Self-compassion as an emotion regulation strategy in major depressive disorder Alice Diedrich a, * , Michaela Grant b , Stefan G. Hofmann c , Wolfgang Hiller b , Matthias Berking d a University of Munich, Department of Psychiatry and Psychotherapy, Research Group: Behaviour Therapy, Nußbaumstr.7, 80336 Munich, Germany b University of Mainz, Department of Clinical Psychology and Psychotherapy, Wallstr. 3, 55122 Mainz, Germany c Boston University, 648 Beacon Street, 4th Floor, Boston, MA 02215, USA d University of Erlangen-Nuremberg, Department of Psychology and Sport Sciences, Bismarckstr. 6, 91054 Erlangen, Germany article info Article history: Received 14 October 2013 Received in revised form 4 May 2014 Accepted 7 May 2014 Available online 27 May 2014 Keywords: Depression Self-compassion Cognitive reappraisal Acceptance Emotion regulation Mood abstract Cognitive reappraisal and acceptance are two presumably adaptive emotion regulation strategies in depression. More recently, self-compassion has been discussed as another potentially effective strategy for coping with depression. In the present study, we compared the effectiveness of self-compassion with a waiting condition, reappraisal, and acceptance in a clinically depressed sample, and tested the hy- pothesis that the intensity of depressed mood would moderate the differential efficacy of these strate- gies. In an experimental design, we induced depressed mood at four points in time in 48 participants meeting criteria for major depressive disorder. After each mood induction, participants were instructed to wait, reappraise the situation, accept their negative emotions, or employ self-compassion to regulate their depressed mood. Self-ratings of depressed mood were assessed before and after each mood in- duction and regulation phase. Results showed that the reduction of depressed mood was significantly greater in the self-compassion condition than in the waiting condition. No significant differences were observed between the self-compassion and the reappraisal condition, and between the self-compassion and the acceptance condition in patients' mood ratings. However, the intensity of self-rated depressed mood at baseline was found to moderate the comparative effectiveness of self-compassion and reap- praisal with a trend of self-compassion being more effective than reappraisal in high depressed mood at baseline. These findings support the use of self-compassion as another adaptive emotion regulation strategy for patients with major depressive disorder, especially for those suffering from high levels of depressed mood. © 2014 Elsevier Ltd. All rights reserved. Major depressive disorder (MDD) is one of the most prevalent (Kessler et al., 2005) and debilitating (Üstün, Ayuso-Mateos, Chat- terji, Mathers, & Murray, 2004) mental disorders. In the last two decades, various authors have explored the role of deficits in adaptive emotion regulation (ER) as a putative risk or maintaining factor of this frequently recurring (Judd, 1997; Kupfer, 1991; Solomon et al., 2000) or even chronic (Keller et al., 1992) disorder (e.g., Berking, Ebert, Cuijpers, & Hofmann, 2013; Hofmann, Sawyer, Fang, & Asnaani, 2012). Thompson (1994) defined ER as “extrinsic and intrinsic processes responsible for monitoring, evaluating, and modifying emotional reactions, especially their intensive and temporal features, to accomplish one's goals” (pp. 27e28). The term adaptive ER usually refers to the application of strategies that allow the individual to cope with undesired emotions in a way that does not interfere with the attainment of personally relevant goals and the satisfaction of basic-needs (Bridges, Denham, & Ganiban, 2004; Grawe, 2007). With regard to the assumed influence of deficits in adaptive ER on the development and maintenance of depression, Berking and Whitley (2014) hypothesized that such cause aversive affective states to persist longer and with greater intensity than desired by the individual, and also lead to the individual experiencing a loss of control over their feelings and hence to the impression that these feelings will continue to impair their well being. According to Teasdale and Barnard (1993), the appraisal of a situation as highly aversive, uncontrollable and stable over time results in the activation * Corresponding author. Tel.: þ49 89 4400 52721. E-mail addresses: alice.diedrich@med.uni-muenchen.de (A. Diedrich), grant@ uni-mainz.de (M. Grant), shofmann@bu.edu (S.G. Hofmann), hiller@uni-mainz.de (W. Hiller), matthias.berking@fau.de (M. Berking). Contents lists available at ScienceDirect Behaviour Research and Therapy journal homepage: www.elsevier.com/locate/brat http://dx.doi.org/10.1016/j.brat.2014.05.006 0005-7967/© 2014 Elsevier Ltd. All rights reserved. Behaviour Research and Therapy 58 (2014) 43e51