PERFECTIONISM, HELP-SEEKING, AND SELF-COMPASSION

Transcription

1 PERFECTIONISM, HELP-SEEKING, AND SELF-COMPASSION By TESSA WIMBERLEY A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA

2 2017 Tessa Wimberley 2

3 To my loving family, mentors, and friends 3

4 ACKNOWLEDGMENTS I thank my family, in all of its many forms, for the depth of support they have provided me over the past five years. This dissertation would not have been possible were it not for the unwavering love and dedication I received from each of them. Specifically, I cannot express enough gratitude for my parents; their resilience was the greatest gift I received through this process. I also want to send utmost appreciation to my mentor, Laurie, for the exceptional guidance and genuine care I received from her at every turn during my graduate school career. Lastly, I want to thank my partner, John, for all of the laughter, kindness, and acceptance he has given me even during the most confusing and difficult moments. 4

5 TABLE OF CONTENTS page ACKNOWLEDGMENTS... 4 LIST OF TABLES... 7 LIST OF FIGURES... 8 ABSTRACT... 9 CHAPTER 1 INTRODUCTION AND BRIEF LITERATURE REVIEW Perfectionism Help-Seeking and Help-Seeking Barriers Perfectionism and Help-Seeking Perfectionism, Help-Seeking, and Self-Compassion Hypotheses and Research Question METHOD Participants and Recruitment Instruments Demographic Variables Trait Perfectionism Perfectionistic Self-Presentation Help-Seeking Attitudes Help-Seeking Intentions Self-Compassion RESULTS Preliminary Analyses Data Analysis Measurement Model Structural Models Bootstrapped Path Analysis Direct effects Indirect effects Total effects Additional Analyses Exploratory Analyses DISCUSSION

6 APPENDIX A ALMOST PERFECT SCALE-REVISED (APS-R) B PERFECTIONISTIC SELF-PRESENTATION SCALE (PSPS) C INVENTORY OF ATTITUDES TOWARD SEEKING MENTAL HEALTH SERVICES (IASMHS) D GENERAL HELP-SEEKING QUESTIONNAIRE (GHSQ) E SELF-COMPASSION SCALE (SCS) REFERENCES BIOGRAPHICAL SKETCH

7 LIST OF TABLES Table page 3-1 Descriptive Statistics for Study Variables Correlation Matrix for Study Variables Descriptive Statistics for Demographic Variables Direct, indirect and total effects in the path model Means and standard deviations of predictor and mediator variables by classification

8 LIST OF FIGURES Figure page 3-1 Initial measurement model Initial structural model Revised measurement model Revised structural model, direct pathways Revised structural model, direct and indirect pathways

9 Abstract of Dissertation Presented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy PERFECTIONISM, HELP-SEEKING, AND SELF-COMPASSION Chair: Laurie Mintz Major: Counseling Psychology By Tessa Wimberley August 2017 Perfectionism is a commonly studied multidimensional personality construct that has widely been associated with negative mental health outcomes. Perfectionistic selfpresentation is a concept specifically pertaining to the management of interpersonal perceptions of perfection that is similarly related to negative effects. While treatments for perfectionism have been the focus of recent lines of research, the attitudes and intentions that perfectionists hold toward seeking help are not well understood. Selfcompassion is one construct that has strong implications for the relationship between perfectionism and help-seeking. The present study tested trait perfectionism and perfectionistic self-presentation as predictors of help-seeking attitudes and intentions; self-compassion was examined as a mediator variable. Findings from this study revealed that trait perfectionism did not predict help-seeking as hypothesized but that perfectionistic self-presentation and self-compassion both play significant roles in predicting help-seeking attitudes and intentions. The results of this study have potential clinical implications in terms of the utility of enhancing self-compassion among perfectionists. 9

10 CHAPTER 1 INTRODUCTION AND BRIEF LITERATURE REVIEW Perfectionism is broadly defined as a personality construct related to individuals personal standards and striving behavior that has been investigated across a range of areas, such as mental health, academic performance, interpersonal functioning, and models of personality (e.g. Hewitt et al., 2003; Rice, Ashby, & Slaney, 2007; Rice, Leever, Christopher, & Porter, 2006; Rice, Neimeyer, & Taylor, 2011; Stoeber, 2012). Indeed, perfectionism s role across a spectrum of psychological functioning has been clearly established via various lines of research over the past two decades (Lo & Abbott, 2013). The purpose of this study was to extend this line of research by examining the relationship between perfectionism and help-seeking intentions and attitudes. The following brief review first delineates the construct of perfectionism, including treatment for this concern, before overviewing the concept of help-seeking, including barriers to seeking help. Then the overlap between these two constructs is discussed, with a specific focus on the role of self-compassion. Finally, the purpose and hypotheses of the study are more specifically detailed. Perfectionism Perfectionism is conceptualized as an established personality trait, rather than as a temporary state of being. Indeed, as a trait personality construct, researchers have at times differentiated between maladaptive and adaptive forms of perfectionism as well as discussed a non-perfectionistic personality (Rice & Ashby, 2007). Slaney and colleagues (2001) define adaptive perfectionism as simply holding oneself to high standards, whereas maladaptive perfectionism exists when an individual's high personal standards are also accompanied by disproportionate, self-critical perceptions 10

