 21.76 (SD = 6.77). With reference to ethnicity, 93 were white, two were black, two were Asian, and four described themselves as “other.” Informed consent was obtained and ethical approval was granted by the University of Stirling, UK.

Measures

Depression

The Center for Epidemiological Studies Depression Scale (CES-D, Radloff, 1977) was used to measure each participant’s level of depression. Participants rate statements depending on how strongly they felt the statements applied to them during the past week. On the 20-item measure, there were four options available for each statement: rarely, or none of the time (less than 1 day); some or a little of the time (1–2 days); occasionally or a moderate amount of time (3–4 days); most or all of the time (5–7 days). Some statements referred to negative feelings (e.g., “I was bothered by things that don’t usually bother me”), while others referred to more positive feelings (e.g., “I felt hopeful about the future”). Higher scores are associated with higher levels of depressive symptoms (max score = 60), and any score of 16 or higher is considered to indicate moderate/severe depressive symptoms. The CES-D has been found to have excellent reliability, with a Cronbach’s α ranging from 0.88 to 0.91 and test–retest reliability ICC of 0.87 (Miller et al., 2008). The CES-D has a low correlation with perceived pain (Pearson’s r = 0.27) and a high correlation with mental health (Pearson’s r = 0.75), indicating good validity (Kuptniratsaikul et al., 2002).

Self-Criticism

Participants responded to 18 selected items from the Depressive Experiences Questionnaire (DEQ; 66 total items; Blatt, Quinlan, & D’Afflitti, 1976). When originally validating the DEQ, Blatt et al. (1976) distinguished between two types of depressive experiences, one characterized by strong dependency needs and the other by self-criticism and guilt. We used 18 items that captured only items measuring self-criticism, excluded the items assessing depression, and used the DEQ scoring guide to make this determination. An example item is “I have a difficult time accepting weakness in myself.” Participants rated whether they agreed or disagreed on a 7-point scale (Strongly Disagree = 1 and Strongly Agree = 7). Higher scores are associated with higher levels of self-reported criticism (max score = 126). For the selected items, the Cronbach’s α was .841 indicating good reliability. The internal consistency of the self-criticism factor of the DEQ has been found to be acceptable (Blatt et al., 1976), and test–retest reliability was found to be at acceptable levels over 13-week periods (Zuroff et al., 1983). The internal consistency was also found to be in the high range with a Cronbach’s α of .75 in a college age sample. Considerable evidence supports the validity of the DEQ, such as a positive relationship with depressive affect and dysfunctional attitudes (Blatt et al., 1992). Construct validity of the DEQ has also been supported by relating to measures of depression such as the Beck Depression Inventory (Blatt et al., 1982).

Rumination. Participants responded to 10 selected items from the Ruminative Response Scale (RRS; 22 total items; Treynor et al., 2003). These 10 items were selected by the researcher to capture both the reflection and brooding components of rumination and excluded the items assessing depression due to already administering the CES-D. The RRS scoring guide was used to make this determination. Participants rated how often they engage in particular ruminative behaviors on a 4-point scale (Almost Never = 1 and Almost Always = 4). An example of an item measuring reflection is “[how often do you] go someplace alone to think about your feelings”; an example of an item measuring brooding is “[how often do you] think ‘Why can’t I handle things better?’” Higher scores are associated with higher levels of rumination about past events (max score = 40). The RRS has been found to be a reliable and valid measure of rumination (Roelofs et al., 2006), and recent research has documented sufficient validity for shortened versions and using only the rumination items (Brose et al., 2020). For the selected items, the Cronbach’s α was .830 indicating good reliability.

Working Memory

Two working memory measures from the Automated Working Memory Assessment (AWMA; Alloway, 2007). This working memory assessment was chosen due to its availability at the time of assessment. In the listening recall task, the participant verifies a series of sentences by stating “true” or “false” and recalls the final word for each sentence in sequence. In the spatial recall task, the participant views a picture of two arbitrary shapes where the shape on the right has a red dot on it and identifies whether the shape on the right is the same or opposite of the shape on the left. The shape with the red dot may also be rotated. At the end of each trial, the participant recalls the location of each red dot on the shape in sequence by pointing to a picture with three compass points. Test–retest reliability for the listening recall is .88 and for the spatial recall task is .79 (Alloway et al., 2006; test validity is reported in Alloway et al., 2009). Standard scores (M = 100, SD = 15) were recorded.

Self-Injury and Suicidal History

Participants were administered a self-injury measure developed by the authors of the study, assessing whether or not they had any incidents of self-injury or suicide in their past by indicating yes or no. Specifically, participants were asked “Have you ever deliberately taken an overdose (e.g., pills or medication) or deliberately tried to harm yourself in any other way?” Of the original sample of 101, 19% reported engaging in self-injury. Items assessing the intention, frequency, and the method of self-injury were also included, but due to a low response rate, were not included in analysis.