11 of inadequacy. The chasm between an individual s high standards and their perception of their performance is often called discrepancy (Slaney, Rice, Mobley, Trippi, & Ashby, 2001). Another oft-mentioned aspect of maladaptive perfectionism discussed in the literature is perfectionistic self-presentation. This refers to a tendency for individuals to interpersonally present themselves as perfect in an attempt to conceal imperfections and manage others impressions of them (Hewitt et al., 2003). Hewitt and colleagues (2003) identify three facets of perfectionistic self-presentation: perfectionistic selfpromotion (i.e. attempting to look, demonstrate, or behave in a perfect manner to others), non-display of imperfections (i.e. attempting to prevent others from seeing behavior of a less-than perfect manner), and non-disclosure of imperfections (i.e. attempting to avoid situations that involve admitting or discussing real or perceived shortcomings, mistakes, or failures). Whereas trait perfectionism reflects an individual s deep desire or need to be perfect, perfectionistic self-presentation reflects a more specific need to appear to be perfect; Hewitt et al. (2003) believe that all three facets of perfectionistic self-presentation are associated with personal and interpersonal distress. Existing theory and research suggest that both maladaptive trait perfectionism and perfectionistic self-presentation (hereafter, together referred to as perfectionism) confer vulnerability to psychopathology and decreased well-being (Mackinnon & Sherry, 2012). Indeed, perfectionism has been associated with negative outcomes and psychological distress, such as depression, anxiety, suicidality, eating disorders, substance-related disorders, relationship difficulties, and low self-esteem (Rice, Neimeyer, & Taylor, 2011). In fact, in a clinical review of perfectionism, Egan, Wade, 11

12 and Shafran (2011) contend that perfectionism contributes to the etiology and maintenance of multiple psychiatric disorders, thus asserting that it can be considered a detrimental transdiagnostic process. Not surprisingly, effective methods for assuaging perfectionism have received increased research attention in recent years. Efficacious treatments for this construct and related distress have been identified among several randomized controlled trials (RCTs), the majority of which have employed a cognitive-behavioral approach. Shafran, Cooper, and Fairburn (2002), Pleva and Wade (2007), Kutlesa and Arthur (2008), Arpin- Cribbie and colleagues (2008), Rice and colleagues (2011), as well as Egan and colleagues (2014) have all applied cognitive-behavioral approaches to alleviating perfectionism and all have reported positive outcomes. Additionally, mindfulness and acceptance-based approaches for perfectionism have begun to emerge. Of note, a recent study examining a mindfulness-based self-help intervention for perfectionism demonstrated positive effects in reducing levels of perfectionism and perceived distress among its participants (Wimberley, Mintz, & Suh, 2016). While interventions for perfectionists are clearly needed, the question remains whether perfectionistic individuals would be willing to seek help in the first place, with this question particularly salient for those high in perfectionistic self-presentation. Before turning to this question, however, it is important to first understand the definitions and findings from the general literature surrounding help-seeking. Help-Seeking and Help-Seeking Barriers Help-seeking in a mental health context can be understood as an adaptive coping process characterized by attempting to obtain external assistance for mental health concerns (Rickwood & Thomas, 2012). Help-seeking attitudes pertain to 12

13 individuals cognitive and emotional perspectives toward pursuing help, whereas helpseeking intentions and behaviors relate more directly to the actual likelihood and behavioral process of obtaining help, respectively. Thus, both attitudes and intentions are relevant in gauging individuals general predisposition toward help-seeking behaviors (Rickwood & Thomas, 2012). Help-seeking can take a variety of forms. Rickwood, Deane, Wilson, and Ciarrochi (2005) describe help-seeking as a form of coping that involves interacting with other people. These authors distinguish between informal help-seeking (i.e. support from family and friends) and formal help-seeking (i.e. support from professionals or expert others). Nevertheless, help-seeking is not limited to direct and in-person receipt from others; self-help has recently emerged as an area of attention, in part due to rapidly growing opportunities to use technology to support mental health (Rickwood & Thomas, 2012). Help-seeking can thus pertain to self-help sources such as visual, written, or programmed material that may be available either concretely or through online or computer-mediated mediums (Rickwood & Thomas, 2012). In sum, there are multiple sources of help, which can be categorized in different ways, including formal, informal, and self-help (Rickwood & Thomas, 2012). Certainly, understanding help-seeking attitudes, intentions, and behavior is essential to identifying factors that can increase engagement in counseling and other psychological treatments (Wilson, Deane, Ciarrochi, & Rickwood, 2005). There are many diverse potential barriers to seeking help. Societal stigma and accessibility are generally considered the two main inhibitors for help-seeking (McClure, 2014). Stigma research has demonstrated that individuals are aware of the sometimes negative social repercussions and judgments that exist for those who seek professional 13

14 help (Biddle, Donovan, Sharp, & Gunnell, 2007; Brown et al., 2010; Corrigan, 2004; Gulliver, Griffiths, & Christensen, 2010; Schomerus & Angerneyer, 2008; Vogel, Wade, & Ascheman, 2009; Zartaloudi & Madianos, 2010). Gulliver et al. (2010) reviewed existing research on barriers and facilitators to pursuing professional help and identified mental health stigma as the single most commonly cited barrier to seeking mental health treatment for young adults and adolescents. Even when stigma is overcome, the practicality of obtaining necessary treatment often poses its own limitations. Accessibility barriers to mental health services are typically related to cost, time, location, access, and knowledge about service options (Craske et al., 2005; Mojtabaj et al., 2011; Sturm & Sherbourne, 2001). Related to these barriers, numerous researchers have examined the relationship between help-seeking and demographic characteristics. Such research reveals that males are significantly less likely to have intentions and positive attitudes toward helpseeking than are females (McClure, 2014). This may be because help-related concepts such as dependence and vulnerability are more easily reconciled with societal expectations for females than for males (Addis & Mahalik, 2003; Gorsky, 2010). On the other hand, conclusive findings appear lacking regarding the correlation between age and attitudes related to seeking help, with some studies finding older individuals more likely to seek help (MacKenzie, Gekoski, & Knox, 2006) and other studies finding the reverse (Gulliver, Griffiths, & Christensen, 2010; Rickwood, Deane, & Wilson, 2007). In terms of race/ethnicity, studies find that Caucasian Americans tend to have a more favorable attitudes and greater likelihood of utilizing mental health services than do African Americans or Latino/a Americans (Conner et al., 2010; Wells, Klap, Koike, & 14

15 Sherbourne, 2001). Such findings may be influenced by societal and cultural expectations as well as unjust, differential treatment of minority individuals in comparison to members of the dominant culture (Harley, Jolivette, McCormick, & Tice, 2002). Additionally, there are mixed findings for SES, as some research indicates that lower SES is associated with increased mental health help-seeking (Martin, 2002), and other research indicates that lower SES is related to negative attitudes toward helpseeking (Jagdeo, Cox, Stein, & Sareen, 2009). Clearly, there are a multitude of potential characteristic barriers towards seeking help. Perfectionism and Help-Seeking Intuitively, it would seem that perfectionism (i.e., the need to be perfect) and perfectionistic self-presentation (i.e., the need to appear perfect) may prevent individuals from seeking help. Nevertheless, perfectionism and help-seeking have only infrequently been examined together. Ey, Henning, and Shaw (2000) examined helpseeking attitudes for mental health treatment among medical and dental students. They found socially-prescribed perfectionism to be more associated with students who were distressed, not in treatment, and held more negative attitudes to mental health seeking (Ey et al., 2000). DeRosa, Flett, and Hewitt (2014) examined personality, help-seeking attitudes, and depression among adolescents. In this sample, they found that perfectionistic self-presentation predicted unique variance in symptoms of depression, self-concealment, and negative help-seeking attitudes (DeRosa, Flett, & Hewitt 2014). Flett and Hewitt (2014) conclude that these data suggest that students who are preoccupied with needing to appear perfect will not seek help when it is required, in part, because the act of seeking help can be regarded as an open admission of failure and of not being perfect. Along a similar vein, in their longitudinal study exploring the 15

16 relationship between perfectionism and subjective well-being, Mackinnon and Sherry (2012) reported findings that perfectionistic self-presentation mediated the relationship between higher levels of perfectionistic concerns and lower levels of well-being. Most recently, in their investigation of perfectionism, religious motivation, and help-seeking attitudes toward mental health services among Latter-Day Saint undergraduate students, Rasmussen et al. (2013) reported that higher levels of perfectionism predicted more negative attitudes toward help-seeking. In sum, the limited literature clearly points to the conclusion that perfectionism is a barrier to seeking help, a possibility that is particularly troubling in consideration that perfectionism has been found to be related to psychological distress--or in other words, the very reason that help may be beneficial to such individuals in the first place. Flett, Hewitt, and Heisel (2014) thus urge future mental health prevention efforts to include taking active steps to resolve the unwillingness of perfectionistic self-presenters to seek help and the sense of social isolation and disconnection that such individuals feel. Thus, continued investigation of the relationships between help-seeking and perfectionism would be helpful in expanding this literature and working toward its eventual clinical application. Perfectionism, Help-Seeking, and Self-Compassion While never previously examined in relation to help-seeking and perfectionism, the construct of self-compassion may play an important role in fully understanding the connections between perfectionism and help-seeking. Self-compassion involves feeling touched by one s own suffering, generating the desire to alleviate that suffering, and treating oneself with kindness, understanding, and concern (Neff, 2003). Neff (2003) further conceptualizes self-compassion as having three interacting components: selfkindness versus self-judgment, a sense of common humanity versus isolation, and 16

17 mindfulness when encountering painful thoughts and feelings versus over-identifying with this pain (i.e. perceiving transient feelings as central to one s sense of self). Importantly, self-compassion is considered to require a baseline mindful state of nonjudgmental awareness and acceptance of one s experience and has an intrinsic goal of generating self-directed kindness and care to reduce personal suffering (Neff, 2003). Findings from both Allen and Leary (2010) and Neff, Hsieh, and Dejitterat (2005) suggest that self-compassionate people tend to rely more heavily on adaptive coping strategies, such as positive cognitive restructuring, and less so on avoidance and escape when confronted with distress or personal failures. Per Hewitt et al. s (2003) notion that perfectionistic self-presentation can be viewed as a method of avoidance and distancing from the distress of being seen as imperfect, it seems likely that selfcompassion could be an important component in improving coping and help-seeking for perfectionistic self-presenters. Indeed, Neff, Kirkpatrick, and Rude (2007) reported that self-compassion can serve as a protective factor against self-evaluative anxiety when considering personal weaknesses. Clearly, gaining an increased understanding of how self-compassion may influence distress and coping (including help-seeking) among perfectionists would be beneficial. Hypotheses and Research Question In light of the reviewed literature, the current study aims to examine the relations between perfectionism (i.e., trait perfectionism and perfectionistic self-presentation) and help-seeking attitudes and intentions. Additionally, this study will investigate the role of self-compassion in these relationships. Specifically, this study hypothesizes that: 1. Higher levels of trait perfectionism and perfectionistic self-presentation will negatively predict help-seeking attitudes, help-seeking intentions, and selfcompassion. 17