Procedure

This study was conducted in two phases. In Phase 1, participants recruited from a British undergraduate psychology class completed the selected questions from the CES-D, DEQ, and RRS online to assess depression, self-criticism, and rumination, respectively. In Phase 2, the same group of participants completed the AWMA in a lab setting. All participants completed both phases of the study, and Phase 2 immediately followed Phase one. Participants were debriefed and if an individual responded yes to self-injuring, they were provided with a referral list for further counseling.

Data Analytic Plan

Descriptive statistics were first computed for the mental health measures and demographic information, and correlations were determined between all the included measures (See Table 1 and 2). Following, a multivariate analysis of variance (MANOVA) was conducted to determine significant differences between gender, age, depression (CES-D), working memory scores (AWMA), self-criticism (DEQ), and rumination (RRS). Additionally, multiple one-way analysis of variance (ANOVA) explored the differences between those classified as having significant depressive symptoms compared to those with little to no depressive symptoms, and rates of self-harming in both groups. Following, a binary logistic regression explored which of the independent variables were most associated with self-harm. Lastly, we used a Regression Tree model known as the Classification and Regression Tree (CART). This model has successfully been used to make predictions in medical and clinical settings and has also been used in psychology for decision-making (Steadman et al., 2000). This procedure is based on a questions-decision-tree model where questions are asked on a sequential basis to identify the best set of predictors for a specified outcome. All analyses were completed using SPSS, Version 27.

Table 1.

Correlation coefficients between working memory and mental health scores.

	Verbal WM	Visual spatial WM	Self-criticism (DEQ)	Depression (CES-D)	Reflection (RRS)	Brooding (RRS)
Verbal WM	1
VS WM	.42^*	1
Self-criticism	.04	.05	1
Depression	.02	−.05	.69^*	1
Reflection	.11	.28^*	.52^*	.44^*	1
Brooding	.15	.19	.67^*	.43^*	.56^*	1

Note. WM = Working Memory; * p < .01.

Table 2.

Binary logistic regression of factors associated with self-harm (full sample: N = 101).

Variable	B	SE	Wald	Sig.	CI (Lower/Upper)
Verbal WM	.005	.027	.029	.864	.953	1.060
VSWM	.029	.027	1.085	.298	.975	1.086
Reflection (RRS)	.035	.118	.088	.767	.822	1.304
Brooding (RRS)	−.096	.127	.573	.449	.707	1.166
Depression (CES-D)	−.053	.041	1.688	.194	.875	1.027
Self-criticism (DEQ)	−1.163	.536	4.709	.030*	.109	.894

Note. * p < .05.

Results

The sample mean scores and standard deviations for the verbal working memory (AWMA; M = 100.23; SD = 12.93)), visual spatial working memory (AWMA; M = 97.61; SD = 14.22), self-criticism (DEQ; M = 67.97; SD = 19.06), depression (CES-D; M = 14.91; SD = 9.50), brooding rumination (RRS; M = 10.55; SD = 3.19), and reflection rumination (RRS; M = 9.55; SD = 3.13) assessments are all in average range for a nonclinical population in this age range. A multivariate analysis of variance (MANOVA) indicated no significant differences between men and women on the CES-D [F (1, 99) = .005, p = .946], DEQ [F(1, 99) = 1.759, p = .188], RRS brooding [F(1, 99) = .316, p = .575], RRS reflection [F(1, 99) = 4.942, p = .028] or verbal [F(1,99) = .302, p = .584] or visual working memory [F(1, 99) = 3.560, p = .062]. Using a median split procedure (median age 19), a MANOVA indicated that for verbal working memory, neither those over the age of 19 verbal [F(1, 38) = .676, p = .752] or for those under the age of 19 [F(1, 15) = .007, p = .934] demonstrated significant age differences. The same pattern emerged for visual working memory [> 19: F (1, 38) = 1.053, p = .422; <19: F(1, 15) = 2.105, p = .167]. For each analysis, the p value was reduced from .05 to .01 due to multiple comparisons.

Participants were divided into two groups based on their depressive symptoms on the CES-D, according to the scoring criteria suggested by the scale’s authors: A score of 16 or higher is considered to indicate moderate/severe depressive symptoms. Forty-four participants met criteria for significant depressive symptoms while 57 did not meet this threshold. Within the total sample, 19 had a previous history of self-harm (13 within the depressed group; six within the non-depressed group). A one-way ANOVA confirmed that there was a significant difference in depression scores between these groups: [F (1, 99) = 222.923, p < .001], but after reducing the p value, there were no significant differences between rates of self-harm in the depressed and non-depressed group [F (1, 99) = 6.121, p = .015]. A one-way ANOVA comparing the depressed and non-depressed groups found significance for RSS brooding [F (65, 35) = 3.361, p <.001], but no significant difference between the verbal or visual working memory scores [F (65, 35) = .864, p = .699; F (65, 35) = .803, p = .751] or self-criticism [F (65, 35) = 1.549, p = .080].