18 2. Higher levels of trait perfectionism and perfectionistic self-presentation will negatively predict intentions for seeking formal and informal help sources and positively predict intentions for seeking self-help sources and not seeking help from any source. 3. Self-compassion will positively predict help-seeking attitudes and help-seeking intentions, as well as mediate the relationships between both trait perfectionism and perfectionistic-self presentation and help-seeking variables. In addition to these hypothesized relationships, this study explores the question of how demographic variables correspond to help-seeking variables. It is hoped that these analyses will help clarify previous conflicting findings regarding demographic differences among gender, age, race/ethnicity, and socioeconomic status (SES) in relation to the construct of help-seeking. 18

19 CHAPTER 2 METHOD Participants and Recruitment A total of 387 participants were recruited for this study. Eligible participants were individuals 18 years of age or older. Participants were primarily recruited via Mechanical Turk (MTurk), the Gator Times listserv, flyers, and undergraduate psychology courses. MTurk is an online data collection website where individuals from all over the world can register to complete tasks (including, but not limited to, surveys) for payment. The study was described to all potential participants as a brief survey of personality and attitudes towards mental health and estimated to require 20 minutes to complete. All participants were given an informed consent form prior to the survey proper and a debriefing form following completion of the survey. MTurk participants were given were given $0.75 in compensation after completion of the survey. Students recruited via psychology courses were offered extra credit in their course as compensation. Those recruited via other sources (e.g. flyers, listservs) were offered the opportunity to receive a $25 gift card allotted to every 50 th participant as compensation. Within the study survey, three validity check items were inserted which asked participants to answer in a specific fashion (e.g., for this item select strongly disagree); those who failed to do so were deleted from the data set (n = 13). Additionally, missing participant responses were evaluated. After the data was determined via statistical analysis to be missing at random (MAR; Tabachnick & Fidell, 2007), these participants were removed from further analyses (n = 9). Following both these exclusions, a total of 365 participants remained. 19

20 Instruments Demographic Variables Those who consented to participate were asked to provide the following demographic information: age, gender, race/ethnicity, primary language, relationship status, sexual orientation, highest level of education, and household income. Trait Perfectionism Trait perfectionism was assessed using two of the three subscale scores of the 23-item Almost Perfect Scale-Revised (APS-R; Slaney et al., 2001). Twelve items of the APS-R assess Discrepancy (i.e. the experienced difference between expectation and reality of meeting standards) and seven items assess High Standards (i.e. holding oneself to a high standard of performance and having high expectations of oneself). Example items from the Discrepancy subscale include I am never satisfied with my accomplishments, and Doing my best never seems to be enough. Item examples for High Standards include I try to do my best at everything I do, and If you don t expect much out of yourself, you will never succeed. Participants indicate the extent to which they agree or disagree with each item on a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). Scores on the Discrepancy subscale can range from 12 to 84 and scores on the High Standards subscale can range from 7 to 49. In all cases, higher scores indicate higher levels of that dimension of perfectionism. Psychometric analyses on the APS R have supported the reliability and validity of the subscales. Structure coefficients of items have been reported to range from.42 to.88 and internal reliability has been reported as follows: High Standards α =.85 and Discrepancy α =.91 (Slaney, Rice, & Ashby, 2002; Slaney et al., 2001). See Appendix A for full measure. 20

21 Perfectionistic Self-Presentation The Perfectionistic Self-Presentation Scale (PSPS; Hewitt et al., 2003) was used to assess interpersonal expression of perfectionism using a 7-point Likert scale from 1 (strongly disagree) to 7 (strongly agree). This 27-item measure contains three subscales: perfectionistic self-promotion (10 items; e.g., I must always appear to be perfect ), nondisplay of imperfection (10 items; e.g., I do not want people to see me do something unless I am very good at it ), and nondisclosure of imperfection (seven items; e.g., admitting failure to others is the worst possible thing ). Scores on the perfectionistic self-promotion subscale can range from 10 to 70, scores on the nondisplay of imperfection subscale can range from 10 to 70, and scores on the nondisclosure of imperfection subscale can range from 7 to 49. In all cases, higher scores indicate higher levels of perfectionistic self-presentation. The multidimensionality, reliability, and validity of the PSPS have been supported by studies using adult samples with test-retest alpha coefficients of.83 for perfectionistic selfpromotion,.84 for nondisplay of imperfection, and.74 for nondisclosure of imperfection (e.g., Hewitt et al., 2003). See Appendix B for full measure. Help-Seeking Attitudes The Inventory of Attitudes toward Seeking Mental Health Services (IASMHS; Mackenzie, Knox, Gekoski, & Macaulay, 2004) was utilized to measure help-seeking attitudes. The IASMHS is a 24-item questionnaire and has been standardized for use in the general population and relates to common concerns that individuals face when considering seeking help for mental health issues (Mackenzie et al., 2004). The IASMHS contains three subscales with eight items each: psychological openness, helpseeking propensity, and indifference to stigma (Mackenzie et al., 2004). Item examples 21

22 from each of the aforementioned subscales respectively include: There are certain problems which should not be discussed outside of one s immediate family, I would want to get professional help if I were worried or upset for a long period of time, and I would be embarrassed if my neighbor saw me going into the office of a professional who deals with psychological problems (Mackenzie et al., 2004). Items are rated on a five-point Likert scale ranging from 0 (disagree) to 4 (agree) (Mackenzie et al., 2004). Scores on each subscale range from 0 to 32, where a higher score indicates more positive attitudes toward help-seeking. MacKenzie et al. (2004) reported good internal consistency (i.e., Cronbach s alpha =.76) and test-retest reliability at (i.e., r =.87). See Appendix C for full measure. Help-Seeking Intentions Help-seeking intentions was assessed with the General Help-Seeking Questionnaire (GHSQ; Wilson et al., 2005). This scale was designed to be modifiable for different purposes and needs such that the help-sources used as items and the provided prompt for help (i.e. the type of problem for which participants would intend to seek help) can be changed (Wilson et al., 2005). For the current study, items were grouped into four categories: four items composed informal help sources (e.g. intimate partner, friend, parent, non-parent family member), five items composed formal help sources (e.g. mental health professional, phone helpline, doctor/general practitioner, spiritual/religious leader, academic/vocational figure), one item composed self-help seeking (e.g. self-help resources), and one item composed non-help seeking (e.g. I would not seek help from any source). The following sources were modified from the original scale: Intimate partner became intimate partner (e.g., girlfriend, boyfriend, husband, wife), mental health became mental health professional (e.g. psychologist, 22

23 psychiatrist, social worker, counselor), phone help line became phone helpline (e.g. crisis hotline), doctor/gp became doctor/general practitioner, religious leader became spiritual or religious leader (e.g. Minister, Priest, Rabbi, Chaplain), teacher became academic/vocational figure (e.g. teacher, supervisor, mentor), and youth worker was removed. The following source was added to the utilized version of the scale: self-help resources (e.g. books, audiotapes, web-based content). For the proposed study, a general mental health problem prompt was used (e.g. If you were having personal-emotional problems, how likely is it that you would seek help from the following sources?). All items are rated on a Likert scale from 1 (extremely unlikely) to 7 (extremely likely). The score ranges was as follows: 4 to 28 for informal sources, 5 to 35 for formal sources, 1 to 7 for self-help sources, and 1 to 7 for no help-seeking (reverse coded). For all sources, higher scores indicate higher intentions toward help-seeking. The GHSQ has been shown to have adequate predictive, convergent, and divergent validity as well as acceptable test retest reliability with Cronbach s alpha ranging from.70 to.86 (Wilson et al., 2005). See Appendix D for full measure. Self-Compassion Self-compassion was measured via the 26-item Self-Compassion Scale (SCS; Neff, 2003), which assesses the positive and negative aspects of the three main components of self- compassion: Self-Kindness (five items; e.g., I try to be understanding and patient toward aspects of my personality I don t like ) versus Self- Judgment (five items, reverse-coded; e.g., I m disapproving and judgmental about my own flaws and inadequacies ); Common Humanity (four items; e.g., I try to see my failings as part of the human condition ) versus Isolation (four items; reverse-coded; e.g., When I think about my inadequacies it tends to make me feel more separate and 23

24 cut off from the rest of the world ); and Mindfulness (four items; e.g., When something painful happens I try to take a balanced view of the situation ) versus Over-Identification (four items, reverse-coded; e.g., When I m feeling down I tend to obsess and fixate on everything that s wrong. ). Responses are given on a 5-point scale ranging from 1 (almost never) to 5 (almost always). Mean scores on the six subscales can be summed to create an overall self-compassion score. Scores range from 26 to 130 with higher scores indicating higher levels of self-compassion. The SCS has demonstrated good internal and test-retest reliability in past research (Cronbach s alpha ranging from.80 to.93), and has been shown to differentiate between groups in a theoretically consistent manner (Neff, 2003). See Appendix E for full measure. 24

25 CHAPTER 3 RESULTS This chapter outlines the results of the analyses used to explore the stated hypotheses and research questions investigated in this study. Two statistical packages, AMOS 20.0 and SPSS 19.0, were used to conduct all analyses. Preliminary Analyses Prior to conducting the main study analyses, the variables of interest and demographic data information were inspected for data entry accuracy and missing values. Additionally, the study variable distributions were examined to determine the fit between their distributions and the assumptions of the General Linear Model (GLM) and multivariate analysis. Nine cases were identified through Mahalanobis distance as multivariate outliers with p <.001. With nine outliers deleted, 356 cases remained. Thus, data from 356 participants were utilized in the present study s analyses. Descriptive statistics, including means, standard deviations, skewness, and kurtosis, were obtained (Table 3-1), and Pearson correlation coefficients were computed among all study variables (Table 3-2). All outcome variables were strongly and significantly associated with one another; however, there was no evidence of multicollinearity (with no bivariate correlation =.85 ; Lei & Wu, 2007). Given that skewness and kurtosis ranged between ± 1, the data were assumed to be normally distributed. Descriptive statistics for the demographic variables were also calculated; means and standard deviations for relevant demographic characteristics are presented in Table 3-3. The internal reliability of each self-report scale for the study s sample was calculated using Cronbach s reliability coefficient alpha. The Cronbach s alpha for Discrepancy and High standards as measured by the APS-R were.96 and.90 for this 25