Hypothesis 1

Working memory scores will be negatively correlated with depression, self-criticism, and rumination.

Correlation coefficients between the scores are shown in Table 1. There was no significant correlation between verbal working memory recall and the mental health scores: depression, self-criticism, reflection, and brooding. Similarly, visuospatial working memory recall was not significantly correlated with depression, self-criticism, and brooding. However, visuospatial working memory was significantly correlated with reflection. The mental health scores were significantly related with each other: depression with self-criticism as well as with both reflection and brooding. Self-criticism was also significantly correlated with both reflection and brooding. Please see Table 1 for correlation coefficients and significance values.

Hypothesis 2

Higher scores in rumination and self-criticism and lower scores in working memory will be associated with self-harming behaviors.

A binary logistic regression examined working memory, depression, self-criticism, and reflection and brooding aspects of rumination to see which were most significantly associated with self-harm. The overall model was significant, χ2(6, N = 101) = 27.90, p < .001, Nagelkerke’s R² = .390 but the analysis indicated that only self-criticism was significantly associated with self-harm. Neither rumination, verbal, or visual working memory performance were significantly associated with self-harm. Please see Table 2 for additional information.

Classification and Regression Tree (CART)

Lastly, we used a Regression Tree model known as the Classification and Regression Tree (CART) to further determine which factors were associated with SH. CART is designed to identify higher-order variables that are most related to a target variable (SH), and is sometimes preferable to parametric approaches due to its ability to examine higher-order interactions among predictors to identify similar subgroups and is less influenced by the effects of multicollinearity, (Merkle & Shaffer, 2011) the full sample were split into two branches based on an initial predictor variable: “One must continually work to gain love from another person, that is, love has to be earned (DEQ).” Subsequent branches were identified until reliable subgroups of self-harm outcomes were represented as nodes. If a participant strongly agreed to this item (with a response greater than 5.5), then the tree predicted that 26% of the participants reported inflicting self-harm. Of those who did not strongly concur with this statement, 74% reported not engaging in self-harming behaviors.

Discussion

The aim of this study was to examine cognitive mechanisms that were associated with SH. The main findings were that neither working memory nor rumination influenced self-harming behaviors; however, self-criticism, specifically the notion that love must be earned, was significantly associated with SH in a nonclinical college-aged population.

Looking first at working memory, neither verbal nor visual spatial working memory performance were significantly associated with SH. This pattern was contrary to the emotional regulation hypothesis, where students with lower executive function overall would likely have poor working memory performance and poor emotional regulation leading to a higher likelihood of SH. While past research is mixed on whether or not deficits in inhibition, impulsivity, and executive function exist in those who SH, these results support the idea that working memory in those who self-injure did not differ significantly from those who did not self-injure. This may have occurred because SH typically occurs under extreme emotional stress and not in a controlled environment which may not capture the complexities of an executive functioning or working memory deficit (Janis & Nock, 2009). Indeed, the working memory group mean scores indicated performance within age-expected levels. It is possible that in circumstances of high stress, the working memory scores of those who SH may be more impaired than those who do not.

The next finding relates to rumination. Even though rumination is a predictor of depression, it was not in the present study. This is consistent with Nolen-Hoeksema’s conceptualization that rumination is not necessarily a negative behavior because it can eventually lead to adaptive behavior (Nolen-Hoeksema et al., 2008). Rumination may be used as a pleasant reflection on past events, which may improve a person’s mood and result in a more lucid thought process and better problem-solving ability. Watkins (2008) presents multiple possible constructive consequences of repetitive thoughts, including adaptive preparation and anticipatory planning of similar events by preparing a concrete strategy, and the ability to process and recover from upsetting events by viewing them as an experience that provides an opportunity for learning and future growth.

Similarly, mixed results have been found on whether depression predicts SH with some studies citing elevated levels of depression in self-injurers (Stanley et al., 2001; Zielinski et al., 2017), but others finding no link (Burke et al., 2019). In the present study, there was a greater incidence of self-harming behaviors among those who demonstrated higher depressive symptoms; however, depression scores were not directly related to these behaviors. There are two possible explanations for this pattern. The first is that we recruited a nonclinical sample, so participants’ depression levels were lower compared to a clinically depressed population. The second possible explanation is that self-criticism may mediate the relationship between depression and SH, where higher levels of self-criticism may be the root cause of elevated levels of both depression as well as SH.