26 sample, respectively. The Cronbach s alphas for the subscales of the PSPS for this sample were.77 for the perfectionistic self-promotion subscale,.84 for the nondisplay of imperfection subscale, and.33 for the nondisclosure of imperfection subscale. The Cronbach s alphas for the IASMHS subscales for this sample were.63 for the psychological openness subscale,.83 for the help seeking propensity subscale, and.70 for the indifference to stigma subscale. The Cronbach s alphas for the GHSQ subscales for this sample were.58 for the informal help subscale and.77 for the formal help subscale. Lastly, the Cronbach s alphas for the SCS subscales for this sample were.90 for the self-kindness subscale,.90 for the self-judgment subscale,.84 for the common humanity subscale,.88 for the isolation subscale,.84 for the mindfulness subscale, and.87 for the over-identification subscale. Due to the low alphas observed for the PSPS nondisclosure of perfectionism, IASMHS psychological openness, and GHSQ informal help subscales, researchers attempted to modify these scaled to improve reliability. The PSPS nondisclosure subscale was successfully modified to exclude its weakest items in this sample, one and 16. Cronbach s alpha for this modified version of the nondisclosure of imperfection scale containing five items was.71. However, both the IASMHS psychological openness and GHSQ informal help subscales were not able to be successfully improved via item elimination. Thus, these two subscales were utilized in analyses in their original format. This should be noted as a limitation to the current study and future studies should examine the psychometric properties of these scales in more detail. Data Analysis Anderson and Gerbing s (1988) recommendations were used to assess model fit, namely using a two-step process when conducting structural equation modeling (SEM) 26

27 analyses. They proposed that conducting a confirmatory factor analysis (CFA) of the underlying measurement model before evaluating the structural model is preferred rather than evaluating both models simultaneously. This process allows researchers to specify relationships among all observed variables to latent variables in order to provide evidence of both convergent and discriminant validity of the hypothesized relationships (Campbell & Fiske, 1959). Then, if the convergent and discriminant validity estimates are acceptable, the test of the structural model is a confirmatory analysis of nomological validity (Cronbach & Meehl, 1955). In terms of sample size, SEM in general requires at least 15 cases per each measured indicator (in this case 15 Cases X 15 Measured Indicators = 225; Stevens, 2002). It was determined that the current study had an adequate sample size for conducting SEM analyses (N = 356). Because the chi-square statistic is sensitive to sample size, both the CFA and SEM models were evaluated the using the root mean square error of approximation (RMSEA), the comparative fit index (CFI), and the Tucker Lewis index (TLI). The RMSEA is a population-based statistic that estimates how well a model fits to the data in comparison with no model at all (Jöreskog, & Sörbom, 1993). The CFI and the TLI are sample-based statistics that compare hypothetical models to alternative models, such as null or independence models. RMSEA values <.10 indicate an adequate fit, and values >.10 indicate a poor fit (MacCallum, Browne, & Sugawara, 1996). Values greater than.90 for CFI and TLI indicate an adequate fit (Bentler & Bonnet, 1980; Hu & Bentler, 1999). Measurement Model To analyze the measurement model, maximum likelihood estimation with no missing data was utilized. The hypothesized model was tested for goodness of fit via a measurement model and structural model (Figures 3-1 and 3-2). In both of these 27

28 models, trait perfectionism as measured by the APS-R did not significantly load on any of the observed variables. Thus, the model was revised to exclude this variable, making perfectionistic self-presentation the sole predictor variable. Goodness of fit statistics indicated that the revised measurement model fit the data adequately, X 2 94(356) , p <.000, CFI.927, TLI.906, RMSEA.076, 90% CI [.066,.086]. All loadings of the observed variables on the latent variables,.161 to.930, were statistically significant, p <.05, suggesting that all observed indicators adequately measured their respective latent variables. See Figure 3-3 for the measurement model. Structural Models In order to initially assess the role of the mediator variable, the first structural model assessed direct paths between the predictor and outcome variables only (Figure 3-4) and was then compared to the second structural model which assessed indirect paths between these variables and the mediator variable (Figure 3-5). Goodness of fit and confidence interval statistics demonstrated that the first model did not fit the data adequately, X 2 32(356) , p <.001, CFI.834, TLI.766, RMSEA.094, 90% CI [.078,.111]. However, perfectionistic self-presentation negatively predicted both help-seeking attitudes (r = -.164, p <.05) and help-seeking intentions (r = -.240, p <.01). For the second model, goodness of fit and confidence interval statistics demonstrated that model fit the data adequately, X 2 95(356) , p <.001, CFI.917, TLI.895, RMSEA.080, 90% CI [.070,.090]. In this model, perfectionistic selfpresentation predicted self-compassion (r = -.572, p <.001), but no longer predicted help-seeking attitudes (r = -.059, p =.443) and help-seeking intentions (r = -.061, p = 28

29 .492). Self-compassion predicted help-seeking attitudes (r =.183, p <.05) and helpseeking intentions (r =.316, p <.01). According to the Baron and Kenny (1986) model of mediation, this finding suggests that self-compassion fully mediates the path between perfectionistic self-presentation and help-seeking attitudes and intentions. Bootstrapped Path Analysis In order to further explore this potential mediation effect, the model was then tested with bootstrapped estimates of standard error. Significance tests were conducted using bootstrapped estimates of standard errors for direct, indirect, and total effects; 1000 bootstrapped subsamples were selected. All calculations involved were based on standardized values. Direct effects The significant direct effects highlight the significant relationships in the model while controlling for the other relationships (i.e. the mediator) in the model. Hypothesis 1 was supported. Results indicated that perfectionistic self-presentation had a significant negative direct effect on both help-seeking attitudes and help-seeking intentions (Table 3-4). Additionally, hypothesis 2 was partially supported. Perfectionistic self-presentation had a significant negative direct effect on intentions to seek both formal (r = -.090, p <.01) and informal help (r = -.148, p <.01) and a significant positive effect on intentions to seek no help (r =.113, p <.01). Contrary to the hypothesis, perfectionistic selfpresentation had a significant negative direct effect on intentions to seek self-help (r = -.042, p <.05). Indirect effects Hypothesis 3 was supported. The test of the indirect effects (i.e., the meditational effects) revealed significant indirect effects. Specifically, self-compassion fully mediated 29

30 the formerly significant relationship between perfectionistic self-presentation and helpseeking attitudes and intentions (Table 3-4). Total effects The test of total effects highlight the significant relationships in the overall model, without controlling for other relationships within the model. Results indicated that perfectionistic self-presentation had a significant negative total effect on selfcompassion, help-seeking attitudes, and help-seeking intentions. Self-compassion had a significant positive total effect on help-seeking attitudes and intentions. See Table 3-4 for the selected statistics on all total effects. Additional Analyses An additional research question set forth in the present study pertained to how demographic variables correspond to help-seeking variables, or in other words, if helpseeking attitudes and intentions vary by demographic variable (e.g., by age or gender, for example). The demographic variables examined were race/ethnicity, SES, gender, and age. The dependent variables were the seven measures of help-seeking intentions and attitudes. Specifically, the IASMHS subscales (psychological openness, helpseeking propensity, and indifference to stigma) and GHSQ subscales (intentions to seek formal help, intentions to seek informal help, intentions to seek self-help, and no intentions to seek help) were the dependent variables. Including all help-seeking variables in one MANOVA was deemed justifiable based on both conceptualization and correlations between these measures (Table 3-2). The MANOVA using gender as the independent variable was significant, F(7, 348) = 2.520, p <.05, Wilks' Λ =.952, η 2 =.048). Follow-up ANOVAS revealed that men reported higher intentions to seek no help than women, F(1, 354) = 8.944, p >.01, η 2 = 30

31 .025; Conversely, women had higher intentions to seek informal help, F(1, 354) = 5.418, p >.05, η 2 =.020, as well as higher psychological openness, F (1, 354) = 4.415, p >.05, η 2 =.012, and indifference to stigma, F(1, 354) = 5.085, p >.05, η 2 =.014. The MANOVA conducted using SES as the independent variable was significant, F(35, 1445) = 1.471, p <.05, Wilks' Λ =.863, η 2 =.029). Nevertheless, follow up ANOVAs revealed no significant univariate findings which indicates the presence of overall group differences, yet no strong support for differences between the specific SES categories. The MANOVA using race/ethnicity as the independent variable was significant, F(35, 1499) = 1.471, p <.05, Wilks' Λ =.863, η 2 =.029). Follow-up ANOVAs revealed significant group differences for intentions to seek informal help, F(5, 350) = 2.807, p >.05, η 2 =.039, and intentions to seek formal help, F(5, 350) = 3.110, p >.01, η 2 =.043. Pairwise comparisons revealed that Black/African participants were significantly more likely to seek formal help (M = , SD = 5.203) than were White/European Americans (M = , SD = 6.155, p >.01), Latino(a)/Hispanic Americans (M = , SD = 6.115, p <.05), and Asian\Pacific Islander (M = , SD = 7.152, p <.05). Finally, to examine the relationship between age (a continuous variable) and each of the help-seeking variables, seven Bonferroni-corrected regression analyses were initially conducted. These analyses revealed that age significantly predicted intentions to seek no help, F(1, 353) = 7.630, R 2 =.021, p <.01, help-seeking propensity, F(1, 353) = , R 2 =.037, p <.001, and indifference to stigma. F(1, 353) = 9.426, R 2 =.026, p <.01. To further understand these findings, age was recoded into 31

32 the following categories (i.e , 25-34, 35-44, 45-54, 55-64, 65+) before conducting a MANOVA using this categorical variable as the independent variable and intentions to seek no help, help-seeking propensity, and indifference to stigma as the dependent variables. This MANOVA was significant, F(15, 958) = 2.182, p <.01, Wilks' Λ =.911, η 2 =.030. Follow-up ANOVAs showed significant differences for intentions to seek no help, F(5, 349) = 3.488, p >.01, η 2 =.048, and help-seeking propensity F(5, 349) = 3.022, p >.05, η 2 =.041, but did not reveal significant differences for indifference toward stigma. Pairwise comparisons for intentions to seek no help revealed that 25 to 34 year olds were significantly more likely not to seek help (M = 2.77, SD = 1.880) than were 35 to 44 year olds (M = 1.87, SD = 1.465, p <.01) and 55 to 64 year olds (M = 1.84, SD = 1.305, p <.05). No significant pairwise comparisons emerged for help-seeking propensity; again, this indicates the presence of overall group differences but no strong support for differences among the specific age categories for this variable. Exploratory Analyses Due to unexpected findings regarding the insignificance of the trait perfectionism measure (i.e., the APS-R) when used as a continuous variable in the examined models, researchers sought to further explore this variable and its associated measure. Specifically, based on the conceptualization that there are individuals who can be classified as maladaptive perfectionists, adaptive perfectionists and non-perfectionists, and using APS-R cutoff scores developed by Rice and Ashby (2007), participants were categorized in this manner, resulting in 35.6% categorized as maladaptive perfectionists, 29.3% categorized as adaptive perfectionists, and 35.1% categorized as non-perfectionists. These classifications were then examined in relation to the perfectionism variables that significantly predicted help-seeking in the study model (i.e. 32