Only self-criticism was significantly associated with SH (in 82.2% of the cases), which is consistent with findings from adult populations (Nagy et al., 2021; Sachs-Ericsson et al., 2006). The results from the regression tree highlighted the importance of a belief that love must be earned, and the participants may use SH as a mechanism to relieve feelings of pressure that they have not done enough to earn love from another. One application of these findings is to improve the efficacy of SH interventions, by lowering levels of self-criticism and improving one’s ability to express self-compassion. Traditional inpatient and outpatient treatments for those who engage in self-harming behaviors are typically educational, resource-based, and are generally not highly effective (Bennewith et al., 2002; Nawaz et al., 2021). One application of these findings is to improve the efficacy of SH interventions, by lowering levels of self-criticism and improving one’s ability to express self-compassion. Self-compassion, specifically self-kindness, emphasizes being kind and understanding toward oneself in instances of pain or failure rather than self-critical Cleare et al., 2019; Neff, 2003). By allowing oneself to fail and not believe it is indicative of an unworthiness to be loved, a person may not feel the need to use self-harm to regulate one’s emotional state. While no known psychotherapies exist that use self-compassion to target SH, Van Vliet and Kalnins (2011) described how specific interventions can utilize self-compassion training to treat NSSI behaviors. These treatments may significantly reduce the amount of SH performed if administered to high-risk groups, such as adolescents or individuals diagnosed with borderline personality disorder.

Specifically, treatments incorporating self-compassion with Compassionate Mind Training (Gilbert & Procter, 2006), or Dialectical Behavioral Therapy (DBT) that includes mindfulness and self-compassion training (Linehan, 2014) may address the underlying mechanisms that can trigger SH behavior. Indeed, one of the main components of these treatments is obtaining emotion regulations skills (e.g., distress tolerance, overall skills building, and mindfulness) that challenge self-critical thinking, and cultivate a more balanced emotional response pattern. For those with high rates of self-criticism, targeting these adverse emotional effects of self-criticism by learning emotion regulation skills may reduce self-harming behavior. Exploring the cognitive antecedents of SH is critical to improving the efficacy of current treatments, as insight into specific predictors and an increased overall understanding of the mechanisms responsible for SH can lead to proper assessment and more targeted interventions.

Limitations

As an exploratory, cross-sectional study, several limitations exist that could be addressed in future studies. A validated assessment to measure SH is a necessary foundation for more accurate study of antecedents of self-harming behavior. While the current study assessed for SH, the use of a validated SH scale such as the Self-Harm Inventory (SHI; Agustin et al., 2019) or the Deliberate SH Inventory (Duarte et al., 2019) would have strengthened the current methodology. Also, a convenience sample was used, and there was a very low base rate of self-harm; thus, a larger more diverse sample with current self-harm population would lend more power to the analysis. This is especially relevant when considering the differing rates of SH across populations. Similarly, future research should use other working memory assessments to replicate current results. Future research could explore differences in self-criticism between those that SH with and without suicidal intent, and a longitudinal design would be helpful to examine if self-critical attitude precedes SH.

Conclusion

In summary, the present study found that high levels of self-criticism were associated with self-harming behaviors, specifically the belief that love needs to be continually earned from others. There was a greater incidence of self-harming behaviors among those who demonstrated higher depressive symptoms, but depression scores did not directly influence SH. Additionally, working memory scores did not influence rates of SH which may indicate that future research focus on other cognitive mechanisms or broader executive functioning when exploring SH.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Ethical Approval

Provided by University of Stirling, UK

Informed Consent

Informed consent acquired from all participants.

ORCID iD

Rachel K. Carpenter

Author Biographies

Rachel Carpenter, MS Rachel Carpenter is a PhD candidate in the Clinical Psychology Doctoral Program at East Tennessee State University in Johnson City, TN. She completed her Masters degree in Psychological Science at the University of North Florida with a focus on working memory and augmented reality. She approaches the study of digital games and other media using a clinical approach, hoping to use advanced technology to reduce symptomology in a variety of clinical pathologies. Her published work has focused on working memory and testing modalities, augmented reality and mood, and the ecological considerations of intimate partner violence. Her current research explores working memory, suicide, and severe mental health considerations.

Tracy Packiam Alloway, PhD, is an award-winning psychologist, professor, author, and TEDx speaker. She has published 13 books and over 100 scientific articles on the brain and memory. She has also provided consultancy to the World Bank on reading in developing countries and is a sought-after speaker internationally. Her research has also been featured on BBC, Good Morning America, the Today Show, Forbes, Bloomberg, The Washington Post, and Newsweek, and many others. She was also featured as an expert in the documentary The Observed Life.

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