33 perfectionistic self-presentation and self-compassion). Specifically, a Multivariate Analysis of Variance (MANOVA) was conducted, with the independent variable being perfectionist classification and the dependent variables being the nine measures of perfectionistic self-presentation and self-compassion. Specifically, the PSPS subscales (perfectionistic self-promotion, nondisplay of imperfections, and nondisclosure of imperfections) and SCS subscales (self-kindness, self-judgment, common humanity, isolation, mindfulness, and overidentification) were the dependent variables. Including all perfectionistic self-presentation and self-compassion subscales in one MANOVA was deemed justifiable based on both conceptualization and correlations between these measures (Table 3-2). This MANOVA was significant, F(18, 690) = 9.081, p <.001, Wilks' Λ =.654, η 2 =.192. Follow-up ANOVAs for all nine variables were significant. Specifically, there were significant group differences for self-kindness, F(2, 353) = , p >.001, η 2 =.177, self-judgment, F(2, 353) = , p >.001, η 2 =.228, common humanity, F(2, 353) = , p >.001, η 2 =.0.77), isolation, F(2, 353) = , p >.001, η 2 =.235, mindfulness, F(2, 353) = , p >.001, η 2 =.148, overidentification, F(2, 353) = , p >.001, η 2 =.225, perfectionistic self-promotion, F(2, 353) = , p >.001, η 2 =.094, nondisplay of imperfection, F(2, 353) = , p >.001, η 2 =.120, and nondisclosure of imperfection, F(2, 353) = , p >.001, η 2 =.073. Pairwise comparisons revealed that adaptive perfectionists reported higher levels of self-kindness (p <.001), common humanity p <.001), and mindfulness (p <.001) than maladaptive perfectionists. Similarly, adaptive perfectionists also reported higher levels of self-kindness (p <.001), common humanity (p <.01), and mindfulness (p < 33

34 .001) than did non-perfectionists. Additionally, adaptive perfectionists reported lower levels of self-judgement (p <.001), isolation (p <.001), and overidentification (p <.001) than maladaptive perfectionists. Again, adaptive perfectionists also reported lower levels of self-judgement (p <.01), isolation (p <.001), and overidentification (p <.001) than did non-perfectionists. Furthermore, non-perfectionists reported higher levels of self-kindness (p <.01) and lower levels of self-judgment (p <.001), isolation (p <.001), and overidentification (p <.001) than did maladaptive perfectionists. Common humanity and mindfulness did not significantly differ between non-perfectionists and maladaptive perfectionists. Pairwise comparisons further revealed that maladaptive perfectionists reported significantly higher nondisclosure of imperfections (p <.001), perfectionistic self-promotion (p <.001), and nondisplay of imperfections (p <.001) than did adaptive perfectionists. Adaptive perfectionists and non-perfectionists did not significantly differ on these measures. All means and standard deviations by perfectionistic category can be found in Table

35 Figure 3-1. Initial measurement model. 35

36 Figure 3-2. Initial structural model. 36

37 Figure 3-3. Revised measurement model. 37

38 Figure 3-4. Revised structural model, direct pathways. 38

39 Figure 3-5. Revised structural model, direct and indirect pathways. 39

40 Table 3-1. Descriptive Statistics for Study Variables Mean Std. Deviation Skewness Kurtosis APS-R Stand APS-R Disc PSPS Promotion PSPS Display PSPS Disclosure GHSQ Self-Help GHSQ No Help GHSQ Informal GHSQ Formal IASMH Open IASMH Propensity IASMH Stigma SCS Kindness SCS Judgment SCS Humanity SCS Isolation SCS Mindfulness SCS Over-identity Note. N = 356 for analyses. For all measures higher scores represent higher levels of the construct. APS-R Disc = Almost Perfect Scale Revised Discrepancy subscale; APS-R Stand = Almost Perfect Scale Revised High Standards subscale; PSPS Promotion = Perfectionistic Self- Presentation Scale Perfectionistic Self-Promotion; PSPS Display = Perfectionistic Self-Presentation Scale Non-Display of Imperfection; PSPS Disclosure = Perfectionistic Self-Presentation Scale Non-Disclosure of Imperfection; GHSQ Informal = General Help Seeking Questionnaire intentions of seeking informal help; GHSQ Formal = General Help Seeking Questionnaire intentions of seeking formal help; GHSQ Self-Help = General Help Seeking Questionnaire intentions of seeking self-help; GHSQ No Help = General Help Seeking Questionnaire intentions of seeking no help; IASMHS Open = Inventory of Attitudes toward Seeking Mental Health Services Psychological Openness; IASMHS Propensity = Inventory of Attitudes toward Seeking Mental Health Services Help-Seeking Propensity; IASMHS Stigma = Inventory of Attitudes toward Seeking Mental Health Services Indifference to Stigma; SCS Kindness = Self-Compassion Scale Self-Kindness; SCS Humanity = Self-Compassion Scale Common Humanity; SCS Mindful = Self-Compassion Scale Mindfulness; SCS Judgment = Self-Compassion Scale Self-Judgment; SCS Isolation = Self- Compassion Scale Isolation; SCS Over-identity = Self-Compassion Scale Overidentification 40